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Mindfulness

Mindfulness is a type of meditation practice that fosters a non-judgmental awareness and acceptance of one’s own moment-to-moment experience, including thoughts, emotions and body sensations. It has shown promising results for breaking the cycle of addiction.​

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Gambling, Gaming & Technology Use
Knowledge Exchange

Mindfulness

Welcome to the Mindfulness-Based Relapse Prevention for Problem Gambling section. This section will explore how mindfulness can support your clients in making changes to their gambling behaviours. Emerging research has shown that mindfulness practice can be very helpful for people with gambling problems, as it shows them a way to step out of automatic pilot and cultivate greater awareness of the thoughts and emotions that may lead them to gamble. By cultivating presence and moment-to-moment awareness of their experience as it unfolds, clients are in a better position to make more skillful choices, especially when being triggered to gamble.

Key Concepts

This section provides a general overview of Mindfulness-Based Relapse Prevention for Problem Gambling as well as an overview of the evidence regarding the use of mindfulness for problem gambling. Learn more about applying mindfulness in your practice in the Putting it into Practice section.


Background

The concept of mindfulness as it is known today originated from Buddhist contemplative practices that date back over 2,500 years. The practice was born from a quest to achieve enlightenment and end suffering. In recent years, mindfulness has increasingly been integrated into a variety of physical and mental health care programs. For example, it has been used to help clients deal with chronic pain and cope with cancer. It has also been used to help clients with mental health problems, including depression and substance use problems. Several studies report positive effects of mindfulness meditation. Morone et al. (2008) reported that meditation helped their clients relieve pain as well as improve their attention, sleep and sense of well-being. Similarly, Shonin et al. (2013a) reported that participants with issues of stress and low mood experienced an improvement in psychological well-being because of receiving meditation awareness training. Based on its effectiveness with other conditions, Toneatto et al. (2007) speculated on the role mindfulness could play in problem gambling recovery.


What is mindfulness?

Mindfulness is essentially an awareness and acceptance of your own moment-to-moment experience, including thoughts, emotions and body sensations. It is non-judgmental awareness, but it also involves a sense of detachment from thoughts, emotions and body sensations. That is, you are aware of the content of your thoughts but are not consumed by them or feel that you must act upon them—you can let them slide in and out of awareness. It is well known that you cannot will yourself to stop thinking about something. In fact, the opposite happens—trying not to think about something makes it more difficult to unhook the thought. Rather than trying to suppress unwanted thoughts, being mindful brings awareness to those thoughts and lets them be. This process is one of the key principles taught in a mindfulness class.


Introduction of mindfulness to Western approaches

In 1979, Jon Kabat-Zinn pioneered the implementation of mindfulness in Western medicine through the development of his Mindfulness-Based Stress Reduction (MBSR) program. His focus was to treat patients at the University of Massachusetts Memorial Medical Center who suffered from chronic pain and a variety of other medical issues, including HIV and heart disease.

The focus of his mindfulness-based approach, also called acceptance-based approach, is on a person’s relationship to thoughts and emotions. The aim is for clients to become aware of and accept, without judgment, their present-moment experience and to learn to see thoughts and emotions as passing mental events. It is important to understand that the goal of the contemplative practice is not to change experiences or thoughts but simply to “pay attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p. 4).


The beginnings of mindfulness and relapse prevention

One of the first researchers to recognize the potential for mindfulness in the addiction field was Alan Marlatt. Marlatt recognized that the greatest challenge of substance abuse was not quitting but maintaining the changes. Marlatt was a pioneer in the area of relapse prevention. He realized that meditation could act as a coping strategy for people who were at risk for relapse. As such, practicing meditation could be used as a relapse prevention strategy, providing benefits such as reduced stress and improved life balance. According to Marlatt (1985):

