Category Archives: Studies

Navigating Aortic Valve Replacement (AVR) Surgery with mPEAK and Mindfulness

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Read this very personal story from a recent mPEAK participant and Join Pete Kirchmer for the next mPEAK 3-Day Intensive March 11-13, 2017, UC San Diego Center for Mindfulness, San Diego, CA.

By William R. Matthews, MA, LPC

Medical literature contains numerous references proclaiming the benefits of meditation and mindfulness on cardiovascular health and pain management. But to me, these were merely academic case studies, as I had not personally known anyone who had successfully used mindfulness to manage through a major medical procedure. That is, until August 17, 2016, when I had aortic valve replacement surgery.

I need to back up a moment. In March of 2016 I participated in the three-day mPEAK intensive that included six weekly one-hour conference call follow-ups. For me the follow-up sessions were critical for integrating the didactic and practice sessions taught in the three-day into a consistent meditative practice. mPEAK was my first hands-on experience with mindfulness. At that point in time, I had been aware for several years that I had a bicuspid aortic valve that would “eventually” need replacement (in fact it kept me from fully participating in the five-mile mindful walk that is part of the program), but there had been no discussion of surgery with my primary physician or cardiologist. Two months after returning from mPEAK, my new primary care physician sent me for an ultrasound of my heart. The results indicated significant blockage of the aortic valve, and that started the ball rolling for surgery “as soon as possible.”

When a date for surgery was set, I emailed mPEAK ccf9e-headshot2program director, Peter Kirchmer, asking if he could provide me with additional mindfulness resources on pain management, since that seemed to be a big concern connected to surgeries. In response, Pete wrote “Forget about additional resources. You have everything you need already. Just continue developing the skills you already have.” Wise counsel indeed. So I loaded up my iPod with all the meditation files mPEAK had made available to us on its website, added John Kabat-Zinn’s Mindfulness Meditation for Pain Relief, and a few other meditations. I played these every evening before bed, in the waiting lounges of airports, and in my office sharing them with my clients. Ultimately, my iPod was headed with me to the hospital.

The night before surgery I slept soundly without the benefit of any sleep aid other than my meditation-filled iPod. I arrived at the hospital at 5:40 AM surgery day and was taken back to pre-op shortly thereafter. The nurse remarked that my blood pressure showed no signs of anticipatory anxiety.  I too was surprised at how calm I was considering someone was about to cut my chest open and mess with my heart. I told the nurse about my mindful preparation and she asked a lot of questions of interest to learn more. A brief chat with a family member, a friend and a short prayer from the rector of my church was all I remember before waking up almost six hours later.

I awoke in recovery to see the same three faces that I had left there that morning. After a few minutes I was taken to cardiac ICU. A nurse and a member of the physical therapy team armed with a pillow were waiting for me. The PT announced that she was there to help me get into bed by “leaning into my pain and clutching the pillow” as my incisions were on the right side along with two chest tubes. Even in my post-anesthesia fog, my mind went immediately to a body scan, noting that my left side was incision- and tube-free. I also made a mental note that at home my bedroom is set up so that I can only get into bed from my left side. I got up off the gurney without assistance walked around the end of the hospital bed, sat down and got into bed on the left side of the bed without assistance (with minimal pain) and said, “I think I’ll do it this way instead.” The PT could only respond, “I guess that way’s OK too.”

The nurse waiting her turn with me announced that she was there to help me with pain management. She advised, “The key to pain management is staying ahead of the pain.” I interpreted that to mean don’t wait until the pain gets bad, keep taking your medication. At that point my mind recalled an activity from mPEAK where we were asked to insert a hand up to mid-forearm into a bucket of ice water and keep it there until the pain started to hurt. Most people removed their hands from the buckets in under a minute. The teachers explained that a large part of managing pain is changing our relationship to the pain. After sharing techniques and mindsets for doing so, we were given the opportunity to try immersing our hands into the ice water again. Most everyone were able to keep their hands in the ice water for considerably longer the second time around. With this recollection I informed the nurse of my plan – to measure my pain on a scale from 0-5 every hour or so, and if the pain number was not any higher than the last “reading” I wouldn’t be asking for pain medication. I received medication for pain only twice: 1) shortly after arriving in the ICU and 2) later that day when they removed the chest tubes. By the next morning, the day after surgery, I had discontinued all pain medication for the remainder of my hospital stay.

Prior to my surgery, my cardiologist and cardiac surgeon both agreed that I would need to go to a rehab facility “for at least a week” after being discharged from the hospital because I live alone. However, I created a dilemma for them because my recovery was so quick and complete. The discharge social worker advised me that I didn’t meet any medical criteria for rehab placement. She even had PT and OT evaluate me one more time in hopes of coming up with some reason to get me admitted, but neither could come up with a medical need. So I was discharged after 4-1/2 days, with my doctors agreeing that I could stay with a friend who lived within a mile of the hospital. I had a return visit to the cardiac surgeon four days afterward. At that appointment my cardiac surgeon said I was free to go back home and decide for myself when I would go back to work. I was back to work half-time three weeks after surgery and returned to full-time work the following week.

While I wouldn’t necessarily put AVR surgery in the category of a high performance activity, I am convinced that the skills and tools I learned from mPEAK, played a central role in my recovery.

William R. Matthews, MA, LPC is in private practice with the Great Lakes Psychology Group. Bill works out of GLPG’s office in Clinton Township, Michigan, where he counsels with children, adolescents and adults using family systems, EMDR, Mindfulness and sports psychology approaches. Bill is also a volunteer trainer and curriculum consultant for the University of Notre Dame’s Play Like a Champion Today educational program. Bill can be reached at bill.matt.GLPG@gmail.com.

Join Pete Kirchmer for the next mPEAK 3-Day Intensive March 11-13, 2017, UC San Diego Center for Mindfulness, San Diego, CA.

ccf9e-headshot2Pete Kirchmer is  the Program Director for the UCSD Center For Mindfulness mPEAK (Mindful, Performance Enhancement, Awareness & Knowledge) Program. Pete specializes in coaching his clients in applying the practice of mindfulness to making healthy lifestyle changes as well as improving performance in life, work and sport. For more information about Pete Kirchmer please visit his Mindfulness Based Health Coaching website.

