Urge Surfing or Wiping Out: Urge Surfing or Wiping Out: Mindfulness - - PowerPoint PPT Presentation
Urge Surfing or Wiping Out: Urge Surfing or Wiping Out: Mindfulness for Change and Mindfulness for Change and Recovery Recovery Daniel Gutierrez, Ph.D., LPC, CSAC, NCC Daniel Gutierrez, Ph.D., LPC, CSAC, NCC Alex Hilert, M.Ed. William and
Daniel Gutierrez, Ph.D., LPC, CSAC, NCC William and Mary New Leaf Clinic & Department of Counselor Education Daniel Gutierrez, Ph.D., LPC, CSAC, NCC William and Mary New Leaf Clinic & Department of Counselor Education Alex Hilert, M.Ed. William and Mary Doctoral Student Director, New Leaf Clinic
Agenda Agenda
Discussing Addiction Types of Meditation Introduction to Mindfulness Mindfulness in Addiction Treatment Implementing Mindfulness Strategies Demonstrations and Activities Clinical Considerations Questions Discussing Addiction Types of Meditation Introduction to Mindfulness Mindfulness in Addiction Treatment Implementing Mindfulness Strategies Demonstrations and Activities Clinical Considerations Questions
“You cannot stop the waves, but you can learn to surf.
“You cannot stop the waves, but you can learn to surf.
Introduction Introduction
Substance use disorders have been described as a chronic relapsing condition in which roughly 50% individuals participating in treatment relapse within 6 months (McKay & Weiss, 2001), and up to 80% experience an ongoing cycle of treatment, relapse and problematic drug use Including mindfulness practices into treatment may improve outcomes by altering the craving-use relationship (Brewer et al., 2014; Witkiewitz et al., 2013) Substance use disorders have been described as a chronic relapsing condition in which roughly 50% individuals participating in treatment relapse within 6 months (McKay & Weiss, 2001), and up to 80% experience an ongoing cycle of treatment, relapse and problematic drug use Including mindfulness practices into treatment may improve outcomes by altering the craving-use relationship (Brewer et al., 2014; Witkiewitz et al., 2013)
The Biopsychosocial Model of Addiction The Biopsychosocial Model of Addiction
Biological predisposition and neurobiological dysfunction: cravings and stress responses Psychological Health: negative affect, perceived stress, comorbid psychopathology Social-situational influences: peer pressure, lack of social support, and environmental cues Dynamic reciprocal interactions (i.e. feedback loop) negative affect substance use negative affect Biological predisposition and neurobiological dysfunction: cravings and stress responses Psychological Health: negative affect, perceived stress, comorbid psychopathology Social-situational influences: peer pressure, lack of social support, and environmental cues Dynamic reciprocal interactions (i.e. feedback loop) negative affect substance use negative affect
Mindfulness & Meditation Mindfulness & Meditation
Types of Meditation Types of Meditation
There are many, many forms of meditation (Transcendental, Mindfulness, Yoga, Centering Prayer, ACEM, Zazen…etc.) Each approach has a rich spiritual and historical tradition The overlap creates a difficult in categorizing them For example: They all seem to influence Mindfulness in some capacity (Goleman, 1988) Some approaches (LKM) might be considered more guided imagery There are many, many forms of meditation (Transcendental, Mindfulness, Yoga, Centering Prayer, ACEM, Zazen…etc.) Each approach has a rich spiritual and historical tradition The overlap creates a difficult in categorizing them For example: They all seem to influence Mindfulness in some capacity (Goleman, 1988) Some approaches (LKM) might be considered more guided imagery
Types of Meditation Types of Meditation
Two methods of categorization: Concentrative and Awareness (Seidmeir, 2012, Walsh & Shapiro, 2006) “Be Here Now” meditation and “Be There Now” meditation (Lou Ritz, personal communication) We need more research on various types of meditation: Culturally appropriate approaches are needed Research on other approaches might demonstrate some models are more effective We need to understand what types are most effective for what conditions and in what settings Two methods of categorization: Concentrative and Awareness (Seidmeir, 2012, Walsh & Shapiro, 2006) “Be Here Now” meditation and “Be There Now” meditation (Lou Ritz, personal communication) We need more research on various types of meditation: Culturally appropriate approaches are needed Research on other approaches might demonstrate some models are more effective We need to understand what types are most effective for what conditions and in what settings
Research? Research?
