Is a Buddhist principle that emphasizes on close attention to the present moment being aware of ones senses breathing and thoughts without judgment or evaluation?

Impermanence

Impermanence, or the reality of constant change, is central to Buddhism. As Bien (2006) explains, it is inevitable that we all have to face impermanence. The real question is whether we will come to terms with it. When we resist reality, our suffering increases. Thus, helping patients to accept impermanence can have important clinical implications. Clinicians can do this by presenting examples of impermanence and using language that highlights the ever-changing nature of human experience. They can invite patients to investigate the changing nature of their own lives and experiences and to focus on changing thoughts, emotions, and sensations (Shapiro & Carlson, 2009).

Collective, Historical Trauma

Too often, groups of individuals are not only affected by a single or multiple traumatic events (collective trauma), but this cumulative emotional and psychological wounding is experienced by groups over generations. According to social identity theory, sense of self, or identity, is derived from group memberships, and having a particular identity and affiliation with a group (irrespective of whether it is one that comprises race, religion, gender, or one that entails occupation, or being a breast cancer survivor) serves multiple adaptive functions. Social identities take on considerable importance, particularly when the group is challenged, and a variety of adaptive or counterproductive emotions can be elicited (e.g., collective shame or guilt vs collective anger). These threats can also come to provoke individual or group behaviors that can be either constructive (i.e., prosocial) or destructive (i.e., antisocial).

Members of some groups (e.g., a racial, religious, or cultural group) may accept the impermanence of their own lives, but believe that aspects of their group (e.g., values, morals, beliefs, traditions, and symbols representing the group) will be passed on from one generation to the next. The more they identify with the group, the more threatening they will perceive external threats, leading to efforts to push against the challenge. Thus, it is hardly surprising that a history of collective abuse and threats of extermination, would be associated with group members being especially vigilant, sensitive, and reactive to the perceived evil or malign intents of others. Outsiders might view the heightened vigilance of ingroup members as a neurotic obsession with past trauma (perhaps even resenting the constant referrals to the past collective abuses attributed to the outgroup). Yet, if history is any teacher, then the elevated vigilance might be perfectly reasonable and adaptive.

Carrying the load of collective, historical trauma

The psychological and physical consequences of “collective, historical trauma” experienced by a group can be passed down across generations through multiple processes. Epigenetic changes and parental influences might act in this capacity, but negative outcome can also occur through other processes. In the years following collective trauma, dislocation creates multiple hardships, living conditions may be exceptional disturbed, and poverty may be pervasive, so that the psychologically toxic environment promotes a wide range of physical and mental illnesses.

As with any stressor, wide individual differences exist in relation to the effects of collective trauma. Even within a circumscribed group, such as Holocaust survivors, considerable diversity exists regarding their experiences, and marked physical and behavioral variations occur among survivors and their children. While some survivors might not have seemed to carry the trauma of the Holocaust with them (or, might not have openly expressed their feelings), others frequently displayed one or more of several emotional disturbances, ranging from survivor’s guilt, denial, agitation, mistrust, intrusive thoughts, nightmares, disorganized reasoning, difficulty expressing emotions, anxiety, and depression, although in most instances these were at sub-syndromal levels (Bar-On & Rottgardt, 1998). Whereas some survivors of collective trauma could not stop speaking of their trauma, others rarely spoke of their experiences (a “conspiracy of silence” that was frequently the norm; Danieli, 1998). Even if the trauma was not spoken about, it was nonetheless “silently present in the home.” Despite not directly encountering the trauma, children of those who did might incorporate their parents or grandparents narratives and images into their own schema (Hirsch, 2001). These narratives might have been passed on through both verbal and nonverbal communication, and when blanks existed in the historical accounting, these may have been filled in by the fertile imaginations of children. As it turned out, the children who experienced this silence generally seemed to be more vulnerable to intergenerational transmission of trauma (Wiseman et al., 2002).

The consequences of collective, historical assaults among Indigenous People within the US and Canada (as well as many other countries) aimed at eliminating a group’s identity (“taking the Indian out of the Indian”) can reflect a “soul wound” that isn’t readily eliminated (Duran, Duran, Heart, & Horse-Davis, 1998). These experiences can produce social and psychological consequences on family and communities, fostering disturbed social functioning, an erosion of leadership, basic trust, social norms, morals, and values, often persisting for generations (Bombay et al., 2011, 2014Bombay et al., 2011Bombay et al., 2014). The impact of collective trauma may diminish over successive generations, largely being recalled through rituals and symbols (e.g., holidays and remembrance days) or through story-telling. At the same time, “recovery” might never be complete as feelings concerning these traumatic events sit only slightly below the surface, reemerging with further reminders (e.g., discriminatory behaviors or other threats to the groups’ well-being) of the indignities committed against their group. Once again, the transmission of trauma across generations of Indigenous people can also be influenced by the communications (either silence or continued recapitulation of experiences) between survivors and their children and grandchildren (Matheson, Bombay, Dixon, & Anisman, 2018).

