An introduction to the clinical
utility of mindfulness
Dr. Nic Hooper
Outline of Lecture
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History of Mindfulness
What is Mindfulness?
Typical Mindfulness Practises
Research and Evidence
History of Mindfulness
• Mindfulness and Buddhism
– Originated from the Buddhist tradition
– 7th step of the noble eight fold path as taught by the
originator of Buddhism, Siddhartha Gautama
– Mindfulness led to the ‘cessation of personal
suffering’
– Although taught as part of Buddhism, there is nothing
religious about mindfulness
History of Mindfulness
• Mindfulness and the West
– Jon Kabat-Zinn created Mindfulness Based Stress
Reduction (MBSR) in 1979 to treat chronically ill
– Subsequently a number of other third wave
psychological therapies using mindfulness techniques
developed; ACT, MBCT
– Currently a hugely popular technique receiving a
plethora of research in its favour
What is Mindfulness?
Definition of Mindfulness
“…paying attention in a particular way:
on purpose,
in the present moment,
and nonjudgmentally”
(Kabat-Zinn, 1994, p.4)
Dimensions
• Control of attention
– Bringing your mind back to the present moment
• Willing / accepting stance
– It’s not primarily about altering a feeling state
Some Contrasts
• Relaxation
• Distraction
Relaxation
• It has been suggested that mindfulness is simply
relaxation
• However relaxation has been shown to be very
different from mindfulness
• Namely, most clinical mindfulness skills induce
an active state in clients where psychological
issues are addressed
Relaxation
• Ditto, Eclache and Goldman (2006) and Jain et
al (2007) compared the effects of mindfulness
versus relaxation
– In terms of physiology, Ditto et al (2006) found that
brain activity/cardiovascular effects were different
between the two
– In terms of self report, Jain et al (2007) found that
while relaxation and mindfulness both reduce distress
and foster positive mood states, only mindfulness
reduces distractive and ruminative thoughts
Distraction
• It has also been suggested that mindfulness is a
sophisticated form of distraction
• Thought suppression
Distraction
• McHugh Simpson & Reed (2010) compared distraction
and mindfulness amongst an older population on a
decision making card selection task
• They found that mindfulness enhanced decision making
performance. Distraction worsened it
• Suggesting that different processes are at work
• Broderick (2005) showed similar results in an induced
mood study
Important things to know
about Mindfulness
Mindfulness is experiential
– Intellectual v. experiential /
Knowing v. doing
(may not be the same thing)
– How do we teach people to ride a bike?
The importance of practise
• The more you practise, the better you get!
– Brefczynski, Lutz, Shaefer, Levinson and Davidson
(2007) experienced (+37000 hours) participants were
performing an attentional focusing task using less
neural resources
• Stage 1: Noticing in the present moment
• Stage 2: Noticing non-judgementally in the
present moment
• Stage 3: Rolling out these skills across life
Metaphors and Mindfulness
• Metaphors often help to explain situations with more
clarity
• They can be used to aid an understanding of
mindfulness
– The Puppy; notice your “puppy-like” mind.
– Leaves on a stream
The anti-thesis of Mindfulness
• Mindfulness is an acceptance based strategy
that is directly opposite to avoidance
• Avoidance of unwanted thoughts can lead us to
narrow our behavioural repertoire
• Mindfulness enables us to come into contact
with unwanted thoughts, without it affecting the
way in which we act
Thought suppression and
behavioural avoidance
Typical Mindfulness
exercises
Traditional MFN practices
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Breath
Body
Sounds
Yoga / Walking MFN
Eating
(generalisation is essential)
Breath
• “Sustained single focused attention”
…focus on your breath
…the mind will wander*
…when it does, note where its wandered
…try not to get caught up
…bring yourself back to your breath
* to memories, sounds, thoughts, feelings,
physical discomfort, urges, etc.
Body Scan
Awareness of current physical sensations
Moving attention
Noticing automatic responses
(run… distract… change)
Trying to do things differently:
willingly experiencing discomfort
noticing and still “going there”
Itch / Scratch
• Noticing and playing with urges
• Understanding the thought action link
Walking/Eating Mindfulness
• A bridge between mindful living and mindful
practise
• A great way to bring mindfulness into our
everyday lives
• The raisin task as popularised by Kabat-Zinn
Informal Practice
• Getting people to notice when their behavioural
repertoire narrows or starts moving in a nonvalued direction in the moment
• Check in / What’s coming up? /
What’s going on under the bonnet?
