Mindfulness-Based Stress Reduction (MBSR) – An excerpt from my book “A Doctor’s Guide to Alternative Medicine: What Works, What Doesn’t, and Why – Foreword by Dr. Bernie Siegel

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Mindfulness-Based Stress Reduction (MBSR)ⁱ is a program founded by Jon Kabat-Zinn in 1979 in the Department of Behavioural Medicine at University of Massachusetts Medical Center. Patients were taught to develop non-judgemental, moment-to-moment awareness of thoughts, feelings, and body sensations through a number of mind-body practices. Many subsequent programs have been modeled on this one, and a number of research studies have shown the approach useful for many divergent conditions.

WHAT IS MINDFULNESS MEDITATION?

Meditation is the intentional self-regulation of attention from moment to moment. Mindfulness is a non-judgmental and non-reactive way of paying attention in the present moment to what is happening within us and around us whether we are meditating or doing something active. It has its roots in Buddhism and yogic traditions. Rather than restricting attention to one focus point, as in Transcendental Meditation, this approach emphasizes detached observation of a constantly changing field of focus points. At first, patients learn to concentrate on one focus point such as the successive inflow and outflow of breaths; then they are trained, over a number of sessions, to expand their field of attention to include all physical and mental events like body sensations, thoughts, memories, emotions, perceptions, intuitions, and fantasies.

In awareness meditation practice, no event is considered a distraction but simply another object of observation. No mental event is accorded any relative or absolute value or importance in terms of its content. All thoughts are just noted as they arise and are not judged. The implication is that, when we pay attention without judgement, we see things more clearly and develop a greater understanding of why things are the way they are. The intention is to approach each moment with more calmness, clarity, and wisdom. The patient is taught to respond consciously rather than react automatically to events. Patients are taught to be more mindful of what is occurring in the body, to be less judging, and more accepting of themselves and life’s challenges, and to be more compassionate and kind with themselves and others.

WHAT IS THE MINDFULNESS-BASED STRESS REDUCTION (MBSR) PROGRAM?

Usually the program runs for eight to ten weeks in a small group setting. Patients attend once a week for two hours and usually there is a 6-hour intensive meditation retreat held in the sixth week of the program. There is one hour of homework per day, six days a week, to learn and practice the techniques of mindfulness (logging self-observation, readings, and meditation).

Patients are often given audio tapes to help with daily practice. Mindfulness meditation practice includes:

• Doing a ‘body sweep’ or ‘scan’ while being non-critically aware of posture, movement, resistance, spatial orientation, and using periodic suggestions of relaxation and breath awareness;
• Mindfulness of breath, thoughts, emotions, and other perceptions;
• Hatha Yoga involving simple stretches and postures;
• Doing eating, walking, and standing mindfulness meditation exercises;
• Reading informative material regarding physiology and coping with stress;

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The intention of the program is to teach patients simple techniques that they can continue to practice and utilize in their daily lives after the program is over.

WHAT DO THE STUDIES SHOW?

PAIN

Fifty-one chronic pain patients who had not improved with traditional medical care participated in a ten-week program. Sixty-five percent of patients showed a significant (greater than 33 percent) reduction in pain scores and half of these patients showed a greater than 50 percent pain-reduction result. There were also significant decreases in medical symptoms reported and reductions in mood disturbances and psychiatric symptomatology.ⁱⁱ

A similar study also found decreases in drug use for pain-related symptoms and an increase in self-esteem.ⁱⁱⁱ

STRESS
Twenty-eight individuals who participated in 8-week stress reduction program based on training in mindfulness meditation had significantly greater reductions in overall psychological distress symptoms, an increase in a sense of control in their lives, and higher scores on a measure of spiritual experiences when compared with controls.^iv

Two studies done on medical students showed the program significantly improved the way students handled stress. They had decreased anxiety and depression, increased scores on overall empathy levels, and increased scores on a measure of spiritual experiences after the program.^v

Fifty-nine adults in an eight-week program showed significant decreases from baseline in: daily hassles (24 percent), psychological distress (44 percent), and medical symptoms (46 percent). These results were maintained at the 3-month follow-up compared to control subjects.^vi

CANCER
Eighty-nine patients with a wide variety of cancer diagnoses, stages of illness, and educational background entered a seven-week mindfulness program of 1.5 hours per week. They reported decreasing mood disturbance and stress symptoms for up to six months.^vii

Fifty-nine patients with breast or prostate cancer, after an eight-week MBSR program, showed enhanced quality of life and decreased stress symptoms. There were also changes in cancer-related cytokine production (toxic to cells, causing damage to cell structure or growth), and other changes consistent with a shift in immunity towards a more normal state of health profile.^viii

ANXIETY AND DEPRESSION
A number of studies have shown improvement in depression and anxiety as well as physical symptoms after an MBSR intervention. Mindfulness-based cognitive therapy also reduced the risk of relapse in those patients with a history of three or more previous episodes of depression.

