# Mindfulness-based stress reduction

Mindfulness-based stress reduction (MBSR) therapy is a mindfulness-based program designed for stress management and used to treat other conditions. It is structured as an eight to ten week group program.
MBSR was developed in the late 1970s by Jon Kabat-Zinn at the University of Massachusetts Medical Center. It incorporates a blend of mindfulness meditation, body awareness, yoga, and the exploration of patterns of behavior, thinking, feeling, and action. Mindfulness can be understood as the non-judgmental acceptance and investigation of present experience, including body sensations, internal mental states, thoughts, emotions, impulses and memories, in order to reduce suffering or distress and to increase well-being.
Mindfulness meditation is a method by which attention skills are cultivated, emotional regulation is developed, and rumination and worry are significantly reduced. During the past decades, mindfulness meditation has been the subject of more controlled clinical research, which suggests its potential beneficial effects for mental health, athletic performance, as well as physical health. While MBSR has its roots in wisdom teachings of Zen Buddhism, Hatha Yoga, Vipassana and Advaita Vedanta, the program itself is secular. The MBSR program is described in detail in Kabat-Zinn's 1990 book Full Catastrophe Living.

## History

In 1979, Jon Kabat-Zinn founded the Stress Reduction Clinic at the University of Massachusetts Medical Center. Nearly two decades later, he founded the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. These institutions have been instrumental in supporting the growth and implementation of MBSR in hospitals worldwide. Kabat-Zinn's book, Full Catastrophe Living, which details the MBSR program, became a bestseller and was reissued in a revised edition in 2013. In 1993, Jon Kabat-Zinn's MBSR course was featured in Bill Moyers' documentary, Healing from Within. By 2015, nearly 80% of medical schools offered some element of mindfulness training, and research and education centers dedicated to mindfulness had proliferated.

## Program

A meta-analysis described MBSR as "a group program that focuses upon the progressive acquisition of mindful awareness, of mindfulness". The MBSR program is an eight-week workshop conducted by certified trainers, consisting of weekly group meetings (2.5 hours each) and a one-day retreat (seven-hour mindfulness practice) between sessions six and seven. Participants are also assigned daily homework (45 minutes) and instructed in three primary techniques: mindfulness meditation, body scanning, and simple yoga postures. Group discussions and exploration—of the meditation practice and its application to everyday life—are integral to the program. This component is crucial for understanding how mindfulness can be incorporated into daily living. Body scanning, introduced during the first four weeks, involves quietly sitting or lying while systematically focusing attention on different body regions, starting from the toes and moving up to the top of the head. MBSR is founded on principles such as non-judging, non-striving, acceptance, letting go, beginner’s mind, patience, trust, and de-centering.
According to Kabat-Zinn, the core of MBSR is mindfulness, which he defines as "moment-to-moment, non-judgmental awareness." Throughout the program, participants are encouraged to engage in informal practices by incorporating mindfulness into their daily routines. This focus on the present is believed to enhance sensitivity to both the environment and one's reactions to it, thereby improving self-management and coping skills. It also provides a means to escape from dwelling on the past or worrying about the future, breaking the cycle of maladaptive cognitive patterns. Research has confirmed the validity and reliability of a weekly single-item practice quality assessment. Improvements in self-reported mindfulness and psychological symptoms were predicted by increases in practice quality, although no similar effects were observed for behavioral mindfulness. Additionally, longer practice sessions were associated with better practice quality.
Scientific evidence of the debilitating effects of stress on the human body and its evolutionary origins was highlighted by the work of Robert Sapolsky, particularly in the book Why Zebras Don’t Get Ulcers. Mindfulness meditation has been shown to bring about significant reductions in psychological stress, and appears to prevent the physiological changes and biological manifestations that typically result from psychological stress. Early neuroimaging studies suggest that MBSR training impacts the brain areas responsible for attention, introspection, and emotional processing.

## Extent of practice

According to a 2014 article in Time magazine, mindfulness meditation is becoming popular among people who would not normally consider meditation. The curriculum started by Kabat-Zinn at University of Massachusetts Medical Center has produced nearly 1,000 certified MBSR instructors who are in nearly every state in the US and more than 30 countries. Corporations such as General Mills have made MBSR instruction available to their employees or set aside rooms for meditation. Democratic Congressman Tim Ryan published a book in 2012 titled A Mindful Nation and he has helped organize regular group meditation periods on Capitol Hill.

