Jon Kabat-Zinn

Introduction

Jon Kabat-Zinn (born June 5, 1944) is an American scientist and teacher who did for meditation what few people manage to do for any practice: he took it out of a religious setting and into general medicine without, in most clinicians' eyes, reducing it to a relaxation technique. Trained as a molecular biologist, he founded the Stress Reduction Clinic at the University of Massachusetts Medical Center in 1979 and built the eight-week programme now known as Mindfulness-Based Stress Reduction (MBSR).

MBSR is the ancestor of most secular mindfulness interventions in healthcare, and Kabat-Zinn's definition of mindfulness — "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally" — is the one the research literature uses. The programme has been studied in hundreds of trials, adopted by hospitals, schools, prisons and corporations, and criticised from two directions at once: by researchers who think the evidence has been oversold, and by Buddhist teachers who think the practice has been emptied out.

Early Life and Education

Kabat-Zinn was born in New York City. He studied at Haverford College and then took a PhD in molecular biology at the Massachusetts Institute of Technology, working under the Nobel laureate Salvador Luria. It is an unusual pedigree for someone who would become the most influential meditation teacher in Western medicine, and it helps explain the reception: an MIT molecular biologist was harder to dismiss than a spiritual teacher would have been.

He began practising meditation as a student, at a time when the available literature was either devotional or inaccessible, and the question that shaped his career was whether a contemplative practice could be specified well enough to be taught to patients in a hospital without asking them to adopt a religion.

Academic and Professional Career

In 1979 he founded the Stress Reduction Clinic at the University of Massachusetts Medical Center, and later the Center for Mindfulness in Medicine, Health Care, and Society. He is now Professor of Medicine emeritus at UMass Chan Medical School.

The design of MBSR has changed remarkably little in over forty years: eight weekly group classes of about two and a half hours, a daylong silent retreat, and roughly forty-five minutes of structured home practice six days a week. Four practices carry the curriculum — the body scan, sitting meditation, gentle mindful movement and yoga, and informal mindfulness in ordinary activities. Kabat-Zinn was insistent that the programme is not relaxation training, and that the aim is not to feel calm but to change one's relationship to experience.

The first empirical report came in 1982 in General Hospital Psychiatry: 51 chronic pain patients who had not improved with conventional treatment took a ten-week version of the programme, and 65 per cent showed at least a 33 per cent reduction in pain scores, with gains largely maintained at follow-up. It was an uncontrolled study, and neither its design nor its results would satisfy today's standards — but it is where the research literature begins.

Major Contributions to Psychology

MBSR and the secular template

Kabat-Zinn's principal contribution was structural rather than theoretical. He produced a manualisable, standardisable, eight-week protocol with defined practices and defined homework, which meant that meditation could for the first time be delivered identically in different hospitals and evaluated in a randomised trial. Before MBSR, "meditation" was not a variable anyone could manipulate; afterwards it was.

A definition that survives

His operational definition of mindfulness as present-moment, non-judgmental attention gave the field a construct it could measure, and it underwrites the self-report scales — including the Five Facet Mindfulness Questionnaire — that most mindfulness research depends on.

The downstream therapies

Mindfulness-Based Cognitive Therapy (MBCT), developed by Zindel Segal, Mark Williams and John Teasdale, is the direct descendant: it grafts MBSR's practices onto cognitive therapy for the prevention of depressive relapse, and it has the strongest evidence of any mindfulness-based programme. It is worth being precise about the rest of the lineage, because it is often overstated: Acceptance and Commitment Therapy and Dialectical Behaviour Therapy incorporated mindfulness from quite different theoretical routes — relational frame theory and behavioural analysis respectively — and descend from MBSR only in the loose sense that all of them read the same journals in the 1990s.

How far MBSR travelled

MBSR-derived programmes now run in hospitals, schools, prisons, the military and corporate wellness schemes, and the NHS in the United Kingdom recommends MBCT for people at risk of depressive relapse. Kabat-Zinn is reported to have been involved in mindfulness programmes in settings as varied as the US military and the World Economic Forum, which is precisely what his critics object to and precisely what he means by taking the practice to where suffering actually is.