[O]ne of the most significant effects of regular meditation practice is the development of mindfulness—the capacity to observe the ongoing process of experience without at the same time becoming ‘attached’ or identifying with the content of each thought, feeling, or image. Mindfulness is a particularly effective cognitive skill for the practice of relapse prevention. If clients can acquire this ability through the regular practice of meditation, they may be a​ble to ‘detach’ themselves from the lure of urges, cravings, or cognitive rationalizations that may otherwise lead to a lapse. (p. 319)

How it works

Rather than trying to suppress the unwanted thoughts, the client is encouraged to cultivate an attitude of curiosity, openness, friendliness, non-judgmental awareness and acceptance of the present-moment experience. It is well known that trying not to think about something will often fail. Instead, mindfulness teachings encourage clients to allow these thoughts to come into awareness and, rather than getting caught up in them, bring a gentle, non-judgmental awareness to them and let them be. These attitudes are emphasized through teaching and learning about such themes as beginner’s mind, non-judging, acceptance, letting go, trust, patience, non-striving, gratitude and generosity.


A variety of applications of mindfulness

Since the initial work of Kabat-Zinn and Marlatt, mindfulness-based approaches have been integrated into a variety of other therapies/programs, including Dialectical Behaviour Therapy (DBT), Acceptance and Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Relapse Prevention (MBRP). A core element of a number of these programs (e.g., MBSR, MBCT and MBRP) is that they all follow an eight-week group protocol that uses similar mindfulness meditation practices, such as the body scan, mindful eating, sitting meditation (i.e., mindfulness of the breath, body, sounds, thoughts and emotions), mindful walking and yoga.


Effectiveness of a mindfulness-based relapse prevention approach

Mindfulness has been increasingly implemented into addiction programs, including those for problem gambling. The Problem Gambling and Technology Use Treatment Service at the Centre for Addiction and Mental Health (CAMH) introduced mindfulness groups as a regular part of its treatment program in 2010.

The Mindfulness-Based Relapse Prevention for Problem Gambling program at CAMH is for clients attending problem gambling treatment in the action or maintenance stages of change. Their gambling behaviour would need to be stabilized, meaning that the client has goals of abstinence or controlled gambling.

The development of this program was based on the structure and format of MBSR, MBCT and MBRP but has been tailored for people experiencing problems with gambling.

Here are some comments from participants in past groups:

  • "Now I can recognize what [is] happening internally and separate myself from what I'm thinking."
  • "I have become more aware of the present moment. I have become more mindful and conscious about the present moment, learning to take things one step at a time."
  • "My brain is very busy but in this course, I learned how to stay on NOW, in this moment."
  • "Much better listener and not affected by small things. Conflicts are less severe when you don't react right away."
  • "Mindfulness/awareness of warning signs and triggers is my main tool to not returning to coping via gambling."
  • "Learn how to calm down by using the three minute breathing meditation."
  • "Stop and think before I do any harm or damage to myself."
  • "I learned to discipline myself better."
  • "To be able to control going into auto pilot."
  • "Learned how I sometimes get rid of bad thinking and be relaxed."
  • "Mental and physical health has improved greatly."
  • "Feel more positive."
  • "Always brightened my mood."
  • "Learned about taking your time on something without stressing yourself."
  • "I have more patience and am aware of my heartbeat."
  • "Learn how to calm down—less anxiety."

The aim of a mindfulness approach is for clients to become aware of and accept, without judgment, their present-moment experience and to learn to see thoughts and emotions as passing mental events.


How a mindfulness-based approach can be useful in problem gambling treatment

Cultivating awareness of cognitive distortions and stepping out of automatic pilot

Cognitive factors, such as erroneous beliefs about random chance, play a role in a person’s difficulty with controlling the impulse to engage in repeated, persistent gambling. For example, many problem gambling behaviours (e.g., chasing losses, incremental betting) are linked to erroneous beliefs about the concept of randomness. Yet even if people are taught about the concept of the independence of random events, the act of gambling itself can overpower what they have learned. Furthermore, people with gambling problems often report going into a trance-like state while gambling. Some even report being completely dissociated from their physical body—a passive observer—while their body gambles away their money.

