Review Paper - Journal of Psychology and Cognition (2017) Volume 2, Issue 3

Navigating anxiety and stress through mindfulness: cultivating mindfulness and awareness in a community-based setting

¹Faculty of Medicine, Memorial University, St. John’s, NL, Canada

²Safer Mindfulness Inc., St. John’s, NL, Canada

*Corresponding Author:

Martha Traverso-Yepez
PhD, Associate Professor
Division of Community Health and Humanities
Faculty of Medicine
Memorial University
St. John’s, NL
A1C 5S7, Canada
Tel: (709) 864-6086
E-mail: mtraverso@mun.ca

Accepted date: July 20, 2017

Citation: Traverso-Yepez M, Safer A. Navigating anxiety and stress through mindfulness: cultivating mindfulness and awareness in a community-based setting. J Psychol Cognition. 2017;2(3):177-185

Abstract

Stress and anxiety are afflicting Canadians at all ages significantly impacting their health and well-being. In this article, we argue that community-based non-medical alternatives are needed to relieve pressure from the health care system, provide wellness-based solutions that do not rely on medication and empower the individual to assume a primary role in self-care. We present the evaluation of the 8 week “Navigating Anxiety and Stress through Mindfulness” program aimed to assist individuals who identify problematic anxiety and/or stress by providing training in mindfulness-awareness meditation and related practices. Mindfulness training involves relating with precision and accuracy to whatever arises in one’s state of mind or in the surroundings; awareness training fosters openness and a greater connection to the environment. Rather than regarding anxiety and stress as problems to be gotten rid of, participants were coached to relate to these experiences non-judgmentally, with openness, curiosity and an interest in learning from them. Evaluation data from five groups (40 participants) indicated a 40.4% improvement in scores. Participants’ self-reports indicated significant improvement in their ability to interrupt storylines (discursive thought patterns), rumination, not being fully present and their ability to accept things as they are, ranging from 25% to 60%. It is evident that participants found mindfulness-awareness meditation and related practices beneficial. Their evaluation responses showed significant understanding of the key elements of mindfulness and that they had begun integrating mindfulness into their lives. The majority developed a regular home meditation practice. The program proved to be viable in a community-based setting.

Keywords

Mindfulness-awareness meditation, Community-based intervention, Program evaluation

Introduction

Despite unprecedented gains in prosperity and material well-being in the developed world, in recent decades there has been a parallel increase in various expressions of psychological suffering [1]. Anxiety and difficulties in dealing with stress are among the most common. While worry is a common reaction to a stressful event, according to the Canadian Mental Health Association [2], for some people, worry regularly escalates out of control “or (they) feel like they just can’t stop their worried thoughts”. This chronic sense of lack of control usually affects the person’s entire life—not only their mental health, but their physical health as well. This condition is often diagnosed as ‘Generalized Anxiety Disorder’.

Anxiety disorders, ranging from mild to severe impairment, impact 14% of Canadians [3]. Associated with high levels of anxiety are often high levels of stress, which refers to both the source (i.e., stressful events) and also the person’s experience or response to it [2]. The experience of high levels of stress has become a significant health issue. Statistics Canada [4] highlights that 23% of Canadians 15 years of age and older reported that most days they experience either “quite a bit” of stress or felt their days were “extremely stressful.” In the core working population cohort aged 35 to 54, this percentage increased to about 30%. It is well documented that this phenomenon significantly impacts the economy (reduced work output, absenteeism, disability claims); the health care system (physical and mental health claims), and, more importantly, the lives and well-being of these individuals and their families [5].

Research has confirmed that persistent, high levels of stress contribute to the development of physical and mental disorders [5,6]. Typically, the solution to these health issues has been the medicalization of these conditions, usually neglecting the circumstances and environments that are stress and anxiety inducing [7,8]. As a result, these days, people tend to become dependent upon neuroleptics and other drug treatments for a myriad of psychological and physical complaints. In addition to generating addictions and other negative collateral effects in some cases, these solutions require out-of-pocket expense for users, while the effectiveness of this kind of treatment is limited. Although a less invasive intervention like counseling therapy is recommended [6], only 65% of mental health clients reported receiving these services, as access is limited and wait lists are long [9].