Meditation as Medication Meditation as Medication
Beneficial effects on anxiety, depression, addiction, anger, chronic pain, insomnia, eating disorders, stress related to chronic health conditions, and hyper tension (Creswell, 2017) Positively impacts emotion regulation, emotional intelligence, attention, self-compassion, subjective happiness, empathic concern, and creativity (Sedlmeier et al., 2017) Reduced Blood Pressure and Stress; boosts immune system (Ospina, 2007; Creswell, 2017; Sedlmeier et al., 2017) Beneficial effects on anxiety, depression, addiction, anger, chronic pain, insomnia, eating disorders, stress related to chronic health conditions, and hyper tension (Creswell, 2017) Positively impacts emotion regulation, emotional intelligence, attention, self-compassion, subjective happiness, empathic concern, and creativity (Sedlmeier et al., 2017) Reduced Blood Pressure and Stress; boosts immune system (Ospina, 2007; Creswell, 2017; Sedlmeier et al., 2017)
Emotional Regulation Emotional Regulation
There is more and more convincing proof that meditators have the ability to moderate the intensity of their emotional arousal (Aftanas & Golosheykin, 2005; Seldmeier, 2017). Researchers suggest meditation improves emotional regulation through increased meta-cognitive awareness, acceptance of thoughts, and executive control (Creswell, 2017) There is more and more convincing proof that meditators have the ability to moderate the intensity of their emotional arousal (Aftanas & Golosheykin, 2005; Seldmeier, 2017). Researchers suggest meditation improves emotional regulation through increased meta-cognitive awareness, acceptance of thoughts, and executive control (Creswell, 2017)
Effects on Mood Effects on Mood
Lane, Seskevich and Piper, (2007) studied 200 healthy adults using a number of psychological instruments that focus on mood, anxiety and psychological distress. The clients were given a simple meditation technique and asked to practice it. Those who practiced the technique reduced negative mood and their perceived stress. Those who practiced most frequently had the greatest effects. Lane, Seskevich and Piper, (2007) studied 200 healthy adults using a number of psychological instruments that focus on mood, anxiety and psychological distress. The clients were given a simple meditation technique and asked to practice it. Those who practiced the technique reduced negative mood and their perceived stress. Those who practiced most frequently had the greatest effects.
Stress Recovery Stress Recovery
Goleman (1976) showed meditation teachers and non-meditators films of industrial accidents & measured physiological reactions Meditators showed a unique pattern of reaction: They reacted immediately to the stress and showed the typical fight or flight reaction but then they rapidly recovered to the pre-film level. Goleman (1976) showed meditation teachers and non-meditators films of industrial accidents & measured physiological reactions Meditators showed a unique pattern of reaction: They reacted immediately to the stress and showed the typical fight or flight reaction but then they rapidly recovered to the pre-film level.
Goleman (cont.) Goleman (cont.)
But the non-meditators reacted more slowly and continued to feel the stress both mentally and physiologically for a longer period of time. But the non-meditators reacted more slowly and continued to feel the stress both mentally and physiologically for a longer period of time.
Goleman (cont.) Goleman (cont.)
Goleman concluded that quick stress recovery is a trait of meditators. This is key in the full court press of life where one must recover Goleman concluded that quick stress recovery is a trait of meditators. This is key in the full court press of life where one must recover
Meditation as Therapy Meditation as Therapy
There has been a line of fairly consistent research on the effectiveness of meditation for reducing anxiety, stress, treating phobias, emotional regulation, and excessive anger How do you think this could help someone struggling with an addiction? There has been a line of fairly consistent research on the effectiveness of meditation for reducing anxiety, stress, treating phobias, emotional regulation, and excessive anger How do you think this could help someone struggling with an addiction?
