Applications of Mindfulness-Based Interventions with ... · Applications of Mindfulness-Based...
Transcript of Applications of Mindfulness-Based Interventions with ... · Applications of Mindfulness-Based...
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Applications of Mindfulness-Based Interventions
with People with Developmental Disabilities and
their Caregivers
Nirbhay N. Singh, Ph.D. American Health and Wellness Institute, Raleigh, NC
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Mindfulness
• Road well traveled
• Road less traveled
• Road we are on . . .
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Research Interest
• Treatment teams in mental health
• Treatment teams in developmental disabilities
• Obsessive Compulsive Disorder
• Conduct Disorder
• Aggression
• Mental Illness
• Parent training
• Teacher training
• Staff training
• Health wellness
• Sexual Offenders
• Polydipsia
• Developmental disabilities
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Methodology
• Case studies
• Single-case experimental designs
• Group designs
• Manualized and non-manualized
• Telehealth
• Virtual Reality (in beta testing)
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Components of Mindfulness
• A personal meditation practice
• Behavioral practices (e.g., loving kindness, compassion, and generosity)
• Cognitive strategies (e.g., reflection on the transitory nature of events and emptiness of self)
• Empathic strategies (e.g., tonglen)
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Research Applications
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Aggression
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Mindfulness-Based Procedures
• The individual learns the basic Samatha meditation—based on attention to the breath
• The individual learns how to shift the focus of attention from a visualized anger producing event in the past to a neutral grounding point in the body—the soles of the feet
• The individual applies this mindfulness-based strategy during actual episodes of anger
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Mindfulness Training
• Training is individualized, depending on personal learning characteristics, ability to visualize situations, level of cognitive functioning, and motivation
• On average, training takes about 5 to 10 hours of distributed practice with the trainer
• Instruction on data collection
• Practice homework
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James: Case Study
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Baseline MinfulnessIntervention
1 Yr Follow-Up
Physical AggressionVerbal Aggression
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Case Study
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Baseline MindfulnessIntervention
1 Yr Follow-Up
STAT MedicationPhysical Restraints
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Case Study
0123456789
10
Baseline MindfulnessIntervention
1 Yr Follow-Up
Staff InjuriesResident Injuries
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Moderate ID/DD
• Limitations of the mindfulness interventions for individuals at this level of functioning
• Modifications
• Trainer creativity—behavioral plus personal practice in meditation
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Aggression
0
1
2
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Baseline MindfulnessIntervention
2 Yr Follow-Up
MichaelRosemaryRaymond
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Adult Offenders
• Six adult offenders with mild ID
• Same mindfulness interventions, similar results
• Benefit-cost analysis • Savings of about $50,000 in medical costs for
staff injury • Number of days staff absent from word due to
injuries reduced from 310 days prior to intervention to 15 following mindfulness intervention
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Physical Aggression
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Verbal Aggression
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Adolescents with Asperger Syndrome
• Three adolescents, lived with family
• John, 15-year-old; hitting, kicking, biting, and scratching
• Paul, 13-year-old; hitting, kicking, slapping, scratching, and destroying property
• George, 18-year-old; punching, hitting, and kicking
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Physical Aggression
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Baseline MindulnessIntervention
4-Yr Follow-Up
JohnPaulGeorge
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Parent Injuries
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Baseline MindfulnessIntervention
4 Yr Follow-Up
JohnPaulGeorge
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Sibling Injuries
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Baseline MindfulnessIntervention
4 Yr Follow-Up
JohnPaulGeorge
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Adolescents with Autism
• Three adolescents, lived with family
• Mike, 14-year-old; hitting and kicking family members
• Chris, 16-year-old; hitting, kicking and biting family members
• Steve, 17-year-old; kicking and biting family members
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Physical Aggression
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Baseline MindfulnessIntervention
3 Yr Follow-Up
MikeChrisSteve
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Community-Based Therapist
• Can the mindfulness-based procedures be taught to community-based therapist?
• Therapist certified by American Health and Wellness Institute trainers
• Effectiveness assessed in terms of outcomes for three individuals with maladaptive behaviors
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Kevin
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33.5
44.5
Baseline MindulnessTraining
MindfulnessIntervention
Verbal Aggression
Verbal Aggression
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Samy
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Baseline MindfulnessTraining
MindfulnessIntervention
Disruptive BehaviorWhining
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Monica
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Baseline MindfulnessTraining
MindfulnessIntervention
Physical AggressionVerbal AggressionProperty DestructionRectal DiggingUrinary Incontinence
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Peer as Therapist
• Initial case study (James), taught mindfulness intervention by therapist at age 27, and now 33
• Three participants, all with mild ID and low rates of aggression: • Joshua: age 29, employed as a busboy at a fast
food restaurant • Jeremy: age 28, employed as a bagger at a
grocery store • Jonas: age 32, employed at garden nursery
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Anger
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Aggression
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Health Wellness
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Initial Study: Prader-Willi Syndrome
• The syndrome, genetic disorder, satiety issues
• Risk Factors • morbid obesity • Challenging behaviors
• Control, Management and Treatment
• Diets, drugs, surgery, and lifestyle change
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Participant
• Jason
• 17-year-old, IQ = 75
• Weight = 260 lbs
• Height = 4ft 9 in
• BMI = 57.2
• Goal: reduce and maintain weight at 200 lbs
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Mindfulness-Based Practices
• Physical exercise
• Food awareness
• Mindful eating
• Visualizing and labeling hunger
• Meditation on the soles of the feet
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First Three Phases
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With Mindfulness
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Three-Year Follow-Up
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Weight at End of Phase
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Second Study
• Enhanced 5-component program
• Plus healthy eating principles: • plant based—eat fresh vegetables (both raw and cooked), fruits, whole grains,
legumes/beans, and nuts (especially a handful of walnuts and almonds daily) • whole foods—eat foods that are natural, preferably organic, local, seasonal and,
if at all possible, unprocessed • low fat—choose foods that provide healthy fats from plant sources, such as
avocados and nuts, but avoid low fat processed foods; if meat is a choice, eat leaner meats and seafood; choose low fat dairy products
• variety—as much as possible, eat foods with a wide spectrum of vitamins, minerals, phytonutrients and antioxidants
• spices—if using spices is a choice, emphasize turmeric, saffron, ginger, garlic, and cinnamon
• sodium—eat foods low in sodium; and • caution—avoid as much as possible refined, highly processed foods that have
artificial flavors, colors, preservatives, sweeteners and hydrogenated fats.