PSORIASIS, ALTERED IMMUNE FUNCTION, BRAIN INJURY
Thirty-seven patients with psoriasis, who were about to undergo ultraviolet phototherapy (UVB) or photochemotherapy (PUVA), were randomly assigned to either a mindfulness meditation-based stress reduction intervention, guided by audiotaped instructions during light treatments, or a control condition that consisted of light treatments alone with no taped instructions. Results: Those using the brief audio intervention showed a significant increase in the resolution rate of their psoriatic lesions.^ix

Patients who participated in a MBSR program and afterwards received an influenza vaccine had greater increase in antibody titres compared to waitlist controls. Measurement of their electrical brain activity showed significant increases of activity in the left-side anterior brain, a pattern that is associated with positive mood.^x

Ten participants with traumatic brain injuries who attended a twelve-week mindfulness based therapy had improved quality of life scores when other treatments offered no help.^xi

COMPARED TO RELAXATION TECHNIQUE
In 2007 researchers compared the efficacy of two well-known interventions for psychological distress and anxiety. Eighty-three university students with symptoms of distress were assigned to one of three groups: mindfulness meditation, somatic relaxation techniques or a no-treatment control. After a brief training session in the mindfulness (MBRS) or relaxation technique, students practiced the intervention treatment over a 30-day period. Throughout the trial, measurements were taken for positive state of mind, and for distractive and ruminative thoughts. Results: Brief training and practice of either mindfulness meditation or somatic relaxation techniques significantly reduced distress and improved mood over the no-treatment control group. Researchers also found that those who learned mindfulness techniques had a larger stress-reduction effect and, unlike the relaxation group, showed a significant decrease in distractive and ruminative thoughts.^xii

STUDY REVIEWS USING META-ANALYSIS
After combining results of thirty-nine previous studies involving 1,140 patients, researchers concluded that mindfulness therapy was effective for relieving anxiety and improving mood. The treatment seemed to help ease the mental stress of people recovering from cancer and other serious illnesses, but it had the strongest benefits for people diagnosed with mood disorders, including generalized anxiety disorder and recurring depression.^xiii

While mindfulness based stress reduction (MBSR) has been shown to have a significant positive effect on persons suffering from distress due to mental and physical disorders, one group of researchers performed a review and meta-analysis of ten randomized controlled trials that looked at the efficacy of MBSR in healthy people. Results: A non-specific beneficial effect was shown on stress levels compared to control, both for reducing stress and enhancing spirituality values, including measured increases in empathy and self-compassion. Researchers concluded there is a need for more high-quality trials.^xiv

CONCLUSION

Although many of the studies had no matched or comparable controls designed into their study, it seems fairly apparent that most people with a variety of conditions can benefit from attending mindfulness based stress reduction classes. The challenge for them is maintaining motivation to complete the program, do the homework, and continue with the exercises after the program is over. This form of alternative practice is best suited to those who are willing to become actively involved in their own care. Although offered in many urban centers, it may be difficult to find an approved MBSR program in smaller communities.

ⁱⁱKabat-Zinn, J., ‘An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation’, Gen Hosp Psych, 1982; 4: 33-47.

ⁱⁱⁱ Kabat-Zinn, J. et al., ‘The clinical use of mindfulness meditation for the self-regulation of chronic pain’, J Behave Med, 1985; 8(2): 163-90.

^iv Astin, J.A.,‘Stress reduction through mindfulness meditation: Effects on psychological symptomatology, sense of control, and spiritual experiences’, Psychother Psychosom, 1997; 66(2): 97-106.

^v Shapiro, S.L. et al., ‘Effects of mindfulness-based stress reduction on medical and premedical students’, J Behav Med, 1998; 21(6): 581-99.

^vi Williams, K.A. et al., ‘Evaluation of a wellness-based mindfulness stress reduction intervention: a controlled trial’, Am J Health Promot, 2001; 15(6): 422-32.

^vii Carlson, L.E. et al., ‘The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: six-month follow-up’, Support Care Cancer, 2001; 9(2): 112-23.

^viii Carlson, L. E. et al., ‘MSBR in relation to quality of life, mood, symptoms of stress and immune parameters in breast and prostate cancer outpatients’, Psychosomatic Med, 2003; 65: 571-581.

^ix Kabat-Zinn, J. et al., ‘Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA)’, Psychosom Med, 1998; 60(5): 625-32.

^x Davidson, R.J. et al., ‘Alterations in brain and immune function produced by mindfulness meditation’, Psychosom Med, 2003; 65(4): 564-70.

^xi Bedard, M. et al., ‘Pilot evaluation of a mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries’, Disabil Rehabil, 2003; 25(13): 722-31.

^xii Jain, S. et al., ‘A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction’, Ann Behave Med, 2007; 33(1): 11-21.

^xiii Hofmann, S.G. et al., ‘The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review’, J Consult Clin Psychol, 2010; 78(2): 169-83.

^xiv Chiesa, A., and Seretti, A., ‘Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis’, J Altern Complement Med, 2009; 15(5): 593-600.