Mindfulness-based stress reduction

1. Introduction

Version followed: the UMass Center for Mindfulness MBSR Authorized Curriculum Guide (Santorelli, Meleo-Meyer, Koerbel & Kabat-Zinn, 2017), read in full text through Class 7; Class 8 from a secondary course outline that tracks the same structure; the attitudes from Kabat-Zinn's Full Catastrophe Living (Appendix A). [source: CG2017; UCSD booklet; FCL App. A]

Mindfulness-based stress reduction (MBSR) is an 8-week group educational programme, not an individual psychotherapy. Jon Kabat-Zinn created it at the University of Massachusetts Medical School Stress Reduction Clinic in 1979, for medical patients referred by their doctors. It teaches mindfulness meditation and mindful hatha yoga within a mind-body, "participatory medicine" framework. Participants do formal practices (body scan, sitting, yoga, walking) and informal practices (mindful eating, listening, daily routines). [source: CG2017; FCL App. A]

How change is thought to happen: stress depends largely on how a person relates to and handles events, not only on the events themselves. Daily practice trains moment-to-moment, non-judging awareness of body, breath, sensations, emotions and thoughts. With that awareness, a participant can notice automatic, habitual stress reactions (fight, flight, freeze, numbing, suppression) and choose a more flexible response. The curriculum also stresses an awareness that is already present and does not need to be manufactured. The theme of Class 1 sums up the starting assumption: "as long as you are breathing, there is more right with you than wrong with you" (paraphrased in the UCSD booklet). [source: CG2017 Classes 1, 4, 5; UCSD booklet]

For a psychotherapist: to deliver the programme as "MBSR", you need to keep its core structure and standards and to hold MBSR teacher qualification. The guide says adaptations should be called MBSR only if they keep that structure. A therapist who uses single practices with individual clients is using MBSR-derived techniques, and those uses are marked [synthesis] below. [source: CG2017 prologue; UCSD Good Practice Guidelines]

2. Framework

Overall format (CG2017): about 31 hours of direct instruction in total, made up of:

• an orientation session;
• 8 weekly classes (Class 1 about 3 h; Classes 2–7 about 2.5 h; Class 8 about 3–3.5 h);
• one silent all-day class (about 7.5 h), usually between Classes 6 and 7, or between 5 and 6 if the schedule requires.

Groups have roughly 15–40 participants. The guide counts the sessions inconsistently ("10 sessions" in one place, "9 classes" in another), depending on whether the orientation is counted. Participants commit to weekly attendance and to at least 45–60 minutes of formal home practice a day, at least 6 days a week, plus informal practice. They use guided audio recordings for Weeks 1–6 and practise without recordings from Week 7. [source: CG2017; FCL App. A]

[source: CG2017 pp. 6–38; UCSD booklet; Class 8: Teachable course outline, secondary, [uncertain] whether it matches CG2017 Class 8 word for word]

Moving between stages: progression is by calendar, not by criteria. Every participant moves through the fixed sequence together. The criteria that do exist concern participation:

• Before Class 1: the participant has had the orientation and an individual interview, understands the risks and benefits, and has made an explicit commitment to attend and practise.
• Planned absences: anyone who expects to miss 2 or more classes is encouraged to join a later cycle.
• During the course: missing 3 or more classes is a reason to stop and retake the programme later.
• Class 5: a midway reflection and assessment checks each participant's progress, commitment and expectations.
• Before the all-day class: walking meditation is strongly recommended, and participants are prepared for the silence.

[source: CG2017 Orientation, Class 3, Class 5, Class 6]

Teacher requirements:

• completion of the 8-week programme and of MBSR teacher qualification and certification;
• a relevant professional qualification, or equivalent experience reviewed case by case;
• experience with the population being served;
• a daily personal practice and annual teacher-led silent retreats;
• ongoing mentorship with feedback.

[source: UCSD Good Practice Guidelines; CG2017]

