Psychotherapy 2011 American Psychological Association

2011, Vol. 48, No. 2, 198 208 0033-3204/11/$12.00 DOI: 10.1037/a0022062

PRACTICE REVIEW

What Are the Benefits of Mindfulness? A Practice Review of

Psychotherapy-Related Research

Daphne M. Davis and Jeffrey A. Hayes

Pennsylvania State University

Research suggests that mindfulness practices offer psychotherapists a way to positively affect aspects of
therapy that account for successful treatment. This paper provides psychotherapists with a synthesis of
the empirically supported advantages of mindfulness. Definitions of mindfulness and evidence-based
interpersonal, affective, and intrapersonal benefits of mindfulness are presented. Research on therapists
who meditate and client outcomes of therapists who meditate are reviewed. Implications for practice,
research, and training are discussed.

Keywords: mindfulness, psychotherapy, meditation, literature review

Mindfulness has enjoyed a tremendous surge in popularity in the ing. We begin by exploring the meaning of the term mindful-
past decade, both in the popular press and in the psychotherapy ness.
literature (Didonna, 2009a; Shapiro & Carlson, 2009). Owing
largely to the success of mindfulness-based stress reduction Definitions: Ancient and Modern
(MBSR) programs and the central role of mindfulness in dialecti-
cal behavior therapy, as well as acceptance and commitment The term mindfulness has been used to refer to a psycholog-
therapy, mindfulness has moved from a largely obscure Buddhist ical state of awareness, a practice that promotes this awareness, a
concept to a mainstream psychotherapy construct. Advocates of mode of processing information, and a characterological trait
mindfulness would have us believe that virtually every client, and (Brown et al., 2007; Germer, Siegel, & Fulton, 2005; Kostanski &
their therapists, would benefit from being mindful. In fact, mind- Hassed, 2008; Siegel, 2007b). The word mindfulness originally
fulness has been proposed as a common factor in psychotherapy comes from the Pali word sati, which means having awareness,
(Martin, 1997). Among its theorized benefits are self-control attention, and remembering (Bodhi, 2000). Mindfulness can sim-
(Bishop et al., 2004; Masicampo & Baumeister, 2007), objectivity ply be defined as moment-by-moment awareness (Germer et al.,
(Adele & Feldman, 2004; Brown, Ryan, & Creswell, 2007; Leary 2005, p. 6) or as a state of psychological freedom that occurs
& Tate, 2007; Shapiro, Carlson, Astin, & Freedman, 2006), affect when attention remains quiet and limber, without attachment to
tolerance (Fulton, 2005), enhanced flexibility (Adele & Feldman, any particular point of view (Martin, 1997, p. 291, italics included
2004), equanimity (Morgan & Morgan, 2005), improved concen- in original text). For the purposes of the present paper, and for the
tration and mental clarity (Young, 1997), emotional intelligence sake of consistency with most of the research that is reviewed
(Walsh & Shapiro, 2006), and the ability to relate to others and subsequently, mindfulness is defined as a moment-to-moment
ones self with kindness, acceptance, and compassion (Fulton, awareness of ones experience without judgment. In this sense,
2005; Wallace, 2001). Is mindfulness as good as advertised, how- mindfulness is viewed as a state and not a trait, and while it might
ever? What does the research literature have to say about the be promoted by certain practices or activities (e.g., meditation), it
benefits of mindfulness? The purpose of this paper is to provide is not equivalent to or synonymous with them. When slightly
psychotherapists with information about the empirically supported different definitions of mindfulness are used in the literature that is
advantages of mindfulness, contextualized by effect sizes of these reviewed, these shall be noted.
advantages. In addition, we review research on practices that have Mindfulness has similarities to other psychotherapy-related con-
been found to promote mindfulness, as well as the effects on structs. For example, mindfulness is similar to mentalization
therapists and trainees exposed to mindfulness meditation. The (Bateman & Fonagy, 2004, 2006; Fonagy & Bateman, 2008), the
paper concludes with implications for practice, research, and train- developmental process of understanding ones own and others
behavior in terms of individuals thoughts, feelings, and desires.
Both constructs emphasize the temporary, subjective, and fluid
nature of mental states and both are thought to enhance affect
Daphne M. Davis and Jeffrey A. Hayes, Counseling Psychology
regulation and cognitive flexibility (Wallin, 2007). Mindfulness
Proram, Pennsylvania State University. differs from mentalizing in that mindfulness is both being aware of
Correspondence concerning this article should be addressed to Jeffrey the reflective self engaged in mentalizing, and the practice of
A. Hayes, 307 Cedar Building, Penn State University, University Park, PA fully experiencing the rising and falling of mental states with
16802. E-mail: jxh34@psu.edu acceptance and without attachment and judgment. Wallin proposes

