Mindfulness, as the term is used in behavioral therapy, simply means paying close attention to something you are currently experiencing

This could be something external to you, such as all the sounds now available to your ears, or to something internally present to you, such as the sensation of your breath. Behavioral therapy uses mindfulness to help people get unstuck from negative thoughts (defusion) and to help emotions run their course (habituation).

The full definition of mindfulness often cited is:  “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (p. 4). Kabat-Zinn, J. 1994. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion.
 
Because mindfulness is such a large topic, I have broken the module into sections. It would be great if you can work through them all at one go! But if not, you can more easily pick up where you left off by selecting from the list below.


 
I. Mindfulness in the Service of Defusion

When you watch a scary movie, do you get scared?

     
 
Good! Isn't it interesting that our emotions can respond to movies, even though we know that what we're watching is not real?

Behavioral therapy says that you only get scared if your attention “fuses” with the movie. Fusion means that your attention is making the imaginal portrayal “real” for you; your emotions respond as if what is happening in the movie is really happening around you.

 
Maybe you haven’t seen a movie that’s scary enough! Or you might not be letting your attention “fuse” with the movie. (Do you laugh at the scary parts?) 

Behavioral therapy says that you only get scared if your attention “fuses” with the movie. Fusion means that your attention is making the imaginal portrayal “real” for you; your emotions respond as if what is happening in the movie is really happening around you. 

 
I'd like you to think for a moment about what factors would make it more likely that you would fuse with the movie. Of the pairs below, can you pick which one would increase your fusion (and hence, if it's a scary movie, how scared you get)? 
- Staying silent, vs. laughing and talking
- Watching by yourself, vs. watching in a group
- Watching while on a shift at work, vs. watching at a moment of leisure
- Watching in a dark house, vs. watching poolside at a fun party

 
Anything you do that makes it easier for you to immerse your attention in the movie will increase your state of fusion. 

Now, there are screens outside of your mind, and inside of your mind. The internal screen is our imagination and memory, which present to us a stream of ever-changing images or words. Sometimes a passing image “hooks” our attention and we get drawn into it: this is the work of fusion.

If the fusion is weak, we easily unhook our attention and return to what we were doing. If it is strong, we can get carried away for a longer period of time. At its strongest, fusion produces the inward collapse of attention that we call tunnel vision.

 
Is it any wonder, then, that people are most likely to get hooked by their thoughts when they are alone, when everything else is quiet around them, when they have no task to focus on?

 
The power of a thought to produce fusion is called salience. Highly salient thoughts have a magnetic power that draws our attention to them; and they also have the power to activate our emotions once we fuse with them. 

Salience comes from the significance of the pain or pleasure contained in the content of the thought. Thoughts with a negative (threat) salience produce one set of emotions upon fusion (fear, anger, despair, etc.); thoughts with positive (opportunity) salience produce another set of emotions upon fusion (desire, love, etc.).

So does salience simply mean how noticeable or important a thought is?

     
 
That's right. Salience is a property of a thought/image in itself. You can also think of it as the emotional "charge" the thought has. This is an important concept, since it allows you to conceptually separate the idea of the thought from the experience of the emotions the thought triggers when you fuse with it.

 
Actually, that's all salience really means. 

Salience is a property of a thought (or image) in itself. You can also think of it as the emotional "charge" the thought has. This is an important concept, since it allows you to conceptually separate your idea of the thought from the experience of the emotions the thought triggers when you fuse with it.

 
If you fuse with the thought of a coming opportunity for a physical pleasure that you have come to love, a craving will be aroused. We can call the effect of fusion on our emotions and our bodies resonance.

The greater the fusion, the more our bodies resonate with the thought. This resonance, in turn, can make the fusion more appealing and cause our attention to fuse more completely, creating "tunnel vision" for the craving and turning our arousal into a readiness to act.

 
What we are talking about here is the power of a passing thought — for instance, a sexual thought — to arouse our passions. If the thought regards a significant amount of pleasure (as sexual thoughts always do), it has the potential to cause maximal arousal and readiness to act; the only limiting factor with sexual thoughts is the degree to which the thinker fuses his attention with them.

