About Mindfulness

Application of Mindfulness is rapidly gaining attention in the medical and mental health field. It’s application is extensive including parenting practice. What is mindfulness? How is it applied in clinical practices? Does it have any scientific foundation? What is the brain mechanism behind practising mindfulness? How to have a taste of mindfulness?

What is mindfulness?

Mindfulness means paying attention to the present moment purposefully and non-judgmentally. It is about having self-awareness and compassionate acceptance of all the experiences, including thinking, feeling and body sensation, one will have in the present moment1,2.

Application and scientific foundation of Mindfulness

Dr Jon Kabat-Zinn is the pioneer to apply mindfulness in medical setting for helping chronic pain patients to cope with pain symptoms. In 1979, he established the Center for Mindfulness of the University of Massachusetts Medical School and developed the programme of Mindfulness-Based Stress Reduction (MBSR) aiming to help the chronically ill patients to cope with their pain and related symptoms.

MBSR is a psychoeducational experiential learning programme based on mindfulness as its foundation. It is an eight-week programme with three-hour weekly group meeting and a day of retreat. Through a series of mindful practices such as breathing, walking and yoga, the participants learn together with facilitation by MBSR teachers. All the participants are invited to share in the group on what they have experienced. Self-awareness of our thinking, feeling and body sensation can be enhanced throughout the course as well as from self-practice at home every day.

In 1992, using MBSR programme as the foundation,Professor Zindel Segal, John Teasdale and Mark Williams in Britain developed the Mindfulness-Based Cognitive Therapy (MBCT) to treat patients with depression. In 2000, they published the first MBCT trial which indicated significant post-trial reduction of risk of relapse in depression3. They further elaborated on how MBCT helped in treating depression and reduction of relapse in their book published in 20024.

Basically, MBCT is similar to MBSR in format. Yet, MBCT focuses specifically on depressive mood and negative cognition. Participants learn to purposefully bring their awareness to the habitual thinking pattern, emotional responses and behavioral reactions with a non-judgmental, curious, and compassionate acceptance. MBSR and MBCT were both being employed to treat anxiety disorders such as Generalized Anxiety Disorder and patients with other psychological distress. The result indicated both modes led to significant reduction of anxiety symptoms, enhanced psychological wellbeing and improved stress coping5.

MBSR and MBCT have been applied to other clinical patients such as those with heart disease, gastrointestinal illness, cancer, post-traumatic stress disorder and insomnia. They have also been used to help the general population to cope with stress arising from family, work and interpersonal relationship6,7.

Through adaptation of MBSR, Nancy Bardacke founded Mindfulness-Based Childbirth and Parenting (MBCP) in 1998. By practicing mindful meditation and yoga, learning related knowledge on child birth and participating in group dialogue, the expectant parents are facilitated to adjust to the tremendous physical and role changes in pregnancy and childbirth. Preliminary research had indicated decreases in anxiety and depression during pregnancy after attending MBCP8,9.

Mindfulness has been applied in other populations such as parents of children with special needs. In recent research studies, parents of children with Autism Spectrum Disorder, after attending mindfulness programme, reported significant reduction of stress level. Their children also showed decreased challenging behaviours and increased compliance behaviours10,11,12,13. Besides, parents of typical children who attended the programme were found to have better psychological wellbeing in both the parents and their children14, or enhanced attention control and emotion regulation in their children15. Mindfulness training was also included in the curriculum of some regular schools. The students were shown to have improvement in cognitive control, stress coping and emotional control16.

Locally, different professionals have tried to use MBSR & MBCT in recent years to help both clinical patients as well as the general population to cope with stress and symptoms of their illness. Some non-profit making agencies have provided mindfulness parenting courses to help parents of children with special needs (such as Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder) to cope with stress. To promote psychological wellbeing through integrating mindfulness into daily life, the New Life Psychiatric Rehabilitation Association has introduced the concepts through lively animation videos. Local research studies are emerging17,18. Yet, future research endeavor on randomized controlled trial and longitudinal studies is very much required17,19.

The brain mechanism behind practicing mindfulness

Researchers have tried to investigate the possible mechanism behind mindfulness using both structural and functional magnetic resonance imaging. Studies showed that when people having mindfulness practice for a period of time, there was increased in the gray matter density of the brain areas such as hippocampus, posterior cingulate cortex, temporal-parietal junction and insula20,21. These brain areas play an important role in emotion regulation, empathy and compassion. Besides, research findings also showed there was a decrease in the density of the gray matter of amygdala, which correlated with a change in perceived stress levels20,21. Apart from the brain structure, researchers also found changes of brain activity when people were engaging in mindfulness practice. Increased brain activity was identified at the anterior cingulate cortex and anterior insula which had positive effects on attention control and pain sensation21,22. Thus, practising mindfulness is found to have actual impacts on the brain structure and brain activity21,22,23,24.

