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Mindfulness is "the intentional, accepting and non-judgmental focus of one's attention on the emotions, thoughts and sensations occurring in the present moment", which can be trained by meditational practices derived from Buddhist anapanasati. It has been popularized in the west by Jon Kabat-Zinn with his Mindfulness-Based Stress Reduction (MBSR) program.
Clinical psychology and psychiatry since the 1970s have developed a number of therapeutic applications based on mindfulness for helping people suffering from a variety of psychological conditions. Clinical studies have documented the physical and mental health benefits of mindfulness in general, and MBSR in particular. Programs based on MBSR and similar models have been widely adapted in schools, prisons, hospitals, veterans centers, and other environments.
- 1 Definitions
- 2 Historical development
- 3 Trait, state and practice
- 4 Therapy programs
- 5 Scientific research
- 6 Criticism
- 7 See also
- 8 Notes
- 9 References
- 10 Sources
- 11 Further reading
- 12 External links
Trait, state and practice
According to Brown, Ryan, and Creswell, definitions of mindfulness are typically selectively interpreted based on who is studying it and how it is applied. Some have viewed mindfulness as a mental state, while others have viewed it as a set of skills and techniques.
A distinction can also be made between the state of mindfulness and the trait of mindfulness. According to David S. Black, whereas "mindfulness" originally was associated with esoteric beliefs and religion, and "a capacity attainable only by certain people", scientific researchers have translated the term into measurable terms, providing a valid operational definition of mindfulness.[note 1] Black mentions three possible domains:
- A trait, a dispositional characteristic (a relatively long lasting trait), a person's tendency to more frequently enter into and more easily abide in mindful states;
- A state, an outcome (a state of awareness resulting from mindfulness training), being in a state of present-moment awareness;
- A practice (mindfulness meditation practice itself)[note 2]
- "A quality of consciousness manifest in, but not isomorphic with, the activities through which it is enhanced."
- "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".
- "Mindfulness is a way of paying attention that originated in Eastern meditation practices
- "Paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally"
- "Bringing one’s complete attention to the present experience on a moment-to-moment basis"
The first component 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 bringing awareness to current experience - observing and attending to the changing fields of "objects" (thoughts, feelings, sensations), from moment to moment - by regulating the focus of attention". Orientation to experience (the second component) involves maintaining an attitude of curiosity about objects experienced at each moment, and about where and how the mind wanders when it drifts from the selected focus of attention. Clients are asked to avoid trying to produce a particular state (i.e. relaxation), but rather to just notice each object that arises in the stream of consciousness.:233
Mindfulness is founded on modern[note 3] vipassana, the training of sati, which means "moment to moment awareness of present events", but also "remembering to be aware of something". It leads to insight into the true nature of reality, namely the three marks of existence, the impermanence of and the unsatisfactoriness of every conditioned thing that exists, and non-self. With this insight, the practitioner becomes a socalled Sotāpanna, a "stream-enterer", the first stage on the path to liberation.
Jon Kabat-Zinn and MBSR
In 1979, Jon Kabat-Zinn founded the Mindfulness-Based Stress Reduction (MBSR) program at the University of Massachusetts to treat the chronically ill.[note 4] This program sparked the application of mindfulness ideas and practices in Medicine[note 5]:230–1 for the treatment of a variety of conditions in both healthy and unhealthy people. MBSR and similar programs are now widely applied in schools, prisons, hospitals, veterans centers, and other environments.
One of MBSR's techniques - the "body scan" - was derived from a meditation practice ("sweeping") of the Burmese U Ba Khin tradition, as taught by S. N. Goenka in his Vipassana retreats, which he began in 1976. Mindfulness practices were inspired mainly by teachings from the Eastern World, particularly from Buddhist traditions. It has since been widely adapted in secular settings, independent of religious or cultural contexts.[note 6][note 7]
Mindfulness is gaining a growing popularity as a practice in daily life, apart from buddhist insight meditation and its application in clinical psychology. Mindfulness may be seen as a mode of being, and can be practiced outside a formal setting. 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. In the U.S. business world, interest in mindfulness is rising strongly. Many companies are providing 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, formerly, the failed Nortel Networks).
