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Mindfulness-Based Interventions in Context COMMENTARIES Mindfulness-Based Interventions in Context: studies from the Center for Mindfulness in Medicine, Past, Present, and Future Health Care, and Society not reviewed by Baer but which Jon Kabat-Zinn, University of Massachusetts raise a number of key questions about clinical appli- Medical School cability, study design, and mechanism of action, and (7) current opportunities for professional training and devel- For Francisco Varela, 1945–2001 opment in mindfulness and its clinical applications. Key words: mindfulness, meditation, mind/body medicine, mindfulness-based stress reduction (MBSR), Baer’s review (2003; this issue) suggests that mindfulness- mindfulness-based cognitive therapy (MBCT). [Clin Psy- based interventions are clinically efficacious, but that bet- chol Sci Prac 10: 144–156, 2003] ter designed studies are now needed to substantiate the field and place it on a firm foundation for future growth. appreciate the opportunity to comment on Baer’s (2003; Her review, coupled with other lines of evidence, sug- I this issue) review of mindfulness training as clinical inter- gests that interest in incorporating mindfulness into clin- vention and to add my own reflections on the emergence ical interventions in medicine and psychology is growing. of mindfulness in a clinical context, especially in a journal It is thus important that professionals coming to this field explicitly devoted to both science and practice. The uni- understand some of the unique factors associated with verse of mindfulness1 brings with it a whole new meaning the delivery of mindfulness-based interventions and the and thrust to the word practice, one which I believe has the potential conceptual and practical pitfalls of not recog- potential to contribute profoundly to the further develop- nizing the features of this broadly unfamiliar landscape. ment of the field of clinical psychology and its allied disci- This commentary highlights and contextualizes (1) what plines, behavioral medicine, psychosomatic medicine, and exactly mindfulness is, (2) where it came from, (3) how it health psychology, through both a broadening of research came to be introduced into medicine and health care, (4) approaches to mind/body interactions and the develop- issues of cross-cultural sensitivity and understanding in ment of new classes of clinical interventions. the study of meditative practices stemming from other THE GROWING INTEREST IN MINDFULNESS cultures and in applications of them in novel settings, I find the Baer review to be evenhanded, cogent, and per- (5) why it is important for people who are teaching mind- ceptive in its description and evaluation of the work that fulness to practice themselves, (6) results from 3 recent has been published through the middle of 2001, work that features mindfulness training as the primary element in Address correspondence to Jon Kabat-Zinn, c/o Center for various clinical interventions. It complements nicely the Mindfulness in Medicine, Health Care, and Society, University of recent review by Bishop (2002), which to my mind ignores Massachusetts Medical School, Shaw Building, 55 Lake Avenue some of the most important, if difficult to define, features North, Worcester, MA 01655. of such interventions in its emphasis on the perceived need DOI: 10.1093/clipsy/bpg016 2003 AMERICAN PSYCHOLOGICAL ASSOCIATION D12 144 to reduce to a clinical algorithm the complexity of the WHAT EXACTLY IS MINDFULNESS, AND WHERE DOES practice and nuanced delivery of mindfulness-based stress IT COME FROM? reduction (MBSR). As pointed out by Baer, mindfulness has to do with par- Both Baer and Bishop pose important questions that re- ticular qualities of attention and awareness that can be cul- quire addressing if researchers and clinicians are ultimately tivated and developed through meditation. An operational to understand mindfulness and its clinical utility. Both re- working definition of mindfulness is: the awareness that views agree that the scientific study of mindfulness and emerges through paying attention on purpose, in the pres- MBSR to date suffers from a range of methodological ent moment, and nonjudgmentally to the unfolding of problems, a view with which I concur. When a field is in experience moment by moment. Historically, mindfulness its infancy, it is not uncommon for the first generation of has been called “the heart” of Buddhist meditation (Thera, studies to be more descriptive of the phenomenon rather 1962). It resides at the core of the teachings of the Buddha than definitive demonstrations of efficacy. Attempts at the (Gunaratana, 1992;Hanh, 1999;Nanamoli & Bodhi, 1995), latter tend to evolve over time after the potential value of traditionally described by the Sanskrit word dharma, which a new approach has