BHECN webinar series How to Apply Mindfulness-Based Relapse Prevention. December 5, 2017 Dr. Dennis McChargue Associate Professor of Psychology, UNL

Transcription

1 BHECN webinar series How to Apply Mindfulness-Based Relapse Prevention December 5, 2017 Dr. Dennis McChargue Associate Professor of Psychology, UNL

2 About This Series: Core Topics for Behavioral Health Providers BHECN's webinar series designed to educate behavioral health trainees about practical topics in behavioral health Expert presenters provide a mixture of principles and case based application All webinars are free of charge Topics include: Presenter Topic Date Dr. Will Spaulding Schizophrenia- Part 1 and Part 2 October 19th Dr. Mario Scalora Forensic Issues and Civil Commitment November 9 th Dr. Dennis McChargue Dr. Amanda Duffy Randall & Liam Heerten-Rodriguez Dr. Amanda Duffy Randall & Liam Heerten-Rodriguez Dr. Amanda Duffy Randall & Liam Heerten-Rodriguez Dr. Amanda Duffy Randall & Liam Heerten-Rodriguez Dr. Amanda Duffy Randall & Liam Heerten-Rodriguez How to Apply Mindfulness-Based Relapse Prevention Basics of Sexual Health Working with Sexual Challenges Older Adult Sexualities LGBQ Sexualities Working with Trans Clients throughout the Lifespan December 5th January 15th Feb 15th March 15th April 19th TBD

3 About BHECN The Behavioral Health Education Center of Nebraska (BHECN), pronounced beacon, was established in 2009 by a legislative bill to address the shortage of behavioral health professionals in rural and underserved areas of the state. unmc.edu/bhecn MISSION: BHECN is dedicated to improving access to behavioral health care across the state of Nebraska by developing a skilled and passionate workforce.

4 Announcements Attendees are muted To ask a question, please type it in to the Questions box in your GoToWebinar control panel Slides are available to download in Handouts section of control panel Please complete survey after the webinar

5 Recording available Click the link to view a recording of today's webinar and information on future webinars

6 Dr. Dennis McChargue Dr. McChargue is an Associate Professor of Psychology at the University of Nebraska- Lincoln. Dr. McChargue s expertise focuses in primary and secondary prevention of substance use disorders and the treatment of co-occurring mental health and substance use disorders. He has published over 69 articles and edited two books. He also has more than 20 years in training substance use relapse prevention skills.

7 How to Apply Mindfulness Relapse Prevention Dennis E. McChargue, PhD

8 Financial Disclosure There are no financial arrangements with myself and the publishers of the mindfulness-based relapse prevention.

9 Today s Training Efficacy Evidence Relapse Prevention Assumptions Mindfulness Assumptions Applications to Relapse Prevention with Examples Body Scan Urge Surfing SOBER Cognitive Diffusion Q&A

10 Efficacy Evidence 6 & 12 Month Outcomes: Relapse 2 Better than TAU, but similar to RP Use Days and Reduced Heavy Drinking 2,7 Better than RP and TAU Efficacious with Diverse Populations 1 Efficacious for Severe SUD 2 Efficacious for those with Co-Occurring Depression & Anxiety Sxs 2

11 RELAPSE PREVENTION ASSUMPTIONS Trigger Initial Reaction: Thoughts, Sensations and/or Emotions Urges AUTO PILOT Believe Thoughts React (ReLapse) More Thoughts Relapse Cycle

12 Key Assumptions of MBRP MIND Process INQUIRY PROCESS Direct Experience BRING AWARENESS TO DIRECT EXPERIENCE Reaction (judgment, story) Reaction REDUCE REACTIVITY TO JUDGMENTS/STORIES Reaction REDUCE MALADAPTIVE REACTIONS

13 Mindfulness Targets for Skill Building Riding Out Urge Response trigger Initial Reaction: Thoughts, Sensations and/or Emotions Urges Turning Off AUTO PILOT Believe Thought s React (ReLapse) Relapse Cycle More Thoughts Not Reacting Penberthy et al., (2015)

