In Buddhism, meditation is often described as a tool for taming "the monkey mind" — the human brain’s proclivity for bouncing from thought to thought. Most of these thoughts are centered on the past — generating feelings like sadness, regret, or guilt — while the rest are focused on the future: the "what ifs" that plague us, and prevent us from experiencing the present.

Hard science backs up claims that meditation has positive effects on the brain. Scans have shown that Buddhist monks who have long practiced meditation had more brain waves indicative of "large-scale coordination of neural circuits;" they also showed increased activity on the left side of the prefrontal cortex, which is associated with feelings of happiness and serenity. 

There is a great alignment between Western therapeutic approaches and meditation’s application for directing our thought processes, recognizing our emotions, and being more aware of ourselves and the present moment. But bringing meditation into a therapy or counseling practice effectively isn’t always as easy as turning on some ambient music and having a patient close their eyes; providers will need to figure out the right approach for each patient, address skepticism and comfort levels, and ensure consistency to see results. 

In this post, we’ll cover each of those areas and explain how therapists, counselors, and other mental health providers can bring mindfulness into their practices successfully.

The Growing Role of Meditation Therapy

A 2012 study found that of those who meditate, 76% were doing so for overall health and wellbeing, and half were doing it to improve memory and concentration. Nearly 30% of people used to address anxiety, stress (~22%), and depression (~18%), with about 64% reporting that it "helped a great deal" with these conditions. About 35% were doing meditations with a health provider.

Meditation’s popularity has grown significantly since this study, so it’s safe to say those numbers have risen accordingly. Dating as far back as 5,000 B.C.E., the practice has now steadily worked its way into counseling and therapy practices since the 1970s— which are also considered healing practices — earning its own label, "meditation therapy." Meditation is used in Cognitive Behavioral Therapy to increase acceptance and reduce reactivity, in "mindfulness psychotherapy" to free patients from mental conditioning, and in therapy programs centered on trauma recovery. In the process, providers are collecting some intriguing data on the relationship between meditation and emotions.

In the last few years, we’ve learned that practicing Behavioral Mindfulness Meditation (BMM) has shown to reduce emotional reaction intensity; that mindfulness-based treatment has promising applications for those suffering from PTSD; and that meditation as part of group therapy can bring long-term improvement to participants.

Meditation Therapy Techniques

The practice of meditation can be classified as "formal" or "informal" — meditating against a recognized framework during a dedicated time span (formal) or engaging in mindfulness while doing something else (informal). Informal meditation can include intentionally practicing self-awareness and focusing on the present while walking, doing dishes, or folding laundry. Formal meditation practices are more commonly used as part of therapeutic practice as a way to improve cognition, behavior patterns, and emotions.

Elements of formal meditation techniques run the gamut, from guided imagery to focused breathing and progressive muscle relaxation. The formal meditation therapy techniques predominant in therapeutic practices include:

Mindfulness Based Stress Reduction (MBSR) was originally developed for hospital patients suffering from terminal illnesses, disabilities, and chronic pain, and was meant to ease the anxiety and depression that accompanies those types of conditions. It worked and expanded to other therapeutic sessions — 2019 data shows that 80% of German psychotherapists use MSBR as part of their practice in one-on-one settings at least some of the time.

Mindful Based Cognitive Therapy (MBCT) MBCT is most often used to treat anxiety, recurrent depression, eating disorders, bipolar disorder, ADHD, PTSD, and psychosis. This approach focuses on breathing as a way to return to the present, and is seen as a "bridge" between formal and informal meditation. Studies reinforce MBCT’s effectiveness in reducing relapse into depression for patients with a history of multiple occurrences. Some countries, like the UK and Germany, include MBCT in their official clinical guidelines in the treatment of depression.

Acceptance and Commitment Therapy (ACT), like MSBR, has worked well for patients dealing with anxiety, panic attack management, depression, substance abuse, chronic pain, cancer, and psychosis. The foundation of this approach is using mindfulness and self-awareness to alter how patients view their relationship with the symptoms of their condition. For example, trying to cope with the effects of anxiety rather than eradicate the anxiety itself. Therapists accompany this practice with Cognitive Behavioral Therapy (CBT) in a series of small steps.

