MBSR Curriculum Guide 2017 FEB[2] · care and attention, the MBSR program curriculum into...

Mindfulness-BasedStressReduction(MBSR)

AuthorizedCurriculumGuide©

2017

VersionRevisedandEditedby:

SakiF.Santorelli,EdD,MAFlorenceMeleo-Meyer,MS,MA

LynnKoerbel,MPH

JonKabat-Zinn,PhDMBSRprogramfounderandcreatoroftheMBSRcurriculum

TheMindfulness-BasedStressReductionauthorizedcurriculumguideisthepropertyoftheUniversityofMassachusettsMedicalSchool,CenterforMindfulnessinMedicine,HealthCare,andSociety™andmaynotbecopied,distributed,ortransferredtoanyindividualoranyorganizationwithoutwrittenpermission.

CenterforMindfulnessinMedicine,HealthCare,andSociety(CFM)UniversityofMassachusettsMedicalSchool

Mindfulness-BasedStressReduction(MBSR)AuthorizedCurriculumGuide©

2017

ACKNOWLEDGEMENTS

Weofferadeepbowofgratitudetoourcolleagueswhohaveshepherded,withgreatcareandattention,theMBSRprogramcurriculumintomainstreammedicineandhealth

caresince1979…

JonKabat-Zinn,PhDMBSRprogramfounderandoriginalcurriculumwriter

MelissaBlacker,MAMajoreditorialcontributionstomultiple

revisionsoftheMBSRcurriculum

Contributorstothis2017versioninclude:GwénolaHerbette,PhDCarlFulwiler,MD,PhD

PleasedirectallcorrespondenceregardingtheAuthorizedCurriculumGuide©toJean Baril: [email protected]

mailto:[email protected]?subject=Question Regarding MBSR Curriculum Document



2017

TableofContents

Prologue………………..………………………………………………………… 1

MBSRCourseOverview ………………………………………………………… 4

OrientationSessionOverview …………………………………………………. 6

OrientationSessionLogisticalDetails…………………………………………... 8

ClassOne ………………………………………………………………………. 12

ClassTwo ………………………………………………………………………. 15

ClassThree ………………………………………………………………………. 18

ClassFour ………………………………………………………………………. 21

ClassFive ………………………………………………………………………. 24

ClassSix ………………………………………………………………………. 28

All-DayClass……………………………………………………………………… 32

ClassSeven………………………………………………………………………. 36

ClassEight ………………………………………………………………………. 39

NotesontheCurriculum…………………………………………………………. 42

Appendix:ConductingOrientationSessionsattheUMassCenterforMindfulness44

Prologue

BySakiF.Santorelli

Eightcenturiesago,duringthelasttwelveyearsofhislife,thegreatteacherandpoet,JelaluddinRumi,recitedandwrotetheMasnavi–sixvolumescomprising64,000linesofpoetry.Inthisgreatwork,oneofthetopicsRumispeaksaboutiswhathecallsthe“varietyofintelligences”and,aswell,about“UniversalIntelligence”-whathereferstoas“TheMindoftheWhole.”Likeallgoodteachers,heurgesusto“figureouthowtobedeliveredfromourownfiguring.”1

Inanotherinstancehecommentson“personalintelligence”:

Personalintelligenceisnotcapableofdoingwork.Itcanlearn,butitcannotcreate.Thatmustcomefromnon-time,non-space.Realworkbeginsthere.”2

Hespeaks,too,aboutwhathecalls“twokindsofintelligence”:

Onethatisacquired…onealreadycompletedandpreservedinsideyou.3

InthecontextofthisMindfulness-BasedStressReduction(MBSR)CurriculumGuidethese“twokindsofintelligence”maybewellworthexploring.

AcquiredIntelligence:TheInstrumentalDimensionofMBSR

OftenenoughpeoplelearningtoteachMBSRaskmethequestion,“HastheMBSRcurriculumchangedmuchin38years?”Iamkeenlyattentivetothesilencethatusuallyensuesbetweenuswhenthisquestionarises.

Whatistheanswer?Yes?No?YesandNo?NeitheryesnornoseemstometobeaboutasclosetorealityasIcanland.

Atheart,theMBSRcurriculumhasremainedabsolutelytruetotheformandformlessnessthatitenteredtheworldwithin1979.Fornow,thebasicstructureoftheprogram,thesequencingofmeditationpractices,theunderlyingclassthemesandthememespermeatingtheprogramremainrobustandintact.

1 Moyne,J.,Barks,C.(1984).OpenSecret.Putney,VT:ThresholdBooks.2Moyne,J.,Barks,C.(1994).SayIAmYou.Athens,GA:MAYPOP.3Moyne,J.,Barks,C.(1988).ThisLonging.Putney,VT:ThresholdBooks.

Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 1

Inaggregate,thesecurricularcomponentsconstitutethe“instrumental”domainoftheMBSRcurriculum.ThisinstrumentaldomainiswhatRumiisreferringtoas“acquired”intelligence.

Acquiredintelligencecomesthroughpractice,throughrepetition,attainmentandthedevelopmentofskillsandcompetencieslearned,understood,andexperientiallyrefinedovertime.Surely,theinstrumentalisofgreatvalue,comprisingonedomainoflearning.

Seenthroughtheperspectiveoftheinstrumental,thiscurriculumguideisakintoanoperatingmanual-aclass-by-classhandbook.Understandablyso,whensomeoneisfirstlearningtobecomeanMBSRteacher,thecurriculumisoftenapproachedinthisway.

Whenviewedthroughthelensoftheinstrumental–theworldofdoingandbecoming-thentheanswertothequestionofwhetherthecurriculumhaschangedleanstowards“no”;thecurriculumhasnotchangedmuchatallsince1979.

Ofcourse,hereinliesoneoftheinherentdangersofpublishingan“authorizedcurriculumguide.”Soonenough,itwillbemistakenfora“manualizedprotocol.”Soonenough,peoplewillbecomefastenedtotheform–boundtightlytotheinstrumental-becauseitprovidesastructure,atrajectory,andamapthatiseasilymistakenfortheterritory.Whilevaluableandoftentimescomforting,thisisalsoproblematicbecauseitislimiting.

Muchofthetime,wewantthemaptobetheterritorybecausewedesperatelywantconstancy.Surelyitissoofteneasierforustoholdfirmlytoandbecomfortedbytheinstrumental-bytheform.

Havingestablishedsomesenseoftheinstrumentaldimensionofintelligence,let’snowturnourattentiontoawhollyotherdomainofintelligence.

“AlreadyCompleted”Intelligence:TheNon-InstrumentalDimensionofMBSR

Atthemostbasiclevel,youneedaroomtoteachMBSR,agatheringplaceforpeople.

Ofcourse,youalreadyinhabitaroomthatisalwayswithyou.Thisistheroomofyourheart.Rumicallsthisplacelessplace:

“Thefreshnessinthecenterofyourchest”…“Thecityinsideyourchest.”

Thisfreshnessisoutsideofspaceandtime,outsideofneedingtogetanything,outsideoftransformingyourselforanyoneoranything-noattaining,nonon-attaining,nocompletenessorincompleteness…simplybeing.

Thisisthenon-instrumentalactualityofMBSR,theintelligencethatisalreadycompletewithinyou–andwithinthosewithwhomyouwork.Thisintelligencedoesnotneedtobeacquiredbutrather,remembered.


Thisistherealcurriculum…therealguide…thedeepspringfromwhichMBSRflowsoutofyouandmakesitswayintotheworld.

YoumightconsiderreturningtothiswaterwheneveryouneedareminderofwhoandwhatyouarebehindallthewordsandformsdescribedinthisCurriculumGuide.This“freshness”availabletoyouwheneveryoubecomelostortired,overextendedordiscouragedorsimplyinneedofrestandeaseandtherefreshmentofnotneedingtopursueanyaimatall.

Isuspectthatifyouallowyourselftheroom,you’lldiscoverforyourselfthatholdingtoofirmlytotheinstrumentalinevitablyblindsyoutothenon-instrumental-towhatismostessentialaboutMBSR-becauseitismostessentialaboutyouandallhumanbeings.

LikeRussianMatryoshkadolls,theinstrumentalisnestedwithinthenon-instrumental.Ifthiswerenotthecase,howcouldyoulearnanything?Howcouldyouloveanyone,iflovewerenotaninnateattributeofyourbeing?Howcouldyouacheandfeeltendernessintheorbitofanother’spain,ifempathywasn’tinherent?Surely,wecanlearntobecomeincreasinglyfamiliarwiththeseattributesthroughdeliberatenessandpractice.However,iftheywerenotalreadypartandparcelofwhoandwhatyouare,youwouldhavenoreferencepointforloving,compassionating(asWaltWhitmansays)orassumingyourownmeasureofuniversalresponsibility.

IfMBSRisworthanything,itsworthliesinitsaliveness.ItsalivenessrestsinthebasicungraspabilityofthecurriculumasMBSR.Seenfromthisvantagepoint–thevantagepointofthenon-instrumental-thentheanswertothequestion,“hasthecurriculumchanged”isyes.Thecurriculumhaschanged-because,likeeverythingelse,itisconstantlychanging.Likewise,whoandwhateveryouthinkofas“you”isalsocontinuallychanging.ThisdynamicfluxisnoneotherthanthecreativenatureofRumi’s“UniversalIntelligence”reflectedthroughyouandembodiedasyou.And,ofcourse,asyougrowanddeepen,thecurriculumischanged,deepeningandexpandingintonewexpressionsofitself,endlessly.

Ultimately,andinaverypalpableway,the“curriculum”ofMBSRisnoneotherthanyourlifeandthelivesofthepeopleyou’llshareinandengagewithweekbyweekintheclassroom.Thesuffering,theinconstancy,thelackofasolid,concrete“self”-thewishforreliefofsufferingandthelongingforwellbeingthatyoucarrywithinyou,andallthepeopleyou’lleverworkwithcarrywithinthem-isthecurriculum,thevitallifeofMBSR.

Now,asyouturnthepageandenterthisMBSRCurriculumGuide,nowandagain,andoverandoveragain,myinvitationtoyouistorealizethattherealguidetotheMBSRcurriculumisalwaysavailableinsideofyou,alwaysawaitingyourattention,alwaysrestinginyourcompletenessoutsideofanynotionsofhereandnow,pastandfuture,timeandspace.




2017

Overview

AstheplaceoforiginofMindfulness-BasedStressReduction(MBSR),theUniversityofMassachusettsCenterforMindfulnesshas,since1979,conceptualized,developed,implementedandresearchedMBSRintheformofan8-week,10-sessioncoursecomprisedof31hoursofdirectinstruction.

This2017versionofMBSRCurriculumGuideisbaseduponourcumulativeexperiencetotalingmorethanonemillionhoursofclinicalcare,morethan24,000MBSRprogramcompleters,referredbymorethan7,000physicians,hundredsofotherhealthcareprofessionals,andthroughself-referral.Inourview,maintainingthefidelityandintegrityofMBSRasdetailedinthisCurriculumGuidewillhelpinsuretheclinicalefficacy,scientificvalidity,andeducationalrigorofthisapproach.

AdherencetothetheoreticalconstructsandcoreelementsofMBSRasdescribedinthisCurriculumGuidearebaseduponclinicalexperienceandscientificinvestigations.Astheseinvestigationsproceedandnewdiscoveriesaremade,wewelcomeandarepreparedtoaltertheMBSRcurriculum.

Currently,thereareawide-rangeofmindfulness-basedprogramsthathavedevelopedoutofthebasicstructureandformatofMBSR.WeapplaudtheseadaptationsandexperimentswhilestronglyurgingourcolleaguestocallwhattheydoMBSRonlyiftheyadheretothestructureandstandardsdescribedherein.Withoutsuchadherence,theveracityofMBSRwillbediminishedandthescientificresultsincreasinglysuspect.

Atitscore,MBSRisbasedonsystematicandintensivetraininginmindfulnessmeditationandmindfulhathayoga.Thecurriculum,originallydevelopedbyJonKabat-Zinn,Ph.D.,isanexpressionandreflectionofthiscoreprinciple.Therefore,itistermed“mindfulness-based.”IncontinualdevelopmentintheMindfulness-BasedStressReductionClinicatUniversityofMassachusettsMedicalSchool,thecurriculumisdesignedtoguideMBSRprogramparticipantsinthe“how”oflearningtopractice,integrate,andapplymindfulnessintheireverydaylives.TheprimaryintentionoftheMBSRcurriculumistocreateastructuredpathwaytorelievesufferingandincreasewellbeingforpeoplefacingahostofchallengesarisingfromawiderangeofmedicalandpsychologicalconditionsandthedemandsandstressorsinherentintheeverdaylivesofhumanbeings.

EmbeddedwithinthecontextofMind-BodyandParticipatoryMedicine,theMBSRcurriculumfocusesontheexperientialcultivationofboth“formal”and“informal”mindfulnesspracticeasameansoffamiliarizingoneselfwithawarenessitself(mindfulness).Therecognitionofaninnate,ever-presentawarenessisthefoundationforthedevelopmentofpositivehealthbehaviors,psychologicaland


emotionalresilience,andanoverarchingsenseofwellbeingthatcanbeeffectivelycultivatedandrelieduponacrosstheadultlifespan.

MBSRclinicalandbasicscienceresearchandourexperienceattheCenterforMindfulnessattheUniversityofMassachusettsMedicalSchoolstronglysupportstheefficacyofMBSRasaneffectiveclinicalapproachthatcanbeutilizedbyparticipantsfarbeyondcompletionoftheprogram.


OrientationSession:Overview

(Foranin-depthdescriptionoftheOrientationSessionasfollowedatUMassMedicalSchoolseeAppendixA)

Overview ThemainintentionsoftheOrientationinclude:

v FamiliarizingpotentialparticipantswithwhatMBSRisandisnot

v Providingparticipantswithanexperienceofmindfulnessinanatmosphereoftrustandnon-judgmentalawarenessandexchange

v Educatingparticipantsaboutprogramprocedures

v Assessinghowparticipantsinteractinthegroupsettingtodeterminewhethertheprogramisagoodmatch

v Meetingwitheachparticipantindividuallyforabriefscreeninginterview

v Elicitingacommitmentfromparticipantstoengageinactiveparticipationintheprogram,whichincludesweeklyclassattendanceandaminimumof45minutestoonehourofformalhomepracticeaswellasinformalpracticethroughouttheday

RecommendedTime

Allocations1:00-1:25hourstocoverallcomponentsinlargegroup

FormalPractice

ShortYogasequenceSittingMeditation–AwarenessofBreath

InformalPractice

FollowingtheGroupOrientationSession,ifparticipantsarewaitingtheirturnforanindividualinterview,aninvitationcanbeofferedtoconsiderbecomingaware—forbriefmoments—oftheenvironment,bodilysensations,feelingsofimpatienceorboredom,excitementetc.

