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Josephine George

on 8 October 2016

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Transcript of Mindfulness

What is it?
Why is it beneficial?
How do you do it?
When can it be used?
• Chronic pain and stress related conditions
• Acceptance based
• Formal meditation practices of up to 45 minutes
• 8 week intensive training in mindfulness meditation
• Classes 2.5-3 hours, plus homework minimum 45mins per day, 6 days per week.
• Class of up to 30 people
• Incorporates information about stress including physiology, perceptions and response
• Exercises include raisin eating, body scan, sitting meditation, hatha yoga, walking meditation, incorporation of poetry, and an all-day meditation session

• Emphasizes balance and synthesis between opposing ideas, particularly between acceptance and change – teaches behaviour changing strategies
• Combination of group sessions in which skills/strategies are taught and individual therapy sessions to facilitate skills application to daily life
• A large selection of short informal exercises, typically across a year of therapy/training
• 4 modules of skills training: core mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance
• Goal to develop ability to control attention. Inability to do so results in fixation on particular things and lack of concentration
• Teaches there is a logical mind, emotional mind, and a wise mind which combines the two
• ‘’What’ skills’ – Observing (internal/external experiences non-judgmentally), Describing (call a thought a thought/ a feeling a feeling – to remove some of its power), and Participation (being wholly involved in an activity and signing up to other activities in which to practice this)
• ‘’How’ skills’ – Nonjudgmentally, One-mindfully (focusing undivided attention on one thing at a time), and Effectively (doing what works regardless of opinions or feelings towards it)

• Significant reductions in clinician ratings of severity of GAD and in self-report measures of anxiety, worry, and depressive symptoms
• Significant increase in self-reported quality of life
• Significant reduction in proposed mechanisms for experiential avoidance
• All of the above maintained 3 months after treatment
• Significantly better outcomes in all of the above measures in comparison to a control group

A programme run in the workplace resulted in improved job performance, reduced absenteeism, significant improvement in general mental health, depression, and innovation potential

Service Users:
The evidence base supports use of MBI with the majority of difficulties service users (SU) experience: chronic mental health conditions, chronic pain, fatigue, and anxiety. There is also evidence of improvements in learning capacity and executive function, which is potentially beneficial for service users with brain injuries and those with learning disabilities

Treatment planning criteria:
There is evidence that MBI directly improves a range of areas of the service's treatment planning criteria (concentration, attention, memory, physical demands of work (sitting/standing/stamina/fatigue), social and behavioural aspects, and accuracy (EF))
The reduction in symptoms impairing function (e.g. pain, anxiety, psychosis) produce secondary vocational benefits including: improved attendance, a boom and bust avoidance strategy to improve consistency of performance, and reduction in risky behaviours such as substance abuse. All of which are barriers to gaining and keeping work roles.

Occupation and Vocation:
All benefits result in improved function, which is an enabling factor for SUs to participate in the occupations involved in work-like roles. Furthermore, there is also evidence of workplace specific benefits associated with employer expectations and values, thus improving employability.
Mindfulness concerns awareness. It is the intentional direction of attention to present experiences, with an approach has been described as non-judgemental, accepting, curious, interested, open-hearted and compassionate.

It contrasts to states of automatic behaviour and preoccupation (with memories, plans, worries and wishes).

