Old wine in new glass- mindfulness and it's application in psychiatry.

1. Mindfulness
Dr Diptadhi Mukherjee
LGBRIMH, Tezpur
Date: 07/12/15
Unit presentation

2. Outline
• History
• Definitions
• Construct and Measures
• Practice types
• Neurobiology
• Mindfulness in psychotherapy
• Mindfulness in psychiatric illness
• Criticisms
• Conclusion
• References

3. History
• “Mindfulness" originates from the Pali term sati and in its Sanskrit
counterpart smṛti.
• Sati/ Smṛti originally meant "to remember" , "to recollect" , "to bear in
mind“
• The arisement of sati calls to mind the wholesome dhammas such as the
four establishments of mindfulness, the five faculties, the five powers, the
seven awakening-factors, the noble eight-factored path, and the
attainment of insight
• The Pali-language scholar Thomas William Rhys Davids (1843–1922) first
translated sati in 1881 as English mindfulness in sammā-sati "Right
Mindfulness; the active, watchful mind".
• Davids explained, sati is literally 'memory' but is used with reference to
the constantly repeated phrase 'mindful and thoughtful' (sato sampajâno);
and means that activity of mind and constant presence of mind which is
one of the duties most frequently inculcated on a good Buddhist."

4. History
• The Four Noble Truths- express the basic orientation of Buddhism: this
worldly existence is fundamentally unsatisfactory, but there is a path to
liberation from repeated worldly existence. The truths are as follows:
1. The Truth of Dukkha is that all conditional phenomena and experiences
are not ultimately satisfying;
2. The Truth of the Origin of Dukkha is that craving for and clinging to what
is pleasurable and aversion to what is not pleasurable result in becoming,
rebirth, dissatisfaction, and redeath;
3. The Truth of the Cessation of Dukkha is that putting an end to this
craving and clinging also means that rebirth, dissatisfaction, and redeath
can no longer arise;
4. The Truth of the Path Of Liberation from Dukkha is that by following the
Noble Eightfold Path—namely, behaving decently, cultivating discipline,
and practicing mindfulness and meditation—an end can be put to
craving, to clinging, to becoming, to rebirth, to dissatisfaction, and to
redeath.

7. History
• Ram Mohan Roy (1772-1833)- Transcendentalism was closely connected
to the Unitarian Church
• Vivekananda- modern interpretation of Hinduism became widely popular
in the west. Vipassana meditation, presented as a centuries-old
meditation system- a 19th-century reinvention
• Pali Text Society- which gained popularity in south-east due to the
accessibility of the Buddhist sutras through English translations from the.
• Theosophical Society- brought western attention in the 19th century.
• D.T. Suzuki- popularized Zen Buddhism in the west through the writings

8. History
• In 1979, Jon Kabat-Zinn founded the Mindfulness-Based Stress Reduction
(MBSR) program at the University of Massachusetts to treat the
chronically ill
• Sparked the application of mindfulness ideas and practices in Medicine
• Its practice does not imply following any specific philosophical or religious
tradition (Kabat-Zinn et al. 2000).
• “Mindfulness movement”

9. Definitions
• Mindfulness can described as a non -elaborative, non-judgmental, present
centered awareness in which each thought, feeling, or sensation that arises in
the attentional field is acknowledged and accepted as it is. (Williams and
Teasdale, 2002)

11. Definition
• Definition of mindfulness involves three qualities and three activities.
• The accompanying qualities are (1) non-judgmentally, with acceptance,
allowing; (2) in the present moment, with beginner’s mind; and (3)
effectively.
• The three activities include (1) observing, noticing, bringing awareness;
(2) describing, labeling, and noting; and (3) participating.
• They posit three components of mindfulness: (1) intention, (2) attention,
and (3) attitude (IAA) as follows:
1. “On purpose” or intention.
2. “Paying attention” or attention.
3. “In a particular way” or attitude (mindfulness qualities).

