Motivation and emotion/Book/2013/Mindfulness

Mindfulness:
What is it and how can it be developed?

Mindfulness and its role in psychological well-being

Mindfulness is often spoken of synonymously as insight meditation, which means a deep, penetrative non-conceptual seeing into the nature of mind and world (Kabat-Zinn, 2003). This seeing requires a spirit of perpetual and persistent inquiry-as in, what is this?- toward whatever arises in awareness, and toward who is attending, who is seeing, who is meditating. Its role in deep inquiry and the cultivation of insight have led some to argue that that mindfulness provides a unique perspective that can inform critical issues in cognitive science, neurophenomenology, and attempts to understand the cognitive underpinnings of human experience itself (Varela, Thompson, & Roach, 1991).

The universe of mindfulness brings with it a whole new meaning, and thrust to the word practice, one which researchers believe has the potential to contribute profoundly to the further development of the field of clinical psychology and its allied disciplines, behavioral medicine, psychosomatic medicine, and health psychology, through both a broadening of research approaches to mind/body interactions and the development of new classes of clinical interventions (Kabat-Zinn, 2003). Mindfulness has to do with particular qualities of attention and awareness that can be cultivated and developed through meditation. Mindfulness is the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment (Kabat-Zinn, 2003).

Historically, mindfulness has been called the heart of Buddhist meditation (Thera, 1973). It resides at the core of the teachings of the Buddha, traditionally described by the Sanskrit word dharma, which carries the meaning of lawfulness as in "the laws of physics" or simply "the way things are", as in the Chinese notion of Tao. One might think of the historical Buddha as among other things, a born scientist and physician who had nothing in the way of instrumentation other than his own mind and body and experience, yet managed to use these native resources to great effect to delve into the nature of suffering and the human condition (Baer, 2003). What emerged from this arduous and single-minded contemplative investigation was a series of profound insights, a comprehensive view of human nature,and a formal "medicine" for treating its fundamental "dis-ease", typically characterized as the three "poisons": greed, hatred (aversion), and ignorance/delusion (unawareness) (Kabat-Zinn, 2003). One might think of dharma as a sort of universal generative grammar, an innate set of empirically testable rules that govern and describe the generation of the inward, first-person experiences of suffering and happiness in human beings (Kabat-Zinn, 2003). In that sense, dharma is at its core truly universal, not exclusively Buddhist. It is neither a belief, an ideology, nor a philosophy. Rather, it is a coherent phenomenological description of the nature of mind,emotion, and suffering and its potential release, based on highly refined practices aimed at systematically training and cultivating various aspects of mind and heart via the faculty of mindful attention (Kabat-Zinn, 2003).

The words for mind and heart are the same in Asian languages; thus mindfulness includes an affectionate,compassionate quality within the attending, a sense of openhearted,friendly presence and interest. It should also be noted that mindfulness,being about attention,is also of necessity universal (Kabat-Zinn, 2003). There is nothing particularly Buddhist about it. We are all mindful to one degree or another, moment by moment.It is an inherent human capacity. The contribution of the Buddhist traditions has been in part to emphasize simple and effective ways to cultivate and refine this capacity and bring it to all aspects of life (Kabat-Zinn, 2003). In this regard, mindfulness certainly received its most explicit and systematic articulation and development within the Buddhist tradition over the past 2,500 years, although its essence lies at the heart of other ancient and contemporary traditions and teachings as well, approaches that can be of great value in refining one's own practice, insight, and teaching (Kabat-Zinn, 2003).

Learning mindfulness

Mindfulness is believed to be a skill that can be learned and developed through meditation practice.It was introduced within the Pali Canon of Buddhist scriptures in the Mahasatipitthana Sutta as a set of contemplative exercises to observe internal and external phenomena (Walsh,1980). Mindfulness meditation, also known as insight-oriented meditation or vipassana,is one of several meditations in Buddhist practice (Hamilton et al., 2006). Consistent with positive psychology goal of promoting resilience,mindfulness includes goals such as enhancing well-being and awareness of the self and environment, along with disciplining the mind and emotions (Hann, 1975, 1993; Levine, 2000). Mindfulness meditation was venerated in the Buddhist tradition as a powerful and efficient technique to quite the mind by active observation of the breath and various physical and psychological states (Gampopa, 2000). In the context of Buddhist practice, this observation was intended to illustrate the impermanent nature of cognitive, affective, and physical phenomena. Recognizing these phenomena as impermanent, the practitioner becomes less reactive and can maintain affective balance in the face of potentially difficult circumstances, a concept called equanimity (Kumar et al., 2008).

