Clinical Handbook of Mindfulness (128 page)

ter study these two ways of applying mindfulness-based interventions. MBCT

constructs a platform for the delivery of what cognitive behavior therapy

understands to be the thought and mood patterns contributing to relapse in

depression and what the rigorous practice of mindfulness offers in develop-

ing a different relationship to those experiences. MBSR offers the systematic

exploration of the effects of stress as a potent component in our relation-

ship to healing and health and works with generic medical and psychological

problems. Both offer an opportunity for the group participants to enhance

experiential understanding about a more universal arena of health and well-

being, one that is heart centered in its fullest sense by connecting to a deep

core of wisdom; a profound feeling of being at home regardless of where we

are and what is happening.

Mindfulness is a way to remember how to re-discover the experience of

the moment. Its practice takes us deeply into the way the mind/body works.

It is only by meeting our minds over and over again in practice that we can

hope to convey a sense of insight bathed in compassion and embark on the

journey of embodying what is being asked in teaching. For this reason pro-

fessional teaching programs need to encompass both intellectual and experi-

ential learning in mindfulness, otherwise what the practice has to offer will

lose its heart centered approach to working with suffering.

References

Baer, R. (2003). Mindfulness training as a clinical intervention: A conceptual and

empirical review.
Clinical Psychology: Science and Practice, 10
, 125–143.

Baer, R., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-

report assessment methods to explore facets of mindfulness.
Assessment, 13
(1),

March, 27–45.

Concise Oxford Dictionary (2004). Eleventh Edition

Dalai Lama & Cutler, H. C. (1998).
The art of happiness
. New York: Riverhead

Books, 41.

Davidson, R. J. & Harrington, A. (Eds.) (2002).
Visions of compassion
. New York.

Oxford University Press.

Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., et al. (2003). Alter-

ations in brain and immune function produced by mindfulness meditation.
Psycho-

somatic Medicine, 65
, 564–570.

Dimidjian, S., & Linehan, M. (2003). Defining an agenda for future research on the clin-

ical application of mindfulness practice.
Clinical Psychology: Science and Practice,

10
(2), 166.

Ekman, P., Davidson, R. J., Ricard, M., & Wallace, B. A. (2005). Buddhist and psycho-

logical perspectives on emotions and well-being.
Current Directions in Psycholog-

ical Science, 14
(2), 59–63.

Freedberg, S. (2007). Re-examining empathy: A relational-feminist point of view.

Social Work, 52
(3), 251–259.

Gilbert, P. (2006).
Compassion: Conceptualizations, research and use in psychother-

apy
. New York: Routledge.

Glaser, A. (2005).
A call to compassion
. York Beach, ME: Nichols-Hayes, Inc.

Goleman, D. (2003).
Destructive emotions
. New York: Bantam

Chapter 25 Training Professionals in Mindfulness

475

Kabat-Zinn, J. (1990).
Full catastrophe living
. New York: Bantam Doubleday Dell.

Kabat-Zinn, J. (2003) Mindfulness-based Interventions in context: Past, present and

future.
Clinical Psychology: Science and Practice, 10
(2), 145.

Kabat-Zinn, J., & Santorelli, S. (1996).
A teaching mandala. Mindfulness-based

stress reduction professional training resource manual
. Massachusetts: Center

for Mindfulness in Medicine, Health Care, and Society.

Palmer, & Parker J. (1998).
The courage to teach
. San Francisco: John Wiley &

Sons, 6, 11

Segal, Z., Williams, J., & Teasdale, J. (2002).
Mindfulness-based cognitive therapy for

depression: A new approach to preventing relapse
. New York: Guildford Press.

Shanafelt, T. D., Bradley, K. A., Wipf, J. E., & Black, A. L. (2002). Burnout and self-

reported patient care in an internal medicine residency program.
Annals of Inter-

nal Medicine, 136
, 358–367.

Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching Self-Care to Caregivers:

Effects of Mindfulness-Based Stress Reduction on the Mental Health of Therapists

in training.
Training and Education in Professional Psychology, 1
(2), 105–115.

Appendix A: Mindfulness Practice

Thomas Bien and Fabrizio Didonna

Traditional Buddhist teaching says there are 84,000 dharma doors. In

essence, that means there are lots of ways to practice. Here are some that

we consider useful as a foundation for mindfulness.

A Word About Posture

In the practice of formal meditation the first step is finding a correct physi-

cal posture. Our body posture has a very direct and powerful effect on our

state of mind. We know that body and mind are interrelated, and for this

reason the mindful state arises naturally when physical posture and mental

attitude support each other. So, a correct and upright posture helps one’s

mind naturally come to rest in a state of calm and presence. The best medita-

tion posture is one in which you feel yourself at once comfortable, relaxed,

alert, and grounded one that you can maintain comfortably for some time. A

correct posture reduces obstacles to concentration such as physical pain,

distractions, sleepiness, and wandering mind. We can achieve this if the

body finds balance, stillness, stability, and wakefulness. As Tibetan Buddhist

teacher Sogyal Rinpoche said (1994): “The whole point of correct posture is

to create a more auspicious environment for meditation”.

When we meditate it is helpful to wear loose clothing, with nothing con-

stricting the waist, and no shoes or, better yet, barefoot.

There are several postures that can allow you to establish the best condi-

tions for meditation. In the
sitting position
you may choose to settle on a

straight-backed chair or on a soft surface on the floor, with your buttocks

supported by a cushion such as the traditional
zafu
or kneeling bench.

