Happiness. Intention. Afternoon workshop. Surgeon General. What is happiness? When do you feel happy and what about that makes you happy?

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Intention The Art and Science of Mindfulness What is mindfulness? Mark Levine M.D. How is it helpful? What is the scientific evidence that supports its value?

1 Intention The Art and Science of Mindfulness What is mindfulness? Mark Levine M.D. How is it helpful? What is the scientific evidence that supports its value? Afternoon workshop What is compassionate mindful attention? How do we integrate this mindful attention into psychotherapy? How do patients learn and apply these skills? Surgeon General If I could tell you that there was one factor in your life that could lower your risk of having a heart attack or stroke, that could increase your chances of living longer, that could increase your productivity at work and the likelihood that you get a promotion, and that could even increase your success in losing weight What would that factor be? Vivek Murthy M.D. 4 Happiness What is happiness? When do you feel happy and what about that makes you happy? 6 1

2 Qualities of Happiness Many kinds of emotions Feel present, undistracted, in the moment Awareness or a knowing of being happy. A deep sense of flourishing that arises from an exceptionally healthy mind not a mere pleasurable feeling, a fleeting emotion, or a mood, but an optimal state of being. Matthieu Ricard, PhD 7 Happiness Set Point Can we influence these mental condition? Win Lottery Paralyzed for life YR: The How of Happiness Sonia Lyubomirsky Ph.D. reviewed research which found several key factors which maximized happiness: Gratitude Self appreciation Kindness Curiosity Optimism Savoring She and other researchers noted that all of these qualities depend on awareness of self and of others. 2

3 By awareness, I mean a knowing of thoughts, emotions or sensations that comes from paying attention on purpose. Exercise: Bringing attention to the sensations in the right hand, left foot then both hands. Discussion: Observing how attending lights up the awareness of sensation. In the 1990 s the connection between emotions, happiness and awareness became the focus of research by psychologists Drs. John Mayer and Peter Salovey who introduced the term emotional intelligence. 13 Their work was popularized by Dr. Daniel Goleman who summarized hundreds of studies which showed that performance, leadership and happiness were dramatically enhanced by emotional intelligence. This research identified 5 innate capacities which could be learned and strengthened.. Self- Awareness Self- Regulation Motivation Empathy Social Skills Dr. Flow Their research showed that awareness was the foundation for emotional intelligence. This was the first body of western research to support the idea that happiness, performance and leadership could be enhanced by strengthening awareness. fully immersed aware of the moment present free of preoccupation 3

Dr. Flow Prior to this research psychologist Mihaly Csikszentmihalyi (pronounced Mee hy Cheek sentme hy ee) had spent two decades studying happiness and peak performance and coined the term flow to

4 Dr. Flow Prior to this research psychologist Mihaly Csikszentmihalyi (pronounced Mee hy Cheek sentme hy ee) had spent two decades studying happiness and peak performance and coined the term flow to describe this experience in which people are fully immersed and aware of the moment, in which people feel present and free of preoccupation. In such moments, people are happy. A deep sense of flourishing that arises from an exceptionally healthy mind not a mere pleasurable feeling, a fleeting emotion, or a mood, but an optimal state of being. Matthieu Ricard, PhD 19 The challenge here was that flow was something that happened to people in certain activities. Some people might say that golf or cooking or hiking was their meditation. The process was passive, even random, because there was no method to reliably train people to get into flow. It mainly happened. When are humans most happy? When are humans most happy? To gather data on this question, Matt Killingsworth Ph.D., who researches happiness, recently built an app, Track Your Happiness, that let people report their feelings in real time. Among the surprising results: We're often happiest when we're in the moment. And the flip side: The more our mind wanders, the less happy we can be. How do you feel? What are you doing? 3 Questions Are you thinking about something other than what you re currently doing?