12. Measures
• Brown, Ryan, and Creswell divided mindfulness in three constructs
 A trait-like construct- a dispositional characteristic (a relatively long lasting
trait),a person's tendency to more frequently enter into and more easily
abide in mindful states;
• Seven mindfulness measures have been developed which are based on
self-reporting of trait-like constructs:
 Mindful Attention Awareness Scale (MAAS)
 Freiburg Mindfulness Inventory (FMI)
 Kentucky Inventory of Mindfulness Skills (KIMS)
 Cognitive and Affective Mindfulness Scale (CAMS)
 Mindfulness Questionnaire (MQ)
 Revised Cognitive and Affective Mindfulness Scale (CAMS-R)
 Philadelphia Mindfulness Scale (PHLMS)

13.  A state- like phenomenon- an outcome (a state of awareness resulting
from mindfulness training), being in a state of present moment
awareness;
• The Toronto Mindfulness Scale (TMS) measures mindfulness as a state-like
phenomenon
 A practice-like construct- mindfulness meditation practice itself.
• Mindfulness teaches the practice of observing thoughts without getting
entangled in them
• Approaching them as though they were leaves floating down a stream.
• It is not about replacing negative thoughts with positive ones, but rather
accepting one’s ongoing flow of thoughts, sensations, and emotions.
• The practice of mindfulness involves both formal and informal meditation
practices and non-meditation-based exercises.

14. Mindfulness Practice Types
• Formal mindfulness, most often referred to as meditation, involves
intense introspection whereby one sustains one’s attention on an object
(breath, body sensations) or on whatever arises in each moment (called
choice less awareness).
• Informal mindfulness is the application of mindful attention in everyday
life. Mindful eating and mindful walking are examples of informal
mindfulness practices. In fact any daily activity can be the object of
informal mindfulness practice.
• Non-meditation-based mindfulness exercises are specifically used in
dialectical behavior therapy (DBT; Linehan, 1993) and acceptance and
commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999).
Therapists and therapist trainers could use some of these exercises to
cultivate mindfulness for their therapeutic relationships.

15. Mindfulness and neurobiology
• Shown to increase cortical thickness in areas associated with attention
and sensory processing, such as the prefrontal cortex and right anterior
insula.
• Associated with greater prefrontal cortical activation -- greater reduction
in amygdala activity during affect labeling tasks, which results in
enhanced affect regulation
• Role in maintaining balanced prefrontal asymmetry.
 Relative left prefrontal activation is related to an affective style characterized
by stronger tendencies toward positive emotional responses and
approach/reward oriented behavior
 Relative right sided activation is associated with stronger tendencies toward
negative emotional responses and avoidant/withdrawal oriented behavior.
• However, these findings have not been consistent.
• These findings suggest neural changes in association with meditation and
provide a potentially promising avenue for future research.
Ivanovski B & Malhi GS (2007)

16. Mindfulness techniques (Crane, 2009)
• Three Minutes of Mindfulness
– First minute: During the first minute, try to simply notice your thoughts and
feelings. One has to try to focus and notice their thoughts and feelings as they
occur.
– Second minute: During the second minute, awareness to include physical
sensations. Awareness of thoughts and feelings has to be maintained.
– Third minute: In the final minute, include the space around you. Awareness of
thoughts and feelings has to be maintained as well as the bodily sensations. Notice
the room or area around. As the third minute comes to a close, bring your
attention back to your breath and slowly open your eyes.
• The Raisin
– In this exercise raisin is held in the palm. It is looked, examined, felt, smelled,
tasted, notice every aspect of it. Then the experience is described. This exercise is
about cultivating awareness and beginning to learn to focus on the here-and-now.
It is about being in the present moment.

