Applications of MM in psychotherapy
The preponderance of research about the clinical utility of MM has used standardized MMBIs such as MBSR, MBCT, TM, and others. However, in actual clinical practice, the use of standardized protocols may be the exception rather than the norm. A recent survey indicates that individualized use of MM techniques, such as breath-focused awareness, may be the most common clinical application of MM (Waelde et al. in press), and there is a growing clinical literature about applications of MM techniques within conventional psychotherapy (Germer 2005; Pollak et al. 2014). Applications of MM in psychotherapy might be thought of as occupying a continuum of usage intensity, ranging from the use of mindfulness by the therapist only to standardized protocols applied as adjuncts or stand-alone treatment.
A spectrum of usage intensity
A burgeoning literature describes the benefits of MM practice for psychotherapists themselves. Recent work shows that a brief training program can increase therapist skills and knowledge related to mindfulness (Aggs and Bambling 2010). A prospective study found that psychotherapists in training who participated in nine weeks of Zen meditation had better therapeutic course and treatment outcomes than non-meditating controls (Grepmair et al. 2007). In post-disaster settings, MM training may address therapists’ trauma symptoms related to their own disaster exposure and losses and promote coping selfefficacy (Hechanova et al. 2015; Waelde et al. 2008). It has been suggested that mindfulness training can enhance therapist qualities related to common factors of effective treatment, such as affect tolerance, acceptance, empathy, equanimity, paying attention, and accepting the limits of psychotherapy (Fulton 2005). Moreover, therapist training is thought to be a prerequisite to the applications of MM in psychotherapy, particularly for the more involved applications.
Perhaps the most common application of MM in psychotherapy is the ad hoc use of breath-focused attention to help the client become more aware of inner experience, thoughts, and feelings during the session. In this implementation, the therapist integrates MM techniques into conventional psychotherapy with the aim of helping the client to tolerate other therapeutic procedures, such as exploration of trauma memories (Waelde 2015). The therapist may also introduce everyday mindfulness exercises, such as a practice of breath awareness during daily activities or stressful moments. Breath awareness in daily life may be a particularly accessible practice for clients; it was used by a majority of MBSR participants three years after the program, whereas only a minority practiced sitting meditation (Miller et al. 1995). Depending on client need and motivation, the therapist may teach very brief, breath-focused sitting meditation to develop present moment awareness and cultivate acceptance, with a focus on developing ways for the client to practice that are easy and pleasant (Germer 2005). Standardized MM protocols teach clients to use longer periods of daily MM practice. Research has shown that the amount of daily sitting meditation practice is associated with increases in mindfulness and decreases in psychological symptoms (Carmody and Baer 2008; Waelde et al. 2004, 2008). Although there has been much speculation that standardized protocols such as MBSR might be useful adjuncts to conventional psychotherapy, one study showed greater termination among clients receiving adjunctive MBSR relative to those who received psychotherapy alone (Weiss et al. 2005). Most of the research about MMBI has examined it as a stand-alone treatment, though as reviewed below, only a subset of studies have included participants with diagnosed disorders.