mit-c for children, adolescents and families
DESCRIPTION
Mindfulness Informed Therapy for Children, Adolescents and FamiliesTRANSCRIPT
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Children, Adolescents and Families
Cameron AggsDr. Danielle McCarthy Mindfulness Training Australia
Copyright (c) 2013 Freya Combes and Mindfulness Training Australia, All Rights Reserved | MiT - Mindfulness Informed Therapy
Australian College of Community Services
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OverviewSession 1:
Components of mindfulness and key concepts
Session 2:Developmental considerations
Session 3:Challenges of childhood and adolescence (with case
studies)
Session 4: Facilitation practice
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Aims....Theory: To present an overview of mindfulness and
applicable developmental considerations that
scaffolds integration of MiT-C concepts and practices
Experiential: To provide a space for you to
experience mindful state of consciousness, to give you
techniques and concepts to help you get back there:
Both independently and when working with clients.
Resources: To provide exercises and resources to get
you forming new habits and practicing in new ways
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | [email protected]
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MethodsPowerpoints
COS Worksheets
Video
Brief Meditations
Participation in brief meditations is voluntary
Evoking mindfulness as the best method for learning
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | [email protected]
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MindfulnessWhat is it?
How does it enhance the process and content of working with clients?
Mindfulness and Emotion RegulationWorking through difficult emotionsKnowing and Naming
The importance of Scaffolding…
Modeling Mindfulness: Using your faculty of attention and your willingness ‘feel into’ experience as tools.
What does it mean to be present?Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | [email protected]
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Working with Therapist Factors
Who among us can evoke a state of
presence at will?
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | [email protected]
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True…?
“The mind if not stirred, will become clear”
-Sogyal Rinpoche
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | [email protected]
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What is Mindfulness……?
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“Bringing one’s complete attention to the
experiences occurring in the present moment,
in a nonjudgmental or accepting way”
(Brown & Ryan, 2003; Kabat-Zinn, 1990).
A Definition of Mindfulness…
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Our “map”: IAA model of mindfulness
(Shapiro et al., 2006)
Intention
Attention Attitude
Paying attention in a particular way…
Kabat-Zinn, 1994, p4
and non-judgmentally.
on purpose, in the present moment,
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Holding in Mind: IntentionsWhat do you want from mindfulness?
This moment…?
This meditation / workshop / this session…?
More generally inc this treatment episode?
Tip #1: Mindfulness is an intentional activity
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Attending SkillsPlacing your attention where you want it…
Attentional placement:Shifting and sustaining attention
Non-judgmental Awareness Inhibiting secondary appraisals
Noticing and Naming Ability to put inner experience into words
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Attending: Using your faculty of attention as a tool: Disengaging
from worry and rumination
Inwardly: Fostering Internal Attunement / Meta-Cognitive Awareness: What’s happening for me now..?
Outwardly: Promoting the ability to use relationships and the world around us to heal and
To come into a state of “Presence”
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What do we really mean by ‘being present’?
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Presence….
What are the qualities of that?
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3 Qualities of Presence
Light: As in buoyant in the Mind Unencumbered by past and future and fixation
Relaxed: As in soft in the body Particularly the belly, chest, shoulders, jaw
Grounded: The bum in the chair and the feet on the floor Mind ‘riding’ the breath
Light. Relaxed. Grounded.
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4 Breaths TechniqueComing into a state of presence:
Lightly, mindfully watching the breath
Coordinating with the fingers: Motor-movement
Rounds of 4
Combine with FBB technique
“These 4-Breaths are Mine”
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“The mind if not stirred, will become clear”
Sogyal Rinpoche
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Mindful Attitudes: More than just Attention
The anesthetic of internal attunement….
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AttitudesGOAL
Curiosity :
Openness
Acceptance
Love
Metaphor / key principles
Curious Explorer
“It is already here: Let me feel it
As an active state
Friendliness
Saying ‘Yes’ to Experience
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Focusing on Acceptance
It’s an intentional activity…
Saying “Yes” to experience
- Tara Brach
“It’s already here…. Let me feel it”
-John Kabat-Zinn
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | [email protected]
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Learning to let it flow…
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | [email protected]
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2-Step process
Before ‘Letting-flow’, we must chart the course of this stream. We must know its texture…. The feelings, the pain of it, the impact. We must learn how to make a space for it as it is.
