Mindfulness Training as a Clinical Intervention: A ...

1 Send correspondence to Ruth A. Baer, Department of Psychol-ogy, 115 Kastle Hall, University of Kentucky, Lexington, KY40506-0044. E-mail: based on Training in Mindfulness skills arebecoming increasingly popular. Mindfulness involves in-tentionally bringing one s attention to the internal and ex-ternalexperiences occurring in the present moment, andis often taught through a variety of meditation review summarizes conceptual approaches to mind-fulness and empirical research on the utility of Mindfulness -based interventions. Meta-analytic techniques were in-corporated to facilitate quantification of findings andcomparison across studies. Although the current empir-ical literature includes many methodological flaws, find-ings suggest that Mindfulness -based interventions maybe helpful in the treatment of several disorders.

2 Method-ologically sound investigations are recommended in orderto clarify the utility of these words: Mindfulness , meditation, meta-analysis,treatment outcome.[Clin Psychol Sci Prac 10: 125 143,2003] Mindfulness is a way of paying attention that originated inEastern meditation practices. It has been described as bringing one s complete attention to the present experi-ence on a moment-to-moment basis (Marlatt & Kris-teller, 1999, p. 68) and as paying attention in a particularway: on purpose, in the present moment, and nonjudg-mentally (Kabat-Zinn, 1994, p. 4). The ability to directone s attention in this way can be developed through thepractice of meditation, which is defined as the intentionalself-regulation of attention from moment to moment(Goleman & Schwartz, 1976; Kabat-Zinn, 1982). The cur-rent Mindfulness literature describes numerous meditationexercises designed to develop Mindfulness skills (Hanh,1976; Kabat-Zinn, 1990, 1994; Linehan, 1993b).

3 Manyencourage individuals to attend to the internal experiencesoccurring in each moment, such as bodily sensations,thoughts, and emotions. Others encourage attention toaspects of the environment, such as sights and sounds(Kabat-Zinn, 1994; Linehan, 1993b). All suggest thatmindfulness should be practiced with an attitude of non-judgmental acceptance. That is, phenomena that enter theindividual s awareness during Mindfulness practice, such asperceptions, cognitions, emotions, or sensations, are ob-served carefully but are not evaluated as good or bad, trueor false, healthy or sick, or important or trivial (Marlatt &Kristeller, 1999). Thus, Mindfulness is the nonjudgmentalobservation of the ongoing stream of internal and externalstimuli as they recently, Mindfulness has been a relatively unfa-miliar concept in much of our culture (Kabat-Zinn, 1982),perhaps because of its origins in Buddhism.

4 Kabat-Zinn(2000) suggests that Mindfulness practice may be beneficialto many people in Western society who might be un-willing to adopt Buddhist traditions or vocabulary. Thus,Western researchers and clinicians who have introducedmindfulness practice into mental health treatment pro-grams usually teach these skills independently of the reli-gious and cultural traditions of their origins (Kabat-Zinn,1982; Linehan, 1993b). In the current empirical literature, Clinical interventions based on Training in Mindfulness skillsare described with increasing frequency, and their popu-larity appears to be growing rapidly. According to Salmon,Santorelli, and Kabat-Zinn (1998), over 240 hospitals andclinics in the United States and abroad were offering stressreduction programs based on Mindfulness Training as ofMindfulness Training as a Clinical Intervention: A Conceptual and Empirical ReviewRuth A.

5 Baer, University of KentuckyDOI: 2003 AMERICAN PSYCHOLOGICAL ASSOCIATION D121251997. Mindfulness Training is also a central component ofdialectical behavior therapy (Linehan, 1993a, 1993b), anincreasingly popular approach to the treatment of border-line personality disorder. The empirical literature on theeffects of Mindfulness Training contains many method-ological weaknesses, but it suggests that Mindfulness inter-ventions may lead to reductions in a variety of problematicconditions, including pain, stress, anxiety, depressive re-lapse, and disordered eating ( , Kabat-Zinn, 1982; Kabat-Zinn et al., 1992; Kristeller & Hallett, 1999; Shapiro,Schwartz, & Bonner, 1998; Teasdale et al., 2000).This review summarizes the recent literature on mind-fulness Training as a Clinical intervention. First, currentmethods for teaching Mindfulness skills are , conceptual approaches that articulate how mindful-ness skills may be helpful in treating Clinical conditions aresummarized.

