Minding the Buddhist roots of westernized mindfulness training

Estimated reading time: 31 minutes

Taking mindfulness training out of the Buddhist context was a brilliant move by Jon Kabat-Zinn when he created the Mindfulness-Based Stress Reduction (MBSR) program. Unfortunately, doing so also potentially sealed the gate leading to the immense richness of that setting full of important insights and applications (Maex, 2011).

In this article, I am following the lead of psychiatrist Dr. Edel Maex (2011). Much like Dr. Maex, as a lay practitioner, drawing on Buddhist tradition and my science training, I hope to place mindfulness training concepts back into the Buddhist context of the Four Noble Truths and The Noble Eightfold Path (Maex, 2011).

The purpose of this article is to provide some context for our participants in the Mindfulness Skill Training in Medicine (MSTM) program. What follows is my attempt to give a background and answer questions that we sometimes get regarding mindfulness training’s Buddhist roots.

But before endeavoring a deep dive into what for some readers may be unfamiliar territory, let me start with a brief overview of the state of mindfulness training in the West.

Mindfulness Training for Westerners is Taught Out of Context

Dr. Kirsti Artz and I created the Mindfulness Skill Training in Medicine (MSTM) program. The main aim of the MSTM program is to educate healthcare professionals about mindfulness skills that may increase their self-care, awareness, compassion, and other focused concern and reduce the chances of distress and burnout. 

Much like Kabat-Zinn’s MBSR program, we also stripped the Mindfulness Skill Training in Medicine (MSTM) program of its Buddhist origins to increase acceptability for our work amongst physicians and many other healthcare providers. We rooted the MSTM program in evidence derived from contemplative neuroscience, meditation, and mindfulness research. Taking a westernized approach is necessary because many of our MSTM program participants are exclusively trained in the West and less familiar with Buddhist traditions. 

Why is it Important to Recognize the Buddhist Roots of Mindfulness Training?

We researchers do not randomly generate ideas and hypotheses. We always start with a research hypothesis. Forming the best mindfulness research hypotheses could be achieved by drawing from scientific, clinical, and Buddhist resources. This due diligence helps us generate meaningful and valuable mindfulness research hypotheses without wasting time studying intrinsically trivial toys (Van Dam et al., 2018; Maex, 2011).

As you soon will see, mindfulness training is only one factor of the Noble Eightfold Path leading to the cessation of suffering. We’ll quickly discover that ignoring the other seven factors of the path limits what we know about mindfulness training crucially (Van Dam et al., 2018). 

Of course, I am not alone in claiming that context matters. For example, Van Dam et al. (2018) also point out that mindfulness training is part of a more comprehensive goal and attitude pattern. They write that historically, mindfulness training and the attitudes qualifying attention and awareness accompany some higher pursuit (e.g., enlightenment). 

In this higher pursuit, we need to include recognition/awareness, tranquility, concentration, equanimity, energy, joy, and discrimination (Van Dam et al., 2018).

Accounting for those broader co-variables of mindfulness training creates problems regarding the validity of westernized mindfulness training. Van Dam et al. (2018) inform us that the state of mindfulness supposedly measured by research is not the same as what westernized mindfulness training and meditation attempt to promote. I have written more about this topic in an article titled “Mindfulness Research Does Not Support Media’s Claims.”

Further complicating research is that mindfulness training can differ significantly from practitioner to practitioner. Long-term meditators’ practice can vary considerably. Potential research participants can come from diverse contemplative traditions or westernized mindfulness training. They can come as beginners, novices, or expert meditation status. Researchers need to account for those differences (Van Dam et al., 2018). 

To quickly recap, mindfulness training, as approached in the West, including the Mindfulness Skill Training in Medicine (MSTM) program Dr. Kristi and I developed, is stripped of its roots. But to our defense, we never miss an opportunity to remind our MSTM participants about the limitations of the evidence we used to create the MSTM program.

Now we have set the stage, and we know that there is more to the story than first meets the eye. Let’s take a closer look at the context in which mindfulness training has been practiced for over 2,500 years.

Minding the Buddhist Roots of Mindfulness Training 

To understand the Buddhist context in which mindfulness training fits into contemplative practice from a monastic perspective, or even from a lay practitioner perspective, we need to get a glimpse of mindfulness training’s position in the context of the Four Noble Truths and the Noble Eightfold Path. Only then will we be able to appreciate that we Westerners may miss essential insights into contemplative practice.

Let’s begin with Shakyamuni Buddha. After his enlightenment, the Buddha shared his experience and taught us how we could end our suffering. Two main principles express those teachings (Bodhi, 2013).

