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

Mindfulness and Christian Meditation

By Ingrid Ord

I am frequently asked to comment on Christian meditation websites, and these requests have increased as, I suspect, the availability of such websites has increased. Many Christian denominations are represented, and I suspect that there is a fairly even distribution, although I have not researched this. Many offer courses, retreats and material such as books and CD’s in their shopping areas.

I am not going to pinpoint any particular website as I am perturbed by something which I will go on to explain, and I do not wish to denigrate the work of any particular group or person.

It is no secret that over the centuries multiple variations of forms of worship and religious practices have become popular in the Christian church. Indeed, they have been the root of many a conflict leading, in the most extreme cases, to murder and suicide. Any form of ‘packaging’ a set of rituals and rules for the practice of worship and communion with God is, unfortunately, vulnerable to the perils of being exalted from ‘one way of doing it’ to ‘the only way to do it’.

I fear that this might happen to Christian meditation if it is linked to any prescribed manner of behaving. In all of my work with ACT and how it can be helpful for Christians, I have stayed away from Christian traditions, for the reason explained above, and stuck with the one religious text common to all Christian traditions: the Bible.

I have found a very rich connection between mindfulness and Christian meditation, in the Bible, and explain this and have written about it and produced a CD. In no place do I prescribe a manner of behaving, as that is best left to the individual and the complexity of their needs and ways of relating. I explain this a little later – but first I think it may be helpful to tell you a (true) story to illustrate the connection.

This morning the sun was shining brilliantly, the sky was a pristine blue and I noticed a feeling of hopefulness. Nothing very intense, just a mild, general, ‘I can do this’ kind of a day. It is now clouding over, threatening rain and I am aware of a slight ‘slowing down’ within me, and barely perceptible thoughts about how difficult things are. As my spirituality is very important to me, I also find my thoughts tending towards God and His part in all of this. Couldn’t He just arrange for me to have one, really good day? Doesn’t He know that I am an African to whom sunshine is life and joy and motivation in contrast to these grey, English skies which breathe ‘trudge’ and ‘plod’ and ‘do it grudgingly because you have to’ kind of days?

Before I started regularly practising mindfulness and Christian meditation, I would only have known that I felt mildly disgruntled, but not really have known why. Then I would have felt guilty for being ungrateful and become embroiled in a complexity of thoughts and feelings about how bad, unworthy etc I am. Now I can tease out my thoughts and feelings and notice how they are linked to small changes in the environment/context. I also notice what I want to do as a result (ie: go back to bed) and purposefully assess whether that lines up with what is important to me (ie: catching up with my correspondence). Then I can make an informed decision.

It just so happens that I am still writing because I chose to continue doing something that is important to me, and, coincidentally, the sun is shining again. The sunshine is now a bonus, and not something upon which my sense of vitality or purpose is dependant. Very much connected is whether this becomes important in my relationship with God, or not. In other words, if my happiness depended upon whether the sun shines or not, and God says He loves me, then He could prove it by making the sun shine. Right? So if He doesn’t, does that make Him perverse, unloving or perhaps a liar?

If you have read thus far, you may find the above a little strange, especially if you have different religious views from me. To my mind, and in the minds of some, if not many, other Christians, these thoughts would all be entirely logical. I am now aware of them as a direct result of my practice of mindfulness over the years. This awareness has helped me to clear the confusion about why I feel like I do, and what I should do about it. Judging myself for not being content has also been replaced with compassion for my reactions to current difficulties.

Part of the whole process described above is to do with my relationship with God, and that, together with questions about whether he is perverse, unloving or a liar are settled through meditation. I say ‘settled’ and not ‘answered’ because part of the process has been to learn to live with ambiguity about the ways of God. What the Bible says about God is unambiguous, whether you believe it or not. If you believe it, then questions about His character become irrelevant because the answer is written and, although difficult to understand, the matter is settled upon remembrance of that which is written. What is written is that God is good, just, and loving, and has a wonderful plan for each of His children.

