By Malcolm Huxter MAPS, clinical psychologist, North Coast Area Health Service, NSW and in private practice

Spirituality means different things to different individuals. For many, spirituality is one way to cope with that which is difficult to bear. As an important dimension of life, spirituality may be relevant for the psychologist, both as a personal practice and a framework for the therapeutic encounter.

Buddhism is often considered a spiritual practice. The principles and practices of Buddhism, such as mindfulness, are becoming popular with many psychologists. Coming from a framework of Buddhism, Bhikkhu Bodhi defines mindfulness as "to remember to pay attention to what is occurring in one's immediate experience with care and discernment" (according to Sharpiro, 2009, p.556). There is, however, no consensus about the definition of mindfulness in contemporary psychology. In addition, mindfulness is often utilised in a way that is divorced from a coherent framework. As contemporary psychology becomes interested in Buddhist practices such as mindfulness, it is important that a framework of these practices is clarified.

The Buddhist framework

The word ‘Buddha' comes from the root ‘budh', which means ‘to wake, to know'. The Buddha as an awakened psychologist taught ways to wake up to ourselves and our condition. The four noble truths express the fundamentals of the Buddha's teaching. These truths describe a pair of cause-effect relationships: suffering and its causes; and freedom from suffering and its causes. Though they are usually referred to as noble truths, they can also be called the ennobling truths, in that they can be applied to the basic patterns evident with all psychological disorders and provide a way out of these disorders.

First truth

The term dukkha (Pali) is used in reference to the first truth of suffering. Dukkha has been described by Thanisarro (1996) as that which is difficult to bear. Dukkha includes all the varied forms of mental/emotional distress found in psychological disorders.

Second truth

According to Buddhism, the root causes (the second truth) of dukkha are contextually dependent on mental, emotional and behavioural tendencies that incline towards:

  • Greed - addiction to pleasant feelings, or craving and clinging
  • Ignorance - not knowing, misapprehension and misperception
  • Hatred - rejection, avoidance, struggle with unpleasant feelings, or aversion.

According to Buddhism, dukkha arises and continues because of an interdependent cyclic relationship between environmental conditions and tendencies based on the root causes. Depending on one condition the next condition on the cycle will arise.

Third truth

Nirvana (a Sanskrit term) is used in reference to the third truth. According to one translation, the word literally means Un (nir) + binding (vana) (Thanissaro, 1996). Thus, freedom is defined not in terms of what it is, but in terms of what it is not. Here, freedom means that one is unbound by patterns and habits that lead to dukkha. Nirvana is the result of exiting unhelpful interdependent cycles.

Fourth truth

The eightfold path is the fourth truth and it represents the path of freedom. The eight factors on this path are divided into three basic categories, which have an interdependent relationship.

Eight factors of the fourth truth

Traditionally each factor of the path begins with the term ‘right', which could also, in the therapeutic context, be understood as complete, authentic, and skilful. The eight factors of the path are not linear, but together make up an interdependent system, "comparable to the intertwining strands of a single cable that requires the contributions of all the strands for maximum strength" (Bodhi, 2000a, p.13).

Right view is the understanding that actions have consequences, and that unhelpful, unwise actions lead to anguish. Right view leads to the motivation to make skilful decisions - decisions to let go of destructive patterns. This represents right view and right intention, the wisdom component of the path. Thus motivated, one acts in ways that are consistent with one's best intentions and understanding. This represents right speech, action and livelihood, the ethical component of the path. An ethical life results in the development of mental composure and stability, aided by remembering to bring attention to our experience. This represents right energy, mindfulness and concentration, the meditation component of the path. Composure and attention stimulates wisdom, which stimulates the continuation of the path.

Wisdom has been described by Thanissaro (2006) in the following way. "The Buddha had a simple test for measuring wisdom. You're wise, he said, to the extent that you can get yourself to do things you don't like doing but know will result in happiness, and to refrain from things you like doing but know will result in pain and harm." This passage emphasises the importance of action directed towards wellbeing and away from harm. This ethical direction characterises the entire path.

Dependent co-arising

Dependent co-arising is the fundamental principle through which the Buddha understood the nature of things. The four truths provide a particular instance of this general principle. While dependent co-arising is complex and difficult to understand, it is explained succinctly throughout the discourses as follows:

When this exists, that comes to be:
With the arising of this, that arises.
When this does not exist that does not come to be,
With the cessation of this, that ceases.
Bodhi, 2000b (p. 552)

In other words, in the absence of a cause, anguish does not arise.

