Mindfulness-Based Occupational Therapy
Complementary and alternative medicine (CAM) and integrative medicine (IM) have been growing rapidly in the psychodynamic and humanistic traditions of psychotherapy to help meet the needs of our growing chronic public physical and mental health disease crisis. The current demand for highly qualified professionals who teach the skills of mindfulness has grown exponentially in recent years. The year 1990 was a watershed, after which "mindfulness" as a discrete term began to take hold in the discourse of academic medicine and psychology (Dryden and Still, 2006). This is the publication date for Jon Kabat-Zinn’s book Full Catastrophe Living, describing the mindfulness-based stress reduction (MBSR) program that he developed in 1979 at the University of Massachusetts Medical Center. The curriculum started at the University of Massachusetts Medical Center has produced nearly 1,000 certified MBSR instructors who are in nearly every state in the US and more than 30 countries.
Almost every major medical center in the US currently has an IM center and many include mindfulness and or MBSR as an integral component to their programming. MBSR is now used as a therapeutic intervention in over 700 hospitals worldwide. Meditation and mindfulness have been featured in cover stories in the Scientific American, New York Times, Time Magazine, and Newsweek (Kalb, 2003, Stein, 2003). MBSR and other mindfulness-based approaches are now considered "evidence-based treatment" due to the extensive amount and quality of research with randomized, controlled clinical trials that has abounded over the past 10 years. In fact, 52 papers were published in 2003, rising to 477 by 2012. Nearly 100 randomized controlled trials had published by early 2014.
Clinical trials that are currently underway studying the efficacy of MBIs are with the following: asthma, bone marrow transplant, breast cancer, chronic pain, chronic obstructive pulmonary disease (COPD), HIV/AIDS, hot flashes, hypertension, immune response to HPV, IBS, lupus, myocardial ischemia, obesity, cancer, arthritis, organ transplant, type-2 diabetes, other medical conditions including psychiatric disorders, such as anxiety disorders, eating disorders, personality disorders, PTSD, schizophrenia, suicidality, and others (Clinical Trials, 2008). Grossman et al. (2004) characterized the current research findings with this statement, “Thus far, the literature seems to clearly slant toward support for basic hypothesis concerning the effects of mindfulness on mental and physical well-being.” (Fang, C. Y., 2010; Morgan, N., 2014).
Mindfulness and MBSR are not just in Western medicine. More than 2,000 people from companies like Google, Facebook and Instagram showed up earlier this year in San Francisco for a mindfulness conference called Wisdom 2.0. Google now offers their 52,000 employees free lessons in mindfulness. Corporations such as General Mills have made it available to their employees and set aside rooms for meditation. Democratic Congressman Tim Ryan published a book in 2012 titled A Mindful Nation and he has helped organize regular group meditation periods on Capitol Hill. An all-party parliamentary mindfulness group was developed in the UK for the House of Lords. In the UK, three universities offer master’s level post-graduate professional training in mindfulness-based approaches: The University of Exeter and Oxford University Mindfulness Centre in England, and Bangor University Center for Mindfulness, Research, and Practice in Wales.
Mindfulness-Based Interventions (MBIs) are growing in number as well. Mindfulness-Based Cognitive Therapy (MBCT), Dialectical Behavioral Therapy (DBT), and Acceptance and Commitment Therapy (ACT) are three MBIs that are drawing the most cultural attention at this moment. Occupational therapists are currently using all three of these MBIs as interventions within their practice. It is clear that the time is right for the profession of occupational therapy to embrace this emerging demand and create it's own path by merging the therapeutic skills of mindfulness with the depth and complexity of the profession of occupational therapy to create a new practice area called Mindfulness-Based Occupational Therapy (MBOT).
Advanced training in Mindfulness in Occupational Therapy (or Mindfulness-Based Occupational Therapy - MBOT) would provide occupational therapists with in-depth training in foundations of mindfulness practice and mentorship to develop evidence-based MBOT interventions for their unique practice settings. This kind of training will ensure a depth of personal mindfulness practice combined with the intellectual, theoretical, and historical underpinnings of mindfulness practice and skills for facilitating mindfulness in clinical settings unique to occupational therapy. It would fulfill the growing demand for training specifically designed for occupational therapists who wish to include mindfulness as a significant part of their clinical practice in mental and physical health settings, and would set a standard demonstrating competency and international collegial collaboration in combining mindfulness and occupational therapy. Contact Rochelle McLaughlin to inquire about such training programs in development.
This emerging therapeutic approach, Mindfulness-Based Occupational Therapy (MBOT) blends the two therapeutic disciplines of occupational therapy (OT) and mindfulness into a new Mindfulness-Based Intervention (MBI). MBOT’s focus is multifactorial. Elements of mindfulness foundations are woven into the fabric of skillful occupational engagement “interoccupational relationships”, effective interpersonal therapeutic relations, the enhancement of the therapeutic use of self, and the development compassionate care of oneself and other. Application of mindfulness-based practices is an essential aspect of this intensive MBOT training certificate program. Integration of mindfulness-based methods and skills are appropriately merged with occupational therapy interventions using evidence-based approaches.
It can be a profound realization to recognize that the capacity to build mindful awareness of one's body and mind can be assistive in addressing many of the the underlying problems of modern diseases. Mindfulness is the practice of purposefully attending to the present moment with an attitude of openness and curiosity. When we teach the heartfulness and skillfulness of mindfulness as occupational therapists, we become healing facilitators of our client's capacity to become co-healers using the wisdom of their own body and mind. This can be incredibly empowering.
