Podcast Transcript
Mindfulness Skills to Help with Adult ADHD
Summary: In this episode of the Pocket MD podcast, Laura Knouse, PhD, interviews John Mitchell, PhD, about the use of mindfulness skills to help adults with ADHD. Dr. Mitchell explains that mindfulness is a practice that involves being nonjudgmental, describing things with awareness, and acting with awareness in the present moment. He discusses how mindfulness can help individuals with ADHD by improving their ability to regulate attention and emotions. Dr. Mitchell also shares the findings of several studies that have shown the effectiveness of mindfulness-based interventions in reducing ADHD symptoms and improving executive functioning. He suggests that clinicians can introduce mindfulness to their patients by starting with simple practices, such as focusing on the breath, and gradually incorporating mindfulness into their daily lives. Dr. Mitchell emphasizes the importance of finding a good therapist who can provide guidance and support in integrating mindfulness into treatment. He also recommends resources such as clinician manuals and books on mindfulness for ADHD. Overall, Dr. Mitchell encourages clinicians to give mindfulness a try and explore different ways to incorporate it into their practice.
Laura Knouse, PhD
Laura Knouse, PhD, is a clinical psychologist whose research and clinical expertise focus on the nature, assessment, and treatment of ADHD in adults, specializing in cognitive-behavioral therapy (CBT) for adult ADHD. An associate professor of psychology at the University of Richmond, she earned her PhD from the University of North Carolina at Greensboro and completed clinical internship and postdoctoral fellowships at Massachusetts General Hospital and Harvard Medical School. Her recent research aims to better understand the self-regulation and motivation difficulties of college students with ADHD through the lenses of cognitive and social psychology in order to develop effective interventions. Recent collaborative work with faculty in other disciplines focuses on how leaders can most effectively cope with personal crisis and how growth mindsets are related to mental health and coping.
John Mitchell, PhD
John Mitchell, PhD, is an associate professor of psychiatry and behavioral sciences at Duke University. He earned his PhD from the University of North Carolina at Greensboro in 2009 and completed clinical internship and postdoctoral training at Duke University Medical Center. His research focuses on ADHD treatment development and ADHD-related outcomes into adulthood. Dr. Mitchell has authored or coauthored over eighty scientific papers and book chapters, and he coauthored the book Mindfulness for Adult ADHD: A Clinician’s Guide. He has led grants funded by the National Institutes of Health. In addition to research, Dr. Mitchell is a practicing licensed psychologist in the Duke ADHD Program, working with adolescents and adults with ADHD.
Learning objectives:
- Identify the symptoms of ADHD that mindfulness can help to improve.
- Explain what mindfulness-based treatment for ADHD looks like.
- Understand and explain how mindfulness can be practiced throughout a busy workday.
- Learn how clinicians can get further training or certification to integrate mindfulness into their practice.
Announcer: You are listening to Pocket MD: Training on ADHD in Children and Adults.
Dr. Laura Knouse (00:07): Welcome to another episode of the Pocket MD podcast. My name is Dr. Laura Knouse, and I'm a professor of psychology at the University of Richmond and a licensed clinical psychologist specializing in skills-based treatments for adults with ADHD. Today I am excited to host a conversation about the use of mindfulness skills to help adults with ADHD, and for that, I'm joined by my colleague Dr. John Mitchell. Welcome, John.
Dr. John Mitchell (00:34): Hey, Laura. Good to see you.
Dr. Laura Knouse (00:36): Great. Can you tell us a little bit about yourself?
Dr. John Mitchell (00:38): I am an associate professor at Duke University, and I do a mixture of research and clinical work. I'm a clinical psychologist by training, and a lot of my clinical work is in the ADHD program at Duke, primarily working with adults and young adults with ADHD, and then my research is in primarily ADHD, including mindfulness.
Dr. Laura Knouse (01:05): So, Dr. Mitchell, you've researched and you use mindfulness to help adults with ADHD. You've written a guide for clinicians who want to use these approaches with their patients and their clients, so we are excited to hear from you. To start off, can you tell us what is mindfulness and how is it similar to but distinct from meditation?
