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

Before you close your eyes: things to know about meditation

“Do you meditate?”

It’s a common question these days. Almost everyone I speak to has taken a mindfulness program or is looking for a place to learn how to meditate. It’s an exciting time as well because, as healthcare professionals, we’re finding ways to help people that seem to be making a difference in their lives. So, how can there be a problem with that?

None, if meditation is taken up with an understanding of what it is and how it works. And, more important, how it doesn’t work.

What we think meditation is

Most people want to feel free of the stresses in their lives and it’s a realistic desire. Jobs are demanding or lost; relationships are frayed; the world seems fragile with disasters and destruction; chronic illnesses are affecting so many people. Who wouldn’t want something for these turbulent moments that gives a few moments of peace? When we approach meditation with the agenda of feeling better,  it can feel good and for many of us, it may be enough to get us through the tough times.

But, is meditation just a practice of feel-good sayings or moments of by-passing reality?

What is meditation, really?

A Zen teacher said, “If all it takes to be enlightened is sitting, then frogs would be enlightened.”

If you’ve been meditating and still find yourself getting angry, frustrated, sad, or reactive, welcome to being human. The one thing meditation will not change is the natural responses we have to upsetting events in our life. Of course, the Catch-22 is that the more upset we feel in our lives, the harder it is to meditate because it’s all the same mind and mental habits.

The intent of meditation is to become aware of three patterns of reactivity:

Anger – I don’t want what I have
Clinging – I want what I don’t have
Confusion – I don’t know why things are going the way they are

If it’s happening in our everyday lives, it’s going to pop up in on the cushion as well. And, when it does, we start to feel meditation “isn’t working”. That’s when we may start avoiding or only sitting if it gives us good feelings like relaxation.

What keeps us from going back to the cushion?

In Buddhist psychology, there are five habit patterns that get in the way of changing our reactivities (and why we need to “meditate” throughout the day):

Desire for things that please us
It’s easy to see that if we really want to sleep in because the bed is so warm and cozy, we’re less likely to get out and get our butt on the cushion. that’s a low-level example, but I think we can see that many activities appear more desirable than sitting still – especially if sitting still brings up unpleasant thoughts and emotions!

Anger
It’s the same with feelings of anger; whether in the everyday activities of our lives or when we sit and the gates open, anger is a tough emotion to be a comfortable feeling. The problem is, if we’re practising anger throughout the day, it’s more likely to show up when we sit down and relax our mental control. So, watch for those moments of irritation when you’re off the cushion!

Sloth & torpor
I admit these are my favourite obstacles! Most days, by the time I get home, I’m wiped out – lethargy and laziness are my BFFs. If I try to sit when I feel this way, I just end up drifting off to sleep, which I rationalize as being one with the cosmic vastness. I also know that moment-by-moment, I’m likely practising sloth & torpor in my day as well. That means I need to pay attention to my procrastination and avoidance patterns.

Worry & agitation
These buddies are linked to needing an outcome that reassures us we’re doing the right thing. The problem is that there’s no “right thing” in most activities and our perfectionism pushes us to set unrealistic standards. Do a reality check: is what you’re aiming for really what’s needed.

Doubt
This obstacle is the foundation of the previous four. And, it’s a sneaky one! It shows up as perfectionist tendencies, reverse praise (You did so well the last time!), cautious behaviour and procrastination, and so much more. Learn what you go-to excuses are for not getting to something that needs doing. See which of the previous four obstacles are partnering up with doubt to bring you to a grinding halt.

Am I getting enlightened?

Let’s hope so! Be careful of the hype around meditation. It doesn’t cure everything (or anything, actually). However, it can become possible to develop a level of steadiness that makes things more understandable. It can become the pause in our interactions that allow us to make a better choice, or see how we get in our own way. The catch is that it takes practice – and avoiding the desire for and addiction to the quick-fix of relaxation is the first step.

If you want to practice, try our meditations here (in French here) or on Insight Timer.

Mindful Self-Compassion 5-Day Intensive, Toronto ON 2016

MINDFUL SELF-COMPASSION 5-DAY INTENSIVE

Christopher GermerLynette Monteiro
Toronto ON Canada

MAY 30 – JUNE 3, 2016

Join us in the exciting city of Toronto for a week of practice in Mindful Self-Compassion.