Meditation Models for the Counselor’s Toolbox Meditation Models for the Counselor’s Toolbox
Addictions Treatment: Step 11: “Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God’s will for us and the power to carry that out.” Loving-kindness meditation seen to increase empathy in counselor trainees (Lepma, 2011) Mindfulness correlates to increased self-efficacy with beginning counselors (Greason & Cashwell) Multiple models already exist: MBCT, MBSR, ACT, DBT, MBRP Addictions Treatment: Step 11: “Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God’s will for us and the power to carry that out.” Loving-kindness meditation seen to increase empathy in counselor trainees (Lepma, 2011) Mindfulness correlates to increased self-efficacy with beginning counselors (Greason & Cashwell) Multiple models already exist: MBCT, MBSR, ACT, DBT, MBRP
Mindfulness Mindfulness
What is Mindfulness? What is Mindfulness?
meditation Kabat-Zinn’s definition: The awareness that arises through paying attention on purpose, in the present moment, nonjudgmentally
meditation Kabat-Zinn’s definition: The awareness that arises through paying attention on purpose, in the present moment, nonjudgmentally
The Eightfold Path The Eightfold Path
Mindfulness Practices Mindfulness Practices
Informal vs. Formal practices Seated meditation Movement practices (e.g. mindful walking, tai-chi) Informal vs. Formal practices Seated meditation Movement practices (e.g. mindful walking, tai-chi)
Mindfulness Basics Mindfulness Basics
Mindfulness helps with… Mindfulness helps with…
Staying calm and centered Making space for difficult emotions Shifting attention away from painful stimuli Insight into our habitual thought patterns Helps increase bodily awareness Having self-compassion “befriending the mind” Staying calm and centered Making space for difficult emotions Shifting attention away from painful stimuli Insight into our habitual thought patterns Helps increase bodily awareness Having self-compassion “befriending the mind”
Research on Mindfulness Training Research on Mindfulness Training
Mindfulness training has been associated with reduced reactivity to craving cues (Westbrook et al., 2011) More adaptive responses to stressors (Brewer et al., 2009) Improvements in emotional regulation, cognitive control, and executive functioning (Holzel et al., 2011) Improves attention, working memory, metacognitive awareness (Cresswell, 2017) Decreases attempts to avoid unwanted thoughts (Bowen et al., 2006) Mindfulness training has been associated with reduced reactivity to craving cues (Westbrook et al., 2011) More adaptive responses to stressors (Brewer et al., 2009) Improvements in emotional regulation, cognitive control, and executive functioning (Holzel et al., 2011) Improves attention, working memory, metacognitive awareness (Cresswell, 2017) Decreases attempts to avoid unwanted thoughts (Bowen et al., 2006)
R.A.I.N. R.A.I.N.
Recognize Accept Investigate with curiosity Non-attach Recognize Accept Investigate with curiosity Non-attach
Mindfulness In Therapy Mindfulness In Therapy
Utilized in several therapeutic modalities: DBT; MBSR; ACT; MBCT; MBRP; and MORE Reviews of the literature suggest mindfulness-based therapies can: Assist with pain management Boost immunity Prevent relapse for depression Reduce symptoms of stress, anxiety, and depression Reduce rates of relapse in addictions Utilized in several therapeutic modalities: DBT; MBSR; ACT; MBCT; MBRP; and MORE Reviews of the literature suggest mindfulness-based therapies can: Assist with pain management Boost immunity Prevent relapse for depression Reduce symptoms of stress, anxiety, and depression Reduce rates of relapse in addictions
Mindfulness & Addictions Treatment Mindfulness & Addictions Treatment
Breaking Bad Habits: Mindful Addiction Recovery Clip Breaking Bad Habits: Mindful Addiction Recovery Clip
https://www.youtube.com/watch?v=ivE6DWCNfug
Research Findings – Mindfulness in SUD Treatment Research Findings – Mindfulness in SUD Treatment
Mindfulness meditation moderated the relationship between craving and number of days of substance use at follow up (Enekma & Bowen, 2017) In recent meta-analysis, researchers found in five RCTs mindfulness treatments outperformed other interventions in reducing frequency of alcohol and drug related problems and in enhancing long-term abstinence (Li et al., 2017) Mindfulness meditation moderated the relationship between craving and number of days of substance use at follow up (Enekma & Bowen, 2017) In recent meta-analysis, researchers found in five RCTs mindfulness treatments outperformed other interventions in reducing frequency of alcohol and drug related problems and in enhancing long-term abstinence (Li et al., 2017)
Research Findings (cont.) Research Findings (cont.)
