Mindful Psychotherapy

Having begun treatment, they soon discover (if they didn?t know already) that they are thinking and acting in ways that trigger, sustain or escalate their negative moods and emotions. (This is in addition to whatever the rest of the world is doing to cause their troubles; see box below.)

But before they can tackle these issues efficiently, there are two fundamental skills that therapy clients need to cultivate:

1. How to concentrate their attention and efforts on things that are within their control, and shrug off things that are not. This may seem like simple common sense ? and of course it is. But most of us are not nearly as good at it as we could be or need to be. Usually the reason we are not good at it is that our moods and emotions interfere with following such a sensible policy. As a result, clients need to learn something else first, and it is this:

2. How to weaken the hold of disruptive moods and emotions over their thoughts and actions. Until this is done, their moods and emotions will affect their thinking and behavior in ways that prolong their suffering or even make it worse.

So, while we will also be doing other things in your therapy, please start planning right now to develop these two essential skills. They will be crucial to your success.

You may ask, "How can I free myself from moods and emotions that mess up my thinking and keep me from acting the way I'd like to If that were so easy, I wouldn't be in therapy."
Good point; so here is at least the beginning of an answer: The key to putting emotions and moods in their proper place is learning how to accept and tolerate them, even when they are quite unpleasant, until they go away by themselves - which they will always do if given a chance. And the key to making that happen as soon as possible is managing your attention - or as it is sometimes called, being 'mindful.'

Here's how it works

When we are feeling upset, we are likely to focus narrowly on our distress, perhaps also telling ourselves that we can't stand to feel like this another minute. We are carried away by the experience or we are paralyzed by it; we may fight it or we may look for ways to escape from it.

At other times, instead of being focused directly on the emotion, our attention may stray to thoughts of other places (real or imaginary) and other times (the past, or the future as we imagine it) that are associated with it. We stew about experiences that might have gotten us into our current predicament, or guess at what fate awaits us if we don't get out of it, or perhaps think about how nice things once were or will be if we can ever escape from it.

The trouble is, by thus reacting blindly ('unmindfully') to the mood or emotion - by automatically making a big deal of it and elaborating on it - we are strengthening its hold on us. Therefore, to weaken its grip we need to partly disengage from it - though not by denying its reality or escaping from it.

In practice, this means re-focusing on something that is going on right here and right now - but this time without all the usual elaboration of the emotion

Gone with the wind?

The mood or emotion will in time lose its strength or even disappear all by itself. And if we do this repeatedly, it will recur less often and less intensely,

The idea is to keep our attention as much as possible on whatever we are aware of in the present moment, without judging it or interpreting it or trying to run away from it - in fact, without reacting to it in any way except to simply note that it is going on. (This is basically what is meant by being 'mindful.')

Using the diagram above as a guide, you learn to put your attention 'into the box' and not on the reactions, thoughts or images outside of it.

By 'staying in the box' - by being mindful and trying to accept your experience just as it is at the moment - you will learn that even an unpleasant mood or emotion can be tolerated long enough for its intensity to fade spontaneously. More important still, it will bit by bit lose its power over your thoughts and behavior. You will be gaining ground against the conditioned reactions that have been making you unhappy and keeping you that way.

Then, having altered your negative emotion or mood in the direction of just another thing that is going on at the moment, you will be in a better position to identify and change any ways of thinking or acting that have been triggering or maintaining your distress.

Some interesting facts

1. This is very similar to the effects of certain widely-prescribed medications - except that you will have achieved it through the cultivation of valuable skills that will be yours for life, and do not have to be repeatedly prescribed by a physician and purchased from a drugstore. It is therefore likely that your recovery will be more durable and consistent than it would be if you just relied on drugs.
2. By focusing your attention 'in the box' - that is, in the here-and-now - you are automatically keeping it away from things that are outside your personal control. Remember, there is nothing you can do to change the past, and the future isn't here yet. The only time you can make a difference is right now, and the only place from which you can make it is right here.
3. Mindfulness is not some brand-new discovery, straight from the psychology lab. It is a re-discovery of one of the key teachings of Siddhartha Gautama, better known as Buddha, who lived 2,500 years ago. Yet despite its ancient lineage, it is strikingly consistent with what has been found in 20th-century research on Pavlovian conditioning and behavior therapy.

First steps

Early in your therapy, you will be taught a number of ways to manage your attention. They have helped a great many people, and are designed to break the stranglehold of past conditioning on your emotions and moods. Please make a special point of practicing these attention-management exercises several times a day until they have become second nature and you find yourself doing them automatically whenever the need arises.

The strategic difference

If you are familiar with other kinds of psychotherapy - including other cognitive-behavioral approaches - you may have noticed how they differ from the strategy described here.

Many non-behavioral therapies urge you to talk about and try to explain your undesirable moods and feelings at great length, in the belief that elaborating them in this fashion will somehow change them. And it does - often by making them worse. At best, these 'aboutish' therapies are very inefficient at securing the kinds of changes you actually want. Perhaps now you can see why.

Other non-behavioral approaches, the so-call expressive therapies, urge clients to 'get in touch with' their feelings and 'vent' them as forcefully and dramatically as possible. This is another kind of elaboration, and it does sometimes produce relief - usually short-lived. (Done outside the therapy office, it can also get you in trouble.)

Meanwhile, certain other forms of cognitive behavior therapy (CBT) also contain inherent inefficiencies. The problem here is that they put too much emphasis on correcting cognitive errors - i.e., ways of thinking that lead to negative moods and emotions. Their central strategy of 'cognitive reconstruction,' while usually essential at some point in treatment, tends to be applied prematurely. Such approaches overlook the power of emotion to undermine the effects of cognitive change unless it is first brought down a few notches by other means.

The central dilemma, and its solution

Especially early in therapy, we have almost no ability to keep negative emotions from arising in the first place, and have only limited ability to change them by the most obvious means once they are under way. Cognitive reappraisal can help, but it often leads to this classic dilemma: "Doctor, I know intellectually that it's senseless to feel the way I do, but my feelings aren't listening to my intellect."

But this isn't where it has to end. The key insight is this: Irrational and counterproductive thinking, at least in my own judgment, is more likely to sustain or amplify moods and emotions than to be the thing that initiates them. This means that we can (and usually must) begin by working on moods and emotions that are already underway - lowering the volume on them, so to speak, through mindfulness training.

Somewhat in the way antibiotics work by lowering a patient's bacteria count so his immune system can finish the job, reducing emotional intensity with mindfulness has the effect of turning emotion-laden situations into manageable events - which can then be dealt with by clear thinking and well-chosen actions in the ordinary way.

The discovery that attention management - the cultivation of mindfulness - can achieve this mission-critical goal gives the approach outlined here a strategic advantage we are not likely to find elsewhere.

Additional material:

Description of mindfulness in practice by the director of the University of Massachusetts Medical Center's Stress Reduction Clinic.

New York Times op-ed article on the need for mindfulness by Tenzin Gyatso, the 14th Dalai Lama.

New York Times article on how mindfulness meditation affects brain functioning.

Wall Street Journal article by Sharon Begley on the same topic.

©1997-2006 John Winston Bush - All rights reserved.