Mindfulness-Based Therapy

Mindfulness-based therapy brings meditation practice into ordinary talking therapy. You learn to notice thoughts, feelings and body sensations as they arise, and to watch them instead of reacting to them straight away. It sounds simple. Doing it takes practice.

What follows sets out what the therapy trains and the two main programmes built on it. It also covers the evidence, and where care is needed.

By Team TherapyRoute

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The one skill at its centre

Mindfulness is an old practice with roots in contemplative traditions across many cultures.¹ It can be taken up for spiritual, psychological, or medical reasons. The aim differs each time. In therapy, one skill sits at the centre of the work.

That skill is learning to notice a thought as a passing mental event.¹ You watch it arrive and pass, rather than treating it as a fact about the world, and that difference is what the training works on. Feeling afraid does not always mean you are in danger.

Thinking that you are unloved is not the same as being unloved. The shift is small. It changes how much a thought can direct what you do next.

What the therapy trains you to do

Dialectical behaviour therapy is built around teaching specific skills, and in it mindfulness is taught as concrete skills.¹ Three make up the core. You observe, you describe, and you take part.

Observing means attending to what is there, without pushing it away. Describing means putting plain words to what you notice. Taking part means entering fully into what you are doing now, instead of standing outside it and commenting.

Each of the three carries the same conditions. You practise without judging, one thing at a time, and with attention to what actually works.

Being present does not mean you can never plan ahead. It means planning while knowing that planning is what you are doing. The difference is awareness, not the activity.

The two main programmes

Two structured programmes are used most often in clinics. Both teach the same practice. They differ in what they were built for.

Mindfulness-Based Stress Reduction (MBSR). Jon Kabat-Zinn founded Mindfulness-Based Stress Reduction, or MBSR, in 1979.² He set it up at the University of Massachusetts Medical Center. The programme uses meditation to help people respond to stress differently, and it is widely used both for stress itself and for living with chronic pain.

Mindfulness-Based Cognitive Therapy (MBCT). Mindfulness-Based Cognitive Therapy blends cognitive therapy, which works with patterns of thinking, with meditation.³ It was built to stop depression from coming back. Teasdale and colleagues found that it lowered the risk of depression returning.³ That held for people who had first recovered with medication.

Relapse means the illness returning after a period of recovery. Preventing it is a stated priority in UK clinical guidance (NICE) on treating depression in adults.⁴ That makes this a meaningful focus for the therapy.

Where it sits among the therapies

Mindfulness-based therapy is one of the newer "third wave" behaviour therapies.⁵ Third wave means the most recent generation. Acceptance and commitment therapy and dialectical behaviour therapy sit in the same group.

These approaches attend to the context and function of thoughts, not only their form.⁵ In plain terms, they ask what a thought does and when it turns up, rather than only whether it is true. The behavioural therapies they grew from developed in the 1950s across three continents. That work included Joseph Wolpe in South Africa.

What the evidence shows

Mindfulness has been studied for more than three decades.² It shows a positive effect on stress-related symptoms, including depression and chronic pain.

Brain-imaging research suggests mindfulness practice can lower activity in the amygdala, the part of the brain that responds to threat.² Lower activity there can mean less reactivity to triggers. In everyday terms, the same event sets off a smaller reaction.

This is not a quick fix. These are skills that develop with practice over time, and what people notice usually comes on gradually rather than in a single session. Results vary from person to person, and no outcome is guaranteed.

Who it suits, and where to take care

Mindfulness-based therapy suits many people dealing with stress or low mood, and it can also help people living with recurring depression or chronic pain. It is not the right starting point for everyone.

For some people, turning attention inward can bring difficult memories to the surface.² Strong body sensations can come with them. This is common in people who have a history of trauma.

For them, the work needs careful pacing and a safe setting. That is not a reason to rule it out. It is a reason to do it with a therapist trained to set the pace.

Mindfulness is also not simply relaxation or positive thinking. It means paying honest attention to what is there, including the parts you would rather not look at. A forced good mood is not the aim.

Finding the right therapist

Mindfulness-based therapy should be led by a trained mental health professional. Meditation training alone is not enough. The work combines mindfulness training with sound therapeutic skill, including the judgement to know when a person needs slower pacing.

The next step is finding that person. Read how to find the right therapist for you.

Related reading:

• Mindfulness - the core practice behind this therapy
• Meditation - a related contemplative practice
• Acceptance and Commitment Therapy (ACT) - a sister third-wave approach

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This article is for general information and learning. It is not a substitute for professional mental health care. Mindfulness-based therapy should be practised by qualified professionals with proper training.

References

1. [1] Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). New York: Guilford Press. psycnet.apa.org/record/2014-55948-000.
2. [2] van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking.
3. [3] Gabbard, G. O. (Ed.). (2007). Gabbard's Treatments of Psychiatric Disorders (4th ed.). Washington, DC: American Psychiatric Publishing.
4. [4] National Institute for Health and Care Excellence. (2022). Depression in adults: treatment and management (NICE guideline NG222). nice.org.uk/guidance/ng222.
5. [5] Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Philadelphia: Wolters Kluwer.