3 Evidence Based Treatments in
Integrative Medicine-Behavioral Health
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Behavioral Medicine for Mental Health Professionals
A Training Resource
By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T
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3 Evidence Based Treatments (EBT's) to Use in Integrative Medicine Settings
The three EBT’s to be used by behavioral health consultants in integrative medicine settings are”
1. Motivational Interviewing
2. Solution Focused Brief Therapy (SFBT)
3. Mindfulness Based Stress Reduction
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Motivational Interviewing
Steps in Motivational Interviewing:
1. Engaging
2. Focusing
3. Evoking
4. Planning
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A Helping Truism
How many helpers does it take to change a light bulb?
Just one, but the light bulb has to want to be changed.
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So How Do We Define Motivational Interviewing?
Miller and Rollnick (2013) give us three definitions:
Layperson’s definition: Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.
Practitioner’s definition: Motivational interviewing is a person-centered counseling style for addressing the common problem of ambivalence about change.
Technical definition: Motivational interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.
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Guiding Principles of Motivational Interviewing
R: Resist the Righting Reflex with Clients
People who enter helping professions often have a powerful desire to set things right, to heal, to prevent harm and promote well-being which is called the Righting Reflex. When seeing someone headed down the wrong path, helpers will usually want to get out in front of the person and say, “Stop! Turn back! There is a better way!”
U: Understand the Clients’ Motivations
It is the clients’ own reasons for change, and not the helpers that are most likely to trigger behavior change. And so helpers need to be interested in the clients’ own concerns, values, and motivations.
L: Listen to the Clients
MI involves at least as much listening as informing. Normal expectations of a professional consultation are that the helpers have the answers and will give them to their clients. Often helpers do have answers, and clients come to them for this expertise. When it comes to behavior change, though, the answers most likely lie within the clients and finding them requires some listening.
E: Empower the Clients
Outcomes are better when clients take an active interest and role in their own health care. Empowerment is helping clients explore how they can make a difference in their own health. Clients’ own ideas and resources are key here.
(Rollnick, Miller, & Butler, 2008).
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What is the Righting Reflex?
- It is the natural inclination we have to make it better for another person
- What’s the danger? We tell the other person what to do, how to do it, and why they should do it without talking to them and learning what they think.
- It creates resistance in that we move away from the partnering stance of MI and into the expert top-down role.
- What to do when you find yourself doing this? Stop and Reset: “Mrs. Smith, I realize I have been just lecturing you on how you can deal with your diabetes without learning what you are thinking. Let me back up and hear from you, wherever you would like to start.”
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Righting Reflex Assumptions to Let Go of in Motivational Interviewing
1. They ought to change
2. They want to change
3. Their health is the prime motivating factor for them
4. If they do not decide to change, the consultation has failed
5. Individuals are either motivated to change, or they’re not
6. Now is the right time to consider change
7. A tough approach is always best
8. I’m the expert they must follow my advice
9. A negotiation approach is always best
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Four Processes in Motivational Interviewing
Engaging: Behavioral Consultants and patients establish a helpful connection and a working relationship. Therapeutic engagement is a prerequisite for everything that follows and it involves developing a working alliance.
Focusing: Behavioral Consultants and patients develop and maintain a specific direction in the conversation about change. In the course of helping relationships, a direction towards one or more change goals usually emerges.
Evoking: eliciting the patients’ own motivations for change which is the heart of MI. It occurs when there is a focus on a particular change and the Behavioral Consultant harness the patients’ own ideas and feelings about why and how they might do it. Evoking is having the patients voice the arguments for change.
Planning: encompasses both developing commitment to change and formulating a specific plan of action. It’s a conversation about action that can cover a range of topics, conducted with a sharp ear for eliciting patients’ own solutions, promoting their autonomy of decision making and continuing to elicit and strengthen change talk as a plan emerges
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The Spirit of Motivational Interviewing
1. Collaboration (vs. Confrontation) focused on mutual understanding, not the Behavioral Health Consultant being right. Collaboration is a partnership between the Behavioral Health Consultant and the patients, grounded in the point of view and experiences of the patients.
