Mindfulness E-Book

Katie Witkiewitz

• Herausgeber: Hogrefe Publishing
• Kategorie: Fachliteratur
• Serie: Advances in Psychotherapy - Evidence-Based Practice
• Sprache: Englisch

Seitenzahl: 210

Veröffentlichungsjahr: 2018

Beschreibung

Clear and compact guidance on integrating mindfulness into practice This clear and concise book provides practical, evidence-based guidance on the use of mindfulness in treatment: its mechanism of action, the disorders for which there is empirical evidence of efficacy, mindfulness practices and techniques, and how to integrate them into clinical practice. Leading experts describe the concepts and roots of mindfulness, and examine the science that has led to this extraordinarily rich and ancient practice becoming a foundation to many contemporary, evidenced-based approaches in psychotherapy. The efficacy of mindfulness-based interventions in conditions as diverse as borderline personality disorder, post-traumatic stress disorder, depression, alcohol and substance use, emotional dysregulation, attention-deficit hyperactivity disorder, chronic stress, eating disorders, and other medical conditions including type 2 diabetes and rheumatoid arthritis is also described. The book is invaluable reading for all those curious about the current science around mindfulness and about how and when to incorporate it effectively into clinical practice.

Leseprobe

Mindfulness

Katie Witkiewitz

University of New Mexico, Albuquerque, NM

Corey R. Roos

University of New Mexico, Albuquerque, NM

Dana Dharmakaya Colgan

Pacific University, Hillsboro, OR

Sarah Bowen

Pacific University, Hillsboro, OR

About the Authors

Katie Witkiewitz, PhD, is Associate Professor of Psychology at the University of New Mexico and the Center on Alcoholism, Substance Abuse, and Addictions. She is a licensed clinical psychologist and has worked extensively on the development and evaluation of mindfulness-based treatments for alcohol and drug use disorders.

Corey R. Roos, MS, is a 4th-year clinical psychology doctoral student at the University of New Mexico. He has experience delivering mindfulness-based interventions among clinical populations, particularly individuals with substance use disorders, and he is currently working on developing a mindfulness-based intervention for addictive disorders that can be delivered as a rolling group.

Dana Dharmakaya Colgan, MS, MA, is a 4th-year clinical psychology doctoral student at Pacific University. She has been a student of meditation and mindfulness for two decades and an instructor of meditation and yoga since 2007. She is engaged in the research and clinical application of mindfulness and self-compassion to foster resilience, well-being, and enhanced physiological functioning among first responders.

Sarah Bowen, PhD, is Assistant Professor of Psychology at Pacific University and a licensed clinical psychologist. Over the past 15 years, Dr. Bowen’s research, clinical, and training activities have focused on the development, efficacy, and cultural adaptations of mindfulness-based programs. She has conducted clinical trials and trained individuals from diverse populations and settings, both in the US and internationally, including work in prisons, medical and treatment centers, and academic institutions. She is committed to increasing the understanding of and access to mindfulness practice, especially for individuals with logistical, financial, or social barriers to these approaches.

Advances in Psychotherapy – Evidence-Based Practice

Series Editor

Danny Wedding, PhD, MPH, School of Medicine, American University of Antigua, St. Georges, Antigua

Associate Editors

Larry Beutler, PhD, Professor, Palo Alto University / Pacific Graduate School of Psychology, Palo Alto, CA

Kenneth E. Freedland, PhD, Professor of Psychiatry and Psychology, Washington University School of Medicine, St. Louis, MO

Linda C. Sobell, PhD, ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Ft. Lauderdale, FL

David A. Wolfe, PhD, RBC Chair in Children’s Mental Health, Centre for Addiction and Mental Health, University of Toronto, ON

The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a reader-friendly manner. Each book in the series is both a compact “how-to” reference on a particular disorder for use by professional clinicians in their daily work and an ideal educational resource for students as well as for practice-oriented continuing education.

The most important feature of the books is that they are practical and easy to use: All are structured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls,” marginal notes, and summary boxes assist orientation, while checklists provide tools for use in daily practice.

