This book is an invitation to the reader to embark upon a journey of self-development, self-discovery, learning, and healing. It is based on thirty-four years of clinical experience with more than twenty thousand people who have begun this lifelong journey via their participation in an eight-week course known as Mindfulness-Based Stress Reduction (MBSR) offered through the Stress Reduction Clinic at the University of Massachusetts Medical Center in Worcester, Massachusetts. Now, as of this writing, there are over 720 mindfulness-based programs modeled on MBSR in hospitals, medical centers, and clinics across the United States and around the world. Many more thousands of people have participated in these programs worldwide.
Since the founding of the clinic in 1979, MBSR has contributed steadily to a new and growing movement within medicine, psychiatry, and psychology that might best be called participatory medicine. Mindfulness-based programs have become an opportunity for people to engage more fully in their own movement toward greater levels of health and well-being as a complement to whatever medical treatments they may be receiving, starting of course from where they are at the moment they decide to take up this challenge: namely, to do something for themselves that no one else on the planet can do for them.
In 1979, MBSR was a new kind of clinical program in a new branch of medicine known as behavioral medicine or, more broadly now, mind-body and integrative medicine. From the perspective of mind-body medicine, mental and emotional factors, the ways in which we think and behave, can have a significant effect, for better or for worse, on our physical health and our capacity to recover from illness and injury and lead lives of high quality and satisfaction, even in the face of chronic disease, chronic pain conditions, and endemically stressful lifestyles.
This perspective, radical in 1979, is now axiomatic throughout medicine. So we can simply say at this juncture that MBSR is just one more aspect of the practice of good medicine. In this day and age, that means, as we just saw, that its use and value are supported by increasingly strong scientific evidence of its efficacy. That was much less the case when this book was first published. This edition summarizes some of the salient scientific evidence in support of mindfulness-based programs and their effectiveness for stress reduction, symptom regulation, and emotional balance in a wide variety of ways, in addition to its effects on the brain and immune system. It also touches on some of the ways in which mindfulness training has become integral both to good medical practice and to effective medical education.
The people who embark on this journey of self-development, self-discovery, learning, and healing that is MBSR do so in an effort to regain control of their health and to attain at least some peace of mind. They come referred by their doctors—or, increasingly now, self-referred—for a wide range of life problems and medical problems ranging from headaches, high blood pressure, and back pain to heart disease, cancer, AIDS, and anxiety. They are young and old and in-between. What they learn in MBSR is the how of taking care of themselves, not as a replacement for their medical treatment but as a vitally important complement to it.
Over the years, numerous people have made inquiries about how they can learn what our patients learn in this eight-week course, which amounts to an intensive self-directed training program in the art of conscious living. This book is above all a response to those inquiries. It is meant to be a practical guide for anyone, well or ill, stressed or in pain, who seeks to transcend his or her limitations and move toward greater levels of health and well-being.
MBSR is based on rigorous and systematic training in mindfulness, a form of meditation originally developed in the Buddhist traditions of Asia. Simply put, mindfulness is moment-to-moment non-judgmental awareness. It is cultivated by purposefully paying attention to things we ordinarily never give a moment’s thought to. It is a systematic approach to developing new kinds of agency, control, and wisdom in our lives, based on our inner capacity for paying attention and on the awareness, insight, and compassion that naturally arise from paying attention in specific ways.
The Stress Reduction Clinic is not a rescue service in which people are passive recipients of support and therapeutic advice. Rather, the MBSR program is a vehicle for active learning, in which people can build on the strengths that they already have and, as we noted, come to do something for themselves to improve their own health and well-being, both physical and psychological.
As we just saw, in this learning process we assume from the start that as long as you are breathing, there is more right with you than wrong with you, no matter how ill or how despairing you may be feeling in a given moment. But if you hope to mobilize your inner capacities for growth and for healing and to take charge in your life on a new level, a certain kind of effort and energy on your part will be required. The way we put it is that it can be stressful to take the stress reduction program.
