MiT-C for Children, Adolescents and Families

Children, Adolescents and Families

Cameron AggsDr. Danielle McCarthy Mindfulness Training Australia

Copyright (c) 2013 Freya Combes and Mindfulness Training Australia, All Rights Reserved | MiT - Mindfulness Informed Therapy

Australian College of Community Services

OverviewSession 1:

Components of mindfulness and key concepts

Session 2:Developmental considerations

Session 3:Challenges of childhood and adolescence (with case

studies)

Session 4: Facilitation practice

Aims....Theory: To present an overview of mindfulness and

applicable developmental considerations that

scaffolds integration of MiT-C concepts and practices

Experiential: To provide a space for you to

experience mindful state of consciousness, to give you

techniques and concepts to help you get back there:

Both independently and when working with clients.

Resources: To provide exercises and resources to get

you forming new habits and practicing in new ways

Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | [email protected]

MethodsPowerpoints

COS Worksheets

Video

Brief Meditations

Participation in brief meditations is voluntary

Evoking mindfulness as the best method for learning


MindfulnessWhat is it?

How does it enhance the process and content of working with clients?

Mindfulness and Emotion RegulationWorking through difficult emotionsKnowing and Naming

The importance of Scaffolding…

Modeling Mindfulness: Using your faculty of attention and your willingness ‘feel into’ experience as tools.

What does it mean to be present?Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | [email protected]

Working with Therapist Factors

Who among us can evoke a state of

presence at will?


True…?

“The mind if not stirred, will become clear”

-Sogyal Rinpoche


What is Mindfulness……?

“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).

A Definition of Mindfulness…

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,

Holding in Mind: IntentionsWhat 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

Attending SkillsPlacing 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

Attending: Using your faculty of attention as a tool: Disengaging

from worry and rumination

Inwardly: Fostering Internal Attunement / Meta-Cognitive Awareness: What’s happening for me now..?

Outwardly: Promoting the ability to use relationships and the world around us to heal and

To come into a state of “Presence”

What do we really mean by ‘being present’?

Presence….

What are the qualities of that?

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.

4 Breaths TechniqueComing 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”

“The mind if not stirred, will become clear”

Sogyal Rinpoche

Mindful Attitudes: More than just Attention

The anesthetic of internal attunement….

AttitudesGOAL

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

Focusing on Acceptance

It’s an intentional activity…

Saying “Yes” to experience

- Tara Brach

“It’s already here…. Let me feel it”

-John Kabat-Zinn


Learning to let it flow…


2-Step process

Before ‘Letting-flow’, we must chart the course of this stream. We must know its texture…. The feelings, the pain of it, the impact. We must learn how to make a space for it as it is.

= Acceptance


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:

I-SIFTI (me)

Sensations

Images

Feelings

Thoughts

“Mindfulness is an intentional activity which consists

of:

1. Bringing one’s complete attention

2. To the present moment,

3. In a nonjudgmental or accepting way”

Recapping So Far….

Mindfulness Pro’s and Cons

Positives

Transportable

Immediate

Experiential

Stretches the full continuum of mental health experience

Formal and informal practices

Disadvantages

Intentional (forgetting is a big problem)

Difficult to operationalise and explain

We can be “dissmissing” sometimes when using it

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

Embodied Mindfulness

Applying Mindfulness: Who

Teaching Mindfulness:Child’s independent practice

Adults and children

Increasing capacity with age (and development) for children to engage in independent mindfulness practice

WhyGreater 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

WhyGreater mindfulness associated with higher:

Healthy self-regulation

Emotion regulation

Positive affect

Quality of life & life satisfaction

Social skills

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

Attention and executive functioning

Self-efficacy for reducing substance use

Sleep

Where does MiT-C fit?

Mindfulness-informed interventions

• MiT-C: utilising and integrating your existing clinical skills into a mindfulness framework•Acceptance and Commitment Therapy (ACT)

• Dialectical Behaviour Therapy – adolescents (DBT-A)

Mindfulness-based interventions

• Mindfulness-based stress reduction for children (MBSR-C)

• Mindfulness-based cognitive therapy for children (MBCT-C)

• Independently developed mindfulness programs

Embodying and modeling of mindfulness with clients

MiTTherapy process skill: Embodying mindfulness

Intervention technique: eg 2-hands, 4-breaths, Metaphore, POC exercise, 3-Minute Breathing Space, Body Scan, Working with DiscomfortFlexible delivery of client-centred techniquesUse of mindfulness in assessement,

psychoeducation, intervention, and in the relational space

Targets Emotional Regulation capacity

Central Concepts, Psycho-education and Debriefing

Internal experiences (reactions) occur Thoughts, feelings, body sensations, urges to act

Internal experiences are transient and change with time

Acknowledges that “negative” thoughts and feelings are experienced by everyone

Experiential avoidance

Developmental Modifications: Psycho-education in child friendly terms

Things happen inside of us (thoughts, feelings, body sensations, urges to act). These things change with time (e.g., intensity, location).

Most people find it difficult to control feelings and thoughts that pop into our heads.

How we feel about (and relate to) what happens inside of us is important.

