Mindfulness : - Mindful Self-Compassion - Christopher Germer, PhD
Transcript of Mindfulness : - Mindful Self-Compassion - Christopher Germer, PhD
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 Application
of Behavioral Medicine
Ronald D. Siegel PsyD
Christopher K. Germer PhD
Andrew Olendzki, PhD
Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhD
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Mindfulness: What Is It? Where Did It Come From?
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,humanbeingshavesoughttodiscoverthecausesofsufferingand
themeanstoalleviateit.Soonerorlater,weallaskthesamequestions:“WhyamInotfeeling
better?”“WhatcanIdoaboutit?”Inhabitingaphysicalbodyinevitablyexposesustopain
associatedwithsickness,oldage,anddeath.Wealsostruggleemotionallywhenconfrontedwith
adversecircumstances,orwithbenigncircumstancesthatweseeasadverse.Evenwhenourlives
arerelativelyeasy,wesufferwhenwedon’tgetwhatwewant,whenwelosewhatweoncehad,
andwhenwehavetodealwithwhatwedonotwant.Frombirthuntildeath,wearerelentlessly
tryingtofeelbetter.
Asthisbookwillshow,mindfulnessisadeceptivelysimplewayofrelatingtoall
experiencethatcanreducesufferingandsetthestageforpositivepersonaltransformation.Itisa
core psychological process that can alter how we respond to the unavoidable difficulties in life—notonlytoeverydayexistentialchallenges,butalsotoseverepsychologicalproblemssuchas
suicidalideation(Linehan,1993),chronicdepression(Segal,Williams&Teasdale,2002),and
psychoticdelusions(BachandHayes,2002).
Mindfulness is not new. It’s part of what makes us human—the capacity to be fully consciousandaware.Unfortunately,weareusuallyonlyinthisstateforbriefperiodsoftime,
andaresoonreabsorbedintofamiliardaydreamsandpersonalnarratives.Thecapacityfor
sustainedmoment-to-momentawareness,especiallyinthemidstofemotionalturmoil,isa
specialskill.Fortunately,itisaskillthatcanbelearned.
Mindfulnessisanelusive,yetcentral,aspectofthe2500year-oldtraditionofBuddhist
psychology.Wecantalkaboutmindfulnessorwriteatlengthaboutit,buttotrulyunderstand
mindfulnesswehavetoexperienceitdirectly.Thisisbecausemindfulnesspointstosomething
intuitive 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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Mindfulness: What Is It? Where Did It Come From?
The Ancient Meaning of Mindfulness
“Mindfulness,”asusedinancienttexts,isanEnglishtranslationofthePaliword,sati,which
connotesawareness,attention,andremembering.(Paliisthelanguageinwhichtheteachingsof
the 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.Justbybecoming
awareofwhatisoccurringwithinand
aroundus,wecanbegintountangle
ourselvesfrommentalpreoccupationsand
difficult emotions. Sometimes this can be quitesimple,asinthecaseofamentally
retardedmanwhomanagedhisanger
outburstsbyshiftinghisattentiontothe“solesofthefeet”wheneverhenoticedhewasangry
(Singh,Wahler,Adkins,&Myers,2003).Byredirectingattention,ratherthantryingtocontrolor
suppressintenseemotions,wecanregulatehowwefeel.
Anotheraspectofmindfulnessis“remembering.”Thisdoesnotrefertomemoryofpast
events.Rather,itmeansrememberingtobeawareandpayattention,highlightingtheimportance
ofintention in mindfulness practice. Each moment we remind ourselves: “Remember—be aware!”
But“mindfulness”meansmorethanbeingpassivelyaware,orbeingawarefor
awareness’sake.TheBuddhistscholar,
JohnDunne(2007)haspointedoutthat
awareness,attention,andremembering
(sati)arepresentwhenasniper,withmalice
inhisheart,takesaimataninnocentvictim.
Obviouslythisisnotwhatwe’retryingto
cultivateaspsychotherapists,norisitthe
goalofBuddhistpsychology.Rather,the
purposeofmindfulnessinitsancientcontextistoeliminateneedlesssufferingbycultivating
insightintotheworkingsofthemindandthenatureofthematerialworld.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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Mindfulness: What Is It? Where Did It Come From?
practitionerisactivelyworkingwithstatesofmindinordertoabidepeacefullyinthemidstof
whateverhappens.
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;ifwearefeeling
lazy,wemightwanttotrytoraisethelevelofenergyinthemindorbody.Mindfulnessaloneis
not sufficient to attain happiness, but it provides a solid foundation for the other necessary factors (Rapgay&Brystrisky,2007).Intheclassicalliterature,mindfulnesswasusuallydiscussedin
termsofitsfunction,notasagoalinitself.Mindfulnessisultimatelypartofaprojectdesigned
to uproot entrenched habits of mind that cause unhappiness, such as the afflictive emotions of anger,envy,orgreed,orbehaviorsthatharm
ourselvesandothers.
Therecentfocusonmindfulawarenessin
psychotherapyisastrategiccorrectiontosome
moderntreatmenttrends.Manywell-intentioned
therapists prematurely attempt to “fix” a patient’s problems,unwittinglybypassingself-acceptance
andself-understanding.Aswillbedemonstratedthroughoutthisvolume,ouremotionaland
behavioral 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
AsmindfulnessisadoptedbyWesternpsychotherapyandmigratesawayfromitsancient
roots,itsmeaningisexpanding.Mostnotably,mentalqualitiesbeyondsati(awareness,attention,
andremembering)arebeingincludedin“mindfulness”asweadaptittoalleviateclinical
conditions.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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Mindfulness: What Is It? Where Did It Come From?
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).Thesethreeelementscanbefoundinmost
modernpsychologicalliteratureonmindfulness.Althoughthe“acceptance”componentis
impliedintheclassicalBuddhisttexts,ithelpstomakeitexplicitforclinicalapplication.Other
relatedshorthandexpressionswemightusefortherapeuticmindfulnessinclude“affectionate
awareness,”“mindfulacceptance,”“openheartedpresence,”and“mindfulcompassion.”
