3] Managing Stress Mindfully
Contemplative Practices in Action
Hooria Jazaieri and Shauna L. Shapiro
Mindfulness, a translation of the traditional Eastern words including smrti (Sanskrit), sati (Pali), and dranpa (Tibetan), is associated in contem- porary Western psychology as the awareness one achieves through intentionally attending in an accepting and discerning way to one’s current moment-to-moment experience.1,2 Mindfulness involves an intimate knowing of what is arising as it is arising, without trying to change or control it. Thus, the process of mindfulness involves changing one’s relationship to experience as opposed to changing experience itself.
Any activity can be an opportunity to practice mindfulness—walking, washing dishes, eating, conversing—anything, as long as you are bringing full attention to the present. Essentially, life itself becomes the practice as every moment is a new opportunity to train your attention, thus creating the ability to respond to stress instead of habitually react- ing. Mindfulness is a natural human capacity, and it can be cultivated through formal practice.
Often we are told that being mindful takes too much time or effort, or at times, seems counterproductive to our culture of doing. Mindfulness does in fact require us to stop in a sense—this may feel awkward, uncomfortable, or unproductive at first. However, when practicing mindfulness, the goal is not to get anywhere or do anything. It is not about being or feeling a certain way. It is about trusting that you are already where you need to be, and you already are the way you need to
be. Mindfulness requires the element of letting go and allowing things to unfold in their own natural way:
[It is] an invitation to cease clinging to anything—whether it be an idea, a thing, an event, a particular time, or view, or desire. It is a conscious decision to release with full acceptance into the stream of present moments as they are unfolding. To let go means to give up coercing, resisting, or struggling, in exchange for something more powerful and wholesome which comes out of allowing things to be as they are without getting caught up in your attraction to or rejection of them, in the intrinsic stickiness of wanting, of liking and disliking. It’s akin to letting your palm open to unhand some- thing you have been holding on to.3
Although the notion of mindfulness is often associated with the rich, 2,600-year-old tradition of Buddhism, it is currently being applied as a universal technique that transcends its religious and cul- tural roots. With this recontextualization of mindfulness comes differ- ent aims; among them the contemporarily relevant aim of managing stress through easing suffering and improving health and well-being. In this chapter, we will briefly describe the historical and religious context from which mindfulness arose, describe the dimensions of the practice and how someone may begin some of the basic exercises, briefly review the empirical literature supporting mindfulness as a treatment intervention, discuss preexisting applications of this prac- tice, and present ideas for new research directions. Our hope is to introduce practices and resources to help manage stress, as well as a radically different way of seeing and being in the world that naturally gives rise to greater states of happiness and ease.
CONTEXT
Although most often associated with Buddhism, mindfulness can be found in various forms in virtually all religions and spiritual practices.4 Methods to enable individuals to focus their attention have been around for centuries, and while the approaches are different, the intention behind them is similar—to alter people’s lives.5 According to Buddhist psychology, suffering comes from our wanting things to be different from what they really are, whether that is wishing for another job, for more money, for a different appearance, or even to be happier. Neuroscientist Daniel Siegel5 suggests that stress and
suffering occur when the mind grasps onto what “should be” and cre- ates this tension between what really is. Though we are presenting mindfulness meditation here as a means of stress management, it is important to note that in Buddhism, the intention of mindfulness training is not for “stress management” but to achieve complete liber- ation from suffering and compassion for all beings.6
However as mindfulness has gone “mainstream”—a recent Google search of the term returned 2,630,000 results—the aims and under- standings have been recontextualized to fit a modern Western culture. The clinical application of mindfulness meditation (also referred to as “insight meditation” or “Vipassana”) in Western psychology can largely be attributed to Jon Kabat-Zinn and colleagues at the Univer- sity of Massachusetts’s mindfulness-based stress reduction (MBSR)7 program. Though MBSR was originally developed to help manage chronic pain, it is currently practiced worldwide and is used with a variety of populations ranging from grade school students to those with psychopathology. The skills one acquires through MBSR have been shown to reduce anxiety and depression symptoms8 as well as increase positive emotional states.9 MBSR truly is “compatible with diverse cultural and religious backgrounds.”10 Regardless of its reli- gious and cultural origins, mindfulness-based interventions have been introduced by researchers and clinicians as an empirically supported treatment (or component of) program.
