InSight Stress Reduction is modeled after the Stress Reduction Clinic at the University of Massachusetts Medical Center founded by Jon Kabat-Zinn.
Based on the Mindfulness-Based Stress Reduction (MBSR) program, researchers have found that:
The following article appeared in the September 1999 edition of Shambala Sun magazine. It is still a timely description of MBSR.
Jon Kabat-Zinn: The Prescription is Meditation
By Lawrence Pintak
From the inner city to the executive suite, in hospitals and prisons, Dr. Jon Kabat-Zinn’s meditation courses are helping thousands handle illness stress, anger and addiction. Lawrence Pintak profiles the man who has brought meditation to the American mainstream.
John Coolidge was alone with his mind. Paralyzed and rendered deaf by a disease that had attacked his nervous system, Coolidge’s eyes were his one link with the world. And now to protect his eyes, the doctors had decreed that each night they must be covered with gauze.
He was left totally isolated—unable to feel, unable to move, unable to hear, unable to see, unable even to breathe without the respirator which kept him alive. "The good news was that my mind worked fine. The bad news was that my mind worked fine," says Coolidge, looking back on the experience.
Through the long hours of the night, Coolidge lay awake and alone, too terrified to sleep. For some, it would have been a prescription for panic. But John Coolidge knew to seek refuge in the one physical sensation he had left—his breath.
"I had been taught a meditation technique in which you watch your breath—in goes the good air, out goes the bad. The ventilator was moving my chest up and down, and it was the one solid thing I had going for me," he recalls. For Coolidge, the simple act of concentrating his awareness on the flow of air into his body provided the anchor that kept his mind under control.
Awareness, concentration and control. This is the mantra of a movement which is today helping thousands of Americans cope with pain and the emotional stresses which, medical science is proving, contribute to disease. The foundation of this movement was laid twenty years ago by an MIT-trained microbiologist who believed science did not end at the laboratory door. Exposed to martial arts, yoga and Zen meditation as a student, Dr. Jon Kabat-Zinn came to realize that Buddhist yogis and Western researchers had much in common.
"They were all inquiring about the nature of reality, the nature of the mind, the nature of being human," says Kabat-Zinn, "and I just didn’t see a big dividing line between one way of inquiring and another."
Kabat-Zinn took a sabbatical from medicine to head the Cambridge Zen Center, and the deeper his practice became, the more convinced he was that meditation could play a crucial role in the healing process. The key was proving it.
"This was unbelievably powerful stuff that no one was looking at from a scientific point," says Kabat-Zinn, a compact man with the face of a Brooklyn street fighter. "But then I came to see that research had been done for years—by meditators and yogis."
As author of the best-selling Full Catastrophe Living, Kabat-Zinn literally wrote the book on using the mind to help heal the body. "He was one of the first people who took Eastern disciplines and began to measure their effects from a clinical perspective," says Garrett Sarley, executive director of the Omega Institute in Rhinebeck, New York, one of the country’s leading centers for mind-body seminars and retreats. "For a doctor to go out and forge that path took a great deal of courage."
Mindful breathing is the core of Kabat-Zinn’s brand of body-mind medicine. "Mindfulness is a way of living your life and holding all of experience," he says, sitting in his office at the Center for Mindfulness in Medicine, Health Care and Society at the UMass Medical Center in Worcester. "These kinds of practices—mindful yoga and meditation—actually have effects on the body that are in the direction of greater health and well-being."
In the two decades since Kabat-Zinn founded the Mindfulness Center, more than 10,000 patients have been through his "stress reduction program"—almost all referred by physicians and other health care professionals. Countless thousands more have taken classes at the more than 240 mind-body stress reduction clinics that have sprung up around the world, many created on Kabat-Zinn’s template. Dramatic reductions in physical and emotional symptoms are common among course participants suffering from a broad range of chronic diseases and medical problems, even as their ability to handle pain and stress increases.
