The idea of using meditation and mindfulness in psychotherapy may seem like a relatively new and fashionable idea, but it has been growing since the inception of psychotherapy itself. The edited book, “Mindfulness, Acceptance, and the Psychodynamic Evolution” can be interpreted as an argument that this approach isn’t just the “third wave of behavior therapy," but has been evident throughout the therapeutic tradition. A similar argument can be made about a mindfulness approach to addiction treatment.
To begin, a look at the benefit of meditation and mindfulness is in order. The benefits, as indicated by the abundance of research, seem endless. There have been numerous studies exuding the benefits of these interventions. These are summed nicely by Keng, Smoski, Robins:
“Benefits of mindfulness to psychological health report benefiting undergraduate students, community adults, and clinical populations (p.1043). Mindfulness has been associated with: higher levels of life satisfaction, agreeableness, conscientiousness, vitality, self-esteem, empathy, a sense of autonomy, competence, optimism, and pleasant affect. Studies have also demonstrated significant negative correlations between mindfulness and depression, neuroticism, absent-mindedness, dissociation, rumination, cognitive reactivity, social anxiety, difficulties in emotion regulation, experiential avoidance, alexithymia, intensity of delusional experience in the context of psychosis and general psychological symptoms.” (p.1043).
Again citing Keng, Smoski, Robins, studies have also demonstrated: Meditators, as compared to non-meditators, reported significantly higher levels of mindfulness, self-compassion and overall sense of well-being, significantly lower levels of psychological symptoms, rumination, thought suppression, fear of emotion, and difficulties with emotion regulation. Changes in these variables were linearly associated with extent of meditation practice. (p. 1043-1044).
As if this weren’t enough, other studies indicate the benefits of mindfulness and meditation to biological functions. A study indicated the eight week Mindfulness Based Stress Reduction (MBSR) course increased positive affect and antibodies to an influenza vaccine. (Davidson, R; Kabat-Zinn, J; Schumacher, J; Et.al; 2003). Another study suggests, “the rate of skin clearing in patients with moderate to severe psoriasis can be accelerated when subjects engage in an audiotape-guided, meditative stress reduction exercise during their UVB or PUVA treatment sessions.” (Kabat-Zinn, J; Wheeler, E; Light, T; Et.al; p.630).
A positive side effect of, or perhaps core component involved in mindfulness, is acceptance. When you non-judgmentally perceive the present moment, there is an underlying current of acceptance. Realizing this, and perhaps perceiving acceptance as one of the beneficial aspects of the mindfulness movement, a type of therapy was developed based on its use (Acceptance and Commitment Therapy/Training, [ACT]). ACT consists of six core processes (Hayes). Without listing them here (you can get some helpful information from the link in the references) the core processes use mindfulness and techniques to foster and deepen acceptance.
The evidence for the psychological benefits of mindfulness, meditation, and acceptance are clear. There are empirical studies supporting all three. These techniques lead to better psychological health, which in turn leads to a happier and healthier life. Though the studies are relatively new, the idea of using meditation, mindfulness (a non-judgmental purposeful awareness of the moment), and acceptance, has been around addiction recovery since the inception of Alcoholics Anonymous.
Perhaps one of the best short passages on acceptance comes from the “Big Book” of Alcoholics Anonymous. In 1939, the year the book (called “Alcoholics Anonymous”, but commonly referred to as the “Big Book”) was published; Doctor Paul Ohliger penned the following:
And acceptance is the answer to all my problems today. When I am disturbed, it is because I find some person, place, thing, or situation-some fact of my life-unacceptable to me, and can find no serenity until I accept that person, place, thing or situation as being exactly the way it is supposed to be at this moment. Nothing, absolutely nothing, happens in God’s world by mistake.
Unless I accept life completely on life’s terms, I cannot be happy. I need to concentrate not so much on what needs to be changed in the world, as on what needs to be changed in me and in my attitudes. (Alcoholics Anonymous, 4th Ed., page 417).
A better passage about how to create happiness by changing one’s attitude would be difficult to find.
According to several sources, (barefootsworld.net, Wikipedia) Richard Walker published his thoughts on staying sober originally in 1949, “Twenty-Four Hours a Day." This book became the second highest selling book from Alcoholics Anonymous. He self-published it after writing these thoughts on index cards, and his A.A group suggesting he make it a book. According to the current publication (Martino Publications), the book was originally published in 1954. The book consists of a daily thought, meditation, and prayer.
