Mind over natter ... sorta ...

Going through a breakup.

It hurts.

Racing thoughts ... obsession sessions ... ruminating ... the whole deal.

Aha, think I -- I should be practicing mindfulness.

So I picture myself lying on soft, green grass of a quiet field.

I picture my thoughts and feelings as soft, puffy clouds ... just moving across the blue, blue sky.  Try letting them appear ... and move across the sky ... and disappear, unjudged ... untouched by me....

Suddenly, the clouds begin to change shape.  They become ... airplanes ... airplanes with the rotund contours of World War II planes in Warner Brothers cartoons.  More and more clouds become airplanes ... and then they start dropping bombs on me -- hundreds of tiny bombs falling from the sky and exploding all around me as I lie on the grass.

Hmmm, I think.  That's pretty funny. Not particularly mindful, granted, but still, actually pretty funny.

Then I remember what my therapist said the last time we talked.  What should I do, I asked, when I am trying to sit with thoughts and feelings without following them ... but without running away from them, either?

Ask yourself, he said, What do I need to do to take care of myself right now?

Answer: laugh.
Answer: invent funny methaphor to impress therapist.
Answer: Remember to ask the question.

Done and done.

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The Now Watch - Because the Time is Always Now

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Newsweek: Buddha Lessons

A technique called 'mindfulness' teaches how to step back from pain and the worries of life.

Byline: Claudia Kalb
For decades, Dalia Isicoff has suffered the agony of rheumatoid arthritis--joint pain, spinal fusion, multiple hip surgeries. Painkillers dull the aches, but it wasn't until she took a course at the University of Maryland's Center for Integrative Medicine that Isicoff discovered a powerful weapon inside her own body: her mind. Using a meditative practice called Mindfulness-Based Stress Reduction, or MBSR, Isicoff learned to acknowledge her pain, rather than fight it. Her negative and debilitating thought patterns--"This is getting worse," "I'm going to end up in a wheelchair"--began to dissipate, and she was able to cut back on her medication. The pain hasn't gone away, but "I view it is an ally now," she says. "Mindfulness is transformational."

With its roots in ancient Buddhist traditions, mindfulness is now gaining ground as an antidote for everything from type-A stress to chronic pain, depression and even the side effects of cancer treatment. At the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School, where MBSR was developed by Jon Kabat-Zinn, a leader in the field, 15,000 people have taken an eight-week course in the practice; hundreds more have signed up at medical clinics across the country. Studies have shown that mindfulness can reduce pain and anxiety. Now researchers are using brain imaging and blood tests to study its biological effects, and early results are intriguing: this spring, the National Institutes of Health hosted its first conference on the topic. "People in the scientific community used to think that this was a lot of mystical mumbo jumbo," says psychologist Ruth Baer, of the University of Kentucky. "Now they're saying, 'Hey, we should start paying attention'."

Paying attention is the very essence of mindfulness. In 45-minute meditations, participants learn to observe the whirring thoughts of the mind and the physical sensations in the body. The guiding principle is to be present moment to moment, to be aware of what's happening, but without critique or judgment. It is not easy. Our "monkey mind," as Buddhists call the internal chaos, keeps us swinging from past regrets to future worries, leaving little time for the here and now. First attempts may provoke frustration ("I'll never be able to do this"), impatience ("When will this be over?") and even banal mental sparks ("What am I going to make for dinner?"). The goal, however, is not to reach nirvana, but to observe the cacophony in a compassionate way, to accept it as transient, "like bubbles forming in a pot of water or weather patterns in the sky," says Kabat-Zinn.

The keystone of mindfulness is daily meditation, but the practice is intended to become a way of life. At Stanford University, Philippe Goldin encourages patients battling social anxiety disorder to take "meaningful pauses" throughout the day as a way to monitor and take charge of their fears and self-doubts. "It breaks the circuit," says one participant. "I always thought that anxiety had me in its grip, but I realized it's the other way around. I have it in my grip. It's a matter of learning to let it go."

