SPECIAL NOTICE: Conference Early Bird Deadline Extended to December 31, 2011!

The excitement generated by those attending and presenting at the first annual Bridging The Hearts & Minds of Youth Conference in San Diego is growing daily, and we are happy to announce an extension of our Early Bird Registration deadline through the end of 2011! Register now to save $45 on general, faculty/staff, and student registrations.

Please note that there are additional savings available for groups of 3 or more attendees, and continuing education credits are available for psychologists, other psychotherapists (MFTs and LCSWs) as well as newly-approved AMA PRA Category 1 Credit™ for physicians.

If you have already registered please help spread the word to your colleagues and friends so they can take advantage of our extended early bird savings.

Wishing you a happy holiday season,
a safe and insightful new year,
and we look forward to being with you in San Diego in February!

Mindfulness for Children No Fad Either- Response to LA Times Article

Amy Saltzman, MD
Mindfulness Teacher & Holistic Physician
Creator and Director: Still Quiet Place Co-founder and Director: Association for Mindfulness in Education She is recognized by her peers as a visionary and pioneer in the fields of holistic medicine and mindfulness in K-12 education. She has conducted research studies evaluating the benefits of teaching mindfulness to child-parent pairs, and to children in low-income elementary schools.

Amy will be co-presenting, along with Margaret Cullen the workshop entitled SMART in Education: Mindfulness-Based Emotional Balance for Educators at the upcoming Bridging the Hearts & Minds of Youth: Mindfulness in Clinical Practice, Education and Research conference, February 4-5, 2012 at the Catamaran Hotel in San Diego.

Experts Say, Mindfulness For Children is “No Fad” Either.

The real experts are the children. “Jessica”, a fourth grade student, participated in a Still Quiet Place course, an eight week Mindfulness Based Stress Reduction course offered at Henry Ford Elementary School. The school serves a low-income population in Redwood City, California. On the last day of class “Jessica” wrote

When I am sad or kind of in a bad mood I take about 10 breaths and I get relaxed. I also forget about my worries. I learned this from Mindfulness. I enjoy coming here because I forget about my troubles and I forget about all the things in my life that is sad. My sadness just fades.

Jessica’s statement, suggests that perhaps Dr. Hoffman’s perception (reported in the January 8th, 2011 LA Times article by Chris Woolston, Mindfulness is No Fad, Experts Say) that children may have trouble understanding or embracing Mindfulness is in error. Not only do children and adolescents understand and embrace Mindfulness, recent cutting-edge research indicates they can reap benefits from practicing Mindfulness, similar to those documented in adults.

As Mr. Woolston’s article highlighted, over 30 years of scientific research with adults has shown that Mindfulness decreases stress, depression, anxiety, and hostility, and enhances compassion, empathy and executive function; executive function is a term that describes the related processes of goal-directed behavior, planning, organized search and impulse control. As a pioneer in the emerging field of offering Mindfulness Based Stress Reduction to children and teens please allow me to share the ground-breaking work indicating that Mindfulness for children is “no fad” either.

Mindfulness is simply paying attention to your life, here and now, with kindness and curiosity. This ability to pay attention is a natural, innate human capacity. Children as young as three can learn to attend to the breath,the five senses, thoughts, and emotions. Slightly older children can attend to impulses and actions, and their effects on others and the world.

For the last decade, colleagues and I have been offering age-adapted Mindfulness-based curricula to at risk youth. (See side bar) Unfortunately, research by Soniya Luthar Ph. D. from Columbia Teachers College shows that many of our youth are at risk. Her data indicate that affluent teens have rates of depression, anxiety and illicit drug similar to their low-income peers.[1] Daily headlines remind us that our children are being diagnosed with depression, anxiety, ADHD, eating disorders, cutting, addictions, suicidal tendencies and other self-destructive behaviors at epidemic rates; cruelty, bullying and violence are on the rise. Most, if not all of our children could benefit from learning to focus their attention, to become less reactive, and to be more compassionate with themselves and others. Those of us involved in this emerging field are motivated by a shared commitment to offer children and adolescents life long skills that will enhance their well-being. We are rigorously investigating whether children and adolescents can reap benefits from practicing Mindfulness, similar to those extensively documented in adults.

For the last decade we have been working in clinics and schools to scientifically assess whether Mindfulness training can enhance children’s attention, executive function, learning, compassion, empathy and general well-being. The preliminary data are encouraging; below are summaries of four recent studies that demonstrate the benefits of offering Mindfulness children and adolescents.

