A Qualitative Study on the introduction of Mindfulness-Based Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers - PowerPoint PPT Presentation

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A Qualitative Study on the introduction of Mindfulness-Based Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers

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Title: A Qualitative Study on the introduction of Mindfulness-Based Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers


1
  • A Qualitative Study on the introduction of
    Mindfulness-Based Relapse Prevention (MBRP) into
    a Therapeutic Community for substance abusers
  • Presented by Anita Harris
  • Research Assistant Coolmine Therapeutic Community

2
Introduction
  • Overview of Mindfulness-Based Relapse Prevention
  • Purpose of the study
  • Methodology
  • Findings
  • QA

3
What is mindfulness?
  • Jon Kabat Zinn describes Mindfulness as
  • paying attention in a particular way on purpose,
    in the present moment, and non-judgementally
  • Emphasis is placed on the breath and teaching
    individuals to return to the present moment by
    focusing on the breath.

4
Mindfulness Meditation
  • Traditionally rooted in ancient Eastern
    traditions, in particular Buddhism
  • Recently adopted by the West in recent years as
    an effective therapeutic intervention for a
    number of psychological and medical problems
  • Perhaps the most noted is mindfulness-based
    stress reduction (MBSR) developed by Jon
    Kabat-Zinn (1979) for individuals suffering with
    chronic pain and stress related disorders.

5
Mindfulness Based Interventions
  • Other well researched and evidence based
    interventions by which mindfulness meditation is
    a core componenet include
  • Mindfulness-Based Cognitive Therapy(MBCT),proven
    to be effective for people with recurrent or
    relapsing depression. (Segal, Teasdale
    Williams)
  • Acceptance and Commitment Thaerapy (ACT)
  • Diaclectical Behavioural Therapy (DBT)
  • Mindfulness-Based Relapse Prevention (MBRP) for
    individuals with addictive behaviours. (Marlatt,
    Bowen, Chawla)

6
Mindfulness and Addiction
  • Addiction is the repeated desire to avoid the
    present moment, which contributes to the urge to
    use.....(Larimer, 1999)
  • Individuals with addictive behaviours have great
    difficulty accepting the present moment (Marlatt)
  • Through cultivating mindfulness awareness it is
    suggested that individuals can create a space
    whereby they can respond skilfully instead of
    reacting automatically. Through the regular
    practise of formal and informal mindfulness
    practises, individuals can be fully in the
    present moment without being wiped out by
    it (Marlatt)

7
Mindfulness- Based Relapse Prevention
  • An 8 week programme combining relapse prevention
    skills with mindfulness meditation
  • A structured protocol with session by session
    agendas containing mindfulness practices/discussio
    ns and worksheets
  • Inquiry process is a central component of
    mindfulness
  • It is important that faciliators of the programme
    not only have experience with substance abuse
    treatment but are fully trained to deliver
    mindfulness training

8
Goals of MBRP
  • 1. Help clients to develop awareness of personal
    triggers and habitual reactions, and learn ways
    to create a pause in this seemingly automatic
    process.
  •  
  • 2. Alter individuals relationship to discomfort,
    learning to recognize challenging emotional and
    physical experiences and responding to them in
    skilful ways.
  • 3. Help clients foster a non-judgmental,
    compassionate approach toward themselves and
    their experiences.
  • 4. Build a lifestyle that supports both
    mindfulness practice and recovery (Marlatt)

9
Context/Background of the study
  • In May 2011, Coolmine TC decided to introduce
    MBRP across its 3 main services, the men and
    womens residentials and the drug free day
    programme
  • Three Coolmine staff members were trained to
    deliver MBRP and acted as facilitators of the
    eight week programme.
  • A pilot group was conducted prior to
    implementation to which I myself was a
    participant observer

10
Aims of the Study
  • Aim of the study was to evaluate the impact of
    the newly introduced MBRP on the TC to which it
    was introduced and HOW it may be helpful to
    individuals with addictive behaviours

11
Objectives
  • Investigate how MBRP was perceived and received
    by both clients and staff at Coolmine TC
  • Gain insight into the self perceived
    benefits/effects of MBRP
  • Outline the mechanisms of how MBRP may be
    helpful to individuals with substance abuse
    problems
  • Place in the broader context of a TC s approach
    to treatment

12
Methodology
  • A qualitative approach was deemed most
    appropriate. Methods Used include
  • Observation
  • Focus Groups with clients only in each of the
    three settings immediately following the end of
    the 8 week programme
  • Semi-structured individual interviews with both
    clients and Facilitators immediately following
    the end of the 8 week programme

