Mindfulness

Modern clinical psychology and psychiatry since the 1970s have developed a number of therapeutic applications based on the concept of mindfulness (Pali sati or Sanskrit smriti) in Buddhist meditation.

 

Definitions

Several definitions of mindfulness have been used in modern Western psychology. According to various prominent psychological definitions, Mindfulness refers to a psychological quality that involves

bringing one’s complete attention to the present experience on a moment-to-moment basis,

or involves

paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally,

or involves

a kind of nonelaborative, nonjudgmental, present-centered awareness in which each thought, feeling, or sensation that arises in the attentional field is acknowledged and accepted as it is

Bishop, Lau, and colleagues (2007) offered a two component model of mindfulness:

The first component [of mindfulness] involves the self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment. The second component involves adopting a particular orientation toward one’s experiences in the present moment, an orientation that is characterized by curiosity, openness, and acceptance.:232

In this two-component model, self-regulated attention (the first component) involves conscious awareness of one’s current thoughts, feelings, and surroundings, which can result in metacognitive skills for controlling concentration. Orientation to experience (the second component) involves accepting one’s mindstream, maintaining open and curious attitudes, and thinking in alternative categories (developing upon Ellen Langer’s research on decision-making). Training in mindfulness and mindfulness-based practices, oftentimes as part of a quiet meditation session, results in the development of a Beginner’s mind, or, looking at experiences as if for the first time.

 

Historical development

In 1979 Dr. Jon Kabat-Zinn founded the Mindfulness-Based Stress Reduction program at the University of Massachusetts to treat the chronically ill, which sparked a growing interest and application of mindfulness ideas and practices in the medical world:230-1 for the treatment of a variety of conditions in people both healthy and unhealthy. Many of the variety of mindfulness-based clinical treatments we have today are mentioned on this webpage below.

Much of this was inspired by teachings from the East, and particularly from the Buddhist traditions, where mindfulness is the 7th step of the Noble Eightfold Path taught by Siddhartha Gautama, The Buddha, who founded Buddhism almost 2,500 years ago. Although originally articulated as a part of what we know in the West as Buddhism, there is nothing inherently religious about mindfulness, and it is often taught independent of religious or cultural connotation.

Clinical research shows Buddhist mindfulness techniques can help alleviate anxiety, stress, and depression

Teachers such as Thich Nhat Hanh have brought mindfulness to the attention of Westerners. Mindfulness and other Buddhist meditation techniques receive support in the West from figures such as the scientist Jon Kabat-Zinn, the teacher Jack Kornfield, the teacher Joseph Goldstein, the psychologist Tara Brach, the writer Alan Clements, and the teacher Sharon Salzberg, who have been widely attributed with playing a significant role in integrating the healing aspects of Buddhist meditation practices with the concept of psychological awareness and healing. Psychotherapists have adapted and developed mindfulness techniques into a promising cognitive behavioral therapies vis. Acceptance and Commitment Therapy (ACT, pronounced act) ACT was recently reviewed by SAMHSA’s National Registry of Evidence-Based Programs and Practices

 

Scientific research

Over the past 30 years there has been an increase in the number of published studies on mindfulness. The current body of scientific literature on the effects of mindfulness practices is promising despite the presence of many methodological weaknesses. The current research does suggest that mindfulness practices are useful in the treatment of pain, stress, anxiety, depressive relapse, disordered eating, and addiction, among others. Mindfulness has been investigated for its potential benefit for individuals who do not experience these disorders, as well, with positive results. Mindfulness practice improves the immune system and alters activation symmetries in the prefrontal cortex, a change previously associated with an increase in positive affect and a faster recovery from a negative experience.

Mindfulness is often used synonymously with the traditional Buddhist processes of cultivating awareness as described above, but more recently has been studied as a psychological tool capable of stress reduction and the elevation of several positive emotions or traits. In this relatively new field of western psychological mindfulness, researchers attempt to define and measure the results of mindfulness primarily through controlled, randomised studies of mindfulness intervention on various dependent variables. The participants in mindfulness interventions measure many of the outcomes of such interventions subjectively. For this reason, several mindfulness inventories or scales (a set of questions posed to a subject whose answers output the subject’s aggregate answers in the form of a rating or category) have arisen.

