Mindfulness: A New Paradigm of Psychosocial Care in the Palliative Care Setting in Southeast Asia

Abstract

Alleviation of suffering in palliative care needs a combination of good symptom control and psychosocial care. The capacity of mindfulness to promote psychological flexibility opens up possibilities of creating a paradigm shift that can potentially change the landscape of psychosocial care. In this review, we attempt to introduce 4 methods to establish mindfulness based on 'The Discourse on the Foundations of Mindfulness', a core text of Theravada Buddhism, followed by a brief comparison of the concepts and practices of mindfulness in different cultures and religions in Southeast Asia. Next, 2 mindfulness-based interventions specifically designed for palliative psychosocial care - mindfulness-based supportive therapy (MBST) and mini-mindfulness meditation (MMM) are introduced. We hypothesise that mindful practices, tailored to the palliative setting, can promote positive psychosocial outcomes.

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September 2017, Vol. 46 No. 9
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1Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, Malaysia
2Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Centre, Malaysia
Address for Correspondence: A/Prof Tan Beng Seng, Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, Lembah Pantai, 59100
Kuala Lumpur, Malaysia.
Email: pramudita_1@hotmail.com
Mindfulness: A New Paradigm of Psychosocial Care in the Palliative Care Setting in
Southeast Asia
Seng Beng Tan , 1MRCP, David Paul Capelle, 1MRCP, Nor Zuraida Zainal, 2MPM, Ee Jane Lim, 1, Ee Chin Loh, 1MRCP,
Chee Loong Lam, 1MRCP
Mindfulness in Palliative Care—Seng Beng Tan et al
Commentary
Abstract
Alleviation of suffering in palliative care needs a combination of good symptom control
and psychosocial care. The capacity of mindfulness to promote psychological exibility
opens up possibilities of creating a paradigm shift that can potentially change the landscape
of psychosocial care. In this review, we attempt to introduce 4 methods to establish
mindfulness based on ‘The Discourse on the Foundations of Mindfulness’, a core text of
Theravada Buddhism, followed by a brief comparison of the concepts and practices of
mindfulness in different cultures and religions in Southeast Asia. Next, 2 mindfulness-based
interventions specically designed for palliative psychosocial care – mindfulness-based
supportive therapy (MBST) and mini-mindfulness meditation (MMM) are introduced. We
hypothesise that mindful practices, tailored to the palliative setting, can promote positive
psychosocial outcomes.
Ann Acad Med Singapore 2017;46:XX-XX
Key words: End-of-life care, Mindful, Satipatthana, Spiritual care, Spirituality
Introduction
Alleviation of suffering in palliative care needs a
combination of good symptom control and psychosocial
care. Psychosocial care is dened as care concerned with the
psychological and emotional well-being of the patient and
their family or carers, including issues of self-esteem, insight
into and adaptation to the illness and its consequences,
communication, social functioning and relationships.1 It
encompasses general approaches such as establishing a
supportive relationship, practising good communication,
exercising empathy, fostering hope and supporting the
family; and specic psychological interventions such as
supportive psychotherapy, cognitive-behavioural therapy,
family-focused grief therapy, meaning-centred therapy and
dignity therapy.2-7
Mindfulness and the Alleviation of Suffering
‘Mindfulness’ is a common translation of the Pali word
‘sati’, which means bare attention. It is often dened as
paying attention in a particular way: on purpose, in the
present moment, and non-judgmentally.8 It is a state of pure
awareness just before we start to conceptualise something.9
Although the word ‘mindfulness’ is most often associated
with Buddhism, mindfulness is a universal human capacity
to “look inside” our mind common to most religions and
Western psychology.10 In addressing suffering at the end
of life, we have been “looking outside” for solutions most
of the time, without realising that “looking inside” may
unveil better solutions and thus create a paradigm shift
that can potentially change the landscape of psychosocial
care completely.