Mindfulness is still viewed in Buddhist traditions as a cornerstone for cultivating affective balance (Wallance & Shapiro, 2006). In 1979, Kabat-Zinn introduced a structured 8-week group training to cultivate mindfulness, mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1990). The focus is on doing exercises, such as the body scan, yoga, sitting, and walking meditation. MBSR is a group-based intervention program originally designed as an adjunct treatment for patients with chronic pain (Kabat-Zinn, 1982; 1990). The program offers intensive training in mindfulness meditation to help individuals relate to their physical and psychological conditions in more accepting and nonjudgmental ways. In this program a group of up to thirty participants meet for two to two and half hours per week for mindfulness meditation instruction and training (Kabat-Zinn, 1990). In addition to in-class mindfulness exercises, participants are encouraged to engage in home mindfulness practices and attend an all-day intensive mindfulness meditation retreat. The premise of MBSR is that with repeated training in mindfulness meditation, individuals will eventually learn to be less reactive and judgmental toward their experiences, and more able to recognize, and break free from, habitual and maladaptive patterns of thinking and behavior (Hamilton et al., 2006).

More recently, Segal and colleagues combined MBSR with cognitive therapy, so-called mindfulness-based cognitive therapy (MBCT; Segal et al., 2002). Learning to early recognize and attend to distressing thoughts and emotions and to disengage from automatic dysfunctional thoughts and behavioral patterns (such as rumination and avoidance) are believed to be a core aspect of MBCT. In recent years, these mindfulness-based interventions have become increasingly popular psychological interventions and most research on mindfulness is focusing on the effects of these interventions on health outcomes (Coelho, Canter, & Ernst, 2007). Mindfulness training has become an increasingly useful clinical intervention for promoting emotion regulation (Hayes & Feldman, 2004; Linehan, 1993). Mindfulness training has been incorporated into psychotherapies for a variety of psychiatric disorders, including major depression (Segal et al., 2002), generalized anxiety disorder (Kabat-Zinn et al. 1992; Roemer & Orsillo 2002), borderline personality disorder (Linehan, 1993), eating disorders (Kristeller & Hallett, 1999), post-traumatic stress disorder (Wolfsdorf & Zlotnick, 2001), and substance abuse (Marlatt, 1994).

Mindfulness practice has a rich historical tradition as a way to develop emotional stability. Mindfulness training teaches participants to cultivate a new relationship with internal experiences that involves regulating attention so that it is maintained on immediate experience, without avoiding, over-engaging, or elaborating the experience (Kumar et al., 2008). The practitioner also learns to approach experiences with an orientation of acceptance and observation, regardless of the valence and desirability of the experience (Bishop et al., 2004). Consistent with early Buddhist perspectives, mindfulness meditation in Western practice is hypothesized to develop a distance from, or decentered relationship with, one's internal and external experiences, thereby decreasing emotional reactivity and facilitating a return to baseline after reaction (Kumar et al., 2008). Several lines of research suggest that emotion regulation is an essential component of mental health and that problems of regulation are associated with a variety of forms of psychopathology (Kumar et al., 2008).

In traditional Buddhist writings, mindfulness is thought to improve well-being by reducing tendencies towards aversion and attachment to internal and external phenomena, which facilitates emotional regulation (Kumar, 2002; Wallace & Shapiro, 2006). There is substantial evidence that both avoidance and over-engagement with emotions are associated with worse psychological and physical health outcomes. Consistent with the original instruction of mindfulness in the Mahasatipitthana Sutta, Kabat-Zinn (2003) contrasts mindfully allowing oneself to acknowledge and experience emotional pain with emotional avoidance, suppression,and preoccupation ((Kumar et al., 2008). Mindfulness research has linked the cultivation of present-centered awareness to a number of important emotional outcomes, including greater emotional resiliency in those suffering debilitating illnesses, and increased levels of positive affect and empathy in nonclinical populations (Shapiro, Speca, Patel, & Goodey, 2003).

