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Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
MiT FOR TRAUMA DISORDERS
Cameron Aggs Clinical Psychologist & Director
Mindfulness Training Australia
cam@bemindful.com.au
Sponsored by The Belfast Trust
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Overview
• Session 1:
– Overview of mindfulness and key concepts
– Experiential exercises: 3MBS, 2H and 4B techs
• Session 2:
– Mindfulness in the context of trauma
– Mindfulness and case formulation
• Session 3:
– Mindfulness and the psychotherapy relationship
– Facilitating the 3MBS, 2h and 4B techs
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Materials and Process
• Slides
• Experiential activities
– Participate as much as you feel comfortable
– Respect one another’s confidentiality
– Volunteering for demonstrations
• Choose a client to keep in mind
• Password resources
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Begin with the end in mind
• Safety, Safety, Safety
• Mindfulness should be embodied (RB2RB)
• Mindfulness and process: Deepening the clinical narrative
• No 1 Mindfulness Target: Enhancing a willingness to feel into
and to safely experience SIFT experiences
– Importance of the breath
– Relevance of Self-As-Context
• Know your mechanisms!
• Find your entry point. Scaffold.
• Make sure you have enough resources to build the
capacities you are seeking to foster
• Make sure you can do what you are asking of your clients.
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
4Breaths Technique
Coming into a state of presence:
• Lightly, mindfully watching the breath
• Coordinating with the fingers: Motor-
movement
• Rounds of 4
“These 4-Breaths are Mine”
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
What does mindfulness mean to you ?
Copyright (c) 2013 Mindfulness Training
Australia, All Rights Reserved | MiT -
Mindfulness Informed Therapy
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
“Bringing one’s complete attention to the
experiences occurring in the present
moment, in a nonjudgmental or accepting
way”
(Brown & Ryan, 2003; Kabat-Zinn, 1990).
What is Mindfulness?
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Our “map”:
IAA model of mindfulness
(Shapiro et al., 2006)
Intention
Attention Attitude
Paying attention in a particular way…
Kabat-Zinn, 1994, p4
and non-judgmentally.
on purpose, in the present moment,
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Holding in Mind: Intentions
• What do you want from mindfulness?
• This moment…?
• This meditation / workshop / this session…?
• More generally inc this treatment episode?
Tip #1: Mindfulness is an intentional activity
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Attending Skills
Placing your attention where you want it…
• Attentional placement:
– Shifting and sustaining attention
• Non-judgmental Awareness
– Inhibiting secondary appraisals
• Noticing and Naming
– Ability to put inner experience into words
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
The process of mindfulness
(the WHAT and HOW)
Noticing and naming
with mindful attitudes
(internal & external
experiences)
Letting go (creating
space)
Focus/Re-focus
attention
Choose an aspect of
internal or external
experience to focus
attention on
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Attending:
• Using your faculty of attention as a tool:
Disengaging from worry and rumination
• Fostering Internal Attunement / Meta-CognItive
Awareness: What’s happening for me now..?
• The ability to come into a state of “Presence”
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
3 Qualities of Presence
• Light: As in buoyant in the Mind
– Unencumbered by past and future and fixation
• Relaxed: As in soft in the body
– Particularly the belly, chest, shoulders, jaw
• Grounded: The bum in the chair and the feet on the
floor
– Mind ‘riding’ the breath
Light. Relaxed. Grounded.
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Presence…
“The mind if not stirred, will become clear”
Sogyal Rinpoche
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
4Breaths Technique
Coming into a state of presence:
• Lightly, mindfully watching the breath
• Coordinating with the fingers: Motor-
movement
• Rounds of 4
• Combine with FBB technique
“These 4-Breaths are Mine”
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindful Attitudes: More than just
Attention
The anaesthetic of internal attunement….
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Attitudes
GOAL
• Curiosity :
• Openness
• Acceptance
• Love
Metaphor / key principles
• Curious Explorer
• “It is already here: Let me
feel it
• As an active state
• Friendliness
Saying ‘Yes’ to Experience
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
3 Minute Breathing Space = Making a Space for
What is Happening now
Step 1: Taking stock / Gathering the mind
Step 2: Focusing and redirecting the attention
Step 3: Expanding awareness and returning
Hot tip: Bookmark: youtube “3 minute breathing space” (it’s the
first one that comes up)
Experiential Exercise: 3MBS:
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
I-SIFT
• I (me)
• Sensations
• Images
• Feelings
• Thoughts
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
MINDFULNESS: COMPONENTS AND
CENTRAL CONCEPTS
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Central Concepts
• The ubiquity of human suffering
• Internal experiences are transient and change
with time
• Thoughts and emotions are not facts
• Though some are very ‘sticky’
• They happen within a larger context: The Space
of the Mind
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
A Central task
• To disengage from fixation on verbally-based
mental content and fusion with emotional
material
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
And again…
“The mind if not stirred will become clear”
-Sogyal Rinpoche
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
But!
• Before ‘Letting-Go’, of thoughts we must learn
to ‘Be-With’ our primary emotional
experiences
Saying ‘Yes’ to experience
- Tara Brach
“It’s already here…. Let me feel it”
-John Kabat-Zinn
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
‘Being – With’
• Special relevance to anxiety disorders…
• Feeling into
• Going deeper….
