覺察減壓

覺察減壓（Mindfulness-Based Stress Reduction, 簡稱 MBSR) 、以Mindfulness為基礎之壓力減低，是一個為期八週、有實證基礎的課程計畫，可提供非宗教性、密集的覺察訓練，以幫助有壓力者、焦慮者、憂鬱者和疼痛者。覺察減壓由喬·卡巴金（Jon Kabat-Zinn）教授於1970年代在麻塞諸塞州大學的醫學中心開發此課程，它結合了覺察冥想、身體意識、瑜伽來對行為、思維、感覺和行動方式進行探索。覺察可以理解為對當前經驗的非判斷性接受和當下經驗，包括身體覺知、內在心智狀態、思想、情緒、衝動和記憶，目的是減少壓抑或苦惱，並增加幸福感。覺察冥想是一種培養注意力、發展情緒調控、和減少沉思和憂慮的方法。過去的幾十年中，覺察冥想一直是可控的臨床研究主題，有增進心智健康 、和促進身體健康的潛在效果。雖然覺察減壓源自於精神式的引導，但該課程與宗教是無關的 。覺察減壓課程在覺察減壓在1990年發表的著作 Full Catastrophe Living (譯：災難生存法則) 中有詳細描述。
缩略图| 以覺察為基礎的減壓診所的創始人Jon Kabat-Zinn

 歷史 
1979年，喬‧卡巴金在成立了覺察減壓診所，二十年後他在麻州大學醫學院成立醫學、健康照護、和社會覺察中心。這兩個機構使覺察減壓在全球的醫院得到長遠的發展和實際運用。卡巴金在他1990年最暢銷的著作(譯：災難生存法則；臺灣目前翻譯此書名為正念療癒力胡君梅、黃小萍（譯）。正念療癒力：八週找回平靜、自信與智慧的自己（卡巴金博士二十年經典增訂版）。新北市：野人，2013年。（原著Kabat-Zinn J，2013年）。) 中詳細描述了MBSR計劃課程，該書於2013年以修訂版重新發行。1993年，Bill Moyer 在其 Healing from Within  (譯：從內在開始治療) 一書中推廣卡巴金的MBSR課程。到了2015年時，全美有將近80%的醫學院都提供了覺察訓練的元素Buchholz, Laura (Oct 2015). "Exploring the Promise of Mindfulness as Medicine". JAMA. 314 (13): 1327–1329. doi:10.1001/jama.2015.7023. PMID 26441167，使得以覺察為主的研究和教育中心的數量越來越多。

 課程 
覺察減壓是一種團體課程，著重於以漸進方式獲得有關覺察的注意覺知。覺察減壓是一個為期八週的工作坊課程，由經認證的培訓師講授，內容包括每週2.5小時的團體會議、在第六週和第七週中的一日靜修(含7小時的覺察訓練)、每天45分鐘的在家練習作業、和三種正式技術的指導：覺察冥想、身體掃描及簡單的瑜伽姿勢。課程的重點透過團體討論和探索而獲得覺察的練習經驗和生活應用。前四週的課程重點在於身體掃描，此為正式的覺察技術，它需要安靜地坐著或躺著，並有系統地將注意力集中在身體的各個部位，即注意力從腳趾頭開始，然後慢慢向上移動到頭頂。覺察減壓基本上是無評斷、不費力、接受、放下、初學者心態、耐心、信任、和非自我中心Frewen, P. A.; Evans, E.M.; Maraj, N.; Dozois, D. J.; Partridge, K. (2008). "Letting go: Mindfulness and negative automatic thinking". Cognitive Therapy and Research. 32 (6): 758–774. doi:10.1007/s10608-007-9142-1。

喬·卡巴金認為覺察減壓的基礎是覺察，他對「覺察」的定義是「當下、無評斷的覺知 (moment-to-moment, non-judgmental awareness)」。課程中，參加者需在日常生活中練習覺察、併入覺察。專注於當下，可以增加對環境的敏感度和反應能力，進而強化自我管理和因應能力。覺察亦提供沉思過去和擔心未來的出口，並打破適應不量的認知過程Hayes, Steven C.; Villatte, Matthieu; Levin, Michael; Hildebrandt, Mikaela (2011-01-01). "Open, Aware, and Active: Contextual Approaches as an Emerging Trend in the Behavioral and Cognitive Therapies". Annual Review of Clinical Psychology. 7 (1): 141–168. doi:10.1146/annurev-clinpsy-032210-104449. PMID 21219193。

