Mindfulness for Mental

Health Professionals

Martha P. Childers, M.A., Ed.Spec.

2013 GKCPA Annual Fall Conference
November 15, 2013
1 p.m. - 2:30 p.m.
Johnson County Community College

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 Contents

Overview
Benefits
Mindfulness-Oriented Psychotherapy
Application
References and Contact Information

2
Be
3
Present
4
Be Present
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Overview of Mindfulness

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 History of Mindfulness
 Ancient Eastern religious practices, particularly
India, China, Tibet, and Japan
 1960’s, Indian guru Maharishi Mahesh Yogi
brought Transcendental Meditation to U.S.
 1968, Harvard cardiologist Herbert Benson tested
ability to lower blood pressure (results—no
change); he later developed relaxation response
 1970s, Ainslie Meares, an Australian psychiatrist,
studied meditation to enhance immune system to
reduce tumors
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 Clientele Readiness

36% of American use some form of

alternative medicine, including herbal
supplements, meditation, acupuncture,
chiropracty and yoga
National Center for Complementary and
Alternative Medicine (National Institutes
of Health)
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 Database Search Results
MedlinePlus.Gov (mindfulness 82
NOT attention)
APA website (mindfulness) 338
ACA website (mindfulness) 347
PsychInfo (mindfulness in title) 2,209
(2014-1975)
Google (mindfulness) 11,100,000
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 Research

NIH RePORTER 109

NIH funded for past 25 years
ClinicalTrials.gov 344
privately & publicly funded
PubMed 996
2013-1982

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 Mindfulness Definitions

Mindfulness: A moment-to-
moment awareness of one’s
experience without judgment
Mindful awareness: deep abiding
presence
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 Mindfulness Assumptions

Mindfulness is a natural human

capacity
All human beings want health,
happiness and freedom from
suffering

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 Benefits
Boost to working memory No known side affects
Less emotional reactivity Reduced rumination
Relationship satisfaction Stress reduction
Increased immune function Increase focus
More cognitive flexibility Reduced psychological
distress
Enhance self-insight, morality, Fear modulation
intuition
Increased information processing Improved well-being
speed
Inexpensive (purchase books, attend Decreased task effort 13
 Risks
• A small number of people became disoriented
or anxious and experienced some negative
feelings
• Utilizing mindfulness techniques alone
without conventional medical care for some
diseases may have serious consequences
• Escapism

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Jon Kabat-Zinn, pioneer in applying
mindfulness to healing in America, developed
the first and still most popular mindfulness-
based technique in 1979 at University of
Massachusetts Medical School and
subsequently founded the Center for
Mindfulness in Medicine, Health Care, and
Society at the Medical School.
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 Jon Kabat-Zinn

http://www.youtube.com/watch?v=6aaJtBKwK9U

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 Mindfulness Practices
Informal practice: Intentionally bringing
open, accepting, discerning attention to
daily life.
Note: clinical practice is considered
informal
Formal practice: Systematic meditation
practices geared to cultivate mindfulness
skills.
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 Elements of Mindfulness Practice
 Intention: set a goal to reach it
(e.g. self-exploration, stress management, self-
liberation and compassion)
 Attention: observe internal and external experience
in a discerning, nonreactive, sustained, and
concentrated way
 Attitude: nonjudging, nonstriving, nonattachment,
acceptance, patience, trust, openness, curiosity,
letting go, gentleness, nonreactivity, loving-
kindness, warmth, friendliness, kindness
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 Brain Changes
The frontal lobe is shown to increase in size
with meditation: responsible for initiating
and coordinating motor movements; higher
cognitive skills, such as
problem solving,
thinking, planning,
and organizing; and
for many aspects of
personality and
emotional makeup. 19
 Brain Changes (con’t)

