mindfulness: what is it? where does it come from?

From Didonna, F. (Ed.) (2008).Clinical Handbook of Mindfulness. New York: Springer.

nicabmwww.nicabm.com

Mindfulness:WhatIsIt?

WhereDoesItComeFrom?

Distributed with permission by:The National Institute for the Clinical Applicationof Behavioral Medicine

Ronald D. Siegel PsyDChristopher K. Germer PhD

Andrew Olendzki, PhD

Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhDDistributed with permission by

The National Institute for the Clinical Application of Behavioral Medicinewww.nicabm.com

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Mindfulness: What Is It? Where Did It Come From?


RonaldD.SiegelPsyD,ChristopherK.GermerPhD,AndrewOlendzki,PhD

We can make our minds so like still water that beings gather about us, that they may see, it may be, their own images, and so live for amomentwithaclearer,perhapsevenwithafiercerlifebecauseof our quiet. WilliamButlerYeats

Throughouthistory,humanbeingshavesoughttodiscoverthecausesofsufferingandthemeanstoalleviateit.Soonerorlater,weallaskthesamequestions:“WhyamInotfeelingbetter?”“WhatcanIdoaboutit?”Inhabitingaphysicalbodyinevitablyexposesustopainassociatedwithsickness,oldage,anddeath.Wealsostruggleemotionallywhenconfrontedwithadversecircumstances,orwithbenigncircumstancesthatweseeasadverse.Evenwhenourlivesarerelativelyeasy,wesufferwhenwedon’tgetwhatwewant,whenwelosewhatweoncehad,andwhenwehavetodealwithwhatwedonotwant.Frombirthuntildeath,wearerelentlesslytryingtofeelbetter.

Asthisbookwillshow,mindfulnessisadeceptivelysimplewayofrelatingtoallexperiencethatcanreducesufferingandsetthestageforpositivepersonaltransformation.Itisacore psychological process that can alter how we respond to the unavoidable difficulties in life—notonlytoeverydayexistentialchallenges,butalsotoseverepsychologicalproblemssuchassuicidalideation(Linehan,1993),chronicdepression(Segal,Williams&Teasdale,2002),andpsychoticdelusions(BachandHayes,2002).

Mindfulness is not new. It’s part of what makes us human—the capacity to be fully consciousandaware.Unfortunately,weareusuallyonlyinthisstateforbriefperiodsoftime,andaresoonreabsorbedintofamiliardaydreamsandpersonalnarratives.Thecapacityforsustainedmoment-to-momentawareness,especiallyinthemidstofemotionalturmoil,isaspecialskill.Fortunately,itisaskillthatcanbelearned.

Mindfulnessisanelusive,yetcentral,aspectofthe2500year-oldtraditionofBuddhistpsychology.Wecantalkaboutmindfulnessorwriteatlengthaboutit,buttotrulyunderstandmindfulnesswehavetoexperienceitdirectly.Thisisbecausemindfulnesspointstosomethingintuitive and pre-conceptual. With committed practice, every person can gradually figure out how to become more and more mindful in life, even in the face of significant suffering. Cultivating mindfulnessis,andhasalwaysbeen,adeeplypersonaljourneyofdiscovery.



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The Ancient Meaning of Mindfulness

“Mindfulness,”asusedinancienttexts,isanEnglishtranslationofthePaliword,sati,whichconnotesawareness,attention,andremembering.(Paliisthelanguageinwhichtheteachingsofthe Buddha were originally recorded. The first dictionary translation of sati into “mindfulness” dates to 1921 (Davids & Stede, 1921/2001). As we shall see, the definition of “mindfulness” has been somewhat modified for its use in psychotherapy, and it now encompasses a broad range of ideasandpractices.

Awarenessisinherentlypowerful,andattention,whichisfocusedawareness,ismorepowerfulstill.Justbybecomingawareofwhatisoccurringwithinandaroundus,wecanbegintountangleourselvesfrommentalpreoccupationsanddifficult emotions. Sometimes this can be quitesimple,asinthecaseofamentallyretardedmanwhomanagedhisangeroutburstsbyshiftinghisattentiontothe“solesofthefeet”wheneverhenoticedhewasangry(Singh,Wahler,Adkins,&Myers,2003).Byredirectingattention,ratherthantryingtocontrolorsuppressintenseemotions,wecanregulatehowwefeel.

Anotheraspectofmindfulnessis“remembering.”Thisdoesnotrefertomemoryofpastevents.Rather,itmeansrememberingtobeawareandpayattention,highlightingtheimportanceofintention in mindfulness practice. Each moment we remind ourselves: “Remember—be aware!”

But“mindfulness”meansmorethanbeingpassivelyaware,orbeingawareforawareness’sake.TheBuddhistscholar,JohnDunne(2007)haspointedoutthatawareness,attention,andremembering(sati)arepresentwhenasniper,withmaliceinhisheart,takesaimataninnocentvictim.Obviouslythisisnotwhatwe’retryingtocultivateaspsychotherapists,norisitthegoalofBuddhistpsychology.Rather,the

purposeofmindfulnessinitsancientcontextistoeliminateneedlesssufferingbycultivatinginsightintotheworkingsofthemindandthenatureofthematerialworld.Themindfulness

Just by becoming aware of what is occurring within and around us, we can begin to untangle ourselves from mental preoccupations and difficult emotions.

The mindfulness practictioner is actively working with states of mind in order to abide peacfully in the midst of whatever happens.



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practitionerisactivelyworkingwithstatesofmindinordertoabidepeacefullyinthemidstofwhateverhappens.

Throughmindfulness,wedevelop“streetsmarts”tomanagethemind(Bhikkhu,2007).It helps us to recognize when we also need to cultivate other mental qualities—such as alertness, concentration, lovingkindness, and effort—to skillfully alleviate suffering. For example, if in meditationwearebeingself-critical,wemaywanttoaddadoseofcompassion;ifwearefeelinglazy,wemightwanttotrytoraisethelevelofenergyinthemindorbody.Mindfulnessaloneisnot sufficient to attain happiness, but it provides a solid foundation for the other necessary factors (Rapgay&Brystrisky,2007).Intheclassicalliterature,mindfulnesswasusuallydiscussedintermsofitsfunction,notasagoalinitself.Mindfulnessisultimatelypartofaprojectdesignedto uproot entrenched habits of mind that cause unhappiness, such as the afflictive emotions of anger,envy,orgreed,orbehaviorsthatharmourselvesandothers. Therecentfocusonmindfulawarenessinpsychotherapyisastrategiccorrectiontosomemoderntreatmenttrends.Manywell-intentionedtherapists prematurely attempt to “fix” a patient’s problems,unwittinglybypassingself-acceptanceandself-understanding.Aswillbedemonstratedthroughoutthisvolume,ouremotionalandbehavioral problems can be amplified by our instinctive efforts to avoid discomfort by propelling ourselvesintochange-seekingactivity.Theapproachofthenew,mindfulness-orientedagendais“awareness and acceptance first, change second.”

Therapeutic Mindfulness

AsmindfulnessisadoptedbyWesternpsychotherapyandmigratesawayfromitsancientroots,itsmeaningisexpanding.Mostnotably,mentalqualitiesbeyondsati(awareness,attention,andremembering)arebeingincludedin“mindfulness”asweadaptittoalleviateclinicalconditions.Thesequalitiesincludenon-judgment, acceptance,andcompassion JonKabat-Zinn,theforemostpioneerinthetherapeuticapplicationofmindfulness,defines it as “the awareness that emerges through paying attention on purpose, in the present moment,andnonjudgmentallytotheunfoldingofexperiencemomenttomoment”(Kabat-Zinn,2003, p. 145). In 2004, Bishop et al offered a consensus paper on the definition of mindfulness: Mindfulnessis“self-regulationofattentionsothatitismaintainedonimmediateexperience,

Mindfulness is ultimately part of a project designed to uproot entrenched habits of mind that cause unhappiness...



