Motivation and emotion/Book/2011/Mindfulness

Mindfulness:
How effective is mindfulness in managing emotions

Multimedia presentation (5 min)

Overview

At some point in your life, you probably will, or already have, sought to alleviate some sort of emotional suffering. Psychological suffering can come in many different guises, such as: stress, anxiety, depression, interpersonal conflict, confusion and despair (Germer, 2004). Some of our suffering is existential in nature, such as distress regarding sickness, death and purpose of life. Other types of suffering may come from more personal sources, such as past experience, current circumstances, genetic predisposition or an interaction of many different factors (Germer, 2004). Mindfulness is a deceptively simple practice that has long been used to reduce the experience of suffering that we all encounter. Being mindful is not simply an activity that, upon deciding to practise it, one is immediately able to live in the present moment and experience the positive rewards that mindfulness can produce. Rather, it is experienced through daily practice, both formally and informally and develops over time (Kabat-Zinn, 2003). This chapter will illustrate the potential of mindfulness to manage difficult emotions.

The Numbers

Psychological disorder prevalence

We all know that psychological disorders exist in our society. So what are the real facts and figures regarding what is going on around us?

According to the World Health Organisation (2003), about 450 million people currently suffer from a mental or behavioural disorder. In any given year, approximately 30% of the adult population will suffer from a recognised psychiatric disorder and approximately half of all Americans will suffer from a DSM-IV classified psychiatric disorder at some point in their lives (Kessler, Chiu, Demler & Walters, 2005; Kessler, Berglund, et al., 2005). The World Health Organisation also reports that depression is the fourth largest, most financially burdensome and most debilitating disorder in the world and by the year 2020 it will move up to second on this list (WHO, 2010). In any given week, one in ten adults will be suffering from clinical depression and 55 percent of the entire population will be diagnosed with clinical depression at some point during their lives (Davies, 1997). Moreover, almost one third of the population will be diagnosed with an anxiety disorder during their lifespan with a median age of onset of 11 years old (Kessler, Berglund, et al., 2005).

Furthermore, of greater concern is the finding that approximately one in two people will consider suicide at some point during their lives and, even more concerning is the fact that one in ten people will actually attempt to kill themselves (Harris, 2006). It is also important to consider normative life events that are not considered ‘clinical disorders’ as such, but cause suffering just the same. These could include grief, loneliness, low self-esteem, alienation or distress related to racism, bullying, domestic violence and divorce (Harris, 2006).

In pursuit of happiness

In the western world conditions of living are higher than they have ever been (Harris, 2007).

There have been significant advances in medical treatment and accessibility to such treatment (Harris, 2007). Food, housing, education and sanitation are considerably better, and improvements in justice, ability to travel and access to career opportunities, have all increased standards of living (Harris, 2007).

So why is it that in this day and age, where standards of living far exceed those experienced before, psychological health remains as much of an issue as ever?

It seems that one answer may lie in the many myths and assumptions about happiness that our society take to be true.

Myths and assumptions about happiness

According to Harris (2006), Western psychology is founded on several ill-founded myths and assumptions:

Happiness is a natural state for all human beings:
One such assumption is that humans are innately psychologically healthy beings (Harris, 2006). It is argued that given the right environment, lifestyle and social settings, all humans will be naturally happy and content.
If you are not happy, you are defective:
In accepting myth number one, societies' logical conclusion would be that psychological suffering is abnormal. We then challenge or criticise ourselves for feeling emotions such as anxiety or despair, as if these feelings are a sign of weakness (Harris, 2006 & 2007). However, given the prevalence of psychological disorders in our society, it is clear that mental health issues are far from being against the norm.
We must rid our lives of negative feelings in order to succeed:
Western society places great emphasis on pursuing happiness and as such, society tells us that in order to create a better life, we must avoid or ‘push away’ negative thoughts and focus on positive ones instead (Harris, 2007). On face value, this seems to be merely common sense. However, in every meaningful interaction we have in life, such as relationships or career moves, we encounter a range of both positive and negative emotions, such as joy, excitement and inspiration, but also stress, anxiety and trepidation (Harris, 2007). So if an emphasis is placed on accumulating positive feelings only, clearly those difficult feelings that inevitably accompany the positive ones can cause distress. In order to succeed in making a better life, we must be prepared to have uncomfortable feelings.
We should be able to control our feelings and thoughts:
Unfortunately, we are not able to control our thoughts as much as we would like (Harris, 2007). This is not to say that we have no control, merely that we have less control than western society would have us believe (Harris, 2007). When reviewing the prevalence of psychological disorders, it can be seen that the many attempts to tell us that we can change the way we feel by changing our thoughts, clearly does not work for everyone, all the time.

