Abstract
Mindfulness-based stress reduction (MBSR) programs may mitigate the effects of stress and disease. This integrative review identified 21 clinical studies on MBSR interventions. Although preliminary findings suggest health enhancement from MBSR, controlled, randomized studies, the operationalization of constructs, and qualitative research are needed.
Mindfulness-based stress reduction (MBSR) is a well-defined and systematic patient-centered educational approach that uses relatively intensive training in mindfulness meditation as the core of a program to teach people how to take better care of themselves and live healthier and more adaptive lives. 1 In addition to reducing day-to-day stress, mindfulness meditation or practice can be beneficial for people experiencing a wide range of physical and psychological illnesses in diverse life situations. 2 MBSR can be offered to heterogeneous groups and is readily adapted to various settings. 3 Additionally, preliminary efficacy of MBSR in improving health and lowering health care utilization has been demonstrated with Spanish-speaking individuals. 4,5
Mindfulness practice means paying attention in a particular way: on purpose, in the present moment, and without judgment. 6 It is not thought of as a technique, but rather as a way of being that is meant to be practiced both formally and informally on a daily basis, independent of any particular problem state. 1 Regulating one's attention, which is believed to lie at the core of perception, appraisal, and insight, may lay the foundation for effective coping and behavioral change by reducing stress reactivity. 7 In developing the capacity to step back and observe the flow of consciousness, mindfulness can short-circuit the fight or flight reaction characteristic of the sympathetic nervous system, allowing individuals to respond to the situation at hand, instead of automatically reacting to it on the basis of past experiences. 8
The cultivation of mindfulness is a daily practice in which one learns to work with the full range of human emotions and mind states. It is impossible to fail at mindfulness practice if one is willing to bring whatever one is experiencing into the field of awareness. 3 Mindfulness meditation is oriented toward what is right with people and aims to nurture and strengthen innate human capacities for relaxation, awareness, insight, and behavior change. 4 The emphasis of this practice is to encourage each individual to explore inner resources for growth, learning, and healing. 9 As such, mindfulness meditation promotes a holistic, self-regulatory approach to health, congruent with nursing values and beliefs. 10-14
MBSR programs generally consist of 8 to 10 weekly group sessions with 1 session being an all day retreat. 15 The format is skill-based and psychoeducational with considerable in-session experience and discussion. Participants are educated about the psychophysiology of stress and are provided opportunities to apply mindfulness skills to specific situations. 15 Daily homework exercises largely involve the practice of formal sitting meditation, body scan, walking meditation, eating meditation, and yoga guided by audiotapes. 16 In addition, participants are asked to informally bring mindfulness to their day-to-day activities, particularly during times of stress. 6 The group format creates a cost-effective intervention by efficiently utilizing health care providers' time.
Interest in MBSR programs has grown significantly since they were introduced in 1979 at the MBSR clinic of the University of Massachusetts, Worcester. 17 Today at least 242 MBSR programs are located across the United States and around the world. Ongoing professional trainings and internships in MBSR continue to foster interest in this treatment approach.
Although preliminary evidence suggests that MBSR programs hold promise in mitigating the effects of stress and disease on individuals, thereby promoting health, little is known about this treatment intervention. 18 The purposes of this integrative research review are to analyze the existing knowledge regarding the clinical effects of MBSR programs and to identify gaps in the current knowledge base.