Mindfulness and Experiential Learning
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“Non-judgment, in mindfulness theory, is accepting the current state as part of a constant flow of changing experiences. This paradigm suggests that letting go of judgment strengthens the mind, and it challenges the illusion that over-thinking something gives one control over it.” Mindfulness and Experiential Learning By Bauback Yeganeh Over the last forty years researchers from and medicine. Empirical studies are now and David Kolb many different theoretical perspectives finding statistical support for what many have discovered that individuals develop have known for two millennia: that practic- consistent, routinized approaches to learn- ing mindfulness enhances mental and ing called learning styles (Sims and Sims physical health, creativity, and contextual 2006). Of the models that have emerged, learning. In a world of flux and rapidity, Experiential Learning Theory (ELT) has living mindlessly can result in a host of largely influenced leadership and organiza- problems including but not limited to: tun- tion development. The experiential learn- nel vision, increased stress, reduced physi- ing cycle is one of the most well-known cal health, reduced creativity, and difficulty illustrations in management education and navigating complex systems. As our sister has become the key theoretical model to fields of psychology and social psychology express the nature of experiential learning grow mindfulness research and practices, (Cunningham, 1994). our field must as well. In this article we Experiential learning theory also forms explore and discuss mindfulness as a tool some of the basis for notions of the learn- to assist learners in unlocking their full ing organization (Vince, 1998; Casey, 1993; learning potential in organizations. Senge, 1990). Furthermore, organizational research and practice supports the premise Mindfulness that when learning is defined holistically as the basic process of human adaptation, So what exactly is mindfulness? Any it subsumes more specialized managerial construct that has existed for thousands processes such as entrepreneurial learning, of years has many definitions. We would strategy formulation, creativity, problem like to offer two of the most widely solving, decision- accepted descriptions of mindfulness. In making, and leadership. our research with Darren Good at Case Learning styles are used to make sense Western Reserve University, we found of the world and adapt to it. But what hap- two predominant streams of mindfulness pens when learners over-routinize their research and practice, meditative mind- learning styles? Are they missing oppor- fulness and socio-cognitive mindfulness tunities to reach their learning potentials? (Good & Yeganeh, 2006; Yeganeh, 2008). This article discusses how mindfulness techniques can enhance experiential Meditative Mindfulness. Although it is learning and provides tools for practice in widely used as part of a secular mindful- organizations. Mindfulness is an age old ness practice, mindfulness is the core of practice used to overcome the tendency to Buddhist meditation (Kabat Zinn, 1994). “sleep walk” repetitively through our lives. Thich Nhat Hanh, Gunaratana, Kabat- In recent times it has been accepted into Zinn, and other present day authors mainstream psychology, social psychology, advocate developing mindfulness through Mindfulness and Experiential Learning 13
Figure 1: Meditative and Socio-Cognitive Mindfulness/Mindlessness Comparison meditation techniques to help people heal which is described themselves and live intentionally. A dis- as automatic tinction of meditative mindfulness is that behavior. When it requires a discipline of anchoring the mindless, “we act mind in the present moment. This is often like automatons accompanied with a practice of aware- who have been ness and acceptance through breathing. programmed to act Kabat-Zinn (1994) defines mindfulness according to the as “paying attention in a particular way: sense our behavior on purpose, in the present moment, and made in the past, non-judgmentally” (p.4). Non-judgment, rather than the 5. in mindfulness theory, is accepting the present.” (Langer current state as part of a constant flow of & Moldoveanu, changing experiences. This paradigm sug- 2000, p.2). Mindfulness from the socio- cognitive mindfulness deemphasizes medi- gests that letting go of judgment strength- cognitive perspective requires broadening tation, suggesting supplemental practices ens the mind, and it challenges the illusion one’s repertoire of cognitive categories. such as placing a value on doubt, looking that over-thinking something gives one The idea of creating new categories was for disconfirming data, and producing control over it. Authors who discuss mind- influenced by Langer’s earlier studies in new ways of thinking and acting. Each of fulness within these parameters also talk bias and prejudice. Explaining the practical these approaches offer research streams about the antithesis of mindfulness which benefits she illustrates that “If we describe in which a person’s degree of mindfulness is mindlessness, or a state of autopilot and someone we dislike intensely, a single is measured through statistically vali- lack of intention. Are you aware of your statement usually does it. But if, instead, dated