As research into the applications of mindfulness progresses, both in the medical field for problems like pain and chronic illness management, and in the mental health field through therapies such as Dialectical Behavior Therapy, Acceptance & Commitment Therapy, and Mindfulness-Based Cognitive Therapy continue to increase the empirical support for the efficacy of this approach in a variety of conditions, it behooves us to learn more about this and apply it in our own lives and practices. Kevin Drab
Kevin J. Drab, M.A., M.Ed., LPC, NBCCH, CAC Dipl. Behavioral Counseling & Training 418 Stump Rd., Suite #208, North Wales, PA 19454 tel: (215) 527-2904 e-mail: [email_address] Web site: http://BCTpro.com Mindfulness & Acceptance: Therapeutic Applications
All you really need to do is accept this moment fully. You are then at ease in the here and now and at ease with yourself. -- Eckhart Tolle The Power of Now
<ul><li>Breathing in, </li></ul><ul><li>I calm my body, </li></ul><ul><li>Breathing out, </li></ul><ul><li>I smile. </li></ul><ul><li>Dwelling in the present moment, </li></ul><ul><li>I know this is a wonderful moment. </li></ul><ul><li>-- Thich Nhat Hanh </li></ul>
<ul><li>The Guest House </li></ul><ul><li>This being human is a guest house. </li></ul><ul><li>Every morning a new arrival. </li></ul><ul><li>A joy, a depression, a meanness, </li></ul><ul><li>Some momentary awareness </li></ul><ul><li>comes as an unexpected visitor. </li></ul><ul><li>Welcome and entertain them all! . . . </li></ul><ul><li>The dark thought, the shame, the malice, </li></ul><ul><li>meet them at the door laughing, </li></ul><ul><li>and invite them in. </li></ul><ul><li>Be grateful for whoever comes, </li></ul><ul><li>because each has been sent </li></ul><ul><li>as a guide from beyond. </li></ul><ul><li>-- Jalal Al-Din Rumi </li></ul>
<ul><li>T he basis of Aaron Beck’s Cognitive Model that persistent “dysfunctional attitudes and assumptions” lead to emotional problems and behaviors has been found to lack empirical support, as does the argument that changing dysfunctional thinking and maintaining that change is the key to the changes seen with cognitive-behavioral approaches. </li></ul>How Does Cognitive Therapy (CT) Actually Work?
Differential Activation Hypothesis Dysfunctional thoughts can be found in everyone, including those who have been through therapy. With susceptible individuals mood can activate dysfunctional thoughts, which in turn accentuate mood, which intensify focus on negative thoughts / perceptions / reactions, - resulting in a intense persistent depression, anxiety, etc. Relatively easy accessibility to negative material when mood is negative, even if only mildly so.
The Ruminative Mind <ul><li>“ Ruminative response style ” – some people have a tendency (probably due to genetic / biochemical contributors) to over focus for prolonged periods of time on negative mood and material, generally in a obsessive belief that such attention will enable them to solve the “problem.” </li></ul><ul><li>Instead they increase and maintain the emotional state, while arriving at no “solution”. </li></ul>
<ul><li>CT appears to change the client’s relationships to their negative thoughts and feelings, and this is central to CT’s effectiveness, rather than the focus on cognitive change. </li></ul><ul><li>CT teaches the client a process of stepping back (also known as “distancing” or “decentering”) from cognitive content to assess it, resulting in seeing thoughts and feelings in a wider perspective, sufficient to be able to see them as simply “thoughts” rather than necessarily valid reflections of reality or central aspects of the self. </li></ul>Feelings and thoughts are not facts! Feelings and thoughts are not facts! Feelings and thoughts are not facts!
<ul><li>Decentering also decreases rumination which is at the core of most mental distress. </li></ul><ul><li>If this is truly how cognitive therapy works, are there other ways to bring about a shift in a person’s relationship with their thoughts/feelings which would not have any of the unnecessary CT elements explicitly directed at changing thought content? </li></ul>
MINDFULNESS To pay deliberate attention to our experience from moment to moment, to what is going on in our mind, body and day to day life and doing this without judgment. Mindfulness, as a therapeutic tool, is the development of the ability to recognize and disengage from mind states characterized by self-perpetuating patterns of ruminative, negative thought.