= Acceptance
Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | [email protected]
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3 Minute Breathing Space = Making a Space for What is Happening now
Step 1: Taking stock / Gathering the mind
Step 2: Focusing and redirecting the attention
Step 3: Expanding awareness and returning
Hot tip: Bookmark: youtube “3 minute breathing space” (it’s the first one that comes up)
Experiential Exercise: 3MBS:
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I-SIFTI (me)
Sensations
Images
Feelings
Thoughts
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“Mindfulness is an intentional activity which consists
of:
1. Bringing one’s complete attention
2. To the present moment,
3. In a nonjudgmental or accepting way”
Recapping So Far….
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Mindfulness Pro’s and Cons
Positives
Transportable
Immediate
Experiential
Stretches the full continuum of mental health experience
Formal and informal practices
Disadvantages
Intentional (forgetting is a big problem)
Difficult to operationalise and explain
We can be “dissmissing” sometimes when using it
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The process of mindfulness (the WHAT and HOW)
Noticing and naming with
mindful attitudes (internal & external
experiences)
Letting go (creating space)
Focus/Re-focus
attention
Choose an aspect of internal or
external experience to
focus attention on
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Embodied Mindfulness
Applying Mindfulness: Who
Teaching Mindfulness:Child’s independent practice
Adults and children
Increasing capacity with age (and development) for children to engage in independent mindfulness practice
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WhyGreater mindfulness associated with lower:
Depressive symptoms
Anxiety
Stress
Internalizing symptoms
Externalizing behaviour problems
Worry and rumination
Negative affect
Substance use coping
Somatic complaints
Psychological inflexibility and thought suppression and control
Mindfulness interventions resulting in lower:
Depressive symptoms and low mood
Anxiety
Stress
Internalizing symptoms
Externalizing behaviour problems
Difficulties with emotion regulation
Problem behaviours in the classroom
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WhyGreater mindfulness associated with higher:
Healthy self-regulation
Emotion regulation
Positive affect
Quality of life & life satisfaction
Social skills
Academic competence
Mindfulness interventions resulting in greater:
Feelings of calm/relaxation
Social skills
Personal and social well-being
Self-esteem and self-acceptance
Awareness and recognition of types of emotions
Attention and executive functioning
Self-efficacy for reducing substance use
Sleep
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Where does MiT-C fit?
Mindfulness-informed interventions
• MiT-C: utilising and integrating your existing clinical skills into a mindfulness framework•Acceptance and Commitment Therapy (ACT)
• Dialectical Behaviour Therapy – adolescents (DBT-A)
Mindfulness-based interventions
• Mindfulness-based stress reduction for children (MBSR-C)
• Mindfulness-based cognitive therapy for children (MBCT-C)
• Independently developed mindfulness programs
Embodying and modeling of mindfulness with clients
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MiTTherapy process skill: Embodying mindfulness
Intervention technique: eg 2-hands, 4-breaths, Metaphore, POC exercise, 3-Minute Breathing Space, Body Scan, Working with DiscomfortFlexible delivery of client-centred techniquesUse of mindfulness in assessement,
psychoeducation, intervention, and in the relational space
Targets Emotional Regulation capacity
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Central Concepts, Psycho-education and Debriefing
Internal experiences (reactions) occur Thoughts, feelings, body sensations, urges to act
Internal experiences are transient and change with time
Acknowledges that “negative” thoughts and feelings are experienced by everyone
Experiential avoidance
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Developmental Modifications: Psycho-education in child friendly terms
Things happen inside of us (thoughts, feelings, body sensations, urges to act). These things change with time (e.g., intensity, location).
Most people find it difficult to control feelings and thoughts that pop into our heads.
How we feel about (and relate to) what happens inside of us is important.
Sometimes people see certain thoughts and feelings as “bad”. When we mindfully notice our thoughts or feelings we see them just as thoughts or just as feelings.
There is a difference between describing and judging what is happening inside of us.
“Creating Space” (instead of defusion, decentering and reperceiving)
Creating Space allows us to choose our reaction
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The Three Rs of Mindfulness
Release the mind from ‘too much
thinking’ and/or the struggle against
‘what is’.
Relax the body, notice your breathing.