Dr. John Mitchell (01:26): Mindfulness comes from an over 2,000-year-old Buddhist phenomenology, so to define it is pretty complicated. There's a lot of different slices. I think in clinical practice in psychology, we define it in a number of different ways. Some people define it almost like a personality trait, the act of being nonjudgmental, describing things with awareness, acting with awareness, and how you interact in the world with those kinds of traits. That's one way. Another way is kind of thinking of it as like a process that involves orienting your attention to something on purpose in the present moment and approaching that with openness and curiosity and acceptance. I'd say that one of the most popular definitions is by Jon Kabat-Zinn, who's well known for bringing this into western psychological practices in the late seventies. His definition is generally paying attention on purpose in the present moment with a nonjudgmental attitude while adopting a sense of curiosity.
Dr. Laura Knouse (02:38): Excellent. That sounds like a wonderful state of mind to cultivate for both patients and clinicians, for lack of a better term, the theory of change. Why should we think that mindfulness could help people with ADHD? And does it seem to be helpful with some kinds of symptoms rather than others?
Dr. John Mitchell (02:57): I think at a big level with mindfulness, we're practicing observing what's going on in the present moment, going beyond the judgment that can get in our way of how we see the world. And then, when we can observe things in a different way, and we can observe ourselves and how we're interacting with our environment, I think that's a foundation to choose what we intend to do. So, it's all about being intentional in how we act. I think at the foundational level, that's something that it does and how it's supposed to work, and I think that has relevance for ADHD and depression and substance use and so on. When it comes to the theory of change and why it should work with ADHD, if you look at the actual practices, you can even see the relevance of common practices of mindfulness, of breath exercise that we typically use in mindfulness-based treatment programs.
(03:58): With that, you practice observing your breath, so you're focusing on one thing and then you practice, how do I respond to myself when I notice that my attention strays, and how do I bring myself back to the thing that I want to focus on? And that's the act of regulating attention—and what's a core problem in ADHD, as you know, it's regulating attention. Now there's an exercise called the RAIN exercise, where we practice recognizing, accepting, investigating, and nurturing with particular emotional experiences. Essentially, what that does is that it helps regulate your emotions, which we know is something that's a big issue in ADHD, especially among adults. So, I think even when you look at the actual practice level, it has very clear relevance, but I don't think it's always been there and stood out.
(04:53): I think initially mindfulness meditation-based interventions are not intuitive for ADHD, right? Like sit still and focus on one thing for a population that's characterized by fidgetiness and restlessness and difficulty sustaining attention. In 2007-ish, I think was when Lidia Zylowska's first feasibility study came out looking at mindfulness for adults with ADHD, and I think that was the first trial; I could be wrong, but I think so. Then there was this gap in follow-up studies, and it was around 2011, I remember I was reading a couple of mindfulness review articles and they were not on ADHD at all, but a lot of them ended in the same way that, oh, this seems like an intervention that would be well-suited for a clinical population like people with ADHD, because when you just look at the practices, it seems to have relevance.
Dr. Laura Knouse (05:50): Nice. And then I know that you conducted your own study, so only the second, I think, trial that investigated use of mindfulness-based treatment. I have read and enjoyed and really respected that work. So, tell us a little bit more for people who have not read that kind of work. What does a full mindfulness-based treatment for ADHD look like?
Dr. John Mitchell (06:10): It looks different for adults versus if you're doing it in a pediatric population. I'd say on the adult side we have the Mindful Awareness Practices program that's been published as a clinician manual, as you mentioned, so thanks for the plug for the book, Dr. Knouse. That's an eight-week program. I'd say on the child side, the My Mind program from Susan Bogles from the Netherlands, and that's been published. If people are looking for good guides, if they're doing treatment with children or adolescents with ADHD, that's a good one to check out. They're both eight-week treatments. The Mindful Awareness Program or MAPS sets based on kind of like the parent mindfulness-based intervention, the MBSR (Mindfulness-Based Stress Reduction), what MAPS looks like for adults with ADHD, it's modified to make it more ADHD friendly. One thing is there's shorter practices, there's formal meditations, and those range somewhere between five to fifteen minutes, which is a better fit for attention span for ADHD, and you work your way up gradually over time.
