Welcome! Explain outline for today: introduction, exercise, overview of the course, body scan, & practice for the next week.

Transcription

1 1 MBCT Session 1: Automatic Pilot Welcome! Explain outline for today: introduction, exercise, overview of the course, body scan, & practice for the next week. Introduction Especially: name, how much previous experience of meditation, what hope to get from course. In pairs, or if planning to meet in the same small groups each week: Divide into groups with a team member in each group and do the introductions in small groups ( Home groups ). Raisin exercise Discuss in groups of 4 or in home groups. Points to draw out: We usually eat on autopilot. Compare e.g. driving home and you don t recall how you got there, or finding yourself in a room and you can t remember what you came for. Automatic pilot is dangerous if you have suffered from depression: o You may not notice bits of negative thinking. o If this is unchecked it may lead to stronger feelings of sadness, building up into depression. Mindfulness means deliberately paying attention to the patterns of the mind, and learning to shift when they are unhelpful. Mindfulness brings choice. Un-mindfulness means you miss out on some of the richness of life, and it allows depression to creep up on you (when you mind is elsewhere). Overview Three steps to MBCT: developing Awareness, Being with experience & making skilful Choices (so that we don t become depressed). First half of the course is mainly about developing awareness and stepping out of autopilot. Body scan practice Explain what we do in the body scan (i.e. how we do it) and some of the rationale: The emphasis of the course is on developing mindfulness (i.e. a gentle, interested awareness) in many different ways; today we focus on the body. This has two main advantages:

2 2 1. It can help to deal with emotions. Depression is associated with, for example, a stooped posture. Noticing that our posture is stooping may be early feedback that we are moving towards depression again. 2. Often people who are depressed try to think their way out of problems. However this thinking can just reinforce the low mood. How we are holding our experience in the body can give a useful fresh perspective. What happens in the body scan is that we: 1. We systematically bring attention to sensations in the body. This helps us to increase our awareness of bodily sensations (with the above 2 advantages). 2. Our mind will tend to wander off. When it does we notice where the mind has gone to. This helps us to get to know our mental habits more clearly, and to step out of being in automatic pilot mode (with its attendant dangers for people at risk of recurrent depression). 3. We then return our awareness to body sensations. This helps us to not get stuck in our head, and helps us to develop the skill of being able to more our awareness around. Tea break Review practice just completed (discuss in pairs or home groups) NB Let people know how long they have to discuss to help ensure everyone gets a chance to speak. Take feedback from the whole group Enquiring into people s experience to guide self-learning and model kindly curiosity, and where appropriate responding to questions. Practice between sessions Important: it is insufficient just to attend course. Learning a skill. No need to enjoy it, just do it! 1. Bodyscan audio 2. Complete practice record form 3. One mindful activity (eg washing up, showering, walking to bus, etc.) 4. Eat at least one meal mindfully Discuss in pairs or home groups: which routine activity you will do when will listen to audio obstacles to practice how to overcome the obstacles Give out handouts and practice for the week

3 1 MBCT Session 2: Automatic Judgements Theme (Give a brief introduction) During the body scan (or any mindfulness practice), when we notice that our mind has wandered off three benefits accrue. Firstly by deliberately attending to where the mind has gone to, we step out of being in automatic pilot. Secondly we make a shift from doing mode (goal-orientated, pressurized and potentially stressful) to being mode (appreciative, receptive, opening to new possibilities). Thirdly we see more clearly the chatter of the mind (especially its automatic judgements), and how it controls our reactions to everyday events. We may not normally notice the judgements, because they are habitual, yet they can completely grip the mind and convince us. Our judgements mean that we don t really see our experience (a judgement is an interpretation) and they can take us down routes in our minds that lead to difficulties. Body Scan Practice Aim to shift from doing to being mode. Notice automatic judgements & try to let go. Review practice just completed (discuss in pairs or home groups) Review practice done over the past week (discuss in small groups) (i.e Body scan & mindful activities) Take feedback from the whole group Enquiring into people s experience to guide self-learning and model kindly curiosity, and where appropriate responding to questions. Themes emerging: Am I doing it right? Instruction is just to do it - you don t have to enjoy it. Painful sensations. Just pay attention to sensations rather than think about if. The conditions weren t right. Can t prevent unpleasant things from happening. Wandering mind. It is in the nature of the mind to wander. Beware of seeing it as something wrong when the mind wanders. Body scan is opportunity to disengage from old habits of mind (again & again & again).