TypicalClassSequence

v Overviewoforientation

v BriefhistoryofMBSRandtheStressReductionClinic(SRC)(adaptforlocalvenueasneeded)

v IntroduceMindfulness

v Briefpractice(yoga,shortAOB)(PracticeisofferedherejustasitisdoneintheMBSRclass,includingguidancefortakingcare,self-assessingbeforetakingpartinanymovement,andexploringone’scurrentlimitswithoutpushingoneselfbeyondthem)

v BriefsharingoftheimmediatemindfulnesspracticeexperiencewithOrientationSessionparticipants

v ClassLogistics:Times,dates(includingtheAll-Dayclass),theimportanceofattendingeachclassandthecommitmenttodailypractice


TypicalClassSequence(cont)

v ClassContent:Experientiallearningofformalandinformalpractices;recordingsandhomepractice;classtopics:Perception,stressphysiology,stressreactivityandresponding,communication

v GuidelinesforParticipation:Commitment,engagementwithpractice,noneedto“believe”anythingasapre-requisiteforparticipation,attentivenesstoone’sexperienceastheprimary“data.”Notethatwhileparticipantsarenotrequiredtospeakinclass,classdialogueinsmallgroupsandthelargergroupisameaningfulpartofclasstime.

v Risks&Benefits:

Risks–Physical,emotional,time,social;alsonotepossibleexclusionsorareastotalkmorewithinstructorduringinterview:Addiction,earlyrecovery,untreatedpsychosis,acutedepression,

suicidality,PTSD,SocialAnxiety,recentloss.Thesecircumstancesorconditionsdonotruleoutthepossibilityofbeingintheclass,butitis

essentialtosharewiththeteacherduringtheinterviewtheseoranythingthatfeelsimportanttoshare.Duringtheinterviewthe

teachercanoffersuggestionsforsupportandmakerecommend-dationsforthemostsuccessfuloutcomesforparticipationintheMBSRclass(PleaserefertoAppendixAfordetailedinformationandproceduresregardingcandidatereferralstoappropriatemedicalandpsychologicalprofessionalsandhealthemergencyintervention.)

Benefits–Bettercoping,evidence-based,dependentonconsistentpractice,capacitytobettercareforself,noguarantees

v Inviteadditionalquestions

v IndividualInterview


MBSROrientationSessionLogisticalDetails

LogisticsoftheMBSRCourse:BelowaredetailedlogisticsthatareincludedintheCFMOrientationSessions.Somelogisticsareadaptabledependingonthevenueandwhetherthereisoneclassorseveralbeingofferedinagiventimeframe;optionsareindicatedbelow.PleaseseeStandardsofPracticeformoreinformationonprogrammaticelementsrequiredtobeconsidered“MBSR.”

v Thecoursemeetseveryweekfor8weeks,eitherinthemorningorevening,for2.5to3.5hours(adapttimesforlocalvenue).

v Thereisan“All-day”class(asilentretreatday)betweenthe6thand7thweekonaweekendday,from8:45a.m.–4:30p.m.(ItisalsopossibletoholdtheAll-dayclassbetweenthe5thand6thweekifschedulesdemand).

v Formalandinformalpractices:Ineachclassparticipantswilllearnaboutandpracticedifferentformsofmindfulnessincludingformalpracticesofyoga,sittingmeditation,bodyscan,andwalkingmeditationaswellasinformalpracticessuchasmindfuleating,speakingandlistening,andmindfulnessofdailyactivities.

v Topicscoveredinclass:Participantswilllearnaboutstress,andexplorethehabitual,automaticbehavioral,physical,emotionalandcognitivepatternsaswellasinvestigate,indetail,moreeffectiveandskillfulresponsestothechallengesanddemandsofeverydaylife.Inparallel,we’llalsobeexploringwhatitmeanstotakecareofourselvesandflourish,howtorelatetoourselvesandothersmoreeffectivelyandwhatitmightbeliketonourishbehaviorsandactivitiesthatexpressourinnatecapacityforwellbeing.

v Ineachclasstherewillbeperiodsofformalmindfulnesspractice,smallandlargegroupdiscussionsandtalks,aswellaspracticesandexercisesrelatedtothatweek’stopics.

v RecordingsforHomePractice:ParticipantswillreceiveCDsorMp3downloadswithguidedmeditationandyogapracticesandahomepracticemanual,weeklyhandoutsoremail/onlineinformationwitheachweek’sformalandinformalpracticeassignments.

v Classsize:Therewillbeapproximately_______peopleineachclass.(Classsizesmayvaryfromasfewas15andasmanyas40dependingonthevenue,community,etc.SeeStandardsofPracticeforsuggestedclasssize.)

v Whattowear/bring:Comfortableclothing,looseatthewaistthatallowsforunconstructedbreathing,supportspractice.Therearenoscheduledbreaksduringclass;takecareofpersonalneedsasrequired(thisincludesbathroom,food,water,medications).Encourageeatinglightlybeforeclassandavoidhavingfoodintheclassroom,althoughiffoodisneededformedicalreasons,individualsshouldbeaccommodated.Requestrefrainingfromuseofscentedpersonalcareproducts(thismayincludedetergents)duetoothers’sensitivity.

v Dailyhomepracticeconsistsof40-45minutesofrecordedformalpracticeinadditiontootherexercises,activities,orpracticenotrequiringarecording.Totaldailypracticetimeis


60minutesormore.Encourageparticipantstoconsiderhowtheywillsetasidetimefordailypracticesincethisisanessentialcomponenttotheprogram.

v AcknowledgestressfulnessofparticipationinMBSR.Thisincludestimecommitmentandotherpossiblechallenges.

v Attendance:Attendanceatall9classes,includingtheall-dayclassisemphasized.Ifaparticipantmissesaclass,theremaybepossibilitiesformakinguptheclassthatweekonanotherdayifmultipleclassesareheldatthesite(dependentonvenue).Ifsomeoneknowstheywillmiss2ormoreclasses,encourageparticipationinadifferentcycle.If,duringthecourse,aparticipantmisses3ormoreclasses,theyareencouragedtodropoutandtaketheentireprogramagaininanothercyclewhentheyareabletomakethetimecommitment.Emphasizetheimportanceofarrivingontime.Remindparticipantstocalltheteacheriftheyareunabletoattendclass,needtomakeupinanotherclass,orknowyouwillbelateforclass.

v Weatherpolicies:Explainanyinclementweatherpolicy.

v Informedconsent-Classaudioandvideorecordingsforteacherdevelopment(ifapplicable;dependentonvenue):Explainthenatureanduseofvideoandaudiorecordingofeachclass.Informparticipantsrecordingsareusedsolelytosupportongoingteacherdevelopmentandcompetencyassessment.HaveparticipantssignInformedConsentdocumentbeforeOrientationorthefirstclass.

Explaintherisksandbenefitsoftheprogram.(Note:itisonlyafterthesehavebeenexplainedthattheparticipantcansigntheinformedconsentagreement.)

Physicalrisks(Ifabriefyoga/movementpracticeisofferedduringtheOrientationSession,asissuggested,theseintroductorypointsofguidanceshouldbeincludedduringthatmovementexperienceandthenreviewedinmoredepthhere):

v Theprimaryphysicalriskisconnectedtopracticingmindfulyoga.

v Knowingoneselfandtakingcareofoneselfisatthecoreofmindfulness.

v Ifaparticipanthearsguidancethattheyknowisnotappropriatefortheirbodyorcondition,orifanythingcausespain,thecorrectactionistodisregardtheteacherandeithermodifythepose/movement,restandimaginedoingthepose/movement,ornoticeandacknowledgeanythoughtsoremotionsthatmaybearisingintheexperienceofnotdoingthepose/movement.

v Focusisonexploringone’sphysicallimits,bygoingtotheedgeofthoselimits,butnotbeyond.Thisexplorationisdoneslowlyandwithsensitivity,guidedbytheteacher.

v BeingawareofthebodyfrommomenttomomentandineverydaysituationsisanessentialaspectofMBSR.Theformalyogasequencesareastructuredwayofdevelopinggreaterbodyawareness,andassuch,areawarenesspracticesratherthanpracticestodevelopaspecificformoralignmentthatisoftenemphasizedinothertypesofyoga.


v Theteacheroffersmodificationsoradaptationstoposes/movementstomeetthevarietyofcapacitiesintheclass(aswasdemonstratedinthebriefpracticeguidedduringOrientationsession).

v Participantswithphysicalconditionsorlimitationsshouldasktheirhealthcareprovidertoreviewtheposturesinthepracticemanual,andtosuggestonlythoseposturesthataresuitable.

Emotionalrisks:

v Feelingsofsadness,anger,orfear,couldseemorbecomestrongeraspracticedevelops,sincepayingattentioninaconsciousway—perhapsforthefirsttime—canhighlightemotions.

v Ahistoryoftrauma,abuse,significantrecentlossormajorlifechanges,oraddictiontosubstancesmayheightenemotionalreactions.Pleasespeakwiththeteacherifthisoccurs,andtogetheryoucandeterminethebestcourseofaction(i.e.,modifyingpractice,droppingthecourse,waitingforanothertimewhenacutesymptomsmaybeless).

v Participantsmaymakediscoveriesaboutthemselvesthattheymaynotlike.

v Participantsmaybechallengedandfindthemselvesfacingtheunknown.

v Experientiallearningisoftennon-linear;participants’symptomscansometimesworsen,particularlyintheearlyweeksoftheprogram.Evenwithregularpractice,participantsmayfeellike“nothingishappening.”Thisisnormalandatypicalaspectofanylearningprocess.Participantsareencouragedtospeaktotheirteacherwithanyconcerns.

Otherpeopleinyourlife:

v Itmaybeachallengetosetasidethespaceandtimetodothispractice;requestingassistancefromfromfamily,friendsand/orco-workersmaybesupportive.

v Participantsmayexperiencechangesinreactivity,behaviorandcommunication,andfamily,friendsand/orco-workersmaybeuncomfortablewiththesenewbehaviorsorattitudes.

v Participantsmayfindthattheirrelationshipschangeasattentiondeepensandnewbehaviorsevolve.

Time:v Findingtimetomakeanewhabitofmindfulnesspracticecanbechallenging:it’snormalto

havetheideathatthereisnotenoughtimeforpractice.Participantsoftenfind,counter-intuitively,thatsettingasidetimeforpracticeincreasesthesenseofspaciousnessintherestoftheday.


Benefits:

v Increasedawarenessandconcentration

v Discoveringnewwaystocopemoreeffectivelywithexistingconditionsdifficulties,painorsuffering

v Learningtotakebettercareofoneself

v Manyphysical,psychologicalandemotionalhealthbenefitsofMBSRhavebeenreportedinscientificliterature

v WecannotguaranteeorpromiseanyparticularresultsfromparticipationintheMBSRcourse.Rather,emphasisisplacedontheparticipant’sactiveengagementintheprogram.Weencourageparticipantstoassumethestanceofascientistinvestigatingtheirareaofinterest:withopennessandcuriosity,suspensionofjudgementandasenseofhealthyquestioning.Itismoreimportantforaparticipanttoexperienceforthemselveswhateverishappening,ratherthanfortheteachertotellthemwhatmayormaynothappenasaresultoftheirparticipationinthecourse.

Inviteadditionalquestions


ClassOne

Overview This3-hoursessionincludesareviewoftheapproachandtheestablishmentofalearningcontractwiththeparticipant/patient.ThetheoreticalunderpinningsofmindfulnesswithinthecontextofMind-BodyandParticipatoryMedicineandtheapplicationofself-regulatoryskillsrelatedtotheindividual’sconditionorreferringdiagnosisarealsoestablished.Theparticipant/patientisexperientiallyintroducedtomindfuleating,somestandingyogastretches,mindfulnessofbreathingandthebodyscanmeditation.Homepracticeisassignedusingthefirstguidedrecording(bodyscanmeditation)asameansofbeginningtolearntobecomefamiliarwithmindfulawarenessofthebody.

Theme Fromourpointofview,aslongasyouarebreathing,thereismorerightwithyouthanwrongwithyou,nomatterwhatchallengesyouarefacing.Challengesanddifficultiesareworkable.Mindfulawareness,definedastheawarenessthatarisesfrompayingattention,onpurpose,inthepresentmoment,non-judgmentally,(Kabat-Zinn,J,FullCatastropheLiving,1990,2013)isfundamentaltothisapproachsincethepresentmomentistheonlytimeanyoneeverhasforperceiving,learning,growingandtransforming.

Buildingtrustwithinthegroupandbeginningtosenseacommunity;definingandapplyingmindfulnesstoourlifeexperientially;openingandstartingtoexplore;acknowledgingalternativeperspectives;trustingthepossibilitytoseeoneselfwithfresheyes.

RecommendedTime

Allocations

FormalPractice–Approximately1hour(muchdependsonthesizeofthegroupandhowmuchtimeisallottedforthebodyscan).

InformalPractice–Approximately20-30minutes(eatingmeditation)

GroupDiscussion–1hour+(dependingonsizeofgroupandneedsforgroupintroductions

Logistics(attendance,announcements,homepractice)–30minutes

FormalPractice OpeningPractice(brief,arriving)

BodyScan

StandingYoga(ItisrecommendedthatafewposesfromtheStandingYogasequencebeintroducedinclasses1,2,4and5,sothatbyClass5,whenparticipants/patientsreceivetheStandingYogarecording,allStandingYogapostureswillhavehavebeenintroduced,eliminatingtheneedtodothesequenceinitsentiretyinclass5)

InformalPractice

EatingMeditation



(continued)

Welcomeandbriefintroductionofprogrambytheinstructor

Openingmeditation:becomingattentivetoandawareofthoughts,emotions,andsensationsinthepresentmoment(mayalsoincludewhatisseen,heard,othersenses)

Classresponsestoopeningmeditation(canbejustafewresponsesifitisalargeclass)

Reviewdefinitionofmindfulness,includingentiretimeinclassasanopportunitytopracticemoment-to-momentseamlessawareness(notjustinthemeditations)

Reviewofguidelinesforparticipationi.e.:Confidentiality,self-care,communicationwithinstructor,noadvice-giving,nofixingorrescuingothers,avoidanceofscentiedproducts,etc.

Guidedindividualinternalreflection:Whathasbroughtyouhere?Whatisyourintention?Whatdoyoureallywant?(Option:smallgroupordyadsharingaboutguidedreflectionbeforegoingintolargegroup.)

Groupgo-around:Provideparticipantswiththeopportunitytointroducethemselves,whattheyareherefor,andtheirgoalsandexpectationsfortheprogram.Theinstructormaymakeinstructivecomments,observations,andwelcomingremarksfromtimetotimeinresponsetoindividuals.Thisisnotadiscussion;avoidcross-talkbetweenparticipants,andteachermayinformthegroupthats/hemayneedtointerrupttokeepontimeandmaintainguidelines.Mindfullisteningandspeakingmaybeintroducedhere.Encourageeveryonetospeak—evenifonlytosaytheirname.Alsoencouragethosewhomaybeattendingforprofessionaltrainingpurposes(e.g.asthebeginningofMBSRteachertraining,forinstance,orinordertointroducemindfulnesstotheirpatientsorclients)todropbeneaththeprofessionalroletothepersonalaspectsoftheirlives,tobeauthenticandwillingtoexplorewhatisavailableforthem,withoutpre-conceptionsofthisprogramsolelyasatraining,butrathertoseetheirfullpartipationasanessentialpartoftraining.

