1. Introduction to Mindfulness

2. Alexandra Arbogast, LICSW, RYT, CMT
Presenter
Alexandra Arbogast, LICSW, RYT, CMT
Program Coordinator & Therapist
Mind-Body Medicine Program
Internal Medicine / Warrior Clinic / NICoE
WRNMMC /

3. The Mind-Body Medicine Program at Walter Reed - Bethesda
Based on the premise that the mind and body are intimately interconnected. Utilizes techniques to optimize this relationship for improved health and wellbeing.
Teach mindfulness-based skills that can be integrated into daily life to reduce stress, manage pain, enhance sleep, strengthen positive qualities, and improve overall quality of life.
Offers a low-cost, self-directed, complement to traditional medical care.
Mindfulness-based skills
Improved self-management
Tap into self-healing potential
Complement to other care

4. Mind-Body Skills Mindfulness Relaxation Yoga Positive Psychology
Attention training to cultivate qualities of concentration, clarity, and equanimity. The common thread connecting all other skills.
Relaxation
Techniques to elicit the relaxation response in mind and body
Yoga
Movement and breathing strategies to synchronize mind and body and release tension.
Positive Psychology
Practices to cultivate and strengthen positive mind/emotional states.
Resiliency Training
Techniques for balancing the nervous system, processing trauma, and strengthening the ‘resilient zone’.
Mindfulness is common thread throughout

5. Mindfulness

6. It’s Hot! 30 million Americans have tried it or practice regularly
In the past year alone, it has been the cover story of Time and Scientific American and there was just a 60-minutes special on it
Oprah, NFL players, and even the US Marines are doing it
It is being integrated into schools, prisons and practiced by politicians.

7. Founder of Mindfulness-Based Stress Reduction (MBSR)
What is it?
“Mindfulness means paying attention in a particular way; On purpose, in the present moment, and nonjudgmentally.”
-Jon Kabat-Zinn
Founder of Mindfulness-Based Stress Reduction (MBSR)
One definition
JKZ-Pioneer of mindfulness in the West. Founder of Mindfulness Based Stress Reduction. Touch on more later
2 Main components:
Present moment awareness
Attitude of non-judgmental curiosity

8. Regular Practice Cultivates 3 Core Skills
Concentration: The ability to focus and stabilize one’s attention.
Sensory Clarity: The ability to keep track of the components of sensory experience as they arise in various combinations, moment-by-moment.
Equanimity: The ability to ‘be with’ experience with an attitude of gentle matter-of-factness.
According to Shinzen Young, another pioneering mindfulness teacher in the West, mindfulness practice cultivates 3 core skills

9. Mindfulness Training Techniques
Many techniques! Depends on teacher and tradition
Restrictive or open attention
Noting option
Beginner practices:
Restrictive focus, such as breath meditation
Develops/strengthens core skills of concentration, clarity and equanimity
Intermediate / advanced practices:
Open awareness to increasing amount of sensory experience, such as “choiceless awareness”
Formal and informal practices
Noting – for example, observe a thought, note “thinking” or more specifically “judging” or “planning”. Many ways to note as well.

11. Where Does It Come From?
In the 19th century, mindfulness was used to translate the Pali word Sati. Pali is the canonical language of Theravada, a form of Buddhism found in Southeast Asia.
“Establishing Mindfulness” (Satipatthana) is a primary practice of Theravada Buddhism.
It is said to lead to insight into the true nature of self and reality (impermanence, the suffering of conditioned existence, and non-self)
This is not to say that mindfulness was only practiced in Buddhism. There are versions of mindfulness and meditation in many of the worlds traditions.

12. Mindfulness Arrives in the West
In the 60’s and 70’s, Westerners began going to Southeast Asia to learn mindfulness practices. They brought those practices back to the West and began to teach them within the framework of Buddhism.
In the 80’s and 90’s, it was discovered that those practices could be extracted from Buddhism and the cultural matrix of Asia and used within a secular context.
Jack Kornfield, Sharon Salzberg, Joseph Goldstein

13. Secular Mindfulness
Mindfulness awareness practices started to be used within a secular context to develop useful attentional skills.
These practices became ever more prevalent in clinical settings for pain management, addiction recovery, stress reduction, and as an adjunct to psychotherapy.
Useful attentional skills
More prevalent in clinical settings

14. Mindfulness in Healthcare
In 1979, Jon Kabat-Zinn created Mindfulness-Based Stress Reduction (MBSR) at the University of Massachusetts Medical School to treat chronically ill patients.
Subsequently, a number of other psychotherapeutic modalities centering around mindfulness were developed: Acceptance and Commitment Therapy (ACT); Mindfulness- Based Cognitive Therapy (MBCT); Dialectical Behavioral Therapy (DBT).
JKZ – PhD in Molecular Biology from MIT. Thinks of himself as Scientist vs Buddhist
DBT – Borderline Personality Disorder
MBCT - depression