been at least tentatively established. carries the meaning of lawfulness as in “the laws of physics” This now appears to be the case with mindfulness-based or simply “the way things are,”as in the Chinese notion of interventions. Both Baer and Bishop conclude that enough Tao. One might think of the historical Buddha as, among evidence has now accumulated to warrant the develop- other things, a born scientist and physician who had noth- ment of more methodologically rigorous investigations of ing in the way of instrumentation other than his own both the clinical efficacy of mindfulness training in various mind and body and experience, yet managed to use these specific disorders and the possible mechanisms and path- native resources to great effect to delve into the nature of ways through which it might exert characteristic effects suffering and the human condition. What emerged from within those specific disorders. this arduous and single-minded contemplative investiga- The very fact that an increasing number of studies on tion was a series of profound insights, a comprehensive mindfulness and its clinical applications are being funded view of human nature, and a formal “medicine” for treat- and published and that an increasing number of doctoral ing its fundamental “dis-ease,”typically characterized as the theses on mindfulness are appearing in Dissertation Ab- three “poisons”: greed, hatred (aversion), and ignorance/ stracts suggests that this is an area that is currently sparking delusion (unawareness). considerable interest, perhaps driven primarily by the in- Of course, the Buddha himself was not a Buddhist. One tuition that new dimensions of therapeutic benefit and might think of dharma as a sort of universal generative novel insights into mind/body interactions might accrue grammar (Chomsky, 1965), an innate set of empirically through its exploration. Because interest in mindfulness testable rules that govern and describe the generation of and its applications to specific affective conditions is likely the inward, first-person experiences of suffering and hap- to increase even further, particularly within the cognitive piness in human beings. In that sense, dharma is at its core therapy community with the development of mindful- truly universal, not exclusively Buddhist. It is neither a be- ness-based cognitive therapy (MBCT; Segal, Williams, & lief, an ideology, nor a philosophy. Rather, it is a coherent Teasdale, 2002) and with the use of mindfulness within phenomenological description of the nature of mind, dilectical behavior therapy (DBT; Linehan, 1993), it be- emotion, and suffering and its potential release, based on comes critically important that those persons coming to highly refined practices aimed at systematically training the field with professional interest and enthusiasm recog- and cultivating various aspects of mind and heart via the nize the unique qualities and characteristics of mindful- faculty of mindful attention (the words for mind and heart ness as a meditative practice, with all that implies, so that are the same in Asian languages; thus “mindfulness” in- mindfulness is not simply seized upon as the next prom- cludes an affectionate, compassionate quality within the ising cognitive behavioral technique or exercise, decon- attending, a sense of openhearted, friendly presence and textualized, and “plugged” into a behaviorist paradigm interest). And mindfulness, it should also be noted, being with the aim of driving desirable change, or of fixing what about attention, is also of necessity universal. There is is broken. nothing particularly Buddhist about it. We are all mindful COMMENTARIES ON BAER 145 to one degree or another, moment by moment. It is an in- as through participation in periodic teacher-led, intensive herent human capacity. The contribution of the Buddhist meditation retreats, which can last from a weekend to 3 traditions has been in part to emphasize simple and effec- months or more (see, for example, Goldstein, 1987;Gold- tive ways to cultivate and refine this capacity and bring it stein, 2002; Goldstein & Kornfield, 1987; Walsh, 1977, to all aspects of life. In this regard, mindfulness certainly re- 1978). This phenomenon represents a cultural shift that ceived its most explicit and systematic articulation and may be only in its infancy. Nevertheless, it provides a range development within the Buddhist tradition over the past of rich resources for personal practice and dialogue that can 2,500 years, although its essence lies at the heart of other contribute toward the training and development of a co- ancient and contemporary traditions and teachings as well, hort of highly competent teachers, from a wide variety of approaches that can be of great value in refining one’s own professional backgrounds, committed
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