AEDP

Core Skills Training:

How to Integrate Mindfulness & Focusing

into the AEDP Therapeutic Process(11th July, 2015)

Judy Wong

Registered Psychologist

Marriage & Family Therapist

Somatic Experiencing Practitioner

Certified AEDP Supervisor

11th July,2015 1

Paradigm Shift

• Affect regulation & emotional processing are

highlighted as central to psychopathology and

thus psychotherapy practice ( Dorpat, 2001,

Fosha, 2000, Goleman, 1995, Shore & Shore,

2008).

11th July,2015 2

Paradigm Shift

“Affect Communicating Cure” Vs “Talk Cure”

“working through” is not a matter of time,

but of adequate emotional experience

(Osimo, 2003)

11th July,2015 3

Adding Tools for Your tool Box

• A recent survey of trauma therapists indicated

most therapists integrate mindfulness &

meditation into standard treatment rather

than offering it in an adjunctive format.

(Waelde, 2015)

11th July,2015 4

Mindfulness

“Mindfulness is paying attention in a particular way; on purpose, in the present moment, and non-judgmentally. “

(Kabat-Zinn, 2012. p.3)

“ Mindfulness training involves the focusing attention in a mindful way---with curiosity, openness, acceptance, and kind regard---on what is happening as it is happening.”

(Siegel & Gottman, 2015. P. 218)

11th July,2015 5

Goals of mindfulness:

•Have an increased awareness of the present

moment.

• The focus of mindfulness is to be aware of and

observe the constantly changing internal &

external stimuli.

• Be aware and accepting whatever state the

mind & the body are in.

Mindfulness

11th July,2015 6

Clinical benefits of mindfulness

• Enhanced pain tolerance

• Increased flexibility, self respect, relaxation

• Fear & arousal inhibition

• Emotional clarity (Bishop, Shapiro, Carlson, Anderson, Carmody, et al., 2004; Masicampo & Baumeister,

2007; Fulton, 2005)

• Enhanced self-regulation, enable a form of ‘internal

attunement’ (Siegel, 2007a)

• Effective sleep, sensitivity to heart rate & breathing

• Decreased serum cortisol levels, dissociation &

rumination (Lee, Zaharlick, & Akers, 2011) 11th July,2015 7

Mindfulness and Synaptic change

• Drive energy and information flow to a circuit called

ATTENTION

• Map out the mind through ATTENTION

• Engage the prefrontal cortex in learning about

procedural tendencies and reflect on them rather

then enacting them…more adaptive & responsive to

current life situation (Davidson et al., 2003).

• Neurons fire together, wired together, program set.

• Change the connection of synapses (i.e. change the

neural excitation pathway)11th July,2015 8

Mindfulness & Mood Regulation

• Traumatized clients learn to slowly increase

awareness of body sensations, movement &

impulses and to tolerate them, changes take

place in the insula & medial prefrontal cortex,

allows for down-regulation of defensive action

systems, increased engagement of

attachment, exploration, & sociability

systems.

( Lanius, lanius, Fisher, & Ogden, 2006)

11th July,2015 9

Mindfulness & Dissociation

• Overcoming trauma related dissociation (TRD)

through self-regulation of attention to maintain the

continuity of present moment experience,

including thoughts, feelings, and sensory

experience (Bishop et al., 2004)

11th July,2015 10

Mindfulness & Self-Reflection

• Rather than overly identifying and accepting

the experience as reality, mindfulness

encourages decentralizing, be self-reflective

about the thoughts and feelings as transient

mental events in a wilder field of awareness.

(Teasdale et al., 2002)

11th July,2015 11

Mindfulness & Awareness

• “Awareness, as opposed to avoidance, of

one’s internal states allows feelings to be

known, and be used as guides for action. Such

mindfulness is necessary if one is to respond

adaptively according to the current

requirements for managing one’s life. By

being aware of one’s sensations one

introduces new options to solve problems.

This allows people to not react reflexively, but

to find better ways to adapt.”

( Van der Kolk, 2002) 11th July,2015 12

Convergence of AEDP & Mindfulness

• AEDP aims to cultivate the emergence of true

self experience through the non-judgmental

acceptance, by a compassionate other, in the

present moment, of the authentic affective

bodily-rooted self experience and expression.

