Clinical uses of Mindfulness Training

1. Clinical uses ofMindfulness Training Alistair Smith, Clinical Psychologist alistair@cali.co.uk e-mail me if you want a detailed handout, with references, about mindfulness training and some related acceptance-based therapies

2. What is mindfulness? 1. Mindfulness means paying attention in a particular way; • on purpose, • in the present moment, • and nonjudgementally Jon Kabat-Zinn

3. What is mindfulness? 2. Being mindful is not emptying the mind: it’s an investigation into being human. It is not thinking a certain way, or avoiding thinking a certain way: it is being open to the whole of our experience right now Training ourselves to be more mindful, we work a lot with the body – the body is present even when the mind wanders! The shift from doing to being is crucial: mindfulness requires paying attention, yet equally needs compassionate acceptance. The two work together to bring about change Mindfulness is hard to describe. To understand the relevance, we must experience as well as think about it

4. Do we need special training, to be mindful? • Mindfulness is quite everyday (so is mindlessness!) • It takes practice to develop awareness of when & where our attention goes. That practice itself brings about change. • Mindfulness Trainingfocuses on attention, acceptance, self-compassion and the possibility of living mindfully and letting this alter one’s life in profound (and unpredictable) ways

5. Consequences of living unmindfully “…over the past few years, Victoria, who is 52 this year, has been through some of the most trying times of her life … ‘I’m trying very hard to live in the moment,’ she says. ‘Otherwise you’re not present in your own life. But it took me about 40 years to cotton on to that. … In the past I always worked so quickly, I wasn’t actually experiencing anything.’ Interview with Victoria Wood, Good Housekeeping, March 2005

6. Mindfulness-Based Stress Reduction (MBSR) • Designed for people with chronic pain or incurable illness • Specific practices designed to anchor awareness in the present: Mindful sitting; walking; stretching. Also, being deliberately mindful during everyday activities • A way to become alert to thoughts and feelings before they drive our emotions or actions, and establish some detachment from them. (Not censoring or repressing them) • Delivered as 8 weekly sessions of 2½ hours (plus one all-day session) with intensive daily home practice • Teaches voluntary control of attention, as well as acceptance of self and situation. (Not resignation: freedom from reacting automatically)

7. What is MBSR good for? 1. • Lasting benefit for people with chronic physical pain. • Lasting improvement in Generalised Anxiety, panic • Stress reduction, e.g. in medical and nursing students; in prisons • Helps cancer patients cope with emotional distress; people with MS; organ transplants, fibromyalgia, Parkinson’s disease; heart attacks • Promotes healing in psoriasis • Useful with binge eating • Has been adapted to relationship enhancement for couples • Helps frail old people & carers cope with disability & loss of function • Helped stroke survivors. Those practising mindfulness were less depressed, less anxious, and experienced better quality of life

8. What is MBSR good for? 2 Lazar et. al. scanned brains of people who practiced mindfulness meditation 40 minutes per day and of controls with no meditation experience. Even controlling for age and education, some cortical areas were thicker in participants who meditated. These included the right anterior insula, involved in monitoring bodily functions, and parts of prefrontal cortex involved in attention and sensory processing Parts of the prefrontal cortex showed thinning in older controls but not in older participants who meditated, suggesting meditation may offer protection from age-related neuronal loss. Lazar, Kerr, Wasserman and Gray (2005) NeuroReport, 16, 1893-1897

9. It is remarkable how liberating it feels to be able to see that your thoughts are just thoughts and that they are not “you” or “reality” … recognizing your thoughts as thoughts can free you from the distorted reality they often create and allow for more clear-sightedness and a greater sense of manageability in your life Kabat-Zinn, 1990, pp 69-70

10. MBCT: mindfulness for depression We all experience periods of lowered mood, but if we’ve never been depressed may think “I’m having a bad day” or make external attributions, e.g. “He’s really upsetting me” • If we’ve often been depressed, low mood easily activates negative self-evaluation & pessimistic rumination. If accepted as factual, these intensify low mood & negative thinking, leading to depression • Teaching people to attend deliberately helps them shift to information processing modeswhich promote effective emotional processing. When we’re paying attention here and now, our minds are not free to drift into unhelpful rumination • For people who’d been depressed several times, MBCT reduced relapse rates by about half, in several careful studies

11. MBCT and other disorders • Avoidance of aversive experience versus acceptance • Mindfulness-based interventions have been designed and are being tested, for various anxiety disorders • MBCT is being adapted for many clinical problems. These include: psychosis; eating disorders; ‘borderline personality disorder’; chronic fatigue; OCD; health anxiety; and stroke. Client groups range from childhood to old age • For each specific condition, different mindfulness-compatible aspects of cognitive theory and therapy are introduced.

12. Mindfulness and individual therapy. 1 Attention, acceptance and compassion resemble Rogers’ non-specific therapeutic factors (empathy, warmth and unconditional regard), factors common to effective therapies Practising mindfulness can be therapist training, whether or not it is focused on the conduct of therapy It can help us to: listen; separate our own reactions from therapeutic response to clients; develop detachment from our own thinking so that can better develop an ‘internal supervisor’. We can model ‘spacious mind’ for our client

13. Mindfulness and individual therapy. 2 Mindfulness can be taught to individual clients as a more or less important aspect of their therapy. Although some practices may be taught as in group mindfulness training, there can be more flexibility - also more demand for the therapist to be creative (We must help clients not to misuse mindfulness practice as another form of avoidance). Germer, Siegel & Fulton (2005) write helpfully about teaching depressed clients to ‘turn towards life’ and anxious ones to ‘befriend fear’ through mindfulness.

14. Risks of mindfulness training • Any approach that is powerfully beneficial may have potential for harm, so we must be careful • In MBCT research some people were not helped – notably when their depression was triggered by major recent life events. Accommodating to major losses involves several psychological tasks. People with a recent diagnosis of cancer, or recently informed of a poor prognosis, may need time to process this before engaging with an approach which could confront them with stark facts before they are ready

15. How to explain all this to clients? Discuss what they have tried already and whether it is has been enough (presumably not, or they would not have come to you – but do they really see that yet?) Invite them to consider how much of the time, when they are troubled, their mind is in the future or the past (e.g. worrying, planning, regretting) Would it help to be better at spotting when the mind is down some dead end yet again, and to have strategies for staying more in touch with what is real right now? Investigate with them whether they are particularly self-critical when distress is worst; (if so, does that help?) Do they think that learning to be mindful in an accepting way may promote a bit more self-compassion – and would that be desirable? Does the client think tackling this in a group setting might help?