MBSR Standards of Practice
Edited and Revised by:
Saki F. Santorelli, EdD, MA Professor of Medicine
Executive Director, Center for Mindfulness (2001 - 2017)
Director, Stress Reduction Program (2001 - 2017)
Background and Overview
Mindfulness-Based Stress Reduction
Jon Kabat-Zinn, PhD
Kabat-Zinn, J. Mindfulness Meditation: What It Is, What It Isn’t, And It’s Role In Health Care and Medicine In: Haruki, Y., Ishii, Y., and Suzuki, M. Comparative and Psychological Study on Meditation. Eburon, Netherlands, 1996. Pg. 161-169.
Mindfulness-Based Stress Reduction (MBSR) is a well-defined and systematic patient-centered educational approach which uses relatively intensive training in mindfulness meditation as the core of a program to teach people how to take better care of themselves and live healthier and more adaptive lives. The prototype program was developed at the Stress Reduction Clinic at the University of Massachusetts Medical Center. This model has been successfully utilized with appropriate modifications in a number of other medical centers, as well as in non-medical settings such as schools, prisons, athletic training programs, professional programs, and the workplace. We emphasize that there are many different ways to structure and deliver mindfulness-based stress reduction programs. The optimal form and its delivery will depend critically on local factors and on the level of experience and understanding of the people undertaking the teaching. Rather than "clone" or "franchise" one cookie-cutter approach, mindfulness ultimately requires the effective use of the present moment as the core indicator of the appropriateness of particular choices. However, there are key principles and aspects of MBSR which are universally important to consider and to embody within any context of teaching. These include:
a) making the experience a challenge rather than a chore and thus turning the observing of one's life mindfully into an adventure in living rather than one more thing one "has" to do for oneself to be healthy.
b) an emphasis on the importance of individual effort and motivation and regular disciplined practice of the meditation in its various forms, whether one "feels" like practicing on a particular day or not.
c) the immediate lifestyle change that is required to undertake formal mindfulness practice, since it requires a significant time commitment (in our clinic 45 minutes a day, six days a week minimally).
d) the importance of making each moment count by consciously bringing it into awareness during practice, thus stepping out of clock time into the present moment
e) an educational rather than a therapeutic orientation, which makes use of relatively large "classes" of participants in a time-limited course structure to provide a community of learning and practice, and a "critical mass" to help in cultivating ongoing motivation, support , and feelings of acceptance and belonging. The social factors of emotional support and caring and not feeling isolated or alone in one's efforts to cope and adapt and grow are in all likelihood extremely important factors in healing as well as for providing an optimal learning environment for ongoing growth and development in addition to the factors of individual effort and initiative and coping/problem solving.
f) a medically heterogeneous environment, in which people with a broad range of medical
conditions participate in classes together without segregation by diagnosis or conditions and
specializations of intervention. This approach has the virtue of focusing on what people have in
common rather than what is special about their particular disease (what is "right" with them rather
than what is "wrong" with them), which is left to the attention of other dimensions of the health care
team and to specialized support groups for specific classes of patients, where that is appropriate.
It is in part from this orientation, which differs considerably from traditional medical or psychiatric
models, which orient interventions as specifically as possible to particular diagnostic
categories, that the generic and universal qualities of MBSR stem. Of course, stress, pain, and
illness are common experiences within the medical context, but beyond that, and even more
fundamentally, the participants share being alive, having a body, breathing, thinking, feeling,
perceiving, and incessant flow of mental states, including anxiety, worry, frustration, irritation and
anger, depression, sorrow, helplessness, despair, joy, and satisfaction, and the capacity to
cultivate moment-to-moment awareness by directing attention in particular systematic ways. They
also share, in our view, the capacity to access their own inner resources for learning, growing, and
healing (as distinguished from curing) within the context of mindfulness practice.
In addition to these factors, which encourage flexibility and appropriate modification for non-hospital-based and non-medically-based MBSR program, there are minimal standards of form and content for medically-oriented, HMO and hospital-based programs to appropriately call themselves MBSR. These are outlined in detail in the following section.
While individual pre and post program interviews have not been used in all HMO-delivered programs, (see Appendix C) they are highly recommended as an integral and important part of the MBSR intervention. If omitted, an appropriate and thoughtful substitute must be included to ensure an effective "launch" of the MBSR experience for individual participants and the class as a whole.