1. 14-05-11
1
John
Briere,
Ph.D.
Departments
of
Psychiatry
and
Psychology
University
of
Southern
California
USC
–
Adolescent
Trauma
Training
Center
National
Child
Traumatic
Stress
Network
www.johnbriere.com
Trauma-­‐related
outcomes
— Posttraumatic
stress
— Dysphoria
— Identity
disturbance
— Affect
dysregulation
— Relational
problems
— Negative/insecure
attachment
schema
Clinical
presenta3on:
Over-­‐developed
avoidance
— Thought
suppression
and
denial
— Substance
abuse
— Tension
reduction
behaviors
— Self-­‐injury
— “Compulsive
sex
— Bingeing
and
purging
— Dissociation

2. 14-05-11
2
Defini3on
of
mindfulness
— The
learned
capacity
to
maintain
moment-­‐
by-­‐moment
awareness
of
-­‐-­‐
and
openness
to
-­‐-­‐
current
experience,
including
internal
mental
phenomena
and
impinging
aspects
of
the
external
world,
without
judgment
and
with
acceptance
Is
there
evidence
that
mindfulness
is
helpful
with
trauma-­‐related
difficul3es?
— Mindfulness-­‐based
interventions
have
been
shown
to
assist
those
with:
— Anxiety
and
depression
— Substance
abuse
— Disordered
eating
— Self-­‐injurious
behavior
— Low
self-­‐esteem
and
other
cognitive
distortions
— Borderline
personality
disorder
— PTSD
— (see
a
review
of
meta-­‐analyses
by
Briere
&
Scott,
2014)
Aspects
of
pos@rauma3c
trauma3c
distress
that
respond
to
mindfulness
— Intrusive
memories
of
trauma
that
appear
to
be
real
— Dissociation
and
other
forms
of
disconnection
— Negative
thoughts
about
self,
others,
and
the
environment
— Hyperarousal
of
the
sympathetic
nervous
system
— “Impulsive”
behaviors

3. 14-05-11
3
Intrusive
memories
of
trauma
that
appear
to
be
real
— In
actuality,
implicit
(nonverbal),
sensory/
experiential
memories
of
the
trauma
that
are
triggered
by
reminiscent
stimuli
in
the
current
environment
— When
triggered,
“take
over”
normal
experience
and
appear
to
be
real
Mindfulness
training
can
help
by:
— Helping
to
process
trauma
memories
so
that
they
no
longer
intrude
— Encouraging
metacognitive
awareness,
so
that
intrusive
“reality”
is
identified
as
the
past
Processing
memories
so
that
they
no
longer
intrude:
The
Pain
Paradox
— Suppression,
rejection,
or
avoidance
of
pain
=
increased
suffering
and
decreases
awareness
— Literature
on
substance
abuse,
dissociation,
thought
suppression
— Limits
to
processing,
the
downside
of
numbing
— Nonjudgmental
acceptance
of
pain
=
decreased
suffering
and
increases
awareness
— Direct
experience
of
pain/distress
allows
it
to
be
processed,
decatastrophized,
and
gained
from
(posttraumatic
growth)

4. 14-05-11
4
Mindfulness
is
the
an3thesis
of
avoidance
— Allowing/accepting
painful
memory
parallels
“therapeutic
exposure:”
— “Inviting
your
fear
to
tea”
or
‘”leaning
into
pain”
— Mindful
awareness
of
distress
without
trying
to
avoid
or
suppress
it
— Leads
to
“trimming”
of
conditioned
emotional
responses
to
memory
and
— Reduced
need
for
dissociation
and
other
avoidance/numbing
Mindful
processing
1)
Have
client
enter
mindful
space
(typically
through
brief
meditation
on
breath)
2)
Invite
him/her
to
describe
a
previously
decided-­‐upon
traumatic
event
— Complexities
associated
from
speaking
from
a
mindful
place
(remembering
and
speaking)
Mindful
processing
—
As
emotions
or
thoughts
intensify
and
potentially
threaten
to
derail
mindfulness
— Invite
client
to
return
to
breath
for
a
minute
or
so
— Gently
encourage
acceptance
of
experience
— When
client
is
ready,
suggest
return
to
memory
— If
significant
and
sustained
difficulty
with
memory
— Return
to
brief
meditation
— Break
up
narration
into
smaller
“chunks”
— Consider
processing
less
powerful
memory

5. 14-05-11
5
Encouraging
metacogni3ve
awareness
— “Just
thoughts”
–
the
critical
discrimination
of
intrusion
versus
perception
of
reality
— Growing
awareness
of
subjectivity
of
perception
— Greater
participant-­‐observer
capacity
— “Just
triggers”
–
Trigger
identification
and
intervention
(Briere
&
Scott,
2012).
— Reduced
identification
with
flashbacks,
intrusive
thoughts
and
memories,
activated
negative
cognitions
Hyperarousal
of
the
sympathe3c
nervous
system
— Anxiety,
tension,
irritability,
hypervigilance,
jumpiness,
poor
sleep
— Mindfulness
training
can
help
by
teaching
“settling”
skills
— Meditation
— Mindful
breathing
(Briere
&
Semple,
2013)
“Impulsive”
involvement
in
dysfunc3onal
behaviors
— In
actuality,
not
impulsive
as
much
as
a
logical
coping
response
to
an
imbalance
between
level
of
traumatic
stress
and
extent
of
affect
regulation/tolerance
capacity
— When
pain
exceeds
capacity
to
tolerate
pain,
tension-­‐reduction
behaviors
(e.g.,
self-­‐injury,
bulimia,
aggression,
dysfunctional
sexual
behavior)
and
substance
abuse
are
motivated
and
reinforced

