Episode 126 :: Cynthia Price :: Mindfulness for Substance Use Disorder
You're listening to episode one twenty six of present moment. Welcome to present moment, mindfulness practice and science. I'm Ted Meissner. Present moment is podcast with interviews conversations. And roundtable discussions, we speak with mindfulness. Researchers about their newest findings published in peer reviewed science journals teachers about their understanding and methods as they work with students of mindfulness authors about their books and interests, and we also speak with everyday practitioners. The website present moment mindfulness dot com has shown for each episode long with resource materials. Dr Cynthia price joins us to speak about the study mindful awareness, embody oriented therapy for women in substance use disorder treatments. If you listening to this podcast and find value in insights from what shared here know that this is made possible from your generosity and the generosity of others. Like, you I want to thank those of you who are making monthly donations to keep this podcast going. And if you're not yet, please take a moment. Go to present moment mindfulness dot com and click on make donation one time or especially monthly donations show. You value this work, which can't happen without you. Thank you for your help you support that you're kind generosity. Have you ever felt disconnected perhaps even dissociated from your body? This can happen for many reasons some benign and some rooted in the experiences during one's lifetime like trauma. My voice can be a way to reconnect, and they'll getting through those waters can be difficult does benefit from the guidance of competent professional. It can be done. Cynthia price. PD L MP is a research associate professor at the university of Washington cynthia's research and clinical expertise is in the acquisition of intercept of awareness imbredded practice for twenty years. She developed mindful awareness embody oriented therapy, or m ABT to teach intercept of awareness and related skills for self care and emotion regulation research program is focused on studying the efficacy mechanisms of MA BT for distressed populations. The majority of work focuses on community based research for individuals who are disconnected from their bodies, doodoo, substance use, trauma, or pain. She is the director of the center for mindful body awareness nonprofit focused on teaching may be t- in integrating mindful body awareness education into programs for underserved populations. Our guest today is Dr Scindia price Cynthia welcome to the podcast led to have you here. You for having me. So let's dive right in want. You to tell us a bit about your background. Well. I'm now research professor at the university of Washington, but I started out and my. Early twenties as a massage therapist, and in the course of being private practice realize working with a lot of emotional issues with my client said went back to school again masters in counseling psychology, not in order to do traditional talk therapy. But to bring those skills more of more. Body psychotherapy approach that continue to use touch. So isn't practice for almost twenty years and worked a lot with people who are just connected from their bodies to? Various things from but a lot of trauma a lot of. And sexual trauma in the client has in with a lot of chronic pain. And at some point in their I decided I really was interested in in bringing this work to more people than. Who I could reach in my private practice than hunt tried to legitimize this type of work in some way has seemed to be so useful to folks. And and now, you know unexpectedly sort of almost decided well one way to do that was research, and maybe I should go back to also that's ended up doing and what brought me to university of Washington was to to really learn how to do interventions research study exactly what I have been doing practice all these years or more or less. Of course, you know, when you're when you're doing research, you you you create which is why they did create a a research protocol for an intervention that is very contained not like clinical practice, which you can see people very long time. So. So that's a little that's kind of how God here. And what my background is. So how about mindfulness did you I encounter that? Because it seems to be a pivotal role in what you've developed. Yeah. Well, it's as when when I first started college, I was religion, major and. I learned about them within the context of being a religion major. But. You know? But I, but I I would have to say that I've I. A lot of how I understand my own cessation with monthly and this work doesn't come from there at all it comes from. Really working in presence as a body worker and throughout much years of practice and training in focusing which is Eugene gentleman's work, which was very much about how people create get touch with their present moment awareness in the body. But I think so much of of. What my relationships mindfulness comes out of Mike and working with clients in that way. So let's talk a little bit about what it is that you've developed tell us about mindful awareness, embody oriented therapy. Okay. So this is an approach basically eight week intervention like so many mindfulness based interventions. That is really designed to teach people very fundamental skills of accessing their capacity to accessing sensory awareness. So their inner vitally experience physical sensations emotional sensations. That's really sort of the wedding receptor witness means so mindful, Madison body oriented therapy is about helping people to on the mental skulls intercept awareness, and we'd. This intervention was really designed out of my experience, clinically of orca people pretty disconnected from their bites. So they didn't have to do that. And when you work a lot with people trauma history. So a lot of chronic pain is common and so. So not to say that this work isn't really helpful for people who don't, you know, who are how the who may not have about level disconnection that so many people do have chronic pain or really high levels of stress or or trauma history. But it really is designed to as Tate that pass ity and Hannah coming back to being able to really easily or at least with more ease. Connect in with semitic experience to bring attention very consciously. I'm very deliberately into places in the body and develop a capacity to stay there. And a very mindful way meditative way, observing compassionately what ever is happening inside. And so we teach people how to do that to this approach