View Full Version : Mindful awareness and ADHD


Kunga Dorji
05-30-11, 07:25 AM
The following few posts contain an extracted summary I have made of some of the highlights of this chapter from the "Clinical Handbook of Mindfulness"

This is quite long but it is a bit of a quick and dirty cut and paste job- and I have rather rushed it as I am also doing a lecture on ADHD for a group of psychologists tomorrow.

However if you read through it you will see that there is some very serious thinking going on here and every prospect of much more useful research information being forthcoming in the not too distant future.

The highlighting and the italics are mine. A small nod to readability.


<style type="text/css">p { margin-bottom: 0.21cm; }</style> The faculty of voluntarily bringing back a wandering attention over and over again, is the very root of judgment, character, and will. No one is compos sui (master of himself) if he have it not. An education which should improve this faculty would be the education par excellence. But it is easier to define this ideal than to give practical instructions for bringing it about.
William James, 1890


This connection between the ability to regulate attention and well-being is profoundly exemplified in mindfulness or mindful awareness, and a neuropsychiatric condition called attention-deficit hyperactivity disorder (ADHD). In both, the role of attention is thought to be crucial to the self-regulation of cognition, emotion, and behavior, and while ADHD may be considered a disorder characterized by difficulties in self-regulation, mindful awareness training maybe considered a tool of enhancing self-regulation.


ADHD is a behaviorally defined condition characterized by a clustering of symptoms of inattention (e.g., “difficulty following tasks,” “forgetful”) and/or hyperactivity and impulsivity (e.g., “fidgety,” “difficulty remaining seated”) with onset by seven years of age and impairment in at least two settings (APA, 1994).


It should be noted that although ADHD is a categorically defined condition (i.e., either the diagnosis is present or absent), the continuous nature of the behavioral dimensions of inattention and hyperactivity-impulsivity is well recognized (Smalley, 2008a; Swanson et al., 2001).


Three inter-related broad areas—attention/cognition, affect, and stress reactivity show differences in ADHD and likely play a role in its etiology.


A variety of treatments have been investigated in ADHD including:
psychotropic medications (stimulants and non-stimulants),
psychosocial treatments (behavioral therapy, cognitive-behavioral therapy, family therapy, social skills training), individual psychotherapy, coaching,
and complementary and alternative approaches (neurofeedback, dietary changes, supplements, and mind-body interventions) (Arnold, 2001)


Stimulant medications are considered “best practice” in the treatment of ADHD across the lifespan (Dodson, 2005).


While clearly helpful for many ADHD individuals, as many as 20–30% of children and adolescents and perhaps 50% of adults are considered non-responders because of insufficient reduction in symptoms or intolerable side effects


Novel non-pharmacological treatment strategies that target neurocognition and/or build self- awareness and self-regulatory capacities are of increasing interest in ADHD.


An 8-week training called mindful awareness practices for ADHD (MAPs for ADHD; see description in section to follow) was tested in an open label study with pre- and post-assessments of ADHD symptoms, symptoms of mood and anxiety, perceived stress, mind- fulness and measures of neurocognition (attention, inhibition, and work- ing memory). Several of the self-report scales (ADHD, anxiety, depression, stress and mindfulness measures) were also collected at 3 months after the training. The study and its initial results are described in detail elsewhere (Zylowska et al., 2008). Overall, the study found good program adherence rate and high satisfaction among the participants. Pre-post training comparisons showed significant (p < 0. 01) reductions in self-reported ADHD, anxiety, and depressive symptoms as well as measures of conflict attention and attentional set-shifting. In addition, (unpublished data) significant (p < 0. 01) improvements were found in measures of perceived stress and mindful- ness. At a 3-month follow-up, additional improvements were reported in ADHD symptoms with no changes (e.g., no additional improvement or loss of improvement) in anxiety, depression, mindfulness, or stress. The study demonstrated that mindfulness-based training is a feasible intervention in a subset of ADHD adults and adolescents and may improve behavioral and neurocognitive impairments.

