A Mindfulness-Based Stress Reduction Workbook

Today it’s my pleasure to bring to you Gina Biegel, LMFT and author of The Stress Reduction Workbook for Teens: Mindfulness Skills to Help You Deal With Stress and her audio CD Mindfulness for Teens. Gina is a psychotherapist who works in private practice and for a large health management organization. Her passion and focus is teaching mindfulness-based stress reduction (MBSR) with adolescents, children, adults, teachers, and health and business professionals.

Gina has adapted MBSR to MBSR-T for the adolescent population and conducted a randomized control trial assessing the efficacy of this program with significant results. She has published an article about her findings in the Journal of Consulting and Clinical Psychology (JCCP). Gina is also currently conducting a formal research study to assess the efficacy of the Mindful Schools program.

Today, Gina talks to us about how to teach mindfulness to teens to help them focus and be happy.

Elisha: What is the difference between teaching mindfulness to adults versus teens?

Gina: I think the most important thing to pay attention to when you are using mindfulness with teens is assessing whom you are working with developmentally.  For example, are you working with teens in middle school or those in their senior year of high school?  There are many differences to notice with these two groups of teenagers.  Also, in terms of emotion regulation and coping strategies I find that teens are not as able to respond to life’s stressors, both large and small, with the same ability an adult.  It’s important to keep in mind that teens from every region of the world, nationally and internationally are going to come from a multitude of different backgrounds (e.g., socioeconomically, ethnically etc.).  It’s necessary to look at teens as a population, but within this population consider the unique aspects of the group all the way down to each individual you are exposed to.  Additionally, I find that teens are very open to mindfulness skills and to learning something new.  To many of these teens, the skills they need to become socially and emotionally balanced young adults is not where I believe they should be and mindfulness is a pathway to this and if you can plant seeds that later grow into flora all the better.

Elisha: One of the practices you have in your book is Doing Schoolwork Mindfully. Since this is such a prevalent issue among teens (and their parents), can you give us a sample session here of what this looks like?

Gina: I encourage teens that have difficulties with focus, concentration, and/or overload from anxiety before a test or with doing homework:

1. First start and just notice their breath as it already is.  This will first, connect their head to their body, and if they are noticing their breath they hopefully aren’t noticing worry thoughts or focus on self-judgments that they “can’t pay attention,” to take a break from these thoughts even if for a brief moment. 
2. Once they have noticed a few breaths, I encourage them to do a brief body-scan meditation, and I will offer this meditation in the room with them. 
3. Next, I ask them to visualize taking the test or doing their homework, and to see them completing it with ease and to remind themselves that they can do their best.  This can assist in reducing the added pressure they have from themselves and from their parents. 

Once they have gone through this process, they can then begin, and if they start noticing difficulty again, to take a pause and go through this process again.  It is also a practice in being kind to the self.  For more details on this practice, teens can follow Activity 18 in my workbook or audio track 13.

Elisha: In your book you say, “Being happy and enjoying your life takes more than just a passing thought or statement; it is about actively noticing and doing what makes you happy.” How do you teach teens to do this?

Gina:  There is a saying in the mental health field, something to the effect, “if it is working do more of it.”  I notice that some teens who are suffering from depression, anxiety and the like, at times add to their suffering or make their problem(s) worse by engaging in negative-coping strategies and self-judgments. If there are things that they can do that make them happy, then do more of it.  I encourage teens to notice what healthy activities they engage in that make them happy, whether they take up a short or long period of time or if they are free or expensive.  Once they have this list, they can always turn to it when they feel like nothing in their life brings them happiness or calms them and do something from the list.  If we don’t teach someone how to be happy how can we expect him or her to automatically be happy?  We encourage teens to take a foreign language in high school, preferably for three years; I believe we need to teach them the foreign language, to most teens, of mindfulness.

Elisha: If you were sitting across the table from a teen who was stressed out right now, how would you engage him or her?

