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
• BHECN's webinar series designed to educate behavioral health
trainees about practical topics in behavioral health
• Expert presenters provide a mixture of principles and case
based application
• All webinars are free of charge
• Topics include:
The Behavioral Health Education Center of Nebraska (BHECN), pronounced “beacon”, was established in 2009 by a legislative bill to address the shortage of behavioral health professionals in rural and underserved areas of the state.
unmc.edu/bhecn
MISSION: BHECN is dedicated to improving access to behavioral health care across the state of Nebraska by developing a skilled and passionate workforce.
About BHECN
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Announcements
Click the link to view a recording of today's webinar and information on future webinars
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Recording available
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