Mindfulness Singapore 2010 by Dr Chris Walsh

1. Introduction to Mindfulness
Based Therapies
By Chris Walsh
"Only what you have experienced yourself can be called
knowledge. Everything else is just information"
Albert Einstein

2. Definition of Mindfulness
Consciously cultivating
an openhearted,
moment to moment,
nonjudgemental awareness
Adapted from J Kabat-Zinn 2005,Coming to Our Senses, p24

3. Mindfulness not new!!!

4. Purpose of Workshop
• What Mindfulness Is And How It Works
• Clarify Common Misunderstandings
• Suitable Application of Mindfulness to Your Work
• Practical Applications in Daily Experience
• Brief Mindfulness Interventions
• Strategies to Address Difficulties
• Where to Access Resources
Using
• Theoretical Framework & Direct Experience

6. The New Wave
of Mindfulness Based Treatments
• Jon Kabat-Zinn: MBSR
• Marsha Linehan: DBT
• Zindel Segal, Mark Williams & John Teasdale: MBCT
• Steven Hayes: ACT
• Alan Marlatt: Urge Surfing, Vipassana, MBRP

7. "Meeting of Minds".
His Holiness the 14th Dalai Lama
will meet with
Professor Aaron Tim Beck

8. Wild geese

9. What is Mindfulness?
Definition (Kabat- Zinn)
Paying attention in a particular way
on purpose,
in the present moment,
and nonjudgmentally.
• Sensory impressions
• Thoughts including Imagery
• Emotions
• Urges & Impulses
Technique: Focus on breath, repetitive phrase
Mindfulness is oriented to the processes of consciousness rather than content

10. Mindfulness not a new therapy!
• Eastern & Western Spiritual Contemplative Traditions
• Phenomenology
• Psychoanalysis
– Free Association & Free Floating Attention
• Experiential Therapies
– Gestalt
– Existential Psychotherapy

11. Five Minute Breathing
Mindfulness

12. Mindfulness Instructions
• Relaxed But Alert Posture
• Focus Attention on The Breath
• Let Breath Breathe Itself
• All Thoughts Including Images Are Equal While Meditating
• Sounds & Sensations Are Okay
• When Realise Distracted Gently Bring Attention Back To Breath
• Whatever Happens is Okay

13. Pleasant Events Calendar
What was Were you How did What What
the aware of the your body moods, thoughts
experience? pleasant feel, feelings, are in
feelings in detail, and your mind
while during this thoughts now as you
the event experience? accompanie write about
was d this this event?
happening? event?
Heading Yes. Lightness in Relief, It was such a
home at the the face. pleasure. small thing
end of work Aware of “That‟s good.” but I‟m
– stopping, shoulders “How lovely!” glad I noticed
hearing a bird dropping, (the bird) “It‟s it.
sing. Uplift of so
corners of the nice to be
mouth. outside”

15. Five Minute Breathing
Mindfulness

16. Waving to a Friend

17. Mood Based Inferences

18. NAT’s CBT
Anxiety
Safety Behaviours
(Avoidance)

19. Mindfulness Not Just Relaxation
Suppression of Thoughts, Sensation or Emotions
Causes Rebound.
(Wenslaff et al. 1991)
So Dealing With Anxiety
by Distraction
(Including Relaxation
Techniques)
Is Considered Another
Form of Avoidance
Mindfulness Deals With This Problem
By Accepting Whatever Arises.

20. “The practice of mindfulness defuses our
negativity, aggression, and turbulent
emotions…..
Rather than suppressing emotions or indulging
in them, here it is important to view them,
and your thoughts, and whatever arises with
an acceptance and generosity that are as
open and spacious as possible.”
(Sogyal, 1992 p123 the Tibetan Book of Living
and Dying.)

