Mindfulness Soul Medicine for Client and Clinician

1. Mindfulness Soul Medicine for Client and Clinician William C. Hale, PhD, LICDC-CS Glenbeigh Hospital

2. Today We Will… • Explore the principles of mindfulness and its therapeutic value for our clients and ourselves. • Learn to recognize situations in which mindfulness interventions may be effective in therapeutic practice, and explore how and when to introduce them. • Develop a basic repertoire of mindfulness exercises which can be used with our clients and ourselves.

3. What is Mindfulness? • Rooted in Buddhism – Adopted by andadapted to western medicine and psychotherapy. • It is used to address many physical and psychological issues. • It is not considered a technique as much as a way to live. • Mindfulness is a way of doing, and away of being… • In the World – With Others – With Events – With Ourselves • When being mindful, you do not have to respond in any other way. Mindfulness is in itself its own response It is a response … not a reaction.

4. What is Mindfulness? • Paying attention to what is happening: • In your immediate experience (Here & Now) • Deliberately (On purpose) • Without Judgment (Just allowing the experience) • ‘The direct experience of experiencing’ • ‘Awareness of your awareness’

5. Kanji Symbol for Mindfulness念 nian Composed of two characters: jin今 (here / present) xin心 (heart) Experiencing the present moment with your heart

6. Why Mindfulness? • Most often we try to live in impossible places: • The Past (Re-living Past Experiences & Emotions) • The Future (“Pre-living” - Attempting to Predict & Control) • Neither past nor future exist…except in our minds. • We tend to behave as habit machines on auto-pilot. • Rarely do we pay attention to what we are experiencing now. • As a result, we forfeit our present awareness and miss so much. • Mindfulness brings us back into our lives now. • It allows us to experience the reality of life – that is only the present. • It helps us to see that the present is okay to experience.

7. Uses and Benefits of Mindfulness • Mindful attention and nonjudgmental awareness have been associated with cognitive and emotional wellbeing, work satisfaction and less burnout in therapists and those in other professions. • Mindfulness can increase a sense of self-efficacy, self-compassion, autonomy, and empathy. • It and been effective in addiction relapse prevention, pain management, and the treatment of depression and anxiety

8. Reperceiving • Reperceiving is a “meta-mechanism” in which there is a shift in perspective. We can witness and be involved, without being engulfed. (Shapiro et al, 2006) • “The first realization in “meditation” is that the phenomena contemplated are distinct from the mind contemplating them.” (Goleman, 1980) • One fully experiences what is being mindfully perceived, but not identifying with it. I am I and it is it. I can be close to it and fully aware of it without becoming it. • Mindfulness promotes connection, while maintaining boundaries.

9. Mindfulness in DBT • Dialectical Behavior Therapy – Developed for treatment of Borderline Personality Disorder • Blends Western (CBT) and Eastern thought • 4 ‘Modules’ which use Principles of: • Acceptance • Distress Tolerance • Interpersonal Effectiveness • Mindfulness • Mindfulness integrates ‘Emotional Mind’ and ‘Reasonable Mind’ which results in the creation of‘Wise Mind’

10. ‘What’ Mindfulness Skills • Observe • Notice and be fully present with whatever it is • Describe • Convey what you have observed • Participate • Engage completely in what you are doing now

11. ‘How’ Mindfulness Skills • Non-judgmentally • No opinion of ‘good’, ‘bad’, ‘right’, ‘wrong’, etc • One-Mindfully • What you are doing is all you are doing • Effectively • Focus in a way that works for you – but focus

12. Acceptance and Commitment Therapy (ACT) • Goal is to live your life effectively with your internal experience. • Applies mindfulness principles to memories, present thoughts and feelings, allowing them to be present without trying to avoid them – stressing that they are not reality – they come and go, and have only the power one gives them through self talk/judgment. • We can observe thoughts and feelings without becoming them. We are not our experiences – we simply have our experiences. • Once internal experience is accepted, the goal is to move on and act in accordance with one’s identified values. • Similar to managing cravings in relapse prevention: Allow the craving to be present and accept it, then engage in something else which supports the recovery process.

