Mindfulness and Relapse Prevention

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(MBRP) is a treatment approach developed at the Addictive Behaviors Research Center at the University of Washington, for individuals in recovery for addictive behaviors.
MBRP is designed to bring practices of mindful awareness to individuals suffering from the addictive trappings of the mind. These practices are intended to foster increased awareness of triggers, destructive habitual patterns, and “automatic” reactions that seem to control many of our lives. The mindfulness practices in MBRP are designed to help us pause, observe present experience, and bring awareness to the range of choices before each of us in every moment. We learn to respond in ways that serves us, rather than react in ways that are detrimental to our health and happiness. Ultimately, we are working towards freedom from deeply ingrained and often catastrophic habits.
MBRP is designed as an aftercare program integrating mindfulness practices and principles with cognitive-behavioral relapse prevention. It is best suited to individuals who have undergone initial treatment and wish to maintain their treatment gains and develop a lifestyle that supports their well-being and recovery.

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  • Many therapeutic and spiritual systems have mindfulness as a core component of their approach. Examples: Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) program Marsha Linehan’s Dialectical Behavior Therapy Steven Hayes’ Acceptance and Commitment Therapy (ACT) Zindel Segal’s Mindfulness-Based Cognitive Therapy G. Marlatt’s Relapse Prevention Therapy Various forms of Buddhism, such as Zen, Insight, etc.
  • How Does Relapse Happen? The Cognitive Behavioral Model Marlatt & Gordon, 1985 High-Risk Situation Effective Coping Response Increased Self-Efficacy Decreased Probability of Relapse Ineffective Coping Response Decreased Self-Efficacy + Positive Outcome Expectancies (for initial effects of the substance ) LAPSE (Initial Use of Substance ) Increased Probability of Relapse “ Abstinence Violation Effect”
  • Marlatt and Gordon (1985) Specific interventions include identifying specific high-risk situations for each client and enhancing the client’s skills for coping with those situations, increasing the client’s self-efficacy, eliminating myths regarding alcohol’s effects, managing lapses, and restructuring the client’s perceptions of the relapse process. Global strategies comprise balancing the client’s lifestyle and helping him or her develop positive addictions, employing stimulus control techniques and urge-management techniques, and developing relapse road maps.
  • As the Step reads it states that we seek through “prayer and meditation.” When I began getting sober I noticed that many people in the rooms did not pay attention to the “ and ” and left a specific meditation period out of their program. The type of meditation that the Big Books talks about is more of a reflective, thinking over things, type of quiet period. This mirrors what most Western religious people in the 1930’s knew about meditation and AA’s roots in the Protestant Oxford Group. Meditation, as we know it today, was not widely understood, yet, in the United States. But, these early members were onto one of the keys to emotional and spiritual sobriety which Bill W. would focus on later on in his sobriety Here are some of the quotes in the Big Book that stand out for me: “ On awakening let us think about the twenty-four hours ahead. We consider our plans for the day. Before we begin, we ask God to direct our thinking, especially asking that it be divorced from self-pity, dishonest or self-seeking motives.” Page 86 Yes, morning is considered the best time for meditation before my mind becomes obsessed with the day and my ego begins to run the show. “ Under these conditions we can employ our mental faculties with assurance, for after all God gave us brains to use. Our thought- life will be placed on a much higher plane when our thinking is cleared of wrong motives. “ page 86 My thinking had become unmanageable and is probably the root cause of many of my troubles. I think many of us are thinkaholics and meditation helps to teach us detachment from our thoughts. “… .we ask God to direct our thinking, especially asking that it be divorced from self-pity, dishonest or self-seeking motives.” Page 86 In meditation, I can practice opening myself to my higher power, detaching from my ego, and allowing the divine therapist some time and space to help heal me in ways that I cannot understand. “ Here we ask God for inspiration, an intuitive thought or a decision. We relax and take it easy. We don't