Dr. Marcella Zauner-Grois
Mindfulness as the basis of the MBSR program, in contrast to classical behavioral therapy , which is change-oriented and focuses on problem behavior, is first and foremost a principle or actually an attitude that encompasses the whole of life and only then a strategy for support within the framework of therapeutic processes.
Many patients are extremely skeptical at the beginning and cannot imagine that such a training could be helpful, since they see the cause of their difficulty and suffering in external circumstances, burdens and limitations – such as unemployment, losses, family conflicts and other problems. And, of course, training cannot eliminate or change them.
What it can do, however, is change one’s own way of dealing with the situation by helping to reduce the constant preoccupation with it, the resistance to it, and the brooding over it-which cause additional stress and mental suffering. The experience made possible by the exercises, that sensations, thoughts and feelings pass if we do not hold on to them, can reduce pressure, bring relief and enable a different way of dealing with the difficulties of everyday life and life itself. Acceptance and serenity contribute to greater psychological stability and well-being.
And training can help to become aware of personal patterns of thinking and behavior, of automated reactions to situations, and to change these patterns.
“Between stimulus and response lies a space. In this space lies our freedom and the possibility to choose our response.” Viktor Frankl
1.history and scientific basis
The foundation of MBSR training for stress management is mindfulness.
“Mindfulness” is Buddhist meditation approaches to training the mind, it is not about learning techniques, but about an inner attitude towards life and all its aspects.
Mindfulness and meditation are not new insights, they have been practiced throughout the ages and in many peoples, cultures and religions.
Mindfulness is a skill that is available to everyone, regardless of spiritual or worldview attitudes. It can be developed and deepened through practice.
Precursors in the preoccupation with stress
The health effects of stress have long been a concern of medicine and research.
As early as 1934, Edmund Jacobson investigated the effects of strong or permanent physical tension on health or the development of diseases and developed PMR – Progressive Muscle Relaxation. The program is intended to contribute to a differentiated perception of the physical condition and the early warning signs of approaching stress by way of conscious tension and relaxation of various muscle groups of the whole body and thus to open up the possibility of coping with it.
Starting in 1936, Hans Seyle, a physician and professor of biochemistry, researched the phenomenon of “stress” and defined it as the interaction of increased stress and the body’s adaptive reactions. The sequence of stress or challenge and physiological reaction, i.e. activation, is not harmful to health per se, but a natural process to ensure life or survival and development. Only when activation phases are not followed by relaxation phases, or not followed by sufficient relaxation phases, does this have consequences such as psychosomatic illness up to and including complete exhaustion and burn-out syndrome.
Richard Lazarus further investigated the topic of stress and summarized his findings in the Transactional Stress Model , according to which the physical stress reaction depends on the subjective evaluation of the triggers or the situation and, above all, how the affected person assesses his or her coping options.
Stress management is about retaining access to one’s own competencies and being able to use creative leeway. Even if the external circumstances cannot be changed, the inner attitude or evaluation can be changed. This reduces pressure and enables appropriate action or relaxation.
From about 1970 onwards, it was John Kabat-Zinn who succeeded in bringing mindfulness back to consciousness in the contemporary Western world, establishing it and making it usable, detached from the spiritual background of Buddhism.
John Kabat-Zinn was born in 1944, the son of a well-known immunologist. While studying molecular biology at MIT/Massachusetts Institute of Technology in Boston, he practiced Zen and yoga – which he then taught for decades – and studied Eastern wisdom traditions. Based on these experiences, he began in 1979 to develop mindfulness training on an ideologically neutral basis and to integrate it into the treatment of pain patients and the chronically ill, with the aim of enabling patients to deal differently with the symptoms and the stress they cause.
The “MBSR-Mindfullness Based Stress Reduction” program then became established at the medical falculty, the department was named “Stress Reduction Clinic”, and the training was researched and developed further. In 1990, John Kabat Zinn wrote his foundational work, Full Catastrophe living, which lays out the essence of MBSR training.
In Germany, the book was published under the title “Gesund durch Meditation” (Healthy through Meditation) and contributed, among other things, to the paradigm shift in the health care system by introducing a holistic view of human beings and helping them to activate their self-healing powers. The focus is not on the disease, but on what works, despite and with pain and symptoms.
Many more publications and collaborations followed with physicians and researchers such as Mark Williams, Saki Santorelli, also with spiritual teachers such as the Dalai Lama as well as many others.
From 1997 John Kabat Zinn also taught in German-speaking countries and made MBSR known here.
2. explanatory model for the mode of action of MBSR training.
Just as experiences in prayer or meditation are difficult to put into words, mindfulness and its effects can be described, but the changes it brings about become accessible only through one’s own direct, lived experience and regular practice.