Mindfulness-Based Occupational Therapy (MBOT) explores true healing as a journey of learning and connecting. It is not a model of fixing, correcting, or repairing. MBOT is steeped in a model of cultivating deeper levels of personal understanding and greater degrees of insight. The skills of mindful awareness are tools that help us all engage in close connectivity with ourselves and our infinitely vast human experience in each moment. The skills shed light on our present moment experience and help us build trust in our capacity to heal ourselves, our communities, and the world.
Occupational therapists work on the front lines of incredible human suffering. An occupational therapist who has his or her own personal mindfulness practice will be more able to remain present to his or her own internal mental and emotional experience and physical wellbeing from one moment to the next thereby reducing potential for burnout and enhancing self-efficacy. Dr. Dan Siegel, researcher, author, and director of The Mindsight Institute at UCLA describes this process as neurological "integration". He invites us to "connect rather than correct." Learning to be in wise relationship to our experience in each moment without needing it to be any other way and developing deeper levels of understanding. In this way, we are capable of learning, growing, and healing ourselves and cultivating a more wise relationship to our work as OTs.
Occupational therapy promotes health by enabling people to perform meaningful and purposeful occupations.  However it is often the case that we are not present or "conscious" during these meaningful occupations. Not only are we not present but we are often lost in ruminative thoughts and unacknowledged judgements. This mental phenomena can often be dysfunctional or destructive to our emotional, mental, and physical health. We can be significantly limiting our experience of our lives by living only in the unacknowledged, often habitual, cognitive domain of experience. We can be drawn away and disconnected from our experience for long periods of time and even life times.
When we are disconnected from our lives we are unable to fully experience our daily activities even those that we might consider “meaningful” and the quality of participation in meaningful occupations can suffer. MBOT invites us to live the following questions as a journey of inquiry, healing, growth, and learning:
"What is my quality of participation in the activities that are meaningful to me or my client?"
“How can I cultivate a healthy and meaningful experience in my daily activities?”
“How can I assist my client in cultivating a higher quality of participation in the occupations they consider meaningful?”
As the occupational therapist integrates mindful awareness into his or her own daily personal and professional life they begin to become aware of their personal quality of participation in meaningful activities. Through the engaged participation in meaningful occupations the OT will gain insight into the significance of the healing nature of being more aware and present with our unfolding experience in each given moment. Establishing connection to our experience during daily occupations gives us the opportunity to develop deeper levels of understanding of the significance of daily occupations in one's life and deeper levels of awareness of our own patterns of behavior and it’s effect on our health and wellbeing. The enhanced awareness allows us to notice our relationship to our daily occupations and offers us the opportunity to choose and establish deeper levels of wise relationship to the fullness of our lives. Through this gained insight, the seeds of awareness are then infused into all clinical interventions as well as personal and professional interactions.
MBOT is appropriate for any population an occupational therapist would work with: pediatric to geriatric populations, stroke survivors to individuals on the autistic spectrum. MBOT is a valuable practice to help improve clinical outcomes and reduce stress and anxiety on the part of the clinician and the patient. MBOT draws from awareness-based practices and somatic approaches to healing. It incorporates features of mindfulness into interventions: awareness, compassion, acceptance, motivation, embodiment, and learning skills and tools for how to be in wise relationship to intensity for vastly varying expressions of physical and mental suffering.
A Few Ways for Occupational Therapists to incorporate mindfulness:
- Mindfulness of Self: Awareness of body/needs of body, breath, thoughts, emotions, clarity of values. Awareness of approach, personal communication styles, verbal cues, body language, presence. Weaving mindfulness practices into informal aspects of OT interventions and other OT daily work activities. Continue to develop the foundations of mindfulness in one’s life.
- Awareness Tools and Skills: Share what you "know". The skills and tools must be embodied in order to be modeled or shared authentically. If any mindfulness skills, tools, or practices do not ring true for you, don’t use them. If you bring an awareness tool, practice, or skill as a therapeutic modality bring it with the intention that you will also benefit and grow from the practice. The OT becomes a part of the process of the authentic healing relationship.
Explicitly guiding MBSR practices such as the body scan, formal sitting practice, mindful yoga, mindful walking practices. Practice with your client with the intention of authentically working with the practices as well. OTs must teach the formal practices from the inside meaning that they have a well-eestablish personal mindfulness practice first. Also using informal practices of mindfulness as a therapeutic modality.
- Mindfulness of Client and Context: In-tune with client's experience by slowing down enough to be aware of subtleties of the situation, the context, and client in the moment. "Connecting rather than correcting" (Siegel, 2013), expressing compassion, and being motivated by personal empathic drives that are developed through personal awareness practices. Becoming present to the unfolding experience. Allowing the client to be fully seen and heard.
- Research: Mindfulness and MBSR are very well researched. Use evidence-based knowledge to back up your recommendations. In 2012 there were 477 peer reviewed studies published on mindfulness. Nearly 100 randomized controlled trials had published by early 2014. Here is a link to a resource for Mindfulness Research: http://www.mindfulexperience.org/
Resources for mindfulness training for OTs:
Dr. Brewer's Mindfulness and Addiction Treatment can be found here
Teacher Training Programs in SF Bay Area here.
You can watch a Mindfulness-Based OT video here.
A few additional resources:
Here are a few quotes from students following the completion of the MBOT Course at San Jose State University: