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Clinical Applications of Mindfulness

Clinical Applications of Mindfulness. Dr. Tamara Russell King’s College London, UK PROSER Meeting, IPq , HC Sao Paulo Sept 20 th 2011. Outline of the Talk. What is Mindfulness? Transdiagnostic ? Process (Approach versus Avoid) Clinical Application (issues).

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Clinical Applications of Mindfulness

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  1. Clinical Applications of Mindfulness Dr. Tamara Russell King’s College London, UK PROSER Meeting, IPq, HC Sao Paulo Sept 20th2011

  2. Outline of the Talk What is Mindfulness? Transdiagnostic? Process(Approach versus Avoid) Clinical Application (issues)

  3. Historical Development of Mindfulness Eastern contemplative traditions MBSR (1980’s) DBT/ACT (1990’s) MCBT (2000’s)

  4. Clinical Applications MBSR (JKZ) – physical and mental health settings Dialectical Behaviour Therapy (Linehan) MBCT (Oxford, UK) – mental health setting MB-EAT (Kristeller) Acceptance and Commitment Therapy (Hayes) Group/Individual Myriad of other “mindfulness” applications and adaptations

  5. Applications in Psychiatry Major Depression Borderline Personality Disorder Bipolar Anxiety Disorders (OCD, Anxiety, Phobias) Psychosis Carers (Staff and Families) Eating Disorders BN/AN/EDNOS

  6. But what is it? How can we understand for ourselves? How can we explain to a colleague, carer/family or client?

  7. Mindfulness….. “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (Kabat-Zinn 1994, pg. 4) ?? What does this really mean?

  8. Let’s Have a go……

  9. What can we notice about the mind?

  10. “Monkey Mind”

  11. Open Awareness

  12. Focused Attention

  13. Anchor Something to return to Something to keep focus on NOT distraction

  14. Time of Practice Lutz, A et al (2008) Trends in Cognitive Science, 12(4), 163-169

  15. With psychiatric distress…What is that mind like?

  16. Which one? • Open Awareness? • Focused Attention?

  17. What is at the heart of our clinical work? Suffering Unskilful Responding Mental Distress

  18. What is at the heart of our clinical work? Suffering Unskillful Responding Mental Distress Affect Cognition “Sensations” Non Acceptance “Fighting” Avoidance Attachment Symptoms

  19. MBCT/MBSR Formal group programs with specific training pathway Training to highlight these unskillful patterns and learn new ways of responding to “sensations” Informal mindfulness Individual mindfulness in the therapy room Adaptations (MB-EAT; psychosis, BMT)

  20. Review of MBCT Fjorback, L. O., Arendt, M., Ørnbøl, E., Fink, P. & Walach, H. (2011) Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy – a systematic review of randomized controlled trials , Acta Psychiatrica Scandinavica, 124 (2) pp 102–119 Chiesa, A. & Serretti, A. (2011) Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry Research, 187(3), 441-53

  21. www.mindfulexperience.orgMindfulness Research Guide by David BlackMindfulness Research Monthly (MRG)

  22. Issues Dosage Adequate control groups Small N’s Durability of effects re: longitudinal studies Measurement of mindfulness Key ingredient? Adaptations? Implementation fidelity

  23. Training Teachers to Deliver Mindfulness-Based Interventions: Learning from the UK Experience Rebecca S. Crane, Willem Kuyken, Richard P. Hastings, Neil Rothwell, J. Mark G. Williams Mindfulness (2010) 1:74-86

  24. Core Processes?Why does this work?Caveat: not always about reducing symptoms

  25. Mindfulness Training … Suffering Unskillful Responding Mental Distress Embrace “sensations” Acceptance & compassion Turn Towards Symptoms less distressing

  26. Highly Recommended Article

  27. Summary Turn towards and TAKE A LOOK difficult experiences Accept them and explore them (get to know them) Reduce the secondary suffering that arises from unskilful responding Increased self-knowledge and self-efficacy and sense of control Stop “fighting” with self

  28. With Mindfulness

  29. MFG IFG Anterior Cingulate Insula SMA/SSII Parietal Lobe (uperior) Limbic (Amg, Hipp) Sub-cortical (Thal, Basal Ganglia)

  30. Blue = NF>EFYellow = EF > NFMBSR Group

  31. No short cuts!

  32. What are we asking are patients to do (and how can we do that?)

  33. Preparation • COURAGE • CURIOUSITY • COMPASSION

  34. StaticDynamicBody Signature

  35. Process Move from Doing to being Start where they are at (pacing) A long long journey (for us and them) Not linear No outcome/expectations

  36. Some quotes from patients (psychosis/ED)

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