Mindfulness and trauma

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Mindfulness and trauma
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Mindfulness

• Translation of ancient Pali word sati -
  awareness
• direct, open-hearted knowing
• Traditionally cultivated by meditation practices
• Learning to pay attention
• Moment by moment
• Intentionally
• With curiosity and compassion

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Overview of MBCT

• Eight weekly classes plus all-day session. Each 2
  - 2.5 hours.
• Pre-class interview
• to explain, motivate and point out the
  commitment that will be necessary
• Up to 12 in each class (Kabat-Zinn 30 in each
  class)
• Homework, up to one hour per day, 6 days a week
  - mostly audiotapes of mindfulness practice
  generalisation practice
• Pattern
• First half - concentration/steadying the mind
• Second half wider awareness relapse prevention

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First outcome trial results

• For patients with only 2 previous episodes (23
  of sample) - No effect of MBCT on relapse
• For patients with 3 or more previous episodes
  (77 of sample) - Significant effects
• TAU 66 relapsed in 12 months
• MBCT 37 relapsed in 12 months

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Teasdale, Segal, Williams et al., 2000,
JCCPSurvival Curve (for patients with 3 or more
previous episodes - 60 weeks)
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Does MBCT reduce symptoms for currently
depressed suicidal? (Oxford Varela Pilot
Trial Barnhofer, Crane et al, 2009)

• Three or more prior episodes or chronic
  depression
• Currently depressed or residual symptoms
• All BDI gt20
• All suicidal
• Randomly allocated to
• MBCT TAU
• TAU alone (n 14 in each group)
• BDI scores

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Williams et al 2013

• MBCT V Active Control
• Dismantling study
• Results - equal except for people with recurrent
  depression based on childhood adversity and/or
  trauma

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Relationship between Mindfulness And trauma
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What is mindfulness and how can it help ?

• Mindfulness is the awareness that emerges
  through paying attention in a particular way. . .
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• - on purpose
• - in the present moment
• non-judgementally.
• To the unfolding of experience moment by moment
• Jon Kabat-Zinn 2003

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Mindfulness

• Embedded within
• EMDR
• DBT
• Sensorimotor
• ACT
• ? Can formal mindfulness practice be used

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Mindfulness-based approaches to trauma

• Mindfulness as skill for emotional regulation
• Small pilot 8 week course for patients attending
  sexual abuse service
• (Jane Dallas Ross, Christine Steverson )

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Body Scan Meditation the foundation to the
programme

• Aims
• Direct experiential knowing
• Deliberately engaging and disengaging attention
• Relating skilfully to mind wandering
• Allowing things to be as they are
• Learning how the breath can act as a vehicle
• Noticing and relating differently to mental
  states
• Noticing, acknowledging and returning

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Two case examples

• 1. Patient with complex trauma one year emdr/
  sensorimotor approach and then eight week
  course
• 2. trauma following sexual assault CBT approach
  and then eight week course

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Previous research ?

• MBSR for low income African American women with
  PTSD Dutton et al 2010
• Mindfulness intervention for child abuse
  survivors Kimbrough et al 2010
• Mindfulness meditation training combined with
  EMDR single case study

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The Symptoms of Trauma

• Persistent re- experiencing flashbacks
• Intense negative response to triggers
• Avoidance stimuli , social
• Fragments of memory missing
• Disengagement from life
• Numbing
• Low mood, hyper vigilance, anger, irritability ,

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The Neurobiology of Trauma
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How might Mindfulness help

• Compassion
• Safety
• Awareness
• (Taking Refuge Tara Brach )

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Changes in self compassion
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Mindfulness training increases viscero-somatic
processing and uncouples narrative-based
processing (Farb et al, 07)