Live Mindfully: mindfulness

Showing posts with label mindfulness. Show all posts

Millennium Park Zen Group

The Millennium Park Zen Meditation Group is a month old now. We meet every Wednesday afternoon, from 2:15 to 3:30 pm. Each meeting, we practice the Zen tradition of sitting meditation (zazen) and walking meditation (kinhin), and we also have a discussion. I've been trying to post something weekly about the most recent discussion, and you can see these posts in our blog section, if you like. If you are interested in joining us for meditation and discussion of Zen meditation and mindfulness, just contact me at thomson@integrativehealthpartners.org.

Mindful Eating and Weight Loss

This winter, our course in mindful eating will begin soon after New Year’s Day, on January 11. For many people struggling with food and weight related issues, the New Year is not particularly happy. The holiday season often leads to overeating and weight gain as people are presented with even more calorie dense foods and alcohol than usual. Add holiday stress to the equation, such as internal pressure to secure the “perfect” gift, or to create a memorable holiday despite financial or time constraints. The often painful discrepancy between how we think our families and our celebrations ought to be and the way they actually are can be difficult to tolerate. This stress and negative affect can result in impulsive overeating and overdrinking, because in the moment the rest of that cake and the eggnog promise some comfort and relief.

Overconsumption, increased stress, and resulting weight gain often propel individuals to a wish for change, such as making a New Year’s resolution to get control of eating and to lose weight. Unfortunately, many people make the same New Year’s resolutions year after year because goals such as “lose 75 pounds” or “get up at 5 a.m. daily to run” are typically not achievable or sustainable. A large amount of psychological research also underscores the importance of selecting goals that are realistic and moderate rather than extreme. An “all or nothing” radical change program frequently results in “nothing” because it’s not possible to maintain a 500 calorie a day “cleanse” without binge eating in response to an overly depriving diet.

Sadly, even if we are being more moderate about weight goals, more research is finding that, as millions of people have experienced for themselves, it is very difficult to lose weight and to maintain the loss (see this article in the New York Times). We have known for some time that only a minority of individuals manage to sustain significant weight loss, but now we understand more about how and why this is so difficult. Humans evolved in a “feast or famine” environment, and our bodies developed numerous mechanisms designed to ensure our survival. We seem to be hard wired to prefer sweets, fat, and lots of variety, all of which were adaptive in our ancestral environment. Diets tend to be viewed by the body as alarming indicators of potential starvation that must be abated by a metabolic drop, and actual weight loss seems to result in ongoing secretion of chemicals designed to increase food intake and restore the lost weight.

Does this mean it’s hopeless to try to lose weight? Not at all; I know many people who have done it and maintained their loss. Individuals who binge eat and respond to negative emotions by overeating can frequently change these patterns and gradually lose weight. Also, stress is a significant contributor to weight gain; stress results in the secretion of cortisol, which promote abdominal weight gain. Research is demonstrating that mindfulness based interventions can be very helpful with such issues. Dalen et al. (2010) conducted a six week mindfulness class that showed numerous beneficial outcomes on eating variables as well as emotional factors. Participants reported weight loss, reductions in binge eating, increases in feelings of control around food, and improvements in their levels of stress and depression. Daubenmier et al. (2011) conducted a four month mindfulness based program for stress eating. Obese treatment participants showed large decreases in cortisol secretion. Although they did not lose weight over the course of the study, they maintained their weight, whereas control group participants gained weight and showed no changes in cortisol. Finally, a one day mindfulness and acceptance workshop (Lillis et al., 2011) was found to decrease self reported binge eating in a three month follow up.

Mindfulness based interventions enable individuals to become more accepting of internal experiences rather than avoidant. Being able calmly and compassionately to sit with a painful feeling and to recognize it as a transient mental event lessens the urge to self-medicate with food. Becoming more aware of what hunger and satiety feel like promotes more attuned responses to these signals from the self. Such attunement fosters the development of an sensible eating program that may result in weight loss. Feel free to read more about Integrative Health Partners’ six week Mindful Eating Class, designed for people who want to find a way to actually live their New Year’s resolutions.

Mindful Eating Class Begins Jan 11

Integrative Health Partners' next class in Mindful Eating, taught by Mary Connors, Ph.D., will begin on January 11, 2012. We know that the new year is a time in which we reflect on our goals and our health, and we want to provide this support for people who want to move in a positive direction around issues of eating, weight and nutrition.

Our mindful eating class is a six-week program. In it, Dr. Connors will help you clarify your needs and goals and provide really useful information on eating, dieting, nutrition and psychology. She will teach a variety of mindfulness techniques to help you find emotional balance and respond more effectively to the stresses that can trigger emotional overeating. This class can help you learn to be more aware of your real needs regarding food, and more capable of being truly self-nurturing. Mindfulness provides a way to actually be present with your eating, and so helps you experience greater enjoyment and reduces the ‘automatic’ nature of overeating problems.

The class is a great chance to learn to develop a mindfulness practice and to apply it to a really important area of daily life. Be sure to call Mary if you are interested or have any questions: her phone is 312-372-5501. You can also read more about our program on the Integrative Health Partners website. You can also send an email through our Contact page.