So why mindfulness?

Kabat-Zinn (2003, p. 148) suggests that we live in a society that continually devalues the present moment in favour of “perceptual distraction, self-absorption, and addiction to a feeling of “progress”". It seems that, rather than trying to avoid all negative thoughts in a constant striving for happiness, a conceptual change needs to occur whereby a greater acceptance of negative or difficult emotions and a reduction of the struggle for happiness takes place. The practice of mindfulness is a way of achieving this.

What is mindfulness?

Mindfulness has been described as “consciously bringing awareness to your here-and-now experience with openness, interest and receptiveness” (Harris, 2006, p.2). It has also been defined as “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, 2003, p. 145).

However, Harris (2006) contends that, regardless of the definition, mindfulness as a concept has three important facets. These include: living in the present moment, engaging fully in what you are doing rather than ‘getting lost’ in your thoughts, and allowing your feelings to be as they are, letting them come and go rather than trying to control them (Harris, 2006). It is suggested that in the process of observing our inner experiences with openness and interest, we are able to deal with feelings and emotions that we find distressing and they then become less threatening to us (Harris, 2006).

It is a given that if we teach ourselves to be less distressed by difficult experiences in our lives, suffering will decrease. However, this is easier said than done. The body and mind instinctively react to painful experiences, and life often includes pain. Mindfulness provides a way of becoming less reactive in those moments (Germer, 2004). However, being mindful is not simply an activity that, upon deciding to practice it, one can immediately be able to live in the present moment and experience the positive rewards that mindfulness can produce. Rather, it is experienced through daily practice, both formally and informally and develops over time (Kabat-Zinn, 2003). Using mindfulness techniques offer a way of relating to all experiences, positive, negative and neutral, so that suffering is reduced and one’s sense of well-being increases (Germer, 2004).

“…[mindfulness] is an invitation to allow oneself to be where one already is and to know the inner and outer landscape

of the direct experience in each moment."

– Jon Kabat-Zinn, 2003, p. 148

Mindlessness

To be mindful is to be aware of the here-and-now and to recognise what is occurring in the present moment (Germer, 2004). However, naturally, we are rarely mindful. As humans, we easily get distracted and absorbed in thoughts about what is occurring at the time. This occurrence is referred to as mindlessness (Germer, 2004; Hollis-Walker & Colosimo, 2011). Mindlessness occurs in everyday life. Examples of mindlessness include:

Moving through tasks too quickly without giving an appropriate amount of attention to them.
Getting entangled in thoughts about the past or the future.
Accidentally spilling or breaking things due to inattentiveness.
Being on ‘autopilot’ while driving and then going in the wrong direction.
Snacking on food without being aware of eating.

History of mindfulness

The practice of mindfulness stems back to ancient times where its practice was considered an essential part of spiritual living (Kabat-Zinn, 2003; Keng, Smoski & Robins, 2011). It has been through Buddhism, however, that its legacy has been best preserved and articulated over the past 2500 years (Germer, 2004; Kabat-Zinn, 2003). Although mindfulness has its roots in eastern traditions and is often associated with the formal practice of mindfulness meditation, it is, however, more than just meditation (Shapiro, Carlson, Astin & Freedman, 2003). Meditation simply provides the structure to practice and develop mindfulness skills (Shapiro et al., 2006).

The beginnings of mindfulness in Western psychology can be traced back to the Zen Buddhism movement in America during the 1950s and 1960s. It was during the 1960s that interest in using meditation techniques as part of psychotherapy, especially psychoanalysis, began to grow (Keng et al., 2011). Psychological research into heightening awareness and broadening the boundaries of consciousness using techniques such mediation began during the 1960s and 1970s. However, it was not until the late 1970s that a focus on using mindfulness meditation as an intervention to improve psychological well-being began (Keng et al., 2011).