Mindfulness was more effective in reducing prescription opioid abuse in adults with chronic pain then a traditional support group (Garland et al., 2014) Mindfulness reduced attentional bias to substance related cues (Garland et al., 2010), reduced stress (Li et al., 2017), and enhanced brain functioning related to self-control (Tang et al., 2013). Mindfulness was also superior in a study with racial and ethnic minority female clients (Witkiewitz et al., 2013) Mindfulness was more effective in reducing prescription opioid abuse in adults with chronic pain then a traditional support group (Garland et al., 2014) Mindfulness reduced attentional bias to substance related cues (Garland et al., 2010), reduced stress (Li et al., 2017), and enhanced brain functioning related to self-control (Tang et al., 2013). Mindfulness was also superior in a study with racial and ethnic minority female clients (Witkiewitz et al., 2013)
Mindfulness-Based Relapse Prevention Mindfulness-Based Relapse Prevention
A program integrating mindfulness meditation practices with traditional relapse prevention (RP) MBRP is an outpatient after care program to foster sustainable lifestyle for individuals in recovery It is a quest for the middle way a balance between harmful indulgence and strict renunciation; between self-discipline and self-compassion Effective and skillful means for diligent intentional behavior change while emphasizing kindness and flexibility A program integrating mindfulness meditation practices with traditional relapse prevention (RP) MBRP is an outpatient after care program to foster sustainable lifestyle for individuals in recovery It is a quest for the middle way a balance between harmful indulgence and strict renunciation; between self-discipline and self-compassion Effective and skillful means for diligent intentional behavior change while emphasizing kindness and flexibility
Mindfulness in Relapse Prevention Mindfulness in Relapse Prevention
Understand how craving leads to use via absence of awareness of the experience and its consequence Learn to understand what might be “underneath” the craving or urge Learn to shift from reactive, habitual, self-defeating behaviors Create space between stimulus and response Uncouple the trigger and the desire to use
How do we do this?
Understand how craving leads to use via absence of awareness of the experience and its consequence Learn to understand what might be “underneath” the craving or urge Learn to shift from reactive, habitual, self-defeating behaviors Create space between stimulus and response Uncouple the trigger and the desire to use
How do we do this?
Automatic Pilot Automatic Pilot
Reacting based on emotions Believing our thoughts are reality Lacking awareness of our immediate physical experience Curiosity is the antidote
“Raisin” meditation
“Walking down the street” exercise
Reacting based on emotions Believing our thoughts are reality Lacking awareness of our immediate physical experience Curiosity is the antidote
“Raisin” meditation
“Walking down the street” exercise
Sober Breathing Space Sober Breathing Space
Stop at random times throughout the day and in risky situations
Observe the sensations that are happening Breath: Attend to the breathing
Expand awareness to include the entire body and the whole experience Respond mindfully instead of reactively
Anywhere, anytime, any place
Stop at random times throughout the day and in risky situations
Observe the sensations that are happening Breath: Attend to the breathing
Expand awareness to include the entire body and the whole experience Respond mindfully instead of reactively
Anywhere, anytime, any place
*Based
MBRP (Bowen et al., 2009)
Urge-Surfing Urge-Surfing
*Based
MBRP (Bowen et al., 2009)
Mindfulness Exercises (From ACT) Mindfulness Exercises (From ACT)
Metaphors Such as “the unwelcome neighbor” Exercises Acceptance Journal Mindfulness Meditation Experiential exercises (clipboard) Meditation – Scripted or Informal Metaphors Such as “the unwelcome neighbor” Exercises Acceptance Journal Mindfulness Meditation Experiential exercises (clipboard) Meditation – Scripted or Informal
(Harris, 2009)
ACT – Mindfulness Exercises ACT – Mindfulness Exercises
Take Ten Breaths Slow, deep breaths, breathing out as slowly as possible; allow them to refill by themselves Notice all the bodily sensations Let your thoughts come and go like passing cars Expand your awareness Take Ten Breaths Slow, deep breaths, breathing out as slowly as possible; allow them to refill by themselves Notice all the bodily sensations Let your thoughts come and go like passing cars Expand your awareness
(Harris, 2009)
ACT Mindfulness Exercises ACT Mindfulness Exercises
(Harris, 2009)
ACT- Mindfulness Exercises ACT- Mindfulness Exercises
(Harris, 2009)
ACT- Mindfulness Exercises ACT- Mindfulness Exercises
Some people find it helpful to silently say to themselves, “I don’t like this feeling, but I have room for it.” or “It’s unpleasant, but I can accept it.”