5 650,000 real time reports from over 15,000 people Forty seven percent of the time, people are thinking about something other than what they re currently doing. Dr. Killingsworth found that people are less happy when they re mind wandering no matter what they re doing. Wandering Attention: 47 % For example, people don t really like commuting to work very much; it s one of their least enjoyable activities. Yet people are substantially happier when they re focused only on their commute than when their mind is wandering off to something else. This pattern holds for every single activity we measured, including the least enjoyable. 25 About Wandering The mind's innate capacity to wander appears to serve at least two creative purposes: scanning for opportunity and threats and processing sensory and cognitive information Why wandering often makes us unhappy When our minds wander, we often think about unpleasant things: our worries, our anxieties, our regrets, comparisons, criticisms. We then have mental reactions to these negative thoughts and emotions which adds to our distress. We start reacting to our thoughts and emotions as if they were real threats. These negative thoughts turn out to have a gigantic relationship to unhappiness All mood fluctuates. It is not the mood that does the damage. It is our mental reaction to our mood. Mark Williams Compassionate attending allows us to improve the mental conditions in which these negative thoughts arise. Even when people wander into neutral thoughts they are often less happy than when they are present with an unpleasant experience

6 Dr. Killingsworth concludes that presence, what Goleman called awareness, makes us happy. Awareness makes us happy Why learn mindfulness to train awareness? Albert Einstein observed that We can't solve problems by using the same kind of thinking we used when we created them. It may be ineffective to only use intellectual intelligence to train emotional intelligence. We can't solve problems by using the same kind of thinking we used when we created them. Albert Einstein 34 In other words An ancient approach to emotional intelligence We can t strengthen emotional intelligence by simply increasing our information. Mindfulness refers to a 2500 year old training in attention and awareness. Mindfulness emphasizes training in awareness. Like emotional intelligence mindfulness training is primarily experiential rather than intellectual

7 Mindfulness The awareness that arises by paying attention on purpose with a gentle curiosity to the present moment. This natural capacity for awareness can be strengthened through practice. How awareness arises as we pay attention Exercise: Bringing attention to the sensations in the right hand, left foot then both hands. Discussion: Observing how attending lights up the awareness of sensation. 38 Meditation: Physical sensation of the breath Bringing attention to the physical sensation of the breath wherever this sensation is more prominent. Meditation on the Breath 40 Attending & Reattending to the breath Meditation on the breath Wandering to Thoughts, Emotions & Sensations Pleasant, unpleasant or neutral Awareness of wandering Reattending Natural, Effortless Capacity Attention has a quality or attitude: either critical harsh judgmental struggling or gentle curious inquisitive. What happens when we bring a gentle curiosity to whatever arises and then Gently shift attention back to the breath?

Noticing Wandering Insula Awareness of Wandering The Awareness Cycle As awareness of wandering arises, gently shifting attention frees us from any struggle.

Neuroimage (2012) 59:750-760 Ricard et al. Scientific American (2014) 311:38-45 Why is attending with gentle curiosity important for happiness?

8 Noticing Wandering Insula Awareness of Wandering The Awareness Cycle As awareness of wandering arises, gently shifting attention frees us from any struggle. This gentle attending and shifting is conscious and purposeful. Neuroscientists can now measure brain activity in each phase of this cycle. Attending Shifting Attention 43 Hasenkamp et al. Neuroimage (2012) 59: Ricard et al. Scientific American (2014) 311:38-45 Why is attending with gentle curiosity important for happiness? Attending in this way, influences the mental conditions in which thoughts, emotions and sensations become connected or shaped to produce the experience of each moment Mental conditions Thoughts, emotions and sensations spontaneously arise in mental conditions which are influenced by the focus, attitude and intention of our attending. Mindfulness practice strengthens a kind, curious, purposeful attitude of attention. This combination of focus, attitude and intention nurtures mental conditions which Mathieu Ricard describes as healthy or flourishing, enhancing ease and diminishing stress. Attitude Attention Thoughts, Emotions & Sensations Intention

