Today, the picture is dramatically different. In a 2007 survey conducted by the Psychotherapy Networker, 41.4 percent of the nearly 2,600 therapists who responded reported that they were practicing some form of “mindfulness therapy.” Mindfulness-based treatments are now being introduced into graduate programs, are frequently discussed at academic conferences, and are a constant on the workshop circuit. Certificate programs are appearing. Books about mindfulness for the treatment of you-name-it are coming out weekly, and we’ve even gotten to the stage where we’re beginning to see titles like “Beyond Mindfulness.”
Is this just a passing therapy fad? If so, why has it taken off so rapidly? Is it another therapeutic bubble? Or has the field really stumbled upon something that has the potential to fundamentally change the way we practice?
Several explanations of the explosion of interest in the integration of mindfulness practices and psychotherapy have surfaced. One dates back to counterculture days: a lot of baby boomers back then experimented with consciousness-altering substances and practices, eventually turned to meditation, and later became psychotherapists or psychological researchers. Now that they’re the elders, they’re coming out of the closet in droves. (As Steve Hayes put it, “The crazies are driving the bus.”)
Another explanation relates to the evolution of behavior therapy, which involves three major developmental phases. The first, behavior therapy proper, was classical conditioning and behavior modification. As time passed, behavioral clinicians realized that these approaches, based on animal learning, miss something vital about human beings: we think and feel a lot. So CBT was born, based on the idea that we can use learning theory to modify patterns of thoughts and feelings, and by doing so, improve both behavior and subjective experience. It soon came to dominate the psychotherapy world.
What both behavior therapy and CBT have in common is the intent to change overt or covert maladaptive behavior. Both have historically deemphasized elements of the psychodynamic and humanistic traditions from which they differentiated themselves—particularly the importance of an intimate therapeutic relationship and the need to accept, move toward, and be with difficult emotional experiences. Once mindfulness practices had been introduced to the CBT community through DBT and MBCT, they became a vehicle through which CBT clinicians could deliberately incorporate acceptance and therapeutic presence into their work. Interest in it took off, and research supporting its efficacy exploded.
Another factor behind the popularity of the mindfulness movement involves the mainstreaming of ancient mind-training disciplines like yoga and tai chi, which only “counterculture types” once practiced. Now virtually every health club and community center offers classes, and participants include athletes, artists, lawyers, and business executives. This trend has ushered in openness to ideas from Eastern wisdom traditions, which have trickled into the medical field.
Our Troublesome Wiring
The most compelling argument supporting the use of mindfulness practices to treat a wide range of disorders is based on evolutionary psychology: we didn’t evolve to be happy. In this line of reasoning, mindfulness practices were first developed in ancient times to counteract vestigial neurobiological mechanisms that make us miserable, and these same practices can be successfully adapted in modern psychotherapy to the same ends.
Biologists agree that natural selection favors whatever increases organisms’ chances of survival to the age of procreation, allows them to mate successfully, and helps their offspring do the same. So this is what our minds evolved to do. If we imagine our ancestors on the African savannah several million years ago, they had little chance of survival relying upon their fingernails, teeth, hearing, sight, and smell. In most of these areas, they were much less well equipped than the competition, and in some, they were downright pathetic. (Imagine confronting a lion with your bare hands.) What we had, of course, was the ability to think, and hands with opposable thumbs with which to make tools. So it’s no accident that the first thing most of us discover when we take up mindfulness practice is that our minds are thinking machines—they just won’t stop.
But evolutionary psychologists tell us that we didn’t evolve to think just any thoughts. The ancient hominids who repeatedly thought about bad stuff—who remembered what they saw a lion do, or what happened when someone backed over a cliff—were likelier to survive. If they forgot the good stuff—a satisfying sexual encounter or the location of a luscious piece of fruit—they still lived another day. So we evolved minds that are like Velcro for bad thoughts and Teflon for good ones. Our ancestors weren’t the happy hominids—they usually died before having kids.
Another product of natural selection is our remarkably effective stress-response system. Our fight-freeze-flight responses are reliably activated in response to any perceived danger. This frequently saved our ancestors and an astonishing variety of other mammals from perishing. It just doesn’t work so well in tandem with highly evolved cerebral cortexes. While other animals’ arousal systems reliably return to baseline shortly after danger has passed, ours get stuck in the “on” position as we think about what’s coming next. All day long, we think about what went wrong in the past and might go wrong in the future, experiencing painful emotions each time. Mark Twain summed this up nicely near the end of his life: “I am a very old man and have suffered a great many misfortunes, most of which never happened.”
Another hardwired evolutionary heritage that gets us into trouble is our predilection to seek pleasure and avoid pain. This, too, has been adaptive. Most things our ancestors found pleasurable, such as having sex, eating when hungry, finding warmth when cold, or cooling off when warm, contributed to survival. Similarly, avoiding pain usually meant keeping the body intact. What could be wrong with this? A lot, it turns out.