Adapted from Segal Williams and Teasdale (2007). Copyright by the Guilford Press.

Transcription

1 Adapted from Segal Williams and Teasdale (2007). Copyright by the Guilford Press. TURNING TOWARD THE DIFFICULT In Session 5 we extended our formal practice to begin deliberately to turn toward and approach painful experiences with kindness. The basic guideline in this practice is to become mindfully aware of whatever is most predominant in our moment-by-moment experience. If the mind is being repeatedly drawn to particular thoughts, feelings, or bodily sensations, the first step is to intentionally cultivate a gentle and friendly awareness of whatever is pulling for our attention, over and over. The second step is to notice, as best as we can, how we are relating to whatever arises in the body or mind. Our reactions may determine whether they are passing events or if they will persist. Often we can be with an arising thought, feeling, or body sensation but in a non-allowing, reactive way. If we like it, we may become attached to it, and try to hold on to it. On the other hand, if we dislike it, then we may experience fear or irritation, tense up and contract, or try to push it away. Each of these responses is the opposite of allowing. LETTING GO AND LETTING BE The easiest way to relax is first, to stop trying to make things different. Allowing experience means simply allowing space for whatever is going on. Through cultivating a willingness to experience, we settle back into awareness of what is already present. We let it be we simply notice and observe whatever is already present. This is the way to relate to experiences that have a strong pull on our attention, however powerful they seem. When we see them clearly, it helps prevent us from getting pulled into brooding or obsessing about them, or trying to suppress or avoid them. We begin the process of freeing ourselves. We open up the possibility of a skillful and compassionate response rather than a knee-jerk reaction, automatically using old (and often unhelpful) strategies. A NEW PRACTICE While meditating, we explored a new way of approaching the difficult. If we noticed that awareness kept being pulled away from the breath (or other focus of attention) to particular sensations in the body associated with physical discomfort, emotions, or feelings, the first step was to become mindfully aware of those physical sensations, to deliberately move the focus of attention to the part of the body where those sensations were strongest. The breath provided a useful vehicle to do this just as you practiced in the body scan we took a gentle and friendly approach to that part of the body by breathing into it on the in breath, and breathing out from it on the out breath. Acceptance is not resignation. Acceptance, as a vital first step, allows us to become fully aware of difficulties, and then, if appropriate, to respond in a skillful way.

2 USING THE BREATHING SPACE EXTENDED INSTRUCTIONS When you are troubled in thoughts or feelings: Awareness Observe bring the focus of awareness to your inner experience and notice what is happening in your thoughts, feelings, and bodily sensations. Describe, acknowledge, identify put experiences into words, for example, say in your mind, A feeling of anger is arising or Self-critical thoughts are here. Redirecting Attention Gently redirect your full attention to the sensations themselves. Once the attention has moved to the bodily sensations and you have the item in the field of awareness, say to yourself, It s OK. Whatever it is, it s OK. Let me feel it. Then, just stay with the awareness of these bodily sensations and your relationship to them, breathing with them, accepting them, letting them be. It may be helpful to repeat, It s OK. Whatever it is, it s OK. I can feel it, using each out breath to soften and open to the sensations of which you become aware. If necessary, because the sensations are too intense, focus on the sensations of breathing in and out (expanding on the inhalation and softening on the exhalation). EXPANDING ATTENTION Allow your attention to expand to the whole body especially to any sense of discomfort, tension, or resistance. If these sensations are still there, then take your awareness there by breathing into them on the in breath. Then, breathe out and continue softening and opening with the out breath. Become aware of and adjust your posture and facial expression. As best you can, bring this expanded awareness to the next moments of your day. HOME PRACTICE FOR WEEK FOLLOWING SESSION 5 1. Practice Sitting Meditation daily (alternative days: CD 2, no CD sit with silence for minutes) and record your reactions Minute Breathing Space Regular: Practise three times a day at times that you have decided in advance. Record each time and note any comments/difficulties Minute Breathing Space Responsive/Coping: Practise whenever you notice unpleasant feelings. Record each time by circling CR for the appropriate day on the Record Form; note any comments/difficulties. 4. Complete the Automatic Thought Record for at least one hot thought this week.

3 HOME PRACTICE RECORD FORM SESSION 5 Record each time you practice. Also, make a note of anything that comes up, so that we can talk about it at the next meeting. Day/date Practice* (Yes/No) Comments * Practices to record: Sitting Meditation (), 3 Minute Breathing Space (3), and Responsive/Coping Breathing Space ().

