Introduction
“What a liberation to realise that the “voice in my head” is not who I am. Who am I then? The one who sees that”. – Eckhart Tolle
When Michael Jordan was asked how he was able to transform his on-court leadership and lead the Chicago Bulls to six NBA championships, he attributed it to a pretty unsuspecting character. George Mumford, his mindfulness meditation teacher, who has also worked with the likes of Kobe Bryant and Shaquille O’Neal on optimising their sporting performance (Mumford, 2015). Since the late 1990’s, there has been an exponential rise in published research on the topic of mindfulness-based interventions. Eighteen million Americans now have a meditation routine, and 44% of all U.S. companies offer mindfulness training to their members of staff (Kotler & Wheal, 2017). What started as an alternative approach within mind/body medicine, has now breached the domains of the mainstream, with major developments being seen in clinical and sport psychology, cognitive therapy, neuroscience, education, law, business, and the military (Williams & Kabat-Zinn, 2011). This article will seek to understand the eastern origins of mindfulness practice and highlight its key characteristics, before examining how it has been secularised and developed to form interventions such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT). Finally, differences in cultural ontology between east and west, particularly in relation to the self, will be used to examine the difficulties in operationalising mindfulness within a dualistic scientific setting and incorporating mindfulness techniques into reductionist interventions.
What is Mindfulness?
“The medicine for my suffering I had within me from the very beginning, but I did not take it. My ailment came from within myself, but I did not observe it. Until this moment. Now I see that I will never find the light unless, like the candle, I am my own fuel”. – Bruce Lee
Mindfulness originates from Buddhist philosophy and acts as the central tenet for many of its meditative traditions, such as Zen, Shambhala, and Vipassana (Khusid & Vythilingham, 2016) and has been defined as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, 2003; p145). Translated from the Pali word sati, mindfulness encompasses an array of meanings, but the most important relate to “clear awareness” and “memory” (Dreyfus, 2011; Harris, 2014). In Buddhism, the origins of suffering (dukkha) are thought to be caused by our ignorance of the impermanent nature of the universe (anitya), and our patterns of attachment and resistance towards pleasant or unpleasant experiences (Vago & Silbersveig). Through formal meditative practice, which entails sitting or lying still and placing awareness on a particular aspect of experience, such as the rhythm of breathing, physical sensations, or a chosen mantra, or participating in mindfulness-based movement activities such as yoga, tai-chi, and qigong (Crane, 2017; Lucas et al. 2016), the individual is able to practice becoming aware of, and disidentifying from, their habitual unconscious cognitions and develop a sense of familiarity with the feeling of clarity and calmness that arises (Vago & Silbersveig, 2012). The cultivation of this state of awareness allows the individual to adopt a much more accepting, non-judgemental attitude; a kind of ‘go with the flow’ mentality, towards both internal and external stimuli, which can cause drastic improvements in general well-being (Shapiro et al. 2008). These experiences are validated by studies in neuroscience, which show the ability of mindfulness meditation to elicit structural changes in the brain, specifically, increasing the density of white matter in the anterior cingulate cortex; responsible for self-regulation, and reducing the density of grey matter in the right hemisphere of the amygdala; responsible for the expression of negative emotional states (Hölzel et al. 2009; Tang et al. 2010). Mindfulness has been shown to demonstrate broad utility across a vast array of clinical settings, including predicting the efficiency of attentional networks (Di Francesco et al. 2017), enhancing adaptive affective processing (Dixon & Overall, 2016; Kang et al. 2017), building cognitive resilience in high-stress populations (Jha et al. 2017), increasing divergent, creative thinking capabilities (Berkovich-Ohana et al. 2017), reducing depressive ruminative thoughts (Perestelo-Perez et al. 2017), addressing emotional eating problems in bariatric patients (Wnuk et al. 2017), improving smoking abstinence programs (Davis et al. 2017), and even promoting political compromise in areas of prolonged intergroup conflict (Alkoby et al. 2017). The benefits also translate to many dimensions of sporting performance, with research demonstrating the ability of mindfulness to reduce perceived stress and subsequent rates of athlete burnout (Gustafsson et al. 2015), improve pain management, enhance self-esteem (Carlisle 2017), as well as facilitate the experience of flow (Kee & Wang, 2008; Kaufman, Glass, & Arnkoff, 2009; Bervoets, 2013).
