The Mindfulness Response and Cultural Awareness

The Mindfulness Response and Cultural Awareness

Some people are unable to pay for therapy, get to a therapist, or are afraid to get therapy. This blog offers some notes for those who want to change their mindset or their attitude and can’t. The source came from research in group therapy for severe mental health symptoms that arise with trauma memories from PTSD, psychosis, substance abuse, and mood disorders that include self-injurious behaviors, and suicidal, or homicidal thoughts. The ideas are taken from group therapy conversations that describe how participants worked through difficult symptoms and situations. The model came from research and observations from adding self-compassion concepts, many other therapy techniques, and philosophy to a cognitive behavior therapy base.

The Mindfulness Response Model

This is a dialogue with yourself about well-being. Current definitions of self-actualization refer to Maslow’s Hierarchy of Needs and state that not everyone will reach this ultimate point since it is the top of the model; achieving these higher levels of the model is much more difficult.

            The Mindfulness Response teaches people to observe, accept, and acknowledge difficult symptoms and simply let the symptoms be present. This becomes a learning process of observing the symptoms.  The Mindfulness Response uses learned skills to help group therapy participants gain self-awareness by practicing mindfulness and acceptance of symptoms. Through acceptance, they were able to change.  The Distressing Reaction Response shows the frustration and worry surrounding the reaction to difficult symptoms such as those resulting from psychosis, mood disorders, trauma, panic attacks, and addiction. To gain insight and find inner peace, participants practiced regularly with the group and at home (Lund, 2021).

            The ability to recognize symptoms and decide to respond differently was observed among those who engaged in the group therapy process. The goal was not to make the participants feel happy but to feel less depressed or anxious and feel more control over the symptoms.

            The participants showed changes in their behaviors, thoughts, and feelings from their admission to their discharge day twelve weeks later. Changes in relationships, expressions, and self-knowledge were noticeable by staff. They became more relaxed and observant of their negative thoughts, and their mood swings. They became open to helping and supporting each other. Their demeanors became calmer. The participants discussed and questioned each other to compare notes on their skills during the process. The results were positive. The participants’ attitudes changed during the learning process.

To Maslow, self-actualization describes the desire for self-fulfillment, i.e., a person’s full potential. Group therapy participants who were honest and open with themselves, aware that they needed help, accepted their reality, and came to the group seeking assistance for their symptoms. They can be described as having attained self-actualization. To be self-actualized, a participant can exhibit a genuine desire to change, representing their self-fulfillment. 

Maslow’s Hierarch of Needs

As participants became more aware of their acceptance, candid and frank discussions arose. Their feelings of safety in the group enabled them to express the need to find their full potential during this healing process. Practicing mindfulness engages the mind in surprising ways, and for participants with severe symptoms, healing was a journey that occurred over time.         

Awareness of Symptoms, Race, LBBTQIA2S

            Participants who attended the group therapy came from all BIPOC racial groups and LGBTQIA2S backgrounds. Some were biracial or multiracial. They had higher levels of stigma and shame because of their diagnosis.  Some had many different diagnoses and were managing symptoms from multiple areas of mental health and physical health. Mental health problems included areas such as depression or bipolar, PTSD, substance abuse, and psychotic symptoms. 

            The group treated everyone as a valid and equal member. It didn’t matter if a person had different beliefs, skin color, or sexual orientation. The group emphasized the self-compassion concepts and were reminded to be non-judgmental to themselves and others. Self-kindness was discussed for those who struggled with negative thoughts and critical voices, and they were told to not call themselves names, don’t put themselves down, don’t swear at themselves, and don’t criticize themselves.

            When members related stories of trauma or voices that were criticizing, others listened patiently and later validated their feelings. Sometimes members talk about other friends or family members telling them “It’s all in your head.” The group reminded them that it is a real thing and right now it is difficult to manage the feelings and the thoughts, and any other sensation that goes with it. Self-compassion concept of mindfulness was discussed with the skills of observing, acknowledging, and accepting the symptoms for what they are, and just letting them be there.

            Members talked about how hard this was and others agreed with them. Some told them that after observing the emotions from trauma and feeling supported by the group they gained an understanding of how and why they acted in the past. The group reminded members that they made the best choice possible in the past.

Some members talked about how they regretted their past actions. The group reminded them that they are in the present now and have much more knowledge than they did when they were in the past and that they are a different person now. The group assured some members that they were not here today to blame anyone. With self-compassion concepts, the group discussed how they observe and acknowledge the past but stay in the present.

There were discussions about feeling guilty or ashamed of their past. The group reminded members that it was important to acknowledge those feelings, but that the past is not now, but it is gone, and the group was not here to judge them. The group told them they were here in the group to listen and offer suggestions or support.

The participants learned from each other in the group therapy process and applied countless skills to their personal lives. They shared their experiences of how they viewed their symptoms from a self-compassionate perspective. Emphasis on self-kindness and becoming non-judgmental toward themselves and others had a noticeable effect on them.

Those who attended regularly, participated, and practiced at home discussed the type of mindfulness that helped calm themselves. Over weeks, the participants learned to disengage from distressing symptoms. Those who stayed on longer talked to others about how they had changed their reactions to their symptoms and felt more in control. (Lund 2021, Chadwick, 2006).

