Mindfulness and Mental Health. Kelley Raab Mayo, M.Div., Ph.D. September 19, 2013

Transcription

1 Mindfulness and Mental Health Kelley Raab Mayo, M.Div., Ph.D. September 19, 2013

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3 What is Mindfulness? What is mindfulness and what is its relationship to mental health? Mindfulness, as defined by Zen master Thich Nhat Hanh, is the practice of being fully present and alive, body and mind united. Mindfulness is the energy that helps us to know what is going on in the present moment (Shambala Sun, 2008).

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5 What is Mindfulness? Mindfulness is a form of meditation originally derived from the Theravada tradition of Buddhism. The 2,500 year-old practice known as Vipassana was developed as a way to cultivate greater awareness and insight. Mindfulness is often translated as to see with discernment.

6 What is Mindfulness? Mindfulness is the awareness that emerges through paying attention, on purpose, in the present moment, and non-judgmentally, to things as they are (Williams, Teasdale, Segal, Kabat- Zinn, The Mindful Way Through Depression, 2007, p. 24)

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8 BUT Mindfulness is presymbolic. Mindfulness can be experienced and it can be described, as long as you keep in mind that the words are only fingers pointing to the moon. They are not the moon itself (Gunaratana, Mindfulness in Plain English, 2011, p, 131).

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10 Mindfulness is simple but not easy With the pressures society places on being constantly busy, productive, and on the move, it can be difficult to settle down and be present for even five minutes. Over the long term it's remembering to be mindful that's the hard part. The good news is it does get easier with time and practice. Practiced consistently over time it becomes second nature.

11 Three Axioms of Mindfulness Intention Your intention is your motivation for practicing mindfulness. The strength of your intention helps to motivate you to practice mindfulness on a daily basis, and shapes the quality of your mindful awareness. Attention Mindfulness is about paying attention to your experience. Your mindful attention is mainly developed through various different types of meditation either formal or informal Attitude Mindfulness involves cultivating an accepting, open, and kind curiosity towards one s experience.

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13 Four Foundations of Mindfulness Thich Nhat Hanh 1. Mindful observation of the body The first establishment of mindfulness is the body, which includes the breath, the positions of the body, the parts of the body, the four elements of which the body is composed, and the dissolution of the body. The first practice is the full awareness of breathing.

14 Four Foundations of Mindfulness Thich Nhat Hanh 2. Mindful observation of feelings There are three sorts of feelings: pleasant, unpleasant, and neutral. The teaching of this exercise is to identify and be in touch with these feelings as they arise, endure, and fade away. The practitioner is neither drowned in nor terrorized by that feeling, nor does he/she reject it. This is the most effective way to be in contact with feelings.

15 Four Foundations of Mindfulness Thich Nhat Hanh 3. Mindful observation of consciousness (or mind) The contents of the mind are psychological phenomena called mental formations. We mindfully observe the arising, presence, and disappearance of the mental phenomena which are called mental formations. We recognize them and look deeply into them in order to see their substance, their roots in the past, and their possible fruits in the future, using conscious breathing while we observe.

16 Four Foundations of Mindfulness Thich Nhat Hanh 4. Mindfulness of the objects of mind (or mental objects) When sitting in meditation, we concentrate our mind on the object of our observation sometimes a physical phenomenon, sometimes psychological and we look deeply into that object in order to discover its course and its nature. If we look carefully and deeply, we will see that the arising, enduring and ending of the object is dependent on other things (principle of interbeing and interpenetration)

17 Mindful awareness of the hands

18 Benefits of Mindfulness Mindfulness has numerous health benefits. Training in mindfulness has the potential to increase awareness of thoughts, emotions, and unhealthy patterns of mind that make you more susceptible to stress.

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20 Benefits of Mindfulness Mindfulness can help you live more in the present moment. You can practice mindfulness while eating, walking, talking, or doing just about anything.

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23 Benefits of Mindfulness Mindfulness practice is the practice of being 100% honest with ourselves. (Gunaratana, Mindfulness in Plain English, 2011, p. 42).

