#27: Mindfulness, Chronic Pain, and OT with Patricia Motus

[MUSIC] Especially during this pandemic, I feel like wherever I turn, I am hearing and reading about the benefits of mindfulness. But with all this fanfare, we as occupational therapists have to ask, does the evidence behind mindfulness justify incorporating it into our occupational therapy treatments? And the systematic review that we are going to look at today says yes. That at least for specific chronic pain conditions, mindfulness does have compelling evidence behind it. The authors provide a great overview of the problem of the state of chronic pain management. And then they also discuss various mindfulness-based interventions for chronic pain. After we review and analyze the article, it is our pleasure to welcome to the podcast Patricia Modis, O-T-R-L-R-Y-T. Patricia uses yoga, meditation, grounding, and life and health coaching to help clients navigate life transitions. She and I will discuss the article, including some ways that you can incorporate mindfulness into your traditional O-T practice. So let's dive in. Welcome to the O-T potential podcast, where we review new and influential O-T journal articles that invite on an expert guest to help us pull out actionable takeaways that you can implement in your practice starting today. Welcome to the podcast. I'm your host, Sarah Lyon, O-T-R-L. And before we dive into mindfulness, chronic pain, and O-T with Patricia, I wanted to let you know that this podcast may qualify as continuing education for you. You are probably listening to this podcast on a free podcast platform, but to gain continuing education credit, you will need to be a member of the O-T potential club, our O-T Evidence-Based Practice Platform. It is just currently $79 to sign up for the club. And once you're in there, you'll be able to find a five-question test associated with this podcast. And take the test, and if you pass, you'll earn a continuing education certificate. So we're going to mind that this time could count as a continuing education course. I wanted to state our two learning objectives, so you can be thinking about them throughout the podcast today. Our first learning objective is that you will be able to identify simple ways to incorporate mindfulness into your traditional occupational therapy treatments. And our second is that you will be able to identify several types of mindfulness-based interventions and how they may complement your occupational therapy delivery. So let's talk through this article before we bring on Patricia. The article that we are looking at today is called Mindfulness-Based Interventions for Chronic Pain, Evidence in Applications. It comes to us from the Asian Journal of Psychiatry. It was published in 2018, and it is ranked 98th on our list of the 100 most influential OT journal articles. As I mentioned already, the authors start with this overview of the many problems with the state of chronic pain. And it is just hard to overstate the global problem of chronic pain. This is a massive issue around the globe, and the opening of the article really hits you with lots of facts on chronic pain. Simply to find chronic pain lasts longer than three months, it can either get progressively worse or reoccur intermittently. And chronic pain outlasts the typical healing process, and its presence is often associated with disability, financial loss, decrease productivity, absenteeism, emotional and social problems in poor well-being. Estimates show that chronic pain affects at least 10% of the world's population, and this is not only true in adults, it is also common in children and adolescents. The reported prevalence in the article was 25%, I looked that up in more recent literature and saw the same kind of statistic echoed. The authors also really highlighted information from a 2015 report on the global burden of disease, which presented information on years lived with a disability for 310 diseases and injuries. Six of the top 20 diseases and injuries that they highlighted were related to chronic pain. Number one on their whole entire list was low back pain, number five was neck pain, number seven was migraine, number eight was other musculoskeletal disorders, number 13 was osteoarthritis, and number 18 was medication overdose headache. And also of note on this list, number three major depression and number nine anxiety disorders are often associated with or the result of chronic pain. So basically these statistics together tell us lots of people suffer from chronic pain and then the impact of years lived with a disability is profound for these chronic pain conditions. In the next section, the authors go into the menace of opioids, and when I'm reading a journal article and I see a word like menace, that definitely draws my attention because it's such a loaded word. But I think that opioids are definitely definitely merit this kind of language many of us have firsthand experience with the devastating effects of the opioid crisis. The use of opioids has risen exponentially in recent decades, but these medications have not reduced the prevalence of chronic pain. But what they have done is created a public health crisis of opioid overdose deaths, the rate of which continues to rise in the US and the numbers recently reached the unprecedented number of 75,000 deaths per year. We reviewed a great article in the club previously that gave this history on how effective and safer options like occupational therapy got sidelined by opioids. And that article was called providing chronic pain management in the fifth vital sign era. You can read that in the club or you can just Google it. I think it's a really important read for occupational therapists. So after establishing this menace of opioids, the author is going to a high level overview of alternative treatments for chronic pain. They tell us that based on the opioid crisis guidelines like those published by the Center for Disease Control and Prevention here in the US have evolved. The CDC now encourages non opioid pharmacological treatments and alternative therapies as the first line treatments for chronic pain. Past research has shown many non pharmacological treatments to be effective in treating