These slides explore the importance of religion in individuals lives. While more the half of Americans identify religion or spirituality as vital to their lives therapists and doctors often do not include these beliefs in their treatment.

1. Religion Health
and Psychotherapy
Meeting Clients On Their Terms
Michael Changaris, Psy.D.

2. Freud and
Religion
Religion, Freud believed,
was an expression of
underlying psychological
neuroses and distress.
Freud believed that religion is a means of giving structure
to social groups, wish fulfillment, an infantile delusion, and
an attempt to control the outside world.
"Religion is an illusion and it derives its strength from the
fact that it falls in with our instinctual desires." --Sigmund
Freud, New Introductory Lectures on
Psychoanalysis,1933.

3. The human psyche is
religious by nature.
Symptoms come from
psycho-spiritual roots.
Had semi-psychotic state
after falling out with Freud.
Jung viewed life as an
ongoing transformation that
is a process of
―individuation.‖ He argued
that individuation was the
―mystical heart‖ of all
religions. At once it is a
meeting of the self and the
ultimate.
Carl Gustav Jung - 26 July 1875 – 6 June 1961
Jung played an indirect role
“As far as we can discern, the sole in the founding of AA and
purpose of human existence is to believed in a ―spiritual cure
kindle a light in the darkness of mere for alcoholism.‖
being…”

4. Matter of Facts…
Two views of the world – ―Idealists and Materialists‖
To idealists, spirit or mind is primary, and created matter
secondary.
To materialists, matter is primary and mind or spirit is
secondary, a product of matter acting upon matter.
Logical positivism used formal logic to underpin an
empiricist account of our knowledge of the world.
We live in a ―De-enchanted‖ world.
Mind – Brain – Self (universal mind)

5. Importance of Religion in US

6. Religious Importance in Americans
of Non-European Descent
African-Americans are among the most likely to report a
formal religious affiliation, with fully 87% of African-Americans
describing themselves as belonging to one religious group or
another.
African-Americans (79%) say religion is very important in their
lives, compared with 56% among all U.S. adults.
African-Americans (53%) report attending religious services
at least once a week, more than three-in-four (76%) say they
pray on at least a daily basis and nearly nine-in-ten (88%)
indicate they are absolutely certain that God exists.
Pew Research Center's Forum on Religion & Public

7. Religious Importance in Americans of
Non-European Descent
Latino(a)s also report affiliating with a religion at a similarly
high rate of 85%; among the public overall, 83% are
affiliated with a religion.
94% of Filipino Americans Report being highly religious
(not Pew Data)
87% of Korean Americans Report being highly religious
(not Pew Data)

9. Religious Importance
in Elders
Descriptive findings indicate that 96% of elders use prayer
to cope with stress based on the Jalowiec Coping Scale.
Women and African American Elders used prayer to cope
with stress significantly more often than did men and
euroamericans.
The most frequently reported alternative treatment modality
for elders was prayer (84%).

10. Discussion
? What role does religion play in therapy?
? Have you worked with clients when it was
central to therapy?
? How do you work with religious and
spiritual experiences in therapy?
? How have you seen religion help clients?
? How have you seen religion hinder clients
growth?

11. William James was the
Popularize of American
Psychology.
His works form the
foundations of the field and
are still often quoted.
Co-author of James Lang
Theory of Emotions.
Gave a series of lectures
compiled in the book,
―The Varieties of
Religious Experience‖
in University of Edinburgh in
Scotland between 1901 and
1902.

12. William James
But such individuals are ―geniuses‖ in the religious line; and like
many other geniuses who have brought forth fruits effective
enough for commemoration in the pages of biography, such
religious geniuses have often shown symptoms of nervous
instability.
There are moments of sentimental and mystical experience . . .
that carry an enormous sense of inner authority and illumination
with them when they come.
Religion can lead to profound psychological change granting
new found passion for life, depth, love and security.
Mystical experiences can create profound changes in brief
moments. They often feel as if the individual is connected to and
expressing a vast intelligence. They are impossible to put into
words but transformative to those who experience them.

