Mindfulness for Everything

by Vishvapani

Picture an FWBO meditation class and you imagine a room full of people sitting quietly on cushions in front of a Buddha image. But an increasingly common variation is a room of people lying down, relaxing deeply as the leader guides them in taking their attention through the body.

The body scan is a distinctive element in the six, eight or ten week courses that are proliferating in FWBO centres as they engage with the world of Mindfulness-Based Therapy (MBT). The faculty of mindfulness—broadly defined as non-judgmental present-moment awareness—has always been a key element of the Buddhist path; and in recent years psychologists and healthcare professionals have been recognizing its value for people experiencing conditions ranging from stress and depression to addiction, chronic pain and ill health. A natural crossover exists between this growing medical interest in mindfulness and the skills that FWBO meditators and teachers have developed in their years of practice. So how are people from the FWBO engaging with MBTs, and what issues are emerging as they do so?

Mindfulness-Based Therapies

Although the world of Mindfulness-Based Therapy is fairly new, it is already rather complicated, at least on the surface. Prepare to be bombarded by acronyms. There is Mindfulness-Based Stress Reduction (MBSR); Mindfulness-Based Cognitive Therapy (MBCT); Mindfulness-Based Relapse Prevention (MBRP); Mindfulness-Based Pain Management (MBPM); and more. As the names suggest, these therapies apply mindfulness to various conditions; others, such as Acceptance and Commitment Therapy (ACT) or Dialectical Behavioral Therapy (DBT) use mindfulness in conjunction with other forms of treatment.

The alphabet soup was first stirred in 1979 when Jon Kabat-Zinn wondered if the mindfulness meditation he practiced at the Insight Meditation Society could help the patients he was seeing at the University of Massachusetts Medical Centre. These were people for whom the doctors could do no more. Despite extensive medical treatment they still suffered chronic pain or illness, or one of the many kinds of dis-ease that we call ‘stress’. He developed an eight-week course that engaged them in regular and fairly intensive practice of body scans, mindfulness of breathing meditation, hatha yoga and other exercises aimed at developing awareness. He called his approach Mindfulness-Based Stress Reduction (MBSR).

The effect of MBSR courses was carefully monitored and results were remarkable. People reported lower levels of stress, and even a reduction in their symptoms. Above all, they felt hopeful and empowered because mindfulness enabled them to affect their experience for the better. What’s more, follow-up studies showed that years after taking the course many participants continued to use the techniques they had learned

 Medical authorities and funders were impressed, and they were delighted by the course’s cost-effectiveness. While conventional treatments involve expensive drugs or lengthy one-to-one therapy, MBSR can be taught to groups of up to thirty people at a time, and it uses the cost-free resources of the participants’ own minds. If this sounds mercenary, it is important to note that for Kabat-Zinn, himself, MBSR’s effectiveness springs from its spiritual depth. As he writes in his best-selling 1991 book Full Catastrophe Living, ‘What we really offer people is a sense that there is a way of looking at problems that can make life more joyful and rich … and also a sense of being somehow in control.’

 Kabat-Zinn’s activities developed into the Center for Mindfulness, and their influence spread. One example is described in the book, Mindfulness-Based Cognitive Therapy for Depression by three cognitive psychologists, two of whom are British. Their work with people suffering from depression showed them that, while drugs could help alleviate depression, seventy percent relapsed if they ceased taking the drugs.  Cognitive Behavioral Therapy (CBT) could also help, with more lasting results, but there is a UK-wide shortage of qualified therapists.  In any case depression, once experienced, is highly likely to recur - a new episode starts when someone starts to ruminate on thoughts of unworthiness or frustration, and this produces depressed moods, which in turn produce further negative thoughts. The result is a descending spiral that creates a strongly depressed state of mind. But if the person can notice that these thoughts are starting to recur before they have gained in strength, they can choose not to pursue them.

The psychologists concluded that their patients needed a technique that would help them to be aware of their thoughts; and their search for such a therapy led them to Kabat-Zinn, meditation and mindfulness. Some years on, MBCT has been approved by the UK’s National Institute of Clinical Excellence (NICE) for treatment to prevent relapse into depression - which is known to affect around twenty percent of the population of developed countries at some point in their lives. Masters degrees in MBCT are taught at the Centre for Mindfulness Research And Practice in Bangor, and another course is being developed in Oxford.

Mindfulness has also been used to treat addiction, eating disorders, anxiety and numerous other conditions. Breathworks is a home-grown approach, developed by Vidyamala, a member of the Western Buddhist Order, which I will describe below.