self-report assessments. Meditative breathing right now? Try some deep calm we are forced to describe the person in mindfulness is often measured by Brown & breaths from the diaphragm prior to read- great detail, eventually there will be some Ryan’s Mindful Attention Awareness Scale ing on. Try practicing acceptance of what- quality we appreciate” (Langer, 1989, (MAAS) (Brown & Ryan, 2003) and socio- ever you are experiencing in the moment p.66). One of the reasons Langer’s work is cognitive mindfulness is measured by the by letting go of evaluation and judgment. so compelling is that it thoroughly sup- Langer Mindfulness Scale (LMS) (Bodner, ports the notion that simple labels (e.g., 2000). A factor analyses (Yeganeh, 2006) Socio-cognitive mindfulness. Developed good and evil) do not accurately reflect the of these two scales completed by 314 par- by social psychologists, this understand- complexity of the world. Instead they allow ticipants confirmed multiple and unique ing of mindfulness emphasizes cognitive for mindless rationalizations that justify dimensions to mindfulness. Our research categorization, context and situational a broad range of dysfunctional behaviors, supports the following multi-dimensional awareness (Langer 1997; Langer, 2000). from ineffective to criminal. Are you aware definition of mindfulness: Harvard social psychologist Ellen Langer, of how you are sorting and labeling what often relates mindfulness to learning: you are reading right now? Are you aware Mindfulness is a state in which an individual: of the images, memories, and thoughts 1. focuses on present and direct experience “When we are mindful, we implicitly that your mind is recalling as you are read- 2. is intentionally aware and attentive or explicitly (1) view a situation from ing? Try exploring one or two categories 3. accepts life as an emergent process of several perspectives, (2) see informa- you have been using while digesting this change tion presented in the situation as novel, article thus far. (3) attend to the context in which we One way to distinguish the two schools Mindfulness and Experiential Learning perceive the information, and eventu- of thought is that meditative mindfulness, ally, (4) create new categories through with its focus on present centered aware- Building on this research, we began to which this information may be under- ness, describes an internal process required explore the notion that mindfulness might stood.” (Langer,1997, p.111) to maintain a mindful state, where socio- increase the effectiveness of learning cognitive mindfulness definitions seem to from experience. Specifically we designed Langer (1997) argues that our school sys- focus on cognitive applications of mind- a study to explore the learning style(s) of tems largely encourage mindless learning fulness (e.g. how we can more effectively mindful individuals using the two mind- through the accumulation of “objective” sort out experiences and make sense of fulness scales just described and the Kolb truths, rather than mindful learning which the world based on new mental categories/ Learning Style Inventory (Kolb 2007) based places a value on context, uncertainty, models). Furthermore, meditative mindful- on experiential learning theory (Kolb, and doubt. As with meditative mindful- ness authors offer techniques in practicing 1984). By understanding the relationship ness, socio-cognitive mindfulness authors mindfulness through breathing, acceptance between mindfulness and experiential contrast mindfulness with mindlessness, and present centered awareness. Socio- learning styles, we could begin to design 14 OD PRACTITIONER Vol. 41 No. 3 2009
Figure 2: mindful experiential learning practices to style were influenced by William be used in organizations. James, the originator of the theory Experiential Learning Theory (ELT) of experience on which ELT is based. defines learning as “the process whereby James (1890) stated, “no state once knowledge is created through the transfor- gone can recur and be identical mation of experience. Knowledge results with what it was before” (p.155). The from the combination of grasping and mind often neglects the rich context transforming experience” (Kolb, 1984, p.41). available for observation that makes The ELT model portrays two dialectically experience unique. Instead it often related modes of grasping experience— automatically labels stimuli based on Concrete Experience (CE) and Abstract limited exposure and moves on to Conceptualization (AC)—and two dialecti- the next stimulus to under-observe. cally related modes of transforming experi- To extend this further, our labels of ence—Reflective Observation (RO) and work experiences such as produc- Active Experimentation (AE). Experiential tive, boring, awful, successful, learning is a process of constructing knowl- urgent, relaxed, and so on are also Mindfulness becomes important when edge that involves a creative tension among often based in automatically categorizing we consider how we choose to process and the four learning modes. This process is experience, rather than being fully pres- learn from events at work. Learning style portrayed as an idealized learning cycle or ent in the unique context of the moment. determines the way we process the pos- spiral where the learner “touches all the James’ emphasis on immediate direct sibilities of each