I sometimes explain this by saying that there are times when you have to light one fire to put out another. There are no drugs that will make you immune to stress or to pain, or that will by themselves magically solve your life’s problems or promote healing. It will take conscious effort on your part to move in a direction of healing, inner peace, and well-being. This means learning to work with the very stress and pain that are causing you to suffer.
The stress in our lives is now so great and so insidious that more and more people are making the deliberate decision to understand it better and to find imaginative and creative ways to change how they are in relationship to it. This is especially relevant to those aspects of stress that cannot be entirely controlled but can be lived with differently if we learn to bring them into at least momentary balance and integrate them into a larger strategy for living in a healthier way. People who choose to work with stress in this way realize the futility of waiting for someone else to make things better for them. Such a personal commitment is all the more important if you are suffering from a chronic illness or disability that imposes additional stress in your life on top of the usual pressures of living.
The problem of stress does not admit to simpleminded solutions or quick fixes. At root, stress is a natural part of living from which there is no more escape than from the human condition itself. Yet some people try to avoid stress by walling themselves off from life experience; others attempt to anesthetize themselves one way or another to escape it. Of course, it is only sensible to avoid undergoing unnecessary pain and hardship. Certainly we all need to distance ourselves from our troubles now and again. But if escape and avoidance become our habitual ways of dealing with our problems, the problems just multiply. They don’t magically go away. What does go away or gets covered over when we tune out our problems, run away from them, or simply go numb is our power to continue to learn and grow, to change and to heal. When it comes right down to it, facing our problems is usually the only way to get past them.
There is an art to facing difficulties in ways that lead to effective solutions and to inner peace and harmony. When we are able to mobilize our inner resources to face our problems artfully, we find we are usually able to orient ourselves in such a way that we can use the pressure of the problem itself to propel us through it, just as a sailor can position a sail to make the best use of the pressure of the wind to propel the boat. You can’t sail straight into the wind, and if you only know how to sail with the wind at your back, you will only go where the wind blows you. But if you know how to use the wind’s energy and are patient, you can sometimes get where you want to go. You can still be in control.
If you hope to make use of the force of your own problems to propel you in this way, you will have to be tuned in, just as the sailor is tuned in to the feel of the boat, the water, the wind, and his or her course. You will have to learn how to handle yourself under all kinds of stressful conditions, not just when the weather is sunny and the wind blowing exactly the way you want it to.
We all accept that no one controls the weather. Good sailors learn to read it carefully and respect its power. They will avoid storms if possible, but when caught in one, they know when to take down the sails, batten down the hatches, drop anchor, and ride things out, controlling what is controllable and letting go of the rest. Training, practice, and a lot of firsthand experience in all sorts of weather are required to develop such skills so that they work for you when you need them. Developing skill and flexibility in facing and effectively navigating the various “weather conditions” in your life is what we mean by the art of conscious living.
The issue of control is central to coping with problems and with stress. There are many forces at work in the world that are totally beyond our control and others that we sometimes think are beyond our control but really aren’t. To a great extent, our ability to influence our circumstances depends on how we see things. Our beliefs about ourselves and about our own capabilities as well as how we see the world and the forces at play in it all affect what we will find possible. How we see things affects how much energy we have for doing things and our choices about where to channel what energy we do have.
For instance, at those times when you are feeling completely overwhelmed by the pressures in your life and you see your own efforts as ineffectual, it is very easy to fall into patterns of what is called depressive rumination, in which your unexamined thought processes wind up generating increasingly persistent feelings of inadequacy, depression, and helplessness. Nothing will seem controllable or even worth trying to control. On the other hand, at those times when you are seeing the world as threatening but only potentially overwhelming, then feelings of insecurity and anxiety rather than depression may predominate, causing you to worry incessantly about all the things you think threaten or might threaten your sense of control and well-being. These could be real or imagined; it hardly matters in terms of the stress you will feel and the effect it will have on your life.
