Mindfulness is an approach to handling the stresses and strains of life by bringing our full attention to the present moment in a non-judgemental and accepting way.1 In other words, it is a way of learning to relate directly to whatever is happening in life in the present moment – a way of taking charge of one’s life, a way of doing something for oneself that no one else can do.
It is consciously and systematically working with one’s own stress, pain, illness, and the challenges and demands of everyday life. In developing the capacity to stand back and observe the flow of oneself, mindfulness can short-circuit the ‘flight or fright’ reaction of the sympathetic nervous system, allowing a sense of responding rather than reacting.
Jon Kabat Zinn,1,2,3 who first introduced Mindfulness-Based Stress Reduction (MBSR) to patients in Massachusetts in the 1970s, realised that the approach of observing the mind and body from moment to moment without judging, labelling or trying to fix anything could help patients suffering from chronic illnesses, stress and anxiety.2,3
Mindful-based approaches in the UK were drawn from this bank of experience and are now being given a high profile through the work of Segal, Williams, Teasdale and associates.4,5 They have extensively researched this approach with patients suffering from recurrent depression and formed a similar approach called Mindfulness-Based Cognitive Therapy (MBCT). This has now been validated by the National Institute for Clinical Excellence (NICE) and helped mindfulness-based approaches in the NHS become a treatment of choice. Recent research has shown that MBSR/MBCT is also an effective intervention for various conditions6,7 such as chronic pain, fibromyalgia, sleep disorders, psoriasis8 and cancer.9
There is also a gathering of scientific evidence from neuroscientists in relation to the insular cortex and its role in helping to cope with emotions through meditation.10 Studies are now in progress to define exactly what are the components of change.
There is a growing body of knowledge indicating that MBSR enhances wellbeing, mental health and physical health.6 It is for this reason that more than three years ago, two interested workers (one staff counsellor and one phsysiotherapist) within the occupational health (OH) department at South Devon Foundation Healthcare Trust (SDFHCT) set up an eight-week mindfulness programme for staff suffering from stress.
While there is a stress policy in place, we wanted to offer individuals the opportunity to learn and experience a new way of being that would impact on all aspects of their lives. The approach we use is taught by Bangor University and incorporates many of the MBSR and MBCT components promoted by professor Williams and colleagues at Oxford Cognitive Therapy Centre (and more recently at Exeter University).There are a few studies looking at the effectiveness of mindfulness approaches with healthcare professionals. Individuals report decreased perceived stress and greater self-compassion,11 and the other two found a reduction in stress and burnout.12,13
We believe anecdotally this has been beneficial both in encouraging staff to return to work earlier, and giving staff different ways of relating to and coping with stressful situations. Outcome measures are used to evaluate the course. However, these were not intended to be used as part of a research study.
The programme we offer consists of a taster session, eight weekly classes, and a review session one month later. The course includes:
Guided instruction in mindfulness meditation practices (ie, the body scan, sitting meditation and breathing space)
Mindful movement (ie, stretching, walking and very basic mindful yoga)
Education on the psychophysiology of stress
Group enquiry and discussions aimed at enhancing awareness of the present moment, and in everyday life
Home assignments: participants are asked to notice their everyday experiences and bring a sense of mindfulness to them – for example, showering, brushing their teeth, or eating a meal mindfully.
Five home practice CDs (narrated by professor Mark Williams of Oxford Cognitive Therapy Centre) and a week-by-week home practice manual.
The aim of the programme is to learn new ways to handle our moods and emotions that help us to remain well. Using various practices involving sitting, lying down and gentle movement, we bring the focus of our attention to body sensations, feelings and emotions as they arise, and watch thoughts and observe them as they change.
To focus on these changes we have to first become aware of them. Participants are reminded that their only aim is to notice what is happening, in the present moment, without judgement, but with a curious and kind mind. This is much harder than it sounds and is paradoxical as people are usually striving to get somewhere, asking: “Am I doing it right?”. This practice, however, is about being with what is: the joyous and the difficult, and accepting it rather than pushing it away. To begin with, we place our attention in different parts of the body (the body scan) as a focus to anchor our awareness in the present moment.