The insular cortex is shown to increase in

side with meditation: responsible for
emotional awareness,
self-recognition,
sense of homeostasis,
music, rhythm, and
language processing
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 Brain Changes (con’t)
Gray matter increases in left
hippocampus: plays a distinct role in
complex aspects of perception,
movement, emotion, and cognition, each
of which contributes to
the overall experiences
captured in declarative
memories. 21
 Brain Changes (con’t)

Posterior cingulate cortex shows increased

gray matter density: prominent role for the in
pain and episodic memory retrieval, may be
involved in the capacity to
understand what other
people believe. This area
has been defined in
Alzheimer’s disease. 22
 Brain Changes (con’t)

Gray matter increases in temporo-

parietal junction: recruited selectively
for the attribution of mental states,
memory, learning,
involved in social
cognition

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 Brain Changes (con’t)

Gray matter increases in Cerebellum:

helps to regulate emotion and
cognition

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 Brain Changes (con’t)

Decrease in parietal lobe:

visual and spatial

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 Brain Changes (con’t)
Decrease in amygdala: role in
processing memory and emotional
reactions,
player in stress

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 Brain Changes (con’t)

Decrease in size of thalamus: relaying of sensory

and motor signals to the
cerebral cortex, and
the regulation of
consciousness,
sleep, and
alertness

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 Ted Talk: Brain Changes

Sara Lazar, neurologist and psychologist who

studies brain changes due to meditation
at Harvard Medical School

http://www.youtube.com/watch?v=m8rRzTtP7Tc

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Benefits of Mindfulness

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 Benefits of Practice

Bring unconscious values to awareness

Decide whether to pursue those values
Develop wholesome and skillful values
(based on universal values)

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 Benefits to Psychotherapy

Strongest predictor of therapeutic outcomes is

relationship variables
Freud: “An evenly hovering attention”
Perls: “Attention in of itself is curative”
Rogers: empathy, unconditional positive
regard, congruence
 Benefits for the Clinician
 Foster attention, empathy, compassion, patience,
intentionality, gratitude, body awareness, presence
 Understand own psychodynamics, difficulties, goals
 Better able to develop new adaptive behaviors
 Fewer symptoms of anxiety, depression, hostility,
somatization, stress, obsessions, and compulsions
 Means of self-care
 Better quality of life
 Useful for a wide range of populations
 Improve ability to develop therapeutic skills
 Expand professional focus to include positive
growth, development, and transformation 32
Mindfulness-Oriented
Psychotherapy

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Mindfulness-Oriented Psychotherapy
Beginning Meditation

Close eyes
Relax your body
Breathe in deeply
Hold it briefly
Breathe out slowly and fully
3 times
Open eyes
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 Mindfulness-Oriented Psychotherapy

1. Mindful therapist: personal practice of

mindfulness meditation to cultivate presence
in therapeutic work
2. Mindfulness-informed psychotherapy:
application of mindfulness theories and
research along with Buddhist psychology
3. Mindfulness-based psychotherapy: teaching
clients mindfulness skills and practice
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 1
Mindful Therapist

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 Mindful Therapist

 Attention and therapist presence

 Therapist attitudes
 Self-compassion and attunement
 Empathy and attunement with others
 Emotion regulation

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 Mindful Therapist
Attention and Therapist Presence

 Attention capacity and therapeutic presence

 Attitudes applied during therapy
 Self-compassion and self-attunement of
therapist
 Therapist empathy attunement toward client
 Therapist emotion regulation and handling of
countertransference
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Mindful Therapist: Therapist Attitudes

Nonstriving
Nonattachment Gentleness
Acceptance Nonreactivity
Nonjudging Letting go
Patience Loving-kindness
Trust Warmth
Openness Friendliness
Kindness Curiosity
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 Mindful Therapist
Self-Compassion and Attunement

Ability to feel empathy for another or

own suffering and wish to act on these
feelings to alleviate suffering
Self-attunement requires development of
a “witness consciousness” or in
psychodynamic terms, “observing ego”