new emerging experience, bases”—experiencing, reflecting, thinking, sensual experience is exactly the focus on which in turn determines the range of and acting—in a recursive process that is here and now experience that has been choices and decisions we see. The choices responsive to the learning situation and characterized by mindfulness for thou- and decisions we make to some extent what is being learned. Immediate concrete sands of years. James also emphasized the determine the events we work through, and experiences (experiencing) are the basis for importance of attention. He defines a spiral these events influence our future choices. observations and reflections. These reflec- of interest-attention-selection similar to Thus, people create themselves and their tions are assimilated and distilled into the experiential learning cycle that creates learning styles through the choices of abstract concepts (thinking) from which a continuous ongoing flow of experience the actual occasions they live through. new implications for action can be drawn. summarized in the pithy statement—“My For many, this learning style choice has These implications can be actively tested experience is what I agree to attend to.” become relatively unconscious, comprised and serve as guides in creating new experi- (1890, p. 403). This also is a central ele- of deeply patterned routines applied glob- ences (see Figure 2 ). ment of mindfulness. ally to learning situations. Mindfulness Learning style describes the unique Supporting these links between learn- can put the control of learning back in the ways that individuals spiral through the ing from experience and mindfulness, learner’s hands. learning cycle based on their preference our research found that individuals who for the four different learning modes— scored high on Langer’s mindfulness scale Practicing Mindful Experiential Learning CE, RO, AC, & AE. Because of our genetic emphasized direct concrete experience in makeup, our particular life experiences, their learning style (Yeganeh, 2006). We As it relates to mindfulness, ELT provides and the demands of our present environ- also found that individuals scoring high on a grounded explanation of the learning ment, we develop a preferred way of choos- mindfulness did not score high on reflec- processes of the mind when making sense ing among these four learning modes. We tive observation, suggesting that they were of the environment (Zull 2002). The mind resolve the conflict between being concrete not “lost in thought” or rumination but makes sense of complex environments by or abstract and between being active or were attentive to their experiences. The generalizing. In doing so, rules and guide- reflective in patterned, characteristic ways. results suggest that the practice of mind- lines are abstracted (AC) from experiences ELT posits that learning is the major deter- fulness could help individuals learn from (CE) which are then acted (AE) and/or minant of human development and how experience in two ways: reflected (RO) on. Indeed this is what has individuals learn shapes the course of their 1. Encouraging a focus on here-and-now enabled early civilizations to take shelter personal development. Previous research experience uncluttered by preconcep- when weather worsens, use fire to ward (Kolb 1984) has shown that learning styles tions and bias off nocturnal scavengers, seek medicine are influenced by personality type, culture, 2. Intentionally guiding their learning when ill, teach right from wrong, and so on educational specialization, career choice, process by paying attention to how they and so forth. It is clear that this propensity and current job role and tasks. are going through the phases of the to generalize can be a gift, enabling us to Our hypotheses about the relation- learning cycle thrive. However, the process of general- ship between mindfulness and learning izing from experience can also result in Mindfulness and Experiential Learning 15
Figure 3: Mindful Experiential Learning Practice Guide rumination, bigotry, fortunetelling, stress, disallows the mind and body and the like; all of which decrease learning to suffer from things beyond ability. The ability to generalize is neutral; one’s control. This can paradoxi- it is how we go about doing so that deter- cally enable one to attain goals mines generative or degenerative outcome. that may have otherwise been Incorporating mindfulness practices into self-sabotaged by stress and experiential learning processes will help attempts at over-controlling. organization members become more Working toward goals is con- intentional about how and when they learn. gruent with practicing mindful An underlying assumption in mindful experiential learning in orga- experiential learning is that the quality of nizations. However having an experiential learning increases as orga- overbearing outcome-orientation nization members are more intentional. in which preoccupation with Practical examples of mindful experiential a specific result hinders work learning in organizations are limitless. For effectiveness, is a classic sign of example, organizational teams can increase mindlessness. awareness of how individuals work with one another in specific situations, and who Tools for Mindful Learning is best for specific kinds of work on a team. Leaders can better manage complex