Welcome to this new edition of Full Catastrophe Living. My intention in revising the book for the first time in twenty-five years has been to update it and, perhaps more importantly, to refine and deepen the meditation instructions and the description of mindfulness-based approaches to life and to suffering, given the many years that have elapsed since the first writing. The updating felt necessary because the scientific investigation of mindfulness and its effects on health and well-being has grown tremendously over this period. Still, the more I entered into the actual process of revising the text, the more it felt to me that the basic message and content of the book needed to remain essentially the same, simply amplified and deepened where appropriate. In spite of its seductiveness, I didn’t want the tail of the exploding scientific evidence for the efficacy of mindfulness and how it might exert its effects to wag the dog of the interior adventure and potential value that mindfulness-based stress reduction (MBSR) offers. In the end, the book remains what it was intended to be from the start—a practical guide to commonsensical ways in which to cultivate mindfulness and its deeply optimistic and transformative view of human nature.
Personally, from my very first exposure to the practice of mindfulness, I was astonished and heartened by its nurturing effects in my own life. That sense has not diminished over the past forty-five-plus years. It has only deepened and grown more reliable, like an old and trustworthy friendship, sustaining in even the hardest of times, and at the same time, hugely humbling.
At the time I was working on the original version of this book, my editor suggested that it would not be wise to put the word catastrophe in the title. He was concerned that it might repel many potential readers right from the start. So I tried hard, very hard, to come up with a different title. I thought of and discarded dozens. Paying Attention: The Healing Power of Mindfulness was high on the list. It certainly conveyed for me what the book was about. But the title Full Catastrophe Living just kept coming back over and over again. It simply wouldn’t go away.
In the end, it wound up being okay. To this day, people come up to me and tell me that this book saved their life, or the life of a relative or friend. It happened again recently, at a Mindfulness in Education conference I was attending in Cambridge, Massachusetts, and then again at a mindfulness conference in Chester, England, the following week. I am always deeply moved, often beyond words, as I try to take in the full import of what people are communicating back to me about its effects on their lives. Sometimes the stories are hard to hear—very hard—the suffering that led them to this book inconceivable. And yet, that was its original purpose, to touch something very special that lies within us, our capacity for embracing the actuality of things, often when it seems utterly impossible, in ways that are healing and transforming, even in the face of the full catastrophe of the human condition. Bill Moyers, who filmed our program as part of his public television series Healing and the Mind, told me that when he was covering the Oakland fire of 1991, a year after the book came out, he saw a man clutching a copy under his arm after his house burned down. And somehow New Yorkers seem to get the title right away.
Such responses affirm what I sensed from the very beginning of the work in the Stress Reduction Clinic, watching the effect that the practice of mindfulness had on our patients—many of whom were falling through the cracks of the health care system and not getting entirely better, if at all, from the various treatments they were receiving for their chronic medical conditions.* It was clear that there is something about the cultivation of mindfulness that is healing, that is transformative, and that can serve to give our lives back to us, not in some romantic pie-in-the-sky way, but because simply by virtue of being human, to quote William James, the father of American psychology, “… we all have reservoirs of life to draw upon of which we do not dream.”
Like subterranean water, or vast oil deposits, or minerals buried deep within the rock of the planet, we are talking here of interior resources deep within ourselves, innate to us as human beings, resources that can be tapped and utilized, brought to the fore—such as our lifelong capacities for learning, for growing, for healing, and for transforming ourselves. And how might such transformation come about? It comes directly out of our ability to take a larger perspective, to realize that we are bigger than who we think we are. It comes directly out of recognizing and inhabiting the full dimensionality of our being, of being who and what we actually are. It turns out that these innate internal resources—that we can discover for ourselves and draw upon—all rest on our capacity for embodied awareness and on our ability to cultivate our relationship to that awareness. We go about this discovery and cultivation through paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.
