Meditation-Based Therapy

Meditation-Based Therapy
By David Mellinger, MSW, BCD

Anxiety fills people’s minds with repetitive negative thoughts- even predatory worries – entwined with tension and fear. Even as we’re caught in the throes of angst, our values and yearnings often keep flashing through our minds. Despite our awareness that our thoughts are irrational and distorted and our feelings disturbed, at times we can’t seem to right them. Still, many of us who are stuck in negative thinking can learn to ride out the waves of nervous energy. We can remain focused on what we value and hold dear, while instilling and sustaining the awareness that it’s worthwhile to harness this energy to press ahead, regardless of doubt and dread.

Although anxiety is commonly perceived as an experience to be shunned, at the core of anxiety and worry is energy seeking access to pathways for living intensely and achieving what is meaningful and important. Psychologist Mary Pipher observed that many people discover they can reconnect with the parts of themselves that reflect aspects of their true self and regain the energy and drive to do what they care most about and work for the betterment of others (Pipher, 1994, p. 72).

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Meditation-based therapy (MBT) can help achieve this deeply human goal. MBT is powerful behavioral medicine–psychotherapy invigorated by mindfulness meditation. Mindfulness meditation is an ancient tradition of reflection and contemplation that’s swept into modern psychological thought and practice. Originating with the teachings of 2,500-year-old Asian vipassana (insight meditation), mindfulness is mental training to experience the present with an attitude of openness, freshness, and willingness to engage in the comings and goings of our thoughts, feelings, and sensations. Psychologists, medical researchers, and neuroscientists have accumulated impressive evidence of the value of mindfulness for a wide variety of health and mental health problems, and it has proven to be a potent means of managing stress and overcoming pathological worry.

Caught Up in Sticky Thinking. Many of us literally “worry ourselves sick” when anxiety or depression trouble us: We may concurrently experience physical tension, unsettled stomachs, or disturbed sleep, with our minds swirling with edginess, dread, and vulnerability. We may fear the worst, feel very stressed out, and become caught up in negative thinking that’s tough to control and tougher to halt. I’ve dubbed this malaise “sticky thinking” – the reflection in our consciousness of our fears for the future, deep self-doubt and harsh self-blame, ways we’ve felt wronged that still smart, frustrations with others or ourselves. . . The list goes on. Sticky thinking is a blend of repetitive, negative thinking and disturbing emotions, along with an internal resistance to disengage from it. Such thinking leads directly into disturbing worry, anxiety, or depression. Using MBT, you can learn to keep from following sticky thinking’s lead, and to disengage from it.

Buddhist Psychology on Worrying Ourselves Sick & Release from Worrying Ourselves Sick

Buddhist psychology holds that human beings are fundamentally good and that our most basic qualities are positive: openness, intelligence and warmth (Trungpa, 2002). The perspective of mindfulness meditation, based on this psychology, relates sticky thinking to the bad mental habits of worrying and the sense of being stuck or trapped inside ourselves and controlled by our experiences. Our troubles also relate both to our limited ability to “see what is” – to see ourselves, others, and the world clearly and objectively – and to our deep uneasiness with feeling vulnerable, our reflexive tendency to not trust ourselves and others.

Meditation and MBT can enable us to change and transcend these limitations. We’re enabled to tune in to our nature and the nature of our troubles, augmenting our capacity to be kind, not harsh, to ourselves and others, more responsive to the freshness of nature and life experience, and open to the vast possibilities of openness and appreciation.

Wandering Minds. Our minds are built to wander. They leap toward the stars or plunge us into the depths, slip us sideways, shoot ahead or tumbling backwards. The wandering of our minds causes us big trouble when complicated – as it often is! – by loss of direction and the tilting of our mental time machines.

Loss of Mental Direction – The direction of our thinking is dictated at times by the Prime Directive–our built-in tendency to dwell on events and ride the trains of thought that could signify our very survival is at stake. The Prime Directive doesn’t distinguish between real threat and false alarms; but under its sway, we’re fraught with intense feelings of anxiety, fear, or anger.

Our Time Machines Tend to Tilt – Our minds have easy access to the Mental Time Machine – our uniquely human faculty for using our imagination to travel to the future or back to the past to consider what may await us or review what has happened so we may avert preventable hazards and learn from past errors. But once our wandering minds start tilting toward strong negative feelings, the time machine is likely to misnavigate us into ruminating about past errors, active worry, or dread of unlikely future catastrophes. Worse, it may leave us stuck wherever we’ve journeyed to in our minds, under the pernicious influence of sticky thinking.