In this article, after reflecting on the increasing prevalence of anxiety and high levels of stress in our society, we explore the applicability of mindfulness, as an appropriate and effective alternative for people who are struggling with anxiety and stress. This is accomplished through the program evaluation of “Navigating Anxiety and Stress through Mindfulness,” an eight-week workshop series that was conducted with five groups in a community-based setting. In our discussion and final considerations, we analyze the dynamic and potential benefits of this particular kind of intervention.

Anxiety and Stress in Modern Life

As human beings, while we have achieved an unparalleled level of scientific and technological development, we have found that one of the most challenging endeavors is to grasp the complexity of the mind. Recognizing this, early philosophers delved into investigating the nature of mind and Western psychology made this its focus of attention. Without having some understanding of the nature of mind, one’s life is often based on habit patterns or the “automatic pilot” mode, causing one to drift at the mercy of external events.

For Csikszentmihalyi, the only way to be able to deal responsibly with ourselves, other human beings, our environment, and all the technology we have created in recent decades is to become better acquainted with how one’s mind works. As human beings, he asserts, we are in constant interaction with two opposing active forces. One is leading toward decay and disintegration (including chaos and death) and the other is a creative force focused on maintaining an orderly state and balance in our lives and our surroundings. In line with the latter, through the process of socialization and the accumulated cultural, scientific and technical accomplishments we have inherited, people usually strive for both self-preservation and efficiency. This evolutionary process has taken over the important task of ensuring that energy and resources from the environment are used to further life and counteract disintegration and chaos, which includes delaying death and striving for a better quality of life [10].

The exponential growth of modern science and technology throughout last century led many people to believe in the myth of progress as a straightforward path, which would allow conquering humanity’s worst evil [11]. However, as early as the mid-twentieth century, it was clear to many that the exponential growth of scientific, technological and cultural knowledge was resulting in both benefits and negative and alienating forces that we need to learn to navigate. At that time, May was concerned about the increasing levels of anxiety in American society [12]. He traced the anxiety of the modern age back to Rene Descartes’ mind-body split, the emphasis on the mechanical and rational aspects of experience and the disavowal of whatever did not fit within this pattern. Biologists and ecologists developed similar insights about the inapplicability of linear models of analysis to “living systems” and the impact this mechanistic worldview has had on human beings and society.

In addition, while the related values of individualism and competitiveness fit well with the development of modern industrialism and capitalism, they generate psychological isolation and other sources of anxiety. Thus, with the rise of capitalism and the market-based economy came the phenomenon of individualistic competitiveness, wherein one’s fulfillment is enhanced at the expense of others. Identifying oneself as distinct, separate, and disconnected from the rest of the world promotes self-absorption, amplifying the need to protect oneself from environmental threats. When coupled with consumerism, this conditions people to live in a nonstop “having” mode [13]. Today, the values of individualistic competitiveness and consumerism are being unrelentingly promoted by the current economic system through the digital interconnectedness of the Internet.

How to achieve a sense of balance becomes a key question. In order to understand and deal with this complexity, as well as the myriad sources of stress in everyday life, awareness is required. There are non-medical ways to protect oneself from the ongoing negative impacts on health and well-being. Rather than becoming further trapped in rumination and/ or worry surrounding a particular issue, one approach is to simplify one’s mind and one’s life and stay grounded in the “here and now” of one’s experience.

In this regard, the practice of mindfulness-awareness meditation—which includes the development of selfknowledge and awareness, a present-moment orientation, a non-judgmental attitude and openness to what is—gives the practitioner tools that can be used to help interrupt rumination, broaden one’s horizons beyond self-concern, and experience uncertainty and the unknown in a safe environment.

