Partners in Change:

Psychological and Community Services, PLLC

By Partners in Change, May 16 2019 04:29PM

Meet Lincoln and Sadie, our in-house therapy dogs in training at Partners in Change. Lincoln and Sadie have a special role in our clinic. The hard working canines are a part of our clinical team, providing affection and a sense of comfort to the clients we serve. Therapy dogs work in different settings from hospitals, schools, retirement homes and out-patient clinics, working as a team with their human.

Research demonstrates there are physical and mental benefits when including a canine friend in a therapy session. These benefits involve a release of serotonin, prolactin and oxytocin--hormones that improve mood and emotional connection. The release of these hormones helps elevate moods, lower anxiety, reduces loneliness, increases mental stimulation, and can be the ice breaker in the therapeutic process (Morrison, 2007). Lowering blood pressure and regulating heart rate are also benefits of canine companions in therapy and at home.

This is just a snapshot of the benefits of having Lincoln and Sadie join our team. We enjoy our dogs as do our clients. Although they may look like they are just hanging around greeting clients, they have a far greater impact then what meets the eye. We took some time to ask what they think of their role here at Partners in Change.

So let us introduce you to our resident therapy dogs. Lincoln, whose parents are co-owners of Partners in Change, Dr. Ann Date and Dr. Tom Olson. Lincoln is a red fox lab and he is almost 2-years old. Sadie, whose owner is Katie Fall, outpatient therapist at Partners in Change, is a West Highland Terrier that is six months old. She loves people and the other dogs. Sometimes that can be a distraction for her, but she is eager to please. We took the time to interview Lincoln and Sadie to get their perspective of their experiences at Partners and Change.

Transcript of Interview:

Question: How did you become interested in becoming a therapy dog?

Lincoln: I really didn’t have a choice unless I wanted to stay home by myself all day.

Sadie: Same here. I’m glad to tag along every day!


Question: What do you find most rewarding?

Lincoln: People petting me, playing fetch or other games, and giving me treats.

Sadie: Playing with the kids that come into the clinic because they think I’m awesome! And watching the birds outside of the big window dreaming I am chasing them all over the yard.


Question: Are you required to complete a series of trainings before you become a therapy dog? How far along are you in your training?

Lincoln: I didn’t know about certifications. My parents are not taking me to any trainings. I know to sit and lay down if they tell me to. Sometimes I will respond to “come here” but only if there isn’t something more interesting for me to do. I just like people and am easy to get along with – that’s why I’m here. I also like to chew on an occasional toy.

Sadie: I am in an intermediate puppy obedience class right now. They are trying to teach me to listen, but there are so many things to look at, it’s really hard. I have lots of canine friends in that class and they find interesting things to look at too! My owner says I have a year or so to go before I am certified. This summer I get to do a trick class and learn all kinds of fun stuff, like how to pick up a phone. I hope they teach me how to shut a door.


Question: What do you appreciate about the clients who visit the clinic?

Lincoln: I appreciate the kids who come and play with me. Also, I like adults who say nice things about me and pet me.

Sadie: I like the treats the therapists give me. I hear a bag rattle and I am on it. Whatever they want, I’ll do it. I like to play with the kids, I’m still learning to not get too excited.


Question: What would you like people to know about you?

Lincoln: I really like the beefier treats. Purina treats are okay but the treats that are made with real meat is the best. Actually, little slices of steak would be fine with me – or cheese for that matter. I’m not a big fan of fruits but I like a carrot now and then.

Sadie: I love people, but I also like to do my own thing. I tend to be independent, but in the end, I want to be good. So, sometimes I need reminding of the goal, but I was easy to potty train!

Next time you visit the clinic you may see our furry friends walk by. They are part of our family and their purpose is to provide additional support to the clients we serve.


Moorison, M.L. (2007). Health Benefits of Animal-Assisted Interventions. Complementary Health Practice Review, 12(1), January 2007, 51-62.