MBT and Mindfulness Meditation

A therapist skillful in MBT is experienced both with mindfulness meditation and “new wave” or “third wave” Cognitive-Behavioral Therapy (CBT) that stresses acceptance as well as relief from emotional disturbance. MBT is the product of the convergence of cognitive-behavioral therapy (CBT) and psychological mindfulness (PsyM) – “awareness of present experience with acceptance” – and it is transforming contemporary psychotherapy. PsyM is deeply related to traditional mindfulness, but the difference is that PsyM is a trainable mental skill taught in psychotherapy and practiced between sessions. The precepts of mindfulness meditation are learned as part of MBT – the “principles that are learned in advance” of the skills taught early in meditation practice. Thus PsyM teaches us to focus on the present, to experience mental events as separate from taking action, and to refrain from shutting down experiences just because they’re painful or trying to prolong them because they feel good.

Formal meditation and psychological mindfulness both encompass three essential mindfulness meditation skills – focusing your attention, opening your awareness, and enhancing loving kindness. As your MBT therapist interweaves your therapy with these essential skills, you can face your problems afresh as they arise. Meditation teacher Julie Brams describes the difference between mindfulness-based therapy and mindfulness meditation practice as the difference between learning and experience. In MBT, we learn about mindfulness, while through formal meditation practice we gradually become more mindful.

Acceptance-based therapy is an important element of MBT. When aspects of our current situation aren’t immediately changeable, or when the costs of change are too dear, acceptance helps reduce the suffering that results from continually telling ourselves that the situation shouldn’t be the way it is. When combined with acceptance, PsyM leads to tolerance of negative moods and emotions and “stopping the battle” within ourselves and about our issues.

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MBT can be greatly enhanced by engaging in regular, formal mindfulness meditation practice – 20 or 30 minutes a day of practice, daily if possible, typically devoted to sitting quietly and focusing one’s attention on an object of meditation. In mindfulness meditation, we practice expanding our minds, hearts, and awareness in the widest, clearest way possible to enrich our experience – calming, learning to really focus, opening our awareness, and discovering our uniquely human endowment of the capacity for kindness, friendliness, and compassion. Ultimately, meditators may realize through insight – through direct experience that reshapes our awareness – that passing thoughts and feelings needn’t forever define us nor constrict our activities and joy of living. By working skillfully toward mindfulness through practice of formal meditation, MBT, or a combination, we can do better, live better, and be better.

The Mindfulness Skills

Let’s explore parallels between formal meditation practice and psychological mindfulness and the ways people master mindfulness skills through MBT. Mindfulness meditation entails practice in focusing attention and concentrating, open awareness of what occurs, and loving kindness meditation. Being mindful means activating and enhancing our awareness of the wealth of events, impressions, impulses, and thoughts that we experience.

Focusing Attention – Classic mindfulness training begins with work on developing concentration – remaining mentally in the present, keeping our attention focused, and coping with our tendency to become distracted. Practice in concentration entails intentionally narrowing the focus of one’s attention onto a single process, like the breath, or a specific point in the natural environment, like the flame of a candle.

We can only concentrate on one thing at a time, like our breath, a candle flame, or a point or simple process in the natural environment.

Once we’re able to really focus, we can enhance our capacity to cope with anxiety and worry. We become more capable of honing in on what‘s important, able to think more carefully and to stay present during vital learning experiences and interactions. When our sleep is disrupted by anxiety, worry, or restlessness, concentrating on the breath can really help. Ultimately, concentration on our breath can strengthen our ability to prevent or cease worrying ourselves sick and counteract catastrophizing about anxiety-provoking future events.

Try It for Yourself:

“Stop for a few seconds, take three conscious breaths, and move on. . . Don’t make it into a project. Pause and allow there to be a gap in whatever you’re doing.”

From Taking the Leap by Pema Chödron (2009)

 Open Awareness: Taming Our Wandering Minds ­– According to Buddhist psychology, people who are prone to anxiety, depression, or sticky thinking may not be able to respond with clarity and objectivity when faced with unpleasant or negative perceptions, such as negative self-thoughts and emotions, or distressing images. They may slip automatically into sticky thinking – into worrisome or ruminative states of mind (Hofmann, 2016, p. 138).

Mindfulness experts sometimes describe training in focusing the attention and sustaining open awareness as “taming our minds.” When we’re upset, our thinking becomes jumpy, judgmental, erratic, or even catastrophic. We’re rather like endangered wild animals, afraid and unwise. Open awareness practice enables us to be very aware of all that’s going on in our minds from one moment to the next. It trains us to refrain from judging mental events as positive or negative, from shuttling around in the Time Machine, and to keep from getting too caught up with our thoughts or impulses. It enables us to become “lighter of body and spirit” –a phrase used in Metta meditation, a traditional mindfulness practice. Meditation trains us to better use our minds for higher purposes – being objective, thinking clearly, and managing our feelings intelligently.