15. Mindfulness in Society
Increasingly, it is being understood that mindful awareness is a cultivatable skill with broad applications through all aspects of society, including education, prison system, politics, business, and even the training of soldiers.
Tim Ryan
-Congressman from Ohio
-Promoting meditation on Capitol Hill
-Secured federal funding for a pilot meditation program at schools in his district
-Wrote a book, “A Mindful Nation: How a Simple Practice Can Help Us Reduce Stress, Improve Performance, and Recapture the America Spirit.” On how he sees mindfulness as a cure to the stress of modern life, and something that can help heal Congress and the world.
-“If this can help me, a half-Irish, half-Italian quarterback from Northeast Ohio, it’s for everybody,”
Schools
school year
The Mindful Schools Program partnered with the UC-Davis
Conducted largest randomized-controlled study to date on mindfulness and children
937 children, 47 teachers in 3 Oakland public elementary schools.
The Mindful Schools curriculum produced statistically significant improvements in behavior versus the control group with just 4 hours of mindfulness instruction for the students.
Found increases in paying attention, calming/self-control, self-care/participation, and showing care for others

16. The Benefits of Mindfulness
One of the main reasons mindfulness is entering the mainstream more and more is because of all the research coming out on the benefits.

17. Changes the Brain in Positive Ways
Mindfulness…
Changes the Brain in Positive Ways

18. Shows how the brain changes in positive ways with meditation!
Parts of brain related to attention, sensory processing, emotion and stress regulation, and empathy/compassion, are strengthened!
For example, research from Dr. Richard Davidson’s lab at the University of Wisconsin-Madison has shown that meditators are better able to monitor emotions and thoughts and let go of those that might cause distress.
At the University of North Carolina, psychologists studying mindfulness found mindfulness-trained participants showed significant improvement in their critical cognitive skills and performed significantly higher in cognitive tests than a control group, after only 4 days of training for only 20 minutes per day.
Shows how the brain changes in positive ways with meditation!

19. Overcoming Fear and Anger
Old Brain Vs. New Brain
Newest part of brain evolutionarily – prefrontal cortex and specifically anterior cingulate – responsible for higher thinking and processing faculties such as intuition, empathy, and social awareness – get strengthened through meditative practices
Oldest part of brain – hindbrain, more primitive, survival brain, governs instinctual behavioral reflexes driven by fear and anger – gets suppressed and controlled through meditative practices
So meditative practices strengthen higher functioning parts of brain and subdue more primitive brain

20. Neuroplasticity
Recent research in neuroscience shows that we have the power to influence our brains.
When we think certain thoughts, it strengthens those neural circuits. Mental States Become Neural Traits!
Self-Directed Neuroplasticity =
Nurture positive states of mind
to strengthen and build those neural
networks. Make Happiness a Habit!
The brain is like a muscle that we can
build through practicing skills.

21. Pro-Social Behavior Impulse Regulation Emotional Awareness
Compassion & Empathy
Forgiveness
Increased awareness of one’s internal and external experience promotes reflection, self regulation, and caring for others
Impulse regulation
--studies show mindfulness reduces aggression and disruptive behavior
--helps us manage reactions to triggers like anger, danger
2) emotional awareness
--managing emotions
--Applied to interpersonal relationships
--Studies found that meditators have higher levels of activity in the parietal parts of their brain, which is associated with increased consciousness and the ability to resonate to other people’s feelings and thoughts
3) Development of empathy
--Findings indicate that even very short-term practice of compassion meditation, a more directive kind of mindfulness practice, induces explicit and implicit increases in positive affect toward strangers. One study done at Stanford University suggests that a short 7-minute practice of loving-kindness meditation can increase social connectedness.
--Another study found that eight-week meditation trainings led participants to act more compassionately toward a person  who is suffering (give up their chair to someone in crutches) — regardless of the type of meditation that they did (mindfulness or compassion).
4) Forgiveness
--well being strategy, exercises directed towards self and other’
--self compassion, maitri
Relationships- correlation between mindfulness practice in couples and an enhanced relationship. The couples reported improved closeness, acceptance of one another, autonomy, and general relationship satisfaction

22. Compassion Cultivation Training
Stanford University’s School of Medicine
The Center for Compassion and Altruism Research and Education (CCARE)
--The center has also developed a secular compassion education program with Thupten Jinpa, Buddhist scholar and personal translator to the Dalai Lama.
--Stanford’s Compassion Cultivation Training (CCT) is an 8-week course designed to develop the qualities of compassion, empathy, and kindness for oneself and others.
--The course, developed by a team of contemplative scholars, clinical psychologists, and researchers at Stanford University, combines traditional contemplative practices with contemporary psychology and scientific research on compassion.
--Daily meditation, visualization, and breathing practices to develop loving-kindness, empathy, and compassion

