I am not this body: Mindfulness for Pain Management

maple shadowPain is unavoidable. We inhabit a system that is engineered to become wonky, cranky, and otherwise uncooperative over time. We know this conceptually but not when and how it matters. Why me? What now? tend to be our responses when the body fails us – as it inevitably does. In case you think this is only a problem for aging folk or those afflicted with strange hard-to-diagnose illnesses, it’s not. Athletes injure themselves. Random acts happen to young and old alike that leave them having to reshape not only their bodies but their mental attitudes towards their entire life.

Joy is unavoidable too. We have a resilient system that is subtly wired to sense into experiences that nourish and sustain us. We don’t know this in the definition of sensing joy; we hope and believe it will be true some day – if we’re really good, work hard, and check off all the boxes that we think entitle us to joy. And it’s not just aging folk who do that. In fact, the older you get the more you begin to see that it’s not the boxes you’ve checked off that brought you joy in any lasting way. Continue reading

Credible Teachers of Mindfulness: How can you know?

Mindfulness-Based programs have become the go-to treatment around the world and their popularity has made treatment more accessible in many ways. Despite the popularity or maybe because of it, several articles have argued against mindfulness because it  (1) seems to be the fix-it for many ills, (2) doesn’t stay true to its Buddhist roots and (3) understates its “dark side”. There is concern that mindfulness therapies and programs are often sold as much better than the traditional methods of treating depression, anxiety, and other psychological disorders. Such concerns were supported when a recent study showed that statistically mindfulness-based therapies (MBTs) have a moderate effect when studied in comparison with wait-list controls and when participants are compared to their pre-post scores. More than that, MBTs are not better than traditional cognitive behavioural therapy or pharmacological treatments. The deepest concern however relates to the qualifications of those who teach mindfulness as more and more programs are offered by individuals and groups with little or no training in mindfulness concepts and approaches.

Elisha Goldstein, writing for the magazine Mindfulness, re-stated some of these issues that constitute a “mindfulness backlash” in his recent blog post which claimed that there is little evidence for a backlash. What stands out in his discussion about the issues facing programs that offer mindfulness is the emphasis on trusting that “skilled mindfulness teachers” will neither over-sell the treatment scope and that “credible teachers” will walk participants through their misunderstanding of what is mindfulness. Goldstein goes on to say – even more emphatically – that it is important to seek out teachers who are well-trained. He adds a link to finding qualified teachers via the Center for Mindfulness at the University of Massachusetts, the birthplace of Mindfulness-Based Stress Reduction (MBSR).

What is left unsaid however is that the focus of all discussions and debates of mindfulness programs are anchored in the original one, Mindfulness-Based Stress Reduction (MBSR). This particular program was developed by Jon Kabat-Zinn and the acronym has taken on an iconic status much like the terms Xerox or Kleenex. When most professionals discuss mindfulness programs they are typically referring to MBSR unless it is clear from the outset that the topic is related to Mindfulness-Based Cognitive Therapy (MBCT). This assumption leads to confusion because MBSR, while being the original, is not the only mindfulness treatment program.

Does it matter? Absolutely. While most programs have a similar format (8-10 weeks, groups, meditation and yoga, etc.), significant aspects of the program will differ. Even more than that, the type of training and confirmation of skills of the teacher will differ considerably. And since Goldstein makes a very good point that we need to find credible teachers, it is important to note that not all qualified mindfulness teachers will have been trained in MBSR itself.

Recently, the Center for Mindfulness at the University of Massachusetts (CFM-UMass; the home base for MBSR and training of MBSR teachers) announced a format of teacher training that includes training those who will train teachers. While it’s perfectly understandable that CFM-UMass has taken a firm stand in cultivating MBSR teachers, this move is not without its detractors. However, it will filter those who have been teaching without full training at CFM-UMass and passing their programs off as MBSR. Nevertheless, this raises a difficult issue for those who have been trained in approaches that are not MBSR but which are legitimate approaches; the cachet of the term MBSR now takes on a more serious tone because many identify it as THE treatment program and may be confused by others.

