Category Archives: Thoughts & Anecdotes

Dealing With the Classic MBSR Week 8 Question: Will Your Butt Be On The Cushion Tomorrow?

Perhaps the number one question asked by participants in MBSR or MBCT groups is: “Where can I go to continue to practice in a group?” The question behind the question is “How will I sustain the momentum I have built up over the past 8 weeks and continue to formally practice mindfulness?” We frequently suggest to our participants that they connect with each other to form small sitting groups. This article from mindful.org provides some nice guidelines for doing just that. We will refer folks to this helpful piece to support them in their practice.

Cheers! Here’s to Wonderful Old Wine in Amazing New Mindfulness-Based Bottles

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

A colleague of mine emailed me yesterday to ask my advice. She had submitted a paper for publication in a respected scientific journal that looked at one particular aspect of Mindfulness-Based Stress Reduction (MBSR). One of the reviewers, apparently intending it as a significant criticism, asked if MBSR wasn’t just “old wine in new bottles”, noting that Carl Rogers and Gestalt therapists had been bringing mindfulness into psychotherapy years before anyone had heard of MBSR. She wanted to know how to respond to this rather stern criticism of her very thoughtful and innovative work.

I told her that she should agree with the reviewer.

Mindfulness is indeed, VERY old wine. Relatively speaking, MBSR and all the rest of the mindfulness-based interventions being devised and deployed in clinical practice these days are indeed quite new “bottles.” But nobody has suggested otherwise! From the beginning, Jon Kabat-Zinn (MBSR) , Marsha Linehan (Dialectical Behavior Therapy – DBT), Zindel Segal, Mark Williams and John Teasdale (Mindfulness-Based Cognitive Therapy – MBCT) and other treatment developers have openly and reverently acknowledged the very deep and ancient roots of mindfulness, mindfulness practice and the wisdom of drawing on these roots for the relief of suffering.

In his book Full Catastrophe Living, Jon Kabat-Zinn writes:

Although at this time mindfulness meditation is most commonly taught and practiced within the context of Buddhism, its essence is universal. Mindfulness is basically just a particular way of paying attention. It is a way of looking deeply into oneself in the spirit of self-inquiry and self-understanding. For this reason it can be learned and practiced, as we do in the stress clinic, without appealing to Oriental culture or Buddhist authority to enrich it or authenticate it. Mindfulness stands on its own as a powerful vehicle for self-understanding and healing. In fact, one of its major strengths is that it is not dependent on any belief system or ideology, so that its benefits are therefore accessible for anyone to test for himself or herself. Yet it is no accident that mindfulness comes out of Buddhism, which has as its overriding concerns the relief of suffering and the dispelling of illusions. (p. 12-13)

But where the analogy of old wine in new bottles falls apart, is that the “bottles” or the interventions themselves are an integral part of what makes these new programs effective and powerful. These are not meditation classes or silent retreats at remote monasteries, but fully thought out, carefully devised and thoroughly researched psychological interventions that honor the roots of their “wine” and skillfully bring it to suffering individuals in very systematic, deliberate and empirically-supported ways.

A plethora of studies have established MBSR as an effective intervention for addressing the suffering associated with chronic pain, cancer, sleep disturbance, anxiety, and ADHD, just to name a few (Grossman, 2004)(Hofmann, 2010). The 8-week program has been shown to not only reduce a variety of physical and psychological symptoms, but more recently has been shown to bring about structural, measurable changes in the brain itself. Constructed thoughtfully, MBSR has a relatively standardized protocol and logical progression that has consistently (for over 30 years) guided skeptical novices (facing the full spectrum of illness and symptoms, both medical and psychological) through a series of specific exercises and homework practices to a place of ease and equanimity that motivates them to want to continue various forms of mindfulness and meditation practice for years to come.

Focused on helping people alter their relationship with the experiences of their lives (whether those experiences are physical symptoms like pain, or mental phenomena like critical thoughts), mindfulness practice exposes options and flexibility that many never realized they had. One patient of mine with chronic neck and back pain (and significant depression as well) said it best when he noted, “I’ve been a tough guy all my life. I learned to play hurt in sports, to claw my way to the top of my field, and even to fight every day with this horrendous pain. What mindfulness allowed me to do was to see that I could dance with my pain.”

