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Mindfulness in Clinical Psychology

Buddhism and Science March 2010. Mindfulness in Clinical Psychology. Mark Williams University of Oxford Department of Psychiatry Collaborators: Zindel Segal, John Teasdale, Jon Kabat-Zinn Oxford Team: Melanie Fennell, Thorsten Barnhofer, Catherine Crane,

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Mindfulness in Clinical Psychology

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  1. Buddhism and Science March 2010 Mindfulness in Clinical Psychology Mark Williams University of Oxford Department of Psychiatry Collaborators: Zindel Segal, John Teasdale, Jon Kabat-Zinn Oxford Team: Melanie Fennell, Thorsten Barnhofer, Catherine Crane, Danielle Duggan, Adhip Rawal, Emily Hargus, Wendy Swift www.mbct.co.uk

  2. Outline • Clinical psychology and cognitive science • Depression recurrence • Outcome evidence • What is going on? • Modes of self-focus • Conceptual vs experiential • Exploring modes of self-focus • in eating pathology • through neuroimaging • Mindfulness and relapse signatures

  3. Age of onset of major depression (N = 4041; Zisook, 2007, Amer. J. Psychiat)

  4. Depression recurrence • More than 50% who do recover will have at least one further episode • Those with history of 2 or more episodes have 70-80% chance of recurrence

  5. Mindfulness-based Cognitive Therapy (MBCT) • Designed for patients in remission • to prevent relapse/recurrence • Format • Pre-class interview • Eight weekly classes. Each 2 hours. • Around 12 in each class • Teaching meditation • sustained attention on breath and body • thoughts as mental events • Home-based practice, up to one hour per day, 6 days a week - mostly CDs of mindfulness meditation practice

  6. Teasdale, Segal & Williams, et al.,2000 Survival Curve (for patients with 3 or more previous episodes - 60 weeks) 1.00 MBCT: 37% 0.5 TAU: 66% 10 20 30 40 50 60

  7. Procedural replication (Ma & Teasdale, 2004, J.Consult.Clin.Psychol.)

  8. Kuyken et al (2008) MBCT vs m-ADMs

  9. Outline • Clinical psychology and cognitive science • Depression recurrence • outcome evidence • What is going on? • Modes of self-focus • Conceptual vs experiential • Exploring modes of self-focus • in eating pathology • through neuroimaging • Mindfulness and relapse signatures

  10. Automatic vs strategic processes • Darwin (1872) • What we seen in humans is a combination of • evolutionary old, automatic reactions • Switch on AND OFF depending on contingencies • evolutionary newer, strategic, representational and symbolic reactions (working “off-line”)

  11. Two Modes of Self-focus: Conceptual and Experiential Labeling Elaborating Analyzing Judging Goal-setting Planning Comparing Remembering Self-reflecting Conceptual / Simulation Environmental Input Experiential / Direct SeeingTastingTouching HearingSmelling Visceral sensations Proprioceptive sensing

  12. Conceptual mode useful • To complete meanings • To complete tasks • But when it becomes over-used • Preoccupied by meaning • Planning (even when not wanted)

  13. Consequences of conceptual mode (from the Mindful Attention and Awareness Scale; Brown & Ryan, 2003) • I find it difficult to stay focused on what’s happening in the present. • I tend to walk quickly to get where I’m going without paying attention to what I experience along the way. • It seems I am “running on automatic” without much awareness of what I’m doing. • I rush through activities without being really attentive to them. • I get so focused on the goal I want to achieve that I lose touch with what I am doing right now to get there. • I find myself preoccupied with the future or the past. • Cf Cornell Campus experiment

  14. …in depression • Key maintaining factor PERSISTENT OVER-USE OF CONCEPTUAL MODE • “adhesive pre-occupation” (rumination) & Attempts to stop it (avoidance) • lack of interest in anything else

  15. For example • Focus on • Feelings of tiredness

  16. Mindfulness training: Shifting mode of self-focus- from conceptual to experiential A Conceptual/ Simulation Environmental Input Perceptual/Direct B

  17. Outline • Clinical psychology and cognitive science • Depression recurrence • outcome evidence • What is going on? • Modes of self-focus • Conceptual vs experiential • Exploring modes of self-focus • in eating pathology • through neuroimaging • Mindfulness and relapse signatures

  18. (Adhip Rawal’s DPhil thesis) • Choose a condition where self-focus most problematic • Students with high eating concerns • Anorexic in-patients

  19. Induction of processing modes (Watkins & Teasdale, 2004) • Sample item: • the physical sensations in your body • the way you feel inside • how awake or tired you are • Mode induction • Conceptual: • Think about the causes, meanings and consequences of…… • Experiential: • Focus your attention on the experience of …… • 8 minutes

  20. Stress test for Eating Concerns • Imaginary meal procedure (Shafran et al.,1999) • Participants asked to imagine eating a fattening food for a period of 2 minutes.

  21. Outcome measures • Estimate of actual weight “How much do you think you weigh right now?” • Moral wrongdoing: • How morally unacceptable/wrong do you feel (0-100%) it was to think about eating the food • Urge to reduce/cancel effects: • “How strong do you feel is your urge (0-100%) to reduce or cancel the effects of thinking about the food?” • Neutralization • imagining exercising • imagining eating celery • checking shape in a mirror

  22. Condition, p < .05 Mean Weightchange Conceptual Experiential Analogue study: Pre and post stressor difference in weight estimate (in kg) for high ED group

  23. Mean ratings for moral wrongdoing/unacceptability post stressor for high and low ED groups

  24. Proportion of neutralisers and non-neutralisers post stressor for the high ED group

  25. Anorexic patients? • N = 13 in-patients • BMI=17.2 • Matched controls

  26. Patient study: Pre vs post stressor difference in weight estimate (in kg)

  27. Patient study: Proportion neutralised after stressor in each condition

  28. Mindfulness training increases ‘viscero-somatic’ processing and uncouples ‘narrative-based’ processing (Farb et al, 07) Farb, N., Segal, Z.V., Mayberg, H., Bean, J., McKeon, D., Fatima, Z., & Anderson, A. (2007). Attending to the present: Mindfulness meditation reveals distinct neural modes of self-reference. Soc Cog Aff Neurosci., 2, 313-322.

  29. Outline • Clinical psychology and cognitive science • Depression recurrence • outcome evidence • What is going on? • Modes of self-focus • Conceptual vs experiential • Exploring modes of self-focus • in eating pathology • through neuroimaging • Mindfulness and relapse signatures

  30. Relapse signatures (Emily Hargus’s data) • Individual patterns of prodromal features that warn of onset of episode • Very important for self-management (schizophrenia, bipolar disorder, suicidal behaviour) • Not just whether noticed, but how we relate to them – • enmeshed • “I’m not ever going to be able to sleep again” • with meta-awareness (“decentered”) • “I felt life was getting difficult, but it was my own inability to cope at that time”

  31. Meta-awareness of relapse signature

  32. Summary • Mindfulness training can reduce depression recurrence • Training in experiential mode of self-focus - can prevent over-use of conceptual mode • Impact of mode of self-focus • also seen in eating pathology • can be explored through neuroimaging • Encouraging evidence for MBCT in decentring from suicidal thinking

  33. Thank you • www.mbct.co.uk

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