4 2 I was bored / irritated. Approach with curiosity (when did it arise; was it constant or fluctuating; how long did it last; what other thoughts, feelings and bodily sensations were drawn into it?) It was great / I fell asleep. Not trying to achieve a particular state; although when allow body to be it can sometimes relax. But striving after some goal can get in the way of just being with whatever experience arises. I am trying my best, but I don t get it. Not striving for any goal, just being with experience. Sometimes the best way to change emotions can be to try not to change them (without that being a subtle way to fix). I got too upset. Thinking about emotions can distance you from them, but prevents them being processed. Finding a balance between retreating from bodily sensations, and being blown away. Tea break Thoughts and feelings exercise Set up as if for meditation notice responses to following scenario: You are walking down the street, and on the other side of the street you see somebody you know. You smile and wave. The person just doesn t seem to notice and walks by. Notice thoughts, feelings, images, and body sensations. Write up on flipchart. Points to draw out: A (situation) B (thoughts) C (feelings); however often don t notice B A happens and end up with C. The more we can be aware of our (automatic) thoughts, the less we will be carried away the cascade of emotions. How we interpret the event will affect how we feel. Our interpretation reflects what we bring to the situation as much as its objective content. Also how we interpret the event will be affected by how we are feeling (what thoughts would you be most likely to have if you were still depressed?) That interpretations of the same situation vary over time or between people indicates thoughts are not facts. Negative thinking is often a warning sign of oncoming depression. I.e. notice how distorting depressed mood can be. In future note negative thinking and consider if may be distorted by a depressed mood.

5 3 Awareness of pleasant events All experience is coloured by being pleasant, unpleasant or neutral (hedonic tone). We are often powerfully affected by this feeling tone, and it can trigger rumination / the mind to wander especially automatic judgements of our experience and how it should be. It is important to become aware of these pivotal moments. Bringing mindfulness to pleasant events can be a way of experiencing them without adding any extra thoughts (eg wishing it to go on forever; wondering why it doesn t happen more often). Help notice what (even slightly) positive things may (already) be occurring. Become more aware of the thoughts, feelings and body sensations accompanying pleasant experiences. Aim to link awareness of the body to awareness of the body s reactions and responses to everyday events. Give out handouts and ask people to fill in a pleasant event from the last 24 hours. NB Some people can find it hard to distinguish the different elements of their experience in this way. If helpful, explain that often there is just a fused whole ensemble, but with practice they may find that they can start to distinguish different elements. (10 Minutes) Mindfulness of breathing Find a comfortable posture that embodies dignity and alertness. Pay attention to the physical sensations of breathing. Each time the mind wanders off, note what took it away and return to the breath. Implicit message: it is just as valuable to become aware that the mind has wandered off and bring it back, as it is to remain focused on the object of attention. Describe practice for the week

