New brain study sheds light on how mindfulness reduces suffering associated with pain

Mindfulness has been shown in numerous studies to effectively attenuate pain, but a new study about to be published suggested that the way in which this reduction happens is much different than other, more typical coping mechanisms. These findings go to the heart of the difference between pain and suffering, by elucidating the different patterns of brain activation associated with each and showing how suffering is reduced throughout the practice of mindfulness, even when the sensation of pain is present.

In a study comparing meditators to non-meditators by researchers from Giessen University in Germany, Maastricht University in the Netherlands, and Massachusetts General Hospital, much was learned about the neural processes involved in the reduced suffering in the face of pain experienced by meditators. The findings of this study were recently published ahead of print in the journal Cerebral Cortex.

Mindfulness refers to a specific inner stance of purposefully paying attention to experiences in the present moment in a nonjudgmental way. For example attention is focused on the sensory aspects of a sensation alone, rather than the cognitive and emotional reactions to those sensory experiences. In mindfulness, these sensory aspects are investigated with curiosity and acceptance. Instead of being reactive and judgmental of sensations, people become fully aware of the experience in the present moment and relate to it in an objective and neutral way.

Thirty-four healthy individuals participated in the study; 17 of them were experienced mindfulness meditators. While brain activation of participants was measured in the MRI scanner at Giessen University, participants received mildly painful electric shocks on the left lower arm. Participants were instructed to relate to the shocks in different ways: with mindfulness, and with a normal, daily life stance. Participants were then asked to rate the intensity and unpleasantness of the shocks, and the anticipatory anxiety in regard to receiving the shocks.

During the practice of mindfulness, experienced meditators experienced the pain as significantly less unpleasant. In addition they reported less anticipatory anxiety, even though they didn’t perceive the intensity of the sensations differently. The MRI images revealed interesting changes in brain activation during the state of mindfulness in mindfulness meditators: increased activation in brain regions that are involved in processing the sensory aspects of the pain experience (posterior insula/secondary somatosensory cortex), but decreased activation in brain regions that are involved in regulating pain through reappraisal (lateral prefrontal cortex). Thus, the meditators fully experienced the pain, but they suffered less from it.

This pattern of brain activation is in sharp contrast to other psychological pain modulation strategies: When participants reduce pain by reappraising it (i.e., a cognitive reinterpretation), there is an increase in activation in the lateral prefrontal cortex. Activation in sensory brain areas on the other hand typically decreases. While the pattern of brain activation revealed in this new study is in sharp contrast to other pain modulation strategies, it is well-aligned with theories of mindfulness.

“The increased activation in sensory pain areas in the brain, that we found during the practice of mindfulness seems to be aligned with the increased focus on the sensory aspects of the pain that meditators report”, says Tim Gard, first author of the study. “Simultaneously we saw decreased brain activation in brain regions that are involved in reappraisal. During the state of mindfulness, meditators seem to be in contact with the present moment experience as it is, without reappraising or evaluating it.”

“It is very interesting that the pattern of brain activation that we observed during the attenuation of pain in a state of mindfulness is in sharp contrast to other forms of pain modulation”, says Tim Gard. “It indicates that mindfulness really is a different way of reducing pain. These findings might have interesting clinical implications. The revealed unique mechanisms of pain modulation might be utilized to improve or develop new strategies for the management of chronic pain”, according to Tim Gard. “While the current study investigated the effects of the state of mindfulness on pain perception in healthy subjects, future studies are required to test whether the findings can be generalized to chronic pain.”

Reference:

Gard, T., Hölzel, B.K., Sack, A.T., Hempel, H., Lazar, S.W., Vaitl, D., & Ott, U.: Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain. Cerebral Cortex, published online on December 15 2011, doi: 10.1093/cercor/bhr352

http://cercor.oxfordjournals.org/content/early/2011/12/14/cercor.bhr352.abstract

Wondering about ways that MBSR touches lives? This graduate says it beautifully and powerfully.

