7 pill 7 pillars of min indfulness Historical Roots of - PDF document

Noga Zerubavel, PhD 10/26/2015 UNC School of Social Work’s Clinical Lecture Series Agenda • Characterizing mindfulness • Mindfulness-based CBT for University of North Carolina at Chapel Hill depression School of Social Work October 26, 2015 • Benefits of mindfulness and Noga Zerubavel, Ph.D. relevance to depression Psychiatry & Behavioral Sciences Duke University Medical Center noga.zerubavel@duke.edu Wha hat is is min indfu fulness? Paying attention in a particular way: 1) On purpose 2) In the present moment 3) Nonjudgmentally (Kabat-Zinn, 2003) 7 pill 7 pillars of min indfulness Historical Roots of Mindfulness 1. Nonjudgment – not applying evaluations • Most systematically articulated and emphasized in Buddhism 2. Patience – without urgency • Contemplative traditions in many other 3. Beginner's mind – openness, curiosity religions, including Christianity and 4. Trust – in one’s inner wisdom Judaism 5. Nonstriving – process rather than outcome • Meditation as a spiritual practice 6. Acceptance – reality as it is • Meditation as a way to reduce suffering 7. Letting go – getting unstuck  Now applied to secular context (Kabat-Zinn, 1990) UNC School of Social Work Clinical Lecture Series 1

Noga Zerubavel, PhD 10/26/2015 Mi Mindfulness ss in n the he West t as a Secular Prac acti tice • Research on meditation began in late 1950s/early 1960s • Research on mindfulness meditation as a clinical intervention began in early 1980s • Insight Meditation Center – founded early 1970s in Barre, MA – Sharon Salzberg, Jack Kornfield, Joseph Goldstein • Jon Kabat Zinn established the Stress Reduction Clinic in 1979, now the Center for Mindfulness – Mindfulness Based Stress Reduction (MBSR) through the University of Massachusetts Medical Center Min Mindfulness pr practic ice Practice 1 ) Formal practice • Meditation practice (often 20-40 minutes) to cultivate • Like any skill it takes practice skillfulness • Vipassana meditation practice – sitting, standing, lying • Systematic training down, walking • Mindful embodiment practice – yoga, tai chi, qigong • Regular, consistent practice • Nonstriving – not about achievement; still 2) Informal practice • Practice of mindfulness (techniques and practicing after decades of meditation metacognitions) in everyday contexts • Directing one’s attention • Eating mindfully, washing dishes mindfully, listening to music mindfully Formal practice Mindfulness Mi ss Med Meditati tion Trai ains 2 Typ ypes of Attention on Open Monitoring Focal Attention • No explicit focus on • Directing objects of attention on a awareness. chosen object. • Non-evaluative • Detecting mind labeling of wandering. experience . (Lutz et al., 2008) UNC School of Social Work Clinical Lecture Series 2

Noga Zerubavel, PhD 10/26/2015 Informal practice So why don’t people practice more? • Time • Priorities • Focus on others • Not feeling that one is worth it • Believing that one is doing it “wrong” or not well enough Min Mindfulness in in everyday lif life Min indfulness ss-based • Take moments throughout the day to observe Cognit Co itiv ive Be Behavioral l breath, take a break, or simply check in with yourself with nonjudgmental awareness • Become aware of thoughts, feelings, and Therapy Th sensations throughout the day • Practice nonjudgmental awareness of the present moment • Fully inhabit the body and attend to sensory experience during a daily activity Controlled st studies es of mindfulnes ess-bas ased ed int nter erventions ns • Overall, two categories of intervention: 1. Meditation-oriented interventions  Mindfulness-based Stress Reduction (MBSR)  Mindfulness-based Cognitive Therapy (MBCT)  Mindfulness-based Relapse Prevention (MBRP) 2. Interventions that incorporate less formal mindfulness practices and exercises  Dialectical Behavior Therapy (DBT)  Acceptance & Commitment Therapy (ACT) Bowen et al. (2010), Hayes et al. (1999), Kabat-Zinn (1990), Linehan (1993), Segal et al. (2002). https://goamra.org/resources/ UNC School of Social Work Clinical Lecture Series 3

