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What’s on your Mind? - Mindfulness-Based Therapies and Mental Health (Part 1)
Gareth John   Oct 7, 2015   Ethical Technology  

Before I begin, full disclosure and some caveats:

* In my youth I trained for thirteen years as a Buddhist priest, first with the Japanese Zen tradition and then within the Tibetan tantric tradition. As such, mindfulness based meditation formed the basis of my practice, even when, later in my training, other methods began to be employed.

* The above in no way suggests that I am an expert in mindfulness. While there is a crossover between mindfulness practiced within a religious or spiritual movement and a purely secular one, it is worth bearing in mind that I practiced as a Buddhist first and foremost. My experience of mindfulness is my own. Your mileage as a practitioner will almost certainly vary.

* I have nothing against mindfulness-based therapies in principle; however I do have concerns as to its current ‘panacea to all ills’ approach and the direction that seems to be leading, in particular in the realm of mental health. I will be arguing that in my opinion mindfulness-based therapies can sometimes be counterproductive and even, in some cases, downright harmful. What’s good for the goose may well not be good for the gander.

A brief history: mindfulness is a pre-Buddhist technique of being aware moment-to-moment, of one’s subjective conscious experience from a first-person perspective. In the Buddha’s first sermon to the five non-Buddhist ascetics following his enlightenment, he refers to the word satipatthana, which we translate as ‘mindfulness’, but which had as its origins the meaning of ‘memory’. The fact that he did so without going into great detail as to its meaning suggests that it was well known at the time. Contemporary theory suggests that it was originally used by the Brahmanical traditions in the sense of memorised Vedic scriptures – a form of meditation in itself.

Modern teachings on mindfulness are almost exclusively derived from a particular 20th century interpretation of one text, the Pali Satipatthana Sutta (The Discourse on the Establishing of Mindfulness). The main practice outlined in this text is of satipatthana as breath meditation, anapanasati.

One focusses on the breath, keeping awareness there, continually ‘remembering’ the breath. As the physical breath becomes tranquil, one moves from body contemplation to the awareness of the subtle feelings of bliss and rapture that arise with the movement of the breath. The mind becomes purified. Following this the practising Buddhist moves on to other more advanced meditation techniques, although mindfulness always remains at the centre of these techniques and is returned to again and again even as one progresses.

For the sake of clarity the more usual Pali translation for mindfulness is simply sati and its Sanskrit counterpart smriti which often makes writing about it a little bit easier.

So, although almost certainly predating it, it is with the writings of the early Buddhist tradition – the Theravada – that mindfulness becomes prominent. It’s worth noting that this early formulation did not involve the inclusion of postures and daily activities among its meditation exercises other than as a part of its preparation. It’s also significant that in the Theravada tradition alone, there are over fifty methods for developing mindfulness and forty for developing concentration, so there was early on an incredibly richness and diversity of practice.

I could go on about the history of mindfulness and its place in Buddhist history, but that would take us far outside the remit of this article. I will place some books in the bibliography below which I feel may be useful should you be interested to look into this further.

Bring us up to the present day and the figure of Jon Kabat-Zinn. Born 5th June 1944, Kabat-Zinn is Professor of Medicine Emeritus and creator of the Stress Reduction Clinic and the Centre for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School.

Kabat-Zinn was a student of several of the Buddhist teachers teaching at the time such as Roshi Philip Kapleau, Thich Nhat Hanh and Zen Master Seung Sahn. He helped found Cambridge Zen Centre. He also studied and later taught at the Insight Meditation Society (IMS) located in Barre, Massachusetts and founded in 1975 by Sharon Salzberg, Jack Kornfield, and Joseph Goldstein, rooted in the Theravada tradition. In 1979 he founded the Stress Reduction Clinic at the University of Massachusetts Medical School, where he adapted the Buddhist teachings on mindfulness and developed the Stress Reduction and Relaxation Program.

Kabat-Zinn subsequently began to remove the Buddhist framework around which mindfulness was built and renamed the Stress Reduction and Relaxation Program the Mindfulness-Based Stress Reduction (MBSR), playing down the Buddhist connection and integrating the mindfulness teachings with those of science. This secular technique, which combines meditation and hatha yoga, has since spread worldwide. This integration of yoga and studies with Buddhist teachers claims to help patients cope with stress, anxiety, pain, and illness by using what is called ‘moment-to-moment awareness.’ It is now offered by medical centres, hospitals, and other health organisations, with books written by Kabat-Zinn such as Kabat-Zinn, J. (2013). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. London: Piatkus and Kabat-Zinn, J. (2004). Wherever You Go, There You Are. London: Piatkus, helping to make him and his method internationally famous.[1]

So what exactly is MBSR? Well, it’s basically an eight week course to (and I quote from the MBSR website) “access and cultivate your natural capacity to actively engage in caring for yourself and find greater balance, ease, and peace of mind.” It claims that since 1979 more than 22,000 people have completed its course. It also offers Mindfulness Tools: a five day residential program for those who may not be able to attend the eight week version and an online version also. For the eight week course they offer a sliding scale of fees depending on income from $545 up to $725. Mindfulness Tools tuition costs $625 with accommodation fees on top. The MBSR online course costs a mere $199 with a further $120 thrown in if you want to take a mindfulness test at the end.

