1. Mindful enquiry and dialogue to support change in CFS/ME
Fiona Wright Occupational Therapist.
Rhonda Knight RGN
Trained patient Volunteer

2. Objectives Reflect on how mindfulness can support change
Reflect on what changes can/could happen
Understand and practice a model of mindful enquiry and dialogue
Consider if this can be used in evidenced based practice.

3. Plan of session
Introductions –experience of MBCT – personal, clinical etc. (5mins)
Practice and whole group dialogue (15 mins)
Patient experience of change though mindfulness (10 mins)
Mechanisms of mindfulness and Model of enquiry (10 mins)
Practice (5mins)
Enquiry and dialogue in 3s (20 mins)
Whole group discussion/reflection
What next?

4. Personal History of CFS/ME
diagnosed with CFS/ME five years ago at the NBT CFS/ME clinic
knew nothing about it, except for the unfortunate description of “yuppie flu”
however on reflection, I probably had been living with the symptoms of CFS/ME since my late teens
always had an explanation for the cluster of symptoms I was experiencing
sore throat and swollen lymph nodes (heavy teaching load)
joint and muscle pain (walked/cycled too far)
fatigue (busy week)
post exertional malaise (lazy/getting old)
brain fog (maybe I WAS depressed/getting dementia?)
severely impacted on my personal and professional life over the years – always felt I had never reached my “potential”

5. Introduction to mindfulness
was invited to participate in an 8 week mindfulness programme (MBCT)
wondered how it could help me
BUT was willing to try anything that might improve my quality of life
if only I knew then that “mindfulness is about embarking on an adventure of a lifetime, and that it’s a lifelong adventure” (Jon Kabat Zinn)
would I have started? I didn’t realise what I was committing myself to!
initially was really sceptical, especially about the guided meditations
“Get a grip!” – how can I breathe through my toes? I use my lungs!!”
also kept falling asleep during the body scans
felt that I was failing yet again
however, explanations of mindfulness were supported by reference to research/literature by FW
being an academic, that helped me to maintain my commitment to practice – it was evidence based!

6. Turning point
slowly began to realise that mindfulness is about being curious about what is happening in the “here and now”
became aware of when my thoughts were getting side tracked
and noticing when I was falling asleep/waking up was actually being mindful
gradually learnt not to berate myself, but to come back to the practice and refocus on my breathing
so I wasn’t failing at being mindful!!
the real turning point though happened in week 6 of the programme, in the session entitled “Thoughts are not facts”
I’ve always tried to be kind and compassionate towards others, but why was I so judgemental, harsh, uncompassionate and angry towards myself?
I wouldn’t treat anyone else that way!!
Thoughts are just thoughts, not FACTS

7. Changes in my life due to MBCT
am more aware of my emotions, thoughts and where I feel them in my body
now more of a “half full cup” person instead of a “half empty one
see the world in a more positive light
feel more in control of my life
choosing how to react/respond to what “life throws at me”
learning to adopt the seven attitudinal factors of mindfulness in my life:
non-judging: less criticism of self and others, resulting in
patience: more patient with self – taking care of myself
beginners mind: continuing to learn new things in my mindfulness practice
trust: in myself (eg: What do I need to do now?)
non-striving: more being, less doing, so fewer episodes of “boom and bust”
acceptance: of my diagnosis, a different lifestyle “Right now, it is like this!”
letting go: unfinished PhD – but still using my skills, just not in the way that I envisaged

8. How did this all happen? to tell you the truth, I have no idea!! BUT
was repeatedly reminded to be “kind and gentle” in the guided meditations
encouraged to be curious about my experience during the mindfulness meditations
“What am I experiencing right now?”
given the opportunity to reflect on my homework practice in each session
started to take care of myself by asking myself
“What do I need now?”
“What do I need to do now?”
noticed changes in how I was thinking after engaging in the written homework
less of the old powerful thoughts – “I’m so lazy/useless/hopeless”; “I’m such a failure”; “I’m a real fraud/not really ill”
also old behaviours were changing
not so helpless, fearful, anxious, detached or such a tearful victim of a LTC

9. My life now living with CFS/ME?
continue to engage with my daily mindfulness practice
still live with the symptoms, but I now enjoy what I do, in spite my limitations
accept that there will be times when I have a relapse – don’t fight it so much now and don’t get so angry
regret the past less, and don’t worry so much about the future – saving energy for today
a much less fearful, timid and anxious person
instead of living with the multitude of negative emotions, thoughts and behaviours, I now try to live mindfully, using the liberating mantra of an unknown author:
“Replace fear of the unknown with curiosity”

10. Mechanisms of mindfulness (Shapiro et al 2006)
intention
attitude
attention

11. Link with patients experience
Attitude
was repeatedly reminded to be “kind and gentle” in the guided meditations
Attention
“encouraged to be curious What am I experiencing right now?”
Intention
“What do I need to do now?”

