Mindfulness-based stress reduction

Mindfulness-based stress reduction (MBSR) is an eight-week evidence-based program that offers secular, intensive mindfulness training to assist people with stress, anxiety, depression and pain. It is a practical approach which trains attention, allowing people to cultivate awareness and therefore enabling them to have more choice and take wise action in their lives. 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, yoga and exploration of patterns of behaviour, thinking, feeling and action. Mindfulness can be understood as the non-judgemental acceptance and "open-hearted" investigation of present experience, including body sensations, internal mental states, thoughts, emotions, impulses and memories, in order to reduce suffering or distress and to increase well-being. (Kabat-Zinn, 2003). Mindfulness meditation is the method by which mindfulness skills are cultivated.[1][2] Over the past twenty years mindfulness meditation has been the subject of more controlled clinical research.[3] 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.[4] While MBSR has its roots in spiritual teachings, the program itself is secular.[5]

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History
Jon Kabat-Zinn, founder of the Mindfulness Based Stress Reduction Clinic

In 1979 Jon Kabat-Zinn founded the Mindfulness Based Stress Reduction Clinic at the University of Massachusetts Medical Center, and nearly twenty years later the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School.[2] Both these institutions supported the growth and implementation of MBSR into hospitals worldwide.[2] In 1993 the MBSR course taught by Jon Kabat-Zinn was featured in Bill Moyer's Healing from Within. In 2015, MBSR is practiced as a complementary medicine, commonly in the field of oncology;[2] in the same year, 2015, close to 80% of medical schools are reported[6] to offer some element of mindfulness training and research and education centers dedicated to mindfulness have proliferated.

Program

MBSR has been described as "a group program that focuses upon the progressive acquisition of mindful awareness, of mindfulness".[7] The MBSR program is an eight-week workshop taught by certified trainers that entails weekly group meetings (2.5 hour classes) and a one-day retreat (seven-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.[2] Group discussions and exploration - of experience of the meditation practice and its application to life - is a central part of the program. Body scanning is the first prolonged formal mindfulness technique taught during the first four weeks of the course, and entails quietly sitting or lying and systematically focusing one's attention on various regions of the body, starting with the toes and moving up slowly to the top of the head.[1][3] MBSR is based on non-judging, non-striving, acceptance, letting go, beginners mind, patience, trust, and non-centering.[8]

According to Kabat-Zinn, the basis of MBSR is mindfulness, which he defined as "moment-to-moment, non-judgmental awareness."[9] During the program, participants are asked to focus on informal practice as well by incorporating mindfulness into their daily routines.[2] 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.[10]

Scientific evidence of the debilitating effects of stress on human body and its evolutionary origins were pinpointed by the ground-breaking work[11] of Robert Sapolsky, and explored for lay readers in the book "Why Zebras Don't Get Ulcers".[12] Sapolsky's work consequently promotes mindfulness-based techniques for a better lifestyle and healthy stress management.

Extent of practice

According to a 2014 article in Time magazine, mindfulness meditation is becoming popular among people who would not normally consider meditation.[1] 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.[1][13]

Methods of practice

Mindfulness-based stress reduction classes and programs are offered by various facilities including hospitals, retreat centers, and various yoga facilities.[14] Typically the programs focus on teaching,

  • mind and body awareness to reduce the physiological effects of stress, pain or illness
  • experiential exploration of experiences of stress and distress to develop less emotional reactivity
  • equanimity in the face of change and loss that is natural to any human life
  • non-judgemental awareness in daily life
  • promote serenity and clarity in each moment
  • to experience more joyful life and access inner resources for healing and stress management
  • mindfulness meditation

Evaluation of effectiveness

Mindfulness-based approaches have been tested for a range of health problems including anxiety disorder, mood disorder, substance use disorder, eating disorders, chronic pain, ADHD, insomnia, coping with medical conditions, with many populations including children, adolescents, parents, teachers, therapists, and physicians.[10] As a major subject of increasing research interest, 52 papers were published in 2003, rising to 477 by 2012.[1] Nearly 100 randomized controlled trials had been published by early 2014.[15]

Research suggests mindfulness training improves focus, attention, and ability to work under stress.[16][17][18]

A 2013 statement from the American Heart Association on alternative approaches to lowering blood pressure concluded that MBSR was not recommended in clinical practice to lower blood pressure.[19] MBSR can have a beneficial effect helping with the depression and psychological distress associated with chronic illness.[20]

Preliminary evidence suggests efficacy of mindfulness meditation in the treatment of substance use disorders; however, further study is required.[21] 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.[22]

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.[23] The meta-analysis showed that between pre- and post-testing there were 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.[23] 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.[24]

See also
  • Buddhism and psychology
  • Buddhist meditation
  • Metacognition
  • Mindfulness (journal)
  • Mindfulness and technology
  • Mindful yoga
  • Self-compassion
  • Yoga as therapy

