Полная версия
Mindfulness in Eight Weeks
The quality of acceptance that emerges from mindfulness training isn’t simple passivity, however. It’s not that we passively allow the world to roll over us, or that we stop making ethical judgements. Far from it. Mindfulness training might even enable you to be more appropriately assertive. It might sharpen your capacity for drawing ethical distinctions. But all of this can be done with wisdom and with kindness.
With mindfulness training you begin to develop a greater capacity to allow what is the case to be the case and to respond skilfully and appropriately with a warm open-heartedness.
This book is based on a completely secular approach to mindfulness training. It is for people of any religion or none. For 2,500 years, however, the ideas and practices at the core of the approach were found almost exclusively in Buddhist monasteries in Asia. So far as we’re aware, the Buddha was the first person in history to use the idea of mindfulness as we use it in contemporary mindfulness approaches. He taught a number of mindfulness practices and other methods for developing and sustaining mindfulness and he spoke at length of the immense benefits that are on offer from engaging in those practices. That approach and a body of teachings and practices that came from it lived on in a wide variety of Buddhist monastic contexts in Asia but, for 2,500 years, people outside of Asia knew almost nothing about it.
Towards the end of the nineteenth century that began to change as European explorers, scholars and colonial administrators began to discover and translate into their own contexts some of what was going on in Asian monasteries. At first, only a tiny handful of these took up the practices for themselves, and the penetration of mindfulness approaches into European and North American culture was slow and gradual. But it built steadily and received a boost in the 1950s with the emergence of the Beats – poets and writers like Allen Ginsberg, Jack Kerouac and Gary Snyder, who began to publicly advocate the practice. It received more of a boost in the 1960s and 1970s with the psychedelic movement, when people like myself – hippies and wannabe hippies – began to get involved. But mindfulness practices were still largely to be found only in Buddhist contexts.
Towards the end of the 1970s, however, a very significant shift took place. Much of this comes down to Jon Kabat-Zinn. Jon had trained as a molecular biologist and was working as such at a hospital near Boston – the University of Massachusetts (UMass) Medical Center. In his student days he had come upon Buddhism and had established a regular daily meditation practice. Apart from his work at the hospital, he also taught yoga. He engaged with his scientific work, but two other questions kept bothering him. One question he expressed as ‘What shall I do with my life? What kind of work do I love so much I would pay to do it?’ The other was more to do with the patients who came to the hospital.
He saw that people came to the hospital because, in one way or another, they were suffering. But how many of them, he wondered, left the hospital with that suffering resolved? In discussion with physicians at the hospital he came to the conclusion that it was maybe something like 20 per cent of patients. What, he wondered, was the system offering to the other 80 per cent?
While on a silent meditation retreat in 1979 these two streams of questioning resolved themselves in a ‘vision’ lasting maybe 10 seconds, which Jon describes as an instantaneous seeing of vivid, almost inevitable connections and their implications.
He recognised in that moment that the way he was working on that retreat on his own mind and mental states might have enormous benefits for the people who came to the hospital with their suffering. He saw that it might be possible to share the essence of the meditation and yoga teachings that he had been practising for the past 13 years with those who might never come to a Buddhist centre, and who would never be able to discover that essence through the words and forms that were used in such places. He resolved to try to make the practices and the language used to describe them so commonsensical that anyone might benefit from them.
Jon persuaded the hospital authorities to let him and his colleagues have some space in the basement, and there they developed what soon came to be known as the eight-week Mindfulness-Based Stress Reduction (MBSR) programme. He and his colleagues worked to develop a contemporary vocabulary that spoke to the heart of the matter without reference to the cultural aspects of the traditions out of which those practices emerged.
Jon had trained as a scientist and knew the value of research, so he and his colleagues researched the patient outcomes of their programme and, bit by bit, what is now a very considerable body of research evidence into the efficacy of the training began to emerge. At the time of writing there are many thousands of peer-reviewed scientific papers investigating the effects of mindfulness training. If you’re interested in these, you’ll find an extensive database of them at www.mindfulexperience.org.
It soon became clear that MBSR training enabled people to deal much better with chronic pain. They also became more adept at managing the various stressors that accompanied whatever issues had brought them to the hospital. The research indicates that the programme is successful at helping people deal with difficulty and, at the time of writing, more than 20,000 people have completed the eight-week course at UMass itself. More than 740 academic medical centres, hospitals, clinics and freestanding programmes offer MBSR to the public around the world, and interest in mindfulness training has continued to build as it has become increasingly apparent that it is not only stress and chronic pain that are positively affected when you learn to work with your attention in a different way.