羅伯特·薩波斯基在其專書「為什麼斑馬不會得到潰瘍？」(Why Zebras Don't Get UlcersSapolsky, Robert (2004). Why Zebras Don't Get Ulcers. USA: Holt paperbacks. p. 560. ISBN 978-0805073690) 中為非專業的讀者進行探究，可提供減壓效果和壓力起源的科學實證Sapolsky, Robert (1982). "The endocrine stress-response and social status in the wild baboon". Hormones and Behavior. 16 (3): 279–292. doi:10.1016/0018-506X(82)90027-7. PMID 6890939。覺察冥想可顯著地降低心理壓力Sharma M, Rush SE (October 2014). "Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review". Journal of Evidence-Based Complementary & Alternative Medicine. 19 (4): 271–86. doi:10.1177/2156587214543143. PMID 25053754Hofmann SG, Sawyer AT, Witt AA, Oh D (April 2010). "The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review". Journal of Consulting and Clinical Psychology. 78 (2): 169–83. doi:10.1037/a0018555. PMC 2848393. PMID 20350028，亦可防止因心理壓力而導致的相關生理變化和生物學臨床表現。

 覺察練習之推廣 
根據《時代》雜誌2014年的一篇文章，覺察冥想在平常不會冥想的人們中越來越流行Pickert, K. (February 2014). "The art of being mindful. Finding peace in a stressed-out, digitally dependent culture may just be a matter of thinking differently". Time. 183 (4): 40–6. PMID 24640415。喬·卡巴金在麻州大學醫學中心開設的課程已經培養了將近1,000名獲得覺察減壓認證的講師，這些講師遍布美國每個州和30多個國家。例如 General Mills 公司已為其員工提供冥想的空間；民主黨國會議員提姆·瑞安則在2012年出版了一本名為「覺察國家 (A Mindful Nation)」之專書，他在國會山莊協助並組織了定期的團體冥想活動Rojas, Warren (January 8, 2014). "A Meditation on the Quiet Time Caucus". Roll Call. Archived from the original on January 9, 2014. Retrieved April 4, 2014.。

覺察練習之方法
醫院、靜修中心和各種瑜伽場館都已提供覺察減壓的課程。這些課程都很注重以下的教學內容：
以身心覺知來減輕生理壓力、疼痛或疾病。
實際體驗壓力和苦惱以減少情緒反應。
以鎮定來面對人類生活中自然發生的變化和損失。
日常生活中的無評斷覺知。
隨時保持寧靜和清明。
體驗更快樂的生活並獲得內在療癒能量。
覺察冥想。