            The group therapy participants noticed an inner understanding developed along with increased knowledge about their serious mental illness symptoms and their choices about how they responded to their symptoms. Their self-talk was more neutral and accepting of their distressing symptoms. They practiced identifying their negative or self-critical thoughts and discussing them with others.

            The motivation levels began to change. After learning skills and using them, the group members began to develop motivation. They talked about how they felt more inner strength and confidence in making decisions. They began to view themselves in a new way and incorporated more activities into their schedules. Their relationships with others became more open as they began to see themselves in a new light. They returned to activities like college, paid or volunteer work, parenting, and caring for their families.

            When participants completed the program, they were asked about what they felt helped them the most from being in the group therapy, and their responses related to Yalom’s (1985) therapeutic forces in groups. These factors include hope, universality, information, altruism, relationships with their family, social skills, modeling behaviors, interpersonal learning, belonging, risk, and responsibility. Most chose universality and felt relieved that other people experienced suffering and pain.

Cultural Awareness

Participants from BIPOC and LGBTQIA2S groups who learned and practiced mindfulness developed different attitudes toward themselves and others.  Gupta (July 2020) described individuation as a practice that creates curiosity. Participants began to interact with other group members and noticed stereotypes that arose in their minds.  The discussions became open as participants were encouraged to be non-judgmental, observe, acknowledge, and notice their thoughts, feelings, images, and actions. They accepted other group members for who they were.

Group members used and practiced prosocial behaviors that focused on positive feelings like compassion, gratitude, equality, generosity, and forgiveness. They applied these behaviors to themselves and others to remove stigma and shame. Applying self-kindness to themselves and other group members came through discussions about symptoms, suffering, stigma, and the negative thoughts, feelings, images, and sensations that they experienced. It helped them become a mentor to others in the group and created resilience and courage.

Radical compassion developed in participants who regularly attended and practiced skills from group therapy, and openly discussed their symptoms and issues with other group members. Perspective-taking gave them permission to understand and imagine what it might be like to walk in the shoes of another group member.

Cultural Issues and Mental Health Stigma

            Those who were in the group were aware that all of them faced stigma and exclusion from others in the community. This type of exclusion comes when a person admits to severe symptoms or mental illness. There was a high level of understanding when people who were BIPOC or LGBTQIA2S talked about being excluded since all of them had experienced it in some way in their lives. This brings about a layer of shame.

            When people talk about being on leave from work or having to drop out of college or needing to go to treatment, sometimes they don’t know how to explain their circumstances. They ask others in the group how to tell someone and the discussion is lengthy. What they say may depend on how much support they have from friends or family. ‘

            Usually, there is a silence in the room. That silence is broken by reminding the group that everyone in the world will experience depression, anxiety, grief, and loss. You really can’t escape it because things happen over time. Common humanity is discussed. All of these symptoms are common to cultures all over the world.  PTSD, suicidal thoughts, and psychosis are also common to many other people, although they are more difficult to discuss.

            The conversation turns to who is involved and how much information needs to be disclosed. With work or college, doctor notes or psychiatry notes ensure that the situation is valid and requires treatment. The group agreed that co-workers may not need details, a boss might, and Human Resources probably would need more information.

            Students were encouraged to contact their department of disability. Some were unaware that there was such a department. The group told them to get a note from their psychiatry provider or primary care physician as evidence that they needed the leave of absence. With this in place, they would not be penalized for having to leave in the middle of a semester. The documentation would help them return to college when they were ready.

            The discussions that occurred within the group carefully scrutinized their symptoms and issues. Other group members discussed similar experiences and pointed out what they felt in the past, earlier when they joined the group, and how they had grown with the support of the group. The discussion addressed the distressing symptoms from every possible angle. It didn’t matter whether a person was BIPOC, LGBTQAI2S, or White, all understood how it felt to be shunned because of who they were. This discussion about shame and guilt opened numerous conversations and helped them build support for each other.

            As they began to use self-compassion skills and other skills from theories and philosophies their level of shame and guilt decreased. Once this occurred, discussions expanded to a wider range of topics, including psychosis symptoms, suicide, self-injurious behaviors, reckless behaviors, and homicide. One participant said that they had not experienced a group that had discussed psychosis and PTSD symptoms this often and that those symptoms were the toughest for them to address. They agreed as a group how difficult it had been to get others to accept that they had severe symptoms and couldn’t do what they previously were doing.

The next conversation

The Mindfulness Response and Psychosis, and What Reality Is

References

Chadwick, P. (January 2006). Person‐Based Cognitive Therapy for Distressing Psychosis.

Oxford: John Wiley & Sons Print ISBN:9780470019313 |Online ISBN:9780470713075         DOI:10.1002/9780470713075

Lund J.D. (2021) Mindfulness, Group Therapy, and Psychosis: Training Decreases Anxiety and Depression in Outpatients with a Psychotic Disorder in a Non-Randomized Within Group Comparison. J Psychol Psychotherapy. 11:388. doi:10.35248/2161-0487.20.11.3