198
 WHAT ARE THE BENEFITS OF MINDFULNESS? 199

that the receptivity that mindfulness fosters enables the process of Mindfulness is systematically cultivated in Vipassana practice by
mentalization to occur. applying ones attention to ones bodily sensations, emotions,
A second construct, intersubjectivity (Benjamin, 1990), has thoughts, and surrounding environment (Bodhi, 2000; Germer,
been theorized to relate to Buddhist psychology (Epstein, 2007; 2005; Germer et al., 2005; Gunaratana, 2002; Wallace, 2001;
Surrey, 2005; Thompson, 2001; Wallace, 2001) and to being in the Young, 1997).
present moment in psychotherapy (Stern, 2004). Mindfulness and While it may be assumed that all meditation practices equally
intersubjectivity are similar in that they both enable a sense of benefit the practitioner, research rather intriguingly suggests that
connection with others (Thompson, 2001), or what Thich Nhat different styles of meditation practice elicit different brain activity
Hanh (1987) calls interbeing. Interbeing is a Buddhist notion that patterns (Cahn & Polich, 2006; Lutz, Dunne, & Davidson, 2007;
by living in the present moment, the interdependent nature of all Valentine & Sweet, 1999). For example, mindfulness meditation
phenomena and people is experienced (Hanh, 1987). To date, there more than concentrative forms of meditation (e.g., focusing on a
is no research relating mindfulness with either mentalization or mantra) has been shown to stimulate the middle prefrontal brain
intersubjectivity. associated with both self-observation and metacognition (Cahn &
Finally, insight, the conscious process of making novel connec- Polich, 2006; Siegel, 2007b) and foster specific attentional mech-
tions (Hill & Castonguay, 2007), can be construed as a beneficial anisms (Valentine & Sweet, 1999). With the advancement of
outcome of mindfulness practice. Siegel (2007b, 2009) has pro- neurological technology, mindfulness researchers are examining
posed a neurological basis for the connection between mindfulness distinct components of mindfulness meditation such as focused
and insight, and research discussed later in this article has begun to attention, open monitoring (nonjudgmental moment-to-moment
support this proposition. observation of ones experience), and loving-kindness compassion
practice and their specific physiological outcomes (Lutz, Slagter,
How Can Mindfulness Be Enhanced? Dunne & Davidson, 2008; Lutz et al., 2009).

Although there are several disciplines and practices that can

cultivate mindfulness (e.g., yoga, tai chi, qigong; Siegel, 2007b),
Empirically Supported Benefits of Mindfulness
the majority of theoretical writing and empirical research on the As research evidence begins to accumulate concerning the pos-
subject has focused on mindfulness developed by mindfulness itive outcomes of mindfulness, it is possible to categorize these
meditation. Meditation refers to: benefits along several dimensions. Three dimensions that are par-
ticularly relevant to psychotherapy pertain to the affective, inter-
A family of self-regulation practices that focus on training attention
and awareness in order to bring mental processes under greater
personal, and other intrapersonal benefits of mindfulness. Another
voluntary control and thereby foster general mental well-being and empirically supported benefit of mindfulness, empathy, will be
development and/or specific capacities such as calm, clarity, and discussed later in the paper when research is reviewed on thera-
concentration (Walsh & Shapiro, 2006, p. 228). pists who practice mindfulness meditation. Practical examples of
mindfulness-based interventions that could be used with clients are
While a myriad of meditation practices including Tibetan and provided in Table 1.
Zen Buddhist meditation styles also cultivate mindfulness, the
term mindfulness meditation is typically used synonymously with
Affective Benefits
Vipassana, a form of meditation that derives from Theravada
Buddhism (Gunaratana, 2002; Young, 1997). Vipassana is a Pali Emotion regulation. There is evidence that mindfulness
word for insight or clear awareness and is a practice designed to helps develop effective emotion regulation in the brain (Corcoran,
gradually develop mindfulness or awareness (Gunaratana, 2002). Farb, Anderson, & Segal, 2010; Farb et al., 2010; Siegel, 2007b).

Table 1
Examples of Mindfulness-Based Interventions for Clients

Benefits Practical mindfulness-based interventions to use with clients

Emotion regulation Can you stay with what is happening right What can you tell me about your experience right now? Notice
now? . . . Can you breathe with what is any changes in your feeling, however subtle.2
happening right now?1
Decreased reactivity & Slowly scan your entire body starting at your Can you allow and accept this feeling and stay in touch with it
increased response toes. Notice any sensations in your body without reacting to it? If not, what is happening in your
flexibility without trying to change them.3 experience thats reacting to this feeling? 4
Interpersonal benefits For couples: Face each other, look into each For couples: Face each other, look into each others eyes, and
others eyes and notice what reactions, practice sending loving-kindness to one another.5
feelings, and thoughts arise.5
Intrapersonal benefits Therapist and client can practice mindfulness Informal daily practice can include: walking and eating meditations,
meditation together during the therapy such as mentally saying lifting . . . . stepping forward. . heel
session.6 touching. . toe touching . . lifting . . . when walking.7
1 2 3 4 5
(Morgan, 2005, p. 135). (Morgan, 2005, p. 138). (Body Scan, Kabat-Zinn, 1990). (Adapted from Didonna, 2009b). (MBRE, Carson et al.,
2006). 6 (Lysack, 2005). 7
(Germer, 2005, p.14).
200 DAVIS AND HAYES