17. • The Park Bench
– This park bench experience is analogous to an exercise that can be done with thoughts,
feelings, physical sensations, and observations of the space around. It have to described
next.
• Breathing Techniques
– Breath of Fire: Kapalabhati Pranayama: Kapalabhati is a very active, forced exhalation
with a passive inhalation. Try starting with 2-3 rounds of 30 exhalations. Then, gradually
increase the exhalations, have to feel comfortable.
Nostril Alternating Breath: Nadi Sodhana Pranayama: Closing off right nostril with the
thumb and inhale into the left nostril. Next, closing off left nostril with forefinger (or
another finger), open the right nostril by removing thumb and exhale through the right
nostril. It have to be tried doing 5 "rounds" when begin. As one feel more comfortable, it
has to tried10 or 20 rounds.
Three Part Breath: Dirga Pranayama: Dirga Pranayama is called the three part breath
because you are actively breathing into three parts of your abdomen. The first position
is the low belly (just below the belly button), the second position is the low chest (belly
and lower half of the rib cage), and the third position is the upper chest and low throat
(just above the top of the sternum). The breath is continuous, inhaled and exhaled
through the nose.

18. • Body Scan/Savasana
– Sitting or lying down in a comfortable position (savasana is the "corpse
pose"), one has to take a minute or two to breath deeply and relax.
Closing eyes and bringing your focus to this present moment and your
physical self.
A quick body scan can take 30 seconds. A longer body scan can take 30
minutes. Based on needs and circumstances, this exercise can be very
flexible.
• Visualization
– Sitting in a relaxed position, begin by taking a few deep breaths to calm
and bring mind to the present moment. Begin to visualize a place or space
where one can be at peace. One may find it most helpful to imagine a new
place, where one have never been. It can resemble something familiar, but
should be a unique space.
• Concentration/Dharana Meditation
– This form of meditation focuses the attention on an "object." The
object could be an actual physical object, a sound, an image, a mantra,
or just about anything else. The object of focus is not the most
important piece. Instead, what is most important is simply the process
of learning to concentrate. Learning this skill will have its own
benefits: relaxation and stress reduction.

19. • Mindful Breathing/Anapanasati
– begin by taking a few deep breaths to relax.
– begin with breathing normally through nose and paying attention to your
inhalations and exhalations.
– One has to try to find a spot where breath is most noticeable. may want to try
counting your breaths (1-10 and then start over).
– may also want to name inhalations by saying to oneself, "In" and name your
exhalations by saying, "Out."
– If need to use counting or naming, use them as tools to help maintain a focus on
your breathing. Do not let them become the object of focus.
• Mindfulness Meditation/Vipassana
– object of meditation is one's own consciousness.
– use the breath as an anchor to the present moment, it is no longer the only object
(as in other forms of meditation)
– become aware of whatever the most prominent stimulus is in that moment, and
we allow that stimulus to be our object- may be a thought, a feeling, a physical
sensation, a sound, a smell, or just about anything else.
– simply notice it without becoming involved in thinking about it. In this sense, we
are working toward achieving an objective and non-reactive state of mind.
– At the same time, Vipassana is not primarily a relaxation technique and we are not
trying to flee from reality or go off into a trance. The goal is active and objective
observation of our subjective experience, without attachment.

20. MINDFULLNESS IN PSYCHOTHERAPY
1. Mindfulness-based stress reduction (Kabat-Zinn, 1990):
• The first of the mindfulness-based interventions was MBSR
(Kabat-Zinn, 1990).
• Program consists of eight weekly 2- to3-hour classes and one
daylong class.
• Includes formal guided instruction in mindfulness meditation and
mindful body movement or yoga practices, exercises to enhance
awareness in everyday life
• Daily assignments lasting from 45 minutes to an hour that are
largely meditations, and methods for improving communication.
• The program emphasizes being present with sensations within the
body, and then expanding this to emotions and thoughts.
• MBSR aims to help people develop an ongoing meditation
practice.

21. 2. Dialectical behaviour therapy (Linehan, 1993):
• Combined a commitment to the core conditions of acceptance
and change through the Hegelian principle of Dialectics (in which
thesis + antithesis → synthesis)
• DBT is used primarily with people diagnosed with borderline
personality disorder, who are frequently deficient in this respect.
• Mindfulness is considered a foundation for the other skills taught-
helps individuals accept and tolerate the powerful emotions they
may feel when challenging their habits or exposing themselves to
upsetting situations
• The mindfulness skills that are taught divide into two sets:
– the ‘what’ skills of observing, describing or participating
– the ‘how’ skills of being non-judgmental, ‘one-mindful’ and effective as
attention is deployed.
• Patients are seen weekly
• Goal to improve interpersonal skills and decreasing self-destructive
behavior

22. 3. Mindfulness-based eating awareness training (Kristeller &
Hallett, 1999):
• Represents an extension of MBSR and MBCT designed for
people with binge eating disorder.
• The resulting program is usually longer than 8 weeks and is
premised on mindfulness practice
• Goal: reversing the lack of awareness of bodily and internal
states that has been commonly observed among people
with eating disorders.

23. 4. Acceptance and commitment therapy (Hayes et al, 1999):
• Based on a radical behavioral analysis of patients’ difficulties.
• Appropriate therapeutic plans are selected from a full and
varied menu.
• They fall under six main headings:
i. Cognitive diffusion
ii. Acceptance
iii. Contact with the present moment
iv. Observing Self
v. Values, and
vi. Committed action.

24. 5. Mindfulness-based cognitive therapy (Segal et al, 2002):
• Developed as a treatment approach to reduce relapse and
recurrence of depression.
• MBCT is based on MBSR, but integrates several elements of
cognitive therapy such as client education and emphasis on the
role of negative thoughts.
• Stressed on how rumination, avoidance, suppression, and the
struggle with unhelpful cognitions and emotions can
perpetuate distress rather than resolve it.

25. Other therapies
• Morita therapy
• Adaptation Practice
• Hakomi therapy
• Internal Family Systems Model (IFS)
• Positive psychotherapy
• Mindfulness relaxation

26. Mindfulness In Various Psychiatric Disorders
• In Depression: Here three consideration are useful as therapist explore
behaviour with the patient.
• Mindfulness of intention:
– inquire about precipitants, problem and pain.
– how closely a patient’s living aligned with his or her heart’s desire?
– helped clarify values and then develop a willingness to behave in ways
that are more consistent with these values.
– The goal is for patients to live their deeper intentions.
• Restraint from harm:
– the patients are asked whether they have any intention to harm
themselves.
– Usually, when a patient is speaking, there is a turning and the voice
drops off or the patient looks aside. The vitality of words seems to drain
out. Then the patient is brought back to awareness of how does it feels
to discuss the matter.
– Eventually, in this patient is invited to develop a lived, non-judgmental
awareness of the self injurious behavior.
(Hayes, Strosahl, et al.,1999)

27. • Kindness towards oneself:
– By asking patients the ways in which they are kind to themselves, they
is engaged in a more intimate, experience-near way.
– Cultivating a moment by moment awareness of being kind to oneself
puts a patient in direct contact with possible obstacles doing so.
Understanding why we are not kind to ourselves can be freeing.
– Yet, simple mindful observation can also help to gain freedom from
our repetitive behaviors.

28. • In Anxiety disorder:
– A mindfulness based approach to treating anxiety involves becoming
less identified with our thoughts: simply noticing the events, as it is
occurring, with acceptance.
– This approach would encourage the patient to explore the feeling of
racing heart and related thoughts in great detail, as they arise.
– The process of being aware moment to moment, dismantles the fear
by distinguishing the raw facts of experience from the frightening
conclusion we draw shortly thereafter.
• In psycho-physiological disorder:
– Recovery from the syndrome requires interrupting the pain cycle.
– This involves basic elements, all of which can be supported by mindful
practice: a) cognitive restructuring b) resuming full physical activity c)
working with negative emotions.
– Both mindfulness practice and its associated insight would be effective
in resolving the muscle tension disorders, Gastrointestinal and
dermatological disorders, sexual dysfunctions and insomnia.