chronic pain. These include mindfulness based interventions, cognitive behavioral therapies, acceptance and commitment therapy, hypnosis, physical therapy, occupational therapy and exercise. So from here to wrap up their introductory information, the authors zoom in on an overview of mindfulness based interventions for chronic pain. In their overview of this topic, they let us know that the practice of mindfulness can be traced back to several ancient traditions, including Vipassana, Buddhist and Zen practices. The author's credit, John Kabat-Zinn, for drawing on these traditions to establish mindfulness based interventions or MBIs, which I note there are a lot of resources out there from John Kabat-Zinn, like he recently did a master class so there's a lot out there from him and definitely made me interested in taking some of his courses. But Kabat-Zinn defines mindfulness as the awareness that emerges through purposeful, non-judgmental attention to the present moment. In MBIs or those mindfulness based interventions, clients are encouraged to change the way they relate to pain by suspending judgment towards the thoughts accompanying the perception of pain. And here's a really important part. When we change how we think about pain, this theoretically uncouples the sensory dimension of pain from the effective alarm reaction, which then attenuates the experience of suffering via cognitive re-evaluation. So that was kind of a complicated sentence, but in my own words, I would say, as you're thinking about your pain, the idea is that that helps you turn off that fight or flight alarm system that is naturally coupled with pain and thus helps make your pain more manageable. The goal of these MBIs is to reduce the pain. It is often not possible to completely eliminate it, but hopefully it can be reduced enough so the patient can learn to live a productive life even in the presence of discomfort. MBIs revolve around formal and informal meditation training, patient education, yoga exercise, and individual or group dialogue. They can serve as standalone treatments or be used alongside other pharmacological and non-pharmacological measures like occupational therapy. Specific mindfulness-based interventions that they mentioned are mindful meditation, mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-based acceptance and commitments therapy. So with all that background information, what does this paper seek to add to the body of literature on alternative chronic pain treatment? This paper is a systematic research review. Two of the three authors appear to be practicing psychiatrists from the United States who reviewed the research related to mindfulness-based interventions for specific types of chronic pain. As you're reading this article, I really feel like you can tell that these authors are practicing clinicians who are really trying to understand the clinical applications of the research. So what evidence did the authors include in their review? The author searched for evidence from the past five years and included randomized controlled trials, randomized clinical trials, and meta analyses. They look for papers that included keywords like mindfulness and then terms related to chronic pain. So what evidence did they find in their review? The authors identified 11 studies and then they grouped them into three categories. MBI's for chronic low back pain, MBI's for chronic migraine and headaches, and MBI's for chronic musculoskeletal pain. I'll refer you to the paper to dig into the specific results of the studies, especially if there's a specific type of pain that might interest you, and for our sake on the podcast, I'm just going to focus on their high level discussion and conclusions. So what did their discussion of the research entail? The authors found that there was consistent evidence in support of MBI's or those mindfulness-based interventions in the treatment of chronic low back pain, migraines and headaches, and musculoskeletal pain. The authors contend that MBI's can reduce pain and improve functioning, and interestingly, MBI's also seemed to help alleviate comorbid conditions such as depression and anxiety. This aligns with the past research that has indicated that mindfulness can decrease the following, pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional disability. So ultimately, the authors concluded that MBI's have consistently demonstrated moderate success in the treatment of several chronic pain disorders. The advantages of MBI's are that they pose no risk of addiction or abuse, they yielded positive treatment outcomes, and that improvement in comorbid conditions. And that wraps up our breakdown of the article. I did want to share two of my personal takeaways before we bring on Patricia, and I wanted to let you know that these are just my personal takeaways. They were not mentioned specifically in the article. My first takeaway was just from my reading, this did not seem to be the strongest systematic review that we've looked at. If you noted in the beginning, this article was 98th on our list of the 100 most cited OT related research articles. So it's pretty far down the list, meaning it wasn't as highly cited as some of the other research that we look at. And some of the things I noted was that the research question wasn't super clear, the methods weren't described in as great as detail as we're used to in many of the articles that we're looking at. That being said, the trade off was definitely that it seemed like we were hearing from clinicians, which in my personal reading, I thought it was a pretty readable article, and you could really sense the strength of the convictions of these authors. My second takeaway that I wanted to share is that despite this article shortcomings, the article's message and the related research is still really important for OT's to consider. The key message that I got from this article was this reminder that quote unquote alternative therapies like mindfulness and occupational therapy are considered the first line treatment for chronic pain along with non opioid medications. Our guidelines have really shifted so opioids are not that first line treatment that they once were. I think this article was just