Mindfulness has continued to develop in Western psychology and is now used through several different clinical treatment interventions. Mindfulness-Based Stress Relief was initially developed by Jon Kabat-Zinn during the late 1970s. Kabat-Zinn began using mindfulness meditation as a way of treating individuals with chronic pain (Germer, 2004; Kabat-Zinn, 2003; Keng et al., 2011). However, several other clinical interventions use mindfulness-related principles and practices to treat individuals who are experiencing psychological distress. These include: Mindfulness-Based Cognitive Therapy, Dialectical Behaviour Therapy and Acceptance and Commitment Therapy (Baer, 2003; Carmody & Baer, 2008; Keng et al., 2011).

The benefits of mindfulness

Research has shown that mindfulness is associated with psychological well-being (Baer, 2003; Grossman, Niemann, Schmidt & Walach, 2004; Keng et al., 2011). It has been argued that awareness and non-judgmental acceptance of the here-and-now experience are helpful in reducing psychological distress, such as feelings of anxiety, stress, despair and fear (Keng et al., 2011). Many of these forms of distress can manifest themselves within the individual to form maladaptive tendencies to avoid, suppress or over-engage with these difficult emotions (Keng et al., 2011).

Meta-analytic studies have shown that mindfulness-based therapies can be beneficial for individuals experiencing psychological disorders such as anxiety, depression and borderline personality disorder (Grossman et al., 2004; Hofmann, Sawyer, Witt & Oh, 2010; Keng et al., 2011). It is argued that mindfulness skills enhance the ability to cope, not only with distress and disability in everyday life, but also during episodes of intense stress or serious disorder (Grossman et al., 2004; Hoffman et al., 2010).

Self-Determination Theory- The Three Needs

Furthermore, research indicates that self-reported mindfulness and psychological health are correlated (Keng et al., 2011). These correlations have been shown in a number of different sample populations, including undergraduate students, adults in the community as well as individuals who are suffering from mental health disorders (Keng et al., 2011). Questionnaires have been developed in order to attempt to measure mindfulness as a trait-type attribute. Interestingly, trait mindfulness has been shown to be correlated with many factors that would appear to be important for psychological well-being. Correlations have been found with higher levels of satisfaction, self-compassion, self-esteem, empathy, optimism, competence and sense of autonomy (Brown & Ryan, 2003; Hollis-Walker & Colisimo, 2011; Keng et al., 2011).

According to self-determination theory, three fundamental innate psychological needs are required to be satisfied in order to ensure psychological well-being (Ryan & Deci, 2000). The needs of autonomy, competence and relatedness form the basis of psychological health (Ryan & Deci, 2000). It is of interest then, that individuals who scored more highly on trait mindfulness were also correlated with higher levels of competence and a sense of autonomy (Brown & Ryan, 2003). This, in accordance with self-determination theory, indicates that developing mindfulness abilities can increase psychological well-being. Self-determination theory also posits that open awareness is particularly important in helping the individual to make choices that are in alignment with their needs, values and interest (Ryan, Huta & Deci, 2008). This is also of interest given that from the earliest mindfulness teachings, opening awareness has been a fundamental factor in achieving well-being (Kabat-Zinn, 2003). Hollis-Walker and Colosimo (2011) suggest that their findings indicate that individuals who scored higher on the mindfulness scale are more capable of identifying, managing and resolving problems that occur in day-to-day living and that this encourages psychological well-being.

More recent research has sought to study the mindful brain (Hölzel et al., 2011; Taylor et al., 2011). Taylor et al. (2011) investigated the neural responses of individuals who practice mindfulness to emotional stimuli and compared results between experienced and beginner practitioners. Their results indicated that extensive mindfulness practice fosters emotional stability and modulates a number of regions in the brain that are involved in the neural responses to emotional experiences.

To confirm what mindfulness theory has long purported, the results of the study by Taylor et al. (2011) indicate that long term mindfulness practice induces brain activity patterns that are associated with acceptance of emotional stimuli and lower levels of interference from internal states (Taylor et al., 2011). The authors argue that this possibly points to better awareness of the here-and-now. Conversely, their results also indicate that less experienced mindfulness practitioners show brain activity that relates to voluntary regulation of emotion, which infers less acceptance of emotional states, and lower levels of emotional stability (Taylor et al., 2011).

However, due to the introspective nature of mindfulness, there has been a large reliance on self-report measures (Keng et al., 2011). Keng et al., 2011 question whether the construct of mindfulness is actually measurable by factual knowledge. The authors query how closely self-reports of mindfulness actually reflect the experiences of everyday life. Further research using multiple methods of assessment is required (Keng et al., 2011).

