The Healing Power of Mindfulness
Boyce convenes a distinguished panel — made of Jon Kabat-Zinn, Susan Bauer-Wu, and Daniel Siegel — to discuss the health benefits of
mindfulness — what it does, how to do it, why it works.
we think of mindfulness or meditation, the words conjure images of a
quiet, private time of tranquility and peace. When we think of hospitals
and doctors’ offices, we think of the anxiety, pain, and chaos we might
experience there, and presume that mindfulness doesn’t have a place in
health care. Some leading health care professionals want to change that.
Because they’ve seen the evidence that mindfulness is profoundly
healing, they’re taking it right into the middle of the American health
care system, from prevention, diagnosis, and treatment, through cure,
palliative care, and even health administration and medical training.
With the help of Susan G. Komen for the Cure, the world’s largest
grassroots network of breast cancer survivors and activists and sponsor
of the Lynn Lectures on integrative medicine, we brought together three
of the world’s leading specialists on the healing power of mindfulness
and the benefits of integrative medicine for a discussion of the present
and future of mind–body medicine.
—Barry Boyce, Senior Writer
Kabat-Zinn, Ph.D., is the founding executive director of the Center for
Mindfulness in Medicine, Health Care, and Society at the University of
Massachusetts Medical School, and creator of the famed Mindfulness-Based
Stress Reduction program. He is the author of several best-selling
books, including Full Catastrophe Living; Wherever You Go, There You Are; and most recently, Coming to Our Senses: Healing Ourselves and the World through Mindfulness.
Bauer-Wu, Ph.D., is an associate professor of nursing and Georgia
Cancer Coalition Distinguished Scholar at Emory University in Atlanta.
She is a researcher, clinician, and educator whose work focuses on the
clinical application of meditation and its effects on health and quality
of life in individuals living with serious illness, especially cancer.
Siegel, M.D., is a clinical professor of psychiatry at the UCLA School
of Medicine. He is director of the Mindsight Institute and co-director
of the UCLA Mindful Awareness Research Center. He is the author of The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being, and Mindsight: The New Science of Personal Transformation.
What are some of the benefits of mindfulness—both the practice and the state of mind—for our health and healing?
Kabat-Zinn: To be in relationship to what you are going through, to
hold it, and, in some sense, to befriend it—that is where the healing or
transformative power of the practice of mindfulness lies. When we can
actually be where we are, not trying to find another state of mind, we
discover deep internal resources we can make use of. Coming to terms
with things as they are is my definition of healing.
this kind of awareness can have virtually immediate effects on health
and well-being. As crazy as it sounds, it’s possible to befriend your
pain or your fear—rather than feeling that you can’t get anywhere until
this thing that bothers you is cut out or walled off or shut down.
That’s a really profound realization for someone to come to. It’s very
healing to realize, if only for a moment here and a moment there, that
you can be in a wiser relationship with your interior experience than
just being driven by liking it or hating it.
like to say to our patients who come to Mindfulness-Based Stress
Reduction that there’s more right with them than wrong with them, no
matter what their diagnosis is. We’re going to pour energy into what’s
right with them, and see what happens. It’s a great adventure and it’s
very satisfying to be able to see people light up as they experience the
knowledge that it’s okay to be where you are as you are.
Siegel: To help people be with their pain, or with knowledge of their
metastasis, or of their mortality, it’s so valuable for them to discover
a spaciousness of mind where they realize they’re part of a universal
flow of things—people get ill, people do die, and they’re part of that
big picture. Within that spaciousness, there is a great clarity that
isn’t the same as relaxation. It’s not just hanging loose. You get
beyond your internal dialogue of “I want to be better now.” You can be
in the midst of great difficulties and yet find immense composure and
Bauer-Wu: It’s so very important for people who have cancer or any
other serious illness to be in tune with what they’re experiencing,
rather than shut off from it, which can so often be the case. One of the
most important benefits of mindfulness is attentiveness to what is
happening in your body, your mind, and your environment—being present
for what’s happening to you, with you, and around you at a particular
moment in time. Mindfulness becomes a foundation to help patients make
good decisions and navigate all they have to go through.
benefit of mindfulness is having less emotional reactivity and more
stability of mind. Not overreacting emotionally brings greater mental
clarity, which is healthy in and of itself. Having stability of mind
makes you better able to cope with the experience of illness and all it
involves. That is a very significant and positive outcome.