9 Mental Conditions are like a chemical solution in which thoughts, emotions and sensations arise. Attention, attitude and intention all influence the mental conditions in which these thoughts, emotions and sensations arise. Attitude can be harsh and critical or curious and compassionate. Intention, the reason that we are attending, influences both where we focus our attention and the attitude of that attention. ( ant story ) In this way attention, attitude and intention reinforce each other. By training where, how and why we pay attention mindfulness allows us to cultivate mental conditions which influence how we organize thoughts, emotions and sensations to shape moment by moment experience Mindfulness trains Attention The Neuro-science What is the evidence that awareness from gentle curious attention changes the structure and function of the brain? Attitude Intention Neuroplasticity What we pay attention to and how we pay attention changes the structure and function of our brains. The brain is plastic. We are always shaping our brain, however, mindfulness offers us a choice to intentionally rather than unconsciously shape our brain with training. What we practice becomes stronger. Shauna Shapiro Ph.D. What do you want to practice? 9

Superhighway Habit of struggle and distress Country Road of Compassion

brain associated with memory and spatial navigation, the hippocampus, is

And the longer someone has been driving a cab in London, the larger and

57 Increased cortical thickness The insula, part of the cortex, processes

10 Superhighway Habit of struggle and distress Country Road of Compassion London The London Cabby studies: Research has shown that the part of the brain associated with memory and spatial navigation, the hippocampus, is bigger and more active in London cabbies than in the average person. And the longer someone has been driving a cab in London, the larger and more active their hippocampus. 57 Increased cortical thickness The insula, part of the cortex, processes sensory and emotional information. In meditators, after 8 weeks, the insula becomes thicker. (Lazar et al., 2005 (Lazar et al., 2005) 59 10

Pre- Frontal Cortex The amygdala generates positive and negative emotional signals.

Amygdala 61 Human telomeres lengthen Elissa Epel, PhD et al. 2014 ) Psoriasis heals faster (Jon Kabat-Zin et al.

, 2012 Increase in left PFC activity associated with optimism and stronger immune function after 8 weeks of mindfulness training.

11 Pre- Frontal Cortex The amygdala generates positive and negative emotional signals. Research at Stanford ( Goldin ) in social phobia showed decrease size and activity of the amygdala after only 8 weeks of meditation training. Amygdala 61 Human telomeres lengthen Elissa Epel, PhD et al ) Psoriasis heals faster (Jon Kabat-Zin et al., 2012) Studies Psoriasis heals faster after 8 weeks of meditation with improved immune function. Jon Kabat Zin et al., 2012 Increase in left PFC activity associated with optimism and stronger immune function after 8 weeks of mindfulness training. (Davidson and Kabat Zinn 2003) Recurrent major depression (Siegel Archives., 2010 PFC,Optimism & Immunity (Davidson, Kabat-Zinn, et al 2003) In recurrent major depression, meditation worked as well as medication. Siegel Archives., 2010 Human telomeres, the protein caps on end of genes, lengthen following 8 weeks of meditation. Elissa Epel, PhD et al Four Decades of Research Significant Effects on both Physical and Psychological Health 11

Mindfulness and Health Medical Benefits Psoriasis Chronic pain Fibromyalgia Cancer Multiple Sclerosis Tension Headaches Hypertension Immune Functioning Increased Telomerase Psychological/Behavioral

