Mindfulness: An Exploration of Mindfulness in Therapeutic Approaches

Mindfulness has been trending in popular western culture recently. It is promoted as almost a panacea; mindfulness is said to help with everything from pain management to burnout prevention to psychotherapy and self-help. Indeed, the latest research indicates that mindfulness can play a part in helping folks with a variety of conditions such as obesity, anxiety, and even preschool learning outcomes – so clearly this mindfulness trend is not only hype (for more information on latest research see American Mindfulness Research Association). This article will first explore manifestations of mindfulness in some of the "third wave" therapeutic approaches, and will conclude with a description of some ways that mindfulness is an important (yet not explicit) part of good Motivational Interviewing (MI) practice.

I am an aspiring Buddhist, therapist, and trainer myself, so I have some experience with mindfulness. I have seen the benefits of practicing mindfulness in a variety of forms including sitting meditation, mantra meditation, mindfulness activities from therapy manuals, yoga, and others. Mindfulness practice has helped me personally become more focused and present with myself and others, and practicing mindfulness has frankly made me a better trainer and clinician. The personal definition of mindfulness that I typically think of is “paying attention in the moment without judgment and on purpose.”

In the below paragraphs I have attempted to outline 4 ideas of mindfulness, starting with a brief look at Buddhist connections to mindfulness. It is my hope that the diversity of mindfulness approaches and definitions demonstrated here can add richness to our conception of what mindfulness is and help us experience mindfulness for ourselves. Following this literature review of mindfulness I have included my thoughts on how the practice of mindfulness is an important part of MI practice.

​Mindfulness in Buddhism
The Buddhist Pali term “sati” is often seen as a root of the concept of mindfulness, the term can be translated as “presence of mind.” In many Buddhist traditions the achievement of sati is just one component of a larger meditation practice that can include multiple mind states and focuses (Chiesa & Malinowskil, 2011 & Yun, 1999). Right Mindfulness is also a translation of a key part of the Eight Fold Path presented by the Buddha to end suffering. Regarding mindfulness, the Buddha taught:

"This is the one-way path for the purification of beings, for the surmounting of sorrow and lamentations, for the passing away of pain and dejection, for the attainment of the true way, for the realization of Nibbana - namely, the four establishments of mindfulness” (Bodhi, 2005, p. 281).

The four establishments include bringing awareness to one’s own body, observing one’s own feelings, reflecting on one’s thoughts, and noticing external phenomenon. The approach when making these observations should be free from commentary and free from judgment (Hanson, 2006).

Venerable Thich Nhat Hanh, a renowned Zen monk, describes "The Three Miracles of Mindfulness:" Presence, The Other, and Working With Positive and Negative Elements. The Miracle of Presence refers to each person’s ability to be present with their thoughts, emotions, and experiences. The Miracle of The Other refers to noticing other objects such as the sun and the moon, the environment and other living beings. Working With Positive and Negative Elements refers to skillfully interacting with the world in a mindful way. One part of the practice is to embrace the positive or helpful experiences, and Ven. Thich Nhat Hanh notes that negative or less pleasant experiences should be experienced with compassion in a way that is similar to a mother caring for a crying baby (Hanh, 2010).

Mindfulness in Mindfulness Based Stress Reduction (MBSR)
Kabat-Zinn defines mindfulness as “paying attention in a particular way, on purpose, in the present moment, and non-judgmentally” (1994, p.4). Kabat-Zinn is heavily influenced by the Buddhist concept of mindfulness and relies on formal medication practices that are shared with Buddhist practices such as sitting meditation and walking meditation. This definition highlights intention of practice, attention of practice, and the way or approach of practice. In MBSR there is a practice of body scans, formal sitting meditation and yoga poses in order to achieve a mindful state (Chiesa & Malinowskil 2011).

Mindfulness in Dialectical Behavior Therapy (DBT)
Linehan, the founder of DBT defines mindfulness as “awareness without judgment of what is, via direct and immediate experience” (Sanderson, 2006, p.1). To understand mindfulness, DBT outlines 3 primary states of mind: Reasonable Mind, Emotional Mind, and Wise Mind. Practitioners who want to engage in mindfulness should strive for a Wise Mind, which is a healthy balance of the emotional and reasonable mind (Linehan, 1993).

DBT breaks down the practice of mindfulness into 2 skills groups. The 3 “What Skills” of DBT Mindfulness include observing, describing and participating in an experience. The 3 "How Skills” of mindfulness refer to maintaining an approach of non-judgment, one-mindedness, and an aim towards being effective. This practical conception of mindfulness, and the “How and What Skills” offered by DBT offers participants a structure that can be applied to a variety of experiences and settings (Dietz, 2012).

Mindfulness in Acceptance Commitment Therapy (ACT)
A definition of mindfulness presented by ACT is “consciously bringing awareness to your here-and-now experience with openness, receptiveness and interest” (Harris, 2008, 135). To facilitate the practice of mindfulness, ACT conceptualizes 2 “selves,” the Thinking Self and the Observing Self. ACT purports that it is through the observing self (the part of one’s mind that notices without judgment or commentary) that one can succeed in attaining mindfulness (Harris, 2008).