Mindful Breathing and EMDR

An ongoing discussion in the Mindfulness and Psychotherapy Study Group has investigated the similarities of mindfulness-based psychotherapy and EMDR. We've noted that the EMDR protocol asks the client to become deeply aware of present moment experiences, including thoughts, feelings, and bodily sensations, and to track those experiences as they change over time. Clearly, in this moment-by-moment awareness, a substantial degree of mindfulness is being elicited in EMDR treatment. Even the act of tracking a moving finger with the eyes requires a sustained contact with present moment visual sensation, and can be considered a mindfulness practice.

Now, there is some interesting research exploring the therapeutic mechanisms in both EMDR and mindfulness practice. Marcel van den Hout and colleagues (2011) have just published a paper whose title says it all: "EMDR and mindfulness: Eye movements and attentional breathing tax working memory and reduce vividness and emotionality of aversive ideation."

This study demonstrated that putting one's attention on either breathing or eye movement essentially takes up some of the available mental bandwidth. The authors at Utrecht University suggest that this is a possible explanation for the increased emotional stability found in mindfulness and EMDR practices. While attending to breathing or eye movements, they argue, we just don't have the mental capacity to pay as much attention to emotions or distressing imagery. They found that breathing and eye movements taxed working memory to the same degree, and had similar (but not identical) effects on a person's experience of emotional distress.

This makes a lot of sense, and this finding dovetails with another discussion we have been having, about the way the brain processes different kinds of information. We know from the work of Farb and colleagues (2007) that different areas of the brain are involved in processing sensory experience and abstract thought or imagery. Thus, adding eye movements or mindful breathing to an emotional experience would shift the location of brain activity away from the "narrative" areas responsible for "aversive ideation," and instead engage areas dedicated to a more sensory level of processing. With a greater "experiential focus," we are less able to generate an emotionally reactive state because we are more grounded in the realistic, sensory, and non-ideational level of experience. It may be that the stabilizing effects of mindful breathing or eye movements come not simply by "overloading" the brain's information processing capacities, but by actually processing experience in a different way.

Buddhist psychology (or what modern psychology is beginning to refer to as the "Buddhist Psychological Model") suggests that mindfulness keeps us in contact with things as they really are by interrupting the processes of mental proliferation that create misunderstanding and reactivity. In mindfulness, we are grounded in what is "really real," as it were, and less carried away in our imagination, prejudice, and reactivity. Current scientific research into the psychology of mindfulness is beginning to suggest ways in which this process is supported at a neurobiological level. In future discussions in the study group, we will be exploring ways to bring this scientific knowledge into the consulting room, and find more effective ways of modelling and evoking mindfulness in the therapeutic relationship.

Unlimiting the Mind

Andrew Olendzki's book, Unlimiting Mind (2010) is the first text we will read in this year's study group in mindfulness and psychotherapy. Olendzki is one of the foremost American teachers of Vipassana, a Buddhist school which emphasizes mindfulness. His writing is wonderfully clear and he makes some of the ancient Buddhist texts and ideas very accessible.

For the next meeting of the study group (October 8), I'm recommending that we focus on the sections that are most directly related to Buddhist psychology and the underpinnings of mindfulness: section 4, "The Practice;" section 5, "Understanding the Teachings;" and section 8, "The Emergence of Mindfulness".

Olendzki has chosen a great title for this work, because it addresses the central question of Buddhists and psychologists alike. How do we get free of the limitations which stand between us and a fulfilling, worthwhile life? Olendzki turns to ancient Buddhist sources (the scriptures recorded in the Pali language about 300 years after Buddha's death) for his answer, and so gives us a window into the wisdom and traditions that have preserved mindfulness to this day. He writes insightfully about the conditioning which leads all of us to go through our lives on automatic pilot, concerned primarily with how to accumulate the things we like and get rid of the things we dislike. We are hardly aware of the psychological processes that restrict our happiness, and Olendzi's great contribution is to make those mental functions accessible to our western consciousness.

One very interesting approach to Unlimiting Mind is to read it while reflecting on our modern applications of mindfulness. It is especially illuminating to consider the connection between values and mindfulness in Acceptance and Commitment Therapy (ACT) while reading Olendzki's account of "Changing your mind" in section 4. Also, in section 5, Olendzki discusses one of my favorite concepts from Buddhist psychology: Papanca. Referring to our tendency to "mentally proliferate" on our experience, and to become absorbed in our reactions to the point of being completely out of touch with our basic experience, papanca is the Buddhist forerunner of ACT's core concept of cognitive fusion.

I'm hoping that reading Unlimiting Mind will develop a familiarity with Buddhist psychology that will help us see the roots of the ACT processes that were rediscovered though Relational Frame Theory. I'm looking forward to a stimulating and wide-ranging discussion on October 8th.

Mindfulness and Stress Reduction Class Begins February 23

We can all relate to the idea of being "stressed out." Whether caused by relationships, work, or illness, stress takes a very real toll on our minds and bodies. So when we cannot eliminate external sources of stress, we must find a different, healthier way to relate to them. And the practice of mindfulness is such a way.

