Clinical Handbook of Mindfulness (6 page)

or pointed to in this volume, include: (1) whether mindfulness is best char-

acterized as a state, a trait, or a way of being in relationship to any state or

trait, or put otherwise, a way of seeing/knowing/being that is continually

deepening and changing; (2) differentiating between thinking and aware-

ness; and refining the clinical utility of both without confusing them; (3)

elucidating the various dimensions of the experience of “self” and its neural

correlates, as per the work of Farb et al.
[14]
and the skillful understanding and clinical utility of the experience and embodiment of anata (not self); (4)

investigation of possible biological pathways via which mindfulness might

exert the various effects that are now being elucidated; (5) the need for

much more creative control groups to differentiate between mindfulness-

specific and general enthusiasm/attention-based outcomes; (6) how we con-

tinue to remind ourselves that the deepest insights relevant to both clinical

applications and also study design and interesting research questions may

come out of our own direct experience of mindfulness practice as clini-

xxxii

Foreword

cians and researchers; (7) on-going conversations about skillful ways to avoid

reifying mindfulness into a concept or a “thing” as it becomes increasingly

well known; (8) developing well-considered and appropriate standards for

training and assessing mindfulness instructors, recognizing that the particu-

lar background, first-person experience with formal mindfulness meditation

practice, and attendant skill sets required to teach mindfulness-based inter-

ventions are not readily amenable to the customary manualized approach to

delivery of psychological interventions; (9) effective ways to train clinically

based mindfulness instructors in the practice itself and in specific curricula

for specific mindfulness-based interventions without losing the essence and

simplicity of the practice or collapsing its multiple-dimensionality; and (10)

a continual raising of the challenges involved in taking on the work of mind-

fulness in clinical settings, the occupational hazards associated with profes-

sional roles and callings, and the recognition of increasingly skillful ways to

catch ourselves getting caught up in ambition-driven striving or mere endless

doing, and losing track of the domain of being, and of awareness itself.

In this vein, I couldn’t help noticing and delighting in the fact that the

words “wise” and “wisdom” were not shied away from in appropriate con-

texts in many of the chapters of this book. To me, this is a positive indica-

tor that the practice itself is shifting the vocabulary we use to think and talk

about effective clinical interventions and outcomes, and is elevating the ways

in which we hold those who come to us who are sorely suffering and in need

of being seen and met wholly and wholeheartedly (as we need to do for our-

selves and each other as well). I will single out only one sentence from one

chapter because it states a perspective that is often tragically missing in the

clinical setting in both medicine and psychology: “In DBT, it is assumed that

all people have innate access to wisdom
[15].
”

The heart of mindfulness-based interventions lies in a deep silence, still-

ness and openheartedness that is native to pure awareness and can be expe-

rienced directly both personally and interpersonally. The consequences of

such cultivation (Pali:
bhavana
) may go far beyond symptom reduction and

conventional coping adjustments, defining new ways of being in the body

and in the world that are orthogonal to the conventional perspective on both

health and well-being. Indeed, perhaps the collective efforts in this emerg-

ing field, as represented here, are defining new ways of being and knowing

that express the wisdom and beauty inherent in being human - as well as

new ways to measure its biological and psychological consequences. It is

my hope that this volume, and the flowering of present and future research

and clinical practices that it represents, be a major catalyst in our deepening

understanding of the human psyche and its capacity for, and yearning for

experiencing the wholeness that is its intrinsic nature.

Jon Kabat-Zinn, Ph.D.

Worcester, Massachusetts

September 15, 2008

References

1. Suzuki, S.
Zen Mind, Beginner’s Mind
, Weatherhill, NY, 1970.

2. Coupled with another Handbook on the subject which appeared in German in

2004: Heidenreich T and Michalak J. Aksamkeit und Akzeptanz in der Psychother-

pie: Ein Handbuch dvgt-Verlag, Tübingen, 2004.

Foreword

xxxiii

3. Ghandi, M. http://www.quotationspage.com/quotes/Mahatma Gandhi/

4. Ludwig, D. personal communication, June, 2008.

5. Bodhi, B.
The Noble Eightfold Path: Way to the End of Suffering
, Buddhist Pub-

lication Society Pariyatti, Onalaska, WA, 1994.

6. Grossman, P. On measuring mindfulness in psychosomatic and psychological

research,
Journal of Psychosomatic Research 64
:405–408, 2008.

7. Thera, N.
The Heart of Buddhist Meditation
, Samuel Weiser, NY, 1962.

8. See
The Heart of Understanding: Commentaries on the Prajnaparamita Heart

Sutra
Hanh TN Parallax Press, Berkeley 1988; also Kabat-Zinn J
Coming to Our

Senses
, Hyperion, NY, 2005, pp.172-183.

9. Cullen, M. Mindfulness: A Working Definition In:
Emotional Awareness: Over-

coming the Obsatacles to Psychological Balance and Compassion
, The Dalai

Lama and Paul Ekman, Henry Holt, New York, 2008. pp.61–63

10. See for example, Varela FJ, Thompson E, Roach E.
The Embodied Mind: Cogni-

tive Science and Human Experience
, MIT Press, Cambridge, 1991 ; and Thomp-

son, E. Mind in Life: Biology, Phenomenology, and the Sciences of Mind. Belknap

Harvard University Press, Cambridge, 2007; Depraz N, Varela F, Vermersch P. The

Gesture of Awareness: An Account of its Structural Dynamics. In:
Investigating

Phenomenal Consciousness
. Velmans M (ed.), John Benjamins Publishing, Ams-

terdam, 2000.

