1. Mindfulness and Mental
Health
Kelley Raab Mayo, M.Div., Ph.D.
September 19, 2013

3. What is Mindfulness?
• What is mindfulness and what is its relationship to
mental health?
• Mindfulness, as defined by Zen master Thich Nhat
Hanh, is “the practice of being fully present and
alive, body and mind united. Mindfulness is the
energy that helps us to know what is going on in
the present moment” (Shambala Sun, 2008).

5. What is Mindfulness?
• Mindfulness is a form of meditation originally
derived from the Theravada tradition of
Buddhism.
• The 2,500 year-old practice known as Vipassana
was developed as a way to cultivate greater
awareness and insight.
• “Mindfulness” is often translated as “to see with
discernment.”

6. What is Mindfulness?
“Mindfulness is the awareness that emerges
through paying attention, on purpose, in the
present moment, and non-judgmentally, to things
as they are” (Williams, Teasdale, Segal, KabatZinn, The Mindful Way Through Depression, 2007,
p. 24)

8. BUT…
Mindfulness is presymbolic.
Mindfulness can be experienced and it can be
described, “as long as you keep in mind that the
words are only fingers pointing to the moon. They
are not the moon itself” (Gunaratana,
Mindfulness in Plain English, 2011, p, 131).

10. Mindfulness is simple but not easy
• With the pressures society places on being
constantly busy, productive, and on the move, it
can be difficult to settle down and be present for
even five minutes.
• Over the long term it's remembering to be
mindful that's the hard part. …The good news is
it does get easier with time and practice.
Practiced consistently over time it becomes
second nature.

11. Three Axioms of Mindfulness
• Intention – Your intention is your motivation for practicing
mindfulness. The strength of your intention helps to
motivate you to practice mindfulness on a daily basis, and
shapes the quality of your mindful awareness.
• Attention – Mindfulness is about paying attention to your
experience. Your mindful attention is mainly developed
through various different types of meditation – either
formal or informal
• Attitude – Mindfulness involves cultivating an accepting,
open, and kind curiosity towards one’s experience.

13. Four Foundations of Mindfulness
Thich Nhat Hanh
1. Mindful observation of the body
“The first establishment of mindfulness is the body,
which includes the breath, the positions of the body,
the parts of the body, the four elements of which the
body is composed, and the dissolution of the body.”
The first practice is the full awareness of breathing.

14. Four Foundations of Mindfulness
Thich Nhat Hanh
2. Mindful observation of feelings
There are three sorts of feelings: pleasant, unpleasant, and
neutral. The teaching of this exercise is to identify and be
in touch with these feelings as they arise, endure, and fade
away.
The practitioner is neither drowned in nor terrorized by
that feeling, nor does he/she reject it. This is the most
effective way to be in contact with feelings.

15. Four Foundations of Mindfulness
Thich Nhat Hanh
3. Mindful observation of consciousness (or mind)
The contents of the mind are psychological phenomena
called mental formations.
We mindfully observe the arising, presence, and
disappearance of the mental phenomena which are called
mental formations. We recognize them and look deeply
into them in order to see their substance, their roots in the
past, and their possible fruits in the future, using conscious
breathing while we observe.

16. Four Foundations of Mindfulness
Thich Nhat Hanh
4. Mindfulness of the objects of mind (or mental
objects)
When sitting in meditation, we concentrate our mind on
the object of our observation – sometimes a physical
phenomenon, sometimes psychological – and we look
deeply into that object in order to discover its course and
its nature. … If we look carefully and deeply, we will see
that the arising, enduring and ending of the object is
dependent on other things (principle of interbeing and
interpenetration)

17. Mindful awareness of the hands

18. Benefits of Mindfulness
Mindfulness has numerous health benefits.
Training in mindfulness has the potential to
increase awareness of thoughts, emotions, and
unhealthy patterns of mind that make you more
susceptible to stress.

20. Benefits of Mindfulness
• Mindfulness can help you live more in the present
moment.
• You can practice mindfulness while eating,
walking, talking, or doing just about anything.

23. Benefits of Mindfulness
“Mindfulness practice is the practice of being 100%
honest with ourselves.” (Gunaratana, Mindfulness
in Plain English, 2011, p. 42).

25. Benefits of Mindfulness
“When we watch our own mind and body, we
notice certain things that are unpleasant to
realize. …. Before we try to surmount our defects,
we should know what they are …” Gunaratana,
Mindfulness in Plain English, 2011, pp. 42-43).

