Becoming more mindful: Can
you benefit?
Richard E. Berger, MD
University of Washington
…receiving a cancer
diagnosis is like a soldier
being dropped into a jungle
war zone without a map,
compass or training.
Michael Lerner-Commonweal
Cancer Self Help Program
How do you make sound decisions
and live fully, when you are up to
your ass in alligators?
QuickTime™ and a
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Mindfulness is a mental state,
characterized by concentrated
awareness of one's thoughts,
feelings and actions.
Paying attention, on purpose, in
the present moment, non-judgmentally
Mindfulness promotes the
replacement of reactivity with
considered conscious decisions.
Development generally requires
practice.
Benefits mindfulness
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Live life more fully in present moment
Practice kindness toward yourself
Less suffering from pain
Appreciate what is right with you
Mobilize inner and outer resources
Take control of life and attention
Mindfulness Effects on Cancer
Patients
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Improved mood
Decreased stress
Decreased anxiety
Improved adjustment to diagnosis
Metanalysis of 6 studies by Mitchim et al, ONCOLOGY NURSING FORUM - VOL 34, NO 5, 2007
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Mindfulness Effects on Cancer
Patients
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Improved quality of life
Improved feeling of control
Improved sleep
Less suffering from pain
Metanalysis of 6 studies by Mitchim et al, ONCOLOGY NURSING FORUM - VOL 34, NO 5, 2007
Effects Mindful Practices
weight
blood sugar
bp
Improved lipid profile
cortisone
inflammation
Improved well-being,
alertness
• pain with stress
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 brain size, grey matter
 quality of life
 concentration
 learning
 sleep quality
 body awareness
depression
Changes DNA activation
NIH conference 2009 Mind/Body Med.
Mindfulness Increases
Survival
• Hypertension
• Cardiac Disease
• Cancer??
– Decrease PSA rise. J Urol. 2001 Dec;166(6):2202-7
"Moral excellence comes about
as a result of habit. We become
just by doing just acts, temperate
by doing temperate acts, brave by
doing brave acts."
-Aristotle
What is cost of becoming
more mindful?
A. Nausea?
B. Your hair falls out?
C. 6 weeks painful recovery?
D. 30-60 minutes/day of sitting quietly,
alertly and non-doing?
PRACTICE
PRACTICE
PRACTICE
But the practice is
the goal!
Things for Pretty Sure
• If you don’t practice something, you
won’t get much better at it.
• You are always practicing something.
(Habits)
• You can choose what you practice.
A Native American elder once described his own inner
struggles in this manner: “Inside of me there are two dogs.
One of the dogs is mean and evil. The other dog is good.
The mean dog fights the good dog all the time”.
When asked which dog wins, he reflected…
“The one I feed the most”.
George Bernard Shaw
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Start Easy
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Mindfulness Practice
Real life problems
MEDITATION IS…
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THE PUPOSEFUL PRACTICE OF MINDFULNESS
AWARENESSING
PRACTICING CALM ALERTNESS
PRACTICING EXPERIENCING “WHAT IS”
GETTING FAMILIAR WITH YOURSELF
What do you practice in
mindfulness?
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Quieting your mind
Recognizing discursive thoughts
Letting go of discursive thoughts
Recognizing urges
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What do you practice in
mindfulness?
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Letting go of urges
Recognizing emotions
Letting go of emotions
Creating space around mental
events
RAIN
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R-Recognize
A-Allow
I-Investigate
N-Not me or Let
go or Let be
Mindfulness and View
Sensory Perceptions
Thoughts , concepts
Thoughts, concepts
Mindful view of Thoughts,
Emotions, Sensations
Confusion Thoughts
With Reality
Experience of World
Experience of World
PINBALL WIZARD THINKING
“That deaf, dumb,
and blind boy, sure
plays a mean
pinball.”
The Who
You Are Not Your Thoughts
Mindfulness Based Stress
Reduction: MBSR
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MEDITATION
BODY AWARENESS PRACTICE
YOGA
8 weeks, 2-3 hours/week
Daily practice-45 min.