 效果評估(相關研究成果) 
覺察方法有益於健康的成年人Vonderlin, Ruben; Biermann, Miriam; Bohus, Martin; Lyssenko, Lisa (2 March 2020). "Mindfulness-Based Programs in the Workplace: a Meta-Analysis of Randomized Controlled Trials". Mindfulness. doi:10.1007/s12671-020-01328-3Dawson AF, Brown WW, Anderson J, Datta B, Donald JN, Hong K, et al. (November 2019). "Mindfulness-Based Interventions for University Students: A Systematic Review and Meta-Analysis of Randomised Controlled Trials". Applied Psychology. Health and Well-Being: aphw.12188. doi:10.1111/aphw.12188. PMID 31743957、青少年和兒童Zenner C, Herrnleben-Kurz S, Walach H (2014). "Mindfulness-based interventions in schools-a systematic review and meta-analysis". Frontiers in Psychology. 5: 603. doi:10.3389/fpsyg.2014.00603. PMC 4075476. PMID 25071620Dunning DL, Griffiths K, Kuyken W, Crane C, Foulkes L, Parker J, Dalgleish T (March 2019). "Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents - a meta-analysis of randomized controlled trials". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 60 (3): 244–258. doi:10.1111/jcpp.12980. PMC 6546608. PMID 30345511，並可改善如飲食失調Sala, Margarita; Shankar Ram, Shruti; Vanzhula, Irina A.; Levinson, Cheri A. (25 February 2020). "Mindfulness and eating disorder psychopathology: A meta‐analysis". International Journal of Eating Disorders. doi:10.1002/eat.23247. PMID 32100320Carrière, K.; Khoury, B.; Günak, M. M.; Knäuper, B. (February 2018). "Mindfulness-based interventions for weight loss: a systematic review and meta-analysis". Obesity Reviews. 19 (2): 164–177. doi:10.1111/obr.12623. PMID 29076610Rogers JM, Ferrari M, Mosely K, Lang CP, Brennan L (January 2017). "Mindfulness-based interventions for adults who are overweight or obese: a meta-analysis of physical and psychological health outcomes". Obesity Reviews. 18 (1): 51–67. doi:10.1111/obr.12461. hdl:10072/393029. PMID 27862826、精神疾病Xue, Jiaming; Zhang, Yun; Huang, Ying (June 2019). "A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms". Medicine. 98 (23): e15957. doi:10.1097/MD.0000000000015957. PMC 6571280. PMID 31169722Cavicchioli, Marco; Movalli, Mariagrazia; Maffei, Cesare (2018). "The Clinical Efficacy of Mindfulness-Based Treatments for Alcohol and Drugs Use Disorders: A Meta-Analytic Review of Randomized and Nonrandomized Controlled Trials". European Addiction Research. 24 (3): 137–162. doi:10.1159/000490762. PMID 30016796Spijkerman, M.P.J.; Pots, W.T.M.; Bohlmeijer, E.T. (April 2016). "Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials". Clinical Psychology Review. 45: 102–114. doi:10.1016/j.cpr.2016.03.009. PMID 27111302Hofmann, Stefan G.; Sawyer, Alice T.; Witt, Ashley A.; Oh, Diana (2010). "The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review". Journal of Consulting and Clinical Psychology. 78 (2): 169–183. doi:10.1037/a0018555. ISSN 1939-2117. PMC 2848393. PMID 20350028、疼痛管理Hilton, Lara; Hempel, Susanne; Ewing, Brett A.; Apaydin, Eric; Xenakis, Lea; Newberry, Sydne; Colaiaco, Ben; Maher, Alicia Ruelaz; Shanman, Roberta M.; Sorbero, Melony E.; Maglione, Margaret A. (22 September 2016). "Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis". Annals of Behavioral Medicine. 51 (2): 199–213. doi:10.1007/s12160-016-9844-2. PMC 5368208. PMID 27658913Zeidan F, Martucci KT, Kraft RA, Gordon NS, McHaffie JG, Coghill RC (April 2011). "Brain mechanisms supporting the modulation of pain by mindfulness meditation". The Journal of Neuroscience. 31 (14): 5540–8. doi:10.1523/JNEUROSCI.5791-10.2011. PMC 3090218. PMID 21471390、睡眠障礙Wang, Yuan-Yuan; Wang, Fei; Zheng, Wei; Zhang, Ling; Ng, Chee H.; Ungvari, Gabor S.; Xiang, Yu-Tao (2020). "Mindfulness-Based Interventions for Insomnia: A Meta-Analysis of Randomized Controlled Trials". Behavioral Sleep Medicine. 18 (1): 1–9. doi:10.1080/15402002.2018.1518228. PMID 30380915Kanen, Jonathan; Nazir, Racha; Sedky, Karim; Pradhan, Basant (30 April 2015). "The Effects of Mindfulness-Based Interventions on Sleep Disturbance: A Meta-Analysis". Adolescent Psychiatry. 5 (2): 105–115. doi:10.2174/2210676605666150311222928、癌症照護Xunlin, NG; Lau, Ying; Klainin-Yobas, Piyanee (2020). "The effectiveness of mindfulness-based interventions among cancer patients and survivors: a systematic review and meta-analysis". Supportive Care in Cancer. 28 (4): 1563–1578. doi:10.1007/s00520-019-05219-9. PMID 31834518Xie, Congyan; Dong, Bei; Wang, Lihong; Jing, Xiuchen; Wu, Yin; Lin, Lu; Tian, Li (March 2020). "Mindfulness-based stress reduction can alleviate cancer- related fatigue: A meta-analysis". Journal of Psychosomatic Research. 130: 109916. doi:10.1016/j.jpsychores.2019.109916. PMID 31927347、心理壓力等的各種健康問題DiRenzo, Dana; Crespo-Bosque, Monica; Gould, Neda; Finan, Patrick; Nanavati, Julie; Bingham, Clifton O. (18 October 2018). "Systematic Review and Meta-analysis: Mindfulness-Based Interventions for Rheumatoid Arthritis". Current Rheumatology Reports. 20 (12). doi:10.1007/s11926-018-0787-4. PMC 6233984. PMID 30338418Simpson, Robert; Simpson, Sharon; Ramparsad, Nitish; Lawrence, Maggie; Booth, Jo; Mercer, Stewart W. (February 2020). "Effects of Mindfulness-based interventions on physical symptoms in people with multiple sclerosis – a systematic review and meta-analysis". Multiple Sclerosis and Related Disorders. 38: 101493. doi:10.1016/j.msard.2019.101493. PMID 31835209Guo, Jia; Wang, Hongjuan; Luo, Jiaxin; Guo, Yi; Xie, Yun; Lei, Beimei; Wiley, James; Whittemore, Robin (11 December 2019). "Factors influencing the effect of mindfulness-based interventions on diabetes distress: a meta-analysis". BMJ Open Diabetes Research & Care. 7 (1): e000757. doi:10.1136/bmjdrc-2019-000757. PMID 31908794Demarzo, M. M. P.; Montero-Marin, J.; Cuijpers, P.; Zabaleta-del-Olmo, E.; Mahtani, K. R.; Vellinga, A.; Vicens, C.; Lopez-del-Hoyo, Y.; Garcia-Campayo, J. (9 November 2015). "The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review". The Annals of Family Medicine. 13 (6): 573–582. doi:10.1370/afm.1863. PMID 26553897。覺察議題已經逐漸成為研究顯學，學術機構在2003年發表了52篇論文，到了2012年已增加到477篇論文。2014年初則已經發表了近100篇隨機對照實驗的實證研究論文Hurley, Dan (January 14, 2014). "Breathing In vs. Spacing Out". New York Times Magazine. Retrieved April 9, 2014.。

