Mindfulness: Being Where You Are and Doing What's Important

Courtesy of: Hank Robb, PhD, ABPP

I purposely did not title this “meditation” because it seems to me the word “meditation” now has quite a number of different and contradictory meanings. One meaning is a practice that produces the “relaxation response”, the opposite of the “stress response”.

I think relaxation is a great thing, but that is not what I mean to talk about here. There are lots of good instructions to achieve a “relaxation response”. Simply focusing on your breathing and noticing that while you can control your breathing, if you do nothing at all, breathing goes on all by itself. Focusing on this continual process of inhaling and exhaling, inhaling and exhaling and bringing yourself back to the process whenever your “mind wanders” is one good way to achieve relaxation. I’ve known a number of people who use it as an aid to falling asleep. If you are tired and you “relax”, sleep will often follow.

The problem of the “wandering mind” is that you may find you simply are no longer psychologically where you are physically. That’s not so bad unless your aim is to do something you consider important. Since there is no time or place when one can do ANYTHING—including important things—except right here and right now, then psychologically, being some place other than the present moment is a problem.

Thus the aim of this article is to assist in bringing ourselves into “the present moment” or, said another way, “being right here, right now”, or said yet another way, being psychologically where we are physically.

Why? So we can better do what we choose to make important with our life.

I’m going to call this “becoming mindful”. The problem isn’t so much that one’s mind wanders. The problem is more that we go “wandering” along with it. There is a certain sense in which each of us is “our body”. However, in another more psychological sense, we “have bodies”. These are MY hands, MY feet and this is MY mouth.

From this more psychological point of view, your body is something you “possess” rather than something that you “are”. The same thing can be said of your thoughts, by which I mean those “radio programs” inside your head, or your images (by which I mean any experience with a “picture”), or your bodily sensations (I’ll just call them “sensations” for short). By sensations, I mean things like your heart is beating faster or slower, your hands feeling cooler or warmer, or your stomach feeling tense or more relaxed.

Sometimes we can control our thoughts, images and sensations. Many times we cannot. Thoughts like, “What a loser I am,” or craving sensations to use a psychoactive substance, or sexual images more or less just “show up”. We don’t ask them to be there; they just “arrive” whether we want them or not. If I ask you not to think of a white bear, my guess that you have already thought of one. You didn’t “ask” it to come… it just did!

While we may not be able to stop our thoughts, images and sensations from “arriving”, we don’t have to “believe” them when they do. There is a big difference between having the thought, “My life is awful!” and BELIEVING the thought, “My life is awful!”. There is a big difference between “surfing an urge” and “tumbling around in it”. You don’t have to avoid urges, or thoughts, or images, in order to avoid being controlled by them.

One thing that can really help in choosing whether to “buy” a thought or image or sensation is to first notice, “Hey, that’s a THOUGHT! Hey, that’s an IMAGE! Hey, that’s a SENSATION!” That “psychological YOU” that does the choosing can then better choose whether to take a thought or an image or a sensation “seriously”. YOU will make that choice much more mindfully if YOU first recognize them for what they are… namely nothing more than a bunch of YOUR thoughts, YOUR images and YOUR sensations. They aren’t YOU… YOU are the person having them.

There are some characteristics of this “psychological YOU” that are worth noting. First, the “psychological YOU” has been around for about as long as you can remember. When you were five or eight or ten and had a completely different body, pretty much the same YOU that is here now, was there back then. Secondly, this psychological YOU is a little like the eye of a hurricane. While thoughts, images and sensations swirl around and come and go, this psychological YOU remains pretty much as it always has been. The experience is a little like the way a playing field remains pretty much the same even though the many games played on it may be very different; or like the way a kitchen remains pretty much the same even though the many meals prepared in it may be very different. Sometimes it is nice to experience a sense of stability in life especially if many other places are changing. This “YOU” provides that sense of stability.

A third (and perhaps most important) characteristic is that when in contact with this psychological YOU, it is quite clear that no matter how “out of control” YOUR thoughts, images or sensations seem to be, YOU are very much in control of YOUR hands, arms, feet and mouth. No matter how much YOU have the thought, “I MUST drink,” YOU can choose to do things with YOUR hands, arms, feet and mouth other than drink. No matter how strongly YOU have an urge to avoid work, YOU can choose to do things with your hands, arms, feet and mouth that keep you focused on work. No matter how vividly YOU have an image of a short run of enjoyment, YOU can do the things that are important to you in the long run.