Using the framework for case conceptualisation

The four noble truths of the Buddha's teaching could be described from a CBT perspective as follows.

  1. There are presenting problems or disorders.
  2. There are causative factors for the arising of these problems, and for their maintenance.
  3. It is possible to be free from these problems, or at least reduce the severity of their symptoms.
  4. There are treatments, using cognitive, behavioural and affective strategies, that address the causative and maintaining factors.

Clinically, the four truths and dependent co-arising together provide a framework for case conceptualisation. For example, catastrophising is a maintenance process for the panic cycle (Wells, 1990). If, however, catastrophising thoughts are not believed - if this particular cause is absent - then the severity of panic may reduce, or the cycle is short circuited and panic disappears entirely.

The same principles can be applied to depression. For example, mindfulness based cognitive therapy (MBCT; Segal, Williams & Teasdale, 2002) demonstrates that mindfulness helps to prevent the relapse of depression. Segal et al. (2002) have found that when ruminative thoughts are not taken as facts to be believed - when that maintenance factor is absent - then there is less likelihood of relapse.

Though mindfulness is often used as a technique independent from a framework, the developers of MBCT warn about using it disconnected from a context (Teasdale, Segal & Williams, 2003). From a Buddhist perspective, the context for the therapeutic use of mindfulness is the eightfold path.

Reflections on the path

It says in the discourses that the teachings of the Buddha are well-explained, directly visible, timeless, verifiable, and to be personally experienced by the wise. In my opinion, the path is beneficial for the psychologist and the client.

I often provide the quote about the Buddha's test for measuring wisdom to people I see, both individually and in groups, in mental health services. It is especially appreciated by those suffering with bipolar disorder. Wisdom helps them to refrain from being entangled in destructive patterns and to cultivate the helpful. Wisdom enables them to choose to surf destructive manic urges, and at the other end of the spectrum, to choose to break entrenched cycles of depression.

I was first introduced to the Buddhist psychology of awakening about 34 years ago. Over the past 20 years it has been interesting to witness the growing interest in aspects of the path, such as mindfulness, in the field of clinical psychology. Many Buddhist psychologists, such as myself, have experienced a mix of jubilation and reservation about the use of mindfulness practices in the clinical setting. The jubilation comes from the accessibility of this powerfully therapeutic tool to the wider community, where it has helped a wide range of individuals suffering with psychological disorders. The reservations about the use of mindfulness in clinical settings come from the observation that its practice is often separated from a context of wisdom and ethics.

From a Buddhist perspective, mindfulness is only one component on the path, and to separate and isolate parts of any therapeutic approach reduces the adaptability, flexibility, and power of these approaches. Just like pulling the strands out of cable will make it weak and prone to snapping under stress, separating mindfulness from its strengthening framework could make it ineffective, or, in some cases, simply dangerous.

In summary, as a spiritual practice the eightfold path is a path of awakening. When we wake up, we still experience the effects of change, yet the suffering often associated with change is either reduced or completely released. At a clinical level, the four noble truths and dependent co-arising can become a framework to understand how the various factors on the path work therapeutically. Thus, the Buddha's psychology of awakening can be a path of psychological freedom for both the therapist and the client.

The author can be contacted at malhuxter@gmail.com or access www.malhuxter.com for free resources.

References

Bodhi, B. (2000a). The noble eightfold way: Way to the end of suffering. Onalaska, WA: BPS Pariyatti Editions.

Bodhi, B. (2000b). The connected discourses of the Buddha: A translation of the Samyutta Nikaya. Somerville MA: Wisdom Publications.

Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2002). Mindfulness-based cognitive therapy for depression. New York: The Guilford Press.

Sharpiro, S. L. (2009). The integration of mindfulness and psychology. Journal of Clinical Psychology, 65(6), 555-560.

Teasdale, J.D., Segal, Z., & Williams, M.G. (2003). Mindfulness training and problem formulation. Clinical psychology: Science and practice, 10, 157-160.

Thanissaro B. (1996). The wings to awakening. Barre, MA: The Dhamma Dana Publication Fund.

Thanissaro B. (2006). The integrity of emptiness. Retrieved 2006 from
www.accesstoinsight.org/lib/authors/thanissaro.

Wells, A. (1990). Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behavior Therapy, 21, 273-280.

InPsych August 2009