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Responding to growing interest among psychotherapists of all theoretical orientations, this practical book provides a comprehensive introduction to mindfulness and its clinical applications. The authors, who have been practicing both mindfulness and psychotherapy for decades, present a range of clear-cut procedures for implementing mindfulness techniques and teaching them to patients experiencing depression, anxiety, chronic pain, and other problems. Also addressed are ways that mindfulness practices can increase acceptance and empathy in the therapeutic relationship. The book reviews the philosophical underpinnings of mindfulness and presents compelling empirical findings. User-friendly features include illustrative case examples, practice exercises, and resource listings.

<p>A number of books have explored the ways psychotherapy clients can benefit from learning and practicing mindfulness. This is the first volume to focus specifically on how mindfulness can deepen the therapeutic relationship. Grounded in research, chapters demonstrate how therapists' own mindfulness practice can help them to listen more attentively and be more fully present. Leading proponents of different treatment approaches—including behavioral, psychodynamic, and family systems perspectives—illustrate a variety of ways that mindfulness principles can complement standard techniques and improve outcomes by strengthening the connection between therapist and client. Also presented are practical strategies for integrating mindfulness into clinical training.</p>

Mindfulness, originally a construct used in Eastern spiritual and philosophical traditions, has found new utility in psychotherapy practice. Mindfulness practice has been recently applied to treatments of several psychological and health related problems, and research is showing successful outcomes in psychological interventions incorporating mindfulness practices. Several schools of psychotherapy have theorized why mindfulness may be an effective intervention. One population which would theoretically be benefited by mindfulness practice in treatment consists of those individuals who have experienced traumatic events and are exhibiting post-traumatic stress disorder and/or related correlates of past trauma. The present paper gives a general review of the application of mindfulness to clinical psychology interventions. Additionally, we explain how mindfulness is applicable to our integrative behavioral approach to treating trauma and its sequelae. Specifically, this paper will (a) give a general overview of the conceptions and applications of mindfulness to psychology and psychotherapy and provide a brief account of the concepts origins in eastern traditions; (b) discuss the theoretical conceptualization of clinical problems that may relate to the long-term correlates of trauma; (c) describe how mindfulness, acceptance and the therapeutic relationship can address trauma symptoms and discuss a modified treatment approach for trauma survivors that incorporates mindfulness and acceptance practices into traditional exposure treatment.

Interest in applications of mindfulness-based approaches with adults has grown rapidly in recent times, and there is an expanding research base that suggests these are efficacious approaches to promoting psychological health and well-being. Interest has spread to applications of mindfulness-based approaches with children and adolescents, yet the research is still in its infancy. I aim to provide a preliminary review of the current research base of mindfulness-based approaches with children and adolescents, focusing on MBSR/MBCT models, which place the regular practice of mindfulness meditation at the core of the intervention. Overall, the current research base provides support for the feasibility of mindfulness-based interventions with children and adolescents, however there is no generalized empirical evidence of the efficacy of these interventions. For the field to advance, I suggest that research needs to shift away from feasibility studies towards large, well-designed studies with robust methodologies, and adopt standardized formats for interventions, allowing for replication and comparison studies, to develop a firm research evidence base.

<p>Recovered recurrently depressed patients were randomized to treatment as usual (TAU) or TAU plus mindfulness-based cognitive therapy (MBCT). Replicating previous findings, MBCT reduced relapse from 78% to 36% in 55 patients with 3 or more previous episodes; but in 18 patients with only 2 (recent) episodes corresponding figures were 20% and 50%. MBCT was most effective in preventing relapses not preceded by life events. Relapses were more often associated with significant life events in the 2-episode group. This group also reported less childhood adversity and later first depression onset than the 3-or-more-episode group, suggesting that these groups represented distinct populations. MBCT is an effective and efficient way to prevent relapse/recurrence in recovered depressed patients with 3 or more previous episodes.</p>