Trait, state and practice
Seven mindfulness measures have been developed which are based on self-reporting of trait-like constructs:
- Mindful Attention Awareness Scale (MAAS)
- Freiburg Mindfulness Inventory (FMI)
- Kentucky Inventory of Mindfulness Skills (KIMS)
- Cognitive and Affective Mindulness Scale (CAMS)
- Mindfulness Questionnaire (MQ)
- Revised Cognitive and Affective Mindulness Scale (CAMS-R)
- Philadelphia Mindfulness Scale (PHLMS)
The Toronto Mindfulness Scale (TMS) measures mindfulness as a state-like phenomenon, that is evoked and maintained by regular practice.
According to Steven F. Hick, mindfulness practice involves both formal and informal meditation practices, and nonmeditation-based exercises. Formal mindfulness, or meditation, is the practice of sustaining attention on body, breath or sensations, or whatever arises in each moment. Informal mindfulness is the application of mindful attention in everyday life. Nonmeditation-based exercises are specifically used in Dialectical Behavior Therapy and in Acceptance and Commitment Therapy.
Mindfulness meditation is practiced sitting with eyes closed, cross-legged on a cushion, or on a chair, with the back straight.[web 1] Attention is put on the movement of the abdomen when breating in and out, or on the awareness of the breath as it goes in to and out of the nostrils. As thoughts come up, one returns to focusing on breathing. One passively notices one's mind has wandered, but in an accepting, non-judgmental way. Meditators start with short periods of 10 minutes or so a day. As one practices regularly, it becomes easier to keep the attention focused on breathing. Eventually awareness of the breath can be extended into awareness of thoughts, feelings and actions.
Mindfulness-based stress reduction
Mindfulness-based stress reduction (MBSR) is a cognitive and behavioral therapy program developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center, which uses a combination of mindfulness meditation, body awareness, and yoga to help people become more mindful. In recent years, meditation has been the subject of controlled clinical research. This suggests it may have beneficial effects, including stress reduction, relaxation, and improvements to quality of life, but that it does not help prevent or cure disease. While MBSR has its roots in spiritual teachings, the program itself is secular.
Mindfulness-based cognitive therapy
Mindfulness-based cognitive therapy (MBCT) is a psychological therapy designed to aid in preventing the relapse of depression, specifically in individuals with Major depressive disorder (MDD). It uses traditional Cognitive behavioral therapy (CBT) methods and adds in newer psychological strategies such as mindfulness and mindfulness meditation. Cognitive methods can include educating the participant about depression. Mindfulness and mindfulness meditation, focus on becoming aware of all incoming thoughts and feelings and accepting them, but not attaching or reacting to them. Like CBT, MBCT functions on the theory that when individuals who have historically had depression become distressed, they return to automatic cognitive processes that can trigger a depressive episode. The goal of MBCT is to interrupt these automatic processes and teach the participants to focus less on reacting to incoming stimuli, and instead accepting and observing them without judgment. This mindfulness practice allows the participant to notice when automatic processes are occurring and to alter their reaction to be more of a reflection. Research supports the effects of MBCT in people who have been depressed three or more times and demonstrates reduced relapse rates by 50%.
Acceptance and commitment therapy
Acceptance and commitment therapy or ACT (typically pronounced as the word "act") is a form of clinical behavior analysis (CBA) used in psychotherapy. It is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility. The approach was originally called comprehensive distancing. It was developed in the late 1980s by Steven C. Hayes, Kelly G. Wilson, and Kirk Strosahl.
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, 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 meditations.
Mode Deactivation Therapy
Mode Deactivation Therapy (MDT) is a treatment methodology that is derived from the principles of cognitive behavioral therapy and incorporates elements of Acceptance and commitment therapy, Dialectical behavior therapy, and mindfulness techniques. Mindfulness techniques such as simple breathing exercises are applied to assist the client in awareness and non-judgmental acceptance of unpleasant and distressing thoughts and feelings as they occur in the present moment. Mode Deactivation Therapy was developed and is established as an effective treatment for adolescents with problem behaviors and complex trauma-related psychological problems, according to recent publications by Jack A. Apsche and Joan Swart.
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.
- Morita therapy
The Japanese psychiatrist Shoma Morita, who trained in Zen meditation, developed Morita therapy upon principles of mindfulness and non-attachment. 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
- Hakomi therapy
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 (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.
