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Using Mindfulness for People who Support Those with Enduring Needs Steve Noone Neil Sabin NTW NHS FoundationTrust.

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Presentation on theme: "Using Mindfulness for People who Support Those with Enduring Needs Steve Noone Neil Sabin NTW NHS FoundationTrust."— Presentation transcript:

1 Using Mindfulness for People who Support Those with Enduring Needs Steve Noone Neil Sabin NTW NHS FoundationTrust

2 Over view Discovering the wolf….

3 Over view How should we ‘prepare’ staff for what they may experience whilst caring ? Provide a conceptual overview Consider some simple exercises Time to share ideas

4 Staff Behaviour Challenging Behaviour

5 Staff Behaviour Challenging Behaviour Staff Negative Emotional Reactions

6 Staff Behaviour Challenging Behaviour Staff Negative Emotional Reactions Staff Stress

7 Staff Behaviour Challenging Behaviour Staff Negative Emotional Reactions Staff Stress

8 Staff Behaviour Challenging Behaviour Staff Negative Emotional Reactions Staff Stress

9 Feelings identified by carers (R McDonald 2006) Good: Trusted, worthwhile, skilled, connection, empathy, happiness, satisfaction, joy, excitement, pride, relief, heart-warming

10 Feelings identified by carers (R McDonald 2006) Uncomfortable: Embarrassment, stupidity, anxiety/fear, confusion, anger, sadness, failure, overwhelmed / dread, useless, frustration, disbelief, alarming and nerve-wracking, distressed, powerless, annoyed, shame at own disgust

11 Becoming a Resilient Caregiver McCurry (2006) Resigned - asks for no help often becomes sick and depressed Resentful - shocked and bitter will often blame others Resilient - detach themselves and not take the behaviour personally

12 Becoming a Resilient Caregiver Resilient - detach themselves and not take the behaviour personally Maintain a sense of humour Aware of the tender moments in the day and look for the uplifts that are part of being a caregiver

13 Research Acceptance and Commitment Therapy – Occupational Stress (Bond & Bunce, 2000; Bond & Flaxman, 2006; Bond, Flaxman, & Bunce, 2008) – (Noone & Hastings; 2009; 2010; 2011). Mindfulness and field learning disabilities – care staff working with aggression, (Singh et al., 2006), – reduce the use of physical restraint, (Singh et al., 2009) with forensic services, (Singh et al., 2011) – with patients with aggression and mental health problems (Singh, et al.,2007) and clients with learning disabilities and aggression, (Singh, Wahler, Adkins & Meyers, 2003).

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15 What is ACT ? Psychotherapeutic approach built on principles of behavioural analysis Normalises human suffering Much of suffering is a consequence of – verbal evaluation of an event and – attempt to avoid ones experience

16 Core Ideas of ACT Clean pain: falling down a hole Dirty pain: is trying to dig What happens if attempting to control is the problem?

17 Core Ideas of ACT To try and control is to try and stop experiencing what you are experiencing Leads to experiential avoidance The real problem is lack of psychological flexibility

18 The transcendent challenge of our time is the objectification and dehumanization of others Steve Hayes

19 Consider these photos Just look at each photo and notice what thoughts pop into your head They will be either neutral Positive ….or negative

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21 Fusion Inaction Psychological Inflexibility Experiential Avoidance Past and Future Conceptualized Self (Ego) Unclear values

22 Defusion Committed Action Promoting Psychological Flexibility Acceptance Contact with the present moment Self as Context Values

23 Where to start ?

24 Structure of Day Reflection – on what I bring to my job – personal cost of being stressed – how thoughts operate Clarify – my values and how I want to live my life Discriminate – coping that works and what doesn’t – between me and my thoughts Make a personal commitment to my values

25 What do you bring to your job Patience Humour Stay calm Keep to care plan Listen Empathy Understanding Share good times Protect rights Enable development Ensure safety Protect dignity Advocate for person Energy Enthusiastic

26 Head Banging with fist Punching Scratching Biting Screaming Throwing Objects Kicking Eye Gouging Relentless Questioning Attacked with Objects One client attacking another client Spitting Withdrawing Picking own wounds Air Swallowing Breaking Furniture Running away Hand Biting Banging head against wall

27 Job Advert Wanted: Patient, calm, understanding, empathic, energetic, enthusiastic person, who is able to keep to care plan, protect the rights of a vulnerable person, ensure the safety of clients and members of the public,will protect the dignity of stigmatised people and be a keen advocate.

28 To work with people who will: Bite, throw objects, scratch, attack you with objects,head bang with fist, withdraw, bang head against wall, spit, bite their own hand, run away, break furniture, attack other clients, kick,eye gouge, scream, ask continuous questions, pick own wounds, swallow air,

29 Job advert A good sense of humour and a clean driving license desirable. The organisation is committed to promoting a work -life balance

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31 Structure of Day Reflection – on what I bring to my job – personal cost of being stressed – how thoughts operate Clarify – my values and how I want to live my life Discriminate – coping that works and what doesn’t – between me and my thoughts Make a personal commitment to my values

