Mindfulness and Therapy    


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The Concept of Mindfulness in Psychotherapy

A central starting point of the mindfulness-based intervention is a changed way of dealing with emotionally challenging experiences. This starting point is non-mindfulness: the dominance of mental processes such as daydreams, fantasies, thoughts about the future, memories, and pondering.


In order to work scientifically with mindfulness, it is necessary to filter out the mindfulness concept that has been handed down within the cultural/spiritual tradition in order to establish which components are actually effective in the therapeutic context and which ones tend to have a mystic background. This separation from the spiritual context is like a sorting process to find which aspects of mindfulness fulfill a function in spirituality but are not helpful in therapy. The result is a simplified operational definition of the concept of therapeutic mindfulness.

How valuable is this type of approach?


1. Clinicians require a conceptual tool in order to direct their actions.


2. For research, a concept determination with clearly defined components is required so that new interventions can be constructed.


The therapeutic mindfulness approaches that have been used up to now in psychotherapy differentiate in the extent to which the principles of mindfulness are integrated. A distinction is made between mindfulness-analogous, mindfulness-informed, and mindfulness-based methods.


Mindfulness-analogous: Principles are similar to the mindfulness principle, but are not identical (such as Freud’s “evenly suspended attention”).


Mindfulness-informed: Specific communication of mindfulness-based principles. However, mindfulness is not the main technique of the method; instead, it is one of several treatment elements (such as DBT and ACT in which formal meditation exercises are not practiced).


Mindfulness-based: Distinct relationship with the traditional concept of mindfulness. Mindfulness is the main element, and intensive formal meditation exercises are performed on a regular basis (such as MBCT and MBSR). The mindfulness-based pain therapy (MBPT) according Dr. Peter Tamme for the treatment of chronic pain falls into this latter category.


The mindfulness model offers astonishing possibilities in various areas of psychotherapy. In addition to representing a partial aspect of some psychotherapeutic methods, mindfulness has now established itself through the development of disorder-specific concepts into a recognized technique with constantly growing popularity.


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Basic Principle


The basic idea of the mindfulness-based intervention is that a large portion of what we think, feel, and do is a consequence of unconsciously implicit processes. Furthermore, we can observe that an intentional wanting to let go of unpleasant stimuli or experiences will fail because symptoms only intensify when we want to get rid of them. We are all familiar with the phenomenon that we cannot make ourselves want to fall asleep if this does not occur on its own, or that an itch does not disappear just by wanting it to go away, or that we cannot relax on command when we are tense at that moment.

The path out of the dilemma is offered by ending the opposition to the lamented symptom, which means giving up the resistance to the aversive stimuli. This occurs by discovering the implicit, automated, and dysfunctional patterns of thinking, feeling, and behavior that have otherwise caused the reaction.

Proof of Effectiveness

Before we talk about the proof of effectiveness for a new technique in psychotherapy, it should be noted that no psychotherapeutic technique has proved to be effective for pain patients on the basis of scientific criteria. Psychotherapists obviously do not like to hear this. Yet, it is surprising that – especially from the circles of psychotherapists – the issue is provocatively raised as to whether serious evidence for the effectiveness of mindfulness-based techniques exists.


Although there have been studies on effectiveness for some of the psychotherapeutic approaches that have been used with pain patients up to now, they have not been conducted within the context of pain-therapy treatments. Just the fact that behavior therapy has proved to be effective in the treatment of panic anxiety does not necessarily permit this conclusion to be transferred to pain patients. This allows us to shelve the discussion about the proof of effectiveness for the mindfulness-based psychotherapeutic technique for now.


The measure of all things in traditional psychotherapy, as well as in the mindfulness-based technique, is the subjective experiences of the affected individual (empiricism). In contrast, the science of the objectification also strives for third-party assessment by independent investigators.


For most psychotherapeutic treatment procedures, it is simply impossible to conduct the controlled randomized trials (CRTs) that are demanded by science. This means that MBPT is in the best of company (with psychoanalysis, for example). There are an abundance of empirical studies on mindfulness-based techniques, which ultimately contributed toward the advancement of the mindfulness procedures as a first-choice therapy for the treatment of so-called impulse disorders.



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Whether the researchers evaluate the technique one way or the other is insignificant for the patients. They want help – not on paper but in a way that can be experienced tangibly and with little effort. This is what the pain therapist thinks as well. The same also applies to payers unless the demand for CRTs that cannot be fulfilled is abused in order to refuse any of the incurred costs.


We call on therapists who offer MBPT not to destroy the major benefits of the MBPT in terms of its effectiveness, suitability for group therapy, quick learnablity, and ease of communication through inappropriately high fee demands. It will only be possible to spread the method when the payers are convinced that MBPT results in a previously unachieved cost-benefit ratio.


Copyright Dr. Peter Tamme and Dr. Iris Tamme

Last update: August 4, 2012