Feeling threatened can easily lead to feelings of anger and hostility and from there to outright aggressive behavior, driven by deep instincts to protect your position and maintain your sense of things being under control. When things do feel “under control,” we might feel content for a moment. But when they go out of control again, or even seem to be getting out of control, our deepest insecurities can erupt. At such times we might even act in ways that are self-destructive and hurtful to others. And we will feel anything but content and at peace within ourselves.
If you have a chronic illness or a disability that prevents you from doing what you used to be able to do, whole areas of control may go up in smoke. And if your condition causes you physical pain that has not responded well to medical treatment, the distress you might be feeling can be compounded by emotional turmoil caused by knowing that your condition seems to be beyond even your doctor’s control.
What is more, our worries about control are hardly limited to our major life problems. Some of our biggest stresses actually come from our reactions to the smallest, most insignificant events when they threaten our sense of control in one way or another: the car breaking down just when you have someplace important to go, your children not listening to you for the tenth time in as many minutes, long lines at the supermarket checkout.
It is not that easy to find a single word or phrase that really captures the broad range of experiences in life that cause us distress and pain and that promote in us an underlying sense of fear, insecurity, and loss of control. If we were to make a list, it would certainly include our own vulnerability, our wounds, whatever they may be, and our mortality. It might also include our collective capacity for cruelty and violence, as well as the colossal levels of ignorance, greed, delusion, and deception that seem to drive us and the world much of the time. What could we possibly call the sum total of our vulnerabilities and inadequacies, our limitations and weaknesses and foibles, the illnesses and injuries and disabilities we may have to live with, the personal defeats and failures we have felt or fear in the future, the injustices and exploitations we suffer or fear, the losses of people we love and of our own bodies sooner or later? It would have to be a metaphor that would not be maudlin, something that would also convey the understanding that it is not a disaster to be alive just because we feel fear and we suffer; it would have to convey the understanding that there is joy as well as suffering, hope as well as despair, calm as well as agitation, love as well as hatred, health as well as illness.
In groping to describe that aspect of the human condition that the patients in the stress clinic and, in fact, most of us at one time or another need to come to terms with and in some way transcend, I keep coming back to one line from the movie of Nikos Kazantzakis’s novel Zorba the Greek. Zorba’s young companion (Alan Bates) turns to him at a certain point and inquires, “Zorba, have you ever been married?” to which Zorba (played by the great Anthony Quinn) replies, growling (paraphrasing somewhat), “Am I not a man? Of course I’ve been married. Wife, house, kids … the full catastrophe!”
It was not meant to be a lament, nor does it mean that being married or having children is a catastrophe. Zorba’s response embodies a supreme appreciation for the richness of life and the inevitability of all its dilemmas, sorrows, traumas, tragedies, and ironies. His way is to “dance” in the gale of the full catastrophe, to celebrate life, to laugh with it and at himself, even in the face of personal failure and defeat. In doing so, he is never weighed down for long, never ultimately defeated either by the world or by his own considerable folly.
Anybody who knows the book can imagine that living with Zorba must in itself have been quite “the full catastrophe” for his wife and children. As is so often the case, the public hero that others admire can leave quite a trail of private hurt in his wake. Yet ever since I first heard it, I have felt that the phrase “the full catastrophe” captures something positive about the human spirit’s ability to come to grips with what is most difficult in life and to find within it room to grow in strength and wisdom. For me, facing the full catastrophe means finding and coming to terms with what is deepest and best and ultimately, what is most human within ourselves. There is not one person on the planet who does not have his or her own version of the full catastrophe.
Catastrophe here does not mean disaster. Rather, it means the poignant enormity of our life experience. It includes crisis and disaster, the unthinkable and the unacceptable, but it also includes all the little things that go wrong and that add up. The phrase reminds us that life is always in flux, that everything we think is permanent is actually only temporary and constantly changing. This includes our ideas, our opinions, our relationships, our jobs, our possessions, our creations, our bodies, everything.