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33 THE SWEET SPOT Vividly recall a “sweet “memory and get in touch with the emotions. What is meaningful about this memory? WHAT MATTERS? What do you really want? What matters to you, in the big picture? What do you want to stand for? Is there anything in your life right now that gives you a sense of meaning, purpose, vitality? SPEECHES Imagine your 80 th birthday (or 21 st or 50 th, or retirement party etc). 3 people make speeches about what you stand for, what you mean to them, the role you played in their life. Imagine them saying whatever you most want to hear. FORMS & WORKSHEETS Valued living questionnaire Bull’s eye Life compass Clarifying Values

34 Structure of Day Reflection – on what I bring to my job – personal cost of being stressed – how thoughts operate Clarify – my values and how I want to live my life Discriminate – coping that works and what doesn’t – between me and my thoughts Make a personal commitment to my values

35 Experiential Avoidance FUSION Entanglement with categorical, judgmental thought Conceptualized Self (Ego) Inaction Past and Future Unclear values Psychological Rigidity

36 Cognitive Defusion “I used to think that the brain was the most wonderful organ in my body. Then I realized what was telling me this.” -Emo Phillips

37 Defusion exercises Don’t think about chocolate cake! Forget the numbers Objectify the mind – its only looking out for you Leaves on a stream/ protestors/ cars in street Replace “buts” with “ands”

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39 Fusion We buy into stories of who we are and who others are Inaction Unclear values Psychological Rigidity Experiential Avoidance Past and Future

40 RFT & The Self

41 Verbal behavior gives rise to three types of self: – Object of verbal knowledge The conceptualized self Self as content – Process of verbal knowledge The knowing self Self as process – Locus of verbal knowledge transcendent self Self as context or perspective The Three Selves

42 Structure of Day Reflection – on what I bring to my job – personal cost of being stressed – how thoughts operate Discriminate – coping that works and what doesn’t – between me and my thoughts Clarify – my values and how I want to live my life Make a personal commitment to my values

43 Values Assessment Rating Form

44 Goals Actions & Barriers

45 Using mindfulness with care staff

46 1. General Introduction to Mindfulness Staff Training a. Discussion of staff-individuals with (ID) positive and negative interactions b. Discussion of previous training programs t c. Staff members’ experiences with previous staff training d. Discussion of staff members’ expected outcomes e. Discussion of the aims of the mindfulness staff training f. Review of program requirements: reading, meditation practice, application of mindfulness, and data collection g. Maintaining a practice journal h. Set homework tasks

47 2. Knowing Your Mind a. Interactive review of homework b. Review of mindfulness and mindlessness c. Identification of instances of mindfulness and mindlessness during staff-individual with ID interaction d. Basic meditation techniques for sitting and walking meditation e. Meditation practice on Observing Your Mind f. Discussion of practice on Observing Your Mind and its applications in staff-individual with ID interactions g. Set homework practice

48 3. Focused attention a. Interactive review of homework b. Review of focused attention c. Breathing as focused attention or awareness d. Meditation practice on Breathing e. Discussion of practice on Breathing and its applications in staff-individual

49 4. Focused Attention on Arousal States a. Interactive review of homework b. Review of arousal states that precede and follow staff-individual with ID interactions c. Meditation practice on Arousal d. Discussion of practice on Arousal and its applications in staff-individual with ID interactions e. Set homework tasks

50 5. Being in the Present Moment a. Interactive review of homework b. Review of being in the present moment in the midst of chaos c. Meditation practice on Being in the Present Moment d. Discussion of practice on Being in the Present Moment and its applications in staff-individual with ID interactions e. Set homework practice

51 6. Beginner’s Mind a. Interactive review of homework b. Review of premature cognitive commitment; bounded versus unbounded reality; conditioned versus unconditioned responses c. Meditation practice on Beginner’s Mind d. Discussion of practice on Beginner’s Mind and its applications in staff-individual with ID interactions e. Set homework practice

52 7. Being One with the Individual with ID a. Interactive review of homework b. Review of being in the ‘zone’ or having a ‘peak experience;’ being one with the individual with ID c. Meditation practice on Being One with the Individual d. Discussion of practice on Being One with the Individual and its applications in staff-individual with ID interactions e. Set homework practice

53 8. Non-judgmental Acceptance a. Interactive review of homework b. Review of acceptance and non-judging; non- judgmental acceptance of the individual with ID c. Meditation practice on Non-judgmental Acceptance d. Discussion of practice on Non-judgmental Acceptance and its applications in staff-individual with ID interactions e. Set homework practice

54 9. Letting go a. Interactive review of homework b. Review of doing one’s part and letting go of everything else c. Meditation practice on Letting Go d. Discussion of practice on Letting Go and its applications in staff-individual with ID interactions e. Set homework practice

55 10. Loving kindness a. Interactive review of homework b. Review of acting with loving kindness and compassion c. Meditation practice on Loving Kindness d. Discussion of practice on Loving Kindness and its applications in staff-individual with ID interactions e. Set homework practice

56 11. Problem Solving a. Interactive review of homework b. Review the nature of problems and solutions c. Meditation practice on Problem Solving d. Discussion of practice on Problem Solving and its applications in staff-individual with ID interactions e. Set homework practice

57 12. Using Mindfulness in Daily Interactions a. Interactive review of homework; data collection b. Putting it all together; review of meditation exercises and applications c. Meeting staff members’ expectations; staff-individual with ID interactions then versus now d. Discussion on mindfulness in daily interactions e. Plans for follow-up, keeping in touch, and long-term practice


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