Some people find it helpful to silently say to themselves, “I don’t like this feeling, but I have room for it.” or “It’s unpleasant, but I can accept it.”
Commitment Techniques Commitment Techniques
Commitment Exercises Commitment Exercises
Metaphors Titanic Bicycle Exercises Bull’s Eye Exercises Miracle Question Anniversary Party Metaphors Titanic Bicycle Exercises Bull’s Eye Exercises Miracle Question Anniversary Party
Timeline Exercise (Villatte, 2010) Timeline Exercise (Villatte, 2010)
Get present Imagine you have a red marker and put an “X” on the timeline the first time the pain appeared. Slowly move forward on that timeline, making a red mark each time pain was present in your life. As you look at the painful moments, can you sense a common thread there? Was there disappointment? Loss? Rejection? Fear? Betrayal? Even though the pain occurred at different times and in different circumstances, can you see some connection there? As you think about the pain you’ve experienced in your life, you may notice some resistance- an urge to erase it or cover it up. Think about all the ways you’ve tried to escape from the pain in your life. Any attempt to hide it or forget about it, the ways you may have bended or distorted your time line in an effort to get rid of the pain or any chance you might encounter it again. Now imagine you also have a big, black permanent marker and cross out any part of that timeline where you struggled with your pain. These black marks may be short, representing moments or days of
Get present Imagine you have a red marker and put an “X” on the timeline the first time the pain appeared. Slowly move forward on that timeline, making a red mark each time pain was present in your life. As you look at the painful moments, can you sense a common thread there? Was there disappointment? Loss? Rejection? Fear? Betrayal? Even though the pain occurred at different times and in different circumstances, can you see some connection there? As you think about the pain you’ve experienced in your life, you may notice some resistance- an urge to erase it or cover it up. Think about all the ways you’ve tried to escape from the pain in your life. Any attempt to hide it or forget about it, the ways you may have bended or distorted your time line in an effort to get rid of the pain or any chance you might encounter it again. Now imagine you also have a big, black permanent marker and cross out any part of that timeline where you struggled with your pain. These black marks may be short, representing moments or days of
those red ticks, representing each painful moment you have lived, and the thick black marks, representing all the attempts to avoid or escape your pain. What is the score in this battle? Has the black effectively wiped out the red?
have? What emotions are present? What thoughts? Sensations?
marks (crossing out days, weeks, or even years of your life)...ask yourself this...what if it were true? That your experience is actually correct? No matter how hard you try, you will never be free of that pain. That for as long as you are you, your life will be marked at times with red. (PAUSE)
line will be or when the next red tick will show up. And here you stand, with a black permanent marker. What would it be like to walk away from the battle and embrace the complexity of life, periodically marked with pain, but not distorted by costly struggle? In what direction will that line move? What will fill all of those moments that previously would have been crossed out with black?
those red ticks, representing each painful moment you have lived, and the thick black marks, representing all the attempts to avoid or escape your pain. What is the score in this battle? Has the black effectively wiped out the red?
have? What emotions are present? What thoughts? Sensations?
marks (crossing out days, weeks, or even years of your life)...ask yourself this...what if it were true? That your experience is actually correct? No matter how hard you try, you will never be free of that pain. That for as long as you are you, your life will be marked at times with red. (PAUSE)
line will be or when the next red tick will show up. And here you stand, with a black permanent marker. What would it be like to walk away from the battle and embrace the complexity of life, periodically marked with pain, but not distorted by costly struggle? In what direction will that line move? What will fill all of those moments that previously would have been crossed out with black?
