Shambhala Sun Features Mindfulness-Based Relapse Prevention (MBRP) in latest issue

One Moment at a Time, is the title of a recent item in David Swick’s column The Mindful Society published in the most recent edition of Shambhala Sun, about the relationship between mindfulness and substance use disorders. The article specifically highlights Mindfulness-Based Relapse Prevention (MBRP) and the work of the late G. Alan Marlatt, Sarah Bowen and colleagues at the Addictive Behaviors Research Center at the University of Washington. 

By Blair Buckman

Most of us are looking for magical solutions to solve our problems instantaneously. Some of us turn to indulgences like ice cream for a quick fix, and others habitually turn to more harmful addictive substances, like alcohol or drugs. Addiction affects millions of individuals and their families each year and can be an insurmountable obstacle for many. Dr. Lawerence Peltz, a Massachusetts psychiatrist, describes mindfulness as “the microscopic version of One Day at a Time,” adding “it’s One Moment at a Time.”

Much of the research on mindfulness and addiction is conducted at the Addictive Behaviors Research Center at the University of Washington in Seattle, established by the late Alan Marlatt. Dr. Sarah Bowen and her colleagues there have conducted a number of studies on the topic, including a study examining mindfulness implementation among previously imprisoned drug and alcohol offenders. She found that by learning mindfulness practices, they were able to recognize internal triggers without responding to them, therefore reducing the likelihood of returning to drug and alcohol use as compared to control subjects that did not receive mindfulness training. Their MBRP program was modeled after Segal, Teasdale and Williams’ Mindfulness-Based Cognitive Therapy (MBCT) program and Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR). MBRP assists people in developing awareness of what their triggers and habits are, in addition to changing how we respond to physical and emotional discomfort. Furthermore, MBRP assists in developing a compassionate and nonjudgmental mindset.

The program emphasizes meditation practices and implementation of mindfulness practices in daily life in order to regain control of our attention and actions. Bowen and colleagues will be integrating mindfulness meditation practices and utilizing demonstration, role-play, simulated exercises, and inquiry to teach MBRP in a 5-day intensive retreat training through the UCSD Center for Mindfulness at the EarthRise Retreat Center in Petaluma, California in April 2012. More information about the training is available through the UCSD Center for Mindfulness.

We invite you to read the full text of David Swick’s article, in the November issue of the Shambhala Sun, available on newsstands now.

 

Mindfulness and Yoga: Complementary Paths of Health, Healing, and Wellbeing

By Amy Holte, Ph.D., M.Ed.

Amy Holte

Amy teaches Mindfulness-Based Stress Reduction for the UC San Diego Center for Mindfulness, which is launching a new monthly 2nd Saturday workshop series entitled “Mindfulness, Meditation and Yoga” starting Saturday August 13^th 9-10:30am that she will teach, with registration open to anyone. The following article draws from her work teaching mindfulness, yoga, and meditation to help people suffering from stress and stress-related conditions, including depression, anxiety, and chronic pain.

As I’ve been teaching various forms of contemplative practice over the past dozen years or so in different settings with a wide variety of groups, I have observed that people who practice “yoga” do not always have a sitting meditation practice, and that people who meditate do not always have a contemplative-oriented movement practice. This trend seems to reflect a wider societal phenomenon evident in a number of fields, notable philosophy, psychology, and medicine, over the past few hundred years to separate the realms of mind and body. Thus, one feature of the mindfulness-based stress reduction (MBSR) program, and other mindfulness-based programs, that strikes me as particularly powerful is the blending of both of these approaches to self-development within the same course offering. In my experience, these two approaches – sitting meditation and mindful movement — are intimately tied to one another, and, when practiced together in a complementary way, inevitably deepen one’s practice.