In terms of proposed mechanisms of change, Corcoran et al. Lieberman, 2010). In one study, participants randomly assigned to
theorize that mindfulness meditation promotes metacognitive an 8-week MBSR training group were compared to waitlisted
awareness, decreases rumination via disengagement from perse- controls on self-report measures of depression, anxiety, and psy-
verative cognitive activities, and enhances attentional capacities chopathology and on neural reactivity as measured by functional
through gains in working memory; these cognitive gains, in turn, magnetic resonance imaging (fMRI) after watching sad films (Farb
contribute to effective emotion regulation strategies. et al., 2010). Participants exposed to MBSR displayed significantly
In support of Corcoran et al.s model, research indicates that less anxiety, depression, and somatic distress relative to the control
mindfulness meditation is negatively associated with rumination group (Farb et al., 2010). Still further, fMRI data indicated that the
and is directly related to effective emotion regulation (Chambers, MBSR group had less neural reactivity while exposed to the films
Lo, & Allen, 2008; McKim, 2008; Ramel, Goldin, Carmona, & than the control group, and they displayed distinctively different
McQuaid, 2004). In particular, 20 nonclinical novice meditators neural responses while watching the films than they did prior to the
who participated in a 10-day intensive mindfulness meditation MBSR training. These findings suggest that mindfulness medita-
retreat were compared to a waitlisted control group on mindful-
tion shifts individuals ability to employ emotion regulation strat-
ness, rumination, affect, and performance tasks for attention
egies that enable them to experience emotion selectively, and that
switching, sustained attention and working memory (Chambers et
the emotions they experience may be processed differently in the
al., 2008). Following the meditation retreat, the meditation group
brain (Farb et al., 2010; Williams, 2010).
had significantly higher self-reported mindfulness, decreased neg-
In a study of trait mindfulness, Way et al. (2010) investigated
ative affect, fewer depressive symptoms, and less rumination com-
pared to the control group. In addition, the meditation group had the relationships among mindfulness, depressive symptoms, and
significantly better working memory capacity and greater ability to neural activity in a nonclinical sample of adults. Trait mindfulness
sustain attention during a performance task compared to the con- was found to be inversely related to amygdala activity when
trol group. Differences were not detected between the groups on participants were in a resting state; amygdala activity was further
self-reported anxiety or positive affect. associated with depressive symptoms. This study provides support
Chambers et al.s (2008) finding that mindfulness training de- that trait mindfulness may alter baseline amygdala activity so that
creased rumination is consistent with research with participants serves a preventive or buffering role in depressive mood.
having chronic mood disorders. Ramel et al. (2004) found that Erisman and Roemer (2010) conducted a study in which partici-
participants in an 8-week MBSR training had significantly less pants in an experimental group were exposed to a brief mindfulness
reflective rumination compared to: a) participants initial rumina- intervention and then watched film clips that contained either positive
tion scores, and b) a control group matched on age, gender, and affect or mixed affect. Compared to a control group, participants in
initial depressive symptoms. In addition, decreases in rumination the experimental group reported more positive emotions after watch-
scores were significantly predicted by participants amount of ing the film clips containing positive affect and reported less negative
meditation practice. In another study, prepost scores after an emotions after watching affectively mixed film clips.
8-week MBSR intervention were compared among a community Jha et al. (2010) examined working memory capacity and emo-
sample that experienced ongoing anxiety, depression, and/or tional experience among a military group who participated in an
chronic pain (McKim, 2008). Following MBSR, participants had 8-week mindfulness training, a nonmeditating military group, and
significantly higher scores on self-reported mindfulness and sig- civilians; both military groups were in a highly stressful predeploy-
nificantly lower scores on self-reported rumination, psychological ment period. The nonmeditating military group displayed decreased
distress, depression, anxiety, and physical illness. Mindfulness working memory capacity over time whereas working memory ca-
scores significantly predicted anxiety, rumination, medical symp- pacity among nonmeditating civilians was stable across time. Within
toms, and psychological distress. Furthermore, the relationship the meditation military group, working memory capacity increased in
between mindfulness and depression was significantly mediated proportion to actual amount of meditation practice. In addition, med-
by decreased rumination.
itation practice was directly related to self-reported positive affect and
A recent meta-analysis of 39 studies supports the efficacy of
inversely related to self-reported negative affect. Working memory
mindfulness-based therapy for reducing anxiety and depression symp-
capacity mediated the relationship between meditation practice time
toms (Hoffman, Sawyer, Witt, & Oh, 2010). MBSR and mindfulness-
and negative affect. These findings suggest that adequate mindfulness
based cognitive therapy constituted the majority of mindfulness-based
meditation practice may enhance working memory capacity, similar
therapies in these 39 studies. For clinical populations, the average
prepost effect size was large, and a moderate effect size was found to results obtained by Chambers et al. (2008), thereby promoting
among nonclinical populations. For 19 studies that assessed depres- effective emotion regulation during periods of stress when working
sive and anxiety symptoms in long-term follow-ups, moderate effect memory may otherwise diminish.
sizes supporting the effectiveness of mindfulness interventions were Thus, research indicates that meditation may elicit positive
detected. Hoffman et al. concluded that mindfulness-based therapy emotions, minimize negative affect and rumination, and enable
has utility for potentially altering affective and cognitive processes effective emotion regulation. Even eight weeks of mindfulness
that underlie multiple clinical issues. meditation practice may alter the ways in which emotions are
Hoffman et al. (2010)s findings are consistent with evidence regulated and processed in the brain (Williams, 2010). Emotion
that mindfulness meditation leads to increased positive affect and regulation has such strong empirical support as a benefit of mind-
decreased anxiety and negative affect (Davidson et al., 2003; fulness meditation that recently the term mindful emotion regu-
Erisman & Roemer, 2010; Farb et al., 2010; Jha, Stanley, Kiyo- lation was coined to refer to the capacity to remain mindfully
naga, Wong, & Gelfand, 2010; Way, Creswell, Eisenberger, & aware at all times, irrespective of the apparent valence or magni-
 WHAT ARE THE BENEFITS OF MINDFULNESS? 201