Each week has a specific theme, starting with exploring the ‘Automatic pilot mode’. This is a state of being ‘out of touch’ with what we are doing and how we are being – for example, we can often drive for miles without being aware of ourselves or our surroundings. In the same way, people or events can trigger old habits of thinking and feeling that are often unhelpful and may lead to a worsening mood and stress. By becoming aware of our thoughts, feelings and bodily sensations from moment to moment, we are creating greater freedom and choice: we do not have to go down the same old mental road that may have caused problems in the past.
The second week of the programme highlights the difficulties people have in sustaining the homework practices (45 minutes’ body scan each day) and noticing how much the mind wanders and the many judgments that arise. The body scan and breathing practice teaches us to deliberately pay attention and keep bringing the mind back – with an acceptance of whatever is there (thoughts, feelings, sensations).
Often people judge thoughts and feelings as abnormal, wrong or unacceptable, which can set off an unhelpful internal dialogue. Instead, we acknowledge what is there and come back to the breath or part of the body. In the session we use the enquiry to investigate participants’ experiences and use this opportunity to link this to teaching points such as: thinking outside the box, accepting and letting go, dealing with difficulties, thoughts are not facts, presence, etc.
The three-minute breathing space is a useful component taught from week three which directs people to acknowledge in any situation – what is here right now? (stage 1); then to focus on the breath (stage 2); and then expand the awareness to the full body and space around the body (stage 3).
Jon Kabat-Zinn’s attitudinal foundations of Non judging, Patience, Beginner’s Mind, Trust, Non-striving, Acceptance and Letting go, are discussed and revisited within the theme of each particular week.
We are building a scaffolding with these themes and practices to allow more challenging ideas later in the programme, such as the notion that thoughts are not facts. This is a way of standing back to see a thought for what it is – a mental process.
Another active exercise is used by asking people to look at what nourishes them or depletes them in everyday life. This more behavioural aspect of the course encourages participants to make changes by taking steps into more nourishing or mastery activities. Those wanting to find out more about the actual programme can consult the MBCT Manual written by Segal, Williams and Teasdale,14,15 who outline the eight-week course comprehensively.
Experience so far
We have run five courses with about 12-14 participants per group. We have found that offering a ‘taster’ session is invaluable in giving a clear sense of the commitments of the programme – for example, the amount of weekly homework required to gain optimum benefit (around an hour a day).
This is not a programme to be approached carelessly; people need to put in time and energy, which is not an easy option if they already do not have the time to spare.
By giving applicants a clear idea of what is involved in the taster session, potential drop-out rates from the course have been reduced to virtually none.
Moreover, the taster session gives the programme facilitators the opportunity to assess clients’ suitability for the group in terms of their level of support and mental health.
Once people have opted into the programme, and we have accepted them, they are asked to sign a participant agreement form, which outlines areas of confidentiality and their responsibilities. They are also asked to complete three questionnaires for our audit and evaluation.
The facilitators are accomplished and skilled at creating a safe, supportive and engaging environment, and teachers need to practice meditation themselves.
Reasons for participating
Stress and burn-out
Chronic pain and illness – eg, headaches, digestion problems such as irritable bowel syndrome
Anxiety and panic (and stuttering)
The comments we have received from those who have taken part so far have been positive. Many participants have emphasised the life-changing nature of the training. We ask participants to complete three questionnaires on entry and on completion of the course. These are the World Health Organisation (5) Wellbeing Index16 and the 37-item short form Profile of Mood States (POMS-sf) 17 and the CAMS-R.18 The CAMS – R is a measure of mindful states.
In the group which finished in December 2008, each member felt better on all three measures, even though one group member was going through a crisis on the last session. She was able to manage the situation mindfully, and her score reflected this.
At the review session, most people are actively using some aspect of the course (the body scan, breathing meditation or movement) to continue the mindfulness practice, and most use the three-minute breathing space in challenging situations which they find gives them a platform from which to respond, rather than react.
Of course it is unknown at the present time whether participants continue their daily practice, or any practice at all, but researchers19 in a series of MBSR follow-up studies found that 75% of their participants were still practicing some form of meditation.
