Rezvan Ameli, Ph.D. Chief Psychologist and Director of Clinical Training, MAP-NIMH May 2009 Rezvan.Ameli@nih.gov www.rezvanameli.

com

Some Facts About Mindfulness

Mindfulness does not require any particular religious

or cultural belief system.

It is not something we acquire.
It is simple but not easy! There has been and explosion of interest in

mindfulness.

Definition # 1
"Mindfulness is to be aware . To be aware when you are breathing in and to be aware when you are breathing outit 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
Thich Nhat Hanh
Book recommendation: Peace is Every Step

Definition # 2
"Mindfulness is paying attention,

on purpose, in the present, and non-judgmentally , to the unfolding of experience moment by moment
Jon Kabat-Zinn Book Recommendation: Full Catastrophe Living

Definition #3
Mindfulness is to distinguish awareness from mental activity it is to learn to be aware of our own mental states without being caught in them
Jack Kornfield Book Recommendation: Wise Heart

Influential scientist of mindfulness: the Buddha

Subject: Human Condition Finding: Suffering is universal. We suffer because of the way in which we relate to our human condition (not the human condition itself). There is hope of liberation from suffering

Suggestion: Replace the word suffering with stress

Pain vs. Suffering

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

What is the Solution?

Accept what is, including impermanence Let go of attachments

Stay present (live in our bodies not in our heads)

Maintain a kind & friendly attitude towards

ourselves and others

Attitudinal Foundations of Mindfulness

Non-Judging
Patience Trust Non-striving Acceptance Letting go Beginners Mind
Adapted from Full Catastrophe Living by Kabat-Zinn

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

Stress Reaction Vs. Response

Stress reaction: External event internal event

alarm reactivity stress reaction acute hyper arousal increases chance of survival in a dangerous and hostile situations Stress Response: introducing conscious process that influences the flow of events that are likely to bring about automatic reactivity.

We can make a choice: React or Pause and Respond

Between the stimulus and response, there is a space and in that space lies our freedom and power to choose our response." Victor Frankl We can choose not to throw the second arrow at ourselves

The President pauses . . .

Adverse impact of stress

Immune system
Cardiovascular system Nervous system Increases inflammation Increases negative mood states Increases adrenaline and cortisol levels

Sky is the limit

Stress
Changeable aspects
Problem focused

Unchangeable aspects
Acceptance

strategies Teaching skills/ providing information

Compassion
Humor Keeping count of

positives in life

Familiar?
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.

Reinhold Niebuhr (1892-1971)

Positive & Negative Affect

Are not on the same continuum. Impact physiological , behavioral and social domains They impact disease outcome (Grant, et al 2009) and

longevity (Nyklicek & Kuijpers 2008) Mindfulness decreases negative affect and increases positive affect (Ludwig & Kabat-Zinn 2009, Greeson 2008, Baer 2003)

Mindfulness Research
Pain management/pain reduction (Kabat-Zinn)
Immune functions (Kabat-Zinn, Creswell) Brain function changes with mindfulness

(Davidson) Depression (Segal, Williams, Teasdale) Eating disorders (Wansink) Empathy/reduction in physician error (Epstein, Santorelli)

Mindfulness: Major Impact Third Wave of Psychotherapies

Mindfulness Based Stress Reduction (MBSR) (Jon

Kabat-Zinn) Mindfulness Based Cognitive Therapy (MBCT) (Zindel Segal, John Teasdale, Mark Williams) Dialectical Behavior Therapy (DBT) (Marsha Linehan) Acceptance Commitment Therapy (ACT) (Steve Hays)

What do people report after a course in mindfulness training?

Lasting decrease in physical and psychological

symptoms An increase in ability to relax Reduction in pain/or enhanced coping with pain Greater energy and enthusiasm for life Improved self-esteem

Center for Mindfulness in Medicine, Health Care, and Society, UMASS School of Medicine

How do we do it? simplified

RAIN of Compassion

Recognition- NOTICE what is happening Acceptance say yes, allow, make room for the experience. Investigate be curious, even familiar experiences do not repeat. Non-identification become a witness to the experience. Do not
get caught in it.

+ Compassion: maintaining at attitude of kindness,

friendliness, and gentleness towards self and others.

To what do we apply Mindfulness?

Start with a pause and a heartfelt smile of course:
Eating Breathing Pain Cravings Walking Listening Anger Standing Seeing Fear

Sky is the limit!

Practice, practice, practice

Developing and cultivating a mindfulness practice is simple but not easy. Most likely you will need teachers and fellow travelers along the way. Formal practice Informal practice

Practice & Research resources

NIH- R&W Next course beginning May 15th.

(Rezvan.Ameli@NIH.Gov) NIH Mind Body Week Sept 8-11, 2009 Insight Meditation Community of Washington DC University of Maryland NCCAM

Other practice & research resources

University of Massachusetts Center for Mindfulness in

Medicine, Health Care, and Society UCLA Semel Institute, Mindful Awareness Research Center Insight Meditation Society -Massachusetts Spirit Rock - California Omega Institute New York