In the traditional Eastern use, “meditation” and its practices are bhavana and dhyana. Meditation denotes both the process of attaining and the state of the mind's clear attentiveness toward awareness of its awareness. This state of mental clarity, a clear mind, is “meditative” whether identifying with any detailed content of its conscious awareness. A meditative mind is engaged in mindful awareness. Often, the ideal intention is toward achieving “thoughtless” awareness.

The classical meaning of “thoughtless” suggests realizing a mind that is awake, alert, and tranquilly active. This mental space approximates a relative emptiness or clarity of content. This condition is an intention to be approximated, possibly not reached by most meditators. The Eastern sense of “emptiness” of mental content is complex to fathom. It suggests a fluidity of mental contents in which no “object” such as thought rigidly binds a focus of attention. This state is a clear mind. Mental content traditionally refers to “objects” that populate the mind. These take forms such as sensations, emotions, feelings, images, thoughts, and imaginations. Using the expression, the knower and known, to explain this idea, “knower” is the ego or self that mindfully meditates. The “known” are the objects of attention used as anchors on which to meditate.

Mindfulness meditation or “the establishment of mindfulness” is satipatthana. Insight meditation is vipassana bhavana. The state of awareness established by meditation is “mindfulness” or sati (from the Buddhist Pali language related to Sanskrit) and smriti (from the Hindu Sanskrit language). The term smriti connotes remembering, recalling, and bearing in mind values, viewpoints, and beliefs from the voluminous teachings of Buddhist dhamma and Hindu dharma. These are the corpus of sacred scriptures. The term sati thus suggests mindfulness memory, preferred in this book.

Hindu Sanskrit or Buddhist Pali language sources, sometimes mixtures of both, make rigid distinctions difficult. However, in mindfulness and meditation contexts, each has nuances. For example, sati means mindfulness, dhyana means meditation, and Samadhi denotes profound meditative absorption. This in-depth level is a peak spiritual refinement in the Yoga system (discussed in Chapter 1).

Mindfulness as a mode of awareness has also been described as present-centered and nonevaluative “bare attention.” The German-born monk Nyanaponika Thera (Siegmund Feniger, 1901–94) coined this term in his 1954 book, The Heart of Buddhist Meditation. Writers in the field question whether the implications unnecessarily exclude bearing in mind the respective admonitions and dharmas that are part of other practice perspectives.

Chapter 4 discusses Learned Mindfulness as sati, mindfulness or mindfulness memory. Mindfulness, therefore, as a mode of awareness involves the self-regulation of attention. This focus maintains immediate experience orienting with curiosity, inquiry, openness, and acceptance (Bishop et al., 2006). Receptivity and acceptance with monitoring rather than active efforts to reach a goal characterize mindful awareness. The term mindfulness as sati or mindfulness memory is this book's definition because memory implies effortless recall of embedded knowledge. Mindfulness orientation is experiencing present-centered assimilated knowing.

Concentrated practices toward mindfulness clear and reboot the mind of involuntary mind wandering. This gap in flexible attention includes patterns of “fixedness” in thought and emotional processing. Current mindfulness defines “practice” to mean being purposefully aware for a specified time during the day or week. For example, mind wandering occurs on average about 46.9% of the waking time in most people (Fox & Christoff, 2018). Thus, mindfulness helps to recenter and refocus attention and minimize mind wandering.

Mindfulness in the West does not denote the Eastern notion of emptying the mind wholly of its objects or contents. Instead, Western mindfulness aspires to a mind alert and aware for significant times during the day. Intensive practices periodically strengthen the ability to remain mindful between these exercises—a mindfulness readiness. In the West, commonly sought results are relaxation, reduced anxiety, more in-depth psychological composure, and calm. Mindfulness-based techniques are now part of psychiatric practices: in selected psychopathologies, substance use disorders, eating difficulties, and wellness psychoeducation programs (Zerbo, Schlechter, Desai, & Levounis, 2017). Accredited sources support the benefits of mindfulness for both physicians and patients. Health-promoting benefits stem from the modulation or cessation of discursive, rambling thoughts practitioners correlate with anxiety, mental distress, and suffering. Behavior change is part of this.

Mind wandering occurs when thoughts are not focused on a single topic or task for an extended time. This “off-task” distraction is also task-negative network inattention. Multitasking is both a cause and effect of a less than mindful perspective. The stable trait of mind wandering is transient. It fluctuates in people with lower mood or depression (Killingsworth & Gilbert, 2010). Colloquially termed a “psychological Sahara,” those in this off-task state report thinking about past or future. The brain's default mode network (DMN) links to mind wandering and internally directed thought (Gruberger, Ben-Simon, Levkovitz, Zangen, & Hendler, 2011). The DMN is an essential consideration in mindfulness. It maintains an internally generated loop of self-referential narratives. This self-world imagery fills the void when the mind idles between tasks. Dysregulation of the hippocampus via gamma-aminobutyric acid is involved in mind wandering (Schmitz, Correia, Ferreira, Prescot, & Anderson, 2017).