30. • In Borderline Personality disorder:
– In DBT practiced for BPD, the goals of mindfulness practice are simply
to practice and to experience “Wise Mind”.
– Different names for wise mind- “true self”, “spirit”, and others refer to
it as “being centered”.
– You’re in wise mind when your emotions and your thoughts work
together so that wise action is easy, even when your life and/or
circumstances are really hard.
– You’re in wise mind when you can meet each moment of life as it is,
not as you would have it be, and respond to it skillfully.
– People who practice mindfulness get better at enduring pain, better at
solving problems, better at not creating misery for themselves, and
better at participating fully in those moments of life that are joyful.
(Sanderson;1993)

32. • In Anorexia Nervosa
– An evaluative study on the effectiveness of Acceptance and
Commitment Therapy (ACT) for treatment of anorexia nervosa (AN)
using a case series methodology among participants with a history of
prior treatment for AN, found that ACT could be a promising
treatment for sub-threshold or clinical cases of AN, even with chronic
participants or those with medical complications. (Berman MI, 2009).
• Drug -Refractory Epilepsy Patients
– A randomized control trial on ACT and yoga among drug-refractory
epilepsy patients found that both therapies significantly reduce seizure
index and increase quality of life over time.
– ACT reduced seizure index significantly more as compared with yoga.
Participants in both the ACT and yoga groups improved their quality of
life significantly as measured by one of two quality-of-life instruments.
– The study concluded that complementary treatments, such as ACT and
yoga, decrease seizure index and increase quality of life.
(Lundgren T, 2008)

33. • In Psychosis:
– Segal, Williams et al. (2002) stress the importance of having a clear
formulation when using mindfulness training with a specific disorder.
– Chadwick, Birchwood and Trower (1996) argue that cognitive therapy
for psychosis should not be aimed at trying to control psychotic
symptoms such as voices, images and paranoid intrusions, but at
alleviating the distress associated with them.
– In Baer’s review there is no study applying mindfulness as an
independent component to psychosis
– A study by Bach & Hayes (2002) showed that with only four hours of
ACT, hospital re-admission rates for schizophrenic patients dropped by
50% over the next six months.
– A scarce literature exists on meditation and psychosis, and it contains
cautions against teaching meditation to people vulnerable to or
currently experiencing active symptoms of psychosis (Deatherage and
Lethbridge, 1995).

34. Mindfulness In Cancer:
• In a RCT treatment group had fewer overall Symptoms of Stress; fewer
Cardiopulmonaryand Gastrointestinal symptoms; less Emotional
Irritability, Depression, and Cognitive Disorganization; and fewer Habitual
Patterns of stress.
• Overall reduction in Total Mood Disturbancewas 65%, with a 31%
reduction in Symptoms of Stress
(Speca, 2000)

35. Mindfulness And Substance Use
• Sarah (2005) evaluated the effectiveness of a Vipassana meditation (VM)
course on substance use and psychosocial outcomes in an incarcerated
population keeping matched control.
• Results: (after release from jail) significant reductions in alcohol, marijuana,
and crack cocaine use and decreases in alcohol-related problems and
psychiatric symptoms as well as increases in positive psychosocial outcomes.
• Janis Leigh et al (2005) (1) explored the relationship between mindfulness and
spirituality, and (2) investigated the relationship between mindfulness and/or
spirituality and alcohol and tobacco use.
• They found in addition, smoking and frequent binge-drinking were negatively
correlated with spirituality scores; as spirituality scores increased the use of
alcohol and tobacco decreased. Thus, spirituality may be related to decrease
in substance use.
• But the research data till date has not revealed the ultimate effectiveness of
mindfulness for substance abuse and addiction. It might be that mindfulness is
a helpful, but not a sufficient factor as a means to address substance abuse
(Appel, 2009).

