Bringing mindfulness into clinical practice in India

In 2009, I organised the first mindfulness session with a patient with depression, his wife and a staff nurse of the hospital. The four of us sat in a large hall and meditated mindfully for the first the time in the history of our institution. In the same year, on behalf of the Holistic and Psychosomatic Clinic of the Department of Psychiatry at the Government Medical College, Thiruvananthapuram, the first mindful life management (MLM) stress management workshop was organised. Lasting 150 min, this gradually paved the way for half-day and full-day workshops. To date, more than 500 workshops have been conducted.

In 2016, we thought of a psychotherapy module for use by mental health professionals for specific psychiatric disorders. Drawing on mindfulness-based stress reduction (MBSR),^{Reference Kabat-Zinn2} mindfulness-based cognitive therapy (MBCT),^{Reference Segal, Williams and Teasdale11} mindfulness-integrated cognitive–behavioural therapy (MiCBT),^{Reference Cayoun12} acceptance and commitment therapy (ACT)^{Reference Hayes, Strosahl and Wilson13} and our own little programme of mindful life management (MLM) we formulated mindfulness-unified cognitive–behavioural therapy (MUCBT). We organised the first state-level training programme for about 20 mental health professionals, including psychiatrists, psychologists and counsellors. In 2018, we organised the first national-level workshop on MUCBT for 20 selected mental health professionals from all over India. To my good fortune, I was able to attend a teachers’ training workshop organised by Oxford Mindfulness Centre (OMC) in 2017, with Dr Wilhem Kuyken, the then Director of OMC, as the chief trainer. Kuyken and his studies on depression and mindfulness were an inspiring experience to cherish for a long time. And over the past 3 years, two national workshops and a 100-session webinar on different topics related to mindfulness have materialised. The webinar is in progress and covers topics ranging from what mindfulness is to its neurobiology and future. Our state today is the first state in India to have introduced mindfulness for a state police force, producing nearly 25 trainers. We have also organised mindfulness training for mental health professionals in different parts of India, medical students, oncologists and teachers. The programme today is offered free of cost from the Government Medical College, Thiruvananthapuram, in South Kerala.

How far mindfulness has come

Learned as a method of stress management for my own self and to mitigate the suffering of the patients whom I care for, over the years, I discovered that mindfulness is an easy method that could be incorporated into the moments of life. Today, mindfulness is a word equally near and dear to the homes of millions across the world and to the citadels of scientists.^{Reference Sacchet14} Both as a household tool for wellness and as a management strategy for mental and physical disorders, mindfulness finds its place in healthcare.^{Reference Tlalka15} It also has a major role in the areas of education,^{Reference Batra16} management and the workplace.^{Reference Craig17}

Mindfulness helped me to attempt listening better, attempt to be present with less distraction, attempt to accept my annoyance over the little things, face challenges by looking at them from a new perspective, attempt to communicate better, understand the array of emotional fluctuations and to feel a deeper sense of connection and gratitude. Perhaps the best part of mindfulness training was the feeling of a deeper sense of connection and gratitude. Some nights are more difficult than others. Mindfulness helps me to surf through the troughs and gutters of life with compassionate awareness.

Today, after nearly a decade and half has glided under the bridge of time, mindfulness has entered the mainstream medical arena with dreams of a better tomorrow. In the area of mental healthcare, mindfulness-based interventions (MBIs) find application in the treatment of a large number of psychiatric disorders. There is evidence in support of this in stress management,^{Reference Sharma and Rush18,Reference Chiesa and Serretti19} pain management,^{Reference Majeed, Ali and Sudak20,Reference Skaer21} depression,^{Reference van der Velden, Kuyken, Wattar, Crane, Pallesen and Dahlgaard22–Reference Hofmann, Sawyer, Witt and Oh24} anxiety,^{Reference Hofmann, Sawyer, Witt and Oh24–Reference Behan26} borderline personality disorder,^{Reference Carmona i Farrés, Elices, Soler, Domínguez-Clavé, Pomarol-Clotet and Salvador27} addiction management,^{Reference Garland and Howard28} relapse prevention^{Reference Grant, Colaiaco, Motala, Shanman, Booth and Sorbero29} and the like. During periods of severe crisis, MBIs have been found to be of benefit to the community.^{Reference Behan26} MBIs benefit not only the patient population, but also healthcare staff, including physicians.^{Reference Burton, Burgess, Dean, Koutsopoulou and Hugh-Jones30,Reference Lomas, Medina, Ivtzan, Rupprecht and Eiroa-Orosa31}

On the same road, there are parallel attempts to trivialise mindfulness as a quick fix to generate happiness, health and a balanced life. The cold war, though muffled now, continues on its own way. Is mindfulness a hope or hype? – the question is openly discussed now.

Mindfulness, I feel, is the practice of experiencing each moment of our day-to-day life as it happens. As Jon Kabat Zinn suggested, the introduction of mindfulness into the mental health field definitely has a potential to change the face of mental healthcare.