13. Aspects of Religion
Moral System: All religions have a system of moral
behaviors that help people live a ―good‖ life.
Practices: These are the tools, rituals, spiritual technology,
skills and habits that the religion offers to help develop
either moral habits or spiritual experiences.
Beliefs: These are the ideas, thoughts, stories,
philosophies and teachings that create the ―rasa‖ of a
religion. These include elaborate cosmologies,
relationship to ―ultimate‖ and the role of women in liturgical
life.
Experiential/Mystical: These are the direct contact with the
sacred. These can include visions, speaking in tounges,
divine union, enlightenment, peace that passes
understanding.

14. Spirituality Definition
NIHR (National Institute of Health Care Research)
Defines Spirituality As: The ―feelings, thoughts,
experiences that arise in search for the sacred.‖
Search: ―Are the attempts at identifying,
articulating, maintaining, transforming,
understanding, knowing and embodying.‖
Sacred: Is the divine, higher power, or ultimate
reality as understood by the person.

15. Religion: Operationalized
1. Religious/spiritual preference or affiliation. – Affiliation with
specific spiritual or religious group.
2. Religious/spiritual history. – History of participation, Religious
trauma, upbringing, and transformative moments.
3. Religious/spiritual participation. – Frequency and amount of
engagement in spiritual or religious activities.
4. Religious/spiritual ―private‖ practices. - Prayer, meditation,
rituals, ceremonies, contemplation, dance, movement and
work.
5. Religious/spiritual support. – Social support, Spiritual
Guidance, Material Support and Imaginable Support.

16. Religion: Operationalized
6. Religious coping. – Ways individuals participate to cope
with life experiences.
7. Religious/spiritual Beliefs and Values. - Morality and
belief structures. How the beliefs are held (truth,
metaphoric, aspiration etc.).
8. Religious/spiritual Commitment. Level of importance of
religion/spirituality and how much it motivates actions.
9. Religious/spiritual Motivation for Regulating and
Reconciling Relationships. – Forgiveness, atonement…
10. Religious/spiritual experiences. – Personal experiences
with the divine.

17. A Qualitative Study of Religion
in Therapy
Outpatient psychotherapy clients report a desire to discuss
religious or spiritual topics in their therapy, and many also
indicate that religion and spirituality are of central importance to
their healing and growth.
Clinicians‘ uncertainty may be related as well to the minimal
coursework, supervision, and training regarding the place of
religion-spirituality in therapy.
Furthermore, they may also feel that working with religious or
spiritual issues in therapy is outside their area of expertise and
may thus refer clients presenting with such concerns to other
professionals
Clients felt that spirituality was important to discuss in therapy
and felt validated and acknowledged by therapists‘ explicit and
implicit religious or spiritual interventions.

18. A Qualitative Study of Religion
in Therapy
Therapists focused on existential questions or anger at God.
These discussions were facilitated by clients‘ perception of
therapists as open, accepting, and safe.
Discussions typically became unhelpful when clients felt that
their therapists were passing judgment or imposing their
own beliefs on them.
As an example, one client reported that her therapist
told the client that she was „„too Catholic,‟‟ which made
the client feel bad.
A third client ‗‗got real mad inside and left therapy‘‘ because
she did not know what the therapist meant by the comment
that the client was ‗‗too Catholic.‘

19. Religious or Spiritual Based
Therapies
Secular w/ Spiritual
Roots Overtly Spiritual
DBT – Dialectical Transpersonal
Behavioral Therapy. Psychotherapy.
MBSR – Mindfulness American Association of
based stress reduction. Christian Counselors.
Jungian analysis.
Alcoholic Anonymous…
ACT – Acceptance and (NA, OEA, Alonon,
commitment therapy. CODA)
Humanistic Therapies

20. Carl Rodgers
Transcendent
Humanism
An increasingly existential lifestyle – living
each moment fully –"To open one's spirit to
what is going on now, and discover in that
present process whatever structure it
appears to have" (Rogers 1961)
Increasing organismic trust – they trust their
own judgment and their ability to choose
behavior that is appropriate for each
moment.
Holistic approach to human existence
through investigations of meaning, values,
freedom, tragedy, personal responsibility,
human potential, spirituality, and self-
actualization.