## Methods of practice

Mindfulness-based stress reduction (MBSR) classes and programs are offered at various facilities, including hospitals, retreat centers, and yoga studios. These programs typically focus on teaching:
* Mind and body awareness to reduce the physiological effects of stress, pain, or illness
* Experiential exploration of stress and distress to cultivate less emotional reactivity
* Equanimity in the face of change and loss, which is a natural part of human life
* Non-judgmental awareness in daily life
* Promotion of serenity and clarity in each moment
* Experiencing a more joyful life and accessing inner resources for healing and stress management
* Mindfulness meditation

## Evaluation of effectiveness

Mindfulness-based approaches have been found to be beneficial for healthy adults, for adolescents and children, healthcare professionals, as well as for different health-related outcomes including eating disorders, psychiatric conditions, pain management sleep disorders, cancer care, psychological distress, and for coping with health-related conditions. Research suggests that mindfulness-based stress reduction (MBSR) is especially effective in managing stress and improving quality of life in the context of health by offering a non-pharmacological approach that enhances functional status and well-being across a diverse range of health related conditions. As a major subject of increasing research interest, 52 papers were published in 2003, rising to 477 by 2012. Nearly 100 randomized controlled trials had been published by early 2014.
According to a systematic review and meta-analysis, mindfulness meditation programs demonstrated moderate evidence of reducing anxiety, depression, and pain, but showed low evidence for improving stress/distress, mental health-related quality of life, positive mood, attention, substance use, eating habits, sleep, and weight. The study highlighted the need for stronger research designs to better understand the effects of meditation programs on various dimensions of mental health.
The development of therapies to improve individuals' flexibility in switching between using and not using emotion regulation (ER) methods is necessary because it is linked to better mental health, wellbeing, and resilience. According to research, those who attended MBSR training exhibited greater regulatory decision flexibility. In post-secondary students, research on mindfulness-based stress reduction has demonstrated that it can reduce psychological distress, which is common in this age range. In one study, the long-term impact of an 8-week mindfulness-based stress reduction (MBSR) treatment extended to two months after the intervention was completed.
Research suggests mindfulness training improves focus, attention, and ability to work under stress. Mindfulness may also have potential benefits for cardiovascular health. The effectiveness of MBSR in treating psychological disorders, particularly anxiety and depression, has been supported by recent meta-analytic evidence. However, MBSR was found to be not more effective than traditional cognitive behavioral therapy and showed only moderate efficacy compared to other active treatments. In cancer patients, MBSR was found effective in reducing cortisol levels leading to stress, and in some cancer types immune function improved. Evidence suggests efficacy of mindfulness meditation in the treatment of substance use disorders. Mindfulness training may also be beneficial for people with fibromyalgia.
In addition, recent research has explored the ability of mindfulness-based stress reduction to increase self-compassion and enhance the well-being of those who are caregivers, specifically mothers, for youth struggling with substance use disorders. Mindfulness-based interventions allowed for the mothers to experience a decrease in stress as well as a better relationship with themselves which resulted in improved interpersonal relationships.
It has been demonstrated that mindfulness-based stress reduction has beneficial impacts on healthy individuals as well as suffering individuals and those close to suffering individuals. Roca et al. (2019) conducted an 8-week mindfulness-based stress reduction program for healthy participants. Five pillars of MBSR, including mindfulness, compassion, psychological well-being, psychological distress, and emotional-cognitive control were identified. Participants psychological functioning were examined and assessed using questionnaires. Mindfulness and overall well-being was significant between the five pillars observed.
Mindfulness-based interventions and their impact have become prevalent in every-day life, especially when rooted in an academic setting. After interviewing children, of the average age of 11, it was apparent that mindfulness had contributed to their ability to regulate their emotions. In addition to these findings, these children expressed that the more mindfulness was incorporated by their school and teachers, the easier it was to apply its principles. In a 2021 Cochrane review for mindfulness-based psychological interventions for medical students and junior doctors its utility remained unconfirmed due to few studies and risk of bias.
MBIs (mindfulness-based interventions) showed a positive effect on mental and somatic health in social interactions when compared to other active treatments in adults. However, these effects were largely independent of gender, study sample, duration, and compliance with the MBSR intervention. The research also highlighted that while MBIs were effective, their benefits were generally modest compared to other therapeutic interventions.