Category Archives: Cancer

Learn From the Founder of Mindful Awareness in Body-oriented Therapy (MABT)

By Cynthia Price

Cynthia Price, PhD MA LMT is a Research Associate Professor at the University of Washington in Seattle.  Shestudies Mindful Awareness in Body-oriented Therapy (MABT), an approach she developed to facilitate body/interoceptive awareness and related skills for self-care and emotion regulation.  She has clinical and research expertise working with people who are disconnected from their bodies due to trauma, chemical dependency, chronic pain or other life stressors.  Director of the non-profit Center for Mindful Body Awareness http://www.cmbaware.org/ she is involved in training clinicians in the MABT approach and implementing programs, particularly for underserved populations, to help make somatic awareness more available to more people.

Interoceptive awareness – the awareness of inner body sensations – is integral to mindfulness practice.  Most often, in mindfulness classes and practice, people engage in interoceptive awareness by attending to the sensation of their breathing or by engaging in a body scan.  Learning to become aware of how one feels inside is critical for gaining access to emotions, the link between emotions and physical sensations, and having an overall embodied sense-of-self.  Likewise, learning to integrate mindful attention to bodily experience in daily life can enhance regulation and self-care.

However, mindful attention to the body is not easy for everyone.  This tends to be particularly true for people who are unfamiliar with the practice, those who have high levels of stress, and those who may avoid awareness of their inner body sensations due to physical or emotional pain, for example those with a history of physical and/or sexual trauma. For some, individualized assistance in a safe therapeutic relationship is needed to develop interoceptive awareness as well as the capacity for sustained attention to internal experience. Mindful Awareness in Body-oriented Therapy (MABT) was developed to explicitly teach fundamental interoceptive awareness skills and to develop the capacity for sustained attention to interoceptive experience. The MABT approach grew out of Cynthia Price’s clinical work with people who were seeking emotional awareness and healing but were disconnected from their bodies. In more recent years, research findings highlight how helpful the MABT approach can be for reducing mental and physical health distress and for increasing emotion regulation.  As one research participant wrote about learning this approach:  “I tried meditating over the years and I was never able to concentrate. With MABT, I was able to slow my mind down and then follow what she (the therapist) was saying, concentrating on a body part, and what I was feeling and afterwards talking about that. Eventually, I learned to do that by myself. This is why I thought this approach was amazing because it taught me to meditate. Now I meditate every night. The difference is having someone lead me into learning how to do it first.’’ 

Join Cynthia Price and her colleagues for the Mindful Awareness in Body-oriented Therapy (MABT) professional training, April 28 – May 7, 2018 at Joshua Tree Retreat Center, Joshua Tree, CA. Mindful Awareness in Body-oriented Therapy (MABT) is an empirically validated 8-week intervention that combines manual, psychoeducation, and mindfulness approaches to teach interoceptive awareness and related practices for self-care and regulation.  To learn more, listen to the Liberated Body podcast in which Cynthia describes the MABT approach:  https://www.liberatedbody.com/podcast/cynthia-price-lbp-060

References:

  • Price, C. & Smith-DiJulio, K. (2016). Interoceptive Awareness is Important for Relapse Prevention: Perceptions of Women who Received Mindful Body Awareness in Substance Use Disorder Treatment. Journal of Addictions Nursing, 27 (1): 32-8. PMC4784109.
  • Price, C., Wells, E., Donovan, D., Rue, T.  (2012). Mindful Awareness in Body-oriented Therapy as an Adjunct to Women’s Substance Use Disorder Treatment:  A Pilot Feasibility Study.  Journal of Substance Abuse Treatment, 43: 94-107.
  • Price, C., Taibi, D., Smith Di-Julio, K., Voss, J. (2013). Developing Compassionate Self-Care Skills in Persons Living with HIV: a Pilot Study to Examine Mindful Awareness in Body-oriented Therapy Feasibility and Acceptability. International Journal of Therapeutic Massage and Bodywork, 6(2): 1-11.
  • Price, C., McBride, B., Hyerle, L., Kivlahan, D. (2007).  Body-oriented Psychotherapy for Female Veterans with PTSD Taking Prescription Analgesics for Chronic Pain: A Feasibility Study.  Alternative Therapies in Health and Medicine, 13(6):32-43.
  • Price C. (2005).  Body-Oriented Therapy in Recovery from Childhood Sexual Abuse:  An Efficacy Study.  Alternative Therapies in Health and Medicine, 11, (5): 46-57.