11th July,2015 13

The science of mindfulness

• https://www.youtube.com/watch?v=yqUNtLb

woj4

11th July,2015 14

The healing power of mindfulness

• https://www.youtube.com/watch?v=_If4a-

gHg_I

11th July,2015 15

Essence of Mindful Awareness

• Stable

• Clear

• Sense of presence

(Siegel, 2007)

11th July,2015 16

Techniques for Experiencing

Mindfulness

Formal practices

•Sitting meditations (attending to breathing, body sensations, sounds, thoughts, etc.)

•Movement meditations (walking meditation, mindful yoga stretches, Tai Chi)

•Group exchange (led exercises, guided discussion of experience)

Informal practices

•Mindful activity (mindful eating, cleaning, driving, etc.)

•Structured exercises (self-monitoring, problem-solving, etc.)

•Mindful reading (especially poetry)

•Mini-meditations (e.g. the ‘3 minute breathing space’)

(Mace, 2007)11th July,2015 17

Clinical Applications of Mindfulness

Specific applications of mindfulness based

Interventions:

•Mood (anxiety, depression)

•Intrusions (ruminations, hallucinations, memories)

•Behaviours (bingeing, addiction, self-harm, violence)

•Problems of relating (attitudes, empathy)

•Problems of self (self-consciousness, self hatred) (Mace, 2007)

11th July,2015 18

Pilot Study on Mindfulness Training

for Children Paired Samples Test

Paired Differences

t df Sig. (2-tailed)Mean Std. Deviation Std. Error Mean

95% Confidence Interval of the

Difference

Lower Upper

Pair 1Pair 1preanxiousdepressed preanxiousdepressed --

postanxiousdepressedpostanxiousdepressed2.076922.07692 2.465142.46514 .68371.68371 .58725.58725 3.566593.56659 3.0383.038 1212 .010.010

Pair 2prewithdrawndepressed -

postwithdrawndepressed.23077 1.30089 .36080 -.55535 1.01689 .640 12 .534

Pair 3presomaticcomplaints -

postsomaticcomplaints.69231 1.75046 .48549 -.36548 1.75010 1.426 12 .179

Pair 4presocialproblems -

postsocialproblems.84615 3.64797 1.01177 -1.35829 3.05060 .836 12 .419

Pair 5prethoughtproblems -

postthoughtproblems1.23077 2.71274 .75238 -.40852 2.87006 1.636 12 .128

Pair 6Pair 6preattentionproblems preattentionproblems --

postattentionproblemspostattentionproblems1.615381.61538 2.534382.53438 .70291.70291 .08387.08387 3.146893.14689 2.2982.298 1212 .040.040

Pair 7prerulebreakingbehavior -

postrulebreakingbehavior.23077 1.48064 .41066 -.66398 1.12551 .562 12 .584

Pair 8preaggressivebehavior -

postaggressivebehavior1.76923 3.03188 .84089 -.06292 3.60138 2.104 12 .057

Pair 9Pair 9preinternalizingproblems preinternalizingproblems --

postinternalizingproblemspostinternalizingproblems3.000003.00000 3.582363.58236 .99357.99357 .83520.83520 5.164805.16480 3.0193.019 1212 .011.011

Pair 10preexternalizingproblems -

postexternalizingproblems2.00000 3.80789 1.05612 -.30108 4.30108 1.894 12 .083

Pair 11Pair 11pretotalproblems pretotalproblems --

posttotalproblemsposttotalproblems8.692318.69231 9.113959.11395 2.527762.52776 3.184803.18480 14.1998114.19981 3.4393.439 1212 .005.005

(Wong, 2014)11th July,2015 19

Mindful awareness, Neural Integration,

Secure Attachment, & Psychotherapy

Correlations and overlaps:

1.Body regulation

2.Attuned communication

3.Affective balance

4.Fear modulation

5.Response flexibility

6.Self-understanding/insight

7.Empathy

8.Morality

9.Intuition

(Siegel,2009, p167)

11th July,2015 20

Five Factors of Mindfulness:

1. Non-reactivity to inner experience

2. observing/noticing/sustaining/attending to sensations, perceptions thoughts, feelings ( remain present with)

3. Acting with awareness/not on automatic pilot, concentration/non-distraction

4. Describing/labeling with words

5. Nonjudgmental of experience (vs criticizing oneself, discerning with clarity)

11th July,2015 21

Mindfulness as Applied in AEDP

Therapeutic Process :

Directed mindfulness that guides patient’s attention

toward particular elements of present-moment

experience to achieve therapeutic goals:

•Affective regulation

•moment-to-moment tracking of bodily rooted

emotions

•Intrapersonal attunement ( self-compassion)

•Neural integration linking differential components of

the nervous system

11th July,2015 22

Mindfulness for emotional

regulation:

Focusing on body sensations,

Building resources,

Focusing on dyadic affect regulation

Attunement---moment to moment

tracking & matching client’s ANS

arousal, help client stays within the

window of affect tolerance.

