The Mindful Path to Communication: Enhancing Therapy and Reducing Stress with Dr. Angela Medina

I am very excited to share with you my conversation with Dr. Angela Medina, an innovative clinician and researcher at Florida International University.  I am sure all of us have felt the detrimental effects of stress to the therapeutic process, It can be within us, within those that we serve in the therapy room, and in the support system of individuals with communication challenges.  That’s why I was really intrigued when I encountered Angela’s work on the intersection of mindfulness and communication disorders. I reached out to her and am so thankful she agreed to share her time with us. During our conversation Angela talks about her personal journey of integrating mindfulness into speech therapy, detailing its benefits not only for individuals with various communication challenges but also for clinicians. Angela gives us practical applications that can be seamlessly incorporated into therapy sessions.

She also helped me better understand the critical role of mindfulness in the personal and professional lives of speech-language pathologists and audiologists, offering strategies for self-regulation and stress management amidst the challenges of the profession. This episode is a must-listen for anyone interested in enriching our enjoyment of our clinical practice and enriching the lives of those we serve with the power of presence and awareness.

Resources from Dr. Medina and Our Discussion:

• https://www.waterford.org/resources/mindfulnes-activities-for-kids/
• Csikszentmihalyi, M. Flow: The psychology of happiness. (Amazon Affiliate Link)
• https://www.uclahealth.org/programs/marc/free-guided-meditations/guided-meditations
• Boyle, M. P. (2011). Mindfulness training in stuttering therapy: A tutorial for speech-language pathologists. Journal of fluency disorders, 36(2), 122-129.https://doi.org/10.1016/j.jfludis.2011.04.005
• Medina, A. M., & Mead, J. S. (2021). An exploration of mindfulness in speech-language pathology. Communication Disorders Quarterly, 42(4), 257-265.https://doi.org/10.1177/1525740120942141
• Medina, A. M., & Mead, J. S. (2023). SLPs’ Use of Mindfulness in Personal and Professional Contexts: A Follow-Up Study. Communication Disorders Quarterly, 15257401231169216.
• https://www.npr.org/2021/12/21/1066585316/mindfulness-meditation-with-john-kabat-zinn
• Kabat-Zinn, Jon, and Thich Nhat Hanh. Full catastrophe living means using the wisdom of your body and mind to face stress, pain, and illness. (Amazon Affiliate Link)
• https://mindfulnessresearch.wixsite.com/the-mindfulness-rese

I launched the Speech, Language, and Therapy Podcast with a mission to develop a deep understanding of the connection between speech therapy and overall well-being, especially in the area of stuttering. Inspired by my guests, I founded Brouwer Therapy to translate these insights into action.If you would like more information about connecting with me and my private practice: www.brouwertherapy.com

Transcript

 

Welcome to the show, Angela.

Thank you for having me. I'm really excited to chat with you.

 

Yeah, I'm just really excited. You're here and excited to get into this topic. So could you start by giving us a little background  and tell us how you got inspired to explore mindfulness and communication disorders. 

Yeah.  So as a clinician, most of my experience is working with the autistic population, pediatrics within the school setting. But research wise, I focus on stuttering and adults, specifically cultural and linguistic population. Groups that are underrepresented in the literature and in doing my research and reading the literature, I kept seeing mindfulness popping up and it really grabbed my interest because I've heard of mindfulness prior to that, really, in the context, I had a friend who is a dietitian and she's like, have you heard of this thing called mindful eating? 

Where, you know, you, how does the food feel when you chew it? What does it taste like? How, what are your emotions while you're eating? Like be with your food. That was my first exposure to mindfulness. And then I started reading Mihaly Csikszentmihalyi's book, Flow, and that's grounded in mindfulness as well.

So that was my background coming into it. And I thought, wow, that's perfect for stuttering. That makes so much sense. And just down the hall from me, we have our department mindfulness guru, Dr. Jeannie Meade. She was doing mindfulness with our students already. Cause you know, at grad schools, like they're stressed out, they're worried.

There's a lot, a lot of feelings there. So she was already doing that stuff. So I knocked on her door one day and I said, I think there's an awesome opportunity for us to collaborate. With your mindfulness expertise and my knowledge of stuttering, let's do something. So that's how I plopped into mindfulness as it relates to communication sciences and disorders.



 Yeah, that's just so cool. And it makes so much sense.

I'm looking forward to hearing more about how you've integrated that in your practice.   So can you tell us a little bit more about how that evolved and how clinicians can use mindfulness techniques?  

When Dr. Mead and I started collaborating, our first step was to see How are our peers using this already in speech pathology? So we did , a scoping review of the literature to see what was out there in terms of the different disorders and how people may have been reporting using mindfulness.

