Live Mindfully: study group

Showing posts with label study group. Show all posts

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.

Mindful Parenting

One of the topics for the December 18 meeting of our Study Group in Mindfulness and Psychotherapy will be Mindful Parenting, with a presentation by Jacqueline Herbstman, LCSW.

It's hard to think of a situation in which Mindfulness might be more important - and more helpful - than in the parent-child relationship. From our clinical practice, we know a lot about the positive effects of a nonjudgmental, attentive presence on children's sense of well being, attachment, and self-esteem. Being with another, without distraction, is really what we mean when we talk about "quality time." It's the basis of intimacy in any relationship.

Here are some research reports about mindfulness in the perinatal period (Duncan, 2009), and about mindfulness in parenting relationships (Coatsworth, 2009 and Macdonald, 2008).

Minding Our Mindfulness

Next Friday (November 20) the Mindfulness and Psychotherapy Study Group will be reflecting on the issue of the therapist's mindfulness. I thought I'd like to suggest that, between now and then, we might experiment with deliberately finding our mindfulness before we begin some of this week's therapy sessions.

Here's a guide for a brief, pre-session mindfulness exercise for therapists. In composing it, I've tried to touch on all of the elements of the Acceptance and Commitment Therapy "hexaflex" model. I've also remembered Shauna Shapiro's suggestion that we think of mindfulness as a matter of intention, attention, and attitude.

Find the intention to take a few mindful breaths, and do it.
Am I willing to be open to any experience being offered right now? (Actually check in with yourself: What is your level of willingness? Can you rate it from 0-10?)
Why do I want to be mindful right now?
What can I be aware of right now: in my body, in my thoughts and feelings, in my sense of pleasure or discomfort, in my experience of being in this room? Am I completely open to having this experience? If not completely, do I want to open up more, be more accepting? Why?
What am I aware of about the person I'm meeting? Am I open to "not knowing" much more than I actually know right now? Am I willing to let go of what I already know in order to be open to whatever I am about to experience?
What are my thoughts, judgments, and feelings about this person? Am I aware of them as experiences I am having, rather than facts about this person? Am I able to be fully accepting of all these aspects of my experience?
What are my intentions in this particular meeting?

It might also be useful to get in touch with any overarching intentions you have, and articulate them briefly. I sometimes find it grounding to remember the very traditional Buddhist dedication: "May all beings be happy, joyous, and live in safety." Your own values or faith tradition might suggest a similar intention.

I'm looking forward to our discussion of our experiences on Friday!

Study Group Resumes September 18

Image via Wikipedia

Our study group in mindfulness and psychotherapy will resume on September 18 at 10:00 am. In our first meeting, we will investigate early Buddhist psychology and the transformation of negative states through mindfulness.

If you did not participate in the study group last year, but would like to join us this year, please give me a call at 312.263.8034.

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.

Study Group Update

Continuing our discussion on "What is mindfulness?", I'm posting links to two papers that will deepen our understanding:

Bishop et al, 2004 should be read first, and
Hayes & Shenk, 2004 is a response to the Bishop paper.

To assist you in exploring mindful breathing, try using these links to download some helpful mp3s.

We will try to meet on the third Friday of each month (with the exception of December). Just as a reminder, study group dates for the rest of this' semester' are:

October 17
November 21
December 12
January 16

And please, enjoy your breathing!

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!

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.

This Friday's Study Topic

Image by practicalowl via FlickrIn our study group this Friday (the last for the summer) I'd like to focus on the topic of cognitive defusion and to discuss our experiences integrating this concept into clinical practice. You might find these lectures by Jason Luoma on Cognitive Defusion an interesting way to begin reflecting on the topic.

Cognitive defusion is one of the ways in which mindfulness of thoughts has found a home in psychotherapy theory and technique. I'm looking forward to deepening our understanding of this topic through our discussion on Friday.

Acceptance, Avoidance, Attention, and Wisdom

Image via WikipediaIn this week's study group, we were delighted to have a visit from Delany Dean, Ph.D., who was in Chicago presenting her Mindfulness Based Wellness research at the APS conference. A very interesting thread of the discussion took up the issue of attention regulation and avoidance, and I'd like to explore it at greater length here.

The basic instruction for mindfulness meditation often asks the meditator to keep her attention on the breath. Inevitably, the mind will wander on some way, and will perhaps become absorbed for many minutes in some topic. When we notice this happening, we are to gently return our attention to the breath, in a non-judgmental fashion. This process may be repeated dozens of times in a meditation session.

This process is often discussed as a kind of attentional training: learning to notice when our attention has wandered to some unintended subject, and making a conscious choice to redirect our attention away from the "accidental" topic and back to the "intended" topic, the breath.