- Positive psychology
Principal researchers belonging to the Positive Psychology school, including Martin Seligman and Jonathan Haidt, suggest that mindfulness is but one (albeit a major) component of a "repertoire" of disciplines that have been shown to significantly improve "Subjective Well-being" (happiness). They recommend a combination of exercise, mindfulness meditation, cognitive behavioral therapy, and, where needed, medication (esp selective serotonin reuptake inhibitors).
- Mindfulness relaxation
In the 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. Twelve such methods are detailed at Mindfulness Research Guide. Examples include:
- the Mindful Attention Awareness Scale (MAAS);
- 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.
Effects of mindfulness meditation
Research has shown meditation to be beneficial in lowering blood pressure, decreasing anxiety, as well as improving numerous other physical and mental health conditions.
A 2013 meta-analysis of mindfulness-based therapies (MBT), involving 209 studies and 12,145 participants, indicated that MBT is moderately effective in pre-post studies, superior to some treatments (psychoeducation, supportive therapy, relaxation, imagery, and art-therapy), but not more effective than traditional Cognitive Behavioral Therapy. The analysis found that MBT was more effective in treating psychological disorders than it was in treating physical or medical conditions. MBT showed "large and clinically significant effects in treating anxiety and depression", with gains maintained at follow-up. These findings were similar to those obtained in previous meta-analyses. The authors acknowledged, however, the wide variation between the studies in their design, interventions, participants, outcomes, and quality; it is thus possible that their conclusions may be overstated.
A systematic study on the efficacy of various forms of meditation programs (inc mantra, transcendental, and mindfulness meditation), commissioned by the US Agency for Healthcare Research and Quality, was published in 2014. After a review of 17,801 citations, the study based its conclusions on 41 randomized controlled trials with an active control, involving 2,993 participants. It concluded that "Meditation programs, in particular mindfulness programs, reduce multiple negative dimensions of psychological stress.":vii The assessment found that:
- "Mindfulness meditation programs improved multiple dimensions of negative affect, including anxiety, depression, and perceived stress/general distress ... the effects were significant for anxiety and marginally significant for depression at the end of treatment, and these effects continued to be significant at 3-6 months for both anxiety and depression";:130
- there is a "small and consistent signal that any domain of negative affect is improved in mindfulness programs when compared with a nonspecific active control";:131
- although the effects were small, they are "fairly comparable with what would be expected from the use of an antidepressant in a primary care population";:131
- MBT "did not show superiority for any outcome" when compared to such therapies as exercise, yoga, progressive muscle relaxation, cognitive behavioral therapy, and medications;:131
- MBSR has a small effect on general pain severity, and causes "a statistically significant 30 percent reduction in abdominal pain severity at 2 months that maintained at six months".:133
- "no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight."[web 2][note 9]
In 2011, NIH's National Center for Complementary and Alternative Medicine (NCCAM) released findings from a study in which magnetic resonance images were taken of the brains of 16 participants 2 weeks before and after the participants joined the mindfulness meditation program by researchers from Massachusetts General Hospital, Bender Institute of Neuroimaging in Germany, and the University of Massachusetts Medical School. Researchers concluded that
..these findings may represent an underlying brain mechanism associated with mindfulness-based improvements in mental health.
The analgesic effect of MM involves multiple brain mechanisms including the activation of the anterior cingulate cortex and the ventromedial prefrontal cortex. In addition, brief periods of MM training increases the amount of grey matter in the hippocampus and parietal lobe. Other neural changes resulting from MM may increase the efficiency of attentional control.
According to the American Cancer Society,
... available scientific evidence does not suggest that meditation is effective in treating cancer or any other disease".
Beyond its use in reducing depressive acuity, research additionally supports the effectiveness of mindfulness meditation upon reducing cravings for substances that people are addicted to. Addiction is known to involve the weakening of the prefrontal cortex that ordinarily allows for delaying of immediate gratification for longer term benefits by the limbic and paralimbic brain regions. Mindfulness meditation of smokers over a two-week period totaling 5 hours of meditation decreased smoking by about 60% and reduced their cravings, even for those smokers in the experiment who had no prior intentions to quit. Neuroimaging of those who practice mindfulness meditation has been shown to increase activity in the prefrontal cortex, a sign of greater self-control.
As part of treatment for substance abuse disorders (SUDs), conclusive data for efficacy is lacking, significant methodological limitations exist and it is unclear which people with SUDs might benefit most from mindfulness meditation (MM).
