Mental illness and kabat zinn
MENTAL ILLNESS IS a leading cause of disability and premature mortality in America and contributes to a significant portion of health care resources. Studies in neuropsychiatry and neurobiology show that serious mental illness, including mood and anxiety disorders, diminishes a vulnerable individual’s neurobiological threshold for environmental stressors. This vulnerability results in a chronic course of periods of relapse and remittance of symptoms. The recurrent nature of these episodes of psychiatric symptoms are associated with varying degree of functional disability characterizing the chronic course of mental illnesses (Teasdale et al 2000 and Young et al 2001).
Effective interventions for the treatment of mental illness are of major concern for advanced practice psychiatric nurses (APPN). Increasingly, innovative therapeutic treatment approaches that address the chronic nature of mental illness and relapse are being addressed in the psychiatric literature (Segal, Williams & Teasdale, 2002). Increasing evidence supports the use of nontraditional, or alternative therapy (AT) treatment approaches, for relieving emotional and physical distress in patients with physical and mental illness (Snyder & Lindquist, 1998). In one study among outpatients with psychiatric disorders, (N=213), Knaudt et al. (1999) found alternative therapies including, regular periods yoga, exercise, and meditation, often used in combination with conventional medicine treatments, significantly improved symptoms of their illness. Cuellar, N., Cochran, S., Ladner, C., Mercier, B., Townsend, A., Harbaugh, B. and Douglas, D., 2003. Depression, and the use of conventional and nonconventional Interventions by rural patients. Journal of the American Psychiatric Nurses Association 9 5, pp. 151–158. Abstract | Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (2)Cueller et al. (2003) found demographic disparity in the provision of AT where it is more likely to be offered to urban populations. This finding supports Astin’s study (1998), which found predictors of use of AT included higher education, urban residents, persons with a holistic health philosophy, and commitment to global issues and personal and spiritual growth. Mindfulness-based therapeutic interventions, one example of AT, is an approach that promotes use of meditative practices and its aim is to offer patients increasing insight through focused attention on conscious thoughts, feelings, and bodily sensations. This approach complements and expands traditional psychiatric/psychological approaches to the treatment of emotional suffering as it encompasses the spiritual aspects of the human experience.
Mindfulness-based approaches have been shown to relieve distress and increase perceived sense of control for individuals with chronic medical and psychiatric illnesses (Miller et al 1995; Borysenko 2002 and Kabat-Zinn et al 1985). Mindfulness-based therapeutic interventions teach patients an alternative perspective from which to view their situation, a more detached perspective to observe ones stream of changing thoughts, feelings, and bodily sensations. Mindfulness interventions teach patients to become increasingly more attentive to the moment by engaging in a state of attentiveness to observe their inner thoughts and feelings as well as their outer world of actions and perceptions. The aim of this therapeutic approach is fundamentally to teach patients with mental illness ways to improve distress and manage their suffering (Borysenko, 1988). Mindfulness is explored in the next section.
Overview of mindfulness
Mindfulness has been gaining widening acceptance in the Western world, especially with respect to its application in the relief of human distress and suffering (Hirst, 2003). It is only in the past 20 years that Western physicians, neuroscientists, and mental health professionals have begun to comprehend the wisdom of 2,500 years of Buddhist philosophy and recognize the interrelationship between emotional states and physical and mental well being (Goleman, 1997). According to Buddhist tradition, mindfulness, sometimes referred to as awareness, or insight (vipassana), is a state of being purposefully attentive to one’s moment-by-moment experience. This includes an awareness of one’s own perpetuating and maladaptive mental habits impeding personal growth and understanding (Kabat-Zinn 1990; Goleman 1997; Gunaratana 2002 and Snyder & Lindquist 1998). Mindfulness is a highly disciplined skill and its cultivation and therapeutic usefulness requires training and daily meditative practices (Kabat-Zinn, Lipworth, & Burney, 1985).
Mindfulness requires individuals to engage in self-awareness, self-acceptance, and a personal desire to change habitual ways of thinking and behaving. All experience is treated equally with respect to mindfulness, including thoughts, feelings, and bodily sensations. Nothing is suppressed or expressed and change is experienced as an inevitable passing flow of life. Mindfulness requires individuals to accept their various states of mind implicitly, and then fully observe these states of mind, described as somewhat like taking the stance of a detached witness. Moreover, mindfulness requires that individuals become fully aware of their perceptual experiences, and create a sense of balance and tolerance for ones conscious experience. This detached stance enables one to respond rather than react to ones habitual ways of thinking, moving, and doing. Mindfulness offers individuals skills, such as meditation of the breath and relaxation practices, with which to calmly and purposely respond to ones experience of distress (Santorelli, 1992).
According to Gunaratana (2002), rehearsal of mindfulness practices offers individuals a new way to experience the world and the impact of mental illness on their own lives. Buddhist tradition describes purposeful attention to the moment as “engaging in the being mode,” which is believed to displace habitual patterns of thought that otherwise might lead one towards maladaptive functioning. Contrasted with the being mode, habitual reaction to one’s mental activity, such as compulsive maladaptive behavior, is referred to as “engaging in the doing mode” (Kabat-Zinn 1990 and Goleman 1997). Individuals with chronic mental illness frequently engage in the doing mode, which promotes habitual and ruminating patterns of negative thoughts associated with maladaptive responses to their illness. Buddhist teachings understand the being mode as a mental mode, that is, a structure of the mind. Similarly, in Western thought, the cognitive model of depression and anxiety, understands these mental modes as structures of the mind. According to the cognitive model of depression and anxiety (Young, Weinberger, & Beck, 2001), these mental modes are reflected in an individual’s thoughts, feelings, and behaviors and may perpetuate pain and suffering for individuals experiencing medical and psychiatric illnesses. Mindfulness-based stress reduction interventions reflect this understanding of the being mode as key for offering efficacious tools and treatment for individuals with mental illnesses. Both informal and formal methods of mindfulness practice are taught to individuals. Informal methods include: awareness of the present moment; maintaining this “presence” through difficult physical or emotional experiences such as painful medical treatments or grief; and being conscious of the self in activities of daily living. Formal methods of mindfulness practice include: meditation; breathing exercises; and yoga (Prewitt, 2000). Jon Kabat-Zinn has integrated both informal and formal methods in his mindfulness-based stress reduction programs.
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