6 Finally, the empirical literature on the effectsof Mindfulness Training is review does not address transcendental meditation(TM) and other concentration-based approaches, whichhave been reviewed elsewhere (Delmonte, 1985; Smith,1975). Concentration-based approaches train participantsto restrict the focus of attention to a single stimulus, suchas a word ( , a mantra), sound, object, or attention wanders, it is redirected to the object ofmeditation. No attention is paid to the nature of the dis-traction. Mindfulness meditation, in contrast, involves ob-servation of constantly changing internal and externalstimuli as they review also does not address Langer s (1989, 1997)cognitive model of Mindfulness , which includes alertnessto distinctions, context, and multiple perspectives, open-ness to novelty, and orientation in the present (Sternberg,2000).

7 Mindfulness interventions studied by Langer andcolleagues ( , Langer, 1989; Langer & Moldoveanu,2000) often include teaching participants to consider in-formation or situations from multiple perspectives orwithin new contexts in order to increase learning or cre-ativity. Although this concept of Mindfulness shares withmeditative approaches an emphasis on flexible awareness inthe present, several important differences can be s (1989) Mindfulness interventions usually involveworking with material external to the participants, such asinformation to be learned or manipulated, and often in-clude active, goal-oriented cognitive tasks, such as solvingproblems. In contrast, the meditation-based approachesdescribed in this review often are directed toward the in-ner experiences of the individual ( , thoughts, emo-tions) and emphasize a less goal-directed, nonjudgmentalobservation.

8 Langer (1989) has cautioned against drawingunwarranted parallels between the two forms of mindful-ness, noting that they are derived from very different his-torical and cultural BASED ON Mindfulness TRAININGM indfulness-Based Stress ReductionThe most frequently cited method of Mindfulness trainingis the Mindfulness -based stress reduction (MBSR) pro-gram, formerly known as the stress reduction and relax-ation program (SR-RP; Kabat-Zinn, 1982, 1990). It wasdeveloped in a behavioral medicine setting for populationswith a wide range of chronic pain and stress-related disor-ders. The program is conducted as an 8- to 10-week coursefor groups of up to 30 participants who meet weekly for 2 hr for instruction and practice in Mindfulness med-itation skills, together with discussion of stress, coping, andhomework assignments.

9 An all-day (7 8-hr) intensivemindfulness session usually is held around the sixth Mindfulness meditation skills are taught. For ex-ample, the body scan is a 45-min exercise in which atten-tion is directed sequentially to numerous areas of the bodywhile the participant is lying down with eyes closed. Sen-sations in each area are carefully observed. In sitting med-itation, participants are instructed to sit in a relaxed andwakeful posture with eyes closed and to direct attention tothe sensations of breathing. Hatha yoga postures are usedto teach Mindfulness of bodily sensations during gentlemovements and stretching. Participants also practice mind-fulness during ordinary activities like walking, standing,and in MBSR are instructed to practice theseskills outside group meetings for at least 45 min per day, sixdays per week.

10 Audiotapes are used early in treatment, butparticipants are encouraged to practice without tapes aftera few weeks. For all Mindfulness exercises, participants areinstructed to focus attention on the target of observation( , breathing or walking) and to be aware of it in eachmoment. When emotions, sensations, or cognitions arise,they are observed nonjudgmentally. When the participantnotices that the mind has wandered into thoughts, mem-ories, or fantasies, the nature or content of them is brieflynoted, if possible, and then attention is returned to theCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE V10 N2, SUMMER 2003126present moment. Thus, participants are instructed to no-tice their thoughts and feelings but not to become absorbedin their content (Kabat-Zinn, 1982). Even judgmentalthoughts ( , this is a foolish waste of time ) are to beobserved nonjudgmentally.