Mindfulness-Based Stress Reduction

The MBSR program emerged in 1979 as a way to integrate Buddhist mindfulness meditation into mainstream clinical medicine and psychology.  107 Originally designed by Dr. Jon Kabat-Zinn at the University Of Massachusetts Medical Center, the MBSR program was a group-based program designed to treat patients with chronic pain. Since then, MBSR has also been used to reduce morbidities associated with chronic illnesses such as cancer and acquired immunodeficiency syndrome and to treat emotional and behavioral disorders. 98

Main components:

The mindfulness component of the program incorporates three different practices: a sitting meditation, a body scan, and Hatha yoga. In addition to the mindfulness meditation practice that forms the basis of the intervention, patients are taught diaphragmatic breathing, coping strategies, assertiveness, and receive educational material about stress. 96 The foundation for the practice of MBSR is the cultivation of seven attitudes:

1. Nonjudgmental, becoming an impartial witness to your own experience; 

2. Patience, allowing your experiences to unfold in their own time;

3. Beginner's mind, a willingness to see everything as if for the first time; 

4. No striving, having no goal other than meditation itself; 

5. Acceptance, of things as they actually are in the present moment; 

6. And not censoring one’s thoughts and allowing them to come and go.

 

In addition to these attitudes, a strong motivation and perseverance are considered essential to developing a strong meditation practice and a high degree of mindfulness. 48 These attitudes are cultivated consciously during each meditation session.48 As with other mindfulness practices, posture and breathing are essential. 48 The practitioner sits upright, either on a chair or cross-legged on the floor, and attempts to focus attention on a particular object, most commonly on the sensations of his or her own breath as it passes the opening of the nostrils or on the rising and falling of the abdomen or chest. 48

Whenever attention wanders from the breath, the practitioner will simply notice the distracting thought and then let it go as attention is returned to the breath. This process is repeated each time that attention wanders from the breath. The MBSR program incorporates formal meditation (i.e., seated, walking, Yoga) and informal meditation (i.e., the application of mindfulness to the activities of daily life). In informal practice, practitioners are reminded to become mindful of their breath to help induce a state of physical relaxation, emotional calm, and insight.48

The seated meditation is done either on the floor or on a straight-backed chair. 48 When sitting on the floor, a cushion approximately 6 inches thick should be placed beneath the buttocks. The practitioner may use the “Burmese” posture in which one heel is drawn in close to the body and the other leg is draped in front, or a kneeling posture, placing the cushion between the feet. 48 The sincerity of effort matters more than how one is sitting.

48 Posture should be erect with the head, neck, and back aligned. The shoulders should be relaxed and the hands are usually rested on the knees or on the lap with the fingers of the left hand above the fingers of the right and the tips of the thumbs just touching each other. 48

The body scan is the first formal mindfulness technique that mediators do for a prolonged period and is practiced intensively for the first 4 weeks of the program. Body scanning involves lying on your back and moving the mind through the different regions of the body, starting with the toes of the left foot and moving slowly upwards to the top of the head. Scanning is done in silence and stillness.

The third formal meditation technique used in the MBSR program is mindful Hatha yoga.  It consists of slow and gentle stretching and strengthening exercises along with mindfulness of breathing and of the sensations that arise as the practitioner assumes various postures 48

Breathing:

Breathing is passive and without any specific pattern. 48

Attention and its object:

During sitting meditation, the attention is focused on the inhalation and exhalation of the breath or on the rising and falling of the abdomen. When the mind becomes distracted with other thoughts, the attention is gently, but firmly returned to the breath or abdomen. During the body scan, attention is focused on the bodily sensations. When the mind wanders, attention is brought back to the part of the body that was the focus of awareness.48 In contrast to other Yoga practices, mindful Hatha yoga is focused less on what the body is doing and more on maintaining moment-to-moment awareness. As in the seated meditation and body scan, the attention is focused on the breath and on the sensations that arise as the various postures are assumed. 

Spirituality and belief:

MBSR was designed as a secular, clinical practice and its practice does not require adopting any specific spiritual orientation or belief.

Training:

The program consists of an 8-week intervention with weekly classes that last 2 to 3 hours. There is a day-long intensive meditation session between the sixth and seventh sessions.  48, 96 Participants also complete 45-minute sessions at home, at least 6 days a week for 8 weeks. 48 During the 2-hour weekly sessions, participants are instructed in the informal and formal practice of mindfulness meditation. Participants must commit to a daily, 45-minute home practice of the skills taught during the weekly meetings. 48

The components of practice change as participants become more adept in sitting meditation, body scan, and Yoga. Body scan is initially practiced at least once per day for 45 minutes for about 4 weeks. It is then practiced every other day, alternating with Yoga. 48

Criteria of successful meditation practice:

The proper practice is determined by an experienced teacher. In the absence of any religious or spiritual component, the measure of success is the achievement of successful outcomes, whether subjective (reduced perceived stress, reduced anxiety, etc.) or objective (reduced blood pressure, reduction in medication usage, etc.).