21. Focusing: Eugene Gilden
Clearing a space: What I will ask you to do will be silent, just to yourself. Take a moment just to
relax . . . All right – now, inside you, I would like you to pay attention inwardly, in your body,
perhaps in your stomach or chest. Now see what comes there when you ask, "How is my life
going? What is the main thing for me right now?" Sense within your body. Let the answers come
slowly from this sensing.
Felt Sense: From among what came, select one personal problem to focus on. DO NOT GO
INSIDE IT. Stand back from it. Of course, there are many parts to that one thing you are thinking
about – too many to think of each one alone. But you can feel all of these things together.
Handle: What is the quality of this unclear felt sense? Let a word, a phrase, or an image come up
from the felt sense itself. It might be a quality-word, like tight, sticky, scary, stuck, heavy, jumpy or
a phrase, or an image. Stay with the quality of the felt sense till something fits it just right.
Resonating: Go back and forth between the felt sense and the word (phrase, or image). Check
how they resonate with each other. See if there is a little bodily signal that lets you know there is
a fit.
Asking: Now ask: what is it, about this whole problem, that makes this quality (which you have
just named or pictured)? Make sure the quality is sensed again, freshly, vividly (not just
remembered from before). When it is here again, tap it, touch it, be with it, asking, "What makes
the whole problem so ______?" Or you ask, "What is in this sense?‖ Be with the felt sense till
something comes along with a shift, a slight "give" or release.
Receiving: Receive whatever comes with a shift in a friendly way. Stay with it a while, even if it is
only a slight release. Whatever comes, this is only one shift; there will be others.
http://www.youtube.com/watch?v=j7PEC5Mh5FY&feature=related

22. Mystical Experiences
Christian Mysticism: "devotion of ecstasy or rapture," a
passive state, in which the consciousness of being in the
body disappears .
Buddhist Mystical Description of Awakening: Body and
mind drops away.
Islamic Mystics (Sufism) Hafiz:
“And the sun and all light
Have forever fused themselves
Into my heart and upon
My skin.”

23. Abhidhamma
The earliest Buddhist writings are preserved in the three-
part Tipitaka (Pali; Skt. Tripitaka). The third part (or pitaka,
literally "basket") is known as the Abhidhamma
(Wikipedia)
The Abidharma is a systematic tool and series of
teachings designed to lead to liberation.
Abhidharma method presents the Buddha's teachings in
technical terms that are carefully defined to ensure
analytical exactitude.
Ronkin, Noa, "Abhidharma", The Stanford Encyclopedia of Philosophy (Fall 2010 Edition), Edward N. Zalta (ed.),
URL = <http://plato.stanford.edu/archives/fall2010/entries/abhidharma/>.

24. Stan Grof – Spiritual
Emergency
Spiritual Emergence Network - provides
individuals that are experiencing difficulties
with psychospiritual growth a therapist
referral and support service that is staffed
by trained graduate students. In a culture
which has not understood issues
surrounding spiritual development,
the gift of being heard
and understood by a
knowledgeable and
supportive listener
can be life-altering.

25. Spiritual Emergency
It is possible to undergo a profound crisis
involving non-ordinary experiences and to
perceive it as pathological or psychiatric when
in fact it may be more accurately and
beneficially defined as a spiritual emergency.
-- Stanislav Grof
St. John of the Cross, ―Dark night of the soul.‖
―It is the journey of the soul from its bodily home to her union
with God. It happens during the night, which represents the
hardships and difficulties she meets in detachment from the
world and reaching the light of the union with the Creator.‖
Zen - Makyo refers to the hallucinations and perceptual
distortions that can arise during the course of meditation and
can be mistaken by the practitioner as "seeing the true nature"
or kensho.

26. Kundilini
Awakening.
Tingling in the body and brain region,
Heat or cold in the system,
Fluttering or twitching of muscles,
Spontaneous yoga asans or kundalini yoga
movements,
Sexual desire for partner,
Experience of divine light within.
Spontaneous bliss, intensely pleasurable,
Tremendous vibratory energy.

27. Discussion
? Are there ―healthy‖ non-ordinary mind
states?
? How can these states effect therapy?
? How can you tell the difference
between ―healthy‖ non-ordinary mind
states and healthy?

28. Herbert Benson, M.D.
founder of the Mind/Body Medical Institute a
Massachusetts General Hospital. Harvard
Medical School graduate.

