Science Update: Inform Your Mindfulness Teaching and Practice with Current Research.

Transcription

1 Science Update: Inform Your Mindfulness Teaching and Practice with Current Research

2 Moderator Introduction Randy Wolbert, LMSW, CAADC, CCS

3 How to Submit Questions Submit your questions by typing your question into the Q&A box and clicking Send. If you don t see a Q&A box, click the icon with a? to toggle the display of the Q&A section.

4 How to See the Video If you do not see the trainer, click the Participant icon on the top of the control panel (to the right of your WebEx window).

5 Presenter Introduction Cedar Koons, MSW, LISW

6 Conflict of Interest Disclosure Cedar Koons, MSW, LCSW Part-owner of Santa Fe DBT. Contracted Trainer for Behavioral Tech, LLC and receives compensation for training and consultation services.

7 Presented by Cedar R. Koons, MSW, LCSW Moderated by Randy Wolbert, MSW, LCSW Sponsored by Behavioral Tech, Science Update: Mindfulness Research Presented by Cedar Koons MSW LCSW 2016 Cedar Koons, MSW, LCSW 7

8 Overview of Today s Topics 2016 Cedar Koons, MSW, LCSW 8

9 Why Know the Research? Mindfulness is part of the foundation of DBT core in skills and used in team and individual therapy Understanding the research can improve the specificity of your teaching Knowing the research can improve the delivery of individual therapy and coaching. Being informed about the research may increase understanding of your practice Cedar Koons, MSW, LCSW 9

10 Research on mindfulness: a brief history Beginning in late 1980 s with MBSR Became a hot topic Research in fields of health, behavioral health, education and business Behavioral health research on depression relapse prevention, coping with stress, chronic pain and illness, substance use disorders, binge eating, anxiety and more Still a hot topic but more rigor is now demanded 2016 Cedar Koons, MSW, LCSW 10

11 Key factors in evaluating the research on mindfulness Is the study rigorous, peer reviewed and respected? Are the outcomes statistically significant with good effect sizes and based on large sample sizes? Did the study utilize a clear definition of the mindfulness intervention? Did the study look for potential adverse reactions? What was the control condition? 2016 Cedar Koons, MSW, LCSW 11

12 Your Brain on Mindfulness what do we know? 2016 Cedar Koons, MSW, LCSW 12

13 RCT s of mindfulness and health some areas of investigation Headaches Hypertension Psoriasis Obesity Smoking Cessation Diabetes Self-care Insomnia Low Back Pain 2016 Cedar Koons, MSW, LCSW 13

14 Reviewing the outcomes MB interventions improve self-care and coping significantly, especially MBSR MB interventions also reduce anxiety and depression but not necessarily the physical parameters of disease, MBSR and MBCT MB interventions appear to promote functional brain changes to lower stress MB interventions are often more effective compared with TAU, relaxation training or psycho-education, especially MBSR Physical exercise with psycho-education are sometimes as effective as MB interventions 2016 Cedar Koons, MSW, LCSW 14

15 A recent example MBSR and low back pain. Randomized into three groups, MBSR, TAU and CBT. MBSR showed significant reductions in catastrophic thinking and emotional reactivity over CBT and TAU. However, at 52 weeks differences were few and small in size between CBT and MBSR. Both MBSR and CBT better than TAU Cedar Koons, MSW, LCSW 15

16 What about MB interventions and mental health? 2016 Cedar Koons, MSW, LCSW 16

17 Contrast of mindfulness-based interventions with DBT mindfulness MB interventions usually teach mindfulness meditation, sometimes for up to 45 minutes per day (MBSR & MBCT) MB interventions are frequently short in duration: MBSR and MBCT are 8 week treatments done in a group MB interventions sometimes use additional mindfulness activities such as non-strenuous yoga, body scan, guided meditation and visualization People enrolled in MB interventions are rarely suicidal or self-harming at intake 2016 Cedar Koons, MSW, LCSW 17

18 Similarities of MB interventions and DBT DBT and most MB interventions involve instruction in observing with the senses. DBT and most MB interventions teach nonjudgmental curiosity about inner experiences DBT and most MB interventions teach nonreactivity to inner experiencing DBT and most MB interventions encourage participants to tune in to present moment as frequently as possible during the day 2016 Cedar Koons, MSW, LCSW 18

19 Components of mindfulness interventions to consider Duration of practice Focus of practice Frequency of practice Mindfulness alone or with visualization, yoga, body scan, etc. With or without psycho-education Training of instructors 2016 Cedar Koons, MSW, LCSW 19

20 Mindfulness and Mental Health Outcomes RCT s and Reviews Most studies are of MBSR and MBCT. Some studies develop other mindfulness applications MB-EAT, MBRP, and ACT and other MB interventions. Most compare to TAU, or wait list. Many studies are intent to treat. Some studies utilize college students or other non-clinical populations 2016 Cedar Koons, MSW, LCSW 20

21 Weaknesses found in some studies Insufficient information on the interventions mindfulness poorly described, conceptualized Mindfulness sometimes not the central component other elements predominate Inadequate control for comparison or no control in pilot studies Small effect sizes or low significance when compared with robust controls Cedar Koons, MSW, LCSW 21

22 Examples: Mindfulness and Depression 2007 Annals of Behavioral Medicine, Shamini et al., N=81, mindfulness meditation compared to somatic relaxation. Both groups improved. No difference in reduction of distress. Mindfulness group had significant increase in positive states of mind and decrease in rumination. College students, 1 month duration 2016 Cedar Koons, MSW, LCSW 22