Mindfulness Training Leads to Important Changes in the Brains of World-Class BMX Cyclists

By Lori Haase, Ph.D.

mpeak-medals copyResearchers at UC San Diego School of Medicine who have been working with Olympic BMX cyclists to improve their athletic prowess have documented areas of the brain that appear to respond to mindfulness training. Specifically, recent results suggest that these peak performers were better able to appropriately anticipate challenges and found that they could remain focused and aware of their performance in the midst of the split-second stressors that arise in a BMX race that can be intense and often lasts for fewer than two minutes with multiple competitors vying for a place at the finish line. These results suggest that BMX performance may be enhanced through the regular practice of mindfulness meditation.

Reporting in a recent issue of Frontiers in Behavioral Neuroscience (abstact, full article) researchers show that a 8-week intensive mindfulness training course, known as mPEAK, altered the cyclists’ brain activity patterns in two performance-relevant ways:

As measured by fMRI activity in the anterior cingulate cortex (ACC) and insula were enhanced during the anticipatory and recovery phases of a stress-provoking exercise. The ACC and insula are believed to play a strong role in interoception, the ability to sense bodily sensations such a heart rate and integrate them with external stimulation and emotional overlay.

“Prior to the test, their brains were ramping up for activity,” said first author Lori Haase, Assistant Clinical Professor of Psychiatry, UC San Diego School of Medicine. “We interpret this as meaning the athletes are anticipating the stress and getting ready for it.”

The second measurable change was an apparent reduction in the level of connectivity between posterior cingulate cortex (PCC) and both the right medial frontal cortex and ACC, during the stress-evoking test, in which athletes were asked to breathe through a narrow straw that restricted air flow. The PCC is implicated in self-awareness and self-referential thoughts. A reduction in connectivity to this brain area is consistent with the idea that mindfulness training heightens a person’s awareness of bodily sensations, with less self-referential processing added to what is being experienced physically. “This can potentially help athlete stay present to their performance ,” Haase said.

Taken together, these results suggest that significant changes in the brain, directly related to performance in intense and physically demanding activities like BMX cycling or other athletic endeavors, can result from a relatively brief and focused program like the UC San Diego Center for Mindfulness’ mPEAK course.

About The Author: Lori Haase is a Licensed Clinical Psychologist and in addition to her clinical training, she is also a neuroscientist investigating the neural substrates of resilience and optimal performance and their modification through mindfulness training. Dr. Haase is Director, co-developer, and teacher of the Mindful Performance Enhancement, Awareness and Knowledge (mPEAK) program.​

Learn about the mPEAK 3-Day Intensive mPEAK program February 13-15, 2016  at the Catamaran Hotel in San Diego, CA. Activities include: meditation; talks on the relationship between neuroscientific findings, peak performance and mindfulness; experiential exercises; group discussion; and home practices. CE credits are available. Register here.

For our local San Diego residence you are also invited to register for the full 8-Week mPEAK program held at the UC San Diego Center for Mindfulness. The next course starts in January 2016.

 

What Time is It? Inspiring a shift from tic-toc to lub-dub.

by Royan Kamyar

royanRoyan Kamyar, M.D., MBA is Founder and CEO of Owaves, a lifestyle medicine technology company based in Encinitas, CA producing software tools for wearable devices that inspire and motivate the next generation to engage in healthy lifestyle activities.  Royan has presented at TEDxUCSD and been quoted by Forbes, Reuters, FOX News, Xconomy, U-T San Diego and the San Diego Business Journal.  Royan earned his M.D. at Baylor College of Medicine, MBA at the Rady School of Management, UC San Diego, and BA and BS in Biochemistry and Business Administration at UC Berkeley and the Haas School of Business.  He serves on the Formative Board of Directors for UC San Diego Center for MindfulnessMindfulness-Based Professional Training Institute and is an active member of the American College of Lifestyle Medicine.

Image Credit: Dadara

[Image Credit: Dadara]

Imagine a flowering plant. A baking cake. A rising stock price. A healing wound. Time passing can be a beautiful thing.

Why then does the cartoon above resonate so deeply with us? Is it our fear of mortality? Our never-ending list of to-do’s and things left undone that haunt us moment-to-moment? Are we as a culture, as a species, doomed to brood on the past, fear the future, and run away from the present?

The Centers for Disease Control and Prevention (CDC) identifies our sense of “time scarcity” as a leading source of stress in the United States — a primary cause of heart disease, our number one killer. Meanwhile, growing positive psychology research demonstrates the healing power of “being in the present.”

What if our relationship with time shifted? What if we began to view time as a source of inspiration instead of dread? What if each glance at the watch put us more “in the moment,” made us feel more focused, centered and alive? Few realize that our modern timekeeping system is fundamentally arbitrary. Hours, minutes and seconds have no home in cosmology, but rather the digits of our hands…

Technology is evolving as we speak to put smartphones on our wrists. The era of smartwatches with heart rate sensors and real-time monitoring systems is dawning upon us. With processing powers greater than the earliest mainframes and NASA spaceships embedded into our timepieces, we are no longer compelled to settle for a construct of time rooted in hand gestures, ropes and rocks. What if we, as a community of innovators and healers, took the first step in evolving our modern-day answer to the age-old question, “What time is it?”

Mindfulness & Innovations in Timekeeping

The mindfulness community actually has a long and storied track record of innovation in timekeeping, centered around spiritual observations, holidays, rites, rituals, meditation and prayer:

32,000 BCE – Cave art found in France and Germany depicts lunar and seasonal cycles of the “heavens”, representing the first known calendaring system. Its creators are believed to be astronomer-priests of the late Upper Paleolithic Cultures.

4,200 BCE — Ancient Egyptians calculate 365 days between alignments of the sun and Sopdet, goddess of Sirius the Dog Star, marking the Nile’s concurrent flooding and enrichment of the soil.

3,000 BCE — Stonehenge in modern-day England demarcates the annual winter and summer solstices, serving as burial grounds and a venue of ancestor worship and rituals.

2,400 BCE – The first known clocks are the shadow clocks or “obelisks” of ancient Egypt, erected by clerics in pairs at temple entrances for ritual observances.