Not surprisingly, stuttering had the most robust literature for applying mindfulness. to therapy practice. We also found some work in TBI and aphasia just for like the emotional and quality of life aspect of the disorder and coping. And we also found in voice, people are using it in voice.  So that was our, our foundation for getting started.

And then COVID happened.

Right

students were just in such they're in such distress, they're lonely, they're isolated. Are we going to get to graduate? Like nobody knew it was going to happen. So we kind of triage did first aid on the situation.

We just started hosting our own mindfulness program for the students. So much of our work that you see published is on students because that's who we were helping during that time.  Later on,  we were able to go back.  It was like three years post their training. So students who were exposed to  before COVID to see one, are you using the things that you learned for yourself? And two, are you using it with your clients? And we did find that of the 15 who responded, 10 said they were using it in their personal lives, which is awesome.



And. Eight of those ten were using it with their clients, and the two who said they could not use it with their clients were because their clients were too young, or they were working with autistic students, and they just felt it wasn't appropriate to use with them. 



  Like I said, that makes so much sense for so many reasons. And one that occurs to me now is it's just really important for us to be present with our clients in terms of that therapeutic Alliance. . So let's get into some of the specifics and how we can use mindfulness in our own sessions.

 For example, I know you have experience using this when you're providing stuttering therapy.

Sure. You know,  when I look at traditional therapy, we're using mindfulness already, actually, because a precursor for. Stuttering therapy is the client needs to have knowledge of the vocal tract, especially if they're having tension in the vocal tract. And in order to have awareness of it, you have to be present.

You have to feel the tension in the throat or in the vocal cords. You have to feel the tension in the oral cavity and you have to be in the present moment for that. So. That's something I think we're all doing already. We're using mindfulness already. Same goes for articulation too, right? They have to have a sense of, is my tongue touching the alveolar ridge?

You have to be present to do that. So those proprioceptive tactile aspects require mindfulness. Also I'm thinking of the little ones when they're coming in, just taking that breath to relax. the nervous system.  Just take a deep breath.  For language, one of my favorite things, and this can be done with adults too, like we tend to think of  kiddos with language, but a meditation basket where you have items that one can touch and describe the texture. That's your great WH questions. If you want to build those in or just building descriptive skills things that one can smell, maybe things that somebody can taste because All of that requires you to be in the present moment, just feeling like there's a feather in the basket.

What does that really feel like? You can't be thinking about something else while you're touching a feather and considering how it feels, for example. Something else that Dr. Jeannie Mead does, she works with pediatric clients as well, is she always has in the background in the clinic, very, very low volume, 432 hertz,

hertz.

in the background, super low.

Like it does not interrupt the session, but if the kids are getting a little dysregulated, they need some help settling down. She'll say,

say, son,

can you hear it? And they have to stop and be present  to hear the music in the background. And it automatically just brings all that excitement to a level where you can start work again.  With stuttering,  part of the disorder, especially for adults, is like this rumination on past

stuttering

instances of stuttering that might be bothering them. They may be having anxiety about the future with speaking. But if you're in the present moment, You can't worry about the future and you can't dwell on the past and have those negative feelings.

 And that's what's in the literature to regarding mindfulness is and stuttering is being aware of the present moment. And not being somewhere where you're not, that you can't be in the future in the present moment and you cannot be in the past, so that helps to fight those negative feelings and that thought process.

I really love that perspective. Yeah. I'm wondering what you might say to someone who is thinking,  I'm not sure if I have time to integrate mindfulness, I need to be working on the speech or language skills that they're coming in for. 

Yeah, well, I would say that if your client is dysregulated or coming in with,  strong emotions or just not able to focus, well, you're off task anyways. They're not learning the techniques you're teaching them. They're not paying attention to you because they're focused on that negative, uh, feeling or whatever they've brought into the room.

You can't do therapy with the kid who's hiding under a desk or with their head down. So mindfulness is a way to help them,  regulate themselves. And as you said before about the idea of being a safe space for them to kind of let that go  so they can be open to learn what you're going to teach them and collaborate with you for the day.

 Oh, yeah, that's definitely a really valid and important point to make.  This  is an audio only.  Podcast, but I can see in your body language, Angela, that mindfulness has just been a positive concept to integrate into your practice for you and your clients.  Why is it such a powerful thing to integrate into our personal and professional lives? 

I 

that everybody has access to. . Not everybody has insurance, not everybody has the financial means to have therapy. So mindfulness is something we all have access to. It's all within our capability. If you can't get an app to do your guided meditations or breathing exercises, there's YouTube. You don't even need outside things to be mindful.

be mindful.

You can fold your laundry and be with the laundry. You can eat your food that earlier example like eat your food and like what does it taste like? What is it like to chew the food? Just be with whatever it is you're doing. That's for free. And the impact it can have on one's life is just, it's incredible.