Mindfulness for emotional

regulation:

Focusing on body sensations,

Building resources,

Focusing on dyadic affect regulation

Attunement---moment to moment

tracking & matching client’s ANS

arousal, help client stays within the

window of affect tolerance.

Mindful emotional processing:

Receptive awareness of full awareness

Focusing on SIBAM/rim

Alternate with mindful emotional

regulation

Mindful emotional processing:

Receptive awareness of full awareness

Focusing on SIBAM/rim

Alternate with mindful emotional

regulation

Mindful reflective awareness:

self-observational awareness

Internal attunement

integrate with receptivity---

Curiosity

Openness

Acceptance

Love

Interpersonal integration---’feel

felt”

Mindful reflective awareness:

self-observational awareness

Internal attunement

integrate with receptivity---

Curiosity

Openness

Acceptance

Love

Interpersonal integration---’feel

felt”

11th July,2015 23

11th July,2015 24

Effect

Effects of trauma on

three levels of the

brain:

Impairs thinking

processes & rational

problem-solving

abilities.

Overactivates,

Unresolved trauma

continues to trigger

defenses.

In a state of constant

activation---

impulsive automatic

reactions

Effects of trauma on

three levels of the

brain:

Impairs thinking

processes & rational

problem-solving

abilities.

Overactivates,

Unresolved trauma

continues to trigger

defenses.

In a state of constant

activation---

impulsive automatic

reactions

11th July,2015 25

Effective Trauma Treatment

Requires a balanced three levels information

processing:

•Cognitive process---thoughts, beliefs,

interpretations, & other cognitions

•Emotional processing---emotion & affect

•Sensorimotor processing---physical & sensory

responses, sensations, and movement

11th July,2015 26

11th July,2015 27

Polyvagal Theory: The ANS in Emotional

Regulation

• Immobilization---Life threatening situations

– Feigning death

• Mobilization--- Dangerous situations

– Fight-flight behaviors

• Social engagement---safe situations

– Make eye contact

– Facial expression, vocalization, listening.

– Vocalize with an appealing inflection & rhythm.

– Display contingent facial expressions.

(Porges, 2005)11th July,2015 28

State 1: Stress, Distress, & symptoms

Mindfulness for Emotional Regulation

•Nondirected mindfulness: for exploration of

dysregulated clients & finding a focus of

intervention.

•Directed mindfulness: mindfulness that directed

the client’s awareness towards particular

elements of present-moment experience (SIBAM)

for achieving a therapeutic goal.

(Ogden, 2009)11th July,2015 29

State 1: Stress, Distress, & symptoms

Mindfulness for emotional regulation:

• Focusing on body sensations,

• Building resources,

• Focusing on dyadic affect regulation

• Attunement---moment to moment tracking &

matching client’s ANS arousal, help client

stays within the window of affect tolerance.

11th July,2015 30

Directed Mindfulness for Emotional

Regulation

• Increased attention control to reduce habitual patterns of evaluation/appraisal (e.g. good, bad, self blaming...)

•Help to reduce cognitive rumination, a pattern of self-critical in depression.

•Non-judgmental attention allows for novel & emergent feelings of self-compassion.

(Farb, Anderson & Segal, 2007)

11th July,2015 31

Directed Mindfulness for Emotional

Regulation

•Begin with a period of concentrative attention practices to --- strengthen attentional control.

e.g. attending to parts of the body, or breathing.

•Transit to more open monitoring ---widespread attention to all bodily sensations, thoughts, imagery, emotions and action tendencies.

(Mace, 2007)

11th July,2015 32

Directed Mindfulness for Emotional

Regulation

Requires two processes that are distinct from cognitive reappraisal:

1.attention to the present moment body sensation, instead of delving into memory or cognitive elaboration & cognitive evaluation (e.g. ashamed, panicked, anxious)

2. Equanimity, the suspension of judging experience to be intrinsically good or bad until the sensations settled, i.e. her arousal returned to her window of affect tolerance.