The practice of mindfulness is the practice of being present---truly, intentionally, and nonjudgmentally present---with experiences as they unfold. Through the practice of mindfulness, we make a decision to engage with life, developing a greater appreciation for and enjoyment of everyday experiences that might otherwise be minimized or missed. Mindfulness practice also offers us tools to cope with difficult or challenging experiences. We use mindfulness practice to center ourselves and create serenity and stability in the midst of emotional turmoil. Mindfulness develops our cognitive and emotional adaptability & flexibilty, allowing us to respond more skillfully to the challenges we face, rather than reacting reflexively in ways that are both unproductive and compound our stress.

In our Mindfulness & Stress Reduction course, students will learn the fundamentals of formal mindfulness practice, including mindful breathing, body scan, sitting meditation, and walking meditation. The class also encourages informal practice by helping students bring nonjudgmental attention to everyday experiences. The class will focus on using mindfulness to develop a healthier relationship with experiences that cause chronic or acute stress. Each class is composed of a brief educational lecture, group mindfulness practice, and an opportunity to process experiences in the class and discuss ways in which students have applied mindfulness in their everyday lives.

Integrative Health Partners’ Mindfulness and Stress Reduction begins on Tuesday, February 23 and runs for 8 consecutive Tuesday evenings, from 7-8:30pm. The class is held in downtown Chicago, at 180 North Michigan Avenue.

Please contact Becca Meyer at (312) 372-2880 or meyer@integrativehealthpartners.org if you are interested in registering for the course or if you have any questions. There's also more information on our website.

-Becca Meyer, Psy.D.

Is Mindful Eating Right for You?

Starting March 3, 2010, we will be offering another course in Mindful Eating (for those of you in the Chicago area). We developed these classes to help people who feel caught in compulsive eating or dieting patterns, and who want to find their way to a more natural and satisfying relationship with food. You might be asking yourself, Are mindful eating classes the right approach for me? To find out, try considering these statements:

I sometimes binge or eat compulsively
I’ve tried restrictive diets and they don’t work for me
I know I sometimes eat because of stress or emotional needs
I’d like to feel less guilty about my eating and my weight
It would be easier to deal with my eating if I could manage my stress better
I want to learn to eat in a way that nourishes and respects my body
I really value health and wellness, and would be willing to spend a half hour a day to develop this area of my life
I’ve been interested in meditation, yoga, or tai chi
I have a spiritual side
I’d like to develop more patience, acceptance, and forgiveness
I’ve been able to apply myself to activities that require home practice, like music lessons, workouts, or schoolwork
I would like to give and receive help with others in my situation
I’m open to taking a new approach to eating

The more you agreed with these statements, the more likely you are to find mindful eating classes helpful. For more information, call Dr. Mary Connors at 312-372-5501, or visit our website.

Mindfulness as Stability and Investigation

Image by speakingoffaith via Flickr

Mindfulness has sometimes been said to be a function of RAIN: Recognition, Acceptance, Investigation, and Nonidentification (Kornfield, 2008). Each of these four processes make its own contribution to the quality of mindful awareness, and I'd like to explore them today with an emphasis on "investigation."

Sometimes it's not clear that mindfulness is more than relaxation. It's true, mindfulness can often be relaxing, because we get less caught up in the thought patterns that agitate us. This stabilization of attention is referred to in the traditional meditation texts as samatha, and it is a feature of all mindfulness processes. If we think of mindfulness as constructed of RAIN, we can see that Acceptance and Nonidentification are largely samatha processes. Acceptance eliminates the nearly constant tension that we generate by judging and attempting to control our experiences. "I don't like this, this is bad, I want to change this, what can I do to eliminate this experience, what if that doesn't work..." is a familiar train of thought that can be pretty agitating. With Acceptance, we no longer get involved in that source of stress. Acceptance is a process that encourages samatha, or stabilization.

Similarly, Nonidentification also brings stability. If we refrain from identifying with an experience, we don't get so worked up about it. It's not so personal, and therefore not so important that we change it or control it. In Nonidentification, we learn to take our experience as it is, and our reaction to it is gentler and more flexible because we are not so driven by our narcissistic strivings. So Acceptance and Nonidentification both function to increase our stability, and they help mindfulness practices feel relaxing to us.

But mindfulness goes beyond relaxation and arrives at vipassana, or insight. Once we have established some stability and nonreactivity, mindfulness can help us to see our experience for what it is (Recognition) and to explore our lives more deeply (Investigation). Mindfulness can be thought of as asking the gentle question "What is it?" in a way that is continually supported by our breathing and our willingness to be present.

A Zen Buddhist story tells us that a monk was going on a pilgrimage, and another asked him, "Where are you going on your pilgrimage?" The monk replied, "I don’t know." The other monk commented, "Not knowing is most intimate."

Actually, intimacy depends on our ability to have an ongoing conversation with what is present. In intimacy, there is acceptance, of course, but also openness to what’s next, to what we don’t know. When we think we know something, we stop investigating it. There is a saying, “In the beginner’s mind, there are many possibilities; in the expert mind, there are few.”

