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Mindfulness & Addiction

Strategies for Clients and Professionals
September 20, 2013



Marcello Spinella, Ph.D.
Professor of Psychology
Richard Stockton College of New J ersey

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Brief History of Mindfulness
History
Direct origins in Buddhism
o Similar/identical practices in all major religions
o Universal, human psychological skills

Completely Secularized Clinical Programs
o Mindfulness-Based Stress Reduction (MBSR) 1979
o >17,000 people completed the course
o >500 have been trained as teachers
o Other clinical offshoots
Mindfulness-Based Relapse Prevention (MBRP) for addiction

Research basis
o Benefits supported by published scientific studies (<1200)
o Clinical, experimental, neurobiology
o


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Publication Year
Publications in Mindfulness Meditation
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What is Mindfulness?

"Man will become better when you show him what he is like." --Anton Chekhov

Three Components of Mindfulness Meditation:

1. Concentration

a. What is it?

1. Sustained attention - awareness-extending tool (microscope analogy)

2. Trainable (muscle analogy)

b. Why do it?

1. Short-term: Mind alert & Body relaxed
2. Long-term: Benefits every aspect of life

c. How is it done?

1. Focusing & re-focusing
2. Some chosen object
a. Sensations, emotion, thoughts passing
b. Focus may be narrow or broad











"The faculty of voluntarily bringing back a wandering attention, over
and over again, is the very root of judgment, character, and will
An education which should improve this faculty would be the education
par excellence. But it is easier to define this ideal than to give practical
directions for bringing it about."
- William James, Principles of Psychology



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2. Clarity

a. What is it?

1. Observing perspective of current experience (e.g. thoughts, emotions, sensations)

2. Observing the process not content. Example:
a. Content What you are thinking about
b. Process Observing the fact that thinking is occurring












b. Why do it?

1. Divide & conquer strategy
a. See components of experience (seeing, hearing, feeling, thinking, etc.)
b. Disentangled - more tolerable, manageable

2. Disidentifying/Decentering
a. You are not your thoughts (or emotions, sensations, etc.)
b. Observing awareness perspective (meta-cognitive awareness)
c. Passing events
d. Reacting becomes a choice, rather than a compulsion (e.g. cravings)


Although meditation is not thinking, nevertheless it can be clear
awareness of thinking
--Joseph Goldstein


We shift our focus from clinging to the content of our suffering
to observing the process. Already, in that shift, we have ceased
to suffer.
--Cheri Huber

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c. How is it done?
1. Focus on one component at a time (and/or in combination; apple analogy)
2. Optionally facilitated by mental labeling (feeling, thinking, etc.)

3. Equanimity

a. What is it?
1. Changing the relationship to experiences
2. Attitude of non-interference with the natural flow of experiences
3. Synonyms: Allowing, Non-judgmental attitude, Acceptance

b. Why do it?
1. Suffering = Pain x Resistance (Shinzen Young)






c. How is it done?
1. Practicing a shift in attitude
a. Radical permission to experience whatever comes up
b. Attitude of allowing, moment by moment


Serenity Prayer:
God grant me the serenity
to accept the things I cannot change; Equanimity
courage to change the things I can;
and wisdom to know the difference.



Freedomis not freedom from having
emotions; it is freedom from complicating
them."
--Gil Fronsdal

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2. Equanimity is not apathy:
a. Not trying to control internal experience
b. May or may not involve external action










Motivating Factors

1. Changes are subtle & gradual, but cumulative
a. Short-term: seems like nothing is happening, but it is.
b. Rewiring your brains response to experiences

2. Reward instead of punish

a. Dont judge/punish
1. Wandering mind is inevitable - unrealistic to expect the mind to stay blank
2. We have no control over when the mind wanders
3. Punishment not helpful, counter productive

b. Reward instead of punish
1. Wandering Failure
2. Re-focus =success (every single time)
a. Feel good about it!
b. Tell yourself Good! every time you refocus (can drop it later)

c. Most important motivating factor!

Frustrated,
Stressed
Graceful,
Efficient
Restless,
Helpless/depressed
Peaceful
Frustrated,
Stressed
Graceful,
Efficient
Restless,
Helpless/depressed
Peaceful
Equanimity Resistance
No action
Action
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3. Benefit happens no matter what
a. Peaceful experience notice it
b. Confusion, chaos notice it
c. Both are equally good
d. Have equanimity with the lack of equanimity (accept the lack of acceptance)

4. Attitude of self-compassion, kindness Cannot emphasize enough

5. Attitude of curiosity


Payoffs - When a Meditation Technique "Works": (reasonable time frame)

1. Cognitive
a. Increased mental focus/clarity
b. Insight - deeper self-knowledge, understanding

2. Emotional:
a. Reduced suffering from pain (physical/emotional)
b. Increased satisfaction from pleasure (physical/emotional)

3. Behavioral: Adaptive changes in behavior



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Five Ways to Meditate
(Shinzen Young)
Overview:
1. Focus In Internal experience (See In, Hear In, Feel In)
2. Focus Out External experience (See Out, Hear Out, Feel Out)
3. Focus on Rest Restful states
4. Focus on Change Change in any experience
5. Focus on Positive Positive feel, image, and/or talk


The "Five Ways" (in depth):

1. Focus In

a. Observing internal emotions and/or thoughts:
1. Mental images
2. Mental talk/sounds
3. Emotional feelings in the body
(one by itself or any combination)

