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They all attribute the change in their lives to the same
"cure," a class in mindfulness-based stress reduction offered
through Duke's Integrative Medicine Program at the Center for
Living.

Over the course of eight weeks, participants learn the
rudiments of practicing mindfulness, or being aware of
themselves and the world around them. They learn techniques
such as focused breathing, meditation and yoga, and with that,
begin to find they have more control over the stress that
affects their health, whether it comes from work or
illness.

Mindfulness, says Jeff Brantley, who developed and leads the
class, is a way of being more aware of thoughts, feelings and
physical sensations. "It's noticing these without absorbing
into them, without latching onto them," he explains. "It's a
way to be present, to be fully aware in the moment."

The use of mindfulness in reducing stress is not new,
Brantley says. Duke's class is modeled on successful programs
at other academic medical centers, including one started at the
University of Massachusetts Medical Center by Jon Kabat-Zinn.
Kabat-Zinn's research has shown that patients can learn
mind-body techniques to reduce their reaction to stress and by
reducing stress, better cope with pain and other illness
impacted by stress.

The use of the mind in dealing with the body's ills is
well-accepted in the general public, though perhaps in
different terms; the phrase "mind over matter" conjures images
of mind and body as opponents, with will power winning over the
physical. Brantley teaches a method more akin to "mind with
matter" or "mind in matter."

The structure of the class is simple. Twenty-some
participants in the class meet once a week for a
two-and-a-half-hour session at the Center for Living. They show
up in comfortable clothes, some with pillows or pads to support
backs or bodies as they position themselves in chairs or on the
floor.

Most sessions begin with participants sitting in chairs
pulled into a circle at the front of the dimly lit auditorium.
Brantley begins with housekeeping, handing out sheets that
explain the theme for that week's class, the in-class practice
to be experienced and the "homework" for the week. One Saturday
during the eight-week course will be spent in silent
mindfulness practice with the group. The first week, homework -
to which each participant agreed to commit an hour daily -
includes practicing mindful breathing in different situations,
practicing a body scan each day and eating one meal
mindfully.

Intention and commitment reign as two of the keys to the
class. Brantley advises participants not to expect a blissful
experience - or any other type. Instead, he encourages a sense
of curiosity. "See what you discover, approaching the moment
without judging yourself or what you experience," he says.

On the night of the first class, Brantley passes a batch of
raisins around the circle, instructing each person to take a
couple. One woman wrinkles her nose and whispers to a friend
beside her, "Ugh. I hate raisins."

The instruction comes. Brantley wants the class to imagine
they've never seen one of these objects before, never tasted
one. He wants the class to discover that raisin very slowly,
feel its texture, taste it, explore it. And eat it as slowly as
possible, noticing each sensation as it comes.

"I never knew I could concentrate so much on a raisin," one
person comments afterward. "I hadn't been conscious of its
structure and I was surprised at some of the thoughts I had
while doing this."

It's an opening exercise that initiates participants to the
richness of moments they frequently let pass. And it begins
showing them how they can focus attention without becoming
trapped in a piece of experience.

As the class progresses, from breathing and stretching
exercises to 20-minute sessions of silent meditation,
participants practice becoming aware of the sensations in the
body and how to "let go" of them. As they realize muscles are
tensed and tight, they relax. They identify pain, and instead
of fighting it, recognize its presence, and it lessens. They
become aware of emotions, and instead of berating themselves,
accept the emotions, and the stress eases.

Heart patient Jim Lea signed up for the first class Brantley
offered last fall. He says the course made a big difference in
his life, both in dealing with pain and reducing stress.

"I've always been a pretty rampant Type A, which I'm sure
has contributed to the reason why I've had seven grafts and 15
angioplasties," said the Burlington man. Nearly three years
ago, he began having recurrent heart problems and suffered
great anxiety associated with the problems. While he had
dabbled with meditation as a way to deal with stress, he hadn't
made much headway.

"I'd read a book, but never had success before mainly
because I thought it was something you did instead of a matter
of being aware of what was around you. Just finding out that
meditating is not difficult, that it's as easy as breathing. I
thought it was something you worked at."

He says he's gotten an appreciation for the calming effect
of mindfulness, an effect he can summon when irritation starts
to bubble up in his daily life. He can dispel his anger at the
clumsy gas station attendant or in traffic, overcome anxiety
and pain that accompanies angina.

For another man, his need for help living with crippling
back pain brought him to the class. He had some difficulty in
some exercises - sitting for long periods is difficult and
being on the floor wasn't always comfortable. But from the
first class, he embraced the program and was pleased with the
results. "I had been fighting the pain for so long, or trying
to ignore it or mask it. Suddenly, just being aware without
trying to do anything, to just recognize it and let it be,
makes a huge difference. I'm not fighting my body, I'm
accepting it. The pain's there, but it's not absorbing me
completely."

The class isn't just for patients. The program also attracts
people coping with the daily stresses of work and family life.
Brantley has been involved in a program with similar elements
for hospice workers to study the effects of mindfulness on
caregiving and self-care. He hopes to bring the benefits of
mindfulness to Duke employees as well.

Employees may not be experiencing their own physical
illness, but the stress of working with patients and in
high-pressure situations creates problems for the caregivers.
Brantley tries to include as many employees in the course as
possible, at a discount as the balance of paying participants
allows. Duke participants have included doctors, Center for
Living staff, members of pastoral care and others.

Dr. Steve Bredehoeft, who directs the blood service, entered
the course for both professional and personal reasons. He
co-directs a course in medical practice and health systems for
med students, and wanted to better understand the role of
integrative medicine in clinical practice. He also wanted to
benefit from learning about mindfulness and its use in [stress]
reduction.

"I came away greatly impressed with the skills that were
taught as a means of addressing any number of kinds of stress,"
said Bredehoeft, who continues to practice mindfulness
regularly, nearly six months after taking the course. "There
were those whose stress was primarily from the workplace, under
great job pressures and they found the skills to be directly
applicable to coping with those job stressors. For others, they
were experiencing some kind of chronic disabling pain or other
disability, and the techniques, based on their descriptions,
made these situations far more tolerable and gave them a
greater sense of control over their lives."

Gaining control may have been the most beneficial skill
Karen Gray took from the class. A cardiologist's right arm in
the office at the Center for Living, she's under daily pressure
to help keep things running smoothly, as well as handle her
personal life which includes a husband and teen-aged son, a
mother-in-law with a life-threatening illness, and her own
health problems. After taking the first mindfulness-based
stress reduction course offered, she encouraged her spouse to
sign up for the next one.

They no longer practice together, she says, but they use the
techniques they learned. "We remind each other ... to breathe,
to be mindful. Sometimes when going into a stressful situation,
we discuss it mindfully beforehand. It has helped tremendously.
Sometimes we just say, 'Let's just breathe and take this a
minute at a time and deal with it.'"