Chapter 21: Sustained Mindfulness Development Versus Mindfulness-Based Therapies

Paying attention to the breath or the body as described in the previous two mindfulness-related articles, will help to keep otherwise wandering mind at one place—keep the mind in the present moment. Developing the skills necessary to keep the mind in the present moment and in a non-judgmental way, would lay a positive foundation for improving brain activities. Mindfulness boosts self-awareness and makes one aware of thoughts coming to the mind, so as feelings of bodily sensations as they arise and go and gives one an opportunity to be aware of impermanence. 

Instead of suppressing thoughts and making judgments, maintenance of mindfulness trains one to recognize, accept, and let go of these incoming thoughts and experiences. The ability to maintain the mind (thoughts) in the present-moment experience leads to the ability to focus and concentrate the mind on the current moment (3). In addition, the practice keeps the mind in the present, allowing one to experience and use optimal behavioral choices (4).

Mindfulness training methods:

The skills associated with mindfulness training can be taught in a secular way (5). However, the basic development and understanding of mindfulness derived from Hindu and Buddhist teachings and practices. When a small component of ‘mindfulness activity’ is extracted from Buddhist teachings and try to implement as a standalone entity, as with mindfulness-based stress reduction (MBSR) and similar practices, would not provide the intended or sustained benefits of the Right Mindfulness practices taught in Buddhism. The latter will be explained in the next article.

Association, understanding, and the development of compassion and altruism, etc., are integral parts of Buddhist teachings. Collectively, these activities markedly improve in clinical outcomes in a sustainable manner (15). In basic mindfulness development programs, secular practices are taught without referring to a religion or religious quotation. However, advancing the path of mind development in the absence or devoid of spirituality, is unlikely to be successful. However, for many, the expectation is to establishing regular mindfulness. That itself can lead to mental and physical relaxation, though may not be sustainable.

What does mindfulness offer to us in this life?

Over the past two decades, MBSR and mindfulness-based cognitive therapy (MBCT) have been used experimentally and therapeutic manner for a variety of disorders. The most important and the beneficial aspect of right mindfulness is prevention of ailments, including, anxiety, depression, anger, jealousy, and reducing the risks and the severity of certain disorders. Right mindfulness can be effectively use as a prophylactic tool for disease prevention. Thus, it is not surprising that, meditation practices has been used over thousands of years to relieve stress, overcome and prevent depression and anxiety, and perhaps stress-associated other ailments such as cancer.

Mindfulness meditation promotes the therapeutic effects, improving the “bare attention.” Mindfulness skills, such as non-judgmentally and non-discursively attending to our mind—the moment-to-moment flow of consciousness (16)—are key parts of training that are explicitly taught in traditional Theravāda Buddhist doctrine and its meditative practices.

Buddhist mindfulness practices and disease prevention:

Buddhist meditation teaching and practices can be useful in understanding psychological disorders. In addition, such would also increasingly influence psychotherapeutic management. A case study that used the Theravada Buddhist mindfulness meditation and cognitive therapy practices as treatment, in people with depressive disorder reported positive outcomes (17). It emphasized the influence of Buddhist concepts and mindfulness meditation practices on synergizing psychotherapeutic approaches.

Others have suggested variances to such practices, such as incorporating a contextual view of the Buddhist teachings of mindfulness into the application of psychotherapy, including an understanding of the core mechanisms of different modalities of mindfulness and psychotherapy (18). Such teachings are thought to augment innate health in ordinary life activities, thereby supporting a natural healing path for each individual.

The current tendency of incorporating the Buddhist psychology into psychotherapeutic practices is encouraging and worth pursuing further. However, research must be conducted with open mindedness to evaluate how such practices can be optimized and individualized. In addition, many, unique approaches to alleviate the suffering from mental disorders and the psychological aspects of physical disorders have been described in Buddhist teachings. 

Incorporating Buddhist mindfulness teachings and practices to medicine:

Practical and easily implementable specific aspects of these teachings could be developed into protocols and incorporated as an adjunct therapy to allopathic medicine, for the benefit of patients. Some have expressed the need for conducting research into the neuroscientific correlations of Buddhist concepts of the mind and examine evidence-based use of techniques such as meditation in psychotherapeutic practice (18).

