Mindful Breathing and EMDR

An ongoing discussion in the Mindfulness and Psychotherapy Study Group has investigated the similarities of mindfulness-based psychotherapy and EMDR.  We've noted that the EMDR protocol asks the client to become deeply aware of present moment experiences, including thoughts, feelings, and bodily sensations, and to track those experiences as they change over time.   Clearly, in this moment-by-moment awareness, a substantial degree of mindfulness is being elicited in EMDR treatment.  Even the act of tracking a moving finger with the eyes requires a sustained contact with present moment visual sensation, and can be considered a mindfulness practice.

Now, there is some interesting research exploring the therapeutic mechanisms in both EMDR and mindfulness practice.   Marcel van den Hout and colleagues (2011) have just published a paper whose title says it all: "EMDR and mindfulness: Eye movements and attentional breathing tax working memory and reduce vividness and emotionality of aversive ideation."

This study demonstrated that putting one's attention on either breathing or eye movement essentially takes up some of the available mental bandwidth.  The authors at Utrecht University suggest that this is a possible explanation for the increased emotional stability found in mindfulness and EMDR practices.  While attending to breathing or eye movements, they argue, we just don't have the mental capacity to pay as much attention to emotions or distressing imagery.  They found that breathing and eye movements taxed working memory to the same degree, and had similar (but not identical) effects on a person's experience of emotional distress.

This makes a lot of sense, and this finding dovetails with another discussion we have been having, about the way the brain processes different kinds of information.  We know from the work of Farb and colleagues (2007) that different areas of the brain are involved in processing sensory experience and abstract thought or imagery.  Thus, adding eye movements or mindful breathing to an emotional experience would shift the location of brain activity away from the "narrative" areas responsible for "aversive ideation," and instead engage areas dedicated to a more sensory level of processing.  With a greater "experiential focus," we are less able to generate an emotionally reactive state because we are more grounded in the realistic, sensory, and non-ideational level of experience.  It may be that the stabilizing effects of mindful breathing or eye movements come not simply by "overloading" the brain's information processing capacities, but by actually processing experience in a different way.

Buddhist psychology (or what modern psychology is beginning to refer to as the "Buddhist Psychological Model") suggests that mindfulness keeps us in contact with things as they really are by interrupting the processes of mental proliferation that create misunderstanding and reactivity.   In mindfulness, we are grounded in what is "really real," as it were, and less carried away in our imagination, prejudice, and reactivity.  Current scientific research into the psychology of mindfulness is beginning to suggest ways in which this process is supported at a neurobiological level.  In future discussions in the study group, we will be exploring ways to bring this scientific knowledge into the consulting room, and find more effective ways of modelling and evoking mindfulness in the therapeutic relationship.

Mindful Attention and Mindful Intention

In our study group on mindfulness and psychotherapy last Friday, we had an interesting discussion about the qualities of mindful attention. We were exploring the difference between concentration practices and mindfulness, and I'd like to continue that investigation here. Please feel free to add your own comments at the end of this post.

Concentration on a single subject is a practice that typically results in calming, or the stabilization of attention. This is a necessary condition of mindfulness, because without stability, our minds will engage in their default activity of generating and exploring myriad associations, and it will be very easy to be distracted or preoccupied. When we temporarily narrow the scope of attention to our breathing and our posture, we also cease following distracting thoughts and experiences. The mind stabilizes, just as a glass of cloudy water will clear if we just set it down and refrain from agitating it. When we are stable, we become less reactive, and we experience that state as emotional calmness and mental clarity.

We might draw distinctions between stabilizing practices, which usually involve narrowing attention, and mindfulness practices, which might encompass a much broader field. But I think it is misleading to carry this too far. It's more accurate to say that in mindfulness, attention acquires a degree of flexibility, as well as stability. Mindfulness is better defined by the intention to be welcoming toward any experience than by the broadness or narrowness of the attentional scope at any given moment.

Our mindfulness may lead us to inspect a certain phenomenon quite intensely (we might mindfully study a flower, for example) without ignoring other phenomena arising in the present moment. Thus, our encounter with the flower might also evoke an awareness of the sun, rain, and soil that have nourished this flower, its place in the web of life, and even the stretch we feel in our back muscles as we bend over to smell it. We cultivate an openness to all these thoughts and experiences, even though they go beyond what we normally think of as "flower." In many mindful activities, attention might be given to both the universal and the particular, enriching our experience of ourselves in the world. Because we have the intention to welcome our experience, our awareness is multifaceted and our insight is deepened; because we have stability, we are not instantly carried away into distracting and irrelevant thoughts.

