/‘Warm’ mindfulness may be best for breaking unhealthful habits

‘Warm’ mindfulness may be best for breaking unhealthful habits


Mindfulness interventions can help people change unhealthful behaviors, such as smoking, drinking, and overeating. However, fostering self-compassion may be crucial for the interventions’ success, according to a review of existing research.

Most people are aware that adopting a more healthful lifestyle can bring enormous benefits for their physical and mental well-being. However, initiating and sustaining the necessary changes, such as quitting smoking, getting more exercise, and eating a more healthful diet, can be challenging.

According to a roundup of research published in Harvard Review of Psychiatry, mindfulness-based interventions (MBIs) can improve a person’s ability to change their behavior by boosting their capacity for focused attention and emotion regulation.

In 1977, Jon Kabat-Zinn of the University of Massachusetts Medical School in Worcester began creating the first MBI called Mindfulness-Based Stress Reduction. He defined mindfulness as “awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.”

In recent years, psychiatrists have developed other MBIs tailored for specific conditions. These include mindfulness-based relapse prevention, for helping people overcome addictions to alcohol and illicit drugs, and mindfulness-based cognitive therapy, for preventing relapse in depression.

The authors of the new review, led by Dr. Zev Schuman-Olivier of Harvard Medical School in Boston, MA, cite clinical evidence that MBIs can reduce a wide range of unhealthful behaviors, such as smoking and binge eating.

They also cite preliminary research, which suggests that MBIs can improve patients’ ability to manage chronic conditions, such as hypertension, chronic obstructive pulmonary disease, and diabetes.

Mindfulness meditation involves focusing one’s attention exclusively on the breath or another bodily sensation, and gently returning it to the chosen sensation whenever the mind wanders.

In addition to improving attention skills, this may increase a person’s capacity for interoceptive awareness of internal bodily signals, which the authors believe to be one of the keys to regulating emotions and behavior.

The authors of the new review explore evidence from brain imaging studies that shows mindfulness training changes connectivity in a region called the insula, where interoceptive signals from around the body are processed.

According to a leading theory, someone trying to give up smoking learns through mindfulness to recognize and focus on the bodily sensation of craving nicotine. They learn to experience this craving without getting “caught up” in it and responding in a habitual way.

But the authors highlight an important distinction that has emerged in recent years: between a more traditional “cool” approach to teaching mindfulness meditation, which aims to cultivate an attitude of acceptance toward unpleasant sensations, and a “warm” approach, which explicitly incorporates self-compassion.

They write that people who have deep-seated problems regulating their emotional state — for example, as a consequence of unresolved trauma or marginalized social status — can find the “cool” approach challenging.

Rather than fostering a sense of equanimity, focusing on unpleasant sensations can provoke resistance or even an adverse reaction to meditation.

The authors write that in such cases, incorporating self-compassion into mindfulness training could provide a more effective strategy for regulating emotions than acceptance alone.

They explain:

“Self-compassion involves responding with a warm, kind, and understanding orientation toward oneself, as one would to a close friend, when we suffer, fail, or feel inadequate. […] Interventions and programs that focus explicitly on cultivating inner compassion, which includes and extends beyond self-kindness, may help facilitate behavior change, particularly for individuals who are prone to excess self-criticism, shame, or unworthiness.”

Concluding their review, the authors note that there remain several limitations in the evidence base for mindfulness practices.

In particular, they write that studies tend to overrepresent well-educated, affluent, and white populations, and underrepresent ethnic, sexual, and gender minorities.

This is important because the latter groups may have a relatively high burden of chronic illness, substance use, and high risk behaviors.

The authors also call for more high quality research. Suggested improvements include objective measures of outcomes, larger samples, and studies with “active control groups,” comparing MBIs with other interventions rather than individuals on a waiting list.

In addition, they note that few studies monitor or report adverse reactions to MBIs.

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