Clinical Applications of Mindfulness. Dr. Tamara Russell King’s College London, UK PROSER Meeting, IPq , HC Sao Paulo Sept 20 th 2011. Outline of the Talk. What is Mindfulness? Transdiagnostic ? Process (Approach versus Avoid) Clinical Application (issues).
Dr. Tamara Russell
King’s College London, UK
PROSER Meeting, IPq, HC Sao Paulo
What is Mindfulness?
Process(Approach versus Avoid)
Clinical Application (issues)
Eastern contemplative traditions
MBSR (JKZ) – physical and mental health settings
Dialectical Behaviour Therapy (Linehan)
MBCT (Oxford, UK) – mental health setting
Acceptance and Commitment Therapy (Hayes)
Myriad of other “mindfulness” applications and adaptations
Borderline Personality Disorder
Anxiety Disorders (OCD, Anxiety, Phobias)
Carers (Staff and Families)
How can we understand for ourselves?
How can we explain to a colleague, carer/family or client?
“paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (Kabat-Zinn 1994, pg. 4)
?? What does this really mean?
Something to return to
Something to keep focus on
Lutz, A et al (2008) Trends in Cognitive Science, 12(4), 163-169
Formal group programs with specific training pathway
Training to highlight these unskillful patterns and learn new ways of responding to “sensations”
Individual mindfulness in the therapy room
Adaptations (MB-EAT; psychosis, BMT)
Fjorback, L. O., Arendt, M., Ørnbøl, E., Fink, P. & Walach, H. (2011) Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy – a systematic review of randomized controlled trials , Acta Psychiatrica Scandinavica, 124 (2) pp 102–119
Chiesa, A. & Serretti, A. (2011) Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry Research, 187(3), 441-53
Adequate control groups
Durability of effects re: longitudinal studies
Measurement of mindfulness
Training Teachers to Deliver Mindfulness-Based Interventions: Learning from the UK Experience
Rebecca S. Crane, Willem Kuyken, Richard P. Hastings, Neil Rothwell, J. Mark G. Williams
Mindfulness (2010) 1:74-86
Acceptance & compassion
Symptoms less distressing
Turn towards and TAKE A LOOK difficult experiences
Accept them and explore them (get to know them)
Reduce the secondary suffering that arises from unskilful responding
Increased self-knowledge and self-efficacy and sense of control
Stop “fighting” with self
With Mindfulness Interventions: Learning from the UK Experience
MFG Interventions: Learning from the UK Experience
Parietal Lobe (uperior)
Limbic (Amg, Hipp)
Sub-cortical (Thal, Basal Ganglia)
Blue = NF>EF Interventions: Learning from the UK ExperienceYellow = EF > NFMBSR Group
Move from Doing to being
Start where they are at (pacing)
A long long journey (for us and them)
“You that?)don’t have to worry about what’s right and wrong in your head, you know it’s not judging what goes through your head, its just accepting it as it is, not worried about vindictive voices, or whatever, it’s just accepting that’s the way it is. No right, no wrong”
“It’s a way of trying not to get the thoughts to go away, but to stop worrying about them and the anxiety about them”
“before .. I was fighting against it, thinking “no this I wrong” ….. Today it was just let them come”
“for the six …participants, the core experience of the M-BED group involved a journey that began from a lonely, hate-filled relationship with a totally disconnected, disembodied, idealised, objectified image of self, to a relationship with self that was curious, interested, aware, open, gentler, kinder and more authentic.” (pg. 69)
Eating Disorders, 2008. Vol 16: pg. 52-72
“How is it possible to be so unconscious of the way you appear, yet be so obsessed with it? I think I disassociate from my body 90% of the time”
“there is no body beyond my head because my body is source of self-consciousness best ignored”
“I feel like I approach every social interaction loaded with all kinds of ideas of who I think I am, or how I ought to act, or what this person wants from me, to the point that it interferes with my being able to focus on what they’re saying.”
“Prior to MBED I often just wanted to get a knife and cut off my abdomen, I hated it so much”
“I think about my stomach as another unit, a thing, not a part of me”
“I guess I don’t recognize my body as being important or valid”
“I away, but to stop worrying about them and the anxiety about them”hate what I’m doing to myself. I recognize it as self-punishment/mutilation but my intellect and emotions aren’t communicating with each other. The urge to overeat is overriding all other considerations, even vanity. . . . Body feels awful. Aches + pains all over, bloated, constipated, flatulent, headaches, nausea, puffy ankles. Can no longer see stomach. Body full of air. I really hate feeling this way and cannot see that it’s ever going to change.”
“now I am no longer yelling at myself in my own mind – I used to be afraid of silence and stillness, which is why I had to do something all the time, including eating … nothing ever really made me happy … feeling nothingness is as close to happy as I have ever been”
“My meditation practice has provided me with an
opportunity to accept myself, although facing that space that is myself feels scary. Although my sense of self is still pretty weak, I am willing to fight for my psychic space.”
“The more I meditate, the more accepting I am towards myself and the easier it becomes not to judge my thoughts. When I can see the reality of myself, I don’t have to try and hate myself and send myself away.”
“The meditation helped me to really slow down, stop and think, and re-evaluate who I was and what I wanted out of life.”
McIver et al (2009) Yoga as a treatment for binge eating disorder: a preliminary study. Complementary Therapies in Medicine, 17, 196-202.
McIver et al (2009) “Overeating is not about the food”: Women describe their experience of a yoga treatment program for binge eating. Qualitative Health Research, 19(9), 1234-1245.
Qualitative Themes disorder: a preliminary study.
Process disorder: a preliminary study.
Toxicity, Burnout, Stress
Divide: “us” and “them”
Empathy (emotional availability)
Self-care and nurturing (barriers)
http://nucleosaberser.blogspot.com/p/palestras.html disorder: a preliminary study.
Workshop on 28th September
6pm to 9pm
Espaço Marcos Rojo
October 22nd – all day