Theexplicitadditionof“acceptance”tothemindfulnessformulamakessensetomost
psychotherapists.Thisisespeciallythecasewhenourpatientsareconfrontedwithoverwhelming
traumaticcircumstances.Awarenesswithoutacceptancecanbelikelookingatascaryscene
under 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,kindnesswithout
clear awareness can lead to sugar coating the difficulties of life that need to be addressed. Sans
awareness,acceptancecouldbecomeaformofdefensiveavoidance.
Whenpatientscometopsychotherapy,theyareoftenindiredistress,seekingaperson
whowilltakethetimetounderstandwhotheyareandwhytheysuffer.Theydesperatelywant
astrategyforrelief.Compassionistheinvisiblematrixthatholdstheentireenterprise.The
word“compassion”comesfromtheLatinroots,com pati,orto“sufferwith.”That’showwe
really come to understand what our patients are going through—we suffer withthem.Ifweoffer
helpful 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-acceptanceishopefullypartofouremotional
landscape;inthetherapyrelationship,acceptanceandcompassionareessentialfortheprocessto
beeffective.
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Mindfulness: What Is It? Where Did It Come From?
Mindfulness and Mindlessness
Apsychotherapistneedstoexperiencemindfulnessinordertointegrateitintohisor
herclinicalpractice.Learningmeditationfromanexperiencedteacheristhebestwaytobegin
and 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-oriented
therapistmayask,momenttomoment,“HowdoIcultivateawarenessofpresentexperiencewith
acceptance,formyselfandmypatient?”Thiscanbeatouchstoneforpractice.
While its definition is easy to remember, the directexperienceofmindfulnessismoreelusive.
Sometimesmindfulnessiseasiesttounderstandby
examiningitsopposite.Evencasualself-examination
revealsthatourtypicalmentalstateisremarkably
mindless.Wespendmostofourtimelostinmemories
ofthepastandfantasiesofthefuture.Moreoftenthannot,weoperateon“autopilot,”whereour
mindsareinoneplaceandourbodiesareinanother.
Anembarrassingexampleofthishappenedtooneofusrecentlywhiledrivingtopresent
aworkshoponmindfulnessandpsychotherapy:
Iwasinarushandrunninglate.Suddenly,afewminutesintomydrive,Irealizedthat
I was heading in the wrong direction on the Massachusetts Turnpike—a toll road on which theexitscanseemasthoughtheyare50milesapart.Iwondered,“Whowasdrivingthecar?”
“Whodecidedtoheadwest?Mymindwasbusypreparingmypresentation,whilemybodywas
steeringthecarautomatically,skillfullyheadinginthewrongdirection.
Similarexamplesabound.ConsidertheleadingcauseofemergencyroomvisitstoNew
YorkhospitalsonSundaymornings:bagel-cuttingaccidents.Whileinteractingwithfamily
membersontheweekend,manypeoplearesodistractedbyinterpersonaleventsthattheirbodies
cut bagels on automatic—and their bodies aren’t very good at this without guidance from the consciousmind.
Another,lesspainful,exampleofeverydaymindlessnessoccursinrestaurants.Haveyou
noticedhowmuchrestaurantconversationrevolvesaroundwhereyouateinthepast,orwhere
Psychotherapists also benefit from a conceptual road map to guide their work.
Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhD
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Mindfulness: What Is It? Where Did It Come From?
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,perhapstenminutesintoa
psychotherapy session with a frustrating patient, “Darn, forty minutes to go!” When we reflect honestly,wenoticethatwe’rerushingthrough,ortryingtogetridofmuchofourlifeexperience.
Youmaynoticethiseveninthepresentmoment:Asyoureadthesesentences,where
hasyourmindgone?Haveyouhadthoughtssuchas,“Iwonderifthisbookisgoingtobe
worthwhile?”“MaybeIshould’vegottenanotherone,”or“Thisisprettyinteresting,Ihopethe
restofitisgoodtoo.”Perhapsyourmindhasleftthebookentirely,andyou’rethinkingabout
whatyou’lldolater,orwhathappenedearliertoday.
Thepervasivenessofeverydaymindlessnessisparticularlystrikingwhenweinquire
intowhatreallymattersinourlives.
Takeafewsecondstorecallamomentin
yourlifethatyoureallyvalued.(Really,
stopreadingforamomentandthink
ofone.)Perhapsitwasaspecialtime
withsomeoneyoulove,oramagical
experienceinnature.Duringthismoment,wherewasyourmind?Wasitfocusedonrecallingthe
past, or imagining the future? Most people find that the moments they value the most are those in whichthey’refullypresent,noticingwhatishappeninghereandnow.
Thesearemomentsofmindfulness.Wenoticethepositionsofourhands,andthe
sensationsofholdingaknifeandbagel.Weareawareofourbodiessittinginthecarwhen
wedrive,andwenoticetheothercars,theroad,thescenery.Wetastethefoodweeat,and
weactuallyexperiencethesight,sound,andemotionalpresenceofourpatientsduring
psychotherapy.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.
Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhD
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Mindfulness: What Is It? Where Did It Come From?
While notoriously difficult to convey with words, the Zen Haiku tradition endeavors to capturemomentsofmindfulness.HereisaclassicexamplefromMatsuoBasho,awandering
Japanesepoetofthe17thcentury:
Anoldpond!
A frog jumps in — Thesoundofwater.
(Toyomasu,2001)
Mindfulness Practice
Whileitcanbedisturbingtonoticehowfrequentlywearemindless,andhowmuchof
ourliveswewishaway,thereisalsogoodnews:mindfulnesscanbecultivated.Justaswecan
improve physical fitness through regular physical exercise, we can develop mindfulness through deliberatementalpractices.