The Benefits of Pets for Human Health. http://www.center4research.org/benefits-pets-human-health/




By Partners in Change, Apr 9 2019 07:18PM

Many individuals experience serious mental illnesses, including Schizophrenia, Schizoaffective Disorder, and other psychological disorders in which symptoms are severe, persistent, and life impairing. Having a serious mental illness, or SMI, can negatively affect a person’s ability to communicate. For example, a person experiencing a depressive episode can have trouble concentrating on a conversation. Instead, his or her mind might wander during the conversation. Additionally, he or she might have trouble remembering important details of the conversation later. This does not necessarily reflect disinterest in the conversation or intentional disrespect toward the conversation partner. Rather, difficulty concentrating and memory impairment are common symptoms associated with major depressive episodes, which can occur during the course of some SMI diagnoses. Other symptoms that can arise during the course of SMI can also hinder communication. For example, a person with SMI may withdraw or isolate him/herself from others, have difficulty expressing his/her emotions, or display particularly intense emotions.


Effective communication can be challenging, but it is an important skill for people with SMI and those in their support networks to continuously develop. Effective communication can reduce frustration and stress for both a person with SMI and supportive others, which is important as increased stress can increase psychological symptoms in a person with SMI and burnout in a supportive other. Effective communication can also strengthen bonds between a person with SMI and a supportive other, which is crucial as the consistent support of others can positively influence a person’s mental health recovery.


Here are some tips to improve communication:



1. Eliminate or minimize distractions when having a conversation. Concentration difficulties occur in many psychological diagnoses, but concentration can often be improved if fewer distractions are present. If a person is engaging in an activity, be sure to ask if this is a good time for a conversation. If it is a good time for a conversation, turn off the television, put aside the smart phone, find a quiet place, and devote your attention fully to the conversation for the duration of the conversation.


2. Pay attention to both verbal and non-verbal forms of communication. One symptom of some SMI diagnoses is called flat affect, which means that a person might not show emotions in facial expressions. Alternatively, he/she might display an emotion that is different from the emotion that he/she is describing. For example, a person with Schizophrenia might say that she is very sad, but smile or laugh as she speaks about what is triggering her sadness. After your conversation partner finishes expressing his/her thoughts, summarize what you believe was the message and give your partner a chance to correct any misunderstandings. For example, you might say, “I want to be sure that I understand what you’re saying. You said that you’re sad because you just heard that a friend passed away. Did I understand you correctly?”


3. If a person is experiencing psychological symptoms, keep communication simple, clear, and brief. If you are asking questions, ask them one at a time and give your partner a chance to respond before asking another question. If you are providing directions or instructions, provide them one step at a time, if possible. If you are making a request, make one request at a time and allow the person to complete the request. Be prepared to break a large request into more manageable steps. For example, a request to complete a chore like cleaning the kitchen requires many steps. You might break that large request into smaller steps by saying, “I would really appreciate your help cleaning the kitchen. Let’s start with the cabinets. Could you dust the cabinets, please?”


4. Allow for pauses in the conversation to give your conversation partner a chance to process what you have said and ask questions or respond to you. Sometimes a person with SMI may need a little extra time to collect his/her thoughts or to find the words to express a message. Prior to engaging in the conversation, be sure you have time to spend in the conversation without rushing it.


5. Be polite and respectful during the conversation. For example, do not interrupt, assume you know what your partner will say and therefore finish your conversation partner’s sentences, or talk down to your partner. Instead, demonstrate your care and support for your conversation partner by making eye contact, showing interest with your body posture (e.g., sitting forward attentively with your arms open in your lap rather than reclining with crossed arms), and listening to what your partner is saying rather than planning what you want to say next.


Using good communication skills on a regular basis with a conversation partner with SMI increases the likelihood that both you and your conversation partner will feel understood and that your partner will incorporate the skills you demonstrate into his/her own communications. If you are making requests using good skills, it is also more likely that the conversation partner will complete the request. Sometimes, however, communication with a person with SMI who is experiencing active psychological symptoms can be very difficult, as in the instance of trying to understand a person experiencing mania who is speaking very quickly about many different topics. If you notice that communication with a loved one with SMI is consistently difficult, bring your concern to the attention of your loved one and work together to determine if extra support is needed. Sometimes communication difficulties can signal that a person’s mental health is declining. For example, increasingly hostile or irritable interactions with a loved one with SMI might indicate that he/she is experiencing increased mood symptoms, which is important information for the treatment team. Members of your loved one’s treatment team, such as a case manager or therapist, can help you troubleshoot and might be able to offer personalized communication skills to practice.



By Partners in Change, Apr 9 2019 02:50PM

Pain can be excruciating. It can push us to the point of begging for mercy and crying out in desperation for relief. Throughout our human experience, pain will be present to varying levels of severity and frequency. We are injured, we have pain, and we heal. But what about pain that seems to stick around long past an injury? Or pain that appears in the absence of any pathological tissue damage? Chronic pain is a challenge for many Americans today. Of those suffering from chronic pain, the overwhelming majority do not have clearly, identifiable structural damage. Studies show that 85% of chronic back pain, 90% of pelvic pain syndromes, 98% of headaches, 99% of fibromyalgia, and 99% of irritable bowel syndrome is brain induced- meaning without evidence of any pathological tissue damage (Deyo et. Al. 1992; Kroenke, 2003). This does not presume that this pain is not real or one has the simple choice to no longer experience it, but rather that the experience of pain is most often a result of learned neural pathways in the brain.


In 2011, The Institute of Medicine put out a Report titled “Relieving Pain in America” giving us some significant insight into pain and how we treat it. The report found that 100 million Americans suffer from chronic pain- more than cancer, diabetes, and heart disease combined. It also shockingly found that none of the pain treatment options currently in use are actually working. Things like pharmacological agents, surgery, steroid injections, and implantable drug delivery systems are not found to be curing pain. Recent studies show that opioids are no better than Tylenol for chronic pain (Krebs EE, Gravely A, Nugent S, et al. 2018). There are no studies showing that surgery is more effective for low back pain than physical therapy, stretching, or doing nothing and waiting it out. Even injection therapies are found to be no more effective than placebo (Chou et. Al. 2009).


Perhaps even more surprising are findings from a study published in 2014 by Waleed Brinjikji from the Mayo Clinic in which MRI’s conducted on completely healthy individuals with no reports of any back pain show that 52% of 30-year-old’s and 80% of 50-year-old’s have disc degeneration. Further, 40% of 30-year-olds and 60% of 50-year-olds have bulging discs. There are no studies that find any significant connection between the experience of pain and MRI results and although bulging disc and disc degeneration are a normal aspect of aging, they are not stand alone in causing pain.


How does pain work in the brain?

Our brains construct our experience of pain. Touching a hot stove inherently does not give us the experience of pain- our brains do that. When an injury occurs, it sends a signal to the subconscious, automatic parts of the brain. The brain decides if there is a need to activate the danger/alarm signal thus resulting in pain. Emotional pain activates this same danger/alarm mechanism which can activate physical pain. All pain is a conscious message from the brain; the message could be that our leg is broken or it could be that something in our life needs attending to.


Once pain occurs it becomes a learned neuropathway in the brain. This becomes a vicious cycle as the pain itself can further activate the danger/alarm mechanism increasing our experience of pain. This is a cycle of chronic or recurrent pain learned by the brain. This works the same as when we learn how to walk or ride a bike- it becomes automatic. Also influencing our pain experience is the way we respond to our pain. That is the more we think about it, monitor it, avoid it, fear it- the stronger these pain pathways in the brain become.


What is missing in our standard treatment of pain?

It is the connection between the mind and body. The understanding that emotional injuries activate and process through the same systems in the brain as a physical injury. One study demonstrating this was done by the University of Michigan using functional MRI scanning to explore the experience of physical vs emotional injury (Kross, et. Al. 2011). Their findings confirmed that physical pain and emotional pain are experienced in exactly the same patterns in our brains. Studies like this show us that emotional pain can lead to physical pain and vice versa.