These reports suggest that problem gambling often involves automatic thoughts that take place outside of awareness and that people with gambling problems might benefit from greater awareness of their present-moment experience. This may help them avoid slipping into automatic pilot and being overwhelmed by their thoughts. Many attempts have been made to help people with gambling problems by teaching them a greater understanding of probability, but the key problem remaining is that when they gamble, they operate on automatic pilot. According to Toneatto et al. (2007):

[D]istinguishing mental events from the responses to them provides a choice to the gambler regarding how best to respond, rather than react, to gambling related cognition. It is argued that improving gambler’s mindfulness can help them overcome the erroneous beliefs and automatic behaviours associated with problem gambling. Learning to relate differently to gambling cognitions may be as important as, if not more important than, challenging the specific content of the thoughts. (p. 94)

Therefore, the mindful approach to erroneous cognitions brings awareness to those thoughts and, in particular, the automatic nature of those thoughts. By bringing awareness to their thoughts, clients can recognize that these are just thoughts and not act on them. As noted, people with gambling problems often do know that these thoughts are inaccurate but, in the excitement of gambling, simply go into automatic pilot. Mindfulness may be a means of breaking out of that cycle by helping the client avoid automatic pilot.

Seeing thoughts and emotions as passing mental events

If people learn how to cultivate non-judgmental awareness of their thoughts and emotions by practicing mindfulness, the urges and cravings that often drive them to gamble or relapse may be overcome.

One technique of mindfulness is an "urge surfing" analogy to help clients cope with the intensity of their cravings. Riding the wave of craving (i.e., the urge to gamble) is like riding on a surfboard without being submerged by the intensity of the wave. Clients accept the idea that the urge will happen, but through this meditation exercise, they become aware of their urges and therefore are not ruled by them.

The key learning here is recognizing the impermanence of all experiences and understanding that urges are passing mental events that do not have to be acted upon or fought. One simply accepts the urges as thoughts, feelings and body sensations—nothing more—and lets them slide in and out of awareness.


The nine attitudes of mindfulness in Jon Kabat-Zinn’s Full Catastrophe Living

The following attitudes that help deepen mindfulness can be useful in many areas of someone’s life, including having to cope with addictive behaviours like problem gambling. These attitudes can provide a different perspective, which can help with stress management, emotion regulation and impulse control. These attitudes are all interrelated and overlap with each other.

  • Beginner’s mind: Seeing something as if you are seeing it for the first time. Bringing an attitude of "not knowing" to every situation, for only then can you truly "bear witness." Zen Master Shunryu Suzuki once said, "In the beginner’s mind there are many possibilities, but in the expert’s there are few" (Suzuki, 1970, p. 21). This could be similar to the way babies see the world—with wonder and curiosity and without any language.
  • Non-judging: Not trying to get rid of judgment but instead becoming aware of your judging nature. Seeing things as they are, while being aware of any judgment, allows you to see things clearly and stops you from being compelled to act while on automatic pilot.
  • Acceptance: Accepting the way things are and not the way you want them to be. Resisting the way things are is not accepting but rather creates suffering. Accepting does not mean you have to like or condone what is. Acceptance is the first step toward change.
    • The Serenity Prayer can help here: "Grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference."
  • Letting go: Allowing things to be as they are when you catch yourself grasping or clinging to something (e.g., an idea)—letting go or letting be is the opposite of clinging and grasping. Not getting too caught up in having things another way from what they already are. This can be the doorway to freedom. Every time we take a breath in, we have to let it go.
  • Trust: Trusting in the wisdom of the body and life. Many vital bodily functions happen on their own, without the need for us to do anything. For instance, plants grow, and our bodies can breathe on their own. Trust in the flow of life.
  • Patience: Being here and now and not always trying to get to the next moment. We are always rushing to get to the next thing that we never appreciate the present. Patience can protect us from getting angry and help us keep calm under pressure.
  • Non-striving: Cultivating being and non-doing. Not having to get anywhere or change anything. Letting things be as they are and going with the flow of life. Cultivating the being mind as opposed to the doing mind.
  • Gratitude: Being grateful for what you have and not focusing on what you do not have. This can protect you from constantly complaining and finding the negatives in things.
  • Generosity: Serving others without expecting anything in return. Cultivating an attitude of giving rather than clinging. The greatest gift that you can give anyone is your non-judgmental presence.




