Rezvan Ameli, Ph.D.Chief Psychologist and Director of Clinical

Training, MAP-NIMH May 2009

Rezvan.Ameli@nih.govwww.rezvanameli.com

Some Facts About MindfulnessMindfulness 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 out…it 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 ConditionFinding: 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 PainFirst ArrowInevitableSensationImpermanence

(Sickness, old age, death) is inherent in human condition

SufferingSecond ArrowOptionalPain + resistanceAttachment 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 Beginner’s Mind

Adapted from Full Catastrophe Living by Kabat-Zinn

Be empty of worrying Think of who created thoughtWhy do you stay in prisonWhen the door is so wide openMove outside the tangle of fear thinkingLive in silenceFlow down and downInto always wideningRings 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 systemCardiovascular systemNervous system Increases inflammationIncreases negative mood statesIncreases adrenaline and cortisol levels

Sky is the limit

StressChangeable aspects

Problem focused strategies

Teaching skills/ providing information

Unchangeable aspects

AcceptanceCompassionHumorKeeping 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

domainsThey 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 ResearchPain 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 PsychotherapiesMindfulness 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

symptomsAn increase in ability to relaxReduction in pain/or enhanced coping with

painGreater energy and enthusiasm for lifeImproved self-esteem

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

How do we do it? simplifiedRAIN 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 Walking Standing Breathing Listening SeeingPain Anger FearCravings … …

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 practiceInformal practice

Practice & Research resources

NIH- R&W –Next course beginning May 15th. (Rezvan.Ameli@NIH.Gov)

NIH Mind Body Week Sept 8-11, 2009Insight Meditation Community of Washington

DCUniversity of MarylandNCCAM

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 -MassachusettsSpirit Rock - CaliforniaOmega Institute – New York