The Recovery Center: Wellness into Action in Mental Health Services

• Foundations of the Recovery Center include:– Psychiatric Rehabilitation-

focus on functional skill and Support development as it relates to whole health.

– Adult Education: Utilize universal design teaching modalities to engage adult learners to shift attitudes, gain knowledge, skills and supports.

• Cross Walk services with Readiness to change theory to DEVELOP Readiness to change:

offer courses at contemplation, preparation and action levels.Primary Values:

Personhood, Choice,Self-determination, Hope

NO ORDINARY DOOR

This might look like an ordinary door, but it is the door to the B.U. Recovery Center. The Center helped open and maintain my road to recovery. The many skills I have learned and been coached on at the Recovery Center are computer knowledge, communication skills, nutrition, and most importantly self-respect and confidence. The center deals with the whole person not just the mental illness. The support I receive here has been a critical aspect in my recovery process. I am leading my life because I walked through this door.

Wellness Classes at Recovery Center

• Yoga• Tai chi• Chi Gung• Stress Hardiness• Supported Physical

Activity• Nutrition and Cooking• Reiki• Walking groups• Mindful Eating• Meditation• Outdoor Adventures

Wellness Interventions

• All interventions offered in group sessions• All manualized to some degree• Many peer led• Classes offered on a semester basis at university-

based center• Take advantage of normalized setting of university for

some classes• Participants report liking the non-stigmatizing setting

of a university rather than a mental health clinic

Conceptual, Research and Practical Issues of a Mindfulness Approach to Eating Well

• Research suggests that many individuals with severe mental illness have significant health risks in part due to poor diet and obesity

• Mindful eating is an approach to overeating as well as other eating disorders

Rationale

• Dieting /commercial weight loss programs are not an enduring approach to eating well. They entail a disengagement from the use of internal cues of hunger and satiety.

• People with mental health conditions often have food related diseases, as well as eating habits that are triggered by stress, poverty and negative emotions.

Mindful Eating, Mindful Life• Mindfulness techniques

reduce stress, alleviate health problems.

• Mindful eating helps people recognize differences between emotional and physical hunger and introduces a “moment of choice” between the urge and eating.

• NIH studies of mindful eating for treatment of eating disorders.– (Harvard Health Letter, 2011)

Conceptual, Research and Practical Issues

• Mindfulness skills teach people to observe feelings, behaviors and experiences, to disengage non- healthy reactivity, and to develop more balanced relationships with their selves, with their bodies and with food.

• Making choices about food is an ever present part of daily life that has enormous health consequences for all people.

• Because Mindfulness eating engenders awareness of WHY one eats, it is a helpful skill to lose weight and acts against MINDLESS eating.

Research and Practice• Prevalence of obesity in

persons with mental illnesses has been reported to be as high as 55% (De Hert, et. al, 2009)

• Significant medical consequences of obesity –type II diabetes, dyslipidemias, metabolic syndrome and hypertension. All these factors contribute to the nearly double risk of dying from cardiovascular disease.

• SES, smoking, medications are contributing factors.

• Modifying dietary behaviors through mindfulness hold promise as a health intervention as well as a generalized skill to promote stress resiliency and wellness.(Framson, et. al, 2009) .

• Mindfulness is a learned skill that is linked in the research to many positive health outcomes (Brown, et. al, 2009; Framson, et al, 2009 Kabat-Zinn, et. al, 1992)

Process

• Class focused on attitudes, knowledge, skills and supports.

• 12 weeks; 2 (1.5) hr sessions/week.

• Students encouraged to bring own food for the lunch based class.

Teaching/Facilitator Process• Review• Orientation

– Bell exercise– Breath exercise– Use of hunger scale– Recite a meal time

contemplations– Silent eating with music

• Skills Training– Multimodal activities– UDL principles employed

PRACTICE HOMEWORK

Tapes for Students to bring home

Curriculum Topics• Training the mind to be present

and focused on eating.• Eating Mindfully: Using a hunger

scale.• Applying Moderation: Avoiding

Extremes.• Distinguishing Emotional from

Physical Hunger.• Applying Strategies to overcome

emotional hunger.• Developing Stress Hardiness and

Patience with Old Eating Habits.• Practicing Self-Acceptance, Self-

Compassion, and Self-Forgiveness

• Building Optimism.• Developing Gratitude for the

Food We Eat.• Practicing Generosity through

Sharing of Food with one Another.

• Choosing Health and Recovery –Promoting Foods.

• Increasing Personal Awareness.• Increasing Environmental

Awareness.• Planning, Creating Shopping Lists

and Preparing Meals.

Demographic SummarySample Size

18 studentsAge

MeanSD

Gender N %Male 10 55.6%Female 8 44.4%

Race N %White 16 88.9%Asian 1 5.6%Black 1 5.6%

50.7 years13.7 years

Primary Psychiatric Diagnosis

28%

28%

39%

6%

Schizoprenia or Schizoaffec-tive Disorder

Bipolar Disorder

Major Depressive Disorder

Other

Medical Conditions

• 12 of 18 students (66.7%) reported having a medical condition• Most common medical conditions:

Clinica

l Obesit

y

Diabetes

Hyperte

nsion

Epilepsy

Arrhyth

mia

Asthma

Benign Brain Tumor

Cardiova

scular D

isease

Crohn's D

isease

Hypoth

yroidism

Narcolepsy

0

1

2

3

4

5

Num

ber o

f Stu

dent

s

Mindful Eating Questionnaire

• Five Subscales related to mindfulness:– Awareness– Distraction– Disinhibition– Emotional Response– External Cues

• Higher scores indicate student progress

Mindful Eating Questionnaire: Mean Scores Before and After

*Indicates p-values <0.05

Three Factor Eating Questionnaire

• Three Factors: – Cognitive Restraint– Uncontrolled Eating– Emotional Eating

• Cognitive Restraint: Higher scores indicate student progress

• Uncontrolled Eating and Emotional Eating: Lower scores indicate student progress

Three-Factor Eating Questionnaire Cognitive Restraint: Mean Scores Before and After

Before After 0.00

0.50

1.00

1.50

2.00

2.50

3.00

2.19

2.56

p-value <0.05

Three-Factor Eating Questionnaire Mean Scores Before and After

• Uncontrolled Eating • Emotional Eating

Before After0.00

0.50

1.00

1.50

2.00

2.50

3.00

2.412.05

Before After0.00

0.50

1.00

1.50

2.00

2.50

3.002.90

2.39

p-values <0.05 for both

Future Hopeful Directions

• Scaling Up: Manualizing the curriculum; Implementing a larger study with broader investigation on health related factors.

• dorih@bu.edu