MINDFULNESS AND THE CHRISTIAN UNDERSTANDING OF WELLBEING

Prof Jim McManusVisiting Fellow, Heythrop College9 February 2016

For todays slides and a reading pack

• Jim.mcmanus@Hertfordshire.gov.uk

Some Concepts• Positive Psychology is about the science and art of

human flourishing• Wellbeing• Mindfulness is a technique within this and other schools

for wellbeing• Stress management are tools and techniques• Mindfulness is not mysticism in and of itself but is akin to

mystical practices• It is not eastern or western, it’s pretty universal

Overview• from a public health perspective• from a Christian perspective• Wellbeing - orientations• Stress• Positive Psychology• Mindfulness• Drawing Principles Together• Christian Tradition

Discussion• What is a Christian understanding of wellbeing?• What components can that be divided into?• What are practical concerns that arise from this in

healthcare?• What are practical concerns that arise from this in

pastoral care?

Getting orientations: The Balanced Person Worldview eg Jewish, Christian, humanistAnthropology: human being as creature or end in itself

Your approach to Psychology – the study of the cognitions and behaviours of the human person eg Positive Psychology

Wellbeing – a concept common to many concerns scientific and spiritual Mindfulness,

just one of many techniques and practices

Pastoral approaches to BalanceINDIVIDUAL CONGREGATION

• Healing Sacraments• Nurturing Congregational Life• Guiding• Reconciling• Discipline

SOCIALSocial MinistrySocial Teaching

Public Health approach to balance • Biological• Psychological• Social (Justice, chronic and toxic stress )• Determinants of Health

Based on meditation traditions but is not dependent on any belief or ideology. Risks and benefits here. It is NOT just eastern.

It is about being aware of what is happening in the present on a moment-by-moment basis

It is contrasted with states of mind in which attention is focussed elsewhere e.g. pre-occupation with memories, fantasies, plans or worries, and behaving automatically without awareness of ones actions.

It includes a sense of approaching all experience with openness and kindly curiosity, rather than avoiding difficult experience or judging them or us.

So, if that’s balance…what is mindfulness about?

“paying attention in a particular way;

On purpose, in the present moment,

and non-judgmentally” (Jon Kabat-Zinn, 1994, pg4).

Mindfulness

Attitude Attention

Intention

• Non-judging• Patience

• Beginners Mind• Trust

• Non-Striving• Acceptance

• Letting go/be or non-attachment

Foundations of PracticeKabat-Zinn (1990) Seven Core attitudes

Mindfulness Meditation

Mindfulness meditation is NOT:

‑ Positive thinking

‑ Just another relaxation technique

‑ Going into a trance

-Trying to blank your mind

• Formal practice – meditation e.g. bodyscan, mindful movement, sitting practice, breathing space

• Informal Practice – awareness of body sensations, thoughts, emotions and sensory input during daily life. Practiced in ordinary activities like eating, washing brushing teeth

Mindfulness is essentially experiential

The Essence of Mindfulness: ‘Being’ vs. ‘Doing’

Striving vs. Non-StrivingAvoidance vs. ApproachThoughts as ‘real’ vs. Thoughts as thoughtsLiving in the past and future vs. Living in the present

momentIndirect experience vs. Direct experienceAutomatic vs. IntentionalTeresa’s Four Gardens Analogy in Prayer (See workbook)

The Stress Reduction Clinic was founded in 1979 in a teaching hospital in Mass. USA by Jon Kabat-Zinn, mainly for people with chronic pain and stress related disorders (see www,umassmed.edu)

MBSR - generic

MBCT ‑ specificDeveloped in UK and Canada by Mark Williams, John Teasdale and Zindel Segal, cognitive therapists working with depression

Aimed at the prevention of depressive relapse; includes information on how depression is maintained

Participants trained when in remission

Similar 8‑week group format, based on MBSR with added cognitive therapy elements (Segal at al, 2002)

MBCT

MBCT integrates two very different traditions:

• The tradition of cognitive and clinical science, and

• The tradition of Buddhist psychology and mindfulness meditation

• Wrongful assumptions this doesn’t exist in other religious traditions

From Buddhist Teaching (Dharma)

• Mindfulness of the breath• Mindfulness of the body, in stillness and in movement• Mindfulness of thoughts• Mindfulness of everyday experiences• Compassion, acceptance

From CBT

• A cognitive model of vulnerability to emotional disorder• A cognitive model of what maintains distress• Options for working with negative thoughts• Increasing nourishing activities• Relapse prevention

What Keeps Us Stuck in Distress?

