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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

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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?


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)


Myriad of other “mindfulness” applications and adaptations

Applications in psychiatry

Applications in Psychiatry

Major Depression

Borderline Personality Disorder


Anxiety Disorders (OCD, Anxiety, Phobias)


Carers (Staff and Families)

Eating Disorders


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?



“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?

Let s have a go

Let’s Have a go……

What can we notice about the mind

What can we notice about the mind?

Monkey mind

“Monkey Mind”

Clinical applications of mindfulness

Open Awareness

Clinical applications of mindfulness

Focused Attention

Clinical applications of mindfulness


Something to return to

Something to keep focus on

NOT distraction

Clinical applications of mindfulness

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?

Clinical applications of mindfulness

Which one?

  • Open Awareness?

  • Focused Attention?

What is at the heart of our clinical work

What is at the heart of our clinical work?


Unskilful Responding

Mental Distress

What is at the heart of our clinical work1

What is at the heart of our clinical work?


Unskillful Responding

Mental Distress




Non Acceptance





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

Clinical applications of mindfulness

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




Adequate control groups

Small N’s

Durability of effects re: longitudinal studies

Measurement of mindfulness

Key ingredient?


Implementation fidelity

Clinical applications 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

Core processes why does this work caveat not always about reducing symptoms

Core Processes?Why does this work?Caveat: not always about reducing symptoms

Mindfulness training

Mindfulness Training …


Unskillful Responding

Mental Distress

Embrace “sensations”

Acceptance & compassion

Turn Towards

Symptoms less distressing

Highly recommended article

Highly Recommended Article



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

Clinical applications of mindfulness

With Mindfulness

Clinical applications of mindfulness



Anterior Cingulate



Parietal Lobe (uperior)

Limbic (Amg, Hipp)

Sub-cortical (Thal, Basal Ganglia)

Clinical applications of mindfulness

Blue = NF>EFYellow = EF > NFMBSR Group

No short cuts

No short cuts!

What are we asking are patients to do and how can we do that

What are we asking are patients to do (and how can we do that?)






Static dynamic body signature

StaticDynamicBody Signature



Move from Doing to being

Start where they are at (pacing)

A long long journey (for us and them)

Not linear

No outcome/expectations

Some quotes from patients psychosis ed

Some quotes from patients (psychosis/ED)

Clinical applications of mindfulness

“You 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

Clinical applications of mindfulness

“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 (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)

“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

“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”

Clinical applications of mindfulness

“I 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

“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 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.”

Clinical applications of mindfulness

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

Clinical applications of mindfulness

Qualitative Themes

Clinical applications of mindfulness


Own practice as a health care provider

Own Practice as a Health Care Provider

What is at the heart of our clinical work2

What is at the heart of our clinical work?


Unskillful Responding

Mental Distress


Core humanity

Core Humanity?

Toxicity, Burnout, Stress


Divide: “us” and “them”

Empathy (emotional availability)

Self-care and nurturing (barriers)



Mindfulness Centre of Excellence London

Clinical applications of mindfulness

Workshop on 28th September

6pm to 9pm

Espaço Marcos Rojo

October 22nd – all day

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