mindfulness & hypnosis Stewart Mercer & James Hawkins

what is mindfulness?  Kabat-Zinn (Full catastrophe living, 1990): paying attention in a particular way, on purpose, in the present moment and without judgement.  Bishop et al (Mindfulness: a proposed operational definition, 2004): The first component involves the self-regulation of attention so that it is maintained on immediate experience … the second component involves adopting a particular orientation toward one's experiences in the present moment … that is characterized by curiosity, openness, & acceptance there are several quite widely used definitions:

mindfulness: two helpful lenses one lens sees mindfulness interventions as adaptations of various traditional Buddhist meditation practices  Mindfulness-based stress reduction (MBSR); Mindfulness- based cognitive therapy (MBCT); Mindfulness-based relapse prevention (MBRP); Loving-kindness meditation and Compassionate mind training (CMT).  This is where the current flowering of scientific interest in the clinical possibilities of mindfulness began.  Research grows showing the value of these approaches.  There are interesting & important questions about the mechanisms involved e.g. improvements in mindfulness, self-compassion, experiential tolerance, self-regulation …

mindfulness: two helpful lenses a second lens sees mindfulness as a useful attentional and attitudinal mode which can be encouraged in a variety of ways – of which meditation is only one  Here mindfulness is considered to overlap with a number of related concepts – attention, acceptance, de-centring, cognitive defusion, metacognition, openness, compassion  There are a series of so-called “Third wave” cognitive behavioural therapies that emphasise developing a different response to distressing experience rather than trying to challenge the content or alter the experience  These include mindfulness training, metacognitive therapy, acceptance & commitment therapy, DBT, etc

the buddhist noble eightfold path  wisdom:  right understanding & right intention  ethical conduct:  right speech, right action, right livelihood  meditation:  right effort, right mindfulness, right concentration to relieve suffering & lead to self-awakening the eightfold path divides into 3 basic divisions

buddhist meditation NICE guideline for generalised anxiety NICE guideline for recurrent depression marshmallow research & child NZ study right effort rightmindfulnessrightconcentration

broad to narrow focus spectrum narrow focus effort, depth peacefulness mindfulnessconcentration broad focus awareness acceptance

mindfulness meditation works a wealth of emerging research demonstrates the value of mindfulness practice both for patients & practitioners  tested across a broad range of problem areas – depression, anxiety, substance abuse, eating disorders, chronic pain and a variety of chronic medical conditions  tested too with diverse populations – adults, adolescents, children, parents, teachers, students, therapists, doctors  meta-analysis (39 studies) – Hofmannn, S. G., et al. (2010). "The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review." J Consult Clin Psychol 78(2):  systematic review (15 studies) – Merkes, (2010). "Mindfulness- based stress reduction for people with chronic diseases." Aust J Prim Health 16(3):  well over 200 studies in my personal database & growing!

research challenges include  better quality research – for example more studies that compare mindfulness meditation approaches with active alternative treatments (like applied relaxation), better controls for example for allegiance effects  improved understanding of the important therapeutic mechanisms – reduced reaction to potentially upsetting thoughts/emotions/events (especially spirals of rumination & worry); reduced internal/external avoidance; reduced self-judgement & increased self-compassion; increased self- control/emotion-regulation; relevance of home practice to changes in mindfulness; increased value-driven action  better integration with other interventions – for example value-driven action, broader health practices, concentration meditation forms, other seven aspects of the eightfold path!

other “mindfulness approaches” there are a whole series of emerging therapeutic approaches that include an emphasis on mindfulness & acceptance rather than trying to change difficulties  Compassionate mind training (CMT)  Acceptance & commitment therapy (ACT)  Metacognitive therapy (MCT)  Functional analytic therapy (FAP)  Behavioural activation (BA)  Integrative behavioral couple therapy (IBCT)  Dialectical behavior therapy (DBT)

other “mindfulness approaches” a recent excellent overview of this field is provided by: Hayes, S. C., M. Villatte, et al. (2011). "Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies." Annual Review of Clinical Psychology 7(1): A wave of new developments has occurred in the behavioral and cognitive therapies that focuses on processes such as acceptance, mindfulness, attention, or values. In this review, we describe some of these developments and the data regarding them, focusing on information about components, moderators, mediators, and processes of change. These “third wave” methods all emphasize the context and function of psychological events more so than their validity, frequency, or form, and for these reasons we use the term “contextual cognitive behavioral therapy” to describe their characteristics. Both putative processes, and component and process evidence, indicate that they are focused on establishing a more open, aware, and active approach to living, and that their positive effects occur because of changes in these processes.

four aspects of helpful inner focus exploring & processingencouragingmindfulness reducing negative states nourishing positive states