研究證實，覺察減壓方法可使大專學生減輕心理壓力(此年齡常見心理壓力)。有研究指出8週覺察減壓 (MBSR) 的效果可多延長兩個月Felver, Joshua C.; Morton, Melissa L.; Clawson, Adam J. (2018). "Mindfulness-Based Stress Reduction Reduces Psychological Distress in College Students". College Student Journal. 52 (3): 291–298. ISSN 0146-3934。

覺察減壓技術可對飲食失調者有幫助，亦會改善人們對自己身體的看法Khoshkerdar, Parya; Raeisi, Zohreh (March 2020). "The effect of mindfulness‐based stress reduction on body image concerns of adolescent girls with dysfunctional eating attitudes". Australian Journal of Psychology. 72 (1): 11–19. doi:10.1111/ajpy.12265. ISSN 0004-9530。MBSR 注重有效的因應技巧，可透過自我同情來改善人際關係、正向影響一個人的身體形象、和增進幸福感。

研究證實，覺察訓練可增進壓力下的聚焦能力、注意力和工作能力Lazar SW, Kerr CE, Wasserman RH, et al. (November 2005). "Meditation experience is associated with increased cortical thickness". NeuroReport. 16 (17): 1893–7. doi:10.1097/01.wnr.0000186598.66243.19. PMC 1361002. PMID 16272874Cloud, John (2010-08-06). "Losing Focus? Studies Say Meditation May Help". Time.Krompinger J., Baime M. J. (2007). "Mindfulness training modifies subsystems of attention". Cognitive, Affective, & Behavioral Neuroscience. 7 (2): 109–119. doi:10.3758/CABN.7.2.109. PMID 17672382，覺察也對心血管健康有潛在益處Levine, Glenn N.; Lange, Richard A.; Bairey‐Merz, C. Noel; Davidson, Richard J.; Jamerson, Kenneth; Mehta, Puja K.; Michos, Erin D.; Norris, Keith; Ray, Indranill Basu; Saban, Karen L.; Shah, Tina; Stein, Richard; Smith, Sidney C. (11 October 2017). "Meditation and Cardiovascular Risk Reduction". Journal of the American Heart Association. 6 (10). doi:10.1161/JAHA.117.002218. PMC 5721815. PMID 28963100.Grierson AB, Hickie IB, Naismith SL, Scott J. (2016). "The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models". Psychol. Med. 46 (12): 2467–2484. doi:10.1017/S0033291716001392. PMID 27352637Pascoe, Michaela C.; Thompson, David R.; Jenkins, Zoe M.; Ski, Chantal F. (December 2017). "Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis". Journal of Psychiatric Research. 95: 156–178. doi:10.1016/j.jpsychires.2017.08.004. PMID 28863392。有證據顯示，覺察冥想有益於抑制藥物濫用Sancho M, De Gracia M, Rodríguez RC, Mallorquí-Bagué N, Sánchez-González J, Trujols J, Sánchez I, Jiménez-Murcia S and Menchón JM. (2018). "Mindfulness-Based Interventions for the Treatment of Substance and Behavioral Addictions: A Systematic Review". Front. Psychiatry. 9 (95). doi:10.3389/fpsyt.2018.00095. PMID 29651257Chiesa A, Serretti A (April 2014). "Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence". Substance Use & Misuse. 49 (5): 492–512. doi:10.3109/10826084.2013.770027. PMID 23461667Garland EL, Froeliger B, Howard MO (January 2014). "Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface". Frontiers in Psychiatry. 4: 173. doi:10.3389/fpsyt.2013.00173. PMC 3887509. PMID 24454293和改善全身肌肉無力Adler-Neal, Adrienne L.; Zeidan, Fadel (27 July 2017). "Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations". Current Rheumatology Reports. 19 (9): 59. doi:10.1007/s11926-017-0686-0. PMC 5693231. PMID 28752493Henke, Miriam; Chur-Hansen, Anna (5 June 2014). "The effectiveness of mindfulness-based programs on physical symptoms and psychological distress in patients with fibromyalgia: A systematic review". International Journal of Wellbeing. 4 (1): 28–45. doi:10.5502/ijw.v4i1.2.Lauche, Romy; Cramer, Holger; Dobos, Gustav; Langhorst, Jost; Schmidt, Stefan (December 2013). "A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome". Journal of Psychosomatic Research. 75 (6): 500–510. doi:10.1016/j.jpsychores.2013.10.010. PMID 24290038.。

