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by Richa Bhatia, MD, FAPA
Richa Bhatia

What is Mindfulness?

Mindfulness is a term that is commonly used these days. What really is mindfulness?
Mindfulness involves bringing awareness to the present moment, through non-judgmental noticing and observing, with the goal of being fully present in the current moment. 

Benefits of Mindfulness

There is plenty of research evidence showing that mindfulness based practices have many benefits- they can help reduce anxiety, insomnia, pain, overeating, and enhance mood and emotional regulation ability. Research has shown that mindfulness based practices can even alter the neural circuitry or wiring of the brain for the better.

Some benefits from mindfulness can be felt almost instantaneously. A study shows just 5 minutes of mindful breathing to be effective in diminishing felt distress, blood pressure, and pulse rate, among palliative cancer patients.

  1. A recent study found just 20 minutes of mindful breathing to be more beneficial in decreasing suffering among palliative care caregivers, as compared to 20 minutes of supportive listening2.
  2. Mindful breathing has been shown to reduce test anxiety in university students3.
  3. A recent study revealed that mindfulness based breathing is beneficial in decreasing the acute effects of abstinence from smoking and in reducing smoking behavior4.
  4. Mindfulness can be practiced by anyone- all human beings have the capability of practicing mindfulness. Not only that, mindfulness practices are available to you any time you need them. The more regularly you practice mindfulness, the more accessible it will be for you when you need it. 

How to Practice Mindfulness 

Examples of mindfulness based practices, include but are not limited to, mindful breathing, mindful walking, mindful eating, among others. Mindfulness can be practiced even in routine and simple daily activities such as, while brushing your teeth. Often, the mind tends to go into an auto-pilot sort of mode, when one is engaged in such routine, basic activities. When the mind is on autopilot, the focus becomes not so much on the present moment or on the task being performed, but, on some other thoughts or aspect of life, usually belonging to the future or the past. Mindfulness helps to experience and be in the present moment. 

Mindful Breathing

A popular and evidence based technique to practice mindfulness involves mindful breathing. The breath can serve as an anchor to return to, whenever you need it. Mindful breathing positively affects key brain regions involved in emotional regulation, such as amygdala and amygdala’s connectivity to the prefrontal cortex.5 This simple breathing technique can put you in a state of relaxation. It is beneficial to start with small, realistic goals (such as 5 minutes or so, of practice at a time), and gradually increase the time duration as you feel comfortable. 

  • First, place yourself in a comfortable position which allows you to be awake.
  • You may keep your eyes open or closed, whichever your prefer.
  • Then, start with taking a few deep breaths, inhaling through your nose till your belly expands, and slowly letting out through your mouth to release the breath completely.
  • Now, let yourself settle into your natural pattern of breathing. 
  • Now, focus on your breath flowing in through your nose, and out through your mouth. 
  • You may notice the rise and fall of your belly with in-breaths and out-breaths.
  • As you do this, you may notice thoughts crossing your mind. This is normal.
  • Be gentle to yourself, and do not judge yourself for having other thoughts while you are trying to focus on your breath. 
  • When you notice your mind focusing on thoughts, bring your attention gently back to your breath. Rest in the comforting knowledge that you can return to your breath anytime. 
  • In 5 minutes of this practice, or when you’re ready to wrap this exercise up, shift your awareness from your breath to noticing how your body or mind feels.

There are several other ways of doing mindful breathing practices, for instance, by counting in-breaths/out-breaths.

Note: Please do not practice these exercises when driving or operating heavy machinery, as they may impair alertness. If you suffer from any moderate to severe respiratory illness/difficulty, before undertaking any of the above-mentioned exercises, please consult your physician to check if these practices would be suitable for your specific condition. 

Mindful Walking

Mindful walking involves walking in a way that involves non-judgmental noticing of what’s around you in your environment and/or your internal mind state. Walking in a rapid, goal directed manner typically is not mindful walking.

  • For this, walk at a leisurely or natural pace. 
  • Notice the sensation of your feet touching the ground.
  • Notice how the fresh air feels against your face.
  • Notice any sounds around you, such as birds chirping.
  • Notice what’s around you, such as green trees, grass, plants, a water fountain, or leaves on the ground.
  • Notice the state of your mind. As you do this, aim to just notice any thoughts that cross your mind. Do not fixate on or judge these thoughts.

You may do this practice for an amount of time that feels comfortable. 