• Making a space
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
BREAK! 
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Review…
Mindfulness is the capacity to come into a
state of presence, to not be overly judgmental
/ non-catastrophic about our encounters with
suffering, and to make space for whole range
of affective life, with the confidence that it is a
SIFT experiences are passing on through….
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Correlational Research
Greater mindfulness
associated with higher:
• Healthy self-regulation
• Emotion regulation
• Positive affect
• Quality of life & life
satisfaction
• Social skills
• Relationship Satisfaction
• Academic competence
Mindfulness interventions
resulting in greater:
• Feelings of calm/relaxation
• Social skills
• Personal and social well-
being
• Self-esteem and self-
acceptance
• Awareness and recognition
of types of emotions
• Self-efficacy for reducing
substance use
• Sleep quality
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindfulness: Does it Matter?
Greater mindfulness
associated with lower:
• Depressive symptoms
• Anxiety
• Stress
• Internalizing symptoms
• Externalizing behaviour
problems
• Worry and rumination
• Negative affect
• Substance use coping
• Somatic complaints
• Psychological inflexibility and
thought suppression and
control
Mindfulness interventions
resulting in lower:
• Depressive symptoms and low
mood
• Anxiety
• Stress
• Internalizing symptoms
• Externalizing behaviour
problems
• Difficulties with emotion
regulation
• Problem behaviours in the
classroom
• Keng, S.L. (2011). Effects of mindfulness on
psychological health: A review of empirical studies.
Clinical Psychology Review. 31, 1041-1056
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
What: spectrum of mindfulness-informed interventions
Mindfulness-informed interventions
• Acceptance and Commitment
Therapy (ACT)
• Dialectical Behaviour Therapy –
adolescents (DBT-A)
• Individualised intervention plan: (e.g.
MiT)
Mindfulness-based interventions
• Mindfulness-based stress
reduction (MBSR)
• Mindfulness-based cognitive
therapy (MBCT)
• Independently developed
mindfulness programs (MiCBT)
Embodying and modelling of mindfulness with clients
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Modelling Mindfulness,
Psychotherapy Process
Mindfulness Informed Therapy
Mindfulness as
metaphor, psychoeducation and
technique
 Adults and children
 Increasing capacity with age (and development) for children to engage in
independent mindfulness practice
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindfulness and Psychotherapy
Process: Clinical Algorithm
Client Characteristics:
• What is the client’s presenting problem?
• Severity and Level of impairment?
• Stage of Change?
• Client’s theory of Change
• Character organisation?
- Courtesy, Joe Coyne
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindfulness and Therapist Factors
• Theoretical orientation
• Level of training and supervision
• Clinical assumptions
• Presence of a personal practice
• How we deal with our own suffering
• Access to Resources
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindfulness and Systemic Factors
• Nature of the Services
• Type and scope of intervention
• Frequency of Contact
• Broader social, economic ecology
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
My Clinical Assumptions
• The Importance of Following the clients lead:
What moment is this?
• Live Company: A mind-minded other..
• Psychotherapy as Co-regulation
• Behavioural Activation
• Scaffolding:
• Importance of Understanding Mechanisms
• Entry Point >>>> Consolidating Gains
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindfulness and Trauma….
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
What is Trauma
“Any circumstance in which an event, or series of
events, overwhelms a person’s capacity to protect his
or her psychic well-being or integrity, where the
power of the event is greater than the resources
available for effective response and recovery.”
Cloitre, Cohen & Koenen (2006)
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Single Incident trauma
Large-T (Single Incident)
• Car accidents
• Sexual Assault
• Natural Disaster
• Exposure to combat
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Complex Trauma
Small-”t” (chronic)
- Trauma that occurs repeatedly and
cumulatively, usually over a period of time and
within specific relationships and contexts
(Courtois, 2004)
- Chronic missatunement by attachment
figures, neglect, child abuse
- ‘The Troubles’
- Response of Self (ROS) matters
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Three Clusters of PTSD
• Re-experiencing: Recurrent or intrusive
recollections, distressing dreams
• Avoidance of stimuli: Numbness, thought
suppression, experiential avoidance
• Hyperarousal:
insomnia, irritability/anger, difficulty
concentrating, hypervigliance, (Fairbank et
al., 2001)
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Experiential Avoidance: The Primary
Target of MiT
• Posttraumatic symptoms are developed and
maintained by experiential avoidance (EA)
• EA: Defined as an unwillingness to experience
unwanted internal events.
• Habitual attempts to avoid trauma-related
thoughts, emotions and memories lead to the
core symptoms of PTSD.
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Experiential Avoidance**
In both undergraduate and combat-exposed
samples, experiential avoidance was found to be a
stronger predictor of current psychological distress
than was the severity of the index trauma and previous
psychological distress!