That being the case, it is important to know that there are a number of other training centres that train teachers for mindfulness programs.

The M4 Program, Ottawa Mindfulness Clinic. The M4 (includes Mindfulness-Based Symptom Management; MBSM) training is in-depth and takes as long as a year. It requires applicants to have a clear rationale for wanting the training and expects a high level of participation. They attend the 8-week program as participants and do twice the expected formal and informal practices. They must attend a silent retreat in the year of their training. Current research and topics in mindfulness treatments are researched especially in their area of interest of specialization. They attend a training in the specifics of the delivering the program and in cultivating teacher qualities. Before teaching the M4 potential teachers must teach under supervision (qualification level) and then teach for 3 sessions with senior teachers in the clinic for Certification.

MBSR, University of Massachusetts, Center for Mindfulness. This is the original MBSR program and the training is extensive.

MBCT, The Centre for Mindfulness Studies. The training in MBCT is offered through various forms of study and teacher development. This program is supported by the Factor-Inwentash Faculty of Social Work (University of Toronto) which offers a certificate in MBCT.

MiCBT, Mindfulness integrated Cognitive Behaviour Therapy. An approach to mindfulness that weaves together Western psychology with Eastern principles of mindfulness. Training is comprehensive and a graduate diploma is offered for teachers.

Applied Mindfulness Meditation, Faculty of Social Work, University of Toronto. This program offers what is likely one of the most extensive trainings in mindfulness, meditation, and all its attendant components.

Training in the UK. This website lists various programs that train mindfulness teachers, including MBCT teachers. Rebecca Crane and her colleagues at Bangor University have also developed a teaching assessment protocol for the cultivation of mindfulness teachers which is a gold standard for any teacher who is dedicated to cultivating their skills.

Mindful Self-Compassion, Center for Mindful Self-Compassion. Developed by Christopher Germer and Kristin Neff, Mindful Self-Compassion (MSC) has developed a following in the last year as the teacher training becomes more available globally.

UCSD Mindfulness-Based Professional Training Institute. For training in various mindfulness-based programs such as Mindfulness-Based Relapse Prevention, Mindful Eating, etc.

Institute for Meditation and Psychotherapy offers a certificate program in mindfulness and psychotherapy. The founding practitioners include Paul Fulton, Christopher Germer, Ronald Siegel, Trudy Goodman – all well-regarded in the field of meditation and clinical psychology.

If you intend to take a mindfulness program, ask the sticky questions. It’s your health and your wellbeing. Be informed. The program may not be MBSR. And it may be something valid and well-supported in its own right.

 

2014 Teacher Training Graduates

Graduates of M4 Teacher Training - Foundational Level

Graduates of M4 Teacher Training – Foundational Level

 

Please welcome our new graduates of the Ottawa Mindfulness Clinic M4 Program Teacher Training (Level I – Foundations of Mindfulness).

It was an amazing weekend filled with flooded out rental rooms and air conditioners that struggled with the heat! This weekend retreat capped the participants hard work that, in some cases, took a year of study and practice. These graduates have completed the 8-week M4 program, researched and reviewed the current issues in mindfulness treatments, attended silent retreats, and developed practice in the program fundamentals of a mindfulness program. In this retreat, they will have practiced the essentials of a mindfulness program including incorporating ethics into a mindfulness curriculum.

A deep bow of gratitude to our senior teachers (Level II – Certified) who helped with the training.

 

Is Mindfulness the same as Buddhism?

DSC_0049There’s been a lot of chatter on the internet these days about Mindfulness and Buddhism. In a nutshell, practitioners, writers, and philosophers of Buddhism have expressed concern about the potential misuse of Buddhist beliefs and concepts by mindfulness-based interventions or programs. There is much merit to these concerns although the discussions tend to become bogged down with a lot of arguments that missed the central point. There are important issues about Mindfulness and Buddhism as well as Mindfulness itself that anyone considering a program should take the time to investigate. Below are some of these issues that may be helpful to consider.