Yoga:IntroductiontostandingMountainPoseandafewotherstandingposes(Seerecommendationunder“FormalPractice”onpreviouspage).

Raisin-eatingexercise:introductiontomindfulnessmeditationusingtheordinaryactofeating,followedbyadialogueabouttheexperience.Focusondirectsensoryobservation–whatcanbeseen,felt,heard,smelled,tasted.Observingandthenslowlyeatingoneraisin,withguidancefrominstructor,stoppingforobservationsfromparticipants.Bringingfriendlycuriositytothisinvestigation,theneatingasecondraisininsilence.Instructorisattentivetoobservationsthataredeductions,opinionsandtheoriesremovedfromtheparticipant’simmediateexperience.Groupdialoguecanbeaninquiryintowhatisdirectlyexperiencedthroughthispractice.Theinstructorstaysawakeandalivetotherecognitionofpast


TypicalClassSequence(continued)

experienceinfluencingthepresent;theinterconnectionoftheraisinto-sun,soil,rain,energyofplanting,harvesting,deliveringthefood,andthenbecomingtheenergyofthebody;relationshipbetweenhunger,satisfaction,emptiness,andfullness;andwhatshowsupwhenpresentforthefullactofeating.Notneedingtonecessarilybringthesetopicsforward,butallowingthemtoariseinthegroup.

Abdominalbreathing:Tiethemoment-to-momentawarenessofeatingexercisetoexperiencingthebreathinthesameway.Introducevariouscomfortableposturesforlyingdown:corpsepose,astronautpose,orsittinginchairsifnecessary.Focusonthefeelingoftheabdomenrisingandfallingwiththein-breathandtheout-breath,mindfully“tasting”thebreathinthesamewaythatthegrouptastedtheraisin.Non-judgmentallyobservingone’sownbreathingfrommomenttomoment;andbringingone’sattentionbacktothebreathandthepresentmomentwhenthemindwanders.

BodyScan:Frommindfulnessofbreathing,moveintoguidedbodyscanwithpeoplecontinuingtolieonfloororsittingincomfortableposition.

Finishwithdiscussionofpeople’sexperienceswiththebodyscanandassigndailyhomepractice.Giveinstructionsforuseofthe45-minuteBodyScanrecordingforhomepracticeduringWeekOne.

Reviewhomepractice.EndwithshortAwarenessofBreath(AOB)meditation.

HomePractice • BodyScanrecording≥6daysthisweek

• HomePracticeManual:The9DotsPuzzle.Giveinstructionstoworkwiththepuzzleandalsobeattentivetohowyouapproachthepuzzle.

• Eatonemealthisweekmindfullyoratleastafewbitesduringonemeal

• Optionalinformalpractice(“smalldoses,manytimes”):Informallyandintentionallynoticeorcultivatemomentsofawarenessduringtheday—tuningbrieflyintothebreath,body,sounds,whatcanbeseen,andthoughtsandemotions—whateverispresent,noticingwithoutjudgment;recognizingdirectlythatyoucandeliberatelycultivateacontinuityofawarenessthroughoutyourdayasawayofbeginningtoaccessyourinnateresourcesforcopingandmeetingliveinwaysthatarelessconditionedandmoreappropriatetosituationsyouarefacing

• Optionalinformalpractice:Informallypracticesomeofthemindfulstretchesyoulearnedinclassasawaytoreconnectwiththebodyandthepresentmoment


ClassTwo

Overview This2.5hoursessionincludesonehourofexperientialmindfulnesstrainingandskilldevelopment,andonehourormoreoffocuseddialogueandreflectiononhomepracticeand,thematically,ontheroleofperceptionandconditioningintheappraisalandassessmentofstress.Thepivotalroleofself-responsibilityinthepositivedevelopmentofshortandlong-termchangesinhealthandhealth-enhancingbehaviorsisintroduced.Homepracticeisassignedwithanemphasisontheregulardailypracticeofthebodyscanforasecondweek,plusintroductionofshortperiodsofsittingmeditation,andtheapplicationandintegrationofmindfulnessintotheparticipant’severydaylife.

Theme Perceptionandcreativeresponding:Howyouseethings(ordon’tseethem)willdetermineinlargemeasurehowyouwillreactorrespondtothem.Thistiesinwithhowpeopleseetheirparticipationintheprogram;howtheyseetheirpain,theirillness;thestressandpressuresintheirlives;thelevelofcommitmenttheywillbringtotheprogramandtothepersonaldisciplineitrequires.Maketheconnectiontoautomatichabitualstressreactivityandrecoveryfromacutestressors,andtheprinciplethat“It’snotthestressorsperse,buthowyouhandlethem”thatinfluencestheshortandlong-termhealtheffectstheymayhaveonyourmind,bodyandoverallsenseofhealthandwellbeing.

RecommendedTime

Allocations

FormalPractice–1hour

GroupDiscussion–40minutes

DidacticPresentation(ninedots)–30minincludinggroupdiscussion


FormalPractice Openingmeditation

SittingMeditation

StandingYoga-afewpostures(optional)

BodyScan(45minutes)

AOBsittingmeditation(introductionwithposturalguidance)

InformalPractice

Forhomepractice:Mindfulnessofroutineactivities:Brushingteeth,washingdishes,takingashower,takingoutgarbage,shopping,readingtokids,eating(participantchoosesone).

Continueincludingsomeoftheyogaposesintoyourday.Becomeawareofrepetitivemovementsinordinaryactivities,i.e.gettingintoandoutofthecar,preparingmeals,bathingchildren,takingawalk,etc.



Standingyoga

Guidedbodyscan

Smalland/orlargegroupwork:Discussionofthebodyscanexperiencebothinthesessionaswellashomepracticewithparticularattentiontohowsuccessfultheywereatmakingthetimeforit,problemsandobstaclesencountered(sleepiness,boredom,other),howtheyworkedwiththemornot,andwhatparticipantsmaybelearningand/orseeingaboutthemselvesfrompracticingthebodyscan.

Establishtheuniversalityofthewanderingmindandthenotionofworkingwiththisrecognitionwithcuriosity,acceptance/acknowledgmentanddeliberate,repeated,re-focusingofattention;explicitlylettingparticipantsknowthatthisdeliberatere-directingofmindand“comingback”isasmuchapartofthemeditationpracticeasstayingontheobjectofattention;noting(withoutanalysis)wherethemindgoesandwhatisonone’smind.Emphasizetheimportanceofdesistingfromrepressingandsuppressingthoughtsorfeelingsorforcingthingstobeacertainway.Bestwaytogetsomewhereisnottotrytogetanywhere,noteven“relaxed.”Theoptionisto“letbe”or“letgo.”Thisisanewwayoflearning.Thebodyhasitsownlanguageanditsownintelligence.Non-conceptual.

Discusseatingonemindfulmealand/ortheexperienceoftheirrelationshipwithfoodthisweek.

9-DotsPuzzle:Examinetheexperienceofworkingwiththe9-DotPuzzleandthethemeofexpandingthefieldofawarenesswhenfacingfamiliarornewchallengesorcircumstances.Severalsubthemesmayemergeoutofthisexperience.Thesemayinclude:wayssomeoneproblemsolves,recognizingconditionedbehavioral,cognitiveandemotionalpatternsthatarisewhenworkingwithdifficultiesandchallenges(including“solving”the9-DotsPuzzle);beginningtorecognizepatternsthatareself-defeatingornon-productiveaswellaswaysthatthepastinfluencesthepresent(labels,beliefs,identities);alongwiththebreakthrough“aha!”experience.(Mayconnectany/allofthesethemestopracticingthebodyscan.)

Option:Usetheoldwoman/youngwomanorothertrompeL’oeilorotherperception-challengingvisualaidstoinvestigatedifferentwaysofseeingornotseeing.

SittingMeditation:Introducesittingmeditationwithawarenessofbreathing(AOB)asprimaryobjectofattention.Beginbyintroducingandexploringposturaloptions.Doabriefguidedmeditation.

DiscussionabouttheAOBmeditation.

Gooverhomepractice.EndwithshortAOBmeditation.


HomePractice • BodyScanrecording≥6timesperweek

• AOBsittingmeditation:10-15minutesperday–Norecordingforhomepractice.Participants/patientsareinstructedtopracticeontheirown.Thisisnotaboutcontrollingorchangingthebreath,butratherbeingwiththebreathandthebodilysensationsofbreathing,noticingwhenattentionwanders,anddeliberatelyreturningattentiontothebreath

• FilloutPleasantEventsCalendarfortheweek–oneentryperday.Note:Ifnopleasanteventisperceivedonagivenday,thereisnoneedtofilloutthecalendarforthatday

• Chooseonedailyactivitytobringfullawarenesstofortheweek:Brushingteeth,takingoutthegarbage,takingashower,feedingapet,etc.


ClassThree

Overview Inthis2.5hoursession,participantspracticeseveraldistinctyetinterrelatedformalmindfulnesspractices--mindfulhathayoga(endingwithabriefbodyscan),sittingmeditationandoptionalwalkingmeditation--foraminimumof90minutes.Thisextendedformalpracticeperiodisfollowedbyinquiryintoandexplorationofparticipants’experienceswithin-classandassignedhomepractices.Typicaltopicsincludechallengesandinsightsencounteredinformalpracticeandinintegratingmindfulnessintoeverydaylife.

Theme Thereispleasureandpowerinbeingpresent.Attendingtoandinvestigatingthewaythingsareinthebodyandmindinthepresentmomentthroughthepracticesofyogaandmeditation.

RecommendedTime

Allocations

FormalPractice–70-90minutes

GroupDiscussion–1hour


FormalPractice Openingmeditation,whichcanflowintolongersittingpracticeofAOBwithattentiontoposture

MindfulLyingDownYoga

WalkingPractice(Iftime):Thispracticecanbeintroducedatanytimefromweekthreeforward–Itisstronglyrecommendedthatmindfulwalkingbeintroducedatleastonetimepriortotheallday-class.

Closingmeditation

InformalPractice

Reminderduringclassdiscussions(bothsmallandlargegroup)ofmindfullisteningandspeaking


Classthreeoptionsforincreasingseamlesscontinuityofpracticeincludethepossibilityofmovingdirectlyfromsittingtolyingdownyogaorfromsittingtowalkingtolyingdownyoga,offeringalongerperiodofformalpractice.Inthiscase,thegroupdialoguewouldincludewhatwasexperiencedinallthepractices.

Sittingmeditationwithawarenessofbreathing.Specificguidancerelatedtoestablishingastable,uprightandbalancedsittingposture.

Groupdiscussiononsitting,bodyscan,andmindfulnessinroutineactivities.Discusstheimportanceofbeingembodiedthroughthesharingofparticipants’directexperienceoffeelingembodied(establishedintheirsomatic/bodilyexperience)orungroundedanddisconnectedfromthebody.

Optional:Introducewalkingmeditation.



LyingDownYoga:SlowlymovethroughthesequenceofposturesontheLying-downYogarecording,withguidanceandcommentsinterspersedasrequired.Emphasisisonmindfulnessandapproachingone’scurrentlimitswithgentleness—learningtodwellattheboundarywithoutoversteppingandinvestigatingwhatissensitiveandwise,moment-to-momentforeachparticipant.Participantsareencouragedtoavoidanyposturestheyfeelwouldcauseinjuryorasetbackand,toexperimentwithcautionandcarewhenindoubt.Particularattentionispaidtopeoplewithchronicmusculoskeletalproblemsi.e.lowerback,neck,jointsandchronicpainingeneral.Verbalguidanceisexplicitandaccurate(i.e.iflyingonthefloor:“…drawingtherightkneeuptothechestandwrappingyourarmsunderthethigh…”)sothatpeopleknowwhattodowithouthavingtolookattheteacher.WeexpectallMBSRteacherstoactivelydemonstratetheyogaposturesalongwithprogramparticipants.Thismayincludeofferingchairoptionsorotheradaptationsforpeoplewithphysicallimitations.Teachersareencouragedtorespondtospecificparticipantneedsandtailortheposturesaccordingly.Theteacherisencouragedtoaskifanyoneneedsadditionalguidanceregardingaposture,andifneeded,theteachercanassisttheparticipant,askingpermissionfirstbeforemakingphysicalcontact.

Itisskillfulandsupportivetoofferchairyogaadaptationsforthosewhoareunabletoliedownonthefloor.Thismaynecessitatemovingbackandforthbetweenthefloorandachairasyouguideparticipantsintheyoga.

Groupdiscussionabouttheexperienceofpracticingtheyogapostures.

GooverPleasantEventsCalendar,beingparticularlyattentivetoexploringtheordinarinessofexperiencingamomentaspleasant.

(Optional:beforeaformalgroupdiscussionwiththeparticipantsaboutthePleasantEventsCalendarconsiderleadingashortguidedreflectionthatasksparticipantstoselectonepleasantevent,focusingonphysicalsensations,emotions,andthoughtsastheyariseasmemory,andthenastheyariseinthepresentmoment.)

Particularemphasisonmind/bodyconnections,patterns,whatpeopleobserved/learnedaboutthemselvesineverydaycircumstances.Also,wonderingtogetheriftherewereanypleasantmomentsexperiencedduringthebodyscaninthepastweek(orsittingpractice).Investigatingwhatqualitiesinallofthesepleasantmomentsoreventscausedthemtobelabeledaspleasantbytheparticipant?Whatqualitiesdothesedistinctpleasantmomentsoreventshaveincommonfortheparticipant?(Thisisanopeningtoacknowledgehowhabitsareconditionedandourdesiretowantthingstobeacertainwaythatresultsinattachment,aversionetc.Note:thisisnotanopportunityfora‘lecture’butaweavingtogetherofsomeofthewaysourbehaviorsarepatternedbasedupontheactualityofparticipants’responses).Relatetoobservationsthatwemissmanyofourpleasantmoments,perhapsfocusingonlyontheunpleasantones.



Possiblethemesofconnection,belonging,andcontactbeinganimportantelementofpleasantmoments.Also,theremayalsobetheperspectiveofnotwantinganything,justappreciatingwhatwealreadyhaveandthepossibilityofhavingpleasantmomentsinspiteofbeinginacrisisorinphysicaloremotionalpain.(Option:PleasantEventscanbe“unpacked”inClass4,alongwiththeUnpleasantEventsCalendar,dependingontimeandinclinationoftheinstructor.)

Assignhomepractice,alternatingyogawiththebodyscan.Emphasizetheimportanceofgettingdownonthefloorandworkingmindfullywithyourbodyeveryday,ifonlyforafewminutes.

Finishclasswithashortsittingmeditation,AOB,expandingattentiontothewholebody.

