Mindfulness: Meditation Vs. Skill Set

As a long term yogic and vipassana meditator, and a mindfulness-based psychotherapist who regularly teaches meditation practices to my patients, I find the growth of mindfulness as a clinical intervention very timely. Last year, I attended two conferences focused on the use of mindfulness as a clinical intervention:  “Meditation and Psychotherapy” at Harvard Medical School and “Mindfulness and Psychotherapy” at UCLA.

Interestingly, the conference at Harvard featured a greater percentage of presenters who do not use meditation as an intervention in their clinical work. For them, mindfulness is a teachable skill set, extrapolated from a way of viewing life gained from sustained Buddhist meditation practices. These presenters included: Steven Hayes, founder of ACT, Lizbeth Roemer, U Mass GAD researcher and clinician, Tal Ben-Shahar, Harvard Lecturer on Positive Psychology, and Jayme Shorin, LICSW, sensorimotor trainer. The fact that the organizers of the Harvard conference felt it necessary to devote over half of the presentation time to methodologies that do not include meditation was, for me, significant.

Though this might be expected at a “Mindfulness and Psychotherapy” conference, in fact the UCLA conference featured more presenters discussing the use of meditation and compassion practices as a clinical intervention. These presenters included: Thich Nhat Hahn, Vietnamese Buddhist monk and meditation teacher, Jack Kornfield, Tara Brach, Harriett Kimble Wrye, and Trudy Goodman, all psychologists and meditation teachers, and Dr. Daniel Siegel & Harvard neuroscientist Sara Lazar presenting the neurobiology of meditation.

Due to the continuing trend in mental health toward brief, CBT methods and away from depth-oriented, psychodynamic therapies, one can easily see how a reduction of “mindfulness” to an easily deliverable skill set would be a natural outcome of the environment in which it is delivered. But is the doing away with meditation practice psychotherapeutically wrong or ineffective? Not necessarily.

Even in the East, Karma Yoga is an example of a path to liberation which eschews formal meditation practice in favor of a commitment to the work one does in the world as spiritual practice. Also, with neuroscience showing significant brain changes from long-term mindfulness meditation, one can easily see how a researcher like Steven Hayes could create mental exercises that simulate, through active questioning of the validity of language, the realization of the contextual nature of the self., i.e., “Am I really these thoughts and beliefs that my mind continually comes up with?”

Years of meditation cultivates a natural non-reactivity to experience. But why wait years, when simple instructions for distress tolerance, like those featured in DBT can be dispensed to patients suffering from emotion dysregulation? Following in the footsteps of ACT is Acceptance-based psychotherapy which focuses on delivering skills for realizing and accepting here and now experience with compassion; something vipassana meditation and metta practices are well documented at cultivating in long-term practitioners. Yet again, why practice meditation at all when mindfulness skills can be learned and behaviors changed?

Additionally, it must be acknowledged that most psychotherapists will not want to learn and commit to a daily mindfulness meditation practice, or be trained to teach mindfulness meditation. Therefore, it may be more desirable and practical in clinical settings to deliver a CBT-like mindfulness skill set rather than teach meditation

In light of all these benefits, what do we lose in clinical practice when we allow instruction of vipassana/mindfulness meditation to fall into disfavor or become outmoded? The following list is my best guess at an answer to this question:

1.The long and short term stress-reducing physical effects of meditation
2.The plethora of profoundly, positive neural changes evidenced in the brains of long term vipassana/Tibetan Buddhist meditators
3.The deep emotional healing that comes from metta/forgiveness/compassion meditation practices
4.The benefits of setting aside time in our busy lives for silence, meditation and contemplation
5.The cultivation of peacefulness
6.The deepening of connection with and respect for our planet and all living things upon it, which naturally arise from sustained meditation practice
7.The shared joy of a community of meditators; whether traditional sanghas or 8-week mindfulness-based groups like Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy for Depression Relapse Prevention (MBCT), or Mindfulness-Based Relapse Prevention for addiction recovery (MBRP).

I have seen patients experience radical change from incorporating mindfulness meditation and mindfulness skills into their daily lives and I am excited to offer MBRP, a mindfulness-based intervention for addiction relapse prevention in San Jose, CA in March 2008. Please contact me for more information.