Mindful Awareness in Body-Oriented Therapy (MABT)

1. Introduction

Version followed: the three-stage, eight-session individual MABT protocol described by Price & Hooven (2018, Frontiers in Psychology), with session format and delivery details from the University of Washington NIH trial protocol (ClinicalTrials.gov NCT04082637, 75-minute weekly sessions). The full MABT treatment and training manuals are not public and are not drawn on [uncertain: wording and timings inside the manual may differ from what is given here].

Mindful Awareness in Body-oriented Therapy (MABT) was developed by Cynthia J. Price, PhD, MA, LMT, at the University of Washington (Seattle). She directs the non-profit Center for Mindful Body Awareness, which runs the trainings (Atlas attribution confirmed) [source: USABP CMBA page; Price & Hooven 2018]. MABT is an individual, manualised mind-body approach. It combines manual touch, mindfulness and psychoeducation to teach interoceptive awareness, defined as the capacity to identify, access and appraise internal bodily signals. It grew out of Price's earlier body-oriented therapy (BOT) protocol for women recovering from childhood sexual abuse. That protocol had three components: massage, body-awareness exercises, and "delving", a Focusing-derived attention to the felt sense in a body area [source: Price 2003 USABPJ].

How change happens (authors' model). Stress, pain and trauma can recalibrate how bodily signals are produced and perceived. The authors call these calibrations "set points": adaptive at first, they persist after they stop being useful and lead to hypo- or hyper-awareness and avoidance of the body. MABT teaches the skills one at a time, in this order:

Awareness: the client learns to notice and name sensation. The expected effect is better sensory awareness.
Access: the client learns to bring attention inside the body. The expected effect is less distress.
Appraisal: the client learns to hold attention there, notice shifts, and reappraise their experience from direct bodily awareness and insight. The expected effect is better emotion regulation and resilience.

The work stays inside a "therapeutic window" where affect is tolerable and helpful, and that window widens gradually [source: Price & Hooven 2018]. MABT is marketed as particularly suited to clients with high experiential avoidance [source: USABP CMBA page]. It is used as an adjunct, for example to substance use disorder (SUD) treatment or medication for opioid use disorder [source: NWATTC webinar slides; NCCIH research result].

2. Framework

Format. Eight individual sessions, once a week. The trials used 75 minutes per session ("1.25 hours") and allowed up to about 12 weeks to fit the eight sessions in [source: NCT04082637 protocol; Price et al. 2013 IJTMB; NCCIH]. Sessions take place partly seated (check-in and review) and partly with the client lying on a massage or treatment table, prone or supine, or seated, while the therapist uses touch [source: Price & Hooven 2018]. In the NIH trials MABT was delivered by licensed massage therapists trained in the protocol. The protocol (version 3.0) also allowed MSW/LMHC clinicians [source: NCT04082637; NCCIH].

Every session has the same frame:

A semi-structured check-in on how the client is, including review of home practice.
The stage-specific skill training.
A seated session review in which the client recaps the highlights.
A collaboratively designed take-home practice.

[source: NCT04082637; Price & Hooven 2018]

Stage	Sessions	Goal	Core training	Component minutes (webinar slides)
1. Awareness: Body Literacy	1–2	Identify and describe body sensations	Touch-guided body literacy, delivered in the context of massage	Check-in 30, body literacy 45, review 15, plus home practice
2. Access: Interoceptive Awareness Exercises	3–4	Bring attention inside the body; begin linking physical and emotional sensation	Breath-flow, softening, and internal-area attention exercises	Check-in 30, body literacy review 15, interoceptive access training 30, review 15
3. Appraisal: Mindful Body Awareness Practice	5–8	Sustain inner attention, notice shifts, reappraise	Sustained mindful attention in a body area, then the whole body	Check-in 30, body literacy review 15, mindful body awareness practice 30, review 15

[source: Price & Hooven 2018 Tables 1–2; NWATTC webinar slides; NCT04082637]

[uncertain] The slide minutes add up to 90 minutes, but the trial sessions were 75 minutes. The protocol's own Table 2 lists about 40 minutes of massage/body literacy in Stage 1 and about 10 minutes in Stages 2–3, with totals that do not reconcile. Treat the minutes as proportions: check-in about a third of the session, training the largest block, and a short review.