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25 Benefits of Mindfulness When we watch our own mind and body, we notice certain things that are unpleasant to realize.. Before we try to surmount our defects, we should know what they are Gunaratana, Mindfulness in Plain English, 2011, pp ).

26 Myths of mindfulness Dr. Lynette Montiero Be in the moment Often we hear it used as a way of not being in the moment It is frequently used a way of saying, I just want the pleasant stuff. Being in the moment means holding a steady awareness of everything that is happening without rejecting or clinging to any one experience.

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28 Myths of mindfulness Dr. Lynette Montiero Let go We talk about letting go of our anger or grief and feel frustrated when anger or sadness shows up... Letting go is the process of opening ourselves to the experience we are having without engaging the old habits of judgmental thinking and self-criticism.

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30 Myths of mindfulness Dr. Lynette Montiero Accepting what is Often we worry that accepting something is the same as being passive or staying a victim to our circumstances Acceptance is the practice of looking into our experience, our situation, and seeing all the dimensions in it. It is seeing it for what it truly is and not what we wish it was.

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32 Mindfulness-Based Stress Reduction (MBSR) Jon Kabat-Zinn, Ph.D. (1982, 1990), developed a Mindfulness-Based Stress Reduction (MBSR) program at the University of Massachusetts Medical Center in Since then, MBSR programs, based on his model, have been implemented worldwide.

33 MBSR program - Kabat-Zinn 1) Consists of 8 weekly 2.5 hour-long classes and one day of silence in between the 6th and 7th weeks 2) Formal practices include a body scan, sitting meditations, mindful yoga, mindful walking, and mindful eating 3) Home practice is an integral part of the program

34 Learning Objectives of MBSR 1. Experiencing new possibilities reframing; beginner s mind 2. Discovering embodiment (e.g., emotions as experienced in the body) 3. Cultivating the observer practice of noticing when and where the mind has wandered (fostered by inquiry) 4. Moving towards acceptance, nonjudgment, compassion

35 Mindfulness and mental health Mindfulness-based therapies have been used with different clinical psychiatric populations, such as clients with anxiety and depressive disorders, eating disorders, gambling and addictive disorders. Mindfulness has been used in the treatment of borderline personality disorder and with clients with a history of childhood sexual abuse.

36 Mindfulness and mental health Specifically, mindful meditative techniques and self-awareness exercises help by cultivating an awareness of thoughts and feelings, accepting, and letting them be.

37 Mindfulness-Based Interventions MBSR (Mindfulness-Based Stress Reduction) ACT (Acceptance and Commitment Therapy DBT (Dialectical Behavior Therapy) MBCT (Mindfulness-Based Cognitive Therapy) MBRP (Mindfulness-Based Relapse Prevention) MB-EAT (Mindfulness-Based Eating Awareness Training Mindfulness-based interventions continue to evolve.

38 Is mindfulness for everyone? As Hayes and Feldman (2004) note, careful consideration must be given to clients abilities to face their own negative material without use of their current coping strategies. Hayes, A. and Feldman, G. (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology: Science and Practice 11(3)),

39 Neuroscience of Mindfulness David Rock, author of Your Brain at Work You can experience the world through your narrative circuitry You can also experience the world more directly, which enables more sensory information to be perceived and allows you to get closer to the reality of any event. Noticing more real-time information makes you more flexible in how you respond to the world. You also become less imprisoned by the past, your habits, expectations or assumptions, and more able to respond to events as they unfold.

40 Neuroscience of Mindfulness Farb, Segal, Mayberg, et al. (2007). Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. SCAN 2, Mindfulness training allows for a distinct experiential mode in which thoughts, feelings, and bodily sensations are viewed less as being good or bad or integral to the self and treated more as transient mental events that can be simply observed.

