nhs introductory mindfulness guide
TRANSCRIPT
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An Introductory Guide to
Mindfulness Skills
Dr. Paul Flaxman City University London
Copyright note. This guide has been developed for participants involved in the Promoting the Psychological Well-Being of NHS Staff project, funded by a grant from the Economic and Social Research Council (ESRC). The guide should only be received by participants involved in that project. No part of this document or the associated audio files may be copied or reproduced without prior permission from Dr Paul Flaxman, City University London.
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CONTENTS
INTRODUCTION
What is Mindfulness? 4
What are the Benefits of Mindfulness? 6
HOW TO DEVELOP MINDFULNESS
Formal Mindfulness Meditation, Brief Mindful Practices, Mindfulness
of Daily Activities
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How to Use this Guide and the Audio Files 8
OVERVIEW OF MINDFULNESS EXERCISES
The Raisin Exercise; Body Scan; Mindfulness of Breathing; Breathing
Space
9
Common Challenges 10
FOUR-WEEK TRAINING PROGRAMME
Week 1: Raisin exercise + body scan + awareness of daily activities 13
Week 2: Body scan + mindfulness of breathing + awareness of daily
activities
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Week 3: Mindfulness of breathing + awareness of daily activities +
the breathing space
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Week 4: Making mindfulness part of your life 14
Mindfulness practice diary 15
MINDFULNESS BOOKS AND RESOURCES 16-17
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WELCOME
You have received this guide to mindfulness skills as part of your participation in an
improving staff well-being research project. May I take this opportunity to thank you once
again for taking the time out to participate in my research. As well as receiving this guide,
you will also receive a final summary report of the project, once all the results have been
analysed. It is anticipated that the results of the project will lead to additional training
programmes designed to promote staff well-being and recovery during leisure time.
This guide includes a brief introduction, which describes mindfulness as bringing awareness
to your present moment experience, and explains why this skill is helpful for well-being and
performance. I also outline some recommended ways of developing mindfulness skills,
including guided meditation, brief practices, and bringing present moment awareness to
your routine daily activities. Towards the end of this guide, I have outlined a four-week
training programme. If you are able to practice the exercises as suggested, it is likely you will
be taking a major step towards building mindfulness into your life.
I should say at this point that practice is absolutely crucial! If you do not engage in the
various exercises you will not develop greater mindfulness, and you will not obtain the
benefits that mindfulness has to offer. At first, you just need to practice, even if you don’t
see any immediate benefits or understand why you are doing it. Sometimes you will find the
exercises enjoyable, while at other times you will find them frustrating, tedious, or boring. It
matters not – just keep practicing. Be assured that you will be developing a skill that has
been practiced for thousands of years, and which is now recommended in many
mainstream forms of psychological therapy, stress management, coaching, and
performance enhancement programmes.
Should you wish to read more about mindfulness or explore further training, I have included
a number of books and other resources at the end of the guide.
I wish you well as you embark on your journey towards the cultivation of mindfulness.
Dr Paul Flaxman, City University London, July 2010
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INTRODUCTION
What is Mindfulness?
Mindfulness training has become one of the most important techniques in modern
psychotherapy, stress management, pain management, and performance enhancement.
While mindfulness has become increasingly popular, it is probably the oldest psychological
skills technique we know of. Mindfulness has strong roots in Buddhism, but it is also found
in the practices of Hinduism, Islam, and Christianity (just Google ‘history of mindfulness’ and
you will find various accounts of its long and fruitful history).
Mindfulness is often described as the process of bringing a certain quality of attention to
our moment-by-moment experience. Mindfulness involves becoming more fully aware of
both our internal experiences (e.g., thoughts, feelings, and bodily sensations), and external
experiences (e.g., sounds, interpersonal interactions), as they are happening in the present
moment.
Importantly, mindfulness involves adopting a non-judgemental perspective toward our
internal experiences. This means ‘letting go’ of judgements and evaluations of thoughts,
feelings, or bodily sensations as good or bad, in order to simply be aware of those
experiences just as they are. It is a way of putting our human capacity for awareness to good
use. Mindfulness practice is essentially a form of awareness training – learning to focus and
sustain the spotlight of one’s awareness on present moment experiences.
Jon Kabat-Zinn – one of the West’s most prominent mindfulness trainers – describes
mindfulness as:
“paying attention in a particular way: on purpose, in the present moment, and non-judgementally.”
