Category Archives: Thoughts & Anecdotes

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

logo-mpeak

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.

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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.

 

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.

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.

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, 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.



Mindfulness: How Does It Work?

Our colleagues Mark Lau and Andrea Grabovac have written a fascinating and groundbreaking paper introducing a Buddhist psychological model of mindfulness that we think is worth reading. Here is a brief introduction (and link to the full paper).

By Mark Lau, Ph.D. and Andrea Grabovac, MD, FRPCP

Mark Lau

Interest in mindfulness-based interventions (MBIs) continues to grow, fueled by studies demonstrating their clinical effectiveness.  More recently, researchers have been examining specific psychological and cognitive mechanisms by which MBIs may exert their clinical effects.  Clarification of specific mechanisms will allow further optimization of these therapies.  With this goal in mind we introduce a Buddhist psychological model (BPM) in the June issue of the journal Mindfulness based on the psychological framework of the Theravada Buddhist contemplative traditions from which many of the techniques used in MBIs are adapted.

Andrea Grabovac, M.D.

Andrea Grabovac

Briefly, the BPM provides a detailed, step by step description of how the habitual reactions of attachment and aversion to feelings are the genesis of a cascade of mental events that lead to suffering.  According to the BPM, the subjective sense of a continuous stream of consciousness is made up of numerous, discrete sense impressions and mental events (sensations), most of which occur outside of one’s awareness.  Each sensation inexorably carries with it a feeling tone, which falls into one of three categories: pleasant, unpleasant, or neutral (neither pleasant nor unpleasant). The term “feeling tone,” as used in this context, is not synonymous with emotions, such as fear, joy, or anger; rather it is an immediate and spontaneous experience that arises with each sensation.  These rapid and transient feeling tones, which are often unnoticed, are the key trigger for habitual attachment (holding onto a sensation) and aversion (pushing away a sensation) reactions.

According to the BPM, mindfulness has its effect by short circuiting the above process. It does this in two main ways:

  1. training attention regulation skills
  2. insight

Training attention results in an improved ability to selectively orient one’s attention away from the proliferation of mental events following attachment/aversion reactions.  This is possible because attentional resources are limited: one cannot be focused intently on an object (such as the breath) and engaging in ruminative thought patterns simultaneously.  Mindfulness training improves both the ability to recognize the occurrence of unhelpful mental proliferation, and the ability to stop rumination by focusing attention elsewhere.  Facility with these skills allows ruminative thoughts to be treated as mental events rather than aspects of reality of self.  All current MBIs train attention regulation as their primary mode of therapeutic action.

The other mechanism by which mindfulness reduces suffering (mental proliferation) is via insight.  Insight is a direct, non-conceptual understanding achieved through the repeated examination (via mindfulness practice) of the following three characteristics that are present in all sensations:

  1. impermanence (sensations are transient – they arise and pass away)
  2. unsatisfactoriness (attachment/aversion to the feeling of sensations leads to suffering)
  3. not-self (sensations do not contain or constitute any lasting, separate entity that could be called a self)

Mindfulness of these characteristics results in progression through a series of insights leading to enlightenment, as described in the Theravada Buddhist tradition.  A side effect of such insight is a long-term reduction in habitual attachment/aversion reactions and a consequent decrease in mental proliferation and rumination.

For a more detailed description of the above, please see the free, full version of an article describing the Buddhist Psychological Model here, online first.   We hope that this model will help clarify the mechanisms of mindfulness as taught in MBIs and stimulate further discussion and understanding of the complex, multifaceted nature of mindfulness and its allied disciplines.

You can reach Andrea Grabovac, the first author on the paper, via email at agrabovac@bccancer.bc.ca

 

Letting everything become your teacher… absolutely everything!

“I’m going to give you a little advice. There’s a force in the universe that makes things happen; all you have to do is get in touch with it. Stop thinking…let things happen…and be…the ball.” – Ty Webb (played by Chevy Chase in the 1980 comedy Caddyshack)

By Steve Hickman
It’s not every day that you find 80s screwball comedies referenced in articles about mindfulness, so you’ve got to give me credit for even trying. Hang in there and see if you find any wisdom in this silliness. Who says meditation has to be so serious, anyway?