struggle.” Page 86 I relax and let go. I am constantly thinking and feeling and doing. How can I access my higher power or the universe if I am never quiet and still. “ We are often surprised how the right answers come after we have tried this for a while. What used to be the hunch or the occasional inspiration gradually becomes a working part of the mind.” Page 87 Group meditations provide a safe haven to discover meditation, to learn different techniques from experienced meditators and to relax into that deep group energy. “ There are many helpful books also. Suggestions about these may be obtained from one's priest, minister, or rabbi. Be quick to see where religious people are right. Make use of what they offer. “ page 87 “ As we go through the day we pause, when agitated or doubtful, and ask for the right thought or action.” Page 87 Try doing mini-meditations throughout the day – breath deeply, listen to your breath for several minutes. “ It works - it really does.” Page 88 Mindfulness, if practiced regularly can be a positive, substitute addiction with one distinction that separates it from a self destructive addiction. It is not an escape or a means of avoidance. It is a way of staying present with pain and discomfort, rather than fleeing from pain and discomfort. Instead of staying compulsively busy to avoid an urge, running from an urge or giving in to an urge by using; a person practicing mindfulness observes and accepts the urge, and rides it like a wave – knowing that every urge has a beginning, middle and end - and that this one too will pass. Mindfulness is a way of engaging the rational mind in response to the fight or flight response of the primitive, addictive brain. Mindfulness helps a person recognize strong urges or feelings as invitations to accept or decline after careful consideration, rather than commands to act immediately. Mindfulness allows a person to remain calm under fire, and choose a rational response to a stimulus that is in his/her long term best interest.
  • Dr. Jon Kabat-Zinn is credited with bringing mindfulness to the modern treatment world. His basic definition of mindfulness is Mindfulness is about being fully awake to our lives. It is about perceiving the exquisite vividness of each moment. We feel more alive. We also gain immediate access to our own powerful inner resources for insight, transformation, and healing. - Jon Kabat-Zinn Mindfulness Skills There are mindfulness skills that need to be learned and practiced. If practiced routinely, twice a day when calm, it will be easier to call upon the skills in a crisis and to apply them when needed. Part of the beauty of mindfulness practice, is that the practice does not necessarily require sitting in a certain position or closing the eyes. Mindfulness can be practiced throughout the day during activities and as part of the activities. Some essential mindfulness skills are: Awareness : Awareness involves focusing attention on one thing at a time, while at the same time recognizing that there are many things going on. Some of these things are external such as sounds, odors, touch, and sights, while some of these things are internal, such as our feelings, thoughts, urges, impulses, etc. Non-judgmental : The emphasis is on observing without judging or labeling things as “good” or “bad.” The idea is to observe my angry feelings without judging them as bad or feeling a need to get rid of them or do something about them. It’s like holding my anger at arm’s length and just noticing that this is anger. Then understanding that not only is it anger, but that it’s ok that it is anger and even understandable that anger would be there. Present Moment : A present moment focus or being in the present moment means fully participating in the present without being distracted by guilt from the past or worry and anxiety about the future. It means engaging in activities that are meaningful today, not just mindlessly doing what I have always done or going through the motions without attention to what I am experiencing. Open Mind (or Beginner’s Mind ): An open mind or beginner’s mind is childlike (not childish). It is being open to new experiences and seeing them as they are; not how you have judged them to be or think they should be. If I attend an event with the mindset that “this is going to be a waste of time,” I have a preconceived notion about the event that prevents me from experiencing the event as it is. Likewise, if I already know it all, I’m not open to learning anything new, or experiencing the joy and bliss of learning. A Beginner’s Mind is what a child has who experiences something for the first time. Drug Addiction and Mindfulness Part I Drug Addiction and Mindfulness