11. Santorelli, SF. CFM Guidelines for Assessing the Qualifications of MBSR Providers,

2004. In:
MBSR Professional Training Manual
, Santorelli SF and Kabat-Zinn, J

(Eds), CFM UMass Medical School Worcester, MA.

12. Wallace, A.
Genuine Happiness: Meditation as the Path to Fulfillment
Wiley,

Hoboken, NJ 2005.

13. Ricard, M.
Happiness: A Guide to Developing Life’s Most Important Skill
Little

Brown, NY 2006.

14. Farb NAS, Segal ZV, Mayberg, H et al. Attending to the present: mindfulness medi-

tation reveals distinct neural modes of self-reference.
Social Cognitive and Affec-

tive Neuroscience Advance Access
, August 13, 2007.

15. Rizvi, SL, Welch, SS, Dimidjian S.
Mindfulness and Borderline Personality Disor-

der
(Chapter 13, this volume).

Introduction: Where New

and Old Paths to Dealing

with Suffering Meet

Fabrizio Didonna

All humanity’s miseries derive from not being able to sit quietly in a

room alone.

– Blaise Pascal, Seventeenth-century French philosopher

Over the last 2 decades there has been growing interest in the possible

effectiveness of Eastern psychology in a clinical setting and in particular,

those techniques based on practices of Buddhist origin. Numerous stud-

ies have attempted to investigate the possible clinical implications of these

approaches and their application in the treatment of psychological disorders.

In a spontaneous manner and through the independent work and studies of

many researchers and therapists, this has given rise to a trans-epistemological

approach, leading to experimentation and the application in clinical settings

of principles and methods deeply rooted in Eastern psychology.

Interest in these approaches stems from an awareness that despite the

importance of scientific methodology, which aims at ensuring rigorous pro-

cedure and seeks to further evidence-based knowledge, there appears to be

a considerable need to combine these practices with the innate components

of human nature that are decisive in influencing an individual’s interpretation

of events and his/her emotional attitudes and behavior. These components

can be found in the
acceptance of experience
(Hahn, 1998; Hayes, Strosahl,

& Wilson, 1999), a
compassionate attitude
toward one’s own and other peo-

ple’s suffering (Gilbert, 2005), the
capacity to observe oneself without judg-

ing
(Kabat-Zinn, 1990), and the idea that the mind can observe itself and

understand its own nature (Dalai Lama, Benson, Thurman, Goleman, & Gard-

ner, 1991). They are also found in the capacity to direct attention toward the

emotional sphere and the relationship of interdependence and reciprocal

influence existing between the mind and the body (Goleman, 1991) and in

more general terms in a harmonizing and normalizing attitude toward intrap-

ersonal and interpersonal variables.

All of these components can be summed up in the concept of

mindfulness
.

As is well explained in the first part of this book, mindfulness is the “heart,”

or the core teaching, of Buddhist psychology (Kabat-Zinn, 2003), and it is

inherently a state of consciousness that involves consciously attending to

1

Introduction: Where New

and Old Paths to Dealing

with Suffering Meet

Fabrizio Didonna

All humanity’s miseries derive from not being able to sit quietly in a

room alone.

– Blaise Pascal, Seventeenth-century French philosopher

Over the last 2 decades there has been growing interest in the possible

effectiveness of Eastern psychology in a clinical setting and in particular,

those techniques based on practices of Buddhist origin. Numerous stud-

ies have attempted to investigate the possible clinical implications of these

approaches and their application in the treatment of psychological disorders.

In a spontaneous manner and through the independent work and studies of

many researchers and therapists, this has given rise to a trans-epistemological

approach, leading to experimentation and the application in clinical settings

of principles and methods deeply rooted in Eastern psychology.

Interest in these approaches stems from an awareness that despite the

importance of scientific methodology, which aims at ensuring rigorous pro-

cedure and seeks to further evidence-based knowledge, there appears to be

a considerable need to combine these practices with the innate components

of human nature that are decisive in influencing an individual’s interpretation

of events and his/her emotional attitudes and behavior. These components

can be found in the
acceptance of experience
(Hahn, 1998; Hayes, Strosahl,

& Wilson, 1999), a
compassionate attitude
toward one’s own and other peo-

ple’s suffering (Gilbert, 2005), the
capacity to observe oneself without judg-

ing
(Kabat-Zinn, 1990), and the idea that the mind can observe itself and

understand its own nature (Dalai Lama, Benson, Thurman, Goleman, & Gard-

ner, 1991). They are also found in the capacity to direct attention toward the

emotional sphere and the relationship of interdependence and reciprocal

influence existing between the mind and the body (Goleman, 1991) and in

more general terms in a harmonizing and normalizing attitude toward intrap-

ersonal and interpersonal variables.

All of these components can be summed up in the concept of

mindfulness
.

As is well explained in the first part of this book, mindfulness is the “heart,”

or the core teaching, of Buddhist psychology (Kabat-Zinn, 2003), and it is

inherently a state of consciousness that involves consciously attending to

1

2

Fabrizio Didonna

one’s moment-to-moment experience (Brown & Ryan, 2003). This state is

cultivated and developed through meditation practice (Kabat-Zinn, 2005),

which offers a method by which we can become less reactive to what is

happening to us in the present moment. It is a way of relating to our entire

experience (be it positive, negative, or neutral), which provides us with a

means by which we may reduce our general level of suffering and increase

our level of well-being (Germer, Siegel, & Fulton, 2005).

A crucial aspect of most mindfulness practices is a sense of heightened

but detached awareness of sensory and thought experience and, as Wolinsky

(1991) argues, mindfulness is actually the way out of the everyday trances

we live at the mercy of through unconscious, habitual, automatic patterns

of conditioning. Understanding the therapeutic value of these processes may

represent a particularly important integration of Eastern and Western psy-