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Anthony Quintiliani, Ph.D, LADC

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May 12, 2018 By Admin

Vipassana for Depression, Anxiety, Trauma, and Addictions

Vipassana for Depression, Anxiety, Trauma, and Addictions

The integration of Vipassana meditation with various forms of therapy has for many years been a standard of treatment worldwide and in Vermont, especially when impulse control and emotion regulations issues are included.  Buddhist Psychology offers clear explanations why this intervention may be helpful for so many suffering people. The four most common clinical conditions of depression, anxiety, trauma, and addictions are strongly and positively influenced by regular practice of this form of meditation. Below I have noted in a very basic manner how Vipassana’s effects may be explained via Buddhist Psychology and the dharma.

  1. Impermanence is a focal aspect of Buddhist Psychology, meditation practice, and dharma. This constant of change may be explained best as the rising and falling of all humanly perceived phenomena. Although arising and falling away in conscious awareness include all phenomena, some clarity is needed regarding use of it in clinical practice. Sense impressions, mental events, sensations/feelings/emotions, impulsive behavior, and compulsive cognitions all relate to the clinical conditions noted here. Therefore, any intervention that brings important insight may be useful.
  2. Humans suffer from habitual behaviors and reactions. It is best recognized in attachment to positive  sense objects or experiences and aversion to negative ones. Sensory impressions and mental events about them lead to active roles on the hedonic treadmill. When we use sensory information and experience awareness of something that we evaluate as pleasant, neutral, or unpleasant we behave according to samsara – we crave for more or desire aversion from such phenomena.  We may not at all realize that our attachment/desire to continue the pleasant – as well as the aversion to continue the unpleasant – is our major cause of unhappiness, pain, and suffering.  Likewise the lack off this awareness or insight has the same unpleasant effects – we suffer. We become stuck wanting  what we want but cannot always get, and hoping to avoid unpleasant experiences that may be unavoidable in human life. We tell ourselves only if I had…then I would be happy. General dissatisfaction, unfortunate as it is, is the human norm.
  3. The information and processes noted above do NOT include a separate, long-lasting, independently arising entity called the Self. We do need to recognize that I am NOT my depression, anxiety, trauma, or addictions. I am simply aware or conscious of the fact that “I” am experiencing or feeling depression, anxiety, trauma, or addictions. It is only in more advanced Buddhist practices that we work seriously on the “no-self” reality. There are significant consequences in over-identification with either pleasant or painful experiences.  Believing that it is “my self” that is trapped disempowers us in many important ways.  The Four Noble Truths and The Eight Fold Path can help us.
  4. In very unique ways Vipassana meditation can help us in all of the above.  Here are some skills recommended by S. N. Goenka (now deceased).  First, anchoring the breath by paying attention to the upper lip and the nostrils as you breathe in and out. In anapana sati we simply pay undivided attention to the feelings/sensations as we breathe in and out. Moment-to-moment bare attention is practiced for at least 30 minutes.  To be successful, you must practice letting go of thoughts, emotions, and memories of past suffering.  When they arise simply note that it/they have come up, and pay no attention to it/them – hold a non-evlautaive stance and stay with your breath. It will require significant practice before you can do this well.  Awareness may then be expanded to the throat and chest areas – just feeling sensations of awareness  as you breathe in and out. Second move into about 30 minutes of loving kindness meditation. Third, complete a body scan with attention only from head to toes and back again for about 30 minutes. Just pay attention to the awareness of sensations and feelings as you are guided slowly down and up the body. When distractions come, simply return attention back to the part of your body you are working with now.
  5. Vipassana (Pali for “seeing things as they actually are”) allows us to learn all there is to know in items 1-3 above, and how to benefit significantly from such understandings. Long-term Vipassana practice may eventually bring you to a more stable self-existence, fully focused on your state of meditative awareness without strong reactivity in life. At some point you will become aware of interoception, the ability to feel sensations in your body before they bloom into emotions and behaviors. In the clinical conditions noted, such a skills can be live-saving.