Mindful Parenting

In our day to day work, it is common to see parents being frustrated in parenting. Even though the parents understand well the reason behind their frustration, they may still have great difficulty in controlling their own emotions. They know well the principles and strategies in positive parenting. However, when they are facing the child at that moment, they show difficulty in controlling their emotions even though they are aware that such responses are ineffective and even harmful to their children and themselves!

In the book published in 2014, Dr Jon Kabat-Zinn and his wife have shared their similar struggles and they further illustrated how mindfulness can help in parenting2. In mindful parenting, when facing inappropriate child behaviours, parents’ attention is neither on the inappropriate behaviours nor immediate handling of the child. Instead, the parents can bring their attention back to the present moment of themselves. With compassionate attitude, bring awareness and acceptance to see the present self and behaviors of the child. The awareness of "to see as they are" means: I notice my present thinking, feeling and body sensation as they are, without any judgment. Mindful parenting is not about judging the parent's thinking, feeling and body sensation as being right or wrong. It is even not about teaching parenting skills. It is a reminder to the parents to make choice of bringing back their attention to the present moment purposefully. While such awareness is being enhanced, parents will have more space to “see” the child's behaviours. To see the child's behaviours as they are with compassion can help parents to “see and feel” the needs of the child.

Through continuous practice of mindfulness, changes will occur in brain structure and brain activity, an empathetic and compassionate state of mind will be gradually cultivated. Parents will be less disturbed by the usual emotional and thinking responses. They will then be better able to use their wisdom on parenting. Action is more important than words in learning mindful parenting. Parents have to practise every small step every day, just like strengthening the muscle.

Taste of mindfulness

Being a helping professional, we can have a taste of mindfulness through minute things we do in daily routines. Practice can help strengthen the linkage of awareness and the present moment. It helps to elicit our internal resources and wisdom to deal with daily stresses. We can start with bringing attention to our breathing:

  • We are breathing every moment. We can bring our attention to every breath. We only need to pay attention to every breathing in and breathing out.
  • No matter where we are, such as waking up in the morning, brushing teeth, driving to work, waiting for traffic lights, sitting in front of the computer thinking about the next task, before seeing the next client, and on the way home at the end of the day etc., we can bring our attention to our breathing. These exercises do not need extra time. You only need to remember.
  • Apart from bringing our attention to breathe in daily life, we can also try regular breathing exercise every day.The 3 minutes breathing space by Dr Jon Kabat-Zinn can be one of the options.
  • Mindful practice requires a non-judgmental and compassionate heart to accept the non-persistence, inattentiveness and all other inadequacies during practice. One only needs to bring the attention back to the present moment tenderly.

Apart from breathing, examples of other mindfulness exercises are walking and eating. Through persistent practice, awareness of the present moment can be enhanced. Having non-judgmental and compassionate awareness, we can have more space to choose to act with wisdom and freedom.

