Monthly Archives: May 2011

Mindfulness: How Does It Work?

Our colleagues Mark Lau and Andrea Grabovac have written a fascinating and groundbreaking paper introducing a Buddhist psychological model of mindfulness that we think is worth reading. Here is a brief introduction (and link to the full paper).

By Mark Lau, Ph.D. and Andrea Grabovac, MD, FRPCP

Mark Lau

Interest in mindfulness-based interventions (MBIs) continues to grow, fueled by studies demonstrating their clinical effectiveness.  More recently, researchers have been examining specific psychological and cognitive mechanisms by which MBIs may exert their clinical effects.  Clarification of specific mechanisms will allow further optimization of these therapies.  With this goal in mind we introduce a Buddhist psychological model (BPM) in the June issue of the journal Mindfulness based on the psychological framework of the Theravada Buddhist contemplative traditions from which many of the techniques used in MBIs are adapted.

Andrea Grabovac, M.D.

Andrea Grabovac

Briefly, the BPM provides a detailed, step by step description of how the habitual reactions of attachment and aversion to feelings are the genesis of a cascade of mental events that lead to suffering.  According to the BPM, the subjective sense of a continuous stream of consciousness is made up of numerous, discrete sense impressions and mental events (sensations), most of which occur outside of one’s awareness.  Each sensation inexorably carries with it a feeling tone, which falls into one of three categories: pleasant, unpleasant, or neutral (neither pleasant nor unpleasant). The term “feeling tone,” as used in this context, is not synonymous with emotions, such as fear, joy, or anger; rather it is an immediate and spontaneous experience that arises with each sensation.  These rapid and transient feeling tones, which are often unnoticed, are the key trigger for habitual attachment (holding onto a sensation) and aversion (pushing away a sensation) reactions.

According to the BPM, mindfulness has its effect by short circuiting the above process. It does this in two main ways:

  1. training attention regulation skills
  2. insight

Training attention results in an improved ability to selectively orient one’s attention away from the proliferation of mental events following attachment/aversion reactions.  This is possible because attentional resources are limited: one cannot be focused intently on an object (such as the breath) and engaging in ruminative thought patterns simultaneously.  Mindfulness training improves both the ability to recognize the occurrence of unhelpful mental proliferation, and the ability to stop rumination by focusing attention elsewhere.  Facility with these skills allows ruminative thoughts to be treated as mental events rather than aspects of reality of self.  All current MBIs train attention regulation as their primary mode of therapeutic action.

The other mechanism by which mindfulness reduces suffering (mental proliferation) is via insight.  Insight is a direct, non-conceptual understanding achieved through the repeated examination (via mindfulness practice) of the following three characteristics that are present in all sensations:

  1. impermanence (sensations are transient – they arise and pass away)
  2. unsatisfactoriness (attachment/aversion to the feeling of sensations leads to suffering)
  3. not-self (sensations do not contain or constitute any lasting, separate entity that could be called a self)

Mindfulness of these characteristics results in progression through a series of insights leading to enlightenment, as described in the Theravada Buddhist tradition.  A side effect of such insight is a long-term reduction in habitual attachment/aversion reactions and a consequent decrease in mental proliferation and rumination.

For a more detailed description of the above, please see the free, full version of an article describing the Buddhist Psychological Model here, online first.   We hope that this model will help clarify the mechanisms of mindfulness as taught in MBIs and stimulate further discussion and understanding of the complex, multifaceted nature of mindfulness and its allied disciplines.

You can reach Andrea Grabovac, the first author on the paper, via email at agrabovac@bccancer.bc.ca

 

How Does MindLESSness Inform Psychotherapy? Join the Conversation Amongst Teachers

The integration of Mindfulness and Psychotherapy is a topic of fast-growing interest among clinicians and clients worldwide. The following is the first in a series of informal conversations between Trudy Goodman, Ph.D., Elisha Goldstein, Ph.D. and Steven Hickman, Psy.D., the teachers for a unique upcoming professional training retreat entitled “Mindfulness in Psychotherapy” to be held October 2-7, 2011 at the Joshua Tree Retreat Center in Southern California. Enjoy!
 