MBSR is not about avoiding stress triggers or simply managing stress symptoms, but about experiencing the workings of our consciousness, recognizing its functioning, and working with it. An essential principle is not to push away, but to mindfully accept all that arises. This reduces the experiential avoidance that often reinforces and perpetuates symptoms.
It is also not about what supposedly should be, ought to be, or would be desired, but about observing what patterns of thinking, feeling, and behaving are going on at the moment, which is to say, what is, and thus gaining a more realistic view of situations. It should become possible to recognize that to a large extent it is not the external circumstances that cause stress, but one’s own reactions to them. This realization should make new, different behavior possible.
This is achieved by consciously perceiving the present experience – all that is, now in this moment – in an attitude of friendly acceptance or calm acceptance.
The modes of action of mindfulness or mindfulness-based practices can be described according to Michalak et al. (2012) can be summarized as follows:
1. training of attention- concentration on the here and now, getting out of dysfunctional brooding loops.
2. increase of contact with the here and now- perception of the diversity and richness of each moment.
3. change of mental mode- away from doing to being.
4. Early detection of unfavorable build-up processes – this enables exit and thus reduction of pressure.
Meanwhile, the process of disidentification is also discussed as relevant. The observer attitude is supposed to lead to perceiving feelings and thoughts as temporary phenomena of the mind rather than as a reproduction of reality. Through this change of perspective, it is possible to detach oneself from thoughts and associated feelings as well as behavioral automatisms, i.e. not to identify with them, but to observe them in a distanced way.
And observation alone usually results in a change in experience!
Another factor is said to be improved emotion regulation . This comes about through attention control, increased awareness of reactions or patterns that are taking place, and a reduction in the tendency to brood. Fear of experiencing emotions is also said to decrease.
In the meantime, the topic of embodiment, in particular the embodiment of feelings, is also being discussed as another possible impact factor. Embodiment deals with the interactions of body and psyche and assumes that consciousness needs the body as a basis. Body postures therefore have an impact on cognitions and emotions and vice versa.
Consideration of the improvement of body awareness as a further impact factor of mindfulness also fits in with this. Through the training of differentiated body awareness, patients are better able to consciously feel their body and to perceive the build-up processes between physical and cognitive or emotional processes in order to break out of this cycle (Michalak et al., 2010).
Even though relaxation is not a goal of mindfulness exercises, they can still bring about deep physical relaxation. In any case, mindful perception of tension as a sign of stress is helpful, which can be seen as another effective factor of mindfulness.
Self-compassion can also be increased through mindfulness and create positive impact. An MBCT study of patients suffering from recurrent depression showed that participation in the program led to increases in self-compassion in addition to increases in mindfulness. This in turn had positive effects on depression symptoms. Being compassionate with oneself does not prevent unfavorable cognitions from occurring, but it does reduce the unfavorable effects of these thoughts (Kuyken et al., 2010)
3. evidence on the effectiveness of MBSR
The advantage of MBSR training over other mindfulness practices is the standardization of the program, i.e., that all courses follow the same sequence and content, which enabled the corresponding research.
There are now a large number of studies that have examined and empirically proven MBSR for various physical and mental illnesses.
All studies come to overall consistent evidence of effect with medium effect sizes (such as Baer, 2003; Grossmann et al.,2004; Shigaki et al.,2006; Keng et al., 2011;).
There are also more recent studies on individual disorders and areas:
- Effects on brain and immune functions (Davidson et al.,2003).
- Cancer ( Carlson &Garland, 2005).
- Anxiety disorders ( Hofmann et al.,2010).
- Pain syndromes ( Rosenzweig et al., 2010). Previous studies with chronic pain patients already showed reductions in psychological distress and functional limitations, both in the short term and in a 4-year catamnesis. (Kabat-Zinn et al., 1985 and 1987).
- Job-related stress in health care workers (Christopher &Maris, 2010).
- Multiple sclerosis ( Grossmann et al., 2010).
- Fibromyalgia (Schmidt et al., 2011).
Further references to studies can be found in Petra Meibert, Johannes Michalak and Thomas Heidenreich (eds.) Die “dritte Welle” der Verhaltenstherapie, Grundlagen und Praxis(2013) Weinheim, Basel: Beltz Verlag pp.165-179.
A comprehensive collection of studies and research projects is offered in the “Mindfulness Research Guide” by editor Daniel Black, www.researchgate.net.
4. the program -contents and procedure
“We must be willing to break away from the life we have planned so that we can find the life that is waiting for us.” Oscar Wilde
The training is designed as an 8-week group program for 8 to approx.20 TN and includes a session of 2-3 hours each week, a full “day of mindfulness” towards the end of the program, and daily home practice between sessions.
