Principles and Application of Mindfulness and Art Therapy Amee Le| Occupational Therapist | November 2014

Agenda

• Mindfulness & Brain Injury Research

• What is Mindful Art Workshop?

• Group Protocol

• Weekly Themes

• Outcome Measures

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Learning Objectives

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Be inspired to consider these useful tools in your current programs and adding them to your treatment toolbox.

Be familiar with how mindfulness and art therapy can be combined into an effective clinical program.

Appreciate the value of using mindfulness for persons with cognitive impairments.

Mindfulness, Group Therapy & Brain Injury

Mindfulness-Based cognitive therapy reduces symptoms of depression in people with a traumatic brain injury: Results from a randomized controlled trial

• Bedard et. al. (2013)

• Mindfulness based cognitive therapy (MBCT) by Segal et al. (2002)

• Reduction in depression

• Maintained at the 3 months follow-up

A Pilot Study Examining the effects of Mindfulness-Based Stress Reduction on Symptoms of Chronic Mild Traumatic Brain Injury/Postconcussive Syndrome

• Azulay et al. (2013)

• Mindfulness based stress reduction (MBSR) by Jon Kabat-Zinn (2009)

• Improvement in perceived quality of life scale especially in management of cognitive, emotional symptoms

• Statistically significance aspects of working memory and regulation of attention

A Randomized Controlled Trial of Mindfulness Based Art Therapy (MBAT)

• 93 women with a cancer diagnosis

• Exclusion criteria: terminal, concurrent psychiatric diagnosis of major mood disorder, psychotic disorder or significant cognitive deficits

• 8 weeks MBAT psychosocial group or wait list control group

• Consecutive weekly meetings; two and a half hours long

• Sessions are standardized in format using a manual

• Decreased in symptoms of distress

• Improvements in quality of life

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A Randomized Controlled Trial of Mindfulness Based Art Therapy (MBAT) Monti et al. (2006)

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• Body scan meditation, sitting meditation, gentle Hatha yoga, walking meditation

Mindful Meditation

• Drawing (coloured pencil, marker, pastel, watercolor crayon, paint), collage, open studio Art Activity

• Practice mindful meditation for 6 days a week for 30 minutes by using guided audiotape

• Recommendations for reading to support Mindfulness curriculum were offered

Home Assignment

I s a t h e r a p e u t i c w o r k s h o p

f o r c l i e n t s w i t h a n

a c q u i r e d b r a i n i n j u r y .

T h e p r o g r a m t e a c h e s c l i e n t s

t o u s e p r i n c i p l e s o f

M i n d f u l n e s s & M e d i t a t i o n

a n d A r t T h e r a p y

t o c a r v e e r a s e r s t a m p s a n d

c r e a t e p r i n t s .

G

O

A

L

To facilitate acceptance by creating a safe space where participants can engage in

the process of finding meaning through shared experiences.

Can’t Stop Tomorrow by Fiona

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Group Protocol

1 Introduction & Journaling

2 Breathing Meditation

3 Mindfulness Lesson & Meditation

4 Art Instruction & Seated Yoga

5 Art Class & Group Support

6 Gratitude

9 Everybody Needs Love by Henry

Group Structure Eight consecutive weeks

Two hours long

Mindful Meditation includes: breathing meditation, mindfulness meditation, and yoga movement meditation

Art Activity includes: carving linoleum or erasers & stamp pads for printing

Blog: Sharing the blog posts of the participant’s artwork, gratitude quotes and mindfulness themes

No Homework

10 Life by Neil

Tools of the trade

12 Art Journaling Toyota, One Fish, Two Fish by Orlando

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Storms by Roxanne

Storms, Strength and Wisdom

REM – Forward by Micky

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The Beautiful Sunshine by Maria

Black & White Thoughts

When the Walls Come Down by Fiona 15

Wishes and Releases

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Art Collage by Chris

Depression, anxiety, stress scale (DASS)

Subject Measure Pre Post

1 Depression Severe --

Anxiety Normal --

Stress Moderate --

2 Depression Moderate Normal

Anxiety Mild Normal

Stress Mild Normal

3 Depression Severe Severe

Anxiety Moderate Normal

Stress Moderate Moderate

• The DASS is a 42-item self report instrument

• The DASS questionnaire is in the public domain, and may be downloaded from this website.

• Measures were gathered before the workshop and at the end of the workshop

General Self Efficacy Scale

• It assesses the strength of an individual belief in his or her own ability to respond to novel or difficult situations and to deal with any associated obstacles or setbacks.

