Mindfulness in Psychology

Mindfulness is an intentional act to focus attention on the present without forming judgments. During mindfulness a person becomes more aware of their emotions and physical status.

Mindfulness is the basic human ability to be fully present, aware of where we are and what we're doing, and not overly reactive or overwhelmed by what's going on around us.

Mindfulness can be cultivated through formal meditation, but it can also be practiced in everyday activities, such as eating, walking, or working. When we practice mindfulness, we pay attention to our thoughts, feelings, bodily sensations, and surrounding environment without judgment. We simply observe what is happening, without trying to change it.

Mindfulness has been shown to have a number of benefits, including reducing stress, improving focus and concentration, and increasing self-awareness. It can also help us to cope with difficult emotions and to live more fully in the present moment.

Two Components of Mindfulness


Mindfulness strategies focus on the two components of attention and acceptance.
Attention is the focus on one's breathing, thinking, feelings, and physical sensations.
Acceptance is observing without judging that which has been observed during the attentional process. (APA, 2019)

Measuring Mindfulness

Use the links to read about scales that measure dimensions of mindfulness.

  Child and Adolescent Mindfulness Measure CAMM

  Mindful Attention Awareness Scale MAAS

Some mindfulness strategies
Find a quiet place where you won't be disturbed.
Sit in a comfortable position with your back straight.
Close your eyes and focus on your breathing.
Notice the sensations of your breath as it enters and leaves your body.
If your mind wanders, gently bring it back to your breath.

Continue to focus on your breath for 5-10 minutes.


Mindfulness Interventions
Mindfulness-based stress reduction (MBSR)- Weekly sessions or classes that teach exercises.
Mindfulness-based cognitive therapy (MBCT) - An addition of mindfulness techniques to cognitive-behavioral therapy.

Effects of Mindfulness

Representative effect sizes based on the largest number of studies were identified across a wide range of populations, problems, interventions, comparisons, and outcomes (PICOS). A total of 160 effect sizes were reported in 44 meta-analyses (k = 336 RCTs, N = 30,483 participants). MBIs showed superiority to passive controls across most PICOS (ds = 0.10–0.89). Effects were typically smaller and less often statistically significant compared with active controls. MBIs were similar or superior to specific active controls and evidence-based treatments. (Abstract, Goldberg et al., 2022)

Effect-size estimates suggested that MBT is moderately effective in pre-post comparisons (n = 72; Hedge's g = .55), in comparisons with waitlist controls (n = 67; Hedge's g = .53), and when compared with other active treatments (n = 68; Hedge's g = .33), including other psychological treatments (n = 35; Hedge's g = .22). MBT did not differ from traditional CBT or behavioral therapies (n = 9; Hedge's g = − .07) or pharmacological treatments (n = 3; Hedge's g = .13). (Abstract, Khoury et al., 2013)

Mindfulness and Relationships

Mindfulness in relationships involves a non-judgemental focusing on being together and includes an increased awareness of the other person and their needs.

Findings from this review suggest that higher levels of mindfulness, both dispositional and learned, are consistently correlated with greater relationship satisfaction. Research indicates a handful of specific mechanisms, seemingly fostered through mindfulness, that may account for the repeatedly demonstrated association between mindfulness and relationship enhancement. Proposed mechanisms that may explicate this connection are examined, including individual wellbeing, emotion skillfulness, enhancements in sexual satisfaction, increased empathy, and healthier stress responses. (Abstract, Kozlowski, 2013)

To summarize the heterogeneous quantitative literature regarding individual outcomes, mindfulness interventions for couples seem to increase mindfulness, self‐compassion, well‐being, and quality of life. Additionally, we found initial evidence of beneficial effects on relieving psychopathological symptoms and psychobiological stress measures. Measures of relationship quality were the predominant dyadic outcome. (Abstract, Winter et al., 2021)

Sexual mindfulness
Sexual mindfulness is being fully present and aware of oneself and one's partner in the moment of sexual intimacy.

Defined as present-moment, non-judgmental awareness, mindfulness skills have been incorporated into both individual and group treatment programs and found to be effective for significantly improving several domains of sexual response and decreasing sex-related distress. (Abstract, Brotto, 2013)

Mindfulness and behavioral addictions

"Results suggest that mindfulness-based interventions are effective in reducing mental distress and craving reactions. Reductions in craving levels were reported in four of six studies with biggest effects for mindfulness-based cognitive therapy and mindfulness-enhanced cognitive behavioral therapy. Successful reductions in mental distress were identified in five of seven studies that used diverse mindfulness-based techniques. However, no more than one study on mindfulness-based interventions reporting improvements in self-control, inhibitory control, maladaptive decision-making, and cognitive biases could be identified. (Abstract, Brandtner et al., 2022)

