Mindfulness in therapy

An article in the New York Times health section today, entitled "Lotus Therapy," describes the increasingly prevalent use of mindfulness techniques in psychotherapy over the past ten years. The article describes the state of research on the use of mindfulness meditation as "thin," and indeed the evidence for the effectiveness of mindfulness' use for anxiety and depression is not as substantial as the evidence for cognitive-behavioral therapy or antidepressant medication. However, the research that has been conducted to this point paints a picture of mindfulness meditation as a useful tool -- for those inclined to use it -- in fighting depression and anxiety.

A fair consideration of the strength of evidence for mindfulness meditation vs. psychotherapy and pharmacological treatments should keep in mind a few key points:

1) Few people make the claim that mindfulness meditation is an appropriate substitute for either cognitive-behavioral therapy or for medication. Typically it is described as an important complement to psychotherapy. Comparing its effectiveness to that of either of the other two treatment modalities sets up a false dichotomy.

2) The use of mindfulness in psychotherapy has become widespread only relatively recently, and thus has not had the benefit of decades of research studies to support its effectiveness. As mentioned in the Times article, there is an increasing effort being made to include mindfulness in NIH-funded research studies.

Challenges to seeking help

A recent New York Times article highlighted the difficulty many people face in deciding whether or not to seek help for emotional problems – readable at http://www.nytimes.com/2008/04/18/us/18vets.html. The article describes a recent privately conducted research study that concluded that 19% of the 1.6 million members of the American military who have recently served in Iraq or Afghanistan have symptoms of posttraumatic stress disorder or major depression. Of the 19%, however, only slightly more than half have sought help.

There are many reasons that people are reluctant to seeking help for emotional difficulties. One reason is the commonly held belief that one should be able to handle whatever life throws one’s way, and that seeking help is akin to cheating, or to admitting defeat. Many people truly, deeply believe that the problems they are experiencing are their own fault, and thus, it would wrong to seek help. While it may be true that they have contributed to these problems, it is often untrue that seeking help would be a copout. For example, let’s say that you had a close friend who started to drink too much. Let’s say this drinking became a problem in their lives, and affected your friend’s relationships and work. Fortunately, your friend recognized that the drinking had become problematic, but blamed themselves for “letting things get to this point” and insisted that cutting back on drinking was the only answer to their problems – “simple as that.” Wouldn’t you want your friend to at least try to seek help, even if they ultimately decided that it wasn’t for them?

Ultimately, whatever change does happen in psychotherapy occurs because of changes made by the person themselves, regardless of any guidance from a therapist.

Another factor that plays into reluctance to seek help is described very well in the New York Times article – fear of one’s employer finding out, resulting in negative consequences. In the case of the military, servicemen and women are typically aware that their commanding officer has access to their full medical records, which would include any mental health services received, especially those received from the U.S. Military health system. For people outside of the military, working in the private sector, there are often similar fears. A typical source of these concerns is the question of whether a company’s human resources departments can obtain personal health information from the health insurer. Unfortunately there is often little information available about how justified this concern may be.