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therebyallowingforincreasedrecognitionofmentaleventsinthepresentmoment.”And,“adoptingaparticularorientationtowardone’sexperiencethatischaracterizedbycuriosity,openness, and acceptance” (p. 232). The second part of this definition captures an essential emotionalorintentionalattitudeofmindfulnessinclinicalsettings. A stripped-down definition of “therapeutic mindfulness” that we and our colleagues at the Institute for Meditation and Psychotherapy find useful is awareness,ofpresent experience,with acceptance(Germer,Siegel,&Fulton,2005).Thesethreeelementscanbefoundinmostmodernpsychologicalliteratureonmindfulness.Althoughthe“acceptance”componentisimpliedintheclassicalBuddhisttexts,ithelpstomakeitexplicitforclinicalapplication.Otherrelatedshorthandexpressionswemightusefortherapeuticmindfulnessinclude“affectionateawareness,”“mindfulacceptance,”“openheartedpresence,”and“mindfulcompassion.” Theexplicitadditionof“acceptance”tothemindfulnessformulamakessensetomostpsychotherapists.Thisisespeciallythecasewhenourpatientsareconfrontedwithoverwhelmingtraumaticcircumstances.Awarenesswithoutacceptancecanbelikelookingatascarysceneunder a bright floodlight. Sometimes we need softer light—like a candle—to approach difficult experience. The more intensely we suffer, it seems, the more we need acceptance and compassiontobeabletoworkwithwhat’soccurringinourlives.Conversely,kindnesswithoutclear awareness can lead to sugar coating the difficulties of life that need to be addressed. Sansawareness,acceptancecouldbecomeaformofdefensiveavoidance. Whenpatientscometopsychotherapy,theyareoftenindiredistress,seekingapersonwhowilltakethetimetounderstandwhotheyareandwhytheysuffer.Theydesperatelywantastrategyforrelief.Compassionistheinvisiblematrixthatholdstheentireenterprise.Theword“compassion”comesfromtheLatinroots,com pati,orto“sufferwith.”That’showwereally come to understand what our patients are going through—we suffer withthem.Ifweofferhelpful advice to a patient without first providing acceptance and compassion, he or she simply feelsmisunderstood. Similarly,intheintrapersonal, therapeutic relationship—the one we have with ourselves—compassion is also important. Self-compassion and self-acceptance are “skillful means”forbeingawareundertryingcircumstances.Weneedanopenhearttohaveopeneyes.Whenwepracticemindfulnessbyourselves,self-acceptanceishopefullypartofouremotionallandscape;inthetherapyrelationship,acceptanceandcompassionareessentialfortheprocesstobeeffective.



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Mindfulness and Mindlessness Apsychotherapistneedstoexperiencemindfulnessinordertointegrateitintohisorherclinicalpractice.Learningmeditationfromanexperiencedteacheristhebestwaytobeginand is strongly recommended. Psychotherapists also benefit from a conceptual road map to guide their work. To this end, we suggest using the definition of mindfulness just mentioned: (1) awareness, (2) of present experience, (3) with acceptance(Germer,Siegel,&Fulton,2005).Amomentofmindfulnesscontainsthesethreeintertwinedelements.Themindfulness-orientedtherapistmayask,momenttomoment,“HowdoIcultivateawarenessofpresentexperiencewithacceptance,formyselfandmypatient?”Thiscanbeatouchstoneforpractice.

While its definition is easy to remember, the directexperienceofmindfulnessismoreelusive.Sometimesmindfulnessiseasiesttounderstandbyexaminingitsopposite.Evencasualself-examinationrevealsthatourtypicalmentalstateisremarkablymindless.Wespendmostofourtimelostinmemoriesofthepastandfantasiesofthefuture.Moreoftenthannot,weoperateon“autopilot,”whereourmindsareinoneplaceandourbodiesareinanother.

Anembarrassingexampleofthishappenedtooneofusrecentlywhiledrivingtopresentaworkshoponmindfulnessandpsychotherapy: Iwasinarushandrunninglate.Suddenly,afewminutesintomydrive,IrealizedthatI was heading in the wrong direction on the Massachusetts Turnpike—a toll road on which theexitscanseemasthoughtheyare50milesapart.Iwondered,“Whowasdrivingthecar?”“Whodecidedtoheadwest?Mymindwasbusypreparingmypresentation,whilemybodywassteeringthecarautomatically,skillfullyheadinginthewrongdirection.

Similarexamplesabound.ConsidertheleadingcauseofemergencyroomvisitstoNewYorkhospitalsonSundaymornings:bagel-cuttingaccidents.Whileinteractingwithfamilymembersontheweekend,manypeoplearesodistractedbyinterpersonaleventsthattheirbodiescut bagels on automatic—and their bodies aren’t very good at this without guidance from the consciousmind. Another,lesspainful,exampleofeverydaymindlessnessoccursinrestaurants.Haveyounoticedhowmuchrestaurantconversationrevolvesaroundwhereyouateinthepast,orwhere

Psychotherapists also benefit from a conceptual road map to guide their work.



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youmighteatinthefuture?Onlyoccasionallydoweactuallytastethefoodthatwe’reeating. And then there are our deliberate efforts to escape the present moment—trying to get to the “good stuff.” Do you ever find yourself rushing through the dishes to get to your cup of tea,book,ortelevisionprogram?Haveyoueverhadthethought,perhapstenminutesintoapsychotherapy session with a frustrating patient, “Darn, forty minutes to go!” When we reflect honestly,wenoticethatwe’rerushingthrough,ortryingtogetridofmuchofourlifeexperience. Youmaynoticethiseveninthepresentmoment:Asyoureadthesesentences,wherehasyourmindgone?Haveyouhadthoughtssuchas,“Iwonderifthisbookisgoingtobeworthwhile?”“MaybeIshould’vegottenanotherone,”or“Thisisprettyinteresting,Ihopetherestofitisgoodtoo.”Perhapsyourmindhasleftthebookentirely,andyou’rethinkingaboutwhatyou’lldolater,orwhathappenedearliertoday. Thepervasivenessofeverydaymindlessnessisparticularlystrikingwhenweinquire

intowhatreallymattersinourlives.Takeafewsecondstorecallamomentinyourlifethatyoureallyvalued.(Really,stopreadingforamomentandthinkofone.)Perhapsitwasaspecialtimewithsomeoneyoulove,oramagical

experienceinnature.Duringthismoment,wherewasyourmind?Wasitfocusedonrecallingthepast, or imagining the future? Most people find that the moments they value the most are those in whichthey’refullypresent,noticingwhatishappeninghereandnow. Thesearemomentsofmindfulness.Wenoticethepositionsofourhands,andthesensationsofholdingaknifeandbagel.Weareawareofourbodiessittinginthecarwhenwedrive,andwenoticetheothercars,theroad,thescenery.Wetastethefoodweeat,andweactuallyexperiencethesight,sound,andemotionalpresenceofourpatientsduringpsychotherapy.Rightnow,trynoticingthepositionofyourhandsasyouholdthisbook,thephysicalexperienceofsittingorlyingdown,andhowyourmindreactstothesewords.Mindfulnessinvolvesbeingpresenttoourlives.

When we reflect honestly, we notice that we’re rushing through, or trying to get rid of much of our life experience.



