1. Conducting Mindfulness-Based Interventions
Generational Resilience Conference
Point Clear, Alabama
October 29, 2014
Elise Labbé-Coldsmith, PhD.
Department of Psychology
University of South Alabama

2. Goals of Presentation
Identify different perspectives on defining mindfulness and the origins of mindfulness-based approaches to psychotherapy 
Describe the core components of mindfulness- based interventions and implement basic mindfulness meditation exercises
Describe a mindfulness-based intervention for chronic pain, illness and stress from an evidenced based perspective.

3. Brief History “Mindfulness”
Pali word sati “awareness” or “bare attention.”
Mindfulness
Practice of meditation and other techniques and strategies to enhance paying attention on purpose in the present moment

4. Brief History 2,500 years ago, the Buddha taught mindfulness
1960s and 1970s
Mental health practitioners often pathologized meditation
Meditation teachers were frequently dismissive of Western psychology and psychotherapy

5. Brief History In the mid-1990s Increasing dialogue and research
Interest in Eastern psychology and philosophy grew as more translations of Buddhist teachings became available
Increasing dialogue and research
Mindfulness as a unifying concept across various Western psychotherapies as well as between Eastern and Western psychologists and philosophers

6. Brief History
Components of mindfulness that span across psychotherapies
The mind can observe itself
The mind can grow in self-understanding, capacity to accept experience, view oneself in a nonjudging manner, and experience compassion for the suffering of oneself and others

7. Brief History 1990 Kabat-Zinn
Full Catastrophe Living: Using the wisdom of your body and mind to face stress, pain and illness (1990)
Stress Reduction and Relaxation Program, University of Massachusetts Medical Center
Practical guide
8-week course
10 years, 4,000 participants

8. Defining Mindfulness Mindfulness Moment-to-moment awareness
Leads to conscious self-regulation by explicitly infusing “ attention” with seven mindfulness qualities:
acceptance, non-judging, non-striving, patience, trust, openness, and letting go
Jon Kabat-Zinn (1992)

9. Mindfulness (Shapiro & Carlson, 2009)
Big M
Mindfulness Awareness
A way of being in the moment
Intention to attend with mindful awareness
Mindfulness qualities
Little m
Mindful Practice
Intentionally foster M

10. Formal Mindfulness Practice
Experience mindfulness using a formal practice
Mindfulness Meditation
Let’s try it!

11. Mindfulness
Not just attending to the present moment but the way one intends to attend using the mindfulness qualities
Promotes better self-regulation
Promotes feelings of wholeness and connectedness with others and the world

12. Mindfulness Qualities: Cognitive
Nonstriving: not goal oriented; remaining unattached to outcome or achievement
Nonjudging: impartial witnessing; observing without evaluation and categorization
Acceptance: being open to seeing and acknowledging things as they are

13. Mindfulness Qualities: Cognitive
Patience: allowing things to unfold in their time in regard to ourselves and others
Trust: trusting both oneself and the process of the mindfulness practice
Openness: seeing things as though for the first time; creating possibilities by paying attention to all feedback
Letting go: nonattachment; not holding on to thoughts, feelings, or experiences

14. Mindfulness Qualities: Emotional
Gratitude: the quality of reverence; appreciating and being thankful for the present moment
Gentleness: characterized by a soft, considerate, and tender quality; soothing but not passive, undisciplined, or indulgent

15. Mindfulness Qualities: Emotional
Generosity: giving within a context of love and compassion, without attachment to gain or thought of return (what’s given need not be material)
Empathy: the quality of feeling and understanding another person’s situation—their perspectives, emotions, actions, and reactions—and communicating this to the person
Loving-kindness: a quality embodying benevolence, compassion, and cherishing; a quality filled with forgiveness and unconditional love

16. Mindfulness Interventions
Well-known evidence-based practice for psychological and health disorders
Secular practices - based on Buddhism
Mindfulness Based Stress Reduction (MBSR)
Mindfulness Based Cognitive Therapy (MBCT)
Acceptance & Commitment Therapy (ACT)
Dialectical Behavior Therapy(DBT)

17. Meta-Analyses & Research Studies
Clinical and non-clinical populations with people of all ages
Increases in immune, neurological and endocrine functioning
Reductions in pain and stress ratings
Increases in coping and quality of life
Increase positive emotions and decrease neuroticism and negative emotions
Reduced rumination

18. Meta-Analyses & Research Studies
Increase in working memory
Increase in focused attention
Less emotional reactivity to negative experiences
Increase in cognitive flexibility
Increase in relationship satisfaction

19. Research Example Farb et al (2010) 8 weeks MBSR
Randomly assigned, wait list comparison
Measured depression, anxiety, pre-post
fMRI during & after watching a sad film
Found less reactivity during exposure
Different pattern than prior to MBSR
Negative emotions processed differently after MBSR

