Transcript Alistair Smith Presentation

Clinical uses of
Mindfulness Training
Alistair Smith, Clinical Psychologist
[email protected]
e-mail me if you want a detailed handout, with
references, about mindfulness training and some
related acceptance-based therapies
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What is mindfulness? 1.
Mindfulness means paying attention in a
particular way;
– on purpose,
– in the present moment,
– and nonjudgementally
Jon Kabat-Zinn
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What is mindfulness? 2.
Being mindful is not emptying the mind: it’s an investigation
into being human.
It is not thinking a certain way, or avoiding thinking a certain
way: it is being open to the whole of our experience right now
Training ourselves to be more mindful, we work a lot with the
body – the body is present even when the mind wanders!
The shift from doing to being is crucial: mindfulness requires
paying attention, yet equally needs compassionate acceptance.
The two work together to bring about change
Mindfulness is hard to describe. To understand the relevance,
we must experience as well as think about it
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Do we need special training, to be mindful?
 Mindfulness is quite everyday (so is mindlessness!)
 It takes practice to develop awareness of when & where our
attention goes. That practice itself brings about change.
 Mindfulness Training focuses on attention, acceptance, selfcompassion and the possibility of living mindfully and letting
this alter one’s life in profound (and unpredictable) ways
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Consequences of living unmindfully
“…over the past few years, Victoria, who is 52 this year,
has been through some of the most trying times of her
life … ‘I’m trying very hard to live in the moment,’ she
says. ‘Otherwise you’re not present in your own life. But
it took me about 40 years to cotton on to that. … In the
past I always worked so quickly, I wasn’t actually
experiencing anything.’
Interview with Victoria Wood, Good Housekeeping, March 2005
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Mindfulness-Based Stress Reduction
(MBSR)
 Designed for people with chronic pain or incurable illness
 Specific practices designed to anchor awareness in the
present: Mindful sitting; walking; stretching. Also, being
deliberately mindful during everyday activities
 A way to become alert to thoughts and feelings before they
drive our emotions or actions, and establish some detachment
from them. (Not censoring or repressing them)
 Delivered as 8 weekly sessions of 2½ hours (plus one all-day
session) with intensive daily home practice
 Teaches voluntary control of attention, as well as acceptance
of self and situation. (Not resignation: freedom from reacting
automatically)
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What is MBSR good for? 1.
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Lasting benefit for people with chronic physical pain.
Lasting improvement in Generalised Anxiety, panic
Stress reduction, e.g. in medical and nursing students; in prisons
Helps cancer patients cope with emotional distress; people with
MS; organ transplants, fibromyalgia, Parkinson’s disease; heart
attacks
Promotes healing in psoriasis
Useful with binge eating
Has been adapted to relationship enhancement for couples
Helps frail old people & carers cope with disability & loss of
function
Helped stroke survivors. Those practising mindfulness were less
depressed, less anxious, and experienced better quality of life
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What is MBSR good for? 2
Lazar et. al. scanned brains of people who practiced mindfulness
meditation 40 minutes per day and of controls with no
meditation experience. Even controlling for age and education,
some cortical areas were thicker in participants who meditated.
These included the right anterior insula, involved in monitoring
bodily functions, and parts of prefrontal cortex involved in
attention and sensory processing
Parts of the prefrontal cortex showed thinning in older controls
but not in older participants who meditated, suggesting
meditation may offer protection from age-related neuronal loss.
Lazar, Kerr, Wasserman and Gray (2005) NeuroReport, 16,
1893-1897
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It is remarkable how liberating it feels to be
able to see that your thoughts are just thoughts and
that they are not “you” or “reality” … recognizing
your thoughts as thoughts can free you from the
distorted reality they often create and allow for
more clear-sightedness and a greater sense of
manageability in your life
Kabat-Zinn, 1990, pp 69-70
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MBCT: mindfulness for depression
We all experience periods of lowered mood, but if we’ve never
been depressed may think “I’m having a bad day” or make
external attributions, e.g. “He’s really upsetting me”
 If we’ve often been depressed, low mood easily activates
negative self-evaluation & pessimistic rumination. If
accepted as factual, these intensify low mood & negative
thinking, leading to depression
 Teaching people to attend deliberately helps them shift to
information processing modes which promote effective
emotional processing. When we’re paying attention here and
now, our minds are not free to drift into unhelpful rumination
 For people who’d been depressed several times, MBCT
reduced relapse rates by about half, in several careful studies
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MBCT and other disorders
 Avoidance of aversive experience versus acceptance
 Mindfulness-based interventions have been designed
and are being tested, for various anxiety disorders
 MBCT is being adapted for many clinical problems.
These include: psychosis; eating disorders;
‘borderline personality disorder’; chronic fatigue;
OCD; health anxiety; and stroke. Client groups range
from childhood to old age
 For each specific condition, different mindfulnesscompatible aspects of cognitive theory and therapy
are introduced.
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Mindfulness and individual therapy. 1
Attention, acceptance and compassion resemble Rogers’
non-specific therapeutic factors (empathy, warmth and
unconditional regard), factors common to effective therapies
Practising mindfulness can be therapist training, whether or
not it is focused on the conduct of therapy
It can help us to: listen; separate our own reactions from
therapeutic response to clients; develop detachment from our
own thinking so that can better develop an ‘internal
supervisor’. We can model ‘spacious mind’ for our client
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Mindfulness and individual therapy. 2
Mindfulness can be taught to individual clients as a
more or less important aspect of their therapy.
Although some practices may be taught as in group
mindfulness training, there can be more flexibility also more demand for the therapist to be creative
(We must help clients not to misuse mindfulness
practice as another form of avoidance).
Germer, Siegel & Fulton (2005) write helpfully about
teaching depressed clients to ‘turn towards life’ and
anxious ones to ‘befriend fear’ through mindfulness.
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Risks of mindfulness training
 Any approach that is powerfully beneficial may
have potential for harm, so we must be careful
 In MBCT research some people were not helped
– notably when their depression was triggered
by major recent life events. Accommodating to
major losses involves several psychological
tasks. People with a recent diagnosis of cancer,
or recently informed of a poor prognosis, may
need time to process this before engaging with
an approach which could confront them with
stark facts before they are ready
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How to explain all this to clients?
Discuss what they have tried already and whether it is has been
enough (presumably not, or they would not have come to you –
but do they really see that yet?)
Invite them to consider how much of the time, when they are
troubled, their mind is in the future or the past (e.g. worrying,
planning, regretting)
Would it help to be better at spotting when the mind is down
some dead end yet again, and to have strategies for staying
more in touch with what is real right now?
Investigate with them whether they are particularly self-critical
when distress is worst; (if so, does that help?)
Do they think that learning to be mindful in an accepting
way may promote a bit more self-compassion – and would
that be desirable?
Does the client think tackling this in a group setting might help?
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