Return to this moment; where you have
all the resources you need…
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Developmental considerations
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Developmental Considerations
Receptive language skills are needed
Concepts can be abstract
Mindfulness inherently uses skills that are less well developed in children and adolescents than adultsLanguage (understanding and expressing themselves)Meta-cognition Executive function and attention skills
Mindfulness practice builds on developmental capacities (e.g., attention and executive function)
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Principles of Developmental Modifications
Matching the mindfulness practices to the developmental needs of the child/adolescent
7 years: selective attention develops and self-talk is becoming internalised Enables focused attention practices
10 years and onwards: dual attention skills developingMore capable of noticing internal and external experiences
simultaneously
Adolescence: increase in abstract thinking, attention and executive function skills Easier to understand abstract concepts inherent in
mindfulness
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Mindfulness Practices: Building Blocks
Sensory information
FeelingsThoughts
Breath
Focused attention practices
Body sensations
InteractionsDual attention practices
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Developmental Modifications: Language
Use developmentally appropriate/child friendly language
Scaffold descriptive language with word lists or visuals
Slowing down
NOTICING and NAMING
what is happening RIGHT HERE, RIGHT NOW
Being CURIOUS about what is happening for you
Being WILLING to feel
Being KIND to yourself & don’t judge yourself for what you are experiencing
LETTING GO
CREATING SPACE TO CHOOSE
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Child Friendly IAA terms
Intention
Attention Attitude
Focusing/refocusing on the here and now
Noticing and naming
Letting go and creating space
Checking in
Curiosity
Kindness
Willingness
Choosing
Slowing down
Remembering
Knowing why
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Developmental Modifications: Psycho-education in child friendly terms
Things happen inside of us (thoughts, feelings, body sensations, urges to act). These things change with time (e.g., intensity, location).
Most people find it difficult to control feelings and thoughts that pop into our heads.
How we feel about (and relate to) what happens inside of us is important.
Sometimes people see certain thoughts and feelings as “bad”. When we mindfully notice our thoughts or feelings we see them just as thoughts or just as feelings.
There is a difference between describing and judging what is happening inside of us.
“Creating Space” (instead of defusion, decentering and reperceiving)
Creating Space allows us to choose our reaction
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Developmental ModificationsUsing metaphors to illustrate and explore
mindfulness conceptsKeep it simpleDon’t overload with too many or varied
metaphorsUse of visual props
Length of practices
Kids want to (and will) move Formal ‘mindful movement’ exercises ‘Curious’ observation of urge/intent to move and of the
actions when they do move
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Debriefing What level of structure do they need in the debrief?
Will they get lost in verbal discussion? Use a visual prompt or debrief sheet? Use an expressive debrief (e.g., using line, colour and shape in a body
outline to represent the practice experience) or a written reflection? Can they identify the difference between thoughts, feelings and body
sensations?
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Developmental Modifications: Debriefing
Can they recall and verbalise their experiences? Did they report that they “noticed nothing”, that they
“can’t remember” or answer “I don’t know”? Normalise that many children and adolescents find it
difficult to be able to notice and then describe what occurred for them
Future intervention: Facilitate an experience of them being able to notice and
name something that is happening for them right nowExample:
choose a relevant sensory system and create a situation where there is a change in the input
highlight a concrete physical sensation that they are likely to be feeling. Suggest a range of possible adjectives and ask them to identify a few relevant words
Dialoguing to build in situ verbal reporting skills
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Mindfulness Practice: 2 Hands
Place one hand is on the chest and the other hand on the abdomen.
Breathe and notice:Where is the breath moving? Is the breath deep or shallow? Fast or slow?Which hand is moving more?
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Mindfulness Practices: 4 Breaths or Breath Counting
With each breath touch the thumb to finger-tip and note an experience. As you begin a new breath move your thumb to the next finger.
Notice (with curiousity): 4 breaths 4 external experiences
sensory information like sights, sounds, smells, what they are touching 4 internal experiences
thoughts feelings, body sensations, urges A combination of internal and external experiences
The process of ‘letting go’ by moving your fingers physically ‘creates space’.
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Mindfulness Practices: Sensory Information
Sight and touch
Sound
Taste
Movement
Identify the sense or sensory system that is to be the focus of the practice.
