Introduction to Mindfulness Based
Stress Reduction:
CALM of NEPA
Phillip Sallavanti
What is Meditation
• “Medicine” and “Meditation” arise from the
same Indo-European root
– Meaning “to measure”
– Suggesting an action to establish wholenesshealth
• MBSR has its core the practice of mindfulness
mediation and the intention to establish
wholeness
What is Mindfulness
Jon Kabat-Zinn defines mindfulness as paying attention, on
purpose, in the present moment and non-judgmentally
OR more simply BEING HERE NOW
with an attitude of openness, curiosity and kindness
Defining
Mindfulness in MBSR
A Model of Mindfulness
Attention
Intention
Attitude
The three axioms of Intention, Attention, and Attitude (IAA)
are not sequential, but rather are engaged simultaneously
in the process of mindfulness (Shapiro, et al., 2006).
Defining
Mindfulness in MBSR
• Three Axioms of Mindfulness (Shapiro et al., 2006)
• Intention changes over time: “from self-regulation,
to self-exploration, and finally to self-liberation”
• Attention has two facets: sustained focus and
flexibility of focus
• Attitude of non-judgment: this is not an affect-free
“bare awareness,” but rather an accepting, open, and
kind curiosity towards one’s own experience
Awareness is Continuous
• The “triangle” of awareness:
• Body sensations
• Thoughts
• Emotions
• But we don’t always bring attention to our
awareness
• Much of the day, we’re on autopilot
• Attending to the body/breath brings us into the
present moment — immediately
Mindfulness in MBSR
• A Meta-Mechanism of Mindfulness: Reperceiving
(Shapiro et al., 2006)
• “…a rotation in consciousness in which what was
previously ‘subject’ becomes ‘object.’”
• This is basic to human development; mindfulness
practice simply accelerates development
• Does not create distance and disconnection from
one’s experience, but rather enables one to look,
feel, and know more deeply
Mindfulness in MBSR
• Self regulation and self management: We can
identify and then choose to override habitual
reactions and respond with more balance and
greater skill
• Values clarification: We can reflect on values we may
have adopted unquestioningly and choose to adapt
or adopt values more resonant with the current
context
The program
• Introduction to MBSR
• 8 week program
• 2 ½ hours a week
Educational, not therapeutic orientation —
classes provide a community of learning and
practice, for motivation, support, and
belonging. Focus is on what‘s right with you
not what‘s wrong with you.
Mindfulness Practice in MBSR is Formal or
Informal
• Formal: a specific form of practice, at a
specific time and place, for a set duration
• Four common forms: Body scan, sitting
meditation, walking meditation, mindful
movement
• Informal: bringing mindful attention to any
activity, any situation, any time, anywhere
Mindfulness-Based Stress Reduction
• Offered at > 700 medical centers in U.S. and
around the world
• 30 years of research in a wide range of
chronic clinical ailments
• 700% increase in the amount of studies since
2003
Mindfulness Based Interventions
Mindfulness-Based Stress Reduction (MBSR)
• Mindfulness-Based Cognitive Therapy (MBCT)
• Mindfulness-Based Relapse Prevention (MBRP)
• Mindfulness-Based Art Therapy (MBAT)
• Mindfulness-Based Relationship Enhancement (MBRE)
• Mindfulness-Based Eating Awareness Training (MB-EAT)
• Mindfulness-Based Rational Emotive Behavior Therapy
(MBREBT)
• Mindfulness-Based You Name It (MB-ETC)
• Dialectical Behavior Therapy (DBT)
• Acceptance and Commitment Therapy (ACT)
Definition of Stress
• Stress is the response to a perceived threat to
our psychological or physical well being
coupled with the believe that we don’t have
the resources to cope
What happens in a traffic jam
• Body sensations
• Thoughts
• How we perceive something actually shapes
our experience.
• Body cant distinguish between a thought and
an actual threat.
• Hard wired for stress response.
