Is Your Mindfulness Program Trauma-Sensitive? 3 reasons you need to know and 3 questions to ask.

It was a busy day in the week about 16 or 17  years ago. Emails were still clunky communication channels, which was good because the voicemail I was listening to carried all the emotions we miss in typescript. She was scared, she said. Having a hard time breathing. After a treatment program. Meditation. Mindfulness. Please call.

Back then, I wasn’t a fan of mindfulness-based programs – a seemingly new-fangled, somewhat New-Age-ish approach to treating mental health difficulties. There was little research to support it as a psychological treatment and, what seemed to me, a whole lot of blind enthusiasm for it. As a long-time meditator, I was also resistant to the idea of bringing something that was clearly a spiritual practice into a healthcare field with its clear rules against imposing religious or personal spiritual practices on our patients/clients.

When I met with the caller, I was ready for a story of incompetence and cult-like indoctrination by the people offering the program. It wasn’t that simple. The mindfulness program had been offered by someone with current training (training is very different now) and the meditations were within the range of what any professional trained in psychological approaches would use as relaxation response or calming breath strategies. And yet, the program had triggered something very distressing for her. From the first day of the program and until she left abruptly, she experienced panic attacks, a sense of being separate from the immediate environment, disembodied, and had nightmares. She didn’t inform the facilitator nor had there been any follow-up when she stopped attending the classes. When I asked, she described having been told in the second class, during a homework review when she disclosed her reaction to the Body Scan, that she simply had to “stay with it”. There were reassurances that “it will pass” and “just sitting with it” would resolve the feelings of anxiety.

This initial case became one of many over the years. Buddhist practitioners who had gone to silent retreats, mindfulness-seekers attending 8-week programs or short intense versions of the same, long-term meditators who suddenly found themselves in whirlpools of distressing emotional and physical experiences. They spoke of feeling like failures in their spiritual practices; angry and betrayed that something intended to relieve psychological distress had caused more suffering. They all had one question: Why were they not warned?

Why is knowing about adverse psychological experiences (APEs) important? Here are five reasons.

Reason 1: It’s not new.

That spiritual practices can lead to distress has been known for as long as spiritual practices have been around. My colleague, Jane Compson¹, discussed the different ways spiritual practitioners view these periods of intense distress.

(A) psychiatrist trained in Western allopathic medicine may judge that the distress is symptomatic of mental illness exacerbated by meditation, and suggest that the person stop meditating.  A Buddhist teacher, on the other hand, may understand the distress as a sign that the meditator is progressing through stages of insight towards liberation of suffering, and suggest more meditation or auxiliary practices as a way of moving through this stage.

She calls for a greater awareness of these APEs because their potential for harming the individual practitioner raises ethical issues of whether and how to offer meditation practices in any setting, spiritual or secular.

Reason 2: It can happen independently of experience or context.

Buddhist scholar/researcher Jared Lindahl, neuropsychologist Willoughby Britton and their colleagues² published what is likely the first in-depth examination of APEs among meditators. They reported that among Western Buddhist meditators

More than a quarter (29%) of practitioners first encountered challenges within their first year of practice, almost one half (45%) between 1±10 years of practice, and one quarter (25%) after more than 10 years of practice.

Challenges occurred during or immediately following a retreat for 43 practitioners (72%). The other 17 practitioners (28%) reported challenging experiences in the context of daily practice. About three-quarters (72%) of participants were regularly practicing within a meditation community or were working with a teacher (75%) when challenging experiences arose.

While we may think that spiritual practitioners experience a different context and intensity of meditation, Lindahl and colleagues point out that

…a number of participants also reported challenging or difficult experiences under similar conditions as MBIs, that is: in the context of daily practice; while meditating less than 1 hour per day, or within the first 50 hours of practice; and with an aim of health, well-being or stress-reduction. Some types of practice associated with challenging meditation experiences were in many cases not dissimilar from the primary components of MBIs.

Reason 3: Awareness of psychological and trauma history is important

More relevant to our discussion here, in Lindahl’s study 32% had a psychiatric history and 43% had a trauma history. They are careful to indicate that prior histories are not necessarily predictive or considered risk factors. At the same time, we know enough about the way psychological challenges, in particular, trauma, are processed that some caution is advisable.

This is where things get really complicated. Many of us may not know that or don’t see ourselves as having experienced trauma. While I do get irritated when some authors equate the “trauma” of burnt toast to the level of aversive childhood experiences (ACEs) that lead to significant debilitation in adulthood, trauma is an historic reality for many of us. The challenge is when we are so functional that we, ourselves, no longer view our history as “traumatic”. We may well have rebounded from it in healthy ways and feel it is something in our past.