Our lives are full of chronic and acute stressors—some are predictable
while others catch us off guard. Some are real while others are imag- ined. Mindfulness mediation is thought to affect the stress response in four stages—first, by freeing the senses from anything that is occupying them. Second, with practice, it provides the participant with tools to observe patterns of reacting or responding. Third, with even more practice, conditioned and habitual ways of reacting and responding gradually weaken. Finally, mindfulness meditation affects the stress response by allowing one to have a more effective and “wiser” response to any experience that emerges.11
DIMENSIONS OF THE PRACTICE
Some claim that in order to gain success in any field, one must practice the specific task for 10,000 hours.12 We are not suggesting that you attempt to practice mindfulness meditation for 10,000 hours, through electroencephalogram studies of experienced (10,000–50,000 hours)
and novice meditators have shown that meditation provides both short- and long-term benefits to health and well-being.13 Therefore, we are simply suggesting that you practice, in whichever way happens to be your way.
If at first you can manage only five minutes a day, or even one minute, that is fine—there is no right way of practicing. Simply stopping and remembering to shift your attention, even momentarily, from your usual state of doing and into a state of being is enough (and even more imperative to practice when feeling stressed). This comes from one’s ability to experience with a sense of curiosity and kindness instead of with judgment or preference. It requires an enormous amount of patience and practice because it is a completely different experience from what we are used to—“if you happen to stumble upon somebody who is meditating, you know instantly that you have come into the orbit of something unusual and remarkable.”14
THE SITTING PRACTICE
Sitting meditation is one of the most frequently practiced approaches to formally exercising mindfulness. There are several sit- ting practices you may choose to experiment with. We will discuss three of the most common, observing the breath, body scan, and Hatha yoga.
Observing the Breath
Observing one’s breathing is considered to be one of the simplest and most effective ways to begin practicing mindfulness. Observing the breath is simply that—paying attention to the inhalation and exha- lation of air without changing what is currently going on. The breath is really the foundation to a mindfulness practice because with any of the exercises, one begins by focusing all of the attention on the breath. You can begin the practice of observing the breath by sitting in a com- fortable, upright fashion, closing your eyes, and simply breathing naturally—making no effort to control or change the breath, just focusing all of the attention on the breath. Observing the rhythm, the length of each in-breath and each out-breath, the temperature, how the body moves—the nostrils, shoulders, chest, rib cage, and belly. Continuing to observe all of the qualities of the breath, without elaborating on its implications or creating any need for action. Prac- tice for two to three minutes to begin with and then try extending it
for longer periods of time. Some find it helpful to set an intention before beginning this sitting exercise by silently speaking something that resonates for them in the moment. “May I be nonjudgmental,” or “May I be gentle with myself ” are examples of such intentions.
Throughout the practice, attention will inevitably wander off the breath to thoughts, memories, fantasies, and feelings that arise. Sim- ply notice them and let them go, gently bringing the attention back to the breath. Observe judgmental thoughts (e.g., “there are so many better things that I could be doing with my time instead of this”) in a nonjudg- mental manner. Steadily repeat the process of directing your attention back to your breath each time you notice your mind is wandering—this may happen dozens of times in the span of minutes. Continue to practice using your breath as an anchor, as your breath is always there and you may come back to it at anytime, whether you are feeling anxiety, stress, or even in moments of delight. Your breath is always there to help you cope with the next moment, stressful or otherwise.
Body Scan
Another form of sitting practice is the body scan where you pro- gressively move your attention throughout the body, feeling each region. You can begin the practice by first comfortably lying down on your back with your legs extended, your arms by your sides with your palms facing up, and gently closing your eyes. If you choose, you may begin by setting an intention for this practice, speaking silently something that resonates for you in this moment; for example, “May I accept my body,” or “May I cultivate greater patience.” Begin by focusing your attention on the breath and observe nonjudgmentally as it moves in and out of your body.
