Mindfulness for Complex Posttraumatic Stress Disorder

By Jeff Dwarshuis LMSW, ACSW

Mindfulness is the act of intentionally living with awareness in the current moment and striving for its benefits of decreased stress and increased happiness, mind control and emotional regulation.

Often when people are not mindful, they are focusing on both the past and the future. This can cause difficulty since focusing on the future can lead to a fear of future events. Also, focusing on the past can lead to negative emotions if one is thinking about past trauma or past events leading to negative thoughts about oneself. This is particularity true with individuals who have a history of repeated abuse or repeated traumatic incidences causing Complex Posttraumatic Disorder.

Mindfulness allows someone to focus on the past, present and future with control so that thoughts and feelings don’t become overwhelming.

Mindfulness is not a quick fix for stress or suffering. Although the benefits can be experienced quickly, the best and most long-lasting impacts come from keeping a routine of practice.

Mindfulness skills are those conscious acts that increase one’s ability to be mindful in a large variety of contexts in life. The following is a list of five things that can be done to be mindful.

Five Things to Do to Be Mindful

1. Mindful Breathing 

The practice of mindful breathing serves two purposes. First, it causes a physical reaction that relaxes the body and the mind. Second, it provides a beginning point for being mindful and focusing on the moment. Mindful Breathing is the central exercise for mindfulness and is extremely beneficial for self-regulation even if done apart from any other exercises. Follow these steps.

  1. Breath through your nose and fill your lungs with air. While doing this be sure that your stomach is moving more than your chest.
  2. Think about your body from head to toe and notice where in your body you feel relaxation. Continue for at least ten minutes. Keep your breathing smooth and regular.
  3. Develop mindfulness and staying in the present moment by focusing only on your breathing. Also, be aware of the physical sensation of air moving through your nose and to your lungs. Notice the pauses between breaths. If you become distracted and think about something else, simply return to focusing on your breathing.  For a good and extended training use Jon Kabat – Zinn’s audio training called “Guided Mindfulness Meditation: Body Scan Meditation”.

2. Observe and Describe Things That Are External

Observing is the act of purposefully noticing the reaction of our senses in the current moment. The power of observing comes from the fact that it requires one to step back from an object and notice it from a distance.

Describing is the act of tracking an observation. It involves labeling something or putting words to experience. Describing mindfully requires one to focus only on the facts without judgment. Thus, one should describe only the who, what, when, where and how of an observation.

The second step in mindfulness is to observe and describe things that are external using one of the five senses. Thus, one can observe and describe a smell, a physical sensation, a taste, a sound or a sight. Also, all observations and descriptions are of things that are external and not internal such as thoughts, feelings or memories.

Begin this step by picking things to observe and describe. Observe and describe one thing at a time and consciously stay in the moment. Pick a variety of things to observe in order to individually use all or most of the five senses. Keep from using judgment.

3. Observe and Describe Things that are Internal

Observing and describing things that are internal is usually more difficult than observing and describing things that are external. However, the practice of mindfulness makes this task more tangible.

Use the skill of observing and describing to observe, label and describe an emotion. Notice the emotion and hold onto it for a period then let it go. Emotions are things that exist in the current moment and are meant to be experienced as well as completed. Don’t judge the emotion but observe and describe only the facts or consequences of the emotion.

Use the skill of observing and describing to observe, label and describe a thought. Thoughts are a part of our daily existence and direct us to reason. Next, challenge this by observing and describing a thought of yourself that is negative. Perhaps this is a negative self belief such as “I am bad”, “I am not good enough” or “I am damaged”. Observe and describe this negative thought about yourself then let it go. Negative thoughts cause the most trouble for someone when they go unrecognized. Their power deceases when they are recognized and challenged through replacing them with rational positive thoughts or pushing them away.

Next observe and describe a memory. Challenge this process by picking a negative memory. Again observe, describe and let it go. Do not judge it or yourself but describe only the facts.

The most common topics for internal observation and description are thoughts, feelings, memories and body sensations. The most difficult topics for observation and describing are any of the above topics that are negative.

4. Create Expanded Awareness by Combining Mindful Breathing, Observations and Descriptions

As stated, mindfulness is the act of intentionally living with awareness in the current moment and striving for its benefits of decreased stress and increased happiness, mind control and emotional regulation. The skill of mindfulness is increased through the act of expanding awareness. Expanding awareness consists of the movement from one present focus to another within a controlled set of time. Basically, it is the combined use of the skills presented above. Here are some examples.

Begin mindful breathing until feeling relaxed and focused. Then observe and describe something external. When completed return to mindful breathing.

Begin mindful breathing until relaxed and focused then observe and describe a thought and return to breathing. If it is a negative self thought use the concepts described before of replacing the negative thought or pushing it away. When completed, return to mindful breathing.

Use this method in various combinations including mindful breathing, thoughts, feelings, body sensations, memories and external observations. It can be done in any combination. However, there are some suggestions to consider.

  1. Use mindful breathing in most all combinations when possible.
  2. Begin expanding awareness by using external observations before internal observations.
  3. Begin by using smaller combinations such as only two combinations.
  4. After practicing expanded awareness on more basic topics include negative thoughts, feelings and memories. These are more difficult to process and resolve yet they also provide the greatest benefit of change.

The overall impact of mindfulness practice is an increased ability to stay in the moment and not be pulled into the negative consequences of distracting or overwhelming thoughts of the past or future. Also, it should lead to a resolve and control of present negative thoughts, feelings, memories and body sensations that lead to problems in relationships, behavior, performance and many problems in mental health.