Inner control can be a potent tool in the fight against all sorts of chronic conditions. In a pilot study of 18 obese women, Jean Kristeller, director of the Center for the Study of Health, Religion and Spirituality at Indiana State University, found that mindfulness meditation, augmented with special eating meditations (slowly savoring the flavor of a piece of cheese, being aware of how much is enough), helped reduce binges from an average of four per week to one and a half. Now Kristeller is wrapping up a larger study that she says confirms her earlier findings. Mindfulness helped participant Chuck Cooley, 43, identify anxiety as a trigger for overeating--and cut back on the pizza buffets. "Before, I was on automatic pilot," he says. Now "I can take my time and enjoy a smaller portion."

Mindfulness takes you out of your same old patterns. You're no longer battling your mind in the boxer's ring--you're watching, with interest, from the stands. The detachment doesn't lead to passivity, but to new ways of thinking. This is especially helpful in depression, which plagues sufferers with relentless ruminations. At least half of all patients who have had one or two episodes of clinical depression will relapse into another; the more episodes, the higher the risk. University of Toronto psychiatry professor Zindel Segal combines mindfulness with conventional cognitive behavioral therapy, teaching patients to observe sadness or unhappiness without judgment. In a study of patients who had recovered from a depressive episode, Segal and colleagues found that 66 percent of those who learned mindfulness remained stable (no relapse) over a year, compared with 34 percent in a control group. Now Segal has a $2.1 million grant from the NIH to compare mindfulness against antidepressants as a maintenance therapy after relapse. Segal's patient Suzanne Simoni, 47, says she has learned to identify the early signs of an emotional hurricane--fatigue, irritability, hopelessness--before it hits. "I have the chance to catch it earlier," she says. And possibly steer it away altogether.

The biological impact of mindfulness--on the brain, the blood, the immune system--is the next frontier in scientific research. In an intriguing study published several years ago, Kabat-Zinn found that when patients with psoriasis listened to meditation tapes during ultraviolet-light therapy, they healed about four times faster than a control group. In an effort to understand how this kind of dramatic response is possible, scientists are hunting down mindfulness's biological footprints. Kabat-Zinn and neuroscientist Richard Davidson, of the University of Wisconsin, found that after eight weeks of MBSR, a group of biotech employees showed a greater increase in activity in the left prefrontal cortex--the region of the brain associated with a happier state of mind--than colleagues who received no meditation training. When the techies were given a flu vaccine, those with the greatest left-brain activation mounted the most vigorous antibody assault against the virus.

There's more in the pipeline. The University of Massachusetts' mindfulness center is studying the impact of mindfulness and diet on PSA levels in prostate cancer. Stanford's Goldin is taking brain images of social-anxiety patients to see if the practice affects emotional trigger points, like the amygdala, which processes fear. And at Maryland's Center for Integrative Medicine, director Dr. Brian Berman is tracking measures of inflammation, including gene expression, in patients with rheumatoid arthritis. For Dalia Isicoff, the payoff is already clear: "I'm at peace," she says. Her mind and her body, together.

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The Independent: De-clutter your mind

Mindfulness is a new, mysticism-free meditation technique that Americans are using to chase away the stresses of daily life. And experts believe it can also help us beat depression - for good. Jane Feinmann reports

It's 7am in my kitchen and a gentle, cultured voice is inviting me to focus on the here and now and on each breath as it goes in and out of my nostrils. I'm not to worry if my mind wanders, whether it's to the past, to current worries, to future planning, even to fantasies and day dreams. Each time I become aware of this wandering, I'm simply to note where my mind has gone before bringing it back to focus entirely on this particular breath as I inhale and exhale at this particular moment.

To users of yoga or meditation, the words on my CD may be familiar, the kind exercise that people like me use to de-stress every day of the week. What may surprise, however, is that the guided meditation is delivered not by a bearded guru, but by one of the country's leading psychologists. As such, it's a new kind of therapy that is taking America by storm, helping a variety of groups, from over-stretched business executives to criminals and drug addicts to find a permanent way of dealing with the stresses and strains of everyday life. Perhaps more surprisingly, it has also just been recommended by the National Institute of Clinical Excellence (NICE) as "a significantly effective" way of preventing the recurrence of depression.

NICE is not suggesting that the NHS should fund Oriental religious experiences, the search for special mantras, nor, indeed, exotic sects that insist on chastity, promiscuity or the wearing of saffron robes. Even the lotus position is optional. Mindfulness meditation has its roots in ancient Buddhist traditions, but is entirely stripped of mystical elements.