41 Mechanisms of Action McCown and Reibel, Shift to observer consciousness, decentering; e.g. I am not my thoughts, I am not this pain 2. Reperceiving shift from identification with one s experience to experience being available for observation; enables looking, feeling, and knowing more deeply

42 Mechanisms of Action Vago and Silbersweig. (2012). Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness. Frontiers in Neuroscience, 2012 Using the S-ART framework, authors suggest that mindfulness fosters mental training to develop metaawareness of self (self-awareness), an ability to effectively manage or alter one s responses (self-regulation), and the development of a positive relationship between self and other (self-transcendence).

43 Mechanisms of Action Holzel, Lazar, Gard, et al. (2011). How Does Mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science 6: Attention regulation thought to be a prerequisite for the other mechanisms 2. Body awareness 3. Emotion regulation 4. Change in perspective on the self

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45 Additional Mechanisms Decrease in ruminative thinking Decrease in worry Increase in mindfulness Increase in acceptance without judgment Increase in self-compassion

46 Mindfulness at the Royal Mindfulness has been integrated into many inpatient units at the Royal, including mood, geriatrics, substance use (and Meadow Creek), schizophrenia, ROMHC At BMHC, mindfulness has been integrated into secure treatment unit and forensic treatment unit

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48 Mindfulness at the Royal Mindfulness-based Cognitive therapy is an option for clients in the mood outpatient program, based on appropriateness and referral. MBCT was specifically designed to treat major depression relapse. MBCT integrates components of MBSR with cognitive behavioural therapy (CBT) by decentering from ruminative thoughts and emotions.

49 DOING MIND From Williams and Penman (2011): Automatic pilot Analyzing Striving Seeing thoughts as solid and real Avoidance Mental travel time Depleting activities

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51 BEING MIND From Williams and Penman (2011): Conscious choice Sensing Accepting Treating thoughts as mental events Approaching Remaining in the present moment Nourishing activities

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53 Wise Mind DBT meets the 12 Steps, Platter, 2010 Wise mind results from using both emotion mind and reasonable mind together (Linehan, 1993). Marsha Linehan (founder of DBT) states: Wise mind is that part of each person that can know and experience truth. It is where the person knows something to be true or valid. It is almost always quiet, It has a certain peace. It is where the person knows something in a centered way.

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55 Mindfulness at the Royal MBSR has been offered to staff in two formats: Traditional 8 week program ( ) Modified 4-week program for inpatient staff teams (ongoing) Informally, as mindful movement/yoga and meditation classes for staff, both at ROMHC and BMHC

56 Mindfulness Study, the Royal The participants for this study were a group of 22 female health care workers between the ages of 24 and 69. Participants were assessed before and after an 8-week MBSR program using the Self Compassion Scale, the Quality of Life Inventory and the Maslach Burnout Inventory. Comparisons were made pre/post treatment using the subscales of the aforementioned measures. A significant decrease in the self judgment subscale of the Self Compassion Scale was observed in the sample population at an alpha of.004. This indicates that mindfulness training was effective at reducing self judgment.

57 Mindfulness and Self-Compassion Mindful self-compassion is being aware in the present moment when we're struggling with feelings of inadequacy, despair, confusion, and other forms of stress (mindfulness) and responding with kindness and understanding (selfcompassion). C. Germer,

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59 Conclusions Jon Kabat-Zinn, Full Catastrophe Living (1990/2005): In this book we will be learning and practicing the art of embracing the full catastrophe. Catastrophe here does not mean disaster. Rather, it means the poignant enormity of our life experience. (p. 6)

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61 Conclusions Everyday we are engaged in a miracle which we don't even recognize: a blue sky, white clouds, green leaves, the black, curious eyes of a child - our own two eyes. All is a miracle. Thich Nhat Hanh The Miracle of Mindfulness

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63 Conclusions Bhante Gunaratana, Mindfulness in Plain English (2011): Mindfulness is not trying to achieve anything. It is just looking (147) Yet the ultimate goal of [meditation] practice remains: to build one s concentration and awareness to a level of strength that will remain unwavering even in the midst of the pressures of life in contemporary society (153)

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