Efficacy of Mindfulness Interventions in Clinical Settings

Mindfulness meditation is based on an ancient spiritual practice developed in the Buddhist tradition. Its dissemination in the West was sporadic until the middle of the twentieth century, when worldwide travel by mindfulness teachers and communication between East and West facilitated a more frequent transfer of these teachings and practices to the Western world. A review of the literature on mindfulness applications that were developed to address a variety of health issues shows that the most common form of intervention is Mindfulness-Based Stress Reduction (MBSR), which emerged in the late 1970s through the efforts of Dr. Kabat- Zinn, a physician who is also a practitioner of Buddhist meditation and hatha yoga. His familiarity with the suffering of hundreds of patients with chronic pain led him to begin systematizing the MBSR approach to include key principles of Buddhist meditation practice, combined with body scan and hatha yoga postures [14].

The 1970s and 1980s were decades when many Eastern trained meditation teachers were sharing their understanding with Westerners, presenting mindfulness meditation as “a way of being in the moment” (as opposed to endless distraction through doing), by paying attention to one’s thoughts and other internal and external experiences in a non-judgmental way [15].

As summarized in the second edition of Full Catastrophe Living, first published in 1990, the benefits from this kind of practice do not come from a purposeful engagement in accomplishing something or getting somewhere, but simply through accepting one’s lives and circumstances as they are, no matter how complicated or distasteful they may be. It involves holding to this “being in the moment” with “huge tenderness and kindness toward ourselves and find(ing) ways to honor the full dimensionality of our possibilities for living sane, satisfying, and meaningful lives” (p. xxx). This then creates ground for action and engagement.

Beginning in the 1990s, publications on clinical applications of mindfulness began to sprout. From approximately 100 in 2005, that number rose to more than 1,500 in 2013 [15], including systematic reviews [16-20]. Although mindfulness-based therapeutic approaches have typically been used for specific clinical purposes (i.e., cancer treatment, heart and other chronic health issues), the beneficial path of mindfulness has often reduced symptoms of anxiety, stress and depression that are frequently associated with these conditions.

Two of these reviews are mainly focused on stress, anxiety and depression, conditions which are on the rise, especially in the developed world [18,19]. Along with an increase in scientific knowledge of brain plasticity, interest is soaring regarding the beneficial psychological effects of mindfulness for mental health-related issues, such as sleep disturbances, more serious mental health conditions and mental fatigue associated with brain damage [21-23]. The study by Krusche et al. [22] showed significant decreases in perceived stress, anxiety and depression, with further decreases one month later at follow-up. Highlighting a key element of the training, Krusche et al. noted a correlation between the amount of meditation practice participants reported and outcomes in relation to baseline severity [22].

Although MBSR is the longest-standing mindfulness program in the West that has been applied in the health care context, other mindfulness-based approaches combined with cognitive-behavioral therapy have also reported positive outcomes for anxiety and stress [16], including Mindfulness Based Cognitive Therapy (MBCT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Relapse Prevention (MBRP).

While there is ample evidence in clinical settings, there have been significantly fewer occasions of interventions occurring in non-clinical community-based settings. Considering the insufficiency of timely interventions for mental health issues in health care institutions, the community-based, non-clinical intervention to be explained below offers interesting lessons.

The Mindfulness Approach of This Program and its Delivery

In the “Navigating Anxiety and Stress through Mindfulness” program, mindfulness and awareness are cultivated both through the formal meditation practice and mindfulness-in-everyday-life practices. In terms of the meditation practice, “mindfulness” here refers as relating with precision and accuracy to whatever is arising in one’s state of mind or in the surroundings. Simplicity and peaceful abiding (non-action) are hallmarks of this process. “Awareness” refers to not dwelling on the products of mindfulness (nonattachment) and to openness, a sense of space/totality and a greater awareness of the environment [24].

Navigating Anxiety and Stress through Mindfulness is a meditation-based mindfulness training program that is predicated on the view that all states of mind are workable. From the point of view of meditation practice, there are no good thoughts and bad thoughts, and feelings and emotions are not to be rejected, suppressed, avoided or diminished. The word “Navigating” suggests that rather than regarding anxiety and stress as problems to be solved or fixed, participants are encouraged to relate to them non-judgmentally, with acceptance and curiosity—in fact, to make friends with them while remaining grounded in the present.