The high likelihood of recurrence in depression is linked to a progressive increase in emotional reactivity to stress (stress sensitization). Mindfulness-based therapies teach mindfulness skills designed to decrease emotional reactivity in the face of negative affect-producing stressors. The primary aim of the current study was to assess whether Mindfulness-Based Cognitive Therapy (MBCT) is efficacious in reducing emotional reactivity to social evaluative threat in a clinical sample with recurrent depression. A secondary aim was to assess whether improvement in emotional reactivity mediates improvements in depressive symptoms. Fifty-two individuals with partially remitted depression were randomized into an 8-week MBCT course or a waitlist control condition. All participants underwent the Trier Social Stress Test (TSST) before and after the 8-week trial period. Emotional reactivity to stress was assessed with the Spielberger State Anxiety Inventory at several time points before, during, and after the stressor. MBCT was associated with decreased emotional reactivity to social stress, specifically during the recovery (post-stressor) phase of the TSST. Waitlist controls showed an increase in anticipatory (pre-stressor) anxiety that was absent in the MBCT group. Improvements in emotional reactivity partially mediated improvements in depressive symptoms. Limitations include small sample size, lack of objective or treatment adherence measures, and non-generalizability to more severely depressed populations. Given that emotional reactivity to stress is an important psychopathological process underlying the chronic and recurrent nature of depression, these findings suggest that mindfulness skills are important in adaptive emotion regulation when coping with stress.
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<p>Baer's review (2003; this issue) suggests that mindf ulness-based interventions are clinically efficacious, but that better designed studies are now needed to substantiate the field and place it on a firm foundation for future growth. Her review, coupled with other lines of evidence, suggests that interest in incorporating mindfulness into clinical interventions in medicine and psychology is growing. It is thus important that professionals coming to this field understand some of the unique factors associated with the delivery of mindfulness-based interventions and the potential conceptual and practical pitfalls of not recognizing the features of this broadly unfamiliar landscape. This commentary highlights and contextualizes (1) what exactly mindfulness is, (2) where it came from, (3) how it came to be introduced into medicine and health care, (4) issues of cross-cultural sensitivity and understanding in the study of meditative practices stemming from other cultures and in applications of them in novel settings, (5) why it is important for people who are teaching mind-fulness to practice themselves, (6) results from 3 recent studies from the Center for Mindfulness in Medicine, Health Care, and Society not reviewed by Baer but which raise a number of key questions about clinical applicability, study design, and mechanism of action, and (7) current opportunities for professional training and development in mindfulness and its clinical applications.</p>

OBJECTIVES: The objectives of this study were to assess the general acceptability and to assess domains of potential effect of a mindfulness-based stress reduction (MBSR) program for human immunodeficiency virus (HIV)-infected and at-risk urban youth. METHODS: Thirteen-to twenty-one-year-old youth were recruited from the pediatric primary care clinic of an urban tertiary care hospital to participate in 4 MBSR groups. Each MBSR group consisted of nine weekly sessions of MBSR instruction. This mixed-methods evaluation consisted of quantitative data--attendance, psychologic symptoms (Symptom Checklist 90-Revised), and quality of life (Child Health and Illness Profile-Adolescent Edition)--and qualitative data--in-depth individual interviews conducted in a convenience sample of participants until interview themes were saturated. Analysis involved comparison of pre- and postintervention surveys and content analysis of interviews. RESULTS: Thirty-three (33) youth attended at least one MBSR session. Of the 33 who attended any sessions, 26 youth (79%) attended the majority of the MBSR sessions and were considered "program completers." Among program completers, 11 were HIV-infected, 77% were female, all were African American, and the average age was 16.8 years. Quantitative data show that following the MBSR program, participants had a significant reduction in hostility (p = 0.02), general discomfort (p = 0.01), and emotional discomfort (p = 0.02). Qualitative data (n = 10) show perceived improvements in interpersonal relationships (including less conflict), school achievement, physical health, and reduced stress. CONCLUSIONS: The data suggest that MBSR instruction for urban youth may have a positive effect in domains related to hostility, interpersonal relationships, school achievement, and physical health. However, because of the small sample size and lack of control group, it cannot be distinguished whether the changes observed are due to MBSR or to nonspecific group effects. Further controlled trials should include assessment of the MBSR program's efficacy in these domains.