Once you are in touch with the breath, you may start by bringing attention to the toes of the left foot, slowly moving up the foot and the leg. Upon reaching the pelvis, do the same with the toes of the right foot, gradually moving up the body to the torso, lower back, abdomen, upper back, chest, and shoulders. Upon reaching the shoulders, slowly and systematically go to the fingers of the left hand, moving up the arm and returning back to the shoulders and then repeating on the fin- gers of the right hand. Upon reaching the shoulders again, move to the clavicle, the neck, throat, and continuing to the face, bringing attention to the lips, nose, eyes, and ears. Conclude the body scan by moving to the back of the head and to the top of the head. Attempt to keep focus on each part of the body for at least one minute and really pay close
attention to the sensations in that particular area. After moving through the regions of your body, return to the breath and focus attention to whatever arises.
Hatha Yoga
Though there are many ways of practicing being in your body, Hatha yoga is a method whereby participants incorporate gentle yoga stretches and postures that are designed to enhance mindful awareness of bodily sensations and to balance and strengthen the musculoskele- tal system. Each pose and each exercise is done deliberately with the intention of paying attention to the moment-to-moment sensations that arise while keeping awareness fixated on the breath. Yoga is practiced in the same spirit and attitude that is applied to the other meditation practices, including gentleness, curiosity, nonattachment, beginner’s mind, patience, nonjudging, nonstriving, and acceptance. While a by-product of mindful yoga is that it may help you become stronger, more flexible, and improve balance, it also helps with relaxing yourself and reducing stress.
For your yoga practice you may choose to use a mat or a pad and place it on the floor. Perhaps you may choose to use a manual or DVD to guide you through this practice. It is important not to compare yourself with others if doing this in a group setting or even not to com- pare yourself to your past performances. Instead, be aware of what is happening to your body, in that very moment. While practicing, it is essential to bring your attention to subtle thoughts or commentary run- ning through your mind, as these unconscious notions influence our state of being and may cause great distress. This awareness and ability to continually redirect attention back to your practice will increase your sense of self and encourage your mindful yoga exercise.
INFORMAL PRACTICES
There are numerous ways of bringing mindfulness practice into your daily life outside of the formal meditation period. Remembering to simply be being, rather than be doing is a useful mantra. Just as a vio- linist practices his or her violin, we too must fine-tune this new skill of mindfulness so that with time, this practice of paying attention to the present moment-to-moment experience becomes effortless.
As we mentioned previously, any activity, as long as you are awake, can be an opportunity to practice mindfulness. We can be mindful
during routine activities such as taking a shower, kissing our signifi- cant other good-bye, writing an e-mail, or petting our dog. Deliber- ately bringing the minutia of the experience into awareness—these individual moments are what make up our lives, and too often, we are not fully awake for them: feeling the sensation of water streaming through your hair in the shower as you rinse out the shampoo; truly being in the moment as you kiss your significant other good-bye as you part ways for the day; being aware of any thoughts, feelings, or physical tensions as you type an e-mail to someone; experiencing the way your dog’s hair feels between your fingers as you run your hands through her coat. As Kabat-Zinn7 writes, it is “really doing what you’re doing.” Intentionally choose to live your life more fully and vividly, instead of on automatic pilot, which makes our daily routines seem exhausting and monotonous. In this section we will discuss two ways of really doing what you are already doing in everyday life more mindfully—eating and walking.
Mindful Eating
One method of practicing mindfulness in an informal fashion is through eating mindfully. First, simply observe how you eat, without changing anything about it. Do you eat with someone? Do you eat standing up or sitting down? Perhaps while doing something else? Where do you eat—on a couch, in bed, at a table, in front of the com- puter? How much do you eat? How long does it take you to eat? How do you feel before and after you eat? How do you determine what to eat?
