An introduction to the clinical utility of mindfulness
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An introduction to the clinical utility of mindfulness. Dr. Nic Hooper. Outline of Lecture. History of Mindfulness What is Mindfulness? Typical Mindfulness Practises Research and Evidence. History of Mindfulness. Mindfulness and Buddhism Originated from the Buddhist tradition

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An introduction to the clinical utility of mindfulness

An introduction to the clinical utility of mindfulness

Dr. Nic Hooper


Outline of lecture

Outline of Lecture

  • History of Mindfulness

  • What is Mindfulness?

  • Typical Mindfulness Practises

  • Research and Evidence


History of mindfulness

History of Mindfulness

Mindfulness and Buddhism

Originated from the Buddhist tradition

7th step of the noble eight fold path as taught by the originator of Buddhism, Siddhartha Gautama

Mindfulness led to the ‘cessation of personal suffering’

Although taught as part of Buddhism, there is nothing religious about mindfulness


History of mindfulness1

History of Mindfulness

Mindfulness and the West

Jon Kabat-Zinn created Mindfulness Based Stress Reduction (MBSR) in 1979 to treat chronically ill

Subsequently a number of other third wave psychological therapies using mindfulness techniques developed; ACT, MBCT

Currently a hugely popular technique receiving a plethora of research in its favour


What is mindfulness

What is Mindfulness?


Definition of mindfulness

Definition of Mindfulness

“…paying attention in a particular way:

on purpose,

in the present moment,

and nonjudgmentally”

(Kabat-Zinn, 1994, p.4)


Dimensions

Dimensions

Control of attention

Bringing your mind back to the present moment

Willing / accepting stance

It’s not primarily about altering a feeling state


Some contrasts

Some Contrasts

Relaxation

Distraction


Relaxation

Relaxation

It has been suggested that mindfulness is simply relaxation

However relaxation has been shown to be very different from mindfulness

Namely, most clinical mindfulness skills induce an active state in clients where psychological issues are addressed


Relaxation1

Relaxation

Ditto, Eclache and Goldman (2006) and Jain et al (2007) compared the effects of mindfulness versus relaxation

In terms of physiology, Ditto et al (2006) found that brain activity/cardiovascular effects were different between the two

In terms of self report, Jain et al (2007) found that while relaxation and mindfulness both reduce distress and foster positive mood states, only mindfulness reduces distractive and ruminative thoughts


Distraction

Distraction

It has also been suggested that mindfulness is a sophisticated form of distraction

Thought suppression


Distraction1

Distraction

McHugh Simpson & Reed (2010) compared distraction and mindfulness amongst an older population on a decision making card selection task

They found that mindfulness enhanced decision making performance. Distraction worsened it

Suggesting that different processes are at work

Broderick (2005) showed similar results in an induced mood study


Important things to know about mindfulness

Important things to know about Mindfulness


Mindfulness is experiential

Mindfulness is experiential

Intellectual v. experiential / Knowing v. doing (may not be the same thing)

How do we teach people to ride a bike?


The importance of practise

The importance of practise

The more you practise, the better you get!

Brefczynski, Lutz, Shaefer, Levinson and Davidson (2007) experienced (+37000 hours) participants were performing an attentional focusing task using less neural resources

Stage 1: Noticing in the present moment

Stage 2: Noticing non-judgementally in the present moment

Stage 3: Rolling out these skills across life


Metaphors and mindfulness

Metaphors and Mindfulness

Metaphors often help to explain situations with more clarity

They can be used to aid an understanding of mindfulness

The Puppy; notice your “puppy-like” mind.

Leaves on a stream


The anti thesis of mindfulness

The anti-thesis of Mindfulness

Mindfulness is an acceptance based strategy that is directly opposite to avoidance

Avoidance of unwanted thoughts can lead us to narrow our behavioural repertoire

Mindfulness enables us to come into contact with unwanted thoughts, without it affecting the way in which we act


Thought suppression and behavioural avoidance

Thought suppression and behavioural avoidance


Typical mindfulness exercises

Typical Mindfulness exercises


Traditional mfn practices

Traditional MFN practices

Breath

Body

Sounds

Yoga / Walking MFN

Eating

(generalisation is essential)


Breath

Breath

“Sustained single focused attention”

…focus on your breath

…the mind will wander*

…when it does, note where its wandered …try not to get caught up

…bring yourself back to your breath

* to memories, sounds, thoughts, feelings, physical discomfort, urges, etc.


Body scan

Body Scan

Awareness of current physical sensations

Moving attention Noticing automatic responses (run… distract… change)

Trying to do things differently: willingly experiencing discomfort noticing and still “going there”


Itch scratch

Itch / Scratch

Noticing and playing with urges

Understanding the thought action link


Walking eating mindfulness

Walking/Eating Mindfulness

A bridge between mindful living and mindful practise

A great way to bring mindfulness into our everyday lives

The raisin task as popularised by Kabat-Zinn


Informal practice

Informal Practice

Getting people to notice when their behavioural repertoire narrows or starts moving in a non-valued direction in the moment

Check in / What’s coming up? / What’s going on under the bonnet?

