A lot of survivors have a love-hate relationship with mindfulness. Some say it’s working, some say it doesn’t. We need to take a closer look to understand why.
I define mindfulness as guided attention that is marked by curious observation without evaluation, description without interpretation and the possibility to wait and let things pass instead of blindly reacting. Mindfulness is a tool to increase awareness. It can be turned inward, as a distant observer of body, emotions and thoughts, or outward, focussing on our perception through our senses.
For PTSD
Mindfulness is one of the standard tools for trauma therapy. It is often used for grounding and self-soothing (focus on perception), emotional regulation and reflection (focus inward) and the position of the distant observer is key in many techniques for trauma exposure. You actually cannot hope to make it through exposure therapy without the ability to be present. Van der Kolk calls it a „cornerstone of recovery from trauma“. There is scientific evidence that a regular mindfulness practice helps to reduce the symptoms of PTSD and improves impulse control.
Mindfulness turned outward is often used as a grounding exercise when patients go into hyper/hypoarousal. While this might still work if it is just a mild experience, it is not helpful in the deep red/blue on the scale. Brain scans of dissociating people prove what patients experience: that the areas in the brain that are responsible for our awareness, for both our body and self, are shut down. In that condition it is actually physiologically impossible to be mindful. We need to use different tools. Mindfulness is ultimately more a tool for the yellow area than the red and blue.
While mindfulness can be very helpful it is also often very uncomfortable for people who experience chronic dissociation.
Most patients struggle heavily with body-focussed mindfulness because they usually avoid awareness of their body; it is triggering. This is a discomfort that we have to work through, because we cannot properly connect our body to the present while we keep up dissociation and avoidance and it is in the connection to the present and to safe physical experiences in the present where we will find healing and a relief from re-experiencing.
The discomfort can also occur if we chronically dissociate our emotions and start to get in touch with them through mindfulness. It takes a while to learn how to become a distant observer. And some people will fall out of their window of tolerance right away.
Some survivors cannot tolerate mindfulness because it gets loud in their head. When they are more present they can hear other parts inside and they are too scared to face them. It is impossible to ground someone who is dissociating to avoid their inner experience. No grounding technique, that includes mindfulness, will work here.
Yet maintaining our avoidance means maintaining our PTSD symptoms.
In my own experience Ts often encourage mindfulness on a pretty high level without warning the patient enough about the discomfort and without explaining why it is still important to stick with it until it gets easier. Many patients need smaller steps.
For DID
When we use mindfulness for DID we need to be aware that one parts guided attention doesn’t automatically result in an increase of awareness in another part. Without a special effort in co-consciousness it will only be the part fronting who is participating in the exercise. If the problem is not with the front person but another part inside who needs orientation and grounding mindfulness can be utterly useless. Like with DBT Skills we need to connect with the parts inside first.
If we do that we might run into all the problems mentioned for PTSD as well as trance logic that is specific to structural dissociation. Examples for trance logic might be parts who think that they have their own body, that they still have a kids body, that they can move the body independently from the outside world or that they won’t influence other parts if they do something with the body. Those are just a few examples. Trance logic is basically endless, seems logical somehow but it is not connected to reality.
Presentification is one of the huge tasks of DID recovery and it is achieved by becoming more mindful of the present. Asking a part inside to look through the eyes and touch with the hands can cause difficulties eg that the part insists that this is not their body or panic about the sudden realization of being stuck in an old body or being in a strange place. It doesn’t mean that this awareness is bad, it is actually needed, but it should be approached very carefully and gently. Just telling someone to practice mindfulness and leaving them alone with the chaos that awareness can create is a terrible experience that can actually cause dissociation/shutdown as a protection from that.
I personally believe that the best way to use mindfulness in DID is in connection with daily tasks, like mindfully folding laundry or washing dishes. It can teach us to be more present and it works well with co-consciousness without focussing on the body too much.
Observing emotions or thoughts when every part is having their own seems like an impossibility to me. It is where mindfulness stops to make sense.
I do have positive experiences with very short (2-5 minutes) periods of mindfulness meditation that focusses on the breath and that, when the system is advanced, can be done co-consciously. This is only possible because everyone is paying attention to one small shared thing like the breath and I consider it something close to a circus trick.
For us and other systems we know it has been possible for the host or single parts to participate in a mindfulness practice that looks similar to that done for simple PTSD, with the same benefits and struggles and also a greater ability to stay grounded for systemwork. Other systems simply shut down immediately. So while mindfulness is tricky with DID it is not a complete waste of time for some systems. Only using mindfulness will not be enough.
For complex DID (RA/MC)
We are no experts in this area, so I will just share a few thoughts. Some systems are booby-trapped when it comes to presentification. They might experience inner attacks for even trying mindfulness.
There is also a difference between experiencing natural (body)flashbacks or having parts who create these flashbacks as punishment. To stop flooding it needs negotiations with the parts causing them. It will not be affected by the front persons attempts for grounding and orientation.
I am not saying that the tricky parts wouldn’t profit from being more mindful. That could actually get them oriented in time and space. But they will first have to be connected to the body. If they are living in a complex inner world they might have inner bodies and telling them to look around and use their senses might simply lead them to look around in the inner world and take in what was created for them to see. By connecting them with the body first we can make sure they look at the outside world. There is no such thing as being oriented in time and space, or being mindful, without being oriented in the body.
I hope that this can give you a more complex understanding of mindfulness, when to use it and where to be cautious.
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