To ensure that the participants are ready to commit themselves in this way, there is a preliminary discussion with the course instructor in which they are informed about all aspects of the training. Your personal motivation for the training will be clarified to avoid misconceptions and associated disappointments.
In general, it is important to take a detailed medical history before starting training to determine whether there are any disorders or illnesses that should be treated medically and/or psychotherapeutically and/or that represent contraindications.
The training is about detaching oneself from one’s ideas, desires and expectations and consciously perceiving the actual experiences of the present moment with an attitude of friendly acceptance.
A main part of the program is formed by three formal exercises: the body scan, mindful yoga exercises and sitting , walking and breathing meditation. Informal exercises involve doing everyday tasks, such as household chores, in an attitude of mindfulness, noticing the reactions of the mind and body.
Another indispensable part is the daily homework of about 45 minutes, which the participants complete independently, sometimes with the support of worksheets and CDs.
In addition, results of stress research are communicated and focus topics such as dealing with pain, difficult feelings and thoughts, mindful communication as well as self-compassion and compassion for others are developed together.
The therapist’s own experience with training and meditation practice is a prerequisite in order to be able to understand the patients’ difficulties in implementation and to support them accordingly.
Although the training can be an initial impulse for a change in perception and attitude, success depends to a large extent on the participants completing the daily exercises. This can be ensured in the clinical setting for the duration of the course, but in the outpatient setting and thereafter, it is up to the motivation of the participant themselves. And in order to promote this motivation of the participants, it is helpful to have gone through a training as a therapist yourself and to have made an effort to do the daily routine of the exercises, with all the demands that this implies. It is precisely the embedding and maintenance of mindfulness in everyday life that enables, maintains and even increases the desired positive effects!
The exemplary schedule of an 8-week training with the main topics of the sessions and the exercises can be found in the appendix as well as the instructions for some important standard exercises.
5. areas of application
General indication:
Mindfulness and acceptance are to be understood as cross-situational principles of life and only secondarily as therapeutic strategies or interventions. The goal is to improve and refine the perception of physical sensations, thoughts and feelings, as well as to change the attitude towards this phenomenon.
MBSR has proven effective in stress management and prevention as well as in supporting the treatment and management of a variety of physical and psychological disorders, as the training can favorably influence dysfunctional and disorder-maintaining processes.
As described above, the training is conducted in a group setting, as the exchange in the group contributes significantly to improved understanding and motivation. However, with appropriately precise goal setting and necessary adaptation, it can also be used in individual settings to support the therapeutic process.
MBSR is recognized in the U.S. as a behavioral health educational method and is partially funded by health insurance companies. For about ten years MBSR has also been used in Germany in clinics, state institutions and also in companies for stress management and prevention. In the Essen-Mitte clinics, for example, the MBSR program is integrated into the part-time inpatient treatment in the department “Internal Medicine V – Clinic for Naturopathic Treatments and Integrative Medicine”.
6. specific interventions
Because of the compelling evidence of its positive effects, MBSR has been and continues to be researched, and applications based on Kabat -Zinn’s MBSR training are being developed for specific target groups and with different emphases:
Program for the treatment of patients with recurrent depressive disorders MBCT Mindfullness based Cognitif Therapy – Zindel V., Segal J., Mark Williams, John D.Teasdale.
Two factors play a role in the development and maintenance of the condition of recurrently depressed patients – on the one hand, dysfunctional basic assumptions and negative thought patterns, which also subside after the depressive phase has subsided but are easier to activate again with each phase, and on the other hand, a tendency to brood. This hinders the ability to deal constructively with the situation or symptomatology and solidifies the depressive mood.
The program aims to identify and stop negative thinking patterns and rumination tendencies at an early stage. For this purpose, mindfulness is to be used to practice a conscious, non-judgmental directing of attention to the present moment, to thoughts, feelings and bodily sensations. The point is not to work on and change the thoughts, as in classical cognitive therapy, but the inner attitude or attitude towards them.
Mindfulness-based relapse prevention or mindfulness-based addiction treatment.
MBRP Mindfullness Based Relapse Prevention.
G. Alan Marlatt
This structured program for use in addiction treatment was developed at the University of Washington by Prof. G. Alan Marlatt and his team and has been in use since 2010. The eight-week program consists of elements from Jon Kabat-Zinn’s (MBSR) Mindfulness-Based Stress Reduction , Alan Marlatt’s Relapse Prevention Therapy (RPT) and Mindfulness-based Cognitive Therapy (MBCT) by Zindel Segal and others.