Moving between stages. The sequence is fixed (sessions 1–2, 3–4, 5–8), but delivery is individualised. Earlier skills are reviewed briefly in every later session (the "body literacy review"). Within a stage, the therapist moves on when a skill comes easily and breaks it into smaller steps when it is hard [source: NCT04082637; Price 2003 on the BOT predecessor]. Practical readiness markers [synthesis, derived from the stage goals]:

Into Stage 2: the client can name at least some sensations in specific, qualitative terms (for example "tight, burning" rather than "fine").
Into Stage 3: the client can bring attention into at least one inner area and keep it there for a short time, which the therapist also perceives as a change in tissue quality.

If a client is not ready, slow down within the window rather than skipping ahead [source: Price & Hooven 2018].

Booster. In the opioid use disorder trial, clients with continued substance use at 6 months were offered six more sessions. These kept the full stage structure, with emphasis on the components the client most needed to review [source: NCT04082637].

3. Guiding principles

[source for all items: Price & Hooven 2018 unless marked; NWATTC slides; USABP CMBA page]

Interoception is a learnable skill, taught step by step. Never assume the client can already feel inside. Start with identifying sensation, then teach access, then sustained attention.
Stay in the therapeutic window. Pace each step so that affect stays tolerable and useful, and widen the window slowly. Back off at signs of hypo- or hyperarousal.
Experiencing comes before naming. Words support sensation. Help the client find words, but the aim is the felt experience.
Present-moment focus. Keep attention on what is sensed now (sensation, emotion, body awareness), not on stories about the body [source: NWATTC slides].
Mindful attitude: openness, curiosity, self-compassion. Model and invite non-judging curiosity toward whatever is found, including discomfort.
Listen to the body rather than fix it. A participant summarised the acceptance theme as "Learning to listen to my body, not fix it" [source: NWATTC slides]. In practice, the therapist does not try to make the sensation go away.
The client is a collaborator and guide. The client's report steers the work. The process unfolds, so follow what emerges [source: NWATTC slides; Price & Hooven 2018].
Trust and safety first. Build them through careful listening, consistency, familiarity, and the check-in [source: NWATTC slides; NCT04082637].
Therapist presence, and assessment of client presence. The therapist cultivates their own presence and reads the client's presence through touch (tissue quality changes when the client "drops in" or drifts). This guides teaching moment to moment [source: Price & Hooven 2018; USABP CMBA page; Blackburn & Price 2007 cited].
Inquiry builds curiosity. Ask specific, open questions about sensation rather than giving interpretations [source: USABP CMBA page].
Touch guides attention. Touch is used to direct and ground awareness and to assess presence, not as treatment of tissue for its own sake. Self-touch is taught so the skill can be carried home [source: Price & Hooven 2018; UCSD CIH page].
Incremental, individualised learning. Tailor strategies and home practice to the client, encourage them, and build in small steps [source: NWATTC slides].
Integration into daily life. Every session ends with a client-led review and a home practice the client finds feasible. Practice is considered critical [source: Price & Hooven 2018].
Reappraisal through the client's own insight. Help clients notice and remember shifts (for example, a calm state they can return to). Let them draw their own conclusions about their coping [source: Price & Hooven 2018].
Scope and competence. Touch-based delivery requires appropriate licensure and safety training, plus skills for mental health concerns, including managing transference and countertransference. Where touch is inappropriate for the client or the clinician, adapt with client self-touch [source: Price & Hooven 2018].

4. Intervention inventory

The items below follow the session frame and the three stages. All example language is illustrative unless it appears in quotation marks with a citation. The sources describe techniques at the level of procedure and vignette, not as scripts. Steps marked [synthesis] fill operational gaps and keep to the published procedure.