It is difficult (and inappropriate) to make comparisons between the experiences and consequences associated with collective trauma across different groups. Each collectively traumatized group is unique, each involves its own series of experiences, and each has its own consequences. This said, the long-term impacts of collective, historical trauma are not “just” a result of the trauma per se, but might also be subject to the healing opportunities (or the lack of such opportunities) that came afterward, particularly if these groups continued to live in substandard conditions and experienced ongoing discrimination. As well, while ingroup and outgroup support and nurturance could potentially act against adverse effects emerging, in the end, traumatized groups may need to find their own ways of healing, without government agencies looking over their shoulders, pushing them one way or another. If nothing else, this will allow for the adoption of a strength-based approach to overcome current problems and may thus be instrumental in self-healing.

Class 8—Breastfeeding: Mindfulness and the Birth of a Nursing Relationship

The focus of Class 8 is mindfulness practice and breastfeeding. As always, the first part of class is devoted to formal practice, and this week, in preparation for the course ending, sitting meditation is practiced with minimal instructions. Inquiry focuses on the expectant parents’ experiences of mindfulness practice during the past week and a conversation about mindful parenting, including how children are constant reminders of impermanence, the afflictive emotions or contractions in parenting and life, using the breath to come back to the present moment, moving toward expansion of the mind and heart as they have been learning to do, and wise, skillful action born from kindness and compassion are all a part of the teaching. In naming their own next developmental task in the life cycle, expectant parents are encouraged to see themselves as a couple evolving into a team, one that is building something larger than themselves, namely, a family.

The second half of Class 8 is devoted to the topic of breastfeeding. Beginning with the body, expectant parents learn about the anatomy of the breast, the physiology of breastfeeding, the mind–body connection during breastfeeding, and how mindfulness supports the complex hormonal interplay between mother and baby through the calm and connection (oxytocin) system. The health benefits of breastfeeding for both mother and baby, the conditions for optimizing the establishment of the breastfeeding relationship, how the capacity to be present supports the psychophysiology of breastfeeding, and attachment and bonding are all reviewed. Physical pain, disappointment, grief and letting go are named as possible components of the breastfeeding experience.

Understand Principles of Everyday Healthy Living

This section introduces clients to the principles of everyday healthy living. Therapists ask clients about how successful they were at balancing their emotions recently. Furthermore, they prompt clients to brainstorm ways they might be better able to rebalance their energies and emotions so that they can become more centered and balanced. Therapists emphasize that reflecting upon principles of everyday healthy living can help people improve their mood, feel more balanced, and have a positive outlook on life. They highlight that these principles have been an integral part of many different Asian heritage cultures for thousands of years. Because the treatment manual was specifically developed for Chinese Americans, the particular principles listed in the manual have all been verified as being part of Chinese cultural traditions, philosophy, and religions. In addition, many of these principles are directly related to Confucianism, Buddhism, Hinduism, and Taoism, and other religions and philosophies which have influenced many different Asian heritage cultures for thousands of years.

However, when using the manual for other Asian heritage populations, it is important to verify whether these specific principles also apply to the client’s particular individual and cultural background. Generally speaking, many of these principles are associated with a variety of different Asian cultures. However, not all of the principles presented will necessarily resonate to every individual from every Asian background. Consequently, it is important to confirm and verify which principles apply to the specific culture of the client in order to tailor therapy to their particular beliefs. Therapists can also ask the client if there are additional extant principles that are not listed in the manual, but that are part of their cultural background and may be useful. If there are additional principles that they feel may be beneficial, they can also be applied in a therapeutic manner.

Many of these principles have been around for thousands of years and have strengthened and enriched people’s lives during difficult times. They can help people increase insight and awareness, cope with life stresses, stay emotionally healthy, problem solve, and improve relationships with others. Learning how to reflect upon these principles will enable clients to let go of emotional pain and thereby focus on positive aspects of their lives. Therapists ask the client how they might be able to integrate and incorporate each of the principles into their everyday life. They are asked to indicate which principles they most resonate with, and which ones are less applicable to their specific life situations. In addition, they should be asked why it would be important to regularly remind oneself of each of these healthy living principles on a daily basis, as well as during stressful times.

Developing a cueing system that prompts clients to cognitively reframe and to utilize therapeutic interventions during stressful and emotional situations is an important aspect of effective therapy. Cueing can help prevent downward spirals and reduce the likelihood of being trapped in negativity. Clients are asked to think about what might help them remember to reflect on these principles. Therapists should encourage clients to practice these methods both during difficult times, as well as times when clients feel more at peace—which can actually be one of the best times when they can understand and utilize therapeutic principles to address life problems.

