Mindfulness Practice in Clinical Work

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Mindfulness Practice in Clinical Work

• Steve Gonzalez, LISW
• Our breath is the bridge from our body to our
  mind (Hahn)

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Objectives

1. Participants will learn ways to apply mindfulness
   in clinical practice
2. Participants will learn how to apply mindfulness
   in personal life
3. Participants will gain an understanding how
   mindfulness promotes balance, healing, and
   self-growth

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A mindful verse

• We can not do anything about Yesterday, it is
  gone forever. The future is a mystery. Today
  however, is a precious GIFT.
• That is why we call it the PRESENT.

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Lyrics Right Now Van Halen

• Right now
• Theres no tomorrow, right now
• Come on its everything, right now
• Its a magic moment
• Do it right here and now
• It means everything
• Right here and now

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What is Mindfulness?

• A quality of present moment awareness, openness,
  acceptance, and being nonjudgmental
• Experiencing the moment as it happens- it is the
  only moment that exists
• Human Being/not human doing
• Fully engaged in the moment-right here and now

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You must be present to win

• Many times we live our lives mindlessly,
  mechanically on automatic pilot
• We all have experiences of being/living in the
  present
• The door to the present moment, to true
  appreciation of our entire lives, is cultivation
  of the practice of mindful awareness-an intimate
  relationship with the present Jean Smith

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Common Elements-Mindfulness (Germer, 2005)

• Non-conceptual awareness without absorption in
  our thought process
• Present-centered thoughts about our experience
  are one step removed from the present moment
• Nonjudgmental no right or wrong, good/bad
• Nonverbal mindfulness not captured in words,
  awareness occurs before words arise in the mind
• Intentional continuous redirection to the
  present moment

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Common Elements-cont.

• Exploratory mindful awareness is always
  investigating subtle levels of perception
• Participant observation experiencing the
  mind/body more intimately versus detached
  witnessing
• Liberating mindful awareness provides freedom
  from conditioned suffering

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Mindfulness Based Practices

• 1979 Mindfulness Based Stress Reduction
  Kabot-Zinn
• 1993 DBT Linehan
• 2000 Mindfulness Based Cognitive Therapy
  Teasdale et al
• 2002 Mindful Recovery Bien
• 2004 ACT Hayes

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Mindful presencetherapeutic Alliance

• Fully being present with the client leads to
  empathy, warmth, understanding, acceptance,
  attention, and compassion
• Research shows these qualities improve the
  therapist/client relationship

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Advantages of Mindfulness

• Prevent Clinician Burn-Out
• Complimentary to Clinical Models
• Theoretical Frame Work
• Self-growth
• Life starts with a breath and ends with a
  breath (Yogi Bhajan)

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The Breath

• We are not in touch with our breath-its just
  there. In mindfulness we get in touch with it and
  notice how the breath changes with our moods. We
  dont control the breath. Just notice it,
  observe, watch, and feel the breath.
• Karen Ryder, instructor, Stress Reduction Clinic,
  UMASS Medical Center

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Mindfulness of the Breath

• Serves as your anchor point
• Brings you back to the here now moment
• Helps to broaden your perspective

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Mindfulness form of meditation

• Developing 3 qualities of attention
• Withholding of Judgment
• Intentional Awareness
• Focus on the present moment

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1. Withholding Judgment

• Natural tendency to evaluate/judge our
  experiences and attach meanings
• These judgments can get in the way (neutral,
  detached)
• All experience is accepted and all judgments are
  let go
• Acceptance-acknowledging the reality of your
  experience

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2. Intentional Awareness

• Choosing to focus your attention on a particular
  experience and keep your attention there
• Becoming aware of the mind wandering
• Bring your mind back to the present moment

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3. Focus on the Present Moment

• Awareness of breath
• Focus on body sensations
• Pay attention to the flow of thoughts/feelings
• Notice thoughts as thoughts and feelings as
  feelings-do not get caught up on content
• Each moment is a series of new beginnings

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Meditation

• Scientists study it. Doctors recommend it.
  Millions of Americanspractice it everyday. Why?
  Because meditation works.
• (Time. August 4, 2003).

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Studies on Meditation

• Various research studies have proven the
  effectiveness of meditation and how practice can
  positively impact emotional and physical health.

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Benefits of meditation

• Improved concentration and focus
• A greater sense of peace and well-being
• A feeling of calmness
• Simple drug free stress reduction
• Improved mental and physical health

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Misconceptions of Meditation

• 1. Meditation is too complicated
• 2. Meditation takes up too much time
• 3. You have to have absolute silence to meditate
• 4. Meditation is not a religion
• 5. Meditation is an excuse to escape reality and
  responsibilities
• 6. There is only one way to meditate

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Meditation is for anyone

• Meditation can be practiced by anyone regardless
  of age, gender, orientation, occupation,
  nationality or religion
• The best part- it can be done for free

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Establishing a meditation Practice

• Find a comfortable and quiet place
• Chose a time of day that is right for you
• Make a commitment to practice on a consistent
  basis
• Sit in manner that allows you to be relaxed and
  alert
• Let yourself settle in and get centered
• Find a focal point for your attention

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Establishing Meditation-continued

• Wear comfortable clothing
• Trust the process
• Continue for a comfortable period of time
• Set no goals-just meditate
• Practice, Practice, Practice

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counting the BreathDeveloping awareness of
Cbreathing

• Good Posture-deep belly breathing
• Count to ten in-breath one, out-breath one
• Count from 10 to 1 in same manner
• In-breath- out breath
• Mind training to develop concentration and
  getting to know yourself
• Lose your focus start back at one

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2. Follow your breath

• Notice your breathing is long or short, deep or
  shallow, cool or warm?
• Just notice and observe
• Make no judgments
• Be present in the moment
• Advanced practice-notice and observe your thoughts

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Reflections

• Pain is inevitable suffering is optional
• Pain does not equal suffering
• Pain x resistancesuffering (Siegel, 2005)

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Transforming Feelings Practice(Braza, 1997)

• Begin mindful breathing
• Thoughts lead to feelings anger
• As the feeling anger enters consciousness
• Simply become aware of anger and bring attention
  back to the breath
• Awareness reduces the power of anger
• In the moment accept anger. Do not resist.
  Embrace anger

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Transforming Feelings cont.