HomePractice • AlternateBodyScanrecordingwithLying-downYogarecording,everyotherday≥6daysperweek

• SittingmeditationwithAOB-15-20minperday

• FilloutanUnpleasantEventsCalendarfortheweek,oneentryperday


ClassFour

Overview Duringthis2.5hoursession,participantsengageinacombinationofthethreemajorformalmindfulnesspracticesthattheyhavealsobeenpracticingathomeduringtheprecedingthreeweeks.Theseinclude:mindfulhathayoga,sittingmeditationandthebodyscan.Inthisclass,abriefguidedbodyscancanbepracticedbeforethestartofthesittingpractice(thisisoptionalandlyingdownisnotnecessary).Instructionemphasizesthedevelopmentofconcentration,embodiment,thecapacitytotrainandre-directattention,andthesystematicexpansionofthefieldofawareness.

Theme Howconditioningandperceptionshapeourexperience.Bypracticingmindfulness,wecultivatecuriosityandopennesstothefullrangeofexperienceandthroughthisprocesscultivateamoreflexibleattentionalcapacity.Welearnnewwaysofrelatingtostressfulmomentsandevents,whetherexternalorinternal.Explorationofmindfulnessasameansofrecognizingandreducingthenegativeeffectsofautomatic,habitualstressreactivityaswellasthedevelopmentofmoreeffectivewaysofrespondingpositivelyandpro-activelytostressfulsituationsandexperiencesisaddressedwithincreasingdepthanddimensionality.Thephysiologicalandpsychologicalbasesofstressreactivityarereviewedandin-depthdiscussionisdirectedtowardusingmindfulnessasawayofworkingwith,reducing,andrecoveringmorequicklyfromstressfulsituationsandexperiences.Dailypracticeaimedatrecognizingandexperientiallyinquiringintoautomatichabitualreactivepatternsisassignedforhomepractice.

RecommendedTime

Allocations

FormalPractice–1hourand10minutes



FormalPractice Openingmeditation

StandingYoga

Sittingmeditation

Closingmeditation

InformalPractice

Reminderduringclassdiscussions(bothsmallandlargegroup)ofmindfullylisteningandspeaking


StandingYogapostures(buildingfromthosedonelastweek)

Sittingmeditationwithfocusonbreath,bodysensations(introducedviabriefbodyscanwhilesitting),andthewholebody.Particularemphasisonworkingwithpainfulphysicalsensations.Introducingwaysofworking



withdiscomfort/pain:shiftingpostureifpainisposture-related;usinguncomfortablesensationsasobjectofawarenessbyinvestigatingquality,duration,andnatureofsensations—highlightingthecontinuallychangingaspectofbodilysensations,andshiftingattentiontothebreathifsensationsareoverwhelming.Inaddition,explorationofthepossibilityofbringingawarenesstoemotionsorthoughtsthatmightalsobepresentwithphysicalpainorothersensations(forinstance,tighteningorconstrictingwhenexperiencingpain).Thiscanalsobeexpandedtoemotionalpainordiscomfort.Thesameapproachescanbeofferedwithemotionalpain:Knowingexperiencedirectly,usinguncomfortableemotionsasobjectsofawareness,andalsoshiftingattentiontothebreathifemotionsbecometoodifficultorofprolongedintensity.Todevelopgreaterflexibilityofattention,emphasisisplacedonmodulatingattentiontoworkmoreeffectivelywithstrongbodilysensationsandemotionsasameansofself-regulationandcopingmoreeffectively.

Groupdiscussionexploringthesittingmeditationpracticedatthebeginningofthissession.Inquireintotheexperienceofworkingwithphysicalsensations,thedailysittingpractice,andyoga.Fine-tuneyogainstructionsasrequired.Inviteexplorationabouttherelationshipbetweenpracticingyogaandthebodyscan.Connecttodailylifeexperience.

Optional:BeforeagroupdiscussionwiththeparticipantsabouttheUnpleasantEventsCalendar,considerleadingashortguidedreflectionthatasksparticipantstoselectoneunpleasantevent,focusingonphysicalsensations,emotions,andthoughtsastheyariseasmemory,andthenastheyariseinthepresentmoment(thisallowseventhosewhomaynothavecompletedthehomepracticetoparticipatefully).

ReviewUnpleasantEventsCalendar,beingparticularlyattentivetoexploringthefamiliarityofunpleasantmoments.Emphasisonmind/bodyconnections,patterns,whatpeopleobserved/learnedaboutthemselves.,andwonderingtogetheriftherewereanyunpleasantmomentsexperiencedduringanyoftheformalorinformalhomepracticesinthepastweek.Investigatinganycommonattributesinalloftheseunpleasantmomentsoreventsthatcausedthemtobelabeledasunpleasant.Whatqualitiesdothesedistinctunpleasantmomentsoreventshaveincommon?

(Note:ifPleasantEventswerenotinvestigatedinclassthree,bothPleasantandUnpleasantEventsmaybeexploredinthissession.)

Groupdiscussion:Continueexploringphysicalsensations,emotions,andthoughtsassociatedwithunpleasantevents.Connecttoexperienceofstress--Howdoweactuallyexperienceitphysically,cognitivelyandaffectively?Askparticipantstonamestressors--whatisparticularlystressfulforyouandwhatareyoudiscoveringaboutstressandstressreactivitythroughthepracticeofmindfulness?Explorewiththeclasstheir


TypicalClassSequence(continue)

experienceofAutomatic,HabitualStressReactivity(See:Kabat-Zinn,FullCatastropheLiving,2013,pgs306-334).Howdoesitinfluencemind,body,health,andtheirpatternsofbehavior?Associationwithexpectations,notgettingone’sownway(whatismyway,anyway?…wouldIknowitifIgotit?andhowlongwoulditlast?)Definitionsofstressandstressors(see,forexample,evolvingtheoriesandstudiesaboutstressfromCannon,Selye,Lazarus,Sapolosky,McEwen.)Besttoexplorethisthroughdialogueandreflectionratherpresentingdidacticallyasalecture.

Assignhomepractice

Concludeclasswithbriefsittingmeditation

HomePractice • AlternateBodyScanrecordingwithLying-downYogarecording,everyotherday≥6daysperweek

• Sittingmeditation20minutesperdaywithattentiontobreathing,otherphysicalsensations,andawarenessofthewholebody

• Beawareofautomatichabitualstressreactionsandbehaviorsduringtheweek,withouttryingtochangethem

• Beawareoffeelingstuck,blocking,numbing,andshuttingofftothemomentwhenithappensthisweek

• Reviewinformationaboutstressinpracticemanualorhandout


ClassFive

Overview Duringthis2.5hoursession,participantsengageinacombinationofthethreemajorformalmindfulnesspracticesthathavealsobeenpracticedathomeduringtheprecedingthreeweeks:Thebodyscan,mindfulhathayogaandsittingmeditation.Thissessionmarksthehalfwaypointinthecourse.Itemphasizesthecapacityofparticipantstoadaptmorerapidlyandeffectivelytoeverydaychallengesandstressors.Experientialpracticeofmindfulnesscontinueswithanemphasisonresponding(vs.reacting)tostressorsandthevalueandutilityofmindfulnessinlearningtostop,stepbackandseemoreclearly/objectivelyandtothenbeinabetterpositiontomakeinformedchoices(responding)inmeetingvarioussituations.Tofurtherthecapacitytorespond,problem-,emotion-,andmeaning-focusedcopingstrategiesmaybedelineated(SeeLazarusandFolkman,andFolkman.)Acentralelementofthesessionisorientedaroundtheparticipant’scapacitytorecovermorerapidlyfromstressfulencounterswhentheyoccur.Strategiescontinuetobedevelopedwithemphasisonthegrowingcapacitytoattendmorepreciselytoavarietyofphysicalandmentalperceptionsandtousethisawarenessasawayofdeliberatelyinterruptingandinterveninginpreviouslyconditioned,habitualbehaviorsandchoosingmoreeffectivemindfulness-mediatedstressresponses.(See:Kabat-Zinn,FullCatastropheLiving,2013,pgs335-349).Neuroscienceresearchmaybeappropriatelyincludedhere,andisbestintroducedinrelationtowhatisbeingreportedbyparticipantsregardingtheiractualexperience.Dailymindfulnesspracticeisassigned,withanemphasisontheobservationandapplicationofmindfulawarenessindailylife.

Theme

ThemeOne

Awarenessofbeingstuckinone’slifeorinparticularsituationsinone’slife,highlightingtheconditionedpatternsoftenencounteredinhighlydemandingsituationsinwhichonefindsoneself(i.e.fight,flight,andfreeze–stressreactivity/automaticity/mindlessness.)Investigationofthewayspeopleoftencopeincluding:numbing,denial,passive-aggressiveness,suppressionoffeelings,substancedependency,thoughtsofsuicideetc.Recognizingandhonoringthefactthatthesecopingmethodsmayhavebeenprotectiveandsupportedsurvival,andthattheymaynowbecounter-evolutionaryandlimiting,ifnotself-destructive.Note:Thesetopicsmayhaveariseninclassfourasautomatichabitualstressreactivityandthebiologyoffight,flightandfreezewereunpacked.Thisthememaycontinueasparticipantsexploreanddescribewhatitwasliketobringacloseandcaringattentiontotheirautomatichabitualstressreactionswithouttryingtochangethem.


Theme(continued)

ThemeTwo

Connectmindfulnesswithperception/appraisalinthecriticalmoment(themomentofconsciouscontact),andwiththearisingofreactivephysicalsensations,emotions,cognitionsandbehaviors.Emphasisonattentivenesstothecapacitytorespondratherthantoreacttostressfulsituations.Exploretheeffectofemotionalreactivityinhealthandillness.Acknowledgethefullrangeofemotionsand,whencalledfor,toexpressthemwithclarityandrespectforselfandother.Exploreaswellthecapacitytorecovermorequicklyasameansofreducingthe“wearandtear”onthebody-mindthatoccurswhenareactivecycleofarousalpersists.

RecommendedTime

Allocations




FormalPractice

Openingmeditation

StandingYoga(afewposes)

Sittingmeditation(thelonger,fullsitisoffered,includingallfiveobjectsofawarenessandmoresilence)

Closingmeditation

InformalPractice



Standingyoga45minuteSittingMeditationattendingtobreath,body,sounds,andthoughtsandemotionsas“events”inconsciousness,distinguishingtheeventfromthecontent,andthenopeningtochoicelessawareness/openpresence,andreturningtobreathattheend,groundinginthebody.Longerspansofsilenceduringformalmindfulnesspracticeareemphasized.

Frommeditationmoveintoguidedreflection:Theprogramishalf-overtoday.Howhasitbeengoingsofar?Pauseandtakestock:WhatamIlearning,ifanything?Howdoesitshowupinmylife,ifatall?HowamIengagingwiththisprogramintermsofcommitmenttoweeklyclassesanddailypractice?IfIhavebeenfindingitdifficulttopracticeathomeand/orattendweeklyclasses,amIwillingtorecommitforthesecondhalfofthecourse?Notethatgrowthisnon-linear.Lettinggoofexpectationsforthesecondhalfbasedonexperienceofthefirsthalfofcourse.Invitationtopracticeandtakeeachmomentasanewbeginning,afreshopportunitytobefullyengaged,fullyalive.



Exploringthesequestions,MidwayAssessmentformsarehandedout,asassessmentsarecompleted,participantsmoveintodyadstodiscusstheirexperienceoftheprogramsofar.(Ifnowrittenmidwayassessmentisused,dyadsandalargegroupdiscussioncanbesubstituted.However,whenpossible,werecommendtheuseofwrittenself-assessmentsasitprovidesmanyparticipantswithausefulformofself-reflectionwhileprovidingtheinstructorconfidentialandcandidresponsesfromindividualparticipantsthatcanbefollowedupasanothermeansoftailoringthecoursetoeachperson.)Inquireintoexperiencespracticingthemeditation,bodyscanandyogahomepractice,aswellasthenewmeditationintroducedatthebeginningofclass.Exploreobservationsofreactingtostressfuleventsduringtheweek.Notehabitualbehavioralpatterns,thoughtsandemotionsassociatedwiththefeelingofbeingstuckintheseconditionedreactions.Includepatternsthatariseduringmeditationpractice.Introduceandaskifpeoplearealsoexperiencing–eveninsmallways–agreaterpossibilityofrespondingwithawarenessinthesemoments,ratherthanreactingautomatically.Inmakingthedistinctionbetweenreactingandresponding,emphasizethatinmanysituations,reactingisskillful.It’snotthestressbuthowyouperceiveandrelatetoitthatdictatesitseffectsonthemindandthebody(withinlimits).Option:Reviewreactingvs.respondingdiagrams(fromFullCatastropheLiving2ndedition,2013.)Mentionevolvingtheoriesandstudiesaboutstresshardiness,coping,resilience(see,forexampleKobasa,Antonovsky,SchwartzandShapiro,Garmezy,Werner,Bonanno),andalsoneuroscienceregardingneuroplasticityanddefaultmodenetwork(Hölzel,Farb,Brewer,andothers).Asinclassfour,itisbesttoexplorethisthroughdialogueandreflectionratherpresentingdidacticallyasalecture.Gooverhomepracticeassignment--EmphasizethatthenewSittingrecordinghasmoresilenceonittoallowparticipantstopracticemoredeeplyontheirowninbetweentheguidedinstructions.Briefsittingmeditation

HomePractice

• Provideparticipantsnewguidedmeditationpractices(CDsorinstructonMP3dowloadifused)–SittingMeditationandStandingYogaSequence.AlternateSittingMeditationwithStandingYogaandeitherBodyScanorLyingDownYoga(forexample:Onedaypracticesittingmeditation,thenext,practicestandingyoga,thethirddaypracticesittingmeditation,thefourthday,practicethebodyscan,etc.).


HomePractice(continued)

• FilloutDifficultCommunicationsCalendar

• Bringawarenesstomomentsofreactingandexploreoptionsforrespondingwithgreatermindfulness,spaciousness,andcreativityinformalmeditationpracticeandineverydaylife.Rememberthatthebreathisananchor,awaytoheightenawarenessofreactivetendencies,toslowdownandmakemoreconsciouschoices.


ClassSix

Overview Inthis2.5hoursession,experientialtraininginMBSRcontinueswithanemphasisonthegrowingcapacitytoself-regualteandcopemoreeffectivelywithstress.Discussionisorientedaroundthecontinueddevelopmentof"transformationalcopingstrategies":Awareness,attitudesandbehaviorsthatenhancethepsychologicalcharacteristicknownas“stresshardiness"orresilience.TheoryislinkeddirectlytotheMBSRmethodsandskillsbeingpracticedandgroundedintheactuallifeexperiencesoftheparticipants.Theemphasiscontinuestobeonthebroadeningofparticipants’innerresourcesfordevelopinghealth-enhancingattitudesandbehaviorsandthepracticalapplicationofsuchcompetenciesintoparticipants’particularlifesituationsandhealthstatus.Dailymindfulnesspracticescontinuetobeassignedforhomepracticewithanemphasisontheobservationandapplicationoftheseskillsineverydaylife.Participantsengageinanin-depthexplorationofstressasitpresentswithinthedomainofcommunications–particularly,difficultandchallenginginterpersonalexchanges.Thefocusofthisstrategy-buildingsessionrevolvesaroundtheapplicationofpreviouslylearnedmindfulness/MBSRskillsandmethodsintheareaofcommunications.Avarietyofcommunicationstylesareexaminedbothdidacticallyandexperientially,andstrategiesformoreeffectiveandcreativeinterpersonalcommunicationaredeveloped.