2. Evocation (Drawing Out, Rather Than Imposing Ideas) to "draw out" the persons' own motivations and skills for change. The MI approach is one of the Behavioral Health Consultants’ drawing out the patients' own thoughts and ideas, rather than imposing their opinions as motivation and commitment to change is most powerful and durable when it comes from the patients.
3. Autonomy (vs. Authority) patients are encouraged to take lead in developing a “menu of options’ as to how to achieve desired change. Unlike some other treatment models that emphasize the Behavioral Health Consultants as authority figures, Motivational Interviewing recognizes that the true power for change rests within the patients. Ultimately, it is up to the patients to follow through with making changes happen. This is empowering to the patients, but also gives them responsibility for their actions.
4. Compassion Behavioral Health Consultants’ having their hearts in the right place so that the trust they engender will be deserved. The Behavioral Health Consultants act benevolently to promote the patients’ welfare, giving priority to the patients’ needs. Behavioral Health Consultants are there for their patients’ benefit and not primarily for their own.
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Principles of Motivational Interviewing
Principle 1 of Motivational Interviewing: Express Empathy
Expressing empathy towards the patients shows acceptance and increases the chance of developing a rapport.
Acceptance enhances self-esteem and facilitates change.
Skillful reflective listening is fundamental.
Patients’ ambivalence is normal
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Principle 2 of Motivational Interviewing: Develop Discrepancy
- Developing discrepancy enables the patients to see that their present situation does not necessarily fit into their values and what they would like in the future.
- The patients rather than the Behavioral Health Consultant should present the arguments for change.
- Change is motivated by a perceived discrepancy between present behavior and important personal goals and values.
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Principle 3 of Motivational Interviewing: Roll with Resistance
- Rolling with resistance prevents a breakdown in communication between patients and Behavioral Health Consultants and allows the patients to explore their views.
- Avoid arguing for change.
- Do not directly oppose resistance.
- New perspectives are offered but not imposed.
- The patients are a primary resource in finding answers and solutions.
- Resistance is a signal for the Behavioral Health Consultant to respond differently.
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Principle 4 of Motivational Interviewing: Support Self-Efficacy
- Self-efficacy is a crucial component to facilitating change. If the patients believe that they have the ability to change, the likelihood of change occurring is greatly increased.
- Patients’ beliefs in the possibility of change is an important motivator.
- The patients, not the Behavioral Health Consultants, are responsible for choosing and carrying out change.
- The Behavioral Health Consultants’ own beliefs in the patients’ ability to change becomes a self-fulfilling prophecy
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You can get more information on Motivational Interviewing at:
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Solution-Focused Brief Therapy (SBFT)
SBFT was developed by Steve De Shazer and his colleagues at the Brief Family Therapy Center in Milwaukee, Wisconsin.
In solution-focused brief therapy, the emphasis is placed on building exceptions to the presenting problem and making rapid transitions to identifying and developing solutions intrinsic to the patient or problem.
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Motivation Is an issue in SFBT
- Motivational Interviewing
- Motivational Enhancement Therapy
- Evoking self-motivation
- Asking open-ended questions
- Stages of change model
Evoking Self-Motivation
Questions to ask
- What things make you think that this is a problem?
- What do you think will happen if you do not make a change?
- What are the reasons you see for making a change?
- What makes you think you need to make a change?
- What makes you think that if you decided to make a change, you could do it?
- What do you think would work for you, if you needed to change?
- How much does your use concern you?
Open-Ended Questions
What brings you here today?
- So you are here to talk about getting healthier?
In what ways are you concerned about your health?
- Do you have unhealthy habits that you need to be change?
What do you think you want to do about your unhealthy behaviors?
- When do you plan to make these changes?
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Stages of Change
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
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High Lights of Solution-Focused Brief Therapy
- Focusing on competence rather than pathology
- Finding a unique solution for each person
- Using exceptions to the problem to open the door to optimism
- Using past successes to foster confidence
- Using goal-setting to chart a path toward change
- Sharing the responsibility for change with the patient
The Gold Rules of Solution-Focused Brief Therapy
- "If it ain't broke, don't fix it!"
- Once you know what works, do more of it!
- If it doesn't work, then don't do it again – do something different!
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What is Solution-Focused Brief Therapy (SBFT)?
Solution-Focused Brief Therapy:
- Helps patients develop a desired vision of the future wherein the problem is solved, and explore and amplify related their exceptions, strengths, and resources to co-construct a patient-specific pathway to making the vision a reality.