Since the thought regards intense pleasure, fusing with the thought is itself pleasurable (remember that fusion makes the thought “real” to your passions), which can increase the resonance of the passions. This positive feedback loop drives tunnel vision.

 
Imagine a young woman who is struggling with an addiction to Kit Kat bars, and who had usually bought a bar every day on her way home from class. As she sits in class, the pleasure of eating Kit Kats comes up in her stream of thoughts and her attention immediately fuses with it, producing a craving within her. 

If she had read the Reframing module, she would use the sensation of the resonance within her as a wake-up call, reminding her to reframe the present craving as an opportunity for practice. Then she would use the skills in this module: first using mindfulness to get unstuck from the highly salient Kit Kat thought, and then to habituate the craving that was triggered.

 
Grounding Exercise
Imagination and memory take you from the here-and-now; your external senses, on the other hand, are always in the present moment. To directly counter the inward collapse of your attention into your imagination, you can outwardly flex your attention into your external senses. 

The grounding technique is simple way to get your attention defused from your thoughts. Try to notice five distinct colors around you right now; then notice five distinct sounds (or at least listen to sounds coming from five different directions); then feel five different textures (or imagine feeling them — it’s strange, but it works). Then repeat the cycle, noticing four colors, four sounds, four textures; then repeat with three of each, then two, then one; then also notice a taste and a smell. Once finished, return your attention to the task at hand.

 
You might notice that, while trying to do the exercise, your attention occasionally slips back into your imagination. Perfect! This gives you a chance to again defuse by letting go of the distraction and re-engaging the exercise right where you left off. It is this repeated outward flexing of the attention that builds the skill of defusion.

There is an even simpler way of grounding yourself in the present moment. If you would like to see its power, try this next simple exercise...

 
Time-Stamping Thoughts
Rest your elbow on something, and point your arm and hand and fingers directly up. We are turning your arm into a thought-labeler. If your thoughts are in the present moment, point your hand straight up; if your thoughts go into the future, move your forearm palm-downwards, a little bit if only a bit in the future, a lot if your thoughts go far into the future (if your forearm is resting on a table, “all the way” would have your palm touching the surface of the table). If your thoughts go to the past, move your forearm in the palm-backwards direction, again moderating it depending on how far back your thoughts go (all the way back would mean the back of your hand is touching something). Now, spend a minute using your arm to keep track of where in time your thoughts go; but once you’ve labeled a thought as past-present-future, clear your mind and let another thought pop in.

 
Now try to deliberately hold your thoughts in the present moment. As soon as they move to the past or future, deliberately return them to the present.

 

Now try this: while still keeping your thought-labeler going, try opening to the sensation of the breath, especially in the front of the chest (around the sternum). Use the sensation of the breath to ground yourself in the present moment. 

Was it easier to keep your thoughts in the present moment?

     
 
Good! In my experience with patients, most find that it is MUCH easier to maintain their attention in the present moment if they use the internal sensation of the breath, rather than their external senses. The main exception is if the person is in an interesting environment with many sounds and sights to notice. The benefit of the breath is that it is always there, and it is always changing, providing your attention with something dependable yet dynamic.

We've already set the stage now for the third defusion exercise...

 
Interesting. In my experience with patients, most find that it is MUCH easier to maintain their attention in the present moment if they use the internal sensation of the breath, rather than their external senses. The main exception is if the person is in an interesting environment with many sounds and sights to notice. The benefit of the breath is that it is always there, and it is always changing, providing your attention with something dependable yet dynamic. 

We've already set the stage now for the third defusion exercise...

 
Mindfulness of the Breath
Mindfulness is simply paying continuous and deliberate attention to just one aspect of your present sensory experience. When applying this to the breath, you will soon discover that breathing is a rather large sensory experience!

 
You can be mindful of anything you are feeling—even sensations you aren't currently aware you have. For instance, try for a moment to close your mouth and breathe through your nose. Pay attention to the feeling of the air moving through your nostrils.

Do this for a minute.

Can you notice how the air feels cooler as you are breathing in, and a bit warmer as you are breathing out?


 
Keep at it a bit longer. Unless you're in a place where the temperature is extremely warm, you'll start to notice it.

 
Good. Chances are that you did not notice this temperature difference before, but you were able to feel it once you became mindful of the air moving as you breathed. That's practicing a simple form of mindfulness.

 
The first sensation in the chest that comes to our awareness is the movement of the chest wall. The intercostal muscles (between our ribs) contract as we inhale, and relax as we exhale. We can learn to feel the cycle of contracting and relaxing within these muscles (and also perhaps within the diaphragm, which contracts and relaxes at the same times).

This cycle is the first sensory "undulation" (or sine wave) in the chest. By focusing on it you can learn to be an observer of your breath: not controlling it, just letting it happen, noticing the rhythmically increasing and decreasing sensation of tension.

 
II. Mindfulness for Habituation
Get ready, the plot is about to thicken! The second "undulation" in the chest involves the beating of your heart when you're mindful. Check out the video below to see the transforming effect of mindfulness on heart rate.

Look at the upper-left-hand quadrant to see the second-by-second changes in the heart rate of the subject. At around forty seconds in — the moment the person focused mindfully on his breath — you will notice the significant change in the rhythm of the heart. I think you'll be surprised!

 
Can you guess what was making the heart rate rise and fall so rhythmically?



 
You're right! The heart rate was increasing and decreasing in precise synchronization with his inhaling and exhaling, respectively. Since he was breathing regularly, the increase and decrease of the heart rate was also regular.

 
Not quite, although it was an interesting possibility. The heart rate was increasing and decreasing in precise synchronization with his inhaling and exhaling, respectively. Since he was breathing regularly, the increase and decrease of the heart rate was also regular.

 
When we practice mindfulness, we activate our parasympathetic nervous system, which engages whenever we are in "opportunity mode." (The opposite, the sympathetic nervous system, is used in "threat mode" or the "fight-or-flight response.") When you turn your parasympathetics on through mindfulness and regular breathing, your heart rate drops as you exhale and returns to baseline as you inhale, producing a characteristic sine wave. (An aside: people who exercise regularly get much more impressive sine waves when practicing mindfulness. See Priming module for more.) 

The greater the mindfulness, the more profound the parasympathetic activation, and the bigger the difference between heart rate at the top of the inhale and the bottom of exhale—in technical terms, the greater the "heart rate variability."

See Kleen, M., & Reitsma, B. (2011). Appliance of Heart Rate Variability Biofeedback in Acceptance and Commitment Therapy: A Pilot Study. Journal of Neurotherapy15(2), 170–181.
 
So, what do you think is the relationship between heart rate variability (HRV) and addictions?


 
Actually, it's the reverse: addictions go along with having lower heart rate variability. That result is exactly what we would expect: people with addictions tend not to be practicing mindfulness, and since mindfulness and parasympathetic activity go together, that means people with addictions should have lower heart rate variability.

 
Let's try again. You might have more success this time if you try to make use of context clues.

 
That's right! People with addictions have lower rates of mindfulness and less parasympathetic activity (measured by heart rate variability) than people without addictions. The same is true for people with anxiety disorders and depression. 

People often say that as sympathetic activities are about "fight or flight," parasympathetics are about "rest and digest." Parasympathetics turn off sympathetics; when you have high parasympathetic activity, your system "digests" emotional activation very quickly. 

This means that if you have a strong craving, being mindful of it and viewing it as an opportunity to practice puts you into a parasympathetic "opportunity mode," and this works quickly to habituate the craving.

See, for example, Lin, P.-C., Kuo, S.-Y., Lee, P.-H., Sheen, T.-C., & Chen, S.-R. (2014). Effects of internet addiction on heart rate variability in school-aged children. The Journal of Cardiovascular Nursing, 29(6), 493–498.
 
Here's a helpful image. All sensations get piped up to your sensory cortex, where you experience them consciously. To make sure that you don't get flooded with all those sensations, your thalamus is able to turn down the valves on these sensory pipes so that the sensory flow barely reaches your brain. 

