What is MMTT?

Mindfulness & Metta-based Trauma Therapy (MMTT) is a self-help therapy for improving self-regulation in people suffering from trauma and stressor-related disorders that can be practiced online. The therapy was developed by Dr. Paul Frewen, a psychologist at Western University, Canada. MMTT involves learning to apply 6 therapeutic principles to your everyday life through the practice of a reflective journaling exercise we call Mindful and Metta Moments, as well as through the practice of guided meditations. The 6 therapeutic principles of MMTT are: 1) Presence, 2) Awareness, 3) Letting-Go, 4) Metta, 5) Re-Centering and De-Centering, and 6) Acceptance and Change. Our first research paper describing the initial development and proof of concept evaluation of MMTT was published in the peer-reviewed academic journal Mindfulness in 2015.

Gratitude (Acknowledgements) This website would not be possible without the help of many people who we would like to thank here. First and foremost, thanks go to Les Flodrowski, MSc, BCSc, who - as the site's Web Designer and IT Consultant - has always been a model for the Noble Principles of Right Intention and Right Effort. Thank you also to the electronic image artist "Freepik" (from flaticon.com) who authored the lotus flower icons used on the site and in several meditation videos. A number of images (e.g., .gif's) too numerous to list here were also collected freely from the web and used as backgrounds in the meditation timer app; thank you to all of the authors. Thanks also to the many students at Western University in London, Ontario, Canada who have contributed content including the guided meditations and have assisted in the research and evaluation of the interventions included on the site. Finally, we thank the funding agencies that have contributed to research and development of the website, including the Canadian Institutes for Health Research, Ontario Mental Health Foundation, Canada's Department of National Defense, Veteran's Affairs Canada, and the Department of Psychiatry of Western University, Canada.

MMTT Instructional Video

This video and the text below describe the MMTT website, its features and uses.

About MMTT – About MMTT Video

Trauma and Stressor-related Disorders

Trauma and stressor-related disorders are psychological problems that are caused by the experience of one or more traumatic life events or relationships. Different researchers and clinicians define traumatic life events in different ways; some definitions are very broad and general, whereas others are more specific. For the purposes of this website, we define traumatic life events and relationships somewhat broadly as any life event or relationship that caused a person psychological harm that continues to be experienced long after the event occurred or the relationship ended. Examples of traumatic life events include:

  • rejection, abandonment or betrayal following the ending of a close and loving relationship;
  • experiences of complicated or extended grieving following the loss of a loved one (complicated bereavement);
  • being physically or sexually assaulted, or witnessing or finding out that this happened to another person you care about;
  • being verbally or emotionally abused or bullied, including as a child;
  • being abused, mistreated or neglected by caregivers when you were a child;
  • being in a life threatening or physically disabling event, for example, as in military combat, a serious car accident, or a fire, workplace accident or natural disaster;
  • experiences of guilt and shame for physical or psychological harm that you have caused another person.

Traumatic life events and traumatic relationships can cause psychological harm in the form of intrusive and distressing memories, thoughts, bodily reactions, sensory perceptions, and emotions. Common psychological problems caused by traumatic life events and relationships include anxiety disorders, depression, PTSD, and dissociation.

Although it is normal to feel anxious or depressed for brief periods of time within any given day, people with anxiety and depressive disorders experience fear-based distress, worry, or feelings of depression that are chronic and difficult to control or stop. Their feelings of anxiety and depression get in the way of their relationships and ability to complete tasks. It is the disabling and impairing nature of some people's anxiety and depression that differentiates their experiences from the everyday normal experiences of anxiety and depression that nearly everyone experiences to a small degree.

Posttraumatic Stress Disorder (PTSD) involves psychological symptoms that are similar in a number of ways to those of anxiety and depression but which are particularly focused on a person's experience of a past or ongoing traumatic event or relationship. People with PTSD experience repeated intrusive and distressing memories about the traumatic event or relationship that they try to avoid but cannot stop.

Some people with a dissociative presentation of PTSD also experience what we have called trauma-related altered states of consciousness (TRASC). TRASC can be experienced in different forms, for example, disturbances or alterations in a person's sense of time, thought, their body, and their emotions. For example, a person may experience a TRASC of their sense of time when they experience flashbacks of traumatic events and lose track of what is happening in the present, or have the sense of time seeming to slow down or speed up especially when they are reminded about a traumatic event. They may also experience TRASC of thought (e.g., in the form of hearing voices in their head), a TRASC of their sense of their body (e.g., having out-of-body experiences, or feeling like their body - or part of their body - feels or seems like it is not their own), or a TRASC of emotion (e.g., feeling emotionally numb, or feeling like they are no longer themselves when they experience certain emotions). People may also experience an altered sense of self, for example, feeling like they do not know who they are, or feeling like their sense of self is divided into more than one different and seemingly separate senses of self.

