MINDFULNESS TOO! BRINGING THE PRACTICE HOME

MINDFULNESS TOO! BRINGING THE PRACTICE HOMEPresented by Dianne Lemieux, Ph.D. & Elaine Rodgers, R.N.Mindfulness Oriented PsychotherapyPractice Options1) A therapist may develop a personal formal or informal practice of mindfulness meditation in order to develop a more mindful presence in psychotherapy.

2) A therapist may utilize a therapeutic frame which is informed by their own practice of mindfulness, research or literature regarding mindfulness or Buddhist psychology.

3) A therapist may teach patients how to practice mindfulness. Germer, C. (2005) Personal Inquiry1) Am I interested in pursuing mindfulness practice for my own personal and or professional growth?

2) Am I willing to commit to a daily practice of mindfulness?

3) How would I like to incorporate mindfulness in my clinical, teaching or consulting practice?

4) What further training do I need?

Forms of Meditation PracticeConcentration Practices use one-pointed focus on a single object (breath, sound, mantra, word, image) to calm and stabilize the mind. Aim and sustain.Mindfulness or awareness practices cultivate an open awareness on what is happening as it is happening without judgment. Also sometimes referred to as insight meditation or Vipassana in the Theravada Buddhist tradition.Concentration MeditationSamatha (laser light beam)Samatha (Pali) : tranquility and concentrationAny object of awareness may be used as an object of concentration Internal objects: words, images, a spot on the body, the breathExternal objects: candle flame, mandala, image, a dot on the wall.Benefit: calm, stable mind detached from emotional and interpersonal involvementIn concentration practice, the mind is gently returned to the object of meditation when we notice it has wandered.The Relaxation Response (Benson, 1975)

Germer, C. (2005)

Mindfulness MeditationVipassana, Insight (searchlight)Sati (Pali): awareness, attention, rememberingExpanded focus on a wider range of objects as they arise in awareness one at a time.Benefits: Greater awareness of the personal conditioning of our minds and an understanding of the mind itselfMay include any sense (sight, sound, touch, smell, taste, hearing) as well as thoughts and emotions Germer, C. (2005)Mindfulness/ConcentrationMeditationsConcentration and mindfulness practices actually complement each otherMindfulness begins with concentration meditation. Once a certain stability of the mind is reached, the practioner shifts to a mindfulness focus.

Research suggests that the two forms of meditation are in fact neurologically different Lazar, S. (2005)

Definitions of MindfulnessMindfulness is paying attention on purpose non-judgmentally in the present moment. Kabat-Zinn, J. (1994)Mindfulness meditation is a consciousness discipline revolving around a particular way of paying attention in ones life. It can be most simply described as the intentional cultivation of nonjudgmental moment-to-moment awareness. Kabat-Zinn, J. (1996) Definitions of MindfulnessMindfulness is self-regulation of attention so that it is maintained on immediate experience thereby allowing for increased recognition of mental events in the present moment and adopting particular orientation toward ones experience that is characterized by curiosity, openness, and acceptance Bishop et al. (2004)Components of MindfulnessIntentionalityPresent Centered AwarenessAcceptance/Non-JudgmentMindfulness Practice is Not Trying to have a blank mindTrying to achieve a special state of mind or trance state Avoiding difficultiesEscaping physical painPushing away thoughts or emotions Bypassing our personality problemsWithdrawing from other peopleA relaxation techniqueA religion

You are probably a dog story11Attitudinal Foundations of Mindfulness Practice1. Non-Judging2. Patience3. Beginners Mind4. Trust5. Non-Striving6. Acceptance7. Letting Go - Kabat-Zinn, J. (2005)

Modes of PracticeInformalFormalIntensive RetreatGuided Informal Practice/DiscussionEating one raison guided practice14Informal Practice ExamplesFor Daily LifeWashing your hairBrushing your teethShavingTaking a showerEatingWalking from your house to the carDriving Petting the dog Washing the dishes (any chore)Practice Opportunities For Mindfulness During The DayWaiting for 3 rings of the phone before answeringPausing before speakingNotice getting up from your desk at workTurning the computer on or off or switching applications take a mindful pauseNotice the action of walking through doorwaysNotice the action of picking something up Pause after looking at the clock or your watchQuick and Instant Practice(Helpful for Anxiety)Choose a reference point as a meditation bellStop and take three slow deep breathsBring the mind to the present moment on the in breathScan the body and relax as much as you can any tension held in the body on the out breathNotice any thoughts/emotionsProceed with what you had been doing Quick and Instant Practice(with visualization)Choose a reference point as a meditation bellStop and take three slow deep breathsWith each exhalation repeat the phrase I feel calm, relaxed and at peace or choose another phase that you resonate with. (Your visualization is a function of your intention for yourself.) Proceed with what you had been doing

Usually give this instructions when teaching in the office on the first session18MBCTThe 3-Minute Breathing Space Basic Instructions1. AwarenessBring yourself into the present moment by deliberately adopting an erect and dignified posture. If possible, close your eyes. Then ask: What is my experience right nowin thoughts,in feelingsand in bodily sensations?