If you are a psychotherapist, then perhaps you recognize those moments with clients or patients when you don’t quite feel like you are JUST a therapist, but that your presence seems to transcend that role. It is as if your manifestation in the room extends beyond simply a treatment plan, case conceptualization or intervention. You have the sense that what is at work is something larger than that, that you are holding a space of equanimity, patience, non-judgment and curiosity that is allowing this person before you to finally have an opportunity to experience themselves and their troubles in a wholly different and powerful way. There is a palpable sense of healing taking place, a felt sense of transformation unfolding in the space you have created together.

In those moments, I believe that we ARE the mindfulness of the healing relationship, the therapeutic field. We don’t DO mindfulness in psychotherapy, we ARE mindfulness in psychotherapy. It just happens.

But is it possible to not only notice it when it happens, but increase the likelihood that it will? Can we learn to cultivate mindfulness in psychotherapy in such a way that we are more effective to our clients and patients, as well as happier, more satisfied human beings in our own right?

I think we can, although I also think that it’s not entirely clear how to go about making this happen. It goes beyond simple instruction to “BE the mindfulness (i.e. “BE the ball.”). It probably arises out of practicing mindfulness intensively, regularly and systematically to create a foundation of personal mindfulness from which we then practice psychotherapy. And then perhaps we can learn some ways to work from that platform to facilitate our day-to-day therapeutic work to infuse it with presence, non-judgment, equanimity and all the rest, for the betterment of those who seek our services.

This exploration fascinates me, which is why I sought out my esteemed colleagues Trudy Goodman and Elisha Goldstein to create and offer a professional training retreat on Mindfulness in Psychotherapy. This training, if you are interested, will be offered on October 2-7, 2011 at the Joshua Tree Retreat Center in Southern California, and will combine mindfulness practice with an exploration of the process of integrating mindfulness into therapeutic presence, mindfulness-based interventions and individual or group psychotherapy.

But my purpose in writing this piece was not solely to promote this training retreat. Instead it was to invite you to consider how you ARE the mindfulness of the therapeutic relationship and perhaps to offer your own comments on this topic. What do you do to integrate mindfulness into your clinical work? Do you think there is benefit in “Being the ball”?

I’m truly curious about your take on this topic. I’m basically a curious guy. “So I got that goin’ for me, which is nice.”

Every Moment an Opportunity for an Epiphany

I am sure to grow old.
I cannot avoid aging.
I am sure to become sick.
I cannot avoid sickness.
I am sure to die.
I cannot avoid death.
All things dear and beloved to me
are subject to change and separation.
I am the owner of my actions;
I will become the heir of my actions.
— Anguttara Nikaya

Elana Rosenbaum

Elana Rosenbaum

Every now and then something happens that is pivotal in our lives by which we measure time, a marker event like 9/11, a marriage or divorce, a birth or death or a diagnosis such as cancer. I’ve divided time into pre cancer and post stem cell transplant for lymphoma.  The time is marked not by age but by changes in my world. Pre-cancer mortality was a given intellectually but post diagnosis I knew it in my heart, head and gut.   Death became a part of my awareness and I could no longer delude myself into believing that illness and loss happened to others but not to me. These last few weeks, with the earthquake ,tsunami, and radiation leaks in Japan  as well as war in Libya I am reminded of the universality of suffering and its pain.     I am inspired by the courage and cooperation of the Japanese people and horrified by the hatreds and violence of war. It feels like the whole world is trembling.  I ask myself daily, how am I living my life? What are my priorities? How am I putting mindfulness into action and what is possible to help others?

A favorite cartoon of mine is of two mice on an exercise wheel. One of the mice is shown peddling frantically and spinning around and around while the other is resting comfortably on the rim of his wheel with his legs dangling over it. The caption under him reads, “I’ve had an epiphany.”

Years ago my meditation teacher, Larry Rosenberg, talked about rolling over and over again and again in the mud.  I never quite understood what he meant until I began to notice certain thought patterns that refused to quit. I didn’t think in terms of greed, hatred and delusion I only knew that certain thoughts made me unhappy and created feelings, sensations and actions that perpetuated misery, mine and others.  I’ve been a psychotherapist since 1975. In working with my patients at a large HMO it seemed all too easy to slip into the morass of worry, fear and doubt. Identification with these states perpetuated misery by defining who we thought we were and what life held for us. This lead to immobility and more fear, anger and delusion.

Frustration and discouragement led me to the medical center and Jon’s (Kabat-Zinn) weekly yoga class and Larry’s (Rosenberg) meditation sessions. One short hour opened a window into possibilities. I would return to work energized and refreshed with greater clarity and patience to be with another. As my practice deepened compassion and understanding grew and real change became possible.