Mindfulness and Christianity

The current study incorporated explicitly religious constructs to create a Christian accommodative mindfulness (CAM) protocol that was used with a small group of Christian psychotherapy clients seeking treatment for symptoms of depression or anxiety. Shame, which is often at the root of many psychological and spiritual health conditions, was also measured as were a variety of resiliency factors to determine the effectiveness of the CAM protocol in a real-world, clinical setting. Results from this N-of-1 time-series study using five subjects revealed significant effect sizes (more than half of the total individual effect sizes measured were found to be 'very effective') that associate CAM with decreased depression, anxiety, and shame and increased resiliency measures in the sample. (Abstract, Jones et al., 2021)

References

American Psychological Association. (2019, October 30). Mindfulness meditation: A research-proven way to reduce stress. https://www.apa.org/topics/mindfulness/meditation

Brandtner, A., Antons, S., King, D. L., Potenza, M. N., Tang, Y.-Y., Blycker, G. R., Brand, M., & Liebherr, M. (2022). A preregistered, systematic review considering mindfulness-based interventions and neurofeedback for targeting affective and cognitive processes in behavioral addictions. Clinical Psychology: Science and Practice, 29(4), 379–392. https://doi.org/10.1037/cps0000075

Brotto, L. A. (2013). Mindful sex. Canadian Journal of Human Sexuality, 22(2), 63–68. https://doi.org/10.3138/cjhs.2013.2132

Goldberg, S. B., Riordan, K. M., Sun, S., & Davidson, R. J. (2022). The empirical status of mindfulness-based interventions: A systematic review of 44 meta-analyses of randomized controlled trials. Perspectives on Psychological Science, 17(1), 108–130. https://doi.org/10.1177/1745691620968771

Jones, T. L., Garzon, F. L., & Ford, K. M. (2021). Christian accommodative mindfulness in the clinical treatment of shame, depression, and anxiety: Results of an N-of-1 time-series study. Spirituality in Clinical Practice. https://doi.org/10.1037/scp0000221

Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleau, M. A., Paquin, K., & Hofmann, S. G. (2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical psychology review, 33(6), 763–771. https://doi.org/10.1016/j.cpr.2013.05.005

Kozlowski, A. (2013). Mindful mating: Exploring the connection between mindfulness and relationship satisfaction. Sexual and Relationship Therapy, 28(1–2), 92–104. https://doi.org/10.1080/14681994.2012.748889

Winter, F., Steffan, A., Warth, M., Ditzen, B., & Aguilar, R. C. (2021). Mindfulness‐based couple interventions: A systematic literature review. Family Process. https://doi.org/10.1111/famp.12683

Geoffrey W. Sutton, PhD is Emeritus Professor of Psychology. He retired from a clinical practice and was credentialed in clinical neuropsychology and psychopharmacology. His website is  www.suttong.com

 

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Psychotherapy and Counseling

Most people do not distinguish between the concepts psychotherapy and counseling. Psychotherapy is a working communication relationship between two people--a clinician and a person seeking help. The kinds of help provided vary with the clinician but commonly include strategies for relieving emotional distress, solving or coping with life problems (e.g., grief, couple or family relationships, school or career decisions), and changing thoughts and behavior patterns that interfere with adapting to and enjoying life.

In the past, psychologists, psychiatrists, and social workers provided psychotherapy. Counselors, some nurses, and some clergy provided counseling. Nowadays, clinicians use both terms. Most providers are licensed or certified to provide the services they advertise. Psychiatrists are physicians. Psychologists hold doctorates in psychology (some hold a master's degree). Other clinicians usually hold at least a master's degree.

I was a psychotherapist for many years. Like others of my era, we went to conferences, watched demonstrations, and read books in an effort to become better therapists. Many of us had years of supervision during school and after graduation. We believed that new research would uncover effective treatments or new components of treatments that would help our clients get well.

Several other factors came into play: medications and managed care.

As medications became more specific for the treatment of common conditions like depression and anxiety, I and others began to wonder about the value of psychotherapy- especially if medication was better or equal to psychotherapy and cost less. In this light, I began to take courses in psychopharmacology in the hope that psychologists could prescribe medication. I worked with others to pass legislation before I decided to retire from psychotherapy.

The second factor was the emergence of managed care insurance companies that gained control of approving psychotherapy visits. Approvals required increasing amounts of paperwork and the payment to clinicians was drastically reduced. For therapists trained in cognitive-behavioral approaches like myself, it was no big deal to provide treatment goals, document interventions, and provide data. Indeed, we considered this "scientific approach" the only way to do psychotherapy. The hassle was mostly dealing with approvals and different forms from different insurance companies.