Notice: Physical sensations or
describing words Whether the sensations or
experiences change in intensity, location or size
Automatic judgments (thoughts)
Debrief: Did they noticed their attention
shifting to, or being caught in, other internal experiences (thoughts and feelings) during the practice
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Mindfulness Practice: Mindful Movement
Notice: the physical sensations involved in the movement
(including the sense of pressure and weight)the way that sensations change during the stages
of the movementthe sense of body as a whole
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Challenges of childhood and adolescence
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Formulation of DisordersDisorder Fusion with thoughts
and feelingsExperiential Avoidance
Anxiety Worry & future focused thoughts (“what if…”)
Avoiding anxiety provoking situations.
Depression Rumination & past focused thoughts.Negative view of self, world and future.
Maladaptive coping strategies to manage feelings.
Anger and externalising behaviour
“I can’t control it”“It happens so fast”“It’s not fair ”“It’s not my fault”
Of own distressing feelings. Of owning responsibility.
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AnxietyIntention Attention Attitude
Slowing down Focusing/refocusing on the here and now
Curiosity
Remembering Noticing and naming Kindness
Choosing Letting go and creating space Willingness
Knowing why Checking in/checking out
Practices and Considerations for Intervention Planning
Checking In (thoughts, feelings, body sensations, urges)/Triggering relaxation response: 2 Hands, 4 Breaths, POC, 3MBS
Psychoeducation about experiential avoidance
Mindful exposure (thoughts, feelings, and behaviour)
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Case Study: AnxietyChild
9 year old male
Presenting difficulties: Separation anxiety When mother drops child
at school in the morning, child becomes distressed – crying, begging mum to stay, saying he feels sick – and not wanting her to go.
Adolescent
15 year old female
History of bullying
Presenting difficulties: Can talk to adults without
difficulties Experiences difficulties talking
with same-aged peers Avoids or tries to avoid going
to social events (e.g., parties), outings (e.g., to the beach) and school activities (e.g., giving a speech in class).
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Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | MiT - Mindfulness Informed Therapy
Case Study Points For Discussion
Developmental and/or systemic considerations
Formulation
Mindfulness-informed intervention plan
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DepressionIntention Attention Attitude
Slowing down Focusing/refocusing on the here and now
Curiosity
Remembering Noticing and naming Kindness
Knowing why Letting go and creating space Willingness
Choosing Checking in/checking out
Practices and Considerations for Intervention Planning
Checking In (thoughts, feelings, body sensations, urges)/Triggering relaxation response: 2 Hands, 4 Breaths, POC, 3MBS
Risk Assessment & Planning
Behaviour Activation
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Case Study: Depression Adolescent
15 year old female
History of bullying
Parents divorced 5 years ago
Presenting difficulties: Low mood Poor sleep Lethargy Reduced appetite (although some emotional eating) Reduced concentration and motivation Loss of pleasure in previously enjoyed activities Suicidal ideation – suicidal thoughts; no plan or intent
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Anger and Externalising Behaviour
Intention Attention Attitude
Slowing down Focusing/refocusing on the here and now
Curiosity
Remembering Noticing and naming Kindness
Choosing Letting go and creating space Willingness
Knowing why Checking in/checking out
Practices and Considerations for Intervention Planning
Checking In (thoughts, feelings, body sensations, urges)/Triggering relaxation response: 2 Hands, 4 Breaths, POC, 3MBS
Mapping warning signs
Choosing a helpful expression of feelings
Sensory and movement practices
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Mindfulness Practices: situational training for identified triggers
Soles of the feet Asking clients to breath naturally and then
remember an anger-provoking incident. Notice bodily signs of anger Shifting attention to the soles of the feet (a neutral
part of the body)
Standing StrongSoles of feet up to abdomen to check-in with the
speed and depth of their breath
Role Plays
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ADHDIntention Attention Attitude
Slowing down Focusing/refocusing on the here and now
Curiosity
Remembering Noticing and naming Kindness
Choosing Letting go and creating space Willingness
Knowing why Checking in/checking out
Practices and Considerations for Intervention Planning
Checking In (thoughts, feelings, body sensations, urges)/Triggering relaxation response: 2 Hands, 4 Breaths, POC, 3MBS
Mapping signs of being “off task”. Use of visual cues. Nonverbal or visual signal between child and adult (parent/teacher) that attention has wandered.
