What are mindfulness-based approaches?
Mindfulness-based approaches are intended to teach people practical skills that can help with physical and psychological health problems and ongoing life challenges.
Mindfulness-based approaches are an integration of ancient Buddhist practices and philosophy of mindfulness, with current psychological understanding and knowledge, they are taught in an entirely secular way, and have no religious context at all. Mindfulness-based approaches are intended to help in pragmatic, practical ways, the approaches facilitate us in realising and accessing our existing inner understanding. Mindfulness is taught through meditation skills which include bringing attention to the breath and the body during stillness and movement.
The two main approaches that have been developed in recent years are Mindfulness-Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT) both of which are taught over eight 2 hr or 2.5 hr. sessions.
Mindfulness-Based Stress Reduction (MBSR)
MBSR is a group-based programme developed by Kabat-Zinn and colleagues at the University of Massachusetts Medical Centre, Centre for Mindfulness (CFM) for populations with a wide range of physical and mental health problems. It has been extensively studied since the late 1970’s. The Center for Mindfulness has been continuously delivering MBSR to patients within a large traditional American hospital for over 25 years. By 1999 over 10,000 patients had completed the programme . They have extended the teaching of MBSR into prisons, into poor inner-city areas, to medical students, and into corporate settings. MBSR has become a part of a newly recognised field of integrative medicine within behavioural medicine and general health care.
The ancient practice of mindfulness, adapted from its use as a spiritual practice, is rendered into an accessible form relevant to the difficulties faced by patients suffering from a variety of physical and psychological illnesses. The training is not tailored to any particular diagnosis. The programme thus involves intensive training in mindfulness meditation together with discussion on stress and life skills.
The evidence base on MBSR shows significant positive effect sizes with participants with chronic pain, fibromyalgia, multiple sclerosis, generalised anxiety disorder and panic, psoriasis, cancer and health care provider self care.
Mindfulness-based Cognitive Therapy (MBCT)
MBCT is an integration of MBSR with Cognitive Behavioural Therapy (CBT). It was developed and initially researched through a three site randomised control trial. It was developed to help people suffering from depression. It has been shown to help recovered recurrently depressed participants, through teaching them skills to disengage from habitual ‘automatic’ unhelpful cognitive patterns. The pattern of mind which makes people vulnerable to depressive relapse is rumination, in which the mind repetitively re-runs negative thoughts. The core skill that MBCT is teaching is to intentionally ‘shift mental gears’.
MBCT differs from conventional CBT as it does not place emphasis on changing belief in the content of thought. The focus in MBCT is on a systematic training to be more aware, moment by moment of physical sensations and of thoughts and feelings as mental events. This facilitates a ‘decentred’ relationship to thoughts and feelings from which we can see them as aspects of experience which move through our awareness and which are not necessarily reality in any given moment.
The evidence base on MBCT shows that it can halve the relapse rate in recovered patients with three or more episodes of depression. It is effective in preventing ‘autonomous’ relapses but not those provoked by stressful events.
Other targeted versions of MBCT have now been developed. e.g. MBCT for chronic fatigue syndrome and for oncology patients.