I've experienced it myself  I have  severe social anxiety. I I'm a warrior, but mindfulness is something that has helped me in my personal life. Just when I feel my body, like I just feel the anxiety coming on. I bring myself back to the present moment.  And that goes away because I can't be worried if I'm thinking about how the wind feels on my skin or the texture of  the chair Or the smell from the candle you can't think about the thing you're worrying about if you're with the present moment So knowing that this is something our clients can have access to outside of the therapy room is just very powerful

And I think that's another strength of mindfulness is it can be personalized.

Some people

struggle to sit and  do  a formal meditation and  clear your mind. That's really hard.

It is hard for people. And I think that's what turns a lot of people off to mindfulness and meditation, all that as they just can't sit still and quiet their mind. So I think it's important. to do something that works for you. Be it a walking meditation, be it one minute of just trying to clear your mind.

Listening to 432 Hertz music,

Mm hmm.

making it personal to you. That's within your reach. That's not going to frustrate you   so it's all about what works for you in the moment. What do you need? What does your body need?

your body?

Yeah. Yeah. And starting, like you said, wherever you're at, accepting wherever you're at, it doesn't have to be 30 minutes.

It can be five breaths. Um, you know,  so I'm thinking kind of of a listener out there who's like, okay, I'm on board.  I've used some mindfulness, you know, oh, I'd love it if my day was more mindful and my clients were more mindful.  If they were just beginning that journey  where should they start? 

 , something that you could do is, as you start your day and you're sitting at the desk or whatever, just stop for 30 seconds. What do you hear? What do you smell? What do you see?

Just tuning in to those five senses the best that you can. That's an easy first start. I'm thinking about in the school setting, I always had to walk to my students classrooms to pick them up for therapy.

So on that walk to therapy, make it a walking meditation. Really look at the beauty of like, I don't know, lots of elementary schools have. Kids artwork on the walls or even if there's nothing on the walls,  what color is the paint on the walls? What's the texture of the walls? What do I hear again?

Like tuning into the five senses is a very easy way to get started taking deep breaths. Oh, it's so cleansing. It's so easy. It's really easy to do also, but just carving that time to do it even if it's a couple of seconds. And then as you get more comfortable, You build on that time. I have found I've gotten to a place where I'm being mindful.

But I'm not like working so hard to do it. I'm just doing it because it's just something I've been practicing for so long now. 

That is absolutely perfect. Yeah. And I think that really brings us into a good place in terms of being there for the families and the children and the adults that, that we're seeing.  I'm curious. Do you find that you use similar techniques across ages and diagnoses, or is it kind of tailored to their communication profile? 



You can use these techniques across disorders and across age groups. I would say a potential barrier or something to consider would be the A client's cognitive abilities and attention abilities. So because things like guided meditation require

longer

Longer stretches of attention. That would be something to consider.

And also cognitive load  for  TBI, aphasia, I would consider that, but  these guided meditations or whatever activities you're doing can be shortened again. Like the beauty of mindfulness is it can be tailored to the moment, to the person. Whatever's needed in front of you.

And the impact is just instantaneous. So that could work for little ones. It could work for older ones.  It's great for any disorder because to have a calm body and mind prepares one to learn new skills and remember them.



That makes so much sense.

You know, each individual is unique, but one of the things I loved about being a school clinician was I , could often be their safe space  in the day, you know a safe space, one of the safe spaces and be at their level  in terms of communication, academic, cognitive, and just be a part of their lowering the stress of the day.

And so I think this is a really really, really cool way to. I don't know, supersize that or, you know, supercharge that in terms of it being that, and like, sometimes I think in my experience, kids come in and they're just anxious, stressed, some of them more than others, obviously, from what's going on in the day.

And to include that has, I would imagine, one of the benefits for  the session, and then maybe even beyond, you're planting those seeds, aren't you?

Right. It's tools for their toolbox. It's not just for speech and language therapy. If you're feeling anxious in class or something's going on at home, these are tools that can be used in any aspect of your life.   



Yeah, exactly. Is there anything else that you want to say about how you're incorporating mindfulness within or at the end of sessions?



Another thing for our literacy clients or for working on writing gratitude. Having gratitude and reflecting on things you're grateful for. That's something to write about, to read about. That's another way to cultivate mindfulness.

And then to close a session.  . I'm thinking again in the school setting having 5 kids, right? You're doing group therapy, going in a circle, what are you thankful for today?

And just even that little moment of like giving your clients a second to think about that they're being with you, they're being in the present moment.

, I do this in my support group with people who stutter, , we share things like negative experiences that have happened, negative thoughts.  Those just come up in the support group, but  thoughts are just that.

They're just thoughts, right? We are the ones assigning a negative value or a positive value to it. So just challenging your client. To think about it as just the thought. Dr. Jeannie Mead always says  

our mind is the sky and our thoughts are the weather. The weather passes, let it pass. It's going to pass. And just look at it for what it is. It's a thought. It's not good or bad. So I challenge my support group members to do that when we talk about some negative things that come up. 