Kabat-Zinn: Actually, we don’t yet have a language for describing what
mindfulness is. That’s one of the exciting parts of all the mindfulness
research that’s happening. With so many different perspectives coming to
bear on it, including neuroscience and clinical medicine, we will be
able to describe it more richly. I’m fine with calling it a practice,
but we have to distinguish it from many other kinds of practice. It’s
not exactly like practicing the piano, for example. It does involve
discipline in that way, but you’re not trying to become a virtuoso.
prefer to call mindfulness a way of being. That gives people much more
latitude in what they’re actually experiencing, because it’s not about
trying to be in a special state, and if you’re not in that state, then
you’re doing something wrong. It’s rather that you can bring awareness
to any state you happen to be in. There’s nothing wrong with being
caught up in difficult, stressful, agitated, or confusing moments.
why characterizing mindfulness as a mind state can be problematic. If
we’re talking about transforming health care or transforming any
individual’s relationship to their own body—especially if they’re in
pain or suffering with cancer or another life-threatening illness—the
idea that mindfulness is a particular mind state can be misleading. When
we’re experiencing these conditions, the mind might be very agitated
and disturbed. There will be emotional reactions, as Susan mentioned.
Therefore, the idea that there is a sought-after mind state, and that if
you were really good enough you would find it and everything would be
great for the rest of your life, would be a misapprehension of what
mindfulness really is.
Siegel: In neuroscience, we do talk about a momentary set of brain
firing patterns that we would call a brain state. If you want to jump
from brain to mind, some people would call it a state of mind. You could
make the argument that there is something we could call “awareness,”
and within that general term there are many different ways of being
example, if I’m really angry, and I have a gun in my hand, I’m aware
that the gun is in my hand. If I shoot someone, you could say I’m
perfectly aware that I committed this act. But when we discuss what we
might call “mindful awareness,” something more is going on. If I am
mindfully aware, I will be imbued with all sorts of discernment about
whether the action I’m about to take is a good action for the person in
front of me and for me. I would have a broader sense than just being
aware of the gun in my hand. I would have a larger picture of the
moment-to-moment unfolding, not just the sensation. So I might put the
the Buddhist teacher Joan Halifax pointed out in a recent retreat I
took part in, there is a difference between being aware and being aware
with wisdom. When you look at the neuroscience, being aware with wisdom
likely involves a whole set of what we would call the middle structures
of the prefrontal area. One possible view is this: When we talk about
the focus of attention, we often are referring to the dorsolateral, or
side, areas. Wisdom, compassion, empathy, self-understanding, being
aware of your own body, being able to be flexible, pausing before you
act—all those elements of our mental experience seem to correlate with
middle prefrontal activity, not just the side prefrontal activity. The
person using his dorsolateral area is aware of the gun and aims well,
because he’s got good attention. But the person who is mindfully aware,
we can propose, harnesses all the correlates of wisdom and compassion,
and in that moment he either doesn’t pick up the gun, or thinks of other
options, or pauses before the impulse turns into action.
practice can uncover dark and difficult thoughts, which people can find
quite shocking. Is that beneficial in the middle of a health crisis?
Siegel: Much of what happens in the mind is not within consciousness,
yet these non-conscious processes have an impact on our health. Bringing
these negative thoughts, such as fear, hostility, betrayal, or sadness,
to awareness is part of basic health, because those thoughts—what in my
field are called unintegrated neural processes—are basically like black
holes. They have so much gravity to them that they suck the energy out
of life. They influence the health of the mind, its flexibility and
fluidity, its sense of joy and gratitude. They impact relationships,
leading to rigid ways of behaving or explosive ways of interacting. They
also influence the body itself, including the nervous system and the
an exploratory process like mindfulness that brings those fearful
negative thoughts to awareness can be very beneficial. Sometimes you
have to name it to tame it. A number of studies suggest that when you
bring something into awareness, and describe it, you can move that
previously negative energy—a draining thought or cognition—into a new
mindfulness, what was not available to awareness becomes available. We
need to support people in that journey, because bringing more of what’s
going on in the mind to awareness can be a very helpful development in a
Kabat-Zinn: We often relate to our thoughts, whether they’re intensely
negative or not, as a reliable statement of the truth. When you’re
angry, everything can seem threatening or annoying or inadequate. You
believe what your thoughts are telling you. Mindfulness of thoughts
allows you to be aware of a thought or strong emotion as a kind of a
storm in the mind or an event in awareness. Once you see it as an event
or a storm, it no longer has the same power over you.