But the body knows the trauma differently.

This is where being trauma-informed as a mindfulness therapist and as a mindfulness consumer is very important. The following three questions may help to be trauma-informed and know if the program you are considering is trauma-sensitive.

Question 1: Is the program trauma-sensitive?

This is actually a pre-program question. Ask the facilitators if they are informed of the potential challenges someone with trauma may encounter. Practices such as the Body Scan can evoke reactions if the participant has a history of physical or sexual abuse. Meditations that drop into deep relaxation and open the field of awareness can be anxiety-provoking. What are the facilitators’ approaches should this happen – in the classroom or between classes?

Question 2: What do certain terms mean?

“Just sit with it” or “turn towards the distress” are typical suggestions when participants are feeling distressing sensations or emotions. For the most part, they are acceptable suggestions or invitations to develop distress tolerance. However, if the distress escalates quickly or becomes too intense, these are not the best first line of practice. Ask for clarity and expect responses that are in everyday language.

Question 3: What practices are being taught to help when APEs occur?

Every program is different however there should be a component of grounding practices, resetting the physiology (using the breath), and/or adaptations to typical approaches in meditation. Can you open your eyes if things get activating internally? Can you stand, step out of the room and return, or care for yourself in some way that respects your needs and those of other participants? Can you meet with the facilitator after the class or, if you need to, during the week?

Mindfulness programs can be very helpful and life-changing. Our role as facilitators is to ensure that these practices can change your life in the right direction. Our role as participant is to feel safe and supported as we go along this path of practice.

Recommended Book: Trauma-Sensitive Mindfulness: Practices for safe and transformative healing by David Treleaven, W.W. Norton & Company


  1. Compson, J.C. (2018). Adverse Meditation Experiences: Navigating Buddhist and Secular Frameworks for Addressing Them. Mindfulness, http://link.springer.com/article/10.1007/s12671-017-0878-8
  2. Lindahl et al., (2017). The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLoS ONE 12(5): e0176239. https://doi.org/10.1371/journal.pone.0176239

February is Psychology Month: Who needs psychotherapy?

Let’s talk!

Sometimes we just need a place where we can say what’s in our heart and mind without fear of being ridiculed or punished. Psychological services such as psychotherapy offer that opportunity. It’s a chance to examine how our thoughts, feelings, and actions come together either to help or hinder us in our relationships.

Psychologists offer many forms of therapy – most of which have a strong evidence-based support. That means, there is research supporting the effectiveness of the treatment. Some therapies are in the growth process – mindfulness is one of them – and have a base of moderately supportive evidence; however, we have to be aware that the media hype may be exaggerating the effectiveness.

If there’s one reason people seek out psychotherapy, it’s to feel validated in their thoughts and feelings. That doesn’t mean they’re looking for someone to say they’re right about what they feel or believe. Therapy is an opportunity to test out how well-supported our strong feelings and beliefs are.

Sometimes, we need that support so we can make decisions about our lives. A relationship may not be working out or be unhealthy for us. An education or career path may seem to be the wrong choice and needs an unbiased person who can help us hear our deepest desires.

 

 

 

Of course, sometimes we need to examine our strongly-held beliefs because they may be ways of seeing the world and others that are not working anymore.

 

 

 

 

The Canadian Psychological Association offers this information page to help us understand important aspects of effective psychological treatment.

You can also go through the Psychology Works Fact Sheets here. These pages give information on many issues psychologists can help with.

 

Here’s a chart by the Ontario Psychological Association that shows how different healthcare professions can help:

Mostly, as Psychologists, we hope we can offer you a chance to just be appreciated for who you are.

 

 

 

 

(Sorry, our Regulatory College doesn’t allow us to lick your face. But we can offer soft tissues and a glass of water or tea!)

Viewpoint Psychotherapy offers mindfulness workshops

Siobhan Nearey, Registered Psychotherapist and OMC-trained mindfulness teacher, has opened her private practice! Please visit Viewpoint Psychotherapy for information on the terrific workshops she will be offering.

 

DE-STRESS YOUR SPRING

Three one-hour talks with Siobhan Nearey, Registered Psychotherapist, about reducing your stress and putting the spring back into your step!

Special rate: All three talks for $60. Please email talks@vpt123.ca for discount code.

Please subscribe to our newsletter for more information on events.

So, What’s the Deal with Mindfulness?        Tues, Apr 4, 2017 @ 7:00 pm,  cost: $25               Buy Tickets

Wondering what’s up with mindfulness? Research indicates that it benefits our physical and mental well-being. But isn’t that just one more thing to squeeze into our busy lives?

