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 root
Meaning “to measure”
Suggesting an action to establish wholeness- health
MBSR has its core the practice of mindfulness mediation and the intention to establish wholeness

3. What is Mindfulness
Jon Kabat-Zinn defines mindfulness as paying attention, on purpose, in the present moment and non-judgmentally
OR more simply BEING HERE NOW
with an attitude of openness, curiosity and kindness

4. Defining Mindfulness in MBSR
A Model of Mindfulness
Attention
Intention
Attitude
The 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 focus
Attitude 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 sensations
Thoughts
Emotions
But we don’t always bring attention to our awareness
Much of the day, we’re on autopilot
Attending to the body/breath brings us into the present moment — immediately

7. Mindfulness in MBSR
A 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 development
Does not create distance and disconnection from one’s experience, but rather enables one to look, feel, and know more deeply .

8. Mindfulness in MBSR
Self regulation and self management: We can identify and then choose to override habitual reactions and respond with more balance and greater skill
Values 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 duration
Four common forms: Body scan, sitting meditation, walking meditation, mindful movement
Informal: 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 world
30 years of research in a wide range of chronic clinical ailments
700% 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 Stress
Stress 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 sensations
Thoughts
How 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 health
Asthma, 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 conditions
Anxiety 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 conditions
hypertension,
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 disorders
eating disorders,
personality disorders,

18. outcomes
45% reduction in anxiety
35% reduction in depression Ĥ

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, 2010 19

20. No similar changes in other regions20

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 Changes
Participation 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.

24. Mindfulness and the Therapeutic Encounter

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 Weil
From 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 Presence
Processes that can interfere with present-moment awareness include:
Comparison and evaluation
Complexity, busy-ness, and confusion
“Yes, but” conversations
Taking sides
Strong 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:
Apathy
Demoralization
Intrusive thoughts
Reduced quality of life
Sleep disruption
Substance 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 engagement
Distress tolerance
Active listening and empathy
Nonjudgmental 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 other
Slow down the interaction to enhance attention
Notice what you feel and where you feel it
Adopt a non-judgmental stance
Acknowledge what you have heard
Validate the emotions
Articulate needs (all parties)
Trust the interaction

32. Mindfulness for Teachers
A study with public school teachers by Diane Reibel, PhD, Jefferson University

33. School District
Urban-fringe district- directly adjacent to Philadelphia
8 elementary schools, 2 middle schools, 1 high school
5,500 students 33

34. Participants in First MBSR Program
First 8 week MBSR program
19 people –one dropped out mid-way
Age range years old, mean age 46
14 elementary school teachers
2 high school,
2 special education coaches
1 professional education coordinator 34

35. Brief Symptom Inventory Scores
All values means p<0.01
Reductions in GSI 53% ANX 48%
DEP 58% SOM 58% 35

36. Maslach Burnout Scale- Educators’ Survey Scores
EE=Emotional Exhaustion, DP = Depersonalization
PA= Personal Accomplishment
25 % decease in EE and 13 % improvement in PA p<0.005 36

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 effective
17 I am better able to manage stress
5 I am more productive
16 I can better manage my emotions
8 I am better able to prioritize
16 I am more present for my students 37

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 detail
ability to refresh perception of the moment
metacognitive awareness
ability for self-regulation
emotional flexibility
awareness of body, thoughts, feelings
quick recovery to mental calm, emotional balance
relaxation response capacity
satisfaction in everyday living
Photo from

39. MBSR Research at Jefferson

40. Medical Conditions of MBSR Participants (136)
Chronic Pain (30%)
Hypertension (20%)
Anxiety/Panic Disorder (18%)
Depression (16%)
Cancer (12%)
GI Distress, Diabetes, Arthritis, Sleep disorders, AIDS/HIV, MS, Lupus
Significant comorbidity- 2/3 of participants had 2 or more illnesses
(Mean Age 47, 70% Women, 30% men)

41. MBSR Research at Jefferson

42. MBSR Research at Jefferson

43. MBSR Research at Jefferson

44. One Year Follow-Up
Benefits were maintained in Anx, Dep, Som, GSI, MSCL and five of eight of the SF-36 health related quality of life scores.

45. Health-Related Quality of Life Outcomes for Patients with Chronic Pain (n=99)*
*p<.05

46. MBSR Research at Jefferson

47. Change in NKCA following in Relationship to Improvement in MCS

48. n=48 RCT EEG: ↑left prefrontal cortex activation

49. Mindfulness supports Resilience
Resilience the ability to respond constructively to life.
Mindfulness feeds resiliency in 4 main ways
Sensitivity increases to notice challenges
Self calming by slowing down habitual reactions
Experiencing comfortable and uncomfortable emotions and sensations with conscious choices
Recovering- shifting attention to the present without self judgment or inner commentary
kids

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 cravings
8 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 Teens
Teenage 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 News
If 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 Teens
mindfulness 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 Zone
Placing attention on the task by accepting internal and external distractions.
Allowing them to be as they are
When 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. Mindfulness
Sometimes 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

65. The Time is NOW

66. Between the stimulus and the response there is a space.
Within that space lies our freedom Victor Frankel