Clinical Handbook of Mindfulness (43 page)

and invite patients to do the same
. Often, especially at the beginning,

patients tend to judge the “success” of the practice sessions, the positive

or negative changes, their own feelings at the time, or their mental con-

tents. Following the examples and instructions of the leader, they initially

learn not to pass judgment on the experience of others; as the practice

slowly goes ahead, they will acquire the ability not to judge themselves

and their own experience, which is much more complex.

•
Communicate clearly that meditating implies the unconditioned

acceptance of anything arising moment by moment
. The first thing

that we can suggest to a patient is to note and record (without judg-

ing himself/herself) during the early experiences with the practice of

mindfulness the moments when he or she would tend to react (or actu-

ally reacts) to the disturbing experience, noticing the type of evalua-

tions that lead to the non-acceptance and to the dysfunctional reactions

as well.

Chapter 8 Mindfulness and Feelings of Emptiness

147

•
Refrain from offering solutions or answers
. At any time during the

individual or group intervention, patients are simply asked to become

aware of their difficulties and remain in contact with them. The aim is

to promote acceptance, “being” and not “doing”, suggesting the detach-

ment from a reactive way, aiming at getting results and answers to any

problem.

•
Validate the patient’s emptiness experience together with all the

elements connected thereto
: Validation, according to
Linehan (1993),

is a therapeutic strategy consisting in giving value to the subjective expe-

rience of a patient. In particular, it is needed when the individual finds

himself/herself in a
self-invalidating state
, a mental state where he or she

negatively judges or tries to suppress any aspect of his or her own expe-

rience, considering it dishonorable, wrong, horrible, or unacceptable by

others. In this condition, totally aimed at judging or denying, rather than

at understanding one’s own mental states, the patient is not in a position

to reflect on it in a constructive way. The simple fact of succeeding in shar-

ing one’s own perceptions of the feelings of emptiness, being able to feel

that they are accepted, not receiving any type of judgment while they are

reported, and not feeling pressured to modify or find a solution to them

validates the experience as of itself.

Possible Usefulness and Effects of the Intervention

Clinical observation suggests that a mindfulness-based intervention may help

a patient deal with his/her experience of emptiness in many ways. This

approach might make it possible to

• identify the prodromes or the early signs of emptiness before it starts, as

well as at-risk situations;

• succeed in identifying the components of one’s own “emptiness”:

thoughts, physical feelings, emotional states and impulses, acquiring

awareness;

• neutralize the tendency to self-invalidate one’s own experience, develop-

ing the ability to cross one’s own inner state;

• become able to remain in that state without exasperating it by activating

secondary emotions
(guilt, shame, anger) or with an escalation of anxiety;

• accept being in contact with the experience of emptiness without enact-

ing dysfunctional behavior in order to escape it, also thanks to the aware-

ness of its transience;

• lower the intensity of suffering experienced in the feeling of emptiness

and its frequency;

• succeed in sharing what patient feels with others and accept their

support.

Summary and Future Directions

The feeling of emptiness may be one of the most difficult psychological phe-

nomena to explain and describe, but it is also not an unusual symptom to

find in both normal and pathological human experience. In this chapter, the

authors have tried to illustrate the state of the art present in the literature

with respect to the clinical problem of emptiness and show how the concept

148

Fabrizio Didonna and Yolanda Rosillo Gonzalez

of emptiness is utilized in radically antithetical ways in Western psychology

compared to its meaning in Eastern psychology.

The authors have proposed some hypotheses to explain the possible mech-

anisms of actions of mindfulness with regard to the clinical experience of

emptiness. The potential clinical effectiveness of mindfulness with respect

to feelings of emptiness should mostly be due to exposure to the different

stimuli configuring the aversive experience, usually avoided or suppressed,

most often dysfunctionally. Surely there are also other possible mechanisms

of change in the potential clinical relevance of mindfulness on the feeling of

emptiness. Different meta-cognitive processes are developed and strength-

ened during its use of mindfulness such as detachment or the self-regulation

of attention. Becoming aware of what one really feels inside an experience of

emptiness; identifying emotions, thoughts, and feelings related thereto; man-

aging to observe everything by decentering; and reflecting on one’s own

cognitive functioning and on the consequences of the dysfunctional behav-

ior actually mean improving the meta-cognitive functions implying control-

ling and regulating of one’s own mental states.

Some treatment guidelines have been proposed on pathological empti-

ness, but it is important to stress that these interventions are never a sub-

stitute for an overall psychological therapy for the pathology that is at the

root of the feeling of emptiness. Furthermore, we believe that this type of

intervention must be carried out by therapists expert in the disorder pre-

senting emptiness as a symptom and with a long and regular mindfulness

practice. At the moment there are few studies that have investigated the phe-

nomenological experience of emptiness and there are even fewer that have

certified the effectiveness of the treatments carried out thereon.

Future research is needed to more thoroughly study this clinical phe-

nomenon since it is common to numerous nosographic frames that are

extremely different from one another. The importance of methodologically

sound research in this area cannot be overstated as this could lead to a better

understanding of the activating and maintenance mechanisms of the phe-

nomenon, as well as how therapeutic intervention like mindfulness-based

training, used for the pathology presenting these symptoms, modify and

improve this challenging and disabling experience.

I am tired of being bedridden with the feeling that something must happen
.

I don’t understand what is happening to me. I have never been afraid

of the dark: but maybe mine is not fear of the dark. I have exchanged

day for night. At night I open the shutters and I always keep the light

on. . .during the day I close everything in order to isolate myself from the

thought that everyone is working or doing something. Lately I have started

to go to bed dressed and putting the pillow on top of the blankets for

thickness
.