If a certain sensation suddenly becomes more relevant (i.e., salient, because of a threat or opportunity detected by your amygdala), your thalamus will open the valves, allowing the sensation to flow more fully into your conscious awareness. That process works automatically; it's what would happen to sensations on your leg if a centipede started crawling up it—suddenly, you'd be very aware!

 
There's another way of opening valves that is completely deliberate. It begins in your prefrontal cortex, which reaches down into the thalamus, locates the right sensory pipe, and "manually" opens the valves so that the sensation gets fully experienced. 

Do you think that this manual process of "opening the valves" is the same thing as mindfulness?


 
Exactly! "Opening the valves" is the same thing as making yourself mindful of a given sensation.

 
You might be using a more nuanced definition of mindfulness than I am. Here, the process of "opening the valves" to allow a sensation to flow into your awareness is practicing mindfulness.

 
In the Patience module, we discussed that you will act on your cravings (emotions) only if you are unwilling to experience them. If you act on them, the cravings go away—momentarily, at least.  But they are guaranteed to come back. 

Our image helps us to understand what happens if you are unwilling to experience the craving: with the valves to the sensation closed, there is nowhere for the sensation of the craving to go; instead, it builds until you act on it. It is unwillingness to experience the sensation of the craving that leads to the closing of the valves.

 
In the "piping" analogy, the sensation of the craving is the gas in the pipes. It's meant to flow back up into your upper sensory cortex, where it gets naturally processed. However, if you close the valves (because you are unwilling to experience it), it gets "stuck," staying unprocessed and growing in intensity, just like gas building under pressure.

 
If you are willing to suffer the sensation of the craving (meaning that you open the valves) you will necessarily habituate the craving. Patience uses mindfulness of the craving to "digest" it properly. That's what produces the habituation curve shown below.

 
The more open the sensory valves are (the more mindful you are), the faster the process of habituation goes.

The purpose of having an emotion is to tell us something about what's going on, using our automated detection system (the amygdala). If your amygdala notices a threat of pain, it conveys that data to you as the sensation of fear; if it notices an opportunity for pleasure, it conveys the sensation of craving. How do you think mindfulness leads to the decrease in these sensations?


 
No, mindfulness doesn't go against nature's purposes. Try again. Perhaps it will help to consider what the amygdala is trying to tell the brain, and whether mindfulness deals properly or improperly with the messages the amygdala sends.

 
You answered correctly! Mindfulness fulfills the teleology of emotion.

That is to say, your amygdala wants to tell you what threat or opportunity it has discovered; it tells you by creating the emotional sensation (especially in the chest). If you tune in voluntarily to that sensation (i.e., be fully mindful of it), the emotion has served its purpose.

It's as if a "message received" reply is sent to your amygdala, allowing it to turn down the volume. As you continue tuning in to the sensation, it continues to turn down the sensation, until it is gone.

 
People who are not generally mindful tend to miss these message-sensations (cravings, fears). Without a "message received!" reply, the amygdala—ever the dutiful neuro-servant—turns up the volume on the sensation, especially if it's a really important threat or opportunity. It will generally keep doing this until either you pay attention to the message, or you act on the craving or fear. The stronger the craving or fear gets, the more likely it is to trigger tunnel vision and automated compliance.

In short, there are two ways to "get rid" of an emotion: by being mindful of it, or by acting on it (that is, satisfying it).  

What, then, would you say about using distraction as a way of coping with cravings? (This is, by far, the number one strategy people use!)


 
Not quite. Try again! Consider whether distraction really fits either of the two ways of "getting rid" of an emotion.

 
Exactly. Distraction techniques are doomed to fail because they frustrate and thwart your amygdala.  They keep you from receiving the message, which is the key step that signals to your amygdala that it can turn down the message and eventually turn it off.

As a result of distraction, your amygdala will likely turn up the power of the craving until, eventually, tunnel vision kicks in, and you cave.