- Thus, patients find their own way to a solution, based on their emerging definitions of goals, strategies, strengths, and resources.
- Even in cases where patients come to use outside resources to create solutions, it is the patients who take the lead in defining the nature of those resources and how they would be useful.
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Techniques of Solution-Focused Brief Therapy
1.Pre-therapy change (What have you done since you made the appointment that has made a difference in your problem?)
2.Miracle question (If a miracle happened and the problem you have was solved while you were asleep, what would be different in your life?)
3.Scaling questions (On a scale of zero to 10, where zero is the worst you have been and 10 represents the problem being solved, where are you with respect to __________?)
4.Taking "time-outs" Suggesting to the client "While I step out, I want you to think of the next smallest step you could take that would bring you to the next number on the scale."
5.Affirm patient competencies (e.g., tell the patient, "I am impressed you are sitting in that chair again after what you just went through"). Many of these patients have never had this success acknowledged before.
6.Task assigning: Suggest tasks that the patients can perform to improve their situation (e.g., ask them to do something achievable that would provide useful information or move them closer to the "miracle" they has chosen).
7.Exception questions (Direct patients to times in their lives when the problem did not exist)
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You can get more information on Solution Focused Brief Therapy at:
Solution Focused Brief Therapy (SBFT) at:
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Mindfulness Stress Reduction (MBSR)
In Jon Kabat-Zinn’s Own Words
From:
Jon Kabat-Zinn (2016). Mindfulness for Beginners: Reclaiming the Present moment-and your life. Sounds True, Inc: Boulder, Colorado
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What is Mindfulness
Mindfulness is:
awareness, cultivated by paying attention in a sustained and particular way:
- on purpose,
- in the present moment, and
- non-judgmentally.
(Source: Jon Kabat-Zinn (2016). Mindfulness for Beginners: Reclaiming the Present moment-and your life. Sounds True, Inc: Boulder, Colorado, p. 1)
What is Meditation?
Meditation is any way in which you engage in:
1. systematically regulating your attention and energy
2. thereby influencing and possibly transforming the quality of your experience
3. In the service of realizing the full range of your humanity
4. your relationships to others and the world.
(Kabat-Zinn, 2016. p.1)
Two Forms of Meditation in MBSR
There are two complementary ways to do this:
- formally: Formally means engaging in making some time every day to practice with the guided meditations
- informally: Informally means letting the practice spill over into every aspect of your waking life in an uncontrived and natural way
These two modes of embodied practice go hand in hand and support each other, and ultimately become one seamless whole, which we could call living with awareness or wakefulness
(Kabat-Zinn, 2016. p2)
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Practice of Mindfulness
•the very intention to practice with consistency and gentleness — whether you feel like it or not on any given day — is a powerful and healing discipline.
•Without such motivation, especially at the beginning, it is difficult for mindfulness to take root and go beyond being a mere concept or script, no matter how attractive it might be to you philosophically.
•While mindfulness and the current high levels of public and scientific interest in it may indeed appear to some to be much ado about nothing
•it is much more accurate to describe it as much ado about what might seem like almost nothing that turns out to be just about everything
•As you practice Mindfulness You are going to experience firsthand that “almost nothing.” It contains a whole universe of life-enhancing possibilities.
(Kabat-Zinn, 2016. p3)
Opportunities provided by practicing MBSR
Mindfulness as a practice provides endless opportunities:
- to cultivate greater intimacy with your own mind and
- to tap into and develop your deep interior resources for learning, growing, healing, and
- potentially for transforming your understanding of who you are and how you might live more wisely and with greater well-being, meaning, and happiness in this world.
(Kabat-Zinn, 2016. p4)
Importance of Breath in MBSR
- The fact is that you are a being that breathes
- You drink in the air on each in-breath, giving it back to the world on each out-breath. Your life depends on it.
- your breathing can serve as a convenient first object of attention to bring you back into the present moment, because you are only breathing now — the last breath is gone, the next one hasn’t come yet — it is always a matter of this one. So, it is an ideal anchor for your wayward attention. It KEEPS you in the present moment.
