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Mindfulness and Feelings of Emptiness

January 2009

In book: Clinical Handbook of Mindfulness (pp.125-151)

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Shanghai Jiao Tong University

The feeling of emptiness is a common symptom or phenomenological experience found in clinical practice with several kinds of disorders.What is, however, more difficult is finding two patients who describe this experience in the same way. Patients report different experiences: “I feel an emptiness inside,” “everything seems empty,” “I feel like I’m falling into a great emptiness,” “nothing makes sense because of the emptiness,” and many others. Though at first sight they may appear to be very similar, some specific and distinctive characteristics surface on closer observation. The diagnoses that comprise these manifestations can be multiple and are recurrent in relation to a series of disorders: from common depressive episodes to personality disorders, even in comorbidity with other pathologies.

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Mindfulness and Feelings

of Emptiness

Fabrizio Didonna and Yolanda Rosillo Gonzalez

“Nothing is as unbearable for man as to be completely at rest, without

passion, without business, without distraction, without application to

something.”

In such a state of rest man becomes aware of “his nothingness, his

foresakenness, his insufﬁciency, his dependence, his impotence, his

emptiness.”

Incontinently there springs from the depth of his soul “the ennui, the

blackness, the tristesse, the chagrin, the spite, the despair.”

Blaise Pascal

Introduction

The feeling of emptiness is a common symptom or phenomenological

experience found in clinical practice with several kinds of disorders. What is,

however, more difﬁcult is ﬁnding two patients who describe this experience

in the same way. Patients report different experiences: “I feel an emptiness

inside,” “everything seems empty,” “I feel like I’m falling into a great empti-

ness,” “nothing makes sense because of the emptiness,” and many others.

Though at ﬁrst sight they may appear to be very similar, some speciﬁc and

distinctive characteristics surface on closer observation. The diagnoses that

comprise these manifestations can be multiple and are recurrent in relation

to a series of disorders: from common depressive episodes to personality

disorders, even in comorbidity with other pathologies.

This phenomenon seems to be a universal human experience and might

not always seem directly linked to a pathology. All of us, at some moment in

our lives, can experience a “feeling of emptiness,” without suffering from

a mental disorder. Like many other nonspeciﬁc symptoms, the feeling of

emptiness is neither a necessary nor a sufﬁcient reason for a frank diagnosis

although it has become one of the inclusion/exclusion nosological criteria of

borderline personality disorder (BPD) in the Diagnostic and Statistical Man-

ual of Mental Disorders (DSM-IV, American Psychiatric Association, 2000).

The experience of emptiness has aroused the interest of well-known schol-

ars and has become the main subject of their writings. Unfortunately, few

thorough or rigorous studies have focused speciﬁcally on emptiness. This

may be because of the many methodological problems involved in this type

of study. For example, what do we mean by experience of emptiness? Does

this feeling of emptiness always present itself in the same way? Does it vary

125

126 Fabrizio Didonna and Yolanda Rosillo Gonzalez

according to the disorder diagnosed? Although we will try to answer these

questions, at least in part, in this chapter, the main aim is to take the reader

through a theoretical reﬂection on the possible clinical use of mindfulness,

to alleviate, reduce, or eliminate the suffering caused by the experience of

emptiness as a pathological symptom.

Psychology and Emptiness

He who has a why to live, can bear almost any how

Nietzsche

The experience of emptiness has not been studied only by psychologists.

Various categories of scholars, including philosophers and theologists, have

been and still are interested in this phenomenon of human experience.

However, if we focus speciﬁcally on psychology, we can highlight some

epistemological approaches that, more than others, have tried to explain

this psychological experience. Cognitive-behavioral theory (Linehan, 1993;

Young, 1987), existential psychology (Frankl, 1975, 1963; May, 1950, 1953),

and psychoanalysis (Kernberg, 1975; Kohut, 1971, 1977) are some of the

theoretical perspectives that have provided important contributions to the

understanding of the experience of emptiness. These contributions will be

discussed in detail below.

Cognitive-Behavioral Theory and Feelings of Emptiness

Several cognitive-behavioral authors have suggested that the experience of

emptiness can be a sort of dysfunctional avoidance strategy in a situation of

deep subjective suffering (Beck, Freeman et al., 1990; Linehan, 1993; Young,

1987). Linehan (1993) bases her therapeutic model on the idea that the

inability to regulate and modulate painful emotions is an essential element

in explaining the behavioral difﬁculties of patients with BPD. These patients

present a sort of intolerance to negative emotions: “Many borderline patients

try to control their emotions simply by forcing themselves not to feel what

they are experiencing” (Linehan, 1993). Other researchers, such as Fiore and

Semerari (2003), speak of a state of emotional anesthesia to avoid any suf-

fering by which patients detach themselves from everything and everyone.

Young, Klosko, and Weishaar (2003) have identiﬁed various modes,mean-

ing the speciﬁc emotions, cognitions, and behavior active in a person in the

here and now. Among these, the detached protector mode aims at isolating

the person from his needs and feelings, creating a sort of detachment with

a protection purpose. The main symptoms of this mode include depersonal-

ization, self-harm, boredom, and feelings of emptiness. These theories can be

associated with Hayes, Wilson, Gifford, Follette, and Strosahl’s (1996) asser-

tions on experiential avoidance.

Experiential avoidance is a putative pathological process recognized by a

wide number of theoretical orientations. Experiential avoidance is the phe-

nomenon that occurs when a person is unwilling to remain in contact with

particular private experiences (e.g., bodily sensations, emotions, thoughts,

memories, and behavioral predispositions) and takes steps to alter the form

or frequency of these events and the contexts that occasion them. We occa-

sionally use terms such as emotional avoidance or cognitive avoidance

Chapter 8 Mindfulness and Feelings of Emptiness 127

rather than the more generic experiential avoidance when it is clear that

these are the relevant aspects of experience that the person seeks to escape,

avoid, or modify. We recognize that thoughts, memories, and emotions are

richly intermingled and do not mean to imply any necessary rigid distinc-

tion among them (although distinctions might be drawn by some theoretical

perspectives without threat to the underlying principle of experiential avoid-

ance) (Hayes et al., 1996).

The question, then, is what can a patient do if, as has been hypothesized by

the aforementioned authors, the feared stimulus is one’s own emotions? How

can a person avoid something that is not outside, but part of his or her natural

and theoretically adaptive response to the outside world? Certainly, a possi-

bility is to try not to feel, as was said above. Experiencing this “emptiness”

creates a detachment leading to actions aimed at distancing the subject from

the stimulus situation, that is, the negative emotions, replacing them with

physical pain (self-harm), numbness (alcohol or substance abuse), euphoria

(acting out dangerous behaviors), or physical gratiﬁcation (sexual promiscu-

ity, bulimic crises), all manageable situations from the subject’s point of view.

Referring to the BPD, Linehan (1993) claims that exposure to an invalidat-

ing environment, where inadequate and unforeseeable answers follow the

manifestation of a person’s inner experiences, leads to the non-recognition

or inhibition of negative emotions. This continuous inhibition of negative

emotions leads to emotional avoidance. The paradigm, the author claims,

is similar to learning ﬂight behavior to avoid painful stimuli. In this case,

the emotions, meaning the complex response of the body (activation of the

central nervous system accompanied on a neurovegetative, behavioral, and

cognitive level by speciﬁc modiﬁcations), seem to be conditioned. This con-

ditioning may have been caused by a repeated process of adversive asso-

ciation stimuli such as those previously described by Linehan regarding an

invalidating environment. If we add this to speciﬁc circumstances, increases

in fear not caused by events experienced by the subject but rather by the

simple repeated presentation of discriminative and conditioned stimuli, con-

nected to such events (Sanavio, 1991), we ﬁnd that even simple physical

sensations, previously associated with a negative emotion, can produce a

phenomenon known as incubation of fear. The sense of emptiness could

be triggered by the simple arising of one of these discriminative stimuli, pre-

ceding the activation of the negative emotions, which the subject avoids and

sometimes fails to recognize.

Existential Psychology

Viktor Frankl coined the term “existential vacuum” (1963; 1973), and aspects

of the meaning of this term come close in meaning to the term “emptiness”

as described in this chapter. Frankl posits that humans have a “will to mean-

ing,” which is as basic to them as the will to power or the will to pleasure.

The frustration of the will to meaning results, in Frankl’s estimation, in a

“noogenic neurosis” – an abyss experience (Hazell, 2003). If meaning is what

you desire, then meaninglessness is a hole, an emptiness, in our lives. When-

ever you have a vacuum, of course, things rush in to ﬁll it. Frankl (1963)

suggests that one of the most conspicuous signs of existential vacuum in

our society is boredom. He points out how often people, when they ﬁnally

128 Fabrizio Didonna and Yolanda Rosillo Gonzalez

have the time to do what they want, don’t seem to want to do anything,

for example, people go into a tailspin when they retire, students get drunk

every weekend, and people submerge themselves in passive entertainment

every evening. He calls this the “Sunday neurosis” and deﬁnes it as “that

kind of depression which afﬂicts those who become aware of the lack of

content in their lives when the rush of the busy week is over and the void

within themselves becomes manifest” (Frankl, 1963, p. 169). The result of

this is an attempt to ﬁll our existential vacuums with “stuff” that, because

it provides some satisfaction, we hope will provide ultimate satisfaction as

well; for example, we might try to ﬁll our lives with pleasure, eating beyond

all necessity, having promiscuous sex, living “the high life;” we might seek

power, especially the power represented by monetary success; we might ﬁll

our lives with “busyness,” conformity, and conventionality; or we might ﬁll

the vacuum with anger and hatred and spend our days attempting to destroy

what we think is hurting us. We might also ﬁll our lives with certain neurotic

“vicious cycles,” such as obsession with germs and cleanliness, or fear-driven

obsession with a phobic object. The deﬁning quality of these vicious cycles

is that, whatever we do, it is never enough.