So, the kind of mindfulness I am talking about includes being present with YOUR thoughts, images and sensations while recognizing they ARE only a bunch of thoughts, images and sensations, and also recognizing YOU can exert control over your hands, arms, feet and mouth.

The mindfulness I am talking about also includes “being mindful” of what direction you are taking with your hands, arms, feet and mouth. It asks the question, “Am I—right here, right now—in this present moment moving my hands, arms, feet and mouth in a direction that is actually important to me?”

“If I choose to be the best student I can be, are these movements that I am making—right here, right now—in that direction?”

“If I choose to be the best parent I can be, are these movements that I am making—right here, right now—in that direction?”

“If I choose to be the best mate I can be, are these movements that I am making—right here, right now—in that direction?”

“If I choose to be the best worker I can be, are these movements that I am making—right here, right now—in that direction?”

“Whatever direction I choose, are these movements that I am making, in this present moment—right here, right now—taking me in that direction? If not, then with my very next movement, I will put my actions in line with the direction in my life that I choose to make important.”

How does a person “be where they are and do what’s important”?

Like anything else, by practicing! Our thoughts and images and sensations invite us to take a ride out of the present moment and off to… well who knows where!!! However, when we notice they are ONLY thoughts, ONLY images, and ONLY sensations, we can “let them leave the station” without us. We focus on doing—in this very moment—whatever the moment requires for us to move in directions we choose to make important with our life.

Practice, practice, practice and most likely, we’ll get better at:

1. Being mindful that our thoughts, images and sensations are only that;

2. Being mindful of our control over our hands, arms, feet and mouth; and

3. Being mindful of choosing the direction in which we exert that control.

The Struggle with Sleeplessness

One of the key tools that the world’s foremost sleep coaches at the Sleep School use is acceptance and commitment therapy, or ACT. Guy Meadows nicely described ACT as “a revolutionary research-based psychological tool that recognises that it is our struggle or reaction to pain and suffering that actually makes them worse.” ACT promotes mental flexibility, openness and curiosity, so rather than struggling against negative thoughts and feelings, we learn to observe, accept and then let them go.

So how does this relate to chronic insomnia?

Research and clinical experience points to the struggle with sleeplessness is the critical process instigating and sustaining insomnia. Older approaches such as traditional cognitive behaviour therapy sometimes focus on getting rid of symptoms associated with poor sleep. Trying to block out or challenge certain thoughts, or remove anxious feelings. When it comes to the struggle with sleeping (as with anxiety, sadness, and so many other struggles), the thoughts and feelings end up coming back stronger, in greater numbers and with more frequency. Your energy is inadvertently put into trying to get rid of what you don’t want, rather than into what you do want, which is to sleep.

What if a sleep expert found he couldn’t sleep?

In the introduction to his fantastic “Sleep Book” Guy Meadows recounts when the thought popped into his head “what if I became an insomniac to?” Finding himself sleep sleepless, unable to switch off, his mind bringing up more and more worrisome thoughts, “I’m the guy who helps other people to sleep and now I can’t!” While his body wound up the tension, anxiety, urgency… Deep breathing, muscle relaxation, trying to clear the mind, all backfiring. Eventually falling asleep in the early hours of the morning. And the following day those thoughts showing up with even more urgency. He struggled to think back to what he used to do to get to sleep… nothing! Struggling with thoughts and feelings about sleep entangled and prevented. ACT skills are fantastic in this area.

How will we know this is working for you?

Is what you really want less worries about sleep, less agitation in the body, or simply more sleep? Is the quickest way to that battles with the mind, struggles with the body, or opening up to whatever thoughts and feelings are happening, letting them come and go as they will if we can but only actively let them, letting your body do its thing. Guy’s program helps his English clients discover how the struggle to sleep actually prevents sleep, learned through experience what they cannot change, through active coaching how to open up to those thoughts and feelings, to build a new sleeping pattern, and connect this with deeply held values for their personal and broader lives. We can’t take you to London, but we can train you in the skills to help sleep soundly, and live fully.

From Struggling to Striving

ACT can quickly transform struggle into thriving, as it completely changes the psychology agenda. We drop the struggle to rid of difficult thoughts and feelings. We coach skills to quickly handle them more effectively, emphasising living the kind of life you want. There are six core psychological skills to ACT, grouped into 3 simple and powerful processes: be present, open up, and do what matters.