Research on Mindfulness and Health
•
•
•
National Institutes of Health funding wide range of clinical studies of
mindfulness in medicine and mental health
Asthma, bone marrow transplant, breast cancer, chronic pain,
chronic obstructive pulmonary disease, fibromyalgia, HIV, hot
flashes, hypertension, immune response to HPV, irritable bowel
syndrome, lupus, myocardial ischemia, obesity, prostate cancer,
rheumatoid arthritis, solid organ transplant, type-2 diabetes, and
other medical conditions
Anxiety disorders, delusional disorder, depression, drug abuse and
dependence, eating disorders, personality disorders, PTSD,
schizophrenia, suicidality, and other psychiatric disorders
Research on Mindfulness and Health
• National Institutes of Health funding wide range of clinical
studies on mindfulness in medicine and mental health,
including:
•Asthma,
•bone marrow transplant,
•breast cancer, chronic pain,
•chronic obstructive pulmonary
disease,
•fibromyalgia,
•HIV,
•hot flashes,
•hypertension,
•immune response to HPV,
•irritable bowel syndrome,
•lupus,
•myocardial ischemia,
•obesity,
•prostate cancer,
•rheumatoid arthritis,
•solid organ transplant,
•type-2 diabetes,
•other medical conditions
Research on Mindfulness and Mental
Health
•
•
•
•
Anxiety disorders,
•
delusional disorder, •
depression,
•
drug abuse and
•
dependence,
• eating disorders,
• personality disorders,
PTSD,
schizophrenia,
Suicidality,
other psychiatric
disorders
outcomes
• 45% reduction in anxiety
• 35% reduction in depression
No similar changes in
other regions
MBSR and Cognitive Function
• Recently, researchers have reported improvement
in sustained attention and working memory
measures in novice meditators who underwent
MBSR training relative to a comparison group who
did not undergo the training. (Amishi Jha)
Brain Changes
• Participation in an MBSR program results in
increases in regional brain gray matter density
regions associated with learning, memory,
emotion regulation, perspective taking.
(Holzel et al., 2011)
Mindfulness Enhances Attention
• Slagter et al. (2007) found mindfulness
practice affected distribution of attentional
resources.
• Time required to identify and consolidate
visual targets in short-term memory
precludes recognition of second target
within 500 ms.
• Mindfulness practitioners with 3 months’
experience identified second target within
500 ms window.
• Practitioners used fewer resources
(measured by scalp recorded brain
potentials) to identify first target.
Mindfulness and the Therapeutic
Encounter
The Miracle of Attention
“The capacity to give one’s
attention to a sufferer is a very rare
and difficult thing; it is almost a
miracle; it is a miracle.”
Simone Weil
From Waiting for God, New York: Putnam, 1951.
What Is Therapeutic Presence?
A definition (Bugenthal,1987):
•
•
•
Being open and available to all parts of the client or patient’s
experience…
Being open and available to all of one’s own experience as one
is with the client or patient…
Being able to respond from the immediacy of that
experience…
Therapeutic presence is not cognitive, contrived, or controlled. It
is simply as “withness.”
Obstacles to Presence
• Processes that can interfere with presentmoment awareness include:
–
–
–
–
–
–
–
Comparison and evaluation
Complexity, busy-ness, and confusion
“Yes, but” conversations
Taking sides
Strong past or future orientation (rumination/worry)
Focusing on what something “means about me”
Problem-solving orientation
• Obstacles to presence may be sources of burnout and
secondary traumatic stress – or “empathic stress
fatigue” (Figley, 1995; Halifax, 2011).
• Symptoms can include:
• Apathy
• Demoralization
• Intrusive thoughts
• Reduced quality of life
• Sleep disruption
• Substance use
Mindfulness Interventions for Health Care
Professionals
• Since 1978, approximately 30 empirical studies have
been published involving the use of mindfulness-based
interventions with health care professionals (ranging
from physicians to nurses to psychologists).