Painful ThoughtsPainful Emotions

Painful

SensationsPainful Memories

Reading List• Centre for Mindfulness Research & Practice: University of

Wales www.bangor.ac.uk/mindfulness

Biology of StressThe Least You Need to Know:1. Stress 101 (Definitions):

Stress, Stressor, Eustress vs. Distress, Homeostasis

2. Stress Response (3 Stages of GAS)

3. Stress and PersonalityType A, Type B

4. Stress and Disease/Illness

5. Basic Stress Management Strategies

STRESS 101 Stress: Body and mind’s reaction to challenging events in life.

Causes of Stress = Stressors Is all stress bad? “Bad Stress” (Distress) vs. Good Stress (Eustress)

Causes of Stress

Major Life Changes

Everyday Problems

SurroundingsSocial

Determinants of Health

1.

2.

3.

1.

2.

3.

1.

2.

3.

Do all equate to the same level(s) of stress?

BalanceWhat should you feel like?• EMOTIONALLY• .• .• . HOMEOSTASIS:• PHYSICALLY• .• .• .

Balance of Body and Mind

Early Warning Signs of Stress

• Physical

• Emotional

• Behavioral

Fight-or-FlightResponse

Things you only see in movies….

THE STRESS RESPONSE Physiological Adaptations

Heart Rate Blood Pressure Breathing Energy Endorphins

Blood FlowTo Muscles

WHY ZEBRAS DON”T GET ULCERS

“A zebra’s stress response kicks in when the zebra is chased by a lion; when the

zebra escapes, the stress response shuts off. In between predation attempts the zebra is at ease. It doesn’t flood itself with stress hormones wondering when

the next lion is going to show up”Robert Sapolsky

THE STRESS RESPONSEThen:

Prepared the body for living (survival) Response to physical stress: animals, rock slides, famine, drought, etc. Most stress was short in time.

THE STRESS RESPONSE Now:

Most danger is not physical Response to emotional problems: work, money, noise, relationships Stress is ongoing or constant

…AND WHY HUMANS DO

“The human mind is so powerful, the connections between perception

and physiological response so strong, that we can set off the flight-or-flight response by just

imagining ourselves in a threatening situation.”

The End of Stress

General Adaptation Syndrome

1. Alarm ReactionBody is shocked by the stress

2. Stage of ResistanceBody tries to fight off the stress

3. Stage of ExhaustionStress does not go away, body has no more energy to fight the stress, illness or disease

STRESS & DISEASE

Increased Blood pressure Increased Heart Rate = Increased Heart attacks Others…. Lowers your body’s ability to fight off diseases or illnesses (the immune system)

STRESS & DISEASE

“Between 60 and 90% of all our population’s visits to doctor’s offices are stress-related and probably cannot be

detected, much less treated effectively, with the medications and procedures on

which the medical profession relies almost exclusively.”

Dr. Herbert Benson, Timeless Healing

“PRESSURE is what happens to you, STRESS is how you react to these pressures.”

The worse your social circumstances, the greater the burden of chronic stress, the higher the risk of mental and physical disease

What Are Our Goals?• Limit NOT Eliminate stress• Use stress in a positive way• Use it to improve our performance

• It is the combination of feeling good and functioning effectively.

• It includes the experience of negative emotions and managing them successfully.

(Huppert, 2005, 2011)Director of Cambrige University

Wellbeing Centre

Wellbeing – functional view

Five components (Seligman, 2011)

• Positive emotions • Engagement • Relationships • Meaning • Accomplishment

Role of Mindfulness in enhancing well-being as it increases positive emotions.

(Huppert, 2011)

Wellbeing

Evidence from the 2008 Mental Capital and Wellbeing Project summarised into 5 key messages

www.neweconomics.org/projects/five-ways-well-being

5 Ways to Wellbeing

Mindfulness

Connect

Be Active

Take Notice

Keep Learning

Give

Applications of Mindfulness• Discussion

Downside of Mindfulness – colliding with the dark night of the Soul

• What downsides might you find?• What traditional spiritual and pastoral practices might

have been used by traditions to steer their way out of these?