In introducing the principles, it is recommended to review all of them before selecting which ones will be emphasized in treatment. After the overview, clients can come back to and more deeply explore and discuss specific principles that they more strongly identify with. A number of principles were listed because we wanted clients to have a flexible menu of options that could be best applied to their particular life situations and problems. Mastering and applying every single principle to the client’s life situation is not the goal of the treatment manual. Although this could eventually be done, this would take a great deal of time, and focusing on the most relevant principles is the primary goal.

Specifically, we want clients who utilize skill sets that help facilitate faster change, so that they have positive experiences with therapy. This is especially important for Asian heritage populations. Focusing on implementing too many different principles could result in client confusion or therapists losing the attention and interest of their clients because they feel overwhelmed. Limiting the number of principles they focus on is especially important for clients who are depressed because they typically have limited emotional energy, concentration, motivation, and anhedonia. By initially focusing on the most beneficial principles, therapists will be able to streamline and provide a refined individual treatment plan. The principles of everyday healthy living listed in the manual include:

Realism (Don’t be too critical of self or others and have realistic expectations);

Impermanence (Life is always changing);

Cause and effect (Understand the consequences of one’s actions);

Determination (Work hard and try your best);

Consistency (Following through, being reliable, having stability in life);

Contentment (Focus on what we do have rather than what we don’t have);

Forgiveness (Learn to forgive and forget);

Compassion (Toward self and others);

Letting go (Release the negative emotions that hurt us inside).

A brief description of each principle is provided below:

Realism (pronounced héhūxiànshí in Mandarin Chinese—合乎現實). This is an important principle because it is important for people to not be too critical of themselves and of other people. People need to have realistic expectations for work, school, and various life situations and stressors such as family relations, managing conflict, job seeking and unemployment, admission into schools, physical health, aging parents, and financial burdens. According to Buddhism, being realistic, having clarity, possessing insight, and having accurate perceptions of one’s surroundings are essential elements of realism, which is a requisite for enlightenment.

Impermanence (pronounced fēihéngdìng in Mandarin Chinese—非恆定). Life is ever-changing and continually presents challenges. All people are faced with various life obstacles that are often out of their control. It is important to be able to adjust and adapt one’s expectations and understand that most things in life are impermanent. Valuing the principle of impermanence not only will help a person to live in the present moment, but can also increase happiness and reduce dwelling on difficult situations. Buddhism emphasizes the importance of accepting the impermanence of life because it is one of the keys to reducing and being free from attachments and sufferings. Only then can a person find true inner peace and enlightenment.

Cause-and-effect (pronounced yīnguǒ in Mandarin Chinese—因果). The choices a person makes can dictate the quality of various aspects of their life. It is important to understand that actions can have either positive or negative consequences. Good choices result in positive outcomes, such as improved life situations, greater happiness, better interpersonal relationships, and enhance physical and mental health. Conversely, poor choices result in the exacerbation of existing problems, interpersonal conflict, social isolation, and also have a negative toll on emotional health and well-being. In Buddhism, karma (also known as the law of cause-and-effect) is an important principle and part of the Four Noble Truths (ie, truth of the cause of suffering). Specifically, people may increase their own suffering by making poor decisions and choices, thus making the cessation of suffering more difficult.

Determination (pronounced jiāndìngyìzhì in Mandarin Chinese—堅定意志). It is important to work hard and try your best. In addition, it is important to incorporate the previous principle of realism, and not to overly criticize oneself or interpret outcomes that don’t match your initial goal as failures. Determination is also associated with “Right Effort,” an essential component of the Buddhist Noble Eightfold Path. It is also part of Confucian philosophy, where diligence and a strong work ethic are heavily emphasized and seen as a key to success. Because not everything in life is easy, dedication and having the “right effort” can be one of the most important principles for preventing problem development and having a sense of accomplishment. This principle applies to work, family and social life, physical health, as well as improving one’s mental health by working hard and strengthening oneself in therapy.

Consistency (pronounced shǐzhōngrúyī in Mandarin Chinese—始終如一). In order to be successful and have a healthy and successful life, we need consistency. This applies to a number of areas, including being consistent in our exercise routine, social relationships, work practices, and even in the way that we communicate (eg, healthy communication vs passive-aggressive communication). When we are inconsistent, others perceive us to be unreliable, inconsiderate, and lacking in work ethics. Somebody who is consistent also tries to maintain balance and a feeling of centeredness, despite whatever stresses they face or the manner that other people communicate to them (eg, if somebody is yelling at them, they consistently practice responsive and healthy communication in order to reduce conflict and focus on effectiveness).

Contentment (pronounced mǎnzú in Mandarin Chinese—滿足). One of Buddha’s teaching is that “contentment is the greatest wealth.” Specifically, in order to reach enlightenment and achieve optimal health, we need to recognize and appreciate all of the privileges that we have in life. Too much focus on what we do not have, especially when it comes to material goods, can lead people astray and lead to greater suffering. Gratitude and cherishing the positive traits of our family and friends is essential to having healthy relationships. Being grateful and seeing the positive aspects of yourself and your life situation helps us develop a more positive and peaceful mindset.

