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MINDFULNESS
has been a cornerstone of Buddhist practice for about two and
a half thousand years. The essence of mindfulness is paying deliberate
attention to our experience as it unfolds moment by moment, with an attitude
of friendliness and curiosity.
In the late 1970s Jon Kabat-Zinn in Massachusetts started using
mindfulness as a therapeutic modality, especially for people with chronic pain,
but also for people with anxiety and stress. He developed an eight-week
course called mindfulness-based stress reduction (MBSR) using mindfulness
meditation and simple yoga. His work showed that about two thirds of people
with chronic pain benefited, and benefits were maintained at four-year follow-
up. In particular, people benefited if they continued to practise mindfulness,
even if only informally (as oppose to formal sitting meditation).
Mindfulness-based cognitive therapy (MBCT) for
depression was based on Kabat-Zinn’s work,
incorporating some ideas from cognitive therapy.
Depression has a high relapse rate, and the aim was
to develop a maintenance form of cognitive therapy
that could keep people well after they had
recovered from an episode of depression.
Although initially work began as cognitive
therapy with some elements of
mindfulness added in, it ended up being
primarily a mindfulness meditation
course. A three-centre trial showed that
it reduced the risk of relapse in those
with three or more episodes of
depression, and subsequently it was
included in the NICE guidelines for
preventing recurrent depression.
MBSR and MBCT have generated a wide interest in using mindfulness for a
range of conditions. A review in 2013 reported that there had been 209
randomised controlled trials involving mindfulness. Given the relapsing nature
of addiction, the work on MBCT suggested mindfulness might also be helpful
for use in addiction. Mindfulness-based relapse prevention (MBRP) is an
adaptation of MBCT for preventing relapse into addictive behaviour.
RELAPSE PREVENTION
The key components of MBRP are threefold (in a handy ABC). The first part is
developing awareness. This is done through sitting meditation, a body scan,
mindfulness of everyday activities such as walking or eating, and a ‘breathing
space’ – a mini-meditation that can be done anytime during the day. Bringing
awareness to simple activities like eating, we start to recognise that frequently
our mind is not fully attending to what we are doing. Often our minds are
caught up in worrying about the future or going over the past, rerunning
arguments or playing out fantasies – a condition referred to as automatic pilot.
The sitting meditations provide an opportunity for watching the mind in
more depth. For example, in the mindfulness of breathing meditation the
breath is used as a focus. Inevitably the mind frequently wanders off from the
breath, and in acknowledging where the mind has gone we can develop
awareness of habitual thoughts and emotions. By recognising what is going
on, we step out of automatic pilot, with its danger of running off down relapse-
predisposing mental habits. Triggers and unhelpful mental patterns are
recognised earlier, when it is easier to choose something other than an
addictive behaviour. The second stage is learning to ‘be’ with experience. The
emphasis is to not push away unwanted experiences, but instead find a way of
letting them be. This helps to avoid suppression or unhelpful habitual reaction.
It can also lead to a change in perspective so that thoughts and emotions are
not over-identified with: thoughts are just thoughts, not (necessarily) facts.
The third stage is making skilful choices. On the basis of greater
awareness and when not acting out of habitual reactions, it is possible to
make wiser decisions about how best to act.
IS MINDFULNESS EFFECTIVE?
Preliminary work suggests that MBRP may be helpful in preventing relapse into
substance use. To date there have been eight randomised controlled trials.
Two showed no difference from controls, but the others showed reduced
substance use. Some studies also showed improvements in other areas, such
as enhanced psychological and social adjustment, and reduced craving.
Mindfulness is being used with other therapeutic modalities. In developing
dialectical behaviour therapy (DBT) for borderline personality disorder, Marsha
Linehan included mindfulness as part of the package. Mindfulness is used to
encourage acceptance and to extinguish automatic avoidance of emotions, and
DBT has been adapted for substance misuse treatment.
Acceptance and commitment therapy (ACT) emphasises accepting difficult
thoughts and emotions in the service of moving towards goals that are in line
with a person’s values. Although ACT was not developed from the mindfulness
tradition, mindfulness practices are now often used to enable the acceptance
part of ACT. It has been used to help with a wide variety of disorders including
substance misuse, for which there is a growing interest in its application.
Mindfulness appears to be helpful for a range of psychological disorders,
as well as improving well-being and psychological functioning. For the future,
rather than focusing just on relapse prevention (MBRP), mindfulness courses –
referred to as mindfulness-based addiction recovery (MBAR) – may be seen as
a support to the broader journey of recovery.
Dr Paramabandhu Groves is an NHS consultant psychiatrist at Camden
and Islington NHS Foundation Trust, specialising in addictions, and clinical
director of Breathing Space, www.breathingspacelondon.org.uk
The Buddhist way
The practice of
mindfulness can
be a powerful
tool in preventing
relapse and
supporting
recovery, says
Dr Paramabandhu
Groves
July 2014 |
drinkanddrugsnews
| 13
Recovery |
Mindfulness
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