Category Archives: Fibromyalgia

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.

 

 

Staying : turning towards what is difficult [ Part I]

By Char Wilkins,

charwilkinsChar Wilkins, MSW, LCSW is a mindfulness-based psychotherapist who works with individuals, couples and groups incorporating the intention and skills of mindfulness as a foundation from which to explore one’s life. She leads  MBSR, and Mindful Eating/Conscious Living (MECL) retreats for our Professional Training Institute and programs in her own practice for the general public.

When challenging or unwanted thoughts, emotions or behaviors arise most of us want to avoid or distract ourselves. We may use food, drugs, work or exercise to temporarily sooth, comfort or numb the difficult internal experience. Unfortunately, repeatedly coping in this way creates a habituated pattern that carries with it more shame and fear, and the hope of change slips further away into a seemingly endless out-of-control cycle.

There is of course, a reason why in mindfulness-based work we turn towards what we believe to be so difficult that if we don’t run, we won’t survive. And that is because when we come to know the taste, texture, temperature, shape, sound and movement of the unwanted thought, emotion or sensation, it is no longer a lurking shadow threatening to overwhelm us. It is felt and known for what it is: just a thought. Observed and held in awareness without judgment, it takes its right-sized place in the scope of who we are. Turning toward the difficult offers the possibility of freeing ourselves from the very patterns we fear the most.

Perhaps you’re thinking that this “staying with thing” is not the way you want to spend your day off. It’s not a comfortable thing to do. It just doesn’t have the same feeling that you get when you’re angry, depressed or anxious and think: ” A day at the beach is what I need.” or “A hot fudge sundae would do the trick right about now.”   But one getaway is never enough, is it?  And then, of course, returning is too much. This jumping back and forth we do is wearisome. That’s why the practice of mindfully staying with what is here right now, is so important. Ultimately it conserves energy, time, wear and tear on body and soul, and so much drama is avoided.

I’m aware that I ask participants in MBSR, MBCT and MECL programs to do a very challenging thing: be present to what is arising in the moment and to allow it to be known. It isn’t easy to not turn away from, to not disassociate, to not to run.  Bolting is the norm. If it doesn’t feel good, leave. Leave the person, place or thing. I’m not suggesting that you stay if you’re being abused. I’m talking about the everyday moments when we think, “I wouldn’t have to get so angry if only he wouldn’t ____________.  If she’d just ______________, I’d be happy.” As I’ve sat with clients and participants over the years, I’ve watched so much “bolting,” that recently I thought a new reality TV show entitled “Extreme Bolting might get higher ratings than the X Games since more people bolt than Cave Dive, go Wingsuit Flying or attempt Extreme Ironing. Look it up, it’s worth it.

In Part 2, I’ll share how in working with women who have experienced abuse or trauma mindfulness of the body can help them learn how to stay with what is difficult.

Listen on Monday September 9, 2013 from 12:00pm-1:00pm to Char Wilkins, MSW, LCSW, in a special teleconference  exploring how we sometimes use food which temporarily soothes, comforts or submerges the difficult internal experiences.

 

MBSR & Fibromyalgia a Preliminary Study

Mindfulness-based Contemplative Training Reduces Avoidance and Facilitates Disengagement from Threat in Women Diagnosed with Fibromyalgia
David Vargo