Forgiveness (pronounced kuānshù in Mandarin Chinese—寬恕). Being able to forgive and forget is essential for not internalizing negative life stresses and emotions. Holding grudges and resenting others only increases the negativity in our lives, and ultimately hurts oneself in the end. Although not easy, finding a way to forgive and let go of pain can be extremely beneficial to a person’s health. The ability to forgive oneself is just as important as our ability to forgive others. Dwelling and holding onto past issues is also associated with stress generation. For example, when we are resentful, we act and communicate in ways that increase interpersonal conflict. Acceptance and forgiveness of oneself and others is an important teaching of Buddhism. By forgiving, we are able to move on with our lives and allow ourselves to heal.

Compassion (pronounced cíbēi in Mandarin Chinese—慈悲). Compassion is a core teaching of Buddhism and is often promoted by the Dalai Lama. In order to reach enlightenment, a person must have both wisdom and compassion—which are deeply intertwined. Specifically, we must be able to have empathy and understanding of other people’s feelings in order to have true insight and awareness. Teaching clients to utilize “wise action” and put themselves in other people’s shoes can help promote their emotional intelligence and help them understand other people’s perspectives. Moreover, compassionate individuals are better able to respond rather than to react because they are able to think about others, not just themselves. The more we are compassionate toward others, the more likely others are able to be compassionate toward us. When we are compassionate, we are also more capable of forgiveness and less likely to focus on negative feelings such as anger, resentment, and criticism, which can be bad for our health. It is also important that we be compassionate toward not only others, but also ourselves. This is underscored by many Buddhist leaders. For example, Buddha once stated, “If your compassion does not include yourself, it is incomplete.” Having love and compassion for oneself is crucial to a long, happy, and emotionally healthy life for oneself and those around you. The 14th Dalai Lama also stated, “If you want others to be happy, practice compassion. If you want to be happy, practice compassion.”

Letting Go (pronounced fàngxià in Mandarin Chinese—放下). Learning how to let go of the stresses and worries around us is vital for our inner peace and emotional well-being. Harboring negative feelings toward oneself or others can be toxic and counterproductive. When we don’t let go, these damaging feelings eat us up inside and promote interpersonal conflict and poor decision-making. Letting go of anxiety, anger, hate, jealousy, and sadness is essential to good physical and mental health. Although these emotions can be natural initially, they can be damaging in the long run if we hold onto them too long. Life is much more enjoyable when we can focus on the positive and appreciate what we have. This is also a core teaching of Buddhism and many other Asian religions, which emphasizes that overly strong attachments can be destructive. Detachment or the ability to detach is a core clinical skill and aligns with the belief system and philosophies of many Asian heritage traditions.

After reviewing the principles of everyday healthy living, therapists work with the client to apply the more relevant principles to the problems that the client is facing. Clients are asked which principles resonate with them most. In addition, they are asked to integrate these principles into their lives. They are asked to use the principles to guide how they might think about particular situations, communicate in different ways, and problem-solve life situations that they are facing in an effective manner. Clients are asked to discuss with the therapists some of the issues that are affecting their lives. Clients are also asked to think about the advantages and disadvantages of reflecting on different principles. Moreover, therapists point out that by reflecting upon these principles, clients can become internally stronger, and feel healthier, more balanced, and centered. Utilizing principles of everyday healthy living is an important cultural adaptation that integrates extant cultural strengths into Western psychotherapy.

Conclusion

Effective communication, like effective organization, is complicated because it relies not just on technical tools, but also on the implementation of the tools. In general, it is probably best not to view these separate sections as mutually exclusive. Just as the invention of the telephone did not completely replace letters and the fax machine did not supplant the telephone, all of these communication tools can peacefully coexist. Users just need to consider what they need to communicate and how they might want the information communicated back to them. Then, they might think about the person they’re communicating with and consider the most effective way to reach them, much the same way as academics consider the best journal for their type of research.

Some users are not responsive to email so it does not make sense to email them for something needed immediately. No amount of email management will get someone to respond when that is not their inclination. But perhaps introducing someone like that to chat might make them more reachable and responsive. The immediacy and impermanence of chat may represent an attractive alternative. Or, perhaps it is simply a matter of accepting that, for some users, a telephone is still the best way to get a response.

These tools are not answers so much as they’re simply platforms. IRC is a fascinating and wonderful way for users to communicate, but all parties have to be committed to using it. This might require some social engineering, like perhaps a standing meeting that takes place within an IRC channel. Some users might have a more positive response to IRC if someone else configures their client for them. Little things like this make alternative means of communication more palatable to users who are not inclined to experiment.

And for users invested in Gmail, Google Hangouts is a fantastic tool, as it seamlessly integrates chat, both text and video, in the Gmail web interface. Emails and chat messages all wind up in the same place.