3. Guiding principles

• Awareness is already present; the curriculum is scaffolding. Practically, treat the guide as a structure to embody, not a rigid protocol to recite. [source: CG2017 prologue]
• More right than wrong with you. Start from capacity and wholeness, not from pathology. [source: CG2017 Class 1]
• Experience is the primary data. Ask participants to approach the course like a scientist, with curiosity and suspended judgment. Belief is not required. [source: CG2017; UCSD booklet]
• No promised outcomes. Never guarantee results, and frame the course as an experiment. [source: CG2017 Orientation]
• Non-striving. The guide notes that the best way to get somewhere is often not to try to get anywhere. Practically, do not set symptom targets for a practice, and favour letting be. [source: UCSD booklet; FCL App. A]
• Seven attitudinal foundations: non-judging, patience, beginner's mind, trust, non-striving, acceptance, letting go. Name them, model them, and point them out in participants' reports. Later editions of Full Catastrophe Living reportedly add generosity and gratitude [uncertain]. [source: FCL App. A]
• Commitment and self-discipline. Practise daily whether or not you feel like it. Help each participant form a personal vision that keeps practice going through low-motivation periods. [source: FCL App. A]
• Formal and informal practice together. Every week, link the formal practices to ordinary activities. [source: CG2017]
• Dialogue over lecture. Teach stress concepts by drawing them out of participants' own reports. Use reflection, dyads and go-rounds before whole-group discussion. [source: CG2017 Class 4; UCSD booklet]
• Stay close to direct experience. In inquiry, gently steer interpretations and stories back to what was actually sensed, felt and thought. [source: UCSD booklet]
• No advice-giving or cross-talk. Keep confidentiality and self-care as group guidelines. [source: CG2017 Class 1]
• Work at the edge, not beyond it. In yoga and in emotional territory, participants may disregard any instruction that does not suit their body. Offer chair and other options. [source: CG2017 Orientation, Class 3]
• Consent for touch. Ask permission before any physical contact. [source: UCSD booklet]
• Teacher embodiment. Do your own daily practice, practise alongside the group, and demonstrate the yoga. [source: UCSD Good Practice Guidelines; FCL App. A]
• Reacting versus responding. Teach the move from automatic reaction to chosen response, while acknowledging that a reaction can sometimes be skilful. [source: CG2017 Class 5]
• Whatever arises is workable. Pleasant and unpleasant experiences are equally occasions for attention; the all-day class is not meant to be pleasant or unpleasant. [source: CG2017 All-Day]
• Fidelity. Call a programme MBSR only if it keeps the core structure and standards; otherwise call it MBSR-informed. [source: CG2017 prologue]

4. Intervention inventory

The sequence follows CG2017. All example wording is illustrative unless it is quoted and cited. Practice lengths are those the sources give. Where the sources give a practice only by name, the steps below are reconstructed and tagged [uncertain] or [synthesis].

4.1 Orientation session and individual interview

• Purpose: explain what MBSR is and is not; give a short taste of practice; screen; get informed consent and commitment. [source: CG2017 pp. 6–11]
• Steps:
  1. Briefly present the programme's history and what mindfulness is.
  2. Lead a short standing yoga sequence and a short sitting with awareness of breath, then invite brief sharing.
  3. Cover logistics, course content and participation guidelines.
  4. Explain the risks and benefits:
     • physical: the main risk is in the yoga. Stay at your edge, ignore any instruction that does not suit your body, and check postures with your own clinician if you have a medical condition;
     • emotional: strong feelings may surface and symptoms may temporarily get worse;
     • relational: relationships may shift;
     • time: setting aside daily practice time can be hard;
     • benefits: better awareness, coping and self-care, with no result guaranteed.
  5. Take questions.
  6. Hold a brief one-to-one interview with each person. Raise these topics directly: addiction or early recovery, untreated psychosis, acute depression, suicidality, PTSD, social anxiety, recent loss. They call for discussion and possible referral; none is an automatic exclusion.
  7. Get explicit commitment to weekly attendance and to 45–60 minutes of daily formal practice. Advise anyone expecting to miss 2 or more classes to join a later cycle.
  8. Obtain consent for recording only after the risks and benefits have been explained.
• Example language (illustrative): "This isn't a quick fix. It's eight weeks of daily practice, and some weeks it may feel like nothing is happening, or even that things are harder. Does that fit with what's going on in your life right now?"
• Watch for:
  • active suicidality, current psychosis, or untreated PTSD with flashbacks that close-eyed body practice could trigger. Consider deferral, concurrent therapy, or a smaller trauma-informed format [synthesis];
  • expectations of a cure;
  • schedules that make attendance unrealistic.
  • A good orientation ends with a clear, freely chosen commitment and a clinical safety plan for higher-risk participants [synthesis].

4.2 Inquiry (dialogue after each practice)

• Purpose: help participants learn from their own direct experience of a practice and draw out the curriculum's themes, rather than lecturing. [source: CG2017; UCSD booklet]
• Steps: CG2017 names no fixed steps; the sequence below is a [synthesis] consistent with the guide's stated methods (guided reflection, then dyads or small groups, then the whole group or a go-round).
  1. After the practice, allow a moment of silence.
  2. Invite a short dyad exchange or private reflection.
  3. Open the whole group with an open question about what was noticed.
  4. With each person, slow down to the sensations, feelings and thoughts actually present.
  5. Bring a story or interpretation back to direct experience.
  6. Link what was noticed to the week's theme, usually only after several people have spoken.
  7. Do not fix, reassure or give advice, and do not allow cross-talk.
• Example language (illustrative):
  • "What did you notice?"
  • "When you say it was a disaster, what was actually there in the body at that moment?"
  • "And what happened next?"
  • "Did anyone notice something different?"
• Watch for:
  • the teacher drifting into teaching or counselling;
  • one person dominating the dialogue;
  • participants judging their practice as success or failure. Normalise wandering and sleepiness as part of the practice. [source: CG2017 Class 2]
  • It is working when participants start describing experience in their own words, as changing sensations and passing thoughts. [synthesis]

