Mindfulness Isn’t Enough

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Chances are, you’ve heard the term “mindfulness,” which refers to the practice of non-judgmental awareness of the present moment. Mindfulness-based interventions can help reduce stress, decrease symptoms of anxiety and depression, and improve the overall quality of life. As a clinical psychologist, I am a big proponent of mindfulness. I meditate regularly and have conducted some of the research showing how meditation techniques can help decrease the negative effects of stress and even change stress-related gene expression.

It’s clear more people are becoming informed of some of the positive effects of mindfulness given the surge in popularity of meditation apps, but it’s critical to remember that this technique is only one tool in the mental health toolkit. A recent study of popular smartphone apps for anxiety and depression found that the vast majority of people using these apps were only exposed to mindfulness and a handful of other meditation techniques. While 96 percent of people who use a mental health app were exposed to mindfulness, only 2 percent included cognitive techniques, which guide people through steps to notice and change unhelpful thought patterns. For example, if you are being particularly self-critical, you might ask yourself, “What would I tell a friend who was in a similar situation?” Cognitive techniques form the foundation of cognitive behavioral therapy (CBT), one of the most common and successful evidence-based types of treatment.

Based on work by psychologist Aaron Beck, CBT is an efficacious treatment for a wide range of mental health conditions. Newer versions of CBT, such as dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT), include mindfulness techniques alongside various other skills. However, limiting yourself to just mindfulness techniques would be like trying to build a house with only a hammer—you could make significant progress, but eventually, you would need other tools as well. When I’m working with a patient who has anxiety or depression, I never use mindfulness alone. Instead, I assess the patient’s symptoms and consider using mindfulness exercises and other CBT techniques, including:

Exposure techniques

Facing our fears, otherwise known as exposure techniques, can be a powerful CBT tool for those struggling with anxiety. While it can seem counterintuitive, it has proven to have long-term positive benefits, but virtually none of the consumer-focused digital mental health apps that people use include exposure techniques. For example, the act of exposing someone with a fear of spiders (otherwise known as arachnophobia) to a spider may seem impossible, but after thoughtful and consistent exposure in a safe environment, the patient learns that they are able to tolerate the fear, ultimately decreasing their anxiety around spiders.

Behavioral activation

Engaging in enjoyable and meaningful activities is another important CBT tool for those with depression. Referred to as “behavioral activation,” the basic idea is that when people are depressed, they may stop doing activities that they previously enjoyed and give them a sense of accomplishment, but staying home in bed only leads to people feeling more depressed. Instead of waiting until they feel “up for it,” behavioral activation helps people to schedule activities into their day, which leads to a positive spiral of improving their mood. Only 3 percent of people using mental health apps are guided through behavioral activation techniques.

Homework assignments

A lot of progress can be made during therapy sessions, but homework assignments are critical in order for patients to apply these learnings to their everyday lives. That is where the real progress is made, but none of the most commonly available mental health apps include homework assignments.

It’s important to remember that every person is unique and will require a different modality of care for their mental health illness. It’s not a one-size-fits-all approach. Dozens of research-based techniques exist. If you are thinking about using a mental health app, consider researching the most effective treatments for your condition. You should also determine whether the app considers issues of diversity, equity, and inclusion and whether you’d also benefit from the guidance of a provider, which may be especially important for patients experiencing higher levels of anxiety or depression.

To find a therapist near you, visit Psychology Today’s Therapist Directory.