It was at such an eight-week program that John Coolidge learned to watch his breath, three years before the auto accident that left his pelvis crushed and triggered the onset of Guillain-Barre syndrome, a trauma-related disorder that causes paralysis by attacking the lining of the nerves.
"It felt like I was dying in phases," recalls Coolidge, shortly after he was released from six months of hospitalization. "I basically meditated my way all through it. My folks would literally see my heart rate and respiration rate go down on the monitors. You could literally see the relaxation electronically."Before the ordeal was over, Coolidge would use the techniques for more than just stress management. As feeling slowly began to return to his limbs, the lumbar punctures that tracked his recovery—tests in which electrically charged needles were inserted into the nerves—became increasingly painful.
"It was like getting hooked up to an electric fence for an hour," he recalls with a shudder. Once more, Coolidge resorted to meditating on his breath.
"It absolutely helped to offset the pain," he says of the breath meditation. "You’re still aware of it, but it doesn’t control your thinking. The pain or the fear doesn’t have to be dominant. That doesn’t mean it disappears, but it doesn’t have to be the only thing going on."
Would Coolidge have survived if he had not gone through the Kabat-Zinn program? Probably, but he suspects the experience would have been much worse. "The meditation allowed me to concentrate the fight that was in me on productive areas," he explains. "I was able to fight the disease, the paralysis, the pneumonia, and not at any time fight the fact that I was in those circumstances—not spend any time being angry."
"Holding on to how it should be, rather than how it is, is a huge energy drain for most of us," instructor Florence Meyer tells a stress reduction class assembled on the second floor of the Joseph Benedict Building at UMass-Memorial Hospital. Meyer is seated cross-legged on a meditation cushion.
Two dozen people, a mix of corporate executives and blue collar workers, professionals, and middle-class grandmothers, doctors and psychologists, are scattered around the crowded room, some on cushions on the floor, others perched on chairs that line the walls. They have one thing in common: they are all trying to cope—with stress, with pain, with disease.
"Have you ever heard how they trap monkeys in India?" Meyer asks, beginning a story that is a staple of the course. "They put out a box with a hole just large enough for the monkey to fit his hand in. Inside is a banana. Once the monkey grabs the banana, he can’t get his hand out. All he has to do is let go of the banana. But he doesn’t, and he’s trapped.
"What are the things we hold on to that trap us?" she asks the group, which she has just led in a 40-minute silent meditation.
"We all have things we don’t have control over," says Meyer, one of nine staff members who teach both students and other instructors from around the country. "But there is always something we can control—when we are going to give something energy and when we’re not."
Control. The word echoes through the classrooms and literature of the Mindfulness Center. "Most days are like playing ‘Beat the Clock,’ " says Susan, an emergency room nurse who, like many in the room, is struggling to handle the pressures of work, family and life. "I used to lose control and escalate with the people I work with. Now I can step aside, take a few breaths and continue my work in a calm manner."
Judy, who is juggling two jobs to get by, says the pressure had become too much the previous day, and she finally broke down in tears.
"If you had connected with what was going on, you could have made a choice," Meyer reminds her. She recounts for the group the steps toward facing stress mindfully: "Be aware of the feeling. Go to the breath, even if it’s just for a moment. Re-connect with yourself. The cause of the stress may not go away, but that’s okay. You can now make a choice how to react."
"It was an amazing thing that I was able to get control of my stress," affirms Linda King, a self-confessed "Type A personality" who was able to discontinue her high blood pressure medication after taking the course. "It sounds very simple—it’s all about centering yourself and breathing—but physiologically it has a tremendous effect on the body."
"I’ve seen a number of people go into that course and come out more insightful, better able to deal with their symptoms, and sometimes actually having less symptoms," confirms Dr. John K. Zawacki, a UMass gastroenterologist who has referred many patients to the program.
Documenting those changes has been a prime goal of the Mindfulness Center.
