Connecting Mind, Body & Soul: Mindfulness and Yoga for Recovery

2. Connecting Mind, Body & Soul: Mindfulness and Yoga for Recovery Crys Rivers and Paul Savery

3. What’s Coming Up • ‘Recovery Oriented System of Care’ • CBT/Third wave • Meditation/Mindfulness • Yoga/Trauma sensitive yoga • Mindfulness practice • Real world implementation • Q&A

4. Recovery Oriented System of Care • Recovery (the healthy state) not addiction (the pathological state) is the organizing principle • Emphasis on resilience and recovery processes as opposed to pathology and disease processes Recovery goals: 1. Reduction and/or elimination of symptoms 2. Improving internal wellness, health and quality of life 3. (Re)joining and (re)building a life in the community Some key elements of ROSC: • value and support the many pathways to recovery • services that are multi dimensional and integrated • services designed to respond to chronic conditions

5. Cognitive Behavioral Therapy • The cognitive aspect is the part where the client learns new methods and ways to change old thinking patterns and habits. • The hallmark of CBT is an intense focus on thought processes and belief systems. • The overall goals of the approach are to help people identify problematic beliefs and thought patterns, which are often irrational or unrealistic, and replace them with a more rational and realistic views.

6. Cognitive Behavioral Therapy Clients learn how to relax their body. Muscle tension and shallow breathing are both linked to stress and anxiety (and sometimes depression). CBT techniques include slowing down, focusing on the “here and now” and relaxation

7. Third wave Mindfulness-based interventions that have the best empirical support: • Mindfulness-Based Relapse Prevention (MBRP) • Mindfulness Based Stress Reduction (MBSR), 3. Mindfulness Cognitive Behavioral Therapy (MCBT), 4. Acceptance and Commitment Therapy (ACT) 5. Dialectical and Behavioral Therapy (DBT)

8. Mindfulness-Based Relapse Prevention MBRP curriculum integrates mindfulness meditation practices with cognitive-behavioral strategies to support clients and promote vital lifestyle modifications for a healthy life of recovery. MBRP teaches effective skills to reduce stress, manage urges and cravings, and cultivate compassion and acceptance.

9. Mindfulness-Based Relapse Prevention • Dr. G. Alan Marlatt is the founder and director of the Addictive Behaviors Research Center at the University of Washington, where he developed MBRT • Leading practitioner of CBT • Dr Marlatt was given the Innovators in Combating Substance Abuse Award by the Robert Wood Johnson Foundation in 2001, and in 2004 he received the Distinguished Researcher Award from the Research Society on Alcoholism.

11. Meditation “Suppose you read about a pill that you could take once a day to reduce anxiety and increase your contentment. Would you take it? Suppose further that the pill has a great number of side effects, all of them good: increased self esteem, empathy and trust: it even improves memory. Suppose ,finally, that the pill is all natural and costs nothing. Now would you take it? The pill exists. It is meditation.” Happiness Hypotheses - Jonathon Haidt, 2005

12. Mindfulness • In other types of meditation, practitioners seek to transcend or “lose” themselves. • The goal of mindfulness meditation is different • “An intentional focused awareness – a way of paying attention on purpose to the present moment, non judgementally.” Kabat -Zinn

13. Mindfulness Mindfulness practices used by MBSR, MBCT, MBRP. • Body scan meditations - low scan of entire body • Mindful movement - mindfulness awareness of body during yoga • Sitting meditation - mindfulness of breath, body, feelings, thoughts and emotions • Walking meditation-mindfulness in action • Loving kindness/Compassion practices • Mindful eating

14. Mindfulness Immediate effects • Lowers heart rate • Lowers blood pressure • Activates the soothing relaxation response (parasympathetic nervous system) • Settles fight and flight stress response (sympathetic nervous system) • Activates sensory awareness and control of attention

15. Mindfulness Long term effects: • Dampens reactivity to stress • Increases positive emotions • Enhanced neural integration and self regulation including increased insight and self awareness, modulation of fear, enhanced empathetic resonance,greater response reflexivity for pausing before acting.

16. Mindfulness “Meditation is a practice of psychological weightlifting” Regular practice has 3 immediate consequences: 1.Increased discipline 2. Increased commitment to ones own self care 3. Regularization of one’s lifestyle Michael McGee,MD ,2008

17. Mindfulness Practitioners find a comfortable position, close their eyes and focus first on breathing, passively observing it. Let the mind settle into the rhythm of breathing. If their mind wanders (a stray thought or emotion), gently redirect attention to the breath. Relax and take note of body sensations, sounds and moods. Notice them without judgment. The aim is to achieve focused awareness on what is happening moment to moment.