Library of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the Library of Congress Control Number 2016961405

Library and Archives Canada Cataloguing in Publication

Witkiewitz, Katie, author

Mindfulness / Katie Witkiewitz, University of New Mexico, Albuquerque, NM, Corey R. Roos, University of New Mexico, Albuquerque, NM, Dana Dharmakaya Colgan, Pacific University, Hillsboro, OR, Sarah Bowen, Pacific University, Hillsboro, OR.

(Advances in psychotherapy--evidence-based practice ; 37)

Includes bibliographical references.

Issued also in electronic formats.

ISBN 978-0-88937-414-0 (softcover).--ISBN 978-1-61676-414-2 (PDF).--ISBN 978-1-61334-414-9 (EPUB)

1. Mindfulness-based cognitive therapy. 2. Mindfulness (Psychology). 3. Textbooks. I. Roos, Corey R., author II. Colgan, Dana Dharmakaya, author III. Bowen, Sarah (Clinical psychologist), author IV. Title. V. Series: Advances in psychotherapy--evidence-based practice ; 37

RC489.M55W55 2017

616.89’1425

C2016-907322-X

C2016-907323-8

Cover image © m-imagephotography – iStock.com

© 2017 by Hogrefe Publishing

http://www.hogrefe.com

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Format: EPUB

ISBN 978-0-88937-414-0 (print) • ISBN 978-1-61676-414-2 (PDF) • ISBN 978-1-61334-414-9 (EPUB)

http://doi.org/10.1027/00414-000

Citability: This EPUB includes page numbering between two vertical lines (Example: |1|) that corresponds to the page numbering of the print and PDF ebook versions of the title.

|v|Preface

The theories, understandings, and practices reviewed in this book are rooted in a rich and ancient tradition. We want to provide a brief and simplified introduction to contemporary applications of “mindfulness” as delivered within secularized mindfulness-based interventions. This is by no means a complete account of mindfulness practices, and can at best provide a very broad overview to a longstanding, multifaceted, and now multi-cultured system of understanding and practice. This book is intended for those who are curious about the roots and practices of mindfulness, and the directions of current science and clinical applications. It is a starting place for readers interested in learning about an extraordinarily rich and honored practice, and the ways in which mindfulness training has become foundational to many evidenced-based approaches in psychology.

We dedicate this book to Dr. G. Alan Marlatt (1941–2011) who provided the foundation for an evidenced-based and integrated mindfulness approach to the prevention of addictive behavior relapse. We also dedicate this work to the many research participants and clients who continually inspire us and remind us of the importance of the dissemination of mindfulness-based interventions. We would also like to acknowledge Dr. Danny Wedding, who provided invaluable comments and editorial feedback, and Dr. Linda Sobell, who invited us to author this book.

KW dedicates this book to her current and former students who continue to support this work.

CRR dedicates this book to his parents, Richard and Cindy, who have taught him what it means to be kind and compassionate.

DDC dedicates this book to Don, whose bountiful love, support, and quiet patience never cease to amaze her.

SB dedicates this book to her many teachers, in their many forms, who continue to point her towards perseverance, authenticity, and growth.

