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 Centre for Addictionand Mental Health |
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Publications
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Issues and Trends: Mindfulness meditation paves the road to recovery in addictionCrossCurrentsHelen Buttery Kerry has just used mindfulness-based relapse prevention (MBRP), which is showing potential as an adjunct therapy for people
recovering from addiction. MBRP merges mindfulness-based stress reduction (MBSR) with traditional clinical practices and is
built on the concept of mindfulness credited to Jon Kabat-Zinn more than 30 years ago at the University of Massachusetts Medical
Center’s Stress Reduction Program. Since then, mindfulness practice has spread to more than 240 hospitals and treatment centres
across North America and Europe. Its usefulness is also growing, and now embraces addiction. “Mindfulness is a component of all psychotherapy and any type of self-regulation,” says Tony Toneatto, a senior scientist
at the Centre for Addiction and Mental Health (CAMH) in Toronto and an associate professor in the Departments of Psychiatry
and Public Health Sciences at the University of Toronto. Toneatto, who has himself practiced mindfulness meditation for the
past 20 years, has been studying its potential use in treatment for gambling and addictions for almost 10 years. First used to treat physical pain and illness, mindfulness meditation moved on to treat anxiety and depression and now has
extended its reach further to help people with addiction, including smoking and gambling. Once dismissed by skeptics as a
passing fad, mindfulness meditation now sits firmly atop a body of scholarly research supporting its potential as an adjunct
to conventional psychological therapies. A study published in the American Journal of Drug and Alcohol Abuse in March suggests that MBSR should be integrated further into treatment for substance use disorders. Another study, currently
under review, supports the remedial validity of MBRP. The study is planned for publication in an upcoming issue of the journal
Substance Abuse. In fact, the entire issue of the journal will focus on mindfulness, a cognitive state that practices being aware, non-judgmentally,
in the present. Still, mindfulness is hardly new. In fact, almost all world religions, for example, Judaism, Christianity and Hinduism, include
some form of meditation or contemplation. Mindfulness meditation’s roots reach back to fifth-century B.C. in India, where
Buddhism was born. Now, it is finding its way into academia. Two years ago, under the guidance of Toneatto, the University
of Toronto started a minor program, and soon will offer a major, in Buddhism, Psychology and Mental Health. The curriculum
includes classes on Buddhist psychology, Buddhism and the science of mindfulness meditation and Buddhism and cognitive science.
Toneatto says the program’s popularity stems from interest in understanding consciousness and behaviour outside of the dominant
western discourse of reductionism that pervades psychology. Mindfulness meditation also strays from traditional western approaches to therapy, as it breaks down the dichotomous clinician-patient
divide as – more often than not – clinicians teaching mindfulness are also practicing it. Like Toneatto, that is how Kabat-Zinn
got turned on to mindfulness meditation – by practicing it to cope with the stress of graduate school. It is also how Dr. G. Alan Marlatt, a native of Vancouver, British Columbia, and now professor and director at the Addictive
Behaviors Research Center at the University of Washington, discovered it. In fact, those facilitating the eight-session MBRP
course under Marlatt must practice what they preach. “The facilitator is sharing in the process, and that makes a big difference,”
he explains. The popularity of mindfulness meditation may also be attributed to the fact that, despite its Buddhist roots, it has no religious
affiliation. “Kabat-Zinn secularized mindfulness,” explains Lisa Vettese, a clinical psychologist in private practice in Toronto
and a mindfulness researcher and educator. Vettese teaches MBSR to six groups every year. Participants’ issues range from
stress to chronic pain, and in some instances, associated drug problems. Anyone can do and benefit from mindfulness meditation,
whether it’s a clinician, like Vettese, who says that mindfulness has brought a sense of equanimity into her busy life, or
a former cocaine user, like Kerry, who uses mindfulness meditation to deal with thoughts of recidivism. There are several ways to “do” mindfulness meditation. The most basic involves deep, or diaphragmatic, breathing, where the
person focuses on breath. Another strategy used in both MBSR and MBRP is the body scan, which focuses on feeling different
body sensations. “People with craving find this very helpful, as we try to teach that cravings are natural, to pay attention
to feelings and sensations, to learn to accept them and they will pass,” says Marlatt. Another technique for people with impulses
related to addiction is “urge surfing,” used by Kerry in the opening of this story. The key, regardless of the motivation behind it, is that the person accepts their thoughts and feelings in a non-judgmental
way. The practice is the same, but what it is being applied to is different. “You can’t get rid of these thoughts and cravings,
but you can relate to them in a different way,” explains Marlatt. Allowing and accepting thoughts, such as cravings, strays
from traditional cognitive-behavioural therapy (CBT), which supports learning new ways of thinking by giving up, or pushing
out, these thoughts. Mindfulness meditation and CBT may seem like strange bedfellows, but Toneatto’s study published in the January 2007 issue
of the Journal of Gambling Issues describes the usefulness of mindfulness meditation as an intervention compatible with CBT. Toneatto points out that CBT is
the most “scientifically validated psychotherapy” around, stressing that mindfulness meditation is not a stand-alone therapy;
rather, it is useful as a supplementary and complementary approach to traditional therapies. Although stemming from two very
different worldviews – mindfulness is rooted in Buddhist India and CBT emerged from western psychotherapy – they are quite
compatible, says Toneatto. Some, like Diane Frederick, who calls herself a “cognitive-behaviourist with heart,” attributes this compatibility to mindfulness
having a “softening” effect on CBT. This allows for a more compassionate approach to treatment, says Frederick. What separates
mindfulness meditation from traditional therapeutic techniques is that during intense emotional periods people don’t have
to try to understand or analyze their problem. Simply put, mindfulness meditation allows the person to recognize thoughts
in a non-judgmental way, and then CBT addresses these thoughts when the person is more grounded. Frederick runs a clinical private practice in Kitchener, Ontario, and agrees that mindfulness meditation is a useful adjunct
to CBT, especially for people with addiction. “CBT is about changing the content of thoughts,” she says, but “it is beyond
anyone in early addictions recovery.” This is because a client isn’t ready for CBT until he or she can accept those thoughts
– that is, be mindful of them. “What mindfulness does is allow the person to develop a non-judgmental attitude toward the
thoughts and sensations that occur,” she says. This is particularly useful for people with addiction, who, Frederick says,
have a critical voice and who tend to relapse around negative emotional states and interpersonal conflict. Mindfulness meditation
allows the person to slow down and simply let the thoughts occur, without judgment. “Mindfulness teaches a person to be witness
to themselves,” she says. Then, once a person is able to see their behaviours as addictive patterns without judgment they
can start the hard work of CBT to change these patterns. * Not her real name |
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Last updated: August 21, 2009 4:26 PM Published: July 01, 2011 6:49 AM ID#45544-R |