Mechanisms of mindfulness

Some researchers have proposed a model of mindfulness, in an effort to elucidate potential mechanisms to explain how mindfulness affects positive change (Shapiro et al., 2006). Studies have identified three axioms of mindfulness:intention,attention, and attitude (IAA). From an understanding of IAA, we can deduce how mindfulness might work. Intention, attention and attitude are not separate processes or stages- they are interwoven aspects of a single cyclic process and occur simultaneously (Shapiro et al., 2006).

Intention

Previously Western psychology attempted to extract the essence of mindfulness practice from its original religious/cultural roots, thus it lost to some extent, the aspect of intention, which for Buddhism was enlightenment and compassion for all beings (Shapiro & Schwartz, 2000).It seems valuable to explicitly bring this aspect back into western psychological models (Shapiro & Schwartz, 2000). Kabat-Zinn(1994),has written that our intentions set the stage for what is possible. They remind you from moment to moment of why you are practicing in the first place? He continues to say that he used to think that meditation practice was so powerful, that as long as you did it at all,you would see growth and change. But time had taught him, that some kind of personal vision is also necessary (Kabat-Zinn, 1994). This personal vision or intention is often dynamic and evolving (Feldman et al., 2007).The role of intention in meditation practice is exemplified by researchers, who explored the intentions of meditation practitioners and found that as mediators continue to practice, their intentions shift along a continuum from self-regulation, to self-exploration, and finally to self-liberation (Shapiro, 1992). Further, the study found that outcomes correlated with intentions. Those whose goal was self-regulation and stress management attained self-regulation, those whose goal was self-exploration attained self-exploration, and those whose goal was self-liberation moved towards self-liberation and compassion service (Shapiro, 1992). These findings are in line with the definition of intentions as dynamic and evolving, which allows them to change and develop with deepening practice, awareness, and insight. The inclusion of intention (i.e., why one is practicing) as a central component of mindfulness is crucial to understanding the process as a whole, and often overlooked in other contemporary definitions (Bishop et al., 2004).

Attention

A second fundamental component of mindfulness is attention. In the context of mindfulness practice, paying attention involves observing the operations of one's moment-to-moment, internal and external experience. Researchers refer to this as a return to things themselves,that is, suspending all the ways of interpreting experience and attending to experience itself, as it presents itself in the here and now (Shapiro et al., 2006). In this way, one learns to attend to the contents of consciousness, moment by moment. Attention has been suggested in the field of psychology as critical to the healing process. For example, Gestalt therapy emphasizes present moment awareness, and its founder, Fritz Perls claimed that, attention in and of itself is curative (Shapiro et al., 2006). The importance of attention can also be seen in cognitive-behavior therapy, which is based on the capacity to attend to (i.e., observe) internal and external behaviors. At the core of mindfulness, is this practice of paying attention ( Shapiro et al., 2006).

Attitude

How we attend is also essential. The qualities one brings to attention have been referred to as the attitudinal foundations of mindfulness (Kabat-Zinn, 1990, & Shapiro & Schwartz, 1999, 2000). This axiom asserts that the attitude one brings to the attention is essential. Often, mindfulness is associated with bare awareness, but the quality of this awareness is not explicitly addressed. However, the qualities one brings to the act of paying attention is crucial. For example, attention can have a cold, critical quality, or it can include an affectionate,compassionate quality, a sense of open hearted, friendly presence and interest (Kabat-Zinn, 2003). It is helpful to note the Japanese characters of mindfulness are composed of two interactive figures: one mind, and the other heart (Santorelli, 1999). Therefore, perhaps a more accurate translation of mindfulness from the Japanese is heart-mindfulness, which underlines, the importance of including heart qualities in the attentional practice of mindfulness (Shapiro & Schwartz, 2000). Researchers have proposed that people can learn to attend to their own internal and external experiences, without evaluation of interpretation, and practice acceptance, kindness and openness even when what is occurring in the field of experience is contrary to deeply held wishes or expectations (Shapiro & Schwartz, 2000). However, it is essential to make the attitudinal quality of attention explicit. It is important for the practitioner to consciously commit, e.g. may I bring kindness, curiosity, and openness to my awareness, may I infuse my awareness with compassion, etc. It has been seen that with intentional training, one becomes increasingly able to take interest in each experience as it arises and also allow what is being experienced to pass away (i.e., not be held on to)(Shapiro et al., 2006). Through intentionally bringing the attitudes of patience, compassion and non-striving to the attentional practice, one develops the capacity not to continually strive for pleasant experiences, or to push aversive experiences away. In fact, attending without bringing the heart qualities into the practice may result in practice that is condemning or judgmental of inner experience (Shapiro et al., 2006).