What do you value? What do you value?
www.theactmatrixacademy.co m www.theactmatrixacademy.co m
Clinical Considerations Clinical Considerations
Mindfulness & Spirituality Mindfulness & Spirituality
“Mindfulness meditation can foster an increased sense of spirituality by disengaging self- focus and engaging in a broader view of interconnectedness in which oneself is seen as not separate from the other people and the world” (Greeson et al., 2011 p. 508) In participants who completed mindfulness-based stress reduction, daily spiritual experiences enhanced by mindfulness played a role in mental health improvements (Greeson et al., 2011) Mindfulness interventions have been demonstrated to enhance presence of meaning in life of participants in a study of college students (Bloch et al, 2017) “Mindfulness meditation can foster an increased sense of spirituality by disengaging self- focus and engaging in a broader view of interconnectedness in which oneself is seen as not separate from the other people and the world” (Greeson et al., 2011 p. 508) In participants who completed mindfulness-based stress reduction, daily spiritual experiences enhanced by mindfulness played a role in mental health improvements (Greeson et al., 2011) Mindfulness interventions have been demonstrated to enhance presence of meaning in life of participants in a study of college students (Bloch et al, 2017)
Mindfulness & Spirituality Mindfulness & Spirituality
Several studies have found integrating spirituality into mediation improves
Pargament, 2005, 2008) Meditation has been an integral part of several of the world’s religion’s spiritual paths eg: Mantra meditation, contemplative prayer, centering payer Spirituality is associated with decreased drug and alcohol for individuals with substance use disorders (Robinson et al., 2007; Katsogianni et al., 2015) Several studies have found integrating spirituality into mediation improves
Pargament, 2005, 2008) Meditation has been an integral part of several of the world’s religion’s spiritual paths eg: Mantra meditation, contemplative prayer, centering payer Spirituality is associated with decreased drug and alcohol for individuals with substance use disorders (Robinson et al., 2007; Katsogianni et al., 2015)
Mindfulness & The Purposeful Life Mindfulness & The Purposeful Life
Mindfulness as an Existential Intervention Mindfulness as an Existential Intervention
Mindfulness allows individuals to engage in their life’s experience to the fullest Mindfulness meditation and existential theory are both concerned with exploring human existence Both acknowledge impermanence, uncertainty, suffering and death Mindfulness can allow for transcendent experiences congruent with finding a sense of meaning in life Mindfulness allows individuals to engage in their life’s experience to the fullest Mindfulness meditation and existential theory are both concerned with exploring human existence Both acknowledge impermanence, uncertainty, suffering and death Mindfulness can allow for transcendent experiences congruent with finding a sense of meaning in life
Diversity Factors Diversity Factors
Mindfulness is been demonstrated to be culturally appropriate intervention for many diverse groups and its focus on stress reduction may benefit individuals who disproportionately face race-related stressors (Greenfield et al., 2018) However, People of Color benefited less from MBRP when in groups that were majority White Thus, counselors should focus on building group cohesion to improve trust and safety in the group (Greenfield et al., 2018) Mindfulness is been demonstrated to be culturally appropriate intervention for many diverse groups and its focus on stress reduction may benefit individuals who disproportionately face race-related stressors (Greenfield et al., 2018) However, People of Color benefited less from MBRP when in groups that were majority White Thus, counselors should focus on building group cohesion to improve trust and safety in the group (Greenfield et al., 2018)
Trauma-Informed Mindfulness Trauma-Informed Mindfulness
Pre-screen for trauma Environmental factors (e.g. lighting) Check-ins with individuals with trauma Establish norms of confidentiality and safety Allow clients to keep opt-out or keep eyes open during meditation Assist clients with finding suitable anchor that won’t trigger anxiety Watch for dissociation (Treleaven, 2017) Pre-screen for trauma Environmental factors (e.g. lighting) Check-ins with individuals with trauma Establish norms of confidentiality and safety Allow clients to keep opt-out or keep eyes open during meditation Assist clients with finding suitable anchor that won’t trigger anxiety Watch for dissociation (Treleaven, 2017)
Trauma-Informed (cont) Trauma-Informed (cont)
Incorporate mindful movement exercises Provide choices rather than directives Assist participants with learning “grounding skills” Educate yourself about trauma Build relationships with trauma professionals (Treleaven, 2017) Incorporate mindful movement exercises Provide choices rather than directives Assist participants with learning “grounding skills” Educate yourself about trauma Build relationships with trauma professionals (Treleaven, 2017)
Hurdles of a Consistent Meditation Practice Hurdles of a Consistent Meditation Practice
Time Access to a teacher/community Procrastinating/lack of motivation Resistance Doubt or confusion Adherence research Time Access to a teacher/community Procrastinating/lack of motivation Resistance Doubt or confusion Adherence research
