Presentation on theme: "Introduction to Mindfulness Based Stress Reduction: CALM of NEPA"— Presentation transcript:
1 Introduction to Mindfulness Based Stress Reduction: CALM of NEPA Phillip Sallavanti
2 What is Meditation“Medicine” and “Meditation” arise from the same Indo-European rootMeaning “to measure”Suggesting an action to establish wholeness- healthMBSR has its core the practice of mindfulness mediation and the intention to establish wholeness
3 What is MindfulnessJon Kabat-Zinn defines mindfulness as paying attention, on purpose, in the present moment and non-judgmentallyOR more simply BEING HERE NOWwith an attitude of openness, curiosity and kindness
4 Defining Mindfulness in MBSR A Model of MindfulnessAttentionIntentionAttitudeThe three axioms of Intention, Attention, and Attitude (IAA) are not sequential, but rather are engaged simultaneously in the process of mindfulness (Shapiro, et al., 2006).
5 Defining Mindfulness in MBSR Three Axioms of Mindfulness (Shapiro et al., 2006)Intention changes over time: “from self-regulation, to self-exploration, and finally to self-liberation”Attention has two facets: sustained focus and flexibility of focusAttitude of non-judgment: this is not an affect-free “bare awareness,” but rather an accepting, open, and kind curiosity towards one’s own experience
6 Awareness is Continuous The “triangle” of awareness:Body sensationsThoughtsEmotionsBut we don’t always bring attention to our awarenessMuch of the day, we’re on autopilotAttending to the body/breath brings us into the present moment — immediately
7 Mindfulness in MBSRA Meta-Mechanism of Mindfulness: Reperceiving (Shapiro et al., 2006)“…a rotation in consciousness in which what was previously ‘subject’ becomes ‘object.’”This is basic to human development; mindfulness practice simply accelerates developmentDoes not create distance and disconnection from one’s experience, but rather enables one to look, feel, and know more deeply.
8 Mindfulness in MBSRSelf regulation and self management: We can identify and then choose to override habitual reactions and respond with more balance and greater skillValues clarification: We can reflect on values we may have adopted unquestioningly and choose to adapt or adopt values more resonant with the current context
9 The program Introduction to MBSR 8 week program 2 ½ hours a week Educational, not therapeutic orientation — classes provide a community of learning and practice, for motivation, support, and belonging. Focus is on what‘s right with you not what‘s wrong with you.
10 Mindfulness Practice in MBSR is Formal or Informal Formal: a specific form of practice, at a specific time and place, for a set durationFour common forms: Body scan, sitting meditation, walking meditation, mindful movementInformal: bringing mindful attention to any activity, any situation, any time, anywhere
11 Mindfulness-Based Stress Reduction Offered at > 700 medical centers in U.S. and around the world30 years of research in a wide range of chronic clinical ailments700% increase in the amount of studies since 2003
12 Mindfulness Based Interventions Mindfulness-Based Stress Reduction (MBSR)Mindfulness-Based Cognitive Therapy (MBCT)Mindfulness-Based Relapse Prevention (MBRP)Mindfulness-Based Art Therapy (MBAT)Mindfulness-Based Relationship Enhancement (MBRE)Mindfulness-Based Eating Awareness Training (MB-EAT)Mindfulness-Based Rational Emotive Behavior Therapy (MBREBT)Mindfulness-Based You Name It (MB-ETC)Dialectical Behavior Therapy (DBT)Acceptance and Commitment Therapy (ACT)
13 Definition of StressStress is the response to a perceived threat to our psychological or physical well being coupled with the believe that we don’t have the resources to cope
14 What happens in a traffic jam Body sensationsThoughtsHow we perceive something actually shapes our experience.Body cant distinguish between a thought and an actual threat.Hard wired for stress response.