Kunga Dorji
05-30-11, 07:28 AM
And here is some more.



<style type="text/css">p { margin-bottom: 0.21cm; }</style> There are many definitions of self-regulation, either as a unitary concept, or as its components of emotional regulation, cognitive regulation or behavioral regulation. Terms such as impulse control, inhibition, self- control, self-management, self-correction or independence have been used to describe aspects of self-regulation.


It can be said that self-regulation is central to being a human being,
a mark of one’s ability to execute a choice, self-correct and over-ride pre-potent responses that can come from genetics/biology, intrauterine environmental influences, and/or or early learning.


While we recognize that 1) emotional regulation involves conflict or executive attention or cognitive control (Hariri, Bookheimer, & Mazziotta, 2000; Ochsner & Gross, 2005); 2) affective states or stress can influence attention (Davidson, Amso, Anderson, & Diamond, 2006); and 3) stress response is likely related to one’s cognitive-emotional regulation capacities (Urry et al., 2006), we discuss these domains separately to emphasize affect and stress as the so far under-emphasized dimensions in ADHD and targets for mindfulness-based approaches.
Mindful Awareness as an Attention/Cognition Regulation Tool in ADHD
In ADHD, impairments in four cognitive processes are fairly consistently found to show deficits: language processing (e.g., verbal fluency, reading, spelling), working memory, inhibition (the ability to inhibit a response), and attention (Barkley, 1997; Nigg, Blaskey, Stawicki, & Sachek, 2004; Seidman, 2006; Verte, Geurts, Roeyers, Oosterlaan, & Sergeant, 2006)
Several of these cognitive processes are known to work together in forming executive function,


Given the multiple attention/cognitive impairments in ADHD, mindful awareness training can be seen as either a remediation (compensatory) or rehabilitation (reversal) approach in this condition.


Individuals with ADHD often show deficits on various measures of attentional processes including alerting, orienting and/or conflict attention. Alerting refers to how attention is readied and sustained; Orienting defines how attention is placed (disengaged and reengaged) and conflict attention is defined as the process of inhibiting an automatic response in order to attend to a less automatic response.
The diverse processes involved in formal and informal mindfulness practice are likely to repeatedly engage executive function (attention, working memory and inhibition) potentially leading to strengthening of these abilities and broad changes in self-regulatory abilities. As attention is at the core of mindfulness practice (i.e., “paying attention to attention”) all attentional systems (alerting, orienting, and conflict) (Fan et al., 2002) are likely to be involved.


Other mindfulness meditation exercises train flexibility of attentional focus by varying focus from narrow to broad and engendering the so-called open awareness or “receptive attention” (Jha, Krompinger, & Baime, 2007).


Mindful awareness in daily life (or informal practice) in which the individual checks his/her awareness/attention throughout the day may continue to engage the same attentional networks as in formal practice but perhaps offer modalities to generalize from the educational or clinical setting where the practices may be introduced.


Emerging empirical research is demonstrating that attention and its networks can be modified by meditation training in different non-clinical or clinical populations. A study by Jha (2007) showed that intensive (1-month retreat) training with long-term meditators improved alerting attention but less-intensive (8-week non-retreat setting) training with novices impacted orienting attention. At the same time, long-term meditators appeared to have better conflict attention abilities than novices at the beginning of the study. A review of different meditation studies implicate activation of the anterior cingulate (ACC) and the prefrontal cortex (Cahn & Polich, 2006) structures that are involved in the development of conflict attention and self-control/self- regulatory capacities and the modulation of cognition and emotion in adults (Creswell, Way, Eisenberger, & Lieberman, 2007; Lieberman et al., 2007). Pagnoni and Cekic (2007) demonstrated that long-term meditators when compared to healthy controls did not show typical age-related declines in attentional performance and had less age-related gray matter volume reduction in several brain regions, particularly the putamen.


