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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.

Published in: Health & Medicine, Spiritual

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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