Critical Reflection on the Intervention - Case Study Example

Critical Reflection on the Intervention and Feedback Sheets CRITICAL REFLECTION ON THE INTERVENTION AND FEEDBACK SHEETS Introduction Interest in mindfulness-based approaches to stress reduction research has increased over the last ten years, with more than one hundred randomized controlled trials reporting their findings during this period. This intervention proposal involved the adaptation of Kabat-zinn’s (2005) mindfulness-based stress reduction (MBSR) program, particularly its breathing observation and sitting meditation elements, for five international students as part of a support peer group. As group leader, the researcher led these students in conducting the two exercises in four one-hour sessions over one month. After the four sessions, the researcher will then ask the participants for feedback on the mental, emotional, and physical changes resulting from the intervention. Various studies have suggested the importance and benefits of incorporating mindfulness approaches into stress therapy interventions. However, the research studies have had mixed reviews in terms of MBSR’s ability to actually prevent stress, rather than only relieving symptoms of stress and improving quality of life (Aschbacher et al, 2014). As a result, the researcher found the need to investigate whether the MBSR approach, consisting of sitting meditation and breathing observation, was associated with beneficial reduction of psychological stress related to culture shock for international students. This paper seeks to critically reflect on the successes and weaknesses of the mindfulness-based stress reduction intervention. Effectiveness of MBSR Enhancement of Mindfulness Possibly the most important question in undertaking this intervention is how mindfulness can be improved or enhanced to reduce stress. While there are a number of disciplines used in the cultivation of mindfulness, majority of empirical research and theoretical writing has focused on breathing observation and mediation in developing mindfulness (Sibinga et al, 2011). Technically, sitting meditation in the context of this intervention proposal refers to self-regulation practices conducted in a sitting position focused on developing awareness and attention to make mental processes more controllable via voluntary means. In turn, this would be expected to foster general mental health and well-being, as well as the development of particular capacities like concentration, clarity, and calm. Breathing control refers to awareness of breathing by focusing on one’s breathing pattern, while observing their thoughts without paying too much attention to them, instead focusing on the breathing (Sibinga et al, 2011). In the context of this intervention proposal, this exercise is expected to help the students in calming their minds and concentrating better, which should reduce stress. Shapiro et al (2011) suggest that sitting meditation and breathing observation systematically cultivate mindfulness, although he notes that whether enhancement of mindfulness acts to reduce stress is another matter. Kabat-zinn (2005) proposes mindfulness as a way of paying attention without judgment on a specific purpose, moment-on-moment, through which the individual improves awareness of their body and mind. In this case, the sue of sitting meditation and breathing observation allows the individual to improve awareness of their bodily sensations, feelings, and thoughts sans self-criticism, in turn learning to accept their experiences as presented to them instead of seeking ideal experiences. Using the example of international university students as part of the intervention proposal, emotions and stress related to moving to a new country with a new culture should be regulated by the two mindfulness exercises. This would replace the tendency of such students to react to their new environment via previous conditioning and habits. In addition, there is increasing evidence that exercises that apply the individual’s attention to their surrounding environments build on the individual’s ability to focus on present emotions and sensations (Shapiro et al, 2011). Research into how meditation and breathing observation as part of the mindfulness approach work from the neural perspective has shown that its effects are exerted on the components of emotional regulation, body awareness, attention regulation, and changes in self-perception. Using neuro-imaging techniques, Baer et al (2012) suggest that mindfulness sitting meditation and other mindfulness practices are positively associated with alterations to the frontal-limbic network, temporal-parietal junction, insula, default mode network structures, and anterior cingulated cortex. Sitting meditation is identified to stimulate the mid pre-frontal cortex compared to other forms of meditation that stress concentration, which is associated with meta-cognition and self-observation, while also fostering particular attention-related mechanisms (Baer et al, 2012). From the literature, it emerges that advances in neurological technology are improving the ability to ascertain specific psychological and physiological outcomes of mindfulness approaches on psychological distress. These neuro-physiological findings should provide more in-depth, future interventions in treating issues related to mental disturbances due to changes in the environment. Benefits of Mindfulness Approaches to Stress Reduction There is increasingly strong evidence that sitting meditation and breathing observation, as part of MBSR approaches, helps in enhancing