Mindfulness training can lead to significant, persistent, and very welcome changes in how people experience their mental life – bringing about more accurate perceptions and responses, access to greater warmth and connectedness, as well as more effective action. As with any intervention, it can misfire.
Mindfulness training must be used carefully in a clinical context. Contrary to popular misconceptions mindfulness is not a tranquilizer: in its traditional form, mindfulness practice is intended to be disruptive and destabilizing of the status quo – the status quo being, generally, the domination of experience by a tangle of thoughts about past and future. There are two main classes of problems that can occur as people take on a mindfulness practice: those that occur when the instructions are not used accurately, and those that occur when instructions are used accurately.
“Feel the sensations of the breath. If you notice that you’re not feeling the breath, feel the breath, right away. The breath is always happening, right now.”
When the instructions are not followed
It is typical for people to hear the simple instructions for mindfulness, and rather than follow them, engage instead in their own particular variety of neurotic exertion, which may include excessive strain, self-criticism, performance anxiety, feeling incompetent or overwhelmed. At the beginning, this tendency should be expected and addressed in careful communication and assessment, so that people can be protected from ‘mindfulness practice’ that is really a session of intensified and sometimes painful neuroticism. When this tendency is pronounced, a variety of methods may be used. For example, short practice periods during therapy sessions are recommended, giving opportunity for communication and reinforcement of the precision of technique, before sending people off to practice alone at home.
When the instructions are followed
It is important to remember that mindfulness has the intended effect of disrupting habitual patterns of mind, and this may include patterns of coping and self-soothing. Most people who appear for clinical treatment have a hard-won repertoire of coping and soothing strategies, which may operate with or without awareness. These may not be well designed, but they generally do contribute to stability and a sense of control. I have found it remarkable that many people, including those who experience great distress in their daily lives, have naturally discovered elements of mindfulness practice and make use of them in their coping and self-regulation. However, most people have other coping and soothing methods based on mental routines that are quite vulnerable to disruption by mindfulness training. It is important to monitor people in session while they begin to practice, particularly those suffering from severe anxiety, obsessiveness, or trauma. When mindfulness instructions are followed with precision, unexpected troubles may come to awareness as layer upon layer of distraction dissolve.