Mindfulness: The Art of Unthinking

By Dr. Daniel Rola, DTCM, L.Ac. · Updated from the original May 16, 2017 article

“Peace of mind produces right values, right values produce right thoughts.”

— Robert M. Pirsig, Zen and the Art of Motorcycle Maintenance

Health and healing involve more than the place that hurts. They also involve how we sleep, move, respond to stress, and live with the challenges in front of us.

In my original article on mindfulness, I wrote about the importance of caring for the whole person. That remains central to my approach today. Alongside acupuncture, manual therapies, and movement, mindfulness can be a key part of an individualized treatment plan at our clinic.

Since 2017, research has added to our understanding of where mindfulness can help, especially in managing anxiety and persistent pain. It has also given us a clearer picture of its limits.

What does “unthinking” mean?

Have you ever been outside on a beautiful day while your mind was still working through yesterday’s conversation or tomorrow’s responsibilities? Our attention can be somewhere else even when our bodies are right here.

Mindfulness is the practice of noticing the present moment with curiosity and less judgment. Meditation provides a dedicated time to practice that skill. Everyday mindfulness brings it into walking, eating, movement, and conversations.

By “unthinking,” I mean loosening the grip of constant mental commentary. Thoughts will still arise. The practice is to notice them, recognize when they have carried us away, and gently return our attention. A wandering mind gives us another opportunity to practice.

What does the science show?

Stress, anxiety, and emotional well-being

A major review of 47 trials involving 3,515 participants found that mindfulness meditation programs produced small to moderate improvements in anxiety, depression, and pain. The review did not establish that meditation was better than other active treatments.^[1]

A more recent randomized trial enrolled 276 adults with anxiety disorders. An eight-week mindfulness-based stress reduction program met the study’s criteria for being no less effective than escitalopram on its primary anxiety measure.^[2] This was a structured program with instruction and substantial home practice. It does not mean a few minutes with an app will produce the same result, or that someone should stop prescribed medication.

Persistent pain and daily function

For people living with chronic pain, a useful outcome may be greater ease with daily activities, even when some pain remains.

In a trial of 342 adults with chronic low back pain, approximately 61% of those assigned to MBSR had a meaningful improvement in function at 26 weeks, compared with 44% receiving usual care. MBSR and cognitive behavioral therapy, or CBT, produced similar outcomes.^[3]

A 2025 trial involving 770 adults with opioid-treated chronic low back pain found improvements in pain and function in both mindfulness-based therapy and CBT groups over 12 months, with no significant differences between them on the primary outcomes. Opioid doses also decreased in both groups. Because there was no usual-care-only group, this study cannot tell us how much of that change was caused by either therapy.^[4]

Mindfulness can offer a way to work with the distress surrounding pain. That does not mean pain is imaginary, or that meditation repairs an injured tendon, joint, or disc.

Sleep

A review of 18 randomized trials involving 1,654 participants found that mindfulness interventions improved sleep quality compared with general attention or education controls. They did not demonstrate an advantage over established sleep treatments.^[5] Mindfulness may be a useful part of a sleep plan; ongoing insomnia also deserves assessment and appropriate treatment.

How might mindfulness help?

One way to understand the practice is as training in how we respond. We notice a sensation, thought, or emotion, then practice staying with it without immediately reacting. For someone with persistent pain, that might mean recognizing a worried prediction about movement and discussing a manageable next step with their clinician.

Laboratory research also suggests that mindfulness can influence pain processing. A study published online in 2024 and in a 2025 issue of Biological Psychiatry found different brain activity patterns during mindfulness-related pain relief and placebo-related relief.^[6] The experiments involved healthy volunteers and brief heat pain, so the findings do not establish what happens in every chronic pain condition.

These findings are interesting, but the practical question is simpler: does the practice help you cope, function, and participate more fully in your life?

What is MBSR?

Mindfulness-Based Stress Reduction (MBSR), developed by Jon Kabat-Zinn, is a structured eight-week educational program. It typically includes weekly instructor-led sessions, an extended practice day, and regular home practice. Participants learn sitting meditation, body awareness, mindful movement, and ways to apply these skills to stress and daily life.^[7]

A formal MBSR course involves considerably more than a brief breathing exercise during an appointment. Mindfulness practices incorporated into clinic care can provide an accessible starting point; patients interested in the full program can seek a trained MBSR instructor.

A key part of health, healing, and your treatment plan

At Santa Cruz Acupuncture Orthopedics & Sports Medicine Clinic, we view mindfulness as a key component of whole-person health and healing. When appropriate for your needs and preferences, we include mindfulness practices in your individualized treatment plan.

This may involve a simple attention practice, comfortable breathing, or mindful movement to use between visits, alongside acupuncture, manual therapy, rehabilitation, and other appropriate care. We can adapt the approach to your comfort and discuss whether more structured training would be useful.

The research described here evaluates mindfulness programs themselves. It does not establish that adding a brief meditation to acupuncture produces the same benefits as a full MBSR course.

Our goal is to give you practical tools that support your care beyond the treatment room and help you get back to what you love.

A simple way to begin

1. Choose a comfortable position. Sit with support or stand somewhere steady. Keep your eyes open if that feels better.
2. Pick an anchor for your attention. Notice your natural breathing, the contact of your feet with the floor, or sounds around you.
3. Notice when your mind wanders. Gently return to the anchor without criticizing yourself.
4. Start with one to three minutes. Treat this as a manageable introduction, rather than a dose proven to reproduce a clinical trial’s results.
5. Bring it into daily life. Try a brief pause before a meal, a phone call, or your prescribed movement practice.

Meditation can sometimes increase anxiety or emotional discomfort.^[8] If that happens, pause and let your clinician know. An eyes-open practice, an external focus, or support from a qualified instructor may be a better fit. Mindfulness complements appropriate medical and mental health care.

Make room for a different response

We cannot make life entirely free of stress, injury, or uncertainty. We can practice meeting those experiences with greater awareness and care.

If you would like to explore how mindfulness can fit into your treatment plan, bring it up at your next visit or contact the clinic.

Be well and thrive!
Dr. Daniel Rola, DTCM, L.Ac.

Research and resources

1. Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine. 2014;174:357–368. PubMed.
2. Hoge EA, et al. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders. JAMA Psychiatry. 2023;80:13–21. PubMed.
3. Cherkin DC, et al. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain. JAMA. 2016;315:1240–1249. PubMed.
4. Zgierska AE, et al. Mindfulness vs Cognitive Behavioral Therapy for Chronic Low Back Pain Treated With Opioids. JAMA Network Open. 2025;8:e253204. PubMed.
5. Rusch HL, et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Annals of the New York Academy of Sciences. 2019;1445:5–16. PubMed.
6. Riegner G, et al. Mindfulness Meditation and Placebo Modulate Distinct Multivariate Neural Signatures to Reduce Pain. Biological Psychiatry. 2025;97:81–88. Published online 2024. PubMed.
7. Brown University. Mindfulness-Based Stress Reduction.
8. National Center for Complementary and Integrative Health. Meditation and Mindfulness: Effectiveness and Safety.

Educational information; individual treatment decisions depend on your clinical needs.