Everyone’s heard of mindfulness these days – stress reduction programs based on a secularized meditation practice have proliferated across many domains. How did this happen? Vipassana –or mindfulness meditation– was once slightly suspect, a habit of hippies, an exotic religious practice. The road to the social mainstream, it turns out, originated in the Ambulatory Services Department of the University of Massachusetts Hospital in Worcester. Jon Kabat-Zinn, who devised the well-known Mindfulness Based Stress Reduction (MBSR) program, was looking for a way to “catch patients who tend to fall through the cracks in the health care delivery system.” Many were people dealing with chronic pain, for whom neither drugs nor surgery provided relief.
Normal pain, like when you burn your finger on a hot iron, is an adaptive response. It alerts your brain to the damage of your skin cells and produces a motor response: you withdraw your hand from the hot iron immediately. Chronic pain, on the other hand, is pathological. The continuation of pain causes stress and is of no physical benefit. In the 1970s, medical researchers began to understand the complexity of chronic pain. Ronald Melzack and his colleagues developed a psychophysiological model that explained why chronic pain tended to intensify over time. Once the initial pain stimulus was removed, they found there were second order cognitive and affective-motivational effects. How a person interpreted pain (cognitive dimension) and the angry or helpless feelings generated by their interpretation (affective dimension) could heighten and sustain the experience of pain.
Jon Kabat-Zinn recognized that people who suffered from chronic back, neck, or shoulder pain shared something in common with serious meditators. When a person sits motionless in meditation for sustained periods, for example when on retreat, they often experience extreme pain. However, they are trained to deal with this. Traditional meditation instruction offers a coping mechanism. Meditators learn a habit of non-judgmental observation that allows them to detach the physical sensation of pain from the interpretative and emotional reactions to it. Since this process addresses both the cognitive and affective dimensions of pain, Kabat-Zinn reasoned that it could be an effective medical intervention.
Mindfulness was taught to chronic pain sufferers in an outpatient program at U Mass Hospital as part of a carefully designed research study. Two-thirds of the patients reported that their pain was reduced by at least one-third. Half of the patients reported their symptoms were reduced by 50% or more (Kabat-Zinn 1982). This study provided the justification for continuing to develop mindfulness as a behavioral intervention. Since then, mindfulness has been used in many different settings and thousands more research studies have been performed.
I’m reading a bunch of these studies for Chapter Three (still working . . . ), so come back to the blog soon!
Kabat-Zinn, J. “An Outpatient Program in Behavioral Medicine for Chronic Pain Patients Based on the Practice of Mindfulness Meditation – Theoretical Considerations and Preliminary Results.” General Hospital Psychiatry 4, no. 1 (1982 1982): 33-47.
Melzack, R., and C. Perry. “Self-Regulation of Pain: The Use of Alpha Feedback and Hypnotic Training for the Control of Chronic Pain.” Experimental Neurology 46 (1975): 452-69.
Melzack, R., and P. D. Wall. “Pain Mechanisms – a New Theory.” Science 150, no. 3699 (1965): 971-979.