Tag Archives: Sarah Bowen

Petaluma: Training in Mindfulness-Based Cognitive Therapy

text & photos by Dzung Vo
Windswept Trees. MBCT Training, Earthrise Retreat Center, Petaluma, California (2/18/13)

these three words
express my experience with
the Mindfulness-Based Cognitive Therapy (MBCT) Teacher Training
which is a very skillful application
of mindfulness for preventing relapse of chronic depression in adults

Sitting View. MBCT Training, Earthrise Retreat Center, Petaluma, California (2/17/13)

the five-day training was an interesting hybrid
of a meditation retreat
and professional training workshop
i was fascinated to watch my mind going back and forth
between “just being”
enjoying the breathtaking natural environment
walking, eating, and sitting mindfully
being fully in each breath
and “doing”
watching my analyzing, planning, comparing and judging mind at work

breathing in, i am aware of my thinking
breathing out, i smile …

View from Hill. MBCT Training, Earthrise Retreat Center, Petaluma, California (2/18/13)

how lucky i am
to be able to consider this experience
part of my “work”
more and more, as my work comes from the heart
the line between my profession and my bodhisattva path
begins to dissolve…

Deer Having Dinner. MBCT Training, Earthrise Retreat Center, Petaluma, California (2/18/13)
"May Peace Prevail on Earth." MBCT Training, Earthrise Retreat Center, Petaluma, California (2/21/13)

the faculty
(zindel segal, sarah bowen, and steve hickman)
brought tremendous warmth, gentleness
and clarity of vision
in teaching and embodying the training
the students brought a depth and diversity
of practice and experience
and a bright curiosity

it gives me great hope
to see these practices
skillfully adapted and offered to the world

it gives me great humility
to be a part of this growing “professional sangha”

MBCT Petaluma Class of 2013. Earthrise Retreat Center, Petaluma, California (2/22/13)
MBCT Teacher Training, Petaluma, Class of 2013

i bow deeply to all of you

Dzung Vo and Ken Ginsburg, Philadelphia, 11-21-11I have long had a dream to teach mindfulness practice to adolescents suffering from chronic illness and chronic stress. With my position at the British Columbia Children’s Hospital–and the luxury of having a more functional health care system with sufficient time to spend with my patients and explore issues deeply–I have finally had a chance to start making this a reality.

(see more photos on my flickr set)

Shambhala Sun Features Mindfulness-Based Relapse Prevention (MBRP) in latest issue

One Moment at a Time, is the title of a recent item in David Swick’s column The Mindful Society published in the most recent edition of Shambhala Sunabout the relationship between mindfulness and substance use disorders. The article specifically highlights Mindfulness-Based Relapse Prevention (MBRP) and the work of the late G. Alan Marlatt, Sarah Bowen and colleagues at the Addictive Behaviors Research Center at the University of Washington. 

By Blair Buckman

Most of us are looking for magical solutions to solve our problems instantaneously. Some of us turn to indulgences like ice cream for a quick fix, and others habitually turn to more harmful addictive substances, like alcohol or drugs. Addiction affects millions of individuals and their families each year and can be an insurmountable obstacle for many. Dr. Lawerence Peltz, a Massachusetts psychiatrist, describes mindfulness as “the microscopic version of One Day at a Time,” adding “it’s One Moment at a Time.”

Much of the research on mindfulness and addiction is conducted at the Addictive Behaviors Research Center at the University of Washington in Seattle, established by the late Alan Marlatt. Dr. Sarah Bowen and her colleagues there have conducted a number of studies on the topic, including a study examining mindfulness implementation among previously imprisoned drug and alcohol offenders. She found that by learning mindfulness practices, they were able to recognize internal triggers without responding to them, therefore reducing the likelihood of returning to drug and alcohol use as compared to control subjects that did not receive mindfulness training. Their MBRP program was modeled after Segal, Teasdale and Williams’ Mindfulness-Based Cognitive Therapy (MBCT) program and Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR). MBRP assists people in developing awareness of what their triggers and habits are, in addition to changing how we respond to physical and emotional discomfort. Furthermore, MBRP assists in developing a compassionate and nonjudgmental mindset.

The program emphasizes meditation practices and implementation of mindfulness practices in daily life in order to regain control of our attention and actions. Bowen and colleagues will be integrating mindfulness meditation practices and utilizing demonstration, role-play, simulated exercises, and inquiry to teach MBRP in a 5-day intensive retreat training through the UCSD Center for Mindfulness at the EarthRise Retreat Center in Petaluma, California in April 2012. More information about the training is available through the UCSD Center for Mindfulness.

