Mindfulness Informed Therapy for Children, Adolescents and Families

1. Children, Adolescents and
Families
Cameron Aggs
Dr. 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

2. Overview
 Session 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

3. 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
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4. Methods
 Powerpoints
 COS Worksheets
 Video
 Brief Meditations
 Participation in brief meditations is voluntary
 Evoking mindfulness as the best method for learning
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5. Mindfulness
 What is it?
 How does it enhance the process and content of working
with clients?
 Mindfulness and Emotion Regulation
 Working through difficult emotions
 Knowing 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?
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6. Working with Therapist
Factors
Who among us can evoke a state of
presence at will?
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7. True…?
“The mind if not stirred, will become clear”
-Sogyal Rinpoche
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8. What is Mindfulness……?

9. “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…

10. 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,

11. Holding in Mind: Intentions
 What 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

12. Attending Skills
Placing 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

13. 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”

14. What do we really mean by „being present‟?

15. Presence….
What are the qualities of that?

16. 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.

17. 4 Breaths Technique
Coming 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”

18. “The mind if not stirred, will become clear”
Sogyal Rinpoche

19. Mindful Attitudes: More than just
Attention
The anesthetic of internal attunement….

20. Attitudes
GOAL
 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

21. 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 | info@bemindful.com.au

22. Learning to let it flow…
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23. 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 | info@bemindful.com.au

24. 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:

25. I-SIFT
I (me)
Sensations
Images
Feelings
Thoughts

26. “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….

27. 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

28. 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

29. 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

30. Why
Greater 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

31. Why
Greater 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

32. 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

33. MiT
 Therapy process skill: Embodying mindfulness
 Intervention technique: eg 2-hands, 4-breaths,
Metaphore, POC exercise, 3-Minute Breathing Space,
Body Scan, Working with Discomfort
 Flexible delivery of client-centred techniques
 Use of mindfulness in assessement, psychoeducation,
intervention, and in the relational space
 Targets Emotional Regulation capacity

34. 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

35. 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

36. 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…

37. Developmental considerations

38. 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 adults
 Language (understanding and expressing themselves)
 Meta-cognition
 Executive function and attention skills
 Mindfulness practice builds on developmental capacities
(e.g., attention and executive function)

39. 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 developing
 More 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

40. Mindfulness Practices: Building
Blocks
Sensory
information
FeelingsThoughts
Breath
Focused attention
practices
Body sensations
InteractionsDual attention practices

41. 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

42. 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

43. 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

44. Developmental Modifications
 Using metaphors to illustrate and explore mindfulness
concepts
 Keep it simple
 Don’t overload with too many or varied metaphors
 Use 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

45. 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?

46. 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 now
 Example:
 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

47. 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?

48. 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‟.

49. 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

50. 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
movement
 the sense of body as a whole

51. Challenges of childhood and
adolescence

52. Formulation of Disorders
Disorder Fusion with thoughts
and feelings
Experiential 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.

53. Anxiety
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
Psychoeducation about experiential avoidance
Mindful exposure (thoughts, feelings, and behaviour)

54. Case Study: Anxiety
Child
 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).

55. Case Study Points For
Discussion
 Developmental and/or systemic considerations
 Formulation
 Mindfulness-informed intervention plan
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56. Depression
Intention 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

57. 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

58. 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

59. 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 Strong
 Soles of feet up to abdomen to check-in with the speed
and depth of their breath
 Role Plays

60. ADHD
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 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

61. 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 wants
 Aggressive behaviour: hitting, yelling, swearing, throwing
objects

62. Accessing Resources
 Password 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
Copyright (c) 2013 Mindfulness Training Australia, All Rights
Reserved | MiT - Mindfulness Informed Therapy

63. 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.
Copyright (c) 2013 Mindfulness Training Australia, All Rights
Reserved | MiT - Mindfulness Informed Therapy

64. 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]
Copyright (c) 2013 Mindfulness Training Australia, All Rights
Reserved | MiT - Mindfulness Informed Therapy

65. Thank You!
Danielle@mindfultherapy.com.au
cam@bemindful.com.au
Copyright (c) 2013 Mindfulness Training Australia, All Rights
Reserved | MiT - Mindfulness Informed Therapy

66. Additional Material

67. Metaphors
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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‟

68. Using Metaphors
Clouds 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?

69. 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

70. Nature of Attention
Spotlight
 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

71. Train of thought
 Thoughts 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?”

72. Thought Parade