Tag 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.

 

 

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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

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