I was familiar with this domain of being from my own experiences with meditation long before there was a science of mindfulness. And if a science of mindfulness had never emerged, meditation would still be just as important to me. Such meditative practices stand on their own. They have their own compelling logic, their own empirical validity, their own wisdom which can be known only from the inside, through their actual purposeful and intentional cultivation over time in one’s own life. This book and the MBSR program it describes are offered as a framework and guide for navigating often unfamiliar and sometimes difficult territory with a degree of clarity and equanimity. You will find other potentially useful books listed in the Appendix. They are offered so that your journey within this domain, should you choose to make it a lifelong one, will have rich, varied, and continual support and nurturance, and so that you can benefit from multiple perspectives on the territory, its opportunities, and its challenges. For it is truly the journey and adventure of a lifetime lived fully—or maybe I should say, wakefully.
Since no map completely describes a territory, ultimately it has to be experienced in order for us to know it, navigate within it, and benefit from its unique gifts. It has to be inhabited or, at the very least, visited from time to time, so that we can experience it directly, firsthand, for ourselves.
In the case of mindfulness, that direct experiencing is nothing less than the great adventure of your life unfolding moment by moment, starting now, where you already are, wherever that is, however difficult or challenging your situation. As we often say to our patients in the Stress Reduction Clinic in our very first encounter with them:
… from our point of view, as long as you are breathing, there is more right with you than wrong with you, no matter what is wrong. Over the next eight weeks, we are going to pour energy in the form of attention into what is right with you—much of which we never notice or take for granted, or don’t fully develop in ourselves—and let the rest of the medical center and your health care team take care of what is “wrong,” and just see what happens.
In this spirit, mindfulness, and in particular the MBSR program described in this book, is an invitation to become more familiar with the field of your own body, mind, heart, and life by paying attention in new, more systematic and more loving ways—and thereby discover important dimensions of your own life that you may not have noticed or that, for some reason, you have ignored until now.
Paying attention in new ways is a very healthy and potentially healing thing to do, although, as you will come to see, it isn’t really about doing at all, or about getting somewhere else. It is much more about being—about allowing yourself to be as you already are, and discovering the fullness and the vast potential within such an approach. Interestingly, the eight-week MBSR program is really just a beginning, or a new beginning. The real adventure is and has always been your whole life. In a sense, MBSR is only a way-station, and hopefully also a launching platform into a new way of being in relationship with things as they are. The practice of mindfulness has the potential to become a lifelong companion and ally. And whether you know it or not when you start, by engaging in these mindfulness practices you are also joining a worldwide community of others whose hearts have been drawn to this way of being, this way of interfacing with life and with the world.
Above all, this book is about the cultivation of mindfulness through practice. It is an engagement we will have to undertake with huge resolve and, at the same time, with the lightest of touches. Everything in this book we will touch on is meant to support you in that engagement.
It turns out that this book and the work of the Stress Reduction Clinic that it describes—the work of MBSR—were instrumental, along with the efforts of many others, in launching a new field within medicine, health care, and psychology, and, in parallel, a growing science of mindfulness and its effects on health and well-being at every level of our biology, psychology, and social connectedness. Mindfulness is also increasingly influencing many other fields, such as education, law, business, technology, leadership, sports, economics, and even politics, policy, and government. This is an exciting and promising development because of its potential healing benefits for our world.
In 2005, there were more than a hundred papers on mindfulness and its clinical applications in the scientific and medical literature. Now, in 2013, there are more than 1,500, plus an ever-increasing number of books on the subject. There is even a new scientific journal called Mindfulness. Other scientific journals have followed suit, publishing special issues or special sections on mindfulness. In fact, so high is professional interest in mindfulness, its clinical applications for health and well-being, and the mechanisms by which it might be exerting its effects, that the research in this area is expanding exponentially. What is more, the scientific findings and their implications for our well-being and for our understanding of the mind-body connection as well as stress, pain, and illness are becoming more intriguing by the day.