4.0 Touch in MABT: scope, consent and alternatives (applies to every touch item)

Purpose: In MABT the therapist's hands guide the client's attention to a region, ground awareness, and let the therapist read the client's presence through changes in tissue quality. In Stage 1 the work is delivered in the context of massage [source: Price & Hooven 2018; NCT04082637].
Scope: Touch-based MABT requires appropriate licensure, safety skills and MABT training. In the trials it was delivered by licensed massage therapists, and by MSW/LMHC clinicians under protocol v3.0 [source: Price & Hooven 2018; NCT04082637]. Before using touch, check what your licence, employer, insurer and jurisdiction allow, and get supervision from an MABT-trained supervisor. Many psychotherapy licences restrict or forbid touch. In that case use the self-touch variant (4.15) [synthesis].
What the sources specify: In the predecessor BOT protocol, touch was done over clothing and individualised for safety and comfort [source: Price 2003]. The MABT trial protocol lists anxiety caused by touch as a known risk [source: NCT04082637]. The vignettes place hands on the top of the shoulders, and one hand front and one hand back at the lower thoracic spine, low back or abdomen [source: Price & Hooven 2018]. [uncertain] Clothing arrangements in current MABT and the full list of hand positions are not given in the sources.
Consent steps [synthesis; not given in the sources]:
1. Before the first touch, explain why MABT uses touch (to guide attention, not to treat or fix), where hands will go, that the client stays clothed, and that touch is always optional.
2. Ask for explicit consent for each new region and each new session. Name the self-touch or towel alternative as an equal option.
3. Agree a stop signal (a word or a raised hand) and say that stopping needs no explanation.
4. Tell the client before you place or move your hands.
5. Check in during contact ("Is this pressure OK?").
6. Ask afterwards how the touch was for them, and record the consent.
7. With trauma survivors, plan in advance which regions are off-limits. Never touch breasts, genitals, buttocks or the inner thighs.
Watch for: bracing, breath-holding, freezing, apology or compliance without engagement, and sudden tissue "emptiness". These may signal that touch has become unsafe for the client. Stop, take your hands off, and ask [synthesis].

4.1 Semi-structured check-in (every session)

Purpose: Build trust and familiarity, hear how the client is, review home practice, and choose the focus for today's training [source: NCT04082637; Price & Hooven 2018].
Steps:
1. Seated, open with how the client has been physically and emotionally since last session.
2. Ask what home practice they did, how often, and what they noticed. Note any barriers.
3. Listen for body references (pain, tension, hesitancy about an area). In vignette 2, for example, the client feared that breathing into her low back would trigger a spasm.
4. Agree with the client what to work with on the table.
5. In the slides, about 30 minutes; in vignette 2, about 20 minutes [source: NWATTC slides; Price & Hooven 2018].
Example language (illustrative): "How has your body been this week? ... When you did the shoulder practice, what did you notice, even small things?"
Watch for: practice logs, if you use them (the trials used a MABT Practice Log) [source: NCT04082637]. Also listen for bodily avoidance in the narrative. A check-in that drifts into a full talk-therapy session is a sign to steer back gently to present experience [synthesis].

4.2 Psychoeducation on interoception

Purpose: Help the client understand that the body carries information about emotion and stress, that disconnection is often a learned way of coping with stress, pain or trauma, and that the skills are learnable [source: Price & Hooven 2018; NWATTC slides].
Steps:
1. In session 1, explain briefly what interoceptive awareness is and the three-stage plan.
2. Normalise difficulty feeling or describing sensation.
3. Return to short explanations whenever a link between body and emotion shows up. One client's insight was "I didn't realize that my body can tell me how I'm feeling!" [source: Price & Hooven 2018].
4. [uncertain] The content of MABT's manualised psychoeducation is not described in the sources. Keep it brief and experiential [synthesis].
Example language (illustrative): "Many people learn to tune out their bodies when life is stressful or painful. That makes sense as protection. Here we'll practise tuning back in, a little at a time, at your pace."
Watch for: lecture-length explanations that replace experience. Also check that the client understands that the goal is noticing, not achieving relaxation [synthesis].