In a randomized controlled trial conducted by Maria Napoli, Ph.D., first, second, and third graders participated in a bi-weekly, 12-session integrative program of Mindfulness and relaxation. The students showed significant increases in attention and social skills, and decreases in test anxiety and ADHD behaviors.[2]

Lisa Flook, Ph.D. and her colleagues at the Mindfulness Awareness Research Center at UCLA studied second and third graders who did Mindfulness Awareness Practices for 30 minutes twice a week for 8 weeks. Children who began the study with poor executive function had gains in behavioral regulation, meta-cognition, and overall global executive control. These results indicate training in Mindfulness benefits children with executive function difficulties (the children most likely to have difficulties and cause disruptions in the classroom) .[3]

In a study with 4th-7th graders and their parents, that I conducted in collaboration with the Department of Psychology at Stanford, the children participated in 75 minutes of Mindfulness training for 8 consecutive weeks. At the conclusion of the study the children demonstrated increased ability to orient their attention, as measured by an objective computerized Attention Network Task, and decreased anxiety. In written narrative the children also reported decreased emotional reactivity, and increased impulse control.[4]

In research on teaching Mindfulness to adolescents conducted by Gina Biegel, MA, MFT, the teens reported reduced symptoms of anxiety, depression and somatic (physical) distress, and increased self-esteem and sleep quality. Independent clinicians documented a higher percentage of diagnostic improvement in the Mindfulness group (vs. the control group). In layperson’s terms, this means that adolescents who were initially diagnosed with clinical depression and anxiety were no longer depressed or anxious.[5]

While these studies are preliminary, they reinforce what “Jessica”, in 4th grade, already knows—Mindfulness for Children is “No Passing Fad”. In closing I’ll defer to another expert, a fifth grade girl from Menlo Park, California.

Mindfulness is a great class because you can chill out, and relax. It will cool you down and make you less stressed. You should try it if you are mad or sad or just want to feel better. That’s what I do. Try it!
[1] Luthar, S., The Culture of Affluence; the Psychological Costs of Material Wealth, Child Development, 2003; 74 (6), 1581-1593.

[2] Napoli, M. ”Mindfulness Training for Elementary School Students: The Attention Academy” Journal of Applied School Psychology (2005) Vol. 21(1)

[3] Flook, L. “Effects of Mindful Awareness Practices on Executive Functions in Elementary School Children” Journal of Applied School Psychology (2010) 26: 1, 70 -95

[4] Saltzman, A., (2008) “Mindfulness-Based Stress Reduction for School-Age Children, 139-162. In L. Grecco, Acceptance and Mindfulness Treatments for Children and Adolescents: A Practitioner’ Guide, Oakland, New Harbinger, 2008,

[5] Biegel, G. “Mindfulness-Based Stress Reduction for the Treatment of Adolescent

Psychiatric Outpatients: A Randomized Clinical Trial” Journal of Consulting and Clinical Psychology (2009) Vol. 77, No. 5: 855–866

Opening the Heart at Stanford, Google and Beyond

Margaret Cullen is a Licensed Marriage and Family Therapist and a Certified Mindfulness-Based Stress Reduction Teacher. In 2008 she launched a mindfulness-based emotional balance program for teachers and school administrators in Denver, Boulder, Ann Arbor, and Vancouver, B.C.  Margaret will be co-presenting, along with Amy Saltzman, MD the workshop entitled SMART in Education: Mindfulness-Based Emotional Balance for Educators at the upcoming Bridging the Hearts & Minds of Youth: Mindfulness in Clinical Practice, Education and Research conference, February 4-5, 2012 at the Catamaran Hotel in San Diego. (This article originally appeared in “Inquiring Mind.”)

Five years ago, a professor of neurosurgery at Stanford had a revolutionary idea: open a center dedicated to compassion right in the middle of the university. Today, The Center for Compassion and Altruism Research and Education (CCARE) flourishes within this citadel of academia. Here, it quietly pursues its mission of supporting and conducting rigorous scientific studies of compassion and altruism, developing ways to cultivate compassion and promote altruism within individuals and throughout society.

