Attuned BreathAttuned Breath

CenteringCentering

A Contemplative Practice forA Contemplative Practice for

Cognitive Cognitive DefusionDefusion::

Integrating Psychology and Integrating Psychology and

Spirituality to Activate Well-BeingSpirituality to Activate Well-Being

Presenter:Presenter:

Chaplain Judy Chaplain Judy Seicho Seicho Fleischman MS BCCFleischman MS BCC

I.I. Purpose of this WorkshopPurpose of this Workshop

Learn skills, which complement the methods of ClinicalLearn skills, which complement the methods of ClinicalPastoral Education (CPE), toPastoral Education (CPE), to

!! Treat psycho-spiritual distress utilizing a clinically-Treat psycho-spiritual distress utilizing a clinically-framed method called framed method called Attuned Breath CenteringAttuned Breath Centering(ABC).(ABC).

!! Care for yourself Care for yourself at the same timeat the same time utilizing utilizing ABC.ABC.

!! Experience and Provide the elements of ABCExperience and Provide the elements of ABC

"" Attuning (identifying intention/ aspiration)Attuning (identifying intention/ aspiration)

"" Breathing (mindfully)Breathing (mindfully)

"" Centering (focussing attention on intention)Centering (focussing attention on intention)

II. What is Attuned Breath

Centering?

! A contemplative practice of paying attention tointention while mindfully breathing.

! Developed by this writer, in step with CognitiveBehavioral Therapy(CBT) and its principle ofCognitive Defusion.

! Activates presence, acceptance, and commitmentas the foundation for transforming psycho-spiritualstressors and restoring sense of well-being.

! Sustains client(s) and caregiver" Practice-centered relationship

" Scalable expression of capacity to

• Connect

• Integrate differences

• Function (get needs met)

III. Benefits of ABCIII. Benefits of ABC

!! Comfort and behavioral shiftComfort and behavioral shift"" Reduce symptoms of pain and anxietyReduce symptoms of pain and anxiety

"" Restore sense of well-beingRestore sense of well-being

"" Integrate as adaptive intervention or ongoing supportIntegrate as adaptive intervention or ongoing supportstrategystrategy

"" Transform maladaptive behaviors into adaptiveTransform maladaptive behaviors into adaptivecoping toolscoping tools

!! AccessibilityAccessibility"" Religious or secular framingReligious or secular framing

"" Language (form of contemplative practice)Language (form of contemplative practice)•• Verbal or WrittenVerbal or Written

•• ImageryImagery

•• Music/soundMusic/sound

•• MovementMovement

III. Benefits of ABC (cont.)III. Benefits of ABC (cont.)

!! ScalabilityScalability

"" Individual and collective (groups/systems)Individual and collective (groups/systems)

!! AdaptabilityAdaptability

"" SettingsSettings

"" PopulationsPopulations

IV. How does ABC work?IV. How does ABC work?

(key elements)(key elements)

!! AttunedAttuned"" MindfulMindful

"" ReflectiveReflective

"" SimpleSimple

!! BreathBreath"" PresencePresence

"" ContactContact

"" AcceptanceAcceptance

!! CenteringCentering"" ConnectingConnecting

"" ActivatingActivating

"" IntegratingIntegrating

Try it outTry it out

!! Mindful BreathingMindful Breathing"" Noticing next in-breath and out-breathNoticing next in-breath and out-breath

!! Attention to IntentionAttention to Intention"" Breathing inBreathing in

•• What keeps me going?What keeps me going?

"" Breathing outBreathing out

•• WhatWhat’’s important, right now?s important, right now?

!! Refine until simple statement of core value(s)Refine until simple statement of core value(s)"" CPE reflective listeningCPE reflective listening

"" Non-violent communication (NVC)Non-violent communication (NVC)

"" Voice dialogueVoice dialogue

V. V. Psychology meets SpiritualityPsychology meets Spirituality

! Attuned Breath Centering (ABC) is in step withCognitive Behavioral Therapy (CBT) and its principleof Cognitive Defusion (CD).