A recent randomized clinical trial reported in the Archives of General Psychiatry by Zindel Segal and his colleagues has established MBCT as an equally effective treatment to antidepressant medication in preventing relapse in previously depressed patients (Segal et al. 2010). Based upon the twin foundations of cognitive behavioral therapy and mindfulness, MBCT is being implemented with a wider and wider variety of diagnostic populations with repeated (if still somewhat preliminary) success. The heart of MBCT is encouraging the patient to simply notice the activity and patterns of the mind, adopting a “decentered” stance toward thinking in which thoughts are experienced as arising phenomena in awareness and not fact or imperative. The patient begins to become aware of the constructions of the mind, the “stories” if you will, that the mind constructs around the actuality of experience. The unreturned wave of a friend soon balloons into yet another indication that one is not worthy of friendship. The flutter of a heartbeat in a stressful situation soon billows into the anxious mushroom cloud of the specter of a heart attack.  And the patient learns to adopt an abiding presence that notices these processes and recognizes the option to not become entangled in them in the way in which they have in the past.

In his 1923 encyclopedia article “Psycho-Analysis,” Freud noted that “the attitude which the analytic physician could most advantageously adopt was . . . a state of evenly suspended attention, to avoid so far as possible reflection and the construction of conscious expectations.”

“Construction of conscious expectations” indeed! And with some perspective and “evenly suspended attention” one can encounter the frightful booming Wizard of Oz and also notice the presence of the pathetic little man behind the curtain. Thoughts are not facts. “Don’t believe everything you think,” says the bumper sticker.

It is my observation that mindfulness, at its essence, is not a treatment in and of itself. It is a very important component of all good treatment, whether explicitly named or not. It is the attitude that we embody when we work with clients and patients, the space we create with them in the therapy room, and healing force that works in them when they encounter what they have often encountered and respond in a healthy way rather than react in a habitual way. And it can also be utilized in a very specific, explicit and replicable way to address a variety of psychological disorders.

I happily and gratefully acknowledge the roots of the old wine in its “new bottles.” And raise my glass to toast those who have applied their considerable wisdom, experience and intelligence to finding ways to relieve suffering in thousands, if not millions of our fellow human beings.

Cheers!

NOTE: This article will be appearing in the upcoming edition of the newsletter of the California Psychological Association.
REFERENCES:
Kabat-Zinn, J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Delta. 1990

Grossman, Niemann, Schmidt and Walach Mindfulness-based stress reduction and health benefits: A meta-analysis Journal of Psychosomatic Research/Vol 57 (No. 1), July 2004

Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol./Vol 78 (No. 2), Apr 2010

Segal, Bieling, Young, MacQueen, Cooke, Martin, Bloch and Levitan Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression Arch Gen Psychiatry/Vol 67 (No. 12), Dec 2010

Cancer: Listening for a Mindful Life

By Regina Huelsenbeck, PhD

I can remember that day. I was home from college for Thanksgiving break. I had picked up my best friend for lunch; we were going shopping, and then later, out for the evening. We had quite the day planned… Before CancerI just needed to stop by my pediatrician’s office for a quick checkup. I had a lump on the side of my neck; it had been there since spring of my freshman year. It was now fall of my sophomore year and it had gotten much larger, so I finally decided to tell someone. I didn’t think it was really anything. I was 19 years old and my world did not have the space for such notions. The doctor however, looked pretty worried, and sent us over to an ENT (ear, nose & throat) surgeon who immediately took a needle biopsy.

A few days later, we got the biopsy results. We had just gone to see the movie The Bodyguard (yes, Whitney Houston). I was riding in the back seat of our car, with that same friend when my mother got the call. She turned around from the front seat, phone to her ear, and announced, “Its Hodgkin’s, Regina”. … … “I have cancer?” It did not compute. The feeling I had is still so hard to describe. I wasn’t even in that car anymore. Cancer ShockI was physically sitting in the backseat looking out the window. But psychically, upon hearing those malignant words I had popped into another reality. I had left the world of the healthy-living-well people and was sinking down into what can only be described as an underworld.

Illness is the night side of life, a more onerous citizenship.  Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.  Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. ~Susan Sontag

With sickness comes isolation, sometimes vivid dreams, visitations in fever induced states and reflection; it is indeed another world. However, the lights of illness have a unique way of illuminating forgotten energies and disconnected pieces. In this respect, illness can and often does become an opportunity for reconnection, an anamnesis.

Through my journey into that underworld, I wondered how and why I got cancer. I have come to believe not only that I became ill for many reasons but that I was the only one who could uncover those reasons. No one else was qualified. No one could really tell me how I contracted cancer, exactly what I did or why I had it… I had lymphoma, and “they” really didn’t know and still don’t know what causes it. No one can truly provide a linear causal reason.

And that’s not the point anyway. The point is not necessarily what caused it; the point is really where this line of questioning took me, what this exile from the land of the fast movers and healthy shakers did for me.

