Mindfulness. Mandakini Sadhir, MD Assistant Professor Division of Adolescent Medicine Department of Pediatrics UK HealthCare

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1 Mindfulness Calligraphy by Thich Nhat Hanh Mandakini Sadhir, MD Assistant Professor Division of Adolescent Medicine Department of Pediatrics UK HealthCare

2 Adolescence Marked by pubertal growth, psychosocial and cognitive development. Risk taking behaviors and mood disorders are common during this period.

3 ADOLESCENT BRAIN Frontal Cortex: decision making, self control LIMBIC SYSTEM: EMOTIONAL BRAIN Fear, anger, fight or flight response Feelings of pleasure Development of reward behaviors such as eating and sex. Memory storage and retrieval PREFRONTAL CORTEX: CEO OF BRAIN Planning Setting priorities Organizing thoughts and problem solving Suppressing impulses Weighing consequences of one s actions Limbic System - Amygdala (learning, emotions): makes young teens especially susceptible to engaging in risk-taking

4 Adolescence PFC Amygdala I like drugs!! PFC I hate school! I ll skip school and get drunk. Amygdala NOT GOOD NEWS: Hot decisions more likely than Cold decisions Stress aggravates the situation Young adulthood I am planning for the future PFC Amygdala GOOD NEWS: Pruning of PFC neurons produces a more efficient PFC by young adulthood Decision making maturity PFC: Prefrontal cortex Source:

5 Managing Stress Healthy coping skills- deep breathing exercises, Meditation Mindful meditation, transcendental meditation, zen meditation etc., yoga, exercise, progressive muscle relaxation, listening to music, dance, aromatherapy, writing etc. Unhealthy coping skills- using drugs, self harm, overeating, restricting food, excessive gaming/internet use, risky behaviors.

6 Mindfulness is.. Paying attention in a particular way, on purpose in the present moment in non judgmental way Jon Kabat- Zinn Paying attention in a particular way on purpose in the present moment with unconditional love Dzung Vo

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8 Mindfulness Is not. Religion Relaxation; seeking bliss Emptying your mind Cure-all Quick fix Self absorbed Substitute for addressing social determinants

9 Mindfulness for Teens- Emerging Evidence Mindfulness based interventions have found to be feasible and acceptable in children and adolescent population. Attention- concentration, ADHD, academic performance Medical Blood pressure Risk behaviors Fighting, substance use Emotional regulation Stress, depression, anxiety, PTSD, Positive affect, eating disorders Social Empathy, and Compassion, Pro social school behaviors, family functioning Chronic illness- Pain management, coping with illness Improved Sleep

10 Mindfulness based intervention Beneficial effect on depression, quality of life, and acceptance of pain in adolescents with recurrent headaches. Study investigating impact of mindfulness based stress reduction program in adolescents with functional somatic pain syndromes found preliminary evidence of improvement in functional disability, symptom impact and anxiety. Among adolescents and young adults who were cancer survivors, mindfulness based intervention resulted in significant reduction in emotional distress and improvement in quality of life at 3 months of follow-up. In addition, participants had reduced negative attitudes toward self and demonstrated significant improvement in mindfulness skills. Zoogman S, Goldberg, SB, et al Mindfulness Interventions with Youth: A Meta-Analysis. Mindful Apr;6(2): Thompson M, Gauntlett-Gilbert J. Mindfulness with children and adolescents: effective clinical application. Clin Child Psychol Psychiatry Jul;13(3): Zenner C, Herrnleben-Kurz S, Walach H. Mindfulness-based interventions in schools-a systematic review and meta-analysis. Front Psychol Jun 30;5:603 Ahola Kohut S, Stinson J et al. Mindfulness-based interventions in clinical samples of adolescents with chronic illness: a systematic review. J Altern Complement Med Mar 29 Hesse T, Holmes LG, et al. Mindfulness-Based Intervention for Adolescents with Recurrent Headaches: A Pilot Feasibility Study. Evid Based Complement Alternat Med. 2015; 2015:

11 Mindfulness based stress reduction (MBSR) Eight week program with each session lasting for 2.5 hrs. Provides mindfulness training through the practice of meditation and hatha yoga. In each session, learners are taught mindful techniques and encouraged to engage in sharing of their learning experiences and difficulties to understand elements of stress. During these 8 week sessions, program seeks - to strengthen ability to focus on the present moment and accept experiences or thoughts as they arise without trying to control them; - explore personal experience and paying attention to its emotional and sensory aspects rather than intellectual description; - fully accept personal experience with its positive as well as negative elements including feelings of pleasure, joy, frustration, rage, or uneasiness. - develop the ability to actively choose which personal experiences to be lived and what elements to be focused, acted upon or examined. - teaches the ability to give up all pretense of having direct control over reality. Kabat-Zinn, J. Full Catastrophe Living: Using the Wisdom of your Body and Mind to Face Stress, Pain, and Illness Fifteenth Anniversary Edition New York, NY: Bantam Dell. [Shonin E, Van Gordon W. The Mechanisms of Mindfulness in the Treatment of Mental Illness and Addiction. International Journal of Mental Health and Addiction. 2016; 14(5):

12 Other approach Transcendental Meditation Vipassana Zen meditation Tai chi ( is a noncompetitive, self-paced system of gentle physical exercise and stretching) Mindful movement

13 Just Breathe Mindful school

14 Mindfulness in Education

15 What are the program goals? To provide universal, developmentally appropriate mindfulness instruction that fosters mental health and wellness; To enhance emotion awareness and emotion management skills and to foster wholesome emotional balance; To strengthen attention; To expand the repertoire of skills for stress management; To help students integrate mindfulness into everyday life.

16 Mindfulness for Providers

17 Mindful-Breathing