Mindfulnesspracticesallinvolve
someformofmeditation.Especiallyin
theWest,misconceptionsaboutmeditation
practiceabound.Itmaythereforebehelpful
toexaminesomeofthemostcommon
misunderstandings.
Not Having a Blank Mind:While
someconcentrationpracticesaredesignedtoemptythemindofthought,thisisnotanaimof
mindfulnesspractice.Nordowewishtobecomestupid,orloseouranalyticalabilities.Instead,
mindfulnesspracticeinvolvestrainingthemindtobeawareofwhatitisdoingatalltimes,
includingbeingawarethatwearethinkingwhenwethink.
Not Becoming Emotionless:Manypeoplesecretlyhopethatmindfulnesspracticewill
relievethemoftheburdenofemotion.Especiallywhenindistress,thefantasyofbecoming
emotionlesscanbequiteappealing.Inreality,mindfulnesspracticeoftenhasquitetheopposite
effect.Becausewepracticenoticingthecontentsofthemind,wecometonoticeouremotions
morefullyandvividly.Ourabilitytorecognizehowwefeelincreasesaswerelinquishnormal
defenses,suchasdistractingourselvesfromdiscomfortwithentertainmentoreating.
Just as we can improve physical fitness through regular physical exercise, we can develope mindfulness through deliberate mental practices.
Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhD
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Mindfulness: What Is It? Where Did It Come From?
Not Withdrawing from Life: Because most meditation practices were originally refined bymonks,nuns,andhermits,peopleoftenassumethattheyinvolvewithdrawingfromliving
a 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’retakingthetimeto
payattentiontoourmoment-to-momentexperience.
Not Seeking Bliss:Theimageofthespiritualmasterblissfullysmilingwhiletherest
ofusstrugglewithexistentialrealityisveryappealing.Earlyintheirmeditationcareers,many
people become distressed when they find that their minds wander and they feel agitated or unsettled.Whileexceptionallypleasantstatesofminddooccur,inmindfulnessmeditationwe
allow them to arise and pass—not clinging to blissful states nor rejecting unpleasant ones.
Not Escaping Pain:Ratherthanescapingpain,mindfulnesspracticehelpsustoincrease
ourcapacitytobearit.Wedeliberatelyabstainfrom
automaticactionsdesignedtomakeourselvesfeel
better.Forexample,ifwearemeditatingandanitch
arises,atypicalinstructionistoobservetheitchand
noticeanyimpulsesthatarise(suchastheurgeto
scratch)—but to not act on the urge. As a result, we actuallyexperiencepainanddiscomfortmorevividly.Thisextendsbeyonditchesandphysical
paintoincludethefullspectrumofemotionaldiscomfortaswell.Asweexploreandaccept
theseunpleasantexperiences,ourcapacitytobearthemincreases.Wealsodiscoverthatpainful
sensationsaredistinctfromthesufferingthataccompaniesthem.Weseethatsufferingarises
whenwereacttopainwithresistance,protest,oravoidanceratherthanmoment-to-moment
acceptance.
Forms of Pracitce
Therearemanywaystocultivateawarenessofcurrentexperiencewithacceptance.Not
surprisingly,alloftheminvolverepeatedpractice.Ifwewanttoimproveourcardiovascular
fitness, we might begin by integrating physical exercise into our everyday routine—taking the stairsinsteadoftheelevator,orridingabicycleinsteadofdrivingtowork.Ifwewanttobecome
even 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.
Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhD
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Mindfulness: What Is It? Where Did It Come From?
Everyday Mindfulness:Thisinvolvesremindingourselvesthroughoutthedaytopay
attentiontowhatishappeninginthemomentwithoutradicallyalteringourroutines.Itmeans
noticingthesensationsofwalkingwhenwewalk,thetasteofourfoodwhenweeat,andthe
appearanceofoursurroundingsaswepassthroughthem.TheVietnameseZenteacherThich
NhatHahnsuggestsanumberoftechniquestoenhanceeverydaymindfulness.Forexample,
when the telephone rings, try just listening at first, attending to the tone and rhythm of the sound asonemightlistentoamusicalinstrument.Orwhiledriving,whentheredtaillightsofanother
vehicleappear,tryappreciatingtheircolorandtextureasonemightinlookingatabeautiful
sunset.
Formal Meditation Practice:Thisinvolvessettingasidetimetogotothemental“gym.”
Weregularlydedicateacertainperiodtositquietlyinmeditation.Therearemanytypesof
meditationthatcancultivatemindfulness.Mostinvolveinitiallychoosinganobjectofattention,
suchasthebreath,andreturningourattentiontothatobjecteachtimethemindwanders.This
developsadegreeofcalmnesswhich,inturn,enablesustobetterfocusthemindonthechosen
object.Oncesomeconcentrationisestablished,mindfulnessmeditationentailsdirectingthe
mind to whatever begins to predominate in the mind—usually centering on how the event is experiencedinthebody.Theseobjectsofattentioncanbephysicalsensationssuchasanitch,
ache,orsound;oremotionalexperiencesastheymanifestinthebody,suchasthetightnessinthe
chestassociatedwithanger,orthelumpinthethroatthatcomeswithsadness.Regardlessofthe
chosenobjectofattention,wepracticebeingawareofourpresentexperiencewithacceptance.
Retreat Practice:Thisisthe“vacation”thatisdedicatedentirelytocultivating
mindfulness.Therearemanystylesofmeditationretreats.Mostinvolveextendedperiodsof
formalpractice,oftenalternatingsittingmeditationwithwalkingmeditation.Theyareusually
conductedinsilence,withverylittleinterpersonalinteraction,exceptforoccasionalinterviews
with 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.
Wegettovividlyseehowourmindscreatesuffering
inanenvironmentwhereallofourneedsaretended
to. Many people find that the insights that occur—duringevenasingleweek-longintensivemeditation
retreat—are life transforming.
The effects of mindfulness practice seem to be dose-related.
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Mindfulness: What Is It? Where Did It Come From?
