Mindfulness Matters

Mindfulness Matters

Kripalu Center for Yoga and Health: “Your Brain on Yoga”

posted by exquisitemind

The Kripalu Center for Yoga and Health in Lenox Massachusetts is a unique institution and community. If you don’t already know about, please allow me to introduce you to it. I just returned from directing a course there over the weekend based on my book entitled: “Wild Chickens and Petty Tyrants: Metaphors for Mindful Living.” Kripalu is a wonderful place situated in a landscape of soothing physical beauty in the Berkshire Mountains, it throbs with an energy of people seeking their truth through yoga, meditation, healing arts, among many other disciplines. A weekend workshop at Kripalu is a time to learn and to relax; to enjoy wholesome food and the company of dynamic and friendly people. Around the workshop times, yoga classes at different levels are offered including a yoga dance hour. I did this on Saturday. It was a fabulous workout and great fun, led by renown yoga dance teacher Toni Bergins, creator of Journey Dance. If you don’t want the structure of a workshop, you can go to Kripalu for Retreat and Renewal. Here you can partake in yoga classes and other classes, hike the grounds, sit in the sauna and enjoy the healing atmosphere of this magical place. I am pleased and proud to be a new member of the teaching faculty of this singular organization.
Kripalu offers training throughout the year for Yoga Teacher Training, Massage Therapy, and Ayurvedic Medicine. The Institute for Extraordinary Living (IEL) Directed by Stephen Cope is conducting research on the brain effects of yoga using neuroimaging. Sarah Lazar who has conducted ground breaking research on the brain effects of mindfulness meditation is leading the research. Yoga has penetrated our culture with 6.9% or 15.8 million people in the United States practicing yoga. Another 8% of population are interested in trying yoga. Kripalu Yoga emphasizes compassion and witness consciousness, representing a more contemplative form of yoga than the many varieties available to the interested seeker. The yoga efficacy study conducted by Sarah Lazar tested 16 yoga practitioners, 18 meditation practitioners, and 16 control subjects. All subjects underwent brain imaging via functional MRI (fMRI). Cortical thickness was measured for each group. Meditators meditated while in the MRI tube while yoga practitioners imagined going through a yoga routine (since the claustrophobic like confines of the MRI tube do not permit actual yoga asanas). Results will be published soon. The IEL is also conducting research on the beneficial effects of yoga on musical performance (in conjunction with the famed Tanglewood  Music Center) and the effects of yoga for veterans with posttruamatic stress disorder (PTSD).
Kripalu is a non-profit organization and thrives through the generosity of its donors and program participants. Visit them at http://kripalu.org/
I am currently in the process of planning my next teaching engagement at Kripalu, so stay tuned for more details.

Mud Season: The Way Beyond is Through

posted by Dr. Arnie Kozak

Mud season has arrived early in mid-march. Warm days and sunshine are melting the snowpack and the ground is thawing, partially in places and yielding to soft pools of mud in many spots. A sign at the nature preserve near my house has a sign encouraging hikers to walk through the mud and not around the puddles. To do so will help the ground to heal and will not prolong the proliferation of mud by extending the vulnerability of the trails by foot traffic.

In our emotional life we might heed the same advise. To heal we need to walk through the mud and not seek to go around it. The classic wisdom urges: the way beyond is through. When we avoid our difficult situations we prolong the muck. Healing happens through courageous exposure to the painful situations of our life. There is an old Buddhist saying: “Hot Buddha sweats; cold Buddha shivers.” To this we can end “Buddha walking in mud season gets wet and muddy feet!” That’s the reality of walking through the mud, our feet get wet and mud gets between our toes. That is what is so.

But we might add something to this — a resistance to this simple moist and cool reality. We don’t “want” to get our feet wet and we are willing to walk around the puddles to avoid this. In the process of doing so we damage the trail, prolong its “healing.” And what is this wanting all about? What’s wrong with wet feet? What’s the big issue with muddy toes? We typically don’t reflect on these questions and go directly to a conditioned response of aversion. And this aversion can lead to avoidance. And this avoidance can lead to an inability to heal from the situations that confront us, if we take the metaphorical suggestion of the trail to its logical conclusion. Behavioral psychology has shown us that avoidance prolongs fear conditioning.

Our natural tendency is to avoid situations that make us anxious. The avoids relieves that sense of anxiety and thereby becomes a potent reinforcement (negative reinforcement in this case). Therefore, the next time anxiety arises we are more likely to avoid it again, engaging the behavior that has been reinforced. This avoidance can become a habit, even a way of life. So the best counsel is to take a straight line path through the mud.

Notice how the mud feels, its coolness, its dampness, its texture, and so forth. If we are open to noticing in this way we might even remember the pleasure of playing in the mud as a child, long before we insisted on things being just so. There was a freedom we once had and have now lost when we impose so many conditions on the conditions we confront. To realize our Buddha nature we just need to feel the mud between our toes. If we can do so with interest and a smile we are well on our way to recapturing that lost freedom.