Key elements of the program include: 1) grounding, which supports waking up from daydreaming and the automatic pilot mode of operating to bring one back to the present moment, synchronizing body and mind; 2) experiencing the transiency of one’s thoughts, feelings and emotions and the fact that they will not last; 3) instead of continuing to believe that one’s thoughts, feelings and emotions are factual and true, the practitioner comes to see them as fleeting and not connected to “me” and “my”; 4) cultivating an understanding of nonduality introduces the possibility of experiencing thoughts, feeling and emotions as they are, rather than through the filter of labels defined by polarities such as “good” and “bad”; 5) harshness towards oneself negatively impacts wellbeing; cultivating loving-kindness helps practitioners begin to make friends with themselves and transition from selfhatred and self-criticism to self-acceptance and appreciation; and 6) “basic goodness”, which refers to the fundamental intelligence, compassion and openness that exist within each individual. Familiarity with these innate capacities is cultivated through mindfulness practice.

The sessions included: a) introduction of mindfulness practices and exercises, b) meditation practice, c) meditation guidance and Q&A, d) presentation aided by PowerPoint, e) discussion in pairs, f) journaling, and g) worksheet completion (during some sessions). The presentations focused on:

1. Introduction to Mindfulness

2. Mindfulness and Awareness Meditation and Anxiety/ Stress

3. Anxiety and Worry: Imagination vs. Reality

4. Attention: Our Precious Resource

5. Stress: Reacting vs. Responding

6. Fear and Fearlessness

7. Basic Goodness: A Breath of Fresh Air

The key practices are:

1. Mindfulness-Awareness sitting meditation, which is the core practice and comprises a number of elements:

i) Awareness of breath and posture enables one to ground oneself in the here and now, providing a sane reference point distinct from the internal swirl of thoughts, daydreams, judgments, regrets, worries, planning, problem-solving, etc. This orientation establishes a direct contact with reality (the phenomenal world).

ii) In terms of breath, the emphasis is on the outbreath, providing a sense of openness, which shifts the habitual inward focus on “me” to a bigger space.

iii) A technique is introduced to help the practitioner nonjudgmentally recognize mental activity as thoughts and return to the breath, which, over time undermines attachment to and identification with mental states. Recognizing one’s thoughts and coming back to the breath and posture again and again underscores the simplicity of the practice. Because dwelling on thoughts and concerns can lead to rigid mindsets, stuck patterns, and obsessiveness, the element of “letting go” is key.

iv) Working with self-criticism, self-judgment and selfcondemnation is also part of this practice, first by becoming aware of these habitual patterns, and then by bringing a non-judgmental, accepting attitude towards one’s experience. Over time, becoming acquainted with one’s “basic goodness” (inherent sanity, healthiness and wakefulness) allows one to access natural warmth, kindness, openness, and wisdom within oneself [25].

vi) In today’s world marked by busyness, limitless options and claustrophobia of the mind, sitting practice affords the opportunity to explore what it’s like to simply be, without trying to accomplish anything, thereby interrupting the compulsion for constant engagement. Through regular practice, participants begin to get to know their own minds: the thoughts, feelings, emotions, moods and sensations that come and go. They have a chance to explore what it means to “Know Thyself” through the application of mindfulness practice.

2. Walking meditation brings the practice of mindfulness and awareness into an active mode—bridging to everyday life. It affords a further opportunity for grounding and doing one thing at a time, while not losing sight of the big picture/environment. Key elements of sitting meditation are reinforced through this dynamic practice.

3. The pausing practice of head and shoulders provides a way to disengage from the flow of events of the moment and allow a mental gap, free from occupation and involvement. Introducing the non-doing element of sitting practice into everyday life brings a fresh perspective.

