Neogeneses

Abstract

Mindfulness-based programs, practices, and therapies feature prominently in the toolkit of many mental-health professionals. Having a basic knowledge of such therapeutic modalities can be essential to the ethical and successful practice of any form of evidence-based psychotherapy. Mindfulness-based programs and therapies, which feature mindfulness practices either by definition or as integrated into the core of their philosophy, rarely pose any risk to clients or patients in most therapeutic settings. An awareness of populations of clients or patients who might suffer harm due to the therapeutic deployment of mindfulness-centric therapies, in any therapeutic space, is an essential knowledge which serves to avoid such adverse reactions in those populations. Mindfulness practices can generally act as an effective adjunct treatment for many less-severe mental health, behavioral, or interpersonal complaints, while therapeutic modalities like Mindfulness-Based Cognitive Therapy, Dialectical Behavioral Therapy, or Acceptance and Commitment Therapy, all prominently featuring components of mindfulness, can effectively treat a broad spectrum of more-severe mental health complaints. Mindfulness-based techniques prove to be of a clear, safe, and practical utility in and in proximity to various psychotherapeutic settings.

Keywords: Mental health, mindfulness, psychotherapy, therapeutic modalities, mindfulness-based therapy

Mindfulness in Psychotherapy: Pragmatic Applications

            Any practical and evidence-based therapeutic modality can be expected to be more useful than others as applied across inherently unique individuals. Individuals ranging from those who seek support for specific concerns of any severity to those who might evidence constellations of complaints or symptoms each require care and consideration in the assessment of personal circumstances, histories, and treatment options, et alia, during any stage of the provision of clinical support. Though this is clearly something which rationally and ethically occurs whenever any psychotherapeutic relationship is established and maintained, the process requires a thorough functional working knowledge of both the complaints an individual might report – and the treatments which might create best outcomes.

Aside from training in various schools, styles, or subtypes of various psychotherapies, any professional qualified to conduct psychotherapy is ideally able to quickly determine if mindfulness-based therapies would prove to be useful in a therapeutic capacity. The needs of a client/patient are dynamic and necessitate constant adaptation. The ability of a psychotherapist to adapt must be active and can be necessitated repeatedly within just a single session of psychotherapy.

When considering the serious and vital responsibility of mental health professionals, counselors, or psychotherapists, ethics must be observed. A key point of any ethical therapy is the ancient concept of “primum non nocere.” The principle of ‘first doing no harm’ thus includes the correct selections of any therapeutic modalities, adding an oath-sworn weight to this core precept of care. Particularly, this is true for eclectic therapies and when working with more complex cases, where sums of knowledge and experience could seemingly be at odds with one another when not deftly employed in the proverbial hands of a competent professional. For therapeutic modalities which hinge upon or leverage mindful practices, a basic knowledge of mindfulness-based practices and their applications becomes an immense asset.

Perhaps the most well-known and versatile therapy involving mindfulness is Mindfulness-Based Stress Reduction (MBSR). Mindfulness-Based Stress Reduction is a less intensive form of therapy that can be practiced at home over varying periods of time – often over a predesigned period eight weeks. It is arguable that Mindfulness-Based Stress Reduction isn’t always psychotherapeutic treatment when self-directed without any substantial psychotherapeutic oversight. Being a pathway to help almost any person become more present in their own experience of life, MBSR must only be recommended by mental health professionals when any serious mental health concerns are absent in a hypothetical client or patient. Mindfulness-Based Stress Reduction is especially effective in decreasing the symptoms of milder anxieties, depressions, and the stressors of modern lifestyles, and is safe to practice without professional oversight is such cases (Mindfulness Meditation, 2019).

When treating clients/patients in a therapeutic setting, some wider-ranging concerns can be extended to couples or families. They are of course worthy of broader consideration. Caretakers, spouses, and family members experiencing things like caretaker anxiety or old-fashioned existential dread are often fine candidates for MBSR.

Recommending only the self-guided flavors of MBSR to a severely depressed client/patient, conversely, could become a therapeutic mistake resulting in dire hypothetical consequences when severe concerns are otherwise left untreated. While a therapist’s knowledge and awareness regarding the recommendation of MBSR as a primary form of therapeutic treatment must be firm and astute, similar therapeutic modalities assuredly exist which can efficaciously treat the more severe forms of anxiety and depression. Therapeutic techniques which derive from (or directly involve) mindfulness-based practices are extremely prominent in western psychotherapy and can efficaciously treat far more than anxiety or depression, fortunately.

