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So the question is here, what is mindfulness relative to exposure? How are they different? How are they the same? What relative contributions can they each uniquely bring to the healing process?

Mindfulness is the simple act of paying attention, primarily in reference to the contents of mind itself. It’s the mind attending to mind. One does this in a very open, accepting and non-directive fashion. The idea behind this is that by simply watching the conditioned mind, we actually can achieve some distance and objectivity from the transient urges, fantasies, emotions, thoughts, and beliefs that perpetually buffet us, such that over time, we are able to decrease our reactivity to the forces of our conditioned mind. We can watch with equanimity and balance with the increasing realization that we are not defined by the transient forces of our mental events. As a scuba diver, it is apparent that most of the energy one expends during a dive is actually at the surface where there are waves and chop. There is also little visibility at the surface since light is being reflected and refracted in many directions due to the tumult of the surface. Once one dives beneath the waves, all is clear and serene. One can just drift with the current, barely using ones flippers to propel along the reef. Following this metaphor, most of us spend our lives at the surface, never realizing the vast clarity of the most oceanic parts of our selves.  Practices of mindfulness and meditation, offer us such opportunities. In later blogs, I will offer more concise instructions on how to engage in mindfulness exercises, especially when it comes to facing the darkest emotions that we spend so much energy trying to control and fight against.

The term exposure is really shorthand for stimulus exposure. What this refers to is the procedure of confronting an organism with a cue or stimulus that has been associated through conditioning with an aversive event whether it be foot shock in the case of a poor little lab rat, or, say, parental rejection in the case of us humans. What happens is that these aversive conditioned cues take on powerful drive impetus and thus have the power to compel an organism to avoid or escape from the noxious stimuli. Much of our behavior is in fact designed to reduce our exposure to difficult emotional experiences that arise as a result of historical conditioning. These avoidant tendencies are further bolstered by our shared cultural beliefs that perpetuate the notion that the so called negative or dark emotions are “dangerous”, “bad”, “destructive”, and thus in need of control and subjugation. Exposure based psychotherapies are based upon the powerful notion of experimental extinction. Extinction  (Pavlovian) is a important learning principle that holds that if a stimulus is not followed by an aversive event, the conditioned response (in this case avoidance) will eventually cease. The organism is essentially learning that the stimulus no longer predicts danger or discomfort. So, if our poor little lab rat has been provided with a conditioned anxiety response to say a yellow light, since that light was paired with shock, and then offered an opportunity to avoid the shock by pressing a bar which opens a door that exits into an adjoining “safe” chamber, the rat will quickly acquire that response. Now, let us say we disconnect the shock. How will the rat ever know since he is leaving the chamber before the shock interval would begin since there is a brief gap in time between the light offset and shock onset? He will continue (theoretically) to maintain his avoidance in perpetuity. So how do we “cure” our little friend of his yellow light phobia? That’s easy. We change the contingency such that the bar press no longer operates the door. While at first the rat will be freaked out since he is surely anticipating shock, he quickly comes to learn that shock is no longer forthcoming and he will quickly chill out even if the yellow light turns on. This is exctinction. Exposure based therapies are based on this basic principle. Therapies such as “flooding”, “response prevention” and “implosion” are all based on this basic premise.

OK, I know this may be a little tedious and boring, but please bear with me. This is building towards some very important stuff that will be inherently more interesting!

The argument that I will be making is that much of our issues, suffering and symptoms are the direct result of our learned avoidant mechanisms. It also helps us explain why we have become so unmindful We have actually learned to leave our selves since we often do not like what we feel. For this reason, we have learned to engage in a control war with our selves which manifests via a variety of behavioral and cognitive mechanisms. To become free, we must learn to face ourselves in all manners and in so doing relinquish our control mechanisms. Mindfulness can be a huge tool in this endeavor however it won’t always be enough on its own. Some parts of ourselves will be perceived as too threatening to face, and the layers of control too well established so as to defy mindful attention. Thus behavioral exposure tools will be required to facilitate and maintain the process.