Mindfulness and Kathy M. Sanders, M.D.

Psychotherapy
Abstract: Mindfulness is a natural human mental state of moment-to-moment awareness of present experience. It is a
skill that can be trained using meditation techniques that sustain focus on the present moment with a nonjudgmental

SYNTHESIS
CLINICAL
attitude. Mindfulness training has been shown to be effective in relieving the suffering of numerous medical and psy-
chological conditions while enhancing well-being. In particular, affective disorders including anxiety, depression, and
personality disorders are particularly well suited to demonstrate benefit to patients when integrating mindfulness medi-
tation techniques with usual psychotherapies, primarily cognitive behavior therapies. In addition, early evidence shows
that when the clinician is practicing mindfulness, there is a positive impact on the outcome of the therapy. Mindful-
ness-based therapeutic interventions are an important technique for clinicians to be aware of in the treatment of their
patients’ distress. Further study using larger sample sizes and more controlled conditions is warranted to establish the
benefit and efficacy of mindfulness-based psychotherapies.

Mindfulness refers to the mental quality of being
fully present and attentive in the moment. This
human mental activity of focusing on the present
moment with all one’s attention leads to a state of
mind in which thoughts and feelings are detached
from past and future speculations. This mindful
state is characterized by less judgment, prejudice,
and worry and more openness, acceptance, and em-
pathy (1). The consistent practice of training the
mind to attend in the present moment without
judgment rather than pursue thoughts and feelings
about the past or anticipations about the future is
the technique integrated into psychotherapy and
behavioral interventions. These meditation prac-
tices have been increasingly studied over the last
several decades; specifically, researchers have fo-
cused on the effect of consciousness and affect reg-
ulation in both patients and practitioners. In this
article I will define mindfulness and explore its cur-
rent applications in various psychotherapies as well
as its impact on the therapist. Specific psychother-
apies that incorporate mindfulness as a component
of treatment will be reviewed as well as the evidence
for its efficacy in psychiatry. The widespread use of
mindfulness techniques in medicine and psychol-
ogy will be noted. A summary of the evidence that
shows the effective incorporation of mindfulness
training in cognitive behavior treatments for nu-
merous medical and psychiatric conditions should
encourage the informed psychotherapist to be
aware of its benefits and utility in clinical practice. I
will conclude with some comments on how mind-
fulness training affects the therapist and the out-
come of therapy.
DEFINITION
The practice of mindfulness training for thera-
peutic purposes has been defined by Kabat-Zinn
and Epstein’s work over the last two decades.
Mindfulness is defined as “paying attention in a
particular way: on purpose, in the present moment,
and nonjudgmentally” (1– 4). Mindfulness is a hu-
man mental function that enhances clarity of
thought and a more heart-felt engagement with life
(1). The goal of mindfulness is “maintaining aware-
ness moment by moment, disengaging oneself from
strong attachment to beliefs, thoughts, or emo-
tions, thereby developing a greater sense of emo-
tional balance and well-being” (1). Epstein (2) de-
fines the goal of therapeutic mindfulness as the
abilities for “compassionate informed action in the
world, to use a wide array of data, make correct
decisions, understand the patient and relieve suffer-
CME Disclosure
Kathy M. Sanders, M.D., Assistant Professor, Harvard Medical School, Massachusetts General
Hospital, and Training Director, MGH/McLean Adult Psychiatry Residency Program, Boston, MA.
Reports no competing interests.
Address correspondence to Kathy M. Sanders, M.D., Wang Ambulatory Care Center 812,
Department of Psychiatry, Massachusetts General Hospital, 15 Parkman St., Boston, MA 02114;
e-mail: ksanders@partners.org.