12 Mindfulness and Health Medical Benefits Psoriasis Chronic pain Fibromyalgia Cancer Multiple Sclerosis Tension Headaches Hypertension Immune Functioning Increased Telomerase Psychological/Behavioral Decreased Depression Decreased Anxiety Decreased Panic Attacks Decreased Insomnia Decreased Binge Eating Decreased ADD Decreased OCD Decreased Substance Abuse Smoking Cessation Research demonstrates that meditation decreases pathology. The original intentions of Meditation were not to reduce hypertension and panic attacks... Expanding the Paradigm Self-Awareness (Kabat-Zinn, 1996) Self-Regulation (Shapiro et al 2006) Empathy (Lesh, 1970, Shapiro et al 1998) Self-Efficacy (Kabat-Zinn, 1996) Happiness (Smith, Compton, & West, 1995) Sense of control (Shapiro, 1998; Astin, 1997) Spirituality (Shapiro, Schwartz, Bonner, 1998, Astin, 1997). Compassion (Self and Other) (Neff, 2010, Shapiro, et al, 2008). Moral Development (Nidich et al 1983) Cognitive Capabilities Attention (Jha et al, 2007; Slagter et al, 2007) Concentration (Murphy & Donovan, 1996) Creativity (Murphy & Donovan, 1996) Memory (Jha, Stanley 2012; Cranson et al, 1991) Academic Performance (Hall, 1999) Reduces Cognitive Rigidity (Greenberg et al, 2012) Ethical Decision Making (Shapiro, Jazzeri, Goldin, 2012) In 2013, over 2200 research studies on mindfulness Integrating Mindfulness and Compassion into the Helping Professions Mark Levine M.D. 12

13 Reviewing the a.m. session Mental Conditions are like a chemical solution in which thoughts, emotions and sensations arise. Attention, attitude and intention all influence the mental conditions in which these thoughts, emotions and sensations arise. Attitude can be harsh and critical or curious and compassionate. Intention, the reason that we are attending, influences both where we focus our attention and the attitude of that attention. ( ant story ) In this way attention, attitude and intention reinforce each other. By training where, how and why we pay attention, mindfulness allows us to cultivate mental conditions which influence how we organize thoughts, emotions and sensations to shape moment by moment experience Mental conditions Attention Mindfulness trains Attention Thoughts, Emotions & Sensations Attitude Intention Attitude Intention The Science of the Pleasant Why compassionate, gentle, curious attending to the neutral and the pleasant is important How attending to the pleasant builds healthy mental conditions

Chill monkeys & Worried Monkeys Human beings had two types of evolutionary ancestors : worried monkeys who thought there was a tiger behind every bush and chill monkeys who weren't so worried about

14 Chill monkeys & Worried Monkeys Human beings had two types of evolutionary ancestors : worried monkeys who thought there was a tiger behind every bush and chill monkeys who weren't so worried about the tigers. We survived as a species because we excelled at worry. Brain research is now showing that the default state of the brain is to notice, remember and react more intensely to the negative than the positive. As psychologist Rick Hanson notes, The brain is good at learning from bad experiences but bad at learning from good ones. In other words, our brains have a negative bias Observations about Negative Bias How the negative bias creates stress People really thrive when positive moments outnumber negative ones by at least a threeto one ratio. ( Sonja Lyubomirsky PhD) Intimate relationships usually need at least five positive interactions to balance every negative one. ( John Gottman PhD ) If 7 things go well in a day and 1 goes poorly, what do we remember most that night? Pausing into Pleasant The negative bias creates stress because it focuses our attention on negative thoughts. Over millions of years our biologic systems developed to respond to acute immediate danger such as the lions and tigers that might eat us. Our innate fight or flight response is a cascade of stimulating alerting neuro hormones, such as adrenalin and cortisol, which prepares us to fight or flee by increasing heart rate, respirations, blood flow, muscle tension and vigilance. However, we are biologically unprepared for chronic stress. In his book, Why Zebras Don't Get Ulcers, neuro psychologist Robert Sapolsky PhD notes that the fight or flight response is designed to react to an immediate danger that is followed by periods of rest. Our bodies are not designed to tolerate the repeated daily stress from overreacting to our own thoughts as if they were dangers. A practice for restoring healthy mental conditions Let s begin by pausing and Paying Attention to a Pleasant or Neutral* Sensation then Staying with this sensation for one or two breaths. As we wander, gently shifting attention back to the neutral or pleasant sensation. Pausing and staying with the feeling of pleasant or neutral sensations is a way of retraining our negative attention and changing our attitude towards our own thoughts. * Noticing how attending to a neutral sensation also supports a gentle curious attitude of attention and sometimes also reveals what is pleasant in this neutral moment