Instead of seeking nirvana or even trying to relax, the modest aim of the 40-minute daily act of meditation is to become aware of thoughts and bodily sensations as though they were traffic passing an open window or leaves floating down a stream. "It is remarkable how liberating it feels to be able to see that your thoughts are just thoughts and that they are not 'you' or 'reality'," says Jon Kabat-Zinn, a Sixties meditation enthusiast turned professor in mind-body medicine who first introduced mindfulness as a stress treatment 25 years ago.

In the past 15 years, mindfulness has become a mainstay of psychological treatment in the US. Full Catastrophe Living, published by Kabat-Zinn in 1990, became a best-seller. More than 200 clinics based on his original Stress Reduction Clinic at the University of Massachusetts Medical Center have been set up across the US, with more than 15,000 people completing the eight-week meditation course that includes weekly classes and daily home-based practice.

Studies have shown the benefits of mindfulness in tackling a range of difficult-to-treat health problems, including chronic pain, psoriasis and binge-eating - with the phenomenon leading to a recent cover story in Newsweek, straplined "The New Science of Mind & Body".

The most impressive and strictly scientific research, on which the NICE guideline is based, was a British study - a randomised controlled trial that followed 145 people with a history of at least two episodes of major depression over a period of 60 weeks. During the trial, half the group received eight weeks of Mindfulness Based Cognitive Therapy (meditation training along with education into the nature of depression).

The study was carried out by a group of psychologists, who since the early 1990s have been searching for ways of preventing recurrent depression. This followed research showing that antidepressants, far from curing depression, simply suppress symptoms. The brain frequently improves upon its capacity to react to small changes in mood with large changes in negative thinking, with the risk of relapse increasing with each new bout of the blues.

As NICE points out, antidepressants coupled with cognitive therapy are highly effective at treating acute depression. But long-term preventative treatment with either medication or psychotherapy is both unrealistic and probably unwelcome. This is where evidence-based meditation comes in, with the emphasis on the evidence. At the end of 60 weeks, just over a third of those who were taught meditation had suffered depression, compared to two-thirds of the control group. Significant indeed.

While the study has the scientific validity of a pharmaceutical trial, there are significant differences between taking a pill and mindfulness. For a start, the claims for mindfulness would not appear on the packaging of an antidepressant. In his latest book, Coming to Our Senses, Kabat-Zinn describes it as: "A love affair with what is most fundamental in life, with what is so, with what we might call truth, which for me includes beauty, the unknown and the possible, how things actually are in this very moment." The payoff of that potential, however, is that it is hard work. "[It's] not for the faint-hearted," he warns.

Mark Williams, a professor of psychology at Oxford University and lead researcher on the recurrent depression trial, discovered the truth of that statement back in 1992 when he and colleagues visited the UMass Medical Center. "At the time we were looking for ways of preventing recurrent depression, and mindfulness seemed to be a technique that we could incorporate into a cognitive behavioural programme as an extra problem-solving skill," he recalls. The teachers there were ultra-cautious. Mindfulness, they explained, is a state of being rather than a therapeutic technique. "It will be neither effective nor possible to recommend that others meditate without having an ongoing meditation practice oneself," Kabat-Zinn explained.

This insistence on the need for practitioners to learn meditation came as a shock to Williams - and remained so in the weeks and months that he battled to maintain a 40-minute a day meditating habit. "It was a huge struggle, partly because of the time. I also found it hard to expose my ignorance, especially in something that I was supposed to be teaching to patients." An unlooked-for bonus, however, was that by facing this challenge he developed a new kind of empathy with patients. "Practitioners who train in mindfulness stop being 'us and them' - we're just all in the same boat," he says.

A further problem was "abandoning conceptual systems of problem-solving", something he now recognises as a helpful but over-used cognitive skill. A breakthrough, he recalls, was realising that the practice wasn't supposed to be enjoyable, nor even relaxing. "Just doing it, keeping up the practice for 40 minutes, was all I had to do. That feeling was common among those who completed the eight-week training programme - emerging from a period of struggle to a new sense of freedom. People find they can liberate themselves from old habits and see their thoughts from a new perspective. That's something many people are still waiting for after years of analytical psychotherapy."