Part II mySoberLife.com - YouTube Informative and motivating clips dealing with substance abuse, addiction and recovery produced by mySoberLife.com. We regularly produce series with experts in the field of addiction and recovery as well as sobriety stories. mySoberLife.com is an onli Mindfulness Exercises Mindful of Breathing : Mindful breathing involves focused attention on breathing. Notice how you are breathing. Notice slower breathing and fuller breaths. Notice your belly rise and fall as you breathe in and out. When your mind drifts away from your breathing, and it will, simply notice what caught your attention and gently shift your attention back to your breathing. (For more information on using deep breathing and muscle relaxation to reduce stress, click here .) Mindful of Sounds : Following mindful breathing, focus your attention on sounds; soft sounds, loud sounds, nearby sounds, distant sounds. Notice your response to sounds. Notice if you are annoyed by a sound or judging a sound; then gently re-direct yourself to listening to sounds without judging. When your attention drifts away to a thought, notice what thoughts you were distracted by, and gently return your attention to sounds. Meditation : The purpose of mindfulness meditation is to become more aware and accepting of internal processes; thoughts, feelings, urges, sensations, cravings, triggers, etc. Meditation is not intended for relaxation. People who are extremely anxious about internal processes or have difficulty sitting still may need to work up to a full session of 20 minutes, beginning with only 2-3 minutes at a time and working on other exercises more at first. The goal is 20 minutes of meditation two times a day. During meditation, if your mind drifts to thoughts about the past or worries about the future, gently re-direct your attention to the present moment. Mindfulness meditation is about staying in the present, not about achieving a heightened state of awareness or bliss. For more information about Transcendental Meditation, click here . Mindful Eating : When eating mindfully, choose a place that is quiet and free of distractions. Before beginning to eat, look at the food. Notice what it looks like; its shape and size and color, and how it smells. Notice any internal sensations; salivation, hunger, urges before you taste the food. Now take a bite. Notice the taste, texture, and sensations in your mouth. Notice your chewing. Notice urges to swallow. Notice your swallowing. Notice your stomach as you swallow. Continue eating mindfully, noticing sensations in your stomach; feelings of hunger and fullness. Decide when you are finished eating based on when you are no longer hungry. Avoid eating while engaged in other activities, such as watching television, reading, or working. Notice feelings and thoughts associated with eating and urges to eat between meals. Beginner’s Mind : Pick an object in the room that is familiar to you, and examine it with your beginner’s mind; that is, as if you have never seen the object before. Some people imagine they are an alien from another planet or an alien on another planet, and are seeing the object for the first time. Notice the shape, weight, texture and color of the object. Try to imagine what the object could be used for. As you continue to examine the object, do you notice anything about it that you may not have noticed before? When you put the object away, reflect on what you learned about the object that you didn’t already know. Consider what would happen if you approached other areas of your life with a beginner’s mind; people, places, objects, situations. How would these other areas of your life be the same or different if you approached them with beginner’s mind? What expectations do you now have that you would not have if you saw them for the first time? Mindful of Thoughts : Once you are comfortable and have become mindful of your breathing, shift your attention to your thoughts. Become aware of whatever enters your mind. Remember that your purpose is simply to observe the thoughts that are in your mind without judging them. Observe thoughts as they come and go in and out of your awareness without trying to engage them, continue them, stop them or change them. Simply notice them. If you find yourself getting caught up in a thought, notice what caught your attention, then gently re-direct yourself to observing your thoughts. It is normal to get caught up in thoughts. When this happens, return to observing thoughts. Mindful of Emotions: Begin by getting comfortable and becoming mindful of breathing. Think of an event in the past in which you experienced a particular feeling that you want to get in touch