Mindfulness and meditation therapy

Mindfulness and meditation therapy are neither subordinate nor synonyms that can be replaced with each other. They are two independent concepts that have the same origin, cross each other, empower each other, and have clear boundaries of applicability in clinical applications. This is a core conclusion that is relatively recognized by academic circles and clinical practitioners.

It’s interesting to say that when I attended a clinical psychological supervision workshop last month, a new cognitive-behavioral counselor directly classified the 8-week Mindfulness-Based Stress Reduction (MBSR) intervention plan for anxious clients as “meditation therapy application.” The supervisor raised a big question mark on the spot. Many friends who are new to the field of mental health have probably encountered similar misunderstandings. They either think that "mindfulness is a type of meditation" or that "the core of all meditation therapies is to practice mindfulness." In fact, both of these statements only touch half of the truth.

Let’s break down the most basic definition first: The commonly used clinical concept of “mindfulness” is derived from Jon Kabat-Zinn’s definition, which refers to “the purposeful and non-judgmental placing of attention on the current state of awareness.” It is essentially a psychological state and can also be a type of training goal. "Meditation therapy" is a general term for all clinical intervention techniques centered on sustained attention regulation. It is subdivided into dozens of branches such as concentration meditation, compassion meditation, transcendental meditation, visualization meditation, etc. The application scenarios range from emotional regulation to trauma healing.

I previously received a visit from a patient with panic disorder. Sitting with his eyes closed would trigger a sense of near-death, and he was unable to complete regular meditation training. The intervention plan I gave him was "mindful cup holding": every time he felt flustered, he would hold a mug filled with warm water of about 40 degrees Celsius, and focus entirely on the temperature of the contact between the cup wall and the palm, the roughness of the ceramic surface against fingerprints, and the weight of the cup until his breathing stabilized. This is a very typical mindfulness intervention, but no meditation techniques are used in the whole process - you see, mindfulness can be completely separated from the existence of meditation. Mindful walking, mindful eating, and mindful housework are all exercises that bring awareness back to the present moment. There is no need to cross your legs, close your eyes, or find a quiet room.

When talking about this, I have to mention the differences that are still being debated in the academic circles. Most cognitive-behavioral researchers prefer the "mindfulness core theory." Last year, a meta-analysis published by the Department of Psychology at Beijing Normal University covering 127 randomized controlled trials showed that among the effect sizes of various types of meditation therapies on improving symptoms of anxiety and depression, the contribution of improved mindfulness levels of clients accounted for 62%. Scholars in this group generally believe that mindfulness is the core effective factor of most meditation therapies. Even techniques such as compassion meditation that focus on emotional mobilization essentially stabilize attention through mindfulness first, and then complete the arousal of positive emotions.

But most practitioners of transpersonal orientations and those with traditional spiritual backgrounds disagree with this statement. A consultant I know who has 20 years of experience in Vipassana practice said that in the original Theravada Buddhist system, mindfulness is a state that arises naturally after long-term meditation practice and is not a goal deliberately pursued at all. ； Many meditation techniques currently used in clinics, such as visualization meditation for trauma healing and guided meditation with holotropic breathing, have the core goal of mobilizing subconscious emotions and completing trauma repair. Deliberately maintaining "non-judgmental awareness" will hinder the release of emotions. At this time, mindfulness is only a tool used to stabilize attention and prevent the client from falling into excessive dissociation. It is not the core of the intervention at all. There are also some traditional meditation practices, such as hidden visualization practices, that require practitioners to deliberately strengthen the imagery of visualization, which is completely contrary to the requirement of "non-judgmental" mindfulness.

In clinical practice, I rarely struggle with the relationship between the two. When I meet a client who can sit still and has no history of serious trauma, I will use mindfulness-guided meditation therapy to help him improve his awareness of emotions.； When you encounter a client who cannot sit still or is resistant to sitting meditation, teach him to do mindful breathing for two minutes while taking the subway or eating lunch. The effect may not be worse than sitting for 40 minutes to meditate. Many clients will be confused at first, "Should I practice mindfulness or meditation?" I usually say it directly. There is no need to worry about the name. It can help you not get stuck in the regrets of the past and the anxieties of the future, and can stop you in the present moment. This is a useful practice.

A few days ago, I saw an old consultant who has been practicing clinical medicine for 18 years post on WeChat, saying, "Tie mindfulness and meditation therapy together is like equating eggs with cakes - you need eggs to make most cakes, but eggs can do much more than just cakes, and eggs are not necessary for all cakes." Rough words or not, it's almost the relationship between the two.