Alternative treatments for ADHD and ADD, Mindful awareness
By Dr. Lidia Zylowska, MD, Los Angeles psychiatrist
What is Mindful Awareness?
Mindful awareness is a type of mental training developed from long-standing meditation practices. It involves intentionally bringing attention, with an attitude of curiosity and openness, to the present moment (for example, paying attention to one’s breath, body sensations, thoughts, feelings or sounds in the room).
Attention directed in a non-judgmental manner expands our awareness of what is happening inside or outside of us on a moment by moment basis. Ultimately, mindful awareness leads to enhanced self-awareness and a realization of what can be changed about our thinking, our reactions or our behavior in order to have more positive lives.
In particular, individuals with ADHD learn to observe ADHD symptoms non-judgmentally with self-compassion and at the same time work to change what can be changed. Such practice can lead to a greater ability for focus, self-direction, personal growth, and an improved mood.
What is the philosophy behind the use of Mindful Awareness?
We all have the capacity to observe and learn how our mind behaves and how it interacts with our body and our actions. This observation is enhanced when we pay attention to the present moment with openness and without being judgmental. Since many psychological and physical problems (including ADHD) are influenced by the interaction between mind, body and behavior, by investing in this type of training, we can transform our difficulties and develop more ability to correct them.
How is Mindful Awareness used to treat ADHD?
Mindful awareness, either alone or in combination with other tools such as medication, therapy, diet and life style change, can help ADHD in a number of ways.
First, the practice increases awareness of when attention shifts and teaches individuals to redirect their attention to the present moment. In this way, mindful awareness helps us to catch ourselves when distraction happens and focus on what we intended to focus on.
Second, we learn to notice when we are in the automatic pilot mode or when we are doing things out of habit, without being fully aware of what we are doing. The automatic pilot happens whenever we get absent-minded or preoccupied with our thinking, stressed, or in the midst of intense emotions. When on autopilot, we often do things without awareness and do not realize that there may be better ways of approaching a situation.
Many ADHD symptoms happen automatically or out of habit, for example, daydreaming, interrupting, procrastinating, or fidgeting. Arguing and impulsivity are other examples of being on automatic pilot. Many difficulties related to poor executive function such as jumping around in a conversation, starting and not finishing things, or being disorganized, often arise out of lack of awareness. Mindful awareness improves the ability to notice when such automatic ADHD-related patterns arise and creates the opportunity to choose to do things differently
In other words, by stepping out of automatic pilot, we learn to exercise better self-regulation and manage the ADHD symptoms more effectively.
Third, mindful awareness is an effective way to balance emotions. Those with ADHD can have difficulty with emotional ups and downs, anger, and impulsive reacting. Mindful awareness helps us to notice our experience, including feelings and associated body sensations, and to form a witnessing perspective. It allows us to become aware of our emotions without being flooded or driven by them or pushing them away. In this way we learn not to overreact, avoid painful feelings or become overly connected to our feelings.
How often should Mindful Awareness activities be used?
In training, two types of mindfulness practice are used: formal and informal. Formal practice entails intentionally setting aside some time for meditation (this can be done from few minutes to more than an hour). Informal practice involves remembering to bring attention to the present moment many times throughout your day, in the midst of working, playing or interacting with others.
What are the effects of Mindful Awareness?
Recent neuroimaging research suggests that meditation can impact the areas of the brain important for attention and emotional regulation. For example, individuals who have meditated long-term show enhanced functions in the prefrontal cortex, an area of the brain also important in ADHD.
Mindful awareness has been increasingly used as a tool to foster wellness, especially psychological well-being. Research studies have shown that it can help lower chronic stress and pain and reduce vulnerability to anxiety, depression, and addictions. Studies also show that it can also lead to a more balanced mood, improved impulse control, a greater sense of well being, and increased self-compassion and empathy for others. All these effects can benefit someone with ADHD since high stress, mood problems, anxiety, impulsivity, relationship problems, and risk for addiction are unfortunately common with ADHD.
