Mindfulness Techniques in Therapy

Mindfulness-Based Cognitive Therapy (MBCT) combines the traditional practices of mindfulness with the practical techniques of cognitive therapy. It is used with people managing everyday stress and difficulty with emotional regulation, and with people living with conditions such as depression and anxiety.

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Core Principles of MBCT

MBCT rests on the idea that noticing your current experience, without judging it, can change how you respond to stress and emotional pain. It combines mindfulness practices, such as meditation and breathing exercises, with cognitive behavioural strategies for working with distressing thoughts and emotions.

Integration of Mindfulness and Cognitive Therapy

Combining mindfulness with cognitive behavioural strategies is intended to help you recognise the automatic patterns of thinking that precede a dip in mood, and to interrupt them. The practice is one of attending to thoughts and feelings as events, rather than treating each one as a verdict about yourself.

Developing Emotional Awareness

MBCT trains you to observe emotions as they arise and to notice the reaction that tends to follow. Noticing that sequence is what allows a different response to become possible.

MBCT's clearest established use is preventing relapse in recurrent depression.

Key Mindfulness Techniques as Therapy Tools

1. Body Scan Meditation

• Purpose: The body scan builds awareness of physical sensations throughout the body. It is used to notice areas of tension or discomfort that often go unregistered.
• Therapeutic Application: Regular practice is used to connect bodily sensation with emotional state. In therapy it helps you notice the physical cues that accompany anxiety or stress, often earlier than you would otherwise.

2. Sitting Meditation

• Purpose: This form of meditation involves sitting quietly and attending to aspects of your experience, such as the breath, sounds, or thoughts, without judging them.
• Therapeutic Application: Sitting meditation is used to practise staying present with distressing thoughts or feelings rather than acting on them immediately.

3. Mindful Breathing

• Purpose: Attending to the breath returns attention to the present moment. It is the simplest of the practices and the one most people start with.
• Therapeutic Application: Mindful breathing can be used in almost any setting to work with acute stress responses. Therapists often teach it as a first response to anxiety or panic. How much it settles a given episode varies from person to person and from occasion to occasion.

4. Walking Meditation

• Purpose: Walking meditation involves moving slowly and deliberately while attending to the body's movements and sensations. It brings mindfulness into physical activity.
• Therapeutic Application: This technique is often used when still meditation is difficult to sustain, and offers a way to practise that does not require sitting.

5. The Three-Minute Breathing Space

• Purpose: A short, structured practice designed to step out of a stressful activity and return attention to the present. It has three steps: observing your current experience, focusing on the breath, and widening your awareness.
• Therapeutic Application: Therapists use the Three-Minute Breathing Space as a brief practice that can be applied in the middle of an overwhelming moment, when a longer sitting practice is not possible.

These are the core practices of MBCT. Which of them suits you, and how they are used, is worked out with your therapist. Depending on what you are managing, that may be a depression therapist or an anxiety therapist.

Integrating Mindfulness into Therapeutic Practices

Mindfulness practices are usually taught in therapy and then practised between sessions. Three things make that practice easier to sustain:

Consistent Practice

A regular routine matters more than a long one. A specific time each day, in the morning or in the evening, is easier to keep than an open intention to practise when there is space.

Adapting to Personal Needs

The practices are adaptable. If sitting still for long periods is difficult, mindful walking is a reasonable substitute. Discuss adaptations with your therapist rather than dropping the practice altogether.

Using Digital Aids

Many apps offer guided meditations, reminders, and a record of practice, which some people find useful when starting out. An app is not a substitute for therapy, and the National Center for Complementary and Integrative Health advises against using meditation as a reason to postpone seeing a health care provider about a health problem.³

What the Evidence Supports

The research on mindfulness is uneven. It is strong for one specific use and thinner elsewhere, so it is worth separating the two.

Preventing Relapse in Recurrent Depression

This is where the evidence for MBCT is strongest. An individual patient data meta-analysis of nine randomised trials, covering 1,258 patients, found that people who received MBCT had a lower risk of depressive relapse over 60 weeks than those who did not (hazard ratio 0.69, 95% CI 0.58 to 0.82). Compared with other active treatments, including maintenance antidepressants, the risk was also lower (hazard ratio 0.79, 95% CI 0.64 to 0.97). The effect was larger for people with more pronounced residual symptoms before treatment.²

Anxiety and Depression Symptoms

In research summarised by the National Center for Complementary and Integrative Health, mindfulness-based approaches reduced the severity of anxiety and depression symptoms more than usual treatment, and performed about as well as established psychological therapies.³ That is a comparison with other therapies, not a claim that mindfulness outperforms them.

