Thank you for attending this Envision NM webinar conference. We will begin shortly.

1. Thank you for attending this Envision NM webinar conference. We will begin shortly. • To connect audio, please telephone 1-800-617-4268 Access code: 30655612# • Please mute/un-mute your telephone line by pressing *6. You may also press your mute button on your headset or speakerphone during the webinar when you are not speaking. Do not place your phone on hold. • This session is being recorded. If you are called on and do not wish to answer, feel free to say “pass”.

2. Disclosure: • UNM CME policy, in compliance with the ACCME Standards of Commercial Support, requires that anyone who is in a position to control the content of an activity disclose all relevant financial relationships they have had within the last 12 months with a commercial interest related to the content of this activity. • The presenter discloses that he/she/they have no relevant financial relationships with any commercial interest. • Accreditation: • The University of New Mexico School of Medicine, Office of Continuing Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. • The Office of Continuing Medical Education designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. • Envision NM is a division of the UNM Department of Pediatrics and receives funding from the NM Department of Health and the NM Human Services Department.

4. Innovations in Stress Reduction: A Mindfulness-based Stress Reduction Approach Carmen Martinez-Tittmann, LMSW, LPCC Presented for Envision NM H2T Conference April 12th, 2011

5. Jon Kabat-Zinn & Mindfulness-based Stress Reduction • An MIT molecular biologist, author of 5 books, (2 bestselling) and scientific papers • The Stress Reduction Clinic, University of Mass., 1979 • Center for Mindfulness in Medicine, Health Care and Society at the University of Mass., medical school/ 1995 • Work has been featured in PBS by Bill Moyers Documentary, Healing and the Mind, on NBC Dateline and on ABC’s Evening News as well as on the Oprah Winfrey Show

6. More on Jon Kabat-Zinn • Over 200 medical centers and clinics in the US and elsewhere now use the Mindfulness-based Stress Reduction or MBSR model

7. Mindfulness: • “Paying attention on purpose in the moment without judgment” JKZ

8. Mindfulness-based Stress Reduction: • An educational model vs. therapeutic model • An acceptance model vs. change model Formal Practice: • Body scan, body awareness, mindful movement (gentle yoga) & meditation Informal practice: • mindful eating, washing a dish, reading to the kids or taking a shower

9. Meditation: • “Particular way of paying attention that gives rise to moment-to-moment nonjudgmental awareness” • “A way of being—being present and seeing things as they are” JKZ

10. Evolution of MBSR: • Jon Kabat-Zinn developed an American/non-religious vocabulary • Mainstreamed what had previously been accessed through a religious vocabulary • Allowed for a more universal access

11. My Relationship to MBSR: • “To be grounded in our own first-person experience and steeped in our own practice.” • Meditation Practice (10 years) • Training with JKZ (2004) • Teaching in Scientific Studies and Corporations • Applying it to Clinical Practice, individual clients, groups and families

12. What the Studies Show: • UNM researchers found that participation in a MBSR course decreased anxiety and binge eating • 5th grade girls who did a 10-week program of yoga & other mindfulness practices were more satisfied with their bodies and less preoccupied with weight. • The likelihood of recurrence for patients who had experienced three or more bouts of depression was reduced by half through Mindfulness-based Cognitive Therapy, an offshoot of MBSR • 8 weeks of MBSR resulted in an improvement in the immune profiles of people with breast or prostate cancer which corresponded with decreased depressive symptoms (Shambhala Sun, March 2010)

13. Data: • “Our findings suggest the usefulness of MBSR as an intervention for a broad range of chronic disorders and problems. In fact, the consistent and relatively strong level of effect sizes across very different types of sample indicates that mindfulness training might enhance general features of coping with distress and disability in everyday life, as well as under more extraordinary conditions of serious disorder or stress“. • Grossman P, Niemann L, Schmidt S, Walach H: Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res, 2004; 57: 35-43

14. Definition of Stress: • Psychological: The perception that your circumstances have exceeded your capacity to cope • Physiological: A state of internal imbalance of unrelieved dominance of the fight or flight response…

15. Fight of Flight Response: • An involuntary response of increased: blood flow, heart rate, blood pressure, breathing or metabolism • Prepares us for conflict (fight) or escape (flight) • Chronic activation increases risk for: • High blood pressure • A weakened immune system

16. Stress: • “Stress is a complicated cascade of physical and biochemical responses to powerful emotional stimuli. Physiologically, emotions are themselves electrical, chemical & hormonal discharges of the human nervous system. Emotions influence and are influenced by the functioning or our major organs, the integrity of our immune defenses and the workings of the many circulating biological substances that help govern the body’s physical states.” Gabor Mate, M.D.