tude of any emotion that is experienced (Chambers, Gullone, & Interpersonal Benefits
Allen, 2009, p. 569).
Decreased reactivity and increased response flexibility. The question of how mindfulness affects interpersonal behavior
Research has demonstrated that mindfulness meditation enables has been pursued recently by scholars who have addressed con-
people to become less reactive (Cahn & Polich, 2009; Goldin & cepts such as mindful relating (Wachs & Cordova, 2007), mindful
Gross, 2010; Ortner, Kiner, & Zelazo, 2007; Siegel, 2007a, 2007b) responding in couples (Block-Lerner, Adair, Plumb, Rhatigan, &
Orsillo, 2007), and mindfulness-based relationship enhancement
and have greater cognitive flexibility (Moore & Malinowski, 2009;
(MBRE) (Carson, Carson, Gil, & Baucom, 2006). Evidence indi-
Siegel, 2007a, 2007b). Evidence indicates that mindfulness med-
cates that trait mindfulness predicts relationship satisfaction, abil-
itators develop the skill of self-observation that neurologically
ity to respond constructively to relationship stress, skill in identi-
disengages automatic pathways created from prior learning and
fying and communicating emotions to ones partner, amount of
enables present moment input to be integrated in a new way
relationship conflict, negativity, and empathy (Barnes, Brown,
(Siegel, 2007a). Meditation activates regions of the brain associ- Krusemark, Campbell, & Rogge, 2007; Wachs & Cordova, 2007).
ated with more adaptive responding to stressful or negative situ- Barnes et al. found that people with higher trait mindfulness
ations (Cahn & Polich, 2006; Davidson et al., 2003). Activation of reported less emotional stress in response to relationship conflict
this region of the brain corresponds with faster recovery to base- and entered conflict discussion with less anger and anxiety. Evi-
line after being negatively provoked (Davidson, 2000; Davidson, dence shows that mindfulness is inversely correlated with distress
Jackson, & Kalin, 2000). contagion and directly correlated with the ability to act with
Moore and Malinowski (2009) compared a group of experi- awareness in social situations (Dekeyser, Raes, Leijssen, Leyson,
enced mindfulness meditators with a control group who had no & Dewulf, 2008). Thus, empirical evidence suggests that mind-
meditation experience on measures assessing their ability to fulness protects against the emotionally stressful effects of rela-
focus attention and suppress distracting information. The med- tionship conflict (Barnes et al., 2007), is positively associated with
itation group had significantly better performance on all mea- the ability to express oneself in various social situations (Dekeyser
sures of attention and had higher self-reported mindfulness. el al., 2008), and predicts relationship satisfaction (Barnes et al.,
Mindfulness meditation practice and self-reported mindfulness 2007; Wachs & Cordova, 2007). Given that the therapeutic rela-
were correlated directly with cognitive flexibility and atten- tionship is emotionally intimate, potentially conflictual, and inher-
tional functioning. ently interpersonal, therapists trait mindfulness may aid their
In another study, individuals with one month to 29 years of ability to cultivate and sustain successful relationships with clients.
mindfulness meditation practice experience viewed pleasant,
unpleasant, and neutral pictures and then had their reaction Other Intrapersonal Benefits
times measured to categorizing tones as either short or long
(Ortner et al., 2007). Reaction time was thought to represent In addition to the affective and interpersonal benefits identified
emotional interference with the categorization task. Meditation above, mindfulness has been shown to enhance functions associ-
experience was inversely related to emotional interference ated with the middle prefrontal lobe area of the brain, such as
when viewing unpleasant pictures. Ortner et al. suggest that self-insight, morality, intuition, and fear modulation (Siegel,
mindfulness meditation practice may help individuals disen- 2007b, 2009). There is also evidence that mindfulness meditation
gage from emotionally upsetting stimuli, enabling attention to has numerous health benefits including increased immune func-
be focused on the cognitive task at hand. In a follow-up study, tioning (Davidson et al., 2003; see Grossman, Niemann, Schmidt,
participants were assigned to either a 7-week training in mind- & Walach, 2004 for a review of physical health benefits). Mind-
fulness meditation, relaxation meditation, or a waiting list con- fulness meditation has been shown to improve well-being (Car-
trol group. The mindfulness meditation group exhibited less mody & Baer, 2008) and reduce psychological distress (Coffey &
Hartman, 2008; Ostafin et al., 2006).
emotional interference in response to the unpleasant pictures
Neuroplasticitythe rewiring that occurs in the brain as a
than the other groups. Ortner et al.s findings support the notion
result of experiencenow explains how regular mindfulness
that mindfulness meditation decreases emotional reactivity.
meditation practice alters the brains physical structure and
In addition, Cahn and Polich (2009) assessed the reactions of
functioning (Davidson et al., 2003; Lazar et al., 2005; Siegel,
very experienced mindfulness meditators to distracting stimuli.
2007a; Vestergaard-Poulsen et al., 2009). Changes in the structure
Findings revealed that while in a meditative state, practitioners of the brain include thicker brain regions associated with attention,
displayed minimal emotional and cognitive reactivity to distracting sensory processing and sensitivity to internal stimuli (Lazar et al.,
stimuli. These findings support the notion that mindfulness med- 2005), distinct gray matter concentrations (Hlzel et al., 2008), and
itation contributes to decreased reactivity. thicker brain stems, which may account for positive cognitive,
A recent study investigated the effects of MBSR training on emotional and immunoreactive benefits (Vestergaard-Poulsen et
emotional reactivity and regulation of negative self-beliefs among al., 2009). Research suggests that states experienced during mind-
adults with social anxiety disorder (Goldin & Gross, 2010). Par- fulness meditation eventually can become effortless traits over
ticipants completed two attention tasks before and after participat- time (Farb et al., 2007; Siegel, 2007a). Thus, the longer therapists
ing in an 8-week MBSR training. In prepost tests, participants practice mindfulness meditation, the more they may benefit from
displayed lower levels of negative emotion, decreased amygdala its effects.
activity, and increased levels of activity in areas of the brain Other benefits of mindfulness meditation practice include in-
associated with attentional deployment. creased information processing speed (Moore & Malinowski,
202 DAVIS AND HAYES

