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The ABC Practical Mindfulness Course

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1 The ABC Practical Mindfulness Course
3rd July 2009 The ABC Practical Mindfulness Course Chris Trepka 2009 Chris Trepka, Enschede 2009 1

2 The ABC Practical Mindfulness Course
3rd July 2009 Why am I here, doing this? Chris Trepka, Enschede 2009 2

3 The ABC Practical Mindfulness Course
3rd July 2009 I need mindfulness Chris Trepka, Enschede 2009 3

4 The ABC Practical Mindfulness Course
3rd July 2009 We need mindfulness Chris Trepka, Enschede 2009 4

5 The ABC we didn’t learn at school
The ABC Practical Mindfulness Course 3rd July 2009 The ABC we didn’t learn at school Chris Trepka, Enschede 2009 5

6 The ABC Practical Mindfulness Course
3rd July 2009 Mindfulness is ‘‘paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment.’’ Jon Kabat-Zinn Chris Trepka, Enschede 2009 6

7 5 facets of mindfulness (Baer et al)
The ABC Practical Mindfulness Course 3rd July 2009 5 facets of mindfulness (Baer et al) Facets Example items Observing I notice the smells and aromas of things Describing I am good at finding words to describe my feelings Acting with awareness I find myself doing things without paying attention (R) Non-judging of inner experience I think some of my emotions are bad or inappropriate and I should not feel them (R) Non-reactivity to inner experience I perceive my feelings and emotions without having to react to them Chris Trepka, Enschede 2009

8 What is mindfulness really?
The ABC Practical Mindfulness Course 3rd July 2009 What is mindfulness really? It is a fool’s errand scientifically to try to understand what mindfulness “really” is, if by that one means whatever is being described by the prescientific, lay concept “mindfulness.” Hayes & Plumb Chris Trepka, Enschede 2009

9 What is the function of mindfulness?
The ABC Practical Mindfulness Course 3rd July 2009 What is the function of mindfulness? Attempting to change the impact of thoughts or feelings requires changing the context in which those events occur. Mindfulness seeks to do just that by changing the observer’s relationship to their thoughts and other private experiences rather than changing belief in thought content Hayes & Plumb Chris Trepka, Enschede 2009

10 Mindfulness from the bottom up
The ABC Practical Mindfulness Course 3rd July 2009 Mindfulness from the bottom up Human Language and Cognition is Based on Learned Derived Relations Derived Relational Learning Greatly Expands the Capacity for Human Pain We Try to Solve the Problem of Pain by an Over-extension of Problem Solving The Overextensions of Verbal Relations are better Regulated by Changes in the Functions of Private Experiences [in comparison with more Verbal Problem Solving or Verbally Guided Challenges to the Content of Private Experience] Chris Trepka, Enschede 2009

11 In less technical language…
The ABC Practical Mindfulness Course 3rd July 2009 In less technical language… We learn to think relationally, which works instrumentally, but increases our access to pain, and causes misery when applied to our own insides. you cannot rein in this kind of judgment judgmentally, but you can learn to do so mindfully, with resulting broad and deep benefits, especially when it is part of a pattern of values-based action. Chris Trepka, Enschede 2009

12 The ABC Practical Mindfulness Course
3rd July 2009 ACT and mindfulness A set of skills to increase psychological flexibility 4 hexaflex processes provide a working definition of mindfulness: contacting present moment, acceptance, defusion, self as context 2 other processes intertwined – mindfulness enhances values work and effective action Chris Trepka, Enschede 2009 12

13 The ABC Practical Mindfulness Course
The Primary ACT Model of Treatment 3rd July 2009 Psychological Flexibility Chris Trepka, Enschede 2009 13

14 Mindfulness training - how accessible?
The ABC Practical Mindfulness Course 3rd July 2009 Mindfulness training - how accessible? Courses are experiential and emphasise extensive practice hence not suitable for participants with psychosis, depression, anxiety... Course leader needs personal mindfulness practice and a mindful presence Buddhist influence brings an implicit spiritual element Chris Trepka, Enschede 2009 14

15 Limitations to mindfulness training in 1:1 ACT
The ABC Practical Mindfulness Course 3rd July 2009 Limitations to mindfulness training in 1:1 ACT Individual therapy does not provide the optimal context for learning mindfulness skills Insufficient opportunities to practice mindfulness in the optimal learning context of an experiential group Chris Trepka, Enschede 2009 15

16 The ABC Practical Mindfulness Course
3rd July 2009 My influences Kevin Polk’s Togus Intensive Outpatient Program iView (and now the Grid!) Noticing: a proxy for mindfulness & self as context Russ Harris’ “The Happiness Trap” Robert Fritz’s “The Path of Least Resistance” My wonderful colleagues, Lorna Mundy, Helen Clarke and others Chris Trepka, Enschede 2009 16

17 The ABC Practical Mindfulness Course
VITALITY Three Senses of Self – Russ Harris’ version of the iView Observing Self Physical Self Effective Action Thinking Self Struggle Values Ineffective Action SUFFERING Chris Trepka, Sheffield 2009 17

18 The ABC Practical Mindfulness Course
3rd July 2009 SENSORY EXPERIENCE YOU STRUGGLE VALUES MENTAL EXPERIENCE The Grid – adapted from Kevin Polk Chris Trepka, Enschede 2009

19 The ABC Practical Mindfulness Course
3rd July 2009 Noticing (Kevin Polk) ‘We long ago found that most people did not like the formal mindfulness practice and they did not keep it up after they left the program. Now we just have them notice, notice, notice in each of the groups we do’ ‘If someone asks a question, we almost always answer the question in terms of giving him or her credit for noticing’ ‘Using this method we never disagree with clients about much of anything. We just say “yes, that’s it” and head toward the iView’ ‘It’s safe to say we say the word “Noticing” or “Notice” at least 1000 times in four days’ Chris Trepka, Enschede 2009 19