18. Mindfulness In 2008 The National Institutes of Health was financing more than 50 studies testing mindfulness techniques, up from 3 in 2000, to help relieve stress, soothe addictive cravings, improve attention, lift despair and reduce hot flashes. Lotus Therapy by Benedict Carey,New York Times,2008

20. Yoga • “Meditation in motion” Other well-known forms of motion-Meditation are Tai Chi, Qi Gong, • Yoga integrates both movement and meditation, “the co- existence between stillness and dynamism” • “To fully experience yoga……requires a shift in consciousness, an awareness that is in the absence of all judgements, in the absence of the turbulent commenting mind and instead being in the presence of the witness. In the presence of a silenced and peaceful mind. This is meditation.” Julie Gargano www.pranahouse.com.au Prana House 2007

21. Yoga Yoga’s function as a stress reliever is not in dispute. “Yoga and meditation do several things, and perhaps one of the most important is that they allow individuals to cope with stress better….At the core of a lot of addiction is a search for that kind of relief from the stressful world.” Sat Bir Khalsa,MD, an assistant professor of medicine at Harvard Medical School who studies the medical effects of yoga

22. Trauma Sensitive Yoga • Grounding physical practice • Breath Awareness and Self-Regulation • Mindful choices • Take effective action with positive consequences • Notice that postures have a natural beginning and end • Community building

23. Suggestions for Yoga Programs • Close collaboration between clinicians and yoga therapists • Strong screening/ intake process • Address potential triggers in: • Environment • Teacher attire & qualities • Language • Postures/ Exercises • Assists/ Adjustments • Gather student and clinician feedback, continue to refine the program

24. LET US PRACTICE

26. Integrative Restoration (iRest) The Integrative Restoration Institute (IRI) employs Integrative Restoration (iRest) which is a form of deep relaxation, self-inquiry and meditation. • iRest is currently being used by members of the Armed Forces as a way of understanding, coping with, and most importantly, healing the hidden wounds that confront active duty soldiers and veterans on a daily basis. • Research has shown iRest effectively reduces PTSD, depression, anxiety, insomnia, chronic pain, and chemical dependency, as well as increases well-being

28. Mind Body Awareness Project • Supported by $1,000,000 Robert Wood Johnson Foundation grant • Santa Cruz, CA • Providing mindfulness based interventions for rehabilitation of incarcerated youth and youth on probation • Model …..“off the charts” • In 2010, MBA formed a partnership with The National Council on Crime & Delinquency and Colorado State University with the goal of conducting some of the first longitudinal research on the effects of mindfulness-based programming on at-risk, violence-prone youth.

30. “The Dhamma Brothers” • Donaldson Correctional Facility (maximum-security) in Bessemer Alabama • 1,500 prisoners, participated in extended Vipassana retreat, an emotionally and physically demanding program of silent meditation lasting 10 days and requiring 100 hours of meditation. • “Vipassana is what all the other treatment programs arehoping for. It actually works, and has a demonstrable effecton the inmates and a positive effect on the staff.”Dr. Ron Cavanaugh, Director of Treatment for the Alabama Department of Correction

32. Trauma Center’s Yoga Program • Trauma Center at JRI in Boston, MA • Founded by Dr. Bessel van der Kolk • Provides clinical services to traumatized children, adults and their families • Research program • Yoga program • Offered in the same facilities as the clinical care • At risk youth at school locations • Veterans at both community centers and on military bases, such as Camp Lejeune

33. Developing Your Own Program • Use existing pilot programs as a model • Practical Approach: • find an instructor who: • is certified and skillful (at least 1,000 teaching hours) • has trauma competent yoga and mindfulness training (or relevant training) • collaboration between yoga teacher and clinical staff to produce a suitable therapeutic structure . . . • equipment needed is relatively inexpensive: mats, Mexican blankets, foam blocks • optional equipment includes eye pillows and bolsters

34. Questions ?

35. Contact Information Crys Rivers JD, E-RYT 919-357-8006 crys@groovyyogi.com Paul Savery 919-715-2774 paul.savery@dhhs.nc.gov

36. Why has it taken so long? • We are only just reaching a stage of “assimilative integration” in the evolving relationship between meditative and Western psychological practices • While mindfulness and clinical psychology can be seen to share similar goals, the two practices have, until recently, remained segregated • There was, “a prolonged period of mutual ignorance in which each tradition remained blissfully or willfully ignorant of the other” (Walsh and Shapiro (2006)

37. Why has it taken so long? 1. Most western clinicians are unfamiliar with the various meditative traditions. Western clinicians are not experienced meditators. 2. Difficulty in integrating meditation into a coherent Western mental health framework 3. Mental health field has traditionally served individuals who have an illness which impairs their life. In contrast Eastern spiritual traditions are vehicles for enhancing mental health and even attaining enlightenment (“ultimate mental health”) 4. Western culture now demands personal meaning and self fulfillment