MINDFULNESS BASED STRESS REDUCTION MBSR Jim Messina Ph

MINDFULNESS BASED STRESS REDUCTION (MBSR) Jim Messina, Ph. D. , CCMHC, NCC, DCMHS-T Lecturer in CMHC Program, Troy University, Tampa Bay Site

BACKGROUND ON MBSR

What is Mindfulness? The practice of mindfulness involves: ■ learning (or perhaps more accurately re-learning) how to be present and aware in a given moment ■ Teaching ourselves to be more Aware: to direct focus of attention to something like our body, our mind, or something in the environment Present: being in this place and moment, right here, right now Focused: more able to be able to choose and control where we place our attention ■ Mindfulness is a “skill” that can be learned and can improve with practice ■ It promotes better patience, compassion, kindness toward ourselves and others

RESEARCH ON MINDFULNESS

Mindfulness Research ■ Mindfulness helps us to tap into the present moment – for relaxation and reduction of stress in any situation: at home, at the office or school, while driving, and while shopping ■ Mindfulness has been found to reduce opioid cue-reactivity while restructuring natural reward processing and provides preliminary support for the hypothesis that behavioral interventions may ameliorate craving by enhancing reward responsiveness (Garland, Froeliger, & Howard, 2014). ■ Mindfulness has been shown to be both feasible and efficacious as a treatment for cooccurring prescription opioid misuse and chronic pain (Garland, Manusov, Froeliger, Kelly, Williams & Howard, 2014). ■ Providing training and promoting mindfulness as an effective factor for the treatment and reduction of detrimental impacts of addiction can be a major step toward treatment of dependency on drugs and its individual and social impacts. Through providing adequate trainings to patients, the addiction intensifying factors can be harnessed, preventive measures can be strengthened, and the forthcoming detrimental outcomes can be prevented (Imani, Vahid, Gharraee, Noroozi, Habibi & Bowen, 2016).

Findings on Impact of MBSR in His Own In his book Full Catastrophe Living, Jon Kabat-Zinn reports: Words “By the end of eight weeks, when the program comes to an end ■ Their smiles and more relaxed bodies are evident to even the most casual observer. ■ Although they were originally referred to the clinic to learn how to relax and to cope better with their stress, it is apparent that they have learned a lot more than that. ■ Our outcome studies over many years, as well as participants’ anecdotal reports, show that they often leave with fewer and less severe physical symptoms and with greater selfconfidence, optimism, and assertiveness. ■ They are more patient with and more accepting of themselves and their limitations and disabilities. ■ They are more confident about their ability to handle physical and emotional pain, as well as the other forces in their lives. ■ They are also less anxious, less depressed, and less angry. ■ They feel more in control, even in very stressful situations that previously would have sent them spinning out of control. ■ In a word, they are handling “the full catastrophe” of their lives, the entire range of life

RESEARCH ON MBSR

Earliest Research on MBSR The earliest available research in MBSR demonstrated that MBSR: ■ May help a broad range of individuals to cope with their clinical and nonclinical problems in a metanalysis of 20 studies from previous 2 decades (Grossman, Niemann, Schmidt & Walach, 2004). ■ Was found to help clients increase their mindfulness, and wellbeing and decrease their stress and symptoms (Carmody & Baerm 2007). ■ Was found to reduce ruminative thinking and trait anxiety, as well as to increase empathy and self-compassion for individuals who came for help to address handling stress in their lives (Chisea & Serretti, 2009). ■ Was found to assist clients with social anxiety disorder to have improvement in anxiety and depression symptoms and self-esteem as well as reducing emotional reactivity while enhancing emotional regulation (Golden & Gross, 2010). ■ Was found to assistclients to experience reduction of symptoms of stress and mood disturbance as well as in mindfulness, spirituality and self-compassion (Birnie, Speca & Carlson, 2010).

