Category Archives: Pain

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.

 

 

Navigating Aortic Valve Replacement (AVR) Surgery with mPEAK and Mindfulness

logo-mpeak

Read this very personal story from a recent mPEAK participant and Join Pete Kirchmer for the next mPEAK 3-Day Intensive March 11-13, 2017, UC San Diego Center for Mindfulness, San Diego, CA.

By William R. Matthews, MA, LPC

Medical literature contains numerous references proclaiming the benefits of meditation and mindfulness on cardiovascular health and pain management. But to me, these were merely academic case studies, as I had not personally known anyone who had successfully used mindfulness to manage through a major medical procedure. That is, until August 17, 2016, when I had aortic valve replacement surgery.

I need to back up a moment. In March of 2016 I participated in the three-day mPEAK intensive that included six weekly one-hour conference call follow-ups. For me the follow-up sessions were critical for integrating the didactic and practice sessions taught in the three-day into a consistent meditative practice. mPEAK was my first hands-on experience with mindfulness. At that point in time, I had been aware for several years that I had a bicuspid aortic valve that would “eventually” need replacement (in fact it kept me from fully participating in the five-mile mindful walk that is part of the program), but there had been no discussion of surgery with my primary physician or cardiologist. Two months after returning from mPEAK, my new primary care physician sent me for an ultrasound of my heart. The results indicated significant blockage of the aortic valve, and that started the ball rolling for surgery “as soon as possible.”

When a date for surgery was set, I emailed mPEAK ccf9e-headshot2program director, Peter Kirchmer, asking if he could provide me with additional mindfulness resources on pain management, since that seemed to be a big concern connected to surgeries. In response, Pete wrote “Forget about additional resources. You have everything you need already. Just continue developing the skills you already have.” Wise counsel indeed. So I loaded up my iPod with all the meditation files mPEAK had made available to us on its website, added John Kabat-Zinn’s Mindfulness Meditation for Pain Relief, and a few other meditations. I played these every evening before bed, in the waiting lounges of airports, and in my office sharing them with my clients. Ultimately, my iPod was headed with me to the hospital.

The night before surgery I slept soundly without the benefit of any sleep aid other than my meditation-filled iPod. I arrived at the hospital at 5:40 AM surgery day and was taken back to pre-op shortly thereafter. The nurse remarked that my blood pressure showed no signs of anticipatory anxiety.  I too was surprised at how calm I was considering someone was about to cut my chest open and mess with my heart. I told the nurse about my mindful preparation and she asked a lot of questions of interest to learn more. A brief chat with a family member, a friend and a short prayer from the rector of my church was all I remember before waking up almost six hours later.

I awoke in recovery to see the same three faces that I had left there that morning. After a few minutes I was taken to cardiac ICU. A nurse and a member of the physical therapy team armed with a pillow were waiting for me. The PT announced that she was there to help me get into bed by “leaning into my pain and clutching the pillow” as my incisions were on the right side along with two chest tubes. Even in my post-anesthesia fog, my mind went immediately to a body scan, noting that my left side was incision- and tube-free. I also made a mental note that at home my bedroom is set up so that I can only get into bed from my left side. I got up off the gurney without assistance walked around the end of the hospital bed, sat down and got into bed on the left side of the bed without assistance (with minimal pain) and said, “I think I’ll do it this way instead.” The PT could only respond, “I guess that way’s OK too.”

The nurse waiting her turn with me announced that she was there to help me with pain management. She advised, “The key to pain management is staying ahead of the pain.” I interpreted that to mean don’t wait until the pain gets bad, keep taking your medication. At that point my mind recalled an activity from mPEAK where we were asked to insert a hand up to mid-forearm into a bucket of ice water and keep it there until the pain started to hurt. Most people removed their hands from the buckets in under a minute. The teachers explained that a large part of managing pain is changing our relationship to the pain. After sharing techniques and mindsets for doing so, we were given the opportunity to try immersing our hands into the ice water again. Most everyone were able to keep their hands in the ice water for considerably longer the second time around. With this recollection I informed the nurse of my plan – to measure my pain on a scale from 0-5 every hour or so, and if the pain number was not any higher than the last “reading” I wouldn’t be asking for pain medication. I received medication for pain only twice: 1) shortly after arriving in the ICU and 2) later that day when they removed the chest tubes. By the next morning, the day after surgery, I had discontinued all pain medication for the remainder of my hospital stay.

Prior to my surgery, my cardiologist and cardiac surgeon both agreed that I would need to go to a rehab facility “for at least a week” after being discharged from the hospital because I live alone. However, I created a dilemma for them because my recovery was so quick and complete. The discharge social worker advised me that I didn’t meet any medical criteria for rehab placement. She even had PT and OT evaluate me one more time in hopes of coming up with some reason to get me admitted, but neither could come up with a medical need. So I was discharged after 4-1/2 days, with my doctors agreeing that I could stay with a friend who lived within a mile of the hospital. I had a return visit to the cardiac surgeon four days afterward. At that appointment my cardiac surgeon said I was free to go back home and decide for myself when I would go back to work. I was back to work half-time three weeks after surgery and returned to full-time work the following week.

