Mindfulness for Health

[Introduction to, 9 Keys to Mindfulness for Health: Health Psychology, ?2023]

Mindfulness is good medicine.

The trait, state, and practice of mindfulness – a ‘mind training’ or heightened awareness of both external and internal stimuli, alongside a system of ethical and compassionate living, emerges from Buddhism with antecedents in its parent religion of Hinduism.

In fact – it’s not necessarily the best translation of the concept.

In Sanskrit, India’s ancient language in which Hindu and Buddhist terminology is rooted, the word we translate into ‘mindfulness’ in English is most closely aligned with ‘remembering’.

I like this. A journal-keeper for 4 decades thus far (and practicing mindfulness for nearly as long), I’ve always begun each new journal with “…remember who i am…” written in isolation on the book’s first blank page.

A remembering, of the true self – and equally, a remembering that ‘self’ is an illusion.

But I digress. (We’ll circle back to this.)

When in English we exhort someone to ‘be mindful’ of something, we’re asking them to take special care. In some ways this does in fact apply to the practice of mindfulness, now also secular, as we take care of our mind, our inner life, our moral and ethical way of being in and interacting with the surrounding world. The mindful state is one of heightened awareness as we pay careful attention to the details of our lives, as we notice all the richness around us – and within us.

Mindfulness, then, is a trait – some people are more naturally mindful, aware, alert, focused – and a state, which we can cultivate and in which we can be, at some times more than others. But most of all: it’s a practice, one that we can integrate into our daily lives seamlessly, and which will bring us a calmness, a contentedness, and a compassionate attitude toward ourselves, others, and the natural world.

Mindfulness is good medicine.

This is also literally intended, as the condition and practice we call mindfulness has enormous health benefits, not only mental-emotional but also physiological – and thus, the premise of this book. More on this in a moment.

But first: what, indeed, is mindfulness?

Focus and notice, as I like to say – but don’t attach.

Of course it’s much more than this, as we’ll see in our 9 keys. At its simplest, however, mindfulness means paying careful and considered – and considerate – attention to our lives, both inner and outer. At the same time, while we recognize our thoughts and emotions as they arise, we also let them drift on by, without a need to latch onto and be defined by them. This is best achieved in a state of ‘beginner’s mind’, one of openness, curiosity, and acceptance, much as we would see in a child.

Rather than, I think, therefore I am (sorry, Descartes), mindfulness is a focus on simply being, and being fully in the present moment. Being, not doing (though we’re not therefore stuck in inaction); existing, fully and richly, rather than striving toward achievement. Self-worth simply as a sentient being, rather than based on anything we’ve done.

And isn’t that already a deeply peaceful place to be?

This doesn’t mean that we no longer have goals – but we learn to have and work toward them in a way that’s separate from our inherent self-worth, that we’ve determined as important to but not defining us. One of the principles of mindfulness that we’ll see in our keys is ‘non-striving’, but we’ll also see that it doesn’t mean inaction; rather, it refers to a way of moving naturally and gracefully through life, going with its flow rather than fighting against it. More on that soon, too.

And how does this fit in with health psychology, our other premise of this book?

My doctoral degree was in health psychology, and mindfulness was an essential part of my professional life. (I say ‘was’ because I’ve just now retired from active practice.) Health psychology, in its biopsychosocial framework, helps people to create and follow healthy lifestyle choices, to discover what best motivates them to adhere to those practices, and to uncover those hidden areas of resistance that may get in their way. It’s easy to see how a mind training such as this can be complementary.

Mindfulness has found its way into many areas of psychology, in fact (Gordon et al., 2021). Buddhism itself, differing from other religions in its absence of deity and emphasis on mental training, has often been compared to psychology, and a Buddhist psychology discipline has emerged. The religion maintains a primary focus on the universal nature of suffering (Four Noble Truths) and its alleviation (8-fold path) toward an ultimate goal of release from suffering (enlightenment); mindfulness is one of the eight practices.

