MindfulnessBased Stress Reduction as an Adjunct to Psychotherapy

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Mindfulness-Based Stress Reduction as an Adjunct
to Psychotherapy

• with
• Steve Shealy, PhD
• www.BeMindful.org

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What is Mindfulness?
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Definitions of Mindfulness

• moment-to-moment awareness
• keeping ones consciousness alive to the present
  reality
• the clear and single-minded awareness of what
  actually happens to us or within us at the
  successive moments of ones unfolding perception
• a subtle, nonverbal experience that defies
  definition

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Definitions of Mindfulness

• As Mindfulness relates to psychotherapy, it
  may be best defined as
• awareness of
• ones present experience
• with acceptance.

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Mindfulness isintentionally directing ones
attention to their present experience without

• judgment
• internal dialogue/self-talk
• emotional reactivity/acting in
• physical reaction/acting out
• attempting to avoid the experience

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Mindfulness is being with our unfolding
experience without adding our usual elaborations
and distortions to that experience.
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MINDFULNESS-BASEDINTERVENTIONS Mindfulness-Based
Stress Reduction Program (MBSR) founded by Jon
Kabat-Zinn, Ph.D. for medical illnesses and
psychiatric disorders in 1979.
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The MBSR Program Includes

• Sitting Meditation
• Body Scan
• Mindful Hatha Yoga
• Walking Meditation
• Informal daily practices

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The MBSR Program

• 8-week commitment
• 8 2-1/2 hour group sessions
• 45-60 minutes daily homework
• A day-long mostly silent retreat

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The MBSR Program

• The primary goal is to establish
• the Habit Of
• Mindfulness

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Clinical Research

• into the Effectiveness of
• Mindfulness Based Stress Reduction

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Clinical Research

• two decades of published research
• best data for chronic pain and anxiety disorders
• also studies on depression, fibromyalgia,
  psoriasis, breast cancer, inner-city populations,
  medical students/residents
• on-going research into other diseases/disorders
• mindfulness-based cognitive therapy (MBCT)

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Those practicing mindfulness commonly report
experiencing

• Relaxed awareness of the present moment
• Enhanced psychological flexibility
• Release of attachment and aversion
• Greater stress tolerance and impulse control
• Clarity and awareness of thought patterns
• Greater insight

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MBSR has demonstrated its usefulness in treating

• Chronic Pain
• Psoriasis
• Anxiety Panic Disorders
• Depression
• Fibromyalgia
• Prostate Breast Cancer
• HIV/AIDS other illnesses

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Clinical research demonstrates long-lasting
improvements

• Improved health-related quality of life
• Reduced chronic pain physical distress
• Fewer and less intense headaches
• Reduced pain-related drug use
• Decreased blood pressure
• Strengthened immunity
• Improved sleep quality
• Reduced tension, anger and fatigue

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Clinical research demonstrates long-lasting
improvements

• Improved regulation of emotions
• Increased social activity and vitality
• Reduced anxiety, panic depression
• Reduced substance abuse
• Decreased interpersonal problems
• Increased sense of meaning in life
• Enhanced self-esteem
• Decreased psychiatric hospitalizations

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Chronic Pain Patients

• An Outpatient Program in Behavioral Medicine for
  Chronic Pain Patients Based on the Practice of
  Mindfulness Meditation. Kabat-Zinn, J. General
  Hospital Psychiatry (1982)
• n51
• t pre-/post-, 7 mo. follow-up
• chronic pain patients

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Chronic Pain Patients

• ? 1/2 of patients gtgt 50 decrease in pain
• ? 2/3 of patients gtgt 33 decrease in pain
• ? significant increase in life activities
• ?Medical symptoms (MSCL)
• 1/2 of patients gtgt 33 decrease
• 1/3 of patients gtgt 50 decrease
• ?Psychological symptoms (GSI)
• 1/2 of patients gtgt 33 decrease
• 1/3 of patients gtgt 50 decrease
  
• ?Mood symptoms (TMD)
• 2/3 of patients gtgt 50 decrease
• 3/4 of patients gtgt 33 decrease

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Chronic Pain Patients

• Four-year Follow-up of a Meditation-Based Program
  for the Self-Regulation of Chronic PainTreatment
  Outcomes and Compliance. Kabat-Zinn, et al
  Clinical Journal of Pain (1987)