Theme Stressfulcommunications;knowingyourfeelings;expressingyourfeelingsaccurately;developingagreaterawarenessofinterpersonalcommunicationpatterns,andbarrierstodoingsoareallexplored.Interpersonalmindfulness:remainingawareandbalancedinrelationships,especiallyunderconditionsofacuteorchronicstress,thestrongexpectationsofothers,pasthabitsofemotionalexpression/suppressionandthepresentationofselfineverydaylifeareinvestigatedusingawiderangeof“embodied”methods.Basedontheskillsthatwehavebeendevelopingthroughtheentireprogram,allinstructionalprocessesemphasizecultivatingthecapacitytobemoreflexibleandtorecovermorerapidlyduringchallenginginterpersonalsituations.

RecommendedTime

Allocations


GroupDiscussion–1hourand10minutes



FormalPractice StandingYoga

Sittingmeditation

Closingmeditation

InformalPractice



StandingyogaSittingmeditationwithlessinstruction/moresilence:breath,body,sounds,thoughtsandemotions,choicelessawareness/openpresence,withoptiontoreturntobreathattheend.Optional:returnmidwayevaluationswithcomments.Possibilityofusinganonymousquotesfromparticipants’evaluationstoidentifyandsharetheexperiencesandlearningdiscoveriesofthisparticulargroup.Discussthehomepractice,especiallyexperienceswiththerecorded45-minutesittingmeditation.Explore:Whatdidyounoticeaboutrespondingmorecreativelyinlifeandinthemeditationpracticeitself?Weretherenewresponses?Whatsurprisedyou?Whereareyoufindingtheintegrationofmindfulnessinyoureverydaylifeparticularlychallengingordifficult?Discusstheupcoming“AllDay”session.Explaintheintentionsunderlyingthissessionanddescribeindetailthestructureandformatoftheday,includingoptionsforself-careandteacheravailability.Discusshowtoworkwithextendedperiodsofsilenceandpractice.Providesuggestionsforpreparingfortheday,includingwhattobring:Lunch,loosefittingclothes(layers),matorblanketetc.Optional:guidedreflection–recallasituationfromtheDifficultCommunicationsCalendar.Examinehabitualrelationalpatternsandhowtheyareexperiencedinthemindandbodyandhowtheymanifestasbehavior.Optional:DiscussinsmallgroupsordyadsActivitiesandgroupdiscussionaboutdifficultcommunications.Thereareanumberofexercisesthatcanbeusedtoexplorethistopic.Emphasisofmostofthecommunicationsexercisesusedinclassis“embodiment”-engagingthebodyinitsusualposturalpatternsincludinggestureandvoicetoneetc.whenindifficultinterpersonalsituationsasameansofexploringbothfamiliarandmorenovel



approachestomomentsofdifficultcommunication.Thisembodyingprocesstendstocatalyzeawareness,therebymakingbothhabitualandnewresponsesmorereadilyavailableforself-reflectionandinquiry.Thedialogueandinquiryduringtheseexercisesallowsaheightenedawarenessofhabitualpatternsandbehaviors,notonlyintherealmofinterpersonalcommunication,butalsoinone’sintra-personallife.Itisessentialtopauseandreflecttogetherontheseexperiencesandtonoticehowrelationalpatternsareexternalizationsofinternalmindandbodystates.Participantsmakeconnectionsbetweentheirpresent-momentexperienceofwitnessingand/orparticipatingintheseexercisesandthepersonalcognitive,emotionalandbehavioralpatternswithwhichtheyhavebecomefamiliarduringtheMBSRcourse.Theseexercisesalsoprovideanopportunityforparticipantstoexperimentwithnewbehaviorsandnewwaysofengaginginterpersonally.Theintentionbehindengaginginanyofthefollowing(oranyother)communicationexercisesisthecultivationofawarenessinintra-andinterpersonalsituations.Theparticularformtheseexercisestakeislessimportantthantheessenceofthisintentionandthepotentialofintegratingmoreeffectivepatternsofcommunicationintoeverydaylife(See:Meleo-Meyer,F,inD.McCown,D.Reibel,andM.Micozzi(Eds),ResourcesforTeachingMindfulness:ACross-culturalandInternationalHandbook,2017).Someoftheoptionsforcommunicationsexercisesmayinclude,butarenotlimitedto:Speakingandlisteninginterpersonalpractice:Indyads,participantsaregivenatopicbasedonclassdiscussionsandcontent.Onespeaks,onelistens,thenreverseroles.Thepowerofactivelisteningishighlightedasthelistenerreflectsbackwhatthespeakershared.Rolesarethenreversed.Experiencingandexploringpatternsofcommunicationbyphysicallyenactingandexpressingdifferentpatternsandoptions(i.e.passive,aggressive,assertive,etc.),thenhavingclassparticipantsadaptposturesthatexpressthesecommunicationoptions,possiblyinteractinginpairs,smallgroupsortheentireclass.Aikido-based“pushingexercises”:Twopeopledemonstratingviarole-playthefollowing:

• theinitialcontactwhenexperiencinginterpersonalconflict(takingthehit)

• avoidingconflict/steppingaside/passive-aggressive• beingsubmissive• beingaggressive



• engagedinanequalstruggle• assertive,“blendingandentering,”meetingaggression,staying

engagedandwitheyeandwristcontact,whilesteppingoutofthepathofpotentialharmfulemotionalaggression

Demonstratewithaco-teacherorvolunteer(choosecarefully,itmaybebeneficialtopracticewiththevolunteerbeforeclass).

• Theteacherinvitesclassparticipantstosharewhatisdirectlyexperiencedastheywatcheachphaseofthe“pushingexercises.”Theteacherhighlightseachoptionasawayofmeetingchallenges(notonlyinterpersonalcommunication):Takingthehit,avoiding,aggressive—engagedinthestruggle,and“blendingandentering.”Asparticipantsafetyisparamount,classparticipantsarenotinvitedtoengagewitheachothertophysicallypracticetheAikido.Emphasisontheimportanceofcenteringinthemoment,takingafirmstand,notrunningawaybutnothavingtobeintotalcontrol,theimportanceof“enteringandblending”whilesimultaneouslymovingoutofthedirectpath,makingcontact(handtowrist),turning,acknowledgingtheotherperson’spointofview,showingone’sownpointofview,stayingintheprocesswithoutknowingwhereitisgoingorbeingfullyincontrol,maintainingmindfulness,openness,stayinggroundedandcentered.

• TheteacherinvitesclassparticipatestosharewhatisdirectlyexperiencedastheywatcheachphaseoftheAikido“pushingexercises.”Theteacherhighlightseach.

• Verbalaikidoroleplay–similartoabove,butdonewithdialogue

withvolunteer.Explorationofassumptions:Guidedbyinstructor,participantsfaceeachotherinsilence,andareledintonoticingdifferencesbetweenobservationandassumingorinterpreting/mindreading.ThismaybefollowedbystructureddialoguebetweenparticipantsAssignhomepracticeEndwithshortAOB/sittingmeditation

HomePractice • AlternateSittingMeditationrecordingwithBodyScanand/orStandingorLyingdownYogarecordings


The“AllDay”Class:ASilentRetreat

Overview Theintensivenatureofthis7.5hoursessionisintendedtoassistparticipantsinfirmlyandeffectivelyestablishingtheuseofmindfulnessacrossmultiplesituationsintheirlives,whilesimultaneouslypreparingthemtoutilizethesemethodsfarbeyondtheconclusionoftheprogram.

Theme Cultivatingasenseofpresencefrommomenttomoment,andbeingopentoanyexperience,whetherevaluatedaspleasant,unpleasantorneutral,asanopportunitytopracticemindfulattention.

FormalPractice

YogaSittingMeditationBodyScanWalkingMeditationMountainorLakeMeditationEatingMeditation(informal,atlunch)Optional:Fast/SlowWalking*Loving-KindnessMeditationVisualmeditationfollowedbymindfulwalking,possiblyoutdoors,stoppingandnoticingonething.ClosingMeditation

InformalPractice

Seamlesscontinuityofmoment-to-momentawareness,whetherinformalpracticeortransitioning


TypicalClassSequence(Note:Timesaresuggestions.Sizeofclassandotherfactorsmayincreaseordecreasethetimeslisted.However,thesearegoodapproximationstokeepinmindtobothsettledeeplyintopractice,andalsotoofferbothstillnessandmovementpracticetocareforthebody.)Morningsessionoptions:BriefsittingmeditationinsilenceWelcome,introductionofteacher(s),andguidelinesfortheday,includingsilence,avoidingeyecontact,self-care,availabilityofteachers,etc.Sittingmeditation:focusonawarenessofbreathing(20’)GuidedYoga,withtheoptionofendingwithshortbodyscan(45’-55’)Slowwalkingmeditation:withintroductoryguidance(15’-30’)Sittingmeditation:lessguidance,moresilence(30’-40’)Slowwalkingmeditation:lessguidance(20’)



MountainorLakemeditation--Theseimagesareusedtoassistpartici-pantsintheirunderstandingabouthowtocreativelyworkwiththemselvesandusetheirinnatecapacitytocultivateparticularhumanqualities.The“mountain”and“lake”aremetaphors(ratherthanvisualizations)usedtoconnecttoaspectsofthemselves–theirinnate,innerreservoirsofstability,sovereignity,flexibilityandfluidity.Theimagesarenotintendedtotakeparticipantsoutofthepresentmomenttosomeotherplaceortime.(25’-30’)Talk–anopportunitytogiveencouragementorinspiration,withtheoptionoftellingateachingstoryorrecitingapoemanddrawingoutoneormoreofthecoreteachingelementsofthecurriculum.(10’-15’)Lunchinstructions(5’)Silentlunch(45’-60’)Afternoonsessionoptions:StandingYoga(30’)orFast/slowwalkingexercise.TheuseoftheFast/Slowwalkingexercisemaybeeliminatedentirelyinfavorofmoresilenceandsolitarypractice(replacedwithStandingYoga),orusedpartiallydependingonthevenueandpopulation.Weincludeithereforthosewhomayhaveexperienceditorbeenwell-trainedinguidingit.Participant/patientsafetyistheprimaryconcern.Inaworkenvironment,itmaybeskillfultousethefastwalkingportions(firstmoremindlesslyandautomatically,then,moving—evenveryquickly—withawarenessandintention)asanimportantpointoflearningandpractice.ThisportionoftheexercisecanalsobeusedinClass7,whentheapplicationofmindfulnessindailylifeishighlighted.Thisexerciserequiresspecific,well-pacedverbalguidancebytheteach-er.Dependingonthesizeofthegroup,assistantsmayalsobeneededtoensuresafety.Includerepeatedinstructionsfornoticing,inmovementandstillness,variousmind-bodyexperiences.Emphasizeoptionsformeetingneedsastheyarise,andthepossibilityformovinginandoutoftheexercise.(Note:Ifpeoplechoosetositoutforpartoralloftheexercise,theteacher’sguidanceincludessuggestionsforactiveparticipationbynotingmind-bodyexperienceswhilesittingandcontinuousconnectionbytheteacher(s)withpeoplesittingdown,assuringandinvitingthembackintotheexercisewhenitbecomesslowerifthespeedofmovementhaskeptthemfromactiveparticipation.)(30’)Beginwithslowwalking,graduallymovetoeachperson’susualwalkingpace,pause…Inthepauses,invitepeopletobeattentivetobody,



thoughtsandemotions…beginwalkingatacomfortablepace,incrementallyincreasingspeed,withinstructionstoincreasebodytension(i.e.clenchfistsandtightenjaw)andmovingtowardsdeliberate(imaginary)objectives(forexample,beinglateandneedingtorush…continueincreasingpace,changingdirections,thenstoppingandinvitingparticipantstobeattentivetotheirentireexperience.Then,beginwalkingagainataregularpacewithinstructionsforstayingpresentandopen…increasingthepace,unclenchinghandsandjaws,callingtomindthesamedeliberate(andimaginary)objectivesbutthistime,withpresenceandawareness,whilecontinuingtowalkfaster,changingdirections,andagainstopping.Teacherasksparticipantstoreflectoncurrentmind-bodyexperienceandnoteifthereareanydifferencesbetweenthepreviousroundofwalking.(Mayendhereorcontinuewithnextportion).Teachergivesinstructionsforveryslowlywalkingforwardwitheyesclosed,keepingarmsandhandsatsides,gentlyleaninginwhenparticipantsmakecontactwithothers,pausingandexperiencingthecontactbeforemovinginanotherdirection.Doingthisforseveralminutes,thenstopping.Theentireprocesscanberepeatedwithparticipantswalkingbackwardsandveryslowly.Afteroneorbothphases,teacherencouragesparticipantstoreflectontheirmind-bodyexperience.Teachergivesfurtherinstructionstoorienttocenterofroom(openeyes,noticewherecenteroftheroomis,and“aim”thebodytowardsthatpoint,thenreturntoeyesclosed),andcontinuestheinvitationtowalkslowlybackwards,makingcontactwithothersandremaininginphysicalcontactwhilemovingtowardsthecenteroftheroom.(Note:intheinterestofinclusion,provideoptionsforsteppingintocontactoroutofcontact,aspersonalneedsdictate.)

