MiT-A for Anxiety and Trauma Disorders

Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | info@bemindful.com.au
MiT For Anxiety & Trauma Disorders
Cameron Aggs Clinical Psychologist & Director
Mindfulness Training Australia
Cam @bemindful.com.au
In collaboration with the Australian College
of Community Services

Overview
• Session 1:
– Overview of mindfulness and key concepts
– Experiential exercises: 3MBS, 2H and 4B techs
• Session 2:
– Mindfulness, Clinical Algorithm and Case Formulation
– Mindfulness in the context of trauma and other anxiety
disorders
• Session 3:
– Mindfulness-Informed Interventions: Video
– Facilitating the 3MBS, 2h and 4B techs

Materials and Process
• Slides
• Experiential activities
– Participate as much as you feel comfortable
– Volunteering for demonstrations
• Choose a client to keep in mind
• Video
• Password resources

Beginning with the end in mind
• Mindfulness and the Magic Question
• Safety, Safety, Safety…
• Mindfulness should be embodied (RB2RB)
• Enhancing a willingness to feel into and to safely experience
SIFT experiences
– Importance of the breath
– Relevance of Self-As-Context

• Know your mechanisms!
• Socialise early. Find your entry point. Scaffold.
• Jigsaw metaphor
• Make sure you have access to enough resources to build the
capacities you are seeking to foster
• Make sure you can do what you are asking of your clients (or
are cognisant of how hard it can be!)

Who here can come into a state of presence at will?

4Breaths Technique
Coming into a state of presence:
• Lightly, mindfully watching the breath
• Coordinating with the fingers: Motor-movement
• Rounds of 4
“These 4-Breaths are Mine”

What does mindfulness mean to you ?
Copyright (c) 2013 Mindfulness Training
Australia, All Rights Reserved | MiT
- Mindfulness Informed Therapy

“Bringing one‟s complete attention to the experiences occurring in the
present moment, in a nonjudgmental or accepting way”
(Brown & Ryan, 2003; Kabat-Zinn, 1990).
What is Mindfulness?

Our “map”:
IAA model of mindfulness
(Shapiro et al., 2006)
Intention
Attention Attitude
Paying attention in a particular way…
Kabat-Zinn, 1994, p4
and non-judgmentally.
on purpose, in the present moment,

Holding in Mind: Intentions
• What do you want from mindfulness?
• This moment…?
• This meditation / workshop / this session…?
• More generally inc this treatment episode?
Tip #1: Mindfulness is an intentional activity

Attending Skills
Placing your attention where you want it…
• Attentional placement:
– Shifting and sustaining attention
• Non-judgmental Awareness
– Inhibiting secondary appraisals
• Noticing and Naming
– Ability to put inner experience into words

The process of mindfulness
(the WHAT and HOW)
Noticing and naming
with mindful
attitudes (internal &
external
experiences)
Letting go
(creating space)
Focus/Re-focus
attention
Choose an aspect
of internal or
external experience
to focus attention on

Attending:
• Using your faculty of attention as a tool: Disengaging from worry
and rumination
• Fostering Internal Attunement / Meta-CognItive Awareness:
What‟s happening for me now..?
• The ability to come into a state of “Presence”

3 Qualities of Presence
• Light: As in buoyant in the Mind
– Unencumbered by past and future and fixation
• Relaxed: As in soft in the body
– Particularly the belly, chest, shoulders, jaw
• Grounded: The bum in the chair and the feet on the floor
– Mind „riding‟ the breath
Light. Relaxed. Grounded.

Presence…
“The mind if not stirred, will become clear”
Sogyal Rinpoche

Points of Contact
Becoming Present:
• Feet on the floor
• Bottom in the Chair
• The breath moving in and out of the body
Grounded inwardly, focused outwardly…

Mindful Attitudes: More than just
Attention
The Flavour of Mindfulness: The anesthetic of internal
attunement….

Attitudes
GOAL
• Curiosity :
• Openness
• Acceptance
• Love
Metaphor / key principles
• Curious Explorer
• “It is already here: Let me
feel it
• As an active state
• Friendliness
Saying „Yes‟ to Experience

3 Minute Breathing Space = Making a Space
for What is Happening now
Step 1: Taking stock / Gathering the mind
Step 2: Focusing and redirecting the attention
Step 3: Expanding awareness and returning
Hot tip: Bookmark: youtube “3 minute breathing space” (it‟s the
first one that comes up)
Experiential Exercise: 3MBS:

I-SIFT
• I (me)
• Sensations
• Images
• Feelings
• Thoughts

MINDFULNESS:
COMPONENTS AND
CENTRAL CONCEPTS

Central Concepts
• The ubiquity of human suffering
• Internal experiences are transient and change with time
• Thoughts and emotions are not facts
• Though some are very „sticky‟
• They happen within a larger context: The „Space of the Mind‟

A Central task
• To disengage from fixation on verbally-based
mental content and fusion with emotional
material

And again…
“The mind if not stirred will become clear”
-Sogyal Rinpoche

But!
• Before „Letting-Go‟, of thoughts we must learn to
„Be-With‟ our primary emotional experiences
Saying „Yes‟ to experience
- Tara Brach
“It‟s already here…. Let me feel it”
-John Kabat-Zinn

„Being – With‟
• Feeling into …
• Going deeper….
• Making a space…

BREAK! 

