MBCT with TBI Groups A practitioner’s journey through training and practice with TBI patient groups Elly Nadorp, MSW.,RSW

What is Mindfulness Based Cognitive Therapy (MBCT) Therapeutic approach rooted in mindfulness based stress reduction and cognitive behavioural therapy Geared towards persons with depressive symptoms and who are at risk of depressive relapses

Mindfulness Means : Paying attention in a particular way, on purpose, in the present moment, non-judgmentally. Jon Kabat -Zinn

How the Journey began and continues Research project re MBCT with TBI Population Recruitment and Training of Facilitators Ongoing Practice and Training

Why MBCT with TBI population Growing evidence that MBCT is consistently effective in relapse prevention in recurrently depressed individuals Ma and Teasdale 2004; Segal et al.2002, 2010; Teasdale et al.2000 Previous study results indicated that MBCT applied to TBI population showed significant improvement in health status and depression Bedard, Felteau et al.,2012;2005;2003

MBCT research study for TBI A pilot-tested MBCT program was facilitated at our rehab hospital with patients with TBI Multi –site MBCT research study was funded by Ontario Neuro-trauma Foundation in 2009 and was supported by medical and management teams for implementation on 3 different rehab hospital sites in Ontario 10 facilitators were recruited (through application and interview process) to participate in this study

Facilitator Training during MBCT Research Project Initial 2 day training retreat in Toronto (2009) Biweekly telephone group learning conferences with a certified MBCT teacher ( ) MBCT 5 day training with Dr. Zindel Segal,Dr. Steve Hickman and Dr. Sarah Bowen in California ( 2010) Practice Teaching with a health care providers group (2010) Several MBCT groups with patients for research study ( )

Skills/Knowledge required for TBI client groups Knowing the MBCT curriculum Knowing how to pace and teach the content Being able to guide the meditations and the mindfulness activities Knowing how to do the inquiry process Facilitating the group process and managing group dynamics Understanding brain injury and adjusting the curriculum and the teachings to persons with a brain injuy

Research Outcomes Study outcomes are still being processed however unpublished data to date indicates a statistically significant (26%) reduction in overall depression symptoms Recent publication in Mindfulness Journal November 2012 “Training Clinicians to deliver a mindfulness intervention” Gibbons, Felteau, Marshall, Rees et al Research findings to be available in near future

The Impact of Mindfulness on the Clinician Attitude towards Mindfulness Benefits of Mindfulness on Social Work Practice Mindfulness and Therapeutic Relationship

Attitude toward Mindfulness Practice The practitioner needs to embody its practices (formal and informal) Regular peer support by participating in meetings with other practitioners, attending retreats, and ongoing training opportunities

Facilitator Training after the MBCT Research Project MBCT 5 day advanced teacher training (Inquiry process) at Omega Institute, Maryland, Susan Woods and Char Wilkins ( 2011) Mindfulness for Health Care Professionals Course -Ottawa Mindfulness Clinic ( 8 week sessions,+ a full day silent retreat, 2013) 3 day silent retreat (2013)

Clinical Benefits for Social Work Practice Deeper level of awareness and noticing Attitude that is less judgmental, more accepting Taking a more reflexive, less reactive stance Cultivation of compassion, empathy Decreased stress, improved well being Sense of interconnectedness

Mindfulness and the Therapeutic Relationship Being” mode vs “Doing” mode Therapeutic alliance/Therapeutic presence Open and egalitarian relationship with client Steven Hick and Thomas Bien, 2010

Patients and fellow practitioners MBCT - TBI Research team MBCT and MBSR trainers The Ottawa Hospital Rehab Centre-Medical team and Management support Tel” , ext: Ottawa, Canada Acknowledgments and Contact Information