Further establishing the understanding that emotional injuries activate and process through the same systems in the brain as a physical injury are the multitude of findings related to the impacts of stress on health. Economic uncertainty has been found to greatly increases the psychological sensitivity to physical pain (Chou et. Al 2016). We also know from the widespread ACE Study looking at lifelong impacts of 10 highly stressful adverse childhood experiences (parental separation, witnessing domestic violence, physical sexual or emotional abuse, physical or emotional neglect, a family members incarceration, and a family member struggle with addiction or mental health) that there is a direct connection to early childhood stressors and lifelong physical health and pain. People with 4 or more of these experiences are 3 times as likely to suffer from multiple bodily symptoms, twice as likely to be obese, twice as likely to have emphysema, and on average died 20 years younger (Felitti, et. Al. 1998). Sometimes even decades after some of these stressful childhood experiences, there can be lasting effects on health and physical pain. These above-mentioned childhood experiences are elevated in people with fibromyalgia, migraine headaches, interstitial cystitis (painful bladder), pelvic pain, and irritable bowel syndrome (Goodwin, et. Al. 2003; Sumanen et. Al. 2007; Latthe et. Al. 2006; Meltzer-Brody et. Al. 2007 ; Mayer et. Al. 2001).


The research confirms that the mind and body are living together and a significant proportion of pain is brain induced. It confirms that the brain constructs all pain as a protective mechanism through various neuropathways. Stress and emotions activate the danger alarm mechanism in the same way physical injury does and for many this results in a vicious cycle of chronic pain. Equally important to note is that recovery from pain is possible. Reversal can occur with educational, cognitive, behavioral, and affective interventions.


What happens next?

It is first necessary to identify if symptoms are caused by a structural disorder or by neural pathways in the brain with thorough medical examinations. If no structural damage can be identified, attentions turn to treating neuropathic pain. This new paradigm recognizes that while the pain is both real and powerful, it is a result of neural pathways in the brain. Pain is a prevalent, unavoidable part of the human experience and treatment is available.

References


Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36, 811–6.


Chou R, Atlas SJ, Stanos SP, Rosenquist RW. (2009). Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 34(10):1078-1093.


Chou, E. Y., Parmar, B. L., & Galinsky, A. D. (2016). Economic Insecurity Increases Physical Pain. Psychological Science, 27(4), 443–454. https://doi.org/10.1177/0956797615625640


Deyo RA, Rainville J, Kent DL. (1992). What can the history and physical examination tell us about low back pain? JAMA. 268(6):760-765.


Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS.(1998)Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE)Study. Am J Prev Med.(4):245-58. PubMed PMID: 9635069.


Goodwin, Hoven, Murison & Hotopf, 2003; Sumanen, Rantala & Sillanmaki, 2007; Latthe, Mignini, Gray, hills, & Khan, 2006; Meltzer-Brody et al., 2007; Mayer, Naliboff, Chang & Coutinho, 2001. Childhood adversities (divorce, family conflict, sexual abuse, physical abuse etc.) and adulthood experiences of conflict and victimization are elevated in people with migraine headaches, internal cyctitis (painful bladder), pelvic pain, and irritable bowel syndrome.


Krebs EE, Gravely A, Nugent S, et al. (2018) Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. JAMA. 319(9):872–882. doi:10.1001/jama.2018.0899


Kroenke, K. (2003). Patients presenting with somatic complaints: epidemiology, psychiatric co-morbidity and management. Int. J Methods Psychiatr Res. 12: 34–43.


Kross, E., Berman, M.G., Mischel, W., Smith, E.E., & Wager, T.D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences of the United States of America, 108 15, 6270-5 .


IOM (Institute of Medicine). 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press.



By Partners in Change, Apr 5 2019 01:36PM



Anxiety can be a healthy emotion. It can help us focus on work that we need to accomplish, it can help us remember to bring our lunch to work or anxiety can motivate positive behaviors such as studying for that upcoming test. Other times anxiety develops that is beyond the scope of normal or healthy.