with; happy, sad, glad, scared, upset, angry, proud, embarrassed, etc. Remember the situation and imagine you are in the situation now. What do you see, hear, taste, smell, and touch? Notice what thoughts, feelings and sensations come up as you remember the situation. Pay particular attention to your feelings. Is there one feeling or more than one? Notice any urges to hold onto or push away your feelings. Respond to these urges with understanding. Notice how your body responds to the feelings. Is there tension anywhere? Sweaty palms? Racing heartbeat? Urge to cry? Urge to run or hide? Urge to fix it or make it go away? Simply be aware of your emotions without judging or trying to get rid of them. Re-direct your attention to just observing your emotions. Notice any changes in your emotions during this exercise. Do they change or stay the same? Get stronger or weaker? Return to mindful breathing before ending this exercise, as it can be a difficult one. This exercise can be done with moderate, less intense feelings at first. Mindful of Physical Sensations : Physical sensations can be urges, pain, tension, hunger and racing heart. Begin to focus on sensations involved in your body as your body contacts the surface you are sitting or laying on. Notice the parts of your body that are not in contact with the surface. Notice the sensation of air on skin or a sheet touching the skin. Notice the air temperature. Notice any body sensations: urges, cravings, hunger, pain, muscle tension, racing heart, stiffness, cramps, body temperature, etc. Notice any thoughts or judgments you are making about your physical sensations; then gently re-direct your attention to your body sensations. After 5-10 minutes, shift your attention back to the sensations you feel as your body contacts the surface of your chair or bed, then focus on breathing. Mindfulness in All Activities : We can apply mindfulness to any activity at any time during the day. We can drive mindfully and do household chores mindfully; meaning we are keenly focused on what we are doing at the moment. We can practice mindfulness in the shower, during a walk, in a park, at work, during exercise, in a store, in the Dr’s office, in the waiting room, while dressing, while playing or drawing, etc. When we find feeling of guilt about the past or anxiety about the future creep in, or unwanted thoughts, memories or cravings, we gently re-direct our focus to the here and now.
  • Body Scan A body-centering exercise in which participants are asked to move their awareness through each part of their body accompanied by the pace of their breathing; to be practiced daily. One approach of this exercise is to breathe into the section of one's body being focused on. This has many individual and specific applications which can be of enormous benefit.
  • Urge surfing is a term coined by Alan Marlatt as part of a program of relapse prevention he developed for people recovering from addictions to alcohol and other drugs. It can actually be used to help with any addictive behavior such as gambling, overeating, inappropriate sex or any other destructive impulses. Urges for substance use rarely last for very long. In fact, they almost never last for longer than about 30 minutes, if there is no opportunity to use. People admitted to a high quality detoxification centre where there is no access to their drug of choice often find it remarkable how little craving they get. If there is no opportunity to use then there is no internal struggle. It is this internal struggle that feeds the cravings. Trying to fight cravings is like trying to block a waterfall. We end up being inundated. With the approach of mindfulness, we step aside and watch the water (cravings, impulses & urges) just go right past. This is true for everybody, but few addicts ever give themselves the chance to prove it.
  • An aftercare program integrating cognitive-behavioral relapse prevention skills and mindfulness meditation. The program is informed by mindfulness-based stress reduction (Kabat-Zinn, 1990), mindfulness-based cognitive therapy (Segal, Williams and Teasdale, 2002), and Daley and Marlatt’s (2006) relapse prevention protocol. Intended for individuals who have completed initial (primary) treatment for substance use disorders. Best suited for individuals who have completed inpatient or IOP, are motivated to maintain treatment goals, and are willing to make lifestyle changes that support their well-being and recovery.
  • Ultimately we’re working toward freedom from deeply engrained and often catastrophic habitual patterns of thought and behavior.
  • Each session begins with a mindfulness exercise, followed by a discussion in which experiences and themes are elicited from participants.