ACT mindfulness practice is broken down into three categories of practice: Defusion, Acceptance and Connection. Defusion refers to the practice of distancing or defusing one’s self from thoughts, this process seeks to prevent the self from identifying with or fusing with unhelpful memories, judgments, beliefs, etc. Acceptance refers to the practice of acknowledging and allowing for painful feelings, thoughts, emotions, and the like. In ACT acceptance is the opposite of attempting to control hard experiences, instead expanding one’s capacity to live with these experiences. Connection refers to finding contact with the present moment with openness and curiosity (Harris, 2009).

Mindfulness in Motivational Interviewing (MI)
While mindfulness is not explicitly part of MI practice, I believe that the practice of mindfulness is key to any good MI practice. The whole point of MI is to help others resolve ambivalence and create meaningful and sustained change in their lives. Being present with someone in a particular moment is a basic (yet difficult) foundation for developing any rapport or practicing empathy and acceptance. In fact, if you watch a video of one of the “MI Masters” (Miller, Rollnick or Moyers), you will notice that the MI practitioner seems to be fully present in the moment with the interviewee. I am not sure if this qualifies as mindfulness, but it surely is being present in the moment on purpose. While MI practitioners do not teach mindfulness to clients as part of MI, I believe that mindfulness (like empathy) is a key skill that the MI practitioner must develop in order to be effective in helping clients.

Crafting a skilled complex reflection requires mindfulness. One needs to first use a form of mindful deep listening skills such as deep listening if done right the act of listening itself can be a mindfulness practice. In the next step of crafting a good reflection the interviewer attempts to understand or observe from a stance of curiosity and non-judgment, again this type of observation can be seen as a form of mindfulness. The final step of developing a reflection requires that one make a guess at a deeper meaning. I believe that the other OARS skills could be broken down in a similar fashion; mindfulness is a foundational component in establishing accurate empathy, unconditional acceptance of others and attunement. So mindfulness is not only important in developing skillful utterances, but mindfulness can play an important role in the cultivation of the MI Spirit of Compassion, Acceptance, Partnership and Evocation.

​Summary
In summary, the territory of mindfulness is large and sometimes confusing. The term (similarly to the experience of mindfulness itself) can be fluid and elusive. I have heard it said that experiencing mindfulness is similar to seeing something in ones peripheral view – it is just out of reach and difficult to describe. The Buddhist Ngakpa at my temple often explains how experiences such as mindfulness can be like a dream – the more you think about them the more they change, evolve, or dissipate. He also talks frequently about the difference between academic knowledge and experiential wisdom. It is with this understanding that I hold the various concepts of mindfulness lightly and invite others to do the same.

One commonality across all the concepts of mindfulness discussed in this article is that mindfulness is a practice and an experience, not a mere academic exercise. It is my hope that you have found something useful in reading this article, but it is important to remember that mindfulness needs to be practiced just like any other skill. I encourage you to try a variety of mindfulness activities and see what works best for your practice.

​Works Cited
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Bodhi, B. (2005). In the Buddha’s Words: An Anthology of Discourses From the Pali Canon (Teachings of the Buddha).
Somerville, MA: Wisdom Publications.

Chiesa, A & Malinowskil, P. (2011). Mindfulness-based approaches: are they all the same?. Journal of Clinical
Psychology, 67(4):404-24. Retrieved on 5/6/16 from:
http://www.pmalinowski.de/downloads/chiesa%26malinowski2011.pdf

Dietz, L. (2012). Mindfulness. DBT Self Help. Retireved on 5/6/16 from:
http://www.dbtselfhelp.com/html/mindfulness1.html

Hanh, T.N. (2010). You Are Here. Boulder, CO: Shambala Publications.

Hanson, R. (2006). The Noble Eightfold Path: Right Mindfulness. San Rafael, CA:
Wellspring Institute for Neuroscience and Contemplative Wisdom. Retrieved on 5/6/16 from:
http://www.wisebrain.org/RightMindfulness2.pdf

Harris, R. (2008). The Happiness Trap: How to Stop Struggling and Start Living: A Guide to ACT. Boston, MA: Trumpeter.

Harris, R. (2009). Mindfulness Without Meditation. Healthcare, Counseling and Psychotherapy Journal, 9(4), 21-24.

Kabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York, NY: Hyperion.

Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, NY: Guilford Press.

Sanderson, C. (2006). Mindfulness for Clients, Their Friends and Family Members. DBT Self Help. Retrieved on 5/6/16 from:
http://www.dbtselfhelp.com/mindfulness_for_clients__friends_and_family.pdf

Yun, S (1999). Only a Great Rain: A Guide to Chinese Buddhist Meditation. Somerville, MA: Wisdom Publications.