Mindful Awareness as an Attention/Cognition Regulation Tool in ADHD
In ADHD, impairments in four cognitive processes are fairly consistently found to show deficits: language processing (e.g., verbal fluency, reading, spelling), working memory, inhibition (the ability to inhibit a response), and attention (Barkley, 1997; Nigg, Blaskey, Stawicki, & Sachek, 2004; Seidman, 2006; Verte, Geurts, Roeyers, Oosterlaan, & Sergeant, 2006)
Several of these cognitive processes are known to work together in forming executive function,






Mindful Awareness as an Emotional Regulation Tool in ADHD
High rates of comorbidity of mood, anxiety, substance abuse and behavioral disorders in ADHD have been noted for a long time (Cantwell, 1996; McGough et al., 2005) indicating potential vulnerability to affect dysregulation in ADHD.


The emotional regulation differences in ADHD support the hypothesis that affect (emotional state) regulation is a key continuum underlying ADHD liability and provides further rationale for using mindfulness as a complementary treatment in ADHD.


Higher levels of a dispositional mindfulness correlated with buffering of amygdala response to negative affect via the prefrontal cortex in an affect labelling task


Mindful Awareness as a Stress Regulation Tool in ADHD
There is a large body of research suggesting that stress—such as parental conflict or prenatal/perinatal insults—can increase the risk of ADHD or impairment associated with ADHD


Several studies show abnormal HPA axis response in ADHD


Furthermore, an elevated rate of post-traumatic stress disorder is also found in ADHD,...........and supports the hypothesis that ADHD may be associated with alterations in stress response or stress (allostatic) load. Mindfulness training and other mind-body approaches may impact ADHD via induction of the relaxation response (Benson, 1997; Kabat- Zinn, 1990).


Mindful Awareness and Neuroplasticity—Implications for ADHD
With initially more effortful practice, prefrontal cortical regions are likely to be repeatedly engaged and thus their function may be improved. In addition, as repeated practice continues, automatization of a mindful stance and a corresponding shift from prefrontal cortex to basal ganglia may occurThis automatization of mindful awareness may help bring present-moment aware- ness “on line” more easily (Schwartz et al., 2005a).


In ADHD (as well as non-ADHD individuals), this could lead to a more automatic disruptions of periods of “daydreaming” or “spacing out” or “being caught in thinking” and improved ability to “step back” during periods of intense emotional response.

Kunga Dorji
05-30-11, 07:32 AM
-- and a summary of one of the programs being used.
I have highlighted some of the most salient points.
The method that eliminated my need for stimulants is more intense on the mindfulness side- but for wider use in ADD needs to borrow some of the coaching concepts in the MAPS program.
I hope this extract is sufficiently brief to qualify as "fair dealing".
I would argue that it is.

<style type="text/css">p { margin-bottom: 0.21cm; }</style> Mindful Awareness Practices for ADHD (MAPs for ADHD)
The MAPs program for ADHD differs from other mindfulness-based programs in that it includes (1) a psychoeducation component on the clinical symptoms, neurobiology and etiology of ADHD; (2) sitting or walking meditation periods that are shorter than in other sim- ilar programs (e.g., in MBSR program 45 min of at-home practice is recom- mended); (3) didactic visual aids explaining mindful awareness concepts; (4) strategies from ADHD cognitive-behavioral therapy or coaching to help with mindful awareness practice; and (5) a loving-kindness meditation (an exercise of wishing-well to self and others) at the end of each session to address the low-self esteem problems often associated with ADHD. While body awareness is practiced throughout the training in diverse ways (walking, short movement and stretching exercises, body-breath-sound meditation, and mindfulness of emotions), longer (45 min) body scan and yoga poses typically used in MBSR and MBCT are not included.


Session II: Difficulties in practicing meditation such as distractibility, restlessness, and boredom are discussed and emphasized as common for every- one but also with recognition that they may be particularly difficult for those with ADHD. The approach of returning to the framing of ADHD as an extreme along a normal continuum of functioning discourages the feel- ings of separateness often voiced by ADHD individuals and appears to foster increased self-compassion by recognition of difficulties we all face as part of the “human condition”


While difficulties are explained and validated, participants are encouraged to work with the difficulties as much as they can and take responsibility for their actions.