26. Myths of mindfulness
Dr. Lynette Montiero
Be in the moment –Often we hear it used as a way
of not being in the moment …It is frequently used
a way of saying, “I just want the pleasant stuff.”
…Being in the moment means holding a steady
awareness of everything that is happening
without rejecting or clinging to any one
experience.

28. Myths of mindfulness
Dr. Lynette Montiero
Let go –We talk about letting go of our anger or
grief and feel frustrated when anger or sadness
shows up. .. Letting go is the process of opening
ourselves to the experience we are having without
engaging the old habits of judgmental thinking
and self-criticism.

30. Myths of mindfulness
Dr. Lynette Montiero
• Accepting what is – Often we worry that
accepting something is the same as being passive
or staying a victim to our circumstances…
• Acceptance is the practice of looking into our
experience, our situation, and seeing all the
dimensions in it. It is seeing it for what it truly is
and not what we wish it was.

32. Mindfulness-Based Stress Reduction
(MBSR)
• Jon Kabat-Zinn, Ph.D. (1982, 1990), developed a
Mindfulness-Based Stress Reduction (MBSR)
program at the University of Massachusetts
Medical Center in 1979.
• Since then, MBSR programs, based on his model,
have been implemented worldwide.

33. MBSR program - Kabat-Zinn
1) Consists of 8 weekly 2.5 hour-long classes and
one “day of silence” in between the 6th and 7th
weeks
2) Formal practices include a body scan, sitting
meditations, mindful yoga, mindful walking, and
mindful eating
3) Home practice is an integral part of the
program

34. “Learning Objectives” of MBSR
1. Experiencing new possibilities – reframing;
beginner’s mind
2. Discovering embodiment (e.g., emotions as
experienced in the body)
3. Cultivating the observer – practice of noticing
when and where the mind has wandered
(fostered by inquiry)
4. Moving towards acceptance, nonjudgment,
compassion

35. Mindfulness and mental health
• Mindfulness-based therapies have been used with
different clinical psychiatric populations, such as
clients with anxiety and depressive disorders,
eating disorders, gambling and addictive
disorders.
• Mindfulness has been used in the treatment of
borderline personality disorder and with clients
with a history of childhood sexual abuse.

36. Mindfulness and mental health
Specifically, mindful meditative techniques and
self-awareness exercises help by cultivating an
awareness of thoughts and feelings, accepting,
and letting them be.

37. Mindfulness-Based Interventions
•
•
•
•
•
•
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MBSR (Mindfulness-Based Stress Reduction)
ACT (Acceptance and Commitment Therapy
DBT (Dialectical Behavior Therapy)
MBCT (Mindfulness-Based Cognitive Therapy)
MBRP (Mindfulness-Based Relapse Prevention)
MB-EAT (Mindfulness-Based Eating Awareness Training
Mindfulness-based interventions continue to evolve ….

38. Is mindfulness for everyone?
• As Hayes and Feldman (2004) note, careful
consideration must be given to clients’ abilities to
face their own negative material without use of
their current coping strategies.
• Hayes, A. and Feldman, G. (2004). Clarifying the construct
of mindfulness in the context of emotion regulation and
the process of change in therapy. Clinical Psychology:
Science and Practice 11(3)), 249-254.

39. Neuroscience of Mindfulness
David Rock, author of Your Brain at Work
You can experience the world through your narrative
circuitry…You can also experience the world more directly,
which enables more sensory information to be perceived
and allows you to get closer to the reality of any event….
Noticing more real-time information makes you more
flexible in how you respond to the world. You also become
less imprisoned by the past, your habits, expectations or
assumptions, and more able to respond to events as they
unfold.

40. Neuroscience of Mindfulness
• Farb, Segal, Mayberg, et al. (2007).
Attending to the present: mindfulness meditation reveals
distinct neural modes of self-reference. SCAN 2, 313-322.
• “Mindfulness training allows for a distinct
experiential mode in which thoughts, feelings, and
bodily sensations are viewed less as being good or
bad or integral to the ‘self’ and treated more as
transient mental events that can be simply
observed. …”

41. Mechanisms of Action
McCown and Reibel, 2009
1. Shift to observer consciousness, decentering;
e.g. “I am not my thoughts,” “I am not this pain”
2. Reperceiving – shift from identification with
one’s experience to experience being available
for observation; enables looking, feeling, and
knowing more deeply

42. Mechanisms of Action
• Vago and Silbersweig. (2012).
Self-awareness, self-regulation, and self-transcendence (S-ART): a
framework for understanding the neurobiological mechanisms of
mindfulness. Frontiers in Neuroscience, 2012
• Using the S-ART framework, authors suggest that
mindfulness fosters mental training to develop metaawareness of self (self-awareness), an ability to effectively
manage or alter one’s responses (self-regulation), and the
development of a positive relationship between self and
other (self-transcendence).