13. Mindfulness-Based Stress Reduction (MBSR) • Reduction of stress can be achieved by mindfully allowing/accepting the stressor/symptoms to be present without judgment or attempt to change/remove it. • Eight - Week program combining mindfulness, yoga and meditation to address a variety of medical and psychological conditions. • Used as a complimentary treatment in various settings in managing chronic pain, heart disease, hypertension, cancer, and other disorders. • Acceptance of one’s condition can help manage the condition by reducing stress associated with it. • Mindfulness-Based Cognitive Therapy (MBCT) is based on this modality, but used primarily to treat depression. Allowing unwanted thoughts/feelings associated with depression can dispel the suffering around them

14. Mindfulness-Based Relapse Prevention (MBRP) • Developing awareness of personal triggers (stimuli) and reactions to them (responses) and learning to pause in order to create a new relationship with discomfort. • Learning to change how we relate to emotional and physical discomforts around addictions, and creating more adaptive ways of responding to them. • Approaching ourselves and our experiences (past and present) without judgment, and with compassion. • Creating a new lifestyle which includes mindfulness in the tools of recovery.

15. The Common Threads throughout DBT, ACT, MBSR, MBCT & MBRP? • Nonjudgmental Acceptance of the experience. • Active Awareness of what simply is. • Allowing without demanding. • Therapy is not necessarily about removal of unpleasant experience, but can be about learning to live more comfortably with what is.

16. Mindfulness simply changes how we perceive, thereby changing our experience… Mindfulness is not a cure – it’s better… Elisha Goldstein • Mindful practice allows us to be present in our situation without judgment or attribution of negativity. • Our negative experiences allow us to recognize positive ones. They are our points of comparison by which we identify differences in life.

17. Equanimity Equanimity is a spacious, vast, and even state of mind. It does not take sides. It’s not about being untouched by the world, but letting go of fixed ideas. How else are we to develop compassion and loving-kindness for everyone and everything? Equanimity levels the playing field. We are not excluding anyone from our practice. SakyongMiphamRinpoche The steady state of mind with or without stress. Responding to all things equally. Zen does not confuse spirituality with thinking about God while one is peeling potatoes. Zen spirituality is just to peel the potatoes...Alan Watts

18. Beginner’s Mind (Shoshin) • Attitudes of: • Openness • Eagerness • Curiosity • Willingness • Absence of Preconceived Notions • ‘Tabula Rasa’ stance • “I know” means “I assume I know” • Much would be missed if we assume this

19. As Thinker, Observe Your ThoughtsI used to think my brain was the most wonderful organ in my body. Then I realized who was telling me this… Emo Phillips • When you find yourself getting wrapped up in your thoughts, creating any negative emotion, step back and observe your own thinking mindfully. • You are simply the thinker – creator of the thoughts. You are NOT your thoughts. • Thoughts are not facts. We change them, or they will change on their own. The stream of consciousness is ever flowing.

20. Don’t believe everything you think… • We can observe our thoughts without assuming them to be reality beyond our own mental process. • We can own them simply as our thoughts, not as truth. • Practice discernment… • Separate your thoughts from your affect and behavior • Again…allow them to be without judging them… We can simply learn from them.

21. As Feeler, Observe Your FeelingsMindfully Allow Them All • The same is true of our emotions. When we are mindful of our emotions, we can ‘step back in order to step in’. • We simply allow the feelings to be there. We are NOT our feelings. We are simply the observer of an internal phenomenon. • Just as our thoughts, our feelings are not facts. They change. • They are simply events in the day, as all other events .

22. Mindfully Feeling • Feelings are sacred. • They affirm our humanity. • They affirm our being alive. • For many people in early recovery, feelings are being experienced for the first time in a long time – or ever. • Regardless of what they are – including panic attacks or excruciating cravings – they can be tolerated. • The more in touch we become with them, the more freely and openly we can welcome and allow them to be.