By Steven Hickman, Psy.D.
Director, UCSD Center for Mindfulness

In the course of teaching Mindfulness-Based Stress Reduction, I have had the opportunity to hear first-hand how participation in the program has had an impact on the lives of many people. I know from my own experience of mindfulness practice how powerful it can be, but I often struggle with how to put that into words that really capture the experience. Fortunately, every now and then, one of our MBSR participants articulates it so poignantly and eloquently that I get a new look at how this practice changes lives. Recently, in a class taught by my colleagues Luis Morones and Amy Holte, one of their participants (we will call her Katie to protect her privacy, but she has given us permission to quote her) offered some wonderful feedback about her experience that we felt would be helpful to anyone considering embarking on a practice of mindfulness or in taking an MBSR course. Here is what she had to say:

“Thank you … for letting me attend most of the recent class  (in which I had) a 60% attendance rate, which makes me laugh because in addition to suggesting kindness to ourselves and not always striving towards something (like counting attendance) a mere 60% of your class has changed at least 90% of my life.  Although I have read only the opening of the book and made very little time to practice outside of the class, I cling to the concept of my breath always being there for me, or my feet being planted on the ground, and that has consistently redirected my next action in every situation.  Pausing for a moment to just be present gives you the time to envision a desired outcome or at least remember your long-term goal in any given interaction.

“Always a mellow driver, I now am even more inclined to let others race along without getting upset (hard not to urge others to do the same).  When working with my children, my focus is not on being right, but on getting them to decide for themselves what is right and why.  When there is a work crisis, it is amazing how many people already have the solution but have not dared to allow themselves to solve it.  Or friends who want you to solve their problems but don’t like your solutions, you realize they want the problem, and you can let go without guilt.

“Mostly I am finding that giving myself a moment to reflect keeps me calm and much more able to enjoy everyone’s company.  Just this week, all five of my family were in 1) my bathroom, 2) my closet, 3) our bedroom, and in each instance I stopped myself from saying “why are you all here, stop following me” but thought instead, how wonderful that you want to be with me, that we trust each other and listen to each other and want to be together.”

Katie works in the same office space as that of the UCSD Center for Mindfulness, and her group recently experienced a significant reduction in their workforce. The stress of the process of “downsizing” was immense, and we were moved to extend the offer of free participation in MBSR to any of their group affected by these layoffs. Katie noted, “I know that Steve may have been thinking about laid off employees when he so generously offered us a space in your class, but for those of us left behind to pick up the pieces of the dozen or so people we’ve lost, it has been stressful in a different way – survivor guilt, maybe, and the inability to share about the quality and quantity of work when we should be grateful to still have the opportunity to serve.  If I were going through all of these changes without the anchor of this class, my flame would definitely be starting to flicker!!  It is also such a grounding experience to learn from those whose life situations harbor even darker days. I do so regret having missed the retreat, I felt like I was letting my classmates down, but it was unavoidable.

“I feel so empowered about how to live my life in a way that is healthier and happier and that has positive effects on those I love.”

When I wrote to ask Katie’s permission to share what she wrote in her email to the teachers above, she responded with still more wonderfully descriptive feedback: “. . . essentially this experience has been the best gift since my wedding and the birth of my three healthy boys.  That is really not an overstatement or overly enthusiastic – I feel so empowered about how to live my life in a way that is healthier and happier and that has positive effects on those I love, which was my original goal for joining the group.  It will obviously take a lot more practice, but I can already tell that I am making better choices and just thinking before I speak (I can have a sharp tongue) is improving many relationships.”

It seems as though there is nothing else to say, as Katie said it all quite well! If someone you know could benefit from the practice of mindfulness or may be interested in taking a Mindfulness-Based Stress Reduction course, I highly recommend that you share this blogpost with that person. It could change their life in the way that it changed Katie’s. (NOTE: We have a morning sitting group on weekdays in our office and Katie continues to attend with us many times each week.)

The 2012 Schedule of MBSR Classes offered through the UCSD Center for Mindfulness is now online and available for online registration. Take a look at the lineup starting in mid-January and consider joining us to more fully experience the practice of mindfulness for yourself.

Mindfulness and Yoga: Complementary Paths of Health, Healing, and Wellbeing

By Amy Holte, Ph.D., M.Ed.

Amy Holte

Amy teaches Mindfulness-Based Stress Reduction for the UC San Diego Center for Mindfulness, which is launching a new monthly 2nd Saturday workshop series entitled “Mindfulness, Meditation and Yoga” starting Saturday August 13^th 9-10:30am that she will teach, with registration open to anyone. The following article draws from her work teaching mindfulness, yoga, and meditation to help people suffering from stress and stress-related conditions, including depression, anxiety, and chronic pain.