4. Mindfulness-in-everyday-life activities are opportunities to bring mindfulness and awareness to everyday activities, such as brushing teeth, washing hair, preparing and eating a meal, gardening, walking the dog, etc.

5. Tonglen (compassion practice) i) helps one connect with one’s inherent awakened qualities of lovingkindness and compassion and extend them to others; ii) helps to free oneself from the rigid beliefs, attitudes and patterns that flow from the dualistic view that separates “me” from “others” and the self-absorption that can develop from this mindset; iii) disrupts one’s deeply ingrained habit of seeking pleasure for oneself and avoiding pain; and iv) shifts the emphasis from isolation to relationship and from self to other.

6. A daily practice log was distributed so participants could keep track of the frequency and duration of their practice in between sessions.

The “Navigating Anxiety and Stress through Mindfulness” program was developed and presented by the co-author, a non-clinician who had practiced mindfulnessawareness meditation over several decades and had over 20 years’ experience as an authorized meditation instructor, program developer and workshop facilitator. The sessions were promoted as educational, not counseling or therapy, via e-mail, through community listings in local media and posters in local establishments. They were presented without clinician involvement in three community-based locations: A church, a multi-purpose room made available by a community-based organization and a residence.

Between June 2014 and March 2015, five groups of the eight-week Navigating Anxiety and Stress through Mindfulness program were convened, meeting in the evening two and a half hours per week. Participants paid a modest fee to attend and discounts were provided on an as-needed basis. Individuals who were experiencing considerable stress and/or anxiety in their lives were either referred by clinicians, community-based organizations or friends or they self-referred. Based on the title of the workshop series and the program description that was provided, they opted to participate and contacted the mindfulness instructor to register. The dynamic of the group during the sessions engendered a sense of community. After completion, participants were encouraged to attend a weekly meditation group, their schedules permitting and were included in an e-mail distribution list that provides information about upcoming mindfulness sessions, mindfulness news items and a book study group.

Program Evaluation

During the first session, an overview of the workshop dynamic was presented and participants and presenter agreed to maintain confidentiality with regard to any personal information (including names) revealed during the sessions. Participants were also invited to fill out and sign a waiver, which released the presenter and the building owner from liability.

The program evaluation process (pre- and post-) was also explained to participants. Through the program evaluation, our intention was to assess the process and participants’ perceived outcomes from this kind of intervention. Therefore, formal consent was not required. This was confirmed with the Memorial University Ethics Research Board. That said, participants signed consent forms, agreeing that comments from their post-evaluation forms could be used for dissemination. It was stated that such statements would not be accompanied by any personally identifying information. Anonymous personal codes were used to facilitate pairing pre- and post-evaluations.

The evaluation instrument was developed collaboratively by the authors. The quantitative evaluation consisted of 17 statements that could be answered according to a Likert scale from 1 (Strongly Agree) to 5 (Strongly Disagree). The statements reflected different aspects of the mindfulness practice and its applications that were presented and discussed during the sessions. For example, “I think over and over about things that have already happened” and “I keep projecting my concerns for the future” relate to the central theme of being oriented to the present, noticing that the mind has wandered and coming back to the here and now. “I always have the feeling that there is something I should be doing to get rid of my troubling emotions” reflects one’s tendency to avoid discomfort.

The qualitative evaluation asked the following: i) what were some of the main points that you remember about mindfulness? ii) which mindfulness-awareness practices have you found helpful? iii) how helpful has the workshop series been (a range between 0=not helpful and 10=extremely helpful was provided), and how has it helped you deal with anxiety and stress? iv) the frequency and duration of home practice, v) if you think others could benefit from learning about mindfulness, and vi) suggestions for improving the workshop series. Participants completed the quantitative evaluation during the first session and both quantitative and qualitative components during the last session.

Quantitative Evaluation

The total number of participants who started the program was 61. The 40 participants who completed both the pre- and post-evaluation forms are represented in Table 1, along with the corresponding group average pre- and post-scores and the average improvement. Among those who completed the workshop series, 33 were female and seven were male. Their ages ranged from 27 to 68.