Stress within the teaching profession has a negative impact on the health and well-being of individual teachers and on retention and recruitment for the profession as a whole. There is increasing literature to suggest that Mindfulness is a useful intervention to address a variety of psychological problems, and that Mindfulness-Based Stress Reduction (MBSR) is a particularly helpful intervention for stress. We investigated the effects of teaching a MBSR course to primary school teachers to reduce stress. The MBSR course was taught to a group of primary school teachers and evaluated to establish its effects on levels of anxiety, depression, and stress, as well as movement towards a stated goal and changes in awareness. The results showed improvement for most participants for anxiety, depression, and stress, some of which were statistically significant. There were also significant improvements on two of the four dimensions of a mindfulness skills inventory. These results suggest that this approach could be a potentially cost-effective method to combat teacher stress and burnout.

<p>Mindfulness-based approaches are among the most innovative and interesting new approaches to mental health treatment. Mindfulness refers to patients developing an "awareness of present experience with acceptance." Interest in them is widespread, with presentations and workshops drawing large audiences all over the US and many other countries. This book provides a comprehensive introduction to the best-researched mindfulness-based treatments. It emphasizes detailed clinical illustration providing a close-up view of how these treatments are conducted, the skills required of therapists, and how they work. The book also has a solid foundation in theory and research and shows clearly how these treatments can be understood using accepted psychological principles and concepts. The evidence base for these treatments is concisely reviewed.* Comprehensive introduction to the best-researched mindfulness-based treatments* Covers wide range of problems &amp; disorders (anxiety, depression, eating, psychosis, personality disorders, stress, pain, relationship problems, etc)* Discusses a wide range of populations (children, adolescents, older adults, couples)* Includes wide range of settings (outpatient, inpatient, medical, mental health, workplace)* Clinically rich, illustrative case study in every chapter* International perspectives represented (authors from US, Canada, Britain, Sweden)</p>

Objective: ADHD is a childhood-onset psychiatric condition that often continues into adulthood. Stimulant medications are the mainstay of treatment; however, additional approaches are frequently desired. In recent years, mindfulness meditation has been proposed to improve attention, reduce stress, and improve mood. This study tests the feasibility of an 8-week mindfulness training program for adults and adolescents with ADHD. Method: Twenty-four adults and eight adolescents with ADHD enrolled in a feasibility study of an 8-week mindfulness training program. Results: The majority of participants completed the training and reported high satisfaction with the training. Pre—post improvements in self-reported ADHD symptoms and test performance on tasks measuring attention and cognitive inhibition were noted. Improvements in anxiety and depressive symptoms were also observed. Conclusion: Mindfulness training is a feasible intervention in a subset of ADHD adults and adolescents and may improve behavioral and neurocognitive impairments. A controlled clinical study is warranted. (J. of Att. Dis. 2008; 11(6) 737-746)

Drawing from theories regarding the role of awareness in behavioral self-regulation, this research was designed to examine the role of mindfulness as a moderator between implicit motivation and the motivation for day-to-day behavior. We hypothesized that dispositional mindfulness (Brown and Ryan, J Pers Soc Psychol, 84, 822–848, 2003) would act to modify the expression of implicit autonomy orientation in daily behavioral motivation. Using the Implicit Association Test (Greenwald et al. J Pers Soc Psychol, 74, 1464–1480, 1998), Study 1 provided evidence for the reliability and validity of a new measure of implicit autonomy orientation. Using an experience-sampling strategy, Study 2 showed the hypothesized moderating effect, such that implicit autonomy orientation predicted day-to-day motivation only for those lower in dispositional mindfulness. Those higher in mindfulness showed more autonomously motivated behavior regardless of implicit orientation toward autonomy or heteronomy. It also showed that this moderating effect of awareness was specific to mindfulness and was primarily manifest in spontaneous behavior. Discussion focuses on the implications of these findings for dual process theory and research.