MBRP is specifically designed to prevent relapse in people who are in treatment for abuse of intoxicants such as drugs and alcohol. The combination of mindfulness and relapse prevention is designed to help patients identify the internal and external triggers for risk behaviors, become aware of their dysfunctional habits, and substitute adequate behaviors in their place.
Training for the treatment of binge-eating in particular MBEAT Mindfull-Basesd Eating Awareness Training . Jean L. Kristeller
Jean L. Kristeller is a clinical psychologist who has been involved in treatment and research on nutrition, eating disorders, and obesity for about 30 years. Based on her own experiences and inspired by her collaboration with John Kabat-Zinn, she dealt with mindfulness in all its facets and developed an 8-week program for mindful eating, which is intended to lead to a different approach to one’s own body and nutrition through the conscious perception of bodily sensations such as hunger and fullness.
Mindful Eating and Conscious Living ME-CL Mindfull Eating-Conscious Living Jan C.Bays and Char. Wilkins
Derived from MBEAT, program was developed for people with disordered body image and/or disordered eating behaviors.
Self-Compassion and Personal Growth MBCL Mindfullness -Based Compassionate Living Erik van den Brink, Frits Koster
The MBCL course – developed by Frits Koster and Eric van den Brink (authors of: “Living Compassionately”) – accompanies participants in working with themselves and supports them in personal growth.
Deepening mindfulness practice includes guided meditations with imagination and focus on topics such as:
“the safe place,” “dealing with resistance,” “recognizing inner patterns,” kindness to self and others,” “forgiving self and others,” and the like. Essential are also exercises with the four “helpers”: loving kindness, joy, compassion, serenity and the participants’ common exchange about them in the group.
Mindfulness in Relationships IPM Interpersonal Mindfullness Gregory Cramer, co-founder and president of the Metta Foundation.
IPM is based on the so-called “insight dialogue” developed by Gregory Cramer to transfer experiences from meditation into relationships. “Insight Dialogue” is an interpersonal meditation practice for cultivating mindfulness, wisdom, and compassion in relationships. It is intended to enable sensitivity and clearer understanding in relationships through presence, thereby deepening compassion but also self-compassion.
The six guidelines of this practice are: pause, relax, open up, trust what comes up, listen deeply, and tell the truth
IPM builds on mindfulness practice and is also designed as an 8-week group course.
MSC Mindful Self Compassion Kristin Neff and Christopher Germer
Mindfulness and (self-)compassion are fundamental skills that help reduce suffering and promote well-being. Self-compassion means dealing with ourselves even in difficult situations in the same way we deal with others, especially close ones, treating ourselves with as much respect, goodwill and generosity.
It is also designed as an 8-week program to build and deepen compassion and serenity.
Mindfulness-Based Pain Management MBPM Mindfullness-Based Pain Management- Breathwork Method Vidyamala Burch
This eight-week program, which Vidyamala Burch developed based on her own chronic pain condition, includes mindfulness and compassion exercises as well as theoretical background on the development of pain and mechanisms of its perpetuation and amplification, and is designed to help improve quality of life despite and with pain.
www.breathworks-mindfullness.org.uk
Mindfulness-Based Childbirth and Parenting MBCP Mindfullness- Based Childbirth and Parenting . Nancy Bardacke
This 9-week program, developed by Nancy Bardacke, is designed to comprehensively prepare expectant parents for pregnancy, childbirth and the life changes that come with parenthood.
Mindfulness-based Elder Care MBEC Mindfullness-based Elder Care (McBee 2008).
This program was developed in 2003 by Lucia McBee for Seinors in need of care and their caregivers. The focus will not be on deficits, but on strengths and inner resources, and will use meditation and gentle yoga exercises to bring mindfulness closer. It helps participants better cope with the changes brought about by aging and being old. One study found that those seniors who participated felt less sad and experienced less pain than before (McBee et al.,2004)
7. contraindications and side effects
Mindfulness-based practices have a positive effect on a wide range of disorders, and to date there have been no studies specifically on contraindications and side effects. Another criticism is that studies on long-term effects and sustainability are lacking.
The use of MBSR training and its variants is not recommended for the following diseases and conditions:
- Acute psychoses and psychotic disorders
- Acute intoxication or influence of medication and substance dependence
In these patients, the ability to perceive is too impaired.
- Posttraumatic disorders
Here, attention-direction to internal states may be too painful and can trigger flash-backs.
- Weakness states – physical and mental
- Suicidal crises
It can also be too much of a burden for the necessary exercise practice in cases of severe depression or physical pain and weakness.
- Careful consideration should also be given to training for obsessive-compulsive disorder.