Plumb, Orsillo, & Luterek, 2004
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mechanisms of Change: You Are Safe Now
A Biopsychosocial Approach
Biologically:
• Relaxation Response:
Parasympathetic Nervous System Activation
• Diaphramatic breathing:
Optimal Oxygen / Carbon Dioxide ratio
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
You are safe now…
Psychologically
– Present moment awareness: The trauma is past
– Non-judgmental assimilation of trauma into
coherent narrative (importance of psychotherapy
relationship
– Thoughts / feelings / memories can be felt and
observed
– Observing Self / Sense of Agency
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
You Are Safe Now
Socially
– Enhancing capacity for social meditation
– Effective engagement in relationships
– Values based living
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mechanisms of Change: Exposure
Safety Exposure Emotional Processing
Repeated Exposure Mastery
• Biologically
• The Breath: Entering the relaxation response
• Decreasing stress and tension in the body
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Exposure
Psychologically
• Feelings can be felt, memories can be integrated into
coherent narrative
– Ie inner experiences can be felt, named, and shared
• One-moment at a time
• Curious Explorer: SIFT
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Exposure
Relationally
• The Therapy Relationship is safe:
– Mind Minded,
– Accurate Attunement: Following Lead
– Containing
– At the client’s pace
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Clinical Markers **
• Viewing, trauma-related thoughts and feelings from a
nonjudgmental perspective,
• Increase their contact with the present moment: The
trauma is not now.
• A felt awareness that thought suppression, avoidance
etc is unnecessary and counter productive
• Behavioural Activation / Acting with Awareness:
Moving on into a values congruent future
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindfulness and Treatment Planning
• Safety
• Embodied Mindfulness
• Mindfulness and the Working Alliance
• Assessment
• PsychoEducation
• Mindfulness as Metaphore / Deepening the
Narrative
• Experiential
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindfulness and Treatment Planning
• Find your entry point
• Start somewhere – review and revisit
• Scaffolding new parts of mindfulness in line with
unfolding treatment trajectory and
understanding of mechanisms of mindfulness.
• Link in session activities to homework exercises.
• Practice. Practice. Practice.
• Be curious every session - track the client
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Safety
The theory:
• Appreciation for the impact of (particularly complex)
trauma on the ability to use relationships productively
and ‘feel into’ experience
• The ambiguous nature of mindfulness
• Radical departure from usual way of being / defensive
structures
The Practice:
• POC Exercise: Agency
• Eyes Open Modification
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindfulness Practice: 2 Hands
• Place one hand is on the chest and the other
hand on the abdomen.
• Breathe and notice:
– Where is the breath moving?
– Is the breath deep or shallow? Fast or slow?
– Which hand is moving more?
• Rate our of 100%
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
POC: Points of Contact – Inward focus
Noticing the feeling of your feet on the floor, bottom
in the chair and your breathing…
For clients:
• Engenders safety (groundedness and an ‘inward
focus’
• De-stabilising aspect of mindfulness practice
• Deepens the impact of the therapy
relationship, potentiates the therapy hour
For the therapist:
• The how of ‘Therapeutic Presence’
• Enables frustration tolerance
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Practice!
• Coach each other through the P.O.C > 2Hands
• Provide a rationale: Link to assessment and
ongoing socialisation process
• Encourage partner (You are fostering a
trajectory to end in a sense of Mastery)
• Provide feedback
• Swap
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindfulness as Assessment
• Assess trauma type and severity
• What is the clients theory of change, level of
impairment etc?
• Mindfulness and a sense of agency and safety
– Modifying Points of Contact exercise
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Psychoeducation: IAA terms
Intention
Attention Attitude
Focusing/refocusing on the here
and now
Noticing and naming
Letting go and creating space
Checking in
Curiosity
Kindness
Willingness
Choosing
Slowing down
Remembering
Knowing why
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Psycho-Education: Know your
Mechanisms!
Self-Compassion
DefusionPositive Affect
Acceptance
Interoceptive
Exposure
Agency
RelaxationAttention Switching
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Psycho-Education: Acceptance
Acceptance is an intentional activity…
Saying “Yes” to experience
- Tara Brach
“It’s already here…. Let me feel it”
-John Kabat-Zinn
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindfulness & Metaphor
• Using metaphors to illustrate and explore mindfulness concepts
– Keep it simple and Don’t overload with too many or varied metaphors
Metaphor Target area
Clouds in the sky Self as Context: Interoceptive Experiences are safe
Leaves on a stream /
River Bank
Internal experiences are constantly changing + Observer Self
Training the Puppy Gentle and Firm orientation to attentional control. Forming a
relationship with the self
Narrowing focus –
widening lense
Attention is a tool
‘Turning Towards’,
Saying ‘Yes’
Mobilising acceptance in behavioral terms
Train of thought Internal experiences are constantly changing
Making space /
feeling into…
Mobilising acceptance in behavioral terms
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Potential Experiential Mindfulness
Trajectory
• 2 Hands >>> P.O.C >>>> 4 Breaths >>>
• 3Rs >>> 3MBS >>>
• Breathing Meditation >>>> Body Scan
>>>>Sitting with discomfort
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Mindfulness Practices:
4 Breaths or Breath Counting
4 Breaths
• With each breath touch the thumb to
finger-tip and note an experience. As
you begin a new breath move your
thumb to the next finger.
