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Embracing the Now! How Mindfulness can Build

Resilience in Students and Educators

Dzung X. Vo, MDClinical Assistant Professor

Adolescent Medicine

Summer Institute 2013: Promoting Mental Health in BC SchoolsVancouver, BC ● August 21, 2014

Ly M. Hoang, MASenior School Counsellor

Declaration of Disclosure•Dzung Vo, MD, will be publishing a book entitled The Mindful Teen (New Harbinger Publications, April 205)

•We have no other actual or potential conflict of interest in relation to this program.

•We also assume responsibility for ensuring the scientific validity, objectivity, and completeness of the content of our presentation.

Dzung Vo, MD

Ly Hoang, MA

Acknowledgments

• Jake Locke, MD

• Nimi Singh, MD

• Kelty Mental Health Resource Centre

• York House School

Presentation Objectives

1) Define mindfulness

2) Share the benefits of mindfulness

3) Share mindfulness practices

4) Opportunity for asking questions

5) Share resources for further inquiry

Invitation to You

• Experiences of Mindfulness

• Let go of expectations

• “Beginner’s Mind”

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Guided Practice: Mindfulness of Breathing

Calligraphy by Thich Nhat Hanh

Case: 16y Female

• 16y Female, Grade 11

• Reputation: “Anxious, perfectionist, high-strung”

• On IEP: Gifted with learning disability

• “Meltdowns” before & after exams

• Referred to Counsellor’s office by multiple staff: Came to office in tears

Mindfulness: Personal Experience

Ly Hoang and Dzung Vo on Mindfulness Retreat (Plum Village, 2010)

Mindfulness in Youth: Potential Benefits

• Improve mental health?• Promote development of emotional

regulation and stress management?• Provide lifelong skills?• Improve School Functioning?• Improve School Performance?• Help Teachers?

What is Mindfulness?Mindfulness

Calligraphy by Thich Nhat Hanh

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What is Mindfulness?

“Paying Attention in a particular way:

On Purpose

in the Present Moment

and Non-Judgmentally”

- Jon Kabat-Zinn

Kabat-Zinn J: Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. 1994. p.4.

Mindfulness Practice is…

AutopilotAutopilot AwarenessAwareness

Mindfulness Practice is…

Past/FuturePast/Future Here and Now

Here and Now

Mindfulness Practice is…

JudgmentJudgment CompassionCompassion

Mindfulness Practice is…

“Reacting”“Reacting” “Responding”“Responding”

Mindfulness Practice is…

RuminatingRuminating Letting GoLetting Go

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Mindfulness Myths

• Having a “blank” or “empty” mind

• Seeking “bliss”

• “Escaping pain”

• Relaxation exercises

• “Zoning out,” “Navel Gazing”

• Panacea for everything

• Substitute for advocacy and social change

Is Mindfulness a Religion?

Present in ALL Wisdom Traditions

Formal Mindfulness

• Sitting Meditation

• Body Scan

• Walking Meditation

• Mindful Movements

Moving Meditation

Informal Mindfulness

• Not taking specific time “just” for mindfulness

• Walking

• Eating

• Listening and speaking

• Becoming mindful in all moments of daily life

Mindfulness-Based Stress Reduction (MBSR)

• Centuries: Eastern meditation traditions

• 1979: Stress Reduction Clinic, University of Massachusetts Medical School

• 8-week Program• 2009: Over 240

hospitals and clinics

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Mindfulness: Clinical Interventions

• MBSR: Mindfulness-Based Stress Reduction (Kabat-Zinn)

• MBCT: Mindfulness-Based Cognitive Therapy (Segal, Williams, & Teasdale)

• DBT: Dialectical-Behavioral Therapy (Linehan)• MBRP: Mindfulness-Based Relapse Prevention

(Bowen, Chawla, & Marlatt)• MB-EAT: Mindfulness-Based Eating Awareness

Training (Kristeller et al)• MBCP: Mindfulness-Based Childbirth & Parenting

(Bardacke)• MBSR-T (Teens) (Biegel)• MARS-A: Mindful Awareness and Resilience

Skills for Adolescents (Vo & Locke)

Mindfulness in Adults: Meta-Analysis

• Moderate evidence benefits:– Anxiety

– Depression

– Pain

• Low evidence: Stress/distress, mental-health-related Quality of Life

• Conclusion: Small to moderate reductions of stress-related sx’s

Goyal. JAMA Intern Med. 2014;174(3):357-68

MBSR, Stress, Amygdala

Holzel BK. Soc Cogn Affect Neurosci. 2010; 5: 11-17

“Mindfulness: Youth Voices” Video

http://keltymentalhealth.ca/healthy-living/mindfulness

Adapting Mindfulness Teaching for Youth

• Cognitive Development: Concrete language

• Attention: Shorter Practices• Examples: Relevant• Social environment: Teen-friendly• Settings: Clinical; Educational;

Community

BC Children’s Hospital: MARS-A

• “Mindful Awareness and Resilience Skills for Adolescents”

• Adapted from MBSR (Kabat-Zinn), MBCT (Segal et al), MBSR-T (Biegel)

• Adolescents age 15-19y with psychological distress

• With or without chronic illness, chronic pain

Kabat-Zinn J. Full Catastrophe Living. New York: Bantam Dell, 2005Segal, Williams & Teasdale. Mindfulness-Based Cognitive Therapy for Depression (2nd Ed). New York: Guilford Press, 2012Biegel G et al. J. Consulting and Clinical Psychology. 2009; 77(5): 855.

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Mindfulness in Youth: Meta-Analysis

• 20 articles met inclusion criteria– Mostly school-based

• MBI beneficial for range of outcomes– Small-moderate effect sizes

– No iatrogenic harm

• Greatest Benefits:– Psychological Symptoms

– Clinical PopulationsZoogman S. Mindfulness. Jan 2014.