29. Relaxation Skill
Tonglen – ―The tonglen practice is a method for
connecting with suffering —ours and that which is all
around us— everywhere we go. It is a method for
overcoming fear of suffering and for dissolving the
tightness of our heart.‖ – PemaChodron
It is also a great skill for building Distress Tolerance…
Basics: Think of a minor slightly frustrating event.
Notice how it makes your body and mind feel. Breath
as you breath in breath in the frustration. As you breath
out breath out compassion.

30. Health Outcomes
and Religion
All cause mortality is reduced by
spiritual and religious practice.
Depression, anxiety, aggression are
all reduced by
spirituality/religiousness.
Belief in angry or punishing God reduces positive health
outcomes.
Watching T.V. preachers has negative and not positive
health impacts.

31. Health Outcomes
and Religion
Two factors account for Positive Health
outcomes and religion:
―Religious attendance (RA).‖
Religious coping
RA also positively impacts all cause
mortality to the greatest degree.
Religion has a correlation with better recovery from illness and
transplants.
Religion is correlated with reduced mortality after heart surgery,
mortality after heart cancer.
Religious practices are correlated with reducing the impact of
pain.

32. Health Outcomes
and Religion
Yoga mitigates depression,
anxiety and PTSD.
Yoga shows changes in stress response
and HRV.
Yogic breathing is safe for those with COPD
A non-placebo controlled study with mall N found ―short-
term training in yoga is well tolerated and induces
favorable respiratory changes in patients with COPD.‖
Religiousness: No direct effect on observable symptoms
in COPD but displayed increased quality of life, reduced
depression, anxiety and less reported subjective
symptoms.

33. Negative Health
Effects of Religion
Religious medical neglect –
Some individuals have gotten sick or died due to the religious
beliefs that medical interventions are not helpful.
Current birth control controversy.
Women‘s sterilization in the early 1900‘s
Benson Study: Prayer had negative impact on health.
Some argue it was due to a nocebo effects.
Destructive beliefs: A belief in an angry punishing God
leads to negative health impacts.

34. Prayer and
Health
Distant intercessory Prayer:
Praying for the health of
another. Most studies find
no or mixed impact. Some find
significant impact on health.
Contemplative Prayer: Sitting in the presence of God. No direct
studies found.
One study found five types—supplication, devotion,
intercession, gratefulness, and contemplative prayer—elicited
varying degrees of improvements in heart rate variability and
corresponding psychophysiological coherence. (DOI: 10.1111/j.1467-
9744.2009.01036.x)
Prayer as coping
Prayer - A two-group controlled clinical trial in ICU of Baqiatallah
hospital in 2010. Those ―Studied with recorded prayer for 3 days
used prayer attributed to Prophet Muhammad‖ Had a highly
divergent course of illness for those who prayed and those who
did not.

35. Theoretical Models of Mechanism of
Health and Prayer
Prayer may improve health because of the placebo effect
Prayer may lead to increase health-related behaviors
Prayer may help by distraction from illness or increasing
positive emotions.
Prayer may increase health act of supernatural being.
Prayer may change energy systems: e.g. chi.
Prayer may link the consciousness of two individuals an
promote healing.
Breslin, J. M., Lewis, A. C. (2008). Theoretical models of the nature of prayer and health: A
review. Mental Health, Religion & Culture, Vol. 11, Iss. 1,

36. Mechanisms of Positive Health
Impacts of Religion
Increased positive health behaviors. Some evidence suggests that
―strict‖ conservative religions have healthier participants.
Social Support – Social support has many positive impacts on
health. It has biochemical effects on brain health, inflammation,
stress levels and purely behaviorally other people to help solve
problems and material support. Religions often put a premium on
support behaviors.
Coherence Hypothesis: Religion offers meaning and purpose even
in suffering. As Victor Frankle said,
“A (wo)man can survive any
“what”

37. Coherence Hypothesis
Coherence has been shown in many studies to be one of the
key principles underling the impact of religion on health.
―God would never give you more then you can handle.‖
―This is the Buddha appearing before you finding ways to free
you from your own attachments, the very attachments that has
made you suffer again and again and again.‖
DBT – ―Any time you feel a difficult emotion or have a stressful
event it is a good chance to practice a skill and learn to use the
skill more effectively.‖

38. Bruce McEwen Preeminent Stress Researcher and
Author of ―The End of Stress as We Know It‖
Allostatic
Load

39. Adverse
GAD PTSD Childhood Life
Coping Events Stress Chronic
Style Pain
Depression
Personality
Poor Social
Sleep Support
Inflammatory Cortisol
Oxytocin ANS Balance
Response
And HRV
Heart Disease

