Mindfulness practices have been rigorously studied for decades and practiced for millennia. The concept was largely unknown in the West until Jon Kabat-Zinn, Ph.D., developed mindfulness-based stress reduction (MBSR) for chronically ill patients at Massachusetts General Hospital in 1979. The eventual integration of mindfulness into mainstream medicine and psychology signaled a radical shift in thinking about stress and disease.
Today, mindfulness is used in hospitals worldwide, and most medical schools offer some kind of mindfulness training. Mindfulness meditation has also found a home in psychology. Combined with cognitive behavioral therapy (MBCT), it helps clients understand and interrupt the thought patterns that trigger anxiety and depression.
Many therapists may also find practicing mindfulness to be a helpful antidote for their own stress, sometimes even improving therapeutic outcomes in their practice. When a therapist has cultivated mindful awareness, clients often appear more relaxed and are better able to connect with their own process of healing. As Christopher Willard, PsyD, a psychologist and mindfulness expert at Harvard Medical School, puts it, “clients with mindful therapists get better faster.”
Kabat-Zinn defines mindfulness as “paying attention in the present moment, on purpose, without judgment.” Willard says it’s “attention in the here and now. Acceptance without judgment.”
The ability to occupy the present fully — without anxiety about the future or ruminations about the past can be a foundation for health and resilience.
There are dozens of ways therapists can incorporate mindfulness into their practice. It might be as simple as having clients breathe or perform visualization or sound exercises at the start of the session to help them relax and become more present. It can involve work on emotion regulation or self-regulation of attention. This helps people see their thoughts as thoughts, rather than get caught in them as reality.
“By watching thoughts without being drawn into them, you can learn something profoundly liberating about thinking itself, which may help you be less of a prisoner of those thought patterns—often so strong in us—which are narrow, inaccurate, self-involved, and also just plain wrong,” Kabat-Zinn writes.
For example, a client might believe ‘I’m not good enough,’ ‘I’m going to lose my job,’ or ‘I’m going to get sick,’ without evidence. When they understand that these thoughts aren’t true and they don’t have to buy into them, they more easily move from a fixed mindset to one of growth.
Depending on the client and therapeutic approach, it’s possible to go in many directions from there. Below are three of the most common examples of mindfulness in action.
Kabat-Zinn says the breath acts like an anchor “to tether attention to the present moment.” The mind inevitably will drift, but the breath brings people back to the present.
Willard goes further: “Regulating the breath regulates the body, which regulates the brain, impulses, and emotions.” Aim for five or sixth breath cycles in a minute, with an extended outbreath. A shorter inhale and longer exhale can get people down from fight-or-flight to the window of tolerance.
There’s some debate about how proscriptive breathing practices should be. Counting breaths may initially help some, but the point is to simply breathe. Kabat-Zinn writes that for breathing to nurture mindfulness, you only need to “tune into the feeling of the breath coming into the body and the feeling of the breath leaving the body.”
For therapists, Willard also advises doing mindfulness practices, like breathing, between clients. “Regulate your breath,” he says. “Clients want us to be more empathetic. And we are if we practice mindfulness. Being more empathetic and happier with less stress extends outside our practice to the people we live with and beyond.”
Willard recommends visualization or sound exercises to help ground anxious clients. Different clients will find different visualizations useful, and it’s important to figure out what’s best for each person.
If visualizations are disorienting, sound exercises are a good alternative. Willard adds that sound exercise should start with a focus on the “farthest away sound someone can hear,” then gradually move to sounds that are increasingly close.
Sensations in the body turn into emotions, which turn into thoughts and then actions. Mindfulness can help clients unravel these chains of behavior and develop healthier ways to respond to stress.
For example, during a dysregulated stress response, blood flows out of the prefrontal cortex to the amygdala, triggering fight-or-flight. At the same time, cortisol floods the system, swamping oxytocin receptors, raising the heart rate, and hijacking breathing. When there’s a degree of mindfulness in the brain and body, breathing becomes regular, the heart rate slows down, and muscles relax. Oxytocin, the mediator of well-being and social interaction, is more available, making people feel safer and more connected.
Mindfulness can help accomplish the major shift from fight-or-flight to attend-and-befriend. It offers a simple but powerful way to change the direction and quality of a person’s life and heal relationships outside the therapeutic setting.
There have been hundreds of other studies documenting the benefits of mindfulness, both in and out of therapeutic settings. Some have focused on lifelong meditators. For 14 years, researchers at the Center for Healthy Minds at the University of Wisconsin-Madison mapped the brain of a well-known Tibetan monk, Yongey Mingyur Rinpoche (YMR). He started meditating at age nine, and as might be expected, regulatory parts of his brain matured early. Throughout the study, his brain remained nearly a decade younger and healthier than his chronological age. YMR also overcame severe childhood panic attacks with a mindful acceptance approach to emotional regulation—a technique he now teaches.
Sara Lazar, Ph.D, Associate Researcher in Psychiatry at Massachusetts General Hospital and an Assistant Professor in Psychology at Harvard Medical School, has also used neuroimaging to demonstrate how meditation changes brain structure. In her studies, mindfulness consistently caused an increase in gray matter in the hippocampus, the seat of learning and memory, and a decrease in gray matter in the amygdala. It also strengthened the bond between neural regions associated with sensory awareness and perception.
Jon Kabat-Zinn: “Wherever You Go There You Are: Mindfulness Meditation in Everyday Life.”
April 6, 2021, webinar, Mindfulness for Therapists in the Age of Anxiety with Christopher Willard, PsyD.
Psychiatry Research: “Mindfulness practice leads to increases in regional brain grey matter density.”
Psychiatric Clinics of North America: “Mindfulness-Based Interventions for Anxiety and Depression.”
International Journal of Cognitive Therapy: “A Brief Mindfulness-Based Cognitive Therapy (MBCT) Intervention as a Population-Level Strategy for Anxiety and Depression."
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