What kind of investigation is mindfulness? Here’s a part of what TS Eliot said about it:

We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
Through the unknown, remembered gate
When the last of earth left to discover
Is that which was the beginning;
At the source of the longest river,
The voice of the hidden waterfall
And the children in the apple-tree
Not known, because not looked for
But heard, half heard, in the stillness
Between the two waves of the sea.
Quick now, here, now. Always
A condition of complete simplicity
Costing not less than everything

We are talking about a kind of investigation into what’s been there all along, but we have been unable to appreciate. An investigation into the source of the longest river of the endless present moment. We hear the waterfall of thought as it is, and recognizing it for what it is allows us to see through it, to hear the children in the apple tree.

Mindfulness tries to approach all moments and events with Beginner’s Mind - we are calm enough that we can be open to not knowing what it is, or what happens next, or how things are supposed to be. We approach each experience as if it were the only time we encountered this thing. Because it is! We might even say that the essential feature of mindfulness is the understanding that we are missing something: mindfulness starts with the premise that there is always more to discover. Because mindfulness is a process of ongoing exploration, it brings a richness to our lives that would otherwise be lost in our shopworn ideas and mental habits.

Mindfulness in Australia

Image via Wikipedia

Here are some interesting mindfulness handouts from Australia's Centre for Clinical Interventions:

A brief but surprisingly comprehensive introduction to mindfulness practice.
Some information on Letting Go and a Worksheet to practice with.
Information on Accepting Uncertainty and a Worksheet to practice with.

And by the way, for a treasure trove of therapy worksheets, check out the blog by that name: Therapy Worksheets.

The Conditions of Mindfulness

Cover via Amazon

In the recent “Living Mindfully” conference at Fourth Presbyterian Church, we were discussing the characteristics of mindfulness. Jon Kabat Zinn (1994) has famously said that “Mindfulness is a way of paying attention: on purpose, in the present, and non-judgmentally.” In his recent book, The Wise Heart, Jack Kornfield (2008) discusses mindfulness as a function of Recognition, Acceptance, Investigation, and Non-identification (RAIN).

My own summary of the nature of mindfulness is that it depends on our WILLINGness to be completely present.

Welcoming. This refers to our openness to experience, and is the opposite of experiential avoidance (EA - see this previous post). Our typical response to difficult experiences is EA: we try to avoid or reject the experience. This actually increases our distress, since experiences cannot really be “erased” once they have occurred. It turns out that EA adds insult to injury: we have our original distress and we have the damage done by our misguided attempts to refuse it. Being welcoming is not simply passive acceptance, but a deliberate choosing of this very experience, regardless of whether it is pleasant or unpleasant.
Intentional. Our ability to be mindful depends on forming and sustaining the intention to be mindful. We make a commitment to cultivate mindful awareness, and encourage ourselves in this direction throughout the day. Without our intent, (what Jon Kabat Zinn talked about as being mindful “on purpose”) we would not be able to take advantage of the opportunities we have for mindfulness.
Letting go. To be mindful, we have to develop the ability to extricate ourselves from the proliferation of thought (papanca) that results in mental grasping or clinging (upadana). Letting go of a train of thought, once we have become involved in it, is the psychological process that lets us turn dreaming into wakefulness. Letting go is required for that ability to take a fresh relationship to what is happening that we call “beginner’s mind.”
Loving. Being loving means accepting what is, as it is. We could call this, taking good care of the experience. “Loving exactly what is” is non-striving in nature, and it is the essential condition of intimacy.
Inclusive. We bring our whole self to our encounter with the world, and we are aware that there are always vast dimensions of both self and the world that we cannot experience at any given time. Mindfulness is willing to include the aspects of the world that we normally exclude with our habits and prejudices.
Non-reactive. Gradually, in the practice of mindfulness, we come to realize that an experience is not necessarily a call to action. We are descriptive rather than evaluative. Learning to be non-reactive is necessary condition for being welcoming. It opens the way for us to be responsive to our problems rather than simply reacting in an automatic way.
Grounded. To be grounded in the present moment is to know our experience for what it is. A synonym for “grounded” might be “realistic.” Thoughts are not fused with reality, and we do not mistake our thoughts, concepts, or linguistic conventions for the actual world. When we are grounded in our experience (present moment awareness) and realistic about what it is (thoughts are just thoughts, not facts) we are in the best position to respond with skillfulness.

This is a brief outline of the factors of mindfulness. I’d appreciate your thoughts, questions, and feedback.

Poetry from the Conference

Image by ViaMoi via Flickr

During the Midwinter Conference, "Living Mindfully," at Fourth Church this past weekend, we read a number of poems that we hoped would encourage people in their practice of mindfulness. All of them can be found on our website page, "Readings and Poetry" (which you can visit through this link). Just to whet your appetite, here are the two from Mary Oliver:

Mornings at Blackwater

For years, every morning, I drank
from Blackwater Pond.
It was flavored with oak leaves and also, no doubt,
the feet of ducks.

And always it assuaged me
from the dry bowl of the very far past.

What I want to say is
that the past is the past,
and the present is what your life is,
and you are capable
of choosing what will be, darling citizen.

So come to the pond,
or the river of your imagination,
or the harbor of your longing,

and put your lips to the world.

And live
your life.