As I’ve been teaching various forms of contemplative practice over the past dozen years or so in different settings with a wide variety of groups, I have observed that people who practice “yoga” do not always have a sitting meditation practice, and that people who meditate do not always have a contemplative-oriented movement practice. This trend seems to reflect a wider societal phenomenon evident in a number of fields, notable philosophy, psychology, and medicine, over the past few hundred years to separate the realms of mind and body. Thus, one feature of the mindfulness-based stress reduction (MBSR) program, and other mindfulness-based programs, that strikes me as particularly powerful is the blending of both of these approaches to self-development within the same course offering. In my experience, these two approaches – sitting meditation and mindful movement — are intimately tied to one another, and, when practiced together in a complementary way, inevitably deepen one’s practice.

Mindfulness is often conceived of as a moment-to-moment practice of non-judgmentally paying attention to one’s experience, a practice that is cultivated both formally through specific techniques, such as sitting meditation, and informally as one moves through daily life. In this sense, mindfulness has developed over the past half-century or so as a means of experiencing many of the psychological benefits of meditation without necessitating adoption, or even consideration, of specific spiritual, philosophical, or religious beliefs. Thus, although mindfulness grows out of the Buddhist stream of contemplative practice (Maex, 2011), mindfulness as it is practiced today offers a secular pathway for working with the mind and body.

Interestingly, the notion of “mindfulness” is also evoked to refer to a specific mindfulness program. Mindfulness-Based Stress Reduction (MBSR) is a systematic approach to teaching mind-body awareness and growth that was founded by Jon Kabat-Zinn over 30 years ago when others teachers of contemplative paths were also practicing and teaching mindfulness, meditation, and yoga (Kabat-Zinn, 1990). Included in the program of sitting meditation, attention to the breath and thoughts, and body awareness, is a “yoga” practice that resembles the type of practice offered in most yoga studies. This combined approach of MBSR and other mindfulness-based programs (Cullen, M. 2011) has been particularly useful as a means of integrating mindfulness into the therapeutic contexts of medicine, clinical psychology, and healthcare in general.

In a parallel fashion, the practice of “yoga” has also made its way into therapeutic, clinical, and healthcare contexts both on its own as a method of reducing stress and bringing health to the body and mind, and within mindfulness-based program as a means of practicing mindfulness (Harrington, 2008). Distinct from the “mindfulness” milieu, “yoga” has become widely popular as a way of achieving health, fitness, and vigor (Alter, 2004). In this sense, for many people today “yoga” means a physical movement oriented practice of various postures, perhaps also with awareness of the breath and some deeper connection of the body with the mind and other aspects of our being, with benefits of greater flexibility, strength, and diminished stress and pain-related symptoms.

However, in the ancient tradition of yoga, and, in fact, in many non-mainstream circles today, meditation is the ground of yoga. For thousands of years, even predating the era of Classical Yoga (c. 150-200A.D.), the practice of “yoga” centered on meditative practices as the means for uniting the practitioner with the greater reality (Feuerstein, 1998). One important feature of yoga, though, is the fact that it adapts to culture, historical era, etc. Thus, the system of strong physical postures and breathing techniques that we know as “yoga” today actually emerged rather late in the history of yoga, in the 13-15^th centuries, and is more accurately identified as “hatha yoga” (White, 1996). This physical and body oriented method of practicing “yoga” (transformed once again from its medieval manifestation) is what has become a popular means of pursuing health and strength of the body and mind today (Alter, 2004; DeMichelis, 2004; Harrington, 2008), whether on its own or as part of a mindfulness program.

No matter one’s entry point into contemplative practice, whether it be through the physical or the mental, I invite us to consider that these two streams of practice are not separate. Rather, these are complementary means to awareness, health, and wellbeing. Mindfulness helps deepen the process of self-inquiry during physical practice, a lesson that can then be taken off the mat when we move around in life. Similarly, a regular contemplative movement – hatha yoga if you prefer the more traditional name, or simply “yoga,” – supports a sitting meditation practice. Meditators often encounter problems such as pain in the knees and back from sitting for extended periods of time; yet, when a regular “yoga” practice is undertaken, the body becomes transformed in such a way as to allow it to remain comfortably at rest for longer and longer periods of time in a single posture that supports a state of restful awareness experienced in the mind, as well. The effects of systematically practicing yoga take root in the body, transforming it on a day-to-day basis. Together, contemplative sitting and movement practices bring more ease and free practitioners from preoccupation with the pains and limitations that we may normally experience in our body-mind, thus cultivating greater wisdom and wholeness in daily life.

