Developing social skills through mindfulness: the relapse prevention intervention

Transcription

1 Developing social skills through mindfulness: the relapse prevention intervention Prof.ssa Maria Beatrice Toro Direttore e didatta SCINT Scuola di Specializzazione in Psicoterapia Cognitivo Interpersonale (Aut Miur 2008) Docente Psicologia di comunità ROMA, PFSE AUXILIUM Docente Tecniche della comunicazione SSPL LUISS Guido Carli mariabeatricetoro@gmail.com St. ROMA Via Nomentana 257 tel

2 That kind of awareness that emerges paying attention to the moment to moment experience: with intent in the present in a non-judgmental way

3 Mindfulness begins to spread in the years ' 90, thanks to the publication of the first popular book by Jon Kabat Zinn, Full Catastrophe Living. We can think of mindfulness as steady and disciplined application of that Greek "know thyself". So we can define mindfulness as the practice of giving attention knowingly in everything around us and within us. With a series of exercises, one can be able to get more in touch with mental states. Mindfulness requires passion and constancy: progressively, with practice, we become able to reduce stress levels and to acquire a certain mastery and control of internal and external situations.

4 The fundamental process described by Jon Kabat Zinn is a particular way of paying attention, according to the three following characteristics: 1. Intentionality -you must invest in the attentional process, in order to realize the presence of mental mechanisms and to conduct the attention in the desired direction. 2. Focus on the present- the present represents, in a sense, the only time that exists, but, paradoxically, is that to which we dedicate ourselves less, returning with the mind to the past or anticipating what will happen in the future. We often compare the present experience with a desired state, feeling frustration and discomfort; these are emotional elements that denote our desire to get away from what it is, judging harshly our current life.

5 3. Without judging- normally we judge our past experiences based on unconscious beliefs or conditionings of others, and, starting from these assumptions, we condition our attitude toward future events. It is precisely this nonjudgmental attitude that allows us to live our lives as they are, no wait as we designed; we are about to discover them getting better and reach, along the path of practice, to see that in them there is everything.

6 The protocol uses some parts of the therapy for the prevention of relapse of Dr. A. Marlatt and protocols of stress reduction protocols through awareness (Mindfulness based stress reduction, MBSR) by J. Kabatt - Zinn and mindfulness-based cognitive therapy (MBCT). It is intended to promote greater awareness of habitual destructive patterns and trigger automatic reactions, that seem to control the lives of these people. The awareness practices in MBRP are designed to help us to pause, to pay attention to the present moment and to conduct the awareness to the range of personal choices we make in every moment.

7 1. Develop an awareness of personal triggers and habitual reactions to learn how to create a break in these seemingly automatic processes. 2. Change the relationship with discomfort, learning to recognize and handle difficult emotional experiences functionally. 3. Promote a compassionate and non-judgmental mode to their own experience, reducing the sense of guilt that usually refers to the usual mechanisms of consumption. The MBRP takes place in eight meetings lasting about two hours, once a week, and includes practice of mindfulness and psycho-educational exercises, including through the use of metaphors and imagery. During the week between one meeting and the next you are prompted to do the exercises proposing, lasting about 30 minutes.

8 Addiction is a disease, a disease of the mind " S.N. Goenka- master vipassiano The biggest problem of the phenomenon of addiction is relapse prevention. To understand its nature, just look at the scientific literature: the percentage of relapse varies between 40% and 60% of the cases in treatment (McLellan et al., 2000). In relapse takes a leading role the abstinence component, but even more debilitating is craving the uncontrollable desire to once again assume the substance or to repeat the malicious behavior. Compared to the problems of addictions an approach that gave evidence of efficacys is that of Mindfulness Based Relapse Prevention MBRP (Bowen, Chawla, Marlatt, 2010), a, developed at the Addictive Behaviour Research Center at the University of Washington.

9 Several studies have shown the effectiveness of MBPR in reducing the percentage of relapses and the consumption of alcohol or substances with long-term results, strengthening in participants the ability to monitor and adress the discomfort associated with the desire. For example, Bowen, in his first pilot study (Bowen, et al, 2009) reported significantly lower rates of substance use in subjects who received MBRP protocol compared to those treated with TAU in the post-intensive outpatient intervention. In addition, participants showed a greater decrease in desire, a greater acceptance and awareness of their behavior with respect to the other group. Another job (Witkiewitz, Bowen, 2010) demonstrated a reduction in craving, of depressive symptomatology associated to post intensive outpatient intervention and percentage of relapses in subjects who participated at MBPR than those with TAU. Another study (Bowen, et al., 2014) showed that for individuals in convalescence after initial treatment for substance use disorders MBPR, compared to Treatment As Usual, promotes a significant reduction in the risk of relapse in drug use and alcohol. Follow up in 6 months, participants treated with MBPR and RP who took alcohol also report a reduction in terms of days of hiring compared with participants TAU. At 12 months of follow-up, there was a significant reduction in the consumption of drugs and alcohol in subjects treated with MBPR than the other group.