proj- Those who use the Kolb ects without making rash decisions based Learning Style Inventory to on limited information. Strategy makers assess their learning style often can become more effective in processes decide that they wish to develop by rethinking how data is collected and their capacity to engage in one considered. or more of the four modes of the learning Developing the capacity Mindfulness can free the mind to cycle—experiencing (CE), reflecting (RO), for experiencing (CE) intentionally think and create in new ways. thinking (AC) and acting (AE). In some This requires fully opening oneself to direct Those with rigorous mindfulness prac- cases this is based on a desire to develop experience. Direct experience exists only tices routinely practice present centered a weak mode in their learning style. In in the here-and-now, a present moment of awareness. Meditation is a powerful way others it may be to increase capability endless depth and extension that can never to discipline the mind into practicing in a mode that is particularly important be fully comprehended. In fact, being heav- mindfulness. However, there are also for their learning tasks. Because of the ily biased in the thinking mode (being too ways to practice mindfulness for those dialectic relationships among the learn- much “in your head”) can inhibit the ability who are not dedicated to a meditation ing modes, inhibiting dominating modes to directly sense and feel the immediate program. One thing is certain, if organiza- can be as effective in developing strengths moment. Engagement in concrete experi- tion members are interested in develop- as actively developing inhibited modes. ence can be enhanced by being present ing mindful experiential learning skills, Overall learning effectiveness is improved in the moment and attending to direct it is vital to begin a mindfulness routine, when individuals are highly skilled in sensations and feelings. This presence whether through meditation or not. For engaging all four modes of the learning and attention are particularly important those interested in practicing mindfulness cycle at contextually appropriate times. for relationships. Interpersonal skills of without meditation, it is important to find We have created a practical model leadership, relationship and giving and a way to regularly attend to one’s state (Figure 3) from mindfulness and expe- receiving, can improve by developing the in order to be intentional in subsequent riential learning work that answers the experiencing mode of learning. Those who thoughts and behaviors. Self-monitoring following question: What are various tend to be heavy in thinking and light on when coupled with practicing acceptance mindfulness practices that can be used to experiencing may wish to write out lists of creates new opportunities to think and act develop the capacity to engage in one or everything floating around in their minds. in learning situations. This requires a rou- more of the four modes of the learning This can include “to do’s”, ideas, concerns, tine of “checking-in” with the self, which cycle in organizations? The next section and anything else cluttering the mind. The can be done through regular journaling, provides some useful tools to improve mind often replays these thoughts to main- questioning, and/or taking several deep specific modes of experiential learning tain control over them. Once thoughts are breaths from the diaphragm while accept- through mindfulness. Keep in mind that written out, it is easier to practice engag- ing the present moment. Some mistakenly the key to being mindful when learning is ing in the present moment, knowing that confuse acceptance with apathy, which it intentionality, as opposed to being on auto- the list is only a glance away if something is not. In mindfulness theory, acceptance pilot in any of the phases. seems forgotten at a later date. Clearing 16 OD PRACTITIONER Vol. 41 No. 3 2009
the mind is a central tool for shifting from these times through mindfulness. Focus for abstract thought. Be aware that mind- abstract thought into engaging present on the physiological cues that signal when lessly shifting from abstract thought to con- moment experience. Additionally, any time impulsivity is about to occur. When these crete experience can interfere with learning words are being used to think or speak, cues arise, practicing redirecting the mind in some scenarios. Practicing a focused abstract thinking is happening. Words are towards reflection can be a powerful tool. routine of abstract questioning and seeking symbols, representing only a fraction of Those who feel quick to judge and act can shades of gray can develop the mind’s abil- full experience. To develop the capacity routinely ask themselves “what actions ity to fully think in learning situations. for experiencing, one can practice observ- have I been rushing into that I can sit ing the environment while consciously with a bit longer to make sure I am being Developing the capacity shifting the mind away from words that intentional?” This can be done numerous for action arise, and back to the momentary observa- ways. One suggestion we offer clients is Acting requires commitment and involve- tion. Taking deep breaths while doing this, to program their computer calendars to ment in the practical world of real con- anchors the mind in momentary