12. A meta mechanism: Reperceiving
Through the process of mindfulness, one is able to disidentify from the contents of consciousness (i.e., one’s thoughts) and view his or her moment-by-moment experience with greater clarity and objectivity. We term this process reperceiving as it involves a fundamental shift in perspective. (Shapiro et p 377)
“Replace fear of the unknown with curiosity”

13. Mindful Enquiry- same mechanisms as practice?
Attitude
- Not knowing
- Curiosity
Kindness
Embodied
Permission
Flexiblity and letting go
Attention
“encouraged to be curious What am I experiencing right now?” and what is participant experiencing?
Trusting what emerges
Intention
“What do I need to do/ask now?
Curious
Not fixing- foster discovery

14. Layers of enquiry- start at the centre
Direct experience: feeling; seeing tasting, hearing; smelling, noticing that the mind wanders away into thinking
What was that like? what did you notice? What did it feel like? And? anything else you noticed?
Thoughts about this, making sense of the experience; memories that are evoked; stories
How did you feel when....?
What did you do? What did you make of that?
Linking to concepts eg beginners mind, trust; patterns in my life; how can I use this insight and understanding.
PIck up theme of session from the enquiry- automatic pilot, being wiht difficulty, self care etc

15. First or central layer Direct experience:
feeling; seeing tasting, hearing; smelling, noticing that the mind wanders away into thinking
What was that like? what did you notice? What did it feel like? And? anything else you ntoticed?

16. Second layer- Thoughts about this
making sense of the experience; memories that are evoked; stories
How did you feel when....?
What did you do?
What did you make of that?

17. Third layer -Linking to concepts
Making sense of observations, both personally and the theme of the sessions etc. automatic pilot; dealing with difficulty; self care etc.
Awareness of how the mind/body functions- e.g. tendency to critical thinking etc.

18. In any inquiry process, it is important that the teacher takes time with each ‘circle’ and, if the group rushes to discuss or ‘talk about,’ to allow time for participants to come back to simply describing what they noticed. There is no need to stick rigidly to a certain ‘progression’ through the inquiry; it is better for the teacher to see the ‘circles’ as a map of the territory that might be covered in a range of ways depending on what is emergent within the group.
(MBI TAC 2016)

19. curious, embodied and kind!
Exercise
Whole group practice
In 3s practice enquiry- 5 mins each
1 person enquirer; 1 person enquiree 1 person observer
Remember – attitude- friendliness, trust, let go of fixing, achieving; curiosity, sensation. Keep coming back to the centre
Observer- notice own experience as well as what the pair are doing
Keep it simple,
curious, embodied and kind!

20. Taking it further
Effective enquiry seems to be linked to the therapists qualities of warmth, curiously ,patience etc. rather than technical skill (i.e. key features of therapeutic relationships) (Pollack et al 2014)
Related depth of therapists personal mindfulness practice and self enquiry (Segal et al 2013)
So practice and go on retreats!
Have Mindfulness based supervision (peer as well as formal)
Mindfulness training programmes run workshops on enquiry – see CMRP and Breathworks

21. Keep it simple, curious, embodied and kind!

22. References
McCown, D. Reibel, D. & Micozzi, M. S. (2010). Teaching Mindfulness: A practical guide for clinicians and educators. New York: Springer.
MBI TAC
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse (Second Edition). New York: Guilford Press.
Crane, R. (2009)Mindfulness-Based Cognitive Therapy: The CBT Distinctive Features Series. Routledge, NY.
Crane, Rebecca S., Stanley, Steven, Rooney, Michael, Bartley, Trish, Cooper, Lucinda and Mardula, Jody Disciplined improvisation: characteristics of inquiry in mindfulness-based teaching. Mindfulness 6 (5) , pp /s