A New Dawn: Social Work Practice in the Time of Mindfulness and Neuroscience

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1 Social Work Practice in the Time of Mindfulness and PROFESSOR EMERITUS ROB MACFADDEN, UNIVERSITY OF TORONTO A New Dawn: Social Work Practice in the Time of Mindfulness and OASW Annual General Meeting Friday, May 30,

2 Social Work Practice in the Time of Mindfulness and BIO-PSYCHO-SOCIAL The Missing Link For decades social work has committed itself to a biopsychosocial perspective with little evidence of the profession embracing the biological side. With the new knowledge emerging from neuroscience, social work is at a crossroad in adoption of this new paradigm. Advances in imaging and other technologies have opened a vista into the brain to reveal the fundamental components and processes that underlie our thinking, feeling and action. Rosemary Farmer (2009), a social worker, has identified this focus on the brain as the missing link for our profession. 2

3 Social Work Practice in the Time of Mindfulness and MEDITATION For many millennia, people have been practicing forms of meditation that have originated in the East. Although this activity has been slow to be embraced by social work, the 20 th Century has seen meditation travel from the East to the West and be incorporated into hospitals and communities and now clinical practice frameworks. 3

4 Social Work Practice in the Time of Mindfulness and We are a species that requires the most home assembly: brain continues to mature right into the twenties. It changes throughout all of our lifetimes Emotion powers our lives. It is a background and foreground influence. Understanding fear,safety and love is critical to understanding people and for intervention. 4

5 Social Work Practice in the Time of Mindfulness and The brain has developed over millennia and this history influences who we are today. The brain is an archeological record. (Triune Brain by Paul MacLean) In general terms, the brain can be seen in terms of three evolutionary components: The reptilian brain was the first core to develop and is basic life sustaining, controlling key functions such as respiration, circulation, the endocrine system, reproduction, arousal & homeostasis. Much is reflexive and drive based- fear, rage, eating, and mating which still retains a degree of control over our actions. (Brainstem) 5

6 Social Work Practice in the Time of Mindfulness and The paleomammalian brain was added on and brought with it learning, memory and emotion. (Limbic system) The neomammalian brain was a third addition and brought enhanced cognition, enhanced social connection and sense of self and selfawareness. Problem-solving was enhanced and an increased emphasis on social connection enabled us to organize into larger communities, to increasingly plan ahead and to learn more from experience. (Cortex) 6

7 Social Work Practice in the Time of Mindfulness and Louis Cozolino describes psychotherapy in It s a Jungle in There (Psychotherapy Networker 2008 September/October) is like working with an anachronistic menagerie- a human, a horse and a crocodile within the same body. Our skull shares its space with ancient brain equipment and our functioning requires integrating and coordinating these highly specialized and complex systems. These areas of our brain can vie for dominance and experience conflict with each other without us being conscious of this. 7

8 Social Work Practice in the Time of Mindfulness and FLIPPING YOUR LID Dan Siegel s Brain Hand Puppet from Siegel & Hartzell (2003), Parenting from the inside out. P.173 8

9 Social Work Practice in the Time of Mindfulness and Velcro for Negatives: Tilted towards Anxiety and Fear Evolution favours an anxious gene (Aaron Beck). We can be anxious/fearful about anything (e.g., our furniture) Human condition is tilted towards anxiety or fear Different Neuroplastic Properties Hippocampus Etch a sketch-repeatedly Influenced by experience Constantly remodeled cortex Amygdala Keeps a constant dendritic profile-memory Generalizes to as many situations as possible Can make us rigid Therapists are amygdala whisperers: work to build networks of new learnings in hippocampus & prefrontal 9 Empathy, warmth, positive regard creates the nourishing

10 Social Work Practice in the Time of Mindfulness and During fear and stress, Broca s area (speech) inhibited. Yet we need to put feelings into words & narratives to support emotional regulation. Involves integration cognitions and emotions. Broca s area also involved in prediction & anticipation. Impacts good choices & victimization and dissociation. 10

11 Social Work Practice in the Time of Mindfulness and Most Important Discovery in? Neuroplasticity and Neurogenesis 11

12 Social Work Practice in the Time of Mindfulness and Neural Circuitry: We re all electricians. Circuits are being formed, weakened, strengthened, and purged. Experience is like a scalpel. Much happening unconsciously and may be consciously driven. Meditation is an act of circuit building- if you have an awareness of this, then it s a conscious act of circuit building.the ability to control and to direct your attention is essential to well-being. It is the core of emotional regulation. Secret to deliberate circuit building: paying attention. Intentional attention. The ability to connect with, attune to, and help build new neural connections at the heart of psychotherapy. We are all gardeners, helping each other manage and grow our gardens. 12

13 Reacting to Challenges: the Autonomic Nervous System: Stephen Porges & the Polyvagal Theory Excerpted from stephenporges.com Neuroception describes how neural circuits distinguish whether situations Porges believes our nervous system is in a constant quest for safety. 13