36. Mindfulness And Sexual Disorder/ Relationship satisfaction
• Two studies examined the role of mindfulness in romantic relationship
satisfaction and in responses to relationship stress.
• Using a longitudinal design, Study 1 found that higher trait mindfulness
predicted higher relationship satisfaction and greater capacities to
respond constructively to relationship stress.
• Study 2 replicated and extended these findings. Mindfulness was again
shown to relate to relationship satisfaction; then, using a conflict
discussion paradigm-
– Trait mindfulness was found to predict lower emotional stress
responses and positive pre- and post-conflict change in perception of
the relationship.
– State mindfulness was related to better communication quality during
the discussion.
• Both studies indicated that mindfulness may play an influential role in
romantic relationship well-being.
(Brotton, 2008 &2009)

37. Criticisms
• Modern understandings departs significantly from the Buddha’s own
account of mindfulness- While mindfulness is used as a means to reduce
stress, in a Buddhist context it is part of an all-embracing ethical program
to foster "wise action, social harmony, and compassion.“
• The popularization of mindfulness as a "commodity“- "McMindfulness“-
new brand of mindfulness has resulted in the commercialization of
meditation through self-help books, guided meditation classes, and
mindfulness retreats.
• According to Bhikkhu Bodhi, "Absent a sharp social critique, Buddhist
practices could easily be used to justify and stabilize the status quo,
becoming a reinforcement of consumer capitalism."
Ron Purser and David Loy (2013), Beyond McMindfulness

38. Conclusion
• Mindfulness training provides one tool of many to facilitate
both the stabilization and destabilization aspects of change.
• Enthusiasm for mindfulness-based interventions is balanced
by considerable skepticism.
• Much remains to be worked out at theoretical and practical
levels
• Future of mindfulness-based therapies is likely to depend on
demonstrations of their distinct, effective and lasting
contributions that other clinicians cannot ignore.

39. References
• Kabat-Zinn- Mindfulness Training as a Clinical Intervention: A Conceptual and
Empirical Review, by Ruth A. Baer, available at http://www.wisebrain.org
/papers/MindfulnessPsyTx.pdf. 1994
• "The Stress Reduction Program, founded by Dr. Jon Kabat-Zinn in 1979..." -
umassmed.edu
• Mindfulness-based interventions: Effective for depression and anxiety.
Current Psychiatry Vol. 8, No. 12
• Hayes, S.C., Follette, V.M., Linehan, M.M., eds. (2011). Mindfulness and
Acceptance: Expanding the Cognitive-Behavioral Tradition. Guilford Press.
• Safran, Jeremy D. (2014), "Straight Talk. Cutting through the spin on
psychotherapy and mental health", Psychology Today
• Teasdale, J.D., Williams, J.M.G., Segal, Z.V. (2014). The Mindful Way
Workbook: An 8-Week Program to Free Yourself from Depression and
Emotional Distress. Guilford Press.
• https://en.wikipedia.org/wiki/Mindfulness

40. THANK YOU

42. Acceptance and Commitment Therapy
• Created in 1986 by Steve Hayes, ACT was the first of the ‘third wave’
therapies
• ‘Existential Humanistic Cognitive Behavioural therapy’
• A mindfulness based behavioural therapy that challenges the ground rules
of most Western psychology.
• Proven effective with a diverse range of clinical conditions; depression,
OCD, workplace stress, chronic pain, the stress of terminal cancer, anxiety,
PTSD, anorexia, heroin abuse, marijuana abuse, and even schizophrenia.
• A study by Bach & Hayes (2002) showed that with only four hours of ACT,
hospital re-admission rates for schizophrenic patients dropped by 50%
over the next six months.

43. ACT
• *Mindfulness skills are ‘divided’ into four subsets:
– acceptance
– cognitive defusion
– contact with the present moment
– the observing self
ACT Other Mindfulness based therapy
Individualise their own mindfulness
techniques
Essentially manualised treatment
protocols
individuals, couples and
groups
groups
* formal mindfulness

44. ACT
• Healthy Normality Destructive Normality
• ACT postulates that the root of this suffering is human
language itself
• It does this is through setting us up for a struggle with our
own thoughts and feelings, through a process called
experiential avoidance.
• ACT interventions focus around two main processes:
– developing acceptance of unwanted private experiences
which are out of personal control.
– commitment and action towards living a valued life.