  • Awareness: From “automatic pilot” to awareness and choice Triggers: Awareness of triggers, interrupting habitual reactions Acceptance: Change relationship to discomfort, decrease need to “fix” the present moment Balance and Lifestyle: Supporting recovery and maintaining a mindfulness
  • Emotional discomfort – depression, anxiety “ I need a drink/drug…I can’t handle this”
  • Mindfulness-Based Relapse Prevention Delivery MBRP Practitioners adopt a Person-Centered, Rogerian approach MBRP Practitioners use a motivational interviewing style The MBSR (MBRP) Program is characterized by the qualities of authenticity, unconditional acceptance, empathy, humor, present moment experience through which both teacher and student experience the group process; with each being changed as a result (Santorelli) MBRP Practitioners have their own ongoing mindfulness meditation practice similar to what they teach to the group MBRP Practitioners deliver the program according to the MBRP Treatment Manual, but are spontaneous and creative within those parameters
  • Theme: When we experience cravings and urges to use, we often engage in reactive behaviors, acting on them without full awareness of what is occurring and what the consequences will be. This first session introduces the idea of “automatic pilot,” or acting without awareness, and discusses the relationship between automatic pilot and relapse. Each session begins with a mindfulness exercised, followed by a discussion in which experiences and themes are elicited from participants. This session begins by using mindful awareness to recognize this tendency, and then learn ways to begin shifting from habitual and often self-defeating behavior to observation of what is happening in our minds and bodies with “automatically” reacting. This session uses the raisin exercise to introduce mindful awareness and contrast it to automatic pilot. Body scan practice is then introduced as a way of bringing attention to present-moment experiences of the body.
  • Similar to the MBSR and MBCT programs, the first formal meditation practice in the course is the body scan meditation. In the vipassana, or “insight” meditative tradition from which this practice originates, awareness of the body is described as the first foundation of mindfulness. The practice then expands to include awareness of other levels of experience, including emotions and mental events. In the context of relapse prevention, the practice of paying attention to physical experience can be especially valuable, because experiences of reactivity, cravings, and urges often manifest physically before the subsequent chain of thoughts or reactions. When in automatic pilot mode, we often lose contact with the immediate physical experience. Thus, coming back to physical sensations is a way of reconnecting with present experience and can be a first step in shifting from habitual, reactive behavior to making more mindful choices. Home Practice. The first session establishes the tone and the expectation for the remainder of the course by stressing the importance of home practice, while emphasizing the nonjudgmental environment of the group.
  • Begin to use mindfulness to bring greater awareness to this typically automatic process, learning to experience craving and urges in a way that increases our choices in how we respond. The challenge of craving or desire often arises in the form of a longing for peacefulness and relaxation.
  • This may help us learn to “be with” various physical sensations and emotions that arise, including those associated with cravings and urges without reacting in harmful ways. In this session, we also begin the practice of formal sitting meditation. The formal meditation practices taught in this session are intended to provide the foundation for integrating new perspectives and behavior into daily life. The SOBER (Stop, Observe, Breath, Expand, Respond) breathing space is an adaptation of the 3-minute breathing space used in MBCT. Although the SOBER breathing space is important and one of the most useful daily life practices, it is not introduced until Session 3 because of the importance of establishing a foundation of practice to support it. As in MBCT, we often describe the SOBER breathing space using the image of an hourglass: We begin with a broad focus, then narrow the focus to the breath, and finally expand back out into a wider awareness.
  • As in MBCT, we often describe the SOBER breathing space using the image of an hourglass: We begin with a broad focus, then narrow the focus to the breath, and finally expand back out into a wider awareness.
