Goal of Presentation 10/23/2017. Mindfulness. Mindfulness and Relapse Prevention

Transcription

1 Mindfulness and Relapse Prevention Lynn Catlin, PhD, Presenter With help from Sheryl Lilke, Intern Extraordinaire Goal of Presentation Increase Understanding of How Mindfulness Can Aid Preventing Relapse to Addictive Behaviors Introduce Mindfulness Sample Mindfulness Practice Introduce Marlatt s Relapse Prevention Model Introduce Mindfulness-Based Relapse Prevention Mindfulness What Is It, Really And How Can It Help? 1

2 Definition of Mindfulness Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgementally. It s about knowing what is on your mind. ~Jon Kabat-Zinn Mindfulness allows us to step away from being swept up in the moment, to being a neutral observer of the moment, in a state of equanimity, free from emotional reaction, with awareness of what we are feeling internally, emotionally and in our bodies. Mindfulness combats automatic pilot or mindless-ness, the action/reaction sequence that leads to behavior we may later regret Mindfulness creates a space between action and reaction, allowing us more options for further action Examples of Mindful Practices Take a time out from your day Turn your attention inward and note what you are feeling, internally (physical sensations, emotions, thoughts, memories) Look around. Find something beautiful in your surroundings. Attend to the qualities of the beautiful object, and be aware of your response to them Take a deep, intentional belly breath, in and out. Note the sensations, feelings in the breath Other Activities that Can Be Mindfully Undertaken Hatha yoga (combines breath awareness and body movement) Mindful eating (be in the moment with each bite, noting the sensations, taste, smell, feeling of food on the tongue, Mindful walking (take each step with attention to the sensations in the body, the breath and any emotions Mindful moments (become aware of what is happening internally; especially helpful in stressful or negative situations) 2

3 Research Results: Mindful Practices Result in Equanimity to see the world with mental calmness, composure, and evenness of temper, especially in a difficult situation Connectedness to one s self, other people, all beings, nature, God Developing the Observant Mind Awareness that negative and judging thoughts are distractions, needless efforts that can be set aside Awareness that emotions are just emotions they come and go; we can be aware of them without living in them Research Results: 8 Weeks of Mindfulness Training Is strongly correlated with well-being and perceived health Is effective in the reduction of rumination and worry, both of which contribute to mental illnesses such as depression and anxiety Boosts our immune system s ability to fight off illness Increases positive emotions while reducing negative emotions and stress Fosters compassion and altruism (including self-compassion) Increases density of gray matter in brain regions linked to learning, memory, emotion regulation, and empathy Couples feel more satisfied with their relationship, each partner feels more optimistic and relaxed, and feels more accepting of and closer to the other Parents report being happier with their parenting skills and their relationship with their kids, and their kids were found to have better social skills. How Do I Develop a Practice? Start small even 7-10 minutes per day counts! Choose a time and place that will work for you Best if practice is at same time of day (easier to form habit of mind) Be sure you won t be interrupted A guided practice is good to start with Free Apps and YouTube videos Try a variety of types of practice find the one that works best for you If you lose track of your practice, just start again (it is work to establish any new practice/activity in life) Be kind and patient with yourself (always) 3

4 Mindfulness Resources Jon Kabatt Zin Full Catastrophe Living (book) CDs Free Apps the Clinic Therapists Love Smiling Mind Calm Headspace Affirmations Stop, Breathe and Think Insight Timer Guided Relapse Prevention Defining Relapse Can be a return to a pattern of use for those whose goal was abstinence Can be a return to problematic use, for those whose goal was responsible use Relapse is a normal part of the recovery process and can be used to strengthen relapse prevention skills 4

5 G Alan Marlatt s Relapse Prevention Model 1. Understand Relapse Triggers/Risky Situations Research suggests the following are top risks Negative emotional states (stressed-out, angry, sad, hurt, humiliated, lonely) Interpersonal conflict (50% of subjects reported a fight/argument as the reason for relapse) Social pressure (direct and indirect) Positive emotional state (celebration, vacation, doing well in recovery) Physical/Medical (sick, tired, chronic illness, headache) G Alan Marlatt s Relapse Prevention Model 2. Coping Strategies Thoughts - supplant thoughts of use with other thoughts ( I choose not to use ; I can make it through this without using ; I will feel really badly tomorrow if I use ) Actions ways to protect self (e.g., take sober friend to family party where alcohol is present, find sober activities/friends, attending AA/self-help groups) Self-care Keep stress down. Use mindfulness techniques to de-stress (breathing, progressive muscle relaxation, meditation), identify positive social support, healthy diet, adequate sleep, moderate exercise. Know that cravings are normal but do not have to mean a return to use (cravings are actually about 3 minutes long, on average) Relapse Prevention Basics Relapse Cycle: In Recovery Increased Stress Level Thoughts of Use Risky Situation Coping Skills Fail Use (Lapse) Return to Use (Relapse) BUT at each the cycle can be interrupted. The more mindful we become, the easier it is to identify where we are at and to respond to interrupt the cycle 5