此外，最近的研究顯示，覺察減壓會增進照護者(尤其是母親)、抵抗藥物濫用的年輕人之自我同情心和幸福感Smith, Jacqueline M.; Bright, Katherine S.; Mader, Joel; Smith, Jennifer; Afzal, Arfan Raheen; Patterson, Charmaine; Dimitropolous, Gina; Crowder, Rachael (April 2020). "A pilot of a mindfulness based stress reduction intervention for female caregivers of youth who are experiencing substance use disorders". Addictive Behaviors. 103: 106223. doi:10.1016/j.addbeh.2019.106223. PMID 31838440.。覺察介入會使母親的壓力有所減輕，學會與自己相處，進而改善人際關係。

覺察減壓不只影響獨自奮鬥者和其相關的人，也會正面影響健康的族群。2019年，Roca 等人Roca, Pablo; Diez, Gustavo G.; Castellanos, Nazareth; Vazquez, Carmelo (2019-07-18). Sendiña-Nadal, Irene (ed.). "Does mindfulness change the mind? A novel psychonectome perspective based on Network Analysis". PLOS One. 14 (7): e0219793. Bibcode:2019PLoSO..1419793R. doi:10.1371/journal.pone.0219793. ISSN 1932-6203. PMC 6638953. PMID 31318929.研究參與8週覺察減壓課程的健康族群，結果將 MBSR 分成五個面向：覺察、同情、心理幸福感、心理苦惱、和情緒認知控制，並以問卷方式觀察包含這五個面向的心理功能。整體來說，覺察和幸福感是最重要的測量變項。

覺察介入及其影響是非常流行的，尤其覺察已是學術上的顯學。在訪談平均年齡為11歲的兒童之後，可發現覺察有助於他們調節情緒，且兒童們認為，如果學校和老師可介紹和融入越多的覺察，他們便能購更容易地應用覺察的原理原則Hutchinson, Julia K.; Huws, Jaci C.; Dorjee, Dusana (December 2018). "Exploring experiences of children in applying a school-based mindfulness programme to their lives". Journal of Child and Family Studies. 27 (12): 3935–3951. doi:10.1007/s10826-018-1221-2. ISSN 1062-1024.。

如前所述，覺察可增加同情心，而高度的自我同情心則會大幅度地減低壓力Sevel, Landrew S.; Finn, Micheal T.M.; Smith, Rachel M.; Ryden, Anna M.; McKernan, Lindsey C. (February 2020). "Self‐compassion in mindfulness‐based stress reduction: An examination of prediction and mediation of intervention effects". Stress and Health. 36 (1): 88–96. doi:10.1002/smi.2917. ISSN 1532-3005. PMID 31874122.和增進自我覺知能力，這些狀況會發生在課程當中或課程之後。由此可知，覺察減壓可以直接地或間接地提高自我同情心。

在華人相關學術領域中，2020年出版學術性的文獻探討及探索性因素分析之實證研究，Mindfulness中譯釐正為覺察之佛學與科學實證檢驗：覺察與正念判準量表之研發  汪珮渲與賴世烱 (2020)。Mindfulness中譯釐正為覺察之佛學與科學實證檢驗：覺察與正念判準量表之研發。佛學與科學，第21卷，第1期，10-29。]，探討覺察與正念的關係，研究者指出：Mindfulness 之中文翻譯為覺察，佛學專有用語之「正念」確實有評斷正確、正當的正向積極之意，覺察與正念有關，正念可包含覺察，但覺察卻無法包含並代表正念，兩者不能混為一談。該研究中並發展覺察與正念判準量表，用以明確區分覺察與正念為兩個不同面向。

参考文献

Category:心理學
Category:運動心理學
Category:身心療法
Category:替代醫學
Category:佛教
Category:修行法