Sensory and movement practices
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Case Study: Anger &Externalising Behaviour
7 year old boy
ADHD
Presenting difficulties:Suspensions at school due to aggression towards
peers Aggressive at home when he doesn’t get what he
wantsAggressive behaviour: hitting, yelling, swearing,
throwing objects
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Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | MiT - Mindfulness Informed Therapy
Accessing ResourcesPassword Resources: See feedback form
3R’s Meditation: http://bemindful.com.au/general/download/
Youtube: ‘Hidden Holding / Always Held’
Youtube: 3 Minute Breathing Space
Youtube: Rest In Natural Great Peace
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Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | MiT - Mindfulness Informed Therapy
Resources –Books Semple, R.J., & Lee, J. (2011). Mindfulness-Based Cognitive Therapy
for anxious children: a manual for treating childhood anxiety. New Harbinger Publications Inc.
Kaiser Greenland, S. (2010). The Mindful Child. Free Press.
Greco, L.A., & Hayes, S.C. (Eds) (2008). Acceptance & Mindfulness Treatments for Children & Adolescents: A Practitioner's Guide. Context Press.
Miller, A.L., Rathus, J.H., & Linehan, M.M. (2007). Dialectial Behaviour Therapy with Suicidal Adolescents. The Guilford Press.
Schoeberlein, D. (2009). Mindful teaching and teaching mindfulness: a guide for anyone who teaches anything. Wisdom Publications.
McCurry, C. (2009). Parenting your child with mindfulness and acceptance. New Harbinger Publications Inc.
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Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | MiT - Mindfulness Informed Therapy
Resources – Story Books Nhat Hanh, T., & Vriezen, W. (2008). Mindful Movements: Mindfulness
Exercises Developed by Thich Nhat Hanh and the Plum Village Sangha. Parallax Press. [Mixed media product – includes DVD]
Nhat Hanh, T., Plum Village Community & Vriezen, W. (2011). Planting Seeds: Practicing Mindfulness with Children. Parallax Press. [Mixed media product – includes CD]
Nhat Hanh, T. (2012). A Handful of Quiet: Happiness in Four Pebbles. Parallax Press.
Bowden, T., & Bowden, S. (2010). I just want to be me! Building resilience in young people. Exisle Publishing Limited. [Aimed at adolescents]
Alderfer, L. (2011). Mindful monkey, happy panda. Wisdom Publications. [This storybook is aimed at children in early-mid primary school]
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Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | MiT - Mindfulness Informed Therapy
Thank You!
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Additional Material
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Copyright (c) 2013 Mindfulness Training Australia, All Rights Reserved | MiT - Mindfulness Informed Therapy
Metaphors
Metaphor Target area
Clouds in the sky Concepts of mindfulness and ‘creating space’
Leaves on a stream
Concepts of mindfulness and ‘creating space’
No pest control Attitude of non-judgement and ‘creating space’ to allow (rather than trying to control or change) experience
Spotlight/Torch Attention in mindfulness practices
Puppy on a leash Nature of attention and attitudes of kindness
Train of thought Nature of thoughts and ‘creating space’
Thought parade Nature of thoughts and ‘creating space’
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Using MetaphorsClouds in the Sky
Mentally “placing” internal experiences (usually thoughts) on the object and allow it to move (or not move) as it naturally wants to. Does … (object) stick around? Does it feel ok if … (object) is not moving on?
Background (sky) is ‘observing self’/‘self-as-context’ Noticing that the background can observe the objects that
move through it Are you the … (object) or the … (background)? [‘self-as-context’
rather than ‘self-as-content’]
If the child has the capacity, you can link other internal experiences (e.g., feelings) to other objects/events that occur in the background Are you still able to be … (the background) even when …
(feeling) is also happening?
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No Pest Control(reactions happen)
Imagine your distressing or unwanted thoughts, feelings, body sensations are like … cockroaches…
Being able to let the experience be… Not feeling bad that it is here Not trying to get rid of it Not running away from it Not letting the cockroaches control how you act Not trying to make the experience positive (e.g., a butterfly)
Being ok with the experience coming and going… like cockroaches running around you...
Being able to notice the experience and still being able to chose what to do
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Nature of AttentionSpotlight
Shining light on where you want to focus your attention
Puppy on a leash
Like a puppy attention naturally wanders (jumps around)
It takes time to train a puppy (attention) to be able stay in the one place for any length of time
Getting angry at the puppy doesn’t help
Be kind to your wandering mind
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Train of thoughtThoughts don’t stop and they often jump from
one topic to another.
The train of thought can be fast or slow
Creating Space: “Are you standing on the platform or are you riding on the train?”
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Thought Parade