• The Four Noble Truths, and 
• The Noble Eightfold Path

Bhikkhu Bodhi (2013), a Buddhist monk in the Theravada tradition, asserts that the first principle, the Four Noble Truths deal with doctrine, aiming to stimulate understanding primarily. The second principle, the Noble Eightfold Path, teaches discipline, and the primary response it calls for is practice. Indivisibly merged, the doctrine-and-discipline comprise the dhamma-vinaya, short Dhamma (Dharma¹).

It gets a tad complicated for the reader unfamiliar with Buddhist practice but bear with me as this is important. For the moment, let’s say that the internal harmony of the Dharma is guaranteed because the Fourth Noble Truth (the validity of the way) is the Noble Eightfold Path (Bodhi, 2013).

In turn, the first factor of the eight factors of the Noble Eightfold Path, “right view,” demands “right understanding” (sammā-ditthi) of the Four Noble Truths. Therefore, the Four Noble Truths doctrine contains the Eightfold Path. On the other hand, the Noble Eightfold Path doctrine includes the Four Noble Truths. Because of this unification, the Buddha’s teachings penetrate one another (Bodhi, 2013).

A Basic Overview of the Four Noble Truths

The First Noble Truth (Dukkha)

The First Noble Truth teaches that all life is suffering (dukkha). Scholars encourage using the term dukkha without translating it into English because both translation and interpretation are overwhelmingly insufficient and deceptive (Walpola, 1974).

Although overly undeveloped, here is a more holistic exemplification of dukkha. Dukkha embraces concepts such as unsatisfactoriness, imperfection, bothersomeness, incoherence, and most important of all, impermanence (Bodhi, 2013; Maguire, 2001; Walpola, 1974).

The noble truth of suffering stipulates that birth is suffering. Getting old is suffering. Chronic disease and sickness are suffering. Dying and death are suffering. Sorrow, lamentation, pain, grief, and despair, yes, you guessed right, are all suffering. Joining with the unpleasant creates suffering. Separation from the pleasant is suffering. Not getting what one wants is suffering (Bodhi, 2013; Maguire, 2001; Walpola, 1974).

It bears worth repeating that my depiction of dukkha is desperately oversimplified, and we’ll investigate more about dukkha in upcoming articles. 

By now, I think you get the point that the business of being human and being alive involves much suffering. So, what is one to do about that suffering? 

It starts with aspiring to identify the source of suffering. The Buddha teaches us about the origin of suffering in the Second Noble Truth.

The Second Noble Truth (Samudaya)

The Second Noble Truth is all about understanding the origin of suffering. Essentially, what causes us to suffer in an impermanent world is not impermanence. It is our relentless desire to attach to things that are not lasting. Thus, the cause of suffering is desire (Bodhi, 2013; Maguire, 2001; Walpola, 1974).

The Second Noble Truth seems simple at first. But then we learn that the desire (thirst or craving) the Buddha has in mind as the origin of suffering is the inappropriate clinging to an ego-oriented notion of self. See, I tried to warn you. It gets complicated. 

The Second Noble Truth is an excursion into teaching us that as long we discriminate between self and other, rather than recognize the interdependence of both, we are subject to harboring the so-called three-poisons of 1) greed, 2) anger, and 3) ignorance. The three poisons fuel desire, the fixation to acquire, to subjugate, to win at any cost, thus creating a vicious cycle of rebirth (samsara) driven by greed, aversion, and delusion (Bodhi, 2013; Maguire, 2001; Walpola, 1974).

In brief, clasping to joy and happiness creates suffering also. Even though there is a lot of dukkha, at times, life can be pretty awesome too! That also makes for suffering. Because no matter how great and wonderful life can be, intrinsically, everything in life is unsatisfying and disturbing. After all, it does not last. Thus clasping to joy and happiness causes a great deal of suffering (Bodhi, 2013; Maguire, 2001; Walpola, 1974).

So far, you have learned that 1) all life is dukkha, and 2) that we ought to grasp the origin of dukkha. Now let’s turn to the instructions of what it takes to end dukkha.

The Third Noble Truth (Nirodha)

Yes, we definitely can end suffering. The Third Noble Truth aims to rouse understanding of the doctrine of the cessation of dukkha. Right view of dukkha’s cessation is the good-news element. The lousy news element is that the ending of suffering relies on realizing “a state of essential emptiness.” In the Theravada tradition, one must realize the absence of any illusion that a separate self exists (Bodhi, 2013; Maguire, 2001).

In the Mahayana tradition, one must realize awareness of the whole universe’s eternal, infinite emptiness. And thus, enlightenment (the cessation of suffering) realizes that no separate self exists (Maguire, 2001).