We invite you to read the full text of David Swick’s article, in the November issue of the Shambhala Sun, available on newsstands now.


Mindfulness Based Cognitive Therapy 10 Years and Onwards: A Personal Reflection by Zindel Segal

Zindel Segal, Ph.D.

Zindel Segal, Ph.D.

Zindel 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 Retreat Training in MBCT on February 19-24, 2012 at the EarthRise Retreat Center in Petaluma, California. Registration is now open for this experiential training event.

With the 10-year anniversary of the publication of Mindfulness Based Cognitive Therapy for Depression nearly upon us, it is a good time to perhaps stop and reflect on where the field stands at this juncture.

Mindfulness-Based Cognitive Therapy for DepressionFor the past decade John, Mark and I have been largely concerned with reaching the first milestone of treatment development – reliable evidence for MBCT’s effectiveness.   Data from 6 Randomized Controlled Trials and 2 meta-analyses (Hoffman, 2010; Piet & Hoogard, 2011) now indicate that Mindfulness Based Cognitive Therapy is associated with a 50% reduction in depressive relapse risk as well producing symptom relief in  anxiety disorders for both adults (Kim et al., 2010) and children (Semple & Lee, 2011).

Having addressed the efficacy question, we are still left to ponder how exactly this multi-modal treatment achieves its benefits.  For example, what is the relative contribution of cognitive therapy principles versus mindfulness practice to outcome?  What about the role of kindness and compassion, both of which are implicit in the program and, as Willem Kuyken’s work suggests, may be one of the consistent gains reported by participants?

Clarifying mechanisms of action is of more than just academic interest, as it will likely inform the approach taken to training the next generation of MBCT practitioners.  The fact that these are questions being asked shows how far we have come from the early days when MBCT was described as a form of attentional control training.

It is always hard to predict what the next 10 years will bring, but my bet is that efforts to disseminate MBCT via online technologies will start to have an impact.  Online approaches may be a response to the fact that there are still far too few MBCT instructors and too many patients seeking care.  The challenge for online MBCT will be to adapt to an internet friendly format, while holding onto the practice dimension, which however you slice it, always comes down to being a personal, non-electronically mediated experience.  It should all make for a very interesting ride.

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. 2010 Apr;78(2):169-83.
Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2011 Aug;31(6):1032-40.
Geschwind N, Peeters F, Drukker M, van Os J, Wichers M. Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: A randomized controlled trial. J Consult Clin Psychol. 2011 Jul 18. [Epub ahead of print] 
Kim B, Lee SH, Kim YW, Choi TK, Yook K, Suh SY, Cho SJ, Yook KH Effectiveness of a mindfulness-based cognitive therapy program as an adjunct to pharmacotherapy in patients with panic disorder. J Anxiety Disord. 2010 Aug;24(6):590-5. Epub 2010 Apr 3.
Semple R & Lee, J (2011).  Mindfulness Based Cognitive Therapy for Anxious Children.  New Harbinger:  Oakland.

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

Zayda Vallejo

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

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

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

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

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

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

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

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

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

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

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

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.

Tara Brach praises new MBRP manual

MBRP ManualGuilford Press has recently released Mindfulness-Based Relapse Prevention for Addictive Behaviors by Sarah Bowen, Neha Chawla and G. Allan Marlatt, the developers of MBRP.

Respected author of Radical Acceptance and mindfulness teacher  Tara Brach recently praised the book,  noting that “Mindfulness is the single most powerful tool available for those seeking freedom from addiction. Drawing on their notable wealth of research and clinical experience, Bowen et al. have created a groundbreaking relapse prevention program. For any therapist drawn to the practice of mindfulness, this guide provides a clear, accessible, and sensitive way to engage clients in a process of deep transformation and healing.”

The new book is described as  a detailed description of the 8-week program designed for clients in early recovery from addictive behaviors. The guide offers detailed curricula for each session, examples of client-therapist exchanges, meditation exercises, and discussions of issues that commonly arise in sessions. It is intended for clinicians with a strong background in mindfulness meditation who are interested in using mindfulness-based practices to offer clients new skills to meet the day-to-day challenges of recovery.

The MBRP program, adapted from MBSR and MBCT, integrates mindfulness practices with evidence-based cognitive and behavioral strategies. The practices are designed to help clients raise awareness of triggers and reactions, learn new ways to relate to discomfort (e.g., emotional distress or craving), and relate to one’s own experiences, whatever they may be, with compassion and a sense of space that allows for skillful choice versus habitual reactivity.

The MBRP developers will be leading a 5-Day Professional Training in MBRP through the UCSD Center for Mindfulness in March 2011 in Southern California as well as another one in Rochester, New York in September 2011.