Mindfulness

Elizabeth Winder interviews Jini Lavelle

[Biodata and picture of Elizabeth Winder will be found by clicking here]

'I can feel guilty about the past,
apprehensive about the future, but only
in the present can I act. The ability
to be in the present moment is a
major component of mental wellness.'

Mindfulness, being present in the moment and being aware of one's physical and mental experience in the moment,  is a core concept in much eastern philosophy. Meditation techniques have become part of some western psychotherapy approaches, and their impact is now the subject of some western medical research, particularly with relation to their impact on mental health conditions. Nurturing Potential sub-editor Elizabeth Winder interviews Jini Lavelle, a therapist trained in Mindfulness who runs regular courses in Mindfulness for Oxfordshire Mind.

EW: First of all, can you describe what Mindfulness is, and how the meditation techniques have become part of western medical practice?  

JL:   Mindfulness training develops conscious awareness and focused attention. This enables us to become more aware of our behaviour and interaction, and to respond skillfully to events in our lives and to past patterns of behaviour. Dr. Jon Kabat-Zinn's definition of Mindfulness  is 'Paying attention in a particular way; on purpose, in the present moment, and non- judgementally". He founded the stress reduction clinic at the University of Massachusetts Medical Center about 25 years ago. He himself practiced meditation, and he set up the clinic to treat chronic medical cases which had exhausted known treatments using the Eastern practice of meditation. Since then it has been used for all forms of chronic problems including stress, anxiety, chronic illness, pain, cancer, heart disease and depression.  

Research followed on the programme that had been developed, and the results were very effective.  This is self-help, self-therapy, and people felt they were in control.  The programme expanded to the general public, into education, business, ethnic minority communities, with specialised programmes for different groups.  In the States judges have their own programme once a year. People were really empowered by being able to treat themselves, rather than passively accepting treatment. 

EW:  I believe there are two main types of technique, Mindfulness based stress reduction, and Mindfulness based cognitive therapy. How do these differ? 

JL:    Stress is the cause of a great deal of physical and mental illness. While John Kabat-Zinn was working on physical illness, a team of clinical psychologists, John Teasdale at Cambridge University, Mark Williams then at Bangor University, and Zindel Segal at the University of Toronto investigated the use of Mindfulness Based Stress Reduction (MBSR) to prevent relapse in depression. They adapted and incorporated the programme developed at the University of Massachussetts  into Mindfulness Based Cognitive Therapy (MBCT), in which there is an emphasis on specific techniques for depression relapse. While cognitive therapy works with the automatic thoughts present in depression, MBCT enables a person to stand back from those thoughts and separate them out from the person, rather than allowing them to define the person. 

EW: How available is Mindfulness training in the UK and elsewhere, for practitioners and for clients? 

JL:   Provision of training is very patchy. When John Kabat-Zinn began his programme, he was an experienced meditator. He could not find meditating psychologists to help with the training; he had to use yoga/meditation teachers who had a sufficient grounding in meditation and bodywork. In the groups that I run, there are people using it for their own symptoms, and for personal and professional development. The course I run would enable a professional to add this to their professional repertoire, but they would need a much deeper grounding in yoga and bodywork to teach Mindfulness. The three professors I mentioned are themselves meditators. It is something that has to be taught from one's own experience, rather than an academic perspective. 

One of the tenets of the programme is that the teacher has to practice the programme along side the  participants. 

EW:  You've been teaching Mindfulness with Oxfordshire Mind for three years now. How did this come about? 

JL:    It came about through my own experience of clinical depression. Despite years of psychotherapy, and being trained as a therapist myself, I still experienced chronic depression. Then someone gave me Kabat-Zinn's book and I began to practise the programme on myself  and worked with colleagues on it. As  result of becoming mindful I began to handle my depression. I wanted to set up a programme for the public, because in this country at that time there were only research programmes being conducted in clinical settings. I approached Oxfordshire Mind to get this going, and they financed the publicity. I organised research with the Oxford University Department of Psychiatry, which is now complete and about to be published. 

EW:  How do you arrange your courses? 

JL:    It is an eight week programme of weekly two and a half hour sessions, one full day session, and approximately an hour's practical homework per day by the participants. 

EW:  What sort of people come on your courses, and what are they expecting to achieve? 

JL:   The groups include members of the public who self-refer or are referred by their GPs or psychiatrists, and mental health professionals who want to use Mindfulness in their work. Often people are looking to professionals for a cure, and then discover they can participate in their own health and wellbeing. They won't get a cure, but they may change their way of life to reduce their stress. One common problem is rumination, that people are running the same thoughts over and over again in their heads, and believing them. However the thoughts run automatically like a computer programme. Mindfulness is about seeing thoughts as thoughts not as who you are. 

EW:  Do their expectations alter during the course?  

JL:   I don't know what to say! Out of all recognition! They stop looking for a cure, and become aware they do have choices. They stop being the victims of their symptoms and start taking responsibility for their lives. Sometimes this programme is called the art of conscious living. Thick Nat Hanh, the Vietnamese Zen Master and poet describes mindfulness as “keeping one’s conscious alive to the present reality”. 

EW:  How do you adjust  your teaching  for people with mental health conditions or short concentration spans? 

JL:     I did some pioneering work with people with long-term schizophrenia who had lived in institutions. They loved it! It can be used, and it can be adapted. We did it for two hours a week, and now at the same project they offer mindfulness daily for 45 minutes, and continue to send project workers to me to be trained.  

Learning to concentrate in a particular way is central to the training. One of the first exercises with a new group is to concentrate on the five toes of the left foot for half a minute. Most people are unable to do that without falling asleep or their thoughts drifting off, which means they can't be present in the moment. Being able to feel sensation in the body is essential to being able to be in the present moment; to be able to feel and “follow” the breath with focus enables  the meditator to stop rumination and anticipation [fear and anxiety of the future].   

EW:  Are you able to assess the impact these techniques have on people with longstanding mental health problems?  

JL: Yes . We have excellent results from our research and constant positive feedback from our participants. I know that people will not go away unchanged. Participants become  aware of their thoughts and feelings and what stresses them, and are able to bring themselves out of automatic pilot into the moment and  respond to a situation rather than react out of old patterns. They discover a deeper appreciation of life.  

References: 

Segal, Williams, & Teasdale.  Mindfulness-based Cognitive Therapy for Depression. A new approach to preventing relapse. New York: Guildford Press, 2001. 

Jon Kabat-Zinn.  Full Catastrophe Living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Delta, 1990.

Biodata: Jini Lavelle is a Transpersonal psychologist and psychotherapist. She also works  for Allies Advocacy, a service providing advocacy to patients  on the psychiatric wards in Oxfordshire. She runs programmes of mindfulness for personal and professional development throughout the year and can be contacted at Oxfordshire Mindfulness on 01865 370132 or jinilavelle @ waitrose.com.  

Elizabeth Winder.  While training as an integrative psychotherapist, Elizabeth helped to set up a user-led mental health day service and provided counselling within prison as a Probation Service volunteer.  She now runs an independent  service providing advocacy to psychiatric in-patients.  Email: magenta@ewinder.free-online.co.uk