Mindfulness in Education: Canada

• BC: MindUP

• Toronto: Mindful Ambassador Council

Schonert-Reichl K. Mindfulness. 2010; 1(3): 137.http://mindfulnesswithoutborders.org/youth

MindUP: Video

http://vimeo.com/86520490 (6 min)

http://thehawnfoundation.org/

MindUP: Research

• Grade 4 – 7• Acceptable and feasible for teachers• Improved Optimism• Improved prosocial classrooms

behaviors• Less depression, aggression• Improved stress regulation

Schonert-Reichl K. Mindfulness. 2010; 1(3): 137.Lawlor MS. New Directions for Youth Development. 2014;142:83

Mindfulness in Education

• Related to SEL: Social-Emotional Learning

• Cognitive, Executive Functioning

• Social skills, Emotional regulation

• Teachers: Self-efficacy, Classroom Management

• Caution: Research still in infancy

Meiklejohn J. Mindfulness. 2012; 3(4):291Frank. Research in Human Development. 2013; 10(3):205.Greenberg MT. Child Dev Perspectives. 2011; 0(0):1

Mindfulness Case Study: York House School

• Individual counselling

• Assemblies

• Before test and exams

• School play

• Mindfulness club

• Supporting staff

• “Mindful culture”

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Back to the Case: 16y Female

• Introduced mindfulness as a stress management strategy

• Practiced together

• Guided practice before test and exams

• Dramatic change in coping noticed by staff and the student herself

Mindfulness for Teachers

Teaching Mindfulness

“Take my advice,

I’m not using it”

Why Mindfulness for Teachers?

• Teaching is socially and emotionally demanding

• Teachers are expected to:– Support students emotionally– Model healthy emotional regulation– Create positive classroom

environment

Jennings, P. A. (2011). Promoting teachers’ social and emotional competencies to support performance and reduce burnout. In A. Cohan & A. Honigsfeld (Eds.), Breaking the mold of pre-service and inservice teacher education: Innovative and successful practices for the 21st century (pp. 133–143). New York: Rowman & Littlefield.

Jenning and Greenberg. (2009). Review of Educational Research. 79, 491.

SMART in Education

• Stress Management and Relaxation Techniques (SMART) in Education

• Professional Development for K-12 Teachers and administrators

• 8-week program, Modeled on MBSR• Currently piloted in Colorado &

Vancouver• http://smart-in-education.org

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SMART in Education

• “I have never experienced this in all my years of teaching. The kids are really calm”

• “I am getting a lot more than I bargained for… I am softer and kinder to the world”

• “I now approach my day… with greater confidence”

http://smart-in-education.org

CARE: Cultivating Awareness and Resilience in Education

• Teachers pre-K-12. Goals:– Improve overall well-being &

effectiveness – Improve teacher-child relationships and

classroom environment– Increase students’ prosocial behaviors

• Various formats: Intensives, retreats• Preliminary Research: Promising

www.garrisoninstitute.orgJennings PA. Journal of Classroom Interaction. 2011; 46(1):37.

“I've learned that people will forget what you said, people will forget what you did, but people will never forget how

you made them feel.”

-- Maya Angelou

“Object” Meditation

Image courtesy of SOMMAI / FreeDigitalPhotos.net

Mindfulness in Education: More Programs and Resources• MindUP (BC)

– http://thehawnfoundation.org/mindup/

• Mindful Schools (California)– http://www.mindfulschools.org/

• .Be (“dot-be”) (UK)– http://mindfulnessinschools.org/

• Mindfulness for Schools: Goodwill Teaching Guide (UK)– http://www.mindfulnessforschools.com

Mindfulness in Education: More Resources

• Broderick P., Learning to BREATHE. (2013)

– http://learning2breathe.org

• Saltzman A., A Still Quiet Place. (2014)

– www.stillquietplace.com

• MindUP Curriculum (Scholastic)

• Srinivasan M., Teach, Breathe, Learn. (2014)

– htttp://teachbreathelearn.com

• McHenry & Brady, eds. Tuning In: Mindfulness in Teaching and Learning.(2009)

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Mindfulness in Education: More Programs and Resources• MBSRBC.ca

• Dalai Lama Center for Peace and Education

– http://dalailamacenter.org/

• Mindfulness in Education Network

– www.mindfuled.org

• Association for Mindfulness in Education

– www.mindfuleducation.org

• Collaborative for Academic, Social, and Emotional Learning (CASEL)

• www.casel.org

Further Resources

• Stahl & Goldstein. A Mindfulness-Based Stress Reduction Workbook. (2010)

• Biegel G. The Stress Reduction Workbook for Teens. (2009)

• Willlard C. Mindfulness for Teen Anxiety. (2014)

• Greenland SK. The Mindful Child. (2010)

• Himmelstein, S. A Mindfulness-Based Approach to Working with High-Risk Adolescents (2013)

• Willard C. Child’s Mind (2010)

• Late 2014 or early 2015: Dzung Vo, The Mindful Teen (New Harbinger Publications)

– www.newharbinger.com

– Twitter: @TheMindfulTeen

Questions?

Dzung X. Vo, MDdvo@cw.bc.ca

Twitter: @DzungXVo, @TheMindfulTeen

Ly M. Hoang, MAlhoang@yorkhouse.ca

STOP MeditationBriefly step into present moment

• S Stop

• T Take 3 Breaths (or more)

• O Observe (body, feelings, thoughts)

• P Proceed

• Whenever you “hear a bell” – i.e., door closing, phone rings, car honking etc

• Whenever you feel stress arise

“Keeping Quiet,” Pablo Neruda