PSYU2201 Counselling Approaches and Principles Lecture Notes PDF

PSYU2201 Counselling Approaches and Principles LECTURE 6 & 7 - MINDFULNESS AND ACCEPTANCE APPROACHES Acknowledgement of Country Macquarie University acknowledges the traditional custodians of the Macquarie University land, the Wattamattagal clan of the Darug nation, whose cultures and customs have...

PSYU2201 Counselling Approaches and Principles LECTURE 6 & 7 - MINDFULNESS AND ACCEPTANCE APPROACHES Acknowledgement of Country Macquarie University acknowledges the traditional custodians of the Macquarie University land, the Wattamattagal clan of the Darug nation, whose cultures and customs have nurtured, and continue to nurture, this land, since the Dreamtime. I’d like to pay my respects to Elders past, present and future, and particularly to any Indigenous students in this unit. 2 Mindfulness Based Approaches Two key frameworks: 1. Mindfulness Based Cognitive Therapy (MBCT) – Segal, Williams, and Teasdale 2. Acceptance and Commitment Therapy (ACT) – Harris 3 A Definition of Mindfulness Mindfulness means paying attention in a particular way; on purpose; in the present moment and non-judgmentally. Jon Kabat-Zin 4 Exercise • Body Scan 5 Examples of Mindfulness Practice • • • • • • • • • • • • Guided meditations Mindful walking Deep breathing Guided imagery Tuning in with senses Body scan Mindful tasting Mindful colouring Mindful journaling Progressive muscle relaxation Gardening Playing music 6 The Efficacy of Mindfulness • • • • • • • • Helpful in reducing rumination (Chambers et al., 2008) Helpful in reducing stress (Hoffman et al., 2010) Improves working memory (Jha et al., 2010) Enhances focus (Moore and Malinowski, 2009) Reduces emotional reactivity (Ortner et al., 2007) Increases cognitive flexibility (Siegel, 2007a) Increases relationship satisfaction (Barnes et al., 2007) Reduces symptoms associated with a range of diagnoses, such as anxiety, depression, and eating disorders (Didonna, 2009). 7 Mindfulness Based Cognitive Therapy • Developed for the prevention of depressive relapse. • More recently, evidence has emerged for its effectiveness for a range of diagnoses including: ― Biploar Disorder (Perich et al., 2013) ― Generalised Anxiety Disorder (Wong et al., 2016) ― Panic Disorder (Kim et al., 2010) ― Obsessive Compulsive Disorder (Key et al., 2017) ― Sexual Disorders [sexual desire in women (Fruhauf et al., 2013) and provoked vestbulodynia (Brotto et al., 2015)] ― Hypochondriasis (McManus et al., 2012) ― Borderline Personality Disorder (Sachse, 2011) ― ADHD (Gu et al., 2017; Schoenberg et al., 2014) 8 Mindfulness Based Cognitive Therapy • • • Usually run in groups. Typically consists of 8 weekly sessions, 2hrs in length. Consists of various formal and informal meditations, i.e., guided body scans, bringing attention to breathing. • Uses a graded approach where guidance is gradually removed. • Incorporates elements of cognitive therapy and psychoeducation, i.e., learning how to identify early warning thoughts that signify worsening symptoms. • However, the therapeutic stance differs from how traditional cognitive behavioural therapy is conceptualised in that there is little emphasis on changing or altering thought content. Rather, there is a focus on the individuals’ awareness of their relationship to their thoughts and feelings with the aim to enhance meta-cognitive awareness. - (Sipe et al., 2012) 9 Depression and Relapse • Clear evidence that depression is a chronic and relapsing condition. • At least 50% of patients who recover from a single episode will go on to have another episode (Kessler et al., 2003). • Around 60% of patients in Australia who have had one major episode will go on to have further episodes (Shawyer, 2012). 10 What Causes Relapse? • When mood becomes low, depressive thinking kicks in for previously depressed individuals. • Cognitive processing is automatic - thinking runs around well worn “mental grooves” (Segal et al., 2013). Thinking then intensifies mood. • Depressive thinking in both content (i.e., failure/loss) and process (i.e., rumination). - (Teasdale et al., 1995) 11 Aim of Relapse Prevention The aim of relapse prevention is to provide clients with the tools to disengage from these ruminative and self-perpetuating modes of mind which are activated when they feel sad, or at other times when they are exposed to triggers for relapse (Segal et al., 2013). 