For Stress Reduction, Meditate!

Jon Kabat-Zinn, Ph.D., and director of the Stress Reduction Clinic at the University of Massachusetts Medical Center, is internationally known for his work using meditation to help medical patients find relief from chronic pain and stress-related disorders. More important, perhaps, he brings to the arena of mind/body science a touch of the poet as well as the pragmatist, giving us the hows and whys of meditation in a language we don't often associate with the subject.

In this interview with Bill Moyers, Kabat-Zinn describes meditation as a way of being, a reservoir of stability and insight.

How do your patients react when you begin to talk with them about meditation?

One of the questions we had to answer right from the beginning was: Would this be so weird that nobody would be interested in doing it? People might say, "What are you talking about? Meditation? Yoga? Give me a break!" Meditation had never been tried before in a medical center, so we had no idea whether mainstream Americans would accept a clinic whose foundation was intensive training in meditative discipline.

Doctors refer patients to us for all sorts of very real problems. These people are not at all interested in meditation, or yoga, or swamis, or Zen masters, or enlightenment. They're suffering, and they come because they want some relief from their suffering, and they want to reduce their stress. One reason that people take to our program is that it's completely demystified. It's not anything exotic. Meditation just has to do with paying attention in a particular way. That's something we're all capable of doing.

I wonder if it would have been as successful if you'd called it "Courses in Meditation" instead of "Stress Reduction Clinic"

Oh, I can guarantee you that it wouldn't have. Who would have wanted to go to a meditation class? But when people walk down the halls in this hospital, and they see signs saying "Stress Reduction and Relaxation," they respond, "Ah, I Could use that." Then meditation seems to make sense, because we're trying to penetrate to the core of what it means to work with the agitated mind by going into deep states of relaxation.

That makes me wonder whether you may have tapped into the power of the placebo here. People think it will work for them, so they feel better even though they're not sure what is happening.

Why not? I'll take transformational change any way it comes. One way to look at meditation is as a kind of intrapsychic technology that's been developed over thousands of years by traditions that know a lot about the mind/body connection. To call what happens "the placebo effect" is just to give a name to something we don't understand. If people have very strong expectations that something might happen, that expectation itself might be useful.

We ask people to do a lot of hard work, so we hope they'll start out with a positive attitude—even if that might be thought of as a placebo. But actually, people very often start with more of a negative attitude. We ask them just to try to suspend judgment and not to become so hard to convince that they can't listen to their own breathing or observe their own minds.

What do your hard-nosed colleagues—the cardiologists and brain surgeons, for example—think of you and this little crowd?

We get patients from all of them, and many come themselves. They feel that the proof is in the pudding and that what we really need to do is study this stuff a lot more. The notion that the mind and body are actually different sides of the same coin goes all the way back to the origins of medicine. For most of its history the practice was not separated from other aspects of human activity.

Is that why you begin with something as common and simple as eating a raisin?

Yes. The point of that exercise is to respond to all the baggage people carry about what meditation is. We want to dispel those notions right away. So we say, "Look, the first exercise we'll do isn't breathing; it isn't sitting in the full lotus posture and pretending you're in a fine arts museum, or standing on your head. We're just going to eat a raisin—but eat it mindfully, with awareness."

You look at the raisin—feel it, smell it, and with awareness bring it to the mouth gradually, and see that saliva starts to get secreted just as you bring it up. Then you take the raisin into the mouth, and you begin to taste this thing that we usually eat automatically. From there it's a very short jump to realize that you may not actually be in touch with many of the moments of your life, because you're so busy rushing someplace else.

And do you bring people back to their breathing for the same reason—to give the mind one thing to concentrate on?

Yes, exactly. Once we do the raisin exercise, people begin to realize that there's nothing magical about mindfulness. Most of us do a lot of different things when we're eating—read, talk, watch television. Slowing it down and really tasting your food helps bring you into the present moment. Then we transfer mindfulness from eating to breathing and say, "Now, taste your breath in the same way."

Some people ask, "Why should I pay attention to my breathing? It's so uninteresting." I say, "Well, if it's so uninteresting to you, try this experiment: Clamp your thumb and forefinger over your nose like this, and keep your lips closed. Then see how long it takes for breathing to become really interesting." Turns out it's not very long. We don't appreciate some of the things that are most valuable in our lives.

Breathing is central to every aspect of meditation training. It's a wonderful place to focus in training the mind to be calm and concentrated. As we experience the flow of the breath, the same reaction often comes up in relation to breathing as when we ate a raisin with mindfulness: "Wow, I didn't realize a breath is such a rich experience."