Obviously, the journey was not all roses and inspirational change. It was hard and lonely and painfully self-reflective. I was also pretty pissed off. I was angry about missing out on what I considered to be the life I was “supposed to be living”. I was sick and I was tired. I was worried about the boy who no longer wanted to date me because I had cancer. I was worried that I had no hair and I was worried about being different from all my peers.

mindfully cutting veggiesThe angry part of me was not concerned with macrobiotics, death, meditation, mindfully cutting vegetables (something my macrobiotic instructor insisted upon- it wasn’t enough to simply prepare the dang recipes, everything had to be done a certain way: which I now understand, but then, not so much) or larger existential questions. A larger part of me, however, woke up because of my cancer experience. This part of me had questions and was ready to explore! This part of me truly blossomed after treatments were over and remission set in. This part of me did wonder about the benefits of slowly, mindfully cutting vegetables.

I became extremely interested in illness and the mind-body connection. I attended a conference on healing sponsored by the Institute of Noetic Sciences. My career and truly my life’s passion grew from the basic interconnected ideas discussed in this conference.  I was enlivened! I now had even more questions about the mind-body connection, healing and consciousness.

I returned to college and changed my major (fashion merchandising) to nutrition and minored in psychology. I found my true love studying the psyche and set out to become a clinical psychologist (FYI: a very long road). 745 years later, I completed my doctoral dissertation on the experience of living with cancer. I also penned a chapter for Newsweek journalist Jamie Reno’s book of lymphoma survivor tales: Hope Begins in the Dark. Much of this article was taken from that chapter. Today I work mindfully with others struggling to heal, understand and integrate the cancer experience. I am grateful for this work, the questions which continue to emerge and the answers that flow from the spirit of each client.

ListenSo the saying goes that a “gift” is contained within life’s tragic experiences.   Although if you’re in the midst of chemo and someone suggests that cancer is a gift, you may envision yourself punching them in the head (believe me I get it!) But maybe, just maybe, you might consider taking a walk on the inside, and beginning to listen for your message. Illness sometimes presents itself to offer a wake-up call for more conscious living, a new direction or a new perspective. Perhaps it’s simply an opportunity to slow down, but more likely, it has come for a reason. You are the only one who can uncover and then begin to live into those discoveries. Through the uncertainty of illness blooms a new order, a new understanding, a new consciousness, something is healed and perhaps a new enlivened path is revealed.

Take a Walk on the Inside:

1.      Regular Sitting Mindfulness Meditation practice (sign up for MBSR class here)

2.      Journaling: “Bones, Dying into Life” by Marion Woodman, “Writing for your Life” by Deana Metzger, “Rebirth” by Deborah Ludwig, or take course with Sharon Bray: “Writing through Cancer”. Next workshop begins Feb 28th (more information here)

3.      Yoga:  Stacy McCarthy The Soul of Yoga

4.      Mindful Psychotherapy (check out my web page here)

5.      Mindfully preparing food and cutting vegetables (I had to put that in for my macrobiotic teacher)

6.     cancer and mindfulness How to Book: Mindfulness-Based Cancer Recovery by Linda E. Carlson & Michael Speca.

Sources:

Myss, C.  (Speaker).  (1993).  Why people don’t heal. Institute of Noetic Sciences.  Boca Raton, FL.

Newman, M.  (1994).  Health as expanding consciousness.  New York, NY:  National League for Nursing Press.

Robbins, J.  (1998).  Reclaiming our health:  Exploding the medical myth and embracing the sources of true healing.  Tiburon, CA:  H J Kramer, Inc.

Sontag, S.  (1989).  Illness as metaphor and AIDS and its metaphors. New York, NY:  Picador U

Humble in the Presence of Learning and Growing: The Experience of Leading a Professional Training

Steve HickmanBy Steven Hickman
For the eighth time in the past five years, I have had the profound honor and deep joy to participate as a teacher in a 5-Day Professional Training Retreat in Mindfulness-Based Cognitive Therapy (MBCT). The training took place at beautiful EarthRise Retreat Center in Petaluma, California and I had the privilege of teaching alongside my friends and esteemed colleagues, Dr. Zindel Segal and Dr. Sarah Bowen.

31 professionals came from as far away as Hong Kong to learn about MBCT andMBCT Professional Training how it is taught, learning “from the inside out” in this amazing retreat format. Early morning movement and meditation practice and periods of silence (including several silent meals) punctuated our five days together in a way that allowed participants to ground their learning in the refuge of mindfulness. They began as students and ended as teachers, in that they first were participants in an actual MBCT group (reacting and responding to the various practices and exercises that are part of MBCT) and by the end of the training they were leading each other through sitting meditations, body scans and more.

