1. Mercer University Department of Physical Therapy Robin Underwood, PhD, OT/L

2. 9/25/15Robin Underwood, PhD, OT/L 2 * I’ve been around a long time! * Been an OT for almost 40 years * Worked in mental health, acute medical, rehab, outpatient and SNF * Manager for many years: OTs, PTs, SLPs, SWs, TRs, nurses * Masters in Health Policy and Administration at Mercer * Past 15 years: work with female survivors of domestic violence * Have a son who is a PT and just finished residency at Mercer

3. 9/25/15Robin Underwood, PhD, OT/L 3 * Started in mental health * Focus on daily occupations, routines, habits * Purpose is to increase participation and quality of people’s lives * Focus on Person, Environment, and Task * Work with anyone who has barriers to doing what he or she wants and needs to do

4. * By the end of this session, the participants should be able to: * Define mindfulness based interventions * Describe the rationales for using them with themselves and patients/clients * Describe their experiences with practicing mindfulness techniques * Find resources to use with patients/clients and themselves 9/25/15Robin Underwood, PhD, OT/L 4

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8. * Paying close attention to your moment-to-moment experience while not getting caught up in your ideas, opinions, likes and dislikes (Kabat-Zinn, 2013, p. 21) * Awareness of present experience with acceptance” (Siegel, 2010, p. 27) * Being “here” now * It’s “a way of being, not a technique” (Kabat-Zinn, 2005, p. 58) 9/25/15Robin Underwood, PhD, OT/L 8

9. 9/25/15Robin Underwood, PhD, OT/L 9 * To reduce our own stress levels * To be able to focus and concentrate better * To be present with ourselves so that we are aware of our perceptions as therapists * To be present with our patient/clients * To constantly get in touch with what we ask our patients/clients to do all of the time: be mindful, when learning or relearning certain occupations and skills

10. 9/25/15Robin Underwood, PhD, OT/L 10 * For ourselves and our patients/clients: * It’s “about care, about a willingness to come up close to our [AND THEIR]discomfort and pain without judgment, striving, manipulation, or pretense” (Santorelli, 2000, p. 36).

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12. 9/25/15Robin Underwood, PhD, OT/L 12 * A Pause for Presence * De*Stress*ify App * Anchor is the breath

13. 9/25/15Robin Underwood, PhD, OT/L 13 * Evidence-based Practice: * Mindfulness based intervention is an effective method for reducing anxiety, stress, and depression (Hofmann, Sawyer, Witt, & Oh, 2010). * Systematic review and meta-analysis of RCTs of use of standardized MBSR (Mindfulness Based Stress Reduction and MBCT (Mindfulness Based Cognitive Therapy) programs: * Statistically significant improvement in physical functioning and quality of life (Gotink et al., 2015)

14. 9/25/15Robin Underwood, PhD, OT/L 14 * Evidence-based practice : * Statistically significant findings for individuals with fibromyalgia: * improvement of QOL ( Schmidt, et al., 2011) * Statistically significant findings for parents of children with DDs: * decreased stress and depression and increased QOL (Neece, 2014) * Statistically significant findings for individuals with mild to severe DDs: * reduction of behavior and psychological problems of (Hwang, et al., 2013) * Statistically significant findings for of individuals with chronic pain who were taking opioids: * reductions in functional interference, including mood, walking ability, work, relationships, sleep, and enjoyment of life (Garland et al., 2013)

15. 9/25/15Robin Underwood, PhD, OT/L 15 * Evidence based practice: * Preliminary statistically significant evidence of the benefits of MBIs for individuals with TIAs and CVAs: * Improvement across a range of psychological, physiological, and psychosocial outcomes including anxiety, depression, mental fatigue, blood pressure, perceived health, and quality of life (Lawrence et al., 2013) * Statistically significant findings for individuals with MS: * Reduction of pain, fatigue, anxiety, depression and impact of MS (Bogosian et al., 2015)

16. 9/25/15Robin Underwood, PhD, OT/L 16 * Neurological changes * Dan Harris: Hack your brain’s default mode * https://community.cfmhome.org/t/dan-harris- hack-your-brains-default-mode-with- meditation-3-min/653 https://community.cfmhome.org/t/dan-harris- hack-your-brains-default-mode-with- meditation-3-min/653

17. 9/25/15Robin Underwood, PhD, OT/L 17 * Neuroplasticity: * Harvard and U of Mass fMRIs study: * 8 weeks of MBSR led to thickening in multiple regions of brain: * Learning and memory * Emotional regulation * Sense of self * Perspective taking * Amygdala got thinner and correlated to improvement in perceived stress scale * Holzel et al., 2010

18. 9/25/15Robin Underwood, PhD, OT/L 18 * Neuroplasticity: * University of Toronto fMRI study: * 8 weeks of MBSR training delivered in a corporate setting led to * Increases in neuronal activity in embodied present moment experience * Decrease in activity of mind wandering * Davidson et al., 2003

19. 9/25/15Robin Underwood, PhD, OT/L 19 * Neuroplasticity: * UCLA & Carnegie Mellon study: * Study of adults 55-85 after participating in MBSR course: * Reduction of loneliness * Reduced expression of genes related to inflammation * Creswell et al., 2012

20. 9/25/15Robin Underwood, PhD, OT/L 20 * Started by Jon Kabat-Zinn in 1979 at University of Mass Medical Center * Based on Buddhist meditation traditions * Intensive 8 week course * 3 hrs. in class weekly * 1 full-day on a weekend: silent retreat * 45 minutes of practice each day * Focus on sitting, body scan, walking, and eating meditations * Extensive training to teach a class

21. * Seven attitudinal factors considered to be major pillars of mindfulness practice: * Non-judging * Patience * A beginner’s mind * Trust * Non-striving * Acceptance * Letting Go 9/25/15Robin Underwood, PhD, OT/L 21

22. * Practicing meditations using apps or CDs, like De*Stress*ify: Sitting Meditation Body Scan: Being in Your Body Effective method for developing concentration and flexibility of attention simultaneously A way to “actually feel and inhabit each region you focus on and to linger in it in the timeless present” (Kabat-Zinn, 2013, p. 78) 9/25/15Robin Underwood, PhD, OT/L 22

23. Walking Meditation: Bringing attention to each movement as you are doing it 9/25/15Robin Underwood, PhD, OT/L 23

24. 9/25/15Robin Underwood, PhD, OT/L 24 * How do I become mindful or help my patients/clients to become mindful? * Classes: * http://www.umassmed.edu/cfm/stress- reduction/mindfulness-tools/ * Practice- like strengthening muscles * Apps, CDs, YouTube videos * Try mindful eating: no TV, conversations, distractions

25. 9/25/15Robin Underwood, PhD, OT/L 25 * Refer to Reference List

26. 9/25/15Robin Underwood, PhD, OT/L 26 Questions?