Suffering is a specic state of severe distress associated
with events that threaten the intactness of a person.11 It
occurs when there are perceived damage to the integrity of
the self, helplessness in the face of a threat and exhaustion
of personal and psychosocial coping resources.12
The specic
dimensions of suffering include physical, psychological,
social and spiritual. Suffering can be examined from an
event perspective which focuses on “looking outside” at the
events that trigger suffering; and an experience perspective
which emphasises “looking inside” the inner experiences
of such events.13

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Mindfulness in Palliative Care—Seng Beng Tan et al
How does mindfulness work in the alleviation of
suffering? Several mechanisms of mindfulness have been
proposed. Metacognitive awareness is the awareness of
one’s thoughts and feelings as mental events, rather than
the self. Decentering allows one to step back to observe
one’s thoughts and feelings. Defusion allows one to remove
the “fuse” from one’s thoughts and feelings. Reperception
helps one to disidentify from one’s thoughts and feelings
so one can perceive with greater objectivity and clarity.14-16
These mechanisms may lead to a greater degree of cognitive,
emotional and behavioural exibility, and an increase in
capacity to “let go” of the negative effects of one’s thoughts,
impulses and feelings.
The Practices of Mindfulness in Southeast Asia
The key practices to establish mindfulness have been
well described in ‘The Discourse on the Foundations of
Mindfulness’ (‘Satipatthana Sutta’ in Pali), a core teaching
on mindfulness fundamental to Theravada Buddhism in
Southeast Asia.17-20 Within the discourse, 4 foundation
practices have been described – ‘mindfulness of the body’,
‘feelings’, ‘mind’ and ‘dhammas’ (mental processes), as
summarised in Table 1. The rst way to establish mindfulness
is to practise ‘mindfulness of the body’. It is the simplest and
most direct way to reduce stress and suffering, and it forms
the basis for all other mindful practices. The exercises in
mindfulness of the body include mindfulness of one’s breath,
postures, activities and physical body. These exercises can
help us to decondition our strong identication with the body
and lessen suffering that arises from such identication.
In the context of mindfulness, one’s ‘feelings’ refer to
the perception of pleasantness, unpleasantness or neutrality
towards an event. This is not to be confused with the common
denition of ‘feeling’ in the English language, which can
refer to the awareness of either a physical sensation or
an emotion. Awareness of our feelings in the context of
mindfulness is a crucial factor in the alleviation of suffering
because most of our reactions and actions are conditioned
by our feelings. We crave the feeling of pleasantness, resist
or avoid the feeling of unpleasantness and disregard the
feeling of neutrality. Thus, mindfulness of feelings helps
us to recognise these deeply ingrained habitual reactions
so that we can stop ourselves from reacting thoughtlessly
towards such feelings.
Next, mindfulness of ‘mind’ trains us to pay attention to
the presence or absence of unwholesome and wholesome
mental states. The 3 unwholesome mental states refer to
the mental state of greed, anger and delusion. Greed is the
selsh desire for something pleasant. Anger is the feeling
of annoyance over something unpleasant. Delusion in the
context of mindfulness is the unawareness of the reality –
the reality of impermanence (temporal reality – that things
change from time to time), selessness (spatial reality – that
things are conditioned, the ‘I’ is not a lasting independent
entity but a collection of physical and mental processes that
change from time to time), and suffering (psychological
reality – that suffering arises when we cannot accept
things as they are or as they change). Wholesome mental
states refer to the mind when it is free from greed, anger
and delusion. Mindfulness of mind allows us to watch the
arising and fading of different mental states instead of being
lost in them. This simple recognition of unwholesome
and wholesome mental states is followed by recognising
the presence or absence of calmer states of mind in later
exercises, which prepare us for a detailed investigation of
mental processes – mindfulness of dhammas.
Mindfulness of dhammas begins with contemplation of
mental processes that block psychological freedom from
gross to subtle levels, namely the hindrances (mental habits
that block our mindfulness progress), the aggregates (the
5 components that constitute the ‘self’ and become the
objects of our identication) and the sense spheres (how
we experience the world through our 5 senses and our
mind). These are followed by contemplation of the factors
that lead to psychological freedom. The culmination of
mindfulness practice is reached with the contemplation of
the 4 noble truths, which are the truth of suffering, causes
of suffering, cessation of suffering and the paths leading
to cessation of suffering. The nal practice allows us to
recognise suffering when it arises, together with the factors
that lead to suffering; and to recognise the cessation of
suffering when it fades away, together with the paths that
lead to cessation of suffering.