Sometimes people see certain thoughts and feelings as “bad”. When we mindfully notice our thoughts or feelings we see them just as thoughts or just as feelings.

There is a difference between describing and judging what is happening inside of us.

“Creating Space” (instead of defusion, decentering and reperceiving)

Creating Space allows us to choose our reaction

The Three Rs of Mindfulness

Release the mind from ‘too much

thinking’ and/or the struggle against

‘what is’.

Relax the body, notice your breathing.

Return to this moment; where you have

all the resources you need…

Developmental considerations

Developmental Considerations

Receptive language skills are needed

Concepts can be abstract

Mindfulness inherently uses skills that are less well developed in children and adolescents than adultsLanguage (understanding and expressing themselves)Meta-cognition Executive function and attention skills

Mindfulness practice builds on developmental capacities (e.g., attention and executive function)

Principles of Developmental Modifications

Matching the mindfulness practices to the developmental needs of the child/adolescent

7 years: selective attention develops and self-talk is becoming internalised Enables focused attention practices

10 years and onwards: dual attention skills developingMore capable of noticing internal and external experiences

simultaneously

Adolescence: increase in abstract thinking, attention and executive function skills Easier to understand abstract concepts inherent in

mindfulness

Mindfulness Practices: Building Blocks

Sensory information

FeelingsThoughts

Breath

Focused attention practices

Body sensations

InteractionsDual attention practices

Developmental Modifications: Language

Use developmentally appropriate/child friendly language

Scaffold descriptive language with word lists or visuals

Slowing down

NOTICING and NAMING

what is happening RIGHT HERE, RIGHT NOW

Being CURIOUS about what is happening for you

Being WILLING to feel

Being KIND to yourself & don’t judge yourself for what you are experiencing

LETTING GO

CREATING SPACE TO CHOOSE

Child Friendly 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

Developmental Modifications: Psycho-education in child friendly terms

Things happen inside of us (thoughts, feelings, body sensations, urges to act). These things change with time (e.g., intensity, location).

Most people find it difficult to control feelings and thoughts that pop into our heads.

How we feel about (and relate to) what happens inside of us is important.

Sometimes people see certain thoughts and feelings as “bad”. When we mindfully notice our thoughts or feelings we see them just as thoughts or just as feelings.

There is a difference between describing and judging what is happening inside of us.

“Creating Space” (instead of defusion, decentering and reperceiving)

Creating Space allows us to choose our reaction

Developmental ModificationsUsing metaphors to illustrate and explore

mindfulness conceptsKeep it simpleDon’t overload with too many or varied

metaphorsUse of visual props

Length of practices

Kids want to (and will) move Formal ‘mindful movement’ exercises ‘Curious’ observation of urge/intent to move and of the

actions when they do move

Debriefing What level of structure do they need in the debrief?

Will they get lost in verbal discussion? Use a visual prompt or debrief sheet? Use an expressive debrief (e.g., using line, colour and shape in a body

outline to represent the practice experience) or a written reflection? Can they identify the difference between thoughts, feelings and body

sensations?

Developmental Modifications: Debriefing

Can they recall and verbalise their experiences? Did they report that they “noticed nothing”, that they

“can’t remember” or answer “I don’t know”? Normalise that many children and adolescents find it

difficult to be able to notice and then describe what occurred for them

Future intervention: Facilitate an experience of them being able to notice and

name something that is happening for them right nowExample:

choose a relevant sensory system and create a situation where there is a change in the input

highlight a concrete physical sensation that they are likely to be feeling. Suggest a range of possible adjectives and ask them to identify a few relevant words

Dialoguing to build in situ verbal reporting skills

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?

Mindfulness Practices: 4 Breaths or Breath Counting

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’.

Mindfulness Practices: Sensory Information

Sight and touch

Sound

Taste

Movement

Identify the sense or sensory system that is to be the focus of the practice.

Notice: Physical sensations or

describing words Whether the sensations or

experiences change in intensity, location or size

Automatic judgments (thoughts)

Debrief: Did they noticed their attention

shifting to, or being caught in, other internal experiences (thoughts and feelings) during the practice

Mindfulness Practice: Mindful Movement

Notice: the physical sensations involved in the movement

(including the sense of pressure and weight)the way that sensations change during the stages

of the movementthe sense of body as a whole

Challenges of childhood and adolescence

Formulation of DisordersDisorder Fusion with thoughts

and feelingsExperiential Avoidance

Anxiety Worry & future focused thoughts (“what if…”)

Avoiding anxiety provoking situations.

Depression Rumination & past focused thoughts.Negative view of self, world and future.

Maladaptive coping strategies to manage feelings.

Anger and externalising behaviour

“I can’t control it”“It happens so fast”“It’s not fair ”“It’s not my fault”

Of own distressing feelings. Of owning responsibility.

