1. MINDFULNESS and DISTRESS TOLERANCE SKILLS September 28, 2007 Patricia M. McGuire, M.D.

2. Goals and Objectives  Identify the basic tenets of Mindfulness  Identify the triad of Distress Tolerance Skills  Practice skills during the seminar and set future practice goals

3. MINDFULNESS

4. MINDFULNESS  Being in the PRESENT MIND  Being be in control of your own mind  Not letting your mind be in control of you

5. MINDFULNESS is NOT…  Meditation  Relaxation  Spiritual or religious  Calming  A means to stop being “emotional”  A means to being a “good person”

6. “ There are two ways to wash the dishes. The first is to wash the dishes in order to have clean dishes and the second is to wash the dishes to wash the dishes.” Thich Nhat Hanh The Miracle of Mindfulness

7. MINDFULNESS: STATES of MIND Reasonable Mind Emotion Mind WISE MIND

8. MINDFULNESS: Taking Hold of Your Mind  “How” Skills –Non-Judgmentally –One-Mindfully –Effectively  “ What” Skills –Observe –Describe –Participate

9. MINDFULNESS: “How” Skills  NON-JUDGMENTALLY

10. MINDFULNESS: “How” Skills MINDFULNESS: “How” Skills  ONE-MINDFULLY

11. MINDFULNESS: “How” Skills  EFFECTIVELY

12. MINDFULNESS: “What” Skills  OBSERVE

13. MINDFULNESS: “What” Skills  DESCRIBE

14. MINDFULNESS: “What” Skills  PARTICIPATE

15. MINDFULNESS takes -  Practice

16. DISTRESS TOLERANCE SKILLS  Sources of Stress  Crisis Survival Strategies

17. SOURCES of STRESS  Environmental  Social Stressors  Physiological  Thoughts

18. Stress Reactivity  Automatic  Flight vs. Fight  Goal: regain immediate control  Fight: aggression; hostility  Flight: withdrawal into substance abuse, over-work; over-eating

19. Stress Responsiveness  Openness  Allows 100% mental capacity  Taps creativity and imagination  Cognitive set

20. Feeling Thermometer 100 80 60 40 0 20

21. CRISIS SURVIVAL STRATEGIES  Distraction –BEAR IT  Self Soothing –Five Senses  Focused Activity –IMPROVE the moment

22. DISTRACTION  B = Breathing focus  E = Exercise  A = Activity  R = Relaxed muscles  I = Imagery  T = Thought stopping

23. THOUGHT STOPPING

24. SELF SOOTHING  Vision  Hearing  Taste  Smell  Tactile

25. FOCUSED ACTIVITY: IMPROVE the moment  I = Image of a safe or soothing place  M = Mindfulness  P = Prayer  R = Relaxation  O = Out of the situation (time out)  V = Volunteer  E = Encouragement (cheerleading)

26. Practice

27. References  Davis, Martha, McKay, Matthew, Eshelman, Elizabeth.: The Relaxation & Stress Reduction Workbook; New Harbinger Publications; 5th edition, September 2000.  Hanh, Thich Nhat: The Miracle of Mindfulness; Beacon Press; May 1999.  Kabat-Zinn, Jon: Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life; Hyperion; 2005. Kabat-Zinn   Linehan, Marsha: Skills Training Manual for Treating Borderline Personality Disorder; Guilford Press; 1993.

28. QUESTIONS?