For more information refer to Follette, V. M. and Briere, J. et.al. (2015). Mindfulness-Oriented Interventions for Trauma…New York: Guilford Press, pp. 273-283, 329-342. See also Ariele and Manahemi (1997). Doing Time, Doing Vipassana (Film); and, www.prisondhamma.org.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton SanghaChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

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New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: Addiction, Anxiety, Buddhism, Depression, Featured, Meditation, Mindful Awareness, Trauma, Vipassana Meditation Tagged With: ADDICTIONS, ANXIETY, DEPRESSION, TRAUMA, VIPASSANA

April 30, 2018 By Admin

Mindfulness-Based Therapy for Trauma

Mindfulness-Based Therapy for Trauma

In line with the thousands of studies now available supporting the use of mindfulness-based interventions in depression, anxiety, chronic pain and addictions (via emotion regulation and interoception), this post will review recommended mindfulness interventions for trauma and PTSD. The post will note information from two recent books on this topic. Also recognize that meta-analytic research in 2004, 2010, and 2014 have found that mindfulness-based interventions improve depression, anxiety, chronic pain, and emotion regulation. These are common conditions co-occurring with addictions and trauma. Such interventions may be carried out as part of various Western therapies: cognitive, behavioral, cognitive-behavioral, dialectical-behavioral, and even psychodynamic.

Follette, Briere and others (2015, 2018) note the many benefits of using mindfulness-based skills as part of trauma therapy. Here is their summary. Mindfulness interventions when implemented by a mindfulness practitioner:

  1. Improves compassion, self-compassion, and radical acceptance;
  2. Improves the negative effects of deprivation, oppression, loss, and harm;
  3. Enhance contemplative responses;
  4. Integrates trauma-informed care with yoga and meditation;
  5. Clarifies emotion mind from reasonable mind;
  6. Empowers personal embodiment and being with one’s conditions;
  7. Expands loving kindness;
  8. Enables effective use of RAIN skills;
  9. Softens harsh, self-critical views of self;
  10. Reduces over-identification with traumatic experiences;
  11. Softens anger and blame;
  12. Brings people to the present – leaving “stuckness” in the past;
  13. Reduces apprehensions about the future;
  14. Strengthens meta-cognitive awareness of thoughts and images as triggers;
  15. Improved emotion regulation – less reactivity and impulsivity;
  16. Teaches breathing retraining for vagal and para-sympathetic activation;
  17. Teaches thoughts and emotions are only thoughts and emotions – not the self;
  18. Improves one’s sense of well-being and happiness; and,
  19. Often enhances self-esteem and empowerment.

Davis (2016) adds the following mindfulness-based effects:

  1. Improves balance in mind-body-heart (soul;);
  2. Empowers better stress reduction practices;
  3. Reduces the personal struggle to control cognitions, emotions, and behaviors;
  4. Enhances one’s observational capacities to just be present and “see” via mindful abiding;
  5. Allows people to recognize experience and life as pleasant, neutral/boring, and unpleasant as norms; and,
  6. Enhances the ability to be grounded when triggered.

For more information refer to Follette, V. M. , Briere, J. et.al. (2015, 2018). Mindfulness-Oriented Interventions for Trauma: Integrating Contemplative Practices. New York: Guilford Publications. See also Davis, L. (2016). Meditations for Healing Trauma. Oakland, CA: New Harbinger Publications.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton SanghaChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: ANTHONY QUINTILIANI, Benefits of Meditation, Featured, Healing, Mindful Awareness, MIndfulness, PTSD, Trauma Tagged With: ANTHONY QUINTILIANI, MEDITATION, MEDITATION FOR TRAUMA HEALING, MINDFUL HAPPINESS, TRAUMA

March 11, 2017 By Admin

Object Relations Therapy for Trauma

Trauma: Object Relations Therapy

Object relations therapists, D. W. Winnicott especially, have presented a logical analysis on how to provide object-relations-oriented therapy to people suffering from the effects of psychological trauma. Such attachment-based trauma therapy provides support and healing from trauma, loss and long-term trauma-effects.  The interventions below combine the best of object relations therapy, mindfulness therapy (MBSR, ACT), and cognitive-behavioral therapy. Here is the listing of therapeutic functions and interventions.