Biological changes started to show up in the research as well. One early instance of this was the finding that, among patients who came to the hospital for treatment for psoriasis, the symptoms of those who engaged in the MBSR course alongside that treatment cleared up around 50 per cent faster than the symptoms of patients who didn’t. What this seemed to show was that what people were doing with their minds, the work they were doing with their attention, was actually changing their bodies.
The understanding of the way in which mindfulness training affects us biologically received a further boost when neuroscientists began to investigate its effects.
Part of this story goes back to 1992, when a small group of neuroscientists led by Professor Richard Davidson and helped by Alan Wallace, a Western Buddhist scholar, travelled to Dharamsala in the foothills of the Indian Himalayas on a kind of neuroscience expedition. They took with them an array of what was then cutting-edge scientific equipment: laptop computers, electroencephalographs, battery packs and a generator. They wanted to meet some of the Tibetan Buddhist hermit-meditators who lived in the hills above the town and they hoped to recruit from among them a cohort of expert meditators – people who had put in tens of thousands of hours of meditation practice. The neuroscientists wanted to study the pattern of their brain activity. They were particularly interested in the habits of thinking and feeling they exhibited when not meditating. If these demonstrated that the subjects had unusual habitual traits, these might reflect enduring functional changes that had occurred in their brains as a result of their mental training.
This first foray simply failed. To begin with, the yogis were unimpressed by what seemed to them to be the scientists’ uninformed and naïve perspectives on meditation. ‘We seemed like primitive Neanderthals to them,’ explained Alan Wallace, who helped to facilitate the encounters.
In the end the scientists got no usable data from that trip. But they’d made a start and, with the Dalai Lama’s help, in 2001 a number of maroon-robed Tibetan Buddhist monks began to make their way to Davidson’s Laboratory for Affective Neuroscience in Madison, Wisconsin, to meditate with EEG caps stuck on their already shaven heads. These were ‘Olympic-level athletes’ of meditation, with many years of intensive practice behind them. The results were astounding. The expert meditators exhibited patterns of brain activity never before measured by science. We’ll look in more detail at some of these findings in Week Three. They’re particularly interesting because from them scientists were encouraged to investigate what changes might show up in people who had no previous meditation experience and who took up an eight-week mindfulness training course. Here, they found (and research continues to find) highly significant changes in the patterns of brain activation – and even changes in the brain’s physical structure – that follow from just eight weeks of mindfulness training.
A significant event in the development of secular mindfulness training came about in 1992 when three distinguished cognitive psychologists – Zindel Segal, Mark Williams and John Teasdale – were asked by the director of a clinical psychology research network to develop a group-based therapy for the treatment of relapsing depression.
Significant depression is a highly disabling condition. Besides emotional pain and anguish, people who are depressed also experience levels of functional impairment comparable to those found in major medical illnesses – including cancer and coronary heart disease – and a World Health Organization projection suggests that of all diseases depression will impose the second-largest burden of ill health worldwide by the year 2020.
Roughly one in 10 of us in Europe and North America will experience serious depression at some point in our lives. In some parts of the population that is more like one in four. What is more, when people have had three or more serious episodes of depression there is something like a 67 per cent chance that their depression will relapse.
Back in 1992, the two treatments that seemed to be most effective in treating people with relapsing depression were one-to-one cognitive behaviour therapy (CBT) or maintenance doses of antidepressants. Both of these are relatively expensive. Not everyone is comfortable taking the drugs and they can have unwanted side effects. And not everyone can have one-to-one CBT – there is a limit to the availability of trained therapists. Coming up with an economically viable and effective group-based intervention therefore seemed urgent.
To understand the approach Segal, Williams and Teasdale took, and why they took it, it will be helpful to consider a scenario they outline in the first of their books – Mindfulness-Based Cognitive Therapy for Depression.
Mary has just come from work. She’s tired and she looks forward to spending her evening relaxing in front of the television. However, there’s a message on her answerphone. Her partner is going to be late getting back from work. She gets angry and feels disappointed and upset. Then she starts to recall other occasions that month when the same thing happened. She begins to imagine that her partner may be being unfaithful to her. She pushes that thought to one side but it comes back with even greater force when she imagines that she has heard some laughter in the background of his voicemail. Nausea comes up – and it doesn’t end there. Her mind rapidly starts to conjure up images of an unwanted future – solicitors, divorce courts, having to buy another home, living in poverty. She feels herself getting more and more upset as her anger begins to turn into depression. Her mind throws up images from the past when she was rejected and lonely. She ‘knows’ that all their mutual friends would abandon her for him. Tears flow as she is left wondering what to do. Sitting in her kitchen she asks herself ‘Why does this always happen to me?’ and she tries to work out why she always reacts this way.