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Three Participants with Prader-Willi Syndrome
• Miles • Age = 19, weight = 351 lbs, height = 5 ft 3 inches • BMI = 62.3
• Mingus • Age = 17, weight = 153 lbs, height = 4 ft 8 inches • BMI = 34.3
• Monk • Age = 16, weight = 149 lbs, height = 4 ft 7 inches • BMI = 34.6
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Miles
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Mingus
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Monk
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Weight at End of Phase
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BMI at End of Phase
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Smoking Cessation
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Mindfulness Practices
• Intention
• Mindful observation of thoughts: • Focus on successive thoughts • Observe the beginning, middle and end of each
thought • Observe thoughts as clouds passing through
awareness • Observe the desire to smoke as thought clouds
• Meditation on the Soles of the Feet • If the urge to smoke id too strong
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Research Studies
Staff Training in Mindfulness
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Mindful Caregiving
• Mindfulness-based training for caregiver staff
• Carers of adults with profound multiple disabilities
• Outcome measured in terms of levels of happiness observed on the faces of the individuals: • any facial expression or vocalization typically
considered to be an indicator of happiness among people without disabilities including smiling, laughing, and yelling while smiling’’
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Mindful Practices
SESSION TOPIC
I Preliminaries
II Observing your mind
III Samatha meditation
IV Being in the present moment
V Beginner’s mind
VI Being the activity
VII Review and wrap-up
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Percent Intervals of Happiness
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Baseline MindfulnessTraining
MindfulnessPractice
BruceSteveDave
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Transfer of Mindfulness
• Assessed the transfer of mindfulness training of care staff to the behavior of their own children
• Same staff as in the previous study
• Care staff had 5 children whose behavior was monitored
• Noncompliance was the target behavior
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Reduction in Non-Compliance
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Mindful Staff Increase Learning
• 15 group home care staff, 5 in each home
• 10 men and 5 women
• 18 individuals, 6 in each home
• Behavioral training that preceded mindfulness training was not as effective as desired
• Mindfulness-based training provided only to the care staff, but the outcomes were measured on the individuals
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BASELINE MINDFULNESS TRAINING
MINDFULNESS PRACTICE
Jason 2.25 1.88 0.81
Joseph 4.00 3.56 0.88
Dawn 6.43 4.50 3.56
Wendy 0.58 0.38 0.19
Janet 0.25 0.25 0.06
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Results
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Baseline BehavioralTraining
MindfulnessTraining
Interventions forAggressionObjectives Mastered
Physical Restraints
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Social Validation and Staff Satisfaction
0102030405060708090
100
Baseline BehavioralTraining
MindfulnessTraining
Social ValidationStaff Satisfaction
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Mindful Staff Do Not Use Restraints
• 23 care staff in 4 group homes provided mindfulness-based training
• 20 individuals ranging from mild to profound levels of ID/DD served in these homes
• 9 individuals had concomitant mental illness
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Mindfulness Practices
SESSION TOPIC
I Preliminaries
II Knowing your mind
III Samatha meditation
IV Focused attention on arousal
V Being in the present moment
VI Beginner’s mind
VII Being one with the individual
VIII Non-judgmental acceptance
IX Letting go
X Loving kindness
XI Problem solving
XII Using mindfulness in daily interactions
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Physical Restraints
0
0.5
1
1.5
2
2.5
3
Baseline MindfulnessTraining
MindfulnessPractice
AM ShiftPM Shift
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Parent Training in Mindfulness
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Parents with Children with Autism
• Three mothers, three children with autism
• 12-week mindfulness parenting course, similar to staff training program but refined for parenting
• Assessed changes in children’s behaviors
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Aggression, Non-compliance and Self-Injury
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Aggression
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Non-Compliance (Child 1 & 2) Self-Injury (Child 3)
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Parents with Children with ID/DD
• Four mothers, four children with ID/DD
• 12-week mindfulness parenting course, same as in the previous study
• Assessed changes in children’s behaviors
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Aggression
0
2
4
6
8
10
12
14
16
Baseline MindfulnessTraining
MindfulnessPractice
Child 1Child 2Child 3Child 4
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Positive Social Interactions with Siblings
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Negative Social Interactions with Siblings
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Mindfulness-based Interventions
Is it a viable therapeutic modality for individuals with developmental disabilities?
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Is Mindfulness a viable Therapeutic Modality in the field of Developmental Disabilities?