Mindfulness meditation as a catalyst for behavioural change

The traditional practice of mindfulness meditation has existed for thousands of years, but the teachings of mindfulness meditation have recently surged in popularity within personal, corporate, and academic landscapes (Shonin, Van Gordon, & Griffiths, 2015). Today’s trendy soup-du-jour, seems to involve more and more people taking a few moments out of their busy days to sit cross-legged and focus on their breath. The reasons for doing this, however, are myriad. Stress reduction, better sleep, and improved focus are just a few of the benefits that meditation practitioners hope to gain from their consistent investment in the practice. But mindfulness, and specifically meditation, can actually be much more than just a few health benefits; though most would agree that those benefits are reason enough to at least try meditating. In the world of psychology, meditation represents a powerful tool that can complement the work of therapists or clinicians.

Mindfulness has been defined as consciously and nonjudgmentally paying attention to the present moment (Marcus & Zgierska, 2009). Mindfulness encourages awareness and acceptance of thoughts, feelings and bodily sensations as they arise, and recognition of their constantly changing and impermanent nature. Meditation practitioners are taught to acknowledge, observe and accept their internal experience rather than to change, suppress, or react to it. That sounds easy and simple enough, but in the world of behavioural change that can be anything but comfortable. Sometimes the present moment – and all the unwanted thoughts, negative emotions, and unpleasant body sensations that come with it – is simply too uncomfortable to bear. So many of us (present company included) tend to do what we have always done to cope and that is avoid.

Avoidance is not always a bad thing as sometimes it is the choice that makes the most practical sense in the moment. But if avoidance is someone’s only strategy for managing the many stressful moments of life, then it could spell problems in the long-term. It should not come as a surprise that roughly 70% of substance abuse relapses result from unpleasant emotions and physical discomfort (Shafiei et al., 2014). And it is certainly not only in the field of substance abuse where this is relevant. Research also shows that when individuals self-identify with problematic pornography use, their consumption may be a maladaptive coping strategy and form of experiential avoidance, which is an effort to cope with and manage unwanted thoughts or negative feelings (Wetterneck et al., 2012). When the realities of abstinence or reduction reveal an internal state that can be fraught with pain, discomfort, or immense craving, sometimes avoidance via substance use or via engagement with self-soothing behaviour may seem like the only way to find relief, even if only for a short time. Clinical or not, behavioural change is hard. Avoidance can seem like the easier choice, even though the coping strategy itself leads to additional harm. Here is where the practice of meditation can have tremendous benefits.

Meditation does not create change by itself. In fact, meditation is actually the opposite of change, tasking the individual to focus their attention on calmly and non- judgmentally accepting whatever the present moment may look or feel like, without trying to change, control, or adjust that experience in any way. With meditation, you stop avoiding and face what you have been running from so that when you face discomfort in everyday life, you will have already practiced sitting with and observing those uncomfortable internal states. When it comes to behavioural change, the desired outcome from meditation is the improved capacity for more conscious and productive decisions.

Mindfulness encourages awareness and acceptance of thoughts, feelings and bodily sensations as they arise, and recognition of their constantly changing and impermanent nature.

Meditation is a natural complement to many psychotherapeutic methodologies and interventions. As opposed to being cognitive and intellectual, meditation is more experiential, which means it can be used alongside other cognitive- based therapies, like acceptance and commitment therapy or cognitive behavioural therapy as a complementary tool. In a sense, mindfulness meditation serves as a practical training ground – we can call it working in the trenches – where individuals can practice and rehearse non-reactively observing and being with cravings, urges, and unwanted thoughts (Marlatt & Chawla, 2007; Bowen et al., 2006). Since more than 50% of lapses and relapses can be credited to high-risk situations – namely negative emotional states and cravings or urges to use (Larimer, Palmer, & Marlatt, 1999) – developing and strengthening emotional regulation skills and body sensation awareness are important goals in the treatment of substance dependence and compulsive behaviours (Berking et al., 2011). The enhanced ability to objectively observe one’s own internal experience sets the conditions necessary for the individual to learn productive ways of responding to their internal experience so that emotional instability and impulse control difficulties stop perpetuating the cycle of reactive consumption (Kuvaas et al., 2014; Dvorak et al., 2014).