Finally, many organizations have their own chat tools, frequently based around the campus email system. If a user’s campus or organization has access to this kind of tool, and if the user only needs to communicate with people within the campus or organization, this can be a simple and easy way to touch base, without having to investigate a new tool platform, although, like any new tool, there will probably be a learning curve in learning to use the enterprise chat tool.

There is no shortage of cloud-based communication options. The major challenge is getting collaborators to agree upon a tool and then to keep themselves in that magical middle ground, where communication is effective and robust, but no one feels inundated by messages.

5 Mental Time Travel

Most of our research on self-distancing has focused on how people can reflect adaptively on negative experiences by self-distancing using visual imagery (i.e., adopting a fly on the wall perspective) or linguistic (i.e., engaging in non-first-person self-talk) techniques. Recently, we have begun to explore whether people can self-distance through an alternative mechanism: by focusing on their future selves. Our motivation to pursue this question stemmed from the recognition that both common wisdom and research suggest that the passage of time improves the way people feel about negative experiences (Gilbert, Pinel, Wilson, Blumberg, & Wheatley, 1998). But can the healing power of time be harnessed through mental time travel to imagine a future self without having to wait for actual time to pass?

4.1 Cultural Contradictions or Expansion of Civil Society?

(a)

As important as official government agencies may be in recognizing new art forms, public policy alone does not account for the rise of outsider art. It is only one ingredient among others, of which the most important are art market initiatives. Although therapists played a vital part in recognizing the creations of their patients, the discovery of outsider art hinged on collectors, dealers, and scholars in the context of an expanding art world. These developments were vital to broadening the domain of the arts more generally, including the entry of new collectors. This is indicated by the growth of interest among African–American collectors in African tribal art as well as in works by African–American artists (Halle 1993). The exclusionary definition of art proposed by some of the most influential philosophical estheticians and buttressed by the academic system has ceded to one more sensitive to nuance, process, and inclusivism: not high vs. low but high and low; not insider vs. outsider but insider and outsider; not art vs. politics but art and politics. These boundary blurring innovations are seen by some as a danger, indications that much of the Western world has entered a period of ‘cultural declassification—an unraveling and weakening of ritual classifications.’ The discomfort that this may create is expressed by the sociologist Daniel Bell, who regrets this symptom of the decline of the fine arts into no more than the impermanence of fashion. He takes it as a sign of an esthetic malaise because of a ‘disjuncture of culture and social structure’ (Bell 1996). Other sociologists, such as Paul DiMaggio, see declassification from a more dispassionate standpoint, as a predictable result of the intimate relation between them. DiMaggio attributes it to a combination of factors, among which the most salient are the transformation of local upper classes into a US elite, anchored in organizations and less in community; an increase in the influence of commercial principles of classification as popular culture industries expand; the emergence of relatively autonomous and competitive high culture art worlds; the growth of mass higher education; and changes in the US state (DiMaggio 1987, p. 452).

While an air of elitism still clings to the arts, both artists and the public they seek have expanded to the point where earlier conceptions of exclusivity seem to many to be in need of revision. To some degree, this was driven by the new challenge of the 1960s when abstractionism was confronted by Postmodernism. In Andreas Huyssen's analysis, Postmodernism challenged the avant garde autonomous fine art sphere, which had preserved traditional strictures of uniqueness and originality from the illegitimate importations of technology. In challenging this position, certain artists launched a revolution that brought the techniques of mass media into the domain of the fine arts. No longer would the quasi-sacred realm of fine art be clearly distinguished from that of commerce. Instead, it came to include everyday consumer goods, on the same level as the aura-laden fine art to which Walter Benjamin had directed his attention (Benjamin 1969). In the process, they blurred the line—the Great Divide—between fine art and commercial art (Huyssen 1986, Cherbo 1997). Moreover, makers of prints, color lithographs, and photographs that reproduce unlimited numbers of copies were not content to be mere adjuncts for reproducing already acknowledged works of art. Instead, they claim these media of design and advertising are themselves Art. Upholders of the older, exclusive avant garde ideals became the chief detractors of Postmodernism. Their efforts were largely in vain: the day of clearcut boundaries between fine and other art forms had passed.

Postmodernism has another side that is closely connected to the make up of societal membership. Although the situation varies considerably from one nation to another, in many the exclusion from the esthetic core of certain art forms on the basis of their creators' categorical memberships—based on gender, race, class, status, or socially defined handicaps—have gained attention of policy makers and scholars. Since art worlds are embedded in, and encompass a part of, the social fabric, it is not surprising that the tensions and demands of under-represented groups and their art works are revealed in them. These forms of the Postmodern turn have implications for all the arts, but outsider art may be the most salient because it reveals the multitude of domains in which different forms of artistic excellence are recognized.