! What is Cognitive Defusion?

" Experiencing thoughts, images, emotions, andmemories as what they are, not what they appear to be.

" one of six principles utilized in Acceptance andCommitment Therapy (ACT), a branch of CBT.

! What is ACT?

" ACT uses acceptanceacceptance and mindfulnessmindfulness strategies• • Accept your reactions and be present

• • Choose a valued direction

• • Take action

! ABC is a way to ACT

VI. ABC in VI. ABC in ACTionACTion::

Primary Population TreatedPrimary Population Treated

! WHO: Persons living with HIV who report history

of trauma, emotional deprivation, mental illness

and substance use (some in recovery).

! WHEN: Feb. 2006 - Oct. 2009

! WHERE: Housing Works, Inc., New York City

" largest minority-run social service and advocacy

agency in the U.S. for persons living with

HIV/AIDS.

VI. ABC inVI. ABC in ACTion ACTion::

Primary Population Treated (cont.)Primary Population Treated (cont.)

! WHAT: Individuals and groups

! Partnership with Interdisciplinary (ID) Team

! Integration with “Healing Community” ID Care Model

" Application within “Adult Day Treatment” Program

• Individual treatment

" Spiritual assessment

" Spiritual Care planning

" Spiritual Intervention

• Weekly therapeutic groups

• Healing services and Community programs

! Considerations in tailoring treatment

SpiritualSpiritual

assessment to actionassessment to action!! Written tool developed in partnership with TheWritten tool developed in partnership with The

Healthcare ChaplaincyHealthcare Chaplaincy"" What keeps you going? (What keeps you going? (““hopehope””))

"" WhatWhat’’s important in your life? (s important in your life? (““purposepurpose””))

!! Connect questions with breath cycleConnect questions with breath cycle"" Breathing in, what keeps me going?Breathing in, what keeps me going?

"" Breathing out, whatBreathing out, what’’s important?s important?

!! Broadly-framed contemplative practiceBroadly-framed contemplative practice"" Clients disconnected from/not identified with religionClients disconnected from/not identified with religion

and prayerand prayer

"" Clients with insight but no behavioral shiftClients with insight but no behavioral shift•• E.g., those in recovery from addictive substances/behaviorsE.g., those in recovery from addictive substances/behaviors

VII. VII. CommentaryCommentary

!! How can the benefits of ABC be measured?How can the benefits of ABC be measured?

Measurable outcomeMeasurable outcome

evaluationevaluation!! Concrete practice invites concrete evaluationConcrete practice invites concrete evaluation

"" How many times do you practice ABC per week?How many times do you practice ABC per week?

"" How often are you experiencing symptoms ofHow often are you experiencing symptoms of•• Clinical depressionClinical depression

•• AnxietyAnxiety

•• Pain (define type)Pain (define type)

"" How often/much are you taking meds for?How often/much are you taking meds for?•• Clinical depressionClinical depression

•• AnxietyAnxiety

•• Pain (define type)Pain (define type)

"" How often/much are you self-medicating?How often/much are you self-medicating?•• Recovery (addictive substances and behaviors)Recovery (addictive substances and behaviors)

VII. VII. Commentary (cont.)Commentary (cont.)

!! How can the benefits of ABC be measured?How can the benefits of ABC be measured?

!! How is thisHow is this transdisciplinary transdisciplinary care? care?

"" ““Cross-trainingCross-training””

"" Integration as adaptive clinical treatmentIntegration as adaptive clinical treatment

"" Patient-centered CARE planningPatient-centered CARE planning

•• Charting <==> ConnectingCharting <==> Connecting

•• Assessing <==> AppreciatingAssessing <==> Appreciating

•• Referring <==> RelatingReferring <==> Relating

•• Educating <==> EmpathizingEducating <==> Empathizing

VII. VII. Commentary (cont.)Commentary (cont.)

!! How can the benefits of ABC be measured?How can the benefits of ABC be measured?