The health psychologist works closely with medical professionals in the hospital or clinical setting, to assist people in complying with medical regimens and adopting healthy behaviors, in order to improve their condition (Bogucki et al., 2022). A practice of mindfulness is therefore commonly found in this setting (Howarth et al., 2019; Porter et al., 2022) – and even applied to health psychologist trainees (Jiménez-Gómez et al., 2022), as well as to physicians (Murphy et al., 2023). Mindfulness does not in any way emerge from the field of health psychology nor is it used by all health psychologists, but it’s often integrated and a good deal of research as well as clinical practice connect the two.

It’s also useful to note that mindfulness, for all its focus on ‘mind’, includes a keen awareness and appreciation of the body, a focus on taking care of one’s body and physical health, and of the mind-body integration – precisely the biopsychosocial model of health psychology.

In my 4 decades of mindfulness practice, I’ve found that, while much of the focus is on the mind, it’s the practices related to my physical body that keep me grounded, connect me to the natural world, and engender a profound wonder at the workings of my body and appreciation for my existence as a creature of nature. Walking meditation, breathing practice, and indeed, a weekly 3-hour walk and meditation while deeply immersed in nature are essential to both my sense of wellbeing and presence of meaning.

Back to mindfulness. The heightened awareness or hyperattention that this practice represents, alongside nonattachment and also nonjudgment as we engage in compassion for ourselves and others, is a form of meta-cognition (Dunne et al., 2019); we observe our own thoughts, as if from a distance. Simultaneously, it represents a meta-emotional intelligence (D'Amico & Geraci, 2023), as we recognize, understand, and let go of emotions without judgment.

Further, a regular practice and state of mindfulness results in time affluence (Schaupp & Geiger, 2022); as we pay careful attention to our lives, time stretches before us and we are rich. That all too common feeling of ‘time flying by’, that increases with age and has reached an breathtaking speed in our technological era – when it’s suddenly New Year’s Eve and you’re sure that last year’s was only yesterday – fades away. When we notice and are fully engaged in our lives, we know keenly the answer to ‘where has the year gone?’ – as our experience of that year was exceedingly full, with many meaningful moments and experiences.

Time slows down. Life is rich and full. Who doesn’t want that?

Ultimately, as we become ever more adept at this mind training, with its aspects of nonattachment, nonjudgment, non-striving, and compassion, we become increasingly aware that we are connected to, even part of, all other sentient beings, what Buddhism calls ‘nonduality’. This term represents a worldview in which all phenomena ‘interexist’; mind and body are one, the individual is one with all humanity, the human species is one with all other species, and so forth – no separation. The self as an independent structure becomes less significant (Buddhism deems ‘self’ an illusion), a concept with which collectivist cultures are inherently familiar and which is innately connected to mental health (Giommi et al., 2023). This ‘quiet ego’ (Liu G et al., 2022), or self-transcendence, is what leads one, then, to enlightenment: knowledge and insight into one’s own mind, deep understanding of one’s interconnectedness, an awareness of universal truth and the nature of reality, wisdom, and contentment.

The science of mindfulness is well established in psychological, behavioral, and neurological models, delineating the effects of a present-moment, nonjudgmental focus on attention, emotion, and biological regulatory processes (Bravo et al., 2022), with a wide range of health outcomes and ongoing research in a multitude of applications. The brain has been mapped via fMRI during mindfulness practice in both clinical and nonclinical settings (Sezer et al., 2022), demonstrating alterations in neural connectivity related to attention control, self-awareness, emotional regulation – and pain relief.

Mindfulness meditation, one of its primary practices, is indeed deemed ‘good medicine’ (Wiles, 2023), promoting the brain’s executive function and salience networks (Bokk & Forster, 2022; Bremer et al., 2022). It’s also useful when practiced by clinicians themselves, improving the function and patient interaction of both physicians (Liu C et al., 2022) and psychotherapists (Shireen et al., 2022). As a model for clinical practice itself, person-centered mindfulness is considered optimal (Koenig, 2023).

The most common form of mindfulness meditation includes a focus on one’s breathing, with an awareness of thoughts and emotions as they arise followed by their gentle release and refocus on breathing. Specific topic foci are also used in meditation; one of the most well-known, meant to generate compassion, is the Loving Kindness Meditation to be later described in full, while another is a meditation on one’s own death, and there are many more. Guided imagery is often used by novice meditators, a type of meditation in which the voice, in person or recorded, of another (or a recording of one’s own voice, for the strongest effect) guides one through a mental image or experience.