Research Snapshot

The relationship betw​een mindfulness and problem gambling

Mindfulness-based interventions have been emerging as an effective treatment option for a variety of mental health and behavioural conditions. For example, the literature shows support for the use of mindfulness-based therapies to treat:

  • anxiety (Arch et al., 2012; Van Gordon et al., 2014)
  • depression (Teasdale, 1999)
  • self-control/substance use disorders (Powers et al., 2009; Witkiewitz et al., 2014; Zgierska et al., 2009)
  • gambling behaviours (Chen et al., 2014; de Lisle et al., 2014; Griffiths et al., 2015; Maynard et al., 2015; McIntosh et al., 2016; Reid et al., 2014; Riley, 2014; Toneatto et al., 2014).

Research shows that people with gambling problems have significantly lower levels of self-reported mindfulness when compared to people in the general population (de Lisle et al., 2014). Lower levels of mindfulness were associated with higher levels of psychological distress, demonstrating an inverse relationship. These results also point to the effectiveness of mindfulness-based interventions, as higher levels of mindfulness were associated with reduced psychological distress, leading to fewer ruminative thoughts, improved emotional dysregulation and decreased suppression of unwanted thoughts (de Lisle et al., 2014).


What is the neurobiology behind mindfulness?

Neuroimaging studies have implicated an extended network of brain regions responsible for reward-based decision-making and reinforcement learning in gambling-related behaviours. These studies point to dysregulation in the “brain reward system,” including the regions known as the ventromedial prefrontal cortex, striatum, amygdala and insula (Chu & Clark, 2015; Clark et al., 2014).

In recent years, the insula has emerged as a key brain area involved in gambling-related behaviours. In general, the insula is responsible for sensory coding of physiological and internal stimuli as well as how these translate into conscious feelings. Through the repeated pairing of a particular behaviour (e.g., gambling behaviours) with reinforcing effects, these signals begin to generate urges and cravings over time (Craig, 2009).

The insula has also been shown to play a role in cognitive distortions commonly exhibited in gambling. A study by Clark and colleagues (2014) compared people with lesions to the ventromedial prefrontal cortex, insula and amygdala against healthy controls and people with lesions in other brain regions on both a slot-machine and a roulette task. On the slot-machine task where the starting position was determined by choice, healthy (control) participants showed an increase in motivation to continue playing following a near miss (a loss that falls close to the jackpot). However, this effect was absent in the group with insula damage. Similarly, on the roulette task, healthy participants tended to avoid a colour after an increasing run of that colour (the gambler’s fallacy). This pattern of behaviour was also absent in the group with insula damage.

People with gambling problems display an increased sensitivity to near misses (Chase & Clark, 2010) as well as the gambler’s fallacy (Marmurek et al., 2014). Therefore, it is hypothesized that overactivity of the insula may contribute to the increased susceptibility of people with gambling problems to cognitive distortions (Chu & Clark, 2015).

The literature demonstrates that mindfulness- or meditation-based techniques are useful in reducing insula responsivity, showing promise for the management of cognitive distortions, urges and cravings that are associated with problem gambling (Kirk et al., 2011; Paulus & Stewart, 2014; Potenza et al., 2013).


Benefits of mindfulness in problem gambling

Mindfulness-based interventions are thought to help people with problem gambling cultivate a heightened sense of present-centred awareness regarding their gambling-related cognitions, which helps them employ more adaptive behavioural responses (Lakey et al., 2007). Mindfulness also enables people to develop adaptive coping responses toward unwanted thoughts as they enter conscious awareness (de Lisle et al., 2014). Moreover, through meditation exercises, people can become more aware of their gambling urges without being dominated by them or acting on them (Chen et al., 2014).


Models of mindfulness for problem gambling

Three main models have been proposed to explain how mindfulness works in the context of problem gambling. Being aware of these models can help with our understanding of mindfulness and highlight ways to implement and tailor mindfulness-based interventions for people with gambling problems.

Differential Activation Hypothesis Model

In the context of problem gambling, negative feelings often arise following a big loss. Habitual thought patterns aimed at improving one’s current state then occur. However, if these thoughts do not improve one’s state, negative feelings develop and poor coping strategies (e.g., gambling) may be used to reduce negative affect. Mindfulness can help clients adopt present-centred awareness, whereby people can learn to recognize these feelings and cognitions as passing mental events (de Lisle et al., 2012).

Self-Regulatory Executive Function Model

This model explains problem gambling as an interaction of three levels of cognition: (1) stored knowledge or beliefs; (2) interpretations of events/patterns; and (3) thought processes operating outside of awareness. Interactions between these cognition levels in people with gambling problems would result in a “perceived reality that must be acted upon.” Mindfulness training allows people with problem gambling to bring non-judgmental awareness to mental events, shift their attention, recognize that thoughts are not facts and develop more adaptive responses (de Lisle et al., 2012).

Intention Attention Attitude Model

This model defines mindfulness as a cyclic interplay between intention, attention and attitude. It helps people with problem gambling break the cycle of their repeated thoughts, associations, interpretations and urges of gambling without clinging to them (de Lisle et al., 2012).


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Although cognitive-behavioural therapy (CBT) is currently the treatment of choice for problem gambling, some researchers argue that CBT might not be suitable for everyone (de Lisle et al., 2014; Maynard et al., 2015). Therefore, an innovative therapeutic approach such as mindfulness may prove to be an appropriate alternative treatment for problem gambling.

However, positive results obtained in the research surrounding mindfulness-based interventions for problem gambling must be interpreted with caution. To date, no controlled clinical trials evaluating the effectiveness of mindfulness-based interventions for problem gambling have been conducted (Toneatto et al., 2014). The research studies that do exist cite several methodological limitations, such as small sample sizes, limited eligible studies (meta-analyses) and varying conceptualizations of mindfulness (de Lisle et al., 2012; Maynard et al., 2015; McIntosh et al., 2016).


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Putting It Into Practice

The content in this section demonstrates how the key concepts of mindfulness can be applied to working with clients with gambling problems. Many clinicians use a preferred framework or multiple frameworks in their practices, including holistic, anti-oppressive, systems-theory, disability or social-determinants-of-health frameworks. The information provided here is meant to complement whatever framework or theory may be guiding your clinical practice.

Mindfulness-Based Relapse Prevention for Problem Gambling

This diagram outlines how mindfulness can help with triggers and urges to gamble.

Mindful Response and Non-mindful Reaction diagram


Screening clients for appropriateness of using mindfulness (for application individually or in a group)

Mindfulness-Based Relapse Prevention for Problem Gambling groups were developed for clients in the action and maintenance stages of change. Clients need to be screened for appropriateness for this type of intervention.

Exclusion criteria are not unlike those for other types of treatment groups and may include active suicidal ideation, untreated psychosis, untreated major depression and active trauma responses (e.g., clients with dissociation, difficulty with affect regulation, etc.)—anything that would make it difficult for the client to sit in quiet meditation for at least 20 minutes at a time.

Prior to the start of the group session, you may want to have a brief discussion with group members about any prior experience with mindfulness, although this is not a requirement to attend the mindfulness group. What is important is that they have an interest in learning a different way of being.