In the first of a series of conversations,  Steve, Trudy and Elisha talk about the importance of mindlessness in the therapeutic session.

Steven Hickman, Psy.D.Steve: Today as I worked with a particularly frustrating client whom I experience as quite intransigent and unwilling (unable?) to make change despite constantly extolling his desire for things to be different, I was caught off guard. I had just pointed out his apparent lack of motivation to change (in appropriately therapeutic terms), and he replied by asking in a slightly defensive tone of voice, “Do you talk to all your patients like this?” I’m embarrassed to admit it, but he called me on my mindlessness in that session. Fortunately, I was able to make use of the moment clinically.

Call it countertransference if you like, but for that period of time I was not responding to the human being sitting across from me (and suffering, I might add), but was marching to the beat of some other drummer of my own mind’s making. It strikes me now that it is in these moments of having our mindlessness become vividly apparent, that we actually become more fully mindful, just as when we notice that our attention has wandered in meditation, we are actually as present as we can be! It seems that mindFULness actually becomes most apparent against the backdrop of mindLESSness. What do you think?

Elisha Goldstein, Ph.D.Elisha: There’s a very common misunderstanding in the practice of mindfulness that the practice is to stay focused on whatever we’re paying attention to and deviation from that is “bad” mindfulness. In my personal experience in session with a client or out of session in my own life, it is these moments that I wake up to recognize that I’ve been drifting that seem the most valuable to me. Why? It is this precise moment that I wake up to the fact that I have a choice to intentionally practice cultivating a sense of presence once again and this, in  my mind, is the foundation to mindfulness and psychotherapy.

Presence may be something that some people naturally have more than others, but the truth is, it’s a skill and we can all cultivate it through practice. For better or worse, our brains seem to make things more habitual after they are practiced and repeated. So we need the moments where we’re drifting off the path of being connected to the moment to exercise that intentional muscle of nonjudgmentally guiding our attention back to being present with what’s here.

Trudy GoodmanTrudy:   Since psychotherapy is a relational process, I look at the times of ‘mindlessness’ as a time of disconnection in the relationship. What’s interesting about drifting away from being present in the relationship is to look at what was happening the moment before, when I was still present? And what is happening now, when my attention has wandered away? Where did it go? And how might this be a mini/micro re-enactment of the client’s conditioned relational patterns, or my own?

Rather than see this temporary disconnect as a failure to practice either mindfulness or psychotherapy well, these times actually provide an opportunity to understand the relationship better. If, as the late psychoanalyst Paul Russell suggested, we define resistance as the therapist’s resistance to what’s happening in the clinical encounter, mindless disconnections can get much more interesting! What’s going on in the moment that makes us turn away in restlessness, boredom, frustration? What’s being revealed about the relationship?

As clinicians, we work to cultivate our own mindful presence in a way that is suffused with compassion towards oneself and others, so that we can choose more wisely how to respond to such moments of disconnection. Mindfulness offers us a bridge back to adjusting our stance as therapists to be more continuously curious, congruent and caring. Moments of mindful awareness are quite accessible, but continuity of this quality of compassionate presence has to be consciously chosen, intended, and developed through our own meditation practice.

For me, working with this kind of authentic attentiveness – while staying open to learning about myself in the process — is an act of love. And love is part of what mindfulness meditation is all about! Wisdom and clarity without compassion and love is like a bird with one wing. We need two wings to ‘fly’ in all our relationships — clinical, professional and personal. How wonderful that even moments of mindlessness can be a bridge to insight, to understanding what gets in the way of loving. Mindless moments of disconnection, when met with kindness and curiosity, can teach us how to connect and be wholeheartedly present with ourselves and all those whose lives we touch, just the way we are.

We invite you to join in this conversation.  Please share your thoughts, questions and stories below. Your interaction creates a living wisdom from which all of us can benefit. As these conversations accumulate, we will collect them on a separate page of our blog for review and comment. Visit the UCSD Center for Mindfulness Professional Training site for information on this and other trainings offered.