The most prominent include:

• the Attention Awareness Scale
• the Freiburg Mindfulness Inventory
• the Kentucky Inventory of Mindfulness Skills
• the Cognitive and Affective Mindfulness Scale.

Through the use of these scales – which can illuminate self-reported changes in levels of mindfulness, the measurement of other correlated inventories in fields such as subjective well-being, and the measurement of other correlated variables such as health and performance – researchers have produced studies that investigate the nature and effects of mindfulness. The research on the outcomes of mindfulness falls into two main categories: stress reduction and positive-state elevation.

 

Stress reduction

Human response to stressors in the environment produces emotional and physiological changes in individual human bodies in order to cope with that stress. This process most likely evolved to help us attend to immediate concerns in our environment to better our chances of survival, but in modern society, much of the stress felt is not beneficial in this way. Stress has been shown to have several negative effects on health, happiness, and overall wellbeing. (See stress (biology). One field of psychological inquiry into mindfulness is Mindfulness-based stress reduction or MBSR. Several studies have produced relevant findings:

• Jain and Shapiro (2007) conducted a study to show that mindfulness meditation may be specific in its ability to “reduce distractive and ruminative thoughts and behaviours”, which may provide a “unique mechanism by which mindfulness meditation reduces distress”.
• Arch (2006) found emotional regulation following focused breathing. A breathing group provided moderately positive responses to emotionally neutral visual slides, while “unfocused attention and worry” groups responded significantly more negatively to neutral slides.
• Brown (2003) found declines in mood disturbance and stress following mindfulness interventions.
• Jha (2010) found that a sufficient meditation training practice may protect against functional impairments associated with high-stress contexts.
• Garland (2009) found declines in stress after mindfulness interventions, which are potentially due to the positive re-appraisals of what were at first appraised as stressors.

 

Elevation of positive emotions and outcomes

While much research centered on mindfulness seeks to reduce stress, another large body of research has examined mindfulness as a tool to elevate and sustain “positive” emotional states as well and their related outcomes:

• Fredrickson (2008) studied the building of personal resources through increased daily experiences of positive emotions due to meditation. She found that meditation practice showed increases over time in purpose in life, social support, and decreased illness symptoms.
• Davidson (2003) found that mindfulness meditation increased brain and immune function in positive ways, but highlighted the need for additional research.
• Brown (2009) investigated subjective well-being and financial desire. He found that a large discrepancy between financial desires and financial reality correlated with low subjective well-being but that the accumulation of wealth did not tend to close the gap. Mindfulness however was associated with a lower financial-desire discrepancy and thus a higher subjective well-being, so mindfulness may promote the perception of “having enough”.
• Shao (2009) used a randomised controlled study to illuminate the correlation between MBA candidates subjected to a mindfulness intervention and increased academic performance. He found mindfulness was positively related to performance for women.
• Davidson et al. showed that mindfulness practice improves the immune system and alters activation symmetries in the prefrontal cortex, a change previously associated with an increase in positive affect and a faster recovery time from exposure to a negative experience. These changes in subjects persisted even after periods they were done meditating.

 

Future directions

The research leaves many questions still unanswered. Much of the terminology used in such research has no cohesive definition. For example, there is a lack of differentiation between “attention” and “awareness” and an interchangeable use of the two in modern descriptions. Buddhist contemplative psychology however, differentiates more clearly, as “attention” in that context signifies an ever-changing factor of consciousness, while “awareness” refers to a stable and specific state of consciousness.

 

Reception and criticism

Various scholars have criticized how mindfulness has been defined or represented in recent western psychology publications. B. Alan Wallace has stated that an influential definition of mindfulness in the psychology literature (by Bishop et al.) differs in significant ways from how mindfulness was defined by the Buddha himself, and by much of Buddhist tradition. For example, Wallace writes that

