The MBCAS program is based on the MBSR, Mindfulness-Based Cognitive Therapy (MBCT; Segal et al. 2002) and Mindfulness-Based Relapse Prevention (MBRP; Bowen et al. 2011) programs. It is designed for seniors, defined as people 65 years or older, who are healthy or mostly healthy. Its main objectives are to teach them to (a) observe current experiences with nonjudgmental awareness, (b) identify automatic behaviors or reactions to current experiences that are potentially nonadaptive, and (c) enhance and reinforce positive coping with typical difficulties that they face in their daily lives. An experienced mindfulness instructor teaches the MBCAS program.
Aims
MBCAS shares the following aims with other mindfulness-based programs, such as MBSR, MBCT, or MBRP: (a) to stimulate awareness of automatic responses; (b) to exercise self-observation of mental and emotional events which trigger automatic reactions; (c) to encourage more adaptive responses, as an alternative to automatic reactions; and (d) to develop acceptance of and compassion toward one's own internal and external events. In addition, MBCAS includes specific objectives for seniors, including (a) to stimulate verbal skills related to the consciousness of inner experiences; (b) to move mindfully in the context of one's physical limitations; (c) to experience feelings of losing control, without nurturing other thoughts such as the risk of losing autonomy; (d) to disentangle oneself from negative thoughts specific to aged people (e.g., “I'm too old to change,” “It's normal to feel sad when you get old”) (Tison and Hautekeete 2001); and (e) to enhance and reinforce positive coping with typical difficulties that seniors have to deal with in their daily life (e.g., health problems with irreversible physical consequences, psychosocial limitations such as being unable to drive, or the death of peers).
Course Duration
The MBCAS program is provided in eight monthly sessions and seven intermediate practice sessions. This is unlike the other mindfulness-based interventions, which are presented in eight weekly sessions. The rationale and reasons for this unusual duration are the following: (a) the underpinning of the program is self-development of seniors and this takes time—a lot more time, given their age and potential for decreasing cognitive abilities; (b) healthy seniors are generally not eager to follow an intensive 8-week program because there is no clinical urgency; (c) healthy seniors have a need to feel competent and thus are not eager to be closely guided; (d) healthy seniors have a need to exercise and explore new learning within their own rhythm of life and a longer intervention period gives more time to practice alone, with regular guidance and group meetings; (e) a longer intervention period provides more opportunities to engage in meditation practice under “real-life conditions” and permits the ritualization of the practice; and (f) with a more relaxed training pace and an enhanced opportunity to really practice, the instructor becomes less important than the participant's experience.
The temporal design of MBCAS is a monthly 2-h session in a closed group, followed 2 weeks later by a 1-h practice session, in an open group that includes current participants, seniors who previously attended the program, students, and academic colleagues. While the number of group sessions, training hours, and cost are similar to other standard mindfulness-based interventions, the opportunities for individual practice during the MBCAS program are four times greater. It would be interesting to assess whether the regularity of daily practice and attendance at the monthly sessions are affected by this particular temporal design.
Structure
MBCAS uses group training, a format well suited to seniors. As many seniors live alone at home, group training provides an opportunity for social interaction in the local community. The format enables the acquisition of new behaviors through observational learning and modeling what has worked for other group members (Bandura 1977). Furthermore, it provides opportunities for sharing experiences and additional insights from group members, and the motivation to not only participate consistently but also take the training to the next level.
The mindfulness training was conceived as a group process, where participants and instructors meet regularly to learn and practice. The core of any mindfulness program takes place during these practice sessions, where each participant exercises the connection to his or her inner world at the same time as others practicing in the same room, and sharing with others, moment-by-moment. Thus, each participant could report on his or her unique inner experience, which has been knitted with the shared common moment (e.g., the bird song that some have heard and appreciated, while some have not, or a participant's cough). Moreover, people are generally seated in a circle, which enables subtle and inherent information to pass within the group: “When one sits in a circle with others, everyone is equal and linked… Because everyone is interrelated and derives meaning through the relationship of the circle, each person's vision is transformed as the circle takes form” (Murdock 1990, pp. 180–181). The communication process turns from one to another, with the instructor becoming no more important than any other participant.
This group process provides a unique way of learning about “inter-being,” a major pillar of any mindfulness-based program (Hanh 2009). The concept of inter-being is a concise formulation of the doctrine of dependent co-arising—that there is no independent self and all things arise in dependence upon multiple causes and conditions—as explicated in the paticcasamuppada-vibhanga Sutta (Dalai Lama 1992). This linking process—the inter-being—stimulates relationships with others and goes beyond the duality of “I” and “others.” This non-dual exploration is fundamental in any mindfulness-based intervention.
Contents
The topics covered in the eight monthly sessions included: (1) Who controls my life: my habits or my consciousness? (2) How does my mind work? (3) Breathing as an anchor to the present moment. (4) Developing awareness of my moods. (5) Dealing with uncomfortable situations. (6) How about my future? (7) What can I do: adapt or resist? and (8) Taking care of myself, day after day.
To develop the participant's mindfulness, two kinds of exercises were used: (a) focusing on something specific during meditation, an excellent training to reduce distraction and loss of focus and to increase concentration, and (b) simply “being,” that is, without selecting or avoiding anything that could emerge during a meditation session, which is standard training for cultivating presence and openness moment-by-moment. The progression of the exercises starts with the very tangible bodily sensations and moves toward the less tangible inner experiences (i.e., the observation of one's thoughts and emotions). The meditation and cognitive exercises in MBCAS are similar to those used in other programs but adapted to the needs of the seniors. At the end of each session, the participants receive audio CDs, written material, and home practice exercises.
The basis of mindfulness practice is to cultivate disidentification from one's experience of internal events. For example, the participants are taught, “I am not what I feel or think,” in order to understand that feeling anxious or having negative ideas at one moment does not mean that they are that inner feeling or thought. They learn to observe their thoughts, feelings, and emotions as transient events that pass through their mind but to not hold on to them as being true or descriptive of them (Allen et al. 2009). To reinforce this decentering process (i.e., not believing all of our thoughts), MBCAS enables the participants to learn to establish new relationships with their thoughts, feelings, and emotions, through various exercises. In order to foster the learning of the decentering process, the MBCAS program includes experimenting with the feeling of losing control. Thus, seniors explore their automatic reactions during short experimental situations, where they meet the fear of losing control. For seniors who have tried to master their moods for years and who worry about aging and loss of autonomy, the perspective of developing a new relationship with themselves is deeply touching and hopeful.
As in the other mindfulness-based programs that stimulate body consciousness, MBCAS incorporates mindful movements in various postures and walking exercises. This component is particularly important in the context of aging and often aching bodies, where movements may be affected by arthritic pains or other physical limitations. Participants learn eight adapted movements, in both sitting and standing positions. The objective is to awaken the consciousness of the upper body by gently mobilizing the joints. These movements may stimulate and possibly strengthen muscle tone as well as balance when in a standing position (upper body mobility, motor coordination of hands, and balance on each foot). The MBCAS program provides the opportunity to be more mindful of upper body tensions and movements, allowing better understanding of one's bodily sensations. The participants are invited to practice all eight movements every day.
The walking exercise permits rediscovering a certain quality of openness to and acceptance of the present moment. Participants are encouraged to explore walking at various speeds in order to rediscover their safe balance. They may also try the walking exercise with a small rice bag on top of their head, to practice the feeling of having or losing control, and cultivate their kinesthetic sense of verticality. Even though it is not an objective per se, in time, practicing conscious verticality stimulates deep musculature and frees the head. This results in an enhanced physical presence that inspires dignity.