in incremental way. We start sort of more on that. Extra of the body. You could say to building the capacity to actually put language to sensation which is abusing for everybody a move from there and to developing the capacity to notice since Asian in the body in an internal way through some exercises using breath using. Intention, and then we move into really more of the meditation piece of helping someone bring their attention into very identified. Places. Like, I'm gonna go into the Harvey gin in the center might Chester go into valley, remove the minimize router, wherever it is that that person has symptoms or has a sense of disease, or whatever some sense of emotional holding for them to go into that place in develop a capacity to actually stay there attempt to how things how feels to be there what they notice how it shifts when able to stay there. So our experiences that that were really teaching people the big steps or time in order to really develop acidy to that. So that's the start kinda more externally on the body than what exercises man with that. That more meditative points and all of this uses touch to help people really bring their attention to their body out them bring your attention back to their body when they start to float out more start thinking, so it's very much a combination of manual psycho, educational and mindfulness to kind of all altogether. Thank you. And I'm really interested in hearing about this recent study on NBC tea for women in substance use disorder treatment. During if he could tell us a bit about that study, did you decide to work with this particular group? Well, I. I didn't have a really strong. Clinic. I did have a lot of clinical expertise people substances disorder. But. When I was a post doc, I was funded on on a grant from Ben National Institute of drug abuse. Or my post doc, so I learned about substance abuse treatment at that time, and then the expectation that post outlets that we would write a grant that would go to the national suit. And at the time they were looking for specifically they were looking for studies in complementary alternative at so I wrote a grant funded so this is a lot of years ago. And that was my first any with women and substance use disorder treatment. It was first study that had done at that population. And it was small, and we got some pretty promising results. And so bad got started and the truth is that wear my clinics for teeth is strongest is true. And all these a hundred percent of these women have Charlie street. So, you know, my own personal interest is very much very much overlaps with this population because of that much part. But so this this the jury ferring too is the follow up to that. This was a larger five year process. A study that we implemented in three community clinics in the Seattle area. All for women who were in outpatient treatment, forceps user soldiers. Could they could have been, you know, addictive, alcohol or opiates or emphatic means or math or multiple multiple things that they were using. But they didn't apps Nate absence based patient treatment. And we did our study at clinics. The intervention happened at clinics and. Yep. So bad. That's how that got started. One of the things you mentioned that stood out for me was that there was a very strong correlation between trauma and substance abuse. And India work with trauma in chronic pain. And other other things of that nature. I'm wondering if. Part of what your design of the program rupture designed the study is really getting at the root of how you use the program, and your course to really get at the roots of the trauma, and the the release from the addictions follow from that that part of what you're doing. I mean, maybe being explicit, right? The women that we see in especially community-based treatment. Certainly for this for this study. They have had very very little mental. Support for trauma. So. You know, some of these women have you know, they've they've got abuse histories that started when they were children and continued into their relationships and you add onto that if they've been using drugs on street. Having other kinds of violence. They're exposed. So it's pretty pervasive and vani doesn't get dealt with. And they end up in treatment for substance use. But usually haven't really had any treatment of other other trauma any other kind of related mental health conditions at all. So when we're doing this work. That's usually what they absolutely that's what they do. They bump into. When you're asking people to pay attention to their bodies and that. The typical very common normal human response to protect ourselves from from emotional pain is is to dissociate from advise as so that we can get through get through the idea last. So. That's what they bump into is. I don't visit comfortable for me. Or I have no idea how feel in you know, as they learn these skills, they become more aware of how they feel start making the lakes between things like, oh, I feel released sad in this part of my and that sadness, you know, they can start making other kinds of links for themselves ramble that sadness loved over from y or whatever. And just them then noticing, oh, this is a real trigger for me. I used to use because I didn't know how to handle out of feel that nece in. So I would go substances in this give allowing me the space to actually be my feelings to know that I can to know that it's safe in my Lai, do this and not meet us until learn how to feel all of that. And so that is exactly what happens, and I think it really is much. I really do think crow law. These folks the trauma is what's fine. Use. So when you're doing a guidance of a meditation in new program and understanding the touches part of this is sometimes of its apprising for the participants. When those emotional revelations come about. It's pricing. But it's it's a president different ways. For for for for for people. You know, sometimes it surprising that they're not used to yielding a positive relationship to their audience sometime. So when they discover that oh my gosh. Not only had something feel sad, and I can be with it. And then that feels good like there's there's way in which that sadness shifts for me on my sense of myself. I my body shifts in a way that actually makes me feel more whole that makes me feel more empowered or strong myself. That's often a surprise for people, really lovely way. So that's a common kind of story one that is in more myst- Lee satisfying. As therapists to watch happen. And it's very impactful for for the participants. So for this particular paper in this