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While notoriously difficult to convey with words, the Zen Haiku tradition endeavors to capturemomentsofmindfulness.HereisaclassicexamplefromMatsuoBasho,awanderingJapanesepoetofthe17thcentury: Anoldpond! A frog jumps in — Thesoundofwater. (Toyomasu,2001)

Mindfulness Practice Whileitcanbedisturbingtonoticehowfrequentlywearemindless,andhowmuchofourliveswewishaway,thereisalsogoodnews:mindfulnesscanbecultivated.Justaswecanimprove physical fitness through regular physical exercise, we can develop mindfulness through deliberatementalpractices. Mindfulnesspracticesallinvolvesomeformofmeditation.EspeciallyintheWest,misconceptionsaboutmeditationpracticeabound.Itmaythereforebehelpfultoexaminesomeofthemostcommonmisunderstandings. Not Having a Blank Mind:Whilesomeconcentrationpracticesaredesignedtoemptythemindofthought,thisisnotanaimofmindfulnesspractice.Nordowewishtobecomestupid,orloseouranalyticalabilities.Instead,mindfulnesspracticeinvolvestrainingthemindtobeawareofwhatitisdoingatalltimes,includingbeingawarethatwearethinkingwhenwethink. Not Becoming Emotionless:Manypeoplesecretlyhopethatmindfulnesspracticewillrelievethemoftheburdenofemotion.Especiallywhenindistress,thefantasyofbecomingemotionlesscanbequiteappealing.Inreality,mindfulnesspracticeoftenhasquitetheoppositeeffect.Becausewepracticenoticingthecontentsofthemind,wecometonoticeouremotionsmorefullyandvividly.Ourabilitytorecognizehowwefeelincreasesaswerelinquishnormaldefenses,suchasdistractingourselvesfromdiscomfortwithentertainmentoreating.

Just as we can improve physical fitness through regular physical exercise, we can develope mindfulness through deliberate mental practices.



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Not Withdrawing from Life: Because most meditation practices were originally refined bymonks,nuns,andhermits,peopleoftenassumethattheyinvolvewithdrawingfromlivinga full, interpersonally rich life. While there are certainly benefits to be derived from practicing mindfulness in a simplified environment, even in these settings one isn’t exactly withdrawing. Instead,thevicissitudesoflifeareexperiencedmorevividly,becausewe’retakingthetimetopayattentiontoourmoment-to-momentexperience. Not Seeking Bliss:Theimageofthespiritualmasterblissfullysmilingwhiletherestofusstrugglewithexistentialrealityisveryappealing.Earlyintheirmeditationcareers,manypeople become distressed when they find that their minds wander and they feel agitated or unsettled.Whileexceptionallypleasantstatesofminddooccur,inmindfulnessmeditationweallow them to arise and pass—not clinging to blissful states nor rejecting unpleasant ones. Not Escaping Pain:Ratherthanescapingpain,mindfulnesspracticehelpsustoincreaseourcapacitytobearit.Wedeliberatelyabstainfromautomaticactionsdesignedtomakeourselvesfeelbetter.Forexample,ifwearemeditatingandanitcharises,atypicalinstructionistoobservetheitchandnoticeanyimpulsesthatarise(suchastheurgetoscratch)—but to not act on the urge. As a result, we actuallyexperiencepainanddiscomfortmorevividly.Thisextendsbeyonditchesandphysicalpaintoincludethefullspectrumofemotionaldiscomfortaswell.Asweexploreandaccepttheseunpleasantexperiences,ourcapacitytobearthemincreases.Wealsodiscoverthatpainfulsensationsaredistinctfromthesufferingthataccompaniesthem.Weseethatsufferingariseswhenwereacttopainwithresistance,protest,oravoidanceratherthanmoment-to-momentacceptance.Forms of Pracitce Therearemanywaystocultivateawarenessofcurrentexperiencewithacceptance.Notsurprisingly,alloftheminvolverepeatedpractice.Ifwewanttoimproveourcardiovascularfitness, we might begin by integrating physical exercise into our everyday routine—taking the stairsinsteadoftheelevator,orridingabicycleinsteadofdrivingtowork.Ifwewanttobecomeeven more physically fit, we might set aside time to exercise formally, perhaps at a gym or health club. To really accelerate the process, we might go on a fitness-oriented vacation, in which much ofthedayisspentinvigorousexercise.Similaroptionsareavailableforcultivatingmindfulness.

Rather than escaping pain, mindfulness practice helps us to increase our capacity to bear it.



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Everyday Mindfulness:Thisinvolvesremindingourselvesthroughoutthedaytopayattentiontowhatishappeninginthemomentwithoutradicallyalteringourroutines.Itmeansnoticingthesensationsofwalkingwhenwewalk,thetasteofourfoodwhenweeat,andtheappearanceofoursurroundingsaswepassthroughthem.TheVietnameseZenteacherThichNhatHahnsuggestsanumberoftechniquestoenhanceeverydaymindfulness.Forexample,when the telephone rings, try just listening at first, attending to the tone and rhythm of the sound asonemightlistentoamusicalinstrument.Orwhiledriving,whentheredtaillightsofanothervehicleappear,tryappreciatingtheircolorandtextureasonemightinlookingatabeautifulsunset. Formal Meditation Practice:Thisinvolvessettingasidetimetogotothemental“gym.”Weregularlydedicateacertainperiodtositquietlyinmeditation.Therearemanytypesofmeditationthatcancultivatemindfulness.Mostinvolveinitiallychoosinganobjectofattention,suchasthebreath,andreturningourattentiontothatobjecteachtimethemindwanders.Thisdevelopsadegreeofcalmnesswhich,inturn,enablesustobetterfocusthemindonthechosenobject.Oncesomeconcentrationisestablished,mindfulnessmeditationentailsdirectingthemind to whatever begins to predominate in the mind—usually centering on how the event is experiencedinthebody.Theseobjectsofattentioncanbephysicalsensationssuchasanitch,ache,orsound;oremotionalexperiencesastheymanifestinthebody,suchasthetightnessinthechestassociatedwithanger,orthelumpinthethroatthatcomeswithsadness.Regardlessofthechosenobjectofattention,wepracticebeingawareofourpresentexperiencewithacceptance. Retreat Practice:Thisisthe“vacation”thatisdedicatedentirelytocultivatingmindfulness.Therearemanystylesofmeditationretreats.Mostinvolveextendedperiodsofformalpractice,oftenalternatingsittingmeditationwithwalkingmeditation.Theyareusuallyconductedinsilence,withverylittleinterpersonalinteraction,exceptforoccasionalinterviewswith teachers. All of the activities of the day—getting up, showering, brushing teeth, eating, doing chores—are done in silence, and used as opportunities to practice mindfulness. As one observer put it, the first few days of a retreat are “a little like being trapped in a phone booth with a lunatic.” We discover how difficult it is to be fully present. The mind is often alarmingly activeandrestless,spinningstoriesabouthowwellwe’redoingandhowwecomparetoothers.Memoriesofundigestedemotionaleventsenter,alongwithelaboratefantasiesaboutthefuture.Wegettovividlyseehowourmindscreatesufferinginanenvironmentwhereallofourneedsaretendedto. Many people find that the insights that occur—duringevenasingleweek-longintensivemeditationretreat—are life transforming.

The effects of mindfulness practice seem to be dose-related.