Similarly, researchers have developed a definition of mindfulness which includes the
following two components:
1. Self-regulation of attention - that is, maintaining attention on immediate, here and
now experience.
2. Non-judgemental orientation toward one’s experiences - an orientation
characterised by curiosity, openness, and acceptance.
Such definitions can be useful to practitioners and researchers of mindfulness. However,
developing mindfulness is more about your personal experience than it is about intellectual
understanding. This is why mindfulness trainers always develop their own personal practice
before advising others on how to cultivate mindfulness skills. Hence, the principal aim of
this guide is to provide you with an experiential introduction to mindfulness – to take you
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through a series of exercises that encourage you to bring mindful awareness to your current
bodily sensations, thoughts, and feelings.
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What are the Benefits of Mindfulness?
A great deal of research has established the health, well-being, and performance benefits of
practicing mindfulness. For example, for over 20 years, Jon Kabat-Zinn and his colleagues in
Massachusetts have been establishing the benefits of mindfulness for helping people
manage chronic pain and symptoms of stress. More recently, research teams in the UK have
demonstrated the effectiveness of mindfulness training for reducing depression (and
mindfulness training is now included in the NICE recommendations for treating depression).
I have included some references at the end of this document if you are interested in reading
more about mindfulness research (I would particularly recommend the review of
mindfulness by the Mental Health Foundation).
To summarise, mindfulness training has been associated with the following benefits:
50% reduction in depression relapse rates over 12 months
50% reduction in general psychiatric symptoms
70% reduction in anxiety
44% reduction in medical symptoms
17% reduction in daily hassles, and 31% reduction in general psychological distress,
among employees trained in the workplace
Some of the most remarkable research findings are emerging from studies that have
assessed the impact of mindfulness meditation on brain and immune system functioning. In
particular, mindfulness meditation has been associated with an increase in brain waves
linked to relaxation, positive mood, and being alert. People who meditate have been found
to have greater cortical thickening in the parts of the brain associated with increased
awareness and attention. In other words, mindfulness training helps you to become more in
tune with your here and now experience, and this has an observable positive influence on
your brain!
More generally, mindfulness is a very useful tool for helping us untangle from difficult or
unwanted thoughts and feelings. It is therefore a very powerful technique when we find
ourselves worrying excessively about the future or ruminating over the past. Mindfulness is
not designed to stop the mind having unwanted thoughts (that’s what minds love to do!),
but the skill allows you to experience such thoughts as passing events in the mind. If you
build mindfulness into your life, you are likely to become much more aware of how your
mind works – noticing the habitual thinking patterns that your mind tends to pursue.
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HOW TO DEVELOP MINDFULNESS
Mindfulness is developed by engaging in a series of meditation-type exercises that ask you
to focus your awareness, in a non-judgemental way, on your current experience. In this
guide, you will be introduced to some of the most common mindfulness practices.
Before considering each of these techniques, it is worth summarising the important features
of mindfulness:
Mindfulness involves bringing awareness to the present moment, and experiencing
internal events from a more accepting and non-judgemental perspective
Mindfulness is a psychological skill that can be honed with regular practice; to
develop the skill, it can be helpful to practice some form of mindfulness every day
Mindfulness exercises are not designed to help you reduce, control, or avoid
unwanted thoughts and emotions
Similarly, relaxation is not the goal of mindfulness (even though the exercises
sometimes produce feelings of calmness or relaxation)
When practicing mindfulness, it doesn’t matter whether your current internal
experience is pleasant or undesirable; the important thing is that you practice being
aware of your various experiences as they unfold from one moment to the next
Developing mindfulness takes practice. It is crucial that you get into the habit of practicing
some form of mindfulness every day. This can include a formal eyes-closed meditation,
along with other practices such as bringing awareness to routine activities (e.g., brushing
one’s teeth, or travelling to and from work).
There are essentially three ways of developing mindfulness skills:
1. Formal mindfulness meditation
This involves closing your eyes and placing awareness on current sensations in the
body (e.g., noticing the sensations of breathing). These practices can be performed
lying down on a bed or mat, or sat upright in a chair.
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2. Brief mindful practices
This guide also introduces shorter mindfulness exercises (such as the ‘breathing
space’), which can be performed with eyes open. In these exercises you bring
awareness to current bodily sensations at frequent points during your day.