Practitioners of mindfulness who also practise meditation have noted how the experience of practising mindfulness can be very similar to the experience of practising meditation. This has led to a certain amount of confusion, even amongst professionals. Both terms have become common in the media and popular psychology, and can have very different meanings for different people.

Mindfulness as a therapeutic practice has no essential spiritual connotations. The aim is to relearn how we can simply let our thoughts, emotions and physical urges or sensations just ‘be’, without trying to ‘do’ anything with them or about them. No spiritual exercise is part of the practice. Meditation is usually linked with spiritual practices which have spiritual gains as their goal. The difference between the two practices lies in the goal of the practitioner, although the method of practise may appear to be very similar.

It is not essential for a Christian to practise meditation in order to benefit from mindfulness. Some may find it threatening to consider doing meditation as it is often linked with other religions.

The aim of Christian meditation is very specific, and it is very important to keep in mind whether one is doing an exercise as mindfulness, or as Christian meditation.

Christian meditation:

In Psalm 1 the Psalmist says ‘Blessed is the man (whose) delight is in the law of the LORD, and on his law he meditates day and night.’ Blessed means ‘happy’! Does that, and the word ‘delight’, mean that meditation on God’s word is, in fact, a source of happiness?

The Bible says that God wants a relationship with us based on love, obedience and trust and not an empty show of rituals (1 Samuel 15:22).

Praying and communicating with God can be difficult as it involves conveying our thoughts and feelings, and listening to what God may be saying. In close relationships words are not always needed. The mere presence of the loved one brings delight. It is a profoundly moving experience to be free of the need for words and to just be in the Presence of God, in the spirit.

Sometimes there are words, and you may hear the ‘still small voice’ (1Ki 19:12) (NIV) of God in these ‘quiet and alone’ times. Paying attention to what God may be saying in that moment can be a great help in experiencing the Presence of God in a full and open relationship.

Sometimes there are words, oftentimes no words but just a sense of being in His Presence. This is Christian meditation.

Where does mindfulness fit in?

The practice of mindfulness can facilitate and provide a platform for the practice of Christian meditation. Kabat-Zinn says that what tends to happen in mindfulness is that it shows us how to ‘surf the wave between chaos and order’. Even when we feel very turbulent or our minds are troubled, mindfulness helps us to ‘find the sweet stillness inside the wave.’ (Rich Simon, Mary Sykes Wylie) Mindfulness is good preparation for focussed attention on God’s word.

Paying attention to ‘what comes up’ in the present moment with no goal other than just to notice, and continually returning to this task without judging oneself, brings us to a ‘Just as I am’ state of mind.

It is hard not to judge ourselves and try to ‘fix’ things about ourselves before approaching God. It is natural to want to protect parts of ourselves from scrutiny. It is hard enough to be willing to notice certain aspects of ourselves without going into judgemental mental activity when we are alone. That is why it takes practice to allow all these parts to be present when we spend time with God.

In approaching ourselves first, in an attentive manner without judging, we allow the totality of who we are right now to be present.

Meditation is not difficult in the sense that it requires skilful learning. It is difficult because it ‘goes against the grain’. Just as it is not easy to take time out from daily tasks to exercise physically, so it is not easy to take our minds out of their usual activities into a special time of just experiencing the present moment, right here, right now.

As mentioned earlier, it is important to remember what we are aiming at. The aim of Christian meditation is not to empty the mind but to focus upon ‘obedience and faithfulness’ to God which, as Foster suggests, is what ‘most clearly distinguishes Christian meditation from its Eastern and secular counterparts.’ (p37) (Foster, 1998) Further on he states that ‘..detachment is not enough; we must go on to attachment.’(p43)

The bible is replete with suggestions about many different ways to meditate and many different things to meditate upon. We will just have to leave that for another time.

Much of what has been written here has been taken from my book ‘ACT With Faith’ (2014) and on the CD which I recorded in 2009 called ‘Mindfulness and Christian Meditation’. Both are exclusively available on the website ‘Actwithfaithbook.com’ in paperback, PDF, CD and MP4 format.

Other references include:

Foster, R. (1998). In Celebration of Discipline (20th ed.).