which is a major concern for patients, is to a very large degree a
disease of disregulated thinking. There’s a lot of evidence that
mindfulness can actually help you develop a whole different relationship
with the stream of negative thoughts called depressive rumination.
Mindfulness has profound health implications for depression and also for
Bauer-Wu: It’s important to emphasize that noticing negative thoughts
through mindfulness is not merely a passive process. Noticing the
thoughts allows you to take action. You gain the insight and then you
can do something about it.
Kabat-Zinn: Yes. The real meditation practice is your life and how you
conduct it from moment to moment. Mindfulness helps you to take wise and
discerning action, which is vitally important if you want to
participate in your own healing process.
What role can mindfulness play in prevention?
Bauer-Wu: I see three overarching areas where mindfulness aids in
prevention: stress reduction, early diagnosis, and making healthy
know there’s a clear association between stress and illness. Acute
illness, such as an upper respiratory infection or gastrointestinal
irritability, is often exacerbated or triggered by stress. We know that
mindfulness and related interventions reduce stress reactivity and make
one less prone to developing these acute illnesses and infections. There
are many studies supporting this effect, including one that Jon was
involved in that showed increased antibody levels after mindfulness
terms of chronic illnesses—ranging from cancer to cardiovascular
disease, diabetes, and autoimmune disease—all of them have an
inflammatory component, and inflammation and stress are absolutely
associated. We’re showing through studies that mindfulness practices
have an impact on inflammatory processes in the body. Conceivably, if
you begin these practices earlier, you may be able to prevent some
serious chronic illnesses associated with inflammation.
terms of early diagnosis, many people are not really in tune with their
bodies, so they don’t notice when something’s wrong. Their body might
be alerting them to something that needs to be checked out, but they’re
not really paying attention to their way of being and what’s happening
in their body. With mindfulness, they might notice it sooner, when it
could be diagnosed at an earlier stage.
terms of healthy lifestyle choices, we can think of Dan’s analogy of
dropping the gun. The gun could be a cigarette, another piece of cake,
or working to the point of fatigue. Mindfulness can help you notice what
the body needs and help you make good lifestyle choices. So in all of
these ways, mindfulness can help to prevent illnesses down the road.
Siegel: In addition to what it can do for the body, the mindful way of
being supports a healthy mind and more empathic relationships. Those
three—body, mind, and relationship—are the three major dimensions of the
human experience that an integrated health care ought to be concerned
with. Self-compassion and compassion for others are enhanced with a
mindful way of being. These are very helpful for someone undergoing
treatment, which is a process involving relationships with family
members, friends, and colleagues, as well as caregivers and health
How can mindfulness help in the diagnosis and treatment phases of illness?
Bauer-Wu: In the early phase, after someone is diagnosed with serious
disease, there is an intense period of uncertainty. Of course, there is
uncertainty throughout the whole trajectory from diagnosis through
treatment and cure or palliative care, but at the beginning there are so
many questions in people’s minds. It’s very common for the mind to jump
to the worst-case scenario and spin a whole story of what’s going to
happen. Mindfulness practice helps to ground people in what is true for
them right now. It helps them break out of the story, to be more
centered and less overwhelmed. It also increases their ability to
communicate effectively with their caregivers, and helps the caregivers
communicate better with them.
the treatment phase of cancer of radiation, chemotherapy, or surgery,
there is a whole host of physical symptoms ranging from pain to nausea
to itching to diarrhea. Body–mind awareness practices help people ride
the waves of these symptoms, which are constantly in flux.
Kabat-Zinn: One of the reasons our health care system is breaking down
is that we need more participation from the people who are suffering.
