Mindfulness-based stress reduction – A millennial's musings

The darker side of mindfulness: being overwhelmed, side effects and the difficulty of finding a good teacher

It was my pleasure to speak to Dr Chris Walsh, an Australian mindfulness pioneer since the 1980’s and a respected psychiatrist. Dr Walsh has trained with leading Western mindfulness figures such as Jon Kabatt Zinn, Mark Williams, Kristin Neff and Daniel Siegal. Dr Walsh and I spoke about the darker side of mindfulness.

As with any area experiencing such strong growth, mindfulness is surrounded by myths and misconceptions. What is one that you feel particularly strongly about?

It’s used by business to make people work harder. It’s not so much a myth, it’s just the way it is being used.

People think it’s a relaxation technique. This is tricky to address. Mindfulness does help people to relax, but that’s not the main game. It’s about training your awareness.

You cannot count on mindfulness to make you relax.

If occasionally mindfulness doesn’t help you relax, you will feel that it’s not working and are missing out on an opportunity to learn to hold an unpleasant feeling. This can be destructive.

Mindfulness can bring out negative emotions, especially during the initial stages. How would you recommend that a person deals with that?

The first thing is to have a good teacher. It’s a delicate balance and it can be hard to know when to lean into the negative emotion and when to stand back from it.

The basic principle is that it is ok to feel challenged, but it’s not okay to feel overwhelmed.

With any kind of learning, including learning to be mindful, it is normal to oscillate between feeling comfortable and feeling challenged. If you’re never challenged, especially with something experiential like mindfulness or a sport, the learning isn’t in its optimal state. Getting overwhelmed in mindfulness is the equivalent of getting injured when training, and this sets back the progress.

I have a few tricks on how to deal with being overwhelmed during mindfulness.

The feeling of being overwhelmed is most likely to occur when doing a body scan, especially when focusing on the chest and abdomen as this is where we tend to feel anxiety. I encourage people to find “safe places” where they are less likely to feel this anxiety: such as the resting one’s attention on the sensation of breath in their nose. Even this can be too much for some people.
Awareness of sounds can also help, as the attention is then focused on something outside the body.
Allowing oneself to move can also help to deal with the sense of being overwhelmed. In the Tibetan mindfulness tradition you can move; in the Zen tradition you are meant to be still no matter how much one’s knees hurt. This stillness doesn’t work for people with a lot of agitation. Doing walking mindfulness or exercising before doing mindfulness can help greatly. Some people think that this is an avoidance behaviour. I believe, it is taking a distance, while still still remaining present to the difficult experience.
Sometimes it is okay to let one’s mind wander off. When I run classes with inpatients, I tell them that it’s okay to daydream if it gets too much. The important thing is: come back because this way you can learn what has changed. This is very empowering: we don’t always have to do something to change things. They change by themselves.

These tips work for patients with mental health issues, e.g. PTSD, as well as people with no mental health issues.

Have you ever had any experiences when mindfulness had side effects? The “decentering” in mindfulness may impact an individual’s concept of the “self”. There are anecdotal reports of some vulnerable individuals developing dissociation and psychosis after reading self-help books or attending seminars – and more recently after practicing mindfulness. Do you see any risks in “trying it at home” when it comes to mindfulness?

It is damaging when people use mindfulness to dissociate or disconnect in some way. Two patients I encountered were attached to ecstatic states.

The first was a man with a background of heroin and alcohol addiction. He was able to stay away from drugs and alcohol for 10 years and then relapsed – which is when he came to me. He told me he was using mindfulness to stay away from his addictions and meditated for 8 hours a day! Just before the relapse he got a job: this stopped him from meditating for 8 hours a day, and so he relapsed.

When I questioned him about his mindfulness practice, he told me that he would just got into a blissful state for 8 hours, never experiencing any negative emotions.

I asked him to deliberately call to mind some unpleasant experiences while practicing mindfulness and pay attention to how it felt in his body rather than holding on to these blissful states. The lesson here is to get comfortable with feeling uncomfortable. In Tibetan Buddhism, they talk about samadhi. It is a blissful state – and sometimes people get addicted to this state. Some people this is enlightenment, but the Buddhist teachers say that that’s a delusion, an unhealthy attachement to something.

The second case that comes to mind was of a man with schizophrenia. Many of my patients with schizophrenia derived a great benefit from mindfulness. This man was having a Kundalini experience, where energy was going up and down his spine. They talk about it in the Hindu tradition. He would go through this experience for many hours a day and it made him more delusional and psychotic. It was very hard to persuade him to do less meditation!

I wouldn’t’ call either of these experiences mindfulness, as they weren’t this open, non-judgemental states. This is why having a teacher is important: so that you can reflect on your experience and receive some guidance.

How should one go about choosing their mindfulness teacher?

There are no absolute guarantees. I am aware of some highly trained psychiatrists who teach mindfulness, but don’t practice it. They say they do, but by talking to them, you quickly realise they don’t: they have a kind of striving attitude.

