What’s in a Name? Mindfulness-Based Stress Reduction (MBSR) as the Evidence-Based Hypnotherapy
(6 min read)

I suggest that Mindfulness-Based Stress Reduction (MSBR) is a form of hypnosis under a different name. This immediately begs the question: Why is MBSR considered empirically evidenced and adopted under the CBT umbrella, while hypnosis is still struggling for a wider acceptance despite existing centuries earlier?

MBSR is but one aspect of the Buddhist Noble Eightfold Path that incorporates other aspects under the three dharma seals (impermanence, non-self, and nirvana) and the three actions (karma) (mind action (thoughts), speech action, and body action). (Nhat Hanh, 2006). The Noble Eightfold Path (Fung & Wong, 2017) uses:

1. Right View
2. Right Thinking
3. Right Mindfulness
4. Right Speech
5. Right Action
6. Right Effort (Right Diligence)
7. Right Concentration
8. Right Livelihood

The third path—Right Mindfulness—is effectively the core or heart of Buddhist teaching and involves returning to the present moment, without judging or reacting. This is the aspect that Jon Kabat-Zinn (1982) repackaged for a Western audience in the late 1970s.

Taking but one aspect, albeit an important and useful one of the Eightfold elements, and bringing that into a cognitive framework, was a masterstroke of marketing. There was an opportunity to tap into the general public’s fledgling interest in Eastern practices throughout the tail-end of the 1970s and early 1980s as Western minds were becoming more open to workable offerings from the East (Harrington, 2009). MBSR was a result of, as Kabat-Zinn says, taking the Buddhism out of Buddhist meditation. Kabat-Zinn gives some clues into his thinking about why the need was to remove the Buddhist part out of the Buddhist Way of Life and dilute it to a relaxation meditation:

Had I decided, for purity’s sake, to call it 'The Right-Mindfulness-Based Stress Reduction Program', how much traction do you imagine it would have had in medicine in 1979? Or even now? (Kabat-Zinn 2017, ft 15, p1134; emphasis added).

However, as acceptance of Buddhism has grown in the West over the years, psychological mindfulness is often presented as being more like Buddhist Mindfulness than it is or was ever intended to be. While this has become an effective marketing tool, it is misleading.

The two—mindfulness (MBSR) and Mindfulness (Buddhist Practice)—are vastly different in overall scope, power, and method. MBSR becomes more of a cognitive, conscious, temporary reprieve, whereas Buddhist Mindfulness is a more complex and complete layered Way of life.

Developing an eight-session, staggered course of various meditations like the body scan, sound and movement meditations, along with standard Zen exercises of eating mindfully meditations, breathing techniques and the like, allowed MBSR to become a workable and successful approach to dealing with stress.

Being a fairly quick intervention among the many extensive psychotherapeutic offerings, MBSR found a willing audience. More importantly, taking the third Eightfold Path (Right Mindfulness) aspect and isolating it in a meditation, allowed MBSR to be explicitly described, easily replicated, and in turn gain extensive empirical evidence, becoming a mainstay of Psychology’s CBT mainstream offerings — quite a coup for something that may be considered a bit airy-fairy a few years earlier.

A quick look at the number of published papers about MBSR demonstrates its exponential growth, having one paper published in 1966; two in 1979; a few per year through the 1980s and 1990s; with exponential growth beginning in 2006, reaching a total of 16,581 in 2021 (Baminiwatta, & Solangaarachchi, 2021)¹.

I suggest when the ultimate goal of MBSR is achieved, what you have is the beginning of a hypnotherapy session. This may ruffle some feathers of those attached to the ‘scientifically-evidenced’ version of psychological mindfulness, and maybe even the hypnotherapy-world practitioners, but the reality is that psychological mindfulness is hypnosis at its most rudimentary form.

Let’s compare the two definitions from "mainstream" medicine. MBSR is a meditation technique that is now mainstream and defined by the founder, Jon Kabat-Zinn as:

… the awareness that emerges through paying attention, on purpose, in the present moment, and non-judgmentally to the unfolding experience moment to moment (Kabat-Zinn 2003, p.145).

Achieving the first part of this process as defined requires a focussing of the mind on the present moment to remove ruminations of the past and anxieties of the future. The second part of this definition provides the goal, or rather the suggestion, to not judge the present moment regardless of what feeling, emotion or situation you are in. Taken as a whole, the awareness that emerges though the process of MBSR is through focussing or relaxing, and taking onboard the suggestion to be non-judgemental about whatever and wherever you are at.

What is the official definition of hypnotherapy? While it is not without its detractors, for the purposes of this article, we will limit our definition of hypnotherapy to arguably the most accepted version provided by Division 30 of the American Psychological Association (APA):

A state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion (Elkins, et al., 2015, p.6).

According to their definition, there are two stages common to hypnosis (APA DIv. 30 [brochure]). The first is the "Induction Phase" where the person focusses the mind through things like achieving a relaxed state that brings a heightened awareness that makes them more susceptible to suggestion. The second part is the "Application Phase" which is where the therapist makes a suggestion of a goal-oriented command to be carried out.