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Theeffectsofmindfulnesspracticeseemtobedose-related.Ifonedoesalittlebitofeverydaypractice,alittlebitofmindfulnessiscultivated.Ifonedoesmoreeverydaypractice,andaddstothisregularformalpracticeandretreatpractice,theeffectsaremoredramatic.Whilethis has long been evident to meditators, it is beginning to be documented through scientific research(Lazaretal,2005).Why Mindfulness Now? Wearecurrentlywitnessinganexplosionofinterestinmindfulnessamongmentalhealthprofessionals.InarecentsurveyofpsychotherapistsintheUnitedStates(Simon,2007),thepercentageoftherapistswhosaidthattheydo“mindfulnesstherapy”atleastsomeofthetimewas41.4%.Incomparison,cognitive-behavioraltherapywasthemostpopularmodel(68.8%),andpsychodynamic/psychoanalytictherapytrailedmindfulnessat35.4%.Twoyearsago,wespeculatedthatmindfulnesscouldeventuallybecomeamodelofpsychotherapyinitsownright(Germer,Siegel,&Fulton,2005).Thattimeisrapidlyapproaching. Why?Oneexplanationisthattheyoungpeoplewhowerespiritualseekersandmeditatorsinthe1960’sand70’sarenowseniorclinicalresearchersandpractitionersinthemental health field. They have been benefiting personally from mindfulness practice for many years and finally have the courage to share it with their patients. Anotherexplanationisthatmindfulnessmaybeacoreperceptualprocessunderlyingall effective psychotherapy—a transtheoretical construct. Clinicians of all stripes are applying mindfulnesstotheirwork,whethertheyarepsychodynamicpsychotherapistswhoprimarilyworkrelationally,cognitive-behavioraltherapistswhoaredevelopingnew,moreeffective,

structuredinterventions,orhumanisticpsychotherapistsencouragingtheirpatientstoenterdeeplyintotheir“feltexperience.”Thecommontherapeuticquestionis,“HowcanIhelpthepatienttobemoreacceptingandawareofhisorherexperienceinthepresentmoment?”

Perhapsthestrongestargumentforthenewfoundpopularityofmindfulnessisthat

...mindfulness may be a core preceptual process underlying all effective psychotherapy...

...the soft science of contemplative practice is being validated by “hard” scientific research.



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science is catching up with practice—the soft science of contemplative practice is being validated by “hard” scientific research. Meditation is now one of the most widely studied psychotherapeutic methods (Walsh and Shapiro, 2006)—although, admittedly, many of the studies have design limitations(AgencyforHealthcareResearchandQuality,2007).Between1994and2004,thepreponderanceoftheresearchonmeditationhasswitchedfromstudiesofconcentrationmeditation(suchastranscendentalmeditationandtherelaxationresponse)tomindfulnessmeditation(Smith,2004). Wearecurrentlyina“thirdwave”ofbehaviortherapyinterventions(Hayes,Follette,& Linehan, 2004). The first wave focused on stimulus and response in classical and operant conditioning.Thesecondwavewascognitivebehaviortherapy,whichworkstochangethecontentofourthoughtstoalterhowwefeel.Thecurrent“thirdwave”ismindfulnessandacceptance-basedtherapy.ResearcherssuchasStevenHayes,thefounderofAcceptanceandCommitmentTherapy,discoveredmindfulnessandacceptance-basedtreatmentstrategieswhilelookingfornovelsolutionstointractableclinicaldilemmas.Others,suchasMarshaLinehan,whodevelopedDialecticalBehaviorTherapy,hadapersonalinterestinZenBuddhismandsoughttointegrateprinciplesandtechniquesfromthattraditionintoclinicalpractice.Wearenowinthemidstofa fertile convergence of modern scientific psychology with the ancient Buddhist psychological tradition. Inthenewmindfulnessandacceptance-basedapproach,therapistshelppatientsshifttheirrelationshiptopersonalexperienceratherthandirectlychallengingmaladaptivepatternsofthought,feeling,orbehavior.Whenpatientscometotherapy,theytypicallyhaveanaversiontowhat they are feeling or how they are behaving—they want less anxiety or less depression, or want todrinkoreatless.Thetherapistreshapesthepatient’srelationshiptotheproblembycultivatingcuriosityandmoment-to-momentacceptanceofuncomfortableexperience. Forexample,apanicpatient,Kaitlin,spent the previous five years white-knuckling the steeringwheelofhercarwhiledrivingtowork.Shewasdoingallthetraditionalbehavioralstrategies:sheexposedherselftohighwaysandbridges,shepracticedrelaxation,andshecouldeffectivelytalkherselfoutofherfearofdyingfromaheartattack.Still,Kaitlinwonderedaloud,“WhytheheckdoIstillsufferfrompanic?”TheansweristhatKaitlinneverlearnedtoreallytolerateanxietyitself.Shewasalwaysrunningawayfromit.Sheneededthemissinglinkthatthethird generation of behavior therapies addresses—learning to accept inevitable discomfort as we

...the missing link that the third generation of behavior therapies addresses is learning to accept inevitable discomfort as we live our lives in a meaningful way.



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liveourlivesinameaningfulway. Anotherarenaofresearchthatisfuelinginterestinmindfulnessisbrainimagingandneuroplasticity. We know that “neurons that fire together, wire together” (Hebb, 1949 in Siegel, 2007), and that the mental activity of meditation activates specific regions of the brain. Sara Lazar andcolleagues(2005)demonstratedthatbrainareasassociatedwithintrospectionandattentionenlargewithyearsofmeditationpractice.Davidsonetal(2003)foundincreasedactivityintheleftprefrontalcortexfollowingonlyeightweeksofmindfulnesstraining.Theleftprefrontalcortexisassociatedwithfeelingsofwell-being.Increasedactivityinthispartofthebrainalsocorrelatedwiththestrengthofimmuneresponse to a flu vaccine. More dramaticchangescouldbefoundinthebrainsofTibetanmonkswhohadbetween10,000to50,000hoursofmeditationpractice(Lutzetal,2004). The evidence from scientific studies is validating what meditators have long suspected, namelythattrainingthemindchangesthebrain(Begley,2007).Wearenowbeginningtoseewhereandhowmuchchangeispossible.Furthermore,thechangesthatoccurinthebrainwhenweareemotionallyattunedtoourowninternalstatesinmeditationseemtocorrelatewiththosebrain areas that are active when we are feeling connected to others (Siegel, 2007)—suggesting thattherapistscantraintheirbrainstobemoreeffectivetherapeuticallybypracticingmindfulnessmeditation. Practical Applications of Psychotherapy Psychotherapistsareincorporatingmindfulnessintotheirworkinmanyways.Wemightimagine these on a continuum, from implicit to explicit applications—from those hidden from

viewtothosethatareobvioustothepatient. Onthemostimplicitendisthepracticingtherapist.Asjustmentioned,whenatherapistbeginspersonallypracticingmindfulness,hisorhercapacityforemotionalattunementseemstoincrease.Regardlessoftheoreticalorientation,

The evidence from scientific studies is validating what meditators have long suspected, namely that training the mind changes the brain.

...when a therapist begins personally practicing mindfulness, his or her capactiy for emotional attunement seems to increase.



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modelsofpsychopathology,ormodesofintervention,thetherapistseemstobeabletomorecarefully attend to and empathize with a patient’s experience. The therapist’s need to “fix” problemsdiminishesasheorshecultivatesthecapacitytobewithanother’spain.Therapistsfeelclosertotheirpatients,developingcompassionbothbybecomingawareoftheuniversalityofsuffering,andbyseeingmoreclearlytheirinterconnectionwithothers.Researchinthisareaisjustbeginning(Grepmair,Mitterlehner,Loew,&Nickel,2006;Grepmair,Mitterlehner,Loew,&Nickel,2007) Nextalongthecontinuumisthepracticeofmindfulness-informedpsychotherapy(Germer,Siegel,&Fulton,2005).ThisistreatmentinformedbytheinsightsthatderivefromBuddhistpsychologyandmindfulnesspractice.Thetherapist’sunderstandingofpsychopathologyandthecausesofhumansufferingchangeasaresultofobservinghisorherownmindinmeditationpractice.Insightssuchasunderstandingthearbitraryandconditionednature of thought, seeing the counterproductive effects of trying to avoid difficult experience, andnoticingthepainfulconsequencesoftryingtobuttressoursenseofseparateself,allhaveanimpactonhowweapproachourpatients’problems. Finally,themostexplicitapplicationofmindfulnesstopsychotherapyismindfulness-basedpsychotherapy(Germer,Siegel,&Fulton,2005).Mindfulness-basedtherapistsactuallyteach mindfulness practices to patients to help them work with their psychological difficulties. Ahostofmindfulness-basedinterventionsarecurrentlybeingdevelopedforawiderangeofclinicalproblems.Sometimesthepatientistaughtatraditionalmeditationpractice,andothertimesthatpracticeiscustomizedforthepatient’sparticulardiagnosis,personalitystyle,orlifecircumstances.

