An introduction to the clinical An introduction to the clinical utility of mindfulnessutility of mindfulness

Dr. Nic HooperDr. Nic Hooper

Outline of Lecture

• History of Mindfulness

• What is Mindfulness?

• Typical Mindfulness Practises

• Research and Evidence

History of MindfulnessHistory of Mindfulness

• Mindfulness and BuddhismMindfulness and Buddhism

– Originated from the Buddhist traditionOriginated from the Buddhist tradition– 77thth step of the noble eight fold path as taught by the step of the noble eight fold path as taught by the

originator of Buddhism, Siddhartha Gautamaoriginator of Buddhism, Siddhartha Gautama– Mindfulness led to the ‘cessation of personal Mindfulness led to the ‘cessation of personal

suffering’suffering’– Although taught as part of Buddhism, there is nothing Although taught as part of Buddhism, there is nothing

religious about mindfulnessreligious about mindfulness

History of MindfulnessHistory of Mindfulness

• Mindfulness and the WestMindfulness and the West

– Jon Kabat-Zinn created Mindfulness Based Stress Jon Kabat-Zinn created Mindfulness Based Stress Reduction (MBSR) in 1979 to treat chronically illReduction (MBSR) in 1979 to treat chronically ill

– Subsequently a number of other third wave Subsequently a number of other third wave psychological therapies using mindfulness techniques psychological therapies using mindfulness techniques developed; ACT, MBCTdeveloped; ACT, MBCT

– Currently a hugely popular technique receiving a Currently a hugely popular technique receiving a plethora of research in its favourplethora of research in its favour

What is Mindfulness?What is Mindfulness?

Definition of MindfulnessDefinition of Mindfulness

“…paying attention in a particular way:

on purpose,

in the present moment,

and nonjudgmentally”

(Kabat-Zinn, 1994, p.4)

DimensionsDimensions

• Control of attentionControl of attention– Bringing your mind back to the present moment Bringing your mind back to the present moment

• Willing / accepting stanceWilling / accepting stance– It’s not primarily about altering a feeling stateIt’s not primarily about altering a feeling state

Some ContrastsSome Contrasts

• Relaxation

• Distraction

RelaxationRelaxation

• It has been suggested that mindfulness is simply relaxation

• However relaxation has been shown to be very different from mindfulness

• Namely, most clinical mindfulness skills induce an active state in clients where psychological issues are addressed

RelaxationRelaxation• Ditto, Eclache and Goldman (2006) and Jain et

al (2007) compared the effects of mindfulness versus relaxation– In terms of physiology, Ditto et al (2006) found that

brain activity/cardiovascular effects were different between the two

– In terms of self report, Jain et al (2007) found that while relaxation and mindfulness both reduce distress and foster positive mood states, only mindfulness reduces distractive and ruminative thoughts

DistractionDistraction• It has also been suggested that mindfulness is a It has also been suggested that mindfulness is a

sophisticated form of distractionsophisticated form of distraction

• Thought suppressionThought suppression

DistractionDistraction

• McHugh Simpson & Reed (2010) compared distraction McHugh Simpson & Reed (2010) compared distraction and mindfulness amongst an older population on a and mindfulness amongst an older population on a decision making card selection taskdecision making card selection task

• They found that mindfulness enhanced decision making They found that mindfulness enhanced decision making performance. Distraction worsened itperformance. Distraction worsened it

• Suggesting that different processes are at workSuggesting that different processes are at work

• Broderick (2005) showed similar results in an induced Broderick (2005) showed similar results in an induced mood studymood study

Important things to know Important things to know about Mindfulnessabout Mindfulness

Mindfulness is experientialMindfulness is experiential

– Intellectual v. experiential / Knowing v. doing (may not be the same thing)

– How do we teach people to ride a bike?

The importance of practiseThe importance of practise

• The more you practise, the better you get!– Brefczynski, Lutz, Shaefer, Levinson and Davidson

(2007) experienced (+37000 hours) participants were performing an attentional focusing task using less neural resources

• Stage 1: Noticing in the present moment• Stage 2: Noticing non-judgementally in the

present moment• Stage 3: Rolling out these skills across life

Metaphors and MindfulnessMetaphors and Mindfulness

• Metaphors often help to explain situations with more clarity

• They can be used to aid an understanding of mindfulness– The Puppy; notice your “puppy-like” mind.– Leaves on a stream

The anti-thesis of MindfulnessThe anti-thesis of Mindfulness

• Mindfulness is an acceptance based strategy that is directly opposite to avoidance

• Avoidance of unwanted thoughts can lead us to narrow our behavioural repertoire

• Mindfulness enables us to come into contact with unwanted thoughts, without it affecting the way in which we act

Thought suppression and Thought suppression and behavioural avoidancebehavioural avoidance

Typical Mindfulness Typical Mindfulness exercisesexercises

Traditional MFN practicesTraditional MFN practices

• BreathBreath• BodyBody• SoundsSounds• Yoga / Walking MFNYoga / Walking MFN• EatingEating

(generalisation is essential)(generalisation is essential)

BreathBreath

• “Sustained single focused attention”…focus on your breath…the mind will wander*…when it does, note where its wandered …try not to get caught up…bring yourself back to your breath

* to memories, sounds, thoughts, feelings, physical discomfort, urges, etc.

