The ABC Practical Mindfulness Course

Chris Trepka 2009

Why am I here, doing this?

I need mindfulness

We need mindfulness

The ABC we didn’t learn at school

Mindfulness is

‘‘paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment.’’

Jon Kabat-Zinn

Facets Example items

Observing I notice the smells and aromas of things

Describing I am good at finding words to describe my feelings

Acting with awareness I find myself doing things without paying attention (R)

Non-judging of inner experience

I think some of my emotions are bad or inappropriate and I should not feel them (R)

Non-reactivity to inner experience

I perceive my feelings and emotions without having to react to them

5 facets of mindfulness (Baer et al)

What is mindfulness really?

It is a fool’s errand scientifically to try to understand what mindfulness “really” is, if by that one means whatever is being described by the prescientific, lay concept “mindfulness.”

Hayes & Plumb

What is the function of mindfulness?

Attempting to change the impact of thoughts or feelings requires changing the context in which those events occur. Mindfulness seeks to do just that by changing the observer’s relationship to their thoughts and other private experiences rather than changing belief in thought content

Hayes & Plumb

Mindfulness from the bottom up• Human Language and Cognition is Based on Learned

Derived Relations• Derived Relational Learning Greatly Expands the

Capacity for Human Pain• We Try to Solve the Problem of Pain by an Over-

extension of Problem Solving• The Overextensions of Verbal Relations are better

Regulated by Changes in the Functions of Private Experiences [in comparison with more Verbal Problem Solving or Verbally Guided Challenges to the Content of Private Experience]

In less technical language…

1. We learn to think relationally,2. which works instrumentally,3. but increases our access to pain, and causes misery

when applied to our own insides.4. you cannot rein in this kind of judgment

judgmentally,5. but you can learn to do so mindfully, with resulting

broad and deep benefits, especially when it is part of a pattern of values-based action.

ACT and mindfulness

• A set of skills to increase psychological flexibility

• 4 hexaflex processes provide a working definition of mindfulness: contacting present moment, acceptance, defusion, self as context

• 2 other processes intertwined – mindfulness enhances values work and effective action

Self asContext

Contact with the Present Moment

Defusion

Acceptance

Committed Action

Values

Psychological

Flexibility

The Primary ACT Model of Treatment

Mindfulness training - how accessible?

• Courses are experiential and emphasise extensive practicehence not suitable for participants with psychosis, depression, anxiety...

• Course leader needs personal mindfulness practice and a mindful presence

• Buddhist influence brings an implicit spiritual element

Limitations to mindfulness training in 1:1 ACT

• Individual therapy does not provide the optimal context for learning mindfulness skills

• Insufficient opportunities to practice mindfulness in the optimal learning context of an experiential group

My influences

• Kevin Polk’s Togus Intensive Outpatient Program– iView (and now the Grid!)– Noticing: a proxy for mindfulness & self as context

• Russ Harris’ “The Happiness Trap”• Robert Fritz’s “The Path of Least Resistance”• My wonderful colleagues, Lorna Mundy,

Helen Clarke and others

Physical Self

Thinking Self

Three Senses of Self – Russ Harris’ version of the iView

Observing Self

VITALITY

Values

Effective Action

Ineffective Action

SUFFERING

Struggle

STRUGGLE VALUESYOU

SENSORY EXPERIENCE

MENTAL EXPERIENCE

The Grid – adapted from Kevin Polk

Noticing (Kevin Polk)• ‘We long ago found that most people did not like the

formal mindfulness practice and they did not keep it up after they left the program. Now we just have them notice, notice, notice in each of the groups we do’

• ‘If someone asks a question, we almost always answer the question in terms of giving him or her credit for noticing’

• ‘Using this method we never disagree with clients about much of anything. We just say “yes, that’s it” and head toward the iView’

• ‘It’s safe to say we say the word “Noticing” or “Notice” at least 1000 times in four days’

The path of least resistance• Robert Fritz – a musician not a psychologist• “Sigmund Freud was a doctor” (orientation to

alleviating disease not creating health)• The usual responding or reacting tends to lead to

inertia or oscillation• Alternatively become the creative force in your

own life • Creating as a conscious act sets up a different

energy – between your desired result and what currently exists

A – Awareness of what’s here

• Expanding awareness of experience:– Sensations– Perceptions– Emotions– Cognitions– Urges

• Beginner’s mind• Just noticing

B – Being with what’s here

• Open, curious, accepting• Patiently allowing things to unfold in their own

time• Allowing emotions and sensations to open• Noticing what the mind is doing and what urges

arise without going with that• Holding what is here (lightly) and letting go of

wanting to alter anything• Another B – Breathing with what’s here

C – Choosing what to do with it

• More control over – what you do in the present environment– where you place your attention

• This is where freedom actually exists• The illusion of freedom to think, feel, want,

have things be so, change the past or future• Two other Cs

– Creating– Caring

1 – Introduction

• Welcome, introductions, ground rules• Orientation talk

– Circles diagram– You noticing is not a thing and has no limits– Why I need mindfulness– Qualities of mindful noticing– The ABC– Course outline

• Awareness of feet and hands exercise

2 – Your body and the world

• Reflections on the week• Breathing exercise• Body awareness• Noticing the world exercise• Breathing to connect exercise

3 – Doing and Feeling

• Walking exercise• Raisins exercise• Expansion exercise• Urge surfing exercise

4 – Your mind

• Thought watching exercise• Time travelling exercise• Leaves on a stream exercise• Nodding to and letting go exercise

The time line

Distant Past Recent Past Present Near Future Distant Future

5 – Choosing, creating, caring

• Values exercise• Eyes on exercise• Creativity exercise

6 – Follow-up

• How is this working for you?• Body awareness exercise• Expansion exercise• Walking exercise

The initial pilot

• 6 service users, 3 therapists• Introduction• 4 weekly sessions• Follow up

Outcome impressions

• The therapists learned something• So did some of the clients• Dropout is a barrier• Person in a crisis is a barrier• Quiet clients may need more help to engage

well• The talkative person helps everyone

Limitations of the pilot sample

• Clients who remain very entrenched in problems

• Clients I’m trying to detach from• A highly avoidant client found the course

increasingly aversive

Is this worth pursuing?

Ideas for a more formal pilot

• Try the main course within a whole day?• Try with clean and less entrenched clients• Potentiate and back up with more scripts and

handouts• Use MAAS, AAQ, CORE-10, Progress Q• Compare effects with those waiting, and

follow-up• Assess if other therapy progresses better

References

• Baer, R. A. (2003). Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice, (10)2, 125-143.

• Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15, 329-342.

• Fritz R (1989) The Path of Least Resistance. Ballantine.• Harris R (2007) The Happiness Trap. Robinson• Kabat-Zinn J (2005) Coming to Our Senses. Piatkus.

References – ACT theory• Fletcher, L. & Hayes, S. C. (2005). Relational Frame Theory,

Acceptance and Commitment Therapy, and a functional analytic definition of mindfulness. Journal of Rational Emotive and Cognitive Behavioral Therapy, 23, 315-336.

• Hayes, S. C., & Plumb, J. C. (2007) Mindfulness from the Bottom Up: Providing an Inductive Framework for Understanding Mindfulness Processes and their Application to Human Suffering. Psychological Inquiry, 18(4), 242-248.

• Hayes, S. C., & Wilson, K. G. (2003). Mindfulness: Method and process. Clinical Psychology: Science and Practice, 10, 161-165.

• Hayes, S. C., & Shenk, C. (2004). Operationalizing mindfulness without unnecessary attachments. Clinical psychology: Science and practice, 11, 249-254