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Mindfulness 2015 LME and SD

An introduction to the theory and application of mindfulness with adults
by

Lisa-Marie Emerson

on 26 June 2016

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Transcript of Mindfulness 2015 LME and SD

Lisa-Marie Emerson and Sara Dennis
Mindfulness
How can it help?
When might mindfulness be helpful?
paying attention in a particular way;
on purpose,
in the present moment,
and non judgmentally.

What is mindfulness?
Defining mindfulness
Mindful eating
Buddhist origin
5 Facets definition
Attention and acceptance
A mindful stance
Observe - "I intentionally stay aware of my feelings"
Describe - "My natural tendency is to put my feelings into words"
Act with awareness - "I find myself doing things without paying attention" (reversed)
Nonjudgment - "I tell myself I shouldn't be feeling the way I'm feeling" (reversed)
Nonreactivity - "I watch my feelings without getting lost in them"
Baer et al. (2006)
Attention:
Acceptance:
Self-regulation of attention so that it is maintained on immediate experience
orientation toward one’s experiences in the present moment, characterized by curiosity and openness
Learning outcomes
To be open to experiences of mindfulness and contribute reflections
To describe mindfulness
To outline the context in which mindfulness may be helpful
To outline specific applications of mindfulness
Therapeutic approaches
Mindfulness-based stress reduction
Mindfulness-based cognitive therapy
8-week intensive training course, drawing together mindfulness meditation and yoga
"Although at this time mindfulness meditation is most commonly taught and practiced within the context of Buddhism, its essence is universal. … Yet it is no accident that mindfulness comes out of Buddhism, which has as its overriding concerns the relief of suffering and the dispelling of illusions."
(p. 12-13; Kabat-Zinn, 2005)
Dialectical Behaviour Therapy
Acceptance and Commitment Therapy
Compassion Focused Therapy
Developed specifically for people with borderline personality disorder
Brings together cognitive change techniques and acceptance techniques
Key tenets include observation, mindfulness and non-judgement
Thoughts
Consider in formulation
Evidence base
Books
Further sources of information
Websites and apps
Training
CDs
Slow down automatic behaviour / habit
Respond more effectively
Task - what type of problem?
MBCT includes cognitive-therapy based exercises
Experiential learning programs including formal and informal mindfulness practices
Development of focusing, sustaining and switching attention, and accepting present moment experience
Clinical studies of MBSR with adults show efficacy in coping with chronic pain, stress, anxiety, psoriasis, eating disorders, fybromyalgia, substance abuse and cancer.
Main evidence base for MBCT is relapse prevention in recurring depression (NICE guidelines).
MBCT also adapted for effective use with GAD, currently depressed and suicidal behaviour
Effect sizes of MBSR and MBCT on physical and psychological outcomes range from .50-.59
Mindfulness as a nonmeditative component
Left-hand side of 'hexaflex'
Aims to tackle shame and self-criticism, as transdiagnostic problems
Gilbert, P. (2009). Introducing compassion-focused therapy.
Advances in Psychiatric Treatment, 15, 119-208.
Further reading
Gilbert, P. The Compassionate Mind. Constable: London.
Harris, R. (2009). ACT made simple. New Harbinger
Publications: Oakland.
Further reading
Based on ideas of:
cognitive fusion
experiential avoidance
Hayes, S. C. (2004). Acceptance and Commitment Therapy,
Relational Frame Theory, and the third wave of behavior
therapy. Behavior Therapy, 35, 639-665.
Based on ideas of 'threat' affect regulation system dominates inner and outer worlds
difficulty feeling safe in themselves and in relationships
Utilises mindfulness to develop self-compassion
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guildford Press.
Further reading
Kabat-Zinn, J. (1990). Full Catastrophe Living. Delta: New York.
Further reading
Mindfulness with Jon Kabat-Zinn 1 hour video on youtube
www.getsomeheadspace.com
Headspace app - ten minutes for ten days
Kabat-Zinn, J. (2004). Wherever you go, there you are. Piatkus: London
Lejeune, C. (2007). The worry trap. New Harbinger Publications: Oakland.
Available from Centre for Mindfulness Research and Practice, Bangor University
And www.oxfordmindfulness.org
http://www.bangor.ac.uk/mindfulness/
Offer 8-week courses based on MBCT; professional workshops and teacher training routes
http://breathworks-mindfulness.org.uk/
Offer 8-week MBSR courses in Sheffield, Leeds and Manchester
Friendly wishes
Mindfulness-based therapies using mindfulness meditation as main component of therapy - MBCT, MBSR