a clear reminder that the use of opioids has really wreaked havoc on our communities and their use has also stifled progress on pain treatments that can be just as effective much safer and ultimately probably more cost effective. I really think that OT's should be reading articles like this and examining our own role in pain management. There is such a massive need around our globe for safer, better ways to address chronic pain. So to help us lay the groundwork for what those initial steps can look like related to integrating more mindfulness into your occupational therapy, it is just my pleasure to bring on Patricia Modis, OTRL, RYT. Patricia is a Filipino American, a native New Yorker and a product of the City University of New York's York College Occupational Therapy Program. She is a holistic occupational therapist and registered yoga teacher with 22 years of unique clinical experiences working in community mental health programs across New York City. Focus on serving those impacted by trauma, domestic violence, homelessness, HIV/AIDS and co-existing health conditions. Some of her other clinical experience includes work in hospitals, vocational rehab, homeless and domestic violence shelters, sheltered workshops, the New York City public school system, adult home care group homes and other supported residential settings. Her experience and passion also extends into academia. Since 2000, Patricia has been mentoring, supervising and teaching various levels of OT students and practitioners. In her roles as fieldwork educator, program developer, guest lecture, mentor and adjunct instructor at Stanbridge University's OTA program. Patricia states that her purpose also extends to holistic wellness, where she incorporates complementary and integrative modalities and teaches weekly virtual trauma informed yoga and meditation classes at holistic transitions, which is her private practice. So without further ado, it is my pleasure to welcome Patricia onto this podcast. Patricia, it's great to have you. Thank you so much for having me, Sarah. It is such an honor to be on your platform. I'm so thankful to be talking about this topic today. It's such a big topic to be talking about chronic pain and mindfulness. They're both big topics in their own and then to kind of be merging them together. As I've been reflecting on mindfulness today, I've been realizing about myself that, like as I look back over my life, I've thought of mindfulness and occupational therapy as things that have kind of run parallel to each other. Like, I've always been interested in mindfulness and then I have this occupational therapy work. But honestly, I haven't thought a lot about how they intersect and spending time in this article made me feel like I was just kind of missing the boat. Like, there's such an obvious connection and I'm so thankful to be talking to you about it today. Oh, me too. I'm excited to delve into it. Yes. I wanted to start with your story, starting with first how you found occupational therapy and then how you found mindfulness. Okay. Well, I've been a practicing OT for 22 years now. I found OT many moons ago. I found it actually in my late 20s, so I've been sort of jumping from one health profession to the next, just trying to figure out what it was that I really wanted to do. Really trying to find a profession in healthcare that offered good job potential and earning potential for the future. And I looked into nursing, I looked into physical therapy and pharmacy even. And I just realized that those were not for me. And it really stumbled upon OT and OT had just the right kind of blend of science and also creativity that really appealed to me. So I also was able to find, you know, in addition to deciding, okay, what profession am I going to get into? Let me see what schools are around me to see how I can actually pursue this and nursing programs at the time were full, wait listed pharmacy programs were available, but, you know, quite pricey, right? So I found an occupational therapy program within the city university of New York system, which was really quite reasonable as far as OT, tuition's are concerned. So I'm a product of the CUNY's York occupational therapy program, your college occupational therapy program. And it was really an affordable way for me to get the education that I was seeking in a profession that was hopefully going to be grown. So that was the plan for OT had no idea where my career would end up. But just to go back to your question about mindfulness, I think that goes back to OT school, you know, we had to read group protocols to create right activities to plan. I remember during my level one field work, my mental health field work, I was assigned to the veterans administration hospital on 23rd Street in Manhattan, and my OT supervisor at the time led a meditation group for the veterans. And that was really my first experience ever of, you know, kind of seeing this in action in an OT setting. And I remembered the gentlemen just, you know, feeling really good and relaxed into the group, right? Again, this is 20 years ago, so from what I remember, positive feelings all around, that was my first exposure to mindfulness aside from, you know, learning about some, you know, meditation or breathing activities that we could do while in our psychosocial, you know, classes, right? It probably wasn't until, you know, I started my own sort of yoga practice, right? And, you know, learning more about meditation and breath work and understanding that that I was more conscious about incorporating it into my OT work. And that kind of coincided with my, I guess during the time when I started working at Barrier Field Living, which was a nonprofit that served survivors of domestic violence. So it kind of just came at the right time and my understanding for the concept, the idea, right? And perhaps it's because this was as a therapist, you know, mindfulness practices, I always pitch them as something that we can take ownership of ourselves and try to do sort of like a self-care strategy, right? That we can pull out of our toolbox whenever we need to, right? And in these settings, I found that, you know, you just needed every strategy, you could. I just need to fill