4/11/2019 Namaste A deep bow to you all KEYNOTE Mindfulness-Based - - PDF document

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Nirbhay N. Singh, PhD, BCBA-D

Clinical Professor of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA EDITOR-IN-CHIEF Mindfulness | Journal of Child and Family Studies | Advances in Neurodevelopmental Disorders ✪ 6th Annual Symposium| Cranston, RI April 11 2019 | 8:45 AM-10:15 PM

KEYNOTE

Mindfulness-Based Programs for Behavior Analysts

Namaste A deep bow to you all

Challenging Behaviors

• There is challenging behavior
• There is a function of the

behavior

• There is a treatment for the

challenging behavior

• Treatment is based on principles
• f learned behavior

Carr, E. G. (1977). The motivation of self-injurious behavior: A review of some hypotheses. Psychological Bulletin, 84(4), 800-816

BEHAVIOR ANALYSTS

Challenging Behaviors

• There is challenging behavior
• There is a function of the

behavior

• There is a treatment for the

challenging behavior

• Treatment is based on principles
• f learned behavior

Carr, E. G. (1977). The motivation of self-injurious behavior: A review of some hypotheses. Psychological Bulletin, 84(4), 800-816

• There is suffering (dis-ease)
• There is a cause of the suffering
• There is a treatment for the

suffering

• Treatment is based on the

eightfold path

The Buddha (2600 years ago). The Four Noble Truths

BEHAVIOR ANALYSTS MINDFULNESS

Challenging Behaviors

• There is challenging behavior
• There is a function of the behavior
• There is a treatment for the challenging

behavior

• Treatment is based on principles of

learned behavior Increasing emphasis on technical purity and adherence to BCBA certification

• requirements. Focus on teaching socially

significant behaviors and reducing challenging behaviors. Based on learning theory—deals with manipulating behavior.

Carr, E. G. (1977). The motivation of self-injurious behavior: A review of some hypotheses. Psychological Bulletin, 84(4), 800- 816

• There is suffering (dis-ease)
• There is a cause of the suffering
• There is a treatment for the

suffering

• Treatment is based on the

eightfold path

The Buddha (2600 years ago). The Four Noble Truths

BEHAVIOR ANALYSTS MINDFULNESS

Challenging Behaviors

• There is challenging behavior
• There is a function of the behavior
• There is a treatment for the challenging

behavior

• Treatment is based on principles of

learned behavior Increasing emphasis on technical purity and adherence to BCBA certification

• requirements. Focus on teaching socially

significant behaviors and reducing challenging behaviors. Based on learning theory—deals with manipulating behavior.

Carr, E. G. (1977). The motivation of self-injurious behavior: A review of some hypotheses. Psychological Bulletin, 84(4), 800- 816

• There is suffering (dis-ease)
• There is a cause of the suffering
• There is a treatment for the suffering
• Treatment is based on the eightfold

path Emphasis on personal experience to verify teachings: If it works for you, engage in the practice. If it does not, discard it. Focus on reducing dis-ease and increasing happiness in life. Based on matters of the heart—deals with manipulating the mind.

The Buddha (2600 years ago). The Four Noble Truths

BEHAVIOR ANALYSTS MINDFULNESS

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The First Behavior Analyst?

TEACHABLE UNITS

• TASK ANALYSIS — The process of

breaking a complex skill or series of behaviors into smaller, teachable units

—Cooper, Heron & Heward (2019)

Example: Putting a Coat On 1 Pick up the coat by the collar (the inside of the coat should be facing you) 2 Place your right arm in the right sleeve hole 3 Move your arm through until you can see your hand at the other end 4 Now reach behind with your left hand 5 Locate the left sleeve hole 6 Put your arm in the left sleeve hole 7 Move your arm through until you see your hand at the other end 8 Adjust the coat so it is ready to zip Behavioral Approach

TEACHABLE UNITS Mindfulness of Breathing

1. Breathing in long, one understands: “I breathe in long”; or breathing out long, one understands, “I breathe out long.” 2. Breathing in short, one understands: “I breathe in short”; or breathing out short, one understands, “I breathe

• ut short.”

3. One trains: “I shall breathe in experiencing the whole body”; one trains: “I shall breathe out experiencing the whole body.” 4. One trains: “I shall breathe in calming bodily activity”; one trains, “I shall breathe out calming bodily activity.”