4.3 Group introductions, intentions and guidelines (Class 1)

• Purpose: form the group, clarify why each person came, and set the ground rules. [source: CG2017 Class 1; FCL App. A]
• Steps:
  1. Open with a short meditation.
  2. Go round the group: each person gives their name, what brought them, and what they hope for. In the original clinic, patients named three goals.
  3. Agree the guidelines: confidentiality, self-care (including the right to modify or pass), and no advice-giving.
• Example language (illustrative): "Just a sentence or two about what brought you here and what you'd like from these eight weeks. You can always pass."
• Watch for: disclosures beyond what the person seems ready for. Gently invite them to keep it brief and to talk to you individually afterwards [synthesis].

4.4 Raisin (mindful eating) exercise (Class 1)

• Purpose: contrast automatic pilot with full attention, using an ordinary act. It is the first experience of mindfulness. [source: CG2017 Class 1; Palouse manual]
• Steps: [synthesis of the standard format; the sources give the exercise only by name]
  1. Give each person one or two raisins.
  2. Guide slow attention to seeing, touching, smelling and hearing the raisin, then to placing it in the mouth without chewing, then to slow chewing and tasting, then to swallowing and the after-sensations.
  3. Notice thoughts, memories and likes or dislikes along the way.
  4. Inquire afterwards.
• Example language (illustrative): "Look at this as if you'd never seen one before… Notice any urge to hurry… Now, slowly, bring it to your lips."
• Watch for:
  • disgust, or participants with eating disorders. Offer another object or simply observing. Food can be a trigger, so mention the exercise at screening for those at risk [synthesis].
  • It is working when participants report noticing far more than usual, or catching how automatically they eat.

4.5 Abdominal (diaphragmatic) breathing (Class 1)

• Purpose: introduce the breath as an anchor felt in the body. [source: CG2017 Class 1, named only]
• Steps: [uncertain: details not in the text; standard format]
  1. The participant lies or sits.
  2. A hand rests on the belly.
  3. They feel the belly rise on the in-breath and fall on the out-breath, without forcing the breath.
• Example language (illustrative): "Let the breath breathe itself. Just feel the belly rising… and falling."
• Watch for:
  • attempts to breathe "correctly". Mindfulness of breath does not control the breath. [source: UCSD booklet]
  • possible dizziness from over-breathing [synthesis].

4.6 Body scan

• Purpose: the first major formal practice. It trains sustained, detailed, non-judging attention to the body and the skill of returning attention when the mind wanders. The home recording is about 45 minutes, done at least 6 days a week in Weeks 1–2; it then alternates with yoga, is used again on the all-day class, and is repeated in Class 8. [source: CG2017; UCSD booklet]
• Steps:
  1. The participant lies on their back, or sits if lying is uncomfortable.
  2. Settle and feel the body as a whole, and its contact with the floor.
  3. Feel the breath.
  4. Move attention slowly through the body: the toes of the left foot, then up the left leg; the right foot and leg; the pelvis; the torso; the arms; the neck; the head. [source: Palouse manual; FCL]
  5. In each region, notice whatever sensation is present, or its absence, without trying to change it.
  6. When the mind wanders, notice where it went and return to the region.
  7. End with awareness of the whole body. Shorter versions are possible but secondary. [source: Palouse manual]
• Example language (illustrative): "If there's no sensation in the toes right now, that's what you notice. No need to make anything happen."
• Watch for:
  • sleepiness, which is normal. Suggest opening the eyes or practising at a more alert time of day, and not late at night. [source: CG2017 Class 2; FCL App. A]
  • boredom and restlessness, which are part of the practice;
  • intensified pain or emotion. Allow repositioning and returning to the breath.
  • For trauma survivors, offer open eyes, sitting up, or skipping body regions linked to trauma [synthesis].
  • It is working when participants can describe sensations more precisely and report less fighting with wandering attention, not necessarily relaxation. [synthesis]

4.7 Mindful standing yoga

• Purpose: mindfulness in movement. Yoga is treated as awareness practice, not alignment or fitness, and it opens most classes. [source: CG2017; UCSD booklet]
• Steps:
  1. Lead gentle standing postures and stretches, demonstrating while you practise alongside the group.
  2. Direct attention to sensation, breath and the edge of each stretch.
  3. Pause between postures to feel the after-effects.
  4. Offer chair versions and permission to rest or simply imagine the movement.
  5. Ask permission before any hands-on assistance.
• Example language (illustrative): "Go only as far as your body says yes today. Hold at the edge, breathe, and notice. Resting is also practice."
• Watch for:
  • competitiveness and pushing through pain;
  • medical restrictions. Participants should check postures with their own clinician. [source: CG2017 Orientation]
  • It is working when participants modify postures for themselves and notice that the edge changes from day to day. [synthesis]

4.8 Mindful lying-down yoga (Class 3 onward)

• Purpose: a floor-based sequence for home practice, alternated with the body scan. It is explicitly adapted for chronic pain. [source: CG2017 Class 3]
• Steps:
  1. Lead gentle postures on the mat (back-lying, side-lying and similar). The guide's specific sequence was not reproduced here.
  2. Give chair alternatives.
  3. Keep attention on sensation and breath, with rests between postures.
• Example language (illustrative): "If this movement isn't available, do it in your imagination and notice what that's like."
• Watch for: pain flare-ups. Help participants distinguish the intensity of a stretch from warning pain [synthesis].