• Notice (with curiousity):
– 4 breaths
– 4 external experiences
• sensory information like
sights, sounds, smells, what they are
touching
– 4 internal experiences
• thoughts feelings, body
sensations, urges
– A combination of internal and external
experiences
• The process of ‘letting go’ by moving
your fingers physically ‘creates space’.
Breath Counting
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Clinical Uses for Meditation
• Selling meditation: Finding a way of talking about meditation
that makes sense.
• Constraining gains: starting with FBB +4B
• To focus a session: Do at Beginning
– Establish a narrative for this early on and stick with it.
• As treatment: Emotional processing, attention
training, synergies with schema-focused and cognitive work
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
• As homework: Start with diaphragmatic
breathing (Crawl and/or two breaths) prior to
doing guided meditations
• Using meditation like a Personal Trainer.
Discourse: Building neural circuits
• Trajectory:
– Start with Body scan (relaxation
– > breathing meditation (attention regulation),
– > noticing thoughts and feelings (meta-cognitive
awareness
– > guided imagery (creating a safe place)
– > sitting with discomfort (interoceptive exposure /
emotional processing
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Meditation-Check list: Learning
Opportunities
Attention
• Thoughts will continue to be there and that is okay
• You can learn to let go of thoughts
Attitude
• Things are okay as they are
Experiential
• The present moment is a nice place to hang out
• Your ally is close at hand: Diaphragmatic breathing:
Long, deep and slow
• Feeling it at a physical level
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
In-session meditation: Emotional Processing
• Discuss a worry - Find the bottom line /what is the
essential message?
– Eg. “I am not good enough”
• Guide a meditation starting with relaxing into FBB
• Evoke the message: “Imagine it like a radio
station….”
• Notice feelings and body sensation. Special
attention to belly and chest.
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Using Metaphors
Clouds in the Sky
Mentally “placing” internal experiences (usually thoughts) on the object and
allow it to move (or not move) as it naturally wants to.
– Does … (object) stick around?
– Does it feel ok if … (object) is not moving on?
– Background (sky) is ‘observing self’/‘self-as-context’
– Noticing that the background can observe the objects that move through
it
– Are you the … (object) or the … (background)? *‘self-as-context’ rather
than ‘self-as-content’+
If the child has the capacity, you can link other internal experiences (e.g.,
feelings) to other objects/events that occur in the background
– Are you still able to be … (the background) even when … (feeling) is also
happening?
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
No Pest Control
(reactions happen)
• Imagine your distressing or unwanted
thoughts, feelings, body sensations are like …
cockroaches…
• Being able to let the experience be…
– Not feeling bad that it is here
– Not trying to get rid of it
– Not running away from it
– Not letting the cockroaches control how you act
– Not trying to make the experience positive (e.g., a butterfly)
• Being ok with the experience coming and going… like
cockroaches running around you...
• Being able to notice the experience and still being able to
chose what to do
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Nature of Attention
Spotlight
• Shining light on where you
want to focus your attention
Puppy on a leash
• Like a puppy attention
naturally wanders (jumps
around)
• It takes time to train a puppy
(attention) to be able stay in
the one place for any length of
time
• Getting angry at the puppy
doesn’t help
• Be kind to your wandering
mind
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Train of thought
• Thoughts don’t stop and they often jump from
one topic to another.
• The train of thought can be fast or slow
• Creating Space: “Are you standing on the
platform or are you riding on the train?”
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Thought Parade
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Take Home Summary
• Safety, Safety, Safety
• Mindfulness should be embodied (RB2RB)
• Deepening the clinical narrative
• Enhancing a willingness to feel into and to safely
experience SIFT experiences
– Importance of the breath
– Relevance of Self-As-Context
• Know your mechanisms: Password Resources
• Find your entry point. Build from there.
• Make sure you have enough resources to build
the capacities you are seeking to foster
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
Thank You!
More information at www.bemindful.com.au
Email me: cam@bemindful.com.au

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MiT-T - Mindfulness Informed Therapy for Trauma disorders

  • 1. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au MiT FOR TRAUMA DISORDERS Cameron Aggs Clinical Psychologist & Director Mindfulness Training Australia cam@bemindful.com.au Sponsored by The Belfast Trust
  • 2. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Overview • Session 1: – Overview of mindfulness and key concepts – Experiential exercises: 3MBS, 2H and 4B techs • Session 2: – Mindfulness in the context of trauma – Mindfulness and case formulation • Session 3: – Mindfulness and the psychotherapy relationship – Facilitating the 3MBS, 2h and 4B techs
  • 3. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Materials and Process • Slides • Experiential activities – Participate as much as you feel comfortable – Respect one another’s confidentiality – Volunteering for demonstrations • Choose a client to keep in mind • Password resources
  • 4. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Begin with the end in mind • Safety, Safety, Safety • Mindfulness should be embodied (RB2RB) • Mindfulness and process: Deepening the clinical narrative • No 1 Mindfulness Target: Enhancing a willingness to feel into and to safely experience SIFT experiences – Importance of the breath – Relevance of Self-As-Context • Know your mechanisms! • Find your entry point. Scaffold. • Make sure you have enough resources to build the capacities you are seeking to foster • Make sure you can do what you are asking of your clients.