Another practice of mindfulness, technically a meditation but applied differently, is the mantram repetition. In this, a key phrase is silently repeated throughout the day to retrain one’s brain and reduce psychological distress, as evidenced in the research review conducted by Schneider et al. (2023). Positive effects of this practice were seen in the recent pandemic (Oman et al., 2022) and in US veterans suffering from posttraumatic stress disorder (Malaktaris et al., 2022), while there are many other applications (Hulett et al., 2022).

The use of one’s breath, as a focal point in meditation and a source of connectedness between mind and body, is a key practice of mindfulness. Body awareness itself, as mentioned, is also significant, including meditations on one’s body, listening to the body’s wisdom, extending compassion to one’s body, and in forms such as walking meditation. The latter can be practiced indoors or outside, and when out in nature, often has a secondary effect of increasing one’s feeling of connectedness to the natural world (Sanyer et al., 2022) which in turn promotes one’s personal health (Djernis et al., 2023). Technology has also contributed to the practice of mindfulness, including apps and podcasts as well as virtual and augmented reality (Harley, 2022).

Let’s return now to our premise of mindfulness for a broad spectrum of health benefits. The practice of mindfulness has been applied not only to health care but also to education, sports, the workplace, prisons, and environmentalism, among others, and nearly 50 years after its introduction to the general public beyond its Buddhist context, remains one of the most actively researched topics. In health care, we see benefits not only for mental health as one might expect, but also a range of physical concerns; as we know that stress contributes to illness both mental and physical, this isn’t particularly surprising.

As we look at some of these benefits, please also note that each research reference included in this section to follow is a very recently conducted review, thus representing multiple studies.

For mental and emotional health, we see cognitive benefits in attention, memory, and other executive function (Melis et al., 2022; Smart et al., 2022), and affective, in reduction of anxiety and depression (Johannsen et al., 2022); benefits are also noted for psychosis (Yip et al., 2022) and for PTSD (Sun et al., 2021; Vadvilavi?ius et al., 2023). Mindfulness has also been demonstrated to improve resilience (Reitsema et al., 2023; Wexler & Schellinger, 2023) and generally increases one’s subjective wellbeing (Sulosaari et al., 2022). And as we’ve already seen, mindfulness directly increases self-awareness and emotional intelligence, along with goal-setting and motivation.

When it comes to physical health, there’s evidence of benefit to sleep quality (Yang et al., 2022), chronic pain management (Feng et al., 2022; Soundararajan et al., 2022), immunity and inflammation (Dunn & Dimolareva, 2022), cardiac health specifically in lower blood pressure (Conversano et al., 2021), and gastrointestinal health specific to irritable bowel disorder (Balestrieri et al., 2023; Weaver & Szigethy, 2020). Recent research is ongoing in areas of women’s reproductive health including premenstrual syndrome, infertility, pregnancy and childbirth, and menopause. Other ongoing research, not yet conclusive, is being conducted in areas such as diabetes, multiple sclerosis, eating disorders and weight reduction, and substance abuse and addiction. (No doubt there are even more, in this very actively researched topic.)

Correlation between mindfulness and anti-aging is indicated, though also in ongoing research and not yet firmly established; initial studies indicate positive effects on protecting telomeres and reducing background inflammaging, both directly related to cellular aging, while research specific to Alzheimer’s and other dementia is also underway. The evidence is already clear, however, that mindfulness practice can help us to age well, in those previously mentioned areas of cognition, mood, chronic pain, cardiac, gastrointestinal, sleep hygiene, stress reduction and resilience – all of which have direct bearing on how we age.

Thus, the interest of health psychology in the practice of mindfulness is clear: its multiple applications to health both physical and mental, and emphasis on both mind and body, render it one of the most useful approaches to health and motivation to healthy behavior.

Our 9 keys to mindfulness for health, then, are these: attention, present moment, beginner’s mind, nonattachment, nonjudgment, body awareness, non-striving, nonduality, ego transcendence – and, our bonus: enlightenment. These are core areas of mindfulness; we’ll look at each from the perspective of health promotion and wellbeing.

Shall we begin?

9 Keys to Mindfulness for Health by Anne Hilty, ?2023

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