Mindfulness-Based Psychotherapy: Zen and Now

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When it comes to mindfulness-based therapy, it’s a true case of what’s old is new again.

Mindfulness-based treatments have been described as psychotherapy’s “third wave,” coming on the heels of behaviorist approaches and cognitive interventions, respectively. While seemingly new, mindfulness can be traced back to antiquity. Current secular approaches are clinical adaptations of wisdom and techniques that have existed since at least the time of the Buddha, several hundreds of years before the birth of Christ.

My personal interest in mindfulness—using mindfulness meditation to improve well-being—grew out of work treating clients with substance use disorders. The “Big Book” of Alcoholics Anonymous famously describes people with addiction as “restless, irritable, and discontented,” and I needed a larger repertoire of tools for dealing with these symptoms. I quickly discovered that I could use mindfulness approaches to help address other mental disorders and run-of-the-mill problems of living.

What is Mindfulness?

The mind is a chaotic place with thoughts, emotions, impulses, and sensations flitting across the screen of consciousness. Although they are harmless in themselves, we can become absorbed in these private experiences and bring ourselves unhappiness. This normal human condition can become magnified in pathological states, and lead to such problems as depressive rumination, anxious perseveration, or catastrophizing.

Authors Ruth A Baer and Jennifer Krietemeyer describe mindfulness as a way of directing attention (Baer RA, ed. Mindfulness-Based Treatment Approaches. Burlington, MA: Academic Press, 2006:3–27). Using mindfulness meditation, we try to become a dispassionate observer of our private experiences and outer circumstances and simply accept things as they are. This “choiceless awareness” keeps us grounded in the present and prevents us from falling into familiar but painful cognitive and emotional ruts.

Treatment Paradigms

Mindfulness-based psychotherapies have proliferated in recent decades. We now have mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-based relapse prevention, mindfulness-based childbirth and parenting, and mindfulness-based eating awareness training. All of these are psychotherapies in which mindfulness is the principal component, and other aspects of therapy are embedded within the mindfulness training. In addition, there is acceptance and commitment therapy (ACT), and dialectical behavior therapy (DBT), two psychotherapies in which mindfulness is a component that serves a role to varying degrees. For more information about ACT, see “Acceptance and Commitment Therapy: A Different Approach.”

All of these models include mindfulness practices that are combined with additional content and exercises particular to the symptoms and disorders being treated. Many paradigms were originally developed to help treat a specific condition, but have since been applied to other mental disorders.

Does it Work?

Mindfulness-based psychotherapies have been successfully used for a wide variety of mental disorders, medical conditions, and social problems in children through older adults. Readers are encouraged to explore the comprehensive evidence base compiled by Baer and the many contributing authors to the book, Mindfulness-Based Treatment Approaches (op cit).

On a more general level, being situated in the present moment is highly correlated with self-reported well-being. This was demonstrated in a 2010 study conducted by Harvard University psychologists (Killingsworth MA and Gilbert DT, Science 2010;330(6006):932).

Their study used an iPhone app to gather about 250,000 data points about subjects’ thoughts, feelings, and activities as they went about their daily lives. These were acquired real-time from 5,000 people in 83 countries. Study participants reported above average happiness when their minds were not wandering compared to when they were engaged in various forms of wandering. Moreover, researchers found that participants’ mental state (mind wandering versus not wandering) was a better predictor of their happiness than the activities they were doing.

They concluded that “a human mind is a wandering mind, and a wandering mind is an unhappy mind. The ability to think about what is not happening is a cognitive achievement that comes at an emotional cost.” This is perhaps the most compelling experimental evidence of the beneficial effects of being present-focused or mindful.

The most effective way for clinicians to begin integrating mindfulness into therapy is to practice mindfulness themselves. One of the best places to start is with non-technical books and resources. You will find some accessible titles that you can also recommend to clients in the resource box below.

For an expanded look at the evidence, see “What the Research Reveals About Mindfulness-Based Therapy.”

TCRBH’s Take: One way in which mindfulness approaches differ from many other therapeutic approaches is that talking about problems is a peripheral, rather than a central, part of treatment. The psychologist Gordon Paul’s classic question, ‘‘What treatment, by whom, is most effective for this individual, with that specific problem, and under which set of circumstances?’’ is certainly relevant when it comes to the use of mindfulness approaches. Benefits may be limited when applied with individuals for whom an experiential focus is (and remains) unappealing. For others, however, a mindfulness approach may provide an opportunity for change that transcends the change that would be achieved through other therapeutic interventions.

Additional Resources


  • Awareness by Anthony de Mello, New York, NY: Doubleday, 1990.
  • How to Train a Wild Elephant by Jan Chozen Bays, Boston, MA: Shambhala Publications, 2011.
  • Mindfulness for Beginners by Jon Kabat-Zinn, Louisville, CO: Sounds True, 2012.
  • The Miracle of Mindfulness! by Thich Nhat Hanh, Boston, MA: Beacon Press, 1976.
  • The Power of Now by Eckhart Tolle, Vancouver: Namaste Publishing, 1997.
  • Zen Mind, Beginner’s Mind by Shunryu Suzuki, Boston, MA: Weatherhill, 1970.

Multimedia Resources

<p style="font-size:" -1em;"="">Source: David A. Frenz, MD, medical director, addiction medicine, HealthEast Care System, St. Paul, Minnesota.