Mindfulness is often conceived of as a moment-to-moment practice of non-judgmentally paying attention to one’s experience, a practice that is cultivated both formally through specific techniques, such as sitting meditation, and informally as one moves through daily life. In this sense, mindfulness has developed over the past half-century or so as a means of experiencing many of the psychological benefits of meditation without necessitating adoption, or even consideration, of specific spiritual, philosophical, or religious beliefs. Thus, although mindfulness grows out of the Buddhist stream of contemplative practice (Maex, 2011), mindfulness as it is practiced today offers a secular pathway for working with the mind and body.

Interestingly, the notion of “mindfulness” is also evoked to refer to a specific mindfulness program. Mindfulness-Based Stress Reduction (MBSR) is a systematic approach to teaching mind-body awareness and growth that was founded by Jon Kabat-Zinn over 30 years ago when others teachers of contemplative paths were also practicing and teaching mindfulness, meditation, and yoga (Kabat-Zinn, 1990). Included in the program of sitting meditation, attention to the breath and thoughts, and body awareness, is a “yoga” practice that resembles the type of practice offered in most yoga studies. This combined approach of MBSR and other mindfulness-based programs (Cullen, M. 2011) has been particularly useful as a means of integrating mindfulness into the therapeutic contexts of medicine, clinical psychology, and healthcare in general.

In a parallel fashion, the practice of “yoga” has also made its way into therapeutic, clinical, and healthcare contexts both on its own as a method of reducing stress and bringing health to the body and mind, and within mindfulness-based program as a means of practicing mindfulness (Harrington, 2008). Distinct from the “mindfulness” milieu, “yoga” has become widely popular as a way of achieving health, fitness, and vigor (Alter, 2004). In this sense, for many people today “yoga” means a physical movement oriented practice of various postures, perhaps also with awareness of the breath and some deeper connection of the body with the mind and other aspects of our being, with benefits of greater flexibility, strength, and diminished stress and pain-related symptoms.

However, in the ancient tradition of yoga, and, in fact, in many non-mainstream circles today, meditation is the ground of yoga. For thousands of years, even predating the era of Classical Yoga (c. 150-200A.D.), the practice of “yoga” centered on meditative practices as the means for uniting the practitioner with the greater reality (Feuerstein, 1998). One important feature of yoga, though, is the fact that it adapts to culture, historical era, etc. Thus, the system of strong physical postures and breathing techniques that we know as “yoga” today actually emerged rather late in the history of yoga, in the 13-15^th centuries, and is more accurately identified as “hatha yoga” (White, 1996). This physical and body oriented method of practicing “yoga” (transformed once again from its medieval manifestation) is what has become a popular means of pursuing health and strength of the body and mind today (Alter, 2004; DeMichelis, 2004; Harrington, 2008), whether on its own or as part of a mindfulness program.

No matter one’s entry point into contemplative practice, whether it be through the physical or the mental, I invite us to consider that these two streams of practice are not separate. Rather, these are complementary means to awareness, health, and wellbeing. Mindfulness helps deepen the process of self-inquiry during physical practice, a lesson that can then be taken off the mat when we move around in life. Similarly, a regular contemplative movement – hatha yoga if you prefer the more traditional name, or simply “yoga,” – supports a sitting meditation practice. Meditators often encounter problems such as pain in the knees and back from sitting for extended periods of time; yet, when a regular “yoga” practice is undertaken, the body becomes transformed in such a way as to allow it to remain comfortably at rest for longer and longer periods of time in a single posture that supports a state of restful awareness experienced in the mind, as well. The effects of systematically practicing yoga take root in the body, transforming it on a day-to-day basis. Together, contemplative sitting and movement practices bring more ease and free practitioners from preoccupation with the pains and limitations that we may normally experience in our body-mind, thus cultivating greater wisdom and wholeness in daily life.