Metaphor as Upaya (Skillful Means)

posted by exquisitemind

Much of what we communicate relies on comparing one thing to another; something known to help us understand something less known. This is the most basic sense of metaphor: understanding one thing in terms of another. When the Buddha gave his first teachings some 2500 years ago, he made ample use of metaphor. He continued to rely on metaphor throughout his long teaching career. Buddhist scholar Damien Keown emphasized this when he said, “The Buddha’s skill in teaching the Dharma, demonstrated in his ability to adapt his message to the context in which it was delivered. Parables, metaphors, and similes formed an important part of his teaching repertoire, skillfully tailored to suit the level of his audience.” Upaya or skillful means is embodied by the Buddha’s use of metaphor in his teaching. When it comes to understanding mindfulness – a core component of the Buddha’s teachings – it is hard to do so without turning to metaphor. I would dare say it is impossible to do so, and I have explored a variety of ways in which this can be done in my book, Wild Chickens and Petty Tyrants: 108 Metaphors for Mindfulness (Wisdom Publications).
Some metaphors are dead. The imaginative power they once invoked has long been worn down by the passage of time. For instance, we are unlikely to think of our heads when we refer to the head of a table. Other metaphors are not dead but remain hidden from view. These are everyday metaphors such as the notion that the mind is a container that things can come into and out of; a space where things can happen and do happen like thoughts and images. Some metaphors are deliberate and obvious, as the ones we use in poetry. Indeed Robert Frost warned, “Unless you are at home in the metaphor, unless you have had your proper poetical education in the metaphor, you are not safe anywhere.” Metaphors powerfully influence everything we think and say, and the metaphors we use can determine our happiness—or lack thereof. Recognizing and changing our metaphors can move us toward greater joy.
In a modern day context, Shinzen Young, engages upaya by using mindfulness of music meditation to reach young people. This adaptation helps troubled youths get the benefits of mindfulness without having to cut through any of the cultural obstacles that may stand in the way of embracing meditation. They are understanding one thing (mindfulness) in terms of another (music). This transfer of meaning from one domain to another facilitates learning. These kids get wise without having to try to do so. We all use metaphors and follow in the steps of the Buddha when we do so.  I humbly follow in this tradition and invite you to do the same.
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To learn more about metaphors read Wild Chickens and Petty Tyrants: 108 Metaphors for Mindfulness and attend the workshop based on the book Wild Chickens and Petty Tyrants: Metaphors for Mindful Living at the Kripalu Center for Yoga and Health in the beautiful Berkshire Mountains, 12-14 March 2010.

Mindfulness for the Nursing Profession

posted by exquisitemind

“Today’s healthcare environment is turbulent, rapidly presenting nurses with stimuli, interruptions, and competing priorities. The stakes of success are extraordinarily high; nurses in all roles must cope successfully with numerous demands to make timely, accurate decisions affecting human lives.” (Pipe et al., 2009) 

Nursing professionals face enormous challenges. The work is difficult and demands full presence, energy, and commitment.  Stress is a pervasive fact of the profession, and it affects institutions and individuals, and even the caring relationship itself. 
Stress can impair the health care provider’s ability to observe, to listen, and to understand the patient. To practice safely, healthfully, and with compassion, nurses need to effectively manage stress. Taken to an extreme, when acute stress becomes chronic, impairments can be seen in immune system and cognitive functioning. One research group rang a note of caution that “unfortunately, breakdowns in attention raise the risk of serious consequences such as symptom recognition, medication errors, and patient safety issues” (Pipe et al. 2009). 
Mindfulness is a proven strategy that can help nurses to cope with the demands of their work and their lives (Baer 2003; Carmody et al., 2009; Grossman, 2004; Ludwig & Kabat-Zinn, 2008). Of the hundreds of clinical studies conducted on mindfulness-based interventions, 75% of them have been conducted in the past five years pointing to the mindfulness revolution sweeping health care. 
A wealth of different clinical interventions have been developed and researched that include mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), mindfulness-based relapse prevention (MBRP), and mindfulness-based eating awareness training (MB-EAT). 
 