In this book, we will be learning and practicing the art of embracing the full catastrophe. We will be doing this so that rather than destroying us or robbing us of our power and our hope, the storms of life will strengthen us as they teach us about living, growing, and healing in a world of flux, change, and sometimes great pain. This art will involve learning to see ourselves and the world in new ways, learning to work in new ways with our bodies and our thoughts and feelings and perceptions, and learning to laugh at things a little more, including ourselves, as we practice finding and maintaining our balance as best we can.
In our era, the full catastrophe is very much in evidence on all fronts. A brief reading of any morning newspaper will drive home the impression of an unending stream of human suffering and misery in the world, much of it inflicted by one human being or group of human beings on another. If you listen with an attentive ear to what you hear on radio or television news programs, you will find yourself assaulted daily by a steady barrage of terrible and heartbreaking images of human violence and misery, reported in the always matter-of-fact tones of polished broadcast journalism, as if the suffering and death of people in Syria, Afghanistan, Iraq, Darfur, Central Africa, Zimbabwe, South Africa, Libya, Egypt, Cambodia, El Salvador, Northern Ireland, Chile, Nicaragua, Bolivia, Ethiopia, the Philippines, in Gaza or Jerusalem or Paris or Beijing or Boston, or Tucson, Aurora, or Newtown, and whatever community is next on that list—and the list, sadly, appears endless—were just part of the prevailing climatic conditions that follow on the local weather report in the same matter-of-fact tones, without so much as a nod to the incomprehensible juxtaposition of the two. Even if we don’t read or listen to or watch the news, we are never far from the full catastrophe of living. The pressures we feel at work and at home, the problems we run into and the frustrations we feel, the balancing and juggling that are required to keep our heads above water in this increasingly fast-paced world, are all part of it. We might extend Zorba’s list to include not only wife or husband, house and children, but also work, paying the bills, parents, lovers, in-laws, death, loss, poverty, illness, injury, injustice, anger, guilt, fear, dishonesty, confusion, and on and on. The list of stressful situations in our lives and of our reactions to them is very long. It is also constantly changing as new and unexpected events demanding some form of response continue to surface.
No one who works in a hospital can be unmoved by the infinite variations of the full catastrophe that are encountered every day. Each person who comes to the Stress Reduction Clinic has his or her own unique version, just as do all the people who work in the hospital. Although people are referred for training in MBSR with specific medical problems, including heart disease, cancer, lung disease, hypertension, headaches, chronic pain, seizures, sleep disorders, anxiety and panic attacks, stress-related digestive problems, skin problems, voice problems, and many more, the diagnostic labels they come with mask more about them as people than they reveal. The full catastrophe lies within the complex web of their past and present experiences and relationships, their hopes and their fears, and their views of what is happening to them. Each person, without exception, has a unique story that gives meaning and coherence to that person’s perception of his or her life, illness, and pain, and what he or she believes is possible.
Often these stories are heartbreaking. Not infrequently, our patients come feeling that not only their bodies but their very lives are out of control. They feel overwhelmed by fears and worries, often caused or compounded by painful family relationships and histories, and also by tremendous feelings of loss. We hear accounts of physical and emotional suffering, of frustration with the medical system; poignant stories of people overwhelmed by feelings of anger or guilt, sometimes deeply lacking in self-confidence and self-esteem from having been beaten down by circumstances, often since childhood. And many times we see people who were or are literally beaten down through physical and psychological abuse.
Many of the people who come to the Stress Reduction Clinic have not seen much improvement in their physical condition despite years of medical treatment. Many do not even know where to turn for help anymore and come to the clinic as a last resort, often skeptical about it but willing to do anything to get some relief.