your toolbox with every strategy that you possibly can. So it fit really well with the work that I was doing at the time and, yeah. Yeah, your story like makes me think about so many different aspects of this topic when I think as OT's so many of us are drawn to the field because it is creative and holistic and mindfulness fits so well with that. So I can see the draw of OT's into that. And then like you, I also had the experience where I taught a relaxation class and I was like, oh, this works. Like, oh, the men really enjoy doing this. And then that pushed me to consider, was that look like for my life? Like, I'm teaching it and I'm like, oh, I need that too. Like, and then there's just a natural growth, then it's interesting how we use it as a tool to our clients and it's also something that we can use for ourselves. Yes, very true. I'm curious, I want to get right into this article. There was just so many interesting aspects to talk about. And I guess just start with your initial impression of this mindfulness and chronic pain article that we looked at. Yeah, I mean, I'm no expert as you and I both know are my researcher in this topic, but I have to say that in my work and through my own, you know, little sort of subjective data, certain collection and through the subjective reports of the clients that I worked with, you know, really through scales. Like, how are you feeling at the beginning of the session and how are you feeling at the end of the session, right? You're feeling any different, are you feeling less pain, et cetera? I have to say that I agree with the article, right? And when we talk about chronic pain, also the article doesn't necessarily define this. They talk more about headaches, migraine and other people who sort of suffer from chronic pain, but in the work that I did, we also talked a lot about emotional pain, right? And I find that these practices are very effective for that kind of pain, quote unquote, as well, right? And sometimes I think when it comes to pain, it just intertwines. It's a little bit of both just because of the circumstance. So yes, to answer your question, I've applied mindfulness practices in my work, people who have been in chronic pain because of their diagnoses, their conditions, again, emotional pain. And through the subjective data gathering, I think that, you know, I'd have to agree with its effectiveness. Yeah, I definitely agree with as I was reading the article, I did keep thinking of trauma too, and how sometimes a chronic pain condition is related to a traumatic experience. And those things are so intertwined, and it made me want to do more reading on the topic because I feel like mindfulness can help in so many aspects. This was really focused on like back pain. Yeah, very like specific physical pain, but I would have. Yeah, it made me want to read an article that was more expansive on it too. Yeah, so I'd love to hear just a little bit more, you've done multiple things in your career, worked in multiple settings, because you just tell us a little bit more about how you've used mindfulness, either informally or more formally in like a meditation setting. Yeah, so I've worked for several sort of community-based programs where clients either were domestic violence survivors, homeless, displaced, experienced some kind of trauma or dealing with some kind of chronic illness, which then makes life more challenging to handle. Yeah, so imagine these individuals in a variety of community-based programs, whether they're there for the day, for an appointment, one-on-one, or a group perhaps. So those are probably the two most popular ways that our services are offered, or I offered the services. And through these groups, there's, you know, just a variety of different ways to kind of approach mindfulness, especially as OT's, and you know, after I sort of have broadened my scope of it, right, or my vision of mindfulness, and really kind of have a better understanding of how that really intertwines with OT. So I feel that every time we have a client participate in any session, that's already a mindful session, right? They're there for a specific reason with a specific intention, right? And they're, we're going to encourage them to be as less judgmental as possible along the way, regardless of whatever goal that is that we're working on with them. But to give you more specific examples, so mindfulness-based activities are generally based on specific sort of sensory awareness types of activities, like body awareness types of activities, right? Grounding activities and breathing techniques, so it's a combination of all of those things. So if you incorporate any of that into any of your work, you're incorporating mindfulness for sure. And as OT's, as we have our clients again, participate in ADLs, we're having them stay on task, right? We're having them really stay in the moment as they're engaging in this specific ADL, so that in itself is helping our clients being mindful. But of course, you can also run stress management-based groups, right? That really teach and allow folks to practice these mindfulness-based interventions, right? Like breathing, box breathing, I mean, you know, just breathing from the diaphragm, right? And it just all sorts of, I mean, there's so many different kinds. And really try out different types, forms of meditation. One of the most popular meditation groups that I ran at the Men's Shelter was the Raisin Meditation, right? Like a food meditation activity where you're sitting there and just savoring every moment from opening that box of raisins all the way to the last morsel of flavor, right? So imagine taking 10 minutes to eat one raisin. So that's mindfully eating a raisin, because you're exploring its textures. First, you're looking at it. First, you're touching it. You're looking at it, and then you can smell it, and then put it in your mouth, and et cetera, et cetera. That's how we prolong it. But it was fun. It was hard to get the gentleman not to eat the raisin initially, and I would have to joke and, you know, say, "I'm going to have to charge you for a second raisin." So, yes, you know, that's an example of a group, mindful in this group that I ran. And also movement-based