13
Findings
  • Objective 1 Investigate how MBRP was perceived
    and received by both clients and staff at
    Coolmine TC
  • Meditation as relaxation???.
  • Largely well received by both clients and staff
  • Better received by the clients in the residential
    programme than those in the day programme-
    Surprising giving that it is designed as an
    aftercare programme

14
Objective 1 contd.....
  • No one particular reason for lack of enthusiasm
    in the day programme but facilitators lack of
    confidence in delivering the programme may have
    being a facto
  • Facilitator stated she was not ready to deliver
    and felt she required more time and training
    before she could confidently deliver.

15
Objective 1 Contd......
  • In both residentials, it was received a lot more
    positively.
  • Critical turning point for most clients was in
    week 3-4 of the programme-Got an understanding
  • The majority of clients and staff perceived
    mindfulness to be a highly valuable and
    beneficial programme that could help them with
    their recovery process

16
Critical Turning Point
  • something happened to me in that room in
    the third week. It was like I could feel it, all
    the tension and worry wash away from me just for
    that twenty minutes or whatever it was. I had
    relief from my head. I felt it, I felt relief
    for the first time since Id been in here and
    since then I love it I can say, hand on my
    heart, I love mindfulness, it gives me that
    relief and I dont think anyone would understand
    how much it means to have relief from your own
    head unless they had been tormented themselves
    with their head. (Marie).

17
Objective 2 Benefits/Effects of MBRP
  • Benefits cited by many of the clients
  • To learn how to sit with youself and be okay
  • Being taught how to return to the present moment
  • Acceptance of uncomfortable thoughts and emotions
  • Heightened awareness
  • Practical and useful practices for
    triggers/cravings and high risk situations
  • Reduced stress
  • Anger management
  • Increased retention/ Helped many clients stay in
    the community
  • Heads slowed down

18
Objective 3Outline the mechanisms of how MBRP
may be helpful to individuals with substance
abuse problems
  • A highly beneficial technique cited by many was
    the Sober Breathing Space (a 3 minute mini
    meditation technique)
  • Stop-stop right what your doing now
  • Observe- what is going on with you right now in
    this moment, in your body, your thoughts, your
    emotions
  • Breathe-bring your attention to breathing, keep
    your focus there
  • Expand- your awareness to include a sense of the
    whole body and the situation you are in
  • Respond-to whatever situation with awareness

19
Objective 3 Contd....How MBRP may be helpful
  • Formal practices helped many calm the mind
  • Thoughts are just thoughts-a very powerful
    message to many of the clients
  • Able to verbalise how they are feeling-inquiry
    process really helped many clients put into words
    how they are feeling and locate it in their body
  • It okay- Strong message
  • Its okay, its okay to feel this way. Really,
    really powerful nearly choked me up at one stage
    when I heard it in one session. I really felt
    like crying. But its something I tell myself a
    lot of the time now. That meant a lot to me.

20
Objective 3 contd...
  • Acceptance of emotions/thoughts/situations
  • For many the inquiry process that follows the
    practises has helped them to talk about
    cravings-which many stated they would not have
    done in other groups
  • Interesting finding was how many, especially
    women struggled with the Loving Kindness
    practise.
  • Became very evident how self critical many
    clients are

21
Objective 4 Place in the broader context of a
TC s approach to treatment
  • Mindfulness as confrontational- Many clients
    described it as hard work and as the most
    confrontational work they have ever did
  • The educative and therapeutic elements of MBRP
    appear o fit well with the TC approach
  • Like the TC approach, it seeks to address the
    whole self by placing clients at the centre of
    their recovery
  • Its a self help approach which uses group as
    method
  • For one staff member and a couple of clients the
    practise of urge surfing conflicted with the TC
    approach to treatment

22
Conclusion
  • Significant changes have occurred at both staff
    and clients level- all largely positive about the
    introduction of MBRP
  • Study would support the view that Coolmine as an
    organisation has changed significantly-open to
    change
  • Some implementation issues in Day programme
  • All in all, a programme viewed by the staff and
    clients as one with real perceived gains

23
Recommendations
  • More thought exploring the differences between
    the day programme and residentials-so that future
    use will be based on a recognition of difference
  • Closed groups more beneficial
  • Further training for facilitators
  • Facilitators to be mindful of the language used
    and spend more time on the introductory piece
    with clients

24
Thank You !QA

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