In comparing the definitions of MSBR and hypnotherapy, both can be viewed as having two phases. For both, the first phase is focussing the mind, typically through a relaxation method. In MSBR the second phase is accepting the present in a non-judgmental way. While on the face of it, this second phase of MSBR appears to be a different process to the second phase of hypnotherapy, it is in fact just one, albeit a common one, of the infinite number of suggestions that can be given in this phase of hypnotherapy. Under these mainstream definitions, the practical process of MBSR is actually a focussed mind in a relaxed state plus a goal-oriented suggestion. In fact, the suggestion to relax, or pay attention to the present moment, is, strictly speaking, a suggestion, as is the suggestion to accept the present moment in a non-judgemental way. Therefore, even the first step in MBSR can be considered hypnosis according to the Div. 30 definition.

Hypnotherapy, after achieving a relaxed state, can add any goal-oriented suggestion to move beyond a problem. It is designed to bypass the critical faculty, or conscious thinking part of the mind, enlisting the greater unconscious creativity and wisdoms to sort the problem at the unconscious level.

MBSR focusses on a conscious awareness of the present moment, which places you at the mercy of the non-judging acceptance of whatever, which may include problematic emotions or experience. MBSR is about using that conscious focus and then trying or pretending your way into accepting where you are at. The process of including the suggestion is the same, the difference is the suggestions themselves.

As a hypnotist working in the clinical space, the most curious thing is how hypnosis is not generally considered a mainstream treatment, but there is ample evidence for MBSR, although MBSR is a weaker rudimentary form of hypnosis. Why this inconsistency? Undoubtedly, MBSR has proven itself in the Cognitive Behavioural world to be a great treatment, so why not hypnosis? Using part of the Buddhist Mindfulness tradition, and calling this one aspect of mindfulness (MBSR) is a bit misleading. However, Mindfulness or mindfulness has successful results at all levels. The processes of MBSR and hypnosis are functionally equivalent, yet the acceptance of the "evidence" for either one is vastly different.

The thing is, hypnosis and original mindfulness were here centuries before each was diluted through being forced into a cognitive, empirically-evidenced, psychological behavioural framework. Hypnosis ended up as a relaxation tool in hypnotherapy, while Buddhist Mindfulness had one part re-branded as psychological mindfulness in MBSR. Although it is the same name, there is a difference in overall power and approach—not all mindfulness is created equally.

Kabat-Zinn re-packaged part of an ancient technique by isolating and taking it out of 2,500 years cradling of epistemological and ontological belief systems and Way of life. Which is great for gaining empirical evidence, but it is only part of a greater framework that is much harder to scientifically measure or adequately explain.

Similarly, hypnosis and hypnotherapy are more than just the relaxed state of accepting your moment or being at the mercy of a feeling. Getting the mind right is where the change happens, not the conscious pretend. The next problem is explaining to the mainstream world that has embraced MBSR while looking down their nose at the unscientific quackery of hypnotherapy, that these processes are the same.

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¹See the chart on Baminiwatta, & Solangaarachchi, 2021, p. 2101 of researched published paper figures from the American Mindfulness Research Association, where results stop at 2021, but the exponential nature suggests greater numbers for 2022 and 2023.

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References

APA Div. 30 (brochure) Hypnosis: What is it and can it help you feel better, APA Division 30, Society of Psychological Hypnosis, https://www.apadivisions.org/division-30/about/hypnosis-brochure.pdf, Retrieved 101023.

Baminiwatta, A., & Solangaarachchi, I. (2021). Trends and developments in mindfulness research over 55 years: A bibliometric analysis of publications indexed in web of science. Mindfulness, 12(9), 2099-2116.

Elkins, G. R., Barabasz, A. F., Council, J. R., & Spiegel, D. (2015). Advancing research and practice: The revised APA division 30 definition of hypnosis. International Journal of Clinical and Experimental Hypnosis, 63(1), 1-9.

Fung K. & Wong J.P. (2017). Acceptance and Commitment Therapy and Zen, in Matsuda A. and O'Donohue W.T. (eds), Handbook of Zen, Mindfulness, and Behavioural Health, Mindfulness in Behavioural Health, Series Editor: Nirbhay N. Singh.

Harrington, A (2009), The cure within: A history of mind-body medicine, W. W. Norton & Company, New York and London.

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156.

Kabat-Zinn, J. (2017). Too early to tell: The potential impact and challenges-ethical and otherwise-inherent in the mainstreaming of dharma in an increasingly dystopian world, Mindfulness, 2017, 8: 1125-1135.

Nhat Hahn T. 2006, Understanding our Mind, Parallax Press.

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Dr. Steve Woodbury, Ph.D., has spent his lifetime researching and experiencing many forms of pain treatments from the Western biomedical model through to advanced Zen Trainings overseas. Visit his website at http://hobartmodernhypnosis.com.au/.

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