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
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
Overview of Mindfulness-Based Relapse Prevention
Purpose of the study
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.
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.
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)
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)
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
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)
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
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
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
Aqualitative approach was deemed most appropriate. Methods Used include:
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
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
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.
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
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).
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
Practical and useful practices for triggers/cravings and high risk situations
Increased retention/ Helped many clients stay in the community
Heads slowed down
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
“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”.
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
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
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