According to one psychological paper on the topic, mindfulness is “a kind of nonelaborative, nonjudgmental present-centered awareness in which each thought, feeling, or sensation that arises in the attentional field is acknowledged and accepted as it is. …. The modern psychological account of mindfulness, which is explicitly based on the descriptions of mindfulness presented in the modern Vipassana (contemplative insight) tradition of Theravada Buddhism…. is oddly at variance with the Buddha’s own description of mindfulness, or sati: “And what monks, is the faculty of sati? Here, monks, the noble disciple has sati, he is endowed with perfect sati and intellect, he is one who remembers, who recollects what was done and said long before.” …. So, rather than refraining from labeling or categorizing experiences in a nonjudgmental fashion, in the earliest, most authorititative accounts, sati is said to distinguish between wholesome and unwholesome, beneficial and unbeneficial tendencies. The contrast between the ancient and modern accounts is striking.:61

Wallace concludes that “The modern description and practice of mindfulness are certainly valuable, as thousands of people have discovered for themselves through their own practice. But this doesn’t take away from the fact that the modern understanding departs significantly from the Buddha’s own account of sati, and from those of the most authoritative commentators in the Theravada and Indian Mahayana traditions.”:62

Eleanor Rosch has stated that contemporary “therapeutic systems that include mindfulness” “could as much be called wisdom-based as mindfulness-based.”:262 In these therapeutic approaches

Mindfulness would seem to play two roles: as a part of the therapy itself and as an umbrella justification (“empirical”) for the inclusion of other aspects of wisdom that may be beyond our present cultural assumptions. Where in this is mindfulness in its original sense of the mind adhering to an object of consciousness with a clear mental focus?:262

William Mikulas, in the Journal of Consciousness Studies, stated that “In Western psychology, mindfulness and concentration are often confused and confounded because, although in the last few years there has been a moderate interest in mindfulness, there has not been a corresponding interest in concentration. Hence, many mindfulness-based programs are actually cultivating both concentration and mindfulness, but all results are attributed to mindfulness.”:20

 

Specific mindfulness-based therapy programs

Since 2006 research supports promising mindfulness-based therapies for a number of medical and psychiatric conditions, notably chronic pain (McCracken et al. 2007), stress (Grossman et al. 2004), anxiety and depression (Hofmann et al. 2010), substance abuse (Melemis 2008:141-157), and recurrent suicidal behavior (Williams et al. 2006). Bell (2009) gives a brief overview of mindful approaches to therapy, particularly family therapy, starting with a discussion of mysticism and emphasizing the value of a mindful therapist.

 

Mindful and Reflective Parenting

Cara Luneau Boulder Institute for Psychotherapy and Research; also Naropa University developed a reflective parenting program in 2007 based on Peter Fonagy’s work at the Tavistock clinic of London. This program promotes an understanding that the practice of mindfulness meditation provides opportunity for the development and enhancement of reflective functioning as well as for improved self-regulation. The program emphasizes mindfulness practices while teaching parents to self-regulate and to think reflectively about themselves and their children.

 

Morita therapy

The Japanese psychiatrist Shoma Morita, who trained in Zen meditation, developed Morita therapy upon principles of mindfulness and non-attachment.

 

Gestalt therapy

Since the beginnings of Gestalt therapy in the early 1940s, mindfulness, referred to as “awareness”, has been an essential part of its theory and practice.

 

Adaptation Practice

The British psychiatrist, Clive Sherlock , who trained in the traditional Rinzai School of Zen, developed Adaptation Practice (AP) in 1978 based on the profound mindfulness/awareness training of Zen daily-life practice and meditation. Adaptation Practice is used for long-term relief of depression, anxiety, anger, stress and other emotional problems.

 

Mindfulness-based stress reduction

Jon Kabat-Zinn developed the Mindfulness-Based Stress Reduction (MBSR) over a ten-year period at the University of Massachusetts Medical School. He (1990:11) defines the essence of MBSR: “This “work” involves above all the regular, disciplined practice of moment-to-moment awareness or mindfulness, the complete “owning” of each moment of your experience, good, bad, or ugly.” Kabat-Zinn explains the non-Buddhist universality of MBSR:

Although at this time mindfulness meditation is most commonly taught and practiced within the context of Buddhism, its essence is universal. … Yet it is no accident that mindfulness comes out of Buddhism, which has as its overriding concerns the relief of suffering and the dispelling of illusions. (2005:12-13)

MBSR has clinically proven beneficial for people with depression and anxiety disorders. This mindfulness-based psychotherapy is practiced as a form of complementary medicine in over 200 hospitals, and is currently the focus of numerous research studies funded by the National Center for Complementary and Alternative Medicine.

