Have you ever wondered to yourself “what is mindfulness?”

Have you ever thought about what mindfulness-based interventions are applicable to OT practice?

Have you ever wondered if you are implementing mindfulness-based interventions into your clinical practice without even knowing it?

Have you ever thought to yourself “I'm not in a mental health setting and I don't really know how to implement mindfulness-based interventions into OT clinical practice”?

I'm here to tell you that you are not alone if you have ever had any of these thoughts. I've been a therapist for 9.5 years and found myself asking similar questions at various points throughout my career. Travel back in time with me for a second to my first couple of years in clinical practice. I spent my first four years in a level one trauma hospital-affiliated inpatient rehabilitation setting, primarily servicing individuals with neurological conditions. My clinical practice included lots of self-care interventions, functional mobility interventions, one handed technique training sessions, behavioral management strategies, neuromuscular reeducation, and anything else that you can think traditionally is represented in this adult practice setting. Then I began to notice that sometimes my therapeutic use of self and my implementation of things like principles from Taylor’s Intentional Relationship Model were just as important as the high repetition or task-oriented training or (insert here) that I was providing to my clients. I began to realize that even in a traditional physical rehabilitation setting, I needed to tap into skills that I learned in my psychosocial classes more intentionally and apply them more consistently in my daily OT practice. You see it was very easy to get caught up in the demands of an inpatient rehabilitation facility including productivity standards, length of stays being shorter and shorter, and maximizing repetitions and trials within one session because you don’t get many. Which don’t get me wrong, evidence supports interventions that are task specific and highly repetitive (totally not knocking it, I promise!). But what I realized is that when individuals are not regulated or primed or prepped or attentive or whatever term you would like to use here, they cannot optimally engage in whatever it is that is before them. So, I asked myself, “what are some other ways to support occupational engagement that I’m not doing?”.

Throughout the years, I had excellent mentors who I witnessed demonstrating an array of interventions, including mindfulness-based interventions, into clinical practice in adult physical rehabilitation settings skillfully. I began to consume literature in my free time to supplement what I was seeing in clinical practice and then attempting to implement what I was reading. Now fast forward with me a few years as I began a post-professional doctorate program at five years into clinical practice. It's here that I chose to complete my post-professional doctorate capstone project on mindfulness. What I realized in my needs assessment is that many students and clinicians did not feel confident in utilizing mindfulness-based interventions in clinical practice. As I talked to occupational therapy educators, I realized that there is an interest of educators to provide quality education about mindfulness interventions to their students to better equip their students for practice implementation. Through the conduction of the capstone project, I gained a much deeper appreciation and knowledge base for mindfulness and also came to a realization that more work regarding mindfulness and its connection to occupational therapy is needed. 

One article that I came across during my post-professional doctorate capstone project was a paper by Elliot (2011) who writes that that mindfulness is both the meditative practice, which is an occupation itself, and a means to enhance the experience of occupations. This stuck with me. Elliot (2011) provides a call to the field of occupational science for further investigation of mindfulness for occupational engagement. Elliot (2011) dives deep into Langer’s psychological perspective of mindfulness and highlights how the principles choosing to notice the details of daily live and occupations can impact health of an individual. In contrast, Elliot (2011) refers to Kabat-Zinn’s take on mindfulness describes state mindfulness that emerges from active meditative practices. Active participation in mindfulness can be formal or informal noting that “informal mindfulness exists in the application; the awareness of the experience of participation in everyday activities” (Elliot, 2011, pp. 369). Here is where lies an opportunity for OTPs to harness our unique skillset. We are the experts in activity analysis, creating the ‘just right challenge’, and collaborating with our clients to cultivate meaning. So how to do we encourage ‘occupational mindfulness’? 

Have you ever driven home, pulled in the driveway, and realized you don’t know how you got there? You don’t recall any of the drive at all. Have you made dinner and the entire time you are thinking about work and all the things you need to do the next day? And possibly forgot an ingredient? Maybe you overcooked the pasta noodles because you weren’t tuned in fully. 

Many people go about their day moving from task to task without fully experiencing the ‘doing’ of the task at all. We are frequently mindless, rather than mindful. We are easily distracted by the stressors and the external pressures that surround our lives. Now imagine being someone who recently experienced a stroke, or a heart attack, or any medical event that changes their life. Can you imagine how distracting the stress and thoughts of that situation can be? Can you imagine how difficult it would be to optimally engage in occupations when uncertainties, pain, and change surround you? 

Now imagine this:

A state of inner stillness.

An ability to be fully present in the moment.

An awareness of self and senses.

Intention behind your thoughts but also being non-judgmental to if your thoughts wander and then come back.

If we take a second to look back at the definitions of mindfulness, we might acknowledge that being in a mindful state or having achieved mindful traits seems inherently individually focused. However, I encourage you to think about how OTPs support clients through progression of independence with other physical and cognitive skills. I view facilitating someone’s increased ability to take hold of their own thoughts and increase their present awareness as a scalable skill as well. If we as OTPs can provide formal or informal mindfulness-based interventions that facilitate a state of present-being for our clients, maybe we can support occupational mindfulness.

References:

Elliot, M. L. (2011). Being mindful about mindfulness: An invitation to extend occupational engagement into the growing mindfulness discourse. Journal of Occupational Science 18(4), 366-376. http://dx.doi.org/10.1080/14427591.2011.610777