Eating is an activity that plays a central role in our lives—physically, emotionally, and socially. Eating provides us the nourishment and sustenance to live, and yet we often do not pay close attention to the activity of eating, or to how we decide what we are going to eat and how much. Mindful eating involves setting an intention before you eat, becoming aware of the process of choosing what to eat, listening to your body to determine what it needs, and then eating slowly, con- sciously with your full attention on the moment-to-moment experience of eating.
As a mindful eating exercise, try sitting down to a meal and pausing before you begin eating. Set an intention for this meal, for example, “May this food nourish me”; “May I be present for this meal”; “May I appreciate all that was involved in providing this meal.” Then, not- ing the food on your plate, taking it in with all of your senses—notice
the color, size, shape, and aroma. Note any sensations in your body or any anticipation of eating—perhaps you feel a bit of saliva building up in your mouth. Slowly take a small bite but do not begin chewing yet—continue to pay attention to anything that comes to your mind about the taste, the temperature, the texture, and any thoughts or sen- sations you are experiencing. Begin to chew slowly—noticing what it feels like to chew, the movement of your jaw, any changes in the tex- ture or flavor of the food. When your mind inevitably wanders, con- tinue to redirect your attention back to your food. Notice the feeling of the subtle transition from chewing to swallowing. Take another bite and repeat the exercise. Maybe this meal is triggering memories for you, perhaps memories of a person, a fond vacation, or the last time you had this meal. Simply note where your attention has wan- dered off to and gently bring it back to where you are and what you are intentionally doing. Perhaps impatience arises; simply notice it nonjudgmentally, and continue to chew and swallow slowly and mind- fully. After you finish your meal, observe how you feel immediately afterward, and an hour or two later. Notice your energy level, your mood, how your belly feels.
We are not suggesting that all of your meals are consumed in this
meticulous of a manner; however, we are presenting another way of practicing mindfulness in your everyday life and a way of changing your relationship to food. As an alternative to practicing mindful eating with an entire meal, you may choose to practice with a raisin or strawberry, or even the first bite of a meal—something small where you are able to direct your attention to the practice of eating even if for just a few minutes.
Walking Meditation
Most of us spend at least some of our day walking, whether it is from the car to the store, from the office to a meeting, or from our house to the park. Typically, we are just trying to get from one point to the next without paying much attention to how we are getting there. Walking is another everyday activity where you may bring the formal practice of mindfulness into this informal realm. Walking can become meditative only when we are intentionally bringing awareness to each step we take.
We invite you when you are walking to just walk. Walk purely for the sake of walking instead of combining it with your usual habit of planning, thinking, talking, and worrying. Perhaps begin by selecting
a place where you can practice walking back and forth at a leisurely rate. First, become aware of yourself and your surroundings, then begin to walk. Make an effort to be fully and completely aware of each foot as it makes contact with the earth; what part of your foot comes down first? How does weight shift in your body? How long is each stride? At what point do you pick up your other foot? It may be helpful to note what you are experiencing in each movement, whether you are “lifting,” “stepping,” or “placing” your foot. When you reach the end of your path, briefly pause and turn around. Do this at whatever speed feels right for you and keeps your attention focused. Thoughts or judgments may arise; acknowledge their presence and gently direct your attention back to each methodical step. You may choose to prac- tice this for 15 or 20 minutes.
Try to bring this same spirit of awareness of your walking when you park your car and go into stores to shop or run errands, when you are walking from one building to another at work, or when taking a stroll as a way to relax and decompress after a long day. We are often rushing through all of these things to the next activity, so we fail to really expe- rience them. Through practicing walking mindfully, you are teaching yourself to walk through life more wakefully.