6. 14-05-11
6
Mindfulness
training
can
help
by:
— Reducing
trauma-­‐related
distress,
per
exposure
— Increasing
affect
regulation
capacities
— Urge
surfing
— Trigger
identification
and
intervention
— Reducing
impact
of
distress
by
changing
the
client’s
relationship
to
pain
Empirically-­‐based
mindfulness
therapies
— Mindfulness-­‐based
Stress
Reduction
(MBSR;
Kabat-­‐Zinn)
— Eight
weekly
group
sessions,
each
lasting
approximately
two
and
a
half
hours
— One
day-­‐long
session
during
the
sixth
week.
— Homework
assignments
— Meditate
6
days
a
week
for
45
minutes
each
day
Empirically-­‐based
mindfulness
therapies
— Mindfulness-­‐based
Cognitive
Therapy
(MBCT;
Segal,
et
al)
— Mindfulness-­‐based
Relapse
Prevention
(MBRP;
Marlatt
&
Gordon)
— Acceptance
and
Commitment
Therapy
(ACT;
Hayes)
—
Dialectical
Behavior
Therapy
(DBT;
Linehan)

7. 14-05-11
7
Is
it
always
appropriate
to
teach
mindfulness
to
client?
— Therapist
qualifications
— Regular
meditation
practice
— Personal
practice
may
not
make
a
good
teacher
— Would
classic
trauma
treatment
be
more
helpful
at
this
point
in
time?
— Would
it
take
too
much
time?
The
alterna3ve:
A
hybrid
approach
• Screen
for
the
appropriateness
of
mindfulness
(typically
meditation)
training
• Extreme
posttraumatic
stress,
severe
depression,
paradoxical
anxiety,
psychosis,
mania,
high
suicidality
• When
appropriate,
referral
to
an
MBSR
or
MBCT
group
• Versus
therapist
as
mindfulness
teacher
The
alterna3ve:
A
hybrid
approach
• As
the
client
gains
mindfulness
skills,
he/she
can
be
called
upon
during
trauma-­‐focused
psychotherapy
to
foster
• Increased
affect
regulation
• Exposure
and
emotional
processing
of
memories
• Altered
cognitive
relationship
to
experience
(“just
thoughts/memories,
not
facts”

8. 14-05-11
8
Beyond
mindfulness:
Existen3al
reconsidera3on
— In
both
Western
and
Eastern
psychology,
chaos/pain/obstacles
can
be
seen
as
opportunities
for
growth
— Confrontation
with
–
and
acceptance
of
–
impermanence
— Reduced
impacts
of
“accidents
waiting
to
happen”
— Increased
openness,
appreciation
of
the
here-­‐
and-­‐now
(this
moment
is
all
there
is)
— Options
for
new
model
of
“self”
Suggested
readings
n Baer,
R.
A.
(2003).
Mindfulness
training
as
a
clinical
intervention:
A
conceptual
and
empirical
review.
Clinical
Psychology:
Science
and
Practice,
10,
125–143.
n Briere,
J.
(2013).
Mindfulness,
insight,
and
trauma
therapy.
In
C.K.
Germer,
R.D.
Siegel,
&
P.R.
Fulton
(Eds.),
Mindfulness
and
psychotherapy,
2nd
edition
(pp.
208-­‐224).
NY:
Guilford.
n Briere,
J.,
&
Scott,
C.
(2014).
Mindfulness
in
trauma
treatment.
In
J.
Briere
&
C.
Scott,
Principles
of
trauma
therapy:
A
guide
to
symptoms,
evaluation,
and
treatment,
2nd
edition
DSM-­‐5
update.
Thousand
Oaks,
CA:
Sage.
n Briere,
J.
&
Semple,
R.
(2013).
Brief
Treatment
for
Acutely
Burned
Patients
(BTBP):
Treatment
manual.
University
of
Southern
California,
Los
Angeles,
CA.
Suggested
readings
n Germer,
C.K.,
&
Siegel,
R.D.
(Eds.),
(2012).
Compassion
and
wisdom
in
psychotherapy
(pp.
265-­‐279).
New
York:
Guilford.
n Germer,
C.J.,
Siegel,
R.D.,
&
Fulton,
P.R.
(2013).
Mindfulness
and
psychotherapy,
2nd
edition.
New
York:
Guilford
Press.
n Kornfield,
J.
(2008).
The
wise
heart:
A
guide
to
the
universal
teachings
of
Buddhist
psychology.
NY:
Bantam.