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 Mindful Therapist
Meditation for Witness Consciousness (con’t)
 Feel safe
 Close eyes
 Relax body
 Breathe to go into meditative state (frontal lobe
and insular cortex engage)
 Move consciousness to top of head and observe
yourself
 Move consciousness on top of that and observe
self observing self
 Come out of meditate state and open eyes when
ready 41
 Mindful Therapist
Self-Compassion and Attunement (con’t)
Attend to our own suffering
Recognize our own suffering is not unique
Begin to understand in a visceral way that all
beings experience suffering
Develop compassion for others and a strong
desire to alleviate suffering in self and others
Universality of being human helps develop
self-compassion
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 Mindful Therapist
Self-Compassion and Attunement (con’t)
Therapists who are less accepting and
more critical of themselves have been
shown to be more hostile, controlling,
and critical toward their clients
Therapists who are more self-accepting
tended to engage clients in more
accepting, supportive transactions
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 Mindful Therapist
Empathy and Attunement with Others

 Empathy is necessary for effective

therapy
 Research has shown that meditation
strengthens empathy

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 Mindful Therapist
Emotion Regulation

Research shows that mindfulness practice

can help individuals regulate their emotions
Attending to and regulating personal
emotions, therapists can be more present and
accepting of their clients
Witnessing clients experience provides a
place for clients’ emotions and sets a
boundary around client and therapist
experiences
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 Mindful Therapist
Emotion Regulation
Meditation to Dissipate Emotion
Imagine putting 1T of salt in a
glass of water and how it would
taste
Pour it into a pitcher of water
Pour it into a lake
Pour it into the ocean
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 2
Mindfulness-Informed
Therapy

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 Individuals Possibly Unsuitable for
Mindfulness-Informed Therapy
 People with personality disorders may require
traditional counseling before they learn
meditation to look deeply inside themselves
 Clients who may have psychotic tendencies may
not have strong enough psychic structures to
practice mindfulness
 Individuals diagnosed with major depressive
disorders may not be able to concentrate enough
and meditation could potentially lead to
rumination resulting in a depressive episode
 Some controversy about using it in cases of
traumatic stress
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 Mindfulness-Informed Therapy
Impermanence
Accepting What Is
Conscious Responding vs Automatic Reactivity
Curiosity and Investigation
Paradox
Interdependence
Essential Nature

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Mindfulness-Informed Therapy (con’t)

Recommended books:
Epstein, M. (2013). Thoughts without a
thinker: Psychotherapy from a Buddhist
perspective. NY: Basic Books.

Kornfield, J. (2008). The wise heart: a

guide to the universal teachings of
Buddhist psychology. NY: Bantam Books.
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Mindfulness-Informed Therapy
Impermanence

Everything changes

This too shall pass

Persian ‫این نیز بگذرد‬
Arabic ‫كله ماشي‬
Hebrew ‫גם זה יעבור‬
Turkish Bu da geçer (yahu)

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 Mindfulness-Informed Therapy
No Self

No stable, solid, unchanging entity

labeled “self” exists
Experience the ever-changing and
flowing reality of self
“The mind changes with
inconceivable rapidity.” Subhuti
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 Mindfulness-Informed Therapy
No Self (con’t)

Explore your own self through time

13 years old
21 years old
A year ago

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 Mindfulness-Informed Therapy
Accepting What Is
Resisting what is actually happening,
wanting things to be different than they
are creates suffering
Suffering based on one’s relationship to
what is happening
Not accepting what is creates suffering
Goal: no resistance
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 Mindfulness-Informed Therapy

Therapists asks --
What is the patient not accepting?