While the news that we can acquire the skills necessary to end dukkha is welcome, the downer here is that it necessitates a lot of hard work on the practitioner’s part. You can only come to know what enlightenment is and what it means by experiencing it yourself. Nobody can do this work for you. You must roll up your sleeves and commit to journeying the path! 

Now let us take a closer look at the Fourth Noble Truth, the middle way (majjhima patipada).

The Fourth Noble Truth (Magga)

While the first three Noble Truths deal primarily with doctrine, the Fourth Noble Truth, “The Noble Eightfold Path,” or the “middle way,” is at the very core of the Buddha’s teaching. The Noble Eightfold Path is also a clear departure from doctrine as it teaches discipline, and the principal response it calls for is practice (Bodhi, 2013).

Because the Buddha walked the path himself, he learned experientially. He discovered the hard way, by trial and error, what worked and did not work. However, modifying the practice as needed allowed the Buddha to reach enlightenment finally (Maguire, 2001).

With enlightenment came the realization that the path toward enlightenment is the Middle Way. The Middle Way strives, through avoiding extremes, to balance samsara (worldly engagement) and nirvana (release from worldly engagement) (Maguire, 2001).

After his enlightenment, the Buddha taught concerning a set of conditions he said anyone could develop. These conditions fit together into a systematic structure, “a path” in the word’s most basic application—inevitably a path for movement leading to a goal (Bodhi, 2013).

The Buddha provides us with explicit instructions toward that goal:

“You yourselves must strive. The Buddhas are only teachers. The meditative ones who practice the path are released from the bonds of [dukkha].”

(Bodhi, 2013)

And practicing the path means that one has to master eight factors: right view, right intention, right speech, right action, right livelihood, right effort, right mindfulness, and right concentration.

The ultimate goal of the path? The cessation of dukkha! 

The Buddha’s Noble Eightfold Path (the Middle Way) breakthrough hoisted him from a wise and altruistic sage to a world-renowned teacher. To his Sangha, the Buddha was unequivocal the…

“…arouser of the unarisen path, the begetter of the unbegotten path, the expounder of the unexpounded path, the knower of the path, the expert with regard to the path, adept at the path.”

(Gopaka Moggallāna Sutta [Moggallāna the Guardsman], n.d.).

It is beneficial to point out again that the end of suffering is entirely in the practitioner’s hands, seeking to end suffering. The Four Noble Truths teach doctrine, and the primary response they elicit is understanding. In contrast, the Noble Eightfold Path teaches discipline, with practice being its immediate response (Bodhi, 2013).

Following the Noble Eightfold Path propels us toward practicing 1) moral discipline, 2) concentration, and 3) wisdom. Because of that, The Noble Eightfold Path is also called “The Threefold Training” (Bodhi, 2013).

I promise we will dive into The Threefold Training of the Noble Eightfold Path in just a moment.

Colleagues in healthcare wanting to adopt an evidence-based approach to “mindfulness training” for themselves and their patients need to know about mindfulness training’s limitations. We want to raise an awareness that meditation and mindfulness training research carried out in the West pretty much ignores mindfulness training contextual relationship and interdependence on the other seven of the Noble Eightfold Path’s eight factors (Van Dam et al., 2018).

This methodological design flaw grossly limits the conclusions that we can draw about the effectiveness of westernized mindfulness training and contemplative practice (Van Dam et al., 2018).

As you will see, the terms mindfulness and mindfulness training refer to an extensive pattern of mental states and practices that could be rooted in a wide variety of secular and religious contexts (Van Dam et al., 2018).

Here then is an overview, from a Buddhist perspective, of what all else plays into a person’s “state of mind” as far as our endeavors of measuring the effects of mindfulness training should be concerned.

Threefold Training: The Noble Eightfold Path

The Noble Eightfold Path, also called Threefold Training, consists of eight parts (factors) grouped according to three goals (Maguire, 2001).

According to Bhikkhu Bodhi (2013), the first path factor of “right view” (samma ditthi) is the forerunner of the entire path. The guide for all the other factors. Right view allows us to recognize our starting point, destination, and the milestones to pass as practice advances.

We have to begin with the right idea, agreeing with the truths acquired through learning and supplemented through reflection. When our training matures, the eye of wisdom (Goal 3) opens by itself, penetrating the Moral and Ethical Conduct Group (Goal 1) and the Concentration and Mental Discipline Group (Goal 2), thus freeing the mind from bondage (Bodhi, 2013).

Goal 3: The Wisdom Group (Paññakkhandha)

Why begin with the third goal? The difficulty sometimes arises over an apparent inconsistency in the path factors’ arrangement and the threefold training. The wisdom group (Goal 3) includes the first two path factors, right view, and right intention. But the wisdom group is the last stage in the threefold training. Yet, we place the wisdom group’s two factors at the Noble Eightfold Path’s beginning rather than its end.

