Post on 24-Dec-2015
Mindfulness in Psychotherapy: Managing Pain
with
Steve Shealy, PhD
What is Mindfulness?
Mindfulness is:intentionally directing one’s attention to their present experience without:
judgment internal dialogue/self-talk emotional reactivity/acting in
physical reaction/acting out attempting to avoid the experience
Definitions of Mindfulness:
As Mindfulness relates to psychotherapy, it may be best defined as
awareness of
one’s present
experience
with
acceptance.
Mindfulness in Psychotherapy: Pain
This focused state of mind regardless of underlying state results in an experience that seems deeper, richer and more fulfilling
Pain can serve as the underlying state leading to this clarity and focus of mind
Mindfulness in Psychotherapy: Pain
Clear Focus of Mind Often Occurs: In a Very Relaxed State
OR in a Very Dangerous or Threatening Situation
Mindfulness in Psychotherapy: Pain
We balance this
Increased
Awareness
with
Equanimity
Mindfulness in Psychotherapy: Pain
Equanimity: Maintaining a Balanced MindBetween:
Suppression: stuffing the experience down
Identification: fixating and holding onto the experience, not allowing it to pass through
Mindfulness in Psychotherapy: Pain
Equanimity is remaining relaxed and open to the experiences passing through our awareness with an attitude of lovingkindness
Chronic Pain PatientsFour-year Follow-up of a Meditation-Based Program for the Self-Regulation of Chronic Pain:Treatment Outcomes and Compliance. Kabat-Zinn, et al Clinical Journal of Pain (1987)
n=225 t= pre-/post-, 4 yr. follow-up
chronic pain patients (min pain = 6 mos., mean pain = 8.1 yrs.)
Chronic Pain Patients: 4 Yr FU
decreased pain (PRI)30-55% great improvement40% moderate improvement25% no change5% worse decreased negative body image (BPPA)decreased medical complaints (MSCL)decreased psych symptoms (GSI)gains maintained (except PRI) x 4yrs
overall improvement (3.8-4.0) maintained at 4yrs
“anything of lasting value or importance?” 86% yes 67% reported 8-10/10 importanceCompliance:
AOBDL 78-90%any of 3 formal practices = 93%regular meditation 50% at 1 yr.,
30% at 4 yrs.sporadic meditation 20%marginal meditation 50%
Chronic Pain Patients: 4 Yr FU
Commentsimpressive maintenance of
gainshigh compliance self-controlled
How does Mindfulness “work” for pain
reduces suffering (reduces resistance) works as a “deep cleansing” of emotional blockages
decreases anger, fear, sorrow and guilt
develops a sense of connectedness with all things
leads to a happiness not related to circumstance
Break Through Pain: a Step-By-Step Mindfulness Meditation Program for Transforming Chronic and Acute Pain by Shinzen Young, 2004, Sounds True.
Suffering = Pain X Resistance
Two Challenges Facing the Pain-Mgt Client: Conceptual: understanding the pain process in a new way
Practical: acquire focusing skills/concentration needed to experience pain in a new way
Mindfulness in Psychotherapy: Pain
The “silver lining” regarding having a pain issue:
By learning to focus your mind, your entire life changes. Focusing the power of your mind is the single most important tool one can have in life.
Mindfulness in Psychotherapy: Pain
Three aspects of this method observe precisely have equanimity be sensitive to how things change
Mindfulness in Psychotherapy: Pain
Addressing Pain through “Divide and Conquer”
approach:
Taken as a whole/unified experience, Pain can seem overwhelming
When broken down into its component parts, Pain can seem quite manageable
Mindfully Working with PainDivide and Conquer Method
Emotions: Ideas in the Mind and Sensations in the Body
Mind: Mental Images and Internal Conversations
Sensations: Flavors and Locations
Mindfulness in Psychotherapy: Pain
Suffering is a function of Pain X Resistance
Resistance has 2 sources:
conscious: judgment, wishes, fearful projections
unconscious: an underlying habit of resistance
schema (see Emotional Alchemy)
sankara (Buddhist Psychology)
Observing Pain allows the unconscious to unlearn
its habit of resistance
Mindfully Working with Pain
3 Basic Strategies for Working with Pain:
focusing on the pain focusing on the mental and emotional reactions to the pain
focusing away from the pain onto something soothing and pleasant
Mindfully Working with Pain
Methods of Working with Pain
Free-Floating with the Discomfort Local Intensity and Global Spread Breath Pleasure
Relaxing with Out Breath
Pleasure of O2 Entering the Body
Mindfully Working with Pain
Methods of Working with Pain
Being present with Secondary Sensations: Physical: heat, nausea, fatigue, agitation, jerking, etc
Emotional: anger, fear, sadness, shame
These may represent unprocessed body memories coming up (purification process)
Mindfulness in Psychotherapy: Pain
Pain can function as a conduit or tunnel into the deepest reaches of the unconscious mind.
The quickest way to break up pain is to observe it without the slightest desire that it be different in any way.
When observed with enough precision and patience, pain fosters spiritual insight and emotional purification.
Mindfulness in Psychotherapy: Pain
As this process of purification
deepens:
powers of observation increase
glimpses into impermanent nature of experience
vibrating atoms of pure energy underlying it all, being with the Flow
of Nature through the body and mind
Mindfulness in Psychotherapy: Pain
Pain experienced skillfully brings us closer to our Spiritual Source (process of purification)
Sun Dance (Native Americans) “Marathon Monks” (100 day pilgrimage/9 day sit)
Mindfulness in Psychotherapy: Pain
A conceptual reframing of pain into a Spiritual Path
Pain X Acceptance = Spiritual Purification
Mindfulness in Psychotherapy: Pain
There is a temporary or conditional relief that comes through eliminating a particular pain…
and there is permanent or unconditional relief that comes thorough retraining our relationship to any and all pain.
Mindfulness Based Stress Reduction
& Psychotherapy
Steve Shealy, PhDwww.BeMindful.org
813-980-2700