 

 

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Mindfulness Shines A Light on Anger

by Margaret Cullen and Gonzalo Brito Pons

margaretMargaret Cullen and Gonzalo Brito retrato-gonzalo-argentinaPons, co-authored “The Mindfulness-Based Emotional Balance Workbook. Join them for the Mindfulness-Based Emotional Balance (MBEB) Teacher Training Intensive, April 9-15, 2017 at EarthRise Retreat Center, Petaluma, CA. Mindfulness-Based Emotional Balance is an empirically-supported 9-week psycho-educational group intervention that teaches mindfulness meditation and emotion training.

It’s such a shame to think of how often we deride ourselves, and each other, for being “emotional.” It’s like jumping on someone for breathing. Emotion is a process that is a vital part of being alive. As the pioneering psychologist of emotions Paul Ekman has said, emotion is a kind of rapid, automatic appraisal of what’s going on. It’s influenced by our evolutionary past as well as our personal past, such that when “we sense that something important to our welfare is occurring…a set of physiological changes and emotional behaviors begins to deal with the situation.”

You’ve been endowed with a nervous system that has evolved over thousands of generations in a way that you didn’t choose. By the time you actually realize that you have a mind and a brain, the basic rules of how they work are already in place. The events that trigger our emotional responses are sometimes universal and sometimes personal. Almost anyone would feel fear at the sight of an oncoming car, but only some of us are afraid of hiking down steep trails while others happily scramble down them like a mountain goat. The triggers that each of us carries with us often come from early childhood and can continue quite unconsciously into adulthood.

And opportunities for emotion abound. Remembering, talking about, or imagining a past emotional scene or thinking of future scenarios can trigger emotions. Observing another person’s emotions (even on a TV screen) can elicit an emotional response. Role playing or theater can elicit emotion; and so can seeing an event that offends our sensibilities, like someone talking on a cell phone at the symphony or throwing trash into the street.

One of our most potent emotions—whose inward and outward effects can have disastrous consequences—is anger. In evolutionary terms, its main adaptive function is to remove obstacles that thwart us. When we feel anger, it’s because the primitive brain is trying to tell us something needs to change. We share this emotion with other mammals and even with reptiles. Baby humans come already well equipped with the capacity to get angry. If you hold a baby by her arms from behind, preventing her from grabbing a toy, she will get pretty angry, furrowing her brow, tightening her muscles, trying to move forcefully to get the toy, and perhaps shouting with a squeaky voice. When the baby grows up, she can have an analogous reaction when someone cuts her off on the road, especially if she’s already late for an important meeting! Anger also shows up when you—or others you feel connected to—are treated unjustly, or when someone or something prevents you from meeting your goals and needs.

Regardless of what triggers them, emotional responses can be either functional or dysfunctional. If we automatically swerve from an oncoming car, the fear response is extremely functional. If we’re afraid to leave the house for fear something terrible will happen, we are now in a disorder that is on the very dysfunctional side of fear, a disorder that no doubt is being triggered by an imported script from past trauma.

Until around the 1970s, it was commonly believed that the nervous system was essentially fixed throughout adulthood; that brain functions remained constant and that it was impossible for new neurons to develop after birth. If you were born with a “glass half-empty” attitude, it would be a life-sentence of unhappiness. Neuroscience has changed all that with the concept of neuroplasticity, which suggests that, in reality, human brains are flexible and change through experience. Although there are some fixed rules about what minds and brains can do, it’s also true that there is a space of freedom to respond rather than react that can be cultivated through mindful observation and practice. And in that space, we have an opportunity to work creatively with the dysfunctional aspects and enhance the more functional aspects of our emotional life.

Consciously or not, we’re constantly training our minds and brains to respond to circumstances. By virtue of repetition, our reactions crystallize into emotional patterns and neural pathways, which, in turn, influence the way we perceive reality. This is particularly true when we’re in the grips of a strong emotion, which is sometimes called the refractory period, a period of time when we’re only able to take in information and evoke memories that confirm, maintain, or justify the emotion we are feeling. This same mechanism that guides and focuses our attention can also distort our ability to deal with both new information and knowledge already stored that does not match the current emotion. We can all think of countless examples when we have missed obvious cues or forgotten historical data when we were “blinded” by a strong emotion. It’s not called “blind rage” for nothing.

