1. Mindfulness

2. Aims of this session Introduction to mindfulness How it helps depression and anxiety Relaxation exercise Research Questions Interactive

3. History of mindfulness Practised in both Eastern and Western religions and philosophies. Modern society also aware of it through Yoga, Tai Chi, Qi Gong, Meditation and Sport training.

4. What is mindfulness? Full mind on what is happening now Awareness Noticing whats happening without commenting Attentiveness to this moment Simply being present

5. Qualities of Mindfulness Spaciousness

6. Feeling at ease

7. Benefits of mindfulness Stepping back to allow a objective view of the internal or external experience. Spontaneously produce insight into ones behaviour, allowing lasting change.

8. Depression and Anxiety Internal and external stimuli trigger a response. The physical, mental and emotional aspects feed off each other, eg thought of vulnerability – fear – hyperventilation Hopelessness – sadness – tiredness

9. Habitual Patterns

10. Habitual patterns Conditioning of present response by past events A bad experience as a child produces a unconscious, and disproportionate fear response as an adult, eg fear of dogs Depression follows an often well travelled, previously conditioned train of thought, spiralling down to despair. Disproportionate to the present stimulus.

11. Relaxation exercise Stop thinking for a while Thinking is necessary for anxiety and depression to persist. Withdrawing thought starves the negative pattern of “fuel”, resulting in cessation. Perseverance and practise are needed for success.

12. How to relax Put attention into the body and sustain attention there. E.g. the breath. Double benefit of abdominal breath awareness for anxious people. Frequent, short periods, at least to begin with. To fit in with the persons lifestyle

13. Teaching awareness exercises Quick and easy, fits into a ten minute consultation. Adjunct to other treatment. Build a new resource for the future. Try it now. Information sheet.

14. Doing it Sit comfortably. Hand over solar plexus. Close eyes. Notice the hand, notice the rising and falling. Follow the downward motion of the out breath down towards the feet. Notice sounds, light, the body. If one starts thinking return attention to the hand. Open your eyes when ready.

15. Make it a new habit Lying in bed, sitting with a cup of tea etc. Not when ones attention is needed elsewhere eg driving. 2-3 minutes, stop when one’s enjoying it. Do it several times a day ideally. Re-focusing ones mental energy, mindfulness will eventually enter activities without trying.

16. What is going on in the world of mindfulness? Jon Kabat-Zinn UMMS Full Catastrophe Living (1990) http://www.umassmed.edu/cfm/http://www.umassmed.edu/cfm/ Bangor university. http://www.bangor.ac.uk/mindfulness/ Oxford university, Prof Mark Williams http://cebmh.warne.ox.ac.uk/csr/mbct.html

17. What is going on in the world of mindfulness? Mindfulness based stress reduction (MBSR) mindfulness based cognitive therapy (MBCT) http://mbct.co.uk/http://mbct.co.uk/ Endorsed by NICE.

18. Research (i) Randomised clinical trial [Kabat-Zinn, Wheeler, et al 1998] Psychosomatic Medicine, 60, 625-32  Patients with moderate to severe psoriasis undergoing phototherapy(UVB) or photochemotherapy (PUVA) Listened to guided meditation tapes while receiving the ultraviolet light treatments Healed at approximately four times the rate of subjects receiving just the light treatments

19. Research (ii) Kabat-Zinn, J., Massion, A.O., Kristeller, J., et al. (1992) Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders American Journal of Psychiatry, 149, 936-943

20. Research(iii) Mindfulness-Based Cognitive Therapy (MBCT) 8-week MBSR course with added elements of Cognitive Behaviour Therapy Professor Mark Williams, Dr John Teasdale, and Professor Zindel Segal to address the problem of relapse and recurrence in clinical depression.

21. (iii-continued) randomisation to continue with treatment as usual or, in addition, to receive MBCT (Teasdale et al., 2000). RCT, 145 recovered (but recently and recurrently depressed) patients in the community the following year, for those with 3 or more previous episodes of depression, MBCT treatment significantly reduced relapse from 66% (control group) to 37% (treatment group). These results have recently been replicated in another, as yet unpublished, RCT (Ma and Teasdale, 2002).

22. The Future locally. ? Set up a mindfulness training programme. ? Set up a mindfulness group for health professionals and/or patients.