Are you suggesting that my mind shouldn't be wandering, or fleeing or that it shouldn't be distracted?

No, I'm not. A wandering mind is the normal state of affairs. But from the meditative perspective, the normal state of mind is severely suboptimal. It's more asleep than awake. The mind is someplace else, and the body is here. In that state, you can't function at your best. Any athlete will tell you that. The mind that has not been developed or trained is very scattered. That's the normal state of affairs, but it leaves us out of touch with a great deal in life, including our bodies.

Doesn't that suggest that by focusing on breathing, you're simply not thinking any longer about your pain but shifting your focus to something else?

Actually, the instructions are exactly the opposite. I don't say, "Well, just fantasize something that will be so interesting that you'll forget about your body." I say, "Go into the body, go into the lower back, breathe with it and try to penetrate the pain with your awareness and your breathing. So it's the opposite of distraction.

Physiologically, does that reduce stress?

It certainly does. Stress is the response to the demands placed on your body and mind. The more you are in distress from pain or anxiety, the worse you'll feel, and that will have physiological consequences. If you can learn to be comfortable within the pain or anxiety, the experience will be completely changed. But you're not trying to make the pain go away.

This is a fundamental point that people sometimes misunderstand at first. They'll come to the stress thinking we'll make all their stress go away. But we actually move into the stress or pain and begin to look at it, and to notice the mind's reactions, and to let go of that reactivity. And then you find that there is an inner stillness and peace within some of the most difficult life situations. It's right in this breath, and it's right in this experience. You don't have to run away to get it someplace else.

When you said to your patients this morning, "Your mind has a life of its own," was that just a figure of speech?

No, that refers to mindfulness. If you spend a lot of time observing your thoughts and feelings, you begin to realize that your thought process is very chaotic—it's here and there and everywhere else. And when you try to focus your attention on one thing, very often the mind doesn't want to stay focused on it for very long and will go off and think about this or that. Your mind has a certain kind of energy that likes to go different places, and it's very hard to concentrate and reach a state of calmness.

When you told them to bring their minds back, I thought, "Well, there is an 'I' that is independent of the mind."

We don't know what that is but we do know that human beings have a capacity for awareness and self-observation. That is really what meditation is all about—cultivating and developing the capacity to attend from moment to moment.

Often we do what's called "selfing," where something comes up that we identify with so strongly that we think, "That's me." It takes many forms: "I'm a failure, I'm no good, I'm inadequate, I'm unworthy." Feeling unworthy is not a problem; unworthiness is a common human feeling. But as soon as you connect "I" to it, you classify it, and it becomes much more real, more concrete. Then you've got a real problem.

We often work with people who have panic attacks and extreme anxiety. If you have panic disorder and you say, "I'm afraid," and the "I" function identifies with the content in the mind that is fearful, then the fear takes on a reality of its own and begins to take over your life. But if you step back and just look at the fear and notice that it usually takes the form of thoughts and feelings in the mind, all of a sudden you become the observer: "Oh, there's that thought coming up. The content of it is fear, and it has a heavy-duty charge, but I don't have to get sucked into it."

Is that what you mean when you say, "I want you to become the scientist of your own mind and body?"

Exactly. To know about it from the inside. To become so familiar with its workings that when something comes up, you actually observe it, and you can say, "Wow, I haven't seen this one before."

But being the scientist of your own mind/body connection doesn't mean you have to control it. It's not as if we're trying to get hold of our superphysiological control knobs and tune up our immune system and tune down something else. What we're learning is a new kind of science and inner science in which you become more familiar with the workings of your own body. That doesn't mean you could write a scientific treatise about it. What it means is that you'll live more intelligently. You'll make decisions that are more apt to bring you in touch with the way things work for you in the world.

Is there a scientific basis for the work you're doing with meditation?

We're trying as best we can to deliver this intervention based on intensive training and mindfulness. At the same time, we're attempting to study it scientifically. What we've found is that there seems to be remarkable symptom reduction, both physical and psychological, over the eight-week course, and it tends to persist over time.

For example, people come to the clinic with panic disorders, which are usually treated with medication. We don't address their panic or fear directly, we just teach them mindfulness, and they practice that over the course of the eight weeks. Their levels of anxiety and panic drop dramatically over the eight weeks and, according to our later study, for at least three years.

How do you explain that?

