EMDR & Mindfulness Interventions for Anxiety, Depression, Panic, Trauma, and Other Disorders

Trauma & MindfulnessEffective Interventions for Healing & Resilience

Jamie Marich, Ph.D., LPCC-S, LICDC-CSFounder & Director, Mindful Ohio@jamiemarich@dancingmindful

About Your PresenterLicensed Supervising Professional Clinical Counselor (MH)Licensed Independent Chemical Dependency CounselorAuthor, EMDR Made Simple (2011), Trauma and the Twelve Steps (2012), Trauma Made Simple (2014), & Dancing Mindfulness (2015)Fourteen years of experience working in social services and counseling; includes three years of experience in civilian humanitarian aid in Bosnia-HercegovinaSpecialist in addictions, trauma, abuse, dissociative disorders, performance enhancement, grief/loss, and pastoral counseling Trained in several specialty interventions for trauma, most notably EMDR TherapyCreator of the Dancing Mindfulness practice What led you to this conference?

ObjectivesSummarize how mindfulness is relevant for clinical mental health and recovery settings. Describe how mindfulness practice helps to heal the brain of someone affected by traumatic stress. Explain the impact of trauma on human behavior from a variety of perspectives (e.g., person centered, psychological/diagnostic). Develop a comprehensive trauma-informed treatment plan incorporating mindfulness- informed interventions. Instruct clients in 5-10 mindfulness-informed clinical strategies, especially those focusing on trauma stabilization. Demonstrate how mindful practices can positively impact clinician efficacy.

MindfulnessMindfulnessMindfulnessMindfulnessEnglish term mindfulness first coined in 1881Comes from the Sanskrit word smriti meaning awareness, specifically, coming back to awareness

Which implies? MindfulnessPaying attention in a particular way: on purpose, in the presence of the moment, and non-judgmentally; as if your life depended on it (Kabat-Zinn, 2003/2005/2011) The self-regulation of attention to the conscious awareness of ones immediate experiences while adopting an attitude of curiosity, openness, and acceptance (Bishop, Lau, Shapiro et al., 2004) Mindfulness (van der Kolk, 2014)Mindfulness: Being able to hover calmly and objectively over our thoughts, feelings, and emotions and then take our to time to respond.This process allows the executive brain to inhibit, organize, and modulate the hardwired automatic reactions preprogrammed into the emotional brain.

MindfulnessIn 2012 alone, over 500 peer-reviewed studies on mindfulness in clinical work published and this number continues to multiply

For complete research summaries, good resources include:

Mindfulness Research GuideMindfulness Research Monthlywww.mindfulexperience.orgwww.mindfulexperience.org

An Introduction to Classic Mindfulness Practices

Skill 1: Practicing Awareness

Video ResourceTo review all of the skills covered today, please visit the following free resource:

www.traumamadesimple.com/videos

Skill 2:Belly BreathingSkill 3: Clench & Release

Mindfulness: Reviews & Meta-AnalysesMindfulness brings about various psychological effects, including increased subjective well-being, reduced psychological symptoms, and reduced emotional reactivity (Keng, Smoski, & Robbins, 2011).

Mindfulness based interventions are effective treatments for a variety of psychological problems, especially in reducing anxiety, depression, and stress, at very least on par with cognitive and behavioral interventions (Khoury, Lecomte, Fortin, et al., 2013).

Examples of Formal Mindfulness-Based InterventionsMindfulness-Based Stress Reduction (MBSR)Mindfulness-Based Relapse Prevention Therapy (MBRP)Dialectical Behavioral Therapy (DBT)Mindfulness-Based Cognitive Therapy (MBCT) Acceptance and Commitment Therapy (ACT)

Seven Primary AttitudesNon-judgingPatience Beginners MindTrustNon-strivingAcceptanceLetting go

Other Potential AttitudesFriendlinessGratitudeGentlenessCuriosityNon-attachmentNon-reactivityHappinessCreativityAttunementPersistence ConfidenceWillingness

Discussion QuestionsWhat is the impact of the mainstreaming of mindfulness on mental health, specifically as it relates to trauma?