Thupten Jinpa was enlisted as a visiting research scholar at CCARE, during which time he developed a course of study called the Compassion Cultivation Training (CCT). An eight-week program modeled after Mindfulness-Based Stress Reduction (founded at the University of Massachusetts by renowned meditation teacher Jon Kabat-Zinn), CCT teaches Buddhist meditation practices in a completely secular way. Instead of focusing on mindfulness, though, this training emphasizes practices of the heart.

Beginning by developing a foundation of breath awareness, the program systematically teaches students to cultivate the qualities of kindness (metta) and compassion (karuna). Each series of the program begins by sending kindness to people such as grandparents, friends and children—those individuals toward whom it is easy to access tenderness. From there, participants progress to thinking of people about whom they are ambivalent or who cause them downright frustration: the barista at the local café, the bagger at the grocery store, the ex-husband’s new wife. The CCT strives to help individuals imagine each of these people happy and flourishing. But the program also encourages participants to remember or imagine times when they themselves have been hurt, shamed, ill or suffering in some way. By working through such progressions, participants can learn to strengthen the muscle of the heart. Such strengthening can engender a fearlessness that allows them not only to send others wishes of love, and compassion, but to also breathe others suffering into their own hearts and to breathe out relief and ease.

To date, the program has been piloted at Stanford, Google, the Cancer Support Community and in a few series open to the general public in the San Francisco Bay Area. As one of the senior teachers, I have witnessed many transformations. A recent training I led with cancer patients and their loved ones generated a number of moving stories. The following are just two of the narratives of heart that emerged from the eight-week program:

A cancer patient in active treatment has been living with, and caring for, her ninety-five-year-old mother. Having developed her own capacity for tenderness and generosity, the daughter made a radical decision. At our closing circle she shared with tears that she and her mom had invited her suicidal and recently homeless nephew, a war veteran, to come live with them. She said, “Before this course, I might have tried to help him, but my heart wouldn’t have been open enough to take him into my home.” Through this extraordinary act of compassion, both she and her mother learned that, in spite of the limitations imposed by age and illness, they could find happiness by helping another person.

A retired professor of environmental science took the course in order to support his wife, a cancer patient. He told us, “I spent a lot of time talking with my students about the ‘problem’ of poverty, but I just didn’t feel the suffering.” About to cry, he said, “If I had taken this course earlier, I think I would have been a better teacher. Poverty isn’t just a term you can pass over and move on. I’m now able to draw it in and feel the pain. This has been a big aha.”

MBSR & Fibromyalgia a Preliminary Study

Mindfulness-based Contemplative Training Reduces Avoidance and Facilitates Disengagement from Threat in Women Diagnosed with Fibromyalgia
David Vargo