• Outcomes have included improvements in:
− Burnout symptoms and job engagement
− Distress tolerance
− Active listening and empathy
− Nonjudgmental self-reflection and self-compassion
Therapist Practice Improves
Patient Outcomes
• A controlled, double-blind study of therapy outcomes for
inpatients whose psychotherapists meditated daily (Grepmair et
al., 2007) found:
− Significant differences in symptom reduction for those
whose therapists meditated -- as measured on 8 scales of
SCL-90 (global severity index, somatization, insecurity in
social contact, obsessiveness, anxiety, anger/hostility,
phobic anxiety, & psychoticism)
− Patients of meditating therapists reported greater
subjective improvement following their sessions and made
better assessments of their development of new behaviors
Applying Mindfulness in Interpersonal
Communication
• Mindfulness practice can facilitate compassionate
communication even in high-stress environments:
• Attend to self and other
• Slow down the interaction to enhance
attention
• Notice what you feel and where you feel it
• Adopt a non-judgmental stance
• Acknowledge what you have heard
• Validate the emotions
• Articulate needs (all parties)
• Trust the interaction
Mindfulness for Teachers
A study with public school teachers
by Diane Reibel, PhD, Jefferson
University
School District
• Urban-fringe district- directly adjacent to
Philadelphia
• 8 elementary schools, 2 middle schools, 1 high
school
• 5,500 students
Participants in First MBSR Program
• First 8 week MBSR program
• 19 people –one dropped out mid-way
• Age range 25- 60 years old, mean age 46
14 elementary school teachers
2 high school,
2 special education coaches
1 professional education coordinator
Brief Symptom Inventory Scores
18
16
14
12
10
8
6
Pre
Post
4
2
0
GSI
ANX
DEP
SOM
All values means p<0.01
Reductions in GSI 53% ANX 48%
DEP 58% SOM 58%
Maslach Burnout ScaleEducators’ Survey Scores
45
40
35
30
25
20
15
Pre
Post
10
5
0
EE
DP
PA
EE=Emotional Exhaustion, DP = Depersonalization
PA= Personal Accomplishment
25 % decease in EE and 13 % improvement in PA p<0.005
Teachers’ Feedback on Effectiveness of
MBSR
•
•
•
•
•
•
How has this program helped you become more
effective at work? (check all that apply)
0 It has not helped me to be more effective
17 I am better able to manage stress
5 I am more productive
16 I can better manage my emotions
8 I am better able to prioritize
16 I am more present for my students
Research on mindfulness programs in K-12 schools
shows student benefits in increased . . .
- ability to discern detail
- ability to refresh perception of the moment
- metacognitive awareness
- ability for self-regulation
- emotional flexibility
- awareness of body, thoughts, feelings
- quick recovery to mental calm, emotional
balance
- relaxation response capacity
- satisfaction in everyday living
Photo from www.mindfulschools.org
MBSR Research at Jefferson
Medical Conditions of MBSR Participants
(136)
•
•
•
•
•
•
•
Chronic Pain (30%)
Hypertension (20%)
Anxiety/Panic Disorder (18%)
Depression (16%)
Cancer (12%)
GI Distress, Diabetes, Arthritis, Sleep disorders, AIDS/HIV, MS, Lupus
Significant comorbidity- 2/3 of participants had 2 or more illnesses
•
(Mean Age 47, 70% Women, 30% men)
MBSR Research at Jefferson
MBSR Research at Jefferson
MBSR Research at Jefferson
One Year Follow-Up
• Benefits were maintained in Anx, Dep, Som,
GSI, MSCL and five of eight of the SF-36
health related quality of life scores.
Health-Related Quality of Life Outcomes
for Patients with Chronic Pain (n=99)
100
90
80
70
60
50
40
30
20
10
0
*
*
*
*
*
*
*
Pre
Post
*p<.05
PF
RP
BP GHP
VT
SF
SF-36 Subscales
RE
MH
MBSR Research at Jefferson
Change in NKCA following in Relationship to
Improvement in MCS
140
Baseline
Post-MBSR
Lytic Units
120
100
80
60
40
20
0
No Improvement
Improved
Group
n=48 RCT
EEG:
↑left prefrontal
cortex activation
Mindfulness supports Resilience
• Resilience the ability to respond constructively
to life.
• Mindfulness feeds resiliency in 4 main ways
1. Sensitivity increases to notice challenges
2. Self calming by slowing down habitual reactions
3. Experiencing comfortable and uncomfortable
emotions and sensations with conscious choices
4. Recovering- shifting attention to the present
without self judgment or inner commentary
Mindfulness therapy helps prevent
D & A relapse
• One year following treatment far fewer
participants used drugs or alcohol.
• Teaching self awareness help people understand
what drives cravings
• 8 percent in mindfulness participants reported
drug use compared to 14 percent in 12 step
program and 17 percent in traditional relapse
prevention group.