Literature
Lehrhaupt, L., Meibert, P. : Managing stress with mindfulness (2010) Munich: Kösel Publishers
Lehrhaupt,L., Meibert,P., Krudup,K. Managing stress with mindfulness MBSR and mindfulness exercises for every day 2 CD’s (2013) Munich: Kösel Publishers
Cornelia Löhmert , Rüdiger Standhart : MBSR Die Kunst das ganze Leben zu umarmen Einübung in Stressbewältigung durch Achtsamkeit, Buch mit 2 Hör-Cd’s (2014) Stuttgart: Klett- Cotta
Margraf., Schneider, S. (Eds.): Lehrbuch der Verhaltenstherapie Vol. 1, 3rd ed. (2013) Heidelberg: Springer Medizin Verlag.
Petra Meibert, Johannes Michalak, and Thomas Heidenreich (eds.): The “Third Wave” of Behavior Therapy, Foundations and Practice (2013) Weinheim, Basel: Beltz Verlag.
Michalak, J., Heidenreich, T. & Williams, J.M.G., (2012): Mindfulness advances in psychotherapy. Göttingen: Hogrefe
Segal ,Z.V., Williams, J.M.G.& Teasdale, J.D.(2008): Mindfulness-based cognitive therapy for depression: a new approach to relapse prevention. Tübingen: dgvt-Verlag
Teasdale,J.D., Moore, R.G., Hayhurst,H.,Pope,M., Williams, S.& Segal,Z.V.( 2002): Metacognitive awareness an prevention of relapse in depression: empirical evidence. Journal of Consulting and Clinical Psychology, 70, 275-287.
Williams,M., Kabat-Zinn,J. et al: Mindfulness, Its Roots, Its Fruits (2013) Freiburg: Arbor Verlag.
2.exercise instructions formal exercises
a. The Raisin Exercise- Introduction to Mindfulness
b. Breathing meditation
b. The Body Scan
c. The sitting meditation
d. The walking meditation
e. simple yoga exercises
Important beforehand
In all instructions it is important to convey to the patients in advance that there is no right or wrong, no particular goal or result to strive for and achieve, but that it is a matter of feeling what is, noticing what thoughts and feelings arise, that it is normal when the mind digresses, that it is already mindful to notice this and return to the exercise, observing all this with kindness and curiosity.
It is then also important to make sufficient pauses at suitable points during the speech so that the participants have time to perceive the corresponding impressions. It can be helpful to do the exercise yourself, if possible.
In the case of breathing, sitting and walking meditation, the duration of the exercise should also be determined in advance, about 10 minutes at the beginning, later up to 30 minutes or more depending on the condition of the participants, the progress of the exercise and the time available.
A detailed exchange afterwards about the participants’ experiences with the exercise helps on the one hand to discuss any difficulties and to provide helpful tips and on the other hand to become aware of the experiences made, to consolidate and to deepen them.
- The raisin exercise
“I’m handing out raisins now. (alternatively go also gummy bears oä) You take two, three of them and keep on the open palm. Now imagine that you are an alien who has landed on Earth, has never seen anything like it before, and wants to carefully explore this unknown object and later describe it in all its facets back home.
So we will explore this raisin with all our senses – see, touch, hear, smell and taste. Whatever you perceive is okay… even thoughts and sensations that distract you. When you notice them, let them pull and return to the raisin.
First of all, look at a raisin specimen- what does the surface look like, the texture, …. the color, does the object shine or is it matte, solid color or shaded…. what is the shape ,….is it transparent or not,….. is there still a visual impression?
Then feel the surface, is it rough or smooth, soft , dry, moist, sticky…. How does the thing feel, elastic or brittle, plump or hutzelig, …….was you can still perceive?
Now we hold the object to our ear and try if it makes sounds when we move it between our fingers…. none , quiet and barely perceptible or distinct, does it crunch or squeak maybe…….?
Now we bring it to the nose and draw breath …. can you detect a smell? …. Tart or sweet, mild or intense, musty, sulfurous…. or different?
And then take the thing gently between your lips, what can you notice? Take it slowly into your mouth, very carefully, you don’t know what it is….how does the surface feel on your tongue,……. what does it do when you move it back and forth in your mouth, does it change….. , does it stay compact or does it soften? Notice what is happening in your mouth….
And only now do you take the object between your molars. Is there an impulse to bite?….. wait another moment…. and now bite once carefully… what do you perceive? What taste do you notice,….how does it change as you begin to chew slowly, what tastes emerge?…. and then, after carefully crushing the object, swallow it and feel for it… how far down the esophagus can you feel it…. What taste still lingers in your mouth ……sweet, sour, salty, bitter… or other?
Take another moment and feel all this before you then explore a second raisin again at your own pace and with all your senses.