- This is one of many reasons why paying attention to the sensations of breathing in the body serves as the first object of attention for beginning students
- But attending to the feeling of the breath in the body is not only a beginner’s practice. It may be simple, but the Buddha himself taught that the breath has within it everything you would ever need for cultivating the full range of your humanity, especially your capacity for wisdom and for compassion
(Kabat-Zinn, 2016. p11)
What is awareness
- Awareness is a capacity that you are intimately familiar with and yet are simultaneously complete stranger to.
- the training in mindfulness is really the cultivation of a resource that is already ours.
- It doesn’t require going anywhere
- it doesn’t require getting anything
- but it does require learning how to inhabit another domain of mind that you are, as a rule, fairly out of touch with.
- and that is what you might call the “being mode” of mind.
(Kabat-Zinn, 2016. p17)
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Doing Mode vs Being Mode
Most of your life you are absorbed in doing
- in getting things done
- in going rapidly from one thing to the next
- or in multitasking — attempting to juggle a bunch of different things at the very same time
- Often your life becomes so driven that you are moving through your moments to get to better ones at some later point
- You live to check things off your to-do list, then fall into bed exhausted at the end of the day, only to jump up the next morning to get on the treadmill once again.
- This way of living is compounded by all the ways in which your life is now driven by the ever-quickening expectations you place on yourself and that others place on you and you on them, generated in large measure by your increasing dependence on ubiquitous digital technology and its ever-accelerating effects on your pace of life.
(Kabat-Zinn, 2016. p18)
Human Doing vs Human Being
- If you are not careful, it is all too easy to fall into becoming more of a human doing than a human being, and forget who is doing all the doing, and why.
- This is where mindfulness comes in.
- Mindfulness reminds you that it is possible to shift from a doing mode to a being mode through the application of attention and awareness.
- Then your doing can come out of your being and be much more integrated and effective.
- What is more, you cease exhausting yourself so much as you learn to inhabit your own body and the only moment in which you are ever alive — this one.
(Kabat-Zinn, 2016. p18)
Mindfulness Is Universal
- Mindfulness is often described as the heart of Buddhist meditation. Nevertheless, cultivating mindfulness is not a Buddhist activity.
- In essence, mindfulness is universal because it is all about attention and awareness, and attention and awareness are human capacities that are innate in all of us.
- historically speaking, the most refined and developed articulations of mindfulness and how to cultivate it stem from the Buddhist tradition, and Buddhist texts and teachings constitute an invaluable resource for deepening your understanding and appreciation of mindfulness and the subtleties of its cultivation.
(Kabat-Zinn, 2016. p21)
Mindfulness is a State of Being Awakened
Awakened to what?
- To the nature of reality
- to the potential for freeing oneself from suffering
- by engaging in a systematic and very practical approach to living
(Kabat-Zinn, 2016. p24)
Is your mind ready to be fully aware?
- If you are going to use the mind to observe and befriend and ultimately understand itself, first you will have to learn at least the rudiments of how to stabilize it enough so that it can actually do the work of paying attention in a sustained and reliable way
- becoming aware of what’s going on beneath the surface of its own activities. Even your best efforts can easily be thwarted by all the ways in which you distract yourself.
- Your attention is not very stable and is invariably carried off someplace else a good deal of the time, as you will experience for yourself with the guided meditations.
- With ongoing practice, you at least become far more familiar with the mind’s comings and goings; over time, in important ways,
- the mind learns how to stabilize itself, at least to a degree. Even a tiny bit of stability, coupled with awareness, is hugely important and transforming,
- so it is very important not to build some kind of ideal about your mind not wavering or being absolutely stable in order for you to be “doing it right.”
- That may happen in rare moments under particular circumstances, but for the most part, as you will see, it is in the nature of the mind to wave.
- Knowing that makes a huge difference in how you will approach the meditation practice.
(Kabat-Zinn, 2016. p24)
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Inhabiting Awareness Is the Essence of Practice
- The challenge of mindfulness is to be present for your experience as it is, rather than immediately jumping in to change it or try to force it to be different.
- Inhabiting awareness is the essence of mindfulness practice,
- no matter what you are experiencing, whether it arises in formal meditation or in going about your life.
- Life itself becomes the meditation practice as we learn to take up residency in awareness — this essential dimension of your being that is already yours but with which you are so unfamiliar that you frequently cannot put it to use at the very times in your life when you need it the most.
