Lotus Therapy - New York Times Looks at Mindfulness and Psychotherapy

Lotus Therapy is an interesting article. Mindfulness and other elements of Buddhist practice have been making inroads into Western psychology for many years, but in the last year or so it seems to have reached some kind of tipping point.

Here is a big chunk of the article:

This exercise in focused awareness and mental catch-and-release of emotions has become perhaps the most popular new psychotherapy technique of the past decade. Mindfulness meditation, as it is called, is rooted in the teachings of a fifth-century B.C. Indian prince, Siddhartha Gautama, later known as the Buddha. It is catching the attention of talk therapists of all stripes, including academic researchers, Freudian analysts in private practice and skeptics who see all the hallmarks of another fad.

For years, psychotherapists have worked to relieve suffering by reframing the content of patients’ thoughts, directly altering behavior or helping people gain insight into the subconscious sources of their despair and anxiety. The promise of mindfulness meditation is that it can help patients endure flash floods of emotion during the therapeutic process — and ultimately alter reactions to daily experience at a level that words cannot reach. “The interest in this has just taken off,” said Zindel Segal, a psychologist at the Center of Addiction and Mental Health in Toronto, where the above group therapy session was taped. “And I think a big part of it is that more and more therapists are practicing some form of contemplation themselves and want to bring that into therapy.”

At workshops and conferences across the country, students, counselors and psychologists in private practice throng lectures on mindfulness. The National Institutes of Health is financing more than 50 studies testing mindfulness techniques, up from 3 in 2000, to help relieve stress, soothe addictive cravings, improve attention, lift despair and reduce hot flashes.

Some proponents say Buddha’s arrival in psychotherapy signals a broader opening in the culture at large — a way to access deeper healing, a hidden path revealed.

Yet so far, the evidence that mindfulness meditation helps relieve psychiatric symptoms is thin, and in some cases, it may make people worse, some studies suggest. Many researchers now worry that the enthusiasm for Buddhist practice will run so far ahead of the science that this promising psychological tool could turn into another fad.

“I’m very open to the possibility that this approach could be effective, and it certainly should be studied,” said Scott Lilienfeld, a psychology professor at Emory. “What concerns me is the hype, the talk about changing the world, this allure of the guru that the field of psychotherapy has a tendency to cultivate.”

Buddhist meditation came to psychotherapy from mainstream academic medicine. In the 1970s, a graduate student in molecular biology, Jon Kabat-Zinn, intrigued by Buddhist ideas, adapted a version of its meditative practice that could be easily learned and studied. It was by design a secular version, extracted like a gemstone from the many-layered foundation of Buddhist teaching, which has sprouted a wide variety of sects and spiritual practices and attracted 350 million adherents worldwide.

I haven't seen the studies showing that mindfulness practice can make things worse (though they mention one with depression in the article). I would be hesitant, however, to use mindfulness practice with a client who tends to dissociate too easily or too often - it would be counter-productive.

Late in the article, you'll find this:

The question, said Linda Barnes, an associate professor of family medicine and pediatrics at the Boston University School of Medicine, is not whether mindfulness meditation will become a sophisticated therapeutic technique or lapse into self-help cliché.

“The answer to that question is yes to both,” Dr. Barnes said.

My fear is that this cliché thing has already happened. True mindfulness practice does not happen only in the therapist's office -- it happens in our cars when we get angry, or when we are arguing with our partner, or when we are sad and find ourselves craving a gallon of ice cream. Many Buddhists also make this mistake, thinking that mindfulness only happens on the cushion -- my experience is that we make much more progress with mindfulness as a part of our daily lives.

Here is some info from Wikipedia on the uses of mindfulness in therapy:

Recent research points to a useful therapeutic role for mindfulness in a number of medical and psychiatric conditions, notably chronic pain (link) and stress (link). Recent research suggests that mindfulness-based cognitive therapy can be used to prevent suicidal behavior from recurring in cases of severe mental illness (Journ. Clin. Psych. 62/2 2006).

Dr. Jon Kabat-Zinn developed the Mindfulness-Based Stress Reduction (MBSR) program. MBSR is a form of complementary medicine offered in over 200 U.S. hospitals and is currently the focus of a number of research studies funded by The National Center for Complementary and Alternative Medicine. Kabat-Zinn also wrote a book about mindfulness called Wherever You Go, There You Are.

Mindfulness is a core exercise used in dialectical behavior therapy, a psychosocial treatment Marsha M. Linehan developed for treating people with Borderline Personality Disorder.

Mindfulness is also used in some other newer psychotherapeutical methods, such as Acceptance and Commitment Therapy and Mindfulness-based Cognitive Therapy, which is based on the Mindfulness-Based Stress Reduction programs.

Since the beginnings of Gestalt therapy in the early 1940s mindfulness has been an essential part of the theory and practice of Gestalt therapy, although within the frame of Gestalt therapy theory it appears as "awareness".

The end of the NYT article also lists a variety of meditative practices that have been found to be useful:

Tai Chi

An active exercise, sometimes called moving meditation, involving extremely slow, continuous movement and extreme concentration. The movements are to balance the vital energy of the body but have no religious significance.

Studies are mixed, some finding it can reduce blood pressure in patients, and others finding no effect. There is some evidence that it can help elderly people improve balance.

Transcendental Meditation

Meditators sit comfortably, eyes closed, and breathe naturally. They repeat and concentrate on the mantra, a word or sound chosen by the instructor to achieve state of deep, transcendent absorption. Practitioners “lose” themselves, untouched by day-to-day concerns. Studies suggest it can reduce blood pressure in some patients.

Mindfulness Meditation

Practitioners find a comfortable position, close the eyes and focus first on breathing, passively observing it. If a stray thought or emotion enters the mind, they allow it to pass and return attention to the breath. The aim is to achieve focused awareness on what is happening moment to moment.

Studies find that it can help manage chronic pain. The findings are mixed on substance abuse. Two trials suggest that it can cut the rate of relapse in people who have had three or more bouts of depression.

Yoga

Enhanced awareness through breathing techniques and specific postures. Schools vary widely, aiming to achieve total absorption in the present and a release from ordinary thoughts. Studies are mixed, but evidence shows it can reduce stress.

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