Mindfulness and trauma

1. Mindfulness and trauma

2. Mindfulness • Translation of ancient Pali word “sati” - “awareness” • direct, open-hearted “knowing” • Traditionally cultivated by meditation practices • Learning to pay attention • Moment by moment • Intentionally • With curiosity and compassion

3. Overview of MBCT • Eight weekly classes plus all-day session. Each 2 - 2.5 hours. • Pre-class interview • to explain, motivate and point out the commitment that will be necessary • Up to 12 in each class (Kabat-Zinn – 30 in each class) • Homework, up to one hour per day, 6 days a week - mostly audiotapes of mindfulness practice + generalisation practice • Pattern • First half - concentration/steadying the mind • Second half – wider awareness; relapse prevention

4. First outcome trial: results • For patients with only 2 previous episodes (23% of sample) - No effect of MBCT on relapse • For patients with 3 or more previous episodes (77% of sample) - Significant effects • TAU: 66% relapsed in 12 months • MBCT: 37% relapsed in 12 months

5. Teasdale, Segal, Williams et al., 2000, JCCPSurvival Curve (for patients with 3 or more previous episodes - 60 weeks)

6. Does MBCT reduce symptoms for currently depressed & suicidal? (Oxford Varela Pilot Trial: Barnhofer, Crane et al, 2009) • Three or more prior episodes or chronic depression • Currently depressed or residual symptoms • All BDI >20 • All suicidal • Randomly allocated to • MBCT + TAU • TAU alone (n = 14 in each group) • BDI scores

7. Williams et al 2013 • MBCT V Active Control • Dismantling study • Results - equal except for people with recurrent depression based on childhood adversity and/or trauma

8. Relationship between Mindfulness And trauma

11. What is mindfulness and how can it help ? ‘Mindfulness is the awareness that emerges through paying attention in a particular way. . . . - on purpose - in the present moment non-judgementally”. To the unfolding of experience moment by moment’ Jon Kabat-Zinn 2003

12. Mindfulness Embedded within EMDR DBT Sensorimotor ACT ? Can formal mindfulness practice be used

13. Mindfulness-based approaches: to trauma Mindfulness as skill for emotional regulation Small pilot 8 week course for patients attending sexual abuse service – (Jane Dallas Ross, Christine Steverson )

14. Body Scan Meditation: the foundation to the programme Aims: Direct experiential knowing Deliberately engaging and disengaging attention Relating skilfully to mind wandering Allowing things to be as they are Learning how the breath can act as a vehicle Noticing and relating differently to mental states Noticing, acknowledging and returning

15. Two case examples 1. Patient with complex trauma – one year emdr/ sensorimotor approach – and then eight week course 2. trauma following sexual assault – CBT approach and then eight week course

16. Previous research ? MBSR for low income African American women with PTSD –Dutton et al 2010 Mindfulness intervention for child abuse survivors – Kimbrough et al 2010 Mindfulness meditation training combined with EMDR – single case study

17. The Symptoms of Trauma • Persistent re- experiencing – flashbacks • Intense negative response to triggers • Avoidance – stimuli , social • Fragments of memory missing • Disengagement from life • Numbing • Low mood, hyper vigilance, anger, irritability ,

18. The Neurobiology of Trauma

20. How might Mindfulness help • Compassion • Safety • Awareness • (Taking Refuge : Tara Brach )

21. Changes in self compassion

24. Mindfulness training increases ‘viscero-somatic’ processing and uncouples ‘narrative-based’ processing (Farb et al, 07)