Below are the Mindfulness Based Interventions (MBI) offered in mental health and medical settings
-Baer & Krietemeyer, 2006
Take in a scene as if to draw it - notice the light and shadow, textures, colours, movement, etc. Label these while noticing them. Notice internal reaction to the scene, and label aspects of this too
Walking meditation: walk and as you do so notice the components of the internal experience, e.g. the shift of weight from one foot to the other, the swing of your legs, the changes in balance, etc. (MBSR)
Three minute breathing space: (MBCT)
Body scan: sit comfortably with eyes closed. Focus attention sequentially on the different areas of the body, starting with the toes of one foot. Notice the sensations present without judgement or trying to change them - just with openness and curiosity. Carefully observe the qualities of any aches or pains, and simply notice the lack of sensation in areas this occurs
Apply mindful focus when having a stretch at the desk or using brain gym techniques such as these:
Apply mindful focus to the sound around you: count or label the sounds of your own inhaling and exhaling, what other background sounds can you hear? - the hum of the computer, the churn of the printer, the sound of a fan, other peoples footsteps, clicking and typing, the wind outside, traffic in the distance, birds cheeping... notice and label each level of sound.
Listen to a piece of music, note the layers of instruments, the parts of the harmonies, your own internal reaction to it - in thoughts and emotion, and any bodily reactions to the rhythm, etc.
Youtube, Apps, and Websites all host voice guided meditations, e.g. www.smilingmind.com.au (also available as a free app) which hosts guided meditations tailored to age
Youtube also has lots of 'sounds of nature' videos which can be listened to with mindful focus
Practice using labeling to separate self from thoughts:
"I am having a thought that..." (ACT)
All can be used subtly in a working environment and relate to different sensory preferences

Stimuli can be graded - this video is more stimulating and engaging, therefore it is less challenging to maintain focus.
Advising SUs about when it is appropriate and beneficial to practice mindfulness...
Before interviews
When having to concentrate for a long period of time
As a pacing break activity
During episodes of increased symptoms (e.g. pain, fatigue, psychosis)
During periods of increased productive demands
As part of daily routine: e.g. set an alarm on phone to schedule it regularly, or bring mindful focus to one component of morning or evening routine - this will increase benefits over time and increase process familiarity
Track fatigue/anxiety levels to notice increases and use this as an indicator to practice mindfulness
Mindfulness Based Stress Reduction (MBSR)
Dialectical Behaviour Therapy (DBT)
Mindfulness Based Cognitive Therapy (MBCT)
• Prevention of relapse of major depressive episodes for those currently in remission
• Acceptance based
• Formal meditation practices of up to 45 minutes
• 8 week group of up to 12 people
• One 2 hour session per week plus homework
• Includes MBSR methods (excluding all-day meditation session) plus others, including Three Minute Breathing Space exercise, and deliberating bringing to mind difficulties in sitting meditation
• Integrates exercises based on elements of CBT which explore the relationship between thoughts and feelings and encourages seeing thoughts as ‘mental events’ rather than representing truth.
• Supports an understanding of the link between wellbeing and activity in relation to depression relapse, individuals create their own lists of pleasure and mastery activities to draw on when motivation begins to dip
• Individuals create relapse prevention action plans which involve awareness of their relapse warning signs and what to do when they have noticed them

Acceptance & Commitment Therapy (ACT)
• Applicable to a wide range of problems and disorders to facilitate progress towards a life that is meaningful to the individual
• Incorporates both behaviour change processes and mindfulness and acceptance processes
• Central concept is to veer away from experiential avoidance (avoiding negative experiences by engaging in behaviours such as substance abuse, dissociation and avoidance of people/places/situations) which research suggests actually increases negative experiences
• Encourages abandonment of attempting to control experiences
• Promotes exposure to avoided experiences and focusing on the component parts of these (e.g. exposure to anxiety and noticing the rapid heart rate)
• Cognitive diffusion – observe thoughts without assuming they are true or important, letting them come and go without analyse, dispute, or attempting to change their content – in order to reduce behavioural impact
• Self as context: “I am having the thought that” – facilitate recognition that the self is separate from the thought to prevent fusion with the thought (‘I am not a “failure”, but rather a person who sometimes has thoughts about failure.’
• Values and committed action: looking at values and goals in life and the behaviour changes necessary to achieve them.

