1. Introduction to Mindfulness
Katy James
Clinical Service Lead – West Norfolk Wellbeing Service
Chartered Counselling Psychologist, CBT Psychotherapist, CAT Practitioner, Mindfulness Teacher
General introduction to yourselves as presenters
Introduce that you work as part of the Wellbeing Service, which is an NHS service to help people to take steps themselves to manage common symptoms of stress, anxiety and low mood before they get too entrenched.
We want to make it as easy as possible for people to get access to help and these sessions we hope help people decide if they want to take the next step and which part of the service might suit them best.
At the end of the session we will give you a range of options you can choose from to take next steps.
You may also decide this is not the right service or right time for you or you may have come along on behalf of a friend or family member and just coming to find out more information.
As an NHS service we ask you to complete your details as a record that you have attended and this is kept in line with data protection, we will not inform your GP unless you decide to access our full service or indicate a risk to yourself on the forms.
If you have any questions do feel free to ask us at the end of the session today.
In today’s session you can listen and are free to ask questions as we go along if you wish, although we will not ask you to speak to us and you are welcome to listen quietly.
EQUIPMENT NEEDED:
Mindfulness Handouts
Stress Control dates
Top tips booklet
Options form
MDS
Self referral form
Projector and laptop

2. Overview CBT and mindfulness What is mindfulness?
Why is mindfulness useful?
Mindfulness practices.
Everyday Mindfulness
What is the Wellbeing Service?
Here is an overview of the topics we will be covering
Go through the headings

3. CBT and beyond! Move from: thought content…
Finding and analysing ‘evidence’
Scientific, Socratic method
To: Thoughts (beliefs) about thoughts!
Patterns of thinking or thoughts as ‘mental events’
Traditional CBT looks at what we think and takes a scientists approach to this. What are the themes – what is the evidence for these thoughts, or beliefs. For example – a person with panic disorder who believes: if I go to the supermarket I’ll get so anxious that I have a heart attack/faint/go mad/act in a way that is socially ‘weird’! Leading to avoidance which provides implicit evidence – see, I’m only still alive/not mad/conscious, etc because I haven’t been out! We will look for evidence, indeed construct experiments where we go out and find this evidence.
Similarly in depression, we can identify negative thoughts about the self (I’m a failure’), the world/others (‘other people see I’m a failure and will judge me’) and the future (‘Things will always be like this’)- this is Beck’s negative cognitive triad. We do similarly, looking for evidence (cognitive restructuring), and actively seeking evidence, (directly through experimentation), or indirectly though behavioural activation (doing more, which we know makes us feel better, and gives us opportunities to notice positives).
This work is effective (or at least as effective as medication – and cheaper with less relapse!), but there can be problems of generalisability, and in some cases (e.g. GAD) an effect of increasing focus on thoughts which can be counterproductive, these tend to be a feature of a group of treatment resistant clients – this is the often sited phenomenon from therapists that they manage to challenge one distorted belief, and another one pops up about something different!
CBT treatments have been becoming more and more sophisticated (or perhaps simpler?!), GAD being a good example of where metacognitive approaches have taken off – instead of looking at the content of thoughts, we look at the beliefs that people hold about their thoughts themselves. Examples of this are (and I know we will all have heard these before (or even held them ourselves!)- “worrying helps me to solve problems”, “if I think the worst, then I will be prepared for it” (or, even more infuriatingly): “If I think the worst, then I can’t be disappointed”. These types of beliefs make it hard for therapist and client to work together, as their goals are at odds – the therapist want the client to worry less, but the client fears this will mean they cannot problem solve etc so will hold on to this mental behaviour. There are also negative beliefs about cognition which can also cause problems, such as “if I worry to much then I will go mad!”, “I just can’t stop myself thinking – I’m totally out of control!”).
Working we thoughts on this meta level (thoughts about thinking) have led to new approaches to thoughts, advancing the idea of ‘thoughts are not facts’, less in terms of needing to come up with evidence to prove thoughts wrong, but looking at thoughts as mental events. Some approaches work on the belief in the controllability of thoughts via focusing exercises etc– such as in the case of worry, whilst other approaches work on the acceptance of thoughts as phenomena to be observed, but that do not have any more inherent meaning or significance than any other sensation or experience (such as hearing a sound, or experiencing an increased heart rate). The same approach is then taken to emotional states (BPD), and physical states (pain).