12 Mindfulness Based Cognitive Therapy (MBCT) for Depression • Aim of MBCT is to help individuals make a radical shift in their relationship to thoughts, feelings, and bodily sensations that contribute to depression. Attempts to cope can make depression worse. • Core skill is the ability to recognise and disengage from mind states characterised by self-perpetuating patterns of ruminative, negative thought. - (Segal et al. 2013; Williams et al., 2007). 13 How it works: A Neurobiological Perspective • When engaged in rumination, people often experience these thoughts as if they were actually happening and thus the amygdala (emotional centre of the brain) registers threat (Sipe et al., 2012). • According to Mayberg (2003) depression is characterised by higher baseline amygdala activity, higher amygdala reactivity to emotional stimuli, and dysfunction between limbic and cortical circuits that regulate affective states (Sipe et al., 2012). • Functional magnetic resonance imaging studies reveal that people who score higher on instruments designed to measure aspects of mindfulness, when compared to lower-scoring people, have lower baseline right amygdala activation and depressive symptoms (Creswell et al., 2010). 14 How it Works: Enhancing the Ability to Deploy Attention • • • • Intentionally deploying attention allows for flexible cognitive and behavioural responses. For those with depression, there is often a disproportionate amount of attention, behaviours, and cognitive resources devoted to resolving or avoiding unwanted thoughts, feelings, and experiences. As people learn to practice metacognitive awareness by labelling thought and feelings as mental events, distress cognition may be perceived as less threatening and less demanding on cognitive resources. Mindfulness training may also improve attentional control and affect regulation by improving working memory, which is a resource in willfully guiding behaviour and overcoming emotionally intrusive thoughts in the setting of cognitive or emotional demands. - (Sipe et al., 2012) 15 How it Works: Two Modes of Action “Doing Mode” (DM) “Being Mode” (BM) 16 The Doing (Driven) Mode • The doing mode is goal driven. • Awareness of the difference between how things are and how you want them to be. • Triggers a negative emotion, characterised by a sense of dissatisfaction. • Sets in motion certain habitual patterns. 17 Habitual Patterns in the Doing Mode • Continuous monitoring and evaluation - reducing the gap between current and ideal states. • Thinking is used to try to resolve the discrepancy – explanations, analysing the past, future pathways. • Mind becomes completely preoccupied and the present moment is given low priority. 18 Doing Mode vs Problem Solving • In the doing mode, thinking is not done intentionally, consciously nor has it been planned. It is an automatic process – a mental habit “in the back of the mind”. • Very different to intentional, structured and contained problem solving/solution focused strategies. 19 The Being Mode • Not motivated towards achieving any goal. • Focus of the being mode is "allowing" and "accepting" whatever comes along (i.e., thoughts). • The "Being Mode" is practicing "non-doing" • You can transform your experience just by the way you pay attention. 20 On Being… • Idea is to intentionally stop all the “doing” and to relax into the present without trying to fill it up with anything. It is about allowing yourself to be in the moment with things exactly as they are, without trying to change anything. • The mind can be dedicated to the processing of the moment by moment experience allowing the individual to be fully present and aware of whatever is. 21 Summary: Doing vs Being • The "doing mode" and the "being mode" are descriptions of two ways in which our mind can function. • Mindfulness teaches/provides us with the means to change mental modes, by choosing what we are going to attend to and how we are going to attend to it. The essential first step is to recognize the “doing state of mind” and then have the ability to switch awareness and attention into the “being state of mind”. 22 Techniques 1 • Rationale: How will MBCT help you? • Psychoeducation. • Mindfulness as a core skill. Involves: ― ― ― ― ― Awareness when the mind goes into rumination. Learning how to exit these cognitive routines. Freeing oneself from the need for things to be different. Ceasing efforts to escape or avoid the unhappiness. Aim is freedom, not happiness/complete calm etc. 23 Techniques 2 • Where in your day will you find time for practice? • Exercises: Raisin Exercise 3-Minute Breathing Space https://insighttimer.com/markwilliams/guidedmeditations/the-3-minute-breathing-space Sitting meditation Walking meditation Working with difficulty meditation Compassion meditation 24 Techniques 3 • Experiential learning is key. Through these exercises clients begin to learn: 1. Concentration/attention 2. Awareness of thoughts/emotions/impulses/body 3. Being in the moment – present 4. Decentering – relating to thoughts, feelings, impulses, body sensations, as passing events rather then getting caught up in them, or seeing them as “reality”. 