Psychotherapy Works

On average, a person who participates in psychotherapy is better off than about 79% of people who do not get treatment.

This statistic is based on an average effect size of .80 in treatment studies reported by Bruce Wampold, “The research evidence for The common factors models: A historically situated Perspective.” 2010, p. 55.

  

Psychotherapists still care a lot about effective interventions. But what we have learned is that there are other factors at work when people get well. Psychotherapy works. Psychotherapy can be powerful. But it's not always a particular treatment technique that works. Instead, psychotherapy works based upon several interactive components.

The secret sauce in psychotherapy is the whole package consisting of five active ingredients.

Remembers the five factors by the acronym PRICE.

PRICE =  Psychotherapists, Relationship, Interventions, Clients, Extratherapeutic.

Psychotherapists

The fact is, some clinicians are better than others. We know that and yet you do not hear much about it. It's difficult to isolate specific factors. But in common experience we know people who are warm, inspiring, and full of hope. Their enthusiasm can be catching. We also know people who are dull and boring or who appear cold and aloof. Some psychotherapists are also brilliant and full of creative ideas-others not so much.

Findings from the work of Carl Rogers still make sense about the need for a warm and caring psychotherapist. Psychotherapists are also responsible for setting expectations. Expectations are important to outcomes. Psychotherapists are not equally effective. More research is needed on the therapist as a highly important factor.

Relationship (therapeutic or working alliance)

The relationship between a psychotherapist and a client is a critical component in treatment. Many effective outcomes can be traced to the connection made at the first session. As in any endeavor in life involving two or more people, a working relationship is important to success. Research suggests that an effective working alliance depends on the therapist and agreement on the treatment goals and procedures.

Interventions/Treatment

Treatment does matter in the context of the other factors. But often a specific type of treatment can be as good as another if the therapist is skilled at the intervention and an organized approach is employed. It's also important that both psychotherapist and client collaborate in the process. The fact that different interventions work suggests there is something about the confidence therapist and client place in the explanation and activities.

Clients (or Patients)

 More research is needed about the role of clients in successful outcomes. But we do know that some client characteristics are important. Level of motivation, personality factors, and attachment history are a few factors linked to outcomes. What's highly important is their participation according to Orlinsky and colleagues. Clients are agents who actively shape therapy as they interact with a therapist.

Clients are better at determining successful outcomes than are therapists. Getting client feedback is important to evidenced-based practice.

Extratherapeutic factors

This is a catchall term for things that happen in life, which can be linked to outcomes. Changes in general health, jobs, relationships, and many other aspects of life can make a significant difference in how people fare during a course of psychotherapy. These factors are beyond the control of the psychotherapist but must be kept in mind if we are to be honest about the role of psychotherapy.

Perspective on Medicine

I continue to be in awe of the advances made in modern medicine. I am glad for the progress that helps so many of us live better and longer lives with less pain than in the recent past. There is no reason to detract from the medical model.

But there is reason to realize the important role of psychological factors in wellness overall and in the treatment of those conditions considered psychological (e.g., depression, anxiety). The fact is, at this point in time, psychotherapy is more effective than some medications. And that relationship factors between physician and patient are important for outcomes in general health as well.

Note
I no longer provide psychotherapy. I write, give talks, and consult on research projects

References

To read more, see the edited work by B. L. Duncan and others The heart and soul of change: Delivering what works in therapy (2nd ed.).  Washington, DC, US: American Psychological Association.

For an important summary:

Orlinsky, D. E., Ronnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy
process-outcome research: Continuity and change. In M. J. Lambert (Ed.),
Bergin and Garfield's handbook of psychotherapy and behavior change (5th ed.,
pp. 307-390). New York: Wiley.

Other related research

Sutton, G. W., Arnzen, C., & Kelly, H. (2016). Christian counseling and psychotherapy: Components of clinician spirituality that predict type of Christian intervention. Journal of Psychology and Christianity, 35, 204-214. Academia Link    ResearchGate Link

Sutton, G. W., Kelly, H., Worthington, E. L. Jr., Griffin, B. J., & Dinwiddie, C. (2018) Satisfaction with Christian Psychotherapy and Well-being: Contributions of Hope, Personality, and Spirituality. Spirituality in Clinical Practice, 5 (1), 8-24, doi: 10.1037/scp0000145  Academia Link    ResearchGate Link

Connections

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FACEBOOK   Geoff W. Sutton

TWITTER  @Geoff.W.Sutton

LinkedIN Geoffrey Sutton  PhD

Publications (many free downloads)

     

  Academia   Geoff W Sutton   (PhD)

     

  ResearchGate   Geoffrey W Sutton   (PhD)