1. An introduction to the clinical utility of mindfulness
Dr. Nic Hooper

2. Outline of Lecture History of Mindfulness What is Mindfulness?
Typical Mindfulness Practises
Research and Evidence
Introduction to cbt and the third wave

3. History of Mindfulness
Mindfulness and Buddhism
Originated from the Buddhist tradition
7th step of the noble eight fold path as taught by the originator of Buddhism, Siddhartha Gautama
Mindfulness led to the ‘cessation of personal suffering’
Although taught as part of Buddhism, there is nothing religious about mindfulness

4. History of Mindfulness
Mindfulness and the West
Jon Kabat-Zinn created Mindfulness Based Stress Reduction (MBSR) in 1979 to treat chronically ill
Subsequently a number of other third wave psychological therapies using mindfulness techniques developed; ACT, MBCT
Currently a hugely popular technique receiving a plethora of research in its favour
Talk about 1st, 2nd and 3rd wave a little

5. What is Mindfulness?

6. Definition of Mindfulness
“…paying attention in a particular way:
on purpose,
in the present moment,
and nonjudgmentally”
(Kabat-Zinn, 1994, p.4)

7. Dimensions Control of attention Willing / accepting stance
Bringing your mind back to the present moment
Willing / accepting stance
It’s not primarily about altering a feeling state

8. Some Contrasts
Relaxation
Distraction

9. Relaxation It has been suggested that mindfulness is simply relaxation
However relaxation has been shown to be very different from mindfulness
Namely, most clinical mindfulness skills induce an active state in clients where psychological issues are addressed

10. Relaxation
Ditto, Eclache and Goldman (2006) and Jain et al (2007) compared the effects of mindfulness versus relaxation
In terms of physiology, Ditto et al (2006) found that brain activity/cardiovascular effects were different between the two
In terms of self report, Jain et al (2007) found that while relaxation and mindfulness both reduce distress and foster positive mood states, only mindfulness reduces distractive and ruminative thoughts
How would relaxation help us in everyday life? When clinical issues are arising

11. Distraction
It has also been suggested that mindfulness is a sophisticated form of distraction
Thought suppression

12. Distraction
McHugh Simpson & Reed (2010) compared distraction and mindfulness amongst an older population on a decision making card selection task
They found that mindfulness enhanced decision making performance. Distraction worsened it
Suggesting that different processes are at work
Broderick (2005) showed similar results in an induced mood study

13. Important things to know about Mindfulness

14. Mindfulness is experiential
Intellectual v. experiential / Knowing v. doing (may not be the same thing)
How do we teach people to ride a bike?

15. The importance of practise
The more you practise, the better you get!
Brefczynski, Lutz, Shaefer, Levinson and Davidson (2007) experienced ( hours) participants were performing an attentional focusing task using less neural resources
Stage 1: Noticing in the present moment
Stage 2: Noticing non-judgementally in the present moment
Stage 3: Rolling out these skills across life

16. Metaphors and Mindfulness
Metaphors often help to explain situations with more clarity
They can be used to aid an understanding of mindfulness
The Puppy; notice your “puppy-like” mind.
Leaves on a stream

17. The anti-thesis of Mindfulness
Mindfulness is an acceptance based strategy that is directly opposite to avoidance
Avoidance of unwanted thoughts can lead us to narrow our behavioural repertoire
Mindfulness enables us to come into contact with unwanted thoughts, without it affecting the way in which we act

18. Thought suppression and behavioural avoidance

19. Typical Mindfulness exercises

20. Traditional MFN practices
Breath
Body
Sounds
Yoga / Walking MFN
Eating
(generalisation is essential)

21. Breath “Sustained single focused attention” …focus on your breath
…the mind will wander*
…when it does, note where its wandered …try not to get caught up
…bring yourself back to your breath
* to memories, sounds, thoughts, feelings, physical discomfort, urges, etc.
Breath is a constant, gives us somewhere to build from.

