the mindful path in trauma care - tlcinstituteonline.org · –i don’t know how/can’t meditate....

The Mindful Path in Trauma CareCherie L. Spehar, LCSW, CTC-S, RPT-S

Smiling Spirit Pathways: The Apex Center for Trauma Healing LLC

Apex, NC

Copyright 2013 Cherie L. Spehar, LCSW, CTC-S, RPT-S

TODAY‘S MINDFUL PATH

❖ Exploring Mindfulness !❖ A Working Definition !❖ Mindful Concepts, Ideas, Techniques !❖ The Science, Art, and Practice Framework !


Today’s Path• The Science:

–Why is it significant in trauma work?

–What do studies show?

–How is that important?

–What does that mean for self as clinician and self as person?

–What does that mean for client?


Today’s Path• The Art

–The balance and dance between client, clinician, self, shadow, light, wisdom, safety, knowledge and practice

–Pacing checklist –Understanding mindfulness in the

context of trauma-informed care


Today’s Path

• The Practice –How can you introduce mindfulness

to your clients?

–What are some mindfulness practices and techniques?

–The Mindfulness Spectrum


What Is Mindfulness?

• Common Misconceptions – It’s against my religion. – It’s too new agey. – I don’t want to hypnotize myself. – It’s from the occult. – I don’t know how/can’t meditate. – Others?

• These are what Mindfulness is NOT


A Basic Definition

!

AWARENESS Noticing


Mindful Awareness of:

Self Body Emotions Thoughts Place 5 Senses Spirit


A Working Defintion

Mindfulness is the capacity to be aware of states of being, thoughts, present experiences

and to “to see with a beginner’s mind.”!–Suzuki Roshi !

!Mindfulness is how we pay attention to

thoughts, feelings, sensations, and what power we give them. ~Spehar


Why Use Mindfulness?

• Internal balance • Intra and interpersonal connection • Developing safety with feelings • Emotional regulation • Promotes calm by working directly with the

body’s natural stress response • Proven changes in brain structure


Client Benefits

• Helps them discover internal resources such as capacity, spaciousness, love (Kornfield, 2012).

• Increases flexible thinking and feeling • Generates insight • Increases personal authenticity – critical for

survivor to thriver work • Builds new neural pathways • “It is the opposite of denial”..(SSP client)


Client Benefits• Provides a sense of trust in their ability to

manage thoughts and feelings– their “personal Mindfulness Gauge” (Rothschild, 2011)

• Demonstrates the temporary nature of feelings, thoughts, reactions

• Reduces avoidance, gently and without significant threat

• Teaches replacement options – curiosity • Restores harmony by activating the PNS


THE “SCIENCE” OF MINDFULNESS

Understanding and applying the new research


Scientific support – Mindfulness grows brain!

• Brain is physically changed/transformed • Proven health benefits of mindfulness • Research identified brain changes – what are

they, and what do they mean for practitioners? • Neuroplasticity and mindfulness • “Mindsight” – “the capacity to sense that your

mental activities are not the totality of who you are” - Siegel


What happens in the brain when we are mindful?

“The left prefrontal cortex is the part of your brain that’s directly behind the forehead and to the left, just above your left eye. In advanced meditators, we find that there is a greater degree of specific activity in this part of the brain than in the brains of people who do not meditate.” (Thompson, 2013)


More structural brain changes..• The parietal lobe has been shown to be more developed

in long time meditators. (Thompson, 2013). !

• M.R.I. brain scans taken before and after the participants’ meditation regimen found increased gray matter in the hippocampus, an area important for learning and memory. The images also showed a reduction of gray matter in the amygdala, a region connected to anxiety and stress. A control group that did not practice meditation showed no such changes.(Bhanoo, 2011).


• http://www.youtube.com/watch?v=wdHRR_XuJQo

Figure 1. Correlations of the score of the describing facet in mindfulness tendency and gray matter volume.