Practice expanded awareness daily doing three sets of ten minutes each. People will vary in their need so you may prefer to do it more or less than this. Set aside a time to practice so you can concentrate on the results. Also, begin to then use in your daily activities.

5. Participation

Another mindfulness skill is the practice of participation. Mindfulness can be increased by thoughtfully considering how you approach social activities. Living in the moment when involved with people requires a certain level of letting go of typical routines and responses to actively participate in things around you.

Practice participation by joining an activity and going with the flow. Open to the direction and norms that are being established by others involved in the activity. Allow yourself to stretch your norms and step into something new. Practice by being involved in activities of school, church, sports or general activities of having fun.

Participation does not have to be done all the time but a skill that is practiced to the extent that it helps to be more naturally mindful in social contexts.

After practicing these five skills above begin to use the list of three things below to increase the quality of mindfulness skills.

Three Ways to Increase the Quality of Being Mindful

1. Strive for Nonjudgmental Observations and Descriptions

The act of judgment is costly to one’s well-being and initiates thoughts and feelings that make it difficult to remain in the present. It is a problem when someone is thinking judgmentally about themselves. Striving for nonjudgment is a skill that needs to be used during the tasks of observation and describing. To keep a nonjudgmental attitude, follow these suggestions.

  1. Focus on the facts of what you are observing and keep from evaluating it as good or bad.
  2. Remain especially aware of judgment when acknowledging your own thoughts, feelings and values. Keep from interpretations and opinions of yourself and others.
  3. Don’t compare yourself or others.
  4. Decease judgmental thoughts by counting them and writing them down as well as observing your judgmental posture, facial expressions and tone.

2. Do What Is Effective

When people get preoccupied by past experience or upcoming anxieties they tend to react irrationally and solve problems poorly. For example, if someone has a history of limited validation by family or peers their memories of these times might compel them to want to appear as right in their views or disagreements. A ridged posture in relationships is destructive and not effective. Another example of ineffective behavior is avoidance. If someone has a history of helplessness or verbal abuse their memories of these events might cause them to approach problems by avoiding them or seeing them as too big to solve. Mindfulness practice helps someone to live in the present. That skill combined with attention to being effective allows someone to better solve their problems. For doing what is effective follow these ideas.

  1. Know your goals for a situation and do what is needed to achieve them.
  2. Focus on what works to solve a problem. Don’t let emotions interfere.
  3. Follow the rules. Rules generally keep people on a track of possibilities and methods for solving a problem.
  4. Do what is needed for the situation rather than what might be seen as fair, comfortable or desirable.
  5. Ask yourself “Am I trying to be effective or am I trying to be right”?

3. Approach Tasks One-Mindfully

When someone is living in a mindful way it means they are letting go of the distractions that keep them from being in the moment. This can be increased by thoughtfully evaluating and changing how tasks are approached.

If you have many tasks to accomplish, do only one thing at a time and keep your focus on that task. If you begin multitasking, then stop and return to doing one task. Apply this routine to the hard tasks at work and home as well as positive things like eating, talking with friends and having fun.

Holding It All Together Using Wise Mind

Practicing Wise Mind consists of a daily approach to thoughts, feelings, decisions and values that keeps from extremes in thinking and behavior. Extremes in thinking and behavior are generally irrational and are not productive for problem solving or emotional health and are influenced by past hardships, anxiety about upcoming events, negative thoughts and self beliefs and poor regulation of emotion. Mindfulness helps people stay in the present and the practice of Wise Mind is another skill to make this happen. Wise Mind can be seen as an acceptance and synthesis of the opposites or extremes in a situation in an effort to consciously recognize them to remain balanced. Here are some examples.

1. Keep an even balance between Thoughts and Feelings

If someone is not in touch with their emotions, it leaves them vulnerable to unsafe situations since they are not aware of the negative emotional reactions that bad situations can bring. On the other hand, people who are overly emotional tend to make poor decisions since intellect is hard to access if emotions are running high. Keeping a balance between thoughts and feelings requires that we recognize and manage emotions while combining them with reason so we can make good decisions and solve problems.

2. Balance Doing Behavior with Existing

The extremes of workaholic behavior and laziness or avoidance are ineffective, and the hardships of their results are destructive. Balancing these two extremes allows for being able to do what is needed to get things done and solve problems while also remaining able to experience, as needed, the uniqueness of each moment.

3. Balance Desire for Change with Accepting Things as They Are

Some things in life cannot be changed and attempts to change an impossible situation are both tiring and useless. Also, being too quick to accept things as they are can create helplessness. A balance of these two things allows for an ongoing desire to change things while also being willing to accept things as they are in the moment.

4. Balance Self Denial with Self Indulgence

A life of self denial requires the avoidance of need while self indulgence is a preoccupation with future need. Both extremes are ineffective for maintaining a happy life. Create a balance of these extremes by consciously satisfying the senses while also practicing moderation.

Resources

Cognitive Therapy – Basic and Beyond by Judith Beck (1995)

Full Catastrophe Living by Jon Kabat – Zinn (2013)

Wherever You Go There You Are by Jon Kabat – Zinn (2005)

Guided Mindfulness Meditation; Four Practice CDs. Series One by Jon Kabat – Zinn

The DBT Skills Training: Handouts and Worksheets by Marsha Linehan PhD

Traumatic Stress: The Effects of Overwhelming Experience on The Mind, Body and Society by Bessel Vander Klok, Alexander Mc Farlane, and Lars Weisaeth (2007)

The Anxiety and Phobia Workbook by Edmond Bourne (2015)

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