Mindfulness-Based Interventions to Depressive Symptomatology I: Introduction, Background and Critical Analysis
The next section contains a review of relevant literature on mindfulness-based interventions to treat depression. Definitions of mindfulness are discussed in relation to their root in research. As well, mindfulness on a definitional basis is delineated from mindfulness meditation. Mindfulness is then further described in relation to comparing it to different modes of being. More particularly, mindfulness is delineated from mindlessness in order to facilitate a deeper contrasting comparison of what mindfulness entails. Then, mindfulness is discussed in relation to its origin in Eastern philosophy and its origins in Buddhism. Mindfulness viewpoints on a spiritual level from Buddhism are also discussed as opposed to merely describing definitions from a clinical standpoint. Presence of mindfulness in other religions is discussed in this review to exemplify that it is not something that has etiological roots merely in Buddhism. Then, a discussion of mindfulness-based interventions into psychology is discussed in that the clinical modalities of MBSR and MBCT that have been formulated are elaborated on.
The second section of this review then partakes in an extensive critical analysis of literature pertaining to efficacy and criticisms of mindfulness interventions to depression. The utility of mindfulness is discussed in relation to benefit for the therapist and the client as a result of augmented establishment of therapeutic alliance. As well, an elaboration of reported spiritual components of mindfulness is discussed. Studies pertaining to mindfulness tend to be devoid of this element and so the researcher felt that it was important to include reported benefits in this domain in this review. Efficacy of mindfulness was broken down into neuropsychological benefits affiliated with usage of this practice in relation to attention and concentration areas. Examining mindfulness-based applications to attention and concentration were deemed as being important to examine since they both play an integral role in depression. As well, these studies examined its implication in augmenting functioning of brain areas responsible for dysphoric mood. A specific discussion and analysis of studies pertaining to prospective efficacy of MBSR and MBCT modalities in relation to depression was then undertaken. Then, although sparseness was present in the research, an examination of mindfulness-based interventions with current depressive episodes was undertaken. Other variations of mindfulness-based interventions outside of the traditional MBCT and MBSR modalities are then discussed. Finally, the second section of this review partakes in an extensive critical analysis of criticisms that have been put forth about mindfulness-based interventions in the field of psychology as a whole and in treatment of depression.
The word mindfulness is a translation to English from the Pali language (Germer, 2004). When one is mindful, he or she is said to have his or her attention focused on the present moment and thus is not dwelling on the past or focusing on the future (Germer, 2004). Therefore, when one is mindful he or she is said to exhibit joy and possess a clear mind state (Germer, 2004). Kabat-Zinn (1994) further described mindfulness as being an attentional process through which one pays attention on purpose, within the present moment in a nonjudgmental fashion (as cited in Kabat-Zinn, 2013). Bloch, Moran, and Kring (2010) described mindfulness as being something that involves focusing one’s attention on emotions as opposed to suppression or avoidance of an emotional event. In addition to being attentive to the present moment, mindfulness also entails one being cognizant of what is occurring from one moment to the next (Germer, 2004; Kabat-Zinn, 2013; Warren, Brown & Ryan, 2003).
Mindfulness conspicuously utilizes conscious awareness as a practice in that an adherent to mindfulness-based practice uses focused sensitivity to a range of experience of very limited quality (Germer, 2004). Germer (2013) further described that when one is mindful, his or her attention is not in the past or the future and he or she is also not rejecting or trying to maintain what is taking place in the present moment. Hence, mindfulness is a state of allowing things to be. Mindfulness thus entails permitting one’s experience to be just as it is occurring in the present moment, which entails acceptance of positive and difficult experiences as they occur (Germer, 2013). Hanh (1976) further described mindfulness as a state of awareness that facilitates one having one’s consciousness awake to the current reality (as cited in Baer, 2005).
Mindfulness Versus Mindfulness Meditation
Brantley (2014) delineated that there is a distinction that exists in relation to mindfulness and meditation practice. As described, mindfulness entails one’s capacity to engage in nonjudging awareness of a reflective nature and to use a welcoming attitude. Mindfulness is described as being a quality that has availability to all human beings. Namely, this is because mindfulness is an awareness that one experiences as they are immersed in the present moment and noticing what is occurring. Hence, one does not need to engage in meditation to experience mindful moments (Brantley, 2014).
Conversely, meditation is a term that is utilized to encompass a multitude of practices (Brantley, 2014). However, in essence meditation is a practice that entails cultivation of a more focused form of attention, stronger awareness, and more understanding (Brantley, 2014). Practicing meditation allows one to train one’s mind to hone skills of attention, intention, and attitudes pertaining to being nonjudgmental and accepting (Brantley, 2014). Meditation has been further described as being a consciousness discipline (Kabat-Zinn, 2013). Namely, Kabat-Zinn (2013) opined that the state of being in waking consciousness for humans is not maximally optimal. Hence, meditation practice is thought to be a means to free oneself from distortions that occur as a result of emotional and thought processes one may possess in waking consciousness (Kabat-Zinn, 2013). Hence, in sum, the term mindfulness itself can be thought of as a psychological process in that the mind is used to gain attentional awareness (Germer, 2013). However, it can also be used as a practice, as in the form of mindfulness meditation (Germer, 2013). Additionally, it can be used to describe overall the theoretical construct of mindfulness (Germer, 2013). Mindfulness as a theoretical construct has etiological roots in Eastern philosophy which are elaborated on in subsequent sections of this review. Within mindfulness meditation, there are different forms that are taught. Namely, these forms include attention (concentration), open monitoring (mindfulness), and loving-kindness and compassion meditation (Germer, 2013). These forms will be explained further in this review.
Mindfulness and Mindlessness
To further assist in understandings of mindfulness, it is useful to compare it to its opposite of “mindlessness.” Mindfulness entails one being able to disengage from reverie within one’s meditative practice and to come back to experiencing the present moment fully (Germer, 2013). To engage in this process, one must hold the intention to disengage from one’s reverie and to replace it with an orientation of attention and awareness (Germer, 2013). Mindfulness is also described as being a tool that teaches individuals to be less reactive to what is occurring in the present moment (Germer, 2013). It is a way of relating to experience in such a way that the suffering one experiences overall diminishes and one’s sense of well-being in turn increases (Germer, 2013).
Conversely, mindlessness entails such activities as one rushing through activities without paying attention to them, failing to notice feelings of tension physically or discomfort in the body, forgetting someone’s name, being preoccupied with past or future, or mindlessly eating without being cognizant that one is eating (Germer, 2013). Hence, one can observe that mindlessness entails a lack of attentiveness to the present moment, which is often because one is preoccupied with one’s thoughts. From a Buddhist perspective, we are continually immersed in a dream-like state, mindlessness, which is limiting in nature in relation to our normal state of consciousness (Kabat-Zinn, 2005). Hence, it is thought that one can access the components that lie beneath the surface of consciousness by means of utilizing an alert interest, mindfulness, to permit what is lying beneath the surface to emerge (Kabat-Zinn, 2005).