Remember that the goal with these practices is not perfection. It’s normal for the mind to wander. When you notice your mind wandering, it’s not an indication that you are not doing the practice properly. The key is to notice and gently bring attention back. Initially, if you haven’t done these ever before, these practices can feel simplistic or even boring. However, the benefits of mindfulness have been established by research. Developing a regular practice of mindfulness can go a long way in alleviating stress, and enhancing emotional well-being. Headspace, Mindfulness Daily are some mindfulness apps that have been rated highly.6  While benefits can be experienced even with much smaller durations of practice as mentioned above, research shows that about 8 weeks of regular practice lays a good foundation for reaping optimal benefits and for developing sustainable practice.

Note: This article is for informational purposes only and is not intended to provide medical or psychiatric advice or recommendations, or diagnostic or treatment opinion. This is not a complete review or description of this subject. If you suspect a medical or psychiatric condition, please consult a health care provider. All decisions regarding an individual’s care must be made in consultation with your healthcare provider, considering the individuals’ unique condition. If you or someone you know is struggling, please contact the 24/7, confidential National Hotline at 1-800-273-8255 or use the crisis text line by texting HOME to 741741 in the US, or go to http://www.suicide.org/international-suicide-hotlines.html for the suicide hotline number for your country.


References:
1.    Ng CG, Lai KT, Tan SB, Sulaiman AH, Zainal NZ. The Effect of 5 Minutes of Mindful Breathing to the Perception of Distress and Physiological Responses in Palliative Care Cancer Patients: A Randomized Controlled Study. J Palliat Med. 2016 Sep;19(9):917-24. doi: 10.1089/jpm.2016.0046. Epub 2016 Apr 25.

2.    Tan SB, Ching HC, Chia YL, Yee A, Ng CG, Hasan MSB, et al. The Effect of 20-Minute Mindful Breathing on the Perception of Suffering and Changes in Bispectral Index Score (BIS) in Palliative Care Informal Caregivers: A Randomized Controlled Study. Am J Hosp Palliat Care. 2019 Dec 19:1049909119894507. doi: 10.1177/1049909119894507. [Epub ahead of print]

3.    Cho H, Ryu S, Noh J, Lee J. The Effectiveness of Daily Mindful Breathing Practices on Test Anxiety of Students. PLoS One. 2016;11(10):e0164822. Published 2016 Oct 20. doi:10.1371/journal.pone.0164822

4.    Lotfalian S, Spears CA, Juliano LM. The effects of mindfulness-based yogic breathing on craving, affect, and smoking behavior. Psychol Addict Behav. 2020 Mar;34(2):351-359. doi: 10.1037/adb0000536. Epub 2019 Nov 21.

5.    Doll A, Hölzel BK, Mulej Bratec S, Boucard CC, Xie X, Wohlschläger AM, et al. Mindful attention to breath regulates emotions via increased amygdala-prefrontal cortex connectivity. Neuroimage. 2016 Jul 1;134:305-313. doi: 10.1016/j.neuroimage.2016.03.041. Epub 2016 Mar 24.

6.    Mani M, Kavanagh DJ, Hides L, Stoyanov SR. Review and Evaluation of Mindfulness-Based iPhone Apps. JMIR Mhealth Uhealth. 2015;3(3):e82. Published 2015 Aug 19. doi:10.2196/mhealth.4328.


About the Author

Richa Bhatia, MD, FAPA is a Child, Adolescent and Adult psychiatrist, dual Board certified in Child, Adolescent and General Psychiatry. She is the author of 2 books: ‘Demystifying Psychiatric Conditions and Treatments’ and ‘65 Answers about Psychiatric Conditions’. Previously, she served as a faculty member in the departments of psychiatry at Harvard Medical School and Geisel School of Medicine at Dartmouth. She serves as an Associate Editor for Current Psychiatry, Section Editor for Current Opinion in Psychiatry and is on the editorial board of several other psychiatry journals. She is an expert contributor for Psychology Today and Thrive Global. Some of her interests are childhood depressive and anxiety disorders, the interface between medical and psychiatric conditions, differential diagnosis, compassion and bullying prevention. She is an active member of the Child and Adolescent Psychiatry Section of the World Psychiatric Association (WPA), the American Psychiatric Association and the Anxiety and Depression Association of America.

The severity of my anxiety has ebbed and flowed throughout my life since my late high school/early college days. As an adult, I have found that things like mindful breathing make my anxiety a lot worse, when I am going through an especially anxious time in my life. A few weeks ago I had been feeling heightened levels of anxiety for about a week, and I nearly had a panic attack trying to complete a mindful breathing activity with a small group of people. It feels like the times it would be most helpful it is actually detrimental. Is that common? Are there strategies for working through that?

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