(07:18): Thinking of it with a shaping principle: whereas in traditional MBSR, you might be doing 45 minutes sitting meditations, and those typically are not such a good fit for our adults with ADHD that we work with. The interventions typically involve education about ADHD as well, and then also typically involve not just the formal meditation exercises, but informal exercises as well. One way to get into a mindful state and to be more mindful in general is to practice through a formal meditation, but then there's also informal ways to do it as well. That might be doing a non-meditation exercise, but just typically in the first session we might do something like just observe some kind of behavior and do it in a different way so you can kind of observe yourself if you use your left hand to brush your teeth, try using your right hand, things like that.
(08:14): So, typically what it looks like in a general session is we do an intro mindfulness meditation exercise. We have some new theme that has relevance for ADHD, so we're not just learning about mindfulness meditation practices as some kind of esoteric thing, but so that it's something that can be really clearly applicable to ADHD and has relevance to it. And then we practice it, we meditate in group, and then we talk about how are we going to apply this over the week ahead. And you kind of do some hands-on planning. Since this is an ADHD population, we use CBT skills to support the use of the mindfulness skills. So, how am I going to use reminders so that I can remember to practice at the same time each day? And then also with some of the programs, some of the treatments like MAPS, we end each session with a brief appreciation exercise as well, because as clinicians who work with adults, ADHD, we all know, I know as you well know, the self-talk can be extremely critical, very unfair and so it's a way to work away at that kind of continuously throughout each session.
Dr. Laura Knouse (09:25): That leads to a question I've been thinking about, which you started to address, which is, how do you see mindfulness skills integrating with other kinds of skills-based treatments like CBT or sort of self-regulation or executive functioning skills? How do you see them playing well together?
Dr. John Mitchell (09:42): So, CBT and mindfulness-based interventions, they're different—and this makes me think about the conversations that we've had about this at ABCT [Association for Behavioral and Cognitive Therapies] and back in the grad school days—they're all part of the behavioral therapy family. Mindfulness-based interventions are part of these third-wave interventions and can be very complementary and fit well with interventions like CBT. Other interventions like DBT Enact have a healthy dose of mindfulness; they're not traditionally thought of as mindfulness-based interventions, but mindfulness is a strong part of DBT Enact, and then how to integrate them in the MAPS program, for example, we have in there how to use CBT skills to support the practice of mindfulness. Also, they can be very complementary and you can learn the skills together as well and learn CBT skills to help out with daily planning and then maybe use mindfulness as a way to deal with the frustration when it's hard to implement it. And so, separate interventions that can be totally complimentary as well.
Dr. Laura Knouse (10:54): It makes me think of, from your intro, you mentioned the idea that mindfulness can be helpful in being more intentional about things, right? Actually making a conscious choice about what you want to do as opposed to being led around by say, impulsivity or the emotion of the moment. So, I think about how mindfulness skills could help clients in those moments choose to use a self-regulation skill rather than go with their default setting. I just appreciate what you're saying about how they're complimentary.
Dr. John Mitchell (11:24): That's a common theme that comes up throughout mindfulness-based interventions is being an automatic pilot and using mindfulness as a way to break out of that automatic pilot mode, and now we're doing things where we're not just acting because this is how we habitually act. This is our behavioral repertoire, but instead this is stopping, looking around, and thinking, where do I want to go from here and what's my intention? And it's always helpful to use values to guide that. So you can think about the big picture about, where do I want to go right now and how does that fit with my values? And yes, I think mindfulness is a way to establish that platform.