The Wisdom Group is developed not through intellectual prowess but through cultivating truth from one’s experience. The goal here is not to gain knowledge or facts but insights (Maguire, 2001).

I: Right View (Samma-diṭṭhi) 

We commonly interpret right view as seeing each moment or phenomenon as it truly is. Rather than through the filter or preconceptions or conditioning (Maguire, 2001).

II: Right Intention (Sammā-saṃkappa)

Right intention, or sometimes called right thought, is a penetrating view of the nature of existence, gained through deep reflection and validated through investigation. Right intention induces a restructuring of values, settling the mind toward goals comparable with a new vision. The mind’s application to achieve those goals is what is meant by right intention (Bodhi, 2013).

Goal 1: The Moral and Ethical Conduct Group (Sīlakkhandha)

The principles of moral and ethical conduct restrain immoral actions and promote good conduct. They are not prescribed merely as guides to action but primarily as aids to mental purification. As a necessary measure for human well-being, ethics has its unique justification in the Buddha’s teaching. Ethical conduct’s importance cannot be underrated. In the Noble Eightfold Path’s unique context, moral and ethical principles are subordinate to the path’s governing goal, final deliverance from suffering (Bodhi, 2013).

Thus, we must take up moral training under the guardianship of the first two factors, right view and right intention, to become a proper part of the path. The moral and ethical group then helps lead the way to the training in concentration and wisdom (Bodhi, 2013).

III: Right Speech (Sammā-vācā)

The Buddha divides right speech into four components: abstaining from false speech, abstaining from slanderous speech, abstaining from harsh speech, and abstaining from idle chatter. Speech can break lives, create enemies, and start wars, or it can give wisdom, heal divisions, and create peace. From this, we can appreciate the need to make this capacity the advancement of human excellence rather than, as too often has been the case, the instrument to human degradation (Bodhi, 2013).

IV: Right Action (Sammā-kammanta)

Right action means refraining from unwholesome deeds that surface through the body as their natural means of expression. The pivotal element in this path factor is the mental factor of abstinence. But because this abstinence applies to actions performed through the body, it is called “right action.” The Buddha mentions three components of right action: abstaining from taking life, abstaining from taking what is not given, and abstaining from sexual misconduct (Bodhi, 2013).

V: Right Livelihood (Sammā-ājīva)

Right livelihood means that practitioners following the Buddha’s teachings are encouraged to engage in work that assists oneself and others in living a healthy, honorable life to attain enlightenment (Maguire, 2001).

Goal 2: The Concentration and Mental Discipline Group (Samadhikkhandha)

The concentration and mental discipline group get its name from the goal to which it aspires. What is the goal? 

The control of sustained concentration is itself required as the support for insight and wisdom. Wisdom is the primary tool for liberation from suffering. But the penetrating vision wisdom yields is only possible when the mind has been composed and collected. Thus, right concentration brings the indispensable stillness required to the mind. Right concentration does so by unifying it with undistracted focus on a suitable concentration object (Bodhi, 2013).

To do so, however, the factor of concentration needs the support of effort and mindfulness. Right effort delivers the energy demanded by the task, right mindfulness the steadying points for awareness (Bodhi, 2013).

In the Dhammapada, the Buddha said, 

“The mind is restless, unsteady, hard to guard, hard to control. The wise one makes it straight, like a fletcher straightens an arrow. The mind is mercurial, hard to restrain, alighting where it wishes. It is good to tame and master this mind, for a disciplined mind brings happiness.”

(as quoted in Surya Das, 1998, p. 261)

Right effort, right mindfulness, and right concentration thus provide instructions on how to straighten the mind like a fletcher straitens an arrow to gain insight and wisdom.

VI: Right Effort (Sammā-vāyāma)

Right effort is a critical component in each person’s quest for their own liberation from suffering. While the Buddha has mapped the path to freedom from suffering, journeying the way requires putting the path into practice. An undertaking demanding energy. The landscape of the mental process one faces results in a division of right effort into four “great undertakings” (Bodhi, 2013, p. 33): 

1. To prevent the arising of unarisen unwholesome states.
2. To abandon unwholesome states that have already arisen.
3. To arouse wholesome states that have not yet arisen.
4. To maintain and perfect wholesome states already arisen. 

It is important to reiterate that right effort, the labor of self-cultivation, is not easy, and no one can do it for us but ourselves, but it is not unendurable (Bodhi, 2013).

VII: Right Mindfulness (Sammā-sati)

We translate the mental faculty of sati (Pali) into mindfulness. Sati transports the field of experience into focus. Sati makes the present experience accessible to insight. The practice of right mindfulness requires cultivating the mind to persist in contemplating the present moment, open, quiet, and alert (Bodhi, 2013).