4.3 Body literacy training (Stage 1, sessions 1–2; reviewed later)

Purpose: Teach the client to identify body sensations and put them into words. This is the "awareness" capacity. Use it as the foundation for every client, and especially with clients who answer body questions with "fine" or "nothing" [source: Price & Hooven 2018].
Steps:
1. Positioning: the client lies on the massage table (prone, supine or side-lying as comfortable) or sits, clothed [source: Price & Hooven 2018; clothing from Price 2003, BOT].
2. With consent (4.0), the therapist applies moderate pressure to an area where tension is expected or reported, for example the top of the shoulders. In the trials this was done within massage [source: Price & Hooven 2018; NCT04082637]. [uncertain] Massage strokes and sequence are not described.
3. Ask what the client notices in the area under your hands.
4. If the answer is vague ("fine"), ask again, more specifically, about the exact spot.
5. Use reflective listening on whatever word comes ("tight"). Then ask about its qualities: sharp or dull, location, size, movement, temperature, spread.
6. If the client cannot find words, offer a list of sensation words to choose from (4.4). Optionally describe what you feel under your hands as a model (4.5).
7. Notice and name spontaneous changes, such as a deep breath followed by softer shoulders. Ask the client what changed.
8. Extend the inquiry to other regions (back, arms, legs) so the client starts mapping the whole body [source: vignette 1, Price & Hooven 2018].
9. Close by having the client sit up for the session review (4.13).
Example language: Reflecting a change: "You just took a couple deep breaths ... your shoulders relaxed a bit" [source: Price & Hooven 2018, vignette, abridged]. Inquiry (illustrative): "Under my hands here, what do you notice? ... Tight? Say more about the tightness: is it sharp, dull, spreading anywhere?"
Watch for: progressively more specific, qualitative descriptions, sensations noticed in more places, and spontaneous release. Naming is secondary to experiencing, so don't drill vocabulary [source: Price & Hooven 2018]. Distress at contact or numbness calls for slower pacing (Section 5).

4.4 Sensation vocabulary support (word list)

Purpose: Give clients with poor body vocabulary words to match against what they feel [source: Price & Hooven 2018].
Steps:
1. Offer a small set of contrasting descriptors (for example tight/loose, warm/cool, heavy/light, sharp/dull, still/moving, achy, tingly, numb).
2. Ask which, if any, fits. Allow "none of these" and "I don't know".
3. Use the client's own word from then on. [uncertain] The MABT word list itself was not available. The words above are illustrative [synthesis].
Example language (illustrative): "Some people notice things like heavy, warm, buzzy or tight. Does any of those fit, or is it something else?"
Watch for: a client choosing words to please you. Check that the chosen word fits by asking them to feel again [synthesis].

4.5 Therapist tactile modelling

Purpose: Model noticing by describing what the therapist feels under their hands [source: Price & Hooven 2018].
Steps:
1. Briefly describe the tissue quality you perceive, tentatively and without interpreting (for example, "I feel quite a lot of firmness here").
2. Ask whether that matches the client's experience.
Example language (illustrative): "Under my hand it feels firm, a bit like it's holding. What's it like from the inside?"
Watch for: the client deferring to your perception. Always privilege the client's report [synthesis].

4.6 Body–emotion linking questions

Purpose: Begin linking physical and emotional sensation, which is the Stage 2 goal [source: NCT04082637; NWATTC slides].
Steps:
1. When the client expresses emotional distress, ask how their body feels right now.
2. When they express physical distress, ask how they feel emotionally.
3. Reflect any link that the client makes. Do not supply it yourself.
Example language (illustrative): "As you talk about this, what's happening in your body?" / "With that ache there, how are you feeling emotionally?"
Watch for: spontaneous links, for example noticing that the shoulders tighten when anxious. These are markers of growing interoceptive awareness [synthesis].

4.7 Body scan (seated or on the table)

Purpose: Build awareness of internal experience across the body and find a region to work with [source: NWATTC slides; Price & Hooven 2018, vignette 3].
Steps:
1. Seated (vignette 3) or lying down, invite the client to close their eyes or lower their gaze.
2. Guide attention region by region (for example feet, legs, pelvis, abdomen, chest, back, shoulders, arms, neck, head).
3. At each region, invite the client to notice sensation without changing it.
4. Ask where they notice most, and what it is like.
5. Use the region found as the focus for access or sustained-attention work. [uncertain] The order and duration of the MABT body scan are not specified in the sources.
Example language (illustrative): "Let your attention move down into your belly ... just notice what's there, nothing to change."
Watch for: regions the client skips or reports as blank. These are often avoided areas and should be approached gradually [synthesis].

