Meditation and Mindfulness-Based Treatment Approaches

Transcription

1 Meditation and Mindfulness-Based Treatment Approaches Sarah Bowen, PhD Assistant Professor Dept. of Psychiatry and Behavioral Sciences University of Washington

2 What is Mindfulness? A systematic development of attention to present moment experience with an attitude of acceptance and nonjudging (Bishop et al., 2004; Kabat- Zinn, 1994)

3 What is Mindfulness? A systematic development of attention to present moment experience with an attitude of acceptance and nonjudging (Bishop et al., 2004; Kabat- Zinn, 1994)

4 Mindfulness and Relapse Prevention Direct Experience (sensation, thought, feeling tone ) pain Relationship (Reactions, stories, judgment) suffering Automatic Past/Future Judgment/Nonacceptance Attention, Present, Nonjudging

5 Practicing Mindfulness (Present Moment) (Attention) Mind on chosen target (Nonjudgment) Notice wandering, begin again Attention Wanders

6 Mindfulness: Modern History 500 B.C. Spanned countries / cultures for thousands of years (Hinduism, Christianity, Islam, Buddhism) 19 th century Came to the West via practitioners immigrating to U.S. from Asia 1960s 70s Vipassana popularized by psychotherapists and Western teachers (Goldstein 1976; Goldstein and Kornfield, 1987) 1990s present Third wave integrates mindfulness into CBT

7 Mindfulness-Based Treatment Psychological and medical benefits Depression (Teasdale et al., 1995 Ma & Teasdale, 2004; Bondolfi et al., 2010; Kuyken et al., 2008; Segal et al., 2010) Anxiety (Koszycki et al., 2007) Fibromyalgia (Sephton et al., 2007) Cancer (Monti et al., 2006; Hebert et al., xx; Speca et al., 2000; Foley et al, 2010) HIV (Creswell et al, 2009) Back pain (Morone et al., 2008) Rheumatoid arthritis (Pradhan et al., 2007) Multiple sclerosis (Grossman et al, 2004; 2010) Med and premed student stress (Shapiro et al., 1998) Binge eating (Kristeller & Hallet, 1999) Addiction (Brewer et al., 2009; Bowen et al., 2006; 2009; 2010; Zgierska et al., 2009; Vieten et al., 2009)

8 Mindfulness-Based Interventions Formal Meditation Practice Home practice 6 out of 7 days, minutes Interventions Mindfulness-Based Stress Reduction (MBSR) (Kabat-Zinn, 1986; 1992) Mindfulness-Based Cognitive Therapy (MBCT) (Segal, Teasdale & Williams, 2000) Mindfulness-Based Relapse Prevention (MBRP) (Bowen, Chawla, & Marlatt, 2009)

9 Mindfulness-Based Stress Reduction (MBSR) Developed for management of chronic pain and illness Jon Kabat-Zinn, Ph.D. and colleagues, studies: Significant effects in chronic pain, stress, cancer, psoriasis, anxiety and depression (Grossman, Niemann, Schmidt & Walach, 2003)

10 Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale 2002) Prevent relapse to major depression Awareness Change Recognize cognitive patterns in mild sadness Moods remain mild and transient vs. escalate to severe affective states

11 essential to understanding how the mind behaves and how thoughts and expectations can either facilitate or reduce the occurrence of addictive behavior. Marlatt, G. A. (2002). Cognitive and Behavioral Practice, 9(1), pp

12 Behavioral Model of Relapse Vulnerabilities, Predispositional Factors Temporary alleviation Trigger Discomfort, Dissatisfaction Craving Substance Use Relapse Cycle

13 Mindfulness and Substance Use Attention: Direct observation of the mind Awareness of triggers and responses Interrupt previously automatic behavior Present moment: Acknowledge/attend to present experience Acceptance and Nonjudgment: Accept the unchangeable; defuse from attributions and thoughts that often lead to relapse

14 Dismantling and Bringing Curiosity Thought Sensation CRAVING Emotion Craving Use Curiosity Urge to React Underlying Needs

15 Urge Surfing Intensity Time Staying with discomfort as it grows, Using breath to stay steady, Trusting it will naturally subside

16 Meditation in Jail Minimum security jail Substance use charges 10-day Vipassana ( Insight ) meditation Led by appointed teachers Noble Silence ~ 10 hours per day of practice Focus on attachment vs. substance use Funded by National Institute of Alcohol and Alcoholism; PI: G. Alan Marlatt

17 Outcomes N = % men Age 37 61% Caucasian 13% African American 8% Latino/a 8% Native American 3% Alaskan Native 2% Asian/PI 5% multiethnic or other Nonrandomized (No BL differences on key demographic or outcome variables) 3-Month follow-up Substance Use Marijuana, Crack cocaine, Alcohol, Negative consequences Psychosocial Outcomes Psychiatric symptoms (depression, anxiety, hostility) Optimism (Bowen et al., 2006; 2007)