Table 1. Number of participants and average improvement by group and combined.

The individual scores are out of 85, coming from 17 questions with scores 1 to 5 on a Likert scale. As the average score changed from 40.3 to 56.6, there is an overall improvement of 40.4% (16.3/40.3) for the combined five groups. The statements in Table 2 evidenced the highest changes between pre- and post-scores and are presented in descending order. Totals include responses from all participants (1=Strongly Agree; 5=Strongly Disagree). The numbers below refer to the average increase in score for participants in all five groups. Since only whole numbers were used, the decimals indicate an average increase of between one and two points for the corresponding evaluation statement. It is clear that an improved understanding of the internal dynamic that keeps one hooked to habitual response patterns is the most promising aspect of this approach.

Table 2. Evaluation statements with the highest change.

Qualitative Evaluation

Participant responses to open-ended questions were categorized for tabulation. Sometimes they included more than one expression or idea. Consequently, the total number of ideas expressed in relation to the questions below is greater than the total number of participants. Following are the questions with the corresponding categories, ranked by number of responses (Table 3).

Table 3. What are the main points remembered about mindfulness?

In addition, single responses included: importance of a regular meditation practice, provide tools to deal with everyday stress, self-absorption causes suffering, a life skill and not a recreational pastime and involve a positive disposition. Some examples of participants’ expressions follow:

• Seeing things for what they are. Acting from where I am now, not past or future.

• Let the thoughts roll in and out without judging, and recognizing that they’re only thoughts.

• Importance of ‘being’. Learning to let go; let it be. Recognizing goodness within and connections with others. I have a long way to go, although it’s not about attaining a goal. Try to focus on the big picture.

• Keeps my mind from racing all over the place. Gives me confidence that I can and will take time for myself, to slow down the busy-ness of life.

• Compassion, non-judgmental and empathy (Table 4).

Table 4. Which mindfulness-awareness practices do you find most helpful and why?

Additionally, single responses included: understanding that thoughts are not reality, making friends with myself, not being judgmental, knowing I can’t control the world, doing one thing at a time, being quiet, reviewing some of the readings, being grateful for everyday and the basis of life and breathing (Tables 5 and 6).

Table 5. How helpful has this workshop series been for helping you deal with anxiety and stress? (0=not helpful; 10=extremely helpful).

Table 6. In what ways has this workshop series been helpful?

Additional single responses included: increased awareness of the feelings of others, realizing I create my negative self-talk; taking me less seriously, meditating during the night helps sleep, and giving me a tool to stand tall again.

One participant mentioned that he/she did not have time for practice. A sampling of expressions of responses to this question follows:

• It has enabled me to build a relationship with myself from a kind and grateful perspective. Also, it’s simply fascinating to me intellectually/philosophically.

• I appreciate calming my mind. Sometimes I remove myself from a stressful situation.

• It helped me greatly as it gave me a realistic view on meditation. I had an idea it was something very different from what we practiced. I no longer have an unrealistic view and am easier on myself.

• I know I can deal with anxiety better because of the tools used in this series and in everyday life.

• It helped me to view stress and anxiety differently, and to see my environment in a new way—through a different lens.

When participants were questioned if they have been able to do some meditation practice at home, their responses included: once or twice a week (6 participants), three to four times a week (18 participants) and five or more times a week (15 participants). The session length ranged from 5-15 min (12 participants) to more than fifteen minutes (28 participants). A last question asked if they thought that other people could benefit from learning about mindfulness—both meditation and the other practices. All 40 answered “Yes”.

Discussion

Most participants began the program wishing to “get rid of” anxiety. Throughout the program, a different viewpoint was introduced, which is that regarding one’s feelings and states of mind as “bad” in favour of those that are more pleasant can actually increase stress by reinforcing the habitual tendencies towards grasping and aversion that perpetuate suffering [24,26]. Being coached to “turn towards” their experience, whether it is pleasant or unpleasant, provides an alternative to acting habitually and escaping through avoidance, which has been referred to as “experiential avoidance” [27]. What enables this shift is becoming accustomed to relating to “what is” rather than what might be and the development of a non-judgmental attitude towards one’s experience—a hallmark of the process of making friends with oneself that is fundamental in mindfulness practice.

