Asthma, a pulmonary condition, is a chronic respiratory disorder typified by persistent underlying inflammation of tissues, airway obstruction, congestion, hyperresponsive airways, and the narrowing of smooth airway muscle. Asthma is one of the most common chronic medical conditions in children and is the leading cause of school absenteeism. This chapter describes childhood asthma, including its causes and triggers. It elucidates the extant research supporting treatment of the disorder and provides step-by-step empirically based interventions to ameliorate asthmatic symptomatology in children. The psychological underpinnings of asthma have been investigated in the field of psycho-neuroimmunology (PNI), which examines the interplay of the central nervous system, neuroendocrine, and immune system with psychological variables and their relation to physical health. Researchers have shown that relaxation and guided imagery (RGI), written emotional expression, yoga, and mindfulness therapy improve pulmonary lung functioning, decrease rates of absenteeism, and improve overall quality of life.

The primary purpose of Module 3 of the MAC program is the understanding and exploration of values as a central orienting concept. In the context of understanding the important role of values in enhanced performance and quality of life, the functional and dysfunctional role of emotions is also considered. This chapter suggests to clients that their personal values will be the anchor point for all behavioral decisions that need to be made in the course of enhancing performance and achieving goals. The concepts of mindful awareness, mindful attention, and cognitive fusion and cognitive defusion become integrated with the concept of values-directed versus emotion-directed behavior. The Relevant Mindful Activity Exercise is intended to connect the mindfulness concept to a relevant performance situation in the client’s life. The question of personal values is particularly salient when confronted by the variety of emotions and internal rules that client confronts on a daily basis.

This chapter presents the theoretical and empirical rationale for the development of an innovative intervention for the enhancement of performance. The mindfulness-acceptance-commitment (MAC) approach to performance enhancement is based on an integration of mindfulness and acceptance-based approaches and is specifically tailored for high-performing clientele. The predominant psychological approaches have emphasized the development of self-control of internal states such as thoughts, emotions, and physical sensations and have been commonly referred to as psychological skills training (PST) procedures. The self-regulatory PST procedures most often discussed are goal-setting, imagery/mental rehearsal, arousal control, self-talk modification, and precompetitive routines. The efficacy of psychological skills training techniques and procedures for performance enhancement has been most carefully evaluated within the context of athletic performance enhancement. Mindfulness can be seen as the process that promotes greater awareness of internal experiences and the defusion of one’s thoughts, emotions, and bodily sensations.

This chapter describes a systematic approach to intervention planning in performance psychology. It presents a case formulation method for a comprehensive understanding of the client, and an appropriate multilevel classification system for sport psychology (MCS-SP) classification that subsequently either guides the proper delivery of the mindfulness-acceptance-commitment (MAC) program or leads to the determination that the performer’s needs are beyond the scope of the MAC program. The MCS-SP categorizes the issues and barriers facing the performer into four classifications: performance development (PD), performance dysfunction (Pdy), performance impairment (PI), and performance termination (PT). In the case formulation method suggested in the chapter, the practitioner’s first goal is to conceptualize performance needs and barriers based on the information systematically collected during the assessment process.

Beginning with Module 5 of the mindfulness-acceptance-commitment (MAC) protocol, this chapter seeks to enhance the client’s commitment to attaining performance-related values through the activation of specific values-directed behaviors. In this portion of MAC, the intent is to help clients distinguish between goals and values and explicate specific behaviors that will optimize what really matters to them in their individual performance domain. The chapter reviews the role that emotion plays as a barrier against necessary performance behaviors and, conversely, the concept of poise as a necessary ingredient in optimal performance. It identifies specific behaviors that, if engaged in regularly and consistently, are likely to result in enhanced performance. In Module 5, the consultant continues to help the client move ever closer to mindful engagement in competition by focusing more heavily on mindfulness practice.

This chapter presents an overview of the issues and challenges that confront the consultant when utilizing the mindfulness-acceptance-commitment (MAC) in a group or team setting, and how these issues were reflected with the lacrosse team. The stated goal of the MAC program was to promote enhanced performance through the development of greater poise and concentration. One of the challenges to engaging in an experientially intensive program like the MAC is ensuring that all participants are both completing and receiving maximum benefit from their between-session forms and exercises. Given the central place of mindfulness exercises in the MAC program, it is particularly important that sufficient time is allotted for in-session mindfulness practice. Prior to beginning the group program, the consultant can recommend to clients with performance dysfunction (Pdy) that they not join the group, but instead engage only in individual sessions.

The primary purpose of Module 4 of the MAC protocol is the development of an understanding of the costs associated with experiential avoidance. This chapter highlights the contrasting benefits of experiential acceptance in pursuing performance desires within the context of a values-based life. The essential goal of the MAC program is to convey the idea that emotions are not the enemy of effective performance, but rather it is the things that people do to eliminate or otherwise control emotions that are counterproductive to high-level performance states. A consultant and client explore the workability of the client’s past efforts to control negative thoughts, emotions, and bodily sensations. Mindfulness exercises should be used as a means of enhancing the capacity to observe and describe internal processes and external events. The chapter concludes with a discussion on the issue of the consultant’s comfort with and understanding of the basic acceptance model.

The primary intent of mindfulness-acceptance-commitment (MAC) Module 2 is an expanded introduction to the importance of mindful awareness and mindful attention in promoting behavior change in general and enhanced performance in particular. This chapter suggests that Module 2 and all subsequent modules begin with the ‘Brief Centering Exercise’. During Module 2, the practitioner describes mindfulness as a process and points out that mindfulness exercises are a means to develop specific skills of self-regulated attention, cognitive defusion, and personal awareness. The primary means of promoting self-awareness throughout the MAC program is the during- and between-session use of a variety of mindfulness exercises intended to enhance awareness of internal and external events and enhance the self-regulation of attention. One of the key elements to the successful completion of the MAC protocol is adherence to the between-session exercises.

By the final mindfulness-acceptance-commitment (MAC) module, clients should be regularly engaged in exercises to promote MAC skills that are central to optimal human performance. These skills include: mindfulness, acceptance and commitment. The overarching purpose of Module 7 is to prepare the client for the completion of the MAC program by stressing the lifelong nature of these skills and exercises. When reviewing the entire MAC program, this chapter suggests that the consultant begin with a review of the initial stated purpose for the client’s participation in the program, including a discussion of the performance-related issues and goals that existed at the time the MAC program was initiated. The chapter presents the relationship between the formal consultant-guided MAC program and the less formal, self-guided MAC program. Prior to the completion of the MAC protocol, the chapter also suggests that the consultant discuss the unbreakable link between self-reflection and self-correction.