An introduction to the clinical utility of mindfulness

1. An introduction to the clinical utility of mindfulness Dr. Nic Hooper

2. Outline of Lecture • History of Mindfulness • What is Mindfulness? • Typical Mindfulness Practises • Research and Evidence

3. 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

4. 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

5. What is Mindfulness?

6. Definition of Mindfulness “…paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p.4)

7. Dimensions Control of attention Bringing your mind back to the present moment Willing / accepting stance It’s not primarily about altering a feeling state

8. Some Contrasts Relaxation Distraction

9. 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

10. 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

11. Distraction It has also been suggested that mindfulness is a sophisticated form of distraction Thought suppression

12. 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

13. Important things to know about Mindfulness

14. Mindfulness is experiential Intellectual v. experiential / Knowing v. doing (may not be the same thing) How do we teach people to ride a bike?

15. 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

16. 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

17. 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

18. Thought suppression and behavioural avoidance

19. Typical Mindfulness exercises

20. Traditional MFN practices Breath Body Sounds Yoga / Walking MFN Eating (generalisation is essential)

21. 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.

22. 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”

23. Itch / Scratch Noticing and playing with urges Understanding the thought action link

24. 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

25. 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

26. Case Vignette

27. 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

28. 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

29. 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!’

30. Research and Evidence

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. Results – BAT data

39. Results – STAI data

40. 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

41. 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

42. 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)

43. 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)

44. 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