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.”
The Summits for Clinical Excellence bring together thought leaders on cutting-edge topics in multi-day national and regional conferences. Summits on mindfulness, trauma, process addiction, and shame appeal particularly to private practice behavioral healthcare professionals. Other Summits address the national opioid crisis from a regional perspective and engage a diverse group of stakeholders.