Frankl conducted many studies where he interviewed people on “existen-

tial emptiness” (1975). At the Policlinic Hospital in Vienna, he found that

55% of patients had experienced a loss in the meaning of life, and a statistical

survey showed that 25% of European and 50% of American students had had

this experience. In Frankl’s thinking, the experience of emptiness is made

up of two feelings: a feeling that life is meaningless and a feeling of inner

emptiness. This bifactorial quality in the experience of existential vacuum

is sometimes undifferentiated from other concepts such as boredom and

depression: “The existential vacuum manifests itself mainly in a state of bore-

dom” (Frankl, 1963, p. 169). Another important representative of existential

psychology, Rollo May (1950, 1953), has illustrated some useful ideas on the

concept of the experience of emptiness. In his earlier work, May (1950) con-

nects the experience of anxiety with the threat of nonbeing, that is, anxiety

is the experience of being afﬁrming itself against nonbeing: “Emptiness and

loneliness, are thus the two phases of the basic experience of anxiety”. In

1953 (p. 14), he wrote: “...the chief problem of problem in the mid-decade

of the twentieth century is emptiness. By that I mean that not only do peo-

ple not know what they want; they often do not have any clear idea of what

they feel ...they have no deﬁnite experience of their desires or wants.” May

relates the experience of emptiness with turning to drug use or to the use of

sex in a mechanical way: “... the most common problem now is not social

taboos on sexual activity or guilt feelings about sex itself, but the fact that

sex for most people is an empty, mechanical and vacuous experience” (May,

1953, p. 15). This behavior, which is found rather frequently in some types of

disorders such as BPD, is often traced back by the same patients to their own

experience of emptiness. Other interesting reﬂections by the author refer

to the relationship between the experiences of emptiness, helplessness, and

powerlessness (May, 1953). The experience of emptiness rather generally

comes from people’s feeling that they are powerless to do anything effective

about their lives or the world they live in. Inner vacuousness is the long-

term accumulated result of a person’s particular conviction toward himself,

namely, that he or she cannot act as an entity in directing his or her own life,

Chapter 8 Mindfulness and Feelings of Emptiness 129

and since what he or she wants and what he or she feels can make no real

difference, he or she gives up wanting and feeling. Apathy and lack of feeling

are also defenses against anxiety (May, 1953, p. 22).

Psychoanalysis and Emptiness

As far as psychoanalysis is concerned, let us take a look at Otto Kernberg’s

work (1975) on the experience of emptiness. Kernberg used psychodynam-

ics and object-relations theory as a means of explaining the various forms the

experience might take. For him, the experience of emptiness arises when

there is a loss of what Jacobson (1964) calls “self feeling”. Kernberg points

out that although there are several forms of the experience of emptiness,

there are two broad reactions to the experience: that of “acting out” in a

forced attempt to regain a sense of internal aliveness and that of submit-

ting to the experience and going through one’s daily activities in a split-off,

mechanical fashion (Hazell, 2003).

Kernberg (1975) also highlights the difference between the two concepts

of emptiness and loneliness, which at times can be confused in a clinical

context: “loneliness implies elements of longing and the sense that there are

others that are needed, and whose love is needed and who seem unavail-

able now.” If this longing were present, the individual would not feel empty.

Emptiness is the lack of others without the realization of the lack or the

longing to ﬁll the lack (Hazell, 2003). In general, Kernberg (1975, p. 220)

posits that: “The experience of emptiness represents a temporary or perma-

nent loss of the normal relationship of self with the object relations, that

is, with the world of inner objects that ﬁxates intrapsychically the signiﬁcant

experiences with others and constitutes a basic ingredient of ego-identity ....

Therefore, all patients with the syndrome of identity diffusion (but not with

identity crises) present the potential for developing experiences of empti-

ness.” The author hypothesizes that the experience of emptiness could be

different depending on the personality experiencing it, and he describes

the feeling of emptiness as it may occur in four personality types (depres-

sive, schizoid, narcissistic, and borderline), arguing that its form, intensity,

and etiology will differ for each type. While Kernberg interprets the expe-

rience largely in terms of object relations, Heinz Kohut (1977, p. 243) uses

the framework of “self psychology” to explain this experience: “The psy-

chology of the self is needed to explain the pathology of the fragmented self

and of the depleted self (empty depression, i.e., the world of unmirrored

ambitions, the world devoid of ideals).” He argues that the experience of

emptiness is a symptom of narcissistic personality disorders (NPDs). The self-

structure matures gradually in response to optimal failures in mirroring and

idealized ﬁgures. If the failures are sub-optimal, the self-structure becomes

friable and labile. One of the experiential outcroppings of this is the expe-

rience of emptiness, especially in the face of criticism or lack of warmth or

acclaim from the environment. Kohut argues that very often, in response to

early traumatic environmental failures, reactions develop, very often in the

way of a soothing mechanism, to cope with, and alleviate the pain of the

inner emptiness (Hazell, 2003). On occasion, a person will develop “a psy-

chic surface that is out of contact with an active nuclear self” (Kohut, 1977,

p. 49). This concept sounds extremely close to the concept of “false self

130 Fabrizio Didonna and Yolanda Rosillo Gonzalez

system” proposed by Winnicott (1965a,b) and developed by Laing (1969).

The false self is like a mask or set of clothes, donned to adapt to society but

cut off from the individual’s real self that lies hidden, even to the individu-

als themselves. This psychological state can lead to frequent experiences of

emptiness: When the person attempts to discover his or her “true feelings,”

he or she is so alienated from them through habit that he or she draws a

blank and feels empty (Hazell, 2003).

Among the symptomatic responses to the experience of emptiness, Kohut

cites the following: an excessive interest in words, pseudovitality, compul-

sive sexuality, addictions, and delinquency. Each of these is a reaction to the

inner experience of emptiness and is employed as a means of counteract-

ing the experience in some way. Kohut also posits that young adulthood and

middle age are the critical testing grounds for the cohesiveness of the sense

of self, and there are thus times when the individual is especially prone to

experiences of emptiness.

Subtle variants of these psychodynamic explanations for the experience of

emptiness, basically growing out of “object relations theory,” can be found

in a number of other works. Bowlby (1980) follows the thought of Winni-

cott in that he connects feeling of emptiness with the experience of loss.

“Numbness” and “emptiness” are, in Bowlby’s model, the ﬁrst phases of the

human being’s reaction to a loss. For Bowlby this loss is conﬁned to a loss

through death. He argues, however, that a small loss may act as a trigger for

a prior, more serious loss. Bowlby also offers a hint at an explanation for the

feeling of emptiness or numbness although he does not propose it as such.

He cites the disruption of habitual responses that occur to the person who

has recently experienced a loss. This, in turn, leads to a vague sense of dis-

orientation, much akin to the disorientation Bowlby mentions in his earlier

works on attachment and separation (Bowlby, 1980, p. 94).

Feelings of Emptiness and Essential Needs

Other valuable hypotheses have been suggested by Almaas (1987) and

Trobe-Krishnananda (1999). Almaas (1987), in the chapter called “The The-

ory of Holes,” describes how energetic holes develop inside when an essen-

tial need is not met as a child. A hole is a feeling of emptiness inside in

relation to some aspect of our being that was not nourished and therefore

not developed. According to Trobe-Krishnananda (1999), because it is fright-

ening and uncomfortable to feel these holes, we spend much of our time and

energy in our daily life unconsciously trying to ﬁll them. Much of our behav-

ior is directed at getting others to ﬁll them. There may be many reasons that

these holes exist; many of them can be difﬁcult to explain, but they are prob-

ably directly related to basic needs that remain unfulﬁlled. Although there is

really only one hole inside, the author makes distinctions to help with clarity.

Those of us who did not receive the support we needed to ﬁnd out who we

were may develop a support hole. When we did not get the recognition we

needed, we have a recognition hole.Wecanhaveaworthiness hole when

we feel that we are not good enough as a person or when we don’t feel spe-

cial or respected. In this latter case, we then hunger for someone to validate

us with the hope that the hole can be ﬁlled. We may develop holes related

to being perfectionists and self-critical or to having deep fears of survival; we

Chapter 8 Mindfulness and Feelings of Emptiness 131

may have holes connected to feeling unwanted and abandoned or to getting

warmth, touch, and closeness; in this case, we become dependent on some-

one to provide that for us. We may also have a hole related to trust when

we feel that opening up and being vulnerable exposes us to mistreatment,

control, or manipulation by another.

