Yesterday evening was the fifth session of the MBSR course that I'm attending.  I'd missed the fourth session because of my wife's birthday, but I did jot down some thoughts last week in the blog post "Learning MBSR: ... body scan, Damasio on identity, and informal practice".  There were seven of us attending tonight's session, so two were missing.  We began with a straight 45 minute sitting meditation - slightly "marines" when my usual practice is 20 minutes.  The experience of "swimming out" into a longer group practice echoes back for me to a series of meditation retreats I went to in my 20's.  Memories, not so much visual or verbal, more a sense in my body of poignancy, happiness, strength, youthfulness, openness.  Strange.

And after the meditation, the course trainer spent a good deal of time talking with people in the group about how they had experienced the 45 minute practice.  In fact this seems to be the main teaching focus during these evening classes, at least at the moment -  a longish led practice (so a good deal of instruction during the meditation itself) and then quite a prolonged discussion about individuals' experience during the sitting.  Rich in many ways.  Plenty of fresh material to look at.  Plenty of opportunity to emphasise Non-judge and Non-react facets of mindfulness practice, which (along with Act-aware) seem so core in reducing depressive relapse and probably other states linked with excessive worry & rumination.  Examples include problems with anxiety and irritability, as well as current experience of depression (not just relapse prevention) - see the recent paper "The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode".

There were a whole series of topics covered, including the potential value of "difficult" meditation sessions where one is dealing with pain, tiredness, distraction and so on.  Maybe these harder sessions are better vehicles for practising Non-judge and Non-react than easier, more enjoyable sessions are?  This seems quite probable, but it would be a brave (and possibly masochistic) soul who consistently exposed themselves to this kind of practice if it was always a painful, distressing slog for them.  Possibly pleasant, peaceful sessions encourage us to keep going through the occasional painful, distressing sessions where maybe more of the therapeutic benefit actually arises - that's a nice reversal of a more usual view of meditation where experiences of peaceful calmness may be considered to be what carries the benefit.  As is usual, the truth is probably somewhere in between, with real gains to be had both from "easy" and from "difficult" sessions.  And it may well be helpful, whether one is actively teaching this kind of meditation or simply encouraging one's own practice, to keep in mind that the "difficult" sessions are genuinely likely to be particularly valuable in providing opportunites to practise Non-react and Non-judge.  I note, for example, that in the recent paper "Developing an observing attitude: an analysis of meditation diaries in an MBSR clinical trial", the authors reported "All participants, to varying degrees, described moments of distress related to practice; at the end of the course, all participants who completed the training demonstrated greater detail and clarity in their descriptions, improved affect, and the emergence of an observing self. The closed-ended coding schema, carried out to shed light on the development of an observing self, revealed that the emergence of an observing self was not related to the valence of participants' experiential descriptions: even participants whose diaries contained predominantly negative characterizations of their experience throughout the trial were able, by the end of the trial, to demonstrate an observing, witnessing attitude towards their own distress. Progress in MBSR may rely less on the valence of participants' experiences and more on the way participants describe and relate to their own inner experience."

We spoke too about the spectrum of broad-focused mindfulness practice and narrow-focused concentration practice.  See the earlier blog post "What is mindfulness?" for more on this distinction.  It's worth remembering that there seems value in both ends of the broad/narrow focus spectrum.  So traditionally the Buddhist "Noble Eightfold Path" recommended both "Right Mindfulness" and "Right Concentration", and more modern evidence-based guidelines currently recommend mindfulness for reducing depressive relapse but recommend applied relaxation (a more narrowly focused concentration practice) for treating generalised anxiety.  And actually mindfulness practice constantly slides across into more narrowly focused concentration styles.  The injunction to repeatedly "escort the attention back to the breath", to me, is a form of concentration.  I would suggest that pure, broad-focus mindfulness would simply request that one be aware of whatever is happening in the present moment.  Suggestions to pay particular attention to body or breath or other specific aspects of one's broad non-selective awareness immediately add a more narrowly focused concentrative element.  And I think this addition of a concentrative element makes very good sense.  To me, a pure broad-focus mindfulness practice is immensely challenging - like soloing up a cliff without any pitons or ropes for protection.  One constantly falls off away from a present moment focus.  Using breath and body add a "safety rope" that one can repeatedly come back to.  It's the addition of this more concentrative element that helps one learn to stay on the cliff of present focused attention (with our tendency to repeatedly fall off into a focus on the past, future or fantasy).  As usual, a helpful question is "what are we trying to achieve?" when deciding what balance of narrow and broad focus to encourage.  And it's even a tempting research question to ask whether teaching a concentrative narrow-focused applied relaxation form that highly emphasised Non-judge and Non-react might in fact reduce depressive relapse as much as broad-focused mindfulness training.  Well there's a thought!  See, for example, the paper "Long-term evaluation of the effectiveness of additional Autogenic Training in the psychotherapy of depressive disorders".  And an even more obvious question - does adding goodwill/loving-kindness practice to MBSR/MBCT increase improvements in the Non-judge facet of mindfulness and boost effectiveness in reducing depressive relapse?

The evening moved on to a tea break.  Again we were encouraged to bring the tea back and pair up to discuss how our home practice had gone in the previous week.  I think there's a possibility of improving course outcomes here.  There does seem enough evidence to suggest that more home practice is likely to lead to greater change in mindfulness and increased benefits from taking the course.  How can one encourage the "Right effort" needed to practise regularly?  I'll blog separately on this, but I suspect this might involve more active input to encourage practice.  My partner and I in this pair exercise discussed a number of issues.  One that particularly interested me was how to develop greater "informal" mindfulness practice.  This links so much to one of my personal goals for attending this course.  I wrote "At a personal level, I live life somewhat at 110%. There's lots that's good about this but definitely, at times, I miss the taste of the moment as I reach out for the next goal. I welcome the opportunity to explore "being" and "savouring" more."  And how to encourage "being" and "savouring"?  I'll look at this more, but one tool I'd like to experiment with is the "Mindful attention diary".  This is a spin-off of the "Mindful attention awareness scale (MAAS)" - an assessment tool that is more focused on Act-aware than the broader "Five facet mindfulness questionnaire" that I more routinely use.  There is interesting evidence suggesting that the Act-aware and Observe facets of mindfulness are particularly associated with increased positive experience.  The originators of the "MAAS" suggest this too with their finding that higher moment to moment scores on the MAAS diary are associated with more frequent & more intense current pleasant & positive emotional states (this is not so ‘significantly' the case with the general ‘state' questionnaire).  Fun to experiment!