Foundations of Mindfulness-Based Stress Reduction (MBSR)
Jon Kabat-Zinn, M.D. began using the techniques of mindfulness with his patients in the late 1970s and early 1980s. This work eventually led to the development of the Mindfulness -Based Stress Reduction (MBSR) program at the University of Massachusetts Medical Center. Since that time, there has been a wealth of research into the benefits of mindfulness. The seminal work by Kabat-Zinn on the use of mindfulness is Wherever You Go, There You Are (1994).
The program as designed by Kabat-Zinn combines mindfulness and yoga in an eight-week intensive training program. It began at the Stress Reduction Clinic at the University of Massachusetts Medical Center, and is now offered at over 200 clinics and medical centers throughout the world. Nearly three decades of research into MBSR and mindfulness continues to demonstrate the effectiveness of this approach in dealing with a wide range of both mental and physical health care problems.
What Is MBSR?
MBSR is an eight-week intensive course in using mindfulness as a tool to reduce stress. Since its inception in 1979, over 20,000 people have completed the program. MBSR is heavily evidence-based. It is one of the more well-researched programs in history. It is also one of the most widespread stress reduction programs in the world.
The core concept of MBSR is to learn to step out of autopilot and to become fully aware of what is happening in our lives at any given moment. This is accomplished by moving from doing mode, in which our minds become preoccupied with completing the tasks of the day, and entering into being mode, where we simply allow ourselves to experience our perceptions of the world. By entering being mode we disengage from the “doing” activities of rumination and avoidance behaviors. We stop trying to find solutions to problems that may have no solution. We just allow ourselves the freedom to “be.” In gaining this freedom, we learn to let go of the stress that accompanies negative thought and feeling cycles.
Applications for MBSR
Kabat-Zinn created MBSR as a stress reduction program in 1979. Since that time, studies have examined the use of mindfulness in a wide variety of applications. Some of these include:
- Astin (1997) found that mindfulness meditation increased sense of control over the practitioner’s life circumstances and enhanced their spiritual experiences.
- Barnes, et al (2004) found that meditation helped to reduce blood pressure and heart rate in youth.
- Brown & Ryan (2003) demonstrated that mindfulness increases a sense of wellbeing.
- Carson, et al (2001) found that MBSR alleviated symptoms of stress in cancer patients, and also improved their overall moods.
- Davidson, et al (2003) studied the power of mindfulness meditation to improve immune system functioning.
- Kabat-Zinn (1982) studied the effects of mindfulness on the management of chronic pain. Although participants indicated that there was no decrease in the severity of the pain after participating, they did state that the practice of mindfulness allowed them to accept the pain. This led to better overall lifestyle ratings. A follow-up study in 1988 revealed similar results. Overall, participants were better able to regulate chronic pain after participating in mindfulness meditation classes.
- Kabat-Zinn, et al (1992) showed that MBSR could be used to effectively treat anxiety disorders
- Kaplan and Galvin-Nadeau (1993) studied the effects of MBSR n patients with fibromyalgia.
- Kristeller & Hellett (1999) reported that mindfulness-based interventions were effective in treatment of binge-eating disorders.
- Mills & Allen (2000) studied mindfulness of movement as a technique for helping victims of multiple sclerosis.
- Reibel, et al (2001) demonstrated a positive correlation between MBSR and health-related quality of life ratings.
- Semple, et al (2005) studied the utility of mindfulness in treating children with anxiety disorders.
- Shapiro, et al (2007) looked at the effects of MBSR on therapists-in-training.
This is just a small sampling of some of the most recent research into the efficacy of MBSR in helping practitioners reduce stress and improve their quality of life. MBSR and mindfulness continue to demonstrate efficacy in a wide variety of applications for a large range of mental and physical health issues.