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 Mindfulness-Informed Therapy
Conscious Responding vs
Automatic Reaction

Let go of habitual problem solving

mode
Bring to awareness difficult
emotions
Feel the emotions in the body
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 Mindfulness-Informed Therapy
Conscious Responding vs
Automatic Reaction

Insanity: Doing the same thing

over and over again and
expecting different results.
Albert Einstein
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 Mindfulness-Informed Therapy
Curiosity and Investigation

Investigate own experience deeply

Trust own experience
Develop own beliefs on the basis of
own experience
Explore self to find a deep sense of
self-knowing
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 Mindfulness-Informed Therapy
Curiosity and Investigation (con’t)

Out of caring curiosity and interest, help

client investigate own experience by
stepping outside personal, subjective
experience and take a more inquisitive,
objective view.
Ultimately help the client get in touch
with own instincts.
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 Mindfulness-Informed Therapy
Curiosity and Investigation (con’t)
“I have been and still am a seeker, but I
have ceased to question stars and books; I
have begun to listen to the teaching my
blood whispers to me.” Hermann Hesse,
Demian
“I will follow my instincts, and be myself
for good or ill.” John Muir
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 Mindfulness-Informed Therapy
Curiosity and Investigation (con’t)

“Instinct is a marvelous thing. It can neither be

explained nor ignored.” Agatha Christie, The
Mysterious Affair at Styles
“Trust instinct to the end, even though you can
give no reason.” Ralph Waldo Emerson
 “Instinct leads me to another flow.” Queen
Latifah
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 Mindfulness-Informed Therapy
Curiosity and Investigation (con’t)

Be a lamp unto yourself

The Buddha

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 Mindfulness-Informed Therapy
Paradox

Penetrate deeply into the

nature of things
Accept that one simply does
not know some things

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 Mindfulness-Informed Therapy
Interdependence

All things are intimately connected

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 Mindfulness-Informed Therapy
Interdependence (con’t)

butterfly effect n (Physics / General Physics)

the idea, used in chaos theory, that a very small
difference in the initial state of a physical system
can make a significant difference to the state at
some later time

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 Mindfulness-Informed Therapy
Essential Nature

All beings are born with a pure

and noble essence
A client’s essential being is
virtuous, pure, and deeply lovable

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 Mindfulness-Informed Therapy
Essential Nature (con’t)

Go into a meditative state

See yourself as a pure and
noble essence, virtuous, pure,
and deeply lovable
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 3
Mindfulness-Based
Psychotherapy

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 Mindfulness-Based Psychotherapy

Mindfulness-based stress reduction

Mindfulness-based cognitive therapy
Mindfulness-based eating awareness
training, art therapy, relapse prevention,
relationship enhancement
Dialectical behavior therapy (DBT)
Acceptance and commitment therapy
(ACT)
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 Mindfulness-Based Psychotherapy
Mindfulness-Based Stress Reduction
(MBSR)
 8-week program
 Up to 35 participants
 Meet weekly for 2 ½ - 3 hours
 6-hour silent retreat week-end after week 6

Kabat-Zinn, J., & Nhá̂ t Hạnh, Thích (1990).

Full catastrophe living: Using the wisdom of
your body and mind to overcome pain, stress,
and illness. New York: Delta.
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 Mindfulness-Based Psychotherapy
Mindfulness-Based Cognitive Therapy
(MBCT)
Integrates MBSR and CBT
Developed in late 1990’s for depression relapse
prevention
Segal, Z. V., Williams, J. M. G., Teasdale, J. D.
and Kabat-Zinn, J. (2012). Mindfulness-based
cognitive therapy for depression: A new
approach to preventing relapse (2nd ed.). New
York: Guilford Press.
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Mindfulness and Cognitive Therapy
Perception and thought drive emotion and
behavior; change relationship to thought and
change behavior
Cognitive therapy: technique to change
thought, resulting in changed behavior
Mindfulness: emphasizes meditation as way to
become aware of moment-to-moment
experience, resulting in behavior change

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 Mindfulness-Based Psychotherapy
Mindfulness-Based Eating Awareness Training

Based on MBSR and integrates CBT.

