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Mindfulness-Based Stress Reduction (MBSR) is an eight-week, evidence-based program designed to provide secular, intensive mindfulness training to help individuals manage stress, anxiety, depression, and pain. MBSR was developed in the late 1970s by Jon Kabat-Zinn at the University of Massachusetts Medical Center. It incorporates a blend of mindfulness meditation, body awareness, yoga, and the exploration of patterns of behavior, thinking, feeling, and action. [1] [2] Mindfulness 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. [1] [3] Mindfulness meditation is a method by which attention skills are cultivated, emotional regulation is developed, and rumination and worry are significantly reduced. [3] [4] [1] During the past decades, mindfulness meditation has been the subject of more controlled clinical research, which suggests its potential beneficial effects for mental health, [5] [6] [7] athletic performance, [8] [9] as well as physical health. [10] [11] [12] While MBSR has its roots in wisdom teachings of Zen Buddhism, Hatha Yoga, Vipassana and Advaita Vedanta, the program itself is secular. [1] [13] The MBSR program is described in detail in Kabat-Zinn's 1990 book Full Catastrophe Living. [1]
In 1979, Jon Kabat-Zinn founded the Mindfulness-Based Stress Reduction Clinic at the University of Massachusetts Medical Center, and nearly two decades later, the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. [2] These institutions have been instrumental in supporting the growth and implementation of MBSR in hospitals worldwide. [1] Kabat-Zinn's book, Full Catastrophe Living , which details the MBSR program, became a bestseller and was reissued in a revised edition in 2013. [1] In 1993, Jon Kabat-Zinn's MBSR course was featured in Bill Moyers' documentary, Healing from Within. [14] By 2015, nearly 80% of medical schools offered some element of mindfulness training [15] , and research and education centers dedicated to mindfulness had proliferated.
A meta-analysis described MBSR as "a group program that focuses upon the progressive acquisition of mindful awareness, of mindfulness". [14] The MBSR program is an eight-week workshop conducted by certified trainers, consisting of weekly group meetings (2.5 hours each) and a one-day retreat (seven-hour mindfulness practice) between sessions six and seven. Participants are also assigned daily homework (45 minutes) and instructed in three primary techniques: mindfulness meditation, body scanning, and simple yoga postures. [1] Group discussions and exploration—of the meditation practice and its application to everyday life—are integral to the program. This component is crucial for understanding how mindfulness can be incorporated into daily living. Body scanning, introduced during the first four weeks, involves quietly sitting or lying while systematically focusing attention on different body regions, starting from the toes and moving up to the top of the head. [1] [2] MBSR is founded on principles such as non-judging, non-striving, acceptance, letting go, beginner’s mind, patience, trust, and non-centering. [15] [1]
According to Kabat-Zinn, the core of MBSR is mindfulness, which he defines as "moment-to-moment, non-judgmental awareness." [1] Throughout the program, participants are encouraged to engage in informal practices by incorporating mindfulness into their daily routines. This focus on the present is believed to enhance sensitivity to both the environment and one's reactions to it, thereby improving self-management and coping skills. It also provides a means to escape from dwelling on the past or worrying about the future, breaking the cycle of maladaptive cognitive patterns. [16] Research has confirmed the validity and reliability of a weekly single-item practice quality assessment. Improvements in self-reported mindfulness and psychological symptoms were predicted by increases in practice quality, although no similar effects were observed for behavioral mindfulness. Additionally, longer practice sessions were associated with better practice quality. [17]
Scientific evidence of the debilitating effects of stress on the human body and its evolutionary origins was highlighted by the work of Robert Sapolsky, particularly in the book Why Zebras Don’t Get Ulcers . [16] [17] Mindfulness meditation has been shown to bring about significant reductions in psychological stress, [5] [18] [19] and appears to prevent the physiological changes and biological manifestations that typically result from psychological stress. [11] [12] [10] Early neuroimaging studies suggest that MBSR training impacts the brain areas responsible for attention, introspection, and emotional processing. [20]
According to a 2014 article in Time magazine, mindfulness meditation is becoming popular among people who would not normally consider meditation. [18] 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 MBSR instruction 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. [18] [19]
Mindfulness-based stress reduction (MBSR) classes and programs are offered at various facilities, including hospitals, retreat centers, and yoga studios. [20] These programs typically focus on teaching:
Mindfulness-based approaches have been found to be beneficial for healthy adults, [5] [21] [22] for adolescents and children, [23] [24] healthcare professionals, [25] as well as for different health-related outcomes including eating disorders, [26] [27] [28] psychiatric conditions, [29] [30] [31] [32] pain management [33] [3] [34] sleep disorders, [35] [36] cancer care, [37] [38] psychological distress, and for coping with health-related conditions. [39] [40] [41] [42] Research suggests that Mindfulness-Based Stress Reduction (MBSR) is especially effective in managing stress and improving quality of life in the context of health by offering a non-pharmacological approach that enhances functional status and well-being across a diverse range of health related conditions. [43] As a major subject of increasing research interest, 52 papers were published in 2003, rising to 477 by 2012. [18] Nearly 100 randomized controlled trials had been published by early 2014. [44]