Well, something is going on here that reaches the organism as a whole. What it involves is basically training people to watch their thought process as a flow and to step back from it in the way that we were talking about before and not immediately hook the "I" onto it.

Now the people with panic disorder may or may not be experiencing fear at any given moment while they're practicing, because the mind is constantly changing and coming up with this or that. They're simply asked to observe, to be mindful, to stay in the body, and to watch what's going on in the mind, learning neither to reject things nor to pursue things, but just to let them be and let them go.

Because you've been training yourself in the meditation practice to stay in the present moment, and to calmly watch these events in the field of your consciousness, like waves coming up in the mind, you don't get so hooked by the emotional content and you aren't sucked into terror. You realize, "Well, those are thoughts, too," and you come back to your belly and back to your breathing.

In that way, you begin to experience what I mean when I say "your wholeness." You realize that you are more than a body. You are more than the thoughts that go through your mind. And you begin to realize that you're an elaborate universe that's very hard to describe or understand but that is quite miraculous. If you feel comfortable within it, even if you don't understand it, then you can live your life with a greater sense of control, especially in relation to situations that previously might have sent you spinning out of control.

A lot of people are going to think, "Why don't I just relax on the couch instead of doing this exotic, un-American thing? All that mumbo-jumbo about mindfulness—I mean, what in the world is going on?"

When you're lying on the couch and taking it easy, if you watch what's going on in your mind and body, you may discover that it's far from relaxing. You may be doing a lot of thinking, or daydreaming, or worrying, or fantasizing.

Most people don't realize that the mind constantly chatters. And yet, that chatter winds up being the force that drives us much of the day in terms of what we do, what we react to, and how we feel. Meditation is a way of looking deeply into the chatter of the mind and body and becoming more aware of its patterns. By observing it, you free yourself from much of it. And then the chatter will calm down.

When you start focusing on your breathing, for instance, you're giving the mind one thing to do: just ride the waves of the in-breath, then ride the waves of the out-breath. There's nothing magical about it. But as you continue, you'll begin realizing that it doesn't take long before the mind wants to go someplace else. It doesn't want to just stay with the breath. It doesn't want to just experience one thing. It wants to go to a lot of other places, and it wants to think about the future and the past.

Meditation is a discipline for training the mind to develop greater calm and then to use that calm to bring penetrative insight into our own experience in the moment. From that insight comes greater understanding and, therefore, greater freedom to conduct our lives the way we feel would lead to the greatest wisdom and happiness. Now that sounds like a big mouthful, but it turns out that it's a very practical thing to do. It's not at all un-American. In fact, Thoreau went off to Walden Pond, as he said, "to live intentionally, to live deliberately," so that when death came, he wouldn't discover that he hadn't lived. Doesn't that make sense?

Is the purpose of meditation to slow the mind down?

I would say that there is no purpose in meditation. As soon as you assign a purpose, you've made it just another activity to try to get someplace or reach some goal.

But third-party insurance companies are not underwriting the cost of your patients being here for no purpose.

That's true. The people in the program were all referred by their doctors in order to achieve some kind of improvement in their condition. But paradoxically, they are likely to make the most progress in this domain if they let go of trying to get anywhere and just learn through the practice of meditation to experience their moments as they untold.

What does that have to do with stress and healing, which is why they're here and why they're reimbursed?

It may turn out that the deep physiological relaxation that accompanies meditation is, in itself, healing. When I set up this program back in 1989, the idea was to explore the possibility of creating a clinical service in a major medical center that would catch people who were falling through the cracks of the health care system and to challenge them to do something for themselves as a complement to whatever their medical treatments were.

The idea was not to cure them but to help them access their deep inner resources for healing, calming the mind, and operating more effectively in the world, and to help them develop strategies and resources for making sensible, adaptive choices under pressure, coping with stress, feeling better about their bodies, and feeling more engaged in life. We wanted to see whether these inner resources would have any effect on their chronic medical condition and it turned out that they did, and that people improved in many ways.

Measuring the effects of what we did is a different story. We have decades worth of science left to do in order to get to the bottom of what it means to go into deep states of relaxation and to change one's relationship to one's own body in terms of the actual felt experiences of it.

How would you define mind/body medicine to me?

Over the past several hundred years we've tended to look at disease as being more or less a function of the physical body, and to look at thoughts, feelings, emotions, and social interactions as being in the domain of the mind. For the most part, we've thought that the disease process is independent of mind. If for example, you get a bacterial infection, how you feel about that infection is not going to make a difference—but penicillin will make a big difference. In this model you diagnose what's the matter with the body, treat it, and then get on with your life.

