Mindfulness and Urban Youth

Erica M S Sibinga, MD, MHSGeneral Pediatrics & Adolescent Medicine

Johns Hopkins School of MedicineDecember 4, 2009

Learning objectives

Improve understanding of mindfulness Review effects of mindfulness in adults Learn about mindfulness for youth

No conflicts of interest to disclose

What is mindfulness?

What is mindfulness?

Mindfulness is a conscious,

moment-to-moment awareness,

cultivated by systematically paying attention on purpose in a particular way.

—Jon Kabat-Zinn

Mindfulness qualities

Non-judging Patience Beginner’s Mind Trust Non-striving Acceptance Letting Go

Popular interestOprah—“Missing the Moment” (Oprah.com)

Trying to live fully in the present—or, said another way, "being in the moment"—is a challenging proposition. We frequently get caught up in our routines, habits and thoughts, and find ourselves feeling disconnected from what is happening around us…or even within our own bodies. Instead, we spend our time and energy creating to-do lists and dwelling in the past.

These thought patterns—wishing, hoping, planning, missing and regretting—prevent us from truly being present and from completely engaging in what is happening in our lives right now…in the present moment. Instead, we often find ourselves running on "autopilot"—without conscious awareness—because we have literally become lost in our thoughts.

Mindfulness-based stress reduction (MBSR) program Developed by Jon Kabat-Zinn, 1979 MBSR core elements Grossman 2004; Kabat-Zinn 1990

Structured 8-10 week program Groups typically 10-40 participants Approximately 2 hours per session Content:

mindfulness meditation practice mindful awareness during yoga postures mindfulness during stressful situations

MBSR instructor training (UMass)

MBSR evidence—adults

MBSR is beneficial in heterogeneous populations of adults (including healthcare providers) Kabat-Zinn, Carlson, Davidson, Antoni, Robinson, Grossman, Baer, Krasner, etc.

Improved mental health Improved quality of life Improved immune parameters

Enhanced response to flu vaccine

MBSR evidence—emerging for children and youth

Few published studies on MBSR for youth Case studies, multi-modal studies Ott, Wall, Bootzin

HIV-infected youth Sibinga

Outpatient psychiatric patients Biegel

Possible MBSR mechanism(s)

Likely multiple pathways and/or synchrony of brain waves Goldin, Singer

“Re-perceiving” (shift in perspective) Shapiro

Decrease in rumination Rumination mediates MBSR’s effect on psychological

distress & depression Jain, Ramel

Decrease self-centeredness Hutcherson, Farb

fMRI shows less activity in self-focused region of brain

Decrease negative automatic responses Hutcherson Brief meditation interrupts automatic negative responses

Mindfulness for urban youth

The Three Breaths Break Stop and Pause

When you are stressing or busy or on automatic pilot, just stop. Stop everything. Put everything down a minute. Turn off the music or the TV, or leave the room. Close your eyes.

Take three mindful breaths. Just drop into the breath, this breath. Nothing to do, nowhere to go in this moment.

Say to yourself “in” with the in-breath and “out” with the out-breath.

Preliminary studies

Uncontrolled study of MBSR program Mixed methods (survey & interview) IRB approved N=33; 26 (79%) completers Post-program improvement in:

Hostility (p = 0.02) Overall discomfort (p = 0.01) Emotional discomfort (p = 0.02)

Results—qualitative data (N= 15)

Interview data—5 themes emerged Decreased anger Fewer conflicts Improved relationships Improved coping skills Improved physical well-being

Improved coping skills

“Breathing meditation—use it everyday at work. Helps me calm myself, prepare for my day.”

“Learning that I control my stress. It’s up to you whether you allow yourself to be stressed or not.”

Fewer conflicts

“I’ve actually practiced it the other day. I was about to get in an argument. I just sat there and I took three breaths and did my own little counting in my head and took three more breaths. And I was actually calm and left the argument—just let it be.”

“Before I would say ‘I’m gonna smack you’ and actually hit people. Now I be more calm. I say ‘Can you please stop’.”