• 8 percent reported drinking after 1 year
compared to 20 percent in the other 2 therapy
groups.
“Compared to what we ought to
be, we are only half awake.”
…William James
Mindfulness and Teens
• Teenage years are some of the most stressful
of your life. 70% of teens say they are stressed
out.
• Pressure about grades, parents who just don’t
seem to “get it” and friends who drive you
“crazy”.
The Good News
• If you learn a few strategies for getting stress
under control now, you'll have the skills you
need to deal with problems and difficult
feelings that life sends your way in high school
and beyond.
Mindfulness and Teens
• mindfulness approaches are producing
benefits in teens in the form of more feelings
of well-being, less anxiety and worry, and less
emotional reactivity (Burke 2010).
• Research in mindfulness indicates that this
program may help students improve focus,
enhance self-confidence, and provide a basis
for developing positive coping and timemanagement skills.
Mindfulness and Teens
• “These skills can help teenagers navigate
effectively through a time in life that can be
confusing, filled with uncertainties, and
exceedingly stressful. These life-skills form the
basis for building successful relationships,
beginning with oneself.” Jon Kabat-Zinn,
founder of MBSR, from forward of Learning to
BREATHE.
What does Mindfulness have to do
with SPORTS
• Seattle Seahawks are taught Yoga and
Mindfulness Meditation as part of their
training. Teaching them how to stay focused
and placing their attention where they choose
The Zone
• Placing attention on the task by accepting
internal and external distractions.
• Allowing them to be as they are
• When an athlete can notice this and perceive
it for what it is simply a thought or a feeling
they are better able to enter the zone.
Russell Okung
• “Meditation is as important as lifting weights
and being out here on the field for practice, its
about quieting the mind and getting into
certain states where everything outside of you
doesn't matter in that moment. There are so
many things telling you that you can’t do
something, but you take those thoughts
captive, take power over them and change
them.”
Mindfulness at Penn State
• For 15 minutes a day, Tim Frazier, Penn State's
senior point guard, finds a quiet place,
switches on a podcast, and meditates. Along
with his teammates.
• "The game moves so fast, it's hard to focus on
the here and now," said Frazier, who is pretty
fleet of foot himself. "Meditation slows me
down [mentally], keeps me more relaxed and
more focused."
Mindfulness
• Sometimes during the game, you focus on whether
past plays were good or bad," Frazier said, "but
meditation brings you back to the play at hand.“
• Part of mindfulness is to learn to observe situations
rather than automatically reacting to them," said Diane
Reibel, director of the Mindfulness Institute at
Jefferson University Hospital. "Mindfulness teaches you
to pause for a split second and notice, for example, 'oh,
yes, anger is rising.' It gives you a way to approach the
anger without acting on it. You can choose to use that
energy in a positive, rather than negative way.
Outcomes can be different; you have a choice."
Mindfulness and Sports
• Mindfulness practice really isn't that different
from athletic training,” mindfulness practice
changes the structure of the brain through
which awareness operates. Just as running
increases the strength of the quadriceps
muscle, mindfulness practice strengthens the
executive control function of the brain."
Abridged Mindfulness Intervention to
Support Wellness in First-Year
Medical Students
• The beneficial effects of MBSR mirror those
found in prior studies in student populations.
Shapiro et al. studied a randomized
population of premedical and medical
students who underwent a similar 8-week
mediation program and found reduced anxiety
and depression, and increased empathy at the
end of 8 weeks.22 Jain et al. demonstrated
reductions in distress and improvements in
positive mood states.31
• improved total mood disturbance scores in the MBSR
group compared with controls in a sample of volunteer
medical students.23 Warnecke et al. demonstrated that
mindfulness reduced PSS and anxiety as measured by
the DASS in a randomized group of senior medical
students at 8 weeks.24 Our study extended the period
of observation considerably to 6 months. The effect
have been associated with positive findings relevant to
medical student wellness in other published literature.
Neff and McGehee32 reported mental health benefits
including diminished anxiety and depression as well as
greater feelings of social connectedness
The Time is NOW
Between the stimulus and the response there is a space.
Within that space lies our freedom.
Victor Frankel