2009), decreased task effort (Lutz et al., 2009), and having fewer found that they believed that mindfulness meditation helped de-
thoughts that are unrelated to the task at hand (Lutz et al., 2009). velop empathy toward clients. In particular, interviews were con-
In particular, Lutz et al.s research implies that due to increased ducted with six psychotherapists who each had more than 10 years
attentional skills and increased ability to manage distractions, of experience practicing both therapy and mindfulness meditation.
therapists who practice mindfulness meditation may have an in- Consistent themes from the data indicated that mindfulness helps
creased ability to be present to their clients. therapists: develop their ability to experience and communicate a
felt sense of clients inner experiences; be more present to clients
Effects of Meditation on Therapists and suffering; and help clients express their body sensations and feel-
Therapist Trainees ings. Finally, along similar lines, Wang (2007) used a passive
design and found that therapists who were experienced mindful-
Whereas the literature on the benefits of applying mindfulness ness meditators scored higher on measures of self-reported empa-
approaches to psychotherapy clients is vast (see Didonna, 2009 thy than therapists who did not meditate.
and Baer, 2006 for reviews), research on the effects of mindfulness
on psychotherapists is gradually emerging. This body of literature Compassion
will be reviewed and synthesized below. Practical examples of
mindfulness-based interventions for therapists and therapist train- In addition to empathy, a second therapist characteristic that
ees in practice are shown in Table 2. seems to derive from meditation is compassion. For example,
MBSR training has been found to enhance self-compassion in
Empathy health care professionals (Shapiro, Astin, Bishop, & Cordova,
2005) and therapist trainees (Shapiro, Brown, & Biegel, 2007).
Mindfulness meditation consistently has been theorized to pro- Kingsbury (2009) investigated the role of self-compassion in re-
mote empathy (Anderson, 2005; Fulton, 2005; Martin, 1997; Mor- lation to mindfulness. Two components of mindfulness, nonjudg-
gan & Morgan, 2005; Shapiro & Izett, 2008; Walsh & Shapiro, ing and nonreacting, were strongly correlated with self-
2006), and research utilizing a variety of methods is now accumu- compassion, and two dimensions of empathy, taking on others
lating in support of this premise. In a within-subjects study on perspectives (i.e., perspective taking) and reacting to others af-
meditation and empathy, counselors in training demonstrated in- fective experiences with discomfort. Self-compassion fully medi-
creased empathy after participating in a 4-week Zen meditation ated the relationship between perspective taking and mindfulness.
training (Lesh, 1970). In a between-groups experiment, premedical
and medical students who participated in an 8-week MBSR train-
Counseling Skills
ing had significantly higher self-reported empathy than a control
group (Shapiro, Schwartz, & Bonner, 1998). A qualitative study Empirical literature now demonstrates that including mindful-
(Aiken, 2006) of therapists who were experienced meditators ness interventions in psychotherapy training may contribute to the

Table 2
Examples of Mindfulness-Based Interventions for Trainees and Therapists

Benefits Practical mindfulness-based interventions for trainees and therapists mindfulness