(Kabat-Zinn, 2016. p26)
Mindfulness is a Practice of Discipline
- To cultivate mindfulness really does involve and call out of you a certain constancy of motivation and purpose in the face of all sorts of energies in your life, some from inside yourself and some from outside, that dissipate your awareness by perpetually distracting you and diverting you from your intentions and purpose.
- The discipline is really the willingness to bring the spaciousness and clarity of awareness back over and over again to whatever is going on — even as you feel you are being pulled in a thousand different directions.
- Just taking this kind of stance toward your own experience, without trying to fix or change anything at all, is an act of generosity toward yourself, an act of intelligence, an act of kindness.
- the word discipline comes from disciple, someone who is in a position to learn. So when you bring a certain discipline to the cultivation of mindfulness, you are aware of how challenging it is to bring a sustained attending to any aspect of your life
- You are actually creating the conditions for learning something fundamental from life itself. Then life becomes the meditation practice and the meditation teacher, and whatever happens in any moment is simply the curriculum of that moment.
(Kabat-Zinn, 2016. p27)
Real challenge is how will you be in relationship to whatever is arising?
The real challenge is how will you be in relationship to whatever is arising?
- Here is where freedom itself is to be found.
- Here is where a moment of genuine happiness might be experienced, a moment of equanimity, a moment of peace.
- Each moment is an opportunity to see that you do not have to succumb to old habits that function below the level of your awareness.
With great intentionality and resolve:
- You can experiment with non-distraction
- You can experiment with non-diversion.
- You can experiment with non-fixing.
- You can experiment with non-doing.
(Kabat-Zinn, 2016. p28)
Thinking is your Default Setting
- Thinking seems to constitute your “default setting” rather than awareness.
- It is a good thing to notice, because in this way, you might slowly shift from this automatic reverting to thinking over and over again to another mode of mind that may stand you in far better stead, namely awareness itself.
- Perhaps over time you can adjust your default setting to one of greater mindfulness rather than of mindlessness and being lost in thought.
- As soon as you take your seat or lie down to meditate, the first thing you will notice is that the mind has a life of its own.
- It just goes on and on and on: thinking, musing, fantasizing, planning, anticipating, worrying, liking, disliking, remembering, forgetting, evaluating, reacting, telling itself stories — a seemingly endless stream of activity that you may not have ever noticed in quite this way until you put out the welcome mat for a few moments of non-doing, of just being.
- This is what the thought-stream does, and that is precisely why you need to become intimate with your mind through careful observation. Otherwise, thinking completely dominates your life and colors everything you feel and do and care about.
- And you are not special in this regard, Everybody has a similar thought-stream running 24/7, often without realizing it at all.
(Kabat-Zinn, 2016. p30)
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Befriending your thinking
It is very important as a beginner that you understand right from the start that meditation is about
- befriending your thinking – is about holding it gently in awareness, no matter what is on your mind in a particular moment.
- It is not about shutting off your thoughts or changing them in any way.
- Meditation is not suggesting that it would be better if you didn’t think and were simply to suppress all those sometimes unruly, disturbing, and disquieting, sometimes uplifting and creative thoughts when they arise.
- If you do try to suppress your thinking, you are just going to wind up with a gigantic headache. Such a pursuit is unwise, pure folly — like trying to stop the ocean from waving.
(Kabat-Zinn, 2016. p35)
Not taking your thoughts personally
It is a big step toward reclaiming your life when you realize that, no matter what their content, good, bad, or ugly, you do not have to take your thoughts personally. You can recognize them simply:
- As thoughts
- as events in the field of awareness
- As events that arise and pass away very rapidly
- that sometimes carry insights
- sometimes enormous emotional charge
- that can have a huge effect for better or for worse in your life depending on how you are in relationship to them.
(Kabat-Zinn, 2016. p39)
AVOID SELFING
- If you fall into the thought-stream and get caught up with various thoughts, especially if you self-identify with them — saying to yourself: that is “me” or that is “not me” — then we are really caught.
- For this is where the ultimate attachment arises, with the identifying of circumstances or conditions or things with the personal pronouns, namely “I,” “me,” and “mine.”