23. Any Eventis an invitation to mindful practice • Old habits of perception and reaction are automatic. • Mindfulness begins in recognizing our natural tendency to react in any situation in ways which may not work well. • We can always choose how we are going to be with our experience and restructure our frame of awareness through: • Dis-identification • Re-perceiving • Mindful Detachment When we change the way we look at things, the things we look at change... Wayne Dyer

24. Mindfulness & Anxiety / Panic One is a great deal less anxious if one feels perfectly free to be anxious… Alan Watts • Fear of having a panic attack increases the likelihood that the next one will occur…and catastrophizing it makes it worse. • Self-talk about the attack can be changed. • Mindful awareness of the anxiety is a ‘behavioral experiment’ . • A person can invite and allow the experience – without judging or initially attempting to relieve it. • One notices and learns from feelings and thoughts about the panic, and how they can modulate it in either direction. • We can learn to tell ourselves: “As long as I am breathing, there is more right with me than wrong with me.”

25. Mindfulness & Depression • For chronic or seasonal depression, uncouple the experience from one’s definition of self. • You have depression – you are not the depression. You have feelings of worthlessness/hopelessness/etc. You are not worthless/hopeless/etc. • The same with negative cognitions – you are simply having negative thoughts – they do not have to be your reality. • Practice loving kindness toward self. Do not judge or deride yourself because of the depression. • Identify small, simple activities which can distract, reframe, empower, and do them mindfully. Seek the FLOW experience – even if in a very small way (Engagement, Mastery, Connection) • Help someone remember that even this experiences changes.

26. Mindfully Allowing Anger: Non-reactivity • Notice your anger and how you want to act/speak at this moment. Do not act on it at this time. • Notice your ‘demands’ or ‘shoulds’ being placed on the object of anger that are not being met. • Pay close attention to other feelings that may be present with the anger – especially fear if it is present. • Notice breathing – heartbeat – any other physical feelings – and how these may be different from your normal state. • Then Ask: How do I normally breathe? Would that be better for me now? Would I like to feel calmer? Where do I want the locus of my control to be right now? • Notice your breathing and pulse beginning to slow naturally, just from your own awareness and reflection. (Doing Calm)

27. The Power of the Pause

28. Mindfully Allowing Cravings in Recovery • A craving is no different from any other subjective event. It comes…it goes…and can simply be experienced. • For people struggling with addiction, these events can be extremely powerful and seemingly overwhelming. • Observing the Experience (Urge-Surfing) • Notice the feelings associated with the urge – physical sensations and emotions. • Notice the thoughts that arise in response to the urge – desire to drink/use, desire to maintain sobriety and continue recovery, judgment of self for having them…just notice without responding. • Notice your initial behavioral response preferences – then notice how those preferences change as you allow the urge just to be.

29. Remember the 3 Axioms of Cravings for Persons in Recovery • Cravings can never make someone do anything. The response to cravings is always one’s choice. • Cravings can be very uncomfortable – but they are never unbearable. Their “unbearability” is a product of the craver’s judgment of them (which leads to reactivity to them). • Cravings will always pass. Like everything else, they are simply events in the day.

30. Just for today… • Recovering chemically dependent persons know that they can only stay sober one day…one decision at a time. • Goals for lifelong sobriety can be made, but the only way they are reached is working with what life presents to any person right now. • Remaining in this day – in this moment without thinking about how long one can/will remain sober allows sobriety to be lived now. Time no longer matters.

31. Mindfulness & Physical PainEach condition I flee from pursues me. Each condition I welcome transforms me… Jennifer Paine Welwood • Pain is experienced with suffering and is exacerbated by negative appraisals of the sensation. • This results in anxiety, anger, sadness, and other emotional reactions, along with perception of the pain being worse. • The perceiver ‘braces’ for the sensation, expecting suffering, which leads to more suffering. • Mindful allowing and describing of the sensation helps reinterpret the experience and lessen suffering. • It uncouples the link between sensation and appraisal of the experience → creating opportunity for a new response. • Perceiver learns that one’s life is not the pain - although the sensation is real, mastery of the experience is possible.

32. Mindful Eating • When you eat, who is truly hungry? • Your stomach/body? • Your emotions? • Learning to be aware of your thoughts and feelings around eating is as integral to eating as the action of eating itself. • We rarely (if ever) are present with our food and eating. • Taking time for each step in the process: Seeing » Choosing » Touching » Smelling » Placing » Tasting » Chewing » Swallowing » Following

33. Experiential Avoidance is the Source of SufferingPain is Inevitable. Suffering is Optional… Buddhist Proverb Life with all it brings is the norm…not happiness. Pleasure and comfort, while very real when present, are nonetheless fleeting. Embracing the “Full Catastrophe” of Life – letting life just be what it is - results in peace. Grant me the serenity to accept the things I cannot change…

34. Radical Acceptance(Est quod est) • Allowing and accepting…rather than resisting… all circumstances life brings us. • Each experience is simply another life experience… not to be experienced with anger, fear or judgment… but just to be experienced as part of life. • We can simply go through anything life gives us with peace and serenity. It does not mean we have to want it, like it, or condone it – we just accept it. • Always remember……est quod est…… it is what it is.

35. Embracing is more powerful than Resisting • Allow yourself to see any experience as a gift. • Here is the gift of sadness. What can I learn about myself from this gift of sadness? • Here is the gift of anger. What can I learn about myself from this gift of anger? • Here is the gift of fear. What can I learn about myself from this gift of fear? • While you did not invite it into your life, it is here. So how do you want to reframe it?

36. Being With Others…Mindfully “Out beyond ideas of wrongdoing and right-doing there is a field. I'll meet you there. When the soul lies down in that grass the world is too full to talk about.” ― Rumi • Regardless of our therapeutic orientation or field of expertise, allowing ourselves just to be fully present with the person we strive to help without defensiveness or agenda can enhance the relationship. • Loving-kindness • Equanimity • Non-Judgment • We break old connections between stimulus, perception, judgment, and reactions …and reconnect with new awareness and heart. • We connect…but do not become. • We learn to respond to others and with others rather than to react.

37. Loving Kindness MeditationIf you really resent someone, pray for them for a while and see what happens… AA Saying • Practice of opening the heart to love, empathy and compassion - while reducing anger, fear and stress. • Similar to Acting Opposite in DBT when loving kindness is directed toward those feared or resented. • First object in loving kindness practice is oneself. • When practiced regularly, it can improve attitudes toward self and others. • May be safe. • May be healthy. • May have ease of body and mind. • May be at peace.

38. Practicing What We Preach:We can only share what we have. • When the therapist is practicing mindfulness as a way of life and a way of therapy. • The therapist approaches the client in a different way. Mindfulness is embodied in the relational field, and modeled silently and subtly. • The therapist shares part of him/herself, rather than merely trying to instruct. • This leads to more effective therapy. Being and doing with the client are far more effective than ‘telling’. • Simply being present with others may be the most important factor in helping them to heal.

39. Mindfulness of Mindfulness • Beginners try to be mindful of their mindfulness • Am I doing this right? • I have to focus on just what is here right now. • What is here now is your awareness of your awareness. • Do not judge yourself for this • Simply acknowledge it and bring attention back onto the experience of that moment. • Part of that experience can be your judgment of / frustration with the process.

40. Allowing Distraction as Part of the Process • Distractions in the field of awareness are simply part of the experience. • Trying to ignore the distraction or force it out of your mind will only give it more of your attention. • Acknowledge it, and accept your thoughts/feelings about it. • Invite it in and just let it be. • This allows you to refocus on the primary object of your mindful awareness.

41. Mindful Acceptance in the AA Big Book And acceptance is the answer to all my problems today. When I am disturbed, it is because I find some person, place, thing or situation — some fact of my life — unacceptable to me, and I can find no serenity until I accept that person, place, thing or situation as being exactly the way it is supposed to be at this moment. Alcoholics Anonymous (4th ed.) , pg 417

42. Thoughts on Mindfulness Meditation is the discovery that the point of life is always arrived at in the immediate moment… Alan Watts Realize deeply that the present moment is all you ever have. Make the now the primary focus of your life… Eckhart Tolle Life always gives us exactly the teacher we need at every moment. Every moment is the guru… Charlotte Joko Beck I can feel guilty about the past, apprehensive about the future, but only in the present can I act. The ability to be in the present moment is a major component of mental wellness… Abraham Maslow