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Chronic Pain Patients 4 Yr FU

• decreased pain (PRI)
• 30-55 great improvement
• 40 moderate improvement
• 25 no change
• 5 worse
• decreased negative body image (BPPA)
• ?decreased medical complaints (MSCL)
• ?decreased psych symptoms (GSI)
• ?gains maintained (except PRI) x 4yrs

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Chronic Pain Patients 4 Yr FU

• overall improvement (3.8-4.0) maintained at
  4yrs
• ?anything of lasting value or importance? 86
  yes
• 67 reported 8-10/10 importance at 4 yrs.
• ? Compliance
• AOBDL 78-90
• any of 3 formal practices 93
• regular meditation 50 at 1 yr., 30 at 4 yrs.
• sporadic meditation 20
• marginal meditation 50

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Chronic Pain Patients 4 Yr FU

• Comments
• ?impressive maintenance of gains
• ?high compliance
• self-controlled

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MBSR and Anxiety Disorders

• Effectiveness of a Meditation-Based Stress
  Reduction Program in the Treatment of Anxiety
  Disorders, Kabat-Zinn, J.,American Journal of
  Psychiatry, 1992
• prospective cohort
• n22
• t pre-/post-, 3 mo. follow-up
• anxiety disorders (GAD, panic disorder
  /-agoraphobia)

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MBSR and Anxiety Disorders

• ? 20/22 individual improvement
• ? 25-65 decrease in mean Hamilton and Beck
  depression and anxiety scales
• ? decreased frequency of panic attacks
• ? decreased medical symptoms (MSCL)
• ? gains maintained at 3 month follow-up
• ? 90 still using techniques at 3 months

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MBSR and Anxiety Dx 3 Yr FU

• Three-Year Follow-Up and Clinical Implications
  of a Mindfulness Meditation-Based Stress
  Reduction Intervention in the Treatment of
  Anxiety Disorders. Miller, et al, General
  Hospital Psychiatry, 1995
• retrospective cohort
• n18
• t pre-/post-, 3 yr. follow-up
• anxiety disorders

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MBSR and Anxiety Dx 3 Yr FU

• 18/22 responded
• ?gains maintained at 3 years (mean Beck and
  Hamilton depression/anxiety all
  unchanged)
• 4 patients discontinued all other treatments
• 10/18 continued formal mindfulness practice
• 16/18 AOBDL
• anything of lasting value or importance?
  16/18 yes

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MBSR and Major Depression

• Prevention of Relapse/Recurrence in Major
  Depression by Mindfulness-Based Cognitive
  Therapy. Teasdale, et al., Journal of Consulting
  and Clinical Psychology, 2000.
• experimental trial (TAU vs. TAU MBCT)
• n145
• t pre-/post-, 1 yr. follow-up
• major depression

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MBSR and Major Depression

• Prevention of Relapse/Recurrence in Major
  Depression by Mindfulness-Based Cognitive
  Therapy. Teasdale, et al., Journal of Consulting
  and Clinical Psychology, 2000.
• decreased risk of relapse by 39-44 in patients
  with h/o gt 3 recurrences
• ?no significant difference in patients with lt 2
  recurrences

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Underlying Mechanisms

• research shows that changing deeply ingrained
  habits requires
• developing awareness and discontinuing old
  behaviors
• establishing and repeating new behaviors
• these occur over a significant period of time (no
  quick-fixes)
• these habits can be either
• ways of thinking, speaking and/or behaving
• underlying unconscious tendencies (anxiety vs.
  calmness)

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Underlying Mechanisms

• MBSR an integration of meditation (mind) and yoga
  (body) facilitates habit change
• Increased awareness of old behaviors and triggers
  preceding them
• A host of new behaviors (sitting, eating and
  walking meditation, hatha yoga)
• Regular practice of these new, stabilizing,
  self-calming behaviors
• homework exercises and supportive group
  interaction over a two month period
• strong support for MBSR in empirical literature
  (chronic pain, anxiety, depression)

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Mindfulness Based Stress Reduction
Psychotherapy

• Steve Shealy, PhD
• www.BeMindful.org
• 813-980-2700