When Death Comes

When death comes
like the hungry bear in autumn,
when death comes and takes all the bright coins from his purse

to buy me, and snaps the purse shut;
when death comes
like the measle-pox;

when death comes
like an iceberg between the shoulder blades,

I want to step through the door full of curiosity, wondering:
what is it going to be like, that cottage of darkness?

And therefore I look upon everything
as a brotherhood and a sisterhood,
and I look upon time as no more than an idea,
and I consider eternity as another possibility,

and I think of each life as a flower, as common
as a field daisy, and as singular,

and each name a comfortable music in the mouth,
tending, as all music does, toward silence,

and each body a lion of courage, and something
precious to the earth.

When it’s over, I want to say: all my life
I was a bride married to amazement.
I was the bridegroom, taking the world into my arms.

When it’s over, I don’t want to wonder
if I have made of my life something particular, and real.
I don’t want to find myself sighing and frightened,
or full of argument.

I don’t want to end up simply having visited this world.

Midwinter Conference on Living Mindfully

The Counseling Center of the Fourth Presbyterian Church in downtown Chicago is sponsoring a workshop on mindful living. Here's the announcement from their January newsletter:

Living Mindfully
A Midwinter Conference

The ancient practice of mindfulness is being rediscovered and reclaimed as a modern method of finding well-being, improving relationships, and living our lives completely. To provide an opportunity to explore the benefits of mindfulness and learn ways to practice mindful living, on Saturday, February 28, the Lorene Replogle Counseling Center will host a one-day conference on “Living Mindfully.”
Dr. Roger Thomson, Director of Training at the Lorene Replogle Counseling Center, a clinical psychologist, and a Zen Buddhist priest, will be the keynote speaker. Details about this conference, which will run from 9:00 a.m. to 2:30 p.m., are available in the literature racks and by contacting the Counseling Center at 312.787.8425.

Mindful Brain, Whole Person

Image via WikipediaFollowing up on yesterday's discussion in the Mindfulness and Psychotherapy Study Group, I'm posting two papers on brain activity and mindfulness. Stein (2008) and Creswell (2008) both report that the habit of mindfulness leads to greater prefrontal cortical activity, and less amygdala activation, during the processing of emotions. This is just the finding that we (and especially TS) predicted. Congratulations, Tom!

Thus, when asked to identify the emotion expressed in the photo of a person's face, people high in mindfulness approached the task with less emotional reactivity than people who were low in mindfulness. When we think of the typical mindfulness procedure of being aware of and noting mental states without getting caught up in them, this finding makes a lot of sense.

It also underscores another point from our discussion. Mindfulness is not simply sensory awareness, but a complete and integrated awareness in which our verbal, emotional, and sensory brains all participate. Mindfulness relies on what Marsha Linehan called our "wise mind" (aka prefrontal cortex) along with all of our other faculties. Maybe we could say that mindfulness does not involve stopping thinking (as people sometimes believe) but rather integrating our thinking without getting caught up in it. These studies clearly point to a rebalancing of complex brain functions that occurs as the result of mindfulness. Mindfulness is not (as my Zen teacher would say) "lobotomy zen." It's more like bringing our whole selves to bear as we experience our lives. It's a way of being all one piece.

Mindfulness and Experiential Avoidance

Image via CrunchBaseIn general, we might say that mindfulness is a process of "turning toward rather than away." In our last study group, our mindfulness experience demonstrated how complex that process actually is. Sustaining mindfulness over a period of time inevitably involves "decisions" (on a fully conscious or a less-than-conscious basis) about how attention is allocated. It was obvious to us that those decisions were sometimes made for what we might call "defensive" reasons. Or, to put it less pejoratively, affect regulation needs contributed to our decisions about how to guide our attention. Sometimes, this is clearly in the service of sustaining mindfulness (if we get too caught up in an emotion, we will probably lose our mindfulness). At the other end of the spectrum, some experiences are avoided because they are felt to be dangerous and destabilizing to the psyche, and this "turning away" can have very negative consequences. Within the mindfulness-based psychotherapies, Experiential Avoidance (EA) is often discussed as an element of psychopathology that can be mitigated with mindfulness practice.

To guide our discussion on this topic (November 21st), I'm posting two papers for you to download and study. Chawla (2007) is a review of the research on experiential avoidance. The other paper is a compendium of measures used in Acceptance and Commitment Therapy research, and it begins with a section about the Acceptance and Action Questionnaire that will be relevant to our discussion.

I think it will be interesting to use this research to illuminate our in-the-moment mindfulness experiences. Enjoy your reading!

Mindful Attention and Mindful Intention

In our study group on mindfulness and psychotherapy last Friday, we had an interesting discussion about the qualities of mindful attention. We were exploring the difference between concentration practices and mindfulness, and I'd like to continue that investigation here. Please feel free to add your own comments at the end of this post.

Concentration on a single subject is a practice that typically results in calming, or the stabilization of attention. This is a necessary condition of mindfulness, because without stability, our minds will engage in their default activity of generating and exploring myriad associations, and it will be very easy to be distracted or preoccupied. When we temporarily narrow the scope of attention to our breathing and our posture, we also cease following distracting thoughts and experiences. The mind stabilizes, just as a glass of cloudy water will clear if we just set it down and refrain from agitating it. When we are stable, we become less reactive, and we experience that state as emotional calmness and mental clarity.