This is similar to the attitude used in ADHD coaching where gentle yet firm support is used to help with quick discouragement, lack of persistence or inconsistent effort often reported in ADHD. In dealing with difficulties with distraction, it is emphasized that “it is not about staying with your breath but returning to your breath” to encourage persistence even in the context of frequent distractions


Session III
The participants are asked to practice mindful awareness throughout the week by using using cueing questions of “where is my attention right now?” or “what am I doing right now?” and bringing yourself back to the intended task.


Session V
Overly negative or critical thoughts are explored using an exercise in a dyad and reporting self- judgments to the partner. In clinical practice, ADHD individual often report low-self esteem and endorse overly critical self-judgments.


Session VIII: The mindful awareness concepts and practices are reviewed and resources for a continuous mindful awareness practice are provided. Par- ticipants comment on what they learned in the process of the class during a “speaking council” exercise in which everyone has a chance to comment about their experience.


Learning mindfulness is framed as life-long process of checking in with one’s attention, renewing the intention to return to the present moment, and applying the acceptance-change dialectic in each day.


Environmental modifications derived from ADHD coaching and CBT approaches are reviewed to help remember to be mindful or practice loving- kindness such as visual reminders, using a habitual activity as a reminder to be mindful (e.g., associating the act of turning on a computer with becoming mindful), e-mail reminders to be mindful, using electronic organizers as reminders, having a friend or a spouse as a mindfulness-coach, and attending an on-going meditation group or periodic workshops/retreats.

Kunga Dorji
06-01-11, 11:06 PM
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06-01-11, 11:09 PM
And yet more:
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Kunga Dorji
06-01-11, 11:11 PM
the remainder:

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I hope this will be enough to get the idea across that there is very serious work being done in this area.

ilovemusic
07-24-11, 08:44 AM
> Learning mindfulness is framed as life-long process of checking in with one’s attention, renewing the intention to return to the present moment, and applying the acceptance-change dialectic in each day.
I think it's what it is — a "complementary" treatment. As a complementary treatment I'm sure it helps but it doesn't fix the problem. When I felt Concerta working, again, the difference in performance in conversations was so big that "checking where attention is accepting if it isn't where it should be" sounds like child's play although I know it's the only way without medication. That's what I've been doing. I'm very sorry for people who can't get medication working for them for some reason and I'm not even sure I will get it working for me consistently. But what I felt was great and it just eliminates the problem. What this mindful awareness thing does is, I think, just helps to accept the problem. But it doesn't eliminate it. In other words, at best it will help ADDer to reach his peak performance without meds, but no way it will beat his performance with working medication.

Wisefolly
09-29-11, 05:46 PM
Wow! Thanks for all the valuable info. Are you a mental health practitioner yourself?

I skimmed through it and hope to read more I remember later.

ilovemusic, I understand your point, but I don't think medication completely fixes the problem either (not that you were necessarily saying it was the entire solution). Part of m4w has always been uneasy about the meds, though right now I know I really can't function without them. There's a lot more to think about with this, and I might have to write more later because my thoughts are too complex, ana there's too many of them at the same time to get it all down now.

Kunga Dorji
09-29-11, 07:42 PM
Wow! Thanks for all the valuable info. Are you a mental health practitioner yourself?

I skimmed through it and hope to read more I remember later.

ilovemusic, I understand your point, but I don't think medication completely fixes the problem either (not that you were necessarily saying it was the entire solution). Part of m4w has always been uneasy about the meds, though right now I know I really can't function without them. There's a lot more to think about with this, and I might have to write more later because my thoughts are too complex, ana there's too many of them at the same time to get it all down now.

I'm actually a family physician who now deals mostly with mental health issues- starting at the home base!

The reason I keep drawing attention to this is based upon my own personal experience of mindfulness.