(Mace, 2007)

11th July,2015 33

Directed Mindfulness for Emotional

Regulation

Body-reading and tracking of client’s immediate

experience:

•Physical signs of ANS arousal

•Changes of body sensations

•Somatic sign of emotions(e.g. moist eyes, change in

facial expression, voice & tone)

•Movement

•Beliefs

•Cognitive distortion (e.g. “I’m bad”)

11th July,2015 34

Directed Mindfulness for Emotional

Regulation

Aim & Sustain the focus of attention

•Use experiential language/contact statement to

communication relevant information to the client

•Redirect client’s orienting and attention to the present

moment bodily experience rather then only emotions

or stories.

•Utilizing somatic resources to help clients maintain

optimal arousal, e.g. movement, grounding, focusing

on the supported posture, centering, titration &

pendulation.

11th July,2015 35

Directed Mindfulness for Emotional

Regulation

Contact statements:

•simple and short

•Precise and resonant can induce and maintain

social engagement

•Intended to facilitate self-observation rather

than analysis

•Allowing client to attune more deeply to what’s

happening in the body and fine-tune the

description of his experience

( Ogden, 2006) 11th July,2015 36

State 2: The processing of Emotional

Experience

Mindfulness & Sensorimotor Processing

•Noticing & changing somatic tendencies in the present

to the exclusion of emotions & content limit the

information to be addressed to a tolerable amount &

intensity, facilitate affect regulation, paves the way for

future work with strong emotion.

•Learn to extend & refine their mindfulness of the body,

clients always discover the impulse to fight or flee that

were inhabited for the sake of survival.

11th July,2015 37

State 2: The Processing of Emotional

Experience

Mindfulness & Expansion of Regulatory Boundaries :

•Explorations that increase the client’s ability for play and

positive affect can mitigate maladaptive procedural

tendencies. Tracking of the body responses evoked by

the client’s narrative, not only alert attachment related

procedural learning, but also to expressions of social

engagement, positive affect and play.

•Therapist watches for the indication of positive affect,

participates and calls for attention to them, expresses

curiosity, enabling the moment to linger

(Ogden, 2009) 11th July,2015

State 2: The processing of Emotional

Experience

Mindfulness & Emotional Processing:

•Awareness of emotions---the bodily sensations and

physiological changes may reflect action tendencies.

•Awareness of the elements of continual feedback

loops of emotion: single emotion, blends of emotions,

perception, cognition, behavior, and blends of blends

of emotions

(Ogden, 2009)

11th July,2015 39

The Wheel of Awareness

• The wheel of awareness (rim, spokes,& hub) and the sectors of the rim: first five(outer world), sixth(body), seventh (mind/mental activities), & eighth ( relationships)senses

(Siegel, 2007, p. 121)

11th July,2015 40

The Wheel of Awareness

Rim represents the potential object of awareness.

1.The first five senses represents the physical plane

of knowing aspect of the outside world.

2. The sixth sense includes sensations in our limbs,

our body motion, tension or relaxation of our

muscle, visceral: heart, lung, and intestines---

source of intuition shape our emotional state,

influence our reasoning, hormonal state of the

body shapes our feelings.11th July,2015 41

The Wheel of Awareness

Rim:

3. The seventh sense enables the aspects of mind-thoughts, feelings, intentions, attitudes, concepts, images, beliefs, hopes, dreams – of oneself or others to be brought into the focus of attention.

4. The eighth is the “relational sense”, represents our sense of relationship, our connection with some being- resonate state, feel felt by other and feel a part of a large whole, awareness of our own intention

11th July,2015 42

The Wheel of Awareness

Spokes

•represents the intentional focus of attention on some aspect of the rim.

•We can build the skill of concentration by a practice on the focusing on one chosen object at a time, e.g. the steps, the breath, the movement of the body, a part of the body, or a picture.

•Focusing the mind, and returning to the object when our attention wander---”aim & sustain”function of concentration.

11th July,2015 43

The Wheel of Awareness

Hub of mind: the capacity to keep track of the target of attention.

•the choice to refocus our attention & the capacity to realize that our attention has wandered is the essential aspect of mindful awareness.

•purposefully train our mind return our target ---a foundation for creating a mindful state of awareness.

•Repeated mindful hub activation can likely induce neuroplastic changes.

11th July,2015 44

State 3: Metaprocessing of

Transformational Experience

Mindfulness & Neural Integration

•Mindfulness enables us to differentiate different of awareness from one and other- and then link them. Being mindful is profoundly integrative.

•The sensory stream is an important element to ground us in the present moment, the here-and-now.

•Mindful brain is the practice of skill of disarming the predominance of top-down flow so that we can sense the primacy of bottom-up with more clarity.