Body ScanBody Scan

Awareness of current physical sensations

Moving attention Noticing automatic responses (run… distract… change)

Trying to do things differently: willingly experiencing discomfort noticing and still “going there”

Itch / ScratchItch / Scratch

• Noticing and playing with urges

• Understanding the thought action link

Walking/Eating MindfulnessWalking/Eating Mindfulness

• A bridge between mindful living and mindful practise

• A great way to bring mindfulness into our everyday lives

• The raisin task as popularised by Kabat-Zinn

Informal PracticeInformal Practice

• Getting people to notice when their behavioural repertoire narrows or starts moving in a non-valued direction in the moment

• Check in / What’s coming up? / What’s going on under the bonnet?

• Pacing, Exercise, Role-Plays

Case Vignette

Case Vignette

• Jack – a burly 15-year-old with severe, intractable back pain

• Often either inactive and fearful of his pain or trying to ‘push through it’ (sadly, unsuccessfully)

• Had become more angry, family saw risk of lashing out. Both he (and his family) avoiding risky social situations

Case Vignette

• Initially, he didn’t see the point of mindfulness

• Being in the group helped, he learnt by proxy. Started to buy into the idea of “surfing” sensations

• With widened attention Jack discovered that ‘pain’ was actually a bundle of sensations including fears, frustrations and urges to move or avoid

Case Vignette

• Started being able to see his angry thoughts as ‘just thoughts’ - surfing urges without doing anything impulsive

• When asked about these situations at the end of the programme, he laughed and said:‘I know I can bring the puppy back!’

Research and Evidence

Mindfulness and anxietyMindfulness and anxiety

• Kabat-Zinn et al (1992) gave 22 patients with Generalized Anxiety Disorder (GAD) 12 week MBSR

– Found significant improvements in measures of anxiety (and depression) at 3 month follow up

• Miller et al (1995) did a three year follow up with the same patients

– Found that the gains had been maintained

Mindfulness and depressionMindfulness and depression• Teasdale et al (2000)

– Depressed patients either received MBCT or Treatment as Usual (TAU)

– Results showed that those who received MBCT were significantly less likely to relapse into depression

Mindfulness and chronic painMindfulness and chronic pain

• Randolph et al (1999) gave 78 chronic pain patients MBSR

• Patients showed improvements in;– Ratings of pain– Other medical symptoms– General psychological symptoms

– Changes were maintained at follow up

Mindfulness and smoking Mindfulness and smoking cessationcessation

• Gifford et al (2004) gave ACT in 7 individual/group sessions vs. the standard Nicotine Replacement Therapy

– Results showed that significantly more participants had maintained their abstinence at 1 year follow up in the ACT group

Mindfulness and eatingMindfulness and eating

• Tapper et al (2009)– 68 women– All trying to lose weight– Given either a mindfulness/control intervention– 2 four hour workshops

– Results; women in the mindfulness condition lost more weight and also reported exercising more at 6 month follow up

Mindfulness and phobiaMindfulness and phobia

• Hooper, Davies, Davies & McHugh (2011)

– Comparison of mindfulness vs. thought suppression in the management of spider fear

– Participants underwent a 10 minute intervention before completing a Behavioural Approach Test (BAT)

– Participants also completed anxiety measures pre and post BAT

Behavioural Approach Test (BAT)Behavioural Approach Test (BAT)1. Move 1 metre to the table2. Move 1 more metre to the table3. Approach the table4. Touch the jar for more than 10 seconds5. Lift up the jar6. Open the jar7. Touch the spider with a pencil for more than 10

seconds8. Remove the spider from the jar9. Touch it with a finger for more than 10 seconds10.Put the spider on their hand

Results – BAT dataResults – BAT data

Results – STAI dataResults – STAI data

Mindfulness and care givingMindfulness and care giving• Singh et al (2003)

– Gave caregivers of adults with profound multiple disabilities an 8 week mindfulness course

– Results showed that the patients of those caregivers given mindfulness training became significantly happier during interactions with them

Mindfulness and aggressionMindfulness and aggression

• Heppner et al (2008)

– Gave half of the participants a mindfulness intervention (5 minute raisin task) before completing a social rejection task, known to induce aggression

– Results showed that those given the intervention displayed less aggression/hostility than their control condition counterparts

Mindfulness meta analysisMindfulness meta analysis

• Baer (2003)

– Performed a meta-analysis on 21 adult mindfulness studies of adequate quality

– Conditions included chronic pain, anxiety and depression

– Large mean effect size post treatment (0.74, SD=0.39 [Cohen’s d]) medium effect size at follow-up (0.59, SD=0.41)

– “…may bring participants with mild to moderate psychological distress into or close to the normal range” (pp.137)

Mindfulness meta analysisMindfulness meta analysis

• Grossman et al (2004)

– Reviewed 64 studies

– Found consistent improvement and relatively strong effect sizes across:

– Mental health (e.g. depression, anxiety, coping style) physical well-being (e.g. medical symptoms,

sensory pain, physical impairment, and functional estimates)

SummarySummary

• Mindfulness seems to be making huge strides in terms of research

• However, to avoid the current criticisms levelled at CBT

• A huge emphasis will have to be placed on the processes at work in mindfulness– Exposure– Willingness– Meta-cognition– Control of attention