Mind wandering is an inadvertent, involuntary nonfocused state of inattention. Although semantic difficulties arise when words such as daydreaming and reverie appear synonymous, their meanings differ. Daydreaming has more consciously intentional directedness toward diffuse attentiveness and a subtle pleasurable quality. Reverie suggests an almost dreamlike state of rapture in an affectionately engaged scenario. The discussions here restrict mind wandering to inadvertent, unintentional, nonfocused inattention (Seli, Risko, & Smilek, 2016). Boredom is perceiving the environment as dull, tedious, and lacking in stimulation. Goetz and colleagues describe calibrating boredom as the passive searching for new ideas. This condition is not unpleasant. It is open to new thoughts and boredom-reducing options (Goetz et al., 2014).

“Attention” has been viewed as the “sixth” vital sign over the last decades. It joins blood pressure, heart rate, respiratory rate, temperature, and regrettably “pain.” Attention difficulties associate with symptomatic dysregulation, distress, and may need treatment. Different subspecialties describe inattention and its distressing effects differently; measuring this “sign” is seldom precise. This medicalization has led to an array of attentional disorder diagnoses and the prescription, sometimes over prescription, of psychostimulant medications, many with potentially adverse side effects. Many other behavioral impairments often present themselves as primary signs and complicate this inattention. The wise physician carefully rules out primary learning disorders and substantially lowered IQ scores while choosing a medication with minimal or no effects on appetite, sleep, and tendency to increase anxiety and mood instability (Ninivaggi, 2017a, 2017b). A range of long-acting adrenergic α-2 agonists or atomoxitene may be safe choices, if clinically needed. A certain amount of mind wandering or inattention is part of people's normal waking state. Excessive mind wandering and bona fide inattention needs strident measurement to verify fidelity and correct identification (Seli, Smallwood, Cheyne, & Smilek, 2015). Attention, executive control, and mind wandering relate, though differently (Smallwood & Schooler, 2006).

Patients and parents seeking higher levels of intellectual performance often request aggressive management of attention with drugs. This practice may lead to unhelpful and unsafe treatment with endpoints ill-advised when not supported by other available, nondrug methods. These methods are more intensive educational curriculums and workarounds. They included modifications and adaptations to measured cognitive platforms and tracked potential for improvement (Catalá-López et al., 2015). Mindfulness offers an additional innovative option.

Thus, why choose mindfulness to help center attention? Mindfulness as an aspirational antidote arises from the typical default of mind wandering and the rambling distractedness of thought contents. The wish to regulate this evokes the dialectic of opposites: mind wandering and its contrast with mindfulness. Trying to attain synchrony of opposite poles reflects the universal impulse toward self-modulation, natural homeostasis. Moderation and the ideal of “the middle path” have always been adaptive goals in any rational endeavor. The emotional dimension, however, of feeling the tension of extremes and a challenge to master them involves exciting and pleasurable experiences. These include the excitement of the anticipation, the building of expectations, and the pleasurable satisfaction resulting from incremental approximations and final achievement.

While this book centers on mindfulness comprehension and applicability, there is a growing literature on mindfulness used to enhance and modulate activities of everyday life: eating, exercise, leisure, child rearing, and more. Mindful approaches even address addictive behaviors (Brewer, 2018; Brewer, Elwafi, & Davis, 2013). Anxiety and harmful habits respond to mindfulness interventions. Mindful awareness once learned becomes part of everyday experience. Becoming mindful is an unfolding process of self-understanding, understanding others, and a fuller, consciously aware life with meaning.

The structured and repeatedly validated techniques of Mindfulness-Based Stress Reduction (MBSR) by the distinguished psychologist Jon Kabat-Zinn focused on the physical level of stress and supportive care for ailments such as cancer, chronic pain, heart disease, and fibromyalgia (Kabat-Zinn, 2000, 2005, 2011, 2013a, 2013b; Kabat-Zinn & Williams, 2011; Vago & Nakamura, 2011). A psychotherapy, Mindfulness-Based Cognitive Therapy (MBCT), was used for depression relapse (Morgan, 2010). MBCT emphasized changing the awareness of and relationship to thoughts rather than the thoughts. A significant part of this process included the development of “decentering.” “Decentering” entails distinguishing rigid identification with one's thoughts as personal facts identical with oneself (Bernstein et al., 2015). These therapeutic interventions occurred 45 minutes per day, 6   days per week over eight weekly sessions and a daylong retreat.