The practice requires that a practitioner becomes aware and drops all judgments and rationalizations. The invitation is to note whatsoever arises unassumingly. Riding the waves of changing mental events just as it is happening. Like a surfer owns the waves of the ocean. We base the entire practice on always nudging the mind back into the present moment. With solid footing standing in the here and now and not wandering off. Without being floated away by the currents of distracting thoughts (Bodhi, 2013).

VIII: Right Concentration (Sammā-samādhi)

The eighth factor of the path is right concentration, and it represents a magnification of a mental factor existent in all states of consciousness. Right concentration aims to join the other mental factors in the effort of cognition (Bodhi, 2013).

Right concentration is responsible for keeping the mind centered on its object. At any particular moment, the mind must be aware of something. This something could be a sight, a sound, a smell, a taste, a touch, or a mental object (Bodhi, 2013).

This one-pointedness of mind explains that all acts of consciousness entail a central focal point, relating to, or being an object, from its outer boundaries to its innermost nucleus. Right concertation is entirely wholesome one-pointedness. Right concentration is the concentration in a wholesome, rather than an unwholesome state of mind (Bodhi, 2013).

Now that you have a rudimentary overview of the Noble Eightfold Path (Threefold Training) and how to ease pain and cease suffering as taught by the Buddha, maybe it’s time to talk about lifestyle medicine?

Mindfulness Training and the Noble Eightfold Path in Healthcare: Lifestyle Medicine Anyone?

Besides being board-certified in Emergency Medicine, Dr. Kristi also holds a board certification in Lifestyle Medicine. It seemed only appropriate to mention the American College of Lifestyle Medicine.

Like many of our Western colleagues, Dr. Kristi and I take an entirely westernized, secular approach to facilitate the MSTM program. However, I seldomly miss a chance to point out that 2,500 years ago, the Buddha may have developed one of the most challenging, longest-running, remarkably comprehensive, practical, and useful Lifestyle Medicine programs in existence today. 

In this article, I argue that it may have been unwise to extract mindfulness training from its Buddhist roots and why we must consider the merits of all eight Noble Eightfold Path factors.

At this point, the curious reader may be interested in learning about the definition, vision, mission, and position statements of the American College of Lifestyle Medicine and their very unlikely and unintentional alignment with the doctrines, principles, and practices of the Noble Eightfold Path that you just explored.

Take a look at the following graphic from the American College of Lifestyle Medicine that focuses on six areas to improve health.

Suppose you paid attention while reading about the Noble Eightfold Path’s eight factors above. Then, you cannot help but notice that all eight factors of the path, and not just mindfulness training, comprise a solid framework with instructions to create a healthy life. 

The Four Noble Truths and the Noble Eightfold Path provide us with a rationale and instructions on preventing, treating, and potentially even reverse diseases by replacing unhealthy behaviors with positive ones. Similar to the suggestions proposed by the American College of Lifestyle Medicine. I assure we will explore more on that connection and hypothesis in future articles.

Below I aim to continue to make the case that perhaps we must consider all Noble Eightfold Path factors on our quest to end all dukkha and not just mindfulness training.

How to Journey the Noble Eightfold Path?

But for the time being, yes, it is correct that the Noble Eightfold Path is a matter of practical application rather than intellectual knowledge. However, to apply the path correctly, it has to be adequately understood. Essentially, right understanding of the path is itself a component of the practice. Right understanding is an aspect of right view, the first path factor, the antecedent, and guide for the rest of the path (Bodhi, 2013).

Just as recognizing that lifestyle medicine requires a considerable investment of time and energy for those who want to get at the root causes of suffering, the higher reaches of the Noble Eightfold Path may seem remote from us in our current position. 

The considerable demands of the practice of the Noble Eightfold Path may seem challenging to accomplish. But even if the heights of understanding seem distant at the moment, all the means we need to reach those heights rest presently underneath our feet (Bodhi, 2013).

The path’s eight factors are always accessible to us; they are the mental components that we can establish in our mind exclusively through determination and effort (Bodhi, 2013).

We have to begin by straightening out our views and clarifying our intentions. Then we have to purify our conduct — our speech, action, and livelihood. Taking these measures as our foundation, we have to apply energy and mindfulness to cultivate concentration and insight (Bodhi, 2013).

Once you cultivate concentration and insight, the journey along the Noble Eightfold Path is a matter of regular practice and gradual progression, without anticipating quick results. For some, progress may be prompt, while progress may be hindered for others in certain circumstances. Regardless of the degree to which progress happens, it should generate neither delight nor despair (Bodhi, 2013).