2,100 BCE — Assyrians, Sumerians and Babylonians of the Middle East establish twelve phases of the moon, or “moonths”, per lunar calendar year. Holy days are declared on the first, seventh and fifteenth of each month.

1,000 BCE – Egyptian clerics develop water clocks or “clepsydras” to continue tracking proper timing of rituals throughout the night, i.e. in the absence of sun and shadows.

100 BCE – Chinese, Korean and Japanese Buddhist monks advance incense timers to replace the more flammable and inaccurate candle clocks of the day. Utilizing various scents, one smells the time change.

1200-1300 AD — Benedictine Monks of Western Europe become the first clockmakers of the region and create the mechanical clock. Adding weights and escapements to water clocks automates ringing of the communal prayer bell.

1582 AD — To more accurately celebrate Easter in its relation to the March equinox, Pope Gregory XIII spearheads the Gregorian Calendar widely used today. The Gregorian Calendar arrives closer to the tropical or “solar” year than the preceding Julian Calendar.

The Origins of Tic-Toc

The divisions of years, months and days are rooted in cosmological events and account for consistent measurements across disconnected cultures. Subdivisions of weeks, hours, minutes and seconds, however, are largely arbitrary and varied more greatly throughout history.

Weeks, for example have seen lengths of 3 to 13 days depending on prevailing leadership. Decisions usually hinged on what was deemed a reasonable workweek as per autocrat or religious text, i.e. “… on the seventh day he rested.” Papal States used six hour days as recently as the 1800’s with 6 o’clock pointing fixedly to sunset, and the Japanese had a twelve hour system with intervals that varied in length according to the season. Decimal time was used by China throughout most of its history dating back to 1000 BCE, was espoused by the French Revolutionary thinkers of the late 1700’s and resurfaced in 1998 when the Switzerland-based Swatch company proposed “Internet Time” of 1000 beats per day.

The sexagesimal system which lies at the heart of our modern-day “tic-toc” was similarly devised for convenience, not derived from scientific fact or basic principles. The ancient Sumerians and Babylonians used sixty as a mathematical base due to its ease of counting with two hands. Each finger segment on one hand represented a number one through twelve demarcated by the thumb, and each digit of the other hand represented a multiplier. Multiplying twelve finger segments by five digits provided a max count of sixty. The number sixty is also considered a “superior highly composite number” in mathematics, meaning it is easily divisible and lends itself well to fractions.

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[Image Credit: Ministry of Education, Brazil]

The Problems with Tic-Toc

Dr. Jon Kabat-Zinn presents a valuable anecdote from the Mindfulness-Based Stress Reduction (MBSR) program he developed at the University of Massachusetts Medical Center, in his manuscript Full Catastrophe Living:

Linda described feeling as if a large truck were always right on her heels, driving just faster than she can walk. It was an image people could relate to; the vividness of it sent a wave of acknowledging nods and smiles through the room…

Her mind was the truck. It was always right behind her, pushing her, driving her, allowing her no rest, no peace.

In the modern age, feeling overwhelmed and out-of-sync is an increasingly common experience. Heart disease is real, heart attacks are real, and the CDC sobers us with the knowledge that this “time scarcity” mentality is a chronic stressor.

Perhaps it is not surprising then that one of the central tenets of mindfulness-based stress reduction is to encourage patients to adopt the present moment. As Dr. Kabat-Zinn explains:

Mindfulness is paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment.

The ancient Greeks embraced two definitions of time to help carry this distinction. “Chronos” was used to discuss chronological or sequential concepts of time, with which we are most familiar and tic-toc describes quite well. “Kairos”, on the other hand, translates to the “eternal moment” in which everything actually happens. This latter concept is missing from our current communication of time and resonates with Dr. Kabat-Zinn’s teaching.

Among pools of evidence collecting around the importance of present moment awareness, Science published a Harvard study in 2010 demonstrating a link between “mind-wandering” and mental health. Over 250,000 data points from 2,250 subjects between the ages of 18 and 88 shows our minds are focused on the past or future 46.9% of the day, leading directly to poor mood. As summarized by study co-author psychologist Matthew A. Killingsworth:

Mind-wandering is an excellent predictor of people’s happiness. In fact, how often our minds leave the present and where they tend to go is a better predictor of our happiness than the activities in which we are engaged.

The tic-toc almost by definition puts us in a sequential frame of mind rather than in the moment. This shift first took hold in the Western world during the Middle Ages with the spread of the mechanical clock. Benedictine Monks lived ascetic lives centered on punctual communal prayer six to seven times per day. Bells (Celtic = clocca or “clock”) were rung manually to inform the community of established timetables. By adding weights and escapements to water clocks, a bell could be rung automatically without requiring a brother present, and more dependably as well.

As the National Watch and Clock Collectors Association notes:

Time no longer flowed like water through a clepsydra — it ticked. It was no longer a seamless continuum, but a succession of short periods.

The streaming of water, passing of a shadow or burning of a flame became replaced by the now familiar “tic-toc”. With the dawning of the Industrial Revolution and mass scaling of clock and watch production, “dollar watches” put everyone in a mechanical state-of-mind and helped synchronize the workforce. Time became money as factories calculated hours worked as key labor costs and employees as wages. As per American historian Lewis Mumford, “… the archetypal model for the industrial era was the clock.”

The tic-toc represented a major departure from cosmological cues for the average person organizing her or his day, as the sundial became officially obsolete in the 1800’s. Perhaps the greatest divorce came more recently with the International Committee for Weights and Measures decision to re-define the second in 1967. A “second” no longer represents an arbitrary fraction of Earth’s rotation around the Sun, but rather:

9,192,631,770 periods of the radiation corresponding to the transition between the two hyperfine levels of the ground state of the caesium 133-atom.

While this advances our computer networking capabilities and satellite communications, the tightening of our “tic-toc” does not necessarily serve to heal our emotional relationship with time. In fact, the focus by such governing bodies on the physics and engineering components of time misses the human implications that actually define it.

Within some of our lifetimes, Albert Einstein brought forward the general theory of relativity, which proved without a doubt that a second for you is not the same as a second for me:

Put your hand on a hot stove for a minute, and it seems like an hour. Sit with a pretty girl for an hour, and it seems like a minute. That’s relativity.