6 1 MBCT Session 3: Mindfulness of Breath Theme / recap (Give a brief introduction) Last week we started noticing judging mind. In judging mode we often compare how we are faring with our standards for happiness that we set ourselves this can lead to unhappiness. We try to solve our problem (eg why we are unhappy this morning) by thinking / ruminating. People who have suffered from depression are more prone to rumination going round well-worn grooves in the mind. Studies show that while ruminating you are less likely to be able to solve problems (compare Eureka! in the bath when you are not trying to solve the problem). Paying attention to bare sensations (of the breath, the body or sounds) shifts us out of doing / judging mode and helps us to become aware of unhelpful patterns. The breath is a helpful object to pay attention to: It brings us into the present instead of (worrying about) the past or (planning) the future. It is always there, and a marker of our emotional state. It helps us to attend to something that is the opposite of goal orientation. Repeated practice helps us let go of ruminative thinking (and can act, temporarily, as a distraction from it). It helps us to dis-identify with thoughts thoughts are just thoughts. Mindful exercises and Mindfulness of breath and body Explain rationale of practices. Lead exercises and explain how to do the mindfulness of breath and body before leading it through. Rationale includes: Different approaches to being mindful; shifting from doing to being mode; and opportunity to notice automatic judgements and try to let go of them. 1. Swing from side to side 2. ditto turning foot out 3. Rotate feet 4. Rotate knees (knees together) 5. Circle with knee (lifting leg up) 6. Rotate hips 7. 3 circles with whole arm (each way) 8. Big circles 9. Rotate head 10. Reaching up with alternate hands + pausing with arms out 11. Loops with arms 12. Holding sphere / tree hug 13. Close eyes and stand still

7 2 Review practice just completed (discuss in pairs or in home groups) Review practice over the last week (discuss in small groups) (I.e. body scan, mindfulness of breathing and mindful activities) Themes emerging: Trying to control the mind. Don t! Let things be & return to the breath. Curiosity & kindness. Try to bring this to noticing how & where the mind moves. Painful sensations. Just pay attention to sensations rather than think about it, or just note the sensations are there and return to the breath. Strong emotions. Hold in awareness, e.g. here is fear rather than I m terrified of making this presentation, or oh, anger is here rather than I m fed up with her talking to me like this. Automatic thoughts. Recognize the patterns and don t criticize yourself for having the thoughts. Tea break Review practice Pleasant events diary (write up in separate columns: thoughts, body sensations and emotions). Themes: Trivial moments contain elements we are not usually aware of. Distinguishing between thoughts, body sensations and emotions can be a revelation. Awareness of body sensations can help with recognizing subtle emotional changes. 3-minute breathing space Importance of generalizing from formal meditation to daily life (therefore mindful activities, today mindful walking and breathing space). 1. Awareness: Set up body, close eyes. Where am I? What s going on? (especially any discomfort). 2. Gathering: Attend to breath gathers scattered mind, having stepped out of autopilot. 3. Expanding: Attention to whole body; as if whole body breathing. Discuss in pairs, how and when will do it 3 times each day.

8 3 Mindful walking Increasing body awareness is helpful: It gives a different place from which to view thoughts & emotions. It helps to change emotional experience and gives more choice on how to respond. The body is involved in the feedback loop maintaining negative moods; e.g. tension with anxiety, wilting with depression. Body awareness promotes awareness of emotions and the choice to change them through changing the body. Aim to link awareness of the body to awareness of the body s reactions and responses to everyday events. Give out handouts and practice for the week Including pleasant and unpleasant events diary. The unpleasant events diary is an opportunity to notice triggers that may lead to a worsening in mood how thoughts, emotions and body sensations can cohere

9 1 MBCT Session 4: Staying Present Theme / recap (Give a brief introduction) Observing our mind we can notice two main tendencies: to chase after pleasant experience (craving / attachment) and to push away unpleasant experience (aversion) often by distraction, ignoring or ruminating over. Although these strategies can sometimes work, they are based on wanting things to be other than how they are, and this can often lead to suffering. Mindfulness offers a different strategy, which is to be present with our experience, rather than trying to make it change. Paradoxically, this can lead to fresh perspectives, instead of reacting in habitual and often unhelpful ways. In learning to be present with our experience, we begin to move onto the second step of MBCT: being with experience (especially difficulties), although the main emphasis is still developing awareness (first step) and we move more fully onto the second step next week. In the second half this week we start to explore the territory of depression. NB Mindfulness differs from rumination / preoccupation which: Involves thinking rather that direct experience (especially body sensations) Is based on judgement things should not be like this Tends to trigger other thoughts / memories e.g. getting into listing reasons to be angry or feel hard done by, or this always happens to me Mindfulness of breath, body, sounds and thoughts (40 minutes approx timing, leave sufficient time for discussion) Explain how to do this practice. Review practice just completed (discuss in pairs or in home groups) Review practice done over past week (discuss in small groups) I.e. mindfulness of breathing, mindful walking and breathing space.

