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A Qualitative Study on the introduction of Mindfulness-Based Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers Presented by Anita Harris Research Assistant Coolmine Therapeutic Community. Introduction. Overview of Mindfulness-Based Relapse Prevention

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A Qualitative Study on the introduction of Mindfulness-Based Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

Presented by Anita Harris

Research Assistant Coolmine Therapeutic Community


Introduction
Introduction Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

Overview of Mindfulness-Based Relapse Prevention

Purpose of the study

Methodology

Findings

Q&A


What is mindfulness
What is mindfulness? Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

Jon KabatZinn describes Mindfulness as

paying attention in a particular way; on purpose, in the present moment, and non-judgementally

Emphasis is placed on the breath and teaching individuals to return to the present moment by focusing on the breath.


Mindfulness meditation
Mindfulness Meditation Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

Traditionally rooted in ancient Eastern traditions, in particular Buddhism

Recently adopted by the West in recent years as an effective therapeutic intervention for a number of psychological and medical problems

Perhaps the most noted is mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn (1979) for individuals suffering with chronic pain and stress related disorders.


Mindfulness based interventions
Mindfulness Based Interventions Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

Other well researched and evidence based interventions by which mindfulness meditation is a core componenet include:

Mindfulness-Based Cognitive Therapy(MBCT),proven to be effective for people with recurrent or relapsing depression. (Segal, Teasdale & Williams)

Acceptance and Commitment Thaerapy (ACT)

Diaclectical Behavioural Therapy (DBT)

Mindfulness-Based Relapse Prevention (MBRP) for individuals with addictive behaviours. (Marlatt, Bowen, Chawla)


Mindfulness and addiction
Mindfulness and Addiction Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

Addiction is the repeated desire to avoid the present moment, which contributes to the urge to use.....(Larimer, 1999)

Individuals with addictive behaviours have great difficulty accepting the present moment (Marlatt)

Through cultivating mindfulness awareness it is suggested that individuals can create a space whereby they can respond skilfully instead of reacting automatically. Through the regular practise of formal and informal mindfulness practises, individuals can be fully in the present moment without being “wiped out by it”(Marlatt)


Mindfulness based relapse prevention
Mindfulness- Based Relapse Prevention Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

An 8 week programme combining relapse prevention skills with mindfulness meditation

A structured protocol with session by session agendas containing mindfulness practices/discussions and worksheets

Inquiry process is a central component of mindfulness

It is important that faciliators of the programme not only have experience with substance abuse treatment but are fully trained to deliver mindfulness training


Goals of mbrp
Goals of MBRP Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

1. Help clients to developawareness of personal triggers and habitual reactions, and learn ways to create a pause in this seemingly automatic process.

2. Alter individualsrelationship to discomfort, learning to recognize challenging emotional and physical experiences and responding to them in skilful ways.

3. Help clients foster a non-judgmental, compassionate approach toward themselves and theirexperiences.

4. Build a lifestyle that supports both mindfulness practice and recovery (Marlatt)


Context background of the study
Context/Background of the study Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

In May 2011, Coolmine TC decided to introduce MBRP across its 3 main services, the men and women’s residentials and the drug free day programme

Three Coolmine staff members were trained to deliver MBRP and acted as facilitators of the eight week programme.

A pilot group was conducted prior to implementation to which I myself was a participant observer


Aims of the study
Aims of the Study Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

Aimof thestudy was to evaluate the impact of the newly introduced MBRP on the TC to which it was introduced and HOWit may be helpful to individuals with addictive behaviours


Objectives
Objectives: Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

Investigate how MBRP was perceived and received by both clients and staff at Coolmine TC

Gain insight into the self perceived benefits/effects of MBRP

Outline the mechanisms of how MBRP may be helpful to individuals with substance abuse problems

Place in the broader context of a TC’ s approach to treatment


Methodology
Methodology Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

Aqualitative approach was deemed most appropriate. Methods Used include:

Observation

Focus Groups with clients only in each of the three settings immediately following the end of the 8 week programme

Semi-structured individual interviews with both clients and Facilitators immediately following the end of the 8 week programme


Findings
Findings: Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

Objective 1: Investigate how MBRP was perceived and received by both clients and staff at Coolmine TC

Meditation as relaxation???.