The intensity and effects of these holes and the degree to which they can

affect the development and life of an individual may depend on the partic-

ular way in which he or she is able to deal with this experience. In some

cases, these holes create a co-dependency in which individuals continually

push other people away while longing for closeness at the same time. Our

holes create deep anxiety and our life becomes a constant unconscious com-

pulsion to ﬁll them. Every hole creates a dependency on the outside in some

way, either by desiring another or a situation to ﬁll it or by avoiding a per-

son or situation because of the hole. Our holes have a powerful effect on

the type of people and situations we attract. We have a compulsion to cre-

ate situations that provoke our holes because that is often the only way we

become aware that they are there. This is the way that we can learn about

and develop what is missing inside. We need the challenge to grow (Trobe-

Krishnananda, 1999).

When we don’t have awareness or understanding of our holes and the way

they are affecting our lives, we naturally feel that something on the outside

has to change for us to be happy. This is one of the cardinal beliefs of what

the Trobe-Krishnananda has called “emotional child” – an inner experience

of self, derived from the childhood wounds and negative experiences full of

fear, shame, and mistrust and covered with compulsive behavior. For exam-

ple, people can ﬁnd themselves repeating the same painful patterns in their

relationships without understanding why; they can become lost in addictive

behavior, or they may have repetitive accidents or illnesses or sabotage their

life repeatedly (Trobe-Krishnananda, 1999). Because of the emptiness inside,

when individuals are identiﬁed with the emotional child,theyexperience

themselves as needy. It is not real, but it leads to their believing that life or

others have to ﬁll the hole. People have to start treating us better or give us

more recognition, love, space, attention, and so on. Another reaction is that

individuals try to ﬁll the holes with things that make them feel better such as

drugs, objects, or entertainment. It can be very difﬁcult to ﬁnd other ways to

end the discomfort, pain, anxiety, and fear that holes cause, without ﬁlling

them from the outside. People can realize that the efforts to ﬁll the holes

from the outside never work – it only creates deeper frustration. What does

work is beginning to understand our holes – what they are, where they come

from, and how we can ﬁll them. To do this, it could be helpful to have a look

at what the author calls “the essential needs”.

As a child, we each have essential needs (see also Bowlby, 1980). When

these needs are not met, we could live in a constant state of deprivation.

That deprivation is the hole inside, longing to be ﬁlled. While the degree

and types of deprivation vary, we all share a common experience of depri-

vation in some form. From our deprivation, we unconsciously project our

unmet needs onto our lovers, children, close friends, and those we work

with – in fact, on anyone with whom we relate. The closer the connection,

the deeper the projection. The experience of being deprived is universal,

and it is an important rite of passage. People usually start out in a state of

132 Fabrizio Didonna and Yolanda Rosillo Gonzalez

denial, in which they are not even aware that they were deprived of cer-

tain essential needs or how. Trobe-Krishnananda (1999) highlighted some of

individuals’ essential needs: the need to feel wanted and to feel special and

respected; the need to have our emotions, thoughts, and perceptions vali-

dated (see also Chapter 11 in this volume); the need to be encouraged to

discover and explore our unique aptitudes and turns, sexuality, resourceful-

ness, creativity, joy, silence, and solitude; the need to feel secure, protected,

and supported; the need to be physically touched with loving presence; the

need to be inspired and motivated to learn; the need to know that it is right

to make mistakes and to learn from them; the need to witness love and inti-

macy; the need to be encouraged and supported to separate; and the need to

be given ﬁrm and loving limits and boundaries. This list is where an individ-

ual’s deprivation comes from, and it is ever present. It is interesting to notice

that when one starts a relationship with another person, very often he or she

is unconsciously experiencing these unmet needs. When there is no aware-

ness, the individual automatically moves into one of ﬁve behavioral patterns

of the emotional child: reaction and control, expectation and entitlement,

compromise, addictiveness, or magical thinking (Trobe-Krishnananda, 1999).

For this author, the starting point for overcoming these holes, and feelings of

emptiness, is recognizing how automatically people try to ﬁll them from the

outside. This process of watching and understanding releases energy to break

the automatic behavior and just be with the experience of emptiness when

it is provoked. This means feeling it and letting it be there without trying to

ﬁx or change anything. Mindfulness, as we will see in the last part of this

chapter, can be the core strategy to developing this non-reactive attitude.

Mindfulness and Emptiness: The “Paradox” of Meditation

If you say you are somebody, you are attached to name and form,

so I will hit you thirty times.

If you say you are nobody, you are attached to emptiness,

so I will hit you thirty times.

What can you do?

Soen Sa Nim (Citated in J. Kabat-Zinn, Coming to Our Senses)

As we mentioned in the introductory paragraph, the aim of this chapter is

to theorize a possible clinical use of mindfulness to treat the pathological feel-

ing of emptiness. To be able to speak about the relationship between mind-

fulness and emptiness, it is essential to know how it is conceived within the

psychological and philosophical approaches and traditions that have given

origin to meditative practice.

The concept of emptiness in Eastern psychology and culture is totally unre-

lated to that of the West, especially considering the negative value that is

commonly ascribed to it in the West. An analysis of the classical texts of Tao-

ism or Chinese Buddhism is enough to conclude that the Christian-Western

concepts are basically opposite of those illustrated in Eastern thought.

The majority of Buddhist schools share a series of basic common prin-

ciples. What interests us is called Sunyata (Sanskrit), generally translated

into English as “emptiness” or “voidness.” This is a concept of central impor-

tance in the teaching of Buddha since a direct realization of Sunyata is a

Chapter 8 Mindfulness and Feelings of Emptiness 133

requirement for achieving liberation from the cycle of existence (samsara)

and full enlightenment. Widely misconceived as a doctrine of nihilism, the

teaching on the emptiness of people and phenomena is unique to Buddhism,

constituting an important metaphysical critique of theism with profound

implications for epistemology and phenomenology.

Sunyata means that everything one encounters in life is empty of abso-

lute identity, permanence, or “self.” This is because everything is interrelated

and mutually dependent – never wholly self-sufﬁcient or independent. All

things are in a state of constant ﬂux where energy and information are for-

ever ﬂowing throughout the natural world giving rise to themselves under-

going major transformations with the passage of time. This teaching never

connotes nihilism – nihilism is, in fact, a belief or point of view that Buddha

explicitly taught was incorrect – a delusion, just as the view of materialism, is

a delusion. In the English language, the word emptiness suggests the absence

of spiritual meaning or a personal feeling of alienation, but in Buddhism the

emptiness of phenomena enables liberation from the limitations of form in

the cycle of uncontrolled rebirth. Kabat-Zinn (2005, p. 180) explains the

concept:

People can get scared even hearing such a thing, and may think that it is

nihilistic. But it is not nihilistic at all; emptiness means empty of inherent self-

existence, in other words that nothing, no person, no business, no nation or

atom exists in and of itself as an enduring entity, isolated, absolute, indepen-

dent of everything else. Nothing! Everything emerges out of the complex play

of particular causes and conditions that are themselves always changing. This

is a tremendous insight into the nature of reality.”

Further he posits that “Emptiness is intimately related to fullness. Empti-

ness doesn’t mean a meaningless void [...]emptiness is fullness, [...]is the

invisible, intangible “space” within which discrete events can emerge and

unfold. No emptiness, no fullness.”

Rawson (1991) states that “One potent metaphor for the Void, often used

in Tibetan art, is the sky. As the sky is the emptiness that offers clouds to

our perception, so the Void is the ‘space’ in which objects appear to us in

response to our attachments and longings.” The Japanese use of the Chinese

character signifying Sunyata is also used to connote sky or air.

Sunyata is a key theme of the heart sutra (one of the Mahayana Perfec-

tion of Wisdom Sutras), which is commonly chanted by Mahayana Buddhists

worldwide. The heart sutra declares that the skandhas, which constitute

our mental and physical existence, are empty of any such nature or essence.

However, it also states that this emptiness is the same as form (which con-

notes fullness), that this is an emptiness which is at the same time not differ-

ent from the kind of reality which we normally ascribe to events, and that

it is not a nihilistic emptiness that undermines our world, but a “positive”

emptiness that deﬁnes it.

The inability to experience emptiness (Sunyata), considered as the true

nature of reality, would represent a sort of primordial ignorance of the human

being (avidya). When this happens, it is called nirvana (the awakening) in

Buddhism. This concept is a central part of all the Buddhist psychology, so

much so that the teachings of Buddhism on the nature of reality develop

in order to help understand this vacuity. Mark Medweth (2007) explains

134 Fabrizio Didonna and Yolanda Rosillo Gonzalez

this notion of emptiness in Buddhism: “Emptiness has been a term used

to describe many psychological states in the West, including the confusing

numbness of the psychotic, incomplete feelings of the personality disorders,

identity diffusion and existential meaninglessness (Epstein, 1989). Buddhists,

however, refer to emptiness as the ultimate reality. Emptiness assumes a

deﬁning role in the notion of ‘self’; it is the experience of emptiness that

destroys the idea of a continuous, independent individual nature. Unlike

many Western misconceptions, emptiness is not an end in itself nor is empti-

ness considered real in a concrete sense but merely a speciﬁc negative of

inherent existence (Epstein, 1988). While the ordinary consciousness per-

ceives things as permanent and independent, Buddhists would counter that

perceived phenomena are interdependent and thus empty of permanence

and without an identity based on their own assumed nature (Komito, 1984).