Facilitating Group Meditation Facilitating Group Meditation
Focus on teaching basic meditation posture Assist clients learn to find comfortable position where they are balanced and aligned Help clients select meditation “anchor” E.g. the breathe, sensations throughout the body, a mantra Normalize distraction and difficulties Meditation takes a life time to master Emphasize self-compassion You are doing it right as long as you are making an effort to stay balanced, alert, and present Focus on teaching basic meditation posture Assist clients learn to find comfortable position where they are balanced and aligned Help clients select meditation “anchor” E.g. the breathe, sensations throughout the body, a mantra Normalize distraction and difficulties Meditation takes a life time to master Emphasize self-compassion You are doing it right as long as you are making an effort to stay balanced, alert, and present
Sample Curriculum: Lessons 1-4 Sample Curriculum: Lessons 1-4
Session one: Automatic pilot and relapse; provide rationale for its relevance (e.g. increasing awareness of patterns of thoughts, feelings and behaviors leading to addiction); practice mindfulness of breathing 8-10 minutes Session two: Awareness of triggers and craving; Recognizing thoughts and emotions in relation to triggers; psychoeducation on addiction; guided body-scan meditation 20 minutes; Session three: Integrating mindfulness in daily life; awareness of hearing; discuss home-based practice; urge-surfing meditation 20 minutes Session four: Mindfulness in high-risk situations; analyze underlying needs that drive urges to react (e.g. stress reduction and affect regulation; “staying with discomfort and pausing before reacting”; clients learning SOBER breathing space
*Based on MBRP (Bowen et al., 2009)
Session one: Automatic pilot and relapse; provide rationale for its relevance (e.g. increasing awareness of patterns of thoughts, feelings and behaviors leading to addiction); practice mindfulness of breathing 8-10 minutes Session two: Awareness of triggers and craving; Recognizing thoughts and emotions in relation to triggers; psychoeducation on addiction; guided body-scan meditation 20 minutes; Session three: Integrating mindfulness in daily life; awareness of hearing; discuss home-based practice; urge-surfing meditation 20 minutes Session four: Mindfulness in high-risk situations; analyze underlying needs that drive urges to react (e.g. stress reduction and affect regulation; “staying with discomfort and pausing before reacting”; clients learning SOBER breathing space
*Based on MBRP (Bowen et al., 2009)
Sample Curriculum: Lesson 4-8 Sample Curriculum: Lesson 4-8
Session five: Acceptance and skillful actions; Discussion of theme, mindful movement; SOBER breathing space Session six: Seeing thoughts as thoughts; thoughts and relapse discussion; practice mindful breathing meditation Session seven: Self-care and lifestyle balance; practice loving kindness meditation; discuss “where does relapse begin?” ; practice body scan meditation Session eight: Social Support and continuing practice; discuss plans for continued practice; concluding meditation; and closing circle Based on MBRP (Bowen et al., 2009) Session five: Acceptance and skillful actions; Discussion of theme, mindful movement; SOBER breathing space Session six: Seeing thoughts as thoughts; thoughts and relapse discussion; practice mindful breathing meditation Session seven: Self-care and lifestyle balance; practice loving kindness meditation; discuss “where does relapse begin?” ; practice body scan meditation Session eight: Social Support and continuing practice; discuss plans for continued practice; concluding meditation; and closing circle Based on MBRP (Bowen et al., 2009)
Running a Successful Program Running a Successful Program
Integrating group discussions and encouraging group cohesion Modeling mindfulness characteristics (e.g. presence and non-judgment) Providing resources for clients to practice guided meditation at home (CD’s, websites, books etc.) Encourage continued practice at home Research finds that the more meditation practice is done at home by clients the less likely they are to experience relapse and cravings (Grow et al., 2015) Utilize homework assignments (e.g. journaling about triggers; taking a mindful walk) Integrating group discussions and encouraging group cohesion Modeling mindfulness characteristics (e.g. presence and non-judgment) Providing resources for clients to practice guided meditation at home (CD’s, websites, books etc.) Encourage continued practice at home Research finds that the more meditation practice is done at home by clients the less likely they are to experience relapse and cravings (Grow et al., 2015) Utilize homework assignments (e.g. journaling about triggers; taking a mindful walk)
Clinician Resources Clinician Resources
The developers of MBRP offer 5-day intensive trainings, books, and training DVDs http://www.mindfulrp.com/For-Clinicians.html Books: ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy by Russ Harris Mindfulness-Based Relapse Prevention for Addiction: A Clinicians’ Guide by Sarah Brown and Neha Chawla Mindfulness retreats (many offer CEUs for clinicians!!!) The developers of MBRP offer 5-day intensive trainings, books, and training DVDs http://www.mindfulrp.com/For-Clinicians.html Books: ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy by Russ Harris Mindfulness-Based Relapse Prevention for Addiction: A Clinicians’ Guide by Sarah Brown and Neha Chawla Mindfulness retreats (many offer CEUs for clinicians!!!)