Gina: The most important thing is to be yourself!  I hope that I don’t come across with an all-knowing attitude instead I try to view myself as just another person on their path and if I can help in some way then that is wonderful and if I can’t, then I accept that as well.  I look at work with teens as being part of their journey.  I try to give them a different experience with an adult and not create, as much as possible, a 1-up position that can so easily be taken advantage of.  I would like to meet teens where they are.  For example, I like to use their language and share age-appropriate anecdotes that hopefully they will be able to relate to.  I also use a comfortable body posture.  After all of the aforementioned, I would mention what I notice, “It seems like you are stressed right now, what is going on… do you feel like talking about it?”  If the teen opens up then we go from there, if the teen on the other hand says, “I don’t know” or seems closed off, I might offer some red flags to notice what might be a response to stress both physically and psychologically and share with them what led me to think they might be stressed in the first place.  A few other tips would be to use mindful listening and offer respect to the teen sitting across from you; he/she might not often get listened to or treated with respect.

Thank you so much Gina! As always, please share your thoughts, stories and questions below. Your interaction provides a living wisdom for us all to benefit from.

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com

There are moments of truth in life when we just can’t help but be moved by a moment. I experienced one of those moments recently. Last weekend I was at a wedding and the couple had to scramble last minute as the rain outside made it impossible for them to get married in the breathtaking outdoor setting that they had set their hearts on. After a last-minute plan B was concocted and set in place an indoor ceremony was created and we all took our seats. First came the groom with his parents and when he was in place with all the parents, groomsmen and bridesmaids, the bride appeared and there was the moment.

As the gaze of the groom and bride met I couldn’t help but notice a welling up of emotion in my heart and felt the tears come to my eyes filled with joy and hope. There was something just so beautiful about that moment and the moments that unfolded. I could sense by their smiles and the look in their eyes that the bride and groom were enshrouded in the present moment, deeply in touch with the meaning that was there (especially with the contrast of all that had just gone through).

What is it about the moment a bride and groom catch each other’s gaze that wells up those feelings in us? As I reflect on this what first comes to mind is a sense of hope, possibility and promise for the future and there’s something beautiful about that alone.

But that doesn’t seem to hit the core of it. As I inquire deeper, I can’t help but think that there is something deep inside each one of us that wants to feel a sense of belonging and acceptance and that moment is the ultimate fruition of that longing.

As this is occurring, there seems to be a deep sense of belonging and acceptance that goes deeper than just an intellectual understanding, but seems to be felt on a soul level. A commitment is being symbolically made that says I accept you and you accept me for the entirety of this life. We are partners in this life together.

In the Jewish tradition there is a saying that in this case, the bride recited as she looked into her soon-to-be husband’s eyes:

“Dodi li, va’ani lo (My beloved is mine and I am his…)”

This speaks to the core of acceptance and belonging. All the love that had been felt in the relationship up to this point is peaking in that moment as the gaze locks and the ceremony unfolds.

This longing is so primal in each of us that that moment pulls on our heartstrings as a loving resonance occurs of what is so beautiful before our eyes.

Ofcourse this reaction is going to vary from wedding to wedding and from person to person (with some seeming to go in the opposite direction), but there is enough of a common reaction to these moments that seems to make it a shared truth among many people for a longing for love, belonging and acceptance.

Now, if we can get the couple to share with us how they dealt with their stress management leading up to the wedding, that’s fuel for another post.

In the end, this is a truth we want to remind ourselves of as the marriage continues and children start becoming part of the picture. We can all take a lesson from these big moments.

As always, please share your thoughts, stories and question below. Your interaction provides a living wisdom for us all to benefit from.

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com

In an earlier post I published Jeffrey Schwartz, M.D. with his article focusing on why empathy can be a two edged sword which became very popular and later interviewed him about why recent research in the field of neuroscience has been largely a waste of money. Jeff is a psychiatrist, researcher in neuroplasticity and internationally recognized expert in Obsessive Compulsive Disorder. He is also author of the popular books Brain Lock: Free Yourself from Obsessive-Compulsive Behavior and The Mind and the Brain: Neuroplasticity and the Power of Mental Force. 