10 2 Take feedback from the whole group Enquiring into people s experience to guide self-learning and model kindly curiosity, and where appropriate responding to questions. Themes emerging: If going well. That is nice, but the aim is to pay attention equally when it is boring or difficult. Beware getting attached to having good meditations which will pass and then feeling frustrated when they are not good. Review practice pleasant and unpleasant events diary Write up in separate columns: thoughts, body sensations and emotions. Themes: Notice events that are not inherently ve or +ve, but are affected by mood / interpretation. Watch out for aversion to ve mental events, leading to a vicious circle. Notice underlying wanting things to be different. Tea break Starting to explore the territory of depression: Automatic thoughts questionnaire If wish: Put a circle for how you are now and a cross for how you were at your most depressed Or notice which ones have most changed or ones that you were 100% convinced of, but are not any longer Look for hit list of favourites DSMIV diagnostic criteria Exploring the territory of depression can help to see how things change, as well as what the mind can do to you. Some people may find that what they thought were personal failings are actually symptoms of depression. Negative thoughts are part of depression. Depression includes a whole constellation of symptoms. Review MBCT model Depression comes in a constellation of symptoms: emotions (depressed, irritable); thoughts ( I am worthless, This will never change ); bodily sensations (tiredness, churning in stomach); and other experiences (e.g. poor sleep, anhedonia). They all get associated with each other and one symptom e.g. feeling tired can lead to others until the whole lot re-constellate. Mindfulness offers a way of stepping out of autopilot, and not reacting negatively to difficult experience.

11 3 3-minute breathing space coping [Try to use when someone is upset or people are distracted.] Try to use the breath space whenever there are unpleasant feelings / a sense of tightness or holding / feeling overwhelmed. Use the full 3 minutes, or just momentarily if circumstances don t allow. The aim is not necessarily to feel better, but to be with the experience (and not make it worse), which may offer alternative perspectives. 1. Awareness: Set up body, close eyes. Where am I? What s going on? (especially any discomfort). 2. Gathering: Attend to breath gathers scattered mind, having stepped out of autopilot. 3. Expanding: Attention to whole body; as if whole body breathing. Give out handouts and practice for the week Short sitting (optional if time)

12 1 MBCT Session 5: Allowing / Letting be Theme / recap (Give a brief introduction) The first half of the course has emphasised bringing awareness to where our mind wanders; using awareness to return us to the present; and using the breath as a vehicle to more our attention around. In the second half we will be using these skills to help to prevent relapse into depression and to create a different relationship to our experience especially unwanted experience. We will be learning to cultivate acceptance, allowing and letting be, rather than expending energy trying to keep unwanted experience out. Acceptance is not the same as resignation which implies passivity and a sense of helplessness. Acceptance is about letting things be; finding out what s happening, before rushing in to try and fix things. The advantages of acceptance are: 1. Paying attention intentionally, we prevent our attention being hijacked by passing thoughts and moods. 2. Changing our basic stance from not wanting to opening, we help to break the chain of habitual reactions that leads towards depression. E.g. I am stupid to think this. I should be able to cope with this. 3. It provides an opportunity to check the accuracy of our thoughts, e.g., If this goes on any longer, I shall scream. Mindfulness of breath, body, sounds and thoughts (40 minutes approx timing, leave sufficient time for discussion) Explain that during this meditation we start to practise the second step of being with more fully. Cultivating acceptance / being with during the meditation: At some point during each of the 4 stages of this practice suggest to people that when the mind is repeatedly pulled towards a particular experience (thought, emotion, bodily sensation) or there is an emotionally strong experience that they do some of the following: 1. Deliberately bring attention onto that experience. 2. Bring awareness to the body and how that experience is being held in the body. Instead of grasping tightly onto pleasant experience or pushing away unpleasant experience, try to hold the experience with a sense of allowing and letting be.

