Hektoen International

A Journal of Medical Humanities

Mindfulness meditation as psychotherapy

Migel Jayasinghe

This article was previously published by the author between the years of 2006 and 2018. The original publisher has since been lost and the article edited and republished by Hektoen International staff. Other appearances of this text elsewhere on the internet may be unauthorized.


Art by Tushara Jayasinghe.

Cognitive Behavioral Therapy (CBT) is one of the most common treatments used for depression and various related psychiatric illnesses. Historically it developed from a coming together of two strands of therapy, Behavior Therapy and later Cognitive Therapy. CBT is the currently approved mainstream approach. Behavior Therapy developed at a time when behavior based on learned responses to associations, rewards, and punishments (as in the work of Pavlov and Skinner) was still regarded as sufficient to explain human behavior. Cognitive Therapy was born later, when incorporating mediation of thought and language (what went on inside the “black box” of the individual mind) became equally or even more important in explaining human behavior.

CBT is approved by the National Institute for Clinical Excellence (NICE) in the UK. However, since no one therapy (including medication) has proven to be beneficial for all patients, the field of counseling and therapy is replete with many alternatives such as psychoanalysis, Gestalt Therapy, NLP (Neuro-Linguistic Programming) and other “talking” therapies. These therapies are not seen as “scientific,” or objective and repeatable using quantitative, statistics-based research. Increasingly, it appears that “mind,” a concept formerly totally alien to statistical research based psychology, is being accepted as something more than neural activity in the brain and as the basis of human behavior.

From here, it has been quite a jump to accept “mindfulness meditation”—borrowed from the Hindu and Buddhist traditions, where it has been practiced for five millennia as a means to reach enlightenment. So, mindfulness-based Cognitive Therapy (MBCT), may be seen as an innovation through the fusion of two widely divergent areas separated by origin and culture. Even so, it appears MBCT has been proven effective in treating patients with persistent or recurring depression.

Mindfulness meditation is the cultivation of awareness of the activity of one’s consciousness from moment to moment. This can stop individuals from being trapped in constant ruminations and automatic patterns of thinking and mood. It is best achieved by concentrating on one’s breathing (in and out) without attempting to control the flow of thoughts. Alternatively, one can slowly move awareness to the physical sensation in each part of the body from head to toe. For those who can distance themselves from their daily stream of thoughts and sensations, the reward is perfect bliss. Sadhus in India have been known to remain seated in the lotus position for months or even years. The difference between this devotional mindfulness meditation and its use in therapy is that in therapy, the objective is to monitor and stop the stream of negative thoughts by enabling the patient to realize that such thoughts and feelings are not inevitable. There is no religious or transcendental objective beyond the capacity for healthy everyday living.

Therapeutic mindfulness was originally developed by Prof. Jon Kabat-Zinn of the University of Massachusetts Medical Center in 1979 as an eight-week program designed to reduce stress. “Research shows that MBSR (Mindfulness-Based Stress Reduction) is enormously empowering for patients with chronic pain, hypertension, heart disease, cancer, and gastrointestinal disorders, as well as for psychological problems such as anxiety and panic.”1 Several studies have found MBCT effective in patients who had suffered three or more episodes of depression in the past.

What are the mechanisms at work in mindfulness meditation? One of the hypothesized explanations is the concept of “defusion,” in which patients learn to distance themselves from their recurring negative thoughts without attempting to change the thoughts themselves. Mindfulness allows patients to observe their mental activity while stepping back from the culturally constructed inner commentary and move to another different self. A fixed, unvarying identification with the past is no longer seen as inevitable.

Teasdale, J.D., Moore. R.G., Hayhurst, H., Pope, M. Williams, S. & Segal, Z.V. developed the Differential Activation Hypothesis (DAH) to explain the mediating mechanisms in MBCT.2 In studying patients with a history of relapses into depression, they found that often transient negative moods led to negative thought patterns which spiraled into full-blown depressive episodes. Taught to practice mindfulness meditation, these patients learned to early on become aware of their transient negative moods which led to a relapse. To these patients mindfulness meant an act of “decentring” or consciously observing the stream of thoughts and emotions as if they were bystanders. This helped to prevent the automatic thinking connected with the downward spiral towards a relapse. Patients learned to become aware of their thought processes and to put aside these thoughts without fixating on or identifying with them.