15 Attending to the Pleasant Discussion: Rebalancing the negative bias Attending to the pleasant is one way of rebalancing our negative bias. We can train ourselves to feel the positive as well as the negative. By staying briefly, for a breath or two, with positive sensations, we allow our bodies to receive the benefit of pleasant moments and nurture positive mental conditions. Bringing a gentle curiosity to each moment is like adding an alkaline substance to an acid solution. We can neutralize the acidity of stressful mental conditions of our mind. When we feel the sensations of pleasant moments, our bodies decrease the production of stress hormones such as adrenalin and cortisol and release neuro hormones associated with ease such as oxytocin and endorphins. 86 Two different effects So we have two different effects: a short term immediate effect of enriching the moment and a longer term effect of rebalancing our mental systems. In any moment, this rebalancing of our negative bias requires only a few breaths of attending to whatever pleasant or even neutral sensation is available.later, we shall see how even attending to the negative with a particular attitude of gentle curosisty can rebalance our mental conditions. Practicing Again Again let s pause Paying attention to a pleasant or neutral sensation Staying with this sensation for one or two breaths. When we wander, gently shifting attention back to the neutral or pleasant sensation Meditation : An image that makes you feel happy 5Practices to nurture positive mental conditions Meditation Mindful Listening Journaling Bring to mind an image that makes you feel happy in whatever way. This might be the image of a person, a pet, a place or any happy recollection Observing whatever image arises and then feeling the sensations in the body now. As the mind wanders, noticing and gently returning to that image, and then back to the sensations

Mindful Listening For the listener, simply listening without speaking and as we listen bring attention to the physical sensations in the body.

And for both noticing as the mind wanders in bringing the tension back to the felt sense of speaking or listening. Dyad Mindful listening has many benefits & applications What do we notice?

16 Mindful Listening For the listener, simply listening without speaking and as we listen bring attention to the physical sensations in the body. For the speaker simply speak with whatever comes to mind and allowing ourselves to pause into the silence when nothing comes to mind. Feeling the physical sensation of speaking and pausing. And for both noticing as the mind wanders in bringing the tension back to the felt sense of speaking or listening. Dyad Mindful listening has many benefits & applications What do we notice? Perhaps the most important thing we ever give each other is our attention... A loving silence often has far more power to heal and to connect than the most wellintentioned words." Rachel Naomi Remen 93 Writing down our thoughts anchors our attention into the felt physical sensations of the writing: the pen, the paper, seeing the words, feeling the movement of our fingers, hand and arm. Attending in this way encourages a gentle curious attitude towards our thoughts and emotions and frees us from our tendencies to judge, compare, and criticize our thoughts. This freedom encourages an unimpeded flow of thought, creativity and insight. Journaling 16

17 Journal Dyad Describe five things that you appreciate about yourself. Be specific and include some details or examples. As you write, occasionally pausing and feeling whatever sensations might be in the body now. Share in whatever detail you choose what you wrote. Then returning to the writing Emotions are contagious. For the listener, simply listening without speaking and as we listen bring attention to the physical sensations in the body. For the speaker simply speak with whatever comes to mind and allowing ourselves to pause into the silence when nothing comes to mind. Feeling the physical sensation of speaking and pausing. And for both noticing as the mind wanders in bringing the tension back to the felt sense of speaking or listening. Our brain is wired to feel in our body the emotions that we observe in others moment by moment. 100 Dyad: Gratitude Popcorn discussion What do you feel grateful for? Answer Attending to Sensation Thank each other What do you feel grateful for? What did we notice? With each answer pausing and feeling into the felt emotional and physical sensations in the body now. If the mind wanders, gently noticing. Also, pausing into silence as needed

Self- Regulation Part Four Exploring Negative Mental Reactions Thus far we have been learning how gentle curiosity and embodiment (connecting to physical sensations) cultivate healthy mental

Next, we will explore how the awareness cultivated by curiosity and embodiment can free us from the impact of negative stressful thoughts. 104 Can we bring the same gentle curiosity to thoughts?