groups, right? You know, when you're working with a client on a home exercise program, that's being mindful, right? You're helping a client with their balance. That's being mindful. You're helping them ground on their feet first, right? Are you helping them first kind of understand, "Okay, is it a good idea to stand now? Do you feel grounded? Do you feel secure?" So these are all mindfulness practices in my opinion. Yeah, the article definitely pushed me to, like, expand my vision of mindfulness, too, is not just, like, an hour of meditation, but even, like, if we pause with our clients to take a deep breath, like, when they're struggling with something, that's a mindfully grounding activity. And the article talked about, like you said, both informal moments like that and then more formal practices just all have the evidence behind them is compelling, for sure. Yes. Kind of dig a little deeper into that connection between mindfulness and OT, I think you, like, started to allude to that, but in some ways, it feels like almost everything we do as OT's could be considered, like, a mindfulness practice. I just wonder if you could speak to that connection more and how you've come to think about that for yourself. Yes. In my experience, I think that mindfulness enhances our ability to participate in occupation, right, all of us, clients, and, you know, and I speak about me particularly, right? When I'm more mindful about the things that I, too, that experience is just so much more enhanced, right? So coming from that sort of famous reference, and then the other two pieces of mindfulness, right, which is one being in the present moment, and again, as OT's, as we're engaged in a session with the client, we're paying attention to that particular experience with that, right? So we're there with them in the moment, they're bringing their attention to that ADL, IADL, whatever that might be, we're engaging in. And as OT's, we may not even realize how, you know, that we're incorporating mindfulness into our work, right? But we're doing it through the act of doing, right? So through the act of doing our occupations. So, you know, we don't really have to do anything else other than that, right? The rest, I think, is just, well, the rest will talk a little bit more, I guess, after this piece, but the second leg of mindfulness is being, so the first leg is being in the moment, the second leg is really being of no judgment, right? So, as therapists in these sessions, we are often their support, we're there breaking down the tasks, you know, with the clients identifying where it is, where they may need us, or the support that they may need. But in that process, we are paying careful attention with kindness, right? We're doing this with kindness, and we're doing it without judgment. So, again, something that's just natural in our role. So, I think that those two complement each other beautifully. And another piece too that, in preparing for this interview, I was reminded I was really this whole idea of repetition and practice, right? Both are also ring true for mindfulness and occupational therapy. Like, we both thrive, or we expect for improvement through repetition and practice, where improvement might be a judgment word to use, and that be the best in this context, but, you know, based on that person's perspective, okay? So, those are a thing, a few ways that mindfulness and occupational therapy really complement each other. Yeah. Yeah, I'm thinking of both the therapists being mindful and practicing those two pillars of being present and nonjudgmental, and encouraging and supporting our patients and their own mindfulness too of being present and what they're doing and nonjudgmental of how it's going. And, like, part of occupational therapy does involve this, like, trial and error sometimes of trying different things and seeing what works and were just as humans, sometimes we don't enjoy the process of trial and error. So, we have to encourage our patients in that nonjudgmental view of what's going on as we're trying out new things that's just going to be part of the process of sometimes we'll make mistakes, and that's how we move forward. Mindfulness is such a powerful tool in that. So, for therapists who are working in traditional settings, you and I both have experience in like group settings, but I'm thinking of someone who's like in a cute care or an outpatient, I wanted to ask about simple ways that they can more explicitly incorporate mindfulness into their treatment sessions. So, you've been playing here in this larger theme of like, oh, maybe everything is mindfulness, but, but what are some, what are some simple mindfulness practice where you think therapists could lean into that more explicitly? Yeah, so, oh gosh, where do I even begin, right? Because there's so many different settings, but my favorite mindfulness practices are sort of incorporated into my work were breathwork, meditation, my body scan, my dictations were great ways to sort of help folks ground, stretching, or mindful movement is also another great way. It's, these practices have been a great leader really start sessions, allowing myself and the client to be present, you know, together, cohesively, right, because we're engaging in the same practice together, and it really just allows for the rest of the session to be more productive, yeah, in my experience. And so, you know, those were a few, but I guess in a more kind of traditional OT setting, where you're working with somebody on actual ADLs, right, so maybe we can pick a chore of some kind, like maybe washing dishes, right, if someone were you're working with someone on washing their dishes and you're engaging in this activity and some kind of sync situation when there's plates and such, right, actually practicing the task. It's just a matter of incorporating again, like the sense of real awareness, the breathing techniques, and the movement that's all involved, right, so as you're starting with the activity, you can, you know, perhaps cue the client to pay more attention to the temperature of the water, right. Really feeling the sensations of that and then feeling the texture of the sponge as you're rubbing it against the various shapes and