Mike Tyson, one of the most famous professional boxers of all-time, said that everyone has a plan, ‘until they get punched in the mouth’. When it comes to behavioural change, you can prepare the best possible plan alongside the world’s most prominent experts, but once you leave the safe space of our home or therapist’s office, it’s the stresses of everyday life that provide the proverbial punches to the mouth. Taking the time to create detailed and personalised plans are certainly worthwhile, but without the practical application that meditation can provide, it can be an endless cycle of self-sabotage if the underlying behavioural triggers are not addressed. What the individual really needs in their everyday life – outside of their safe space – is improved self-regulation and self-management skills, and those are exactly the qualities that meditation can nurture. The silence and stillness of meditation provide the perfect backdrop for cultivating improved self-regulation and self- management skills.

Meditation develops and trains various mental and attentional skills that can help the individual productively manage their moment-to-moment experience. Meditation allows individuals to be more sensitive to their surroundings and promotes productive thought processes and behaviours (Langer, 2004). Specifically, mindfulness theory addresses the two basic ingredients that form the foundation of all mindfulness- based approaches – awareness and acceptance – in relation to the context of the present moment and how these qualities improve sensitivity to internal and external environments (Demick, 2000; Langer & Moldoveanu, 2000). Attention and awareness seem to work synergistically to enhance capacities for information gathering, developing insight, and facilitating adaptation to the ever-changing variables of life (Brown et al., 2007).

Meditation also cultivates the skill of focus and concentration, which has been shown to improve cognitive functioning and memory (Mrazek et al., 2013), makes it easier to sustain voluntary attention (MacLean et al., 2010), and draw attention away from the past and future during current decisions (Hafenbrack, Kinias, & Barsade, 2014); all of which are important to self-management and self-regulation. Lastly, meditation has been associated with reduction in stress and mood disturbances (Birnie, Speca, & Carlson, 2010) and increased self-compassion (Baer, Lykins, & Peters, 2012). All of these mental and attentional skills contribute to an individual’s ability to make constructive decisions from moment- to-moment.

Meditation may not be the holy grail of interventions, but it provides a relatively safe environment in which individuals can turn their attention inward towards the thoughts, emotions, and body sensations that drive unconscious, reactive, and problematic behaviours.

It is worth noting that a meditation practice can be a lot harder and more challenging than an individual bargained for. That is because being more present can be particularly uncomfortable, especially for someone new to meditation. When unpleasant internal experiences have been the driving force of reactive behaviours for a long time, settling into a sense of stillness to face those experiences should be done patiently, carefully, and safely. It is helpful to liken meditating to settling into a hot bath. If you just jump into the hot water, you will scream in pain, and possibly burn yourself. Better to enter the bath slowly, one body part at a time, giving each part time to acclimate to the temperature of the water before submerging completely. If you approach your bath slowly and mindfully, it can be a soothing and relaxing experience, as opposed to potentially damaging or traumatising.

Meditation may not be the holy grail of interventions, but it provides a relatively safe environment in which individuals can turn their attention inward towards the thoughts, emotions, and body sensations that drive unconscious, reactive, and problematic behaviours. Meditation represents the brave and courageous journey inward, where we come face-to-face with the thoughts and sensations that trigger bad habits and prevent us from making the meaningful changes that we want for ourselves.

With meditation we become more aware of, and comfortable with, our internal states. We learn to trust that the present moment is safe and that whatever we are feeling or experiencing will eventually pass, no matter the experience. Ultimately, this journey is about taking back responsibility for our lives and creating a more conscious way forward. And is that not what all of us really want? Is it not the goal of every psychological intervention to improve the client’s capacity for self-awareness, self-management, and self-regulation? Given how important the awareness of our internal experience is to behavioural change, it’s well worth the initial discomfort diving into the deep end of meditation.