Dr. Laura Knouse (12:08): Yes, it sort of reminds me of, I think it was Russ Barkley who talked about ADHD not being a disorder of attention, but a disorder of intention and making that a reality.
Dr. John Mitchell (12:18): Yes, yes. I think you actually did a clip a couple of weeks ago that I came across, a YouTube one, that reviews some of the mindfulness for ADHD literature. And when I saw that, that was the first thing that came to mind that, yes, how we had talked about that this is an intention deficit disorder. I think mindfulness really fits well from that theoretical kind of framework.
Dr. Laura Knouse (12:44): That's a good segue. You talked about this a little bit so far, some of the research evidence that you've been involved in, but could you say just a little bit more about where the evidence, the state of the evidence is for mindfulness for ADHD and adults?
Dr. John Mitchell (12:58): It's really gotten big, especially over the past ten years. Today, there's been a number of feasibility trials that show, can we do this with adults with ADHD? Is it acceptable to them? And now we have enough trials where we can absolutely say that. To date there's been, I believe, five randomized controlled trials. And so out of those five, three compared a mindfulness-based intervention against a waitlist control group, and then two compared it against inactive treatment. And when you look at the waitlist control group studies, you see consistent findings with improvement in ADHD symptoms, executive functioning trait mindfulness [dispositional mindfulness], and in the one study that looked at it, emotion dysregulation as well.
In one study, they compared mindfulness against treatment as usual.(13:59): They saw improvement in ADHD symptoms up to, I believe, about six months out, plus improvements and things like trait mindfulness, general mental health measure, executive functioning. And so they compared a mindfulness-based intervention against a psychoeducation group was what they called it. And that study's interesting, especially when you pick it apart. Basically, for that one, the mindfulness group did show significant effects for trait mindfulness, ADHD symptoms. There was no difference between groups. Both groups actually improved. So you could say, well, is that just regression to the mean? Did both groups just get better over the course of time? We've got waitlist control group studies that show that no, it's not just the effect of time. So in that particular study, then what was going on, and I enjoyed speaking to people about it to try to make sense out of it, but the other study where a psychoeducation was used against some other adult ADHD treatment, was a CBT trial.
(15:09): In that study, both interventions were performed exactly the same. I'd say that with that one study that we have, it's an interesting finding. It's performing just as well as an active treatment comparison that performs just as well as cognitive behavioral therapy, which we know has some pretty important therapeutic effects for adults with ADHD. And then just one other trial that it wasn't a randomized trial, but it did have two treatment comparison conditions. It was a DBT skills training group and a mindfulness training group. And in that study, when you looked at symptoms like ADHD symptoms at the group level, both groups improved. When you looked at rates of individual improvement, it actually favored the mindfulness group. It was 31% that improved in the mindfulness group versus 12% in the DBT skills training group, so there's a lot of nuance in there. It's a research literature that's really young, but then also I believe that we have enough evidence to say, okay, there's some effects that we see on ADHD symptoms, executive functioning symptoms. It's also something where we need more rigorous trials. And I think it's finding that balance of how do we be good clinical scientists and find that balance of we need good thorough research, and then also this is a tool that can help our patients right now. And I think that we see effects. We don't have to wait on that.
Dr. Laura Knouse (16:48): I couldn't agree more, and I think the evidence that mindfulness can be useful for a whole range of other challenges that people have, stress reduction, et cetera, to me is also important evidence for this conversation. I might imagine that there are clients for whom this is a really appealing mode of treatment, and that motivation piece can't be underestimated, I think when it comes to finding the right treatment for a client. I don't know what you think about that.
Dr. John Mitchell (17:16): To what extent do we take into account the preferences of the people that we're working with? And if you've got enthusiasm for treatment, especially one like this, then where we do have some pretty good evidence about the effects, then, well, I'm about to say it almost like in a judgmental way, the right thing to do, but I'm trying to also embrace some mindfulness as well, and not sound judgmental, but yeah, it sounds like that that would be consistent with the research literature and then also consistent with our clients' wishes and preferences as well. I think you can get a lot of buy-in because a lot of people really are intrigued about mindfulness, and they might be more intrigued than other treatments because I practice those in clinical practice.
