May 18, 2015

Why Wilderness?

Diane Ryan, Mirasol Executive Director, in climbing gear

The first time I took Mirasol clients camping, there was widespread anxiety about the trip. One client in particular was worried about the tents, the sleeping bags, the wild animals, the bathroom situation … every question answered triggered another a new concern! She was very quiet on the ride to the camping site, and I wondered whether she would be able to relax and enjoy the experience. After we set up camp and began exploring the area, she found me collecting wood for the fire. I anticipated another round of questions, but instead she just grinned and said, “You know, it’s weird, but this is the most like myself that I’ve ever felt!”

That incredibly gratifying experience has reoccurred many times, as clients encounter themselves in unfamiliar environments and experience a fresh perspective that might only be achieved after months or years of traditional therapeutic interventions. Almost by definition, eating disorders arise from an individual’s inability to connect with the self and with others.

The limitless ability of the natural world to both challenge and soothe presents opportunities to grow new relationships, and make wilderness interventions a natural fit for both adolescents and adults in treatment (Caulkins, White and Russell, “The Role of Physical Exercise in Wilderness Therapy for Troubled Adolescent Women”, Journal of Experiential Education, March, 2006).

The goal of experiential interventions is to create opportunities for engagement in the healing process. Wilderness therapy with its remote location and intentionally primitive conditions, promotes therapeutic interactions, social connection and leadership development and fosters interdependence, awareness, openness, personal responsibility and self-reflection. Within this context, therapists encourage, reinforce and assist the client in processing these changes both individually and in groups.

This theoretical approach is based on the assumption that behavior change occurs when direct experiences are applied in a challenging environment. Wilderness is used as an instrument to quickly and effectively impact individual decision-making. It provides the opportunity for physical and emotional shifts while uncovering maladaptive behaviors that may interfere with recovery (Kessell, M. J., “Women’s adventure group: Experiential therapy in an HMO setting”, Women and Therapy, 15(3-4)).

Your Brain On Wilderness

Challenge courses, hiking and other outdoor activities have always been part of Mirasol’s eating disorder treatment program. But in 2006, Ryan began adding wilderness experiences including camping and even caving. The response from clients and staff was overwhelmingly positive. More importantly, EEG brain maps and standard psychological tests demonstrated significant decreases in symptoms of anxiety and depression.

“There was a significant improvement in brain functioning for most participants, especially in the beta waves that are generally associated with anxiety,” says Ryan. Most clients also reported a decrease in symptoms of depression and an increase in their ability to cope with stress, as measured by a Children’s Depression Inventory (CDI) and Coping Skills Inventory (CSI) administered before and after the camping trips.

The visible transformation that occurs during Mirasol’s adventure therapy program is a huge source of inspiration to clients and their families as well as Mirasol staff. Ryan recalls another experience with a severely depressed adolescent client:

“She had only been with us a few weeks, and she wasn’t doing well. She refused to eat, and we considered transitioning her to another program where she could receive a higher level of care.
We were all surprised when she agreed to participate in a weekend camping trip that we had planned for her last weekend at Mirasol. And then almost hour by hour, she began to lighten up, talk to other clients and participate in group activities. By Sunday, she came to me and said she wanted to stay at Mirasol, and, for the first time, she told us she wanted to get better. She began following her meal plan, and although she continued to struggle, she never returned to that dark place where she had been before the camping trip.”

The limitless ability of the natural world to both challenge and soothe presents opportunities to grow new relationships, and make wilderness interventions a natural fit
for both adolescents and adults in treatment.

Mirasol recently expanded its eating disorder treatment programs to include backpacking. So far as we know, no other eating disorder treatment program offers backpacking, despite the proven efficacy of wilderness therapy for troubled adolescents. We’ll be offering — weather permitting — bimonthly two- and three-day trips, taking advantage of Arizona’s wealth of impossibly lovely wild public lands. Each trip includes a 50-50 split of medically- and emotionally-appropriate clients and the clinical staff required to ensure their safety and support them in their journey.

Photo of women backpacking in Aravaipa Canyon

May 5, 2015
Marion MacDonald

First Backpacking Trip with Mirasol Clients

trail-bossThere were those of us — myself included — who doubted it would be possible to incorporate backpacking into a residential eating disorder treatment program. Executive Director Diane Ryan, Admissions Director Carol Magee and I began talking about expanding Mirasol’s adventure therapy program to include backpacking in October, 2014. The challenges seemed overwhelming. First of all, since clients obviously don’t come to treatment outfitted for backpacking, we needed to purchase all the equipment from tents, sleeping bags and sleeping pads to flashlights, hiking poles and utensils. Over the next six months we patrolled eBay and Craigslist for good used equipment, and picked up additional items at sales. Friends got wind of the project and stepped forward with gear to loan or donate.

