• Mindfulness, in its simplest sense, is a mental discipline that involves training attention

• It teaches us how to use the mind in a different way

• Among other things it has been found to be associated with a significant reduction in pain, fatigue, and sleeplessness

Written by Associate Professor Craig Hassed MBBS, FRACGP, Monash University, Department of General Practice craig.hassed@monash.edu

Mindfulness, the most scientifically investigated form of meditation, has been the subject of a huge growth of interest in clinical and scientific circles in recent years.  The evidence is suggesting that learning to pay attention may be the most important skill we ever learn. 

Mindfulness, in its simplest and most universal sense, is a mental discipline that involves training attention.  

It teaches us how to use the mind in a different way and to focus on the things that are most useful and helpful in our lives thus helping us to live more consciously and fully.

When our mind is wandering we are not paying attention to what we are doing. This results in more mistakes, less efficiency, and less enjoyment. When we are not paying attention our mind may get up to ‘mischief’ in the form of worry and rumination which are at the very heart of anxiety and depression. 

When we are not paying attention we often make mountains out of mole-hills and perceive stressors that don’t even exist, except in our imaginations. This amplifies our level of stress enormously which takes a toll on our mental and physical health.

The ’fight or flight response’ is a natural, necessary and appropriate response to a threatening situation if it is based on a clearly perceived actual threat – say confronting a tiger.

This turbo-charge of energy is coded into our systems by nature in order to preserve life. It is appropriate and life protecting, however that’s providing it is only turned on when it needs to be and it is allowed to turn off when no longer needed and is not prolonged.

When we activate it inappropriately we experience it as anxiety; these chemicals and changes are being switched on with nowhere to go. This takes its toll over time including producing allostatic load (1) which is like a physiological wear-and-tear on the body. High allostatic load, among other things, leads to increased inflammation and progression of chronic illnesses.

The good news is that these effects can all be reversed over time with the regular practice of mindfulness meditation. The focusing of attention on the here and now helps us to see which stressors are actually present and which ones are only in our imagination.

The list of applications of mindfulness/meditation for healthcare and personal development grows every year. The research into preventing relapse in depression has probably caused more interest than any other single application.

Some of the benefits of mindfulness-based meditation found in research are listed below:

• mental health: e.g. therapeutic application for depression, anxiety, panic disorder, stress, emotional regulation, addiction, sleep problems, eating disorders, ADHD, autism, greater resilience

• neuroscience: e.g. structural and functional changes in the brain, stimulation of neurogenesis (the process by which neurons or nerve cells are generated in the brain), possible prevention of dementia and cognitive decline, down-regulating the amygdala, improved executive functioning and working memory, reduced default mental activity, improved self-monitoring and cognitive control, improved perception of sensory input

• clinical: e.g. therapeutic applications for pain management, symptom control, coping with chronic illness (e.g. cancer and MS), metabolic and hormonal benefits (e.g. reduced allostatic load, cortisol), facilitating lifestyle change (e.g. weight management, smoking cessation), improved immunity (e.g. improved resistance, reduced inflammation), improved genetic function and repair, slower ageing as measured by telomeres (the protective caps on the ends of chromosomes that affect how quickly cells age)

• performance: e.g. sport, academic, leadership qualities, mental flexibility and problem solving, decision-making

• education: e.g. improved problem-solving, executive functioning and working memory, better focus, less behavioural problems

• relationships: e.g. greater emotional intelligence and empathy, improved communication, reduced vicarious stress and carer burnout

• spiritual.

Mindfulness-Based Cognitive Therapy (MBCT) combines the insights and attitudes gained through meditative practices and the cultivation of mindfulness in daily life. It emphasises the ability to stand back from and be less attached to the thinking mind, to be more accepting and self-compassionate, and to be present and free of worry about the future and rumination on the past.

MBCT more than halves the relapse rate for people who have had depression in the past (2) by changing relationships to negative thoughts and emotions rather than by changing belief in thought content (3). We don’t so much have to control negative thoughts and emotions, but we don’t have to be controlled by them either. We can learn to stand back from them without being reactive or judgmental.

Work by the team led by Australia’s Nobel Prize winning researcher, Elizabeth Blackburn, has found that meditation may slow genetic ageing and enhance genetic repair (4).

Mindfulness meditation has been found to be associated with a significant reduction in pain, fatigue, and sleeplessness, but improved functioning, mood and general health for people with chronic pain syndromes (5,6,7).

For people with chronic illnesses there are significant improvements seen in overall quality of life, symptoms of stress, and sleep quality, immunity and lower levels of the inflammatory hormones (8).

Mindfulness is more than learning to pay attention – it also implies cultivating an attitude of openness, interest and acceptance. It is a form of meditation and a way of living.

When we fight with the thoughts and feelings we would rather not be having, we actually feed them with more attention, and increase the impact that they have. Learning to notice them and be non-reactive and non-judgmental of them is an important aspect of learning to be free of them.