  • When we scratch the wound and give into our addictions we do not allow the wound to hear. But when we instead experience the raw quality of the itch or pain of the wound and do not scratch it, we actually allow the wound to heal. So not giving in to our addictions is about healing at a very basic level. It is about truly nourishing ourselves. – Pema Chodren
  • AA’s Bill Wilson’s meditation, visualization In Twelve Steps and Twelve Traditions , Bill Wilson, the co-founder of AA, writes: “We want the good that is in all of us , even the worst of us, to flower and grow. Most certainly we shall need bracing air and an abundance of sunlight; nothing much can grow in the dark. Meditation is our step out into the sun. How, then, shall we meditate?” [1] According to Wilson, “The actual experience of meditation and prayer across the centuries is, of course, immense. The world’s libraries and places of worship are a treasure trove for all seekers.”[2] Wilson, in other words, was open to meditative knowledge wherever it could be found–whether in Hinduism, Buddhism, distant libraries, the local Catholic church, or anywhere else. After introducing his readers to the prayer of St. Francis of Assisi, he writes, “As beginners in meditation, we might now reread this prayer very slowly, savoring every word and trying to take in the deep meaning of each phrase and idea. It will help if we can drop all resistance to what our friend says. For in meditation, debate has no place. We rest quietly with the thoughts of someone who knows, so that we many experience and learn.”[3] Then what? Wilson writes, “As though lying upon a sunlit beach, let us relax and breathe deeply of the spiritual atmosphere with which the grace of this prayer surrounds us. Let us become willing to partake and be strengthened and be lifted up by the sheer spiritual power, beauty and love of which these magnificent words are the carriers. Let us look now upon the sea and ponder what its mystery is; and let us lift our eyes to the far horizon, beyond which we shall seek all those wonders unseen.”[4] Was this significant? According to AA historian Glen C., “Bill W. then introduces a new technique in the 12 & 12, on page 100, where he suggests using guided imagery and visualization to help calm ourselves down when we are upset, angry, and anxious. This was not part of traditional western spirituality, but modern psychologists have now come to realize how effective this is, and frequently recommend this as a good way to re-center ourselves.”[5] Endnotes: 1. Twelve Steps and Twelve Traditions, pg. 98 2. Ibid., pg. 98 3. Ibid., pg. 99-100 4. Ibid., pg. 100 5. Twelve Step Meditations, Part Three,under title of “Guided Imagery,” by AA historian Glen C. http://westbalto.a-1associates.com/FOR%20THE%20NEWBY/twelvestep_meditation.htm
  • Mindfulness and Relapse Prevention

    1. 1. 1Mindfulness-BasedRelapse Prevention forAddictive BehaviorsHolly Cook, LPC-MHSPIntegrative Life Center
    2. 2. Breathing in,I calm my body,Breathing out,I smile.Dwelling in the presentmoment,I know this is a wonderfulmoment.--Thich Nhat Hanh2
    3. 3. How Does Relapse Happen?The Cognitive-Behavioral Model3High-RiskSituationEffective CopingResponseIncreasedSelf-EfficacyDecreasedProbability ofRelapseIneffectiveCopingResponseDecreased Self-Efficacy+PositiveOutcomeExpectancies(for the initialeffects of thesubstances)Lapse(initial use ofthe substance)“Abstinenceviolationeffect”Increasedprobabilityof relapseSlides: Bowen et al. 2011 Marlatt & Gordon, 1985
    4. 4. Relapse Prevention Therapy4IneffectiveCopingResponseHigh RiskSituationCoping SkillsTrainingStressManagement,RelaxationEducation aboutImmediate vsDelayed EffectsDecreased Self-Efficacy+PositiveOutcomeExpectancies(for the initialeffects of thesubstances)Lapse(initial use ofthe substance)“AbstinenceViolationEffect”SelfMonitoring,InventoryofSituationsContract toLimit Use,Reminder Card(what to do if youlapse)CognitiveRestructuringLapse is a mistakeversus a failureMarlatt & Gordon, 1985
    5. 5. AA and Meditation• Step 11: “Sought through prayerand meditation to improve ourconscious contact with God as weunderstood Him, praying only forknowledge of His will for us and thepower to carry that out.”– Big Book: p 86 – 87– Twelve Steps and Twelve Traditions: p1005
    6. 6. Mindfulness“Awareness that emerges throughpaying attention in a particular way:on purpose, in the present moment,and nonjudgmentally"(Kabat-Zinn, 1994).6
    7. 7. Mindfulness and SubstanceAbusePayingattention…Greater awareness oftriggers and responses,interrupting previouslyautomatic behavior(Bresslin, et al., 2002)In the presentmoment…Accepting presentexperience rather than usingsubstances to avoid it.7Nonjudgmentally…Detach from attributions and“automatic” thoughts that oftenlead to relapse.