focus.psychiatryonline.org FOCUS Winter 2010, Vol. VIII, No. 1 19

 SANDERS

Table 1. Mindfulness-Based Therapies fulness and skills training (interpersonal effective-

Population Mindfulness Delivery of
Therapy Treated Training Therapy Homework
MBSR Chronically ill Central Group Yes
MCBT Anxiety and Central Group Yes
depression
DBT Borderline Part Individual and Yes
group
ACT Various/addictions Part Individual and Yes
group
ing.” Hence, for the clinician, it is the practice of
cultivating nonjudgmental awareness in day-to-day
life as a practical tool for self-awareness and self-
reflection. This skill builds up a latency of reactivity
that allows for different decisions and options to be
entertained before taking the characteristic or pat-
terned response that has been dysfunctional for our
patients or has served the unconscious bias in the
practitioner. When established as part of a focused
treatment, the usual cognitive behavior techniques
seem to be enhanced in efficacy for the patient’s
condition (5). Because mindfulness techniques fos-
ter individual acceptance and responsibility, the pa-
tient may feel more empowered in the pursuit of
health and healing of a variety of chronic medical
and psychiatric conditions. The ability to take
charge of the desired change in one’s life is en-
hanced by regular cultivation of mindfulness. One
could even say that the wellness, recovery, and pre-
vention movements initiated several decades ago
are manifesting in our health care delivery system
today as the increased interest and use of mindful-
ness training.
MINDFULNESS-BASED
PSYCHOTHERAPIES
Over the past several decades, mindfulness med-
itation training has been integrated into cognitive
behavior therapy, leading to new treatments with
multiple components (Table 1). These compo-
nents include mindfulness meditation practices,
skills training, and relaxation techniques. Kabat-
Zinn’s mindfulness-based stress reduction (MBSR)
programs (6) and Linehan’s dialectical behavioral
therapy (DBT) (7–9) have led the way for numer-
ous approaches and techniques that integrate
mindfulness in therapy. MBSR has been shown to
decrease pain and facilitate recovery for numerous
medical and psychiatric conditions (1, 3, 5, 10).
DBT is an efficacious treatment for borderline per-
sonality disorder. Mindfulness meditation is one of
the core elements in DBT, which integrates mind-
ness, emotional regulation, and distress tolerance)
in a comprehensive treatment approach for border-
line pathology (8). The ability to gain some per-
spective through mindfulness training underpins
the development of the other self-modulating skills
by the individual. Teasdale and others developed a
mindfulness-based cognitive behavior therapy
(MCBT) for the treatment and prevention of re-
lapse in major depression (11, 12). They found that
for patients who had more than three relapses of
major depression, the use of MCBT significantly
reduced further relapse compared with a control
group. With positive experience using mindfulness
in DBT for borderline personality disorder and the
clear benefits using mindfulness techniques as part
of cognitive behavior therapy (CBT) for depression
and the prevention of relapse of depression, there
has been a growing use of mindfulness as part of the
treatment for many medical and psychiatric condi-
tions. Stephen Hayes (13) developed a branch of
CBT called acceptance and commitment therapy
(ACT). This therapy uses a mindfulness approach
to experience “what is” rather than trying to deny
or change the painful experience that brings the
patient to treatment. However, desired change is
brought about through an acceptance and tolerance
of the offensive reality in the service of reframing,
integrating, and developing from the distress.
All of these techniques use manuals, are generally
time-limited, and use mindfulness meditation
training for therapeutic purposes. During active
treatment, these therapies incorporate other tech-
niques such as self-reflection, journal writing, skills
training, affect tolerance, reframing, and accep-
tance of “what is” without judgment. The core
component in all these treatments is learning mind-
fulness meditation skills. Various exercises are used
to teach patients the skill of focusing their attention
on the breath, parts of the body, emotions, and
thoughts to enhance the holistic experience of the
present moment. Patients are taught to maintain
their focus on the object of attention moment by
moment; when emotions, sensations, or thoughts
arise, they are instructed to practice nonjudgmental
observation while bringing their awareness back to
the present moment by refocusing on the object of
attention (Table 2). As training progresses, the abil-
ity to generalize these mindfulness skills becomes a
part of daily life and not just limited to the medita-
tion session. This practice allows individuals to ob-
serve their thoughts and feelings as changing, non-
permanent, and within a larger context. The
mental training to accept the flow of experience
using present moment attention builds an ability to
delay reactivity, which allows the patient to choose

20 Winter 2010, Vol. VIII, No. 1 FOCUS THE JOURNAL OF LIFELONG LEARNING IN PSYCHIATRY

a different behavior that may be better adaptive.