Specific to nurses, Beddoe (2004) demonstrated that an 8-week mindfulness-based stress reduction intervention for nursing students significantly reduced anxiety. The students who practiced at home experienced additional benefits. These benefits spilled over into daily life and participants felt greater well-being and improved coping skills.  Mackenzie et al. (2006) studied a four-week mindfulness-based stress reduction intervention for nurses and nurse aides. The mindfulness intervention participants experienced significant improvements in burnout symptoms, relaxation, and life satisfaction. 
Pipe et al. (2009) studied nurse leaders with a 4-week mindfulness-based intervention (compared to a leadership intervention). The mindfulness group saw greater improvement in mood symptoms.
Neuroscience studies of meditation have demonstrated enduring and beneficial changes in both the function and structure of the brain that persist beyond the period of meditation (Davidson et al. 2003; Farb et al. 2007; Lazar et al. 2006; Luders et al. 2009; Lutz et al. 2008). 
Neuroscientist Daniel Siegel (2007) concludes that mindfulness produces a form of neural integration and coherence that leads to more adaptive functioning. The areas of the prefrontal cortex that show increases in grey matter are responsible for emotional regulation (including modulating fear) and an increased ability to be resilient in the face of stress. Other capacities affected include the regulation of body systems, attuning to others, responding flexibly, and exhibiting insight and empathy. 
For example, Lazar et al (2006) found that mindfulness meditation led to a thickening in areas of the prefrontal cortex linked to these functions, and that these changes were correlated with the length of time practicing. Lutz et al. (2008) conclude that:
Practitioners of mindfulness have recognized key benefits from cultivating attention in this way. 
By bringing ourselves into the present moment and away from future- and past-oriented narrative thinking (or critical commentary about the present moment) we shift our relationship to stress. We can think of the present moment as a vacuum chamber and that stress, anxiety, and depression-generating thoughts require an oxygen rich atmosphere to thrive. By being in the present moment we help ourselves as health care providers to moderate the challenges of stress, even having the opportunity to transform previously overwhelming situations into ones of challenge and mastery. 
This presence also helps us to be better clinicians. We are more present, more available, and better able to access empathy, compassion, and caring skills. The mindfulness teacher Sharon Salzburg noted, “the act of being completely present is truly an act of love.” Can we bring this love to our work? Mindful attention helps us to be wholehearted in our work and in full contact with both the joys and sorrows of patient care. When we are fully engaged we are devoting less internal resources to psychological and behavioral defenses and thus have more available for our patients. 
Cultivating the skills of mindfulness also gives us something to offer our patients. In any given moment we can encourage our patients to pay attention to their breathing, redirecting their attention away from painful narratives and into the present moment. The more we can embody mindful awareness the more we can give to our patients in this way.
In sum, mindfulness can help us to be the clinicians we aspire to be without paying the emotional cost of exhaustion and burnout. 
Whether nurses, physicians, or mental health providers we all endeavor to help our patients and we would like to provide this loving care in a way that does not damage our own health. We function within a highly stressful and often dysfunctional system of health care delivery. Mindfulness training can be a key component for coping with the demands of being a nurse today.
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Arnie Kozak, Ph.D. (http://exquisitemind.com) is a Licensed Psychologist and author of the recently published Wild Chickens and Petty Tyrants: 108 Metaphors for Mindfulness (Wisdom). 

References

Baer, R. (2003). Mindfulness Training as a Clinical Intervention: Conceptual and Empirical Review. Clinical Psychology: Science And Practice, 10(2), 125-143. 

Beddoe, A. E. & Murphy, S. O. (2004). Does mindfulness decrease stress and foster empathy among nursing students? Journal of Nursing Education, 43(7). 305-312. 

Carmody, J. et al. (2009). An Empirical Study of the Mechanisms of Mindfulness in a Mindfulness-Based Stress Reduction Program, Journal of Clinical Psychology, 65(6), 613-626. 

Davidson, R., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564-70. 

Day, P. O. & Horton-Deutsch, S. Using mindfulness-based therapeutic interventions in psychiatric nursing practice-part I: Description and empirical support for mindfulness-based interventions. Archives of Psychiatric Nursing, 18(5). 164-169. 

Day, P. O. & Horton-Deutsch, S. Using mindfulness-based therapeutic interventions in psychiatric nursing practice-part II: Mindfulness-based approaches for all phases of psychotherapy-clinical case study. Archives of Psychiatric Nursing, 18(5). 170-177.
Farb, N. et al. (2007). Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. SCAN. 


Grossman, P., et al. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research 57, 35-43. 


Kang, Y. S., Choi, S. Y., & Ryu, E. (2009). The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. Nurse Education Today, 29(5). 538-543 

Lazar, S. et al. (2006). Meditation experience is associated with increased cortical thickness. NeuroReport, 16. 1893-7. 

Luders, E. et al. (2009). The underlying anatomical correlates of long-term meditation: Larger hippocampal and frontal volumes of gray matter. NeuroImage, 45, 672-8. 

Ludwig, D. S. & Kabat-Zinn, J. (2008). Mindfulness in Medicine.  JAMA, 300(11), 1350-52. 

Lutz, A., et al. (2008). Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise. PloS ONE 3, e1897 

Mackenzie, C. S., Poulin, P. A., & Seidman-Carlson, R. (2006). A brief mindfulness-based stress reduction intervention for nurses and nurse aides. Applied Nursing Research, 19(2). 105-109. 

Pipe, T. B., Bortz, J. J., Dueck, A., et al. (2009).  Nurse Leader Mindfulness Meditation Program for Stress Management A Randomized Controlled Trial. Journal Of Nursing Administration, 39(3). 130-137. 

Shirey, M. R. (2007). An evidence-based solution for minimizing stress and anger in nursing students. Journal of Nursing Education, 46(12). 568-571.
Siegel, D. (2007). The Mindful Brain. New York: Norton.

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