mindfulness mindfulness & hypnosis& hypnosis

Stewart Mercer & James Stewart Mercer & James Hawkins Hawkins

what is mindfulness?what is mindfulness?

Kabat-Zinn Kabat-Zinn (Full catastrophe living, 1990):(Full catastrophe living, 1990): paying paying attention in a particular way, on purpose, in the attention in a particular way, on purpose, in the present moment and without judgement. present moment and without judgement.

Bishop et al Bishop et al (Mindfulness: a proposed operational (Mindfulness: a proposed operational definition, 2004):definition, 2004): The first component involves the The first component involves the self-regulation of attention so that it is maintained self-regulation of attention so that it is maintained on immediate experience … the second on immediate experience … the second component involves adopting a particular component involves adopting a particular orientation toward one's experiences in the orientation toward one's experiences in the present moment … that is characterized by present moment … that is characterized by curiosity, openness, & acceptancecuriosity, openness, & acceptance

there are several quite widely used definitions:

mindfulness: two helpful mindfulness: two helpful lenseslensesone lens sees mindfulness interventions as

adaptations of various traditional Buddhist meditation practices

Mindfulness-based stress reduction (MBSR); Mindfulness-Mindfulness-based stress reduction (MBSR); Mindfulness-based cognitive therapy (MBCT); Mindfulness-based based cognitive therapy (MBCT); Mindfulness-based relapse prevention (MBRP); Loving-kindness meditation and relapse prevention (MBRP); Loving-kindness meditation and Compassionate mind training (CMT). Compassionate mind training (CMT).

This is where the current flowering of scientific interest in This is where the current flowering of scientific interest in the clinical possibilities of mindfulness began.the clinical possibilities of mindfulness began.

Research grows showing the value of these approaches.Research grows showing the value of these approaches. There are interesting & important questions about the There are interesting & important questions about the

mechanisms involved e.g. improvements in mindfulness, mechanisms involved e.g. improvements in mindfulness, self-compassion, experiential tolerance, self-regulation …self-compassion, experiential tolerance, self-regulation …

mindfulness: two helpful mindfulness: two helpful lenseslensesa second lens sees mindfulness as a useful

attentional and attitudinal mode which can be encouraged in a variety of ways – of which

meditation is only one Here mindfulness is considered to overlap with a Here mindfulness is considered to overlap with a

number of related concepts – attention, acceptance, number of related concepts – attention, acceptance, de-centring, cognitive defusion, metacognition, de-centring, cognitive defusion, metacognition, openness, compassion openness, compassion

There are a series of so-called There are a series of so-called “Third wave” “Third wave” cognitive cognitive behavioural therapies that emphasise developing a behavioural therapies that emphasise developing a different response to distressing experience rather than different response to distressing experience rather than trying to challenge the content or alter the experience trying to challenge the content or alter the experience

These include mindfulness training, metacognitive These include mindfulness training, metacognitive therapy, acceptance & commitment therapy, DBT, etc therapy, acceptance & commitment therapy, DBT, etc

the buddhist noble eightfold the buddhist noble eightfold pathpath

wisdom: wisdom: right understanding & right intentionright understanding & right intention

ethical conduct: ethical conduct: right speech, right action, right livelihoodright speech, right action, right livelihood

meditation: meditation: right effort, right mindfulness, right right effort, right mindfulness, right

concentrationconcentration

to relieve suffering & lead to self-awakening

the eightfold path divides into 3 basic the eightfold path divides into 3 basic divisionsdivisions

buddhist meditationbuddhist meditation

NICE guideline for NICE guideline for generalised anxietygeneralised anxiety

NICE guideline for NICE guideline for recurrent recurrent

depressiondepression

marshmallow research & marshmallow research & 2011 1000 child NZ 2011 1000 child NZ

studystudy

right effortright effort

rightrightmindfulnessmindfulness

rightrightconcentrationconcentration

broad to narrow focus broad to narrow focus spectrumspectrum

narrow focus narrow focus effort, depth effort, depth peacefulnesspeacefulness

mindfulnessmindfulness concentrationconcentration

broad focus broad focus awarenessawarenessacceptanceacceptance

mindfulness meditation worksmindfulness meditation worksa wealth of emerging research demonstrates the value of mindfulness practice both for patients &

