Khabira on current approaches to mindfulness in Western medicine and psychology.
When I first came to Poona in 1978, Osho was giving the „Take it Easy“ discourses on the Zen sutras of Ikkyu. For me, it was the first encounter with meditation, and Osho’s talks about nothingness and watchfulness gave me the first glimpses of a freedom which I had longed for all my life. Over the next two decades, I got all my inspiration from his discourses and from whatever was happening in the larger sannyas community.
In the meantime, this has changed, and I have started looking beyond the world of Osho. I studied Psychology and completed the Bachelor with distance studies at a university in England. There I realized that mindfulness as inspired by the Buddhist tradition has entered mainstream Psychology and Psychotherapy, with what I perceive as an impressively high level of clarity.
In the following, I will give you a short overview of some of these approaches, which are the well-known Mindfulness-Based Stress Reduction (MBSR) of Jon Kabat-Zinn, the Mindfulness Based Cognitive Therapy for Depression (MBCT) and Acceptance and Commitment Therapy (ACT). Also, I will give you some neuroscientific background information.
Jon Kabat-Zinn comes from the Buddhist tradition. He is Professor of Medicine Emeritus and founded the Stress Reduction Clinic at the University of Massachusetts in 1979. Mindfulness-Based Stress Reduction (MBSR) is meant for people in all kinds of situations of stress, such as medical conditions or stress at the workplace. It is an eight-week program, during which participants are asked to commit to 45 minutes of mindfulness practice daily on six days of a week.
This practice consists of sitting meditation, walking meditation, Yoga or Body Scan in order to get in touch with the body (directing attention to different parts of the body while lying down). Kabat-Zinn also emphasizes mindfulness in daily life, which according to him means living each moment fully and just feeling whatever is happening in the moment. A famous exercise of his is the raisin-exercise: inviting people to eat one raisin slowly and mindfully, thus teaching them how to experience the moment fully.
According to Kabat-Zinn, important aspects of mindfulness practice are non-judging, patience, an attitude of a beginner’s mind (in Osho’s words probably “not-knowing”), trust, non-striving, acceptance and letting go. I find it interesting that similar to Osho, Kabat-Zinn also refers to Zorba the Greek. His main book is called “Full Catastrophe Living”, referring to Zorba’s “full catastrophe”. For Kabat-Zinn, this means embracing whatever life brings, all the ups and downs, all the catastrophes.
MBSR is practiced in over 300 clinics and health centers world-wide. There is a MBSR institute in Freiburg, where I live, in which the MBSR program is taught and teachers are trained. One of the people who are inspired by Jon Kabat-Zinn is Luise Reddemann, a famous trauma therapist. She went to Kabat-Zinn in 1993 and is practicing mindfulness herself ever since.
Reddemann emphasizes the need for therapists to have their own practice of mindfulness, saying that mindfulness helps to develop acceptance, compassion and empathy. Also, she introduces mindfulness as specifically modified to suit traumatized people to her patients. In her experience, traumatized patients tend to drift off into dissociation when doing the traditional Vipassana practice, therefore she starts by teaching them things such as being mindful of the body touching the chair while sitting.
From a neuroscientific point of view, there are several studies suggesting that mindfulness furthers the growth of the hippocampus. The hippocampus is an area in the brain which is responsible for storing conscious context information about experiences: it stores the conscious “when”, “where” and “what” about events. The hippocampus is very vulnerable to stress and shrinks when extreme stress is experienced, such as in trauma or prolonged daily stress. A larger hippocampus makes people less prone to be stressed or traumatized.
Another approach employing mindfulness is Mindfulness-Based Cognitive Therapy for Depression. It is based on the work of Jon Kabat-Zinn, using the same 8-week-sequence. This therapy was devised by the clinical psychologists Segal, Williams and Teasdale in order to help recovery from depression and prevent relapse.
Earlier psychological treatments involved cognitive therapy, which argues that mental disorders are the result of negative thinking and dysfunctional attitudes. Therefore, cognitive therapy tries to change the content of people’s thoughts. However, Segal, Williams and Teasdale found that it is not the content of people’s thinking which makes them depressed, but the relationship they have to their thoughts. They noticed that by distancing themselves from negative thoughts, seeing thoughts simply as thoughts rather than a reflection of reality, people are less likely to experience a relapse in depression.
Therefore, Williams, Segal and Teasdale went to visit Jon Kabat-Zinn in 1993 in order to explore mindfulness. Initially, as instructors, they refused to develop their own mindfulness practice. However, when they started teaching mindfulness to patients, they realized that they could not properly teach it without having their own experience of it. So they went back to Kabat-Zinn to learn the practice of mindfulness for themselves.
In their therapeutic approach, they emphasize the need to step out of automatic pilot and become aware of the present moment. Another issue is staying present to whatever experience there is, rather than becoming attached to beautiful experiences or trying to get rid of difficult or painful experiences. This involves acceptance, allowing and letting be. In addition, people are reminded that thoughts are not facts, that the same old thoughts are nothing but a tape in the mind. When this approach was evaluated, the psychologists found that it reduces the risk of relapse almost by half for patients with a long history of depression.