Mindfulness-Based Interventions
“As MBSR teachers, we cannot teach someone their insights; at best, we create the space in the MBSR classroom for insights to bubble up from awareness, naturally on their own”. – Allan Goldstein
Although mindfulness practice originates from spiritual traditions, the key premises can be easily transferred to a secular setting (Harris, 2014). This has seen the development of two key mindfulness-based interventions, Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT). MBSR was first developed in 1979 by Dr. Jon Kabat-Zinn at the University of Massachusetts as a holistic method for treating patients with a wide variety of physical and psychological problems. The program consists of eight 2.5 hour weekly sessions of extensive mindfulness practice with each individual encouraged to do 45-minutes daily practice on their own accord (Crane, 2017). Although MBSR has seen significantly positive treatment effects in populations such as breast cancer survivors (Christensen & Marck, 2017), war veterans with post-traumatic stress disorder (Cole et al. 2015) and adolescents with mental health concerns (Van Vliet et al. 2016), the holistic nature of the practice has made it difficult for science to isolate the specific mechanisms of action. This seems to highlight friction between cultural viewpoints, as the scientific community demands that all interventions be evidence-based from randomised controlled trials, where cause and effect relationships can be isolated and established, which leads to doubt over the empirical basis of a lot of the mindfulness research. Conversely, mindfulness practitioners see the cut-throat reductionist analysis of something so complex and multi-faceted as a disservice to the heart and spirit of the teachings, and worry that the authenticity of the practices are being lost in translation (Fennell & Segal, 2011). Kabat-Zinn himself voiced his concerns over the cognitive therapy community’s implementation of mindfulness techniques into interventions such as MBCT, over fears that it would be “plugged into a behaviourist paradigm with the aim of driving desirable change, or fixing what is broken” without respecting the unique essence of mindfulness as an ongoing practice or a lifestyle, rather than a temporary treatment technique or exercise.
Nevertheless, the development of MBCT, which was specifically designed by Segal, Williams, and Teasdale (2002) to prevent patients recovering from serious depression from engaging in thought patterns that may increase the likelihood of relapse, attempted to bridge the gap between the purely acceptance-based MBSR and the more control-oriented Cognitive Behavioural Therapy (CBT). Unlike MBSR, participants in MBCT are taught the techniques of mindfulness meditation in a group-based setting and the teachings of non-judgemental acceptance are placed within a more control-based cognitive framework. The program consists of eight weekly 2-hour sessions, including one silent whole day of mindfulness practice. Throughout the course of the eight weeks, students are taught body-scan meditation (moving awareness through various regions of the body), mindful movement (maintaining present awareness of all sensations associated with each movement pattern), sitting meditation and ‘the 3-minute breathing space’, which is a mini-meditation practice that can be implemented in particularly stressful situations (Crane, 2017). Participants are taught to use their enhancements in attention to try and notice the origins of their depressive ruminative thought patterns, but the ability to decentre from their thought patterns is only implemented at times of potential relapse. Teasdale elucidates the incompatibility of mindfulness and relapses in depressive mind-states and suggests that the process of “shifting” into a mindful mode of being can be used to interrupt the chain of negative feedback loops and prevent the onset of depressive episodes (Segal, Williams, Teasdale, 2012). A meta-analysis by Perestelo-Perez et al. (2017) examining the efficacy of MBCT on reducing ruminative thought patterns in participants who had suffered at least one major depressive episode, included nine randomised controlled trials and revealed a significant moderate effect of MBCT when compared to treatment as usual. Evidently, MBCT provides an extremely potent alternative for helping people with their psychological issues, but the question remains: is MBCT a true representation of mindfulness practice? Or has is just been “plugged” into a behaviourist paradigm as Jon Kabat-Zinn feared? In order to better understand these questions, ontological differences between eastern and western culture must be considered.