10 Mindfulness is a form of intrapersonal tuning. «The tuning is the heart of all relationships that involve caring for another person, such as that between parents and children, teachers and students, patient-therapist, friends etc.» (Siegel, 2009). The other plays a vital role in mental health because the quality of interpersonal relationships is one of the markers of individual health (Toro, Serafinelli, 2015). Emotional relationships promote longevity and allow an individual to achieve health and wellness state from a medical point of view. Mindful awareness represents a form of relationship with oneself, an internal form of tuning, which creates health and welfare states (Siegel. 2009).

11 At intrapersonal level, Mindfulness decreases stress levels, prevents relapses, fosters emotional regulation, increases the immune system and allows greater pain tolerance; in particular, it is useful for pain and for chronic diseases, because it allows the individual to bear more effectively such a permanent situation. At interpersonal level, awareness practices develop positive qualities such as compassion, gratitude, listening and acceptance of the other. The acquisition of such quality leads to benefits in every individual's life context such an improvement in relations. Through Mindfulness, it is possible to increase interpersonal qualities of the practitioner in order to enhance its ability to get in touch with negative emotions and verbalizzarle more easily to others without fear of judgment in order to create a relational and social context that may be more accepting and functional, eliminating the automatic blocking the person in pathology and forced him to repeat the substance abuse behaviour.

12 Hypothesis: can awareness be a significant factor for promoting social skills and help interpersonal relationships? Sample: Non-clinical 100 people of Italian origin selected according to their age, between 20 and 70 years. Tools: SIBS-scale evaluation of interpersonal and assertive behavior FFMQ -Five Facet Mindfulness Questionnaire Results: who is able to pay attention and observe his thoughts, feelings, perceptions and emotions (ability of observation), manifests a low difficulty in expressing their negative feelings, he is able to enforce their rights, he is at ease among other people, he can express his opinion in the presence of contrary views and he has also more ease in expressing affection and pleasure, favoring the creation of a relational and social context that can be functional. The ability to get in touch with one's thoughts, emotions and feelings and, therefore, the ability to recognize and describe them verbally, allows the individual to enter into a deeper connection with themselves and with others. In this way, through the achieved awareness, the individual can express themselves freely without any prejudice.

13 Bowen, S., Chawla, N., Collins, S.E., Witkiewitz, K., Hsu, S., Grow, J., Clifasefi, S., Garner, M., Douglass, A., Larimer, M.E., Marlatt, A.(2009). Mindfulness-based relapse prevention for substance use disorders: a pilot efficacy trial. Substance Abuse, 30(4): Bowen, S., Witkiewitz, K., Clifasefi, S.L., Grow, J., Chawla, N., Hsu, S.H., Carroll, H.A., Harrop, E., Collins, S.E., Lustyk, M.K., Larimer, M.E. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA Psychiatry, 71(5): Chawla, N., Bowen, S., Marlatt, G.A. (2010). Mindfulness-Based Relapse Prevention for addictive behaviour: a clinical guide. London: Guilford Press. Grossman, P., Niemann, L., Schmidt, S., Walach, H. (2004). Mindfulness based stress reduction and health benefits: a meta-analysis. Journal of Psychosomatic Research, 57(1): Kabat-Zinn, J. (1990). Full catastrophe living:using the wisdom of your body and mind to face stress, pain and illness. Dell Publishing. New york. Tr. It. (2005). Vivere momento per momento. Sconfiggere lo stress, il dolore, l ansia e la malattia con la saggezza di corpo e mente. Milano: Corbaccio. McLellan, A.T., Lewis, D.C., O'Brien, C.P., Kleber, H.D. (2000). Drug dependence a chronic medical illness: implications for treatment insurance, and outcomes evaluation. JAMA, 284: Segal, Z.V.. Williams, J.M.G., Teasdale, J.d. (2002). Mindfulness based cognitive therapy for depression: a new approach to preventing relapses. New York: Guildford Press. Tr. It.(2006). Mindfulness. Al di là del pensiero attraverso il pensiero. Torino: Bollati Boringhieri. Siegel, D.J. (2009). Mindfulness e cervello. Milano: Raffaello Cortina Editore. Toro, M.B., Serafinelli, s. (2014). Comprendere e sostenere le relazioni:il contributo della mindfulness interpersonale in Modelli per la mente. CIC Edizioni Internazionali Anno VI- n.1/2014 ISSN Toro, M.B., Serafinelli, S. (2015). Mindfulness insieme. Coltivare la consapevolezza con se stessi, in coppia e sul lavoro Milano: FrancoAngeli. Witkiewitz, K., Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of consulting and clinical psychology, 78(3):