1. One trains: “I shall breathe in experiencing joy”; one trains: I shall breathe out experiencing joy.” 2. One trains: “I shall breathe in experiencing happiness”; one trains: I shall breathe out experiencing happiness.” 3. One trains: “I shall breathe in experiencing mental activity”;

• ne trains: I shall breathe out

experiencing mental activity.” 4. One trains: “I shall breathe in calming mental activity”: one trains; I shall breathe out calming mental activity.” First Tetrad Second Tetrad

Mindfulness of Breathing

1. One trains: “I shall breathe in experiencing the mind”; one trains: I shall breathe out experiencing the mind.” 2. One trains: “I shall breathe in gladdening the mind”; one trains: I shall breathe out gladdening the mind.” 3. One trains: “I shall breathe in concentrating the mind”; one trains: I shall breathe out concentrating the mind.” 4. One trains: “I shall breathe in liberating the mind”; one trains: I shall breathe out liberating the mind.” 1. One trains: “I shall breathe in contemplating impermanence”;

• ne trains: I shall breathe out

contemplating impermanence.” 2. One trains: “I shall breathe in contemplating dispassion”; one trains: I shall breathe out contemplating dispassion.” 3. One trains: “I shall breathe in contemplating cessation”; one trains: I shall breathe out contemplating cessation.” 4. One trains: “I shall breathe in contemplating letting go”: one trains; I shall breathe out contemplating letting go.” Third Tetrad Fourth Tetrad

The First Task Analyst? Ānāpānasati Sutta—the 16 steps to awakening

CRITICAL DIFFERENCES

• Behavioral
• function(s) of the behavior at the time of

assessment, with consideration of proximal and distal antecedents

• Knowing the functions helps to derive the

intervention

• Focus on current behavior change,

generalization, and maintenance

• Mindfulness
• Deals with the causes and conditions of suffering

(dukkha—dis-ease).

• Causes are like behavioral functions
• Conditions involve knowing about the feelings,

emotions, and perceptions of the person

• Knowing the causes and conditions helps in the

skillful use of mindfulness—in the selection of behavioral responses and/or meditations

• Focus on awakening

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Behavior Analytic Approaches

• Behavior Plans (or PBS/PBIS plans) work

very well if designed appropriately and implemented with fidelity

• Parents and caregivers (including

teachers) report being stressed

• Implementing behavior plans often adds

to their stress

• When challenging behavior reaches

acceptable limits, fidelity of implementation drops, challenging behavior eventually returns, plan needs updating, etc.

• How do behavior analysts break this cycle
• f behavioral programming?
• Marc Gold: Try another way

THE GRODEN NETWORK

Behavior Analytic Approaches

• Mark Durand: Optimistic Parenting

Durand guides parents step by step through the process of:

• pinpointing the "why" behind challenging behavior
• tuning in to their own thoughts, emotions, and self-talk
• understanding how their thoughts affect their interactions

with their child

• interrupting negative thoughts and replacing them with

positive, productive ones

• achieving a healthy balance between taking care of their
• wn needs and their child's needs
• using effective emergency strategies when quick behavior

intervention is needed

• implementing long-term strategies for lasting behavior

improvements

• weaving functional communication training into everyday

routines and interactions

• addressing the most common problem areas, such as sleep

and transitions

• increasing mindfulness and parenting "in the moment”

Try Another Way

Behavior Analytic Approaches

• Joseph M. Lucyshyn: Family-Centered Positive

Behavior Support (FCPBS)

• Examines the internal, external, and social validity of

an ecological, family-centered positive behavioral support approach with families of children with developmental disabilities and severe problem behavior.

• FCPBS empowers families to transform problematic

parent-child interactions into constructive interactions in the context of valued family routines in the home and community.

• Lucyshyn et al. (2018). Transforming coercive processes in

family routines: Family functioning outcomes for Families of children with developmental disabilities. Journal of Child and Family Studies, 27(9), 2844-2861.

• Lucyshyn et al. (2015). Transforming parent-child interaction

in family routines: Longitudinal analysis with families of children with developmental disabilities. Journal of Child and Family Studies, 24(12), 3526-3541.

Try Another Way

Behavior Analytic Approaches

• Mark Dixon and Donna Paliliunas: AIM: Accept –

Identify –Move; A behavior analytic curriculum for social emotional development in children

• Components: Mindfulness, ACT, and ABA
• AIM introduces and blends together the concepts of

Mindfulness, Acceptance and Commitment Therapy, and Applied Behavior Analysis. Together the approach seeks to improve the lives of children with or without disabilities who struggle with social and emotional challenges. Or in

• ther words, every child.
• Included is a comprehensive theoretical overview,

detailed program guide, and entire curriculum:

• Introduction to foundational concepts
• The AIM Curriculum implementation guides
• 75 easy-to-implement mindfulness lessons designed

specifically for children

• 175 ACT daily lessons that are presented in tiers of

intervention intensity

• Over 75 supplemental worksheets for ACT lessons
• Data collection and progress monitoring forms
• The Children's Psychological Flexibility Questionnaire

(CPFQ) assessment tool

Try Another Way

What is it and how does it work?

MINDFULNESS

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What is MINDFULNESS?