11th July,2015 45

Mindfulness Training & Neural Integration

• https://www.youtube.com/watch?v=LiyaSr5a

eho

11th July,2015 46

Mindfulness & Neural Integration

11th July,2015 47

Mindfulness and integrative aspects of

therapeutic relationship

11th July,2015 48

Mindfulness and integrative aspects of

therapeutic relationship

• Tracking the experience of shared awareness:

Therapist pauses & considers the dimensions of

awareness that shared in the tracking, receptive to

the internal state of the patient and focuses

attention on that shared state, …open to feedback

and honors input

• The joint focus attention stimulates neuronal firing is

the essence of attunement. Neurons that fire

together, wire together in specific ways harness

higher integration. (Siegel, 2009)11th July,2015 49

State 4 The Core State & the Truth

Sense

Mindful reflective awareness on the unfolding

of transformational phenomena:

•self-observational awareness

•Internal attunement

•integrate with receptivity---

•Curiosity

•Openness

•Acceptance

•Love

•Interpersonal integration---’feel felt”11th July,2015 50

Mindful Therapist

To develop a more skillful way to be a healer to deepen

mindfulness and self-understanding to your clients:

•Presence

•Tripod: openness, objectivity, observation

•Tracking

•Attunement

•Resonance

•Trust

(Siegel, 2010)

11th July,2015 51

Mindful Therapist

Presence:

•Open and flexible movement through time, the flexible motion back and forth from possibility to probability to activation.

•Being open, let go of the tendency of words, and other top-down constructs to dominate our present awareness

•Requires a tolerance for both uncertainty and vulnerability.

•Not the same as passive, but is an actively receptive state.

•Self-monitor our internal state, fight-flight-freeze response in the body.

11th July,2015 52

Mindful Therapist

Tripod:

1. Openness---accepting our own emotional reactions without making harsh criticism, receiving things as close to they actually are. Let go of tendency of words & other top-down constructs to dominate our present awareness.

2. Observation---being nonjudgmental, being nonreactive, acting with awareness, and the ability to label and describe with words the internal world).

3. Objectivity---the capacity to differentiate different streams of awareness. This power of discernment has the potential to free us from automatic pilot

11th July,2015 53

Mindful TherapistTracking:

•Stay present & track what experiencing in the share awareness, moment by moment.

•communicating what they are experiencing in here and now

•“stay with’ whatever arise in their awareness.

•Tracking the eight senses in real time.

•The tracking experience of shared awareness is the essence of attunement and subsequent resonance---more integrated dyadic states---neural integration by sharing a focus of attention & intention, connecting with the internal world of others.

•Deep tracking skills transcends the experience of separation.

11th July,2015 54

Mindful Therapist

Attunement: focus our attention on others and bring into our awareness the internal state of the other.

•Objective side: notice not just the words but also the nonverbal patterns of energy and information flow: elements of eye contact, facial expression, and tone of voice, posture, gesture, and timing & intensity of response.

•Subjective side: the authentic sense of connection, seeing the client deeply, and take in the essence in that moment.

•Tune in to our own internal shifts, our body sensations and stay present with whatever arise.

•Self-regulation.

11th July,2015 55

Mindful Therapist

Resonance: coupling presence and attunement into a whole function, taking the internal state of the client into themselves.

•Moves from understanding to engagement with curiosity, openness, acceptance and love (COAL).

•COAL means to be in a mindful state.

•“Don’t be too sure”

•Connect with the client, let the client know that we feel his feelings enables him to “feel felt”.

•Joining with the client in deep explorations of right-hemisphere-dominant bodily awareness and narrative explorations that weave a deep, visceral way of making sense with the past, present and the anticipated future.

11th July,2015 56

Mindful Therapist

Trust: is letting go, a willingness to rely on others for connection, comfort, and protection. A state of receptivity akin to Porges’s (2009) notion of love without fear.

•Attune to self and reduce stress through practice of mindful awareness, classic loving-kindness meditation (Kornfield, 2oo8).

•Let defense down, release restrictions to our innate capacity, move towards integrative state.

•Open to the meaning of missed connections with the client.

•Trust emerges with our sense of being open, connected to ourselves, others, and the world. 11th July,2015 57

Porges social engagement system

• http://www.somaticpractice.net/trainings/tou

ch_skills/resources/articles/polyvagal/Porges-

2003-

Social_Engagement_and_Attachment.pdf

11th July,2015 58

11th July,2015 59

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(Ed.), EMDR as an integrative psychotherapy approach: experts of diverse orientation explore the paradigm prism 11th July,2015 60