4.9 Sitting meditation: awareness of breath (AOB) (Class 2 onward; brief AOB opens and closes classes)

• Purpose: steady attention, anchored in the breath. Participants learn to notice the mind wandering and return without self-criticism. Home practice grows from 10–15 minutes (Week 2) to 15–20 minutes (Week 3) to 20 minutes (Week 4). [source: CG2017 Classes 2–4]
• Steps:
  1. Set up an upright, dignified posture: on a chair with feet flat, or on a cushion with the hips above the knees, hands resting on knees or lap. [source: Palouse manual; CG2017 Class 3]
  2. Eyes closed or lowered.
  3. Feel the breath where it is most vivid, without controlling it.
  4. When the mind wanders, notice where it went, then gently escort attention back. Do not push thoughts away.
  5. Repeat without counting the wanderings as failures.
• Example language (illustrative): "The moment you realise you've drifted, you're already back. Just note where the mind went, and return to this breath."
• Watch for:
  • breath-focused anxiety or panic. Offer another anchor, such as the feet, the hands or sounds, and open eyes [synthesis].
  • posture pain. Allow mindful shifts in posture. [source: CG2017 Class 4]

4.10 Sitting with sensations, pain and emotions (Class 4)

• Purpose: turn toward difficult body sensations and feelings with curiosity instead of reacting automatically. [source: CG2017 Class 4]
• Steps:
  1. Start with the breath anchor.
  2. Widen attention to body sensations.
  3. When an intense sensation or emotion arises, the participant may mindfully shift posture.
  4. Or they may explore the sensation: its location, quality, and how it changes from moment to moment.
  5. Notice thoughts about the sensation as distinct from the sensation itself [synthesis, consistent with CG2017].
  6. If overwhelmed, return to the breath.
• Example language (illustrative): "Is it one solid block of pain, or does it pulse, shift, change edges? … And if it's too much, come back to the breath. That's a wise choice, not a failure."
• Watch for:
  • flooding. The participant has explicit permission to step back.
  • catastrophic interpretations of symptoms;
  • new or unexplained physical symptoms. Refer for medical review [synthesis].

4.11 Extended sitting: all objects of awareness and choiceless awareness (Class 5 onward)

• Purpose: a 45-minute sitting with more silence. Attention moves through breath, body, and other objects, then rests in open, choiceless awareness. The guidance gets lighter in Class 6 and is used again in Class 7. [source: CG2017 Classes 5–7; UCSD booklet]
• Steps: [uncertain: the guide's object sequence is not drawn on in full; a common sequence after Kabat-Zinn is: breath, body as a whole, sounds, thoughts as events, emotions, then choiceless awareness of whatever is most prominent]
  1. Settle with the breath.
  2. Expand to the whole body.
  3. Open to sounds as they arise and pass.
  4. Observe thoughts as events in the mind, not facts.
  5. Note emotions and where they are felt in the body.
  6. Finally, rest in awareness itself without picking an object.
  7. Leave longer silences between instructions.
• Example language (illustrative): "Let thoughts come and go like sounds… not following, not pushing away."
• Watch for: unanchored open awareness can be destabilising for dissociative or traumatised participants. Keep the breath or body available as a home base [synthesis; see Britton et al. 2021 on dissociation].

4.12 Walking meditation (Class 3 onward; strongly recommended before the all-day class)

• Purpose: mindfulness in movement, useful when sitting is too agitating or sleepy. [source: CG2017 Class 3; UCSD booklet]
• Steps: [uncertain: standard format; the sources name it without step detail]
  1. Walk slowly back and forth along a short path.
  2. Feel the lifting, moving and placing of each foot, and the shifts of weight.
  3. Eyes are open and gaze lowered.
  4. When the mind wanders, return to the soles of the feet.
  5. Pause and turn mindfully at each end.
• Example language (illustrative): "You're not going anywhere. Just this step… and this one."
• Watch for: balance problems. Offer a wall or chair to hold, or a seated foot-awareness alternative [synthesis].

4.13 Fast/slow walking (all-day class, optional)

• Purpose: notice mind-body states at different paces. [source: CG2017 All-Day; UCSD booklet]
• Steps:
  1. Pace the walking clearly by voice, alternating between very slow and brisk.
  2. Use assistants for safety where needed.
  3. Participants may sit out; standing yoga can replace the exercise.
• Watch for: collisions and falls, and participants with mobility limits.