Resources for Clients Resources for Clients
MBRP offers a directory of trained clinicians and free audio meditations http://www.mindfulrp.com/For-Clients.html Mindfulness smart-phone apps: Insight timer; Headspace; Calm; Stop, Breathe & Think; Craving to Quit
Books:
Mindfulness for Beginners: Reclaiming the Present moment and your life by Jon Kabat-Zinn Community mindfulness groups Refuge Recovery: A Buddhist-based Recovery Group MBRP offers a directory of trained clinicians and free audio meditations http://www.mindfulrp.com/For-Clients.html Mindfulness smart-phone apps: Insight timer; Headspace; Calm; Stop, Breathe & Think; Craving to Quit
Books:
Mindfulness for Beginners: Reclaiming the Present moment and your life by Jon Kabat-Zinn Community mindfulness groups Refuge Recovery: A Buddhist-based Recovery Group
Concluding thoughts Concluding thoughts
Mindfulness-based therapy can be adapted for clients with addictions in individual and group formats Mindfulness can be offered in a stand-alone course or offered in conjunction with other evidenced-based treatment approaches Clinicians can use mindfulness appropriately by assessing client’s trauma history, offering multiple approaches to meditation, and integrating the client’s spirituality into treatment Mindfulness-based therapy can be adapted for clients with addictions in individual and group formats Mindfulness can be offered in a stand-alone course or offered in conjunction with other evidenced-based treatment approaches Clinicians can use mindfulness appropriately by assessing client’s trauma history, offering multiple approaches to meditation, and integrating the client’s spirituality into treatment
Contact Us Contact Us
Alexander Hilert – ajhilert@email.wm.edu Daniel Gutierrez – dgutierrez@wm.edu New Leaf Clinic - Phone: 757-221-2363 Email: newleaf@wm.edu Alexander Hilert – ajhilert@email.wm.edu Daniel Gutierrez – dgutierrez@wm.edu New Leaf Clinic - Phone: 757-221-2363 Email: newleaf@wm.edu
References References
Grow, J., Collins, S. E. Harrop, E.N., & Marlatt, G. A. (2015). Enactment of home practice following mindfulness-based relapse prevention and its association with substance-use
Li, W., Howard, M. O., Garland, E. L., & Lazar, M. (2017). Mindfulness treatment for substance misuse: A systematic review and meta-analysis. Journal of Substance Abuse Treatment, 75, 62-96. Witkiewitz, K., Greenfield, B. L., & Bowen, S. (2013). Mindfulness-based relapse prevention with racial and ethnic minority women.Addictive Behaviors, 38(12), 2821-2824. Grow, J., Collins, S. E. Harrop, E.N., & Marlatt, G. A. (2015). Enactment of home practice following mindfulness-based relapse prevention and its association with substance-use
Li, W., Howard, M. O., Garland, E. L., & Lazar, M. (2017). Mindfulness treatment for substance misuse: A systematic review and meta-analysis. Journal of Substance Abuse Treatment, 75, 62-96. Witkiewitz, K., Greenfield, B. L., & Bowen, S. (2013). Mindfulness-based relapse prevention with racial and ethnic minority women.Addictive Behaviors, 38(12), 2821-2824.