References

  1. Jon Kabat-Zinn (2016). Mindfulness for Beginners: Reclaming the Present Moment and Your Life. Sound True Inc.
  2. Jon Kabat-Zinn & Myla Kabat-Zinn (2014). Everyday Blessing Mindfulness For Parents. Published by Piatkus.
  3. Williams J.M.G., Teasdale J.D., Segal Z.V. et al. (2000). Mindfulness-Based Cognitive Therapy Reduces Overgeneral Autobiographical Memory in Formerly Depressed Patients. J Abnormal Psychol., 109, 150-155.
  4. Segal, Z. V., William, J.M.G., & Teasdale, J.D. (2002). Mindfulness-Based Cognitive Therapy for Depression. New York. Guilford Press.
  5. William, R. M. (2012). Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, and Zen Meditation for Depression, Anxiety, Pain and Psychological Distress. Journal of Psychiatric Practice, Vol. 18, No 4, 233-252.
  6. Skinner E., Beers J. (2016). Mindfulness and Teachers’ Coping in the Classroom: A Developmental Model of Teacher Stress, Coping, and Everyday Resilience. Handbook of Mindfulness in Education. Mindfulness in Behavioral Health 99-118.
  7. J Kabat-Zinn (2013) Full Catastrophe Living, Revised Edition: How to cope with stress, pain and illness using mindfulness meditation. Hachette UK
  8. Larissa G.D., Nancy B. (2010). Mindfulness-Based Childbirth and Parenting Education: Promoting Family Mindfulness During the Perinatal Period. Journal of Child and Family Studies, Vol 19, 2, 190-202.
  9. Nancy Bardacke (2012). Mindful Birthing: Training the Mind Body and Heart for the Childbirth and Beyond. HarperOne.
  10. Bluth K., Roberson P. (2015). A Stress Model for Couples Parenting Children with Autism Spectrum Disorders and the Introduction of a Mindfulness Intervention. Journal of Family Theory & Review 5, 194-213.
  11. Singh N., Lancioni G. (2014). Mindfulness-Based Positive Behaviors Support (MBPBS) for Mothers of Adolescents with Autism Spectrum Disorder: Effects on Adolescents’ Behavior and Parental Stress. Mindfulness 5, 646-657.
  12. Renee L. C, Angelika A, Dennis W. M. (2016). Mindfulness, Stress and Well-Being in Parents of Children with Autism Spectrum Disorder: A Systematic Review. Journal of Child and Family Studies, Vol 25(1), 1-14.
  13. Ahmad R., Muayyad A. (2016). Effectiveness of Mindfulness-Based Intervention on Perceived Stress, Anxiety, and Depression Among Parents of Children with Autism Spectrum Disorder. Mindfulness 1-14.
  14. Townshend K., Dip G., Jordan Z. (2014). The effectiveness of Mindful Parenting programs in promoting parents’ and children’s wellbeing: a systematic review protocol. JBI Database of Systematic Reviews & Implementation Reports, 12(11), 184-196.
  15. Semple, R. J., Lee, J., Rosa, D., & Miller, L. F. (2010). A Randomized Trial of Mindfulness-Based Cognitive Therapy for Children: Promoting Mindful Attention to Enhance Social-Emotional Resiliency in Children. Journal of Child and Family Studies, 19(2), 218-229.
  16. Schonert-Reichl, K. A., Oberle, E., Lawlor, M. S., Abbott, D., Thomson, K., Oberlander, T. F., & Diamond, A. (2015). Enhancing cognitive and social–emotional development through a simple-to-administer mindfulness-based school program for elementary school children: A randomized controlled trial. Developmental Psychology, 51(1), 52-66.
  17. Wong S., Mak W., Cheung E., Ling Candy Y.M., Lui Wacy W.S., Tang W.K., Wong Rebecca L.P., Lo Herman H.M. Mercer, Ma Helen S.W. (2011). A randomized, controlled clinical trial: the effect of mindfulness-based cognitive therapy on generalized anxiety disorder among Chinese community patients: protocol for a randomized trial. BMC Psychiatry, 11:187.
  18. Lau N. S., Hue, M. T. (2011). Preliminary outcomes of a mindfulness-based programme for Hong Kong adolescents in schools: well-being, stress and depressive symptoms. International Journal of Children's Spirituality, Vol 16(4), 315-330.
  19. Hou R.J., Wong S.Y.-S, Yip B.H.-K, Hung A.T.F., Lo H.H.-M., Chan P.H.S., Lo C.S.L., Kwok T.C.-Y., Tang W.K., Mak W.W.S., Mercer S.W., Ma S.H. (2014). The Effects of Mindfulness-Based Stress Reduction Program on the Mental Health of Family Caregivers: A Randomized Controlled Trial. Psychotherapy and Psychosomatics, 83: 45-53.
  20. Hölzel, B. K. Carmody, J, Evans, K.C., Hoge, E. A., Dusek J. A., Morgan L., Pitman R. K., Lazar S.W. (2009). Stress reduction correlates with structural changes in the amygdala. Social Cognitive Affect Neuroscience10.1093.
  21. Chiesa, A., Serretti, A. (2010). A systematic review of neurobiological and clinical features of mindfulness meditations. Psychological Medicine, Vol 40, 1239-1252.
  22. Germer, C. K., Siegel, R. D., & Fulton P. R. (2nd Ed) (2013). Mindfulness and Psychotherapy. New York: The Guilford Press.
  23. Hölzel B. K., Carmody J., et al (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, Vol 191, 36-43.
  24. David S. L., Jon K. Z. (2008). Mindfulness in Medicine. JAMA, 300(11), 1350-1352.

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