Mindfulness can increase choice in life, make pleasant experiences more vivid, and difficult experiences more manageable. The group format also creates a cost effective intervention by utilising OH time efficiently. Thus, the course has proved life-changing for some of the participants, and has even resulted in small groups being set up to continue the practice.
By bringing awareness to the present moment staff are more able to cope with stressful events at work and at home in a responsive and non-reactive way. This is not seen as a quick fix, and we encourage participants to continue the home practice and use whatever practices work best for them – ie, the breathing practice alone, the body scan or the yoga, or all three. Mindfulness practice is not for everyone, and those who are uncommitted are usually teased out in the taster session and directed on to other stress reduction courses running in the community.
Although we collect data to measure effectiveness, it is important during the course not to lose some of the important aspects of mindfulness – that of non-striving, staying in the present and, of course, trust. However, we know that it is an honour to be able to deliver the course and therefore have to balance this with needing to show in quantitative terms that people benefit.
Lynne Holmes (RGN, RHV, BACP Reg, BSc Hons Health) is staff counsellor in the OH department of Regent House.
Professional training and further information
Kabat-Zinn J (1990) Full Catastrophe Living, New York, Delacorte
Kabat-Zinn J (1982) An Outpatient program in Behavioural Medicine for Chronic pain patients based on the practice of Mindfulness Meditation: Theoretical considerations & preliminary results. General Hospital Psychiatry,4,33-47
Kabat-Zinn J, Massion A O, Kristella J et al (1992) Effectiveness of a Meditation-Based Stress Reduction Program in the Treatment of Anxiety Disorders. American Journal of Psychiatry. 149:7. 936-943
Teasdale JD.Segal ZV,Williams JMG et al (2000) Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology. 68:615-623
Kenny M A.Williams JMG (2007) Treatment resistant depressed patients show a good response to Mindfulness-based Cognitive Therapy. Behaviour Research and Therapy, 45,617-625
Baer R A, Smith G T, Hopkins J et al (2006) Using Self Report Assessment Methods to explore facets of Mindfulness. Assessment. March;13(1):27-45
Bishop, S R (2002) What do we really know about mindfulness-based stress reduction? Psychosomatic Medicine, 64, 71-84.
Kabat-Zinn, Wheeler, Light, et al: (1998) Psychosomatic Medicine 60:625-632
Speca M, Carlson L E, Goodey E. et al (2000) A Randomized, Wait-list Controlled Clinical Trial: The Effect of a Mindfulness Meditation-based Stress Reduction Program on Mood and Symptoms of Stress in Cancer Outpatients. Psychosomatic Medicine. 62:613-622
Lazar. S. Kerr.C,Wasserman R et al. (2006) Meditation experience is associated with increased cortical thickness. www.pubmencentral.nih.gov
Shapiro S L, Astin J A, Bishop S R et al (2005) Mindfulness Based Stress Reduction for Health Care Professionals: Results from a Randomised Trial. International Journal of Stress Management. 12(2):164-176
Cohen-Katz J, Wiley S D, Capuano T et al (2004) The effects of Mindfulness-based Stress Reduction on Nurse Stress and Burnout. Holistic Nursing Practice.18(6):302-308
Galantino M L, Baime M, Maguire M et al (2005) Association of Psychological and phsysiological measures of stress in health-care professionals during an eight-week mindfulness meditation program:mindfulness in practice. Stress and Health Vol 15 (4):255-261
Al Z V, Williams J M G & Teasdale J D (2002) Mindfulness-based Cognitive Therapy for Depression: A new approach to preventing relapse. Guildford, New York.
Williams J M G, Segal Z V, & Teasdale J D & Kabat-Zinn J (2007) The Mindful Way through Depression: freeing yourself from chronic unhappiness. Guildford, New York
www.who-5.org (1998 version)
Curran S L (1995) Short Profile of Mood States(POMS-SF): Psychometric Information: 7;80-83
Baer RA. (2006) Mindfulness-Based Treatment Approaches. Elsevier, UK
Kabat-Zinn J. Lipworth L, Burney R & Sellers W. (1987) Four year follow-up of a meditation-based programme for the self-regulation of chronic pain:treatment outcomes and compliance. Clinical Journal of Pain,2,159-173