2. GatheringThen, gently redirect full attention to breathing, to each in-breath and to each out-breath as they follow, one after the other.Your breath can function as an anchor to bring you into the present and help you tune into a state of awareness and stillness.

Use in MBCT built into the practice protocol for use several times a day19MBCTThe 3-Minute Breathing Space Basic Instructions Continued3. ExpandingExpand the field of your awareness around your breathing, so that it includes a sense of the body as a whole, your posture, and facial expression.

The breathing space provides a way to step out of automatic pilot mode and reconnect with the present moment.The key skill in using Mindfulness-based Cognitive Therapy (MBCT) is to maintain awareness in the moment. Nothing else.

Segal, Z., Williams, J., Teasdale, J (2002)

On The Spot Informal Practices1)Whenever you encounter distress this week, turn your attention toward it.2) If your reaction is overwhelming to a particular part of the practice, take a break and switch to lovingkindness or mindfulness practice3) Choose one day this week to do a kindness for someone and pay attention to all of the kindnesses that come your way on that day. 4) Practice inner smile on a daily basis. 5) Choose one day to do walking Metta meditation.Guided Formal Practice/DiscussionBreath to body scan- importance of focusing on the body- many people are detached from the body- the body is always in the present moment bringing attention to the body assists bringing the mind into the present moment22Examples of Formal PracticeSitting meditationStanding meditationBody ScanWalking MeditationLoving-Kindness/Compassion PracticesContemplative PrayerYogaTaijiQigongMindfulness Myths1) I dont have the time!2) Im too restless!3) I am afraid of my mind!4) I wont get anything done!5) It will take time away from my kids! 6) I cant meditate!7) Im too tired!1)Consistency not the amount of time is what is important-do you have 5 mins today?-Tara Brach 2)Try mindful movement3) focus outwardly to begin with i.e. walking, nature, sounds, eating 4) Actually the experience of most people is that they have more time- they are able to set priorities, feel less stressed out less tired and more efficient 5) Kids enjoy meditation too and actually remind their parents or join them Jon's Yoga experience w/kids-pets 6) Expectations of achieving a certain result24The Five Hindrances to Meditation (From the Pali Cannon)AttachmentAversionSloth/Torpor Restlessness/WorryDoubtWorking with AttachmentWanting MindDesire, lust, obsession with sensory objects or spiritual desiresShift the attention of the mind from the object itself to the experience of the wanting mind. Equanimity practice is useful to bring in.

Working with AversionHatred, frustration, impatience, guilt, depression, pain, resistance Avoid going into the practice with the attitude If Im mindful, it will go awayDont bore into the aversion or it will feel like a pressure cooker. Open attention wide and alternate between the aversive experience and sound and back (Titrating the experience with the spaciousness of sound.) Notice the quality of mind whatever it is

Working With Sloth/TorporSleepiness, boredomRecognize what is happeningRefrain from acting it outRealize it is impermanentGet interested in the changing nature of itYou may need more sleep!Keep your eyes openSwitch to standing or moving meditationWorking with RestlessnessWandering MindRestlessness, agitation, often suppression of another affect that wants to be knownPutting the bull in a big pastureOpening the field of awareness to seeing (with a soft gaze) or hearing without notingAttempt to stay as still as possible vow sitting

Working with DoubtDelusion, indecision, confusion, over intellectualizingDont go into the storyline and stay out of the content of the doubtSee what else is there

Intensive Retreat PracticeAll day in MBSR and MBCTretreat centersteacher ledweekend to 3 months (Rains retreat)Forest Monastery at IMS long term meeting with teacher maybe 2x/wk.self directed similar at Christian Monasteries such as Gethsemane in KY 31Breath AwarenessSet Up Instructions for Breathing Meditation1) Settle into a comfortable posture in which you are relaxed but alert.2)Take a few long slow breaths connecting with the body and releasing any obvious tension.3) Allow the breath to return to normal.5) Feel your body as a whole with wide attention.4) Continue to scan through the body releasing any obvious tension as best you can.