While I wouldn’t necessarily put AVR surgery in the category of a high performance activity, I am convinced that the skills and tools I learned from mPEAK, played a central role in my recovery.

William R. Matthews, MA, LPC is in private practice with the Great Lakes Psychology Group. Bill works out of GLPG’s office in Clinton Township, Michigan, where he counsels with children, adolescents and adults using family systems, EMDR, Mindfulness and sports psychology approaches. Bill is also a volunteer trainer and curriculum consultant for the University of Notre Dame’s Play Like a Champion Today educational program. Bill can be reached at bill.matt.GLPG@gmail.com.

Join Pete Kirchmer for the next mPEAK 3-Day Intensive March 11-13, 2017, UC San Diego Center for Mindfulness, San Diego, CA.

ccf9e-headshot2Pete Kirchmer is  the Program Director for the UCSD Center For Mindfulness mPEAK (Mindful, Performance Enhancement, Awareness & Knowledge) Program. Pete specializes in coaching his clients in applying the practice of mindfulness to making healthy lifestyle changes as well as improving performance in life, work and sport. For more information about Pete Kirchmer please visit his Mindfulness Based Health Coaching website.

The Mindfulness Solution to Pain: Read The Story of Adam & MBCPM

 

Mindfulness-BJG_1-full-resolution-copy-150x150ased Chronic Pain Management (MBCPMTM) founder Jackie Gardner-Nix is a Physician and Chronic Pain Consultant, St Michael’s Hospital, Toronto and Associate Professor, University of Toronto. Join Jackie May 10-15, 2016 at EarthRise Retreat Center, Petaluma, CA, for a 5-Day Professional Training.

The Mindfulness-Based Chronic Pain Management (MBCPMTM) course is a modification of the Mindfulness-based Stress Reduction courses established by Jon Kabat-Zinn which are now world-wide. There are cognitive aspects to the MBCPMTM course, as well as carefully crafted meditations to speak more to the chronic pain sufferer than the general participant who signs up for mindfulness training.

In most Mindfulness program there MBCPM-Bookis a curious ratio of 70 to 80% women to 20 to 30% men, yet men benefit very much from this work, and many of the leading teachers in Mindfulness are men. The following is a moving story emailed to me one year after taking our course by a young man, his site connecting with mine where I was co-facilitating the course via telemedicine in Ontario, Canada. At his site sat a young, softly spoken neurologist, doing her first co-facilitation via telemedicine with me after training in our curriculum, before launching her own courses. He repeated the course to gain more training in mindfulness, joining her for her first solo course.

Adam’s Story

by Adam Michael Segal

Pain overview:

My chronic pain odyssey began in early 2012. It was based in my bladder and was from an inflammatory condition called Interstitial Cystitis (IC). I also later developed chronic neuropathic pain. The pain was debilitating, relentless and as it persisted and intensified, it completely broke me down. It ruled my life. As a result, my marriage ended. I was unable to work. I fell into a major depression. I was 37 and doubted I would make it to 40.

MBCPMTM: After seeing nearly 20 specialists, I was referred to Dr. Jackie Gardner-Nix’s Mindfulness Based Chronic Pain Management (MBCPMTM) class in the summer of 2014. While initially shy and quiet, as I started to speak with classmates, I felt understood for the first time in years, even validated. Finally, there were people who could relate to me and my suffering. And a doctor who actually ‘got it!’ As I read sections of Dr. Jackie’s book, The Mindfulness Solution to Pain, it was like reading my biography. Some case studies in the book were people just like me – similar personality traits, pain triggers and emotional responses to pain.

Over time, the book, classes, activities, guided imagery and meditation collectively led to something transformative happening; my attitudes and views started to change. I began to realize that my emotions, especially bitterness and hopelessness, impacted my pain in a negative way. I began to gradually accept the pain and let it be. I started to focus my thoughts on the positive things in my life. For example, I had written a manuscript for a children’s book and I started to explore publishing it. And I went to my GP to get referred to a urologist in Kingston, Ont., who was Canada’s leading authority on IC.

Fall of 2014: I met with the urologist. I went into that consult with a positive, hopeful attitude. I can say emphatically that MBCPMTM contributed significantly to me being positive during the doctor visit. Everything I learned from MBCPMTM helped arm me with the courage to follow the urologist’s treatment regimen, which included invasive and painful bladder instillations – a treatment I had feared tremendously. Within a few months, my symptoms started to improve considerably.

Winter 2014/2015: I participated in a second round of MBCPMTM led by another doctor who was trained by Dr. Jackie. By March, I returned part-time to my job and dedicated the rest of my time and strength to the arduous process of self-publishing a book. In September, the book was printed and I started to do readings and author visits at schools. Children literally mob me like a rock star when I read. They laugh and learn and I glow in knowing my creation brings them such joy. In October, I hosted a book launch party with over 100 people. An article about the book and the pain I managed well enough to produce it, was published in a local paper.

