Last updated June 12, 2015
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Introduction

Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain

Suffering and joy are ubiquitous. The sensitive heart yearns to bridge the chasm that hangs between the poles of this dichotomy. Yet the heart can be obscured by the mind, which may be torturer, taskmaster, or teacher. The magnitude of suffering inflicted by the mind is perhaps no more apparent than in the afflictions of addiction, stress, and pain. These interrelated forms of misery seem to arise from a deep psychological cling- ing or aversion to the conditions of life. However harsh one’s experience is in the moment, mental and physical pain are stoked into a conflagration of anguish when the mind craves or rejects the experience of the present moment. We frantically hold on to what we fear to lose, and we run from that which we fear to find. These reactions seem to be reflexive, automatic, and inherent in the human condition. But are they inevitable? Are we condemned to tread the well-worn grooves of self-destructive habits? The answer to this question arises in the depths of quiet contemplation, in the dawning light of self-awareness. Although human existence can be afflicted by negative mental states, so too can it be liberated by cultivating a higher kind of mind. This quality of mind, known as mindfulness, may be strengthened through intentional effort and training.

The word “mindfulness” may be applied to both a set of contemplative practices as well as to the distinct psychological states and traits cultivated by these practices. “Mindfulness” is an English term that has been imposed on a diverse set of cross- cultural traditions and techniques that most notably emerged in Asia over 2,500 years ago but also have manifestations in the mystical branches of Judaism, Christianity, and Islam as well as in numerous indigenous cultures around the world. In truth, no one culture can lay claim to mindfulness, for at its core, mindfulness is a fundamental aspect of human consciousness, an innate psychophysical operation that is garbed by language in cultural systems designed to impart a means of developing this naturalistic function. Various traditional and modern schools of thought offer scaffolding by which one may learn to develop and use mindfulness for the benefit of self and others.

There are numerous Western conceptualizations of mindfulness. Many of these conceptualizations stem from scientist–practitioners in medicine and psychology who have become interested in mindfulness because of its demonstrably salutary effects on both mental and physical health. These conceptualizations are, in turn, derived from reinterpretations of teachings from Theravada, Mahayana, Zen, and Tibetan Buddhist traditions, among others. Since at least the turn of the 20th century, these schools of Buddhism have influenced American and European culture, and hence it is not surprising that many modern conceptualizations of mindfulness originate from these philosophical-spiritual frameworks. Yet it must be clearly stated that mindfulness is truly nondenominational and nonreligious; it is a tool and function that may enhance sacred and everyday experience alike. In the West, mindfulness has been secularized, stripped of its religious–cultural trappings for use by non-Buddhists. Indeed, emerging research indicates that mindfulness has much clinical utility and may ease the forms of suffering and social ills that are part and parcel of modern life.

To understand mindfulness, it is helpful to use traditional concepts as the context within which to grasp the modern, academic definition. In Sanskrit, the ancient language of the Indo-Tibetan Buddhist traditions, the concept of mindfulness is associated with three terms: “manasikara,” “smrti,” and “samprajana” (Blo-bzan-grags-pa, 2000; Lutz, Dunne, & Davidson, 2007). Manasikara refers to the property of mind that attends to or turns toward the object of focus. In other words, it is manasikara that enables us to stay focused on reading each word on this page. Smrti refers to the property of mind that takes hold of or retains the object of focus. In other words, it is smrti that enables us to remember to stay focused on reading the words on this page when our mind wanders. Samprajanya refers to the metacognitive dimension of the mind—that is, the aspect of mind that monitors the content of consciousness while reflecting back on the process of consciousness itself (Nelson, Stuart, Howard, & Crowley, 1999). In other words, samprajana is the observing or witnessing faculty that allows us to be aware of when our mind has wandered, and, in the present example, when our mind is focused on read- ing. The practice of mindfulness is the practice of engaging these three naturally occur- ring faculties while tempering them with a sentiment of compassion and nonjudgment. Thus, the practice of mindfulness generates an open, kindly state in which the mind retains focus on the object of attention (for example, the sensation of the breath flowing into one’s nostrils) while simultaneously reflecting awareness back on itself. As the state of mindfulness deepens over time, it begins to take on an expansive, self-reflective quality, not unlike what one experiences when one stands between two mirrors and observes them reflecting an image to infinity. The distinction between the observer and the observed fades, the usually sharp division between the self and the world begins to soften, and a sense of all-pervading presence expands into space. Or, as it is said, “Mind is like space; it has the nature of space; equal to space, it encompasses everything” (Namgyal, 2006, p. 192). Awareness remains, pure, clear, vast, and undefiled, like the reflection of the sky in a mountain lake, unstained by the passage of clouds which are merely reflected, insubstantial, and ever-changing images.