Have a look at the six processes in really cool visual form here:

4 & 1/2 Steps to Vitality

By Nikita Kotlarov, learn more about Nik at his website mindzone.

Ever had a day when you woke up and things seemed just right? You couldn’t explain it. The world hasn’t changed. But you felt just good. What if there was a reliable way of producing this effect? Wouldn’t you want to take advantage of it?

Today, we identify a number of things that an individual could do to feel better. Some of these are ‘magic pills’ in that they work better and have fewer side effects than any of the non-magical pills we are aware of. Chances are, as a Psychologist, I will be closer at putting myself out of a job if you did these things:

  1. Nutrition – our brains consume great amount of energy. What this means, there is a need in having the right fuels to power this incredible machine (and the rest of your body too). It also means that similarly to any machine there are by-products (like exhaust fumes) that need to be cleared out. We’ve all heard ‘what you see is what you get’ – with your body and mind it’s ‘what you put in is what you get’. Want to feel great? Give your body and mind the building blocks of feeling great.
  2. Exercise – should I stop here…? Ok, by now you probably have heard something positive about exercise. Probably heard about the recommended daily exercise routines. You probably tried to put your mind at ease by saying that you cant afford it or that there is no time, etc. Especially in young families where the demands of work and parenting can be quite overwhelming it is particularly difficult. I am not an exception and also go through periods of time when I struggle to stick to regular exercise. I do believe that you are wonderfully creative. So creative that if you put your mind to finding 30mins per day to have a leisurely walk/jog, you would do it. If you haven’t, something else is holding you back – what is it? What can wonderfully creative person do about it?
  3. Social participation – we are group animals. We do not thrive in isolation. Some very powerful biological (yes – hard wired) processes are involved here. Consider how painful isolation (exclusion, ostracism, banishment) is for us. Some very weird processes take place when we are alone. And it is unfortunate that we live in a culture that frowns upon anything that is not strength, pushing us to hide when we don’t feel well. Isolating makes us feel even worse. The opposite is also true – our experiences of stress, pain, healing, trauma, etc – all improve when we are connected with others.
  4. Hobby – interestingly, we feel better when we have regular times to do things for no other reason but because we find them interesting/fun.

4½ Finally, at any of these points, you could say to me – well Nik, that’s easier said than done! Chances are, I will agree with you – you are completely right. It is easier said than done. At any of these ‘magic pills’ you may find things that hold you back. For example, after an injury – what can you do to exercise safely? Or, what is the right nutrition? What if I just moved to the area and don’t know anyone, how can I participate socially? Every one of these questions has merit. My ½ input here is: ‘not knowing gives you the first step’ – finding out, problem solving, brainstorming, etc. Finally, if you are feeling stuck – consult someone – friend, spouse, therapist, etc. I hope that every therapist’s goal is to put themselves out of the job. To work with their Clients in such a way that they will not need therapy anymore.

The Neuroscience of Stress and Mindfulness 

Fortunately, the emerging field of cognitive neuroscience is making it increasingly clear that you can train your brain to support you in taking a mindful approach to stress. With practice, you can achieve a more relaxed and transcendent state of mind that will override the rigid, anxious, autopilot mode that stress creates. Even better, the mental skills needed to make this shift aren’t difficult to master, and they get stronger and stronger with practice.

In this section, we’ll give you a brief lesson in brain anatomy and nervous system physiology so you can better understand how stress affects your brain and body. The brain consists of an elaborate system of neural circuitry that functions, in part, to help you maintain an ongoing balance between your stress and relaxation responses. This balancing act is achieved through continual interactions between two different parts of your nervous system: the reticular activating system and the dorsolateral prefrontal cortex.

The Limbic System 

The limbic system is a complex set of brain structures that includes the hippocampus, hypothalamus, amygdala, and other nearby areas of the mammalian brain. It is primarily responsible for processing emotional responses to stress. The limbic system is integrated into an even more basic part of the nervous system: the reticular activating system.

The reticular activating system consists of the primitive part of the brain that produces emotional arousal and the well-known fight-or-flight response. This part of the brain evolved early on to offer protection from all kinds of natural threats to survival. Thus, it’s exquisitely sensitive to any kind of threat— including threats we just imagine. So you can merely think of a stress-producing situation at work or school and trigger numerous physical, emotional, and mental stress reactions, even though you aren’t actually in that situation. The branch of the nervous system that supports all of these stress-related changes is called the sympathetic nervous system (SNS). The name is ironic, because SNS activation makes you anything but sympathetic!

