Mindfulness is a state of presence of mind in which a person is awake enough to experience the present state of his immediate environment, body, and mind, without being distracted by streams of thoughts, memories, fantasies, or strong emotions, without thinking about or evaluating these perceptions.
Mindfulness can be understood as a form of awareness related to a special state of perception and consciousness, as a special personality trait, and as a method of reducing suffering (in the broadest sense).
Historically, “mindfulness” is found primarily in Buddhist teachings and meditation practices. In Western culture, the practice of “mindfulness” has become known through its use in the context of various psychotherapy methods.[1] The term mindfulness is also used in the context of care ethics for a practice of caring.
Definitions of mindfulness
Mindfulness according to Kabat-Zinn
One of the most commonly cited definitions in the research comes from Jon Kabat-Zinn.[2] According to this definition, mindfulness is a particular form of attention that is intentional, relates to the present moment (rather than the past or the future), and is non-judgmental.
Mindfulness according to Brown and Ryan
Brown and Ryan[3] focus strongly on the attention aspect and formally define mindfulness as receptive attention and awareness of momentary occurrences and experiences.
In their review paper[4] they summarize various definitions and concepts of mindfulness from different Buddhist traditions. Accordingly, the following aspects of mindfulness are described:
1. Clarity of consciousness (e.g., in Henepola Gunaratana, Nyanaponika, Charles Tart),
2. Non-conceptual, non-differentiating awareness,
3. Flexibility of awareness and attention,
4. Empirical attitude in relation to reality,
5. Awareness oriented to the present,
6. Stability or duration of attention and awareness.
Distinguishing of mindfulness from concentration
Mindfulness can be clearly distinguished from concentration.\[6]\[7]\[8]\[9] Concentration consists of attentively tuning in to a particular object or subject, such as a line of writing, focusing one’s gaze on it, and devoting one’s entire attention to that limited area of one’s perception. “Mindfulness” has an opposite orientation to this.[10] Here the focus of attention is not deliberately narrowed, but rather made wide. At its maximum, a wide-angle\[11]\[12] attentional attitude is then attainable, consisting in a comprehensive, clear, and wide-awake openness to the entire fullness of perception.
This state of consciousness has been characterized and referred to as panoramic awareness by Chögyam Trungpa. \[13]\[14][15] Mindfulness practice (or mindfulness meditation) directed in this way toward open expanse (Bodhidharma) therefore gradually leads to such “complete” awareness that traditionally it is referred to as “right” or “perfect mindfulness,” a state of wide-awake presence of mind or presence “in which the mind is wide like the firmament”—extremely clear, vivid, and transparent.[16]
Kabat-Zinn gave the following description of mindfulness in his book _Finding Peace in Everyday Life_: “…however intense and satisfying it may be to practice concentration, the result remains incomplete unless it is supplemented and deepened by the practice of mindfulness. On its own, it (concentration) resembles a withdrawal from the world. Its characteristic energy is closed rather than open, absorbed rather than accessible, trance-like rather than wide awake. What this state lacks is the energy of curiosity, of a thirst for knowledge, of openness, of receptiveness, of engagement with the whole spectrum of human experience. This is the domain of mindfulness practice…”\[17]\[18]
History of the term
Mindfulness in Buddhism
Mindfulness (Pali: sati, Sanskrit: smṛti) is a basic meditative practice —observing human existence with its body, its feelings and its mind – that underlies all Buddhist schools, but is especially imparted, taught and practiced in the Burmese Theravada tradition. Sati describes the quality of the mind to be fully aware of what is present in it. Where samma sati, or right mindfulness, is distinct from mere attention. Right or complete (samma) here means conducive and sufficient to the attainment of the goal of liberation from suffering. Although many kinds of mindfulness practices are offered today under the label of “Buddhism,” many of them are not really in accord with Buddhist teaching and practice.\[19]\[20]
Three doctrinal teachings of the Buddha, the Anapanasati Sutta (on mindfulness in breathing), the Satipatthana Sutta (on the foundations of mindfulness; as well as the Mahāsatipatthāna Sutta, which is identical in content but expanded) in the Majjhima Nikaya as well as Digha Nikaya of the Sutta Pitaka, describe mindfulness and its practice. The “four foundations of mindfulness” according to the Satipatthana Sutta are.
- Mindfulness of the body
- Mindfulness of the feelings/sensations (evaluation as well, sore, or neither-well-nor-sore)
- Mindfulness of the mind (its current state or changes of state, e.g. distracted, concentrated, confused)
- Mindfulness on the mind objects (i.e., all external and internal objects/things perceived in the moment)[21].
Mindfulness meditation is also referred to as Vipassana in Buddhism. It can be distinguished from concentrative meditation (Samatha), which is the foundation of mindfulness meditation.