Review…
Mindfulness is the capacity to come into a state of
presence, to not be overly judgmental (non-catastrophic)
about our encounters with suffering, and to make space for
whole range of affectively-engaged living, with the confidence
that SIFT experiences are passing on through…. and, that we
are the conscious, cognisant space within which that all
happens

Correlational Research
Greater mindfulness
associated with higher:
• Healthy self-regulation
• Emotion regulation
• Positive affect
• Quality of life & life
satisfaction
• Social skills
• Relationship Satisfaction
• Academic competence
Mindfulness interventions
resulting in greater:
• Feelings of
calm/relaxation
• Social skills
• Personal and social well-
being
• Self-esteem and self-
acceptance
• Awareness and
recognition of types of
emotions
• Self-efficacy for reducing
substance use
• Sleep quality

Mindfulness: Does it Matter?
Greater mindfulness
associated with lower:
• Depressive symptoms
• Anxiety
• Stress
• Internalizing symptoms
• Externalizing behaviour
problems
• Worry and rumination
• Negative affect
• Substance use coping
• Somatic complaints
• Psychological inflexibility
and thought suppression
and control
Mindfulness interventions
resulting in lower:
• Depressive symptoms and
low mood
• Anxiety
• Stress
• Internalizing symptoms
• Externalizing behaviour
problems
• Difficulties with emotion
regulation
• Problem behaviours in the
classroom
• Keng, S.L. (2011). Effects of mindfulness on
psychological health: A review of empirical
studies. Clinical Psychology Review. 31, 1041-
1056

What: spectrum of mindfulness-informed
interventions
Mindfulness-informed
interventions
• Acceptance and Commitment
Therapy (ACT)
• Dialectical Behaviour Therapy –
adolescents (DBT-A)
• Individualised intervention plan:
(e.g. MiT)
Mindfulness-based
interventions
• Mindfulness-based stress
reduction (MBSR)
• Mindfulness-based cognitive
therapy (MBCT)
• Independently developed
mindfulness programs
(MiCBT)
Embodying and modelling of mindfulness with clients

Modelling Mindfulness,
Psychotherapy Process
Mentalising the Clinical Algorithm
Mindfulness Informed Therapy
Mindfulness as
metaphor, psychoeducation and
technique

Mindfulness and Psychotherapy
Process: Clinical Algorithm
Client Characteristics:
• What is the client‟s presenting problem?
• Severity and Level of impairment?
• Stage of Change?
• Client‟s theory of Change?
• Character organisation?
- Joe Coyne

Mindfulness and Therapist Factors
• Service in which we are embedded
• Theoretical orientation
• Access to training and supervision
• Clinical / Couseling / Case-work assumptions
• Presence of a personal practice
• How we deal with our own suffering
• Access to Resources

Mindfulness and Systemic Factors
• Nature of the Services
• Type and scope of intervention
• Frequency of contact
• Broader social, economic and political context

My Clinical Assumptions
• The Importance of following the clients lead: What moment is
this?
• Live Company: A mind-minded other..
• Client engagement as co-regulation
• Hypothesis testing: Integrative and client-centered treatments
• Behavioural Activation
• Scaffolding:
• Importance of Understanding Mechanisms
• Entry Point >>>> Consolidating Gains

Self Audit
What I do well:
• Patients feel heard, feel felt…
• A mind-minded other: „Live Company‟
• Engendering hope
• A sense of “We”
What I struggle with:
• A consistent psychotherapy frame
• Intellectualising

Tailoring individual treatments
• Anxiety specifically and psychopathology generally initially
develop in invalidating developmental contexts
– Clinical Algorithm
• Skills based vs relationally focused treatments
– Healing nature of attuned relationships
– Emotional processing vs building new capacities

Mindfulness and anxiety….