Mindfulness can help you take a more active role in your health and
are not a machine being taken to the shop for a repair or a tune up.
It’s best if you can begin participating in your own health care as
early as possible. Starting in childhood by learning mindfulness
practices in school would put people on the road to a much more healthy
relationship to their body and their emotions. That’s much healthier
than the default mode where you just hope for the best and treat the
body more or less as an automobile that you drive into the hospital for
repairs when it breaks down.
participation in the process is important for many reasons. In addition
to awareness of your lifestyle and the state of your body and mind, as
Susan and Dan were talking about, once you have been diagnosed it’s
important to be able to negotiate with your doctor about treatment
options. There are so many potential pathways you can go down, and you
need to have as much agency as possible in that situation. For one
thing, it brings a certain peace of mind when you’re an engaged
participant as opposed to a passive recipient of treatment.
speaks to an entirely different way of practicing medicine that
recruits the internal resources of the patient in the treatment process.
That’s what MBSR is designed to do. There is now more than thirty-one
years of evidence that the program can make a remarkable difference in
people’s relationship to their illness and how it unfolds. If you go
into radiation, chemotherapy, or surgery with greater awareness and
mindfulness, that will make a huge difference. Also, when you’re more
accepting of what’s going on in the present moment, you bring less
resistance and can be a full participant, not just a recipient of
radiation and chemotherapy. Sometimes you even need less anesthetic if
you’re being mindful.
Siegel: It’s very easy to be in denial about a change in your body,
whether it’s a change in intestinal functioning, a lump in the breast,
or irregularity in breathing, all of which might indicate the onset of
disease. Many people avoid going to the doctor even for a regular
check-up for fear of what they might find out. When we operate on
auto-pilot, we tend to avoid things that might be distressing.
of the elements of research on Mindfulness-Based Stress Reduction that I
find most impressive is the work that Richie Davidson and Jon have done
showing that even after one eight-week MBSR course, a “left-shift” has
been noted, in which the left frontal activity of the brain is enhanced.
This electrical change in brain function is thought to reflect the
cultivation of an “approach state,” in which we move toward, rather than
away from, a challenging external situation or internal mental function
such as a thought, feeling, or memory. Such an approach state can be
seen as the neural basis for resilience. With a mindful way of being,
you’ve developed your skill to stay present for what you might otherwise
try to escape. From that point of view, diagnosis would be enhanced,
because denial would be overcome. If you think about it, this is the
mind doing what is most helpful for mind and body. Ignoring is
Also embedded within the mindful way of being is the sensory mechanism we
call “interoception”—being aware of your internal bodily state. An
increased capacity for interoception correlates with activity in a part
of the brain called the right insula, which is in the middle prefrontal
area we discussed earlier. This area has been shown to be activated by
mindful awareness practices. In addition, two studies out of Harvard and
UCLA show structural changes in the right anterior insula suggesting
that the regular practice of being mindful leads to changes in the
structural connectivity within the nervous system that would indicate an
increase in interoceptive ability.
Kabat-Zinn: We did a study on people with psoriasis, a skin disease
that is an uncontrolled cell proliferation in the epidermis. We
demonstrated that the skin of people who meditate while they’re
receiving ultraviolet light therapy clears four times faster than in
people who were getting the ultraviolet light by itself. That’s one
example of a study suggesting how present-moment awareness can make a
profound difference in the healing process. Since psoriasis and basal
cell carcinoma have kissing-cousin genes in common, maybe it’s possible
for the mind to regulate in some way or other the unfolding of even an
oncogenic process. We just don’t know, but it certainly would be worth
doing studies on that.
been discussing mindfulness and health from the perspective of the
patient. What role can mindfulness and awareness practices play for
Siegel: There are indications that mindfulness practices can be very
beneficial for doctors, nurses, and other kinds of caregivers. A study
by Krasner and Epstein showed that teaching primary care physicians
mindfulness practices reduced burnout and maintained empathy. Work by
Shauna Shapiro on medical students shows that teaching them mindfulness
practices increases their capacity for empathy, and an empathic
clinician can have a powerful effect on patient well-being. A study
performed at the School of Medicine and Public Health at the University
of Wisconsin–Madison showed that health care practitioners who are
empathic seem to be able to reduce the duration of the common cold in
patients and boost their immune systems.
