1. Mindfulness for meditation haters: appliance of heartrate coherence training in ACT Marco Kleen MSc BrainDynamics Groningen / PsyAdvies.nl University of Groningen marcokleen@hotmail.com1

2. Mindfulness: definitions Skill: being present, observing one’s experiences in a non-judgemental way no matter how aversive those experiences may be Attitude: compound factor of four ACT processes in the hexaflex (acceptance, being present, defusion and self-as-context) marcokleen@hotmail.com2

3. Disadvantages of formal mindfulness training Resistance against meditation-like techniques Religious objections Time investment Dogmatic appliance marcokleen@hotmail.com3

4. Goals Pragmatic mindfulness Function of the excersize is more important than the form Increase accesibility of mindfulness for ‘meditation haters’ Research biological marker of mindfulness marcokleen@hotmail.com4

5. Heartrate variability Variance of interval between heartbeats Sympathetic and parasympathetic ANS Reflects emotional functioning (among other variables) marcokleen@hotmail.com5

6. Coherence Chaos

7. Coherence vs chaos Coherence  focussing on breath, acceptance, being open minded, focussing on present, mindfulness. Technically: dominance of 0.1 Hz frequency. Chaos  problem solving, non-acceptance, experiential avoidance Being coherent can be trained  Heartrate Coherence Training (HCT) marcokleen@hotmail.com7

8. Applications Heartmath Emwave® protocol (= HCT; counterconditioning). Primairy goal: symptom (stress) reduction HCT adapted to the hexaflex (HCT-ACT) ‘mindfulness through heartrate coherence training’. Primairy goal = practical mindfulness marcokleen@hotmail.com8

9. HCT-ACT Heartmath ® Freeze Framer/Emwave: easy to use biofeedbackprogram Low intensity: 3 x 7 minutes per session Homework: 10 minutes a day marcokleen@hotmail.com9

10. Two Phases Phase 1. Skilltraining Phase 2. Exposure marcokleen@hotmail.com10

11. Phase 1: skilltraining Teaching basic mindfulness Focus on breath Focus on bodily experiences Focus on thoughts (self as process) marcokleen@hotmail.com11

12. Phase 2: exposure Graduated exposure Teaching clients to be accepting and curious towards aversive emotions, thoughts, memories Autobiographic material, symbolic letters, photographs, imaginary exposure, exposure in vivo, hyperventilation provocation marcokleen@hotmail.com12

13. Pilotstudy Pre-posttest design: Mindfull Attention Awareness Scale (MAAS) Avarage weighted cohrence scores (GGC’s): - low = 0 - medium = 1 - high = 2 T0: Baseline T1: After skilltraining T2: First exposure T3: Last exposure marcokleen@hotmail.com13

14. Population N =7 clients refered to outpatient mental health facility for psychotherapy Experiential avoidance marcokleen@hotmail.com14

15. Primairy results Qualitative: positive reactions of clients, automatic generalization of techniques in daily life, no dropouts Quantitative: paterns of coherence and self reported mindfulness in accordance with predefined hypotheses marcokleen@hotmail.com15

16. Hearrate coherence marcokleen@hotmail.com16 Mean weighted coherence scores Wilcoxon Signed Ranks test, p < o.o5

17. Mindfulness marcokleen@hotmail.com17 Mean self-reported mindfulness (MAAS) Wilcoxon Signed Ranks test, p < o.o5

18. Conclusions Mindfulness throught HCT-ACT seems feasable HCT increases mean weighted coherence scores and mean selfreported mindfulness Heartrate variability may be a biological marker for mindfulness marcokleen@hotmail.com18

19. Restrictions Small non-randomized group Control of breath? Enthousiasm researcher marcokleen@hotmail.com19

20. Publication Kleen, M. & Reitsma, B. (in press). Mindfulness door middel van hartslagcoherentietraining. De toepassing van biofeedback in Acceptance and Commitment Therapy (ACT). Psychopraxis, summer 2009. Mindfulness through hearratecoherence training: appliance of biofeedback in Acceptance and Commitment Therapy (ACT). marcokleen@hotmail.com20

21. LIVE DEMONSTRATION marcokleen@hotmail.com21