In relation to the sense-of-self, in Buddhism, emptiness does not imply (as

Westerners have often interpreted) the abandonment or annihilation of the

ego, ‘self,’ or ‘I’ but simply a recognition that this ‘self’ actually never existed

at all (Epstein, 1989). Buddhism is not an escape from the world but sim-

ply a refusal to extend or exaggerate the importance of conventional reality.

In so doing, the mind becomes empty of struggle, allowing us to see things

as they are in an ultimate sense. Thus, in Buddhist psychology, the empty

quality of the mind is regarded as the true nature of a person.” Therefore, a

translation of this mental and experiential state in Western terms is what we

called “mindemptiness”.

The Feeling of Emptiness as an Indicator

of Psychopathology

There are many psychological disorders in which the feeling of emptiness

generally presents itself as a transitory symptom (e.g., eating disorders,

obsessive compulsive disorders, PTSD, schizophrenia) or as a rather stable

phenomenological condition (personality disorders). Describing all these dis-

orders is beyond the scope of this chapter, so we will limit the following

discussion to pathologies where the feeling of emptiness often appears to be

a central and recurrent experience of the pathology.

Personality Disorders and Emptiness

All clinicians who have worked with personality disorders are familiar with

the relationship between this type of disorder and the experience, often

reported by patients during sessions, of the feeling of emptiness. The descrip-

tions, the hypothesized causes, and the consequences of experiencing these

sensations vary greatly even within the different disorders in Axis II (DSM-IV,

1994). We will now try to discuss what “emptiness” means when we come

across a patient with a speciﬁc personality disorder.

Borderline Personality Disorder

The main characteristics of BPD, as reported in the DSM-IV (APA, 2000), are

a pervasive instability condition of interpersonal relations, self-esteem, and

mood and a marked impulsiveness, with onset in early adult age and occur-

ring in several contexts. Among all the diagnostic criteria of the disorder,

Chapter 8 Mindfulness and Feelings of Emptiness 135

criterion 7 speciﬁes, “These individuals can be affected by chronic feelings

of emptiness. They are easily bored, they are continuously searching for

something to do.” This state, as well as anger, has been a speciﬁc charac-

teristic of this disorder since its ﬁrst formalized empirical descriptions (Fiore

& Semerari, 2003). Kernberg (1975), in his descriptive analysis, considers it a

minor criterion. Other important authors like Gunderson and Singer (1975)

or Spitzer (1975) consider this diagnostic criterion a discriminating feature

of this disorder.

As previously pointed out, several authors in the ﬁeld of cognitive-

behavioral therapy think that the experience of emptiness in BPD can be

a sort of dysfunctional avoidance strategy in situations of clear subjective suf-

fering and associated with a major risk of abuse or injuries to self and others

(Beck, Freeman et al., 1990; Linehan, 1993; Young, 1987). According to Fiore

and Semerari (2003), the perception, in this type of patient, of the “unwor-

thy self” and the “vulnerable self” can expose them to intolerable pressure.

At times, patients succeed in escaping this pressure, detaching themselves

from everybody and everything and entering into a state of numbness. This

is the condition where frequent suicide attempts and self-injuries occur more

frequently, representing a state of complete detachment from the world or a

way to evoke such detachment. Other times, according to these authors, the

emptiness can be perceived as “a painful sense of lack of purpose.” In these

cases, patients tend to react by raising their level of arousal, for example,

seeking promiscuous sexual relationships, dangerous acting out, and alcohol

or substance abuse to the point of no return or bulimic crises.

From a psychodynamic perspective, Pazzagli and Monti (2000) for research

purposes consider that two of the criteria listed in the DSM-IV for BPD diag-

nosis, chronic feelings of emptiness and efforts to avoid abandonment, can

be appropriately grouped together in the concepts of “solitude and empti-

ness.” According to the authors, the borderline person functions via osmosis:

He is empty but, at the same time, intolerant of a solitude in which he keeps

looking for objects to ﬁll this inner sense of emptiness. The solitude of the

BPD patient is actually an intolerance of true solitude, the solitude of being

able to be alone. It is a solitude dominated by emptiness: a void in the outside

world, made up of inadequate objects, sporadic, stormy, and superﬁcial rela-

tionships prone to sudden break-ups, and a void in the inner world, always

subject to the threat of rupturing and the loss of limits.

In a research study conducted by Rogers, Widiger, and Krupp (1995) aimed

at identifying the qualitative differences of depression diagnosed in patients

with BPD and others, the most frequent aspects associated with depression

were found to be self-condemnation, emptiness, abandonment fears, self-

destructiveness, and hopelessness. The authors conclude that the depression

associated with borderline pathology is unique in certain aspects. The impli-

cations of the study outline the importance of considering the phenomeno-

logical aspects of depression, among which is the experience of emptiness,

in the BPD. Leichsenring (2004) reports the following in another study: “Clin-

ical observations suggest that depressive experiences in patients with bor-

derline personality disorder have a speciﬁc quality. These experiences are

characterized by emptiness and anger (‘angry depression’).” In this study,

this observation was tested empirically. Westen et al. (1992) found an inter-

personally focused “borderline depression” that was phenomenologically

136 Fabrizio Didonna and Yolanda Rosillo Gonzalez

characterized by emptiness, loneliness, despair, and an unstable negative

affectivity. The quality of the depression may also have consequences for

pharmacotherapy (Westen et al., 1992, p. 391). The qualitative experience

of depression (e.g., emptiness or anger) may inﬂuence a patient’s reaction to

drugs more strongly than the diagnosis (depression).

Narcissistic Personality Disorder

The essential characteristic of NPD is a pervasive picture of grandiosity,

necessity of admiration, and lack of empathy, with onset in early adult age

and present in a variety of contexts (DSM-IV, APA, 2000). On the whole, we

can say that the authors studying the disorder can be divided into those who

describe some subtypes (Gabbard, 1989; Millon, 1999) and those who lean

more to a Horowitz-type interpretation assuming that a subject experiences

a set of multiple distinct mental states. These authors observe how the nar-

cissists oscillate between states of grandiosity, emptiness, shame, anguished

depression, and dysregulated affect with acting-out tendencies (Horowitz,

1989; Young & Flanagan, 1998; Dimaggio et al., 2002). A substantial agree-

ment exists between the various authors: It is most probable that the narcis-

sist experiences on the whole mental states described in the literature and

that the diagnosed subtype is characterized by the most important and mani-

fest of mental states. Dimaggio et al. (2002) have identiﬁed in their work four

mental states: grandiosity, transition, frightening depression, and devitalized

emptiness. In this state of devitalized emptiness, the emotional experience

is completely shut down; not only are feelings of weakness and fragility “sco-

tomized” (obscured, clouded), but also feelings overall are. Subjects feel cold,

detached, distanced from others and from their own inner experience, and

they perceive an almost unreal world; their body is annoyingly far away and

they are anhedonic. The experience is not at all intensely unpleasant; for

a long time narcissists dwell in this state where they are untouchable, not

subject to self-esteem ﬂuctuations and to the complex, annoying, and incom-

prehensible demands of others.

The fantasy of success and almightiness can ﬁll up mental life even

though these subjects lack the triumphant echoes overwhelming the state

of grandiosity. The aims are mostly inactive. This state largely coincides

with the clinical descriptions of Modell (1984), which describes patients

as being closed up as if in a “cocoon.” In the long run, this state becomes

ego-dystonic: The subject perceives life as empty and boring, the emotional

coldness touches him, and his need for relationships surfaces unconfessed

(Dimaggio, Petrilli, Fiore, & Mancioppi, 2003).

The sense of emptiness as an important and distinctive experience in NPD

has been indicated by a large number of authors. Forman (1975) made a

summary of the characteristics that emerge from the descriptions of Kohut

(1971). The most important are low self-esteem, a tendency to have hypocon-

driac episodes, and a feeling of emptiness or a deﬁciency of vital force.

Millon (1996) gives us the following description of the narcissistic prototype

at a biopsychological level in clinical settings: “the narcissistic personality

presents a general indifference, unﬂappability, and fake tranquility...except

when his narcissistic conﬁdence is threatened, where brief demonstrations

of anger, shame or feelings of emptiness appear.” Millon identiﬁes rational-

ization as a mechanism of defense in NPD; if the rationalization fails, these

Chapter 8 Mindfulness and Feelings of Emptiness 137

individuals often feel rejected and embarrassed, and experience feelings of

emptiness. Kernberg (1975) explains how the experience of emptiness in

narcissists is characterized by the addition of strong feelings of boredom

and restlessness: “Patients with depressive personality and even schizoid

patients, are able to empathize deeply with human feelings and experiences

involving other people, and may feel painfully excluded from and yet able to

empathize with love and emotion involving others...patients with narcissis-

tic personalities, on the other hand, do not have that capacity for empathiz-

ing with human experience in depth. Their social life, which gives them

opportunities to obtain conﬁrmation in reality or fantasy of their needs to be

admired, and offers them direct instinctual gratiﬁcations, may provide them

with an immediate sense of meaningfulness, but this is temporary. When

such gratiﬁcations are not forthcoming, their sense of emptiness, restless-

ness and boredom take over. Now their world becomes a prison from which

only new excitement, admiration, or experiences implying control, triumph

or incorporation of supplies, are an escape. Deep emotional reactions to art,

the investment in value systems or in creativity beyond gratiﬁcation of their

narcissistic aims, is often unavailable and indeed strange to them” (1975,

p. 218)

Schizoid Personality Disorder

The essential characteristics of schizoid personality disorder are a pervasive

condition of detachment from social relations and a restricted range of emo-

tional experiences and expressions in interpersonal contexts. The onset of

this condition is in early adult age, and it is present in a variety of contexts

(DSM-IV, APA, 2000).