Blind and Blaming

MindfulnessBasedEmoBalanceWB-CF.inddAlthough it’s quite possible to get mad at ourselves, the energy of anger is generally directed outward and it’s often linked with blame. This tendency to blame, strike out, punish, and retaliate makes anger especially challenging to sit with, and a big source of interpersonal suffering. When we feel anger toward someone, our sense of “self” and “other” gets very solid. In this state, we exaggerate all the negative qualities of the other person and become blind to positive attributes, which in turn feeds the aversion. The complexity and nuance of the other is reduced to a monolithic negative cartoon called “the enemy.”

We often wonder why we’re angriest at those we’re closest to. For one thing, people who know us intimately also know what can hurt us the most. Someone said, “Your family knows how to push your buttons because they actually installed them.” But a less glib reason is that it tends to be safer to show anger to an intimate than to a stranger. You can express aggression to your partner when you’re actually mad at your boss, probably because it’s less likely your partner will fire you. We can be frustrated about ourselves but direct our anger outside. It’s uncanny that we can even get quite angry at inanimate objects—a door, a table, a wall, or a shoe.

And that very fact reveals something that illuminates what’s really happening: although it feels as if the source of anger is out there, the anger comes from within. Other people are just pretending to be the real enemies. In fact, it’s possible to see them as our “patience coaches,” offering us opportunities to explore and tame the anger habit. If everyone was nice and considerate, how could we train in patience, how could we learn to tame our anger?

There’s an old story about a man who was sailing his boat on clear and sunny day, when a dense fog rolled in. Just as he had decided to return to shore, he noticed the profile of another boat coming in his direction. “Keep your distance!” the boatman shouted, concerned about a possible collision. But the other boat just kept approaching. The boatman used all his skills to swiftly shift direction, so there was more room for the other boat. He got really upset when he saw that the other boat changed its own course, now coming directly to him. “Stay out of my way!” he shouted again, but the other boat just kept coming closer, until it finally crashed into his boat.

The man was enraged: “You idiot! What the hell are you doing?!” He got totally worked up and continued his rampage until the fog lifted enough so that he was able to see that the other boat was empty—it was just an old abandoned boat floating downstream. Now he was perplexed and frustrated: To whom could he express his anger? Could he project his anger onto an empty boat? Without a person to blame, it was impossible to keep the story of anger going.

Ask yourself: Do I ever get mad at “empty boats”? If so, where does this anger come from? Where does it go?

Becoming aware of the inner terrain of anger can be helpful in catching it sooner and sparing ourselves and others the hurt and regret that often ensue from acting out anger. To work with anger, we need to see the space between trigger and reaction in order to mindfully look within.

Door Number Four

Anger is tricky because there’s a cost both to showing anger and to suppressing it. Suppressing doesn’t actually solve anything. It only postpones having to deal with anger while it keeps quietly simmering under the surface, wreaking havoc with our bodies. But if we show it, almost invariably we either hurt others or provoke retaliation. Another common habit is unconsciously “feeding” the mind states of anger with our stories of blame and victimization, thereby reinforcing the anger habit.

It’s rare that therapists nowadays advise their clients to act out their anger with real or symbolic others (punching pillows, shouting loudly in an empty room, and so on), partially because brain science has demonstrated that each time anger is expressed it gets rehearsed and strengthened. The idea that if you let your anger out you will reach peace and calm is simply not true—the satisfaction of the discharge will invariably be transient relief. And the anger will be saying, “I’ll be back.”

Most of us know we can get a certain satisfaction or relief when we express aggression. There can be a seductive quality to the anger, and an adrenaline rush, and that’s why it can become a habit, even an addiction. Anger is like a fuel. When we get angry we can feel energized, stronger, bigger—picture an angry cat with a curved spine and raised hair, pretending to be bigger than it is to scare away what it’s actually scared of. However, anger isn’t a very efficient fuel, because it burns hot and costly. It can be quite polluting on the inside and outside, and it’s heavy and corrosive in the system.