15 Research on Mindfulness and Health National Institutes of Health funding wide range of clinical studies of mindfulness in medicine and mental healthAsthma, bone marrow transplant, breast cancer, chronic pain, chronic obstructive pulmonary disease, fibromyalgia, HIV, hot flashes, hypertension, immune response to HPV, irritable bowel syndrome, lupus, myocardial ischemia, obesity, prostate cancer, rheumatoid arthritis, solid organ transplant, type-2 diabetes, and other medical conditionsAnxiety disorders, delusional disorder, depression, drug abuse and dependence, eating disorders, personality disorders, PTSD, schizophrenia, suicidality, and other psychiatric disorders
16 Research on Mindfulness and Health National Institutes of Health funding wide range of clinical studies on mindfulness in medicine and mental health, including:Asthma,lupus,bone marrow transplant,myocardial ischemia,breast cancer, chronic pain,obesity,chronic obstructive pulmonary disease,prostate cancer,rheumatoid arthritis,fibromyalgia,solid organ transplant,HIV,type-2 diabetes,hot flashes,other medical conditionshypertension,immune response to HPV,irritable bowel syndrome,Anxiety disorders, delusional disorder, depression, drug abuse and dependence, eating disorders, personality disorders, PTSD, schizophrenia, suicidality, and other psychiatric disorders
17 Research on Mindfulness and Mental Health Anxiety disorders,PTSD,delusional disorder,schizophrenia,depression,Suicidality,drug abuse and dependence,other psychiatric disorderseating disorders,personality disorders,
18 outcomes45% reduction in anxiety35% reduction in depressionĤ
19 Stress reduction correlates with structural changes in the amygdala Stress reduction correlates with structural changes in the amygdala. Hölzel BK, Carmody J, Evans KC, Hoge EA, Dusek JA, Morgan L, Pitman RK, Lazar SW. Soc Cogn Affect Neurosci. Mar 5, 201019
21 MBSR and Cognitive Function Recently, researchers have reported improvement in sustained attention and working memory measures in novice meditators who underwent MBSR training relative to a comparison group who did not undergo the training. (Amishi Jha)
22 Brain ChangesParticipation in an MBSR program results in increases in regional brain gray matter density regions associated with learning, memory, emotion regulation, perspective taking. (Holzel et al., 2011)
23 Mindfulness Enhances Attention Slagter et al. (2007) found mindfulness practice affected distribution of attentional resources.Time required to identify and consolidate visual targets in short-term memory precludes recognition of second target within 500 ms.Mindfulness practitioners with 3 months’ experience identified second target within 500 ms window.Practitioners used fewer resources (measured by scalp recorded brain potentials) to identify first target.
25 The Miracle of Attention “The capacity to give one’s attention to a sufferer is a very rare and difficult thing; it is almost a miracle; it is a miracle.”Simone WeilFrom Waiting for God, New York: Putnam, 1951.
26 What Is Therapeutic Presence? A definition (Bugenthal,1987):Being open and available to all parts of the client or patient’s experience…Being open and available to all of one’s own experience as one is with the client or patient…Being able to respond from the immediacy of that experience…Therapeutic presence is not cognitive, contrived, or controlled. It is simply as “withness.”
27 Obstacles to PresenceProcesses that can interfere with present-moment awareness include:Comparison and evaluationComplexity, busy-ness, and confusion“Yes, but” conversationsTaking sidesStrong past or future orientation (rumination/worry)Focusing on what something “means about me”Problem-solving orientation
28 Burnout and Empathic Stress Obstacles to presence may be sources of burnout and secondary traumatic stress – or “empathic stress fatigue” (Figley, 1995; Halifax, 2011).Symptoms can include:ApathyDemoralizationIntrusive thoughtsReduced quality of lifeSleep disruptionSubstance use
29 Mindfulness Interventions for Health Care Professionals Since 1978, approximately 30 empirical studies have been published involving the use of mindfulness-based interventions with health care professionals (ranging from physicians to nurses to psychologists).Outcomes have included improvements in:Burnout symptoms and job engagementDistress toleranceActive listening and empathyNonjudgmental self-reflection and self-compassion
30 Therapist Practice Improves Patient Outcomes A controlled, double-blind study of therapy outcomes for inpatients whose psychotherapists meditated daily (Grepmair et al., 2007) found:Significant differences in symptom reduction for those whose therapists meditated -- as measured on 8 scales of SCL-90 (global severity index, somatization, insecurity in social contact, obsessiveness, anxiety, anger/hostility, phobic anxiety, & psychoticism)Patients of meditating therapists reported greater subjective improvement following their sessions and made better assessments of their development of new behaviors
31 Applying Mindfulness in Interpersonal Communication Mindfulness practice can facilitate compassionate communication even in high-stress environments:Attend to self and otherSlow down the interaction to enhance attentionNotice what you feel and where you feel itAdopt a non-judgmental stanceAcknowledge what you have heardValidate the emotionsArticulate needs (all parties)Trust the interaction
32 Mindfulness for Teachers A study with public school teachers by Diane Reibel, PhD, Jefferson University
33 School DistrictUrban-fringe district- directly adjacent to Philadelphia8 elementary schools, 2 middle schools, 1 high school5,500 students33
34 Participants in First MBSR Program First 8 week MBSR program19 people –one dropped out mid-wayAge range years old, mean age 4614 elementary school teachers2 high school,2 special education coaches1 professional education coordinator34
35 Brief Symptom Inventory Scores All values means p<0.01Reductions in GSI 53% ANX 48%DEP 58% SOM 58%35
36 Maslach Burnout Scale- Educators’ Survey Scores EE=Emotional Exhaustion, DP = DepersonalizationPA= Personal Accomplishment25 % decease in EE and 13 % improvement in PA p<0.00536
37 Teachers’ Feedback on Effectiveness of MBSR How has this program helped you become more effective at work? (check all that apply)0 It has not helped me to be more effective17 I am better able to manage stress5 I am more productive16 I can better manage my emotions8 I am better able to prioritize16 I am more present for my students37
38 ability to discern detail ability to refresh perception of the moment Research on mindfulness programs in K-12 schools shows student benefits in increased . . .ability to discern detailability to refresh perception of the momentmetacognitive awarenessability for self-regulationemotional flexibilityawareness of body, thoughts, feelingsquick recovery to mental calm, emotional balancerelaxation response capacitysatisfaction in everyday livingPhoto from
49 Mindfulness supports Resilience Resilience the ability to respond constructively to life.Mindfulness feeds resiliency in 4 main waysSensitivity increases to notice challengesSelf calming by slowing down habitual reactionsExperiencing comfortable and uncomfortable emotions and sensations with conscious choicesRecovering- shifting attention to the present without self judgment or inner commentarykids
50 Mindfulness therapy helps prevent D & A relapse One year following treatment far fewer participants used drugs or alcohol.Teaching self awareness help people understand what drives cravings8 percent in mindfulness participants reported drug use compared to 14 percent in 12 step program and 17 percent in traditional relapse prevention group.8 percent reported drinking after 1 year compared to 20 percent in the other 2 therapy groups.