Where the Evidence Is Thinner, and What Can Go Wrong

Broader claims made for mindfulness, about concentration, productivity, or general wellbeing, are far less well established than the depression relapse finding. Reviewing mindfulness across psychotherapy, Mace noted that isolating mindfulness as a distinct ingredient from everything else a therapy does remains difficult.¹

Practice is also not neutral. Across studies reviewed by the National Center for Complementary and Integrative Health, about 8 percent of participants reported a negative effect from meditation, most commonly anxiety and depression, a rate similar to that reported for psychological therapies generally.³ This is a reason to learn the practices with a clinician, not a reason to avoid them.

Chronic Pain

Mindfulness is also used in the management of chronic pain, usually as mindfulness-based stress reduction rather than MBCT. The National Center for Complementary and Integrative Health reports that mindfulness-based stress reduction and cognitive behavioural therapy both reduced pain intensity more than no treatment, with no important difference between the two approaches, and that mindfulness-based stress reduction was associated with short-term improvement in low-back pain but not in fibromyalgia pain. It also notes that the studies behind these findings were of low quality.³ The use is real and established in practice; the evidence behind it is weaker than the evidence on depression relapse, and the aim is a changed relationship to pain rather than its removal.

Mindfulness does not suit everyone. If it is not the right fit, there are other therapy techniques and tools to consider, including approaches with a different focus such as EMDR.

Conclusion

Mindfulness techniques give you a structured way of working with your thoughts and feelings. Learned with a trained professional, they are a recognised part of treatment for recurrent depression and are used alongside treatment for anxiety and stress. What they achieve varies between people, which is why the practice is worked out with a clinician rather than followed as a formula.

Key Takeaways

• Strongest for depression relapse: MBCT's clearest established use is preventing relapse in recurrent depression. It is also used alongside treatment for anxiety, PTSD, and everyday stress, where the evidence is less settled.
• Short practices are usable anywhere: Mindful breathing and the Three-Minute Breathing Space can be learned quickly and used in most settings, including in the middle of a difficult moment.
• Used within therapy: These practices are taught as part of a treatment, not instead of one, and are worked out with your therapist.
• Practice can raise distress: A minority of people report a negative effect, most often anxiety or low mood. This is worth naming with a clinician rather than pushing through alone.
• Adaptable: If sitting still is difficult, walking or short practices can replace longer sitting meditation.

FAQ

What makes mindfulness a useful tool in therapy?

It changes how you relate to your experience, so that a difficult thought or feeling can be noticed rather than immediately acted on.

How can I fit mindfulness into a busy schedule?

Start with short practices, such as the Three-Minute Breathing Space, which can be done at any point in the day.

What are simple mindfulness exercises I can start with?

Mindful breathing and the body scan are the usual starting points.

How does mindfulness relate to conditions like anxiety or PTSD?

It is used alongside treatment, to help you notice distress without being carried by it. Sustained practice can also raise distress, particularly early on and particularly where there is a trauma history, and in research reviewed by the National Center for Complementary and Integrative Health about 8 percent of participants reported a negative effect, most often anxiety or depression.³ If you live with PTSD, begin with a clinician who knows your history rather than on your own.

What are common difficulties in practising mindfulness?

Distraction is the usual one. The practice is to notice it and return your attention, without treating the distraction as a failure.

Are there mindfulness exercises that help with focus?

Mindful breathing and sitting meditation are the practices most often used for attention. Evidence for lasting gains in concentration is less established than the evidence on depression relapse.

How can I track the effect of mindfulness on my mental health?

Keep a journal of your mood, stress levels, and sleep over time, and review it with your therapist.

References

1. Mace C. Mindfulness in psychotherapy: an introduction. Advances in Psychiatric Treatment. 2007;13(2):147-154. cambridge.org
2. Kuyken W, Warren FC, Taylor RS, et al. Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials. JAMA Psychiatry. 2016;73(6):565-574. doi.org/10.1001/jamapsychiatry.2016.0076
3. National Center for Complementary and Integrative Health. Meditation and Mindfulness: Effectiveness and Safety. June 2022. nccih.nih.gov