ThePennsylvaniaStateUniversity

NurturingMindfulnessin CaregiversandChildren: APromisingApproachforStress Reduction ACF March2012

MarkGreenberg mxg47@psu.edu

GoodAfternoon!

WhatisMindfulness?
Mindfulnessis:payingattention, inaparticular way,onpurpose,inthepresentmoment, nonjudgmentally.KabatZinn,1990 Anawarenessofonesconductandthequalityof onesrelationships,inwardlyandoutwardly,interms oftheirpotentialtocauseharm,areintrinsic elementsofthecultivationofmindfulness. Mindfulnessineverydaylifeisthe ultimatechallengeandpractice. KabatZinn 2011

 MindfulnessQualitiestoNurtureinChildren andAdults! Calmness Kindness/Compassion(Conceptof Interdependenceofallthings) Clarity/Insight(Awareness/Reflectivity abilitytoDecenter)

ResearchonEffectsofMindfulness
Symptoms(pain,reportedstress)
Depression(Teasdale) Anxiety(Miller) Chronicpain

Behavior
SubstanceUse Suicide(Williams) Aggression

ResearchonEffectsofMindfulness
BrainActivityandExecutiveFunction
fMRI andEEGfindings(Davidson,Posner,Tang,Jha. Lazar,etc) Workingmemory Inhibitorycontrol Attentional Control(Lutz,Jha)

Psychophysiology
Cortisol (Carlson,2007;) Telomereactivity(Epel,ucdavis) Immunefunction(Davidson)

Peer-reviewed Research on Contemplative Practices 2000-2011

MindfulnessisEverywhere

PEACE PromotingEmpathyAwarenessand CompassioninEducation

Mindfulness and Teaching - CARE Mindfulness and Parenting Mindfulness Programs for Children and Youth

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WhatareIndicatorsofMindfulnessin InterpersonalContexts?
Listeningwithfullattentionto childrenandcolleagues Presentcenteredawarenessofemotionsexperiencedbyselfand studentsduringinteractions Opennessandnon(low?)judgmentalacceptanceand receptivity tochildsthoughtsandfeelings Selfregulationinteaching/parenting Lowreactivity and Low automaticity inreactiontonormativechildandadolescent behavior Awarenessofandresponsivenesstochildsindividualneeds teachablemoments Compassion forselfandstudents
Coatsworth,Duncan,Jennings,Turksma,Greenberg
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Mindfulnessand FamilybasedPrevention
ExtendingMindfulnesstoParentingand Family/ParentingInterventions
Stress
Extrafamilial(Parentslives) Family/Parentingstress Relationshipchangesandtensionswithadolescents

InterruptingAutomaticnegativerelationshippatterns AttentiontoParentwellbeing FocusonCompassionforSelfandYouth Applicationofskillsinchallengingsituations

NotestsofMindfulParentinginterventions
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MindfulParenting

Mindfulness contextualizedforparentingsituations IntrapersonalandInterpersonal 5Coreelements ListeningwithFullAttention Presentcenteredattention EmotionalAwarenessofSelfandChild NonjudgmentalAcceptanceofchildandself Selfregulationinparenting CompassionforSelfandChild
Duncan,L.G.,Coatsworth,J.D.,&Greenberg,M.T.(2009).Amodelofmindful parenting:Implicationsforparentchildrelationshipsandpreventionresearch. ClinicalChildandFamilyPsychologyReview,12, 255270.
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Parent

AdolescentDynamics

ChangingDynamicInteractionsMAY contributetocyclicalpatternsofnegativity.
Youth Response/Negativity
Increasein HOSTILE/
CONTROLLING

parenting

ParentNegativity

Disengageor Withdrawal (GivingUp?)