Noga Zerubavel, PhD 10/26/2015 Min Mindfulness-based CB CBT Back to to the de definition on of mindfulness • Efforts to avoid or control thoughts and emotions contribute to dysregulation  Thoughts often cannot be controlled Paying attention in a particular way:  Emotions cannot often be controlled  Many life situations cannot be controlled 1) On purpose  Our reactions or responses are within our control  Directing one’s attention 2) In the present moment • Change stance toward emotional experience by observing and accepting  Opposite of worrying and ruminating  Paradoxical effect that symptoms are often reduced 3) Nonjudgmentally  Even when not, distress is.  Releases attachment to shoulds, Pain x Nonacceptance = Suffering contributes to acceptance Hayes et al. (1999), Linehan (1993), Roemer & Orsillo (2009), Segal et al. (2002), Witkiewitz et al. (2005) Fo Focus of MB MB-CBT MB MB-CBT Stan ance and sty style • Focus is on the approach to one’s own internal experiences • Collaborative • Thoughts about and reactions to the emotional • The human condition – “we” experience create distress and suffering • Collecting data from a place of curiosity • Focus on meta-cognitions; observe and notice the cognitions and their impact • Investigating hypotheses  Judgment of emotions • Modeling compassion and acceptance of  Nonacceptance of emotions • Practice acceptance while moving toward change challenges paired with commitment to caring for oneself effectively Hayes et al. (1999) Linehan, (1993) Roemer & Orsillo (2009); Segal et al. (2002), Witkiewitz et al. (2005) MB MB-CBT For ormat MB MB-CBT Goal Goals for or Treatment • Structured with an agenda • Treatment goals are behavioral • Includes mindfulness practice • Goal of living valued life despite/along with symptoms  Theoretical use, focused on awareness and  Paradoxical results - symptoms are often reduced nonjudgment of present moment experience • Acquisition and generalization of skills  Contrast to traditional CBT technical use for relaxation  Anyone can learn a skill • Home practice assignments  Skills develop through practice • Not avoiding experience, even when distressing  168 hours per week! • Find tenderness and openness toward experience • Balance acceptance and change UNC School of Social Work Clinical Lecture Series 4

Noga Zerubavel, PhD 10/26/2015 Serenity ty pr prayer as an n example of Mai Main messag ages s of mindfulness-based CBT syn ynth thesis • Approach emotions, thoughts, and urges as experiences that come and go  Can facilitate this process through cultivating the ability to release our attachments to controlling our internal experiences and developing our ability to let go God grant me the serenity to accept the • Willingness to experience whatever comes things I cannot change;  Greeting whatever presents itself (feelings, images, sensations, thoughts)  Finding tenderness and openness toward experience The courage to change the things I can; • Make room for living with the symptom  Idea of living a life worth living, not waiting for symptoms to end before beginning And the wisdom to know the difference. your life • Relinquish judgment of ourselves and others • With mindfulness practice, one will begin to perceive alternatives to automatic assumptions and reactions Mi Mindfulness ss-base sed Cog ognitive Self- Curiosity Wisdom Behavioral al Therapy Applied to to the Compassion Territory of Depressi sion Cultivate Recognize Identify habitual commitment to choice points in patterns; assess taking care of daily life for wise whether patterns oneself are helpful or decision-making unhelpful Doin oing Mo Mode Automatic pi pilot ot • Motivated by achievement, striving for goals • Often we live on automatic pilot , without awareness of • Focused on planning, preparing for goals the details of what we are doing • Productivity, efficiency • On automatic pilot, we are more likely to engage in habitual patterns of thinking, which may be maladaptive • Outcome focus or unhelpful Being Mode • By becoming aware of thoughts, feelings, and body • sensations, we cultivate greater capacity to respond Acknowledging what is already here instead of react rather than focusing on goals • Direct experience of the present • No need to evaluate experience • Process focus UNC School of Social Work Clinical Lecture Series 5