Is mindfulness a religion? On the other side of that debate, is modern-day mindfulness too watered down?

What are the most trauma-informed ways to use mindfulness-based interventions?

Can certain mindfulness practices actually be contraindicated for trauma and grieving?

Ram Dass (Richard Alpert, Ph.D.)

BREAK TIMESkill 4: Body Scan

Trauma

Etymological OriginTrauma comes from the Greek word meaning wound

What do we know about physical wounds and how they heal?

DSM-5 Nutshell Definition of PTSD(Post-Traumatic Stress Disorder ) (American Psychiatric Association, 2013)Exposure to actual or threatened a) death, b) serious injury, or c) sexual violation: direct experiencing, witnessing (Criterion A)Intrusion symptoms (Criterion B) Avoidance of stimuli associated with the trauma (Criterion C)Cognitions and Mood: negative alterations (Criterion D)Arousal and reactivity symptoms (Criterion E) Duration of symptoms longer than 1 monthFunctional impairment due to disturbances

Mindfulness is often described as the practice of responding to instead of reacting to stress.Mindfulness (van der Kolk, 2014)Mindfulness: Being able to hover calmly and objectively over our thoughts, feelings, and emotions and then take our to time to respond.This process allows the executive brain to inhibit, organize, and modulate the hardwired automatic reactions preprogrammed into the emotional brain.

Mindfulness (van der Kolk, 2014)Traumatized people are often afraid of feelingmindfulness practices can help orient them to and ease them into this process by widening sensory experiencePracticing mindfulness is calming to the sympathetic nervous system, lessening the destruction of fight/flight responsesThe practices help to promote distress tolerance as awareness develops that emotional states constantly shift

Trauma: small-tAdverse life experiences (Shapiro, 2014)Not necessarily life threatening, but definitely life-alteringExamples include grief/loss, divorce, verbal abuse/bullying, and just about everything elseThe trauma itself is not the problem, its whether or not the trauma has been able to heal/process adaptively that leads to problems If it was traumatic to the person, then its traumatic.According to the adaptive information processing model, little t trauma can be just as valid and as clinically significant as Big T trauma.

An EMDR Clients Perspective: Lily Burana (2009)PTSD means, in talking over beer terms, that youve got some crossed wires in your brain due to the traumatic event. The overload of stress makes your panic button touchier than most peoples, so certain things trigger a stress reaction- or more candidly- an over-reaction. Sometimes, the panic button gets stuck altogether and youre in a state of constant alert, buzzing and twitchy and aggressive.

An EMDR Clients Perspective: Lily Burana (2009)Your amygdala- the instinctive flight, fight, or freeze part of your brain- reacts to a trigger before your rational mind can deter it. You can tell yourself, its okay, but your wily brain is already ten steps ahead of the game, registering danger and sounding the alarm. So you might say once again, in a calm, reasoned cognitive-behavioral-therapy kind of way, Brain, its okay

An EMDR Clients Perspective: Lily Burana (2009)But your brain yells back, Bullshit kid, how dumb do you think I am? Im not falling for that one again. By then, youre hiding in the closet, hiding in a bottle, and/or hiding from life, crying, raging, or ignoring the phone and watching the counter on the answering machine go up, up, up, and up. You cant relax, and you cant concentrate because the demons are still pulling at your strings.

An EMDR Clients Perspective: Lily Burana (2009)The long-range result is that the peace of mind you deserve in the present is held hostage by the terror of your past.