Pause and silence
And now take the third raisin and eat in their usual way.
Break
What do you notice ? ……..im difference from the above exercise…… “
A good conclusion is also to consider together what and who, which stations in the past, where, in which places, how much time, which work steps it took at all, so that we could hold this one raisin in our hands here and now at this moment!
- Breathing meditation
The breath accompanies us throughout our lives from beginning to end, our body breathes day and night without us being aware of it or having to actively do anything about it. The breath is the link between thoughts, feelings and body reactions, it shows us with its nature whether we are currently relaxed or stressed and we can also trace the connection between thoughts, emotions and body reactions through the breath. Therefore – and above all, because he is simply always there – he is suitable in many ways as an object of meditation.
“Now assume a sitting position that allows them to sit relaxed and awake. – feet firmly on the floor, back relaxed but straight, and erect, ,head sitting relaxed on your shoulders, chin slightly tilted towards your chest, looking down at the floor in front of you. If possible, close your eyes – this makes it easier to trace the sensations within us – or let your eyes rest on a point on the floor.
The muscles in the jaw, neck and shoulders and abdomen are loose. Leave behind all the thoughts and impressions you came here with, as best you can, turn away from what will come later. There is nothing else to do right now but to be here with all attention and completely in the present moment – here and now.
Now focus your attention on your body, where it touches the seat, how do you feel the ground under your feet, can you perceive how the clothes feel on your skin or do you feel the warmth or coolness of the environment.
And now turn your attention to the breath, feel for the next breath, where do you feel it…. more when inhaling or exhaling, perhaps in the abdomen, which rises and falls slightly…. or at the nose, when the air flows into the body and out again….feel for the place where you perceive the breath most strongly and linger with your attention there as best you can. Notice the individual breaths without actively intervening, the small pause between breaths, how inhaling and exhaling change slightly with each breath….observe your body as you breathe.
And it is quite normal for your thoughts to begin to wander and digress, or for a bodily sensation to come to the fore. When you become aware of this, take note of it and bring your attention back to the breath, however many times this may repeat itself, kindly and patiently, again and again.
If your posture has imperceptibly changed and interferes with breathing, gently correct it and then turn back to the breath……
Longer pause……
… and then gradually you let your attention wander back to all the other sensations in this room, to the sounds, to the people, you open your eyes at your own pace, perhaps stretching and stretching as it is good for you, and you return all the way back here.”
- The Body Scan
If possible, the Body Scan is performed lying down. Mats are needed, possibly small pillows for the head, knee rolls and blankets. The participants are instructed to lie down – if necessary with a pillow, roll and blanket – to loosen constricting clothing, to let the legs fall apart a little.
The instruction is also important that there is nothing special to achieve, but only to direct the attention consciously to the individual body parts and the respective sensations at this point, also that it is normal to digress and that in this case it is a matter of returning to the conscious perception of the individual body parts, as often as it happens, kindly and patiently without judgment and without condemning oneself for it. The exercise is designed to help build a better connection to one’s body, to move from doing mode to being mode, and to become more sensitive to the body’s signals.
“And now, when you are well in your position, turn your attention to the body – where is it resting on the floor, where is there a touch with the clothes, with the blanket, …….? and now turn to the abdomen and the sensations there when inhaling and exhaling, the differences in inhaling and exhaling, and whether and how the breath might change.
You feel the weight of your body on the mat and let yourself sink a little deeper into the mat with each breath.
And now feel into your left foot, the big toe… the little toe….the toes in between…. the sole of the foot…. the heel… what is there to perceive, how does it feel…. and maybe in some places there is nothing to feel, that’s okay too.
And with the next breath let your attention move up the left calf, the bottom resting on the floor………the top…….further to the knee…… the thigh, back and front……………and now to the leg as a whole………….after a deep breath move your attention to the right foot…. big toe….. small toe, the toes in between….. the sole of the foot, the heel, ……the right calf….bottom…. top….. up to the knee and then the thigh…..and then the right leg as a whole, maybe there are sensations of lightness or heaviness…… a pulling…. or tingling, throbbing…. or even nothing specific…. it’s like it is right now.
And with each breath you sink a little deeper onto the pad, letting tension flow into the floor, you relax as best you can right now… with each breath a little more…..
If in between your thoughts wander and you digress, this is perfectly normal, and the moment you become aware of it, mindful and kind, you let go of the thoughts and return to exploring your body with its full attention.
After the legs, now turn to the hips and the area in between ……..then your buttocks… the left half …. and the right… maybe there are different sensations ……the tailbone…..and then move your attention to the abdomen… what is there to sense……..in the organs….in the stomach…. maybe movements of the intestines….
