Module 1 Mindfulness - GlobalPodiumapp.globalpodium.com/resource/100_db4cb_Single File... · 2017. 3. 27. · Goals of mindfulness training Ground rules Prosand Cons Intro Ice breaker

SDS Seminars Ltd

BPS Approved Certificate in Third Wave CBT

Module 1

Mindfulness

with Dr Fiona Kennedy

Course Materials

1

DrFionaKennedy

BPS Approved Certificate in Third Wave CBT

Module 1

MINDFULNESS2 Day Course

© 2017, Fiona Kennedy, exclusively licensed for SDS Seminars Ltd

§ Defining MindfulnessDay one focuses on thinking a little about mindfulness, and experiencing a lot of it. It’s been said that using mindfulness therapeutically will oftenfail if therapists do not practice it themselves. Our own personal journey with mindfulness is of great importance, so

§ Experiencing MindfulnessThe days will provide many opportunities to practice open awareness, of things in the present moment, both outside ourselves and inside ourminds and bodies.

§ Being Mindful Towards Our ClientsHolding the client in our awareness without judging, interpreting or rushing to problem solve, in other words, mindfully, allows a deep and richcomprehension of their situation and struggle. From this perspective we can genuinely approach how it feels to be the client, and begin ourcommunication from their own standpoint, rather then our own.

§ Mindfulness As A Therapeutic ToolSeveral evidence based therapeutic and coaching approaches now incorporate mindfulness as a therapeutic tool. How can we bring mindfulnessinto our own therapeutic or coaching practice. How to ‘sell’ mindfulness by giving our clients a reason to use it.

§ Formulating Problems As A Lack Of MindfulnessMany human struggles involve ruminating about the past, worry and panic about the future, and self-judgment. These are all ways of not beingmindful. Formulating the problem not as a thing to be overcome but an internal state to be accepted. This opens the way for therapies thatemphasise living a meaningful life, rather than just ‘feeling better’.

§ Teaching Clients To Use MindfulnessExperience has shown that there are more and less effective ways to take clients on the mindfulness journey. As a skill it needs to be practiced.To be practiced it needs motivation, patience and persistence. Different mindfulness exercises are ‘easy’ and ‘difficult’ or perhaps ‘beginner’ and‘advanced’ skills. This part of the training will allow participants to try out ways and means of encouraging clients on this journey.

§ Running A Mindfulness GroupThe second day will include instructions, discussion and role play of running a mindfulness group. This will use the basic structure from a DBTgroup approach and this dovetail into the 2 day DBT third wave presentation.

Aims For 2 Days

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§History, Definitions

§Current Uses

§Theory

§Effectiveness

What Is Mindfulness?


§The Buddha:

§Western Idea:

History

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§ Intentionally living with awareness in the presentmoment§ Wake up from automatic pilot to participate and be present

§ Without judging or rejecting the moment§ Notice consequences and helpfulness/harmfulness-but letgo of suppressing, evaluating, avoiding or blocking

§ Without attachment to the moment§ Attend to the experience of each new moment, don’tignore the present by clinging to past or grasping for future

Definitions


At the still point of the turning world.Neither flesh nor fleshless;Neither from nor towards;At the still point there the dance is,But neither arrest nor movement.And do not call it fixity,Where past and future are gathered.Neither from nor towards,Neither ascent nor decline.Except for the point, the still point,There would be no dance and only the dance.

§ —T.S.ELIOT,“BurntNorton”(1935)

Definitions

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§ The intentional practice of mindfulness andmindfulness skills

§ How?§ Anywhere, anytime, while doing anything. Pay attention tothe moment non judgmentally

§ Meditation§ Focus attention (open or focus mind)§ Non judgmentally (without attachment/avoidance)§ Let go of analysis let the word do the work§ Carry practice into daily life

Mindfulness practice


§ The literature on effects of mindfulness trainingcontains many methodological weaknesses,

§ Mindfulness interventions may improve pain, stress,anxiety, depressive relapse, and disordered eating(e.g., Kabat-Zinn, 1982; Kabat-Zinn et al., 1992;Kristeller & Hallett, 1999; Shapiro, Schwartz, &Bonner, 1998; Teasdale et al., 2000).