3. Mindfulness of daily activities
This third type of practice involves becoming more aware as you perform daily
activities such as eating, drinking, showering or bathing, driving, washing up,
exercising and so on. We perform many activities on ‘automatic pilot’; mindfulness
encourages you to be present to each moment much more frequently.
How to Use this Guide and the Audio Files
This guide provides an introduction to mindfulness, including its benefits for improving well-
being and performance. The exercises described in this document have been recorded as
audio files, which will be sent to you on a CD or will be available for download from a
webpage.
Towards the end of this guide you will find a recommended training schedule for the next
four weeks. If you stick to this schedule as best you can, it is likely that you will have taken
an important step in the development of mindfulness. If there are times that you forget to
practice, you can always refer back to this guide and begin again.
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OVERVIEW OF MINDFULNESS EXERCISES
The aim of this guide is to introduce you to some core mindfulness practices. These
exercises have been borrowed from various mindfulness training programmes, including
mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1990), mindfulness-based cognitive
therapy (MBCT; Segal et al., 2002), and acceptance and commitment therapy (ACT; Hayes et
al., 1999). You will be introduced to the following well-known mindfulness exercises: The
raisin exercise, the body scan, mindfulness of breathing, and the breathing space. Each of
these exercises is described briefly below. These exercises have been recorded as audio files
so that you can practice at home.
The Raisin Exercise
This is a common and useful way to introduce mindfulness. Taking our time with a raisin
provides a number of useful insights, including how mindfulness differs from doing things on
automatic pilot (such as stuffing raisins in our mouth without much awareness!).
The practice also shows how the quality of the experience can change when we bring
mindfulness to the table. It is likely that by focusing on the experience, you really notice the
intense flavours that a raisin provides.
The Body Scan
Learning to shift the spotlight of your non-judgemental awareness around the body is a
great way to cultivate mindfulness. It strengthens your ability to use your attention and
awareness to bring you into the present moment. This exercise is longer than the others, so
it provides plenty of opportunities to be distracted by thoughts and feelings, and therefore
plenty of opportunities to return once again to present moment sensations.
Mindfulness of Breathing
Awareness of the breath is central to mindfulness practice. You can focus on any area of the
breath that feels most prominent for you. That might be where the air comes in and out of
your nostrils, or the way the abdomen rises and falls with each breath. When beginning the
mindfulness journey, it can be useful to stay focused on one aspect of breathing during each
practice. For example, in this guide, you will practice being aware of the sensations and
movement in the belly as you breathe in and out. The instructions repeatedly ask you to
gently return to the breath as soon as you notice that your mind has wandered away to
other things.
Here’s another way of describing this practice – as you breath in, know that you are
breathing in; and, as you breath out, know that you are breathing out.
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The Breathing Space
The breathing space involves three steps:
Step 1: Pull yourself out of automatic pilot and contact the present moment
This can be done by asking yourself, What is in my experience right now? What bodily
sensations are here? What thoughts am I having right now? What feelings am I having? This
helps to activate your present moment awareness.
Step 2: Narrow your awareness to your breathing
Focusing on the breath helps to ‘anchor’ your awareness to the present moment.
Step 3: Expand your awareness to the entire body
This final step helps you to develop a more flexible awareness. Going from a narrow focus
on the breath to a broader focus on all the sensations throughout the entire body.
The three steps can be completed in a couple of minutes, and the exercise may be
performed with your eyes open or closed.
It can be useful to practice the breathing space exercise three or more times per day, and to
use it whenever you find yourself becoming wrapped up in unhelpful thoughts or emotions.
Common Challenges
Focusing on one’s present moment experience might sound easy, but you may quickly
discover that it is not easy at all! I have listed below some common challenges that can
occur when practicing mindfulness, along with some tips on how to deal with those
challenges when they arise.
My mind keeps wandering off
During the exercises you will be asked (for example), to focus your attention on breathing.
Before long, you may find that your mind drifts away to other things, and you become
‘hooked’ by particular thoughts. It is common for people to think that this is wrong, and that
they are not performing the exercises correctly. In fact, drifting away into thoughts is to be
expected – that’s what minds do! Indeed, noticing that you have drifted away into thought,
noticing what you were thinking, and then gently returning your awareness to the breath or
body are all important parts of mindfulness. You will find that mindfulness instructions
provide frequent guidance on returning to the body when the mind has drifted away to
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other things. The mind is often drifting off into the past or the future, while your bodily
sensations are always occurring in the here and now.