CULTIVATION OF ATTITUDES
In Kabat-Zinn’s book Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness,7 he describes seven attitudinal foundations of mindfulness: nonjudging, the mindfulness practice that requires us to intentionally suspend judgment and evalu- ation and just simply be aware of whatever arises; patience, whereby we allow things to unfold in their own time, as there is no reason to rush one moment to get to the next; beginner’s mind, a willingness to see everything in life as if it were being experienced for the first time; trust, the quality of trusting in the knowledge that there is innate wisdom in all of us and therefore looking within ourselves for guidance rather than outside for clues on how we should be; nonstriving, which is being fixed on achieving nothing, having no goals, going nowhere, getting nothing, detaching oneself from any particular outcome; acceptance, coming to terms with reality by being receptive and open to whatever is actually here in the present moment, regardless of whether we agree or approve of it; and finally, letting go, which was described at the beginning of the chapter as a way of just letting things be and
accepting them for what they are, holding onto nothing. All seven of these attitudes are interconnected; practicing one almost always inevi- tably leads to practicing another.
In addition, Shapiro and Schwartz15,16 have included the qualities of nonattachment, letting go of grasping or clinging to a particular out- come and allowing things to unfold; curiosity, a genuine interest in one’s experience, being willing to explore and investigate; gentleness, a tender quality that is soft though not to be confused with undisci- plined or passive; nonreactivity, the ability to respond where we come from a place of clarity and consciousness instead of automatically reacting in a conditioned or habitual way; and finally, loving kindness, demonstrating love, benevolence, and friendliness.
These attitudes can be thought of as the manner in which we go about our mindfulness practice. It is with these attitudes that we approach observing the breath, the body scan, Hatha yoga, eating, walking, or whatever activity we choose to be mindful while doing. Keeping these interrelated attitudes at the forefront of the practice allows us to create a space where empathy and compassion for our- selves and others may be cultivated.
SPIRITUAL MODELS
Many people tend to seek and want to feel connected to something greater than themselves, without necessarily being tied to a formal religion. Since “most human behavior is learned observationally through modeling,”17 it seems logical that we look to spiritual models. Due to the context where mindfulness arose, the Buddha is a common example of a spiritual model who exemplified seeking a clam or medi- tative state.
Spiritual modeling has been defined as the act of learning spiritually relevant behaviors or skills through observing other people—spirituality is “caught, not taught.”18 Through observational spiritual learning, four processes are used: attention, retention, reproduction in behavior, and motivation.19 MBSR supports all four spiritual modeling processes and allows us to link spiritual beliefs to practices.20 Oman and Beddoe21 examined MBSR and suggested that it offers support for spiritual mod- eling in several ways. The group format through which MBSR is taught facilitates collaboration between fellow participants and allows them to draw upon each other as models. Furthermore, text from “spiritually oriented poets such as Jalaluddin Rumi, Walt Whitman, or others, are
commonly used in MBSR session to illustrated and support meditative states of mind.”20
Whether everyday models, such as a mother, a close friend, or col- league, or revered models, such as the Buddha, Jesus, Mother Teresa, His Holiness the Dalai Lama, Mahatma Gandhi, Martin Luther King, or Nelson Mandela, spiritual modeling is all around us if we pay atten- tion. For many, these spiritual models motivate us through our daily lives or our practices as we seek meditative or calm states of mind.
OTHER CONSIDERATIONS
It is important to note that although you may be practicing mind- fulness in a formal setting, you are encouraged to also bring mindful- ness to seemingly ordinary activities like walking, eating, or standing. It is useful to apply these same general principles outside of the formal meditation practice as much as possible, keeping you grounded in the here and now instead of focusing on ongoing streams of thoughts that are often confused with reality, worries that tend to only increase your stress levels, or rumination that drains us of energy that can be better used elsewhere.
You may find that different practices fit you better than others; that is fine. It is important to find your way of practicing by experimenting— varying the length of time, the location, the time of day which you practice, the quality of your attention, and seeing how it effects your practice. For most of us, the practice of mindfulness is quite challenging and requires practice, discipline, and intentional effort. It is important to remember to set aside time for yourself to practice formal meditation, whether it is 20 or 40 minutes, once or twice a day, whatever you find to be most effective at alleviating your stress.