Contents

Preface

1 Description

1.1 Terminology and Definitions

1.2 Historical Roots of Mindfulness

1.2.1 Ancient and Contemporary Teachings of the Buddha

1.2.2 Translation of Buddhist Practices Into Western Science and Medicine

1.3 Eastern and Western Variations

2 Theories and Models

2.1 The “Mindfulness-Based” Movement

2.1.1 Mindfulness-Based Stress Reduction (MBSR)

2.1.2 Mindfulness-Based Cognitive Therapy (MBCT)

2.1.3 Mindfulness-Based Relapse Prevention (MBRP)

2.1.4 Other Mindfulness-Based Approaches Based on the MBSR Model

2.2 Related Models and Approaches

2.2.1 Dialectical Behavior Therapy

2.2.2 Metacognitive Therapy

2.2.3 Compassion Focused Therapy

2.2.4 Acceptance and Commitment Therapy

2.3 Mechanisms of Action

2.3.1 Reductions in Maladaptive Self-Regulation and Experiential Avoidance

2.3.2 Emotion Regulation

2.3.3 Values-Consistent Behavior

2.3.4 Regulatory Flexibility

3 Assessment and Treatment Indications

3.1 Indications

3.2 Different Forms of Mindfulness

3.2.1 Mindfulness as a Practice

3.2.2 Mindfulness as a State

3.2.3 Mindfulness as a Trait

3.2.4 Measures of Constructs Related to Mindfulness

3.3 Objective Measures of Mindfulness

3.3.1 Passive Measures of Mindfulness

3.3.2 Biomarkers of Mindfulness

3.3.3 Behavioral Measures of Mindfulness

3.4 Self-Report Measures of Mindfulness

3.4.1 Self-Monitoring of Mindfulness Practice

3.4.2 State Measures of Mindfulness

3.4.3 Trait Measures of Mindfulness

3.4.4 Related Measures to Assess Processes in Mindfulness-Based Interventions

4 Treatment

4.1 Overview and Treatment Rationale

4.2 Therapeutic Approach

4.2.1 Importance of Personal Practice

4.2.2 Motivational Interviewing Style

4.2.3 Modeling Qualities of Mindfulness

4.2.4 Guidelines for Leading Mindfulness Practices

4.2.5 Inquiry

4.3 Incorporation of Poetry, Metaphors, Imagery, and Storytelling

4.4 Formal and Informal Mindfulness Practices

4.4.1 Formal Mindfulness Practices

4.4.2 Informal Mindfulness Practices

4.5 Participant Considerations

4.5.1 Participant Willingness

4.5.2 Adapting Mindfulness-Based Approaches to Meet Participant Needs

4.5.3 Contraindications

4.6 Structural Adaptations for Delivering Mindfulness-Based Interventions

4.6.1 Closed Group Format

4.6.2 Rolling Group Format

4.6.3 Residential Treatment Settings

4.6.4 Individual Format

4.7 MBIs Training and Supervision

4.8 Efficacy of MBIs and Related Approaches

4.8.1 Mindfulness-Based Stress Reduction (MBSR)

4.8.2 Mindfulness-Based Cognitive Therapy (MBCT)

4.8.3 Mindfulness-Based Relapse Prevention (MBRP)

4.8.4 Mindfulness-Based Cancer Recovery (MBCR)

4.8.5 Mindfulness-Based Eating Awareness Training (MB-EAT)

4.8.6 Mindfulness-Based Therapy for Insomnia (MBTI)

4.8.7 Efficacy of Related Approaches

5 Further Reading

6 References

7 Appendix: Tools and Resources

Mindfulness Practice Record

Body Scan Meditation

Sitting Meditation

|1|1Description

1.1 Terminology and Definitions

Mindfulness is often translated as seeing with discernment. Mindfulness practice is a form of mental training that enhances one’s ability to nonjudgmentally attend to the present moment: a phenomenological process oriented toward a gradual understanding of one’s direct experience (Goldstein, 1980). As a type of consciousness, it has the quality of a presence of mind with a certain stability of focus (Bodhi, 2011). Increased mindfulness can afford an individual freedom from misperceptions, rigid and problematic thinking patterns, and self-imposed limitations that interfere with optimal mental and physical health. Mindfulness can also be understood by its contrast to restlessness, forgetfulness, behavioral and cognitive automaticity, and states of mind in which attention is focused elsewhere, such as preoccupation with memories, anticipation of the future, rumination, and worry (Brown & Ryan, 2003).