Our speed, our culture, our circumstances, our environment, our climate, our neighbor, our mindspace all dramatically impact our individual perceptions of time. Further, Einstein’s contributions to quantum mechanics helped show the existence of time actually depends on our perceptions of it. No consciousness, no time. So these changes in perception that we feel and experience on a regular basis are not simply novelties or asides in the calculations of time, but real occurrences that get neglected in our current approach.

In the 1950’s, University of Minnesota biologist Franz Halberg coined the term “circadian” (Latin = around a day). Known as the “godfather of chronobiology,” he helped establish a fundamental, evolutionary relationship between our biology and time. We now know that every cell in our body, down to the DNA level, has some “awareness” of (or dependency on) the time of day. This is true for virtually every known organism, even those that are single-celled.

The implications of these “circadian rhythms”, or physiological patterns dictated by the rise and fall of the sun, are both broad and deep. Recent research encouraged the World Health Organization to label night-shift work as a “probable carcinogen”, in the same class as UV radiation, due to its devastating impact on circadian rhythms. Poor circadian rhythms are also linked to heart disease, obesity, diabetes, metabolic syndrome and mental health disorders. Our 24/7, hyper-connected, always-on smartphone culture makes the bulk of us “social-shift workers,” exposed to blue light late into the night… and shifting our hormones into dangerous patterns.

circadian

Why then has nothing changed? Does our new subjective, dynamic definition of time, no longer static and mechanical, not change the underlying formula? Does the realization that our biology has a fundamental, natural and overarching relationship with time not beg us to re-evaluate why this is not factored into the perennial question, “What time is it?”

Introducing Lub-Dub

The arbitrariness of our current timekeeping method, combined with the facts that it is out-of-date and fosters a stressful mindset, presents us with a wide-open opportunity to improve. Coupling our evolved understanding of time with modern needs and the latest technologies, perhaps we can imagine a way to re-define the concept so that it better serves our bodies, hearts and minds.

Consider your daily routine. It might look a lot like this: wake up, meditate, eat breakfast, drive to work, work, eat lunch, go for a walk, work some more, drive home, cook dinner, spend time with family, relax and read a book, go to sleep. What is the optimal way to get you from one “daily milestone” to the next? When you realize the bulk of these milestones don’t generally change from one 24-hour block to the next, you begin to sense there might be a better way to organize and track your day.

Peter Galison, physics professor, historian and philosopher at Harvard University defines clocks accordingly:

We’re always looking for things that repeat, over and over again… and that repetition, that cycle of things, forms a clock. That’s all time becomes, is some repetitive process.

So since my daily activity patterns generally repeat from one day to the next, what if they became my “tic” and my “toc”? So my cadence became linked to “breakfast time” and “exercise time” rather than some mechanical, arbitrary construct that lies beneath it? In essence, I become my clock. Lub-dub.

What we can imagine is a shift from a quantitative, mathematical and mechanical view of time towards a more heartful, experiential and soulful view of time — one that makes sense on an emotional and psychological level.

Amazingly, this approach has a biological basis as well. In his study of circadian rhythms, Dr. Aschoff also coined the term “zeitgeber”, German for “time giver” or “synchronizer. ” The zeitgeber is any external or environmental cue that “entrains” or synchronizes an organism’s biological rhythms to Earth’s 24 hour light/dark cycle and twelve month orbit.

Decades of chronobiology research tells us that these same types of intuitive markers for progression of the day, or daily milestones outlined above, are in fact biological zeitgebers. Meals, exercise, and socializing each play a role in establishing our cyclical physiological relationship with the solar environment. This has implications for: our sleep/wake cycle, body temperature, patterns of hormone secretion, blood pressure, digestive secretions, levels of alertness, mood and reaction times just to name a few.

brain

[Image Credit: Nature Reviews Neurology]

Timothy Monk, Professor of Psychiatry at the University of Pittsburgh Sleep Medicine Institute summarizes the value of this framework well:

Circadian rhythms are driven by endogenous processes, are self-sustaining, and rely upon circadian time cues (zeitgebers) to remain appropriately oriented to the individual’s environment and desired routine. The gold-standard measures of human circadian rhythms have been core body temperature and salivary or plasma melatonin levels. However, one can also make the case that the behavioral circadian rhythms related to the timing of sleep, meals, work and social interactions are just as valid circadian rhythms as the physiological ones. Moreover, these are the rhythms most salient to the individual himself or herself.

An additional “bonus” of shifting to this type of intuitive, biologically-based system is that these same behaviors — nutrition, sleep, exercise and socializing — are deemed by the American College of Lifestyle Medicine to be the fundamental building blocks of a long, healthy life. Also called “lifestyle vital signs,” measuring and monitoring these parameters might be more meaningful in predicting long-term morbidity and mortality than the traditional set of vital signs for current and future generations (due to an overall shift from acute to chronic and preventable disease). Following the age-old adage that you cannot manage what you do not measure, taking these health fundamentals into account would help prevent and treat diabetes, obesity, heart disease, high blood pressure, depression, anxiety and more.

For example, we know that heart attacks are most likely to occur shortly after dawn due to concurrent rises in blood pressure and cortisol levels. We also know they are more likely to occur at the beginning of the workweek, when stress from anticipating future events reaches its peak. What if your timekeeping tools took this knowledge into account, and helped you time activities accordingly? Perhaps optimizing algorithms to discourage Monday AM work meetings when possible? Or suggesting stress-reducing sounds or images during these times? Something as simple as a picture of a loved one, left in ambient view on your wristwatch at the right time, might go a long way in dipping your odds for a cardiac event.

CFM OWAVES

[Image Credit: Owaves]

Now time becomes something we can control, name, juggle, design, manipulate and relate to according to our personal biology, desires and needs. Granted, a universal timekeeping system would always need to lie at its base. Meeting times must be coordinated and train crashes prevented. And yet, analogous to “personalized medicine”, we can evolve or grow from this generalized base to create a truly individualized and relevant concept of time that inspires and heals rather than stresses and reduces.

