Mindfulness-based stress reduction
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Mindfulness-based stress reduction (MBSR) is a mindfulness-based program designed to assist people with pain and a range of conditions and life issues that were initially difficult to treat in a hospital setting. Developed at the University of Massachusetts Medical Center in the 1970s by Professor Jon Kabat-Zinn, MBSR 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.
In 1979 Kabat-Zinn founded the Mindfulness Based Stress Reduction Clinic at the University of Massachusetts and nearly twenty years later the Center for Mindfulness in Medicine. Both these institutions supported the successful growth and implementation of MBSR into hospitals worldwide. Today MBSR is practiced as a complementary medicine, commonly in the field of oncology.
MBSR has been described as "a group program that focuses upon the progressive acquisition of mindful awareness, of mindfulness". The MBSR program is an eight-week workshop taught by certified trainers that entails weekly group meetings (two-hour classes) and a one-day retreat (six-hour mindfulness practice) between sessions six and seven, homework (45 minutes daily), and instruction in three formal techniques: mindfulness meditation, body scanning and simple yoga postures. Body scanning is the first prolonged formal mindfulness technique taught during the first four weeks of the workshop, and entails quietly lying on one's back and focusing one's attention on various regions of the body, starting with the toes and moving up slowly to the top of the head.
According to Kabat-Zinn, the basis of MBSR is mindfulness, which he defined as "moment-to-moment, non-judgmental awareness." During the program, participants are asked to focus on informal practice as well by incorporating mindfulness into their daily routines. Focusing on the present is thought to heighten sensitivity to the environment and one’s own reactions to it, consequently enhancing self-management and coping. It also provides an outlet from ruminating on the past or worrying about the future, breaking the cycle of these maladaptive cognitive processes.
Extent of practice
According to a 2014 article in Time magazine, mindfulness meditation is becoming popular among people who would not normally consider meditation. The curriculum started by Kabat-Zinn at University of Massachusetts Medical Center has produced nearly 1,000 certified MBSR instructors who are in nearly every state in the US and more than 30 countries. Corporations such as General Mills have made it available to their employees or set aside rooms for meditation. Democratic Congressman Tim Ryan published a book in 2012 titled A Mindful Nation and he has helped organize regular group meditation periods on Capitol Hill.
Evaluation of effectiveness
Mindfulness-based approaches have been tested for a range of health problems including anxiety disorder, mood disorder, substance abuse disorder, eating disorders, chronic pain, ADHD, insomnia, coping with medical conditions, with many populations including children, adolescents, parents, teachers, therapists, and physicians. As a major subject of increasing research interest, 52 papers were published in 2003, rising to 477 by 2012. Nearly 100 randomized controlled trials had been published by early 2014.
Some research has suggested that therapy incorporating mindfulness might help people with anxiety, depression, and stress. The quality of this research has been the subject of review, however, with mixed results. According to Cancer Research UK, while some evidence has shown MBSR may help with symptom relief and improve quality of life, there is no evidence it helps prevent or cure disease. A 2013 statement from the American Heart Association on alternative approaches to lowering blood pressure concluded that meditation techniques other than Transcendental Meditation, including MBSR, are not recommended in clinical practice to lower blood pressure. Nevertheless, MBSR can have a beneficial effect helping with the depression and psychological distress associated with chronic illness.
Preliminary evidence suggests efficacy of mindfulness meditation in the treatment of substance use disorders; however, further study is required. MBSR might be beneficial for people with fibromyalgia: there is no evidence of long-term benefit but low-quality evidence of a small short-term benefit.
In 2010 a meta-analysis was conducted by Hoffman and colleagues exploring the efficacy of MBSR and similarly structured programs for adults with symptoms of anxiety and depression. The meta-analysis showed that between pre and post testing there was significant medium within-group effect sizes observed on anxiety and depression and also small to medium between-group effect sizes when comparing wait-list, treatment as usual, and active treatment (MBSR), further supporting the literature that states mindfulness-based therapies can be beneficial in treating symptoms of depression and anxiety. A broader meta-analysis conducted in 2004 by Grossman and colleagues found similar effect sizes when testing the physical and mental health outcomes following MBSR treatment.
Implications on the brain
Grey matter concentrations in brain regions that regulate emotion, self-referential processing, learning and memory processes have shown changes in density following MBSR. Additionally, MBSR practice has been associated with improvement of the immune system which could explain the correlation between stress reduction and increased quality of life.
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