4.14 Nine-dots puzzle (Class 1 home practice; Class 2 discussion)

• Purpose: show how unexamined assumptions limit the solutions we can see, introducing the theme of perception and creative responding. [source: CG2017 Classes 1–2]
• Steps:
  1. Hand out the classic puzzle: join nine dots in a 3×3 grid with four straight lines without lifting the pen.
  2. In Class 2, discuss how people approached it, the frustration, and the assumptions that blocked a solution.
  3. Link this to how we frame stressful situations.
• Example language (illustrative): "What rule did you assume that wasn't actually in the instructions?"
• Watch for: turning it into a test of cleverness. Keep the focus on noticing assumptions.

4.15 Informal practice: mindful routine activity and mindful meal

• Purpose: carry awareness into daily life. [source: CG2017 Classes 1–2]
• Steps:
  1. Week 1: one meal eaten with full attention.
  2. Week 2: choose one routine activity, such as showering, washing dishes or brushing teeth, and bring full attention to it every time.
  3. Report back in class.
• Example language (illustrative): "Pick something you do every day anyway. This week, try to actually be there for it."
• Watch for: forgetting. That is normal; noticing that you forgot is itself a moment of awareness.

4.16 Pleasant Events Calendar (Week 2) and Unpleasant Events Calendar (Week 3)

• Purpose: catch, in daily life, how body sensations, feelings and thoughts arise together around pleasant and unpleasant events, and expose patterns of grasping and aversion. [source: CG2017 Classes 2–4; Palouse manual]
• Steps:
  1. Each day, record one pleasant event (Week 2) or one unpleasant event (Week 3), ideally noticed while it was happening.
  2. Note what happened, the body sensations, the moods and feelings, the thoughts, and the thoughts now while writing.
  3. In Class 3 (pleasant) and Class 4 (unpleasant), explore patterns in dialogue: what makes an event pleasant, wanting more of it, resisting the unpleasant, how stress shows up in the body. Use your own worksheet; do not reproduce the UMass forms.
• Example language (illustrative): "When that annoying email arrived, where did you feel it? What did the mind start saying?"
• Watch for: recording only the "story". Ask for sensation-level detail.

4.17 Stress physiology and reactivity dialogue (Class 4)

• Purpose: teach how the stress response works and how automatic, habitual reactivity happens, drawing it out of participants' own calendars rather than by lecture. [source: CG2017 Class 4]
• Steps:
  1. Use the unpleasant-events data to map the chain from trigger to perception, body reaction, emotion, thought and behaviour.
  2. Briefly add the fight/flight physiology.
  3. Contrast acute stress with chronic, accumulated stress.
  4. Home practice: notice automatic reactions without trying to change them, and notice moments of feeling stuck or numb.
• Example language (illustrative): "Before you did anything, what was the very first thing your body did?"
• Watch for: sliding into a didactic lecture; participants blaming themselves for reacting.

4.18 Midway reflection (Class 5)

• Purpose: review progress, commitment and expectations at the halfway point. [source: CG2017 Class 5]
• Steps:
  1. Lead a guided reflection (eyes closed) on why the participant came, what has happened so far, and what they want from the remaining weeks.
  2. Participants complete midway assessment forms. CG2017 uses its own forms; describe yours in your own words.
  3. Discuss in dyads, then in the group.
  4. The teacher may return the forms in Class 6.
• Example language (illustrative): "Without judging how it's gone, what do you notice about your practice so far? What, if anything, do you want to recommit to?"
• Watch for: low home practice. Explore it with curiosity rather than as failure (see section 5).

4.19 Reacting versus responding teaching (Class 5)

• Purpose: frame the central shift: from automatic patterns (fight, flight, freeze, numbing, suppression) to responding with awareness. It emphasises stress hardiness and resilience, with brief references to coping and neuroscience research. [source: CG2017 Class 5; UCSD booklet]
• Steps:
  1. Draw on participants' examples of reactivity.
  2. Name the pause, or the moment of awareness, as the point of choice.
  3. Acknowledge that some fast reactions are skilful.
  4. Assign the Difficult Communications Calendar.
• Example language (illustrative): "Mindfulness doesn't mean never reacting. It means sometimes noticing in time to have a choice."
• Watch for: self-blame for reacting.

4.20 Difficult Communications Calendar (Week 5 home practice)

• Purpose: observe your own patterns in stressful interactions: what you wanted, what the other person wanted, what you actually did, and how you felt in your body. [source: CG2017 Class 5]
• Steps:
  1. Each day, log one difficult exchange: what happened, what you wanted, what the other person seemed to want, what you felt during and after it, and how it resolved. Use your own form.
  2. Review the logs in Class 6.
• Watch for: blaming the other person. Redirect attention to one's own experience.