Kernberg (1975), as previously indicated, thinks that the experience of

emptiness varies in form, intensity, and etiology in relation to the type of

personality disorder affecting the patient. Even in schizoid disorders, spe-

ciﬁc characteristics of emptiness are obviously present. According to the

author, these individuals can experience the emptiness as an inborn qual-

ity that makes them different from others: “in contrast to others, they cannot

feel anything and they may feel guilty because they do not have feelings

of love, hatred, tenderness, longing or mourning which they observe and

understand in other people, but feel they cannot count on to experience

themselves” (1975, p. 215). For these schizoid patients, the experience of

emptiness can be less painful than for the depressed because the contrast

between the periods when they feel empty and those when they would like

to have emotional relations with others is less violent. A feeling of inner ﬂuc-

tuation, of subjective unreality, and the appeasement derived from this same

unreality make the vacuous experience more acceptable to schizoids, allow-

ing them to ﬁll in time with the awareness of external reality opposed to

their subjective experience.

Depression and Emptiness

Many people who come to therapy complain about having a senseless life.

Their words express the idea of deep and anguishing “emptiness” leading

them to wish for death as a liberation from this state. These patients often suf-

fer from depression, and what has been described is only the manifestation

138 Fabrizio Didonna and Yolanda Rosillo Gonzalez

of one of the many emotional, cognitive, and physical symptoms marking the

disease.

Maureta Reyes (2007) deﬁnes this existential emptiness as:

the feeling of a lack of a sense in life, of tediousness, of not knowing the reason

for living, leading to isolation and impoverishment of the relation with family

and society [...]patients with this problem, usually experience moments of

strong tension and anxiety attacks without a valid reason, they worry about

everything, but nothing seriously, they have lost the motivation and interest for

everything and this makes them think that living is the worst thing that can

happen to them. When this situation is prolonged, becoming more intense, it

can lead to suicide.

This type of experience, described as such, appears more frequently in

certain periods of life, for example, during old age, retirement, or the course

of a terminal illness, or in the so-called empty-nest syndrome when adult

children abandon the family home. In the latter case, women, seeing their

role as mothers ending – their children having little need for them and their

husbandsbusyatwork,spendinglittletimewiththem–aremoreprone

to feeling depressive symptoms and a sense of emptiness. Old age, though,

is surely a period where this type of feeling of emptiness becomes more

present. Faced with fears associated with becoming old, such as isolation,

solitude, physical decline, no longer being desired, uselessness, the loss of

every role in society or in the family, and illness, it is easy to imagine how

the lack of one’s own sense of life leads to experiencing emptiness.

The feeling of emptiness in depression is often associated with signiﬁcant

experiences of loss (see also Bowlby, 1980), above all in conjunction with a

ﬁrst depressive episode (see also Chapter 12). In some cases, the feeling of

emptiness is connected not only to what is no longer there, but also to what

will no longer be there in the future.

In the following case example, a 41-year-old depressed patient describes

her deep sense of emptiness derived from the loss of her 15-year-old son who

died tragically in a car accident:

I would never have thought that, from one day to another, life could

change so violently and destructively. With N’s death, I ﬁnd myself having

to reinvent everything, ﬁghting against this harsh reality, with all its emo-

tions and feelings. It is unthinkable that he is no longer here with me and

that he has left this immense emptiness just in this moment: a life yet to

start, come to a sudden end by such an unfair destiny.

The pain is so great that with its presence, it is actually physical every

time I think of the things N. liked and loved to spend his time on, his

determination and will to live. It’s like suddenly opening a door without

expecting to ﬁnd someone there: an icy wave, a shock which rises up from

my feet and leaves me momentarily incredulous that all this belongs to

me. A great weakness is left behind and a loss of feeling pervades my

arms and hands. I get a tingling which becomes all one with a pain in

my stomach as if it were knotted. These are very hard moments that make

me realize that I’ll never have him near me again. This great emptiness

that I perceive projects itself not so much in my past memories which are

alive, but based on the fact that I will never experience some situations or

Chapter 8 Mindfulness and Feelings of Emptiness 139

share them with him. There is only emptiness when I think I’ll never be

able to listen to his secrets, there won’t be any requests of advice, I won’t

be able to see him growing up, becoming a man. I won’t be able to get

excited about his ﬁrst love, a disappointment, a defeat or a victory. There

will only be the lack of a relationship based on participation, bonding,

joining of forces that was just starting and I was really waiting for. Why

has all this been denied me? Everything has become null and void when I

think of all that has been left suspended: it’s like an abnormal condition

in my life that I don’t know how long will last. It’s as if, while I’m watching

a TV programme, this suddenly changes and I’m left here waiting in vain

foreverythingtogobacktonormal,tothepreviousprogramme.

In this patient, like in other individuals suffering from major depression,

the deep and overwhelming feeling of emptiness was determined on the one

hand by what was no longer in her life, but on the other hand by the loss of

what there would not be in the future and that never more will be, that is,

the ineluctable interruption of a plan, a loss in the future.

How Mindfulness Can Help to Deal with and Overcome

the Feeling of Emptiness

There is nothing greater than anything else

Plutarco, Adversus Colotem

Mindfulness as an Anti-avoidance Strategy

If we hypothesize the feeling of emptiness as a sort of emotional avoidance

of a phobic stimulus situation (negative emotion), it is then right to think

that the treatment should include the exposure to the stimulus provoking

fear in the absence of the feared consequences. During this exposure, the

patient is asked to pay attention to the stimuli that he or she usually system-

atically avoids in a controlled way, showing him or her with the same stimuli

(imaginatively or in vivo), thereby hampering avoidance so that the patient

can experience the harmlessness of the stimulus.

It is assumed that exposure causes habituation to the stimulus or a process

of extinction of the avoided reactions, favoring the emotional coping, that is,

preparing the subject to face the emotions resulting from feared situations.

Baer (2003) afﬁrms that among the mechanisms explaining the clinical effec-

tiveness of mindfulness, one of the most important is experimenting through

exercises a form of “exposure” to various types of information (extere-

oceptive and interoceptive) that are usually avoided and/or suppressed.

Kabat-Zinn (1982) used mindfulness on patients affected by chronic pain.

The author has stated that guiding patients to develop a non-judgmental atti-

tude with respect to their own feelings of pain, and helping them to curi-

ously observe them without reacting impatiently or intolerantly, resulted in

a signiﬁcant reduction in suffering, not related to the sensory perception of

pain but to their own emotional reactivity (aversion) toward the perceived

feelings. This can be considered an extended exposure associated with an

140 Fabrizio Didonna and Yolanda Rosillo Gonzalez

attitude of acceptance of physical pain. The result would be an increase in

tolerance toward the suffering and a reduction in the reactive emotionality.

Linehan (1993) starts from the theoretical assumption that BPD emotional

distress is mainly derived from secondary responses (e.g., deep shame, anx-

iety,anger,orguilt)totheprimaryemotionsthatoften,instead,would

be adaptive and context appropriate. A reduction in this secondary stress

requires exposure to primary emotions in non-judgmental circumstances.

In a similar context, awareness and non-judgmental attention toward one’s

own emotional responses can be considered a technical exposure. The basic

concept is that exposure to intense or painful emotions, without associating

negative consequences, will extinguish their ability to stimulate negative sec-

ondary affects. If a patient judges negative emotions as “bad” or “wrong,” it

is obvious that every time he or she experiences them, he or she will have

feelings of guilt, anger, and/or anxiety. Adding these feelings to an already

negative situation will only increase the patient’s distress and will only make

it more difﬁcult to put up with the anguish. Mindfulness is the ability to

ensure or the set of skills capable of ensuring that the patient enacts this

form of perception, taking advantage of all the assumptions needed for it to

be effective. During the practice of mindfulness, we can keep frequency and

duration of the exposure under control. The exercises can be guided so that

they will be clearly speciﬁed and last long enough. Intensity can also be man-

aged by leading patients to set their non-judgmental attention and awareness

on elements outside themselves and far from anxiety-producing stimuli: As

they progress in the process, they bring themselves closer to their physical

sensations, thoughts and, lastly, to their negative emotions. The validating

environment, during mindfulness training, accepts any experience originat-

ing from practice, informing patients that accepting reality does not neces-

sarily mean approving it.

Exposure is probably not the only active factor in the process of mind-

fulness clinical effectiveness that could refer to the experience of empti-

ness. The mechanisms implementing these effects are in our opinion closely

related to the development and initiation of meta-cognitive processes regard-

ing the aforementioned experience.