Still, this second edition has less to do with understanding the psychological mechanisms and neural pathways through which the cultivation of mindfulness might be affecting us—interesting as they may be—than it has to do with our ability to seize hold of our lives and life circumstances, with huge tenderness and kindness toward ourselves, and find ways to honor the full dimensionality of our possibilities for living sane, satisfying, and meaningful lives. None of us, hopefully, will be cultivating mindfulness for the sake of generating colorful brain scans, even though the practice of mindfulness may very well result in beneficial changes not just to the activity in certain regions of our brain, but in the very structure of the brain and its connectivity, along with other potential biological benefits that we will touch on. Such possible benefits take care of themselves. They arise naturally through the practice of mindfulness. Our motivation for cultivating mindfulness, should you choose to pursue it in your own life, will need to be much more basic: perhaps to live a more integrated and satisfying life, to be healthier and perhaps happier and wiser. Other motivations might include the desire to face and cope more effectively and compassionately with our own suffering and that of others, with the stress, pain, and illness in our lives—what I am calling here the full catastrophe of the human condition†—and to be the fully integrated and emotionally intelligent beings that we already are but sometimes lose touch with and drift away from.
Over the course of my own meditation practice and of doing the work I do in the world, I have come to see the cultivation of mindfulness as a radical act—a radical act of sanity, of self-compassion, and, ultimately, of love. As you will see, it involves a willingness to drop in on yourself, to live more in the present moment, to stop at times and simply be rather than getting caught up in endless doing while forgetting who is doing all the doing, and why. It has to do with not “mis-taking” our thoughts for the truth of things, and not being so susceptible to getting caught in emotional storms, storms that so often only compound pain and suffering, our own and that of others. This approach to life is indeed a radical act of love on every level. And part of the beauty of it, as we shall see, is that you don’t have to do anything other than to pay attention and stay awake and aware. These domains of being are already who and what you are.
Even though the meditation practice is really about being rather than doing, it can seem as if it is a major undertaking, and it is. After all, we have to make the time to practice and that does take some doing and requires intentionality and discipline, as we shall see. We sometimes put it this way to prospective participants before we admit them to the MBSR program:
You don’t have to like the daily meditation practice schedule; you just have to do it [on the disciplined schedule you are agreeing to by signing up and then doing the best you can]. Then, at the end of the eight weeks, you can tell us whether it was a waste of time or not. But in the interim, even if your mind is telling you constantly that it is stupid or a waste of time, practice anyway, and as wholeheartedly as possible, as if your life depended on it. Because it does—in more ways than you think.
A recent headline in Science, one of the most prestigious and high-impact scientific journals in the world, read: “A Wandering Mind Is an Unhappy Mind.” Here is the first paragraph of that paper:
Unlike other animals, human beings spend a lot of time thinking about what is not going on around them, and contemplating events that happened in the past, might happen in the future, or will never happen at all. Indeed, “stimulus-independent thought” or “mind wandering” appears to be the brain’s default mode of operation. Although this ability is a remarkable evolutionary achievement that allows people to learn, reason, and plan, it may have an emotional cost. Many philosophical and religious traditions teach that happiness is to be found by living in the moment, and practitioners are trained to resist mind wandering and “to be here now.” These traditions suggest that a wandering mind is an unhappy mind. Are they right?‡
The Harvard researchers concluded, as the headline itself suggests, that indeed, those ancient traditions, which emphasize the power of the present moment and how to cultivate it, were onto something.
The findings of this study have interesting and potentially profound implications for all of us. It was the first large-scale study of happiness in daily life ever conducted. To pull it off, the researchers developed an iPhone app to randomly sample responses from several thousand people to questions about their happiness, what they were doing at that particular moment, and mind wandering (“Are you thinking about something other than what you are currently doing?”). It turned out that people’s minds wandered nearly half the time, according to Matthew Killingsworth, one of the study’s authors, and that the mind wandering, especially when it involved negative or neutral thoughts, appears to contribute to people being less happy. His overall conclusion: “No matter what people are doing, they are much less happy when their minds are wandering than when their minds are focused,” and “we should pay at least as much attention to where our minds are as to what our bodies are doing—yet for most of us, the focus of our thoughts isn’t part of our daily planning … we ought to [also] ask, ‘What am I going to do with my mind today?’ ”§
As you will see, becoming aware of what is on our minds from moment to moment, and of how our experience is transformed when we do, is precisely what mindfulness practice, MBSR, and this book are all about. And just for the record, mindfulness is not about forcing your mind not to wander. That would just give you a big headache. It is more about being aware of when the mind is wandering and, as best you can, and as gently as you can, redirecting your attention and reconnecting with what is most salient and important for you in that moment, in the here and now of your life unfolding.