References Baer, R. A., Lykins, E. L., & Peters, J. R. (2012). Mindfulness and self- compassion as predictors of psychological wellbeing in long-term meditators and matched nonmeditators. Journal of Positive Psychology, 7(3), 230-238. Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S., & Junghanns, K. (2011). Deficits in emotion-regulation skills predict alcohol use during and after cognitive behavioral therapy for alcohol dependence. Journal of Consulting and Clinical Psychology, 79(3), 307–318. Birnie, K., Speca, M., & Carlson, L. E. (2010). Exploring self-compassion and empathy in the context of mindfulness-based stress reduction (MBSR). Stress & Health: Journal of the International Society for the Investigation of Stress, 26(5), 359-371. Bowen, S., Witkiewitz, K., Dillworth, T., Chawla, N., Simpson, T., Ostafin, B., Larimer, M., Blume, A., Parks, G., Marlatt, G. (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of Addictive Behaviors, 20(3), 343-347. Bowen, S., Witkiewitz, K., Dillworth, T., & Marlatt, G. (2007). The role of thought suppression in the relationship between mindfulness meditation and alcohol use. Addictive Behaviors, 32, 2324-2328. Brown, Kirk Warren, Ryan, Richard M. and Creswell, J. David (2007) ‘Mindfulness: Theoretical Foundations and Evidence for its Salutary Effects’. Psychological Inquiry, 18:4, 211 – 237. Demick, J. (2000). Toward a mindful psychological science: Theory and application. Journal of Social Issues, 56(1), 141. Dvorak, R. D., Sargent, E. M., Kilwein, T. M., Stevenson, B. L., Kuvaas, N. J., & Williams, T. J. (2014). Alcohol use and alcohol-related consequences: associations with emotion regulation difficulties. American Journal of Drug & Alcohol Abuse, 40(2), 125-130. Hafenbrack, A. C., Kinias, Z., & Barsade, S. G. (2014). Debiasing the mind through meditation: mindfulness and the sunk-cost bias. Psychological Science, 25(2), 369-376. Kuvaas, N., Dvorak, R., Pearson, M., Lamis, D., & Sargent, E. (2014). Self- regulation and alcohol use involvement: A latent class analysis. Addictive Behaviors, 39(1), 146-152. Langer, E. (2004). Langer mindfulness scale user guide and technical manual. Worthington, OH: IDS Publishing Corporation. Langer, E., & Moldoveanu, M. (2000). Mindfulness research and the future. Journal of Social Issues, 56(1), 129. Larimer, M. E., Palmer, R. S., & Marlatt, G. A. (1999). Relapse prevention. An overview of Marlatt’s cognitive-behavioral model. Alcohol Research & Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism, 23(2), 151-160. Marcus, M. , & Zgierska, A. (2009). Mindfulness-Based Therapies for Substance Use Disorders: Part 1 (Editorial). Substance Abuse: Official Publication of the Association for Medical Education and Research in Substance Abuse, 30(4), 263. MacLean, K. A., Ferrer, E., Aichele, S. R., Bridwell, D. A., Zanesco, A. P., Jacobs, T. L., & ... Saron, C. D. (2010). Intensive Meditation Training Improves Perceptual Discrimination and Sustained Attention. Psychological Science, 21(6), 829-839. Marlatt, G. & Chawla, N. (2007). Meditation and alcohol use. Southern Medical Journal. 100(4), 451-453. Mrazek, M. D., Franklin, M. S., Phillips, D. T., Baird, B., & Schooler, J. W. (2013). Mindfulness Training Improves Working Memory Capacity and GRE Performance While Reducing Mind Wandering. Psychological Science, 24(5), 776- 781. Shafiei, E., Hoseini, A. F., Bibak, A., & Azmal, M. (2014). High risk situations predicting relapse in self-referred addicts to Bushehr province substance abuse treatment centers. International Journal of High Risk Behaviors & Addiction, 3(2), e16381. Shonin, E., Van Gordon, W., & Griffiths, M. D. (2015). Does mindfulness work? BMJ (Clinical Research Ed.), 351h6919. Wetterneck, C., Burgess, A., Short, M., Smith, A., & Cervantes, M. (2012). The role of sexual compulsivity, impulsivity, and experiential avoidance in internet ponography use. Psychological Record, 62(1), 3-17.

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The Importance of Queer-Competent Mental Healthcare

What makes a provider Queer-Competent? Where can LGBTQ+ people find someone who will understand their experiences?

01 Gaurang is the founder of Violet — a platform that connects Queer-Competent providers with LGBTQ+ people in search of therapy.

02 Many LGBTQ+ individuals struggle to find clinicians who understand their experiences and foster an environment of true openness and acceptance.