Mindfulness and Anxiety Disorders
• PTSD
• OCD
• GAD
• Phobias
• Panic Disorder
• Social Anxiety Disorder

Experiential Avoidance: A Primary
Target for Anxiety Disorders
• Anxiety disorders are developed and maintained by a
complex array of factors including experiential avoidance (EA)
• EA: Defined as an unwillingness to experience unwanted
internal events.
• Habitual attempts to anxiety trauma-related thoughts,
emotions and memories lead to the core symptoms of Anxiety.
• Target = Affect Regulation Capacity

Mindfulness and Treatment
Planning
• Establishing a platform of accurate attunement and
(therefore) safety
• Assessment inc client theory of change
• PsychoEducation
• Mindfulness as Metaphore / Deepening the Narrative
• Experiential

Assessment, psycho-education and
experiential techniques
Throughout the psychotherapy journey point is the same:
“ We can become curious about your experience together, that
your what you are going through is understandable, and that
this is a safe place to feel into those parts of your inner
experience that are you find frightening, and which you avoid,
and/or have been experienced in isolation. Through gaining
mastery in here we can help you to generalise it out-there
(and visa versa)…

Mindfulness and CBT
• Moreso than changing maladaptive beliefs, the target of MiT
is changing „maladaptive‟ ways of avoiding anxiety-provoking
stimuli: ie avoidance.
• Its also about the provision of a relationship that can feel into
and cope with that which is more often excluded from
awareness

Mindfulness and CBT
Promoting the willingness to stay with it for „one-more
moment‟ in the service of values-based living

Mechanism 1: Exposure
Safety Exposure H* / Emotional
Processing
Repeated Exposure Mastery / H*
• Biological mechanisms
• The Breath: Entering the relaxation response
• IA: Decreasing stress and strain (bracing) in the body
*H = Habituation

Exposure
Psychological Mechanisms
• Experiential contact: Feelings can be felt, memories can
be integrated into coherent narrative
– Ie inner experiences can be felt, named, and shared
• One-moment at a time: The benefits of staying present
• Acting with Awareness: Availability of safety cues in the
world
• Curious Explorer: SIFT

Exposure
Relationally
• The Therapy Relationship is safe:
– Live Company: A Mind-Minded Other
– Accurate Attunement: Following Lead
– Containing, Reframing, Exploring, Debriefing
– At the client‟s pace

Mechanism 2: Decentering
• Self-as-Context
• Meta-cognitive Awareness
• „Thoughts are not facts‟: Undermining
thought/action fusion
• „Being-Mode‟
• Agency

Potentiating Mechanism 3:
Compassion
• Mindfulness and Self-Attunement
• Friendly Self-Object
• Self-Efficacy
• Potentiating mechanism for Acceptance
• Revolution in self-concept and attachment
security: Self is Good, Safe and Loveable

Interventions
• 2-Hands
• Therapist behaviours: Reframing
• The psychotherapy Narrative / psychoeducation
• Mini thought experiments:
• 4-breaths
• POC – with modifications
• 3MBS- with modifications

Mindfulness Practice: 2 Hands
• Place one hand is on the chest and the other
hand on the abdomen.
• Breathe and notice:
– Where is the breath moving?
– Is the breath deep or shallow? Fast or slow?
– Which hand is moving more?
• Rate our of 100%

POC: Points of Contact –
Inward focus
Noticing the feeling of your feet on the floor, bottom in the chair
and your breathing…
For clients:
• Engenders safety (groundedness and an „inward focus‟
• De-stabilising aspect of mindfulness practice
• Deepens the impact of the therapy relationship, potentiates the
therapy hour
For the therapist:
• The how of „Therapeutic Presence‟
• Enables frustration tolerance

3 Minute Breathing Space = Making a Space for
What is Happening now
Step 1: Taking stock / Gathering the mind
Step 2: Focusing and redirecting the attention
Step 3: Expanding awareness and returning
Working With Discomfort: Exposure to negative affect
modification: Presenter demonstration
Experiential Exercise: 3MBS:

Safety – Modification
• Severity of impairment assessment
• Working Alliance assessment
• POC Exercise: Agency
• Eyes Open Modification
• Relational Exercises

Practice!
• Coach each other through an exercise of your
choosing
• Provide a rationale: Link to assessment and
ongoing socialisation process
• Encourage partner (You are fostering a
trajectory to end in a sense of Mastery)
• Provide feedback
• Swap

Clinical Markers **
• Viewing, trauma-related thoughts and feelings from a nonjudgmental
perspective
• Increase their contact with the present moment: The trauma is not now.
• A felt awareness that thought suppression, avoidance etc is unnecessary
and counter productive
• Behavioural Activation / Acting with Awareness: Moving on into a values
congruent future

Mindfulness as Assessment
• Assess trauma type and severity
• What is the clients theory of change, level of
impairment etc?
• Mindfulness and a sense of agency and safety
– Modifying Points of Contact exercise

Potential Experiential Mindfulness
Trajectory
2 Hands > P.O.C > 4 Breaths > T.E.‟s
3Rs > 3MBS > Body Scan > Breathing
Meditation > Sitting with discomfort