Adverse reactions and harms resulting from any appropriately applied therapeutic modality are exceedingly rare when therapeutic oversight is fully present. The same was thought to be true for therapies which rely upon or integrate mindfulness-based or meditative practices. A thorough study, which examined the potential for harm to occur in clients/patients who received mindfulness-based therapies like Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy (MBCT), concluded that while risks of adverse reactions or harm may exist, such risks are no more (or less) common than the risks presented by comparable therapies in comparable scenarios (Baer et al., 2019). While statistically rare, some of the study’s data suggested that most adverse reactions could be (or were) due to errors made by the counselors and therapists corresponding to the patients who were reported to have experienced adverse reactions per the study’s data sets. This evidence served to absolve these mindfulness-based practices from any statistical culpability, as psychotherapist error seemed to be the likeliest culprit. When any mental health professional integrates any therapeutic modality into their practice, clearly, being ethically sensitive and aware of a patient’s needs serves to optimize the chances of better outcomes while simultaneously mitigating risk – no matter the treatment involved.

Some of the more severe mental health concerns or diagnoses respond poorly to mindfulness-based therapies outright. Considering that mindfulness-based therapies have become popularized within the professional community in treating a panoply of concerns (either as an adjunct therapy or primary treatment modality), these practices are widely regarded as harmless. It almost stands to logic and common sense that therapeutic elements like meditation or intentional awareness can do little ill, though this is not always the case.

Adverse mental health events and adverse reactions have been linked to mindfulness-based therapies in very specific populations of clients and patients actively seeking and participating in psychotherapy. While some studies attempt to define so-called “meditation-related adverse effects,’ it is a concept that is truly difficult to define (Binda et al., 2022). The core theme of being aware of an individual patient’s needs can be likened to prescribing the correct medication for the correct malady: a medical doctor would not prescribe eye drops for the cornea of a patient who might clearly need some insulin for an obvious concern involving their endocrine system.

Sufferers of various psychoses of any etiology, for example, do not respond as well to mindfulness-centric therapies. Symptoms of hallucinations, delusions, or paranoia, characteristic of individuals who suffer from paranoid schizophrenia as much as drug induced psychoses, respond poorly to mindfulness-based treatments as primary treatment modalities. While less-severe forms of depression can respond well to mindfulness-based therapies, severe major depression (which can feature psychosis), as noted, does not. The manic and hypomanic symptoms within the broader spectrum of mood disorders do not respond well to the inclusion of mindfulness-based practices. An argument could easily be made that mindfulness-based therapeutic techniques could be useful in treating the milder depressions experienced by individuals with a diagnosis of cyclothymia, while any hypomania experienced would be less likely to respond to those same techniques.

Many such exceptions to the effective use of mindfulness-based therapies seem to involve treating disorders which feature so-called “positive symptoms.” Generally, positive symptoms are aspects or traits that are added to or amplified in individuals who suffer from a given condition, their symptoms often acting as diagnostic criteria. Hallucinations, delusions, panic, mania, and forced speech are but a few symptoms that are ‘added to’ an individual’s presented symptoms for the associated diagnosis. The positive symptoms of various schizophrenias, the psychoses of those with mood disorders, and the non-depressive symptoms of affective disorders (like manias, mixed states, or irrational anxieties), appear to follow a trend of responding poorly to mindfulness-oriented treatment modalities. This pattern can be easily noticed upon reviewing any number studies which speak to the efficacy of mindfulness-based treatments in comparison to the kinds of mental health concerns which benefit from non-mindfulness-based treatments. Medical and pharmaceutical interventions are of course vastly more favorable and ethical responses to such severe cases. Should symptomology be sufficiently tame – when a patient is in remission or otherwise asymptomatic from such severe complaints – mindfulness-based therapies are once again useful.

Regarding affective disorders, mindfulness can aid in the regulation of the thoughts and emotions of clients or patients in a depressive phase. The deliberate conscious awareness and the perspective granted by mindful practices can serve to decrease negative self-judgements, anxieties, and the milder symptoms of such depressions. These techniques can help such individuals cope with the reality they are experiencing by altering their intrapersonal connection to their own experiences (Farb et al., 2012). The negative thoughts, emotions, and moods suffered by clients or patients with affective disorders are not necessarily disorderly in essence – they’re simply amplified versions of normal moods and emotions. Sometimes even these severe symptoms do respond to talk-therapy without pharmaceutical interventions. Mindfulness’ utility remains, in these cases, at the discretion of a hopefully circumspect and ethical psychotherapist.