Empathy In trainee dyads in therapist & client roles: In dyads, pause after each person speaks and consciously relax.
Have therapists track their internal responses to While pausing, with acceptance and curiosity ask yourself:
client, and what makes them feel more and less What is happening now? What am I feeling now? What
empathetic towards client.7 might this person be experiencing?8
Compassion Visualize an image, color, or memory that elicits Practice sending loving-kindness towards oneself, towards a
feeling friendly towards yourself. Visualize loved one, towards a neutral client, towards a challenging
sending this feeling towards an image of yourself, client, and towards all beings.9
or a challenging client.9
Counseling skills In dyads, sit in silence with eyes open. Pay attention In trainee dyads in therapist & client roles: Have therapists
to your internal experience in the presence of let go of judgments and the desire to say something and
another person, practicing to bring your attention practice fully listening to clients. Have therapists track when
back to their breath when it wanders.10 their attention wanders off and practice returning attention to
back to present moment.7
Decreased stress Bring your attention to your experience of breathing. In dyads, have each person track their own internal feelings,
& anxiety Imagine seeing a client. Pay attention to any thoughts, & sensations as they stand at varying distances
feelings of anxiety and fear. Notice how they shift from each other. Practice with an accepting attitude towards
from moment to moment, allowing what is to be internal reactions with eyes open, with eyes closed, facing
there.11 each other, & with their backs facing each other.10
Other benefits for Therapists can practice formal sitting mindfulness In between sessions, take one minute each to: 1) Ask what is
therapists meditation individually or in groups. my experience right now? 2) Notice the sensation of each in
and out breath 3) Expand your awareness to your whole
body with an attitude of acceptance.12
7
(Adapted from Shapiro & Izett, 2008). 8 (Adapted from Deep Listening & Authentically Speaking, Surrey, 2005). 9
(Adapted from Morgan & Morgan,
2005). 10 (From authors (Davis) mindfulness training at Naropa University). 11 (Adapted from Brach, 2003). 12
(Adapted from 3-minute Breathing
Space from MBCT, Segal, Williams, & Teasdale, 2002).
 WHAT ARE THE BENEFITS OF MINDFULNESS? 203

development of skills that impact trainees effectiveness as thera- Zen, and Vajrayana) for more than five years to examine the
pists. In a 4-year qualitative study, counseling students reported influence of their meditation practice on their work as therapists.
considerable positive effects on their counseling skills and thera- Findings suggested that long-term mindfulness meditation practice
peutic relationships, including being more attentive to the therapy can positively impact therapists ability to distinguish their own
process, more comfortable with silence, and more attuned with experience from their clients experience, can enrich therapists
oneself and clients, after taking a 15-week course that included clarity in their work with clients, and may help develop therapists
mindfulness meditation (Newsome, Christopher, Dahlen, & Chris- self-insight. Other potential benefits of mindfulness include in-
topher, 2006; Schure, Christopher, & Christopher, 2008). Coun- creased patience, intentionality, gratitude, and body awareness
selors in training who have participated in similar mindfulness- (Rothaupt & Morgan, 2007).
based interventions have reported significant increases in self-
awareness, insights about their professional identity (Birnbaum, Client Outcomes of Therapists Who Meditate
2008), and overall wellness (Rybak & Russell-Chapin, 1998).
While the research reviewed above points rather clearly to the
conclusion that mindfulness meditation offers numerous benefits to
Decreased Stress and Anxiety
therapists and trainees, do these benefits translate to psychotherapy
Research has found that premedical and medical students report treatment outcomes? To date, only one study provides evidence. In a
less anxiety and depression symptoms after an 8-week MBSR study conducted in Germany, randomly assigned counselor trainees
training compared to a waiting list control group (Shapiro et al., who practiced Zen meditation for nine weeks reported higher self-
1998). The control group evidenced similar gains after exposure to awareness compared to nonmeditating counselor trainees (Grepmair
MBSR training. Similarly, following MBSR training, therapist et al., 2007). What is more important is that after 9 weeks of treat-
trainees have reported decreased stress, rumination, and negative ment, clients of trainees who meditated displayed greater reductions
affect (Shapiro et al., 2007). In addition, when compared with a in overall symptoms, faster rates of change, scored higher on mea-
control group, MBSR has been shown to decrease total mood sures of well-being, and perceived their treatment to be more effective
disturbance, including stress, anxiety and fatigue in medical stu- than clients of nonmeditating trainees.
dents (Rosenzweig, Reibel, Greeson, Brainard, & Hojat, 2003). Despite these promising results, three other studies suggest that
Using qualitative and quantitative measures, nursing students re- the relationship between counselor trainees mindfulness and cli-
ported better quality of life and a significant decrease in negative ent outcomes is not so encouraging. Stanley et al. (2006) studied
psychological symptoms following exposure to MBSR (Bruce, the relationship between trait mindfulness among 23 doctoral-level
Young, Turner, Vander Wal, & Linden, 2002). Recent evidence clinical psychology trainees in relation to treatment outcomes of
from a study of counselor trainees exposed to interpersonal mind- 144 adult clients in a university community clinic that used manu-
fulness training suggests that such interventions can foster emo- alized, empirically supported treatments. Contrary to expectation,
tional intelligence and social connectedness, and reduce stress and therapist mindfulness was inversely correlated with client out-
anxiety (Cohen & Miller, 2009). Similarly, in a study of Chinese come. This is consistent with other findings that suggest an inverse
college students, those students who were randomly assigned to relationship exists between therapists mindfulness and client out-
participate in a mindfulness meditation intervention had lower depres- comes (Bruce, 2006; Vinca & Hayes, 2007). Still other research
sion and anxiety, as well as less fatigue, anger, and stress-related suggests that no relationship exists between therapist mindfulness
cortisol compared to a control group (Tang et al., 2007). These same and therapy outcome (Stratton, 2006).
students evidenced greater attention, self-regulation, and immunore- One of the difficulties with this small body of research pertains
activity. Waelde et al. (2008) assessed changes in symptoms of to the accuracy of therapist self-reported mindfulness. It could be
depression, anxiety, and posttraumatic stress disorder among New that more mindful people are likely to score lower on a self-report
Orleans mental health workers following an 8-week meditation inter- measure of mindfulness because they are aware of the degree to
vention that began 10 weeks after Hurricane Katrina. Although which they are mindless. Conversely, people who are less mindful
changes in depression symptoms were not found, PTSD and anxiety may not realize it and therefore may be inclined to rate themselves
symptoms significantly decreased after the 8-week intervention. Find- higher on such measures. Also, it is noteworthy that in the one
ings suggest that meditation may serve a buffering role for mental study with positive findings regarding outcome (Grepmair et al.,
health workers in the wake of a disaster. 2007), participants engaged in the practice of meditation rather
than simply reporting their mindfulness. In the studies with neg-
ative or null findings, there was no indication if participants had
Other Benefits of Mindfulness for Therapists
ever engaged in actual meditation. Thus, it may be that meditation
To date, one study has investigated the relationship between is a better predictor of outcome than self-reported mindfulness (see
mindfulness and counseling self-efficacy. Greason and Cashwell Grossman, 2008 for a comprehensive summary of limitations to
(2009) found that counseling self-efficacy was significantly pre- mindfulness research).
dicted by self-reported mindfulness among masters-level interns
and doctoral counseling students. In that study, attention mediated Further Implications
the relationship between mindfulness and self-efficacy, suggesting
that mindfulness may contribute to the development of beneficial Empirically Supported Relationships
attentional processes that aid psychotherapists in training (Greason
& Cashwell, 2009). Dreifuss (1990) interviewed six therapists who Many scholars have proposed that the development of skills and
practiced one of three mindfulness meditation styles (Vipassana, qualities in therapists who practice mindfulness meditation will
204 DAVIS AND HAYES

