An Experiential Introduction to
Mindfulness and MAKE A LINK Communication Skills in Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS), a Group Treatment for Adolescents with Complex Trauma
Mandy Habib, Psy.D. Adolescent Trauma Treatment Development Center North Shore-Long Island Jewish Health System, Manhasset, New York
[email protected]
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Presentation Goals • Introduction & overview of SPARCS & core components • Practice some core skills • Review mindfulness research • Questions and Comments
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Department of Health and Human Services • Mission: To enhance trauma focused services available to traumatized children & adolescents • Build a multidisciplinary collaborative network across the country – Implement & evaluate treatments – Develop resources for mental health providers & general public – Develop trauma-focused trainings
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SPARCS: Structured Psychotherapy for Adolescents Responding to Chronic Stress A Trauma-Focused Guide Ruth DeRosa, Mandy Habib, David Pelcovitz, Jill Rathus, Jill Sonnenklar, Julian Ford, Suzanne Sunday, Christopher Layne, William Saltzman, Copyright © 2009© byVictor North Shore-Long Island Jewish HealthNew System, Great Neck, New York. Ayme Turnbull, Labruna, &Inc.,Sandra Kaplan Habib & Labruna, Neck, York. Copyright Copyright © 2008 by 2011 NorthbyShore-Long Island Great Jewish Health System, Inc., Great Neck, New York.
SPARCS Collaborations • Outpatient Clinics: – – – – – – – – – – – – – – – – – –
Children’s Advocacy Services of Greater St. Louis, St. Louis, MO STARS Community Services, San Leandro, CA Starview Community Services, Long Beach, CA Children’s Institute Incorporated, Los Angeles, CA The Village Family Services, North Hollywood, CA Los Angeles Gay and Lesbian Center, Los Angeles, CA Victor Family Intervention and Community Support, Marysville, CA Child & Adolescent Support, Advocacy & Resource Center, San Francisco, CA Department of Children & Family Services, Chicago & Evansville, IL Catholic Charities, Jackson, MI Open Arms, Inc., Albany, GA New York Foundling, NYC, NY Adolescent Medicine Clinic, New Hyde Park, NY Kennedy Krieger Family Center, Baltimore, MD Mental Health Center of Dane County, Madison, WI Neuropsychiatric Research Institute, Fargo, ND Dakota Children’s Advocacy Center, Bismark, ND Rape & Abuse Crisis Center of Fargo-Moorehead, Fargo, ND
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SPARCS Collaborations • Residential, Day Treatment, Group Home, & Shelters – – – – – – – – – – – – – –
Chaddock, Quincy, IL Andrus Children’s Center, Yonkers, NY Madonna Heights RTC & RTF, Dix Hills, NY Dane County Group Home, Madison, WI St. Mary’s Group Home, Boston, MA Casa Pacifica, Camarillo, CA Covenant House, Hollywood, CA Rebekah Children’s Services, Gilroy, CA Los Angeles Youth Network, Los Angeles, CA Victor Children’s Services, San Bernadino, CA Children’s Hospital Los Angeles, Los Angeles, CA David and Margaret Youth and Family Services, LaVerne, CA Victor Treatment Centers, Regional Youth Services, Victor, CA Adolescent Substance Abuse Program, North Shore LIJ, Glen Cove, NY
• School-based – – – – – – –
Safe Horizon, NYC St. Vincent’s, NYC Teenage Parenting Program, Seaford, NY Star View Adolescent Center, Torrance, CA Center for Child and Family Health, Durham, NC International Institute of New Jersey, Jersey City, NJ University of North Dakota INPSYDE Program, Grand Forks, ND
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“Still in the Middle of the Hurricane”
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Adaptations to Complex Trauma Problems with
Regulation of Affect & Impulses Cognitive Functioning/ Dissociation Somatization Sense of Self Relationships Systems of Meaning Copyright © 2011 by Habib & Labruna, Great Neck, New York.
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SPARCS:
DBT
Overview
16 session treatment guide (60 minutes per session)
Strength-based - Identifying adaptive coping strategies
Present-focused - No systematic exposure component included - How the trauma impacts their lives now - Increase capacity for present-oriented thinking & behavior
Focus on developmental tasks unique to adolescence
Copyright © 2011 by Habib & Labruna, Great Neck, New York.
Target
UCLA Trauma/ Grief
SPARCS:
DBT
Group Members
Adolescents 12-21 years old
History of chronic interpersonal trauma
Living with significant ongoing stressors
May or may never have met full criteria for PTSD
Exhibit functional impairment
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Target
UCLA Trauma/ Grief
Core Skills & Key Concepts • Mindfulness = cultivating awareness
• Distress Tolerance = coping more effectively in the moment • MAKE A LINK = communication & connecting with others • Let ‘M Go = problem-solving and creating meaning • MUPS = ways of coping that mess you up Copyright © 2011 by Habib & Labruna, Great Neck, New York.