My "potted history":

Diagnosed ADHD October 4 2008- Rx 50mg dexamphetamine in divided doss and 1500mg Valproate (PH ? bipolar)

Very good result but for residual issues with emotional impulsivity -especially the tendency to get very angry or anxious very quickly over minor issues.

31 Dec 2009- had a neck problem treated ( atlas subluxation) with improvement in concentration and my tendency to get anxious too easily.

Feb 2010- started training as a provider of Mindfulness Integrated CBT
see www.mindfulness.net.au (http://www.addforums.com/forums/www.mindfulness.net.au)

April 2010- rapid reduction of dexamphetamine requirement to 15 mg/day- tapered Epilim to 500mg/day.

May 2010 - completed mindfulness training.

June 2010- ran out of dexamphetamine and didn't bother to ask for another script.

June 2010- June 2011- Focus good but intermittent issues with fibromyalgia type pain in the back and tendency to easy fatiguability.

June 2011- started "Brain balance training" provided by a practitioner trained in Robert Mellilo's techniques.

Now- 90%resolution of residual fatigue and fibromyalgia issues- much healthier and more relaxed than most of my "normal colleagues"

The only problem- my faith in the institutions that support evidence based medicine has been obliterated- as most of my recovery can be attributed to my ADHD novelty seeking and refusal to bow to academic authority. So I have to watch my back- as the "keepers of intellectual propriety" in my profession can be pretty vicious to any non conformists.

Having said that I have absolutely no objection to using medication to treat ADHD I only wish that other medications we used had the effectiveness profile of the stimulants.
My bottom line was always that the situation was causing me and my family a great deal of distress- and I have always pragmatically wanted the best control (which to me means the most highly refined attention possible)- no matter what means are required to achieve that end.

Musiscience
09-29-11, 08:56 PM
Very great post Barliman.

I really need to get better concentration because the medication does not last long enough for me to make all the work I need to do. You must know what I am going trough since you have been in college in medicine. I am a major in pharmacology and soon going to grad school but I am still in a constant struggle with getting work done, feeling calm and getting rid of anxiety/depression. The question is : How can I become an expert in my field of study if I am that inconsistent and my memory is on and off?

I tried mindfulness meditation but never succeeded to have any good results due to urges to do something else, anxiety and boredom. I wish I could stop medication but every time I do I end up confused like hell and more anxious (Could very well be the withdrawal symptoms, since I never stop for more than 5 days in a row).

I have also tried a change in diet and exercise. Nothing to do. Another possible cause will soon be investigated since my physician is sending me for a polysomnography for possible sleep apnea.

How do you have achieved such a great improvement with mindfulness meditation? Could you share your meditation routine with me?

If I ever get the clear mind I kept trying to get for all my life I will study like I always wanted to and maybe after grad school, if my grades are high enough, apply for medicine (could not get in since my grades are not good enough)

Thank you for letting me ramble, and looking forward for your tips about meditation.

Have a great evening,

Daniel

Wisefolly
09-30-11, 05:01 PM
Yikes! I didn't realize how many errors I had in that post until now. Darn autotext! M4w it
instead of the word me, seriously?

A friend in med school is very into evidence
based medicine, but also sees value on complementary and alternative treatments because he knows the weaknesses that are in the system. Basically, he told me to not completely trust anyone who goes too far to one extreme or the other. Sounds reasonable to me. :)

Kunga Dorji
10-01-11, 07:52 AM
Very great post Barliman.

I really need to get better concentration because the medication does not last long enough for me to make all the work I need to do. You must know what I am going trough since you have been in college in medicine. I am a major in pharmacology and soon going to grad school but I am still in a constant struggle with getting work done, feeling calm and getting rid of anxiety/depression. The question is : How can I become an expert in my field of study if I am that inconsistent and my memory is on and off?

I tried mindfulness meditation but never succeeded to have any good results due to urges to do something else, anxiety and boredom. I wish I could stop medication but every time I do I end up confused like hell and more anxious (Could very well be the withdrawal symptoms, since I never stop for more than 5 days in a row).