A plethora of scientific and clinical research has shown that both modes of practice lead to healing and stress-reduction. For example, relaxation of tense muscles, improvement of blood flow throughout the body, optimization of heart rate and respiration, and reduction of anxiety and depression (Kabat-Zinn, et al., 1992) have all been found in research on both yoga and mindfulness (Benson, H., Beary, J., and Carol, M., 1974). Moreover, improvements in chronic stress-related conditions, such as chronic pain including backaches and headaches (Kabat-Zinn, et al., 1982, 1985, 1986; Galantino, et al., 2004; Tekur, P., Singphow, C., Nagendra, H.R., and Raghuram, N., 2008), irritable bowel syndrome (Kuttner, et al., 2006; Gaylord, S.A., et al., 2011; Kearney DJ, McDermott K., Martinez M., and Simpson T.L., 2011), and arthritis (Pradhan, et al., 2007; Badsha, et al., 2009), heart disease (Ornish, et al., 1998; Sullivan et al., 2009; Allexandre, et al., 2010), insomnia (Khalsa, 2004; Kreitzer et al., 2005), and cancer (Carlson et al., 2003; Witek-Janusek et al., 2008; Ulger and Yagli, 2010) have also been shown in populations practicing both mindfulness and yoga.  Because of this overlap of the benefits of each, and that these methods are complementary to one another, perhaps it is no wonder that they are brought together in MBSR.

So how can we make sense of the observation that different people naturally gravitate towards different types of practice? It is not so difficult to recognize that we each have unique constitutions.  Some people are more introspective by nature, while others are more action and physically oriented. So sitting and practicing meditation may be a more natural behavior for those of the more introspective constitution, while engaging in physical postures, sometimes often quite challenging movements, may offer more appeal for others.

Yet in common between all constitutions is the basic reality of the intimate connectedness of body and mind. This insight is especially relevant when we consider the possibility that the “body” is not merely, or just, “physical” as it in common understandings of the body.  Embedded within the body lies our nervous system, the physical and energetic reality of our minds. Thus, in this sense, the mind resides within the body as a continuous ever-present system that is fully interactive with the rest of the body. In this view, cognitive processes, such as attention, thinking, and problem solving, and emotions as well, are embodied and deeply rooted in the body’s interactions with the world (Varela, et al., 2009). This embodied mind orientation provides an increasingly popular theoretical stance for a holistic view of human nature that the two – body and mind – are not separate.

What does this mean for practice? The practical insight here is to spend at least some time each day on the different types of contemplative practice, both sitting and movement, because each mode of practice supports, complements, and reinforces the other. By exercising the literal muscles of the physical body, we simultaneously exercise the metaphorical muscles of the mind; and, conversely, by strengthening mental acuity and clarity through sitting practice, we also benefit the body. An integrative approach to lifestyle, behavior, and healing cultivates true health and wellbeing.

Dr. Holte is a graduate of The University of Texas at Austin where she completed her doctoral research on meditation and the brain, drawing from both ancient texts and current research on the neuroscience of meditation and clinical effectiveness of yoga and meditation for health conditions.

References

Allexandre, D., Fox, E., Golubic, M., Morledge, T., and Fox, J. E. B. (2010). Mindfulness, yoga, and cardiovascular disease. Cleveland Clinic Journal of Medicine, 77(3), S85.

Alter, J. (2004). The Body Between Science and Philosophy: Yoga in Modern India. Princeton and Oxford: Princeton University Press.

Badsha, H., Chhabra, V., Leibman, C., Mofti, A., and Kong, K.O. (2009). The benefits of yoga for rheumatoid arthritis: Results of a preliminary, structures 8-week program. Rheumatology International, 29(12): 1417-1421.

Benson, H., Beary, J., and Carol, M. (1974). The relaxation response. Psychiatry, 37, 37-46.

Cullen, M. (2011). Mindfulness-Based interventions: An emerging phenomenon. Mindfulness.

DeMichelis, E. (2004). A History of Modern Yoga. London: Continuum.

Harrington, A. (2008). The Cure Within: A History of Mind-Body Medicine. New York. New York: W. W. Norton & Company.