Are Mindfulness-Based Programs and Interventions the same as Buddhism?

The answer will vary depending on the framework we use to address it. At one level, mindfulness is a Buddhism-based concept so it is unavoidable that the core principles guiding any Mindfulness-Based Intervention or Program will reach into a Buddhist conceptualization of its meaning and practice. However, mindfulness has moved far enough away from Buddhist philosophy and has begun to draw from various fields of psychology such as Cognitive Theory, Positive Psychology, Motivational approaches, Organizational Psychology, that it can be said to be a new “wave” in the genre of psychological and organizational approaches.

If you are considering a mindfulness program, there are some underlying concepts and frameworks you may wish to know that will inform your decisions. In our course intakes, we are often asked if the program is Buddhist. We are also asked if there are aspects of the program that would interfere with the person’s religious views or practices. People also want to be assured that the program won’t impose values and beliefs on them that may not fit with their own values and beliefs. These are important questions and need to be addressed openly and all the more important with the debates going around on the Buddhist nature of mindfulness and the potential dangers of teaching it as a secular or psychological modality.

Is Mindfulness the same as Buddhism?

Not completely. We can organize mindfulness programs into two categories: Mindfulness-Informed (MI) and Mindfulness-Based (MB) approaches (edit: See Shapiro & Carlson’s book The Art and Science of Mindfulness). Mindfulness-Informed approaches will draw from Buddhist philosophy using concepts of impermanence, adaptive self (non self), and the reality of suffering. They can also introduce concepts of lovingkindness and compassion. MI approaches may not use meditation practices specifically. Typically, the professional is trained in Buddhist theory and/or practice and therefore understands how our attitude and interpretations of our difficulties leads to our sorrow and suffering. Mindfulness-Based approaches draw from Buddhist practices such as sitting and walking meditation, breath awareness, etc. and build from this a state of steadiness so that the issues that plague us can be faced in a skillful manner. (edit) Additionally, Mindfulness-Based approaches draw from current understanding of stress theory and other psychotherapeutic models. (edit end) The final intention of both MI and MB approaches is the same – the reduction of suffering. Neither approach requires nor relies on a belief in Buddhist religious concepts.

Are all Mindfulness Programs the same?

No. For clarity, I refer to interventions separately from programs. A Program is offered over a time period, typically 8-weeks and may or may have a psychological intent; it may be conducted individually or in a group. “Programs” may be offered for stress management, lifestyle changes, spiritual growth, personal wellness or development. An Intervention refers to the medical- or psychological-based intent of the approach; this may be delivered as a time-framed process in a group or individually. “Interventions” may be offered to deal with physical or psychological issues such as depression, anxiety, chronic pain, physical pain or injuries, etc. These typically require a registered health care professional to supervise or conduct the intervention. Research articles on mindfulness will refer to Mindfulness-Based Interventions (MBIs) or their specific label such as Mindfulness-Based Cognitive Therapy.

There are many, many MBIs! Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, Mindful Self-Compassion, Mindfulness-Based Relapse Prevention (for addictions), Mindfulness-Based Mind Fitness Training, Mindfulness-Based Eating Awareness Training, and so on. And of course, just to add to the confusion, each of these will be taught under different “company” names. The M4 Program we offer at the OMC is a psychologically-based MBI and designed as an intervention for psychological issues such as depression, anxiety, chronic illness etc.

Are Mindfulness Instructors or Teachers accredited, certified or trained professionally?