How Mindfulness-Based Therapy Works

Most Buddhists are familiar with techniques for developing mindfulness, such as the mindfulness of breathing meditation practice, but how can they help with conditions such as chronic pain or depression? In an excellent talk entitled Mindfulness for Just About Everything (available online from Free Buddhist Audio), Paramabandhu, who is both a consultant psychiatrist and the Chair of the London Buddhist Centre, identifies four main therapeutic uses of mindfulness.

Firstly, he says, mindfulness enables people to notice what is happening in their experience, especially when they are engaging in compulsive patterns of thought such as escapist fantasy, rumination and fixation which can prompt destructive or addictive behaviour. Secondly, mindfulness offers a way for people to stay with experience including whatever may be difficult, rather than pushing it away. This produces a change in perspective on those thoughts or experiences, enabling people to see that their thoughts are just thoughts, not facts or reality, and they need not be driven by them. Finally, the new perspective allows choice. Rather than being driven by compulsive reactions to experience, mindfulness creates the mental space that enables people to respond differently.

The practices taught on mindfulness-based courses support people’s efforts to move away from depressive thoughts, accept physical pain, or respond to challenges with creativity rather than stress. Learning to pay attention to the breath helps in learning to notice thoughts and feelings, and in meditation brings calm, in which state it is easier to notice experience and stay with it. MBTs also emphasise grounding awareness in a sense of the body and the breath, and this is naturally healing in itself.

Mindfulness-Based Therapies in the FWBO

The two main FWBO MBT projects are Breathing Space at the London Buddhist Centre (LBC), and Breathworks, which is based at the Manchester Buddhist Centre but trains people from many different places. The two projects engage with the MBT field in rather different ways.

Breathing Space

Paramabandhu first ran an MBCT Meditation for Depression course at the London Buddhist Centre in 2004, drawing on his experience as both a meditation teacher and a consultant psychiatrist. The first course quickly booked up, so he put on a second—and the same thing happened. His Health Service work is with drug and alcohol addiction, and in 2005 he started to offer a six-week course, which he adapted from MBCT called Mindfulness-Based Relapse Prevention (MBRP).

Members of the LBC sangha responded enthusiastically to Paramabandhu’s initiative, in part because it was helping people who otherwise would not attend the Buddhist centre, and Paramabandhu supervised experienced meditation teachers as they trained to run the courses themselves. The courses enabled the centre to make new contacts with the local community, and Tower Hamlets Council has given almost £10,000 to fund free places for local residents. By mid-2007 over 300 people had attended MBT courses at the LBC.

As activities developed, they acquired a name—‘Breathing Space’—and Maitreyabandhu became the Director while Paramabandhu guided the teaching aspect. As the number of courses grew they decided that they needed a large dedicated space for these activities, which wasn’t dominated by a Buddha figure. They decided to convert the LBC’s basement—currently a warren of offices and storerooms—into a large, therapy room and activity space with a reception area and disabled access. They launched an appeal, including £150,000 to be raised from the LBC sangha to refurbish the existing ground floor facilities. In summer 2007 a government-backed investment agency awarded the project a £25,000 grant and £260,000 loan for the basement conversion. This is enough to ensure that Breathing Space can go ahead; but there is a long way to go before the team realise their vision of teaching mindfulness courses to thousands of people and dramatically expanding the scope of the LBC’s activities.

Breathworks

While Breathing Space uses a version of MBSR and MBCT, Breathworks’ approach has grown out of the experience of Vidyamala, an Order member with severe chronic pain. Chronic pain affects around fifteen percent of the population, and it confronts them with a raw version of the existential dilemma about which Buddhism speaks so much. The challenge is to respond constructively to suffering, rather than trying to escape it or reacting angrily. Having learned, through years of struggle, to engage mindfully with her own condition, in 2002 Vidyamala started to share her experience with other chronic pain sufferers by running courses in her room.

A year later Vidyamala teamed up with Sona and Ratnaguna, (whose working name is Gary Hennessey), both of whom are experienced practitioners, to form Breathworks, a not-for-profit company dedicated to making this work more widely available. They ran courses at the Manchester Buddhist Centre and elsewhere, and quickly attracted attention from both health professionals and other Buddhists. Since then Breathworks activities have ballooned. The team often run courses for health professionals and make presentations at conferences.

They have devised a training course that takes place over two weeks, and four such training weeks will be held at Taraloka Retreat Centre in 2008. They have also led training retreats in New Zealand. Twelve people have qualified as Breathworks trainers, and Breathworks courses are being run in Brazil, New Zealand, Ireland and Germany, as well as Cardiff, and Manchester in the UK. In London, Prasannavira runs Breathworks activities through his company, Body of Health, which works with Breathing Space. The Breathworks team anticipate that by the end of 2008 there will be 30 qualified Breathworks trainers. While most of those training are FWBO Buddhists, some are Buddhists from other traditions and some are non-Buddhist health professionals.