The Practices of Mindfulness in Different Cultures and
Religions in Southeast Asia
Southeast Asia is a historical heritage of diverse
cultures and religions. Major religions here include Islam,
Christianity, Hinduism and Buddhism. Living in a plurality
of faiths, people in Southeast Asia spend a signicant
amount of time in spiritual practices such as attending
houses of worship – mosques, churches or temples, reading
sacred texts, performing prayers and rituals, and engaging
in charities. ‘Sati’, the original term for mindfulness in
the Pali language is also translated as ‘to remember’ and
we will demonstrate sati as a key element of spirituality
that transcends traditions, practices and religions. The
comparison of the concepts and practices of mindfulness
in different cultures and religions in Southeast Asia is
presented in Table 2.
From a secular perspective, remembering to “be” and to
step out from running on “autopilot” into the freshness of
the present moment, represent core elements of mindfulness-
based interventions in Western psychology. In Christianity,

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Table 1. The Four Foundations of Mindfulness
Mindfulness of the Body Mindfulness of Mind
Mindfulness of the breath Mindfulness of unwholesome and wholesome mental states
Conscious breathing Unwholesome mental states
Following the entire length of the breath -Mental state of greed
Bringing the mind home to the body -Mental state of anger
Calming the body with the breath -Mental state of delusion (unawareness)
Mindfulness of the 4 postures Wholesome mental states
Mindful sitting -Mental state of non-greed
Mindful standing -Mental state of non-anger
Mindful walking -Mental state of non-delusion (awareness)
Mindful lying down Mindfulness of the 8 pairs of mental states
Mindfulness of physical activities Greedy or not greedy
Full awareness of every activity Angry or not angry
-Going forward and returning Deluded or not deluded
-Looking ahead and looking away Dull or agitated
-Flexing and extending the limbs Stressed or relaxed
-Wearing clothes and carrying things Not concentrated or concentrated
-Eating, drinking, tasting In deep meditation or not in deep meditation
-Urinating and defecating Free or stuck
-Sitting, standing and walking Mindfulness of mental states internally and externally
-Falling asleep and waking up Internal: own mental states and reactivity
-Talking and keeping quiet External: mental states of others
Full awareness of the purpose of every activity Mindfulness of impermanence of mental states
-Wholesome purpose The arising and passing away of mental states
-Unwholesome purpose The quality of the mind (clear, aware, sky-like, luminous)
Full awareness of its appropriateness -Before greed, anger or delusion arises
Full awareness of which eld one is practising -After greed, anger or delusion fades away
-Mindfulness of the body Bare knowing
-Mindfulness of feelings Mindfulness to the extent necessary for bare knowledge
-Mindfulness of mind Knowing things as they are without adding judgment
-Mindfulness of dhammas (mental processes) Continuity of mindfulness
Full awareness of the 3 universal characteristics of reality during
an activity
Repeatedly coming back to mindfulness once distracted
-Temporal reality: impermanence Abiding independently
-Spatial reality: selessness Not clinging to anything
-Psychological reality: suffering The removal of unwholesome thoughts (+ cognitive methods)
Mindfulness of the physical body Replacing the thoughts
Analysis of the anatomical parts of the body Reecting on the negative effects of the thoughts
Analysis of the 4 natures of the body Ignoring the thoughts
-The solid nature (earth element) Removing the source of the unwholesome thoughts
-The uid nature (water element) Suppressing the thoughts with all energy
-The heat nature (re element)
-The movement nature (air element)
Contemplation of decomposition of a corpse (for advanced practitioners)

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Mindfulness in Palliative Care—Seng Beng Tan et al
Table 1. The Four Foundations of Mindfulness (Cont'd)
Mindfulness of Feelings Mindfulness of Dhammas (Mental Processes)
Mindfulness of the feeling tone Mindfulness of the 5 hindrances that block psychological freedom
Pleasant feeling Desire
Unpleasant feeling Ill will
Neutral feeling Sloth and torpor
Mindfulness of the source of the feeling tone Restlessness and worry
From the body (sensations) Doubt
From the mind (emotions) Mindfulness of the 5 aggregates that constitute the “self”
Mindfulness of deled and undeled feelings The body
Deled feeling: sensory pleasure and pain Feelings
Undeled feeling: spiritual pleasure and pain Perceptions
-From practising generosity Mental activities: cognitions and emotions
-From practising love and compassion Consciousness
-From practising renunciation Mindfulness of the 6 sense spheres (how we experience the world)
-From practising mindfulness or meditation Mindfulness of the 7 factors that lead to psychological freedom
