“Your breath is a tool that you have with you at all times, anywhere you go, always readily available.” Lisa Fortuna, M.D., M.P.H., MDiv, shared this insight on the therapeutic potential of the breath during the American Psychiatric Association’s virtual panel discussion “Meditation and Mindfulness: A Cultural Bridge to Mental Wellbeing.”

The ease of access for such a powerful tool has never been more salient, as pervasive inequities widen the gap between diverse groups and the psychosocial resources they need to confront negative mental health outcomes. Dr. Fortuna, a child and adolescent psychiatrist and chair of the Department of Psychiatry at UC Riverside, moderated the session. Her work has focused on the delivery of care for culturally diverse populations, including research on mindfulness-based cognitive therapy for post-traumatic stress (PTSD) and addiction in adolescents.

The intervention achieved meaningful improvement in PTSD and depression symptom severity, and reduced cannabis use among study participants.(1) Dr. Fortuna said of the study, which included many Latino/Hispanic youth, that utilizing mindfulness and attentiveness techniques helped youth reframe their cognitions around trauma. “The mindfulness allowed them to have that meta reflection on their thinking and their experiences to even make a change or difference in it. So, it helped the PTSD directly.”

These interventions are rooted in Mindfulness-Based Stress Reduction (MBSR), a meditation-based therapy developed by Jon Kabat-Zinn, Ph.D., in the 1970s to treat patients with chronic pain. Since then, MBSR-based therapies have demonstrated clinically significant improvement in depression, anxiety and psoriasis and exhibited potential for treating eating disorders, obsessive-compulsive disorder, hypochondriasis, irritable bowel syndrome, and attention-deficit hyperactivity disorder. (2) Mindfulness may also help prevent addiction relapses by interrupting the automaticity responses to substance use triggers and enhance thought suppression in patients with treatment resistant depression, suicidal ideation and social phobia.(2,3)

Deepika Sastry, M.D., one of the speakers on the panel and an avid mindfulness and yoga practitioner, paraphrased author Viktor Frankl, M.D., Ph.D., to underline the power and simplicity in cultivating pauses over automatic responses and thoughts. She said “between stimulus and response, there is a pause. In that pause there is the ability to make a choice, and because of the choice, we are able to grow.” She said that pausing can be very profound as it allows more clarity to understand what would have occurred otherwise, what one should do, all while breaking up the default cycles of the thinking mind. “When we practice these techniques, we are slowly deactivating that network so that it silences the chatter and we can recognize who we really are, what our motivations are, what our desires are. With greater awareness comes self-compassion, observation and peace.”

Panelist Jeffrey Proulx, Ph.D., assistant professor of psychiatry and human behavior at Brown University, has studied the effectiveness of mindfulness-based therapies as stress-reduction measures for populations bearing intergenerational trauma such as Indigenous and African American communities. He advises that the development of mindfulness-based interventions should be participatory, drawing on community strengths, connecting with the group’s cultural values and practices, and should be approached with self-reflective sensitivity on the part of researchers and mental health practitioners.(4) Dr. Proulx provided examples of how his team centered tribal traditions such as utilizing dance and beading in place of walking or breathwork meditations. He said tapping into community advisors to learn and lead mindfulness practices has created spaces for people to work on themselves while also engaging in conversations for social and structural change. He said this empowerment leads to meaningful outcomes for well-being, self-efficacy and more in the communities he has worked with.

For practitioners seeking to integrate mindfulness into mental health or clinical practice, the panelists affirmed that the first step is to develop one’s own meditation practice. This ongoing training is important to understand how to apply and adapt these techniques in developmentally and contextually appropriate ways. Dr. Sastry said she helps her patients integrate mindfulness into their day-to-day routines, particularly during activities they do mindlessly such as eating, walking or driving. She teaches patients to incorporate this attention in their daily activities and to be aware of and accept the present as it exists now, rather than wishing for something different. “In this practice there is no such thing as perfection. It's a complete antithesis of what we're taught. As physicians we're taught to heal suffering and heal pain, with mindfulness you are taught to sit with that suffering, to sit with some of this discomfort, to experience it fully.” It is this quality of mindfulness practice that can represent a powerful tool for addressing moral injury and burnout.

Dr. Sastry shared her experience with burnout, saying that as physicians they are in a constant state of doing and being held to high standards and metrics of productivity. She said the sympathetic nervous system is being activated constantly in an unsustainable way. She recalled the first time she sat to meditate, which only lasted a minute. “That was all I could do; it is a very gradual process. It is scary because you are searching and looking at your authentic self, and sometimes what you find is going to be uncomfortable, but that is part of the process.” Dr. Sastry shared that even just pausing throughout the day, between appointments can activate the parasympathetic nervous system for a calming effect. She engages in a 3-3-3 or 5-5-5 practice, where one breathes in for three (or five) counts, holds for three counts, and breathes out for three counts, doing this three times, especially prolonging the exhalation to relax the body and mind further.

The insights from the panel discussion underscore the profound impact that accessible and culturally attuned approaches like mindfulness-based cognitive therapy can have to empower patients, communities and providers in navigating trauma and burnout and building resilience. By harnessing the simple yet powerful and universally available act of breathing, we can cultivate greater awareness, healing, and agency in our mental well-being—one breath at a time.

By Fátima Reynolds, M.P.H.
Senior Program Manager, Division of Diversity and Health Equity
American Psychiatric Association

Resources

1. APA Webinar
   • Looking Beyond: Meditation and Mindfulness: A Cultural Bridge to Mental Well-being
2. Apps
   • Healthy Minds: -- Free and great for beginners
   • Smiling Mind: -- Free, simple to use. Good for kids/teens/families
   • Headspace: great variety, easy to use/engaging interface, 14-day free trial
   • Calm: also excellent, has more ambient sounds like naturescapes. 50% off for first time users
   • Insight Timer
   • Waking Up
3.  Books
   • Treating co-occurring adolescent PTSD and addiction: Mindfulness-based cognitive therapy for adolescents with trauma and substance-abuse disorders. Fortuna, L. R. & Vallejo, Z. (2015).
   • Beyond White Mindfulness: Critical Perspectives on Racism, Well-being and Liberation. Fleming, D.M., Veronica Y. Womack, V.Y. and Jeffrey Proulx, J., editors. (2022)
4. Scientific Literature
   • Incorporating Traditional Healing Into an Urban American Indian Health Organization: A Case Study of Community Member Perspectives
   • The Effect of Mindfulness on Outcomes in Psychiatric Patients
   • Mindfulness Training Enhances Students’ Executive Functioning and Social Emotional Skills.
   • Mindfulness Meditation and Psychopathology
   • Mindfulness in psychiatry – where are we now?
   • Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy