Adapting Mindfulness Practice for Clients with History of Cognitive Deficits and Substance Use Disorders

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1 Adapting Mindfulness Practice for Clients with History of Cognitive Deficits and Substance Use Disorders Thomas G. Beckers BS,LADC Vinland Center

2 A Brief Moment of your time You are welcome to set aside all activity and follow along as we practice finding an anchor for our attention.

3 What are We Going to Cover? What mindfulness practice is and how it has evolved to become used in Therapeutic settings. How a brain injury effects executive functioning and how chemical dependency treatments strategies need to be adapted for this population. Review curriculum offered to patients involved in a mindfulness practice group as part of their residential chemical health program at Vinland Center. Review some initial research on mindfulness that was gathered at a semiindependent housing program associated with Vinland Center

4 What is Executive Functioning? Located in the front of the brain known as the prefrontal cortex Responsible for higher end processing (hence the name executive) such as : Short term memory Motivation Problem Solving Attention Impulsive control

5 Introduction to Brain Injury and Executive functioning Acquired Brain Injury (ABI) is an injury to the brain which is not hereditary, congenital or degenerative An ABI is an injury to the brain that has occurred after birth. Causes of an ABI include external forces applied to the head and or neck (traumatic brain injury ), anoxic/hypoxic injury (carbon monoxide poisoning, hemorrhage), intracranial surgery, infectious diseases, seizure disorders or toxic exposure.

6 Introduction to Brain Injury and Executive functioning Traumatic Brain Injury (TBI) is an insult to the brain, not of degenerative or congenital nature, caused by an external physical force that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning. It also can result in the disturbance of behavioral or emotional functioning. Causes of TBI can be motor vehicle accidents, falls or drug and alcohol use.

7 Other Diagnosis That Impact Executive Functioning Serious and Persistent Mental Illness diagnosis Including Mood disorders Depression Thought disorders Schizophrenia Learning Disabilities Fetal Alcohol Syndrome Disorder

8 Brain injury symptoms Brain Injury symptoms : Cognitive Changes Emotional Changes And Physical Changes

9 Cognitive Changes Short-term or long-term memory loss Slowed processing of information Impaired judgment Trouble concentrating or paying attention Difficulty keeping up with conversation; trouble finding words Spatial disorientation Difficulty organizing or problem solving Inability to do more than one thing at a time Difficulty with language or speech production

10 Emotional changes Depression, grief over loss of ability, or chemical changes caused by the injury Anxiety, restlessness, agitation Lower tolerance for stress Irritability, frustration, impatience Mood swings Impulsiveness and lack of inhibition Emotional flatness and passivity

11 Physical Changes Seizures Fatigue, increased need for sleep Insomnia Sensory loss or impairment Blurred or double vision Headaches or migraines Trouble with balance and dizziness Decreased motor abilities Sexual dysfunction Muscle control and balance problems Ringing in the ears Hormonal changes

12 Chemical Dependency Treatment for Brain Injured Adults Traditional community programs are cognitive based and may not take into account the cognitive impairments of Brain- Injured clients such as : Diminished emotional regulation Diminished speed of processing, attention, concentration, and mental flexibility Diminished memory function Diminished insight and self monitoring And Diminished impulse control

13 Chemical Dependency Treatment for Brain Injured Adults Adjust expectations towards relapse containment versus abstinence Make group sizes and case managers case loads smaller Adjust group meeting times for a maximum of forty five minutes Avoid confrontation Use motivational strategies Pay attention to learning style Have limits but allow for some flexibility

14 Chemical Dependency Treatment for Brain Injured Adults Use as much experiential learning as possible Adjust individual meeting times to maximize ability. Use a wide array of materials Coach supports in the community on how to communicate with somebody with a brain injury Provide concrete treatment curriculum in a slower paced, repetitive way

15 What is Mindfulness? Mindfulness means paying attention, without judgment, to what is happening right now in our bodies and minds. Paying attention to our bodies and minds without judgment means we notice what it is going on, but we don t decide if it s good or bad, right or wrong