Mindfulness is a skill that can be developed through practice, just like any other skill. You could also think of it as a muscle. The muscle of mindfulness grows both stronger and more supple and flexible as you use it. And like a muscle, it grows best when working with a certain amount of resistance to challenge it and thereby help it become stronger. Our bodies, our minds, and the stress of our daily lives certainly provide us with plenty of resistance to work with in that regard. Indeed, you might say they provide just the right conditions for developing our innate capacities for knowing our own mind and shaping its ability to stay present to what is most germane and important in our lives, and, by doing so, discover new dimensions of well-being and even happiness without having to change anything.
The very fact that studies such as this one, which make use of emergent consumer technologies to sample the experience of very large numbers of people in real time, are now being conducted with scientific rigor and published in top-tier journals is itself an indicator of a new era in the science of the mind. Recognizing that what is on our mind may have a greater influence on our sense of well-being than what we are doing in particular moments has profound implications for understanding our own humanness, and for shaping, in very practical and yet very personal, even intimate ways, our understanding of what is involved in being healthy and genuinely happy. The intimacy, of course, is with ourselves. This is the essence of mindfulness and its cultivation through MBSR.
Many streams within science—from genomics and proteomics to epigenetics and neuroscience—are revealing in new and indisputable ways that the world and our own ways of being in relationship to it exert significant and meaningful effects at every level of our being, including on our genes and chromosomes, on our cells and tissues, on specialized regions of our brain and the neural networks that link those regions, as well as on our thoughts and emotions and our social networks. All these dynamical elements of our lives, and many more as well, are interconnected. Together they constitute who we are and define our degrees of freedom to develop to our full human capacity—always unknown and always infinitely close.
What it means for each of us to be human, coupled with the Harvard researchers’ question, “What am I going to do with my mind today?” lie at the heart of mindfulness as a way of being. Only, for our purposes here, I would rephrase that question slightly, putting it in the present tense: “How is it in my mind right now?” We can also extend the question to ask: “How is it in my heart right now?” And “How is it in my body right now?” We don’t even have to ask using thought alone, for we are capable of feeling how it is in the mind, in the heart, in the body—right in this moment. This feeling, this apprehending, is another way of knowing for us, beyond merely thought-based knowing. We have a word for it in English: awareness. Making use of this innate capacity for knowing, we can investigate, inquire, and apprehend what is so for us in profoundly liberating ways.
To cultivate mindfulness, requires that we pay attention and inhabit the present moment, and make good use of what we see and feel and know and learn in the process. As you will see, I define mindfulness operationally as the awareness that arises by paying attention on purpose, in the present moment, and non-judgmentally. Awareness is not the same as thinking. It is a complementary form of intelligence, a way of knowing that is at least as wonderful and as powerful, if not more so, than thinking. What is more, we can hold our thoughts in awareness, and that gives us an entirely new perspective on them and on their content. And just as our thinking can be refined and developed, so our access to awareness can be refined and developed, although as a rule, we get precious little schooling in how to go about it, or even that it is possible. It can be developed through exercising our capacity for attention and discernment.
Moreover, when we speak of mindfulness, it is important to keep in mind that we equally mean heartfulness. In fact, in Asian languages, the word for “mind” and the word for “heart” are usually the same. So if you are not hearing or feeling the word heartfulness when you encounter or use the word mindfulness, you are in all likelihood missing its essence. Mindfulness is not merely a concept or a good idea. It is a way of being. And its synonym, awareness, is a kind of knowing that is simply bigger than thought and gives us many more options for how we might choose to be in relationship to whatever arises in our minds and hearts, our bodies and our lives. It is a more-than-conceptual knowing. It is more akin to wisdom, and to the freedom a wisdom perspective provides.