Mindfulness training has had salutary effects with adult populations and it is seen as a potentially helpful to children’s development. How to implement mindfulness practices with young children is not yet clear; some meditation practices, like sitting still for long periods with internally-self-regulated focused attention, seem developmentally inappropriate. Montessori schooling is a 100-year-old system that naturally incorporates practices that align with mindfulness and are suited to very young children. Here I describe how several aspects of Montessori education, including privileging concentrated attention, attending to sensory experience, and engaging in practical work, parallel mindfulness practices. These aspects might be responsible for some of the socio-emotional and executive function benefits that have been associated with Montessori education, and they could be adapted to conventional classroom methods.
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Objective Although the relationship between religious practice and health is well established, the relationship between spirituality and health is not as well studied. The objective of this study was to ascertain whether participation in the mindfulness-based stress reduction (MBSR) program was associated with increases in mindfulness and spirituality, and to examine the associations between mindfulness, spirituality, and medical and psychological symptoms. Methods Forty-four participants in the University of Massachusetts Medical School's MBSR program were assessed preprogram and postprogram on trait (Mindful Attention and Awareness Scale) and state (Toronto Mindfulness Scale) mindfulness, spirituality (Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale), psychological distress, and reported medical symptoms. Participants also kept a log of daily home mindfulness practice. Mean changes in scores were computed, and relationships between changes in variables were examined using mixed-model linear regression. Results There were significant improvements in spirituality, state and trait mindfulness, psychological distress, and reported medical symptoms. Increases in both state and trait mindfulness were associated with increases in spirituality. Increases in trait mindfulness and spirituality were associated with decreases in psychological distress and reported medical symptoms. Changes in both trait and state mindfulness were independently associated with changes in spirituality, but only changes in trait mindfulness and spirituality were associated with reductions in psychological distress and reported medical symptoms. No association was found between outcomes and home mindfulness practice. Conclusions Participation in the MBSR program appears to be associated with improvements in trait and state mindfulness, psychological distress, and medical symptoms. Improvements in trait mindfulness and spirituality appear, in turn, to be associated with improvements in psychological and medical symptoms.

<p>Interest in mindfulness and its enhancement has burgeoned in recent years. In this article, we discuss in detail the nature of mindfulness and its relation to other, established theories of attention and awareness in day-to-day life. We then examine theory and evidence for the role of mindfulness in curtailing negative functioning and enhancing positive outcomes in several important life domains, including mental health, physical health, behavioral regulation, and interpersonal relationships. The processes through which mindfulness is theorized to have its beneficial effects are then discussed, along with proposed directions for theoretical development and empirical research.</p>

<p>Interventions based on training in mindfulness skills are becoming increasingly popular. Mindfulness involves intentionally bringing one's attention to the internal and external experiences occurring in the present moment, and is often taught through a variety of meditation exercises. This review summarizes conceptual approaches to mind-fulness and empirical research on the utility of mindfulness-based interventions. Meta-analytic techniques were incorporated to facilitate quantification of findings and comparison across studies. Although the current empirical literature includes many methodological flaws, findings suggest that mindfulness-based interventions may be helpful in the treatment of several disorders. Methodologically sound investigations are recommended in order to clarify the utility of these interventions.</p>

Children with ADHD are often non-compliant with parental instructions. Various methods have been used to reduce problem behaviors in these children, with medication and manipulation of behavioral contingencies being the most prevalent. An objection often raised by parents is that these management strategies require them to impose external control on the children which not only results in the children not learning self-control strategies, but also does not enhance positive interactions between them and their parents. Studies have shown that providing mindfulness training to parents, without a focus on reducing problem behaviors, can enhance positive interactions with their children and increase their satisfaction with parenting. We were interested to see what effects giving mindfulness training to two mothers, and subsequently to their children, would have on compliance by the children. Using a multiple baseline across mothers and children design, we found that giving a mother mindfulness training enhanced compliance by her child. When the children were subsequently given similar training, compliance increased even more markedly, and was maintained during follow-up. The mothers reported associated increases in satisfaction with the interactions with their children and happiness with parenting. We suspect that the mindfulness training produces personal transformations, both in parents and children, rather than teaching strategies for changing behavior.

