If there is a term in the therapy world that could qualify as both “hottest trend” and “most misunderstood” at the same time, “mindfulness” makes a strong case.
The practice of mindfulness has landed on national newsmagazine covers and the program logs of nearly every televised influencer in popular psychology. Still, even among clinical professionals the term often is miscast as being synonymous with meditation or relaxation, in part because much of the medical community first was introduced to the concept as part of mindfulness-based stress reduction, a practice founded by Jon Kabat-Zinn, PhD, for stress and illness management.
Mindfulness in and of itself is not a relaxation technique, though it can help achieve that, says Jamie Marich, PhD, an Ohio therapist and trainer with specialties in mindfulness, trauma-informed care and Eye Movement Desensitization and Reprocessing (EMDR). Mindfulness more closely means “being able to be with whatever comes,” Marich says, which could even refer to fully experiencing feelings of grief.
Marich and other practitioners interviewed by Addiction Professional for this article discussed how mindfulness practice can enhance treatment and early recovery for patients with substance use disorders—provided that professionals understand what mindfulness is and isn't, and also strive to practice what they teach.
“A professional should want at least to have practiced it,” says Ronald D. Siegel, PsyD, assistant clinical professor of psychology at Harvard Medical School. “Otherwise you're talking about a swim coach who doesn't know how to swim.”
Not a quick fix
The origins of the term “mindfulness” trace to a word in Sanskrit that literally means “to come back to awareness.” This can pose a challenge, Siegel suggests, since people are hardwired to an aversion to the experience of physical and/or emotional pain.
“The mindfulness approach is to be aware, with acceptance,” he says. “The goal is to increase our capacity to be in touch with our feelings.”
He illustrates the point by offering the example of the physical sensation of an itch, or an ache. Rather than fighting these sensations by scratching the itch, or shifting body position, the idea in mindfulness is to be open to sensations that prove to be in a constant state of flux. “When you don't fight it, it changes by itself,” Siegel says.
That argument extends to the kinds of self-judgmental thoughts that can derail any individual, and particularly one in the early stages of a recovery journey. An ability to gain insight into the presence of negative thoughts and to allow them to come and go will decrease the likelihood that the individual will buy into these thoughts' content, Siegel says.
Clearly, though, this transformation doesn't come quickly and easily. “People want mindfulness to be a quick fix,” says Margo Blessing, CADC II, a counselor at the Hazelden Betty Ford Foundation. “It is not a treatment alone.”
Adds Marich, “People in recovery tend to be terrified of feeling feelings.” They worry that the process will overwhelm them, or make them feel defective, or that it is not possible when substance-free. Professionals need to reassure patients that mindfulness practice represents a rewiring of the brain over the long haul, she says. So they shouldn't jump to conclusions when they've meditated for five minutes and don't feel better.
Among treatment professionals, there is now “more awareness that you can't throw a bunch of addicts into a room and say, 'Here, meditate,'” Marich says.
Moreover, Siegel says, “Mindfulness doesn't mean you're always calm. It means you're not overwhelmed, not resistant to the moments when we feel powerful emotions.”
Ability to integrate
Marich believes one of the best aspects of mindfulness practice in addiction treatment and recovery is that it can be incorporated alongside any major treatment modality. “You don't have to stop everything [else] you do,” she says.
As she has suggested in her writing and lectures, mindfulness can help bring 12-Step based approaches to new life by offering patients actual tools for how to live one day at a time. She wrote in Addiction Professional in 2014, “I've generally experienced that when clients and newly recovering people are learning to practice mindfulness on some level, they are better able to do later Step work (Steps 4 to 12) because they have the skills to keep themselves calm and regulated if the work proves too intense or triggering.”
Siegel says that with mindfulness helping individuals become less self-critical over time, it can therefore help people turn outward, establishing a closer connection to something outside oneself. For some, the focus could turn to a closer bond with a 12-Step group, he says, while for others the attention might go to the greater meaning inherent in their everyday work.
Siegel, who maintains a private practice in Massachusetts and serves on the faculty of the Institute for Meditation and Psychotherapy, sees mindfulness practice as helping patients to build a healthy reserve of capacity to bear difficulty.
“We are developing distress tolerance—the ability for people to be with their discomfort,” he says.
Professionals' own practice
Blessing says her self-practice of mindfulness has been important in her own recovery. “I think it is really imperative for the person who preaches mindfulness to practice it oneself,” she says. She also sees it as a useful concept for guiding the work of professionals who are not in recovery. “It is starting to become more of a research-based practice,” she says. “There is also a good tie-in to Eastern philosophy.”
Marich adds, regarding professionals' approach to incorporating mindfulness techniques, “If you're just reading from a workbook, you won't be able to deal with the curveballs that clients throw.” A skilled professional with firsthand experience in the challenges around mindfulness practice will be able to work with client resistance, she says.
Marich suggests that for professionals' self-practice of mindfulness, they should start with an activity that they can commit to on a daily basis. It could be as simple as practicing one's daily toothbrushing routine with full attention to that activity. “Five minutes is better than no minute” is a message that can resonate for both professionals and patients, she says.
If that mindful activity can be sustained for a period of about three weeks to a month, it will become a habit, says Marich. She points out that she commits to an annual training for herself amid the teaching on mindfulness that she offers to others.
She adds that it is important when working with patients to convey that the practice of mindfulness can prove as elusive to the professional as it appears to be to the client. “Clients say to me, 'I can't sit still.' I tell them, 'I've practiced this for 10 years, and neither can I,'” Marich says.
Siegel adds that professionals' own practice of mindfulness can't help but be beneficial because “we hear a lot of painful stories in our work. We have to somehow be present for our clients.”
Professionals seem to agree that the attention that mindfulness has received in the popular media has proven beneficial in normalizing the concept for patients. However, clinicians shouldn't be surprised that when patients see media depictions of mindfulness in the form of a perfect-looking person in a meditative state among idyllic surroundings, they might be tempted to say, “That's not me,” Marich says.
Resources on mindfulness
Here are some texts that both clinicians and patients can use to learn more about mindfulness practice:
A Path with Heart: A Guide Through the Perils and Promises of Spiritual Life; Jack Kornfield (Bantam, 1993)
Dancing Mindfulness: A Creative Path to Healing and Transformation; Jamie Marich, PhD (SkyLight Paths, 2015)
Mindfulness for Beginners: Reclaiming the Present Moment and Your Life; Jon Kabat-Zinn, PhD (Sounds True, 2016)
The Mindfulness Solution: Everyday Practices for Everyday Problems; Ronald D. Siegel, PsyD (The Guilford Press, 2010)