Mindfulness has been around for at least thousands of years, often originating out of religious practices. Many consider Jon Kabat-Zinn, as the main person to bring mindfulness out from its roots and into a secular, health-focused perspective. Trained as a molecular biologist and a long-time practicing Buddhist, he believed that mindfulness could serve an important role in medicine. In 1979, Jon Kabat Zinn ran his first Mindfulness-Based Stress reduction group for patients with chronic health conditions at the U Mass Medical Center. For those who practice mindfulness, there is agreement that the best way to introduce mindfulness to others is to practice it yourself. So, I encourage you to view this blog as an invitation to personally practice mindfulness for your own benefit and to consider integrating the mindfulness skills discussed in your clinical work with patients.
If you’re willing, take the next 3 minutes to complete the following Internal Situational Awareness mindfulness exercise. You can either read each brief paragraph, pause and check in, or you can record yourself reading the script aloud, and listen back to it. Where you see a “…” is an opportunity to pause (take 2-3 breaths).
Begin, in this moment, right here…bring your attention to your thoughts…right now, what is your mind telling you? ... [Excellent job checking in with the mind]
Now, what feelings do you notice showing up for you right here?... Pick the top 1 or 2. Might you be able to put them on a scale of 0-10, where 0 equals barely feeling it at all, and 10 equals this is the strongest you’ve ever felt this feeling… [Fantastic job noticing]
Tune in to what is happening in your body in this moment?... Where in your body are you noticing the sensations?... [Good job, taking note of any physical sensations is important]
This practice of internal situational awareness can be done in just a few minutes. It simply involves becoming aware of and naming the thoughts, emotions, and body sensations you are experiencing. Clinically, the practice is great for quickly checking in at the start or end of a psychotherapy session. It’s also a very effective way to help a patient center or ground themselves when they’ve become overwhelmed or dysregulated.
Now that I have your attention, I’d like to briefly review five skills that serve as the foundation of a well-built mindfulness practice for mental health providers.
1- Observe: Observe skills are in action when one notices with direct conscious effort that an experience inside or outside of the body is showing up (i.e., thought, body sensation, sound, breath). From a mindfulness perspective, this type of observing involves two facets: orienting and focusing. Orienting one's self to an experience is like a message that pops up to say, “Get ready, you’re about to experience something!” Focusing is when attention is deliberately cast upon one experience or an aspect of an experience. For example, this might involve paying attention to the breath as it is noticed going into and out of the nostrils. However, the focusing could also include shifting or moving attention around an experience. For instance, when completing a comprehensive psychological intake, it is particularly beneficial to have a very broad focus when gathering clinical information. We want to see the big picture and how patient experiences are interrelated. However, when managing a crisis with a patient experiencing suicidal thinking or behavior, it’s likely more beneficial to narrow one’s attention toward the aspects of risk assessment and crisis intervention needed for that individual.
2- Describe: The describe mindfulness skill involves recognizing and naming our experiences, often through applying verbal labels. There are two main aspects to describing: finding words to name the experience and nonjudgement. Finding words to describe an experience may sound easy, and yet choosing accurate words to reflect the experience can be quite difficult, especially when trying to capture the nuance of the tone or intensity of it. Sometimes the describe skill is referenced in the statement “Name it to tame it.” This is because as we apply verbal labels to our experience, it can aid in regulating our thoughts, emotions, and physical sensations in reaction to the experience. Nonjudgment, as a describe skill in mindfulness, involves an encouragement to describe the experience using descriptive rather than evaluative language. By taking a more nonjudgmental posture towards our experiences, we may find less distress. For example, I am late in completing this blog. A thought that might show up for me is “I am letting my team down and because of that I am a bad employee.” However, if I practice mindfully describing the experience it might go something like this… “I have not completed my blog by the deadline, and I feel disappointed in myself for that. At the same time, I’ve had a lot of competing priorities and I am doing my best.”