Untangling Terminology

As“mindfulness”isabsorbedintomodernpsychologyandWesternculture,thereisgrowingconfusionabouttheterm.Ithascometocoveralotofground.AtleastsomeoftheconfusioncouldbeeliminatedifweusedPali,ratherthanEnglish,words.(ThereaderisreferredtoMindfulnessinPlainEnglishbyBhanteGunaratna(2002)foraremarkablylucidexpositionofPalitermsandhowtheyrelatetomindfulnesspractice.)

Thefollowingisanefforttoteaseapartthedifferentmeaningsofmindfulnesscurrentlyusedinmodernpsychology.



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Classical Concept:Asdiscussedearlier,thePalitermsati,whichisoftentranslatedas“mindfulness,”denotes“awareness,”“attention,”and“remembering.”IntheBuddhisttradition,satiiscultivatedasatoolforobservinghowthemindcreatessufferingmomentbymoment.Itispracticedtodevelopwisdomandinsight,whichultimatelyalleviatessuffering. Psychological Process: Process definitions have an instructional aspect—they indicate what we should do with our awareness. Two process definitions of mindfulness in clinical settingsare“moment-to-moment,nonjudgmentalawareness”(Kabat-Zinn,1990,2006)and“awareness,ofpresentexperience,withacceptance”(Germer,Siegel,&Fulton,2005).Theseprocess definitions suggest, “Look at your moment-to-moment experience, and try to do it with a spirit of acceptance.” Another process definition of therapeutic mindfulness, “attentional control” (Teasdale,Segal,&Williams,1995),suggestsredirectingattentiontomanageemotionaldistress. Process definitions are especially valuable because they identify processes of change or mechanismsofactionthatmayhelpparticularpatients.Intherapy,“mindfulness”ingeneralisconsideredachangeprocess,andsoaretheindividualelementsthatconstitutetherapeuticmindfulness—acceptance, present experience, and awareness. Different patients might require more emphasis on one element or another. For example, self-critical persons might benefit mostfrom“acceptance,”obsessivepatientsmightbehelpedbyfocusingon“presentmomentsensations,” and people with impulse control disorders might benefit most from greater “awareness”—observing the precursors to problem behaviors such as drinking, gambling, or overeating. We can break down the processes even further to fine-tune treatment for particular individuals. For example, there are different styles of awareness that can benefit certain patients:metacognitiveawareness(“thoughtsarenotfacts”)helpschronicallydepressedpeopledisentanglefromdepressiveruminations(Teasdaleetal,2002),whilepeoplewithaschizoidordetached style of relating to their feelings might benefit from a more participatory observational style—intimately observing feelings as they arise in the body.

Meditation Practice:Whensomeonesays,“Idomindfulnessmeditation,”whatisheorsheactuallydoing?Therearethreekeymeditationskillsoftensubsumedundertheheadingof“mindfulnessmeditation:”

Concentration Meditation:Thistechniquehasafocalobject,suchasthebreathoramantra.Theinstructionis,“Whenyounoticethatyourmindhaswandered,gentlybringitback

There are three key meditation skills often subsumed under the heading of “mindfulness meditation:”



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to[theobject].”Concentrationmeditationproducesafeelingofcalmness.ThePaliwordmostassociatedwithconcentrationpracticeissamatha,whilethetraditionalwordformeditationisbhavana,whichmeans“developing.”“Concentrationmeditation”isatranslationofsamathabhavana,thecultivationofconcentration.The“relaxationresponse”(Benson&Klipper,2000)iswell-knownexampleofthismeditationapproach. Mindfulness Meditation:Theinstructionformindfulnessmeditationis,“Noticewhateverpredominatesinawareness,momenttomoment.”Heretheintentionisnottochooseasingleobjectoffocus,butrathertoexplorechangingexperience.Theskillofmindfulnesscultivatesinsightintothenatureofone’spersonalconditioning(e.g.,“fearofdisapproval,”“angeratauthority”)andthenatureofmentalreality(“it’schanging,”“it’softenunsatisfactory,”“the‘self’is fluid”). Thisisprimarilywhatdistinguishes“mindfulnessmeditation”fromotherformsofmeditation,suchasconcentrationmeditationandvariousformsofvisualizationmeditation,anditisauniquecontributionofBuddhistpsychology.ThePaliwordsformindfulnessmeditationarevipassanabhavana,whichtranslateswellasthecultivationofinsightor“insightmeditation.”Westernresearchersandcliniciansusuallyusetheexpression“mindfulnessmeditation”torefertothispractice.

Makingmattersabitmorecomplicated,satiisactuallycultivatedby,andnecessaryfor,bothconcentrationandmindfulnessmeditationtechniques.Thatis,weneedtoknowwherethemindistoconcentrateoneitherasingleobjectormanyarisingobjects.Sincethemindisactivelyengagedwithawiderrangeofexperiencesduringmindfulnessmeditation,itcanbesaidthatsatiismoredeliberatelydevelopedinthisparticularpractice. Duringmindfulnessorinsightmeditation,themeditatorcanalwaysreturntoconcentrationpracticetostabilizeattentionifheorshebecomeslostindaydreamsanddiscursivethinking.Inthisregard,concentrationpractice(samatha)facilitatesmindfulnessorinsight(vipassana)practice. Lovingkindness Meditation:Lovingkindnessistheemotionalqualityassociatedwithmindfulness.TranslatedfromthePaliword,metta,lovingkindnessmeditationcanbeaformofconcentrationmeditation.Thepractitionerreturnsattentionagainandagaintophrasessuchas“MayIandallbeingsbesafe,happy,healthy,andlivewithease.”Thistechniqueallowsthepersontosoftenintoandallowarisingexperiencetobejustasitis.Itiscultivatingtheintentiontobelovingandkind,ratherthansuperimposingwarmfeelingsonourmoment-to-moment experience. The emotional flavor of affectionate awareness typically follows our kindly



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intentions.Lovingkindness(feelingsafe,peaceful,healthy,andfreefromsuffering)keepsthefunctionofmindfulnesspracticeclearinthemindofthepractitioner.Itisaqualityofmindthatideallypervadestheothermeditationpractices.Therefore,whilepracticingconcentrationmeditation,weworktoreceivementaldistractionswithopenheartednessratherthansternness;whenpracticingmindfulnessorinsightmeditation,wegreetallmentalcontentslikewelcomevisitors. Whenoursati(mindfulness)isstrong,wecanchoosetoswitchfluidly among metta (lovingkindness), samatha (concentration), or vipassana (mindfulness or insight)practices,asneeded,eveninasinglesittingofmeditation.Forexample,ifdealingwithpsychologicaltrauma,wecannoticewhenweareoverwhelmedandcanchoosetoredirectattentiontothebreathorexternalsightsandsounds(samatha).Wecanalsoaddsomelovingkindness(metta)toourexperiencetoreestablishameasureofcalmness.Whenwe feel more stable, we can open up the field of awareness again to observe how the trauma memories are experienced in the mind and body (vipassana). In other words, the three skills—concentration, mindfulness, and lovingkindness—can be selectively emphasized in meditation anddailylifetoreducesufferingandincreasehappiness. Common Usage:Tomakemattersevenmoreconfusing,thegeneralpublicinWesterncultureusestheterm“mindfulness”looselytorefertoeveryvarietyofformalandinformalsecularBuddhistpractice.Underthislabel,wenotonlyhavethedifferentmeditationskillsjustmentioned—lovingkindness, concentration, and mindfulness or insight—but also visualization techniquesandinnumerable,informalmeditationstrategiestodealwitheverydaylife.Visualizationmeditationsincludepracticesthatcultivateequanimity,suchasimaginingoneselfasasolidmountainunaffectedbythewindandweather,orasadeeppondunperturbedbythewaves. As mindfulness is incorporated into diverse fields such as health care, education, and business,thetermwillprobablycontinuetoaccrueanincreasingarrayofmeanings.Withinclinicalpsychology,“mindfulness”isalreadyusedinterchangeablywith“acceptance”todescribe the third wave of behavioral treatments. In the field of education, Ellen Langer (1989) describes“mindfulness”asacognitiveprocessthatimpliesopenness,curiosity,andawarenessofmorethanoneperspective.Inthebusinessworld,RichardBoyatzisandAnnieMcKee(2005)encourage“mindfulnesspractice”to“observeemotionalreality”(p.124)inanorganizationand“avoidnarrowfocusandconstantmultitasking”(p.131).