Pacing, Exercise, Role-Plays


Case vignette

Case Vignette


Case vignette1

Case Vignette

  • Jack – a burly 15-year-old with severe, intractable back pain

  • Often either inactive and fearful of his pain or trying to ‘push through it’ (sadly, unsuccessfully)

  • Had become more angry, family saw risk of lashing out. Both he (and his family) avoiding risky social situations


Case vignette2

Case Vignette

  • Initially, he didn’t see the point of mindfulness

  • Being in the group helped, he learnt by proxy. Started to buy into the idea of “surfing” sensations

  • With widened attention Jack discovered that ‘pain’ was actually a bundle of sensations including fears, frustrations and urges to move or avoid


Case vignette3

Case Vignette

  • Started being able to see his angry thoughts as ‘just thoughts’ - surfing urges without doing anything impulsive

  • When asked about these situations at the end of the programme, he laughed and said:‘I know I can bring the puppy back!’


Research and evidence

Research and Evidence


Mindfulness and anxiety

Mindfulness and anxiety

Kabat-Zinn et al (1992) gave 22 patients with Generalized Anxiety Disorder (GAD) 12 week MBSR

Found significant improvements in measures of anxiety (and depression) at 3 month follow up

Miller et al (1995) did a three year follow up with the same patients

Found that the gains had been maintained


Mindfulness and depression

Mindfulness and depression

Teasdale et al (2000)

Depressed patients either received MBCT or Treatment as Usual (TAU)

Results showed that those who received MBCT were significantly less likely to relapse into depression


Mindfulness and chronic pain

Mindfulness and chronic pain

Randolph et al (1999) gave 78 chronic pain patients MBSR

Patients showed improvements in;

Ratings of pain

Other medical symptoms

General psychological symptoms

Changes were maintained at follow up


Mindfulness and smoking cessation

Mindfulness and smoking cessation

Gifford et al (2004) gave ACT in 7 individual/group sessions vs. the standard Nicotine Replacement Therapy

Results showed that significantly more participants had maintained their abstinence at 1 year follow up in the ACT group


Mindfulness and eating

Mindfulness and eating

Tapper et al (2009)

68 women

All trying to lose weight

Given either a mindfulness/control intervention

2 four hour workshops

Results; women in the mindfulness condition lost more weight and also reported exercising more at 6 month follow up


Mindfulness and phobia

Mindfulness and phobia

Hooper, Davies, Davies & McHugh (2011)

Comparison of mindfulness vs. thought suppression in the management of spider fear

Participants underwent a 10 minute intervention before completing a Behavioural Approach Test (BAT)

Participants also completed anxiety measures pre and post BAT


Behavioural approach test bat

Behavioural Approach Test (BAT)

  • Move 1 metre to the table

  • Move 1 more metre to the table

  • Approach the table

  • Touch the jar for more than 10 seconds

  • Lift up the jar

  • Open the jar

  • Touch the spider with a pencil for more than 10 seconds

  • Remove the spider from the jar

  • Touch it with a finger for more than 10 seconds

  • Put the spider on their hand


Results bat data

Results – BAT data


Results stai data

Results – STAI data


Mindfulness and care giving

Mindfulness and care giving

Singh et al (2003)

Gave caregivers of adults with profound multiple disabilities an 8 week mindfulness course

Results showed that the patients of those caregivers given mindfulness training became significantly happier during interactions with them


Mindfulness and aggression

Mindfulness and aggression

Heppner et al (2008)

Gave half of the participants a mindfulness intervention (5 minute raisin task) before completing a social rejection task, known to induce aggression

Results showed that those given the intervention displayed less aggression/hostility than their control condition counterparts


Mindfulness meta analysis

Mindfulness meta analysis

Baer (2003)

Performed a meta-analysis on 21 adult mindfulness studies of adequate quality

Conditions included chronic pain, anxiety and depression

Large mean effect size post treatment (0.74, SD=0.39 [Cohen’s d]) medium effect size at follow-up (0.59, SD=0.41)

“…may bring participants with mild to moderate psychological distress into or close to the normal range” (pp.137)


Mindfulness meta analysis1

Mindfulness meta analysis

Grossman et al (2004)

Reviewed 64 studies

Found consistent improvement and relatively strong effect sizes across:

Mental health (e.g. depression, anxiety, coping style) physical well-being (e.g. medical symptoms, sensory pain, physical impairment, and functional estimates)


Summary

Summary

Mindfulness seems to be making huge strides in terms of research

However, to avoid the current criticisms levelled at CBT

A huge emphasis will have to be placed on the processes at work in mindfulness

Exposure

Willingness

Meta-cognition

Control of attention


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