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Mindfulness and exercise?


ResearchBlogging.org

Now I know this might seem a strange heading when we think of mindfulness practice normally, but this isn’t ‘treatment as usual’. The definition of mindfulness in this study is ‘The body scan practice involves systematically moving awareness through each part of the body and noticing the presence of sensation in a detailed and precise way. This enables contact with the actual sensations of the body (as opposed to thoughts, ideas or fears about these sensations). Mindful movement involves bringing awareness to physical activity, thus allowing movement of the body within the limits of its physical capability. This is taught by means of a comprehensive sequence of movements based on yoga and Pilates.’
I’n not sure I could find a better description of how I hope clinicians of any persuasion could integrate mindfulness into their practice.

I was thinking of how to describe mindfulness, and it is not an easy concept to put into words. It’s an opening of the awareness to make contact with what is, rather than what might be, happening at that time. It’s wordless, mostly, much more about feeling without thinking because words get in the way so often – words contain judgements and evaluations of the meaning of experiences, even when the words are only intended to describe.

The intention behind mindfulness in pain management (and btw it can be used for acute pain as well as chronic) is to allow and accept the sensations that are present, making room for whatever is being experienced at the time. By minimising judgements about the meaning of sensations – such as predictions that it could get worse, recalling how it was ‘last time’, evaluating the sensations as ‘good’, ‘bad’, ‘horrible’, ‘sad’ and so on, awareness of sensations can ebb and flow and it is easier to recognise that no sensation lasts forever – and it is possible to move through them.

I’ve written a lot about acceptance recently, and mindfulness is one strategy that can help with this. I hasten to add that I’m not mindful all day, every day! However it is a process that can be brought into every action we do.

I’d love to see physiotherapists and occupational therapists guiding people they’re working with to be aware of the sensations they are experiencing when they’re doing any movement. What would it be like to notice the heartbeat while stretching, feel the pull of the muscles when bending, experience the breath while relaxing? It would be helpful when working through a graded hierarchy of feared movements – ‘yes, be aware of your mind telling you that it’s scary, notice your emotions and be gentle with them, now bring your mind to your breathing and your heartrate and the muscles that are preparing you to bend’

An interesting aspect of this paper is the use of Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) and the Continuous Performance Task to measure implicit features of affect. In the CPT, participants were required to press the space bar immediately following presentation of any letter except an X and not respond when an X was shown. In the IAT, participants had to decide whether a target word (presented in the centre of the screen) belonged to the category named in the top left-hand corner of the screen or the category named in the top right-hand corner of the screen.  The primary assumption of the IAT is that strongly associated attribute–concept pairs are easier (and thus quicker) to classify together than more weakly associated pairs (Farnham, Greenwald, & Banaji, 1999). Therefore, faster pairings of self-related words and pleasant affect words would indicate a more positive self-concept.

So, after participating in a mindfulness meditation, this group of patients completed both these tests.  The aim was to see whether mindfulness practice would enable them to respond more quickly to pleasant stimuli rather than unpleasant stimuli in the IAT, and also maintain better concentration during the CPT.

What did they find? Well yes, the group that completed the mindfulness meditation did perform more quickly on the IAT at time 2, suggesting that the mindfulness practice does help them attend more quickly to positive stimuli than neutral or negative.  The authors in this paper suggest ‘This finding is consistent with the hypothesis that mindfulness enables greater awareness of a wider range of experience, as opposed to a narrowed focus on the most emotionally salient aspects of the perceptual field, such as pain and negative mood.’

How can we use this information?

Well, I don’t think we can use these specific findings directly in clinical practice.  What we can do, though, is gain more confidence that unconscious process are affected by the deliberate acceptance of experience whether positive or negative – and that this differentially affects the processing of positive emotional content.  So paradoxically, by being willing to accept the negative along with the positive, people actually become more aware of the positive.

In exercise then, bringing mindfulness to the whole range of experience without judgement, being totally present with what is rather than what has been or might be, might be a helpful way to encourage people to also recognise their achievement, and maybe be able to experience the pleasure their body can give them, as well as the pain.

Cusens, B., Duggan, G., Thorne, K., & Burch, V. (2009). Evaluation of the breathworks mindfulness-based pain management programme: effects on well-being and multiple measures of mindfulness Clinical Psychology & Psychotherapy DOI: 10.1002/cpp.653

10 comments

  1. I do really like the emphasis in Pilates on doing the movements slowly and with awareness of breathing and isolating certain muscles. Very different focus on quality of movement rather than number of repetitions.
    Awareness Through Movement (Feldenkris) also has that emphasize on exploring many more possibilities of moving and moving with ease rather than our habitual ways of moving that may no longer serve us.