3- Detach: Detach skills involve a shift in the ways we relate to an experience. Again, there are two main facets to mindfulness detach skills: acceptance and perspective-taking. Learning to observe experiences without having to do anything with or to them is the skill of acceptance. As acceptance is fostered, there is also the opportunity to gain a more neutral perspective on the experience that may have been difficult before. For that reason, sometimes this skill is described as “letting go.” For instance, learning to accept a thought when it shows up, naming it as a thought, and then remembering that thoughts are just thoughts (a mental experience) may support the ability for the thought to come and go (like clouds in the sky)
4- Self-Compassion: Self-compassion skills in action may look like softening toward an experience. You may have detected some self-compassion in the example I shared under the describe skill. Developing self-compassion involves two aspects: empathy and perspective-taking. People are sometimes quite hard on themselves when an experience shows up that is difficult. Thoughts like “I shouldn’t feel this way” or emotions such as anger directed toward oneself can be harsh and contribute to getting stuck in our experience. Through actively bringing a stance of empathy toward ourselves when difficult experiences are present, we can approach them, open up to them, and engage with them, which provides space for reduced suffering. From a perspective-taking lens, consideration can be given to how an experience is related within a social context and whether there might be more than one point of view of the experience (spoiler alert- there are!). For example, as I direct compassion towards myself in dealing with disappointment with myself for being past the deadline for this blog, I can also spend time recalling the competing priorities noted above, validating my efforts to complete the blog as soon as possible, and reminding myself that this is not the first time a blog has been late and that it will all work out.
5- Mindful Action: The skill of Mindful Action involves shifting focus toward values-based, problem-focused action. There are times in life where minds get extra busy/noisy in reaction to challenges or suggest avoidance/escape as a helpful strategy for dealing with difficult life circumstances. Putting the mindfulness skills discussed in this blog to work in these situations offers a new opportunity for mindful action. The two facets of mindful action involve initiating meaningful actions and persisting with intentional actions despite distractions (think relapse prevention). By bringing together mindfulness with action, we ensure that what or who is important in our lives remains the focus of our goals and intentions. Additionally, when we get detoured, as we will in life, mindful action also serves as a mechanism to course correct and persist toward what is meaningful.
I want to end the blog with another invitation to practice. Take a moment now, before moving on with your day…pause and become aware of an internal or external experience showing up for you right now [Observe]…take a moment to name the experience, and if possible, label it without judgment. So if a thought shows up, notice it, label it as such, if an emotion is present, notice and label it [Describe]…Recognize the mind may try to hold onto experiences that are pleasant or quickly push away those that are unpleasant, acknowledge the mind for it’s action and see if you can accept the experience regardless…without trying to change or react to it in any way [Detach]… Might you also be able to cultivate a warm, loving compassion around the experience and for yourself…reminding yourself that you are just as worthy of compassion as those around you and that an experience itself is multifaceted [Compassion]…Centering in on who and what is important to you in this life. What behavior would bring you one small step toward your values? Could you possibly take that small step right now and if you did, how might you imagine you would feel and think today? [Mindful Action]
Throughout the rest of your day, if you’re willing, I invite you to consider bringing mindfulness to your experience using the following guide:
|1||Observe||Become aware of and focus on your experience|
|2||Describe||Name your experience, without judging it|
|3||Detach||Accept your experience for what it is, without having to change or react to it|
|4||Self-Compassion||Develop deep compassion and remember there are multiple perspectives of an experience|
|5||Mindful Action||Engage in values-based, problem-focused intentional actions|
If interested in additional reading, the following books may be especially helpful:
Strosahl, K. D., Robinson, P. J., & Gustavsson, T. (2015). Inside This Moment: A Clinician’s Guide to Promoting Radical Change Using Acceptance and Commitment Therapy.
Strosahl, K. D., & Robinson, P. J. (2015). In This Moment: Five Steps to Transcending Stress Using Mindfulness and Neuroscience.
New Harbinger Publications.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Erin R. Frick, Psy.D., is the Assistant Director, DoD Child Collaboration Study, for the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences at Bethesda, Maryland.