For people with psychiatric conditions, it is better to have someone who understands both the Western and the Eastern traditions. If you have a teacher, a psychologist or psychiatrist, who comes from the Western tradition only, it is important that they practice mindfulness themselves. It’s important for a teacher to be able to tune into the problems that arise for people as they go through their mindfulness journey rather than sticking to a rigid program.

There is a one size fits all approach to mindfulness among the public at the moment. Do you feel that that it’s appropriate for someone to use an app or should they find a teacher?

In my classes, I have a handout that reviews the apps and advises my patients to beware of any apps that tell them what to feel or that they should relax. People can play with apps – it gives them experiential information that allows them to commit to go to a class. Some people learn a lot from the apps. I haven’t seen the good apps causing any harm. Headspace is quite good. Buddhify is great for getting past the idea that mindfulness only happens on a cushion and has lots of shorter meditations that people like. Insight timer has nice mindfulness bells and nice soundtracks. Some are a bit New Age-y, so people need guidance in choosing the right ones. iTunes U UCLA meditations are quite good too. I send people to my website as I have some soundtracks there.

What are your thoughts on transcendental meditation? It became commercialised quite quickly once it reached the West. Do you worry that mindfulness is headed in that same direction?

I did TM for a few years and found it helpful. I studied Buddhist meditation before that and it gave me the impression that the mind has to be completely quiet – which caused a lot of agitation. TM helped me to get past that as it involved returning to the mantra without trying to eliminate thoughts. TM also taught me about preliminary practices such as exercise.

In the East, mindfulness is used to investigate the mind as well as everything else. A lot of the insights of Buddhist psychology are now being confirmed using Western methods, such as fMRI. I believe this aspect of the Eastern tradition doesn’t get enough attention. However, we need to separate the psychology, philosophy and the religion. Those who say that Buddhism isn’t a religion are lying: it is a religion, but as well as that there are psychological and a philosophical components. These can be separated out, just like has happened in the West.

The tradition in the East is 2,500 years old, so we run into a lot of interpretation and translation problems. The Eastern languages have changed in meaning and nuance in that time just as much as Western languages have. Jus think how much trouble we have interpreting Shakespeare and his writing was only 500 years ago. Furthermore, Buddhist psychology is based on human investigation that has evolved over time, so it’s not like the Bible that has been “handed down” and and passed on as some kind of unchanging truth. The Eastern mindfulness tradition, in fact, has a lot in common with the Western scientific tradition. This tradition has evolved from the Socratic tradition which is based on debate and questioning. rather than prescriptive rote learning. I believe that if we start paying more attention to what is already known in the East our progress in understanding the mind will be accelerated and our meditation practices will become even more effective.

Dr Walsh’s own website contains a lot of case studies and blog articles on mindfulness that I would highly recommend: mindfulness.org.au

Why non-judgment and non-striving are misinterpretations of mindfulness

I am mesmerised by the robust evidence for the neurological, biochemical and behavioural benefits of mindfulness. I am working hard to figure out the philosophy behind it, that seems very foreign to me with its “acceptance” and “emptiness”.

For this I interviewed Bob Stahl, PhD. He is a certified mindfulness-based stress reduction teacher with over 25 years of experience. His PhD is in philosophy and religion. How exciting is that?! Bob sheds light on some of the philosophical conundrums of mindfulness that have preoccupied me here. He knows what he’s talking about, having founded 7 mindfulness-based stress reduction programs in medical centres in California and having written a number of books on mindfulness. In addition, Bob runs insight meditation and convergence retreats too. Clearly, I simply couldn’t pass up the opportunity to talk to him. [If, for whatever reason, you’re wondering, this is not a sponsored post.]

You are an expert at mindfulness-based stress reduction. How has it evolved since its inception by Prof. Jon Kabat-Zinn?

I began teaching in 1991, a bit before the big wave of interest in mindfulness that predominantly sparked by Bill Moyer’s series Healing and the Mind and Jon Kabat-Zinn’s work. The mindfulness-based stress reduction (MBSR) programme hasn’t really changed much over the years. The core principles remain. The training of the mindfulness teachers has grown and advanced tremendously, however.

MBSR is secular. Do you think this is more of a benefit or a hindrance to most people starting it?

MBSR is sacred rather than secular. The sole purpose of MBSR is to alleviate suffering.

MBSR is not religious, but it is spiritual.

Secular implies a cold kind of separation. Having said that, MBSR can be delivered in a hospital, which is obviously non-sectarian and open to people of different religious traditions and views. It is indeed not associated with any one organised religion, but it has many underpinnings that MBSR. There are the teachings in Buddhism and Buddhist psychology. There are also the underpinnings of the wisdom traditions of non-duality, stress physiology, neuroscience and group experiential education. The underpinnings come from the wisdom found cross-culturally.

MBSR was designed to help with specific issues. What are the most common problems that people come to you with?

