1. Mindfulness and Self- Soothing Strategies Sarah Caligiuri, LPC NCC

2. Objectives  Describe the benefits of a living a mindful life for both themselves and their clients  Identify which techniques could be beneficial based on diagnoses  Have a repertoire and understanding of mindfulness exercises to use with a range of settings

3. Mindfulness Activity #1  Setting an intention for this session

4. Definition of Mindfulness  “awareness without judgment of what is, via direct and immediate experience”- Marsha M. Linehan, Ph.D., ABPP  “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” –John Kabat-Zinn

5. Mindfulness…  meditation has had a long history in eastern spiritual traditions  These traditions believe that regular practice decreases suffering and increases insight, awareness, wisdom, compassion, and composure  Mindfulness can be seen as the concepts of these eastern religions without the spiritual belief set.

6. Why Mindfulness?  Why choose mindfulness when we live in a society that values multi-tasking and being busy? ~multi-tasking does not lead to fully attentive work or the best work ~by not being in-tune fully we allow for us to avoid emotions and thoughts ~medical, emotional, and psychological improvements ~allows for making better “balanced” decisions

7. Why Mindfulness?  We all have to deal with pain at some point (and more likely multiple points) in life; life is not pain free ~avoiding pain may lead to more problems ~avoiding pain may lead to acting impulsively by engaging in unhealthy behaviors(i.e. substance use, binge eating, purging, SIB, reckless sex, binge watching Netflix, skipping out on responsibilities, and reckless driving)

8. Mindfulness  Mindfulness is turning TOWARD/TO HAVE rather than AWAY/AVOID from our experience ~clients often do things to avoid how they are feeling ~because we live in a busy society it is easy to not realize the emotions we are experiencing(or put a name to them), or thinking ~mindfulness allows us to live in the here and now

9. Self-Soothing  Something we often think about with babies…however it is a life long skill  The capacity to self-soothe can be defined as the ability to manage and/or regulate affect

10. Self Soothing  We develop a capacity to self-soothe by the internalization of early life comforting and soothing experiences  Horton defines the process of transitional relatedness “as the person’s unique experience of an object whether animate or inanimate, tangible or intangible in a reliable soothing manner based on the object’s association or symbolic connection” to a main/primary presence

11. Self-Soothing  For individuals who struggle with self- soothing they are particularly vulnerable when alone (or perceive they are alone) with intense emotion  Many different diagnoses share a common thread of individuals showing difficulty identifying, expressing verbally, and regulating emotions

12. Mindfulness and Self-Soothing  Mindfulness and self-soothing are two sides of the same coin  If we are mindful we are better able to recognize the emotion, label it, and better activate skills

13. Self-Soothing in DBT  In DBT self-soothing is part of Distress Tolerance Skills specifically under crisis survival skills  Mindfulness skills are the foundation to all skills and especially important to utilizing self-soothing  Self-soothing=self-care  Self-soothing uses 5 senses and movement (think of it as the kinesthetic sense)

14. Distress Tolerance – Self- Soothing  Vision  Hearing  Smell  Taste  Touch  Movement

15. Eliciting Self-soothing Ideas  Ask about what was comforting when they were younger  For music make sure it will help to change the mood  Have them think of ones for different settings (i.e. at school may not be able to have music available)  Make portable self-soothing kits  Teach them to use what is in the environment around them to soothe

16. Mindfulness Activity #2  Self-soothing…

17. Mindfulness for the Practitioner  Engaging in mindfulness as a practitioner has a number of benefits including… ~living what you teach/preach ~the same benefits we see in our clients ~being fully present in our sessions ~helps to make mindful decisions to present to clients and shows being more genuine

18. Mindfulness for the Practitioner  Learning the same techniques as the clients and applying them  We often as practitioner can then better regulate ourselves in sessions  Most mindfulness trainings involve the clinician doing the skills and practicing them as a way to learn to teach them  In DBT encouragement to be mindful in session and between sessions about the client and becomes reinforced when being part of DBT Consultation Team

19. Mindfulness Steps  Set the scene (especially when first explaining)…with 60,000 thoughts a day and the emotions they can produce, it can be easy to understand how our minds become unfocused and cluttered  Tie what the client is already connected to the practice (sell it!!!)  Relate it to how it can help their concerns/problems  Point out times or how the client is already being mindful

20. Mindfulness Steps  Formal vs. informal practice  Become aware of what is arising in us as it is happening  Encourage during practices to enter with a “beginner’s mind”

21. Mindfulness Steps  Normalize… ~the mind will wander…it’s okay! Each time you catch it you are being mindful again ~gently bring it back to what the practice is asking you to be aware of ~accept that there may be a reason your mind is wandering and wisely decide if your attention needs to be there for a moment

22. Mindfulness Steps  Try to avoid judgments (emotions are just that emotions…)  Things will come up as you practice…become comfortable with discomfort  This will feel like effort at first and each time will feel different...we cannot replicate the experience perfectly

23. Mindfulness Activity #3  Breathing exercise

24. How does this translate for teenagers  Buy-in is important…selling this is most important by using previous mentioned ways  Express can help in many areas…for high achievers or teens wanting to do better there are studies showing it helps with concentration, and meditating before tests has shown better scores  It is training for their brains…great videos out there to show how it helps (TED talk by Dan Siegel, Brainstorm: The Power and Purpose of the Teenage Brain)

25. How does this translate to teenagers…  Encourage informal practice and typical settings and experiences  Make it fun…try activities!

26. Mindfulness Activity #4  Teen endorsed activities

27. Diagnostic differences for mindfulness  There has been extensive research done on the benefits for depression, anxiety disorders, ADHD, Borderline Personality Disorder, chronic pain disorders, binge easing disorder, bulimia, psoriasis, type 2 Diabetes, fibromyalgia, rheumatoid arthritis, sleep issues, smoking cessation, substance abuse, and chronic low back pain. It has been shown to help with anger and neural plasticity

28. Diagnostic Differences for Mindfulness  With all the benefits there are things to keep in mind for different diagnoses and individual differences  For clients with traumas, who have a fear of loss of control, and psychosis, closing there eyes maybe particularly uncomfortable and make them feel vulnerable to unwanted memories  For highly anxious clients it can be better to use more of a “grounding” techniques and less abstract

29. Mindfulness Activity #5

30. References Baer, Smith, & Allen, (2004). Assessment of Mindfulness by Self-Report: The Kentucky Inventory of Mindfulness Skills. Assessment, 11(3), 191-206. Burdick, D. (2013). Mindfulness Skills Workbook for Clinicians and Clients. Wisconsin: PESI Publishing and Media. Esplen, M.J. & Garfinkel, P.E. (1998). Guided Imagery Treatment to Promote Self- Soothing in Bulimia Nervosa: A Theoretical Rationale. The Journal of Psychotherapy Practice and Research, 7(2), 102-118. Horton, PC. (1981). Solace: The Missing Dimension in Psychiatry. Chicago: University of Chicago Press. Kabat-Zinn, J. (1994). Wherever you go, there you are. New York: Hyperion. Koerner, K, (2011). Doing Dialectical Behavioral Therapy: A practical Guide. New York: Guilford Press Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. Rathus, J.H. & Miller, A. L. (2015). DBT Skills Manual for Adolescents. New York: Guilford Press.