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This page contains a variety of information and written material related to mindfulness and Mindfulness-Based Stress Reduction that may be of interest to you or anyone curious about the topic.
By Jeff Brantley, MD
Duke Center for Integrative Medicine
Meditation refers to the activity of intentionally paying attention, to a particular object for a particular purpose. Spiritual practitioners and members of many faith traditions have developed meditation practices over countless years of human experience. There are literally thousands of ways to practice meditation. As it has been developed in diverse faith traditions, the purpose of all meditation practice is to awaken us. Meditation is intended to bring about transformation and change, through understanding, compassion, and clarity of seeing.
According to many authorities, meditation practices may generally be grouped into two basic categories based on the emphasis placed on directing attention as one practices meditation. First, there are "concentration" practices. In these, the practitioner focuses attention (concentrates) on a narrow field, usually a single object. For example, in the service of spiritual practice, the person may repeat a meaningful phrase or prayer over and over or they may fix their attention on an object or sacred figure. In these concentration practices, when the attention wanders or is drawn away from the object of attention, the practitioner gently returns attention to the object. The object is selected for reasons specific to the person and to their particular faith tradition. Done for health purposes, concentration practices may select a more neutral object such as the sensation of the breath or the sensation of the body as it moves.
The second general category of meditation practice includes all forms of meditation practice, which emphasize awareness or "mindfulness." Such activities seek to develop and nourish present moment awareness. They encourage paying attention in a way so as to be more aware in the present moment of all that is here, and of the constantly changing nature of what is here. These "mindfulness" practices are often described as "being, not doing," because mindfulness itself is the innate quality of human beings which is bare awareness. Mindfulness can be defined as careful, open-hearted, choiceless, present moment awareness.
Mindfulness benefits from the ability to concentrate attention, but is not the same as concentration. It is a quality, which human beings already have, but they have usually not been advised that they have it, that it is valuable, or that it can be cultivated. Mindfulness is the awareness that is not thinking (but that which is aware of thinking, as well as aware of each of the other ways we experience the sensory world, i.e., seeing, hearing, tasting, smelling, feeling through the body). Mindfulness is non-judgmental and open-hearted (friendly and inviting of whatever arises in awareness). It is cultivated by paying attention on purpose, deeply, and without judgment to whatever arises in the present moment, either inside or outside of us. By intentionally practicing mindfulness, deliberately paying more careful moment-to-moment attention, individuals can live more fully and less on "automatic pilot," thus, being more present for their own lives. Mindfulness meditation practices seek to develop this quality of clear, present moment awareness in a systematic way so that the practitioner may enjoy these benefits. Being more aware in each moment of life has benefits both to a person doing specific spiritual practice, and also to the same person in everyday life.
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The use of meditation in health care settings, and for stress reduction is related to discoveries about the mind-body connection in health and illness, which have been made in Western medicine over the last 25 to 30 years. In that time, researchers have discovered that the mind and the body are intimately connected. It is now known that thoughts, beliefs, emotions, and stress all have a great impact on health and illness. Meditation is one of a variety of so-called "self-regulatory practices" which individuals can learn to do for themselves to promote their own health and well-being. Research has shown that individuals who learn and practice these skills are likely to have a better health outcome than those who do not. In particular, research has shown that the ability to concentrate attention can promote deep relaxation in the body, and that the ability to be more mindful in each situation can help break the destructive habitual reactions to stress.
In the approach known as Mindfulness-Based Stress Reduction (MBSR), individuals are taught to practice mindfulness meditation and mindful movement/gentle stretching and yoga as ways to become more aware, more present, and more relaxed as they face the stress of their own lives. Other examples of self-regulatory practices besides meditation are biofeedback, clinical hypnosis, and progressive relaxation exercises.
Research has shown that meditation is similar to other lifestyle change activities in that it is only effective if you do it! Exercise, diet change, or meditation -- any lifestyle change requires consistent practice to gain results. In early studies of meditation, the cardiologist Herbert Benson, at Harvard, demonstrated that practicing meditation 20 minutes twice-a-day was sufficient to bring about significant reductions in blood pressure in many people. The exact number of minutes of daily practice to bring benefits for large populations is not well understood, and, in truth, it probably varies based on a number of considerations. Generally, however, we can say that regular, daily meditation practice of at least 30 minutes or more is very likely to bring benefits to the person who does it.
