Free Clinical Handbook of Mindfulness by Jon Kabat-Zinn, Fabrizio Didonna Page A

without all the cultural and ideological baggage that
    invariably accompanies the whole Eastern gestalt, and for that matter, spiritu-
    ality as it is often spoken about (Jon Kabat-Zinn, personnal communication,
    2008).
    The clinical areas of use of mindfulness-based treatment today are
    extremely broad, and various outcome studies have highlighted the clinical
    relevance of these forms of treatment with respect to a variety of disorders.
    Mindfulness is a key component of several standardized therapy models,
    most of which are included in the cognitive-behavioral approach as will be
    widely illustrated in this handbook: the Mindfulness-Based Stress Reduction
    (MBSR) protocol (Kabat-Zinn, 1990), perhaps the first model involving a
    Introduction
    11
    clinical application of mindfulness, which has been found to be effective in
    the treatment of various anxiety disorders, especially GAD, panic disorder,
    and social phobia (Kabat-Zinn et al., 1992; Borkovec & Sharpless, 2004;
    Miller, Fletcher, & Kabat-Zinn, 1995); the Mindfulness-Based Cognitive
    Therapy (MBCT) model (Segal et al., 2002), an integration of cognitive
    therapy and MBSR, which has been found to be effective in significantly
    reducing the relapse rate in major depression; the integration between
    evolutionary psychology and compassion in psychotherapy by Paul Gilbert
    (2005);
    Marsha
    Linehan’s
    Dialectical-Behavioral
    Dialectrical-Behavioral
    Theraphy (DBT) model, which comprises an important mindfulness-based
    treatment component and which has demonstrated significant effectiveness
    in reducing multi-impulsive and suicidal behaviors in patients suffering from
    borderline personality disorder (Linehan, 1993a, b); and the Acceptance and
    Commitment Therapy (ACT; Hayes et al., 1999), which is consistent with
    mindfulness approaches though it does not explicitly include mindfulness or
    meditation training. In this last therapy method, patients learn to recognize
    an observing self able to see their own thoughts, emotions, and body
    sensations and view them as separate from themselves. In addition to these,
    as will be well described in Parts 3 and 4 of the handbook, there are at this
    moment several other relevant application of mindfulness-based approaches
    for many different psychological disorders in various clinical settings and
    across diverse populations.
    Regarding the state of the art (see also Chapter 3 of this volume), Baer’s
    (2003) judgment after reviewing the empirical literature is that “mindfulness-
    based interventions can be rigorously operationalized, conceptualized, and
    empirically evaluated” (p. 140) and that at present they meet the American
    Psychological Association Division 12 designation as “probably efficacious.”
    Studies of the effectiveness of these approaches are encouraging, but further
    investigation with more randomized and controlled studies is still required.
    It would be important to conduct methodologically sound empirical evalua-
    tions of the effects of mindfulness interventions for a range of problems, both
    in comparison to other well-established interventions and as a component of
    treatment packages.
    We also need to better understand which mindfulness-based interventions
    work and for whom, and which strategies work best for particular patients
    and conditions. It will be possible to reach these goals by developing valid
    and reliable measures of mindfulness (see Chapter 9 of this volume), allow-
    ing measurement of mindfulness and its components and the associations
    between them and clinical change.
    Another central issue to be investigated in working with psychological
    problems is whether or not there are particular brain processes associated
    with specific clinical conditions that mindfulness practice either augments or
    reduces. We also have to improve our understanding of the cognitive, emo-
    tional, behavioral, biochemical, and neurological factors that contribute to
    the state of mindfulness and