Mindfulness

Calligraphy by Thich Nhat Hanh

Mandakini Sadhir, MDAssistant ProfessorDivision of Adolescent Medicine Department of PediatricsUK HealthCare

Adolescence

• Marked by pubertal growth, psychosocial and cognitive development.

• Risk taking behaviors and mood disorders are common during this period.

ADOLESCENT BRAIN

• LIMBIC SYSTEM: “EMOTIONAL BRAIN”

Fear, anger, “fight or flight” response Feelings of pleasure Development of reward behaviors such

as eating and sex. Memory storage and retrieval

PREFRONTAL CORTEX: “CEO” OF BRAIN Planning Setting priorities Organizing thoughts and problem

solving Suppressing impulses Weighing consequences of one’s

actions

http://healthineducation.net/RiskTaking.html

Limbic System - Amygdala (learning, emotions): makes young teens especiallysusceptible to engaging in risk-taking

Frontal Cortex: decision making, self control

Decision making maturity

PFCAmygdala Amygdala

PFC

AmygdalaPFC

NOT GOOD NEWS: “Hot” decisions more likely than “Cold” decisions

Stress aggravates the situation…

GOOD NEWS: Pruning of PFC neurons produces a more efficient PFC by young adulthood

Source: http://healthineducation.net/RiskTaking.html

I like drugs!!

I hate school! I’ll skip school and get drunk.

I am planning for the future

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PFC: Prefrontal cortex

Managing Stress

• Healthy coping skills- deep breathing exercises, Meditation –Mindful meditation, transcendental meditation, zen meditation etc., yoga, exercise, progressive muscle relaxation, listening to music, dance, aromatherapy, writing etc.

• Unhealthy coping skills- using drugs, self harm, overeating, restricting food, excessive gaming/internet use, risky behaviors.

Mindfulness is…..

“ Paying attention in a particular way, on purpose in the present moment in non

judgmental way” Jon Kabat- Zinn

“ Paying attention in a particular way on purpose in the present moment with

unconditional love” – Dzung Vo

MindfulnessIs not ….

• Religion• Relaxation; seeking bliss• Emptying your mind• Cure-all• Quick fix• Self absorbed

• Substitute for addressing social determinants

Mindfulness for Teens- Emerging Evidence

• Mindfulness based interventions have found to be feasible and acceptable in children and adolescent population.

• Attention- concentration, ADHD, academic performance • Medical – Blood pressure • Risk behaviors – Fighting, substance use • Emotional regulation – Stress, depression, anxiety, PTSD,

Positive affect, eating disorders• Social – Empathy, and Compassion, Pro social school

behaviors, family functioning • Chronic illness- Pain management, coping with illness• Improved Sleep

Mindfulness based intervention • Beneficial effect on depression, quality of life, and acceptance of pain in

adolescents with recurrent headaches.• Study investigating impact of mindfulness based stress reduction

program in adolescents with functional somatic pain syndromes found preliminary evidence of improvement in functional disability, symptom impact and anxiety.

• Among adolescents and young adults who were cancer survivors, mindfulness based intervention resulted in significant reduction in emotional distress and improvement in quality of life at 3 months of follow-up. In addition, participants had reduced negative attitudes toward self and demonstrated significant improvement in mindfulness skills.

Zoogman S, Goldberg, SB, et al Mindfulness Interventions with Youth: A Meta-Analysis. Mindful. 2015 Apr;6(2): 290–302Thompson M, Gauntlett-Gilbert J. Mindfulness with children and adolescents: effective clinical application. Clin Child Psychol Psychiatry. 2008 Jul;13(3):395-407.Zenner C, Herrnleben-Kurz S, Walach H. Mindfulness-based interventions in schools-a systematic review and meta-analysis. Front Psychol. 2014 Jun 30;5:603Ahola Kohut S, Stinson J et al. Mindfulness-based interventions in clinical samples of adolescents with chronic illness: a systematic review. J Altern Complement Med. 2017 Mar 29Hesse T, Holmes LG, et al. Mindfulness-Based Intervention for Adolescents with Recurrent Headaches: A Pilot Feasibility Study. Evid Based Complement Alternat Med. 2015; 2015:508958.

Mindfulness based stress reduction(MBSR)

Eight week program with each session lasting for 2.5 hrs. • Provides mindfulness training through the practice of meditation and hatha yoga. • In each session, learners are taught mindful techniques and encouraged to engage

in sharing of their learning experiences and difficulties to understand elements of stress.

• During these 8 week sessions, program seeks - to strengthen ability to focus on the present moment and accept experiences or thoughts as they arise without trying to control them; - explore personal experience and paying attention to its emotional and sensory

aspects rather than intellectual description; - fully accept personal experience with its positive as well as negative elements

including feelings of pleasure, joy, frustration, rage, or uneasiness.- develop the ability to actively choose which personal experiences to be lived and

what elements to be focused, acted upon or examined.- teaches the ability to give up all pretense of having direct control over reality.

Kabat-Zinn, J. Full Catastrophe Living: Using the Wisdom of your Body and Mind to Face Stress, Pain, and Illness Fifteenth Anniversary Edition. 2005. New York, NY: Bantam Dell.[Shonin E, Van Gordon W. The Mechanisms of Mindfulness in the Treatment of Mental Illness and Addiction. International Journal of Mental Health and Addiction. 2016; 14(5):844-849.

Other approach

• Transcendental Meditation • Vipassana• Zen meditation• Tai chi ( is a noncompetitive, self-paced system of

gentle physical exercise and stretching)• Mindful movement

Mindful school

• Just Breathe

Mindfulness in Education

What are the program goals?• To provide universal, developmentally appropriate mindfulness instruction that fosters

mental health and wellness;• To enhance emotion awareness and emotion management skills and to foster

wholesome emotional balance;• To strengthen attention;• To expand the repertoire of skills for stress management;• To help students integrate mindfulness into everyday life.

Mindfulness for Providers

Mindful-Breathing