MBRP Scholarship Offered to Honor G. Alan Marlatt

In honor of his life-long and sustaining contributions to the field of clinical psychology and the treatment of substance use disorders, the UCSD Center for Mindfulness is pleased to announce a scholarship program in the name of G. Alan Marlatt, Ph.D.

As a pioneer in his field and one of the developers of Mindfulness-Based Relapse Prevention (MBRP), Dr. Marlatt had a keen and longstanding interest in fostering the careers and aspirations of professionals (and future professionals) seeking to work in the area of relapse prevention in substance use disorders. In keeping with his interest, the UCSD Center for Mindfulness has established two $500 scholarships toward attendance at the upcoming MBRP 5-Day Professional Training in Rochester, New York, September 11-16, 2011.

The scholarships are available to anyone wishing to attend the training who may face some financial hardship that may prevent them from attending. A brief essay is all that is required to apply for the funding, and the submission deadline is July 11, 2011. For more detailed information, see the UCSD CFM Professional Training website. Please feel free to circulate this information to students, colleagues and other interested professionals.

Letting everything become your teacher… absolutely everything!

“I’m going to give you a little advice. There’s a force in the universe that makes things happen; all you have to do is get in touch with it. Stop thinking…let things happen…and be…the ball.” – Ty Webb (played by Chevy Chase in the 1980 comedy Caddyshack)

By Steve Hickman
It’s not every day that you find 80s screwball comedies referenced in articles about mindfulness, so you’ve got to give me credit for even trying. Hang in there and see if you find any wisdom in this silliness. Who says meditation has to be so serious, anyway?

If you are a psychotherapist, then perhaps you recognize those moments with clients or patients when you don’t quite feel like you are JUST a therapist, but that your presence seems to transcend that role. It is as if your manifestation in the room extends beyond simply a treatment plan, case conceptualization or intervention. You have the sense that what is at work is something larger than that, that you are holding a space of equanimity, patience, non-judgment and curiosity that is allowing this person before you to finally have an opportunity to experience themselves and their troubles in a wholly different and powerful way. There is a palpable sense of healing taking place, a felt sense of transformation unfolding in the space you have created together.

In those moments, I believe that we ARE the mindfulness of the healing relationship, the therapeutic field. We don’t DO mindfulness in psychotherapy, we ARE mindfulness in psychotherapy. It just happens.

But is it possible to not only notice it when it happens, but increase the likelihood that it will? Can we learn to cultivate mindfulness in psychotherapy in such a way that we are more effective to our clients and patients, as well as happier, more satisfied human beings in our own right?

I think we can, although I also think that it’s not entirely clear how to go about making this happen. It goes beyond simple instruction to “BE the mindfulness (i.e. “BE the ball.”). It probably arises out of practicing mindfulness intensively, regularly and systematically to create a foundation of personal mindfulness from which we then practice psychotherapy. And then perhaps we can learn some ways to work from that platform to facilitate our day-to-day therapeutic work to infuse it with presence, non-judgment, equanimity and all the rest, for the betterment of those who seek our services.

This exploration fascinates me, which is why I sought out my esteemed colleagues Trudy Goodman and Elisha Goldstein to create and offer a professional training retreat on Mindfulness in Psychotherapy. This training, if you are interested, will be offered on October 2-7, 2011 at the Joshua Tree Retreat Center in Southern California, and will combine mindfulness practice with an exploration of the process of integrating mindfulness into therapeutic presence, mindfulness-based interventions and individual or group psychotherapy.

But my purpose in writing this piece was not solely to promote this training retreat. Instead it was to invite you to consider how you ARE the mindfulness of the therapeutic relationship and perhaps to offer your own comments on this topic. What do you do to integrate mindfulness into your clinical work? Do you think there is benefit in “Being the ball”?

I’m truly curious about your take on this topic. I’m basically a curious guy. “So I got that goin’ for me, which is nice.”

The Family ADHD Solution

The Family ADHD Solution, by Dr. Mark Bertin is the newest addition to our UCSD CFM Bookstore.