4.8 Grounding to simple sensations

Purpose: Help an escalated client calm by focusing on simple, neutral sensations [source: NWATTC slides].
Steps:
1. Shift attention to feet on the floor, the seat or table beneath the client, and the weight of the body being supported.
2. Ask the client to describe the contact.
3. Stay there until arousal settles, then decide with the client whether to return to the previous focus.
Example language (illustrative): "Let's come to your feet for a moment. What do you notice where they meet the floor?"
Watch for: slower breath, softer face and voice, and orientation to the room. If grounding doesn't help, open the eyes and orient to the room. Sit up [synthesis].

4.9 Breath-flow exercise (Stage 2, access strategy a)

Purpose: Use the felt flow of the exhaled breath to carry attention inside the body. This is the first of the three access strategies [source: Price & Hooven 2018, Table 2].
Steps:
1. The client lies on the table or sits. With consent, the therapist rests one hand on the front and one on the back of the target region. Price & Hooven say training usually starts at the upper chest [source: Price & Hooven 2018].
2. Invite the client to breathe naturally and to feel the out-breath moving through the body toward and through the area under the hands.
3. Ask what they notice as the breath moves.
4. Use tissue quality under your hands to judge whether attention has reached the area. Check that against the client's report.
5. Practise for several breaths, rest, then repeat.
6. Later, move on to more difficult areas, for example toward a painful region. [uncertain] Repetitions and durations are not given in the sources.
Example language (illustrative): "Let the breath be easy. As you breathe out, see if you can feel the breath travel down toward my hands, here in your upper chest. What do you notice?"
Watch for: This is gentle, natural breathing, not breath intensification. If the client starts forcing, deepening or speeding up the breath, or feels dizzy or tingly, return to an ordinary breath and ground (4.8) [synthesis]. Some clients fear that breath will provoke pain or spasm. Address that fear first and begin away from the painful area [source: Price & Hooven 2018, vignette 2].

4.10 Intentional softening of tension (Stage 2, access strategy b)

Purpose: Use intention to soften areas of muscular holding. This gives the client a way to access the inner body and an immediate self-care tool [source: Price & Hooven 2018, Table 2].
Steps:
1. Choose a held area identified through body literacy (for example the shoulders).
2. With hands resting on or holding the area (with consent), or with the client's own hand there (self-touch), ask the client to notice the holding.
3. Invite them to let the area soften, by intention rather than effort, as best they can. Many clients find this easiest paired with the out-breath [synthesis].
4. Ask what happens, and reflect any change you feel under your hands.
5. If nothing changes, normalise that and simply return to noticing.
Example language (illustrative): "Notice how the muscles here are holding. Without forcing, see if they can soften even a little ... What happens?"
Watch for: the client trying to "do relaxation" and becoming frustrated. The skill is the attempt and the noticing, not success [synthesis]. Softening can also release emotion, so be ready to pace (Section 5).

4.11 Directed inner-area attention (Stage 2, access strategy c)

Purpose: Teach the client to bring and keep attention inside a specific internal area, for example the upper chest, low back or abdomen. Use this once the client can identify some sensation [source: Price & Hooven 2018].
Steps:
1. Positioning: supine or prone on the table. With consent, place one hand in front and one behind the area, for example around the lower thoracic region or the abdomen and back [source: Price & Hooven 2018, vignettes 2–3].
2. Start with an accessible area. Typically this is the upper chest; work toward harder areas later.
3. Invite the client to bring their attention to the space between your hands, inside the body.
4. Ask what they notice: size, shape, density, temperature, movement, ache.
5. Monitor tissue quality. When attention drifts, the tissue changes. Check with the client and ask where the shift happened [source: Price & Hooven 2018].
6. If the client cannot stay with an area (for example just above a painful region), move your hands to an adjacent region they can access, and build from there. In vignette 2 the therapist moved up to the lower thoracic spine, and the client could then stay with an "achy" sensation [source: Price & Hooven 2018].
7. Re-invite attention once the client agrees to try again.
Example language (illustrative): "Bring your attention to the space between my hands, inside, not on the surface ... What's there? ... I'm noticing something shifted. Where did your attention go?"
Watch for: reports such as "I'm not in there anymore" [source: Price & Hooven 2018, vignette 3]. These are useful information, not failure. Watch also for emotion surfacing as access deepens (tears or a tight throat in vignette 2). Encourage the client to stay with the feeling only if it remains within the window (Section 5).

