Restoration of the Indigenous Spirit

1. Restoration of the Indigenous Spirit 2013 CANAR Rebecca Ereaux, MSW & Judy Gobert PhD (ABD)

2. Overview • What is “Restoration of the Indigenous Spirit”? • What is Mindfulness? • Why Mindfulness for suicide prevention? • Overview of data on suicide in “Indian Country” • Mindfulness on the Flathead Reservation • Future Plans, Next Steps

3. Restoration of the Indigenous Spirit

4. Mindfulness is… • Paying attention on purpose, • Being in the present moment • Non-judgmentally • Attention (concentration) + Awareness John KabatZinn • Simple, but not easy…….mindfulness is a mental exercise • Attention • Awareness • Acceptance

5. Mindfulness is ……. When the mind is calm and focused in the present, it is neither reacting to memories from the past nor being preoccupied with plans for the future, two major sources of chronic stress known to impact health.” Dr. Joan Borysenko

6. Documented Benefits of Mindfulness • Increased emotional regulation • Increased social skills • Increased ability to orient attention • Increased working memory, planning, and organization • Increased self esteem • Increased sense of calmness, relaxation and acceptance • Increased sleep quality • Decreased test anxiety • Decreased ADHD behaviors-specifically hyperactivity and impulsivity • Decreased negative affect/emotions • Decreased anxiety • Decreased depression • Reduced conduct and anger management problems

8. Awareness & Breath Change sympathetic to parasympathetic balance within minutes! • Check in to find muscle tension, emotional state • Breathe in, belly extends, pause (40%) • Exhale more fully and slowly (60%), pause • 6 breaths per minute or fewer

9. Research on Mindfulness: • Mind/Body Medicine • Neuroscience • Clinical Science

10. Mind Body Connection The interrelationship between thoughts, feelings, beliefs and attitudes and their positive or negative impact on biological functioning, Physical states can affect mental and emotional states, and vice versa.

11. Stress & Effects • Adults with high perceived stress 2.6x greater risk of dying (Nielson, 2008) • Stress can “get under the skin” • Gene expression • Aging: Telomere length • Chronic, severe stress equivalent to an extra 10 years of “aging” (Epel et al., PNAS, 2004)

12. Stress & Diet Work Together to Promote Abdominal Fat (Kuo et al., 2007 Nature Medicine) Study with fats, under in 3 conditions: • Control • Junk Diet • Stress/Junk  a ballooning of visceral fat, abdominal obesity, metabolic syndrome

13. Preliminary Results, Dr. Thao Le • 40 Incarcerated Youth • Native Hawaiin, Pacific Islander ancestry • Collecting and testing secretory IgA, cortisol • Increased IgA – increased immunity • Decreased cortisol – decreased stress

14. Stress Summary • Stress is not just in “head”, but in body, brain, cells • Serious risk factor for physical and mental health • We can live well with stress if we build up resilience factors!

15. Mindfulness & Neuroscience

16. In one study, a research team from Massachusetts General Hospital looked at the brain scans of 16 people before and after they participated in an eight-week course in mindfulness meditation. The study, published in the January issue of Psychiatry Research: Neuroimaging, concluded that after completing the course, parts of the participants' brains associated with compassion and self-awareness grew, and parts associated with stress shrank. Mindfulness Neurobiology

17. A wandering Mind is an Unhappy Mind • Mathew A. Killingsworth and Daniel T. Gilbert • November 12, 2010 Vol330 Science How are you feeling right now? What are you doing right now? Are you thinking about something other than what you’re doing?

18. Mindfulness & Neuroscience

19. Why Mindfulness for Suicide Prevention? To address Suicide we must first speak of it “Silence is dangerous when we pretend the problem is not there…communication is a healer to break the silence.” Canadian First Nations Elder

20. Stress-Diathesis Theory of Suicide • Diathesis means a constitutional vulnerability to develop a disorder/behavior (suicidal behaviors). • Potentiating factors are needed to trigger the disorder/behavior (stress). • Can be influenced by genes, combinations of genes, brain pathology. • Genetics effects, childhood abuse and epigenetic mechanisms are implicated in the etiology of suicidal behavior • Variations in neurotransmitters may influence response. • Relationships between stressors and suicidal behavior may change over time.

21. Suicide Risk Factors Social Environment Individual Physical Environment- Old age (suicide) Younger age (behavior) Male (suicide) Female (behavior) Family history of attempt Child maltreatment Poor health Poverty Unemployment Poverty Social Isolation Local suicide epidemics Economic climate Lack of mental health care services Access to lethal means Increased rates suicidal behavior Psychopathology anxiety depression impulsivity irritability feeling of hopelessness Alcohol/substance abuse Suicidal behavior

22. Tribal Risk Factors • Historical trauma • High unemployment/poverty • High rates of substance abuse • Substandard health/mental healthcare • High incidence of drop outs • Assimilation/Acculturation • High incidence of abuse • High rates of out of home placement • Having a family member who died by suicide

23. Why Mindfulness? • A way to deal with historical stressors and current stress • Historical Cultural Practice • Evidence based results • Has been used with other adolescents • Never been used in a Native community • 30 years of research that shows it’s effective • Elders said to!