What happens if, in the middle of our flower mindfulness, we think of an "irrelevant" thing? What if we notice we are hungry? Without stability, we might reflexively and automatically start walking to the kitchen, thinking of what we will make for lunch, and of the tasks that we will have to accomplish when we finish our meal. We might imagine the person we expect to see at one o'clock, generate images of what he might say to us, and start thinking of what we will say in return. In that process, we might well fail to notice the warmth of the sun on our skin, or the coolness of the breeze. I think we could all agree that, somewhere along the line, our mindfulness was lost.

Alternatively, with stability, when we notice our hunger we might consciously decide to go to the kitchen for lunch, notice the slight feeling of regret we have in putting aside our flower meditation, recognize the food we will eat for lunch depended on the very same earth, rain, sun, and air we noticed as we reflected on the flower, feel our feet contacting the earth as we walk, an notice our own connectedness with the web of being. We might be grateful that we have a nice garden to walk in, and we might notice a desire to take care of it, and to share the experience with others.

Clearly, in this example, mindfulness has continued, evolving with our changing experience. I think it's useful to characterize the mindfulness process as one of both stability and flexibility. Both of these qualities depend on the intention to be mindful. Later in the study group, we will turn to the question of how we nourish that intention, in ourselves and our clients.

Conversational Mindfulness

Image via WikipediaIncreasingly, therapists are becoming interested in encouraging mindfulness, in themselves and their clients. Research has suggested that people in therapy benefit from their own mindfulness practice, and they also benefit from their therapist's mindfulness practice. Some studies have even found better outcomes in psychotherapy when the therapists have a personal mindfulness practice. Steven Hayes, the founder of ACT, believes that therapists must be acting from their own mindfulness in order to be truly helpful to others.

An interesting question comes up: How can we assess the current level of mindfulness of someone we are talking to? Are there things that occur in our conversations that increase or decrease mindfulness?

One way to approach the evaluation of mindfulness is to describe how a person is paying attention. In order to accomplish this, we have to describe mindfulness as it manifests in our typical conversations, with the data that is accessible to an observer. Consider this common type of interaction: someone is telling you what happened when they talked to their sister yesterday. How could we determine whether the story-teller is being mindful? Here are some thoughts about principles, and examples to help in that assessment.

• Mindfulness is non-defensive. It does not attempt to refuse any experience. Mindfulness is accepting, and not reflexively judgmental. As a listener, you might pay attention to whether your comments responded to, or are they ignored or deflected?
• Mindfulness is here and now attention. So in our hypothetical situation, does the story-teller have any awareness of the here and now communication (including you in the conversation, asking your opinion, questioning whether you understand, vs just narrating; making eye contact; talking about feelings or thoughts in the present while telling the story). Subjectively, do you as the listener feel engaged and present? That's a pretty good indication of whether you are being seen by the speaker.
• Mindfulness does not confuse the nature of experience. When we are remembering an interaction with our sister, we're aware that we are engaged in remembering. When we're talking to someone, we are aware we are talking to someone.
  
• Mindfulness does not over-identify with any experience. We do not confuse mental states with external realties (cognitive fusion). Instead of saying things like "I'm a terrible person," the mindful speaker would say "I felt critical of myself."
• Mindfulness is flexible and not preoccupied. Is the narrative characterized by black and white thinking or dogmatic assertions?
  

What could we do to support mindfulness during this hypothetical conversation?

• Listen actively. Helping a person engage with you will bring their awareness into the present.
• Ask questions about current thoughts or feelings (I see you felt very angry when she said that. As you look at your feelings now, do you still feel angry? Are there any other feelings?)
• Bring the person’s attention to something in the present-moment conversation (the person's mood, changes in posture, etc.)
• Process something in the here-and-now interaction (how did you feel when I asked you that question?)
• Support their awareness of breathing, especially if they are uncomfortably "carried away."
• Bring the person’s attention to a cognitive fusion ("You mentioned that you hate your job, but I wonder if what you actually hate is the way you are approaching your job.")

