C128 Introductory Guide

An Introductory Guide to Mindfulness Skills Dr. Paul Flaxman City University London

Copyright note. This guide has been developed for participants involved in the Promoting the Psychological Well-Being of NHS Staff project, funded by a grant from the Economic and Social Research Council (ESRC). The guide should only be received by participants involved in that project. No part of this document or the associated audio files may be copied or reproduced without prior permission from Dr Paul Flaxman, City University London.

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CONTENTS INTRODUCTION What is Mindfulness?

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What are the Benefits of Mindfulness?

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HOW TO DEVELOP MINDFULNESS Formal Mindfulness Meditation, Brief Mindful Practices, Mindfulness of Daily Activities

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How to Use this Guide and the Audio Files

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OVERVIEW OF MINDFULNESS EXERCISES The Raisin Exercise; Body Scan; Mindfulness of Breathing; Breathing Space

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Common Challenges

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FOUR-WEEK TRAINING PROGRAMME Week 1: Raisin exercise + body scan + awareness of daily activities

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Week 2: Body scan + mindfulness of breathing + awareness of daily activities

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Week 3: Mindfulness of breathing + awareness of daily activities + the breathing space

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Week 4: Making mindfulness part of your life

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Mindfulness practice diary

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MINDFULNESS BOOKS AND RESOURCES

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WELCOME You have received this guide to mindfulness skills as part of your participation in an improving staff well-being research project. May I take this opportunity to thank you once again for taking the time out to participate in my research. As well as receiving this guide, you will also receive a final summary report of the project, once all the results have been analysed. It is anticipated that the results of the project will lead to additional training programmes designed to promote staff well-being and recovery during leisure time. This guide includes a brief introduction, which describes mindfulness as bringing awareness to your present moment experience, and explains why this skill is helpful for well-being and performance. I also outline some recommended ways of developing mindfulness skills, including guided meditation, brief practices, and bringing present moment awareness to your routine daily activities. Towards the end of this guide, I have outlined a four-week training programme. If you are able to practice the exercises as suggested, it is likely you will be taking a major step towards building mindfulness into your life. I should say at this point that practice is absolutely crucial! If you do not engage in the various exercises you will not develop greater mindfulness, and you will not obtain the benefits that mindfulness has to offer. At first, you just need to practice, even if you don’t see any immediate benefits or understand why you are doing it. Sometimes you will find the exercises enjoyable, while at other times you will find them frustrating, tedious, or boring. It matters not – just keep practicing. Be assured that you will be developing a skill that has been practiced for thousands of years, and which is now recommended in many mainstream forms of psychological therapy, stress management, coaching, and performance enhancement programmes. Should you wish to read more about mindfulness or explore further training, I have included a number of books and other resources at the end of the guide. I wish you well as you embark on your journey towards the cultivation of mindfulness.

Dr Paul Flaxman, City University London, July 2010

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INTRODUCTION What is Mindfulness? Mindfulness training has become one of the most important techniques in modern psychotherapy, stress management, pain management, and performance enhancement. While mindfulness has become increasingly popular, it is probably the oldest psychological skills technique we know of. Mindfulness has strong roots in Buddhism, but it is also found in the practices of Hinduism, Islam, and Christianity (just Google ‘history of mindfulness’ and you will find various accounts of its long and fruitful history). Mindfulness is often described as the process of bringing a certain quality of attention to our moment-by-moment experience. Mindfulness involves becoming more fully aware of both our internal experiences (e.g., thoughts, feelings, and bodily sensations), and external experiences (e.g., sounds, interpersonal interactions), as they are happening in the present moment. Importantly, mindfulness involves adopting a non-judgemental perspective toward our internal experiences. This means ‘letting go’ of judgements and evaluations of thoughts, feelings, or bodily sensations as good or bad, in order to simply be aware of those experiences just as they are. It is a way of putting our human capacity for awareness to good use. Mindfulness practice is essentially a form of awareness training – learning to focus and sustain the spotlight of one’s awareness on present moment experiences. Jon Kabat-Zinn – one of the West’s most prominent mindfulness trainers – describes mindfulness as: “paying attention in a particular way: on purpose, in the present moment, and non-judgementally.” Similarly, researchers have developed a definition of mindfulness which includes the following two components: 1. Self-regulation of attention - that is, maintaining attention on immediate, here and now experience. 2. Non-judgemental orientation toward one’s experiences - an orientation characterised by curiosity, openness, and acceptance. Such definitions can be useful to practitioners and researchers of mindfulness. However, developing mindfulness is more about your personal experience than it is about intellectual understanding. This is why mindfulness trainers always develop their own personal practice before advising others on how to cultivate mindfulness skills. Hence, the principal aim of this guide is to provide you with an experiential introduction to mindfulness – to take you 4