Sympathetic nervous system activation begins when some type of stress is detected that triggers the limbic system. Within a microsecond, the SNS initiates a cascade of changes in the body. Blood flow in the gut is directed instead to large muscle groups, to prepare them for immediate action, as well as areas in the mid-brain. The hypothalamic-pituitary-adrenal axis of your endocrine system works closely with the sympathetic nervous system and releases stress hormones, such as epinephrine (adrenaline) and cortisol, into your bloodstream. These neurochemicals have an immediate impact on blood pressure, heart rate, and skin temperature. The release of cortisol, in particular, also creates cognitive confusion— which is why people under stress often complain of being confused and having difficulty accurately processing information and making decisions.

Unfortunately, even small daily stresses can stimulate the limbic system and produce powerful stress responses. This is why an awkward interaction with a co-worker or classmate can be as stressful as having a tooth extracted. Chronic SNS arousal, a common result of ongoing daily stress, is also thought to be the underlying cause of most stress-related health illnesses, such as hypertension, heart disease, cancer, and diabetes.

The Dorsolateral Prefrontal Cortex 

The second part of the brain that plays a key role in our response to stress is the dorsolateral prefrontal cortex. This region of the brain evolved later than the limbic system and is basically responsible for most of the higher-order functions we normally associate with being human: attention, emotion regulation, planning, abstract reasoning, and complex problem solving. This region of the brain is your friend when it comes to managing your response to stress. It’s closely linked with the parasympathetic nervous system (PNS), a part of the brain that puts the brakes on all of the physical changes produced by the SNS. When your PNS is activated, your breathing rate and heart rate slow, your blood pressure decreases, and your blood supply is redirected to your brain.

The good news is that, although the effects of SNS activation are immediate and can seem overwhelmingly intense, in reality the PNS is much stronger. The SNS evolved to help us act quickly and effectively in response to a threat and then shut down once the danger has passed. The basic nature of the SNS is to shut down if it receives any type of signal to do so. Therefore, something as simple as taking one or two deep, slow breaths when you’re under stress will immediately activate your PNS and help the SNS shut down. Better yet, applying the mindfulness techniques you’ll learn in this book will help you counter immediate stress reactions and also produce states of relaxation and clarity of thought that are uniquely associated with prolonged activation of the PNS.

Guidelines for Brain Training 

As we’ve mentioned, the brain is a dynamic organ that can be strengthened via mental exercise. So the question isn’t whether the brain can be trained, but how best to train it. As it turns out, there’s quite a bit of new, research-based information on this very topic. We want to share some of the more important findings because they’ll provide guidance in creating your own brain training program and using that program to develop a mindful approach to daily hassles.

Your Undivided Attention Is Essential 

As with creating any new brain habit, practicing mindfulness techniques requires that you pay attention to what you’re doing. Research backs up this commonsense philosophy, with studies showing that the benefits for neural networks and brain structures only occur when people pay close attention while practicing a particular skill (Davidson and Begley 2012). In other words, learning to pay attention, which just happens to be the first skill needed to be in the here and now, is also necessary for any mental training to have an effect on your neural networks and brain structures. So if this approach is to be effective, you can’t be half in the here and now while the other half of you is thinking about what you’ll eat for dinner. You have to be willing to show up and pay close attention to the specific skill you’re trying to master.

Vary What You Practice 

Functional magnetic resonance imaging studies use highly sophisticated brain imaging technology to reveal the strength of electrical activation in certain areas of the brain produced while the subject is performing various mental tasks, such as paying attention, naming or responding to emotions, and observing physical sensations, to name but a few. The basic finding of interest is that the more regions of the brain that are activated by skill training, the stronger the overall effect is on brain efficiency (Davidson and Begley 2012).

For example, the benefits of practicing observing skills (which you’ll learn in chapter 4) increase when you shift back and forth between what you’re aware of externally— like objects, people, smells, or touch—and internally , like thoughts, feelings, or memories. The ability to observe external and internal information is controlled by different structures or neural networks in the brain, so repeatedly shifting focus on purpose strengthens the linkages between these seemingly distinct skills. Therefore, in this book we offer a variety of specific skills to practice; collectively, they’ll give you a greater ability to activate your PNS.

Practice Produces Immediate Benefits 

An earlier view of the brain was that it was relatively fixed and hard to rewire, which meant you might need to practice mindfulness for years before seeing any positive benefits. This made it difficult to sell mindfulness to the general public, given that most people are already overscheduled. Newer findings indicate otherwise, and one immediate implication of neuroplasticity is that changes in brain function can occur much more immediately.