TodayI bring Jeff back to tell us about how mindfulness and his 4 step process can not only help us break free from Obsessive Compulsive Disorder (OCD) but be a path toward greater stress management and well-being.  

Elisha: In your book Brain Lock you present a four step process for working with Obsessive Compulsive Disorder (OCD) that has gained prominence and is being used by therapy centers around the world. Tell us a bit about this 4 step process and why it works?

Jeff: The four steps came out in brain lock published in 1996. I have a new book that’s going to be out in the beginning of 2011 and the co-author, Rebecca Gladding, is former Chief Resident in Psychiatry at UCLA and now UCLA faculty. In this new book we apply these same 4 steps in OCD to a much broader application and really use it as a means for stress management.

I’ll give you both versions.

First step is the same in both, Relabeling. There’s been great work by Matthew Lieberman OF UCLA on the tremendous power of labeling on emotional faces and other things to manage Amygdala hyper-responsiveness, in other words to manage fear and stress responsiveness. This research says if we put a label on our emotion, we can help manage our response to it. So Step 1 is Relabel.

Step 2 is called Reattribute, which in the original 4 steps means attribute the fact that the troublesome feeling or a bothersome emotion that you are feeling is a manifestation of your brain sending you a false message. So don’t attribute it to yourself, your psyche, or your upbringing, but actually attribute it to a maladaptive brain circuit. This helps give you some distance between the sense of who you are and the troublesome feeling which again helps you manage it. Then apply the impartial spectator, which is another term for mindful awareness. We’ve actually just broadened that term to be reframe in the new book.

Reattribute is good in OCD to say “it’s the brain.” In using the brain in a more abstract way we thought the word reframe might be more general than the term reattribute.

The other 2 steps are exactly the same.

Refocus is the 3^rd step. Given what I had said about Quantum Zeno Effect and Hebb’s law and self-directed neuroplasticity, it should be pretty clear why refocus is very important. If you change your focus from a negative maladaptive response to a positive wholesome response that’s going to be conducive to well-being. Refocus will rewire your brain in ways that will be conducive and wholesome and adaptive to your well-being.

Then when you do this regularly, you get to the 4^th step which is Revalue. In Revaluing you change the valuation you put on the initial experience. Revalue is a deeper form of relabeling, so you don’t have to go through a whole linguistic process, but you actually just get a sense of immediacy in knowing this is not a good thing to be focusing on. In other words, these feelings are a destructive brain message and I can manage my responses to and focus away from in an adaptive way.

Revalue just means you put a different valuation on the initial negative experience so you no longer need to use the linguistic cognitive reframing, you do it automatically. From a neuroscience perspective we would posit that this means that instead of needing to primarily use the cortex to do that process, it now becomes a wholesome habitual response because doing it repeatedly and intensively actually gets the basal ganglia or the habit center of your brain to take over the process. So Revaluing is basically all the steps being done by your basal ganglia in ways that would be much faster and much more automatic.

Elisha: If you were sitting across the table from someone struggling with lots of stress in their life, what would be your initial approach, what advice would you give to them?

Jeff: Well I’ve almost answered that in the 4 steps. There is a tremendous power to using labeling. Putting a linguistic label on it and doing it with a cognitive reframe. Here’s the heart of the answer, as you do these steps you begin using your impartial spectator or mindful awareness. What you want to do is get that 3^rd person perspective on 1^st person experience. All of these techniques are really geared toward enabling people to get a 3^rd person perspective on 1^st person experience.

Now being a serious Christian, I’m certainly more than happy for people to bring Jesus in as the impartial spectator. I believe this will be more than just a cognitive reframing, but certainly also a cognitive reframing. It’s probably the best way to get a real 3^rd person to have a perspective on your 1^st person experience. Because Jesus has access to that and Jesus can help you manage it.

