Mindfulness-based stress reduction

So for most commentators today, the original secular mindfulness-based intervention is the MBSR program developed by Jon Kabat-Zinn in the University of Massachusetts Medical Center, which began with his experimental pain clinic in the late 1970s. The seminal statement of this program was published in 1990 in his book Full Catastrophe Living, which is rightly regarded as the classic text of the therapeutic tradition of mindfulness. So if you haven’t read this book, read it. Most of the subsequent mindfulness programs are at least grounded in, or perhaps spring out of, Kabat-Zinn’s work. Including the other major therapeutic program in the field today which is MBCT. We will look into that in the next session.

In today’s session, we’re going to take a look at what MBSR is, how it’s used, and what’s some of our concerns about it might be. The MBSR program is a rigorous and relatively intense eight week program. Participants meet once per week for between two and three hours in small groups of around 20 if possible, but no more than 35. They’re also expected to perform home practice for about 45 minutes per day for the six days of the week on which they don’t meet. And finally, there’s a full six hour retreat day between week six and seven, often on a weekend, during which all participants experiment with maintaining silence.

The MBSR program includes many of the formal practices that are now seen as characteristic of mindfulness interventions in general. This includes the now legendary raisin exercise, the body scan, sitting meditations, walking meditations, also experiments with yoga, or Qigong. For those of you who are wondering about this, yes, MBSR is also the basis of the mindfulness training that we’re doing in this course. So I’m not going to describe all of the practices again. You can check them out for yourselves at your leisure in the meditation apps. The MBSR program is designed principally for adults who perceive themselves as stressed. Hence the question we considered in the last session of what stress might mean objectively is sidestepped.

MBSR is for adults who perceive themselves as stressed. So I ask you, do you perceive yourself as stressed?

MBSR is the most frequently deployed program in trials of the efficacy of mindfulness interventions, especially for so-called healthy populations. In general and perhaps unsurprisingly, the results of the trials based on self reports show that the participation in MBSR Program returns higher scores on trait mindfulness scales such as the mindful attention awareness scale in the Kentucky Inventory of Mindfulness Skills. More interestingly, trials also show that participants who successfully complete the program report greater positive affect, enhanced quality of life, less exhaustion, reduced levels of stress and anxiety. Stress reduction in itself, not only through mindfulness training, is known to alleviate allied forms of psychological distress including disruptive personal relationships, poor levels of job satisfaction, impeded decision making, and burnout.

Some trials also show reports of significant enhancements to what we call positive functioning. Graduates from the MBSR program report feeling wiser, more compassionate, more open to learning, more creative, more empathic to others, and enjoy a richer sense of personal well being. These are the results that most interest the emerging field of positive psychology. It’s important to note here, however, that not everyone who participates in MBSR will realize all, or indeed any, of these outcomes. And one of the big questions for the science of mindfulness is, why not? When a mindfulness intervention doesn’t work, what has gone wrong? At the moment, the answers to this question are relatively untested.

One factor that bears considering is the challenging nature of mindfulness training itself. That is, mindfulness training requires effort, discipline, and sincerity from participants. This often comes as a surprise to people who see from the outside that mindfulness practices usually involve sitting or lying down with your eyes closed and breathing. Truly anyone can do that, right? I’m sure you’ve had no problems with any of the exercises we’ve been trying in our meditation labs, right? What is not visible from the outside is the work being done to bring about a certain kind of attention and a certain tone of awareness.

Yes, the exercises are extremely simple to understand, but anyone who’s tried them will attest to the fact that they’re sometimes excruciatingly difficult to perform. Those of you who are trying the meditation labs in this course for instance will immediately recognize how difficult it is to bring a form of gentle curiosity to the little toe of your left foot. Or how difficult it is to remember to notice when your mind has completely forgotten about that foot and has instead busily planning what you’re going to eat for dinner this evening. In fact, one of the critical tasks for the participant in MBSR is the cultivation of what Jon Kabat-Zinn has called the Seven Attitudinal Foundations of Mindfulness Practice.

Non-judgment, patience, beginner’s mind, trust, non-striving, acceptance, and letting go. We’ll see how these attitudes emerge from Buddist foundations in the next module. For now it’s enough to see that while the practices of MBSR are very, very simple, it’s not always clear even to us, when we are actually performing them. And as we’ve already seen in an earlier session, it’s very difficult for anyone else to measure your mindfulness level from the outside except by asking you questions about the quality of your intention, attention, and attitude.

One of the ways that MBSR tries to integrate this process of reflection into the program itself is through the practice of so-called inquiry or perhaps better inquiry that takes place in each class after each meditation practice. Participants are also encouraged to engage in a similar form of self reflection, by keeping a practice journal throughout the course and afterwards. In the lab section of this module, we’ll also explore the process of inquiry, and I know you’re being very diligent about keeping your own practice journal already, right?

[LAUGH] In other words, while it’s unlikely, unlike for the course of drugs, it is possible that somebody could follow the whole MBSR course and emerge after eight weeks without really having followed the course at all. This actually enables a rather sophistic counter argument that I’ve heard I few times that those who follow the course without participating properly should not expect to see the benefits because they haven’t really participated in a course at all. This means that the course always works when people follow it. And that if it doesn’t seem to work, this is actually because the participant didn’t really follow it despite sitting in class each week and sitting at home every day.

Leaving such sophistry aside, it’s clear that participate motivation emerges as a crucial variable in the effectiveness of the program. The flip side of participant motivation is the attitude and manner of the teacher or therapist who’s providing the course. Again, unlike a course of drugs, it seems very likely that the identity and persona of the instructor in a mindfulness class will make a difference to the experience of the participants. One of the hot topics in the science of mindfulness at the moment, is to what extent it matters.

Whether the teacher is an experienced and accomplished meditator in their own right, and this is now required by the protocols for good practice in MBCT for instance, or whether it’s just as effective to have somebody pretending to be experienced. After all, from the outside who can tell whether such pretense is even necessary or whether it’s actually okay just to teach yourself from a book or an internet based learning environment like this one. Likewise it seems plausible that the ideological or even aesthetic context of a particular course makes a difference.

For many years, for instance, Jon Kabat-Zinn used to be very careful about not encouraging participants in MBSR courses to associate the practices with Buddhism in case this kind of association negatively impacted on their motivation. For other participants an association with Buddhism or ninja or hippies or the Jedi might actually help. So by whom would you rather be taught?

In Buddhism, this tailoring of a message to fit with the ideological and personality features of an audience is known as the deployment of expedient means. So finally, if we’re able to accept that MBSR has various beneficial outcomes, but that these are not necessarily experienced by everyone who attends the course, we also need to consider whether participants might also experience more negative outcomes. As we noted earlier, for various reasons the science tends to search for either therapeutic benefits or enhancements to positive functioning. Yet as we will see in the next module, mindfulness training and particularly open awareness practices also contain a number of risks for participants, ranging from trauma to dissociative disorders.

For now it’s enough that we’re simply aware that there are risks and that these are sufficient for mindfulness training to be contraindicated for some people. We might see responsibility for these as one of the reasons why mindfulness interventions should be led by experienced and qualified teachers. This emphasis on the responsibility of mindfulness teachers is a particular feature in our next session, when we’ll consider the protocols of MBCT, which has been developed as a therapeutic tool to help quite vulnerable populations. And so, now, it’s to MBCT that we turn.