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Mindfulness-Based Stress Reduction (MBSR) offers secular, intensive mindfulness training to assist people with stress, anxiety, depression and pain. 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 behavior, thinking, feeling and action. MBSR can be understood as the non-judgmental acceptance and 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. Mindfulness meditation is a method by which attention skills are cultivated, emotional regulation is developed, as well as rumination and worry are significantly reduced.
Kabat-Zinn described the MBSR program in detail in his bestselling 1990 book Full Catastrophe Living, which was reissued revised in 2013. Body scanning is the first technique 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. MBSR is based on non-judging, non-striving, acceptance, letting go, beginners mind, patience, trust, and non-centering. According to Kabat-Zinn, MBSR is defined as "moment-to-moment, non-judgmental awareness."
Participants 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. Corporations such as General Mills have made it available to their employees or set aside rooms for meditation.
Mindfulness-based stress reduction classes and programs are offered by various facilities including hospitals, retreat centers, and various yoga facilities. 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-judgmental 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-based approaches have been found to be beneficial for adults, adolescents and children, as well as for different health-related outcomes including eating disorders, psychiatric conditions, pain management sleep disorders, cancer care, psychological distress, and for coping with health-related conditions. 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.
Research regarding mindfulness-based stress reduction among post-secondary students has been shown to alleviate psychological distress, something commonly found within this particular age group. In one study, the long-term impact of an 8-week Mindfulness-Based Stress Reduction (MBSR) treatment extended to two months after the intervention was completed. Interventions, such as mindfulness-based approaches, which focus on effective coping skills and improving one’s relationship with themselves through increased self-compassion can positively impact a person’s body image and contribute to overall well-being.
Research suggests mindfulness training improves focus, attention, and ability to work under stress. Mindfulness may also have potential benefits for cardiovascular health. Evidence suggests efficacy of mindfulness meditation in the treatment of substance use disorders.
Mindfulness-based stress approaches have been shown to increase self-compassion. Higher levels of self-compassion have been found to greatly reduce stress. In addition, as self-compassion increases it seems as though self-awareness increases as well. This finding has been observed to occur during treatment as well as a result at the conclusion, and even after, treatment. Self-compassion is both a result and an informative factor of the effectiveness of mindfulness-based approaches.
Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness is a book by Jon Kabat-Zinn, first published in 1990, which describes the mindfulness-based stress reduction (MBSR) program. Kabat-Zinn describes scientific research showing the medical benefits of mindfulness-based interventions (MBIs), and lays out an approach to mind-body medicine emphasizing the depth of the interconnections between physical and mental health. The book has been called "one of the great classics of mind/body medicine", and has been seen as a landmark in the development of the secular mindfulness movement in the United States and internationally.
Full Catastrophe Living grew out of the work of the University of Massachusetts Medical Center's Stress Reduction Clinic, founded in 1979 by Jon Kabat-Zinn. The purpose of the Clinic was to "serve as a referral service for physicians and other health providers, to which they could send medical patients with a wide range of diagnoses and conditions who were not responding completely to more traditional treatments, or who were and not feeling satisfied with their medical treatments and outcomes." MBSR aimed to help patients by providing a relatively intensive training in mindfulness meditation and mindful hatha yoga.
This was meant to serve as an educational (in the sense of inviting what is already present to come forth) vehicle through which people could assume a degree of responsibility for their own well-being and participate more fully in their own unique movement towards greater levels of health by cultivating and refining our innate capacity for paying attention and for a deep, penetrative seeing/sensing of the interconnectedness of apparently separate aspects of experience, many of which tend to hover beneath our ordinary level of awareness regarding both inner and outer experience.
Kabat-Zinn composed Full Catastrophe Living with aim of capturing "the essence and spirit of the MBSR curriculum as it unfolds for our patients", while at the same time articulating "the dharma that underlies the curriculum, but without ever using the word ‘Dharma’ or invoking Buddhist thought or authority, since for obvious reasons, we do not teach MBSR in that way." Kabat-Zinn recalls his desire for the book to "embody... the dharma essence of the Buddha’s teachings" in a way that was "accessible to mainstream Americans", and to avoid "as much as possible the risk of it being seen as Buddhist, ‘New Age,’ ‘Eastern Mysticism’ or just plain ‘flakey.’"