forms of utensils and dishes and glassware that you're washing, right, and maybe the aroma of the dish washing liquid that you're using. So you're slowing it down, you're slowing down this activity, you're breaking it down for such experts, right, so you're just having them kind of press like a slow motion button so that you can actually pay more detailed attention to each of these moments and it's a challenge. You really as a challenge, but that's how you're able to incorporate all of these various senses, right, and then as you're washing the dishes, you're feeling your arms move, right, you're feeling in different directions, you're cleaning the different crevices, right, so there's a lot of sensory awareness there. Yeah, I love that language of like hitting the slow motion button that brings such a visual for me and like I think when communicates that idea really well. I'm curious if you talk about mindfulness with your patients in the article they talked about one of the benefits for chronic pain is when we're mindful, it kind of like uncoupled you from the alarm system that may be going off once we start thinking about what we're doing. It basically helps to calm our fight or flight mode that might be going off is that how you would describe it I feel like I've heard that described in several different ways related to mindfulness how do you talk about that. I actually really talk about it in those terms it's I mean not in those exact same things but in a very simple way right so you're turning off the fighter flight so when you turn off the fighter flight you're no longer in this place where you your energies have to go there that's sort of the primary place for your energies go. But when you're calm when your central nervous system and then the calm state right which is achieved through slowing down your breathing right and really the mindfulness based practices really encourage all of that so when your central nervous system is in a more relaxed state and you're no longer in that fight or flight. So you have more energy to really invest in that better than that sort of the feeling better yeah right your your bodies and the more relaxed state and I think that's why it's effective for pain. Yeah yeah and I'm like is there any bigger gift we could give to our clients than to help them recognize when they're in those two different states to recognize when fire flight is on and then help them recognize when it's off is that something that you've helped people with just recognizing those two different states and do people need help without or is that something they recognize intuitively what your experience there. Yes I feel that most of the clients that I worked with sort of are on automatic like that when when dealing with life circumstances just because of their life circumstances and what they have the resources that they have right so. As an OT I'm a big fan and giving people tools yeah yeah here's your tool bag let's fill it up with stuff right and most of that stuff that we filled up those two kids with really involve mindfulness based practices um specifically because sometimes there were really no other options so as an OT I often pitched myself as you know I'm the non medication way of perhaps. Perhaps dealing with the situation right so if you're interested in a behavioral way of perhaps feeling some relief then come join my group come have a session with me but I'm not you know I can't be that person right so sometimes folks would come because they didn't have any other options yeah right so they're openness of these types of practices was due to the fact that they've tried other things they don't. They have a substance abuse history and they don't want to take medications right so this is an alternative for them and that they're willing to explore and my role was to help them fill their bags so that they can use it whenever they're in these heightened states right whenever they felt they needed it yeah yeah I was definitely thinking just about how. When people find mindfulness it is usually after train lots of things that didn't work beforehand like that's definitely the journey of people who have been in chronic pain they've eliminated lots of possibilities of what could help and so mindfulness is something that they come to after a long journey so. Yes I usually pitch it as you know well it's free yeah that would be my first thing it's free you can do it anytime you want right anywhere you want right find a corner you find your place you tune things off right we're a lot of the settings where I work we're a community program so everyone didn't have a room where they can just sit there and be mindful for an hour right. Typically a big day room where there was chaos and shouting maybe even fights and the idea is to help people still be able to to try to do these practices right even despite those environments those are their environment there's nothing they can do with it or helping them find like you know take a walk maybe over there at the park would be a good time to sit and reflect for a little bit yeah it's free and it's safe was the other thing that the article. Highlighted and then yeah because of those things it's something that you can do for a long term and again just like what a gift to people to give our clients to introduce. Yeah help them find their own mindfulness practice whatever that may look like I like how you mentioned like as OTs we have this like baseline of knowledge about mindfulness but we're not the ultimate experts on it especially as it's becoming more and more robust field where I can see. People seeking out experts in this article may be like as part of our network of OTs we should probably know the other mindfulness based professionals out there to refer people to would you agree and what kind of professionals would you refer to and when. So in probably the past couple of years post pandemic i've been more involved in the virtual OTs space right and i'm learning about all of these other OTs all around the world doing all sorts of amazing so. One of whom is an OT in Canada so I don't know her personally but I love what she presents to the OT world as far as mindfulness is concerned and in fact what she does