4 MAJOR DEPRESSIVE EPISODE Five or more of the following symptoms, one of which should be depressed mood or anhedonia must be present for at least two weeks: Depressed mood Loss of pleasure in usual activities (anhedonia) Feelings of worthlessness or inappropriate guilt Inability to concentrate Fatigue or loss of energy Insomnia or hypersomnia Psychomotor agitation or retardation Significant weight loss or gain Recurrent thoughts of death or suicide GENERALIZED ANXIETY DISORDER A. At least 6 months of "excessive anxiety and worry" about a variety of events and situations. Generally, "excessive" can be interpreted as more than would be expected for a particular situation or event. Most people become anxious over certain things, but the intensity of the anxiety typically corresponds to the situation. B. There is significant difficulty in controlling the anxiety and worry. If someone has a very difficult struggle to regain control, relax, or cope with the anxiety and worry, then this requirement is met. C. The presence for most days over the previous six months of 3 or more (only 1 for children) of the following symptoms: 1. Feeling wound-up, tense, or restless. 2. Easily becoming fatigued or worn-out 3. Concentration problems 4. Irritability 5. Significant tension in muscles 6. Difficulty with sleep D. The symptoms are not part of another mental disorder. E. The symptoms cause "clinically significant distress" or problems functioning in daily life. "Clinically significant" is the part that relies on the perspective of the treatment provider. Some people can have many of the aforementioned symptoms and cope with them well enough to maintain a high level of functioning.

5 Situation Moods (One Word) Who were you with? Where were you? What were you doing? When was it? Rate Intensity of mood (0-100%) Automatic Thoughts (Images or Sentences) Identify the Hot Thought Thought Record Body Sensations Concrete Evidence that Supports the Hot Thought Concrete Evidence That Does Not Support the Hot Thought Alternative / Balanced Thoughts Answer some or all of the following questions: What was going through my mind just before I started to feel this way? What does this say about me? What does this mean about me? My life? My future? What am I afraid might happen? What is the worst thing that could happen if this is true? What does this mean about how the other person(s) feel(s)/think(s) about me? What does this mean about the other person(s) or people in general? What images or memories do I have in this situation? Circle the hot thought in the previous column for which you are looking for evidence. Write factual evidence to support this conclusion. (Try to avoid mindreading and interpretation of facts) Ask yourself questions from the back of this page (left side) to help discover evidence which does not support your hot thought. What did you learn from this? What can you do to cope and feel better? Ask yourself questions from the back of this page (right side) to generate alternative or balanced thoughts Write an alternative or balanced thought. Rate how much you believe in each alternative or balanced thought (0-100%) Rate Moods Now Copy the feelings from the column Moods. Rerate the intensity of each mood (0-100%) as well as any new records.

6 Questions to help find evidence that does not support your hot thought: Have I had any experiences that show that this thought is not completely true all the time? If my best friend or someone I loved had this thought, what would I tell them? If my best friend or someone who loves me knew I was thinking this thought, what would they say to me? What evidence would they point out to me that would suggest that my thoughts were not 100% true? When I am not feeling this way, do I think about this type of situation any differently? How? When I have felt this way in the past, what did I think about that helped me feel better? Have I been in this type of situation before? What happened? Is there anything different between this situation and previous ones? What have I learned from prior experiences that could help me now? Are there any small things that contradict my thoughts that I might be discounting as not important? Five years from now, if I look back at this situation, will I look at it any differently? Will I focus on any different part of my experience? Are there any strengths or positives in me tor the situation that I am ignoring? Am I jumping to any conclusions in columns 3 and 4 that are not completely justified by the evidence? Am I blaming myself for something over which I do not have complete control? Questions to help arrive at alternative or balanced thinking: Based on the evidence I have listed in columns 4 and 5 of the Thought Record, is there an alternative way of thinking about or understanding this situation? Write one sentence that summarizes all the evidence that supports my hot thought (column 4) and all the evidence that does not support my hot thought (column 5). Does combining the two summary statements with the word and create a balanced thought that takes into account all the information I have gathered? If someone I cared about was in this situation, had these thoughts, and had this information available, what would be my advice to them? How would I suggest they understand the situation? If my hot thought is true, what is the worst outcome? If my hot thought is true, what is the best outcome? If my hot thought is true, what is the most realistic outcome? Can someone I trust think of any other way of understanding this situation? Mind Over Mood by Dennis Greenberger and Christine A. Padesky

7 This being human is a guest house. Every morning a new arrival. A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor. Welcome and entertain them all! Even if they are a crowd of sorrows, who violently sweep your house empty of its furniture, still, treat each guest honourably. He may be clearing you out for some new delight. The dark thought, the shame, the malice. meet them at the door laughing and invite them in. Be grateful for whatever comes. because each has been sent as a guide from beyond. - Jelaluddin Rumi, translation by Coleman Barks