17. Stress Re-action: • What does the body need?

18. Emotional Regulation: • Intrinsic and extrinsic processes responsible for identifying, supervising, evaluating, and altering emotional reactions (Thompson, 1994). • A state of equilibrium or balance

19. Emotional Regulation

20. How To Establish Regulation: Stress Response Vs. Stress Re-action • Bringing the attention back to the breath as the object of attention • Noticing bodily sensations • Noticing thoughts • Noticing feelings • Coming back to the breath • Allowing for the experience as best you can without judgment!

21. Stress Response = Regulation Attention: • connection • Regulation • Order • Ease

22. Stress Re-Action: • Price of not paying attention: • Disconnection • De-regulation • Disorder • Disease In this disconnected, deregulated and disordered state we are more likely to react

23. The Practice & Cultivation of 7 Attitudinal Qualities: • Non-Striving • Patience • Non-Judgment • Acceptance • Beginners Mind • Trust • Letting Go

24. Case Testimonial/ Michael • Michael is a 14 year old boy presenting with trichotillomania. • Participated in family therapy and MBSR including body scan and sitting meditation • Strengths include: • Motivation • Intelligence • Current mastery with sports and grades • High achiever • Family support • Trusting relationship with therapist

25. Michael’s Words: “So, what I’ve learned about the Mindfulness is if I ever feel stressed that I’ll notice where I am and why I’m stressed and what I’m doing. So, If I notice that moment I do my best to try to pull my hand down, If I do pull an eyelash I try my best to accept I cannot change it (that one eyelash), it’s in the past and I have to forget about it. If I do kinda pull and I look and see that I’m missing a lot of eyelashes, then I try my best not to judge myself that I’m a bad person, but accept who I am and accept that I’ve got this problem that I have to deal with and I try again.”

26. Michael’s Words: “So, what I’ve learned about the Mindfulness is if I ever feel stressed that I’ll notice where I am and why I’m stressed and what I’m doing. ( paying attention, on purpose, in the moment) So, If I notice that moment I do my best to try to pull my hand down, If I do pull an eyelash I try my best to accept I cannot change it (that one eyelash), it’s in the past and I have to forget about it. (acceptance, letting go, non striving) If I do kinda pull and I look and see that I’m missing a lot of eyelashes, then I try my best not to judge myself that I’m a bad person, but accept who I am and accept that I’ve got this problem that I have to deal with and I try again.” (non-judgment, patience, trust, beginners mind, acceptance)

27. 10 Minute Sitting Meditation: • Discussion of experience

28. “Paying Attention & Cultivation of Awareness changes our view of the world.” • “We can begin to navigate in ways that are highly adaptive, highly supportive of healing, of health, and a healthier way of being—not only in one’s own body but in the world.” Jon Kabat-Zinn

29. References: • Full Catastrophe Living, Using the Wisdom of Your Body and Mind to face Stress, Pain, and Illness, Dr. Jon Kabat-Zinn • The Mindful Brain, Daniel J. Siegel, MD • The Science of Mindfulness, Daniel J Siegel, MD • When the Body Says No, Gabor Mate, MD • Shambhala Sun Guide to Mindful Living, The Science of Mindfulness, Daniel J. Siegel, MD &Toward a Mindful Society, Jon Kabat-Zinn • Websites: Inner kids: www.susankaisergreenland.com/inner-kids.html • CDs: Jon Kabat-Zinn Guided Mindfulness Meditation, Series 1

30. Thank you • Eliminating the gap between what is and what can be in health care for all children