Mindfulness and Chronic Illness
Mindfulness is taking the field of Psychology by storm, and is indeed a very useful set of practices in psychotherapy which have a very strong evidence base.
Mindfulness is the practice of focusing and changing attention in a purposeful manner. Many Mindfulness practices are thousands of years old including meditation practices of Buddhist monks, Yoga, martial arts, and even prayer.
In the fields of psychology and neuropsychology we are beginning to understand what about these ancient meditation practices actually affect us on a biological level. Our scientific understanding of these practices is unlocking countless techniques and applications of Mindfulness, and most importantly we are beginning to understand what aspects of these practices are actually changing our brains.
The purpose of this article is to bring forth some of the key ingredients in Mindfulness practice. The active cognitive shifts that allow us to separate from discomfort, increase awareness, and be able to move forward from sources of distress.
Mindfulness: Quick and Dirty
- Mindfulness is the practice of identifying thoughts and further developing our natural ability to change our focus and attention.
- A key ingredient in Mindfulness practice is finding ways to become an observer versus a participant of our thoughts, emotions, and sensations.
- Learning to observe thought and/or emotion serves two purposes:
- First: it increases our ability to identify what is bothering us and what we are paying attention to.
- Second: it starts the process of separation from the thought and/or emotion.
- Instead of countering the negative thoughts and/or emotions the goal is to accept and embrace them by identifying their purpose in our attention, and how much attention they actually require.
- Once we have become a observer to the source of discomfort and identified and accepted it’s purpose we innately begin to increase our awareness of everything else around us.
- We rebuild our focus on the now, and bring into focus the whatever else is co-existing with discomfort in the present moment. It can be focusing on breathing, looking around us, identifying thoughts that are sources of peace and comfort, and really just about anything that brings a sense of comfort and soothing into present awareness.
- Ideally this process allows us to separate from and contain the sources of discomfort and bring into active awareness what we prefer to pay attention to.
Why is Mindfulness so Important in the Treatment of Chronic Illness
Over the past decade we have learned a lot about how we experience pain and discomfort. The biggest and most revolutionary discovery in regards to our experience of discomfort and pain is that much of it is felt in the emotional center of the brain.
Our sensory reception of pain turns out to be a close neighbor to where we feel emotional suffering. When we experience a physical sensation of pain or discomfort the emotional part of the brain that experiences pain and suffering fires as well. This has a clear evolutionary purpose in that we feel suffering to help us identify solutions and get out of danger when we are sick or injured. The firing of neurons involved in emotional suffering raise injury into conscious awareness allowing us to plan and survive.
However, the downfall is that our minds tend to remain trained on pain and emotional suffering as the brain constantly looks for a solution to the current source of discomfort. In chronic illness this often becomes debilitating since there are only partial solutions to the discomfort.
Our present focus, yes now we’re getting back to Mindfulness, remains trained on solving the pain and discomfort. Our brains want an answer, and continue to scream DANGER even when the reality is that the pain or discomfort is an ongoing baseline, and/or has been addressed medically the best it can be for the moment.
Practicing Mindfulness in these instances allows us to identify sensations of pain and discomfort that do and do not deserve our attention. With practice we can separate ourselves from the experience of emotional suffering and pain and retrain our attention to be on other things.
This does not mean dismissing pain, powering through, or simply trying to ignore. It means making active plans to reduce symptoms, identify activities that are possible with the current symptoms that are positive, and in the end accepting this for what it needs to be in the moment.
The goal is also not to eliminate discomfort, instead it is to move discomfort into the background and allow for positive and enriching experiences to move into the foreground of our awareness.
Example: Mindfulness and Vertigo
Nausea begins, the room starts spinning, and the brain starts screaming panic and anxiety as it no longer knows where it is in the world. Immediately, there is a feeling of distress, extreme physical discomfort, and helplessness.
Backing away from the experience and identification of the stressor:
The room is spinning, I feel like throwing up, I am scared because I can no longer easily tell where I am, I am having a vertigo attack.
The purpose is to identify what is being felt and step into looking at our thoughts, rather than from our thoughts. Through labeling and identification of our experiences we move them into cognition rather than being purely experiential.
Identification of partial solutions:
What can I do to make this a bit better right now? I can take medication X, I can lay down, I can turn the lights down . . .
A lot of Mindfulness exercises do not include this, I find it invaluable. When we experience any sort of stress we are searching for solutions, and there are always at least partial solutions to the problem.
Also there is often an actual problem that needs to be identified and treated immediately. In the case of vertigo it is usually imperative to take medication and get to a safe place.
However, when identifying solutions in Mindfulness the purpose is not to dwell or seek for a full resolution, it is to identify immediate steps that can be taken to make the situation safer and a little bit more comfortable.
Identification of the unsolvable:
I can lessen the experience of the vertigo episode, but not eliminate it. When having this kind of episode I can’t do certain things that I want to get done.
It is a natural response of the brain when the experiencing emotions of suffering and pain to focus on the negative. We are naturally drawn up into a cycle of what we can’t do, instead of what we can do. It is important step in increasing mindfulness to address the existence of “can’t do”, and then build the ability to then bring into awareness the “can do”.