The mechanisms of mindfulness

At this point you may be asking: so how does mindfulness actually work? Although mindfulness is a mostly introspective construct, several mechanisms of action underlying mindfulness have been suggested in order to explain this (Baer, 2003; Keng et al., 2011; Shapiro et al., 2006). According to Shapiro et al. (2006) mindfulness occurs when ‘intention’, ‘attention’ and ‘attitude’ are simultaneously in alignment. Firstly, intention refers to the individual’s purpose for studying and pursuing mindfulness. This may be for self-regulation, self-exploration or self-liberation and may change over time (Shapiro et al., 2006). The authors suggest that intention is a critical element of mindfulness and serves to understand the process as a whole. Secondly, attention refers to the observation of the internal and external experiences present in the moment (Shapiro et al., 2006). It is argued that when an individual does not attempt to analyse these experiences they can learn to observe the free flowing content of their consciousness (Shapiro et al., 2006). Finally, attitude refers to how an individual attends to the moment-to-moment experience. Through mindfulness practice an individual is better able to reduce the continual striving for merely positive experience and avoidance of aversive feelings. This can be achieved through intentionally bringing attitudes of compassion, patience and non-striving to mindfulness practice (Shapiro et al., 2006).

A process known as reperceiving occurs when all three elements take place simultaneously. This results in a shift in perspective (Shapiro et al., 2006). The authors suggest that this is fundamental to the changes that occur with mindfulness practice and thereby facilitates other mechanisms such as self-regulation, values clarification and exposure.

In this context reperceiving is the process whereby an individual is able to de-identify from the thoughts and feelings of the consciousness and can therefore view each present moment experience with more clarity and objectivity (Shapiro et al., 2006). Rather than being caught up in life drama, the individual is able to observe the experiences as a bystander or witness. Through this process of intentionally attending to the contents of the consciousness, it is thought that the individual can begin to fortify the ability to observe the self. Reperceiving allows the individual who is experiencing psychological suffering, be it from problems such as anxiety, depression, or fear, to de-identify from these thoughts and emotions instead of being defined by them (Shapiro et al., 2006).

Further specific mechanisms have also been suggested to describe how mindfulness promotes psychological well-being:

Self-management

Mindfulness provides the skills to be able to self-regulate emotion in ways that encourage psychological well-being. It is thought that reperceiving disrupts automatic thoughts and emotions that lead to maladaptive habits by changing the level of reactivity to these experiences (Baer, 2003; Shapiro et al., 2006). For example, when an individual experiences anxiety and strongly identifies with it, they are more likely to react in unhelpful ways and attempt to regulate these feelings with behaviour such as drinking, smoking or overeating (Shapiro et al., 2006).

However, through reperceiving the individual is able to view the experience of anxiety objectively and accept it as a feeling that is transient and will, at some point, go away (Baer, 2003; Shapiro et al., 2006). Experiencing the impermanence of these feelings allows a higher level of tolerance for unpleasant internal states (Baer, 2003; Shapiro et al., 2006). It is also considered that better self-observation promotes the use of coping skills (Baer, 2003; Keng et al., 2011). Increased awareness of the experience of unpleasant states, such as anxiety or depression, also potentially results in a better ability to recognise early signs of potential relapse as well as then engage in more helpful coping strategies (Baer, 2003; Keng et al., 2011).

Exposure

When an individual learns to experience strong emotions with greater objectivity and less reactivity, in turn, a greater level of acceptance of unpleasant emotional states results (Baer, 2003; Shapiro et al., 2006). This increased tolerance reduces the tendency to avoid difficult emotions and allows for these experiences to occur more frequently, thereby increasing exposure to such states (Shapiro et al., 2006). Coming to understand the impermanence of these experiences, the individual learns not to fear them, thereby allowing desensitisation to occur and the eventual extinction of avoidant behaviours (Baer, 2003; Keng et al., 2011; Shapiro et al., 2006).

Values clarification

Reperceiving may also help an individual clarify what is meaningful to them (Keng et al., 2011). Individuals are conditioned by such external influences, as society, culture or family. Reperceiving enables objective reflection on what values hold more true for the individual, so they are able to respond in ways that are more congruent with their needs, interests or values (Shapiro et al., 2006). Harris (2007) argues that values are important because they can guide and motivate an individual through situations when feelings or emotions may lead them astray. Living one’s life in accordance with their deepest values is ultimately fulfilling and satisfying (Harris, 2007). However, it may cause them to have to face unpleasant or challenging feelings, just as much as experiencing the pleasant feelings associated with value-driven life (Harris, 2007). This highlights the need for acceptance of all emotions: positive, neutral and negative, that mindfulness practice can promote (Harris, 2007).