Theeffectsofmindfulnesspracticeseemtobedose-related.Ifonedoesalittlebitof
everydaypractice,alittlebitofmindfulnessiscultivated.Ifonedoesmoreeverydaypractice,
andaddstothisregularformalpracticeandretreatpractice,theeffectsaremoredramatic.While
this has long been evident to meditators, it is beginning to be documented through scientific research(Lazaretal,2005).
Why Mindfulness Now?
Wearecurrentlywitnessinganexplosionofinterestinmindfulnessamongmentalhealth
professionals.InarecentsurveyofpsychotherapistsintheUnitedStates
(Simon,2007),thepercentageoftherapistswhosaidthattheydo“mindfulnesstherapy”atleast
someofthetimewas41.4%.Incomparison,cognitive-behavioraltherapywasthemostpopular
model(68.8%),andpsychodynamic/psychoanalytic
therapytrailedmindfulnessat35.4%.Two
yearsago,wespeculatedthatmindfulnesscould
eventuallybecomeamodelofpsychotherapyinits
ownright(Germer,Siegel,&Fulton,2005).That
timeisrapidlyapproaching.
Why?Oneexplanationisthattheyoungpeoplewhowerespiritualseekersand
meditatorsinthe1960’sand70’sarenowseniorclinicalresearchersandpractitionersinthe
mental health field. They have been benefiting personally from mindfulness practice for many years and finally have the courage to share it with their patients.
Anotherexplanationisthatmindfulnessmaybeacoreperceptualprocessunderlying
all effective psychotherapy—a transtheoretical construct. Clinicians of all stripes are applying mindfulnesstotheirwork,whethertheyarepsychodynamicpsychotherapistswhoprimarily
workrelationally,cognitive-behavioraltherapistswhoaredevelopingnew,moreeffective,
structuredinterventions,orhumanistic
psychotherapistsencouragingtheirpatientsto
enterdeeplyintotheir“feltexperience.”The
commontherapeuticquestionis,“HowcanI
helpthepatienttobemoreacceptingandaware
ofhisorherexperienceinthepresentmoment?”
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.
Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhD
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Mindfulness: What Is It? Where Did It Come From?
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,the
preponderanceoftheresearchonmeditationhasswitchedfromstudiesofconcentrationmeditation
(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,whichworkstochangethecontent
ofourthoughtstoalterhowwefeel.Thecurrent“thirdwave”ismindfulnessandacceptance-
basedtherapy.ResearcherssuchasStevenHayes,thefounderofAcceptanceandCommitment
Therapy,discoveredmindfulnessandacceptance-basedtreatmentstrategieswhilelookingfor
novelsolutionstointractableclinicaldilemmas.Others,suchasMarshaLinehan,whodeveloped
DialecticalBehaviorTherapy,hadapersonalinterestinZenBuddhismandsoughttointegrate
principlesandtechniquesfromthattraditionintoclinicalpractice.Wearenowinthemidstof
a fertile convergence of modern scientific psychology with the ancient Buddhist psychological tradition.
Inthenewmindfulnessandacceptance-basedapproach,therapistshelppatientsshift
theirrelationshiptopersonalexperienceratherthandirectlychallengingmaladaptivepatternsof
thought,feeling,orbehavior.Whenpatientscometotherapy,theytypicallyhaveanaversionto
what they are feeling or how they are behaving—they want less anxiety or less depression, or want todrinkoreatless.Thetherapistreshapesthepatient’srelationshiptotheproblembycultivating
curiosityandmoment-to-momentacceptanceof
uncomfortableexperience.
Forexample,apanicpatient,Kaitlin,
spent the previous five years white-knuckling the steeringwheelofhercarwhiledrivingtowork.
Shewasdoingallthetraditionalbehavioral
strategies:sheexposedherselftohighwaysand
bridges,shepracticedrelaxation,andshecould
effectivelytalkherselfoutofherfearofdyingfromaheartattack.Still,Kaitlinwonderedaloud,
“WhytheheckdoIstillsufferfrompanic?”TheansweristhatKaitlinneverlearnedtoreally
tolerateanxietyitself.Shewasalwaysrunningawayfromit.Sheneededthemissinglinkthatthe
third 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.
Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhD
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Mindfulness: What Is It? Where Did It Come From?
liveourlivesinameaningfulway.
Anotherarenaofresearchthatisfuelinginterestinmindfulnessisbrainimagingand
neuroplasticity. 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)demonstratedthatbrainareasassociatedwithintrospectionandattention
enlargewithyearsofmeditationpractice.Davidsonetal(2003)foundincreasedactivityintheleft
prefrontalcortexfollowingonlyeightweeksofmindfulnesstraining.Theleftprefrontalcortexis
associatedwithfeelingsofwell-
being.Increasedactivityinthis
partofthebrainalsocorrelated
withthestrengthofimmune
response to a flu vaccine. More dramaticchangescouldbefound
inthebrainsofTibetanmonks
whohadbetween10,000to50,000hoursofmeditationpractice(Lutzetal,2004).
The evidence from scientific studies is validating what meditators have long suspected, namelythattrainingthemindchangesthebrain(Begley,2007).Wearenowbeginningtosee
whereandhowmuchchangeispossible.Furthermore,thechangesthatoccurinthebrainwhen
weareemotionallyattunedtoourowninternalstatesinmeditationseemtocorrelatewiththose
brain areas that are active when we are feeling connected to others (Siegel, 2007)—suggesting thattherapistscantraintheirbrainstobemoreeffectivetherapeuticallybypracticingmindfulness
meditation.
Practical Applications of Psychotherapy
Psychotherapistsareincorporatingmindfulnessintotheirworkinmanyways.Wemight
imagine these on a continuum, from implicit to explicit applications—from those hidden from viewtothosethatareobvioustothepatient.