This dialectic of the acceptance of “what is” and the
desire for behavioral change runs through all of the
mindfulness-based therapies. This mental flexibil-
ity to accept “what is” in the present moment is the
beginning of therapeutic efficacy (14 –16).
APPLICATIONS OF MINDFULNESS
Numerous articles have been written about the
use and effectiveness of incorporating mindfulness-
based therapies in treatment of both medical and
psychiatric conditions. Two recently published
books provide extensive bibliographies and synthe-
sis of much of the literature that shows the effec-
tiveness of these techniques (17, 18). In the initial
studies using MBSR in the treatment of anxiety and
panic, there was significant symptom improve-
ment, which persisted in a follow-up study 3 years
later (6). This study did not have a control compo-
nent but was an indication in the early phase of the
scientific exploration of MBSR that there was sub-
stantial benefit when mindfulness meditation tech-
niques were incorporated in treatment. Recent
studies show the efficacy of mindfulness meditation
incorporated into therapies for pain (19), various
cancers (20, 21), HIV (22), cardiovascular disease
(23, 24), perinatal mood and stress (25), premen-
strual syndrome (26), insomnia (27), anxiety (28),
depression and treatment-resistant depression (29 –
31), suicidal ideation (32, 33), and borderline per-
sonality pathology (9). Weiss et al. (10) found that
when patients with anxiety and depressive symp-
toms were treated with psychotherapy plus MBSR
training, they made psychological improvement
similar to that of a control group receiving just psy-
chotherapy. However, the MBSR-trained patients
showed greater gains in measures of goal attain-
ment and were able to terminate therapy sooner
than control subjects and demonstrated lasting im-
provement and satisfaction at a 6-month follow-
up. Kingston et al. (29) randomly assigned 19 pa-
tients with residual depressive symptoms to either a
MCBT group or a treatment as usual group. They
found significant reduction in the depressive symp-
toms and even more symptom reduction at a
1-month follow-up compared with control sub-
jects. Hepburn et al. (33) randomly assigned 68
patients with depression and suicidal thinking to an
MCBT group or waitlist control group and then
followed Beck Depression Inventory (BDI) scores
and a measure of thought suppression. The MCBT
group improved their BDI scores and demon-
strated diminished thought suppression compared
with the control group. Thought suppression was
correlated with obsessive preoccupation with sui-
focus.psychiatryonline.org
SANDERS
cidal thinking. Less thought suppression meant less
suicidal thinking. All of the studies mentioned
above had small sample sizes, and most of these
studies used control subjects to demonstrate signif-
icant improvement of the condition studied.
BIOLOGICAL BASIS OF MINDFULNESS
Neuroscience findings of neuronal changes dur-
ing meditation are varied and may relate to the
specific type of meditation technique that subjects
SYNTHESIS
CLINICAL
practice (34). For instance, Lazar et al. (35) com-
pared the functional magnetic resonance imaging
(fMRI) studies of five people during Kundalini
meditation with those of control subjects. Their
data reflected activation of frontal and parietal cor-
tex (attentional networks) and cingulate, amygdala,
midbrain, and hypothalamus (arousal and auto-
nomic networks) compared with those of control
subjects. Davidson et al. (36) used fMRI and other
biomarkers to study MBSR practitioners compared
with control subjects and demonstrated activation
of the left prefrontal cortex (increased attention)
and diminution of amygdala activity (less emo-
tional arousal) during mindfulness meditation, im-
plying an increase of positivity and sense of well-
being and less emotional reactivity. The difference
between a more activating meditation technique
such as Kundalini and the calming focus technique
of mindfulness meditation may be reflected in the
different brain changes noted when these distinct
meditation techniques (e.g., activated amygdala for
Kundalini and diminished activity of the amygdala
for mindfulness meditation) are studied. Such a
brain state pattern activated by a mindfulness med-
itation practice may be the common mechanism
(enhanced attention skills with less emotional reac-
tivity associated with the focus of attention) that
facilitates improvement for many different condi-
tions (14, 37).