As mentioned previously, human beings of all faith traditions have practiced meditation as part of their spiritual life. The ability to develop calm and focused attention, and the cultivation of deeper and broader present moment awareness (mindfulness), are both vital supports to any genuine spiritual practice, and thus, both of these benefits of meditation have been developed and enjoyed by countless spiritual seekers.
The use of meditation practices here in the West, largely for health benefits and promoted and investigated by the emerging field of mind-body medicine, for practical purposes, is only about 25 to 30 years old at present. Because of this absence of a previously developed and mature methodology of meditation for health promotion in Western medicine, many of the meditation methods now taught in the West for health purposes owe some (or considerable) debt to the instructions and experience detailed by meditation teachers of more ancient traditions.
There already exists an enormous body of experience with meditation and yogic practice in different traditions worldwide. The challenge for those working in the emerging field of mind-body medicine in the West in the past 25-30 years has been to identify what is useful and relevant about meditation and yogic practices in those more ancient and diverse contexts, and to translate it into something practical for those in the contemporary Western health care culture who wish to utilize that information, be they consumer or provider. Those who have pioneered meditation for health purposes in Western medicine in the past three decades, (Herbert Benson, MD, Joan Borysenko, PhD, Dean Ornish, MD, and Jon Kabat-Zinn, PhD, to name a few) have made deliberate efforts to make the meditation practices they teach non-sectarian and available to people of any and all faith traditions. This is true, for example, for Benson's method of eliciting the "relaxation response" in which instructions may have either a spiritual or secular focus depending on the individual's own preference. Likewise, the practices of mindfulness meditation and yoga/movement taught in the Mindfulness-Based Stress Reduction model (and this program) developed and taught by Jon Kabat-Zinn and his colleagues are explicitly crafted to appeal to individuals regardless of their faith tradition orientation. There is no specific religious or faith tradition emphasis, and the practices taught are offered for anyone who wishes to use them to enhance their own health.
As we practice mindfulness or present moment awareness, we can expect to experience certain difficulties. For example, with growing awareness in each moment, in each situation of our lives, we begin to be aware of the unpleasant and painful as well as the pleasant. We may become more aware of even "neutral" experiences as well, seeing in even these some unpleasant or pleasant aspect previously unnoticed. This growing awareness of the unpleasant can be upsetting to the beginning meditator. He or she can mistakenly believe they are not "doing it right" or are "not cut out to meditate!" At this stage it is vital that the meditator realizes the growing awareness of all aspects of life is actually progress. But if they are in a Mindfulness-Based Stress Reduction Program they might ask, "How does growing awareness of pain and the unpleasant help reduce my stress?" The answer is that to have a chance to reduce our stress and to heal ourselves from the toll stress takes in our lives, we must find a way to see clearly all that is here and to remain aware and present in order to give ourselves the best chance to make the most skillful response to whatever situation life offers us.
So if, through the practice of present moment awareness, we grow in awareness and begin to experience the unpleasant (as well as the pleasant) more deeply, more intensely, this is actually waking up to the reality of our lives. Yet it can be difficult to remain present, to "keep our seat," to continue meditating and continue our practice of present moment awareness. To support us in remaining present in these difficult moments, it is useful to call upon some other qualities we have within us. These qualities are kindness, compassion, and equanimity. It is important to realize that we are not imagining these or making them up. Rather, they are already within, important elements of our deepest nature as human beings. Unfortunately, many people do not realize the depth and power of these qualities within themselves, nor do they know how (or that it is even possible) to bring them forward and to cultivate these qualities in their own lives.
As we gain some increasing awareness of our own pain, it is important to notice our reaction. Too often people meet pain in themselves with criticism, meanness, or a sense of failure. They fall into patterns of stressful and destructive self-blame which just adds to the misery they already feel. Practicing mindfulness, we can be aware of our own pain whatever its nature (physical, emotional, etc.) And we can recognize our patterns and habits of judging and blaming ourselves for our own pain. Recognizing these patterns, we can respond with kindness and compassion instead of reacting with blame and meanness. Our challenge thus becomes, Can we meet and hold our own pain with the same compassion and kindness as we would meet and hold the pain of a loved one? This holding of ourselves in kindness and compassion is not easy! Most of our lives we have taken a very different attitude towards ourselves and our own pain. For that reason, we have to practice kindness and compassion openly and often towards ourselves. Our growing mindfulness can be a great ally in changing our habits of meanness towards ourselves to habits of kindness and compassion. As we learn to be aware of our own pain and our habitual critical and judgmental reactions about the pain, we have a choice in each moment of taking a different path, the path of compassion and kindness.