§ Mindfulness Training as a Clinical Intervention: AConceptual and Empirical Review by Ruth A. Baer

Outcome Studies

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§ Gross, C. R., M. J. Kreitzer, et al. (2011).§ (MBSR) as a treatment for chronic primary insomnia. RCT§ N=30 primary chronic insomnia randomized 2:1 to MBSR orpharmacotherapy (PCT)

§ MBSR=pharmacotherapy on: sleep onset latency, sleep qualityand sleep efficiency

§ Mindfulness-based stress reduction versus pharmacotherapyfor chronic primary insomnia: a randomized controlled clinicaltrial." Explore (NY) 7(2): 76-87.

Outcome Studies


§ Chiesa, A. and A. Serretti (2011).§ MBIs for pain and depressive symptoms in patients withchronic pain.

§ Systematic review 10 studies to July 2009§ MBIs reduce pain symptoms and improve depression§ improvements in psychological measures such as copingwith pain following MBIs

§ further research in larger better designed studies iswarranted.

§ "Mindfulness-based interventions for chronic pain: a systematic review ofthe evidence." J Altern Complement Med 17(1): 83-93.

Outcome

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§ Dobkin, P. L. and Q. Zhao (2011).§ 83 chronically ill patients§ mindfulness related to reductions in depression,stress, medical symptoms and increased sense ofcoherence

§ Future research is needed to identify which factorslead to an increase in mindfulness.

§ Increased mindfulness--the active component of themindfulness-based stress reduction program?"Complement Ther Clin Pract 17(1): 22-27

Outcome


§ Grant, J. A., J. Courtemanche, et al. (2011).§ Meditative practice, has been associated with painreduction, low pain sensitivity, chronic painimprovement, and thickness of pain-related cortices.

§ Zen meditation is more akin to 'no appraisal' than'reappraisal'. This implies the cognitive evaluation ofpain may be involved in the pain-related effectsobserved in meditators.

§ "A non-elaborative mental stance and decoupling of executive andpain-related cortices predicts low pain sensitivity in Zenmeditators." Pain 152(1): 150-156.

Some Theory

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§ Using MRI and a thermal pain paradigm§ We show ZEN practitioners reduce activity inexecutive, evaluative and emotion areas during pain(prefrontal cortex, amygdala, hippocampus).

§ Meditators with the most experience showed thelargest activation reductions.

§ Meditators activated primary pain processing regions(anterior cingulate cortex, thalamus, insula).

Theory


§ Lower pain sensitivity predicted by reductions infunctional connectivity between executive and pain-related cortices

§ Suggests functional decoupling of the cognitive-evaluative and sensory-discriminative dimensions of pain

§ allowing practitioners to view painful stimuli moreneutrally.

§ Possible to self-regulate by reducing higher-orderevaluative processes, as demonstrated here by thedisengagement of anterior brain systems in meditators.

Theory

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§ That include mindfulness training as a component.§ Mindfulness based stress reduction (MBSR; Kabat-Zinn, 1990),

§ Mindfulness based cognitive therapy (MBCT; Segal,Williams, & Teasdale, 2002; Teasdale & Barnard,1993)

§ Dialectical behavior therapy (DBT; Linehan, 1993),§ Acceptance and commitment therapy (ACT; Hays,Strosahl, & Wilson, 1999

Four Therapeutic Systems

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The Pigeon And The Cowboy


§ Ruminations re past: (if only)§ guilt,§ shame,§ anger,§ hatred,§ revenge

Ways To Be Unmindful

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§ Ruminations re present: (I wish)§ Envy§ Bitterness§ discontent§ I can’t§ I don’t§ I won’t



§Ruminations re future: (what if?)§Negative predictions§Catastrophising§ Anxiety§Hopelessness


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§Turning the mind§ Accepting the present§Observing§Describing§Participating§Non-judgemental stance§Wise Mind

Experiencing The Present: Ways To Be Mindful


Wise MindEmotional

Mind

Rational

Mind

Wise Mind

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§Discusssalientlearning

Video


Exercise:

§ How would your client’s life be

§ If s/he accepted their situation/feelings?