Mindfulness is the 7th limb of the Noble Eightfold Path, the first point of the Seven Elements of Enlightenment, as well as the third skill of the total Five Skills: Confidence, Energy, Mindfulness, Collection, Wisdom.
Mindfulness in western medicine and psychology
In the spread of Buddhist mindfulness techniques in the West, the works of Daisetz Teitaro Suzuki, Alan Watts, and Eugen Herrigel, among others, played an important role. From the 1960s on, interest in the use of meditation techniques in the field of psychotherapy increased, especially among psychoanalysts (e.g., C.G. Jung, Erich Fromm) and representatives of humanistic psychotherapy (e.g., Fritz Perls, Carl Rogers, Charlotte Selver). Aspects of mindfulness and acceptance have accordingly been incorporated into psychoanalysis (e.g., in the sense of the_ free association_ of the person undergoing psychoanalysis and the analyst’s equal attention, which Sigmund Freud also called _uncritical self-observation_.[22]), Gestalt therapy, client-centered psychotherapy and the method of Focusing, Gestalt theoretical psychotherapy, and body-oriented methods such as Hakomi.[23]
Gestalt therapy, however, takes an exceptional position here: From the very beginning, i.e., as early as the 1940s, consciousness or awareness (the English term here is “awareness”) formed a fundamental element of its therapeutic theory and practice.[24] Consciousness or awareness, according to Gestalt therapy’s use of the terms, can denote both an unintentional, active, inner attitude of mindfulness and a more directed form of mindfulness, and can be directed at all phenomena of perception and experience. Originally, Laura Perls and Fritz Perls even intended to call this new therapeutic method “concentration therapy” because of this key role of awareness in it.[25]
From the 1960s, interest in the field of experimental psychology grew in forms of expanding consciousness, including through meditation, and the first EEG studies were conducted on meditators.
The first scientific studies on the use of mindfulness meditation in the field of psychotherapy were conducted starting in the late 1970s. A key influence here was the work of Jon Kabat-Zinn, who first used mindfulness techniques (now known as Mindfulness-Based Stress Reduction or MBSR) with patients suffering from chronic pain.[2] Since then, research in the topic has steadily increased, and various other (predominantly cognitive-behavioral) therapeutic approaches have been developed that use mindfulness techniques (e.g. Dialectical Behavioral Therapy, Acceptance and Commitment Therapy, and Mindfulness-Based Cognitive Therapy).[26] Psychodynamic Imaginative Trauma Therapy, developed by Luise Reddemann on a psychoanalytic basis, also contains independent mindfulness exercises as a vital element.
Meanwhile, the principle of mindfulness is used in the context of therapy or prevention of a variety of different psychological and physical disorders or problems.[27] Mindfulness as a topic is also gaining ground in the interdisciplinary advice literature on stress management as well as in the health tourism sector.\[28]\[29]
Research on mindfulness
Questionnaires on mindfulness
Various psychological questionnaires have been developed in an attempt to assess the construct of mindfulness.[26] These include the following:
- The Freiburg Mindfulness Inventory (FFA)[30]
- The Kentucky Inventory of Mindfulness Skills (KIMS)[31]
- The Mindful Attention Awareness Scale (MAAS)[32]
- The Five-Facet Mindfulness Questionnaire (FFMQ)[33], German Fünf Facetten der Achtsamkeit Fragebogen (FFAF)[34]
- The Cognitive and Affective Mindfulness Scale- Revised (CAMS-R)[35]
- The Toronto Mindfulness Scale [36]
- The Philadelphia Mindfulness Scale [37]
- The Southampton Mindfulness Questionnaire (SMQ)[38]
- The Langer Mindfulness/Mindlessness Scale [39]
- The Conscious Presence and Awareness Scale [40]
- The Comprehensive Inventory of Mindfulness Experiences (CHIME)[41]
Neurophysiological methods
Neurophysiological methods have been used to study the effects of mindfulness, including electroencephalographic and imaging methods (e.g., fMRI).[42]
Ospina, et al. conducted a comprehensive review for the United States Department of Health Care and Social Services, summarizing and assessing the results of all studies on meditation and health published through 2005. Of the 813 studies found, 147 (16%) examined mindfulness meditation (including 49 MBSR, 28 Zen meditation, 7 MBCT, 6 Vipassana meditation), 50 of which had a randomized-controlled trial design. Ospina et al. came to the conclusion that there are indications of the effectiveness of meditation techniques, especially in healthy people, but due to the poor quality of most of the studies, it is not yet possible to make a reliable statement regarding the effects of meditation on health.[43] The authors of other reviews also criticized the lack of a randomized-controlled study design.