16 What is Mindfulness? To practice means to : Adopt a nonjudgmental stance to our experience Practice patience Loosen our grip on what we know about our experience Trust our thoughts feelings and experience Recognize the urge to get and hold pleasant experience and push away unpleasant experience Experience the qualities of acceptance Let go

17 How did it Become a Wider Accepted Practice in the West? Moved rapidly from the East to the West in the Last sixty-five years According to website Mindfulness Research Sixty Seven research entities participating in research around the benefits of Mindfulness According to the National Institute of Health there are currently 283 clinical trials underway to continue to the study the effects of Mindfulness

18 How is it Helpful? Increased activation of areas of the brain associated with : Executive Decision-Making Self directed Attention Emotional processing and regulation Higher rates of self efficacy Higher rates of perceived quality of life Greater recognition of positive experiences Reduced reactivity JFK Johnson Rehabilitation Institute

19 Rationale for Mindfulness Group Reinforces Experiential Learning Client s with Brain Injuries often cannot remember specific details of a session but can remember how they felt about it. Group fits in well with other services including, exercise program, recreational therapy outings, outdoors activities, art projects and music therapy Offers concrete intervention to minimize impact of mental health symptoms including, low frustration tolerance, anxiety, depression and impulsivity. Consistent with Vinland Center s goal of treating mind body and spirit

20 Research Research study was designed by Gisli Kort Kristofersson with collaboration from the Center for Spirituality and Healing at the University of Minnesota and Vinland Center. The purpose of this pilot study was to examine the effectiveness and impact of an adapted MBSR program on different psychosocial dimensions of persons suffering from a dual diagnosis of Substance Use Disorders and Traumatic Brain Injury(Kort Kristofersson,2012) Specific focus was placed on : Role of adapted Mindfulness on reducing impulsivity Improving quality of life issues Reducing anxiety and depression symptoms

21 Beginning Steps An adapted mindfulness practice curriculum for both the residential chemical health program and the outpatient program was developed Participants in both the Men s program and Women s program meet as a group one time weekly for 45 minute sessions Individual practice opportunities are also available with guided meditations provided on CD with players and headphones One of four modules is presented in group a week with specific goals, information, practice and homework opportunities. Information includes, concepts of mindfulness and descriptions of practice Practice includes guided body scan meditation, guided siting meditation, standing yoga, and lying yoga

22 Ways to Adapt Program for those with Cognitive Deficits When discussing the practice, use closed ended questions. Describe practice in concrete ways Have them experience the effect rather then talk about it Use repetition. Take extra time to summarize previous sessions Keep group sizes small If someone gets stuck on meditation change description to Brain Hygiene

23 Session #1 Goals To introduce the concept of mindfulness as a tool to calm the body and mind To begin to practice mindfulness by focusing one aspect of present moment experience: our bodily sensations. Information Mindfulness means paying attention, without judgment, to what is happening right now in our bodies and minds. Paying attention to our bodies and minds without judgment means we notice what it is going on, but we don t decide if it s good or bad, right or wrong. Mindlessness is the way most of us lead our lives. We are distracted by what is going on externally in our environment or internally by our thoughts about the past or future. We run from one thing to the next, often not noticing what we are experiencing in our bodies and minds. The good news is that we can train our minds to come back, over and over again, to what is going on right now; we can remember to be human beings rather than human doings. When we remember this, we increase our peace of mind and decrease our stress.

24 Session #2 Goals To reinforce the concept of mindfulness To continue the practice of paying attention to the body through mindful movement To expand the practice of mindfulness by focusing attention on breathing that can be used throughout the day to de-stress. Information Last week we learned that mindfulness means paying attention, without judgment, to what is happening right now in our bodies and minds. This helps us notice when we are distracted by things in our environment that carry us away or by thoughts that cause us stress; it helps us stay centered and calm. Building the muscle of mindfulness requires practice, just like weight training. Today we will be continuing that practice. Moving and breathing are two things we do all the time, but they are often under the radar of our busy minds. When we learn how to focus our attention on listening or on breathing, we learn an important tool for reducing our stress. Instead of reacting to stressful things in our environment or to disturbing thoughts in our heads, we can choose to turn our attention to sounds or to our breathing. We can take a breather from the distractions of our lives and rest in the present moment.

