How to Apply Mindfulness Relapse PreventionAbout This Series: Core Topics for Behavioral Health Providers Presenter Topic Date Dr. Will Spaulding Schizophrenia- Part 1 and Part 2 October

BHECN webinar series

How to Apply Mindfulness-Based Relapse Prevention

December 5, 2017

Dr. Dennis McChargue

Associate Professor of Psychology, UNL

About This Series: Core Topics for Behavioral Health Providers

Presenter Topic Date

Dr. Will Spaulding Schizophrenia- Part 1 and Part 2 October 19th

Dr. Mario Scalora Forensic Issues and Civil Commitment November 9th

Dr. Dennis McChargue How to Apply Mindfulness-Based

Relapse Prevention

December 5th

Dr. Amanda Duffy Randall & Liam

Heerten-Rodriguez

Basics of Sexual Health January 15th

Dr. Amanda Duffy Randall & Liam

Heerten-Rodriguez

Working with Sexual Challenges Feb 15th

Dr. Amanda Duffy Randall & Liam

Heerten-Rodriguez

Older Adult Sexualities March 15th

Dr. Amanda Duffy Randall & Liam

Heerten-Rodriguez

LGBQ Sexualities April 19th

Dr. Amanda Duffy Randall & Liam

Heerten-Rodriguez

Working with Trans Clients throughout

the Lifespan

TBD

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Dr. Dennis McChargue

Dr. McChargue is an Associate Professor of

Psychology at the University of Nebraska-

Lincoln. Dr. McChargue’s expertise focuses

in primary and secondary prevention of

substance use disorders and the treatment

of co-occurring mental health and

substance use disorders. He has published

over 69 articles and edited two books. He

also has more than 20 years in training

substance use relapse prevention skills.

How to Apply

Mindfulness Relapse

Prevention

Dennis E. McChargue, PhD

•There are no financial arrangements with myself and the publishers of the mindfulness-based relapse prevention.

Financial Disclosure

•Efficacy Evidence

•Relapse Prevention Assumptions

•Mindfulness Assumptions

•Applications to Relapse Prevention with Examples

•Body Scan

•Urge Surfing

•SOBER

•Cognitive Diffusion

•Q&A

Today’s Training

6 & 12 Month Outcomes:

•Relapse2

•Better than TAU, but similar to RP

•Use Days and Reduced Heavy Drinking2,7

•Better than RP and TAU

•Efficacious with Diverse Populations1

•Efficacious for Severe SUD2

•Efficacious for those with Co-Occurring Depression & Anxiety Sxs2

Efficacy Evidence

RELAPSE PREVENTION ASSUMPTIONS

TriggerInitial Reaction:

Thoughts, Sensations and/or Emotions Urges

BelieveThoughts

React (ReLapse)

More Thoughts

Relapse Cycle

AUTOPILOT

Key Assumptions of MBRP

Reaction

Reaction

Reaction(judgment, story)

Direct Experience

INQUIRY PROCESS

BRING AWARENESS TO “DIRECT” EXPERIENCE

REDUCE REACTIVITY TO JUDGMENTS/STORIES

REDUCE MALADAPTIVE REACTIONS

MIND Process

Mindfulness Targets for Skill Building

triggerInitial Reaction:

Thoughts, Sensations and/or

Emotions Urges

BelieveThought

s

React (ReLapse)

More Thoughts

Relapse Cycle

AUTOPILOT

Riding Out Urge

Response

TurningOff

Not ReactingPenberthy et al., (2015)

Mindfulness Targets for Skill Building

Witkiewitz et al., 2014

•TRAINING MINDFULNESS VIA BODY SCAN

BODY SCAN (15-45MIN)

•Investigation of the moment-to-moment experiences of the body.

•Methodologically bringing attention to body

•Begins with left foot •Ends at the top of the head

•Create audiotape to facilitate practice

•Many notice many physical sensations (e.g., itches)

•Do in a relaxing environment without distraction

•Lie down unless you get sleepy, then sit https://www.mindful.org/mindfulness-meditation-guided-practices/?utm_source=Mindful+Newsletter&utm_campaign=119539e6ee-Weekly_Wakeup_May_16_20165_12_2016&utm_medium=email&utm_term=0_6d03e8c02c-119539e6ee-21920849#bodyscan

Body Scan Options:

Benefits of Mindfulness

•Dissociates you reaction from your experience

•Brings awareness of cognitive errors

•Eventually reduces cognitive errors influence on your emotional and behavioral reactions

•Reduces Emotional Response to stressful situations.