03 If you're looking for Queer-Competent mental healthcare, or you are a provider who'd like to join Violet's platform, check out the links at the bottom of this article.

Starting therapy can be a challenging process for anyone. How do you know if a therapist is the right fit? One of the most important characteristics of a successful therapy journey, is to feel like you are fully heard, understood, and seen.

Many LGBTQ+ individuals find it difficult to not only find a therapist that is able to do all three, but someone who they can feel comfortable opening up to. With continued stigma and discrimination against LGBTQ+ individuals, Queer-Competence in your mental health provider is as important as ever.

So what makes a provider Queer-Competent? While there are courses and certification programs available, there is no consensus on what qualifies as true Queer-Competence.

At Violet, we take four key components into account when thinking about Queer-Competent care:

1) While Queer-Competent providers may or may not be LGTBQ+ themselves, they possess extensive experience working with the LGBTQ+ population, or have made it their clinical specialty. Many providers are specialized in serving a subset of the Queer Community, especially since it's so diverse.

2) Queer-Competent providers have an unconditional, positive regard and support for their patients’ gender identities and sexual orientations.

3) Queer-Competent providers integrate minority stress and resilience factors into their treatment, addressing both barriers to treatment and mental health, as well as areas in which patients are thriving.

4) Queer-competent providers incorporate building LGBTQ+ community support systems, as well as positive identity-related activities and growth as part of treatment.

LGBT ME: A Conversation on Mental Health within the LGBT Community

When you’re considering a therapist, it can be helpful to look at how well they incorporate these components into their practice. At Violet, we’re building a community of queer-competent mental health providers.

We work with each provider to learn about their strengths, weaknesses, and areas of expertise. With this insight, we help our Community find and book therapists that are the right fit for them. After all, therapy is a journey that’s most fruitful in the company of a provider that sees the whole you.

Interested in investing in your mental healthcare? Find and book a Queer-Competent therapist here. Are you a provider that’s interested in serving more of the queer community? Send us your information to join here.

Poverty and the apathetic Indian

There are numerous ways to ignore poverty, but research should make you open your eyes.

The Indian state currently recognises me as an NRI which, as any non-mainland Indian will tell you, is slightly bemusing since our relations with India has always been one of estrangement. Personally, my feelings towards the Indian nation-state is moody and tenuous—somewhere between like and dislike, between grudging acceptance and unbridled exasperation

However, one interesting fall-out of being an NRI is that spared of the country’s daily cacophony and clutter, one can gain an outsider’s perspective. India is otherwise a vortex, sucking up your energies, your time and, often, you, with every day a small battle to navigate through its organised chaos.

What has struck me every time I visit India is not the overwhelming and heart-breaking scale of poverty but the mass-level, casual, even fierce apathy to it. People have found new and novel ways to unsee, unacknowledge, ignore, disown, discredit, disregard it, blissfully oblivious to it, shutting themselves in through rolled-up windows and shutting out the world through cheap earphones.

Denying reality

This is the favoured, go-to tactic of most privileged Indians—denial. Deny that poverty exists through simple escapism. If you invest enough effort in pretending it’s not there, eventually it will cease to exist for you. If you can look through a beggar, then poor people are not your problem. If you can ignore the skyline dotted with slums then your city isn’t choking and dying. This is mindfulness of another kind. You don’t need expensive yoga and meditation classes to learn this; you simply need to be too exhausted and/ or too self-centred to not care. Of course, this studied ignorance comes after years of training.

To an extent, denial of this kind is a coping mechanism. India is an everyday experience of poverty and navigating it can be gruelling—the beggars cajoling you for money, the homeless listlessly sitting by the roadside, the hovels that crop up on the pavements, the hawkers (many of them children) peddling their wares at traffic signals, the sprawling slums, home to one too many award-winning movies. Another reason for this insouciance is familiarity through over-exposure (the banality of poverty?), leading to a feeling of impotence and despondency, eventually mutating into indifference and insensitivity. After all, with prolonged exposure, our senses can eventually adjust to even the worst sights and smell. Poverty in India is like the air we breathe—toxic and ubiquitous. The only foolproof way to escape both is to move out of the country or hermetically sealing yourself in your homes.