AnxietyIntention Attention Attitude

Slowing down Focusing/refocusing on the here and now

Curiosity

Remembering Noticing and naming Kindness

Choosing Letting go and creating space Willingness

Knowing why Checking in/checking out

Practices and Considerations for Intervention Planning

Checking In (thoughts, feelings, body sensations, urges)/Triggering relaxation response: 2 Hands, 4 Breaths, POC, 3MBS

Psychoeducation about experiential avoidance

Mindful exposure (thoughts, feelings, and behaviour)

Case Study: AnxietyChild

9 year old male

Presenting difficulties: Separation anxiety When mother drops child

at school in the morning, child becomes distressed – crying, begging mum to stay, saying he feels sick – and not wanting her to go.

Adolescent

15 year old female

History of bullying

Presenting difficulties: Can talk to adults without

difficulties Experiences difficulties talking

with same-aged peers Avoids or tries to avoid going

to social events (e.g., parties), outings (e.g., to the beach) and school activities (e.g., giving a speech in class).

Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | MiT - Mindfulness Informed Therapy

Case Study Points For Discussion

Developmental and/or systemic considerations

Formulation

Mindfulness-informed intervention plan

DepressionIntention Attention Attitude


Curiosity


Knowing why Letting go and creating space Willingness

Choosing Checking in/checking out



Risk Assessment & Planning

Behaviour Activation

Case Study: Depression Adolescent

15 year old female

History of bullying

Parents divorced 5 years ago

Presenting difficulties: Low mood Poor sleep Lethargy Reduced appetite (although some emotional eating) Reduced concentration and motivation Loss of pleasure in previously enjoyed activities Suicidal ideation – suicidal thoughts; no plan or intent

Anger and Externalising Behaviour

Intention Attention Attitude


Curiosity






Mapping warning signs

Choosing a helpful expression of feelings

Sensory and movement practices

Mindfulness Practices: situational training for identified triggers

Soles of the feet Asking clients to breath naturally and then

remember an anger-provoking incident. Notice bodily signs of anger Shifting attention to the soles of the feet (a neutral

part of the body)

Standing StrongSoles of feet up to abdomen to check-in with the

speed and depth of their breath

Role Plays

ADHDIntention Attention Attitude


Curiosity






Mapping signs of being “off task”. Use of visual cues. Nonverbal or visual signal between child and adult (parent/teacher) that attention has wandered.

Sensory and movement practices

Case Study: Anger &Externalising Behaviour

7 year old boy

ADHD

Presenting difficulties:Suspensions at school due to aggression towards

peers Aggressive at home when he doesn’t get what he

wantsAggressive behaviour: hitting, yelling, swearing,

throwing objects


Accessing ResourcesPassword Resources: See feedback form

3R’s Meditation: http://bemindful.com.au/general/download/

Youtube: ‘Hidden Holding / Always Held’

Youtube: 3 Minute Breathing Space

Youtube: Rest In Natural Great Peace


Resources –Books Semple, R.J., & Lee, J. (2011). Mindfulness-Based Cognitive Therapy

for anxious children: a manual for treating childhood anxiety. New Harbinger Publications Inc.

Kaiser Greenland, S. (2010). The Mindful Child. Free Press.

Greco, L.A., & Hayes, S.C. (Eds) (2008). Acceptance & Mindfulness Treatments for Children & Adolescents: A Practitioner's Guide. Context Press.

Miller, A.L., Rathus, J.H., & Linehan, M.M. (2007). Dialectial Behaviour Therapy with Suicidal Adolescents. The Guilford Press.

Schoeberlein, D. (2009). Mindful teaching and teaching mindfulness: a guide for anyone who teaches anything. Wisdom Publications.

McCurry, C. (2009). Parenting your child with mindfulness and acceptance. New Harbinger Publications Inc.


Resources – Story Books Nhat Hanh, T., & Vriezen, W. (2008). Mindful Movements: Mindfulness

Exercises Developed by Thich Nhat Hanh and the Plum Village Sangha. Parallax Press. [Mixed media product – includes DVD]

Nhat Hanh, T., Plum Village Community & Vriezen, W. (2011). Planting Seeds: Practicing Mindfulness with Children. Parallax Press. [Mixed media product – includes CD]

Nhat Hanh, T. (2012). A Handful of Quiet: Happiness in Four Pebbles. Parallax Press.

Bowden, T., & Bowden, S. (2010). I just want to be me! Building resilience in young people. Exisle Publishing Limited. [Aimed at adolescents]

Alderfer, L. (2011). Mindful monkey, happy panda. Wisdom Publications. [This storybook is aimed at children in early-mid primary school]


Thank You!

[email protected]

[email protected]

Additional Material


Metaphors

Metaphor Target area

Clouds in the sky Concepts of mindfulness and ‘creating space’

Leaves on a stream

Concepts of mindfulness and ‘creating space’

No pest control Attitude of non-judgement and ‘creating space’ to allow (rather than trying to control or change) experience

Spotlight/Torch Attention in mindfulness practices

Puppy on a leash Nature of attention and attitudes of kindness

Train of thought Nature of thoughts and ‘creating space’

Thought parade Nature of thoughts and ‘creating space’

Using MetaphorsClouds 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?

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

Nature of AttentionSpotlight

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

Train of thoughtThoughts 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?”

Thought Parade

Education

MiT-C for Children, Adolescents and Families