21. Comfort
Challenge
Overwhelm

22. Carmen
• Worry, Over-concern for Others & Over-Activity
• Labelling “Just Worrying” for Continued Over-
Responsibility
• Unexpected of Powerful childhood Classical
Conditioning
• Sitting Mindfully with Somatic Sensations of
Anxiety
Guest House

24. Unpleasant Events Calendar
What was Were you How did What What
the aware of the your body moods, thoughts
experience? pleasant feel, feelings, are in
feelings in detail, and your mind
while during this thoughts now as you
the event experience? accompanie write about
was d this this event?
happening? event?
Driving in a Yes Tightness in Anxiety at It doesn‟t
traffic jam, the arms. running late. really seem to
running Holding Frustration matter
late for an steering with traffic. now. Getting
appointment. wheel tightly. “People upset
Jaws should certainly
clenching. respond more didn‟t help me
Breathing quickly to the get there any
tight and traffic lights. faster.
restricted. Bloody idiots”

26. Five Minute Breathing
Mindfulness

27. Doing Mode Being Mode
• Problem Solving • Accepting & Allowing
• Activated by • Activated by:
– Tasks requiring planning – Being relaxed, meditation
– Threat or stress – Creative Activity “in the zone”
• Evaluates as Good or Bad • Greater Ability to tolerate the
Unpleasant
• Registers Discrepancy
• Allows in New Information
• Recurring Sense of
Unsatisfactoriness • Approach (Open)
• Automatic Pilot – Activated L Frontal Lobe
• Avoidant • Allows Embodied Cognition
– Activated R Frontal Lobe
• Thoughts & Feelings Develop
Independent “Reality”

28. Mindfulness & Cognitive
Therapies
• MBSR & MBCT
– Being mode versus Doing Mode
– Automatic pilot & discrepancy driven behaviour
– Interoceptive exposure
– Attention Control
• DBT
– Distress Tolerance
– Social Skills (Skilful Means)
• ACT
– Defusion
– Values

29. SESSION 1 MBCT/MBSR
Stepping out of Automatic Pilot
• Rationale
– Mindfulness starts when we recognise the tendency
to be on automatic pilot
– Commitment to learning how to step out of it and
become aware of each moment
– Practice purposefully moving attention round the
body
• Practice
– Eating meditation
– Body scan
– Routine activity (homework)
– „Noticing‟ (homework – continues throughout)

31. MBCT/MBSR Delivery
MBCT Practitioners adopt a Person-Centered, Rogerian approach
MBCT Practitioners use a motivational interviewing style
MBSR (MBCT) Program is characterized by the qualities of authenticity,
unconditional acceptance, empathy, humor, present moment
experience through which both teacher and student experience the
group process; with each being changed as a result (Santorelli)
MBCT Practitioners have their own ongoing mindfulness meditation
practice similar to what they teach to the group
MBCT Practitioners use a manual with spontaneity and creativity

33. Five Minute Breathing
Mindfulness

34. Advantages of Mindfulness
• Develops “Observing Self” (Segal, Williams & Teasdale 2002)
• Avoids Feeding or Fighting Thoughts & Feelings (Sogyal Rinpoche, 1992)
• Repetitive Spontaneous Exposure & Desensitisation to Previously Avoided
Thoughts & Feelings (Breslin et al 2002)
• Increases Cerebral Left Prefrontal Activity (Davidson 2003)
• Increases Empathic Capacity & Emotional Intelligence (Goleman)
• Increases Compassion for Self & Others (Neff K.)
• Alternative to Mindless Compulsive Behaviour (Linehan 1993 p69)
• Observing Impermanence thus Allowing Urge Surfing (Marlatt & Gordon 1985)
• Frees Mind from Paradigm Traps Inherent in Language (Hayes, S. C. 2002)
• Creates a Space for Spontaneous Creative Thoughts

36. Initial Problems Practising Mindfulness
• Teacher Needs to be an Experienced Mindfulness
Practitioner
• May Initially Lead to Increased Awareness of Repressed
Unpleasant Feelings
• Need some Pre-existing Ego Strength to Do It
• Difficulty Establishing a Regular Practice
• Striving and Judgementalism

37. Solutions To Initial Problems
• Practice With Therapist in Therapy Sessions
– Containment
– Grounding
– Get Experience of:
• “Observing Self”
• Automatic Flow of The Mind
• Continuingly Changing Nature of Mental Phenomena
• Begin With Simple Awareness of Body Sensations
• Set Brief Easily Manageable Homework Exercises
• Reading, Education, Helpful Feedback

38. Manageable Mindfulness
Homework
• Daily 5 Minute Breath Meditation
• Awareness of An Aspect of A Physical Habit e.g.
– How tight you hold the steering wheel.
– What happens to your breathing in an argument?
– Breath Awareness on Cue
• Waiting for Phone to Be Answered, At a Red Traffic Light
• Walking, Listening to Music, Getting Dressed
• Behavioural experiments
– Shifting awareness in specific situations
E.g. Detailed Awareness of The Phenomena Associated With Cravings