Mindfulness & The BrainDisorganized memory structure may be one process that impedes access to, and modification of, trauma-related cognitive schema (Harvey & Bryant, 1989). Mindfulness can calm a clients inner experience and promote greater introspection (Porges, 2011; see also van der Kolk, 2014)

Mindfulness & The BrainPlays a key role in activating the pre-frontal cortex and promoting a greater sense of concentration (Graham, 2013)Structured mindfulness practice can cause positive structural changes in the brain related to learning and memory (hippocampus) and can cause a thinning in the amgydala, lessening the charge of fear-based responses (Chiesa, Brambilla, & Seretti, 2010; Kabat-Zinn, 2011)

Mindfulness & The BrainMindfulness meditation practices lead to decreases in ruminative thinking (Ramel, Golden, Carmona, & McQuaid, 2004)Alter the neural expression of sadness (Farb, Anderson, Mayberg, et al, 2011) Positively impact working memory capacity and affective experience (Jha, Stanley, Kiyonaga, et al., 2010).

Mindfulness & The Brain

Skill 5: Body Cuing

The Role of Somatic Awareness in Reprocessing Therapies

Discussion QuestionsWhat is the impact of the mainstreaming of mindfulness on mental health, specifically as it relates to trauma?

Is mindfulness a religion? On the other side of that debate, is modern-day mindfulness too watered down?

What are the most trauma-informed ways to use mindfulness-based interventions?

Can certain mindfulness practices actually be contraindicated for trauma and grieving?

Recommendations

Please Return by 1:00pm

General Consensus Model of Trauma Treatment PHASE I: Stabilization

PHASE II: Processing of Trauma

PHASE III: Reintegration

General Consensus Model of Trauma Treatment ISTSS 2012 (Cloitre, et al., 2012) Expert Panel Recommendations state that, regardless of specific modality, this general framework should be followed in treating traumaAlso recommend that Eastern and creative-inspired approaches continue to be explored and implemented into trauma work

Ways to Promote Mindful StabilizationMuscle relaxationBreath work Pressure Points/TappingYoga, Exercise & Movement Imagery/Multisensory Soothing Anything that incorporates the body in a positive, adaptive way!!!

Skill 6: Walking Meditation

Walking Meditation:An Avenue for Bilateral Engagement

Clench & Release:Bilateral Variations

Similarities to Bilateral Forms of Native American Healing Ritual

Skill 7: Butterfly Hug or Monkey Tap (for Stabilization)

Resource Tapping & Mindfulness

Skill 8: Energetic Massage

The 5 Senses & MindfulnessVisualSoundSmellTouch/TactileTaste

Skill 9: Mindful Eating

BREAK TIME

Skill 10: Ujjayi Breathing (Ocean Breathing)Mindfulness & Self CarePromoting mindfulness in psychotherapists-in-training could positively influence the therapeutic course and treatment results in patients (randomized, double-blind controlled study; Grepmair, Mitterlehner, Loew, et al, 2007) Health care professionals participating in a mindfulness-based stress reduction program (MBSR) were able to more fully identify their own themes of perfectionism, the automaticity of other focus, and their tendencies to always enter fixer mode; this recognition led to numerous changes along personal and professional domains (grounded theory; Irving, Park-Saltzman, Fitzpatrick, et al., 2014); a similar study that exclusively studied nurses yielded similar findings (Frisvold, Lindquist, McAlpine, 2012)

Mindfulness & Self CareIn an extensive mixed methods research study with working psychotherapists from a variety of theoretical backgrounds, Keane (2013) concluded that personal mindfulness practice can enhance key therapist abilities (e.g., attention) and qualities (e.g., empathy) that have a positive influence on therapeutic training. Mindfulness practice could provide a useful adjunct to psychotherapy training and be an important resource in the continuing professional development of therapists across modalities.

