In recent years there has been a great shift into studying the benefits of mindfulness. While mindfulness may be having its ‘coming out’ party to the mass public, it has been slowly taking over the West for decades now. Even Western medicine—whose high standards for evidence make it quite the exclusive club to join—has eagerly embraced mindfulness-based interventions.
Key to the new residence of mindfulness in mainstream health care is Dr. Jon Kabat-Zinn, a MIT-trained scientist, who was inspired by the mindfulness teachings of Thich Nhat Hanh, a Zen Buddhist monk and teacher from Vietnam. Founding the Stress Reduction Clinic and the Centre for Mindfulness at the University of Massachusetts Medical School, Kabat-Zinn created the 8-week Mindfulness Based Stress Reduction (MBSR) program in 1979 to offer an alternative way to cope with chronic illness. Since then, mindfulness-based interventions have flourished in health care, especially within mental health, with robust evidence supporting their adaptations for managing a variety of conditions such as stress, pain, chronic illness, anxiety, and relapse from addiction and depression.
Mindfulness Based Cognitive Therapy (MBCT), an adaptation of the MBSR program, has become an effective evidence-based program for the prevention of depressive relapse in people with recurrent depression. Similarly, the mindfulness-based intervention Acceptance and Commitment Therapy (ACT) shows promise for coping with a variety of mood and anxiety symptoms.
Many principles of mindfulness practice are consistent with what we know to be useful in relapse prevention for bipolar disorder. First of all, Kabat-Zinn defines mindfulness as “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally”. Paying attention in this way to our inner and outer world is essential to relapse prevention in bipolar disorder.
Mindfulness provides us with the tools to do just that. By paying attention to your inner experiences (observing your thoughts, feelings, body sensations and urges), early warning signs of impending relapse can become more available. For example, perhaps thoughts of self-doubt and guilt, body sensations of heaviness, and feelings of sadness are part of your relapse signature for depression. Or perhaps feelings of agitation, urges to socialize and move, and thoughts of confidence comprise your signature for mania. By purposely paying attention to your moment to moment experience, you can gain the insight necessary for managing mood symptoms.
Part of paying attention is observing our experiences for what they are: simply experiences that come and go, just as waves rise and then fall away again. This allows us to put some space in between ourselves (the observer of experiences) and the experiences themselves. Often we get caught up in our experiences, so that we fuse or identify with our thoughts (e.g. rather than noticing you’re having the depressive thought “I am worthless”, you fuse with this thought automatically, simply believing that you are worthless). Mindfulness sees thoughts as just thoughts. It’s like we are mountains while our experiences are the weather: the weather comes and goes, while the mountain stands still, observing each storm.
Also essential to the definition of mindfulness is staying in the present moment. Living in the present allows us to engage in life more fully. Human minds, especially when anxious or depressed, naturally spend a lot of time hijacked by thoughts of the past and future. But this causes us to miss out in the richness of what’s happening right before us. Instead we may go about life in autopilot, whether we are eating a meal or talking with a loved one, going through the motions but not really paying attention to what is happening right now. In this way, we miss out on most of our day.
When faced with symptoms of depression and anxiety, living in the present can also feel more tolerable. We have the habit of piling up all our past failings and all the future catastrophes onto our current emotion, so that our pain feels completely overwhelming. But what if you just have to tolerate this sadness, or this fear, for just this moment you are in? Wouldn’t it feel more tolerable?
We can’t successfully push away our stress and pain (just try not thinking of a pink elephant), but we can pay attention to our own experiences to help us respond in ways that match our values, rather than habitually reacting in autopilot. And most importantly, we can hold our experiences with an attitude of acceptance with the understanding that while pain is inevitable, suffering is not. Suffering is when we have pain and don’t accept it; we fight it, trying to push it way. But when we don’t add to it with our own judgments, when we don’t amplify it with piling on the past and future, when we don’t identify with it and make it personal, then we can let it be. Sometimes mood and anxiety symptoms can feel like you’re sitting in the front row of a horror movie, engrossed as you watch it on the big screen. Mindfulness doesn’t remove the movie, but it allows you to keep living your life, this time accepting that the horror movie is still playing, but quietly in corner of the room on a small screen, still in your awareness, but less able to get in the way of the life you want to live.