particular study, tell us a little bit about the structure what what is it that you did? And and especially what ended up being the results, what are you seeing from this? So this study as I said, it took place in the community clinics said there was a research coordinator who basically lived of clinic and recruited women from therapy groups or the study, and if they were interested after eight finished doubt ascetic questioning ours, they were randomized to one of three treatment groups, so all women in the study were in absence as treatment. And so this study was looking at our intervention my awareness, embody oriented therapy. In addition to treatment as usual. So it's called unto junk of treatment. It's on top what they're already getting. And we also have another invention that we offered so which was women's health curriculum. And that was designed what's called an active control shoe, basically, see whether having the extra time in intention might explain results or was maybe doing something in addition. So all the women the study, they were Windham is to either one of three groups treat, MS usual, only control treatment is usual. Plas mindful awareness. That's experimental group or treatments usual, plus the women's health curriculum as the active in controlled condition. So for those who were randomized either the women's health curriculum or the mindful awareness may then got a individuals sessions for an hour and a half. Each session for eight weeks ago, more or less at their clinic. And then we followed all these women for year. So they were as they fill out set of questionnaires when they rolled in the study twelve weeks later after the interventions would have been completed at six months from their enrollment at twelve months from their much. So we've published the findings from this I in Roman period to post intervention, which is what you have seen in terms of those results on what we saw was that the women who received the mindful body awareness had significantly less sets us than those who were in treatment as usual only. And the women who were in the women's health curriculum also improved in their substances. So this significant difference on substance use was only in relationship to between the mindful, awareness and treatments, usual. But what we did see was that those who got the month ally awareness had significantly improved in their in their interests awareness, skills and their mindfulness skills. If they gotten almost all of the intervention, which really tells us that they learn what we reteaching them, and that is important because you wanna know with such an enormously distressed sample. Can they learn what you're teaching them to learn? And and the answer is yes. And that's really important to know related to that. We also looked at depression symptoms craving symptoms post traumatic stress symptoms. At a much valuation. Some of those we saw significant improvement for mindful body compared to both groups that mostly that showed up for those who really got all of the intervention instead of just one or two sessions. What was really exciting about this study what I had never done before was we looked at emotion regulations of Zia logically. So we looked at whether the heart rate variability for these women which tells us, it's a it's a it's an indicator of regulatory Hannity. The how variable wants heartbeat is tells us that we looked at that at rest, we looked at it in relationship to three different kinds of stressors potential stressors was film. One was rumination on stress on on stressful event. One was actually body awareness Abbadi awareness, meditation, and which could be stressful or not stressful. We were in actually sure it turns that doesn't matter. Whether you've ever had on are not everybody found the body awareness, meditation more regulating, but for those who got the mindful body awareness intervention on rast, film, rumination and body awareness. It was a significant increase in their in their regulatory capacity compared to the other two groups, and that was really exciting. To see because there were issues with suffer port on these measures and have to able to see physiologically. This change really supports our idea that what's happening when people learn to be more aware of their internal experience in terms of Audie wariness. There's been a lot to suggest that that facilitates emotion regulation, but it has not really been looked at without revealing before, and it's certainly not been looked at with this population before. And so these results are really really exciting. You know, what are like is? You're speaking refute things that stood on of was that you have an active control. Which was of course, always somewhat challenging when it something like a mindfulness intervention. What is that they do? Instead, that's as the same social effects and all the rest that that might crop up. So great for that. Also that you were not just relying insult report. There is some biological markers that you could use to help support that. And also appreciate just personally your languaging round. These are indicators and. And just this is one of the things that's very enriching for me about speaking. With researchers is you get how science works that. This isn't it or of process that things are not we did this one study and we're done, and we know everything, and it's proven not at all how science works and listeners to this pug cast, if you've heard if you times you've heard me talk about this before I just wanted to thank you Cynthia for modeling that it's wonderful to hear about how that worked. Week dump not right, right. So what these things really being right? And that was that was also something onto ask about you had mentioned as someone doing the research. How wonderful it is to see someone. Have these positive effects from work that you're doing? And I'm curious if respecting the confidentiality of the specifics that I making a guest that there were some really good moments some breakthroughs in some some good experiences. The people had in the program just with this particular study of the immediate pre imposed just within that limited time scale. How did that go for people? What was that? Like, what was it like for you to to be part of this? Oh, well, I love I mean, those are you just have requested than out on the last for his. I mean, I I have the pleasure of supervising all of were on this day. So I get to be a fly on the wall because we audiotape at Ray single session as a way to make sure that the intervention is being delivered as we expect. But also. Has away Tim provide support for this era? So that when things happen, they're not sure. You know, what did I respond the way should've or this is really challenging can help you think through it. You know, we can go to the tape. Listen to it in an Lillian dress questions. So, you know, the the clinician in me loves that. 