Guest Column By Anne Fletcher
Long ago, folks who knew and cared about me suggested that I try meditation and relaxation exercises. I always laughed it off, saying I was too anxious and couldn’t sit still long enough to follow through. When I developed hypertension despite being quite fit and trim, the late Alan Marlatt, Ph.D., my friend and the founder of the Addictive Behaviors Research Center at the University of Washington – one of the first experts to study the possible benefits of mindfulness meditation for individuals with addiction – said, “Through mindfulness, I might be able to help you control your blood pressure without medication.” I wasn’t ready and, quite honestly, was skeptical.
Things changed about a year ago when, to diversify my exercise routine and help my aching back, I began taking yoga classes. As a longstanding avid exerciser and former jogger, I didn’t perceive yoga as real exercise. To my surprise, the first class gave me quite a workout. Equally unexpected, the mindfulness component began to take hold of me. The instructor’s interjections such as, “Calm your mind,” “Let go of thoughts about what you have to do later,” “Focus on your breathing,” and “This time is just for you,” calmed me in a way that I’d been unable to achieve on my own. Shortly thereafter, a visit from my sister (who’d been practicing mindfulness for some time) turned me around when she called to my awareness that I was almost never “in the moment.” Most of my time was spent in the “woulda, coulda, shoulda, gonna” mode.
Several months later, I began working at an outpatient clinic specializing in helping people with substance use and co-occurring mental health disorders, where clients are offered a daily session of meditation. As part of my training, I was expected to observe and participate in groups where meditation and other mindfulness practices are offered. It didn’t take long to witness the benefits for clients, who often report that of the many skills they learn, meditation is the most beneficial. Soon, I began to experience life in a different way.
What is Mindfulness?
“Mindfulness is awareness of present experience with acceptance,” states Harvard psychologist Ron Siegel, Psy.D., author of The Mindfulness Solution. Given that our minds tend to focus on the past or on the future, mindfulness helps us learn to be in the here and now. Sometimes mindfulness can be better understood in terms of what it is not, which helped me “get it” better, as explained by Livingwell.org with examples of mindlessness:
- Breaking or spilling things, clumsiness, having accidents because of carelessness
- Forgetting someone’s name as soon as you hear it
- Listening to someone but not really paying attention
- Getting lost in your thoughts and feelings
- Running on autopilot
- Being preoccupied with the future or the past
- Eating without being aware of eating
- Having periods of time where you have difficulty remembering the details of what happened
- Distracting yourself with things like eating, alcohol, drugs, pornography, and excessive work
Sometimes, mindfulness and meditation are confused. Meditation is a form of mindfulness and the main tool that’s taught and practiced to become more mindful. But mindfulness can be practiced inside or outside of formal meditation. Siegel uses an analogy to physical fitness to pave the way to mindfulness by saying that if you were trying to get into shape, you might start by taking stairs instead of elevators and parking your car a distance from buildings. Similarly, mindfulness could begin with paying more attention to day-to-day activities, like brushing your hair or taking a shower or bath, really tuning in to each step. To progress, if you wanted to become more fit, you might begin walking 20 minutes each day or take a low-level exercise class three times a week.
The mindfulness analogy could be taking time out of your routine to begin formal meditative practices, either alone or in a class, several times a week or for a short time each day. Plenty of meditation resources are available on the Internet and for downloading onto cell phones.
Mindfulness activities outside of meditation can also include short exercises with the senses – for instance, undistracted observation of the natural world, such as spending several minutes observing a flower, insect, cloud formation, or a running stream. Another exercise is mindful listening to music, allowing yourself to become fully immersed and lost in the experience.
Research on Mindfulness for Treating Substance Use Disorders
Years ago, shortly after “Sober for Good” was published, I was fortunate to do some workshops with Dr. Marlatt, when he presented his early findings demonstrating that meditation with prisoners could reduce cravings and substance use following release from custody. Mindfulness meditation for substance use disorders (SUD) trains people to focus their attention on emotions, thoughts, and sensations occurring in the present moment and to develop a nonjudgmental attitude toward these experiences. Such controlled attention can be taught and learned through meditation – hence “mindfulness meditation.” Benefits may include self-observation of desires and plans to obtain and use substances, detaching from their emotional pull. Mindfulness-based practices help to foster awareness of environmental cues and internal thoughts and feelings that have previously triggered drug and alcohol use, interrupting the habit of turning to substances and also enhancing the ability to tolerate distressful experiences that might lead to wanting to “escape” by getting high.
As noted in a 2014 review of the scientific literature on the efficacy of mindfulness-based interventions for substance use disorders (SUD), recent findings from neuroimaging studies suggest that such practices may lead to significant changes in brain structure and activation that have been associated with reduced mental ruminations (replaying something over and over in your mind) and, thus, with a lower likelihood of recurrence of relapse. Published in Substance Use & Misuse, that review of research (including 24 publications through 2011 that the authors deemed of suitable quality) concluded that the evidence suggests that mindfulness-based interventions can reduce consumption of alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates to a significantly greater extent than waitlist controls, general educational support groups, and some specific control groups. They noted, however, that larger, more rigorous randomized controlled studies are needed.