Whether you sit on the floor or on a chair, the key element is to keep

your back straight; not rigid, but simply erect or uplifted, with the back

of the neck aligned with your spine. Adopt a dignified, noble and upright

posture. According to noted mindfulness teacher, Jon Kabat-Zinn (2005), “a

dignified sitting posture is itself an affirmation of freedom, and of life’s har-

mony, beauty, and richness, and the posture itself is the meditation.” A useful

instruction is to imagine you are being pulled up through the top of the head

by a string. If sitting on a chair, you may choose to sit away from the back

of the chair so that your back is self-supporting. Let your feet rest flat on the

floor. Sitting on a chair is a very good way to practice meditation, and should

not be considered less valuable than sitting on the floor. You may also choose

477

478

Thomas Bien and Fabrizio Didonna

to sit in the
kneeling position
(“
Seiza
” or “
Japanese
”) sitting on a bench, or

a cushion that is used as a saddle, with your knees resting on the floor.

Remember that while sitting it is fine to change positions if you feel pain.

It is important to be gentle with yourself.

Allow your hands to find a stable support. You may choose to rest your

hands in your lap, just below the navel, or rest your left hand inside the right

hand, palms facing upwards and thumbs lightly touching. Relax your shoul-

ders. You may keep your eyes open, or gently close them to prevent exter-

nal distractions. However you sit, it is important to find the most balanced,

relaxed and grounded position, one that allows your mind to go deeply into

the process of meditation.

Mindfulness of Breathing

The breath lies at the intersection between the voluntary and involuntary

nervous systems. For this reason, mindfulness of breathing offers a unique

opportunity to bring body and mind together. When we are agitated, we

often catch our breath and breathe shallowly. Because the breath is shallow,

we then feel even more anxious, creating a negative feedback loop: We are

upset or anxious, so we breathe in a tight way. Then because we are breath-

ing in such a way, we start to feel even more anxious.

Fortunately, the reverse is also true. When we let our attention settle on

the breath, calming it by just letting it be itself and not forcing it to go any

particular way, the breathing calms down, and with it, the mind. It is as if

mindful breathing sends a message to the brain, saying, “Everything is okay,

no need to worry,” and this helps us to feel more at ease.

Mindful breathing is foundational to many mindfulness exercises. It need

not take a lot of time, and is very enjoyable and refreshing when done prop-

erly. In fact, the definition of doing it properly is that you enjoy the process.

Mindfulness of breathing can be done sitting, standing, or lying down. Let

your awareness drop down into the abdomen, away from all the thinking,

and simply let your body breathe in and out exactly as it wants to. You can

notice the flow of the air in and out, the rise and fall of the abdomen, the

onset of the breath, the inflection point just before you begin to exhale, and

the length of the pause before your body begins another cycle. Focusing

on what is interesting or pleasant about these sensations greatly facilitates

concentration. Cultivate the sense that with each breath you are nourishing

every cell in your body. When your thinking pulls you away, notice this with-

out recrimination, and come back to the breath. Smile a gentle Buddha smile.

Continue for a comfortable period of time.

Sitting Meditation

There are many different styles of meditation. Each style has somewhat dif-

ferent methods, different goals, and different results. The style of meditation

most related to mindfulness is
vipassana
, sometimes called insight medita-

tion. Descriptions of this technique vary somewhat, but all styles of vipassana

meditation include an object of focus (most often, the breath), and the cul-

tivation of accepting awareness when the mind wanders from that focus.

While concentration is helpful, it is not necessarily the goal of this type of

Appendix A: Mindfulness Practice

479

meditation to attain perfect concentration on the breathing. More important

is that, when the mind wanders, one notices this wandering in a kindly way,

without self-recrimination, and returns gently to the breath. If one continues

to do this, this is correct vipassana. It does not matter whether your mind

wanders one hundred times during the course of a meditation session, or

only once. If you notice each time and bring the mind back, not struggling

against the mind’s natural tendency to wander, but simply observing it, that

is good practice.

In vipassana practice, there is no struggle to identify the thoughts, or to try

to correct them. Rather, one simply notes the thoughts, as much as possible

without getting caught up in their content or debating their validity, and

then returns to the breath. By the endless repetition of this process, the

meditator becomes aware of the
process
of consciousness, coming to know

and accept how the mind works, without struggling against it. One cannot

emphasize enough that the central characteristic is precisely this observing

without struggling.

Here are some specific steps for this practice:

1. Choose a quiet place.

2. As described above, sit in a way that helps you to be both alert and

relaxed.

3. Allow time for the transition from whatever you’ve been doing to the

meditative state, adopting an unhurried attitude. Take a moment or two

to open to the environment around you, the sounds, smells, whatever is

present. Note the sensations present in your body. Feel your skin as that

which
connects
you with everything else rather than that which divides

you from it.

4. Gently allow the focus of your awareness to settle onto the abdomen, to

a point about two finger breadths below the navel. (Alternatively, you can

focus on the point where the air makes contact with your nostrils.) From

there, notice the body breathing in and breathing out, letting the breath

unfold of its own accord, not forcing in any way. Attend clearly to the

pleasantness
of this process.

5. As soon as you notice that your mind has wandered away from the breath,

briefly note what you have been thinking about, or just say to your-

self “thinking, thinking”, and return to your breathing. The most impor-

tant thing to remember is that such wandering is completely natural and

acceptable. So do not engage in accusations against yourself for this. (Or,