Onthemostimplicitendisthepracticing
therapist.Asjustmentioned,whenatherapist
beginspersonallypracticingmindfulness,hisor
hercapacityforemotionalattunementseemsto
increase.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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Mindfulness: What Is It? Where Did It Come From?
modelsofpsychopathology,ormodesofintervention,thetherapistseemstobeabletomore
carefully attend to and empathize with a patient’s experience. The therapist’s need to “fix” problemsdiminishesasheorshecultivatesthecapacitytobewithanother’spain.Therapistsfeel
closertotheirpatients,developingcompassionbothbybecomingawareoftheuniversalityof
suffering,andbyseeingmoreclearlytheirinterconnectionwithothers.Researchinthisareais
justbeginning(Grepmair,Mitterlehner,Loew,&Nickel,2006;Grepmair,Mitterlehner,Loew,&
Nickel,2007)
Nextalongthecontinuumisthepracticeofmindfulness-informedpsychotherapy
(Germer,Siegel,&Fulton,2005).Thisistreatmentinformedbytheinsightsthatderive
fromBuddhistpsychologyandmindfulnesspractice.Thetherapist’sunderstandingof
psychopathologyandthecausesofhumansufferingchangeasaresultofobservinghisorher
ownmindinmeditationpractice.Insightssuchasunderstandingthearbitraryandconditioned
nature of thought, seeing the counterproductive effects of trying to avoid difficult experience, andnoticingthepainfulconsequencesoftryingtobuttressoursenseofseparateself,allhavean
impactonhowweapproachourpatients’problems.
Finally,themostexplicitapplicationofmindfulnesstopsychotherapyismindfulness-
basedpsychotherapy(Germer,Siegel,&Fulton,2005).Mindfulness-basedtherapistsactually
teach mindfulness practices to patients to help them work with their psychological difficulties. Ahostofmindfulness-basedinterventionsarecurrentlybeingdevelopedforawiderangeof
clinicalproblems.Sometimesthepatientistaughtatraditionalmeditationpractice,andother
timesthatpracticeiscustomizedforthepatient’sparticulardiagnosis,personalitystyle,orlife
circumstances.
Untangling Terminology
As“mindfulness”isabsorbedintomodernpsychologyandWesternculture,thereis
growingconfusionabouttheterm.Ithascometocoveralotofground.Atleastsomeofthe
confusioncouldbeeliminatedifweusedPali,ratherthanEnglish,words.(Thereaderisreferred
toMindfulnessinPlainEnglishbyBhanteGunaratna(2002)foraremarkablylucidexpositionof
Palitermsandhowtheyrelatetomindfulnesspractice.)
Thefollowingisanefforttoteaseapartthedifferentmeaningsofmindfulnesscurrently
usedinmodernpsychology.
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Mindfulness: What Is It? Where Did It Come From?
Classical Concept:Asdiscussedearlier,thePalitermsati,whichisoftentranslatedas
“mindfulness,”denotes“awareness,”“attention,”and“remembering.”IntheBuddhisttradition,
satiiscultivatedasatoolforobservinghowthemindcreatessufferingmomentbymoment.Itis
practicedtodevelopwisdomandinsight,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).These
process 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”ingeneral
isconsideredachangeprocess,andsoaretheindividualelementsthatconstitutetherapeutic
mindfulness—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“presentmoment
sensations,” 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”)helpschronicallydepressedpeople
disentanglefromdepressiveruminations(Teasdaleetal,2002),whilepeoplewithaschizoidor
detached 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,”whatisheorshe
actuallydoing?Therearethreekeymeditation
skillsoftensubsumedundertheheadingof
“mindfulnessmeditation:”
Concentration Meditation:Thistechniquehasafocalobject,suchasthebreathora
mantra.Theinstructionis,“Whenyounoticethatyourmindhaswandered,gentlybringitback
There are three key meditation skills often subsumed under the heading of “mindfulness meditation:”
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Mindfulness: What Is It? Where Did It Come From?
to[theobject].”Concentrationmeditationproducesafeelingofcalmness.ThePaliwordmost
associatedwithconcentrationpracticeissamatha,whilethetraditionalwordformeditationis
bhavana,whichmeans“developing.”“Concentrationmeditation”isatranslationofsamatha
bhavana,thecultivationofconcentration.The“relaxationresponse”(Benson&Klipper,2000)is
well-knownexampleofthismeditationapproach.
Mindfulness Meditation:Theinstructionformindfulnessmeditationis,“Noticewhatever
predominatesinawareness,momenttomoment.”Heretheintentionisnottochooseasingle
objectoffocus,butrathertoexplorechangingexperience.Theskillofmindfulnesscultivates
insightintothenatureofone’spersonalconditioning(e.g.,“fearofdisapproval,”“angerat
authority”)andthenatureofmentalreality(“it’schanging,”“it’softenunsatisfactory,”“the‘self’
is fluid”).
Thisisprimarilywhatdistinguishes“mindfulnessmeditation”fromotherformsof
meditation,suchasconcentrationmeditationandvariousformsofvisualizationmeditation,and
itisauniquecontributionofBuddhistpsychology.ThePaliwordsformindfulnessmeditation
arevipassanabhavana,whichtranslateswellasthecultivationofinsightor“insightmeditation.”
Westernresearchersandcliniciansusuallyusetheexpression“mindfulnessmeditation”torefer
tothispractice.
Makingmattersabitmorecomplicated,satiisactuallycultivatedby,andnecessaryfor,
bothconcentrationandmindfulnessmeditationtechniques.Thatis,weneedtoknowwhere
themindistoconcentrateoneitherasingleobjectormanyarisingobjects.Sincethemindis
activelyengagedwithawiderrangeofexperiencesduringmindfulnessmeditation,itcanbesaid
thatsatiismoredeliberatelydevelopedinthisparticularpractice.
Duringmindfulnessorinsightmeditation,themeditatorcanalwaysreturnto
concentrationpracticetostabilizeattentionifheorshebecomeslostindaydreamsanddiscursive
thinking.Inthisregard,concentrationpractice(samatha)facilitatesmindfulnessorinsight
(vipassana)practice.