Fortunately, there are other options besides the “three doors” of suppression, expression, and unconscious fueling. When insults or obstacles are perceived, it’s normal for an anger response to arise. It’s just our nature and evolutionary history at work. Though we may succeed in becoming angry less often, it will always be a part of our emotional lives and it is therefore critical to learn how to relate skillfully with this challenging energy. As soon as you remember that you’re not just a victim of your anger, that you can actually use it as a path of self-discovery, you can practice being present with the feeling of anger, connecting with it, and allowing its energy to arise and pass away without acting on it or suppressing it.

This is “door number four.”

Don’t underestimate the power of this simple method. As with mindfulness generally, it’s simple, but it’s not easy.

The capacity to work with anger mindfully is not a binary, either-you-have-it-or-you-don’t proposition. It’s a practice that builds gradually, strengthening the muscle of mindfulness in the face of pleasant and unpleasant experiences. Instead of identifying with, rejecting, or being unaware of anger, we can learn to approach it with openness and curiosity, trusting that anger has something to teach us, and that this can be a very productive part of practice.

Anger is not a special problem getting in the way of mindfulness practice. It actually provides you with an exceptional opportunity to practice mindfulness, to open up when habit tells you to shut down, to connect with experience when habit makes you disconnect, and to question if the image you’ve constructed of yourself and others is as solid as it appears.

There’s a Cherokee story that captures the nature of anger beautifully. A boy tells his grandfather about his anger at a friend who had done him an injustice. His grandfather replies: “Let me tell you a story. I too, at times, have felt great hate for those who have taken so much, with no sorrow for what they do. But hate wears you down, and does not hurt your enemy. It’s like taking poison and wishing your enemy would die. I have struggled with these feelings many times. My son, the battle is between two wolves inside us all. One wolf brings happiness. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith. But the other wolf…ah! The littlest thing will send him into a fit of temper. He fights everyone, all of the time, for no reason. He cannot think because his anger and hate are so great. Sometimes it is hard to live with these two wolves inside me, for both of them try to dominate my spirit.”

The boy looked intently into his grandfather’s eyes and asked, “Which one wins, Grandfather?”

The grandfather smiled and quietly said, “The one I feed.”

Training in mindfulness is remembering that every moment is an opportunity to practice peace, no matter the circumstances. Our thoughts, words, and actions are food for the wolves we all have inside. There’s no need for guilt when you notice you’re feeding the angry wolf (we all do this, and guilt won’t help). Instead, know that you have the freedom to learn from your experience and keep practicing with patience. Trust that it’s the small—often invisible—steps that take you forward.

MindfulnessBasedEmoBalanceWB-CF.inddMargaret Cullen and Gonzalo Brito Pons, co-authored “The Mindfulness-Based Emotional Balance Workbook. Join them for the Mindfulness-Based Emotional Balance (MBEB) Teacher Training Intensive, April 9-15, 2017 at EarthRise Retreat Center, Petaluma, CA. Mindfulness-Based Emotional Balance is an empirically-supported 9-week psycho-educational group intervention that teaches mindfulness meditation and emotion training.

 

 

eMindful Introduces QuitSmart® Mindfully A Successful Tobacco Cessation Study

site_logoSmokers pay dearly for their habit: their health, fun, relationships, and even their life. We also know that most adult smokers want to quit – more than 69% according to the CDC. Yet most smoking cessation programs don’t work over the long-term. In fact, smokers will try to quit an average of seven times. These statistics alone are why we want to let you know about a new mindfulness-based program: QuitSmart Mindfully which is a tobacco cessation program developed in collaboration with eMindful and Dr. Robert Shipley, Director of the Duke Medical Center Stop Smoking Clinic.

eMindful is offering the program for the first time in November 2013 and it will be taught by eMindful’s senior instructor, Jim Austin. QuitSmart Mindfully consists of 12 classes conducted in eMindful’s live, online classroom (where participants see, hear, speak to, and interact with both the instructor and other course participants) over a seven-week time frame

cfmcolorlogomed copy 2The November QuitSmart Mindfully course will be utilized to collect pre- and post-course data about the success of this program and to coincide with the Great American Smokeout. Through our UCSD CFM blog, the course is available at a deeply discounted rate of $125 (normally $395). Included in the course tuition is the QuitSmart® Kit, which includes an informative guidebook, a relaxing hypnosis CD, and a patented cigarette substitute. 

The new program is based on the highly successful QuitSmart® program: A study at five U.S. Air Force bases showed an impressive 66% quit rate after six months, which proved two to four times more effective than other smoking cessation methods. The program has also produced impressive success rates in studies published in Veterans Health System Journal and Psychology of Addictive Behaviors.

