Mindfulness-Based Stress Reduction

Course Handbook

Chris Worfolk
Mindfulness-Based Stress Reduction (MBSR) is an eight-week programme that
uses a specific type of meditation to reduce stress, anxiety and depression.

It was developed at the University of Massachusetts Medical Center by Jon

Kabat-Zinn and is the original mindfulness programme: the wider field of
mindfulness grew out of Kabat-Zinn’s work on MBSR.

Today, mindfulness is a global field of mental health interventions but MBSR

remains the gold-standard protocol for delivering mindfulness.

What is mindfulness?
Take a few minutes to sit in silence. Bring your attention to your breath. What do
you notice? What comes into your mind? Are you able to stay with the exercise or
do you find yourself distracted?

This is a simple exercise in mindfulness. Paying attention to the present in a way

that we would not normally do.

Kabat-Zinn (1994) defined mindfulness as:

“Paying attention in a particular way: on purpose, in the present

moment, and nonjudgmentally”

This is not how we go through life most of the time. We do things on auto-pilot
while our minds worry about to-do lists, work commitments, family problems
and a long list of other stressors. We sacrifice the present moment to be in doing
mode: always trying to get things done, including thinking about things to try and
find solutions.

Mindfulness suggests that we need to spend more time stepping out of doing
mode and into being mode. Letting go of the problem-solving and bringing our
attention to the present.

When we pay attention in this way, we capture some of the joy of life and reduce
the chronic stress of trying to solve all of our problems. We realise that we spend
our time labelling experiences as good or bad, desirable or undesirable, pleasant
or unpleasant, rather than simply appreciating them.

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How does mindfulness help?
Mindfulness helps in several ways:
1. We spend much of our life on auto-pilot and miss the joys to be found in
the present moment.
2. Constantly trying to problem-solve in doing mode activates our stress
response. This is increasingly ineffective in a world of globalisation, 24/7
social media and abstract problems that do not have an immediate
solution.
3. Judging our experiences causes us to get angry, frustrated or depressed at
our behaviour, rather than recognising ourselves for the imperfect human
beings we are.
4. Promoting greater awareness allows us to stop automatically acting on our
impulses and make different choices.

Is mindfulness relaxing?
A common misconception about mindfulness is that practising is relaxing. Sitting
with our thoughts is often difficult or uncomfortable. But doing so develops our
ability to be mindful which then spills over into the rest of our life.

Think of it like getting fit. You may feel tired all of the time and want to improve
your fitness. So, you go for a run. During the run, you feel more tired. But over time
your fitness improves and you begin to have more energy in everyday life.

How MSBR is taught

Mindfulness-Based Stress Reduction was developed as an eight-week
programme led by a teacher and taught in a group format. A traditional
implementation of MSBR includes:
• 8 weekly 2.5-hour group sessions
• 45 minutes of daily practice at home
• An all-day silent retreat between weeks 6 and 7

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Protocol
This chapter provides a quick reference for the agenda and homework tasks of
each week.

Week 1
Agenda
• Welcome and introduction from the teacher (10 mins)
• Brief breath awareness and discussion (15 mins)
• Group member introductions (15 mins)
• Standing yoga practice (20 mins)
• Raisin practice (30 mins)
• Body scan practice (50 mins)
• Homework tasks (10 mins)
Homework tasks
• Perform the body scan each day using the guided audio provided
• Select one meal and practice mindful eating
• Use informal practice to bring attention to the breath, bodily sensations and
thoughts
• Begin completing the home practice log

Week 2
Agenda
• Welcome (5 mins)
• Standing yoga (20 mins)
• Body scan (45 mins)
• Homework review (20 min)
• Seeing practice (30 mins)
• Breath awareness practice (20 mins)
• Homework tasks (10 minutes)

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Homework tasks
• Perform the body scan each day as we did last week
• Perform the breath and body awareness practice each day
• Select one task each day to use informal practice
• Complete the pleasant events calendar

Week 3
Agenda
• Welcome (5 mins)
• Breath and body awareness practice (20 mins)
• Lying-down yoga practice (75 mins)
• Walking practice (20 mins)
• Homework review (20 mins)
• Homework tasks (10 mins)
Homework tasks
• Perform the body scan or lying-down yoga practice on alternate days
• Perform the breath and body awareness practice each day
• Complete the unpleasant events calendar

Week 4
Agenda
• Welcome (5 mins)
• Standing yoga practice (40 mins)
• Advanced breath and body practice (45 mins)
• Homework review (20 mins)
• Stress group discussion (30 mins)
• Homework tasks (10 mins)
Homework tasks
• Perform the body scan or lying-down yoga practice on alternate days
• Perform the breath and body awareness practice each day

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• Complete the circle of awareness worksheet

Week 5
Agenda
• Welcome (5 mins)
• Standing yoga practice (20 mins)
• Breath and body practice (50 mins)
• Stress group discussion (45 mins)
• Homework review (20 mins)
• Homework tasks (10 mins)
Homework tasks
• Perform the breath and body awareness, body scan and lying-down yoga
practice on alternate days
• Complete a circle of awareness worksheet
• Complete the difficult communications calendar each day