51 “Compared to what we ought to be, we are only half awake. ” “Compared to what we ought to be, we are only half awake.” …William James
53 Mindfulness and TeensTeenage years are some of the most stressful of your life. 70% of teens say they are stressed out.Pressure about grades, parents who just don’t seem to “get it” and friends who drive you “crazy”.
54 The Good NewsIf you learn a few strategies for getting stress under control now, you'll have the skills you need to deal with problems and difficult feelings that life sends your way in high school and beyond.
55 Mindfulness and Teensmindfulness approaches are producing benefits in teens in the form of more feelings of well-being, less anxiety and worry, and less emotional reactivity (Burke 2010).Research in mindfulness indicates that this program may help students improve focus, enhance self-confidence, and provide a basis for developing positive coping and time-management skills.
56 Mindfulness and Teens“These skills can help teenagers navigate effectively through a time in life that can be confusing, filled with uncertainties, and exceedingly stressful. These life-skills form the basis for building successful relationships, beginning with oneself.” Jon Kabat-Zinn, founder of MBSR, from forward of Learning to BREATHE.
57 What does Mindfulness have to do with SPORTS Seattle Seahawks are taught Yoga and Mindfulness Meditation as part of their training. Teaching them how to stay focused and placing their attention where they choose
58 The ZonePlacing attention on the task by accepting internal and external distractions.Allowing them to be as they areWhen an athlete can notice this and perceive it for what it is simply a thought or a feeling they are better able to enter the zone.
59 Russell Okung“Meditation is as important as lifting weights and being out here on the field for practice, its about quieting the mind and getting into certain states where everything outside of you doesn't matter in that moment. There are so many things telling you that you can’t do something, but you take those thoughts captive, take power over them and change them.”
60 Mindfulness at Penn State For 15 minutes a day, Tim Frazier, Penn State's senior point guard, finds a quiet place, switches on a podcast, and meditates. Along with his teammates."The game moves so fast, it's hard to focus on the here and now," said Frazier, who is pretty fleet of foot himself. "Meditation slows me down [mentally], keeps me more relaxed and more focused."
61 MindfulnessSometimes during the game, you focus on whether past plays were good or bad," Frazier said, "but meditation brings you back to the play at hand.“Part of mindfulness is to learn to observe situations rather than automatically reacting to them," said Diane Reibel, director of the Mindfulness Institute at Jefferson University Hospital. "Mindfulness teaches you to pause for a split second and notice, for example, 'oh, yes, anger is rising.' It gives you a way to approach the anger without acting on it. You can choose to use that energy in a positive, rather than negative way. Outcomes can be different; you have a choice."
62 Mindfulness and Sports Mindfulness practice really isn't that different from athletic training,” mindfulness practice changes the structure of the brain through which awareness operates. Just as running increases the strength of the quadriceps muscle, mindfulness practice strengthens the executive control function of the brain."
63 Abridged Mindfulness Intervention to Support Wellness in First-Year Medical Students The beneficial effects of MBSR mirror those found in prior studies in student populations. Shapiro et al. studied a randomized population of premedical and medical students who underwent a similar 8-week mediation program and found reduced anxiety and depression, and increased empathy at the end of 8 weeks.22 Jain et al. demonstrated reductions in distress and improvements in positive mood states.31
64 improved total mood disturbance scores in the MBSR group compared with controls in a sample of volunteer medical students.23 Warnecke et al. demonstrated that mindfulness reduced PSS and anxiety as measured by the DASS in a randomized group of senior medical students at 8 weeks.24 Our study extended the period of observation considerably to 6 months. The effect have been associated with positive findings relevant to medical student wellness in other published literature. Neff and McGehee32 reported mental health benefits including diminished anxiety and depression as well as greater feelings of social connectedness