Yet by the time they have been in the program for a few weeks, the majority of these people are taking major steps toward transforming their relationship to their bodies and minds and to their problems. From week to week, there is a noticeable difference in their faces and their bodies. By the end of eight weeks, when the program comes to an end, their smiles and more relaxed bodies are evident to even the most casual observer. Although they were originally referred to the clinic to learn how to relax and to cope better with their stress, it is apparent that they have learned a lot more than that. Our outcome studies over many years, as well as participants’ anecdotal reports, show that they often leave with fewer and less severe physical symptoms and with greater self-confidence, optimism, and assertiveness. They are more patient with and more accepting of themselves and their limitations and disabilities. They are more confident about their ability to handle physical and emotional pain, as well as the other forces in their lives. They are also less anxious, less depressed, and less angry. They feel more in control, even in very stressful situations that previously would have sent them spinning out of control. In a word, they are handling “the full catastrophe” of their lives, the entire range of life experience, including impending death in some cases, much more skillfully.
One man who came into the program had had a heart attack that had forced him to retire from his work. For forty years he had owned a large business and lived right next door to it. For forty years, as he described it, he worked every day, never taking a vacation. He loved his work. He was sent to stress reduction by his cardiologist following cardiac catheterization (a procedure for diagnosing coronary artery disease), angioplasty (a procedure for expanding the coronary artery at the point of narrowing), and participation in a cardiac rehabilitation program. As I walked by him in the waiting room, I saw a look of utter despair and bewilderment on his face. He seemed on the verge of tears. He was waiting for my colleague Saki Santorelli to see him, but his sadness was so apparent that I sat down and talked with him then and there. He said, half to me and half to the air, that he no longer wanted to live, that he didn’t know what he was doing in the Stress Reduction Clinic, that his life was over—there was no more meaning in it, he had no joy in anything, not even his wife and children, and no desire to do anything anymore.
After eight weeks, this same man had an unmistakable sparkle in his eyes. When I met with him following the MBSR program, he told me that work had consumed his entire life without him realizing what he had been missing, and that it had damn near killed him in the process. He went on to say that he realized that he had never told his children he loved them when they were growing up but was going to get started now, while he still had the chance. He was hopeful and enthusiastic about his life and was able for the first time to think about selling his business. He also gave me a big hug when he left, probably the first he had ever given another man.
This man still had the same degree of heart disease that he had had when he started, but at that time he saw himself as a sick man. He was a depressed cardiac patient. In eight weeks he had become healthier and happier. He was enthusiastic about living, even though he still had heart disease and plenty of problems in his life. In his own mind he had gone from seeing himself as a heart patient to seeing himself as a whole person again.
What happened in between to bring about such a transformation? We can’t say with certainty. Many different factors were involved. But he did take the MBSR program during that time, and he took it seriously. It crossed my mind that he would probably drop out after the first week because, on top of everything else, he had to travel fifty miles to come to the hospital, and when a person is depressed, that is hard to do. But he stayed and did the work we challenged him to do, even though at the beginning he had no idea of how it could possibly help him.
Another man, in his early seventies, came to the clinic with severe pain in his feet. He came to the first class in a wheelchair. His wife came with him to each class and sat outside the room for the two and a half hours it lasted. That first day, he told the class that the pain was so bad he just wanted to cut off his feet. He didn’t see what meditating could possibly do for him, but things were so bad that he was willing to give anything a try. Everybody felt incredibly sorry for him.
Something about that first class must have touched him, because this man showed a remarkable determination to work with his pain in the weeks that followed. He came to the second class on crutches rather than in the wheelchair. After that he used only a cane. The transition from wheelchair to crutches to cane spoke volumes to us all as we watched him from week to week. He said at the end that the pain hadn’t changed much but that his attitude toward his pain had changed a lot. He said it just seemed more bearable after he started meditating and that by the end of the program, his feet were less of a problem. When the eight weeks were over, his wife confirmed that he was much happier and more active.
