Conducting Mindfulness-Based Interventions Generational Resilience Conference Point Clear, Alabama October 29, 2014 Elise Labbé-Coldsmith, PhD. Department of Psychology University of South Alabama

Goals of Presentation Identify different perspectives on defining mindfulness and the origins of mindfulness-based approaches to psychotherapy  Describe the core components of mindfulness- based interventions and implement basic mindfulness meditation exercises Describe a mindfulness-based intervention for chronic pain, illness and stress from an evidenced based perspective.

Brief History “Mindfulness” Pali word sati “awareness” or “bare attention.” Mindfulness Practice of meditation and other techniques and strategies to enhance paying attention on purpose in the present moment

Brief History 2,500 years ago, the Buddha taught mindfulness 1960s and 1970s Mental health practitioners often pathologized meditation Meditation teachers were frequently dismissive of Western psychology and psychotherapy

Brief History In the mid-1990s Increasing dialogue and research Interest in Eastern psychology and philosophy grew as more translations of Buddhist teachings became available Increasing dialogue and research Mindfulness as a unifying concept across various Western psychotherapies as well as between Eastern and Western psychologists and philosophers

Brief History Components of mindfulness that span across psychotherapies The mind can observe itself The mind can grow in self-understanding, capacity to accept experience, view oneself in a nonjudging manner, and experience compassion for the suffering of oneself and others

Brief History 1990 Kabat-Zinn Full Catastrophe Living: Using the wisdom of your body and mind to face stress, pain and illness (1990) Stress Reduction and Relaxation Program, University of Massachusetts Medical Center Practical guide 8-week course 10 years, 4,000 participants

Defining Mindfulness Mindfulness Moment-to-moment awareness Leads to conscious self-regulation by explicitly infusing “ attention” with seven mindfulness qualities: acceptance, non-judging, non-striving, patience, trust, openness, and letting go Jon Kabat-Zinn (1992)

Mindfulness (Shapiro & Carlson, 2009) Big M Mindfulness Awareness A way of being in the moment Intention to attend with mindful awareness Mindfulness qualities Little m Mindful Practice Intentionally foster M

Formal Mindfulness Practice Experience mindfulness using a formal practice Mindfulness Meditation Let’s try it!

Mindfulness Not just attending to the present moment but the way one intends to attend using the mindfulness qualities Promotes better self-regulation Promotes feelings of wholeness and connectedness with others and the world

Mindfulness Qualities: Cognitive Nonstriving: not goal oriented; remaining unattached to outcome or achievement Nonjudging: impartial witnessing; observing without evaluation and categorization Acceptance: being open to seeing and acknowledging things as they are

Mindfulness Qualities: Cognitive Patience: allowing things to unfold in their time in regard to ourselves and others Trust: trusting both oneself and the process of the mindfulness practice Openness: seeing things as though for the first time; creating possibilities by paying attention to all feedback Letting go: nonattachment; not holding on to thoughts, feelings, or experiences

Mindfulness Qualities: Emotional Gratitude: the quality of reverence; appreciating and being thankful for the present moment Gentleness: characterized by a soft, considerate, and tender quality; soothing but not passive, undisciplined, or indulgent

Mindfulness Qualities: Emotional Generosity: giving within a context of love and compassion, without attachment to gain or thought of return (what’s given need not be material) Empathy: the quality of feeling and understanding another person’s situation—their perspectives, emotions, actions, and reactions—and communicating this to the person Loving-kindness: a quality embodying benevolence, compassion, and cherishing; a quality filled with forgiveness and unconditional love

Mindfulness Interventions Well-known evidence-based practice for psychological and health disorders Secular practices - based on Buddhism Mindfulness Based Stress Reduction (MBSR) Mindfulness Based Cognitive Therapy (MBCT) Acceptance & Commitment Therapy (ACT) Dialectical Behavior Therapy(DBT)

Meta-Analyses & Research Studies Clinical and non-clinical populations with people of all ages Increases in immune, neurological and endocrine functioning Reductions in pain and stress ratings Increases in coping and quality of life Increase positive emotions and decrease neuroticism and negative emotions Reduced rumination

Meta-Analyses & Research Studies Increase in working memory Increase in focused attention Less emotional reactivity to negative experiences Increase in cognitive flexibility Increase in relationship satisfaction

Research Example Farb et al (2010) 8 weeks MBSR Randomly assigned, wait list comparison Measured depression, anxiety, pre-post fMRI during & after watching a sad film Found less reactivity during exposure Different pattern than prior to MBSR Negative emotions processed differently after MBSR

