MINDFULNESS SKILLS 10 To individuals at Severe or 8 Alan - PDF document

4/11/2019 • If a pause is inserted between the Parental Use of Physical Restraints Surfing the Urge urges, an urge will arise, peak, and then slowly dissolve or dissipate if the individual does not act on the urge. • The breath is used as a surfboard to ride out the waves of urges by simply observing each urge with an open, equanimous, and curious attitude, without self-judgment, and non-attachment to the urge. 38 • Three adolescents with Autism Singh et al. (2018) Surfing the Urge : Physical Aggression Spectrum Disorder 9 • Ages: 16, 17, and 17 years Surfing the Urge: An Informal Mindfulness • Target behaviors: verbal and 8 Practice for the Self- physical aggression 7 Management of • Training: Aggression by 6 Adolescents with ASD • Training spread over 2 weeks 5 • Results: Alan Brady 4 • Effect size: 0.55 – verbal aggression and Cam 0.29 for physical aggression 3 • All three were taken off their 2 psychotropic medications prescribed for physical aggression 1 0 Baseline Intervention Last 5 weeks 39 40 Surfing the Urge: Verbal Aggression 14 12 Teaching MINDFULNESS SKILLS 10 To individuals at Severe or 8 Alan Profound Levels of Functioning Brady Cam 6 4 2 0 Baseline Intervention Last 5 weeks 41 7

4/11/2019 43 Shaping BELL Mindfulness of Breathing Using the Sound 45 46 Bell for Classroom Bell for Classroom Self-Management of Disruptive Behavior Self-Management of Disruptive Behavior 47 Bell for Classroom HOBERMAN BALL Self-Management of Disruptive Behavior The Breathing Ball 8

4/11/2019 LOTUS BREATHING YOGA Using the Fingers as a Lotus Mindfulness in Motion Walking Meditation Mindfulness in Motion Effects of Teaching CAREGIVERS of Individuals with ASD and/or IDD • Mindfulness-Based (MB) programs WHAT IS MINDFULNESS- MBPBS assist parents, teachers, and other caregivers to reduce their BASED POSITIVE BEHAVIOR perceived stress and enhance their Mindfulness-Based Positive psychological wellbeing, and SUPPORT (MBPBS)? Behavior Support provide effective services to those in their care • Positive Behavior Support (PBS) is an evidence-based approach to MBPBS is the systematic braiding of behavior change two evidence-based complementary models—the yin and yang of • Mindfulness-Based Positive mindfulness-based practices and Behavior Support (MBPBS) is the positive behavior support—focused braiding of two evidence-based on enhancing the quality of life of approaches to behavior change people in human services that are synergistic in their philosophy of care 9

4/11/2019 • Its behavioral in nature Why MINDFULNESS Key Practices • Focuses on private events • Foundational meditations—Samatha with PBS? The MB in (focused, concentration), Kinhin (walking, • Testable—single-subject research designs embodied mindfulness), and Vipassanā MBPBS • Enriches behavioral technology (open monitoring, insight) • Adds new dimensions to our practice— • Five hindrances—sensory desires, ill-will, emotional connection with people who sloth and torpor, restlessness and worry, are suffering and doubt—and their antidotes • Behavior is about emotion regulation, • Four Immeasurables—lovingkindness, stupid! (with apologies to Bill Clinton: “It compassion, empathic joy, equanimity is the economy stupid!”) (equipoise) • Enhances compassion, gratitude, • Three poisons—attachment (upādāna, desire) , anger (patigha), and ignorance empathy, loving kindness, joy, equanimity (avidyā) . . . • Beginner’s mind and being in the present moment and • Mindfulness in Motion—Yoga • Ethical precepts—refrain from harming  It works! living beings, taking that which is not given, and incorrect speech • Primary Care • Developed over the last 20+ years • 1-day mindfulness training MBPBS • Experimentally tested with parents, • Recognize an emergent behavioral paid caregivers, and teachers Stepped-Care Model Mindfulness-Based Positive issue, assess and observe its progress, Behavior Support (completed) of MBPBS and keep an eye on the behavior to see • Series of multiple-baseline designs if an intervention is necessary. • Quasi-experimental designs ONE SIZE DOES NOT FILL ALL: • Randomized Controlled Trials (RCTs) Matching level of service to • Low Intensity Care immediate and long-term • Component analyses (completed) • 1-day mindfulness training needs • MBPBS vs. PBS • 2-day PBS training • MBPBS vs. MB vs. PBS • Comparative effects (completed) • High Intensity Care • Mothers of children with ASD vs. with ID • 7-day intensive or 8-week training in • Preventive effects (in progress) MBPBS program • MBPBS vs. Intervention-as-usual longitudinal • High intensity PBS delivered by BCBA or study BCBA-D behavior analysts • Multiple baseline design across group Singh et al. (2006) homes • 15 group home care staff, 5 in each home • 10 men and 5 women Brief Sampling of Recent Studies • 18 individuals, 6 in each home Singh, N.N., Lancioni, G.E., Winton, A.S.W., Curtis, • Behavioral training that preceded W.J., Wahler, R.G., mindfulness training was not as effective Sabaawi, M., Singh, J., & as desired McAleavey, K. (2006). • Mindfulness based training provided only Mindful staff increase to the care staff, but the outcomes were learning and reduce measured on the individuals aggression by adults with • Target behaviors developmental disabilities. Research in • Individuals: Learning objectives, socially Developmental Disabilities , integrated activities, physically integrated 27 , 545-558. activities, use of restraints, and aggressive behavior • Caregivers: staff satisfaction, social validation (satisfaction) 10

