Does not a day go by that many of us don't wonder how we manage to juggle the pieces of our lives and honorably hold up our responsibilities to family, friends, work, our health, our financial well-being, as well as lead full and satisfying lives? It sometimes doesn't take much to unsettle the delicate balance of forces that constellate as our world, sending it off into a wobble, leaving us struggling to right the course. How do we find a way back?

One route is in practicing mindfulness-based stress reduction. Intensive training in mindfulness meditation can cultivate states of relaxation, improve physical symptoms of pain and chronic illness, open our minds to greater insight, and enhance our physical health and sense of well-being for fuller, more satisfying lives. The course originated twenty years ago with Jon Kabat-Zinn, Ph.D., founder of the Stress Reduction Clinic at the Center for Mindfulness at UMassMemorial Medical Center in Worcester. This form of meditation practice stems primarily from the Buddhist tradition and was intended as a means of cultivating greater awareness and wisdom, helping people to live each moment of their lives as fully as possible. While some forms of meditation involve focusing on a sound or phrase in order to reduce distracting thoughts, mindfulness training does the opposite. In mindfulness meditation, you don't ignore distracting thoughts, sensations or physical discomfort, rather, you focus on them.

An integral part of mindfulness practice is to look at, accept and actually welcome the tensions, stress and pain, as well as disturbing emotions that surface such as fear, anger, disappointment and feelings of insecurity and unworthiness. This is done with the purpose of acknowledging present moment reality as it is found — whether it is pleasant or unpleasant — as the first step towards transforming that reality and one's relationship to it.

Mindfulness-based stress reduction, also. includes the practice of yoga. Yoga encourages musculoskeletal strength, flexibility and balance, as well as inner stillness. It can both relax and energize. Applied in conjunction with mindfulness techniques, yoga is a gentle but powerful form of body-oriented meditation. With continued practice, one can begin to fully inhabit the body, pay closer attention to its fluctuating states and learn to cultivate an early warning system for the presence of stress, tension or pain. With an attitude of mindfulness to both body and mind states, one has more information to work with in potentially handling the day-to-day stressful events in life.

Can thoughts in the mind and tension in the body actually have the capacity to produce bodily symptoms? There is growing evidence that by implementing mind/body techniques, the mind and body are capable of relaxing, new perspectives can be gained, and new ways of coping with one's life can be achieved that can impact symptoms — like gastritis. Dean Ornish, M.D., author of Dr. Dean Ornish's Program for Reversing Heart Disease, provides scientific proof in his landmark research demonstrating, for the first time, that even severe heart disease often can be reversed by practicing meditation, yoga. changing ones diet and participating in group support.

Research on the impact of mindfulness meditation on a variety of symptoms including anxiety disorder, chronic pain and psoriasis has been conducted over the past 20 years by Dr. Kabat-Zinn. He states that "participants report a sharp drop over the eight week course in the number of medical symptoms originally reported, as well as psychological problems such as anxiety, depression and hostility. These improvements occur reproducibly in the majority of participants in every class. They also occur regardless of diagnosis, suggesting that the program is relevant to people with a wide range of medical disorders and life situations."

He also notes, "In addition to having fewer symptoms, people experience improvements in how they view themselves and the world. They report feeling more self-confident, assertive and motivated to take better care of themselves and more confident in their ability to respond effectively in stressful circumstances. They also feel a greater sense of control over their lives, an increased willingness to look at stressful events as challenges rather than threats, and a greater sense of meaning in life."

One frustrated participant came to the clinic with this question: "Can a fish know it is in water? I don't think it is possible, because if you take the fish out of the water, it will die." He saw himself as someone immersed in a cloudy mindstew, unable to gain perspective on himself or his world. Was there the possibility that he could see himself and his thought patterns more clearly?

In the practice of mindfulness meditation, one can cultivate the sense of oneself as a present moment awareness that observes the thoughts that arise in the mind and views them as something to be noted, perhaps responded to, but not to be identified with as "me." As one begins to quiet the mind, this view of our thoughts in relation to ourselves can be cultivated more and more deeply, which can result in more clarity about who we really are. When we realize we are not our thoughts, we can explore them more deeply and begin to move into a greater stillness that offers us further information about who we may really be at our core. Just as the ocean has waves on the surface of the water as well as the silent depths below, we too can know the thought patterns on the surface, as well as the quiet depths within. And so, in answer to this patient's question, the fish does have the possibility of knowing something of the water it is in.

In addition to mindfulness meditation in the medical setting, the training has also been broadened in scope to include inmates in the prison system, inner city residents, Olympic rowing athletes, judges, the Chicago Bulls basketball team, corporate executives, as well as grammar school children. Over 240 mindfulness-based stress reduction programs are currently being offered around the country. Instructors vary with respect to their backgrounds, most being health care professionals with teaching and clinical experience in the health field, or having extensive meditation and yoga backgrounds. 

Whether we are pressed by serious pain and stress, or simply by a mild sense that things are not as we would like them to be, mindfulness meditation is a tool that allows us to see our world as if standing and looking at the landscape of our own particular life and the world around us from a new vantage point. We can begin to recognize the ways in which we contribute to our own discontent and can decide to make a change. Mindfulness meditation offers that opportunity.

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Roberta Lewis is a certified yoga teacher since 1978, trained in Integral Yoga, with several years study in Iyengar Yoga, and training in gentle patient-oriented yoga as offered at the UMass-Memorial Medical Center's Stress Reduction Program founded by Jon Kabat-Zinn. She has been a meditator in the Yoga and Vipassana traditions since 1976. She is trained in Mindfulness-Based Stress Reduction (MBSR) and has been part of the clinical staff of the UMass Stress Reduction Clinic since 1996. She currently teaches yoga and MBSR at Listening: The Barre Integrated Health Center in Barre, MA.