As participants’ negative connotations of the experience of anxiety began to lessen, they were better able to relate to it constructively. Thus, through the practice, participants began to see that all thoughts, states of mind and feelings—including anxiety and stress—come and go, which makes dealing with difficult emotions more workable. Through the lessons of impermanence and the growing awareness that uncertainty is a fact of life, participants started to accept that the anxiety that comes up in response to this is part of a natural process. This view normalizes these feelings and states of mind, in sharp contrast to vilifying them as enemies. It becomes clear that the tendency to automatically identify with one’s habitual thoughts, states of mind and feelings begins to shift. Through familiarization with the practice, it was common for participants to recognize that they were becoming less reactive and more aware in their daily lives, and that their rigid attitudes and beliefs were starting to loosen, allowing for some openness and flexibility.

In this vein, participants were encouraged to acknowledge difficult feelings and emotions, and regard them as not connected to a fixed, unchanging “self” [28]. One participant’s post-evaluation response reflected this: [Mindfulness is about] “not getting caught up in the ‘me-ness’. I can be with all sensations that are horrible, and deal with it—noticing that my storyline/feeling/thoughts are not me.” This comment draws attention to an element of the program that points to the relationship between self-absorption (“me-ness”) and suffering/“neurotic anxiety” [12]. Another participant wrote: “Mindfulness helps me experience fear and anxiety without getting paralyzed.” A third participant wrote: “I have changed my view of anxiety. I now can more easily recognize negative thoughts as just thoughts and stop them from escalating.”

Through ongoing meditation practice, participants started to move away from their habitual response/automatic pilot mode and began to explore other ways of being. In everyday life, some began to perceive that they have a choice as to how they are going to respond in any given situation (such as reacting or waiting). This has been referred to as making a “mindful choice” [29]. An understanding of this is implied in this comment: “[Mindfulness] has helped me with shifting perspective. For example, it’s OK to let the feeling be. I really believe now that there are times when you accept things as they are.”

We observed that participants appreciated the opportunity to learn about mindfulness in a collegial environment, where “their problem” was not the focus. Instead, their underlying healthfulness and well-being was acknowledged in connection with their ongoing mindfulness practice. The pacing over eight weeks enabled them to learn and become familiar with the practice and develop a home practice with some regularity. This was evidenced in all groups and again with participants of groups four and five, who were invited to attend a follow-up session. It was three months after the completion of group four and two months after the completion of group five. A total of seven participants completed the same post-test evaluation that they had filled out during their final session. The data shows not only a sustained level of adherence to the practice and strength in their responses, but a 4.8% gain in the average score compared to the postevaluation score.

Final Considerations

It is evident that mindfulness-awareness practice is a form of meditation that can be applied in community-based settings by an instructor with appropriate training. This approach to teaching mindfulness can provide an effective means of helping people to navigate the troubled waters of anxiety and chronic stress. In the program evaluation, participants’ responses show that they were incorporating what they had learned into their daily lives, to a significant degree. They indicated that the benefits usually start with an increased awareness of what is going on in their lives. Their responses showed a better understanding of themselves and their life circumstances, and an increased preparedness for dealing with challenges. Instead of seeing anxiety and stress as problems to be overcome, they began to see them as “opportunities for transformation” [26].

As mentioned in connection with some of the different forms of mindfulness interventions explored in the literature review, the main limitations of this kind of approach are that its effectiveness depends on 1) a well-trained instructor and 2) the participant’s willingness to continue with the practice over time, with some consistency [16,22]. Because it may be difficult for participants to continue their ongoing meditation practice without the support of the program, they are encouraged to participate in a weekly group mindfulnessawareness meditation session, which meets year-round and at no cost. Some former participants are availing themselves of this opportunity.