THERAPISTSWHO PRACTICE
MINDFULNESS
The use of MBSR programs for health care pro-
fessionals to counteract the stress inherent in health
care settings has been studied owing to the impair-
ment experienced by stressed professionals in the
form of depression, job dissatisfaction, and emo-
tional distress (38). A randomized control pilot
study by Shapiro et al. (38) demonstrated that after
an 8-week MBSR intervention, the mindfulness-
trained professionals showed reduced stress and in-
creased quality of life and self-compassion. Re-
cently, Epstein’s group at the University of
Rochester, which studies medical education and
FOCUS Winter 2010, Vol. VIII, No. 1 21
 SANDERS
Table 2. Mindfulness Exercise
1. Sit comfortably and in a position that fosters alertness. This can be
in a firm-backed chair or on a cushion with attention to maintaining
an erect spine.
2. Gather the proper attitude at the beginning. Take several slow and
deep breaths as you take this opportunity to tune into yourself
without interruption, expectation, or productivity. This is a gift of
time you give yourself.
3. Start to follow your breathing by maintaining your attention on your
breath as you breathe in and out. You may choose to focus on the
sensation of the breath as it expands and contracts within your
torso.
4. Distraction. Whenever you notice that you are thinking or attending
to something other than your breath, bring your awareness back to
the breath without judgmental or critical thoughts concerning your
abilities or experience. Be gentle and noncritical of your efforts. Let
go of any judgment concerning the experience and allow yourself to
be present to only your breath as it goes in and out of your body.
5. Duration. Do this for the next 5–10 minutes with intention to build
up to a 20- to 30-minute session.
6. When it is time to stop, allow yourself to become aware of sounds
and sensations around you while opening your eyes and then end
this time with yourself with a feeling of gratitude.
professionalism, published a study in the annual
medical education issue of JAMA about a mindful-
ness-based program for primary care physicians.
They showed that physicians experiencing burnout
who participated in a continuing medical educa-
tion program based on mindful communication
(mindfulness meditation, narrative medicine, and
appreciative inquiry) had improvements in mea-
surements of personal well-being and increased em-
pathy and compassion for patients (39). The cur-
riculum used mindfulness meditation training
along with writing about personal and professional
challenging experiences (narrative medicine) and
exploring how these experiences were successfully
resolved and what personal qualities were used for
success (appreciative inquiry). Significantly, this
study showed increased empathy, resilience, and
professional efficacy as well as decreases in stress,
emotional distress and reactivity to stress (39).
These changes endured for 3 months after the pro-
gram ended, and the research group plans further
follow-up of the cohort. This study provides evi-
dence to support the development of continuing
medical education programs using a mindfulness
meditation component for the treatment and pre-
vention of physician burnout (39).
Over the past decade, Williams, a research psy-
chologist, has been conducting psychotherapy re-
search and discussed her findings concerning ther-
apist self-awareness in an early career award article
published in 2007 (40). The awareness of positive
22 Winter 2010, Vol. VIII, No. 1 FOCUS THE JOURNAL OF LIFELONG LEARNING IN PSYCHIATRY
or negative thoughts in the therapist during therapy
sessions affected the therapist’s experience of the
efficacy of any particular treatment session. She
found that when therapists are more self-aware
about either their positive or negative inner state
during therapy sessions, both the therapist and pa-
tient experienced the session as helpful. Her con-
clusions call for further research of this process of
the therapist’s mindful presence in the “healing
power of the psychotherapy relationship” (40).