Lovingkindness Meditation:Lovingkindnessistheemotionalqualityassociatedwith
mindfulness.TranslatedfromthePaliword,metta,lovingkindnessmeditationcanbeaform
ofconcentrationmeditation.Thepractitionerreturnsattentionagainandagaintophrasessuch
as“MayIandallbeingsbesafe,happy,healthy,andlivewithease.”Thistechniqueallows
thepersontosoftenintoandallowarisingexperiencetobejustasitis.Itiscultivatingthe
intentiontobelovingandkind,ratherthansuperimposingwarmfeelingsonourmoment-to-
moment experience. The emotional flavor of affectionate awareness typically follows our kindly
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Mindfulness: What Is It? Where Did It Come From?
intentions.Lovingkindness(feelingsafe,peaceful,healthy,andfreefromsuffering)keepsthe
functionofmindfulnesspracticeclearinthemindofthepractitioner.Itisaqualityofmind
thatideallypervadestheothermeditationpractices.Therefore,whilepracticingconcentration
meditation,weworktoreceivementaldistractionswithopenheartednessratherthansternness;
whenpracticingmindfulnessorinsight
meditation,wegreetallmentalcontents
likewelcomevisitors.
Whenoursati(mindfulness)
isstrong,wecanchoosetoswitch
fluidly among metta (lovingkindness), samatha (concentration), or vipassana (mindfulness or insight)practices,asneeded,eveninasinglesittingofmeditation.Forexample,ifdealing
withpsychologicaltrauma,wecannoticewhenweareoverwhelmedandcanchooseto
redirectattentiontothebreathorexternalsightsandsounds(samatha).Wecanalsoadd
somelovingkindness(metta)toourexperiencetoreestablishameasureofcalmness.When
we 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,thegeneralpublicinWestern
cultureusestheterm“mindfulness”looselytorefertoeveryvarietyofformalandinformal
secularBuddhistpractice.Underthislabel,wenotonlyhavethedifferentmeditationskillsjust
mentioned—lovingkindness, concentration, and mindfulness or insight—but also visualization techniquesandinnumerable,informalmeditationstrategiestodealwitheverydaylife.
Visualizationmeditationsincludepracticesthatcultivateequanimity,suchasimaginingoneself
asasolidmountainunaffectedbythewindandweather,orasadeeppondunperturbedbythe
waves.
As mindfulness is incorporated into diverse fields such as health care, education, and business,thetermwillprobablycontinuetoaccrueanincreasingarrayofmeanings.Within
clinicalpsychology,“mindfulness”isalreadyusedinterchangeablywith“acceptance”to
describe the third wave of behavioral treatments. In the field of education, Ellen Langer (1989) describes“mindfulness”asacognitiveprocessthatimpliesopenness,curiosity,andawareness
ofmorethanoneperspective.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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Mindfulness: What Is It? Where Did It Come From?
Despitetherecentproliferationofinterestinmindfulnessanditsmultiplyingmeanings,
thevarioususesofthetermstillhavemuchincommon.Onlytimewilltellwhathappensto
“mindfulness”asthetheoryandpracticesthatbeganinBuddhistpsychologymoveintonew,
heretoforeunimaginabledomains.
Radical Roots
Thecultivationofmindfulnessinarigorouswaycomesfromatraditionwithancient
rootsandloftygoals.Theseoriginsareimportanttounderstandsothatmoderncliniciansdon’t
inadvertentlymissitsprofoundpotentialforpsychologicaltransformation.
As far back as four thousand years ago, we find images of yogis in ancient India sittingcross-leggedinmeditation,gazinginwardwitheyeshalfclosed.Trainingthemind
wasunderstoodastheprinciplemeansofachievingmentalandphysicalhealth,emotional
equanimity,andperfectingthehumancondition.
Mindfulness,aswearecomingtoknowitintheWest,wasmostclearlydescribedin
ancienttimesintheteachingsofthehistoricalBuddha.Accordingtotradition,hewasborn
aprincesome2500yearsago.Attheageof29,herenouncedalifeofcomfortandprivilege
toundertakerigorousmentalandphysicaldisciplinesforsevenyears.Finally,atage36,
heexperiencedabreakthroughofunderstandingthatprofoundlyre-orderedhismind.He
wanderedfromplacetoplaceforthenext40yearsexhibitingbehaviorsdevoidoftheusual
humanpropensitiestowardattachment,
aversionordelusion.Thepsychological
teachings he left behind—including how to cultivate mindfulness—are still accessibletoustoday.
FortheBuddha,themindand
bodyareseenastheproductofmaterialcauses,lackingthedivineessencethatwasassumedby
theIndo-Europeanreligionsofhistime.Nonetheless,intheBuddha’sview,thebodyandmind
canbethevehicleforaprofoundexperienceoftranscendence.Ratherthanbreakingthroughto
somethingdivine,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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Mindfulness: What Is It? Where Did It Come From?
Theprimaryinterestofthistraditionisthequalityofconsciousnessinthepresent
moment.Howexactlyisthemindandbodymanifestinghereandnow?Consciousnessarises
fromawholenetworkofinterdependentfactors,includingallofthedetailsofourgenetic
makeupandpersonalhistory.Eachmomentofconsciousness,inturn,hasanimpactupon
oursubsequentbeliefs,feelings,andbehaviors.Knowingboththecausesandtheeffectsofa
momentofconsciousnessallowsustoparticipateintentionallyintheprocessofliving;tosteera
courseawayfromsufferingandtowardhealthierstates.
WhattheBuddhasawwithgreatlucidityonthenightofhisawakeningwastheworkings
ofhisownmind.Hisinsightshaveprofoundimplicationsformodernpsychotherapy,asthey
revealhowourmindsconstructourexperiencemomentbymoment,andhowtheseconstructions
can lead to suffering. The following description is not for the faint-hearted—it is a radically new psychologyformanyreaders,andsomewhatcomplicated,soweencourageyoutoconsiderit
slowly.