We might draw distinctions between stabilizing practices, which usually involve narrowing attention, and mindfulness practices, which might encompass a much broader field. But I think it is misleading to carry this too far. It's more accurate to say that in mindfulness, attention acquires a degree of flexibility, as well as stability. Mindfulness is better defined by the intention to be welcoming toward any experience than by the broadness or narrowness of the attentional scope at any given moment.

Our mindfulness may lead us to inspect a certain phenomenon quite intensely (we might mindfully study a flower, for example) without ignoring other phenomena arising in the present moment. Thus, our encounter with the flower might also evoke an awareness of the sun, rain, and soil that have nourished this flower, its place in the web of life, and even the stretch we feel in our back muscles as we bend over to smell it. We cultivate an openness to all these thoughts and experiences, even though they go beyond what we normally think of as "flower." In many mindful activities, attention might be given to both the universal and the particular, enriching our experience of ourselves in the world. Because we have the intention to welcome our experience, our awareness is multifaceted and our insight is deepened; because we have stability, we are not instantly carried away into distracting and irrelevant thoughts.

What happens if, in the middle of our flower mindfulness, we think of an "irrelevant" thing? What if we notice we are hungry? Without stability, we might reflexively and automatically start walking to the kitchen, thinking of what we will make for lunch, and of the tasks that we will have to accomplish when we finish our meal. We might imagine the person we expect to see at one o'clock, generate images of what he might say to us, and start thinking of what we will say in return. In that process, we might well fail to notice the warmth of the sun on our skin, or the coolness of the breeze. I think we could all agree that, somewhere along the line, our mindfulness was lost.

Alternatively, with stability, when we notice our hunger we might consciously decide to go to the kitchen for lunch, notice the slight feeling of regret we have in putting aside our flower meditation, recognize the food we will eat for lunch depended on the very same earth, rain, sun, and air we noticed as we reflected on the flower, feel our feet contacting the earth as we walk, an notice our own connectedness with the web of being. We might be grateful that we have a nice garden to walk in, and we might notice a desire to take care of it, and to share the experience with others.

Clearly, in this example, mindfulness has continued, evolving with our changing experience. I think it's useful to characterize the mindfulness process as one of both stability and flexibility. Both of these qualities depend on the intention to be mindful. Later in the study group, we will turn to the question of how we nourish that intention, in ourselves and our clients.

Mindfulness and Psychotherapy Study Groups

Image via Wikipedia In September, we will be starting a new year of our study group in mindfulness and psychotherapy. Last year, we had a very stimulating series of discussions, and I'm looking to more of the same this year. Since several more therapists have expressed interest in joining a study group, I'm thinking of offering two different sections to accommodate people's interests.

Knowledge and Skills in Mindfulness Based Therapies. This section will focus on readings and case discussion in ACT (Acceptance and Commitment Therapy) and other MBTs (Mindfulness Based Therapies). We will emphasize therapeutic principles, learning specific interventions, clinical conceptualization, and discussion of ongoing therapy cases. This section might be most useful to therapists who have already established a personal mindfulness practice. Many of last year's participants may well be most interested in this section.

Mindfulness Practice and Psychotherapy. This section will address the same issues as the one above, but with a greater emphasis on fundamental principles of mindfulness, and more direct support in developing your mindfulness as a therapist. This might be the best choice for therapists who want to establish their personal mindfulness practice.

Both groups will meet at my downtown office once a month, on Friday mornings, 10:00-11:30am, beginning in September (probably the 19th or 26th - there is some flexibility about the details). Tuition is $35 per meeting, and all members are asked to be financially responsible for any missed meetings. I expect that, soon after starting, we'll close the enrollment, so that we can have a stable membership and the richest possible dialog.

Please contact me by email or phone (312-263-8034) if you are interested in either group, and we can talk more about the best course to take. Thanks for your interest!

How Mindful Are You?

One way to assess mindfulness is to look at what it's not. The Mindful Attention Awareness Scale (Brown & Ryan, 2003) is frequently used in mindfulness research. The more you can endorse these traits and experiences, the more you tend to go through life mindlessly:

I could be experiencing some emotion and not be conscious of it until some time later.
I break or spill things because of carelessness, not paying attention, or thinking of something else.
I find it difficult to stay focused on what’s happening in the present.
I tend to walk quickly to where I’m going without paying attention along the way.
I tend not to notice feelings of physical tension or discomfort until they really grab my attention.
I forget a person’s name almost as soon as I’ve been told it for the first time.
It seems I’m “running on automatic” without much awareness of what I’m doing.
I rush through activities without being really attentive to them.
I get so focused on the goal I want to achieve that I lost touch with what I am doing right now to get there.
I do jobs or tasks automatically, without being aware of what I’m doing.
I find myself listening to someone with one ear, doing something else at the same time.
I drive places on “automatic pilot” and then wonder why I went there.
I find myself preoccupied with the future or the past.
I find myself doing things without paying attention.
I snack without being aware that I’m eating.