The intention of the Breathworks team is to create a ‘Breathworks community’, that includes many trainers around the world who will meet for retreats, sharing of experience and further training. While the work’s initial focus was on people suffering chronic pain, in 2005 Ratnaguna and Sona started the ‘Living Well’ course that adapted Breathworks techniques for others. In 2007 the course was extensively revised by Ratnaguna in the light of MBSR and its offshoots, and a new version called ‘Living Well: Mindfulness for Stress’ was piloted in Manchester, Cardiff and Auckland, NZ.

The demand for what Breathworks offers is seen in the success of their guided meditation CDs, which have sold 12,000 since they were launched in 2004, despite being self-published. Vidyamala is currently writing a book about her approach to pain management (I am her editor), which will be published by in September 2008 by Piatkus, the UK publishers of Full Catastrophe Living. Breathworks is increasing known within the worlds of pain management and mindfulness, and several research projects into its techniques are currently being conducted.

The Breathworks programme differs from MBSR and MBCT in several interesting ways. The Pain Management module includes elements drawn from other pain management courses, such as training in ‘pacing’ oneself through the day. The suggestion that participants might decide to actively change their behaviour gives a subtly different message from the MBSR emphasis on noticing without judging or changing. The biggest difference, however, is that, in addition to the body scan and the mindfulness of breathing, all Breathworks courses include a ‘kindly awareness’ practice. This is an adaptation of the metta bhavana (loving kindness) meditation practice, which is taught at FWBO centres alongside the mindfulness of breathing. The kindly awareness practice starts with reflection on one’s own suffering and uses it as a key to develop empathy with others. Vidyamala sees this other-regarding dimension as an important adjunct to mindfulness for people seeking a more creative response to difficult experience.

Other Projects

Mindfulness Works

Kulananda, a senior member of the Western Buddhist Order who co-authored Mindfulness and Money, took the MA in Mindfulness-Based Approaches at Bangor. After graduating he was invited to teach a Buddhist psychology module on the MA programme. He also set up a company, Mindfulness Works, that offers mindfulness courses to companies, business coaches and senior executives as well as in healthcare settings. He works under his civil name: Michael Chaskalson.

Mindfulness Works activities have developed successfully and Kulananda has led courses in the NHS, at business schools, and for corporate clients—including several large professional service firms. As the Mindfulness Works website points out, over half a million people in the UK say that stress, depression or anxiety was caused or made worse by their work, and employers increasingly realise that this affects their businesses. There is clearly a demand for mindfulness in the corporate sector. 

Other FWBO Centres

Karunadaka, the Chair of the Dublin Meditation Centre and Viryasara (Dr Kate Healey), who is a GP, run a successful programme of mindfulness courses at venues in Dublin under the name Blue Sky Mindfulness Meditation Dublin.

The Cambridge Buddhist Centre runs MBSR courses led by Kulananda and Ruchiraketu, who is currently taking the Bangor MA. They have also sometimes worked with John Teasdale, one of the founders of MBCT. Another Bangor student, Taravajra runs MBCT courses at the Evolution Arts and Natural Health Centre in Brighton. In fact MBT courses are popping up on centre programmes around the movement—the North London Buddhist Centre recently ran MBT courses focusing on stress, depression, and chronic pain, all more or less concurrently, with a good take-up for each.

Issues and Prospects

The growing interest in MBTs in mainstream healthcare and psychology creates opportunities for FWBO centres and individuals, but also brings some risks. Depression, stress, anxiety and chronic pain affect large sections of the population, many whom attending would never think of attending a Buddhist centre or a meditation class. We are probably only at the start of the influence of mindfulness on healthcare and on society at large. In time, if research evidence mounts and health budgets adapt to include mindfulness, there may well be formal health service support for these therapies, whether they are taught by Buddhists or health professionals. Jon Kabat-Zinn reportedly described his work as ‘stealth Buddhism’, introducing Buddhist attitudes, experiences and values into the mainstream of society and potentially affecting many millions of people.

Teachers of MBT courses report that participants are often more motivated than those attending other classes at Buddhist centres because they have a real difficulty in their lives for which they need help. The courses are more intensive than other meditation courses, and people often experience benefits to match. I know from my own experience as a teacher that MBT course can be very rewarding.