  • 5. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au 4Breaths Technique Coming into a state of presence: • Lightly, mindfully watching the breath • Coordinating with the fingers: Motor- movement • Rounds of 4 “These 4-Breaths are Mine”
  • 6. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au What does mindfulness mean to you ? Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | MiT - Mindfulness Informed Therapy
  • 7. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au “Bringing one’s complete attention to the experiences occurring in the present moment, in a nonjudgmental or accepting way” (Brown & Ryan, 2003; Kabat-Zinn, 1990). What is Mindfulness?
  • 8. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Our “map”: IAA model of mindfulness (Shapiro et al., 2006) Intention Attention Attitude Paying attention in a particular way… Kabat-Zinn, 1994, p4 and non-judgmentally. on purpose, in the present moment,
  • 9. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Holding in Mind: Intentions • What do you want from mindfulness? • This moment…? • This meditation / workshop / this session…? • More generally inc this treatment episode? Tip #1: Mindfulness is an intentional activity
  • 10. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Attending Skills Placing your attention where you want it… • Attentional placement: – Shifting and sustaining attention • Non-judgmental Awareness – Inhibiting secondary appraisals • Noticing and Naming – Ability to put inner experience into words
  • 11. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au The process of mindfulness (the WHAT and HOW) Noticing and naming with mindful attitudes (internal & external experiences) Letting go (creating space) Focus/Re-focus attention Choose an aspect of internal or external experience to focus attention on
  • 12. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Attending: • Using your faculty of attention as a tool: Disengaging from worry and rumination • Fostering Internal Attunement / Meta-CognItive Awareness: What’s happening for me now..? • The ability to come into a state of “Presence”
  • 13. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au 3 Qualities of Presence • Light: As in buoyant in the Mind – Unencumbered by past and future and fixation • Relaxed: As in soft in the body – Particularly the belly, chest, shoulders, jaw • Grounded: The bum in the chair and the feet on the floor – Mind ‘riding’ the breath Light. Relaxed. Grounded.
  • 14. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Presence… “The mind if not stirred, will become clear” Sogyal Rinpoche
  • 15. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au 4Breaths Technique Coming into a state of presence: • Lightly, mindfully watching the breath • Coordinating with the fingers: Motor- movement • Rounds of 4 • Combine with FBB technique “These 4-Breaths are Mine”
  • 16. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindful Attitudes: More than just Attention The anaesthetic of internal attunement….
  • 17. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Attitudes GOAL • Curiosity : • Openness • Acceptance • Love Metaphor / key principles • Curious Explorer • “It is already here: Let me feel it • As an active state • Friendliness Saying ‘Yes’ to Experience
  • 18. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au 3 Minute Breathing Space = Making a Space for What is Happening now Step 1: Taking stock / Gathering the mind Step 2: Focusing and redirecting the attention Step 3: Expanding awareness and returning Hot tip: Bookmark: youtube “3 minute breathing space” (it’s the first one that comes up) Experiential Exercise: 3MBS:
  • 19. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au I-SIFT • I (me) • Sensations • Images • Feelings • Thoughts
  • 20. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au MINDFULNESS: COMPONENTS AND CENTRAL CONCEPTS
  • 21. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Central Concepts • The ubiquity of human suffering • Internal experiences are transient and change with time • Thoughts and emotions are not facts • Though some are very ‘sticky’ • They happen within a larger context: The Space of the Mind
  • 22. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au A Central task • To disengage from fixation on verbally-based mental content and fusion with emotional material
  • 23. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au And again… “The mind if not stirred will become clear” -Sogyal Rinpoche
  • 24. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au But! • Before ‘Letting-Go’, of thoughts we must learn to ‘Be-With’ our primary emotional experiences Saying ‘Yes’ to experience - Tara Brach “It’s already here…. Let me feel it” -John Kabat-Zinn
  • 25. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au ‘Being – With’ • Special relevance to anxiety disorders… • Feeling into • Going deeper…. • Making a space
  • 26. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au BREAK! 
  • 27. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Review… Mindfulness is the capacity to come into a state of presence, to not be overly judgmental / non-catastrophic about our encounters with suffering, and to make space for whole range of affective life, with the confidence that it is a SIFT experiences are passing on through….
