Evolving Conceptions of Mindfulness in Clinical Settings

A number of issues important to the clinical utility of mindfulness require systematic study. These include the most parsimonious definition of mindfulness for clinical purposes, how mindfulness is best described to be most approachable to patients, and the extent to which mindfulness shares common mechanisms with other mind-body programs. The discussion includes a brief review of the transition of mindfulness from traditional into clinical settings as well as the components commonly contained within clinical descriptions of mindfulness. A model based on facility in the use of attention is proposed, and a description of mechanisms by which attentional skill may lead to the recognition of internal associational processes and account for psychological outcomes is given. Using constructs already familiar to patients, an attention-based conception may also be more accessible to patients than more elaborate descriptions and have greater utility in identifying commonalities that mindfulness training may have with other mind-body programs. Keywords: mindfulness; mindfulness-based stress reduction; attention; meditation; mechanisms Since the introduction of mindfulness into clinical settings, a large number of studies have documented its beneficial effect on psychological distress and well-being (Grossman, Niemann, Schmidt, & Walach, 2004; Shigaki, Glass, & Schopp, 2006). As exemplified by the articles in this issue, studies are now exploring psychological constructs as mechanisms to account for these benefits (including scales to evaluate the mediating effect of mindfulness) as well as the characteristics of patients most likely to benefit from the practice. A number of issues important to the clinical utility of mindfulness still require systematic study however. Important among these are the following: What amount of practice and instruction is required for clinical self-efficacy in mindfulness for patients and also for therapists who teach mindfulness? What might be the simplest and most parsimonious definition of mindfulness for clinical purposes? How might mindfulness best be described and presented to patients so as to make it maximally approachable for the widest range of people (Carmody & Baer, 2009)? To what extent does mindfulness training share common mechanisms with other mind-body programs? 1 In order to provide some context to the discussion of these issues, I begin by briefly reviewing the origins of the term mindfulness and its transition into clinical settings. Next, in order to approach the question of simplifying the clinical definition of mindfulness, I summarize the components commonly contained within the published definitions. Finally, I propose an attention-based model of mindfulness and describe how it may account for observed psychological outcomes. Such a model may result in explanations more immediately comprehensible to patients than the more elaborate descriptions typically used. It may also be more parsimonious and have greater research utility in identifying commonalities that mindfulness training may have with other mind-body programs. THE ROOTS OF MINDFULNESS IN CLINICAL SETTINGS Mindfulness in clinical settings has its roots in Buddhist contemplative/monastic practices. In the Buddhist analysis, suffering originates in ignorance or delusion, and its cessation is cultivated through the wisdom that comes from clear seeing (Thera, 1992). In this understanding, ignorance/ delusion derives not from a lack of scholarship. Rather, it comes from not clearly perceiving the mental components and associations making up everyday perception and experience, resulting in the world not being seen as it truly (objectively) is. Wisdom in this sense derives from direct experience of this process (the insight into the moment-to-moment construction of the sense of personal self or ownership that emerges over the course of the training) and the aim of monastic practice is the realization of this process. …