24. Tribal Strengths & Protective Factors • Strong cultural identity • Language • Cultural ways • Spirituality • Ceremonies • Kinship/family/tribal connectedness • Bi-cultural

25. 90% of those who die by suicide suffer from at least one major psychiatric disorder • Depressive disorders most prevalent (49-64%) • The 2nd disorder is a Substance abuse. • Bi-Polar, Schizophrenia are among the top 4 • 1/3 of male suicides - conduct disorder, co-morbid with a mood, anxiety, or substance abuse disorder. • Ultimately, mindfulness exercises and trains the brain

26. International Suicide RatesWorld Health Organization - 2010

28. Suicide in Montana • For all age groups, Montana has ranked in the top five for suicide rates in the nation, for the past 30 years. • June, 2012 by the Center for Disease Control, Montana has the highest rate of suicide in the United States.

33. Suicide Rates* Among Persons Ages 10–24 Years, by Race/Ethnicity and Sex, United States, 2005–2009

34. 2nd Leading Cause of Death by Age, MT 2004-2008

35. 1st Leading Cause of Hospital Admittance 2009

36. Background- Confederated Salish & Kootenai Tribes • Headquartered in Pablo, the Flathead Reservation is the fourth largest reservation in Montana. • The reservation is home to almost 65% (4,550) of the 7,052 enrolled Confederated Salish and Kootenai tribal members. • The Flathead Indian Reservation is home to three tribes, the Bitterroot Salish, upper Pend d'Oreille and Kootenai. • The reservation includes approximately 1.3 million acres in 4 counties. • The territories of these three tribes covered all of western Montana and extended into parts of Idaho, British Columbia and Wyoming. • The Hellgate Treaty of 1855 established the Flathead Reservation, but over half a million acres passed out of Tribal ownership during land allotment that began in 1904.

37. Confederated Salish & Kootenai Tribes (CSKT) • Community has: • Programs at Tribal Social Services • Circle of Trust Suicide Prevention (SAMSHA funded) • Public media campaign messages by Tribal Elders • Gatekeeper training • Why Mindfulness? • Only five suicide prevention programs for Native American youth have been deemed evidence-based by SAMHSA’s National Registry of Evidence-Based Practices and Programs. • Based on contemplative science: uncover the nature of reality & suffering. • Provides tools/skills, particularly emotional regulation skills.

38. Mindfulness Practice: Developing the “mindfulness” muscle • Mindful Breathing • Mindful Listening • Mindfulness of Nature • Mindful Walking • Mindful Eating • Mindfulness of the Body • Mindful Communication • Informal Mindfulness practices

39. Mindfulness Curriculum • Module 1: Introduction to Mindfulness & Mindful breathing • Module 2: Mindful Listening • Module 3: Mindfulness of Nature • Module 4: Mindfulness of Body • Module 5: Mindfulness of Thought • Module 6: Mindfulness of Emotions • Module 7: Cultivating Compassion & Empathy • Module 8: Judgment & Forgiveness • Module 9: Aligning with Vision

40. Structure within each session • Prayer, Smudge • Check-In • Story/Metaphor or Activity • Reflection/Discussion • Practice • Prayer

42. Translation & Adaptation • Phase 1: • Approval from Council • Presentation to Cultural Committees • Blessing from Elders • Phase 2: • Connecting with Two Eagle River School to offer as an elective class • Required a champion from the community (Judy Gobert) • CSKT Tribal Services involved in all aspects of the project including review of curriculum • Cultural syntonic (goals, metaphors, language and method).

43. Translation & Adaptation • Phase 3: • Expert Mind Body Awareness (MBA) trainers trained facilitators from the community • Four facilitators were selected based on experience with group facilitation, working with youth aged 15-20 years, and similar life experiences. • Along with the 4 facilitators, 20 community members participated in the 2 full days of training • Phase 4: • Mindfulness training was offered as an elective at the school • Training took place 4 times a week (Monday-Thursday) for 9-weeks. • At the end of the pilot study the principal made the elective class a permanent class in the school schedule

44. What Now? • Search for funding to expand beyond the initial pilot study. • Program sustainability requires staffing and expertise in mindfulness, more intensive training. • Attendance at the school is not consistent so it is difficult to have enough students receiving the full 9-weeks of training. • The program, while well received by the community, is not yet established as an evidence based suicide intervention. • Modification of the curriculum over the summer. Offering it to other schools and in the community. • Continue the research, pre & post interviews secretory IgA, cortisol brain scans

45. Partnerships Can Work! • Thao Le, Associate Professor, University of Hawaii at Manoa, Colorado Injury Control Research Center • Judy Gobert, Tribal Social Services Department, Confederated Salish & Kootenai Tribes • Two Eagle River School • LorannStallones, Professor, Colorado State University, Colorado Injury Control Research Center

46. Somewhere deep within there is afirmer, simpler, warmer human being. This human being trusts this human being accepts both the limits that give a human dignity, and the talents that the world awaits. Somewhere deep within there is a purpose that cannot be shaken, a love that no longer fears, and a wisdom that ennobles life. This human being is boththe instrument,and the profound expression of life. Unknown

47. Our Ultimate Goal? Restoration of the Indigenous Spirit