is she teaches other OTs that she offers mindfulness trainings for other OTs and her name is Sarah good i'm not sure if you're familiar. I'll link to her though in our show notes yes she obviously doesn't know that i'm doing a shout out. Hi Sarah. Nice to meet you I love your work. But yeah another Sarah so she's the first OT that comes to mind and then you know there's more structured certificate based program I mean there's mindfulness based stress reduction. Training certification programs right that you know you can go through the john cabit zen. Program is the founder of mbs r but then he also has quite a few prodigies that are also doing such amazing things so you know I think anybody who's interested in expanding their knowledge more in terms of mindfulness I think that would probably be my. The first it's kind of where I went right you read up a little bit more about john cabit zen and then you'll find links to other individuals who are also doing incredible things another person that I'd like to mention cuz i'm just really loving her her manner of speaking her name is dr shana Shapiro and you can find her probably on YouTube but she's an author she's also a clinical psychologist and a professor. And she's just an expert in mindfulness and self compassion so some of the things that I mentioned today were really coming from her thoughts and really from the things that I've learned from her about mindfulness and how she applies it so she has a couple of Ted talks I can also send you. That'd be great her links for that guess so I talked about the training and then for folks are interested in just you know I know that there's a mindfulness based stress reduction training for therapists right for clinicians were interested in being certified in in teaching mindfulness based stress reduction but then there's also just taking a mindfulness based stress reduction course. For ourselves am I confusing okay because I know it's all a mouthful but you can just take a course yourself right just so that you can get a really good sense of what the structure might be like and the the various types of mindfulness based interventions that are sort of accentuated or are utilized within that program. So I found a free one last year I hope it's still free but again it's just a basics it's just the basics of it just if you're interested in really learning a little bit more about it and you know honestly in me learning from some of these sources and coupling that with what I know as an OT right in my OT practice. Yes it just used and blend it in and really went hand in hand yeah yeah it's almost like it I can see how it's hard to before I was thinking of it mindfulness in OT is so separate and then after spending time with it I'm like I don't even see how you can separate them because they're so closely aligned and yes. We learn about mindfulness will help us both as therapists and our clients such a rich field to be digging into for therapists and I know the literature will just keep growing for us to access on it. I hope so I think that again we're already doing this yeah we know so much about sensory awareness we know so much about movement and the body and it's really all a blend of all of that and emotion regulation yeah I love podcasts when we're like oh you're already doing it you're good. We're all doing mindfulness. I just wanted to ask just like where would you like to see OT go in terms of our approach to mindfulness and using mindfulness and just how we think about mindfulness in the future. I mean hopefully those listening to our conversation today will already have sort of like a little bit of a shift right or hopefully some dots have been connected a little bit but you know again we're just going back to our roots right we're just kind of doing our thing we're doing what we know are we're using the knowledge that we have and then we're applying it using it as a tool right so I want OT think of mindfulness based practices as an extra tool that you can really. Use to enhance your session yeah right if you're going to help someone focus and be in that present moment with you like in that ADL whatever that activity might be that's exactly where you want all of your clients to be. For OT's is there thinking about this mindfulness in this new way is there one practice that you would encourage us to like try tomorrow take a deep breath I don't know yeah what would that be what would be like one simple high impact thing that we can do. So this is something that I practice on my own before a resume call right it's nothing major but I usually do you want to do it together oh yeah totally okay yeah so we can have we can have a mindful move get that out of the way perfect. So before every zoom call put my feet on the ground right kind of just feel my feet on the floor that grounding myself to my space put my hands on my lap I really palms on my lap and it's just close my eyes and it's going to be composed of three rounds of breath this whole exercise right so taking a deep inhale in and a deep exhale out. The second inhale you're going to lift your arms up to the sky you're going to interlace your fingers and as you exhale you're going to flip your palms up and you're going to find length in your spine as you exhale. I'm going to add a little bit we're going to side stretch over to the right oh that feels good and take a deep breath in and out while we're there come back to center and we're going to side stretch over to the left and take a deep inhale and exhale while we're there and then come and back to center taking your hands and palms together placing it to our heart center soft bow to the head and then just offering some gratitude for that nice little stretch a nice little break give our bodies and to close the practice taking a deep inhale in and you're most cleansing exhale out. You should be by podcast coach I need that each time before he starts. See you can just play that recording each time. So like it's like three minutes right nothing crazy I even added that whole side stretch thing yes you can omit that if time is limited but it's just a little bit of movement a little bit of fresh air in your lungs in your cells right and it breaks you up a little