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

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Parental Use of Physical Restraints

Surfing the Urge

• If a pause is inserted between the

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

• pen, equanimous, and curious

attitude, without self-judgment, and non-attachment to the urge.

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Singh et al. (2018)

• Three adolescents with Autism

Spectrum Disorder

• Ages: 16, 17, and 17 years
• Target behaviors: verbal and

physical aggression

• Training:
• Training spread over 2 weeks
• Results:
• Effect size: 0.55 – verbal aggression and

0.29 for physical aggression

• All three were taken off their

psychotropic medications prescribed for physical aggression Surfing the Urge: An Informal Mindfulness Practice for the Self- Management of Aggression by Adolescents with ASD

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Surfing the Urge : Physical Aggression

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1 2 3 4 5 6 7 8 9 Baseline Intervention Last 5 weeks Alan Brady Cam

Surfing the Urge: Verbal Aggression

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2 4 6 8 10 12 14 Baseline Intervention Last 5 weeks Alan Brady Cam

To individuals at Severe or Profound Levels of Functioning Teaching

MINDFULNESS SKILLS

4/11/2019 8 Shaping

Mindfulness of Breathing

43

BELL

Using the Sound

Bell for Classroom

Self-Management of Disruptive Behavior

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Bell for Classroom

Self-Management of Disruptive Behavior

46

Bell for Classroom

Self-Management of Disruptive Behavior

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HOBERMAN BALL

The Breathing Ball

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LOTUS BREATHING

Using the Fingers as a Lotus

YOGA

Mindfulness in Motion

Walking Meditation

Mindfulness in Motion

• f Individuals with ASD and/or IDD

Effects of Teaching

CAREGIVERS

MBPBS is the systematic braiding of two evidence-based complementary models—the yin and yang of mindfulness-based practices and positive behavior support—focused

• n enhancing the quality of life of

people in human services

WHAT IS MINDFULNESS- BASED POSITIVE BEHAVIOR SUPPORT (MBPBS)?

MBPBS

• Mindfulness-Based (MB) programs

assist parents, teachers, and other caregivers to reduce their perceived stress and enhance their psychological wellbeing, and provide effective services to those in their care

• Positive Behavior Support (PBS) is

an evidence-based approach to behavior change

• Mindfulness-Based Positive

Behavior Support (MBPBS) is the braiding of two evidence-based approaches to behavior change that are synergistic in their philosophy of care

Mindfulness-Based Positive Behavior Support

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Why MINDFULNESS with PBS?

• Its behavioral in nature
• Focuses on private events
• Testable—single-subject research designs
• Enriches behavioral technology
• Adds new dimensions to our practice—

emotional connection with people who are suffering

• Behavior is about emotion regulation,

stupid! (with apologies to Bill Clinton: “It is the economy stupid!”)

• Enhances compassion, gratitude,

empathy, loving kindness, joy, equanimity . . . and

• It works!

The MB in MBPBS

Key Practices

• Foundational meditations—Samatha

(focused, concentration), Kinhin (walking, embodied mindfulness), and Vipassanā (open monitoring, insight)

• Five hindrances—sensory desires, ill-will,

sloth and torpor, restlessness and worry, and doubt—and their antidotes

• Four Immeasurables—lovingkindness,

compassion, empathic joy, equanimity (equipoise)

• Three poisons—attachment (upādāna,

desire) , anger (patigha), and ignorance (avidyā)

• Beginner’s mind and being in the present

moment

• Mindfulness in Motion—Yoga
• Ethical precepts—refrain from harming

living beings, taking that which is not given, and incorrect speech

MBPBS

• Developed over the last 20+ years
• Experimentally tested with parents,

paid caregivers, and teachers (completed)

• Series of multiple-baseline designs
• Quasi-experimental designs
• Randomized Controlled Trials (RCTs)
• Component analyses (completed)
• MBPBS vs. PBS
• MBPBS vs. MB vs. PBS
• Comparative effects (completed)
• Mothers of children with ASD vs. with ID
• Preventive effects (in progress)
• MBPBS vs. Intervention-as-usual longitudinal

study

Mindfulness-Based Positive Behavior Support

Stepped-Care Model

• f MBPBS
• Primary Care
• 1-day mindfulness training
• Recognize an emergent behavioral

issue, assess and observe its progress, and keep an eye on the behavior to see if an intervention is necessary.