The neuroscientist Daniel Siegel explains that a bipolar disorder (alternating depression and mania) can be the result of a dysfunction in an area of the prefrontal cortex which regulates emotions arising from an evolutionary old part of the brain, the amygdala in the limbic system.
He cites studies which have found that the practice of mindfulness strengthens these regulating areas in the prefrontal cortex. Also, the right hemisphere of the brain is well connected with the limbic system. In a healthy human being, the right, nonverbal and more emotional hemisphere needs to be integrated with the left, logical hemisphere. If the right hemisphere is predominant and not enough connected with the left hemisphere, emotional dysregulation and chaotic outbursts of emotions can be the result.
In his new book Mindsight Siegel describes how he treated a young man with bipolar disorder by teaching him mindfulness instead of giving him medication. After practicing for a while, Siegel’s patient writes in his diary: “… my thoughts and feelings arise – sometimes strong, sometimes weak, just that before they used to feel as if they were me, and now they are more what I experience, but my thoughts and feelings are not me …” Finally, after one year of intensive practice of mindfulness, the young man was free of the strong mood changes which are a characteristic of a bipolar disorder.
Acceptance and Commitment Therapy (ACT – pronounced like the verb “act”) of the clinical psychologists Hayes, Strosahl and Wilson is a different approach, working mainly with understanding the mind. It is inspired in part by Zen Buddhism. ACT argues that a healthy life consists of both good and bad experiences, as we have only limited control over inner and outer events. One example of limited control over inner events is that we cannot influence whether we fall in love with someone or not.
ACT regards human language as the cause of both human achievement and human suffering. Thus, it uses language in order to help people understand the destructiveness of constantly putting experiences into words. It explains that human beings live in a verbal reality which seeks to evaluate, regulate and control experiences rather than directly experiencing “the world as it unfolds in the here and now.”
Verbal activity always involves evaluation, judging events, objects or people as good or bad. An outcome of evaluation is experiential avoidance, which means avoiding undesirable experiences. Excessive verbal activity leads to “cognitive fusion” (identification with words), which results in a domination of minds over people. ACT teaches people to use language without being “consumed” (or used) by it, helping people to become detached from the contents of the mind and stop being “pushed around by words”. It teaches people the difference between evaluation and description, control versus emotional willingness, and “creative hopelessness” as a prerequisite to let go of the struggle of experiential avoidance. Another issue is to become aware of the observing self.
Similar to the Serenity Prayer of Alcoholics Anonymous, ACT promotes acceptance when things cannot or need not change, and changing things that can be changed through choice and committed action. These are the components of ACT:
- take action
ACT argues that people need to clarify their values, as people’s vision is clouded by identification with thoughts. Each individual needs to identify and choose their own values (which may be different for different people), as values give an inherent sense of purpose and meaning in life. They use a well-known exercise which is the “what do you want your life to stand for”-exercise, in which people are asked to imagine their own funeral speech given by a best friend. Chosen values then lead to commitment and action.
The neuroscientific value of acceptance and witnessing in difficult situations is explained by the psychologist Berking. In daily life, the above-mentioned amygdala in the limbic system responds very quickly to perceptions of threat. The response of the amygdala consists of triggering the release of stress hormones, feelings such as fear and bodily responses such as tightening of muscles, sweat and/or high blood pressure.
Berking writes that our automatic response to the firing of the amygdala is negative thinking and fighting the experience. However, this is a vicious circle: as long as there are negative thoughts and inner struggle, the perception of threat remains and the amygdala continues firing. Therefore, Berking suggests that in response to undesired experiences, we should learn to accept and witness events, so that the vicious circle of amygdala firing – negative response is broken and the amygdala can cool down.
It appears that in Western cultures, there is an increasing interest in mindfulness and meditation, many people practice mindfulness, it is employed in psychotherapies and there is plenty of research carried out on this subject. In Freiburg, there is a weekly evening event in the big lecture hall “Audimax” of the Freiburg University in the center of town, a psychosomatic colloquium. It is an event which is free for the public, and where psychologists and physicians from all over the world come to teach (for example, once Peter Levine came to introduce Somatic Experiencing).
One evening, a professor from Zurich came to hold a discourse on mindfulness. I was totally amazed to watch that the whole of Freiburg seemed to rush into the hall: hundreds of people came, the hall was packed with people sitting on the stairs and on the floor. During one exercise we did, I very much enjoyed the experience of sitting in silence with hundreds of people in the University hall in the middle of Freiburg.
Khabira grew up in northern Germany and took sannyas in Poona in 1978. She spent one and a half years in Poona 1 doing groups and working in the ashram. After that, she was part of the Vihan Center in Berlin and later became a commune member in Medina (England) and Hamburg. Between 1987 and 1995, she spent many months each year in Poona, going to Munich in between to earn money. In 2011, she earned a Bachelor of Science degree in Psychology from the Open University, England.