I wrote a blog post a couple of days ago on "MBSR: how important is 'homework' and responses to the bodyscan".  I mentioned there that I'd been through the bodyscan eight times in the previous few days guided by live or recorded directions from five different teachers (this included one self-guided session).  I ended the post saying "What about how the "Body scan" is approached? How is it best to do the exercise itself? How much is it helpful to encourage relaxation, even subtlely? How much is it helpful to encourage effort? Is it useful to underline the benefits that can be achieved? Are we teaching a skill where one can hope to get better at it? I've listened to four experts teaching the body scan in the last eight days. They teach it differently. Not a big surprise. The basic structure is the same, then it's like listening to different jazz musicians interpreting a piece in their varied ways. Are all equally valid, or are some interpretations "better" than others? The crunch is ... what is likely to be most helpful? And this sits on the bigger question, what are the mechanisms that make a MBSR/MBCT course useful? What precisely is it most important for participants to learn?"

I'd like to comment on three areas here.  One is a set of general remarks about the importance of non-specific factors like combating demoralisation, modeling warmth, understanding & acceptance, subtly promoting relaxation, and encouraging home practice.  A second area is the fascinating, apparently paradoxical, challenge of nourishing the mindfulness facets of Non-judging and Non-reacting while also supporting determined commitment to change.  The third area I'd like to touch on is more of a ragbag including the value of Observe & Act-aware mindfulness facets for boosting positive emotions, links to research on mindfulness, attachment style & self-compassion, and the benign mutually reinforcing spiral of mindfulness practice and improved self-regulation.  

So first some general remarks.  I wrote recently about the academic publication "The heart & soul of change: delivering what works in therapy".  The contributors argue - with impressive research back-up - that " ... therapeutic efficacy inheres primarily in the patient's experience and in the use of a remoralizing, resource-enhancing, and motivating relationship with a therapist who is supportive and challenging (in proportions and at times that suit the patient's needs and abilities).  The therapist's procedures are important but become effective largely by contributing to the formation and development of this relationship in the patient's experience.  This view provides a better fit with the cumulative findings of psychotherapy research than does the pharmacological paradigm, as various chapters in this book show."  I know that there are important differences between group skills training and one-to-one therapeutic work, but there are important similarities too.  I believe that teaching mindfulness can helpfully be compared with aspects of "re-parenting".  Warmth, interest, acceptance, encouragement - these kinds of qualities can be transmitted from mindfulness teacher to student both overtly in discussing why & how mindfulness practice could help the student make changes in how they feel & act that are of particular personal importance, and also repeatedly & deeply during the mindfulness exercises themselves.  This warm, accepting encouragement can involve sharing research & personal experience that indicate the student can really help themselves, demonstrating interest & care in the individual student's circumstances & hopes, how the teacher comes across interpersonally, voice tone, body language, facial expression, so much that's of crucial gut-level importance. 

I went on to write "And central to this ... is the practice of session-by-session monitoring and feedback. As the editors propose in their introduction "In the end, monitoring outcomes may provide a common ground for those who advocate empirically supported treatments and those who espouse the importance of common factors." I heartily agree. They point out that "The combination of measuring progress (i.e. monitoring) and providing feedback consistently yields clinically significant change ... Rates of deterioration are cut in half, as is dropout. Include feedback about the client's formal assessment of the relationship, and the client is less likely to deteriorate, more likely to stay longer, and twice as likely to achieve a clinically significant change."   This monitoring that I'm advocating might well include a measure of mindfulness - see the post "A better way to measure mindfulness: a short form of the five facet questionnaire".  It might also include regular assessment of general measures of psychological state - see for example the "Outcomes toolkit" - and a measure like the "Session rating scale" - see my blog post "On becoming a better therapist".

I'd also like to comment briefly on subtly promoting relaxation.  It's interesting how in a 1997 paper, Jon Kabat-Zinn referred to mindfulness training as relaxation techniques.  There clearly are major differences between the more "narrow-focused" concentrative practice of applied relaxation and the potentially more "broad-focused" mindfulness practice of MBSR/MBCT.  Interestingly both Right concentration and Right mindfulness are components of the traditional Buddhist Noble Eightfold Path, and both approaches are recommended in current evidence-based NICE guidelines (mindfulness more for depression and relaxation more for anxiety).  In the real world people often struggle with vulnerability to a variety of difficult states including sometimes feeling low, feeling anxious, and feeling stressed more generally.  Should mindfulness teaching simply ignore the potential value of encouraging relaxation?      

More to follow ...