bit and calms your center yes even just in those few deep breaths. Yeah yeah and I could recognize that difference in myself of just that little bit more of calm after doing that and it is yeah breath and mindfulness it's also powerful and I think lots of OTs are using it already and the more we can learn into lean into the science behind that that makes me really excited for our profession to just have that even more potency to be more explicit about what we're already doing for sure absolutely agree. I wanted to ask you my rapid fire questions if that's okay yes these are at the end of our podcast just to help to get to know you a little bit better as a clinician as we wrap up. Okay it's like family food yeah so if we all would what is the first sentence that you typically say to a client. Hello I'm Patricia I'm part of the OT department depending on you know occupational therapy depressed and what's the last sentence you typically say to a patient. If you have any questions please don't hesitate to let us know how do you describe occupational therapy to someone. Oh that's hard I'll have to choose how I've been describing it lately. Yes and I describe myself as an occupational therapist who helps with life management goals. Oh yeah I like the life management wording for sure. What's your favorite OT assessment to do. I love the COPM who doesn't get the column model. Oh yeah it was probably my top two. Oh I was just introduced to the column model and it's definitely changed the way that I think about things. Even when you were saying the word improve earlier where we got hung up on that I was like oh the column model would be like progress or. So it's too it's too judgmental there's just a negative positive to it so yes yes. I actually a student introduced the column model to me and you know so I have the most respect. Students keep me on my toes but she created this beautiful sort of mural that someone depicted everyone's column model journeys. Oh man so I've been in love with the model since. What is something you've read recently that has inspired you as an OT. I'm a quote girl. Oh yeah. Right I'm all about affirmations and positive quotes right so there's a quote by Satsuki Shibuya. She's a Japanese sort of spiritual thinker she's also a painter I believe but she wrote by doing what you love. You inspire and awaken the hearts of others. So I feel like that just resonated with all the different OT things that I'm doing lately and not even just OT things but all of my offerings to the universe in the world lately. So that really her words really resonated with me. Yeah yeah that's a beautiful I hadn't heard that exact or her quote but the sentiment behind it. I'm so familiar with and yeah I totally agree and I love how she phrased it for sure. My final question is how do you hope a client feels after your initial visit with them? After my initial visit I hope that my client feels hopeful. I hope that they feel accepted, understood and I hope that they feel supported. That's beautiful. We're at the end of our time. Was there any other final thoughts that trickled up for you about mindfulness that you wanted to close on? Gosh you know we talk about mindfulness in terms of our OT work. We touched upon a little bit about mindfulness in our own lives. I think that the best way to incorporate mindfulness into your work is by really practicing mindfulness in your own lives. And taking these mindful moments just like you and I took a few minutes ago. And taking those moments and the more of those moments you have, there's research behind it, there's positive results. I think folks feel that they need to participate in a 20 minute meditation practice. And yes there's absolutely benefits with those two. But if all you have is 5 minutes today or all you have is a moment, right? That's way better than no mindful moment. Yeah. So take it, right? So when you're sipping your cup of coffee, I took a little shower meditation this morning. Just really feeling the water, suds, looking at it and all, right? Took myself a mindful shower. We can incorporate it into so many aspects of our lives. And then once you start doing that, the way that you suggest these things to our clients becomes very natural. So you have no idea how often I suggest shower meditations or food meditations or really just enjoying that first sip of your tea in the morning. These are all mindful moments and these are all mindful practices. Well, this was all so helpful. I know I'm going to benefit personally and I'm so excited for thinking about the OT's who hear this to be incorporating those mindful moments into their practice. Thank you so much for this conversation, for being with us today. You're welcome Sarah and thank you for having me. It's been such an honor and fun. While you all this paper and this conversation just really pushed me to see the intersection between OT and mindfulness. And now that I've seen it, I feel like it's one of those things you can't unsee and I feel like I see mindfulness so baked into our profession. And I'm excited for us to move into this reality where we can just be more explicitly leveraging the exciting evidence that is out there behind mindfulness into our own OT practices. I'll be so curious to hear your thoughts and experiences on this topic. And one of the best places to share your impressions is in the OT potential club. As I mentioned at the beginning of this podcast, the OT potential club is where you can go to take a test and earn a certificate. And we'll also have forums both specifically to discuss this research article and to discuss the podcast. Also have a written breakdown of the journal article we talked about so you can kind of go back through and remind yourself of the high points and I'll also be linking to the resources that Patricia mentioned. We are so proud of the many resources that we have for you in the OT potential club. So if you are not a member, I highly encourage you to join us in there. We would love to hear from you. But for now, I just want to thank you as always for joining us today. I hope this podcast helps you broaden your knowledge, tweak your practice and stay evidence-based. Take care and we'll talk with you next time.