through a series of exercises that encourage you to bring mindful awareness to your current bodily sensations, thoughts, and feelings.

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What are the Benefits of Mindfulness? A great deal of research has established the health, well-being, and performance benefits of practicing mindfulness. For example, for over 20 years, Jon Kabat-Zinn and his colleagues in Massachusetts have been establishing the benefits of mindfulness for helping people manage chronic pain and symptoms of stress. More recently, research teams in the UK have demonstrated the effectiveness of mindfulness training for reducing depression (and mindfulness training is now included in the NICE recommendations for treating depression). I have included some references at the end of this document if you are interested in reading more about mindfulness research (I would particularly recommend the review of mindfulness by the Mental Health Foundation). To summarise, mindfulness training has been associated with the following benefits: 50% reduction in depression relapse rates over 12 months 50% reduction in general psychiatric symptoms 70% reduction in anxiety 44% reduction in medical symptoms 17% reduction in daily hassles, and 31% reduction in general psychological distress, among employees trained in the workplace Some of the most remarkable research findings are emerging from studies that have assessed the impact of mindfulness meditation on brain and immune system functioning. In particular, mindfulness meditation has been associated with an increase in brain waves linked to relaxation, positive mood, and being alert. People who meditate have been found to have greater cortical thickening in the parts of the brain associated with increased awareness and attention. In other words, mindfulness training helps you to become more in tune with your here and now experience, and this has an observable positive influence on your brain! More generally, mindfulness is a very useful tool for helping us untangle from difficult or unwanted thoughts and feelings. It is therefore a very powerful technique when we find ourselves worrying excessively about the future or ruminating over the past. Mindfulness is not designed to stop the mind having unwanted thoughts (that’s what minds love to do!), but the skill allows you to experience such thoughts as passing events in the mind. If you build mindfulness into your life, you are likely to become much more aware of how your mind works – noticing the habitual thinking patterns that your mind tends to pursue.

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HOW TO DEVELOP MINDFULNESS Mindfulness is developed by engaging in a series of meditation-type exercises that ask you to focus your awareness, in a non-judgemental way, on your current experience. In this guide, you will be introduced to some of the most common mindfulness practices. Before considering each of these techniques, it is worth summarising the important features of mindfulness: Mindfulness involves bringing awareness to the present moment, and experiencing internal events from a more accepting and non-judgemental perspective Mindfulness is a psychological skill that can be honed with regular practice; to develop the skill, it can be helpful to practice some form of mindfulness every day Mindfulness exercises are not designed to help you reduce, control, or avoid unwanted thoughts and emotions Similarly, relaxation is not the goal of mindfulness (even though the exercises sometimes produce feelings of calmness or relaxation) When practicing mindfulness, it doesn’t matter whether your current internal experience is pleasant or undesirable; the important thing is that you practice being aware of your various experiences as they unfold from one moment to the next Developing mindfulness takes practice. It is crucial that you get into the habit of practicing some form of mindfulness every day. This can include a formal eyes-closed meditation, along with other practices such as bringing awareness to routine activities (e.g., brushing one’s teeth, or travelling to and from work). There are essentially three ways of developing mindfulness skills: 1. Formal mindfulness meditation This involves closing your eyes and placing awareness on current sensations in the body (e.g., noticing the sensations of breathing). These practices can be performed lying down on a bed or mat, or sat upright in a chair.

