Riding the Wave, Surfing the Urge: Study Suggests Mindfulness May Help with Cigarette Cravings

By Jenny Rogojanski, M.A.

A new study published in this month’s edition of Mindfulness highlights the potential utility of mindfulness for coping with cigarette cravings among smokers.  This study compared the effectiveness of urge surfing, a brief mindfulness-based strategy developed by Alan Marlatt, to an alternate suppression-based strategy for coping with cigarette cravings. Participants in this study were randomly assigned to use one of the two coping strategies to manage their cravings during an experimental exposure to cues associated with cigarette smoking. Seven days later, participants returned to complete a follow-up assessment.

First Author, Jenny Rogojanski

Results from this study indicated that participants in both groups experienced a significant reduction in their amount of smoking when they returned for the follow-up assessment, as compared to their amount of smoking prior to learning their respective coping strategy. Participants in both groups also reported an increase in their self-efficacy for coping with smoking urges at the 7-day follow-up assessment. However, only those participants taught to use the urge surfing technique demonstrated the incremental benefit of reduced levels of negative affect and depressive symptoms at the follow-up assessment. These findings indicate that while both the mindfulness and suppression strategies may be associated with improvements on smoking related outcomes, mindfulness was unique for its beneficial impact on reported emotional functioning over the course of the study. These findings also provide preliminary support for the use of mindfulness-based strategies for coping with smoking urges, as these strategies appear to provide some additional benefits not obtained when coping with smoking cravings through suppression.

References
Rogojanski, J., Vettese, L. C., & Antony, M. M. (2011). Coping with cigarette cravings: Comparison of suppression versus mindfulness-based strategies. Mindfulness, 2, 14-26.

Every Moment an Opportunity for an Epiphany

I am sure to grow old.
I cannot avoid aging.
I am sure to become sick.
I cannot avoid sickness.
I am sure to die.
I cannot avoid death.
All things dear and beloved to me
are subject to change and separation.
I am the owner of my actions;
I will become the heir of my actions.
— Anguttara Nikaya

Elana Rosenbaum

Every now and then something happens that is pivotal in our lives by which we measure time, a marker event like 9/11, a marriage or divorce, a birth or death or a diagnosis such as cancer. I’ve divided time into pre cancer and post stem cell transplant for lymphoma.  The time is marked not by age but by changes in my world. Pre-cancer mortality was a given intellectually but post diagnosis I knew it in my heart, head and gut.   Death became a part of my awareness and I could no longer delude myself into believing that illness and loss happened to others but not to me. These last few weeks, with the earthquake ,tsunami, and radiation leaks in Japan  as well as war in Libya I am reminded of the universality of suffering and its pain.     I am inspired by the courage and cooperation of the Japanese people and horrified by the hatreds and violence of war. It feels like the whole world is trembling.  I ask myself daily, how am I living my life? What are my priorities? How am I putting mindfulness into action and what is possible to help others?

A favorite cartoon of mine is of two mice on an exercise wheel. One of the mice is shown peddling frantically and spinning around and around while the other is resting comfortably on the rim of his wheel with his legs dangling over it. The caption under him reads, “I’ve had an epiphany.”

Years ago my meditation teacher, Larry Rosenberg, talked about rolling over and over again and again in the mud.  I never quite understood what he meant until I began to notice certain thought patterns that refused to quit. I didn’t think in terms of greed, hatred and delusion I only knew that certain thoughts made me unhappy and created feelings, sensations and actions that perpetuated misery, mine and others.  I’ve been a psychotherapist since 1975. In working with my patients at a large HMO it seemed all too easy to slip into the morass of worry, fear and doubt. Identification with these states perpetuated misery by defining who we thought we were and what life held for us. This lead to immobility and more fear, anger and delusion.

Frustration and discouragement led me to the medical center and Jon’s (Kabat-Zinn) weekly yoga class and Larry’s (Rosenberg) meditation sessions. One short hour opened a window into possibilities. I would return to work energized and refreshed with greater clarity and patience to be with another. As my practice deepened compassion and understanding grew and real change became possible.