• Higher scores equals greater self efficacy

• T-Norms for Heterogeneous Adult Population

• Measures were gathered before the workshop and at the end of the workshop

Subject Pre T scores Post T scores

1 40 42

2 44 49

3 48 51

T-Test P Value Statistical Significance

-3.33 0.063 Approaching Significance p=0.06

Outcome Scales

Measures Subject 1 Subject 2 Subject 3 Subject 4

Relaxation NSS p<0.01 p<0.01 NSS

Focus NSS p<0.05 p<0.01 NSS

Mindfulness NSS p<0.01 p<0.05 NSS

Heaviness NSS p<0.05 p<0.05 NSS

Tension NSS p<0.05 p<0.05 NSS

• Single Case Research

• NAP (Nonoverlap of All Pairs) Statistic

• Scale was gathered before the session and after the session

• Results were analyzed contrasting all the pre-session scores with post-session scores

Satisfaction Survey

Measures Strongly

Agree Agree Neutral Disagree

Strongly Disagree

I enjoyed the gratitude exercise 75% 25%

I have a better understanding of myself after the workshop

50% 25% 25%

I found the breathing exercises easy to learn 50% 25% 25%

I found the breathing exercises helped me in my day to day activities

25% 50% 25%

I feel connected to others during the workshop 50% 50%

I am more aware of other people’s feelings and perspective after the workshop

50% 50%

I enjoyed the art exercises 75% 25%

I found the art exercises easy to learn 75% 25%

“I am thankful for my life, for being alive.

Thankful for all the wonderful people who have helped me, and continue to help me.

I am thankful for my family and thankful that I’ve met all of you guys here.

I look forward every Thursday to come here.”

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Brain Injury – A journey with many voices…

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Brain Injury – A journey with many voices…

Outcome Measures

• Depression, anxiety and stress scale (DASS) http://www2.psy.unsw.edu.au/groups/dass/

• Self Efficacy Scale http://userpage.fu-berlin.de/health/selfscal.htm

• Relaxation Thermometer

• Satisfaction Questionnaire (Adapted from the Patient Satisfaction Survey: Pulmonary Rehabilitation and Balance Training Exercises at West Park which as adapted from: The Pulmonary Rehabilitation Toolkit: An Initiative of the Australian Lung Foundation and Australian Physiotherapy Association)

References • Austin, J.J. (1998). Zen and the Brain. Cambridge, Massachusetts, London, England: The MIT Press

• Azulay, J., Smart, C., Mott, T., Cicerone, K., (2013). A Pilot Study Examining the effects of Mindfulness-Based Stress Reduction on Symptoms of Chronic Mild Traumatic Brain Injury/Postconcussive Syndrome. Journal of Head Trauma Rehabilitation, Lippincott Williams & Wilkins

• Bedard, M., Felteau, M., Marshall, S., Cullen, N., Gibbons, C., Dubois, S., Maxwell, H., Mazmanian, D., Weaver, B., Rees, L., Gainer, R., Klein, R., Moustgaard, A. (2013). Mindfulness-Based cognitive therapy reduces symptoms of depression in people with a traumatic brain injury: Results from a randomized controlled trial. Journal of Head Trauma Rehabilitation, Lippincott Williams & Wilkins

• Bedard, M. Felteau, M., Gibbons, C., Klein, R., Mazmanian, D., Fedyk, K., Mack, G. (2005), A Mindfulness-Based intervention to improve quality oflife among individuals who sustained traumatic brain injuries: one year follow-up. The Journal of Cognitive Rehabilitation, 8-13

• Chodron, P. (1997). When Things Fall Apart: Heart Advice for Difficult Times. Boston, MA: Shambala

• Geshe, K.G. (2009). Eight Steps to Happiness; the Buddhist Way of Loving Kindness. Glen Spey, NY: Tharpa Publications

• Geshe, K.G. (2013). How to Solve Our Human Problems. Glen Spey, NY: Tharpa Publications

• Hanh, T.N. (1991). Old Path Whilte Clouds. Berkeley, CA: Parallax Press

• Hanh, T.N. (1998). The heart of Buddha’s Teachings: Transforming Suffering into Peace, Joy and Liberation. New York, NW: Broadway Books.

• Hanh, T.N. (2006). Understanding Our Mind. Berkeley, CA: Parallax Press

• Hye, M.J., Sung, J.L., Yong, G.C., Young, S. (2010). Effects of mindfulness based stress reduction program on depression, anxiety and stress in patients with aneurysmal subarachnoid hemorrhage. Journal of Korean Neurosurgical Society, 47, 345-351

• Monti, D.A., Peterson, C., Kunkel, E.J.S., Hauck, W.W., Pequignot, E., Rhodes, L., & Brainard, G.C. (2006). A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psycho-Oncology, 15, 363-373

• Segal, ZV., Williams, JMG, Teasdale JD. (2002). Mindfulness-Based Cognitive Therapy for Depression. A new approach to preventing relapse, New York, NY: The Guilford Press, 2002 25

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