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2. Brief mindful practices This guide also introduces shorter mindfulness exercises (such as the ‘breathing space’), which can be performed with eyes open. In these exercises you bring awareness to current bodily sensations at frequent points during your day. 3. Mindfulness of daily activities This third type of practice involves becoming more aware as you perform daily activities such as eating, drinking, showering or bathing, driving, washing up, exercising and so on. We perform many activities on ‘automatic pilot’; mindfulness encourages you to be present to each moment much more frequently.

How to Use this Guide and the Audio Files This guide provides an introduction to mindfulness, including its benefits for improving wellbeing and performance. The exercises described in this document have been recorded as audio files, which will be sent to you on a CD or will be available for download from a webpage. Towards the end of this guide you will find a recommended training schedule for the next four weeks. If you stick to this schedule as best you can, it is likely that you will have taken an important step in the development of mindfulness. If there are times that you forget to practice, you can always refer back to this guide and begin again.

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OVERVIEW OF MINDFULNESS EXERCISES The aim of this guide is to introduce you to some core mindfulness practices. These exercises have been borrowed from various mindfulness training programmes, including mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1990), mindfulness-based cognitive therapy (MBCT; Segal et al., 2002), and acceptance and commitment therapy (ACT; Hayes et al., 1999). You will be introduced to the following well-known mindfulness exercises: The raisin exercise, the body scan, mindfulness of breathing, and the breathing space. Each of these exercises is described briefly below. These exercises have been recorded as audio files so that you can practice at home. The Raisin Exercise This is a common and useful way to introduce mindfulness. Taking our time with a raisin provides a number of useful insights, including how mindfulness differs from doing things on automatic pilot (such as stuffing raisins in our mouth without much awareness!). The practice also shows how the quality of the experience can change when we bring mindfulness to the table. It is likely that by focusing on the experience, you really notice the intense flavours that a raisin provides. The Body Scan Learning to shift the spotlight of your non-judgemental awareness around the body is a great way to cultivate mindfulness. It strengthens your ability to use your attention and awareness to bring you into the present moment. This exercise is longer than the others, so it provides plenty of opportunities to be distracted by thoughts and feelings, and therefore plenty of opportunities to return once again to present moment sensations. Mindfulness of Breathing Awareness of the breath is central to mindfulness practice. You can focus on any area of the breath that feels most prominent for you. That might be where the air comes in and out of your nostrils, or the way the abdomen rises and falls with each breath. When beginning the mindfulness journey, it can be useful to stay focused on one aspect of breathing during each practice. For example, in this guide, you will practice being aware of the sensations and movement in the belly as you breathe in and out. The instructions repeatedly ask you to gently return to the breath as soon as you notice that your mind has wandered away to other things. Here’s another way of describing this practice – as you breath in, know that you are breathing in; and, as you breath out, know that you are breathing out. 9

The Breathing Space The breathing space involves three steps: Step 1: Pull yourself out of automatic pilot and contact the present moment This can be done by asking yourself, What is in my experience right now? What bodily sensations are here? What thoughts am I having right now? What feelings am I having? This helps to activate your present moment awareness. Step 2: Narrow your awareness to your breathing Focusing on the breath helps to ‘anchor’ your awareness to the present moment. Step 3: Expand your awareness to the entire body This final step helps you to develop a more flexible awareness. Going from a narrow focus on the breath to a broader focus on all the sensations throughout the entire body. The three steps can be completed in a couple of minutes, and the exercise may be performed with your eyes open or closed. It can be useful to practice the breathing space exercise three or more times per day, and to use it whenever you find yourself becoming wrapped up in unhelpful thoughts or emotions.