There are 3 main interrelated categories: stress, physical pain and illness. This can be related to a chronic or terminal disease, stress at work, or a desire to improve one’s wellbeing.

You teach mindfulness to physicians, nurses and other healthcare professionals. What are some of the main challenges and lessons in mindfulness for this group?

First of all, they are not immune to the human condition that includes ageing, illness, death and separation.

Compassion fatigue, processing the pain of those whom they serve, burnout, anxiety, addiction, depression and insomnia are the most specific problem that affect the people belonging to healthcare professions.

There is strong culture of success in our world. We spend our lives striving for accomplishment in a goal-directed manner. It is quite counterintuitive, if not scary, for a person conditioned like this to engage in a practice of non-striving, non-reactivity, non-attachment and non-judgment. “If I stop striving, will I still be able to accomplish?” Could you comment on this apparent contradiction?

Mindfulness often gets confused with non-striving, non-attachment and non-judgment. People think they are not supposed to feel or have those feelings – and this is actually a misnomer that causes confusion.

Mindfulness is about being present and aware of what’s actually happening and acknowledging it. It is best to leave out words like “without attachment or striving” because many people actually discover how filled they are those feelings.

Could this confusion be arising from our interpretation of Buddhism?

I’ve been a student of Buddhism for many years and lived in a Buddhist monastery for over 8 years. The word for mindfulness is sati.

There’s nothing in the definition that talks about being non-judgmental or non-striving. It’s all about being present, being aware of what’s actually happening in the present moment.

Perhaps, we could say though that non-striving and non-attachment are attitudes that can be brought into mindfulness practice that serve to help us to see more clearly where we are stuck with either grasping or aversion. Let us remember that the sole goal of the mindfulness practice is freedom.

What is the most common misconception about MBSR?

I am very excited about the exponential growth of mindfulness. As with all things that are popular, there are some fads. There is some commercialisation of mindfulness.

There’s also confusion between mindfulness and positive thinking: “You’re saying negative things, you’re not being mindful.” We should be mindful of rage, sadness, anger and fear. That’s just part of the practice. Mindfulness does not mean being positive. It means being aware, present and acknowledge it.

There’s also another apparent contradiction.

Mindfulness is both very personal and completely impersonal.

On one level, mindfulness is incredibly personal. We are really getting into our loves, joys, fears, hates, etc.

We cannot psychologically or spiritually bypass our personality.

Our personality is what we need to work with to grow. We need to understand where it is that we get caught and cannot see clearly, what stories do we tell ourselves, etc. It is incredibly personal. On the other hand, mindfulness is incredibly impersonal. The body is doing its thing, it doesn’t ask us. Mind states come and go out. Whose mind is it anyway?

In Buddhist psychology, there are 6 sense organs: the mind is the sixth.

What does it do? It experiences thoughts and emotions. Just like the nose experiences smells and the ears experience sounds, the mind experiences thoughts and feelings.

In your experience, are there any therapies that MBSR is most synergistic with?

Mindfulness-based cognitive behavioural therapy was developed out of MBSR. It has been shown to be very effective, especially in treating relapses of depression. Furthermore, a variety of programmes, such as mindfulness-based childbirth and parenting, were developed based on mindfulness.

What stops most people from practicing mindfulness every day, given that it can time as little as a few minutes a day?

This is something that comes up a lot. We encourage people to sit with the resistance: what’s there? It could be a number of things. We have such a longing to feel good, but doing preventative things requires a deep commitment.

If you’re really committed to knowing the truth about where you’re stuck, practice becomes a way of life.

Your whole orientation turns towards freedom. It helps people to get inspired.

Sitting and meditating isn’t as important as whether you’re aware of what’s going on inside you, is it coming from some old conditioning, etc.

Could you explain what is involved in a mindfulness retreat?

Retreats are very important.

How can we be with others if we haven’t been with ourselves?

A silent retreat is the time to dive deep into our own life, our own story, where we’re holding on and where we’re pushing away. Retreats can be in the insight meditation tradition, Zen tradition or Tibetan tradition. In the insight tradition, we teach the four foundations of mindfulness, the three marks of existence, the four noble truths.

MBSR stemmed from a retreat. Jon Kabat-Zinn got the idea while on an insight meditation retreat. He left the meditation centre, applied to start a programme – and the rest is history.

I do a lot of retreats on how Dharma informs mindfulness-based approaches. Many people entering into mindfulness don’t have a lot of experience with meditation. We help people to have the experience of the practice and to understand what informs mindfulness approaches.

You sit for 45 minutes, walk for 45 minutes, sit for 45 minutes, walk for 45 minutes… It starts at 6 in the morning and stops at 9 at night. Instruction is given once a day to clarify the teaching. There’s usually a talk in the evening to help guide the meditations. It’s a progression through the four foundation of mindfulness. We also offer group and individual practice discussions to check in with the students.

Bob suggested that I go on a retreat. I am very tempted. He travels all over the world, though he is usually found in sunny California. You can find out more about his centre here.