43. Mechanisms of Action
Holzel, Lazar, Gard, et al. (2011). How Does Mindfulness
meditation work? Proposing mechanisms of action from a
conceptual and neural perspective. Perspectives on
Psychological Science 6:537-559.
1. Attention regulation – thought to be a prerequisite
for the other mechanisms
2. Body awareness
3. Emotion regulation
4. Change in perspective on the self

45. Additional Mechanisms
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•
•
•
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Decrease in ruminative thinking
Decrease in worry
Increase in mindfulness
Increase in “acceptance without judgment”
Increase in self-compassion

46. Mindfulness at the Royal
• Mindfulness has been integrated into many
inpatient units at the Royal, including mood,
geriatrics, substance use (and Meadow Creek),
schizophrenia, ROMHC
• At BMHC, mindfulness has been integrated into
secure treatment unit and forensic treatment unit

48. Mindfulness at the Royal
Mindfulness-based Cognitive therapy is an option
for clients in the mood outpatient program, based
on appropriateness and referral. MBCT was
specifically designed to treat major depression
relapse. MBCT integrates components of MBSR
with cognitive behavioural therapy (CBT) by
decentering from ruminative thoughts and
emotions.

49. DOING MIND
From Williams and Penman (2011):
• Automatic pilot
• Analyzing
• Striving
• Seeing thoughts as solid and real
• Avoidance
• Mental travel time
• Depleting activities

51. BEING MIND
From Williams and Penman (2011):
• Conscious choice
• Sensing
• Accepting
• Treating thoughts as mental events
• Approaching
• Remaining in the present moment
• Nourishing activities

53. Wise Mind
DBT meets the 12 Steps, Platter, 2010
• Wise mind results from using both emotion mind
and reasonable mind together (Linehan, 1993).
• Marsha Linehan (founder of DBT) states: “Wise
mind is that part of each person that can know
and experience truth. It is where the person knows
something to be true or valid. It is almost always
quiet, It has a certain peace. It is where the person
knows something in a centered way.”

55. Mindfulness at the Royal
• MBSR has been offered to staff in two formats:
• Traditional 8 week program (2011 – 2013)
• Modified 4-week program for inpatient staff
teams (ongoing)
• Informally, as mindful movement/yoga and
meditation classes for staff, both at ROMHC and
BMHC

56. Mindfulness Study, the Royal
• The participants for this study were a group of 22 female health
care workers between the ages of 24 and 69. Participants were
assessed before and after an 8-week MBSR program using the
Self Compassion Scale, the Quality of Life Inventory and the
Maslach Burnout Inventory.
• Comparisons were made pre/post treatment using the
subscales of the aforementioned measures.
• A significant decrease in the self judgment subscale of the Self
Compassion Scale was observed in the sample population at an
alpha of .004. This indicates that mindfulness training was
effective at reducing self judgment.

57. Mindfulness and Self-Compassion
Mindful self-compassion is being aware in the
present moment when we're struggling with
feelings of inadequacy, despair, confusion, and
other forms of stress (mindfulness) and
responding with kindness and understanding (selfcompassion).
C. Germer, www.mindfulselfcompassion.org

59. Conclusions
• Jon Kabat-Zinn, Full Catastrophe Living
(1990/2005): “In this book we will be learning and
practicing the art of embracing the full
catastrophe ….”
• “Catastrophe” here does not mean disaster.
Rather, it means the poignant enormity of our life
experience. (p. 6)

61. Conclusions
“Everyday we are engaged in a miracle which we
don't even recognize: a blue sky, white clouds,
green leaves, the black, curious eyes of a child our own two eyes. All is a miracle.”
Thich Nhat Hanh The Miracle of Mindfulness

63. Conclusions
• Bhante Gunaratana, Mindfulness in Plain English
(2011): “Mindfulness is not trying to achieve
anything. It is just looking” (147)
• “Yet the ultimate goal of [meditation] practice
remains: to build one’s concentration and
awareness to a level of strength that will remain
unwavering even in the midst of the pressures of
life in contemporary society” (153)