• How might these considerations be relevant to healthcare practice?

Some Concepts• Positive Psychology is about the science and art of

human flourishing• Wellbeing• Mindfulness is a technique within this and other schools

for wellbeing• Stress management are tools and techniques• Mindfulness is not mysticism in and of itself but is akin to

mystical practices• It is not eastern or western, it’s pretty universal

Getting orientationsWorldview eg Jewish, Christian, humanistAnthropology: human being as creature or end in itself

Your approach to Psychology – the study of the cognitions and behaviours of the human person eg Positive Psychology

Wellbeing – a concept common to many concerns scientific and spiritual Mindfulness,

just one of many techniques and practices

POSITIVE PSYCHOLOGY AND A CHRISTIAN UNDERSTANDING OF WELLBEINGThe Science of Human Strengths and balance

Theological Links• John 10.10• Theology of Human Ecology• Empowerment Theologies• Pastoral Practice focused on enablement• Theology of human flourishing• Spirituality of flourishing

A starting place

• Martin Seligman• APA President 1996• Psychology split into two camps:

• Academics more interested in science.

• Clinicians interested in practice of psychotherapy.

• Hoped to bring science and practice together.

An epiphany: Seligman’s Daughter• Seligman resolved to change.• His purpose in life was not to correct his daughter’s

shortcomings.• Instead, raising her to nurture the strength she displayed

(social intelligence).• Can psychological science be about identifying and

nurturing strengths?• His mission as APA president.

Seligman Experiment: part 1• Escapable shock.

• Had coping mechanism.

• Press nose button to terminate shock.

• “Active”

• Inescapable shock.• Got shock.• No coping mechanism.• No way to terminate shock.

• “Passive

Seligman Experiment: part 2

• All groups received the same condition: escapable shock.

• Put in shuttle box.• Light dimmed.• 10 second later got shock unless they jumped to safe side.

Shuttle box behavior

• Dogs in the escapable shock quickly learned to jump to safe side.

• Dogs in inescapable shock did not jump to safe side. Agitated at first but later laid down and took the shock.

• Dogs in inescapable shock group learned helplessness

Parallels with Reactive Depression

• Triggered by traumatic life event (ex. death of loved one).

• Passivity• Difficulty in learning responses that bring relief.

• Physical symptoms.• Stress related disorders.

Directive Therapy

• Dogs that had been exposed to inescapable shock.

• Remove barrier and push them to safe side.

• Reinstall barrier and force them over it.

• Eventually learn to jump.

Parallels to Treating People• Encourage depressed people to get back into life. Ex:

not willing to leave home.• Small steps. (Go out to movie, then mall.)• Increase difficulty.• Show them they do have control over their lives.• Motivational, learning and emotional gains.

Links to the 5 functions of pastoral care

Prevention of Helplessness

• Seligman suggests the best prevention for helplessness is early experience with mastery.

• Based on life histories of people who were resilient in situations likely to cause helplessness.

• Self-efficacy, competence already in existence. Served as a buffer.

Spirituality of hope and self-efficacy…significant impilcations for theology and pastoral practice

Human strengths • Despite all the difficulties of life, majority of people

manage to live with dignity and purpose.• Positive psychology adopts a more optimistic

perspective on human potential, motives, and capacities.

• Humanistic psychology with scientific methods.

Theological and pastoral links with human strengths?A spirituality of human strengths?

Positive subjective states

• Positive emotions.• Happiness.• Satisfaction with life.• Optimism and hope.• Sources of energy and confidence.

Positive individual traits

• Character strengths and virtues: Wisdom, Courage, Humanity, Justice, Temperance and Transcendence.

• Creativity and excellence.• FLOW by Mihalyi Csikszentmihalyi

Positive institutions

• Develop and sustain institutions that enrich human potential.

• Healthy families• Work environments.• Schools.• Whole communities.• Reduce high risk behavior by punishing or supporting alternatives.

Expand focus• Positive psychology supports efforts to eliminate social

problems such as drug abuse, criminal behavior and mental illness.

• Study the protective factors as well as the risk factors.• Positive emotions and traits that could be used to

combat problems.

Risk and protective factors

• Drug abuse risk factors: Family history, peer influence, unemployment.