We took a leap of faith and purchased 10 wilderness permits in January. The timing was tricky, since we needed to make sure that any clients participating in the program were medically and emotionally stable and that they had arrived at a point in their treatment where a wilderness experience such as this could provide a significant boost to their recovery.

Of course the biggest challenge was the food. In retrospect, it’s hardly surprising that food would be an issue for an eating disorder treatment program. But I had not anticipated the difficulty of balancing the need to comply with each client’s carefully tailored meal plan with the need to maintain pack weight and bulk appropriate for a beginning backpacker. Our heartfelt thanks go out to Chef Dee O’Leary, who went way above and beyond the call to prepare hearty, backpack-friendly meals and snacks for our brave beginners!

The day before the hike was pandemonium, while we packed and repacked between checking the weather and trying to figure out how to transport staff and gear from three locations to a single departure point. We were nearly two hours behind schedule when we set out Thursday morning, but it was a gorgeous spring day with temperatures in the mid-70s and a cloudless sky.

Over the next three days, we shared the magic of a sparkling stream that threads its way between walls of red conglomerate and yellow volcanic tuff in the Galiuro Mountains. There’s no real trail, so we wandered back and forth across the stream in the shade of giant Fremont cottonwoods and Arizona sycamores. We made camp on a sandy beach where there was a nice deep pool warm enough for a refreshing dip and with sun-baked rocks where we could stretch out like the many lizards we saw along the trail.

Evenings we shared our experiences from the day and stories of how we all came to be huddled around a crackling campfire deep in a canyon in the heart of southern Arizona.

I cannot say enough good things about the hard work and dedication of Executive Director Diane Ryan, Primary Therapist Katie Klein and Counseling Assistant PeiDong Zhang, who provided loving and tireless support to all the members of our group.

Only time will tell if this daring experiment produces lasting results. But the obvious delight of the clients who participated was an inspiration to us all.

As one of them remarked, “I always wanted to experience an outdoor adventure like this, but I didn’t think I could. Now I have the confidence to continue exploring my own.” May that confidence stay with you and sustain you and you move forward in your recovery!

Thanks for a memorable weekend, and a very big “wu gong*” to all of you!

*”Wu gong” became our favorite all-purpose expletive after PeiDong identified a large scary bug using his digital dictionary. For example, you might exclaim, “wu gong!” if a giant centipede was crawling down your back.

Apr 23, 2015

Wilderness: A Powerful Intervention in the Treatment of Complex Trauma

photo of Mirasol clients backpacking by a stream in a canyonWilderness therapy is proving to be a powerful intervention in the treatment of complex trauma. Several of the unique features of adventure therapy address the dis-regulation that occurs in the individual’s neurological process from varying degrees of attachment rupture. Wilderness can directly impact resiliency by providing clients with the opportunity to access a sense of safety in a novel way.

Adventure therapy often inspires a high degree of perceived risk or threat, similar to the heightened awareness that accompanies complex trauma. Moving through the experience with peers, solving problems, receiving feedback and practicing neural self-regulation allow participants to develop confidence and a set of skills that translate directly into real-world recovery.

In this setting, the opportunity to connect appropriately, challenge old beliefs, receive support and relate to others allows clients to move forward and deepen their commitment to their own process. Clients are both responsible for their own process and for the experiences of their peers.

Kinesthetically, the physical engagement of the activities encourages clients to develop a new appreciation for, and connection to, their bodies. The immediate need to fuel and care for the needs of the body creates new opportunities for clients who have been emotionally divorced from their physical selves. Nature provides a continuous backdrop of beauty, challenging and nurturing clients to a deep sense of belonging.

Adventure therapy has been shown to increase the effectiveness of other therapeutic interventions, and to improve receptivity to treatment in general. Mirasol is excited to continue the exploration and research of wilderness therapy as a potent intervention in the treatment of trauma and eating disorders.

Watch the video of Mirasol’s first backpacking trip with clients

Apr 22, 2015
Andréa Copeland

QEEG Neurofeedback in the Diagnosis and Treatment of PTSD

Andrea CopelandQEEG guided neurofeedback has given us the ability to diagnose and treat serious disorders such as PTSD through concrete evidence of neural activity.

Post Traumatic Stress Disorder (PTSD) may occur in individuals who have been victims of traumatic events that are outside the range of our usual human experience. The trauma may be the result of physical or sexual abuse, serious accidents or combat. Individual who suffer from PTSD often live in a world of extreme hyper-vigilance, anxiety, and isolation and may suffer from disturbing nightmares and flashbacks.

