`MINDFULNESS MEDITATION Launchpad Community Lecture Tuesday 21st November 2006

Three things I would like to do this afternoon: 1. Introduce you to Mindfulness Meditation and if you wish, to experience a little as a taster. 2. Give some background information and make a few comments about Mindful based approaches to “therapy”. 3. Bring us up to date with what is happening locally and offer invitations. There is an accompanying leaflet.

1. Introduction to Mindfulness Meditation: Experience There is a journey with which I am very familiar. It is the one with which I usually start my working day driving from home to St Nicholas Hospital. When I get to the main road I turn left. That’s the same junction that I turn right if going into town, a journey I often used to make to drop our younger daughter off at the theatre school she used to attend some years ago now. I still have a vivid memory of on more than one occasion driving along and being interrupted by this voice. It said something like: “Dad, where are you going?” although there was an intonation of exasperation after the first time or two. I had turned left and was heading towards to work rather than right towards the Tyne Theatre. I was, mind and body, on automatic pilot. We all adopt automatic modes of behaviour not just in driving someone else where they do not want to go but also, at times, travelling along well worn ruts of thinking, feeling and acting that we would rather not do so. Are you with me? If not where are you? Somewhere in the past, thinking over what you have been doing or think you should have done, or are you planning or worrying about what you might be doing sometime in the future. We spend a lot of time either in the past or the future. But what is it like to be here and now, in the present moment? I want to gently invite you all to take a “breather” with me. In fact some people call it a threeminute breathing space and there are three steps we can take…


The Three Minute Breathing Space – some basic instructions (on the leaflet) i. Awareness Bring yourself into the present moment by adopting an upright and dignified posture. If you are comfortable doing so, close your eyes. Now ask yourself: “What am I experiencing right now?....in my thoughts?….in my feelings?…in my bodily, physical sensations?” Acknowledge and register your experience, even if it is unwanted. ii. Gathering Now gently invite yourself to redirect all your attention to your breathing. Just notice each in-breath and each out-breath as they follow one another. Your breath can function as an anchor to bring you into the present and to help you to become more still and more fully aware. iii. Expanding Allow your field of awareness to expand around your breathing so that it includes a sense of your body as a whole, including posture and facial expression. The breathing space provides a way to step out of Automatic Pilot mode and to reconnect with the present moment. [It is developed beyond this basic format to lead to a moment when there is a choice to either stay with the experience of how things are (pleasant or unpleasant) or to implement a prepared action plan. Mental distress often requires such precision (e.g. doing some practical activity can at times be effective in lifting our mood, at other times it might be a way of avoiding noticing how things really are).]

We have just experienced a flavour of a mindfulness-based approach to looking after ourselves. The key skill is to maintain awareness from moment to moment, nothing else!

So what is this thing called mindfulness, where does it come from and where does meditation come into the picture?


2. Some background information & discussion “Mindfulness is paying attention in a particular way: on purpose, in the present moment and non-judgementally.” Jon Kabat-Zinn (1994) (on the leaflet) (Attention, intention & attitude are referred to later in a research paper Shapiro et al.) Jon Kabat-Zinn et al in Massachusetts USA during 80s & 90s developed Mindfulness Based Stress Reduction programmes and found it effective with pain & stress reduction. This approach adapts and builds on the Buddhist practice of mindful meditation in a way that does not refer directly to a religious and philosophical framework and so makes it accessible to a wide range of users. 8 or 10 session courses with groups, some really much larger than we might ever consider likely to be effective therapeutically, with content include: Body scan Sitting meditation, focussing on the breath (tapes/cds) Eating Gentle stretches (yoga type exercises) Walking meditation 3 minute breathing space Story telling and poetry Group reflection on practice and discussion Homework practice e.g. 40 mins body scan, 40 minutes sitting meditation, selecting an everyday task to carry out mindfully…to wash the dishes to wash the dishes (drive the car to drive the car…!!), cleaning teeth, taking a shower etc

The basic intention is to become aware of what is going on in our bodies and minds. It is not a technique, more a way of life! Here are the mindfulness principles or “pillars” (on the leaflet): Cultivating a helpful attitude to practice: “7 pillars of Mindfulness” 1. Non-judging – all that is needed is to watch what is happening…including how we habitually judge & react to our own experience. 2. Patience – impatience yanks at a knot in shoe-laces and ends up making the knot tighter than before. Patience unravels the knot carefully, one loop at a time. 3. Beginner‟s Mind – „In the beginner’s mind there are many possibilities, but in the expert’s view very few.’ Seeing things, childlike, for the first time. 4. Trust – listening to the teacher helps guide you, but listening to yourself is vital.