Mindfulness of the tendencies of deled feelings Mindfulness
The tendency to seek pleasant feeling Investigation of mental processes
The tendency to avoid painful feeling Energy
The tendency to ignore neutral feeling Rapture
Mindfulness of impermanence of feelings Tranquillity
The arising and passing away of feelings Concentration
The arising and passing away of tendencies Equanimity
Mindfulness of the 4 noble truths
The truth of suffering
The truth of the causes of suffering
The truth of cessation of suffering
The truth of the paths to cessation of suffering
remembering God and His Grace; remembering Jesus
Christ, his life and his self-sacrice, born out of love;
and remembering the Holy Spirit, the energy sent by
God; are fundamental to the practice of Christianity.21 In
Islam, remembering Allah, absolute submission to Allah,
following Prophet Muhammad’s conduct and way of life,
and practising the 5 pillars of Islam, represent Muslim’s
complete submission to the will of Allah.22 For Hindus,
remembering God in diverse forms and approaching God
through knowledge, devotion, service and meditation, are
essential practices to achieve spiritual freedom.23,24 For
Buddhists, remembering and taking refuge in the Three
Jewels – the Buddha, the Dharma (Buddha’s teachings)
and the Sangha (the spiritual community); and practising
the 8 Noble Paths are of primary importance to achieve
enlightenment (complete cessation of suffering).25
Although the description of mindfulness in religions
other than Buddhism is not explicit, the phenomenological
nature of mindfulness is present in practices such as Dhikr
in Islam, Centering prayer in Christianity and Yoga in
Hinduism. Regardless of religion or beliefs, it is easy to
lose ourselves in daily activities and distractions, and fail
“to remember”. Thus, the practice of mindfulness brings
us back to what is most important, even when we are doing
the most ordinary things in our daily life.
The Application of Mindfulness in Palliative Care
Although mindfulness has the potential to reduce
suffering, terminally ill patients are not uncommonly too
sick to participate in mindfulness-based interventions
such as mindfulness-based stress reduction (MBSR) and
mindfulness-based cognitive therapy (MBCT).26,27 MBSR
consists of weekly sessions of 2 hours for 8 weeks, a 1-day
retreat and 45 minutes of homework daily. MBCT is an
8-week programme with weekly 2-hour sessions and 1 day
of classes and homework. Selection of simple and highly
exible mindfulness interventions is necessary to suit the
conditions of sick patients. In our setting, 2 such interventions
are practised: 1) mindfulness-based supportive therapy
(MBST); and 2) mini-mindfulness meditation (MMM).28,29

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Table 2. Comparison of the Concepts and Practices of Mindfulness in Different Cultures and Religions in Southeast Asia
Mindfulness-based Stress Reduction Christianity Hinduism
Concepts Concepts Concepts
Paying attention on purpose Mindfulness of the Trinity Mindfulness of God in separate manifestations
Paying attention in the present moment -The Father -Lord Brahma (The Creator)
Paying attention non-judgmentally -The Son (Jesus Christ) -Lord Vishnu (The Preserver)
Practices -The Holy Spirit -Lord Shiva (The Destroyer)
Raisin meditation Practices Practices
Breathing meditation Loving God The 4 ways to approach God
Body scan Serving God -Jnana Yoga (knowledge)
Mindful movement Attending church -Bhakti Yoga (devotion)
Three-minute breathing space Communion -Karma Yoga (service)
Sounds and thoughts meditation Prayer -Raja Yoga (meditation)
Exploring difculty mindfully Reading the Bible
Befriending meditation
Islam Buddhism
Concepts Concepts
Mindfulness of Allah Mindfulness of the 3 Jewels
Redha: Absolute submission to Allah -Mindfulness of the Buddha
Following the way of life of the Prophet Muhammad -Mindfulness of the Dharma (teachings)
Practices -Mindfulness of the Sangha (spiritual community)
Practising the 5 pillars of Islam Practices
-Faith (Shahadah) The 8 Noble Paths
-Prayer (Salat) -Right understanding
-Charity (Zakat) -Right intention
-Fasting (Sawm) -Right speech
-Pilgrimage (Hajj) -Right action
Reading the Quran -Right livelihood
Reciting Dhikr -Right effort
-Right mindfulness
-Right meditation
MBST is a psychotherapy specically designed for
healthcare providers to practise mindfulness during patient
care. It can be practised even if patients are too sick to
participate in any therapy because it does not require
any extra sessions on top of the usual ward rounds. The
foundation of MBST is based on the theory of suffering in
palliative care. The framework comprises 5 components:
mindful presence, mindful listening, mindful empathy,
mindful compassion and mindfulness of boundaries. The
techniques for MBST include directing one’s attention to the
respective component, sustaining attention, and monitoring
temporal and reactive distraction. The instructions for
practice of MBST are summarised in Table 3.
