Connecting From the Inside Out Mindful Awareness and Interpersonal Effectiveness Zindel V. Segal

John was on his way to school.

John was on his way to school. Who is John?

He was worried about the math lesson

He was worried about the math lesson Who is John?

He was not sure he could control the class again today.

He was not sure he could control the class again today. Who is John?

It was not part of a caretaker’s duty.

It was not part of a caretaker’s duty. Who is John? Do you notce the mental model Do you notice the updating of the mental model Our minds do this quite easily and it is only when we play this type of trick on them that we can become aware of the commentary We are making meaning and we are barely conscious that we are doing it Once we have made the inference the emotion follows behind it I’d call this an inner resource

Discrepancy Reduction Pattern Recognition Threat Detection Discrepancy Reduction I’d call this an inner resource A Brain that is specialized for Recognizing patterns, detecting threats and reducing discrepancies between what where we are where we want to get to is a good thing to have available It has also served us very well from an evolutionary and survival perspective

MINDFULNESS

Three Minute Breathing Space This demonstrates a different way of knowing our experience Perhaps a bit more effortful, than pattern recognition or creating stories Invites us to have a different relationship to mental chatter

3-Minute Breathing Space 1. Awareness - Noting what you are feeling. 2. Redirecting- Bringing attention to the breath. 3. Expanding - Expanding awareness to include a sense of the whole body.

What is Mindfulness? Mindfulness is a type of awareness that is developed by paying attention in a particular way: on purpose, in the present moment, and without judgment. Like any skill it takes practice. Skill Capacity that mindfullness enhances Emotional Intelligence (the current buzz word for a member of the audience is Positive Itelligence)

Doing Mode Being Mode Discrepancy Reducing Problem Solving Story Creating Drawing on Past and Present Mainly Sensory Little Verbal Activity Loose Connections Tolerated Present Focused For the purposes of drawing out these two inner resources, I have named them Doing Mode and Being Mode These are some of their characteristics

THE “PRESENT-MOMENT” PATHWAY Craig, 2009

Right Insula Increases Related To Mindfulness Training Farb et al., 2013

Opposing Effects of Relaxation and Mindfulness Training (Farb et al Opposing Effects of Relaxation and Mindfulness Training (Farb et al., in prep)

Knowing What We Know In Two Different Modes Narrative Focus Experiential Focus Here is some of the neural evidence that our brains can support these two different modes Narrative focus on our mental models versus experiential focus on our mental models is supported different brain regions Farb et al., 2007

“Once we see clearly what's going on in the moment WE CAN CHOOSE how to act on what we're seeing." Sharon Salzberg Choice is informed by our Intentions Intentions determine our actions Our actions create our footprint in the world

Choice Permits Intention Intention Informs Action Action Is Your Footprint In the World A blueprint form mindful living And The rest is up to you

Mindful Resources That Support Greater Interpersonal Connection ADD Concentration Grounding Equanimity Kindness REMOVE Distraction Habit Automaticity Judgment In terms of specific resources, we can think of it in these terms

Interpersonal Mindfulness in Action Listening with beginner’s mind, as if for the first time Trusting in the process and in your capacity to guide the process skillfully. Being open to the outcome, to whatever will arise. Accepting what your client is saying or doing, even if it is difficult to hear - as a starting point Slowing down before you begin to communicate. Paying attention to the breath for a few moments before initiating a conversation, especially if it is expected to be unpleasant. In terms of specific resources, we can think of it in these terms

Would Give Your Seat To A Stranger? Pim et al., 2015

Peer Ratings of Prosocial Behaviors in 9-11 Year Olds Schonert-Reichl, 2015

Mindfulness Based Interventions 8 weekly group sessions of 2 – 2.5 hours duration Homogenous or mixed diagnostic group composition

Gradient of Attentional Focus in Mindfulness Training Tangible Intangible Raisin Body Scan Mindful Walking or Stretching Sitting with the Breath Sitting with Sounds Sitting with Thoughts Sitting with a Difficulty

Making the Practice Accessible

Scope of Clinical Application Depression Relapse Prevention (Teasdale et al, 2000) Treatment Refractory Depression (Eisendrath et al., 2008) Non Melancholic Depression (Manicavasgar et al., 2011) Bipolar Disorder (Weber et al., 2010) GAD (Evans et al., 2008) Panic Disorder (Kim et al., 2010) Cancer: Mood symptoms (Sharplin et al., 2010), Fatigue (van Der Lee & Garssen, 2010) Insomnia (Britton et al., 2010) Hypochondriasis (Lovas, 2010; Williams et al., 2011) Anxiety Disorders in Children (Semple & Lee, 2010) Chronic Fatigue Syndrome (Rimes & Wingrove, 2011) Tinnitus (Philippot et al., 2011) Social phobia (Piet et al., 2010)

Kuyken et al., 2015

Cumulative proportion of unstable remitters who survived without relapse during maintenance/follow-up Segal et al., 2010. 35

FOLLOWING EXPOSURE TO SADNESS... Biological Psychiatry – 2011 – ASK NORM Dr. Farb and colleagues took this same idea, and put it to work in an fmri paradigm. In a 2011 study published in Biological Psychiatry, patients with remitted depression were contrasted with healthy controls on a mood induction paradigm. In both groups, it was observed that sadness triggers the cortical midline, and disengages the sensory regions Evaluation Network Goes Up... Present moment network goes down… Farb et al., 2010 37

MINDFULLNESS TRAINING: REDUCES THE TRADEOFF... x = 8 x = 35 Evaluation Reduced Present Moment Restored Farb et al., 2010

ANCHORED IN EMOTIONALLY TURBULENT WATERS

GREATER POSITIVITY IN EVERYDAY LIFE Geschwind et al., 2011

LESS A TREATMENT – MORE A WAY OF LIFE