The question comes up: could mindfulness of the breath be used as a distraction from something that we would rather not think about? If we engage in conscious breathing during the day, especially in stressful or difficult experiences, are we subtly engaging in an avoidance process which is not essentially different from other avoidance activities like watching TV or smoking a cigarette. In other words, can mindfulness training help us to become very skillful at avoiding experiences we'd rather not have?

There is, in fact, a kind of attention to breathing that I call "lifeboat breathing." This is something that we might do when we have had a very challenging and nearly overwhelming experience (like a panic attack): we pay attention to our breathing as a way to exclude certain other experiences from our consciousness. In psychology, we've know about the process of Reciprocal Inhibition for decades now. Engaging in some activities or responses makes it impossible to engage in certain other activities. We cannot be tense when we relax our muscles, for instance. In difficult emotional storms, it is possible to cling to an awareness of our breathing as a way of saving ourselves from an experience that threatens to overwhelm us. Being completely focused on the breath, there really isn't room to also engage in whatever cognitive processes that were so threatening. And so, the breath becomes a temporary lifeboat in a stormy sea.

All avoidance strategies regulate awareness (they would be useless if they didn't). What differentiates mindfulness from the simple avoidance of unwanted experiences? How is mindfulness different from taking a walk or binge eating?

I personally am skeptical of the almost universally accepted idea that mindfulness can be easily defined as a way of paying attention. We say (somewhat misleadingly) that mindfulness is a way of paying attention in the present, for example. But awareness is always in the present. There is absolutely no way to be aware of the past or future. Being "in the present" does not differentiate mindfulness from any other kind of attention or any other human activity. When we say "Pay attention to present moment experience" we are speaking metaphorically, and not scientifically.

So what do we really mean when we say "I'm not in the present moment?" We mean we have become confused about the real nature of our mental processes. We are engaged in thinking (possibly about something that we are imagining as "the future") in a way that obscures the fact that we are just thinking. And so mindfulness is not "coming into the present" (we have never left the present) but coming into a different relationship with our thoughts (we understand them as thoughts and not realities).

The breath is a great help in the process of coming into a realistic understanding of what we are doing, because we very rarely get confused about our breathing. We have absolutely no interest in our past breathing, and are unlikely to become preoccupied with it. In order to pay attention to an outbreath, we have to relinquish our preoccupation with the inbreath. But in mindfulness, the point of attending to our breath is not simply to be aware of the sensations of breathing in, but to know that we are breathing in while we are doing it. And mindfulness of thinking or feeling is a process of knowing our experience to be what it is, just thinking or just feeling, as it is happening.

In mindfulness, our intention is to be open to any experience and to know it for what it is. It seems to me that the curative and liberating power of mindfulness is not the result of simply having greater control over our attention. It is deeply involved with having more wisdom and compassionate insight into the true nature of our experience.

This is a very broad and complex topic, and I don't pretend to have a complete grasp of it, but I would like to assert a few propositions about mindfulness for the purpose of continuing the discussion.

Mindfulness is essentially a process of reminding ourselves of the reality of our life.
Mindfulness is a way of developing wisdom (disengaging from our illusions) about our experience.
Mindfulness is more like waking from a dream than learning to pay attention to some other element of a dream.

Not very scientific, possibly, but I hope an interesting starting point for further discussion.

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.

Every Day a Gift

This week in our study group on mindfulness and psychotherapy, we were discussing mindfulness of the body. In the Buddhist Sutra on the Four Establishments of Mindfulness, there is an instruction to contemplate the mortality of the body. The meditator is asked to envision the decomposition of a human corpse, holding the realization that his own body is of exactly the same nature, and there is no way for it to escape that fate. On one level, it seems to be the ultimate meditation on both impermanence and “impurity,” encouraging sobriety and a measure of detachment from the endless round of desire that we live in most of the time. It is easy to imagine this meditation as effective in controlling sensual cravings and helping monks uphold their vows of celibacy. And yet, this purpose seems much more appropriate to the homeless monks of India in 500 BCE than to ourselves as twenty first century psychotherapists and clients. During our discussion in the study group on Friday morning, the question arose: what possible value could this mindfulness practice have for us as therapists? Could it find its way into a therapeutic dialog, and if so, in what form?

Some of us realized that, as challenging as it was, we have derived great benefit from the encounters we have had with of our mortality. Those of us who have been cured of serious illnesses, or narrowly escaped terrible injury in an auto accident, have found in these experiences a certain clarification of what is important, what is heartfelt in our lives. We all know (or are!) people who, after a serious diagnosis, have made real changes in our lives. Our awareness of mortality gives us another perspective from which to ask the question, "What is the most important thing?"