13 2 Letting go of aversion in the body, tension. Breathing with sensations; softening, opening. Exploring edges. Noticing intensity increasing & decreasing. An attitude of gentle curiosity, friendliness. Saying, It s OK. Whatever it is, it s OK. Let me feel it. 3. Return to breath once experience is no longer pulling attention. During the 4 th stage (thoughts) suggest that if people have not already been practising being with their experience (as above) that they now try bringing a problem to the workbench of the mind, to practise relating differently to it. Use any difficulty that you are experiencing right now, or bring to mind something in your life that is bothering you (e.g., at home or at work). [Then relate to as above.] If no strong sensations arise in the next few minutes, then try it with any sensations. Review practice just completed (discuss in pairs or in home groups) Review practice done over past week (discuss in small groups) I.e. sitting meditation, breathing space regular & coping Take feedback from the whole group, (as usual). Tea break Read poem by Rumi Gives a flavour of acceptance. Kum nye flying An opportunity to be with experience and practise acceptance. Modified breathing space Aim to be with experience in the body; opening to difficult experience. 1. Awareness. Notice experience; acknowledge & describe. 2. Redirecting attention. Redirect your full attention onto the breath following breath all the way and all the way out (or you can count, as in the first stage of the mindfulness of breathing). 3. Expanding attention. Allow your attention to expand to the whole of the body, especially to any difficult sensations. Breathing with them; softening and opening with the outbreath; saying, It s ok, whatever it is, it s ok. Let me feel it. [NB the modification is that it includes opening to difficulties, especially as these are felt in the body] Give handouts and practice for the week Short sitting (optional if time)

14 1 MBCT Session 6: Thoughts are not facts Introduction exercise Notice what goes through your mind as I say the following sentences: John was on his way to school. He was worried about the maths lesson. He was not sure he could control the class again today. It was not part of a caretaker s duty. Ask for feedback. We interpret bare information all the time. Sometimes this can get us into difficulties. Compare this couple: A: What would you like to eat, fish or chicken? B: I don t mind. Later at a counselling session, A remembers: I asked him what he wanted to eat and he said he didn t care. B: She asked me what I wanted, and I said I would like anything she wanted to cook for me, I was trying to be helpful. i.e., different interpretations of the same events. In depression we tend to interpret events in a negative and denigrating way like we are running a propaganda campaign against ourselves. All future events can reinforce this; we ignore contrary information, and consistent information we notice. In CBT the explicit activity is to notice thoughts, look for evidence for and against them, and challenge the content. When CBT is successful a change takes place on an implicit level, which is that there is a change of relationship to thoughts. What is implicit in CBT, is made explicit in MBCT. Instead of relating from the thoughts (being completely identified with them), we relate to the thoughts as objects of awareness. This is what we have already been practising. With trivial thoughts, just bringing them into awareness can lead to them disappearing. However when thought mesh with one s prevailing mood, they can become more compelling, e.g. I can t do this, I may as well give up. It is like boarding a train. We get carried off to some other destination, which can lead us to a different mental state when we come to. However we still practise seeing these thoughts as just thoughts, noting them and letting them go (as best as we can).