20. What areas of the brain are influenced by meditation?
Medial pre-frontal lobe increased-associated with self-insight, moral reasoning, intuition & fear modulation (Siegel, 2007, 2009).
Decreased limbic system activation (Davidson, 2003; Grossman, 2004).
Increase in gray matter in the insula—located on inside of temporal lobes—senses internal state of the body, increases empathy

21. Additional Brain Changes
Increased hippocampus activity
Reduction in cortical thinning due to aging
Increased activation of left frontal regions, lifting of mood
Thicker brain regions association with attention, sensory processing & sensitivity to internal stimuli

22. Assessing from an Evidence-Based Perspective
Mindfulness Measures
Outcome Measures
Process Measures

23. Mindfulness Measures: Trait
Mindful Attention & Awareness Scale (MAAS)
Brown & Ryan, 2003
Five Facet Mindfulness Questionnaire (FFMQ)
Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006

24. Mindfulness Measures: State
Toronto Mindfulness Scale (TMS)
Lau, Bishop, Segal, Buis, Anderson, Carlson, Shapiro, & Carmody, 2006

25. MBSR Core Components Formal Practice Informal Practice
Fostering M with m

26. Core Components Formal Practice
Many types of formal practice that can be used in mindfulness-based interventions
All could be considered forms of meditation.
These include but are not limited to:

27. Formal Practice Observing the Breath Diaphragmatic Breathing Body scan
Breathing exercises
Observing the Breath
Diaphragmatic Breathing
Body scan

28. Formal Practice Sitting meditations Concentrative
Focusing attention on something in particular
Examples
Lake and Mountain Meditation

29. Formal Practice Mindfulness Meditation
Just observing and noting internal and external experiences
Loving-kindness meditation
Fostering the affective qualities of mindfulness: gratitude, gentleness, generosity, empathy, and loving-kindness
Walking Meditation

30. Informal Practice A variety of informal practices
Help clients generalize the benefits of meditation to everyday life
Encourages bringing mindfulness qualities to whatever they are doing during ordinary activities throughout the day

31. Informal Practice Examples Mindfulness in daily activities
Examples:, answering the phone, hugging another person
Describing and observing
Noticing internal thoughts, feeling and images
Noticing external experiences

32. Informal Practice Sensory exercises Yoga Awareness of posture
Eating, Smells, Touch, Listening to Sounds
Yoga
Hatha Yoga
Awareness of posture
Using poetry and inspirational writings

33. How to Incorporate Mindfulness Into Clinical Practice
Integrate mindfulness concepts
Types of problems in which mindfulness has been shown to work
Individual and group therapy settings
Techniques utilized
Sample protocol for chronic illness, pain, and stress

34. Mindfulness Intervention for Chronic Illness, Pain, and Stress
MBSR in terms of illness, pain and stress
Modifications
Commitment to practice
Eight week protocol
Incorporates concepts, practices, and reflection

35. Session 1 Pre-intervention Introductions ORS
Measure of specific pain, illness, stress, or coping
FFMQ or MAAS
Introductions
Therapists, Participants, Format

36. Session 1 Teach mindfulness concepts at each session
Body and mind
Cognitive aspects
Emotional aspects
Breathing meditation practice introduced
Homework: given each week

37. Session 2 Body Scan Informal mindfulness exercise
Formal mindfulness practice
Audio recording
Informal mindfulness exercise
Incorporating mindfulness into daily routine

38. Sessions 3 & 4 Body scan and yoga Informal mindfulness exercises
Active practice of mind-body connection
Openness and kindness toward the body
Physical endurance, flexibility, and strength
Informal mindfulness exercises
Journaling
Different mindfulness experiences
Review with group

39. Sessions 5 & 6 Sitting meditation Yoga
Begin taking ownership of their practice
Ex: Mountain or lake meditation
Replace body scan with sitting meditation
Yoga
Begin to alternate sitting meditation and yoga
Substitute body scan for yoga if problems with yoga

40. Session 7 or Day Retreat Take ownership of practice
Familiarity with practice
Discontinue use of recordings
Experiment: types of practice, schedule, combination
Foster ability to be in the moment and connect adaptively with mind and body

41. Session 8 Notice instructions/experiences not noticed previously
What has worked and areas for improvement
Guided formal meditation
Notice instructions/experiences not noticed previously
Future meditation practice
Reference audio recordings

42. Session 8 Follow-up assessment
ORS
Measures of specific pain, illness, stress, or coping
FFMQ or MAAS

43. Formal Practice Experience mindfulness using a formal practice
Mountain Meditation
Let’s try it!

44. Conclusions Evidence-based Mindfulness
Growing body of research that MBSR is effective in improving health, reducing illness and mortality rate.
Need more research on process and outcome measures, particularly of mindfulness
Need more RCT in clinical as well as for health, exercise and sport

45. Recommended Readings
Kabat-Zinn, J. (1990) Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Bantam Dell.
Labbé, E. (2011) Psychology Moment by Moment: A Guide to Enhancing Your Clinical Practice with Mindfulness and Meditation. New Harbinger Publications: Oakland, CA.

46. Conclusions Questions? Thank you for your ATTENTION!
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