In addition to the benefit the therapist may have
using mindfulness practices, there is growing evi-
dence that the therapist who practices mindfulness
meditation may have a positive impact on the out-
come of treatment for the patient. Grepmair et al.
(41) studied the effect on treatment outcome when
psychotherapists in training practiced mindfulness
meditation. This German study of postbaccalaure-
ate psychologists in their psychotherapy internship
who practiced mindfulness meditation demon-
strated a positive outcome in the treatment of their
patients. Patients and psychotherapy trainees were
randomly assigned to one of two groups: a group of
patients treated by meditating trainees and a group
of patients treated by trainees who did not medi-
tate. Patient demographics and psychiatric disor-
ders were similar for both arms of the study. Results
of the study showed that patients treated by medi-
tating therapists in training had significant im-
provements in the clarification and problem-solv-
ing effects of the therapy sessions compared with
the control patients. In addition, symptom reduc-
tion on clinical scales for somatization, social inse-
curity, obsessiveness, anxiety, anger/hostility, and
psychoticism was greater for the patients in the
meditation group compared with that for the con-
trol patients. There was no difference in the positive
relationship effects of therapy perceived by the pa-
tients in either arm of the study (41). These find-
ings were gathered as part of the training of psy-
chodynamic psychotherapists in Germany and
warrant more study to generalize their findings to
trainees in the United States.
FUTURE DIRECTIONS
Mindfulness meditation practices have a clear
place in the treatment of psychiatric patients with
regard to disorders of mood regulation, affect tol-
erance, and impulsivity. Because minimal side ef-
fects are associated with this mental training, its
efficacy alone or associated with other modalities
such as psychopharmacology, insight-oriented
therapy, and CBT support its inclusion in the cli-
nician’s armamentarium. With the demonstrated
positive effect of the clinician’s practice of mindful-

ness meditation on treatment outcome for patients,
ongoing studies of mindfulness-based therapies will
have to take into account whether the therapist as-
sociated with control groups is engaged in mindful-
ness meditation. Training of medical professionals
in mindfulness meditation should be further stud-
ied in this era of competency-based medical educa-
tion, which emphasizes the maintenance of self-
care and empathic communication as fundamental
skills in professionalism and interpersonal commu-
nication. Mindfulness is a universal human mental
capacity that enhances mental and emotional agil-
ity and interpersonal communication skills, which
can be cultivated regardless of religious persuasion.
The integration of mindfulness practices into psy-
chodynamic and cognitive behavior psychothera-
pies is a growing area of clinical exploration. Early
studies using mindfulness training in therapy show
increased efficacy of the treatment for patients with
numerous medical and psychiatric conditions as
well as growing evidence of the enhanced efficacy
for the patient when the clinician practices mind-
fulness. Future exploration will include
1) refinement in our definition of mindfulness,
taking into account the various philosophical, spir-
itual, cultural, and intellectual traditions that prac-
tice mental training,
2) understanding the biological mechanisms of
mindfulness in mental functioning,
3) understanding the essentials of mindfulness
training and how best to teach mindfulness skills,
and
4) further research to establish mechanisms of
mindfulness and specific efficacy in the treatment
of patients (42).