Learning to be mindful in a conversation is a crucial social skill. Many of us have the habit of not listening while we are talking, and our relationships can suffer as a result. Mindfulness could reverse that pattern. Also, when we consider that insight depends on the ability to observe oneself non-judgmentally, learning to be mindful in our conversations can increase the chances of learning something about ourselves in real time.

Acceptance, Avoidance, Attention, and Wisdom

Image via WikipediaIn this week's study group, we were delighted to have a visit from Delany Dean, Ph.D., who was in Chicago presenting her Mindfulness Based Wellness research at the APS conference. A very interesting thread of the discussion took up the issue of attention regulation and avoidance, and I'd like to explore it at greater length here.

The basic instruction for mindfulness meditation often asks the meditator to keep her attention on the breath. Inevitably, the mind will wander on some way, and will perhaps become absorbed for many minutes in some topic. When we notice this happening, we are to gently return our attention to the breath, in a non-judgmental fashion. This process may be repeated dozens of times in a meditation session.

This process is often discussed as a kind of attentional training: learning to notice when our attention has wandered to some unintended subject, and making a conscious choice to redirect our attention away from the "accidental" topic and back to the "intended" topic, the breath.

The question comes up: could mindfulness of the breath be used as a distraction from something that we would rather not think about? If we engage in conscious breathing during the day, especially in stressful or difficult experiences, are we subtly engaging in an avoidance process which is not essentially different from other avoidance activities like watching TV or smoking a cigarette. In other words, can mindfulness training help us to become very skillful at avoiding experiences we'd rather not have?

There is, in fact, a kind of attention to breathing that I call "lifeboat breathing." This is something that we might do when we have had a very challenging and nearly overwhelming experience (like a panic attack): we pay attention to our breathing as a way to exclude certain other experiences from our consciousness. In psychology, we've know about the process of Reciprocal Inhibition for decades now. Engaging in some activities or responses makes it impossible to engage in certain other activities. We cannot be tense when we relax our muscles, for instance. In difficult emotional storms, it is possible to cling to an awareness of our breathing as a way of saving ourselves from an experience that threatens to overwhelm us. Being completely focused on the breath, there really isn't room to also engage in whatever cognitive processes that were so threatening. And so, the breath becomes a temporary lifeboat in a stormy sea.

All avoidance strategies regulate awareness (they would be useless if they didn't). What differentiates mindfulness from the simple avoidance of unwanted experiences? How is mindfulness different from taking a walk or binge eating?

I personally am skeptical of the almost universally accepted idea that mindfulness can be easily defined as a way of paying attention. We say (somewhat misleadingly) that mindfulness is a way of paying attention in the present, for example. But awareness is always in the present. There is absolutely no way to be aware of the past or future. Being "in the present" does not differentiate mindfulness from any other kind of attention or any other human activity. When we say "Pay attention to present moment experience" we are speaking metaphorically, and not scientifically.

So what do we really mean when we say "I'm not in the present moment?" We mean we have become confused about the real nature of our mental processes. We are engaged in thinking (possibly about something that we are imagining as "the future") in a way that obscures the fact that we are just thinking. And so mindfulness is not "coming into the present" (we have never left the present) but coming into a different relationship with our thoughts (we understand them as thoughts and not realities).

The breath is a great help in the process of coming into a realistic understanding of what we are doing, because we very rarely get confused about our breathing. We have absolutely no interest in our past breathing, and are unlikely to become preoccupied with it. In order to pay attention to an outbreath, we have to relinquish our preoccupation with the inbreath. But in mindfulness, the point of attending to our breath is not simply to be aware of the sensations of breathing in, but to know that we are breathing in while we are doing it. And mindfulness of thinking or feeling is a process of knowing our experience to be what it is, just thinking or just feeling, as it is happening.

In mindfulness, our intention is to be open to any experience and to know it for what it is. It seems to me that the curative and liberating power of mindfulness is not the result of simply having greater control over our attention. It is deeply involved with having more wisdom and compassionate insight into the true nature of our experience.

This is a very broad and complex topic, and I don't pretend to have a complete grasp of it, but I would like to assert a few propositions about mindfulness for the purpose of continuing the discussion.

• Mindfulness is essentially a process of reminding ourselves of the reality of our life.
• Mindfulness is a way of developing wisdom (disengaging from our illusions) about our experience.
• Mindfulness is more like waking from a dream than learning to pay attention to some other element of a dream.

Not very scientific, possibly, but I hope an interesting starting point for further discussion.