Detachment and Decentering

One of the more important processes in the state of mindfulness is detach-

ment (detached mindfulness; Wells, 1997, 2000, 2006; see also Chapters 5

and 11). According to the author, this attitude would be characterized by

meta-awareness (a form of objective conscience of thoughts), cognitive

decentering (acquired consciousness that thoughts are just thoughts, not

facts), attentive ﬂexibility (self-regulation of attention including both sus-

tained attention and skills in switching, and meta-attention; see also next

paragraph and Chapter 11 of this volume), low levels of conceptual process-

ing (low levels of inner dialogue), and a low level of coping behaviors aimed

at the avoidance or reduction of the threat. This is the equivalent of afﬁrming

that the patient becomes aware of his or her feelings mainly due to the ability

to observe them, implementing a decentering from them, and developing a

better understanding of his or her own cognitive functioning.

Chapter 8 Mindfulness and Feelings of Emptiness 141

Self-Regulation of Attention

Bishop et al. (2004) consider self-regulation of attention to be central among

the main cognitive processes that lead to mindfulness (see also Chapters 5

and 11 of this volume). Wallance and Shapiro (2006) also say that there are

two types of attentive ability: One deals with the ability to continuously

support voluntary attention on a familiar object without forgetfulnesses or

distractions; the other, called “meta-attention,” refers to the ability to moni-

tor the quality of the attention, quickly recognizing if he or she has yielded

to sluggishness or excitement. The concept of self-regulation of attention

would then include three sub-functions: the ability to shift attention from

one content to another, the ability to stay focused on a single object, and

the meta-attentive ability leading to recognizing the moments where the

attention has shifted toward other mental objects. In the process of dynam-

ics, the self-regulation of attention constantly interacts with two other fac-

tors: the unconditioned openness of behavior toward the tried experience

(acceptance equanimity) and the continual consideration given to the func-

tional objectives of the momentary task (intention). The self-regulation of

attention becomes extremely useful in helping subjects to focus on the

components of the experience of emptiness, overcoming the difﬁculties

that are often present in deciphering their own emotional and cognitive

state.

Acceptance

Acceptance, another basic component of the state of mindfulness, has an

essential role in allowing the patient to stay in touch with his or her own

experience of emptiness, thus allowing the exposure to painful stimuli,

whichever they are. Acceptance allows the patient, in a state of psychological

openness and willingness, and through a gentle curiosity to approach various

sources of aversive stimulation that has till that moment caused the person

behavioral patterns of escape, refusal, or avoidance. For Hayes (1994), accep-

tance is a position relative to which previously intrinsically problematic or

painful events become an opportunity of personal growth and development.

Donaldson (2003) and Wells (2002) consider it a meta-cognitive process

operating at a higher level than that of immediate experience, a “meta”

level implying the direct perception of thoughts, feelings, or intentions of

purpose.

Accepting is receiving, welcoming the experience of the moment, stay-

ing fully in touch with one’s own thoughts, emotions and physical feelings,

without reacting to and developing a decentered ability to observe them.

Acceptance gives us the possibility to see our experience in the moment as

it really is. However, accepting does not actually mean appreciating what

we accept. The experience of emptiness could for a certain period of time

be admitted and accepted. This would give the patient the opportunity

to observe the consequences of this contact without negatively labeling it

through judgment.

In a state of acceptance, the person recognizes that some aspects of the

experience cannot be changed while he succeeds in realizing the elements

that can. The patient will, therefore, channel his or her energies toward these

142 Fabrizio Didonna and Yolanda Rosillo Gonzalez

latter ones, trying to respond, where possible, through a thoughtful action,

rather than reacting (with automatic and impulsive actions) to the distressing

experience in order to reduce, and often cancel out, the aversive psycholog-

ical component of the experience. All the signs that accompany the experi-

ence of emptiness are usually submitted to meta-evaluation (a meta-cognitive

process) by the subject; that is, they are affected by a negative meaning con-

sidered highly disagreeable or unbearable, leading the individual to various

attempts of suppression or avoidance. Unconditioned acceptance would be a

different way to relate to the experience that would reduce cognitive avoid-

ance, thereby eliminating one of the factors responsible for the suffering

(Didonna, 2007).

Letting Go

Letting go is the ability directly connected to acceptance that can fail to be

immediately experienced when the patient comes into contact with certain

disagreeable thoughts or feelings. Kabat-Zinn (1990) states that in the prac-

tice of meditation, we deliberately put aside that part of the mind clinging

to certain aspects of our experience and reject others. The non-attachment,

the letting go, is a form of acceptance of the things as they are. This ability

allows patients to give the same attention to all stimuli, regardless of his or

her need to hold on to or distance him/herself from those aspects of the

experience of emptiness that cause suffering, or “entrapping” them in a cer-

tain mental state.

Not Striving

Not striving is the attitude where the patient does not pursue any precise aim

during the practice of mindfulness. There is nothing that he or she should or

should not do. Nothing has to be reached. It is enough “to be” and to remain

in the present, bringing his or her own attention to himself/herself. We need

to ask patients not to want to attain any changes or expect to modify their

own experience of emptiness. The only thing they are to do is to remain

there and observe. The change, if it happens, will paradoxically be the result

of not having sought it out.

Identifying the Precocious Signs of Emptiness

Another important mechanism of change of mindfulness for the experience

of emptiness could be the precious aid given to the ability to identify the

feelings, thoughts, or situations leading to the feeling of emptiness early.

Mindfulness allows patients to gather these signs, which differ depending

on each patient’s own experience, from the onset, helping to identify the

suitable moment in order to use appropriate coping strategies and not to

remain “entrapped” in the emptiness that leads to having to resort to dys-

functional solutions. Baer (2003) suggests that mindfulness training may pro-

mote recognition of early signs of a problem, at a time when application of

previously learned skills will be most likely to be effective in preventing the

problem.

Chapter 8 Mindfulness and Feelings of Emptiness 143

Clinical Application of Mindfulness to the Experience

of Emptiness

Practical Issues

A mindfulness-based intervention with patients affected from a pathological

“feeling of emptiness” should be carried out by an expert therapist in the

practice of meditation. In addition, the therapist should have good clinical

competence with respect to all the psychological problems of the patient

toward which the intervention is directed. The therapist should be ready

to effectively deal with the eventual intense reactions that could be activated

during the sessions, including dissociative crises and intense states of anxiety

or escape.

Many patients who feel emptiness have a long history in invalidating envi-

ronments where their emotions, feelings, and needs have been denied recur-

rently, and the only remaining inner criteria is the one labeling their own

inner experience of the moment as unreliable or dangerous. It is therefore

useful and important to help the patient trust and believe what he or she

is feeling, in his or her own cognitive, emotional, and sensory experience,

learning to listen to herself/himself. Furthermore, a regular practice of mind-

fulness by the patient outside of the therapeutic setting is necessary. It is vital

that he/she has the possibility to ﬁnd a small amount of time to dedicate to

meditative practice every day (even 10–15 minutes). This intervention could

be integrated in a structured mindfulness-based program (e.g., MBSR, MBCT)

or form a speciﬁc independent intervention that could be implemented in

an individual or group setting.

The ﬁnal goal of this training is to lead the patient to explore and confront

his or her own emotions, mainly anxiety, which, as we have hypothesized

above, appears to be strictly related to the emptiness experienced in certain

types of disorders. As suggested by Trobe-Krishnananda (1996), the objec-

tive is to penetrate the fear in depth, but with awareness, compassion, and

understanding, giving value to these feelings and creating an inner space to

allow patients to feel, observe, and accept.

Venturing into this layer of vulnerability is not an easy task for the

patient affected by feelings of pathological emptiness. As we have previously

explained, these people are used to activating a set of avoidance strategies

and mechanisms in order not to feel the suffering. This “shell” keeps psy-

chological fear and pain away, even at the cost of developing alexithymia or

turning psychological suffering into a physical one, sometimes putting the

patient’s life at risk.

In our opinion, approaching the emotional sphere should take place in a

gradual way, with the utmost caution. The activation of emotions at a neu-

rovegetative level is often undifferentiated and can be the same for different

emotions. Any element of this activation can lead the patient back to a state

of emptiness, given the strong evocative potential for emotions associated

thereto. Every session, in such a structured intervention, should include a

gradual increase in the level of difﬁculty, that is, taking the patient a little

closer to the stimuli, situations, and feelings connected to emptiness. Every-

thing has to take place in a completely acceptable and non-judgmental frame-

work. In order to do this, we suggest starting the intervention by teaching

144 Fabrizio Didonna and Yolanda Rosillo Gonzalez

patients to initially focus attention on exteroceptive stimuli, which are usu-

ally less anxiety inducing, doing exercises like mindful seeing or hearing, or

mindful walking (see Appendix A). Only at a later stage, during the course

of the program, are they conscientiously drawn closer to their inner feel-

ings and, therefore, to the enteroceptive experiences; some exercises such

as body scan or sitting meditation (see Appendix A) would be suitable for

this purpose (Didonna, 2007, paper submitted for publication).

Once these abilities have been consolidated, for example, “letting go,” not

passing judgment on their own experience, or “trusting” their own percep-

tions (see also Chapter 11), patients should be in a position to be in contact

with thoughts, feelings, and negative mindsets without enacting avoidance

behaviors. Moreover, during the course of the treatment, patients have the

opportunity to observe their own state of emptiness, to become aware of

its components, and above all, to perceive how secondary emotions and the

increase in emotional reactivity in those situations have decreased, reducing

the level of suffering of this experience. The patient should no longer judge

or blame himself/herself for feeling what he or she feels.