Reprogramming habitual patterns
Practicing mindfulness can help people to begin to recognise their habitual patterns of mind which have developed out of awareness over time, allowing practitioners to respond to their life in new rather than habitual ways. Mindful meditation can become "a mental position for being able to separate a given experience from an associated emotion, and can facilitate a skilful or mindful response to a given situation."
A large part of mindfulness research is dependent on technology. As new technology continues to be developed, new imaging techniques will become useful in this field. It would be interesting to use real-time fMRI to help give immediate feedback and guide participants through the programs. It could also be used to more easily train and evaluate mental states during meditation itself. The new technology in the upcoming years offers many exciting potentials for the continued research.
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 and by much of Buddhist tradition. 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
According to authors well versed in the original Buddhist literature, from which several MBIs [Mindfulness Based Interventions] are overtly or implicitly derived, modern attempts to operationalize mindfulness have consistently failed to provide an unequivocal definition of mindfulness which takes into account the complexity of the original definitions of mindfulness.... Probably, a more in-depth dialogue between Western researchers concerned with the topic of mindfulness and Eastern and Western long-term mindfulness meditation practitioners will be needed before advances into the understanding of mindfulness within Western psychological theoretical frameworks will be achieved.:265
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
- Buddhism and psychology
- Buddhism and science
- Eastern philosophy and clinical psychology
- Mindfulness (journal)
- Psychological mindedness
- Research on meditation
- Neural mechanisms of mindfulness meditation
- Black: "[S]everal decades of research methodology and scientific discovery have defrayed these myths; mindfulness is now widely considered to be an inherent quality of human consciousness. That is, a capacity of attention and awareness oriented to the present moment that varies in degree within and between individuals, and can be assessed empirically and independent of religious, spiritual, or cultural beliefs.
- "Mindfulness meditation" may refer to either the secular, western practice of mindfulness, or to modern Buddhist Vipassana-meditation.
- Vipassana as taught by teachers from the Vipassana movement is a 19th century development, inspired by and reacting against western modernism. See also Buddhist modernism.
- "The Stress Reduction Program, founded by Dr. Jon Kabat-Zinn in 1979..." - http://www.umassmed.edu/cfm/stress/index.aspx
- "Much of the interest in the clinical applications of mindfulness has been sparked by the introduction of Mindfulness-Based Stress Reduction (MBSR), a manualized treatment program originally developed for the management of chronic pain
- "Historically a Buddhist practice, mindfulness can be considered a universal human capacity proposed to foster clear thinking and open-heartedness. As such, this form of meditation requires no particular religious or cultural belief system." - Mindfulness in Medicine by Ludwig and Kabat-Zinn, available at jama.ama-assn.org
- "Kabat-Zinn (2000) suggests that mindfulness practice may be beneficial to many people in Western society who might be unwilling to adopt Buddhist traditions or vocabulary. Thus, Western researchers and clinicians who have introduced mindfulness practice into mental health treatment programs usually teach these skills independently of the religious and cultural traditions of their origins (Kabat-Zinn, 1982;Linehan, 1993b)." - Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review by Ruth A. Baer
- See also Eating One Raisin: A First Taste of Mindfulness for a hand-out file]
- See also Linda Heuman (2014), Meditation Nation, TriCycle for an interpretation of these findings.
- Rosch (2007) is discussing "the four therapeutic systems that include mindfulness training as a component. These systems are Mindfulness Based Stress Reduction (MBSR; Kabat-Zinn, 1990), Mindfulness Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002; Teasdale &Barnard, 1993), Dialectical Behavior Therapy (DBT; Linehan, 1993a,b), and Acceptance and Commitment Therapy (ACT; Hays, Strosahl, & Wilson, 1999). (See also Baer, 2006; and Hayes, Jacobson, Follette, & Dougher, 1994.) Patients are never just given minimalist mindfulness instructions (such as “Pay bare attention to what comes into your mind”) and then left to themselves—for good reason. I know of no cases where anyone has developed a meditation, or even relaxation, practice without considerable input." (p. 261)
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|The Wikibook Dialectical Behavioral Therapy has a page on the topic of: Core Mindfulness Skills|
|Look up Mindfulness in Wiktionary, the free dictionary.|
- Mindfulness Research Guide at the American Mindfulness Research Association. Retrieved 23 December 2013.
- Oxford University Mindfulness Research Centre. Retrieved 23 December 2013.
- Medically Proven Benefits of Mindfulness Meditation. Retrieved 24 June 2014.