Helpful for binge eating disorder and obesity.
Meditations address issues around body shape,
weight, etc.
Kristeller, J. L., Baer, R. A., & Quillian-Wolever, R.
(2006). Mindfulness-based approaches to eating
disorders. In R. A. Baer (Ed.), Mindfulness-based
treatment approaches: Clinician’s guide to evidence
base and applications (pp. 75-91). London:
Academic Press.
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 Mindfulness-Based Psychotherapy
Mindfulness-Based Relationship Enhancement
Modeled on MBSR to enhance relationships of
relatively happy couples
Loving-kindness meditations intended to generate
feelings of loving and caring for partner
Carson, J. W., Carson, K. M., Gil, K. M., &
Baucom, D. H. (2006). Mindfulness-based
relationship enhancement in couples. In R. A. Baer
(Ed.), Mindfulness-based treatment approaches:
Clinician’s guide to evidence base and applications
(pp. 309-331). Amsterdam, Elsevier.
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 Thich Nhat Hanh

http://www.youtube.com/watch?v=NJ9UtuWfs3U
19.06

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 Mindfulness-Based Psychotherapy
Mindfulness-Based Art Therapy
Based on MBSR
Developed for medical populations, piloted for
women with breast cancer. Utilizes creative process
to process emotions arising from the illness, health,
and healing
Monti, D. A., et al. (2005). A randomized controlled
trial of mindfulness based art therapy (MBAT) for
women with cancer. Psycho-Oncology, 15, 363-373.

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 Mindfulness-Based Psychotherapy
Mindfulness-Based Relapse Prevention
Patterned after MBCT
Used for drug, alcohol, and smoking. Relapse
prevented through ability to act as observing
witness and skills to cope with urges, etc.
Marlatt, G. A., & Gordon, J. R. (Eds.). (1985).
Relapse prevention: Maintenance strategies in
treatment of addictive behaviors. New York:
Guillford Press.

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 Mindfulness-Based Psychotherapy
Dialectical Behavior Therapy (DBT)

Combines CBT, emotion regulation, and

mindful awareness to treat borderline
personality disorder
Linehan, M. M. (1993). Cognitive-
behavioral treatment of borderline
personality disorder. New York: Guilford
Press.
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 Mindfulness-Based Psychotherapy
Acceptance and Commitment Therapy

Uses acceptance and mindfulness with

commitment to goals and values along with
behavior change strategies.

Hayes, S. C., Strosahl, K., & Wilson, K. G.

(1999). Acceptance and commitment therapy.
New York: Guilford Press.

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Application

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 Some Mindfulness Practices
Sitting Transcendental Meditation Affirmations
Walking Martial arts: e.g. tai chi, Awaken the senses
karate, judo, aikido
Breathe Make the familiar new Visualizing
again
Yoga Concentrate on a thought, Zen meditation
mantra, activity or image
Mindful Pay attention Focus on breathing
eating
Body Scan Rest quietly and observe Contemplation
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breathing and thoughts
 Mindfulness Meditations for Kids
• Deep breathing: sit in quiet place, inhale slowly
through nose deep into lungs, hold 5 seconds,
release slowly.
• Muscle relaxation: contract group of muscles
tightly. Hold for 5 seconds. Release. Repeat 5
times.
• Visualization: close eyes, picture peaceful place
or event and heart happy sounds, imagine stress
flowing away from body; or visualize competitive
sport activity
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 Mindfulness for Medical Conditions
 Alzheimer’s: reduce loneliness and isolation, linked
to increase risk
 Asthma: improve
 Blood cortisol levels (Stress hormones): reduce
 Brain: relax, focus on current moment, go with flow
of thoughts and sensations
 Cancer: reduce stress hormones that bind with
cancer cells, making cells more invasive, relieve
anxiety , depression, distress, fatigue, mood, sleep
disturbances, improve quality of life, improve
positive outcomes
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 Mindfulness for Medical Conditions (con’t)

Cholesterol: reduce
Colds: relief
Deep belly fat: decrease
Eating: more balanced and emotional
regulation
Fertility: increase
Fibromyalgia: decreases
Health care services: reduce usage

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Mindfulness for Medical Conditions (con’t)