Numbers can deceive

India’s population of the “extreme” poor is only 70.6 million people, as per estimates by the Brookings Institution. The middling poor, one might suppose, are doing okay, grandly living on $2 per day (the report defined extreme poverty as living on less than $1.90 a day). The World Bank has put India’s number of poor people at 270 million in 2012 (it would have decreased by now). The UNDP’s 2018 global Multidimensional Poverty Index (MPI) estimated that 364 million Indians suffer acute deprivations in health, nutrition, schooling, and sanitation. These varying numbers underline the difficulty of defining a poverty line when there are so many dynamic, ever-shifting, immeasurable factors that influence one’s state of being. The probability of intergenerational economic and social mobility is still low as shown by studies and factors like caste, religion, location etc further diminish the possibility of moving up the ladder.

So, where do you even start translating “364 million” into ordinary people that you see every day? The sheer magnitude of these numbers is unfathomable, making a person feel both overwhelmed and indifferent. It is much easier to be detached from the miseries of strangers, treat them as ambient noise, and focus on your own well-being. For instance, during this year’s Diwali in Delhi, I met very few people who wanted to acknowledge the disproportionate effects of air pollution on children from poor communities despite the proven correlation.

Dehumanising the poor

Then there’s the disavowal and discrediting of the facts of their existence—this is where the begging mafia myth has been extremely useful. Despite being debunked multiple times, this is an urban legend that refuses to die because of its usefulness to middle and upper-class Indians in denying the humanity of the poor by peddling the “begging is a crime” non-argument (the Transgender Bill is guilty of this too). So, the money doesn’t actually go to them but to some mafia overlord who maims young children into begging and expropriates our charity. Begging is the crime and our collective apathy is the punishment.

Another extant but false argument is that by giving money or food to beggars we discourage them from finding employment, feeding into the “poor people are lazy” trope. But what does employment for those living in the fringes of society even mean? In this country, a majority of people work in the unorganised sector, the gulf between the number of people entering the job market and number of jobs created is widening, minimum wages are arbitrary at best and inadequate at worst, decent jobs are so few and far between that PhD holders are applying for the lowest ranked government jobs, and manual scavenging is still a thing. So, how do we, born with our class privileges, get to hector them about getting a job as if that is what keeps them poor?

By buying into these kinds of twisted logic and tendentious views, one gets to demonise the “crime” of panhandling, absolve one’s own complicity in our skewed, unequal society, and pontificate on why we shouldn’t help a hungry child. The brilliance of these arguments, all of which carry an undertow of classism, is that it makes us feel morally superior through repudiation. This is the ultimate fantasy- heal the world and make it a better place without lifting a finger.

Lastly, there’s the outright dismissal and disdain for the indigent. Usually favoured by the ultra rich, this toxic attitude has found its way among those who are desperate to enter that hallowed club of the 0.1 per cent and, blind to their own accidents of privilege, are scornful of anyone who isn’t up to their high standards. If the poor are poor, it is because they choose to be and hence, perforce, should be rebuked and shaken out of their indolence. In our mighty haste to blindly follow rich countries, we seem to have borrowed the worst aspects of their cultures, including the concept of “culture of poverty”, trading empathy for disgust, callousness, and cruelty.

This outright hatred of the poor is a result of the growing fanatical belief in the neoliberal, conservative shibboleth of pulling oneself up by the bootstraps, structural oppression and inequality be damned. But does a country like India have the luxury to wax eloquent about the mental poverty of the poor when privation is the norm rather than exception?

It is time to change this false and harmful narrative on poverty and our own attitudes towards those less privileged than us. Indulging in moral self-flagellation or guilt-tripping is pointless. What can and does help is genuine empathy and concrete actions. This includes, but is not limited to, treating people with respect, looking out for the vulnerable, spreading better discourse on the issues of begging and homelessness, and yes, giving them food and money, not for us to feel better but to help them live and live better.

Giving shouldn’t be used as a noble embellishment to vulgar displays of wealth—think of the multi-million dollar Ambani wedding with the token gesture of serving food to the poor. Neither should giving be a one-off that we partake in during specific occasions such as festive holidays. If we can cultivate ignorance, we can nurture empathy as well. It is always okay to care. The fabric of a decent society rests on such acts of kindness. Being poor isn’t a choice; ignoring poverty is.