The Self: East vs West
“Imagination builds the image of the self, and thought then functions within its shadows. From this self-concept grows the conflict between what is and what should be, the conflict in duality”. – Jiddu Krishnamurti
In Buddhism, the ultimate goal is to attain Nirvana, which translates to “blowing out”, where the cessation of suffering (dukkha) is finally realised. One of the key realisations along this process is that of “non-self” (anattã), which means that nothing exists independently; everything in the universe is in a dynamic web of interrelatedness. This includes the notion of the self, and roots Buddhism in an ontology of monistic idealism, as opposed to the material dualism that permeates the majority of western culture. By realising the “illusion of the self”, the propensity for desire, craving and attachment (tanhã) is also transcended, which contributes to the cessation of dukkha (Kabat-Zinn, 2011; Teasdale & Chaskalson, 2011). Academics have tussled with this idea, as Norman (2017) likens deeply mindful states to metacognition, where an individual’s identification with thoughts and emotions is broken, and they begin to view them with greater objectivity, rather than as facets of the self. Many other terms have been coined to describe this process, such as decentering, deautomisation, detachment, and reperceiving, all alluding to a fundamental shift in perspective, where one escapes the limiting parameters of their own subjective point of view (Shapiro et al. 2006). Thus, mindfulness can be thought of as the tool that is used to become aware of awareness, to “use the mind to see through the mind”. This deconstruction of the self is essential to overcome what Van Gordon et al. (2016) calls ontological addiction, which has been defined as “the unwillingness to relinquish an erroneous and deep-rooted belief in an inherently existing ‘self’ or ‘I’ as well as the impaired functionality that arises from such a belief”. It is posited that the belief in a separate self is a logical fallacy and scientifically impossible, considering the multitude of conditions that the human being is reliant upon, such as air, water, food and so on. This is supported by recent developments in neuroscience research, which calls the phenomena of consciousness the “hard problem”, and suggests that, although people tacitly assume that there is a unified, central agent to all of their experiences, this cannot be proven (Hyland, 2015). However, dualist science is predicated upon the perspective of subject/object observation, so it is understandable that this perspective is difficult to incorporate authentically. This is most evident in research by Xiao et al. (2017) who introduces the concept of “the mindful self” in an attempt to integrate Buddhist psychology with one’s self-schemas, suggesting the development of another self, rather than the transcendence of self-concepts entirely. So, does this highlight a fundamental disconnect in the way Western psychology has adopted the use of mindfulness when compared to its Buddhist origins? Buddhist texts treat mindfulness as a constant practice that progresses through multiple phases of development, starting with the awareness of bodily sensations and advancing to clearer awareness of deeper cognitive processes, emotional states, and finally an altered view of self in relation to the universe. Systematic practice is required for its gradual refinement, rather than it being implemented as a symptomatic remedy once psychological issues arise. Conversely, Western psychology seeks to label mindfulness as a stable psychological skill that ignores the developmental and contextual facets of its Eastern origins. Mindfulness is operationalised from intellectual knowledge and contemporary measures of self-reported assessments, rather than from direct phenomenological experience, which does not account for the gradual refinement of the practice, the subsequent increases in experiential vividness, or the difficulty associated with implementing mindful awareness into everyday life (Grossman & Van Dam, 2011). Although the aforementioned scientific studies demonstrate the efficacy of mindfulness-based interventions for alleviating psychological issues in a vast array of settings, further research must aim to reach consensus on the definitions, characteristics, and cultural nuances of such a multi-faceted phenomenon, to ensure that the construct is not misconstrued.
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