• Befriend anger and become one with it
• Breathe in and out, observe and study the anger
• Begin to calm anger-mindful breathing
• Experiencing the feeling of anger in me, I
  breath in .
• Smiling at the anger in me, I breath out.

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Another Example of Mindful Verse working with
anger

• Breathing in, I recognize my anger
• Breathing out, I am aware of how angry I am
• Breathing in, I see my anger overwhelming me
• Breathing out, I recognize that anger affects my
  entire body
• Personalize phrases is key-same method can be
  used for walking meditation

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Informal Practices Daily-Life Mindfulness

• Engaged attention of present moment activity
• Examples-washing dishes, sweeping, jogging,
  driving, waking-up, brushing teeth etc
• Take mindful breaths before, during, and after an
  activity

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Eating Meditation

• Mindful or mindless activity?
• Think about your last meal. Can you recall the
  various tastes, smells, and textures you
  experienced?

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Steps for Mindful Eating

• Remember purpose-to eat and become aware of
  breathing
• Slow down the eating process-chew your food
  slowly
• Involve all your senses sight, hearing, taste,
  smell, touch
• As your mind wanders bring your awareness back to
  the moment of eating

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Walking Meditation

• Become aware of your breathing
• Stepping with your left foot and while breathing
  in say, In.
• As your right foot moves forward, breath out and
  say Out.
• Vary your pace and breathing to suit your needs
  and environment
• As your mind wanders bring your attention back

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Loving-kindness Meditation

• Purpose is to develop compassion for self and
  others
• Chant for self, family, friend, neutral person,
  difficult person, universal
• May I enjoy happiness and the root of happiness
• May I be free from suffering and the root of
  suffering

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Standing Meditation

• Become aware of your breath
• Stand in straight comfortable posture
• Focus on your breath to stay in the moment
• Feel the body sensations
• Connect with the ground, air, sounds, light,
  shadow
• Metaphor-Tree

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Think About

• Exploring ways in which you can apply mindfulness
  in your daily work and or personal life.
• How do you plan to be more mindful while driving,
  using the computer, with colleagues, routine
  activities?

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SUMMARY

• Mindfulness has many applications in the clinical
  setting
• Mindfulness practice can be used to prevent
  burn-out
• Mindfulness practice is research based
• Practice, Practice, Practice
• Clients can gain freedom when they recognize
  that thoughts are not facts they are just
  thoughts

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Book Resources

• Braza, J. (1997) Moment by moment The art and
  practice of mindfulness.
• Hayes, S., Follette, V., Linehan, M (2004)
  Mindfulness and acceptance Expanding the
  cognitive-behavioral tradition.
• Linehan, M (1997) Skills training manual for
  treating borderline personality disorder.
• Nhat Hahn, T (1975) The miracle of mindfulness A
  manual on meditiation.
• Smith, J. (2004) NowThe art of being truly
  present.

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Book Resources p.2

• Bien, T, (2002) Mindful recovery A spiritual
  path to healing from addiction.
• Brantly, J., (2003) Calming your anxious mind
  How mindfulness and compassion can free you from
  anxiety, fear, and panic
• Kabat-Zinn, J., (1990) Full castastrophe living
  using the wisdom of your body and mind to face
  stress, pain, and illness.
• Mruk, C., Hartzell, J. (2003) Zen and
  psychotherapy
• Rosenbaum, R., (1998) Zen and the heart of
  psychotherapy.
• Segal, Z., Williams, J., Teasdale, J., (2001)
  Mindfulness-based cognitive therapy for
  depression.

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Journal Articles

• Kabat-Zinn et al. Effectiveness of a
  meditation-based stress reduction program in the
  treatment of anxiety disorders. American Journal
  of Psychiatry, 1992 149936-943
• Kabat-Zinn, et al. Four year follow-up of a
  meditation-based program for self-regulation of
  chronic pain Clinical Journal of Pain, 1986
  2159-173
• Miller, J et al. Three year follow-up and
  clinical implications of a mindfulness-based
  stress reduction intervention General Hospital
  Psychiatry, 1995 17192-200

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Journal Articles p.2

• Shapiro et al. Effects of mindfulness-based
  stress reduction on medical and premedical
  students Journal of Behavioral Medicine 21581-97
• Teasdale et al. Prevention and relapse in major
  depression by mindfulness-based cognitive therapy
  Journal of Consulting and Clinical Psychology
  2000 68615-623
• Speca et al. A randomized, wait-list controlled
  clinical trial the effect of a mindfulness
  meditation-based stress reduction program on mood
  and symptoms of stress in cancer patients
  Psychosomatic Medicine 62613-22

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Contact Information

• Steve Gonzalez, LISW
• Des Moines Public Schools
• Children and Families of Iowa
• 515-242-8276
• Steven.gonzalez_at_dmps.k12.ia.us