MB-EAT or Mindful Eating Conscious Living (MECL) Which Program is Best for You or Your Population?

by Char Wilkins, LCSW

I’ve been getting a lot of emails asking what is the difference between the MB-EAT program and our Mindful Eating, Conscious Living (MECL) 5-day professional training at the Chapin Mill Retreat Center in Rochester, NY, August 4-9, 2012. I have the unique qualification of having taught both the MB-EAT program and the Mindful Eating, Conscious Living training which I co-teach with Jan Chozen Bays, MD, so I feel I can speak to some of the differences which may help you decide if our training is right for you.

Jan and I see mindfulness as the base from which we work- the heart of the work.  We recognize that many professionals have extensive skills in some areas but need help with mindful eating skills, so Jan and I created this training based on Jan’s book, Mindful Eating: A Guide to Rediscovering a Healthy and Joyful Relationship with Food. We have uniquely brought Jan’s deep understanding of mindfulness and meditation, her extensive work with distressed eating, and her medical background together with my individual and group therapeutic experience working with people with distressed eating patterns, MBSR and MBCT training, and meditation practice.

The professional training we offer is clearly based in a mindfulness approach that addresses thoughts, emotions, physical sensations, and behaviors associated with distressed eating, and provides practical, doable exercises and simple meditations that you can weave into your individual work or into a group program. In our training we don’t teach about calories or how to lose weight, nor do we talk about dietary plans. This is different from most trainings. We do talk about quality of food, types of food the body must have, hunger and fullness, and many other related issues. We are focused on helping people change their relationship to food, eating and their bodies. We provide you with a six-session sample curriculum, yours to adapt to your needs, and CDs that contain meditations and exercises.

MB-EAT, Jean Kristeller’s research initiative, has illuminated some important points with a focus on weight loss, one of the techniques used being mindfulness. For some professionals difficulties arose in teaching a mindfulness approach while instructing patients to reduce calories, use pedometers and assess weight loss. Professionals got confused, and patients get confused. For some people this is not a problem.  The MB-EAT program is a very structured program for groups, and many clinicians told me that they were working one-on-one and wanted the flexibility to bring mindful eating to their individual patients. This is simply a different approach and very valuable for some populations.

Jan and I feel that your own personal experience of going through this hands-on training, doing the eating and mindfulness exercises, hearing your colleagues’ responses and questions, practicing meditation, and being in a supportive community will not only enhance your learning but give you confidence to teach mindful eating to your clients. In teaching mindful eating skills you will provide patients with skills for a lifetime which they can begin again and again if need be, without the “side effects” of yoyo dieting. Additionally, in becoming mindful it spills into all aspects of their life- it becomes a way of being, rather than constantly doing or trying another fad or diet.

I hope this is helpful and will help you choose the program that is best suited to you and the population you serve

Char Wilkins, LCSW is a mindfulness-based psychotherapist who specializes in working with women who have experienced childhood abuse and trauma, and those who suffer with depression, anxiety and disordered eating. She trains professionals in the application of mindfulness in psychotherapy, advanced MBCT skills, mindful eating, and was awarded teacher certification in MBSR by the Center for Mindfulness, UMass Medical School, Worcester, MA. Char serves on the Board of Directors for The Center for Mindful Eating and is the owner/director of the Center for Mindful Living, LLC in Connecticut.

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

UCSD Offers Mindfulness-Based Stress Reduction Workshop for Nurses

We are thrilled to announce registration is now open for our Mindfulness-Based Stress Reduction Workshop for Nurses January 28, 2012, 9am-3pm at UC San Diego Moores Cancer Center, La Jolla, CA. Please join workshop leaders Lois Howland, DrPH, MSN, Livia Walsh LMFT, MS, MA, RN, and Amy Holte, PhD, MEd, in this exciting experiential workshop. You will gain insights on bringing mindfulness into your daily life for self-care along with exploring strategies for offering mindfulness to your patients to promote healing. This continuing education activity has been approved for 7 contact hours by the UCSD Medical Center Nursing EDR which is accredited by the California Board of Registered Nursing, Provider # CEP55 .