18 Mindfulness-Based Relapse Prevention Relapse Prevention Mindfulness-Based Cognitive Therapy For Depression Strategies and practices from several sources Integrates mindfulness meditation and cognitive therapy Clients have completed initial treatment 8-week outpatient group treatment 2-hour weekly sessions Mindfulness-Based Stress Reduction EACH SESSION Formal meditation practice Informal mindfulness practice Cognitive Behavioral skills

19 Eating a Raisin: Shifting out of Autopilot Routine Activities: Continuous attention, natural reinforcement Body Scan: Body awareness, Flexibility of Attention Breath, Thought, Emotion Meditation Awareness of processes Urge Surfing: Relating to Discomfort Kindness, Forgiveness: Shame, Self-Efficacy

20 Inquiry: Practice through Dialogue Pain Affective in left knee, Restlessness discomfort Direct Experience (sensation, thought, feeling tone) pain I can t handle this. I I can t need meditate a drink. (craving) Relationship (Reactions, stories, judgment) suffering

21 Familiarity with Individual Patterns

22 Progressive Awareness Training Thoughts, emotions, and their nature Compassionate and skillful responding Awareness and freedom External, tangible Body sensations Pause in midst of difficulty, curiosity, what is really needed?

23 MBRP Pilot Study N = 168 Completed Inpatient or Intensive Outpatient MBRP Baseline 8 weeks TAU Post Course 2 mos. 4 mos (12-step, Psychoeducation, Process/Support) Funded by National Institute on Drug Abuse Grant R21 DAO A1; PI: Marlatt

24 Participants Age 41; 64% male 50% Caucasian 28% African American 15% Multiracial 7% Native American 72% completed high-school 41% unemployed 33% public assistance 62% less than $4,999 / year Homeless/unstably housed 45% alcohol 36% cocaine/crack 14% methamphetamines 7% opiates/heroin 5% marijuana 2% other

25 Results: Feasibility Attendance 65% of sessions (M = 5.18, SD = 2.41) Formal Practice 4.74 days/week (SD = 4.0) minutes/day (SD =19.5) (Bowen et al., 2009)

26 Results: Main Effects Across 4-month follow-up, significant differences between groups: Mindful awareness (p =.01) Acceptance (p =.05) Craving (p =.02) Substance Use at 2 months (p =.02) Significant mediating effect of craving (Bowen et al., 2009)

27 Results: Depression and Craving Craving Total sample Depression Substance Use Significant mediating effect of craving Craving MBRP Depression Non- Significant Substance Use (Witkiewitz & Bowen, 2010)

28 SB Randomized Trial N = 286 For whom? How? MBRP Baseline RP Post 2m 4m 6m 12m TAU 8 weeks (12-step, Psychoeducation, Process/Support) Funded by National Institute on Drug Abuse Grant

29 Slide 28 SB2 pic Sarah Bowen, 11/20/2013

30 Participants Age 40.6 (11.69) 75% male 65% Caucasian 31% African American 10% Latino/a 15% Multiracial 2% Native American 92% high-school or GED 71% unemployed 59% less than $4,999 / year Primary Substance Meth 10% Heroin 12% Marijuana 11% Other 10% Crack 11% Alcohol 46% 82% polysubstance (Bowen et al., in press)

31 Days of Use over Time (Bowen et al., in press)

32 Primary Outcomes Delay to use, Lower likelihood of use, Fewer days of use MBRP & RP (vs TAU) Delay to first use Fewer days of use at 6 months MBRP (vs RP & TAU) Day of drug use at 12 months Likelihood of any heavy drinking

33 Limitations Attrition Differences between TAU and active treatment groups, (e.g., therapist training, assignment of homework) RP and MBRP interventions matched on time, structure and therapist training Primary treatment outcome measures self-report, with limited urinalysis data Self-reported substance use and urinalysis are often not significantly different (e.g., Jain 2004; Digiusto et al., 1996) Continued aftercare low base rates of use at follow up

34 Adaptations Adult correctional system with Det. Kim Bogucki Seattle Police Department, WA Seattle Police Foundation, WA Juvenile justice system with Dr. Kevin King Greenhill Juvenile Corrections School, WA University of Washington, Seattle WA Tobacco Cessation with Isabel Weiss, Dr. Elisa Kozasa Universidade Federal de São Paulo, Brazil

35 Client Experiences I paused and watched my breath The urges and thoughts would keep poking their heads up, but they got quieter and just weren t as big of a deal... I sat until I didn t feel like I had to act on these thoughts and feelings. Finally, I saw the situation clearly; I could make a different choice. I am now able to regularly surf those kinds of [triggering] situations, not just with drinking but any other discomfort or unpleasant states. [I have] more patience with myself, compassion. Ways to get me back into what is happening and get out of my head.

36 Acknowledgments Investigators: G. Alan Marlatt Katie Witkiewitz Mary Larimer Seema Clifasefi University of Washington Consultants: Zindel Segal Jon Kabat-Zinn Research Team: Neha Chawla Joel Grow Sharon Hsu Susan Collins Erin Harrop Haley Douglas Kathy Lustyk Sara Hoang