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Using Williams & Penman's book "Mindfulness: a practical guide" as a self-help resource (2nd post) - getting ready

I wrote a week ago about using Mark Williams & Danny Penman's excellent book "Mindfulness: a practical guide to finding peace in a frantic world" as a self-help training in mindfulness practice.  In today's post I want to look more practically at getting started with this process.  Obviously you have to get hold of a copy of the book!  In a way it's a bit like a collection of recipes - it's only really nourishing when you do the "cooking" and follow through on the meditation exercises.  So key information is on the CD of eight guided meditations at the back.  You'll need to decide where it's likely to be best for you to listen to and practise these exercises.  This may mean copying the tracks onto your phone, computer or other player.

It's going to be important too to read through the initial four chapters that precede the week-by-week descriptions of the eight session mindfulness programme.  This can be done before starting the meditation sequence or read in parallel to starting the practical exercises.  Looking through the initial chapters should orientate you and help motivate you to put in the time and effort that will be required to make best use of this training.  As I wrote in last week's post, there are very good, evidence-based reasons for expecting that working with this self-help material could be very helpful.  Whether it will be or not will largely now depend on how committed and regular you will be with your practice.  We know too that active reading, where you take a bit of time to think, is likely to be more valuable than simply skimming through the material.  There are downloadable reflection sheets for chapters one & two and chapters three & four that aim to encourage you to chew, digest and get most 'nourishment' from reading these chapters. 

It's also likely to be useful to consider what you are most hoping to see change as a result of going through this training.  There may well be benefits you experience that you haven't even thought of, however you'll probably stay more committed to the practice and be able to select aspects that are most relevant for you, if you're clear why you're going through these meditations and what you hope to see improve.  The post "Building willpower: the seven pillars" explores this territory more fully.  

People vary in how thoroughly they want to assess their progress during this mindfulness training.  There's an argument that says something like "Once you have begun this programme, it's important to maintain a curious, non-gaining attitude that is simply interested in what is.  Assessing and monitoring progress introduces a self-judging element that is contrary to a core emphasis of the training.  It is likely to be better, once you have begun the programme, to simply work through it without thinking about changing things or making progress.  Stay in the here and now!"  This is a perfectly reasonable point of view.  I happen to think it's usually likely to be wrong!

You're almost certainly beginning this mindfulness training because you believe that it might be helpful for you.  A key reason why you have this hope is because there are a whole series of research studies that show the programme can be very helpful.  Every single one of these research studies involved careful assessment and monitoring of participant progress.  If this measurement process tended to interfere with helpful change then we wouldn't have the research and I wouldn't be writing this blog post.  In fact I would argue the reverse - that regular measurement may in fact encourage the process of change.  There is good evidence that improvement in "symptoms" and state made during this programme is largely dependent on practice and on the degree of subsequent change in mindfulness.  There appears to be a very real parallel with a physical exercise programme - for example taking up jogging or going to the gym to improve the health of one's heart and lungs.  The evidence from these kinds of trainings is that regular feedback to participants helps to motivate them and contributes to the progress that they make.  This is why I think that, for most of us, keeping records of our meditation practice and monitoring our progress in developing mindfulness is likely to be well worthwhile.  There are no research studies that I'm aware of that compare progress with monitoring to progress without monitoring, so I agree it's an open question.  Until someone does the research I would argue - unless you have strong personal objections - that you try keeping records and assessing your progress.  You can always stop if it doesn't seem to be suiting you. 

So what should we assess?  Well first of all, please assess mindfulness.  You can download a 24-item questionnaire from the post "A better way to measure mindfulness: a short form of the five facet questionnaire (FFMQ-SF)".  Research suggests that to help with depression, anxiety and other forms of distress, it is particularly important to improve our scores on the facets Non-Judge, Non-React and, to an extent, Act-Aware.  For improvement in "positive" (pleasant) states - rather than just reduction in "negative" (unpleasant) states - the focus is likely to need to include shifts in scores on Act-Aware and Observe.  See the post "Learning mindfulness-based stress reduction ... " for more detail on this.  I would certainly encourage you to complete the FFMQ-SF before and after completing the mindfulness training.  For many people it would be helpful to complete the scale and track your scores weekly or fortnightly throughout the course.  It's likely to be even more beneficial if you keep a visual record of how you're doing on a chart - "a picture is worth a thousand words" - for example, you could use the first week-to-a-square progress chart downloadable towards the bottom of the "Introduction & monitoring" webpage or click here for a PDF. 

I suggest you also assess and track changes in the areas you most want to see improve.  So if you want to reduce depression, or ease anxiety, or get better sleep, or feel happier, or have better relationships or other benefits, it is likely to be helpful to measure where you're starting and track changes in how you're doing.  There are a wealth of questionnaires in the Good Knowledge section of this website.  Good general questionnaires include the depression/anxiety/phobia measure (PHQ-9/GAD-7) with an associated 7 page PDF giving background details and scoring instructions.  Also very helpful in tracking improvements in function - rather than just mood - is the "Work & social adjustment scale" which assesses problems with work, home management, social leisure activities, private leisure activities, and family & relationships (all on 0 to 8 scales). There is also a simple associated sheet giving scoring suggestions

See the "Outcomes toolkit" for other more specific measures.  If there doesn't seem to be an "off the shelf" predesigned questionnaire that describes the issues you most want to see improve, then you can explore using a straightforward 0 to 10 scale.  For many people, shifts in scores on the simple four-item "Rumination questionnaire" will be particularly relevant.  Mindfulness-based cognitive therapy (MBCT) was designed as a way of stepping back from unproductive ruminative spirals of thinking.  It does "what it says on the tin" and it seems that one way MBCT can out-perform relaxation training is by specifically reducing rumination.  Fascinatingly this lessening in rumination seems to be, at least partly, produced by increases in self-compassion.  What is clear - see "Rumination as a predictor of relapse in mindfulness-based cognitive therapy for depression" - is that, unless excessive rumination is reduced, people who learn mindfulness methods are likely to be left too vulnerable to slipping back into distressed states.

For more on "Using Williams & Penman's book ... as a self help resource" see next week's post.

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