Common Challenges Focusing on one’s present moment experience might sound easy, but you may quickly discover that it is not easy at all! I have listed below some common challenges that can occur when practicing mindfulness, along with some tips on how to deal with those challenges when they arise. My mind keeps wandering off During the exercises you will be asked (for example), to focus your attention on breathing. Before long, you may find that your mind drifts away to other things, and you become ‘hooked’ by particular thoughts. It is common for people to think that this is wrong, and that they are not performing the exercises correctly. In fact, drifting away into thoughts is to be expected – that’s what minds do! Indeed, noticing that you have drifted away into thought, noticing what you were thinking, and then gently returning your awareness to the breath or body are all important parts of mindfulness. You will find that mindfulness instructions provide frequent guidance on returning to the body when the mind has drifted away to 10

other things. The mind is often drifting off into the past or the future, while your bodily sensations are always occurring in the here and now. I keep falling asleep For some people – and particularly those who have trouble sleeping – the increased ability to drop off to sleep is seen as one of the benefits of mindfulness. However, during the early stages of practice, falling asleep every time may interfere with you developing the skills. (interestingly, some people have described mindfulness as ‘falling awake’ rather than falling asleep, to emphasise that mindfulness wakes you up from the habitual automatic pilot mode, bringing heightened awareness and attention to what is happening in this moment). Many people find that they nod off during the body scan, which is often performed lying down. If this keeps happening, you could try the exercise sitting upright in a chair. Another useful tip is to open your eyes briefly to allow in some light, and then resume the exercise. If you are worried about nodding off, you can try practicing the exercises with your eyes open – just cast your eyes downwards towards the floor and allow them to become unfocused. I experience unwanted thoughts and/or feelings In our busy lives we tend to be always on the go. When we stop to practice mindfulness we step into a ‘being’ mode – just being with whatever experience shows up. During such moments it is not unusual for difficult thoughts, feelings, and sensations to show up, such as unwanted thoughts of the past, worries about the future, or anger/ irritation towards ourselves or others. This is perfectly normal. In fact, experiencing such thoughts and feelings can be very useful for cultivating mindfulness, as we tend to get hooked by these thoughts and feelings and drift away from focusing on the breath or body. This gives us another opportunity to notice where our mind has gone, and gently return attention to the breath or body. As you develop the skill of mindfulness you may find it easier to acknowledge and accept even difficult thoughts and feelings as passing events in the mind, without becoming overly entangled in them. When you experience difficult thoughts and feelings during a practice, see if you can just acknowledge them (perhaps say to yourself ‘thinking’ or ‘feeling’ to remind yourself what is happening), and then return your focus to your present moment sensations. I get distracted by noises If noise distracts you during a practice, see if you can relate to the noise in the same way as you are learning to relate to your sensations, thoughts and feelings – that is, without 11

judgement. You may try building the noise into your practice; experiencing the noise for what it actually is – sounds reaching your ear drums in this moment, without getting too wrapped up in where the noise is coming from. Just be aware of the experience as it unfolds. I don’t really enjoy doing the mindfulness exercises – I get bored and find them a real chore Practicing mindfulness is not about feeling good or relaxing. The aim is to learn how to relate more skilfully to one’s thoughts, emotions, and bodily sensations, without judgement, as they unfold in the here and now. One practice can be very pleasant, insightful, and even euphoric, while the very next practice can be frustrating, boring, irritating, or disturbing. It matters not. The secret is to just do it. Keep practicing. Build the practice into your daily life. Take a leap of faith to see what happens. Just do it. If you enjoy it, that’s fine. If you don’t enjoy it, that’s also fine. I just don’t have the time Thank your mind for that one! There are many ways to practice mindfulness. If you really cannot find 30 minutes a day to practice one of the longer exercises, start out with 5 or 10 minute practices, or make use of even briefer exercises such as the breathing space. For example, you might choose to take 5 minutes before you get out of bed in the morning to focus on breathing. The secret is to practice every day. As you develop the skill, you may even find that you want to make more time for longer practices.

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FOUR-WEEK TRAINING PROGRAMME Usually, mindfulness training is delivered over several weeks to give you the opportunity to build up your practice. However, you can begin building mindfulness into your daily life right now. I have included some guidance below on how much to practice over the next few weeks. The exercises have been recorded on a CD or will be available to download from a website (if a CD is not enclosed with this guide you will be sent details of the exercise website). Record your experiences in the mindfulness practice diary at the end of this schedule (you might want to take some copies of this diary so that can use it across the four week training period).