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15 The face and voice are significant channels through which safety is communicated to another. Face is the area particularly where presence is communicated to the client (Geller and Greenberg). Faces are information centres along with voice. Over time, the therapist s warm facial connection, receptive posture, open heart and listening presence promotes safety and neural regulation of the client s physiology, strengthening emotional regulation. Therapist s preparation involves cultivating personal presence prior to meeting. This is internal attunement which generates calm and safety within the therapist. Therapeutic presence involves attuning to oneself and one s felt sense of the client. Feeling felt impacts the client s physiology though calming feelings of safety. 15

16 Much of this is also non-verbal. Therapy is not merely the talking cure, but the communication cure. The therapist s whole being functions like a tuning fork, resonating, attuning and feeling empathy. This is highly interactional between the therapist and client. The therapist senses the client and is changed from this feedback. Emotions experienced by the client are being experienced by the therapist and his/her feeling and body state changes. The client senses this change and if there is attunement, the client feels felt which is the sweet spot for change. 16

17 Social Work Practice in the Time of Mindfulness and In mindfulness, Siegel believes the process of following your breath in a certain way and with certain mental filters, leads to the meditator developing a positive, supportive relationship with oneself. This is similar to us being a secure parent to ourselves. We are responsive, accessible and attuned to our behaviour, feelings and perceptions. Therapists talk about creating a supportive, holding environment with clients. Mindfulness is a form of a supportive, holding relationship with ourselves. 17

18 Social Work Practice in the Time of Mindfulness and The social part of the term social worker underscores our profession s recognition of the essential nature of relationships to our existence., similarly, has revealed how fundamental relationships are to our brains, mind and bodies. Human connections help to shape neural connections. As human infants our brains at birth are immature and require considerable home assembly. Relationships essentially sculpt our brains. As a species we are, Wired to Connect (Fishbane, 2007). Louis Cozolino (2010) asserts that there are no single brains and that the brain, besides its genetic component, is a social organ developed through interaction with others. 18

19 Social Work Practice in the Time of Mindfulness and Mirror neurons are neural components designed to pay attention to the behaviours, feelings, intentions of others and to provide this information to our brains. This is a type of social Wi-Fi. When we watch others, the mirror neurons pick up these cues and through the collaboration of other brain components such as the insula, this information flows throughout our body and brain. Aspects of our body resonate with this information and change parts of our own physiology. These changes are sent up the insula and into our prefrontal cortex which perceives these changes as a feeling. Thus, in watching others, we resonate and our bodies change to attune and to reflect these states in others. We are able to feel empathy for the other. The mirror neuron system in others sense the change in our bodily states and resonates with these changes and the other feels felt by us. 19

20 Social Work Practice in the Time of Mindfulness and Therapeutic relationships are viewed as forms of attachment relationships which create the conditions for optimal change. Interpersonal relationships involve biochemical changes which result in many things including new neural connections and learning. This new perspective views social workers as physical change agents involved in stimulating new neural connections. 20

21 MINDFULNESS Social work has become interested in the positive benefits of Mindfulness Meditation and neuroscience is identifying how Mindfulness Meditation has an impact on strengthening aspects of the brain, leading to improved well-being. Definition: Non-judgmental attention to experiences in the present moment (Kabat-Zinn, 1990). Involves attention on the experience of thoughts, body sensations, emotions and observing them as they arise and go away. Two central components: (1 ) regulation of attention to keep it on the immediate experience; (2) approaching experiences with curiosity, openness, and acceptance, regardless of whether they are positive or negative. 21

22 MINDFULNESS Mindfulness fosters an adaptive, flexible orientation to emotional experiences Building acceptance of emotions Openness to experience of emotions- don t have to be surpressed Non-judgmental, reduces guilt, shame Experience emotion in the moment without intense behavioural reactivity Decentered nature: thoughts are thoughts, feelings are feelings, emotions are emotions, physical sensations are sensations THEY ARE NOT YOU 22

23 MINDFULNESS In a meta-analysis of the effects of Mindfulness on the brain, Holzel et al., (2011) identify several brain areas impacted by meditation practices. These include the anterior cingulate cortex, the insula, the dorsal prefrontal cortex, the ventro-medial pre-frontal cortex, the hippocampus and the cingulate cortex. Strengthening these brain components promote the following changes: attention-regulation; body awareness; emotion regulation; change in the perspective on the self (e.g., more positive self-concept and self-esteem, stronger acceptance of self) and increased self-compassion. 23

24 MINDFULNESS Beneficial effects of Mindfulness Meditation found for: Improved immune functioning (Carlson et al., 2007; Davidson et al., 2003) Reduced blood pressure & cortisol level (Carson et al., 2007) Depression (Hoffmann et al., 2010; Teasdale et al., 2000) Chronic pain (Grossman et al., 2007) Anxiety (Hoffman et al., 2010; Roemer et al., 2008) Substance abuse (Bowen et al., 2006) Eating disorders (Tapper et al., 2009) Psychological well-being in healthy participants (Carmody & Baer, 2008; Chiesa & Serretti, 2009) Cognitive Functioning (Jha et al., 2007; Ortner et al., 2007; Pagnoni & Cekie, 2007) 24