REFERENCES
1. Ludwig DS, Kabat-Zinn J: Mindfulness in medicine. JAMA 2008; 300:
1350 –1352
2. Epstein RM: Mindful practice. JAMA 1999; 282:833– 839
3. Kabat-Zinn J: Mindfulness-based interventions in context: past, present,
and future. Clin Psychol Sci Pract 2003; 10:144 –156
4. Germer CK: Mindfulness: What is it? What does it matter? in Mindfulness
and Psychotherapy. Edited by Germer CK, Siegel RD, Fulton PR. New
York, Guilford, 2005, pp 3–27
5. Melbourne Academic Mindfulness Interest Group: Mindfulness-based
psychotherapies: a review of conceptual foundations, empirical evidence
and practical considerations. Aust NZ J Psychiatry 2006; 40:285–294
6. Kabat-Zinn J, Massion AO, Kristeller J, Peterson LG, Fletcher KE, Pbert L:
Effectiveness of a meditation-based stress reduction program in the
treatment of anxiety disorders. Am J Psychiatry 1992; 149:936 –943
7. Linehan MM: Skills Training Manual for Treating Borderline Personality
Disorder. New York, Guilford, 1993, pp 63– 69
8. Linehan MM: Cognitive-Behavioral Treatment of Borderline Personality
Disorder. New York, Guilford, 1993, pp 144 –147
9. Stepp SD, Epler AJ, Jahng S, Trull TJ: The effect of dialectical behavior
therapy skills use on borderline personality disorder features. J Pers
Disord 2008; 22:549 –563
10. Weiss M, Nordlie JW, Siegel EP: Mindfulness-based stress reduction as
focus.psychiatryonline.org
SANDERS
an adjunct to outpatient psychotherapy. Psychother Psychosom 2005;
74:108 –112
11. Segal ZV, Williams JMG, Teasdale JD: Mindfulness-Based Cognitive
Therapy for Depression: A New Approach to Preventing Relapse. New
York, Guilford, 2002
12. Ma SH, Teasdale JD: Mindfulness-based cognitive therapy for
depression: replication and exploration of differential relapse prevention
effects. J Consult Clin Psychol 2004; 72:31– 40
13. Hayes SC: Get Out of Your Mind and into Your Life: The New Acceptance
and Commitment Therapy. Oakland, CA, New Harbinger Publications,
2005
14. Shapiro SL, Carlson LE, Astin JA Freedman B: Mechanisms of mindful-
ness. J Clin Psychol 2006; 62:373–386
15. Childs D: Mindfulness and the psychology of presence. Psychol Psycho-
ther 2007; 80:367–376
16. Garland E, Gaylord S, Park J: The role of mindfulness in positive
SYNTHESIS
CLINICAL
reappraisal. Explore (NY) 2009; 5:37– 44
17. Germer CK, Siegel RD, Fulton PR (eds): Mindfulness and Psychotherapy.
New York, Guilford, 2005
18. Shapiro SL, Carlson LE: The Art and Science of Mindfulness: Integrating
Mindfulness into Psychology and the Helping Professions. Washington
DC, American Psychological Association, 2009
19. Kingston J, Chadwick P, Meron D, Skinner TC: A pilot randomized control
trial investigating the effect of mindfulness practice on pain tolerance,
psychological well-being, and physiological activity. J Psychosom Res
2007; 62:297–300
20. Carlson LE, Speca M, Patel KD, Goodey E: Mindfulness-based stress
reduction in relations to quality of life, mood symptoms of stress, and
immune parameters in breast and prostate cancer outpatients. Psycho-
som Med 2003; 65:571–581
21. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo R,
Mathews HL: Effect of mindfulness based stress reduction on immune
function, quality of life and coping in women newly diagnosed with early
stage breast cancer. Brain Behav Immun 2008; 22:969 –981
22. Barrows K: The application of mindfulness to HIV. Focus: A Guide to
AIDS Research and Counseling. UCSF. 2006 21: 1– 4. www.ucsf-
ahp.org
23. Sullivan MJ, Wood L, Terry J, Brantley J, Charles A, McGee V, Johnson
D, Krucoff MW, Rosenberg B, Bosworth HB, Adams K, Cuffe MS: The
support, education, and research in chronic heart failure study (SEARCH):
a mindfulness-based psychoeducational intervention improves depres-
sion and clinical symptoms in patients with chronic heart failure. Am
Heart J 2009; 157:84 –90
24. Nickels MW, Privitera MR, Coletta M, Sullivan P: Treating depression:
psychiatric consultation in cardiology. Cardiol J 2009; 16:279 –293
25. Vieten C, Astin J: Effects of a mindfulness-based intervention during
pregnancy on prenatal stress and mood: result of a pilot study. Arch
Womens Ment Health 2008; 11:67–74
26. Lustyk MK, Gerrish WG, Shaver S, Keys SL: Cognitive-behavioral therapy
for premenstrual syndrome and premenstrual dysphoric disorder: a sys-
tematic review. Arch Womens Ment Health 2009; 12:85–96
27. Ong JC, Shapiro SL, Manber R: Combining mindfulness meditation with
cognitive-behavior therapy for insomnia: a treatment-development study.