I was being trained as a physician, we weren’t taught about things like
listening or empathy. Even when you have empathic medical students at
the start, by the time the socialization experience of medical school is
done with, much of it has been wrung out of them. Mindfulness could
serve as an antidote to the incredible pressures that young clinicians
are exposed to. They would benefit from learning skills to help maintain
inner resilience, so they can maintain an open, compassionate,
receptive place for their patients while also taking care of themselves.
like the instruction on the airplane to put on your own oxygen mask
first and then help others put theirs on. We’re not giving oxygen masks
to these clinicians. They’re understandably overwhelmed and depressed,
and often feel hopeless. They don’t know what to do with their own
emotional world, so they just withdraw. Everyone suffers because of
Bauer-Wu: I heartily agree. And I would add that their own health
suffers under the strain. When nurses get burned out, they often get
sick and can’t show up for work. That becomes a burden to the health
care system. Professional caregivers are also less attentive when
they’re sick and burned out. Errors occur and overall safety decreases.
Patients are put at risk and costs rise.
believe that physicians and nurses who practice mindfulness are better
diagnosticians. They are more sensitive to the subtleties of the whole
person, not just the physical symptoms that the patient presents with at
the time of the appointment. Some colleagues of mine and I have been
doing work on the idea of “compassionate silence.” Mindfulness and
compassion practices can help clinicians to be fully present and
spacious in the very condensed time they have to meet with a patient.
Physicians and nurses are not generally taught how to be okay with
silence. When a clinician learns to hold whatever is arising, instead of
trying to fix it, push it away, run out of the room, or ruminate about
the next pressing thing they have to do, that’s profoundly healing for
the patient. We also know that clinicians find those experiences some of
the most rewarding as well.
Kabat-Zinn: Until very recently, physicians were not trained in how to
be in relationship with another person who is suffering, who is
frightened and doesn’t understand a lot of what’s going on. The
potential benefits for both the patients and the physicians of
cultivating that kind of empathic presence and silence—and perhaps
embodying silence as a way of being—is unbelievably important.
also helpful for doctors to have the humbleness to know that they can’t
immediately fix everything. There are lots of things that cannot be
fixed in medicine. While it would be wonderful if there were more
cures—and more research should definitely bring more cures in the
future—healing is always possible, even without curing.
we recruited our patients as participants in fostering greater health
and well-being, while coming to terms with whatever illness they may
face with self-compassion and wisdom, it would cost the system a lot
less money. You wouldn’t be throwing fixes that aren’t actually going to
work at people who really don’t need them. But our system continues to
do that out of a kind of desperation.
would make an enormous difference if mindfulness were made available at
the wide mouth of the funnel, so to speak, before people wind up with a
serious condition which requires surgery or a long hospital stay. Our
hospitals and medical centers have the potential to become centers for
integrative health care. If patients and their doctors have access to
mindfulness training, it can revive the sacred dimension of the
doctor–patient relationship based on the Hippocratic principles. It can
move treatment more in the direction of healing the whole person rather
than fixing body parts. The patient would be engaged as an important
part of the process, doctors would be happier, nurses would be happier,
and hospital administrators would be happier. It would cost a huge
Siegel: Mindfulness is a part of a much larger frame that society has
to move to: embracing the importance of our relationships with one
another and seeing that the mind, though it’s not measurable like
physical things are, is actually a real entity whose workings have
monumental effects on the shape of our world—physical and otherwise.
From a scientific research standpoint today, there’s much more support
for putting understanding of relationships and mind on an equal footing
with understanding the workings of the body. I see it becoming a
fundamental part of how clinicians are trained, and I see a new unifying
vocabulary emerging that will allow us to talk about subtleties that
were left unexamined in our previous ways of talking about and
now have worthwhile research results to present to a scientifically
hungry medical student population. We can show them that these aren’t
“soft things.” They aren’t elective, optional concerns. The dynamics of
the mind and relationships with others are fundamental to what it means
to be human and what it means to bring healing into the world.