Last updated on 5th November 2011
Yesterday evening was the second session of this eight week (plus a full day) Mindfulness-Based Stress Reduction (MBSR) course that I am attending. I wrote a week ago about the initial group meeting. There are nine of us plus the trainer on the course, but one of us was unable to make this session. We began the evening with a long guided body scan. It probably took 40 minutes or so. Gosh, I'm getting used to this process now, having practised it for eight days in succession. I wrote yesterday about "MBSR: responses to the body scan", describing the complex mix of therapeutic mechanisms that seem to be involved in this meditation exercise. Different trainers emphasise different balances of these mechanisms (I've been through live or recorded body scans taken by four different "experts" in the last week). I guess the "right balance", if there is such a thing, will depend on what the most important therapeutic mechanisms are. Quite possibly the "right balance" - which mechanisms are most important - will vary depending on the stage of the course we've got to, and on what particular challenges a participant is wanting help with.
Following the body scan, we were encouraged to discuss our practice experiences. The emphasis was primarily on experiences during the 40 minute session we had just been through. There was a bit of discussion about practice during the previous week, but this was less explored. There was a short (5 minutes each way) pair exercise where we focused more on how we had done in our home practice, but obviously 5 minutes each way can tend to produce a rather superficial gallop over what had happened for each of us. Again we broke for the 10 to 15 minute tea break. I think, this evening, I would have preferred more time on pair or small group discussion about our individual progress with the training rather than the more chatty teatime interaction.
I was struggling a bit at this session. There's an apparent paradox. I am very much appreciating the day-to-day mindfulness exercises and the thinking & chewing over what this has triggered in me. I also seem to be benefiting quite considerably (see below). I'm not enjoying the actual class time as much. I'm sure that part of this is because I come into the course with very different experience and maybe somewhat different needs, so it can be tricky.
What do I mean when I say I seem to be "benefiting quite considerably"? I wrote last year about Ruth Baer's very interesting new book "Assessing mindfulness and acceptance processes in clients". I mentioned reviews by two of the originators of Mindfulness-Based Cognitive Therapy (MBSR's close relative) and quoting Zindel Segal who wrote "Informed by the maxim that you can't study what you can't see, Baer's book provides the necessary psychometric underpinning to further our understanding of core change processes in mindfulness-based interventions", while Mark Williams commented "This is an important and timely book. Ruth Baer has brought together international experts in the clinical and research fields to build a critically important bridge between ancient wisdom and modern psychological science. This book will be essential reading for students, researchers, and practitioners of mindfulness and acceptance-based approaches." I have been using several of these assessment measures to track my own progress during the course. One of the most important is the "Five facet mindfulness questionnaire (FFMQ)" (see this website's page "Wellbeing & calming skills" for more on this measure). Before this course began I already had good scores on three facets - Non-React, Describe and Non-Judge - and these haven't particularly changed. However my scores on Observe and Act-Aware have shifted a good deal. Fascinating. I see a similar trend in the more narrowly focused "Mindfulness attention awareness scale (MAAS)" (again look further down the "Wellbeing & calming skills" web page for further details).
Interestingly, in their paper "Is learning mindfulness associated with improved affect after mindfulness-based cognitive therapy?", Schroevers & Brandsma examined "how changes in five core aspects of mindfulness are related to changes in the report of negative and positive affect during an 8-week course of mindfulness-based cognitive therapy." They reported "Results showed significant decreases in negative affect and increases in positive affect. We also found significant increases in four of the five aspects of mindfulness. Importantly, changes in mindfulness were significantly associated with improved affect, with a distinct pattern found for positive and negative affect." They found that "better attention regulation, as indicated by increases in being aware of daily experiences and activities and in observing and attending to experiences, was significantly related to an increased positive affect. A different attitude towards experiences, in terms of more accepting and being more open and curious towards unpleasant experiences, was significantly related to a reduced negative affect."
This figures. I'm fortunate in not suffering particularly from anxiety or depression, so reduction in negative affect isn't a personal target of mine for this course. It's interesting that I already scored well on the FFMQ's Non-React and Non-Judge facets (typically associated with less negative affect). What I am seeing is improvements in the Observe and Act-Aware facet scores (and in the MAAS). So, for example, I go to a regular two hour "free-dance" class and I was struck this week by my increased body awareness during movement - a change that surprised me when I have already been both dancing and meditating for years. Great! However, for reducing negative affect and depressive relapse, the importance of "uncoupling" habitual ruminative reactions from upsetting triggering experiences and of approaching this challenge with curiosity & kindness is increasingly underlined by emerging research. We see this - for example - in Ruth Baer's findings when developing the FFMQ and with results from the Willem Kuyken et al study on MBCT for chronic depression. Willem presented on this mechanisms-of-action issue early last year - see my post "BABCP Spring meeting: the conference - a highlight". This implies that the current research base (and it is being added to all the time) supports the importance of teaching MBSR/MBCT as described by the methods' originators - so trainers (and students) working to help distressing states should emphasise compassionate mindfulness in their practice rather than, for example, relaxation. The mindfulness facets of Non-React and Non-Judge seem especially important in unhooking from self-critical ruminative depressive spirals. Now it's quite possible that this situation could evolve to include encouragement for other mechanisms as well. It's noteworthy, for example, that new evidence-based guidelines published here in the UK earlier this year recommend applied relaxation (not mindfulness) as treatment for anxiety and worry - see my post "New NICE guidance on the treatment of generalised anxiety disorder (GAD)". In this situation, Oscar Wilde may have had a point with his comment "The truth is rarely pure and never simple". And that's before I begin to go looking for currently less emphasised mechanisms-of-action. I'm thinking here of improved self-regulation & self-control, of exposure/desensitisation to upsetting internal & external experiences, of autonomy & values-based action, of increased positive emotions & subsequent improved functioning, of embodied cognition, of a Damasio-style centring/coming home process, of increased attachment security, of changes in compassion for self & others and of several other options - as well, of course, as important non-specific factors like increased hopefulness that positive changes are possible.
I'll write more about this later - both exploring these less spotlighted additional mechanisms of action and looking at how I believe encouragment to relax can clash or integrate with a mindfulness focus depending on how practice instructions are given. And with additional mechanisms of action, I'd like to return to the findings from the Shroevers & Brandsma study I've already mentioned as well as links to Emily Holmes' work on imagery/emotion and on results from the Barbara Fredrickson study on the effects of loving-kindness meditation on emotions & subsequent life satisfaction. This and other territory may be more relevant when approaching mindfulness practice less as a way of reducing suffering and more as a way of potentially increasing flourishing.
This coming week we're due to include a breath-focus meditation in our home practice (as well as the body scan), continue to explore mindfulness particularly during chosen activities (see the post "Mindfulness during daily activities: varying the proportions of the five facets?" for more about this), and start charting pleasant experiences. As a final thought I wonder about the value of including a weekly group version of the "Session rating scale (SRS)" as a way of monitoring participants' engagement in courses like these. I'm due to run an interpersonal group work course starting in a couple of weeks' time - I think I'll give the SRS a try. I'll talk more about this in a later post.
Click through if you want to go to a description of the third evening of the course.