Many use some form of meditation techniques that are integral to their needs and believe that those would enhance the cognitive and affective states of minds (16). In addition, Mahāyāna Buddhism’s teaches skillful means for liberal use of methods or techniques in practice that yield insight into understand the self-nature and to aid in alleviating or eliminating duhkha (i.e., dissatisfaction). 

Few however, assume that participating in the currently popular, short versions of relaxation programs (e.g., MBSR, MBCT, etc.) may cause harm to participating research subjects; perhaps in a similar manner to intentionally subjecting healthy volunteers to the use (test) new pharmacological therapies (16). Nonetheless, there is no evidence of harm and no such concerns or oppositions are reflected in Buddhist teachings.

Taking a less-effective approaches:

Because of the commercial interests, desperation for obtaining funding for research and fame, and lack of understanding of true value of the Right Mindfulness, more than 95% of the current (and ongoing) published mindfulness-based reports are on truncated form of research (that are distanced from Buddhist teachings) and are directed to therapeutic interventions. Whereas, the true value of Right Mindfulness is on “prevention” of diseases, defilements, and mental ailments. discomfort. In addition, the various data reported from short-term, 4- to 8-week training courses, although popular, outcomes are not sustained REF.

While, some of these programs use the right concepts, such as attention, non-judgment, and non-discursively attending to the moment-to-moment consciousness, these are used in isolation, disregarding the big picture of the mind and its development, as taught by the Buddha more than 2,600 years ago. The lack of sustained outcomes with such short course are in part due to the mentioned compartmentalization, lack of association with spirituality and true mental development. In most circumstances these training programs are geared to achieving relaxation as the final goal. Whereas, in Buddhist meditation practices, the mind?body relaxation is the beginning—first step of the meditation process. This is a key difference between the two methods.

Mindfulness training should be use for prevention:

Promoting mindfulness meditation for therapeutic effects, albeit attractive and profitable, it is not the best or right approach. Prevention is the best treatment. Instead, mindfulness development should be used to preventing mental and physical disorders, using holistic approaches. Lack of taking appropriate steps to prevent diseases is like, holding the tail to destroy a tiger—person will never win—failed to overcome from disorders and suffering. 

The above principle applies to individual, families, communities and indeed for countries. Whereas, when prevention is given the priority (whether preventing diseases, accidents, injuries, floods, and other harm) harm can be minimized and disorder(s) can be contained. In the case of diseases, there is no need for expanding hospitals or acute healthcare centers. If done, that is for the benefit of politician and business-people to make money. In addition, prevention is not glamorous and there is no opportunity to mentioned people to make fortunes; thus, no wonder why disease prevention is not popular.

The use of mindfulness for therapeutic purposes, such as treating patients would help. However, it is a small beneficial outcome of the use of mindfulness in the populous. Thus, the important focus of the mindfulness should be to “prevention” of diseases, physical and mental illnesses. This is where mindful meditation can be most valuable to people.  At present, this is virtually neglected because of a lack of understanding and appreciation of its great potentials.

Summary:

In this regard, emphasis has been given in the Theravāda Buddhist doctrine, depicted in Buddhist suttas, to the use of meditative practices in disease prevention. In addition, the cultivation of one-pointedness—present-centered awareness—together with spirituality, are exemplified and taught in Zen and Tibetan Dzogchen and other Buddhist practices. These would immensely benefit the vast majority of practitioners. Rather than using truncated modules with short lived benefits, Buddhist meditation teachings, practices, and insights can be effectively adapted to current situations for the modern society for the benefit of most people.

The next chapter examine few examples of mindfulness-based short-term clinical studies.  

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Professor Sunil J. Wimalawansa, MD, PhD, MBA, DSc, is a physician-scientist, educator, social entrepreneur, and process consultant. He is a philanthropist with experience in long-term strategic planning, and cost-effective investment and interventions globally for preventing non-communicable diseases [recent charitable work]. The author has no conflicts of interest and received no funding for this work.