My own experience of mindfulness began with a day retreat at Oxford. As someone who has repeatedly failed at meditation, I passed a first difficult hurdle when my teacher advised me to be curious about the agonising pain that developed in my left shoulder and to observe without judgement the horror I experienced at the prospect of sitting still for another whole hour.

Since then, supported by the CDs and inspired by Kabat-Zinn's intelligent and passionate writing, I've managed to spend at least a few minutes mindfully every day - "and that's quite enough to get started", says Williams. And it's true. Just this few minutes has given me a sense of the futility of ruminating endlessly over work, money, friends, family and the state of the economy. This type of fretting simply gives a false sense of being in control. Results of laboratory tests showing that mentally gnawing over problems actually results in more persistent and intense sadness.

Far better for me to spend that time focusing on my breath, investigating the sensations in my shins or examining the sounds of passing traffic or the taste of an almond (all recommended mindfulness exercises) - thereby fostering what Williams calls "a decentred relationship to mental contents". As a result, I'm getting a glimpse of spaciousness in my mind, a feeling that I can be my own spin doctor, engaging with the "full catastrophe", but persistently promoting the positive perspective. Who wouldn't want a piece of that?

Bangor University (www.bangor.ac.uk/mindfulness) runs short residential courses for practitioners as well as eight-week courses for stress reduction. They have an online e-group and a list of practitioners trained in mindfulness meditation. A set of five mindfulness meditation CDs are available from the Oxford Cognitive Therapy Centre, £20.00 including p&p. Email orders to octc@oxmhc-tr.nhs.uk

IN FOCUS: HOW TO BEAT THE BLUES

*Remind yourself that time is a product of thought. Minutes and hours are a convention with no absolute meaning, in the words of Einstein. You are only on a treadmill if you choose to be.

*Avoid unsatisfying moments ruminating about the past or worrying about the future. Only reminisce about the past or plan for the future when you do it with awareness. Otherwise, focus on what you are doing and "time will disappear".

*Spend time meditating, even if it's only one minute in every hour.

*Simplify your life. Prioritise and give up activities low down the list and spend that time in silence, in non-doing.

* Slow down the sense of time passing by taking note of ordinary experiences as though they were milestones. Remember how long it can seem to spend a day spent in a foreign city, where every new experience is novel and an adventure.

*Savour the present. Acknowledge that you are not "going" anywhere, that the future will not be any more pleasant or rich. It will be another easily missed moment.

*Formal meditation practice is a wake-up call beyond being continually caught in liking and disliking, wanting and rejecting as well as destructive and unexamined emotional habits. That's why it's worth the challenge.

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Globeandmail.com: Meditating through mental illness

ANNE MCILROY
Originally published
August 15, 2008 at 8:54 AM EDT

The patients are sitting still, their eyes closed, meditating, on the floor of a group therapy room at the Centre for Addiction and Mental Health in Toronto.

It is the fifth week of an eight-week training course in mindfulness meditation for people recovering from depression.

Their goal is to treat any troubling thoughts or emotions with the same detachment with which they monitor the breath flowing in and out of their bodies.

Mindfulness-based psychotherapy is growing rapidly in popularity, and these patients are part of a $2.5-million clinical trial to assess whether it can prevent relapses as effectively as antidepressant medications.

Zindel Segal, a psychologist at CAMH, is a pioneer in the field of assessing the value of mindfulness meditation as a treatment for mental illness.

He is also studying how it physically changes the brain in ways that may be helpful to people recovering from depression or anxiety disorders.

"Depression and anxiety disorders tend to have a chronic, unremitting course," Dr. Segal says.

"So prevention of relapse is as important as lifting patients out of an acute episode."

Mindfulness meditation builds on the teachings of a fifth-century BC Indian prince later known as Buddha. It involves sitting still, with eyes closed, relaxing, and taking note of bodily sensations; the pressure of the floor on your foot, your tummy rising as you breathe. When a person's attention wanders, they are instructed to redirect it back to their breathing.

Once people can do this, Dr. Segal says, they can turn their attention to a troubling thought - an ugly breakup of a romantic relationship, for example. The idea is to endure and accept difficult emotions without trying to change them, to view passing thoughts as an impartial observer.

