Original articleMindfulness, spirituality, and health-related symptoms
Introduction
The field of behavioral medicine has been giving increased attention to the area of spirituality, religiousness, and health [1]. While spirituality and religion have historically been inextricably associated with each other and the terms have often been used interchangeably, for many people they have become distinct and independent constructs [2] that separate religious observance and ritual from spiritual experience. Spirituality has become differentiated from religiousness and the practice of religious behavior to emphasize more humanistic values and personal qualities in which a person's sense of meaning and purpose in life beyond material values plays a central role [3], [4]. In this sense, spirituality has emerged as an important component of quality of life and well-being both in the general population [5] and in patients dealing with illnesses such as cancer [6]. However, although there is considerable evidence of the beneficial effect of religiosity on health and longevity [7], [8], [9], the relationship between spirituality (independent of religious practice) and health is not as well studied [2], [10].
All religious traditions maintain that spirituality can be developed through training, but the secular nature of many people's lives, together with the fact that 82% of Americans express a need for greater spiritual growth [2], makes it important to ascertain whether spirituality can be developed other than through traditional religious practice. Further, since such an approach would differ from the religious behaviors associated with greater health, it is important also to determine whether changes in spirituality also are related to health.
Mindfulness has its roots in Buddhism and is a practice that has long been associated with spiritual development [11], [12]. It has been defined as intentionally paying attention to present-moment experience (physical sensations, perceptions, affective states, thoughts, and imagery) in a nonjudgmental way, thereby cultivating a stable and nonreactive awareness [13], [14]. Mindfulness meditation is the practice that has been traditionally used for the systematic development of mindfulness.
The mindfulness-based stress reduction (MBSR) program provides instructions in mindfulness meditation in a secular context, without the Buddhist cultural and religious overlay. The program has been intentionally designed to give instructions and practice in the integration of mindfulness into everyday life as support in dealing with stressful life situations [15]. Participants learn that attention can be brought to notice whatever thoughts, feelings, and sensations are appearing in awareness, while at the same time remaining aware of the capacity to maintain the focus of attention on these contents without moving toward maladaptive conditioned reactivity or attention deliberately redirected to a wider field of awareness or to a different object. A recent meta-analysis of controlled and observational studies of the health benefits of the MBSR program [14] found that it was useful for patients with a broad range of chronic disorders, and the reported changes in distress have been found to endure on 3-month [16], 6-month [17], 3-year [13], and 4-year [18] follow-ups. It has been suggested that a capacity to bring mental processes under greater voluntary control and directing them in beneficial ways gives the person a greater sense of control [19]. When thoughts and feelings no longer threaten to overwhelm the person [20], [21], psychological and physical well-being is fostered by allowing for the emergence of alternative responses. Furthermore, the development of this openness and acceptance of present-moment experience, coupled with nonreactive self-observation and capacity for choosing the focus of attention fostered by mindfulness, may in turn be valuable in self-regulatory behavior that is consistent with the person's wider needs and values [22].
While a considerable body of published research reports the health-related benefits of participating in mindfulness training through interventions based on the MBSR program [14], the need to confirm mindfulness as a critical component of change has resulted in the publication of operational definitions and several scales purporting to assess mindfulness [23], [24], [25], [26]. In its original descriptions, mindfulness is a subtle notion and the most appropriate method of assessment, including whether it is possible validly to assess it using paper-and-pencil tests remains a topic of debate [27]. In the spirit of this open question, exploring scores on different scales from the same sample provides an opportunity to determine whether similar estimates of mindfulness result and also begins an examination of the possible relationship of mindfulness with existing psychological constructs. The aim of the present study was to ascertain whether participation in the MBSR program is associated with increases in mindfulness and spirituality, and to examine the associations between changes in mindfulness, spirituality, and self-reported medical and psychological symptoms.
Section snippets
Participants and setting
Study participants comprised 44 participants in four concurrent MBSR classes held during the fall of 2004 at the University of Massachusetts Medical School (UMMS) Stress Reduction Program in Worcester, MA. The mean age of the sample was 47.8 years (range, 20–72 years), and 75% (33) were female. Approximately half of the participants were referred by a health care practitioner, and half were self-referred. Participation in the MBSR program was on a self-pay basis.
Demographic characteristics
Participants reported their age,
Results
One hundred seventeen participants enrolled in one of the four MBSR classes held in the fall of 2004; of these, 62 (52%) consented to be part of the present study. Fifty-two (84%) of the study participants completed the program. An additional eight participants did not have complete information for FACIT-Sp and the SCL-90-R at either baseline or follow-up, resulting in complete information for 44 participants. A comparison of the 18 participants for whom there was incomplete information or who
Discussion
Significant increases in mindfulness and spirituality scores and reductions in reported medical symptoms and in psychological distress were associated with participation in the MBSR program. The substantial reductions in medical symptoms and psychological distress, ranging from a median reduction of 50% in anxiety to a 28% reduction in reported medical symptoms, are consistent with other reports of MBSR outcomes [14]. The largest changes in process variables (mindfulness and spirituality) were
FACIT-Sp Items
Respondents indicate on a 5-point scale how true each statement has been for them during the past 7 days:
Meaning and peace items:
I feel peaceful.
I have a reason for living.
My life has been productive.
I have trouble feeling peace of mind.
I feel a sense of purpose in my life.
I am able to reach down deep into myself for comfort.
I feel a sense of harmony within myself.
My life lacks meaning of purpose.
Faith items:
I find comfort in my faith or spiritual beliefs.
I find strength in my faith or
Acknowledgments
This study was conducted at the Division of Preventive and Behavioral Medicine and was partly supported by in-house funds from the Center for Mindfulness, UMMS.
References (55)
- et al.
Religious involvement, spirituality, and medicine: implications for clinical practice
Mayo Clinic Proc
(2001) - et al.
Three-year follow-up and clinical implications of a mindfulness-based stress reduction intervention in the treatment of anxiety disorders
Gen Hosp Psychiatry
(1995) Mindfulness-based stress reduction and health benefits: a meta-analysis
J Psychosom Res
(2004)Measuring mindfulness—the Freiburg Mindfulness Inventory (FMI)
Pers Indiv Diff
(2006)An out-patient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results
Gen Hosp Psychiatry
(1982)- et al.
Spirituality, mindfulness and substance abuse
Addict Behav
(2005) - et al.
Validation of the Mindful Attention Awareness Scale in a cancer population
J Psychosom Res
(2005) Spirituality, religiousness, and health: from research to clinical practice
Ann Behav Med
(2002)- et al.
Spirituality and health: what's the evidence and what's needed?
Ann Behav Med
(2002) Prayer and spirituality in health: ancient practices, modern science
NCCAM Newslett
(2005)