• Hospitalized patients with psychotic symptoms and comorbid conditions under ‘enhanced treatment as usual plans’ (ETAU), randomly assigned half with ACT sessions on top of ETAU
• Those in the ACT and ETAU group had greater improvements in clinician-rated mood symptoms, self-reported distress about hallucinations, and impairment in social functioning, and clinically significant symptom change in overall psychiatric symptoms at discharge compared to those in the ETAU only group.
• Those in the ACT and ETAU group also had decreased believability in the hallucinations over time, which those in the control group did not
• After 4 months there was reduced rehospitalisation in the ACT and ETAU group compared to the ETAU only group

Chronic Mental Health
Generalised Anxiety Disorder (GAD)
Significant increase in attention and attentional control
Decrease in negative affect and fatigue
Improvement in academic performance (cognitive improvements)
Improvement in social behaviour
Increased self control
Improved self regulation
Evidence of prevention of risky behaviours
Improved physiological response to stress

• 3-4 weeks residential treatment program for 108 patients with complex prolonged chronic pain and previous history of unsuccessful treatment
• Findings: statistically and clinically significant improvements for a range of outcome measures, including pain, depression, pain-related anxiety, ‘disability’, ability to sit, stand, and walk, number of medical visits, time spent resting due to pain, use of pain medication, acceptance of pain.
• Majority of these improvements maintained after 3 months
• Biggest impact was on functioning rather than pain; improved functioning attributed to increased acceptance of pain.

Chronic Pain
Executive Function (EF)
In the Workplace
Leaves on a Stream: imagine a stream with leaves floating on it. Keep picturing this stream and every time you experience a thought , place that thought on one of the leaves and watch it float away from you (ACT)
Soldiers in the parade: imagine a parade of soldiers carrying signs, every time you experience a thought, put it on one of the signs and watch the soldiers march it away. - This visualisation is designed to encourage productive behaviour, e.g. the thought may be 'This is going to be a disaster', the soldiers are holding this sign but they are marching on anyway (ACT)
Visualisations and videos of relaxing scenes of nature can be found on youtube to aid this practice.
Terje Sergjerd, 2011. Tentipi presents - El Teide Spain Time Lapse [video, online]. Available from: youtube [Accessed 4th June 2014]
Baer, R. and Krietemeyer, J., 2006. Overview of Mindfulness and Acceptance Based Treatment Approaches. In: Baer, R. ed. Mindfulness-Based Treatment Approaches: A Clinician's Guide to Evidence Based and Approaches. San Diego: Elsevier, Pages 3-27
Gaudiano, B. and Hervert, J., 2006. Acceptance and Commitment Therapy for Psychiatric Inpatients and Psychotic Symptoms. In: Baer, R. ed. Mindfulness-Based Treatment Approaches: A Clinician's Guide to Evidence Based and Approaches. San Diego: Elsevier, Pages 104-105
Roemer, L., Salters-Pedneaut, K. and Orsillo, S., 2006. Incorporating Mindfulness-and-Acceptance-Based Strategies in the Treatment of Generalised Anxiety Disorder. In: Baer, R. ed. Mindfulness-Based Treatment Approaches: A Clinician's Guide to Evidence Based and Approaches. San Diego: Elsevier, Pages 51-74
McCracken, L., Vowles, K. and Eccleston, C., 2004. Acceptance-Based Treatment for Personswith Complex, Long Standing Chronic Pain: A Preliminary Analysis of Treatment Outcome in Comparison to Waiting Phase. In: Baer, R. ed. Mindfulness-Based Treatment Approaches: A Clinician's Guide to Evidence Based and Approaches. San Diego: Elsevier, Page 303
Flaxman, P. and Bond, F., 2006. Acceptance and Commitment Therapy in the Workplace. In: Baer, R. ed. Mindfulness-Based Treatment Approaches: A Clinician's Guide to Evidence Based and Approaches. San Diego: Elsevier, Pages 377-402
Tang, Y., Yang, L., Leve, L. and Harold, G., 2012. Improving Executive Function and its Neurobiological Mechanisms Through Mindfulness-Based Intervention: Advances within the Field of Developmental Neuroscience. Child Development Perspectives [online], 6 (4), 361-366
Roemer, Salters & Orsillo, 2006
Gaudiano & Herbert, 2006
McCracken, Vowles & Eccleston, 2004
Flaxman & Bond, 2006
Tang, Yang, Leve & Harold, 2012
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