4.21 Communication exercises (Class 6)

• Purpose: bring mindful awareness into relationships: knowing and expressing feelings, recognising habitual interpersonal styles, and staying balanced under interpersonal pressure. [source: CG2017 Class 6; UCSD booklet]
• Steps:
  • Speaking/listening dyads: one partner speaks for a few minutes on a set topic, such as a recent stressful exchange. The other listens fully without interrupting, then reflects back what they heard. Swap roles, then debrief.
  • Embodied communication styles: participants physically take on passive, aggressive and assertive postures, standing or with a partner, and notice how each feels in the body.
  • Aikido-inspired "pushing" demonstrations: the teachers, or the teacher with a volunteer, demonstrate responses to a push, such as collapsing, resisting, or blending and redirecting, as a metaphor for responses to conflict. Participants do not practise these physically, for safety.
  • Assumptions versus direct observation: compare what was actually seen or heard with what was assumed. Afterwards, prepare the group for the all-day class: what to bring, the structure, and the silence.
• Example language (illustrative): "As you take the passive posture, what do you notice in your shoulders, your breath, your voice?"
• Watch for: re-enactment of abuse dynamics in the posture work. Offer to observe instead of taking part, and debrief carefully [synthesis].

4.22 All-day silent class

• Purpose: sustained practice, moment to moment, treating every experience as material for awareness. [source: CG2017 All-Day pp. 32–35]
• Steps (CG2017 order):
  1. Give instructions about silence, including no eye contact if participants prefer, and about self-care.
  2. Morning sitting.
  3. Yoga, with an optional body scan.
  4. Slow walking.
  5. A longer sitting.
  6. Mountain or lake meditation.
  7. A short talk.
  8. Silent mindful lunch.
  9. Afternoon standing yoga or fast/slow walking.
  10. Loving-kindness meditation.
  11. A closing practice of "noticing one thing" visually, followed by mindful walking.
  12. 10–15 minutes of silent sitting.
  13. Break the silence with whispered dialogue in pairs, then in small groups.
  14. Closing circle. Make teachers available for brief private check-ins [synthesis].
• Example language (illustrative): "Today isn't meant to be pleasant or unpleasant. Whatever shows up, boredom, sleepiness, peace, irritation, is what we practise with."
• Watch for:
  • surges of agitation, dissociation or traumatic memory during long silence (see section 5).
  • Agree a discreet signal participants can use to get support [synthesis].

4.23 Mountain meditation and lake meditation (all-day class; Class 7 option)

• Purpose: guided imagery that supports stability, dignity and steadiness while experience changes. [source: CG2017 All-Day, named; details from Kabat-Zinn's published guided meditations: [uncertain]]
• Steps:
  1. Sitting (mountain) or lying (lake), settle into the breath.
  2. Mountain: picture a mountain. Gradually let the body become the mountain: rooted base, upright summit. Hold the image while seasons, weather and day and night change around it, relating this to inner weather such as moods and difficulties.
  3. Lake: picture a lake, with a surface that is sometimes stirred and depths that remain still. Rest as the lake.
  4. Return to the breath.
• Example language (illustrative): "Storms can sweep across the mountain. The mountain is still the mountain."
• Watch for: people who cannot visualise. Invite them to work with the felt sense of stability instead [synthesis].

4.24 Loving-kindness meditation (all-day class; Class 7 option)

• Purpose: cultivate warmth and goodwill toward self and others. [source: CG2017 All-Day, named; [uncertain]: phrase sequence]
• Steps:
  1. Silently repeat well-wishing phrases, such as wishes for safety, well-being and ease, directed in turn to oneself, a benefactor or loved one, a neutral person, a difficult person, and all beings.
  2. Feel any response in the body, including none.
  3. Participants write their own phrases if the offered ones don't fit [synthesis].
• Example language (illustrative): "May I be safe. May I be at ease. And if nothing warm comes up, just notice that, kindly."
• Watch for:
  • grief, shame, or a painful sense that the wishes are absent toward oneself. Normalise this.
  • Allow participants to start with a benefactor instead of themselves [synthesis].

4.25 Eating meditation (silent lunch) and "noticing one thing" / window practice

• Purpose: extend formal awareness into eating and seeing. [source: CG2017 All-Day, Class 7]
• Steps:
  • Lunch: eat in silence, slowly, attending to each sense, as in the raisin exercise.
  • Visual practice: look out of a window, or at one object, and attend to colours, shapes and movement without naming them, then walk mindfully.
• Watch for: eating-disorder risk (see 4.4).

4.26 Yoga choices (Class 7)

• Purpose: move from guided to self-directed practice by letting the body choose what it needs. [source: CG2017 Class 7]
• Steps:
  1. A standing body scan.
  2. Identify one area asking for attention.
  3. Explore a posture or movement that meets it.
  4. Discuss how to use yoga in ordinary life.
• Example language (illustrative): "Ask the body: what's called for right now?"