References
  1. Pickert, K. (February 2014). "The art of being mindful. Finding peace in a stressed-out, digitally dependent culture may just be a matter of thinking differently". Time. 183 (4): 40–6. PMID 24640415.
  2. Will, Andrea; Rancea, Michaela; Monsef, Ina; Wöckel, Achim; Engert, Andreas; Skoetz, Nicole (2015-02-12). "Mindfulness-based stress reduction for women diagnosed with breast cancer". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd011518. ISSN 1465-1858.
  3. Ospina, M. B.; Bond, K.; et al. (June 2007). "Meditation practices for health: state of the research". Evid Rep Technol Assess (Full Report) (155): 35–37. PMC 4780968. PMID 17764203.
  4. "Meditation". Cancer Research UK. Retrieved September 27, 2017.
  5. Greeson, Jeffrey M.; Webber, Daniel M.; Smoski, Moria J.; Brantley, Jeffrey G.; Ekblad, Andrew G.; Suarez, Edward C.; Wolever, Ruth Quillian (2011). "Changes in spirituality partly explain health-related quality of life outcomes after Mindfulness-Based Stress Reduction". Journal of Behavioral Medicine. 34 (6): 508–18. doi:10.1007/s10865-011-9332-x. PMC 3151546. PMID 21360283.
  6. Buchholz, Laura (Oct 2015). "Exploring the Promise of Mindfulness as Medicine". JAMA. 314 (13): 1327–1329. doi:10.1001/jama.2015.7023. PMID 26441167.
  7. Grossman, P.; Niemann, L.; Schmidt, S.; Walach, H. (2010). "Mindfulness-based stress reduction and health benefits: A meta-analysis". Focus on Alternative and Complementary Therapies. 8 (4): 500. doi:10.1111/j.2042-7166.2003.tb04008.x.
  8. Frewen, P. A.; Evans, E.M.; Maraj, N.; Dozois, D. J.; Partridge, K. (2008). "Letting go: Mindfulness and negative automatic thinking". Cognitive Therapy and Research. 32 (6): 758–774. doi:10.1007/s10608-007-9142-1.
  9. Mindfulness Stress Reduction And Healing on YouTube
  10. Hayes, Steven C.; Villatte, Matthieu; Levin, Michael; Hildebrandt, Mikaela (2011-01-01). "Open, Aware, and Active: Contextual Approaches as an Emerging Trend in the Behavioral and Cognitive Therapies". Annual Review of Clinical Psychology. 7 (1): 141–168. doi:10.1146/annurev-clinpsy-032210-104449. PMID 21219193.
  11. Sapolsky, Robert (1982). "The endocrine stress-response and social status in the wild baboon". Hormones and Behavior. 16 (3): 279–292. doi:10.1016/0018-506X(82)90027-7. PMID 6890939.
  12. Sapolsky, Robert (2004). Why Zebras Don't Get Ulcers. USA: Holt paperbacks. p. 560. ISBN 978-0805073690.
  13. Rojas, Warren (January 8, 2014). "A Meditation on the Quiet Time Caucus". Roll Call. Retrieved April 4, 2014.
  14. "Mindfulness based stress reduction at El Camino Hospital, Mountain View, CA". El Camino Hospital. 2015.
  15. Hurley, Dan (January 14, 2014). "Breathing In vs. Spacing Out". New York Times Magazine. Retrieved April 9, 2014.
  16. Lazar SW, Kerr CE, Wasserman RH, et al. (November 2005). "Meditation experience is associated with increased cortical thickness". NeuroReport. 16 (17): 1893–7. doi:10.1097/01.wnr.0000186598.66243.19. PMC 1361002. PMID 16272874.
  17. "Losing Focus? Studies Say Meditation May Help". Time. 2010-08-06.
  18. Krompinger J., Baime M. J. (2007). "Mindfulness training modifies subsystems of attention". Cognitive, Affective, & Behavioral Neuroscience. 7 (2): 109–119. doi:10.3758/CABN.7.2.109. PMID 17672382.
  19. Brook, Robert D; Lawrence J. Appel; Melvyn Rubenfire; Gbenga Ogedegbe; John D. Bisognano; William J. Elliott; Flavio D. Fuchs; Joel W. Hughes; Daniel T. Lackland; Beth A. Staffileno; Raymond R. Townsend; Sanjay Rajagopalan (April 22, 2013). "Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure : A Scientific Statement From the American Heart Association". Hypertension. 61 (6): 1360–83. doi:10.1161/HYP.0b013e318293645f. PMID 23608661.
  20. Bohlmeijer, Ernst; Prenger, Rilana; Taal, Erik; Cuijpers, Pim (2010). "The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: A meta-analysis". Journal of Psychosomatic Research. 68 (6): 539–44. doi:10.1016/j.jpsychores.2009.10.005. PMID 20488270.
  21. Zgierska A, Rabago D, Chawla N, Kushner K, Koehler R, Marlatt A (2009). "Mindfulness meditation for substance use disorders: a systematic review". Subst Abus (Systematic review). 30 (4): 266–94. doi:10.1080/08897070903250019. PMC 2800788. PMID 19904664.
  22. Lauche R, Cramer H, Dobos G, Langhorst J, Schmidt S (December 2013). "A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome". J Psychosom Res (Systematic review). 75 (6): 500–10. doi:10.1016/j.jpsychores.2013.10.010. PMID 24290038.
  23. Hofmann, Stefan G.; Sawyer, Alice T.; Witt, Ashley A.; Oh, Diana (2010). "The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review". Journal of Consulting and Clinical Psychology. 78 (2): 169–183. doi:10.1037/a0018555. ISSN 1939-2117. PMC 2848393. PMID 20350028.
  24. Grossman, Paul; Niemann, Ludger; Schmidt, Stefan; Walach, Harald (July 2004). "Mindfulness-based stress reduction and health benefits". Journal of Psychosomatic Research. 57 (1): 35–43. doi:10.1016/s0022-3999(03)00573-7. ISSN 0022-3999. PMID 15256293.
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