Following the Noble Eightfold Path, liberation from suffering is the distinct fruit, and it is bound to bloom forth when there is regular and steadfast practice. The only commitments for reaching the final goal are two: to start and to continue (Bodhi, 2013).

If you can meet those requirements, then there is no doubt that you will attain your goal, which is the liberation from, and the cessation of suffering. 

Journeying and practicing the Noble Eightfold Path sounds a lot like cognitive behavioral therapy, life coaching, lifestyle medicine, or whatever label you want to smack on it. Does it not? 

A knowledgeable mindfulness teacher is the next important topic of Minding the Buddhist Roots of Mindfulness Training. 

The Importance of a Knowledgeable Mindfulness Teacher

From my contemplative practice, I know firsthand, and Maex (2011) also points out that different schools of Buddhism have always adapted their student-teacher relationship to the culture in which it is taught (Maex, 2011).

As I read Maex’s (2011) description of the student-teacher relationship, I cannot help but find an uncanny resemblance to how Dr. Kristi and I facilitate the Mindfulness Skill Training in Medicine (MSTM) program. We always aim to tailor the MSTM program to the abilities of the participants in our groups. We also view the participants themselves as an equally defining element in the relationship.

Let’s further explore why a knowledgeable mindfulness teacher is a crucial ingredient to your mindfulness training success. Kabat-Zinn (2006) proposes that westernized mindfulness training needed to be free of cultural, ideological, and religious elements intrinsic to mindfulness’s Buddhist roots. Kabat-Zinn’s only ambition was 

…to offer an environment within which to experiment with a range of novel and potentially effective methods for facing, exploring, and relieving suffering at the levels of both body/mind, and understanding the potential power inherent in the mind-body connection itself in doing so.

(Kabat-Zinn, 2006, p. 149)

Kabat-Zinn (2006) states that stripping mindfulness of its Buddhist roots was necessary to make it palatable to a Western audience. Nevertheless, mindfulness training needs to persevere faithfully in spirit and substance to the all-embracing dharmic dimensions. Because they are the core of mindfulness practice, I felt the need to introduce the reader of this article to the Four Noble Truths and the Nobel Eightfold Path.

The founder of MBSR, Jon Kabat-Zinn, adds that the onus is definitely on the mindfulness teacher to translate the meditative challenges and context of the Dharma into jargon, vocabulary, techniques, and practices pertinent and appealing to the lives of the participants. Yet, all that needs to happen without diluting Dharma’s teachings (Kabat-Zinn, 2006).

Kabat-Zinn (2006) indicates that this balancing act requires familiarity and an unambiguous degree of understanding of the Dharma, the Four Noble Truths, and the Noble Eightfold Path. A mindfulness teacher can obtain this level of knowledge and expertise only through immersion and personal commitment to the practice. 

That practice needs to be guided or deepened through meditation retreats at Buddhist monasteries and centers or through professional mindfulness skill training programs with teachers who have themselves trained in that way. Ideally both! According to Kabat-Zinn (2006), this twofold expertise and proficiency is a non-negotiable, minimum prerequisite for mindfulness teachers and effective mindfulness skill training programs.

The founder of MBSR confirms that it is tough to teach a skill we have not mastered ourselves. I deem this stance universally accepted because I am always reminded about it by my mentors, Western practitioners, Buddhist teachers, and masters alike (Kabat-Zinn, 2006).

First and foremost, it starts with being an avid practitioner and applying the skills yourself. Only then can we teach out of a passion for the practice (Kabat-Zinn, 2006; Maex, 2011).

Mindfulness Training in Healthcare: Teaching Out of a Passion for the Practice

Compassion is the spontaneous healing response towards suffering. Kindness and patience help us not automatically to react to adverse reactions. Like a robe, they can protect us, even when the process of change is complicated (Maex, 2011).

Emptiness refers to the openness we discover and cultivate in our practice. It refers to insight into the intrinsically insubstantial, empty nature of all things, that they are not permanent and self-existing. It is the point from where it all starts (Maex, 2011).

As far as westernized mindfulness training is concerned, our approach, although a great start, is half-assed! Because we took mindfulness training out of its context, westernized mindfulness training likely closes the door on The Noble Eightfold Path’s immense richness and essential insights and applications, especially when looking for innovative lifestyle interventions in healthcare.

We can learn a little more about the difference between westernized mindfulness training and following the Noble Eightfold Path from Daido Roshi². He encourages us to think about kie-ei. The Japanese word we translate as refuge, as in taking refuge in the Three Treasures. 

The first character, kie means to “unreservedly throw oneself into” (p. 18). There is no safety net and no holding back. The second character, ei, literally means “to rely upon” (p. 18). So we get “Unreservedly throwing oneself into and relying upon.”