Murakami H, Nakao T, Matsunaga M, Kasuya Y, et al. (2012) The Structure of Mindful Brain. PLoS ONE 7(9): e46377. doi:10.1371/journal.pone.0046377 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0046377



Mindful

http://www.nmr.mgh.harvard.edu/~britta/SUN_July11_Baime.pdf.


Traumatized Brain

Traumatized Brain Meditation Brain


To be continued…

Advanced [mindful] practice can help the brain to be able to support higher and higher

levels of connection to the world, often resulting in greater degrees of social awareness, inner freedom, and life

fulfillment.” (Thompson, 2013).


THE ART OF MINDFULNESS

Understanding key points about shaping your use of mindfulness in trauma care


Pacing Points• The Trauma Identity Trio – Victim, Survivor, Thriver –

How do THEY see themselves? !

• Individual Capacity for Awareness !

• Fear Factors – How fearful are they to be present with feelings and thoughts? !

• Regulation Factors-While mindfulness can create regulation, what inner capacity have they already gained to do so?


Mindfulness Pacing Checklist

✓Assess for Victim/Survivor/Thriver benchmarks – why?

✓Check for capacity of awareness, and fear of awareness

✓Explore fear of being with emotions ✓Willingness of client ✓Emotional, Mental, Spiritual Safety


SNAG – Daniel Siegel

• S – Stimulate !

• N – Neural !

• A – Activity and !

• G - Growth


FACES – Dan Siegel

• F - Flexible • A - Adaptive • C - Coherent • E - Energized • S - Stable

“Without FACES, we move toward chaos, rigidity, or both…” (Siegel, 2011).


Contraindicators

3 Critical Reasons Why Mindfulness May Not Be Right for Your Client

!(Okay….maybe just a few more)


“Wherever you go, there you are – HERE you are” ` Elisha Goldstein. And HERE can sometimes be too much or too hard for a healing person

• Dr. Elisha Goldstein states “the fact is our brains aren’t wired to be happy; they’re wired to keep us safe. That’s why left to its own devices the brain isn’t going to be aware of all the good that is around. !

• “There are many writers, psychologists and mindfulness teachers who speak about the essence of our true nature being good, being happy, and being compassionate”…HOWEVER…

• “Our brain is often times not in a state of feeling safe and secure and is more often on the lookout for what’s a potential danger around us. This is what’s been called the brain’s automatic negativity bias. In other words, we’re far more likely to pay attention to what’s not good than to what’s good. This is especially prevalent if you’ve ever struggled with anxiety, depression or any trauma.”


Proceed with Caution• Window of tolerance (Siegel) –

how much bodily/sensory arousal can be tolerated

• Clinician is not informed in mindfulness practice

• A client is too dysregulated or experiencing too many symptoms

• A client does not have an adequate anchoring system

• When trauma symptoms are still assaulting the victim

• Does the client have adequate resources built around the trauma? If not, do NOT proceed with mindfulness.

• If the client does not have a feeling of RELATIVE SAFETY in the world around them, mindfulness is too difficult. “Resources go into scanning the world instead of a capacity to bring attention inward and tune into selves.” (Goldstein)


THE PRACTICE OF MINDFULNESS

Integrating the science and art into your individual practice


Introducing Mindfulness to Clients

• Education – For example: – It’s Brain-Training – Mind-Science – NOT a religion, but many religions use a form

of mindfulness • Share Benefits • Create Safety


How?

• General Mindful Awareness Practices (MAPs)

• Structured Examples –MBSR

–ACT

• Mindful Self-Compassion • Mindfulness “Techniques”


Teaching Mindfulness

!!

An opening collection of key ideas, concepts and phrases for sharing, teaching, and

integrating mindfulness practice with clients


THE PRACTICE OF MINDFULNESS – PART 2 ADVANCED

Integrating the science and art into your individual practice


STRUCTURED MINDFULNESS PROGRAMS


What is MBSR?• Created by Jon Kabat-Zinn • Currently in workbook format • Focuses on awareness of brain habits and

choice making to interrupt unconscious interplay between thoughts, feelings, emotions, and behavior

• Brings awareness to our “choice moments” leading to…

• Presence in the choice space


What is ACT?