Most meditative techniques rely on the attention being focused restfully; hence the term ‘restful alertness.’ When first attempting this, some people feel frustrated and tense as they cannot stop their mind from thinking. However in order to meditate you don’t need to struggle with the distracting stream of circular, habitual, repetitive and imaginary mental activity. You need to learn not to be so reactive to it. This takes the emotive force out of it.

A day is just like a book. If it isn’t punctuated it becomes a blur and makes little sense. These ‘punctuation marks’ are times of consciously coming to rest so that we can remind ourselves to be present and pay attention. For this reason the two following practices are suggested.

The ‘full stop’ (see Exercise 1) could be practiced anything from 5 to 30 minutes twice a day depending on your motivation and opportunity, and the ‘comma’ (see Exercise 2) for 15 seconds to 2 minutes as often as you remember throughout the day. The comma is particularly useful in the time you have after completing one activity and before beginning another.

Informal mindfulness practice There is no point being mindful for 10 or 20 minutes sitting in a meditation chair. The aim is to get out of the chair and be more mindful throughout the day whether eating, walking, talking, driving a car or doing the dishes. Pay attention by connecting with the senses and be present to what is happening as your day and your life unfolds before you.

Sit the body in a chair so that the spine is upright and balanced but relaxed. Have the body symmetrical and allow the eyes to gently close.

Now, move the attention gently through each step. Be conscious of the body and its connection with the chair. Feel the feet on the floor. Notice if the feet are tense. If so allow them to relax if they want to. Similarly, be aware of the legs and allow them to relax if they wish, and so gently move up through each part of the body; the stomach, hands, arms, shoulders, neck and face. If tension or discomfort remains, just notice the presence of tension or discomfort without judgment.

Now take in a deep breath and slowly and gently let the breath out. Repeat this twice more then just allow the breathing to settle into its own natural rhythm without having to control it in any way. If you observe a tendency to try and control the breath, just impartially notice that. Simply be conscious of the breath as the air flows in and out of the nose. If thoughts come to your awareness allow them to come and go without judgment and let the attention return to the breathing. There is no need to struggle with the activity of the mind, nor even wish that it wasn’t there. Like ‘trains of thought’, just let them come and go.

After a time, let the attention move to the listening. Hear whatever sounds there are to hear without having to analyse the sounds. Once again, if thoughts come let them pass. If the mind becomes distracted, for example by listening to some mental commentary or chatter, simply notice and return to the sounds as a gentle way of returning to the present moment.

At the end of this exercise simply be aware of the body again and then slowly allow the eyes to open. After a few moments quietly move into whatever activities await you.

This exercise can take anywhere from a few seconds to a couple of minutes. It is a short punctuation in a busy day between finishing one activity and starting another, for example before starting the car, beginning a meal, before an interview, or between patients. It helps to “clean the slate” making us fresher for the next activity.

The steps and principles are the same as above but just much shorter. Be aware of the body and allow the posture to be balanced and relaxed but upright. Let the body relax generally by taking one or two deep breaths and breathing the tension out. Then let the breath settle and allow the attention to rest with it. Then be aware of the environment and the sounds in it as they come and go. Do not prolong the comma past what is appropriate for that moment, then move quietly into whatever awaits you.

If you are in a busy office and it would be conspicuous to close your eyes just keep them open but rest them on a point as you practice.

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• Mindfulness, in its simplest sense, is a mental discipline that involves training attention

• It teaches us how to use the mind in a different way

• Among other things it has been found to be associated with a significant reduction in pain, fatigue, and sleeplessness

1. McEwen BS. Ann N Y Acad Sci. 2004;1032:1-7.

2. Ma SH, Teasdale JD. J Consult Clin Psychol. 2004;72(1):31-40.

3. Teasdale JD, et al. J Consult Clin Psychol. 2002;70(2):275-87.

4. Epel E, Daubenmier J, Moskowitz JT, Folkman S, Blackburn E. Ann N Y Acad Sci. 2009 Aug;1172:34-53.

5. Kabat-Zinn J et al. J Behav Med. 1985;8(2):163-90.

6. Singh BB, et al. Altern Ther Health Med. 1998;4(2):67-70.

7. Astin JA, et al. J Rheumatol. 2003;30(10):2257-62.

8. Carlson LE. Speca M. Patel KD. Goodey E. Psychosom Med. 2003;65(4):571-81.
   

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• Free online mindfulness course - FutureLearn - Mindfulness for Wellbeing and Peak Performance 

• Mindfulness for Life: McKenzie and Hassed (Exisle Publishing)

• Know Thyself: Hassed (Michelle Anderson Publishing)

• The Essence of Health: Hassed (Random House)

• The Connection - A documentary on the Mind-Body Connection and a companion e-book, the Mindfulness Manual 

• Smiling Mind 

• PubMed A database which you can use to search for studies and medical research. 

• Better Health Channel