Conceptual framework for MBSR effects

MBSRMindfulness

APPRAISAL & COPING

PROCESSES

Threat appraisalPerceived stress Coping mechanisms

PSYCHOLOGICAL &INTERPERSONAL

FUNCTIONING

Psychological symptoms Mood states Interpersonal functioning

HEALTH-RELATED

BEHAVIORS

Pilot RCT—MBSR vs. active control Harriet Lane Clinic patients 13-21 years old Mixed methods

Quantitative—mental health, quality of life, stress Qualitative—individual structured interview

IRB approved

Active control—Healthy Topics (HT) Age-appropriate health education curriculum

(e.g., nutrition, physical activity, etc.) positive adult instructor effects of peer group participation learning new information matched for session frequency and length, time of

day, group size

Does NOT include instruction in meditation

Results: Enrollment & attendance

  Attended >1session

Attended >5 sessions

Total 43 35 (81%)

MBSR 26 20 (77%)

HT 17 15 (88%)

African American 94% 100%

Age (years) 16.0 15.0 (13-19)

Female 86% 80%

Results: Quantitative

MBSR vs. HT participation Increased coping self-efficacy (p=0.26) No differences seen in other mental health,

physical health, stress measures

Results: Qualitative

Qualitative—individual interviews In-person semi-structured interview re:

experience with MBSR & HT programs, techniques, skill acquisition, etc.

Interviews continued until themes saturated 20 interviews

HT—8 MBSR—12

Results: Qualitative

Group experience

Stressors Response to stressors

Perceived group effects

HT Fun

Learned new things

Met friends

Would recommend

Family—deaths, health, divorce, relationships

School—work, grades, graduation

Angry people

No ∆ after class

Listen to music

Sit alone

Go to room

Eat snacks

Watch movies

Healthy eating (quantity & choices)

Exercise/activity

Better choices

MBSR

Fun

Learned new things

Met friends

Would recommend

Family—deaths, health, divorce, relationships

School—work, grades, grad

Friends—relationships, fights

∆ after class

Use 3BB calm, fewer fights

Body scan sleep better

Walking meditation

Fewer fights (verbal & physical)

Improved relationships

Reflection

Internal processes

Self-regulation

MBSR—Change w/ stressor I was a little embarrassed because I really never got fussed

out in front of friends or anything like that. So I took a minute and breathed in and out. And that's that. Because at that point in time, I would sometimes maybe fuss back at him. Or something like that. So I just stopped altogether and started through. And I went to the kitchen. I sat down on the floor and I said, "Dad, she is having a funeral in two days and I need to do her hair because she couldn't go out and get her hair done. Now, is it okay that I do it? I know that it wasn't right for me not to ask you before I brought someone over." And then I stopped and looked at him. So I believe that thinking things through with the mindful-thinking, I was able to solve this situation. Because that situation would have blown up and she would have got put out, and I would have been punished. That's what I think would have happened if I didn't think. Which I usually didn't do, but I do now.

Small RCT—thoughts so far

MBSR participants showed increased coping self-efficacy, as well as expressing more self-awareness and self-regulation

HT seems to function as an effective control group for MBSR in this population

Mindfulness

Mindfulness is a conscious, moment-to-moment awareness, cultivated by systematically paying attention on purpose in a particular way.

—Jon Kabat-Zinn

APPRECIATIONS Study participants

Collaborators Katie Thorpe Carisa Perry-Parrish, PhD Deanna Kerrigan, PhD Miriam Stewart Melissa Heuer Trish Magyari, MS Cora Welsh, CCLS Nancy Hutton, MD Shana Millstein, PhD Jonathan Ellen, MD

Funded in part by: Thomas Wilson Sanitarium

for the Children of Baltimore City

The Hawn Foundation

Resources Wherever You Go, There You Are (Kabat-Zinn,

2005) Coming to Our Senses: Healing Ourselves and the

World Through Mindfulness (Kabat-Zinn, 2005) Everyday Blessings: The Inner Work of Mindful

Parenting (Kabat-Zinn, 1998) National Center for Complementary & Alternative

Medicine (nccam.nih.gov) Mayo Clinic website (mayoclinic.com) Culbert, Timothy (mind-body approaches for

children) Be the Boss of Your Pain; …Stress; …Sleep

Thank you