Mary experiences a whole avalanche of thoughts, feelings and sensations. It is not just the negative matter that caused her to be upset, however, nor is it just the way she found herself trying to deal with it. Instead, it’s as if a whole mode of mind – a complex configuration of moods, thoughts, images, impulses and body sensations – was very quickly wheeled into place in response to the situation. This mode of mind includes both the negative material and Mary’s tendency to deal with it by ruminating.
Like Mary, people who are vulnerable to depression can put much of their time and energy into ruminating about their experience – ‘Why do I feel the way I do?’ Thinking about their problems, their sense of personal inadequacy, they turn things over and over in their minds trying to think their way to solutions and to ways of reducing their distress. But, as Segal, Williams and Teasdale point out, the methods they use to achieve that aim are tragically counterproductive. In fact, when you’re low, repeatedly ruminating – thinking about apparently negative aspects of yourself or of problematic situations – actively perpetuates rather than resolves depression.
What seems to happen is that, at times of low mood, old habits of thinking switch in relatively automatically. That has two consequences: firstly, thinking now runs in well-worn grooves that don’t lead to a way out of depression; secondly, this way of thinking itself intensifies the depressed mood – and that leads to further rumination. In this way a series of self-perpetuating vicious cycles can cause mild and transient low mood to very quickly degenerate into severe, disabling depression.
As Segal, Williams and Teasdale saw it, the task of relapse prevention was therefore to find a way to help patients disengage from negative and self-perpetuating rumination when they felt sad or at other times of potential relapse.
While they were pursuing these questions, John Teasdale, who had long had a personal interest in meditation, was reminded of a Buddhist talk he had attended several years before where the speaker stressed that it is not your experience itself that makes you unhappy – it is your relationship to that experience. This is a central aspect of mindfulness meditation, in which you learn – among other things – to relate to your thoughts just as thoughts. In other words, you learn to see them just as mental events, rather than as ‘the truth’ or ‘me’.
John recognised that this way of ‘decentring’ from negative thoughts, of standing ever so slightly apart from them and witnessing them as an aspect of experience rather being completely immersed in them as the whole of experience, might be a key.
But how could you teach people to do that?
An American colleague, Marsha Linehan, who was visiting John Teasdale and Mark Williams at the Medical Research Council’s Applied Psychology Unit in Cambridge, provided a vital clue. Besides telling them of her own work in helping patients to decentre, she pointed them towards the work being undertaken at UMass by Jon Kabat-Zinn. Looking into his work, they came upon this piece from one of Jon’s books:
It is remarkable how liberating it feels to be able to see that your thoughts are just thoughts and that they are not ‘you’ or ‘reality’ . . . The simple act of recognising your thoughts as thoughts can free you from the distorted reality they often create and allow for more clearsightedness and a greater sense of manageability in your life.
Segal, Williams and Teasdale made contact with Kabat-Zinn and his Stress Reduction Clinic at the UMass Medical Center, began to engage in various ways with his programme and, based largely upon it, formulated their own eight-week Mindfulness-Based Cognitive Therapy (MBCT) programme. Although similar to Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) in many ways, MBCT contains elements of cognitive therapy and theory that address the specific vulnerabilities and exacerbating factors that make depression recurrent.
MBCT itself was originally specifically designed for those vulnerable to depression. Subsequently, variants of it have been developed to help with a wide range of issues: obsessive-compulsive disorder, disordered eating, addiction, traumatic brain injury, obesity and bipolar disorder among others.
When it comes to depression, the results of several large-scale randomised control trials suggest that, for people vulnerable to relapsing depression, a course of MBCT might more or less halve the rate of relapse and, if relapse does occur, those who have trained in MBCT appear to experience it less severely.
My Own History with Mindfulness
I come to this work from a Buddhist background. Born in South Africa and unable to reconcile myself to the apartheid regime, I left there at eighteen and settled in England. Driven to find a framework of values I could depend on and an understanding of how the world worked, I took up a degree in philosophy at the University of East Anglia in Norwich. But that didn’t really fulfil my need. In my final year, though, I had the good fortune to meet a committed practising Buddhist who had come to town to establish a Buddhist centre. He taught me to meditate and that changed everything. I committed to spending the rest of my life devoted to meditation, study, retreat and eventually to teaching others.
I lived sometimes in retreat centres, sometimes in city-based residential Buddhist communities, and gradually came to teach and to publish books on Buddhism (using my Buddhist name – Kulananda), and I thought that was how my life was going to go. For several years I took a kind of digression into the world of business. With a number of Buddhist friends I came to establish a ‘right livelihood’ fair-trade company that dealt in handicrafts from developing countries. The company came to be quite successful in time. At the peak of its success it employed around 200 people, had sales of around £10 million a year and gave its profits – often substantial sums – to various Buddhist charities each year. But running a business turned out not to be what I really wanted to do with myself and in 1988 I returned to a life based more in teaching, studying and meditating.
