Dr. Oscar Koller , MD Buddhist Psychology & Psychotherapy

1. CPA 21st INTERNATIONAL CPD CONFERENCE ABU DHABI - SINGAPORE – JANUARY 14-29, 2018 Dr. Oscar Koller, MD Buddhist Psychology & Psychotherapy

2. OBJECTIVE FOR MY 3 PRESENTATIONS • Introduction to Buddhist Psychology • What is Buddhist Psychotherapy • Diagnosis • Objectives • Methods • Influence on My Practice • Mindfulness and Meditation for Recovering Alcoholics and Addicts • Mindful Eating Disclaimer

3. BEST DAY ofYOUR LIFE • When your first child was born. • When you graduated from University. • Wedding Day. • Today. • When you bought your first house.

4. Flapping like a fish thrown on dry ground, it trembles all day, struggling. Like an archer an arrow, the wise man steadies his trembling mind, a fickle and restless weapon The mind is restless. -Buddha

5. FIRST NOBLE TRUTH Dukkha/Hard to face • Old age, sickness, deathHumiliating blows to our narcissism • Not to get what we wantBeing stuck with what we don’t want • Persuasive unsatisfactoriness Sense of imperfection, uncertainty, futility, unreality The First Noble Truth of the Buddha asks us, above all, to accept the uncertainties that we otherwise try to ignore. In doing so we can then appreciate the rest of the Buddha’s psychology.

6. SECOND NOBLE TRUTH All is on us. • Grasping – craving • Aversion • Delusion • lack of attentionauto pilot • denial/dissociation • misperception of reality Leading to: Jealousy Anxiety Hatred Addiction Shallowness The Second Arrow

7. WHICH WOULD HURT YOU MORE: The First Arrow The Second Arrow

8. THIRD NOBLE TRUTH Letting Go. The wisdom of acceptance Cessation of suffering A story from Make Epstein and Buddhist monk AjahnChah in Thailand: Before saying a word, he motioned to a glass at his side. “Do you see this glass?” he asked us. “I love this glass. It holds the water admirably. When the sun shines on it, it reflects the light beautifully. When I tap it, it has a lovely ring. Yet for me, this glass is already broken. When the wind knocks it over or my elbow knocks it off the shelf and it falls to the ground and shatters, I say, “Of course”. But when I understand that this glass is already broken, every minute with it is precious”.

9. THIRD NOBLE TRUTH Because suffering is self-created people have the ability to consciously intervene, break the links, leading to cessation of suffering – nirvana. In a famous statement, the Buddha is reputed to have said, “I teach one thing and one thing only: suffering and the end of suffering”. As has often been pointed out, to most ears this sounds like two things. But the Buddha was choosing his words carefully. The clear-eyed comprehension of suffering permits its release. The Buddha in his role as therapist, showed how this was possible. The great promise of his teachings was that suffering is on the First Truth and that acknowledging it opens up the others.

10. FOURTH NOBLE TRUTH The Eightfold Path • right view • right intention • right speech • right lifestyle • right action • right effort • mindfulness • concentration Further subdivided into three categories of training: • Wisdom • Meditation • Ethical Life

11. McMindfulness& Frozen Yoga(Miles Neale 2011) • McMindfulness • Secular Buddhism • “Full Monty” Buddhism

12. CLINICAL APPLICATION & MECHANISM OF CHANGEMindfulness-Based Intervention (MBI) • Relaxation • Acceptance • Affect Tolerance • Behavior change • Meta-Cognitive awareness & insight  • Neuroplasticity

13. WHICH ANSWER IS TRUE? • CAD by 20% • CAD by 40% • CAD by 60% • No reduction Two years of meditation training reduces recurrence rates:

14. RELAXATION Two years of meditation training reduces recurrence rates in: CAD by 41% Mortality by 41% 80% of hypertensive patients improved 16% could stop medications

15. ACCEPTANCE Removal of the second arrow Accept life as it is. 72% chronic pain patients moderate – great improvement of quality of life 96% compliance for three years (Kabat-Zinn)

16. AFFECT TOLERANCE One increases exposure to more subtle sensations, thoughts (similar to CBT). Decondition ingrained reactions, find more effective response, greater tolerance, significant reduction in anxiety, panic.

17. BEHAVIOUR CHANGE Avoid maladaptive reactions Addictions OCD Parasuicidal behavior

18. META-COGNITIVE AWARENESS & INSIGHT Mindfulness Based Cognitive Therapy (MBCT) Patients learn to shift, regard thoughts as mental fabrication, arising like clouds in the space of momentary awareness. It is NOT what you are experiencing but how you relate to it Sense of spaciousness and restful awareness; of sheer interdependence and possibility. “I have thoughts, but none of them are me”

19. SELF & EMPTINESS Self-essence is expressed through: • Perseverance • Singularity • Independence If you put the two fundamental Buddhist ideas together – the idea of not-self and the idea of emptiness – you have a radical proposition: neither the world inside you nor the world outside you is anything like it seems.

20. SELF & EMPTINESS As expressed by a 16th century Mongolian lama: I was like a mad child, long lost his old mother, Never could find her, though she was with him always! What did Buddha mean? As a guru said: “You’re real. But you are not really real”

21. BUDDHIST PSYCHOTHERAPY • Diagnosis and Etiology The entire range of psychological suffering – from mere dissatisfaction to severe psychopathology is a function of an untrained, delusional mind. Recognizes self-reification habit that underlies an unconscious process of identification with a traumatic narrative considered the root cause for all disturbances of the mind.

22. BUDDHIST PSYCHOTHERAPY • Objectives To retrain dysfunctional processes of perception, cognition, emotion and behavior so as to achieve a psychological state and eventually a trait of happiness.

23. A MOTHER HAS TO BE, according to D Winnicott: • Always there • Perfect • Good enough • Admiring her child • Distant

24. BUDDHIST PSYCHOTHERAPY • Treatment Methods • Insight-oriented dialogue • Interpersonal • Meditation • Role-Modeling the therapist becomes a positive role model “re-parenting” • Contemplative Education enhance introspection develop awareness cultivate positive emotion–self compassion, meditation, wisdom & ethics

25. NEUROSCIENCE OF MINDFULNESS • The brain consists of 1.1 trillion cells. 10% are neurons. Each has 5000 connections with other neurons, firing 5-50 times a second. • Stress (cortisol) sensitizes the amygdala and weakens the hippocampus. • Simple noting & meditation can down-regulate the amygdala, up-regulate prefrontal cortex.

26. NEUROSCIENCE OF MINDFULNESS • Psychotherapy is an impossible profession (Freud 1937) • Overcoming therapeutic pessimism through mindful cultivation – we are basically all right now. • Feeling cared for. • Meditation helps to increase the thickness of the insular and prefrontal cortex.

27. INSTALLING STATES & TRAITS • States are momentary, temporary conditions like a moment of loving kindness or anger. • Traits are enduring tendencies of heart and mind. They come from states. • Around a third of our personal qualities are innate (DNA, genes). • The root of Buddhism is compassion and the root of compassion is self-compassion (Chodron 2000). • Greed, hatred, delusion – fuel for the fire of suffering • Generosity, love and wisdom – fuel for the fire of happiness

28. 4 STAGES OF WHOLESOME LEARNING HEAL H → have positive experiences E → enrich that experience (duration, intensity, multimodality, novelty) A → absorb it L → link it to other experiences which are significant to us