Mindfulness Training
Dialectical Behavior Therapy and Mindfulness-based CBT are more familiar psychotherapies that utilize mindfulness training (MFT). MFT teaches the user to regulate the flow of energy and information in the mind. This leads to changes in the patterns of activity in the brain. With practice certain patterns and pathways can be inhibited (reduced) and others amplified. Initially this requires effort and is dependent upon the brain's chemical state, but with practice it becomes effortless - a trait. MFT helps the user identify separate “streams” of information flow in the mind, to shift attention, and learn the difference between the “bottom-up” experiential input (i.e. “Just the facts”) versus the “top-down” chatter of our narrative – the stories and meanings we’ve made up. This helps to “objectify” the mind, and separate ourselves (“dis-identify”) from the mental activities of the mind.
We can classify information flows as “experiential” or “meaningful”. Meaningful flows ascribe meaning - it's the narrative chatter of the mind, and includes memories, biases, and explanations we’ve filled in about ourselves, others, and how life works. It's like a running commentary, or what some call "The Committee". The medial prefrontal regions are likely where this “narrative circuitry” lies. MFT helps us to quiet The Committee, separate it from the experiential flow, and allows for greater clarity and objectivity. Why is this important?
Many people are slaves of their narrative chatter, especially when struggling with anxiety and depression. The meaningful information flow includes negative perceptions, distortions, self-doubts, beliefs about being bad, weak, and different. When someone can step back from this and gain some objectivity, it becomes much easier to break this unproductive thought cycle and get the brain back on track with logical, realistic, and helpful thought patterns.
When someone begins MFT after dealing with anxiety and depression, they learn that much of the destructive thought patterns stem from meanings and interpretations they made up as children, which can stick with someone for their entire life, if left unchallenged. In MFT, they can learn to selectively focus on experience and more and more easily disregard the chatter.
Mindfulness Training: Evidence Based Practice
The right prefrontal cortex (PFC) is involved in negative emotions, such as anger, anxiety, depression, and when activated leads to avoidance and withdrawal. In depression and anxiety this area and the amygdala are hyperactive, relative to the left PFC which is oriented toward approach, reward, and positive emotions.
Studies at UCLA have shown that when we use words to identify emotions, the left PFC is activated and the amygdala is down-regulated, and that MFT leads to a more pronounced effect.
MFT probably enhances regions of the brain involved in regulation of emotion, executive attention, insight and empathy, and moral reasoning. An article by Daniel Siegel, in SCAN (2007) reviews brain research and MFT.
For mindfulness trainees, this translates into learning to calm and clear their mind, make better decisions, feel more confident, and be less worried about what others think. This improves self-esteem, self-confidence, hope, and generates further initiative and work in other areas; such as skills training, relationship improvement, and helping others.
MFT: Key Components
The two key components of MFT are learning to be present and nonjudgmental. MFT starts with identifying when our thoughts are in the past or future, and labeling judging as "judging" (and not fact). We don’t control our thoughts or feelings, just identify them in the present, not judge them as good or bad, not hold on nor push them away; that's a big step and a great start for many.
Beyond that, people can learn to better understand their emotions (emotional intelligence), when to trust them and act on them, and when not to. They can learn to identify their thoughts and weed out distortions. MFT does not require a therapist, but applying it to symptoms and “life problems” may.
A Word for Therapists
Adding mindfulness training to our treatment plans enhances many aspects of what we do, from treatment to relapse prevention to wellness. We do not need to teach mindfulness ourselves; instead there are many resources we can refer patients to; Keep an eye out for future resources posted on my website. You may be starting to see how mindfulness can even be applied to medication management. More on that next time!