It's interesting to consider that, in addition to being an assessment instrument, the MAAS is a great guide to how to be mindful. Each of the "mindlessness" statements above can be reversed to make a useful mindfulness practice. Number 15, for example, could easily become the core of a mindfulness intention: "I'd like to be fully aware of what I'm eating and how it tastes."

In our Mindfulness and Stress Reduction classes, we encourage our participants to make "mindfulness contracts" with the activities and places of their lives. A contract to be mindful while walking will help us to take in the pleasures of our bodies and our surroundings. A contract to be mindful when relating to a particular person will help us be less reactive and more skillful when we are with them.

One of the most important things to remember about mindfulness is that it's deliberate. It takes effort to establish it in a new area, because our habits will lead us to be mindless. But the payoff for making the effort is that we get our lives back.

Not a bad trade.

Bringing Mindfulness to Fullness

Image via WikipediaPeople who are struggling with binge-purge problems often find it stressful to make important changes in their binge purge cycle. One of the most difficult aspects of recovery can be tolerating the feelings of fullness that occur after eating. This is not simply a difficulty after a binge, but also after a normal sized meal or snack.

We'd like to get some ideas out to therapists who are taking a mindfulness approach with eating disorders. If you are a person who purges after eating, please talk to your therapist before trying to practice any of these techniques. They may not really be right for you. If you are not seeing a therapist now - what are you waiting for? It's really important to take a purging problem seriously.

One of the strategies we recommend for dealing with uncomfortable fullness is: do something else for half an hour. Take a walk, call a friend, do something absorbing and distracting. Lots of people find that if they can engage in some activity for 30 minutes, the "urge to purge" subsides and the feeling of fullness is less bothersome. It's really important to get through that critical half hour.

In a way, this sounds like an anti-mindfulness approach: try not to pay attention to how you are feeling. In fact, I'd still call it a mindfulness approach, because it is best to engage in the alternate activity with complete mindfulness: while you are walking, really be present in the here and now, be fully aware of your body and your surroundings. It's a matter of bringing our wisdom to bear on the situation. It always good to know what mindfulness practices are too advanced for us. True mindfulness of fullness after a meal can be very hard to actually attain.

We have been working on a "Mindfulness of Fullness" protocol, and wanted to share our ideas with other mindfulness-oriented therapists. We think that the best time to introduce the idea of being mindful of fullness is after the client has already established a basic mindfulness practice, and can pretty reliably use it to calm and center herself. When it seems possible to try it, a mindfulness of fullness meditation can look something like this:

The best situation in which to start the practice is after the client has eaten something that she knows is healthy and nutritious. The feeling of fullness should be noticeable but not overwhelming. It might well be possible to practice this in the office, with the therapist guiding the meditation, during a session that follows lunch or a snack.
Ask the client to rate the sense of fullness she is currently experiencing on a scale from 0 - 10, with 10 being the most full she has ever felt in her life.
Start with a mindful breathing exercise, especially one like our "Mindful Breathing II" (from the right-hand column). It might be good to pay attention to the breath at the nostrils instead of in the belly, just because it's a less conflicted and complicated sensation. If the client is doing this at home, it might be best to actually listen to the mp3 rather than to simply do it from memory. It will support her more in an anxious situation.
Ask the client to get in touch with her reason for doing this meditation: "I want to learn to tolerate my fullness so I can live a longer, healthier life." "I don't want to be afraid of my body any more." "I want to learn to nourish my body." Then, you might try guiding the client through the following steps.
When you're ready, try to notice whatever you can about your present moment experience. If you can, try to notice each element kind of dispassionately. "There's a tightness in the stomach. A thought about purging. A fear of being fat. A desire to learn to eat in a healthy way. "
Try to notice which experiences are just body sensations, which experiences are judgments, which experiences are emotions, and which experiences are thoughts. When you figure it out, you can label the experience: "just thinking" or "just feeling" or "just sensation."
Remember to breathe throughout the exploration, and anytime your anxiety rises.
Try to figure out which aspects of your experience are "optional." Can you let go of making that judgment right now and simply focus on what is basic and real and present? It might be possible to eventually let yourself be aware of your fullness as a simple body experience, without all of the judgment and striving and thought and emotion that you typically add to it. If you can let go of your reactivity to the sensation, and simply be with the sensation as it is, that's a really important milestone.
Rate the sense of fullness you experience on a scale from 0 - 10, with 10 being the most full you have ever felt in your life.
End the meditation with more calming breathing. Again, the "IHP: Mindful Breathing II" exercise is a good one, but the "MARC: 3 minute Metta" could be really helpful, too.

The goal is to be able to tolerate fullness for what it is, a basic and essentially rewarding human experience. Mindfulness can help our clients free themselves from the reactivity and self criticism that turns that experience into something frightening and toxic.

If you are a therapist and have some feedback or ideas about this intervention, please leave a comment. If you'd like more information about our Mindful Eating approach, or about our study group in mindfulness and psychotherapy, feel free to follow these links.

ACT and Personal Coaching

Many of the individuals and couples we see in our practice are dealing with life problems that transcend medically-based diagnostic categories. These issues are not symptoms of larger problems like clinical depression, but the natural expression of our complicated human lives. Most of the time, our problems are just the result of our efforts to get through life as best we can - efforts which have had both positive and negative outcomes.