  1. Provide support for “going-on-being” in the therapeutic alliance and the therapy itself. (Winnicott)
  2. Unconditional positive regard is a must. (Rogers)
  3. Recognize, work with and work through the splitting process as it activates in therapy. (Lineman)
  4. Safely and with effective skill help to re-connect the person with safe transitional space. (Winnicott)
  5. Carefully build and monitor the emotional “holding environment” in both alliance and therapy. (Rogers, Winnicott)
  6. Include contextual stimuli and symbols of the traumatic experience, from very general to specific and shift slowly over time. (Briere)
  7. Once there is a firm alliance and safety in the therapy, be more specific in exposure to traumatic experiences – monitor carefully. (Briere)
  8. In all exposure work, best to utilize SUDs scores from 0 to 100 – larger range between numbers allows deeper investigation and specificity.
  9. Work hard to understand and utilize body-based communications. (Ogden, Fisher, van der Kolk)
  10. Use mindfulness attention and skills (MBSR, ACT) to remain in The Middle Way between traumatic re-exposure and the safety of “going-on-being.” (Briere, van der Kolk)
  11. Check in with the experiences of transference and countertransference as you use images and defenses to support progress. (A. Freud)
  12. Use multi-sensory interventions in gentle, safe, re-exposure to traumatic materials – using one step removed and cognitive processes first. (Quintiliani)
  13. If skilled in its use, utilize the Attachment-CABs-VAKGO-IS-Rels formula for interventions. (Quintiliani – see mindfulhappiness.org for more details)
  14. Using items #s 8-13 above, aim for development of a safe cognitive schema and narrative clarification about the traumatic event/s.
  15. Work closely with the person to help them internalize the growth-benefits of all of the above. Take time with this process.
  16. Be a “good object” and always return to safety over and over again – check-in and stabilizes often.
  17. Slowly and with safety move up the hierarchy of trauma exposure process, possibly experiencing the full array of sensory experience. (Briere, Foa)
  18. Listen, support emotionally, radically accept, validate and understand the process and the person. This is your best way to develop a “good enough” self-object via “transmuting internalization.” (Kohut)  Various mindfulness and CBT skills will be used here.
  19. Use mindfulness and good CBT to make space for acceptance and validation for post-traumatic growth. (Lineman)
  20. Help to impact these positive changes into a “different” memory system as you expand and deepen the narrative.
  21. Support and directly reinforce (behaviorally) the improved self – a “felt sense” of a healthier self psychologically and physically.
  22. Place more and more safety into the transitional space, and generalize this process into therapy and life practices.
  23. Finally, expand the person’s capacity for pleasure, joy, self-esteem, success and HAPPINESS before therapy ends.

For more information refer to Savage Scharff, J. and Scharff, D. E. (1994).  Object Relations Therapy of Physical and Sexual Trauma. Northvale, NJ: J. Aronson.

Note: The ideas have been presented in this text, but I have added more current interventions and details based on new research and treatments.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: Activities, Featured, MIndfulness, MIndfulness Activities, Mindfulness Training, Object Relations Therapy, Therapy, Trauma Tagged With: ACT, COGNITIVE BEHAVIORAL THERAPY, D.W.WINNICOTT, MBSR, MINDFULNESS, OBJECT RELATIONS THERAPY, THERAPY., TRAUMA

January 20, 2017 By Admin

Trauma Therapy Basics from Experts

Trauma Therapy:  Basics from Some Expert Clinicians

For many years trauma therapist have used many approaches in their psychotherapy. Most of these approaches lack strong empirical support for outcomes, and are often the “favorites” of these therapists.  One might wonder what benefits therapists derive from using approaches that are not evidence-based. If an intervention fails to support timely positive changes in people suffering from trauma, WHY would a professional use it? It is common for therapists to use psychodynamic therapy, cognitive therapy, behavior therapy, and cognitive-behavioral therapy (including dialectical behavior therapy).  While it is quite true that people suffering from serious trauma requires an exceptional therapeutic alliance (psychodynamic therapy), modifications in automatic negative thoughts (cognitive therapy), changes in unhelpful behaviors, like self-medication of pain (behavior therapy, and combinations like very well executed cognitive-behavioral therapy), commonly long-term healing outcomes have been somewhat disappointing.  Perhaps an experienced and skilled therapist able to develop a high quality psychodynamic clinical alliance as well as highly effective cognitive-behavioral interventions may achieve admirable outcomes; however, that specific combination of skills is not common. I am suggesting that a high quality helping alliance and successful interventions in thinking and behavior problems may be helpful for people suffering from serious trauma.  However, most of these approaches (other than informed and skilled DBT) miss the mark when it comes to integrated positive impact on the mind-body system.  Even in DBT (and CBT), it is common for it to be used as a form of cognitive therapy – leaving the important behavioral and body-based areas out all together. To take a new look at the traumatized mind-body, witness current successes in trauma-informed yoga and meditation for PTSD.  Recent meta-analytical reviews have noted that meditation (and yoga to a lesser degree) do improve depression, anxiety, physical pain (emotional pain?), and emotion regulation. Therefore, such body-based approaches improve three (depression, anxiety, self-medication) of the common clinical conditions associated with serious trauma.