Even though we can understand the importance of not beating up on ourselves and of practicing habits of kindness and compassion, it can still be quite difficult at times to remain present in the face of pain and unpleasant experience. This is true whether the pain and unpleasant experience arises in our meditation practice or in our everyday life. To cultivate the ability to remain present in these intense situations, it can be especially helpful to remember that we carry in our deepest nature as human beings the quality of equanimity. Equanimity is often defined as even-mindedness or composure in the face of stress. It is associated with the quality of balance. It suggests a habit of mind (and heart) that is rarely disturbed, even under great strain. The meditation teacher, Jack Kornfield, says that equanimity develops in us as we learn to keep our heart open through the changing circumstances of our life. So a kind of courage and a willingness to stay present is also required. This is not just willpower, not gritting one's teeth and enduring. Rather, it is the act of bringing careful and open-hearted attention to what is here. It is not turning away. It is softening into what is present in our awareness in this moment, accepting things as they are in this moment even if that means we must open to a painful or unpleasant experience and see it exactly as it is. Then as we actually sit with increasingly difficult experiences, we discover that what is already in us is an ability to be composed. We can be unshakable. As we sit with these experiences more and more, we can feel the depth of our own equanimity more and more. The realization and manifestation in our own life of this innate quality of equanimity is based on our growing awareness of the impermanence of things and on our ability to accept things as they are in this moment. This equanimity is not to be confused with indifference. Quite the opposite. Equanimity enables us to remain deeply present and open to what is here.
Cultivating equanimity can be a meditation practice in itself. It is commonly recommended one "borrow" the elemental qualities in nature that embody equanimity. For example, one can picture oneself as a mountain, unshakable amidst all the changes and storms which happen on and around it. Or one can identify with a deep and still lake, which rests serene and undisturbed despite the swirl and splash of activity on its surface. Or one can use helpful reminder phrases such as, "May I be undisturbed by the changing circumstances of my life," "May I be aware and at peace with the changes that happen in every life and to everyone," or "May I offer my efforts and help, knowing it may be of great, some, or even no benefit." Another beautiful example of a support to cultivate equanimity in our lives is the famous Serenity Prayer, which asks for the serenity to accept the things we cannot change, to change the things we can, and the wisdom to know the difference.
Thus, using kindness, compassion, and equanimity, deep and authentic qualities within each human being, we can support ourselves to remain present, to be mindful, and then to act in the most healthy and skillful way in even the most stressful situations of our lives.
Have you ever started eating an ice cream cone, taken a lick or two, then noticed all you had was a sticky napkin in your hand? Or been going somewhere and arrived at your destination only to realize you haven't noticed anything or anyone you met along the way? Of course you have, we all have! These are common examples of "mindlessness," or as some people put it, "going on automatic pilot."
We all fall into habits of mind and body, of attention and inattention, which result in our not being present for our own lives. The consequences of this inattention can be quite costly. They can result in our missing some really good things, and also in our ignoring really important information and messages about our life, our relationships, and even our own health.
Our reactions to the stressful events of our lives can become so habituated that they occur essentially out of our awareness, until, because of physical or emotional or psychological dysfunction, we cannot ignore them any longer. These reactions can include tensing the body, experiencing painful emotional states, even panic and depression, and being prisoners of habits of thinking and self-talk including obsessional list making, and intense, even toxic self-criticism.
An important antidote to this tendency to "tune-out," to go on "automatic pilot," is to practice mindfulness. To practice mindfulness means to pay more careful attention in a particular way. We all have the quality of mindfulness in us. It is the quality of bare awareness that knows what is here in the present moment. Mindfulness knows what is going on outside, and also, inside our own skin. However we experience life, through whichever sense gate life comes to us - eyes, ears, nose, tongue, body, even the mind itself - mindfulness is capable of knowing that seeing, or hearing, or smelling, or tasting, or feeling, or even thinking - is happening in this, the present moment.