Mindfulness integrated as functional skill component in therapy - ACT, DBT.
Segal, Z.V., Williams, J.M.G., Teasdale, J.D. (2002). Mindfulness-based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. Guilford: New York.
Baer, R. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10, 125–143.
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004).Mindfulness-based stress reduction and health benefits: A metaanalysis. Journal of Psychosomatic Research, 57, 35–43.
Baer, R. A. (2006). Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. Burlington: Academic Press.
Linehan et al. (2010). Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug-Dependence. The American Journal on Addictions, 8, 279-292.
A diminished awareness of present moment can create problems with automatic actions and behaviour
A struggle with present moment experiences - experiential avoidance
Consider mechanisms
Read and consider the vignette
Consider how you may begin to think about this case
Consider where mindfulness may have a role
Robust effect sizes for effects of mindfulness on anxiety and depression
(Hoffman, Sawyer, Witt & Oh, 2010)
Trials of MBCT for depression
(Teasdale et al., 2000; Ma & Teasdale, 2000)
Likelihood of depressive relapse halved
Measures of mindfulness – KIMS, FFMQ, MAAS
Changes in cognitive skills – selective, executive and sustained attention abilities, working memory capacity
(Chiesa, Calati, & Serretti, 2010)
MBCT / MBSR 8 week course
Key concepts
Auto-pilot contrasts with mindfulness
Being versus doing
The wandering mind
Thoughts as thoughts...
Turning toward difficulty
Pleasure and mastery
...compassion linking in with these last two concepts
Key practices
Eating
Bodyscan
Breathing
Movement
Sounds
Approaching difficulty
Kindness
MiDL
Guidelines for practice
In clinical practice
In vivo experience
Noticing the way in which the body responds to distress
Checking in with thoughts in the moment.
A teacher of mindfulness should have:
Mindfulness based Teacher Training

A recognised mental health qualification relevant to the populations with whom they work.

Ongoing good personal mindfulness practice:
Daily formal and informal practice
Annual retreats
Opportunities to reflect on and inquire about personal practice.

Regular PPD -
CPD teacher training events
Supervision
Do No Harm
Considerations
Current mood:
Capacity for engagement
concentration
Life stage:
Students - age of onset for major psychiatric disorder
Career burnout
transitions
Emotional/physical pain:
Shifts in experience
Possible contra-indications:
Psychosis
Severe psychological problems (unspecified)
Manocha 2000
Germer 2005
"People who de-compensate when cognitive controls are loosened should generally not do formal sitting meditation"
"Ego strength and emotional resilience is important"
People with 'fragile personalities' may benefit - but the practices should be shorter.
Didonna and Gonzalez 2009:
'People with pathological feelings of emptiness' (e.g. eating disorders, PTSD, schizophrenia) can experience intense reactions:
Panic
Dissociation
Need to escape
Chadwick 2010:
Teacher competence in managing difficulty
Short term negative experiences can be a transient part of the process. The skill of the instructor in managing this can determine whether it is experienced as an adverse event or an opportunity for learning and growth.
When being mindful one is less likely to avoid unpleasant emotions. A period of integration and adjustment to this experience may be needed before a person can e comfortable in 'staying with' whatever arises.
Mindfulness can lead into deep exploration of inner space. developing tolerance and compassion for the unpleasant and the difficult can be challenging.
Assessment for mindfulness
Capacity to contain affect
Ability to listen and respond in the present
Able to access and use the home practice materials - C.D
Able to remain in the session
Able to engage with yoga or mindful movement
Able to organise thoughts, and plan for the time commitment, practice time at home etc.


Crane et al 2010
Williams, M., & Penman, D. (2011). Mindfulness: A practical guide to finding peace in a frantic world. London: Piatkus.
positive initial outcomes in a pilot study with 10 people with psychosis
Three emotion systems
Threat
Drive
Soothing
Shifting from avoidance to curiosity
Full transcript