Dr. Laura Knouse (18:05): Sure. One other thought I had, when you were talking about the role of psychoeducation, I think some of those findings you mentioned really also just speak to how important it is to fully educate our clients about what is ADHD so that they can have an understanding of how this is going to help that, how it will make a difference in their lives. Again, speaking to that motivation, and I like how you described the mindfulness treatment, how that also of course involves how will this apply to my specific challenges with ADHD? I think that's so important, too. Even with medication, you need to be able to have an effective psychoeducational moment, more than a moment with your client to help them with their treatment motivation, I think.
Dr. John Mitchell (18:51): Because in clinical practice in doing mindfulness, part of that conversation with the psychoeducation is that ADHD, we talk about it, yes or no, it's a binary construct. But as you know, I'm sure a lot of people listening know that these are symptoms that are normally distributed. And when you look at symptoms when they're normally distributed, then it feels like it's not such a high mountain to climb when you think, okay, my goal is to just move further down the spectrum of symptom severity as opposed to, oh, I've got to get rid of this thing. I've got to get rid of this ADHD. But instead, it is just looking at improvement in degrees of severity. And I think that's a much lighter lift. And who wouldn't prefer to lift something lighter rather than heavier?
Dr. Laura Knouse (19:41): As a clinician, I'm tucking that away into my bag of tricks. I think that's such a great way to describe it for clients for any treatment modality, really, because the truth of this disorder is it's not a thing that you're going to get rid of. When we think, too, from a neurodiversity perspective, that idea of turning down the volume or lightening the load, is such an important metaphor for clients making it feel manageable and also that they're going to still be who they are, just maybe getting those intentions out.
Dr. John Mitchell (20:15): Absolutely. Absolutely. Yeah. I mean, because on the one hand therapy, it can be hard work, and on the other hand, why work harder? We can still see some gains, and we don't have to drastically alter who people are. Isn't that great? Because then, and I'm sure you come across this too, adults with ADHD also, how does this fit within their sense of self and their personality? And they don't come into therapy, at least in my experience, wanting to drastically change who they are, but they do want to work on some of the suffering that's caused in their life right now.
Dr. Laura Knouse (20:55): I think that's a good coping statement, too. For clinicians, this idea is so consistent with skills-based treatments of incremental change, I think is just an important thing to keep in mind. So I'm going to give you some negative self-talk that I have had and see how you might respond to it. What would you say to someone who thinks they're bad at mindfulness or say, I don't think I can meditate every day. How is this going to fit into my life?
Dr. John Mitchell (21:23): This is something that does come up, and I typically say, and this is some of the CBT training kicking in that most people aren't good at things that they haven't really practiced. What if this was a kid you were talking to and they wanted to learn how to play a sport? They wanted to learn how to play soccer and they said, I haven't really played soccer and I'm bad at it. What would we say? Yeah, you probably shouldn't play soccer. No, no. Okay, that's just an indication that this is something that can be practiced. So we want to practice this. And also talking about where can we start? What's a good starting point? Like I mentioned, the mindful awareness practices program for adult ADHD, the practices start at five minutes, not forty-five minutes. And so typically working with clients, we try to set a baseline: Where are you at right now?
(22:23): And we'll work on increasing that baseline with where you're at. And that takes time and that takes work. And then also our goal is not to set you up for failure, because if it is then that's not going to be very motivating, and who's going to want to come into a treatment where they feel like they're always failing? So, we want to set you up for success, and that's okay if you're not good at it yet. And I would actually try to help them reframe that in a more mindful way. One lesson that I learned in my own mindfulness practice as I was doing this with a group and then I said something and then somebody asked me, well, okay, can you just say that, but say that in a nonjudgmental way, be more descriptive? And I'm like, oh, okay. Yeah. So I would ask somebody, well, when you say you're bad at meditating, what does that mean? If you take away the judgmental terms, it probably means
Dr. Laura Knouse (23:18): I'm afraid.