Breath Practice Instructions

1) Become aware that you are breathing.2) What are the sensations?3) Let your attention center on the part of the body where you experience the breath most vividly.4) Let your attention focus on those sensations as you experience breathing in and breathing out.5) Note where your mind goes when it wanders.6) How has thinking impacted your experience? Has any tension returned?7) Let the mind open again to the breath. Breath Practice AdvantagesBreathing is a neutral object of attention for most people so less likely to trigger reactivityThe experience of breathing is present moment (as are all body centered foci)Breathing changes which allows for easier tracking Breathing is rhythmic and cyclic appearing and disappearingWorking With The BodyWorking With Pain Or Discomfort1) Bring your attention to the sensations themselves. If the body is in an awkward position that is doing harm, move to a more comfortable position, mindfully noting your intention to move and paying attention to the movement itself.2) If the pain is tolerable bring your attention to the sensations themselves and note the sensations. Be aware of any feeling tone as you note. These tones may underlie emotions your are also experiencing Note any emotions i.e.. anxiety, anxiety or anger, anger and return to noting the body sensations. As much as possible try to stay out of the story about the pain. Focus on the present moment instead of projecting into the future or slipping back to the past.

Working With Pain Continued3) If the pain sensations are overwhelming, you can shift focus to your breath, sound or focus on a different part of the body such as your hands or the bottoms of your feet.Working With Difficult Emotions

Body Awareness1) Take three deep breaths and focus your attention on your body and a sense of presence releasing any obvious tension as best you can.2) Allow your posture to move into sitting or standing with dignity relaxed, comfortable and alert.3) Allow a slight inner smile to come to your lips.4) Allow the chest to open by rolling the shoulders back and letting them fall away from the ears.5) Relax the jaw, the knees and the hands.

R.A.I.N. PracticeRecognize: Notice what you are experiencing. Stay with the experience rather than thoughts about the experience (the story line), simply note what you are experiencing.

Accept/Allow: Allow the experience (emotion, thought, body sensation) to be as it is in the moment without trying to change it. Look for the impulse to avoid or cling to the experience.

Investigate: Explore the experience with an attitude of openness, curiosity and self-compassion. Watch for the impulse to judge.

Non-identification: Continue to investigate and note the stream of sights, sounds, body sensations, thoughts, emotions and other contents of the mind that come and go. Notice the difference within between claiming the experience as I, me, of mine and just noting the stream or flow of experience. Michelle McDonaldUsing The Breathing Space- Extended InstructionsWhen you are troubled in thoughts or feelings:1. AwarenessObserve- bring the focus of awareness to you inner experience and notice what is happening in your thoughts, feelings, and bodily sensations.Describe, Acknowledge, Identify- put experiences into words, for example, say in your mind, A feeling of anger is arising or Self-critical thoughts are here.

2. Redirecting AttentionGently Redirect your full attention to the breath. Follow the breath all the way in and all the way out. Try noting at the back of your mind, Breathing inbreathing out or counting, "inhaling , oneexhaling, twoetc..

Using The Breathing Space- Extended Instructions Continued3.Expanding AttentionAllow your attention to expand to the whole body-especially to any sense of discomfort, tension, or resistance. If these sensations are there, then take your awareness there by breathing into them on the in breath, then breathe out from those sensations, softening and opening with the out- breath. Say to yourself on the out-breath, Its OK. Whatever it is , its OK. Let me feel it.

Become aware of and adjust your posture and facial expression.As best you can, bring this expanded awareness to the next moments of your day. Segal, Z., Williams, J. , Teasdale, J. (2002) Working With Difficult Thoughts

Working with ThoughtsThe brain is an organ that naturally produces thoughts.In meditation, there isnt a need to look for thoughts.Some thoughts are merely a drifting away from our focus. With these, we can note them and return to our intentional focus of awarenessWorking with Thoughts ContinuedSome thoughts are compelling. With these we can note them and see if there is an emotional tone to the noting.If so we can utilize the instructions for working with difficult emotions or with the body.It is not necessary to investigate the contents of the thoughts.Notice how thoughts appear, persist, change and disappear.How does observing thoughts change them?Novice monk story from the mindful way through depression46Mindful MovementWalking MeditationQi Gong and Taiji Yoga

Bringing In The Good

Cultivating The Four Wholesome States Of MindLovingkindness (metta)Compassion (karuna)Sympathetic Joy (mudita)Equanimity (upekkha)Lovingkindness (Metta) MeditationMetta Defined: lovingkindness, unconditional friendliness, boundless friendliness of the open heart toward othersMasked/Near Enemy: possessive love, sentimentality, attachmentDirect/Far Enemy: hatred, fear, closing down of the mind, constriction of the body mind and heartProgression: oneself, benefactor, dear friend, neutral person, difficult person, all beingsThe budstands for all things, even for those things that dont flower,for everything flowers, from within, of self-blessing,though sometimes it is necessaryto reteach a thing its loveliness,to put a hand on the brow of the flower, and retell it in words and in touch, it is lovely until it flowers again from within, of self-blessing -Galway Kinnell

Lovingkindness Traditional PhrasesMay I be safeMay I be wellMay I be happyMay I have ease of well-beingLovingkindness VariationsMay I be protected in all ways.May my heart be filled with loving kindness. May my body be healthy and strong. May I live with ease and harmony.