Conventional treatment for PTSD typically involves long-term psychotherapy and continuous use of medications that may mask symptoms rather than addressing the root cause. All too often, clients become discouraged and end therapy prematurely before they are truly able to resolve their trauma and recover a sense of safety and contentment. This is where QEEG guided neurofeedback comes in, by locating and addressing the areas in the brain that are not preforming optimally.

Neurofeedback can be used to display a continuous stream of information from the client’s brain. This information is shared with the clients, so that they can train themselves to achieve a more desirable state of being. Knowing they can learn to relax themselves at will provides a tremendous sense of empowerment. As a result they will also notice they are able to rest easier and feel calmer and more confident.

Neurofeedback for PTSD typically consists of 20 to 30 training sessions. During these sessions, clients may begin to recall forgotten details about the traumatic events that caused the disorder. They develop a new ability to tolerate these memories due to improved emotional resilience and sense of ease offered by neurofeedback training.

Neurofeedback can also be used in conjunction with other treatment modalities to measure their effectiveness and determine what types of treatment are most effective for the client.

For more information, see High Tech That Heals: The Use of Neurofeedback in the Treatment of Eating Disorders

Apr 21, 2015
Marion MacDonald

Treating Eating Disorders with Co-Occurring Trauma and PTSD

In this video interview, Executive Director Diane Ryan and Trauma Therapist Ann Twilley describe how and why Mirasol Eating Disorder Treatment Centers developed its specialization in treatment of eating disorders with co-occurring complex trauma and PTSD.

“Years ago most eating disorder treatment centers — Mirasol included — did not include trauma as part of their treatment programs. In fact, people were turned away if they reported significant trauma before we admitted them,” says Ryan.

“So it became evident that that was not going to work, we were not going to be able to take care of people if we weren’t willing to address the traumatic issues in their lives because it was too closely tied in with the eating disorder.”

Ann Twilley, trauma therapist and prior director of Mirasol’s aftercare program, observed the same phenomenon.

“When we were trying to work on the eating disorders, we kept bumping into the trauma, so we absolutely had to do something different,” says Twilley, “and we knew that treating the symptoms wasn’t working, so we had to treat the underlying issues, and a lot of that was about trauma.”

Most treatment centers use a variety of narrative therapies for trauma treatment, but Mirasol clinicians do not believe that this is the most effective strategy.

“We found that people telling their story in a group or even in an individual setting was really re-traumatizing,” says Ryan, ”so we needed to find another approach.”

Twilley notes that many Mirasol clients had already experimented with cognitive behavioral therapy or cognitive behavioral therapy, but it hadn’t worked for them. “It wasn’t sufficient, it wasn’t deep enough work for them, and so that’s how we started going where we went.”

“The gold standard for trauma treatment has always been EMDR (Eye Movement Desensitization and Reprocessing), so that was the first training that we pursued,” says Ryan, “and since we at Mirasol have always emphasized experiential therapy and believed in healing through the body, we then pursued training in some somatic therapies as well.”

“There are a lot of ways you can address trauma through wilderness therapy and similar experiential interventions such as psychodrama, so we began putting more emphasis on training in those areas.”

Over the next several years, Mirasol clinicians obtained training in not only EMDR, but also EFT (Emotional Freedom Techniques) and TRE (Tension and Trauma Release Exercise).

“EFT is something that can be really self-empowering for the client because we can teach the skill,” says Twilley, “and we offer a monthly online alumni group that has been very supportive for clients years after they complete treatment at Mirasol.”

The additional trauma modalities complemented Mirasol’s already comprehensive integrative eating disorder treatment program including polarity therapy, Reiki, cranial sacral therapy, acupuncture, dance-movement therapy, yoga, adventure therapy and neurofeedback.

And tying it altogether, according to Twilley, is Mirasol’s pioneering work in neurofeedback.

“Neurofeedback is the science that supports a lot of the work that we do. Neurofeedback shows us that the client’s brain is changing. That’s really exciting for them to see, and really exciting for us to see.” Neurofeedback can be used in conjunction with other treatment modalities to measure their effectiveness and determine what types of treatment are most effective for the client.

“We’ve developed a strategy that really works for just about any client in terms of teaching them how to master the reactions of their own nervous systems,” according to Ryan.

She notes that Mirasol has recently expanded its adventure therapy program to include backpacking.

“A lot of research has been done about wilderness and what happens in the wilderness to people who have been traumatized, so this creates yet another way to address trauma in a way that is safe and supported and that helps them heal.”