A plethora of scientific and clinical research has shown that both modes of practice lead to healing and stress-reduction. For example, relaxation of tense muscles, improvement of blood flow throughout the body, optimization of heart rate and respiration, and reduction of anxiety and depression (Kabat-Zinn, et al., 1992) have all been found in research on both yoga and mindfulness (Benson, H., Beary, J., and Carol, M., 1974). Moreover, improvements in chronic stress-related conditions, such as chronic pain including backaches and headaches (Kabat-Zinn, et al., 1982, 1985, 1986; Galantino, et al., 2004; Tekur, P., Singphow, C., Nagendra, H.R., and Raghuram, N., 2008), irritable bowel syndrome (Kuttner, et al., 2006; Gaylord, S.A., et al., 2011; Kearney DJ, McDermott K., Martinez M., and Simpson T.L., 2011), and arthritis (Pradhan, et al., 2007; Badsha, et al., 2009), heart disease (Ornish, et al., 1998; Sullivan et al., 2009; Allexandre, et al., 2010), insomnia (Khalsa, 2004; Kreitzer et al., 2005), and cancer (Carlson et al., 2003; Witek-Janusek et al., 2008; Ulger and Yagli, 2010) have also been shown in populations practicing both mindfulness and yoga.  Because of this overlap of the benefits of each, and that these methods are complementary to one another, perhaps it is no wonder that they are brought together in MBSR.

So how can we make sense of the observation that different people naturally gravitate towards different types of practice? It is not so difficult to recognize that we each have unique constitutions.  Some people are more introspective by nature, while others are more action and physically oriented. So sitting and practicing meditation may be a more natural behavior for those of the more introspective constitution, while engaging in physical postures, sometimes often quite challenging movements, may offer more appeal for others.

Yet in common between all constitutions is the basic reality of the intimate connectedness of body and mind. This insight is especially relevant when we consider the possibility that the “body” is not merely, or just, “physical” as it in common understandings of the body.  Embedded within the body lies our nervous system, the physical and energetic reality of our minds. Thus, in this sense, the mind resides within the body as a continuous ever-present system that is fully interactive with the rest of the body. In this view, cognitive processes, such as attention, thinking, and problem solving, and emotions as well, are embodied and deeply rooted in the body’s interactions with the world (Varela, et al., 2009). This embodied mind orientation provides an increasingly popular theoretical stance for a holistic view of human nature that the two – body and mind – are not separate.

What does this mean for practice? The practical insight here is to spend at least some time each day on the different types of contemplative practice, both sitting and movement, because each mode of practice supports, complements, and reinforces the other. By exercising the literal muscles of the physical body, we simultaneously exercise the metaphorical muscles of the mind; and, conversely, by strengthening mental acuity and clarity through sitting practice, we also benefit the body. An integrative approach to lifestyle, behavior, and healing cultivates true health and wellbeing.

Dr. Holte is a graduate of The University of Texas at Austin where she completed her doctoral research on meditation and the brain, drawing from both ancient texts and current research on the neuroscience of meditation and clinical effectiveness of yoga and meditation for health conditions.

References

Allexandre, D., Fox, E., Golubic, M., Morledge, T., and Fox, J. E. B. (2010). Mindfulness, yoga, and cardiovascular disease. Cleveland Clinic Journal of Medicine, 77(3), S85.

Alter, J. (2004). The Body Between Science and Philosophy: Yoga in Modern India. Princeton and Oxford: Princeton University Press.

Badsha, H., Chhabra, V., Leibman, C., Mofti, A., and Kong, K.O. (2009). The benefits of yoga for rheumatoid arthritis: Results of a preliminary, structures 8-week program. Rheumatology International, 29(12): 1417-1421.

Benson, H., Beary, J., and Carol, M. (1974). The relaxation response. Psychiatry, 37, 37-46.

Cullen, M. (2011). Mindfulness-Based interventions: An emerging phenomenon. Mindfulness.

DeMichelis, E. (2004). A History of Modern Yoga. London: Continuum.

Harrington, A. (2008). The Cure Within: A History of Mind-Body Medicine. New York. New York: W. W. Norton & Company.

Feuerstein, G. (1998). The Yoga Tradition: Its History, Literature, Philosophy and Practice. Prescott, Arizona: Hohm Press.

