Today I bring you one of the leaders in the field who goes to the heart of the intersection between mindfulness and psychotherapy. Shauna Shapiro has co-authored The Art and Science of Mindfulness: Integrating Mindfulness into Psychology and the Helping Professions, with Dr. Linda Carlson and has published over 50 book chapters and peer-reviewed journal articles on the topic.  She currently leads mindfulness training programs for professionals nationally and internationally on the applications of mindfulness in the field of health care.

Question: In your book, you cite a huge rise in the last 10 years for National Institute of Health (NIH) funded research studies focusing on mindfulness-based therapies for stress, pain, and/or illness.  Can you tell us a bit about why you think there is such growing interest?

Shauna: In both research and clinical environments there is a rapidly growing interest in mindfulness-based approaches.  For example, searches of the scientific literature on PsychINFO and PUBMED using the same term, “mindfulness-based”, yield 260 and 115 published scientific articles, respectively.  And the enthusiasm of funders, grant peer reviewers and the scientific community has followed this trend:  In 2008 there were 44 funded studies in progress; this number has increased from zero in 1998 and only three in 1999.  I believe the interest and increased funding is due in part to the strong body of research conducted by pioneers in the field, such as Kabat-Zinn and Segal, Williams and Teasdale who provided a clear rationale and direction for future research.  I also believe that there is a cultural shift happening and a deep yearning for greater wholeness and health, for both patients and therapists. Mindfulness offers a simple and easily accessible path toward this – mindfulness offers enormous potential and possibility to the field of health care.  

Question: In your book you talk of three different ways mindfulness can integrate into psychotherapy. The first, the mindful therapist, the second, mindfulness-informed therapy, and the third you call mindfulness-based psychotherapy. Can you give us a rundown to what each is and the benefits of each?

Shauna: These three pathways of integrating mindfulness into psychotherapy were coined by Germer, Segal and Fulton and make up what they refer to as Mindfulness-oriented psychotherapy. I believe this is a simple yet nuanced way of delineating different pathways for integrating mindfulness into psychotherapy, and so in our book, we devote a chapter to each one, fleshing it out and including clinical relevance and examples.

The mindful therapist refers to the fact that mindfulness explicitly trains us in qualities essential to being an effective therapist. Across different therapeutic modalities there is little difference in outcome, however across differing therapies and techniques, the therapeutic relationship is predictive of success. To enhance the relationship we need empathy and presence, two skills specifically cultivated through mindfulness. Thus, the “mindful therapist” refers to the fact that by simply practicing mindfulness you are cultivating skills essential for successful therapy. And yet, few clinical training programs explicitly help therapists cultivate these skills. We are told, “Be empathic, pay attention” however we are not taught how to do so. For this reason, I have devoted a great deal of energy empirically studying the effects of mindfulness on therapists in training, as well as working to develop a curriculum of mindfulness for our students that can be embedded within the graduate training program. In this way, students receive explicit training in mindfulness, helping to cultivate the qualities that are essential to effective therapy.

Mindfulness-informed therapy refers to a second pathway of integrating mindfulness, wherein, therapy is informed by insights derived from meditation, mindfulness practice and Buddhist psychology, but formal meditation and mindfulness practices are not taught. At times, the nature of the clinical work, the client or the setting makes it inappropriate or impractical to explicitly teach formal mindfulness practice. In our book, we elucidate specific themes as well as clinical anecdotes to help expand on this idea.

Finally, mindfulness-based therapy refers to the most obvious way of integrating mindfulness into therapy, by explicitly teaching mindfulness practices, either through manualized group interventions such as MBSR and MBCT, or in individual therapy, where practices are tailored to the specific individual client and circumstances.

Question:  You and Dr. Gary Schwartz have come up with a practical model for health:

intention => attention => connection => regulation => order => health.

Can you explain this a bit to the readers who struggle with pain and stress how they might apply it in everyday life?

Shauna: Our model of health suggests that through intentionally, attending and connecting to our experience we cultivate optimal health.

intention => attention => connection => regulation => order => health.

Intentionally cultivating nonjudgmental attention leads to connection, which leads to self-regulation and ultimately to greater order and health. Through mindfulness practice we are able to attend to the information contained in each moment. We gain access to more data, even those data that may have previously been too uncomfortable or painful to examine. We learn to acknowledge and accept pain and stress, and to listen to it with kindness and care. Through attending in this way, we are able to respond with greater skill and wisdom. We are able to attend to the pain, and choose to self-regulate in ways that foster greater health and well-being. Through consciously (intention) bringing awareness (attention) and acceptance (attitude) to experience in the present moment, we are able to use a wider, more adaptive range of coping skills.

Shauna: What do you feel is some of the most exciting research out there today that’s integrating mindfulness into health and mental health?

Neuroplasticity. I believe this single word gives people hope; hope that change is possible. For example, we used to think that we all had a “happiness set point” much like with weight, and that no matter what our circumstances, we would always end up back at baseline. Good scientific evidence substantiates this theory, for example, people who win the lotto or those who are in a terrible accident and become paralyzed, after an initial spike in the expected direction, return to their baseline levels of happiness. Thus it was concluded that we had a happiness set point that was not very moveable. This is great news if you are born happy, however if you aren’t, it leaves you feeling pretty hopeless…And yet the new research in neuroplasticity demonstrates that we can change our level of happiness because we can modify both the activity and structure of our brain through meditation training. Recent research shows that meditation practice increases activity in areas of the brain associated with positive emotion, and shows structural changes in the brain due to long term meditation practice. This new research is quite hopeful, suggesting that although happiness may not change due to external circumstances, changing our internal circumstances, through mindfulness training, can change our level of happiness.

If you were sitting across the table from a person who was struggling with pain and stress in their lives, what words of wisdom would you give to them?

What I keep coming back to again and again is self-compassion. I am awed by the prevalence of what Tara Brach  refers to as the “trance of unworthiness.” I believe so much of our suffering comes from our sense that we are not okay, not loveable, not good. We blame ourselves for causing the pain or stress, or for not coping with it well enough. We go around feeling fundamentally flawed, unworthy and unlovable, and from this place of contraction and self-loathing, there is no space for change. So, if I were sitting across from someone struggling with pain or stress, I would begin with self-love, self-compassion, kindness, tenderness and acceptance.   I would offer that it is possible to relate to ourselves, our experience, this very moment with kindness. This does not mean we like how things are, it simply means we begin where we are, without judgment, blame or shame. We begin with love, trusting that we are fundamentally okay. “O Nobly Born, O you of glorious origins, remember your radiant true nature, the essence of mind”

Thank you so much for all your great work Shauna. As always, please share your thoughts, questions, and stories below. Your interactions here provide a living wisdom for us all to benefit from.