As you will see further on, when it comes to the cultivation of mindfulness, paying attention to our thoughts and emotions in the present moment is only one part of a larger picture. But it is an extremely important part. Recent work from the University of California, San Francisco, by Elissa Epel, Elizabeth Blackburn (Blackburn shared in the 2009 Nobel Prize for the discovery of the antiaging enzyme telomerase), and their colleagues is showing that our thoughts and emotions, especially highly stressful thoughts that involve worrying about the future or ruminating obsessively about the past, seem to influence the rate at which we age, right down to the level of our cells and our telomeres—the specialized DNA repeat sequences at the tips of all of our chromosomes that are essential for cell division and that shorten over time as we age. They and their colleagues showed that telomere shortening is much more rapid under conditions of chronic stress. But they also showed that how we perceive that stress makes all the difference in how quickly our telomeres degrade and shorten. And it can make many years’ worth of difference. Importantly, this means we don’t have to make the sources of our stress go away. In fact, some sources of stress in our lives will not go away. Still, research is showing that we can change our attitude, and thereby our relationship to our circumstances, in ways that can make a difference in our health and well-being, and possibly to our longevity.
The evidence to date suggests that longer telomeres are associated with the difference between a rating of how present you are (“In the past week, have you had moments when you felt totally focused on or engaged in doing what you are doing at the moment?”) and a rating of how much mind wandering you experienced in the past week (“Not wanting to be where you are at the moment or doing what you are doing”). This calculated difference in the ratings on these two questions, which the researchers are provisionally calling “state of awareness,” is very closely related to mindfulness.
Other studies that looked at levels of the enzyme telomerase rather than at telomere length suggest that our thoughts—especially when we perceive situations as threatening to our well-being, whether they are or not—can have an influence all the way down to the level of this one specific molecule, measured in immune cells circulating in the blood, which apparently plays a major role in how healthy we are and even in how long we might live. The implications of this research may prompt us to wake up a bit more and to pay more attention to the stress in our lives and to how we might shape our relationship to it over the long haul with greater intentionality and wisdom.
This book is about you and your life. It is about your mind and your body and how you might actually learn to be in wiser relationship to both. It is an invitation to experiment with the practice of mindfulness and its applications in everyday life. I wrote it primarily for our patients and for people like them everywhere—in other words, it was written for regular people. And by regular people, I basically mean you and me, anybody and everybody. For when you boil away the narrative of our travails and accomplishments and get down to the essence of being alive and having to deal with the enormity of what life throws at us, we are all just regular people, dealing with that enormity as best we can. And I am not just referring to the hard stuff and the unwanted in our lives—I mean everything that arises: the good, the bad, and the ugly.
And the good is enormous—to my mind, enormous enough to deal with the bad and the ugly, the difficult and the impossible—and it is not just found outwardly, but inwardly as well. The practice of mindfulness involves finding, recognizing, and making use of that in us which is already okay, already beautiful, already whole by virtue of our being human—and drawing upon it to live our lives as if it really mattered how we stand in relationship to what arises, whatever it is.
Over the years, I have increasingly come to realize that mindfulness is essentially about relationality—in other words, how we are in relationship to everything, including our own minds and bodies, our thoughts and emotions, our past and what transpired to bring us, still breathing, into this moment—and how we can learn to live our way into every aspect of life with integrity, with kindness toward ourselves and others, and with wisdom. This is not easy. In fact, it is just about the hardest work in the world. It is difficult and messy at times, just as life is difficult and messy. But stop for a moment and reflect on the alternative. What are the implications of not fully embracing and inhabiting the life that is yours to live in the only moment you ever get to experience it? How much loss and grief and suffering might there be in that?
Coming back to the happiness iPhone app study for a moment, the Harvard researchers had a number of things to say that are germane to us as we embark on our own adventures in mindfulness and MBSR:
“We know that people are happiest when they’re appropriately challenged—when they’re trying to achieve goals that are difficult but not out of reach. Challenge and threat are not the same thing. People blossom when challenged and wither when threatened.”
MBSR is exceedingly challenging. In many ways, being in the present moment with a spacious orientation toward what is happening may really be the hardest work in the world for us humans. At the same time, it is also infinitely doable, as so many people around the world have demonstrated through their participation in MBSR programs and in then continuing to keep up the practice and cultivation of mindfulness as an integral part of their daily lives for years afterward. As you will see, the cultivation of greater mindfulness also gives us new ways of working with what we find threatening, and of learning how to respond intelligently to such perceived threats rather than react automatically and trigger potentially unhealthy consequences.