A young physician’s story comes to mind as another example of embracing the full catastrophe. She was sent to the program for high blood pressure and extreme anxiety. She was going through a difficult period in her life, which she described as full of anger, depression, and self-destructive tendencies. She had come from another part of the country to finish her residency training. She was feeling isolated and burned out. Her doctor had urged her to give MBSR a try, saying, “What can it hurt?” But she was scornful and dubious of a program that didn’t actually “do something to you.” And the fact that it involved meditation just made it worse. She didn’t show up for the first class on the day she was scheduled, but Kathy Brady, one of the clinic secretaries, who had been through the program herself as a patient years before, had called her to find out why, and was so nice to her and sounded so concerned on the phone, she told me later, that she sheepishly showed up for another class the next evening.
As part of her job, this young doctor had to fly in the medical center helicopter on a regular basis to the scene of accidents and bring back severely injured patients. She hated the helicopter. It terrified her, and she always got nauseous flying in it. But by the end of eight weeks in the Stress Reduction Clinic, she was able to fly in the helicopter without getting nauseous. She still hated it with a passion, but she was able to tolerate it and get her job done. Her blood pressure came down to the point where she took herself off her medication to see if it would stay down (doctors can get away with this), and it did. By this time she was in the last few months of her residency training and was exhausted a good deal of the time. On top of that, she continued to be emotionally hypersensitive and reactive. But now she was much more aware of her fluctuating states of body and mind. She decided to repeat the entire course because she felt she was just getting into it when it ended. She did, and continued to keep up her meditation practice for many years afterward.
This doctor’s experience in the Stress Reduction Clinic also led her to a newfound respect for patients in general and for her own patients in particular. During the program, she was among medical patients every week in class, not in her usual role as “the doctor” but as just another person with her own problems. She did the same things they were doing in the course week by week. She listened to them talking about their experiences with the meditation practices, and she watched them change over the weeks. She said she was astonished to see how much some people had suffered and what they were able to do for themselves with a little encouragement and training. She also came to respect the value of meditation as her view that people could only be helped by doing something to them yielded to what she was seeing. In fact, she came to see that she was no different from the other people in the class and that what she could do, they could do, and what they could do, she could also do.
Transformations similar to the ones these three people experienced occur frequently in the Stress Reduction Clinic. They are usually major turning points in the lives of our patients because they expand the range of what they thought was possible for them.
Usually people leave the program thanking us for their improvement. But actually the progress they make is entirely due to their own efforts. What they are really thanking us for is the opportunity to get in touch with their own inner strength and resources, and also for believing in them and not giving up on them, and for giving them the tools for making such transformations possible.
We take pleasure in pointing out to them that to get through the program, they had to not give up on themselves. They had to be willing to face the full catastrophe of their own lives, in both pleasant and unpleasant circumstances, when things were going the way they wanted and when they were not, when they felt things were under control and when they didn’t, and to use these very experiences and their own thoughts and feelings as the raw materials for healing themselves. When they began, it was with thoughts that the program could or might or probably wouldn’t do something for them. But what they found was that they could do something very important for themselves that no one else on the planet could possibly do for them.
In the above examples, each person took up the challenge we extended to them to live life as if each moment was important, as if each moment counted and could be worked with, even if it was a moment of pain, sadness, despair, or fear. This “work” involves above all the regular, disciplined cultivation of moment-to-moment awareness, or mindfulness—the complete “owning” and “inhabiting” of each moment of your experience, good, bad, or ugly. This is the essence of full catastrophe living.
All of us have the capacity to be mindful. All it involves is cultivating our ability to pay attention in the present moment as we suspend our judging, or at least, as we become aware of how much judging is usually going on within us. Cultivating mindfulness plays a central role in the changes that the people who come to the Stress Reduction Clinic experience. One way to think of this process of transformation is to think of mindfulness as a lens, taking the scattered and reactive energies of your mind and focusing them into a coherent source of energy for living, for problem solving, and for healing.