Feuerstein, G. (1998). The Yoga Tradition: Its History, Literature, Philosophy and Practice. Prescott, Arizona: Hohm Press.

Galantino, ML, Bzdewka, T., Eissler-Russo, J., Holbrook, M., Mogck, E., Geigle, P., Farrar, J. (2004). The impact of modified hatha yoga on chronic low back pain: A pilot study. Alternative Therapies, Mar/Ap, 10(2).

Gaylord, S.A., Palsson, O.S., Garland, E.L., et al. (2011). Mindfulness training reduces the severity of irritable bowel syndrome in women: Results of a randomized controlled trial. The American Journal of Gastroenterology, Epub ahead of print.

Kabat-Zinn, J.  (1982). An out-patient program in Behavioral Medicine for chronic pain patients based on the practice of mindfulness meditation:  Theoretical considerations and preliminary results. Gen. Hosp. Psychiatry, 4:33-47.

Kabat-Zinn, J., Lipworth, L. and Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. J. Behav. Med., 8:163-190.

Kabat-Zinn, J., Lipworth, L., Burney, R. and Sellers, W.  (1986). Four year follow-up of a meditation-based program for the self-regulation of chronic pain:  Treatment outcomes and compliance. Clin.J.Pain, 2:159-173.

Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, New York: Delta Trade Paperbacks.

Kabat-Zinn, J., Massion, A.O., Kristeller, J., Peterson, L.G., Fletcher, K., Pbert, L., Linderking, W., Santorelli, S.F.  (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am. J Psychiatry, 149:936-943.

Kearney D.J., McDermott K., Martinez M., and Simpson T.L. (2011). Association of participation in a mindfulness programme with bowel symptoms, gastrointestinal symptom-specific anxiety and quality of life. Aliment Pharmacol Ther., 34(3):363-73.

Khalsa, S.B.S. (2004). Treatment of chronic insomnia with yoga: A preliminary study with sleep-wake diaries. Applied Psychophysiology and Biofeedback, 29(4): 269-278.

Kuttner, L., Chambers, C., Hardial, J., Israel, DM, Jacobson, K., and Evans, K. (2006). A randomized trial of yoga for adolescents with irritable bowel syndrome. Pain Res Manag. Winter; 11(4): 217–224.

Maex, E. (2011). The Buddhist roots of mindfulness training: a practitioners view. Contemporary Buddhism, 12: 1.

Ornish, D., Scherwitz, L.W., Billings, J.H., Gould, K.L.,  Merritt, T.A., Sparler, S., Armstrong, W.T., Ports, T.A., Hogeboom, C., and Brand, R.J. (1998). Intensive lifestyle changes for reversal of coronary heart disease. JAMA, 280(23):2001-2007.

Pradhan, E.K., Baumgarten, M., Langenberg, P., Handwerger, B., Gilpin, A.K., Magyari, T., Hochberg, M.C., Berman, B.M. (2007). Effect of Mindfulness-Based stress reduction in rheumatoid arthritis patients. Arthritis Care & Research, 57(7): 1134–1142.

Tekur, P., Singphow, C., Nagendra, H.R., and Raghuram, N. (2008). Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: A randomized control study. The Journal of Alternative and Complementary Medicine, 14(6): 637-644.

Ülger, O. and Yağli, N.V. (2010). Effects of yoga on the quality of life in cancer patients. Complementary Therapies in Clinical Practice, 16 (2): 60-63.

Varela, F., Thompson, E., and Rosch, E. (1991). The Embodied Mind: Cognitive Science and Human Experience. Cambridge: The MIT Press.

White, D. (1996). The Alchemical Body: Siddha Traditions in Medieval India. Chicago: The University of Chicago Press.