18 Self- Regulation Part Four Exploring Negative Mental Reactions Thus far we have been learning how gentle curiosity and embodiment (connecting to physical sensations) cultivate healthy mental conditions in which thoughts, emotions and sensations arise. We have also explored how this curiosity and embodiment enriches moments and restores mental balance. Next, we will explore how the awareness cultivated by curiosity and embodiment can free us from the impact of negative stressful thoughts. 104 Can we bring the same gentle curiosity to thoughts? Often our attention wanders into thoughts. What happens when we make thoughts the object of attention. 105 Meditation on thoughts: Observing vs. Caught Discussion What happens when we bring this gentle curiosity to thoughts? Thoughts like leaves or clouds Neutral, pleasant or unpleasant Observing is effortless and innate. Noticing when we are observing thoughts and when we are caught in our thoughts about the thoughts. Noticing how we effortlessly wander from observing to caught, how we notice when we wander and effortlessly shift back to simply observing our thoughts

19 Journal & Dyad Bring to mind a mildly distressing situation Noticing the thoughts that come to mind. Record those thoughts. Attending to the sensations in your body now. Dyad: describing the situation, thoughts, emotions & sensations. 110 Struggle In our thought logs we can see how we sometimes struggle with our own negative thoughts as if they were real threats. This struggle triggers a reinforcing chain reaction of negative thoughts and emotions which cause us to suffer. We might also notice how thoughts & emotions reinforce each other and how the more we struggle, the more we suffer. We cannot avoid or deny a distressing thought or emotion. We might also notice how we cannot avoid or deny a distressing thought or emotion. In order to avoid a thought we must pay attention to it. Struggling with a thought actually intensifies the thought Suzuki Roshi Suffering = Pain * Resistance Freedom from distressing thoughts & emotions requires a change in attitude. This gentle curious mindful attitude changes the mental conditions in which thoughts, emotions and sensations arise. In this gentle nurturing environment distress slowly over time dissipates and transforms

20 Negative Bias Our brain s negative bias not only means that we are more attentive to negative events but also that we are more aware of even minor negative moods and thoughts than we are of positive moods and thoughts. As psychologist Dr. Mark Williams notes All mood fluctuates naturally. It is not the mood that does the damage but our mental reaction to our own mood. Our natural bias to focus on and then struggle with our own negative thoughts and emotions can sometimes turn moments of discomfort into chronic feelings of anxiety, depression and pain Practicing the Tool: 3P s Working with Distress Bring to mind a mildly distressing situation Also bring attention to what you are feeling in the body. Then Pausing into the breath sensation then Paying attention to thoughts, emotions and sensations then Pondering: What s really important here? Pause into the Breath Pay Attention Ponder what is Important Discussion Healing Notice that the benefit of these practices does not depend on what arises during the practice pleasant, unpleasant or neutral. We are able to cultivate healing mental conditions with whatever thoughts, emotions or sensations arise. The real source of happiness and stress in our lives is our own mental reaction to situations which includes our thoughts about our thoughts. By cultivating a different attitude of attention to our own thoughts and emotions pleasant, unpleasant or neutral we can strengthen healthy conditions of the mind that are the foundation for happiness and for flourishing

21 The Guest House 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're a crowd of sorrows, who violently sweep your house empty of its furniture, still, treat each guest honorably. 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 whoever comes, because each has been sent as a guide from beyond. Rumi 21

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

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