Coping with Job Stress                                     Wed, Apr 12, 2017 @ 7:00 pm,  cost: $25                Buy Tickets

Are you stressed at work? Isn’t everyone? There’s no magic wand to change our workplaces into supportive and empowering spaces. So, how can you get your life back when work is running you down?

Taking Care of Yourself in a Busy World      Thu, Apr 20, 2017 @ 7:00 pm,  cost: $25             Buy Tickets

Do you find yourself taking care of others, but neglecting your own needs? Do you criticize yourself because you can’t get everything done? Come and learn some self-compassion and self-care techniques that will help you take care of you.

Location: 2487 Kaladar Ave, room 215 (sorry, no elevator)

Call or text: 613-700-4969     Email: talks@vpt123.ca

Special rate: All three talks for $60

Book Review: Siddhartha’s Brain by James Kingsland

sid-brainSiddhartha’s Brain, written by science journalist James Kingsland, opens with what would be a somewhat shocking quote from Ajahn Amaro, a Buddhist monastic in the UK.

We are all mentally ill.

While this should not quite raise the eyebrows of mental health professionals, it is a rather bald (apologies to Ajahn Amaro!) statement to make in public. However, it does set the tone of Kingsland’s book which takes, by turns, an unflinching look at the state of the mindfulness industry today and the roots of its conception in Buddhist teachings. Kingsland presents his work imaginatively. Using the development of the Buddha, Siddhartha, from pampered and protected prince to a teacher of the Eightfold Path to liberation from suffering, he weaves what we know of Siddhartha’s quest and practice into what we know of the results of our current pursuit of liberation through mindfulness. And, it begins with acknowledging that we are all mentally ill.

In this insightful book interlacing the current findings of brain function, mental states, and mental health with the teachings of Buddhist psychology, Kingsland is a craftsman in making neuroscience accessible and presenting it through the lens of contemplative practices. Using the story of Siddhartha Gautama’s own journey to enlightenment, he draws a rich landscape of the merging of Eastern contemplative practice, Western psychology, and contemporary mindfulness.

As a device to introduce us to the roots of contemporary mindfulness and place the history and progress of the Western approach to knowing the mind in that historical context, Kingsland has done a much better job than most writers. Siddhartha’s Brain doesn’t fall into a polemic of modern science or a contemplative holier-than-thou pit; that is refreshing. The writing is crisp and clear, quiet and confident. It invites examination of concepts not by attempting to convince but by introducing perspectives that are easily testable by the reader. Of course, that is in essence the basic teaching of the Buddha: ehi passiko – come and see (for yourself).

Kingsland makes the important point – as have many Buddhist teachers – that one does not have to be Buddhist to meditate or benefit from the practice. In fact, one of the enjoyable aspects of Siddhartha’s Brain is a broader bandwidth than just a Buddhist social and political transmission of wisdom. Kingsland draws from evolution science, psychology, anthropology, and philosophy, weaving them together  with ease. Most poignant for me was his examination of the early beginnings of meditation through the stories of Herbert Benson and the Transcendental Meditation practitioners of Indian guru Maharishi Mahesh Yogi. Benson’s downfall in the community of psychology is a sad part of our collective history and Kingsland’s insight into Benson’s work – that the foundation of all meditation is the evocation of the relaxation response – is a validation of Benson’s valuable work.

I particularly recommend Chapters Three and Four for their lucid descriptions of the roots (The Cloud of Unknowing) and rationale (The Second Dart) for meditation and practice (and a more universal presentation than just a Buddhist one). It’s a bit more of a slog in Chapter Five (The Man Who Disappeared) only because the idea of a “self” that is not fixed in any one definition or role is still alien to our Western senses. Even in psychology today the discussion of identity is a confounding mess with terms like self-esteem, self-image, existential self, categorical self – all of which rests on a concept of a separate(d), individuated entity. Chapter Five will challenge your notions of these variegated and rarefied selves but also introduce you to the social neuroscience that actually supports the observation that there is no fixed unity called a “Self”. As Kingsland puts it:

Thus, from moment to moment, each of us is no more than a unique blend of spices, a homemade garam masala. (p. 101)

My favourite part of the book is the running theme of the Default Mode Network (DMN), a concept gaining much traction in the neuroscience of mindfulness to explain the fluid state of connection/disconnection that can lead to rumination as well as creativity. Kingsland’s description of how the DMN plays a role as our “Self app” that “(posts) repetitive messages of a personal nature on the screen” is a brilliant image of what happens when we wander down those “dark neighbourhoods” noted by the writer Anne Lamott as places she “never goes alone”.