"What that group did—and that’s where they really should be applauded—is they took seriously the need for well-done, randomized studies," says David Larsen, president of the Washington-based National Institute for Healthcare Research, which has helped create courses in spirituality at some sixty medical schools. "They’ve really made a difference, so that now you even have insurance companies funding this type of effort. They’re a model for the rest of us."
Kabat-Zinn and his team have published more than a dozen detailed studies on the effects of mindfulness meditation in major peer-reviewed medical journals. "Unless you are writing up these kinds of experiences in the medical literature in ways that are scientifically valid and reproducible by other places, then it’s just, ‘I hear they do great things over at UMass Medical Center,’ but it wouldn’t go any deeper," says Kabat-Zinn.
Overall, controlled clinical studies carried out by the center have documented symptom reductions of between 29% and 46% among class participants. Breaking it down by condition, people with heart disease experienced a 45% reduction in symptoms; high blood pressure, 43%; pain, 25%, and stress, 31%. Those are the kind of numbers that get the attention of health care providers trying to control costs. Insurance companies and HMOs like Tufts are now picking up at least some of the cost for about a quarter of the program’s participants.
"From our personal experience, we have found their studies to be well-designed and robust," says Dr. Tehseen Salimi, director of medical services for Cigna Healthsource Massachusetts, which is funding a trial program documenting the effects of the mind-body stress reduction course on patients suffering from three specific ailments.
But insurance companies aren’t paying for meditation classes out of the goodness of their hearts. Lowering someone’s blood pressure enough to get them off medication, or helping an ulcer patient redirect his stress, means fewer costs for them. For example, a Kabat-Zinn study published last autumn reported that the skin lesions of psoriasis patients who listened to meditation tapes while undergoing light treatments cleared up four times faster than those who did not. "The implication is that the mind can actually enhance the healing process by a factor of four, and if people need fewer treatments, it costs less," Kabat-Zinn explains.
Participants in the stress reduction classes do more than just sit watching their breath. They are taught simple yoga movements and introduced to a "body scan" technique borrowed from Vipassana meditation, in which they are guided through a process of shifting the focus of their awareness to different parts of the anatomy.
The point of it all is to "be present in your body," as the instructors constantly remind their students, in order to "see events with more clarity and directness" and thus consciously "control what is controllable, and release the rest."
"Most people don’t listen to their bodies at all," says a medical doctor enrolled in a recent course. "They’re so busy doing whatever they’re trying to do, they’re not thinking about what their body’s telling them they should or shouldn’t do."
Each student in the course, which meets three hours a week for eight weeks, is given a set of guided meditation tapes and expected to do at least forty-five minutes of practice each night.
"It’s not a cure-all. It’s not like some magical thing," insists Bob, a stressed-out Metrowest executive who was on tranquilizers and suffering from irritable bowel syndrome before taking the course. "I remember some people saying, ‘I feel ripped off, I thought this was going to be awesome and it wasn’t.’ I think that’s because people think that someone else is going to fix their lives for them. What I found is it’s really hard work, but it’s worth it."
But it is no panacea. That’s evident in the haggard face of a young mother who arrives late to a class at the Mindfulness Center’s inner city campus at a UMass hospital in one of the poorest areas of Worcester, a moribund industrial city in central Massachusetts.
The reek of stale cigarette smoke clings to her like a dirty blanket. She can’t be more than thirty years old, but worry has etched deep hollows in her frail face, adding a decade of age. Her movements are sharp, nervous. She holds her trembling hands firmly in her lap, as if consciously forcing them not to reach for the next cigarette in the chain.
"Do you manage to do the daily practice?" a visitor asks her during a brief break. "Sometimes," she hesitantly replies, eyes shyly straying toward her questioner. "Not much. I have a little daughter, so it’s hard ..." Pause. " ... and we’re homeless."
"They arrive here shaking; sometimes life and hope aren’t present in their eyes," says Fernando A. de Torrijos, director of the inner city program. "The doctors don’t know what to do with them, so they send them here."
Drug addicts, alcoholics, victims of abuse. All the pain of inner city life is present in the class, which many participants take two or three times.