At this point, the clinically minded reader may wonder what these abstract mental faculties, obscure concepts, and foreign metaphors have to do with the treatment of addiction, stress, and pain. Much of chapter 2 is devoted to answering this question. However, in brief, addictive behavior—as well as stress and chronic pain, which often trigger addictive impulses—involves an element of mindlessness (that is, the diametric opposite of mindfulness). Mindlessness refers to automatic habits or compulsions that are executed without conscious, willful intent. To be mindless is to be oblivious, unaware, unconscious. In contrast with focused attention, remembrance of the need to be aware, and meta-awareness itself, the state of mindlessness is characterized by a diffuse, wandering mind—one that is forgetful of its needs and intentions and that acts without awareness. Thus, people struggling to recover from addiction often want to remain sober yet find themselves unconsciously compelled to use drugs or alcohol. Similarly, in spite of people’s clear intentions to remain calm in the face of stress and pain, they may find themselves automatically lashing out in anger or yielding to hopelessness, only to suffer from pangs of guilt and shame at their uncontrolled reactions.

In this sense, addiction and the maladaptive mental states associated with it tend to operate in a context of mindlessness. Despite a substantial body of empirical evidence suggesting that mindless and maladaptive cognitive–emotional processes under- gird alcohol and drug dependence, the most common forms of addictions treatment do not directly target these mechanisms. To fill this gap, Mindfulness-Oriented Recovery Enhancement (MORE) offers promise as an innovative tool in the armamentarium of clinical social work.

MORE is innovative in the sense that it combines mindfulness techniques with principles drawn from cognitive therapy and the positive psychology literature. MORE unites complementary aspects of mindfulness training, cognitive restructuring, and positive psychological principles into an integrative treatment strategy, targeting the mindless or automatic cognitive and emotional processes implicated in addiction, stress, and chronic pain. These three therapeutic bases of MORE are fundamental means of addressing the self-destructive mechanisms that lead to human suffering. As such, they may be referred to as the “foundations of MORE.” Specifically, the foundations of MORE are mindfulness, reappraisal, and savoring. Although the concept of mindfulness has been introduced already, the other two foundations deserve brief introductions. Reappraisal is the process by which a person reinterprets or reframes the meaning of a stressful event or experience. Hence, a challenging experience or event that was once held to be distressing and terrible might be reappraised as a learning opportunity or a source of personal growth. MORE promotes reappraisal by combining mindfulness skills with cognitive restructuring techniques adapted from cognitive therapy. Savoring is the process by which a person intentionally focuses awareness on beautiful, affirming, and rewarding events in the present moment. MORE promotes savoring by using mindfulness techniques to attend to, cultivate, and enjoy positive emotions stemming from the pleasant elements of our lives. All three foundations of MORE are discussed and expounded on in the chapters that follow.

Although these approaches form the foundation of the intervention, MORE is grounded in a particular philosophy and ethos that is just as essential as the techniques and principles taught in each session. Social work (as well as clinical psychology and counseling) may be distinguished as a heart-centered profession in that our efforts are impelled by a deep, abiding sense of compassion and a desire to right the wrongs of the world. These sensibilities impel us to act as advocates, activists, healers, and—ultimately—conduits to the empowerment of vulnerable and marginalized people. Thus, MORE is a strengths-based intervention focused on the cultivation of personal empowerment as a means of promoting recovery. Recovery may be defined as “a process of change through which individuals improve their health and wellness, live a self- directed life, and strive to reach their full potential” (Substance Abuse and Mental Health Services Administration, 2011). MORE was designed to enhance the holistic recovery process for people striving to overcome addiction. In other words, rather than being solely focused on relapse prevention, MORE is centered on helping individuals to recover a meaningful life from the clutches of addiction, stress, and pain. MORE is philosophically grounded in this recovery-enhancement perspective and in the recognition of the inherent capacity of individuals to transcend and transform their limitations into opportunities for growth and well-being. This philosophical perspective permeates MORE and serves as living core of the intervention from which its many concepts and techniques radiate. Thus, from the perspective underlying MORE, a per- son struggling with addiction, stress, or chronic pain has, like all people, the fundamental capacity to overcome obstacles and achieve the kind of personal transformation he or she wishes to achieve. However, this radical change does not come about by magic—it comes as a result of hard work, focused effort, and repeated practice. Each time a person intentionally challenges negative mental states and behaviors and replaces them with positive ones, he or she gradually transforms him- or herself for the better. Ultimately, MORE is founded on this notion of transformation through training. MORE is, at its heart, a form of mind training aimed at increasing freedom and purpose in the face of the endless round of suffering and joy that is human existence.

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