According to a systematic review and meta-analysis, mindfulness meditation programs demonstrated moderate evidence of reducing anxiety, depression, and pain, but showed low evidence for improving stress/distress, mental health-related quality of life, positive mood, attention, substance use, eating habits, sleep, and weight. The study highlighted the need for stronger research designs to better understand the effects of meditation programs on various dimensions of mental health. [45]
The development of therapies to improve individuals' flexibility in switching between using and not using emotion regulation (ER) methods is necessary because it is linked to better mental health, wellbeing, and resilience. According to research, those who attended MBSR training exhibited greater regulatory decision flexibility. [46] In post-secondary students, research on mindfulness-based stress reduction has demonstrated that it can reduce psychological distress, which is common in this age range. 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. [47]
Research suggests mindfulness training improves focus, attention, and ability to work under stress. [48] [49] [50] Mindfulness may also have potential benefits for cardiovascular health. [51] [52] [53] The effectiveness of MBSR in treating psychological disorders, particularly anxiety and depression, has been supported by recent meta-analytic evidence. However, MBSR was found to be not more effective than traditional Cognitive Behavioral Therapy (CBT) and showed only moderate efficacy compared to other active treatments. [54] Evidence suggests efficacy of mindfulness meditation in the treatment of substance use disorders. [55] [56] [57] Mindfulness training may also be beneficial for people with fibromyalgia. [58] [59] [60]
In addition, recent research has explored the ability of mindfulness-based stress reduction to increase self-compassion and enhance the well-being of those who are caregivers, specifically mothers, for youth struggling with substance use disorders. [61] Mindfulness-based interventions allowed for the mothers to experience a decrease in stress as well as a better relationship with themselves which resulted in improved interpersonal relationships.
It has been demonstrated that mindfulness-based stress reduction has beneficial impacts on healthy individuals as well as suffering individuals and those close to suffering individuals. Roca et al. (2019) conducted an 8-week mindfulness-based stress reduction program for healthy participants. [62] Five pillars of MBSR, including mindfulness, compassion, psychological well-being, psychological distress, and emotional-cognitive control were identified. Participants psychological functioning were examined and assessed using questionnaires. Mindfulness and overall well-being was significant between the five pillars observed.
Mindfulness-based interventions and their impact have become prevalent in every-day life, especially when rooted in an academic setting. After interviewing children, of the average age of 11, it was apparent that mindfulness had contributed to their ability to regulate their emotions. [63] In addition to these findings, these children expressed that the more mindfulness was incorporated by their school and teachers, the easier it was to apply its principles. In a 2021 Cochrane review for mindfulness-based psychological interventions for medical students and junior doctors its utility remained unconfirmed due to few studies and risk of bias. [64]
MBIs (mindfulness-based interventions) showed a positive effect on mental and somatic health in social when compared to other active treatments in adults. However, these effects were largely independent of gender, study sample, duration, and compliance with the MBSR intervention. The research also highlighted that while MBIs were effective, their benefits were generally modest compared to other therapeutic interventions. [65]
Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.
Meditation is a practice in which an individual uses a technique to train attention and awareness and detach from reflexive, "discursive thinking," achieving a mentally clear and emotionally calm and stable state, while not judging the meditation process itself.
Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.
Generalized anxiety disorder (GAD) is a mental and behavioral disorder, specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning, and individuals with GAD are often overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work difficulties. Symptoms may include excessive worry, restlessness, trouble sleeping, exhaustion, irritability, sweating, and trembling.
Mind–body interventions (MBI) or mind-body training (MBT) are health and fitness interventions that are intended to work on a physical and mental level such as yoga, tai chi, and Pilates.
Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder, but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD).
Mindfulness is the cognitive skill, usually developed through meditation, of sustaining meta-attention on the contents of one's own mind in the present moment. Mindfulness derives from sati, a significant element of Hindu and Buddhist traditions, and is based on Zen, Vipassanā, and Tibetan meditation techniques. Though definitions and techniques of mindfulness are wide-ranging, Buddhist traditions describe what constitutes mindfulness, such as how perceptions of the past, present and future arise and cease as momentary sense-impressions and mental phenomena. Individuals who have contributed to the popularity of mindfulness in the modern Western context include Thích Nhất Hạnh, Joseph Goldstein, Herbert Benson, Jon Kabat-Zinn, and Richard J. Davidson.
Jon Kabat-Zinn is an American professor emeritus of medicine and the creator of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. Kabat-Zinn was a student of Zen Buddhist teachers such as Philip Kapleau, Thich Nhat Hanh, and Seung Sahn, and a founding member of Cambridge Zen Center. His practice of hatha yoga, Vipassanā and appreciation of the teachings of Soto Zen and Advaita Vedanta led him to integrate their teachings with scientific findings. He teaches mindfulness, which he says can help people cope with stress, anxiety, pain, and illness. The stress reduction program created by Kabat-Zinn, mindfulness-based stress reduction (MBSR), is offered by medical centers, hospitals, and health maintenance organizations, and is described in his book Full Catastrophe Living.