Mindfulness-Based Interventions

In the modern context, mindfulness has been defined as the quality of bringing attention to one’s experience of the present moment without judgment or attachment to outcome (Kabat-Zinn, 1990). Meditation is the most commonly recommended method of developing mindfulness. The key to mindfulness meditation (MM) is to intentionally pay attention to present experience with an attitude that is accepting and nonjudging (Shapiro, Carlson, Astin, & Freedman, 2006). Mindfully being present contrasts with a layered analysis of experience and thinking that is either past- or future-focused. Regular practice of MM is thought to lead to an overall diffusion of mindfulness throughout everyday life. A key goal of the practice of MM is the development of an awareness of impermanence and constant change. Practicing nonattachment to outcomes and letting go of needing things to be a certain way can relieve the suffering caused by grasping at specific desired outcomes. This corresponds to reduced emotional distress and cultivation of positive emotions (Germer & Neff, 2013).

The practice of MM has been incorporated into clinical interventions as a potential pathway to more effectively decrease perceived stress and to regulate emotional reactivity associated with a broad range of clinical and nonclinical conditions. The first formal Westernized MBI, mindfulness-based stress reduction (MBSR) was developed in 1979 by Jon Kabat-Zinn and colleagues at the University of Massachusetts Medical Center. MBSR incorporates elements of MM training with stress reduction techniques in an 8-week group format (Kabat-Zinn, 1990). The program focuses on several core mindfulness practices, including the body scan; sitting, breathing, and walking meditations; and gentle Hatha yoga (see description of practices in Table 16.1). In addition to these mindfulness practices, a key element of MBSR is experiential learning through body awareness and group discussions. Since that time, hundreds of research studies have evaluated the efficacy of MBSR for treating myriad physical and psychological symptoms and disorders, and many review articles and meta-analyses are now available (Bohlmeijer, Prenger, Taal, & Cuijpers, 2010; Chiesa & Serretti, 2009; Zainal, Booth, & Huppert, 2013).

Table 16.1. Formal Mindfulness Meditations in MBSR

In the late 1990s, components of MBSR were combined with cognitive therapy to create mindfulness-based cognitive therapy (MBCT), an 8-week group program to reduce the rate of relapse in patients in remission from major depression (Ma & Teasdale, 2004; Teasdale et al., 2000). Evidence suggests that people who have recovered from depression remain vulnerable to relapse because of previously learned associations between dysphoric mood and patterns of negative, self-devaluative, and hopeless thinking (Marchetti, Koster, Sonuga-Barke, & De Raedt, 2012). As such, subsequent low mood is likely to reactivate old thought patterns and trigger an escalating, self-perpetuating cycle of ruminative cognitive-affective processing. Each subsequent depressive episode is thought to strengthen these associations and less of a catalyst is required to provoke relapse (Post, 2007). MBCT is based on the theory that the risk of depression recurrence can be minimized if people can learn to be more aware of, and disengage from, negative thought patterns and feelings in times of potential relapse or recurrence. Unlike cognitive therapy, which teaches people to change the content of their thoughts, MBCT teaches patients to change one’s awareness and relationship to these thoughts. A recent meta-analysis concluded that MBCT: (1) was associated with a 34% reduction in the risk of relapse/recurrence compared to usual or placebo controls, (2) is as effective as maintenance antidepressant medication, and (3) appears to be even more beneficial for patients with three or more depressive episodes (Piet & Hougaard, 2011).

The use of MBIs has grown rapidly in the primary or adjunctive treatment of a wide range of mental health conditions, including anxiety (Evans et al., 2008; Kim et al., 2009), unipolar depression (Bondolfi et al., 2010; Kuyken et al., 2008), bipolar disorder (Williams et al., 2008), suicidal behavior (Williams, Duggan, Crane, & Fennell, 2006), psychosis (Johnson et al., 2011; Newman Taylor, Harper, & Chadwick, 2009), personality disorders (Soler et al., 2012), eating disorders (Wanden-Berghe, Sanz-Valero, & Wanden-Berghe, 2011), addiction (Hsu, Grow, & Marlatt, 2008), autism (Spek, van Ham, & Nyklicek, 2013), and posttraumatic stress disorder (Omidi, Mohammadi, Zargar, & Akbari, 2013). Clinicians have also used MBIs to treat the psychological and physical effects associated with several chronic diseases, including cancer (Carlson et al., 2013; Carlson & Speca, 2010), HIV/AIDS (Gonzalez-Garcia et al., 2014), fibromyalgia (Schmidt et al., 2011), heart disease (Hughes et al., 2013; Parswani, Sharma, & Iyengar, 2013), diabetes (van Son et al., 2013), brain injury (Johansson, Bjuhr, & Ronnback, 2012), solid organ transplant (Gross et al., 2010), and irritable bowel syndrome (Zernicke et al., 2013). More recently, online adaptations of MBIs have been developed and tested (Zernicke et al., 2013). The consistency of results across conditions suggests that MBIs may target the same underlying processes, regardless of the particular disease presentation (Carlson, 2012).