Not all are. Most professionals will have taken at the very least a 5-day intensive training in the specific area of interest. Some will have continued from this to take on-going training with specialists in their field. (edit) All MBI teachers are expected to have a personal meditative/contemplative practice to support their teaching skills and personal development. (edit end) Health Care Professionals who work in the Mindfulness-Informed approaches will likely have trained in their specific treatment modality (CBT, EFT, etc.) and also continued with a Buddhist or other contemplative practice tradition. Others will have obtained accreditation from specific organizations.  The Center for Mindfulness at the University of Massachusetts offers a teacher certification program for Mindfulness-Based Stress Reduction Programs. Mindfulness-Based Cognitive Therapy accreditation is available from the Factor-Inwentash Faculty of Social Work, University of Toronto. The Center for Mindful Self-Compassion offers teacher training in Mindful Self-Compassion. The University of California at San Diego is developing a Professional Training Institute that will allow teacher-development programs in several streams of Mindfulness-Based Interventions.

One aspect of the training/accreditation question is to consider whether the facilitator or instructor is accredited in their own field of expertise. All health care professionals have a regulatory organization which certifies their training; mindfulness can be viewed as a therapeutic intervention that they provide as a trained health care professional. Other professionals such as educators, coaches, and spiritual care professionals,  will have professional organization that verify their credentials as a trained professional.

Do all Mindfulness-Based Programs have the same positive effect?

It depends. Research shows that MBIs have a positive impact for many issues. Whether an individual experiences the expected positive change depends on the “good fit” between the individual and the program. If the issue is depression, then a “stress” program may not do the job. If there are issues of anxiety that are not disclosed at the intake (yes, there should be an intake!), then this can have an impact on their experience of the program. What can increase the probability of a “good fit” is asking lots of questions at the information session or the intake appointment. The most frequent issues that derail the program for participants are as follows:

  • Realizing that there is a certain amount of sharing that happens in the course
  • Finding out it is not like a school course where we get all the answers from the teachers
  • Not realizing how much time the practices take
  • Wanting a “quick fix”
  • Needing certainty that the practices will work
  • Wanting to “get rid” of the problem

These are all important questions to consider and to ask if you are thinking of taking a Mindfulness-Based Program. It is about your health and well-being. Be proactive. Understand the scope and limits of MBIs. Most of all, know the people offering the programs.

Advanced Praise for “Mindfulness Starts Here”: Dr. Shauna Shapiro

Book-posterMindfulness Starts Here incorporates the rigor of science, the beauty of art, the wisdom of reflection and years of lived experience. The wealth of theory and practice presented in this illuminating text will be of benefit to clinicians and clients alike, and has the potential to transform our individual and collective lives. I highly recommend it.

            Shauna L. Shapiro, Ph.D., Associate Professor Santa Clara University, co-author of The Art and Science of Mindfulness: Integrating Mindfulness into psychology and the helping professions

In 2000, Shauna Shapiro and Gary Schwartz wrote a chapter on intention as one of the key facets of self-regulation(1). The model they presented of self-regulation (the ability to modulate reactivity) drew from many sources in the field of emotion regulation including the area of attention-based regulation (mindfulness) proposed by Jon Kabat-Zinn. Their model of Intention Systemic Mindfulness (ISM) has informed the Mindfulness-Based Symptom Management program taught at the OMC. Over the last ten years, this model and its subsequent expansion, has also become the foundation of our Professional Training Program, particularly in the teacher formation and mentoring process which follows the Level I training (8-week participation in the Core Program & 2 1/2-day skills training retreat) where future teachers’ intention-setting, “mindfulness qualities and systemic perspectives” are cultivated.

Dr. Shapiro and co-author Dr. Linda Carlson have written The Art and Science of Mindfulness: Integrating Mindfulness into psychology and the helping professions. Her new book, co-authored with Chris White, Loving Discipline: A Mindful Guide to a Raising Respectful, Responsible and Cooperative Child, is available for pre-order here.


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(1)The role of intention in self-regulation: Toward intentional systemic mindfulness. Shapiro, Shauna L.; Schwartz, Gary E. Schwartz. In Boekaerts, Monique (Ed); Pintrich, Paul R. (Ed); Zeidner, Moshe (Ed), (2000). Handbook of self-regulation.  (pp. 253-273). San Diego, CA, US: Academic Press, xxix, 783 pp. doi: 10.1016/B978-012109890-2/50037-8

We are 10 Years Old!