 

Mindfulness-based cognitive therapy

Mindfulness-based cognitive therapy (MBCT) psychotherapy combines cognitive therapy with mindfulness techniques as a treatment for major depressive disorder.

 

Acceptance and commitment therapy

Steven C. Hayes and others have developed acceptance and commitment therapy (ACT), originally called “comprehensive distancing”, which uses strategies of mindfulness, acceptance, and behavior change.

 

Dialectical behavior therapy

Mindfulness is a “core” exercise used in Dialectical behavior therapy (DBT), a psychosocial treatment Marsha M. Linehan developed for treating people with borderline personality disorder. DBT is dialectic, explains Linehan (1993:19), in the sense of “the reconciliation of opposites in a continual process of synthesis.” As a practitioner of Buddhist meditation techniques, Linehan says:

This emphasis in DBT on a balance of acceptance and change owes much to my experiences in studying meditation and Eastern spirituality. The DBT tenets of observing, mindfulness, and avoidance of judgment are all derived from the study and practice of Zen meditation. (1993:20-21)

 

Hakomi

Hakomi therapy, under development by Ron Kurtz and others, is a somatic psychology based upon Asian philosophical precepts of mindfulness and nonviolence.

 

Internal Family Systems Therapy

Internal Family Systems Therapy (IFS), developed by Richard C. Schwartz, emphasizes the importance of both therapist and client engaging in therapy from the Self, which is the IFS term for one’s “spiritual center”. The Self is curious about whatever arises in one’s present experience and open and accepting toward all manifestations.

 

Mindfulness meditation in organizations

In the U.S., certain businesses, universities, government agencies, counseling centers, schools, hospitals, religious groups, law firms, prisons, the army, and other organizations offer training in mindfulness meditation.

In the U.S. business world, interest in mindfulness is rising dramatically. This shows in the popular business press, including books such as Awake at Work (Carroll, 2004) and Resonant Leadership: Renewing Yourself and Connecting with Others Through Mindfulness, Hope, and Compassion.

The website of the University of Massachusetts Medical School Center for Mindfulness in Medicine, Health Care, and Society and Carroll’s (2007) book, The Mindful Leader, mention many companies that have provided training programs in mindfulness. These include Fortune 500 companies (such as Raytheon, Procter & Gamble, Monsanto, General Mills, and Comcast) and others (such as BASF Bioresearch, Bose, New Balance, Unilever, and Nortel Networks). Executives who “meditate and consider such a practice beneficial to running a corporation” have included the chairman of the Ford Motor Company, Bill Ford, Jr.; a managing partner of McKinsey & Co., Michael Rennie; and Aetna International’s former chairman, Michael Stephen. A professional-development program — “Mindfulness at Monsanto” — was started at Monsanto corporation by its CEO, Robert Shapiro.

Sounds True, an audio recordings company, has mindfulness as a core value.

At Sounds True, we strive to practice mindfulness in every aspect of our work. Recognizing the importance of silence, inward attention, active listening and being centered, Sounds True begins its all-company meetings with a minute of silence and maintains a meditation room on-site for employees to utilize throughout the day.

In some newspapers, magazines, and scholarly journals in fields other than management, one can find indicators of interest in mindfulness in organizations outside of business. This includes legal and law enforcement organizations.

• Harvard Law School’s Program on Negotiation hosted a workshop on “Mindfulness in the Law & Alternative Dispute Resolution.”
• Police officers in Los Angeles and in Madison, Wisconsin, have received mindfulness training. Many law firms offer mindfulness classes.
• Mindfulness has been taught in prisons, reducing hostility and mood disturbance among inmates, and improving their self esteem.
• There are over 240 mindfulness programs in hospitals and clinics throughout the U.S. Many government organizations offer mindfulness training, including the Army.

Research on mindfulness in the workplace has been conducted by McCormick and Hunter. Hunter has taught a course on mindfulness to graduate students in business at Claremont Graduate University, and McCormick has taught mindfulness in the business school of California State University Northridge. In 2000, The Inner Kids Program, a mindfulness-based program developed for children, was introduced into public and private school curricula in the greater Los Angeles area.