Mindfulness & emotional well being

Mindfulness captures a quality of consciousness that is characterized by clarity and vividness of current experience and functioning and thus stands in contrast to the mindlessness : less awake states of habitual or automatic functioning that may be chronic for many individuals (Brown & Ryan, 2003). Mindfulness may be important in disengaging individuals from automatic thoughts, habits,and unhealthy behavior patterns and thus could play a key role in fostering informed and self-endorsed behavioral regulations, which has long been associated with well-being enhancement (Ryan & Deci, 2000). Further, by adding clarity and vividness to experience, mindfulness may also contribute to well-being and happiness in a direct way (Brown & Ryan, 2003). Through the process of mindfulness, one is able to disidentify from the contents of consciousness (i.e., one's thoughts) and view his or her moment-by-moment experience with greater clarity and objectivity. Researchers have termed this process reperceiving as it involves a fundamental shift in perspective (Shapiro et al., 2006). Rather than being immersed in the drama of our personal narrative or life story, we are able to stand back and simply witness it. It has been suggested, that the first realization in meditation is that the phenomena contemplated are distinct from the mind contemplating them (Goleman, 1980).Reperceiving is believed to be a meta-mechanism of action, which overreaches additional direct mechanisms that lead to change and positive outcomes.Intentionally cultivating nonjudgmental attention leads to connection, which leads to self-regulation and ultimately to greater order and health. Through the process of reperceiving, we are able to attend to the information contained in each moment.We gain access to more data, even those data that may have previously been too uncomfortable to examine (Hayes, 2002). Experiential avoidance becomes less automatic and less necessary. Through this process, dysregulation and subsequent disease can be avoided. In addition, reperceiving interrupts automatic maladaptive habits. We become less controlled by particular emotions and thoughts that arise, and in turn are less likely to automatically follow them with habitual reactive patterns (Hays, 2002). For example, if anxiety arises, and we strongly identify with it, there will be a greater tendency to react to the anxiety unskillfully and subsequently regulate it by some behavior such as drinking,smoking, or overeating. Reperceiving allows us to step back from the anxiety, to see it clearly as simply an emotional state that is arising and will in time pass away (Hays, 2002). Thus, this knowledge of the impermanence of all mental phenomena allows a higher level of tolerance for unpleasant internal states.By developing the capacity to stand back and witness emotional states such as anxiety, we increase our degrees of freedom, in response to such states, effectively freeing ourselves from automatic behavioral patterns (Shapiro et al., 2006). Through reperceiving, we are no longer controlled by states such as anxiety or fear but are instead able to use them as information. We are able to attend to the emotion, and choose to self-regulate in ways that foster greater health and well-being (Brown & Ryan, 2003).

Conclusion

Based on examination of extensive literature,this chapter concludes that mindfulness and its cultivation facilitates adaptive psychological functioning (Keng, Smoski, & Robins, 2011). There is a clear convergence of findings from various studies of mindfulness- all of which suggest that mindfulness is positively associated with psychological health, and that training in mindfulness may bring about positive psychological effects (Keng, Smoski, & Robins, 2011). These effects ranged from increased subjective well-being, reduced psychological symptoms and emotional reactivity, to improved regulation of behavior (Keng, Smoski, & Robins, 2011). There is also an increasingly substantial research body pointing to a number of psychological processes that may serve as a key mechanisms of effects of mindfulness interventions. As research on mindfulness is in its early stages of development, further collaborative research is needed to develop a more solid understanding concerning the nature of mindfulness, how mindfulness can best be measured, fostered, and cultivated, and the mechanisms and specificity of effects of mindfulness-oriented interventions (Keng, Smoski, & Robins, 2011). Future research should also continue to explore other potential applications of mindfulness, and examine practical issues concerning the delivery, implementation, and dissemination of mindfulness-oriented interventions (Keng, Smoski, & Robins, 2011). Given the advances that have been made thus far, it is likely that new paradigms for the understanding and application of mindfulness will continue to appear, which would move us further toward the goals of alleviating human psychological suffering and helping others live a life that is happier and more fulfilling (Keng, Smoski, & Robins, 2011).

See also

• Mindfulness: How effective is mindfulness in managing emotions? (Book chapter, 2011)

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