4.27 Changing seats (Class 7)

• Purpose: make attachment to habit and place visible in a low-stakes way. [source: CG2017 Class 7]
• Steps:
  1. Participants notice how their usual seat feels.
  2. They move in silence to a seat they have not sat in before.
  3. Ask whether each person tends to stay put or to explore, and say explicitly that neither is better.
  4. Invite awareness of attachment to place and routine.
• Watch for: participants with mobility or anxiety needs. They can do this by imagining it [synthesis].

4.28 Lifestyle reflection: nourishing and limiting choices (Class 7)

• Purpose: link practice to daily choices that support or deplete wellbeing. [source: CG2017 Class 7]
• Steps:
  1. Reflect on, or list, daily activities, relationships, food and media use.
  2. Note which nourish and which limit wellbeing.
  3. Choose one small mindful change. CG2017's exact format is not drawn on in full: [uncertain].

4.29 Self-directed home practice without recordings (Week 7 onward)

• Purpose: make the practice the participant's own before the course ends. [source: CG2017 Class 7]
• Steps: about 45 minutes a day, in a mix the participant chooses (for example, sitting plus yoga plus a short body scan), guided by asking what is needed today.
• Watch for: practice falling off. Plan a minimum daily practice and a time of day for it [synthesis].

4.30 Class 8 closing: "the rest of your life"

• Purpose: consolidate learning and plan how to keep practising. [source: Teachable course outline (secondary); theme consistent with CG2017 structure, [uncertain]: CG2017 Class 8]
• Steps:
  1. Body scan, echoing Class 1.
  2. Yoga.
  3. Mostly silent sitting.
  4. Optional guided reflection on why the participant came, what they learned, what it cost them, and their obstacles. Participants may set short-term goals (about 3 months) and long-term goals (several years), with likely obstacles and strategies, and write a sealed letter to themselves for the teacher to post later.
  5. Post-course questionnaires.
  6. Open questions about practice.
  7. A go-around: what each person learned, how they feel about ending, and how they will keep practising.
  8. Final short meditation and acknowledgement.
  9. Share resources: reading, recordings, graduate sessions, retreat centres.
• Example language (illustrative): "Week eight is really the rest of your life. What's one practice you're willing to keep, even on bad days?"
• Watch for: feelings about ending, and loss of the group as a support. Point participants to graduate sittings or groups [synthesis].

4.31 Using MBSR practices with individual therapy clients [synthesis]

This is not MBSR as authorised. If you teach practices one-to-one:

• keep the developmental order: body scan, then breath, then movement, then open awareness;
• start with shorter practices;
• inquire after each practice, as in 4.2;
• assign brief daily home practice and review it each session;
• label the work "MBSR-informed". For recurrent depression, the derived protocol MBCT is the evidence-based option.

5. Handling problems

Adverse effects: what to expect. Britton et al. (2021) interviewed 96 participants three months after 8-week MBCT-type programmes. This is the study behind the "about 6%" figure; it was not an MBSR sample. Results:

• 83% reported at least one meditation-related effect;
• 37% reported effects with a negative impact;
• 14% reported lasting bad effects over a day, 9% over a week, and 6% over a month.

The main patterns were dysregulated arousal and dissociation:

• hyperarousal: anxiety, panic, insomnia;
• dissociation: emotional blunting, derealisation, disturbances in the sense of self.

The authors also reported traumatic re-experiencing, executive dysfunction and social impairment. Insomnia, emotional blunting, self-disturbance and executive dysfunction predicted lasting effects. The authors advise four things:

• monitor actively with specific questions, because open questions missed about 70% of events;
• train teachers to recognise dissociation;
• do not rely on non-judging acceptance alone;
• take brief impairments seriously, for example impairment while driving.

[source: Britton et al. 2021] Applying these findings to MBSR is a reasonable inference: [uncertain].