Marlatt’s group at the University of Washington went on to show in a number of studies that an 8-week, outpatient group approach incorporating mindfulness meditation practice was a feasible and effective approach for people after they complete intensive treatment for substance use disorders. The mindfulness-based relapse prevention manual that he co-authored with psychologists Sarah Bowen and Neharika Chawla is used in treatment programs across the U.S. and internationally. Just last year (after the review above was concluded), this group published the first randomized controlled trial comparing aftercare that included either mindfulness-based relapse prevention, relapse prevention, or “treatment as usual” (abstinence/12-step-based groups with facilitated recovery-oriented discussions) on 12-month outcomes of 286 people who had already completed substance use treatment.
Based on their findings, published in JAMA Psychiatry, the authors concluded that at 6-month follow-up, compared with treatment as usual, the relapse prevention and mindfulness approaches produced significantly reduced relapse risk to drug use and heavy drinking. Relapse prevention delayed time to first drug use, with both relapse prevention and mindfulness participants who used alcohol also reporting significantly fewer heavy drinking days compared with traditionally treated participants. At 12-month follow-up, the mindfulness approach offered added benefit over the other two treatments in reducing drug use and heavy drinking. The authors stated, “Targeted mindfulness practices may support long-term outcomes by strengthening the ability to monitor and skillfully cope with discomfort associated with craving or negative affect, thus supporting long-term outcomes.”
Although the mindfulness intervention does require training and personal practice on the part of clinicians, Dr. Bowen, lead author of this study said, “I have worked with hundreds of therapists who are frustrated with standard cognitive-behavioral relapse prevention models and find the mindfulness training and new way of working to be exciting and revitalizing. They see very different responses from their clients. For them, it’s worth it. We’re not suggesting that relapse prevention be replaced with mindfulness based relapse prevention – we’re offering another approach which may be more attractive and effective for some individuals.”
How Mindfulness is Changing My Life
I have to admit that, when it comes to practicing formal meditation, I struggle, but I’m trying. I benefit most from the mindfulness component of my yoga classes but even more from a skill we teach our clients that we call, “Building Positive Experiences.” It’s largely drawn from the book, Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom by Rick Hanson, Ph.D. and Richard Mendius, M.D., who point out that our brains preferentially store and recall unpleasant experiences. The book offers mindfulness techniques to foster internalization of more positive experiences, which, in turn, can help to build new neural networks.
In short, the authors suggest really paying attention to the good things happening around you all the time, adding, “Actively look for good news.” They talk about savoring experiences, indulging in them and making them last for 10 to 20 seconds – without letting attention wander and allowing the experience to wash over and inside you in a positive way. Another strategy is to sense such positive experiences “sinking in,” imagining that they’re entering into your mind and body like the sun’s warmth.
Using these strategies, I’ve started focusing more on things like unexpected smiles from strangers and the birds that grace my yard. A few weeks ago, I watched two birds preening and fanning their wings under my water sprinkler while the whole scene sparkled in the sun. (Before, I would have seen it and “let it go” – now, I recall the spectacle regularly.) Just recently, a teenager jumped to hit the ceiling at the YMCA, and as I passed, I smiled and said, “Next time.” He beamed at me, thinking I wasn’t paying attention. I savor this moment, recalling how my own grown kids used to tell me that most adults ignore teens. When my baby grandson reached for me for the first time, I felt it inside in a new way, wallowing in it and not letting it go. I use the image when I can’t sleep.
I sweat the small stuff less often and am better at letting things go. (I ask myself, “Is this really worth getting angry about?) I worry less, especially about things that I have no control over. I’m more tolerant of waiting, one of my long-standing pet peeves. (A while back, I realized that I’m five minutes late, even when I try not to be, because I can’t stand wasting time.) If I had to stand in a line or got caught in a traffic jam, it felt like the end of the world. Now it just is.
As someone who always had to have “noise” in the background, I’m now OK with silence and sometimes welcome it. When plans shift suddenly or I can’t get my “to-do” list done, I’m less thrown and better at saying, “Oh well.”
All in all, I feel more satisfied with “what is” and appreciate what I have in a new way. I have more of an inner sense of calm and contentment. Next, I have to learn to be more patient when I’m stuck behind slow drivers.
Online Resources for Mindfulness: From Dr. Siegel’s website:mindfulness-solution.com; for clinician use with clients, from the University of Washington Addictive Behaviors Research Center: mindfulrp.com; a New York Times article on phone apps: nytimes.com.
Anne M. Fletcher is frequently sought out by the media, as well as professional and consumer groups, for her knowledge about behavior change, addiction, recovery, and weight management.