Clinicians like Bessel van der Kolk remind us to pay attention to trauma-formed brain changes: the amygdala, the hippocampus, and the prefrontal area (especially medial PFC). These areas have been impacted, possibly sensitized, to trauma and its sequelae. Such changes may strongly impact the person’s future-orientation to life as less than hopeful, and cause sensitized body-based emoltionaland bodily reactions to conscious and unconscious (autonomic) traumatic cues. MRI research supports the trama-caused changes in both limbic and executive brain centers. It is believed that trauma causes changes in the neurocircuitry of the brain. Such important processes as interoception (mindfulness) and neuroception (polyvagal implications) play important roles in post-traumatic experience. The suggestion is that mindfulness, body-based interventions (meditation, yoga, body scanning, etc.) may be helpful in the experienced therapists’ hands. Recall, however, when it comes to using body-based and mindfulness-based interventions in trauma, the best therapists are also practitioners in these practices. Limbic  and prefrontal interventions, NOT psychodynamic and cognitive interventions, may be highly helpful in effective trauma-informed psychotherapy.

Peter Levine reminds us that the body-based implantation of trauma may be used to slowly assist people suffering from trauma to be one with their memories without becoming powerless over them.  Thus, specifically designed body movement with their associated emotional and memory components as well as verbal processing may be utilized to support recovery from even the most severe traumatic experiences.  He does not forget the role the body plays in trauma and recovery from it.

Stephen Porges of Polyvagal Theory fame, notes that traumatic experience impacts the brain and the central nervous system. He notes a keen focus on the huge implications of the vagal nerve systems. It is possible to use neuroception, which functions as a risk detection system in people with trauma, to slowly help people adjust to the way their body responds to any form of traumatogenic cues – both internal and external. Utilizing adult attachment theory and process in therapy, as well as the possibility of feeling safe in social interactions, helps people with trauma move if slowly into recovery. Physical gestures, body reactions, voice quality, posture, and facial emotions – all part of post-trauma deficits – may be modified so as to assist people to enter recovery.

Pat Ogden, famous for her unique body-based and movement-based approaches, explains how habitual, conditioned body-based reactions may be modified as a new story of the body. These new experiences help to form a new better integrated story about trauma that guides the recovery process and reduces fear. She suggests that very specific forms of body movements may be most helpful here. Perhaps, the brain’s insula and thalamus have also been sensitized to reminders of traumatic experience, thus rendering their typical functions less adaptive.

Note that all of these leading trauma specialists have shifted to interventions with the body rather than typical “talk therapy” that is so often used.  Yes, we do need to have important conversations with people suffering from trauma, but the real power for change comes from working with their bodily memories, reactions, and impulses along with limited verbal interactions. Inner peace, interpersonal safety, and slow readjustment to life are all part of recovery.

For more details and available clinical training refer to www.nicabm.com/holiday 2016… retrieved on December 28, 2016. See also Harrison, P. (August 13, 2014). Long-term course of PTSD revealed. www.medscape.com/viewarticle/829872…retrieved on August 14, 2014.  Also refer to Buczynski, R. (October 23, 2014). PTSD, the hippocampus, and the amygdala – How trauma changes the brain. www.nicabm.com…/ptsd… Retrieved on October 24, 2014.

 Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

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New Edition of Mindful Happiness in Production…Coming soon!

 

Filed Under: Clinical Practice, Clinicians, Featured, People, Therapy, Trauma Tagged With: ANTHAONY QUINTILIANI, BESSEL VAN DER KOLK, CLINICIANS, PAT OGDEN, PETER LEVINE, POLYVAGAL THEORY, PTSD, STEPHEN PORGES, THERAPY., TRAUMA, TRAUMA THERAPY BASICS

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