14 Mindfulness Targets for Skill Building Witkiewitz et al., 2014

15 TRAINING MINDFULNESS VIA BODY SCAN

16 BODY SCAN (15-45MIN) Investigation of the moment-to-moment experiences of the body. Methodologically bringing attention to body Begins with left foot Ends at the top of the head Create audiotape to facilitate practice Many notice many physical sensations (e.g., itches) Do in a relaxing environment without distraction Lie down unless you get sleepy, then sit Body Scan Options: practices/?utm_source=mindful+newsletter&utm_campaign=119539e6ee- Weekly_Wakeup_May_16_20165_12_2016&utm_medium= &utm_term= 0_6d03e8c02c e6ee #bodyscan

17 Benefits of Mindfulness Dissociates you reaction from your experience Brings awareness of cognitive errors Eventually reduces cognitive errors influence on your emotional and behavioral reactions Reduces Emotional Response to stressful situations.

18 Practice Logs Practice What was What did What did What did the you notice you notice you learn? situation? before? after? Emotions: Thoughts: Sensations: Urges?

19 Therapist Note: Key themes to reinforce in all exercises Accept that unwanted thoughts, feelings and sensations happen Being present is foundation to true self-care Seeing Thoughts as thoughts Don t judge, just notice your having them. Step out of auto pilot and guide your life

20 URGE SURFING Riding Out Urge Response trigger Initial Reaction: Thoughts, Sensations and/or Emotions Urges AUTO PILOT Believe Thoughts React (ReLapse) More Thoughts Relapse Cycle

21 Urge Surfing Explore underlying reason for urge Don t react to it Imagine challenging situation, but not most challenging PAUSE, OBSERVE (thoughts, feelings and bodily sensations) Bring similar approach to other mindfulness practice Approach with gentle, nonjudgmental curiosity Surf metaphor Stay present with the intensity of craving w/out reacting or becoming subsumed. Picture as an ocean wave and imagine wave of craving Breath the surfboard to ride wave Ride throughout the peak and decline

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23 SOBER trigger Initial Reaction: Thoughts, Sensations and/or Emotions Urges Turning Off AUTO PILOT Believe Thoughts React (ReLapse) Relapse Cycle More Thoughts

24 SOBER Breathe Expand Awareness Respond Mindfully Observe reactions trigger Initial Reaction: Thoughts, Sensations and/or Emotions Urges Turning Off AUTO PILOT Believe Thoughts React (ReLapse) Relapse Cycle More Thoughts

25 SOBER Example

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27 Cognitive Diffusion (Observing Thoughts as Thoughts) trigger Initial Reaction: Thoughts, Sensations and/or Emotions Urges AUTO PILOT Believe Thoughts React (ReLapse) More Thoughts Relapse Cycle Not Reacting

28 Targets for Cognitive Diffusion

29 Cognitive Diffusion Example

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31 Resource Videos Post-Practice Processing Videos SOBER Processing: Urge Surfing Processing: Cognitive Diffusion Processing:

32 References 1. Amaro et al. (2014). Feasibility, acceptability, and preliminary outcomes of a mindfulness-based relapse prevention intervention for culturally-diverse, low-income women in substance use disorder treatment. Substance Use & Misuse 49; Bowen S. et al. (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); Bowen S, Chawla N & Marlatt GA (2011). Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician s Guide. The Guilford Press: New York. 4. Roos, CR et al., (2017). Baseline patterns of substance use disorder severity and depression and anxiety symptoms moderate the efficacy of mindfulness-based relapse prevention. JCCP 85(1): Penberth JK et al., (2015). Mindfulness-based relapse prevention: History, mechanisms of action and effects. 6. Witkiewitz K et al., (2014). Mindfulness-based treatment to prevention addictive behavior relapse: Theoretical models and hypothesized mechanisms of change. Substance Use & Misuse 49(5): Witkiewitz et al., (2014). Randomized trial comparing mindfulness-based relapse prevention with relapse prevention for women offenders at a residential addiction treatment center. Substance Use & Misuse 49(5):

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34 Recording available Click the link to view a recording of today's webinar and information on future webinars