Kingsland continues in Chapter Ten (Wonderful and Marvelous):

The marvel is that we can learn to control at will the signals that determine which track we take at any particular moment. By honing our powers of attention and emotion regulation through mindfulness practice, we can, if we wish, restrict the time we spend in self-focused, narrative mode of thinking that can lead to anxiety and depression. We can choose to take the scenic route, favouring a more experiential mode of being in which we are not held captive by our thoughts but rather treat them as transient mental events. (p. 235)

Now, I do have two quibbles – not with the book itself but the information offered from two sources. First, (p. 249) when inquiring into the frequently made claim that meditation can trigger unstable mind states, researcher Britta Hölzel is quoted as saying (somewhat flat-footedly) that “I (Hölzel) have never seen any major problems like that in our classes.” This is a common statement I hear from researchers and teachers of various mindfulness-based programs, which while true evades the question itself. In fact, we have, at the Ottawa Mindfulness Clinic, had many applicants to our program who want to learn mindfulness and are fearful because previous experiences have resulted in intense mental distress, including dissociation, depersonalization, and profound anxiety. Whereas it is quite likely that in Hölzel’s experience there have not been such occurrences, it does not therefore mean this is not an area to be sensitive about as clinicians and to investigate further as researchers. Ottawa psychologist Nicola Wright and colleagues have written about adapting mindfulness for vulnerable populations and it does behoove us to acknowledge this as a necessary direction for future research and definitely for caution.

Second, Ajhan Amaro, who seems to have been a delightful guide and teacher for Kingsland, wrote an important response to our target article in Mindfulness (journal). He calls for a need to include ethics explicitly as a core component of mindfulness programs. I do respect the stance taken by MBSR developers that the cultivation of ethical action is inherent in its programming (see discussion on p. 269 of Siddhartha’s Brain). However, a statement of presumed fact is not a substantiated fact nor does it address whether the outcome is in the desired direction. Given that no therapeutic intervention is values-neutral, the examination of how mindfulness can become weaponized (see my earlier blog post) is important. After all, we are collectively responsible to examine if mindfulness training does give rise to skillful action and ultimately compassion for ourselves and all others.

Kingsland has done well in this book to translate complex concepts into accessible knowledge and convey ancient wisdom with a gentle, inviting voice. If you are at all fascinated by how and why our brains and being are the way they are, read this book. If you are curious about how meditation and mindfulness practices can help with the everyday struggles of just being human, read this book.

PTSD, Growth & Recovery: Bouncing Forward by Michaela Haas

Trauma and its sequelae are likely the greatest challenge we face as individuals who have experienced them and as healthcare professionals who try to help. For decades and generations, post-traumatic experiences have been misunderstood, mislabeled, and misrepresented. It wasn’t that long ago when I found myself in a shouting match with a military medical healthcare individual who kept screaming at me, “There is no SUCH thing as PTSD!” It wasn’t that long ago when I listened to some of my education program cohort telling me my reactions to what I felt was professorial bullying were probably “cultural” and “well, you know, not Canadian-like.”

Continue reading

I am not this body: Mindfulness for Pain Management

maple shadowPain is unavoidable. We inhabit a system that is engineered to become wonky, cranky, and otherwise uncooperative over time. We know this conceptually but not when and how it matters. Why me? What now? tend to be our responses when the body fails us – as it inevitably does. In case you think this is only a problem for aging folk or those afflicted with strange hard-to-diagnose illnesses, it’s not. Athletes injure themselves. Random acts happen to young and old alike that leave them having to reshape not only their bodies but their mental attitudes towards their entire life.

Joy is unavoidable too. We have a resilient system that is subtly wired to sense into experiences that nourish and sustain us. We don’t know this in the definition of sensing joy; we hope and believe it will be true some day – if we’re really good, work hard, and check off all the boxes that we think entitle us to joy. And it’s not just aging folk who do that. In fact, the older you get the more you begin to see that it’s not the boxes you’ve checked off that brought you joy in any lasting way. Continue reading

Craig Mackie RSW joins OMC

Craig We are pleased to welcome Craig Mackie RSW to the Ottawa Mindfulness Clinic. Craig has a BA in developmental psychology, MA in philosophy and a Masters of Social Work. He has worked in therapeutic recreation, mental health, and social services for over 10 years. He is a certified Transformative Mindfulness practitioner, 16 Guidelines international facilitator trainer, and has taken multiple trainings in clinical and mindfulness modalities. Currently he teaches in the Applied Mindfulness Meditation program at the University of Toronto and is the Director of Essential Change.

At the clinic, Craig will be offering mindfulness programs for youth and adults.

Program and contact information on the adult and youth programs can be downloaded here:

Youth – Transformative Mindfulness.

Adults- Transformative Mindfulness.