...when practicing mindfulness or insight meditation, we greet all mental contents like welcome visitors.



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Despitetherecentproliferationofinterestinmindfulnessanditsmultiplyingmeanings,thevarioususesofthetermstillhavemuchincommon.Onlytimewilltellwhathappensto“mindfulness”asthetheoryandpracticesthatbeganinBuddhistpsychologymoveintonew,heretoforeunimaginabledomains.

Radical Roots Thecultivationofmindfulnessinarigorouswaycomesfromatraditionwithancientrootsandloftygoals.Theseoriginsareimportanttounderstandsothatmoderncliniciansdon’tinadvertentlymissitsprofoundpotentialforpsychologicaltransformation. As far back as four thousand years ago, we find images of yogis in ancient India sittingcross-leggedinmeditation,gazinginwardwitheyeshalfclosed.Trainingthemindwasunderstoodastheprinciplemeansofachievingmentalandphysicalhealth,emotionalequanimity,andperfectingthehumancondition. Mindfulness,aswearecomingtoknowitintheWest,wasmostclearlydescribedinancienttimesintheteachingsofthehistoricalBuddha.Accordingtotradition,hewasbornaprincesome2500yearsago.Attheageof29,herenouncedalifeofcomfortandprivilegetoundertakerigorousmentalandphysicaldisciplinesforsevenyears.Finally,atage36,heexperiencedabreakthroughofunderstandingthatprofoundlyre-orderedhismind.Hewanderedfromplacetoplaceforthenext40yearsexhibitingbehaviorsdevoidoftheusualhumanpropensitiestowardattachment,aversionordelusion.Thepsychologicalteachings he left behind—including how to cultivate mindfulness—are still accessibletoustoday. FortheBuddha,themindandbodyareseenastheproductofmaterialcauses,lackingthedivineessencethatwasassumedbytheIndo-Europeanreligionsofhistime.Nonetheless,intheBuddha’sview,thebodyandmindcanbethevehicleforaprofoundexperienceoftranscendence.Ratherthanbreakingthroughtosomethingdivine,however,thisexperienceresultsfromaradicaltransformationofthemind.Consciousness itself, though conditioned, can be purified to such an extent that it entirely understandsitselfanditsconditioning.Theresultisnotonlyadeepsenseofpersonalwell-being,butalsothepossibilityofamoreevolvedwayofbeinghuman.

...in the Buddha’s view, the body and mind can be the vehicle for a profound experience of transcendence.



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Theprimaryinterestofthistraditionisthequalityofconsciousnessinthepresentmoment.Howexactlyisthemindandbodymanifestinghereandnow?Consciousnessarisesfromawholenetworkofinterdependentfactors,includingallofthedetailsofourgeneticmakeupandpersonalhistory.Eachmomentofconsciousness,inturn,hasanimpactuponoursubsequentbeliefs,feelings,andbehaviors.Knowingboththecausesandtheeffectsofamomentofconsciousnessallowsustoparticipateintentionallyintheprocessofliving;tosteeracourseawayfromsufferingandtowardhealthierstates. WhattheBuddhasawwithgreatlucidityonthenightofhisawakeningwastheworkingsofhisownmind.Hisinsightshaveprofoundimplicationsformodernpsychotherapy,astheyrevealhowourmindsconstructourexperiencemomentbymoment,andhowtheseconstructionscan lead to suffering. The following description is not for the faint-hearted—it is a radically new psychologyformanyreaders,andsomewhatcomplicated,soweencourageyoutoconsideritslowly.How We Construct Our Experience TheBuddhasawthatallexperienceinvolvesaprocessinwhichtherawdatastreamingintothemindthroughthesensoryorgansor“sensedoors”iscompiledandsynthesizedintoavirtualworldofmeaning.Therearesixsensedoorsinall:theeye,ear,nose,tongue,body,withthe mind itself viewed as the sixth. There are also five primary categories, or systems, whereby the information flowing through these sense doors is processed.

The first category is material form,whichacknowledgesthatthemindandbodyhaveamaterial,biologicalfoundation.Thenextisconsciousness,ortheactofbecomingawareofanobjectbymeansofoneofthesixsenseorgans(againwiththemindasthesixthorgan).Atthisstagetheeyesees,theearhears,thetonguetastes,etc.Thethirdandfourthsystems,whichshapehowconsciousnessmanifests,areperceptionandfeeling. Perception identifies whatisexperiencedthroughaseriesofassociations,interpretingincomingdatainthelightofhistoricallylearnedpatternsofrecognition.Forexample,youcanrecognizejusttwodotsandacurved line to be a face☺, or identify the object in your hands to be a book. “Feeling” provides anaffecttoneforeachmomentofcognition,eitherpleasant,unpleasantorneutral.Thisisahedonicassessmentofeachobject’svaluetotheorganism.Ineverymoment,weeitherlike,dislike,oraren’tinterestedinwhatweperceive. The fifth and final component of the construction of experience is called formations and



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reflects the intentional stance we take toward all objects that we perceive and toward which wehavefeelings.Volitionorintentionistheexecutivefunctionofthemindwhichinitiatesconscious or unconscious choices. Whereas the first four systems yield a sense of what is happening at any given moment, the fifth decides what we are going to do about it. Howdotheseprocessesunfoldtogether?Imaginethatyou’rehungry,andyouopentherefrigerator door. The eye sees patterns of light, dark, and color in the visual field, which are quicklyorganizedbythebrainandperceivedasafreshlymadesandwich.Instantaneouslyapositivefeelingtowardthesandwicharises,andanintentionformstopickitupandeatit.Thisissoonfollowedbythebehaviorofactuallytakingabite.Consciousnesscreatesandrespondstoourrealitysoquicklythattheprocessisusuallyunconscious.

Intentionsandthebehaviorsthatfollowfromthemtendtobecomehabitualandturnintodispositions.Dispositionsaretheresidueofpreviousdecisions,storedinmemoryashabits,learnedbehaviors,personalitytraits,etc.,andprovidehistoricalprecedentsforhowtorespondtoeachnewlyarisingmoment.Feedbackloopsdevelop,wherebyone’spresentresponsetoanysituationisbothshapedbypreviousexperienceandgoesontomoldthedispositionsthatwillinfluence future responses. If we enjoyed this and other sandwiches in the past, we may develop the habit of reflexively picking up and eating sandwiches, even when we’re not really hungry.

Putting this all together, the six sense doors and five systems interact simultaneously to formadynamicinterdependentlyarisingprocessofmindandbody,constructingmeaningfromanever-changingbarrageofenvironmentalinformation.Ineachmoment,whichcanbemeasuredinmilliseconds,allthisarisesconcurrently,organizesaroundaparticularbitofdata,andthenpassesaway.