And now for the back…..how does the lower back feel and the space underneath….. the upper back and how it touches the floor….. on the left side…. on the right side.
You may also notice unpleasant sensations in some places, then breathe gently towards this place…. without anything having to change as a result… and then turn back to the breath, in and out….
You move on from the upper back to the shoulders…..what is there to perceive there….. on the left side… and on the right and in the area in between ….. and then the neck, up the spine to the head and the face….. how does the forehead feel… the eyes …….the nose…. the mouth… the jaw….. the lower jaw… how does the tongue lie in the mouth….. and you move from the head down the spine to the left arm…. upper arm…. Elbow…. Forearm…. to the back of the hand and each finger….. And back up and across the chest…. What’s there just…… down to the right arm….. down to the fingers……………….and then extend your attention to the whole body…..from the top of your head to the tops of your feet…. breathe in, breathe out and feel, notice what is particularly present right now, notice that some things can hardly be felt …… just as it is right now, in this moment… with all thoughts, feelings and sensations…. open to everything .
And after a while you expand your attention to everything around you…. And after a few breaths, slowly return here to this room at your pace.”
- The sitting meditation
Sitting meditation can be done on a chair, stool or cushion. It is important that the pelvis is tilted slightly forward so that the spine can straighten freely. To do this, a pillow or folded blanket can be placed on the back of the chair under the buttocks.
The object of meditation can be the breath, the body with its sensations, the observation of the emerging thought , the focus on a sense, such as listening to sounds.
“You assume an upright ,stable yet relaxed posture, feet flat on the floor, spine aligned vertebra by vertebra like a string of pearls, head drawn up to the ceiling as if on an invisible thread, gaze forward to the floor, hands resting loosely on your thighs or interlocked in your lap.
Keep in mind that the point of this exercise is not to achieve anything in particular, but to take the time to consciously notice each moment what is – the breath, the body, the thoughts and feelings, without changing them.
To begin, turn to your body, how does your body feel from the inside out?…. What sensations do you notice….. where do you feel tension that you can let go of…..notice the movement of the breath…… take a deep breath… in…. out …and direct your attention to where you notice the breath most. Feel how the breath flows into your body ….. and out again….. let the breath flow all by itself, you don’t need to do anything…..
And if you notice that your thoughts are wandering, kindly acknowledge this, let go of the thoughts, and gently and firmly return to observing and noticing the breath. Feel for how unique each breath is, how each is slightly different from the next ……………. Expand your awareness to the whole body….. and notice how your whole body breathes…..
Every now and then you will digress into thoughts, reveries, or worries, this is normal… once you become aware of this, you are mindful and can calmly and decisively bring your attention back to observing the breath.
When unpleasant sensations arise in the body, turn to them, notice their quality, stay with them for a moment before deciding whether to let it be and pass, or to slowly and consciously make a change…….. and then turn back to your breath.
And then before you end the exercise, allow yourself a few moments and give yourself credit for being mindful of dwelling in the state of doing nothing and simply existing in the time just now.”
- The walking meditation
This exercise is about becoming aware of walking – such a simple process that we hardly pay attention to it in everyday life – with mindfulness. It is not about going somewhere and arriving there, but about exploring walking itself.
For this purpose, a suitably large room or even a garden is suitable, in order to have sufficient space there and as little disturbance as possible from the outside.
“You assume an upright posture with your feet hip-width apart on the floor. You breathe in – and out, lowering your shoulders. You notice body sensations and thoughts , return to the breath. Then tilt slightly to the right, to the left, forward and backward until you are balanced, firm and steady. Your arms hang loosely at your sides, your face is relaxed. ….. now shift the weight to the left foot… feel the change……. then put the weight on the right foot….. feel for and then shift the weight back to the left until there is hardly any weight on the right foot….. and when you are ready , lift the right heel and then the right foot slowly off the floor… feeling into the anticipation of the coming step………. You place the right heel a little in front of you on the floor …. and notice how the weight now shifts to the right foot … now slowly lift the left heel off the floor , lift the foot and leg up and place it on the floor in front of you .
You repeat this process carefully and slowly step by step…. first slowly as if in slow motion …. and gradually you find your pace. If your thoughts wander, notice that too, let the distraction go and return to the exercise of walking, step by step……..there is nothing to do now but to put one foot mindfully in front of the other.
Break
And before you’re about to finish the exercise, stop, close your eyes, and feel into the body from head to toes, how it feels now, what may have changed ….. and finish theWalking Meditation with a few deep breaths.”
f. simple yoga exercises
These exercises come from Hatha Yoga, a type of yoga that seeks balance between body and mind. “ha” means sun, “tha” means moon and “yoga” means union, so it means uniting polarities, creating unity. This is to be achieved through physical exercises (asanas), breathing exercises (pranayama) and meditation.