“If I wanted to predict your happiness, and I could know only one thing about you, I wouldn’t want to know your gender, religion, health, or income. I’d want to know about your social network—about your friends and family, and the strength of your bonds with them.”
The strength of those bonds is also known to be highly associated with overall health and well-being. They get deeper and stronger with mindfulness, because mindfulness, as we’ve seen, is all about relationality and relationship—with yourself and with others.
“We imagine that one or two big things will have a profound effect [on our happiness]. But it looks like happiness is the sum of hundreds of small things.… The small stuff matters.”
Not only does the small stuff matter. The small stuff isn’t so small. It turns out to be huge. Tiny shifts in viewpoint, in attitude, and in your efforts to be present can have enormous effects on your body, on your mind, and in the world. Even the tiniest manifestation of mindfulness in any moment might give rise to an intuition or insight that could be hugely transforming. If nurtured consistently, those nascent efforts to be more mindful often grow into a new and more robust, more stable way of being.
What are some of the little things we can do to increase happiness and well-being? According to Dan Gilbert, one of the authors of the happiness study:
“The main things are to commit to some simple behaviors—meditating, exercising, getting enough sleep—and to practice altruism.… And nurture your social connections.”
If what I said earlier about meditation being a radical act of love is true, then meditation itself is also a basic altruistic gesture of kindness and acceptance—starting with but not limited to yourself!
The world has changed hugely, unthinkably, since this book first appeared, perhaps more than it has ever changed before in a twenty-five-year interval. Just think of laptops, smart phones, the Internet, Google, Facebook, Twitter, ubiquitous wireless access to information and people, the impact of this ever-expanding digital revolution on just about everything we do, the speeding up of the pace of life, and our 24/7 lifestyles, to say nothing of the huge social, economic, and political changes that have occurred globally during this period. The ever-accelerating speed at which things are changing nowadays is not likely to abate. Its effects will be increasingly felt and will be increasingly unavoidable. You could say that the revolution in science and technology (and its effects on the way we live our lives) has hardly gotten started. Certainly the stress of adjusting to it on top of everything else will only mount in the coming decades.
This book and the MBSR program it describes are meant to serve as an effective counterbalance to all the ways we get pulled out of ourselves and wind up losing sight of what is most important. We are apt to get so caught up in the urgency of everything we have to do, and so caught up in our heads and in what we think is important, that it is easy to fall into a state of chronic tension, anxiety, and perpetual distraction that continually drives our lives and easily becomes our default mode of operating, our autopilot. Our stress is further compounded when we are faced with a serious medical condition, chronic pain, or a chronic disease, whether our own or that of a loved one. Mindfulness is now more relevant than ever as an effective and dependable counterbalance to strengthen our health and well-being, and perhaps our very sanity.
For while we are now blessed with 24/7 connectivity, which allows us to be in touch with anybody anywhere at any time, we may be finding, ironically enough, that it is more difficult than ever to actually be in touch with ourselves and with the inner landscape of our own lives. What is more, we may feel that we have less time in which to be in touch with ourselves, although each of us still gets the same twenty-four hours a day. It’s just that we fill up those hours with so much doing that we scarcely have time for being anymore, or even for catching our breath, literally and metaphorically—to say nothing of time for knowing what we are doing as we are doing it, and why.
The first chapter of this book is called “You Have Only Moments to Live.” This is an undeniable statement of fact. It will continue to be true, for all of us, no matter how digital the world becomes. Yet so much of the time, we are out of touch with the richness of the present moment and with the fact that inhabiting this moment with greater awareness shapes the moment that follows. Thus, if we can sustain our awareness, it shapes the future—and the quality of our lives and relationships, often in ways we simply cannot anticipate.
The only way we have of influencing the future is to own the present, however we find it. If we inhabit this moment with full awareness, the next moment will be very different because of our very presence in this one. Then we just might find imaginative ways to fully live the life that is actually ours to live.
Can we experience joy and satisfaction as well as suffering? What about being more at home in our own skin within the maelstrom? What about tasting ease of well-being, even genuine happiness? This is what is at stake here. This is the gift of the present moment, held in awareness, non-judgmentally, with a little kindness.