20 The path of least resistance
The ABC Practical Mindfulness Course 3rd July 2009 The path of least resistance Robert Fritz – a musician not a psychologist “Sigmund Freud was a doctor” (orientation to alleviating disease not creating health) The usual responding or reacting tends to lead to inertia or oscillation Alternatively become the creative force in your own life Creating as a conscious act sets up a different energy – between your desired result and what currently exists Chris Trepka, Enschede 2009 20

21 A – Awareness of what’s here
The ABC Practical Mindfulness Course 3rd July 2009 A – Awareness of what’s here Expanding awareness of experience: Sensations Perceptions Emotions Cognitions Urges Beginner’s mind Just noticing Chris Trepka, Enschede 2009 21

22 B – Being with what’s here
The ABC Practical Mindfulness Course 3rd July 2009 B – Being with what’s here Open, curious, accepting Patiently allowing things to unfold in their own time Allowing emotions and sensations to open Noticing what the mind is doing and what urges arise without going with that Holding what is here (lightly) and letting go of wanting to alter anything Another B – Breathing with what’s here Chris Trepka, Enschede 2009 22

23 C – Choosing what to do with it
The ABC Practical Mindfulness Course 3rd July 2009 C – Choosing what to do with it More control over what you do in the present environment where you place your attention This is where freedom actually exists The illusion of freedom to think, feel, want, have things be so, change the past or future Two other Cs Creating Caring Chris Trepka, Enschede 2009 23

24 The ABC Practical Mindfulness Course
3rd July 2009 1 – Introduction Welcome, introductions, ground rules Orientation talk Circles diagram You noticing is not a thing and has no limits Why I need mindfulness Qualities of mindful noticing The ABC Course outline Awareness of feet and hands exercise Chris Trepka, Enschede 2009 24

25 2 – Your body and the world
The ABC Practical Mindfulness Course 3rd July 2009 2 – Your body and the world Reflections on the week Breathing exercise Body awareness Noticing the world exercise Breathing to connect exercise Chris Trepka, Enschede 2009 25

26 The ABC Practical Mindfulness Course
3rd July 2009 3 – Doing and Feeling Walking exercise Raisins exercise Expansion exercise Urge surfing exercise Chris Trepka, Enschede 2009 26

27 The ABC Practical Mindfulness Course
3rd July 2009 4 – Your mind Thought watching exercise Time travelling exercise Leaves on a stream exercise Nodding to and letting go exercise Chris Trepka, Enschede 2009 27

28 The ABC Practical Mindfulness Course
3rd July 2009 The time line Distant Past Recent Past Present Near Future Distant Future Chris Trepka, Enschede 2009 28

29 5 – Choosing, creating, caring
The ABC Practical Mindfulness Course 3rd July 2009 5 – Choosing, creating, caring Values exercise Eyes on exercise Creativity exercise Chris Trepka, Enschede 2009 29

30 The ABC Practical Mindfulness Course
3rd July 2009 6 – Follow-up How is this working for you? Body awareness exercise Expansion exercise Walking exercise Chris Trepka, Enschede 2009 30

31 The ABC Practical Mindfulness Course
3rd July 2009 The initial pilot 6 service users, 3 therapists Introduction 4 weekly sessions Follow up Chris Trepka, Enschede 2009 31

32 The ABC Practical Mindfulness Course
3rd July 2009 Outcome impressions The therapists learned something So did some of the clients Dropout is a barrier Person in a crisis is a barrier Quiet clients may need more help to engage well The talkative person helps everyone Chris Trepka, Enschede 2009 32

33 Limitations of the pilot sample
The ABC Practical Mindfulness Course 3rd July 2009 Limitations of the pilot sample Clients who remain very entrenched in problems Clients I’m trying to detach from A highly avoidant client found the course increasingly aversive Chris Trepka, Enschede 2009 33

34 The ABC Practical Mindfulness Course
3rd July 2009 Is this worth pursuing? Chris Trepka, Enschede 2009 34

35 Ideas for a more formal pilot
The ABC Practical Mindfulness Course 3rd July 2009 Ideas for a more formal pilot Try the main course within a whole day? Try with clean and less entrenched clients Potentiate and back up with more scripts and handouts Use MAAS, AAQ, CORE-10, Progress Q Compare effects with those waiting, and follow-up Assess if other therapy progresses better Chris Trepka, Enschede 2009 35

36 The ABC Practical Mindfulness Course
3rd July 2009 References Baer, R. A. (2003). Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice, (10)2, Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15, Fritz R (1989) The Path of Least Resistance. Ballantine. Harris R (2007) The Happiness Trap. Robinson Kabat-Zinn J (2005) Coming to Our Senses. Piatkus. Chris Trepka, Enschede 2009

37 References – ACT theory
The ABC Practical Mindfulness Course 3rd July 2009 References – ACT theory Fletcher, L. & Hayes, S. C. (2005). Relational Frame Theory, Acceptance and Commitment Therapy, and a functional analytic definition of mindfulness. Journal of Rational Emotive and Cognitive Behavioral Therapy, 23, Hayes, S. C., & Plumb, J. C. (2007) Mindfulness from the Bottom Up: Providing an Inductive Framework for Understanding Mindfulness Processes and their Application to Human Suffering. Psychological Inquiry, 18(4), Hayes, S. C., & Wilson, K. G. (2003). Mindfulness: Method and process. Clinical Psychology: Science and Practice, 10, Hayes, S. C., & Shenk, C. (2004). Operationalizing mindfulness without unnecessary attachments. Clinical psychology: Science and practice, 11, Chris Trepka, Enschede 2009


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