Developmentally, toddlers may worry about fear of imaginary creatures or the dark or have mild-moderate reactions to being separated from a care giver. In school-age children, “healthy worry” is generally focused around concerns about natural events, school performance or specific big events in the future. As children grow-up and become adolescents, concerns often continue about school performance, fitting in and overall health. All of those worries are completely age appropriate and often manageable with brief intervention like deep breathing, taking a brief break or talking to a trusted friend or family member. Children have different tools than adults to face day to day challenges when anxious, therefore it makes sense that the signs and symptoms that indicate a child is experiencing anxiety may be slightly different as well.


Clinical Anxiety occurs when these worries begin to take up a disproportionate amount of the child’s mental or physical energy. This is more common than you might think. Anxiety related symptoms are some of the most commonly reported symptoms in adults and Anxiety Disorders are some of the most common psychiatric disorders diagnosed for children according to a report by Merikangas et al (2010). Despite this fact, many people experience clinically significant anxiety that is undertreated, under recognized or misdiagnosed. An estimated 80% of children who meet criteria for an anxiety disorder are not receiving suitable treatment (Merikangas et al., 2011).


One of the difficulties is that many children may not recognize their fears and worries are unreasonable and, especially if they are younger, may struggle to communicate exactly what they are feeling. It’s important to review the physical symptoms your child is having (i.e. headaches, upset stomach, diarrhea, sleep disturbance). Many children growing up with chronic anxiety are very attuned to their body’s response, sometimes overly so. In many cases, the parent’s response to these symptoms may help the child to label the feeling as anxious/worry. Labeling these feelings alone can sometimes help reduce the uncomfortable sensations. You might notice your child becoming preoccupied with thinking about an upcoming test or starting to withdraw from talking to teammates at a game. Helping them to understand what they’re experiencing is the first step to developing healthy coping skills. It is also your first clue in distinguishing between typical worry and clinical anxiety.



Anxiety in Children: How Can You Help?

Other non-verbal signs a child is experiencing anxiety are: excessive need for reassurance, persistent restlessness or fidgeting, inattention and poor school performance, chronic forgetfulness, losing things, explosive outbursts, pre-occupation with routine or change in eating.


Anxiety is believed to be caused by the interaction of many factors including childhood adversity, stress, or trauma and genetic predisposition. Risk factors to developing anxiety disorders include children who are behaviorally inhibited, what we might think of as shy and non-adventurous, having poor relationship(s) with caregivers and having a parent that has high levels of anxiety.


Clinical criteria that your provider or therapist may be watching for that indicates the presence of Generalized Anxiety Disorder include:

-Chronic, excessive worry in a number of areas with at least one associated with somatic symptoms

-Worry is most often present and not limited to a specific situation or object

-The thoughts are difficult to control and cause impairment in social, occupational or other areas of functioning like avoiding people or places that are linked to the thoughts

-Upsetting thoughts/feelings occur for more days than not and for at least six months


Generalized anxiety disorder is only one type of many that children and adults may experience. To more clearly diagnose anxiety disorders or if you have concerns that your child is experiencing symptoms like mentioned above, please speak a doctor or a mental health provider.


Treatment

The most successful, non-medication based, approach to treating anxiety in children is cognitive behavioral therapy (CBT) (Walkup et al., 2008). The CBT approach is used to help mediate and eliminate anxiety’s pesky symptoms. It involves increasing a person’s awareness of their thoughts, the connection of thoughts with body and emotion responses. Skill are developed in and out of the therapy room to directly manage the body’s response or challenge the mind’s process. For children, this may involve the use of feeling thermometer, games that explore how feelings are experienced or expressed, etc. Medication may be prescribed by physicians in cases of more severe anxiety symptoms. A combination of medication and therapy research has shown has an ~80% effectiveness in treating symptoms to below clinical levels within 3 months (Walkup et al., 2008). Research suggested reducing medication after remission of symptoms within 6- 12 months (Bandelow, Michaelis & Wedekind, 2017).

Anxiety in children can be as difficult for the child and family members as the work it takes to manage the symptoms of a physical medical condition. Talking with a medical provider and mental health professional can help you and your child develop the tools needed to better manage your child’s anxiety.


References

Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9.