In this workshop, nurses will learn how to:

• Practice mindfulness strategies and techniques

• Practice self-care on and off the job

• Apply mindfulness and self-care in daily activities, such as eating, walking, and moving

• Integrate mindfulness into interactions with patients, colleagues, family, and friends

• Improve ability to cope with short- and long-term stressful situations

• Implement brief mindfulness practices with patients and family members as a means of coping with acute pain, anxiety, and distress

Registration

On or Before January 14, 2012: $125

On or After January 15, 2012: $150

Lois Howland, DrPH, R.N.

Senior MBSR Teacher

Lois Howland, DrPH, RN, completed the professional training program in Mindfulness-Based Stress Reduction at the Center for Mindfulness, University of Massachusetts Medical School, and at the Omega Institute with Jon Kabat-Zinn, PhD, and Saki Santorelli, EdD. She has been a mindfulness practitioner since 2000. Dr. Howland is a graduate of the UCSF School of Nursing, and the Harvard School of Public Health. Dr. Howland is a full-time faculty member in the School of Nursing, University of San Diego, and conducts research related to biological mechanisms of stress particularly as it affects maternal and child health.

Livia Walsh, RN, LMFT

MBSR Teacher

Livia Walsh is a nurse and licensed psychotherapist in private practice in Encinitas, California. She developed an interest and pursued training in the area of holistic/integrative health including mindfulness over her 30 plus years of professional practice. She completed the MBSR training program at the University of Massachusetts Medical Center and Omega Institute under the direction of Jon Kabat Zinn, Saki Santorelli and the senior teaching staff. Ms Walsh also teaches MBSR at the Senior Center in Encinitas. She integrates mindfulness in her work with patients and students. In her capacity as clinical supervisor at San Diego Hospice and other institutions she has taught mindfulness-based interventions to graduate/post-graduate students and professional staffs. Ms. Walsh believes strongly in the mind-body connection and in an integrative approach to achieve and sustain optimal health and well being.

Amy Holte, PhD, MEd

Senior MBSR Teacher

Amy Holte, Ph.D.,M.Ed. has been a meditation practitioner since 1997 and has been teaching mindfulness techniques for health, stress-reduction, and well being since 1999. She is a graduate of The University of Texas at Austin where she completed her doctoral research on meditation and the brain in an interdisciplinary Ph.D.program in East West Biopsychology, and a M.Ed. in Human Development and Education. Dr. Holte is the Director of Mind-Body Medicine and Team Leader of the Functional Restoration Program at The Center for Orthopedic Care in SanDiego where she teaches mindfulness, meditation, yoga, and tai chi in her work with chronic pain patients.

Wondering about ways that MBSR touches lives? This graduate says it beautifully and powerfully.

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

In the course of teaching Mindfulness-Based Stress Reduction, I have had the opportunity to hear first-hand how participation in the program has had an impact on the lives of many people. I know from my own experience of mindfulness practice how powerful it can be, but I often struggle with how to put that into words that really capture the experience. Fortunately, every now and then, one of our MBSR participants articulates it so poignantly and eloquently that I get a new look at how this practice changes lives. Recently, in a class taught by my colleagues Luis Morones and Amy Holte, one of their participants (we will call her Katie to protect her privacy, but she has given us permission to quote her) offered some wonderful feedback about her experience that we felt would be helpful to anyone considering embarking on a practice of mindfulness or in taking an MBSR course. Here is what she had to say:

“Thank you … for letting me attend most of the recent class  (in which I had) a 60% attendance rate, which makes me laugh because in addition to suggesting kindness to ourselves and not always striving towards something (like counting attendance) a mere 60% of your class has changed at least 90% of my life.  Although I have read only the opening of the book and made very little time to practice outside of the class, I cling to the concept of my breath always being there for me, or my feet being planted on the ground, and that has consistently redirected my next action in every situation.  Pausing for a moment to just be present gives you the time to envision a desired outcome or at least remember your long-term goal in any given interaction.