'cause I really to really see continue to see how this work helps people and to support therapists who are willing learning to do it too. Well, and so that's that answer to that question. But, but, but as I said earlier, some of some of the most striking and heart warming kinds of stories that that people really talk it out is is is this me connection with their bodies and sense of being able to develop to have new. A tools their whole box basically about south Karen regulation, because we're as in people at the end of every session to collaboratively work with therapist come up with a take on practice. They're gonna do the bills on what they did in that session and to keep track. Analog how often did you do for how long bring that act? So we collect all that data as well. And some women don't bother filling out the log, you know, lives lies chaotic that's like beyond what they can do a male just import verbally what they did. Or didn't do then there's, you know, the gamut in terms of the person who so into it that they spend, you know, a half an hour day every day of the week making sure that close the door they really just quiet in there working on their practice. There's other people that I made a few minutes, and that's all they have. And so. We have that data. But I think it's it's them talking about when is integral to the session. Why did you do in your take home practice? How to go? What questions? Do you have your hunt? We build on that in such a today. Blah, bad is integral to the all that were doing. And so we really hear that. And we ask them to write qualitatively at the end, the one you learn how do you think this recovery if you do so some people respond to that? So we are also doing mixed method study where we're collecting not only suffer questionnaires in psycho physiological data. But also their narrative about how what their experience less and now was mentioned in this paper. We didn't go into in great detail. But overall people love this work those who stick with it. I mean over and over and over again, that's what they say is I really learned how to attention to my emotions. I learnt spend time quitting might taking care of myself. Which is not something I really have done very much. I'm of learned the connection between my physical sensations in my motion sensations. I learned how to meditate which I didn't hire do and what I've tried. I haven't been able to before that's another thing a lot. And I think that's really really key thing for people who are involved in mindful -ness training is that war. Four people have really chaotic lies a lot of coq crank disorders, and and especially trauma histories. There. There can be a lot of additional supports needed. And that's like eight this individual type training can be a really fundamental for stop. That helps them support someone to go into more of a group. Classroom setting or practice setting for months on spectating. We hear that from markets. So that's this particular published work what you working on now. Because there's a continuation of this the mothers. A couple of ways to respond to that. So we as I said meeting, this was a yearlong study. So we are very soon to be putting two we have allies results now and publishing those results you which honestly really pleased about so what we see is that. That a lot of the immediate effects of this intervention that we saw were maintained at twelve months in some or even improved. So for example, substance use we have a significant difference across the whole twelve months for those who receive the monthly body awareness compared to both control conditions, which is really significant to find something that that was our primary. I've comment to actually see that we were able to to have at show up a year out is a big deal. So, but also we. We see those continued improvements in interest awareness on live homeless kills as well as emotion regulations of Zia logically a year out there a significant difference in regulatory capacity physiologically in those got mindful awareness compared to the grips. So these are pretty exciting results and I'm excited to polish them. Related -ly just got funded a few months ago to do a similar study looking at this intervention more people who are in medication assisted for open used to sort or. So these are people who are on people seen instead of methadone just at different drag. And we'll be worth men and women. Unlike the study, which was women only so so excited to do that because it's sort of next step to be. Working at another treatment model, really. But but also really interested in seeing how this works across gender. So that's what we're doing next. Crude looking forward to hearing more and wondering if there's anything else you'd like to share with listeners about to work. About my work. Well, there's two things the other thing that working on that fun is is collaborating with a neuroscientist to look at whether we see changes in the brain also related into such a crossing with this intervention, which if we do will help us understand the war, what were affecting I hope unto this exciting. And the other thing is that I have nonprofit that suffered from my work at the university overlap at its separate in a sensitive really try to help more clinicians. Learn this approach so between do more teaching on working with clinics and service agencies to religion try and bring this work in two into the services that they provide so. That's the other my other half and. And one I'm really excited about because it's really equity how we bring this work to more people and people otherwise actually would Milly Perry little opportunity experience. For those who are listening will be linking to that nonprofit as well. As the work. We've been talking about today. Our guest today, Cynthia price, the thank you so much for being here. Thank you so much for having me, Emily. Appreciate it. Thanks for listening. If you'd like to hear more about something you've heard today's podcast, please come visit the website at present moment, mindfulness dot com. You'll find an entire web page devoted to this. And every episode you can come in on the episode page and find show and other helpful resources for your mindfulness practice. 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