Among the modern versions of mindfulness, mindfulness based stress reduction (MBSR) has played the key role in introducing mindfulness practice to the field of psychology and medicine. In fact, the efforts to integrate mindfulness into psychology have resulted in further adaptation of MBSR into more secular and psychological forms as well as the creation of a number of mindfulness measures such as the Mindful Attention Awareness Scale, the Freiburg Mindfulness Inventory, the Kentucky Inventory of Mindfulness Skills, and the Cognitive and Affective Mindfulness Scale. At the same time there is increasing scrutiny of mindfulness that goes beyond the initial positive efficacy studies resulting in several important questions being raised. These range from the absence of an operational definition of mindfulness as well as little evidence for the mechanisms of mindfulness that account for outcome changes for various psychopathology and medical conditions. Questions about the defining characteristics of mindfulness are also being raised such as the lack of differentiation between the features called attention and awareness and the interchangeable use of the two terms in modern descriptions of mindfulness. Such questions resonate with traditional practitioners of Buddhist contemplative psychology for whom attention signifies an every-changing factor of consciousness, while awareness refers to a stable and specific state of consciousness.

Background: Efforts to improve the recognition and treatment of panic disorder in the primary c~re setting have not resulted in better outcomes. Studies show that even when physicians recognize panic disorder, they do not treat it adequately. Family physicians need specific diagnostic and treatment guidelines when they encounter a patient who has possible panic disorder.Jletbods: Four psychiatrists with expertise in the pharmacotherapy of panic disorder and experience working in the primary care setting reviewed the available treatment literature and developed a consensus treatment algorithm for panic pharmacotherapy in the primary care setting. These proposed guidelines were reviewed for accuracy by 3 additional psychiatric experts and for their applicability to the primary care setting by 2 leading experts on the treatment of mental disorders in primary care.Results: Guidelines for medication selection, dosing, titration, side-effect management, and maintenance treatment are proposed. Modifications for patients already on psychotropic medication are provided, and indications for psychiatric consultation are specified.Conclusions: Panic disorder is a highly treatable condition, and primary care physicians can deliver effective pharmacotherapy if specific guidelines are carefully followed. (J Am Board Fam Pract 1998;11:282-90.)

These results show an effect of symptom sensitivity and harm avoidance on BZ withdrawal symptoms, comparable to prior findings linking dependent personality characteristics to withdrawal severity. Failure to show the expected effect on ability to complete taper may be due to either the more symptomatic nature of the patients in this study.

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