awareness announce this question on their screens sequences. In a sense it is the “bottom of perception: sight, sound, touch, taste, every hour or few hours. Another use- line” of the learning cycle, the place where and smell, and away from abstract thought. ful practice is to hone in on one issue internal experiencing, reflecting and If thoughts appear in the mind, one can that requires reflection, and spend 10-15 thinking are tested in reality. Acting can be gently but firmly re-focus on the breath and minutes to generate new questions to inhibited by too much internal processing away from thinking in order to be more answer about the issue. Create a question in any of these three modes. Acting can be fully present. Deep breathing is a powerful for yourself that you normally would not enhanced by courageous initiative-taking intervention for strengthening the ability ponder, and place a value on doubt, rather and the creation of cycles of goal-setting to experience. Most of us breathe shal- than rushing into being correct. Finally, and feedback to monitor performance. lowly, especially when engaged in tasks that practice acceptance of the moment by Action skills of initiative, goal-setting and pull us away from momentary awareness. identifying which actions are generative action-taking can aid in the development Anchor points for creating a mindful learn- and which ones are just a way of trying to and expression of the acting mode of learn- ing routine can be as simple as routinely take control of an uncontrollable aspect of ing. Mindfulness can assist with this phase taking deep breaths from the diaphragm. the environment. by helping learners be intentional about In order to remember breathing, one can actions, especially when reflective observa- practice routine self check-ins, asking “how Developing the capacity tion is a more comfortable state for the deeply am I breathing right now?” Creating for thinking learner. Asking people novel and thought- reminder cues such as a pen dot on the Thinking requires the ability to cognitively ful questions can be a safe and mindful hand, and/or a symbol at the desk can help represent and manipulate ideas. It can way to begin practicing action. Another as well. Because the practices suggested be distracted by intense direct emotion tool is having the learner envision all the to engage in experience include adapta- and sensations as well as pressure to act ideal behaviors that he/she would like to tions of meditation, they often come with quickly. Engagement in thinking can be practice. The learner then can decide which a host of benefits such as reduced stress, enhanced by practicing theoretical model behaviors would be generative to practice increased clarity, improved health, calm- building and the creation of scenarios for in specific learning situations and begin ness, and creativity. action. Analytical skills of theory building, practicing one or two of them mindfully. data analysis and technology management Learners who would like to move to action Developing the capacity can aid in the development and expression more often or more strongly will benefit for reflecting of the thinking mode of learning. From from being aware of and releasing any Reflection requires space and time. It can a mindfulness perspective, questioning automatic self-judgments, self-schemas, be inhibited by impulsive desires and/or assumptions can help to focus the mind in feelings and thoughts that support inac- pressures to take action. It can be enhanced order to make “theories-in-use” intentional tion. This can be accomplished through by the practices of deliberately viewing rather than automatic. Taking time to view acceptance and breathing practices. Finally, things from different perspective and assumptions from multiple perspectives it is important to keep in mind that acting empathy. Stillness and quieting the mind can enrich thought. A way to do this is isn’t just about filling space with behavior. foster deep reflection. Information skills of to experiment with how one would make Intentionally suspending behavior can be a sense-making, information gathering and sense of a situation if a current belief were mindful act as well. information analysis can aid in the devel- untrue. Another tool is to consider the opment and expression of the reflecting role that context plays in current mental Conclusion mode of learning. To practice this phase models, and how these might differ if of mindful experiential learning, one can the context changed. Creating contextual Everybody has learning style preferences. actively discover critical times of impulsive knowledge rather than pursuing dichoto- Cultivating mindfulness can help organiza- action and plan to suspend action during mous thinking can strengthen the capacity tion members become more intentional Mindfulness and Experiential Learning 17
