1.
Rezvan Ameli, Ph.D. Chief Psychologist and Director of Clinical Training, MAP-NIMH May 2009 [email_address] www.rezvanameli.com

2.
Some Facts About Mindfulness <ul><li>Mindfulness does not require any particular religious or cultural belief system. </li></ul><ul><li>It is not something we acquire. </li></ul><ul><li>It is simple but not easy! </li></ul><ul><li>There has been and explosion of interest in mindfulness. </li></ul>

3.
Definition # 1 <ul><li>&quot;Mindfulness is to be aware . To be aware when you are breathing in and to be aware when you are breathing out…it is the capacity to be aware of what is here . Anything can be the object of mindfulness. Your breath. The sky. It is to be in touch with our felt experience in each moment“ </li></ul><ul><li> Thich Nhat Hanh </li></ul><ul><li>Book recommendation: Peace is Every Step </li></ul>

4.
Definition # 2 <ul><li>&quot; Mindfulness is paying attention , </li></ul><ul><li> on purpose, </li></ul><ul><li> in the present , and </li></ul><ul><li> non-judgmentally , </li></ul><ul><li>to the unfolding of experience moment by moment” </li></ul><ul><li> Jon Kabat-Zinn </li></ul><ul><li>Book Recommendation: Full Catastrophe Living </li></ul>

5.
Definition #3 <ul><li>“ Mindfulness is to distinguish </li></ul><ul><li>awareness from mental activity </li></ul><ul><li>it is to learn to be aware of our own mental states without being caught in them “ </li></ul><ul><li>Jack Kornfield </li></ul><ul><li>Book Recommendation: Wise Heart </li></ul>

6.
Influential scientist of mindfulness: the Buddha <ul><li>Subject: Human Condition </li></ul><ul><li>Finding: Suffering is universal. </li></ul><ul><li>We suffer because of the way in which we relate to our human condition (not the human condition itself). </li></ul><ul><li>There is hope of liberation from suffering </li></ul><ul><li>Suggestion: Replace the word “suffering” with “stress” </li></ul>

7.
Pain vs. Suffering <ul><li>Pain </li></ul><ul><li>First Arrow </li></ul><ul><li>Inevitable </li></ul><ul><li>Sensation </li></ul><ul><li>Impermanence (Sickness, old age, death) is inherent in human condition </li></ul><ul><li>Suffering </li></ul><ul><li>Second Arrow </li></ul><ul><li>Optional </li></ul><ul><li>Pain + resistance </li></ul><ul><li>Attachment to the outcome (Avoidance/Clinging) </li></ul>

8.
What is the Solution? <ul><li>Accept what is, including impermanence </li></ul><ul><li>Let go of attachments </li></ul><ul><li>Stay “present” (live in our bodies not in our heads) </li></ul><ul><li>Maintain a kind & friendly attitude towards ourselves and others </li></ul>

9.
Attitudinal Foundations of Mindfulness <ul><li>Non-Judging </li></ul><ul><li>Patience </li></ul><ul><li>Trust </li></ul><ul><li>Non-striving </li></ul><ul><li>Acceptance </li></ul><ul><li>Letting go </li></ul><ul><li>Beginner’s Mind </li></ul><ul><li>Adapted from Full Catastrophe Living by Kabat-Zinn </li></ul>

10.
<ul><li>Be empty of worrying </li></ul><ul><li>Think of who created thought </li></ul><ul><li>Why do you stay in prison </li></ul><ul><li>When the door is so wide open </li></ul><ul><li>Move outside the tangle of fear thinking </li></ul><ul><li>Live in silence </li></ul><ul><li>Flow down and down </li></ul><ul><li>Into always widening </li></ul><ul><li>Rings of being - Rumi </li></ul>

11.
Stress Reaction Vs. Response <ul><li>Stress reaction: External event  internal event  alarm reactivity  stress reaction  acute hyper arousal  increases chance of survival in a dangerous and hostile situations </li></ul><ul><li>Stress Response: introducing conscious process that influences the flow of events that are likely to bring about automatic reactivity. </li></ul>

12.
We can make a choice: React or Pause and Respond <ul><li>“ Between the stimulus and response, there is a space and in that space lies our freedom and power to choose our response.&quot; </li></ul><ul><li>Victor Frankl </li></ul><ul><li>We can choose not to throw the second arrow at ourselves </li></ul>

13.
The President pauses . . .

14.
Adverse impact of stress <ul><li>Immune system </li></ul><ul><li>Cardiovascular system </li></ul><ul><li>Nervous system </li></ul><ul><li>Increases inflammation </li></ul><ul><li>Increases negative mood states </li></ul><ul><li>Increases adrenaline and cortisol levels </li></ul><ul><li>Sky is the limit </li></ul>