Western psychology often conceptualizes mindfulness as a collection of techniques, but also as a psychological process, a psychological trait, and the positive emotional outcomes of the practice itself (Hayes & Wilson, 2003). A commonly cited definition by Jon Kabat-Zinn (2002) is “the awareness that emerges by way of paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience, moment by moment” (p. 732). Similarly, two salient components of mindfulness are described by Bishop and colleagues as (a) the intentional regulation of attention to and awareness of the present moment and (b) a nonjudgmental and curious willingness to experience the content (thoughts, sensations, and feelings) of the present moment (Bishop et al., 2004). Shapiro and colleagues further distinguished attentional focus from intention (purpose of the focus) in her three factor model of attention, intention, and attitude (Shapiro, Carlson, Astin, & Freedman, 2006). Baer and colleagues proposed a five facet model of mindfulness characterized by observing, describing, nonreactivity to inner experience, nonjudging of inner experience, and acting with awareness (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006). While additional models have been proposed, most of these contemporary models contain three essential elements: awareness of the present moment, attentional allocation, and the cultivation of specific qualities pertaining to the attention and awareness of the present moment.

Foremost of the processes of fostering mindfulness is developing a clear awareness of one’s present internal or personal experiences, including thoughts, emotions, sensations, and behaviors, as well as attention to perception of elements in the surrounding environment, such as sights and sounds. For this reason, some have defined mindfulness as bare attention, or |2|pure or lucid awareness (Dass & Goleman, 1990). These terms suggest that mindfulness reveals what is occurring before or beyond ideas, judgements, or analyses. The Zen metaphor of a polished mirror, through which the mind is able to simply reflect what passes before it, unbiased by conceptual thought about what is taking place, describes this state of pure awareness. This can be contrasted with automatic cognitive and behavioral reactions that occur without conscious awareness. Awareness is often at the forefront of contemporary explanations of and training in mindfulness, and is indeed a necessary and foundational element of mindfulness; however, most (if not all) individuals’ awareness is shaped by conditioning, and contains both valence (positive or negative) and evaluation. Therefore, awareness may be better understood as a precondition to, or elemental factor for, mindfulness, rather than its complete definition.

A second inherent process of mindfulness is attentional allocation, which involves sustained attention, monitoring, and attentional shifting (Garland, Froeliger, & Howard, 2014; Malinowski & Lim, 2015). As an individual attempts to attend to an object (the breath, bodily sensations, sustained attention), one is also acknowledging discursive thoughts and emotions that may arise (a process of monitoring). The ability to notice getting “caught up” in thoughts or emotions, and subsequently returning to the object of attention, requires a purposeful and fluid shifting of attention (attentional shifting). As the mind wanders off into concerns about the future, ruminations about events that occurred in the past, or evaluations of the present moment, the mindfulness practitioner notices these processes and then gently redirects attention back to the sensations and experiences occurring in the present moment.

A third, and perhaps most important, aspect of mindfulness is the cultivation of particular qualities of awareness. Attitudes that exemplify this quality include kindness, curiosity, acceptance, nonreactivity, and equanimity. A kind, curious, and nonreactive awareness is developed so that one simply notices the object, or series of emerging objects, and the secondary evaluations and appraisals that occur. With continued practice, this nonreactive awareness eventually allows for the de-automatization of habitual reactions to the present moment and the associated secondary appraisals, predictions, analyses, critiques, or judgments about what has or is taking place. This process can be understood as the further development and temporal extension of bare attention, thereby adding clarity and depth to the typically shorter periods, or momentary flashes, of time occupied by bare attention (Keng, Smoski, & Robins, 2011; Olendzki, 2011).

Furthermore, the meditator practices meeting all internal experiences that arise – positive, negative, or neutral – with equal interest and equanimity. This is in contrast to the typical human tendency to seek and hold onto pleasure and to avoid and escape from discomfort. Instead, the mindful practitioner remains aware of what is happening internally, with an even and unbiased deportment, as if gazing upon the internal landscape without interference (Desbordes et al., 2014). It is purported that it is only when one can regard an experience, or object of attention, with a balanced objectivity that one is free from emotional agitation, and the understanding of the experience or object is potentially transformative (Olendzki, 2011). This is reflective of the elements of awareness, allocation of attention, and a nonjudgmental or equanimous |3|stance toward all experience. Grossman (2015

|11|2

|23|3Assessment and Treatment Indications

3.1 Indications

As can be seen in Section 2.3, the mechanisms of action that have been attributed to mindfulness are indicative of mindfulness as a transdiagnostic approach suitable for numerous psychological disorders. Maladaptive self-regulation, experiential avoidance, poor emotional regulation, and inconsistent values behavior are problems found in addiction, depression, anxiety, borderline personality disorder, psychosis, eating disorders, and some physical health problems. Mindfulness training has also been identified as a useful tool for improving mental and physical health among people who do not meet criteria for a psychological disorder.