• Protective factors: Strong family values, positive peer influence, employment counseling.

• Most people do not abuse alcohol.• Most gamblers can control themselves.• Positive gambling ads.• Message of hope rather than fear.

Shares ideas with Humanistic Psychology

• Abraham Maslow• Positive instincts to fulfill human potential.

• Strong motivating force to do good.

• Be the best that they could be.

• Self-actualization.• Client-centered therapy of Carl Rogers

Humanistic Psychology• Positive side• Optimistic view of humankind.

• Human abilities.• Growth potential.• Healthy personality.• Pyramid of needs

• Negative side• Non-scientific.• Philosophy rather than psychology.

• Need evidence to support beliefs.

• Self-actualizers rare.• Practical applications.

Positive Psychology emphasis on research.• Most people adapt and adjust to life in creative ways.• Resilience: Bounce back after loss.• Go beyond recovery.• Life takes on new meaning and focus.• Study this strength and resilience using scientific method.• What makes life worth living.

The Greeks had a word for it.

• Plato and Aristotle described the deeper and more balanced for the good life.

• Eudaimonia: literally, “having a good guardian spirit.”

• “Possessed of true well-being.”• A person is truly happy when he has what is worth desiring.

• Living according to virtues and values.

• Fulfilling one’s potential

Plato (or is it da Vinci) by

Raphael

More than Maslow• Fulfilling one’s potential sounds a lot like self-

actualization.• Maslow believed only a few people could reach self-

actualization. Elitist.• Positive psychology has wider view.• “Average” individuals hold potential.• Study regular people with large samples.

Prevention over treatment• Positive psychology seeks to shift some of the focus

from treatment to prevention.• Help more people if we can prevent problems before

they exist (primary).• Or intervene before they get worse (secondary).• Treatment (tertiary).

An attribute of consciousness, i.e. a state of being attentive to and aware of what is taking place in the present moment.

(Brown & Ryan, 2003)

What is Mindfulness?

Mindfulness is non-evaluative and sustained moment-to-moment awareness of thoughts, physical sensations, and affective states.

(Grossman et al., 2004)

What is Mindfulness?

How is Mindfulness measured?Mindful Attention Awareness Scale (MAAS), Brown et al, 2003.

1. I could be experiencing some emotion and not be conscious of it until some time later. 2. I break or spill things because of carelessness, not paying attention or thinking of something else.3. I find it difficult to stay focused on what’s happening in the present

4. I tend to walk quickly without paying attention to what I experience along the way. 5. I tend not to notice feelings of physical tension or discomfort until they really grab my attention. 6. I rush through activities without being really attentive to them. 7. I find myself preoccupied with the future or the past.8. I get so focused on the goal I want to achieve that I lose touch with what I am doing right now to get there. 9. I snack without being aware that I’m eating. etc…

Key Mindfulness Interventions

• Mindfulness-Based Stress Reduction, MBSR by Kabat-Zinn (1982)

• Mindfulness-Based Cognitive Therapy, MBCT by Segal, Williams & Teasdale, (2002)

• Acceptance and Commitment Therapy, ACT by Hayes et al., (1999), Bond and Flaxman

• Other adaptations - However requirements for suitable trainers – (See Bangor University website)First UK conference on Mindfulness in the

workplace February 2012! First time presented at the DOP conference

2012

What is the evidence?

Evidence

 

Mindfulness increases • Positive mental states• Self-regulated behaviours• Heightened self-knowledge

(Brown et al 2003)

Self-awareness enhances • self understanding which allows choices

in alignment with values and intrinsic motivations.

(Lyubomirsky et al 2005)

Changes in the Brain Random Control Trial - Massachusetts Medical school • Mindfulness-Based Stress Reduction 22.6 h + 27 min/ day

homework practice average• N=16 ‘healthy’ participants vs 17 Control - (14/14 analysed)

• MRI scan: Increase in grey matter density in left hippocampus, cortex, cerebellum etc, brain regions involved in learning and memory, emotion regulation, self referential processing and perspective taking.

• Self-reports: Increased on Acting with awareness; Observing, Non judging.