Yeah, that's such a great way to look at it. You know, a lot of times I think about family caregivers, of people with communication difficulties.  Are there some ways that this can be translated into support for them? 

I really appreciate that you asked about parents and caregivers. I truly feel that they're forgotten a lot of the time. And they're an essential part of our lives. The, the therapy, maybe it's more than a triangle, but I see it as the client, the therapist and the family or caregiver. And we, we forget about that a lot.

They need our support and also our clients. If we're lucky, we get them for an hour or two a week, but they're with their family or caregiver or teacher the rest of the time. So we need to ensure that the family and caregiver that they're in a good space as well for them, they. They can use these strategies too  

I think about, you know, on the airplane with the, put the mask, the oxygen mask on yourself first before you help anybody else. That's how I think about it with the family and caregivers. So checking in with them, building that rapport and then sharing, you know, there's this great guided meditation that, that may help you if they're expressing feelings of 

stress or just negative emotions relative to the situation with their family member, you can offer them these things.

  I think it's important for people to know that Mindfulness based interventions is evidence based. It is, it is not just, you know, ah, breathing yoga and they're fixed. No, this is an evidence based approach to social and emotional health. It's in the counseling literature. It's  been shown to be effective.

And so this is something that, you know, we don't have to be psychotherapists to help in the family support. , this is a really helpful thing in terms of  adapting and coping with these,  communication challenges.

 Absolutely. Yes.

I try to let the guest soapbox, but there was mine. 

Yes, it is evidence based and that's important.  As we should be, we're hung up on evidence based practices and this is something, I'll say it again, we're doing it already. We're already doing it. It's, it's embedded in traditional speech therapy approaches.  It works. But  we're talking about it in an open way now. Mindfulness is everywhere and there are just different things we can do with it outside of focusing on the vocal track. We have a whole human being in front of us who has to go outside of the therapy room and live their life with, um, their disorder or their different way of speaking and

and

having this as a tool in their toolbox to cope with that and improve their quality of life.

Like, why would you want to keep that from somebody? It's so easy to do.

would you want to  I think that what holds us back sometimes is compartmentalizing well being as like separate than speech therapy is so, Oh, now I'm working on your well being. Now I'm working on your speech. No, it's all together. It's one thing that we can integrate for the holistic wellness of  people we're serving

I agree. And I, I think there's a fear to like, yes, counseling and addressing the emotional side that is part of our job. It's in our scope of practice, but many of us. are not trained on how to do it. So it's uncomfortable dealing with anything outside of  articulation, language, these things that we had specific classes in.

But it's, it's within our ability.

Mm hmm. It is.

It's just wearing that humanist hat. Right. There's a scientist hat and the humanist hat putting on that humanist hat and just really tuning in to your client's needs, listening to them.

so well said.

So as we're getting towards the end here, Angela, I'm sure there are many people that  Want to know more. 

Can you give some resources or readings  that you could recommend for people if they want to learn

more?

great website. It's waterford. org.   It says it has 50 activities you can do for mindfulness with children, but if you actually start clicking some of the resources they give, it's kind of like opens you up to another 50. So there's more than 50 and they are great. activities that don't require much preparation on your part.   It says it's for kids, but as I've been talking about,  throughout this session  these can be used for adults too so even though the Waterford website says for kids, Absolutely can be used with adults too. They're not childish or  infantile type stuff. I highly recommend Mihaly Csikszentmihalyi's book Flow. 

And there's also great research out there, primarily in the stuttering literature. Michael Boyle has a great paper on mindfulness and stuttering. 



 Those sound great. I'll get those links from you and put them in the episode description so people can easily access those.  I'm actually having some light bulbs popping here above my head. I don't know if you can see them, Angela, but.  So that's really evidence of, of some really great information. Um, you know, as you're speaking, I was thinking about myself and  I a lot of times try to think about how I can work on speech sounds within literacy or, you know, integrate literacy into language. 

And so I think. Likewise, these mindfulness activities, you could be really creative about hitting speech or language goals or, uh, AAC. , if you're including those targets within these activities.  It seems like a great opportunity to be talking about mindfulness concepts and subsequently also be hitting. Some of the other speech and language goals that we have at the same time. 

Yes, absolutely. And I think as speech pathologists, I think we're a creative bunch. So yes. And like mindfulness gives you that flexibility to be creative and have that individualized approach for integrating it into what you're already doing.



It's so great. I'm feeling, I don't know what I'm feeling, lots of things, optimistic and hopeful and intrigued and fascinated with where I can go with this. So Angela, thank you so much for the work you've been doing on this and for graciously sharing your time and sharing your knowledge about this.

Thank you so much for having me.