I’ve been very fortunate. I’ve been teaching MBSR since the early 80‘s with the support of a community dedicated to mindfulness and the eradication of suffering. Community is essential. Overcoming suffering and understanding its causes is often a painful process.  We need each other for support and inspiration. Discovering what helps and what harms takes effort, high ethical standards and steady attention. MBSR is not a technique or a smart career move. It’s goal is liberation and wise action. We are all inter-connected, the rebel in Libya and his antagonist, the tsunami victim and the rescue worker.  We are all responsible for our actions. Just as aging, illness, death and loss is part of life so is compassion, understanding and growth. May our work together bring greater peace for ourselves and our world.

Elana Rosenbaum is a longtime teacher of Mindfulness-Based Stress Reduction and author of a book on her experience of working mindfully with her own cancer diagnosis entitled Here For Now: Living Well With Cancer  Through Mindfulness . There is also a companion Audio CD for her book available, by the same name. To learn more about Elana and her work, download her free meditation audio files, or learn about upcoming events, visit her website at Mindfulliving.com .

We Have Lost a Valued Friend and Pioneer

It is with great sadness that we report that Dr. G. Alan Marlatt passed away this morning at 9:40 am. Alan was a kind and generous man with whom we had the pleasure of working the past couple years in conjunction with the training he and his team offered in Mindfulness-Based Relapse Prevention (MBRP) through UCSD. We are all quite saddened and shocked at the news of the death of this well-respected and widely honored psychologist, colleague and friend.

For those who may be unfamiliar with his work, here are some highlights copied from the biography of him on Wikipedia:

G. Alan Marlatt, Ph.D., was Professor of Psychology at the University of Washington and Director of the Addictive Behaviors Research Center at that institution. He received hisPh.D. in clinical psychology from Indiana University in 1968. After serving on the faculties of the University of British Columbia (1968-1969) and the University of Wisconsin–Madison (1969-1972), he joined the University of Washington faculty in the fall of 1972. He has conducted pioneering research in three areas: harm reduction, brief interventions, and relapse prevention.

In 1996, Dr. Marlatt was appointed as a member of the National Advisory Council on Drug Abuse of the National Institute on Drug Abuse (NIDA). He served as the President of the Society of Psychologists in Addictive Behaviors from 1983-1984; President of the Section for the Development of Clinical Psychology as an Experimental-Behavioral Science of the Society of Clinical Psychology (Division 12 of the American Psychological Association), 1985-1986; and President of the Association for the Advancement of Behavior Therapy, 1991-1992.

Marlatt’s books include Alcoholism: New Directions in Behavioral Research and Treatment (1978), Relapse Prevention: Maintenance strategies in the treatment of addictive behaviors (1985, 2005), Assessment of Addictive Behaviors (1985; 2005), Addictive Behaviors Across the Lifespan (1993), Harm Reduction: Pragmatic Strategies for Managing High-Risk Behaviors (1998), Changing Addictive Behavior (1999), and Brief Alcohol Screening and Intervention for College Students (BASICS) Manual (1999), The Tao of Sobriety: Helping You to Recover from Alcohol and Drug Addiction (2002), and Therapist’s Guide to Evidence-Based Relapse Prevention (2007). In addition, he published over 200 book chapters and journal articles and served on the editorial boards of numerous professional journals, including the Journal of Consulting and Clinical Psychology, Journal of Abnormal Psychology, Addictive Behaviors, and Journal of Studies on Alcohol.

Marlatt received continuous funding for his research from a variety of agencies including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the Alcoholic Beverage Medical Research Foundation, and the Robert Wood Johnson Foundation. In 1990, Marlatt was awarded The Jellinek Memorial Award for outstanding contributions to knowledge in the field of alcohol studies from the International Society for Biomedical Research on Alcoholism. In 2001, he was given the Innovators in Combating Substance Abuse Award by the Robert Wood Johnson Foundation, and in 2004 he received the Distinguished Researcher Award from the Research Society on Alcoholism. He received the Distinguished Psychologist award for Professional Contribution to Knowledge from the Washington State Psychological Association in 1990 and the Distinguished Scientist Award from the Society for a Science of Clinical Psychology in 2000.

We will miss you Alan, but your work will live on through your writings, your teaching and your mentorship of many bright and talented students and former students.