Week 1: Raisin exercise + body scan + awareness of daily activities Try the raisin exercise. You will need to find or buy a raisin (if you can’t stand raisins, you could try the exercise with a jelly baby or other small edible). Really bring your awareness to the food item. Focus on using all of your senses; be in the moment as you inspect and then taste your raisin. Be with the experience of eating a raisin. Perform the body scan once per day for the next week. Record your experiences in the mindfulness diary – this helps you become even more aware of how your experience unfolds. Bring moment-to-moment awareness to one routine activity you perform every day for the next week (e.g., showering, brushing your teeth, first cup of tea or coffee). Practice being present during the activity instead of performing the task on automatic pilot. Pay attention to what you are doing – the feelings in your body, the sensations of performing the activity. Each time you drift away into thought, gently return your attention to what you are doing.

Week 2: Body scan + mindfulness of breathing + awareness of daily activities Perform the body scan every day for the next week At a different time, practice mindfulness of breathing every day for the next week Choose another routine activity to be mindful of each time you perform it over the week.

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Week 3: Mindfulness of breathing + the breathing space + awareness of daily activities Perform mindfulness of breathing every day for the next week. Practice the breathing space at three scheduled times each day (e.g., first thing in the morning, lunch, before bed) Aim to bring mindfulness to the body spontaneously throughout the day (and particularly in those moments when you find yourself becoming wrapped up in unhelpful mindstuff or emotion). For example, if sitting at a desk, just noticing the sensations in your body sat in the chair. If you are walking along, paying attention to the sensation and movement in your body as you walk. If you are having lunch, being fully in the present moment as you eat, noticing the texture and taste of the food.

Week 4: Making mindfulness part of your life Aim to settle into one formal practice every day. Mindfulness of breathing is a good practice to build into your daily schedule (or continue using the body scan if you find that helpful). You could try practicing the exercise without the recorded instructions if that is more practical. Tip: A mindfulness practice is a great way to start the day! Bring present moment awareness to a much larger range of routine activities – challenge yourself to be present during as many routine activities as possible this week. Practice using the breathing space in different contexts, and whenever you find yourself becoming stressed, anxious, or worried.

The secret is to make mindfulness part of your life. Becoming more connected to your here and now experience, and learning to return to your present moment awareness whenever your mind becomes overly entangled in unhelpful thoughts or emotions.

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Mindfulness practice diary Day

Exercise

Duration

Observations and comments

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

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MINDFULNESS BOOKS AND RESOURCES The following books are highly recommended: Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression. NY: Springer. – includes a CD with exercises narrated by Jon Kabat-Zinn Harris, R. (2008). The Happiness Trap: How to stop struggling and start living. Boston, MA: Trumpeter. – useful mindfulness exercises can be download for a small fee Kabat-Zinn, J. (1990). Full catastrophe living: The program of the stress reduction clinic at the university of Massachusetts Medical Center. New York: Dell. Kabat-Zinn, J. (2001). Mindfulness meditation for everyday life. Piatkus Books. Kabat-Zinn, J. (2005). Wherever you go there you are. New York: Hyperion.

Useful websites: For accessing mindfulness information, publications, exercises, training courses, and other resources. www.bangor.ac.uk/mindfulness www.bemindful.co.uk www.mbsr.co.uk http://www.mindfulexperience.org/ Alternatively, simply Google ‘mindfulness’ and you will find various useful resources.

Academically oriented papers and texts: If you are interested in reviewing the theory, research, and practice of mindfulness. Hayes, S. C., & Wilson, K.G. (2003). Mindfulness: Method and Process. Clinical Psychology: Science and Practice, 10, 161-165. Baer, R. A. (Ed.). (2006). Mindfulness-based treatment approaches. San Diego, CA: Elsevier. Baer, R. A. (Ed.) (2010), Mindfulness and acceptance: Illuminating the processes of change. Oakland, CA: New Harbinger.

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Bishop, S. R., et al., (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230-241. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10, 125-143. Davidson, R. J., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564-570. Grossman, P., et al. (2004). Mindfulness based stress reduction and health: A meta-analysis. Journal of Psychosomatic Research, 37, 35-43. Bishop, S. R. (2002). What do we really know about mindfulness-based stress reduction? Psychosomatic Medicine, 64, 71-84. Brown, K. W., & Ryan, R.M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822-848.

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