positive emotions and reduction of stress. Salmon et al (2011), for example, suggest that stress results in physiological and emotional changes in individuals as a way of increasing chances of their survival but that, however, the threats posed by modern society are different despite the body’s reaction mechanisms remaining the same. Such stress can portend a negative influence in the individual’s physical and mental well-being, happiness, and health. They find that mindfulness exercises particularly reduce negative, distracting, and ruminating behaviour and thoughts, especially breathing observation that reduces negative stimuli reactions and regulate emotions, while meditation is noted to reduce stress caused by mood disturbance (Salmon et al, 2011). Importantly, there has been some success in identifying the effect of mindfulness exercises in helping individuals re-assess issues that they consider stressors, after which they may re-label things initially considered stressors. This intervention proposal also proceeds on the basis of evidence that MBSR approaches have shown mood enhancing benefits. Dobkin et al (2012), for example, note that mindfulness approaches like breathing observation can enhance and sustain positive states of emotion, although, unlike in the case of this intervention proposal, it is suggested that the mindfulness exercises should be performed daily to improve positive emotions and self-perception, while decreasing stress symptoms. As a result, this is expected to be one of the intervention proposal’s major limitations since sitting meditation and breathing observation will only be conducted once a week. If successful, however, it is expected that the mindfulness exercises should enhance brain system functions, particularly by improving the brain region related to decreased anxiety and subsequent stress. In their randomised controlled study, Fjorback et al (2011) show that mindfulness exercises have a high correlation with increased performance of international students living and studying MBA degrees in foreign countries. Nevertheless, they also suggest that MBSR approaches could prove ineffective for students with more than two sources of stress, such as family, school, and personal life. Empirical Support for the Success of MBSR With research evidence about the positive influence of mindfulness on psychological distress continues to accumulate, these benefits can be categorized into three major dimensions, particularly in relation to stress therapy; intrapersonal, interpersonal, and affective benefits. Affective Benefits Robins et al (2012) argue that there is evidence of mindfulness helping to develop effective emotion brain regulation, theorising that sitting meditation will decrease rumination through disengagement from distressing cognitive activities, promotes meta-cognitive awareness, and enhances the individual’s attention capacities by enhancing working memory. In light of the current intervention proposal, such cognitive gains would be expected to significantly contribute to effective strategies for emotion regulation, in turn reducing psychological distress. In addition, awareness breathing also has a negative correlation with rumination, as well as a direct relationship with effective emotion regulation, which results in fewer depressive symptoms. Moreover, mindfulness exercises are also associated with decreased rumination in participants with stress, depression, and mood disorders (Robins et al, 2012). Mindfulness-based meditation and breathing awareness also lead to decreased negative anxiety effect and increased positive effect, which are linked to reduction of stress and other mood disorders. Mindfulness meditation has also been implicated in shifting the stressed person’s capacity to use strategies for emotion regulation, which allow for selective emotional experiences that could be differentially processed in the brain (Robins et al, 2012). Therefore, mindfulness awareness breathing and sitting meditation used in the intervention proposal are expected to minimise rumination, elicit positive emotions, and enables effective regulation of emotion, which are important aspects of stress development. Further, there is increasing evidence that mindfulness meditation, specifically, reduces people’s reaction to their environment, while also increasing their cognitive flexibility (Fjorback et al, 2011). This intervention proposal expects that the participants will develop self-observation skills, which will disengage their automatic pathways due to prior learning and allowing for new integration of moment input. This, in turn, should activate the individual’s adaptive response ability, especially when confronted by negative or stressful situations. People who conduct awareness breathing/breathing observation and sitting meditation tend to perform better in terms of self-reported mindfulness, as well as attention measures. Self-reported mindfulness as a result of sitting meditation and breathing observation are directly correlated with attention functioning and cognitive flexibility, which counter the causative factors of stress on the brain (Fjorback et al, 2011). Finally, the ability of mindfulness exercises to reduce emotional reactivity should help the participants in reducing psychological pressures and resultant stress. Interpersonal Benefits Various scholars and researchers have pursued the issue on whether mindfulness portends positive effects on interpersonal behaviour, which is significantly impacted by psychological distress and stress. Nyklíček et al (2013) address concepts like