THE TEACHING OF THE FOUR NOBLE TRUTHS

The First Noble Truth names birth, illness, aging, and death as the four types of suffering inherent to every human life. Suffering also refers to physical pain and discomfort, and to emotions and mind states that preclude the possibility of coexistent happiness or well-being. Common examples are sorrow, fear, anger, hatred, greed, jealousy, aversion, confusion, anxiety, disappointment, shame, and guilt. The Pali word dukkha is most often translated into English as “suffering.” Other common translations point to the comprehensive meaning of dukkha: illness, unhappiness, discomfort, pervasive unsatisfactoriness, or simply stress (Kabat-Zinn, 1990; Harrison, 1994; Epstein, 1995; Olendzki, 2000).

The Second Noble Truth says that there are reasons for our suffering. There are causes and conditions that give rise to unhappiness. The primary cause is ignorance, which refers not to a lack of intelligence but to a misperception of reality. For example, due to ignorance of the law of cause and effect, people tend to seek happiness through actions that could not possibly lead to happiness but instead lead to suffering. Ignorance about impermanence and the nature of change causes people to suffer by assigning permanence to what is by nature impermanent, such as the human body, material possessions, and transient emotions and mental states. Ignorance about the nature of the self causes suffering because people mistake their perceptions, opinions, and experiences for a solid entity of personality. According to Buddhist teaching, we fail to perceive that the self is more a changing process than a static entity. It is constructed anew in each moment through the individual's interaction with the constant flow of sensory perceptions. This false sense of a solid self also creates suffering because it gives rise to painful feelings of separation from other beings and from the natural world.

The Third Noble Truth proclaims that freedom from suffering is possible, that happiness can be found in this lifetime. The happiness that is referred to is often called “genuine happiness,” which means well-being, inner peace, or peace of mind. This is contrasted with the more “ordinary happiness” that can be gained from sensory pleasure, acquisition of material possessions, money, fame, good fortune, or good luck. This is not to say that sensory pleasures, material possessions, etc., are not legitimate types of enjoyment. Rather, distinguishing genuine happiness from ordinary happiness simply points to the truth that seeking inner peace through ordinary happiness will inevitably lead to disappointment and suffering. While transient enjoyment dependent on material objects and external circumstances is certainly pleasurable, it is entirely different from abiding inner peace, cultivated through intention, discipline, and practice.

The Fourth Noble Truth offers a path toward the end of suffering. Understanding this path, and choosing to journey along it, is the first step toward genuine happiness, precisely because it sets one's intention to live with greater awareness. The Fourth Noble Truth is also known as the Noble Eightfold Path, because it is made up of eight interrelated aspects. These eight components are: skillful thought, skillful view, skillful speech, skillful action, skillful livelihood, skillful effort, skillful concentration, and skillful mindfulness. Skillful, in this context, simply means “leading to happiness and well-being.” These eight components can be divided into three groupings: the behavioral, or ethical, group, which includes speech, action, and livelihood; the meditative group, which contains effort, concentration, and mindfulness; and the wisdom group, which is made up of thought and view.

The teaching of the Four Noble Truths posits health to be a far larger concept than we ordinarily take it to be, and proposes that we can consciously influence both the physical and mental aspects of health. By proclaiming that optimum health depends more on genuine inner peace than any other factor, the definition of health is extended far beyond the absence of pain, symptoms, or disease. “Physical health is indeed a blessing, but if it is no longer an option, freedom can still be claimed by the ‘coming to terms with things as they are’ that constitutes mental health” (Olendzki, 2000).

The Buddha's teaching of the Four Noble Truths rests on the assumption that the attainment of happiness is available to all, and that every human being has an equal right to achieve this happiness. Furthermore, despite the differences among people due to age, gender, nationality, ethnicity, religion, language, educational background, and socioeconomic status, it is the experience of suffering and the innate drive for happiness that unite all human beings. The Four Noble Truths assert that every human being belongs to one family of humanity.

Although the MBSR curriculum does not include explicit discussion of the Four Noble Truths, patients generally discover for themselves the immediate relevance of this teaching. In the inner-city medical setting, examples of personal and community dukkha fill the MBSR classroom: a vast array of medical and psychological diagnoses among patients; the illness, death or incarceration of family members; and a constellation of stressors related to poverty, low academic achievement, unemployment, community violence, and marginalization from mainstream culture and society. When patients enter the MBSR program, they are manifesting the First Noble Truth: There is suffering in life.

Over the course of the program, patients experience many and varied benefits. These changes come about through the patient's own efforts, accomplished by engaging in a variety of mindfulness meditation practices and exploring the direct application of mindfulness to all aspects of one's life. Many patients experience a noticeable improvement in symptoms during the first weeks of the program. Initial changes such as decreased physical pain and improved quality of sleep enable patients to gain glimpses of the Third Noble Truth, that relief from suffering is possible. This taste of the Third Noble Truth generally occurs with little understanding of the Second Noble Truth, which explains the causes of suffering.