Commonly in mindfulness courses today, we are taught that certain external stressors cannot be changed, and are best addressed by mobilizing our internal resources to better respond and adapt to our environment. Yet our maligned relationship with time seems to be universal and we know now, increasingly, that our historical perspective of time is incomplete, arbitrary and malleable. Perhaps we should learn from the mindfulness leaders of millennia ago, and play an active, creative role with regard to understanding, communicating and measuring time.

As we speak, physicists and engineers continue to develop incredible methods for fine-tuning existing calculations of timekeeping tools to better run the machines of the world. I propose it is our duty, as a community of healers and innovators, to ensure that human health and well-being is plugged more squarely into the equation.

Continue to explore the Mindfulness courses presented at the UC San Diego Center for Mindfulness. Registration is open for our local 8-Week Mindfulness programs along with our Mindfulness-Based Professional Training Programs that are held in various locations in North America.

 

Learning to Teach MBCT Practices Via the Web: Technology Supporting Teacher Development

By Zindel Segal, PhD and Sona Dimidjian, PhD

Online Training for Teaching Mindfulness In Your Clinical Practice

Z MindfulNoggin_email_adIt was February in 2010, Sona and I were at the end of the fourth day of teaching together a five-day intensive training in MBCT. We were sitting in the lodge of the meditation retreat center in Joshua Tree, California enjoying the beauty, silence, and spaciousness of our surroundings and beginning to engage a question raised by participants in that workshop, like many before them and many to come: how do I carry all that I have learned back into my daily life and work setting? It is a common reaction among participants who have taken MBCT clinical workshops. It usually surfaces towards the end of the training and is expressed in questions such as ‘what comes next?’ or ‘how can I support my learning?’. As we reflected on these questions, we realized that some of the searching arose from the very natural apprehension about returning to solo practice after days of instructed group learning and returning to the hustle and bustle of daily life after engaging deeply the practices of MBCT in a retreat setting. At the same time, however, we also heard in these questions a desire for more support, guidance and community in their intention to integrate the skills and practices they had learned over the week. We began to wonder about ways in which we could support such intentions, building on what we could provide during in person workshops. How could we best support practitioners as they worked to strengthen the experiential and content learning that comes with personal practice and clinical implementation?

mmb-enroll-imgThe issue resurfaced in an interesting way, during our collaboration to develop an online version of Mindfulness Based Cognitive Therapy. We evaluated this digital version of MBCT – called Mindful Mood Balance – in a quasi-experimental open trial with 100 recovered depressed patients at Kaiser-Permanente Colorado and got promising results, Sona Dimidjian, S. Beck, A. Felder, J. Boggs, J. Gallop, R. & Segal. Z. (in press). Web-based Mindfulness-Based Cognitive Therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls. Behaviour Research and Therapy. We are continuing this work on extending MBCT for patients with a recently funded, larger definitive, randomized trial that we will conduct with recovered depressed patients reporting residual depressive symptoms (R01 – MH102229). As we developed Mindful Mood Balance, we began to realize that it was one way we might respond to the questions that were raised at the Joshua Tree retreat center in 2010. Mindful Mood Balance was built to teach patients explicitly some of the core skills of MBCT, but it also might be a valuable resource for clinicians who want to get the “feel” of the MBCT curriculum as it unfolds over time and who might benefit from the structure of an 8-week program in supporting their own practice of the core elements of MBCT. With this knowledge in mind, we also began to imagine other ways in which we could offer training to clinicians on some of the more subtle and challenging aspects of delivering MBCT. We built a program that taught therapists the detailed use of one of the core MBCT skills, the three minute breathing space, which they could use with their clients. We didn’t see either of these offerings as a replacement for in person training, but as another option in the array of treatment/ training resources, with distinct advantages of being able to learn from one’s home on one’s own schedule. .

The Three Minute Breathing Space Course, for example, teaches therapists how to deliver this practice, how to perform inquiry, how to make one’s own recordings and how to integrate the practice into daily life.

Therapists can also participate in a community of learners who are taking the course at the same time. Provided there is interest and benefit, our vision would be to build more contexts for learning responsive to what clinicians find challenging in delivering MBCT.

We have partnered with eLearning experts Brian and Traci Knudson in order to integrate clinical science and leading e-Learning technology, in courseware for health care professionals who want to enhance and enrich their clinical practice through delivering compassionate and effective mindfulness-based interventions. While it is still early days, we are curious to find out whether such modern / technological means can help support others in their use of these ancient / simple practices.

zindel_segal_120x1561Zindel Segal is one of the co-founders and developers (along with John Teasdale and Mark William) of Mindfulness-Based Cognitive Therapy (MBCT). Dr. Segal, along with Sarah Bowen and Steven Hickman, will be leading a 5-Day Professional Training Retreat in MBCT on February 15-20, 2015 at the EarthRise Retreat Center in Petaluma, California. Registration is now open for this experiential training event.

 

 

eMindful Introduces QuitSmart® Mindfully A Successful Tobacco Cessation Study

site_logoSmokers pay dearly for their habit: their health, fun, relationships, and even their life. We also know that most adult smokers want to quit – more than 69% according to the CDC. Yet most smoking cessation programs don’t work over the long-term. In fact, smokers will try to quit an average of seven times. These statistics alone are why we want to let you know about a new mindfulness-based program: QuitSmart Mindfully which is a tobacco cessation program developed in collaboration with eMindful and Dr. Robert Shipley, Director of the Duke Medical Center Stop Smoking Clinic.

eMindful is offering the program for the first time in November 2013 and it will be taught by eMindful’s senior instructor, Jim Austin. QuitSmart Mindfully consists of 12 classes conducted in eMindful’s live, online classroom (where participants see, hear, speak to, and interact with both the instructor and other course participants) over a seven-week time frame

cfmcolorlogomed copy 2The November QuitSmart Mindfully course will be utilized to collect pre- and post-course data about the success of this program and to coincide with the Great American Smokeout. Through our UCSD CFM blog, the course is available at a deeply discounted rate of $125 (normally $395). Included in the course tuition is the QuitSmart® Kit, which includes an informative guidebook, a relaxing hypnosis CD, and a patented cigarette substitute. 

The new program is based on the highly successful QuitSmart® program: A study at five U.S. Air Force bases showed an impressive 66% quit rate after six months, which proved two to four times more effective than other smoking cessation methods. The program has also produced impressive success rates in studies published in Veterans Health System Journal and Psychology of Addictive Behaviors.

QuitSmart Mindfully integrates a significant mindfulness practice component.  The study will assess its ability to help participants:

·      Ease off nicotine.

·      Enhance coping skills by practicing acceptance of cravings, stress and emotional distress, rather than avoidance.

·      See themselves as comfortable nonsmokers rather than as smokers deprived of cigarettes.

·      Develop the respect for their bodies that naturally leads to freedom from cigarettes.

·      Break the smoking habit.

If you, or someone you know, would like to take advantage of QuitSmart Mindfully’s efficacy study, please click the following link to register: http://www.emindful.com/quitsmart-mindfully

Can Mindfulness Make Us Better Teachers?

By Vicki Zakrzewski | October 2, 2013 Republished by permission of the Greater Good Science Center University of California Berkeley. Please click here to view the original article.

bridging2014badgeA new study suggests that training teachers in mindfulness not only reduces burnout but also improves their performance in the classroom.

Imagine this: In the middle of a lesson, one of your students deliberately makes an offensive remark that causes the other students to laugh and threatens to derail your lesson. Your fists start to clench and there’s a tightening in your chest. Before you know it, you snap angrily in a way that 1) doesn’t calm the students down, and 2) makes you spend the rest of the day, or several days, wondering if you’re a terrible teacher. Sound familiar?

This scenario is only one of many that add to a teacher’s daily stress level, which, over time, can lead to burnout—a major issue for those in the education profession. However, adding to this stress is often an educator’s own lack of social-emotional strategies for dealing with the stress and emotional intensity of the job, which researchers suggest may diminish his or her effectiveness as a teacher.

Summer_Institute_Teachers_with_closed_eyesParticipants at the GGSC’s Summer Institute
for Educators
Roibín Ó hÉochaidh

So is there something teachers can do to develop their social-emotional skills, not only to guard against long-term burnout but also to help them deal with stressful events while they’re happening? Yes, according to a new study conducted by the University of Wisconsin’s Center for Investigating Healthy Minds (CIHM):
the practice of mindfulness.

A decade’s worth of research has documented the great physical, psychological, and social benefits of practicing mindfulness, which involves paying careful attention to your thoughts, feelings, and environment. In recent years, schools have embraced mindfulness to help improve students’ attention, emotion regulation, and learning. For the most part, the focus has been on students rather than teachers.

A group of the Center’s researchers, led by Lisa Flook, took a different tack: They conducted a small pilot study to test the impact of an eight-week mindfulness course adapted specifically for teachers. The study found that those who completed the training enjoyed a myriad of personal benefits, including elevated levels of self-compassion and a decrease in psychological ills such as anxiety, depression, and burnout. In comparison, a group of teachers placed on a wait list for the course actually increased in their stress and burnout levels.

But what made this study unique is that it also looked at the participants’ classroom performance, such as their behavior management skills and their emotional and instructional support of students. What it discovered was this: The practice of mindfulness made them more effective teachers, possibly by buffering them from the impact of stressful experiences as they were happening.

In other words, the study suggests that when teachers practice mindfulness, students’ misbehavior and other stressors become like water off a duck’s back, allowing them to stay focused on what teachers really want to do: teach.

So how does the practice of mindfulness actually help teachers in and out of the classroom?

To start, the CIHM researchers defined mindfulness specifically for this study as, “Paying attention in the present moment, on purpose, and without judgment.” Anyone who has taught knows that paying attention in the present moment is incredibly difficult because of the thousand demands on a teacher’s attention all at once. And judgment is a very easy state-of-mind to slip into when confronted by a misbehaving child—you don’t only judge that child but judge yourself for judging him or her.

One of the most basic mindfulness practices involves sitting quietly and bringing one’s awareness to thoughts, emotions, bodily sensations, or an external object. Neuroscientists and emotion researchers have found that this kind of practice heightens the activity in the regions of our brain that regulate our attention, which then carries over into our everyday lives.

For teachers, this means that in the midst of the craziness that is a classroom, we remain aware of what’s going on inside our minds and bodies, which can help us rein in our knee-jerk angry reactions to a situation and instead choose a kinder and more compassionate response.

Lisa_FlookFor example, in the scenario I described at the beginning of this article, a teacher skilled in mindfulness would notice his or her clenched fists and tightening in the chest, take them as a sign that he or she was about to hit the roof, and perhaps take a deep breath or two to calm down. Then he or she would be much better prepared to calmly redirect the students’ attention to the task-at-hand. Boom, done, just like that. Moment passed, no lingering stress in the body or mind of the teacher, and the lesson continues.

Mindfulness practice is also a way to deliberately cultivate positive qualities such as empathy and compassion. Previous studies have linked mindfulness to increased activity in brain regions associated with these positive emotions. In its training for teachers, CIHM included activities such as loving-kindness meditation, which has been found to help promote kindness and compassion toward others.

I like to think that teachers are naturally empathic and compassionate toward their students. But often these qualities get lost in the stress of classroom life, and what suffers most is the all-important relationship between the teacher and the student. By deliberately practicing mindfulness techniques that cultivate kindness toward others, a teacher faced with a misbehaving student might ask the question, “What happened to you?” rather than “What’s wrong with you?”—a more compassionate response that strengthens rather than hinders the teacher-student relationship.

Finally, the CIHM researchers found that the mindfulness group’s self-compassion increased as well—an important component of teacher well-being. Educators have a tendency to beat themselves up over so many things: a failed lesson, saying the wrong thing to a parent, an inability to reach a challenging student, helplessness in the face of a student’s tragic home life—the list goes on and on. And we take it all home at night, leaving us with little psychic space to re-charge for the next day. Over time, our teaching suffers.

Time and again, teachers ask me in workshops and at our Summer Institute for Educators how they can stop thinking about work after they’ve gone home. My suggestion, based on the research, is to have a personal mindfulness practice coupled with self-compassion. Mindfulness teaches us to “notice” our thoughts or thought patterns without judging them as “good” or “bad,” which helps diminish the emotional charge that keeps these challenging school situations reverberating in our heads. Once we’ve neutralized that charge, we can choose to take a more compassionate stance toward ourselves, realizing that all teachers face these challenges and that everyone, including yourself, is doing the best they can.