Authors of other reviews also criticized the poor methodological quality of many studies, but concluded that there is evidence that mindfulness training has a beneficial effect on various aspects of mental health, such as mood, life satisfaction, emotion regulation, and the extent of psychological symptoms.\[26]\[44]
Since the efficacy of _Mindfulness-Based Cognitive Therapy_ (MBCT) in relapse prevention is now considered to be well established in cases of multiple depressive episodes with a history of depression, MBCT has been included as a treatment recommendation for relapse prevention in these patients in the S3 _guideline_ _on depression_.[45]
Mindfulness and emotion regulation
Preliminary studies suggest that mindfulness may lead to improved emotion regulation. For example, fMRI studies showed increased inhibition of the amygdala by the prefrontal cortex during emotion designation in individuals with high levels of mindfulness (as measured by the Mindful Attention Awareness Scale).\[46]\[47]
Criticism of mindfulness
Criticism of concepts and methods of mindfulness exercises is characterized by the vague description of the concept of mindfulness.[48] The ambiguity makes stringent theory building and development near impossible. Thus, mindfulness is usually examined without a larger hypothetical framework or clear theory.[49]
Basically, different types of criticism (e.g., criticism from a sociological perspective and from a behavioral therapy perspective) can be distinguished. In the trends, different approaches to criticism can be found, each of which refers to certain characteristics of the concept of mindfulness and may need to be explained in detail.
Criticism from a sociological point of view
In recent years, the subject-centeredness in many approaches to mindfulness practice has come under criticism.\[50]\[51][52] In this context, mindfulness, according to one of the most common definitions, is described as a form of attention orientation that is intentional, relates to the present moment, and at the same time strives to refrain from judgment.[53] According to this definition, mindfulness does not address external stimuli, but focuses exclusively on their individual internal processing. Perception and evaluation are to be separated or evaluation should be eliminated or even trained away in the long term. The nonjudgmental accepting attitude cultivated in this way is associated with many positive effects, such as an enhanced ability to control emotions, lower susceptibility to stress, depression, anxiety, chronic pain, addictive behaviors, sleep quality, and reduction of retaliatory impulses. [54]
However, such an attitude of acceptance also implies that there is no reason (or reduced emotional incentive) to change anything about the current situation.[49] As sociologist Hartmut Rosa puts it, “What bothers me about it is the apolitical attitude behind it. It’s about wellness, and this attitude does not do justice to the current social problems.”[55] This is the idea behind mindfulness. Following this thought, mindfulness is criticized as a counterproductive political sedative, which not only doesn’t solve any problems, but even distracts from the search for solutions by being subject-centered.[52] “Mindfulness appears in this perspective as an […] even harmful ideology due to its distracting character from the need for structural reform.”[56]
One particular manifestation of this critique deals with the practice of mindfulness in corporate contexts. Since the 1990s, companies have used meditation to help workers reduce stress. In recent years, large companies such as Google, SAP, Apple, and Nike have increasingly begun to offer mindfulness training to their employees for this purpose.[50] However, the subject-centeredness embedded in this interpretation of mindfulness raises significant questions because it locates the causes of stress in the subject, decontextualizes suffering, and thus systematically disregards external causes of stress. It is criticized that mindfulness can be used by companies against the background of a specifically promoted performance culture for the purpose of increasing productivity, while it offers no room for a necessary confrontation with social (or work environment-related) imbalances. Well-being thus becomes a product of self-discipline in the sense of self-optimization.[50] To counter stress caused, or at least influenced, by external circumstances exclusively with internally oriented mindfulness exercises, however, would mean accepting the circumstances without objection instead of questioning the system underlying the stress.[49] Rosa sums up, “Especially in the context of companies, it is to be assumed that mindfulness supports a destructive system.”[55] This is not the case in the context of companies.
Another approach of criticism from a sociological point of view refers to a possible exaggeration of the significance and effect of mindfulness, which is motivated by its economic value. The economic potential of mindfulness (the “mindfulness market”[57]) is emphasized, which fits into the concept of “anxiety consumerism” and the wellness economy[50] and results from a “peculiar” combination of moral and hedonistic components.[58] Dr. Dirk Hohnsträter of the University of Hildesheim summarizes: “Mindfulness […] is as much a cultural trend term as a specific market. It aims not only at a general change of attitude, but at slowing down consumption practices, which are partly to be favored by products specifically designed with this in mind. In this way, political programs are translated into hedonistic experience, ethical concerns into aesthetic forms.”[56] The _Global Wellness Institute_ estimates that the wellness economy will have generated more than $4.5 trillion in sales by 2020.[59] The interest in actual knowledge through open-ended research is thus at least put under tension.[60]