So how does a meditation on death enter into the therapeutic dialog? Mostly, I think, more subtly than in the Mahasatipatthana Sutra. One member of the study group (NR) pointed out that in Native American shamanist traditions, using death as an advisor is a recommended practice. Essentially the same point is made in a Zen monastery, where the instrument that is used to call the monks to meditation is often inscribed with a verse like: "Life and death are serious. Gone is gone. Wake up! Don't waste time."

We do not necessarily notice it, but actually, mortality is a natural part of the discussion whenever we take up the question of how we live our lives, whether in psychotherapy or elsewhere. Questions like “What should I do next…” take on a much deeper meaning when we finish them “…given that my time in this life is limited.” Conventionally, we agree to suppress our mindfulness of this part of the discussion, but it’s worthwhile to consider whether in doing so we are depriving our clients of an important source of meaning and motivation.

Consider this typical statement from the viewpoint of Acceptance and Commitment Therapy:

We explain to clients that the perspective we work from seeks to understand people’s difficulties in the context of a whole life. Sometimes problems become so overwhelming that it is easy to lose contact with the “big picture.” We do want to know how the client has struggled, but seek an understanding of that struggle in the context of a whole person with hopes, desires and aspirations. (Wilson and Murrell, 2004, p. 136)

In this formulation, our mortality lurks just outside the frame of the intervention. The “context of a whole life” inevitably includes the limited nature of that life, whether we choose to recognize it or not. It’s quite possible that Wilson and Murell’s statement could naturally open the door to a discussion of how our impermanence contributes to the quality of our actual presence in life. In fact, it is arguable that such an investigation can be avoided only by the active suppression of awareness.

That discussion would naturally take on different dimensions with different people. But it is frequently found that one outcome of increased awareness of the impermanence of this life is the commitment to pay attention while we are still living. As Mary Oliver says in her poem “When Death Comes,” “I don’t want to end up simply having visited this world.” In some paradoxical way, the reality of the end of life brings us into our lives with awareness, vigor, and appreciation. It is somewhat hard to imagine a context for therapeutic change that does not mobilize this type of engagement.

In my mindfulness and stress reduction classes, one question I have used to good result is: "If life could be about something, what would you want your life to be about?" (see also Wilson and Murrell, 2004, p. 135). This discussion is a critical support to the development of mindfulness practice. No one ever says, “I’d like to find a way to sleep my life away.” Instead, people talk, for example, about wanting to develop their mindfulness so they can pass a deep appreciation of life on to their children. For people to undertake such an unconventional practice as mindfulness, there must be a good reason, and that reason must be consciously affirmed. To remind ourselves of Jon Kabat-Zinn’s basic insight, mindfulness is a deliberate attention.

Occasionally, when my wife and are walking with our mobility-challenged twelve year old golden retriever, she will remark: “Each day with Bailey is a gift.” Inevitably, we are put in touch with our appreciation of and gratitude for the opportunity to have this walk together. It is really worthwhile to pay attention to this moment when we recognize it as irreplaceable.

One insight from the Mahasatipatthana Sutta is that mindful awareness is nurtured by the awareness of life’s actual and limited nature. In the psychotherapeutic field, this tenet has so far been the rather exclusive province of the Existential therapies. Possibly, with the support of those ancients who devoted their lives to mindful awareness, the mindfulness-oriented therapies will take a second look at this basic observation, and consider whether it can be cultivated to therapeutic effect.

Note: to see a draft of the Wilson and Murrell paper mentioned in this post, click here. The reference for the final version is:

Wilson, K. G. & Murrell, A. R. (2004). Values work in Acceptance and Commitment Therapy: Setting a Course for Behavioral Treatment. In Hayes, S. C., Follette, V. M., & Linehan, M. (Eds.) Mindfulness & Acceptance: Expanding the cognitive-behavioral tradition (pp. 120-151). New York: Guilford Press.

Sutra on Mindfulness

In our study group on mindfulness and psychotherapy, we've been asking the question, "What do the original sources tell us that will help us integrate mindfulness into psychotherapy?" I thought it would be good to make the most important sutra on mindfulness available here. This is the Mahasatipatthana Sutta, often translated as "The Four Foundations of Mindfulness," although the title also has more subtle meanings. Maha means "great." Sati means "mindfulness," but it also has the connotation of "remembering." The term uppathana refers to a process of repeated penetration. Sutta is a buddhist teaching. So the Mahasatipatthana Sutta is the great teaching about entering mindfulness time and time again, or I suppose we could say "the teaching on mindfulness practice."

At any rate, here are some translations available on the web. Enjoy your reading!

http://www.accesstoinsight.org/tipitaka/dn/dn.22.0.than.html
http://www.basicbuddhism.org/index.cfm?GPID=47#Breathing
http://www.buddhanet.net/e-learning/mahasati.htm

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.