Every Moment an Opportunity for an Epiphany

I am sure to grow old.
I cannot avoid aging.
I am sure to become sick.
I cannot avoid sickness.
I am sure to die.
I cannot avoid death.
All things dear and beloved to me
are subject to change and separation.
I am the owner of my actions;
I will become the heir of my actions.
— Anguttara Nikaya

Elana Rosenbaum

Every now and then something happens that is pivotal in our lives by which we measure time, a marker event like 9/11, a marriage or divorce, a birth or death or a diagnosis such as cancer. I’ve divided time into pre cancer and post stem cell transplant for lymphoma.  The time is marked not by age but by changes in my world. Pre-cancer mortality was a given intellectually but post diagnosis I knew it in my heart, head and gut.   Death became a part of my awareness and I could no longer delude myself into believing that illness and loss happened to others but not to me. These last few weeks, with the earthquake ,tsunami, and radiation leaks in Japan  as well as war in Libya I am reminded of the universality of suffering and its pain.     I am inspired by the courage and cooperation of the Japanese people and horrified by the hatreds and violence of war. It feels like the whole world is trembling.  I ask myself daily, how am I living my life? What are my priorities? How am I putting mindfulness into action and what is possible to help others?

A favorite cartoon of mine is of two mice on an exercise wheel. One of the mice is shown peddling frantically and spinning around and around while the other is resting comfortably on the rim of his wheel with his legs dangling over it. The caption under him reads, “I’ve had an epiphany.”

Years ago my meditation teacher, Larry Rosenberg, talked about rolling over and over again and again in the mud.  I never quite understood what he meant until I began to notice certain thought patterns that refused to quit. I didn’t think in terms of greed, hatred and delusion I only knew that certain thoughts made me unhappy and created feelings, sensations and actions that perpetuated misery, mine and others.  I’ve been a psychotherapist since 1975. In working with my patients at a large HMO it seemed all too easy to slip into the morass of worry, fear and doubt. Identification with these states perpetuated misery by defining who we thought we were and what life held for us. This lead to immobility and more fear, anger and delusion.

Frustration and discouragement led me to the medical center and Jon’s (Kabat-Zinn) weekly yoga class and Larry’s (Rosenberg) meditation sessions. One short hour opened a window into possibilities. I would return to work energized and refreshed with greater clarity and patience to be with another. As my practice deepened compassion and understanding grew and real change became possible.

I’ve been very fortunate. I’ve been teaching MBSR since the early 80‘s with the support of a community dedicated to mindfulness and the eradication of suffering. Community is essential. Overcoming suffering and understanding its causes is often a painful process.  We need each other for support and inspiration. Discovering what helps and what harms takes effort, high ethical standards and steady attention. MBSR is not a technique or a smart career move. It’s goal is liberation and wise action. We are all inter-connected, the rebel in Libya and his antagonist, the tsunami victim and the rescue worker.  We are all responsible for our actions. Just as aging, illness, death and loss is part of life so is compassion, understanding and growth. May our work together bring greater peace for ourselves and our world.

Elana Rosenbaum is a longtime teacher of Mindfulness-Based Stress Reduction and author of a book on her experience of working mindfully with her own cancer diagnosis entitled Here For Now: Living Well With Cancer  Through Mindfulness . There is also a companion Audio CD for her book available, by the same name. To learn more about Elana and her work, download her free meditation audio files, or learn about upcoming events, visit her website at Mindfulliving.com .

Dealing With the Classic MBSR Week 8 Question: Will Your Butt Be On The Cushion Tomorrow?

Perhaps the number one question asked by participants in MBSR or MBCT groups is: “Where can I go to continue to practice in a group?” The question behind the question is “How will I sustain the momentum I have built up over the past 8 weeks and continue to formally practice mindfulness?” We frequently suggest to our participants that they connect with each other to form small sitting groups. This article from mindful.org provides some nice guidelines for doing just that. We will refer folks to this helpful piece to support them in their practice.

Cancer: Listening for a Mindful Life

By Regina Huelsenbeck, PhD

I can remember that day. I was home from college for Thanksgiving break. I had picked up my best friend for lunch; we were going shopping, and then later, out for the evening. We had quite the day planned… I just needed to stop by my pediatrician’s office for a quick checkup. I had a lump on the side of my neck; it had been there since spring of my freshman year. It was now fall of my sophomore year and it had gotten much larger, so I finally decided to tell someone. I didn’t think it was really anything. I was 19 years old and my world did not have the space for such notions. The doctor however, looked pretty worried, and sent us over to an ENT (ear, nose & throat) surgeon who immediately took a needle biopsy.

A few days later, we got the biopsy results. We had just gone to see the movie The Bodyguard (yes, Whitney Houston). I was riding in the back seat of our car, with that same friend when my mother got the call. She turned around from the front seat, phone to her ear, and announced, “Its Hodgkin’s, Regina”. … … “I have cancer?” It did not compute. The feeling I had is still so hard to describe. I wasn’t even in that car anymore. I was physically sitting in the backseat looking out the window. But psychically, upon hearing those malignant words I had popped into another reality. I had left the world of the healthy-living-well people and was sinking down into what can only be described as an underworld.