45. ACT
• Six core principles of ACT
i. Cognitive defusion
ii. Acceptance
iii. Contact with the present moment
iv. Observing Self
v. Values, and
vi. Committed action.

46. ACT
• Cognitive defusion means we are able to ‘step back’ and observe language,
without being caught up in it. We can recognise that our thoughts are
nothing more or less than transient private events—an ever-changing
stream of words, sounds and pictures. As we defuse our thoughts, they
have much less impact and influence.
 We might simply observe it with detachment; or repeat it over and over,
out aloud, until it just becomes a meaningless sound; or imagine it in the
voice of a cartoon character; or sing it to the tune of ‘Happy Birthday’; or
silently say ‘Thanks, mind’ in gratitude for such an interesting thought.

47. ACT
• Acceptance: making room for unpleasant feelings, sensations, urges, and
other private experiences; allowing them to come and go without
struggling with them, running from them, or giving them undue attention.
• Contact with the present moment: bringing full awareness to you’re here
and- now experience, with openness, interest, and receptiveness; focusing
on, and engaging fully in whatever you are doing.

48. ACT
• The Observing Self: accessing a transcendent sense of self; a continuity of
consciousness that is unchanging, ever-present, and impervious to harm.
From this perspective, it is possible to experience directly that you are not
your thoughts, feelings, memories, urges, sensations, images, roles, or
physical body. These phenomena change constantly and are peripheral
aspects of you, but they are not the essence of who you are.
 Thoughts that arise, and the self who observes those thoughts. From the
perspective of this Observing Self, no thought is dangerous, threatening, or
controlling.
• Values: clarifying what is most important, deep in your heart; what sort of
person you want to be; what is significant and meaningful to you; and
what you want to stand for in this life.
 ‘If taking your life in the direction of these values means you need to make
room for feelings of anxiety, are you willing to do that?’

49. ACT
• Committed Action: setting goals, guided by your values, and taking
effective action to achieve them.
• ACT training helps therapists to develop the essential qualities of
compassion, acceptance, empathy, respect, and the ability to stay
psychologically present even in the midst of strong emotions.
• It is no longer about getting rid of bad feelings or getting over old trauma.
Instead it is about creating a rich, full and meaningful life.
• ‘Embrace your demons, and follow your heart.’

50. Fundamentals of Y-MBCT
1. Yoga in its entirety is Eight steps and three-fold:
Life style, Mind-Body Tools, Using Meditation in
Daily Life
2. Philosophy, Techniques & Practice: ALL THREE
necessary
3. Meditation is NOT an action: It is a state of mind
4. Meditation is part of Yoga & is two-fold:
Concentration(FA) & Mindfulness (OM)

51. 30
20
50
Philosophy
Techniques
Practices

52. WORKING MODELS of MIND & MEDITATION
(Pradhan, 2014)
Based on:
• Five Factor Model of Human Mind/Experience
• Meditation as Detached Observation of Mind
• without reacting to its five contents
• Balanced View of the MIDDLE WAY

53. The Five Factor Model of Human Experience
in the Abhidhamma (Buddha: 6th cent. BC)
• Human Experience is a Co-creation by the
Aggregates
• All Experiences are Temporary & Prone to Change
• Stress & Happiness are experiences: Can be
changed
• One’s Field of Awareness is the Platform to
Experience/
• Experiment to effect the Change
• Distractions during meditation are experiences as
well that can be handled

57. DETACHED MINDFULNESS
• Within the metacognitive mode a type of experience is possible and
desirable in metacognitive therapy. This is the experience of detached
mindfulness (DM; Wells & Matthews, 1994).
• Detached mindfulness refers to how individuals respond to mental events:
worries, intrusive images, negative thoughts and memories, it involves
discontinuation of any further cognitive or coping response to thoughts.
• Detached mindfulness to facilitate low levels of preservative thinking,
attempting to modify maladaptive attentional strategies and dysfunctional
coping behaviors.