"It helps you step back from automatic reactions built into emotions for evolutionary reasons," he says. "Fright, alarm, rejection are experiences that can come over us very quickly."

Pausing at these moments can be helpful for people with a history of depression, he says. They can label and observe emotions rather than automatically reacting.

But there are not a lot of studies that show mindfulness training works as a treatment for mental illness.

The clinical trial now under way is being funded by the National Institutes of Health in the United States and involves 177 patients in Toronto and Hamilton. They have all been successfully treated with antidepressants.

Patients in one group are still on their medication. In the second group, people who have been weaned off antidepressants are getting a placebo. In the third, patients are no longer taking medication but have undergone eight weeks of mindfulness training.

The clinicians following the patients don't know which group they are in. Dr. Segal should have preliminary results in 18 months.

In one mindfulness session, taped as part of the experiment's protocol, a female therapist explains to a group of patients the idea that they could accept troubling or difficult thoughts in the same way parents can love their children despite their sometimes challenging or even outrageous behaviour.

The patients get comfortable on the floor, and she guides them to pay attention to their breathing. She tells them not to banish any thoughts, but to accept them for what they are.

Afterward, one patient says she found the process less intense than the week before.

But another patient, fighting back tears, says she found the session difficult. She says she feels bad about fidgeting and not paying attention.

"I was bothered by pain, and physically uncomfortable."

Dr. Segal knows it isn't easy. He tries to practise meditation himself every morning, and says many doctors find they can guide patients more easily if they have personal experience.

The patients in the trial are also asked to meditate every day at home, and are given CDs to help them.

Dr. Segal, who holds the Morgan Firestone Chair in Psychotherapy at the University of Toronto, became interested in mindfulness meditation in the early 1990s, after University of Massachusetts biologist Jon Kabat-Zinn found that it helped patients with chronic pain.

At the time, Dr. Segal was investigating how psychological treatments such as cognitive behavioural therapy work in patients with depression.

Cognitive behavioural therapy is talk-based therapy that teaches participants new ways of thinking and behaving to overcome negative thought patterns and manage their symptoms.

Studies have shown it can prevent relapses as well as antidepressants can, and Dr. Segal and other scientists have found it can lead to physical changes in the brain.

He thought a version of CBT based on mindfulness meditation might offer patients an advantage, but was worried about being dismissed by his colleagues as being on the fringe of science.

"We didn't call it mindfulness. We called it attention control training," he says.

That was a decade ago, and since then he and other researchers have made intriguing discoveries about mindfulness meditation. Richard Davidson, an American neuroscientist, has done brain scans of Tibetan monks and found they have more activity in their left prefrontal lobes, an indication of positive emotions and good mood.

Dr. Segal wants to know how it changes the brains of people with mood disorders. "To them, returning to normal moods is an important goal."

He and colleague Adam Anderson, a psychologist at the University of Toronto, recently reported the preliminary results of a study done at St. Joseph's Health Centre in Toronto.

It involved two groups of patients suffering from depression, anxiety or chronic pain. One group had taken eight weeks of mindfulness training.

The patients watched and reflected on scenes from sad movies, such as Terms of Endearment, while a functional magnetic resonance imager took a picture of their brains.

While all the patients reported feeling sad after watching the tear-jerker scenes, the brains of those who had undergone mindfulness training responded differently.

The training seemed to quiet parts of the brain that respond to negative emotion with rumination and self-judgment, but to activate another region that integrates information about heart rate, posture and movement.

"There was more of a balance," Dr. Segal says.

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Born Animal: Rats That Live in the Moment

Discovery News reports:

In other news, it appears that rats live mostly in the moment. A study on rodent memory, conducted by University of Western Ontario researchers, found that rats remember, but they do not seem to store memories with a "date stamp" the way that we humans do. This suggests they don't know when the remembered event happened, or how much time has passed since the episode. Perhaps such info wouldn't be helpful to them? Animals evolve what they need to survive, so recounting the exact time and date of a past event probably just wasn't very useful in the rat world. (Although I bet it would be now, such as if a rat could remember the exact time a person puts out yummy dog or cat food each morning.)

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