Although Mindfulness-Based Relapse Prevention for Problem Gambling is done in groups, it is important to note that some of the mindfulness activities can be done individually. Exclusion criteria for working with clients individually may not be as stringent. You can use your discretion regarding how and when to utilize mindfulness with individual clients.


The eight-week protocol for Mindfulness-Based Relapse Prevention for Problem Gambling

Session one: Stepping out of automatic pilot.
This session involves learning how to slow down and be more present in one’s life through practices such as mindful eating and paying attention to the body. As mentioned above, people with gambling-related problems may often gamble while in “automatic pilot.” This first session will help group members recognize when they are in automatic pilot and how to step out of it and become more present in whatever they are doing.
Session two: Developing awareness and coping with cravings/barriers to practice.
This session involves developing greater awareness of triggers to gamble and learning how to respond from a place of mindful awareness. Barriers to meditation and how to work around them are also explored.
Session three: Bringing mindfulness to everyday activities.
This session involves bringing greater mindful awareness to one’s daily activities, such as eating, brushing teeth, cooking, taking a shower and walking. As group members learn to bring mindfulness into their everyday lives, they can also learn to cope with triggers that may arise.
Session four: Being mindful when at risk to gamble.
This session involves teaching participants how to cope when in situations that may put them at risk to gamble. High-risk situations for gambling fall under ten categories: pleasant emotions; negative emotions; conflict with others; social pressure to gamble; need for excitement; worry about debts; confidence in skill; testing personal control; winning and chasing; and urges and temptations.
Session five: Cultivating a different relationship to experience through acceptance and clear seeing.
This session involves the role of acceptance in coping with difficult situations and making more skillful and healthy lifestyle choices. Acceptance is one of the nine attitudes of mindfulness.
Session six: Seeing thoughts as passing mental events.
This session involves exploring the relationship to experience and how this awareness can be helpful in becoming less overwhelmed when challenged. Learning to relate differently to one’s experience is intimately related to the nine mindfulness attitudes.
Session seven: Being good to oneself.
This session involves developing greater compassion and kindness toward oneself and others. Learning mindfulness is not just about cultivating greater awareness but also developing greater compassion, beginning with self-compassion.
Session eight: Maintaining practice after group ends.
This session involves reflecting on the past seven weeks, consolidating the learning and continuing to move forward. Cultivating mindful awareness does not end when the group ends but can become a lifelong process for whomever chooses to do so.

Learn more about Mindfulness-Based Relapse Prevention for Problem Gambling.


Working with clients through a health equity lens

Health equity helps ensure that factors such as gender, race, ethnic background, ability to speak English, sexual orientation, immigration status, income and education do not affect a person's access to or the outcomes of timely, appropriate and high-quality care. The Health Equity Impact Assessment tool developed by the Ministry of Health and Long-Term Care (2012) recommends that all health care decision-making include evaluation of the unintended positive and negative impacts for various population groups, including:

  • Indigenous peoples (e.g., First Nations and Métis peoples and Inuit​)
  • age-related groups (e.g., children, youth, seniors, etc.)
  • people with disabilities (e.g., physical, D/deaf, deafened or hard of hearing, visual, intellectual/developmental, learning, mental illness, addictions/substance use, etc.)
  • ethnoracial communities (e.g., racial/racialized or cultural minorities, immigrants and refugees, etc.)
  • Francophones (e.g., new-immigrant Francophones, deaf communities using LSQ/LSF, etc.)
  • people experiencing homelessness (e.g., marginally or underhoused, etc.)
  • linguistic communities (e.g., uncomfortable using English or French, communication affected by literacy, etc.)
  • people receiving low income (e.g., unemployed, underemployed, etc.)
  • religious/faith communities (e.g., Buddhist, Muslim, Christian, etc.)
  • rural, remote or inner-urban populations (e.g., geographic/social isolation, underserviced areas, etc.)
  • groups defined by sex/gender (e.g., male, female, women, men, trans, transsexual, transgendered, non-binary, two-spirited, etc.)
  • groups defined by sexual orientation (e.g., lesbian, gay, bisexual, etc.).

