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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©toLynnKoerbel,MPH:[email protected]
CenterforMindfulnessinMedicine,HealthCare,andSociety(CFM)UniversityofMassachusettsMedicalSchool
Mindfulness-BasedStressReduction(MBSR)AuthorizedCurriculumGuide©
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.
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 2
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.
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CenterforMindfulnessinMedicine,HealthCare,andSociety(CFM)UniversityofMassachusettsMedicalSchool
Mindfulness-BasedStressReduction(MBSR)AuthorizedCurriculumGuide©
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
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emotionalresilience,andanoverarchingsenseofwellbeingthatcanbeeffectivelycultivatedandrelieduponacrosstheadultlifespan.
MBSRclinicalandbasicscienceresearchandourexperienceattheCenterforMindfulnessattheUniversityofMassachusettsMedicalSchoolstronglysupportstheefficacyofMBSRasaneffectiveclinicalapproachthatcanbeutilizedbyparticipantsfarbeyondcompletionoftheprogram.
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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
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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
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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
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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.
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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.
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Benefits:
v Increasedawarenessandconcentration
v Discoveringnewwaystocopemoreeffectivelywithexistingconditionsdifficulties,painorsuffering
v Learningtotakebettercareofoneself
v Manyphysical,psychologicalandemotionalhealthbenefitsofMBSRhavebeenreportedinscientificliterature
v WecannotguaranteeorpromiseanyparticularresultsfromparticipationintheMBSRcourse.Rather,emphasisisplacedontheparticipant’sactiveengagementintheprogram.Weencourageparticipantstoassumethestanceofascientistinvestigatingtheirareaofinterest:withopennessandcuriosity,suspensionofjudgementandasenseofhealthyquestioning.Itismoreimportantforaparticipanttoexperienceforthemselveswhateverishappening,ratherthanfortheteachertotellthemwhatmayormaynothappenasaresultoftheirparticipationinthecourse.
Inviteadditionalquestions
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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
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TypicalClassSequence
(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
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 13
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
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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
Logistics(attendance,announcements,homepractice)–20minutes
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.
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 15
TypicalClassSequence
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.
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HomePractice • BodyScanrecording≥6timesperweek
• AOBsittingmeditation:10-15minutesperday–Norecordingforhomepractice.Participants/patientsareinstructedtopracticeontheirown.Thisisnotaboutcontrollingorchangingthebreath,butratherbeingwiththebreathandthebodilysensationsofbreathing,noticingwhenattentionwanders,anddeliberatelyreturningattentiontothebreath
• FilloutPleasantEventsCalendarfortheweek–oneentryperday.Note:Ifnopleasanteventisperceivedonagivenday,thereisnoneedtofilloutthecalendarforthatday
• Chooseonedailyactivitytobringfullawarenesstofortheweek:Brushingteeth,takingoutthegarbage,takingashower,feedingapet,etc.
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 17
ClassThree
Overview Inthis2.5hoursession,participantspracticeseveraldistinctyetinterrelatedformalmindfulnesspractices--mindfulhathayoga(endingwithabriefbodyscan),sittingmeditationandoptionalwalkingmeditation--foraminimumof90minutes.Thisextendedformalpracticeperiodisfollowedbyinquiryintoandexplorationofparticipants’experienceswithin-classandassignedhomepractices.Typicaltopicsincludechallengesandinsightsencounteredinformalpracticeandinintegratingmindfulnessintoeverydaylife.
Theme Thereispleasureandpowerinbeingpresent.Attendingtoandinvestigatingthewaythingsareinthebodyandmindinthepresentmomentthroughthepracticesofyogaandmeditation.
RecommendedTime
Allocations
FormalPractice–70-90minutes
GroupDiscussion–1hour
Logistics(attendance,announcements,homepractice)–20minutes
FormalPractice Openingmeditation,whichcanflowintolongersittingpracticeofAOBwithattentiontoposture
MindfulLyingDownYoga
WalkingPractice(Iftime):Thispracticecanbeintroducedatanytimefromweekthreeforward–Itisstronglyrecommendedthatmindfulwalkingbeintroducedatleastonetimepriortotheallday-class.
Closingmeditation
InformalPractice
Reminderduringclassdiscussions(bothsmallandlargegroup)ofmindfullisteningandspeaking
TypicalClassSequence
Classthreeoptionsforincreasingseamlesscontinuityofpracticeincludethepossibilityofmovingdirectlyfromsittingtolyingdownyogaorfromsittingtowalkingtolyingdownyoga,offeringalongerperiodofformalpractice.Inthiscase,thegroupdialoguewouldincludewhatwasexperiencedinallthepractices.
Sittingmeditationwithawarenessofbreathing.Specificguidancerelatedtoestablishingastable,uprightandbalancedsittingposture.
Groupdiscussiononsitting,bodyscan,andmindfulnessinroutineactivities.Discusstheimportanceofbeingembodiedthroughthesharingofparticipants’directexperienceoffeelingembodied(establishedintheirsomatic/bodilyexperience)orungroundedanddisconnectedfromthebody.
Optional:Introducewalkingmeditation.
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 18
TypicalClassSequence(continued)
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.
