October 26, 2018 at 11:01 am #10544Patricia BurkeKeymaster
Mindfulness in Behavioral Health and Co-Occurring Services
Responses to Lesson 1 Homework
Patricia A. Burke, MSW
Whether you are new to the practice of mindfulness or have years of experience, I offer this class as a vehicle for your own personal and professional explorations to whatever extent you choose to engage in that process.
Question 1: Breath Counting Meditation
What did you notice about your physical experience during the Breath Counting Meditation? What did you notice about how your mind responded to focusing on counting your breaths? How would you evaluate the effectiveness of this meditation to calm and/or stabilize your mind?
One of the most important aspects of the Breath Counting Meditation is that it simply gives the mind something other than thoughts to focus on. The breath counting exercise can also help people be more grounded in the present moment. In this way, it may be helpful to people who are experiencing acute or post-traumatic stress reactions. As Melissa commented, “For my clients (especially those with trauma) I often encourage more of the counting (or the 5,4,3,2 1 system) for grounding and to slow down any anxiety.”
Since our thoughts, physical sensations, and feelings are so closely linked, any practice that helps calm the incessant and high stress thinking that the “monkey mind” engages in is bound to help the body relax. As Elaine noted, “I noticed that I was immediately more relaxed, with full breaths instead of the usual short inhales that I catch myself doing throughout my workday.”
In any mindfulness meditation the point of focus, whether it is counting or simply focusing on the breath helps us become aware of our thoughts, but not cling to or dwell on them. Sometimes people will experience some frustration, tension, distraction, or self-judgment with this particular practice. These are common reactions.
When I first started to practice breath counting, I felt as if I needed to get to 10 otherwise I wasn’t doing it correctly. One of the most important things to remember while doing this particular practice for yourselves and for clients is that the “goal” of the practice is not to reach 10, but to feel free to return to 1, one, “One” when the mind wanders. This instruction helps cut through our cultural tendency toward achieving and striving.
It is not unusual for people to actually become tense initially while engaged in meditation or find it challenging to focus on counting. Each time the mind wanders and we gently bring our awareness back to the point of concentration, it gets easier. The mind is a like a runner’s muscles, when it is tense the muscles contract, when the runner stretches, the muscles relax. The Breath Counting meditation is a way to train the mind to relax.
Like any other new skill, mindfulness needs to be practiced. Notice that I use the word practice and not discipline. I prefer the language of practice because, for me, it has a softer, less demanding connotation.
Most of you felt that the Breath Counting meditation was very effective as a practice to calm and stabilize the mind. As Jennifer noted, “I felt that it was an effective way to calm and stabilize my mind. I was less aware of what was going on around me while I was doing the meditation.” Cherie commented, “I found it to be very useful, it was calming and actually self soothing. I enjoyed the guided audio as it helped when my mind would wander to bring my attention back to my breath.” This calming and stabilizing effect is what makes is such a good foundational meditation practice, especially for new meditators and also for people in early recovery who have a difficult time concentrating. This meditation will exercise the mind and build the facility to concentrate.
Don’t worry if you fall asleep during the meditation. In fact the Breath Counting meditation is my preferred practice when I am lying in bed at night and my mind is racing with all the things I didn’t get done that day or need to get done tomorrow. The Breath Counting meditation usually puts me right to sleep. For me it is like reading a boring book or pouring over a spread sheet of numbers. I also practice the Breath Counting meditation when I am particularly anxious, and my mind is ruminating or obsessing (a common experience for people with depression, anxiety, and who are early in recovery from addiction).
Question 2: Basic Mindfulness Meditation
What did you notice about your physical experience during the Basic Mindfulness Meditation? What did you notice about how your mind wandered? What was it like to gently shift your focus of attention from your thoughts to your breath? How would you evaluate the effectiveness of this meditation to make you more aware of the habits of your mind?
Some people find that the Mindfulness Meditation is more difficult in some ways than the Breath Counting exercise. Two very common experiences with the Mindfulness Meditation 1) the mind wanders or races more 2) we become more easily distracted by external stimuli such as sounds or internal stimuli like uncomfortable body sensations. As Elaine commented, “This meditation style really allows you to realize how quickly your mind jumps to your mental to do list, and the worries your mind loves to fixate on.”
Meditation does require effort. That is the practice. We are attached to our thoughts and with practice we can train the mind to shift that energy to focusing on another object of attention, such as counting numbers, saying a mantra or returning attention to the breath. Because the experience of breathing is a less concrete point of focus (i.e. focusing on a body sensation) than counting numbers (i.e. focusing on a mental process) it can be more difficult for some folks and will take more practice. But if you stay with it, the mindfulness practice can provide benefits.
