Does mindfulness meditation bury painful experiences

Mindfulness based cognitive therapy is helpful at treating depression and preventing relapse.

However a reasonable amount of depression is due to some kind of psychological trauma. And other therapies like EMDR or exposure therapy are designed to expose a person to a trauma and help them cope with it.

Does mindfulness ‘bury’ trauma (by encouraging you to focus on awareness rather than follow automatic thoughts), or does it just lower the intensity to a point where other interventions to deal with it are more effective? It seems with MCBT the goal is to create a sense of distance between yourself and your problems while correcting cognitive distortions.

But other therapies like EMDR encourage you to address your pains, including parts you feel you may not feel comfortable facing.

So is there a risk mindfulness can actually bury trauma deeper, or does it just lower the intensity to the point where other interventions are actually more effective at dealing with it? It seems like it is almost discouraging interaction with a traumatic experience whereas other therapies encourage that.

My experience with mindfulness meditation is that it actually helps you deal with your psychological issues. As you sit quietly with yourself and ask yourself questions like, “What is bothering me? Why am I so upset today?”, you’ll get real answers from your sub-conscious (and you can tell the real answers because you burst out crying).

Ok, this is actually a really good question. I’m no expert and I’m not too familiar with MBCT. However, I’ve done prolonged exposure therapy for PTSD, I’ve done Dialectical Behavioral Therapy (which has a heavy mindfulness element) and I’m also a Buddhist pretty familiar with the basic concept of mindfulness.

To start, PTSD is an anxiety disorder, whereas depression is an affective disorder. It stands to reason that the approach to treatment would therefore be different, as would be the theoretical constructs underlying said treatment. That is not to say that PTSD does not often lead to depression–it’s just that they aren’t the same thing.

The major evidence-based theory underlying PTSD (and indeed, panic-related disorders in general) is the old conditioned stimulus-response model. To try to put it simply, people with trauma are conditioned to experience anxiety when they encounter reminders of the trauma, so they avoid those triggers, which exacerbates the anxiety associated with those triggers. The act of trying to suppress the unpleasant feelings/sensations/memories actually makes them more likely to occur at inconvenient and inappropriate times.

Exposure therapy, then, seeks to undo those conditioned responses by exposing the traumatized person to his or her triggers until that person becomes habituated to the anxiety response and thus no longer fears the trigger.

This works really, really well, though it is grueling to experience personally. I received treatment at arguably the best possible clinic in the world to receive exposure therapy – The Center For Treatment and Study of Anxiety, which is the place founded by the inventor of prolonged exposure, Edna Foa. According to my psychologist, exposure therapy is successful at treating comorbid disorders. People who come into the clinic with PTSD and depression or PTSD and some other kind of anxiety usually leave with all psychological disorders significantly improved.

One possible theory as to why this is is that behavior changes cognition automatically. There are a growing number of researchers that believe the ‘‘cognitive’’ element of CBT is unnecessary, not because cognition changes aren’t required to heal from psych disorders, but because behavioral therapy alone causes those cognition changes automatically. Obviously cognitive therapists do not agree.

But while depression might be a common comorbid disorder with PTSD, the theory underlying its origins is quite different. Depression is exacerbated by the things we think about the world and ourselves, and the things we do. People with depression are prone to significant cognitive distortions, such as Overgeneralization, All-Or-Nothing Thinking, and Catastrophizing (this is true to a certain extent with PTSD, but I would argue that PTSD is much more stimulus-response oriented than depression.) People with these cognitive distortions have difficulty taking actions to improve their mood. If PTSD is a habit of avoiding distressing things, depression is a habit of thinking and doing depressing things.

Mindfulness is useful because it breaks through the cognitive distortions that contribute to depression and generalized anxiety. Rather than allowing you to ruminate on something endlessly, it places your attention on the moment and puts you in touch with the impermanence of that moment. It reminds you, in essence, that your thoughts are not some kind of objective reality… they are just thoughts. This can be helpful in clearing your mind long enough to take positive actions to change your mood.

All of these therapies – prolonged exposure, DBT, CBT, MBCT, are cognitive or behavioral in nature, or both. So even though they might use different approaches, they are all based on the assumption that things we think and do affect how we feel. However, the current best treatment for PTSD is prolonged exposure therapy, with success rates as high as 80% when properly implemented. That is true even if the PTSD is accompanied by a comorbid disorder such as depression. So, statistically speaking, a person with PTSD/depression is better off doing prolonged exposure than MBCT or even straight-up vanilla CBT.

Now, if you want to get into the Buddhist conceptualization of mindfulness, it is no about ‘‘burying’’ anything. It is about being present with whatever is there. If you are in the midst of a horrible PTSD-related flashback, mindfulness is sitting and feeling all of those sensations and crying and screaming but being aware of the transient nature of that experience and feeling ultimately at peace with it. I do believe, in that vein, mindfulness and prolonged exposure therapy are two similar means to the same end. In this case, though, I have to argue that prolonged exposure is the more direct route, because it provokes the conditioned response on purpose rather than just waiting for it to show up on its own.

While I am very much a novice, my experience with mindfulness meditation is that it does the opposite of creating a distance between yourself and your problems. The whole point increasing your awareness.

I’ve found, much to my surprise, that looking honestly at my limitations reveals them to be much less onerous than I had previously assumed.