 Heart disease: less lonely, less stress, reverse

carotid atherosclerosis
 Heritable disorders of connective tissue:
ameliorates pain
 High blood pressure: reduce
 Inflammation: reduce levels of proteins linked to
inflammation (heart disease, Alzheimer’s); reducing
loneliness reduces inflammation
 Irritable bowel syndrome: relief
 Longevity: increase
 Menopause: reduce hot flashes
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 Mindfulness for Medical Conditions (con’t)

Poor health: reduce

Osteoporosis: tai chi to maintain bone density
Respiratory infections: reduce
Rheumatoid arthritis: improve quality of life
and reduce psychological distress
Sleep: improve
Stress: linked to heart disease, compromised
immune system functioning, premature
cellular and cognitive aging
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 Mindfulness for Psychological Health
Anxiety: reduce long-term
Caregivers: feel less lonely, isolated, depressed,
less emotional stress
Chronic pain: reduce
Cognitive decline: decrease or prevent
Depression: reduce
Emotion regulation and control: improve
Emotional stress: decrease, focus, decrease
feelings of overwhelm and depression
Focus: improve 87
 Mindfulness for Psychological Health (con’t)

 Inflammation: reduces levels of proteins linked

to inflammation (heart disease, Alzheimer’s)
 Learning: improve
 Life satisfaction: improve
 Memory and mental clarity: improve
 Mood: improve
 Negative thinking: reduce
 Perspective taking: improve
 PTSD: useful for treatment
 Quality of life: improve
88
 Mindfulness for Psychological Health (con’t)

 Relationships: possibly improve

 Relaxation: increase
 Self-awareness: increase
 Smoking: reduced; area of brain linked to self-
control shown to be more active
 Stress: reduce, improve coping strategies
 Sports: help children and athletes focus on
present, reduce nervous energy; positive
affirmations “I learn from my mistakes” “I’m in
control of my feelings” “I can make this goal”
 Values: clarify
89
 Anxiety Meditation
Go into meditative state
Recall an unpleasant memory causing
anxiety
Notice physical feelings
Stay with the physical feelings until they
dissipate or until concentration ends
Come out of meditative state
90
 Decision-Making Meditation
Go into a meditative state
Feel heart and remember the feeling
Think of one option
Feel heart and remember the feeling
Think of another option
Feel heart and remember the feeling
Come out of meditative state and asset feelings
to make decision
91
 Six Focusing Movements:
Meditation for Self-Healing
 Clearing a space: Ask yourself, “How do I feel?”
 Felt sense of the problem: Ask yourself, “Which
problem is the worst?”
 Finding a handle: Name the problem
 Resonating handle and felt sense: Ask, “Is the
handle right?” Adjust the handle as needed
 Asking: Ask the problem
 Receiving: Listen to the response
Gendlin, E. T. (1981). Focusing. New York: Bantam Books.
92
 Discussion

 Ethical concerns about using mindfulness

techniques with clients

 Overcoming resistance in clients

 Effective mindfulness techniques

 Locations to learn mindfulness

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 A Selection of Resources
 American Psychological Association website
 Brainfacts.org
 Kabaat-Zinn, J. (2012). Mindfulness for beginners: Reclaiming the
present moment and your life. Boulder, CO: Sounds True.
 Meditation and Brain Changes: Recent Research and New
Applications. (June 25, 2012) Jon Lieff. (Retrieved Nov. 13, 2013, from
http://jonlieffmd.com/blog/meditation-and-brain-changes-recent-
research-and-new-applications)
 MedlinePlus.gov
 Nhá̂ t Hạnh, Thích. (1987). The miracle of mindfulness: An introduction
to the practice of meditation. Boston: Beacon Press.
 PubMed.gov
 Shapiro, S.L., & Carlson, L. E. (2009). The Art and science of
mindfulness. Washington, D.C.: American Psychological Association.
 Society of Neuroscience website 94
 Martha P. Childers, M.A., Ed. Spec.

[email protected]

816-892-0803

95