Applying Mindfulness Approaches to Stress Reduction
Stress. There is no way to avoid it in today’s fast-paced world. There are, however, ways to better manage stress and anxiety, according to Susan Evans, PhD, Professor of Psychology in Clinical Psychiatry, Director of Education in Psychology, and Director of the Cornell Cognitive Therapy Clinic at Weill Cornell Medicine. Dr. Evans, who is an expert in the cognitive behavioral treatment of anxiety and mood disorders, also specializes in stress management, and specifically Mindfulness Based Stress Reduction (MBSR).
Dr. Evans became interested in MBSR in the late 1990s and completed an internship in 2000 at the Center for Mindfulness at the University of Massachusetts Medical School under the direction of Jon Kabat-Zinn, PhD, creator of MBSR who originally developed the program as an aid in pain relief. Dr. Evans then established the Mindfulness Based Stress Reduction Program at NewYork-Presbyterian.
“Mindfulness is best defined as moment-to-moment non-judgmental awareness; it’s about training your mind to be completely present, right here, right now in the moment,” says Dr. Evans. “The way we do that is through certain formal meditation practices.”
Mindfulness meditation is steeped in the tradition of Theravada Buddhism, Zen practices, and yogi practices, explains Dr. Evans. “Dr. Kabat-Zinn and others have done a lot to westernize the practice; for example, removing any religious language so that it is very palatable. It is not about religion, but it is based on this eastern contemplative tradition.”
Dr. Evans’s MBSR program is an eight-week course, conducted in the spring and fall, primarily for people in the community – working professionals, students, or at-home parents, for example, who are interested in learning how to better manage the stress and anxiety in their lives.
“These are individuals who are not necessarily coming in with any clinical diagnosis of anxiety or depression,” says Dr. Evans. “But I do give them measures of mood states that have various subscales, including anxiety, tension, depression, and fatigue. They score higher than a normative sample that the scale is based on, so it suggests that there is a lot of worry out there. These people are functioning well, but they actually are mildly symptomatic in terms of mood and anxiety.”
Dr. Evans screens participants with the Mindful Attention Awareness Scale designed to assess core characteristics of mindfulness, informed by a sensitive awareness of what is occurring in the present. The scale is comprised of a collection of 15 statements about everyday experience, such as “I do jobs or tasks automatically without being aware of what I’m doing,” with a scale of one (almost always) to six (almost never). Higher scores reflect higher levels of dispositional mindfulness.
The MBSR program consists of formal meditation practices that include body scan meditation in which one focuses on different parts of the body as a way to be present. “We also employ sitting meditation where the primary focus is on the breath. Not changing or manipulating breath in any way, but having the breath as a place to come back to when your mind goes off,” says Dr. Evans. “The other practice is gentle hatha yoga, focusing on the pose and the breath as an anchor to which to return when your mind wanders.”
The program requires a significant time commitment. “There is daily homework and that includes practicing meditation about 30 to 45 minutes each day,” notes Dr. Evans.
Healthcare providers have found the program beneficial as well, says Dr. Evans. “We also conducted a pilot study with medical students here at Weill Cornell Medicine who went through the mindfulness course. They appeared to really enjoy it and benefit with reductions in stress and improved mood. They also said they would like to have shorter, 10-minute meditation practices.”
More recently, Dr. Evans has been examining the constructs of self-compassion and acceptance and how these factors may play a mediating role in the positive findings of MBSR. “We know that from the studies we’ve done here and elsewhere that people experience reductions in anxiety and improved mood and well-being pre to post the eight-week mindfulness sessions,” says Dr. Evans, who conducted an earlier study on MBSR and distress in a community-based sample of 14 participants (see graph below). The results suggested that MBSR appeared to be associated with a reduction of distress and increased awareness of everyday life experiences.
“A question we are exploring now is whether self-compassion and acceptance mediate the positive effects of mindfulness training,” she says. “Self-compassion involves adopting a kind and understanding stance towards ourselves, as well as taking the perspective that suffering and experiences of personal shortcomings are universal. Acceptance entails adopting a balanced approach to negative emotions so that feelings are neither suppressed nor exaggerated.
“Early research in the usefulness of MBSR conducted by Dr. Kabat-Zinn centered on its effect on pain and then anxiety disorders,” says Dr. Evans. “Since then there has been a burgeoning of research and interest in the techniques in the last 10 years.”
In September, Dr. Evans presented research on MBSR in Stockholm, Sweden, at the European Association of Cognitive Behavioral Therapy. Her study, which is under review for publication, was based on data collected on 42 community-based individuals, ages 25 to 74, who completed the eight-week MBSR course. Overall the participants benefited in decreased mood symptoms, and increased mindfulness, acceptance, and self-compassion.
“More and more MBSR is becoming enormously popular,” says Dr. Evans. “When I started the program here at NewYork-Presbyterian, it was relatively new. People weren’t so sure about it, but today it has become part of mainstream health care.
“There’s much more interest now in teaching these skills to young children,” adds Dr. Evans, “and so we are seeing things like mindful eating being taught in schools. I think we’re going to see more of that in the future.”
Evans S, Ferrando S, Carr C, Haglin D. Mindfulness-based stress reduction (MBSR) and distress in a community-based sample. Clinical Psychology and Psychotherapy. 2011 Nov-Dec;18(6):553-58.
Evans S, Ferrando S, Findler M, Stowell C, Smart C, Haglin D. Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders. 2008 May;22(4):716-21.