Early Research on MBSR Research in MBSR demonstrated that MBSR: Effectiveness ■ Has the potential for improving overall well-being, quality of life and enhanced health outcomes for its participants in it group therapy format (Merkes, 2010). ■ Was the most popular of all interventions utilizing mindfulness and that it shows substantial benefit for patients who suffer with chronic health conditions (Carlson, 2012). ■ Result in positive signs of healthy signs of measures of growth in greater emotional regulation (Haslam, Wirth & Robb, 2017). ■ Results in changes in perceived stress, distress tolerance, and mood states from pre- to post-MBSR meaning the people who had lower stress tolerance before participating in MBSR groups were more likely to experience greater benefits than those who had higher tolerance of stress before participation in such groups (Gawrysiak, et al. , 2016). ■ Results in significant improvements in the four components of Psychological Capital (Hope, Self-Efficacy, Resilience and Optimism) and a reduction in depression and anxiety (Jain & Singh, 2016). ■ Has stress-reducing effects due to improvements in perseverative cognition and emotion regulation, two “transdiagnostic” mental processes that cut across stress-related disorders (Greeson, et al. , 2018).

Research on MBSR in relation to Pain ■ A 2011 Systematic review of the literature found that studies up to that date showed that Mindfulness Based Interventions could have nonspecific effects for the reduction of pain symptoms and the improvement of depressive symptoms in patients with chronic pain as well as some improvements in psychologic measures related to chronic pain such as coping with pain following mindfulness based interventions (Chiesa & Serretti, 2011). ■ In a 2017 meta-analysis of 38 studies found that mindfulness meditation was associated with decrease in pain, reduction of depressive symptoms and increase in quality of life (Hilton, et al. , 2017). Analyses of the mechanisms impacted by Mindfulness meditation demonstrated its effectiveness in ■ Reducing pain through multiple unique physiological mechanisms (Zeiden & Vago, 2016) ■ Reduction of emotional reactivity, depression and stress (Brown & Becerra, 2017) ■ Improved general mental health in patients with tension headaches (Omidi & Zarger, 2015).

More Research on MBSR use for Pain ■ Strong encouragement has been made to utilize MBSR with patients with chronic pain because it focuses not only on the mind but also the body (Merkes, 2010). ■ MBSR has the potential to address some of the psychosocial factors that are important predictors of poor outcomes (Cherkin, et al. , 2014). ■ In a brief 5 -week format of MBSR participants demonstrated improvements of increased acceptance through decreased judgment; enhanced observational skills and decreased social isolation resulting in improve psychological health (Bergen-Cico, Possemento & Cheon, 2013). ■ MBSR was found to contribute positively to pain management by lowering anxiety and depression, feelings of controlling pain and acceptance of higher pain which are important dimensions in patients with long-lasting chronic pain (la Cour & Petersen, 2015). ■ Using MBSR resulted in patients revealing significant and clinically relevant improvements in level of pain disability, psychological distress, engagement in life activities, willingness to experience pain and subjective ratings of their current pain (Beaulac & Bailly, 2015).

More Research on MBSR use for ■ Measures of catastrophizing, self-efficacy, acceptance, and mindfulness, and similar Pain effects showed improvement on these measures among individuals with chronic low back pain once they received MBSR (Turner, et al. , 2016). ■ MBSR was found to improve the quality of life for veterans who suffered psychoimmunological factors of lungs damaged from the toxic chemical in the war zone (Arefuasab, et al. , 2016). ■ Use of MBSR with women with chronic pelvic pain has shown promise in pain reduction (Crisp, Hastings-Tolsma & Jonscher, 2016). ■ Use of MBSR with chronic low pain demonstrated through the measurement of increase in quality of life and decrease in pain severity (Ardito, et al. , 2017). ■ MBSR was used with patients with painful diabetic peripheral neuropathy resulting in reduced pain intensity, pain catastrophizing, depression, perceived stress and improved health related quality of life (Nathan, et al. , 2017). ■ Clinical MBSR therapy program intervention improved affective pain, sensory pain and evaluative pain for individual detoxifying from substance abuse (Hosseni, 2017). ■ Pain catastrophizing and psychological distress were identified as individual mediators of the relationship between mindfulness and depressive symptoms for people with chronic pain (Brooks, et al. , 2018).