    8. 8. Formal Practices8Body ScanMindful MovementSitting Meditation“Lovingkindness” or“Metta”Walking MeditationMountain Meditation
    9. 9. “Informal” Practices9Create“SOBER”breathing spaceMindfulness of daily activitiesRiding thiswave, ratherthansuccumbing tothe urge andbeing wipedout by it.Staying with theurge as it grows inintensity, riding itto it’s peak, usingthe breath to staysteady as it risesand crests,knowing it willsubside.Trusting thatwithout anyaction on yourpart, all thewaves ofdesire, likewaves on theocean, ariseand eventuallyfade.Urge Surfing
    10. 10. What is Mindfulness-BasedRelapse Prevention(MBRP)?• An aftercare program integratingcognitive-behavioral relapse preventionskills and mindfulness meditation.• Intended for individuals who havecompleted initial (primary) treatment forsubstance use disorders.10
    11. 11. MBRP• Designed to bring practices of mindful awarenessto individuals caught in the addictive trappings ofthe mind.• Practices are intended to foster increasedawareness of triggers, habitual patterns, and“automatic” reactions that seem to control manyof our lives.• Practices cultivate the ability to pause, observepresent experience, and bring awareness to therange of choices before each of us in everymoment. 11
    12. 12. MBRP Structure• Integrates mindfulness practices with RelapsePrevention• Patterned after MBSR (Kabat-Zinn)and MBCT(Segal et al.)• 8 weekly 2 hour sessions; daily home practice• Components of MBRP• Formal mindfulness practice• Informal practice• Coping strategies(Witkiewitz, Marlatt& Walker, 2005; Bowen, Chawla& Marlatt, 2008)12
    13. 13. Intentions of MBRP13Awareness:From automatic pilot toawareness and choiceTriggers:Awareness of triggers,interrupting habitual interactionsAcceptance:Change one’s relationship with discomfort,decrease need to “fix” the present momentBalance and Lifestyle:Supporting recovery and maintaina mindfulness practiceSlide: Bowen et al. 2011
    14. 14. Inquiry14DirectExperience(pain)Reaction(judgment, story)sufferingReactionReactionMind’sProcessInquiryWhat was the initial directexperience?How did the mind and bodyreact to that?Is this process familiar? Is itrelated to craving, relapses,recovery, daily lifeexperiences?Not Personal:This is what minds do. Noneed for judgment.Adapted from Segal et al., 2002
    15. 15. Facilitating MBRP• Person-Centered, Rogerian approach• Motivational interviewing style• Authenticity, unconditional acceptance,empathy, humor, present moment experience• Embodiment of these qualities• Ongoing personal mindfulness meditationpractice• Spontaneity and creativity15
    16. 16. ResearchSeveral Treatments• Acceptance andCommitment Therapy• Dialectical BehaviorTherapy• MBCT• MBSR• Vipassana MeditationPopulations and Disorders• Stress• Cancer• Psoriasis• Anxiety• Depression• Chronic pain• Psychosis• Trichotillomania• Epilepsy• Borderline PD• Substance Use 16**Few studies of mindfulness and substance use
    17. 17. MBRP Session Themes• Structured protocol with session-by-sessionagendas– Session 1: Automatic Pilot and CravingAwareness,– Session 2: Triggers, Thoughts, Emotions & CravingsPresence– Session 3: Mindfulness in Everyday Life– Session 4: Mindfulness in High-Risk SituationsMindfulness and– Session 5: Balancing Acceptance & Changerelapse– Session 6: Thoughts are not Facts– Session 7: How can I best take care of myself?Bigger picture,– Session 8: Balanced Living and Using What Has Been Learned abalanced life17
    18. 18. Session 1- Automatic Pilot andCraving• Primary intention of the first session is tointroduce some basics of mindfulnesspractice, to offer an experiential sense ofthe automatic pilot mode, and to begindiscriminating between automatic versusmindful awareness.18
    19. 19. Body Awareness•taking focus of your attention away from mind/thoughtand anchoring it in the now of being in your body•being in the body frees vast amounts of consciousnessthat previously had been trapped in useless andcompulsive thinking•let the breath take you into the body•inhabit and experience all aspects of body•imagery may help direct attention initially, but leave itbehind as soon as possible, to directly experience beingthe body don’t just think with your head, but with yourentire body 19