Within the context of a therapeutic relationship with a registered mental health professional such as a psychologist, psychiatrist, or registered psychotherapist, most current therapies for trauma and stressor-related disorders aim to do two things, either sequentially (one after the other) or simultaneously (in combination):

  1. teach some form of self regulation training (i.e., helping a person cope better with difficult emotions), and,

  2. work through or “process” the traumatic event or relationship, whether through verbal dialogue and reflection, writing about what happened (e.g., journaling), artistic expression (e.g., drawing or painting, as in art therapy), or some other method.

Our MMTT website has been designed primarily to assist people with the first of these two tasks of recovering from traumatic events or relationships: self regulation training. On our website you will learn about 6 therapeutic principles of mindfulness- and metta-based psychotherapy and how you can apply these principles to your own life to cope better with difficult feelings. You will also be able to learn and practice different kinds of meditation in order to improve your health and wellbeing. For persons with trauma and stressor-related disorders like anxiety, depression, PTSD and dissociation, in addition to learning and practicing self regulation training such as through use of our website, we also recommend that you seek out the support of a registered mental health professional such as a psychologist, psychiatrist, or registered psychotherapist.

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6 Principles of Mindfulness- and Metta-based Therapy

The word mindfulness essentially refers to "being aware." Research in psychology tends to show that we are surprisingly little aware of our own experiences. In fact, we are essentially rather mindless a lot of the time. Often we are in a state of "automatic pilot," paying little attention to what we are doing or how we are thinking, feeling, and relating to others.

The primary goal of mindfulness-based approaches to therapy is to help people become more mindful which, in turn, often leads to reduced distress and increased health and wellbeing. Importantly, however, mindfulness-based therapies teach people to be more aware in a particular way. As popularized by Jon Kabat-Zinn (1994, p. 4), mindfulness involves "paying attention in a particular: way on purpose, in the present moment, and nonjudgmentally."

In comparison with mindfulness, the word “metta” essentially refers to "lovingkindness," and involves cultivating compassion and kindness toward oneself and others. Metta therefore represents another form of attention or "way of being aware," but one that involves bringing kindness and care toward our experience of ourselves as well as to our experience of other people.

In order to help people become more mindful and have more metta within their everyday life experience, mindfulness- and metta-based therapies essentially aim to do two things:

  1. teach and practice mindfulness-meditation and metta-meditation, and
  2. teach certain concepts or "therapeutic principles" relevant to mindfulness and metta that people can learn to apply to their everyday lives.

On our MMTT website you will learn how to apply the following six (6) therapeutic principles of mindfulness and metta:

  1. Presence (vs. Past) - reminding yourself that you are in the present, and recognizing the influence of the past on your way of relating to the present (i.e., recognizing the influence of past experiences, memories, and emotions on your responses in the here and now);
  2. Awareness - being more experientially aware, especially of stimuli through your five senses and of your emotional states, primarily as a means of grounding yourself and being better able to label and understand your experiences and describe them to others;
  3. Letting-Go - being able to allow distressing experiences to pass by, and recognizing and becoming less attached to acting upon luring harmful impulses or desires;
  4. Metta - experiencing greater lovingkindness and compassion for yourself and trusted others;
  5. Re-Centering and De-centering - feeling more safe and at ease in your body, and being able to feel a greater sense of pleasure and joy in your body, as well as being more able to tolerate bodily feelings of distress;
  6. Acceptance and Change - recognizing the difference between things that cannot be changed and things that can, and beginning to act upon things that can be changed.

These 6 principles are the cornerstones of MMTT. On this website you will be continuously exposed to these principles through the practice of guided meditations. In addition, these principles are used in a reflective journaling exercise we call Mindful and Metta Moments.

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Mindful and Metta Moments

Mindful and Metta Moments is a reflective journaling exercise that we designed in order to help people learn to apply the 6 MMTT therapeutic principles to their everyday life: 1) Presence, 2) Awareness, 3) Letting-Go, 4) Metta, 5) Re-Centering and De-Centering, and 6) Acceptance and Change.