So, we can practice mindfulness and become more present. All we have to do is to establish attention in the present moment, and to allow ourselves to be with what is here. To rest in the awareness of what is here. To pay attention without trying to change anything. To allow ourselves to become more deeply and completely aware of what it is we are sensing! And to be with what it is we are experiencing. To rest in this quality of being, of being aware, in each moment as our life unfolds.
And, to the extent we can practice "being" and become more present and more aware of our life and in our life, the "doing" we do about all of it, will be more informed, more responsive, and less driven by the habits of reaction and inattention.
Make the effort! Whenever you think of it in your day or night, remember that you can be more mindful. See for yourself what it might be like to pay more careful attention and to allow yourself to experience directly what is here, especially including what is here in your own body, heart, and mind. When starting a new activity (beginning a meeting with 2 minutes of silence and attention on the breath, or taking a few mindful breaths before entering a patient's room, or a focus on the breath before starting your exercise routine, are some possibilities). In the middle of an on-going situation or process (bringing attention to the breath, or to the sensations arising while washing dishes, eating a meal, walking the dog, doing a job, etc.) Or when you are just waiting, in between the things on the schedule (gently bringing attention to the breath or the sounds or the sensations or the sights or even the thoughts while at a red light, in a line at the bus stop or grocery, or waiting for someone else to arrive).
In these situations, use the sensation of the breath as the "anchor" for awareness in the present moment. Establish mindfulness on the narrow focus of just the breath sensation. Allow yourself to feel the breath as it goes in, and goes out and the pause between in and out. Do not try to control the breath. Simply let it come and go. Bring as much attention, as completely and continuously as you can to the direct sensation of the breath.
After awhile, if you wish, when you have established awareness on the breath sensation, you could widen the focus to include all body sensations along with the breath sensation. Again, not trying to change anything at all! But, simply allowing yourself to feel, to be aware of the changing sensations in the body.
After awhile, again if you wish, you can further widen the focus to include all that is present. This means whatever you are hearing, seeing, tasting, smelling, touching, or even thinking. Just practice being with these different experiences as they unfold. Allowing yourself to feel your life in this moment. Resting in mindfulness, the open-hearted choiceless awareness of what is here in this moment.
Anytime you feel lost or confused or frustrated, gently narrow the focus and return awareness to the sensation of the breath. You may have to do this frequently. It is ok. Or you may wish to concentrate mainly on the breath, especially if you are new to meditation. That, too, is ok. The important thing is the quality of awareness you bring to the moment. One moment of mindfulness, one breath when we are truly present, can be quite profound. See for yourself!
You can practice mindfulness in this way throughout the day and night! Practice for a few breaths at a time, even for a few mindful moments. And, if you wish, you can make this a more "formal" meditation practice, by setting aside some time (from a few minutes to an hour or more, as you wish) free from other activity or distraction to devote full attention to simply being present, being mindful of what is present. Over time you may find that the "formal" practice supports and strengthens your ability to practice "informally" throughout the day and night in different situations.
Expect your mind to wander! Especially if you practice for even a few breaths or for a few minutes. Practice kindness and patience with yourself when this happens and gently return awareness to the breath sensation.
Notice any tendency to "be hard on yourself," or to feel frustrated or a failure. See this kind of judgment as just another kind of thinking, and gently return awareness to the breath.
Expect to feel some relaxation, especially if you practice for even a few breaths or for a few moments. This relaxed feeling is an ally. It helps us to be more present, more mindful. Relaxation alone is not what mindfulness is about, however! It is about being present with awareness.
Expect to become more mindful with practice! Expect to notice more things, including more painful things. This is actually progress! You are not doing anything wrong! Quite the opposite, you are increasing mindfulness for all things. When you begin to notice the painful things, see if you can hold yourself with compassion and kindness, and continue to bring open-hearted awareness to the experience that is unfolding. By practicing staying present, not turning away from the painful in our lives, we can learn to remain open to all the possibilities in each situation. This increases our chances for healing and transformation in meeting the pain we face. And it also gives us a way to be with those situations when there is nothing more we can do to "get away from the pain" but must find a way to be with it. We can discover that the quality of mindfulness is not destroyed or damaged by contact with pain, that it can know pain as completely and fully as it knows any other experience.
Finally, be careful not to try too hard when practicing mindfulness. Don't try to make anything happen, or to achieve any special states or any special effects! Simply relax and pay as much attention as you can to just what is here now. Whatever form that takes. Allow yourself to experience life directly as it unfolds, paying careful and open-hearted attention.
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