Acceptance of the Dissonance and Moving into a State of “Can Do”:
I can’t do what I want to do, but this is ok, I need to take care of myself and those things can be done later. Even though I don’t feel well, there are things I CAN do, and I can still experience comfort while being uncomfortable.
Our brains do not like unsolved problems, a way around this is to solve the problem by accepting that it cannot be solved. This is the process of shifting away from looking for full solutions, and instead recognizing the benefit of accepting that a partial solution is what can be gained from the current situation.
Observance of the moment:
It is a pretty summer day, I can hear the birds, there are children playing outside. It is dim in the house, and cool. There is some comfort in the dim, cool, and quiet and it is is helping me feel a little better.
The goal is to bring into awareness everything else that is going on. It often helps to focus on the external world first to increase the separation from discomfort. Then stepping back into the internal world with reduced attention on the discomfort and an increased awareness of positive thoughts, plans, etc.
Redirection of Attention and Active Coping:
With vertigo some examples are focusing on one spot, though I prefer to close my eyes and cradle into something (usually the back of the couch). For me it also helps to add low level stimulus that can help continue the redirection of attention. With vertigo I find it is a great time to listen to a book on tape, news radio, or documentary. For some music might be helpful, or simply slipping into more formal meditation practices. I personally enjoy using documentaries and news radio as I am actually learning and experiencing something while I am suffering an attack, rather than just enduring the attack.
This is the process of identifying low impact tasks that can take the center of attention instead of the source of discomfort.
Mindfulness ideally gives us enough space from the source of stress to be able to engage in something else. The goal of mindfulness when managing distress is to move the distress into the background and allow other sources of thought, stimulus and activity into the foreground.
Finding Mindfulness Practices that Work for You: Identify Your Barriers AND Strengths
True story: When I developed Chronic Migraine with MAV and Meniere’s disease I was in the middle of completing my continuing education classes to maintain my professional license. Given the focus of my therapy practice taking a seminar on Mindfulness was a great idea.
Except! Virtually all of the Mindfulness exercises taught in the class of over 50 people involved multi-tonal chanting and humming, and also practicing these techniques while walking.
The exercises being taught were actually on a visceral level triggering for my vertigo attacks. I had to let the instructor know that I couldn’t do the walking exercise because I would likely fall. I sat in the back so I could quickly leave the room if the chanting and humming became overwhelming (and it often did).
However, it was a great chance to practice Mindfulness, while the class was learning their Buddhism based meditation exercises that were triggering me, I used it as an opportunity to practice my own. I meditated on the purpose of Mindfulness and how what the class was learning and what I was doing was in the end achieving the same goal.
There is No One Size Fits All in Mindfulness
With many chronic illnesses there are usually a variety of stimuli, and body postures that can aggravate the condition. So learning a Mindfulness practice that increases discomfort is not the best idea.
As an example: While proper posture and mindfulness based meditation can both greatly improve back pain, learning the mindfulness meditation in complete silence with a straight back in full lotus position is likely going to be the opposite of helpful.
Also, we all have our own innate strengths and weaknesses regarding how we think. The techniques we learn to create a good environment for mindfulness should go with our strengths and not our weaknesses. Not everyone is great at visualization techniques (I tend to suck at them), not everyone is good at breathing exercises, not everyone does well with being in a state of stillness. There are techniques that actual make use of thought flow, involve movement, and allow for outside stimulus.
It is also ok to like parts of a technique and not others, and adjust that technique to fit you. As long as you are working towards retraining attention, you’re not doing it wrong. When I use recorded relaxation and meditation exercises by myself or with clients I focus on identifying what about the exercise is helpful, and what is not. Then in further use of practicing with the recording only using the helpful portions. Usually overtime what is developed is a completely new exercise that is created by and tailored to the individual.
The goal of Mindfulness techniques is to further develop our ability to purposefully guide our attention and focus. The goal of mindfulness is not to eliminate discomfort, but rather teach ourselves to shift discomfort into the background, and give ourselves space to put what is positive in the foreground.
Mindfulness is a process of brain retraining. However, it is not the brain learning a new skill, rather it is teaching the brain to be more aware of its attention and focus, and to be able to purposefully change that direction and focus.
Often in learning Mindfulness relaxation exercises, meditation techniques, Yoga, and various therapeutic models can assist in creating a more ideal environment for the brain to train these skills. However, what is most important is finding what method works for you, and learning to change attention, versus focusing on learning a particular meditation technique.
In fact Mindfulness techniques can be developed out of just about anything. From aromatherapy, to yoga, to Buddhist chanting, to relaxation tapes, visualization exercises, with music, the sky is the limit. Mindfulness can be practiced sitting up, lying down, eyes open and eyes closed. What matters is discovering what works for you.
Resources and References
- Using Mindfulness to Approach Chronic Pain (Psych Central)1
- Article on the Relationship Between Physical and Emotional Pain (Healthline)2
- Keys to Mindfulness Practice (Groundwork Counseling)3
- An Introduction to Mindfulness in Psychotherapy (Advances in Psychiatric Treatment)4
- Mindfulness in Motion (Institute for Mindfulness Studies)5
- Mindfulness Resources for Chronic Pain (Dr. Kavanagh, Rheumatologist)6