The drug-free prescription for stress, depression, anxiety and pain - have you tried it?

“Mindfulness”. Most of us have heard of it, some of us may have actually tried it, but how many of us know exactly what it means? This troublingly vague term can be applied to almost anything: mindful breathing, mindful cooking, mindful cleaning, mindful colouring-in. Is it just another way of describing good old-fashioned relaxation? A fancy form of meditation? Or an offshoot of that other mental-health buzz term, cognitive behavioural therapy?

The truth is that modern mindfulness is a well-defined clinical treatment for a surprisingly wide range of conditions. It has been used by clinicians for five decades and, during that time, has accumulated a huge weight of evidence to support its efficacy. From stress and anxiety to depression, psychosis and pain management, mindfulness has helped millions of people across the world with an array of mental, and even some physical, illnesses. Even if you are not actually sick, practising a little bit of mindfulness has the capacity to improve the quality of everyone’s day-to-day life.

Fundamentally, mindfulness is a mental practice that allows you to focus your attention on the present moment, helping to counteract excessive rumination and become more aware of your own thoughts and feelings, thereby enabling you to better control them. It is derived from “sati”, part of both Hindu and Budhist traditions, meaning “to remember to observe”.

“It’s about becoming aware of the messages your body sends you,” says Angie Ward, chief experience officer and tutor at the teacher training organisation MindfulnessUK. “Often our body picks up on signals of emotional discomfort before our brain does. By learning to tune in to the body’s responses, we can make ourselves more aware of how we are feeling and try to respond to our feelings and the situation, rather than react to them in unhelpful ways. Noticing our thoughts can stop the mind from wandering into difficult places as we can choose to bring it back to the moment. It’s not about trying to feel zen; it’s not about trying to feel anything. It’s just about noticing the way you already feel.”

Clinical use of mindfulness in the west is widely thought to have been started by Jon Kabat-Zinn, professor emeritus of medicine at the University Of Massachusetts Medical School, who took ancient Buddhist ideas surrounding meditation, yoga and spirituality and applied them in a secular, scientific way. 

In 1979 he founded the Stress Reduction Clinic, devising an eight-week programme of what he called Mindfulness-Based Stress Reduction (MSBR). There, he invited medics to send him patients for whom usual medications and treatments hadn’t worked. He began to utilise the ideas around meditation together with the scientific methods in which he was trained. It quickly proved popular and results were positive. He went on to publish various books and academic papers detailing the positive impact MSBR had on stress and the management of chronic physical pain.

As awareness grew, medical professionals began extending the use of mindfulness to other conditions. “In the late Nineties we began using it in the prevention of depression,” says Mark Williams, professor of clinical psychology at Oxford University and co-author of several books on mindfulness, including the most recent, Deeper Mindfulness. “We found it helped people to step back and observe their own negative thoughts and bring them under control. Through daily mindful meditations you can actually train your brain to notice the onset of these thoughts and observe them as they come and go without allowing them to spiral into something deeper.”

Mindfulness-based cognitive therapy was evaluated and trialled in the UK as a preventive measure against depression and first included in the National Institute Of Health and Care Excellence guidelines in 2004. Today, MBCT is included in the guidelines as a means of managing various types of chronic pain, tinnitus, multiple sclerosis and more. Numerous studies have proved it to be effective in helping address mental health problems in the workplace, at universities and in schools.

“I use elements of mindfulness with a wide range of patients affected by neurological conditions, such as acquired brain injuries, epilepsy, multiple sclerosis and Parkinson’s,” says Dr Nicolò Zarotti, a clinical psychologist at the Manchester Centre for Clinical Neurosciences and honorary clinical lecturer at Lancaster University. “It helps facilitate their psychological adjustment to living with a life-changing condition, boost resilience and enhance acceptance.”

So how does it actually work? Professor Mark Williams prescribes a programme of mindful meditations designed to help patients focus their thought patterns. “We start with something called a body scan, where you are encouraged to focus attention like a spotlight on the body, starting with the feet and then moving on to other parts,” he says. “It helps to control attention. Depression is very distracting, it pulls the mind in various directions. Learning to put all of your attention in one place helps prevent that.”

Next, he encourages exercises that focus on breathing techniques. “Modern neuroscience has found that mindful breathing techniques help regulate your nervous system and actually uncouple the parts of the brain that focus on the body and the parts that are involved in overthinking and rumination.”

This process is known as “decentering”. “It’s not about suppressing negative thoughts,” says Williams. “It’s about noticing them but not getting completely entangled in them. You give your brain something else to do other than worrying and ruminating.”

It is a robust and often challenging process. “From my own personal experience, it can be tough because it sometimes forces you to really identify and acknowledge your most negative thoughts and feelings,” says Angie Ward. “But the idea is to befriend them. We all have an in-built negativity bias that encourages us to look out for threats that aren’t always there. If people learn to observe their thoughts within their practice regularly, the science shows we can actually change our neural pathways, becoming more resilient to negative thinking.” This is called neuroplasticity.

Studies have shown MBCT to be as effective in the treatment of depression and anxiety as both antidepressants (such as SSRIs) and cognitive behavioural therapy. “The problem with an antidepressant is that when people eventually decide to come off it, they tend to relapse into depression,” says Williams, “whereas mindfulness equips you with the tools you need to cope with mental health problems whenever they arise.”

Mindfulness groups are one of the most common forms of practice. “This not only helps you learn the meditations but also provides a support network,” says Williams. “But there are a plethora of apps, books and online resources now available that people can turn to if they don’t like the idea of group work and can’t get a referral to a specialist. There is a growing body of evidence that these sorts of resources can be just as useful.”