Mindfulness-based cognitive therapy (MBCT) is an approach to psychotherapy that uses cognitive behavioral therapy (CBT) methods in conjunction with mindfulness meditative practices and similar psychological strategies. The origins to its conception and creation can be traced back to the traditional approaches from East Asian formative and functional medicine, philosophy and spirituality, birthed from the basic underlying tenets from classical Taoist, Buddhist and Traditional Chinese medical texts, doctrine and teachings.
Psycho-oncology is an interdisciplinary field at the intersection of physical, psychological, social, and behavioral aspects of the cancer experience for both patients and caregivers. Also known as psychiatric oncology or psychosocial oncology, researchers and practitioners in the field are concerned with aspects of individuals' experience with cancer beyond medical treatment, and across the cancer trajectory, including at diagnosis, during treatment, transitioning to and throughout survivorship, and approaching the end-of-life. Founded by Jimmie Holland in 1977 via the incorporation of a psychiatric service within the Memorial Sloan Kettering Cancer Center in New York, the field has expanded drastically since and is now universally recognized as an integral component of quality cancer care. Cancer centers in major academic medical centers across the country now uniformly incorporate a psycho-oncology service into their clinical care, and provide infrastructure to support research efforts to advance knowledge in the field.
The psychological and physiological effects of meditation have been studied. In recent years, studies of meditation have increasingly involved the use of modern instruments, such as functional magnetic resonance imaging and electroencephalography, which are able to observe brain physiology and neural activity in living subjects, either during the act of meditation itself or before and after meditation. Correlations can thus be established between meditative practices and brain structure or function.
Buddhism includes an analysis of human psychology, emotion, cognition, behavior and motivation along with therapeutic practices. Buddhist psychology is embedded within the greater Buddhist ethical and philosophical system, and its psychological terminology is colored by ethical overtones. Buddhist psychology has two therapeutic goals: the healthy and virtuous life of a householder and the ultimate goal of nirvana, the total cessation of dissatisfaction and suffering (dukkha).
Eastern philosophy in clinical psychology refers to the influence of Eastern philosophies on the practice of clinical psychology.
In psychology, self-compassion is extending compassion to one's self in instances of perceived inadequacy, failure, or general suffering. American psychologist Kristin Neff has defined self-compassion as being composed of three main elements – self-kindness, common humanity, and mindfulness.
Mindfulness has been defined in modern psychological terms as "paying attention to relevant aspects of experience in a nonjudgmental manner", and maintaining attention on present moment experience with an attitude of openness and acceptance. Meditation is a platform used to achieve mindfulness. Both practices, mindfulness and meditation, have been "directly inspired from the Buddhist tradition" and have been widely promoted by Jon Kabat-Zinn. Mindfulness meditation has been shown to have a positive impact on several psychiatric problems such as depression and therefore has formed the basis of mindfulness programs such as mindfulness-based cognitive therapy, mindfulness-based stress reduction and mindfulness-based pain management. The applications of mindfulness meditation are well established, however the mechanisms that underlie this practice are yet to be fully understood. Many tests and studies on soldiers with PTSD have shown tremendous positive results in decreasing stress levels and being able to cope with problems of the past, paving the way for more tests and studies to normalize and accept mindful based meditation and research, not only for soldiers with PTSD, but numerous mental inabilities or disabilities.
Metacognitive therapy (MCT) is a psychotherapy focused on modifying metacognitive beliefs that perpetuate states of worry, rumination and attention fixation. It was created by Adrian Wells based on an information processing model by Wells and Gerald Matthews. It is supported by scientific evidence from a large number of studies.
Trauma-sensitive yoga is yoga as exercise, adapted from 2002 onwards for work with individuals affected by psychological trauma. Its goal is to help trauma survivors to develop a greater sense of mind-body connection, to ease their physiological experiences of trauma, to gain a greater sense of ownership over their bodies, and to augment their overall well-being. However, a 2019 systematic review found that the studies to date were not sufficiently robustly designed to provide strong evidence of yoga's effectiveness as a therapy; it called for further research.
Mindfulness-based pain management (MBPM) is a mindfulness-based intervention (MBI) providing specific applications for people living with chronic pain and illness. Adapting the core concepts and practices of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), MBPM includes a distinctive emphasis on the practice of 'loving-kindness', and has been seen as sensitive to concerns about removing mindfulness teaching from its original ethical framework. It was developed by Vidyamala Burch and is delivered through the programs of Breathworks. It has been subject to a range of clinical studies demonstrating its effectiveness.
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, revised in 2013, which describes the mindfulness-based stress reduction (MBSR) program developed at the University of Massachusetts Medical Center's Stress Reduction Clinic. In addition to describing the content and background of MBSR, 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.
Mindfulness-Oriented Recovery Enhancement (MORE) is an evidence-based mind-body therapy program developed by Eric Garland. It is a therapeutic approach grounded in affective neuroscience that combines mindfulness training with reappraisal and savoring skills. Garland developed this approach by combining the key features of mindfulness training, "Third Wave" cognitive-behavioral therapy, and principles from positive psychology.