practitioners tested across a broad range of problem areas – depression, tested across a broad range of problem areas – depression, anxiety, substance abuse, eating disorders, chronic pain and a anxiety, substance abuse, eating disorders, chronic pain and a variety of chronic medical conditionsvariety of chronic medical conditions

tested too with diverse populations – adults, adolescents, tested too with diverse populations – adults, adolescents, children, parents, teachers, students, therapists, doctorschildren, parents, teachers, students, therapists, doctors

meta-analysis (39 studies) – Hofmannn, S. G., et al. (2010). meta-analysis (39 studies) – Hofmannn, S. G., et al. (2010). "The effect of mindfulness-based therapy on anxiety and "The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review." depression: A meta-analytic review." J Consult Clin PsycholJ Consult Clin Psychol 78(2): 169-183.78(2): 169-183.

systematic review (15 studies) – Merkes, (2010). "Mindfulness-systematic review (15 studies) – Merkes, (2010). "Mindfulness-based stress reduction for people with chronic diseases." based stress reduction for people with chronic diseases." Aust J Aust J Prim HealthPrim Health 16(3): 200-210. 16(3): 200-210.

well over 200 studies in my personal database & growing!well over 200 studies in my personal database & growing!

research challenges includeresearch challenges include better quality research – for example more studies that better quality research – for example more studies that

compare mindfulness meditation approaches with active compare mindfulness meditation approaches with active alternative treatments (like applied relaxation), better alternative treatments (like applied relaxation), better controls for example for allegiance effectscontrols for example for allegiance effects

improved understanding of the important therapeutic improved understanding of the important therapeutic mechanisms – reduced reaction to potentially upsetting mechanisms – reduced reaction to potentially upsetting thoughts/emotions/events (especially spirals of rumination thoughts/emotions/events (especially spirals of rumination & worry); reduced internal/external avoidance; reduced & worry); reduced internal/external avoidance; reduced self-judgement & increased self-compassion; increased self-self-judgement & increased self-compassion; increased self-control/emotion-regulation; relevance of home practice to control/emotion-regulation; relevance of home practice to changes in mindfulness; increased value-driven action changes in mindfulness; increased value-driven action

better integration with other interventions – for example better integration with other interventions – for example value-driven action, broader health practices, concentration value-driven action, broader health practices, concentration meditation forms, other seven aspects of the eightfold path!meditation forms, other seven aspects of the eightfold path!

other “mindfulness other “mindfulness approaches”approaches”there are a whole series of emerging therapeutic

approaches that include an emphasis on mindfulness & acceptance rather than trying to

change difficulties Compassionate mind training (CMT) Compassionate mind training (CMT) Acceptance & commitment therapy (ACT)Acceptance & commitment therapy (ACT) Metacognitive therapy (MCT)Metacognitive therapy (MCT) Functional analytic therapy (FAP)Functional analytic therapy (FAP) Behavioural activation (BA)Behavioural activation (BA) Integrative behavioral couple therapy (IBCT)Integrative behavioral couple therapy (IBCT) Dialectical behavior therapy (DBT)Dialectical behavior therapy (DBT)

other “mindfulness other “mindfulness approaches”approaches”

a recent excellent overview of this field is provided by:

Hayes, S. C., M. Villatte, et al. (2011). "Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies." Annual Review of Clinical Psychology 7(1): 141-168. A wave of new developments has occurred in the behavioral and cognitive therapies that focuses on processes such as acceptance, mindfulness, attention, or values. In this review, we describe some of these developments and the data regarding them, focusing on information about components, moderators, mediators, and processes of change. These “third wave” methods all emphasize the context and function of psychological events more so than their validity, frequency, or form, and for these reasons we use the term “contextual cognitive behavioral therapy” to describe their characteristics. Both putative processes, and component and process evidence, indicate that they are focused on establishing a more open, aware, and active approach to living, and that their positive effects occur because of changes in these processes.

four aspects of helpful inner four aspects of helpful inner focusfocus

exploring exploring &&

processinprocessingg

encouragingencouragingmindfulnessmindfulness

reducingreducingnegative negative

statesstates

nourishing nourishing positive positive statesstates