- Sometimes this habit is called self-identification selfing, the tendency to put yourself at the absolute center of the universe.
- it can be very helpful to pay attention to how much of the time you are engaged in selfing, and without trying to fix it or change it, simply hold that strong habit of mind in awareness.
(Kabat-Zinn, 2016. p40)
Mindfulness brought to all senses
- the term clearly seeing seems to privilege one particular sense. But “seeing,” in the way it is used in MBSR represents all of your senses, because it is only through your senses that you can be aware of and therefore know anything at all.
- clear seeing also means clear hearing, clear smelling, clear tasting, clear touching, and clear knowing, which would include knowing what’s on your mind, and therefore knowing both what you are thinking and what emotions are visiting
- therefore feeling what you are feeling, grounded in the body, whether it be fear or anger or sadness, frustration, irritation, impatience, annoyance, satisfaction, empathy, compassion, happiness, or anything else.
(Kabat-Zinn, 2016. p54)
You Belong
- You are never alone.
- And you already belong.
- You belong to humanity.
- You belong to life.
- You belong to this moment, to this breath.
When you undertake this practice with a group of other human beings very much like yourself it becomes even more powerful because you can be inspired and motivated by other people’s
- strength and tenacity and insights,
- often manifested in the face of unimaginable life circumstances and difficulties.
(Kabat-Zinn, 2016. p62)
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Mindfulness is not just a good idea
- But mindfulness is a way of being,
- one that requires consistent cultivation.
- It is a discipline all its own that naturally extends into all aspects of life as it is unfolding.
- It is certainly a good idea to be mindful, but mindfulness is not merely a good idea.
- And while it is simple, it is not easy.
- It is not so easy to maintain mindfulness, even over very short periods of time. you saw earlier that in some ways, you could think of it as the hardest work in the world, and the most important.
(Kabat-Zinn, 2016. p64)
Make mindfulness work for you
- until and unless you implement it and sustain it through ongoing, regular practice, leavened with an appropriate attitude of gentleness and kindness toward yourself, mindfulness can easily remain
- simply one more thought to fill your head and make you feel inadequate …
- one more concept
- one more slogan
- one more chore
- one more thing to schedule into your already too-busy day
(Kabat-Zinn, 2016. p64)
Benefits of MBSR
- many clients said to JKZ and staff with great regularity, that they feel that mindfulness training in the form of MBSR gave them back their lives and they are grateful to us for it.
- We often point out that while that may be true to a degree,
- it is also true — perhaps even more true — that we didn’t give them anything. Whatever benefits they received came from their own hard work with the meditation practice, from the inspiration and support of the other people in their class, from their own willingness to engage in and sustain mindfulness practice as a discipline over time, and from the fact of their already being whole in the first place.
- The flowering of mindfulness in one’s life is always more of a development and an integration of what is already here rather than an adding or subtracting of specific qualities.
- JKZ’s clients in the Stress Reduction Clinic, mindfulness is not a nice little idea that you pull out every time you feel stressed. Nor is it a relaxation technique. It’s not a technique at all. It is a way of being.
(Kabat-Zinn, 2016. p112)
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The Attitudinal Foundations of Mindfulness Practice
1. Non-judging
2. Patience
3. Beginner’s Mind
4. Trust
5. Non-Striving
6. Acceptance
7. Letting Go
(Kabat-Zinn, 2016. p123-134)
1. Non-Judging
when you begin to practice the guided meditations,
- notice how frequently judgments of various kinds arise.
- You only need to recognize them.
2. Patience
- Patience is really a wonderful attitude to bring to mindfulness practice because the practice of mindfulness is already, in some fundamental sense, about stepping out of time altogether.
- When you are talking about the present moment, you are talking about now; You are talking about “outside of clock time.”
- You have had moments like that. In fact, you have nothing but moments like that, but you ignore almost all of them, and it’s just once in a blue moon that you will experience a moment when time stops for you
3. Beginner’s Mind
- Beginner’s mind is an attitude.
- It doesn’t mean you don’t know anything.
- It means that you are spacious enough in that moment to not be caught by what it is that you do know or have experienced in the face of the enormity of what is unknown.
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4. Trust
If you can’t entirely trust what you think,
- What about trusting awareness?
- What about trusting your heart?
- What about trusting your motivation to at least do no harm?
