Clinical Handbook of Mindfulness by Jon Kabat-Zinn, Fabrizio Didonna Page B
Authors: Jon Kabat-Zinn, Fabrizio Didonna
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stimulus and response in classical and operant conditioning. The second wave was
cognitive–behavior therapy , which works to change the content of our
thoughts to alter how we feel. The current “third wave” is mindfulness-
and acceptance-based therapy . Researchers such as Steven Hayes, the
founder of Acceptance and Commitment Therapy, discovered mindfulness-
and acceptance-based treatment strategies while looking for novel solutions
to intractable clinical dilemmas. Others, such as Marsha Linehan, who devel-
oped Dialectical Behavior Therapy, had a personal interest in Zen Buddhism
and sought to integrate principles and techniques from that tradition into
clinical practice. We are now in the midst of a fertile convergence of modern
scientific psychology with the ancient Buddhist psychological tradition.
In the new mindfulness and acceptance-based approach, therapists help
patients shift their relationship to personal experience rather than directly
challenging maladaptive patterns of thought, feeling, or behavior. When
Chapter 1 Mindfulness
25
patients come to therapy, they typically have an aversion to what they are
feeling or how they are behaving—they want less anxiety or less depression,
or want to drink or eat less . The therapist reshapes the patient’s relationship
to the problem by cultivating curiosity and moment-to-moment acceptance
of uncomfortable experience.
For example, a panic patient, Kaitlin, spent the previous 5 years white-
knuckling the steering wheel of her car while driving to work. She was
doing all the traditional behavioral strategies: She exposed herself to high-
ways and bridges, she practiced relaxation, and she could effectively talk
herself out of her fear of dying from a heart attack. Still, Kaitlin wondered
aloud, “Why the heck do I still suffer from panic?” The answer is that Kaitlin
never learned to really tolerate anxiety itself . She was always running away
from it. She needed the missing link that the third generation of behavior
therapies addresses—learning to accept inevitable discomfort as we live our
lives in a meaningful way.
Another arena of research that is fueling interest in mindfulness is brain
imaging and neuroplasticity. We know that “neurons that fire together, wire
together” (Hebb , 1949, in Siegel, 2007) and that the mental activity of meditation activates specific regions of the brain. Sara Lazar et al. (2005) demonstrated that brain areas associated with introspection and attention enlarge
with years of meditation practice. Davidson et al. (2003) found increased activity in the left prefrontal cortex following only 8 weeks of mindfulness
training. The left prefrontal cortex is associated with feelings of well-being.
Increased activity in this part of the brain also correlated with the strength of
immune response to a flu vaccine. More dramatic changes could be found in
the brains of Tibetan monks who had between 10,000 and 50,000 hours of
meditation practice (Lutz, Grelschar, Rawlings, Richard, & Davidson, 2004).
The evidence from scientific studies is validating what meditators have
long suspected, namely that training the mind changes the brain (Begley,
2007). We are now beginning to see where and how much change is possible.
Furthermore, the changes that occur in the brain when we are emotionally
attuned to our own internal states in meditation seem to correlate with those
brain areas that are active when we are feeling connected to others (Siegel,
2007)—sugg esting that therapists can train their brains to be more effective therapeutically by practicing mindfulness meditation.
Practical Applications for Psychotherapy
Psychotherapists are incorporating mindfulness into their work in many
ways. We might imagine these on a continuum, from implicit to explicit
applications—from those hidden from view to those that are obvious to the
patient.
On the most implicit end is the practicing therapist . As
cognitive–behavior therapy , which works to change the content of our
thoughts to alter how we feel. The current “third wave” is mindfulness-
and acceptance-based therapy . Researchers such as Steven Hayes, the
founder of Acceptance and Commitment Therapy, discovered mindfulness-
and acceptance-based treatment strategies while looking for novel solutions
to intractable clinical dilemmas. Others, such as Marsha Linehan, who devel-
oped Dialectical Behavior Therapy, had a personal interest in Zen Buddhism
and sought to integrate principles and techniques from that tradition into
clinical practice. We are now in the midst of a fertile convergence of modern
scientific psychology with the ancient Buddhist psychological tradition.
In the new mindfulness and acceptance-based approach, therapists help
patients shift their relationship to personal experience rather than directly
challenging maladaptive patterns of thought, feeling, or behavior. When
Chapter 1 Mindfulness
25
patients come to therapy, they typically have an aversion to what they are
feeling or how they are behaving—they want less anxiety or less depression,
or want to drink or eat less . The therapist reshapes the patient’s relationship
to the problem by cultivating curiosity and moment-to-moment acceptance
of uncomfortable experience.
For example, a panic patient, Kaitlin, spent the previous 5 years white-
knuckling the steering wheel of her car while driving to work. She was
doing all the traditional behavioral strategies: She exposed herself to high-
ways and bridges, she practiced relaxation, and she could effectively talk
herself out of her fear of dying from a heart attack. Still, Kaitlin wondered
aloud, “Why the heck do I still suffer from panic?” The answer is that Kaitlin
never learned to really tolerate anxiety itself . She was always running away
from it. She needed the missing link that the third generation of behavior
therapies addresses—learning to accept inevitable discomfort as we live our
lives in a meaningful way.
Another arena of research that is fueling interest in mindfulness is brain
imaging and neuroplasticity. We know that “neurons that fire together, wire
together” (Hebb , 1949, in Siegel, 2007) and that the mental activity of meditation activates specific regions of the brain. Sara Lazar et al. (2005) demonstrated that brain areas associated with introspection and attention enlarge
with years of meditation practice. Davidson et al. (2003) found increased activity in the left prefrontal cortex following only 8 weeks of mindfulness
training. The left prefrontal cortex is associated with feelings of well-being.
Increased activity in this part of the brain also correlated with the strength of
immune response to a flu vaccine. More dramatic changes could be found in
the brains of Tibetan monks who had between 10,000 and 50,000 hours of
meditation practice (Lutz, Grelschar, Rawlings, Richard, & Davidson, 2004).
The evidence from scientific studies is validating what meditators have
long suspected, namely that training the mind changes the brain (Begley,
2007). We are now beginning to see where and how much change is possible.
Furthermore, the changes that occur in the brain when we are emotionally
attuned to our own internal states in meditation seem to correlate with those
brain areas that are active when we are feeling connected to others (Siegel,
2007)—sugg esting that therapists can train their brains to be more effective therapeutically by practicing mindfulness meditation.
Practical Applications for Psychotherapy
Psychotherapists are incorporating mindfulness into their work in many
ways. We might imagine these on a continuum, from implicit to explicit
applications—from those hidden from view to those that are obvious to the
patient.
On the most implicit end is the practicing therapist . As
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