Infusing Mindfulness-Based Treatments with Defusion Techniques

It’s not exactly news that mindfulness-based therapies are effective. A recent meta-analysis comprising 209 empirical outcome studies indicated that mindfulness-based treatments were effective in treating a variety of psychological disorders. They were as effective as cognitive behavior therapy and pharmacological treatments in the nine studies in which they were compared (Khoury et al., 2013).

Given the boom of research, and the support for mindfulness-based treatments, the next steps might be refining techniques, seeking ways to enhance their application, and building competency in these approaches, in order to boost healing potential beyond the barriers of particular populations and diagnoses.  

Many mindfulness treatments rely on some kind of formal sitting meditation. This is complemented by other mindfulness activities, such as attending to physical sensations while walking, exercising, showering, driving, doing dishes, etc., as well as mindfulness of the physical and cognitive aspects of emotions as a way to help clients respond to thoughts, feelings, and other aspects of their experience in a flexible, adaptive, and effective manner.

Enter defusion. According to acceptance and commitment therapy (ACT) researcher John Blackledge, PhD, using defusion strategies in addition to existing mindfulness-based approaches would expand the range of techniques available for teaching mindfulness. “Research”, Blackledge writes in the book Cognitive Defusion in Practice, “tells us that some [mindfulness] techniques work for some people but not for others, and that there can be significant barriers to regularly engaging in formal sitting meditation” [JG1] (Williams, Van Ness, Jane, & McCorkle, 2012). However, there are techniques already in documented use in some mindfulness-based therapies that that don’t resemble formal meditation or simple mindful awareness of experience, but do resemble common ACT defusion techniques.

In many cases, of course, these commonalities likely reflect the mindfulness-based lineage of these treatments, and do not imply that ACT practitioners or theorists “invented” the techniques. For example, dialectical behavior therapy creator Marsha Linehan (1993) has noted that teaching clients to find words that simply describe their moment-to-moment experiences, and to be wary of—and “unglue” themselves from— opinion words that evaluate that experience, is a standard part of her protocol.

Segal and colleagues (2002) described a mindfulness-based cognitive therapy (MBCT) metaphor that compares recurrent problematic thoughts to a “tape in the mind” that repeatedly plays back under certain circumstances, so as to highlight the insidious nature of such thoughts. The metaphor resembles both the computer programming and “bad news radio” defusion metaphors used in ACT. MBCT practitioners are also directed to promote an understanding of the distinction between facts and interpretations (Segal et al., 2002) that is similar to the distinction made between descriptions and evaluations in ACT.

Furthermore, mindfulness-based relapse prevention (MBRP) therapists have been advised, for example, to help their clients to metaphorically liken their thoughts to “images or words on a movie screen or balloons floating away,” or “a radio broadcast or to a tiny creature on your shoulder delivering a running commentary” (Bowen, Chawla, & Marlatt, 2010). Such strategies closely resemble common ACT defusion and self-as-context techniques, but differ in form from the types of traditional Buddhist meditation and mindfulness practices that dominate most mindfulness-based treatments.

“If finding a more flexible and varied array of mindfulness strategies within these treatments is deemed desirable and potentially useful, then incorporating a range of ACT-based defusion techniques becomes an attractive option,” says Blackledge.