And there is, of course, the obligatory teacher-training qualification, which costs a little over $10,000 with teacher supervision and consultation at around $175 per hour. Oh, and accommodation costs for four silent retreats and an eight day Teacher Development Intensive thrown on top.

As if all this were not enough (and this is of special interest for me as should become apparent) they also offer an MBCT (Mindfulness-Based Cognitive Therapy) course, with much the same structure as the MBSR, but which focusses, “on specific patterns of negative thinking that people with depression are vulnerable to, but which we all experience from time to time.” We’ll return to this later.[2]

Now don’t misunderstand me here – I know how these things work and even in the Buddhist community if we were to teach full-time we required donations in order to continue in our undertakings. In principle I have no problem with organisations like the Centre for Mindfulness, Medicine, Health Care and Society charging fees for their services and in all fairness they do offer scholarships to help towards the cost of their courses, although they can rarely cover the full cost of any one programme. And anyway, their Mission Statement makes it sound like money well spent:

Explore, understand, articulate and further mindfulness in the lives of individuals, organizations and communities through clinical care, rigorous scientific research, professional training, and informed public discourse. [3]

It should also go without saying that there are, of course, many other organisations that claim to teach mindfulness and not all of them are associated with Kabat-Zinn. Here in the UK we have the Mindfulness Association,[4] the British Mindfulness Institute[5] and Work with Mindfulness (which offers mindfulness training and consultancy for organisations, which has become a huge market for mindfulness at present) to name but three.[6] There are lots more if you want to do a Google search, including mindfulness in schools, mindfulness for weight loss, and even mindfulness for your pet should they be feline anxious or simply dog-tired (sorry). You can even make use of apps such as Headspace for mindfulness on the go; meditation made simple. Learn online, when you want, wherever you are, in just 10 minutes a day.[7]

Okay, so far we’ve learned it’s got an ancient pedigree, it’s immensely popular and can be a trifle expensive when purchased privately. It’s even prescribed by the NHS to help prevent anxiety, depression and stress. So what is it? What does it do? Very basically mindfulness is a simple technique whereby one’s intention is to be aware of physical sensations of the body and also simply to notice what the mind does. You don’t suppress your thoughts or attempt to empty your mind or focus on any particular thing; you are simply required to notice thoughts and feelings as they arise without attaching any importance to them. Kabat-Zinn calls it “paying attention on purpose, moment by moment, without judging.” If that’s not worth $10,000 I don’t know what is.

Okay, so I’m being facetious. But the question has to be asked: can an approach so deeply rooted in eastern spiritualism, and which at times comes close to sounding like new age waffle, really work?

The idea behind mindfulness is straightforward and from hereon in I’d like to focus on MBCT in particular. This, you will remember, focuses on turning toward low mood and negative thoughts early in the programme so that participants gain experience with recognizing these symptoms and confidence in their ability to respond skilfully. MBCT was specifically developed as a preventative method to prevent future episodes of depression in people with a history of recurrent depression.

Practitioners argue that the brain’s habit of reliving past stresses and worrying about potential future problems can become an obstacle to mental health. It therefore encourages people to get past those critical thoughts about the past and future and to give them tools to help them become anchored more in the present, to focus more on the sensations of the world from moment to moment.

With regard depression, it is argued that negative thinking leads to lower mood which in itself can lead to recurrence of a depressive episode. MBCT, in a sense, provides the practitioner with the necessary tools to create space between the negative thoughts arising and the lowering of mood – it allows one to change one’s relationship with thoughts so that the practitioner ceases to react to them automatically and respond with them in a more skilful and intentional manner. That’s the hoped for response anyway.[8]

Part Two is HERE

Notes are at the end of Part 3 HERE.

Gareth John
Gareth John lives in Mid Wales; he’s an ex-Buddhist priest with a MA in Buddhist Studies at the University of Bristol, and has performed studies on non-monastic traditions of Tibetan tantric Buddhism.

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