One of the more astonishing findings in this respect comes from the cutting-edge work of neuroscientist Richard Davidson, at the University of Wisconsin. In one study, volunteers were taught a brief loving-kindness meditation in an attempt to compare the electrical patterns in their brains to those of experienced meditators. Remarkably, even after only minimal practice, novice meditators exhibited unique brain activity patterns that were nicknamed the “compassion wave” (Lutz et al. 2004). More recent results suggest that both emotional control and compassionate behavior toward the suffering of others are strengthened by even brief compassion meditation training (Lutz et al. 2008; Weng et al. 2013).

Practice Makes Permanent 

Although brain changes can occur quickly, they aren’t necessarily enduring. In the aforementioned study by Richard Davidson’s team (Lutz et al. 2004), novice meditators did show almost immediate changes in brain readings, but their new patterns weren’t as strong as similar patterns in the brains of experienced meditators. This suggests that extended practice does have benefits: the more you practice, the stronger your compassion wave gets. This type of finding is common in the brain training literature. The more you practice a specific mental skill, like paying attention, the more your brain circuitry evolves to support that skill. The increase in specific types of electrical activity among experienced meditators is probably the result of a far more integrated set of neural circuits and the direct result of prolonged daily practice. Again, to update the old saying, practice doesn’t make perfect; practice makes permanent!

Throughout this book, we’re going to emphasize that this is a lifestyle issue. You can’t practice “drive-by” mindfulness and expect to benefit over the long haul. Then again, why would you want to? These are health-promoting, positive, prosocial skills that can play a huge role in helping you take a more balanced, compassionate approach to yourself and those you care about. Wouldn’t you like to have even more empathy, love, and compassion than you already do? Wouldn’t that be a good thing for you?

Use It or Lose It 

A related finding is that, as with working out to build muscle, if you don’t keep up your brain training regimen, new skills can begin to atrophy. In the University of Wisconsin studies (Lutz et al. 2004), the brain wave changes observed in novice meditators were astonishing but short-lived. Several weeks after the experiment concluded, a follow-up study was conducted to once again examine the brain wave patterns of the two groups of meditators, novice and experienced. Whereas the experienced meditators continued to exhibit the compassion wave at the same strength as before, novice meditators who had stopped practicing the compassion exercise no longer showed this change in their brain wave patterns. Therefore, ongoing practice of the techniques you learn in this book is important; otherwise you might begin slipping back into a stressed-out, autopilot mode. And this type of short-term neuroplasticity means that you’re always training your brain to do something. If you don’t pay attention to what you’re doing, you could end up training your brain to stress you out!

Gentle Reminders 

In this chapter, we introduced the idea that daily stress is a huge enemy in the quest to live the way you want to live. If you avoid, ignore, or downplay the importance of daily stresses, they can pile up and have a devastating impact on both your mood and your health. Therefore, we encourage you to take a more mindful approach to daily stress by paying attention to it and embracing it in a nonjudgmental way. This will help you think clearly about what matters to you in your life and then act intentionally, in ways that reflect your principles.

The tenets of neuroscience offer a fresh perspective on how you can train your brain to support a mindful approach to daily stress. You can directly train your brain to reduce the influence of harmful physiological and mental effects of stress while also increasing your ability to induce states of mindful awareness. But brain science isn’t a panacea for problems with becoming present and following through with your mindfulness game plan. You’ll have to commit to practicing new strategies and doing so persistently over time.

In our culture, we’re bombarded by messages to exercise more often as a way to strengthen our bodies and prevent disease. Yet people often twist their faces in distaste when the discussion turns to the virtues of brain training. For most people, the prospect of coming into contact with their mind on a daily basis seems to be much more aversive than engaging in vigorous physical exercise. In the next chapter, we’ll explore why this is. In large part, it happens because the mind doesn’t necessarily want to cooperate!

What is ACT & Briefly on Medication

Welcome to Brisbane ACT Centre’s first ever blog post. I thought I’d talk in a less formal way about “What is ACT” and how we integrate with medication use in psychological problems. Firstly, off the bat, I personally reckon that “Acceptance and Commitment Therapy” – the underlying model for our work here at Brisbane ACT Centre – is a pretty awful name for a fabulous approach. But it is a name which just happens to make for a great acronym – ACT!