Staying in Touch with the Feeling of Emptiness

At a certain point in the therapeutic program, the patient should directly

face the experience of emptiness. Speciﬁc exercises can be developed to

help the patient to voluntarily enter into such a state. The fear of feeling pain

can keep patients distanced from their own feelings. A particular atmosphere

of acceptance, presenting them with a gentle invitation to get in touch with

what they fear, is required. There must be no pressure or judgment. In order

to recreate this state, it might be sufﬁcient to ask patients to remember the

last time they felt this way, or the time when the feeling was so strong that

they did something particular in order not to feel it. Being “with themselves”

in those moments was not a pleasant feeling.

These experiences can be explored with the guidance of the therapist,

helping patients to focus their attention on certain aspects in order not to

let themselves go, thereby avoiding passing judgment on themselves. The

most important thing is to learn to recognize what is happening, intimately

bonding with what was previously avoided. The instructions could invite the

patient to focus their own attention on those aspects, for example, allow-

ing them to remain inside their experience, preventing the activation of the

escape behavior, or observing how the sense of threat is perceived, or simply

examining when and which type of impulses occur during the session. This

could help, in some cases, to identify even the nature of their own fear con-

nected with the feeling of emptiness (abandonment, failure, violence, judg-

ment, and the thought that the fear will never end) more easily recognized

observing the contents of thoughts in this state.

It is natural for these patients to fear being overwhelmed by the feeling of

emptiness they encounter. The idea of being in contact and remaining with

the feeling is terrifying. For this reason, the method used needs to be well

consolidated, offering a “safe base” made up of previously acquired experi-

ences and abilities, which are needed to deal with stimuli with greater aver-

sive potential. The approach has to happen gradually, with the maximum

sensitivity and without haste, but with the knowledge that with mindfulness

Chapter 8 Mindfulness and Feelings of Emptiness 145

meditation, the individual needs to go through the feeling of emptiness if he

or she wants to be free.

Some possible instructions that can be used in order to allow patients to

better understand and stay in touch with the feeling of emptiness, in a mind-

ful way, are the following (adapted from Trobe-Krishnananda, 1999):

1. Look over your childhood essential needs. Ask yourself: “Do I have a hole

related to this need?”

2. Then focusing on this particular hole, ask yourself: “How does this hole

affect the way I relate to myself?” and “How does this hole affect the way

I relate to people and life?”

3. Staying with this hole, ask yourself: “How do I feel this hole inside?” and

“Which sensations do I feel right now and where in the body?” Allow

yourself to notice your feelings in this moment and realize how they are,

however, different from you, they aren’t you...breathe with them. Try to

observe them, without judging them, carrying a sense of gentle curiosity

toward that experience. You can approach or recede from these feelings,

and ﬁnally try to let them go.

4. Explore your needs: “What thoughts and feelings arise when you con-

sider your needs?” (e.g., “I am weak or needy if I want this” or “I don’ t

feel I have the right to want or need this”). Let’s grant them the possibility

and the necessary time to cross our mind ...; “We accept and are com-

passionate toward these thoughts, realizing that when they were formed,

they certainly made sense and had a function even though we have now

lost them...let’s try to think how much they need us to exist, without

us they don’t have strength or meaning...let’s allow ourselves to observe

and understand them without judging ...”; “Let’s give ourselves permis-

sion to immerse ourselves in our inner experience even though it hurts

and causes pain, breathing together, crossing it and letting it envelop us in

order to reemerge at a certain point...let’s try to observe what happens,

what changes...trusting our experience.”

rWe may also ask the patient to write down, if possible, what beliefs he or

she holds inside about having or expressing these needs.

rAnd eventually may ask: “What were you taught as a child about having

and expressing your needs?” (e.g., “It is selﬁsh to have needs and wants”

and “Men should not have needs and wants”). “Be kind and do not judge

yourself and your own thoughts. There is nothing that you need to do

or not do in this moment. Just stay with yourself and your breath now,

moment by moment ...”.

What Can the Instructor Do

rConsider that sense of pathological emptiness is only the manifes-

tation of a wider range of psychological difﬁculties of the patient.

According to Teasdale (2004), it is necessary to keep in mind the speci-

ﬁcity of emotional disorders examined as well as some speciﬁc interven-

tions likely to help the patient in the effort to modify the processes (apart

from the contents) of his or her own modes of mind. Mindfulness must be

used in an overall therapeutic strategy within a framework of clear under-

standing of the emotional problems of the patient.

146 Fabrizio Didonna and Yolanda Rosillo Gonzalez

rShare with the patient a new conceptualization/formulation of his

problem, helping him or her to formulate an alternative vision of the

feeling of emptiness through a cognitive-behavioral model of understand-

ing the functioning of his or her problem. Some mindfulness-based train-

ing, like MBSR, MBCT, or ACT, use homework (ABC, self-monitoring form,

diary, etc.) as a vehicle for explaining the various cognitive processes at

the basis of the disorder and of their functioning modes when they occur.

rWelcome the difﬁculties of the method reported by patients from

the onset. We need to use the difﬁculties from the beginning as an oppor-

tunity to teach new attitudes for facing the problems. Relating to the dif-

ﬁculties with curiosity and interest, trying to accept them rather than

reject them, deﬁnes the bases for a mindfulness approach to thoughts

and negative emotions, especially those deriving from experiences of

emptiness.

rShare one’s own experience during the meditative practice, invit-

ing patients to do the same. Segal, Willians, and Teasdale (2002, p. 55)

talk about the approach and attitude of the instructors observed in the

MBSR mindfulness program: “the stance of the instructor was itself ‘invi-

tational’. In addition, there was always the assumption of ‘continuity’

between the experience of instructor and the participants ( ...)”. The

assumption was simple: Different minds work in a similar way, and there

is no reason to discriminate between the mind of the person asking for

help and of the person offering it.

Conti and Semerari (2003) describe sharing in a therapeutic context

as a set of explicit interventions where it is stressed that some aspects

of the patient’s experience are shared or shareable by the therapist him-

self/herself. Sharing interventions include elements of both validation and

self-disclosure. With this technique, in fact, the therapist implicitly vali-

dates the patients’ experience through the acceptance and recognition of

the shared dimension and, in so doing, reveals one’s own mental state.

However, this does in no way imply that the patients should feel forced

to report their own experience. It must be clear that it is a free choice

that does not affect the practice. It is enough to be present and to listen

in order to take part in this intervention.

rEliminate any type of judgment during the practice or the sharing,

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.

rCommunicate 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

rRefrain 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.

rValidate 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

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

well as at-risk situations;

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

thoughts, physical feelings, emotional states and impulses, acquiring

awareness;

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

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

rbecome able to remain in that state without exasperating it by activating

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

raccept 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;

rlower the intensity of suffering experienced in the feeling of emptiness

and its frequency;

rsucceed 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

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Une analyse qualitative du sentiment chronique de vide

Article

Nov 2018

Objective: The chronic feeling of emptiness is an affective disturbance experienced by patients suffering from borderline personality disorder, and is poorly described in the literature. It is often assimilated to other feelings like boredom, hopelessness, helplessness, or aloneness. It is difficult to describe and to assess. It is, however, a persistent symptom of borderline personality disorder. Thus, the objective of this qualitative study is to provide a detailed description of chronic emptiness. Method: We carried out a thematic analysis of the descriptions of the chronic feeling of emptiness given by 37 patients clinically diagnosed with borderline personality disorder (including 33 women), mean age of 33.8 ± 10.5 years. The data were collected during a diagnostic interview. All participants also had at least one comorbid psychiatric disorder; especially depression or anxiety was highly prevalent in our sample. Results: Emptiness was described by means of 13 categories. Five categories referring to the theme of absence (of content, of feeling, of finality, of loss, and death), three categories related to the content of emptiness (negative affect, fear, and bodily sensations) and five categories evoking experiences closely associated with the feeling of emptiness (aloneness, confusion, autopilot mode, distancing, and physical descriptions). The most frequently used categories to describe the emptiness feeling were the absence of finality, death, the absence of feeling and the absence of content. Conclusions: We discussed and confronted our categories to the existing literature on chronic emptiness in patients suffering from borderline personality disorder. Absence seems to represent the essence of this experience, with several nuances evoking a multidimensional concept. The frequent occurrence of descriptions of death by patients is evocative of a close relation between chronic emptiness and suicide. The emptiness feeling may also include a particular feeling, composed of negative affect (the most reported one in our study was fear), and bodily sensations. Aloneness was described as a kind of intolerance of being alone and the description of confusion could vary along a continuum; from confused feelings to an altered self-image. Finally, some experiences closely associated with emptiness such as autopilot and distancing could appear to be protective. Surprisingly, boredom was not reported by our sample of patients. The categories revealed in this thematic analysis are mirrored in the literature. It is however important to remind the strong comorbidity of borderline personality disorder in our sample with comorbid psychiatric disorders, especially unipolar mood disorders. And, it is likely that the feeling of emptiness might also be dependent on the psychological context in which it occurs. It is however not possible to disentangle the subjective feeling of emptiness of borderline personality disorder from that of depressive mood. Moreover, emptiness being a vague and an evolving feeling, this transversal study does not allow marking out its contours. Actually, many descriptions may seem similar to clinical concepts such as; anhedonia, avolition, apathy or dissociation. Another limitation of this study is that our analysis is predominantly based on a feminine sample and our results cannot be generalized to men. Finally, we based our analysis on the spontaneous responses of participants asked to describe their experience of emptiness; we did not deepen the questioning in order to not influence the answers’ content; however, this strategy may have limited the richness of the descriptions. Nevertheless, this study is a first qualitative analysis of emptiness in French language and it allows a better understanding of this diagnostic criterion, which is often not well assessed and explained.

