Conducting Mindfulness-Based Interventions

Generational Resilience ConferencePoint Clear, AlabamaOctober 29, 2014

Elise Labbé-Coldsmith, PhD.Department of PsychologyUniversity 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

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

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

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 1Pre-intervention

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

Formal mindfulness practice

Audio recording

Informal mindfulness exercise

Incorporating mindfulness into daily routine

Sessions 3 & 4

Body scan and yoga

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

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

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