  • 28. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Correlational Research Greater mindfulness associated with higher: • Healthy self-regulation • Emotion regulation • Positive affect • Quality of life & life satisfaction • Social skills • Relationship Satisfaction • Academic competence Mindfulness interventions resulting in greater: • Feelings of calm/relaxation • Social skills • Personal and social well- being • Self-esteem and self- acceptance • Awareness and recognition of types of emotions • Self-efficacy for reducing substance use • Sleep quality
  • 29. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindfulness: Does it Matter? Greater mindfulness associated with lower: • Depressive symptoms • Anxiety • Stress • Internalizing symptoms • Externalizing behaviour problems • Worry and rumination • Negative affect • Substance use coping • Somatic complaints • Psychological inflexibility and thought suppression and control Mindfulness interventions resulting in lower: • Depressive symptoms and low mood • Anxiety • Stress • Internalizing symptoms • Externalizing behaviour problems • Difficulties with emotion regulation • Problem behaviours in the classroom • Keng, S.L. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review. 31, 1041-1056
  • 30. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au What: spectrum of mindfulness-informed interventions Mindfulness-informed interventions • Acceptance and Commitment Therapy (ACT) • Dialectical Behaviour Therapy – adolescents (DBT-A) • Individualised intervention plan: (e.g. MiT) Mindfulness-based interventions • Mindfulness-based stress reduction (MBSR) • Mindfulness-based cognitive therapy (MBCT) • Independently developed mindfulness programs (MiCBT) Embodying and modelling of mindfulness with clients
  • 31. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Modelling Mindfulness, Psychotherapy Process Mindfulness Informed Therapy Mindfulness as metaphor, psychoeducation and technique  Adults and children  Increasing capacity with age (and development) for children to engage in independent mindfulness practice
  • 32. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindfulness and Psychotherapy Process: Clinical Algorithm Client Characteristics: • What is the client’s presenting problem? • Severity and Level of impairment? • Stage of Change? • Client’s theory of Change • Character organisation? - Courtesy, Joe Coyne
  • 33. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindfulness and Therapist Factors • Theoretical orientation • Level of training and supervision • Clinical assumptions • Presence of a personal practice • How we deal with our own suffering • Access to Resources
  • 34. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindfulness and Systemic Factors • Nature of the Services • Type and scope of intervention • Frequency of Contact • Broader social, economic ecology
  • 35. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au My Clinical Assumptions • The Importance of Following the clients lead: What moment is this? • Live Company: A mind-minded other.. • Psychotherapy as Co-regulation • Behavioural Activation • Scaffolding: • Importance of Understanding Mechanisms • Entry Point >>>> Consolidating Gains
  • 36. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindfulness and Trauma….
  • 37. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au What is Trauma “Any circumstance in which an event, or series of events, overwhelms a person’s capacity to protect his or her psychic well-being or integrity, where the power of the event is greater than the resources available for effective response and recovery.” Cloitre, Cohen & Koenen (2006)
  • 38. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Single Incident trauma Large-T (Single Incident) • Car accidents • Sexual Assault • Natural Disaster • Exposure to combat
  • 39. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Complex Trauma Small-”t” (chronic) - Trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts (Courtois, 2004) - Chronic missatunement by attachment figures, neglect, child abuse - ‘The Troubles’ - Response of Self (ROS) matters
  • 40. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Three Clusters of PTSD • Re-experiencing: Recurrent or intrusive recollections, distressing dreams • Avoidance of stimuli: Numbness, thought suppression, experiential avoidance • Hyperarousal: insomnia, irritability/anger, difficulty concentrating, hypervigliance, (Fairbank et al., 2001)
  • 41. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Experiential Avoidance: The Primary Target of MiT • Posttraumatic symptoms are developed and maintained by experiential avoidance (EA) • EA: Defined as an unwillingness to experience unwanted internal events. • Habitual attempts to avoid trauma-related thoughts, emotions and memories lead to the core symptoms of PTSD.
  • 42. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Experiential Avoidance** In both undergraduate and combat-exposed samples, experiential avoidance was found to be a stronger predictor of current psychological distress than was the severity of the index trauma and previous psychological distress! Plumb, Orsillo, & Luterek, 2004
  • 43. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mechanisms of Change: You Are Safe Now A Biopsychosocial Approach Biologically: • Relaxation Response: Parasympathetic Nervous System Activation • Diaphramatic breathing: Optimal Oxygen / Carbon Dioxide ratio
  • 44. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au You are safe now… Psychologically – Present moment awareness: The trauma is past – Non-judgmental assimilation of trauma into coherent narrative (importance of psychotherapy relationship – Thoughts / feelings / memories can be felt and observed – Observing Self / Sense of Agency
  • 45. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au You Are Safe Now Socially – Enhancing capacity for social meditation – Effective engagement in relationships – Values based living
  • 46. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mechanisms of Change: Exposure Safety Exposure Emotional Processing Repeated Exposure Mastery • Biologically • The Breath: Entering the relaxation response • Decreasing stress and tension in the body
  • 47. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Exposure Psychologically • Feelings can be felt, memories can be integrated into coherent narrative – Ie inner experiences can be felt, named, and shared • One-moment at a time • Curious Explorer: SIFT
  • 48. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Exposure Relationally • The Therapy Relationship is safe: – Mind Minded, – Accurate Attunement: Following Lead – Containing – At the client’s pace
