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.<ref name="Time2014">Pickert, K.,

 The art of being mindful. Finding peace in a stressed-out, digitally dependent culture may just be a matter of thinking differently, 
 Time, 
 
 Vol. 183(Issue: 4),
 pp. 40–6,
 
 PMID: 24640415,</ref><ref name=":0">Will, Andrea, 
 Mindfulness-based stress reduction for women diagnosed with breast cancer, 
 Cochrane Database of Systematic Reviews, 
 
 
 
 DOI: 10.1002/14651858.cd011518,</ref> Over the past twenty years mindfulness meditation has been the subject of more controlled clinical research.<ref name="Ospina 2007">, 
 Meditation practices for health: state of the research, 
 Evid Rep Technol Assess (Full Report), 
 
 
 pp. 35–37,
 
 PMID: 17764203,
 PMC: 4780968,</ref> 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.<ref name="cruk">

Meditation(link). {{{website}}}. Cancer Research UK.

</ref> While MBSR has its roots in spiritual teachings, the program itself is secular.<ref>,

 Changes in spirituality partly explain health-related quality of life outcomes after Mindfulness-Based Stress Reduction, 
 Journal of Behavioral Medicine, 
 2011,
 Vol. 34(Issue: 6),
 pp. 508–18,
 DOI: 10.1007/s10865-011-9332-x,
 PMID: 21360283,
 PMC: 3151546,</ref>

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.<ref name=":0" /> Both these institutions supported the growth and implementation of MBSR into hospitals worldwide.<ref name=":0" /> 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;<ref name=":0" /> in the same year, 2015, close to 80% of medical schools are reported<ref name="Buchholz">Buchholz, Laura,

 Exploring the Promise of Mindfulness as Medicine, 
 JAMA, 
 
 Vol. 314(Issue: 13),
 pp. 1327–1329,
 DOI: 10.1001/jama.2015.7023,
 PMID: 26441167,</ref> 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".<ref name="MBSR 2003 meta-analysis">,

 Mindfulness-based stress reduction and health benefits: A meta-analysis, 
 Focus on Alternative and Complementary Therapies, 
 2010,
 Vol. 8(Issue: 4),
 
 DOI: 10.1111/j.2042-7166.2003.tb04008.x,</ref> 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.<ref name=":0" /> 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.<ref name=Time2014/><ref name="Ospina 2007"/>

MBSR is based on non-judging, non-striving, acceptance, letting go, beginners mind, patience, trust, and non-centering.<ref>,

 Letting go: Mindfulness and negative automatic thinking, 
 Cognitive Therapy and Research, 
 
 Vol. 32(Issue: 6),
 pp. 758–774,
 DOI: 10.1007/s10608-007-9142-1,</ref>

According to Kabat-Zinn, the basis of MBSR is mindfulness, which he defined as "moment-to-moment, non-judgmental awareness."<ref name=vid></ref> During the program, participants are asked to focus on informal practice as well by incorporating mindfulness into their daily routines.<ref name=":0" /> 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.<ref name=":12">Hayes, Steven C.,

 Open, Aware, and Active: Contextual Approaches as an Emerging Trend in the Behavioral and Cognitive Therapies, 
 Annual Review of Clinical Psychology, 
 
 Vol. 7(Issue: 1),
 pp. 141–168,
 DOI: 10.1146/annurev-clinpsy-032210-104449,
 PMID: 21219193,</ref>

Scientific evidence of the debilitating effects of stress on human body and its evolutionary origins were pinpointed by the ground-breaking work<ref>Sapolsky, Robert,

 The endocrine stress-response and social status in the wild baboon, 
 Hormones and Behavior, 
 
 Vol. 16(Issue: 3),
 pp. 279–292,
 DOI: 10.1016/0018-506X(82)90027-7,</ref> of Robert Sapolsky, and explored for lay readers in the book "Why Zebras Don't Get Ulcers".<ref>Robert, 
  
 Why Zebras Don't Get Ulcers, 
  
 USA:Holt paperbacks, 
 2004, 
  
  
 ISBN 978-0805073690, 
  
  
  
 Pages: 560,</ref> 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.<ref name="Time2014"/> 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.<ref name=Time2014/><ref> Rojas, Warren. A Meditation on the Quiet Time Caucus(link). {{{website}}}. Roll Call. January 8, 2014.