Week 6
Agenda
• Welcome (5 mins)
• Yoga practice (30 mins)
• Breath and body practice (45 mins)
• Homework review (20 mins)
• Communication styles exercise (30 mins)
• Brief breath practice (10 mins)
• Homework tasks (10 mins)
Homework tasks
• Perform the breath and body awareness, body scan and lying-down yoga
practice on alternate days
• Bring awareness to our communication with others: how do we react,
how does it make us feel and considering whether we can bring greater
kindness and compassion to our communication

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• Begin to notice what we take in from the world via technology, reading,
news, food and drink, etc

Week 7
Agenda
• Welcome and different chair exercise (5 minutes)
• Yoga practice (30 mins)
• Breath and body practice (45 mins)
• Review of all-day retreat (10 mins)
• Homework review (20 mins)
• Interacting with the world discussion (30 mins)
• Homework tasks (10 mins)
Homework tasks
• Select either the breath and body awareness, yoga, walking meditation or
body scan. Once you have chosen, perform this practice each day, using a
timer rather than the guided audio if possible.
• Use informal practice for a few minutes first thing in the morning and before
going to bed
• Use the interacting with the world worksheet you completed to apply some
mindfulness tasks to the stressor you selected on the worksheet

Week 8
Agenda
• Welcome (5 mins)
• Body scan practice (30 mins)
• Yoga practice (20 mins)
• Breath and body practice (15 mins)
• Guided reflection on the programme (20 mins)
• Homework review (20 mins)
• Homework tasks (10 mins)
• Closing ceremony (30 mins)

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Homework tasks
• Select one formal and informal practice to focus on over the coming weeks
• Bring awareness to the breath several times per day

Teaching skills
The number one skill any teacher needs is a personal practice. Mindfulness is
experiential and it is therefore essential that a teacher grounds themselves with
their daily practice.

Screening
Before inviting a participant onto the course, it is helpful to screen them for
suitability. Undertaking MBSR is no small commitment: we’re going to ask them
to commit to 45 minutes every day, even when they do not want to.

Therefore, it is important to give some information about what the programme

will involve so that the participant can give informed consent.

In the case of health issues, especially mental health, if the client is still in
treatment they should seek approval from their doctor or therapist before
participating.

Contracting
Once the group comes together, it is important to contract. This is the process
of the group establishing and agreeing on any relevant rules, roles and
responsibilities. This could include:
• Attendance
• Commitment to home practice
• Limits of confidentiality
• Respect for each other

Facilitating group session

Group discussions and reflection are carried out mindfully: with curiosity and
without judgement. For example:

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 Teacher: “What was it like to do that practice?” Participant 1: “It was
hard.” Teacher: “What was it that you found hard?” Participant 1: “I kept
getting distracted and forgetting what we were supposed to be doing.”
Teacher: “Did anyone else have a similar experience?”

Participants are encouraged to be open about and explore their difficulties. The
teacher gathers a wide range of opinions from the group and avoids judging the
experiences as good or bad.

Closing ceremony
After eight weeks of intensive training, group bonds have formed and participants
may be nervous or sad about the programme ending. For this reason, it is
important to manage the ending carefully.

Using a closing ceremony is a helpful way of aiding participants in saying

goodbye to the programme. This can be done in a variety of ways but should
involve each participant saying what in the programme they found meaningful
and how they are feeling now.

Theory and frameworks

In this chapter, we will explore some of the theory that aids our understanding of
mindfulness and the learning process.

The Four Noble Truths

Mindfulness was developed from Zen Buddhism (but now has no religious
connotations) and uses Buddhism’s explanation of suffering as a basis.

The four noble truths, loosely translated, might be read as:

1. Life is suffering
2. Suffering comes from attachment
3. By letting go of attachments we can end suffering
4. We can learn to let go by following the Eightfold Path
In Buddhism, this would then lead to the Eightfold Path to reach enlightenment.
This is where mindfulness diverges into a secular context. However, the idea of

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letting go of attachments: not merely material possessions, but our emotions,
desires and judgements can help free us from the suffering we cause ourselves.

For example, we are struggling with chronic back pain. We judge this as “bad”
and think about living with this for the rest of our lives (attachment to the idea
that we must be well to enjoy life) so become depressed. Instead, if we can find
a new way to make room for the pain, we can reduce the stress and anxiety that
comes with it.

Transformational learning
Transformational learning was developed by Jack Mezirow. Mezirow noted that
we often take knowledge and fit it into the existing way we see the world. For
example, we see a pothole and think to ourselves “typical, that’s the state of this
country” (whatever country you happen to be in).

However, some learning will challenge our worldview and cause us to reconsider
what we take for granted. These are known as disorienting dilemmas.

Mindfulness presents us with this disorienting dilemma: it encourages us

to challenge the way we see the world by experimenting with new ways of
experiencing and carefully reflecting on those experiences.

Experiential learning cycle

The experiential learning cycle was developed by David Kolb. The steps are:
• Concrete experience
• Reflective observation
• Abstract conceptualisation
• Active experimentation
This is how we work with mindfulness. We experiment with a practice and have a
certain experience. We then reflect on it and try and better understand ourselves.

For example, maybe we think we cannot live with this pain. But we decide to try
and make room for it. The experience does not feel good: but it does not feel
worse either. We reflect on this and wonder if maybe trying to push the pain
away is unhelpful. So we decide to experiment with letting the pain in. The cycle
continues as we learn more about ourselves.

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Mindfulness-Based Stress Reduction
Course handbook

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