Illness is the night side of life, a more onerous citizenship.  Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.  Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. ~Susan Sontag

With sickness comes isolation, sometimes vivid dreams, visitations in fever induced states and reflection; it is indeed another world. However, the lights of illness have a unique way of illuminating forgotten energies and disconnected pieces. In this respect, illness can and often does become an opportunity for reconnection, an anamnesis.

Through my journey into that underworld, I wondered how and why I got cancer. I have come to believe not only that I became ill for many reasons but that I was the only one who could uncover those reasons. No one else was qualified. No one could really tell me how I contracted cancer, exactly what I did or why I had it… I had lymphoma, and “they” really didn’t know and still don’t know what causes it. No one can truly provide a linear causal reason.

And that’s not the point anyway. The point is not necessarily what caused it; the point is really where this line of questioning took me, what this exile from the land of the fast movers and healthy shakers did for me.

Obviously, the journey was not all roses and inspirational change. It was hard and lonely and painfully self-reflective. I was also pretty pissed off. I was angry about missing out on what I considered to be the life I was “supposed to be living”. I was sick and I was tired. I was worried about the boy who no longer wanted to date me because I had cancer. I was worried that I had no hair and I was worried about being different from all my peers.

The angry part of me was not concerned with macrobiotics, death, meditation, mindfully cutting vegetables (something my macrobiotic instructor insisted upon- it wasn’t enough to simply prepare the dang recipes, everything had to be done a certain way: which I now understand, but then, not so much) or larger existential questions. A larger part of me, however, woke up because of my cancer experience. This part of me had questions and was ready to explore! This part of me truly blossomed after treatments were over and remission set in. This part of me did wonder about the benefits of slowly, mindfully cutting vegetables.

I became extremely interested in illness and the mind-body connection. I attended a conference on healing sponsored by the Institute of Noetic Sciences. My career and truly my life’s passion grew from the basic interconnected ideas discussed in this conference.  I was enlivened! I now had even more questions about the mind-body connection, healing and consciousness.

I returned to college and changed my major (fashion merchandising) to nutrition and minored in psychology. I found my true love studying the psyche and set out to become a clinical psychologist (FYI: a very long road). 745 years later, I completed my doctoral dissertation on the experience of living with cancer. I also penned a chapter for Newsweek journalist Jamie Reno’s book of lymphoma survivor tales: Hope Begins in the Dark. Much of this article was taken from that chapter. Today I work mindfully with others struggling to heal, understand and integrate the cancer experience. I am grateful for this work, the questions which continue to emerge and the answers that flow from the spirit of each client.

So the saying goes that a “gift” is contained within life’s tragic experiences.   Although if you’re in the midst of chemo and someone suggests that cancer is a gift, you may envision yourself punching them in the head (believe me I get it!) But maybe, just maybe, you might consider taking a walk on the inside, and beginning to listen for your message. Illness sometimes presents itself to offer a wake-up call for more conscious living, a new direction or a new perspective. Perhaps it’s simply an opportunity to slow down, but more likely, it has come for a reason. You are the only one who can uncover and then begin to live into those discoveries. Through the uncertainty of illness blooms a new order, a new understanding, a new consciousness, something is healed and perhaps a new enlivened path is revealed.

Take a Walk on the Inside:

1.      Regular Sitting Mindfulness Meditation practice (sign up for MBSR class here)

2.      Journaling: “Bones, Dying into Life” by Marion Woodman, “Writing for your Life” by Deana Metzger, “Rebirth” by Deborah Ludwig, or take course with Sharon Bray: “Writing through Cancer”. Next workshop begins Feb 28^th (more information here)

3.      Yoga:  Stacy McCarthy The Soul of Yoga

4.      Mindful Psychotherapy (check out my web page here)

5.      Mindfully preparing food and cutting vegetables (I had to put that in for my macrobiotic teacher)

6.      How to Book: Mindfulness-Based Cancer Recovery by Linda E. Carlson & Michael Speca.

Sources:

Myss, C.  (Speaker).  (1993).  Why people don’t heal. Institute of Noetic Sciences.  Boca Raton, FL.