MBSR’s Application with Various ■ Academic health care workers were found to have sustained improved stress Populations management, wellbeing & daily spiritual experiences (Geary & Rosenthal, 2011). ■ Participants related to their experience in MBSR by developing an “observing self” with improvement of emotional health (Kerr, Josyula & Littenberg, 2011). ■ Residents living in a large urban community experienced significant reduction of distress as well as increase in awareness of everyday life (Evans, Ferrando, Carr & Haglin, 2011). ■ MBSR decreases symptoms of PTSD and depressive symptoms and reduction of anxious attachment with female survivors of interpersonal violence (Kelly & Garland, 2016). ■ MBSR used with partners resulted in improved relational health among romantic partners (Khaddouma, Gordon & Strand, 2017). ■ MBSR helped improve levels of anxiety, depression, emotional reactivity and impulsivity with homeless participants (Maddock, Hevey & Eidemeuller, 2017). ■ MBSR helped college students reduced depression, anxiety, stress and anxiety sensitivity through use of a MBSR Bibliotherapy model (Hazlett-Stevens & Oren, 2017). ■ MBSR was successful with college students suffering from perfectionism by increasing self-compassion, reducing impairment and increase in mindfulness practices (James & Rimes, 2018)

MBSR in the Design Mix of Non. Medication Treatment of Pain ■ A systematic meta-analysis of 42 studies in behavioral non-medication intervention (Including Mindfulness-Based Stress Reduction (MBSR) Cognitive Behavioral Therapy and Acceptance and Commitment Therapy) with patients with chronic low back pain (LBP), it was found that behavioral therapy approaches are: 1. Effective particularly in altering pain perception and helping patients to regain their functionality. 2. Treatment outcomes can be improved if the treatments are personalized to individual patients’ needs. 3. Multidisciplinary rehabilitation needs to include more than just physical treatment. A team approach accounting for several aspects within the biopsychosocial model is more likely to help individuals with chronic LBP compared to standard care alone (Vitoula, et al. 2017).

Ideal Model of Non-Pharmacological Treatment of Pain In 2018 in an article in the Journal of Family Practice a report on a meta-analytic review of 42 articles on non-medication pain management the concluded that a pain management plan needs to include the following non-medication modalities recommendations: ■ Self-care goals ■ Exercise or movement-based treatments (e. g. Therapeutic exercise, yoga, tai chi) ■ Mind-body treatment (e. g. Mindfulness, cognitive behavioral therapy, biofeedback) ■ Complementary modalities (e. g. Physical therapy, osteopathic manipulative treatment, chiropractic, massage) (Lemmon & Hampton, 2018) https: //www. mdedge. com/jfponline/article/170928/pain/nonpharmacologic-treatment-chronic -pain-what-works

Summary of Findings on MBSR ■ It is clear that MBSR has been shown to be an effective intervention to use with clients and patients who are dealing with stress not only from medical and psychological conditions but also from natural environmental factors. ■ It would serve mental health professionals well to utilize the MBSR model in treating their clients who have come in seeking help to alleviate their current levels of stress and or who are suffering from chronic pain.

8 WEEK MBSR PROGRAM

Weekly Components of MBSR Program 1. Start off with Chair Yoga (since it accommodates for participants with pain issues) 2. Use of Metaphor as Motivational Stimuli for participants 3. Review of the Participants’ Weekly Progress Reports of Formal MBSR Practice and Informal Handling of various stimuli 4. Practice of the assigned MBSR technique for the Week 5. Review of participants response to this Formal MBSR Technique Experience NOTE: All links for Chair Yoga, Weekly Metaphors as well as handouts used and the weekly progress forms are available at: http: //coping. us/mindfulnessneurobiology/mbsrstressmanagement. html

Chair Yoga Components Providers have the freedom to choose the available chair yoga You. Tubes in whichever order which seem appropriate for their participants ■ Mindful Chair Yoga: A Brief 15 Minute Beginner's Practice: https: //www. youtube. com/watch? v=k 6 Bx. Zep 0 w 44&t=43 s ■ Mindful Chair Yoga: A Complete Beginner's Practice (40 minutes): https: //www. youtube. com/watch? v=bar. Pap-8 vnw ■ Mindful Chair Yoga: A 45 Minute Practice: https: //www. youtube. com/watch? v=ed. ZXrdcz 0 -w ■ Mindful Chair Yoga: A Practice for the Legs (30 min): https: //www. youtube. com/watch? v=6_hp 2 xgdt 3 Y&list=PLN 2 MXzt. Fqf. FV 9 Ri. Fyu 0 d. L 4 q. A 0 w. Ka. CY 8 h. B ■ Mindful Chair Yoga (30 min) Cultivating a Healthy Relationship with Thoughts and Feelings: https: //www. youtube. com/watch? v=z 4 CTG 2 f 0 h. Rk ■ Mindful Chair Yoga (45 min) Cultivating a Healthy Relationship with Thoughts and Feelings: https: //www. youtube. com/watch? v=i 2 e 3 B_Z 8 m. A 0 ■ Mindful Chair Yoga: A Playful Practice (20 min): https: //www. youtube. com/watch? v=WBAc 7 u. Ao. WU&t=88 s ■ Mindful Chair Yoga: A 45 Minute Practice: Through Playfulness https: //www. youtube. com/watch? v=JD 4 Wz. EBCGp. A