Mindfulness is defined as paying attention in the present moment. We investigate the hypothesis that mindfulness training may alter or enhance specific aspects of attention. We examined three functionally and neuroanatomically distinct but overlapping attentional subsystems: alerting, orienting, and conflict monitoring. Functioning of each subsystem was indexed by performance on the Attention Network Test (ANT; Fan, McCandliss, Sommer, Raz, & Posner, 2002). Two types of mindfulness training (MT) programs were examined, and behavioral testing was conducted on participants before (Time 1) and after (Time 2) training. One training group consisted of individuals naive to mindfulness techniques who participated in an 8-week mindfulness-based stress reduction (MBSR) course that emphasized the development of concentrative meditation skills. The other training group consisted of individuals experienced in concentrative meditation techniques who participated in a 1-month intensive mindfulness retreat. Performance of these groups was compared with that of control participants who were meditation naive and received no MT. At Time 1, the participants in the retreat group demonstrated improved conflict monitoring performance relative to those in the MBSR and control groups. At Time 2, the participants in the MBSR course demonstrated significantly improved orienting in comparison with the control and retreat participants. In contrast, the participants in the retreat group demonstrated altered performance on the alerting component, with improvements in exogenous stimulus detection in comparison with the control and MBSR participants. The groups did not differ in conflict monitoring performance at Time 2. These results suggest that mindfulness training may improve attention-related behavioral responses by enhancing functioning of specific subcomponents of attention. Whereas participation in the MBSR course improved the ability to endogenously orient attention, retreat participation appeared to allow for the development and emergence of receptive attentional skills, which improved exogenous alerting-related process.

Mindfulness is defined as paying attention in the present moment. We investigate the hypothesis that mindfulness training may alter or enhance specific aspects of attention. We examined three functionally and neuroanatomically distinct but overlapping attentional subsystems: alerting, orienting, and conflict monitoring. Functioning of each subsystem was indexed by performance on the Attention Network Test. Two types of mindfulness training (MT) programs were examined, and behavioral testing was conducted on participants before (Time 1) and after (Time 2) training. One training group consisted of individuals naive to mindfulness techniques who participated in an 8-week mindfulness-based stress reduction (MBSR) course that emphasized the development of concentrative meditation skills. The other training group consisted of individuals experienced in concentrative meditation techniques who participated in a 1-month intensive mindfulness retreat. Performance of these groups was compared with that of control participants who were meditation naive and received no MT. At Time 1, the participants in the retreat group demonstrated improved conflict monitoring performance relative to those in the MBSR and control groups. At Time 2, the participants in the MBSR course demonstrated significantly improved orienting in comparison with the control and retreat participants. In contrast, the participants in the retreat group demonstrated altered performance on the alerting component, with improvements in exogenous stimulus detection in comparison with the control and MBSR participants. The groups did not differ in conflict monitoring performance at Time 2. These results suggest that mindfulness training may improve attention-related behavioral responses by enhancing functioning of specific subcomponents of attention. Whereas participation in the MBSR course improved the ability to endogenously orient attention, retreat participation appeared to allow for the development and emergence of receptive attentional skills, which improved exogenous alerting-related process.
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<p>Pregnancy is a time of wonder and of momentous change, both emotionally and physically. For many women, it is a time like no other in their lives, filled with excitement and awe but also with great uncertainty and vulnerability. This book-and-audio program brings together writings and simple daily practices for bringing the transformative power of mindfulness to this special time. The Mindful Way through Pregnancyfeatures: •&nbsp;&nbsp; &nbsp;Yoga and meditation teacher Anne Cushman on finding balance amid the emotional ups and downs of pregnancy •&nbsp;&nbsp; &nbsp;Author Celia Straus on bonding with your child during pregnancy •&nbsp;&nbsp; &nbsp;Yoga teacher Jennifer Brilliant on caring for your changing body •&nbsp;&nbsp; &nbsp;Meditation teacher Judith Lief on calming your fears about childbirth and parenthood •&nbsp;&nbsp; &nbsp;Author Mimi Doe on setting your intentions for parenthood •&nbsp;&nbsp; &nbsp;Zen teacher Karen Maezen Miller on mindfulness and the childbirth experience Also included is an audio CD of guided meditation instruction for four simple meditation practices for expectant mothers. Drawn from the Buddhist tradition, these practices offer different ways to develop a sense of calm well-being throughout pregnancy.</p>

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