NOTE: We invite you to pay tribute to Dr. Marlatt by adding any comments or observations you have about him, his work and his legacy in our field.

Dealing With the Classic MBSR Week 8 Question: Will Your Butt Be On The Cushion Tomorrow?

Perhaps the number one question asked by participants in MBSR or MBCT groups is: “Where can I go to continue to practice in a group?” The question behind the question is “How will I sustain the momentum I have built up over the past 8 weeks and continue to formally practice mindfulness?” We frequently suggest to our participants that they connect with each other to form small sitting groups. This article from mindful.org provides some nice guidelines for doing just that. We will refer folks to this helpful piece to support them in their practice.

Cheers! Here’s to Wonderful Old Wine in Amazing New Mindfulness-Based Bottles

By Steven Hickman, Psy.D.
Director, UCSD Center for Mindfulness

A colleague of mine emailed me yesterday to ask my advice. She had submitted a paper for publication in a respected scientific journal that looked at one particular aspect of Mindfulness-Based Stress Reduction (MBSR). One of the reviewers, apparently intending it as a significant criticism, asked if MBSR wasn’t just “old wine in new bottles”, noting that Carl Rogers and Gestalt therapists had been bringing mindfulness into psychotherapy years before anyone had heard of MBSR. She wanted to know how to respond to this rather stern criticism of her very thoughtful and innovative work.

I told her that she should agree with the reviewer.

Mindfulness is indeed, VERY old wine. Relatively speaking, MBSR and all the rest of the mindfulness-based interventions being devised and deployed in clinical practice these days are indeed quite new “bottles.” But nobody has suggested otherwise! From the beginning, Jon Kabat-Zinn (MBSR) , Marsha Linehan (Dialectical Behavior Therapy – DBT), Zindel Segal, Mark Williams and John Teasdale (Mindfulness-Based Cognitive Therapy – MBCT) and other treatment developers have openly and reverently acknowledged the very deep and ancient roots of mindfulness, mindfulness practice and the wisdom of drawing on these roots for the relief of suffering.

In his book Full Catastrophe Living, Jon Kabat-Zinn writes:

Although at this time mindfulness meditation is most commonly taught and practiced within the context of Buddhism, its essence is universal. Mindfulness is basically just a particular way of paying attention. It is a way of looking deeply into oneself in the spirit of self-inquiry and self-understanding. For this reason it can be learned and practiced, as we do in the stress clinic, without appealing to Oriental culture or Buddhist authority to enrich it or authenticate it. Mindfulness stands on its own as a powerful vehicle for self-understanding and healing. In fact, one of its major strengths is that it is not dependent on any belief system or ideology, so that its benefits are therefore accessible for anyone to test for himself or herself. Yet it is no accident that mindfulness comes out of Buddhism, which has as its overriding concerns the relief of suffering and the dispelling of illusions. (p. 12-13)

But where the analogy of old wine in new bottles falls apart, is that the “bottles” or the interventions themselves are an integral part of what makes these new programs effective and powerful. These are not meditation classes or silent retreats at remote monasteries, but fully thought out, carefully devised and thoroughly researched psychological interventions that honor the roots of their “wine” and skillfully bring it to suffering individuals in very systematic, deliberate and empirically-supported ways.

A plethora of studies have established MBSR as an effective intervention for addressing the suffering associated with chronic pain, cancer, sleep disturbance, anxiety, and ADHD, just to name a few (Grossman, 2004)(Hofmann, 2010). The 8-week program has been shown to not only reduce a variety of physical and psychological symptoms, but more recently has been shown to bring about structural, measurable changes in the brain itself. Constructed thoughtfully, MBSR has a relatively standardized protocol and logical progression that has consistently (for over 30 years) guided skeptical novices (facing the full spectrum of illness and symptoms, both medical and psychological) through a series of specific exercises and homework practices to a place of ease and equanimity that motivates them to want to continue various forms of mindfulness and meditation practice for years to come.

