Mental Health Therapists’ Perspectives on the Meaning of Mindfulness

1. Mental Health Therapists’ Perspectives on the Meaning of Mindfulness Sandra Kavanagh & Jean Morrissey School of Nursing & Midwifery Trinity College Dublin

2. A Moment of Mindfulness

3. Overview of Presentation • Background of Study • Literature Review on Mindfulness • Key Findings • Implications for Future Practice

4. Background of Study • MSc Study • Descriptive Qualitative Study • Ethical Approval Granted • Semi-Structured Interview • Process/Thematic Content Analysis Approach • 10 Participants – Accredited /pre-accredited Counsellor/Psychotherapists • Supervisor – Ms Jean Morrissey

5. What is Mindfulness? • The Original Definition of Mindfulness is based on the premise of compassionate awareness by intentionally paying attention to present moment experiences and acceptance of those experiences without judgement

6. What is Mindfulness? • ‘Keeping one’s consciousness alive to present reality…… paying attention in a particular way on purpose in the present moment and non – judgementally’. (Kabat-Zinn 2012, p. 4, 11)

7. Operational Definition • ‘The self regulation of attention towards present moment experience accompanied by a curious open and accepting stance’. (Langdon et al. 2011, p. 270)

8. Spirit of Mindfulness The traditional philosophy behind mindfulness practice is in creating an • Inner calmness • Quieting the mind of any distraction • Freeing the body of any tension or stress

9. Mindfulness Practice To understand the principles behind mindfulness, cultivate mindfulness and develop the capacity to live life in harmony with acceptance, love compassion and clarity requires developing a set of skills through different types of mindfulness practice

10. How? • ‘maintaining awareness of the sensations in your body, the flow of thoughts through your mind, the sounds and sights in your surroundings, thus mindfulness is awareness expanded into ourselves and outward into the world’ (McQuaid & Cameron 2004 p. 12)

11. Meditative Practices

12. Types of Practice • Formal – Mindful of ones mental state and daily activities in the moment • Informal – Breathing Techniques, Sitting Meditation, The Body Scan, Movement Awareness

13. Heart of Meditation • Breathing Technique - foundation for the practice of meditation - awareness of the breath is the means of developing the ability to concentrate and relax into a deeper state of conscious awareness • Sitting and Lying Meditation- allow more ability to develop insight and awareness to where one is in a particular moment.

14. Simple But not Easy • To truly understand mindfulness requires more than just acquiring the skills and knowledge. • Compared to other yogic and other mediative traditions mindfulness is unique in that it requires experience through ongoing personal engagement in the practice. (Kabat-Zinn 2011)

15. Evolution of Mindfulness

16. Originates from Eastern Buddhist Psychology • Considered a Pathway to Enlightenment • To help one become free of all sufferings brought on from unhealthy attachments, desires, cravings , hatred and ignorance (Sach 2007) • A new way of thinking doing and seeing (Kabat-Zinn 2011)

17. Evolution of Mindfulness • The spread of Buddhist Psychology in particular, mindfulness principles and practices have now moved from its place of origin in northern India and has been embraced by western cultures

18. Evolution of Mindfulness • Inspired by Eastern Buddhist Psychology modern Buddhism in particular , the practice of mindfulness has seen a surge of interest within western mental health services. (McWilliams 2012) • Empirical studies show promising results on the clinical benefits of mindfulness applied to clinical practice (Cheisa 2012) • Resulting in medical science and modern psychology integrating Mindfulness Based Interventions (MBI) with a range of people suffering debilitation medical conditions and mental health problems (Kenget al. 2011)

19. Therapeutic Development • Mindfulness Based Stress Reduction (MBSR)- (Kabat– Zinn 1990) • Dialectic Behavioural Therapy (DBT) - (Linehan, 1993) • Acceptance & Commitment Therapy (ACT) -(Hayes et al. 1999) • Mindfulness Based Cognitive Therapy(MBCT) -(Segal et al. 2002)

20. Therapeutic Development • Mindfulness Based Relationship Enhancement Therapy (MBRET) (Carson et al. 2004) • Mindfulness Action Based Cognitive Therapy (MBCT) 16 week group programme combining cognitive with co-existing substance misuse (SUD) and binge eating disorders (BED). (Courbassonet al. (2011) • Mindfulness Based Awareness (MBA), youth specific programme.(Hemelsteinet al. 2012)