 
Mindfulness of cravings focuses specifically on the tension of the craving, usually located in your chest. (The emotional sensation of the craving is always felt above the belt.) Next time you have a craving, or a fear, see if you can tune in to the slight tightness in your chest: this is the core of the craving-sensation. As soon as you locate the tightness, see if you can now feel how the tightness increases slightly as you inhale and decreases slightly as you exhale. 

If you can feel this increasing and decreasing, your "valves" are fully open to the sensation of the craving, and it will habituate.

For an interesting read, see Lacaille, J., Ly, J., Zacchia, N., Bourkas, S., Glaser, E., & Knäuper, B. (2014). The effects of three mindfulness skills on chocolate cravings. Appetite, 76, 101–112. http://doi.org/10.1016/j.appet.2014.01.072
 
Mindfully processing the craving is the surest way to prevent yourself from acting on the craving: you cannot simultaneously focus on and act on a craving. Practicing mindfulness of the breath is the best way of increasing your ability to be mindful of the craving-sensation that rides on top of the breath. 

Obviously, one cannot habituate sexual desires by being mindful of one's sexual response or the thoughts and images that prompt it; those are stimulatory approach behaviors, and they encourage your amygdala to drive the sexual momentum further and deeper. Mindfulness of the tension of the cravings (especially in the chest) works in an opposite way, breaking any resonance with sexual activation.

 
III. Mindfulness in Daily Life
Now I'd like to ask you a few questions about how mindful you are in your daily life. Going through these questions (fifteen in all) will give you a great overview of the scope of the concept of mindfulness.


 
I could be experiencing some emotion and not be conscious of it until some time later.


 
I break or spill things because of carelessness, not paying attention, or thinking of something else.


 
I find it difficult to stay focused on what's happening in the present.


 
I tend to walk quickly to get where I'm going without paying attention to what I experience along the way.


 
I tend not to notice feelings of physical tension or discomfort until they really grab my attention.


 
I forget a person's name almost as soon as I've been told it for the first time.


 
It seems like I am "running on automatic," without much awareness of what I'm doing.


 
I rush through activities without being really attentive to them.


 
I get so focused on the goal I want to achieve that I lose touch with what I'm doing right now to get there.


 
I do jobs or tasks automatically, without being aware of what I'm doing.


 
I find myself listening to someone with one ear, doing something else at the same time.


 
I drive places on "automatic pilot" and then wonder why I went there.


 
I find myself preoccupied with the future or the past.


 
I find myself doing things without paying attention.


 
I snack without being aware that I'm eating.


 
Those questions are taken from the Mindful Attention Awareness Scale (MAAS). The best possible score is 6, the lowest is 1. The average score for adults is 4.2, and for college students it's 3.8. Your score is {{var_score}}.

The MAAS measured your "dispositional mindfulness." In other words, it measured how mindful you are in general. One great feature of dispositional mindfulness is how quickly it can increase if you take care to practice actual mindfulness at least once every day, for even just ten minutes.

 
The mindfulness scale you just skipped would have measured your "dispositional mindfulness." In other words, it measures how mindful you are in general. One great feature of dispositional mindfulness is how quickly it can increase if you take care to practice actual mindfulness at least once every day, for even just ten minutes.

 
The simplest way of learning how to practice mindfulness is by signing up for Headspace at https://www.headspace.com. Headspace will train you on how to practice many useful forms of mindfulness. It takes 10 minutes or so a day, and I've continually seen it produce great results. 

The device used to measure heart rate variability (parasympathetic activation) is called Inner Balance, by Heartmath. You can get it on Amazon. It has a free app that goes with it. I usually have patients use Inner Balance while they do the practices on Headspace (Headspace can run in the background, but Inner Balance cannot). 

With or without these devices, you will take a major step toward growing in purity by committing yourself to practice mindfulness every day.

 
Would you like to know about some free resources for practicing mindfulness?

     
 
This video by Jeremy Woodall is an excellent introduction to Mindful Breathing and the Body Scan, two important kinds of practice. He incorporates a passive relaxation element that isn't formally a mindfulness exercise, but it does help to put your mind safely out of threat mode.

 
Here's a shorter mindfulness of breath exercise (10 minutes).

 
I'd appreciate any feedback you have to offer about this module. Thanks!