Focused on helping people alter their relationship with the experiences of their lives (whether those experiences are physical symptoms like pain, or mental phenomena like critical thoughts), mindfulness practice exposes options and flexibility that many never realized they had. One patient of mine with chronic neck and back pain (and significant depression as well) said it best when he noted, “I’ve been a tough guy all my life. I learned to play hurt in sports, to claw my way to the top of my field, and even to fight every day with this horrendous pain. What mindfulness allowed me to do was to see that I could dance with my pain.”

A recent randomized clinical trial reported in the Archives of General Psychiatry by Zindel Segal and his colleagues has established MBCT as an equally effective treatment to antidepressant medication in preventing relapse in previously depressed patients (Segal et al. 2010). Based upon the twin foundations of cognitive behavioral therapy and mindfulness, MBCT is being implemented with a wider and wider variety of diagnostic populations with repeated (if still somewhat preliminary) success. The heart of MBCT is encouraging the patient to simply notice the activity and patterns of the mind, adopting a “decentered” stance toward thinking in which thoughts are experienced as arising phenomena in awareness and not fact or imperative. The patient begins to become aware of the constructions of the mind, the “stories” if you will, that the mind constructs around the actuality of experience. The unreturned wave of a friend soon balloons into yet another indication that one is not worthy of friendship. The flutter of a heartbeat in a stressful situation soon billows into the anxious mushroom cloud of the specter of a heart attack.  And the patient learns to adopt an abiding presence that notices these processes and recognizes the option to not become entangled in them in the way in which they have in the past.

In his 1923 encyclopedia article “Psycho-Analysis,” Freud noted that “the attitude which the analytic physician could most advantageously adopt was . . . a state of evenly suspended attention, to avoid so far as possible reflection and the construction of conscious expectations.”

“Construction of conscious expectations” indeed! And with some perspective and “evenly suspended attention” one can encounter the frightful booming Wizard of Oz and also notice the presence of the pathetic little man behind the curtain. Thoughts are not facts. “Don’t believe everything you think,” says the bumper sticker.

It is my observation that mindfulness, at its essence, is not a treatment in and of itself. It is a very important component of all good treatment, whether explicitly named or not. It is the attitude that we embody when we work with clients and patients, the space we create with them in the therapy room, and healing force that works in them when they encounter what they have often encountered and respond in a healthy way rather than react in a habitual way. And it can also be utilized in a very specific, explicit and replicable way to address a variety of psychological disorders.

I happily and gratefully acknowledge the roots of the old wine in its “new bottles.” And raise my glass to toast those who have applied their considerable wisdom, experience and intelligence to finding ways to relieve suffering in thousands, if not millions of our fellow human beings.

Cheers!

NOTE: This article will be appearing in the upcoming edition of the newsletter of the California Psychological Association.
REFERENCES:
Kabat-Zinn, J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Delta. 1990

Grossman, Niemann, Schmidt and Walach Mindfulness-based stress reduction and health benefits: A meta-analysis Journal of Psychosomatic Research/Vol 57 (No. 1), July 2004

Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol./Vol 78 (No. 2), Apr 2010

Segal, Bieling, Young, MacQueen, Cooke, Martin, Bloch and Levitan Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression Arch Gen Psychiatry/Vol 67 (No. 12), Dec 2010

Upcoming MBCT Teacher Training Intensive: An opportunity to practice, learn and grow

Learning to lead Mindfulness-Based Cognitive Therapy (MBCT) groups is much more of a process than a destination. Experienced MBCT facilitators and mindfulness teachers Susan Woods and Char Wilkins will soon be gathering with a small group of professionals who have had the opportunity to lead MBCT or other mindfulness-based groups, to more fully delve into the intricacies, challenges, potentialities and pitfalls of this work. Entitled MBCT Teacher Training Intensive (MBCT-TTI), this event takes place March 20-25, 2011 at the EarthRise Retreat Center in Petaluma, California, just north of San Francisco.

Focused largely upon the practice and skill of mindful inquiry (as described quite effectively in Susan’s recent paper on the subject, entitled Transparency in the Art of Teaching Inquiry in the Mindfulness-Based Cognitive Therapy program) this intensive training environment combines aspects of retreat (extended periods of practice, silence and reflection) with a significant degree of experiential learning, supplemented with didactic material.