Ten years ago, we (Frank Musten & Lynette Monteiro) were inspired by the development of Mindfulness-Based Cognitive Therapy (see Mindfulness-Based Cognitive Therapy for Depression: A new approach to preventing relapse by Zindel Segal, J. Mark Williams & John Teasdale; Guilford Press) and, after a brief correspondence with Dr. Segal, launched the Ottawa Mindfulness Clinic. It was a scary venture despite our experience as therapists and use of meditation in individual sessions as an adjunct to progressive muscular relaxation. We also were refining our experiences in the Buddhist community, learning more and more about the foundations of mindfulness, in particular the role of ethics in guiding lifestyle changes. The program took shape as a process of understanding the nature of “symptoms” which reflected our clinical training and interest in finding a way view psychological difficulties such as depression and anxiety as an interaction between internal and external sensation experiences.

OLYMPUS DIGITAL CAMERAThe concepts of mindfulness were still new and not always welcomed by the medical and psychological communities then. So much has changed since! The first class started in May 2003 and was held in a conference room at the Riverside Hospital. It was so crowded – not because of a large enrollment but because of a three-piece horseshoe conference table that took up most of the space. When we did the Body Scan, some participants had to lie down with their legs out the door or under the table itself; one even lay down on top of the table. Still, despite the random sounds of walls and doors being drilled during the Awareness of Breath meditations, transformations occurred.

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The next year the OMC moved to a little space that resembled a very short bowling alley. Here, courses in Mindfulness-Based Symptom Management (MBSM) unfolded over many years. Participants joined us to learn how to breathe through physical and emotional pain, with joy and woe, in sickness and health. It was a joining ceremony in each class, meeting ourselves for the first time and embracing this stranger we had become. It didn’t matter whether we spoke of teacher or participant; change happened.

In 2008, we began the Teacher Training Program at the request of many colleagues. The focus on an Ethics-Based Mindfulness Program was appealing for many professionals who understood intuitively that healthy choices could only come out of a set of principles that directed those choices. The Five Skillful Habits, as the core of the OMC program, was innovative and participants as well as teacher trainees welcomed the idea that skillful choices cannot be left to a process of “just paying attention.”

The OMC moved into new space five years ago and now is composed of several wonderful teachers who facilitate courses in Core Mindfulness, Burnout Resilience, Self-Compassion for Health Care Professionals, Pain & Chronic Illness Management and who coach the Teacher Training Retreat. The OMC is also a Practicuum training facility for PhD candidates in Clinical Psychology at the School of Psychology, University of Ottawa.

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We have been blessed with the generous involvement of the Ottawa community in creating this safe and quiet space where so much healing can happen.

Book-posterOur future is bright and exciting. Our book, Mindfulness Starts Here: An eight-week guide to skillful living, will be published soon and we look forward to continuing to offer our support and care to an ever-growing community of mindfulness practitioners.

Thank you for all you have done to make this a reality!

Teacher Training Graduates 2012

Give It Away & Simply Love

We are thrilled to introduce our new graduates from the 2012 Teacher Training Program in Foundations of Mindfulness.  These amazing health care professionals, clinical psychology PhD candidates and medical students, and even an ethicist took part in the 8-week Mindfulness-Based Symptom Management program as participant-observers, wrote papers and reviews of the current literature and research, and completed the intensive weekend retreat with terrific courage and equanimity.  It was particularly challenging as the air conditioning in the clinic broke down with little warning.  The alternate venue we found provided all of us with ample practice as its air conditioning died, the replacement was inadequate, and the final one installed was only functional because of two powerful fans in the room.  The temperature for the three days was brutal as the participants, coaches, and teachers practice extinguishing the desire for things to be different.  We called this the inaugural session of Hot Mindfulness!

Thank you to the coaches for their terrific guidance and we look forward to seeing the participants’ program designs come to fruition over the next few years!

Remember, you may not be the first to deliver mindfulness but you must ensure you are not the last to do so.  Give it away and simply love!