22. Body Scan Awareness of current physical sensations
Moving attention Noticing automatic responses (run… distract… change)
Trying to do things differently: willingly experiencing discomfort noticing and still “going there”

23. Itch / Scratch Noticing and playing with urges
Understanding the thought action link

24. Walking/Eating Mindfulness
A bridge between mindful living and mindful practise
A great way to bring mindfulness into our everyday lives
The raisin task as popularised by Kabat-Zinn

25. Informal Practice
Getting people to notice when their behavioural repertoire narrows or starts moving in a non-valued direction in the moment
Check in / What’s coming up? / What’s going on under the bonnet?
Pacing, Exercise, Role-Plays

26. Case Vignette

27. Case Vignette
Jack – a burly 15-year-old with severe, intractable back pain
Often either inactive and fearful of his pain or trying to ‘push through it’ (sadly, unsuccessfully)
Had become more angry, family saw risk of lashing out. Both he (and his family) avoiding risky social situations
Pain driving the bus metaphor

28. Case Vignette Initially, he didn’t see the point of mindfulness
Being in the group helped, he learnt by proxy. Started to buy into the idea of “surfing” sensations
With widened attention Jack discovered that ‘pain’ was actually a bundle of sensations including fears, frustrations and urges to move or avoid

29. Case Vignette
Started being able to see his angry thoughts as ‘just thoughts’ - surfing urges without doing anything impulsive
When asked about these situations at the end of the programme, he laughed and said: ‘I know I can bring the puppy back!’

30. Research and Evidence

31. Mindfulness and anxiety
Kabat-Zinn et al (1992) gave 22 patients with Generalized Anxiety Disorder (GAD) 12 week MBSR
Found significant improvements in measures of anxiety (and depression) at 3 month follow up
Miller et al (1995) did a three year follow up with the same patients
Found that the gains had been maintained

32. Mindfulness and depression
Teasdale et al (2000)
Depressed patients either received MBCT or Treatment as Usual (TAU)
Results showed that those who received MBCT were significantly less likely to relapse into depression

33. Mindfulness and chronic pain
Randolph et al (1999) gave 78 chronic pain patients MBSR
Patients showed improvements in;
Ratings of pain
Other medical symptoms
General psychological symptoms
Changes were maintained at follow up

34. Mindfulness and smoking cessation
Gifford et al (2004) gave ACT in 7 individual/group sessions vs. the standard Nicotine Replacement Therapy
Results showed that significantly more participants had maintained their abstinence at 1 year follow up in the ACT group

35. Mindfulness and eating
Tapper et al (2009)
68 women
All trying to lose weight
Given either a mindfulness/control intervention
2 four hour workshops
Results; women in the mindfulness condition lost more weight and also reported exercising more at 6 month follow up

36. Mindfulness and phobia
Hooper, Davies, Davies & McHugh (2011)
Comparison of mindfulness vs. thought suppression in the management of spider fear
Participants underwent a 10 minute intervention before completing a Behavioural Approach Test (BAT)
Participants also completed anxiety measures pre and post BAT

37. Behavioural Approach Test (BAT)
Move 1 metre to the table
Move 1 more metre to the table
Approach the table
Touch the jar for more than 10 seconds
Lift up the jar
Open the jar
Touch the spider with a pencil for more than 10 seconds
Remove the spider from the jar
Touch it with a finger for more than 10 seconds
Put the spider on their hand

38. Results – BAT data

39. Results – STAI data

40. Mindfulness and care giving
Singh et al (2003)
Gave caregivers of adults with profound multiple disabilities an 8 week mindfulness course
Results showed that the patients of those caregivers given mindfulness training became significantly happier during interactions with them

41. Mindfulness and aggression
Heppner et al (2008)
Gave half of the participants a mindfulness intervention (5 minute raisin task) before completing a social rejection task, known to induce aggression
Results showed that those given the intervention displayed less aggression/hostility than their control condition counterparts

42. Mindfulness meta analysis
Baer (2003)
Performed a meta-analysis on 21 adult mindfulness studies of adequate quality
Conditions included chronic pain, anxiety and depression
Large mean effect size post treatment (0.74, SD=0.39 [Cohen’s d]) medium effect size at follow-up (0.59, SD=0.41)
“…may bring participants with mild to moderate psychological distress into or close to the normal range” (pp.137)

43. Mindfulness meta analysis
Grossman et al (2004)
Reviewed 64 studies
Found consistent improvement and relatively strong effect sizes across:
Mental health (e.g. depression, anxiety, coping style) physical well-being (e.g. medical symptoms, sensory pain, physical impairment, and functional estimates)

44. Summary
Mindfulness seems to be making huge strides in terms of research
However, to avoid the current criticisms levelled at CBT
A huge emphasis will have to be placed on the processes at work in mindfulness
Exposure
Willingness
Meta-cognition
Control of attention