Spontaneous improvements of plasma confinement during auxiliary heating have been observed in many tokamaks when the q profile has been modified from its normal resistive equilibrium so that q > 1 and the magnetic shear is reduced or reversed in a region near the magnetic axis. The effects on the overall plasma confinement result from the formation in the plasma interior of transport barriers, regions where the thermal and particle transport coefficients are substantially reduced.These internal barriers are sometimes tied to unique magnetic surfaces, such as the surface where the shear reverses. The reduction in transport appears to result from the suppression of turbulence by sheared plasma flow, which has now been measured in TFTR. Extensions of the theory for turbulence suppression show that this underlying paradigm may also explain other regimes of improved core confinement. The excitement generated by these discoveries must be tempered by the realization that transport and stability to pressure-driven MHD instabilities are intimately linked in these plasmas through the bootstrap current and the effect of the resulting current profile on the transport. Thus the development of control tools and strategies is essential if these improved regimes of confinement are to be exploited to improve the prospects for fusion energy production.