15 2 Practising noticing thoughts we can imagine them as: Images on a cinema screen Actors entering and leaving a stage Clouds in a vast sky (sometimes looming darkly!) Waves on the ocean We can wait for them like a cat at a mouse hole. If thoughts are very compelling or there are lots without any spaces, we can: Notice where they most affect the body, and focus on those sensations. Notice the emotions associated. Imagine the thoughts are like a waterfall with us standing behind the waterfall, seeing its force without getting dragged in. We can start to recognize repeated thought patterns as like tapes in the mind. They will keep coming back, but we can try to not take them too seriously or regard them as minor inconveniences until the batteries run down. Mindfulness of breath, body, sounds and thoughts (40 minutes approx timing, leave sufficient time for discussion) As last week, during each stage guide people to practise staying with recurrent or intense experiences. During the meditation remind people of the different ways of responding to compelling thoughts (above). Review practice just completed (discuss in pairs or in home groups) Review practice done over past week (discuss in small groups) I.e. sitting meditation, breathing space regular and coping Take feedback from the whole group Enquiring into people s experience to guide self-learning and model kindly curiosity, and where appropriate responding to questions. Tea break Alternative viewpoints exercise Read each scenario in turn, notice your immediate thoughts and responses, then discuss in pairs when done both. 1. You are feeling down because you ve just had a quarrel with a colleague at work. Shortly afterward, you see another colleague and they rush off quickly, saying they couldn t stop. What do you think? 2. You are feeling happy because you and a work colleague have just been praised for good work. Shortly afterward, you see another colleague and they rush off quickly, saying they couldn t stop. What do you think?

16 3 Our frame of mind will affect our how we interpret the same situation. If we are in a negative mood there is a danger that we can get trapped by a negative interpretation: negative mood leads to negative thoughts, leads to negative mood. It is important that we recognize our thoughts as interpretations, not facts, even when they are compelling. In meditation we try to notice thoughts as passing events. We notice briefly its content and emotional charge, but try not to get caught up in it. When thoughts get the better of us the first step is to take a breathing space (even a very brief one). This is like opening a door, through which we can see different options: 1. We can watch thoughts come and go without needing to follow them. 2. We can view all thoughts as mental events, not facts (even if they have a strong, compelling feeling associated with them). 3. We can write thoughts down. This gives a pause, and writing can make them less overwhelming. 4. We can ask, Did this thought pop into my head automatically? Does it fit all the facts? Is there something about it I can question? 5. Notice the feelings behind it. 6. Notice the body sensations associated with it. Give out handouts and practice for the week Only two more sessions, so starting to build up your own practice. Short sitting (optional if time)

17 1 MBCT Session 7: How can I best take care of myself Theme / recap (Give a brief introduction) The three steps of MBCT are developing awareness, being with our experience and making skilful choices. This week we move onto the third step making skilful choices. Once we have brought awareness to our experience, we know what is going on, we can then chose how best to respond to the situation. Intentionally choosing to do something is different from fleeing from our experience in a habitual way, which may only exacerbate the difficulties. In the second half of the class we shall look at the sort of activities that can help combat depression. Mindfulness of breath, body, sounds and thoughts (40 minutes approx timing, leave sufficient time for discussion) Working with difficulties in the meditation / deliberately bringing in a difficulty to work with. When the mind is repeatedly pulled towards a particular experience (thought, emotion, bodily sensation) or you are aware of a particular difficulty in your experience: 1. Deliberately bring attention onto that experience. 2. Bring awareness to the body and how that experience is being held in the body. Instead of grasping tightly onto pleasant experience or pushing away unpleasant experience, try to hold the experience with a sense of allowing and letting be. Letting go of aversion in the body, tension. Breathing with sensations; softening, opening. Exploring edges. Noticing intensity increasing and decreasing. An attitude of gentle curiosity, friendliness. Saying, It s OK. Whatever it is, it s OK. Let me feel it. 3. Return to breath once experience is no longer pulling attention. In the last stage if no difficulties have so far arisen, try bringing a problem to the workbench of the mind, to practise relating differently to it. Bring to mind something in your life that is bothering you (e.g., at home or at work). [Then relate to as above.] If no strong sensations arise in the next few minutes, then try it with any sensations.