3.2 Different Forms of Mindfulness

The term mindfulness has a multitude of different meanings, especially as used and understood in contemporary Western contexts. Each of these definitions, or conceptualizations, may call for a different form of assessment. As such, operationalizing mindfulness remains elusive. Thus, a gold standard assessment that characterizes all of the multiple uses, characteristics, and qualities of mindfulness has yet to be developed. In this section, we review some of the current challenges of assessing mindfulness, and provide an overview of extant contemporary assessment approaches that have been developed to best characterize and measure mindfulness.

3.2.1 Mindfulness as a Practice

As reflected in contemporary literature and debates, there are multiple ways of conceptualizing, describing, practicing, or understanding mindfulness. First, mindfulness can be understood as a practice. In the context of medical and psychological treatment, we are trying to engage our participants in these programs in the practice of mindfulness. In many meditation traditions, both the students and teachers of mindfulness meditation are referred to as “practitioners,” and the engagement itself is referred to as “practice.” This is a clear reflection of the understanding that this is a way of seeing and interacting with oneself and the interrelated environment that is, by its nature, an ongoing practice versus a skill that is mastered. Thus, it presents challenging issues to our |24|conventional forms of measurement. Researchers have approached this several ways, and it is an aspect of the field that continues to develop. Some have attempted to measure mindfulness through objective or self-report monitoring of time spent in formal mindfulness practice, while others have attempted to assess resultant changes following a period of practice, or more enduring trait-like characteristics of a practitioner.

3.2.2 Mindfulness as a State

Mindfulness is characterized in several ways, reflected in the many measures used in recent research to assess its changes or levels. It is sometimes characterized as a state of being during a particular moment in time, such that an individual, at a given moment, may be more or less mindful. According to this use of the term, and this approach to assessment, being mindful in a given moment does not necessarily require formal mindfulness practice; the extent of formal mindfulness practice may or may not predict mindful awareness in any given moment.

3.2.3 Mindfulness as a Trait

The majority of mindfulness measures developed in contemporary psychology reflect a trait, or dispositional, conceptualization of mindfulness (these measures are reviewed later in this section). A trait can be defined as a quality or characteristic of an individual, with each person having a lesser or greater predisposition toward that trait in any given moment. In other words, similar to understanding of personality, some individuals have a greater tendency to have more instances of a certain characteristic, such as mindfulness (i.e., state mindfulness) and are thus often characterized as being a “mindful person” (i.e., trait mindfulness). Mindfulness, measured as a trait, has been shown to be highly correlated with other personality and psychological factors, such as neuroticism and conscientiousness (Siegling & Petrides, 2014), and facets associated with self-control and emotion regulation (Lyvers, Makin, Toms, Thorberg, & Samios, 2013). Measures of trait mindfulness tend to focus on an individual’s typical way of responding or being. A paradoxical issue in the assessment of trait mindfulness is that as individuals become more mindful, or aware, of present experiences they also tend to become more aware that there are many periods in which they are not mindful. As such, individuals who begin practicing mindfulness and thus become aware of their own habitual lack of awareness, might report lower levels of trait mindfulness. This is likely to be most prevalent in early practitioners. Over time, however, there is some evidence suggesting that mindfulness practice may indeed lead to increases in measures of state mindfulness, which ultimately leads to increases in trait mindfulness, at least as we currently understand and assess it (Kiken, Garland, Bluth, Palsson, & Gaylord, 2015).

