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Mindful Art Workshop: Principles and Applications

of Mindfulness and Art Therapy

Presenter: Amee Le, OT Reg (Ont.)

Community Head Injury Resource Services of Toronto (CHIRS)

CAOT Lunch & Learn June 10, 2014

L’Association canadienne des ergothérapeutes Canadian Association of Occupational Therapists

Agenda

• Mindfulness & Brain Injury Research

• Mindful Art Workshop Group Protocol & Themes

• Art Showcase

• Emerging Themes

• Key Take Away Points

• Contact Information

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Learning Objectives

1. Appreciate the value of using mindfulness for persons with cognitive impairments.

2. Be familiar with how mindfulness and art therapy can be combined into an effective clinical program.

3. Be inspired to consider these useful tools in your current programs and adding them to your treatment toolbox.

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Mindfulness & Traumatic Brain Injury

Bedard, M., Felteau, M., Marshall, S., Cullen, N., Gibbons, C., Dubois, S., Maxwell, H., Mazmanian, D., Weaver, B., Rees, L., Gainer, R., Klein, R., Moustgaard, A. (2013). Mindfulness-Based cognitive therapy reduces symptoms of depression in people with a traumatic brain injury: Results from a randomized controlled trial. Journal of Head Trauma Rehabilitation, Lippincott Williams & Wilkins Azulay, J., Smart, C., Mott, T., Cicerone, K., (2013) A Pilot Study Examining the effects of Mindfulness-Based Stress Reduction on Symptoms of Chronic Mild Traumatic Brain Injury/Postconcussive Syndrome. Journal of Head Trauma Rehabilitation, Lippincott Williams & Wilkins

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Mindfulness & Brain Injury

• 10 weeks group protocol

• Bedard: Mindfulness based cognitive therapy (MBCT) by Segal et al. (2002) – Reduction in depression

– Maintained at the 3 months follow-up

– Approaching statistical significance p=0.029

• Azulay: Mindfulness based stress reduction (MBSR) by Jon Kabat-Zinn (2009) – Perceived quality of life scale p=0.003

– Perceived self-efficacy scale p=0.001 especially in management of cognitive, emotional symptoms

– Statistically significance aspects of working memory and regulation of attention p=0.01

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A Randomized Controlled Trial of Mindfulness Based Art Therapy (MBAT)

Monti, D.A., Peterson, C., Kunkel, E.J.S., Hauck, W.W., Pequignot, E., Rhodes, L., & Brainard, G.C.

(2006). A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with

cancer. Psycho-Oncology, 15, 363-373.

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A Randomized Controlled Trial of Mindfulness Based Art Therapy (MBAT)

• Cancer patients within the Philadelphia region

• n=111 women with 93 completing both pre/post measurements

• Exclusion criteria: terminal, concurrent psychiatric diagnosis of major mood disorder, psychotic disorder or significant cognitive deficits

• 8 weeks MBAT psychosocial group or wait list control group

• MBAT group demonstrated decreased in symptoms of distress (Symptoms Checklist-90-R)

• Improved in key aspects of health related quality of life (Medical Outcomes Study Short–Form Health Survey)

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Mindfulness Based Art Therapy (MBAT) Group Protocol

• Eight consecutive weekly meetings

• Two and a half hours long

• Sessions are standardized in format using a manual

• Mindful Meditation includes: body scan meditation, sitting meditation, gentle Hatha yoga, walking meditation

• Art Activity includes: drawing (coloured pencil, marker, pastel, watercolor crayon, paint), collage, open studio

• Home assignment: practice mindful meditation for 6 days a week for 30 minutes by using guided audiotape

• Recommendations for reading to support Mindfulness curriculum were offered

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Goals of Mindfulness Based Art Therapy (MBAT)

• Goal of the MBAT program is to facilitate a sense of control by recognizing that each person has a choice to view their illness as is, or alter their relationship to aspects of the illness

• Goal is accomplished by:

1. Mindfulness: Learning self awareness through practicing and experiencing mindfulness practices

2. Art: Creative expression of internal thoughts and emotions through art therapy

3. Group Therapy: Enhancing self-acceptance through verbal and non-verbal bonding and social support in a group structure

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MINDFUL ART WORKSHOP I s a t h e r a p e u t i c w o r k s h o p f o r c l i e n t s w i t h an

a c q u i r e d b r a i n i n j u r y .

Th e p r o g r a m t e a c h e s c l i e n t s t o u s e p r i n c i p l e s o f M i n d f u l n e s s & M e d i t a t i o n

a n d A r t T h e r a p y t o c a r v e e r a s e r s t a mp s a n d c r e a t e p r i n t s .