The Mindful and Metta Moments exercise is based on the "automatic thought record" exercise that was developed as part of cognitive therapy for depression. The automatic thought record essentially asks a person to reflect upon a recent distressing life event, specifically, to describe the thoughts and feelings that they experienced at the time. They are then asked to re-evaluate their thoughts, replacing those that can later be regarded as invalid and illogical, or destructive and harmful, with ones that are more reasoned, balanced, adaptive, and constructive. In essence, people learn to reappraise their life experiences in a way that helps them to be less anxious, irritable, and depressed. The automatic thought record - and other exercises like it - have helped millions of people think and feel in ways that make them less vulnerable to anxiety and depression, as well as to help them recover from trauma and stressor-related disorders.

We have found, however, that one limitation of the automatic thought record is that it doesn't really give people much help as to how they are to generate alternative more adaptive thoughts and feelings about their distressing life events. We therefore developed Mindful and Metta Moments as a journaling exercise that also aims to help people reappraise their life experiences more adaptively, but specifically through the roadmap provided by the 6 MMTT principles: 1) Presence, 2) Awareness, 3) Letting-Go, 4) Metta, 5) Re-Centering and De-Centering, and 6) Acceptance and Change.

In summary Mindful and Metta Moments is a journaling exercise that is similar to an automatic thought record in which you can record what happened during difficult or distressing life experiences and relationships and learn to re-appraise your response to the events using the 6 MMTT principles. Your entries are saved for later reading and, if you wish, you can print or share them with your therapist, if you have one, for feedback and support.

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Guided Meditations

We have included video-guided meditations as aids to your practice of self-regulation. Some of the meditations include Mindful Movement, for example, walking meditations and some easy yoga stretches that, when combined with embodied imagery we call Symbolic Stretching. Other forms of meditation you can practice while sitting, standing, or lying down, for example, body scans and concentration-, mindfulness-, and metta-meditations, as well as guided visualizations and embodied imagery.

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Body Scans

In the most basic of terms, the home of our sense of self is our physical self - our bodies. However, many traumatic events and relationships cause people to fear or even to become disgusted with the experience of their own bodies. Especially when our bodies have been mistreated or harmed, for example, physically or sexually, the physical feeling of our bodies can begin to feel scary or even cause us to be disgusted by or ashamed of our bodily selves. In turn we may try to "shut off" or "numb out" our bodily sensations so that we don’t have to feel them. But if we can't feel safe or comforted within our own bodies, we can't feel safe anywhere. Moreover, if we chronically avoid the physical sensations of our bodies we will be left feeling emotionally numb, empty and devoid of the capacity for joy and pleasure, as well as potentially even more prone to certain physical illnesses and ailments.

This is why we believe the practice of body-focused meditations like body scans can be helpful in recovering from traumatic events and relationships. Body scans essentially involve attending to and labeling the experience of physical sensations in different parts of your body, for example, noticing what sensations you might be able to experience in your belly, heart, lungs, hands, fingertips and toes. Doing so essentially involves listening to what your body is telling you, as if you are giving a voice to your body and listening to what it has to say. With practice, people can begin to become more aware of themselves in an embodied sense, and can begin to feel more safe and comfortable within their physical selves.

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Concentration Meditation

Practicing concentration meditation involves focusing one’s attention on a particular physical object (e.g., a candle flame), on an imagined object (e.g., an imagined candle flame), on a verbalization or mantra (e.g., the sound Om or some particular word, phrase, or repetition, e.g., counting 1-2-3-4-4-3-2-1...) or on a physical sensation (e.g., breathing). The concentration meditator tries to sustain his or her attention on the intended object throughout the duration of the meditation session.

Invariably, however, he or she will become distracted by other thoughts, images, feelings, or sensations during meditation practice; upon becoming aware that he or she has lost his or her focus, he or she simply labels the source of the distraction, and then returns his or her attention to the intended object. Practicing as such can develop a person’s degree of attentional control, making his or her mind more focused and less prone to wandering and distraction. This can help with attentional problems associated with trauma and stressor-related disorders such as distracting and intrusive memories and negative thoughts, dissociation, and general difficulties people often experience concentrating and remembering things. Practicing concentration meditations can also be relaxing in and of itself, particularly when a person’s strength of attention begins to improve.

We developed a scoring procedure we call Meditation Breath Attention Scores (MBAS) in order to measure a person’s degree of attentional concentration during the practice of meditation. Essentially this involves ringing a meditation bell at different time points during a meditation session, at which point the meditator assesses whether he or she is primarily focused on the intended object (e.g., his or her breath) or has become distracted from it; the higher the number of times his or her attention was on the intended object, the greater his or her MBAS. Although we named the MBAS procedure for practices involving breathing as the intended object, in theory MBAS can be applied to any object of attention. With the meditation timer included on our website you can keep track of your MBAS, perhaps finding that your ability to sustain your attention improves the more you practice concentration meditation.

