Considering the Mind

The concept of “mindfulness” has and aggravating chronic pain. The last thing you want recently become popular, yet it is often misunderstood, particularly when applied to individuals living with chronic pain. Mindfulness is the process of paying attention moment-to-moment with purpose but without judgment, trying to look at things from a different perspective. By intentionally focusing our attention to how things actually are in this moment, we can recognize how our minds follow mental routines in a kind of auto-pilot much of the time. This attention can help us make more conscious choices about what we do in the next moment. Mindfulness practice has been shown to have great benefits in the areas of stress reduction, emotional regulation and developing compassion for others, as well as a long list of benefits for chronic health conditions from psoriasis to chronic pain. I would wager you might be thinking focusing on moment-to-moment awareness sounds like the exact opposite of what you would ever do when you are experiencing pain.

When you’re in pain, you want it to come to an end. Immediately. This is extremely understandable for individuals living with the debilitating to do is pay more attention to your pain. But that’s the idea behind mindfulness, a highly effective practice for chronic pain. The thing that makes mindfulness practice different is that it is the combination of awareness and the effort to reduce or eliminate our mind evaluating and judging our experience. This is why mindfulness is so helpful. Instead of focusing on how badly you want the pain to stop, you pay attention to your pain with a new curiosity and without judgment.

This approach is very different from what our brains naturally do when we experience the physiological sensation of pain. Our minds tend to jump into a tirade of judgments and negative thoughts. For example, some people will obsess about how much they hate the pain and want to wish it away. When you judge your pain, this process can only make it worse. In fact, our negative thoughts and judgments not only exacerbate the pain, but they also fuel anxiety, depression and other stressful emotional reactions. Our negative thoughts and judgments can be like a spiral of increasingly unpleasant emotional reactions. Everyone with chronic pain has likely experienced moments when their emotional state has influenced their pain, either with anxiety making pain feel more unbearable, or a positive mood helping you ignore or cope with your pain more effectively. It is very hard to change your emotional state while your mind continues to judge away.

Mindfulness teaches people with chronic pain to be curious about the intensity of their pain, instead of letting their minds jump into thoughts such as: “This is horrible” or “I can’t take anymore of this.” It also teaches individuals to let go of goals and expectations. When you expect something will ease your pain, and it doesn’t – or it doesn’t as much as you’d like – your mind goes into alarm-mode or solution-mode. You start thinking thoughts like, “Nothing ever works.” A simple way to describe the goals of mindfulness is to do as best as you can to engage with the pain just as it is and learn ways to relate to your pain in a new way. It is about finding a way to switch from the stress response alarm to an open learning mindset. In other words, as you’re applying mindfulness to your pain, you might consider your experience and ask yourself: “What can I learn about this pain? What do I notice?”
Mindfulness practice also helps us become more kind to ourselves. Instead of thinking, “I’m a terrible person for being unable to do the things I used to do before my chronic pain condition” you can start to think, “I can recognize my thinking as a pointless and unfair judgment against myself. Instead of getting anxious about my anxiety, or mad at my anger, sad about my depression, or distressed by my pain, I can give myself permission to feel whatever I am already feeling, and make a conscious choice about how to take care of myself.” We often spend huge amounts of time and energy battling ourselves.

Interestingly, practicing mindfulness not only reduces stress, but a “side effect” of being present in what you are doing allows you to get more done. When you are writing a report, you become better able to just write that report without constantly worrying about all the other reports you haven’t written yet. You begin to realize that you can only be present in the moment you are in, and while you may sometimes choose to take the time to plan for the future or learn from the past, you live less in your head and more in your life. All of your experiences can become more enriched when you actually show up for them. The simplest way to think about mindfulness is that it is a type of mediation practice that does not have to be connected with any specific faith or set of religious values.

Practical Application

So how do you practice mindfulness? To practice mindfulness, start by sitting in a comfortable but alert posture. Gently close your eyes. Take a couple of deep breaths, and, as you exhale, settle into your body, relaxing any obvious tension or holding. Then, breathing normally, bring your awareness to your body, sensing for a short while how the body presents itself to you. There is no particular way to be; just notice how you are at this moment.

Then, from within the body, as part of the body, become aware of your breathing, however it happens to appear. There is no right or wrong way to breathe while practicing mindfulness; the key is to simply notice how it actually is right now. Let the breath breathe itself, allowing it to be received in awareness. Notice where in your body you feel the breath most clearly. This may be the abdomen rising and falling, the chest expanding and contracting, or the tactile sensations of the air passing through the nostrils or over the upper lip. Wherever the breath tends to appear most clearly, allow that area to be the home, the center of your attention.

To help maintain contact between awareness and the breath, you may use a label or mental note. Softly, like a whisper in the mind, label the in-breath and out- breath, encouraging the awareness to stay present with the breath. You can label the inhalations and exhalations as “in” and “out,” or perhaps use “rising” and “falling” for the movement of the abdomen or the chest. Don’t worry about finding the right word, just use something that will help you stay connected.

There is no need to force the attention on the breath; to strengthen your ability to become mindful and present, use the gentle power of repeatedly, non- judgmentally returning and resting with the breath. When a strong physical sensation makes it difficult for you to stay with the breath, simply switch your awareness to this new predominant experience. The art of mindfulness is recognizing what is predominant and then sustaining an intimate mindfulness on whatever that is. As if your entire body was a sensing organ, feel the physical experience. Simply allow it to be there. Drop whatever commentary or evaluations you may have about the experience in favor of seeing and sensing the experience directly in and of itself. Carefully explore the particular sensations that make it up – hardness or softness, warmth or coolness, tingling, tenseness, pressure, burning, throbbing, lightness and so on. Let your awareness become as intimate with the experience as you can. Notice what happens to the sensations as you are mindful of them. Do they become stronger or weaker, larger or smaller, or do they stay the same?

As an aid, you can ever so softly label the experience. The labeling is a gentle, ongoing whisper in the mind that keeps the attention steady on the object of mindfulness. You should primarily sense directly the experience and what happens to it as you are present for it. This can sound like: “neck, burning, neck, tingling,hand,neck…” Onceaphysicalsensationhas disappeared or is no longer compelling, you can return to mindfulness of breathing until some other sensation calls your attention.

Three-Minute Breathing Space

I know this exercise may seem strange and it is counter-intuitive that working on refining your attention without judgment could actually help you cope with your pain. Please try this exercise or at least the “3 Minute Breathing Space” before you write this off. If you have any questions, concerns, or would like to tell me about your reactions to this article, or previous Considering the Mind articles, please email Dr. Skellie at overcomingpainNOLA@gmail.com.

AWARENESS – Bring yourself to the present moment by deliberately adopting an erect and dignified posture. If possible, close your eyes. Then ask yourself: • What is my experience right now … in thoughts … in feelings … in bodily sensations (a few moments). Acknowledge and register your experience, even if unwanted.

COLLECTING – Then, gently redirect your full attention to breathing, to each in breath and to each out breath as they follow, one after another: Your breath can function as an anchor to bring you into the present and help you tune into a state of awareness and stillness.

EXPANDING – Expand the field of your awareness around your breathing, so that it includes a sense of the body as a whole, your posture, and facial expression.
(Segal, Williams, & Teasdale, 2002)

I will continue to provide new relation strategies in every new Louisiana Pain Quarterly Magazine because the best way to manage stress and chronic pain is to develop a tool box full of different strategies that you can deploy when needed. Nearly all of the future strategies build on deep breathing, so don’t forget to practice!