This article originally appeared in the February 2004 Harvard Women's Health Watch and is provided courtesy of Harvard Health Publications.

The benefits of mindfulness

Learning to focus the mind can be a healthful antidote to the stresses and strains of our on-the-go lives.

If a high-tech device could tune in to your mind occasionally throughout the day, would it receive a smooth signal of your mind fully engaged in what you’re doing? Or would it likely pick up static? Perhaps your attention jumping from one thing to another? Fretting over the future or second-guessing the past? Half-listening while silently remarking on another’s words?

The ability to pay attention to what you’re experiencing from moment to moment — without drifting into thoughts of the past or concerns about the future, or getting caught up in opinions about what is going on — is called mindfulness.

It’s not a new idea. Religious texts and poets have extolled mindfulness for centuries, and it’s central to many contemplative traditions, such as Buddhism. What’s new is its growing use in mainstream health care and medicine and in nonmedical settings such as workplaces and schools. Why the enthusiasm? Because there’s mounting evidence that cultivating mindfulness can increase our enjoyment of life, expand our capacity to cope with illness, and possibly improve our physical and emotional health. While it doesn’t replace traditional therapies and medications, it can reduce stress and may help other treatments work better.

Focus first, then observe
One form of mindfulness practice is a discipline called mindfulness meditation, which involves sitting (or lying down) quietly for 20 or 30 minutes, once or twice a day. Meditators focus on their breathing or another physical sensation, allowing the mind and body to let go of tensions and concerns. Then they begin to note thoughts, sensations, and emotions that inevitably arise in the mind to pull attention away from the breath. The idea is to observe these “intrusions” without analyzing or suppressing them. Watching the workings of the mind in this way, from a distance, can sometimes help you gain perspective and insight.

In a less formal sense, being mindful means striving to bring a similar focused, nonjudgmental awareness to our usual routines. Meditation practice can enhance everyday mindfulness.

“The informal dimension of mindfulness is the most user-friendly,” explains Patricia Martin Arcari, Ph.D., R.N., director of the mindfulness-based Calm Mother/Happy Child program at the Mind/Body Medical Institute in Chestnut Hill, Mass. “But spending 20 minutes or so in formal meditation improves your ability to focus on the present moment throughout the day.” She explains further, “Meditation is a tool for understanding yourself. When you’re not able to stay focused on your breath, you can begin to see where your head goes during the day and to understand thinking patterns that may be creating problems for you.”

Measuring the effects of mindfulness
At the University of Rochester, psychologists developed a questionnaire (see “Mindfulness in everyday life”) and administered it to a sample of nearly 1,500 people. In the April 2003 Journal of Personality and Social Psychology, they reported that higher scores on their Mindfulness Attention Awareness Scale were correlated with established measures of well-being, including better mood, optimism, more openness to new experiences, and greater satisfaction with life.

Most research on the effects of mindfulness has used the Mindfulness-Based Stress Reduction Program, developed more than 20 years ago by Jon Kabat-Zinn, Ph.D., at the University of Massachusetts Medical School. The program incorporates training in mindfulness meditation (including home practice), exercises to increase mindfulness during daily activities, and discussions with other participants.

A team of researchers led by scientists at the University of Wisconsin studied the long-term effects of this program on the brains and immune systems of workers in demanding jobs at a biotechnology firm. The results were reported in the July/August 2003 issue of Psychosomatic Medicine. Half of the participants enrolled in the eight-week mindfulness course; the rest, a control group, signed up to take it later.

Before the program began, immediately afterward, and four months later, the workers took psychological tests and underwent measures of brain activity. The mindfulness students experienced a decrease in negative emotions after the course, while those on the waiting list noticed no change. The difference was still present four months later. After mindfulness training, brain wave recordings showed a pattern of activity — greater in the left prefrontal cortex than in the right — that’s associated with happiness and optimism. Before the course and in the control subjects, the right-left activity was more even.

The researchers also tested whether mindfulness influenced the immune system by giving all participants flu vaccines after the course. The mindfulness students produced more antibodies than the controls, and the response was greatest in those who shifted most strongly toward a left-dominant brain wave pattern.