Galantino, ML, Bzdewka, T., Eissler-Russo, J., Holbrook, M., Mogck, E., Geigle, P., Farrar, J. (2004). The impact of modified hatha yoga on chronic low back pain: A pilot study. Alternative Therapies, Mar/Ap, 10(2).

Gaylord, S.A., Palsson, O.S., Garland, E.L., et al. (2011). Mindfulness training reduces the severity of irritable bowel syndrome in women: Results of a randomized controlled trial. The American Journal of Gastroenterology, Epub ahead of print.

Kabat-Zinn, J.  (1982). An out-patient program in Behavioral Medicine for chronic pain patients based on the practice of mindfulness meditation:  Theoretical considerations and preliminary results. Gen. Hosp. Psychiatry, 4:33-47.

Kabat-Zinn, J., Lipworth, L. and Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. J. Behav. Med., 8:163-190.

Kabat-Zinn, J., Lipworth, L., Burney, R. and Sellers, W.  (1986). Four year follow-up of a meditation-based program for the self-regulation of chronic pain:  Treatment outcomes and compliance. Clin.J.Pain, 2:159-173.

Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, New York: Delta Trade Paperbacks.

Kabat-Zinn, J., Massion, A.O., Kristeller, J., Peterson, L.G., Fletcher, K., Pbert, L., Linderking, W., Santorelli, S.F.  (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am. J Psychiatry, 149:936-943.

Kearney D.J., McDermott K., Martinez M., and Simpson T.L. (2011). Association of participation in a mindfulness programme with bowel symptoms, gastrointestinal symptom-specific anxiety and quality of life. Aliment Pharmacol Ther., 34(3):363-73.

Khalsa, S.B.S. (2004). Treatment of chronic insomnia with yoga: A preliminary study with sleep-wake diaries. Applied Psychophysiology and Biofeedback, 29(4): 269-278.

Kuttner, L., Chambers, C., Hardial, J., Israel, DM, Jacobson, K., and Evans, K. (2006). A randomized trial of yoga for adolescents with irritable bowel syndrome. Pain Res Manag. Winter; 11(4): 217–224.

Maex, E. (2011). The Buddhist roots of mindfulness training: a practitioners view. Contemporary Buddhism, 12: 1.

Ornish, D., Scherwitz, L.W., Billings, J.H., Gould, K.L.,  Merritt, T.A., Sparler, S., Armstrong, W.T., Ports, T.A., Hogeboom, C., and Brand, R.J. (1998). Intensive lifestyle changes for reversal of coronary heart disease. JAMA, 280(23):2001-2007.

Pradhan, E.K., Baumgarten, M., Langenberg, P., Handwerger, B., Gilpin, A.K., Magyari, T., Hochberg, M.C., Berman, B.M. (2007). Effect of Mindfulness-Based stress reduction in rheumatoid arthritis patients. Arthritis Care & Research, 57(7): 1134–1142.

Tekur, P., Singphow, C., Nagendra, H.R., and Raghuram, N. (2008). Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: A randomized control study. The Journal of Alternative and Complementary Medicine, 14(6): 637-644.

Ülger, O. and Yağli, N.V. (2010). Effects of yoga on the quality of life in cancer patients. Complementary Therapies in Clinical Practice, 16 (2): 60-63.

Varela, F., Thompson, E., and Rosch, E. (1991). The Embodied Mind: Cognitive Science and Human Experience. Cambridge: The MIT Press.

White, D. (1996). The Alchemical Body: Siddha Traditions in Medieval India. Chicago: The University of Chicago Press.

Got Sleep? If not, choose Mindfulness.