40. Suggested Biological
Mechanisms
of Health Promoting Effects
Stefano, G. B., Fricchione, G. L., Slingsby, B. T., Benson, H. (2001)The placebo effect and relaxation respons
neural processes and their coupling to constitutive nitric oxide. Brain Research Reviews

41. Placebo and Nocebo Effect
Mechanism Pain Management
Placebos induced activations of the endogenous Opioid system
in these brain structures:
Anterior Cingulate Cortex (ACC), Orbitofrontal (OFC),
InsularCortices
Nucleus Accumbens (NA) (DA release accounts for 25% of var.
in placebo effects).
Amygdala (AMY)
Periaqueductal GrayMatter (PAG).
Dopaminergic activation was observed in the ventralbasal
ganglia, including the nucleus accumbens.
High placebo responses were associatedwith greater DA and
Opioid activity in the nucleus accumbens.
Nocebo responses were associated with a deactivation of DA
andopioid release.
Scott, D.J., Stohler, C.S., Egnatuk, C.M., Wang, H., Koeppe, R.A., Zubieta, J.K., (2008). Placebo and Nocebo Effects Are Defi
Opposite Opioid and Dopaminergic Responses. Arch Gen Psychiatry;65(2):220-231.

42. Placebo and Nocebo Effect
Mechanism Pain Management
Tracey, I. (2010). Getting the pain you expect: mechanisms of placebo, nocebo and
reappraisal effects in humans Nature Medicine 16, 1277–1283 (2010) doi:10.1038/nm.2229

43. Positive Early
Social Childhood
Interactions Experiences
Effective
Oxytocin Oxytocin
Emotional
Release Release
Regulation
Sustained
Reduction in
Stress
(CORT)
LONG TERM
HEALTH

44. Telomeres – Health – Life Style
Women with high stress had telomeres shorter (10 years of
aging). doi.org/10.1016/S1470-2045(08)70234-1
Telomere shortening cor. w/genetic instability also cor. with
shortened life span as well as a reduced wound healing.
doi.org/10.1016/S1470-2045(08)70234-1
Telomerase increased after 3 mo intensive life style changes.
(doi.org/10.1016/S1470-2045(08)70234-1)
―Telomerase activity was significantly greater in retreat
participants than in controls at the end of the retreat
(p < 0.05).‖ (doi.org/10.1016/j.psyneuen.2010.09.010)

45. God Spot – Temporal Lobe
Epilepse
http://www.youtube.com/watch?v=qIiIsDIkDtg
A link between febrile seizures (seizures coinciding with episodes of
fever in young children) and subsequent temporal lobe epilepsy has
been suggested, but the exact role remains unclear

46. Spiritual Brain
Meditators and Multiple individuals with
extensive religious experience have
drastic changes in the brain. One of the key
factors is asymmetry in the thalamus.
Meditators who practice, ―loving kindness‖ have hyperactivation in the
LPFC.
In a graded stepwise relationship hours of meditation relate to
increased thickness in omPFC.
45 minuets of MBSR changed neural structures for ―promega‖
employees.
Differences have been shown in shamanistic or devotional practices
and meditative states. (changes in prefrontal lobes)
In 4 out of 11 participants who had left fronto-temporal lobe inhibited by
TMS stimulation there was a dramatic increase in artistic ability
(Snyder, et. al., 2003. J Integr Neurosci).
Andrew B. Newberg, A.B., Wintering, N., Waldman, M. R., Amen, D., Khalsa, D. S., Alavi, A. (2010).Cerebral blood flow differences
between long-term meditators and non-meditatorsConsciousness and Cognition, Volume 19, Issue 4, December 2010, Pages 899-

47. The Brain on
Meditation
Some might wonder "What is a
Buddhist monk doing taking such
a deep interest in science?
Although Buddhist contemplative
tradition and modern science
have evolved from different
historical, intellectual and cultural
roots, I believe that at heart they
share significant commonalities,
especially in their basic
philosophical outlook and
methodology.
Dalai Lama at the annual meeting of the Society for
Neuroscience on November 12, 2005 in Washington DC