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Study:SmallRCT
65FamiliesRecruited+Assigned+Assessed atBaseline
SFP:1014(N=23) MSFP(N=25) DelayedInterventionControl(N=17)

AssessedimmediatePreandPost intervention
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Results
Changesinmindfulparentingassociated withchangesin:
AngerManagement Motherspositiveaffect/behavior(m) Mothersnegativeaffect/behavior(m) Youthspositiveaffect/behavior(m&y) Youthsnegativeaffect/behavior(m&y)
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OverallMindfulParenting
1 0.75 0.5 0.25 -2E-15 -0.25 -0.5 -0.75 Pre-test
MSFP SFP

Post-test
Control
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MaternalWellbeing
0.4 0.35 0.3 0.25 0.2 0.15 0.1 0.05 0

Mother Symptoms MSFP v.C

Global Mental Health MSFP v SFP

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ObserveThoughtsasThoughts NotasReality
Onefather,DT,said: [sinceparticipating]IfindthatthemoreIcanremove theangerthatImfeelingfromthesituation,themore productivethesolutionbecomes,andIcanstopand thinkandfeelandexpressnotonlyhowIamfeeling, butitgivesher[mydaughter]achancetoexpresshow shesfeelingandgivesmetime,thatstheimportant thing,givesmesometimetounderstandhowshes feelingandrememberhowoldsheisandthatno matterwhatitis,itsnottheendoftheworld.Usually itsaprettyminorthing,inthebigschemeofthings.

YogaForKids GoogleSearch 21,300,000hits Feb2nd2010

PromotingMindfulnesswithYoga: APilotStudyinUrbanAmerica
TamarMendelson MarkGreenberg AliSmith AtmanSmith AndresGonzalez

Question: CanYogaandMindfulnesssupportthe developmentofchildrentoimprovetheir copingandattention?

Method: Conductapilotrandomizedcontrolledtrial ontheeffectivenessofamindfulnessbased yogaprogramforlowincome,urbanyouth inBaltimore

Background
Youthinlowincome,urbancommunitiesareoften exposedtoconsiderablestress,butmanyhavenot developedskillsforeffectivecoping. Mindfulnessbasedapproaches,suchasyogaand meditation,mayofferuniqueadvantagesfor enhancingresilienceandeffectivecopingand improvingbothstressmanagementandattentional capacitiesamongatriskyouth.

Design
4schools innercityBaltimore 2randomizedtointervention Grades:4th and5th Recruitandmatch~40interventionand40 controls(20kidsperschool)

InterventionModel
StudentsattendtheYoga/mindfulnessprogram 4days/wkfor16weeks. Sessionswerescheduledduringtheschoolday, andlasted~45minutes

TheIntervention
Basedonaseriesofyogicexercisesthatendwithaperiodof mindfulnesstraining. Progressionfromsimpletomorecomplexyogicpostures concludeswithaseriesofbreathingexercises

Themindfulnesstrainingisaguidedexperienceattheend whenstudentslieontheirmatsintherelaxationpose Studentsareinstructedtowithdrawtheirattentionfromthe distractionsaroundthemtoafocalpointinsidethemselves. Theyareguidedinhowtokeeptheirmindsfocusedand centered,strengtheningtheircapacitynottobedistractedby thoughts,sensations,orimpulses.

Youthfocusgroupdata
TheprogramhashelpedmebecausenowIknowdifferent routinesandexercisesthatIcandoathomethathelpsme lowerandreducemystress.SowheneverIgetstressedoutIcan justdoaposeandsometimesIcanshowmymotherandmy family.
4th gradegirl

MostimportantthingIlearnedintheprogramisthatitsall differentwaystodealwithyourstresslikeinsteadoflike fightingandstuff.

5th gradeboy

Ithelpsyourelievestresswhenyoureallyfeelstressedoutor yourereallymadandfocusonwhatsinsideofyouandjust makesurethatyoustaycalm.