We routinely and unknowingly waste enormous amounts of energy in reacting automatically and unconsciously to the outside world and to our own inner experiences. Cultivating mindfulness means learning to tap into and focus our own wasted energies. In doing so, we learn to calm down enough to enter and dwell in extended moments of deep well-being and relaxation, of feeling whole and wholly integrated as a person. This tasting and inhabiting of one’s own wholeness nourishes and restores both the body and the mind. At the same time, it makes it easier for us to see with greater clarity the way we actually live, and therefore how to make changes to enhance our health and the quality of our life. In addition, it helps us to channel our energy more effectively in stressful situations, or when we are feeling threatened or helpless. This energy comes from inside us, and is therefore always available to us to be put to use wisely, especially if we cultivate it through training and personal practice.
Cultivating mindfulness can lead to the discovery of deep realms of well-being, calmness, clarity, and insight within yourself. It is as if you were to come upon a new territory, previously unknown to you or only vaguely suspected, which contains a veritable wellspring of positive energy for self-understanding and healing. Moreover, it is easy to familiarize yourself with this territory and learn to inhabit it more frequently. The path to it in any moment lies no further than your own body and mind and your own breathing. This domain of pure being, of wakefulness, is always accessible to you. It is always here, independent of your problems. Whether you are facing heart disease or cancer or pain or just a very stressful life, its energies can be of great value to you.
The systematic cultivation of mindfulness has been called the heart of Buddhist meditation. It has flourished over the past 2,600 years in both monastic and secular settings in many Asian countries. In the 1960s and 1970s, the practice of this kind of meditation became much more widespread in the world. This was due in part to the Chinese invasion of Tibet and the decades of war in Southeast Asia, both of which made exiles of many Buddhist monks and teachers; in part to young Westerners who went to Asia to learn and practice meditation in monasteries and then became teachers in the West; and in part to Zen masters and other meditation teachers who came to the West to visit and teach, drawn by the remarkable level of interest in Western countries in meditative practices. This trend has only gotten stronger in the past thirty years.
Although, until recently, mindfulness meditation was most commonly taught and practiced within the context of Buddhism, its essence is and always has been universal. In this era, it is increasingly finding its way into the mainstream of society globally, now at a virtually exponential rate. Given the state of the world, that is a very good thing. You might say the world is starving for it, both literally and metaphorically. We will explore this subject further in Chapter 32, when we examine what we are calling world stress.
Mindfulness is basically just a particular way of paying attention and the awareness that arises through paying attention in that way. It is a way of looking deeply into oneself in the spirit of self-inquiry and self-understanding. For this reason it can be learned and practiced, as is done in mindfulness-based programs throughout the world, without appealing to Asian culture or Buddhist authority to enrich it or authenticate it. Mindfulness stands on its own as a powerful vehicle for self-understanding and healing. In fact, one of the major strengths of MBSR and of all other specialized mindfulness-based programs such as mindfulness-based cognitive therapy (MBCT) is that they are not dependent on any belief system or ideology. Their potential benefits are therefore accessible for anyone to test for himself or herself. Yet it is no accident that mindfulness comes out of Buddhism, which has as its overriding concerns the relief of suffering and the dispelling of illusions. We will touch on the ramifications of this conjunction in the Afterword.
This book is designed to give the reader full access to the MBSR training program our patients engage in at the Stress Reduction Clinic. Above all, it is a manual for helping you to develop your own personal meditation practice and for learning how to use mindfulness to promote improved health and healing in your own life. Part I, “The Practice of Mindfulness,” describes what takes place in the MBSR program and the experiences of people who have participated in it. It guides you through the major meditation practices we use in the clinic and gives explicit and easily followed directions for how to make practical and daily use of them, as well as how to integrate mindfulness into your everyday life activities. It also provides a detailed eight-week practice schedule so that, if you choose, you can follow the exact MBSR curriculum that our patients undergo, while you are reading other sections of the book to amplify and deepen your experience with the practice of mindfulness itself. This is the way we recommend you proceed.
Part II, “The Paradigm,” provides a simple but revealing look at some of the latest research findings in medicine, psychology, and neuroscience as background for understanding how the practice of mindfulness is related to physical and mental health. This section develops an overall “philosophy of health” based on the notions of “wholeness” and “interconnectedness” and on what science and medicine are learning about the relationship of the mind to health and the process of healing.