Shapiro, S.L, Carlson, L.E., Astin, J.A. & Freedman, B. proposed a new theory which addressed limitations of the “defusion” and “decentring” hypotheses discussed above. While acknowledging their validity and usefulness, they postulated a “testable theory of the mechanisms involved in how mindfulness affects change and transformation.”3

One definition of mindfulness is “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.”4 Using this definition Shapiro et al. have identified three pillars of mindfulness:

  1. Intention (“on purpose”)
  2. Attention (“paying attention”)
  3. Attitude (“in a particular way”)

Shapiro et al. write, “Intention, attention and attitude (IAA) are not separate processes or stages – they are interwoven aspects of a single process and occur simultaneously. Mindfulness is this moment-to-moment process.”3 Mindfulness is an ongoing process built upon the individual’s intention, attention, and attitude.

Intention, according to Shapiro et al., is at the heart of mindfulness meditation. This aspect is often lost in adapting mindfulness meditation to therapeutic purposes. Enlightenment or self-liberation was the original intention of religious mindfulness meditation. In therapy, self-exploration and self-regulation are the goals, and must be seen as dynamic. Without a clear, early identification of intention, mindfulness meditation is in danger of drifting into aimlessness.

Attention is the second component of mindfulness meditation. “In the context of mindfulness practice, paying attention involves observing the operations of one’s moment-to-moment, internal and external experience . . . At the core of mindfulness, is this practice of paying attention,” such as concentrating on the breath, or asking, “What am I thinking, feeling, and experiencing, right now,” naming the thought or feeling and allowing it to pass. Attention is common to most therapeutic practices. For example, in Fritz Perls’ Gestalt therapy, awareness of the present moment and attention to it is said to be “curative” in itself.

Attitude is referred to as one of the main qualities of mindfulness meditation. It is not a cold and abstract intellectual exercise, but a warm and engaged openhearted activity in which one should strive to have an attitude of affectionate, compassionate involvement without a condemning or judgmental inner experience.

Having set down the three essential axioms or building blocks for the theory they propose, Shapiro et al. go on to postulate “‘a model of the potential mechanisms of mindfulness, which suggest that intentionally (I) attending (A) with openness and non-judgmentalness (A) leads to a . . . shift in perspective which we have termed reperceiving.”3 Essentially, mindfulness meditation helps patients by shifting perspective using intentional, nonjudgmental, attention. This involves separating one’s identity from the contents of one’s consciousness (thoughts) and cultivating an ability to stand back and witness the never-ending drama of our individual life story. Some concepts are already employed by western psychology which are similar to reperceiving, such as “decentring,” deautomatization, and “detachment.” Shapiro et al. explain that “All these concepts share at their core a fundamental shift in perspective. This shift . . . is facilitated through mindfulness—the process of intentionally attending moment by moment with openness and nonjudgmentalness (IAA).”3

Shapiro et al. are careful to stress that research into mindfulness is “still in its infancy and requires great sensitivity and a range of theoretical and methodological” approaches “to illuminate the richness and complexity of this phenomenon.”3 One strength for practitioners exploring the mechanisms of mindfulness meditation is the previous scholarly and scientific investigations seeking to aim at consensus. But the weakness stems from the fact that these are very complex phenomena not necessarily amenable to scientific exploration. When mindfulness meditation is used in therapy, every encounter between therapist and client is a unique experience, so that an objective generalizable theory can only be an approximation, unlikely to be proven or disproven by applying scientific criteria.



  1. http://en.wikipedia.org/wiki/Mindfulnessbased_Cognitive_therapy > Retrieved 23/07/2013.
  2. Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Journal of Consulting and Clinical Psychology, 70(2), 275–287. https://doi.org/10.1037/0022-006X.70.2.275
  3. Shapiro, S.L. Carlson, L.E., Astin, J.A., Friedman, B., Mechanisms of Mindfulness. Journal of Clinical Psychology. 62 373 – 381.
  4. Kabat-Zinn, J., (1994) Wherever You Go, There You Are; Mindfulness intervention in everyday life, Hyperion.
  5. Baer, R.A. (2003) Mindfulness Training as a Clinical Intervention: A conceptual and Empirical Review; American Psychological Association.



MIGEL JAYASINGHE, BA Hons, MSc, AFBPsS, C. Psychol., emigrated to the UK, in 1963, and qualified in Psychology (1971) and Occupational Psychology (1982). Starting as a research assistant at the Industrial Training Research Unit, Cambridge, he worked as an occupational psychologist with the Educational and Occupational Assessment Service in Lusaka, Zambia (1975–1978). Then, was an occupational psychologist with the Manpower Service Commission (1981–1995). He established the vocational assessment and rehabilitation facility for ex-service personnel at Royal British Legion Industries (1996–2001), gained distinction from UK Life Coaching Academy (2002), and ran a workshop at the First Russian Life Coaching Conference held in St. Petersburg (November 2002).


Summer 2021   |    Sections  |  Psychiatry & Psychology

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