The exercises are about mindful conscious awareness of the body, sensations and changes through the respective positions. They also allow us to recognize our limitations and how we habitually deal with them.
It is important that participants take responsibility for their own physical condition. In any case, pain is the absolute limit and should lead to the termination of the exercise!
What is needed is a suitably large, undisturbed room, mats and at most pillows for the head. The instructor’s own practice experience is necessary in order to be able to deal with questions and difficulties of the participants!
1. lying stretched out on the back, legs stretched out, arms to the side of the body, feet falling apart, legs raised if back problems.
2.Pull left knee to the chest, right leg is set up.
3.Keep left knee extended, right leg slides to the floor.
4.release left knee, leg slides to the floor
5.pull right knee to chest, left leg erected.
6.left leg slides on the floor
7.release right knee, both legs are on the floor
8.Pull both knees to the chest, keep the knees encompassed and circle once clockwise, then counterclockwise.
9. pull the knees a little further towards the chest, hold them there and spread the arms out to the sides.
10.knees alternately sink to the left and over the middle to the right, roll the head to the other side in each case.
11. Come from a lying position to a sitting position with legs outstretched, arms crossed in front of the body with palms facing outward.
12.Raise folded arms above head and stretch long, lowering shoulders.
13. come from sitting to quadruped stand with straight back
14. round back to cat hump, head hangs between shoulders
15.return back to straight position, repeat several times
16.buttocks sink to the heels, arms rest on the floor at the side of the head or support the forehead as a base
17.straighten upper body in heel seat and come to standing position
18. Feel the body while standing upright with arms hanging down.
20. raise arms sideways above head and stretch long with palms touching each other
21.lower arms, alternately lower head sideways to the right and then to the left
22.Come back to sitting, draw knees and let them sink outward, soles of feet touch each other.
23.Come back to the lying starting position, legs stretched out or set up and linger for a few breaths.
3. exercise guide informal exercises
These exercises are about performing everyday activities with all the necessary attention and care and to perceive all steps mindfully and with all the senses – visual impressions, sounds, smells, the movements and postures of the body, tactile impressions…- and to return to this activity again and again when the thoughts wander.
The possibilities for doing this are endless, whether it’s mindful eating, preparing a meal, vacuuming, brushing teeth, washing dishes by hand, ironing, showering or bathing, or anything else.
Also walks offer many variants- to look at things in detail and describe them, to perceive them with all senses.
Wash dishes
” The first thing you do is wash a plate as you normally do – probably quickly under running water, with one or two three movements, shake it off, dry it , off into the box… and while you’re doing that you’re probably already thinking about the necessary shopping, what you’re going to cook tonight…… or you’re listening to the radio to hear the news or the weather report… or you’re talking .
Now you stand in front of the sink, breathe in and out deeply, become aware of your body posture… then you close the drain and let water run into the basin… you feel the temperature of the water on the skin of your hands….. You put a drop of detergent into the water, breathe in the scent, create foam with a few movements of your hand – what is it like, what does it look like, which bubbles does it form, is it fine-pored or coarse, does it stay for a while or does it sink quickly…..? You take sponge or cloth… how does it feel …. then you take a cup and look at it- the shape, the glaze and the decoration, how does it feel… light or heavy…. how does the water surface change when you slowly immerse the cup…. What sounds could you perceive…the gurgling of the water…the scraping sound of the sponge…how does the water drain when you take the cup out. Who you take the dish towel- what does it look like, what texture is it finely woven or coarser, how does it feel, smooth or rough, soft, stiff or supple…what movements do your hands make until the piece is dry…. How does it sound when they put it in the box and close the door?……Breathe in and out again and let all these impressions take effect before you finish the activity.”
Many more examples of formal and informal exercises for both individual and group work can be found in the following books, and a collection of mindfulness stories and metaphors can also be found in the therapy tools:
Bowen, Chawla, Marlatt ” Mindfulness-based relapse prevention”(2012) Basel: Beltz.
Burkhard, Alois “Mindfulness II-living consciously”(2008),Munich: CIP Media
Michalak, J., Heidenreich, Th., Williams, J. Mark G. “Mindfulness”(2012),Göttingen: Hogrefe
Schug, Sabine “Therapie Tools Achtsamkeit Materialien für Gruppen- und Einzelelsetting” mit e-book und Audio-Dateien (2016), Basel: Beltz
Shamash, Alidina “Mindfulness for Dummies Facing Things Calmly with a Calm Mind” with CD (2011) Weinheim: WILEY-VCH Publishers.