I keep falling asleep
For some people – and particularly those who have trouble sleeping – the increased ability
to drop off to sleep is seen as one of the benefits of mindfulness. However, during the early
stages of practice, falling asleep every time may interfere with you developing the skills.
(interestingly, some people have described mindfulness as ‘falling awake’ rather than falling
asleep, to emphasise that mindfulness wakes you up from the habitual automatic pilot
mode, bringing heightened awareness and attention to what is happening in this moment).
Many people find that they nod off during the body scan, which is often performed lying
down. If this keeps happening, you could try the exercise sitting upright in a chair.
Another useful tip is to open your eyes briefly to allow in some light, and then resume the
exercise. If you are worried about nodding off, you can try practicing the exercises with your
eyes open – just cast your eyes downwards towards the floor and allow them to become
unfocused.
I experience unwanted thoughts and/or feelings
In our busy lives we tend to be always on the go. When we stop to practice mindfulness we
step into a ‘being’ mode – just being with whatever experience shows up. During such
moments it is not unusual for difficult thoughts, feelings, and sensations to show up, such as
unwanted thoughts of the past, worries about the future, or anger/ irritation towards
ourselves or others.
This is perfectly normal. In fact, experiencing such thoughts and feelings can be very useful
for cultivating mindfulness, as we tend to get hooked by these thoughts and feelings and
drift away from focusing on the breath or body. This gives us another opportunity to notice
where our mind has gone, and gently return attention to the breath or body.
As you develop the skill of mindfulness you may find it easier to acknowledge and accept
even difficult thoughts and feelings as passing events in the mind, without becoming overly
entangled in them. When you experience difficult thoughts and feelings during a practice,
see if you can just acknowledge them (perhaps say to yourself ‘thinking’ or ‘feeling’ to
remind yourself what is happening), and then return your focus to your present moment
sensations.
I get distracted by noises
If noise distracts you during a practice, see if you can relate to the noise in the same way as
you are learning to relate to your sensations, thoughts and feelings – that is, without
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judgement. You may try building the noise into your practice; experiencing the noise for
what it actually is – sounds reaching your ear drums in this moment, without getting too
wrapped up in where the noise is coming from. Just be aware of the experience as it
unfolds.
I don’t really enjoy doing the mindfulness exercises – I get bored and find them a real
chore
Practicing mindfulness is not about feeling good or relaxing. The aim is to learn how to
relate more skilfully to one’s thoughts, emotions, and bodily sensations, without judgement,
as they unfold in the here and now. One practice can be very pleasant, insightful, and even
euphoric, while the very next practice can be frustrating, boring, irritating, or disturbing. It
matters not. The secret is to just do it. Keep practicing. Build the practice into your daily life.
Take a leap of faith to see what happens. Just do it. If you enjoy it, that’s fine. If you don’t
enjoy it, that’s also fine.
I just don’t have the time
Thank your mind for that one! There are many ways to practice mindfulness. If you really
cannot find 30 minutes a day to practice one of the longer exercises, start out with 5 or 10
minute practices, or make use of even briefer exercises such as the breathing space. For
example, you might choose to take 5 minutes before you get out of bed in the morning to
focus on breathing. The secret is to practice every day. As you develop the skill, you may
even find that you want to make more time for longer practices.
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FOUR-WEEK TRAINING PROGRAMME
Usually, mindfulness training is delivered over several weeks to give you the opportunity to
build up your practice. However, you can begin building mindfulness into your daily life right
now. I have included some guidance below on how much to practice over the next few
weeks. The exercises have been recorded on a CD or will be available to download from a
website (if a CD is not enclosed with this guide you will be sent details of the exercise
website).
Record your experiences in the mindfulness practice diary at the end of this schedule (you
might want to take some copies of this diary so that can use it across the four week training
period).
Week 1: Raisin exercise + body scan + awareness of daily activities
Try the raisin exercise. You will need to find or buy a raisin (if you can’t stand raisins,
you could try the exercise with a jelly baby or other small edible). Really bring your
awareness to the food item. Focus on using all of your senses; be in the moment as
you inspect and then taste your raisin. Be with the experience of eating a raisin.
Perform the body scan once per day for the next week. Record your experiences in
the mindfulness diary – this helps you become even more aware of how your
experience unfolds.