How We Construct Our Experience
TheBuddhasawthatallexperienceinvolvesaprocessinwhichtherawdatastreaming
intothemindthroughthesensoryorgansor“sensedoors”iscompiledandsynthesizedintoa
virtualworldofmeaning.Therearesixsensedoorsinall:theeye,ear,nose,tongue,body,with
the 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,whichacknowledgesthatthemindandbodyhave
amaterial,biologicalfoundation.Thenextisconsciousness,ortheactofbecomingawareof
anobjectbymeansofoneofthesixsenseorgans(againwiththemindasthesixthorgan).
Atthisstagetheeyesees,theearhears,thetonguetastes,etc.Thethirdandfourthsystems,
whichshapehowconsciousnessmanifests,areperceptionandfeeling. Perception identifies whatisexperiencedthroughaseriesofassociations,interpretingincomingdatainthelightof
historicallylearnedpatternsofrecognition.Forexample,youcanrecognizejusttwodotsanda
curved line to be a face☺, or identify the object in your hands to be a book. “Feeling” provides anaffecttoneforeachmomentofcognition,eitherpleasant,unpleasantorneutral.Thisisa
hedonicassessmentofeachobject’svaluetotheorganism.Ineverymoment,weeitherlike,
dislike,oraren’tinterestedinwhatweperceive.
The fifth and final component of the construction of experience is called formations and
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Mindfulness: What Is It? Where Did It Come From?
reflects the intentional stance we take toward all objects that we perceive and toward which wehavefeelings.Volitionorintentionistheexecutivefunctionofthemindwhichinitiates
conscious 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,andyouopenthe
refrigerator door. The eye sees patterns of light, dark, and color in the visual field, which are quicklyorganizedbythebrainandperceivedasafreshlymadesandwich.Instantaneouslya
positivefeelingtowardthesandwicharises,andanintentionformstopickitupandeatit.This
issoonfollowedbythebehaviorofactuallytakingabite.Consciousnesscreatesandrespondsto
ourrealitysoquicklythattheprocessisusuallyunconscious.
Intentionsandthebehaviorsthatfollowfromthemtendtobecomehabitualandturn
intodispositions.Dispositionsaretheresidueofpreviousdecisions,storedinmemoryashabits,
learnedbehaviors,personalitytraits,etc.,andprovidehistoricalprecedentsforhowtorespond
toeachnewlyarisingmoment.Feedbackloopsdevelop,wherebyone’spresentresponsetoany
situationisbothshapedbypreviousexperienceandgoesontomoldthedispositionsthatwill
influence 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,constructingmeaningfrom
anever-changingbarrageofenvironmentalinformation.Ineachmoment,whichcanbemeasured
inmilliseconds,allthisarisesconcurrently,organizesaroundaparticularbitofdata,andthen
passesaway.
OneuniquefeatureofBuddhistpsychologyisthatconsciousnessisregardedasan
unfoldingprocess,oranoccurringevent,ratherthanasanexistingentity.Nothingpermanent
abides(andthereisnoenduring“me”tobefound)becauseevery“thing”isaseriesof
interrelatedevents.Theeverydaysensethatwe(andotherbeings)haveseparateexistence
comesfromthefactthateachmomentofcognitionisfollowedbyanothermomentofcognition,
yieldingthesubjectivesenseofastreamofconsciousness.Wehavesimplylearnedtoconnect
thesnapshotstogetherintoacoherentnarrative.Thisisliketheillusionofcontinuousactionthat
ourmindscreateoutofseparateframesinamovie.AmongthegreatinsightsoftheBuddhist
traditionisnotonlythatthisisallhappeningbelowthethresholdofordinaryawareness,butalso
thatthisprocesscanunfoldineitherhealthyandunhealthyways,dependingontheskillsofits
handler.
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Mindfulness: What Is It? Where Did It Come From?
Thisanalysisofhuman
experiencehasimportantandradical
clinicalimplications.Itsuggeststhat
ourreality,includingthesenseof
“self”aroundwhichsomuchpersonal
psychologyiscentered,isbasedona
fundamentalmisunderstanding.Itis
asthoughwebelievedthatapowerful
automobile like a Ferrari was a living being—until we saw it disassembled on the floor of a workshop.Whenweknowthecomponentpartsandhowthey’reputtogether,wecanneverlook
ataFerrariinquitethesameway.Similarly,seeingthewaythe“self”isconstructedcanhelp
both 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,andtohisteachingasakindof
medicine. The illness he is treating is the fact that consciousness is continually influenced by patternsofconditioningthatinevitablyresultinunhappiness,frustration,anddisappointment.
Thisiscertainlyanobservationfamiliartothemodernpsychotherapist.Ratherthanchanging
brainchemistrybypharmaceuticalsorprobingpasttraumasarrestingnormaldevelopment,
however,theBuddha’sapproachistohelpthepatientgaindirectinsightintothenatureof
experience.Thistakesmanyforms.
Onetrackistonoticetheextentto
whichthepatternsofconditioningwe
acquire,throughlearnedbehaviors,
conditionedresponses,orcultural
osmosis,areforthemostpart
builtuponcertainillusionsoreven
delusions.Foremostoftheseareour
remarkablyrobusthabitoftakingwhat
isimpermanentandsubjecttochange
to be stable or reliable; believing that the satisfaction or gratification of desires is sustainable for longerthanafewmomentswhen,becauseoftheformerpoint,itisnot;andprojectingagainand
again 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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Mindfulness: What Is It? Where Did It Come From?
ofwhatishappening.Inotherwords,wecontinuouslydeludeourselvesintobelievingthatwe
canholdontowhatwewantandgetridofwhatwedon’twant,despiteconsiderableevidenceto
thecontrary.Andontopofthis,wedeludeourselvesintobelievingthatastable,independent“I”
or“me”isrunningthisshow.Totheextentthesemisperceptionscanbegraduallyuncoveredand
corrected,considerablehealingcanoccur.