“Always a mellow driver, I now am even more inclined to let others race along without getting upset (hard not to urge others to do the same).  When working with my children, my focus is not on being right, but on getting them to decide for themselves what is right and why.  When there is a work crisis, it is amazing how many people already have the solution but have not dared to allow themselves to solve it.  Or friends who want you to solve their problems but don’t like your solutions, you realize they want the problem, and you can let go without guilt.

“Mostly I am finding that giving myself a moment to reflect keeps me calm and much more able to enjoy everyone’s company.  Just this week, all five of my family were in 1) my bathroom, 2) my closet, 3) our bedroom, and in each instance I stopped myself from saying “why are you all here, stop following me” but thought instead, how wonderful that you want to be with me, that we trust each other and listen to each other and want to be together.”

Katie works in the same office space as that of the UCSD Center for Mindfulness, and her group recently experienced a significant reduction in their workforce. The stress of the process of “downsizing” was immense, and we were moved to extend the offer of free participation in MBSR to any of their group affected by these layoffs. Katie noted, “I know that Steve may have been thinking about laid off employees when he so generously offered us a space in your class, but for those of us left behind to pick up the pieces of the dozen or so people we’ve lost, it has been stressful in a different way – survivor guilt, maybe, and the inability to share about the quality and quantity of work when we should be grateful to still have the opportunity to serve.  If I were going through all of these changes without the anchor of this class, my flame would definitely be starting to flicker!!  It is also such a grounding experience to learn from those whose life situations harbor even darker days. I do so regret having missed the retreat, I felt like I was letting my classmates down, but it was unavoidable.

“I feel so empowered about how to live my life in a way that is healthier and happier and that has positive effects on those I love.”

When I wrote to ask Katie’s permission to share what she wrote in her email to the teachers above, she responded with still more wonderfully descriptive feedback: “. . . essentially this experience has been the best gift since my wedding and the birth of my three healthy boys.  That is really not an overstatement or overly enthusiastic – I feel so empowered about how to live my life in a way that is healthier and happier and that has positive effects on those I love, which was my original goal for joining the group.  It will obviously take a lot more practice, but I can already tell that I am making better choices and just thinking before I speak (I can have a sharp tongue) is improving many relationships.”

It seems as though there is nothing else to say, as Katie said it all quite well! If someone you know could benefit from the practice of mindfulness or may be interested in taking a Mindfulness-Based Stress Reduction course, I highly recommend that you share this blogpost with that person. It could change their life in the way that it changed Katie’s. (NOTE: We have a morning sitting group on weekdays in our office and Katie continues to attend with us many times each week.)

The 2012 Schedule of MBSR Classes offered through the UCSD Center for Mindfulness is now online and available for online registration. Take a look at the lineup starting in mid-January and consider joining us to more fully experience the practice of mindfulness for yourself.

Bridging the Hearts & Minds of Youth: February Conference on Mindfulness with Youth in San Diego

Mindfulness, as a powerful and important means of cultivating health, well-being and equanimity, is nowhere more important than in our work with the young people of our society. Alongside the explosive and transformative growth of mindfulness-based programs for adults, there is a particularly heartening and vibrant effort to bring mindfulness to youth of all ages, in a plethora of settings and formats designed to have a significant impact on the lives and futures of literally millions of young people around the world.

To support and grow this important movement, the UCSD Center for Mindfulness has teamed with Stressed Teens to organize and present a first of its kind conference on February 4 and 5, 2012 entitled Bridging the Hearts and Minds of Youth: Mindfulness in Clinical Practice, Education and Research . The intention of this conference is to bring together a number of key thought leaders in the field of mindfulness, both those engaged in bringing it to youth and those whose influence extends well beyond that one area, with the hope that the synergy created by such a gathering will provide further impetus to a growing and important field.