- What about trusting your experience until it’s proven to be inaccurate — and then trusting that discovery?
- What about trusting your senses?
- What about Trusting your body?
5. Non-Striving
Non-striving is not trivial.
- It involves realizing that you are already here. There’s no place to go, because the agenda is simply to be awake.
- It is not framed as some ideal that suggests that after forty years of sitting in a cave in the Himalayas, or by studying with august teachers, or doing ten thousand prostrations, or whatever it is, you will necessarily be any better than you are now. It is likely that you will just be older.
- What happens now is what matters.
6. Acceptance
Acceptance is an expression of lived wisdom
- Not that it is easy to accept what is unfolding, especially if it is highly unpleasant
- But you can shift to “awarenessing” with acceptance which immediately frees you from the narrative in your head that says” “I’ve got to have conditions be just so in order for the moment to be a happy moment.” But clinging is the opposite of acceptance.
- Acceptance is letting go of the need for things to be in order for you to be happy or in order for you to even show up with awareness in the present moment
- When you can hold whatever is unfolding, pleasant, unpleasant, or neutral in awareness and allow things to be exactly as they already are - then all of a sudden it becomes possible to stand fully in the moment without it having to be any different
7. Letting Go
Letting go means letting be. Letting go is akin to non-attachment to outcome
When you are no longer grasping for:
- what you want
- What you are already clinging to
- Or What you simply have to have
Letting go means not clinging to
- what you most hate
- Or What you have a huge aversion for
Letting go is a healthy condition of mind and heart-it embraces the whole of reality
In a new way. Which needs to be developed through practice
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Getting Started
1. Posture
- Adopt a posture that embodies wakefulness which means to not practice lying down unless you set your mind to Falling Awake-
- If you chose a chair sit in such a way that the back is straight but relaxed with the shoulders and arms hanging off the rib cage, the head erect, and the chin slightly tucked
- Try to sit with your feet uncrossed on the floor and if possible, with your back away from the back of the chair so your posture is self-supporting, with the spine self-elevating out of the pelvis.
(Kabat-Zinn, 2016. p141)
2. What to do with your eyes
- You can be aware with your EYEs closed or open
- If you sit with your eyes open you can either let your gaze fall unfocused on the floor three or four feet out from you or on a wall if you are sitting facing the wall
- Or you could use a mandella which is a picture which you can focus on and allow your being be open to the messages on the Meditation tape
- These suggestions allow you to stay in the moment without fear of falling asleep
(Kabat-Zinn, 2016. p142)
3. Sleepiness
- If you are sleepy, it is best to sit with your eyes open
- Find a time of the day to practice when you are fairly awake: e.g. early in the morning after a good night’s sleep
- Splash cold water on your face before practicing if you feel sleepy – or even take an invigorating cold shower
- Don't Forget: there will be plenty of distractions to work with inwardly and outwardly, no matter how much you regulate the external environment
4. Protecting the Time
- It is best to choose a time for formal practice in which you will not be interrupted
- Shut off your cell phone, pager, computer and the internet
- Close the door of your room and make sure that others know not to interrupt you during this time – good reason for doing the exercise in the morning
Make:
1. This a time strictly to being
2. Time for nurturing yourself through non-doing
3. Time for cultivation of mindfulness and heartfulness
(Kabat-Zinn, 2016. p142)
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MBSR Meditations on the JKZ App:
Mindfulness for Beginners (2 Sessions): What is Mindfulness and Practicing Mindfulness
Coping with Stress: Body Scan, Mindful Yoga, Sitting Meditation and Mindful Yoga 2
Everyday Life Meditations: Sitting Meditations -10, 20 and 30 minutes. Lying Down Meditations - 10, 20 and 30 minutes, Mountain Meditation and Lake Meditation
Healing Yourself and the World: (10 meditations)
Mindfulness for Pain Relief (2 Sessions): 1. Talk about Pain and 2. Befriending what is
Silence with Bells: 7 sessions from 27 minutes to 3 hours and 33 minutes
How to Order the JKZ App: go to The App Store, The in the Search Box type in: JKZ App or Jon Kabat-Zinn JKZ Meditations App and then download
Note: when working with patients we strongly recommend that they begin with the 10 and 20 minute sitting meditations
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