Monthly Archives: June 2011

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.

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.

 

Mindfulness, Hypnosis and Psychotherapy: Where do they meet?

The following is the next in a series of informal conversations between Trudy Goodman, Ph.D., Elisha Goldstein, Ph.D. and Steven Hickman, Psy.D., the teachers for a unique upcoming professional training retreat entitled “Mindfulness in Psychotherapy” to be held October 2-7, 2011 at the Joshua Tree Retreat Center in Southern California. Enjoy! Today, Trudy Steve and Elisha talk about the relationship between mindfulness and hypnosis in psychotherapy and beyond.

Trudy Goodman, Ph.D.

Trudy: (I recently had an opportunity to explore the differences and similarities between mindfulness practice and hypnosis with a client. I thought it might be worth exploring here in our ongoing conversation on mindfulness and psychotherapy.) 

In mindfulness practice, we give our full attention to one subject at a time as a way of training our minds to be attentive to another dimension of awareness, “beneath” the discursive consciousness and the thinking mind (what the hypnotherapist calls executive functioning), and yes – the protective activity of the amygdala can be activated and trained via conscious, mindful breathing for example. Meditation does mirror the receptivity of hypnosis in this way.

In hypnosis, one is led and taught how to drop down beneath the flow of habitual patterns of thinking and perception to a receptive, open state where the therapist’s suggestions can be embedded and incorporated into conscious living. We are doing something similar but different, too. We may also invoke the relaxed, alert, receptive altered state, but we emphasize investigation, inquiry, and looking deeply at what is arising (with the intention to understand, rather than to judge, and the accepting, non-judgmental approach is similar in hypnosis).

One difference is that with mindfulness meditation we are learning how to be both receptive – open, relaxed, alert; and active – forming the intention to stay with experience as it arises and passes away. One goal of MBSR training is to establish and cultivate mindfulness — your ability to direct your awareness intentionally towards what is actually happening, in real time, moment by moment, so you can receive more information, understanding, and compassionate insight as your life unfolds.

There’s no conflict between what your hypnotherapist tells you and what we’re doing because we are actually engaging many capacities of consciousness simultaneously when we focus on one thing at a time – many cognitive and emotional qualities come into play, like the intention to aim or direct awareness, to sustain a close connection with the subject of awareness, AND with awareness of the ebb and flow of mindfulness itself – a kind of meta-awareness – with clear comprehension combined with the suffusion of warmth, acceptance, kindness, even affection, into our mindful awareness of ourselves, others and our world.

So yes, your mind can and does operate on more than one level at a time. What we are doing is bringing more and more of this activity into conscious awareness. We are cultivating strong mindfulness and metta, enabling us to make more conscious choices about the way we relate to experience.  Hopefully, wise choices that result in our living committed, compassionate lives, and enjoying more peaceful, harmonious, loving relationships along the way!

Steve: While I am no expert in hypnotherapy, I do have a strong sense that both mindfulness and hypnosis share an interest in helping people “get out of their own way” in regard to longstanding but dysfunctional, limiting or unskillful habits, attitudes and behaviors. The single-pointed, quiet and patient focus of both practices allows us (both client and therapist) to see these habitual patterns against a plain backdrop of awareness, rather than the cluttered one of everyday busy-ness.

I liken our attempts to make sense of our problems with our typically distracted, multi-tasking minds to trying to watch a movie when someone is trying to carry on a conversation with you at the same time. Both the movie and the conversation might make sense in their own rights, but together they become a mass of conflicting and confusing features that seems completely overwhelming and sometimes discouraging. Mindfulness practice (and therapy) allow the client to develop the attitudinal skills to observe this chaos and respond patiently and kindly, and the attentional skills to direct attention (and psychological resources) toward the “real” issues and perhaps away from imagined or feared ones. This shift can allow a person to see things for what they are, and to recognize where the constructions and stories that we all create are just that: creations, and not facts to be dealt with or resolved.

I am told that hypnosis cannot bring about behavior that is not first desired by the patient or client. If someone does not truly want to change a particular behavior, hypnosis has no magical ability to transcend that desire. Similarly, intention is at the heart of mindfulness in psychotherapy. We seek to tap into the natural intention that each of has to move toward ease, kindness, compassion and fulfillment, by reducing the “obscurations” of habit and conditioning, and thereby reduce suffering. Not much difference between hypnosis and mindfulness in that, is there?

Elisha: I want to make sure we’re differentiating here between mindfulness as a way of life and formal meditation practice. We can practice mindfulness in formal and informal ways and I think the guided formal meditation practice is the one that can be confused with hypnosis. Having been the recipient of both, I would say the big difference for me is that mindfulness is couched within a much larger context and can be seen as a way of life. Not in any dogmatic religious way, but as a philosophy and practice that we can bring into all the things we do.