Behav Ther 2008; 39:171–182
28. Evans S, Ferrando S, Findler M, Stowell C, Smart C, Haglin D: Mindful-
ness-based cognitive therapy for generalized anxiety disorder. J Anxiety
Disord 2008; 22:716 –721
29. Kingston T, Dooley B, Bates A, Lawlor E, Malone K: Mindfulness-based
cognitive therapy for residual depressive symptoms. Psychol Psychother
2007; 80:193–203
30. Kenny MA, Williams JMG: Treatment-resistant depressed patients show
a good response to mindfulness-based cognitive therapy. Behav Res Ther
2007; 45:617– 625
31. Harley R, Sprich S, Safren S, Jacobo M, Fava M: Adaptation of dialectical
behavior therapy skills training group for treatment-resistant depression.
J Nerv Ment Dis 2008; 196:136 –143
32. Birnbaum L, Birnbaum A: In search of inner wisdom: guided mindfulness
meditation in the context of suicide. Sci World J 2004; 4:216 –227
33. Hepburn SR, Crane C, Barnhofer T, Duggan DS, Fennell MJV, Williams
JMG: Mindfulness-based cognitive therapy may reduce thought suppres-
sion in previously suicidal participants: findings from a preliminary study.
Br J Clin Psychol 2009; 48:209 –215
34. Lazar SW. Mindfulness research, in Mindfulness and Psychotherapy.
Edited by Germer CK, Siegel RD, Fulton PR. New York, Guilford, 2005, pp
220 –240
35. Lazar SW, Bush G, Gollub RL, Fricchione GL, Gurucharan K, Benson H:
Functional brain mapping of the relaxation response and meditation.
Neuroreport 2000; 11:1581–1585
FOCUS Winter 2010, Vol. VIII, No. 1 23
 SANDERS
36. Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D,
Santorelli SF, Urbanowski F, Harrington A, Bonus K, Sheridan JF: Alter-
ations in brain and immune function produced by mindfulness meditation.
Psychosom Med 2003; 65:564 –570
37. Stein DJ, Ives-Deliperi V, Thomas KGF: Psychobiology of mindfulness.
CNS Spectr 2008; 13:752–756
38. Shapiro SL, Astin JA, Bishop SR, Cordova M: Mindfulness-based stress
reduction for health care professional: result from a randomized trial. Int
J Stress Manage 2005; 12:164 –176
39. Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney
CJ, Quill TE: Association of an educational program in mindful commu-
NOTES
24 Winter 2010, Vol. VIII, No. 1 FOCUS THE JOURNAL OF LIFELONG LEARNING IN PSYCHIATRY
nication with burnout, empathy, and attitudes among primary care phy-
sicians. JAMA 2009; 302:1284 –1293
40. Williams EN: A psychotherapy researcher’s perspective on therapist
self-awareness and self-focused attention after a decade of research.
Psychother Res 2008; 18:139 –146
41. Grepmair L, Mitterlehner F, Loew T, Bachler E, Rother W, Nickel M:
Promoting mindfulness in psychotherapists in training influences the
treatment results of their patients: a randomized double-blind, controlled
study. Psychother Psychosom 2007; 76:332–338
42. Shapiro SL: The integration of mindfulness and psychology. J Clin Psychol
2009; 65:555–560