5. Non-striving – If striving were effective, wouldn’t you have succeeded already? Mindfulness practice is a chance to try a profoundly different approach. 6. Acceptance – In mindfulness practice we cultivate acceptance by taking each moment and each aspect of our experience just as they come, focussing on the present and being receptive to the flow of all that comes to us and passes on. 7. Letting go – In mindfulness practice we just keep on acknowledging whatever arises, then letting it pass on when it will, making space for the next moment and the next experience. How to catch a monkey? Cut a hole in a coconut and insert a banana. Along comes a monkey, inserts its hand to grasp the banana and as it tightens its grip it becomes impossible to withdraw its hand through the hole. You have your monkey! How often do we let go?

And here is a flavour of one of the readings used in the sessions (on the leaflet):

A flavour of acceptance: “The Guest House” This being human is a guest-house Every morning a new arrival. A joy, a depression, a meanness, Some momentary awareness comes as an unexpected visitor. Welcome and entertain them all! Even if they’re a crowd of sorrows, who violently sweep your house empty of its furniture; still, treat each guest honourably. He may be clearing you out for some new delight. The dark thought, the shame, the malice, meet them at the door laughing, and invite them in. Be grateful for whoever comes, because each has been sent as a guide from beyond. Rumi Muslim 14th century mystic


Some cognitive therapists were looking for ways to help people who had benefited from cognitive therapy prevent relapsing into depression. They examined several possibilities leading them to explore Kabat-Zinn’s work. They tell the story in their textbook (reference on the leaflet) on which a lot of our work locally has been based. They selected parts of Kabat-Zinn’s course as described in his “Full Catastrophe Living” to integrate some cognitive therapy and chose to be selective about the material and guidance to practice meditation themselves, focussing more on the approach as a technique. Initial findings were not satisfactory and so they revisited Massachusetts’s clinic to learn, amongst other things, the centrality of having a personal meditation practice themselves in order to be authentic teachers. And so they created the 8 session mindfulness based cognitive therapy course published in 2002. Bangor, University of Wales became a centre for teaching and training Mindfulness-based approaches. Some years ago now I was asked by a psychologist colleague if I might be interested in this approach, if I had any experience of this form of meditation and if I knew of someone who could help guide us in this approach. A meditation teacher and psychotherapist friend joined us in setting about running a series of introductory workshops. Our primary aim was to see if it is possible to build up a group of clinicians who practiced mindfulness meditation and who then would move onto the clinical application of this approach. (The Royal College of Psychiatry Spirituality Special Interest Group comment about genius of Kabat-Zinn to bridge the personal commitment with clinical effectiveness but shared scepticism about whether the NHS would contain/allow enough Mindfulness Meditation practitioners to practise clinically.) So far more than 150 staff have attended an introductory workshop and about 50 an 8 session course or its equivalent. Most, if not all, take part as much out of personal as well as profession interest. Some reactions include: What did you gain from this session? Myself Body scan- frightening experience, very disturbing 3 minute breathing space “I will never get it” …then, one day, when practising it… “eureka”! My migraine went away Impossible workload became possible! Does it work & who‟s it for? Baer (reference on leaflet) considers Dialectical Behavioural Therapy (Linehan) and Acceptance Commitment Therapy as having common ground with Mindfulness based approaches & evaluates the limited research evidence available to date. She concludes Mindfulness based approaches may help clients through the following mechanisms: Exposure Cognitive Change Self-management Relaxation Acceptance