25 MINDFULNESS In the doing mode for much of our lives. Doing mode is resistant, active, problem-solving, pushing away: negative feelings/cravings. Can lead to dissatisfaction, self-criticism, futility When we suppress feelings, thoughts events, they can come back more intensely and frequently 25

26 MINDFULNESS Being mode not goal-oriented, observational, deep contact with the present Sleepwalking through life. We enter reality with expectations that distort what we are experiencing in the moment. Early memories, for instance, colour the way we see things and people. It sets up a distorted lens which uses expectations to contort present realities. Mindfulness fosters an intentional awareness that creates a paradoxical disidentification from the contents of one s own conscious mind while gently allowing a non-judgmental, full experience of the present moment. 26

27 Positive Emotions: Hanson and Happiness. Inner strengths include character virtues such as generosity, modesty, patience, and also secure attachment, executive self-regulation, distress tolerance, resilience, plus mindfulness, compassion and loving-kindness and positive emotions. These are related to happiness. Have to activate inner states first, then install them. Fostering states until they become traits is the secret. Negative states can quickly become negative neural traits. Most positive states are wasted because they are too short-term. Need to transfer short term states from short-term memory buffers to long term storage or no lasting value. 27

28 H-E-A-L PROCESS Have- you have the positive experience notice one or create one Enrich. Increase duration, intensity, multimodality (bring into body, sit up proudly), Novelty heightens learning and increase personal relevance. Absorb. Visualize it sinking in, sense it, build it. Link. (optional). Hold positive feelings or thoughts or memories in awareness and introduce some painful thoughts, feelings, etc. (natural antidote). 28

29 The positive material will gradually associate with the negative material, soothing, easing and eventually replacing it. Have more episodes over the day, even 30 seconds at a time, half dozen times a day. Dozen or so seconds each time. Will turn activated states into traits eventually. It is startling to realize how unwilling the mind is to give the gift to oneself of a positive experience (Hanson). 29

30 Let us be grateful to people who make us happy. They are the charming gardeners who make our souls blossom. Marcel Proust 30

31 The Time of Mindfulness & Challenges us to understand neurobiology & provides a common language and understanding across professions. Offers clients an understanding of how their brains can impact their perceptions, beliefs, behaviours and feelings. It can NORMALIZE problems. & mindfulness focus on inner realities that also have an important impact on outer realities such as relationships. Integrate well together. can explain why meditation can have such important impacts on factors such as emotion regulation, empathy, attention, anxiety and response flexibility. 31

32 The Time of Mindfulness & Increased understanding and focus on the well-being of the practitioner, on the ability to be self-aware, to be centred and present ( therapeutic presence ) with the client. Highlights the salience of the tuning-fork notion of the clientworker relationship. Mindfulness meditation can help to improve balance, self-awareness, emotional and body awareness and emotional regulation of both the worker and the client. Short breaks of mindfulness practice by the worker between sessions can help the worker to become more centred and possibly more present with the client. Some evidence exists that shows that a short mindfulness break between sessions is related to enhanced effectiveness of the session as perceived by the client. 32

33 The Time of Mindfulness & Increased emphasis on: emotions, experience and the relevance of unconscious, automatic processing fundamental right brain to right brain communication- e.g., eye gaze, prosody, non-verbals emotion regulation, both self and co-regulation neural integration where the parts are working well and also connecting with each other (Dan Siegel) 33

34 References Applegate, J., & Shapiro, J. (2005). Neurobiology for clinical social work: Theory and practice. NY: W.W. Norton & Company. Cozolino, Louis (2010). The neuroscience of psychotherapy: Healing the social brain. Second Edition. NY: W.W. Norton & Company. Damasio, A. (2001). Interviewed in the video, produced by David Grubin, Secret Life of the Brain. NY: Public Broadcasting System. Farmer, Rosemary (2009). and social work practice. Thousand Oaks, CA: Sage. Hanson, R., Mendius, R. (2009). Buddha s brain. Oakland, CA: New HarbingerPublications. 34

35 Holzel, B., Lazar, S., Gard, T., Schuman-Olivier, Z., Vago, D., Ott, U.(2011). How does Mindfulness Meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science 6 (6), MacFadden, R. (2011). Hypnosis and social work practice: Incorporating new perspectives from. In Turner, Frank. Social Work Treatment. Fifth Edition, Chapter 17, MacFadden, R., Schoech, D. (2010). and professional decisionmaking: Implications for ICT. Journal of Technology in Human Services, 28:4, Saleebey, Dennis (1992). Biology's challenge to Social Work: Embodying the personin-environment. Social Work, 37(2),

36 Schore, Allan (2012). The Science of the Art of Psychotherapy. NY: W. W. Norton & Company. Schore, Allan (2003). Affect regulation and the repair of the self. NY: W. W. Norton & Company. Seligman, Martin (2011). Flourish. NY: The Free Press. Siegel, Daniel J. (2010). The mindful therapist: A clinician s guide to mindsight and neural integration. NY: W. W. Norton & Company. See also robertmacfadden.com for a range of related resources from documents to webinars. 36