REVIEW OF THE THEORETICAL AND EMPIRICAL LITERATURE
Although researchers have attempted to empirically examine mind- fulness through some of the constructs associated with it including the cultivation of compassion, awareness, insight, wisdom, and empathy, this rigorous investigation of mindfulness is in many ways antithetical to the rich tradition from which it stems. Nevertheless, numerous scientific research studies have examined the beneficial effects (both psychological and physiological) of mindfulness in clinical and
nonclinical samples ranging from chronic-pain patients, individuals with Axis I disorders (e.g., binge eating disorder, panic, generalized anxiety, depression), Axis II disorders (e.g., borderline personality disorder), mixed clinical populations (Axis I and Axis II disorders com- bined), other medical disorders (e.g., cancer, fibromyalgia, psoriasis, cardiovascular disease, hypertension, HIV/AIDS), and nonclinical populations (e.g., elementary, undergraduate, graduate, and medical students; community volunteers; experienced mediators). Research has shown that mindfulness meditation promotes cognitive change, self-management, relaxation, and acceptance in participants.22,23
Physiologically, mindfulness mediation has shown to exhibit signifi- cant impacts on the autonomic nervous system by slowing heart rate (Cuthbert et al., as cited by Kristeller11) and decreasing blood pressure (Benson, as cited by Kristeller11). More recently, brain-imaging tech- nology such as electroencephalogram studies have shown the positive effects of which even short mindfulness meditation-training programs are capable, such as changing the brain and immune functioning of the participant.24 If stress decreases one’s immune functioning, and mind- fulness has been shown to increase one’s immune functioning, then it is only natural to suggest that it is even more imperative that we prac- tice mindfulness when we are experiencing moments of stress, acute or otherwise.
Several studies have found an increase in spirituality due to participa- tion in MBSR. Carson, Carson, Gil, and Baucom25 found that couples who participated in mindfulness-based relationship enhancement experienced statistically significant increases in spirituality as compared to those who did not received the treatment. When examining under- graduates who received MBSR, Astin26 also found increase in spiritual experiences. Carmody, Reed, Merriam, and Kristeller27 recently found that participation in MBSR intervention significantly increased spirituality, which was associated with medical and psychological improvements.
APPLICATIONS/INTERVENTIONS
There are several empirically validated interventions that are based on mindfulness and also include mindfulness as a component of the treatment program. The most well known is MBSR,7 which is typically designed as an eight-week course with groups of up to 35 participants who meet on a weekly basis for two and a half to three hours and a
six-hour weekend retreat after the sixth class. Participants are taught both formal and informal mindfulness techniques, ranging from sitting mediation, walking mediation, body scan, yoga, and informal daily prac- tices. In addition to class, participants practice for at least 45 minutes a day, six days per week from home and are given audiotapes to assist with their practice.
MBSR has been offered to undergraduate and graduate students alike at both public and private universities. At Santa Clara University, a graduate course in the counseling psychology program entitled “Stress and Stress Management” provides training in mindfulness meditation (through an eight-week MBSR course). Likewise, in Montana State University’s counseling psychology program a course called “Mind/ Body Medicine and the Art of Self-Care” provides students with stress management training through MBSR.28 Recently, MBSR has been applied in the professional workplace, as an increasing number of com- panies offer the course to employees because they recognize that stress poses negative consequences on an employee’s professional effective- ness in addition to his or her personal well-being. Davidson et al.24 examined the effects of MBSR on employees at a biotechnology com- pany compared to a wait-list group and found that antibody production measured four months after the MBSR program was significantly higher in the treatment group.
In addition, there are other therapies that draw largely on Kabat-
Zinn’s MBSR program with specific populations in mind, such as mindfulness-based cognitive therapy,8 a manualized eight-week group approach to the treatment of depression. Recently, we have seen numerous other therapies emerging in the mindfulness-based field: mindfulness-based eating awareness training,29 designed for individuals with binge eating disorder and most recently, obesity; mindfulness- based art therapy,30 which was developed for use in medical populations and also has been applied to women with breast cancer: mindfulness- based relapse prevention,31,32 which has been applied to alcohol and drug abuse as well used as a treatment for smoking cessation; and MBRE25 (mentioned earlier), designed to enhance the relationships of couples.