• It is a mindfulness based/driven therapy • Mindfully and with presence focuses on

– Awareness and Acceptance of a given reality – Choice in a direction of VALUE – Taking action


Mindfulness Mantras

• RAIN • SAFE • SIFT • STOP • FACES • FUSED • Soften, Soothe, Allow • The Still Quite Place


The Still, Quiet Place (Saltzman)

• Practice Activity • Can be adapted for all ages • Let’s try with prose for Kindergarten

through 2nd grade • 5 Minute Capture


SIFT

• S – Sensations !

• I – Images !

• F – Feelings !

• T - Thoughts


RAIN (Tara Brach)

• R – Recognize !

• A – Accept, Acknowledge !

• I – Investigate !

• N – Non-identification


“Simple Pause” - Goldstein

Find a moment to

pause during the day and ask yourself:What is

good right now?

What is steady?

What do I love?


Mindful Speech (Frederick Burggraf)

• Speaking mindfully creates space for choice and regulation !

• It is a moment given to self to tune into what you are about to say before saying it

When I speak mindfully, I place a

pause before each sentence…..


SOFTEN, SOOTHE, ALLOW

• A form of loving-kindness meditation. !

• If you are comfortable, let’s try it now. !

• http://www.mindfulselfcompassion.org/meditations/Soften-Soothe-Allow.pdf


SAFE (Elisha Goldstein)

• S – Soften !

• A – Allow/Accept !

• F – Feel into the emotion with kindness !

• E – Expand awareness and wishes to all people


STOP (Goldstein, et al).• S – Stop • T – Take a few deep

breaths • O – Observe your

experience (body, emotions, thoughts)

• P – Proceed with the question, “What is most important for me to attend to right now?


CREATE A TOUCHSTONE

• Develop an association with something that will remind you at least once a day to pause and tune in. – Rock by doorstep – When you first get in

the car – A sign on the highway


PEACE (Amy Saltzman)

• P – Pause • E – Exhale • A – Acknowledge, Accept, Allow • C – Choose (Clarity, Courage,

Compassion, Comedy) • E – Engage again with people, world


FUSED (Cherie Spehar)• F – Freeze !

• U – Undivided Attention Umbrella !

• S – Sensory Synergy !

• E – Express and Expand !

• D – Delight Demonstration


CORE (Cherie Spehar)

• C – Connected !

• O – Open !

• R – Receptive !

• E - Expectant


NOTICE THREE

• In any given moment of the day, pick a combination of 3 things to focus your mindful attention upon. – Leaves – Blades of grass – Stones – Mugs


MINDFUL SELF-COMPASSION


Mindful Self-Compassion

• What is this form of mindfulness? • Why is it integral to trauma care? • Where does it fit in with the overall pacing

of trauma treatment? • How do we introduce, teach, and support

mindful self-compassion and loving kindness practices?

Copyright 2013, Cherie L. Spehar LCSW, CTC-S, RPT-S. All Rights

Reserved.

Mindful Self-Compassion

• A way of learning to be with Self, feelings, thoughts and internal/external responses in a gentle, judgment free awareness. !

• Promotes safe mindfulness and self-empowerment. !

• Effective and easily learnable techniques


Mindful Self-Compassion Interventions

• Learn 5 new ways to integrate Mindful Self Compassion into trauma care – Trance of Unworthiness – False Refuges – 5 Paths to Self-Compassion – Loving Kindness Meditation – Birds of Flight


Trance of Unworthiness (Tara Brach)

• Created by our belief systems about life, the events that happened to us, and our role as victim or being “fault stricken” !

• Characterized by feelings of being deficient, lonely, and alone


Discover False Refuges

• False refuges (Brach, 2011) are internal places we visit to make sense of our world.

• Unfortunately they are illusions and can’t sustain comfort and wellness.