5th gradegirl

ChangesinSelfRegulation
Anindexofselfregulation;relevanttomindfulness techniquesintheintervention Hasbeenfoundtocorrelatewithheartrateactivity Subscales: Rumination
WhenIhaveproblemswithotherkids,Icantstopthinking aboutthem

Emotionalarousal
WhenIhaveproblemswithotherkids,rightawayIfeelreally angry,sad,scared,orworried

Intrusivethoughts
WhenIhaveproblemswithotherkids,Icantstopthinking

aboutthemwhenItrytosleeporIhavebaddreamsabout them

Interventioneffectsonselfregulation
AdjustedMean (StandardError) Time2Measure RSQInvoluntaryEngagement Rumination IntrusiveThoughts EmotionalArousal ImpulsiveAction PhysiologicArousal
*p <0.05;**p <0.01;***p <0.001

Intervention

Control

ES 0.83*** 0.70** 0.51* 0.64** 0.38 0.39

0.75(0.05) 0.76(0.08) 0.68(0.07) 0.65(0.07) 0.99(0.09) 0.70(0.07)

1.05(0.05) 1.15(0.08) 0.95(0.08) 1.00(0.08) 1.23(0.09) 0.91(0.07)

Pre andPostInterventionInvoluntaryEngagement ScoresbyStudyCondition

1.2

0.8

0.6

Intervention Control

0.4

0.2

0 Pre Post

MindfulnessinTeaching CARE CultivatingAwarenessand ResilienceinEducation

CultivatingAwarenessandResiliencein Education(CARE)
Integratesemotionskillstrainingandmindfulness basedapproachestoemotionregulation AppliesmindfulnesstotheWAYteachers
Teach Relatetostudents Manageclassrooms Modelprosocial behavior

YearlyFacilitatorTrainingatTheGarrisonInstitute (NewYorkState) ResearchProjectsinanumberofUSlocations

CARE InterventionAims
ImproveTeachersWellbeing
Increase
Mindfulness Positiveaffect Efficacy

Decrease
Burnout Negativeaffect

TheProsocial Classroom: AModelofTeacherSocialandEmotionalCompetenceandClassroomandChild Outcomes

Healthy Teacher/Student Relationships Student Social,emotional& academic outcomes

TeachersSocial& Emotional Competence

Effective classroom managementskills

Healthy Classroom Climate

EffectiveSEL implementation

School/CommunityContextFactors Jennings&Greenberg,2009

CAREProgram
ProgramModel
2days 1day(2weekslater) 1day(2weekslater) 1daybooster

Phonecoaching Onlinesupport Sustainabilityplan

ResultsofIESGoal2PilotRCT
TeacherSelfReports
CovarianceAdjustedPostTreatmentMeans Measures ClassroomEfficacy TimeUrgency Sense ofHurry DailyPhysical Symptoms EmotionRegulation(ERQ)Reappraisal Maslach Burnout PersonalAccompl. PANAS PositiveAffect PANAS NegativeAffect CESDepression Intervention X N=23 7.2 3.6 20.6 5.25 4.79 3.46 1.99 12.6 6.7 3.38 14.1 4.54 3.35 4.51 3.36 2.33 15.6 ControlX N=27 Significance/ES **/.51 */.41 **/.54 **/.72 .08/.43 */.40 NS/.20 NS/.36 NS/.29

Emotion Regulation(ERQ)Suppression 2.8

Awareness
Imbeingmoreawareofthekids,more opportunitiestotalkwiththem,justmoreaware ingeneral,ofmyself,whatImfeeling,whatIm eating,whatImdoing,whereImgoingmy awarenesshasjustbeenheightened.AndifIcan justkeepremindingmyselfofthat,justtobe aware,awareofotherpeople,awareofmyown stuff,thatsahugethingformeinlife. TeacherafterCARE

SelfRegulation/Decentering
Immuchmorecalm.EvenwhenImathome, drinkingcoffee,mymindsnotracingina thousanddifferentplaces,Imjustlikingmy coffee.Ivelearnedhowtojusttakethingsfor whattheyareandnotkeepeverythingonmy shouldersallthetime.AndbecauseImnotdoing thatanymore,thatallowsmetotreatmykids betterandaddresstheirneedsbetterandtryand teachthemtobethatwaythroughmyexample. TeacherafterCARE

