Mindfulness-Based Occupational Therapy

     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. 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 dialogue 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. [1] 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. 

Mindfulness-based occupational therapy (MBOT) is occupational therapy that incorporates features of mindfulness into OT practice interventions. MBOT is unique to other interventions traditional to OT practice in that it requires that the OT have their own personal mindfulness practice in order to implement the mindfulness features authentically. However, it is possible to begin to work with the practices at any time as long as the OT's intention is first and foremost for the healing and growth of themselves along side their client. A quote from Heal Thy Self by Dr. Santorelli (1999) describes this practice well:

“The patient-practitioner relationship demands close attention...It is an embodiment, a direct expression of interconnectedness and interdependence. Beyond a doubt we work on ourselves as a means of helping others and, simultaneously, working with others is a way of working on ourselves. The simple truth of this is hard to open up to because it changes the entire nature of the healing relationship from one of fixing and rescuing, or authority and domination, to one of service, collaborative creativity, and inquiry. This alone is a cracking open of our imagined sense of self and position. For our work and our privilege is to assist and accompany others into the discovery of their own intrinsic wholeness existing behind illness, even when death is close at hand or when one faces living with a chronic illness . . . . What is called for, right alongside of our medical procedures and clinical strategies, is a slowing down . . .an intimate embracing of our own tattered hearts.”  

The "mindfulness-based" components of MBOT are based on a program developed by Jon Kabat-Zinn called Mindfulness-Based Stress Reduction (MBSR). Mindfulness practices draw upon universal wisdoms that examine what makes all humans suffer and offer awareness-based relationship to present moment experience. “In mindfulness, the meditator methodically faces the bare facts of his experience, seeing each event as though occurring for the first time” (Goleman, 1988). 

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. MBOT 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:

Links to UMASS's CFM program here and here.

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.

Link to Mindfulness-Based Treatment Approaches resource can be found here.


A few additional resources:

Time Magazine Article: The Mindful Revolution can be found here and here.

Mindfulness on CBS 60 Minutes

A UC Berkeley course on the science of Happiness can be found here.
Video with Dr. Brewer on the Mechanisms of Mindfulness (formerly at Yale and now at UMass CFM) can be found here.
TED video with Dr. Kelly McGonigal on stress beliefs can be found here.
Dr. Jill Bolte Talyor's TED talk can be found here.
Dr. Amy Cuddy's TED talk can be found here.
Dr. Brene Brown's TED talk can be found here.
Shwartzberg Gratitude Video (Cultivating Appreication in Present Moment) can be found here.
A Few Research Study Links: 

A 2011 study demonstrated that mindfulness practice alters the structure of the brain in 8 weeks. The article can be viewed here.

Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders can be found here.

Mindfulness-Based Relapse Prevention for Alcohol and Substance Use Disorders can be found here.
Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process can be found here.
The clinical use of mindfulness meditation for the self-regulation of chronic pain can be found here.

Here are a few quotes from students following the completion of the MBOT Course at San Jose State University:

"Over the course of this semester I have smelled more flowers than I have in my entire life and it has been glorious. While I have been slow to accept and assimilate mindfulness practices into my personal life, I know that I have begun a journey that will carry throughout my life. The most significant things that I have learned from this course are how to be present in the moment, to enrich the moments I am given, to know myself better by being in touch with myself, and to care for myself."
"Moments make up my life and if I let them pass me by and do not take full advantage of these moments my life will pass me by."

"I truly feel that OCTH 210 has been a precious jewel in my OT education. As I reflect upon my time in graduate school, I consider all other courses as the “mind & body” of the curriculum and OCTH 210 as the “heart & soul” of the curriculum, as it has taught me many things that will help to enhance my therapeutic use of self and enrich my overall life experience."

"These themes identified in this course are a reminder that my body and my mind are powerful. They function in relationship to each other as well as within each entity individually at changing levels to support my existence. The things I do and say in my personal and professional life are even more powerful if I am aware of these functions and how they affect my present moment."

"It is fantastically healing to be engaging in activities with focus and concentration instead of constant interruption and drudgery…I could live whelmed instead of overwhelmed, and here instead of there, and genuinely instead of halfheartedly."

"Thinking about myself in the bigger picture, as I go about my day, I remind myself that everything I do has an effect on everything no matter how big or small."

"Being able to be present with our own suffering, translates into the ability to be present with another’s suffering. Being able to be present with our own storms, enables us to be present with another’s storms. This helps to cultivate an empathic response which informs our therapeutic use of self in OT practice."

"When I started comparing how poorly I did things while multitasking versus when actually focusing on the task, I was shocked by how much better I felt about the time I was spending on tasks and by how much better I was relating to people around me when I was actually engaged."

"Low-quality participation in meaningful occupations may have some benefit over complete occupational deprivation, but high-quality participation in meaningful occupation is medicine for the heart, body, and soul."

"I am learning to tap into the wise mind of the awareness of the impermanence of all things, and this eases me into letting things be as they are without needing them to be different. The unexpected and positive result in my life has been a greater calm and lessened anxiety. Mindfulness practice has improved my personal well-being."