  • 49. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Clinical Markers ** • Viewing, trauma-related thoughts and feelings from a nonjudgmental perspective, • Increase their contact with the present moment: The trauma is not now. • A felt awareness that thought suppression, avoidance etc is unnecessary and counter productive • Behavioural Activation / Acting with Awareness: Moving on into a values congruent future
  • 50. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindfulness and Treatment Planning • Safety • Embodied Mindfulness • Mindfulness and the Working Alliance • Assessment • PsychoEducation • Mindfulness as Metaphore / Deepening the Narrative • Experiential
  • 51. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindfulness and Treatment Planning • Find your entry point • Start somewhere – review and revisit • Scaffolding new parts of mindfulness in line with unfolding treatment trajectory and understanding of mechanisms of mindfulness. • Link in session activities to homework exercises. • Practice. Practice. Practice. • Be curious every session - track the client
  • 52. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Safety The theory: • Appreciation for the impact of (particularly complex) trauma on the ability to use relationships productively and ‘feel into’ experience • The ambiguous nature of mindfulness • Radical departure from usual way of being / defensive structures The Practice: • POC Exercise: Agency • Eyes Open Modification
  • 53. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindfulness Practice: 2 Hands • Place one hand is on the chest and the other hand on the abdomen. • Breathe and notice: – Where is the breath moving? – Is the breath deep or shallow? Fast or slow? – Which hand is moving more? • Rate our of 100%
  • 54. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au POC: Points of Contact – Inward focus Noticing the feeling of your feet on the floor, bottom in the chair and your breathing… For clients: • Engenders safety (groundedness and an ‘inward focus’ • De-stabilising aspect of mindfulness practice • Deepens the impact of the therapy relationship, potentiates the therapy hour For the therapist: • The how of ‘Therapeutic Presence’ • Enables frustration tolerance
  • 55. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Practice! • Coach each other through the P.O.C > 2Hands • Provide a rationale: Link to assessment and ongoing socialisation process • Encourage partner (You are fostering a trajectory to end in a sense of Mastery) • Provide feedback • Swap
  • 56. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindfulness as Assessment • Assess trauma type and severity • What is the clients theory of change, level of impairment etc? • Mindfulness and a sense of agency and safety – Modifying Points of Contact exercise
  • 57. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Psychoeducation: IAA terms Intention Attention Attitude Focusing/refocusing on the here and now Noticing and naming Letting go and creating space Checking in Curiosity Kindness Willingness Choosing Slowing down Remembering Knowing why
  • 58. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Psycho-Education: Know your Mechanisms! Self-Compassion DefusionPositive Affect Acceptance Interoceptive Exposure Agency RelaxationAttention Switching
  • 59. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Psycho-Education: Acceptance Acceptance is an intentional activity… Saying “Yes” to experience - Tara Brach “It’s already here…. Let me feel it” -John Kabat-Zinn
  • 60. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindfulness & Metaphor • Using metaphors to illustrate and explore mindfulness concepts – Keep it simple and Don’t overload with too many or varied metaphors Metaphor Target area Clouds in the sky Self as Context: Interoceptive Experiences are safe Leaves on a stream / River Bank Internal experiences are constantly changing + Observer Self Training the Puppy Gentle and Firm orientation to attentional control. Forming a relationship with the self Narrowing focus – widening lense Attention is a tool ‘Turning Towards’, Saying ‘Yes’ Mobilising acceptance in behavioral terms Train of thought Internal experiences are constantly changing Making space / feeling into… Mobilising acceptance in behavioral terms
  • 61. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Potential Experiential Mindfulness Trajectory • 2 Hands >>> P.O.C >>>> 4 Breaths >>> • 3Rs >>> 3MBS >>> • Breathing Meditation >>>> Body Scan >>>>Sitting with discomfort
  • 62. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Mindfulness Practices: 4 Breaths or Breath Counting 4 Breaths • With each breath touch the thumb to finger-tip and note an experience. As you begin a new breath move your thumb to the next finger. • Notice (with curiousity): – 4 breaths – 4 external experiences • sensory information like sights, sounds, smells, what they are touching – 4 internal experiences • thoughts feelings, body sensations, urges – A combination of internal and external experiences • The process of ‘letting go’ by moving your fingers physically ‘creates space’. Breath Counting
  • 63. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Clinical Uses for Meditation • Selling meditation: Finding a way of talking about meditation that makes sense. • Constraining gains: starting with FBB +4B • To focus a session: Do at Beginning – Establish a narrative for this early on and stick with it. • As treatment: Emotional processing, attention training, synergies with schema-focused and cognitive work
  • 64. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au • As homework: Start with diaphragmatic breathing (Crawl and/or two breaths) prior to doing guided meditations • Using meditation like a Personal Trainer. Discourse: Building neural circuits • Trajectory: – Start with Body scan (relaxation – > breathing meditation (attention regulation), – > noticing thoughts and feelings (meta-cognitive awareness – > guided imagery (creating a safe place) – > sitting with discomfort (interoceptive exposure / emotional processing
  • 65. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Meditation-Check list: Learning Opportunities Attention • Thoughts will continue to be there and that is okay • You can learn to let go of thoughts Attitude • Things are okay as they are Experiential • The present moment is a nice place to hang out • Your ally is close at hand: Diaphragmatic breathing: Long, deep and slow • Feeling it at a physical level
  • 66. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au In-session meditation: Emotional Processing • Discuss a worry - Find the bottom line /what is the essential message? – Eg. “I am not good enough” • Guide a meditation starting with relaxing into FBB • Evoke the message: “Imagine it like a radio station….” • Notice feelings and body sensation. Special attention to belly and chest.