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Jan 2018

Celia Mareca

Los cuidadores informales de las personas afectas de demencia, trastorno mental grave o daño cerebral adquirido presentan un elevado nivel de sobrecarga, alto estrés percibido y mayor sintomatología ansioso-depresiva en comparación con la población general. Así mismo, esta situación puede tener efectos sobre los pacientes a los que cuidan. En los últimos años ha aumentado el interés en la atención de estos cuidadores, y su implicación en el programa de rehabi-litación de los pacientes se ha puesto de manifiesto en las guías de práctica clínica de estos trastornos. Por otro lado, las inter-venciones basadas en Mindfulness están en el foco de atención de muchas instituciones, ya que la evidencia muestra beneficios en la esfera emocional, cognitiva y conductual de diferentes patologías. En el siguiente artículo se revisa el estado de la cuestión en relación a las intervenciones con familiares en general, las intervenciones basadas en Mindfulness aplicadas a cuidadores en particular y los posibles mecanismos de cambio que podrían avalar la pertinencia de su apli-cación en esta población. Se revisan para finalizar algunas de las ventajas de estas intervenciones, así como posibles barreras que deben tenerse en cuenta a la hora de su implementación.

Using a Mindfulness-Based Intervention to Promote Subjective Well-Being, Trait Emotional Intelligence, Mental Health, and Resilience in Women With Fibromyalgia

Article

Full-text available

Nov 2019

The objective of the present study was to experimentally assess the effects of a mindfulness-based intervention (MBI) for the improvement of subjective well-being, trait emotional intelligence (TEI), mental health, and resilience in a sample of women with fibromyalgia (FM). The sample consisted of 104 women, between 29 and 77 years old (M = 47.59; SD = 5.93). The measures used were as follows: Satisfaction with Life Scale (SWLS), Positive and Negative Affection Scale (PANAS), Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF), Mental Health Questionnaire (MH-5), and Resilience Scale (ER-14). A quasi-experimental design of repeated measures with a control group (CG) was used: before and after the application of the treatment and a follow-up assessment 6 months after the completion of the intervention. In order to assess the effect of the program, the participants were randomly assigned to the experimental and control conditions. In the pretest evaluation, a multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA) were carried out. In the post-test evaluation, a multivariate analysis of covariance (MANCOVA) of the study variables as a whole was performed. Then, descriptive analyses and analysis of covariance (ANCOVA) of the post-test scores (covariate pretest score) were performed. In the follow-up evaluation, a MANCOVA of the study variables as a whole was performed. Then, descriptive and ANCOVA analyses of the follow-up scores (covariate pretest score) were performed. In addition, the effect size was calculated using partial eta-squared (μ2). The post-test results confirmed statistically significant differences in satisfaction with life (SWL), positive affect (PA), mental health, and resilience. The follow-up results showed statistically significant differences in SWL, PA, TEI, mental health, and resilience. The study provides an effective intervention tool that has been validated experimentally. The general results allow the emphasis of the importance of the implementation of MBIs framed in non-pharmacological treatments in FM.

Preventing and managing challenging behaviour

Article

Feb 2018

Nutmeg Hallett

Patients exhibiting challenging behaviour, which includes any non-verbal, verbal or physical behaviour, is a significant issue in healthcare settings. Preventing such behaviour and the harm it can cause is important for healthcare organisations and individuals, and involves following a public health model comprised of three tiers: primary, secondary and tertiary prevention. Primary prevention aims to reduce the risk of challenging behaviour occurring in the first instance; secondary prevention involves reducing the risk associated with imminent challenging behaviour and its potential escalation; and tertiary prevention focuses on minimising the physical and emotional harm caused by challenging behaviours, during and after an event. De-escalation should be the first-line response to challenging behaviour, and healthcare staff should use a range of techniques - maintaining safety, self-regulation, effective communication, and assessment and actions - to reduce the incidence of challenging behaviour. In some situations, physical interventions may be required to protect the safety of the individual, healthcare staff and other individuals involved, and healthcare staff should be aware of local policies and procedures for this. Following a serious incident, where there was potential or actual harm to patients and healthcare staff, healthcare organisations should use post-incident reviews to learn from the situation, while healthcare staff should be offered the opportunity for debriefing. Positive responses to challenging behaviour at an organisational and individual level can lead to improved work environments for healthcare staff and optimal patient care and outcomes.

Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation

Article

Full-text available

Oct 2017

During the past two decades, mindfulness meditation has gone from being a fringe topic of scientific investigation to being an occasional replacement for psychotherapy, tool of corporate well-being, widely implemented educational practice, and “key to building more resilient soldiers.” Yet the mindfulness movement and empirical evidence supporting it have not gone without criticism. Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled, and disappointed. Addressing such concerns, the present article discusses the difficulties of defining mindfulness, delineates the proper scope of research into mindfulness practices, and explicates crucial methodological issues for interpreting results from investigations of mindfulness. For doing so, the authors draw on their diverse areas of expertise to review the present state of mindfulness research, comprehensively summarizing what we do and do not know, while providing a prescriptive agenda for contemplative science, with a particular focus on assessment, mindfulness training, possible adverse effects, and intersection with brain imaging. Our goals are to inform interested scientists, the news media, and the public, to minimize harm, curb poor research practices, and staunch the flow of misinformation about the benefits, costs, and future prospects of mindfulness meditation.

Praznina kao simptom emocionalne deprivacije u Heseovom Stepskom vuku

Article

Jan 2021

Branka B. Ognjanović

Measuring emptiness: Validation of the Italian version of the Subjective Emptiness Scale in clinical and non-clinical populations

Article

Full-text available

Sep 2021

Background Although a feeling of emptiness is listed only as a symptom of the DSM-5 borderline personality disorder, it is commonly encountered in other disorders. The aim of this study was to validate the Italian version of the Subjective Emptiness Scale (SES-I), a 7-item self-report instrument assessing the feeling of emptiness. Methods Participants in one clinical group (n=63) and one non-clinical group (n=48) completed the SES-I along with several other instruments. A principal component analysis was used to analyze the structure of the SES-I and Cronbach's alpha and Rho's Spearman were used to establish aspects of reliability and validity, respectively. Results The SES-I has a unidimensional structure reflecting the core feature of the feeling of emptiness. It showed an excellent internal consistency (a=.92) and convergent validity, as demonstrated by significant correlations with scores on the Beck Depression Inventory – II and conceptually related scales and subscales of the Millon Clinical Multiaxial Inventory – III and Personality Inventory for DSM-5. Divergent validity was also demonstrated for the SES-I. SES-I scores in the clinical group were significantly higher than in the non-clinical group. A significant relationship was not found between the feeling of emptiness and self-harming behavior, impulsivity and acting-out. Limitations A small sample size, several significant differences between the clinical and non-clinical groups and diagnostic heterogeneity in the clinical group limit generalizability of the study. Conclusion The SES-I is a valid and reliable instrument, which should improve assessment of the feeling of emptiness and help clinicians better understand this complex phenomenon.

Mindfulness as an antidote to conspicuous consumption: The mediating roles of self-esteem, self-concept clarity and normative influence

Article

Jan 2022
PERS INDIV DIFFER

Extant research in consumer behaviour has demonstrated the pervasiveness of conspicuous consumption as a means of psychological salve from inner conflicts such as self-discrepancies with regard to one's status, abilities, power or self-esteem. In this paper we propose mindfulness as an antidote to conspicuous consumption behaviour. Using structural equation modelling and survey responses of 588 consumers (312 non-meditators and 276 meditators), the current research examines the potential sequential mediation effects of self-esteem, self-concept-clarity and consumer susceptibility to normative influence on the association between mindfulness and conspicuous consumption. The results reveal significant differences in conspicuous consumption between the two groups and show that dispositional mindfulness is negatively related to conspicuous consumption in both the samples. Further, mediation effects are confirmed and plausible feedback loops are also identified. The empirical investigation may be useful in understanding the mechanism through which mindfulness works as an antidote to conspicuous consumption, a behaviour which is often seen as detrimental to wellbeing.

Preface to The Family and Individual Development

Chapter

Oct 2016

Donald W. Winnicott

Winnicott’s preface to his book The Family and Individual Development gives a statement of its central topic: the family and the theory of the emotional growth of the human child. Winnicott proposes that the prototype of the place where the developing child meets society lies in the original meeting point for us all, the infant-mother relationship. Included are Winnicott’s acknowledgements for the book.

Schema-focused therapy for narcissistic patients

Article