Mindfulness at its core trains the mind to more actively drop into a kind attention, cultivating a natural warm presence to bring with us throughout our days. In my opinion, this is at the core of self-healing.

Mindfulness also brings people together in community who are interested in living a more present and compassionate life. This may be one of the most important pieces. Ultimately it’s my belief that the most helpful way for people to make change is through a community of peers who support them with this. I see people who engage with mindfulness in psychotherapy and beyond having an inclination toward wanting to be a part of a community that supports a more mindful life.

We invite you to join in this conversation.  Please share your thoughts, questions and stories below. Your interaction creates a living wisdom from which all of us can benefit. As these conversations accumulate, we are collecting them on a separate page of our blog (see the tab above labeled “Mindfulness and Psychotherapy” for the archive) for review and comment. Visit the UCSD Center for Mindfulness Professional Training site for information on Mindfulness in Psychotherapy retreat training.



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 (LUNESTATM) 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

Mindful Eating: The Power of Mindfulness Practice for Client and Clinician

Char Wilkins, M.S.W, L.C.S.W.

Char Wilkins is a mindfulness-based psychotherapist who is trained to teach Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, and Mindfulness-Based Eating Awareness programs. Char has led several professional training retreats for the UCSD Center for Mindfulness.

By Char Wilkins
I found my way to meditation years ago out of necessity- not unlike how people come into therapy and the mindfulness-based courses I teach. Knowing how useful meditation had been in my own life, I began looking for a way to incorporate mindfulness and meditation into my psychotherapy practice for individuals and in groups. The intersection of abuse, body image and eating/food issues is insidiously woven together for many people. Each year I find myself sitting with an increasing number of women struggling with disordered eating borne out of stress and suffering.

Bringing mindfulness into working with painful and habituated coping mechanisms, whether a situational practice or an entrenched eating disorder, seemed to be an appropriate next step. Through mindful eating exercises and meditation, most of the women I see individually or in  MB-intervention programs report that food cravings lessen, they gain skills in self-regulating not only with regard to food and eating but in all areas of their lives, and they become more aware of what, how and the hunger that drives their eating or non-eating. Mindfulness isn’t a cure and it isn’t for everyone, but it can facilitate change.

There is never just one way to address any behavior that arise out of fear or ignorance, but the integration of mindfulness into a treatment plan can be useful to both therapist and client when difficulty around food/eating and body image are part of the landscape. For the healthcare professional, being fully present to the client through the lens of mindfulness provides an anchor for the clinician and a steadying presence for the client. When the pull to be directive with a client about what to do, eat or not eat arises, it’s valuable for the clinician to skillfully attend to their own feelings of anxiety, inadequacy or fear that could cloud their ability to remain fully present and non-judgmental. For the client, the introduction of mindfulness meditations and exercises offer the possibility of a skillful approach to being with difficult emotions, thoughts and behaviors, and a way to be aware of and with physical sensations in body.  Once learned, mindfulness skills are not dependent on the therapist and this helps to shift the client’s locus of control from external to internal.

When working with habituated eating patterns from a mindful stance, the goal is never weight because weight is only a symptom. Just as in meditation where relaxation is the not the goal although it is often a welcomed by-product, weight gain or loss is not the goal. Rather the focus is bringing eating into balance with other important aspects in the client’s life. Because unhealthy eating habits are often closely linked to depression and anxiety, trustworthy ways in which to develop awareness and tolerance of uncomfortable thoughts, feelings and physical sensations are an important consideration of mindful eating practices. Compassionate acceptance of what is here right now brings with it a different perspective and the possibility of choice.

The idea of “acceptance,” “non-doing” or “non-striving” often elicits feelings of agitation, frustration, inadequacy and fear of passivity from the client.  To someone used to following strict diets, excessive exercise or other regimes, cyclical binges or habituated overeating, the idea of not doing something about it can be frightening for client and clinician, even when both are aware of the merciless cycles these behaviors create. Using the principles of mindfulness and mindful eating encourages self-referral, a reduction in impulsivity and a way to steady one’s self in challenging moments.

Once trained in mindfulness meditation and mindful eating practices, a clinician might begin by introducing the concept of mindfulness through the raisin exercise or a simple breath meditation.  My colleague, Jan Chozen Bays, has simple and short, focused eating exercises in her book, Mindful Eating: a guide to rediscovering a healthy and joyful relationship with food.  And there are more and more books, trainings and workshops that can help and support healthcare professionals in this much needed eating awareness work.

Char Wilkins and Jan Chozen Bays will be co-leading a 5-day Professional Training Retreat entitled “Mindful Eating, Conscious Living” on October 2-7, 2011 in Petaluma, CA sponsored by the UCSD Center for Mindfulness. They will also be conducting a 2-day workshop entitled “Mindful Eating: Tasting Satisfaction” on June 18-19 in San Diego.