But as we begin looking at chronic illnesses like cancer and heart disease, which aren't infectious, we see more and more evidence that how we live our lives and, in fact, how we think and feel over a lifetime, can influence the kinds of illnesses that we have. So the mind/body connection really has to do with understanding that the mind and the body are only artificially separate, that they've always been together, and that they have an interactive influence on each other. This idea is not new—it's as old as medicine. It's as old as humanity. I think what's new is the introducing of it into modern Western medicine.

Why the reunion of mind and body now?

To a large extent, it's because some very interesting developments have been happening in science that have forced us to look again at this division. Also, we've reached certain limits in terms of what medicine can do. Americans tend to expect medicine to cure everything—but medicine is capable of doing far less. We also expect to understand everything—but we don't even know what a thought is, although we know we have them.

But do you mean that the insurance companies will reimburse you for teaching people to hang out with themselves that way?

Well, if it's therapeutic, why not? It's a hell of a lot cheaper than opening up their chests. If one person is saved from one major operation by learning how to self-regulate using these mind/body techniques, we've paid for most of the other patients in the clinic for an entire year. Medicine is reaching the point of increasing expenses with diminishing returns. Part of the problem is that a very profound element is missing in medicine: the active participation of the patient. That's where optimizing the mind/body connection really becomes critical. And cheap.

If it's possible to teach people how to self-regulate so that, for instance, they don't go into panic so much, and their blood pressure doesn't escalate so often under stress, and they can handle their pain in such a way that they don't constantly have to go to the emergency rooms, or be medicated because of it, can you imagine how much money that would save the system? So it's totally in the interest of the health care providers and insurance companies to support this kind of thing.

Actually, I think it's a misnomer to call what we have a "health-care system." It's really a "disease care system." Many of the clinics that are developing along these lines are challenging patients to see what they can do for themselves as a complement to their medical treatments. I've seen people in their nineties who are healthy as hell, and other people in their thirties who are an absolute mess. If you had some kind of inner control over that, you could save the system an awful lot of money and save yourself an awful lot of grief.

You mean medicine that enables me to take charge of my own behavior and conduct myself more healthy?

Right, and I think one of the reasons clinics like this one have such high levels of patient satisfaction is that we make this stuff fun. Meditation becomes so compelling that you don't want to stop. It's part of working on oneself to develop one's inner capacity to be whole.

There's something about the discipline associated with these mind/body techniques that empowers individuals and, at the same time, deepens and broadens their perspective on the value of having a body and of taking care of it and nourishing it in a certain way. I think that any doctor would give his or her right arm, so to speak, to have patients who have this perspective because it would help the doctor to care for patients as best he or she could.

Does meditation eventually become just another Band-Aid, something I do when I start to feel bad?

A lot of people think that's what meditation is all about. "I'll learn a little meditation technique, and then when things get too stressful, I'll use my little technique and relax." They think meditation is something to be used when you need it.

Actually, meditation is best described as a way of being. It's like wearing a parachute. You don't want to start wearing the parachute when you're about to jump out of the plane. You want to have been wearing the parachute morning, noon, and night, day in and day-out, so that when you need it, it will actually hold you. You have to carve out some time every day that's your time for just being. And then when stressful situations come up, and you feel like doing more, you have a framework in which to do it and a reservoir of inner calmness and stability and insight.

Excerpted from Bill Moyer's Healing and the Mind (Doubleday;1993). Copyright 1993 by Bill Moyers.

Basic Meditation Exercise

1. Sit with an alert and relaxed body posture so that you feel relatively comfortable without moving. (You can sit either in a straight-back chair with your feet flat on the floor or on a thick, firm cushion three to six inches off the floor.)
2. Keep your back, neck, and head vertically aligned, relax your shoulders find a comfortable place for your hands (usually on your knees).
3. Bring your attention to your breathing. Observe the breath as it flows in and out. Give full attention to the feeling of the breath as it comes in and goes out. Whenever you find that your attention has moved elsewhere, just note it and let go and gently escort your attention back to the breath, back to the rising and falling of your own belly.
4. When you can maintain some continuity of attention on the breath, try expanding the field of your awareness "around" your belly to include a sense of your body as a whole.
5. Maintain this awareness of the body sitting and breathing, and, when the mind wanders, bring it back to sitting and breathing.