By Cindy Gross

Cindy Gross

Do you often lie in bed unable to fall asleep? Do you regularly wake up in the middle of the night or too early in the morning? If so, you are not alone. About 1 out of every 10 adults has chronic insomnia. Insomnia causes daytime problems like feeling fatigued or being unable to concentrate. Insomnia is associated with accidents, low productivity and serious health problems.  It is also an important risk factor for depression. The most common treatment for chronic insomnia is sleeping pills. People regularly take these pills for years, despite troublesome side effects, and without addressing the underlying problems that cause or perpetuate their insomnia. Our findings published in the March/April 2001 issue of EXPLORE (Gross et al., 2011) indicate that mindfulness training may be an effective treatment for chronic insomnia, providing sleep benefits comparable to medication, without the side effects.

Mindfulness, paying attention to the present moment in particular way, is hypothesized to improve sleep by calming the body and stopping mind-racing. The impact of mindfulness training on arousal and poor sleep habits is discussed in Full Catastrophe Living by Jon Kabat-Zinn,  the text which introduced the Mindfulness-based stress reduction (MBSR) program.   Approaches to improve sleep through mindfulness include establishing a mindful pre-sleep routine, not spending time awake in bed (e.g., getting up and doing yoga or something enjoyable if unable to sleep), and switching attention from wakefulness by focusing on the breath or practicing a meditation technique.  In this way, mindfulness is hypothesized to facilitate disengagement from the concerns of the day, and enable falling asleep.   Although studies by our group and others have frequently shown that mindfulness training improves sleep quality, the impact of MBSR training on patients with insomnia had not been tested. Therefore, we decided to conduct a small clinical trial to investigate MBSR’s potential as a treatment for chronic insomnia.

 The purpose of our study was to determine if mindfulness training would enable adults with chronic insomnia to obtain clinically meaningful improvements in sleep, comparable to the sleep benefits they might have obtained using an FDA-approved sedative. Thirty adults with primary chronic insomnia were randomized 2:1 into two groups: MBSR or pharmacotherapy.  Mindfulness training was provided by a skilled MBSR teacher, Terry Pearson, in the standard format of 8 weekly two-and-half hour classes plus a retreat. The pharmacotherapy group was prescribed 3mg of eszopiclone (LUNESTA^TM) nightly for 8 weeks, followed by 3 months of use as needed.  A 10-minute sleep hygiene presentation (i.e., do not watch television in bed, keep the bedroom dark at night, etc. ) was given to all participants by study staff at the start of the study, and staff contacted everyone weekly so they could report any side effects.

Sleep was measured three ways. First, sleep patterns were objectively measured by actigraphy, a wristwatch-like device that measures movement. Second, participants kept daily entries in a log book called a sleep diary. Third, participants completed questionnaires containing widely-used, validated sleep scales including the Insomnia Severity Index and the Pittsburgh Sleep Quality Index.  Sleep measures were obtained before the interventions, and at two and five month follow-ups.   The study participants were 21 to 65 years old (mean age 49) and mostly women (73%).  Most (66%) had been using sleeping pills prior to enrolling in this trial.  Twenty-seven out of 30 patients completed their assigned treatment.

By the end of the 8 week program, MBSR participants significantly reduced the time it took them to fall asleep (-8.9 minutes), as measured by actigraphy. Based on sleep diaries, they fell asleep an average of 22 minutes sooner, and increased their total sleep time by about 34 minutes a night by 5 month follow-up.  All standardized sleep scales showed large, statistically significant improvements from before MBSR to all follow-ups.  No significant differences were found between the sleep outcomes of the MBSR and pharmacotherapy groups, although our sample size was not sufficient to establish that treatment effects were equal.

To evaluate clinical importance, rates of recovery from insomnia were examined. Before treatment, all participants met criteria for insomnia and poor sleep on the Insomnia Severity Index and the Pittsburgh Sleep Quality Index.  By month five, half of the patients randomized to MBSR met stringent criteria for recovery from insomnia. Moreover, none reported adverse events and treatment satisfaction scores were high (averaged 8.8 on a 1 to 10 scale).  Although patients in the pharmacotherapy group obtained similar benefits to sleep outcomes, their treatment satisfactions scores were not high (average 6.1), most continued using sleeping pills to the end of trial, and several reported adverse events.  Although sleep outcomes following MBSR compared favorably with conventional pharmacotherapy, the fact that only half of the patients in this study met criteria for recovery at follow-up suggests that there is still room for improvement in insomnia treatments.