Toward the middle of the 8-week program, when patients experience a significant decrease in stress, they suddenly realize how their own habits of reactivity exacerbate their stress. This realization marks their awakening to the Second Noble Truth: There are reasons for our suffering. As the course unfolds, patients become more skillful in replacing habitual reactions with more conscious responses to stress. The Third Noble Truth is further confirmed, and the Fourth Noble Truth becomes evident. There is a path that leads to decreased suffering; happiness is possible. In the last weeks of the program, patients learn more about the Noble Eightfold Path that is the Forth Noble Truth. The meditation techniques taught throughout the MBSR program belong to the meditative group of the Noble Eightfold Path. As effort, concentration, and mindfulness of the meditative group improve with meditation practice, patients gain greater insight into how the components of the wisdom group affect their health. Patients learn to influence their thoughts and beliefs in the service of their healing. As patients are increasingly able to choose conscious responses to stress, they gain an experiential understanding of the role of speech, action, and livelihood, the behavioral group of the Noble Eightfold Path, in achieving greater happiness and well-being.

Patients who participate fully in the MBSR program discover precisely what the Four Noble Truths proclaim: Health improvement comes about more by changing our relationship to our experience of suffering than by changing the nature of the suffering itself. In the MBSR program, inner-city medical patients come to know through their own experience that dukkha, whether defined as suffering or as stress, is essentially “a remediable attitude that affects all aspects of human existence” (Olendzki, 2000).

Historical overview

The place, context, and tenure where one resides are deeply embedded within sociological and culture spheres. Developing a definition of residential instability requires attention to these shifting historical currents.

Nomadic cultures have existed for centuries with impermanence of location an identifying characteristic of life and community. Traditional residentially-stable communities, such that populated medieval Europe, were marked by strong kinship and community ties (Oishi, 2010). Referencing the German philosopher and sociologist Ferdinand Tonnies’s description of gemeinschaft (a non-mobile, traditional community) and gesellschaft (a modern, mobile community), Oishi (2010) explores this historical turning point as a shift from the relatively unchanging village life to the modern-day industrialized community with an increased emphasis on obtainment of individual goals and wishes. This sociological shift ripened communities for transience.

Residential mobility was eventually viewed as a contributor to social deviancy. Sociologists Shaw and Mckay (1942) explored the role of residential mobility as a contributor to crime and deviant behavior. This ideology culminated in an effort to distinguish causal links between higher rates of residential mobility and unwanted social outcomes. However, this trajectory changed in 1955, when Rossi published his now famous book, “Why families move: a study in the social psychology of urban residential mobility.” Residential mobility was then viewed as a typical response to life-stage events with the intent to increase satisfaction under dynamic contextual circumstances (Rossi, 1955).

Within this new scholarly trajectory, researchers attempted to describe models of migratory patterns, motivation, and predictors for moving (Walport, 1965). These early studies examined variables such as renter vs home-owner status and life cycle transitions (Spear, 1970). Spear (1974) applied the stress-threshold model to describe mobility as a response to environmental stress or dissatisfaction, positing that amenities and location such as size of home and yard, as well as distance from school, shopping, etc. were examples of driving forces behind residential change. This ideological framework assumed that opportunity-seeking behavior is the driving factor behind most residential mobility. The population moves to secure a higher-wage position or improve quality of life (Cadwallader, 1992; Cushing, 1999).

As a result of this change in perspective, the majority of research on this topic reflects the experiences of the nuclear family. Yet this narrow focus omits relevant considerations. “Military families,” for example, illustrate atypical mobility patterns, moving as often as once every three years (Kelley, Finkel, & Ashby, 2003). Yet research exploring outcomes on military children has produced mixed findings. Several researchers found that frequent mobility creates more difficulties with academics and psychosocial domains while other researchers found that mobility promoted adaptation and appreciation for other cultures (Jeffreys et al., 1997; Kelley et al., 2003).

In spite of a century-long research interest, the contextual reasons that perpetuate residential instability for low-income, resource-constrained families have been largely overlooked. Building deterioration, eviction, financial hardship, and/or neighborhood violence reflect the contextual circumstances and external forces that precede moving (Bartlett, 1997; DeLuca, Rosenblatt, & Wood, 2013; Schafft, 2006). More recently, DeLuca et al. (2013) described the context of residential movement patterns among poor African Americans by reporting the contingent circumstances that motivate relocation, defined by the authors as reactive mobility. Unit failure was attributed to more than 25 % of all relocations and more than 80% of the population had moved for reasons beyond their control (DeLuca et al., 2013). Defined as an unexpected move, responsive moving typically necessitates a hasty selection of an alternative, affordable residence. This pattern often perpetuates neighborhood churning, defined as the phenomenon of families moving short distances for minimal gain. These families typically do not gain an improvement in amenities or increased satisfaction with housing or neighborhood (Coulton, Theodos, & Turner, 2012).

Residential instability as a phenomenon impacting low-income families challenges the more traditional understanding of residential movement as opportunity-seeking behavior. This shifting landscape exposes it as a concept that is inadequately defined in spite of its ubiquity.