The section called simply “Stress,” Part III, discusses what stress is and how our awareness and understanding of it can help us to recognize it and deal with it more appropriately in this era that is so defined by the challenges of just getting through the day in our ever-more complex and fast-moving society. It includes a model for understanding the value of bringing moment-to-moment awareness to stressful situations in order to navigate and cope with them more effectively, minimizing the toll in wear and tear they exact from us and optimizing as best we can our well-being and health.
Part IV, “The Applications,” provides detailed information and guidance for utilizing mindfulness in a wide range of specific areas that cause people significant distress, including medical symptoms, physical and emotional pain, anxiety and panic, time pressures, relationships, work, food, and events in the greater world.
The last section, “The Way of Awareness,” Part V, will give you practical suggestions for maintaining momentum in the meditation practice once you understand the basics and have begun practicing, as well as for bringing mindfulness effectively into all aspects of your everyday life. It also contains information about how to find groups of people to practice with, as well as hospitals and community-based institutions that have programs nurturing meditative awareness. The Appendix contains several awareness calendars described in the text, an extensive reading list to support your continued practice and understanding of mindfulness, as well as a short listing of useful resources and websites for the same purpose.
If you wish to transform your relationship to stress, pain, and chronic illness by engaging fully in the MBSR program—whether over a period of eight weeks or on another schedule of your own devising—I encourage you to go through the book in concert with the Series 1 guided mindfulness meditation practice CDs (www.mindfulnesscds.com) that the patients in my classes use when practicing the formal meditations described here. Almost everybody finds it easier, when embarking for the first time on a daily meditation practice, to listen to an instructor-guided audio program and let it “carry them along” in the early stages, until they get the hang of it from the inside, rather than attempting to follow instructions from a book, however clear and detailed they may be. The CDs are an essential element of the MBSR curriculum and learning curve. They significantly increase your chances of giving the formal meditation practices a fair try—which basically means sticking with them on a daily basis over eight weeks—and your chances of connecting with the essence of mindfulness itself. Of course, once you understand what is involved, you can always practice on your own without my guidance whenever you feel like it, as many of our patients do. I hear from many people who continue to use these CDs regularly long after they have completed the eight-week MBSR curriculum, and I am invariably profoundly moved by their ongoing commitment to practice and by their stories of how the various practices have touched and transformed their lives.
But whether you use the CDs (also available as downloads and iPhone apps) or not, anybody who is interested in experiencing the kind of major shifts seen in the majority of participants in the Stress Reduction Clinic at UMass or in MBSR, wherever it is well taught, should understand that the medical patients and others who participate in the program make a strong commitment to themselves to engage in the formal mindfulness practices as described in this book on virtually a daily basis. Just making the time to engage in the MBSR curriculum in this way involves a major lifestyle change from the very outset. Our patients are required to practice with the CDs for forty-five minutes a day, six days a week, over the eight weeks. From follow-up studies, we know that most of them continue to practice on their own long after the eight weeks are over. For many, mindfulness rapidly becomes a way of being—and a way of life.
As you embark on your own journey of self-development and discovery of your inner resources for healing and for working with the full catastrophe, all you need to remember is to suspend judgment for the time being—including any strong attachment you might have to a desired outcome, however worthy and desirable and important it may be—and simply commit yourself to practice in a disciplined way, observing for yourself what is happening as you go along. What you will be learning will be coming primarily from inside you, from your own experience as your life unfolds from moment to moment, rather than from some external authority, teacher, or belief system. Our philosophy is that you are the world expert on your life, your body, and your mind, or at least you are in the best position to become that expert if you observe carefully. Part of the adventure of meditation is to use yourself as a laboratory to find out who you are and what you are capable of. As the legendary New York Yankees catcher Yogi Berra once put it in his unique and charmingly quirky way, “You can observe a lot by just watching.”