23 Depression Continued 2012 Psychological Medicine, Van Aalderen et al. MBCT with recurrent depressed patients (3 or more episodes, including currently depressed patients.) N=205. MBCT + TAU to TAU only. TAU was medication. MBCT sig. improvement in reducing relapse with both groups RCT -- adding Mindfulness to CBT reduced anxiety and depression among pregnant women 2016 Cedar Koons, MSW, LCSW 23

24 Recent Studies 2014 Kristeller et al, MB-EAT vs. Wait List N=150 amount of mindfulness practice predicted reductions in binge eating behavior 2016 Feliu-Soler et al, loving-kindness meditation improved self-compassion in patients with BPD when compared with a MB control group. Self compassion reduced severity of BPD symptoms 2016 Galla, Journal of Adolescence, meditation training with stressed teens (mean age 16.76) improved self-compassion. Increases in selfcompassion predicted reductions in perceived stress, rumination, depressive symptoms and more. (pilot study, not an RTC) 2016 Cedar Koons, MSW, LCSW 24

25 Recent Reviews and Recommendations 2016 MBSR with health care providers 39 studies showed increase on professionals mental health with a focus on emotions and empathy 2016 looked at 15 online MB RTC s which showed promise 2016 Canadian Journal of Psychiatry recommends MBCT as a front-line treatment for MDD 2016 Review of MB programs with At-Risk Adolescents showed only 7 programs, only 3 RTC s. Much more study needed with teens Cedar Koons, MSW, LCSW 25

26 Thoughts about the mechanisms of change 2016 Schelhas, et al, shifting into how to thinking about reducing alcohol intake 2011 Shapiro et al, trait mindfulness mediating MBSR results, improves long term effects 2016 Yang et al, training effects on brain networks as possible mechanism 2015, Taren et al, investigates the role of mindfulness on the amygdala pathways to lower stress 2016, Eustis et al, reductions in experiential avoidance may be a factor in reducing symptoms and improving quality of life 2016 Cedar Koons, MSW, LCSW 26

27 What exactly are we measuring when we measure mindfulness? 2016 Cedar Koons, MSW, LCSW 27

28 Key Elements state and trait mindfulness State mindfulness being aware in the present moment, intentionally, nonjudgmentally. Trait mindfulness the tendency of a person to be mindful even when not really trying. Having mindfulness just happen Cedar Koons, MSW, LCSW 28

29 Measuring States and Traits FFMQ Five Factor Mindfulness Questionnaire observing, describing, acting with awareness, nonjudging of inner experience, non-reactivity to inner experience. MAAS Mindful Attention and Awareness Scale measures attention over several domains: cognitive, emotional, physical Toronto Mindfulness Scale curiosity and decentering FMI Freiburg Mindfulness Inventory to distinguish between experienced and novice meditators Cedar Koons, MSW, LCSW 29

30 Baer et al, 2004, (KIMS), Nicastro et al, 2010 Measuring DBT mindfulness Compared BPD and controls Observing Describing Acting with Awareness Accepting without judging Persons with BPD did lack mindfulness skills Persons with BPD did improve their mindfulness after completing DBT 2016 Cedar Koons, MSW, LCSW 30

31 Brown & Ryan, 2003 State and Trait Mindfulness Measures one factor awareness Awareness across cognitive, emotional, physical and general (daily tasks) experience Examines awareness in the moment (state mindfulness) and awareness over time (trait mindfulness) 2016 Cedar Koons, MSW, LCSW 31

32 Toronto Mindfulness Scale, 2006 Participant engages in a prescribed mindfulness activity prior to answering questions (measuring state mindfulness) Two factors are studied: curiosity and decentering. Curiosity reflects openness to one s inner experience and decentering reflects the ability to step back from identifying with thoughts and emotions. Has been revised to include questions about trait mindfulness (2009) Cedar Koons, MSW, LCSW 32

33 Applications for our DBT clients DBT clients have a lot of the problems for which MB interventions have been developed including depression, stress, anxiety, eating disorders, pain and substance abuse. DBT mindfulness skills teach non-biased observing, acting in awareness and nonreactivity. DBT emphasizes familiarity with state mindfulness and development of trait mindfulness though not by those names Cedar Koons, MSW, LCSW 33

34 Increase specificity of teaching in skills class When teaching mindfulness always include time to practice each skill taught in class. Get feedback about the state of mindfulness experienced. Give corrective feedback as needed. Teach about how the practice of state mindfulness leads to trait mindfulness. If you use mindfulness exercises each week be sure they invoke unbiased observing, describing and participating Cedar Koons, MSW, LCSW 34

35 Introduce mindfulness practices in individual therapy Help clients assess their progress toward trait mindfulness. Start sessions with brief practices of observe Ask clients to use observe/describe when they become judgmental, upset or willful in session Give homework to practice one mindfulness exercise each week. Be sure to review the homework! 2016 Cedar Koons, MSW, LCSW 35

36 Using the Research to improve your practice Are you experiencing state mindfulness when you sit to practice? What happens when an unwanted thought, emotion or bodily sensation arises? Can you observe and step back from judgmental thoughts and reactive interpersonal responses? Do you return to the present moment frequently during your day without judgment? 2016 Cedar Koons, MSW, LCSW 36

37 Final Thoughts Consider using a mindfulness self-report to measure and track your client s and your own state and trait mindfulness. Consider introducing sitting mindfulness practice to stage two and three clients Consider a yearly retreat for you and for your team to strengthen your mindfulness practice. Remember that DBT mindfulness skills are the core skills Cedar Koons, MSW, LCSW 37

38 You can t have an apple without a core! 2016 Cedar Koons, MSW, LCSW 38