This study provides initial evidence of the efficacy of mindfulness training as a treatment for chronic insomnia.  Strengths included a randomized design and verification of the diagnosis of primary insomnia by psychiatric screening and examination by a sleep physician.   Given the absence of side effects and the positive potential benefits of mindfulness that extend beyond sleep, we encourage people with chronic insomnia, particularly those unable or unwilling to use sleep medications, to consider mindfulness training with MBSR.

Funding was provided by a UMN AHC Faculty Development grant to Cynthia Gross and colleagues .

Reference: Gross CR, Kreitzer MJ, Reilly-Spong M, Wall M, Winbush NY, Patterson R, Mahowald M, Cramer-Bornemann M. Mindfulness-Based Stress Reduction vs. pharmacotherapy for primary chronic insomnia: A pilot randomized controlled clinical trial. Explore: The Journal of Science & Healing. Explore. 7(2): 76-87, 2011. PMID: 21397868

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 .

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

The Joy and Miracle of Parenthood- An Interview With Jon Kabat-Zinn

Mindfulness-Based Cancer Recovery: How a Program (and a new book) Were Born

Psycho-oncology researchers and colleagues Linda Carlson and Michael Speca have been running mindfulness-based groups for cancer patients for over ten years now, and that experience has led to the development of a powerful program and now a very helpful new book from New Harbinger entitled Mindfulness-Based Cancer Recovery: A Step-by-step MBSR Approach to Help You Cope With Treatment and Reclaim Your Life. Read their individual accounts of the unfolding of this program below.

Michael: In 1995, I had been working as a newly minted psychologist for a couple of years and found myself working in a busy cancer treatment centre in Calgary, Alberta. On one particular day, two colleagues and I were sitting together having lunch in the hospital cafeteria and talking about our work, which consisted primarily of counseling and providing support to cancer patients and their families.

While discussing with some awe and not a little reverence the immensity of challenges many patients encounter and often overcome, we also spoke of our gratitude for the opportunity to do the work that we did.  Eventually we got around to acknowledging that this work was not without cost to us. Caring about the people with whom we work means sharing in their loss and grief as well as their triumphs. These experiences also heightened our own sense of vulnerability.

As our discussion deepened that day we discovered that we had something else in common. Each of us to varying degrees relied on meditation and yoga to cope with the stresses of our own lives. It occurred to us that some of our patients might benefit from these practices in a different way than what counseling could provide. We wondered if it would be possible for us to offer a program where we could share what we had learned through our own experience with meditation. How would it be accepted in the highly technical and institutional medical setting that was our workplace?

From that point on we set out to develop a program. We cobbled together bits and pieces of the yoga and meditation we had practiced and tied it into what we knew about stress and the mind-body perspective from our training as health professionals. From this we created a workbook for participants. There were about equal parts yoga, including yogic breathing practices, and a range of meditation techniques including mindfulness meditation. The first few times we ran the program we obtained written feedback from everyone at the end of what were then seven-week sessions and used that information to refine our approach. Word of mouth quickly spread and we had little difficulty filling our classes.

Linda: I joined the team first as a psychology intern in 1997, then as a postdoctoral fellow in 1998. Along the way we became more pointedly aware of Jon Kabat-Zinn and his MBSR approach. We developed a profound respect for the sensitivity and thoroughness with which he had described his work in his book Full Catastrophe Living: Using the wisdom of your mind and body to face stress, pain and illness and began to recommend it to all of our patients.

At about that time we began to conceive of our first formal study comparing the changes over time between patients randomized to either our mindfulness program or a wait-list control condition. We were pleased to find that our impressions of the value of these methods and the reports of benefit from patients were supported by the outcomes of that study, which was published in Psychosomatic Medicine in 2000 and has been cited almost 300 times since then!