"I feel like I am bound by chains that I can’t break," says Louise, a woman of indeterminate age who struggles to form the words. She appears mentally handicapped, but experts say the symptoms are actually a legacy of years of abuse, followed by lengthy incarceration in a mental institution. "They tore me down," she says.
"We can use meditation to be present in our situation and use that awareness to break out of our chains," explains instructor Melissa Blacker, a psychologist who was a grief counselor before joining the Mindfulness Center.
But can they? Is there a point at which the burden is just too great? "They come from such a difficult starting point," Kabat-Zinn acknowledges. "We’re not taking people the entire distance to anything in eight weeks. But a lot of the work that we do is planting seeds. Even if you drop out, if you’ve heard one person say, ‘I did this and my pain went away,’ or ‘I handled a very difficult situation in a positive way,’ that’s potentially life-changing."
The inner city classes are free to those who don’t have insurance and can’t afford to pay, the vast majority. Referrals come from clinics, support groups and shelters in the city. Free taxis and child care encourage attendance. Instructors make frequent follow-up calls to those who miss classes, which are also held in Spanish.
Still, since its inception, only 600 of the 2,000 participants have actually completed the inner city course. John, an on-again off-again drug addict, is one who’s made it through the program. He has been an intermittent participant since 1992 and has attended every session for the past two years. Battling a potentially deadly Hepatitis C infection, coping with depression, fighting pain, he is on a toxic cocktail of prescription drugs even as he struggles to stay "clean."
Since he has stuck with it, the meditation class has brought his soaring blood pressure down 10 points. "It’s life or death, but it’s not easy," he says, the words coming in manic, machine-gun bursts. "If I don’t do this, then I will have a heart attack and die."
The desperation is apparent in his voice. "It takes a lot of practice and I have to practice for the rest of my life. It has to become automatic and that’s what I’m working on."
"It’s one of those things that works when you work at it," confirms Sarah, a legally blind diabetic who has attended the course once before. This time she has brought her husband, whose heart is severely damaged. "When I use it, I find myself more calm, relaxed, mellow—better equipped to face the world."
But, she is asked, does it change the difficulties that surround her? "No, but it helps me to respond rather than react, and respond in a more appropriate manner, calmer," she adds with a laugh, "rather than just plunging into things."
Fifty miles and a world away, the attorneys at Boston legal powerhouse Hale and Dorr are also learning to respond more calmly. Last autumn, forty of the mega-firm’s 360 lawyers attended an eight-week course held right in the firm’s elegant State Street offices.
"They found that it improved their ability to respond to many of the challenges and stresses they encounter," reports Brenda Fingold, a partner in charge of training and development who organized the course. "They’re more focused, better listeners and have more energy."
Still, it’s hard to picture a high-powered lawyer stopping to breathe "mindfully" in the heat of a courtroom battle.
"You’d be surprised," says John Hamilton, a senior partner who is now taking one of the firm’s monthly refresher classes. "Lawyers for a long time have done that, stepped back and taken a breath, but this is a more focused and deliberate way of doing it. It’s amazing how refocused you can get. It’s like a muscle—if you keep working at it, it really does prepare you to go into battle."
What is true in the courtroom, participants in the Center’s corporate retreats claim, is also true in the boardroom. "What the practice does is help you bring attention or awareness to whatever is going on. That can be a major financial transaction, management decisions, employee issues or situations at home," says David Friedman, CEO of the Sandy River Group, a chain of long-term care facilities.
But isn’t $4,000 per person—before room and board—for a week of meditation at the corporate retreat programs tough to justify on the bottom line? "It’s mindfulness, but it’s also good business practice," insists Friedman, who has introduced mindfulness training to some of his own senior managers since taking the course.
"I can’t give a cost-benefit analysis, but I know anecdotally that it’s well worth the money we’re spending on it," says Hamilton of Hale and Dorr, which is about to sponsor a second eight-week in-house course.