Maybe it is just a habit, I cannot look for a meaning in everything I do. In

so doing, I miss out on so many things that could make me feel alive. . .Well,

all these thoughts are partly a defense against those feelings of emptiness

that otherwise I would experience. In other words, the truth is that inventing

all these small manias and fears or choosing to live the depression is a more

acceptable way of saying that you do not know what to do with yourself and

your life
.

Angela, a 21-year-old depressed patient

Chapter 8 Mindfulness and Feelings of Emptiness

149

References

Aalmas, A. H. (1987).
The diamond heart series book 1
. Boston: Shambala Publica-

tions.

American Psychiatric Association (APA). (2000).
Diagnostic and statistical manual

of mental disorders
(4th ed., Text Rev.). Washington, DC: Author.

Baer, R. A., (2003). Mindfulness training as a clinical intervention: a conceptual and

empirical review.
Clinical Psychology: Science and Practice, 10
, 125–143.

Beck, A. T., Freeman, A. et al., (1990).
Cognitive therapy of personality disorder
.

New York: Guilford.

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al.,

(2004). Mindfulness: A proposed operational definition.
Clinical Psychology: Sci-

ence and Practice, 11
, 230–241.

Bowlby, J., (1980).
Loss
. New York: Basic Books

Conti, L., & e Semerari, A., (2003).
Linee generali di trattamento dei disturbi della

personalit`

a
, In G. Dimaggio & A. e Semerari (Eds.),
I disturbi di personalit`

a. Mod-

elli e trattamento
. Roma: Editori Laterza (GLF).

Didonna, F. (paper submitted). Mindfulness and its clinical applications for severe

psychological problems: Conceptualization, rationale and hypothesized cognitive

mechanisms of change. Paper submitted to:
International Journal of Cognitive

Therapy
.

Dimaggio, G., Semerari, A., Falcone, M., Nicolò, G., Carcione, A., & Procacci, M.

(2002). Metacognition, states of mind, cognitive biases and interpersonal cycles.

Proposal for an integrated narcissism model.
Journal of Psychotherapy Integra-

tion, 12
(4), 421–451.

Dimaggio, G., Petrilli, D., Fiore, D., & e Mancioppi, S., (2003).
Il disturbo narcisis-

tico di personalit`

a: la malattia della grande vita
, In G. Dimaggio & A. e Semer-

ari (Eds.),
I disturbi di personalit`

a. Modelli e trattamento
. Roma: Editori Lat-

erza (GLF).

Donaldson, E., (2003). Psychological Acceptance: Why every OH/HR practioner

should know about it.
Occupational Health Review, 101
, 31–33.

DSM-IV, (1994).
Diagnostic and statistical manual of mental disorders
, (4th ed.).

Washington, D.C: American Psychiatric Association.

Epstein, M., (1988). The deconstruction of the self: Ego and “egolessness” in Buddhist

insight meditation.
The Journal of Transpersonal Psychology, 20
(1), 61–69.

Epstein, M., (1989). Forms of emptiness: Psychodynamic, meditative and clinical per-

spectives.
The Journal of Transpersonal Psychology, 21
(1), 61–71

Fiore, D., & e Semerari, A., (2003).
Il disturbo borderline di personalit`

a: il mod-

ello
, In G. Dimaggio & A. e Semerari (Eds.),
I disturbi di personalit`

a. Modelli e

trattamento
. Roma: Editori Laterza (GLF)

Forman, M., (1975).
Narcissistic personality disorders and the oedipal fixations
.

Annual of Psychoanalysis, 3, 65–92. New York: International Universities Press.

Frankl, V. E. (1963). (I. Lasch, Trans.)
Man’s search for meaning: An introduction to

logotherapy
. New York: Washington Square Press. (Earlier title, 1959: From Death-

Camp to Existentialism. Originally published in 1946 as Ein Psycholog erlebt das

Konzentrationslager).

Frankl, V. E. (1973). (R. and C. Winston, Trans.)
The doctor and the soul: From

psychotherapy to logotherapy
. New York: Vintage Books. (Originally published in

1946 as Ärztliche Seelsorge.)

Frankl, V. E. (1975).
The unconscious god: Psychotherapy and theology
. New York:

Simon and Schuster. (Originally published in 1948 as Der unbewusste Gott. Repub-

lished in 1997 as Man’s Search for Ultimate Meaning.)

Gabbard, G. O. (1989). Two subtypes of narcissistic personality disorder.
Bulletin of

Meninger clinic, 53
, 527–532

150

Fabrizio Didonna and Yolanda Rosillo Gonzalez

Gunderson, J. G., & e Singer, M. T., (1975). Defining borderline patients: an overview.

American Journal of Psychiatry, 132
, 1–9.

Hayes, S. C., (1994).
Content, context and the types of psychological acceptance
.

In S. C. Hayes, N. S. Jacobson, V. M. Follette, & M. J. Dougher (Eds.),
Acceptance

and change: Content and context in psychotherapy
(pp. 13–32), Reno NV: Con-

text Press.

Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K., (1996).

Experiential avoidance and behaviour disorder: A functional dimensional approach

to diagnosis and treatment.
Journal of Consulting and Clinical Psychology, 64
,

1152–1168.

Hazell, C., (2003).
The experience of emptiness
. Bloomington, IN: 1stBooks.

Horowitz, M. J., (1989). Clinical phenomenology of narcissistic pathology.
Psychiatric

Clinic of North America, 12
, 531–539.

Jacobson, E., (1964).
The self and the object world
. New York: International Univer-