One caveat: The changes rendered through a mindfulness practice do not happen overnight, nor do they last without continuous practice. Although this study showed significant changes in just eight weeks, Richard Davidson, one of the study’s co-authors and a leading expert on the science of emotions and mindfulness, is quick to point out that mindfulness is like going to the gym: You have to keep practicing to enjoy the benefits.

While the practice of mindfulness is never a “cure-all”, research suggests that it is a powerful foundation upon which teachers can start to build their social-emotional skills—and, in turn, improve their teaching. So while we may never be able to stop that student from making an offensive remark, we can control our reaction—which, in the end, may make the student think twice about doing it again.

Resources for educators who would like to start a mindfulness practice:

In addition to the resources listed below the UCSD Center for Mindfulness offers free guided audio and other resources, 5-Day professional mindfulness retreats through our Professional Training Institute, along with next year’s annual 2014 Bridging the Hearts & Minds of Youth conference.

If you would like to try mindfulness in the privacy of your own home, UCLA’s Mindful Awareness Research Center (MARC) offers these free recordings.

If you would like to learn mindfulness in a class, there are several programs geared just for educators, including the Greater Good Science Center’s Summer Institute for Educators, Mindful Schools, the Garrison Institute’s CARE for Teachers, PassageWorks’ SMART-in-Education, and Margaret Cullen’s Mindfulness-Based Emotional Balance.

If you’re unable to attend one of the above teacher-focused programs, there are numerous workshops throughout the U.S and the world teaching Mindfulness-Based Stress Reduction (MBSR), the program, founded by Jon Kabat-Zinn at the University of Massachusetts Medical School, from which the CIHM’s training was adapted.

Tracking Desires Study (The Study Is Now Closed!…thank you all for signing up!)

how many cookies is too manyby  Kellyanna Foster, Lab Manager University of Chicago, Tracking Desires Study
In this study, you can earn up to U.S. $30 in the form of an Amazon.com© voucher!

While the holidays can be a time for tremendous joy and thankfulness, they also have the potential to be a time for thoughtful choices about what we consume and what we do. How can we maintain our health goals in the face of plentiful holiday meals? Which people should we make time to see during this time, and how much time should we reserve for ourselves? Just how many of those delicious holiday cookies our neighbor baked us is too many?

Malte Friese of University of Basel

Malte Friese of University of Basel

Two researchers in the field of social psychology have been investigating the topic of self-control for some time now. Wilhelm Hofmann of The University of Chicago and Malte Friese of University of Basel, Switzerland are interested in how people handle desires in daily life. While past research has shown that Mindfulness has implications for sustained attentional control and stress reduction, Professors Hofmann and Friese are also interested in learning about how Mindfulness may affect how we deal with desires that we encounter on an everyday basis.

Wilhelm Hofmann of The University of Chicago

Wilhelm Hofmann of The University of Chicago

Much of Professor Hofmann’s research uses short online surveys to collect information from people at various times throughout the day. Research participants receive a text message on their smartphone prompting them to respond to a quick survey about what they’re doing at that moment. This way, the study is better able to capture people’s experiences in real time as opposed to traditional, retrospective accounts of what happened throughout the day. These informative, time sensitive accounts give researchers a rich picture of people’s daily experiences with goal-setting, self-restraint, and other topics of interest.

Eligibility Requirements

  • You must own a smartphone with a data plan for internet access and an ability to receive SMS messages.
  • You need to be older than 18 years of age.
  • You must regularly carry your smartphone with you.
  • You should live in the U.S. or Canada.
  • You must be fluent in English.

For more information about the current study, including ways to help participate, you can visit http://tinyurl.com/bp49ykn.

How Do You Meet Your Suffering? Opportunities Abound to Learn Self-Compassion in San Diego

Dr. Kristin Neff and Dr. Christopher Germer have dedicated years to studying, researching, and teaching self-compassion. All of this dedicated effort and passion have resulted in the Mindful Self Compassion (MSC) program, a research- and skill-based eight week training similar in format to Mindfulness- Based Stress Reduction (MBSR) but focused on this key component of how we meet our own suffering. Outside of Dr. Neff and Dr. Germer’s own courses, the The UC San Diego Center for Mindfulness is currently the only place offering MSC courses. (Note: Dr. Neff will present a one-day workshop on the topic in San Diego on September 22, 2013. See below for more details.)

Drs. Neff and Germer trained Michelle Becker, a San Diego Marriage and Family Therapist and MBSR teacher, as the first teacher of the program. She, along with Dr. Steve Hickman, the second teacher trained by Neff and Germer, will lead their second MSC program at the UCSD Center For Mindfulness this September.

In describing how thoughts arise from actions, Michelle noted that “when something bad happens, it is like being hit by an arrow, difficult and painful. Unfortunately, a second arrow, our thoughts and reactions, follows the first. Many times, it is these thoughts and reactions (i.e. “this shouldn’t be happening,” “you failed,” “you’re so lazy,” “maybe you’re stupid”) that cause the bulk of the suffering. The event, the first arrow, is painful, but how different would it be if instead of that second arrow, we just attend to the fact that the first arrow hurt?

Compassion is a response to witnessing suffering. Becker notes that “showing kindness and compassion to ourselves makes such a difference in our lives. Even simply responding by acknowledging ‘Oh wow, that hurt,’ radically changes our experience”.

Through mindfulness and self-compassion training, a space is formed between event and reaction, and within that space, Becker explains, we are able to choose how to react. “When we create the space, it’s the difference between reacting and responding. So when we choose to respond, can we be kind to our own selves?”

Kristin Neff

Kindness and compassion are skills that can be developed. Rather than continually judging and evaluating ourselves, self-compassion involves generating kindness toward ourselves as imperfect humans, and learning to be present with the inevitable struggles of life with greater ease. It motivates us to make needed changes in our lives not from a place of motivating ourselves with punishment, but because we care about ourselves and want to lessen our suffering.  But becoming more compassionate requires breaking down old habits and building new mindful skills and habits.

Step one in developing self-compassion is mindfulness. In order to change a habit, we must become aware of its existence. We need to become aware of whatever sensation, thought, or emotion is causing suffering. Once we identify our suffering, the second step is to remember that we are not alone in our suffering.  Pain and suffering are part of any life, and therefore our suffering is a simply a normal part of belonging to the human race.