mindfulness-based relationship enhancement, mindful responding in couples, and mindful relating, indicating that mindfulness exercises like sitting meditation predict amount of empathy and conflict in interpersonal relationships, emotional communication skills, ability to constructively respond to stress in relationships, and relationship satisfaction. Applied to the intervention proposal, it would be expected that the mindfulness approach exercises used would enhance the participants’ ability to constructively respond to stress when related with other students in the university. It has also emerged that people with enhanced mindfulness traits tend to report less emotion related stress, especially when relating with other people, as well as the fact that they tend to enter stressful discussions with less anxiety and anger (Nyklíček et al, 2013). Evidently, mindfulness exercises, it may be argued, are directly related with awareness in stressful social situations, while being inversely correlated with stress and distress contagion. Therefore, empirical evidence used to support the intervention proposal shows that mindfulness exercises should at least reduce negative reactions to emotional stress in cultural conflicts that international students undergo. Moreover, the participants who undergo mindfulness exercises should have an enhanced capacity to express themselves in stressful social situations, while they are also more likely to be satisfied in their interactions with other students (Nyklíček et al, 2013). Intrapersonal Benefits On top of the interpersonal and affective successes that can be attributed to mindfulness exercises, such as sitting meditation and breathing observation, it has also been suggested that they enhance functions related to the brain’s mid pre-frontal lobe, including fear modulation, intuition, morality, and self-insight (Dobkin & Zhao, 2011). In addition, mindfulness exercises have been found to possess several health benefits, especially in relation to immune functioning. This should be viewed as important because stress leads to the release of the cortisol hormone, which, in turn, dampens the immune system. The use mindfulness exercises to boost the immune system, while not reducing stress, should help in reducing the effects of stress on the international student participants. Moreover, mindfulness exercise, especially breathing observation, has also been proved to reduce psychological distress and improving well-being. MacCoon et al (2012) specifically provide evidence of how mindfulness exercises like sitting meditation alter the functioning and physical structure of the brain, particularly through the process of neuro-plasticity, which involves brain re-wiring due to experience. Alterations in the structure of brain, which involve thickening of regions in the brain associated with sensory processing, attention, and internal stimuli sensitivity, as well as thickening of the brain stem and distinct concentrations of gray matter (MacCoon et al, 2012). In relation to the intervention proposal, these changes resulting from mindfulness exercises could result in immuno-reactive emotional benefits, as well as positive cognitive benefits. With time, it is widely expected that the states experienced by the intervention participants during mindfulness sitting meditation and breathing observation should eventually become traits. Therefore, the longer that the individual practices mindfulness exercises, it is more likely that they will benefit from the exercises’ effects. Mindfulness meditation also benefits individuals through increasing their processing speed, having fewer unrelated thoughts in relation to the situation at hand, and decreased task effort, which are significant predictors of stress (MacCoon et al, 2012). Particularly, increased distraction-management ability and attention skills due to mindfulness meditation should successfully enable the participants to manage stressful activities. Weaknesses of the Intervention There are several limitations to using the MBSR approach in this intervention proposal, which must be considered in designing the intervention and analysing its results. To begin with, the lack of active conditions to compare the experimental condition with, as well as the absence of solid, conclusive evidence that the mindfulness exercises preclude definitive statements concerning mindfulness’ contributions to the observed effects (Greeson et al, 2013). In this case, the intervention proposal cannot exclude the chance that the observed effects could be as a result of factors that are non-specific to the MBSR intervention, including group-related factors, the students being part of a credible program of stress treatment, or the fact that the students are getting attention. Moreover, the instruments and diagnostic procedures used in the intervention proposal may also not be adequate to ascertain that the stress is reduced as a result of the sitting meditation and breathing observation exercises of MBSR (Greeson et al, 2013). As such, it can be said that using a single assessor leads to preclusion of proper evaluation of the diagnostic procedure’s validity and reliability. Because the proposed intervention project has limited resources, this meant that the project cannot use diagnostic clinical interviews in order to examine any changes in the participants’ diagnostic status at follow-up and post-treatment. This may be considered as an unfortunate design flaw in the project, specifically because it runs the risk that the project will solely rely on measures of self-reporting (Kilpatrick et al, 