Theoretical framework of MBSR
The predominant model of behavior modification used by therapists and counselors is Cognitive Behavioral Therapy (CBT). CBT grew out of its predecessor, Behavioral Therapy. One of the tenets of Behavioral Therapy is that the mind is a “black box.” Since, theoretically, one cannot know the contents of another’s mind, therapists and behavioral scientists cannot know for sure which of their techniques are working and which are not. B. F. Skinner and his colleagues therefore conceptualized the mind and its processes as this black box, under the assumption that we can never know its contents. We can only study input and output into this system. In other words, we can only observe events and how a subject reacts to those events. By modifying the events, we modify the resulting behaviors. While this sounds good in theory, some of the conclusions of this line of thinking were uncomfortable. Since, according to behaviorism, only the results matter, a person with a severe mental disorder could be pronounced “cured” by simply modifying the behaviors that led to the diagnosis. A person with severe delusions could be considered “cured” under behaviorism if he were just trained not to talk about the delusions and not to behave oddly in public.
Films like Stanley Kubrick’s A Clockwork Orange, in which the protagonist undergoes a brutal and invasive behavior modification program to “cure” him of his sociopathic behaviors, and the gradual realization that a person’s cognitions play an important part in behavior modification, led to mental health professionals to re-evaluate behaviorism.
As behavioral scientists came to realize that what a person thought about a situation impacted that person’s behavior, a number of new therapeutic techniques, such as Rational Emotive Behavior Therapy, Rational Behavior Therapy, and Rational Living Therapy, began to appear. These models and others like them are known collectively under the umbrella of Cognitive Behavioral Therapy (CBT). The idea inherent in CBT models is that a person’s cognitions (thoughts) about a situation can influence their behaviors. A goal of CBT modes of therapy is to examine a person’s beliefs (cognitions) and to determine which of those beliefs constitute “thinking errors” that lead to undesirable consequences such as maladaptive behaviors. By restructuring beliefs about certain situations, behaviors can be changed.
Cognitive Behavioral Therapies have been hugely successful. By pinpointing the cognitions that need to be changed, patients and therapists are able to target these beliefs for modification. CBT modalities help to identify what needs to be changed, but there is often a missing component, and that would be how to change those beliefs. Mindfulness-Based Stress Reduction offers a path to change that is simple yet powerful. MBSR creates a space in which students can slow down the process of cognition and examine it step-by-step, while using the skills of observing and describing. As students learn to move from reacting to responding, they come to realize which behaviors they would like to change, and which they can simply accept as fleeting processes of the mind.
Research into MBSR shows that it can help reduce pain levels, diminish anxiety and depression, increase a sense of wellbeing, enhance relaxation, decrease psychological and physiological symptoms, increase the ability to act effectively in high-stress situations, and increase self-esteem and self-efficacy ratings.
Techniques of MBSR
MBSR instructs students in a wide variety of meditative practices. One of the goals of MBSR is to increase our awareness of our present state. We go through many activities in life on automatic pilot. For example, prior to reading this sentence, were you aware of your own breathing? In the mindful breathing exercise from Section One we learned to be present in the moment by directing our attention only to our breathing. We can learn to increase our awareness by focusing on anything, but since our breath is always present, we use it as a means of increasing awareness of the present moment. This mindful breathing progresses to mindful sitting, in which we become aware of our body posture and all the sensations and perceptions that accompany it.
In the body scan meditation, students learn to increase their awareness of their own bodies. Our emotions reveal themselves in our bodies before they reveal themselves in our conscious mind. By becoming more aware of what our bodies are telling us from moment to moment, we become more aware of our emotional cycles as well.
In the mindful walking exercise, students of MBSR learn to apply their awareness skills to the simple activity of walking. By noticing what their feet and legs are doing at each step in the process of walking, awareness is increased. As we learn to walk mindfully, we come to realize that there are many daily activities that can be completed in a mindful fashion.
An MBSR program meets for eight weeks, usually in two or three hour sessions, once per week. In addition to these weekly sessions, participants engage in daily mindful meditations, either on their own, or through the use of guided audio recordings.