I have also tried a change in diet and exercise. Nothing to do. Another possible cause will soon be investigated since my physician is sending me for a polysomnography for possible sleep apnea.

How do you have achieved such a great improvement with mindfulness meditation? Could you share your meditation routine with me?

If I ever get the clear mind I kept trying to get for all my life I will study like I always wanted to and maybe after grad school, if my grades are high enough, apply for medicine (could not get in since my grades are not good enough)

Thank you for letting me ramble, and looking forward for your tips about meditation.

Have a great evening,

Daniel

The mindfulness program combines CBT with a body scanning meditation.
The essence of it is that it uses observation of body sensations that arise in different mental states to learn how to mentally dissect the emotion into physical sensations and the thoughts associated with them.

As we progress we learn for instance:
When angry to not speak or act- but to stop and notice the body and to (by intense observation) to cause those sensations to subside, and to delay acting until after we feel completely settled.

When you start out this process is slow, clumsy and incomplete- but by practicing in simulated stress situations you get fast at it very quickly.

Equally, in the early stages you work with gross emotional states like anxiety or anger- but as you develop the technique it works just as well if you apply the technique to restlessness, or that sort of fidgety, mind darting all over the place state that is so much a problem in ADD. It even works pretty well on tiredness, and physical pain.

The most interesting thing was when I sustained a compound fracture of the finger at the end of training- and needed no daytime analgesia at all- despite having to have surgery on it. That really surprised everybody as I have a well earned reputation for a low pain threshold.

The program takes a minimum of 8 weeks with 8 interviews with the practitioner supporting you- and needs about 1/2 hour homework twice daily over all those weeks.

The ongoing practice is much less than that - but I probably do a minimum of 2 ten minute sessions every day.
I often do more- simply because I really value the outcome and the deepening stability that I am experiencing now.

The mindfulness left me with no real problems with attention stability or emotional instability, but it did leave residual fatigue issues- and those were not really correctable with stimulants.

That is where the brain balance stuff has worked.

One of the other positives about the mindfulness is that it sharpened my observation skills to the point where I could quickly see (within 2 appointments) that the exercises suggested by the practitioner were helpful. That was important- as the evidence is relatively thin on the ground for that technique.

Re sleep- one of the big problems I have found is that medical knowledge beyond sleep apnoea and restless legs is pretty limited- which unfortunately leaves most sleep problems poorly assisted by conventional medicine.

Kunga Dorji
10-01-11, 08:03 AM
Yikes! I didn't realize how many errors I had in that post until now. Darn autotext! M4w it
instead of the word me, seriously?

A friend in med school is very into evidence
based medicine, but also sees value on complementary and alternative treatments because he knows the weaknesses that are in the system. Basically, he told me to not completely trust anyone who goes too far to one extreme or the other. Sounds reasonable to me. :)

Overall I like to have as much evidence as possible before trying any treatment.

I do not insist on as much evidence for trying a treatment myself when the treatment is clearly low risk, but if that is the case I need to see results fairly quickly to convince me to continue opening my wallet.

So far that evidence of my own experience has been clear cut in all cases but the case of dietary supplements- but on the balance I still think they have been useful.

As I have mentioned many times though the issue of what is accepted as evidence by medical academic authorities of concern.

After I had the neck treatment (atlas profilax) I started digging through the evidence supporting the idea that atlas subluxations cause significant medical complications.

As a doctor I remain truly embarrassed at the way that good quality research is being excluded from consideration by doctors through all kinds of intellectual subterfuge. "Academic authoritarianism" is alive and well in Medicine.

pechemignonne
10-01-11, 08:17 AM
Have you ever read this, Barliman? If not, I think you would find it interesting:

Why We Don't Need Self-Esteem: On Fundamental Needs, Contingent Love, and Mindfulness
Author(s): Richard M. Ryan and Kirk Warren Brown
Source: Psychological Inquiry, Vol. 14, No. 1 (2003), pp. 71-76
Published by: Taylor & Francis, Ltd.
Stable URL: http://www.jstor.org/stable/1449046

Basically it argues that the concept of self-esteem is flawed because it still posits human worth as being contingent. For example, in psychological terms the things that are supposed to increase self-esteem, such as mastery of some kind of skill, are still external qualifiers. The article argues that mindfulness is better for mental health than self-esteem.