Bring moment-to-moment awareness to one routine activity you perform every day
for the next week (e.g., showering, brushing your teeth, first cup of tea or coffee).
Practice being present during the activity instead of performing the task on
automatic pilot. Pay attention to what you are doing – the feelings in your body, the
sensations of performing the activity. Each time you drift away into thought, gently
return your attention to what you are doing.
Week 2: Body scan + mindfulness of breathing + awareness of daily activities
Perform the body scan every day for the next week
At a different time, practice mindfulness of breathing every day for the next week
Choose another routine activity to be mindful of each time you perform it over the
week.
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Week 3: Mindfulness of breathing + the breathing space + awareness of daily activities
Perform mindfulness of breathing every day for the next week.
Practice the breathing space at three scheduled times each day (e.g., first thing in
the morning, lunch, before bed)
Aim to bring mindfulness to the body spontaneously throughout the day (and
particularly in those moments when you find yourself becoming wrapped up in
unhelpful mindstuff or emotion). For example, if sitting at a desk, just noticing the
sensations in your body sat in the chair. If you are walking along, paying attention to
the sensation and movement in your body as you walk. If you are having lunch, being
fully in the present moment as you eat, noticing the texture and taste of the food.
Week 4: Making mindfulness part of your life
Aim to settle into one formal practice every day. Mindfulness of breathing is a good
practice to build into your daily schedule (or continue using the body scan if you find
that helpful). You could try practicing the exercise without the recorded instructions
if that is more practical. Tip: A mindfulness practice is a great way to start the day!
Bring present moment awareness to a much larger range of routine activities –
challenge yourself to be present during as many routine activities as possible this
week.
Practice using the breathing space in different contexts, and whenever you find
yourself becoming stressed, anxious, or worried.
The secret is to make mindfulness part of your life. Becoming more connected to your here
and now experience, and learning to return to your present moment awareness whenever
your mind becomes overly entangled in unhelpful thoughts or emotions.
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Mindfulness practice diary
Day Exercise Duration Observations and comments
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
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MINDFULNESS BOOKS AND RESOURCES
The following books are highly recommended:
Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through
depression. NY: Springer. – includes a CD with exercises narrated by Jon Kabat-Zinn
Harris, R. (2008). The Happiness Trap: How to stop struggling and start living. Boston, MA:
Trumpeter. – useful mindfulness exercises can be download for a small fee
Kabat-Zinn, J. (1990). Full catastrophe living: The program of the stress reduction clinic at the
university of Massachusetts Medical Center. New York: Dell.
Kabat-Zinn, J. (2001). Mindfulness meditation for everyday life. Piatkus Books.
Kabat-Zinn, J. (2005). Wherever you go there you are. New York: Hyperion.
Useful websites:
For accessing mindfulness information, publications, exercises, training courses, and other
resources.
www.bangor.ac.uk/mindfulness
www.bemindful.co.uk
www.mbsr.co.uk
http://www.mindfulexperience.org/
Alternatively, simply Google ‘mindfulness’ and you will find various useful resources.
Academically oriented papers and texts:
If you are interested in reviewing the theory, research, and practice of mindfulness.
Hayes, S. C., & Wilson, K.G. (2003). Mindfulness: Method and Process. Clinical Psychology:
Science and Practice, 10, 161-165.
Baer, R. A. (Ed.). (2006). Mindfulness-based treatment approaches. San Diego, CA: Elsevier.
Baer, R. A. (Ed.) (2010), Mindfulness and acceptance: Illuminating the processes of change.
Oakland, CA: New Harbinger.
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Bishop, S. R., et al., (2004). Mindfulness: A proposed operational definition. Clinical
Psychology: Science and Practice, 11, 230-241.
Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical
review. Clinical Psychology: Science and Practice, 10, 125-143.
Davidson, R. J., et al. (2003). Alterations in brain and immune function produced by
mindfulness meditation. Psychosomatic Medicine, 65, 564-570.
Grossman, P., et al. (2004). Mindfulness based stress reduction and health: A meta-analysis.
Journal of Psychosomatic Research, 37, 35-43.
Bishop, S. R. (2002). What do we really know about mindfulness-based stress reduction?
Psychosomatic Medicine, 64, 71-84.
Brown, K. W., & Ryan, R.M. (2003). The benefits of being present: Mindfulness and its role in
psychological well-being. Journal of Personality and Social Psychology, 84, 822-848.