May I be safe from internal and external harm.May I be as healthy and strong as it is possible for me to be.May I have the peace and understanding that come from true wisdom.May I live my life with ease. May I love myself unconditionallyCompassion (Karuna)Karuna defined: compassion, a resonating concern, the quivering of the heart in response to sufferingMasked/Near Enemy: pity, righteous anger, overwhelming grief, fear, aversionDirect/Far Enemy: cruelty, gossipProgression: a person with great suffering, self, benefactor, friend, neutral person, difficult person, all beings

Every conflict begins with thoughts of fear, animosity and aggression, which pass through some peoples minds and spread like wildfire. The only antidote to these aberrations is to take on fully the suffering of others. -Matthieu RicardSelf-CompassionA moment of self-compassion can change your entire day. A string of such moments can change the course of your life. Christopher Germer

Self-Compassion PhrasesThis is a moment of suffering Suffering is a part of lifeMay I be kind to myself in this moment May I give myself the compassion I need

Neff, K. & Germer,C. (2009)Compassion PracticeI see your suffering.I care about your suffering.May your suffering end.May the causes of your suffering end.May your suffering end or if it cannot end may you meet the suffering with gentleness, tenderness, and care. May you be free of your pain and sorrow May you find peace.Sympathetic Joy (Mudita)Mudita defined: appreciative joy, sympathetic joy, joy for the joy of others.Masked/Near Enemy: exuberance, attachment to happinessDirect/Far Enemy: envy, jealousyProgression: a person who is currently experiencing great happiness, friend, benefactor, neutral person, difficult person, all beingsWith Mudita the odds of experiencing increased happiness go up 6 billion to one. Those are very good odds! -Dalai Lama XIV

Sympathetic Joy PhrasesMay your happiness and joy continue to grow.May your happiness and good fortune continue.May they increase and never wane.May your happiness and joy never leave you.I am happy that you are happy.Sympathetic JoyObstacles to Joy/Tormenting States of MindJudgmentComparing MindPrejudice/DiscriminationDemeaning MindEnvy/JealousyAvarice/SelfishnessBoredomAllies to JoyGratitude count your blessingsLovingkindnessCompassionRapture-our capacity to take active delightEquanimity (Upekkha)Upekkha defined: equanimity, evenness of mind/heart toward all beings, resting the mind before falling into extremes, a heartfelt connection with spacious balance immeasurable impartialityMasked/Near Enemy: indifference, apathy, callousness, uncaring distanceDirect/Far Enemy: reactivity, attachment, aversionProgression: neutral person, dear friend, benefactor, difficult person, selfThe Eight Vicissitudes: praise & blame, gain & loss, fame & disrepute, pleasure & pain Equanimity PracticeMay we all accept things as they are.May we be undisturbed by the comings and goings of events.I will care for you but cannot keep you from suffering. I wish you happiness but cannot make your choices for you.I offer you my good will no matter what. May I be open, balanced and at peace. May my heart open to your journey.My my heart be at ease with the outer/inner changing conditions of life. May my heart/mind open to this experience with balance and ease. May I accept/open to how it is right now. This is how it is right now.Whether I understand it or not, things are unfolding according to a lawful nature. With an eye made quiet by the power of harmony, and the deep power of joy, we see into the life of things. -William Wordsworth

Gratitude

Your Top Ten List1)2)3)4)5)6)7)8)9)10)Yoga

When you slip inside, something happens. Something deep inside is awakened. You discover you are more than you previously thought yourself to be. And the way you live your life begins to change. If you do not want this awakening go to the movies. If you want this awakening, practice yoga. You get to make that choice every day for the rest of your life. -Swami Nirmalananda SaraswatiMindful YogaMindful yoga is another form of mindful movement or mindful meditation. Yoga means to yoke or to unite. Yoga offers the opportunity to notice how the body and mind relate to each other. Because the body is always in the present moment, uniting the mind with the body helps bring the mind into the present moment.Yoga and Lovingkindness/Guided Practice and DiscussionMindfulness in the Consulting Room One Size Does Not Fit AllCultural/Religious ConcernsEgo Strength/Severity of DiagnosisContraindicationsBibliotherapyOutside referral to a MBSR, MBCT, DBT groupAdapting the protocol to the client rather than the client to the protocolYour own level of training and practiceThe Mindfully Oriented TherapistFinding Your Comfort Level on the ContinuumTrainingMBSRMBCTDBTACTOther AvenuesTraining Resources

Ethical IssuesSensitivity to religious and cultural issuesInformed consentEvidenced basedAppropriate training and consultationLovingkindness and theDedication of MeritMay you be safeMay you be wellMay you be happyMay you be free from suffering