4/11/2019 Aggression and Objectives Mastered by Individuals with IDD and Use of Physical Restraints by staff Social Validation and Staff Satisfaction • Multiple baseline design across preschool Maladaptive Behaviors teachers of children who functioned at the mild level of intellectual disabilities Singh et al. (2013) • 3 preschool teachers • 6 children in each classroom • 2 teacher aides in each classroom What happens to the • Age of teachers: 28, 32, and 26 years behavior of individuals • Age of children: 5 to 8 years with IDD when their • Target behaviors: teacher undertakes a course of mindfulness • Maladaptive behaviors: screaming, kicking, biting, pushing and shoving, hitting, slapping, throwing training? or destroying property, and grabbing food • Compliance with teacher requests • Social interactions (positive, negative, neutral) • Mindfulness training: 2 hours a week for 8 weeks (i.e., 16 hours) • 1-to-1 training with an experienced mindfulness trainer • Data collected for 32 weeks Effect size: phi = .92, p < .001 Compliance with Teacher Requests Positive Social Interactions of Children (% of requests) (% of observations) Effect size: phi = 1.00, p < .001 Almost no change in positive interactions (phi = .044, p = ns.) 11

4/11/2019 Negative Social Interactions of Children Neutral Social Interactions of Children (% of Observations) (% of Observations) Significant increases in neutral interactions (i.e., isolate play) (phi = .841, p < .001) Significant decreases in negative interactions (phi = .761, p < .001) • Quasi-experimental research design Singh, N. N., Lancioni, G. E., 16 Karazsia, B. T., & Myers, R. • 33 support staff Outcomes E. (2016). Caregiver training 14 • 18 adults with developmental disabilities in Mindfulness-Based 12 • Average age of staff: 39 years Positive Behavior Supports Physical Restraint, (MBPBS): Effects on 10 • Average age of individuals: 26 years caregivers and adults with Staff Injury, Peer Injury, • Target variables: 8 intellectual and Pre Training and Staff Turnover Post Training developmental disabilities. • Physical restraints for aggressive behavior 6 (Cascading or Spillover Frontiers in Psychology , 7:98. • Staff injury Effects) 4 • Peer injury 2 • Staff turnover • Staff perceived psychological stress 0 Physical Staff Injury Peer Injury Staff • Cost-benefit analysis Restraint Turnover* • Mindfulness training: 7-day intensive • Data collected for 40 weeks Physical restraints: t (39) = -18.20, p < .001 (Cohen’s d = 5.83). Staff Injury: t (39) = -7.44, p < .001 (Cohen’s d = 2.38) Peer Injury: t (39) = -7.67, p < .001 (Cohen’s d = 2.46). Staff turnover: χ 2 (1) = 11.08, p < .001. • Randomized controlled trial MBPBS vs. Singh, N. N., Lancioni, G. E., training as usual (TAU) Karazsia, B. T., Chan, J., & 35 Outcome • Staff: 37 (MBPBS), 38 (TAU) Winton, A. S. W. (2016). • Adults with developmental disabilities: 24 30 Effectiveness of caregiver Perceived Psychological (MBPBS), 24 (TAU) training in Mindfulness- Stress on PSS-10 25 Based Positive Behavior • Average age of staff: 43 (MBPBS), 45 (TAU) Support (MBPBS) vs. • Adults with developmental disabilities: 39 20 training-as-usual (TAU): A (MBPBS), 42 (TAU) Staff Perceived 15 randomized controlled Stress • Target variables: trial. Frontiers in 10 • Aggressive behavior Psychology , 7:1549. • Physical restraints for aggressive behavior 5 • Stats (emergency) medicine use 0 • One-to-one staffing for aggressive behavior Pre-MBPBS MBPBS Post-MBPBS • Staff perceived psychological stress Training Training Training • Cost-benefit analysis • Mindfulness training: 7-day intensive Pre-MBPBS training versus post-MBPBS: • Data collected for 40 weeks F (2, 64) = 417.56, p < .001 (η 2 = .93). 12