21. Mindfulness & Mental Health Used to promote well being for people with a range of physical conditions and mental health problems • Chronic Pain • Attention Deficit Hyper Activity (ADHD) • Clinical Depression • Anxiety (GAD) • Stress (PTSD) • Psychosis • Schizophrenia • Borderline Personality Disorder (BPD) • Addiction (SUD) • Eating Disorders (BED)

22. Therapeutic Benefits • Self Care (Shapiro et al. 2007) • Improved Therapeutic Alliance (Crane et al. 2010) • Improved Therapeutic Outcomes (Brady et al. 2012) • Reduction in Medication Use (Pauliket al. 2010) • Reduction in Relapse (Bien & Bien 2002) • Increase in Accepting Attitudes (Hemelsteinet al. 2012)

23. Findings - Themes Identified • Mental Health Therapists’ Understanding of Mindfulness • Integrating Mindfulness to Clinical Practice • Developing and Learning Mindfulness

24. Understanding Mindfulness • Being Aware • Being Relaxed • A Way of Being in the Present Moment • A Way of Getting Back in Touch With Oneself

25. My view of mindfulness is being aware of what's around being aware of yourself, being aware of sounds, being aware of what is going around you and also being aware of your body (P7)

26. Spirituality V Religion • My understanding of mindfulness I suppose is basically being in the present moment and calming the spirit. (P5) • Mindfulness is distinct its more I mean mindfulness is you can do it without religion. (P10) • It would be mindfulness but maybe faith it’s hard to distinguish between the two I kind of have the two interwoven. (P3)

27. Tool/Technique/Intervention • I just have a hard time people calling it a therapeutic approach where to me it’s not a therapeutic approach it’s a technique that can be used in therapy. (P4) • It’s a tool to help you to enjoy the journey (P9) • I perceive mindfulness as a therapeutic practice I just cant see how it really is a therapeutic tool. (P1)

28. Integrating Mindfulness into Clinical Practice • Works Well Through All Therapies • Numerous Therapeutic Benefits • Works Predominantly Well With Children, Adolescents and Adults • Works Well With an Accumulation of Mental Health Problems

29. However? Some Clients Non Receptive • I have somebody who has not so much emotional difficulties but behavioural difficulties ADHD compulsions things like that anger management I have found that it can be difficult to try and get them to calm or to accept the fact that what you are trying to do is to just ground them. (P8)

30. Male Clients • Meditation is kind of looked on sometimes especially by some guys as being a soft kind of approach it’s silly kind of thing…. And meditation is not going to do anything. (P8)

31. Early Stages of Bereavement • I probably wasn’t a candidate for a course like that straight away you know it could make me weepy at times…. Its brought me into spaces that weren't easiest for me (P9)

32. Developing & Learning Mindfulness • Ongoing professional development/ Necessary • Non – Engagement in the Practice/Busyiness • Different Styles of Training/Causing Confusion • Limited Available Courses • Training V Practice/Commitment • Competency /Acceptable Levels of Training • Monitoring/Evaluation

33. Concerns • I think from the way its started from were mindfulness started and where it is today in 2012 lets say I think it has been changed a lot it has been shaped a lot and also it has been changed to suit a lot of things. (P7) • Its just you know very much in the west we’re very much about a product we’re very much about creating a product and what we tend to do is in creating that product we tend to lose an essences of what it is and I feel its has become very commercialised. (P1)

34. Desire for Further Training • I don’t think mindfulness is understood I know I have my bit of understanding of it I know people are getting more becoming more aware of what it might be (P2) • I feel I could learn more techniques (P1) • I suppose learning more about the concept I would love (P7)

35. Limitations • Small Sample Size • Similar Backgrounds • One Location • Transcripts Not Reviewed • Anxiety Performance

36. Strengths • In depth insight into real experiences • Opportunity to reflect & elaborate • Reduced Mixed Interpretations • Researcher highly skilled in interviewing

37. Implications • Certified Standardised MBI Training Programs • Supervision with Qualified Mindfulness Supervisor • Mediation Rooms for Therapists • Re-fresher Courses • Regulated Standards of Teacher Training • Regulated Standards of Knowledge /Skills/ Experiential Learning • Regulated Standards of Monitoring & Evaluating Clinical Performance.

38. The Miracle of Mindfulness • ‘Mindfulness is the miracle that can call back in a flash our dispersed mind and restore it to wholeness so that we can live each minute of life… When you enter deeply into the present moment you see the nature of reality and this insight liberates you from suffering and confusion’ -------- ThichNhatHanh

39. Thank You