2011). As a result, it is not possible to exclude the possibility of response biases, such as social desirability effects, in symptoms reporting by the participants. Moreover, it is important to note that with the exception of the self-report questionnaires that are used to measure psychological stress, diagnosis-specific questionnaire measures are absent to measure other diagnosis that could present in form of stress, such as panic disorder and social anxiety disorder (Kilpatrick et al, 2011). This could result in confounding variables in analysing the results of the participants’ self-report questionnaires as these disorders may be misunderstood as stress by the participants. The proposed intervention project’s reliance on general measures of psychological distress in assessing stress levels, in turn, may run the risk that the researcher will not detect alterations in the participants’ avoidance behaviours, particularly those displayed by people with social anxiety disorder and panic disorder (Gu et al, 2015). Thus, it is possible that the participants who take part in the proposed intervention project will feel less stressed as a result of the changes in the affective, somatic, cognitive symptoms of stress, while still experiencing substantial impairment as a result of continued avoidance of various stress-provoking conditions. Moreover, the absence of protocol adherence assessment could prove a weakness of this proposed intervention project. The lack of funding means that video recording the sitting meditation and breathing observation exercises in MBSR will not be possible and, thus, there is no opportunity for independent researchers to rate the intervention’s integrity, competence, and adherence (Gu et al, 2015). In addition, there is no independent therapist to ascertain the proposed MBSR intervention’s internal validity. Another consideration of the proposed intervention’s limitations is the inability of the intervention to assess the actual extent to which the participants adhered to the meditation and breathing observation exercises, as well as their application to mastering these techniques (Keng et al, 2012). In addition, the intervention does not have a way of identifying individual differences between the participants that could have influenced on their ability to master the sitting meditation and breathing observation techniques. The proposed intervention’s exploratory nature should also be noted, which means that the results of the findings should be cautiously analysed and interpreted and used for research in the future. Group differences of the participants at baseline may also pose a limitation to this intervention, especially since the participants may demonstrate significant differences in levels of mindfulness and stress (Keng et al, 2012). This could be as a result of self-selection bias, in which specific characteristics and traits may motivate some people to take part in interventions involving sitting meditation and breathing observation. Alternatively, participants who do not believe in meditation exercises could be representative of healthy samples and could only have been exhibiting stress symptoms as a result of evaluation apprehension, which is a response bias in which rating of self-report items is done on the basis of perceived social desirability as noted above (Keng et al, 2012). These possibilities are likely, especially where the participants consist of classmates and friends of the researcher and where the participants are actually students of psychology. Finally, using self-report scales to evaluate changes in meta-cognitive and affective processing could lead to complications, such as the presence of confounding variables and over-reporting where participants are required to rate experiences related to feelings and emotions (Keng et al, 2012). References Aschbacher, K., Saron, C., Gilbert, A., Arenander, J., & Epel, E. (2014). Effects of Early Adversity and Stress Vulnerability on Treatment Response to Mindfulness-Based Stress Reduction. The Journal of Alternative and Complementary Medicine, 20(5), 51-56 Baer, R. A., Carmody, J., & Hunsinger, M. (2012). Weekly Change in Mindfulness and Perceived Stress in a Mindfulness‐Based Stress Reduction Program. Journal of Clinical Psychology, 68(7), 755-765. Dobkin, P. L., Irving, J. A., & Amar, S. (2012). For whom may participation in a mindfulness-based stress reduction program be contraindicated? Mindfulness, 3(1), 44-50 Dobkin, P. L., & Zhao, Q. (2011). Increased mindfulness–The active component of the mindfulness-based stress reduction program? Complementary Therapies in Clinical Practice, 17(1), 22-27 Fjorback, L. O., Arendt, M., Ørnbøl, E., Fink, P., & Walach, H. (2011). Mindfulness‐Based Stress Reduction and Mindfulness‐Based Cognitive Therapy–a systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124(2), 102-119 Greeson, J., Suarez, E., Brantley, J., Carmody, D., Juberg, M., & Wolever, R. (2013). Can mindfulness-based stress reduction (MBSR) buffer stress reactivity and facilitate physiological recovery in healthy adults? Psychosomatic Medicine, 75(3), 2-3 Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive Therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical psychology review, 37, 1-12 Kabat-zinn, J. (2005). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Delta Paperback Keng, S. L., Smoski, M. J., Robins, C. J., Ekblad, A. G., & Brantley, J. G. (2012). Mechanisms of change in mindfulness-based stress reduction: Self-compassion and mindfulness as mediators of intervention outcomes. Journal of Cognitive Psychotherapy, 26(3), 270-280 Kilpatrick, L. A., Suyenobu, B. Y., Smith, S. R., Bueller, J. A., Goodman, T., Creswell, J. D., ... & Naliboff, B. D. (2011). Impact of mindfulness-based stress reduction training on intrinsic brain connectivity. Neuroimage, 56(1), 290-298 MacCoon, D. G., Imel, Z. E., Rosenkranz, M. A., Sheftel, J. G., Weng, H. Y., Sullivan, J. C., & Lutz, A. (2012). The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR). Behaviour research and therapy, 50(1), 3-12 Nyklíček, I., Mommersteeg, P., Van Beugen, S., Ramakers, C., & Van Boxtel, G. J. (2013). Mindfulness-based stress reduction and physiological activity during acute stress: A randomized controlled trial. Health Psychology, 32(10), 1110 Robins, C. J., Keng, S. L., Ekblad, A. G., & Brantley, J. G. (2012). Effects of mindfulness‐based stress reduction on emotional experience and expression: a randomized controlled trial. Journal of clinical psychology, 68(1), 117-131 Salmon, P. G., Sephton, S. E., & Dreeben, S. J. (2011). Mindfulness‐Based Stress Reduction. Acceptance and mindfulness in cognitive behaviour therapy: Understanding and applying the new therapies, 132-163 Shapiro, S. L., Brown, K. W., Thoresen, C., & Plante, T. G. (2011). The moderation of Mindfulness‐based stress reduction effects by trait mindfulness: Results from a randomized controlled trial. Journal of clinical psychology, 67(3), 267-277 Sibinga, E. M., Kerrigan, D., Stewart, M., Johnson, K., Magyari, T., & Ellen, J. M. (2011). Mindfulness-based stress reduction for urban youth. The Journal of Alternative and Complementary Medicine, 17(3), 213-218 Appendix 6: Post Practice Questionnaire Feedback Sheet 1 1. What are your experiences of this program? Physical Changes After completing this program, I feel that I am able to return to a relaxed, calm state after daily stress has already passed, especially immediately after the exercise sessions. In addition, I have better quality sleep and I am now take deep, slower breaths in stressful situations. Emotional Changes Although I cannot be entirely sure if these are long-term effects, I feel that the program has helped enhanced my ability to detach emotions related to actions from the specific actions. Mental Changes I believe it is this aspect that has been changed the most, especially since I feel able to communicate with myself by understanding my thought process, as well as having more control over what I am thinking about. 2. What do you like about this program? What I liked most about the program is that it has made me aware of my ability to take the smooth with the rough, especially as I come to grips with the new environment. My life has been full of distractions with so much information to absorb from different directions, which has made me suspect that I might be stressed. I really needed an avenue to help me cope with my new life and its stresses and the mindfulness approach has taught me the importance of being aware of my surroundings, physical sensations, and thoughts. I really like that it has awakened me to the positive things in my new environment. 3. What are the challenges that you have during the practice of this program? I did not come across major challenges and my experience was really pleasurable. However, if I had to pick one, I would say that meditation did not turn out to be as simple as it looked. Despite the instructions to use as little concentration and effort as possible during meditation, I can think of numerous activities that need less concentration and effort. Sustaining this absence of concentration and effort was also challenging. Possibly the most significant challenge for me was extending mindfulness to my everyday life. While I eventually found it easy to be mindful when doing sitting meditation and breathing observation, it was more difficult when I joined my friends. 4. What improvements or changes would you suggest to the program? Possibly the only improvement I can suggest for your program is to increase the frequency of the exercise sessions, which would help in making the exercises more of my culture and practice. Feedback Sheet 2 1. What are your experiences of this program? Physical Changes The sitting meditation exercise really helped me in enhancing my range of motion and flexibility, while the breathing observation exercise has helped me control my breathing whenever I feel stressed. In addition, my heart rate has decreased slightly, which I think is a good thing. Emotional Changes By the third session, I was surprised to find that my negative emotions had reduced somewhat, especially when confronted by inconsiderate remarks from other students. I am now able to focus more on the present by increasing my self-awareness through the sitting meditation exercises. Mental Changes My mood has dramatically increased during the last few weeks, which I believe is the result of these exercises. I now know that trying to concentrate on issues that are not under my control will lead to negative mood and stress, which I have not been doing over the past few weeks. 2. What do you like about this program? I have noticed an increased capacity to increase focus on the present, as well as increased awareness of what is going on around me from moment to moment. This is what I like most about this program, the opportunity to learn how I can control my attention to become more present oriented. The breathing exercises were also a nice surprise for me since I am asthmatic, and I believe the exercise may help somehow. 