Okay, better break down what I mean by that: Acceptance can easily sound like tolerance, like simply putting up with feeling anxious, depressed or in pain, which is not at all what we mean. The acceptance part of ACT is about learning specific, easy to practice, evidence based and self-compassionate mindfulness skills to better handle difficult experiences so they’re less likely to be an obstacle to living your life. We’re not asking you to want, or like feeling lousy but we might ask – how long have you struggled to get rid of those feelings? And how successful has that been, long term? And what has it cost you? Skilled ACT therapists can teach you simple ways to be more present in the moment, to simply notice to your worrisome thoughts “as thoughts – not as truths or untruths“, to experience difficult feelings as manageable sensations, and do what matters in your life, in this moment and the next.

Commitment might come across as “having to do things, or forcing yourself”, again, not at all what we mean. See what I mean, great name hey? The commitment part of ACT is more about learning to be a little more aware of what you care about in life. From tiny things like chilling out, eating a bit more healthily, to bigger ones like relationships and work, and becoming a little more able to make small moves, day by day, toward these things. Our values are like a direction on a compass, and small goals are like towns along the way, letting us know when we’re heading where we wish to go. Having a skilled navigator to help us choose our directions and having a great support team to encourage and check up on our progress, can help us along the way. That’s the therapist or coaching role in ACT.

ACT may seem new to many, but really has a 70 year pedigree. ACT simply integrates the best evidence-based practices of decades of behavioral and cognitive research and treatment in an ongoing, ever developing and improving therapy. This includes a scientifically grounded, pragmatic approach to the use of medications.

We recognise that all medications may have benefits and harms, and we’re very careful with informed consent and wise use. It surprises many people to hear that psychiatric medications don’t “fix chemical imbalances” but may take the edge off difficult feelings by causing imbalances – yet this is well known and long proven, and is not unusual with drugs – paracetamol doesn’t help my headache or fever by fixing a paracetamol imbalance, but it can certainly be helpful in certain situations, and less in others. Same for psych drugs. See this recent article also here and this related blog post for more on disproven medication beliefs and their unintended consequences. For more on how ACT therapists relate to medication use, stay tuned!

Acceptance and Commitment Therapy is at heart about workability. Being where you are, and doing what matters in your life. We use any and all ways to help you with this, and we research these scrupulously, test our assumptions, try to find out where we are wrong, and continuously improve. In only the 9 short years I’ve been learning and practising ACT, our approach has deepened, with even more self-compassion focus, briefer and broader applications, more neuroscientific support, and an exponentially growing clinical and research community. Welcome again to Brisbane ACT Centre, and to our blog.

With heart.

Rob
Dr Rob Purssey
MBBS FRANZCP
Psychiatrist and ACT Therapist

Can ACT and Mindfulness Help Ease the Burden of Common Medical Problems?

ACT is closely related to other mindfulness-based approaches, sometimes called “fellow travellers” and two in particular are Mindfulness-based Cognitive Therapy and Mindfulness-based Stress Reduction – MBCT and MBSR.

An important recent review article in the highest profile open source Journal, “Plos one”, showed “Conclusion – The evidence supports the use of MBCT and MBSR to alleviate symptoms, both mental and physical, in the adjunct treatment of cancer, cardiovascular disease, chronic pain, depression, anxiety disorders and in prevention in healthy adults and children.”

13 RCTs showed significant beneficial effect on anxiety. 17 RCTs showed benefit. In this review mindfulness were shown to be helpful with psychological adjustment to cancer, chronic pain, cardiovascular disease, also various mental disorders and mixed populations. Mindfulness helped subclinical anxiety in healthy populations, also depressive symptoms and stress. In children and adolescents significant intergroup improvement in stress, anxiety and several symptoms were found, with more time spent in sitting meditation predictive.

Important review of the evidence of mindfulness based clinical psychology interventions for many conditions, with many countries across the globe, showed beneficial effects mostly in mental health outcomes: depression, anxiety, stress and quality of life all improving significantly. And chronic care mindfulness helped coping with pain, depression, anxiety and stress, and improved quality of life.

Similarly, the most recent meta-analysis of the ACT literature found ACT was superior to waitlist, to psychological placebo and to the standard treatment as usual. ACT was also superior on secondary outcomes, life satisfaction/quality measures and process measures compared to control conditions.

All of the recent meta-analyses have similar findings and some meta-analyses have found superiority for ACT over traditional CBT methods.

To read the Plos one article in detail go to this link