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.

MBSR-LD

Image via WikipediaWhat's the best way to help people learn mindfulness? What kind of programs are actually clinically useful? This recent paper on Low-Dose Mindfulness-Based Stress Reduction (MBSR-LD) is a really good example of some of the investigation that is being done these days. The MBSR model developed by Jon Kabat Zinn is wonderful, but people have been learning mindfulness for millennia in many different contexts, and there are many ways of offering the benefits of mindfulness for therapeutic and wellness purposes.

Many of us have found that, in contrast to the traditional MBSR emphasis on required practice ("You don't have to like it, you just have to do it"), an invitational approach to home mindfulness practice is quite effective. This is especially true when the course helps participants clarify their goals and values. When people know why they want to learn mindfulness, and are supported by their awareness of their deepest values, they will engage genuinely and effectively. I've found that it is very important to devote some class discussions to helping people clarify their values and intentions, because we often need help getting in touch with what is really important to us.

Traditionally, mindfulness practices are learned in the context of vow and intention. In a Zen monastery, for example, monks engage in daily rituals which renew their commitments to work for the liberation of all beings. Having entered the monastery, a monk only has to look around to be reminded that s/he is in this place deliberately, because of a deep intention to realize the buddha way. During my recent three-month experience with monastic training, I was very aware that I had this wonderful opportunity to learn and to grow, and that I needed to pay attention while it was available to me.

I think that clients in our mindfulness-based therapeutic programs participate most fully when they find their authentic reasons for doing so. The mindfulness-based clinical programs we offer, whether "low dose" or "mega dose," are only valuable to the extent that participants recognize them as advancing their life's purposes. I feel strongly that MB programs can benefit by paying attention to the lessons of therapeutic approaches like Motivational Interviewing and Acceptance and Commitment Therapy.

The psychological community is on the verge of discovering many effective ways of integrating mindfulness principles into therapeutic approaches. The so-called "Third Wave" of evidence-based psychotherapy is just forming now, and nowhere near its crest. Let's encourage each other to explore the possibilities!

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Study Group Updates

At our next meeting of the Mindfulness and Psychotherapy Study Group, our guest will be Delany Dean, J.D., Ph.D. Delany is a psychologist in Kansas City who has been writing a great blog and website on mindfulness in psychology. She recently developed a Mindfulness Based Wellness program at Avila University, and she offers mindfulness based therapies in her private practice. We're really honored to have her visit with us while she is in Chicago presenting a poster at a conference.

Before the meeting on May 23, let's read this Baer (2003) review article about the uses of mindfulness training in therapeutic contexts. I'm also putting up a similar (but less technical) review paper (Mace, 2007) for you to peruse.

Finally, following up on our discussion last month, Laurie sent along this paper (Davisdon, et al, 2003) on the effect of mindfulness on brain function. Please enjoy your reading!

Mindfulness in Bariatric Medicine

A paper about the use of mindful eating with bariatric patients, which I co-authored with folks from the Center for Mindful Eating, is available here, from the Bariatric Times.

Also in the realm of health and wellness, take a look at this new post by Dr Delany Dean on meditation and hypertension. Delany also has a link to an article about the interaction of breathing, blood chemistry, and blood pressure. The psychophysiology of breathing was a topic that we were discussing in our last study group.

Well-being and Mindfulness Practice

This study confirms what we have found in all of our mindfulness classes: people who put more time and energy into their mindfulness practice benefit the most.

Carmody J and Baer RA (2007) Relationships between mindfulness practice and wellbeing J Behav Med., Sep 25

Relationships were investigated between home practice of mindfulness meditation exercises and levels of mindfulness, medical and psychological symptoms, perceived stress, and psychological well-being in a sample of 174 adults in a clinical Mindfulness-Based Stress Reduction (MBSR) program. This is an 8- session group program for individuals dealing with stress-related problems, illness, anxiety, and chronic pain. Participants completed measures of mindfulness, perceived stress, symptoms, and well-being at pre- and post-MBSR, and monitored their home practice time throughout the intervention. Results showed increases in mindfulness and well-being, and decreases in stress and symptoms, from pre- to post-MBSR. Time spent engaging in home practice of formal meditation exercises (body scan, yoga, sitting meditation) was significantly related to extent of improvement in most facets of mindfulness and several measures of symptoms and well-being. Increases in mindfulness were found to mediate the relationships between formal mindfulness practice and improvements in psychological functioning, suggesting that the practice of mindfulness meditation leads to increases in mindfulness, which in turn leads to symptom reduction and improved well-being.