Forexample,thereisthestoryofamonkwhocomplainedtohisZenteacherthathewas
anangryperson.Theteachersaid,“Showme.”Sincethestudentwasnotangryatthemoment,
hecouldnotshowit,whereupontheteachersaid,“See,youarenotanangrypersonbecause
you are not angry all the time.” Such insight into the fluidity of experience and insubstantiality ofidentitycanbeenormouslyhelpfultopatientswhohavecorebeliefsaboutbeingunworthy,
unlovable,unintelligent,andsoforth.
Anotherapproachistorecognizethefactthatbehaviorisdrivenbydesire,both
consciousandunconscious,andtousethatknowledgetodiminishandeventuallyeliminatethe
roleofdesireinthemoment-to-moment
functioningofmindandbody.The
impulsetolikesomethingsanddislike
othersleadstopullingsomeobjectsof
experiencecloserandpushingothers
fartherawayfromasenseofselfthat
setsitselfapartfromwhatisactually
happening.Ironically,saytheBuddhists,
theverystrategiesweemployto
overcome 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,whichcanbereplacedbyanattitudeof
equanimityoracceptance.Inclinicalpractice,weseecountlessexamplesthat“whatweresist
persists,”andhowpatientssufferterriblyfromwishingthatthingswouldbeotherthantheyare,
i.e.,fromnotfacing“reality.”
Theunderlyingtendenciesofbothdelusionanddesirearedeeplyembeddedin
humannature,butcanbesuccessfullydiminishedandeveneliminated.Theword“Buddha”
actuallymeans“awake,”andthehistoricalBuddhawasamanwhoundertookaprogramof
transformationthatresultedinhis“awakening”fromthemisconceptionsofdelusionandthe
addictionsofdesire.
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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Mindfulness: What Is It? Where Did It Come From?
Bottom-Up Vs. Top-Down Processing
Moderncognitivescientistsdistinguishbetweenbottom-upandtop-downinformation
processing(Eysenck&Keane,2000).Attheheartofmindfulnessmeditationisanemphasis
uponbottom-up,ratherthantop-down,functionsofthemind.Thatistosay,mindfulnessseeks
tobringattentiondirectlytothestreamofsensorydataenteringexperiencethrougheachofthe
sensedoors:thevisualforms,sounds,smells,tastes,andbodilysensations,aswellastothe
arisingofthoughtsandimagesinthemind.Indoingso,itsteersattentionawayfromthemany
“upperlevel”schemas,narratives,beliefs,andotherconceptualmapswenormallyusetoguide
our way through a day’s experience. This is cognitive behavioral therapy on steroids—bringing attentiontosubtlesensoryexperience,andinsodoing,comingtoseeallthoughtsandtheir
associatedfeelingsasarbitrary,conditionedevents.Whileordinaryconsciousnesstendsto
overlookthedetailsofsensoryexperience(usuallywearejusttryingtoextractfromitwhatisof
interesttoachieveourgoals),mindfulnesspracticeinsteadfocusesuponthesensorydataitself,
foritsownsake,andinvitesthepractitionertoconsistentlyabandonconceptualjudgmentsand
narrativestories.Suchamethodhastheeffectofdeprivingthemindofmuchoftheenergythat
fuelsitsstoriesanddelusions,andtransfersourawarenesstotheareasthatwilldirectlyreveal
the transient, constructed, and selfless nature of experience.
Mindfulness in Context
Asmentionedearlier,mindfulnessispartofaprojectdesignedtouprootharmfulhabits
ofmind.InthetraditionalBuddhistcontext,mindfulness
isembeddedinaneight-foldpathtoalleviatesuffering;
mindfulnessisguidedanddirectedbysevenotherfactors.
Theyare:1)theviewonehasofwhatisreal,important
valuable,anduseful;2)howintentionisusedtoinitiate
andsustainactioninskillfulways;3)thenatureofspeech
that can be either harmful or beneficial; 4) the quality of action as it relates to ethical principles; 5)one’smeansofsustainingoneselfintheworldaslivelihood;6)thedegreeandqualityofeffort
employedtobringaboutchange;7)andconcentrationasafocusingandsupportingfactorto
mindfulness.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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Mindfulness: What Is It? Where Did It Come From?
problemofsufferingingeneral.ManyaspectsofBuddhistpsychologyarethereforeasapplicable
todayastheywereinancientIndia.Asthisbookdemonstrates,psychotherapyisharnessingthe
powerofmindfulnessandacceptancetobringrelieftointractablepsychologicalconditions.
However,theproposedoutcomeofdedicatedBuddhistpracticeisradicallydifferent:the
completecessationofsuffering.Inmodernterms,thismeansenvisioningalifewithoutatrace
ofpsychologicalsymptomsfoundinourdiagnosticmanuals.Suchan“awakened”personlives
naturally,withafullrangeofphysical,emotionalandintellectualcapacities,butwithoutneeding
events 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
Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhD
Distributed with permission by
The National Institute for the Clinical Application of Behavioral Medicine
www.nicabm.com
25
Mindfulness: What Is It? Where Did It Come From?
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
Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhD
Distributed with permission by
The National Institute for the Clinical Application of Behavioral Medicine
www.nicabm.com
26
Mindfulness: What Is It? Where Did It Come From?
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.
Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhD
Distributed with permission by
The National Institute for the Clinical Application of Behavioral Medicine
www.nicabm.com
27
Mindfulness: What Is It? Where Did It Come From?
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.
Ronald D. Siegel, PsyD • Christopher K. Germer, PhD • Andrew Olendzki, PhD
Distributed with permission by
The National Institute for the Clinical Application of Behavioral Medicine
www.nicabm.com
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From Didonna, F. (Ed.)(2008)
Clinical Handbook of Mindfulness.
New York: Springer.Distributedwithpermission.