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TypicalClassSequence(continued)
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
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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
GroupDiscussion–1hour
Logistics(attendance,announcements,homepractice)–20minutes
FormalPractice Openingmeditation
StandingYoga
Sittingmeditation
Closingmeditation
InformalPractice
Reminderduringclassdiscussions(bothsmallandlargegroup)ofmindfullylisteningandspeaking
TypicalClassSequence
StandingYogapostures(buildingfromthosedonelastweek)
Sittingmeditationwithfocusonbreath,bodysensations(introducedviabriefbodyscanwhilesitting),andthewholebody.Particularemphasisonworkingwithpainfulphysicalsensations.Introducingwaysofworking
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 21
TypicalClassSequence(continued)
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
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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
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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.
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 24
Theme(continued)
ThemeTwo
Connectmindfulnesswithperception/appraisalinthecriticalmoment(themomentofconsciouscontact),andwiththearisingofreactivephysicalsensations,emotions,cognitionsandbehaviors.Emphasisonattentivenesstothecapacitytorespondratherthantoreacttostressfulsituations.Exploretheeffectofemotionalreactivityinhealthandillness.Acknowledgethefullrangeofemotionsand,whencalledfor,toexpressthemwithclarityandrespectforselfandother.Exploreaswellthecapacitytorecovermorequicklyasameansofreducingthe“wearandtear”onthebody-mindthatoccurswhenareactivecycleofarousalpersists.
RecommendedTime
Allocations
FormalPractice–1hourand20minutes
GroupDiscussion–1hour
Logistics(attendance,announcements,homepractice)–10minutes
FormalPractice
Openingmeditation
StandingYoga(afewposes)
Sittingmeditation(thelonger,fullsitisoffered,includingallfiveobjectsofawarenessandmoresilence)
Closingmeditation
InformalPractice
Reminderduringclassdiscussions(bothsmallandlargegroup)ofmindfullylisteningandspeaking
TypicalClassSequence
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.
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TypicalClassSequence(continued)
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.).
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HomePractice(continued)
• FilloutDifficultCommunicationsCalendar
• Bringawarenesstomomentsofreactingandexploreoptionsforrespondingwithgreatermindfulness,spaciousness,andcreativityinformalmeditationpracticeandineverydaylife.Rememberthatthebreathisananchor,awaytoheightenawarenessofreactivetendencies,toslowdownandmakemoreconsciouschoices.
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 27
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
FormalPractice–1hourand10minutes
GroupDiscussion–1hourand10minutes
Logistics(attendance,announcements,homepractice)–10minutes
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 28
FormalPractice StandingYoga
Sittingmeditation
Closingmeditation
InformalPractice
Reminderduringclassdiscussions(bothsmallandlargegroup)ofmindfullylisteningandspeaking
TypicalClassSequence
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
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 29
TypicalClassSequence(continued)
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
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 30
TypicalClassSequence(continued)
• 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
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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
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’)
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 32
TypicalClassSequence(continued)
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,
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 33
TypicalClassSequence(continued)
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
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 34
TypicalClassSequence(continued)
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
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 35
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
FormalPractice–1hourand35minutes
GroupDiscussion–45minutes
Logistics(attendance,announcements,homepractice)–10minutes
FormalPractice
Sittingmeditationoptions:Mountain,LakeorLoving-Kindness
Otheroptions:Yoga(classchoices),window,walking
InformalPractice
Reminderduringclassdiscussions(bothsmallandlargegroup)ofmindfullylisteningandspeaking
TypicalClassSequence
Optionsincludeoneorbothofthefollowingexercises:
1) YogaChoicesexercise:eachparticipantdoesastandingbodyscanandidentifiesanareathatneedsattention.Individuallyandwiththegroup,exploreyogaposesthataddressthatareaofthebody,orfavoriteyogapostureslearnedintheprogram.Eachparticipant,withhelpfromtheteacher,ifnecessary,guidesparticipantsintheirchosenpose.Emphasisisonusingyogainordinarydailyexperience,notasaspecial,rarifiedactivity.
2) Exploringthefamiliarandtheunfamiliar-ChangingSeats:Afterparticipantstaketheirseatsintheroom,invitethemtoclosetheireyesandnoticehowitfeelstobesittingwherethey’resitting.Askthemto:
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TypicalClassSequence(continued)
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
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 37
TypicalClassSequence(continued)
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.
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 38
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
Logistics(attendance,announcements,homepractice)–10minutes
FormalPracticeBodyScanYogaSittingMeditation
InformalPractice
Reminderduringclassdiscussions(bothsmallandlargegroup)ofmindfullylisteningandspeaking
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 39
TypicalClassSequence
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.
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TypicalClassSequence(continued)
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
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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
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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.
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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
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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
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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
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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
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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
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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
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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.
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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
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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)
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PhysicalIssues:
v Inabilitytophysicallyattendclasses(thisdoesnotrefertophysicalimpairment,whichisnotanexclusioncriterion,buttothesimpleinabilitytoactuallygettoclass,becauseofbeingbedriddenorhomebound)
Note:Finaldecisionsregardingtheseexclusioncriteriaaresubjecttotheclinicaljudgmentoftheinstructor.
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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
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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?___________________________________________________________________
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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?____________________________________________________________________
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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
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This is a good time to STOP…
and await further directions from your Orientation Session Instructor.
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Please list three personal goals you have for taking the Mindfulness-Based Stress Reduction Program:
1) _______________________________________________________________________________________________________________________________________________________________________________________
2) _______________________________________________________________________________________________________________________________________________________________________________________
3) _______________________________________________________________________________________________________________________________________________________________________________________
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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
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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: ____________
Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School 60