• Low Intensity Care
• 1-day mindfulness training
• 2-day PBS training
• High Intensity Care
• 7-day intensive or 8-week training in

MBPBS program

• High intensity PBS delivered by BCBA or

BCBA-D behavior analysts

ONE SIZE DOES NOT FILL ALL: Matching level of service to immediate and long-term needs

Brief Sampling of Recent Studies

Singh et al. (2006)

• Multiple baseline design across group

homes

• 15 group home care staff, 5 in each home
• 10 men and 5 women
• 18 individuals, 6 in each home
• Behavioral training that preceded

mindfulness training was not as effective as desired

• Mindfulness based training provided only

to the care staff, but the outcomes were measured on the individuals

• Target behaviors
• Individuals: Learning objectives, socially

integrated activities, physically integrated activities, use of restraints, and aggressive behavior

• Caregivers: staff satisfaction, social validation

(satisfaction) Singh, N.N., Lancioni, G.E., Winton, A.S.W., Curtis, W.J., Wahler, R.G., Sabaawi, M., Singh, J., & McAleavey, K. (2006). Mindful staff increase learning and reduce aggression by adults with developmental

• disabilities. Research in

Developmental Disabilities, 27, 545-558.

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Aggression and Objectives Mastered by Individuals with IDD and Use of Physical Restraints by staff

Social Validation and Staff Satisfaction

Singh et al. (2013)

• Multiple baseline design across preschool

teachers of children who functioned at the mild level of intellectual disabilities

• 3 preschool teachers
• 6 children in each classroom
• 2 teacher aides in each classroom
• Age of teachers: 28, 32, and 26 years
• Age of children: 5 to 8 years
• Target behaviors:
• Maladaptive behaviors: screaming, kicking, biting,

pushing and shoving, hitting, slapping, throwing

• r 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

What happens to the behavior of individuals with IDD when their teacher undertakes a course of mindfulness training?

Maladaptive Behaviors

Effect size: phi = .92, p < .001

Compliance with Teacher Requests

(% of requests)

Effect size: phi = 1.00, p < .001

Positive Social Interactions of Children

(% of observations)

Almost no change in positive interactions (phi = .044, p = ns.)

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Negative Social Interactions of Children

(% of Observations)

Significant decreases in negative interactions (phi = .761, p < .001)

Neutral Social Interactions of Children

(% of Observations)

Significant increases in neutral interactions (i.e., isolate play) (phi = .841, p < .001) Singh, N. N., Lancioni, G. E., Karazsia, B. T., & Myers, R.

• E. (2016). Caregiver training

in Mindfulness-Based Positive Behavior Supports (MBPBS): Effects on caregivers and adults with intellectual and developmental disabilities. Frontiers in Psychology, 7:98.

• Quasi-experimental research design
• 33 support staff
• 18 adults with developmental disabilities
• Average age of staff: 39 years
• Average age of individuals: 26 years
• Target variables:
• Physical restraints for aggressive behavior
• Staff injury
• Peer injury
• Staff turnover
• Staff perceived psychological stress
• Cost-benefit analysis
• Mindfulness training: 7-day intensive
• Data collected for 40 weeks

Outcomes

Physical Restraint, Staff Injury, Peer Injury, and Staff Turnover (Cascading or Spillover Effects)

2 4 6 8 10 12 14 16 Physical Restraint Staff Injury Peer Injury Staff Turnover* Pre Training Post Training

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: χ2(1) = 11.08, p < .001.

Outcome

Perceived Psychological Stress on PSS-10

5 10 15 20 25 30 35 Pre-MBPBS Training MBPBS Training Post-MBPBS Training Staff Perceived Stress

Pre-MBPBS training versus post-MBPBS: F(2, 64) = 417.56, p < .001 (η2 = .93). Singh, N. N., Lancioni, G. E., Karazsia, B. T., Chan, J., & Winton, A. S. W. (2016). Effectiveness of caregiver training in Mindfulness- Based Positive Behavior Support (MBPBS) vs. training-as-usual (TAU): A randomized controlled

• trial. Frontiers in

Psychology, 7:1549.

• Randomized controlled trial MBPBS vs.

training as usual (TAU)

• Staff: 37 (MBPBS), 38 (TAU)
• Adults with developmental disabilities: 24

(MBPBS), 24 (TAU)

• Average age of staff: 43 (MBPBS), 45 (TAU)
• Adults with developmental disabilities: 39

(MBPBS), 42 (TAU)

• Target variables:
• Aggressive behavior
• Physical restraints for aggressive behavior
• Stats (emergency) medicine use
• One-to-one staffing for aggressive behavior
• Staff perceived psychological stress
• Cost-benefit analysis
• Mindfulness training: 7-day intensive
• Data collected for 40 weeks