• By assisting client in identifying their false refuges, we can gently aid them in restructuring more solid, wellness based places to live emotionally and mentally

ACES

Acceptance Compassion

Empathy Simplicity

The power in surrendering

• Surrender is associated with giving up and relinquishing – and that is absolutely not what it is. Surrendering is recognition that you have no idea what forces are at work in your life. “I do not understand the multiple forces that are at work in my life and I surrender to the complexity of creation.” ~Caroline Myss

Leaving our Refuges by Surrendering

• We have no authority over major league events like synchronicity, coincidence or love. (Myss, 2012)

• I cannot make one person love me; that they do is a miracle and those are the things that matter. I can’t make one person come into my life – and when someone suddenly does and becomes a friend, that is the thing that changes my life. (Myss, 2012)

The Five Ways to Self-Compassion (Germer, 2009)

Physically Mentally

Emotionally Relationally Spiritually


IS IT TRUE? (Byron Katie)

• Is it true? (Yes or no. If no, move to 3.) !

• Can you absolutely know that it's true? (Yes or no.) !

• How do you react, what happens, when you believe that thought? !

• Who would you be without the thought?


Loving Kindness Meditation

!May I be…..

May you be…. May he be…. May she be….

May all creatures and living things be… I send to myself….


COAL

• C – Curiosity !

• A – Acceptance !

• O – Openness !

• L - Love


Mindfulness and CBT – Spehar

• How are they different? – Mindfulness doesn’t focus on thoughts alone – Sensory awareness is essential – Specific physical regulation techniques – Thought transformers are based in the body – CBT requires judgment of thought (rational?

Wrong vs right thought?) – Mindfulness is based in acceptance of ALL

thoughts, feelings, sensations


Mindfulness Wheel

• There is a continuum of mindfulness that can be conceptualized like a practice wheel. !

• Wheel turns from simple breath, to noticing, to non-judgmental exploration to applying techniques to help you activate the PNS and achieve sensory balance.


On Being a Mindful Clinician

Activity and Advanced Discussion


Mindfulness Across Disciplines

Yoga

Medicine

Education

Mental Health

Massage

Corporate


MINDFULNESS LEADERS

• Tara Brach • Elisha Goldstein • Kristin Neff • Christopher Germer • Pema Chodron • Jon Kabat-Zinn • Thich Nhat Hahn • Tara Brach • Byron Katie

• Sharon Salzberg • Amy Saltzman • Jack Kornfield • Matthew Sandford • Sara Lazar • Rick Hanson • Ronald Siegel • Daniel Siegel


Questions? Do connect!


Smiling Spirit Pathways

• www.facebook.com/smilingspiritpathways !

• www.facebook.com/smilingspiritscribing !

• www.smilingspiritpathways.com !

• www.cheriespehar.com


References• Baime, M. (2011, July). This is your brain on

mindfulness. Shambhala Sun, July, 44. Retrieved from http://www.nmr.mgh.harvard.edu/~britta/SUN_July11_Baime.pdf

• Bertin, M., MD. (13, April 29). Feed your brain, feed your life: The science of everyday mindfulness. [Web log post]. Retrieved from http://www.huffingtonpost.com/mark-bertin-md/mindfulness-benefits_b_3045754.html

• Brach, T. (2003). Radical acceptance: Embracing your life with the heart of a Buddha. New York, NY: Bantam Books.

• Brach, T. (2012). True refuge: Finding peace and freedom in your own awakened heart. New York, NY: Bantam Books.


References• Brach, T. (2012). True refuge: Finding peace and freedom in your

own awakened heart. New York, NY: Bantam Books. • Brach, T. (n.d.). Working with difficulties: The blessings of RAIN. Tara

Brach. Retrieved June 4, 2013, from http://www.tarabrach.com/articles/RAIN-WorkingWithDifficulties.html

• Briere, J., PhD. (n.d.). Mindfulness and trauma: An interview with John Briere [Interview by E. Goldstein PhD]. Retrieved May 18, 2013, from http://blogs.psychcentral.com/mindfulness/2010/03/mindfulness-and-trauma-an-interview-with-john-briere-ph-d/

• Catlin, J. (2013, April 19). Collaborative practices in using mindfulness with trauma [Personal interview].