</ref>

Methods of practice

Mindfulness-based stress reduction classes and programs are offered by various facilities including hospitals, retreat centers, and various yoga facilities.<ref>

Mindfulness based stress reduction at El Camino Hospital, Mountain View, CA(link). El Camino Hospital.

2015.

</ref> 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.<ref name=":12"/> As a major subject of increasing research interest, 52 papers were published in 2003, rising to 477 by 2012.<ref name=Time2014/> Nearly 100 randomized controlled trials had been published by early 2014.<ref name=NYTimes2014> Hurley, Dan,

 Breathing In vs. Spacing Out Full text, 
 , 
 New York Times Magazine, 
 January 14, 2014,

</ref>

Research suggests mindfulness training improves focus, attention, and ability to work under stress.<ref>,

 Meditation experience is associated with increased cortical thickness, 
 NeuroReport, 
 
 Vol. 16(Issue: 17),
 pp. 1893–7,
 DOI: 10.1097/01.wnr.0000186598.66243.19,
 PMID: 16272874,
 PMC: 1361002,</ref><ref>, 
 Losing Focus? Studies Say Meditation May Help, 
 Time, 
 
 
 
 
 
 
 
 Full text,</ref><ref>Krompinger J., Baime M. J., 
 Mindfulness training modifies subsystems of attention, 
 Cognitive, Affective, & Behavioral Neuroscience, 
 2007,
 Vol. 7(Issue: 2),
 pp. 109–119,
 DOI: 10.3758/CABN.7.2.109,</ref>

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.<ref name="aha">Brook, Robert D,

 Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure : A Scientific Statement From the American Heart Association, 
 Hypertension, 
 
 Vol. 61(Issue: 6),
 pp. 1360–83,
 DOI: 10.1161/HYP.0b013e318293645f,
 PMID: 23608661,</ref> MBSR can have a beneficial effect helping with the depression and psychological distress associated with chronic illness.<ref>, 
 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, 
 2010,
 Vol. 68(Issue: 6),
 pp. 539–44,
 DOI: 10.1016/j.jpsychores.2009.10.005,
 PMID: 20488270,</ref>

Preliminary evidence suggests efficacy of mindfulness meditation in the treatment of substance use disorders; however, further study is required.<ref>,

 Mindfulness meditation for substance use disorders: a systematic review, 
 Subst Abus, 
 2009,
 Vol. 30(Issue: 4),
 pp. 266–94,
 DOI: 10.1080/08897070903250019,
 PMID: 19904664,
 PMC: 2800788,</ref> 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.<ref name=fibr>, 
 A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome, 
 J Psychosom Res, 
 
 Vol. 75(Issue: 6),
 pp. 500–10,
 DOI: 10.1016/j.jpsychores.2013.10.010,
 PMID: 24290038,</ref>

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.<ref name=":1">Hofmann, Stefan G.,

 The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review, 
 Journal of Consulting and Clinical Psychology, 
 
 Vol. 78(Issue: 2),
 pp. 169–183,
 DOI: 10.1037/a0018555,
 PMID: 20350028,
 PMC: 2848393,</ref> 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.<ref name=":1" /> 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.<ref>Grossman, Paul, 
 Mindfulness-based stress reduction and health benefits, 
 Journal of Psychosomatic Research, 
 
 Vol. 57(Issue: 1),
 pp. 35–43,
 DOI: 10.1016/s0022-3999(03)00573-7,
 PMID: 15256293,</ref>

See also

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

External links

• Center For Mindfulness (CFM) at University of Massachusetts, where MBSR began
• Not-for-profit Mindfulness Training Institute (Teacher Training in MBSR/CT)

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