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Woven Throughout the Treatment
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Paying attention in a particular way: On purpose, in the present moment, and nonjudgmentally Kabat-Zinn, 1994
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The quality or state of being mindful ….of being Attentive Heedful Thoughtful Earnest Intentional Adapted from the Oxford Dictionary
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Mindfulness: States of Mind
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Linehan, 1993
Role Play
Linehan, 1993
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“What” skills: Observe Describe Participate
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“How” skills: Without Judgment Stay Focused Do What Works Copyright © 2011 by Habib & Labruna, New York.Inc., Great Neck, New York. Copyright © 2007 by North Shore-Long IslandGreat JewishNeck, Health System,
Observing Describing Participating Linehan, 1993
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Observing • Just notice the experience • Watch the sensations, thoughts, feelings, urges come and go • Having a “Teflon Mind” Linehan, 1993
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Describing • Use words for the experience • Labeling • Just the facts Linehan, 1993
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Fully Participate • Becoming “one” with the activity • Being spontaneous • Without self-consciousness Linehan, 1993
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Mindful at the Beach
• If inviting… • If cold… • Fully participate
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Don’t Judge Stay Focused Do What Works Linehan, 1993
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“Metacognitive Awareness” They hypothesize that the mechanism of change is not simply changing the negative content or belief system, but rather, metacognitive awareness changes one’s relationship to negative thoughts. It changes the way that the negative thoughts are experienced. Negative thoughts and feelings “are experienced as mental events, rather than as the self.” Teasdale et al., 2002
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• It’s not just WHAT you’re thinking but HOW you’re experiencing it. • What you’re thinking is separate from who you are. (negative thoughts “are experienced as mental events, rather than as the self.” Teasdale et. al., 2002)
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Mindfulness Practice: Eating mindfully
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Mindfulness Practice: Observe Your Breath Observe Describe Participate
Without Judgment Stay Focused Do What works
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Mindfulness Practice:
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Mindfulness Practice: Observe the Urge
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Mindfulness Practice: some examples
• Blowing Bubbles
• Eating Mindfully
• Guess What it is
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Wise Mind & Mindfulness: Why practice mindfulness…? • Regulation of Affect and Impulses • Somatization • Attention • Self-perception • Rated most helpful
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Mindfulness Research Mindfulness practice associated with: •
Changes in brain function
•
Improved physical health
•
Improvements in psychological well-being
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Mindfulness Practice: Changes in Brain Function •
Mindfulness Practice “can produce increases in relative left-sided anterior activation that are associated with reductions in anxiety and negative affect and increases in positive affect” (Davidson, et al., 2003) –
•
Still evident 4 months later
Activates the neural structures involved in attention and arousal/autonomic control” of the nervous system (Lazar et al., 2000) Copyright © 2011 by Habib & Labruna, Great Neck, New York.
Mindfulness Practice: Changes in Brain Function Monks & Mindfulness (Lebow, 2005): • “Monks’ brain waves were better organized and coordinated”
• Higher activity in left prefrontal cortex = associated with happiness • Differences apparent during periods of non-meditation =
fundamental changes in how the brain operates • Magnitude of differences related to length of practice Copyright © 2011 by Habib & Labruna, Great Neck, New York.
Mindfulness Practice: Improved Physical Health • Increased flu antibodies following 8 weeks of mindfulness (Davidson 2003) • Improvements in symptoms related to numerous medical conditions – Chronic pain
(Kabat-Zinn 1982, 1987; Randolph et al. 1999)
– Fibroymyalgia
(Goldenberg et. al. 1994)
– Psoriasis (Kabat-Zinn, et. al. 1998)
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Mindfulness Practice:
Improvements in Psychological Well Being • Rated as most helpful by teens diagnosed with BPD (Miller et al., 2000)
• Improvements in general mood and decrease in stress (Baer, 2003)
• Decrease in anxiety
(Baer, 2003)
• Decreased rate of relapse and recurrence of MDD (Baer, 2003)*
• Findings evident in many populations Copyright © 2011 by Habib & Labruna, Great Neck, New York.
Mindfulness Practice: Improvements in Psychological Well Being Mindfulness with prison populations • 10 day mindfulness course vs. treatment as usual • Fewer arrests, alcoholism, drug use (Bowen et al. 2006)
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Mindfulness Research • Changes occurred after relatively short periods of intense practice • Changes often maintained for long periods
(Baer, 2003)
–
e.g. cancer patients - maintained at 6 months
–
e.g. patients with anxiety disorders - maintained at 3 years
• Research in its infancy • Meta-analysis: effect size = .74 (i.e. 74% did better than tau or no treatment)
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Being Mindful Daily • How can you (and your clients)…. –Let go of distractions –Do one thing at a time –Let go of judgments –Notice your reactions (without judging) –Let your reactions pass- don’t hold on, don’t push away –Label your thoughts and feelings (they are things, not who you are)
• How do you already do this?
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Mindfulness Practice:
Mindfully Ignoring
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Mindfulness Practice:
Mindfully Ignoring
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MAKE A LINK
Copyright © 2011 by Habib & Labruna, New York.Inc., Great Neck, New York. Copyright © 2007 by North Shore-Long IslandGreat JewishNeck, Health System,
MAKE a LINK •
Communication Skills
•
Based upon Interpersonal Effectiveness skills taught in DBT (Dialectical Behavior Therapy)
• •
When? Why? – Get what you want or say “no” to a request – Keep the relationship – Keep your self-respect Copyright © 2011 by Habib & Labruna, Great Neck, New York.
How NOT to be interpersonally effective
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In order to get what you want and need, you must “MAKE A LINK” or connection with the other person (be) Mindful Act confident Keep a calm & gentle manner Express interest
Ask for what you want Let them know you get their point of view Include your feelings Negotiate—give to get Keep your self respect
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Skill Card
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Ball Count
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It’s easy to miss something you’re not looking for.
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Questions & Comments Copyright © 2009© by2011 North Island Jewish HealthNew System, Copyright byShore-Long Habib & Labruna, Great Neck, York.Inc., Great Neck, New York.
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[email protected]
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