Musiscience
10-01-11, 10:49 AM
Thank you for the answer, I will try to find a practitioner who offer the program. When doing a little research I found a meditation group that gather once a week for two hours just two blocks away from where I live, maybe they could help with the mindfulness meditation part of the treatment.

It is fascinating that you could block the pain with meditation, it could really be compatible with current theory on pain modulation by superior control of afferent pain transmitting neurons (C fibers in your case if I am not mistaken) by the descending nociception inhibitory control system. I had a lecture this week with a researcher on pain and the physiological aspect of placebo effect on pain.

For the sleep problem, I know the solutions are mostly limited to surgery and the use of a CPAP, but I heard that a lot of people get significant amelioration of the condition (apnea) with the CPAP. So I guess if that if I get a diagnosis I will give the CPAP a try.

Thank you again for your answer,

Friendly,

Daniel

Kunga Dorji
10-01-11, 06:06 PM
Thank you for the answer, I will try to find a practitioner who offer the program. When doing a little research I found a meditation group that gather once a week for two hours just two blocks away from where I live, maybe they could help with the mindfulness meditation part of the treatment.

It is fascinating that you could block the pain with meditation, it could really be compatible with current theory on pain modulation by superior control of afferent pain transmitting neurons (C fibers in your case if I am not mistaken) by the descending nociception inhibitory control system. I had a lecture this week with a researcher on pain and the physiological aspect of placebo effect on pain.

For the sleep problem, I know the solutions are mostly limited to surgery and the use of a CPAP, but I heard that a lot of people get significant amelioration of the condition (apnea) with the CPAP. So I guess if that if I get a diagnosis I will give the CPAP a try.

Thank you again for your answer,

Friendly,

Daniel


Treatment of sleep apnoea is definitely worthwhile.

Re Mindfulness- in the USA you will find more practitioners of MBSR.

ONe of the leaders in this field is Dr Lydia Zylowska- with her MAPS for ADHD program:

http://www.lidiazylowska.com/

Looking at that program it combines some ADHD education with a less intense mindfulness program.
It has the virtue that it starts with shorter practice sessions.( a plus for many ADDers)
Given the great results I got from the more intense MiCBT I would think that to get the most out of mindfulness most would want to continue that program longer and go more intensely.

From what I read though- it is likely that MAPS for ADHD practitioners would be aware of that and probably offer tailored interventions to support it.

The pain issue is intriguing.

I have never been a let to forget those Buddhist monks who set themselves on fire to protest the American invasion of Vietnam. It is known that practitioners of that level can get extraordinary degrees of pain control, and I often wonder if some of the people who copied them realised that they did not have the same capacity to deal with pain as those individuals probably did.

Kunga Dorji
10-01-11, 06:17 PM
Have you ever read this, Barliman? If not, I think you would find it interesting:

Why We Don't Need Self-Esteem: On Fundamental Needs, Contingent Love, and Mindfulness
Author(s): Richard M. Ryan and Kirk Warren Brown
Source: Psychological Inquiry, Vol. 14, No. 1 (2003), pp. 71-76
Published by: Taylor & Francis, Ltd.
Stable URL: http://www.jstor.org/stable/1449046

Basically it argues that the concept of self-esteem is flawed because it still posits human worth as being contingent. For example, in psychological terms the things that are supposed to increase self-esteem, such as mastery of some kind of skill, are still external qualifiers. The article argues that mindfulness is better for mental health than self-esteem.

I must see if I can get a copy of the whole article. The introductory page looks interesting.

The subject of self and self esteem goes well past basic therapeutic mindfulness.

