Introduction to Mindfulness

Alexandra Arbogast, LICSW, RYT, CMT Presenter Alexandra Arbogast, LICSW, RYT, CMT Program Coordinator & Therapist Mind-Body Medicine Program Internal Medicine / Warrior Clinic / NICoE WRNMMC 301-319-4960 / Alexandra.S.Arbogast.ctr@mail.mil

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

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

Mindfulness

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.

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

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

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.

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.

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

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

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

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 2011-2012 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

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.

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

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!

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

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.

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

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

Helps Balance the Nervous System Mindfulness… Helps Balance the Nervous System

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

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

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

Relaxation Response Some more on the relaxation response and its benefits

Improves Self-Regulation Mindfulness… Improves Self-Regulation

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

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

Let’s Practice!

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.

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.

Next Steps

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

Questions or Comments Alexandra Arbogast: 301-319-4960 / Alexandra. S Questions or Comments Alexandra Arbogast: 301-319-4960 / Alexandra.S.Arbogast.ctr@mail.mil