• The awareness that emerges through

paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment

Kabat-Zinn (2003, p. 145)

• Mindfulness is a process of regulating

attention in order to bring a quality of non- elaborative awareness to current experience and a quality of relating to one’s experience within an orientation of curiosity, experiential openness, and acceptance.

Bishop et al. (2004, p. 234)

Different Levels Of

Mindfulness Practice

• Mechanistic Mindfulness—

Manasikāra (a type of concentration meditation or Samādhi)

• Ethically Attuned Mindfulness—

genuine sati involves an ethical element (Sīla)

• Fully Informed Mindfulness—Sati-

sampajañña—mindfulness and clear comprehension; paying attention within the context of time, place and situation—ethical practice

• Holistic Mindfulness—Sati-pañña—

transformative mindfulness, mindfulness with wisdom as a spiritual practice

• -Ajahn Amaro & Singh (2019)

How does Mindfulness Work?

Meditation Behavior Change Attention Mindful Actions Awareness

MINDFULNESS- BASED INTERVENTIONS

• Neurodevelopmental disorders
• Schizophrenia
• Bipolar disorders
• Depressive disorders
• Anxiety disorders
• Obsessive-compulsive disorders
• Trauma and stress-related

disorders

• Feeding and eating disorders
• Personality disorders
• Substance-related and addictive

disorders

MINDFULNESS- BASED INTERVENTIONS

• Cancer
• Heart disease
• Hypertension
• GI distress
• HIV/AIDS
• Headaches
• Sleep disturbances
• Fatigue
• Skin disorders
• Migraines
• Diabetes
• Tinnitus
• Fibromyalgia
• and many more . . .

OUTCOMES OF MINDFULNESS-BASED PROGRAMS

• Good evidence for reducing
• Anxiety
• Depression
• Anger and aggression
• Psychological distress
• Emerging evidence for

improving

• Emotion regulation
• Life satisfaction
• General well-being
• Emerging evidence for

reducing

• Anxiety
• Depression
• Anger and aggression
• Oppositional behaviors
• Emerging evidence for

improving

• Emotion regulation
• General well-being

ADULTS CHILDREN

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A behavior analyst’s general approach to developing mindfulness-based programs

• Request for help by individuals,

caregivers, and agencies

• Customized intervention
• Intensive case study
• Single-case experimental designs
• Multiple-baseline
• Changing criterion
• Group designs
• Quasi-experimental (proof-of-concept)
• Randomized controlled trials

Mindfulness-based Programs for People with ASD and/or ID

• Teaching Individuals with ASD and/or OD
• Meditation on the Soles of the Feet (SoF)
• SOBER
• Surfing the Urge
• Body Scan
• Yoga—mindfulness movements
• Specific approaches for those functioning

at the severe and profound levels

• Teaching Parents, Teachers, and Paid

Caregivers

• Meditations
• Mindfulness-based Positive Behavior

Support (MBPBS)

With ASD and/or IDD Effects of Teaching

INDIVIDUALS

Meditation on the Soles

• f the Feet

(SoF)

• The SoF is a skilful means of dealing with

arising anger by shifting attention and awareness from the anger-producing situation to a neutral point on the body, the soles of the feet.

• Can be used to immediately control

arising anger and preempt its expression as verbal or physical aggression

• It is a stabilizing meditation for emotional

arousal

• The SoF practice enables individuals to
• stop (pause),
• refocus the mind from the emotionally

arousing situation to a neutral place on the body,

• be in the present moment, and
• then make a mindful response to the situation

from a state of tranquility

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Singh et al. (2011)

• Three adolescents with ASD
• Ages: 13, 15, and 18 years old
• Target behaviors:
• Maladaptive behaviors: hitting

kicking, biting, scratching, and slapping

• Social interactions (positive,

negative, neutral)

• SoF training:
• Total training time: 5 days, 15-

minute sessions (1 hr. 15mins)

• Data collected for 30 weeks
• Follow-up for 4 years

Self-management of Anger using SoF

Physical Aggression

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SOBER Breathing Space

• SOBER Breathing Space has been

used to self-manage anger and aggression. Stop and be aware of what is happening in that moment, Observe the physical sensations and emotional regulation changes in the body, Breathe by deliberately bringing attention to the breath, Expand awareness of the situation and response options, and then Respond mindfully.

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Singh et al. (2018)

• Four children with intellectual

disabilities

• Ages: 12, 10, 11, and 12 years old
• Target behaviors
• Aggressive behaviors: kicking, slapping,

punching, biting, and pinching

• Mixed motivation
• SOBER Breathing Space training:
• Week 1: 3 x 1-hr training session;
• Weeks 2-4: 2 x 30-min sessions/week
• Total training time: 6 hours
• Data collected for 30 weeks
• Follow-Up for 1-year

Self-management of aggression using SOBER Breathing Space

Verbal Aggression: Home Verbal Aggression: School Physical Aggression: Home Physical Aggression : School