James Strong, S. L. (1890). Strong’s Exhaustive Concordance.

Lawrence, B. (1967). The Practice of the Presence of God with Spiritual Maxims. (F. H. Revell, Ed.) Grand Rapids, MI: Spire Books

Rich Simon, Mary Sykes Wylie. (n.d.). The Power of Paying Attention: What Jon Kabat-Zinn has against spirituality. Retrieved 2009, from Psychotherapy Networker.

Mindfulness, Mothers & Babies

Last week I had the true pleasure and privilege of giving a 2 day Introduction to ACT workshop for more than 55 experienced clinicians at the Queensland Centre for Perinatal and Infant Mental Health full week seminar series. Babies’ and mothers’ attachment needs in the perinatal period, and ACT processes of presence, purpose, acceptance and action made for a perfect fit. Mindful mothering, with our awareness grounded in the present with our baby makes it easier to notice our babies’ need, respond in a natural way, notice the rewards and also the struggles of being a Mum and be present with it all. Many perinatal nurses, psychologists and other clinicians from Brisbane and far beyond had already applying mindfulness based ACT principles and practices in their mother baby work, finding it a beautifully natural process.

Connecting mindfulness with the practical applications of attachment theory comes quite naturally. When mothers are more aware and open and able to respond to infant’s cues (noticing when is it appropriate to play, talk, comfort), and in doing so more attuned in their skin to skin touch, holding, and mutual eye gazing we increase our infants sense of security, comfort, and protection. In doing all of this mothers can assist their babies in experiencing their emotions in an open and expressive way. Secure attachment is also modelled in therapeutic context. ACT therapists strive always to be aware, open and engaged, attuned to the client’s needs, encouraging security and exploration. Indeed we learned ACT skills in the workshop by applying them to ourselves, so as to engage more fully, flexibly and effectively with our clients.

I had extraordinary help in delivering this perinatal ACT workshop from four wonderful women who were not able to be in the room. Koa Whittingham is a psychologist with specialisations in both clinical and developmental psychology, a research fellow at the University of Queensland and a mother, and has written “Becoming Mum” which is a truly unique self-help book. It is the first book written to support women, all women, through the psychological passage to motherhood, empowering them to become the kind of mother they wish to be. There has been a crying need for an ACT book for pregnancy and mothers during infancy, and Becoming Mum is IT! I cannot recommend it highly enough, and did so over and again to the perinatal workshop attendees, nearly all of whom purchased at least one if not 2 or more copies. Koa also writes a great blog,Parenting from the Heart.

Koa is in partnership with General Practitioner academic Dr Pamela Douglas who is developing a service to help mums and unsettled babies especially in the first 16 weeks, Possums Clinic. Pam also helped me in focussing ACT principles upon this uniquely sensitive area of human life. Emma Hanieh is a fantastic ACT therapist from The ACT Centre Adelaide who has a great half hourinterview on ACT and Attachment here, and gave me slides and knowledge from her Perinatal ACT Workshops to help me. Finally Louise Shepherd from The Sydney ACT Centre also provided inspiration through her great mindful motherhood blog posts. Koa, Emma and Louise are all very recent mums (Pam some time ago) and all display wonderful sensitivity, connection and scientific rigour in approach to their lives and work. Not only in ACT training, coaching, RFT and adolescent work are we blessed with superb talent in Australia, our perinatal ACT and mindfulness pedigree is deep and growing.

Koa is providing a Free Brisbane Public Mother’s Day Weekend Event this Saturday 10 May at Aspley for her book. If in Brisbane I encourage you to get along!

Becoming Mum ends with this simply wonderful paragraph:

“Take this lightly too!”

“You shouldn’t live your life by my advice. Don’t turn these concepts such as mindfulness into just another monster. Remember that the thought “I’m not practising mindfulness enough” is also just a thought, and sadness at not accepting your emotions is just another emotion to make room. So don’t start steering your ship by the words in this book; steer it by what you’ve always had in your heart. Steer your ship by your guiding stars – your values -and alter your course as necessary along the way so that you are doing what works for you and for your baby.”

Wise, mindful advice!