Mindfulness systems regard mindfulness and its practices as a process, more a way of life than an occasional meditative exercise. Intimacy with the present moment, not bound by time, and a relaxation of the frenetic pace of routine activities characterize mindfulness. Mindfulness can counterbalance habitually experiencing life as an “emergency.” Mindfulness frequently likens itself to learning “nondoing.” Nondoing highlights the acceptance of oneself attentively at the “now” of the present moment. Chapter 1 discussed the theme of nondoing with its enormous Eastern significance. A by-product of judicious and measured nondoing is the reduction of the sense of pressure “to get things done.”

Acceptance and Commitment Therapy (ACT) developed in the 1990s by Steven Hayes and Colleagues sought to increase psychological flexibility using mindfulness approaches. This mental flexibility involved engaging with the present moment fully as a consciously aware person and changing behaviors toward chosen values. An underlying premise was core distress resulting from avoidance and fear (Hayes, Strosahl, & Wilson, 2012). The acronym, FEAR, represented Fusion with your thoughts, Evaluation of experience, Avoidance of your experience, and Reason-giving for your behavior. In this system, a healthier alternative is to adhere to the guidelines shown by the acronym, ACT: Accept your reactions and be present-focused, Choose a valued direction, and Take action.

Mindfulness meditation is the framework for several protocols. These include an occasional replacement for or addition to traditional psychotherapy, as a relevant part of Dialectical Behavior Therapy (Linehan, Comtois, & Murray, 2006), a tool for corporate well-being, an educational instrument, and a regimen for building more resilient soldiers (Van Dam et al., 2018). Mindfulness falls under the aegis of mind/body perspectives such as the fields of Integrative Medicine, Complementary and Alternative Medicine, and the American Consortium on Integrative Medicine associated with medical schools (Loizzo, 2000). Over the last decade, occupational burnout is prevalent in healthcare. Physician burnout is escalating. Most burnout prevention and restorative protocols recommend mindfulness as a worthwhile intervention. Chapter 4 discusses physician burnout as a modern medical challenge.

The effectiveness of meditative techniques led to modifications of protocols and using mindfulness practices for stress reduction. Reducing distressing rumination and worry over life's puzzling challenges was a significant enhancement. Gradually, the connections with Yoga and Buddhism led to various integrations, too many to detail in this brief review. Bringing into consideration compassion for self and others was another refreshing insight. Mindfulness practices enhance one's sense of concern for suffering and evoke the desire to help. The benefits of becoming mindful, however, include stress reduction and reduced anxiety with mood stability. Greater mental clarity and focus are by-products sought. Mindfulness practice develops more significant self-knowledge and understanding. Behavior change, reduced anxiety, and adaptive coping strategies are parts of this.

Distinctions, therefore, among mindfulness, mindfulness meditation, and meditation clarify nuances. Most recognize mindfulness as a state of awareness that is (1) attentively single, (2) clear, and (3) emotionally poised. To achieve mindfulness, practitioners use mindfulness exercises. These procedures have several terms, each having nuanced emphases. The phrase “meditation practices” is used; less often, “meditation.” This book prefers the more psychologically oriented term “mindfulness” and “pause” to cover both the mindfulness systems and their attainment.

The culturally oriented roots of mindfulness cannot be dismissed without losing something of the heart and soul of any practice. Western methods have tried to westernize mindfulness practices by minimizing these references—mostly, although there are exceptions. For example, David R. Vago PhD, a distinguished cognitive neuroscientist, has contributed seminal work on mapping modalities of self-awareness in mindfulness practice. Attempts to capture a definition of self-processing loom large but remain elusive.

Self-processing typically entails attempts to make sense of perceptual images and mental concepts of oneself. His research offers much in the understanding of self-processing (Vago, 2013, 2014). Northoff (2011) also explains the self-processing theory as have Brewer, Garrison, and Whitfield-Gabrieli (2013), Brewer and Garrison (2013), Brewer, Davis, and Goldstein (2013). While adhering to Buddhist fundamentals, Vago uses Western scientific models to integrate his knowledge of mindfulness mechanisms as a triune of self-awareness, self-regulation, and self-transcendence. Vago and Silbersweig (2012) propose these mechanisms drive mindfulness practices. These intentions naturally strive toward a higher level of personal development and well-being. Self-transcendence may go beyond these. From a psychological perspective, however, it implies reduced egocentricity, narcissism, and more significant empathy and compassion.

Part II of this book (Chapters 3 and 4) covers the author's version of an emotional intelligence perspective of mindfulness. Mindfulness variations attest to the “problem of the one and the many.” These perspectives reflect “the beauty of the one and the many” as it has and continues to exist in diverse, creative efforts toward self-understanding.