What evidence is available that Mindful Awareness is effective in treating ADHD?
Through my personal experience with mindfulness, I came to appreciate it as an important tool for attention and emotional wellness. As a psychiatrist I wanted to use this approach for adults with ADHD. At UCLA, I led the development of the Mindful Awareness Practices (MAPs) for ADHD program which was tested with a group of adults and teens with ADHD.
In our study we found that after eight weeks of training, many participants performed better on several attention and cognitive tests and reported less symptoms of ADHD, anxiety, depression and stress. Three months after the training, many participants continued to report improvements in their ADHD symptoms.
Further research with different groups of adults, teens and children with ADHD is needed to confirm these findings, but our study, along with related mindfulness research, points to mindfulness awareness as a valuable tool in treating ADHD.
How/where can I or my child learn Mindful Awareness practices?
There are many ways to learn mindfulness. If you are an adult, you can start on your own by reading books, listening to CDs or attending a workshop or a class.
I recommend signing up for a class or a workshop so you can get the benefit of hearing other participants’ experiences with this approach. In the LA area, the UCLA Mindful Awareness Research Center offers several classes.
There are also other local resources where individuals can learn mindful awareness practices such as InsightLA or Mindfulness-based Stress Reduction Los Angeles.
In my private practice I often work with adults with AD/HD and I recently put together a CD titled Mindful Solutions for ADHD. The CD draws from the experience of the MAPs for ADHD study and my clinical work.
Also, for those who can’t travel to the West LA area, my colleague Mark Bertin (a developmental pediatrician who works with many parents of AD/HD children) and I will be offering an on-line workshop and an on-line six-week MAPs for ADHD class. For more information please visit my website.
In teaching children mindfulness, I believe that parents are natural teachers. Therefore, if parents invest in mindfulness training for themselves, they can model it for their child. There are also programs or CDs that have been developed to teach mindfulness directly to children. A good resource is a book by Susan Kaiser Greenland titled The Mindful Child.
Basic mindfulness exercise: Breath Awareness
Bringing attention to your breath is the most basic and fundamental mediation. The breath is always in the present (ponder that for a moment!) so it is a great place to focus when our thoughts take us elsewhere. By noticing the breath (or catching self when lost in thinking and gently returning to the breath), one can induce relaxation, train attention/awareness, and increases the ability to step out of the automatic pilot mode. It is also a great way to connect with our body and regulate our emotions. Innately, whenever someone seems overwhelmed, anxious, or over reacting, we often say, “take a deep breath.”
Let’s do a quick exercise. As you are reading this, can you become aware of your breath? Do you notice any rising of your chest or your belly during the in-breath? How about noticing the falling of your chest or your belly during the out-breath? How about the pause between the in- and the out-breath? It may be helpful to place your hand on your belly to feel the sensations of the breath movement.
As you do this exercise, when you catch yourself thinking about something else such as becoming distracted, bored or judging your experience, notice that tendency, and then let go and gently return to your breath. With curiosity, notice the process of observing the breath in and out and what happens to your awareness. Practice this for a few minutes and see what happens for you during this process.
Lidia Zylowska, M.D. is a board-certified psychiatrist focusing on mindfulness-based interventions in mental health and on adult ADHD. She completed a fellowship at the UCLA Center for East-West Medicine and in 2003, was awarded the UCLA Robert Wood Johnson Clinical Scholars Program Fel¬lowship during which she led the study of the Mindful Awareness Program (MAP) for ADHD: A meditation-based training in self-regulation. Dr. Zylowska is one of the co-founders and a faculty member at the UCLA Mindful Awareness Research Cen¬ter (MARC). She has a private practice in West Los Angeles for adults with AD/HD and uses mindfulness in her treat¬ment. Dr. Zylowska periodically offers on-line workshops related to mindfulness and ADHD, and her CD “Mindfulness for Adult ADD/ADHD” will be released in Fall 2009. For more details including an overview of the initial MAP for ADHD eight-week training, please visit Dr. Zylowska’s website.