• Overwhelm, panic or traumatic re-experiencing during a practice
  • The participant can open their eyes, shift posture, orient to the room, return to the breath, or stop and do something ordinary such as walking or having a cup of tea. Stepping back is itself mindful self-care. [source: CG2017 Classes 1 & 4; Palouse manual]
  • Teacher response [synthesis]: give orientation options before every practice, not only after a crisis. Offer alternative anchors (feet, hands, sounds). Shorten silences. Check in privately after class. If symptoms persist for days, reduce or pause formal practice and coordinate with the participant's clinician.
• Dissociation, numbness, unreality, sleep loss, poor concentration after practice [synthesis based on Britton et al. 2021]
  • At Weeks 2, 4 and 6, ask directly about sleep, feeling unreal or detached, and problems concentrating or driving.
  • If these are present: reduce practice length; switch to movement or eyes-open practices; drop long open-awareness sits and the all-day class for that person; refer for assessment if the problems last more than a week.
  • Do not reframe these effects as "progress" or as "just something to accept".
• Symptoms temporarily getting worse; "nothing is happening"
  • Both were flagged at orientation as possible and normal. [source: CG2017 Orientation; UCSD booklet]
  • Respond with curiosity about the actual experience. Distinguish expected discomfort from deterioration in functioning, risk or mood, which calls for a clinical review [synthesis].
• Sleepiness, boredom, restlessness
  • These are normal objects of practice. [source: CG2017 Class 2; FCL App. A; Palouse manual]
  • Remedies: practise with eyes open; sit up instead of lying; choose an alert time of day rather than late at night; when agitated, use walking or yoga.
• Pain and physical limits
  • Work at the edge, not beyond it. Use chair or imagined versions of postures. Check postures with a clinician. [source: CG2017 Orientation, Class 3]
  • Help the participant distinguish stretch sensation from sharp or warning pain [synthesis].
• Low home practice (non-adherence)
  • The commitment was explicit at orientation, and Class 5 reviews it. [source: CG2017]
  • In inquiry, explore the obstacles without judgement [synthesis].
  • Plan practical supports: a fixed time and place, phone silenced, a minimum version for bad days, guilt-free restarts. [source: FCL App. A; Palouse manual]
  • Reconnect the participant with their personal vision. [source: FCL App. A]
• Missed classes
  • Expected to miss 2 or more: encourage joining a later cycle. Actually missing 3 or more: stop and retake later. [source: CG2017]
  • For a single missed class, offer a brief catch-up of the new practices and the new home practice [synthesis].
• Scepticism or resistance ("this is pointless", "I can't meditate")
  • Belief is not required; frame the course as an experiment with the participant's own experience as the data. [source: CG2017]
  • Reflect the doubt without arguing, ask what they actually noticed, and keep the invitation open [synthesis].
• Striving, perfectionism, using practice to get rid of symptoms
  • Name non-striving and patience. [source: FCL App. A]
  • Inquire into the wanting itself, for example: "What happens in the body when the practice 'isn't working'?" (illustrative) [synthesis]
• Group problems (dominating talkers, advice-giving, disclosures)
  • Restate the group guidelines: confidentiality, no advice-giving. [source: CG2017 Class 1]
  • Use dyads to spread airtime. Contain heavy disclosures warmly and follow up one-to-one [synthesis].
• Rupture with the teacher (feeling judged, pushed, or touched without consent)
  • Ask permission before touch. [source: UCSD booklet]
  • Acknowledge the experience openly, own your part, restate the participant's choice and control, and adjust your language. Repair privately if needed [synthesis].
• Suicidality or acute depression emerging during the course
  • These were screening topics. [source: CG2017 Orientation]
  • Do a standard risk assessment and safety planning, and involve the participant's treating clinician or crisis services. For recurrent depression once the person is stable, consider MBCT; for acute risk, specialist treatment comes first [synthesis].
• Addiction, early recovery, psychosis, PTSD, social anxiety, recent loss
  • These need individual discussion and possible referral. [source: CG2017 Orientation]
  • Options: concurrent therapy, trauma-sensitive modifications (eyes open, choice of anchor, shorter silences, permission to leave the room), or deferral for someone with active psychosis [synthesis].
• All-day class difficulties (silence, length, social anxiety)
  • The participant can sit out the fast/slow walking. [source: CG2017]
  • Give a clear plan for how to get support, and let people leave early without stigma [synthesis].
• End of course: loss of the group, practice falling off
  • Point to graduate sessions and resources. [source: Teachable outline, secondary]
  • Plan a minimal daily practice and when to restart it [synthesis].

Sources

Sources:

• MBSR Authorized Curriculum Guide 2017 (UMass CFM; Santorelli, Meleo-Meyer, Koerbel, Kabat-Zinn) – NHS Scotland copy (CG2017; text available through Class 7)
• MBSR TTI Participant Booklet 2023 (UCSD MBPTI), containing the 2017 guide and the Good Practice Guidelines
• Kabat-Zinn, Full Catastrophe Living, Appendix A: Attitudes & Commitment (excerpt) (FCL App. A)
• Britton et al. 2021, Defining and measuring meditation-related adverse effects in mindfulness-based programs
• MBSR Class 8 "The rest of your life" (Mindfulness Training course outline; secondary)
• Palouse Mindfulness course manual (Dave Potter; secondary, MBSR-based)
• NYMC MBSR outline of curriculum (an adapted 4-module course; little used)

Further reading (not drawn on):

• Kabat-Zinn, J. (1990; rev. ed. 2013). Full Catastrophe Living. Bantam/Delacorte.
• 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, 33–47.
• Santorelli, S. F., Meleo-Meyer, F., Koerbel, L., & Kabat-Zinn, J. (2017). Mindfulness-Based Stress Reduction (MBSR) Authorized Curriculum Guide. UMass Medical School Center for Mindfulness.

Further reading (not drawn on): the Wikipedia page and the Brown news release. The detailed scripts for the mountain, lake, loving-kindness and walking meditations and for the stages of sitting practice are not drawn on; those steps are marked [uncertain].