An overview of relevant neuroscience ideas related to mindfulness practices is warranted. The intimate associations between brain and mind are unavoidable. They remain a focus of interest in many research studies. Focusing on mindfulness practice will follow an overview of neuroscience perspectives.

In cognitive neuroscience, the concept of self-referential processing defines and explains how the self apprehends and manages an understanding of itself using its mental contents. Because this is a complicated issue, no consensus has reached final status (Nejad, Fossati, & Lemogne, 2013). Many proposals approximating a reasonable, if not hypothetical and working understanding, exist. Imaging studies associate functional areas of the brain with their presumed actions.

Vago (2014) discusses neural mechanisms for changes in mindfulness by mapping modalities of awareness on brain networks for self-processing. Others have drawn attention to the DMN. This set of brain regions is more active when one rests than when engaging in goal-directed tasks. Mind wandering, antithetical to mindfulness, associates itself with processing in the DMN. These cortical regions coherently fluctuating are called “functional connectivity.” The DMN, mental fluctuations, and distractibility into past and future concerns are active areas of neuroimaging studies related to mindfulness (Molnar-Szakacs & Uddin, 2013). A metaanalysis study on relevant neuroimaging findings, for example, shows self-referential processing associated with these brain areas: medial prefrontal cortex, anterior and posterior cingulate cortex, insula, temporal lobe, hippocampus, and amygdala. Cortical midline structures such as these overlap with the brain's intrinsic DMN (Brewer et al., 2011; Raichle et al., 2001; Qin and Northoff, 2011). With noting the above neuroscience, basic practices follow.

Mindfulness-Based Interventions may be formalized practices, or informally integrated into everyday living (Crane et al., 2017). Two mainstream formalized practices targeting medical and psychological disorders, also mentioned before, are the MBSR and MBCT. These two well-researched, validated, widely used protocols are available in books, manuals, and online. Many informally based meditations and mindfulness practices too many to discuss here abound.

The outer trappings and logistics for these techniques vary. A basic format known as sitting meditation is common. Variations include lying down, walking, body scan practice, Hatha Yoga postures, and others.

Three typical protocols for mindful awareness “Sitting practice” are as follows:

A few words of caution need consideration. Although modern technology has value and benefits, misuse and an overreliance on it can have the potential to downgrade mindfulness, notably, face-to-face human interaction (Schulte-Rüther, Markowitsch, Fink, & Piefke, 2007). Physicians need to see patients as more than mere icons or avatars represented in the electronic medical record as virtual entities. Healthcare is neither a simulation nor an assembly line endeavor. Physicians need as much of a personal touch as possible.

Mindfulness strives for greater intimacy with self-processing and a broadening of empathetic sensitivity toward people. The emphasis is on heightened awareness of sentience. Sentience is feeling and experiencing self and others in deeply subjective ways. It might also extend to experiences outdoors in nature e.g., “green spaces” instead of restricted to isolated, sequestered relations with devices. Sentient awareness highlights human contours. It counters synthetic and mechanical inclinations made blunt by nonhuman feedback.

As one embraces the centrality of sentient experience, mindfulness skill develops. Periodic shifts of mental modes from critical, evaluative thinking toward circumscribed periods of suspended conventional thought occur. Critical thinking and the executive functions emphasizing measurement are higher-order ego skills. Periodic pauses from this toward more relaxed mindfulness, notably with others, are restorative. Human to human feedback conveying the bodily data of emotional communication is essential to enhancing transparent communication. This reequilibration adds to the sustainable platform of mental equipoise.

Mindfulness exercises relax the mind: ego, thinking, and measurement—for a limited time. Assistive technology as an aid to decision-making, however, must not become addictive technology. Thus, too high a reliance on technology in isolation can offset and deter ease into mindfulness approaches. Technology toward facilitating efficient care, not impeding it, augments clinical utility and optimal outcomes.

Using technology mindfully in the already hyperconnected environment requires pause, judiciousness, and deliberation. Apps, websites, and social media can be helpful in connecting with online communities of mindfulness resources. Smartphone, mobile, and Internet-based technologies have converged into an Internet of things, a network of devices, vehicles, buildings, and other objects embedded with electronic sensors, software, and connectivity components still expanding. Fifty billion smart devices all interconnecting are expected by 2020 (Iyer, 2016).

Therefore, discretion is advised in using these resources discriminately. Mindful use is the preferred use. For example, researchers examined over 700 mindfulness apps on the iTunes and google play stores. They found only 4% provided acceptable mindfulness training and education (Mani, Kavanagh, Hides, & Stoyanov, 2015; Torous, Luo, & Chan, 2017). Thus, technology has value, but discernment needs to identify constructive technoinnovations. High-quality apps centered on managing anxiety using mindful techniques are now available. See references and bibliography for resources.