Newman, M.  (1994).  Health as expanding consciousness.  New York, NY:  National League for Nursing Press.

Robbins, J.  (1998).  Reclaiming our health:  Exploding the medical myth and embracing the sources of true healing.  Tiburon, CA:  H J Kramer, Inc.

Sontag, S.  (1989).  Illness as metaphor and AIDS and its metaphors. New York, NY:  Picador U

CBC News Segment on Mindfulness and Mental Illness Features MBCT and Zindel Segal

Looking for a nice introduction to how and why mindfulness might be helpful in regard to depression and anxiety? This segment from CBC’s The Journal program does a great job of noting how mindfulness has become a standard approach to dealing with mood disorders and features one of the developers of Mindfulness-Based Cognitive Therapy (MBCT), Zindel Segal talking about how it all works.

Mindfulness For Teens, Brand New 4-Week Program Coming Up in March at UCSD

In today’s world, teens are under more pressure and stress than ever before.  Increasing demands in technology, academic pressure, and life transitions often result in physical, emotional and psychological symptoms, which can manifest as irritability, anxiety and depression. Over time these symptoms can affect your teen’s wellbeing and happiness. A crucial skill in managing stress effectively is to be able to deal with change whenever it occurs.

UCSD is now offering the first of a series of 4-Week Mindfulness for Teens Programs (each session is 90 minutes) introducing teens to the practice and benefits of mindfulness. Offered for only $150, this program will occur on four consecutive Tuesday evenings from 4:30-6:00 pm. Online registration is now open.

Interview With Jon Kabat-Zinn on the Science of Mindfulness

A fascinating interview with Jon Kabat-Zinn from 2009 entitled “Opening to Our Lives” by Krista Tippett of American Public Media for her program “Krista Tippett on Being”.  Note that there is a small excerpt (and link) on the site of Jon reading Derek Walcott’s wonderful poem Love after Love:

The time will come
when, with elation
you will greet yourself arriving
at your own door, in your own mirror
and each will smile at the other’s welcome,

and say, sit here. Eat.
You will love again the stranger who was your self.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you

all your life, whom you ignored
for another, who knows you by heart.
Take down the love letters from the bookshelf,

the photographs, the desperate notes,
peel your own image from the mirror.
Sit. Feast on your life.

“Love after Love” from COLLECTED POEMS 1948-1984 by Derek Walcott. Copyright © 1986 by Derek Walcott.

Lead Author Zindel Segal Comments on Study Comparing MBCT to Antidepressants

Zindel Segal, Ph.D.

Zindel Segal of the University of Toronto, lead author of a recent study published in the Archives of General Psychiatry that found no difference between antidepressant medication and Mindfulness-Based Cognitive Therapy (MBCT) in preventing relapse in depression, spoke with us recently and offered this commentary on the implications of his study.

“With the growing recognition that major depression is a recurrent disorder, patients need treatment options for preventing depression from returning to their lives. Data from the community suggest that many depressed patients discontinue antidepressant medication far too soon, either because of side effect burden, or are unwilling to take medicine for years.  All depressed patients in our study were first treated with an antidepressant until their symptoms remitted.  They were then randomly assigned to come off their medication and receive MBCT; come off their medication and receive a placebo; or stay on their medication. The novelty here lies in comparing the effectiveness of sequencing pharmacological and psychological treatments versus maintaining the same treatment – antidepressants – over time

“Mindfulness-based cognitive therapy teaches skills in emotion regulation so that patients can monitor possible relapse triggers as well as adopt lifestyle changes conducive to sustaining mood balance.  Clinical assessments were conducted at regular intervals, and over an 18 month period, relapse rates for patients in the MBCT group did not differ from patients receiving antidepressants, with both in the 30% range.

“The real world implications of these findings bear directly on the front line treatment of depression.  For that sizeable group of patients who are unwilling or unable to tolerate maintenance antidepressant treatment, MBCT offers equal protection from relapse.  An additional benefite is that this strategy of sequential intervention– offering pharmacological and psychological interventions– may keep more patients in treatment and thereby reduce the high risk of recurrence that is characteristic of this disorder.”

Dr. Segal will be co-leading a 5-day professional training in MBCT through the UCSD Center for Mindfulness in Northern California in February 2011. For more details, see the Professional Training website.