Why Is Mindfulness Important?

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§When trying to change it makes itworse;

§When it can’t be changed

When acceptance is better than change:


§Thought Suppression

§The Green Rabbit

§Chocolate: Behavioural Rebound

§Distress tolerance (mindful focus)

Cognitive Avoidance

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§Client avoidance

§Client resistance

§ See saw

How To Stop Banging Your Head On A Brick Wall


§Therapist mindfulness§Accepting one’s own emotions andurges

Alternatives To Your Usual Treatment Practice

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1. Reduce avoidance

2. Empower client

3. Empower/relieve/relax therapist

Reasons To Be Mindful 1,2,3

Transference

T

C

T C

PB

T

C

T C

CollaborativeworkingpositionTentativeholdingposition

TherapistburnoutpositionProtectivedistancingposition

PB

PB

PB

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§Choose something you usually do onautomatic

§Do this with awareness

§When? Where?

Mindfulness 3


Identifying judgments in your clients’perspectives:

§ Shoulds, oughts

§Rephrasing non judgmentally

Behaving Mindfully:1. Non-judgmental Stance

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Say it just as it is:§ I can’t,§ It won’t work,§ It’s impossible,§Re-phrasing realistically

2. Observing And Describing


§Committing to action in parallel topain

§Throwing yourself into the present

3. Participating

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§Turning the mind frompast/present/future rumination

§ FOFBOS§BreathFeet

4. Staying in the moment


1. To act your values

2. To achieve your goals

3. To do what works (be effective)

Reasons to be mindful 1,2,3

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§ In my close relationships I want to be...............

§ In my work I want to be...............

§ As a parent I want to be...................

§ In my spiritual life I want to be...........

Values Based Work


§Mindfulness metaphors,

§Relate these to particular clientcircumstances

How To Introduce Mindfulness To Clients

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§ Can communicate difficult to hear point

§ Can lighten emotion

§ Produces imagery, increasing memorability

Why Use a metaphor?


§ Targeting when and how to be mindful

§ Setting ‘homework’ mindfulness tasks

§ Reminding and re-phrasing

In-session And Out Of Session Practice

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§Convincing clients not to judge successby ‘feeling better’

§Managing crises:§Mindful breathing

§Mindful observation

Using Mindfulness In Challenging Situations


§Practicing skills in all different settings,the mindfulness habit

Building Mindfulness Into Clients’ Everyday Lives

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§How might today affect your practice?

Exercise:


§ [email protected]

Evaluations, Goodbye Til Tomorrow!

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§ Feedback and review of yesterday

Day 2 Mindfulness


§ Wise mind§ ‘What’ skills§ Observe§ Describe§ Participate

§ ‘How’ skills§ Non-judgmentalness§ One mindfulness§ Effectiveness

7 Core Mindfulness Skills

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Wise MindEmotional

MindRational

Mind

Wise Mind

CoolRationalTask-focused

WisdomMiddle path

HotMood-dependent


§ Stone on the lake: floating down§ Spiral stairs§ Inbreath “wise” outbreath “mind”§ Inbreath ask Wise Mind a question outbreath listenfor answer

§ Solar plexus/centre forehead§ Expanding awareness§ Dropping into breath pauses§ Other ideas?