Before we launch into this exploration together, you might be interested to know that a number of recent studies of MBSR have shown highly intriguing and promising results. While, as we’ve said, mindfulness has its own internal logic and poetry, and offers many compelling reasons for you to bring it into your life and cultivate it systematically, the scientific findings outlined below, together with those presented elsewhere in the book might provide extra incentive, if any is needed, for following the MBSR curriculum with the commitment and resolve that our patients tend to bring to it.
• Researchers at Massachusetts General Hospital and Harvard University have shown, using fMRI brain scanning technology, that eight weeks of MBSR training leads to thickening of a number of different regions of the brain associated with learning and memory, emotion regulation, the sense of self, and perspective taking. They also found that the amygdala, a region deep in the brain that is responsible for appraising and reacting to perceived threats, was thinner after MBSR, and that the degree of thinning was related to the degree of improvement on a perceived stress scale.‖a These preliminary findings show that at least certain regions of the brain respond to mindfulness meditation training by reorganizing their structure, an example of the phenomenon known as neuroplasticity. They also show that functions vital to our well-being and quality of life, such as perspective taking, attention regulation, learning and memory, emotion regulation, and threat appraisal, can be positively influenced by training in MBSR.
• Researchers at the University of Toronto, also using fMRI, found that people who had completed an MBSR program showed increases in neuronal activity in a brain network associated with embodied present-moment experience, and decreases in another brain network associated with the self as experienced across time (described as the “narrative network,” because it usually involves the story of who we think we are). The latter network is the one most implicated in mind wandering, the trait that, as we just saw, plays such a big role in whether we are actually happy in the present moment or not. This study also showed that MBSR could unlink these two forms of self-referencing, which usually function in tandem.b These findings imply that by learning to inhabit the present moment in an embodied way, people can learn how not to get so caught up in the drama of their narrative self, or, for that matter, lost in thought or mind wandering—and when they do get lost in these ways, that they can recognize what is happening and return their attention to what is most salient and important in the present moment. They also suggest that non-judgmental awareness of our wandering mind may actually be a gateway to greater happiness and well-being right in the present moment, without anything at all having to change. These findings have important implications not only for people suffering from mood disorders, including anxiety and depression, but for all of us. They also offer a significant step toward clarifying what psychologists mean when they speak of “the self.” Differentiating between these two brain networks—one with an ongoing “story of me” and one without—and showing how they work together and how mindfulness can influence their relationship to each other may shed at least a bit of light on the mystery of who and what we consider ourselves to be, and how we manage to live and function as an integrated whole being, grounded at least some of the time in self-knowing.
• Researchers at the University of Wisconsin have shown that training a group of healthy volunteers in MBSR reduced the effect of psychological stress (caused by having to give a talk in front of a panel of unknown and emotionally impassive people) on a laboratory-induced inflammatory process that produced blistering of the skin. This study was the first to employ a carefully constructed comparison control condition (the Health Enhancement Program, or HEP) that matched MBSR in all respects except for the mindfulness practices themselves. The groups were indistinguishable on all self-reported measures of change in psychological stress and physical symptoms following MBSR or HEP. However, blister size was uniformly smaller in the MBSR group following training than in the HEP group. What is more, those individuals who spent more time practicing mindfulness showed a greater buffering of the effect of psychological stress on inflammation (blister size) than those who practiced less.c The authors relate these preliminary findings of so-called neurogenic inflammation to those we reported for patients with the skin disease, psoriasis, also a neurogenic inflammatory condition. That study, described in Chapter 13, showed that people who were meditating while receiving ultraviolet light therapy for their psoriasis healed at four times the rate of those receiving the light treatment by itself without meditating.d
• In a study we collaborated on with this same group at the University of Wisconsin, looking at the effects of MBSR delivered in a corporate setting during working hours with healthy but stressed employees rather than with medical patients, we found that the electrical activity in certain areas of the brain known to be involved in the expression of emotions (within the prefrontal cerebral cortex) shifted in the MBSR participants in a direction (right-sided to left-sided) that suggested that the meditators were handling emotions such as anxiety and frustration more effectively—in ways that we can think of as being more emotionally intelligent—than the control subjects, who were waiting to take the MBSR program after the study was completed but being tested in the lab on the same schedule and in the same ways as the MBSR group. The right-to-left brain shift in the MBSR group was still apparent four months after the program ended. This study also found that when the people in the study in both groups were given a flu vaccine at the end of the eight weeks of training, the MBSR group mounted a significantly stronger antibody response in their immune system in the following weeks than did the waiting list control subjects. The MBSR group also showed a consistent relationship between the degree of right-to-left brain shift and the amount of antibody produced in response to the vaccine. No such relationship was found in the control group.e This was the first study to show that people could actually change, through MBSR training, in eight short weeks, a signature ratio of brain activity between the two sides of the prefrontal cortex, characteristic of emotional style, a ratio that had been thought of as a relatively fixed and invariant “set point” in adults. It was also the first MBSR study to show immune changes.