Loving-Kindnessmeditation:guidanceusingminimaltalking,emphasisonspaciousness,endinginsilence.(ThismeditationisusedtohelppeoplerecognizequalitiesofLoving-Kindness,friendliness,warmthandcompassion,towardsselfandothers,thatarealreadypresentandcapableofbeingcultivated.Careistakentorecognizeandaffirmanyresistancetothepossibilitythatthesequalitiesalreadyexistwithinoneselforwishedforothers.ItisnotessentialtoofferclassicalphrasesofLoving-Kindnesspracticeasthefeelingtoneandsenseofwell-wishingcanbeconveyedmoreimme-diatelyandalsomoreinformallywithoutspecificphrasing.Andsimplephrasescanalsobeintroduced.(25’30’)Optionalendingpractices:“NoticingOneThing”visualmeditationfocusingonone’shand,andseeing,asifforthefirsttime.Thisisfollowedbymindfulwalking,possibly



outdoors,withintentionplacedonmovingslowly,noticingwhatdrawsone’sattention,stoppingandfocusingonthatobject,lingeringthere,exploringtheobjectwithopennesstoseewhatunfoldsasonestayswiththisobject,thenaftersometime,movingtoanotherobjectthatdrawsone’sattention.Teacherringsbellstobringparticipantsbacktoroomandguidesacontemplationonthememoryofwhatwasseen,followedbyanopenawarenessmeditation.(25’-30’)OR:Walkingpractice—invitingparticipantstomoveoutside,awareofthewholebody,meetingtheworld,continuingtheopenreceptivityofloving-Kindnessintowalkingpractice.OR:Briefsittingsalternatedwithbriefperiodsofwalkingandsittinginotherplacesintheroomnormallyavoidedordesired(highlightingthepossibilityorinvitationtofeelgroundedandintheir“seat”evenwhenchangeoccursandespeciallyifthatchangeisundesirable,or,ifthechangeisdesirablebutnotusuallyactedupon).Thispracticeisakintothe“ChangingSeats”exerciseinclass7.SeemoreinstructioninClass7“TypicalClassSequence.”Whateverendingpracticeischosenandbeforesilenceisdissolved,aimtohave10-15’ofsilentsitting.Dissolvethesilencebywhisperinginpairs,theningroupsof4(optional),discussingwhatwaslearnedandexperiencedduringthedayandhowtheparticipantsworkedwithchallenges.(10’-15’)Groupdiscussionanddialogue--Emphasizethatthedayisnotmeanttobepleasantorunpleasant,buthowonemeetsandworkswithwhat-everappears.Inviteparticipantswhohaddifficultiestospeakaboutthemandfeelsupported,andassureeveryonethattherewillbemoretimetospeakabouttheirexperienceinthenextclass.Endwithbrief“goinghometalk”abouttransitioningtotherestoftheday,evening,activities,etc.(20’-25’)Sittingmeditation(5’)Closingcircle-Standingincircle,makingeyecontactwithothers,tuningintofeelingwholeandembeddedinthecontextofthelargergroup.Optiontoreflectandfindonewordtodescribetheexperienceofthemoment.Encouragehonestresponses,acknowledgingthatthis,too,willchange.Good-byes


ClassSeven

Overview Inthis2.5hoursession,experientialtraininginmindfulnesscontinues.TheAllDayClass(silentretreat)isreviewedanddiscussed.Theremaybeacontinuationofthediscussionofcommunicationthatbeganinclass6.Participantsareaskedtoexercisegreaterpersonallatitudeinthechoiceofformalmindfulnesspracticesdoneashomepracticeduringtheweekleadinguptoclasseight.Emphasisisonmaintaining45minutesofdailypractice,withoutrecordedinstructions.Participantsareencouragedtocreatetheirownblendofthevariouspractices.(Forexample,20minutesofsitting,15minutesofyoga,10minutesofbodyscan.)Theintentionistofurthermaintainthedisciplineandflexibilityofapersonaldailymindfulnesspracticebyencouragingpeopletobecomeattunedtothechangingconditionsintheirlivesandtoaskthemselvesquestionslike:“Whatiscalledfornow/today?“WhatdoIneedtotakecareofmyselfnow?”

Theme Integratingmindfulnesspracticemorefullyandpersonallyintodailylife.Participantsareaskedtopurposefullyreflectonlife-stylechoicesthatareadaptiveandself-nourishingaswellasthosethataremaladaptiveandself-limiting.

RecommendedTime

Allocations


GroupDiscussion–45minutes


FormalPractice

Sittingmeditationoptions:Mountain,LakeorLoving-Kindness

Otheroptions:Yoga(classchoices),window,walking

InformalPractice



Optionsincludeoneorbothofthefollowingexercises:

1) YogaChoicesexercise:eachparticipantdoesastandingbodyscanandidentifiesanareathatneedsattention.Individuallyandwiththegroup,exploreyogaposesthataddressthatareaofthebody,orfavoriteyogapostureslearnedintheprogram.Eachparticipant,withhelpfromtheteacher,ifnecessary,guidesparticipantsintheirchosenpose.Emphasisisonusingyogainordinarydailyexperience,notasaspecial,rarifiedactivity.

2) Exploringthefamiliarandtheunfamiliar-ChangingSeats:Afterparticipantstaketheirseatsintheroom,invitethemtoclosetheireyesandnoticehowitfeelstobesittingwherethey’resitting.Askthemto:



Payattentiontowhat’sfamiliar—ifthisisaseattheychooseoften,orwhat’sdifferentifit’sanewseat.

Noticephysicalsensations,thoughts,and/oremotionsthatmaybepresentastheysitinthisfamiliarornewplace.

Theninvitethemtoopentheireyes,andgetasenseofwhattheroomlookslikefromthisperspective.Isitthesameroom?Whydidtheychoosetositwheretheydidwhentheycamein?Scantheroomforaseatinwhichthey’veneversatorwheretheythinktheywon’tliketosit.Askparticipantstomovetothatseat,insilence,andtoclosetheireyesandnoticehowitfeelstobeinthenewplace,withanewperspective,perhapssittingnearnewpeople.Askthemtoconsiderwhethertheytendtostayinthesameplacesortoexplorenewplaces,makingsuretoemphasizethatthesearesimplypatterns,andthatonepatternisn’tbetterthantheother.Canwebeathomewhereverweare?Mentionawarenessofchoicesofpositioningoneselfinaroom,theideaoftakingone’sseatinthemeditation(takingastandwhensitting,nomatterwhereyouare.)Inviteawarenessofattachmenttoplace.WhereamIinmylife–inthismoment?WhereamIgoing?Possiblynotknowingandknowingthat!

Thischangingofseatsmayberepeatedagainorevenseveraltimes.Finally,inviteparticipantstofindaseatandestablishthemselvesinapostureforsittingmeditation,consciouslychoosingtoreturnto“their”familiarseatortoexplorebeinginadifferentplace.

Sittingmeditation:Choicelessawareness,usingthebreathasananchoriflost;alsopossibletoincludeaspectsofMountain,LakeorLoving-Kindnesspractice.Allowmoresilence.Discussthehomepracticeandtheall-dayretreatinrelationtoautomatichabitualstressreactionsandmindfulness-mediatedstressresponsesinmeetingwhateverwasencounteredincludinglikesanddislikes.Whatdidyousee?Whatdidyoulearnaboutyourself?Inviteresponsestodifferentaspectsoftheall-daysession,andwhatparticipantsexperiencedafterwards.Connectthediscussiontotheexperienceofengaginginboththeformalandinformalmeditationpracticesthisweek.Emphasisonimportanceofmakingthepracticeone’sown.Thisweek,norecordingsforhomepractice.Encouragepeopletomaintainthefrequencyanddurationofpractice(45minutesperday)whilechoosingforthemselveshowbesttopracticeontheirown.Option:Questionsandobservationsaboutcommunicationstemmingfromlastweek’ssession.Ifnecessary,thereistheoptionofcontinuingto



explorecommunicationthroughtheexercisesthatarerelatedtothisweek’sclassdiscussion.

Option:IntroduceFast/SlowWalking(seeAll-DayInstructions),usingvariationsasappropriateforvenueandpopulation.

Option:Discussthemeofwhatwetakein,notonlyfoodbutanykindofsensoryexperience,andpatternsthatareself-destructiveandself-nourishing.Thismayincludeinvestigatingchoicesarounduseofelectronicsandtechnology,cellphones,internet,andallmedia.Maychoosetolookatchoicesaroundtime,prioritiesandvalues,continuallyencouragingparticipantsintheireverydaylivestofrequentlyexperimentwithaskingthemselvesthequestion:“What’scalledfornow?”Exploreifandhowmindfulnessmayimpactseeminglyneutralareasandhabitsofourlives,bringingaboutunanticipatedchangesandemotions.

Assignhomepractice

EndwithshortAOB

HomePractice • Norecordingsthisweek.Practiceformalsitting,yoga,walkingand/orthebodyscanonyourown,everydayfor45minutes.(Note:ifthisistoodifficult,suggestalternatingbetweentherecordingsandself-guidanceeveryotherday.)

• Practiceinformallywhenyouarenotdoingtheaboveformalpracticesbybeingasawareandawakeaspossiblethroughouttheday.


ClassEight

Overview Inthis3-3.5hoursession,experientialmindfulnesspracticecontinuesandparticipantsaregivenampleopportunitytoinquireintoandclarifyanylingeringquestionsaboutthevariouspracticesandtheirapplicationsineverydaylife.Areviewoftheprogramisincludedwithanemphasisondailystrategiesformaintaininganddeepeningtheskillsdevelopedduringthecourseoftheprogram.Timeisalsoallottedforasatisfyingclosurebyhonoringboththeendofthisprogramandthebeginningoflivingone’slifeinformedwithmindfulness.Participantshaveanopportunitytospeaktothegroupmuchastheydidinthefirstclass,butthistime,toacknowledgewhathasbeenmostsalient,whattheyaretakingaway,orwhathasbeendiscovered.Itisimportantforallparticipantstoknowthatalltheircommentsarewelcomedinthissegmentofclass8.Byexample,nothingmayhavebeen“salient.”Perhapstheywerecompletelydisappointedbythecourse…orfoundtheinstructordefensiveorunavailabletothem.Thisisnotmeanttobeatimefortestamonialsbutinstead,foropen,honestappraisaloftheirexperienceofMBSR.

Noteonlengthoflastclass:Evenwithsmallergroups,athree-hourclassoffersampletimeandopportunityforpractice,discussionofhomepracticeandhowparticipantswillcontinueafterthecourseisover,aswellastimeforeachpersontospeaktothewholegroup(GroupGoAround)abouttheirlearninganddiscoveries(astheydidinthefirstclassabouttheirintentionsforattending).Ifclasssizeexceeds18,itmaybemoreadvantageoustolengthenthelastclassafullhourlongerthanusual,to3.5hours.

Theme Keepingupthemomentumanddisciplinedevelopedoverthepast7weeksinthemeditationpractice,bothformalandinformal.Reviewofsupportstohelpintheprocessofintegratingthelearningfromthisprogramovertime:Localdrop-inoptions,books,recordings,graduateprograms,freeall-daysessionsforgraduates;localretreatandyogacenters,andotherpertinentresourcesavailabletosupportpractice.

RecommendedTime

Allocations

FormalPractice–60minutesormore

GroupDiscussion–2hoursand20minutes


FormalPracticeBodyScanYogaSittingMeditation

InformalPractice




Bodyscan(comingfullcircle,sincethisishowclassonebegins.)

Yogastretching,eitherguidedorself-guided.

SittingMeditation,mostlysilent.

Optional-LettertoSelf:

a. Guidedreflection–Attheendoftheformalmeditationtherecanbeabriefreflectioninvitedaboutparticipationintheclass.“Whathappened?Whatdoyouwanttorememberaboutyourlearningexperience—intheclass,withthepractices,andinyourlifeasawhole?Whatisessential,thatyoudon’twanttoforget?

b. Optionofsettingthreeshort-term(3months)andthreelong-term(3yearsormore)goalsthatcomeoutofyourdirectexperienceintheprogramandwiththemeditationpractice.Includepotentialobstaclestoreachingthesegoalsandyourstrategiesforworkingwiththem.

Participantswritelettersthatincludeoneorbothofthesethemesandthensealtheminenvelopeswhichtheyself-address.Instructorcollectsenvelopesandwillmailthemsometimeinthefuture.

Guidedreflectionthatincorporatessomeorallofthequestionsbelow.Aseachparticipantcompletestheirlettertheyareplacedinpairsbytheinstructortodiscusshowthecoursehasbeenforthem.Examplesofquestions:(1)Thinkbacktowhyyouoriginallychosetoparticipateinthisprogram.Whatexpectationsdiyouhave?Whydidyouchoosetocompletethecourse?(2)Whatdidyouwant/hopefor?(3)Whatdidyougetoutoftheprogram,ifanything?Whatdidyoulearn,ifanything?(4)Whatsacrificesdidyoumake?Whatwerethecoststoyou?Whatobstaclesdidyouencounter,ifany,andwhatdidyoulearnaboutyourselfinworkingwiththeseobstacles?(5)Ifyouaremotivatedtocontinuetopracticemindfulnesshowwillyoucontinuetopracticewhenthisprogramisover?

Groupdialogueanddiscussion:Discusstheexperienceofpracticingwithoutrecordingsthisweek.Reviewtheentirecourseandfocusbrieflyonsalientfeatures.

Activitiesbelowcanbeofferedintheorderbestsuitedtotheclass.Thereismeritinendingwithcommunityengagement(theGroupGo-Round),havingcoveredthemoredidacticand/orconceptualandinformationalsectionsbeforehand,butthisisuptothediscretionoftheteacher.



Homepractice,HintsandReminders:Reviewoffinalhomepracticesheet(“therestofyourlife”),directionsforaccessingongoingresources(online,handouts,community,regional,internet,etc.)

MBSR“Checklist”:Discussthevalueofputtinglearningtoimmediateuseforcontinuedpractice.Usingindexcardsorprintedsheets,haveparicipantsreflectonwhatcriticalitemsarenecessaryforcontinuedpractice,i.e.,dedicatedspace;cushion,benchorchair;yogamat,timer;etc.Individualtimetowrite,followedbybriefopportunityforgroupshareofintentionstocontinuepractice.

GroupGoAround:Eachparticipantsharestheirexperienceofthecoursewiththewholegroup,howtheyfeelaboutthecourseending,whattheyhavelearned,howtheywillkeepthemomentumoftheirpracticemovingandgrowing.

Finalmeditationandacknowledgementoftheendingofthisparticulargroup.

HomePractice • Gobacktotherecordingsifyouwish.Keepupthepracticeandmakeityourown

• Continuetoworkwithbringingseamlessattentiontoallyourmomentsinordertobemorepresentinyourlife


NotesonTheCurriculum

CentralityofPractice

Startingeachclasswithasubstantiveperiodofformalpracticecanbeveryusefulandexpressesseveralintentions:Ithelpsparticipantsandtheteachertoarriveandsettleintoclass,andfamiliarizesparticipantswiththefeelingofbeingpresent,awake,attentiveandattunedtothemselvesandtheirsurroundings.Inaddition,ifaparticipanthasnotpracticedathome,thisformalpracticeperiodprovidesastrongandcommonlysharedexperiencefromwhichparticipantscanthenspeakandparticipateasfullyasthosewho’veengagedinthehomepracticemoreregularly.

Thisrecommendationisnotmeanttoberigidordogmatic.Rather,wearesharingwithyouarepeatedobservationinourMBSRclassesatUMass.Afteralongerpracticeperiod,wehaveoftennoticedthattheclassroomdialogueisquintessentiallydifferent.Itseemstousthatthelongerpracticeperiodprovidespeopletheopportunitytosettle,i.e.,1)becomegroundedinthebody,2)listenmorecloselytobody,mindandheartand3)cometorestinone’sownpresence.Thisoffersprogramparticipantsmorepossibilityofrespondinginwaysthatdiffermarkedlyfromtheusual“reporting”modes.Peopleseemtomoreeasily movefromthedoingmodetothebeingmode.Thissharedsenseofbeingisenlivening;ittendstoconnectpeopletotheactualityoftheirexperience,enhancesthesenseofpeoplerecognizingourcommonhumanityandassistsMBSRparticipantstomoveoutoftheirusualmodesofspeechtospeechthatsupportsandexpressestransparency,insightandclarity.