Practice Logs

Practice What was the situation?

What did you notice before?

What did you notice after?

What did you learn?

Emotions:

Thoughts:

Sensations:Urges?

•Key themes to reinforce in all exercises•Accept that…

•unwanted thoughts, feelings and sensations happen

•Being present is foundation to true self-care•Seeing…

•Thoughts as thoughts

•Don’t judge, just notice your having them.•Step out of auto pilot and guide your life

Therapist Note:

URGE SURFING

trigger

Initial Reaction:Thoughts,

Sensations and/or Emotions Urges

BelieveThoughts

React (ReLapse)

More Thoughts

Relapse Cycle

AUTOPILOT

Riding Out Urge Response

•Explore underlying reason for urge

•Don’t react to it

•Imagine challenging situation, but not most challenging

•PAUSE, OBSERVE (thoughts, feelings and bodily sensations)

•Bring similar approach to other mindfulness practice

•Approach with gentle, nonjudgmental curiosity

•Surf metaphor

•Stay present with the intensity of craving w/out reacting or becoming subsumed.

•Picture as an ocean wave and imagine wave of craving

•Breath the surfboard to ride wave

•Ride throughout the peak and decline

Urge Surfing

SOBER

triggerInitial Reaction:

Thoughts, Sensations and/or Emotions Urges

BelieveThoughts

React (ReLapse)

More Thoughts

Relapse Cycle

AUTOPILOT

TurningOff

SOBER

triggerInitial Reaction:

Thoughts, Sensations and/or Emotions Urges

BelieveThoughts

React (ReLapse)

More Thoughts

Relapse Cycle

AUTOPILOT

TurningOff

Observe reactions

BreatheExpand

Awareness

Respond Mindfully

SOBER Example

Cognitive Diffusion (Observing Thoughts as Thoughts)

trigger

Initial Reaction:Thoughts, Sensations

and/or Emotions Urges

BelieveThoughts

React (ReLapse)

More Thoughts

Relapse Cycle

AUTOPILOT

Not Reacting

Targets for Cognitive Diffusion

Cognitive Diffusion Example

Post-Practice Processing Videos

SOBER Processing:

https://youtu.be/WN4_zz7lS6U

Urge Surfing Processing:

https://youtu.be/AAoAfmO7kxc

Cognitive Diffusion Processing:

https://youtu.be/UReRwM71dZ4

Resource Videos

1. Amaro et al. (2014). Feasibility, acceptability, and preliminary outcomes of a mindfulness-based relapse prevention intervention for culturally-diverse, low-income women in substance use disorder treatment. Substance Use & Misuse 49; 547-59.

2. Bowen S. et al. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention and treatment as usual for substance use disorders: A randomized clinical trial. JAMA Psychiatry 71 (5); 547-56.

3. Bowen S, Chawla N & Marlatt GA (2011). Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician’s Guide. The Guilford Press: New York.

4. Roos, CR et al., (2017). Baseline patterns of substance use disorder severity and depression and anxiety symptoms moderate the efficacy of mindfulness-based relapse prevention. JCCP 85(1): 1041-1051.

5. Penberth JK et al., (2015). Mindfulness-based relapse prevention: History, mechanisms of action and effects.

6. Witkiewitz K et al., (2014). Mindfulness-based treatment to prevention addictive behavior relapse: Theoretical models and hypothesized mechanisms of change. Substance Use & Misuse 49(5): 513-24.

7. Witkiewitz et al., (2014). Randomized trial comparing mindfulness-based relapse prevention with relapse prevention for women offenders at a residential addiction treatment center. Substance Use & Misuse 49(5): 536-46.

References

BHECN webinar series

The Schizophrenia Spectrum: Part 1-Science

Questions?

Click the link to view a recording of today's webinar and information on future webinars

https://www.unmc.edu/bhecn/education/online-training/core-topics-webinars.html

Recording available