The Three Treasures we take refuge in are the Buddha, the Dharma, the Sangha. Buddha is the teacher, but we accept and acknowledge that all beings are Buddha in the tradition that I practice.

The Dharma is the teachings of the Buddha, the medicine that heals the disease. And the Sangha can be understood as the practitioners of the Buddha’s Dharma. They are not only our fellow travelers on the path, but we also realize Sangha as the entire remarkable universe, all sentient beings (Loori, 2007).

Daido Roshi demonstrates that there is a difference between “Unreservedly throwing oneself into and relying upon” and the more commonly accepted idea of “taking refuge,” which he illustrates as “a shelter or protection from danger or distress” (Loori, 2007, p. 19). 

As this article is about connecting mindfulness practice back to its Buddhist roots, I invite you to ponder the difference between 

1. “Unreservedly throwing yourself into and relying upon” the doctrines and practices of the Noble Eightfold Path or 
2. The half-assed westernized mindfulness approach by “taking shelter or protection from danger or distress.” 

Daido Roshi makes the case much more eloquently in “Invoking Reality” (2007):

“Are we willing to practice the edge, take a risk, unreservedly throw ourselves into practice? Or are we just being opportunistic and calculating, ready only to skim a little cream off the top to take care of the immediate problems, but not prepared to go to the depths [roots of suffering]?”

(Loori, 2007, pp. 20-21)

Mindfulness Training in the West: Context Matters

As mentioned above, John Kabat Zinn essentially created MBSR by stripping many essential aspects of Buddhist practice. Subsequently, much of the westernized approach to mindfulness training that you may be aware of follow Kabat-Zinn’s lead. Including our MSTM program. 

However, concerning the cessation of suffering, you just learned that mindfulness and mindfulness training is only a small part of Buddhist practice (from which we lifted our westernized methods).

That is an important point to make, simply because much misinformation about the effectiveness of mindfulness and mindfulness training has penetrated our society (Van Dam et al., 2018).

Simultaneously, the misinformation and proliferation of missing context from Buddhist practice and flawed research methodology can conceivably lead to people being harmed, deceived, disappointed, and indifferent (Van Dam et al., 2018).

Yes, Dr. Kristi Artz, MD, dipABLM, CCMS, and I created the Mindfulness Skill Training in Medicine (MSTM) program based on limited but high-quality data. Yes, we frequently facilitate the Mindfulness Skill Training in Medicine program for physicians and other healthcare providers. And since our healthcare system aims to be informed by the evidence, we are also acutely aware of MSTM’s limitations. 

In our MSTM facilitated groups, we never miss an opportunity to point out current evidence’s limitations. Hence, this article aims to alert the reader that mindfulness training and practice as taught and perpetuated in the West come with many questions unanswered and much information still missing. It behooves us to mind the Buddhist roots of mindfulness training.

But don’t take my word for it.

Van Dam (2018) et al., an author team of 15 well-respected scientists and researchers that bring diverse areas of expertise, recently published a review of the present state of mindfulness research.  

In the review, the authors give us Kabat-Zinn’s definition of mindfulness as practiced in the West. Kabat-Zinn’s definition of mindfulness also happens to be the most widely used definition in the West,

“…mindfulness is moment-to-moment awareness, cultivated by paying attention in a specific way, in the present moment, as nonreactively, nonjudgmentally, and openheartedly as possible.” 

(Van Dam et al., 2018, p. 38)

Continuing their article, Van Dam et al. (2018) also cite a 2011 paper by Kabat-Zinn. In that paper, the authors suggest, Kabat-Zinn explains that he constructed his definition of mindfulness out of practicality, an operational definition, and not as a definitive statement. He intended to make the Dharma teachings readily acceptable to Western audiences (Kabat-Zinn, 2011).

That being the case, Kabat-Zinn (2011) also clarifies the Buddhist roots of MBSR. He straightforwardly challenges mindfulness training teachers to exemplify the spirit of the Dharma without relying on the terminology, sutras, and teaching methods of conventional Buddhist surroundings, 

Nonetheless, Kabat-Zinn (2011) makes a crucial point when he writes that for mindfulness teachers, personal and professional development exemplifying the spirit of Dharma is indispensable. 

Minding the Buddhist Roots of Mindfulness Training for the Benefit of All Sentient Beings

I hope I succeeded in introducing the reader to a morsel of the current evidence available in the field of mindfulness. On the same token, I aimed to provide much-needed context by offering the reader new to mindfulness training the Four Noble Truths and the Noble Eightfold Path.

In this article, I hope to have given the reader material to think about applying mindfulness training in healthcare and its implications to health outcomes.

Inherently, there could be quite a big difference between “taking refuge” in Western mindfulness training and “Unreservedly throwing yourself into and relying upon” the Four Noble Truths and the Noble Eightfold Path. 