MEDITATION IS NOT…
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SPACING OUT
ANALYZING
TRYING NOT TO THINK
THINKING HAPPY THOUGHTS
VISUALIZATION
DISTRACTION
AVOIDANCE
POSITIVE THINKING
PRAYER?
Mindfulness v Phys. Exercise
• Need faith to start
• Need 6-8 weeks
to see results
• Hardest in the
beginning
• Gets more
enjoyable with
time
• Takes 2 weeks to
establish habit
• Lifelong benefits
Application Mindfulness
RAIN
Event
Emotion
RAIN
RAIN
Pre-response
Thoughts
Past associations
RAIN
Response
Neuron
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Neuroplasticity
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Meditation Brain Studies
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Mindful Meditation
Orientation/Association
Area of Parietal Lobe
Attention/Association
Area
of Frontal Lobe
Th
amygdala/hyppocampu A
mb
H
semotional significance
and LT memory
Activation sympathetic/
Parasympathetic n.s.
Increased activity
Decreased activity
CVS, Immune
effects
H
H
Right v Left Brain
Labeling
Analytic thought
Logic
Language
Conceptual thought
Discursive thought
Experiencing
Holistic thought
Creativity
Art/Music
Intuition
Increasing Awareness
Gradual
acceptance
of holistic,
nonreductionist
experience
Holistic experience
of analysis,
conceptual though
and
discursive thought
=awareness
We are Human Beings
Analyzing &
Ruminating
About Past
The Present
Fantasizing,
Ruminating, Planning
About Future
What lies behind us and what lies before us are tiny matters
compared to what lies within us.
Oliver Wendell Holmes
GOALS
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Better decision making
Increased quality of life
Increased enjoyment of life as it is
Being present
How do you know that you are
doing it right?
If you try, you are doing it right!
Do only as much as maintains
your enthusiasm!
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What is Measures of
Success?
• KINDNESS to yourself & others
• Less reactive decisions
Cancer and Mindfulness
As long as you are breathing,
there is a lot more right with you
than is wrong with you.
Practice Being Aware of What is Right
With you!
Laboratory
Your Mind and Life
Practice Living Every Moment
We All Have an Illness Story
Be mindful of your story
Views of Illness
Restorative
Chaos
Quest
Restorative Narrative
I’ll be healthy again
Our institutionalized narrative
For every suffering there is an outside
remedy given by some authority
Isolating, authority gives patients story
Evades question of mortality and
medical failure
No personal story to fall back on
Arthur Frank
Chaos Narrative
Life never gets better, no sequence of
causality
Vulnerability, futility and impotence.
There is no plot to story, no voice, no
one is in control
Isolating and no motivation
Too easy to dx depression
Arthur Frank
Quest (Mindful) Narrative
Accept illness and attempt to use it
Awareness of illness and life in the
present
Illness as personal but shared journey
Teller tells own story
Personal perseverance and purpose.
Relationship to others- Empathetic
Arthur Frank
Resources
• Selected Readings on Mindfulness
• 8 Minute Meditation: Quiet Your Mind. Change Your Life.
by Victor N. Davich
• Turning the Mind Into an Ally by Sakyong Mipham and
Pema Chodron
• Silence: How to Find Inner Peace in a Busy World by
Christina Feldman
• Full Catastrophe Living: Using the Wisdom of Your Body
and Mind to Face Stress, Pain, and Illness by Jon KabatZinn
• Wherever You Go, There You Are by Jon Kabat-Zinn
• Coming to Our Senses: Healing Ourselves and the World
Through Mindfulness by Jon Kabat-Zinn
• The Miracle of Mindfulness by Thich Nhat Hahn
Web Resources
• www.mindandlife.org
• http://www.dharma.org/ims/ss_meditation_resourc
es.html
• http://www.umassmed.edu/cfm/home/index.aspx
• http://amberstar.libsyn.com/index.php?post_categ
ory=Introduction%20to%20Meditation
Resources
Mindfulness Based Stress Reduction courses.
• John Wendt MD and Sherry Williams
http://paccentermind.org
• Carol Jakus, MA, MSW, LICSW-Seattle Washington,
cjakus@mindfullivingnw.com
• Carol McManus, PT, MS, MA,
http://www.carolynmcmanus.com/pages/workshops.html