Psychoeducation: IAA terms
Intention
Attention Attitude
Focusing/refocusing on the here
and now
Noticing and naming
Letting go and creating space
Checking in
Curiosity
Kindness
Willingness
Choosing
Slowing down
Remembering
Knowing why

Psycho-Education: Knowing your
Mechanisms!
Self-Compassion
DefusionPositive Affect
Acceptance
Interoceptive
Exposure
Agency
RelaxationAttention Switching

Mindfulness & Metaphor
• Using metaphors to illustrate and explore mindfulness concepts
– Keep it simple and Don‟t overload with too many or varied metaphors
Metaphor Target area
Clouds in the sky Self as Context: Interoceptive Experiences are safe
Leaves on a stream
/ River Bank
Internal experiences are constantly changing + Observer
Self
Training the Puppy Gentle and Firm orientation to attentional control. Forming a
relationship with the self
Narrowing focus –
widening lense
Attention is a tool
„Turning Towards‟,
Saying „Yes‟
Mobilising acceptance in behavioral terms
Train of thought Internal experiences are constantly changing
Making space /
feeling into…
Mobilising acceptance in behavioral terms

Clinical Uses for Meditation
• Selling meditation: Finding a way of talking about meditation
that makes sense.
• Constraining gains: starting with FBB +4B
• To focus a session: Do at Beginning
– Establish a narrative for this early on and stick with it.
• As treatment: Emotional processing, attention training,
synergies with schema-focused and cognitive work

• As homework: Start with diaphragmatic
breathing (Crawl and/or two breaths) prior to
doing guided meditations
• Using meditation like a Personal Trainer.
Discourse: Building neural circuits
• Trajectory:
– Start with Body scan (relaxation
– > breathing meditation (attention regulation),
– > noticing thoughts and feelings (meta-cognitive
awareness
– > guided imagery (creating a safe place)
– > sitting with discomfort (interoceptive exposure /
emotional processing

Meditation-Check list: Learning
Opportunities
Attention
• Thoughts will continue to be there and that is okay
• You can learn to let go of thoughts
Attitude
• My feelings are okay as they are
Experiential
• The present moment can be a nice place to be
• Your ally is close at hand: Diaphragmatic breathing: Long,
deep and slow
• Feeling it at a physical level

In-session meditation:
Emotional Processing
• Discuss a worry - Find the bottom line /what is the essential
message?
– Eg. “I am not good enough”
• Guide a meditation starting with relaxing into FBB
• Evoke the message: “Imagine it like a radio station….”
• Notice feelings and body sensation. Special attention to belly and
chest.

Using Metaphors
Clouds in the Sky
Mentally “placing” internal experiences (usually thoughts) on the object and allow it
to move (or not move) as it naturally wants to.
– Does … (object) stick around?
– Does it feel ok if … (object) is not moving on?
– Background (sky) is „observing self‟/„self-as-context‟
– Noticing that the background can observe the objects that move through it
– Are you the … (object) or the … (background)? [„self-as-context‟ rather than
„self-as-content‟]
If the child has the capacity, you can link other internal experiences (e.g., feelings)
to other objects/events that occur in the background
– Are you still able to be … (the background) even when … (feeling) is also
happening?

No Pest Control
(reactions happen)
• Imagine your distressing or unwanted thoughts,
feelings, body sensations are like … cockroaches…
• Being able to let the experience be…
– Not feeling bad that it is here
– Not trying to get rid of it
– Not running away from it
– Not letting the cockroaches control how you act
– Not trying to make the experience positive (e.g., a
butterfly)
• Being ok with the experience coming and going… like
cockroaches running around you...
• Being able to notice the experience and still being able
to chose what to do

Nature of Attention
Spotlight
• Shining light on where you
want to focus your attention
Puppy on a leash
• Like a puppy attention
naturally wanders (jumps
around)
• It takes time to train a puppy
(attention) to be able stay in
the one place for any length
of time
• Getting angry at the puppy
doesn‟t help
• Be kind to your wandering
mind

Train of thought
• Thoughts don‟t stop and they often jump from one topic to
another.
• The train of thought can be fast or slow
• Creating Space: “Are you standing on the platform or are you
riding on the train?”

Thought Parade

• Know your mechanisms!
• Socialise early. Find your entry point. Scaffold.
• Jigsaw metaphor
• Make sure you have access to enough resources to
build the capacities you are seeking to foster
• Make sure you can do what you are asking of your
clients (or are cognisant of how hard it can be!)

Thank You!
More information at www.bemindful.com.au
Email me: cam@bemindful.com.au

MiT-A for Anxiety and Trauma Disorders

Recommended

Recommended

More Related Content

Similar to MiT-A for Anxiety and Trauma Disorders

Similar to MiT-A for Anxiety and Trauma Disorders (20)

Recently uploaded

Recently uploaded (20)

MiT-A for Anxiety and Trauma Disorders

Editor's Notes