Please note that this list is not exhaustive, may not be fully inclusive and/or may not reflect the preferred terminology within the listed population groups. Clients may also identify with more than one of the above. It is important that your problem gambling and mindfulness programs/services incorporate the Health Equity Impact Assessment tool in planning and service delivery. This website will endeavor to provide more evidence-informed content for specific population groups in the future.


Diverse population groups

Anyone can practice mindfulness. Although mindfulness as we know it today originated from Buddhism, in every faith tradition, some form of contemplative practice exists. Practicing mindfulness is really about learning to be present. Anyone can learn to do this regardless of age, culture, race, religion or gender. The present is the only time that actually exists. However, learning to be present is not the only component of mindfulness—there are also the attitudes of mindfulness, including self-compassion.

When teaching mindfulness, talking about Buddhism is not necessary, since the goal to “pay attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p. 4) is not specific to Buddhism. It is a quality that any human being can learn to cultivate, regardless of ethnic or cultural background.


People with disabilities

Little to no research has been done regarding teaching mindfulness practices to people with developmental delays, intellectual disabilities or severe psychotic symptoms. As mentioned above, anyone can learn mindfulness. Teaching mindfulness to people with development delays, intellectual disabilities or severe psychotic symptoms would need to be adapted based on particular needs.

There are many ways to teach someone to cultivate mindful presence, not only through the formal methods of the body scan or mindfulness of the breath. For example, you may assume that someone with attention-deficit/hyperactivity disorder (ADHD) may not be able to learn mindfulness, but the research shows that it can be very useful for someone with ADHD. The mindfulness practices would, however, need to be adapted to what would be useful for the person.

Some clients with significant mental illness may benefit from treatment prior to starting mindfulness for their problem gambling, as the symptoms of their mental illness may pose a barrier to their attendance and adherence. For example, someone with depression may find it difficult to sit quietly during a mindfulness practice without getting carried away by negative thoughts and exacerbating their depression. Therefore, they may benefit from prior treatment for depression.


Training in mindfulness for therapists and group facilitators

Bringing mindfulness to individual sessions with clients and teaching it in a group setting are similar. The meditation practices and attitudes of mindfulness are the same. Specific training for facilitating mindfulness groups or teaching it in a clinical setting is recommended.

Most importantly, it is recommended that therapists who want to teach mindfulness to their clients have their own experience with practicing mindfulness. Research shows that therapists who practice mindfulness are able to be more attuned to their clients. Therapists who practice mindfulness and have some training in it will embody and model the nine attitudes of mindfulness and be able to demonstrate the qualities of presence.

Learning and teaching mindfulness require a strong experiential component, that is, by practicing mindfulness either formally or informally.






Handouts for Clients​​​

  
  
3-Step Breathing Spacemindfulness-3-step-breathing-space
Espace de respiration en 3 étapesmindfulness-3-step-breathing-space-fr
Technique de « surfer sur ses envies »mindfulness-urge-surfing-fr
Urge Surfing Techniquemindfulness-urge-surfing-technique

Clinical simulation video

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Download video transcript

This video clip shows a fictitious therapist and client session for teaching purposes.

The scenario depicts the second mindfulness session with a client (John) who is dealing with problem gambling. During the first session, the therapist explained mindfulness to the client and they both agreed that mindfulness could help with his ability to cope with urges to gamble and his anxiety. In this video, the therapist is inviting the client to recall a recent triggering situation, where he can experience the same thoughts, feelings and body sensations in the present moment. The goal is then to teach the client to apply mindfulness in order to prevent relapse.

The “inquiry” following the meditation focuses on the direct experience of the present moment and how the urge is experienced in the body and mind, without judgment and with compassionate curiosity.

The RAIN technique can also be utilized here, as can the three-step breathing space. The nine attitudes of mindfulness can be helpful here as well.​

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