MBT courses can also help centres and individuals financially. Buddhist centres are usually empty during the day, and at least some MBT courses can take place then. Because MBTs are bracketed with other healthcare offerings the amount that people expect to pay is higher than for other events, especially where they are paid for by health authorities or employers. This is particularly true in the corporate sector. However, MBT is a new area and there are few recognised ways of reaching the people who might benefit. For example, although Breathworks is highly respected by pain specialists, they do not yet get many referrals and currently hospitals cannot buy in Breathworks trainers.

A danger for Buddhists and Buddhist centres in engaging with MBT is that it will subtly alter the flavour of their teaching work. Mindfulness Based Therapy is an emerging profession, and offering meditation professionally is very different from the ‘mutual generosity’ (dana) basis of traditional Buddhist teaching. Buddhist centres that are under considerable financial pressure need to take care that they do not neglect their mainstream activities for the sake of MBTs.

The medical origins of MBSR and MBCT potentially skew the understanding of mindfulness away from how it is seen in the Buddhist tradition. In Buddhist teachings mindfulness is always seen as an aspect of a path that includes other faculties and practices. But in MBTs mindfulness is often spoken of in isolation, or in conjunction with non-Buddhist techniques such as CBT. The resulting view of mindfulness in MBCT, for example, strikes me as very clear but rather narrow. I think it would be unfortunate if views of mindfulness among FWBO Buddhists were strongly influenced by this approach, unless it is thoroughly reviewed in the light of Buddhist teachings. Breathworks’ inclusion of ‘balanced effort’, kindly awareness and its plans for a community of practitioners is an interesting response to the narrowing of views of mindfulness among ‘mindfulness professionals’.

The two main FWBO MBT projects—Breathing Space and Breathworks—have developed in isolation from one another, and there has been little interaction between them. It would be good to see more dialogue between these and other FWBO MBT projects. Potentially, perhaps in conjunction with other Buddhists, they could help to bring a distinctively Buddhist understanding of mindfulness to the MBT world.

Training

There is no commonly recognised MBT accreditation, but three training options are currently available for anyone in the UK wanting to deliver MBTs. Readers may wish to add comments about the provision in other countries. 

Breathing Space offers on-the-job training in MBCT/MBSR to would-be teachers in London.

Breathworks offers a straightforward practice-based training course. This is ideal for working with people experiencing chronic pain, and the new Living Well with Stress course opens up the much wider field of stress management as well. Graduates can also benefit from the Breathworks community.

Bangor University’s MA/MSc in Mindfulness-Based Approaches, which includes a substantial academic component, has attracted a number of Order members. The course’s four modules and a dissertation can be completed in three years, and students are awarded a certificate and then a diploma en route. The qualification in MBCT, with its strong evidence-base, is likely to impress the health service and employers.

 Finding Out More

Books

Full Catastrophe Living: How to Cope with Stress, Pain and Illness Using Mindfulness Meditation by Jon Kabat-Zinn, Piatkus (UK); Delta (US)

Mindfulness-based Cognitive Therapy for Depression: A New Approach to Preventing Relapse by Zindel V. Segal, J. Mark G. Williams, and John D. Teasdale; Guildford.

 

Talks and Articles

Mindfulness for Just About Everything (talk by Paramabandhu, Free Buddhist Audio) www.freebuddhistaudio.com/talks/details?num=OM778

Embodying Engagement (article by Vishvapani on Jon Kabat Zinn & Bernie Glassman): vishvapaniswriting.blogspot.com/2007/01/embodying-engagement-observations-of.html

Mindfulness as Cognitive Training: a Contribution from Early Buddhist Thought by Michael Chaskalson MA dissertation available on Univ. of Wales, Bangor website

 

FWBO Mindfulness-Based Therapy Projects

Breathworks (Manchester) www.breathworks-mindfulness.co.uk/

Cardiff Breathworks www.cardiffyogastudio.co.uk/breathworks.htm

Body of Health (East London) www.bodyofhealth.org/

Mindfulness Works www.mbsr.co.uk/

Blue Sky (Dublin) http://bluesky.ie/

Breathing Space (London) www.lbc.org.uk/breathingspacehome.htm

Cambridge www.cambridgebuddhistcentre.com/stress_reduction/about.php

Evolution Arts, Brighton www.evolutionarts.co.uk/mbct.html

 

Other Mindfulness-Based Therapy Projects

Massachusetts Center For Mindfulness www.umassmed.edu/cfm/index.aspx

Bangor Centre for Mindfulness Research & Practice www.bangor.ac.uk/mindfulness/

Oxford Mindfulness Centre www.so-wide.org/mindfulness.php