48. God Helmet

49. God on the Brain
"God helmet". Michael Persinger (University of Ontario),
Using a helmet that ―entrains‖ brain states triggered
religious experiences.
Andrew Newberg (University of Pennsylvania) observed
Buddhists as they practice ―Śūnyatā, ‖
(emptiness) or meditative nirvana.
The parietal lobes as playing a key role during this
transcendental state.
This area leads to falling away of body and mind (may also
be involved in dissociation) and if damaged the area can
lead to the feeling of being ―disembodied.‖

50. God on The Brain
A study of 40 participants, including Christians, Muslims, Jews
and Buddhists, showed the same areas lit up when they were
asked to ponder religious and moral problems.
Experiencing an intimate relationship with God and engaging in
religious behavior was associated with increased volume of R
middle temporal cortex, BA 21.
Experiencing fear of God was associated with decreased
volume of L presumes and L orbitofrontal cortex BA 11.
A cluster of traits related with pragmatism and doubting God's
existence was associated with increased volume of the R
presumes.

51. Experiencing an intimate
relationship with God (PC1)
positively correlated with cortical
Experiencing fear of God's anger volume at the R middle
negatively correlated with cortical temporal gyrus (MTG), BA 21,
volume at the L precuneus, Non-religious pragmatism
BA 7 and the extending to the temporal pole.
L orbitofrontal cortex, BA 11. inverse of PC3)
(the
positively correlated with
cortical volume at the R
precuneus, BA 7 and the R
calcarine gyrus, BA 17.
Kapogiannis D, Barbey AK, Su M, Krueger F, Grafman J (2009)
Neuroanatomical Variability of Religiosity. PLoS ONE 4(9): e7180.
doi:10.1371/journal.pone.0007180

52. Die Before you die…
Ironic, but one of the most intimate acts
of our body is
death.
So beautiful appeared my death –
knowing Who then i would kiss,
i died a thousand times before i died.
―Die before you die,‖ said the Prophet
Muhammad.
Have wings that feared ever
touched the Sun?
i was born when all I once
feared - i could
love.
Rabia Basri, the highly acclaimed woman sufi saint of 8th century (717 -
801)

53. To Die Before You Die
18% of individuals who with Cardiac Arrest experienced NDE.
Most NDE‘s are filled with joy but some are deeply hellish (about
15%).
Most individuals attempt to make sense of the process. There is
often a increased religiosity in the after math of both types.
Other common response are ―reductionism‖ where the person
attributes the experience to a brain state. Still others are asking
―why did this happen to me?‖ This is associated with blank
states in the NDE.
Clinician explanation fall into three categories: Psychological,
Physiological, and Transcendental.
Griffith, L.J., (2009). Near-Death Experiences and Psychotherapy.
Psychiatry

54. Near Death Experiences
(NDE)
TRANSCENDENTAL ELEMENTS: Another world
Encountered beings, Mystical being, Point of no return
PARANORMAL ELEMENTS: Out of physical body
Senses more vivid than usual, Extra sensory perception
(ESP), Visions of the future.
AFFECTIVE ELEMENTS: Feeling of peace, Surrounded
with light, Feeling joy, Feeling cosmic unity/oneness
COGNITIVE ELEMENTS: Altered sense of time
Accelerated thought processes, Life review and Sudden
understanding
Adapted from Zingrone NL, Alvarado CS. Pleasurable Western adult near-death experiences:
features, circumstances, and incidence. In Holden JM, Greyson B, James D, eds. The Handbook
of Near-Death Experiences. Santa Barbara, CA: Praeger Publishers; 2009:20.

55. Reactions to NDE
PERCEPTION OF SELF: Loss of fear of death, Strengthened belief in life
after death, Feeling specially favored by God, New sense of purpose or
mission, Heightened self esteem
RELATIONSHIP TO OTHERS: Increased compassion and love for others,
Lessened concern for material gain, recognition, or status, Greater desire
to serve others, Increased ability to express feelings.
ATTITUDE TOWARD LIFE: Greater appreciation of and zest for life,
Increased focus on the present, Deeper religious faith or heightened
spirituality, Search for knowledge, Greater appreciation for nature.
PARANORMAL PHENOMENON: Out-of-body experiences, Apparitions,
Extrasensory perception, Precognition, Healing, Spiritual, mystical, or
transcendent experiences.
ALTERATIONS IN PERCEPTION/CONSCIOUSNESS: Heightened
sensation, Physiological alterations, Unusual movements, sensations,
Unusual stimulation of special senses, Mental changes, Increased energy,
decreased need for sleep.
Adapted from Zingrone NL, Alvarado CS. Pleasurable Western adult near-death experiences:
features, circumstances, and incidence. In Holden JM, Greyson B, James D, eds. The Handbook
of Near-Death Experiences. Santa Barbara, CA: Praeger Publishers; 2009:20.

56. Guidelines for NDE
1. Avoid the assumption that a client‘s NDEs are symptomatic of
pathology, but recognize that individuals with mental illness may also
experience NDEs.
2. Respect the profound nature of these experiences as well as the
individuality of each experiencer.
3. Provide a safe, nonjudgmental environment in which patients can
freely discuss their experiences and the emotions surrounding their
NDEs.
4. Avoid projecting your own value system. Remember most of these
individuals have recently nearly died and encourage them to also
express the emotions related to the precipitating events.
5. Normalize the experience for patients without taking away the
uniqueness of the NDE.
6. Assist patients with integrating the NDE into their daily lives to
maintain best possible functioning.
7. Refer patients to local NDE-focused groups, such as IANDS groups
Adapted from Zingrone NL, Alvarado CS. Pleasurable Western adult near-death experiences: features,
circumstances, and incidence. In Holden JM, Greyson B, James D, eds. The Handbook of Near-Death Experiences.
Santa Barbara, CA: Praeger Publishers; 2009:20.

57. DBT – Overview
Dialectics – Being able to move between opposites and through
holding the tension between opposites ―finding a middle path.‖
Good and Bad – Human with positive and negitive traits
Short-term and long-term goods – Will spend time on the phone
after HW is completed.
Humor and Irreverence – Humor requires having a meta-
perspective.
Behavioral Chain Analysis – Links that lead to behaviors
Triggering events, Vulnerability Factors, Behaviors and
Consequences.
Identify each link in the chain like a detective.
Links can be thoughts, feelings, sensations, external reactions.
Excellent Video http://www.youtube.com/watch?v=OlYk2nWECpk

58. DBT – Overview
Three aspects of DBT Treatment.
Individual therapy: Lots of focus on Behavioral Chain
Analysis and stopping ―therapy interrupting behaviors.‖
Skills Group Training: rotating 12 week groups.
24 hr skills coach.
Four Stages of Treatment
Stage 1 – Significant life chaos and emotional dysregulation.
Stage 2 – Chaos reduced emotional distress is still
significant.
Stage 3 – Emotional regulation is with in normal range (aka
―ordinary neurotic‖ like all of us).
Stage 4 – Steady, stable equanimity and enlightenment.

59. DBT – Overview
Four Skill Domains
Mindfulness Skills
How Skills - Non-Judgmentally, One Mindfully, Effectively.
What Skills - Observe, Describe, Participate.
Emotional Regulation Skills – These are the tools an
individual uses to learn to regulate emotions.
Interpersonal Effectiveness Skills – Help people learn to be
effective in relationships (Assertiveness, Keeping Good
Relationships, Negotiation)
Distress Tolerance Skills – Help an individual survive difficult
emotions, thoughts, and events.

60. DBT – Spiritual Roots
Wise Mind – The combination of emotional mind and
rational mind.
Many of the tools in DBT help and individual
move from emotional mind to wise-mind…

61. DBT Skills
Mindfulness Skills – Observe and Describe
Observing is seeing a thing as it self. Artists when they view an
object see the lines, the color and blank spaces. Observe skill is
the ability to see an object just as it is with out mental
commentary.
Describe skill is the ability to describe clearly and cleaning with
out adding to the top of it. Most of the time emotions happen in
an action packet. See – Feel – Judge the Feelings – Respond.
This is a tool see our world and reactions simply as they are.
Emotional Regulation - Opposite Action
All emotions have urges. A times these urges are helpful and
times not. Learning this skill helps us have choice with
emotional reactions and not act on the destructive urges
associated with emotions.
Distress Tolerance - Wise Mind Accepts (see hand out)
http://www.dbtselfhelp.com/html/wave_of_emotions.html
Interpersonal Effectiveness – GIVE (see hand out)

62. Questions