Dr. John Mitchell (23:19): Yeah.
Dr. Laura Knouse (23:20): I don't believe in myself, something like that.
Dr. John Mitchell (23:23): And I find this is difficult, but that's something that can be worked on. I love that. And throughout mindfulness treatment, we're providing encouragement and then also we're trying to help move things along—ultimately really trying to encourage and help people to maybe approach the things that they find uncomfortable. But it would be adaptive to approach more often thinking about putting things off. That thing that you've been procrastinating on, it feels good to avoid it because you don't have to think about it in the short term, but in the long term, that's what brings a lot of people into treatment. And so how can we encourage this approach to those things: sit with that discomfort when we're starting to work on a task and sit with it and work through it?
Dr. Laura Knouse (24:13): Absolutely. I also like that story. You must have felt proud when your client was encouraging you to use the skills. That's that’s pretty cool.
Dr. John Mitchell (24:24): And that's another interesting thing about mindfulness.
Dr. Laura Knouse (24:29): Yeah, that's an equalizer.
Dr. John Mitchell (24:31): Exactly. Because we're all practicing it. It's very different from our training doing CBT. Nobody asks, oh, do you practice CBT in your real life? But it's a very okay thing and very typical thing to ask like, well, what is your meditation practice like doctor so-and-so because it is assumed that you do practice it.
Dr. Laura Knouse (24:53): I'll say, the more I practice CBT self-regulation skills, the more I have brought that into the conversation too, to talk about my, not too much, but talk about my failures of self-regulation and tips and tricks just to model that, normalize that idea that it's something we're always all working on. So I really respond to, I really recognize that potential advantage of mindfulness as a practice that you're doing as well as encouraging your clients. We're all in our journey in some ways.
Dr. John Mitchell (25:22): Right. That's right.
Dr. Laura Knouse (25:24): Now we really sound like psychologists, Dr. Mitchell. Speaking of which, I know that we have a lot of listeners with different professional training and ways of practicing. So here's what maybe a hard question. What are some mindfulness strategies, recommendations, or practices that clinicians could either teach or recommend to their patients if they're in a more busy office setting where they don't have eight sessions, let's say?
Dr. John Mitchell (25:49): Oh, okay. So how do you introduce it? And maybe if you just have a couple of sessions and you want something to stick.
Dr. Laura Knouse (25:59): Or an outside resource too, I think.
Dr. John Mitchell (26:01): Yeah. Yeah. A lot of mindfulness-based interventions start with a basic practice of a mindfulness of breath, and how do I practice sitting with and focusing on each inhale and each exhale and just notice the breath. You're not trying to change it. You don't need to make it better. There's no judgment on where it's at. It is what it is. And so I think I like to start off with that skill, with that formal meditation, and then ask people, how can we use this informally in your everyday life? At what points in the day can you stop, take a breath, breathe in, breathe out, look around, check in with yourself, and then ask yourself how you want to proceed. Or you could just take a snippet of that. So every time you get a text or when you're driving and your car comes to a complete stop and it's safe, focus on your breath.
(26:59): Find moments in the day where you can sit and be present just with one breath. And then if we can do one breath, then we can try to figure out how to build on that. But making that a starting point, and it's not going to make—you mentioned the busy office setting—it's not going to make the office less busy, but it's a moment of calm and centeredness and we all approach the world, I think, in a better version of ourselves when we approach situations in a more calm, centered way as opposed to feeling more in a rush and just acting on automatic pilot. So it's a way to provide some breaks in the day and have more moments of mindfulness. It might not make us totally mindful all the time, but more moments here and there. And that's what we encourage in treatment, because if you do the formal meditation, we celebrate that. And even when you don't, that's okay. There's still a way to dip your toe in the water. You might not be jumping in and doing a cannonball, but you can get into it a little bit, and every little bit helps and can be significant.