23. Helps Balance the Nervous System
Mindfulness…
Helps Balance the Nervous System

24. Stress Response
Loss of prefrontal, or higher thinking, regulation in the brain
React more from primitive/survival parts of brain: emotional thinking, reflexes, survival instincts

25. Stress Response Central Nervous System Autonomic Nervous System
Perception - Narrowed
Memory - Coarse, Imprecise
Learning - Blocked
Conditioning - Defense
Tendency - Regress or Perseverate
Tone – Fight or Flight
Autonomic Nervous System
Heart rate increases
Blood pressure increases
Oxygen need increases
Breathing rate increases
Palms, face sweat
Blood sugar increases
Adrenalin flows
Digestive tract shuts down blood to muscles
Blood vessels constrict in hands, face
Muscular System
Tension
Ready for Action
Jaws Clench
Body Braces for Action
Obviously being in the stress response isn’t an optimal place to resolve conflict from

26. Relaxation Response
Prefrontal cortex more active during relaxation response: leads to improvement in emotion regulation, self-regulation, wise response vs reactive/impulsive/fear-driven response.
See how operating from this place would naturally help with conflict resolution

27. Relaxation Response
Some more on the relaxation response and its benefits

28. Improves Self-Regulation
Mindfulness…
Improves Self-Regulation

29. Mindfulness helps deepen the Resilient Zone
In our “Resilient Zone” we have the best capacity for flexibilty and adaptability in mind, body and spirit.
charge
Release
resilient zone
These skills help us to learn to stay in as well as deepen our resilient zone.
Mindfulness helps deepen the Resilient Zone 29 29

30. Trauma Resiliency Model- e-Trauma Resource Institute
Stressful/Traumatic Event or
Stressful/Traumatic Triggers
Hyperactivity
Hypervigilance
Mania
Anxiety & Panic
Rage
Pain
Stuck on “High”
Hyper-arousal
resilient zone
When we don’t have these skills, we often get bumped out of our resilient zone and through chronic stress and trauma, we can get ‘stuck’ on high or low.
In life and in the midst of conflict or stressful situations, we want to learn to stay in our resilient zone as much as possible. This also has a regulating effect on those around us.
That’s the purpose of learning and practicing these skills.
Depression
Disconnection
Exhaustion/Fatigue
Numbness
Stuck on “Low”
Hypo-arousal
Graphic adapted from an original graphic of Peter Levine/Heller

31. Let’s Practice!

32. Breath-Focus Meditation
Trains the mind to settle, let go of mental clutter, and focus in the present moment. Connects mind with body.
Find a comfortable position either lying down on your back, in a chair, or on a cushion on the floor. Spine should be erect but not rigid.
Scan through the body and release unnecessary tension.
Bring attention to the body with an attitude of friendly curiosity.
Tune into the sensations of your body breathing and focus your attention on the feel of the breath coming in and out.
When your mind wanders, notice, and gently guide attention back to the breath (over and over again).
Practice for 5-30 minutes daily for lasting positive results.

33. Body Scan Meditation
Connects mind with body. Increases ability to track body sensations. Grounds attention in the present moment. Increases insight into changing nature of sensation. Trains mind to tolerate sensation with greater equanimity.
Bring curious, friendly attention to the sensations in your feet. Feel vs think.
Gradually move your way up the body…feeling the ankles, lower legs, knees, upper legs.
Feel sensations in the buttocks, the lower back, middle back, and upper back.
Notice sensations in the pelvis, abdomen, and chest.
Sense the fingers, hands, wrists, forearms, elbows, and upper arms.
Feel sensations in the shoulders. Notice any tension without judging it or trying to change it.
Notice sensations in the neck, throat, jaw, and mouth.
Sense the nose, eyes, forehead, ears, and head.
Feel sensations in the whole body at once. The whole body as one universe of sensation.

34. Next Steps

35. Regular Practice Create ‘Mindful Pauses’ throughout your day.
Take 1-5 minutes to practice slowing down, feeling the body, breathing more fully, letting go of thoughts, and returning to the present moment with gratitude and acceptance.
Set aside 5-30 minutes a day for meditation, yoga, art, or another mindful activity you enjoy.
Surround yourself with support. Get books, audio, phone apps to learn more and keep you motivated in
the practice.
Take a mind-body class
Do a meditation retreat

36. Questions or Comments Alexandra Arbogast: 301-319-4960 / Alexandra. S
Questions or Comments Alexandra Arbogast: /