Wise Mind Practice

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§ OBSERVE§ Notice body sensations§ Pay attention§ Control attention§ Wordless watching§ Observe in and outside

What Skills


§ Put words on§ Label§ Unglue interpretations/opinions from facts§ If you can’t observe it through your senses you can’tdescribe it

Describe

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§ Throw yourself into present activities§ Become one with whatever you’re doing§ Act intuitively from Wise Mind§ Go with the flow

Participate


§ Observe with your eyes§ Clouds, nature, people, faces, features, leaf

§ Observe sounds§ Stop and listen; listen to speech; music

§ Observe smells§ Smells around you, food smells, bath smells, flowers

§ Observe taste and eating§ Eating slowly, lollipop licking, part of meal

§ Observe urges§ Urge-surf, notice urges to avoid, body scan, swallowing urge

Observing Practice

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§ Observe sensations of touch§ Stroke upper lip, walking, sitting, touch something,

§ Observe breath§ Abdominal breathing, pauses, nose sensations, breath whilewalking, while listening to music

§ Observe thoughts§ As they come into your mind, pauses, sky and clouds, soldiers,helicoptering, worries (or shift focus), conveyor belt, river andleaves, railway track

§ Imagine your mind is§ A chessboard, a stage, a TV screen, a book

§ Observe by expanding awareness§ 3 things at once, the space around you, the sheets, a tree

Observing Practice


§ Cloud patterns§ On bench, passers by§ An object from nature§ Describe what a person has just said to you, check§ A person’s face when they seem angry, afraid orsad

§ What a person has done or is doing now§ Other ideas?

Describing What You See

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§ ‘A Feeling Of Anger Is Arising Within Me’§ ‘I Feel X And My Thoughts Are Y’§ ‘When You Do X I Feel Y’§ Describe As Many Thoughts As You Can While Feeling AStrong Emotion

§ Describe Your Feelings As An Object§ Label Thoughts As Judgments§ Label The ‘Mind’ Which Send The Thoughts And Feelings§ Describe Thoughts And Feelings As Helpful Or Unhelpful

Describing Thoughts And Feelings


§ ‘I am inhaling 1 I am exhaling 1…to 10’§ As above, then extend exhalation ‘I amextending breathing out’

§ ‘I am inhaling and following the inhalationfrom beginning to end… I am exhaling and…’

§ Other ideas?

Describe Your Breath

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§ Awareness of connection to the Universe§ Dance to music§ Sing along§ Jump out of bed and dance or sing§ Go to a church and join in singing§ Play karaoke§ Throw self into what someone is saying§ Go running and focus§ Become 1 on inbreath, become 2 on next etc§ Become a word§ Learn to improvise§ Other?

Participating Practice


§ Nonjudgmentally§ See, don’t judge, accept each moment, discernhelpful/harmful, don’t judge your judging

§ One-mindfully§ Rivet self to now, one thing at a time, let go distractions,concentrate your mind

§ Effectively§ Keep goals in mind, focus on what works, play by the rules,act skillfully, let go of wilfulness and sitting on hands

How Skills

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§ ‘A judgmental thought is arising in my mind’§ Count judgmental thoughts§ Replace: state facts, consequences, feelings§ Observe judgmental body language§ Change judgmental body language§ Recount an event nonjudgmentally§ Imagine a person you are angry with. Try to becomeher/him. See from their point of view. Imagineunderstanding them

§ When judgmental practice half smile/willing hands

Nonjudgmentalness


§ Awareness while:§ Making tea/coffee§ Washing dishes§ Cleaning house§ Taking slow-motion bath§ Meditating§ Other?

One - Mindfulness

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§ Observe when getting angry/hostile; ask “is thiseffective?”

§ Observe self when wanting to be right. Give it up andgo for effective

§ Notice wilfulness: “is this effective?”§ Drop wilfulness, practice effective instead§ When feeling angry/urge to be ineffective, practicewilling hands

§ Other?

Effectiveness


§ What process did you feel you needed to workthrough?

§ What blocks did you observe§ In client§ In self

Feedback

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§ Outside-inside§ Concrete-abstract§ Formal-informal§ Easy-difficult§ Cool-hot (emotions)

The Mindfulness Journey


week content

1 Orientation: Goals and Guidelines

Goals of mindfulness trainingGround rulesPros and Cons

IntroIce breakerMindfulness exercisesClarifying motivation

2 Wise MindMindfulness ‘what’ skills

Wise mindobserve

Homework review diaryTeachingPracticeFeedbackhomework

3 What skills describe “

4 What skills participate “

5 Mindfulness ‘How’ Skills Non-judgmental stance “

6 How skills One moment “

7 How skills participate “

8 “ Review, evaluate, goodbyeStrengthening practice, network building, boosters

Running A Mindfulness Group:

