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Mindfulness and Urban Youth
Erica M S Sibinga, MD, MHSGeneral Pediatrics & Adolescent Medicine
Johns Hopkins School of MedicineDecember 4, 2009
Learning objectives
Improve understanding of mindfulness Review effects of mindfulness in adults Learn about mindfulness for youth
No conflicts of interest to disclose
What is mindfulness?
Mindfulness is a conscious,
moment-to-moment awareness,
cultivated by systematically paying attention on purpose in a particular way.
—Jon Kabat-Zinn
Popular interestOprah—“Missing the Moment” (Oprah.com)
Trying to live fully in the present—or, said another way, "being in the moment"—is a challenging proposition. We frequently get caught up in our routines, habits and thoughts, and find ourselves feeling disconnected from what is happening around us…or even within our own bodies. Instead, we spend our time and energy creating to-do lists and dwelling in the past.
These thought patterns—wishing, hoping, planning, missing and regretting—prevent us from truly being present and from completely engaging in what is happening in our lives right now…in the present moment. Instead, we often find ourselves running on "autopilot"—without conscious awareness—because we have literally become lost in our thoughts.
Mindfulness-based stress reduction (MBSR) program Developed by Jon Kabat-Zinn, 1979 MBSR core elements Grossman 2004; Kabat-Zinn 1990
Structured 8-10 week program Groups typically 10-40 participants Approximately 2 hours per session Content:
mindfulness meditation practice mindful awareness during yoga postures mindfulness during stressful situations
MBSR instructor training (UMass)
MBSR evidence—adults
MBSR is beneficial in heterogeneous populations of adults (including healthcare providers) Kabat-Zinn, Carlson, Davidson, Antoni, Robinson, Grossman, Baer, Krasner, etc.
Improved mental health Improved quality of life Improved immune parameters
Enhanced response to flu vaccine
MBSR evidence—emerging for children and youth
Few published studies on MBSR for youth Case studies, multi-modal studies Ott, Wall, Bootzin
HIV-infected youth Sibinga
Outpatient psychiatric patients Biegel
Possible MBSR mechanism(s)
Likely multiple pathways and/or synchrony of brain waves Goldin, Singer
“Re-perceiving” (shift in perspective) Shapiro
Decrease in rumination Rumination mediates MBSR’s effect on psychological
distress & depression Jain, Ramel
Decrease self-centeredness Hutcherson, Farb
fMRI shows less activity in self-focused region of brain
Decrease negative automatic responses Hutcherson Brief meditation interrupts automatic negative responses
The Three Breaths Break Stop and Pause
When you are stressing or busy or on automatic pilot, just stop. Stop everything. Put everything down a minute. Turn off the music or the TV, or leave the room. Close your eyes.
Take three mindful breaths. Just drop into the breath, this breath. Nothing to do, nowhere to go in this moment.
Say to yourself “in” with the in-breath and “out” with the out-breath.
Preliminary studies
Uncontrolled study of MBSR program Mixed methods (survey & interview) IRB approved N=33; 26 (79%) completers Post-program improvement in:
Hostility (p = 0.02) Overall discomfort (p = 0.01) Emotional discomfort (p = 0.02)
Results—qualitative data (N= 15)
Interview data—5 themes emerged Decreased anger Fewer conflicts Improved relationships Improved coping skills Improved physical well-being
Improved coping skills
“Breathing meditation—use it everyday at work. Helps me calm myself, prepare for my day.”
“Learning that I control my stress. It’s up to you whether you allow yourself to be stressed or not.”
Fewer conflicts
“I’ve actually practiced it the other day. I was about to get in an argument. I just sat there and I took three breaths and did my own little counting in my head and took three more breaths. And I was actually calm and left the argument—just let it be.”
“Before I would say ‘I’m gonna smack you’ and actually hit people. Now I be more calm. I say ‘Can you please stop’.”