Even for those without clinical conditions, mindfulness is a useful tool in the daily battle with life’s stresses and strains. The mind can be a chaotic place if left unguarded. Thoughts spiral, worries inflate, worst-case scenarios will run riot unless we develop a mental filing system to keep everything organised. “It’s about developing a quality of consciousness focused on the present moment,” says Zarotti. “And it plays a significant role in cognitive reappraisal, an emotion regulation strategy where you take a step back from an emotional event, rethink it and change your reaction to it – to focus not on what the emotion does to you but rather what you do with it.”

And it’s not all about dealing with negative emotions. Mindfulness can also help enrich our experience of the positives. “With practice, you can become more aware of all the good things around you that might sometimes go unnoticed in busy, stressful lives,” says Ward. “You will notice positive thoughts and feelings when they arrive and perhaps appreciate them more. You might well find yourself becoming more alert to beauty in nature.”

This is just one of the ways in which you can tell if mindfulness is working for you. “I use the analogy of gardening,” says Williams. “You can plant a seed but you don’t expect to see the plant sprout the very next day. You keep watering every day and try to be patient. We suggest trying it for eight weeks before seeing results. Take 10 to 20 minutes to yourself every day to practise mindful meditations. Don’t judge it. Don’t dwell on whether it’s working or not. Just wait. Eventually you will start to notice the benefits. Many people start to feel calmer and more centred within just a couple of weeks.”

It might be scientifically proven to work but there is still something about mindfulness that feels like an art. There is a subtlety to the way in which it works that requires patience and a certain amount of faith. But if the idea of training your brain like a muscle to resist pain, worry, depression and negativity sounds like a lot of hard work, it doesn’t have to be.

“Some forms of meditation and therapy ask to elicit a change in your experience,” says Ward. “But mindfulness is all about just observing the way you already are. By being more aware of yourself, you can take better control of how you feel.”

How to get started

Mark Williams, professor of clinical psychology and author of Mindfulness: A Practical Guide to Finding Peace in a Frantic World, recommends the following exercises:

1. Learning to focus attention

We often find ourselves distracted. Here is something to practise for a few minutes each day that helps your mind to settle. It takes time to learn this, so don’t worry if it feels hard at first.

Start by finding a comfortable posture, either lying down or sitting, spending a few moments bringing your awareness to your whole body, allowing yourself to be just as you are, as best you can.

When you’re ready, bring attention to your feet for 10 breaths. See if it is possible to feel whatever sensations are in your feet – being curious about the ever-changing patterns you find here. Then, shift your attention to the contact with whatever is supporting you (the seat if you’re sitting) for 10 breaths, then your hands for 10 breaths, and eventually coming to focus on the sensations of your breath itself for 10 breaths.

Then, in your own time, choose whether to stay with the breath as your focus or return your attention to your feet, your hands or the contact with your seat or mat if you’re lying down.  

Continue to sustain your attention on the place in the body that you have chosen as your focus for 20 breaths or longer, gently bringing back your attention whenever you find that it has wandered away from where you had intended it to be.

In this way, discover for yourself what supports you in steadying yourself, so you can use this at any time of day or night when the mind feels over-busy or distracted.

2. Sensing the flavour of experience

Anything that arises in the mind or the body automatically brings with it a sense of pleasantness or unpleasantness. This is called the “feeling tone” of an experience. It can be very obvious or more subtle, but if we are not aware of it, it can be a tipping point, making us react in ways that we might later regret. This short meditation can help you notice the flavour of experience moment by moment and provide a vital pause before you decide how to respond.

First, settle yourself by bringing your awareness to your feet on the floor, or the contact with your seat, or your hands on your lap, or your breath. Keep your attention focused on one of these anchors for 10 breaths.

Then, after a while, expand the focus of your awareness to the whole body. Stay here for 20 breaths, or more if you choose, and when you notice any sensation in the body, register whether it’s pleasant, unpleasant or neither.

Then, when you’re ready, register the “feeling tone” of thoughts and emotions that come up. This means taking a moment to register whether any of them are pleasant, unpleasant or neutral. Allow this awareness of thoughts and feelings to last for around two minutes if you can.  

And if a feeling tone is hard to register, let it go and wait for something else to arise, always aware throughout the meditation that if anything, at any time, seems overwhelming, you can bring the focus of your attention back to your breath, or your feet on the floor, the contact with the chair, or your hands on your lap.

3. Dealing with the over-busy mind

When you get very busy, it is hard to switch off. Your mind continues to work in the background – rehashing events of the day or planning actions for tomorrow, even when you’d rather take a rest. Many of these actions may never be taken, and yet they can interfere with taking wise and necessary action. This meditation helps allow you to let go of needless action – at least for now. 

Start by settling yourself for a few moments – attending to the sensations of the feet, contact with the seat, the hands or breath, then, for a few moments more, coming to rest in awareness of the whole body, sitting here.

Then, at a certain point, direct your attention to whatever is arising in mind and body from moment to moment: sensations, sounds, thoughts, feelings – whatever they are. Take each moment as it comes, breath by breath, with openness, curiosity and kindness.

From time to time, you will likely become “lost” in thoughts, carried away by daydreams or plans or worries. As soon as you notice this has happened, on the next out breath, say inwardly “no action needed right now”.

In saying this, you are not trying to make yourself passive, but instead you are practising allowing irrelevant actions to fade so you can more easily see what is the best and wisest way to respond to the big choices in your life.