Keynote speakers, breakout sessions and half-day workshops will form the structure of this gathering, but the intention is to create an overall atmosphere of connection, collaboration, encouragement, support and innovation that will inspire attendees to continue or begin the work of teaching mindfulness to the young people with whom they work. A full description of the conference is available on the UCSD Center for Mindfulness Professional Training website, but a  few highlights include:

Rick Hanson, author of The Buddha’s Brain and Just One Thing: Developing a Buddha Brain One Simple Practice at a Time will be presenting a public talk on Friday evening, February 3 entitled “Taking in the Good: Helping Children Build Inner Strength and Happiness” and then will provide a keynote address on Saturday at the conference itself with the intriguing title “Managing the Caveman Brain in the 21st Century”.

Psychologist and well-known mindfulness researcher Amishi Jha will be offering her insights in another keynote address, entitled “From Dazed and Distracted to Attentive and Calm: What the Neuroscience of Mindfulness Reveals”. Dr. Jha will be joining the other keynote presenters, Susan Kaiser Greenland, Pamela Siegle and Chip Wood on a discussion panel on Saturday as well.

Three post-conference half-day workshops will be offered on Sunday, February 5, allowing attendees to deepen their understanding and training in working with mindfulness and youth. Workshops include one by conference co-organizer Gina Biegel, developer of the Mindfulness-Based Stress Reduction for Teens (MBSR-T); another by Randy Semple, who has adapted Mindfulness-Based Cognitive Therapy (MBCT) for children, and a wonderful session on “Nurturing Your Self in Your Work With Youth” offered by mindfulness teacher and holistic physician, Amy Saltzman.

These are just a few of the highlights of this inaugural conference that promises to be literally packed with interesting and engaging speakers, presentations and experiences. Co-organizers Steven Hickman, Director of the UCSD Center for Mindfulness and Gina Biegel, founder of Stressed Teens, hope that this will become an annual event that makes a significant contribution to the field of mindfulness with youth. If you are an educator, therapist, physician, or just a concerned and engaged parent looking to explore how you might integrate mindfulness in your work with youth, you may want to consider joining this impressive lineup of presenters in San Diego at the Catamaran Resort Hotel on February 4 and 5, 2012. Space is limited, register early and receive a $50 Early Bird Discount.

Meatballs and Mindfulness: It Just Doesn’t Matter!

(Fair warning, I have previously refenced Caddyshack as a source of dharma teaching a few months ago, and today I will draw upon another Bill Murray 70s comedy, Meatballs, for inspiration. If you consider such pop culture references offensive, I invite you to turn to the more conventional items elsewhere on our blog. -SH) 

I sat in our Mindfulness-Based Stress Reduction class last night and listened closely to these people who have become a fleeting family for me over these past six weeks. Their voices were gentler, their faces were softer, their posture was more at ease. They were talking about the “Full Catastrophe” of their lives: deadlines, challenges, pain, relationships. When they walked in the door six weeks ago they wielded these things like weapons or burdens, or both. They were dark, heavy, malignant and unpredictable forces in their lives that seemed to threaten all that they hold dear in life.

Six weeks of mindfulness practice later (and two to go) and, in the vast majority of cases, nothing has changed about these stressful items in their lives.

But they have changed. In remarkable, awe-inspiring ways. They report meeting many of the facets of their lives in a more present-centered, equanimous manner. They are noticing their habitual tendencies and often ineffective coping strategies, and choosing to respond rather than react. To pause and allow a more skillful response to emerge from within rather than doing what they have always done. They have come to practice what the bumper sticker says: “Don’t believe everything you think.”

It is my view that they are viewing the dramas (stories) that are created beyond the actuality of their experience, and seeing right through them to the heart of the matter. They watch the drama unfold and, in some way tell themselves that “it just doesn’t matter”. And what’s even better is that they have a very deep felt sense of what DOES matter. To them, to their future, to their lives.

In the movie Meatballs, the quintessential summer camp movie, replete with adolescent angst, the hyper-hormonal and the perennially awkward, this attitude is amplified through the motivational speech offered up by Bill Murray. Take a look and see if you don’t feel the powerful and liberating  letting go inherent in chanting: “It just doesn’t matter! It just doesn’t matter!” (We probably won’t be hearing the strains of this chant issuing forth from behind the walls of monasteries anytime soon, but the image lightens my mood and makes me smile nonetheless!)