I hope to have provided an acceptable argument why Western practitioners, scientists, clinicians, and people working in healthcare want to immerse themselves in understanding and practicing the Buddhist roots of mindfulness training if drawn to mindfulness interventions.

This article is not a call to action that we all convert to Buddhism and move into monasteries. Not practical. However, there is definitely a place for “lay practitioners” and “householders” to immerse themselves into rigorous practice and exposure to the Dharma teachings, specifically the Four Noble Truths and the Noble Eightfold Path. 

I want to inspire the reader to discover how Buddhist tradition can help solve our society’s most pressing healthcare problems. This article is merely a reminder that mindfulness researchers and teachers are also a community (Sangha) (Maex, 2011).

Because of this bond, just as Maex (2011), I also hope that we will not lose all ties with the richness of mindfulness training’s ancient Buddhist roots. One of the motives for strengthening and grounding ourselves in our Buddhist roots and tradition of mindfulness training is the current popularity of mindfulness and its applications (Kabat-Zinn, 2011).

As Buddhist “lay practitioners,” solidly grounded in our contemplative practice, we are very well positioned to cultivate and care for this multi-dimensional emergence of great transformative and liberating promise for the benefit of all sentient beings and our world (Kabat-Zinn, 2011).

Finally, if I sparked your interest in learning more about mindfulness training in healthcare, I invite you to evaluate several trustworthy and well-established mindfulness training programs. 

If you are a healthcare professional who is entirely new to mindfulness training, our four-session Mindfulness Skill Training in Medicine (MSTM) program may be a safe entry point for you.

Dr. Kristi Artz, MD, dipABLM, CCMS, and I created the Mindfulness Skill Training in Medicine (MSTM) program based on the latest available evidence for busy professionals working in healthcare.

Maybe we can share our expertise and passion for teaching mindfulness skills that you can immediately apply to your personal and professional life. You can find more information about the Mindfulness Skill Training in Medicine (MSTM) program here.

Footnotes:

[1] dharma: a “thing” or “object,”  a physical or mental phenomenon. Capitalized, Dharma refers to the Buddhist “Law” or “teaching.” 

[2] Daido Roshi was one of the most esteemed Zen teachers in the United States. Daido Roshi is the author of numerous books, including The Eight Gates of Zen and The Dharma Eye. He is the founder of Zen Mountain Monastery and the Mountain and Rivers Order, Zen Buddhist temples, practice centers, monasteries, and meditation groups worldwide.

References:

Bodhi, B. (2013, November 30). The Noble Eightfold Path: The way to the end of suffering [Access to Insight (BCBS Edition)]. Access to Insight. http://www.accesstoinsight.org/lib/authors/bodhi/waytoend.html

Gopaka Moggallāna Sutta [Moggallāna the guardsman] (Thanissaro Bhikkhu, Trans.; Majjhima Nikaya 108). (n.d.). Metta Forest Monastery. https://www.dhammatalks.org/suttas/MN/MN108.html

Kabat-Zinn, J. (2006). Mindfulness-Based Interventions in Context: Past, Present, and Future. Clinical Psychology: Science and Practice, 10(2), 144–156. https://doi.org/10.1093/clipsy.bpg016

Kabat-Zinn, J. (2011). Some reflections on the origins of MBSR, skillful means, and the trouble with maps. Contemporary Buddhism, 12(1), 281–306. https://doi.org/10.1080/14639947.2011.564844

Loori, J. D. (2007). Invoking reality: Moral and ethical teachings of Zen. Shambhala.

Maex, E. (2011). The Buddhist roots of mindfulness training: A practitioner’s view. Contemporary Buddhism, 12(1), 165–175. https://doi.org/10.1080/14639947.2011.564835

Maguire, J. (2001). Essential Buddhism: A Complete Guide to Beliefs and Practices. POCKET BOOKS.

Sayādaw, L. (2008). The Noble Eightfold Path and its factors explained (Maggaṅga-dīpanī)) (U Saw Tun Teik & Bhikkhu Khantipālo, Trans.). Buddhist Publication Society. http://www.bps.lk

Surya Das. (1998). Awakening the Buddha within: Tibetan wisdom for the western world. Broadway Books.

Van Dam, N. T., van Vugt, M. K., Vago, D. R., Schmalzl, L., Saron, C. D., Olendzki, A., Meissner, T., Lazar, S. W., Kerr, C. E., Gorchov, J., Fox, K. C. R., Field, B. A., Britton, W. B., Brefczynski-Lewis, J. A., & Meyer, D. E. (2018). Mind the hype: A critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspectives on Psychological Science, 13(1), 36–61. https://doi.org/10.1177/1745691617709589