Meditation and mindfulness are terms that have crept into mainstream culture. These terms are often used interchangeably, but there are subtle differences between the two. Meditation usually refers to a formal practice that can calm the mind and enhance awareness of ourselves, our minds and our environment. Meditation in its many guises has been practiced over millennia by diverse groups of people in many different traditions. Previously practiced primarily in the Eastern traditions, meditation has spread into Western society and is increasingly being used as a therapeutic modality. ‘Mindfulness’ as a term has become ubiquitous in recent times. Mindfulness simply means being aware of the present moment. Meditation comes under the umbrella of ‘mindfulness’ which is a broader concept. Formal meditation practices include mindfulness of breathing, compassion or loving kindness-focused meditation, the use of mantras or phrases as the focus for meditation, among many others.
Underlying each of the different meditation techniques is a simple coming to awareness of the present moment. Being aware of what is happening in the present moment allows the individual to observe what is arising and what is falling away. By doing this and by allowing thoughts to come and go without attachment, without trying to hold on to them, we learn that calm and stillness follows. We come to know our own minds over time and to be aware of patterns of thinking that habitually arise. The key is to gently catch a spiral of thoughts, mind flurry or mind chatter, and observe, noting ‘worry’, ‘lists’, ‘craving’, ‘fear’, and allow the spiral to gently fall away without judgement. Useful techniques in different forms of meditation include mindfulness of breathing (using the breath as an anchor to the present moment), compassion-focused meditation (using loving kindness, and awareness of others’ and our own suffering to be in the present moment), the body scan (being aware of each part of the body in turn as an anchor for the present moment and for where we hold tension and stress in our bodies). Other forms include the use of mantras or phrases to focus attention to the present moment, or walking meditation where the entire focus is on awareness of our feet in contact with the earth and grounding to the present moment. Over time, regular practice of mediation allows individuals to react to their environment and anything that arises in the course of their day with more calm and equanimity. Studies of people who have meditated over the long-term show changes in areas of the brain concerned with stress and anxiety. The prefrontal cortex, the cingulate cortex and the hippocampus show increased activity, and the amygdala shows decreased activity consistent with improved emotional regulation. Other studies have shown that evidence-based therapies such as MBSR also show similar brain changes to those with traditional meditation practice.
As the term ‘meditation’ is so broad, and its therapeutic uses encompass many conditions including pain, mental health and somatic conditions, research into such heterogenous modalities and outcomes has been difficult to conduct in a systematic scientific manner. Recently, there have been more studies of better quality resulting in randomised controlled trials and systematic reviews. Practices such as MBSR and mindfulness-based cognitive therapy (MBCT) have developed from formal meditation practices. These are modularised practices that are feasible to teach and lend themselves more easily to evidence-based practice research. Both are 8-week-long programmes of 2 hours duration a week, with intensive 1-day teaching midway through the programme, and with home practice. MBSR, originally developed by John Kabat-Zinn in the 1970s, adapts formal meditation practices to give a more generalised approach to mindfulness, and MBCT was subsequently developed with more of a focus on depression using a blend of cognitive and mindfulness approaches.
Crises such as the COVID-19 pandemic have shown that change is the only constant. Meditation and mindfulness can offer a helpful way to live with this constant change. MBSR programmes already extant within services can be adapted for online delivery. Meditation apps and online classes can be recommended to patients. Both learning and having a regular meditation practice ourselves can only benefit our patients and ourselves. Meditation and mindfulness are useful skills that can help us to sit with our fears and our circumstances and to observe that like our thoughts, this period in our lives too shall pass.