The third step is to choose to respond with kindness toward our own selves.  Much like we would respond with kindness for a friend who is suffering in the same way. In Michelle’s words, “It’s really that simple. Not easy. But really that simple.” Awareness and compassion are learnable through education and practice.

MSC is based on research. Early clinical studies indicate that MSC practice will increase happiness and lessen anxiety and depression, as well as supporting and improving mindfulness overall.

Even people who have taken MBSR will benefit from MSC.  Michelle commented, “Both programs have the core elements of mindfulness and compassion. Compassion is not trained explicitly in MBSR, but it is important. We do these practices that help us become aware of where we are, and to the extent that where we are is painful. It would be a little bit cruel to become aware of pain and just meet it with harshness instead of offering ourselves the compassion each of us deserves.”

In addressing which program to take, she remarked, “People will benefit from both. There’s a lot of overlap between MBSR and MSC and it’s about which door you choose to take first. For some people, starting with MBSR would be preferable, and for others, starting with MSC would be preferable. If there is a lot of harshness, a lot of self-judgment and self-criticism, probably your experience with MBSR will be deeper and you’ll get more out of it, and it won’t be quite as painful, if you start with MSC.”

For more information on MSC and to register for the 8-week course starting September 20, please visit the Center for Mindfulness website.

To learn more about Dr. Neff’s pioneering research into self-compassion, check out her homepage, her book “Self-Compassion.”

One-DAY WORKSHOP in SAN DIEGO, September 22

You are invited to attend Kristin Neff’s Self-Compassion & Emotional Resilience one-day workshop on September 22, 2012 from 9 am to 4 pm, on the campus of UC San Diego. The workshop will provide simple tools for responding in a kind, compassionate way whenever we are experiencing painful emotions.

Learn About “The Science Of Compassion” First “Unprecedented!” Large-Scale Conference

The Science of CompassionStanford Center for Compassion and Altruism Research and Education (CCARE) presents world experts on compassion, altruism & service The Science of Compassion: Origins, Measures & Interventions
July 19-22 in Telluride, Colorado.

The Stanford University Center for Compassion and Altruism Research and Education (CCARE) presents The Science of Compassion: Origins, Measures and Interventions, the first large-scale international conference of its kind dedicated to study of compassion. The Telluride CCARE event will provide an unprecedented gathering of leading experts in research on compassion, altruism, social connection and service to discuss their latest findings. The conference will explore the origins of compassion and compassionate action, how it can be measured, and how we can foster it through interventions.

CEU: APA-approved Continuing Education Units (CEU’s) offered to psychologists and master’s level clinicians. 1 credit per hour of conference attendance.

The conference is open to researchers and the general public. Among the presenters are key figures in Psychology such as Dr. Phil Zimbardo and keynote speaker Dr. Richard Davidson, pioneering researcher on meditation and brain function. Other invited speakers include such distinguished scholars as Thupten Jinpa Langri (His Holiness the Dalai Lama’s long-time translator).

“While compassion is a fundamental part of every religious tradition, there is an ever enlarging body of scientific evidence that being compassionate has immense positive impact on the individual both in regard to their mental and physical health. This first-of-its-kind conference will highlight these scientific findings and provide a forum for researchers from around the world to collaborate with colleagues from a variety of disciplines. We at CCARE are very excited to sponsor the conference and contribute to this expanding field.” says Dr. James Doty, director of CCARE.

Event co-sponsors include the Telluride Institute, the University of California-Berkeley’s Greater Good Science Center, the University of Wisconsin’s Center for Investigating Healthy Minds, and the Swedish Association for Contemplation in Education and Research.
Between sessions, compassion meditation opportunities practices and interactive workshops will be offered. Seats limited.

For more information/registration, please go to CCARE. For questions and media inquiries, please contact Emma Seppala emmas@stanford.edu (650) 723-3248

SAVE THE DATE! Attend a Self-Compassion Workshop with Dr. Kristin Neff in San Diego.

Saturday, September 22, 2012, Special 1-Day Self-Compassion Workshop at UCSD presented by, Kristin Neff, PhD, author Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind.

Planting Seeds: The Power of Mindfulness

A film for parents and educators combining comic book animation, documentary footage, and classroom materials.

“Planting Seeds” The Power of Mindfulness, the film’s working title, is based on the book, Planting Seeds: Practicing Mindfulness with Children, by Thich Nhat Hanh and the Plum Village Community
 and draws from Plum Village’s thirty years of mindfulness and compassion work with children, parents and educators. The film offers tried-and-true meaningful, fun, and engaging activities that kids can do in any setting and either self-guided or led by an adult. Key practices
presented include mindful breathing, mindful walking, inviting the bell, pebble meditation, the Two Promises or ethical guidelines for children, eating meditation, and dealing with conflict and strong emotions.

“Planting Seeds” will be shot this July in Plum Village, France, during the month-long Summer Retreat, in which thousands of families from all over the world learn how mindfulness can enrich and heal people of all ages. Throughout the month, parents, teachers, childrens, monks, nuns, and Thich Nhat Hanh let us into their experience and share their stories and practice of mindfulness. The result is that this feature documentary and animated film gives everyone an embodied experience of peace and wellbeing and effective tools for creating peaceful, happy lives long after the film is over.

You can learn more about the project, read updates from the film team, or donate to the project, at http://www.indiegogo.com/plantingseedsfilm.

We invite you to participate in one of our UCSD CFM education-based mindfulness Youth and Family Programs; Stress Reduction Program for Teens or A Course in Mindful Parenting.

If you are an educator please consider joining us for our popular  Mindfulness-Based Stress Reduction Workshop for Educators Saturday, November 3, 2012, 9am-3pm.

We are also  happy to keep you up to date on all the exciting developments taking place around our upcoming  Bridging the Hearts and Minds of Youth Conference February 1-3, 2013, Catamaran Resort Hotel, San Diego, CA. Stay informed about Jon Kabat-Zinn’s benefit lecture and very special 3-hour workshop on Mindful Parenting with his wife Myla Kabat-Zinn on the conference website and through liking the conference Facebook Page.