strengthen the therapeutic relationship (Germer et al., 2005; Hick Practice and Clinical Supervision
& Bien, 2008; Shapiro & Carlson, 2009). Future research could
profitably address how therapists mindfulness contributes to crit- Germer et al. (2005) proposed that mindfulness can be inte-
ical relationship factors such as the formation and sustenance of grated into psychotherapy through three means: therapist mindful-
the working alliance, countertransference management, and the ness (therapists own practice of meditation to be more mindful
provision of unconditional regard with difficult clients (Norcross, and present with clients), mindfulness-informed psychotherapy
2002). For example, one study (Wexler, 2006) found that both (i.e., applying Buddhist psychology and mindfulness theory to
client and therapist perceptions of the working alliance were clinical work), and mindfulness-based psychotherapy (teaching
positively related to therapist self-reported mindfulness. In another clients skills through the application of mindfulness practices).
study, however, the relationship between mindfulness and working Davis (2010) has proposed that mindfulness meditation also would
alliance was not significant (Bruce, 2006). Again, it could be that benefit clinical supervision by enhancing supervisors presence to
meditation practice is a better predictor of the working alliance their supervisees and enabling them to be less reactive to super-
than self-reported mindfulness, although this awaits further study. visees anxiety. Table 3 expands on Germer et al. (2005) and Davis
With regard to countertransference management, it is plausible (2010) and provides practical examples and means of integrating
that the nonreactivity and cognitive flexibility fostered by mind- mindfulness into psychotherapy.
fulness should help therapists respond more freely and less defen- The old adage that people can guide another on a path only as
sively to their clients (Gelso & Hayes, 2007). To date, one study far as they themselves have ventured also applies to therapists
has investigated mindfulness and countertransference. Kholooci integrating mindfulness into psychotherapy and into clinical su-
(2008) examined the relationship between self-reported mindful- pervision (Davis, 2010). Introducing mindfulness approaches into
ness and therapists awareness of countertransference. Kholooci psychotherapy necessitates engaging in a mindful practice our-
found a significant inverse relationship between mindfulness and selves as psychotherapists (Hick, 2008). It has been recently pro-
countertransference awareness such that the more mindful thera- posed that therapists who introduce mindfulness interventions with
pists perceived themselves to be, the less aware they were of their clients may find it helpful to explain mindfulness in terms of
countertransference. attention, avoiding jargon that may have unintended negative
In conclusion, while the psychological and physical health ben- effects on clients (Carmody, 2009).
efits of mindfulness meditation are strongly supported by research,
the ways in which therapists mindfulness meditation practice and Training Implications
therapists mindfulness translate to measureable outcomes in psy-
chotherapy remain unclear. Future research is needed to examine Mindfulness as a metacognitive skill has been proposed as a
the relations between therapists mindfulness, therapists regular necessary component of psychotherapy training (Bruce, Manber,
mindfulness meditation practice, and common factors known to Shapiro, & Constantino, 2010; Fauth, Gates, Vinca, Boles, &
contribute to successful treatment outcome. Doing so will foster Hayes, 2007; Vinca, 2009). As research on therapists mindfulness
understanding of how mindfulness meditation may enhance com- continues to emerge, should therapists mindfulness demonstrate a
munication and relationship building skills within the context of meaningful relationship with measurable outcomes in the thera-
psychotherapy. peutic relationship and treatment outcomes, psychotherapy train-