<ul><li>There are two modes of mind we can be in: </li></ul><ul><li>The Doing or Driven mode which is triggered when the mind sees </li></ul><ul><li>that things are other than it would like them to be. </li></ul><ul><li>When easily resolved everything is okay, but when, as usual, </li></ul><ul><li>there is no ready solution and the discrepancy exists, the mind </li></ul><ul><li>continues in a “doing” problem-solving process analyzing and </li></ul><ul><li>reanalyzing all the information, going round and round, seeking </li></ul><ul><li>reassurance and control, dwelling on the discrepancy and </li></ul><ul><li>rehearsing ways to reduce it. This is typically the roots of </li></ul><ul><li>suffering. </li></ul>
<ul><li>The Being mode , is not motivated to achieve a particular goal. Thus there is no need to emphasize discrepancy-based processing. Instead the focus of the being mode is “accepting” and “allowing” what is, without any immediate pressure to change. Awareness rests in the present. </li></ul>
Past Future HERE & NOW Typical mind identifying with thoughts and images, lost in past and future, in doing mode. Present based mind in being mode. Thoughts, images, emotions, sensations Oh my God, what will I do! Did I pay that bill… I’m so unhappy. At least the weekend is almost here. I’ll feel better then. What if I loose my job. Living in a cardboard box. I’m hungry. Did I pay that bill. ---- What if I loose my job. Why didn’t I think of that? Anxious, anxious, anxious.. I need more money. Nobody loves me. Anxious, anxious. It’s going to be awful. I’ll fail. Why did I do that? I was so young. It ruined everything. I said that… why did it have to happen like that? I feel horrible. It was so sad. What is I said it differently? HERE & NOW Sex.. Feel good. 20 x 35 is ? I hate this. Always been this way.
<ul><li>Mindfulness methods are designed to move the </li></ul><ul><li>attention/state of mind from the Doing/Not-in-the-Here </li></ul><ul><li>and-Now mode to the Being/in-the-Here-and-Now mode. </li></ul><ul><li>The basic tool to effect this change of mental modes, or shift of mental gears, is the intentional use of attention and awareness in particular ways. </li></ul><ul><li>This involves moving from a focus on content to a focus on process, away from cognitive therapy’s emphasis on changing the content of negative thinking, toward attending to the way all experience is processed. </li></ul><ul><li>The use of continual self-observation and acceptance are key to mindfulness. </li></ul>
<ul><li>Many therapeutic and spiritual systems have mindfulness as a </li></ul><ul><li>core component of their approach. </li></ul><ul><li>Examples: </li></ul><ul><li>Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) program </li></ul><ul><li>Marsha Linehan’s Dialectical Behavior Therapy </li></ul><ul><li>Steven Hayes’ Acceptance and Commitment Therapy (ACT) </li></ul><ul><li>Zindel Segal’s Mindfulness-Based Cognitive Therapy </li></ul><ul><li>G. Marlatt’s Relapse Prevention Therapy </li></ul><ul><li>Various forms of Buddhism, such as Zen, Insight, etc. </li></ul>Mindfulness
Uses of Mindfulness in Therapy <ul><li>alternative methods for teaching decentering skills. </li></ul><ul><li>Realization that most sensations, thoughts, and emotions fluctuate, or are transient “passing by like waves in the sea.” </li></ul><ul><li>training of patients to recognize when their mood is deteriorating. </li></ul><ul><li>preventing the ruminative thought-affect cycle. </li></ul><ul><li>provide means to stay connected with body and reality </li></ul>
Some therapeutic applications are derived from Vipassana, or Insight Meditation. Using a mediation format one focuses on a sensation, usually breathing, to develop a one-pointed attention to cultivate calmness and stability. Once this is established, one then moves beyond that focus by introducing a wider scope to the observing, as well as an element of inquiry.