Please visit us at: www.mindfulartabi.com 10

GOAL To facilitate acceptance by creating a safe space where participants can engage in the process of finding meaning through shared traumatic experiences.

Can’t Stop Tomorrow by Fiona

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Process of Achieving the Goal 1. Mindfulness: learn the concepts & practice to get a direct experience

2. Art: creating art is a meaningful activity

• Engaging in the process helps participants to experience a difficult emotion without over-reacting or over-identifying with the emotions

• This facilities acceptance and decreases “judgment”

• This allows participants to practice different coping strategies in a safe environment with feedback

• The process encourages participants to find inspiration from within to encourage internal locus of control

• The activity allows participants to express the mindfulness concepts in a functional and meaningful way which helps the person to remember the experience

3. Group Therapy: allows participants to share stories in safe environment which further enhances self-acceptance through verbal and non-verbal bonding and social support

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Group Protocol

1 Introduction & Journaling

2 Breathing Meditation

3 Mindfulness Lesson & Meditation

4 Art Instruction & Meditation

5 Art Class & Group Support

6 Gratitude

Eight consecutive weeks

Two hours long

Mindful Meditation includes: breathing meditation, mindfulness meditation, and yoga movement meditation

Art Activity includes: carving linoleum or erasers & stamp pads for printing

Blog: Sharing the blog posts of the participant’s artwork, gratitude quotes and mindfulness themes

No Homework

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Gratitude “I am thankful for my life,

for being alive.

Thankful for all the wonderful people

who have helped me, and continue to help me.

I am thankful for my family and

thankful that I’ve met all of you guys here.

I look forward every Thursday to come here.”

--Roxanne

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Mindfulness Themes Week Theme

1 Judgment + Acceptance = Surprise!

2 Storms, Strengths and Wisdom

3 Keep Going

4 Prints & Patterns

5 The Intelligent Body

6 Black & White Thoughts

7 Wishes & Release

8 Celebration!

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week

1/8

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Storms, Strength and Wisdom

week

2/8

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week

6/8

Black & White Thoughts - Black & White Prints

Survivor by Maria Fond Memories by Inder 18

Wishes and Releases

week

7/8

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week

8/8

Celebration! Art Exchange

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Art Journaling

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• Death calling

• Coma

• Surviving

• Anger, frustration, denial

• Mourning

• Perhaps a difficult and arduous journey

• At times with mixed blessings

• Finding meaning

• Emerging acceptance

• Gratitude

Brain Injury – A journey with many voices…

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Emerging Themes

Life

Love

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Applications of Mindfulness, Art Therapy and Group Dynamics

1. How can you engage clients internal reflections?

Have you thought about Art Journaling or Photo Journaling?

2. How can you give your clients the experience of relaxation?

What about using a 5-minute Guided Yoga or Meditation with your clients?

Have you tried meditation?

Have you tried meditating with your clients?

3. How do you encourage clients to speak using positive narratives and non-violent language?

Have you tried a Gratitude Exercises or Gratitude Journals?

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References • Azulay, J., Smart, C., Mott, T., Cicerone, K., (2013) A Pilot Study Examining the effects of

Mindfulness-Based Stress Reduction on Symptoms of Chronic Mild Traumatic Brain Injury/Postconcussive Syndrome. Journal of Head Trauma Rehabilitation, Lippincott Williams & Wilkins

• Bedard, M., Felteau, M., Marshall, S., Cullen, N., Gibbons, C., Dubois, S., Maxwell, H., Mazmanian, D., Weaver, B., Rees, L., Gainer, R., Klein, R., Moustgaard, A. (2013). Mindfulness-Based cognitive therapy reduces symptoms of depression in people with a traumatic brain injury: Results from a randomized controlled trial. Journal of Head Trauma Rehabilitation, Lippincott Williams & Wilkins

• Kabat-Zinn, J. (2009). Full Catastrophe Living: Using the wisdom of your body and mind to face stress, pain and illness, 15th ed. New York, NY: Random House Inc.

• Monti, D.A., Peterson, C., Kunkel, E.J.S., Hauck, W.W., Pequignot, E., Rhodes, L., & Brainard, G.C. (2006). A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psycho-Oncology, 15, 363-373

• Segal, ZV., Williams, JMG, Teasdale JD. (2002) Mindfulness-Based Cognitive Therapy for Depression. A new approach to preventing relapse, New York, NY: The Guilford Press, 2002

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L’Association canadienne des ergothérapeutes Canadian Association of Occupational Therapists