What areas of the brain are influenced by meditation? Medial pre-frontal lobe increased-associated with self-insight, moral reasoning, intuition & fear modulation (Siegel, 2007, 2009). Decreased limbic system activation (Davidson, 2003; Grossman, 2004). Increase in gray matter in the insula—located on inside of temporal lobes—senses internal state of the body, increases empathy

Additional Brain Changes Increased hippocampus activity Reduction in cortical thinning due to aging Increased activation of left frontal regions, lifting of mood Thicker brain regions association with attention, sensory processing & sensitivity to internal stimuli

Assessing from an Evidence-Based Perspective Mindfulness Measures Outcome Measures Process Measures

Mindfulness Measures: Trait Mindful Attention & Awareness Scale (MAAS) Brown & Ryan, 2003 Five Facet Mindfulness Questionnaire (FFMQ) Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006

Mindfulness Measures: State Toronto Mindfulness Scale (TMS) Lau, Bishop, Segal, Buis, Anderson, Carlson, Shapiro, & Carmody, 2006

MBSR Core Components Formal Practice Informal Practice Fostering M with m

Core Components Formal Practice Many types of formal practice that can be used in mindfulness-based interventions All could be considered forms of meditation. These include but are not limited to:

Formal Practice Observing the Breath Diaphragmatic Breathing Body scan Breathing exercises Observing the Breath Diaphragmatic Breathing Body scan

Formal Practice Sitting meditations Concentrative Focusing attention on something in particular Examples Lake and Mountain Meditation

Formal Practice Mindfulness Meditation Just observing and noting internal and external experiences Loving-kindness meditation Fostering the affective qualities of mindfulness: gratitude, gentleness, generosity, empathy, and loving-kindness Walking Meditation

Informal Practice A variety of informal practices Help clients generalize the benefits of meditation to everyday life Encourages bringing mindfulness qualities to whatever they are doing during ordinary activities throughout the day

Informal Practice Examples Mindfulness in daily activities Examples:, answering the phone, hugging another person Describing and observing Noticing internal thoughts, feeling and images Noticing external experiences

Informal Practice Sensory exercises Yoga Awareness of posture Eating, Smells, Touch, Listening to Sounds Yoga Hatha Yoga Awareness of posture Using poetry and inspirational writings

How to Incorporate Mindfulness Into Clinical Practice Integrate mindfulness concepts Types of problems in which mindfulness has been shown to work Individual and group therapy settings Techniques utilized Sample protocol for chronic illness, pain, and stress

Mindfulness Intervention for Chronic Illness, Pain, and Stress MBSR in terms of illness, pain and stress Modifications Commitment to practice Eight week protocol Incorporates concepts, practices, and reflection

Session 1 Pre-intervention Introductions ORS Measure of specific pain, illness, stress, or coping FFMQ or MAAS Introductions Therapists, Participants, Format

Session 1 Teach mindfulness concepts at each session Body and mind Cognitive aspects Emotional aspects Breathing meditation practice introduced Homework: given each week

Session 2 Body Scan Informal mindfulness exercise Formal mindfulness practice Audio recording Informal mindfulness exercise Incorporating mindfulness into daily routine

Sessions 3 & 4 Body scan and yoga Informal mindfulness exercises Active practice of mind-body connection Openness and kindness toward the body Physical endurance, flexibility, and strength Informal mindfulness exercises Journaling Different mindfulness experiences Review with group

Sessions 5 & 6 Sitting meditation Yoga Begin taking ownership of their practice Ex: Mountain or lake meditation Replace body scan with sitting meditation Yoga Begin to alternate sitting meditation and yoga Substitute body scan for yoga if problems with yoga

Session 7 or Day Retreat Take ownership of practice Familiarity with practice Discontinue use of recordings Experiment: types of practice, schedule, combination Foster ability to be in the moment and connect adaptively with mind and body

Session 8 Notice instructions/experiences not noticed previously What has worked and areas for improvement Guided formal meditation Notice instructions/experiences not noticed previously Future meditation practice Reference audio recordings

Session 8 Follow-up assessment ORS Measures of specific pain, illness, stress, or coping FFMQ or MAAS

Formal Practice Experience mindfulness using a formal practice Mountain Meditation Let’s try it!

Conclusions Evidence-based Mindfulness Growing body of research that MBSR is effective in improving health, reducing illness and mortality rate. Need more research on process and outcome measures, particularly of mindfulness Need more RCT in clinical as well as for health, exercise and sport

Recommended Readings Kabat-Zinn, J. (1990) Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Bantam Dell. Labbé, E. (2011) Psychology Moment by Moment: A Guide to Enhancing Your Clinical Practice with Mindfulness and Meditation. New Harbinger Publications: Oakland, CA.

Conclusions Questions? Thank you for your ATTENTION! Please stay in touch – email me elabbbe@southaalabama.edu Office: 251-460-7153