There are also cognitive-behavioral interventions that use mindful- ness as a component of the treatment program. Dialectical behavior therapy33,34 is a manualized, multifaceted group and individual thera- peutic approach originally developed for the treatment of borderline personality disorder and is now currently being used with a variety of clinical and nonclinical populations. One of the modules in DBT is
mindfulness, where patients are instructed on how to pay attention to the present moment in a nonjudgmental manner. Acceptance and commitment therapy35 is a treatment whose core principles include acceptance and being in contact with the present moment while also taking into consideration one’s goals and values. It is typically delivered in an individual format but can also be delivered in a group format. Acceptance and commitment therapy has been shown to be successful when applied to individuals with a broad range of psycho- logical problems.
NEW RESEARCH DIRECTIONS
Many have attempted to define the term mindfulness for the purposes of Western psychology. Brown and Ryan9 define mindfulness as “the presence or absence of attention to and awareness of what is occurring in the present” (p. 824). Wallace and Bodhi have stated that mindfulness is simply “bare attention” (as cited by Shapiro and Carlson).23 Bishop and colleagues,36 presented mindfulness as having two components, the first involving the ability to self-regulate attention and maintain focus on present experience, and the second, the adaptation of an open, curious, and accepting orientation to one’s present-moment experien- ces. Shapiro and colleagues2,23 have proposed that mindfulness is both an outcome (mindful awareness) and a process (mindful practice) that involves three key elements: intention (e.g., why you are practicing), attention (e.g., observing moment-to-moment experiences both inter- nal and external), and attitude (e.g., how you attend—the qualities that are brought)—collectively referred to as IAA (Intention, Attention, Attitude).
Current research, as demonstrated previously, suggests that mind- fulness practice is an effective means of reducing stress and enhancing well-being across a wide range of populations. Future research, how- ever, is needed to determine the mechanisms of action for how mind- fulness works. In addition, examining how to best teach mindfulness to diverse populations is crucial, and determining any adverse effects of mindfulness on certain clinical and nonclinical populations would be beneficial to the field.
Another area for future research is to expand the measures used to assess the effects of mindfulness intervention. The majority of the out- come measures in mindfulness studies have been self-report, while some have expanded research to more objectively observable and quantifiable
measures such as electroencephalogram, functional magnetic resonance imaging, and cortisol levels—leading the research in mindfulness to strive toward more objective outcome measures. Though the neuroscientific study of mindfulness meditation has shown exciting preliminary results, it is still in its infancy. Current findings must be supplemented with longitudinal randomized clinical trials to examine the long-term effects mindfulness has on the participant.
CONCLUSION
Four decades of empirical research suggest that mindfulness practice has numerous positive effects such as enhancing physical health, increasing spiritual and psychological well-being, and lowering stress. The intention of this chapter was to introduce mindfulness both as a way of being and as a practice to help with the management of stress. Through the cultivation of mindfulness, we are better able to effectively respond with greater awareness instead of automatically reacting to stress. As our mindfulness builds and becomes more integrated into our moment-to-moment experience, we have greater degrees of free- dom of how we choose to respond, how we choose to live and be in the world. Building a new relationship with our experiences is necessary to finding peace, as Germer37 illustrates:
While striving may allow us to acquire physical comforts, living in the present enables us to live more fully. Everyone feels stress to one degree or another. The conditions of our lives never seem quite right, because our inner experience of them is unsatisfactory. We find ourselves either running headlong toward the future for relief or dwelling in the past, or both. A changed relationship to our experience is needed to find lasting peace. (p. 114)
We believe mindfulness offers one avenue to cultivate this “changed relationship to experience”—and that through this, we will be better able to manage stress and ultimately lead more joyful and fulfilling lives.
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CHAPTER 4