I’ve been very fortunate. I’ve been teaching MBSR since the early 80‘s with the support of a community dedicated to mindfulness and the eradication of suffering. Community is essential. Overcoming suffering and understanding its causes is often a painful process.  We need each other for support and inspiration. Discovering what helps and what harms takes effort, high ethical standards and steady attention. MBSR is not a technique or a smart career move. It’s goal is liberation and wise action. We are all inter-connected, the rebel in Libya and his antagonist, the tsunami victim and the rescue worker.  We are all responsible for our actions. Just as aging, illness, death and loss is part of life so is compassion, understanding and growth. May our work together bring greater peace for ourselves and our world.

Elana Rosenbaum is a longtime teacher of Mindfulness-Based Stress Reduction and author of a book on her experience of working mindfully with her own cancer diagnosis entitled Here For Now: Living Well With Cancer  Through Mindfulness . There is also a companion Audio CD for her book available, by the same name. To learn more about Elana and her work, download her free meditation audio files, or learn about upcoming events, visit her website at Mindfulliving.com .

We Have Lost a Valued Friend and Pioneer

It is with great sadness that we report that Dr. G. Alan Marlatt passed away this morning at 9:40 am. Alan was a kind and generous man with whom we had the pleasure of working the past couple years in conjunction with the training he and his team offered in Mindfulness-Based Relapse Prevention (MBRP) through UCSD. We are all quite saddened and shocked at the news of the death of this well-respected and widely honored psychologist, colleague and friend.

For those who may be unfamiliar with his work, here are some highlights copied from the biography of him on Wikipedia:

G. Alan Marlatt, Ph.D., was Professor of Psychology at the University of Washington and Director of the Addictive Behaviors Research Center at that institution. He received hisPh.D. in clinical psychology from Indiana University in 1968. After serving on the faculties of the University of British Columbia (1968-1969) and the University of Wisconsin–Madison (1969-1972), he joined the University of Washington faculty in the fall of 1972. He has conducted pioneering research in three areas: harm reductionbrief interventions, and relapse prevention.

In 1996, Dr. Marlatt was appointed as a member of the National Advisory Council on Drug Abuse of the National Institute on Drug Abuse (NIDA). He served as the President of the Society of Psychologists in Addictive Behaviors from 1983-1984; President of the Section for the Development of Clinical Psychology as an Experimental-Behavioral Science of the Society of Clinical Psychology (Division 12 of the American Psychological Association), 1985-1986; and President of the Association for the Advancement of Behavior Therapy, 1991-1992.

Marlatt’s books include Alcoholism: New Directions in Behavioral Research and Treatment (1978), Relapse Prevention: Maintenance strategies in the treatment of addictive behaviors (1985, 2005), Assessment of Addictive Behaviors (1985; 2005), Addictive Behaviors Across the Lifespan (1993), Harm Reduction: Pragmatic Strategies for Managing High-Risk Behaviors (1998), Changing Addictive Behavior (1999), and Brief Alcohol Screening and Intervention for College Students (BASICS) Manual (1999), The Tao of Sobriety: Helping You to Recover from Alcohol and Drug Addiction (2002), and Therapist’s Guide to Evidence-Based Relapse Prevention (2007). In addition, he published over 200 book chapters and journal articles and served on the editorial boards of numerous professional journals, including the Journal of Consulting and Clinical PsychologyJournal of Abnormal PsychologyAddictive Behaviors, and Journal of Studies on Alcohol.

Marlatt received continuous funding for his research from a variety of agencies including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the Alcoholic Beverage Medical Research Foundation, and the Robert Wood Johnson Foundation. In 1990, Marlatt was awarded The Jellinek Memorial Award for outstanding contributions to knowledge in the field of alcohol studies from the International Society for Biomedical Research on Alcoholism. In 2001, he was given the Innovators in Combating Substance Abuse Award by the Robert Wood Johnson Foundation, and in 2004 he received the Distinguished Researcher Award from the Research Society on Alcoholism. He received the Distinguished Psychologist award for Professional Contribution to Knowledge from the Washington State Psychological Association in 1990 and the Distinguished Scientist Award from the Society for a Science of Clinical Psychology in 2000.

We will miss you Alan, but your work will live on through your writings, your teaching and your mentorship of many bright and talented students and former students.

NOTE: We invite you to pay tribute to Dr. Marlatt by adding any comments or observations you have about him, his work and his legacy in our field.