WaystoFacilitateMindfulnessin InterpersonalContexts: ATaxonomy

TypesofMindfulPractices IntrapersonalActivities
FormsofSittingMeditation WalkingMeditation FormsofYoga FormsofPrayer

TypesofOutcomes IntrapersonalOutcomes
BrainActivity Symptoms(pain,distress) SelfReportsofIntrapersonal Mindfulness

InterpersonalActivities
DeepListening StoryTelling ContemplativeDialogue/Discourse CouncilProceduresinGroups EmpathyTraining FormsofMartialArts FormsofServiceLearning ContemplativeArtandMusic ContemplatingtheNaturalWorld AwarenessDuringDailyActivities ExplicitCombinationsofBoth

? ? ?

InterpersonalOutcomes
ImprovedInterpersonalRelations SelfAwarenessinEveryday Interactions SelfRegulationinEveryday Interactions Self ReportofInterpersonal Mindfulness CompassionforSelf CompassionforOthers

AreMindfulnessandPracticesthe SameThing?
Practices Meditation Yoga CultivationofPositiveAffect MartialArts ServiceLearning

Mindfulness/ Awareness

BeingIntentional
IthinkwhathelpsmeiswhenIgetfrustrated onmywaytoschool,Ijuststopmyselfandset anintention.WhatdoIreallywanttodo today?WhatsreallyimportantthatIdo today.Itsmorefreeingthansettingagoalor atodolist.
TeacherafterCARE

Insight/Attributional Shift
Ilikeattitudeadjustment.Ithinkthatsagood way(todescribeCARE).Becauseitreallyisyour whole,thewayyoulookatlotsofdifferent thingsitsalmostlikeyougivepeopleacushion, andIvegivenmykidsacushion,andIvegiven myselfacushion,andallowedmyselftorealize whyIreactcertainwaystocertainthingsandthat helpsmetomaybejustnotputitonother peopleanymore.Ithinkaboutmyselfdifferently, andIthinkaboutmystudentsdifferentlynow.I thinkattitudeadjustmentisagoodwaytoput it,notthatyouhadabadonebefore,butyou lookateverythingdifferently.

QuestionstoAskWhen ExaminingaPractice
WhataretheGoals/Outcomes? WhatCanBeMeasuredandHow? WhatPracticesorActivitiesIncrease Mindfulness? HowdotheGoals/Outcomes, Measurements,andPractices/Activities changewithage andcontext?

SkillsandCompetencies
MentalSkills
SelfRegulatorySkills
Attention Emotion(Calmness)

CognitiveSkills
Cognition(Clarity/Awareness) AbilitytoDecenter Attributional Shifts

SocialemotionalbehavioralCompetencies
Empathy/Compassion(Kindness) CommunicationSkills(deeplistening,thoughtfuldialogue)

WeNeedClearDescriptionof Interventions
Richdescriptionofintervention
Specificinstructions

Whatisthesource(s)ofintervention? Hasitbeenmodifiedtobeageappropriate? Whoisinstructor?Whatistheirtraining? Whatisthedosing frequency? Arethereoutofsessionassignments?

WhatCanMindfulPracticesDo
MayHaveQuiteDifferentOutcomes DependingonthePractices(Breathing,Yoga, CompassionFocus,AttentionFocus) MayDependonthePopulation Havingacleartheoryofchangeiscriticaland thisneedstobecontextualized

MindfulnessProjects
Mindfulness and Teaching CARE Mindfulness and Parenting Mindfulness Programs for Children and Youth

Partners:
GarrisonInstitute Contemplation&EducationLeadershipCouncil HolisticLifeFoundation:TravellingYogis JohnsHopkins SchoolofPublicHealth NumerousPublicSchoolDistricts PennState PreventionResearchCenter

Funders:
GarrisonInstitute MindandLifeInstitute Attias FamilyFund JohnsHopkinsCtr onViolencePrevention PSUCenter U.S.DepartmentofEducation NationalInstituteofDrugAbuse