He’s not saying “nothing matters” but exposing the emperor with no clothes, the man behind the curtain, the paper tiger if you will. The coiled hose in the shadows is actually just a hose, and the “story” of it being a rattlesnake poised to attack just doesn’t matter when you see it for what it is. Just this.

 

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

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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.

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Bringing Affectionate Curiosity to Urges and Cravings: Mindfulness as a Means to Prevent Relapse for Women in Early Recovery

Zayda Vallejo

Zayda Vallejo, M.Litt is a Mindfulness-Based Stress Reduction teacher and professional trainer, and co-developed a Mindfulness-Based Relapse Prevention Program for women in addiction recovery for the Boston Public Health Commission. Zayda is the newest addition to the faculty of the UCSD Center for Mindfulness, joining Sarah Bowen and Joel Grow to lead the 5-Day Professional Training in Mindfulness-Based Relapse Prevention (MBRP) at the EarthRise Retreat Center in Petaluma, CA on April 1-6, 2012. The following article describes some of her important work in applying mindfulness (and MBRP) to relapse prevention specifically in a unique population.

The following is a description of the process of adapting the Mindfulness-Based Stress Reduction program (MBSR) to work with women in early recovery from drug and alcohol addiction, enrolled in three residential substance abuse treatment programs, and in one outpatient program, located in an urban center in Massachusetts. Most participants started the intervention two to three weeks after detoxification treatment. A total of 318 women (45% Latina, 35% Black, 20% White) completed baseline interviews. Two hundred and sixty-two women enrolled in the classes, and 61% completed the intervention. The aim was to provide skills training for relapse prevention.

Addressing Barriers
The most important change was the redirecting of MBSR into a program focused on the role of stress in relapse. This was accomplished in part by teaching the participants to become aware of the cravings and urges, with the intention to observe them with a certain spaciousness and affectionate curiosity. A drawing of a triangle with thoughts, feelings/emotions, and body sensations represented in a corresponding apex was presented in every class and created a visual tool that the women remembered easily. By separating the emotions, bodily sensations, and thoughts, and paying attention to each one individually in a systematic way, with moment-to-moment awareness, intending to hold judgments lightly, participants gradually began to feel freedom in choosing their responses instead of continuing with their habitual automatic ways of reacting. Most participants found this visual exercise and the freedom experienced very helpful.

Each class had a theme related to areas that were meaningful to the participants. Some of the class themes included intra- and interpersonal mindfulness, understanding how perceptions could compromise treatment and lead to relapse, and learning how to use mindfulness skills to relate differently to feelings of anxiety, panic attacks, fear, guilt, and shame.

The four practices employed in the traditional MBSR classes were used but the length, sequence, and ways of presenting them varied substantially. The body scan was shortened to reduce potential interference from trauma experience. It was performed in a sitting or standing position, non-sequentially, and interspersed with yoga movements. The eyes were open to promote a sense of safety. The scan began with the feet and legs, followed by yoga for the feet and legs. This process was repeated for all the different parts of the body. Instead of a detailed scan of the pelvic area and breasts, the revised body scan focused on the abdominal area and front of the chest. At times, movement took place first followed by the scanning in order to enhance connectivity with the body.  Though the participants did not do a lengthy body scan they would usually practice daily a two or three minute scanning of the body.

Walking meditation was preceded by very fast walking, decreasing the speed gradually and ending in the mountain pose. After that the participants could do walking meditation at a slow pace. The goal was to meet the women where they were, matching the movement to the agitation and pent-up energy they would exhibit and then progressively slow down.