• A study conducted at UCLA and Carnegie Mellon University showed that participating in an MBSR program actually reduced loneliness, a major risk factor for health problems, especially in the elderly. The study, conducted in adults ranging in age from fifty-five to eighty-five, showed that in addition to reducing their loneliness, the program resulted in reduced expression of genes related to inflammation, measured in immune cells sampled from blood draws. It also resulted in lowering an indicator of inflammation known as C-reactive protein. These findings are potentially important because inflammation is increasingly thought to be a core element of cancer, cardiovascular disease, and Alzheimer’s disease,f and because many different programs designed specifically to target social isolation and decrease loneliness have failed.
In summary, mindfulness is not merely a good idea or a nice philosophy. If it is to have any value for us at all, it needs to be embodied in our everyday lives, to whatever degree we can manage without forcing or straining—in other words, with a light and gentle touch, thereby nurturing self-acceptance, kindness, and self-compassion. Mindfulness meditation is increasingly becoming an integral part of both the American and the world landscape. It is with this recognition, and in this context and spirit, that I welcome you to this revised edition of Full Catastrophe Living.
May your mindfulness practice grow and flower and nourish your life from moment to moment and from day to day.
JON KABAT-ZINN
MAY 28, 2013
* The clinic was set up to serve as a kind of safety net in the hospital to catch people who were falling through those cracks and challenge them to do something for themselves as a complement to whatever their doctors and their health care team were doing for them. Now those cracks are more like chasms. For a powerful indictment of the current state of our health care (really disease care) system and the case for making it much more patient-centered and based on mind-body and integrative approaches, see the 2013 CNN documentary Escape Fire.
† You will find this expression and its origin explained in the Introduction.
‡ Killingsworth MA, Gilbert DT. A wandering mind is an unhappy mind. Science. 2010;330:932.
§ Harvard Business Review. Jan-Feb 2012:88.
‖ Hölzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, Lazar SW. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging. 2010. doi:10.1016/j.psychresns.2010.0.006.
a Hölzel BK, Carmody J, Evans KC, Hoge EA, Dusek JA, Morgan L, Pitman R, Lazar SW. Stress reduction correlates with structural changes in the amygdala. Social Cognitive and Affective Neurosciences Advances. 2010; 5(1):11–17.
b Farb NAS, Segal ZV, Mayberg H, Bean J, McKeon D, Fatima Z, Anderson AK. Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. Social Cognitive and Affective Neuroscience. 2007; 2:313–322.
c Rosenkranz MA, Davidson RJ, MacCoon DG, Sheridan JF, Kalin NH, Lutz A. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain, Behavior, and Immunity. 2013;27:174–184.
d Kabat-Zinn J, Wheeler E, Light T, Skillings A, Scharf M, Cropley TC, Hosmer D, Bernhard J. Influence of a mindfulness-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosomatic Medicine. 1998;60: 625–632.
e Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz MA, Muller D, Santorelli SF, Urbanowski R, Harrington A, Bonus K, Sheridan JF. Alterations in brain and immune function produced by mindfulness meditation, Psychosomatic Medicine. 2003;65:564–570.
f Creswell JD, Irwin MR, Burklund LJ, Lieberman MD, Arevalo JMG, Ma J, Breen EC, Cole SW. Mindfulness-Based Stress Reduction training reduces loneliness and pro-inflammatory gene expression in older adults: A small randomized controlled trial. Brain, Behavior, and Immunity. 2012;26:1095–1101.