25 Session #3 Goals To continue the practice of paying attention to sensations in the body and to the breath. To introduce the concept of the connection between thoughts/bodily sensations/emotions and how they influence one another. Information For the past two weeks we have been strengthening our ability to focus our attention on the present moment and to bring our attention back when it wanders off to thoughts or to things around us. We have been developing the ability to disengage from things that are distracting or upsetting to us and to refocus our attention on what is going on in the moment (breathing, sensations in the body, sound). We may have noticed that our minds are busy thinking all the time and wander away when we are not paying attention. This is normal. Our monkey minds like to hop from one thought to another and don t like staying in one place. Training the monkey mind to stay on one thing gives it some rest and provides some space from which to see what s really going on. One of the things we notice when we practice mindfulness is that our constant thinking gets in the way of seeing the whole picture; we get trapped in old ways of thinking and behave as if we were on automatic pilot. By focusing our attention on the body, the breath, or on sounds, we can stop the train of thought and get off

26 Session #4 Goals To continue and strengthen the practice of mindfulness To understand the concept of how our interpretation of an event affects how we react to it To summarize what can be done when we notice stress in the body or mind Information The practice of mindfulness helps us to calm our minds and bodies and see how our thoughts, emotions, and bodily sensations are connected. By focusing our attention on our breath, our body, or on sounds, we can slow down our monkey minds and come into the present moment. When we slow down and pay attention to what is really happening, we can discover new ways of seeing and responding to problems. We can break out of our more limited or harmful habits and move toward healing and peace.

27 What We Know So Far A mindfulness practice can be adapted to clients suffering from substance use disorders and brain injuries A regular practice of mindfulness offers direct, here and now, feedback on clients own innate ability to calm the body and mind According to study, subjective reporting indicates that practice periods have some positive effects on mood, impulsivity, anxiety and personal relationships of Vinland Center participants(kristoferson, 2012) Using brief 3-5 minute practice sessions before beginning a chemical health group is an experiential way to reinforce the expectation of tolerance and acceptance of self and others

28 Resource List JFK Jhonson Rehabilitation Institute. Mindfulness Meditation. Tasha Mott, Ph.D., Neuropsychologist, Cognitive Rehabilitation Department. PDF file. Retrieved December 8 th, Alternate Therapies in the Treatment of Brain Injury and Neurobehavioral Disorders. A Practical Guide. Gregory J. Murrey, PHD, LO ABPN.2006, The Haworth Press Inc. Chemical Dependency Treatment with Traumatic Brain Injured Clients. Duane A. Reynolds, Gregory J. Murrey P Karol, R. L. (2003) Neuropsychosocial Intervention: The Practical Treatment of Severe Behavioral Dyscontrol After Acquired Brain Injury. Boca Raton, FL: CRC.

29 Resource List Gisli Kort Kristofersson, (2012). The Effects of a Mindfulness Based Intervention on Impulsivity, Symptoms of Depression, Anxiety, Experiences and Quality of Life of Persons Suffering from Substance Use Disorders and Traumatic Brain Injury, A Dissertation Submitted To The Faculty of The University of Minnesota. Received via , October 22, Brain Injury Association of Minnesota

30 Resource List Mindfulness and Acceptance. Expanding the Cognitive-Behavioral Tradition. Edited by Steven C. Hayes, Victoria M. Follette, Marsha M. Linehan The Guilford Press. Page 2. Ayllon, T., Haughton, E. & Hughes, H.B. (1965) Interpretations of symptoms: Fact or Fiction. Behavior And Therapy, 3, 1-7 Mindful Resource guide. National Institue of Health.

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