Motivational Metaphors in MBSR Program ■ Week 1: The Missing Piece by Shel Silverstein ■ Week 2: The Little Engine that Could by Watty Piper and George Hauman ■ Week 3: The Giving Tree by Shel Silverstein ■ Week 4: The Precious Present by Spencer Johnson ■ Week 5: The Missing Piece Meets the Big 0 by Shel Silverstein ■ Week 6: Who Moved My Cheese by Spencer Johnson ■ Week 7: Our Iceberg is Melting by John Kotter & Holger Rathgeber NOTE: There are You. Tube videos selected for the first six metaphors and the links are on the website and for Week 7 a Power. Point on Our Iceberg is Melting is available. Also there are worksheets to be filled out in the weekly sessions once the Metaphor Story is presented to the participants

JKZ Series 1, 2 & 3 JKZ Series 1: Practices Exercises MBSR JKZ Series 3: Practices ■ Body Scan Meditation (45 min) ■ Breathscape (20 min) ■ Mindful Yoga 1 -Lying Down (45 min) ■ Bodyscape (20 min) ■ Sitting Meditation (40 min) ■ Breathscape/Bodyscape (20 min) ■ Mindful Yoga 2 -Standing (45 min) ■ Soundscape (27 min) JKZ Series 2: Practices ■ Mindscape (20 min) ■ 1, 2, 3 Sitting Meditations (10, 20 & 30 min) ■ Dying Before You Die (30 min) ■ 4, 5, 6 Lying Down Meditations (10, 20 & 30 min) ■ Choiceless Awareness (30 min) ■ 7 Mountain Meditation (20 min) ■ 8 Lake Meditation (20 min) ■ 9 Silence with bells (customized) ■ Walking Meditation (10 min) ■ Lovingkindness/Heartscape (47 min) ■ In Everyday Life/Lifescape (12 min) ■ Silence with bells (customized)

Weekly MBSR Exercise Practiced in Session ■ Week 1: Body Scan Meditation (45 min) on JKZ Series 1 ■ Week 2: Sitting Meditation (40 min) on JKZ Series 1 ■ Week 3: Mindful Chair Yoga (40 min video): Mindful Chair Yoga: A Complete Beginner's Practice. Also use Sitting Meditation (10 min) on JKZ Series 2 ■ Week 4: Mindful Chair Yoga (45 min video) Cultivating a Healthy Relationship with Thoughts and Feelings. Also use Sitting Meditation (20 min) on JKZ Series 2 ■ Week 5: Sitting Meditation (30 min) on JKZ Series 2 and Breathscape (20 min) on JKZ Series 3 ■ Week 6: Mountain Meditation (20 min) On JKZ Series 2 and Bodyscape (20 min) on JKZ Series 3 ■ Week 7: Lake Mediation (20 min) on JKZ Series 2 and Soundscape (27 min) on JKZ Series 3 ■ Week 8: Mindscape (20 min) & Lovingkindess/Heartscape (47 min) on JKZ

MATERIALS NEEDED FOR MBSR PROGRAM

Additional Materials Available On MBSR link on Coping. us ■ Weekly Formal and Informal Progress Sheets ■ You. Tube Videos for Weekly Chair Yoga Videos ■ You. Tube Videos for Weekly Metaphors ■ Weekly Handouts for use with Metaphors ■ Weekly Handouts related to MBSR Exercises ■ Handouts for the Raisin and 3 Dot Exercises ■ Participant Evaluation Forms ■ Mandala Handouts for Participants having problems meditating with eyes closed Review at: http: //coping. us/mindfulnessneurobiology/mbsrstressmanagement. html

REFERENCES

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