OneuniquefeatureofBuddhistpsychologyisthatconsciousnessisregardedasanunfoldingprocess,oranoccurringevent,ratherthanasanexistingentity.Nothingpermanentabides(andthereisnoenduring“me”tobefound)becauseevery“thing”isaseriesofinterrelatedevents.Theeverydaysensethatwe(andotherbeings)haveseparateexistencecomesfromthefactthateachmomentofcognitionisfollowedbyanothermomentofcognition,yieldingthesubjectivesenseofastreamofconsciousness.Wehavesimplylearnedtoconnectthesnapshotstogetherintoacoherentnarrative.Thisisliketheillusionofcontinuousactionthatourmindscreateoutofseparateframesinamovie.AmongthegreatinsightsoftheBuddhisttraditionisnotonlythatthisisallhappeningbelowthethresholdofordinaryawareness,butalsothatthisprocesscanunfoldineitherhealthyandunhealthyways,dependingontheskillsofitshandler.



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Thisanalysisofhumanexperiencehasimportantandradicalclinicalimplications.Itsuggeststhatourreality,includingthesenseof“self”aroundwhichsomuchpersonalpsychologyiscentered,isbasedonafundamentalmisunderstanding.Itisasthoughwebelievedthatapowerfulautomobile like a Ferrari was a living being—until we saw it disassembled on the floor of a workshop.Whenweknowthecomponentpartsandhowthey’reputtogether,wecanneverlookataFerrariinquitethesameway.Similarly,seeingthewaythe“self”isconstructedcanhelpboth us and our patients loosen our identification with the changing kaleidoscope of thoughts and feelings that arise in the mind, allowing us to live more flexible, adaptive, happier, productive lives.

A Physician of the Mind

TheBuddhasometimesreferstohimselfasaphysician,andtohisteachingasakindofmedicine. The illness he is treating is the fact that consciousness is continually influenced by patternsofconditioningthatinevitablyresultinunhappiness,frustration,anddisappointment.Thisiscertainlyanobservationfamiliartothemodernpsychotherapist.Ratherthanchangingbrainchemistrybypharmaceuticalsorprobingpasttraumasarrestingnormaldevelopment,however,theBuddha’sapproachistohelpthepatientgaindirectinsightintothenatureofexperience.Thistakesmanyforms.

Onetrackistonoticetheextenttowhichthepatternsofconditioningweacquire,throughlearnedbehaviors,conditionedresponses,orculturalosmosis,areforthemostpartbuiltuponcertainillusionsorevendelusions.Foremostoftheseareourremarkablyrobusthabitoftakingwhatisimpermanentandsubjecttochange

to be stable or reliable; believing that the satisfaction or gratification of desires is sustainable for longerthanafewmomentswhen,becauseoftheformerpoint,itisnot;andprojectingagainandagain onto the field of experience the notion of a person or agent that owns, controls, or consists

...our reality, incuding the sense of “self” around which so much personal psychology is centered, is based on a fundamental misunderstanding.

...we continuously delude ourselves into believeing that we can hold onto what we want and get rid of what we don’t want, despite considerable evidence to the contrary.



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ofwhatishappening.Inotherwords,wecontinuouslydeludeourselvesintobelievingthatwecanholdontowhatwewantandgetridofwhatwedon’twant,despiteconsiderableevidencetothecontrary.Andontopofthis,wedeludeourselvesintobelievingthatastable,independent“I”or“me”isrunningthisshow.Totheextentthesemisperceptionscanbegraduallyuncoveredandcorrected,considerablehealingcanoccur. Forexample,thereisthestoryofamonkwhocomplainedtohisZenteacherthathewasanangryperson.Theteachersaid,“Showme.”Sincethestudentwasnotangryatthemoment,hecouldnotshowit,whereupontheteachersaid,“See,youarenotanangrypersonbecauseyou are not angry all the time.” Such insight into the fluidity of experience and insubstantiality ofidentitycanbeenormouslyhelpfultopatientswhohavecorebeliefsaboutbeingunworthy,unlovable,unintelligent,andsoforth. Anotherapproachistorecognizethefactthatbehaviorisdrivenbydesire,bothconsciousandunconscious,andtousethatknowledgetodiminishandeventuallyeliminatetheroleofdesireinthemoment-to-momentfunctioningofmindandbody.Theimpulsetolikesomethingsanddislikeothersleadstopullingsomeobjectsofexperiencecloserandpushingothersfartherawayfromasenseofselfthatsetsitselfapartfromwhatisactuallyhappening.Ironically,saytheBuddhists,theverystrategiesweemploytoovercome the perceived shortcomings of the world as we find it—embracing what offers pleasure and rejecting what brings pain—have the result of causing and perpetuating greater suffering. Thesolutionistopracticelettinggoofdesireitself,whichcanbereplacedbyanattitudeofequanimityoracceptance.Inclinicalpractice,weseecountlessexamplesthat“whatweresistpersists,”andhowpatientssufferterriblyfromwishingthatthingswouldbeotherthantheyare,i.e.,fromnotfacing“reality.” Theunderlyingtendenciesofbothdelusionanddesirearedeeplyembeddedinhumannature,butcanbesuccessfullydiminishedandeveneliminated.Theword“Buddha”actuallymeans“awake,”andthehistoricalBuddhawasamanwhoundertookaprogramoftransformationthatresultedinhis“awakening”fromthemisconceptionsofdelusionandtheaddictionsofdesire.

Ironically, say the Buddhists, the very strategies we eomploy to overcome the perceived shortcomings of the world as we find it...have the result of causing and perpetuating greater suffereng.



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Bottom-Up Vs. Top-Down Processing

Moderncognitivescientistsdistinguishbetweenbottom-upandtop-downinformationprocessing(Eysenck&Keane,2000).Attheheartofmindfulnessmeditationisanemphasisuponbottom-up,ratherthantop-down,functionsofthemind.Thatistosay,mindfulnessseekstobringattentiondirectlytothestreamofsensorydataenteringexperiencethrougheachofthesensedoors:thevisualforms,sounds,smells,tastes,andbodilysensations,aswellastothearisingofthoughtsandimagesinthemind.Indoingso,itsteersattentionawayfromthemany“upperlevel”schemas,narratives,beliefs,andotherconceptualmapswenormallyusetoguideour way through a day’s experience. This is cognitive behavioral therapy on steroids—bringing attentiontosubtlesensoryexperience,andinsodoing,comingtoseeallthoughtsandtheirassociatedfeelingsasarbitrary,conditionedevents.Whileordinaryconsciousnesstendstooverlookthedetailsofsensoryexperience(usuallywearejusttryingtoextractfromitwhatisofinteresttoachieveourgoals),mindfulnesspracticeinsteadfocusesuponthesensorydataitself,foritsownsake,andinvitesthepractitionertoconsistentlyabandonconceptualjudgmentsandnarrativestories.Suchamethodhastheeffectofdeprivingthemindofmuchoftheenergythatfuelsitsstoriesanddelusions,andtransfersourawarenesstotheareasthatwilldirectlyrevealthe transient, constructed, and selfless nature of experience.

Mindfulness in Context Asmentionedearlier,mindfulnessispartofaprojectdesignedtouprootharmfulhabitsofmind.InthetraditionalBuddhistcontext,mindfulnessisembeddedinaneight-foldpathtoalleviatesuffering;mindfulnessisguidedanddirectedbysevenotherfactors.Theyare:1)theviewonehasofwhatisreal,importantvaluable,anduseful;2)howintentionisusedtoinitiateandsustainactioninskillfulways;3)thenatureofspeechthat can be either harmful or beneficial; 4) the quality of action as it relates to ethical principles; 5)one’smeansofsustainingoneselfintheworldaslivelihood;6)thedegreeandqualityofeffortemployedtobringaboutchange;7)andconcentrationasafocusingandsupportingfactortomindfulness.Whenmindfulnessistakenoutofthisbroadercontext,itspowermaybelimited.For example, it is difficult to sustain mindful awareness if we are causing harm to ourselves or others, or if we do not have the concentration and beneficial intentions to focus our efforts. In otherwords,it’shardtohaveagoodmeditationsessionafterabusydayofcheating,stealing,andkilling. TheBuddhisttraditionhasfocusedonuniversalchallengesinhumanlife,suchasthe

...mindfulness is part of a project designed to uproot harmful habits of mind.