We continued to write grants, run programs, train students and publish the results, which brought us to the 2008 when I was beginning my first maternity leave. Based on our body of work, I was approached by the publisher New Harbinger and asked if I wanted to write a mindfulness book for cancer patients. I thought it was a good idea and would give us a chance to write down a lot of what we had refined into our program over the years. Of course I asked Michael to be my co-author, given that we had been running groups together for the previous 10 years and it was his wisdom to originally develop the program, and the result, almost three years later, is Mindfulness-Based Cancer Recovery!

We are really pleased to see it in print and hope that it may, in some small ways, help those facing this journey. We wrote it with not only people who were diagnosed with cancer themselves in mind, but also their support network of professionals, friends and family. It might also be of interest to health-care professionals interested in applying mindfulness to their own work with people who have cancer and other chronic illnesses.

Interview With Jon Kabat-Zinn on the Science of Mindfulness

A fascinating interview with Jon Kabat-Zinn from 2009 entitled “Opening to Our Lives” by Krista Tippett of American Public Media for her program “Krista Tippett on Being”.  Note that there is a small excerpt (and link) on the site of Jon reading Derek Walcott’s wonderful poem Love after Love:

The time will come
when, with elation
you will greet yourself arriving
at your own door, in your own mirror
and each will smile at the other’s welcome,

and say, sit here. Eat.
You will love again the stranger who was your self.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you

all your life, whom you ignored
for another, who knows you by heart.
Take down the love letters from the bookshelf,

the photographs, the desperate notes,
peel your own image from the mirror.
Sit. Feast on your life.

“Love after Love” from COLLECTED POEMS 1948-1984 by Derek Walcott. Copyright © 1986 by Derek Walcott.

Fight or Dance: You get to choose!

Shauna Shapiro and her colleagues (reference below) wrote about the mechanisms of mindfulness and highlighted “reperceiving” as a fundamental shift in perspective that arises out of the practice of mindfulness. This is not just an interesting theoretical point, it has real consequences.

Consider the case of a patient suffering from chronic pain who learns, through the practice of mindfulness, that his “awareness of pain is not actually in pain”. This reperceiving of what was previously a very personal and self-identified experience affords the patient, in an instant, a whole range of possible behavioral and attitudinal responses to the pain that he cannot directly control. These responses may include some degree of acceptance, accommodation or creative responding that can be characterized as psychological flexibility.

This shift was highlighted with remarkable clarity by a participant in MBSR who had significant amounts of chronic pain, and had suffered with it for many years. This experience led to depression, anxiety and frequent suicidal thoughts when he encountered reminders of the likelihood that his pain would never go away. One day in psychotherapy after completing the MBSR class he noted “I’ve always been a fighter. I wrestled, I played football (and often played hurt), I became successful in business by being tough and competitive, and when I got injured and the pain persisted after multiple surgeries, I fought with the pain too. After taking the class and practicing meditation, I found that instead of fighting with my pain, I could dance with it. That’s huge!” Thus, in a simple but fundamental act of reperceiving (described as “an orthogonal rotation in consciousness” by Kabat-Zinn), this man was able to discover an option that had always been available to him but completely lost in his focus solely upon the pain itself. The profound possibilities inherent in that reperceiving (e.g. dancing rather than fighting with pain) forms a foundation for the type of fundamental changes and transformations that people experience through mindfulness practice.

What are you fighting with and could you consider dancing with it instead?

Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. J Clin Psychol, 62(3), 373-386

Shambhala Sun Launches Mindful

The Shambala Sun Foundation’s new website Mindful is launched! It holds great potential in becoming a quintessential site for everything mindful.

We are happy to announce the UCSD Center for Mindfulness’s inclusion in several categories of mindfulness-related resources listed on Mindful.

Please visit Mindful.org to watch a video of Jon Kabat-Zinn sharing his thoughts on this comprehensive site’s important value.