4.12 Mindful body awareness practice (Stage 3, sessions 5–8)

Purpose: Sustain interoceptive attention in a body area without trying to change it. The aims are to notice internal shifts, to allow insight, and to reappraise one's experience from that direct awareness. This is the appraisal capacity [source: Price & Hooven 2018; NCT04082637].
Steps:
1. Optionally begin with a seated body scan (4.7) to find the area. In vignette 3 this was abdominal heaviness that tends to tighten with anxiety.
2. The client lies on the table. With consent, the therapist places one hand on the front and one on the back of the area [source: Price & Hooven 2018].
3. Guide attention in using the access skills (4.9–4.11). Invite the client to stay and be with themselves in that space, without changing anything.
4. Check in at intervals by asking what is noticed. Reflect it and ask them to describe changes.
5. When attention leaves, name the shift, ask permission to try again, and guide them back.
6. Sustain the attention for as long as the client can, extending this over sessions. Vignette 3 reports about 15 minutes [source: Price & Hooven 2018].
7. Later in the practice, invite awareness of the whole body and any sense of continuity or connection across it [source: Price & Hooven 2018].
8. Help the client make a mental note of any shift (for example calm, spaciousness, wholeness) as a state they can return to. Affirm their noticing; the vignette's wording was "Good noticing and I'm glad to hear that" [source: Price & Hooven 2018].
9. Closing: ask the client to keep the state with them as they slowly come back, taking their time to open their eyes. Then sit up for the review [source: Price & Hooven 2018].
Example language (illustrative): "Let yourself be with whatever is here, nothing to fix ... What are you noticing now? ... As you get ready to come back, see if you can bring that calm with you. Take your time opening your eyes."
Watch for: the space changing (for example from small and closed to larger and lighter) and spontaneous imagery or insight. Watch also for statements of surprise at staying connected, or of hope. These are working signs [source: Price & Hooven 2018]. Spontaneous imagery is the client's experience; don't interpret it [synthesis].

4.13 Session review (every session)

Purpose: Integrate the session cognitively and support reappraisal and motivation. It is also where the home practice is designed [source: Price & Hooven 2018; NCT04082637].
Steps:
1. Move to chairs.
2. Ask the client to recap, in their own words, what stood out: sensations, shifts, links between body and emotion.
3. Reflect, and help them draw their own conclusions, for example about how avoidant coping may distance them from feelings (vignette 2).
4. Affirm the effort and any new capacity.
5. Move on to the take-home practice (4.14).
6. Takes about 15 minutes [source: NWATTC slides].
Example language (illustrative): "What stood out for you today? ... What do you make of being able to stay with that area?"
Watch for: the client generating meaning themselves, rather than the therapist summarising. Watch also for residual activation; if present, ground before they leave [synthesis].

4.14 Collaborative take-home practice (every session)

Purpose: Carry the skills into daily life. Practice is considered critical [source: Price & Hooven 2018; NCT04082637].
Steps:
1. Choose together a short practice drawn from today's work. Typical practices pair self-touch with mindful attention to the body [source: Price & Hooven 2018].
2. Fit it to feasibility: when, where and how often. In vignette 1 the client applied pressure to his neck and shoulders, noticed the sensation and breathed deeply, twice a day (at work and in the evening).
3. Agree how to record it. The trials used a practice log [source: NCT04082637].
4. Review it at the next check-in and adjust.
Example language (illustrative): "What's one small thing from today you could try at home? When in your day would it fit?"
Watch for: practice that is too ambitious, and practice chosen to please the therapist. Small, frequent practice that the client owns is the goal [synthesis].

4.15 Self-touch and no-touch adaptation (towel substitute)

Purpose: Deliver the skills where therapist touch is inappropriate for the client or outside the clinician's scope, and support home practice [source: Price & Hooven 2018; UCSD CIH page].
Steps:
1. Have the client place their own hand(s) on the target area, for example a hand on the upper chest or one on the belly and one on the low back, or apply gentle pressure to the shoulders.
2. Run the same inquiry, access and sustained-attention steps as with therapist touch.
3. For areas that are hard to reach, a small rolled towel under the back (lying down) can stand in for touch, as in vignette 2's home practice [source: Price & Hooven 2018].
4. You lose tactile feedback about presence, so ask more often what the client notices and watch breath, posture and face [synthesis]. [uncertain] The sources did not describe a formal telehealth or group MABT protocol. Self-touch makes remote delivery plausible, but treat any remote adaptation as [synthesis].
Example language (illustrative): "Rest your hand where you feel the tension, with whatever pressure feels right. Now bring your attention to just under your hand."
Watch for: self-touch that turns into self-massage or fixing. Bring the client back to noticing [synthesis].