39. Breathing Space
Observe
1. Body
2. Thoughts and
Breathe
Inferences
3. Skilful Action
Observe Body

40. The Workbench of Your Mind
Thoughts
Bodily
Emotions
Sensations
Behaviour

41. Stop
Take a breath
Observe
Proceed

44. Mindful Movement e.g. Yoga

45. Mindfulness Part
• Meditation practices
• Automatic pilot → Present awareness
• Doing mode → Being mode
• Intellectual construct → direct experience
• Past/Future → Present
• Criticism/judgement → compassion
• Avoidance → approach

46. CBT Part
• Psychoeducation (mood & thinking)
• Options for skilful action
– Nourishing activities
– Options for working with negative thoughts
• Relapse Prevention
– Relapse signatures
– Action planning
• Homework

47. Yin
Receptive
Phenomenology
Openness
Being Mode
Exquisite Awareness
Yang
Creative
Scientific Enquiry
Focused Concentration
Doing Mode
Automatic Pilot

48. Urge Surfing – Alan Marlatt

49. Coral
• 26 y.o.
– Single, living with friends
– Public Servant, Intelligent, University Educated
• Chronic Dysthymia / Depression
– Cipramil 20- 40 mg, ECT
• Recreational Party Drugs, Very Occasional THC

50. Coral‟s Psychotherapy Issues
• Establish connection between drug use and mood
• Differentiate between temporary downs and depressive
relapse
– Harm reduction
• Address broad range of nat‟s that reinforced her sense
of incompetence and inadequacy
• Self doubt, worry, anxiety
• Traditional CBT perceived as invalidating

51. Systemic Constellations
www.constellationflow.com
• Mindfulness Based
• Explores Interconnectedness
• Cultivates harmony within community
• Cultivates compassion
– through intergenerational perspective
• Cultivates wisdom
– by courageously acknowledging what is

52. Five Minute Breathing
Mindfulness

53. www.mindfulness.org.au

54. About Dr Chris Walsh
Dr Chris Walsh MBBS, DPM, FAChAM is a psychiatrist working in private
practice in North Carlton (Melbourne, Australia). He has been working in
psychiatry since 1985. In that time, he has worked in hospitals, jails, community
settings, and drug and alcohol institutions.
In 1983, as a young doctor Chris did a short stint helping out at the Tibetan
refugee hospital in Dharamsala. The Tibetan people's common sense, good
humour and happy nature left a lasting impression on him.
Chris's daily mindfulness practice began eighteen months later, at the same time
as he began working in psychiatry. As a result mindfulness has been organically
integrated into his psychiatric practice from the very start. Chris has a special
interest in applying mindfulness meditation practices to psychotherapy. He is
formally trained in Self Psychology, but his psychotherapy integrates diverse
theoretical frameworks, including cognitive Behavioural Therapy (CBT) and
Gestalt.
Chris also works in the Drug and Alcohol treatment setting and has a strong
commitment to promoting use of mindfulness and awareness of family issues in
that area.

55. Chris is a member of The Family Alcohol and Drug Network (Fadnet) which is a
gathering of professionals from the drug and alcohol field with a particular interest in
family work. These professionals share a deep respect for families and a common
belief in caring for family members affected by problematic substance use. They
recognise and value the healing power within families, and also recognise the value
of family-aware and family-inclusive practice in the treatment of alcohol and other
drug difficulties.
Chris has taken a leading role in family constellation work in Australia. He runs
regular workshops, sponsors senior European teachers, and is a foundation
member of the Melbourne peer supervisions group. He has given presentations at
Australian national professional conferences on both mindfulness and family
constellations. Chris is also the founder and moderator of Constellation Talk a very
active email chat group with almost 600 subscribers worldwide. He has presented
this work around Australia and overseas in the USA, New Zealand and Singapore.
He also coordinated the development of the website for the International sytemic
Constellations Association (ISCA) www.isca-network.org
Chris has a breadth of experience both in his life as well as his work. When he was
a medical student he took a year off from his studies. He spent this year travelling
around Australia working as a labourer in factory and farm jobs. He has diverse
interests including music, poetry and football and is fluent in Spanish.