Over the past forty years a wide variety of clinical issues and syndromes, including chronic pain, anxiety, OCD, depression, self-harming behavior, and addictions, have been proven to respond positively to mindfulness-based interventions. Why is this the case? One literature review of clinical research on mindfulness identified at least five major mechanisms though which mindfulness practice creates positive change.1 These mechanisms include relaxation, acceptance, affect tolerance, behavior change, and meta-cognitive awareness/insight.
Relaxation
When we train in mindfulness of breath, or any other concentration technique, we decrease arousal and eventually experience a sense of calm and relaxation. This helps reduce the reactivity that would ordinarily lead to distraction, feelings of being overwhelmed, or even feelings of panic and anxiety. In fact, the power of relaxation through meditation is so profound that it can even save lives.
Studies have found that two years of meditation training can reduce mortality in cardiac patients by 41%, along with leading to a 46% reduction in recurrence rates of coronary heart disease.2 80% of hypertensive patients displayed lowered blood pressure and decreased reliance on medication as a result of mindfulness meditation, and 16% were even able to discontinue use of all their medications.
Acceptance
Mindfulness training emphasizes an attitude of patience, impartiality, and attention control. This attitude helps us when we begin to encounter upsetting sensations, emotions, and thoughts. Thanks to our training, we can suspend aggressive, punishing, or negative reactions towards unpleasant experiences, and instead we’re better able to understand and learn more about the experiences in question.
Since our reactivity is self-imposed, it can be consciously transformed through the process of learning to recognize and accept things as they are. One clinical demonstration of the effects of mediation on pain showed that a staggering 72% of chronic pain patients undergoing mindfulness training reported moderate to great improvement in quality of life for up to three years after the training.3 This finding suggests that the attitude of acceptance underpinning mindfulness helps transform our relationship with unpleasant experiences.
Our modern culture has made vast strides in medicine, science, and technology. However, this progress often leads to an unspoken assumption that we should be able to eliminate all suffering, and that the goal of life is to live completely free of pain. This naive outlook fails to adequately prepare us to accept life’s inevitable, often uncontrollable difficulties. Mindfulness-based therapies, like Dialectical Behavior Therapy, draw on contemplative science and advocate a healthy balance between striving to change what we can control and accepting conditions and circumstances that we can’t.
Affect Tolerance
As mindfulness training progresses through each Foundation, we move from awareness of objects (such as sound and breathing), to the awareness of sensations, emotions, and thoughts, as well as the conditioned reactions (compulsion, repulsion, and obsession) that accompany them. Exposure Therapy, a common strategy in Cognitive Behavioral Therapy (CBT), involves a process in which patients train to relax while exposing themselves incrementally to a stimulus that ordinarily creates distress or panic.
Meditation, like Exposure Therapy, allows us to experience voluntary, sustained, and systematic exposure to negative stimuli within the safe setting of our own self-attunement, self-regulation and self-compassion. In this way, patients who meditate can learn to decondition their own reactivity: they can begin to break automatic links between stimulus and response, transform adverse reactions, forge new and more effective associative responses, and ultimately harness the power of neuroplasticity to blaze new neural pathways that change mind, brain and nervous system.4
Emotional Regulation
In addition to relaxation and acceptance, emotional regulation is another key psychological mechanism that can result from mindfulness mediation. Commonly, when people feel pleasure, they react with addictive clinging. On the other hand, when they feel pain, they react with various forms of aversion. They may numb with alcohol, food or sex, or alternatively, they may distance themselves from their emotions through intellectualization and compulsive working. Sometimes feelings of pain can cause even more serious nervous system shutdowns to occur, such as dissociation in the case of PTSD.
However, with each attempt to shut down or avoid pain, our ability to endure unpleasant sensations atrophies significantly. While we may be able to temporarily escape an unpleasant feeling, we habituate and reinforce an avoidance response and over the long term we are making ourselves less resilient and less able to face life’s inevitable difficulties.
Because mindfulness helps with emotional regulation, it can be especially helpful in alleviating and eliminating anxiety and panic attacks. In one study, mindfulness-based intervention led to a significant reduction in anxiety and panic attacks in a clinical population.5 In programs like the one in the study, patients learn to experience relaxation using the First Foundation of breath meditation, then move beyond this point to include and assess painful sensations, distressing emotions, and disturbing thoughts.
They learn through exposure to observe their minds from a platform of safety, impartiality and insight. Through mindful observation, they being to understand the fundamental impermanence of the feelings of danger they associate with their sensations, emotions, and thoughts. After acquiring this understanding, patients can then transform their reactions to calm, acceptance, and balanced sensitivity, cultivating a new and more realistic way of relating to their experiences.
Behavior Change
The Buddhist teachings on karma (causal action) from the Second Noble Truth illuminate the fact that our impulsive reactions, originally designed to keep us safe or secure our basic needs, can actually end up reinforcing a self-fulfilling prophesy of our worst case fears.
Through mindfulness training we can achieve relaxation and emotional regulation, which can help us identify healthier behaviors to help navigate our personal histories, reactive impulses, and deeply held false convictions about ourselves, our relationships and our world.