MMMs are a variety of short mindfulness practices
designed for palliative care patients who do not have the time
or energy to attend formal mindfulness-based interventions
such as MBSR and MBCT. The recommended duration is at
least 5 minutes a day but the time can be modied according
to the energy level of patients. Table 4 shows some of the
examples of MMM. Preliminary evidences from a pilot
study and a randomised controlled trial showed that MMM
in the form of 5-minute mindful breathing could be useful
in alleviating distress in palliative care.30,31
Conclusion
We hypothesise that the practice of MBST during every
patient encounter will enhance the therapeutic relationship
and promote positive psychosocial outcomes. It does not
require clinicians to spend more time than usual on their
consultations. However, it begs only for us to initiate this
paradigm shift to change the way in which we carry out
our daily tasks. This slight change in orientation could

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Mindfulness in Palliative Care—Seng Beng Tan et al
Table 3. Instructions for Mindfulness-Based Supportive Therapy (MBST)*
Mindful Presence Mindful Listening Mindful Empathy
Practice mindful breathing Continue mindful breathing Continue mindful breathing
Breathe naturally Listen to patient with your full attention Imagine “entering into” patient’s situation
Notice the ow of air through your nose Listen to the speech Imagine experiencing his or her feelings
Rest your attention gently on your breath Listen to the rate, rhythm, pitch,
volume
Imagine experiencing his or her thoughts
Be aware of your own presence Listen to the silences Find out what patient wants
Feel your whole body Listen with an open and curious heart Express empathy consciously by:
Relax your whole body Create a safe space for patient to
express
Allowing patient to ventilate expression
Give patient 100% of your attention Listen to understand patient’s situation Acknowledging patient’s expression
Maintain good eye contact -Sensations Validating patient’s expression
Observe facial expression -Emotions Normalising patient’s expression
Observe body movement -Thoughts Come back to your breath gently when:
See patient as a whole person -Behaviour You nd yourself overimagining
Come back to your breath gently when: Come back to your breath gently when: You feel like blocking any expression
You nd yourself judging patient You nd yourself judging patient You are affected by vicarious emotions
You nd yourself feeling anxious You feel like interrupting unnecessarily Continue to put yourself in patient’s shoes
You nd yourself feeling rushed You feel like giving advice prematurely
Be there fully for the patient You are affected by
countertransferences
Listen with all of yourself
Mindful Compassion Mindfulness of Boundaries
Continue mindful breathing Continue mindful breathing
Cultivate compassion consciously Be aware of boundaries
Open your heart to feel the suffering of the patient Be aware of your personal boundary
Feel the suffering from the bottom of your heart -Notice your boundary between self and others
Rest in this feeling of suffering for a few moments Notice your own judgment versus patient’s thoughts
Make a sincere wish for this person to be free from suffering Notice your own emotions versus patient’s emotions
Imagine directing your compassion toward the person Be aware of self-care versus patient care
Rest in this feeling of compassion for a few moments -Know your limit of time constraint versus presence
Express compassion consciously by: -Know your limit of countertransferences versus listening
Speaking in a manner that brings comfort -Know your limit of vicarious traumatisation versus empathy
Helping patient to alleviate his or her suffering -Know your limit of compassion fatigue versus compassion
Come back to your breath gently when: Be aware of your professional boundary
You nd yourself judging patient -Cross boundary consciously only if you are convinced that:
You nd yourself being obsessive with care In that particular situation, it's benecial to patient and the
therapeutic relationship without violating your professional
conduct or compromising equity of care
You nd yourself having excessive concern in xing suffering Come back to your breath gently when:
You have excessive attachment to the goal of relieving suffering You nd yourself judging patient for making unreasonable
request
You are emotionally affected by patient’s suffering You are judging yourself for failure to fulll patient’s request
You are feeling guilty of not doing enough You are feeling guilty
You are feeling helpless You are feeling helpless
You feel like saying something unnecessarily You feel like crossing boundary that can harm patient or
yourself
You feel like doing something unnecessarily You feel like avoiding patient due to boundary issues
You feel like avoiding patient due to negative countertransference Maintain self-awareness throughout the encounter
Continue to practice compassion on purpose, in the present moment, non-judgmentally
*A psychotherapy designed to allow healthcare providers to practice mindfulness during patient care.