UsingtheCurriculum

WhilethecurriculumismeanttoenhanceandsupportMBSRteachersintheirteachingofthe8-weekMBSRprogram,itisessentialnottomistakethiswrittendocumentasaformulaicoroperationalmanualinanysense.

InMBSRteachereducationandtrainingprograms,weoftenlikenthecurriculumtothebanksofariver:Providingaformandcontainerfortheflowingwater.Withoutbanks,ariverwouldbesomethingelseentirely.Tobeariver,thereneedstobebanks.Andwithdeep,firmbanks,thewaterhasaplacetocollectandflowandfinditsowndepth.Thus,thecurriculumcontainsthe“essence”oftheprogram—inthisanalogy,thewater—which,atitsmostfundamental,servesasaconveyancefornon-conceptual,non-dualawarenessandwakefulness.Thisshowsupinparticipants’discoveryofdeepinnerresourcesthatinclude:agrowingrecognitionthattheyarefarbiggerthantheirideasandopinionsaboutthemselves.Thisleadstoasenseofdisidentificationwithconditionedhabitsandpatternsusuallyinternalizedas“me”;agreatertoleranceforthesepatternsastheyariseandabuddingsensethattheyarecapableofrespondinginfreshandnovelwaystobothfamiliarandunforeseencircumstancesandsituations.

Whileitmaybetemptingtoconsidertheadditionofvariations,options,andotherwiseworthwhileandevenevidence-basedinterventionalelementsormodalities,itishighlyrecommendedthatteachersstaythecourse,asoutlinedhere.First,fidelitytothewrittencurriculumformhasenormousimplicationsfortherigorofMBSRresearch.Secondly,andperhapsmoreimportantly,therobustness


anddepthoftheprogramismostcertainlynotdependentonnoveltyorvariation.Rather,itisherethatthedepthandrobustnessoftheteacherandhisorherownmeditationpracticeandhowtheteacherhasappliedthatpracticeoverthecourseofone’slife,vividlyshowsitself.

Inexperiencedhands,thecomponentsofthe8-weekMBSRcurriculumcomealivethroughthepersonoftheteacher.Whatshowsupintheclassroomistheauthenticityandimmediacyoftheteachers’owncontemplationand“encountering”oftheexplicitandimplicitcurriculumcontent.Itistheteachers’livedexperienceofmindfulnessaswellasthecontentthemesasthey’vemadeormakethemselvesknownpersonallyanduniquely,thatfostersthedirectandintimateconnectionwithparticipants.Thisconnectionandinteraction—throughtheconduitoftheteachers’practiceandexploration—iswhatmakesthecurriculumcomealive,andwherethe"water"—toreturntoourriveranalogy,flows,evernew.

Whiletheremaybeanoccasiontointroduceavariationonapractice,coursetheme,oractivitythatmayrepresentoramplifythecurriculum,beforedoingso,werecommendyoureflectforatime,consideringyourintentionforsuchchangesoradditionswhilesimultaneouslyreflectingonandtestingyourunderstandingofeachelementofthecurriculumasitcurrentlystands.Inourexperience,thistakesyearsofteaching,yearsofpractice,andyearsofworkingcloselywithawidearrayofprogramparticipants.Soweurgeyoutogoslowly,takingtimeforreflectionanddialogueinternallyand,aswell,withotherteachersandsupervisors,beforeaddingnewelementstothecurriculum.

TheteachingofMBSRtakesnothinglessthanourwillingnesstomeetourselvesandourlivesdirectly,surrendering to not knowing—over and over again—and of being willing to listen and learn,shoulder-to-shoulder,withthosewhoentertheclassroomwithus, inaspiritofhumbleenthusiasmandwonder.


AppendixA:ConductingOrientationSessionsattheCenterforMindfulnessinMedicine,HealthCareandSociety

UniversityofMassachusettsMedicalSchool

BelowisadetaileddescriptionoftheOrientationSessionasdevelopedanddeliveredattheUMassCFM.Thismaybeausefulguide.Itismeanttoprovideoffera“taste”ofhowweconducttheOrientationSessionratherthanasastricttemplatetobefollowedmechanically..CertainelementssuchasTeacherfilming,theuseoftheOrientationQuestionnaireand,participantinterviewproceduresareuniquetotheCenter’sgoalsandsettingandmaynotneccesarilyapplytoyouinyoursituationorsetting.TheOverviewatthebeginningofthisdocumenthighlightstheareasthatshouldbeaddressed,andthesectionlabeled:DetailedLogistics,focusesonthespecificsthatparticipantsneedtoknowinordertomakeaninformeddecisionabouttheirpotentialparticipationintheMBSRprogram.Differentvenuesandconstraintswillnecessitatemodifications,andsomeofthosehavebeennotedinthetextbelow.

Greetparticipantsastheyarriveintheroom,andbeavailabletoanswerquestions.

v RemindpeopletostopfillingoutthepaperworkattheSTOPpageontheOrientationQuestionnaire(SeepageAppendixB)

v Afteraround15minutes,orwhenafewpeoplehavereachedtheSTOPpageofthepaperwork,youcanbegintheorientation

v Reassurepeoplewhohavenotfinishedthepaperworkthattherewillbetimeaftertheorientationtocompleteit,andthatyouwillgiveextrainstructionsforthepagesaftertheSTOPpage

v Remindpeoplewherethebathroomsare,andtoturnofftheircellphones

Introduceyourselfagain,andwelcomeeveryone.

Giveanoverviewofthewholeorientation,includingthefollowinginformation:

v Therewillbetimeattheendtocompletethepaperwork

v Everyonewillmeetbrieflywithyouorwithanotherteacheraftertheorientation(afollow-upphonecallatafuturedatemaysubstituteforaninpersonmeeting)

v Everyonemusthaveabriefinterviewbeforeenrollingintheprogram

v Theremaybesomewaitingbeforetheirinterview

v Encouragepeopletousethistimetomeetotherpeopleintheirclass--theexperienceofwaitingcanbeapracticeofmindfulness


GiveabriefhistoryoftheStressReductionProgramandtheCenterforMindfulnessinMedicine,healthCare,andSociety,includingthefollowingpoints:

v Firstprinciple:EstablishsafetyandconfidentialityatthebeginningoftheOrientationSession

v Theprogramhasalwaysbeenconsideredacomplementtomedicaltreatment.Itisnot“alternativemedicine.”

v Itwasfoundedin1979byJonKabat-Zinn

v SakiSantorelliisthecurrentexecutivedirector

v Therehavebeenjustover24,000graduatesfromtheUMassclinic(asof2017)

v UMassMedicalSchoolisaforwardthinkinglearningcommunityandteachinginstitution.FurtheringtheeducationalmissionofUMASS,theCFMhasaprofessionalMBSRteachereducationprogramunderthebannerofOasisInstitute.Therefore,theremaybesome“teachers-in-training”inyourclasses.Likeyou,theywillbetakingtheprogramasparticipants.TheywillalsobemeetinginasmallgroupseminartolearnmoreaboutteachingMBSR.

v Similarly,UMassisaresearchinstitution.Thisiswhyweaskparticipantstocompletepre,postandfollow-upassessmentsoftheMBSRprogram.ManystudiesconductedhereandatotheracademicmedicalcentershavedemonstratedthebenefitsofmindfulnessandMBSRforpeopleexpereincingawiderangeofconditionsandlifechallengesandweremainkeenlyinterestedinimprovingourprogramcontentandprocesses.

Introducemindfulnessandmentionsomeorallofthefollowingpoints:

v Mindfulnessisinnate;itarisesandisknownaswepayattention,onpurpose,inthepresentmoment,nonjudgmentally.

v Inthispractice,wecultivateasenseofcuriosity,exploration,kindnessandbasicfriendlinesstowhateverweexperience

v Mindfulnesshelpsustowakeuptoourlivesratherthanbeingdrivenonauto-pilot

v Inthispractice,wenoticehowthemindmovestothepastorfuture;assoonasthisisnoticed,webringitbackwithgentlenessandfirmness,toanexperienceinthepresentmoment,suchasthefeelingofthebreathinthebody.Themovementofthemindinvolvedinpastandfuturethinkingsometimescreatesunnecessarysuffering,unproductivestriving,andawastingenergythatcouldbeemployedinhealing,problemsolving,andagreaterenjoymentoflife

v Offerashort(afewminutes)guidedmeditation,toallowpeopletohavea“taste”ofmindfulness.Youcanbeginwithsomemovementpractice,offeringthesamecautionsasonewouldwithanyyogasequenceofferencedinclass.Canalsoguideparticipantstobe


awareofsensationsinthebody,thebreath,othersenseperceptions,emotionsandthoughts

Groupintroductions

v Explainthatwewillbegoingaroundtheroomandthateveryonecantakeamomenttointroducethemselves

v Mentionthestrongemphasisonconfidentialityandsafety,bothinthisOrientationsessionandduringtheentireMBSRcourse

v Encouragepeopletobebrief,tosaytheirnames,wherethey’refrom,howtheyheardabouttheprogram,and/ortocommentonthebriefmeditation

v Youcaninteractwithpeopleastheyintroducethemselves,usingthisformatasawayofconnectingwithprogramcandidatesanddeliveringmoreinformationabouttheprogram

v Note:It’shelpfultoavoidaskingpeople“why”theyhavecome,sincethatwillbeexploredinthefirstclassoftheprogram,andthiswillkeeptheorientationabitlighterintone.However,youmaydecidethatyouwanttodeepentheexperienceoftheOrientationSessionbymakingitmorepersonalandaskingpeopletobemoreself-revealing.Therearepositivesandnegativestobothapproaches.Thedeeperquestioningcanleadtoastrongbondingexperienceforthegroup.Ontheotherhand,someparticipantsmayfindastronglyemotionalOrientationSessiontobesomewhatdisorienting—expectingamoreneutralorlessemotionalexperience.

LogisticsoftheMBSRCourse:

v Thecoursemeetseveryweekfor8weeks,eitherinthemorningorevening,for2.5to3.5hours

v Thereisan“All-Day”class(asilentretreatday)betweenthe6thand7thweekonaweekendday,from8:45a.m.–4:30p.m.(Note:Theall-dayclassbeginsat9:00AM,butgiventhatourall-dayclassintegratesasmanyas150participantsandteachersfrommultipleMBSRcourses,aswellaspastMBSRprogram“graduates”—weinviteparticipantstoarrive15minutesearlytofindaplacetocomfortablysettleinfortheday).ItisalsopossiblefortheAll-DayclasstobeconductedafterClass5,toaccommodateschedulingconflicts.

v Ineachclasswewilllearnandpracticedifferentformsofmindfulnesspractice:yoga,sitting,bodyscan,walkingmeditationandmindfuleating

v Wewilllearnaboutstress,andexploreourownbehavioral,physical,emotionalandcognitivestresspatternsandmoreskillfulresponsestothesereactivestresspatterns,aswellasmoremindfulwaystocommunicateandchoosenourishingbehaviorsandactivities

v Ineachclasstherewillbeperiodsofmindfulnesspractice,groupdiscussionsandtalks,smallgroupdiscussions,andpracticesandexercisesrelatedtothatweek’stopics


v YouwillreceiveCD’sorMP3swithmeditationandyogapractices,andapracticemanual,alongwithweeklyhomepracticesheetswithdetailsofyourhomepractice

v Therewillbearound25–35peopleineachclass.(Classsizesmayvarytoasfewas15andasmanyas40)

v Wearcomfortableclothing,andavoidperfumedtoiletries

v Therearenoscheduledbreaks,butyoucanbringwater,foodormedicineasneeded.Weencourageyoutohaveamealbeforeyourclass

v Expectyourdailyhomepracticetobeatleast1hourperday,orlonger.Makesurethatyoucansetasidethistimefordailypractice

v Highlightthecommitmentrequired,andthattheprogramischallenging

v Encourageattendanceatall9classes,includingtheAllDay.Ifsomeonehastomissaclass,therearepossibilitiesformakinguptheclassthatweekonanotherday.Ifsomeonemissesoranticipatesmissing3ormoreclasses,weencouragethemtodropoutandtaketheentireprogramagaininanothercyclewhentheyareabletomakethetimecommitment

v Emphasizetheimportanceofarrivingontime,notinganyconstraintsaroundenteringthebuilding(e.g.,atUMassCFM,thedoortothebuildingislockedintheeveningafter6:30PM)

v Callyourownteacherifyouareunabletoattendclass,needtomakeupinanotherclass,orknowyouwillbelateforclass.Yourteacherwillnotifytheteacherinthemake-upclassthatyouwillbeattendingthatclass

v Explaintheinclementweatherpolicy,andencouragepeopletosetasidetwomoreweeksforclass,especiallyinthewintercycle

v ExplainaboutclassrecordingsofteachersforongoinglearningandMBSRteachercompetencydevelopment.BeexplicitthatthisisonlyforteacherdevelopmentandassessmentandthatonlyotherMBSRteachersandteacher-trainerswillbeviewing.Letpeopleknowwhichclassesthatcyclewillberecorded,andalsothatparticipants/patientswillneedtosignanInformedConsentdocumentbeforethefirstclass.

Explaintherisksandbenefitsoftheprogram.(Note:itisonlyafterthesehavebeenexplainedthattheparticipantcansigntheinformedconsentagreement).

Physicalrisks:

v Theprimaryphysicalriskisconnectedtopracticingmindfulyoga

v Takingcareofoneselfisatthecoreofpracticingmindfulness

v Ifyouhearguidancethatyouknowisnothealthyforyourbodyorcondition,orifyouarefeelingpain,pleasedisregardtheteacherandeithermodifytheposeorrestandimaginedoingthepose

v Exploreyourlimits;gotoyourownedge,butnotbeyond


v BecauseweareembodiedandYogaisatangibleanddirectmeansofteachingparticipantsaboutmindfulnessofthebody,beingawareofthebodyfrommomenttomomentisemphasizedmorethanproperform

a. Theteachercanhelpyouwithmakingmodifications

b. It’salsoagoodideatoaskyourdoctororphysicaltherapisttoreviewtheposturesinthepracticemanual,andtomakean“x”throughposturesthatarenotsuitableforyou

Emotionalrisks:

v Feelingsofsadness,anger,fear,couldseemstrongeratthebeginningbecauseyoumaybepayingattentioninaconsciouswayforthefirsttime

v Ahistoryoftrauma,abuse,significantrecentlossormajorlifechanges,oraddictiontosubstancesmayheightenthesereactions.Pleasetellyourinterviewerifthisistrueforyou,andwecandeterminetogetherwhetherornotitmakessenseforyoutotakethisclass

v Youmayfindthatyoumakediscoveriesaboutyourselfthatyoumaynotlike

v Youmaybechallenged,andfindyourselffacingtheunknown

v Ifatanytimeduringthecourseyounoticestrongemotionsorheightenedawarenessthatfeelsdistressingorisaconcern,contactyourteacher.Heorshemaysuggestadaptationstopracticetosupportyou.Itmayalsobehelpfulforyourteachertospeakwithyourtherapistifyouareseeingone,withyourpermission.Thiscanassistyourteacherinbettersupportingyou.