4.16 Booster sessions

Purpose: Consolidate skills when problems continue. In the opioid use disorder trial this meant continued substance use at 6 months [source: NCT04082637].
Steps:
1. Offer up to six further sessions.
2. Keep the stage structure, but weight it toward the components the client most needs to review.
3. If the client had no earlier sessions, deliver the first six sessions of the protocol.
Example language (illustrative): "Let's revisit the skills, starting with the ones that slipped most."
Watch for: whether home practice has lapsed. Rebuilding the practice is often the main task [synthesis].

5. Handling problems

Screening and safety before starting.

What the research protocol specified [source: NCT04082637]:

Excluded: overt psychosis or cognitive impairment, pregnancy beyond 24 weeks or of unknown gestation, and inability to stay in the parent treatment.
Sessions stopped (client stays in the study): if the client arrives intoxicated and cannot engage in more than one scheduled session, or if providers have safety concerns such as escalating symptoms.
Expected risks: brief emotional discomfort, anxiety from touch, and anxiety from a new therapeutic relationship.
Safety record: prior MABT studies reported no serious adverse events.
Monitoring: adverse events were logged at every session, with a two-way release of information to the clinical team.

Added screening [synthesis]:

Ask about trauma history connected to touch or to particular body regions.
Ask about current dissociation severity and active suicidality or self-harm. Use your service's standard risk assessment.
Ask about recent injury, surgery, skin conditions or medical restrictions at the regions you plan to touch.
Check pregnancy, which affects whether prone positioning is suitable.
Check medical clearance where pain has not yet been assessed.
MABT uses natural breath, light-to-moderate holding pressure and no cathartic discharge. Do not add breath intensification, deep-tissue work or catharsis.
MABT is an adjunct for stress, pain and emotion regulation. It is not a treatment for physical disease.

The client can't feel anything, or says "fine". Ask again, more specifically, about the exact spot under your hands. Offer a word list. Model by describing what you feel. Use moderate pressure on an area that is likely to be tense. Accept small gains, since naming is secondary to experiencing [source: Price & Hooven 2018]. If the area stays blank, move to a more accessible region (often the upper chest or the shoulders). Treat numbness as a protective adaptation, not a failure [synthesis].

Attention drifts, or the client dissociates during access work. Notice the shift, often as a change in tissue quality. Check in, and ask the client where the shift happened. Move your hands to a nearby region the client can stay with, then build back toward the harder area after they agree to try again [source: Price & Hooven 2018]. Firm, consistent touch helped one anxious client stay calm and refocus [source: Price & Hooven 2018]. For marked depersonalisation, derealisation or loss of orientation: stop the inner focus, have the client open their eyes, ground them in contact and the room (4.8), sit up, and review what the warning signs were. Resume at an easier step next time [synthesis].

Overwhelm, flooding, or strong emotion surfacing. Help the client return to a stable place, normalise the experience, and keep the work inside the therapeutic window. Recognise when a client is not ready [source: Price & Hooven 2018]. When emotion is tolerable (quiet tears, sadness, as in vignette 2), encourage the client to stay with the feeling and the sensation while you stay present. Then link it, in the seated review, to what they now understand about their coping [source: Price & Hooven 2018]. If the emotion is not tolerable: take your hands off (or keep a steady supportive contact if the client asks for it), open the eyes, ground, slow the pace, and shorten the next exposure to that region [synthesis]. Flashbacks and emerging traumatic memories are not processed within MABT. Contain them, stabilise the client, and coordinate with the client's trauma therapist or treatment team [synthesis; Price 2003 raised how to respond to dissociation and traumatic memory as an open training question].