The more severe forms of anxiety, which seem to amplify the normal human emotions of worry, anxiety, nervousness, or unpleasant stress responses, often overextend from a place of normalcy into a place of distress, dysphoria, and disorder. Mindfulness-based therapies can notably treat milder anxieties in therapeutic settings. More severe anxieties, however, like acquired phobias that severely impact life (e.g., agoraphobia), traumas (Post-Traumatic Stress Disorder (PTSD) and it’s ‘Complex’ counterpart (CPTSD)), and Panic Disorder sometimes respond poorly to the kinds of meditation that are often included of mindfulness-based programs. Prematurely galvanizing those kinds of crippling thoughts and emotions through meditating (or ruminating, for that matter), in a therapeutic space, is clearly not advisable. It is of reasonable conjecture that dissociative states could be worsened, fugue states triggered, or symptoms of dissociative identity disorder (DID) intensified in patients who suffer from corresponding disorders when treated with or prescribed certain meditative practices. Due to a dearth of applicable peer-reviewed psychotherapeutic case studies, such conjecture must remain in the realm of theory for now.

Mindfulness practices are not just a theoretically useful adjunct treatment or an independent therapeutic modality: mindfulness is fundamentally embedded in many prominent forms of psychotherapy which are regularly used to treat some of the most severe primary complaints of clients/patients.

Mindfulness-Based Cognitive Therapy (MBCT), a newer therapy which evolved from Cognitive Behavioral Therapy (CBT), is sometimes used to treat various forms of depression deemed to be in remission. MBCT uses components of CBT and mindfulness to shift reactions, awareness, and the overall relationship a person has with their own emotions and thought processes to more healthful states. When working with clients and patients in this manner, associations which can cause automatic negative thinking are targeted. When triggered reactions or events occur (e.g., panic attacks, fugue states, flash backs, dissociation), a malaise often accompanies those maladaptive patterns of thought or emotion; MBCT is noted to be useful in treating social phobias and depression of any etiology in addition to counteracting these kinds of patterns of automatic negative thought.

MBCT is further noted to be useful in its ‘self-help’ variety, as “Mindfulness-Based Cognitive Therapy – Self-Help” (MBCT-SH) proves to be more cost effective than its “Cognitive Behavioral Therapy – Self-Help” (CBT-SH) counterpart in managing milder forms of depression (Strauss et al., 2023). Characteristic of mindfulness-centric therapies, improvements in the severity of anxiety often parallel improvements of depressive symptoms. Though Strauss’ study is noted to be limited by the total number of dropouts from the study’s sample, the findings clearly align with the consensus for one of mindfulness’s primary therapeutic utilities: treating depression and anxiety.

A primary therapeutic goal of positive social outcomes (e.g., improvements in interpersonal relationships) is a popular use of Dialectical Behavioral Therapy (DBT). DBT evolved from Cognitive Behavioral Therapy (CBT), uses acceptance-oriented strategies, and involves coping skills training which often come in the form of mindfulness-based techniques (Tolea, 2021). Prominently leveraging mindfulness-based therapeutic components, DBT can be efficacious in the treatment of borderline personality disorder (BPD), substance use disorders, chronic forms of depression, attention deficit hyperactivity disorder (ADHD), and Alzheimer Disease and related disorders (ADRD) (Tolea, 2021). DBT can help to decrease symptoms of depression, anxiety, emotional outbursts, dissociation, and other maladaptive reactions. For BPD, this is especially saliant. BPD, currently defined or recognized as a Cluster B personality disorder, is notoriously difficult to treat. It is also one of the few personality disorders, especially true of Cluster B, which responds to any form of psychotherapy. Positive social outcomes are often a secondary improvement for clients/patients who receive DBT for any chief complaint – even when social outcomes are not the primary therapeutic goal. This ‘side effect’ is assumed to be due to overall quality-of-life improvements in a more general sense, since fewer problems create less friction within the greater motions of a person living their life.

Mindfulness, as a key component or adjunct treatment, can often serve to create acceptance and healthier coping in clients or patients receiving any associated treatment. Acceptance and Commitment Therapy (ACT), another philosophical/therapeutic cousin of CBT, focuses more on the acceptance of negative thoughts when seeking a negation to those maladaptive reactions to stress (Hofmann & Asmundson, 2008). ACT encourages the individual to grapple with negative thoughts, emotions, or reactions more directly – instead of avoiding those kinds of cognitions. Mindfulness helps to facilitate the calmness, awareness, and strength a person might need while learning to cope with the kinds of cognitions that are often a root of their chief complaints.

It becomes clear that mindfulness can have many applications, uses, and sees integration into many therapies which inevitably appear within psychotherapeutic sessions. A meta-analysis showed that for any of the disorders which are widely regarded as being highly responsive to mindfulness-based therapies, those therapies were roughly as effective as comparable non-mindfulness-based therapies when treating those disorders (Khoury et al., 2013).

Therapists are of course often the practitioners of the very techniques extolled in their therapeutic settings. Therapists must healthfully cope with their patients to maintain healthy therapeutic relationships; doing so serves to help other people heal and ideally produce the best kinds of outcomes. As a result, mental health students, professionals, and many academic and professional peers can strongly benefit from mindfulness programs and are encouraged to learn about or participate in such programs whenever appropriate (Shapiro et al., 2007). The concept of creating a healthier therapeutic setting and conducting successful psychotherapy sessions is inherently implied via the benefits that mindfulness can provide. Even when not directly acting as a component of any given form of psychotherapy, the effects are at least tertiarily palpable due to philosophical proximity or deontological association. Mindfulness has become a common knowledge.

When choosing any of several therapies or techniques which might serve to heal another person within a clinical space, viable therapeutic modalities are numerous. It remains important for any mental health professional to know when to recommend or apply a therapeutic technique within any given therapeutic setting – usually in the name of efficacy, sometimes in the name of harm reduction. Safe and effective when applied appropriately, mindfulness lends its hand to many common mental health concerns while simultaneously maintaining the mental wellbeing of the practitioners who must be able to select and deploy any associated therapies or techniques either dynamically, in-session, or while changing course over larger periods of time in the pursuit of progress for patient outcomes. While mindfulness-based and mindfulness-influenced therapies are not a panacea outright, they are of great psychotherapeutic value. The way in which mindfulness’ ancient roots have formed a core of modern therapeutic paradigms is abundant and clear. Remaining prominent, these evidence-based therapeutic modalities regularly act to assuage the existential qualms of the human condition – just as mindful practices alone often do – independent of era, time, or setting.

References

Baer, R., Crane, C., Miller, E., & Kuyken, W. (2019). Doing no harm in mindfulness-based programs: Conceptual issues and empirical findings. Clinical Psychology Review, 71, 101–114. https://doi.org/10.1016/j.cpr.2019.01.001

Binda, D. D., Greco, C. M., & Morone, N. E. (2022). What Are Adverse Events in Mindfulness Meditation? Global Advances in Health and Medicine, 11, 2164957X221096640. https://doi.org/10.1177/2164957X221096640

Farb, N. A. S., Anderson, A. K., & Segal, Z. V. (2012). The Mindful Brain and Emotion Regulation in Mood Disorders. The Canadian Journal of Psychiatry, 57(2), 70–77. https://doi.org/10.1177/070674371205700203

Hofmann, S. G., & Asmundson, G. J. G. (2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28(1), 1–16. https://doi.org/10.1016/j.cpr.2007.09.003

Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleau, M.-A., Paquin, K., & Hofmann, S. G. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763–771. https://doi.org/10.1016/j.cpr.2013.05.005

Mindfulness meditation: A research-proven way to reduce stress. (2019, October 30). https://Www.Apa.Org. https://www.apa.org/topics/mindfulness/meditation

Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training. Training and Education in Professional Psychology, 1(2), 105–115. https://doi.org/10.1037/1931-3918.1.2.105

Strauss, C., Bibby-Jones, A.-M., Jones, F., Byford, S., Heslin, M., Parry, G., Barkham, M., Lea, L., Crane, R., de Visser, R., Arbon, A., Rosten, C., & Cavanagh, K. (2023). Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported Cognitive Behavioral Therapy Self-help for Adults Experiencing Depression: The Low-Intensity Guided Help Through Mindfulness (LIGHTMind) Randomized Clinical Trial. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2023.0222

Tolea, M. (2021, November 19). The Effect of Mindfulness on Outcomes in Psychiatric Patients. Psychiatric Times. https://www.psychiatrictimes.com/view/the-effect-of-mindfulness-on-outcomes-in-psychiatric-patients