Otherpeopleinyourlife:

v Itmaybeachallengetosetasidethespaceandtimetodothispractice,soit’simportanttorequestsupportfromyourfamily,friendsand/orco-workers

v Youmayfindthatyouchangepatternsofreactivity,behaviorandcommunication,andyourfamily,friendsand/orco-workersmaybeuncomfortablewiththesenewbehaviorsorattitudes

v Youmayfindthatyourrelationshipschange

Time:

v Findingtimetopracticemindfulnesscanbechallenging:itisnormaltohavethethoughtorideathat“Idon’thavethetimetopractice.”Indeed,noonehasthetime;tofollowthroughonyourcommitmenttoyourselfinthecontextoftheiscourse,you’llhaveto“makethetime”topractice.TThiswillrequireanimmediatechangeinlifestyle(i.e.lessTV,lessreadingetc.)Interestingly,andcounter-intuitively,peoplesometimesreportthatsettingasidetimeforpracticeincreasestheirsenseofspaciousnessduringtherestoftheirday


Benefits:

v IncreasedawarenessandconcentrationNewwaystocopemoreeffectivelywithyourowncondition,difficulty,painorsuffering

v Learningtotakebettercareofyourself

v Somepeoplereportaquietermind,asenseofbalanceandenhancedwellbeing

v Manyphysicalhealthbenefitshavebeensuggestedinscientificresearch,althoughthereisnoguaranteedhealthoutcome

Inviteadditionalquestions.

Finishingthepre-evaluationforms(OrientationQuestionnaire,AppendixB):

v Explainthelastfewpagesofthepre-evaluationform(pasttheSTOPpage,listingtheircoursegoals)

v Askthateveryonecompletealloftheirpaperwork,includingtheirregistrationform

v Encourageparticipantstotakeafewmomentstopauseandcontemplatewhattheywouldhavelikedtoaccomplishattheendofthe8weeks.Makesurethatthe3goalsaremanageableanddoable

v Invitetheinterviewingteacher(s)intotheroomandintroducehimorhertothegroup

v Explainthateveryonewillmeetwithoneoftheinterviewingteacherstoreviewtheirformsandhaveabrief,privateconversation

v Oncetheyhavecompletedtheirinterview,supportstaffwillassisttheminenrollingintheclasstimeoftheirchoice.

v Askifthereisanyonewhoisdefinitelynotenrollingorisundecided,andsuggestthattheycomeinforabriefinterviewanywaytodiscusstheirdecision

Thankeveryonefortheirpresenceandparticipation.

IndividualMeetingsandReviewofPaperwork

Themainintentionsoftheindividualmeetingsandreviewofpaperworkare:

v Todeterminewhethertheprogramisagoodmatchfortheparticipant/patientatthistime

v ToscreentheparticipantforsuitabilityfortheMBSRprogram

v Toallowtheparticipanttoaskquestionsthatmaynothavebeensuitableorcomfortableforthemtoaskaboutinthelargegroup


v ToensurethattheparticipanthasallthenecessaryinformationtomakeaninformeddecisionaboutenrollinginanMBSRcourse

v ToreviewOrientationQuestionnaireforpertinentinformationregardingconcernsorissuesrelatedtotheexclusionarycriteria

v IftheMBSRprogramisnotappropriateforthecandidateatthistime,toprovidetherapyreferralsandotherresourcesthatfitthecandidatescurrentneeds

Conductingthebriefindividualinterview

Introduceyourselfagain.Thanktheparticipantforwaiting,ifnecessary.

Explainthat:

v YouwillbetakingafewmomentstoreviewtheirOrientationQuestionnairetomakesurethatitiscomplete

v YoumayaskthecandidatequestionsbasedonanyresponsestotheOrientationQuestionnairethatraiseconcernsabouttheirparticipationintheprogram

v Theparticipantmayaskanyquestionsthattheydidnotwanttoaskinthelargegroup

v Iftheconversationneedstobelongerthanafewminutes,becauseofconcernsregardingtheexclusionarycriteria,askiftheparticipantcanwaituntilafterotherpeoplehavebeenseen,tocandidlyspeakwiththemabouttheseconcerns.

v Reviewthepaperworkforcompletion

v Makesurethattheclassdayandtimeisfilledinonthefrontpage

v IftheOrientationQuestionnaireiscomplete,placeyourinitialsonthefrontpage.Ifitisnotcomplete,asktheparticipanttocompletethequestionnaire.Ifthereareseveralincompleteanswerspleasehavethecandidatecompletethequestionnairebeforecommencingtheinterview

v Especiallyregardingsuicidality:Ifsomeoneissuicidal,askifthepersoniscurrentlyhavingthoughtsofsuicideorhashadtheminthepastdayortwo.Iftheyaresuicidal,askiftheyhaveaplan(indicativeof“activesuicidality”).Iftheinterviewingteacherdoesuncoveractivesuicidalideationwithintentorplan,immediateactionisrequiredtohavethepersonevaluatedbyalicensedmentalhealthprofessionalimmediately.Ifoneisnotavailable,theinterviewerisrequiredtodial911tohavethepersontransportedtoanemergencyroomforimmediateevaluation,andhaveateachersitwiththepersonuntilemergencypersonnelarrive.Theinterviewingteachershouldaskiftheyareintherapyandifareleasehasbeensigned,notifythetherapist.Explaintheexclusionarycriterionrelatedtosuicidality,anddocumenttheconversation.


v Youmayalsodiscussanysenseyouhaveoftheperson’sbehaviorintheOrientation

SessionwhichmayaffecttheirfullparticipationintheMBSRprogram.Observedbehaviorssuchasagitation,interrupting,dominatingthegroup,inappropriatebehavior,extremeshynessornervousnessareimportanttofollowupaboutwiththepersoninquestion.

v Discussanyotherconcern(s)relatedtoinformationontheOrientationQuestionnaire,yoursenseoftheparticipant,clinicaljudgment,andpotentialoftheexclusionarycriteria.

Foranoutlineandexplanationoftheexclusionarycriteria,seethelistattheendofthissection.Ifthereisaconcernoraspecialneed,dothefollowing:

1. Iftheparticipantwillbeinyourownclass,askthemtowaituntiltheendoftheinterviewing

periodsothatyoucantakeextratimetoexplainanyconcerns.Iftheparticipantunderstandstheseconcerns,andseemsstronglymotivatedandmeetstheexceptionstotheexclusionarycriteria,youmayaccepttheparticipantintoyourclass.Iftheexclusionarycriteriaispsychologicalinnatureandtheparticipantisintherapy,havetheparticipantsignthereleaseofinformationformsothatyoucanspeakwiththeparticipant’stherapist.AttachthereleaseofinformationformtotheOrientationQuestionnaire.

2. Documentyourconcernsandconclusionsontheinformationform(“SRPinterviewnotes”)andattachittothepre-evaluationform.Forexample,ifsomeonehaschecked“suicidality”andyoucheckforsuicidalityandfindthatthereisnoactivesuicidalideationandnointentiontocommitsuicide,makeanoteofthisconversation,andsignyourinitials.(Note:Intheinterestoftransparency,uselanguagethatisacceptabletotheparticipant.)AttachtheSRPinterviewnotestothepre-evaluationform

3. Iftheparticipantwillbeinanotherteacher’sclass,dothesameprocedureasin#1and#2aboveandalsoexplaintotheparticipantthattheywillneedtohaveasecondinterviewwiththeMBSRteacherwhosecoursetheywillbeattending.

a. Calltheparticipant’steacherandgivethemtheinformationabouttheparticipanton

thephoneorinperson.Forreasonsofconfidentiality,donotputthisinformationinanemail,forreasonsofconfidentiality.

b. Informthesupportstafftoawaitenrollingtheparticipantuntilafterthesecondinterview.

c. Theparticipant’steacherwillnotifythesupportstaffafterthesecondinterviewiftheydecidethattheparticipantcansafelyenrollinthecourse.

v ThanktheparticipantfortakingthetimetocometotheOrientationSessionandinterview

v Expressyourappreciationtothemfortheirdecisiontoassumegreaterresponsibilityfor

theirownhealthandwellbeingv Aftertheinterview,thesupportstaffwillregisterappropriateparticipants,collecttuition

and,ifnecessary,makeadjustmentstothefinancialagreement


ScreeningCriteriaforExclusionfromtheStressReductionProgram

LifestyleIssues:

v Addictiontosubstances

v Addictsnewtorecovery(lessthanoneyear)

v Inadequatecomprehensionoflanguageinwhichcourseistaught

Exceptions:Intermsofaddiction,ifsomeoneisinrecoverylessthanoneyearandseemshighlymotivated,orisinasupportivetreatmentenvironment,theymayattendclass.

Ifthereisaproblemwithlanguagecomprehension,provisionscanbemadeforinterpretationservices.Thesameholdstrueforhearingimpairment.

Psychologicalissues:

Baseduponpsychologicalissuesandpresentation,ifateacherisNOTconfidentaboutacceptingaparticipant,refertheseconcernsdirectlytotheCFMMedicalDirector.

v Suicidality

v Psychosis(nottreatablewithmedication)

v PTSD

v Depressionorothermajorpsychiatricdiagnosis(ifitinterfereswithparticipationincourse)

v Socialanxiety(difficultywithbeinginaclassroomsituation)

Exceptions:Anyonewhoishighlymotivatedandreceivingtherapyand/ormedicationforthesediagnosesmaybepermittedtosignupfortheclass.However,inthesecases,itisessentialthattheteacherstateclearlythattheywillestablish,remainin,andhaveactiveandongoingcollaborationwiththeparticipant’scurrentmentalhealthcareprovider.Areleaseofinformationmustbeacquired.

AttitudinalIssues:

v Inabilitytocomprehendthenatureandlimitationsofprogram(wantinga“quickfix”withoutinvestingtimeandenergy)

v Inabilitytocommittoattendingclasses(ifsomeoneisgoingtomissthreeormoreclassestheyarereferredtoanothercycle)


PhysicalIssues:

v Inabilitytophysicallyattendclasses(thisdoesnotrefertophysicalimpairment,whichisnotanexclusioncriterion,buttothesimpleinabilitytoactuallygettoclass,becauseofbeingbedriddenorhomebound)

Note:Finaldecisionsregardingtheseexclusioncriteriaaresubjecttotheclinicaljudgmentoftheinstructor.


AppendixB:OrientationQuestionnaire

DATE_______________________

Class Chosen: _________

Orientation Questionnaire (OQ)

Center for Mindfulness in Medicine, Health Care, & Society™

Mindfulness-Based Stress Reduction Program (MBSR)

University of Massachusetts Medical School Division of Preventive & Behavioral Medicine

Thank you, for filling out these forms. We realize the personal nature of these questions.

Please be assured that the completed forms are kept in strict confidence.

Name: _______________________________________________________ E-Mail:_______________________________________________ Telephone# Home ( ) __________________________ Work ( ) __________________________

Cell ( ) _________________________ (Please indicate best tel. # to leave you a message) Office use only


1. What is your main reason for participating in the MBSR Program?___________________________________________________________________ ___________________________________________________________________

2. Occupation: ______________________________________________________

3. Date of Birth: (MM/DD/YEAR) ___/___/_____

4. Family Information: (please circle)Single Married Not Married Living with Partner Separated Divorced Widowed

5. Do you have children? (Yes/No) ___________ 5a. If so, how many?_______ 5b. Ages?______________

6. Do you have close friends? (Yes/No) _____________

7. Sleep quality: __________________________________________

8. Do you smoke? _____ 9 . Caffeinated drinks per day: _____

10. Do you exercise? _____

11. Do you use drugs or alcohol? ________ How much? ____________

12. Do you have a history of substance abuse? ______________________________ ___________________________________________________________________

13. Do you take prescription medications? (Please list):__________________________________________________________________________________________ ___________________________________________________________________

14. Are you currently engaged in psychotherapy?___________________________________________________________________

15. If no, have you been in therapy during the last three years?___________________________________________________________________


16. Previous overnight hospitalizations? (Year)

Medical/Surgical _____________________________________________________________

Psychological _____________________________________________________________

During the last MONTH have you:

a. Considered suicide? YES NO

b. Sought psychiatric help? YES NO

c. Had thoughts of death or dying? YES NO

d. Had urges to beat, injure or harm someone? YES NO

e. Had urges to smash or break things? YES NO

f. Had spells of terror or panic? YES NO

Please take a moment as you respond to the following three questions.

17. What do you care about most?____________________________________________________________________

18. What gives you the most pleasure in your life?____________________________________________________________________

19. What are your greatest worries?____________________________________________________________________


Date: ______________

How did you learn about this program? We are interested in knowing how you learned about our program. Would you help us by checking off any and all of the ways you first learned about the Mindfulness-Based Stress Reduction Program? _____ Primary Care Physician Physician’s first and Last Name___________________________ _____ Other Health Care Provider _____ Specialty Physician _____ Psychologist/Social worker/Psychotherapist _____ Primary Care Nurse Practitioner Other Health Care Provider’s First and Last Name ___________________ ______ Harvard Pilgrim Health Care _____ Tufts Health Plan _____ I received an appointment reminder with information

regarding the Mindfulness-Based Stress Reduction Program _____ Jon Kabat-Zinn’s Book _____ Saki Santorelli’s Book _____ Friend/Relative that took the class _____ Television _____ Article from _______________________________ _____ Google Ad _____ Other (please describe):______________________________________

Center for Mindfulness in Medicine, Health Care, and Society University of Massachusetts Medical School


This is a good time to STOP…

and await further directions from your Orientation Session Instructor.


Please list three personal goals you have for taking the Mindfulness-Based Stress Reduction Program:

1) _______________________________________________________________________________________________________________________________________________________________________________________

2) _______________________________________________________________________________________________________________________________________________________________________________________

3) _______________________________________________________________________________________________________________________________________________________________________________________


Mindfulness-Based Stress Reduction Program UMass Medical School

Informed Consent Agreement

The risks, benefits and possible side effects of the Mindfulness-Based Stress Reduction Program were explained to me. This includes skill training in meditation methods as well as gentle stretching (yoga) exercises. I understand that if for any reason I am unable to, or think it unwise to engage in these techniques and exercises either during the weekly sessions at UMMS or at home, I am under no obligation to engage in these techniques nor will I hold the above named facility liable for any injury incurred from these exercises. Furthermore, I understand that I am expected to attend each of the eight (8) weekly sessions, the daylong session and to practice the home assignments for 40-60 minutes per day during the duration of the training program. __________________ ____________________________________________ Date Please Print Name

____________________________________________ Participant’s Signature

_____________________________________________

Parent or Legal Guardian (If a Minor)

EMAIL COMMUNICATION CONSENT

As a participant in the Mindfulness-Based Stress Reduction Program, you may wish to communicate with your instructor via email on occasion. In order to ensure your privacy, we request that you give written permission for this form of correspondence. Please complete the form below and check one of the following options: ___I give my permission to communicate via email with my program instructor about any aspect of my Mindfulness-Based Stress Reduction Program experience. ___I DO NOT give permission to communicate via email. Signature: ______________________________ Date: ____________


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