The idea of meditation as a form of self-growth was a part of A.A. since its inception. The eleventh step mentions it directly. The “Big Book” provides guidance in when and how the alcoholic can meditate to best improve contact with his higher power (pg. 86, 87). Though being in-touch with a higher power isn’t always the goal of every meditator, the “Big Book” goes on to discuss its benefits. And, returning to “Twenty-four hours a Day” book, the idea is furthered to other meditations meant for self-improvement.
Acceptance has always been a part of therapy, and has grown in importance. Combining acceptance and mindfulness based practices easily fit into addiction therapeutic practices. I’ve been using it in my practice for some time, and included a very brief section on it in my book, “Addiction: A Human Experience”. Many of my clients seeking help for addiction are introduced to ideas of mindfulness, and its relationship to therapy. Though not every client is receptive to the interventions (nor should one type of treatment be applied to all clients) many are, to varying levels. When a client is receptive to initial discussion, education about what mindfulness is, and how to begin practicing it more effectively is discussed. This includes becoming the observer (the ability to cognitively detach from what is occurring in the moment and instead observe what is happening internally), Eckhart Tolle’s suggestion for one to bring awareness into his/her body, allowing consciousness to be centered and directed (as opposed to reacting out of conditioning), as well as meditative techniques (such as the body scan). Clients are given “homework assignments” focused on being mindful in certain aspects in their lives (including meditation). Some use apps, such as “Conscious," which gives daily challenges to be mindful of.
Many clients begin by simply focusing on thoughts for substance use. The goal is to be aware of the thought, recognize it, and not judge or over analyze it. The client is to recognize the insignificance of the thought, how automatic thoughts (including thoughts about substances, as they have become natural, automatic thoughts) are truly meaningless. Next the client focuses on how he or she has the power to determine whether or not to act on a thought. The client can also focus on her breath, simply observe the thought process, and even recognize the thought as absurd. In sessions we discuss incidences in which they have practiced it, circumstances where they might have practiced it, how it worked and obstacles that might have kept it from being effective.
The process of stopping and evaluating thoughts is a form of cognitive challenging (a cognitive therapy intervention which the client has also been educated about). Cognitive therapy has been effectively used with addiction treatment for decades. Mindfulness simply alters the challenge by more directly decreasing the weight, rationality or perceived reality of the thought through awareness that thoughts are not inherently meaningful, while also creating distance from them.
As clients become more adept at mindfulness and acceptance practice, the practice is expanded to other aspects of life. The client is encouraged to become more mindful more often. In so doing, they become more capable of choosing whom they will be in given moments and situations.
I’ve had clients who beyond remaining abstinent have used these techniques to control other impulses, to cope with chronic pain, to become more observant of not only their own thoughts, but also the patterns and behaviors of those around them, and to more effectively mold themselves into who they want to be. For some mindfulness is used to engage in healthier behaviors, such as exercise. Though excuses crowd their mind for delaying or canceling a workout, they simply stop listening, observe the thoughts, and exercise anyhow. Many clients report feeling less stressed, less rushed, and less affected by the ups and downs of daily life. As one of my clients professes, he focuses as much as possible on being the best person he can be in every situation.
Mindfulness based therapies are getting a lot of attention. They are fashionable, and “mindfulness” is a new buzzword in the field. It is outstanding that the benefits of what was once thought to be such an esoteric practice are finally being observed. But it isn’t as new as everyone thinks. Arguably, it’s been around since the inception of therapy, and has certainly been a part of the 12-Step tradition as long as there has been one.
Copyright William Berry, 2016
Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.
Barefootsworld; Twenty-Four Hours a Day; retrieved on 2/17/16 from: http://www.barefootsworld.net/aa24hoursbook.html
Hayes, S; The Six Core Processes of ACT; retrieved on 2/15/16 from: https://contextualscience.org/the_six_core_processes_of_act
Keng, S.L; Smoski, M.J; Robins, C.J; 2011; Effects of mindfulness on psychological health: A review of empirical studies; Clinical Psychology Review; Volume 31, Issue 6, August 2011, Pages 1041–1056.
Stewart, J.M; 2014; Mindfulness, Acceptance, and the Psychodynamic Evolution; Oakland, CA.
Wikipedia; Twenty-Four Hours a Day; retrieved on 2/17/16 from: https://en.wikipedia.org/wiki/Twenty-Four_Hours_A_Day