Largely well received by both clients and staff

Better received by the clients in the residential programme than those in the day programme- Surprising giving that it is designed as an aftercare programme


Objective 1 contd
Objective 1 contd..... Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

No one particular reason for lack of enthusiasm in the day programme but facilitators lack of confidence in delivering the programme may have being a facto

Facilitator stated she was not ready to deliver and felt she required more time and training before she could confidently deliver.


Objective 1 contd1
Objective 1 Contd...... Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

In both residentials, it was received a lot more positively.

Critical turning point for most clients was in week 3-4 of the programme-Got an understanding

The majority of clients and staff perceived mindfulness to be a highly valuable and beneficial programme that could help them with their recovery process


Critical turning point
Critical Turning Point Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

something happened to me in that room in the third week. It was like I could feel it, all the tension andworry wash away from me just for that twenty minutes or whatever it was. I had relief from my head. I felt it, I felt relief for the first time since I’d been in here and since then I love it; I can say, hand on my heart, I love mindfulness, it gives me that relief; and I don’t think anyone would understand how much it means to have relief from your own head unless they had been tormented themselves with their head. (Marie).


Objective 2 benefits effects of mbrp
Objective 2: Benefits/Effects of MBRP Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

Benefits cited by many of the clients:

To learn how to sit with youself and be okay

Being taught how to return to the present moment

Acceptance of uncomfortable thoughts and emotions

Heightened awareness

Practical and useful practices for triggers/cravings and high risk situations

Reduced stress

Anger management

Increased retention/ Helped many clients stay in the community

Heads slowed down


Objective 3:Outline the Relapse Prevention (MBRP) into a Therapeutic Community for substance abusersmechanisms of how MBRP may be helpful to individuals with substance abuse problems

A highly beneficial technique cited by many was the Sober Breathing Space (a 3 minute mini meditation technique)

Stop-stop right what your doing now

Observe- what is going on with you right now in this moment, in your body, your thoughts, your emotions

Breathe-bring your attention to breathing, keep your focus there

Expand- your awareness to include a sense of the whole body and the situation you are in

Respond-to whatever situation with awareness


Objective 3 contd how mbrp may be helpful
Objective 3 Contd....How MBRP may be helpful Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

  • Formal practices helped many calm the mind

  • Thoughtsare just thoughts-a very powerful message to many of the clients

  • Able to verbalise how they are feeling-inquiry process really helped many clients put into words how they are feeling and locate it in their body

  • “It’ okay”- Strong message

    “It’s okay, it’s okay to feel this way. Really, really powerful; nearlychoked me up at one stage when I heard it in one session. I really felt like crying. But it’s something I tell myself a lot of the time now. That meant a lot to me”.


Objective 3 contd
Objective 3 contd... Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

  • Acceptance of emotions/thoughts/situations

  • For many the inquiry process that follows the practises has helped them to talk about cravings-which many stated they would not have done in other groups

  • Interesting finding was how many, especially women struggled with the Loving Kindness practise.

  • Became very evident how self critical many clients are


Objective 4 place in the broader context of a tc s approach to treatment
Objective 4: Place in the broader context of a TC’ s approach to treatment

Mindfulness as confrontational- Many clients described it as hard work and as the most confrontational work they have ever did

The educative and therapeutic elements of MBRP appear o fit well with the TC approach

Like the TC approach, it seeks to address the whole self by placing clients at the centre of their recovery

It’s a self help approach which uses group as method

For one staff member and a couple of clients the practise of “urge surfing” conflicted with the TC approach to treatment


Conclusion
Conclusion approach to treatment

Significant changes have occurred at both staff and clients level- all largely positive about the introduction of MBRP

Study would support the view that Coolmine as an organisation has changed significantly-open to change

Some implementation issues in Day programme

All in all, a programme viewed by the staff and clients as one with real perceived gains


Recommendations
Recommendations approach to treatment

More thought exploring the differences between the day programme and residentials-so that future use will be based on a recognition of difference

Closed groups more beneficial

Further training for facilitators

Facilitators to be mindful of the language used and spend more time on the introductory piece with clients


Thank you q a
Thank You approach to treatment!Q&A


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