Dr. Laura Knouse (28:12): What do you think of the apps? Are there apps that you think could help clients to bring it into their everyday life?
Dr. John Mitchell (28:18): That's a tricky one, right? Because I feel like whenever I get to know more about apps that are out there, the new ones spring up, the big ones, or things like Headspace and Calm. I'm sure there's tons of others I'm not even aware about. Maybe a couple just came out since you and I started talking probably. And so what I try to really emphasize is, let's find some practices that are a good fit with where your practice is at right now, and then something that could encourage that. And so before people go off and find one, I encourage them, let's find out where you're at right now and where you would like to be. And so you're helping out with the planning, you're doing some good goal setting and therapy and all that to prevent
Dr. Laura Knouse (29:08): Burnout.
Dr. John Mitchell (29:09): Absolutely, yeah, helping to provide some guidance and then when they know how to do the practice, then encouraging that exploration if people want to explore. I think that's great. I also think there's something to be said for having one good go-to resource. As you know with working with adults with ADHD, and we do this in CBT too, you could end up finding yourself avoiding working on things because you're looking for the best thing out there, right? For sure. The best planner in CBT. If I find the best planner, then that'll help. And similarly, if I can find the best mindfulness app… then you could be looking for a long time. And that's just doing some of the basic practices.
Dr. Laura Knouse (29:56): So, finding something that's simple enough that it won't get too overwhelming, finding the good enough solution, it sounds like.
Dr. John Mitchell (30:02): Yes. Start off with a good therapist who can help provide some guidance and set your foundation there and then build on it from there.
Dr. Laura Knouse (30:10): Great. Well, I wonder if our conversation has peaked the interest of some of the clinicians listening today. If a clinician listening would like to get further training or certification to integrate mindfulness into their practice, what might you recommend?
Dr. John Mitchell (30:27): There's so many different ways to get involved. There are different forms of certification, for example, in Mindfulness-Based Stress Reduction. You could go that route. What is proper training in order to do a mindfulness-based intervention? That could be a whole other topic. I think a lot of people have different views on that. What if you're a clinician who has a lot of training in these other therapy modalities, then how did we learn those? And it might be as simple as trying to learn some of the principles and learning some of the practices as well. I would say somebody who is wanting to teach it is they would want to also add this to what they do in their personal life as well. And so if you're going to teach mindfulness, I would strongly suggest that you practice mindfulness in your life.
(31:19): Also for ADHD materials, there are clinician manuals out there, as you mentioned earlier, our clinicians guide for adult ADHD. There's the book by Susan Bogles, the Mindful Parenting book. There's a lot out there for people to sample. I'd say the main thing, a couple of the main points would be, to establish your own practice, gain a good understanding of the underlying principles, and then also think about the population that you want to work with and how to make mindfulness relevant to them. Because most people come in looking for treatment, not because they want to be better at meditating necessarily, but they want their lives to be better. And so we want to be able to help to articulate how mindfulness can be relevant to their experience.
Dr. Laura Knouse (32:10): Wonderful. Well, thank you Dr. Mitchell. Is there anything else you think it would be important for our clinicians to know that I haven't asked about or you haven't had an opportunity to speak on?
Dr. John Mitchell (32:22): Oh, goodness. We did cover a lot of ground. No, I'd say just if somebody is new to it, give it a try. And there's lots of different ways to get involved and just get involved. There are online trainings to learn meditation yourself. Go ahead and try out an app. There's lots of good books by people like Jon Kabat-Zinn and lots of other self-help written materials to guide people through the practices. I'd also recommend, when people are learning it, to use narration to guide them through the process. If you're going on a hike, you want a map, and those narrations can provide a map to guide you through the process early on. At least that's what I've found with my own experience, and I see a lot of other people doing as well.
Dr. Laura Knouse (33:10): Wonderful. Thank you, Dr. Mitchell for this fascinating and useful conversation. And be well, be mindful.
Dr. John Mitchell (33:19): Well, thank you. Thank you very much, Dr. Knouse. You too. And take care.
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