And what’s good for private industry just might be good for government. A four-year mindfulness training program that Kabat-Zinn and his team ran in the Massachusetts prison system brought notable reductions in the level of hostility and confusion among prisoners who took the course—that is, until funding was pulled in the heat of the 1996 gubernatorial campaign.
"State Spent Bundle on Yoga for Cons," read a Boston Herald headline that torpedoed the program. "Weld to KO $900G Prisoner Meditation Program."
The paper reported that "a study had found the program to be virtually worthless," Kabat-Zinn recalls ruefully. "We couldn’t respond because we hadn’t processed the data at that time." The detailed response will come in a paper soon to be published in a major criminal justice journal. Based on 1,000 prisoners who took the course, the team documented a 38% increase in self-esteem and a 9% drop in hostility among women, and a 28% increase in self-esteem and 7% decrease in hostility among men.
"The larger implication is that if you are less hostile you are less likely to beat on others," Kabat-Zinn explains, getting excited, "and if you’re self-confident you might be more likely to get a job rather than rob somebody and get addicted to drugs. That ultimately translates into reduced recidivism rates."
Seated in his hospital office decorated with medical degrees and mandalas, Kabat-Zinn eyes his meditation cushion and reflects on his past twenty years in mind-body medicine: "It’s exciting and sobering that these two different worlds have come together. The book hasn’t been written about what is ultimately possible."
Mindfulness meditation may have its roots in an ancient tradition alien to most Americans, but what Kabat-Zinn and others like him have done is strip it down to an essence everyone can understand. "It’s the heart of Buddhist meditative practices, the heart of Sufi practices, the heart of all spiritual practices," he says. "We’re pointing to something that lies in the heart, not out there in history."
Is it Buddhism, or, as some critics claim, another example of Buddhism-lite? "It’s not like we’re trying to create Buddhists," insists Kabat-Zinn, whose instructors come from backgrounds that include Buddhism, Sufism, Yoga and Theosophy. "We’re trying to take that fundamental universal lawfulness that comes out of the Buddhist tradition and see how that is relevant to our lives as regular Americans who aren’t interested in becoming anything else, but might really be interested in becoming who we actually are."
Which means, he says, his clients arrive with a very different set of expectations. "None of them comes with the baggage that people often bring to a meditation center, like, ‘I’ll get enlightened,’ or ‘I’ll sit at the feet of the guru.’ People are coming because of their suffering—it’s as pure as you can get."
Kabat-Zinn calls it American Dharma: "I’ve always thought that it’s about time that we make Buddhist practices commonsensical and part of the American repertoire, so that they’re not foreign, they’re not Asian, they are American."
"Jon is a really good example of somebody who is working very hard to be a translator in the pure sense of the term, without watering down the teaching," says Sharon Salzberg, a founder of the Insight Meditation Society. "Somebody might get involved in Buddhist teaching to address the problem of their headaches, and then they find out some things about themselves and the capacity of their minds and their ability to have compassion. That can be more transforming than they ever imagined, but their initial entrée is something to do with their health."
And while some students do go on to study more advanced Buddhist practices, for most it is the fact that the teachings are reduced to their essence that makes them most valuable.
"You don’t have to go off on a retreat to a cave and do this," argues Hale and Dorr’s Hamilton. "It’s very practical."
"It’s great to have a practice and sit on a cushion and get whatever you can from that," observes Friedman, the CEO. "But for me, the real value is integrating it into my everyday life."
"I get excited about the fact that breath is something I always have with me," agrees Janet, a Massachusetts housewife. "That I don’t need an extra bag for it, that I don’t need to pay for it, that I don’t need to ask somebody for it. It’s a tool I just have and I can call on it whenever I need it."
John Coolidge, whose breath helped him survive the isolation of paralysis, can testify to that.
Lawrence Pintak is a writer, broadcaster and newspaper editor based in Massachusetts who reports regularly on issues of the body, mind and spirit.
Jon Kabat-Zinn: The Prescription is Meditation, by Lawrence Pintak, Shambhala Sun, September 1999.