The essence of psychological mindfulness. During sessions of MBT, the client “allows” the therapist in as a guest in the chambers of his or her mind. Together they reflect on the client’s experiences of anxiety. During their interactions, the therapist guides and helps expand the client’s awareness of cause and effect, the thoughts, feelings, sensations, and impulses that make up his or her anxiety, and the means of strengthening helpful, healthy responding. The client may learn to take perspective, to find the gaps in seemingly incessant sticky thinking, to look beneath the anxiety-laden stories that fill his mind, and to discover that his intentions can guide his attention in clarifying or heartening directions. This is essential psychological mindfulness – promoting self-awareness, facilitating acceptance, and helping to enhance the ability to function with clarity, strength, and mental balance, regardless of whether or not anxiety is present.

Try It for Yourself:

Sample open awareness by setting an alarm for five minutes and sitting upright with your eyes closed. During this time, count every thought, mental image, or action impulse that passes through your mind. Then spend a little while reflecting on the entire experience.

Compassion-Focused Therapy

According to Buddhist psychology, only when we are able to confront difficult sensations, emotions, or thoughts with a degree of kindness, compassion, and composure can we attend to the varieties and textures of present moment experience in a mindful way.

Compassion-focused therapy is based on loving kindness meditation (LKM). Loving kindness is defined as tenderness and consideration toward others (Oxford American Dictionary, 2001): Thus, formal LKM involves “exercising the intention of loving kindness by cultivating a mental state of unselfish and unconditional kindness to all” (Hoffman, 2016). During LKM, meditators speak in a quiet, “mental voice” expressing benevolent wishes toward themselves, their loved ones, their friends and teachers, strangers, adversaries, and then all beings. The power of “the phrases of metta [is that they] should . . . bring one’s full awareness to the phrases, their meaning, and the feelings they bring up.” (p. 139)

Hofmann elaborates upon the capacities of metta meditation:

“By mindfully investigating what occurs when one attempts to generate loving kindness or compassion, it is assumed that insight is gained into the nature of these emotions themselves, as well as one’s personal relationship to them”.

When we practice LKM, our intentions, practice, and perspective are all focused on ultimately achieving loving kindness, compassion, sympathetic joy, and equanimity. As a result, our susceptibility to entering negative, judgmental, stuck states of mind diminishes, reducing the likelihood that we will worry ourselves sick, obsess, dwell in apprehension, or brood in rumination.

“Furthermore, by turning toward this focus of experience in a kind, open, patient, and tolerant manner, a shift . . . toward greater loving kindness and compassion is thought to occur.” (p. 140)

Psychological mindfulness strategies have developed that focus on enhancing your capacity for loving kindness and self-compassion. They can be applied whenever you become aware that you’re feeling disturbed and acting harshly on yourself.

Try It for Yourself:

A fundamental self-compassion technique that I introduce to MBT clients entails making the following request of yourself when you feel very anxious and are self-critical or self-blaming:

“Talk intentionally with yourself the way you would speak with someone toward whom you feel warm and compassionate and who could really use your help.”

MBT for Overcoming Sticky Worry, Rumination, and Bad Moods

Although mindfulness does not in itself resolve emotional disorders, it raises our awareness of the role of irrational thinking in our emotional distress and helps us alter the processes that feed our pain and confusion. We learn to guide ourselves to focus, expand our acceptance of our thoughts, feelings, and impulses, and be kinder to ourselves and others.

Many people with anxiety or depression can benefit from treatment with a therapist skilled in mindfulness-based treatment. Utilizing mindfulness-based techniques, you can become able to abide with disturbing feelings rather than getting drawn into negativity; “unstick” your persistent worry or rumination; prevent bad moods from materializing; and even change long-standing tendencies to worry or brood. If you’re drawn to mindfulness meditation and continue to be challenged or struggle with disturbing thoughts, doubts, and tenacious uneasiness, then MBT might be just what you need.



Chödron, Pema (2009). Taking the Leap. (Boston: Shambala Publications).

Hofmann, Stefan (2016). Emotion in Therapy. (New York: Guilford Press).

Oxford American Dictionary (2001)

Pipher, Mary (1994). Reviving Ophelia: Saving the Selves of Adolescent Girls. (New York: Riverhead Books).

Trungpa, Chogyam Rinpoche (2002). “Basic Goodness or Original Sin?”, Lion’s Roar, November 1.