3. What are the challenges that you have during the practice of this program? The biggest challenge I had was in relation to problems with my thoughts during meditation, where it was difficult to keep other thoughts and out and to quiet my mind as instructed during the sitting meditation. I also struggled with restlessness in the first two sessions, during which I began to think of other things like my class work and parents back home. Finally, I also found the posture initially uncomfortable, which made it difficult to relax. 4. What improvements or changes would you suggest to the program? I would suggest that as the program continues, a better environment should be identified because there were a number of interruptions during the exercises. Maybe other participants should also be instructed to be on time and not to take bathroom breaks during the exercise. I found that this made it difficult to increase my awareness during the breathing observation exercise. Feedback Sheet 3 1. What are your experiences of this program? Physical Changes Physically, I feel that I have fewer headaches, tension, and insomnia in the evenings, particularly after the exercises. In addition, my energy levels tended to improve after the sessions, while my heart rate has also slightly reduced and I feel less anxious most of the time. Emotional Changes My emotions are more harmonious and steady and whereas new experiences would immediately make me feel overwhelmed and unstable, I am now maintaining emotional composure for a longer time compared to before. I also have less negative emotions even when I do not agree with something, which has come about during the program. Mental Changes Generally, I would say that I am less anxious most of the time over the past few weeks, while my friends have commented on more than one occasion that I look happy. Moreover, I have gained peace of mind and more focus on the positive occurrences around me. 2. What do you like about this program? I really like how this program has helped me to feel more in charge of my life and in control of my reactions to stressful situations. Indeed, while I am not sure the program has had much of an impact on my happiness as noted above, I like how the program has shown me a way to be more satisfied with my life. The sitting meditation while observing my breath exercise has been a pleasure for me after a long week in the university as well. 3. What are the challenges that you have during the practice of this program? Possibly the biggest challenge in this program was making time to attend the sessions, especially since schoolwork has increased over the past one month. Away from my personal issues, I found the program challenging in the sense that I was uncomfortable during the sitting meditation, which meant it was difficult to relax as per your instructions. In addition, I also found it challenging to relax due to the frequent interruptions and one of the participants always came late, which made it difficult to sustain my mindfulness. 4. What improvements or changes would you suggest to the program? I think that the program is wonderful and should continue and if I had to suggest any improvements, it would be scheduling of the program in the morning before I embarked on schoolwork. Feedback Sheet 4 1. What are your experiences of this program? Physical Changes As the exercise sessions have proceeded, I have a deeper sense of relaxation, especially in the evening, while my heart rate also tends to be lower after the exercises. In addition, my breathing seems more even and my energy levels have increased significantly. Emotional Changes In the last few weeks, I am less anxious most of the time, tend to worry less especially about my interactions with others, and I am also able to stay calmer in confrontational situations than I was before. Moreover, I am no longer moody all the time, while my nervousness in the classroom has decreased. Mental Changes I would say that my self-confidence has increased in the classroom setting especially when I concentrate on breathing observation techniques taught in the program. Also, my concentration and learning ability have improved slightly, while my sense of well-being has improved markedly. 2. What do you like about this program? I would say that the social benefits that this program promises are the most likeable thing about it, especially in terms of improving my focus by helping me to avoid distractions and improve attention skills. In addition, I also like that the program promises to enhance my interpersonal relationships as I am still making friends in the university. The fact that these exercises should improve my feelings of optimism about others, as well as my relaxation around them, is another aspect of this program that I really like. 3. What are the challenges that you have during the practice of this program? I feel that there were too many distractions, which has proved a major challenge in my attempts to enhance my mindfulness through the breathing observation exercise. Distractions from outside noise and interruptions have distracted me almost every session. Moreover, it has been challenging to forget my previous thoughts, especially during the first session, although this became less of a problem later. Finally, issues with scheduling of the program that clashed with other activities almost made me drop out. 4. What improvements or changes would you suggest to the program? I would make a suggestion that the scheduling of the program’s sessions should ensure that the participants are able to attend easily. In addition, the setting of the program could be moved to a more secluded area of the university to avoid interruptions and distractions. Read More