18 2 Review practice just completed (discuss in pairs or in home groups) Review practice done over past week (discuss in small groups) I.e. sitting meditation, breathing space regular and coping Take feedback from the whole group Enquiring into people s experience to guide self-learning and model kindly curiosity, and where appropriate responding to questions. Tea break Taking Action To Prevent Depression Once we are depressed we can find 101 reasons not to act, so it is important to have helpful activities as part of our daily routine and to be prepared when the warning signs of depression appear. Even when we are not depressed, action tends to precede motivation (we may not feel like doing something until after we have started doing it) but this is especially true when we are depressed. Also tiredness is a part of depression, and that too can make it hard to act. When we are well, if we become tired, resting can refresh. However when we are depressed and feeling tired, resting can lead to feeling even more tired. Exercise: For a typical working day, write down the activities you do. Of these note which ones lift your mood, nourish you, increases your energy (up activities), and which ones lower your mood, dampens your spirits, drains your energy (down activities)? In pairs: Discuss how you could change what you do so that for up activities you do more of them or are more aware of them (look for spaces even amid the busyness) down activities you do less of them or less frequently Feedback If we are sad there are two types of activities that can help lift our mood: Activities that bring pleasure (P) and activities that give us a sense of satisfaction or mastery (M). Depression can undermine taking action because it is harder to enjoy things and you are less likely to feel like doing it, but nevertheless taking action can still help to help with mood. Now mark the list made earlier with either a P or an M.

19 3 Feedback When you notice your mood goes down: 1. Take awareness to the breath (i.e. take a breathing space) 2. Choose either - to focus on the thoughts (be with the thoughts as thoughts, as in the last session) - an activity (i.e. something that might lift your mood) as an experiment; don t expect miracles; try a range of different things, not just the familiar few The more frequently you have been depressed, the more quickly depression gathers again. Therefore it is important to recognize the first signs that can lead to a recurrence these are called Relapse Signatures, and are unique to each individual. Exercise: In groups discuss what are the warning signals of an impending relapse? [Write some up on a flipchart.] Reflect on what in the past has prevented you from noticing and attending to signs of a relapse (e.g. hopelessness is part of depression). How can I include others in an early warning system? Develop an action plan: 1. Take a breathing space. 2. Gather yourself as best as you can: choose a practice from the course, remind yourself of something you heard or read or could now re-read. 3. Do some activity that in the past led to pleasure or mastery (even if it seems futile now). Give out handouts and practice for the week Select your own practice Breathing space (regular & coping) Develop an early warning system } we will discuss these Develop an action plan } next week Breathing space / mindful walking / short sitting (optional if time)

20 1 MBCT Session 8: Using what has been learned to deal with future moods Theme (Give a brief introduction) The essence of the course has been to find skilful ways of responding to relapseassociated automatic thought patterns. Often the skilful response is to do nothing. Pushing away unpleasant experience, paradoxically, often maintains it. Holding our experience in awareness prevents automatic unhelpful mental habits coming into play; allows wise mind to operate and clarify; and can help us to find the appropriate action to take, if any. Body scan practice 1. An opportunity to compare this with the start of the course. Review practice just completed (discuss in pairs or in home groups) Review practice done over the past week (discuss in gropups) I.e. practice of their own choice; breathing space; relapse prevention plan early warning system and action plan. LIST some examples of relapse prevention plans and take questions Tea break How MBCT fits into other meditation taught at the LBC Four loose categories of meditation: 1. Receptive receptive attention to experience (main emphasis of MBCT, also just sitting / pure awareness) 2. Concentrative calms and focuses the mind (e.g. mindfulness of breathing) 3. Generative develops qualities (e.g. mettā bhāvanā) 4. Reflective contemplates a theme (e.g. impermanence)

21 2 Categories overlap, so there is a receptive element to all practices. Attendees on the MBCT course can learn the other practices, but still bring a more receptive attitude to them in their own practice. Review course (for their benefit) + complete evaluation and WHO forms (for our benefit) Discuss in groups where they will go from here (using important reasons from review form). Provide information on next KBT course and Breathing Space weekend retreat. Final feedback / discussion Give out handouts Final sit (e.g. 3 stage mettā bhāvanā self, everyone on the course, the universe)