BodyfulnessCoined by Christine Caldwell (2014) of Naropa UniversityIncludes practices like yoga, somatic processes, Qi Gong, dance, and other practices that add another dimension to the practice of mindfulness by more fully encouraging awareness of the body Developed in response to existing biases against these practices being legitimate meditation and mindfulness avenues Skill 11: Mindful Movements

Final DiscussionIssues with implementation/administrationIssues with client appropriateness and safe implementationIssues with developing your own mindful safe care plan and modeling a mindful life for clients

ReferencesBishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D.,,Carmody, J., & Devins, G. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11, 230241.Caldwell, C. (2014). Mindfulness and bodyfulness: A new paradigm. The Journal of Contemplative Inquiry, 1(1), 77-96. Chiesa, A., Brambilla, P., & Serretti, A. (2010). Functional neural correlates of mindfulness meditations in comparison with psychotherapy, pharmacology, and placebo effect. Is there a link? Acta Neuropsychiatrica, 22, 104-117.Cloitre, M., Courtois, C. A., Ford, J. D., Green, B. L., Alexander, P., Briere, J., Herman, J. L., Lanius, R., Stolbach, B. C., Spinazzola, J., Van der Kolk, B. A., Van der Hart, O. (2012). The ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults. . Retrieved from http://www.istss.org/AM/Template.cfm?Section=ISTSS_Complex_PTSD_Treatment_Guidelines&Template=/CM/ContentDisplay.cfm&ContentID=5185Farb, N., Anderson, A., Mayberg, H., Bean, J., McKeon, D., & Segal, Z. (2010). Emotion, 1, 25-33.Frisvold, M. H., Lindquist, R., & McAlpine, C. P. (2012). Living life in balance at midlife: Lessons learned from mindfulness. Western Journal of Nursing Research, 34, 265-278.Grepmair, L., Mitterlehner, F., Loew, T., Bachler, E., Rother, W., & Nickel, M. (2007). Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: A randomized, double-blind controlled study. Psychotherapy and Psychosomatics, 76, 332-338. Harvey, A. G., & Bryant, R. A. (1989). A qualitative investigation of the organization of traumatic memories. British Journal of Clinical Psychology, 38(4), 401-405.

ReferencesIrving, J.A., Park-Saltzman, J., Fitzpatrick, M., Dobkin, P.L., Chen, A., & Hutchinson, T. (2014). Experiences of health care professionals enrolled in mindfulness-based medical practice: A grounded theory model. Mindfulness, 5, 60-71. Jha, A. P, Stanley, E., Kiyonaga, A., Wong, L., & Gelfand, L. (2010). Examining the protective effects of mindfulness training on working memory capacity and affective experience. Emotion, 10(1), 54-64. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156. Kabat-Zinn, J. (2005). Wherever you go, there you are. (10th anniversary edition). New York: Hyperion.Kabat-Zinn, J. (2011). Mindfulness for beginners: Reclaiming the present moment - and your life. Boulder, CO: Sounds True Books.Keane, A. (2013). The influence of therapist mindfulness practice on psychotherapeutic work: A mixed-methods study. Mindfulness. DOI: 10.1007/s12671-013-0223-9.Keng, S., Smoski, M., & Robins, C. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31, 1041-1056. Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleu, M., Paquin, K., & Hofman, S. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33, 763-771. Marich, J. (2013). Creative mindfulness: 20+ interventions for wellness and recovery. Warren, OH: Mindful Ohio.

ReferencesRamel, W., Golden, P., Carmona, P., & McQuaid, J. (2004). The effects of mindfulness meditation on cognitive processes and affect in patients with past depression. Cognitive Therapy and Research, 28(4), 433-455. Shapiro, F. (2014). The Role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: Addressing the psychological and physical symptoms stemming from adverse life experiences. Permanente Journal, 18(1), 71-77.Shonin, E., van Gordon, W.V., & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioural Addictions, 2, 63-71. Siegel, D. (2007). The mindful brain. New York: W. W. Norton & Co. Van Der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, Viking.

To contact todays presenter:

Jamie Marich, Ph.D., LPCC-S, LICDC-CSMindful Ohio

jamie@jamiemarich.comwww.mindfulohio.comwww.jamiemarich.comwww.dancingmindfulness.com www.TraumaTwelve.com www.TraumaMadeSimple.com