The second edition refines the meditation instructions and descriptions of mindfulness-based approaches found in the first edition, and also reflects the "exponential" growth of scientific research into mindfulness and its clinical applications in the two decades after the book was first published. The title Full Catastrophe Living is derived from the film Zorba the Greek, in which the title character says, in response to being asked whether he has ever married, "Am I not a man? Of course I've been married. Wife, house, kids... the full catastrophe".
According to Kabat-Zinn: Zorba’s response embodies a supreme appreciation for the richness of life and the inevitability of all its dilemmas, sorrows, traumas, tragedies, and ironies. His way is to “dance” in the gale of the full catastrophe, to celebrate life, to laugh with it and at himself, even in the face of personal failure and defeat. In doing so, he is never weighed down for long, never ultimately defeated either by the world or by his own considerable folly.
Kabat-Zinn defines defines mindfulness as "the awareness that arises by paying attention on purpose, in the present moment, and non-judgmentally", while noting that "when we speak of mindfulness, it is important to keep in mind that we equally mean heartfulness... It is a more-than-conceptual knowing. It is more akin to wisdom, and to the freedom a wisdom perspective provides." He emphasizes that mindfulness involves accessing within ourselves capacities that we in fact already possess, "finding, recognizing, and making use of that in us which is already okay, already beautiful, already whole by virtue of our being human—and drawing upon it to live our lives as if it really mattered how we stand in relationship to what arises, whatever it is."
While stressing that "mindfulness has its own internal logic and poetry", he suggests that scientific research showing its beneficial effects for health and well-being may provide extra incentive to follow the MBSR curriculum. Kabat-Zinn begins by laying out what he sees as the foundational attitudes necessary for mindfulness practice - non-judging, patience, beginner's mind, trust, non-striving, acceptance, and letting go.
Kabat-Zinn emphasizes the non-instrumental nature of mindfulness practice, as in his explication of "non-striving": "Almost everything we do we do for a purpose, to get something or somewhere. But in meditation this attitude can be a real obstacle. That is because meditation is different from all other human activities. Although it takes a lot of work and energy of a certain kind, ultimately meditation is a non-doing. It has no goal other than for you to be yourself. The irony is that you already are. This sounds paradoxical and a little crazy. Yet this paradox and craziness may be pointing you toward a new way of seeing yourself, one in which you are trying less and being more. This comes from intentionally cultivating the attitude of non-striving."
Kabat-Zinn then lays out the basis for his approach to health and healing, emphasizing the concepts of "wholeness" and "interconnectedness". He summarizes this approach, which he associates with mind-body and integrative medicine, as follows: "Perhaps the most fundamental development in medicine over the past decades is the recognition that we can no longer think about health as being solely a characteristic of the body or the mind, because body and mind are not two separate domains—they are intimately interconnected and completely integrated. The new perspective acknowledges the central importance of thinking in terms of wholeness and interconnectedness and the need to pay attention to the interactions of mind, body, and behavior in any comprehensive effort to understand and treat illness. This view emphasizes that science will never be able fully to describe a complex dynamical process such as health, or even a relatively simple chronic disease, without looking at the functioning of the whole organism, rather than restricting itself solely to an analysis of parts and components, no matter how important that domain may be as well."
Kabat-Zinn goes on to lay out the extensive scientific evidence for the close interconnection between mental and physical processes, examining the impact that attitudes such as optimism or pessimism, self-efficacy, hardiness, sense of coherence, and anger can have on physical conditions including cancer and heart disease. He also extends the concept of wholeness to stress the intimate interconnectedness of all living and non-living phenomena, approvingly quoting a letter from Albert Einstein stating that the human sense of being "something separated from the rest" is "a kind of optical delusion of consciousness".