Acknowledgement

We would like to thank Julie Huntington, B.Sc., Jeff Doucet, MSW, RSW and Joshua Bragg, B.Sc. for transcribing, categorizing, and tabulating portions of the qualitative and quantitative evaluation data. Our thanks also to Dr. Veeresh Gadag and Mr. Michael Chender for their comments and feedback on a previous version of the paper.

References

1. World Federation for Mental Health. Understanding generalized anxiety disorder. An International Mental Health Awareness Packet. 2008.
2. Canadian Mental Health Association. Learn about generalized anxiety disorder. 2014.
3. Smetanin P, Stiff D, Briante C, et al. The life and economic impact of major mental illnesses in Canada: 2011 to 2041. Risk Analytica. 2011.
4. http://www.statcan.gc.ca/pub/82-625-x/2015001/article/14188-eng.htm
5. Crompton S. What's stressing the stressed? Main sources of stress among workers. Canadian Social Trends. 2011;92:44-51.
6. Monroe SM. Modern approaches to conceptualizing and measuring human life stress. Annu Rev Clin Psychol. 2008;4:33-52.
7. Eckersley R. The science and policy of population health: Giving health a greater role in public policy. Webmed Central. 2011.
8. Maté G. When the body says no: The cost of hidden stress. Vintage Canada. 2011.
9. Sunderland A, Findlay LC. Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey–Mental health statistics. Canada Health Reports. 2012;24(9).
10. Csikszentmihalyi M. Evolving self: A psychology for the third millennium. Harper Perennial, New York. 1994.
11. Gray J. The New Statesman Essay: The myth of progress. New statesman. 1999.
12. May R. The meaning of anxiety. The Ronald Press Company, New York. 1950.
13. Fromm E. To have or to be? Bloomsbury Academic, London. 2013.
14. Kabat-Zinn J, Massion AO, Kristeller J, et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry. 1992;149:936-43.
15. Kabat-Zinn J. Full catastrophe living. Little, Brown Book Group, London.
16. Baer R. Mindfulness training as clinical intervention: A conceptual and empirical review. Clin Psychol Sci Pract. 2003;10(2):125-143.
17. Grossman P, Niemann L, Schmidt S, et al. Mindfulness-based stress reduction and health benefits: A meta-analysis. J Psychosom Res. 2004;57(1):35-43.
18. Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. J Alternat Complement Med. 2009;15(5):593-600.
19. Hofmann SG, Sawyer AT, Witt AA, et al. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010;78(2):169.
20. Fjorback LO, Arendt M, Ørnbøl E, et al. Mindfulness-based stress reduction and mindfulness-based cognitive therapy: A systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica. 2011;124(2):102-19.
21. Black DS, O’Reilly GA, Olmstead R, et al. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: A randomized clinical trial. JAMA Intern Med. 2015;175(4):494-501.
22. Krusche A, Cyhlarova E, Williams JMG. Mindfulness online: An evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression. BMJ Open. 2013;3(11):e003498.
23. Johansson B, Bjuhr H, Rönnbäck L. Evaluation of an advanced mindfulness program following a mindfulness-based stress reduction program for participants suffering from mental fatigue after acquired brain injury. Mindfulness. 2015;6(2):227-33.
24. Trungpa C. The myth of freedom and the way of meditation. Shambhala Publications, Boston. 2002.
25. Trungpa C. The sanity we are born with: A Buddhist approach to psychology. Shambhala Publications, Boston. 2005.
26. Chödrön P. Taking the leap: Freeing ourselves from old habits and fears. Shambhala Publications, Boston. 2010.
27. Hayes SC, Wilson KG, Gifford EV, et al. Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol. 1996;64(6):1152-68.
28. Teasdale JD. Metacognition, mindfulness and the modification of mood disorders. Clin Psychol Psychother. 1999,6(2):146-55.
29. Bowen S, Chawla N, Marlatt GA. Mindfulness-based relapse prevention for addictive behaviors: A clinician's guide. Guilford Press. 2011.