The Mindful Self-Compassion Intensive is offered as a five-day program and qualifies as the prerequisite for training as a Mindful Self-Compassion teacher. Please see the Center For Mindful Self-Compassion for more details on teacher training.

Mindful Self-Compassion is a research-supported program developed by Dr. Christopher Germer and Dr. Kristin Neff. Research studies on self-compassion show that it can lower anxiety and depression, and improve our relationships with others. Continue reading

Solitude, Solstice & the Longest Night

tree

 

We enter solitude, in which also we lose loneliness…

True solitude is found in the wild places, where one is without human obligation.

One’s inner voices become audible. One feels the attraction of one’s most intimate sources.

In consequence, one responds more clearly to other lives. The more coherent one becomes within oneself as a creature, the more fully one enters into the communion of all creatures.

Wendell Berry on solitude from Brain Pickings

 

December 21 (today) will be the shortest day and longest night. As a bonus, tonight will also be the longest night in earth’s history (apparently not according to the linked article). Fascinating astronomical facts! This date, in a mind-opening way, is also the turning point at which the days begin to get longer. As poet and artist Richard Wehrman wrote, introducing his Solstice poem: At the darkest, the turn toward the light.

This time of year is also a time of contemplation, of entering into a period of reflection on the path our life has taken and the cultivation of a wish for the direction it can take. It’s ironically embedded in the most emotionally activating time of year as well. However, we also fear this opportunity for solitude and perhaps fall into the rush and chaos as a welcomed escape from our thoughts because the idea of solitude, being with ourselves, lies too close to our fear of loneliness, being alone, without support or care.

In one recent study, later refuted by Keiran Fox and Kalina Christoff, it seemed like people would prefer to avoid their thoughts to such an extent that they would rather shock themselves. Fox & Christoff re-visited the data from the original researchers and showed that the conclusions didn’t support the conclusion of the participants’ aversion to being alone with their thoughts. Fox & Christoff interpreted the data as suggesting the participants were curious about the shock itself and that several didn’t use the shock at all. Others were thinking pleasant things about weekends, etc. In other words, we don’t tend to be horribly avoidant of our thoughts however we may not be very skillful in relating to them either.

lighthouseSolitude, especially where there is no structured task or schedule, provides the opportunity for spontaneous thoughts that can play a role in creativity. We can also get so caught up in these live-streaming thoughts that we lose track of what our intention was; this is the downside of ‘mind wandering’ (MW). Typically, we believe that the alternative to mind wandering is to get control over that mental process, suppress the thoughts and re-direct ourselves back to the task at hand. In their chapter on this topic, Fox and Christoff explore how the interaction between the mind wandering part of our brain and the metacognitive (reflective, monitoring our own thoughts) is actually cooperative and symbiotic. The positive aspects of this relationship are creativity, mindfulness or insight, and lucid dreaming. Interestingly, in meditation spontaneous thoughts are present as is the awareness or monitoring of these thoughts; and, areas of the brain connected to mind wandering and metacognitive functions both are active.

This contemplative time of year offers us the opportunity to connect with these aspects of our mind. As with anything, it can be directed in a healthy way or in a way that leads us to feel bad (or worse).  This is why consistent and dedicated practice is important. More specifically, a commitment to meditative practice is crucial. Spontaneous thoughts arise and suppression never works; we need to be aware that some thoughts have a positive trajectory, some neutral and some take us down paths that are harmful to our mental health. The metacognitive practice – monitoring the quality and directionality of our thoughts – plays an important role in discerning which thoughts patterns are just re-hashing old unhelpful stories and which are healthy and creative ways of engaging in our life at this moment.

This perspective goes beyond the aphorism that “thoughts are not facts.” The existence of thoughts IS a fact. However the belief that they direct our actions is not a fact. Thoughts play an important role as indicators of wise choices, markers of health and activate our creative encounter with life.