5. Letting go (using the breath) 6. “Being” rather than “doing”. 7. Attending to the manifestation of the problem in the body. 25 Techniques 4 • Other exercises ― ― ― ― ― ― ― ― Reconnecting with avoided emotions. Gathering the “scattered” mind. Attention to pleasant experiences. Recognising “aversion” Deliberately bringing a difficulty to mind. Dealing skillfully with day-to-day life The exhaustion funnel. Self-care: draining versus energising activities. 26 Acceptance and Commitment Therapy (ACT) • Third wave therapies What is ACT? 27 What is the aim of ACT? The aim of ACT is to create a full and meaningful life while accepting the pain that inevitably goes with it. 28 ACT acronym A = Accept your thoughts and feelings, and be present. C = Choose a valued direction. T = Take action. 29 Core Principles of ACT 30 Contact with the present moment • Conscious awareness of your experience in the present moment allows you to accurately perceive what is happening. • Provides important information about whether to change or persist in behaviour. • Enables full engagement in what you are doing. - Harris (2007) 31 Acceptance “Opening yourself fully to experience, as it is, not as your mind says it is” (Harris, 2007) 32 Acceptance 33 Defusion Looking at your thoughts rather than through them. 34 Defusion • The aim of defusion is NOT to feel better, nor to get rid of unwanted thoughts. • The aim is to: • reduce the influence of unhelpful cognitive processes upon behaviours. • Facilitate being psychologically present and engaged in experience. • To facilitate awareness of language process. • To enhance psychological flexibility. - (Harris, 2007) 35 Self-as-context • A consistent perspective from which to observe and accept all changing experiences. • “pure awareness” - (Harris, 2007) 36 Values “Your heart’s deepest desires for the sort of person you want to be and the things you want to do in your time on this planet; in other words, what you want to stand for in life” (Harris, 2007) Aims to: • Give life meaning • Provide motivation and inspiration • Provide guidance for action • Provide a sense of abundance • Different to goals! - (Harris, 2007) 37 Values Exercise • Your 80th birthday party visualisation 38 Committed Action Values-guided, effective and mindful overt behaviour. 39 Psychological Flexibility Psychological flexibility is the ability to be in the present moment with full awareness and openness to our experience, and to take action guided by our values. Put more simply, it’s the ability to “be present, open up, and do what matters.” 40 References Brotto, L. A., Basson, R., Smith, K. B., Driscoll, M., & Sadownik, L. (2015). Mindfulness, 6, 417–432. Creswell J. D, Way B. M, Eisenberger N. I. (2007). Neural correlates of dispositional mindfulness during affect labeling. Psychosom Med, 69,560-565. Fruhauf, S., Gerger, H., Schmidt, H. M., Munder, T., & Barth, J. (2013). Archives of Sexual Behavior, 42, 915–933. Gu, Y., Xu, G., & Zhu, Y. (2017). Journal of Attention Disorders, 22, 388–399. Harris, R. (2007). Acceptance and Commitment Therapy (ACT) Introductory Handout. Harris, R. (2009). Act Made Simple. New Harbinger Hofmann, S.G., Sawyer, A.T., Witt, A.A., & Oh, D. (2010). The effect of mindfulnessbased therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169-183. Keller M.B. et al. (1992). Time of recovery, chronicity and levels of psychopathology in major depression. Archives of General Psychiatry, 49, 809-816. Kessler R.C. et al. (2005). Prevalence and treatment of mental disorders, 1990-2003. New England Journal of Medicine, 352, 2515-2523. Key, B. L., Rowa, K., Bieling, P., McCabe, R., & Pawluk, E. J. (2017). Clinical Psychology & Psychotherapy, 24, 1109–1120. Kim, B., Lee, S-H., Kim, Y. W., Choi, T. K., Yook, K., Suh, S. Y., Yook, K-H. (2010). Journal of Anxiety Disorders, 24, 590–595. 41 References McManus, F., Surawy, C., Muse, K., Vazquez-Montes, M., & Williams, J. M. G. (2012). Journal of Consulting and Clinical Psychology, 80, 817–828. Piet, J., & Hougarrd, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis. Clinical Psychology Review, 31, 1032-1040. Perich, T., Manicavasagar, V., Mitchell, P. B., Ball, J. R., & Hadzi-Pavlovic, D. (2013). Acta Psychiat Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2013). 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