Eight-week courses in mindfulness-based contemplative training focusing on specific meditation and yoga practices have been shown to have explicit benefits for many clinical disorders, especially with relation to treating stress, targeting emotion dysregulation, and attentional processes, yet little research has explored the effects of these practices in the context of bias.
Attentional bias is a tendency to focus on one aspect of the environment over others. A bias may arise through varied mechanisms, but is driven by evolutionarily shaped mechanisms. Attentional bias will influence how one perceives and processes information in the present moment, from the past, and how one anticipates the future. Humans typically have their attention automatically captured by fear-relevant stimuli, and for good reason, to avoid danger and threat of harm. Persistent attentional bias to threat cues in the environment will typically result in increased perception of danger, hypervigilance, and often frequent or intense experiences of anxiety. Although it may appear that an enhanced sensitivity to detecting threat is advantageous, hypervigilance is not necessarily adaptive, as it consists of persistent intensified monitoring and attentional fixedness at the expense of ongoing cognitive demands and a continually active sympathetic nervous system. Hypervigilance may also generalize to innocuous stimuli, wherein non-threatening stimuli are determined to be threatening. Thus, bias becomes a distorted interpretation of one’s experience, with consequences that could lead to chronic anxiety and stress-mediated pathology. Interestingly, there is now evidence that hypervigilant processing could be occurring without conscious awareness, such that very early stages of sensory processing (e.g., < 300 ms from stimulus exposure) are detecting possible threat-related cues. Once a threatening cue is detected, automatic and strategic forms of emotion regulation processing typically follow. Automatic forms of processing have the potential to operate below conscious awareness as well, and are typically over-trained, habitual responses to threat. Strategic forms of processing are more volitional, and cognitive in quality. Avoidance is one emotion regulation strategy that occurs at both automatic and strategic time-courses for the purpose of reducing elaborative or evaluative processing and deflating the threat value of the stimulus. When avoidance becomes habitual, it also can be maladaptive.
Both hypervigilance and avoidance have been found to contribute to the exacerbation of chronic pain and disability, and a vulnerability to pathological emotional states in chronic pain disorders like fibromyalgia (FM). FM is a disorder characterized by diffuse tenderness and widespread chronic pain, and is often accompanied by impaired cognitive, emotional, and physical functioning. Although various external stimuli such as infection, trauma and stress may contribute to development of FM, recent studies have emphasized the role of hypervigilance and avoidance of pain-related information. Pain-related information are cues in the environment or recalled from one’s memory and can be anything from images, sounds, certain trigger words (e.g., sharp, pounding, throbbing), or even people that remind one of a past experience of pain. Because these cues have previously been associated with pain, a heightened sensitivity towards such pain-related information develops and leads to a generalized pattern of hypervigilance.
My colleagues from the Utah Center for Exploring Mind-Body Interactions and I recently published a preliminary study in Cognitive Therapy and Research that investigated attentional bias of pain-related threat between women diagnosed with FM who went through an 8-week course of mindfulness-based contemplative training and an age-matched comparison control group of female FM individuals. The mindfulness-based training program was designed to accommodate the physical limitations of the FM population, but modeled after curriculum for Mindfulness-based Stress Reduction (MBSR) (see paper for exact modifications). A well validated dot-probe task (see paper for methodology of task) was used to explore early versus later stages of attentional bias processing of pain-related threat words. The rapid exposure of cues at short durations (100 ms) intended to capture automatic stages of processing by limiting attention to early sensory-perceptual stages, while longer cue durations (500 ms) intended to capture initial strategic forms of cognitive processing. The data indicated that individuals from the control group appeared to be hypervigilant-avoidant in their processing of pain-related threat, such that pain-related words were rapidly detected and avoided without much time for conscious elaboration. This form of avoidance is presumed to be a highly conditioned, automatized form of processing. Individuals from the control group also appeared to have difficulty disengaging from pain-related threat once strategic, elaborative processing was possible. This lingering engagement with negative stimuli slowed their response time on the dot-probe task, such that processing of threatening stimuli was assumed to interfere with the necessary processing for the task at hand (i.e., keyboard press indicating position of dot-probe). One may speculate that the mental stickiness that is typically described as a target for Buddhist meditation practices could also be explained by disengagement difficulty. Extended elaborative processing has also been implicated in ruminative cognition, a maladaptive, repetitive evaluation of one’s experience in a negative context.
The individuals exposed to mindfulness training demonstrated significantly less avoidance of threat than individuals from the control group and also disengaged more rapidly at later stages of processing. These results suggest that mindfulness training reduces avoidance of pain-related threat at early levels of attention processing, and facilitates disengagement from threat at later stages of processing. Furthermore, it appears that effects of mindfulness training on early attentional threat processing do not remain stable after long-term follow-up. The enduring effects of mindfulness training on attentional bias were assessed 6-months after completion of the mindfulness-based program. With little to no continued meditation practice, the apparent effects on attentional bias were reduced. What did remain was a lack of attentional bias towards pain-related threat in comparison to neutral words.
The take-home message for this preliminary study is that mindfulness training for individuals diagnosed with FM appears to increase engagement with and decrease avoidance of pain-related information that normally leads to anxiety and emotion dysregulation. Furthermore, mindfulness training appears to decrease time of lingering or “mental stickiness” with pain-related information. Further studies will have to investigate whether the decreases in bias after 6 months with little to no continued practice were indicative of a linear trend towards maladaptive avoidant emotion regulation strategies, or a stabilization of attention over time, in which no bias remains between threat and neutral stimuli. This study is the first preliminary evidence for the effect of mindfulness training on attentional bias. Future studies are also needed to clarify changes from pre- to post-meditation training using a mixed level of analysis, so that within and between group comparisons can be properly made.

David R. Vago, Ph.D.
Harvard Medical School
Brigham & Women’s Hospital
Dept. of Psychiatry

reference:
Vago, D.R. & Nakamura, Y. (2011). Selective attentional bias towards pain-related threat in fibromyalgia: Preliminary evidence for effects of mindfulness meditation training. Cognitive Therapy and Research, 6(35), 581-594. doi: 10.1007/s10608-011-9391-x