6 Other Factors Influencing Relapse Automatic Pilot - acting without awareness; relying on old patterns of behavior Abstinence Violation Effect - the black or white thinking that if I have one drink or incidence of drinking, my recovery is over; feelings of failure, shame Positive Outcome Expectancies the belief that a return to use will be different/fun/okay this time Stress and Relapse Stress is a normal part of life The body s stress response system is old; we are here because our ancestors had good stress response systems Works to ensure survival by activating the endocrine system (cortisol & adrenaline) for fight or flight in life threatening emergency situations The brain (hippocampus & amygdala) senses a threat and the body (adrenal glands) goes into action Cannot tell the difference between real life threatening event and our arousal at being stuck in morning traffic Living in a stressful world, we can become chronically over-adrenalized Stress and the Body To survive, the body shuts down certain systems when in fight or flight Digestive Procreative Immune Growth And hyper-activates others Cardiac/circulatory Respiratory Access to glucose Chronic stress leads to physical issues Chronic digestive problems (diverticulitis, IBS) Auto-immune diseases (fibromyalgia, chronic fatigue) Heart and vascular disease Type 2 Diabetes 6

7 Stress & Addiction Brain research suggests people suffering substance addiction (study s focus was alcoholism) have deficits in the stress response system, causing dysfunction The system activates more easily (the threat-meter is overly sensitive) Hormones used to modulate the stress hormones do not function as well (once in fight or flight it is harder to come back) The brain circuits involved in craving are in very close proximity to stress circuitry Stress is interpreted as craving to use Research on Relapse Prevention and Mindfulness Meditation as an aid to preventing relapse goes back to 1974 when transcendental meditation (TM) was popular G Alan Marlatt started using meditation with heavy drinking college students in 1977 Meditation techniques included TM, deep muscle relaxation, daily quiet recreational reading Participants reported significant decreases in alcohol consumption Mindfulness-Based Relapse Prevention Integrated 20 years of research on meditation and relapse prevention Goals of treatment Develop awareness and acceptance of thoughts, emotions and sensations Use these mindfulness skills as a coping strategy when confronted with a risky situation Other components of MBRP Learning effective coping skills Stress Management Enhancing self-efficacy (confidence in maintaining abstinence) Challenging positive outcome expectancies Learning about the abstinence violation effect 7

8 Research Findings: Mindfulness-Based Relapse Prevention (MBRP) Randomized Control trial- OP/Aftercare setting G1: 8 weeks MBRP G2: Treatment as usual (standard 12-step-oriented aftercare combo of process-oriented and psychoed groups Findings: 86% G1 reported continuing meditation posttreatment; 54% continued at least 4 months posttreatment Significantly greater decreases in cravings over the 4 month follow-up period Increases acceptance and a tendency to act w awareness Research Findings: Mindfulness-Based Relapse Prevention (MBRP) Days of substance use decreased to a greater extent (ave.06 days during 8-week course for G1; 2.57 days for G2) Decreased number of days of use continued 2 months post-treatment (2.08 days of use for G1; 5.4 days for G2) Differences between the groups flattened out after 4 months Research Findings: Mindfulness-Based Relapse Prevention (MBRP) Researchers acknowledged the difficulties of maintaining a meditation practice independently Suggested the addition to the MBRP model of an ongoing weekly or monthly meditation group or other continued support Other studies have similar results, and offer empirical promise for MBRP as an aftercare treatment model 8

9 Clinician s Guide Sarah Bowen Neha Chawla G Alan Marlatt MBRP Components 8 week curriculum designed for groups Includes a home practice using guided mindfulness meditation CDs (can use Zinn s but preference is for facilitators to create own using scripts in book) Each week focuses on a topic related to mindfulness and relapse prevention Manual has scripts for exercises and meditations, handouts and materials needed Topics Automatic Pilot and Relapse Awareness of Triggers and Craving Mindfulness in Daily Life Mindfulness in High Risk Situations Acceptance and Skillful Action Seeing Thoughts as Thoughts Self-Care and Lifestyle Balance Social Support and Continuing Practice 9

10 Drink your tea slowly and reverently, as if it is the axis on which the world earth revolves slowly, evenly, without rushing toward the future; live the actual moment. Only this moment is life. ~Thich Nhat Hanh 10