!! How is thisHow is this transdisciplinary transdisciplinary care? care?

!! Adaptability to other settingsAdaptability to other settings

Treatment in Acute Care SettingTreatment in Acute Care Setting

!! Memorial Sloan-Kettering Cancer CenterMemorial Sloan-Kettering Cancer Center

"" ABC as adaptive treatment ABC as adaptive treatment ““bridgebridge”” for for

outpatient=inpatientoutpatient=inpatient

•• ““repeat customersrepeat customers””

!! NYU NYU Langone Langone Medical CenterMedical Center

"" Palliative Care considerationsPalliative Care considerations

Considerations for other settingsConsiderations for other settings

!! HealthcareHealthcare"" Adult Day TreatmentAdult Day Treatment

"" Acute care / VAAcute care / VA

"" RehabRehab

"" Long-term residentialLong-term residential

"" HospiceHospice

!! Non-HealthcareNon-Healthcare"" MilitaryMilitary

"" PrisonPrison

"" SchoolsSchools

"" Corporate and other workplacesCorporate and other workplaces

Mindful + hopeful + purposeful =Mindful + hopeful + purposeful =

Healing oneself, Healing communityHealing oneself, Healing community

VIII. VIII. ResourcesResources

!! www.www.trustingtransitionstrustingtransitions.com/resources.html.com/resources.html

! Marshall B. Rosenberg, Ph.D., NonviolentCommunication: A Language of Life, 2nd. Edition, 2003,Puddledancer Press, http://www.http://www.cnvccnvc.org.org

! Hal Stone, Ph.D., and Sidra Stone, Ph.D., EmbracingOur Selves, The Voice Dialogue Training Manual, 1989,Nataraj Publishing, http://www.http://www.voicedialoguevoicedialogue.org.org

! Steven C. Hayes, Act in Action: Cognitive Defusion,2008, New Harbinger Publications, U.S

!! http://en.http://en.wikipediawikipedia.org/.org/wikiwiki/Acceptance_and_commitment_therapy/Acceptance_and_commitment_therapy

! Fleischman, J., Healing Community: TransformingTrauma in Relationship, 2008, PlainViews, Volume 5, No.11, http://www.http://www.plainviewsplainviews.org/v5n11/.org/v5n11/lvlv.html.html

IX. Contact InfoIX. Contact Info

!! Chaplain JudyChaplain Judy Seicho Seicho FleischmanFleischman

"" Info@Info@trustingtransitionstrustingtransitions.com.com

"" T 212-696-7238T 212-696-7238

Thanks toThanks to

!! My Zen teacher,My Zen teacher, Roshi Roshi PatPat Enkyo Enkyo OO’’HaraHara

!! Chaplain George Chaplain George HandzoHandzo

!! Chaplain Jane Chaplain Jane MatherMather

!! Clients and staff of Housing Works, Inc.Clients and staff of Housing Works, Inc.

!! Patients and staff of Memorial Sloan-Kettering CCPatients and staff of Memorial Sloan-Kettering CC

!! Patients and staff of NYU-Patients and staff of NYU-Langone Langone Medical CenterMedical Center

Thank youThank you

!! My Zen teacher, My Zen teacher, Roshi Roshi Pat Pat Enkyo Enkyo OO’’HaraHara"" Village ZendoVillage Zendo

!! Chaplain George Chaplain George HandzoHandzo"" The Healthcare ChaplaincyThe Healthcare Chaplaincy

!! Chaplain Jane Chaplain Jane MatherMather"" HCC and Memorial Sloan-Kettering Cancer CenterHCC and Memorial Sloan-Kettering Cancer Center

!! Clients and staff of Housing Works, Inc.Clients and staff of Housing Works, Inc.

!! Patients and staff of Memorial Sloan-Kettering CCPatients and staff of Memorial Sloan-Kettering CC