Activity- A Few Simple Ways to be Mindful
Mindfulness can be practised informally throughout the day. Here are few examples of the ways to practice mindfulness anywhere (adapted from Harris, 2009). Ten breaths [edit \| edit source] Focusing on your breathing is a simple way to centre oneself and connect with the present environment (Harris, 2009). It can also easily be practised at any time of the day, especially when experiencing unpleasant or distracting thoughts (Harris, 2009). Take ten slow, deep breaths. Focus on breathing out as slowly as possible until your lungs are completely empty and then allow them to refill themselves. Notice the sensations of your lungs emptying. Notice them refilling. Notice your rib cage rising and falling. Notice the gentle rise and fall of your shoulders. See if you can let your thoughts come and go as if they are just passing cars, driving outside your house. Expand you awareness: simultaneously notice your breathing and your body. Then look around the room and notice what you can see, hear, smell, touch and feel. Thich Nhat Hanh- Mindfulness Master - talks about the value of the mindful breath Mindfulness in your morning routine [edit \| edit source] During the morning choose an activity that forms part of your daily routine, such as having a shower or brushing your teeth. While undertaking this activity, totally focus your attention on what is happening and what you are doing. Focus on your body movements, the feel, the smell, the taste, the sight and the sound that occur during this activity. Notice what is going on with an attitude of openness and curiosity. When your thoughts arise, acknowledge them, and try and let them come and go as they please. Again and again, you’ll get caught up in your thoughts. As soon as you realise this has happened, acknowledge it, note what the thought was that distracted you, and bring your attention back to the activity of the present moment (Harris, 2009).

Summary

In western society, we are encouraged in the pursuit of happiness. However, life involves pain at times. It is inevitable that throughout life we experience challenging emotions such as rejection, grief, disappointment, failure, stress and anxiety (Harris, 2007). The way these emotions are managed can shape how we deal with painful emotions that will, without doubt, occur again in the future. By living life with awareness and non-judgmental acceptance of the here-and-now experience, in a manner that is congruent with one’s needs, values and interests, these feelings of psychological distress are able to be ameliorated. In order to achieve psychological well-being, one has to accept that they must feel the full range of human emotions, including those that are positive, negative and neutral (Harris, 2007). Mindfulness provides the skills to achieve a rich, full and meaningful life (Harris, 2007).

References

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Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848.

Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31, 23-33.

Germer, C. (2004). What is mindfulness? Insight Journal, 22, 23-29.

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57, 35-43.

Harris, R. (2006). Embracing your demons: An overview of Acceptance and Commitment Therapy. Psychotherapy in Australia, 12(4), 2-8.

Harris, R. (2007). The happiness trap: Stop struggling, start living. Wollombi, NSW, Exisle Publishing Ltd.

Harris, R. (2009). ACT made simple. Oakland, CA: New Harbinger Publications, Inc.

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169-183.

Hollis-Walker, L., & Colosimo, K. (2011). Mindfulness, self-compassion, and happiness in non-meditators: A theoretical and empirical examination. Personality and Individual Differences, 50, 222-227.

Hölzel, B K., Carmody, J., Vangel, M., Congelton, C., Yerramsetti, S. M., Gard, T., & Lazard, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 191, 36-43.

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present and future. Clinical Psychology: Science and Practice, 10, 144-156.

Keng, S., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31, 1041-1056.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangus K. R., & Walters , E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593-603.

Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-Month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 617-627.

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78.

Ryan, R. M., Huta, V., & Deci, E. L. (2008). Living well: A self-determination theory perspective on eudaimonia. Journal of Happiness Studies, 9, 139-170.

Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2003). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373-386.

Taylor, V. A., Grant, J., Daneault, V., Scavone, G., Breton, E., Roffe-Vidal, S., Courtemanche, J., … & Beauregard, M. (2011). Impact of mindfulness on the neural responses to emotional pictures in experienced and beginner meditators. NeuroImage, 57, 1524-1533.

World Health Organisation (WHO). (2003). Investing in mental health. Retrieved from www.who.int/mental_health/en/investing_in_mnh_final.pdf

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