Bauback Yeganeh, PhD, is the Founder of B.Y. Consulting (www. byconsulting.org) which focuses on about how they think and behave in a given theory helps us understand the mental leadership development and organi- learning environment. In order to be more architecture of learning. Mindfulness helps zational strategy, and Everidian (www. aware of learning processes, learners must us understand processes by which the everidian.com), an eco-advantage find unique ways to engage in routines of mind is aware, intentional, and accepting. consulting group. Yeganeh’s work momentary awareness. Regular practices Using the two together unlocks a power- of deep breathing can help create anchor ful tool for empowered adult learning in focuses on leadership development, points for learners to check in on thoughts organizations. strategy, and eco-advantage. He has and behaviors. In organizations it is helpful consulted to organizations in The for learners to identify people who they References Americas, Europe, and Asia including can routinely check-in with on the degree The World Bank, United Nations, FIEP to which they are being intentional in Brown, K.W., & Ryan, R.M. (2003). The Brazil, Alcatel Lucent, and Progres- learning situations. These conversational benefits of being present: mindful- sive Insurance. He can be reached at anchors provide environmental cues to ness and its role in psychological well by@byconsulting.org or byeganeh@ stay focused on a mindfulness practice and being. Journal of Personality and Social everidian.com. emotional support to remain optimistic. Psychology, 84, 822-848. Using coaches who are well trained in Bodner, T.E. (2000). On the assessment of David Kolb, PhD, is Professor of Or- mindfulness is also a powerful tool. Finally, individual differences in mindful infor- ganizational Behavior at the Weather- we encourage learners not to be discour- mation processing. Unpublished doc- head School of Management, Case aged when facing difficulty in starting a toral dissertation, Harvard University. Western Reserve University. He is best mindful experiential learning practice. It Casey, D. (1993). Managing learning in known for his research on experiential may be best to try 1 or 2 specific mind- organizations. Buckingham, UK: Open learning and learning styles described ful learning practices, and go from there. University Press. in Experiential Learning: Experience Anything more can be overwhelming and Cunningham, I. (1994). The wisdom of stra- may actually inhibit progress. As tech- tegic learning. London: McGraw-Hill. as the Source of Learning and De- niques are mastered, additional methods Good, D.J., & Yeganeh, B. (2006). velopment. Current research activi- can be added. In this article, we have Mindfulness in moments of monot- ties include assessment of learning provided mindful experiential learning ony. Presentation in Managerial and flexibility, studies of team learning, practices that can improve the quality of Organizational Cognition. Academy of research on the cultural determinants learning in the four modes of experiential Management Annual Meeting, 2006, of learning style, and research on learning. These can be adapted to coaching Atlanta, GA. experiential learning in conversation. processes, employee development pro- Gunaratana, H. (1991). Mindfulness in plain grams, dialogue sessions, cultivating emo- English. Wisdom Publications, Boston, tional intelligence, daily meeting practices MA. and much more. We have presented new Hanh, T.N. (1987). The miracle of mindful- Langer, E.J., & Moldoveanu, M. (2000). research and practical approaches to mind- ness. Boston, Ma. Beacon Press. The construct of mindfulness. Journal ful experiential learning in organizations. Kabat-Zinn, J. (1994). Wherever you go there of Social Issues, 56, 1-9. We encourage others to develop innovative you are. Hyperion: New York, NY. Langer, E.J. (1997). The power of mindful ways to use mindfulness in organizations James, W. (1890). The stream of conscious- learning. Cambridge, MA: Persesus and to share the results through articles ness. Reprinted from The Principles of Publishing. and presentations so that one day using Psychology, I, 224-290, (Dover, 1950) Senge, P. (1990). The fifth discipline: The art mindfulness in organizations becomes the James, W. (1890). The principles of psychol- and practice of the learning organization. norm. We believe it is needed more now ogy. 2 Volumes. NY: Henry Holt & Co. London: Century Business. than ever before. Kabat-Zinn, J.(2003). Mindfulness-based Sims, R., & Sims, S. ,Eds., (2006). Learning Mindfulness is an age old tool to interventions in context: past, present, styles and learning: A key to meeting the enhance life by reducing automaticity. and future. Clinical Psychology: Science accountability demands in education. Mindful experiential learning can be culti- and Practice, 10, 144-156. Hauppauge, NY: Nova Publishers. vated in organizations without mandating Kolb, D. (1984). Experiential learning: Vince, R. (1998). Behind and beyond Kolb’s employees to commit to specific meditation Experience as the source of learning and learning cycle. Journal of Management practices. In many of our experiences with development. Englewood Cliffs, N.J.: Education, 22; 304. coaching leaders, simply presenting some Prentice Hall. Yeganeh, B. (2006). Mindful experien- of the practices discussed in this article has Kolb, D. A. (2007). The Kolb learning tial learning. Case Western Reserve been enough to generate interest, result- style inventory—version 3.1: LSI work- University. Dissertation. ing in self-driven exploration of mindful book. Boston, MA: Hay Transforming Zull, J. (2002). The art of changing the brain. experiential learning. Experiential learning Learning Stylus, Sterling, VA. 18 OD PRACTITIONER Vol. 41 No. 3 2009
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