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Bridging Buddhist Wisdom and Modern Psychology: Supporting Mental Health Care in Bhutan

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Understanding bridges between Buddhist and modern psychological views of the role of context in mental health

Bridging western psychological and Buddhist concepts of wellbeing in psychotherapy

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First systematic effort to integrate Buddhism wisdom with psychotherapy for Bhutanese clients

Tietjen, A.M. (2021). Listening for bridges: Developing a culturally responsive, transdiagnostic approach to psychotherapy for Bhutan. Transcultural Psychiatry. DOI: 10..1177/13634615211058346.

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WHO Definition of Mental Health

“a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.”

Common Mental Disorders: Anxiety, Depression, Responses to Trauma

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Buddhism and Mental Health

Illness and suffering derive from three poisons: desire, hatred, ignorance. These lead to choices that cause suffering.

Alleviation of suffering

Letting go of psychological attachments to the three poisons

Cultivation of compassion and kindness toward others

Building merit through spiritual practices and behavior

Goals of Buddhist practice include: Awareness, flexibility, and skillful responses to others

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Buddhist Perspective on the Role of Context in Mental Health

Nagarjuna --1^st century scholar

Dependent Arising
Impermanence
Emptiness
Karma

Conditions in which people can thrive can be created intentionally

Interdependence of all beings; reciprocal responsibility

Precious Garland of Advice for a King
Zhabdrung, Royal Constitution of Bhutan, Gross National Happiness policy

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Buddhist Perspective on Context….

Tsongkhapa --14^th century scholar

Things can be valid in one context, not in another.

There is no single formulation of reality that is inherently correct.

Moral framework for understanding person – context relationship: Why this relationship is important as well as how it works

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Modern Psychology’s Perspective on the Role of Context in Mental Health

Biopsychosocial, ecological theories
Embeddedness of persons in family, community, workplace, society, culture
Reciprocal influence of persons and contexts
Scientific evidence for specific effects of contextual influences on mental health – Risk and protective factors

What affects mental health and how (by what processes)?

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Culture and Mental Health

Cultures are systems of meaning that guide the actions of their members
Culture is expressed in social institutions and practices,
Culture is located both externally and internally.
Culturally patterned activities shape the brain’s neural pathways and functions.
Culture influences the expression, experience, interpretation, and response to mental illness

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Global Mental Health Movement - WHO

Evidence for understanding and treating mental disorders is based on models and data from the developed world.

There are equally rich traditions of healing in other cultures. All countries can learn from each other and together address health issues worldwide.

The Global Mental Health movement promotes the development of brief mental health treatments based on both scientific evidence and local cultural healing traditions.

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Modern Western Psychotherapy

Healing takes place in context of an interpersonal relationship with an empathic, skilled psychotherapist

Co-creating the conditions for internal change with awareness of external causes and conditions.

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Using Buddhist and Modern Psychological Perspectives on Context in Doing Psychotherapy

Knowledge and awareness of socioeconomic, cultural, personal circumstances of client’s lives
Awareness that all behavior is context dependent, interventions tailored to client
Awareness that helping one client can affect family, community
Knowing that no single worldview is inherently correct, therapist can bridge her Western knowledge with client’s cultural wisdom to facilitate meaningful change

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Bridging Western mental health concepts and Buddhist teachings

Western Processes of Change

Agency, empowerment

Emotion regulation

Flexibility
Nurturing relationships
Non-avoidance
Problem-solving

Buddhist Teachings

Karma
Awareness of emotions, equanimity
Impermanence, letting go
Interconnectedness, compassion
Karma, equanimity
Interconnectedness, karma, dependent arising

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Listening for Bridges

Listen to client’s concerns
Identify need to address a specific principle of change
Bridge mentally to a linked Buddhist teaching
Respond to client in terms of cultural concept
Interventions: evidence-based, congruent with Buddhist teachings

Therapist listens for bridges while holding both sets of conventions about well-being in mind, as well as the lived experience of the client.

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Buddhist-informed Therapy for Bhutan:

Interventions

Awareness of thoughts, emotions, physical sensations

Direct reference to Buddhist teachings

Traditional Buddhist stories

Cognitive behavioral interventions

Ideas and skills from Buddhist literature

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Case Examples

Karma

Anxiety and Compassion

Dependent arising, nurturing relationships

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Conclusions

Vajrayana teachings, Bhutan’s philosophy and history of governance, and Western psychology all support WHO’s commitment to reshaping physical, social, and economic contexts in order to promote mental health.
Understanding Buddhist perspectives on context can help Western-trained psychotherapists tailor their work to Bhutanese clients
Bridging Western psychology and Buddhist wisdom in psychotherapy may strengthen therapeutic change, encourage Bhutanese to use mental health services as needed, and enhance their sense of cultural pride

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