Bandelow, B., Michaelis, S., Wedekind, D. (2017) Treatment of anxiety disorders, Dialogues Clin Neurosci. 19(2): 93–107.


Merikangas, K., Hep, J., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., Benejet, C.,…Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). Journal of American Academy of Child and Adolescent Psychiatry. 49(10): 980-989. doi: 10.1016/j.jaac.2010.05.017


Merikangas, K. R., He, J., Burstein, M. E., Swendsen, J., Avenevoli, S., Case, B., … Olfson, M. (2011). Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45. doi:10.1016/j.jaac.2010.10.006


Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., … Kendall, P. C. (2008). Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety. The New England Journal of Medicine, 359(26), 2753–2766. doi:10.1056/NEJMoa080463


Image Source: https://www.socialworkhelper.com/2017/09/05/anxiety-children-can-help/




By Partners in Change, Mar 7 2014 06:55PM

“We are what we think. All that we are arises with our thoughts. With our thoughts we make the world.”

— Sakyamuni Buddha, The Dhammapada 1:1, Trans. Thomas Byrom


Meditation and mindfulness training have been linked to improvement in mental and emotional health. New research has shown that meditation improves positive functioning long after meditation has ended (Pedersen, 2013). These results support the overarching hypothesis that meditation may result in “enduring, beneficial changes in brain function, especially in the area of emotional functioning,” (Pedersen, 2013).


Long term practice of mindful meditation results in reduced emotional reactivity and increased experience of compassion for others (Pedersen, 2013). Researchers also believe that meditation is the key in helping to ease the need for pharmaceutical drugs as well as dependency on drugs and alcohol. Mindfulness meditation has also been linked to regulate “brain rhythms” in ADHD and other disorders (Pedersen, 2013). The 8-week Mindfulness-Based Stress Reduction intervention has been shown to “alter functional neural responding to affective tasks in healthy individuals,” (Kilpatrick, Suyenobu, Smith, Bueller, Goodman, Creswell, Tillisch, Mayer & Nailboff, 2011).


What exactly is mindfulness? Some of the more common definitions describe mindfulness as “intentionally directing attention toward the present moment and adopting an accepting, nonjudgmental, and/or nonreactive orientation, intent or attitude,” (Lykins, 2009). Mindfulness developed out of eastern spiritual ideologies and has seen exponential growth in the clinical doman in recent years (Lykins, 2009). People who practice mindfulness and meditation report a reduction in suffering and increases in “awareness, insight, wisdom, compassion and equanimity,” (Lykins, 2009).


At Partners in Change we offer an 8-week mindfulness based stress management group. This type of therapy helps the client to better understand the practice and to learn the tools needed to incorporate mindfulness and meditation into their everyday life.


Mindfulness for stress management can help people who have stress-related diseases like anxiety, depression and addiction, as well as physical diseases, like heart problems or cancer (Neale, 2006). Using this approach in addition to other forms of clinical or pharmaceutical treatment can have a positive impact on healing (Neale, 2006).




Kilpatrick, L. A., Suyenobu, B. Y., Smith, S. R., Bueller, J. A., Goodman, T., Creswell, J. D., Tillisch, K., Mayer, E. A. & Nailboff, B.D., (2011). Impact of mindfulness-based stress reduction training on intrinsic brain connectivity. NeuroImage, 56, 290-298.


Lykins, E.L.B., (2009). Effects of mindfulness and meditation experience on cognitive and emotional functioning and ego depletion. College of Arts and Sciences, University of Kentucky. Retrieved from http://0-search. proquest.com.catalog. lib.cmich.edu/docview /915547639?accountid= 10181. (915547639).


Neale, M.I., (2006). An integration of perspectives from buddhism, science and clinical psychology. California institute of Integral Studies. Retrieved from: http://0-search.proquest.com.catalog.lib.cmich.edu/docview/622013745/14349279B52227E03A1/1?accountid=10181


Pedersen, T., (2013). Meditation’s effects on emotion shown to persist. Psych Central. Retrieved from: http://psychcentral.com/news/2013/06/23/meditations-effects-on-emotion-shown-to-persist/56372.html