One of the serious goals of full scale Buddhist practice is to realise the illusory nature of the self concepts we hold. (What we call our self is merely our persona- a sort of artificial construct that we use to negotiate the world. Our view of our self is always dumbed down and either idealised or demonised).

When you get well engaged in mindfulness practice you start to "see through" that sort of "self" idea.

In fact when I am properly engaged and focussed on an activity my self concept almost vanishes.

There is a statement in a book called Zen and the Art of Skiing- about the moment of "flow" or full engagement in the process being undertaken- referencing that sort of abatement of the idea of subject- object.

" No Skier, No Snow: Only Skiing".

In that state the sort of self esteem issues we often have simply vanish.
Once you reach the point when you can slip into that state reasonably readily and deliberately- you no longer take that supposedly defective self of yours so seriously.

Kunga Dorji
10-01-11, 06:48 PM
The other thing that I should mention that I left out before was that in March last year I did a 3 day rhythm meditation workshop called Ta Ke Ti Na.

This is really interesting. It is done in groups of between 40 and about 100 people- and involves building up a polyrhythm through a combination of stepping, clapping and chanting.

The leader pushes the group so hard that everybody ends up getting confused and overwhelmed. In the end- you have to laugh- no matter how ridiculous you feel.


It is usually done as a 3 day workshop- involving 4 sets of about 90 minutes each day.

I went into it mostly to improve my timing as a guitarist.

However at the end of the 3 days my mind was so quiet it was uncanny.

Doing that gave me a big step up in my functioning- and helped with the mindfulness training.

Mind you- the first time I did it - I felt really out of place. I have generally been pretty conservative in the past ( Thank heavens I grew out of that stupidity before I got too old to enjoy myself properly).
I am sure that something like this that involves movement, timing, social activity and fun, would be very helpful for many ADDers.

http://www.taketina.com/

http://www.bosak.com.au/taketina.htm

Vito, ADDer
05-02-12, 11:50 AM
There is no "self" to esteem. The self is a fiction. ADD meds by themselves will do nothing to reveal that truth.

Whether meditation by itself can solve the problems of an ADDled brain is not a question I would even attempt to answer with certainty. I suspect that it's possible, but the more relevant question is whether the investment of time and self-discipline it requires to train oneself (;)) provides sufficient short-term results to keep the novice from becoming discouraged.

In my case, it didn't. I do think that meditation does provide great benefits; it certainly has done so for me. But I also recognize that neurochemistry is insistent. The kind of focus, motivation, patience, persistence, and self-discipline that meditation ultimately requires is the very thing that I lacked...and the very thing that the meds provided (50 mg. dextroamphetamine per day at the start...just like Barliman).

I was diagnosed in 1998 with ADD, 96th to 99th percentile in multiple diagnostic indicators. In the vernacular, I was a basket case—a scientist/engineer with a wife and two kids, working a minimum of 60 hours per week, feeling trapped and hopeless, struggling to "fix" myself with self-help books, tapes, and seminars. I couldn't sit still long enough to meditate. As soon as I remembered something I had to do...ZANG!!! ...adrenalin rush. Meditation wasn't working. Nothing was working.

Then a friend told me, "You can't solve it all with software."

Oh.

Duh...of course! That's what I was trying to do. And it wasn't working. So I went for the ADD evaluation, got the diagnosis, and after a couple of months of trying different medications, I found that dextroamphetamine was exactly what my wetware needed to run all that software.

Along the way, I have gradually learned the skill of meditation. But I had to get control of my neurochemistry FIRST. The meds were indispensable. I wasn't able to do it without them. Maybe someone else could, but I couldn't.

I'm reticent to insist that what works for me will work for anyone else. I don't personally know anyone who is a member of ADD Forums, so I don't know whether there's anyone here who's very much like me, but I suspect that there are plenty of them. If you tried meditation and it didn't work for you, I'm not surprised. Maybe you just weren't ready.

But if you can get your brain to the point wherein it will let you meditate, and you develop the skill of quieting the incessant chatter in your mind, you most likely will find that the benefits affect every aspect of your work, your play, and your relationships with others.