All unfolding within the beauty of the rolling hills of Sonoma County, just minutes north of the Golden Gate, this training affords attendees an opportunity to develop as teachers, therapists, practitioners and human beings.  Retreat-style accommodations are supplemented by light, healthy and largely organic fare with an emphasis on fresh vegetables, organics and an attention to presentation and detail that nicely supports the work of mindfulness.

There are still a few slots available if you or a colleague would be interested in attending. For details, visit the UCSD Center for Mindfulness Professional Training website, or contact the director, Steven Hickman at shickman@ucsd.edu

Cancer: Listening for a Mindful Life

By Regina Huelsenbeck, PhD

I can remember that day. I was home from college for Thanksgiving break. I had picked up my best friend for lunch; we were going shopping, and then later, out for the evening. We had quite the day planned… I just needed to stop by my pediatrician’s office for a quick checkup. I had a lump on the side of my neck; it had been there since spring of my freshman year. It was now fall of my sophomore year and it had gotten much larger, so I finally decided to tell someone. I didn’t think it was really anything. I was 19 years old and my world did not have the space for such notions. The doctor however, looked pretty worried, and sent us over to an ENT (ear, nose & throat) surgeon who immediately took a needle biopsy.

A few days later, we got the biopsy results. We had just gone to see the movie The Bodyguard (yes, Whitney Houston). I was riding in the back seat of our car, with that same friend when my mother got the call. She turned around from the front seat, phone to her ear, and announced, “Its Hodgkin’s, Regina”. … … “I have cancer?” It did not compute. The feeling I had is still so hard to describe. I wasn’t even in that car anymore. I was physically sitting in the backseat looking out the window. But psychically, upon hearing those malignant words I had popped into another reality. I had left the world of the healthy-living-well people and was sinking down into what can only be described as an underworld.

Illness is the night side of life, a more onerous citizenship.  Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.  Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. ~Susan Sontag

With sickness comes isolation, sometimes vivid dreams, visitations in fever induced states and reflection; it is indeed another world. However, the lights of illness have a unique way of illuminating forgotten energies and disconnected pieces. In this respect, illness can and often does become an opportunity for reconnection, an anamnesis.

Through my journey into that underworld, I wondered how and why I got cancer. I have come to believe not only that I became ill for many reasons but that I was the only one who could uncover those reasons. No one else was qualified. No one could really tell me how I contracted cancer, exactly what I did or why I had it… I had lymphoma, and “they” really didn’t know and still don’t know what causes it. No one can truly provide a linear causal reason.

And that’s not the point anyway. The point is not necessarily what caused it; the point is really where this line of questioning took me, what this exile from the land of the fast movers and healthy shakers did for me.

Obviously, the journey was not all roses and inspirational change. It was hard and lonely and painfully self-reflective. I was also pretty pissed off. I was angry about missing out on what I considered to be the life I was “supposed to be living”. I was sick and I was tired. I was worried about the boy who no longer wanted to date me because I had cancer. I was worried that I had no hair and I was worried about being different from all my peers.

The angry part of me was not concerned with macrobiotics, death, meditation, mindfully cutting vegetables (something my macrobiotic instructor insisted upon- it wasn’t enough to simply prepare the dang recipes, everything had to be done a certain way: which I now understand, but then, not so much) or larger existential questions. A larger part of me, however, woke up because of my cancer experience. This part of me had questions and was ready to explore! This part of me truly blossomed after treatments were over and remission set in. This part of me did wonder about the benefits of slowly, mindfully cutting vegetables.

I became extremely interested in illness and the mind-body connection. I attended a conference on healing sponsored by the Institute of Noetic Sciences. My career and truly my life’s passion grew from the basic interconnected ideas discussed in this conference.  I was enlivened! I now had even more questions about the mind-body connection, healing and consciousness.

I returned to college and changed my major (fashion merchandising) to nutrition and minored in psychology. I found my true love studying the psyche and set out to become a clinical psychologist (FYI: a very long road). 745 years later, I completed my doctoral dissertation on the experience of living with cancer. I also penned a chapter for Newsweek journalist Jamie Reno’s book of lymphoma survivor tales: Hope Begins in the Dark. Much of this article was taken from that chapter. Today I work mindfully with others struggling to heal, understand and integrate the cancer experience. I am grateful for this work, the questions which continue to emerge and the answers that flow from the spirit of each client.