2. Focus Out

a. Anchor in the present moment (external sensations)
1. External vision, hearing, & touch

b. Examples:
1. Raking sand gardens
2. Everyday tasks (e.g. dishes, laundry, walking)
3. Looking at an object (candle)
4. Whole visual field while driving
5. Breath (touch around the nostrils, abdomen)


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3. Focus on Rest

a. Relative restful experience
1. Relative lack of activity
2. Gaps between thoughts, sounds, etc.
3. Happen spontaneously, but we can learn to detect them better

b. Examples:
1. Focus on blank - Blank seen with eyes closed
2. Focus on silence Gaps between sounds, silence beneath the sounds
3. Focus on muscle relaxation

4. Focus on Change

a. Noticing change in any internal/external experience (as above 1,2,3)
b. Focusing on the flow of activity aspect
c. Increased tolerance for challenging experience (e.g. stress, cravings)

5. Focus on Positive

a. Ways #1-4 involve just observing
b. #5 involves creating a state & focusing on it
c. Methods:
a. Image Positive mental imagery, visualization (or looking at a picture)
b.Talk - Mentally repeating positive word/statements
c. Feel - Focus on positive feeling
d. Numerous examples (religious and secular)
1. Loving-kindness meditation
2. Hindu or Buddhist mantra
3. Tibetan Deity Yoga
4. Catholic Rosary
5. Islam (repeating Shabadah)
6. Other Christian forms
a. Christian Centering Prayer - Choose word/phrase from scripture (mantra)
b. Eastern Orthodox J esus Prayer (mantra)
7. Secular: Word expressing positive quality (peace, grateful, love)


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Research on Mindfulness & Meditation

Concentration

1. Develops Executive Attentional Network (Chan & Woollacott, 2007)

2. Physiology of Concentration - Lowered metabolism (Anderson, Liu, & Kryscio, 2008; Benson; 1976)
a. Oxygen consumption d. Blood pressure
b. Respiration e. Muscle tension
c. Heart rate f. Stress response











3. Brain Physiology of Meditation
Electroencephalogram (EEG)
Rihs et al., 2007; Kelly et al., 2006; Herbert et al., 2005)
1. Increased alpha and theta waves
a. Different from sleep
2. Increased gamma waves
3. Synchronize/links brain areas


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4. Brain blood flow (fMRI)
a. Frontal lobe networks (**underactive in addiction)
b. Insula Awareness of internal body states

5. Thicker brain structure (MRI) (Lazar et al., 2005)





Mindfulness is Metacognitive Awareness

1. Self-awareness





2. Thinking

a. Less compulsively drawn in by thoughts
1. Self-judgment, criticism
2. Rumination pointless, repetitive thinking
3. Intolerance of uncertainty paralyzed by not having certainty/answers















"Meditation helped me see that my expectations were just stories that I was telling
myself about life. I became free of what life was supposed to be and able to enjoy life
as it was."
--Lee Lipsenthal

We are not stopping thoughts as much as overcoming any preoccupation we have with
them Mindfulness practice won't stop the thinking, but it will help prevent us from
compulsively following thoughts that have appeared.
--Gil Fronsdal

Anything you cannot relinquish when it has outlived its usefulness
possesses you
--Peace Pilgrim

There is a difference between watching the mind and
controlling the mind.
--Henepola Gunaratana

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3. Mindfulness of Emotions








a. Reduces
o Stress (Grossman et al., 2004)
o Anxiety, panic & OCD symptoms
o Depression & relapse
o Coping with many medical illnesses
o Reduced Pain

b. Increases
o Positive emotion

Mindfulness in Addiction Treatment

1. Correlation: more mindfulness, less addiction symptoms (alcohol, sex, gambling, & spending)

2. Prison study (Bowen et al., 2006; Bowen et al., 2007)
a. 10-day retreat vs. treatment-as-usual
b. Reduced cravings - Urge surfing (wave analogy) (i.e. Feel In)
c. Less drug use post-release (alcohol, cannabis, and crack)

3. Smoking:
a. More tobacco cessation (Brewer, et al.)
b. Less cravings

4. Eating Disorders
a. Reduces binge eating (Kristeller & Hallett, 1999)
b. Less dysfunctional eating attitudes (Masuda, 2010)
c. Less body dissatisfaction (Lavender, 2012)

Emotionceases to be suffering as soon as we form a clear
and precise picture of it.
--Baruch Spinoza (1677)

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5. Mindfulness in Healthcare professionals
a. Less stress/burnout (Galantinoet al., 2005; Shapiroet al., 1998)
b. More empathy (Shapiroet al., 1998; McCollum, 2010; Grepmair et al., 2007)
c. More awareness in client sessions (inner & outer)
d. More compassion and acceptance (themselves, clients)
e. Greater improvement of psychotherapists' clients
f. Less burnout in addiction counselors (Vilardaga, 2012)

6. Mindfulness in the Workplace (Walach et al. 2007)
b. Better awareness of work-related problems & attitudes
c. Better coping strategies (more positive, less negative)

7. Personal Relationships (Burpee et al., 2005; Carson et al., 2004)
a. More satisfaction, closeness & acceptance, autonomy
b. Better self-expression (Dekeyser, 2008)


Further Resources:

1. Me
Weekly mindfulness class (free to the public)
o Yoga Nine, Smithville NJ (http://www.yoganine.com/)
Contact me: marcellospinella@gmail.com
Free guided meditations (Audio Downloads: www.snurl.com/marcellogm)

2. The Mindfulness Institute Thomas Jefferson University Hospital
http://www.jeffersonhospital.org/departments-and-services/mindfulness

3. Penn Program for Mindfulness
MBSR Courses (NJ Satellites) (http://www.pennmedicine.org/stress/)