Hotzel et al., (2011). Neuroimaging

Evidence on Health (mental & physical)

• Meta-analysis ( 64 studies of which 20 high quality from 1995-2001) MBSR intervention (Pre-Post) (N=1605) (10 RCT)

• Clinical sample: chronic pain, cancer diagnoses, fibromyalgia, coronary artery disease, anxiety, depression, obesity, binge eating and stress.

• Students and inmates sample: stress.• MBSR positive effects on a broad range of clinical and non clinical problems: Medium strength effect size d = 0.54

Grossman et al (2004) Journal of Psychosomatic Research

Evidence on Relapses

• Mindfulness Based Cognitive Therapy (MBCT) halves the likelihood of depressive relapse in the year following the treatment for people who had more than 3 or more episodes (e.g. Ma & Teasdale, 2004; Segal et al., 2007)

• MBCT (3rd wave of Behaviour Therapy) is one of NHS approved treatments for depression

Stress Reduction

Random Control Trial • 8-week MBSR training for health care employees• From 51 interested, 18 selected for Training and 20 Control but 10 T and 18 C due to drop out.

• Positive changes on all 5 scales: • Satisfaction with life• Burnout scalePerceived stress• Brief symptom inventorySelf compassion

Shapiro et al. (2005). Int. Journal of Stress Management , 12 (2), 164-176.

Quasi Experiment in a US - Southwest University• Sample: 21 participants and 30 control group• Intervention: MBSR training over 5 weeks ( 4 sessions x 3

hours + 1 day on 5thweek). • Improvements in 4 domains out of 5:

Physical (energy & less fatigue; less pain & discomfort, sleep & rest)

Psychological (bodily image, negative/positive feelings, self esteem, thinking, learning, memory & concentration) Social relations Spirituality/personal beliefs Overall QoL & General health (not significantly different from control group)

Jacobs, B. & Nagel, L. (2003). Int. Journal Self Help & Self Care

Quality of Working Life

Many applications

• Health (preventative depression; lifestyles; etc )• Wellbeing (resilience, stress reduction)• Cognitive skills (attention, focus, memory)• Self-regulation of emotions • Interpersonal skills (communication, assertiveness)• Leadership (decision-making, perspective)• Team development (awareness of others’ needs)

“Mindfulness is not the answer for all life’s problems. Rather it is that all life’s problems can be seen more clearly through the lens of a clear mind”.

(Kabat-Zinn p25-26, 1991)

Christian Tradition• From a Christian perspective the human being is called to

union with God and human existence is seen in that light

• Eschatological perspective, teleological perspective

• Mindfulness and Positive Psychology are all fine as far as they go, but they need to be seen in ultimate context

• Traditional Christian views on fulfilment

“I have come that all might have life in its fulness” (Jn 10:10)

Christian approaches to StressNegative PositiveWorm theology – live with it

Punishment for Sin

Weakness – do not give in

Pray

Teleological – God wants us to be happy

Justice – stress often about justice, fairness, equity

Dignity and happiness – stress can be neutral or an evil

The Balanced life and self care – prayer, physical regime, health, caring for the temple of the Spirit

Christian Tradition• Patristic Tradition

• Human development in God• Divinisation• Personalisation• Balanced Life• Happiness is teleological – in context of ultimate end• Creaturliness

• Augustine• PseudoDionysius• Ambrose• Anselms

Christian Prayer Tradition• Contemplation• Mental Prayer• Lectio Divina• Mystical Tradition – living for God, living in the present

moment• The experience of public worship and private prayer• Right relationships

Christian Tradition• The balanced Life

• Internal and spiritual – human development is in context of the life of the spirit and the call to discipleship

• Human flourishing is about right relationship – God, Self, Neighbour• Sanctification – the work of the Church

• John Wesley• Julian of Norwich• Dominican Spirituality – Meister Eckhart and the soul laughing• Quaker Spirituality – Matthew Fox• Catholic Social Teaching – the dignity of the human person• Benedictine Spirituality – Rule of St Benedict

Cistercian Spirituality – Thomas Merton• Carmelite Spirituality – Teresa, Lawrence (practice of the presence)• Contemplation and Prayer in Balance• Self-Care

Bringing this all together• Mindfulness and positive psychology can be aligned to

Christian anthropology• They are useful tools in achieving the balanced life• They are not panaceas• Mindfulness is not for everyone• There are downsides• We still don’t know “how “ it works mechanistically. Does

that matter?