So the saying goes that a “gift” is contained within life’s tragic experiences.   Although if you’re in the midst of chemo and someone suggests that cancer is a gift, you may envision yourself punching them in the head (believe me I get it!) But maybe, just maybe, you might consider taking a walk on the inside, and beginning to listen for your message. Illness sometimes presents itself to offer a wake-up call for more conscious living, a new direction or a new perspective. Perhaps it’s simply an opportunity to slow down, but more likely, it has come for a reason. You are the only one who can uncover and then begin to live into those discoveries. Through the uncertainty of illness blooms a new order, a new understanding, a new consciousness, something is healed and perhaps a new enlivened path is revealed.

Take a Walk on the Inside:

1.      Regular Sitting Mindfulness Meditation practice (sign up for MBSR class here)

2.      Journaling: “Bones, Dying into Life” by Marion Woodman, “Writing for your Life” by Deana Metzger, “Rebirth” by Deborah Ludwig, or take course with Sharon Bray: “Writing through Cancer”. Next workshop begins Feb 28^th (more information here)

3.      Yoga:  Stacy McCarthy The Soul of Yoga

4.      Mindful Psychotherapy (check out my web page here)

5.      Mindfully preparing food and cutting vegetables (I had to put that in for my macrobiotic teacher)

6.      How to Book: Mindfulness-Based Cancer Recovery by Linda E. Carlson & Michael Speca.

Sources:

Myss, C.  (Speaker).  (1993).  Why people don’t heal. Institute of Noetic Sciences.  Boca Raton, FL.

Newman, M.  (1994).  Health as expanding consciousness.  New York, NY:  National League for Nursing Press.

Robbins, J.  (1998).  Reclaiming our health:  Exploding the medical myth and embracing the sources of true healing.  Tiburon, CA:  H J Kramer, Inc.

Sontag, S.  (1989).  Illness as metaphor and AIDS and its metaphors. New York, NY:  Picador U

Humble in the Presence of Learning and Growing: The Experience of Leading a Professional Training

By Steven Hickman
For the eighth time in the past five years, I have had the profound honor and deep joy to participate as a teacher in a 5-Day Professional Training Retreat in Mindfulness-Based Cognitive Therapy (MBCT). The training took place at beautiful EarthRise Retreat Center in Petaluma, California and I had the privilege of teaching alongside my friends and esteemed colleagues, Dr. Zindel Segal and Dr. Sarah Bowen.

31 professionals came from as far away as Hong Kong to learn about MBCT and how it is taught, learning “from the inside out” in this amazing retreat format. Early morning movement and meditation practice and periods of silence (including several silent meals) punctuated our five days together in a way that allowed participants to ground their learning in the refuge of mindfulness. They began as students and ended as teachers, in that they first were participants in an actual MBCT group (reacting and responding to the various practices and exercises that are part of MBCT) and by the end of the training they were leading each other through sitting meditations, body scans and more.

Each time that I get to do this I experience something different, and this time what I took away was captured in the comments and questions people offered late in the week. Early in the week I was struck by the virtual collision between the typical ways in which therapists encounter patients and how an MBCT teacher meets those same individuals. Wanting to teach, fix, shift and “improve” is embedded in our training as therapists, but what we are doing here is so different. Gently guiding people to their own discoveries or awarenesses and to trust their direct moment-to-moment experience above all else feels awkward and insubstantial at first.

But oh, those shifts that took place during the week! It was as if the largely internal process of attending non-judgmentally to all that arises and staying rooted in the fullness of the moment, began to blossom and flourish outwardly in the space between teacher and student, therapist and client. What a great honor and privilege it is to be a part of that process, in some small way, and to be reminded of the power and potential of mindfulness practice. To prevent relapse in depression, to facilitate effective psychotherapy, to bring depth and richness to life itself. There are moments when it all becomes more than words can fully express.

A deep and reverent bow to my colleagues, my students, my new friends. Thank you for the honor of your presence and your hard work.