<ul><li>When thoughts, feelings or sensations come up in your mind, you don't ignore them or suppress them, nor do you analyze or judge their content. Rather, you simply note any thoughts as they occur as best you can and observe them intentionally but non-judgmentally, moment by moment, as the events in the field of your awareness . </li></ul><ul><li>If your mind wanders just note “wandering” and bring your mind back to generally aware of the here and now. </li></ul><ul><li>The moment you realize you are not present, you are present. Whenever you are able to observe your mind you are no longer trapped in it. </li></ul>
<ul><li>The Three-Minute Breathing Space </li></ul><ul><li>a mini-meditation in which we do three steps: </li></ul><ul><li>1. Stepping out of automatic pilot to ask “Where am I?” “What’s going on here?” The aim is to recognize and acknowledge one’s experience at the moment. </li></ul><ul><li>2. Bring your attention to the breath, gathering the scattered mind to focus on your breath. </li></ul><ul><li>3. Expand your attention to include the sense of breath and body as a whole. </li></ul>
<ul><li>Body Scan </li></ul><ul><li>A body-centering exercise in which participants are asked to move their awareness through each part of their body accompanied by the pace of their breathing, and should be practiced daily. </li></ul><ul><li>O ne approach of this exercise is to breath into the section of one's body being focused on. This has many individual and specific applications which can be of enormous benefit. </li></ul>
In Dialectical Behavior Therapy (DBT) There are Specific Skills “ What” Skills: Observe – not caught up in experience; not reacting; “teflon mind;” control attention, not experience; thoughts and images like passing clouds. Describe – put words on experience; describe to self what is happening. Participate – become one with experience; forgetting self; letting go of ruminating; act from “wise mind;” be skillful; practice; accepting self and situation as they are.
DBT “How” Skills Non-Judgmentally – don’t evaluate; focus on what not why or valuation; accept each moment; acknowledge helpful and unhelpful, but don’t judge them; when you find yourself judging, just notice and stop – don’t judge yourself. One-Mindfully – do each thing with your full attention: when you are eating, eat; when you are feeling, feel. If distractions arise, notice them, let go of them go back to what you are doing – again, and again, and again. Do one thing at a time! Effectively – focus on what works, avoiding judgments, meeting needs of situation at moment; accepting what is rather than shoulds and “what-ifs”; keep eye on objectives; let go of negative feelings that don’t help you to reach your goals.
<ul><li>“ Human beings struggle with the forms of psychological pain they have: their difficult emotions and thoughts, their unpleasant memories and their unwanted urges and sensations. They think about them, worry about them, resent them, anticipate and dread them.” </li></ul><ul><li>– Steven Hayes </li></ul>Acceptance and Commitment Therapy (ACT) People suffer.
“ When we get up on the back of the black horse and ride to battle, fighting to win the war against anxiety, depression, thoughts about using drugs, whatever. It’s a war game. “ But there’s a logical problem here, and that is that from this posture huge portions of yourself are your own enemy.” You are living in a war zone within yourself in which there is no chance of winning.” -- Steven Hayes
Experiential avoidance is the process of trying to avoid our own experiences (thoughts, feelings, memories, bodily sensations, behavioral predispositions) even when doing so causes long-term behavioral difficulties (like not having social contacts due to social anxiety, or not exercising because you’re depressed). Of all the psychological processes known to science, experiential avoidance is one of the worst. “ Control is the problem, not the solution!” In the ACT model, attempts at controlling, avoiding, and/or eliminating unwanted private experiences lie at the heart of most unworkable change agendas.