Research indicates that using Mindfulness based approaches with: Chronic pain = less pain & reductions in medical & psychological symptoms. Generalised Anxiety Disorder = improvement in anxiety & depression symptoms. Binge eating = improvements in anxiety & mood. Depression = clients with 2 (?) previous episodes did not benefit but 50% reduction in relapse amongst those with 3 or more. Skin complaints (e.g. psoriasis) = improvements These are tentative findings based on a few studies without control groups, no comparisons with other approaches and small sample sizes but suggest on average participants with mild to moderate psychological distress will be brought into or close to the normal range. It is important that mindfulness is linked to an alternative & coherent views of clients’ problems that are shared with them & reinforced through practice. Meditation is simple – but it is not easy! It allows individuals to switch out of a general goal based mode of processing in which judgements, evaluations & discrepancies between actual & desired states are central. But practice should not be conducted in a goal-orientated manner! (Compared with cognitive behavioural therapy mindfulness based approaches are practice focussed rather than setting out to achieve change.) Mindfulness needs to be integrated into a whole view of emotional suffering and disorder and this resolution lies at the heart of the practice.

How does it work? Shapiro et al.(reference on leaflet): this is a paper towards a model rather than the model with the focus on intention, attention & attitude as the means to reperceiving. They describe the shift from self-regulation, to self-exploration and finally to self-liberation. However, there is a danger, which is also a paradox, that models can become too mechanistic in their explanations of something which depends essentially on practice for the sake of practice.

Why is it becoming so popular now? The medical historian Roy Porter claimed, with others, we live in the age of information. It is often said nowadays we live in the age of anxiety. We seek many ways of resolving our disease including a range of therapeutic approaches which aim to “fix” things for us. In this post-modern world where anything goes and leaves too much to market force, if everything is up for grabs what or who can we trust? Indeed, how can we live with ourselves? I think mindfulness practice reminds us of ancient human wisdom often reflected in world philosophies & religions which help us pay realistic and compassionate attention to ourselves, mind and body (more in the Hebrew tradition than the Greek which can split mind and body). Here are some more contemporary quotes which reflect something of this wisdom:


In the so called Serenity prayer (used in the 8 session course and by many others such as AA) we ask for the grace to accept with serenity the things that cannot be changed, the courage to change the things that should be changed, and the wisdom to distinguish one from the other. “At the still point of the turning world…there the dance is” T S Eliot “Where is the life we have lost in living? Where is the wisdom we lost in knowledge? Where is the knowledge we have lost I information?” T S Eliot “We do not see things as they are. We see them as we are.” The Talmud “Only what you have experienced yourself can be called knowledge. Everything is information.” Albert Einstein “We often lose the vividness of the present moment by „being somewhere else.‟ When we are able to be in the present moment, we become more awake in our lives, more aware, with more choices open to us.” Segal, Williams & Teasdale

What about the state of the world? How can mindfulness make a difference? Can therapy be political? This is too big a question to do justice to here but consider Brian Keenan’s experience reflected in his book “An evil cradling” which seems to epitomise how you cannot always change things, events or people but you can change your relationship to them. This can have an effect on others. Or picture the serene smile of a Tibetan Lama in exile. Acceptance, survival & action are all choices open to us.

3. Invitations Staff are welcome to attend workshops and a special interest group for those interested in the clinical applications of mindfulness based approaches. These are advertised internally in the Trust as are continuation practice sessions open to anyone, staff or patient. Some of us also provide training sessions for clinical psychology students at Newcastle University and CBT trainees locally.


So far as I am aware mindfulness practice has only been introduced to individual service users by clinicians. Some of us are interested in sharing the 8 session course with a group of users or even a mixed group of staff and users. Whatever you think about all of this there is no substitute for experience and practice and it would be good to finish with short period of sitting meditation (time permitting). And remember this may seem simple and it is; but that does not mean it is easy!

5 steps of practice: 1. Whenever possible just do one thing at a time 2. Pay full attention to what it is you are doing. 3. When the mind wanders from this gently bring it back. 4. Repeat step No.3 several billion times. (lifetime achievement!!) 5. Investigate your distractions (Larry Rosenberg (1998)

The Revd F Brian Allen Chaplaincy Team Leader Chaplaincy Centre St Nicholas Hospital Gosforth, Newcastle upon Tyne NE3 3XT 0844 811 5522 ext.28465 Email: Brian.Allen@ntw.nhs.uk


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