Despite an exponentially increasing number of scientific studies on mindfulness, there are several questions that remain unanswered. A recent area of inquiry is whether MBIs reliably increase trait mindfulness. Some studies have |25|found evidence of increases in trait mindfulness (Bowen et al., 2009; Garland et al., 2015; Kiken et al., 2015) and other studies have found no changes in trait mindfulness (Bowen et al., 2014; Goldberg et al., 2015; Witkiewitz, Warner, et al., 2014). While this may reflect failure or lack of reliability of such programs and practices to affect an individual’s tendencies or capacities to be mindful, difficulties in assessing mindfulness, as described in more detail below, may well be responsible (Davidson & Kaszniak, 2015; Grossman, 2011; Witkiewitz & Black, 2014).

3.2.4 Measures of Constructs Related to Mindfulness

There are numerous measures that are associated with the practice of mindfulness and may be used to indirectly measure the acquisition of mindfulness skills or changes in trait mindfulness. In Section 3.2.2 we review several biomarkers that have been shown to be impacted by mindfulness practice or robustly correlated with state and trait measures of mindfulness. In Section 3.2.3 we review behavioral measures of awareness, attention, and mind wandering (which may be considered the opposite of mindfulness). Self-report measures that were designed to assess constructs that are related to mindfulness, such as acceptance (Bond et al., 2011), self-compassion (Neff, 2003), mind wandering (Mrazek, Smallwood, & Schooler, 2012) and coping (Kato, 2012), are also available and are often used in empirical research examining MBIs.

3.3 Objective Measures of Mindfulness

For the purposes of this section, we consider any measure that does not require a subjective judgment or subjective response from an individual to be an objective measure. We review three different types of objective measures: passive measures, biomarkers, and behavioral assessments. Passive measures are assessments that do not require an active response from the individual being assessed. Biomarkers might require an active response on behalf of the individual (e.g., allowing blood to be drawn), but the measure obtained from the individual is an objective measure of some biological indicator (e.g., inflammatory response, cortisol level). Behavioral measures involve a behavioral response and the outcome of interest is typically a quantifiable behavioral indicator based on the demands of the measure (e.g., performance on a sustained attention task).

3.3.1 Passive Measures of Mindfulness

New developments in biosensing technology, including the invention of numerous wearable devices and small sensors that can wirelessly communicate and provide constant data transfer, have great potential to impact the assessment of mindfulness, including the passive monitoring of mindfulness practice. Wireless accelerometers can be used to assess posture during |26|meditation practice (Chang, Chen, Lee, Ching, & Huang, 2012) and many devices assess heart rate, breathing, and sleep cycles. Empirical research has not caught up with most of the new technologies at this point, yet numerous devices are now available and marketed to assist with meditation and assessing states of mind. For example, the Muse headband (http://www.choosemuse.com/, last accessed 7/1/2016), uses seven sensors to measure electrical brain activity, similar to an electroencephalography, and purportedly provides real time feedback about an individual’s level of brain activity. The feedback is broad (e.g., neutral, calm) and we could not locate any peer-reviewed research articles to support the claims of the manufacturer, so it is unclear how well the feedback from the device corresponds to actual neural activity.

A great deal of research on passive monitoring devices is certainly necessary to assess the degree to which they could yield valid assessments of mindfulness practice and mindfulness states. Nonetheless, passively measuring activity, posture, breathing, and heart rate throughout the day and during mindfulness practice could potentially provide a wealth of data about an individual’s engagement with formal and informal mindfulness practices, and could also be used to help therapists monitor progress in MBIs.

3.3.2 Biomarkers of Mindfulness

A biomarker (i.e., biological marker) is an objectively measured indicator of a biological state or biological process. Given the long-standing history of mind–body dualism, states of mind are often not directly characterized as biological; however, the practice of mindfulness, the state of mindfulness, and even the trait of mindfulness are inherently driven by biological processes. Like many psychological constructs there is not a single biological indicator of mindfulness, but there are many biological states and processes that have been shown to be associated with mindfulness practice, mindfulness states, and trait mindfulness. As such, these biomarkers could be useful tools in the assessment of mindfulness and the evaluation of MBIs. Importantly, different types of mindfulness practice and different states of mindfulness are likely associated with different biological processes (Lutz et al., 2015).