Writing for the public

Full Catastrophe Living (1990, substantially revised 2013) and Wherever You Go, There You Are (1994) reached an audience no journal article could, and they are the reason millions of people encountered mindfulness before any clinician recommended it.

Major Publications

Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation. General Hospital Psychiatry, 4(1), 33–47.
Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Delacorte.
Kabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Hyperion.
Kabat-Zinn, J. (2005). Coming to Our Senses: Healing Ourselves and the World Through Mindfulness. Hyperion.
Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness. Guilford Press.

Impact and Legacy

Kabat-Zinn moved meditation from the margin of medicine into its mainstream, and the scale of what followed — a research literature of thousands of trials, a global industry of programmes and apps, mindfulness elements in most modern psychotherapies — is without a close analogue in late twentieth-century clinical psychology.

The scientific assessment is more measured, and the criticisms are worth separating into three kinds.

The evidence is moderate, not strong, and unevenly distributed. The canonical review is Goyal and colleagues (2014) in JAMA Internal Medicine, which screened 18,753 citations and retained 47 randomised trials with 3,515 participants. Its conclusion: moderate-quality evidence of improvement in anxiety, depression and pain, with effect sizes in the region of 0.3 to 0.4 — comparable to a low-dose medication — and low or insufficient evidence of effect on positive mood, attention, substance use, eating habits, sleep and weight. Mindfulness was also not shown to be more effective than other active treatments such as exercise or medication.

The methods have not improved much. Most trials compare MBSR against a waitlist or no treatment, and waitlist comparisons reliably inflate effect sizes for any active intervention. Coronado-Montoya and colleagues (2016) found evidence of positive reporting bias and spin in the mindfulness literature, and Willoughby Britton has noted that experimenter allegiance — which is acute here, since many investigators teach the programmes they evaluate — "can count for a larger effect than the treatment itself." A review of 142 studies published between 2000 and 2016 found no improvement in study quality over that period. In 2018 a large group of researchers including Nicholas Van Dam argued in Perspectives on Psychological Science that the field suffers from conceptual murkiness, inconsistent measurement, failures of replication, and claims of statistical significance whose clinical significance is unclear, and asked for an end to what they called "mindfulness hype." The mechanisms of action remain genuinely unsettled.

The cultural critique goes to the meaning of the practice. Ronald Purser and David Loy's 2013 essay "Beyond McMindfulness" argued that mindfulness had been detached from the ethical framework that gave it purpose and repackaged as a technique for individual performance — a shift that, in Purser's phrase, privatises stress as a personal problem and "turns individuals on themselves." Buddhist scholars and teachers have separately objected to Kabat-Zinn's own framing: his claim that MBSR is "Buddhist meditation without the Buddhism," and even that it represents a "universal dharma" coextensive with the Buddha's teaching, has been called reductionist and mystifying by people who take those traditions seriously.

And the intervention is not inert. A fourth criticism, which only recently got the attention it deserves, is that meditation can make people worse. Reports of meditation-related difficulties — anxiety, depersonalisation, the re-emergence of traumatic material — have been documented for a long time in the contemplative literature and largely absent from the trials, where adverse events were frequently not collected or not reported. Willoughby Britton and colleagues have argued that this is a systematic reporting failure rather than evidence of safety, and that a practice potent enough to change experience is potent enough to disturb it. The point is not that MBSR is dangerous but that the literature does not currently let anyone say how often it goes wrong.

Kabat-Zinn's own position is more careful than that of the movement around him. He has consistently insisted that MBSR is not relaxation, not a productivity tool, and not a quick fix, and he has warned against exactly the commodification his critics describe. The strongest part of the evidence — MBCT for depressive relapse — is strong. The weakest parts are the ones that have been marketed hardest.

Learn More

Ruth A. Baer — mindfulness measurement and the Five Facet Mindfulness Questionnaire
Steven C. Hayes — Acceptance and Commitment Therapy, the other main mindfulness-informed therapy
Aaron Beck — cognitive therapy, the framework MBCT was grafted onto
Matthieu Ricard — a longtime participant in meditation research, known as a subject rather than as an investigator
Sharon Salzberg — who carried Buddhist loving-kindness practice into Western secular mindfulness teaching

References

Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Delacorte.