QuitSmart Mindfully integrates a significant mindfulness practice component.  The study will assess its ability to help participants:

·      Ease off nicotine.

·      Enhance coping skills by practicing acceptance of cravings, stress and emotional distress, rather than avoidance.

·      See themselves as comfortable nonsmokers rather than as smokers deprived of cigarettes.

·      Develop the respect for their bodies that naturally leads to freedom from cigarettes.

·      Break the smoking habit.

If you, or someone you know, would like to take advantage of QuitSmart Mindfully’s efficacy study, please click the following link to register: http://www.emindful.com/quitsmart-mindfully

Opening the Heart at Stanford, Google and Beyond

Margaret Cullen is a Licensed Marriage and Family Therapist and a Certified Mindfulness-Based Stress Reduction Teacher. In 2008 she launched a mindfulness-based emotional balance program for teachers and school administrators in Denver, Boulder, Ann Arbor, and Vancouver, B.C.  Margaret will be co-presenting, along with Amy Saltzman, MD the workshop entitled SMART in Education: Mindfulness-Based Emotional Balance for Educators at the upcoming Bridging the Hearts & Minds of Youth: Mindfulness in Clinical Practice, Education and Research conference, February 4-5, 2012 at the Catamaran Hotel in San Diego. (This article originally appeared in “Inquiring Mind.”)

Five years ago, a professor of neurosurgery at Stanford had a revolutionary idea: open a center dedicated to compassion right in the middle of the university. Today, The Center for Compassion and Altruism Research and Education (CCARE) flourishes within this citadel of academia. Here, it quietly pursues its mission of supporting and conducting rigorous scientific studies of compassion and altruism, developing ways to cultivate compassion and promote altruism within individuals and throughout society.

Thupten Jinpa was enlisted as a visiting research scholar at CCARE, during which time he developed a course of study called the Compassion Cultivation Training (CCT). An eight-week program modeled after Mindfulness-Based Stress Reduction (founded at the University of Massachusetts by renowned meditation teacher Jon Kabat-Zinn), CCT teaches Buddhist meditation practices in a completely secular way. Instead of focusing on mindfulness, though, this training emphasizes practices of the heart.

Beginning by developing a foundation of breath awareness, the program systematically teaches students to cultivate the qualities of kindness (metta) and compassion (karuna). Each series of the program begins by sending kindness to people such as grandparents, friends and children—those individuals toward whom it is easy to access tenderness. From there, participants progress to thinking of people about whom they are ambivalent or who cause them downright frustration: the barista at the local café, the bagger at the grocery store, the ex-husband’s new wife. The CCT strives to help individuals imagine each of these people happy and flourishing. But the program also encourages participants to remember or imagine times when they themselves have been hurt, shamed, ill or suffering in some way. By working through such progressions, participants can learn to strengthen the muscle of the heart. Such strengthening can engender a fearlessness that allows them not only to send others wishes of love, and compassion, but to also breathe others suffering into their own hearts and to breathe out relief and ease.

To date, the program has been piloted at Stanford, Google, the Cancer Support Community and in a few series open to the general public in the San Francisco Bay Area. As one of the senior teachers, I have witnessed many transformations. A recent training I led with cancer patients and their loved ones generated a number of moving stories. The following are just two of the narratives of heart that emerged from the eight-week program:

A cancer patient in active treatment has been living with, and caring for, her ninety-five-year-old mother. Having developed her own capacity for tenderness and generosity, the daughter made a radical decision. At our closing circle she shared with tears that she and her mom had invited her suicidal and recently homeless nephew, a war veteran, to come live with them. She said, “Before this course, I might have tried to help him, but my heart wouldn’t have been open enough to take him into my home.” Through this extraordinary act of compassion, both she and her mother learned that, in spite of the limitations imposed by age and illness, they could find happiness by helping another person.

A retired professor of environmental science took the course in order to support his wife, a cancer patient. He told us, “I spent a lot of time talking with my students about the ‘problem’ of poverty, but I just didn’t feel the suffering.” About to cry, he said, “If I had taken this course earlier, I think I would have been a better teacher. Poverty isn’t just a term you can pass over and move on. I’m now able to draw it in and feel the pain. This has been a big aha.”

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

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 .