Eight-week courses in mindfulness-based contemplative training focusing on specific meditation and yoga practices have been shown to have explicit benefits for many clinical disorders, especially with relation to treating stress, targeting emotion dysregulation, and attentional processes, yet little research has explored the effects of these practices in the context of bias.
Attentional bias is a tendency to focus on one aspect of the environment over others. A bias may arise through varied mechanisms, but is driven by evolutionarily shaped mechanisms. Attentional bias will influence how one perceives and processes information in the present moment, from the past, and how one anticipates the future. Humans typically have their attention automatically captured by fear-relevant stimuli, and for good reason, to avoid danger and threat of harm. Persistent attentional bias to threat cues in the environment will typically result in increased perception of danger, hypervigilance, and often frequent or intense experiences of anxiety. Although it may appear that an enhanced sensitivity to detecting threat is advantageous, hypervigilance is not necessarily adaptive, as it consists of persistent intensified monitoring and attentional fixedness at the expense of ongoing cognitive demands and a continually active sympathetic nervous system. Hypervigilance may also generalize to innocuous stimuli, wherein non-threatening stimuli are determined to be threatening. Thus, bias becomes a distorted interpretation of one’s experience, with consequences that could lead to chronic anxiety and stress-mediated pathology. Interestingly, there is now evidence that hypervigilant processing could be occurring without conscious awareness, such that very early stages of sensory processing (e.g., < 300 ms from stimulus exposure) are detecting possible threat-related cues. Once a threatening cue is detected, automatic and strategic forms of emotion regulation processing typically follow. Automatic forms of processing have the potential to operate below conscious awareness as well, and are typically over-trained, habitual responses to threat. Strategic forms of processing are more volitional, and cognitive in quality. Avoidance is one emotion regulation strategy that occurs at both automatic and strategic time-courses for the purpose of reducing elaborative or evaluative processing and deflating the threat value of the stimulus. When avoidance becomes habitual, it also can be maladaptive.
Both hypervigilance and avoidance have been found to contribute to the exacerbation of chronic pain and disability, and a vulnerability to pathological emotional states in chronic pain disorders like fibromyalgia (FM). FM is a disorder characterized by diffuse tenderness and widespread chronic pain, and is often accompanied by impaired cognitive, emotional, and physical functioning. Although various external stimuli such as infection, trauma and stress may contribute to development of FM, recent studies have emphasized the role of hypervigilance and avoidance of pain-related information. Pain-related information are cues in the environment or recalled from one’s memory and can be anything from images, sounds, certain trigger words (e.g., sharp, pounding, throbbing), or even people that remind one of a past experience of pain. Because these cues have previously been associated with pain, a heightened sensitivity towards such pain-related information develops and leads to a generalized pattern of hypervigilance.
My colleagues from the Utah Center for Exploring Mind-Body Interactions and I recently published a preliminary study in Cognitive Therapy and Research that investigated attentional bias of pain-related threat between women diagnosed with FM who went through an 8-week course of mindfulness-based contemplative training and an age-matched comparison control group of female FM individuals. The mindfulness-based training program was designed to accommodate the physical limitations of the FM population, but modeled after curriculum for Mindfulness-based Stress Reduction (MBSR) (see paper for exact modifications). A well validated dot-probe task (see paper for methodology of task) was used to explore early versus later stages of attentional bias processing of pain-related threat words. The rapid exposure of cues at short durations (100 ms) intended to capture automatic stages of processing by limiting attention to early sensory-perceptual stages, while longer cue durations (500 ms) intended to capture initial strategic forms of cognitive processing. The data indicated that individuals from the control group appeared to be hypervigilant-avoidant in their processing of pain-related threat, such that pain-related words were rapidly detected and avoided without much time for conscious elaboration. This form of avoidance is presumed to be a highly conditioned, automatized form of processing. Individuals from the control group also appeared to have difficulty disengaging from pain-related threat once strategic, elaborative processing was possible. This lingering engagement with negative stimuli slowed their response time on the dot-probe task, such that processing of threatening stimuli was assumed to interfere with the necessary processing for the task at hand (i.e., keyboard press indicating position of dot-probe). One may speculate that the mental stickiness that is typically described as a target for Buddhist meditation practices could also be explained by disengagement difficulty. Extended elaborative processing has also been implicated in ruminative cognition, a maladaptive, repetitive evaluation of one’s experience in a negative context.
The individuals exposed to mindfulness training demonstrated significantly less avoidance of threat than individuals from the control group and also disengaged more rapidly at later stages of processing. These results suggest that mindfulness training reduces avoidance of pain-related threat at early levels of attention processing, and facilitates disengagement from threat at later stages of processing. Furthermore, it appears that effects of mindfulness training on early attentional threat processing do not remain stable after long-term follow-up. The enduring effects of mindfulness training on attentional bias were assessed 6-months after completion of the mindfulness-based program. With little to no continued meditation practice, the apparent effects on attentional bias were reduced. What did remain was a lack of attentional bias towards pain-related threat in comparison to neutral words.
The take-home message for this preliminary study is that mindfulness training for individuals diagnosed with FM appears to increase engagement with and decrease avoidance of pain-related information that normally leads to anxiety and emotion dysregulation. Furthermore, mindfulness training appears to decrease time of lingering or “mental stickiness” with pain-related information. Further studies will have to investigate whether the decreases in bias after 6 months with little to no continued practice were indicative of a linear trend towards maladaptive avoidant emotion regulation strategies, or a stabilization of attention over time, in which no bias remains between threat and neutral stimuli. This study is the first preliminary evidence for the effect of mindfulness training on attentional bias. Future studies are also needed to clarify changes from pre- to post-meditation training using a mixed level of analysis, so that within and between group comparisons can be properly made.

David R. Vago, Ph.D.
Harvard Medical School
Brigham & Women’s Hospital
Dept. of Psychiatry

reference:
Vago, D.R. & Nakamura, Y. (2011). Selective attentional bias towards pain-related threat in fibromyalgia: Preliminary evidence for effects of mindfulness meditation training. Cognitive Therapy and Research, 6(35), 581-594. doi: 10.1007/s10608-011-9391-x