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problemofsufferingingeneral.ManyaspectsofBuddhistpsychologyarethereforeasapplicabletodayastheywereinancientIndia.Asthisbookdemonstrates,psychotherapyisharnessingthepowerofmindfulnessandacceptancetobringrelieftointractablepsychologicalconditions.However,theproposedoutcomeofdedicatedBuddhistpracticeisradicallydifferent:thecompletecessationofsuffering.Inmodernterms,thismeansenvisioningalifewithoutatraceofpsychologicalsymptomsfoundinourdiagnosticmanuals.Suchan“awakened”personlivesnaturally,withafullrangeofphysical,emotionalandintellectualcapacities,butwithoutneedingevents to be other than they are in order to feel fulfilled. By practicing mindfulness, we can learn to lead a peaceful, balanced, loving, life, all the while working for the benefit of others. There is no need to wait for another time, place, or condition for this to occur—we can begin where we are,therapistsandpatientsalike. References

AgencyforHealthcareResearchandQuality(2007).Meditationpracticesforhealth:State

oftheresearch.U.S. Department of Health and Human Services, Evidence Report/

Technology Assessment, Number 155.

Bach,P.,&Hayes,S.(2002)Theuseofacceptanceandcommitmenttherapytopreventthe

rehospitalizationofpsychoticpatients:Arandomizedcontrolledtrial.Journal of

Consulting and Clinical Psychology, 70(5), 1129-1139.

Begley,S.(2007).Train you mind, change your brain. NewYork:BallantineBooks.

Benson,H.,&Klipper,M.(2000).The relaxation response.NewYork:AvonBooks.

Bhikkhu,T.(2007).Bhikkhu,T.(2007).Mindfulness defined.RetrievedNovember30,2007,

from

http://www.dhammatalks.org/Archive/Writings/CrossIndexed/Uncollected/

MiscEssays/Mindfulness%20Defined.pdf

Bishop,S.,Lau,M.,Shapiro,S.,Carlson,L.,Anderson,N.,Carmody,J.,etal.(2004).

Mindfulness: A proposed operational definition. Clinical Psychology: Science and



��


practice, 11(3), 230-241.

Boyatzis,R.&McKee,A.(2005).Resonant leadership: Renewing yourself and connecting with

others through mindfulness, hope, and compassion.Boston,MA:HarvardBusiness

SchoolPress.

Davids,T.&Stede,W.(Eds.)(1921/2001).Pali-English Dictionary.NewDelhi,India:

MunshiramManoharlalPublishersPvt,Ltd.

Davidson,R.J.,Kabat-Zinn,J.,Schumacher,J.,Rosenkranz,M.,Muller,D.,Santorelli,S.,

etal.(2003).Alterationsinbrainandimmunefunctionproducedbymindfulness

meditation.Psychosomatic Medicine,65(4),564-570.

Dunne,J.D.(2007,March).Mindfulness & Buddhist contemplative theory.Posterpresented

atthe2007annualconference,IntegratingMindfulness-BasedApproaches&

InterventionsintoMedicine,HealthCare,andSociety,Worcester,MA.

Eysenck,M.W.,Keane,M.T.(2000).Cognitive Psychology:AStudent’sHandbook.

NewYork:PsychologyPress.

Germer,C.,Siegel,R.,&Fulton,P.(Eds.)(2005).Mindfulness and psychotherapy.NewYork:

GuilfordPress.

Grepmair,L.,Mitterlehner,F.,Loew,T.,&Nickel,M.(2007)Promotionofmindfulnessin

psychotherapistsintraining:preliminarystudy.European Psychiatry(22),485-489.

Grepmair,L.,Mitterlehner,F.,Loew,T.,&Nickel,M.(2006)Promotionofmindfulness

inpsychotherapistsintrainingandtreatmentresultsoftheirpatients.Journal of

Psychosomatic Research60(6),649-50.

Gunaratana,B.(2002).MindfulnessinplainEnglish.Somerville,MA:WisdomPublications.

Hayes,S.,Follette,V.,&Linehan,M.(Eds.).(2004).Mindfulness and acceptance: Expanding



��


the cognitive-behavioral tradition.NewYork:GuilfordPress.

Hebb,D.(1949).Theorganizationofbehavior:Aneuropsychologicaltheory.NewYork:Bantam

Books.

Kabat-Zinn,J.(1990). Full Catastrophe Living.NewYork:DelacortePress.

Kabat-Zinn,J.(2003).Mindfulness-basedinterventionsincontext:Past,present,andfuture.

Clinical Psychology: Science and Practice,10(2).144-156.

Kabat-Zinn,J.(2006,June).Someclinicalapplicationsofmindfulnessinmedicalandmental

healthpractice.InMeditation in Psychotherapy.ConferenceconductedbyHarvard

MedicalSchool,Boston,MA.

Langer,E.(1989).Mindfulness.Cambridge,MA:DaCapoPress.

Lazar,S.,Kerr,C.,Wasserman,R.,Gray,J.,Greve,D.,Treadway,M.,etal.(2005).Meditation

experienceisassociatedwithincreasedcorticalthinkness.NeuroReport,16(17),1893-

1897.

Linehan,M.(1993).Cognitive-behavioral treatment of borderline personality disorder.New

York:GuilfordPress.

Lutz,A.,Grelschar,L.,Rawlings,N.,Richard,M.,&Davidson,R.(2004).Long-termmeditators

self-inducehigh-amplitudegammasynchronyduringmentalpractice.Proceedings of the

National Academy of Sciences,101(46),16369-16373.

Rapgay,L.&Bystrisky,A.(inpress).Classicalmindfulness:anintroductiontoitstheoryand

practiceforclinicalapplication.InLongevityandOptimalHealth:IntegratingEastern

andWesternPerspectives.Annals of the New York Academy of Sciences.

Segal,Z.,Williams,J.,&Teasdale,J.(2002).Mindfulness-based cognitive therapy for

depression: A new approach to preventing relapse.NewYork:GuilfordPress.



��


Siegel,D.(2007).The mindful brain.NewYork:W.W.Norton.

Simon,R.(2007).Thetopten.Psychotherapy Networker,March/April,pp.24,25,37.

Singh,N.,Wahler,R.,Adkins,A.,&Myers,R.(2003).Solesofthefeet:amindfulness-based

self-controlinterventionforaggressionbyanindividualwithmildmentalretardationand

mentalillness.Research in Developmental Disabilities,24(3),158-169.

Smith,J.(2004).Alterationsinbrainandimmunefunctionproducedbymindfulnessmeditation:

threecaveats.Psychosomatic Medicine,66,148-152.

Teasdale,J.,Moore,R.,Hayhurst,H.,Pope,M.,Williams,S.,&Segal,Z.(2002).Metacognitive

awarenessandpreventionofrelapseindepression:Empiricalevidence. Journal of

Consulting and Clinical Psychology,70(2),275-287.

Teasdale,J.,Segal,Z.,&Williams,J.(1995).Howdoescognitivetherapypreventdepressive

relapseandwhyshouldattentionalcontrol(mindfulness)traininghelp?Behaviour

Research and Therapy,33,25-39.

Toyomasu,K.G.(2001,January10).HaikuforPeople.RetrievedJuly20,2007from

http://www.toyomasu.com/haiku/#basho

Walsh,R.&Shapiro,S.(2006).TheMeetingofMeditativeDisciplinesandWesternPsychology:

AMutuallyEnrichingDialogue.American Psychologist,61(3),227-239.



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