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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).

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Clinical applications of mindfulness
Clinical Applications of Mindfulness

Dr. Tamara Russell

King’s College London, UK

PROSER Meeting, IPq, HC Sao Paulo

Sept 20th2011


Outline of the talk
Outline of the Talk

What is Mindfulness?

Transdiagnostic?

Process(Approach versus Avoid)

Clinical Application (issues)


Historical development of mindfulness
Historical Development of Mindfulness

Eastern contemplative traditions

MBSR (1980’s)

DBT/ACT (1990’s)

MCBT (2000’s)


Clinical applications
Clinical Applications

MBSR (JKZ) – physical and mental health settings

Dialectical Behaviour Therapy (Linehan)

MBCT (Oxford, UK) – mental health setting

MB-EAT (Kristeller)

Acceptance and Commitment Therapy (Hayes)

Group/Individual

Myriad of other “mindfulness” applications and adaptations


Applications in psychiatry
Applications in Psychiatry

Major Depression

Borderline Personality Disorder

Bipolar

Anxiety Disorders (OCD, Anxiety, Phobias)

Psychosis

Carers (Staff and Families)

Eating Disorders

BN/AN/EDNOS


But what is it
But what is it?

How can we understand for ourselves?

How can we explain to a colleague, carer/family or client?


Mindfulness
Mindfulness…..

“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?







Anchor

Something to return to

Something to keep focus on

NOT distraction


Time of Practice

Lutz, A et al (2008) Trends in Cognitive Science, 12(4), 163-169


With psychiatric distress what is that mind like
With psychiatric distress…What is that mind like?


Which one?

  • Open Awareness?

  • Focused Attention?


What is at the heart of our clinical work
What is at the heart of our clinical work?

Suffering

Unskilful Responding

Mental Distress


What is at the heart of our clinical work1
What is at the heart of our clinical work?

Suffering

Unskillful Responding

Mental Distress

Affect

Cognition

“Sensations”

Non Acceptance

“Fighting”

Avoidance

Attachment

Symptoms


Mbct mbsr
MBCT/MBSR

Formal group programs with specific training pathway

Training to highlight these unskillful patterns and learn new ways of responding to “sensations”

Informal mindfulness

Individual mindfulness in the therapy room

Adaptations (MB-EAT; psychosis, BMT)


Review of mbct
Review of MBCT

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


www.mindfulexperience.orgMindfulness Research Guide by David BlackMindfulness Research Monthly (MRG)


Issues
Issues

Dosage

Adequate control groups

Small N’s

Durability of effects re: longitudinal studies

Measurement of mindfulness

Key ingredient?

Adaptations?

Implementation fidelity


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


Core processes why does this work caveat not always about reducing symptoms
Core Processes? Interventions: Learning from the UK ExperienceWhy does this work?Caveat: not always about reducing symptoms


Mindfulness training
Mindfulness Training … Interventions: Learning from the UK Experience

Suffering

Unskillful Responding

Mental Distress

Embrace “sensations”

Acceptance & compassion

Turn Towards

Symptoms less distressing


Highly recommended article
Highly Recommended Article Interventions: Learning from the UK Experience


Summary
Summary Interventions: Learning from the UK Experience

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

IFG

Anterior Cingulate

Insula

SMA/SSII

Parietal Lobe (uperior)

Limbic (Amg, Hipp)

Sub-cortical (Thal, Basal Ganglia)


Blue = NF>EF Interventions: Learning from the UK ExperienceYellow = EF > NFMBSR Group


No short cuts
No short cuts! Interventions: Learning from the UK Experience



Preparation
Preparation that?)

  • COURAGE

  • CURIOUSITY

  • COMPASSION


Static dynamic body signature
Static that?)DynamicBody Signature


Process
Process that?)

Move from Doing to being

Start where they are at (pacing)

A long long journey (for us and them)

Not linear

No outcome/expectations



“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”

Paul Chadwick


“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”

Paul Chadwick


Proulx 2008
Proulx away, but to stop worrying about them and the anxiety about them” (2008)

“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


Before training bn
Before Training (BN) away, but to stop worrying about them and the anxiety about them”

“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.”


Before training
Before Training away, but to stop worrying about them and the anxiety about them”

“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.”


After training
After Training away, but to stop worrying about them and the anxiety about them”

“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”


Proulx 20081
Proulx away, but to stop worrying about them and the anxiety about them” 2008

“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.


Mciver et al 2009
McIver et al 2009 disorder: a preliminary study.


Qualitative Themes disorder: a preliminary study.


Process disorder: a preliminary study.


Own practice as a health care provider
Own Practice as a Health Care Provider disorder: a preliminary study.


What is at the heart of our clinical work2
What is at the heart of our clinical work? disorder: a preliminary study.

Suffering

Unskillful Responding

Mental Distress

HUMAN RELATIONSHIPS


Core humanity
Core Humanity? disorder: a preliminary study.

Toxicity, Burnout, Stress

Expectations

Divide: “us” and “them”

Empathy (emotional availability)

Self-care and nurturing (barriers)


Obrigada
Obrigada disorder: a preliminary study.

[email protected]

www.mindbodymot.com

Mindfulness Centre of Excellence London


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


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