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§ Successive approximation§ Errorless learning§ Positive reinforcement of specific behaviours§ Validation§ Self-disclosure§ Modelling§ Generalisation: specific to all situations§ Monitored practice (diary)§ Functional analysis of unwanted behaviour (not doingpractice, saying ‘I can’t do it’)

Behavioural Teaching Principles


§ Opportunity for client/s to learn mindfulness is:§ Repeated re-focusing of attention§ Willing acceptance§ Observing mind (wise mind)

§ Opportunity for client/s to learn mindfulness is not:§ Not relaxation§ Not to feel better§ Not to stop thinking/blank mind

Taking Feedback On Mindfulness Exercises

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§ SMARTER§ Specific§ Measurable§ Achievable§ Realistic§ Time bound§ Evaluate§ Review

Setting Homework & Review


§ Dealing with problems§ Validate§ Observe, describe§ Don’t judge§ Guess function§ Problem solve

Troubleshooting

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§ Examples of disruptive behaviour§ Gentle correction§ Individual work

Managing Disruptive Behaviour


§ Booster sessions§ Apps§ Forums§ Other?

Embedding the Learning

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§ How to measure progress?§ Client goals§ MHmeasures§ Mindfulness/EA questionnaires

§ Five Facet§ KIMS§ AAQ-II§ AFQ-Y§ CAMM

§ See mindfulness tips and resources for more details on these

Evaluating

BPS Approved Certificate in Third Wave CBT Module 1 Mindfulness

Mindfulness Tips and Resources

Physicalising exercise

http://contextualconsulting.co.uk/wp-content/uploads/2013/03/Physicalising-Exercise.mp3

Passengers on the bus

https://www.youtube.com/watch?v=u0VPUudQ7kc

Demons on the boat

https://www.youtube.com/watch?v=z-wyaP6xXwE

Anxiety is a hole with a rope to pull you in

Ice cube exercise

Taking feedback: Awareness Attention Acceptance

Present moment awareness: instant mindfulness:

Where are the soles of my feet?

Visiting my breath?

Acceptance stories

http://www.wisdomcommons.org/virtue/1-acceptance/lifestories

Useful little book

http://www.amazon.co.uk/Teaching-Clients-Use-Mindfulness-Skills/dp/0415696755

Free mindfulness resources:

http://www.mindful.org/mindfulness-practice/7-things-mindful-people-do-differently-and-

how-to-get-started

http://www.freemindfulness.org/download

http://www.mindful.org/mindfulness-practice/7-things-mindful-people-do-differently-and-how-to-get-started

http://www.mindful.org/mindfulness-practice/7-things-mindful-people-do-differently-and-how-to-get-started

http://www.freemindfulness.org/download

REFERENCES FOR MINDFULNESS MEASURES

Baer, R. A., Smith G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-report: The

Kentucky Inventory of Mindfulness Skills. Assessment, 11, 191-206.

Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report

assessment methods to explore facets of mindfulness. Assessment, 13, 27-45.

Bond, F. W., Hayes, S. C., Baer, R. A., et al. (2011). Preliminary psychometric properties of

the Acceptance and Action Questionnaire – II: A revised measure of psychological

inflexibility and experiential avoidance. Behavior Therapy, 42, 676-688.

Greco, L. A., Lambert, W., & Baer, R. A. (2008). Psychological inflexibility in childhood and

adolescence: Development and evaluation of the Avoidance and Fusion Questionnaire for

Youth. Psychological Assessment, 20, 93-102.

BOOKS

Dunkley and Stanton Teaching Clients to Use Mindfulness Skills

Williams and Kabt-Zinn (Eds) Mindfulness

Documents

Module 1 Mindfulness - GlobalPodiumapp.globalpodium.com/resource/100_db4cb_Single File... · 2017. 3. 27. · Goals of mindfulness training Ground rules Prosand Cons Intro Ice breaker