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Anthony Quintiliani, Ph.D, LADC

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October 27, 2019 By Admin

Crisis Resilience Skills

Crisis Resilience Skills  – Mindful Happiness

Below I will list various interventions that have proven effective in reducing the level of personal crisis. The sources for many of these skills came from Burns (1980), Ellis (1995), Seligman (1988), Linehan (1993, 2015)), Hayes (2018), and Thich Nhat Hanh (various publications). The skills noted are for immediate application in crisis and/or post-crisis practice. Due to space limitations, I will not explain details; rather I will list skills with minimum directions. If interested in improving your clinical capacities to deal with crises, you can look up the details on your own. It is a growth process. It is always a good idea to have a clear and practical crisis response plan.

  1. Move to cognition as soon as possible – get out of body reactions and take over the thought process related to the situation. Practice Tara Brach’s RAIN skills (recognize, accept, investigate, and relate to non-self), complete a pros and cons grid (good and not-so-good things about staying the same versus making small changes – CT, MI, CBT). Also distant or distract yourself quickly. Distraction is not to be used in physically dangerous situations.
  2. Practice mindfulness core skills. Begin relaxation breath with deep, slow breathing (polyvagal impediments may exist especially if poorly treated trauma is a reality), use positive imagery, meditate, do yoga, pray, pay attention to non-crisis variables, and live within the realities impermanence.
  3. Practice self-soothing. Remember or engage in positive images, sounds, touch, smells, and tastes. Carry your favorite self-calming scent with you. Rub your hands hard and long until hot, then place them on your face and absorb the healing warmth.
  4. DBT-like skills are highly effective. Use “wide-mind” skills. Try ACCEPTS. Engage in alternative activities, contribute to others, compare downwardly with others, engage in opposite emotion, push away unhelpful thoughts and move away from the situation, engage in productive thinking about what to do now without emotional dysregulation, and improve your sensations. Although not part of DBT, you may wish to practice progressing counting (distractive); say to yourself or outloud consecutive numbers and imagine them in your mind’s eye. Continue to count until the emotional reactivity has reduced.
  5. Practice mindful movement. Do yoga, tai chi, qi gong in more vigorous modes until you notice that your body has experienced a reduction in emotional reactivity. Regular meditation practice is, perhaps, your best option here.  Do vigorous exercise.
  6. Do your best to reduce a “victim” self-image. Work on fear-based reactions and combat hopelessness and helplessness tendencies. Use your older, experienced self’s wisdom.
  7. If in therapy, be certain to process the crisis experience. If your therapist is competent, she/he will include such skills development as part of your treatment.
  8. Hope this quick review has been helpful to you.

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: ANTHONY QUINTILIANI, Crisis Resilience Skills, Featured, MIndfulness, Nhat Hanh Thich, Resilience, Self Care, Trauma Tagged With: CRISIS SKILLS, RESILIENCE, SKILLS, TRAINING

September 19, 2018 By Admin

Preverbal Trauma – Therapy Problems

Preverbal Trauma – Therapy Problems

A. R. Quintiliani, Ph.D., LADC

Preverbal trauma (hereafter PVT) is one of the most pervasively troubling human conditions. PVT occurs when a preverbal child is exposed to parental, caretaker, or other forms of abuse. This abuse may be sexual, physical, or emotional. This form of abuse is so destructive because the child has no cognitive/executive/verbal ways to understand and respond to the experience. The long-term bio-psycho-social-spiritual effects of PVT are quite difficult to treat effectively. One reason for this is that some therapist are determined to utilize their favorite approaches (mainly forms of pure talk-therapy and psychodynamic holding) despite the limited effectiveness that these forms of therapy results in. Still worse for the client is generic talk therapy, often a mixture of various talk-therapy components but no actual evidence-based method of helping. Remember it is our obligation to Do No Harm and to use therapeutic interventions beyond alliance that are effective. There may be moral if not ethical implications here.

It is best to keep in mind that both The American Psychological Association and The Agency of Healthcare Research and Quality found recently that correctly applied CBT is the therapy of choice for most forms of trauma. These investigations were thorough and completed in an independent manner. The APA is a professional guild group representing the interests of psychologists, but the AHRQ is a semi-governmental research arm looking into how we spend healthcare dollars. Their main concern is that we spend healthcare funds doing evidence-based interventions with good outcomes. In the interest of research, of course other therapies have been found to be effective with trauma. To mention a few, these are EMDR, DBT, PET, and, Briere’s self-trauma therapy with slow, complete exposure work. MBSR and ACT may be helpful regarding emotional dysregulation in traumatic re-experiencing and self-empowerment. Of course effective attachment therapy with very specific object relations correctives is also helpful.

The following list contains many conditions that make PVT difficult to treat. These suggest that therapy modifications may be needed. The effects of PVT may include:

  1. The non-verbal experience itself;
  2. Somatics of ACEs;
  3. Unexplained body sensations and feelings;
  4. Unexplained bodily awareness;
  5. Problems with long-term memory formation about the event/s;
  6. Visual observation without clear cognitive understanding;
  7. Painful and uncomfortable sensory experiences without apparent causation;
  8. Possible increased limbic fear reactions without clear rationale;
  9. Emotion dysregulation without grounding about specific stimuli and variables;
  10. Parts-of-body reactions without clear causes;
  11. Classically conditioned emotional responses without clear conscious cause and effects; and
  12. Brain sensitivity to future traumatic experiences.

Hopefully this list will encourage you to re-examine the form of therapy you may be using for PVT. Hopefully, this list of intense suffering of a child due to PVT will motivate you to use an evidence-based approach.

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, Featured, Preverbal Trauma, Therapy, Trauma Tagged With: PREVERBAL TRAUMA, PVT, RECOVERY, THERAPY.

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  

Mindful Happiness cover designs.indd

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

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