Table 3
Examples of Ways to Integrate Mindfulness in the Field of Psychotherapy

Ways mindfulness can be integrated

into psychotherapy Professional avenues for integration Practical examples

Therapist mindfulness Therapists personal meditation practice While others are speaking, practice letting go
Therapists clinical work of your own thoughts, judgments, and
Training programs analyzing, and return to listening
Clinical supervision receptively. Let your listening be
Continuing education wholehearted and attentive . . . . speak
slowly enough to stay connected to your
body and heart.13
Mindfulness-informed psychotherapy Therapists clinical work Apply the Buddhist principal of equanimity to
Training programs a client issue, such as: What happens
Clinical supervision when you let that need be there?14
Continuing education
Mindfulness-based psychotherapy Therapists clinical work Guide clients to: Close your eyes and with
Training Programs curiosity and non-judgment, allow whatever
Clinical supervision emerges in your awareness to be there,
Continuing education letting it come and go. Mentally label your
Mindfulness-based group therapy experience, such as feeling, smelling,
thinking, etc. as you sit for few minutes.15
13 14 15
(Deep Listening & Authentically Speaking, Surrey, 2005, p. 110). (Adapted from Welwood, 2002, p. 190). (Adapted from Mindfulness, Morgan
& Morgan, 2005).
 WHAT ARE THE BENEFITS OF MINDFULNESS? 205

ing could include mindfulness training. Given the push toward measurable counseling skills in both trainees and therapists. For
outcome-based education, training and credentialing as measured example, how does mindfulness meditation practice effect empa-
by training benchmarks and the acquisition of competencies thy and compassion for midcareer or late-career therapists who are
(Kaslow et al., 2002), perhaps mindfulness could be measured in already seasoned veterans?
training programs as a necessary specific competency. Research Shapiro and Carlson (2009) have suggested that mindfulness
support is needed to influence policy changes and changes in meditation can also serve as a means of self-care to help combat
psychotherapy training program requirements. Given that mind- burnout rates. Future research on not only how therapists practice
fulness meditation is a means to develop mindfulness, both coun- of mindfulness meditation helps facilitate trainee development and
selor education and continuing education programs could benefi- affects psychotherapy is needed, but the ways in which therapists
cially offer mindfulness meditation training. own practice of mindfulness meditation can help with burnout
rates and other detrimental outcomes of work-related stress.
Important Next Steps in Research In addition, despite abundant theoretical work on ways to con-
ceptually merge Buddhist and Western psychology to psychother-
Future research holds tremendous potential for uncovering more apy (e.g., Epstein, 2007, 1995), there is a lack of literature on what
about the neurophysiological processes of meditation and the it looks like in session when a therapist employs Buddhist-oriented
benefits of long-term practice on the brain. Research on neuro- approaches (i.e., mindfulness-informed psychotherapy as termed
plasticity may help explain the relationship among length and by Germer, 2005) to specific clinical issues and diagnoses. Given
quality of meditation practice, developmental stages of meditators, the numerous and rich clinical applications of mindfulness-based
and psychotherapy outcomes. More research is needed to better approaches to specific clinical issues, more literature is needed on
understand how the benefits of meditation practice accumulate the ways mindfulness-informed psychotherapy differs from
over time. mindfulness-based psychotherapy in session with clients.
In addition, other means of increasing mindfulness, in addition In conclusion, the momentum within research on mindfulness
to meditation, need to be explored. Given that current research holds promise for a potential transformation in ways to facilitate
does not indicate that therapists self-reported mindfulness en- trainee and therapists development, and means to affect change
hances client outcomes, better measures of mindfulness may need mechanisms known to contribute to successful psychotherapy. The
to be developed or different research designs that do not rely on field of psychotherapy could benefit from future research exam-
self-report measures need to be used. Garland and Gaylord (2009) ining cause and effect relationships and/or mediational models to
have proposed that the next generation of mindfulness research better understand the seemingly fruitful benefits of mindfulness
encompass four domains: 1) performance-based measures of and mindfulness meditation practice.
mindfulness as opposed to self-reports of mindfulness, 2) scientific
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