For example, a person who is rejected by a potential love interest may perceive themselves to be inadequate (misperception), feel shame (adverse emotion), and instantaneously withdraw into isolation (reactive action). Sometimes this isolation results in using alcohol or other substances as coping mechanisms to manage painful feelings. By repeatedly withdrawing and turning to substances for comfort, a person is actually rejecting themselves and their needs and feelings, and setting themselves up for future moments of rejection which will reconfirm their negative self-image.
Meditative training can help our consciousness be present in the gap between feeling and reaction, so that we can have healthier responses to upsetting or negative occurrences. If a sufficient level of attention can be harnessed, and the person in question can recognize and endure these painful feelings long enough to resist withdrawing into alcohol or substance abuse, then they can learn to substitute these negative habits with skills like positive self-talk and effective communication, and help meet their needs for closeness.
Meta-Cognitive Awareness and Insight
In 2000, a group of researchers combined mindfulness with CBT to create Mindfulness Based Cognitive Therapy (MBCT). CBT assists patients in identifying unrealistic or erroneous thought patterns and substituting more accurate ones. In CBT clients are asked to challenge each thought that arises, whereas in MBCT they are simply asked to acknowledge thinking as it occurs and resist getting excessively involved in their thoughts.
This awareness of thinking itself is called meta-cognitive awareness, and in this process thoughts are not reflections of reality, but are instead experienced simply as mental constructions, arising like clouds within the space of momentary awareness. This doesn’t mean that everything in our minds is unreal, but only that thoughts are not inevitable, solid, or permanent. Once this is recognized, we can be more flexible in how we relate to our thoughts, observing them with a sense of spaciousness and restful alertness and then consciously choosing to respond with intent and purpose.
This meta-cognitive awareness then facilitates meta-cognitive insight, or what contemplative science refers to as mindfulness of mind in the traditional training of the Third Foundation. Once a depressed or anxious person can observe their feelings of helplessness, inadequacy, or fear objectively, they are open to the possibility that that these negative thoughts are just that: thoughts, and not accurate reflections of who they are.
Can Mindfulness Meditation Help Me?
You don’t have to be a celebrity or a Buddhist to practice mindfulness. Anyone can practice and get real benefits, but it’s always good to discuss any new approach with your therapist or physician. Many therapists also have training in mindfulness-based therapies such as Dialectical Behavioral Therapy and Mindfulness Based Cognitive Therapy, as well as the emerging discipline of Buddhist psychotherapy.6
These methods offer more than just the technique of meditation, providing also the radical psychology of empowered self-healing. Current research has helped demystify meditation by illuminating the precise neuropsychological mechanism underpinning it efficacy, making it accessible to almost everyone.
Meanwhile, greater cross-cultural and interdisciplinary dialogue with Buddhist scholars and contemplatives has helped clarify exactly how mindfulness works within its 2,500 year-old tradition of contemplative science, inspiring many of us to reexamine our notions of the nature of mind, optimal wellness, and the human potential for healing.
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Sources
1Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10, 125-143.
2Linden, W., Stossel, C. and Maurice, J. (1996). Psychosocial interventions for patients with coronary artery disease: A meta analysis. Archive of Internal Medicine 156(7):745-752.
3Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156.
4Lazar, S. W., Kerr, C. E., Wasserman, R. H., Gray, J. R., Greve, D. N., Treadway, M. T., … & Fischl, B. (2005). Meditation experience is associated with increased cortical thickness. Neuroreport, 16(17), 1893-1897.
5Miller, J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up and clinical implications of a mindfulness-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17, 192-200.
6Neale, M. (2012). What Buddhist Psychotherapy Really Is.
Miles Neale, Psy.D., is a Buddhist psychotherapist in private practice in New York City, Assistant Director of the Nalanda Institute for Contemplative Science, and Clinical Instructor of Psychology at Weill Cornell Medical College. He is a graduate of the doctoral program in clinical psychology at the California Institute of Integral Studies and earned a master’s degree in mindfulness meditation research from NYU’s Gallatin Program of Individualized Study. Dr. Neale complements his Western clinical training with twenty years studying the traditional mind science and meditative arts of Indo-Tibetan Buddhism, has conducted extensive field research while living in various monasteries throughout Asia, and maintained long-term, mentoring relationships with preeminent American Buddhist scholars and Tibetan meditation masters.
In his private practice Dr. Neale combines insight-oriented talk therapy with contemplative wisdom and meditative skills to further empower clients on their hero’s journey of wellbeing, altruism and creativity. As Assistant Director of the Nalanda Institute for Contemplative Science he teaches both public courses and professional training programs based on Tibet’s ancient treasure trove of healing techniques including mindfulness meditation, compassion practice and role-modeling visualization made accessible through the contemporary lens of neuroscience, mind/body medicine, and health psychology. Dr. Neale also teaches and collaborates on state-of-the-art meditation research at Weill Cornell Medical College and has been a contributing expert on mindfulness and meditation for the BBC World Service.