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Table 4. Examples of Mini-Mindfulness Meditation (MMM)
Mindful Breathing Mindful Eating Mindful Movement
Make yourself comfortable Be grateful when you see your food Stop rushing
Relax your body Give your food your full attention Move slowly
Close your eyes gently Place your food gently into your mouth It can be any exercise or walking
Take 2 deep breaths slowly Chew slowly Feel the movement of your joints
Then, breathe naturally Taste every nook and corner of your food Feel your muscle contraction or relaxation
Notice the ow of air through your nose Feel its texture and temperature Feel your skin
Rest your attention gently on your breath Feel the movement of the food as you chew Enjoy the gentle wind caused by movement
If you are distracted by any sounds, body sensations,
thoughts or feelings, gently come back to your breath
Feel it as you swallow Synchronise movement with your breathing
Be aware of the breath for the next 5 minutes Follow the food down to the foodpipe Rest your attention on your posture as you stop
moving
Follow it to your stomach If you are distracted, gently come back to your
movement or posture
Rest in the aftertaste for a few moments Rest your attention on it for the next 5 minutes
Take the next portion when you are ready
If you are lost in thinking, gently come back to your
food
Mindful Smiling Mindfulness of Love Mindfulness of Nature
Imagine your face as a ower bud To love is to bring happiness Choose a leaf, a ower, a stone, a tree or a picture of
nature
Choose your favourite ower Imagine your loved one in front of you Breathe in and out naturally
Visualise its blooming as you start smiling Imagine sending love to him or her Look at it deeply
Smile very slowly See him or her getting happier and happier Appreciate its general characteristics
Smile slowly until it is blooming fully Rest your attention on this love for a while Appreciate its details carefully
Rest your mind in the feeling of happiness Imagine receiving love from this person too See its beauty
Let the feeling spread to your whole body as you
breathe
See yourself getting happier and happier Let go of any judgment
If you are distracted, gently come back to your smile Let go of any distraction Rest your attention on its beauty
Stay with your smile for the next 5 minutes Stay with this love for the next 5 minutes Be one with it for the next 5 minutes
Mindfulness of Pain Mindfulness of Suffering Mindfulness of Death
Seek help from your doctor for analgesia Relax your body Recommended for advanced practitioners
Breathe in and out to centre yourself Take 2 deep breaths slowly May cause considerable distress
Breathe until you feel you are calmer Then, breathe naturally Death is a natural process in life
Then, bring your attention to your pain Allow your mind to calm down It can happen to us at anytime, anywhere
Keep a curious mind to see what pain is Then, bring your attention to your suffering Breathe in and out to centre yourself
Notice the different components of pain Observe your suffering Acknowledge the possibility of death
Sensations Be aware of the events that trigger it Acknowledge its unpredictability
Emotions Be aware of the experiences Then, imagine you are lying on a bed, dying,
surrounded by your family
Thoughts -Your sensations Imagine your experience vividly
Pay attention to the unpleasantness -Your emotions Your thoughts
Notice how unpleasantness changes -Your thoughts Your feelings
Notice your resistance to pain Watch suffering like an outsider Your family
Breathe and relax your body Notice how suffering arises and disappears Your surrounding
Smile to your pain If you nd yourself overthinking about your
suffering, gently come back to your breath
If you notice any unpleasant thoughts or emotions,
gently come back to your breath and calm yourself
down
Imagine breathing in happiness Let your thoughts and emotions come and go as
they are
Imagine breathing out suffering Continue to practice mindful breathing
Continue the exercise for next 5 minutes Rest your mind on imagined scene for next 5 minutes

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Acknowledgement
The authors would like to express their heartfelt gratitude to Dr Tan Min-
Han, Consultant in Medical Oncology and Cancer Genetics at National Cancer
Centre, Singapore, for giving us the great idea of introducing mindfulness
from the Southeast Asian perspective.
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