Each time that I get to do this I experience something different, and this time what I took away was captured in the comments and questions people offered late in the week. Early in the week I was struck by the virtual collision between the typical ways in which therapists encounter patients and how an MBCT teacher meets those same individuals. Wanting to teach, fix, shift and “improve” is embedded in our training as therapists, but what we are doing here is so different. Gently guiding people to their own discoveries or awarenesses and to trust their direct moment-to-moment experience above all else feels awkward and insubstantial at first.

But oh, those shifts that took place during the week! It was as if the largely internal process of attending non-judgmentally to all that arises and staying rooted in the fullness of the moment, began to blossom and flourish outwardly in the space between teacher and student, therapist and client. What a great honor and privilege it is to be a part of that process, in some small way, and to be reminded of the power and potential of mindfulness practice. To prevent relapse in depression, to facilitate effective psychotherapy, to bring depth and richness to life itself. There are moments when it all becomes more than words can fully express.

A deep and reverent bow to my colleagues, my students, my new friends. Thank you for the honor of your presence and your hard work.

Expressing Our Deepest Intention

For those of you who have been kind enough to visit and/or subscribe to the UCSD Center for Mindfulness, become a fan of our Facebook page, follow us on Twitter, joined one of our LinkedIn groups or interact with the UCSD CFM in any other social media venue, we want to thank you deeply for your interest and your support. It has been gratifying and encouraging to see your engagement with this effort. While we can admit to occasionally becoming caught up in the numbers or talking about the “traffic” or “clicks” on these sites, we are constantly reminded that each click on the counter is a living, breathing, feeling human being on his or her own path which happens to have crossed ours for a precious moment. When we remember that, we feel truly honored and a bit humbled by your attention.

We started these ventures to stay connected with a community of like-minded (or just curious) individuals and organizations, and had a very clear intention to engage mindfully in “Social Media Marketing”. To be selective and reflective about what we create and share, to respect people’s busy schedules but not be afraid to offer something up if it felt important to us in some way. We hope that you feel we have stayed true to this intention and we hope that you will call us on it if we stray.

Just wanted to thank you once again for becoming part of our online community. We just found an article/blog post that we think captures the essence of our intentions, in case you want to take a look. It is entitled “10 Mindful Ways to Use Social Media” from the Tricycle Magazine website. Let us know how we’re doing in this regard!

Mindfulness is not a Crystal Ball, But Clarity Can Be Magical

If you are looking for a simple, yet elegant description of what mindfulness is, take a look at this short video by Susan Kaiser-Greenland, author of The Mindful Child. It’s great for kids, but pretty effective for anyone!

 

Interview With Jon Kabat-Zinn on the Science of Mindfulness

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

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

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

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

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

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

Class 4 of Mindfulness in Medicine

Week 4 of the UCSD Medical School Elective Course Mindfulness in Medicine provided an opportunity for self-care, reflection on facing difficulty, how (and whether) to “use”mindfulness in difficult situations and the power of a healing relationship (between us and difficulty, as well as doctor and patient). Read about it all in Class 4: The Meaning of Healing on the Mindfulness in Medicine Pages of our blog.

Heard During a Talk by Tara Brach . . .

Why are we meditating? What are we seeking? Does this look familiar? I don’t know the original source, if someone does, send it along and we will provide proper credit.

If you can start the day without caffeine or pep pills,

If you can be cheerful, ignoring aches and pains,

If you can resist complaining and boring people with your troubles,

If you can eat the same food everyday and be grateful for it,

If you can understand when loved ones are too busy to give you time,

If you can overlook when people take things out on you when, through no fault of yours, something goes wrong,

If you can take criticism and blame without resentment,

If you can face the world without lies and deceit,

If you can conquer tension without medical help,

If you can relax without liquor,

If you can sleep without the aid of drugs,

If you can do all these things,

THEN YOU ARE PROBABLY THE FAMILY DOG

Follow the teacher posts (and those of the students) from the UCSD Mindfulness in Medicine course

The process of learning mindfulness is a fascinating and challenging one, and our hope is that by documenting the unfolding of the course Mindfulness in Medicine: Stress Reduction, Awareness and Healing with first- and second-year medical students at the University of California at San Diego (UCSD) Medical School, we can shed some light on the experience of learning and the nature of mindfulness itself. You are invited to read the weekly entries on our blog page, that will include a short commentary from me as a teacher, and will be followed by comments offered by the students themselves. As part of their assignments in the class, the students are asked to submit journal entries showing that they are engaging with the material presented. I have invited them, if they wish, to submit those entries directly to the blog rather than just to me, in order to create a living record of this potentially powerful class.

Read what they have to say, and if you feel so moved, offer your own comments. We would love to have your input on what is happening here at UCSD and around the country where medical schools are incorporating mindfulness training into their programs.

To read the blog, click on the “MINDFULNESS IN MEDICINE” tab above and choose which week you would like to review.