Kabat-Zinn then lays out a range of scientific evidence relating to the psychological and physiological effects of stress, then goes on to describe how mindfulness practice can alleviate these effects. Drawing on the work of Richard Lazarus and Susan Folkman, he defines psychological stress in terms of the relationship between a person and their environment, which in this case is perceived as taxing or threatening. Kabat-Zinn examines both the prevalence and the deleterious effects of chronic stress within modern societies, noting that many of the automatic stress reactions common to human beings are poorly adapted to the types of problems modern people most often face.
He writes: "Health can be undermined by a lifetime of ingrained behavior patterns that compound and exacerbate the pressures of living we continually face. Ultimately, our habitual and automatic reactions to the stressors we encounter, particularly when we get in the habit of reacting maladaptively, determine in large measure how much stress we experience. Automatic reactions triggered out of unawareness—especially when the circumstances are not life-threatening but we take them that way all the same—can compound and exacerbate stress, making what might have remained basically simple problems into worse ones over time. They can prevent us from seeing clearly, from solving problems creatively, and from expressing our emotions effectively when we need to communicate with other people or even understand what is going on within ourselves.... A lifetime of unconscious and unexamined habitual reactivity to challenges and perceived threats is likely to increase our risk of eventual breakdown and illness significantly."
Habitual maladaptive reactions to stressors can include physical tensions, workaholism, addiction to various chemicals, drugs, or foods, and depressive rumination. Kabat-Zinn describes how mindfulness practice can help people to overcome such maladaptive reactions by bringing them into awareness, "allowing you to engage in and influence the flow of events and your relationship to them at those very moments when you are most likely to react automatically, and plunge into hyperarousal and maladaptive attempts to keep things under some degree of control. Mindful awareness allows us to respond to stressors wisely rather than reacting automatically, helping us to deal with stressors more effectively while also bringing the comfort of wisdom and inner trust, the comfort of being whole."
Kabat-Zinn then offers detailed advice for practicing mindfulness in the face of a range of specific stressors, including medical symptoms, emotional disturbance, time and work pressures, relationship issues, and stress relating to political or world events. Reflecting MBSR's origins in a medical clinic, significant space is devoted to considerations relevant to people suffering from chronic pain and other long-term health conditions. Kabat-Zinn notes that MBSR's approach to pain seems counter-intuitive to many people, as it does not involve trying to get rid of it or distracting the mind from it, but rather involves accepting and investigating the pain with compassionate attention.
He writes: "The way of mindfulness is to accept ourselves right now, as we are, symptoms or no symptoms, pain or no pain, fear or no fear. Instead of rejecting our experience as undesirable, we ask, “What is this symptom saying, what is it telling me about my body and my mind right now?” We allow ourselves, for a moment at least, to go right into the full-blown feeling of the symptom. This takes a certain amount of courage, especially if the symptom involves pain, a chronic illness, or fear of death. But the challenge here is can you at least “dip your toe in the water” by trying it just a little, say for ten seconds, just to move in a little closer for a clearer look? Can we metaphorically put out the welcome mat for what is here, simply because it is already here, and take a look, or even better, allow ourselves to feel our way into the full range of our experience in such moments?"
Kabat-Zinn describes how paying attention to pain in this way can help people to identify with it less - to see a headache as "just a headache" rather than "my headache" - and to overcome habitual maladaptive mental and physical reactions that, in the case of chronic pain in particular, can play a significant role in both the intensity and the salience of pain experiences. Kabat-Zinn describes various scientific studies showing the significant benefits of mindfulness practice for chronic pain sufferers, and illustrates these findings with the stories of MBSR patients.
Subsequent to its publication Full Catastrophe Living became a global bestseller. It has been described as a "landmark" and a "classic" in the fields of mind-body medicine and secular mindfulness, and has been cited in scholarly works more than 11,000 times. The book is generally seen as the foundational text of the mindfulness-based stress reduction (MBSR) program, which is offered in more than 740 hospitals, clinics, and stand-alone programs worldwide. Full Catastrophe Living has also been credited with an important role in inspiring the development of other mindfulness-based interventions (MBIs), including mindfulness-based cognitive therapy (MBCT) and mindfulness-based pain management (MBPM).