In summary for all people, it’s all geared toward getting a 3^rd person perspective on your 1^st person experience which is what we mean by impartial spectator, a term I borrowed from Adam Smith, which is what we mean by mindful awareness, a term I borrowed from Buddha.

To the readers: As always, please share your thoughts, stories and questions below. Your interaction creates a living wisdom for us all to benefit from.

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com

Here is an adapted version of a post I wrote over a year ago and it is an oldie but a goodie so I thought I’d bring it back into awareness. Enjoy!

There’s a funny print cartoon that has a man and woman sitting on the couch staring at a TV screen and the caption below reads, “It’s 12 O’clock, do you know where your mind is?” As time goes on and we grow up from children to adolescents to adults, for many of us, somewhere along the way life begins to become routine. Day in and day out whether we’re walking, driving, talking, eating, going to the grocery store, or being with our families our minds get kicked onto auto-pilot and continue to develop their habitual ways of thinking, interpreting, expecting, and relating to other people. These habits of the mind can keep us stuck in stress, anxiety, depression, or even addictive behaviors.

Here are a few habits of the mind and a mindfulness practice to help you break out of auto-pilot and gain more control over your life.

Common habits of the mind that are not effective for well-being:

• Catastrophizing – If you’re prone to stress and anxiety, you may recognize this habitual mind trap. This is where the mind interprets an event as the worst case scenario. If your heart is beating fast, you may think you’re having a heart attack. If your boss didn’t look at you while walking down the hall, you thinking you’re going to get fired. You get the picture. This style of thinking will support increased stress, anxiety, and even panic.
• Discounting the positive and exaggerating the negative – The news is wonderful at supporting us with this one. This is where we habitually reject or minimize any positive feedback and magnify the negative feedback. The glass is always half empty. If you catch yourself saying something positive and then saying “but” followed by a negative, you are practicing this. “I got a 95% on this test, but I didnt’ get a 100%”. Without awareness, this style of thinking will likely land you in a depressed mood.
• Blaming - Be careful of this one. We all do it, pointing the finger at someone else for our woes or point the finger at ourselves for others woes. “If my boss wasn’t so hard on me at work, I wouldn’t be so anxious” or “It’s my fault my parents got divorced”. Just check in with yourself after noticing this style of thinking. It doesn’t cultivate any solutions and just makes you feel stuck, anxious, or depressed.

Cultivating the ability to be more present to these mind traps will help you break free from them and shift your attention on more effective ways of interacting with life. If you notice catastrophizing, actually say to yourself “catastrophizing is happening right now”, then bring your attention to your breath for a moment to steady your mind and then ask yourself, “what are some other possible reasons why my heart is racing fast (e.g. , I just ran upstairs, I’m nervous)?

If discounting the positive, come back to the breath, and then switch the “but” to an “and” so at least the positive statement get its equal weight, being more realistic and balanced. If blaming, call it out, say to yourself “blaming is happening”. Remind yourself that blaming simply isn’t effective for anyone and then come back to your breath to steady your mind and bring yourself back to the task you were just doing.

This is not an easy process, yet an important one for regaining control from the ineffective habits we develop in our minds. If we’re not mindful in our daily lives, our minds could just fall into their habitual states to the point we’re on our deathbeds asking “where did it all go?”

Just check in with yourself during the day, look at the clock and say, “It’s X O’clock, do I know where my mind is?” You may catch yourself in some mind traps and if not, just notice whatever you are doing in the moment and then continue if you still want to be doing that or change if you’d rather be doing something else.

Try to be patient through this process and not judge yourself if you find the mind traps arising. Judging yourself as bad or wrong is another mind trap that holds keep you stuck. Breathe in, breathe out, and just redirect your focus.

As always, please share your thoughts, stories and questions below. Do you notice when you’re on auto-pilot? What kind of mind traps do you catch in your daily life, what works for you? Writing below helps create a living wisdom that we can all share and benefit from.

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com