Mindfulness without Borders – trauma adapted mindfulness for displaced people
Trauma isn’t the only consequence of the refugee experience but this is often the first word we hear when we read about people who have fled their countries of origin.
However we also know that resilience, courage, and even “adversity activated development” (Papadoplous, 2017), the extraordinary effect of personal growth, are also common in the face of displacement, violence and the struggle of adapting to new host countries. The literature around refugee experience often focuses on the devastating events that led to flight. This is where the trauma discourse takes hold and becomes the dominant narrative. However the ongoing stress of assimilation and adaptation are often the silent but chronically fertile ground for physical and mental ill health in this vulnerable population.
In 2015 and 2016 we saw an unprecedented mass migration of people fleeing war and poverty landing on European shores – a unique event in modern times. What constitutes appropriate help is an ongoing challenge for NGOs and social and health providers, with no obvious answers. In fact the field is beset with problems including lack of funding, limited resources and overlapping service provision (Wessels, 2009). It is notoriously difficult to provide sustainable and effective psychosocial support for this population (Karpuk and Kaur, 2016). As a result well meaning programmes can inadvertently result in unintended consequences that do more harm than good and in the worse cases leave people further traumatised and disempowered.
So how does this connect to mindfulness?
As mindfulness teachers and psychotherapists we asked ourselves whether a trauma adapted mindfulness skills training could offer a new approach to the reduction of stress and improvement in the well-being of displaced people.
With funding from OMC we set out to explore this question and develop a small scale study to investigate the possibilities. Chronic enduring fear and uncertainty, the lack of security and having no safe place to call home take their toll. In conversations with asylum seeking people we heard that they often endure microaggressions and sometimes inhuman treatment in their host communities. In all these circumstances survival mechanisms designed to cope with threat are activated in the body/mind. “Fight, flight, freeze” responses produce hyper aroused states that can remain chronically “switched on”.
In 2016 very little literature or research around trauma adaptations to mindfulness courses existed. In developing Mindfulness without Borders we looked to integrate our knowledge of current trauma and attachment based theory and practice with existing evidence based mindfulness curricula to produce a working model. Deidre Fay’s work with survivors of domestic violence features the central task of becoming “safely embodied” and we followed her lead in offering grounding practices and safe place guided visualisation to create a starting place for introducing titrated and modified mindfulness practices. Mindful movement is often more accessible than breathing and body scan practices and so we introduced this early on in the programme (Emerson, 2015).
“The most important lesson was learning to relax without distractions. I have been doing the breathing and relaxing exercises every night and this has helped me to go to bed early. Previously I had suffered from insomnia and could not get my mind to settle so I could fall asleep. As a result I was waking up tired and very irritated. The course has helped me relax, and set a good bedtime routine. My little one has benefitted the most as I have more energy and patience when I engage with him.” Course Participant, 6 week course
We were also concerned with working together with participants in genuinely collaborative and non-oppressive ways to co-produce a curriculum and course that fit with individuals expressed needs. Rhonda Magee (2017) stresses the importance of attending to our own positionality, recognising identity based inequalities and biases. Drawing on complexity theory we adopted a ‘loose fit’ approach enabling the flexibility to be responsive to issues of language, meaning and need: for belonging and community, for peaceful space free of the burden of childcare, for nurturing and sharing, as well as for learning mindfulness skills.
Following a first iteration of 4 x 6 week courses we build on feedback and increased the length of the course to 10 weeks which is consistent with trauma informed approaches to therapy, establishing a safe context, allowing people to self select in and slowly develop skills through repetition of short practices.
“We learn how we can balance in life how we can relax when we are very stressed” Course Participant, 10 week course
We used drawing as a means of inquiry following practices and collage for exploring The Guest House and a Letter to Self. Using art and craft allowed participants to explore ideas about how to meet and approach experience in a non intrusive and mindful way. We provided food in all the sessions as well as creche facilities. This seemed to us essential not only to improve accessibility but as part of creating conditions that would facilitate and enable participation. Sharing food is also a bonding ritual in most cultures and In the final session women contributed to a meal as part of a celebration of the ending of the course.
“Because in our culture all of us we eat together most of the time, when we eat here together remind us back home this is why most of us like it because we have lost our family, there everybody is joined together … doesn’t matter what we eat but meaning is done is better we are together, feelings good, sharing is good, now our mind is fresh.”
Themes raised in the final feedback focus groups of the 10 week courses included the following points:
- Creche provision is essential for many women to participate,
- English language only was not an insurmountable barrier, imagery and enactment helped with understanding and people liked the added benefit of practicing English
- Having a women only group was important for safety and connection.
Principle concerns included safety, community, and choice and adaptations were as follows:
- Modified shorter practices with embedded language around safety
- Pacing and placing of practices within the 10 week course
- Specific practices for safety and soothing –the safe place meditation, grounding exercises, vagus nerve breathing space – practices drawn from trauma and attachment theory and polyvagal theory – incorporation of understandings into the practices
- Movement as a central mindfulness practice
- Visual imagery for anchoring learning points
- Psychodrama and enactment to illustrate CBT concepts
- Art and creative exercises as an additional tool for processing and in Inquiry
- Women only group
This work has raised a number of questions for further exploration:
- Funding: How do we engage stakeholders, funders, and government in supporting mindfulness initiatives for refugee and asylum seeking populations? (what is the social capital gained in supporting asylum seeking and refugee communities to flourish? )
- What further considerations are needed in this work?
- How can people be truly part of the design of the course? What are participants saying they need and can we respond flexibly?
- How can we effectively support mindfulness teacher training for people coming from within the communities we are working with? What is needed here? We will be making available all resources in the form of the curriculum we developed for the 10 week course as open source. Please contact Ariana or Sheila at email@example.com
Ariana Faris and Sheila Webb
Emerson, David ( 2015) Trauma-Sensitive Yoga in Therapy: Bringing the Body Into Treatment W. W. Norton & Company,
Fay, D ( 2014) Becoming Safely Embodied Skills Manual
Magee, Rhonda workshop Mindfulness and Social Justice OMC 2017
Karpuk D, & Kaur R ( 2016) Integrating Multiple realities: A systemic Action Research in the context of Mental Health System for Refugees and Asylum Seekers in Leeds, Human Systems issue 3 vol 27 P 217 – 234
Papadopolous R.K. (2016) Strangers and Homes, Trauma and Disorder, Distress and Resilience . Presentation at Welsh Psychoanalytic Association Conference day Strangers in our Midst, Cardiff October 2016
Wessells, M.G. (2009) Do No Harm: Toward Contextually Appropriate Psychosocial Support in International Emergencies American Psychologist 842-852