Mindfulness and Exposure: The Differences
OK… so in my last post we examined the similarities between mindfulness and exposure approaches. Now we will explore some of the differences. Clearly, the origination of these approaches to healing arises from vastly different theoretical and cultural points of origin. Behavioral psychology and learning theory provided the basis for exposure-based therapies based on models of conditioning and the extinction of conditioned drive states. Therapies that arose from these learning models were designed to diminish specific symptoms (anxiety, phobias, PTSD etc.) which were the bi-product of conditioning. Mindfulness, on the other hand, arose from a 2500 year old traditioning, originating from the original teachings of the Buddha as a direct application of the understanding of the conditions which give rise to suffering. The goal is to reduce suffering and to provide a path towards spiritual liberation.
So this is the first difference between mindfulness and exposure. We can say that mindfulness is a practice that can address the full range of suffering that appears in day to day life that arises from the tyranny of conditioned mind, whereas exposure-based therapies are more narrowly targeted to address specific feelings/reactions that arise from specific aspects of conditioning.
In mindfulness practice, there is no purposeful direction of attention to any particular thing. one is simply asked to remain open and vigilant to whatever mental content (images, thoughts, memories, sensations) that might spontaneously arise. In exposure therapies on the other hand, one is asked to focus attention on specific cue content areas that are usually presented by the therapist. This can be done through real life (in vivo) exposure or more typically through various forms of exposure conducted in one’s imagination (imaginal). In either case. The patient is asked to also attend to associated feelings and sensations that arise during the process. The material to which one is exposed is determined in large part by the therapist as a function of what he or she is hypothesizing to lie at the root of the anxiety or other emotional drive states that compel the symptom (avoidance response). The therapist can derive these hypotheses from a large body of psychological thought and literature including psychodynamic models of behavior, attachment and other developmental models and so on. Thus, the therapist is not limited to any limited range of orientation. Hypotheses can be confirmed or disconfirmed based on the patients’ response to presented cues, which is one of the beautiful aspects of these techniques. The therapist has the ongoing capacity to test their hypotheses and reformulate them as the process unfolds. Often, the therapist may be guided into very unexpected realms.
Now of course, the big question is, What is occurring inside the participant during mindfulness or exposure therapies? That question is much more difficult to answer and may depend on one’s theoretical orientation rather than some concrete objective reality. I would propose that principles of learning can be evoked in either case. in fact, I might suggest that Buddha himself was a learning theorist (the first!) and discussed in length learning and conditioning factors that impinge on our thoughts and actions. I might direct the reader to previous posts on this subject:
In learning theory, the unreinforced exposure of a conditioned stimulus inevitably leads to extinction (habituation) of the classically conditioned response. Thus, in a simplified sense, one’s brain learns that a given stimulus does not predict danger, then the brain can chill and no longer direct an avoidance or escape response. Thus, for example, an army veteran can hear a helicopter rotor without seeking to duck and cover. In mindfulness practice, one experiences a thought or other internal experience, but without engaging in any reactive response. They just remain openly attentive to processes of mind without contributing to the chain of conditioned responses. Extinction per se may not be the operating principle in mindfulness. It may be a factor but not sufficient to explain the whole thing. The purposefulness of attention, openness, non-judgment and other factors may be required to understand what is actually occurring. There is also now fascinating neurobiological research which sheds some light on what occurs inside the living brain in real time during mindfulness practice eg. see link: Neurobiology of Emotional MindfulnessHowever, I am not aware of equivalent research with exposure therapies which may be useful to compare and contrast underlying neurobiological changes that may occur. And of course, there might be other things occurring that may not be able to be reduced to such mechanistic views of mental phenomena.
In my next post, I will begin to explore the the possibility of forging a synergy of the two approaches.
Please feel free to post comments and questions!