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Introduction
Recently, there has been a lot of enthusiasm for mindfulness practice and its use in healthcare, business and education. Increasing empirical evidence makes mindfulness-based interventions (MBIs) seem promising across a broad range of applications, particularly so for the treatment and prevention of anxiety and depression. This paper introduces some of the ethical and political issues surrounding MBIs to academic population-level bioethics. i Particularly, it discusses how far such interventions are compatible with liberal neutrality; how far it is a problem that mindfulness is applied in settings whose goals are incompatible with the ethics of traditional mindfulness practice; and what role such initiatives should play in situations in which stress and mental illness have social determinants.
Mindfulness and its benefits
Although contemporary secular mindfulness practice draws in important ways on the Buddhist tradition, I will distinguish between Buddhist mindfulness and contemporary mindfulness practice. 2 The term 'mindfulness' encompasses a range of concepts and practices, all of which have important aspects in common but also differ in significant ways. 3 A core idea of contemporary mindfulness is bare attention , the state of mind and metacognitive skill of directing attention towards, and being receptive to, whatever is happening in the present moment both externally and internally. Bare attention is usually combined with the attitude of non-judging acceptance, of being curious and accepting towards thoughts and experiences as they occur.
Mindfulness-based stress reduction (MBSR) was originally developed by John Kabat-Zinn as a group intervention to assist patients with chronic pain. 4 5 Taught in an 8 week course, MBSR typically includes body scanning, simple yoga poses and mindfulness meditation exercises. Mindfulness-based cognitive therapy (MBCT) combines MBSR with elements of cognitive therapy. MBCT was originally designed to prevent relapse in patients with remitting depression. 6 7 One of the aims is to see negative thoughts as mental events instead of taking them at face value so as to prevent that such thoughts have dysphoric effects. Similar to MBSR, MBCT is usually taught in an 8 week course. Besides MBSR and MBCT, other methods exist that integrate mindfulness with other measures. ii
MBIs are used in the treatment of depression, anxiety and relapse prevention. 10-12 A growing number of studies also look at other benefits of mindfulness, including, but...