Fall 2015: I continue to take most of the medications prescribed by the urologist, but I no longer require the invasive treatment. I still experience neuropathy, but it has no impact on my mood. My thoughts, views and attitudes are bursting with hope and optimism. MBCPMTM enabled me to really understand the mind-body connection. It helped me cultivate a frame of mind in which I control my life, not pain. I am mindful every day of how far along I have come and how happy I am to live in the here and now. And that gives me strength to live a fulfilling life.

About the Author

Adam Michael Segal is an expert in healthcare communications and author of the recently published children’s book, Fartzee Shmartzee’s Fabulous Food Fest, available on Amazon. Mr. Segal intends to develop the main character into a health & wellness super hero for children. Earlier in his career, Mr. Segal was a journalist and wrote articles for such media as The Toronto Star, National Post and CBC. Mr. Segal hopes his story inspires others with chronic pain to make mindfulness a central part of their healing solution. He holds degrees in Arts, Education and Journalism.

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.

 

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

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

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… Before CancerI 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. Cancer ShockI 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.

mindfully cutting veggiesThe 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.

ListenSo 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 28th (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.     cancer and mindfulness 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

Fight or Dance: You get to choose!

Shauna Shapiro and her colleagues (reference below) wrote about the mechanisms of mindfulness and highlighted “reperceiving” as a fundamental shift in perspective that arises out of the practice of mindfulness. This is not just an interesting theoretical point, it has real consequences.

Consider the case of a patient suffering from chronic pain who learns, through the practice of mindfulness, that his “awareness of pain is not actually in pain”. This reperceiving of what was previously a very personal and self-identified experience affords the patient, in an instant, a whole range of possible behavioral and attitudinal responses to the pain that he cannot directly control. These responses may include some degree of acceptance, accommodation or creative responding that can be characterized as psychological flexibility.

This shift was highlighted with remarkable clarity by a participant in MBSR who had significant amounts of chronic pain, and had suffered with it for many years. This experience led to depression, anxiety and frequent suicidal thoughts when he encountered reminders of the likelihood that his pain would never go away. One day in psychotherapy after completing the MBSR class he noted “I’ve always been a fighter. I wrestled, I played football (and often played hurt), I became successful in business by being tough and competitive, and when I got injured and the pain persisted after multiple surgeries, I fought with the pain too. After taking the class and practicing meditation, I found that instead of fighting with my pain, I could dance with it. That’s huge!” Thus, in a simple but fundamental act of reperceiving (described as “an orthogonal rotation in consciousness” by Kabat-Zinn), this man was able to discover an option that had always been available to him but completely lost in his focus solely upon the pain itself. The profound possibilities inherent in that reperceiving (e.g. dancing rather than fighting with pain) forms a foundation for the type of fundamental changes and transformations that people experience through mindfulness practice.

What are you fighting with and could you consider dancing with it instead?

Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. J Clin Psychol, 62(3), 373-386

Fascinating New Article on Meditation and Pain: Referring to “No Appraisal” vs “Re-Appraisal”

The Journal "Pain"The journal Pain has scheduled an article for publication in a future issue: “A non-elaborative mental stance and decoupling of executive and pain-related cortices predicts low pain sensitivity in Zen meditators.” The authors are Joshua A. Grant, Jerome Courtemanche, and Pierre Rainville.
ABSTRACT:
Concepts originating from ancient Eastern texts are now being explored
scientifically, leading to new insights into mind/brain function. Meditative practice, often viewed as an emotion regulation strategy, has been associated with pain reduction, low pain sensitivity, chronic pain improvement, and thickness of pain-related cortices.
Zen meditation is unlike previously studied emotion regulation
techniques; more akin to ‘no appraisal’ than ‘reappraisal’. This implies the cognitive evaluation of pain may be involved in the pain-related effects observed in meditators.
Using functional magnetic resonance imaging and a thermal pain paradigm
we show that practitioners of Zen, compared to controls, reduce activity in executive, evaluative and emotion areas during pain (prefrontal cortex, amygdala, hippocampus). Meditators with the most experience showed the largest activation reductions. Simultaneously, meditators more robustly activated primary pain processing regions (anterior cingulate cortex, thalamus, insula). Importantly, the lower pain sensitivity in meditators was strongly predicted by reductions in functional connectivity between executive and pain-related cortices.
Results suggest a functional decoupling of the cognitive-evaluative and
sensory-discriminative dimensions of pain, possibly allowing practitioners to view painful stimuli more neutrally. The activation pattern is remarkably consistent with the mindset described in Zen and the notion of mindfulness. Our findings contrast and challenge current concepts of pain and emotion regulation and cognitive control; commonly thought to manifest through increased activation of frontal executive areas. We suggest it is possible to self-regulate in a more ‘passive’ manner, by reducing higher-order evaluative processes, as demonstrated here by the disengagement of anterior brain systems in meditators.
The author note provides the following contact information: Joshua
Grant, Departement de physiologie, Universite de Montreal, Montreal, QC, Canada H3C3J7; <joshua.grant@umontreal.ca>

Springer Publishes New Journal: Mindfulness

Springer's new journalHow nice to see a major publishing firm come out with a scientific journal dedicated solely to the study of mindfulness. The first volume contains several interesting and intriguing articles.

Mindfulness, Volume 1, 2010

Which article gets your interest? We would love to know . . .