• Pacing, Exercise, Role-Plays
Case Vignette
Case Vignette
• Jack – a burly 15-year-old with severe, intractable back
pain
• Often either inactive and fearful of his pain or trying to
‘push through it’ (sadly, unsuccessfully)
• Had become more angry, family saw risk of lashing out.
Both he (and his family) avoiding risky social situations
Case Vignette
• Initially, he didn’t see the point of mindfulness
• Being in the group helped, he learnt by proxy. Started to
buy into the idea of “surfing” sensations
• With widened attention Jack discovered that ‘pain’ was
actually a bundle of sensations including fears,
frustrations and urges to move or avoid
Case Vignette
• Started being able to see his angry thoughts as ‘just
thoughts’ - surfing urges without doing anything
impulsive
• When asked about these situations at the end of the
programme, he laughed and said:
‘I know I can bring the puppy back!’
Research and Evidence
Mindfulness and anxiety
• Kabat-Zinn et al (1992) gave 22 patients with
Generalized Anxiety Disorder (GAD) 12 week
MBSR
– Found significant improvements in measures of
anxiety (and depression) at 3 month follow up
• Miller et al (1995) did a three year follow up
with the same patients
– Found that the gains had been maintained
Mindfulness and depression
• Teasdale et al (2000)
– Depressed patients either received MBCT or
Treatment as Usual (TAU)
– Results showed that those who received MBCT
were significantly less likely to relapse into
depression
Mindfulness and chronic pain
• Randolph et al (1999) gave 78 chronic pain
patients MBSR
• Patients showed improvements in;
– Ratings of pain
– Other medical symptoms
– General psychological symptoms
– Changes were maintained at follow up
Mindfulness and smoking
cessation
• Gifford et al (2004) gave ACT in 7
individual/group sessions vs. the standard
Nicotine Replacement Therapy
– Results showed that significantly more
participants had maintained their abstinence at 1
year follow up in the ACT group
Mindfulness and eating
• Tapper et al (2009)
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68 women
All trying to lose weight
Given either a mindfulness/control intervention
2 four hour workshops
– Results; women in the mindfulness condition lost
more weight and also reported exercising more at
6 month follow up
Mindfulness and phobia
• Hooper, Davies, Davies & McHugh (2011)
– Comparison of mindfulness vs. thought
suppression in the management of spider fear
– Participants underwent a 10 minute intervention
before completing a Behavioural Approach Test
(BAT)
– Participants also completed anxiety measures pre
and post BAT
Behavioural Approach Test (BAT)
1. Move 1 metre to the table
2. Move 1 more metre to the table
3. Approach the table
4. Touch the jar for more than 10 seconds
5. Lift up the jar
6. Open the jar
7. Touch the spider with a pencil for more than 10
seconds
8. Remove the spider from the jar
9. Touch it with a finger for more than 10 seconds
10.Put the spider on their hand
Results – BAT data
BAT Score
10
9
8
B
A
T
7
S
t
e
p
s
5
6
4
3
2
1
0
mindfulness
thought suppression
Groups
Results – STAI data
65
60
55
S
T 50
A
I
45
S
c
o
40
r
e
35
30
25
Mind 1
Sup 1
Mind 2
Sup 2
Mindfulness and care giving
• Singh et al (2003)
– Gave caregivers of adults with profound multiple
disabilities an 8 week mindfulness course
– Results showed that the patients of those
caregivers given mindfulness training became
significantly happier during interactions with
them
Mindfulness and aggression
• Heppner et al (2008)
– Gave half of the participants a mindfulness
intervention (5 minute raisin task) before
completing a social rejection task, known to
induce aggression
– Results showed that those given the intervention
displayed less aggression/hostility than their
control condition counterparts
Mindfulness meta analysis
• Baer (2003)
– Performed a meta-analysis on 21 adult mindfulness studies of
adequate quality
– Conditions included chronic pain, anxiety and depression
– Large mean effect size post treatment
(0.74, SD=0.39 [Cohen’s d])
medium effect size at follow-up
(0.59, SD=0.41)
– “…may bring participants with mild to moderate psychological
distress into or close to the normal range” (pp.137)
Mindfulness meta analysis
• Grossman et al (2004)
– Reviewed 64 studies
– Found consistent improvement and relatively strong
effect sizes across:
– Mental health (e.g. depression, anxiety, coping style)
physical well-being (e.g. medical symptoms,
sensory pain, physical impairment, and functional
estimates)
Summary
• Mindfulness seems to be making huge strides in terms of
research
• However, to avoid the current criticisms levelled at CBT
• A huge emphasis will have to be placed on the
processes at work in mindfulness
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Exposure
Willingness
Meta-cognition
Control of attention