Take this time to discover this new relationship with yourself.

~~~~~~~~~~~~~~~~~~~

The staff and teachers of the Ottawa Mindfulness Clinic send you warmest wishes for a vivid and luscious celebration of solitude as we turn toward the lightening days ahead.

Thank you for your support of the OMC and our best wishes for the New Year!

U of T Applied Mindfulness Meditation – MIND Certificate Program Registration Open Now

APPLIED MINDFULNESS MEDITATION – MIND CERTIFICATE PROGRAM AT UNIVERSITY OF TORONTO

AMM-MIND program : an interprofessional certificate on mindfulness and mindfulness meditation training, education and integration into our lives. The Inter-professional AMM-MIND certificate at University of Toronto has become internationally , nationally and locally recognized as a unique and exceptional gathering of mindfulness based practitioners, faculty, and mindful leaders who are trying to co-operatively integrate mindfulness and mindfulness meditation into lives, as a way of being , 24/7.

It is our hope to enhance the health , wellness and resiliency of people- no matter what their walk in life. It is also our hope to enhance the humanity in organizations and to bring healthy change to the people who live, work and play in the many systems which make up a vibrant society.

At AMM-MIND we teach applications of mindfulness that are drawn from the 2500 year old traditions of contemplative practice which are now tested and translated into evidence based research. These practices have been proven to: enhance health, wellness and resiliency, develop increased attentional skills and focus, which can reduce error and stress, sick days etc. Imagine the impact of these practices in the health and/or educational system, in the corporate world, in decision making and in leadership. At AMM-MIND we work from a concept of the embodied mind rather than the enskulled brain, that is, we strive for the integration of mind-body relationship in community to enhance health , wellness, resiliency and humanity.

If you are interested in learning about this practice, its history of use and application, in how to integrate this practice into your life at work or at home, in the why and how we meditate then please come join us and be the change- as well as bring the change.

To explore our program’s offering, to seek further consultation with administration or to register for our Open House or workshops.

http://socialwork.utoronto.ca/conted/programs-and-workshops/certificates/mind/

Factor-Inwentash Faculty of Social Work
University of Toronto
246 Bloor Street West
Toronto, ON, Canada

10% Happier – ABC news anchor learns the 1-2-3 of enlightenment

10%happier Once in a while, in this deluge of books claiming insight and enlightenment, a book actually surfaces that speaks to the truth of meditation, practice, mindfulness, and truth of being human. Dan Harris, ABC journalist and anchor of Nightline and the weekend edition of Good Morning America, throws himself wholeheartedly into telling us his story of anxiety, self-doubt, and finding the path through it.  Harris describes his adrenaline-fueled life as a young correspondent for ABC and his slide into drug use to deal with the experiences of reporting on the war in Iraq. As he pulls out of the drug use on his own, he’s left with a hyper-regulated physical system that leads to an on-air panic attack. Harris puts it succinctly:

All of us struggle to strike a balance between the image we present to the world and the reality of our inner landscape. p. 10

This very real tension, fuelled by an inner critic that continuously natters to him about his inadequacies, leads him to therapy. There, his psychologist offers him the opportunity to learn about meditation from a Harvard colleague’s book (I’m dying to know who that was). Harris is skeptical but circumstances contrive to lead him along a path of cautious yet incisive inquiry into the benefits of meditation.

The strength of the narrative is twofold. First, Harris fearlessly lets us into his thinking brain, making us privy to his every experience, evaluation, and re-evaluation at a very human level. The train of thought that takes him from an event to (mentally) ending up in a “flophouse in Duluth” resonates deeply. (My inner critic drops me off under the Rideau Street bridge to live in a cardboard box!) If he holds a strong opinion on an experience, we’re right there. If he has a change of heart/mind about his opinion, we’re right there. Second, Harris draws from his investigative journalistic skills and work on religious topics to give us a vibrant picture of gurus and giants in the meditation field. He describes encounters with blatant honesty and does not shy away from pointing out naked Emperors – well, at least garishly dressed ones.

What I found in this distinctly American subculture (of self-help) was beyond crazy – a parade of the unctuous and the unqualified, preaching to the desperate and, often, destitute. p. 82

It’s a personal thing but I came to appreciate the kindly balanced way Harris pointed out the difficulties with Eckhart Tolle’s “befuddling” teachings and capping it by pointing out Tolle’s work was primarily unattributed material from Buddhist teachings. He might well have taught me to be kind about Tolle. Harris’ interviews and meetings with Deepak Chopra are mini-series-worthy; he pointedly writes that “(i)t was intriguing that someone could strive so nakedly and yet claim to be without stress. (p. 82)”. The issue though is not the toppling of gurus whose supposed teachings suck in the ill-informed or desperate. The lesson for us is in Harris’ unrelenting inquiry, an approach we should all use in assessing whether someone should have access to our vulnerabilities and pain.

