Mindfulness & Stress Reduction

1. Mindfulness & Stress Reduction Rezvan Ameli, Ph.D. Chief Psychologist and Director of Clinical Training, MAP-NIMH May 2009 Rezvan.Ameli@nih.gov www.rezvanameli.com

2. Some Facts About Mindfulness • Mindfulness does not require any particular religious or cultural belief system. • It is not something we acquire. • It is simple but not easy! • There has been and explosion of interest in mindfulness.

3. Definition # 1 "Mindfulness is to be aware . To be aware when you are breathing in and to be aware when you are breathing out…it is the capacity to be aware of what is here. Anything can be the object of mindfulness. Your breath. The sky. It is to be in touch with our felt experience in each moment“ Thich Nhat Hanh Book recommendation: Peace is Every Step

4. Definition # 2 "Mindfulness is paying attention, on purpose, in the present, and non-judgmentally , to the unfolding of experience moment by moment” Jon Kabat-Zinn Book Recommendation: Full Catastrophe Living

5. Definition #3 “ Mindfulness is to distinguish awareness from mental activity it is to learn to be aware of our own mental states without being caught in them “ Jack Kornfield Book Recommendation: Wise Heart

6. Influential scientist of mindfulness: the Buddha • Subject: Human Condition • Finding: Suffering is universal. • We suffer because of the way in which we relate to our human condition (not the human condition itself). • There is hope of liberation from suffering Suggestion: Replace the word “suffering” with “stress”

7. Pain vs. Suffering Pain • First Arrow • Inevitable • Sensation • Impermanence (Sickness, old age, death) is inherent in human condition Suffering • Second Arrow • Optional • Pain + resistance • Attachment to the outcome (Avoidance/Clinging)

8. What is the Solution? • Accept what is, including impermanence • Let go of attachments • Stay “present” (live in our bodies not in our heads) • Maintain a kind & friendly attitude towards ourselves and others

9. Attitudinal Foundations of Mindfulness • Non-Judging • Patience • Trust • Non-striving • Acceptance • Letting go • Beginner’s Mind Adapted from Full Catastrophe Living by Kabat-Zinn

10. Be empty of worrying Think of who created thought Why do you stay in prison When the door is so wide open Move outside the tangle of fear thinking Live in silence Flow down and down Into always widening Rings of being -Rumi

11. Stress Reaction Vs. Response • Stress reaction: External event  internal event alarm reactivity stress reaction  acute hyper arousal  increases chance of survival in a dangerous and hostile situations • Stress Response: introducing conscious process that influences the flow of events that are likely to bring about automatic reactivity.

12. We can make a choice:React or Pause and Respond “Between the stimulus and response, there is a space and in that space lies our freedom and power to choose our response." Victor Frankl We can choose not to throw the second arrow at ourselves

13. The President pauses . . .

14. Adverse impact of stress • Immune system • Cardiovascular system • Nervous system • Increases inflammation • Increases negative mood states • Increases adrenaline and cortisol levels Sky is the limit

15. Stress Changeable aspects • Problem focused strategies • Teaching skills/ providing information Unchangeable aspects • Acceptance • Compassion • Humor • Keeping count of positives in life

16. Familiar? God grant me the serenity to accept the things I cannot change; courage to change the things I can;and wisdom to know the difference. Reinhold Niebuhr (1892-1971)

17. Positive & Negative Affect • Are not on the same continuum. • Impact physiological , behavioral and social domains • They impact disease outcome (Grant, et al 2009) and longevity (Nyklicek & Kuijpers 2008) • Mindfulness decreases negative affect and increases positive affect (Ludwig & Kabat-Zinn 2009, Greeson 2008, Baer 2003)

18. Mindfulness Research • Pain management/pain reduction (Kabat-Zinn) • Immune functions (Kabat-Zinn, Creswell) • Brain function changes with mindfulness (Davidson) • Depression (Segal, Williams, Teasdale) • Eating disorders (Wansink) • Empathy/reduction in physician error (Epstein, Santorelli)

19. Mindfulness: Major Impact Third Wave of Psychotherapies • Mindfulness Based Stress Reduction (MBSR) (Jon Kabat-Zinn) • Mindfulness Based Cognitive Therapy (MBCT) (Zindel Segal, John Teasdale, Mark Williams) • Dialectical Behavior Therapy (DBT) (Marsha Linehan) • Acceptance Commitment Therapy (ACT) (Steve Hays)

20. What do people report after a course in mindfulness training? • Lasting decrease in physical and psychological symptoms • An increase in ability to relax • Reduction in pain/or enhanced coping with pain • Greater energy and enthusiasm for life • Improved self-esteem Center for Mindfulness in Medicine, Health Care, and Society, UMASS School of Medicine

21. How do we do it? simplifiedRAIN of Compassion • Recognition- NOTICE what is happening • Acceptance – say “yes”, allow, make room for the experience. • Investigate –be curious, even familiar experiences do not repeat. • Non-identification –become a witness to the experience. Do not get caught in it. • + Compassion:maintaining at attitude of kindness, friendliness, and gentleness towards self and others.

22. To what do we apply Mindfulness? Start with a pause and a heartfelt smile of course: Eating Walking Standing Breathing Listening Seeing Pain Anger Fear Cravings … … Sky is the limit!

23. Practice, practice, practice • Developing and cultivating a mindfulness practice is simple but not easy. Most likely you will need teachers and fellow travelers along the way. • Formal practice • Informal practice

24. Practice & Research resources • NIH- R&W –Next course beginning May 15th. (Rezvan.Ameli@NIH.Gov) • NIH Mind Body Week Sept 8-11, 2009 • Insight Meditation Community of Washington DC • University of Maryland • NCCAM

25. Other practice & research resources • University of Massachusetts Center for Mindfulness in Medicine, Health Care, and Society • UCLA Semel Institute, Mindful Awareness Research Center • Insight Meditation Society -Massachusetts • Spirit Rock - California • Omega Institute – New York