    20. 20. Session 2: Awareness ofTriggers and Cravings• Focus is on learning to experience triggers,cravings, and thoughts of using withoutautomatically reacting.– Focus on recognizing triggers and what thereaction feels like in the body, specifically thesensations, thoughts, and emotions that oftenaccompany craving.20
    21. 21. Session 3: Mindfulness in DailyLife• Learn about the SOBER space as a wayto expand the quality of mindfulness fromformal sitting or lying down practice to thedaily situations we encounter.– Begin the practice of formal sitting meditation21
    22. 22. “SOBER” Breathing Space22StopObserveBreathExpandRespond
    23. 23. Session 4: Mindfulness in High-Risk Situations• Focus on being present in situations or withpeople that have previously been associatedwith substance use, using mindfulness tolearn to experience pressures or urges to usewithout automatically reaching for asubstance.– Identify individual relapse risks and explore waysto cope with the intensity of the feelings that comeup in high-risk situation.23
    24. 24. Session 5: Acceptance andSkillful Action• Focus is on acceptance of presentexperience as an important foundation fortruly taking care of oneself and seeing moreclearly the best action to take.– Practice techniques such as breathing space andfocus on using these in challenging situations.– This session moves from noticing warning signsand learning to pause to taking skillful action inboth high-risk situations and in daily life.24
    25. 25. The Three-Minute Breathing Spacea mini-meditation in which we do three steps:1. Stepping out of automatic pilot to ask “Where am I?” “What’s going on here?”The aim is to recognize and acknowledge one’s experience at the moment.2. Bring your attention to the breath, gathering the scattered mind to focus on yourbreath.3. Expand your attention to include the sense of breath and body as a whole.25
    26. 26. Session 6: Seeing Thoughts asThoughts• Focus is on furthering exploration of andrelationship to thinking, with a focus onexperiencing thoughts as merely thoughts(even when they feel like the truth).– Look at what role thoughts play in the relapsecycle, specific thoughts that seem especiallyproblematic, and ways to work more skillfully withthese.26
    27. 27. Session 7: Self-Care andLifestyle Balance• This session focuses on personal warningsigns for relapse and how to best respondwhen these warning signs arise.– Includes discussion of broader lifestyle choices,balance, self-compassion, and the importance ofincluding nourishing activities as part of a full,healthy life.27
    28. 28. Session 8: Social Support andContinuing Practice• Review of skills and practices learned in thecourse and discuss the importance of buildinga support system.– Reflect on what has been learned and shareindividual plans for incorporating mindfulnesspractices into daily life.28
    29. 29. All you really need todois accept this momentfully.You are then at ease inthe here and nowand at ease withyourself.-- Eckhart Tolle29
    30. 30. 1. There is a difference between actual pain(emotional and physical) and the sufferingthat we create in our minds.2. The suffering is not only optional, butthere are many ways to remove it, as it isunnecessary, and a tremendous waste oftime, energy and enjoyment of life.Some basic observations whichunderlie most of the mindfulnessapproaches:30
    31. 31. 3.3. The way out of this self-created cell of sufferingis accepting absolutely everything aboutourselves and our lives, by embracing withwakefulness and care our moment-to-momentexperience. This does not mean putting up with atruly harmful circumstance with ourselves orothers.4. “It is remarkable how liberating it feels to be ableto see that your thoughts are just thoughts andthat they are not ‘you’ or ‘reality.’ . . . . the simpleact of recognizing your thoughts as thoughts canfree you from the distorted reality they oftencreate and allow for more clear-sightedness and agreater sense of manageability in your life”--Kabat-Zinn.31

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