That important lesson notwithstanding, Harris’ book is not about the dark side of the self-help subculture. It is very much about one man’s journey into and through his own life. In one way, it is a life no different from many of ours being populated with demons of all varieties and sinkholes of all sizes. In another, it is a life that has a privileged vantage point on human foibles and frailties. As part of the team on the Sunday edition of World News, Harris launched several stories on religious and cultural issues, giving him access to leaders in those fields. Once he began to inquire into meditation, this access included the top names in Buddhist thought and eventually the vast field of Mindfulness.

Still, I appreciated his honesty and humility as he encountered the various teachers, reacted to their styles, and recanted when they revealed more skillful ways of teaching. Harris is nothing if not forgiving! His description of his first 10 day retreat is a worthy read which will either allow you to forgive yourself for one you’ve gone on or convince yourself that you too can survive one. Of course, here again, we need to note that most Insight Meditation Center retreats by the “big names” are impossible to get into without some pull and we’re not likely to be invited to an interview with the big name teacher; at least he was honest about how he got in.

Harris covers the ground of contemporary mindfulness well. He draws from his own growing personal experience of meditation and adds a healthy desire to understand the complex process of meditating. He confronts the “dark side” of becoming too attached to the idea of compassion, a slippery slope that almost leads to his career sliding out from under him. (This is so rarely discussed that it alone is worth the price of the book!) He finds that Middle Path between equanimity and indifference, kindness and being a doormat, compassion and becoming enmeshed, appreciative joy and hypocrisy.

More important, Harris doesn’t oversell his new-found life. He says it’s helped him become 10% happier. He’s realistic about stress and his inner critic: “It’s about mitigation, not alleviation. (p. 160)” He’s insightful about his practice and the core values they reflect: “This is aspirational, not operational. (p.205)” Although Harris doesn’t see himself as enlightened, these are the 1-2-3’s of enlightenment!

This is a book for anyone who carries the burden of a harsh inner voice, who wonders how to wade through the innumerable programs and teachers offering relief, who is fearful that taking a mindful approach to their life may dull their edge in a competitive world, or who simply wants to aspire to be more available for what life has to offer.

Book Review: Everything you wanted to know about meditations

Meditation: The complete guide by Patricia Monaghan and Eleanor G. Viereck (New World Library) is not just about meditation.  Monaghan & Viereck dedicate 43 chapters not only to a variety of meditation approaches but also organize them into their parent traditions.  It is a veritable who’s who and how to of contemplative practices.  In a publishing world overflowing with books on being in the moment, Meditation offers a sensible map to Indigenous traditions, Yoga, Buddhism, Taoism, Judaism, Christianity, Islam, modern forms, creative and active meditations. 

The book starts with a detailed and transparent explanation of what meditation is and is not.  I am relieved to finally read that meditation is not relaxation or self-hypnosis.  It is likely the most active process of taking responsibility for our lives we will ever encounter.  Yet, there is such a cultural misconception of bliss and dissolving away.  In their FAQ section of the Introduction, Monaghan & Viereck pose questions that are commonly heard in any mindfulness course.  However, the way they present the questions is instructive and reveals a strong understanding of the process of contemplative practices.  I particularly liked the section on Reasons for Meditating.  There are no pat answers or fluffy exhortations.  They point pragmatically to which meditation skills are best suited for the individual’s aspirations.

Want to deal with stress?  Here’s what you may want to try.

Attune to your spiritual life?  Here you go.

Engage in your community and bring benefit to other beings?  Try this.

It’s not as prescriptive as it sounds, but it does narrow the search field and encourages a grounded curiosity and an informed exploration.  The general introduction to the book could be a course in itself and I would strongly encourage anyone taking a mindfulness course to use the questions as a guided inquiry to explore for themselves what they really want from an MBSR program. 

The sections on each faith/contemplative tradition can only be summed as “just enough” – sufficient to inform and educate without overwhelming technicality and useless detail.  As a Buddhist practitioner, I was immediately drawn to that chapter.  It was a respectful and wonderfully detailed explanation of aspects and the variety of Buddhist practice convey in easily accessible language.  Again, a great resource for just enough information on Buddhism.  I freely admit a bias to the brush paint chapter also.  Of course, I would have loved to have just stopped there but was drawn to the other faith traditions some of which I knew almost nothing.  The contemplative meditations of Judaism and Islam, Quakers and Native traditions, the movement meditations of Tai Chi and Qigong were delicious windows into treasured practices.

This is a highly recommended guide for all levels of practitioners, teachers, and eternal students.