4. What is mindfulness? Mindful Awareness Turning off the autopilot
“we only have moments to live!” Jon Kabat-Zinn
Best way to find out what it is – give it a go!
exercise
Mindful Awareness: Though mindfulness has Buddhist origins, the practice of mindfulness is non-religious, and is simply deliberately paying attention to the present moment, without judgement. It is used within health contexts throughout the world, for helping people with chronic pain, anxiety, depression, and long terms physical health conditions. It is also used in education contexts, and increasingly, in the workplace.
Turning off the Autopilot: Do you ever have the experience of having been driving or walking, or doing some activity, and suddenly realising that time has passed and you have been caught up in your mind and thoughts, not paying attention to what your body has been doing? This is being on autopilot. We can spend so much time caught up in our thoughts that we can miss out on actually what is going on for us. This means we can miss out on pleasant and important experiences. Being stuck in your thoughts can also mean that we get caught in unhelpful patterns of thinking, such as worrying and the future, or ruminating about the past, whilst missing out on the current moment, and ending up feeling low or anxious. We’ll talk about this more later.
Exercise – raisin exercise or similar, ask for feedback.
15mins

5. Why do mindfulness? The nature of minds ‘Tiger’ exercise
Viewing thoughts as passing mental events
Observing vs judging
Being vs doing
Mindfulness of the breath - grounding
Our anchor to the present moment
The nature of minds – As mentioned earlier, and as you will have noticed in the previous exercise – our minds do what minds do – they think, explore, analyse, categorise… This is not a problem in itself, in fact it can be very helpful to us when we have a problem to solve, or things to figure out! However, sometimes we can get caught up in patterns of thinking that do not help us, they distract us from what we are doing, and at worst, lead us into patterns of worry or rumination that affect our emotional states and our behaviour.
Tiger exercise – ADD SCRIPT
- feedback from this will be that people’s mind manipulated the tiger, maybe got cuaght up in a story, such as the tiger hunting, or being tired etc. may have noticed emotional responses to the tiger…
Viewing thoughts as passing mental events: Ultimately, the practice of mindfulness allows us to observe our thoughts, rather than getting caught up in them. Just as we can observe the sky and the clouds passing through it, or a river, with leaves or twigs flowing down it, we can observe thoughts as passing through our mind, without becoming caught up and/or distressed by these thoughts. This involves a position and intention to observe, rather than judge our thoughts and experiences in the moment. It is the difference between being (noticing) and doing. But this involves practice!
Mindfulness of the breath – just basic grounding, connecting to the ground and following a few breaths.
10-15mins

6. Mindfulness practice Short body scan – 10mins with 5 min feedback
Practice this -
Choose one short 10-15min practice from:
Mindfulness of sounds
Mindfulness of seeing
Mindful Walking
10min feedback

7. Everyday mindfulness ‘Formal’ practice
Incorporating mindfulness into routine activities:
Brushing your teeth
Answering the phone
Turning on the ignition/light/computer
Eating
Washing the dishes
Finding time to set aside to a formal practice, such as extended versions of the body scan and mindfulness of breath that we have practiced, or indeed any of these practices we have covered today, is ideal for learning the skill of mindfulness. This is best done with guidance from a CD or a book and we will give you a handout with a list of these resources that you can download for free, or find in the library or purchase yourself. But it is just as important, and useful, to bring mindfulness into as many aspects of your day to day life as possible.
Here are a few examples, and a hand out with more!
Remember that all you are doing is bringing your attention to the activity, or the breath, and noticing/observing anything that you experience in that moment: sensations, feelings, thoughts, tastes, sounds etc… Not judging these as desirable or undesirable, but simply observing them as they occur, in the moment.
Another quick grounding technique that you might want to use in your day is the breathing space, which is what we are going to finish with today.
After this we will take you through a bit of information about the Wellbeing Service and other things we provide, and there will be a chance for questions about mindfulness or the Wellbeing Service.

8. Breathing Space Breathing space and poem. 5mins Poems:
August Morning – Albert Garcia
Meditation on a grapefruit – Craig Arnold
Smart Cookie – Richard Schiffman
Morning – Krista Lukas
(The Last Things I’ll Remember – Joyce Sutphen) – for walking practice?
Questions (limit this if needed)

9. How Does Our Service Work?
A step by step approach
Helping you to help yourself
Become your own therapist
Face your fears
Practical techniques to help you achieve your goals
The Wellbeing Service:
As well as offering one off taster sessions like today, the service offers other evidence based approaches for dealing with the stresses and strains of everyday living, as well as more serious psychological difficulties.
If you are interested in developing your own meditation or mindfulness practice then please refer to the hand out we have given you with different resources to try. You can also attend other introduction to mindfulness sessions.
If you are particularly interested in mindfulness because of low mood or anxiety and stress being a particular issue in your life then you may be interested in the other interventions we can offer.

10. What are the options? 4 session Improving Your Wellbeing workshops.
E.g. Insomnia, MBCT (dates to be confirmed)
Up to 6 sessions guided self help
CBT, Counselling, other NICE recommended talking therapies
Here we introduce all the options that people can access right now
Make it brief and people can always ask questions.
In the workshops section mention the insomnia workshop, and mindfulness based cognitive therapy. Explain that MBCT is for people with recurrent depression who are in a reasonably stable period as a way of avoiding further bouts of depression. If people are interested in this it is likely that they would benefit from some other interventions first, so can opt for a telephone assessment in the first instance.

11. Questions Any future queries please contact me:
Telephone:
Website: