“Notice That” Integrating Mindfulness into EMDR Therapy & Trauma-Focused Care

1. “Notice That” Integrating Mindfulness into EMDR Therapy & Trauma-Focused Care Ohio Counseling Association Spring Conference 2019 Suzi Rutti, MSW, LISW-S & Rachel Weaver, MSW, LISW-S, LICDC-CS, DBTC, CEAT

2. “Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally” -Jon Kabat Zinn

3. Objectives 1. Define mindfulness and its application to trauma-focused care 2. Discuss EMDR therapy as a mindfulness-informed practice 3. Demonstrate 3 mindfulness strategies for integration into trauma treatment and/or EMDR therapy

4. Practicing Awareness Exercise

5. What is Mindfulness? Mindfulness: a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations without judgment. “Be here now.” Step one is to notice whatever you are doing. This can be eating, walking, listening to music, breathing, almost anything can be “mindful”. How to do it: • Inevitably, your attention will leave and wander to other places. • When you get around to noticing this—in a few seconds, a minute, five minutes—return your attention to the moment/activity. • Don’t bother judging yourself or obsessing over the content of the thoughts. Come back. • You go away, you come back. • That’s the practice. It’s often been said that it’s very simple, but it’s not necessarily easy. • The work is to just keep doing it. Results will come. (Germer, 2004)

6. Meditation vs Mindfulness? Meditation: thinking deeply or focus one's mind for a period of time, in silence or with the aid of chanting, for religious or spiritual purposes or as a method of relaxation Differences between Mindfulness and Meditation? Meditation is dedicated time, set aside to specifically engage in focusing one’s mind fully. This is usually done sitting or lying down quietly with stillness. Mindfulness, however, can pretty much be done…Any Time, Any Place/Environment, During any variety of activities (eating, walking, music, *dancing): Dancing Mindfulness (Germer, 2004)

7. Trauma-Informed Care vs Trauma-Focused Care Trauma-Informed Care • Recognizes the role that unhealed trauma plays in human behavior • Provides a template for minimizing harm in the delivery of human services • Offers an educational framework for human services systems Trauma-Focused Care • Assumes that unhealed trauma plays a major role in presenting issues • Denotes greater action in the delivery of treatment services • Promotes proactive treatment planning to heal the legacy of trauma (Marich & Dansigner, 2018)

8. Neurobiology of Trauma/Triune Brain (English, 2016)

9. EMDR Therapy What is EMDR Therapy? • A structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation which is associated with a reduction in the vividness and emotion associated with the trauma memories. (APA; Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder, July 31, 2017). EMDR Therapy as a Mindfulness-Based Practice • There is considerable overlap between neurobiological models of PTSD and neurobiological findings in the mindfulness literature. Recent research shows that mindfulness-based treatments have the potential to target emotional undermodulation (associated with hyperarousal and intrusion symptoms) and emotional overmodulation (associated with dissociative symptoms). Specifically, evidence suggests that mindfulness-based therapies may be effective in increasing activity in prefrontal regions and reducing activity in limbic regions (e.g., amygdala), and thus may effectively target intrusion and hyperarousal symptoms. (Boyd, et al., 2017)

10. Why Mindfulness? • Awareness • Grounding • Connection • Integration “A human mind is a wandering mind, and a wandering mind is an unhappy mind” (Killingsworth & Gilbert, 2010)

11. Where does Mindfulness fit? Phase 1 History Taking: Awareness of past impacting present Phase 2 Preparation: Resourcing (previously known as Stabilization) Phase 3 Assessment: Emotional/Body Awareness Phase 4 Desensitization: “Notice that;” “Go with that” Phase 5 Installation: Connecting Positive Belief & Body Phase 6 Body Scan: Body awareness Phase 7 Closure: Strategies for use between sessions Phase 8 Reevaluation: Checking back in/future planning

12. Mindfulness Strategies for use with EMDR Therapy • Awareness/grounding • Breathing • Muscle tense/release • Guided visualization • Movement; Dancing Mindfulness • Expressive Arts • Identification of other recovery capital (Marich, 2019)

13. Evaluation of the Process Pleasant? Unpleasant? Neutral?

14. Let’s practice...

15. Breath exercise

16. Container Visualization

17. Movement

18. Discussion • How could these strategies (or others like them) be useful in your trauma-focused practice?

19. Best Practices/Final Notes about Mindfulness • Self-practice • Building a “toolbox”

20. Questions/Comments

21. Resources Trauma Made Simple: www.traumamadesimple.com Institute for Creative Mindfulness: www.instituteforcreativemindfulness.com EMDR Therapy & Mindfulness for Trauma Informed Care (Marich & Dansigner)

22. References • APA; Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (July 31, 2017) https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing • Boyd, et al. (2017). Psychiatry Neurosci. 2018 Jan; 43(1): 7–25. Published online 2017 Oct 3. doi: 10.1503/jpn.170021 Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence. • Germer, C. (2004). What Is Mindfulness… And Why Is It Important to Therapists?Article, Fall 2004. https://www.buddhistinquiry.org/article/what-is-mindfulness-and-why-is-it-important-to-therapists/ • Killingsworth, M.A. & Gilbert, D.T. (2010). A wandering mind is an unhappy mind. Science 330 (6006) November 11, 932-932. • Marich, J. (2019). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Training Course Part 1. Warren, OH: The Institute for Creative Mindfulness. • Marich, J. & Dansiger, S. (2018). EMDR Therapy and Mindfulness for Trauma-Focused Care. New York: Springer Publishing Company. • English, I. (2016). Part 1: Understanding heuristics and biases in homeland security: The triune brain. Retrieved February, 2019 from: https://medium.com/homeland-security/part-one-understanding-heuristics-and-biases-in-homeland-security-the-triune-brain-d374317f508 • Stachelski, M. (retrieved March, 2019). Module 1 - Mindfulness. Colorado Cancer Counseling. Colorado Cancer Clinic. https://static1.squarespace.com/static/5886c191f5e231bd0aca284e/t/5b09d82003ce64b8950687b4/1527371809283/Mindfulness_Managing+Your+Emotions.pdf