“Mark Bertin has written an insightful guide to help families approach the challenges of attentional difficulties with a mindful approach. Research has suggested that learning to be mindfully aware can help reduce stress, focus the mind, keep emotions balanced, and even improve your immune function. The bottom-line of these studies is that you can learn to approach challenging situations with resilience. So why not take the small amount of time to read this wonderful book and prepare yourself and your family well for the challenges ahead?”
–Daniel J. Siegel, M.D., author of Mindsight: The New Science of Personal Transformation and Parenting from the Inside Out

“The stress on parents raising a child with a developmental disorder such as attention deficit/hyperactivity disorder (ADHD) can be intense. It frequently is amplified by all the misinformation about ADHD available in our modern world, which may lead parents to believe they or their child are to blame in some way. This misinformation also can bias family and friends, leading them to be judgmental of parenting skills and to attribute behavioral issues to anything but the actual biological causes of ADHD. The chronic stress of parents has broad implications for all family members.

The Family ADHD Solution addresses parental stress and well-being as well, as that of their children. The foundation of comprehensive ADHD care is compassionate objectivity – in other words, mindfulness. Without any need for formal training, through reading this book parents begin to practice mindfulness as they start to grasp the intricacies of ADHD, better understanding their child and creating appropriate supports at home and school.

In his blog on Psychology Today, Dr. Bertin notes, “ADHD has distinct biological causes, and symptoms extend far beyond inattention and hyperactivity. It’s not a matter of effort for a child; it’s a matter of what skills they have, which ones they don’t yet have, and the care they need to develop them. Complicated decisions are simplified when parents acknowledge the reality of ADHD – including the fact that their kids generally are trying to do the best they can, and struggling because of their ADHD symptoms.”

Likewise, parents of kids with ADHD are trying to do the best they can and often struggling. The amount of effort and consistency required over the years may feel draining. When stress takes over for a parent, it affects their decision making and how they relate to their kids. It also affects how they address problems day-to-day, with old habits more likely to take over, and new possibilities less likely found. And a child’s behavior and well-being may be influenced by how their parents experience stress.

The Family ADHD Solution addresses these challenges through the practice of mindfulness. When parents practice mindfulness, they not only tend to feel calmer and more balanced day-to-day, their children benefit as well. The Family ADHD Solution integrates mindfulness into evidence-based, practical ADHD advice and helps both parents and their children find their way onto a simpler, more balanced path.

For more information, please visit Dr. Bertin’s website.

Mindfulness-Based Cognitive Therapy for Anxious Children

Pre-order Mindfulness-Based Cognitive Therapy for Anxious Children (due out in July) through our UCSD CFM Bookstore, and help support the UCSD CFM, and the wonderful work of Randye J. Semple and Jennifer Lee.

Adults rarely associate childhood with anxiety, but more than one in ten children have anxious thoughts and fears debilitating enough to warrant an anxiety disorder diagnosis. It is essential that therapists who treat children and adolescents understand the most effective approaches for helping young people manage the seemingly overwhelming symptoms of anxiety before they develop into lifelong issues. Developed by mindfulness researchers Randye Semple and Jennifer Lee, the program in Mindfulness-Based Cognitive Therapy for Anxious Children can be used in group or individual therapy. MBCT-C can help children and adolescents become more aware of their thoughts, emotions and behaviors, enhance their social-emotional resiliency, and help them learn to make more skillful life choices.

This complete guide to conducting MBCT-C includes fun and age-appropriate experiential mindful awareness practices for use with anxious children and teens. It includes a full introduction to the theoretical basis and research support for the MBCT-C model, and includes sample session dialogues and suggestions for procedural variations for working with children of varying ages and types of anxiety. The included CD contains guided mindfulness practices and printable handouts for each session. Mental health practitioners will appreciate this complete and practical guide aimed to effectively improve the lives of children and adolescents who suffer from anxiety disorders.

UCSD CFM on NBC San Diego!

Click here to see the UCSD CFM featured on NBC San Diego.

This feature includes scenes of Dr. Rochelle Voth leading one of our MBSR classes, several participant interviews, and benefits of meditation described by, CFM Director, Dr. Steven Hickman.