Despite the differences between psychotherapy and personal coaching, we have found that our training and experience as clinicians can be a tremendous benefit to our personal coaching clients. Not the least benefit is the fact that effective psychotherapists know that a great deal of our suffering comes from the fact that we are simply participating in the human condition (remember the first noble truth?).

I recently ran across a quote on Kelly Wilson's website that nicely articulates the humanism and far-reaching egalitarianism that underlies Acceptance and Commitment Therapy:

ACT does not allow a neat division between people doing treatment and people needing treatment. It is hard to get what is important about ACT without confronting the fact that in a very deep sense, we are all in the same boat. This means that the principles are scalable. ACT addresses obstacles to effective living that transcend diagnostic categories and even the notions of "sick" and "well." ACT attempts to address very fundamental issues that affect us all.

I've always been impressed by the totally non-pathologizing basis of the ACT approach. Its basic assessment categories are about skills and abilities, rather than diagnostic labels. We have found that ACT techniques are a powerful addition to our personal coaching services as well as a basis for psychotherapy. Here are some of the principles that we believe are central to positive change in both psychotherapy and personal coaching, starting of course with:

Acceptance and Commitment. Our coaching strategies rely on this fundamental principle, which we have learned through many years of helping people in psychotherapy: Meaningful change always requires both a thorough acceptance of ourselves as we are, and a commitment to act in accordance with our deep personal values. This is the basis of the ACT approach to psychotherapy.

Positive psychology figures prominently in both our psychotherapy and our personal coaching program. We have learned that happiness is not really the result of things that happen to us, but can be cultivated in the way we engage our lives. We draw on the growing body of psychological research on this topic to help people live more satisfying lives and realize their potentials.

Mindfulness is what enables us to be in the present, the place in which all change occurs. In taking action which actualizes our most far-reaching goals, the only thing we can ever do is take one step from right here. It can be startling to realize how much of our time we spend in daydreams and preoccupations, completely out of contact with our real life. Mindfulness helps us orient to who we really are, and what we are really experiencing. With this perspective, the path to our personal and professional goals is much clearer.

We've written a bit more about Integrative Health Partners' Personal Coaching Program on our website. Feel free to visit and browse.

Conversational Mindfulness

Image via WikipediaIncreasingly, therapists are becoming interested in encouraging mindfulness, in themselves and their clients. Research has suggested that people in therapy benefit from their own mindfulness practice, and they also benefit from their therapist's mindfulness practice. Some studies have even found better outcomes in psychotherapy when the therapists have a personal mindfulness practice. Steven Hayes, the founder of ACT, believes that therapists must be acting from their own mindfulness in order to be truly helpful to others.

An interesting question comes up: How can we assess the current level of mindfulness of someone we are talking to? Are there things that occur in our conversations that increase or decrease mindfulness?

One way to approach the evaluation of mindfulness is to describe how a person is paying attention. In order to accomplish this, we have to describe mindfulness as it manifests in our typical conversations, with the data that is accessible to an observer. Consider this common type of interaction: someone is telling you what happened when they talked to their sister yesterday. How could we determine whether the story-teller is being mindful? Here are some thoughts about principles, and examples to help in that assessment.

Mindfulness is non-defensive. It does not attempt to refuse any experience. Mindfulness is accepting, and not reflexively judgmental. As a listener, you might pay attention to whether your comments responded to, or are they ignored or deflected?
Mindfulness is here and now attention. So in our hypothetical situation, does the story-teller have any awareness of the here and now communication (including you in the conversation, asking your opinion, questioning whether you understand, vs just narrating; making eye contact; talking about feelings or thoughts in the present while telling the story). Subjectively, do you as the listener feel engaged and present? That's a pretty good indication of whether you are being seen by the speaker.
Mindfulness does not confuse the nature of experience. When we are remembering an interaction with our sister, we're aware that we are engaged in remembering. When we're talking to someone, we are aware we are talking to someone.
Mindfulness does not over-identify with any experience. We do not confuse mental states with external realties (cognitive fusion). Instead of saying things like "I'm a terrible person," the mindful speaker would say "I felt critical of myself."
Mindfulness is flexible and not preoccupied. Is the narrative characterized by black and white thinking or dogmatic assertions?

What could we do to support mindfulness during this hypothetical conversation?

Listen actively. Helping a person engage with you will bring their awareness into the present.
Ask questions about current thoughts or feelings (I see you felt very angry when she said that. As you look at your feelings now, do you still feel angry? Are there any other feelings?)
Bring the person’s attention to something in the present-moment conversation (the person's mood, changes in posture, etc.)
Process something in the here-and-now interaction (how did you feel when I asked you that question?)
Support their awareness of breathing, especially if they are uncomfortably "carried away."
Bring the person’s attention to a cognitive fusion ("You mentioned that you hate your job, but I wonder if what you actually hate is the way you are approaching your job.")

Learning to be mindful in a conversation is a crucial social skill. Many of us have the habit of not listening while we are talking, and our relationships can suffer as a result. Mindfulness could reverse that pattern. Also, when we consider that insight depends on the ability to observe oneself non-judgmentally, learning to be mindful in our conversations can increase the chances of learning something about ourselves in real time.