Since the mindfulness practice brings us into a state of more open attention, sometimes intense feelings can arise. It is important to be aware of this possibility when working with clients and be prepared to help people stay grounded and work with the feelings in ways that are appropriate for that person, at that time in their recovery.
The important thing to remember is that there is no right or wrong about the Mindfulness Meditation. In the spirit of the non-judgmental awareness of mindfulness, I hope that you will simply notice your responses to the Mindfulness Meditation and see where these insights take you in your next meditation. Staying in the moment (or I would probably say returning to the moment) does, indeed decrease anxiety. If we are focusing on the present moment we are not dwelling in thoughts about the future or the past, which for most of us and certainly the clients you see are fearful, negative thoughts.
In Mindfulness Meditation we are not trying to stop our thoughts but develop a “relative disinterest” in them. Jennifer noticed, “My physical experience started being distracted by the way I was sitting. Then I decided to just be aware of it and not try to change it. . . There were moments when my mind did wander to anxious thoughts, but I brought my attention back to my breath/body.” This is another way of describing a shift in our relationship to our thoughts and the thinking mind.
As far as teaching clients this subtle discernment, I think that with practice and discussion of clients’ responses to the meditation, this insight will arise spontaneously. It certainly can help to tell clients about this shift, but in order to truly get it, they will need to experience it for themselves. When the Buddha was asked by his followers to teach them, he was reluctant. He insisted that they practice and trust their own experience . . . that the teachings themselves were not the most important aspect of the path of awakening.
Most of you, whether the exercise was easy or challenging, felt that the Mindfulness Meditation is an effective practice to develop awareness of the habits of mind and or enter into a more relaxed experience.
Integration Into Clinical Practice
3) In your own experience, what would you say were the differences and similarities in the two meditation exercises? How would you envision integrating the Breath Counting Meditation and/or the Basic Mindfulness Meditation into your clinical work with people with substance use or mental disorders?
Here are some of the similarities and differences you observed between the Breath Counting and Mindfulness meditations:
Similarities Differences * Enhanced relaxation
* Increased awareness of internal experience.
* Increased experience of calm.
* Having a structured plan with breath counting
* More direction with breath counting
* Breath counting meditation was definitely more focused and goal-oriented
* Basic mindfulness changes the body/mind sensations in a broader way.
* Basic mindfulness mind wandered more.
* Felt grounded with breath counting but floating during basic mindfulness practice.
I think you have accurately captured the gross and subtle differences and similarities between these two forms of meditation practice. Concentration and open awareness are both useful aspects of any method of self-investigation and isn’t that what counseling is all about; helping people become more self-aware so they can make healthier choices and change. The added benefits of relaxation and stress reduction compliment the impact of expanded awareness.
Here are some of the ideas you mentioned about how to integrate the meditations into your clinical practice:
* In a group setting, with breath counting, given the structure and natural flow is very attainable.
* If I were using physical sensations I would individualize it so to support each client as various awareness (sometimes that we are not even aware of) can surface.
* Following a counting exercise I have asked “what was it like for you to just go with this – did you drift – how was it to focus back” and have client’s share their own process.
* I feel both techniques would be useful in practice with patients. Possibly starting with the counting and breathing and moving towards introducing and practice of basic mindfulness meditation.
* I have used variations of this in clinical work with people with SUDs, though the structure of the session often does not allow for several minutes of focused breathing time.
* I think you can gain respect from those with SUD if you help them dip their toes into the counting breath style…. In a sense, you can help them move their addictive behaviors from substances to feeling the calming sensations of meditation instead.
Terrific ideas. As a result of practicing these meditations yourselves, you have some clear ideas about the benefits of both and when and how to introduce them into your clinical practice.
Timing and the stage of recovery or healing are important variables to consider as well as the different effects of both meditations in determining your strategy for integrating them into your work. Please remember as you begin or continue to introduce mindfulness practices into your clinical work that it is important let clients know of the possible risks of meditation (e.g. they might initially feel more anxious or intense emotions might arise) and allow them to opt out or feel free to stop an exercise at any time. It is also important to practice any meditation yourself fully and be comfortable with the practice, before you introduce it to clients so you are aware of all of the potential reactions and responses to it.
Also, for people new to meditation it is often helpful to have an audio or video guide to help stay on track. So if you invite your clients to practice between sessions it can be helpful to point them to the guided versions available on the internet or, if you have the capability, once you become comfortable, make your own personalized recordings for clients based on their needs and what practice works for them.
Thank you all for your willingness to engage in the exercises and your thoughtful comments. Your participation enriches the experience for us all. In our next lesson we will be focusing on the different mindfulness-based therapeutic methods.
Be well. Be in peace.
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