<ul><li>Radical Acceptance </li></ul><ul><li>Accepting absolutely everything about ourselves and our lives, by embracing with wakefulness and care our moment-by-moment experience. … we are aware of what is happening within our body and mind in any given moment, without trying to control or judge or pull away. . . . </li></ul><ul><li>It means feeling sorrow and pain without resisting. It means feeling desire or dislike for someone or something without judging ourselves for the feeling or being driven to act on it. </li></ul><ul><li>Staying with our experience, while not evaluating or focusing on problem-solving, depends on the ability, developed by mindfulness of breathing practice, to maintain a strong focus on what is occurring, while avoiding judging or problem-solving </li></ul>
<ul><li>The empirical literature on the effects of mindfulness interventions suggest that this approach may lead to reductions in a variety of problematic conditions, including pain, stress, anxiety, depression, personality disorders, disordered eating, and addictions, and it is growing in popularity in many fields, especially those related to healthcare. </li></ul><ul><li>Since the first uses of mindfulness in therapy, it has been found that to be effective in teaching and working with clients practitioners must establish their own mindfulness practice as well as learning skills and exercises with direct clinical application. </li></ul>
<ul><li>1. There is a difference between actual pain (emotional and physical) and the suffering that we create in our minds. </li></ul><ul><li>2. The suffering is not only optional, but there are many ways to remove it, as it is unnecessary, and a tremendous waste of time, energy and enjoyment of life. </li></ul>Some basic observations which underlie most of the mindfulness approaches:
<ul><li>3. The way out of this self-created cell of suffering is accepting absolutely everything about ourselves and our lives, by embracing with wakefulness and care our moment-to-moment experience. This does not mean putting up with a truly harmful circumstance with ourselves or others. </li></ul><ul><li>4. “It is remarkable how liberating it feels to be able to see that your thoughts are just thoughts and that they are not ‘you’ or ‘reality.’ . . . . the simple act of recognizing your thoughts as thoughts can free you from the distorted reality they often create and allow for more clear-sightedness and a greater sense of manageability in your life” </li></ul><ul><li>--Kabat-Zinn. </li></ul>
<ul><li>Mindfulness of Breathing </li></ul><ul><li>Mindfulness practice is generally taught by having the individual sit still and keep their awareness focused on the sensations of their normal breathing without striving too hard. Breathing is important. You do it automatically, but when you are under stress your breath becomes restricted. Let it go. Allow your breathing to deepen in a very calming and natural way. Don't force it, just let go of your tension and feel the breath become slower and deeper. </li></ul><ul><li>This practice quiets the mind, and develops the “muscles” of concentration and undifferentiated awareness which enables a separation from the events occurring in one’s mind. Using Mindfulness of Breathing as a "home base" one is able to keep attention stable and alert, and one can than notice the other facets of experience as well. </li></ul>
<ul><li>Sitting – this is a </li></ul><ul><li>general term which </li></ul><ul><li>is often referred to </li></ul><ul><li>as formal meditating, </li></ul><ul><li>beginning with sitting </li></ul><ul><li>for only 3 minutes, and </li></ul><ul><li>slowly extending the length </li></ul><ul><li>of time until one is sitting </li></ul><ul><li>at least 45 minutes a day by </li></ul><ul><li>four weeks. </li></ul><ul><li>Generally we sit with our legs crossed </li></ul><ul><li>shoulders and other parts of the body </li></ul><ul><li>relaxed without too much effort on our part </li></ul><ul><li>to achieve this. </li></ul><ul><li>We have a sense of what is above, a sense that </li></ul><ul><li>something is pulling us up at the same time that we </li></ul><ul><li>have a sense of the ground. The arms should rest </li></ul><ul><li>comfortably on the thighs. </li></ul><ul><li>Those who cannot sit down on a cushion can sit in </li></ul><ul><li>A chair. The main point is to be somewhat </li></ul><ul><li>comfortable . </li></ul>
Body Awareness <ul><li>taking focus of your attention away from mind/thought and anchoring it in the now of being in your body </li></ul><ul><li>being in the body frees vast amounts of consciousness that previously had been trapped in useless and compulsive thinking </li></ul><ul><li>let the breath take you into the body </li></ul><ul><li>inhabit and experience all aspects of body </li></ul><ul><li>imagery may help direct attention initially, but leave it behind as soon as possible, to directly experience being the body </li></ul><ul><li>don’t just think with your head, but with your entire body </li></ul>