Making MBSR More Accessible

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Mindfulness-based Stress Reduction (MBSR) is the best studied method of offering mindfulness in a group format. It is often given in eight week courses, with some programs requiring 28 hours of class time and about 40 hours of home practice. Costs for these courses can exceed $500.00. Thus, participation in a traditionally-structured MBSR course can require a commitment of time and resources that many are unable to make.

One interesting thing about MBSR is that we don't expect to emerge from our first course as mindfulness experts. Hopefully, we have learned some foundational skills and attitudes that we can develop and explore in our ongoing lives. The spirit of investigation is probably the most important thing to cultivate in our first exposure, because that is what will sustain our practice in the long run.

Now, research is emerging about the optimal way of introducing mindfulness, exploring the possibility of mindfulness and stress reduction courses which are shorter and therefore more available to people with difficult schedules and/or limited financial resources. It seems that outcomes from shorter courses are quite similar to those of longer courses.

Here are some statistics from a recent review by James Carmody and Ruth Baer (2009):

A recent report by Jain and colleagues (Jain et al., 2007) of a randomized trial of an MBSR program with 12 hours of class time found a pre- and post-MBSR effect size of 1.36 (Cohen’s d) in the General Severity Index (GSI)... a measure of overall psychological distress. In a recent report of outcomes from an 8-week program comprising 26 hours of class time, Carmody and Baer (2008) found an effect size of .65 for the same measure. Participants in these two studies reported similar levels of distress at preprogram assessment (T score range 62–64)... A recent trial by Klatt, Buckworth, and Malarkey (2008) found an effect size of .61 in a program consisting of 6 in-class hours. Finally, in a recent meta-analysis of MBSR outcomes, Grossman, Niemann, Schmidt, and Walach (2004) reported a mean between-groups effect size at posttreatment for all mental health scales of .62 for a trial in which MBSR included 20 hours of class time (Shapiro, Bootzin, Figueredo, Lopez, & Schwartz, 2003) and a similar effect size (.56) for a trial in which MBSR included 28 hours of class time (Williams, Kolar, Reger, & Pearson, 2001).

In this review, it was found that shorter programs (sometimes referred to as MBSR-ld, or "lower dose") have comparable or even greater impact on stress than the traditional MBSR program. Also, it seems that participants completing the shorter course have a high degree of interest in mindfulness and are motivated to continue to develop their practice.

At Integrative Health Partners, we have decided that our next course in Mindfulness and Stress Reduction will conform to the emerging "LD" model. We will offer a 4 week program modeled on the research of Olivio et al (2009).  Our hope is that people who have felt daunted by the typical 8-week time commitment will find it possible to participate.  If you are interested, feel free to contact Dr. Becca Meyer (312-372-2880) about the details of the next course.

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.

Trophic Factors: Stress and the Shrinking Brain

I can't help but pass along this article in the Boston Globe about the causes of depression and the beneficial action of Prozac. The neuroscience in this article is really interesting. Seratonin may not be the really helpful brain chemical in the action of the SSRIs! Instead, there is a class of proteins (known as "trophic factors") which help brain neurons grow and survive.

Numerous studies had shown that chronic stress damages the brain by suppressing the release of trophic factors. In a series of influential papers published earlier this decade, Duman demonstrated that the same destructive hallmark is seen in depression, so that our neurons are deprived of what they need.

"The mental illness occurs when these stress mechanisms in the brain spiral out of control," he says.

Once that happens, the brain begins to shut itself down, suppressing all but the most essential upkeep.

It is thought that Prozac, and behaviors which help depression, like exercise, apparently work by increasing the release of these proteins and promoting the health of brain cells. A fascinating new theory, in part for its identification of "chronic stress" as one of the risk factors of depression. Apparently, stress can become so harmful that susceptible individuals can develop a kind of organic brain syndrome that actually shrinks brain tissue and results in the syndrome we have come to know as clinical depression.

I'm again reminded that mindfulness (like diet and exercise) is one of the great "protective factors" available to us. Mindfulness not only helps to reduce stress by helping us to see through the stressful mental dramas our minds create on a seemingly endless basis, it also helps us to open up to the true joys of life. It's not hard to imagine that this could actually be healing to the brain!

Thanks to Delany Dean for alerting me to this article through her "my del.icio.us" list.

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Ichigyo Zammai

The practice of doing "just one activity" is called ichigyo zammai in Japanese. It is really a cornerstone of mindfulness practice. Even though it has a Japanese term associated with it, it's really nothing special. We all have experiences of engaging in it. When you think about it, mindful breathing is an example of ichigyo zammai, because we are bringing our awareness to that single activity of breathing. You might say that in mindfulness, when we breathe, we just breathe. The body scan is a similar concentration of awareness into "just one activity."

One-pointedness is essential to the process of dealing with stress because it enables us to be simply in the present, doing what we are doing. Everything else - like worrying about what we are doing, anticipating what will happen next, judging ourselves for what we have already done - is extra. More and more, we hope to make those extra stress-generating activities optional. We hope to have more of a choice about how deeply we get involved in them.

In our stress reduction classes, we emphasize finding the opportunities for ichigyo zammai in our daily lives. I am particularly fond of engaging in it when I am working in the kitchen, preparing food or cleaning up after a meal. I always think it is a good idea to be mindful when I am working with a sharp knife! It's really a simple practice of remembering to breathe with awareness and settle into the present at the beginning of each activity. This encourages the mind to clear and to be really present with the knife and the carrots and the cutting board. Then, as we go through the activity, we commit ourselves to being present, and we decline the myriad opportunities to be distracted and diffused. Gently and joyfully, we keep returning to our present moment, no matter how many times our mind takes us somewhere else.

For me, this practice turns a potentially boring and devalued task into something that is worthy of my attention and something that actually brings me pleasure. If I engage in the task of chopping carrots with full awareness - of my body, the activity, and an appreciation of the way in which the universe has brought this offering of nourishment to me - I can actually find a refuge in the activity. I know that taking care of these carrots is taking care of my family and honoring the efforts of all those beings who caused the carrots and the cutting board to appear before me. Far from drudgery, it is a wonderful opportunity to participate deeply in the process of life on earth.

There are so many of these refuges available to all of us! Possibly we make a decision to be attentive to the space through which we are walking, honoring the people who planted the trees and poured the concrete while we appreciate the beauty and comfort their activities are bringing us. We know that our mindfulness is a process of being aware and then distracted, and then reestablishing our awareness, and we are helped in this process by the fact that every activity is always inviting us to be fully present and engaged. Ichigyo Zammai is actually the practice of participating in our lives.