Fear that attention or breath will cause pain or spasm. Take the fear seriously in the check-in. Start next to the painful area rather than on it, use natural breath only, and let the client set how close to go [source: Price & Hooven 2018, vignette 2; pacing details synthesis].

Touch-related anxiety or rupture (the client flinches, freezes, complies, or later reports discomfort). The protocol lists touch-related anxiety as an expected risk [source: NCT04082637]. Stop touch immediately. Acknowledge what happened without defensiveness, and invite the client to say what didn't feel right. Offer self-touch or the towel variant (4.15). Re-contract on consent and on which regions are off-limits, and bring it to supervision [synthesis].

Erotic or charged transference, or boundary pressure. The authors say MABT clinicians need skills in managing transference and countertransference [source: Price & Hooven 2018]. Keep touch to the agreed regions and keep the client clothed. Address the feelings verbally and seated. Shift to self-touch if needed, and seek supervision promptly. Any sexual contact is an ethical violation, not part of MABT [synthesis].

Non-adherence to home practice. Design the practice together, keep it small and feasible, tie it to existing routines, review it at every check-in, and adjust it rather than reproach [source: Price & Hooven 2018; NWATTC slides; specific tactics synthesis]. In the 2003 BOT pilot a participant who declined homework was raised as an unresolved protocol question [source: Price 2003]. If a client repeatedly declines, ask what gets in the way and accept practice that happens in session only, as a step toward practice at home [synthesis].

Missed sessions and attendance. The trials allowed about 12 weeks for eight sessions [source: NCT04082637]. Keep the stage sequence after gaps, but start with a brief review of earlier skills [synthesis, consistent with the built-in body literacy review].

The client arrives intoxicated. Don't do touch or inner-focus work. Check safety, reschedule, and coordinate with the treating team. Per the protocol, sessions are discontinued if this recurs [source: NCT04082637].

Escalating psychiatric symptoms or suicidality. The protocol stopped MABT when providers had safety concerns, and referred the client to more appropriate care where needed [source: NCT04082637]. Carry out a standard suicide risk assessment and safety planning, and coordinate with the client's team. Pause the inner-focus work until the client is stable [synthesis].

The client wants the therapist to fix the body, or treats MABT as massage. Return to the stance of listening, not fixing. Re-explain that the hands guide attention and that the client's own noticing is the skill [source: NWATTC slides; Price & Hooven 2018].

Sessions turn into talk therapy. Hold the session frame (check-in, training, review). Gently bring the client back to what is sensed now, and use body–emotion linking questions (4.6) to connect the story to the body [synthesis].

Sleepiness or "spacing out" in relaxation. Ask brief questions more often. Invite eyes half-open, or a seated or side-lying position. Remind the client that the aim is attentive noticing, not sleep [synthesis].

Referral and team integration. In community SUD settings, referrals depended on the MABT therapist being known to staff. Therapists embedded in the clinic, with access to treatment records, were considered ideal [source: NWATTC slides].

Ending. How to close the final session was an open question in the 2003 pilot [source: Price 2003]. In session 8, review all three skills, choose the practices the client will keep, and name a calm or connected state they can return to on their own. Plan booster or onward support [synthesis].

Sources

Sources:

Further reading (not drawn on) (via Price & Hooven 2018):

Blackburn, J. & Price, C. (2007). Presence in manual therapy. Journal of Bodywork and Movement Therapies.
Price, C. (2005). Body-oriented therapy in recovery from child sexual abuse: an efficacy study. Alternative Therapies in Health and Medicine.
Price, C. (2006). Body-oriented therapy in sexual abuse recovery: a pilot-test comparison. Journal of Bodywork and Movement Therapies.
Price, C. J. & Smith-DiJulio, K. (2016). Interoceptive awareness is important for relapse prevention. Journal of Addictions Nursing.
Price, C. J. & Crowell, S. E. (2016). Interoceptive awareness training for emotion regulation among women in SUD treatment.
Price, C. J., Pike, K. C., Treadway, A., et al. (2024). Immediate effects of MABT as an adjunct to medication for opioid use disorder. Mindfulness.

[uncertain] The MABT treatment manual and training manual (Center for Mindful Body Awareness) were not available. The PMC full texts and the Springer Mindfulness 2024 full text are not drawn on.

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