Sounds were an easier gateway to awareness than the breath. Sitting meditation started with sounds, progressed to body sensations, and then the breath. Participants initially experienced the breath as boring and abstract. At times, it also triggered flashbacks for some of the women with trauma histories that included choking or a hand being held over their mouths. Interestingly, even though the breath was very difficult to connect with at the beginning, when asked in six and twelve month follow-up interviews, the women often reported that awareness of breath was the ‘tool’ that they practiced on a regular basis and the most helpful to ride cravings, urges, and impulses.

Hatha yoga, called mindful stretching exercises to avoid connotation of a religious nature that exists in some Spanish speaking regions, was the basic staple, and it was performed in any of the segments if the mood of the participants was too lethargic or too distracted. Participants enjoyed both the floor and standing yoga and often mentioned how helpful it was for lower back pain, shoulder and neck pain, and to release tension.

It must be noted that these adaptations were temporary ‘bridges’ until the women had the internal resources to do the practice similarly to the regular MBSR program. For example, during the half day retreat on week seven, women were able to do a body scan lying down on the floor for 45 minutes with no perceived adverse reactions.

Conclusion
The most important change was reframing the approach to focus on relapse prevention. Due to the participants’ trauma histories, short attention span, and low literacy, the language needed to be simplified and more visual components added. The length of the practices was shortened and the sequence and ways of presenting them were changed substantially.

In summary, MBSR is beneficial as an adjunct intervention in residential treatment facilities with individuals in early recovery. However, we found that adaptations were needed in order for the participants to see the program as relevant to their recovery. The participants needed to understand how the skills and tools learned could help them hold or relate to the stress in their daily life with less suffering and more compassion for themselves and those around them.

The Practices of Mindful Eating & Healthy Living: New 4-Week Workshop Launched at UCSD

Following on the heels of our recent successful 2-day workshop by Jan Chozen Bays and Char Wilkins entitled Mindful Eating, Tasting Satisfaction here at UCSD, we are launching a series of 4-week (90 minute sessions) experiential workshops on mindful eating for the general public. Exploring of the intersection of mindfulness, eating, food and physical health, The Practices of Mindful Eating and Healthy Living emphasizes engagement in formal and informal mindfulness meditation practices and eating awareness exercises as a means of bringing about significant changes in behavior, eating patterns and overall health.

Rochelle Voth, Ph.D.

Led by clinical psychologist, mindful eating authority and senior UCSD Mindfulness-Based Stress Reduction (MBSR) teacher Rochelle Voth, Ph.D., this workshop aims to help those who want to find new ways to relate to food, eating, weight and health through the practice of mindfulness. People with previous meditation experience and those new to the practice are invited to participate. Dr. Voth teaches MBSR at the UCSD Center for Mindfulness and also will offer this workshop in her private practice called New Mindful Life. 

The practice of present moment awareness (mindfulness) is at the heart of all aspects of healthy living, as it allows us to see clearly into the choices we make, the emotional reactions we have and the things that are most important to us. Because of the universal nature of mindfulness, while this workshop is focused upon food, eating and weight, the skills gained will apply to all aspects of life, including relationships, work, and physical health.

Participants will explore the joys and sorrows held in eating and food, the disconnects and communions, and the avoidance and cravings – all of which can be opportunities for more conscious, mindful living and eating. Participants will also explore the accomplishments and challenges held in meeting the body, the acceptance and resistance, and the trust and uncertainty- which are also opportunities for more conscious, mindful well-being and health.

The first workshop begins on July 14 from 6 to 7:30 pm at the UCSD Center for Mindfulness, 5060 Shoreham Place, Suite 200, San Diego, CA 92122. For more information and details, peruse our schedule and register at our website or visit New Mindful Life’s site for the schedule at that location.

For healthcare professionals who wish to learn more about teaching mindful eating, you may wish to attend a 5-day Professional Training Retreat entitled “Mindful Eating, Conscious Living” on October 2-7, 2011 at EarthRise Retreat Center in Petaluma, California. This training will also be led by Jan Chozen Bays (author of the book Mindful Eating: A guide to rediscovering a healthy and joyful relationship with food) and experienced mindfulness teacher and trainer Char Wilkins, LCSW.