Mindfulness in everyday life Being mindful means focusing attention on what you’re experiencing from moment to moment. It’s a daunting challenge in a hectic world, but science has begun to establish that it’s a worthwhile habit to cultivate. You can start by getting a sense of how much time you spend not being mindful. See if you recognize any of these statements from a questionnaire developed at the University of Rochester:   I find it difficult to stay focused on what’s happening in the present.   I snack without paying much attention to what I’m eating.   It seems I’m “running on automatic” without much awareness of what I’m doing.   I rush through activities without being really attentive to them.   I tend to walk quickly to get where I’m going without paying attention to what I experience along the way.   I find myself listening to someone with one ear and doing something else at the same time.   I tend not to notice physical tension or discomfort until they really grab my attention. If these sound familiar, there’s plenty of room for increasing mindfulness in your daily life. Take note of times when your thoughts are creating stress or distracting you from the present moment. The Mind/Body Medical Institute suggests that you slow down as you go about everyday activities, doing one thing at a time and bringing your full awareness to both the activity and your experience of it. Here are some tips for integrating mindfulness:   Make something that occurs several times during the day, such as answering the phone or buckling your seat belt, a reminder to return to the present — that is, think about what you’re doing and observe yourself doing it.   Pay attention to your breathing or your environment when you stop at red lights.   Before you go to sleep, and when you awaken, take some “mindful” breaths. Instead of allowing your mind to wander over the day’s concerns, direct your attention to your breathing. Feel its effects on your nostrils, lungs, and abdomen. Try to think of nothing else.   If the present moment involves stress — perhaps you’re about to speak in public or undergo a medical test — observe your thoughts and emotions and how they affect your body.   Find a task you usually do impatiently or unconsciously (standing in line or brushing your teeth, for example) and do it mindfully. Being mindful doesn’t mean you’ll never “multitask,” but you can make multitasking a conscious choice. It doesn’t mean you’ll never be in a hurry, but at least you will be aware that you are rushing. Although upsetting thoughts or emotions won’t disappear, you will have more insight into them and become aware of your choices in responding to them.

Mindfulness over physical illness
The combination of psychological benefits and a bolstered immune system can be particularly helpful to people coping with cancer and other medical conditions.

In a study published in the same issue of Psychosomatic Medicine, 49 women with breast cancer and 10 men with prostate cancer had psychological and immune function testing before and after a mindfulness-based course. Symptoms of stress lessened on 8 of 10 measures, and quality of life improved. More than 40% of the patients reported sleep problems before the course and only 20% afterwards. On average, participants slept about a half-hour longer each night. Most measures of immune function didn’t change, but the production of certain immune cells shifted away from a pattern often seen in depression and cancer. The patients will be followed for a year.

Two other studies have looked at the influence of mindfulness training on symptoms and the use of medical services. In the three months following a mindfulness course at West Virginia University, participants reported 46% fewer medical symptoms than those who received only educational materials and references on stress reduction. At an inner-city clinic in San Francisco, patients required significantly fewer medical visits in the year after a mindfulness course. Such training has also proved useful to people with chronic pain, fibromyalgia, psoriasis, and high blood pressure.

Helping gain control in psychiatric conditions
Mindfulness meditation and related mind/body strategies have become increasingly accepted as a complement to (though not a substitute for) established psychotherapies. Formal mindfulness practice fosters self-awareness and inner calm and improves the ability to tolerate upsetting thoughts. This can help reduce fear and promote a feeling of control. However, it may not have much impact until other treatments begin to work and improve the ability to focus.

Mindfulness-based approaches have been integrated into the treatment of anxiety, panic attacks, depression, and other behavioral and emotional disorders including:

  Binge eating. Mindfulness can help binge eaters realize when they’re full and recognize the urge to eat without succumbing to it. A study at Indiana State University and Duke University found that obese women who practiced mindfulness meditation had fewer binge eating episodes and felt more control over their eating, compared to others treated with a psychoeducational approach.

  Obsessive-compulsive disorder (OCD). People with OCD try to alleviate uncomfortable thoughts and feelings by compulsive, repetitive behaviors. At the UCLA School of Medicine, psychiatrists teach mindfulness to help patients recognize these thoughts and feelings and learn to look at them in a more detached way. Brain imaging showed that mindfulness treatment dampened overactivity in brain areas associated with compulsive behavior.

  Depression relapse. One of the challenges in managing depression is preventing a relapse after successful treatment. In susceptible people, a minor bad mood (sadness, disappointment) can spur out-of-proportion negative thinking, such as thoughts of failure or worthlessness.

Researchers from the United Kingdom and Canada have found that mindfulness training combined with cognitive therapy (in which therapists work with patients to restructure unproductive thought patterns) can help prevent depression from returning. Patients learn to allow moods to come and go without succumbing to depression-inducing thoughts.

A randomized study of recently recovered depression patients who had experienced several relapses showed that those who received mindfulness training along with cognitive therapy were only half as likely to relapse again as those who underwent standard counseling and medication. Results were published in the Journal of Consulting and Clinical Psychology (August 2000). Mental health professionals are now being offered training in mindfulness-based cognitive therapy to prevent depression relapse.