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Mindfulness Meditation

Practicing mindfulness meditation involves intentionally being experientially aware of whatever is happening in the present moment. In comparison with concentration meditation, which involves sustaining one’s attention on a single object or sensation, mindfulness meditation is more open in that one practices being mindfully aware of whatever kinds of experience present themselves.

Nevertheless, the mindfulness meditator usually chooses some primary focus for his or her attention, often involving attending to the experience of breathing or to other physical sensations, images, sounds, or verbalizations. It is just that when other experiences or stimuli present themselves to his or her awareness, these may also be attended to with interest and curiosity.

The critical point is that the mindfulness meditator seeks to be “aware of being aware” of whatever he or she is attending to at any given moment. He or she seeks to avoid becoming engrossed or absorbed in any particular thought, sensation or feeling such that he or she would become less “aware of being aware”. In this way, the mindfulness meditator observes the happenings of his or her experience from a somewhat decentered or detached “observer stance,” avoiding becoming overly involved with or fully identifying with any particular experience.

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Metta Meditation

Metta meditations involve intentionally being kind and compassionate toward ourselves and others. They usually involve silently rehearsing certain choice words or phrases, for example, "May I be happy" and "May I be at peace", as well as wishing the same for other people that you know. Practicing metta meditation can strengthen positive feelings, thereby lessening negative emotions directed toward oneself and others that are associated with trauma and stressor-related disorders, such as feeling emotionally numb, fearful, anxious, guilt, shame, or anger.

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Mindful Movement

During traumatic life events people generally do one or more of the following 4 things, the so-called "4 F's": 1) Fight, 2) Flee, 3) Freeze, or 4) Faint. In addition, during the traumatic event, a person may have wanted to or wished that they could have done one or more different F's but found that they couldn't (e.g., instead of fighting back - like they wanted to - they froze instead).

People with trauma or stressor-related disorders are often caught up or fixated in one of these 4-F states: they are constantly fighting, verbally or physically; or wanting to avoid, flee from or freezing in the presence of real or imagined threats; or temporarily losing consciousness in one form or another, such as going limp, fainting or "blacking out" when exposed to reminders of their trauma. What is important to realize about these responses is that they can often feel like they are happening outside of your own sense of control; it may seem like they happen entirely on their own, even despite your best attempts to control them.

Practicing Mindful Movement is one way for you to get back in control of your body, and to decrease impulsive, out-of-control feelings and behaviours related to the 4-F's. Although when most people think about meditation they think of a person sitting silently and motionlessly in a contemplative state, many forms of meditation actually involve physically moving. Walking meditation, for example, is a form of meditation that involves mindfully walking only a few paces, back and forth; it involves cultivating an awareness of the intentioned, willful, self-controlled movement of your body. Yoga is another form of mindful movement; when intentionally combined with embodied imagery, we call yoga practices Symbolic Stretching.

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Symbolic Stretching

Mindfulness essentially involves being aware of what is happening in the present moment. In mindfulness, we are effectively trying to be aware of "what is", in other words, "what is taking place right now," without any attempt to change it. In comparison, certain other forms of meditation, sometimes called creative meditation, involve intentionally bringing to mind or creating a desirable experience that is different from whatever experience we are having otherwise, usually through some form of positive imagery.

There are at least two kinds of imagery: 1) visualizations, and 2) embodied imagery; they are most easily distinguished through an example. If someone was to tell you to imagine a flower, most people would engage in visualization; they would essentially try to see an image of a flower in their mind's eye. In comparison, if someone told you to imagine being a flower, you might be more likely to engage in embodied imagery, for example, feeling yourself standing tall and upright as the stem, expanding your arms outwards perhaps as leaves and brightening your face as the petals or center of the flower, or maybe reaching up with your arms and fingers to create the petals.

In MMTT we combine physically simple stretches with embodied imagery, calling this combination Symbolic Stretching. In essence we use certain symbols, for example the sun, a mountain, or a tree, that are naturally associated with certain ideas and feelings, for example, health, strength, resilience, life, warmth, beauty, comfort, and safety. We combine these symbols with a physical posture or stretch that seeks to embody the same symbol.

In other words, during Symbolic Stretching a person embodies not only the posture but also the feeling of being the symbol, for example, seeking to feel as if they are the sun, a mountain, a tree, or a flower, or that these symbols are within them. Symbolic Stretching is intended to encourage positive bodily-felt experiences of safety and resilience, combating trauma-related bodily feelings associated with anxiety, fear, loss, anger, numbness, emptiness, shame, or guilt.

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