Conceptual framework for MBSR effects
MBSRMindfulness
APPRAISAL & COPING
PROCESSES
Threat appraisalPerceived stress Coping mechanisms
PSYCHOLOGICAL &INTERPERSONAL
FUNCTIONING
Psychological symptoms Mood states Interpersonal functioning
HEALTH-RELATED
BEHAVIORS
Pilot RCT—MBSR vs. active control Harriet Lane Clinic patients 13-21 years old Mixed methods
Quantitative—mental health, quality of life, stress Qualitative—individual structured interview
IRB approved
Active control—Healthy Topics (HT) Age-appropriate health education curriculum
(e.g., nutrition, physical activity, etc.) positive adult instructor effects of peer group participation learning new information matched for session frequency and length, time of
day, group size
Does NOT include instruction in meditation
Results: Enrollment & attendance
Attended >1session
Attended >5 sessions
Total 43 35 (81%)
MBSR 26 20 (77%)
HT 17 15 (88%)
African American 94% 100%
Age (years) 16.0 15.0 (13-19)
Female 86% 80%
Results: Quantitative
MBSR vs. HT participation Increased coping self-efficacy (p=0.26) No differences seen in other mental health,
physical health, stress measures
Results: Qualitative
Qualitative—individual interviews In-person semi-structured interview re:
experience with MBSR & HT programs, techniques, skill acquisition, etc.
Interviews continued until themes saturated 20 interviews
HT—8 MBSR—12
Results: Qualitative
Group experience
Stressors Response to stressors
Perceived group effects
HT Fun
Learned new things
Met friends
Would recommend
Family—deaths, health, divorce, relationships
School—work, grades, graduation
Angry people
No ∆ after class
Listen to music
Sit alone
Go to room
Eat snacks
Watch movies
Healthy eating (quantity & choices)
Exercise/activity
Better choices
MBSR
Fun
Learned new things
Met friends
Would recommend
Family—deaths, health, divorce, relationships
School—work, grades, grad
Friends—relationships, fights
∆ after class
Use 3BB calm, fewer fights
Body scan sleep better
Walking meditation
Fewer fights (verbal & physical)
Improved relationships
Reflection
Internal processes
Self-regulation
MBSR—Change w/ stressor I was a little embarrassed because I really never got fussed
out in front of friends or anything like that. So I took a minute and breathed in and out. And that's that. Because at that point in time, I would sometimes maybe fuss back at him. Or something like that. So I just stopped altogether and started through. And I went to the kitchen. I sat down on the floor and I said, "Dad, she is having a funeral in two days and I need to do her hair because she couldn't go out and get her hair done. Now, is it okay that I do it? I know that it wasn't right for me not to ask you before I brought someone over." And then I stopped and looked at him. So I believe that thinking things through with the mindful-thinking, I was able to solve this situation. Because that situation would have blown up and she would have got put out, and I would have been punished. That's what I think would have happened if I didn't think. Which I usually didn't do, but I do now.
Small RCT—thoughts so far
MBSR participants showed increased coping self-efficacy, as well as expressing more self-awareness and self-regulation
HT seems to function as an effective control group for MBSR in this population
Mindfulness
Mindfulness is a conscious, moment-to-moment awareness, cultivated by systematically paying attention on purpose in a particular way.
—Jon Kabat-Zinn
APPRECIATIONS Study participants
Collaborators Katie Thorpe Carisa Perry-Parrish, PhD Deanna Kerrigan, PhD Miriam Stewart Melissa Heuer Trish Magyari, MS Cora Welsh, CCLS Nancy Hutton, MD Shana Millstein, PhD Jonathan Ellen, MD
Funded in part by: Thomas Wilson Sanitarium
for the Children of Baltimore City
The Hawn Foundation
Resources Wherever You Go, There You Are (Kabat-Zinn,
2005) Coming to Our Senses: Healing Ourselves and the
World Through Mindfulness (Kabat-Zinn, 2005) Everyday Blessings: The Inner Work of Mindful
Parenting (Kabat-Zinn, 1998) National Center for Complementary & Alternative
Medicine (nccam.nih.gov) Mayo Clinic website (mayoclinic.com) Culbert, Timothy (mind-body approaches for
children) Be the Boss of Your Pain; …Stress; …Sleep