By 2002, however, more than 25 years after my first introduction to meditation, I began to feel the need to make another change and I looked about for a form of training that would build on my existing skills but which would allow me to earn a living in the world. I thought about training in psychotherapy. After all, I’d had many years doing informal pastoral counselling. Searching one day on the Internet, I came upon a master’s degree programme that was being run at Bangor University in Wales. The programme had originally been founded by Professor Mark Williams, one of the founders of MBCT, with the intention of training up a number of people who could begin to bring mindfulness into various clinical settings. That seemed like a marriage made in heaven to me. I joined the programme and graduated from it in 2006.
Reading Mindfulness-Based Cognitive Therapy for Depression – one of the set texts at Bangor – was a profound revelation for me. Here, for the first time, I saw the coming together of two great streams of tradition: Buddhist psychology, which implicitly informs much of what is found in that book, and Western psychology, founded in the tradition of scientific method, which explicitly informs it. Traditional Buddhist psychology, at its best, is founded on a detailed and scholarly investigation of the elements of experience revealed by a collective endeavour of deep introspection over more than 1,000 years. Plunging in meditation into the depths of their own minds, the founding scholars of Buddhist psychology provide us with profoundly valuable insights into the mechanisms of consciousness and the functioning of perception and experience. Western psychology at its best, on the other hand, brings a highly sophisticated scientific method and a well-developed scientific community to its investigations.
In Mindfulness-Based Cognitive Therapy for Depression I saw the first beginnings of what might be achieved as these two streams began to inform one another. I was deeply inspired by the way the authors illuminated some of the inner psychological processes at work in the client group they were concerned with. When we understand the processes that drive us and that make up our experience, we have a much greater chance of freeing ourselves from their unconscious grip. The intersection of mindfulness and Western science, I saw, opened up huge possibilities for human development and human freedom.
Besides relishing the psychological acuity I was discovering, I was also deeply inspired by the explicitly secular nature of the trainings offered by MBSR and MBCT. Ever since discovering mindfulness and related practices for myself I have held a passionate conviction that they offer something deeply lacking in contemporary society. Here, at last, was a vehicle for getting some of these practices and their benefits out into the wider world without any strings attached. I love the freedom and openness of that offering. You don’t need to be a Buddhist or subscribe to any religious framework to get these benefits now. What previously had been taught mainly in Buddhist centres and similar locales could now be made widely available for anyone to try.
While finishing my training in Bangor I had the great fortune to be introduced to John Teasdale, one of the founders of MBCT, who lives – as my wife and I do – in Cambridge. John and I took the mindfulness programme I’d been working with in Bangor, a hybrid of MBSR and MBCT, and tweaked it more particularly towards stress. We then spent some time teaching that programme, along with our colleague Ciaran Saunders, in public courses held in Cambridge. We made video recordings of each taught session and in between sessions the three of us would meet up, replay the recording of ourselves teaching, and comment on what we saw one another doing: what worked and what didn’t work so well. That was one of the richest learning experiences of my whole engagement in the process of mindfulness teaching.
Soon after graduating I was invited to join the team of mindfulness teachers at the Centre for Mindfulness Research and Practice that is located in the School of Psychology at Bangor. I’m now an honorary lecturer there and for many years taught a module on the master’s programme as well as co-leading mindfulness teacher-training retreats.
In 2006 I founded a mindfulness training company, Mindfulness Works Ltd, and with my associates I have since led many public courses in London and elsewhere based on what I learned at Bangor and developed with John.
But my interest in the world of work and business never went away and I’ve found myself increasingly drawn into that field. Part of this is because of what I keep finding on my public courses.
The sense I get from the public MBSR courses I lead is that, for a very large proportion of participants, the greatest source of stress and distress in their lives comes from what they encounter each day at work. I am convinced that, if we can train more mindful leaders, if we can help to create more mindful workplaces, we can have a huge impact on the overall levels of well-being in our society.
I wrote a book on this theme – The Mindful Workplace – and have come increasingly to teach in workplace and leadership contexts, as well as continuing with the public courses. More recently I have become an adjunct professor at IE Business School in Madrid, where I am honoured to be part of an extraordinary faculty teaching an executive master’s in positive leadership and strategy (EXMPLS), which has mindfulness training at its heart. We draw in a high-powered student body from around the world and I’m deeply moved each time I meet the students to see the changes that their deepening engagement with mindfulness practice brings about.