  • 67. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Using Metaphors Clouds in the Sky Mentally “placing” internal experiences (usually thoughts) on the object and allow it to move (or not move) as it naturally wants to. – Does … (object) stick around? – Does it feel ok if … (object) is not moving on? – Background (sky) is ‘observing self’/‘self-as-context’ – Noticing that the background can observe the objects that move through it – Are you the … (object) or the … (background)? *‘self-as-context’ rather than ‘self-as-content’+ If the child has the capacity, you can link other internal experiences (e.g., feelings) to other objects/events that occur in the background – Are you still able to be … (the background) even when … (feeling) is also happening?
  • 68. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au No Pest Control (reactions happen) • Imagine your distressing or unwanted thoughts, feelings, body sensations are like … cockroaches… • Being able to let the experience be… – Not feeling bad that it is here – Not trying to get rid of it – Not running away from it – Not letting the cockroaches control how you act – Not trying to make the experience positive (e.g., a butterfly) • Being ok with the experience coming and going… like cockroaches running around you... • Being able to notice the experience and still being able to chose what to do
  • 69. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Nature of Attention Spotlight • Shining light on where you want to focus your attention Puppy on a leash • Like a puppy attention naturally wanders (jumps around) • It takes time to train a puppy (attention) to be able stay in the one place for any length of time • Getting angry at the puppy doesn’t help • Be kind to your wandering mind
  • 70. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Train of thought • Thoughts don’t stop and they often jump from one topic to another. • The train of thought can be fast or slow • Creating Space: “Are you standing on the platform or are you riding on the train?”
  • 71. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Thought Parade
  • 72. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Take Home Summary • Safety, Safety, Safety • Mindfulness should be embodied (RB2RB) • Deepening the clinical narrative • Enhancing a willingness to feel into and to safely experience SIFT experiences – Importance of the breath – Relevance of Self-As-Context • Know your mechanisms: Password Resources • Find your entry point. Build from there. • Make sure you have enough resources to build the capacities you are seeking to foster
  • 73. Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au Thank You! More information at www.bemindful.com.au Email me: cam@bemindful.com.au

Notas do Editor

  1. Identifying client > reflections after key mindfulness practices > intervention planning
  2. Coming into a state of Presence Attentional placement: Getting out of rumination and worry Internal awareness Being Mode
  3. Clinician using Mindfulness practice without teaching to clientsTeaching concepts (e.g., attitudes) without formal Mindfulness practice
  4. Remaining cognisant of overarching …Broad: What is the frame of engagementSpecific: Following the Clients Lead: What moment is this?What interferes with this….Holding your own stuff in mindFeeling Felt: Rock in the OceanFBB technique
  5. Dissociation, constituting disturbances in conscious- ness, perception, memory, or identity (APA, 2000), may be conceptualized as the clinical antithesis of mindful attention to present experience (Michal et al., 2007).
  6. ). Similarly, Marx and Sloan (2005) reported that at the end of an 8-week follow- up interval, experiential avoidance predicted PTSD symptom severity over and above ratings of PTSD symptom severity obtained at baseline. Experiential avoidance has also been shown to partially mediate the relationship between PTSD and quality of life in civilian survivors of the Kosovo War (Kashdan, Morina, & Priebe, 2009), and to partially mediate the association between interpersonal trauma exposure and symptoms of PTSD (Orcutt, Pickett, & Pope, 2005). he role of thought suppression. Thought suppression, involv- ing conscious attempts to keep unwanted thoughts out of awareness (Wegner, 1994), can be viewed as one aspect of the experiential avoidance construct (Tull et al., 2004). Thought suppression may be particularly ineffective for individuals who have been exposed to a traumatic event because when a person is experiencing stress, efforts to suppress undesired thoughts may paradoxically increase awareness of the very thoughts the person wishes to avoid (Wegner, 1994). THOUGHT SUPPRESSION Chronic thought suppression has been shown to predict PTSD symptom severity among individuals exposed to a ter- rorist attack (Vázquez, Hervás, & Pérez-Sales, 2008). Thought suppression has also been found to predict PTSD symptom severity, when controlling for both general psychiatric symp- tom severity and the number of traumatic events the individual has been exposed to (Tull et al., 2004). Furthermore, several studies have reported that people with PTSD experience rebounds in trauma-related cognitions following thought suppression tasks (Aikins et al., 2009; Amstadter & Vernon, 2006; Shipherd & Beck, 1999, 2005). These studies add to a large body of literature supporting the role of thought suppres- sion in the etiology and maintenance of PTSD (Purdon, 1999). Though this literature implicates chronic thought suppression
  7. Present moment awareness: The trauma is past = Bottom up processing - Observing self Assisting with defusion (me and this experience is different. This is something that I can observeScaffolding (T&T):
  8. With RS – very important
  9. This section is about setting the framework (the ‘how). When we think about Mindfulness what I want you to take away today is that there are 3 components to mindfulness – Attention, Intention, and Attitude. So looking at definition of mindfulness before it’s… paying attention in a particular way, …etc