Dialectical Behaviour Therapy (DBT) has proven most effective for people with Borderline Personality Disorder (BPD), those battling addiction, PTSD, food and eating issues, self-harm tendencies, and suicidal ideations. Primarily, this approach is used in group settings in conjunction with one-on-one therapy and is meant to teach mindfulness skills in two parts: observation (the "what") and compassionate mindfulness (the "how") via informal meditations. Like ACT, this approach emphasizes acceptance, rather than rejection, of one’s conditions and ensuing emotions. 

Transcendental Meditation & Mantras in therapy involve using a repeated phrase or self-affirmation (mantra) to reduce the "emotional symptoms" of depression, anxiety, and stress, from a "small to moderate degree." Standardized programs start with one week of daily meetings, move to weekly sessions, and, eventually, become less frequent. Patients learn individual practices that they do daily on their own. One of the perceived advantages of this approach is that it's easier to pick up and requires less practice to do effectively.

There are two things to note when determining which meditation therapy to incorporate in your practice. First is the variation in how meditation is used in therapy; some types are used as a central focus of sessions, while others are complementary supports to frameworks like CBT. Second, some healthcare providers may choose to employ mindfulness therapy techniques as a preventative measure (before emotions and thoughts spin out of control) while employing it while the patient is experiencing the effects of their affliction.

Mindfulness in Therapy: Tips For Introduction

Based on our research about meditation therapy, there are seven essential aspects to consider to improve providers’ success rate with patients:

1. Engage in mindfulness exercises yourself. Understanding the practice and effects of mindfulness will best prepare healthcare providers to bring it to their patients. Consider other mindfulness-oriented practices as well, such as yoga and breathing exercises.
2. Educate patients. Patients may be unfamiliar with meditation or have preconceived notions about it. Educating patients on the history, purpose, and role of mindfulness in their treatment will help them make informed decisions and assessments about its effects. Most importantly, set expectations about what meditation in therapy can — and can’t — do.
3. Come to an agreement. Establish a mutual understanding of how mindfulness will be used in and outside of therapy sessions. How much time in each session will be dedicated to mindfulness techniques? What is the patient’s hoped-for timeline on meditation mastery? Can they commit to practicing on their own? Getting aligned on these answers will help patients feel in control of any changes to treatment.
4. Have a custom path. Because therapy sessions should offer a balance between mindfulness and other approaches (for example, EMR), there’s no uniform format for every patient. Try different techniques and different media (like Total Brain’s NeuroTunes) to find what works best for your patient’s goals.
5. Bring in digital tools. Instead of sifting through the thousands of meditations on YouTube, take advantage of professionally curated meditation libraries. Patients who take the Total Brain assessment will get a set of targeted recommendations based on neuroscience.
6. Start small. For patients new to meditation, long sessions can be overwhelming. Start with entryway practices like yoga-based deep breathing exercises, then move into five-minute meditations, and build from there. Download our white paper to learn more about how deep breathing helps with stress and anxiety.
7. Check in. Ask your patients about their experiences with mindfulness techniques in therapy. Are they struggling with it in any way? Are they underwhelmed, or surprised? Discussing feelings about their mindfulness practice will help providers assess whether the current approach is the best fit.

Keeping It Going: How to Do Meditation at Home

Most experts recommend that patients practice mindfulness therapy techniques daily for maximum results — which means therapists will need to educate their patients on how to do meditation at home. To improve adherence rates, providers should offer easily accessible digital tools that their patients can use to meditate — as well as track their progress. 

Patients who are onboarded with Total Brain will get a customized set of meditation resources and breathing exercises following a robust assessment. Daily access to their library lets users choose which meditations they want to do and view how many times they’ve done each one. Every three months, the Total Brain app re-assesses patients to gauge improvements in the 12 brain capacities, like resilience and negativity bias. Because Total Brain was built to give clinics tools for measurement-based healthcare, it’s better suited to mindfulness techniques that accompany other therapy frameworks, like behavioral therapy. In addition to making it easier to inform treatments with data, providers will see a lower rate of no-shows.