References• Chödrön, P. (2005). When things fall apart: Heartfelt advice for hard

times. London, UK: Element. • Dan Siegel - Mindfulness, psychotherapy and the brain. (n.d.). Dan

Siegel - Mindfulness, Psychotherapy and the Brain. Retrieved March 7, 2013, from http://www.ithou.org/node/2730

• Germer, C. K. (2009). The mindful path to self-compassion: Freeing yourself from destructive thoughts and emotions. New York: Guilford Press.

• Goldstein, E. (2012). The now effect: How this moment can change the rest of your life. New York: Atria Books.

• Goldstein, E., PhD. (2013, June 19). 3 key mindfulness practices for calm, self-compassion and happiness [Web log post]. Retrieved from http://blogs.psychcentral.com/mindfulness/2013/06/3-key-mindfulness-practices-to-feel-happy-and-free/


References• Hanson, R., PhD. (n.d.). Relaxed and contented: Activating the

parasympathetic wing of your nervous system. (Publication). Retrieved January 5, 2012, from Www.wisebrain.org website: http://www.wisebrain.org/ParasympatheticNS.pdf

• Hayes, S. C., & Lillis, J. (2012). Acceptance and commitment therapy. Washington, D.C., DC: American Psychological Association.

• Kornfield, J., PhD. (2012, December). Helping clients find their wise hearts [Interview by R. Buczynski PhD, Transcript]. Retrieved from Fee Based Webinar - Members Only Access

• McCown, D., Reibel, D., & Micozzi, M. S. (2010). Teaching mindfulness: A practical guide for clinicians and educators. New York: Springer.


References• Mindfulness exercises. (n.d.). Mindfulness Exercises. Retrieved from

http://www.dayonepublishing.com/VMC/Exercises/Exercises.html • Mindfulness practice in the treatment of traumatic stress. (n.d.). -

NATIONAL CENTER for PTSD. Retrieved May 18, 2013, from http://www.ptsd.va.gov/public/pages/mindful-ptsd.asp

• Potential of mindfulness in treating trauma reactions. (n.d.). - NATIONAL CENTER for PTSD. Retrieved May 18, 2013, from http://www.ptsd.va.gov/professional/pages/mindful-PTSD.asp

• Rock, D. (2009, October 11). The neuroscience of mindfulness [Web log post]. Retrieved from http://www.psychologytoday.com/blog/your-brain-work/200910/the-neuroscience-mindfulness

• Sagner, S. D. (2009). Mindfulness and trauma: An exploratory study of mindfulness-based practices in the treatment of trauma and posttraumatic stress disorder.


References• Saltzman, A., MD. (n.d.). Mindfulness: A teacher's guide [Web log

post]. Retrieved January 01, 2013, from http://www.pbs.org/thebuddha/teachers-guide/

• Self-Compassion. (2013, January). Self-compassion. Retrieved from http://www.self-compassion.org/

• Siegel, R. D. (2010). The mindfulness solution: Everyday practices for everyday problems. New York, NY: Guilford Press.

• Smalley, S. L., & Winston, D. (2010). Fully present: The science, art, and practice of mindfulness. [Cambridge, Mass.]: Da Capo Lifelong.

• Spehar, C. L., LCSW. (2011, August 23). Creating connections [Web log post]. Retrieved from http://tlcinstitute.wordpress.com/2011/08/23/creating-connections/


References

• Taylor, J. B. (2008). My stroke of insight: A brain scientist's personal journey. New York: Viking.

• Walsh, C. (n.d.). Some of the benefits of mindfulness. Mindfulness Some of the Benefits of Mindfulness. Retrieved from http://www.mindfulness.org.au/some-of-the-benefits-of-mindfulness/

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