15.
Stress <ul><li>Changeable aspects </li></ul><ul><li>Problem focused strategies </li></ul><ul><li>Teaching skills/ providing information </li></ul><ul><li>Unchangeable aspects </li></ul><ul><li>Acceptance </li></ul><ul><li>Compassion </li></ul><ul><li>Humor </li></ul><ul><li>Keeping count of positives in life </li></ul>

16.
Familiar? <ul><li>God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference. </li></ul><ul><li>Reinhold Niebuhr (1892-1971) </li></ul>

17.
Positive & Negative Affect <ul><li>Are not on the same continuum. </li></ul><ul><li>Impact physiological , behavioral and social domains </li></ul><ul><li>They impact disease outcome (Grant, et al 2009) and longevity (Nyklicek & Kuijpers 2008) </li></ul><ul><li>Mindfulness decreases negative affect and increases positive affect (Ludwig & Kabat-Zinn 2009, Greeson 2008, Baer 2003) </li></ul>

18.
Mindfulness Research <ul><li>Pain management/pain reduction (Kabat-Zinn) </li></ul><ul><li>Immune functions (Kabat-Zinn, Creswell) </li></ul><ul><li>Brain function changes with mindfulness (Davidson) </li></ul><ul><li>Depression (Segal, Williams, Teasdale) </li></ul><ul><li>Eating disorders (Wansink) </li></ul><ul><li>Empathy/reduction in physician error (Epstein, Santorelli) </li></ul>

19.
Mindfulness: Major Impact Third Wave of Psychotherapies <ul><li>Mindfulness Based Stress Reduction (MBSR) (Jon Kabat-Zinn) </li></ul><ul><li>Mindfulness Based Cognitive Therapy (MBCT) (Zindel Segal, John Teasdale, Mark Williams) </li></ul><ul><li>Dialectical Behavior Therapy (DBT) (Marsha Linehan) </li></ul><ul><li>Acceptance Commitment Therapy (ACT) (Steve Hays) </li></ul>

20.
What do people report after a course in mindfulness training? <ul><li>Lasting decrease in physical and psychological symptoms </li></ul><ul><li>An increase in ability to relax </li></ul><ul><li>Reduction in pain/or enhanced coping with pain </li></ul><ul><li>Greater energy and enthusiasm for life </li></ul><ul><li>Improved self-esteem </li></ul><ul><li>Center for Mindfulness in Medicine, Health Care, and Society, UMASS School of Medicine </li></ul>

21.
How do we do it? simplified RAIN of Compassion <ul><li>R ecognition- NOTICE what is happening </li></ul><ul><li>A cceptance – say “yes”, allow, make room for the experience. </li></ul><ul><li>I nvestigate –be curious, even familiar experiences do not repeat. </li></ul><ul><li>N on-identification –become a witness to the experience. Do not get caught in it. </li></ul><ul><li>+ Compassion: maintaining at attitude of kindness, friendliness, and gentleness towards self and others. </li></ul>

22.
To what do we apply Mindfulness? <ul><li>Start with a pause and a heartfelt smile of course : </li></ul><ul><ul><li>Eating Walking Standing </li></ul></ul><ul><ul><li>Breathing Listening Seeing </li></ul></ul><ul><ul><li>Pain Anger Fear </li></ul></ul><ul><ul><li>Cravings … … </li></ul></ul><ul><ul><li>Sky is the limit! </li></ul></ul>

23.
Practice, practice, practice <ul><li>Developing and cultivating a mindfulness practice is simple but not easy. Most likely you will need teachers and fellow travelers along the way. </li></ul><ul><li>Formal practice </li></ul><ul><li>Informal practice </li></ul>

24.
Practice & Research resources <ul><ul><li>NIH- R&W –Next course beginning May 15 th . ( [email_address] ) </li></ul></ul><ul><ul><li>NIH Mind Body Week Sept 8-11, 2009 </li></ul></ul><ul><ul><li>Insight Meditation Community of Washington DC </li></ul></ul><ul><ul><li>University of Maryland </li></ul></ul><ul><ul><li>NCCAM </li></ul></ul>

25.
Other practice & research resources <ul><li>University of Massachusetts Center for Mindfulness in Medicine, Health Care, and Society </li></ul><ul><li>UCLA Semel Institute, Mindful Awareness Research Center </li></ul><ul><li>Insight Meditation Society -Massachusetts </li></ul><ul><li>Spirit Rock - California </li></ul><ul><li>Omega Institute – New York </li></ul>