    I went on automatic for a bit today and then later realized I had put the milk that I intended to culture into yogurt back into the refrigerator after heating it and mixing in a small amount of yogurt starter rather than incubating my batch in my oven ( gas with constant pilot so just warm enough with oven turned-off). So yes I could do with more mindfulness in my day too!

    1. I did Pilates about 20 years ago (beforfe it was fashionable!) and enjoyed it then – but now I believe I’m just a little less flexible than I was… but yes, the mindfulness is an integral part I think. I have to admit to also doing some odd things when not completely aware of what I was doing – like drive to the wrong venue, firmly believing I was actually going to the right place?! strange!

  2. Thanks for this Bronwyn. I have recently done a weekend workshop on Mindfulness and am really excited about the possibilities of incorporating it into elements of my practice. I am reading “Full Catastrophe Living” – a book by Jon Kabat Zinn based on his mindfulness based stress reduction programme. Recommend it. Here are some different definitions of Mindfulness from his book. “Mindfulness is about accepting whatever happens, allowing it to be there and continuing to commit to actions that move in valued directions.” “It’s about observing our thoughts and feelings about any certain experiences and not judging them. Allowing them to be, but learning from unhelpful reactions.” “The complete owning of each moment of your experience – good, bad or ugly.”

    1. Hi Diane
      That’s a great book! Jon Kabat Zinn originally developed the mindfulness based approach for stress management – but it’s far, far more useful than simply ‘stress’ management. And from what he developed and then what Steven Hayes and colleagues have done, we now have ACT and other contextual cognitive behavioural approaches, the ‘third wave’ of cognitive behavioural therapies. It’s been invaluable for me, although I’m such a baby practitioner – so far to go before I can consider myself knowledgeable about it! But well worth learning just for myself, let alone the people I work with!

  3. Yes , would be good if more people were interested in this ! However , I think the practice has to start not with ‘patients’ but with yourself . I have been experimenting with this for years and Bud Craigs paper on intereoception helps convert the often esoteric sounding ideas into a more scientific sounding script . I tried to do this in an inservice but got nowhere as Physiotherapy is largely dominated by biomechanical thinking!
    Misperception of effort/cocontraction is very common generally but more so in chronic pain populations and I think this approach is often far better than loading and strengthening regimes. If you try and model movement and sometimes hands on work to differentiate ‘heaviness’ and lightness can help too…….I use simple chi kung type exercises but translate the ideas into plain English . Sandra Blakeslees book on bodymaps is a great resource and I think there is a research here that looks interesting too http://www.osher.hms.harvard.edu/kerrlab/what_we_study_tai_chi.html

    ian

    1. I totally agree with you that mindfulness has to start with the practitioner! I’m not sure that it’s vital to do slow movements because I know I’ve been ‘in the flow’ when the lights are off, Pink Floyd is pumped up full volume, and I’m just dancing! But then again, to help someone to get in touch with their body takes a gentle guidance and I’ve found that starting with the breath can be the first point of takeoff. I then follow with contact with the ground or the support and work from there. Because I’m not a hands-on therapist I wouldn’t use hands-on, but I can see how this would be useful for some people who really have lost contact with their own bodies. thanks for the link, too, I’ll take a look at it!
      cheers
      Bronnie

  4. I completely love this blog, and it is really reassuring to hear that you also have difficulty in putting into words what mindfulness is to you. I think the idea of being in the moment, and being aware of what is happening around you and to you at a particular moment in time, is so important, especially in our day and age. I find myself constantly looking ahead – planning what I have to do tomorrow, next week, next month, or thinking about what I should be doing, instead of just being aware of what is happening in the moment. thank you for sharing this really insightful post.

    1. Hi Georgia
      Thanks so much for your very kind words – there’s no easy way to say what mindfulness is, is there?! One of the best ways for me to be mindful is to remind myself every time I notice my mind wandering off by itself that just by noticing, I’m being mindful. Then I can gently guide my mind back to whatever I am focusing on (my breathing, or the feel of my feet on the ground, or the glistening sun on the water). One of the best ways for me to be mindful is going fishing – it’s hard not to lose track of time and thinking when you’re in the rhythm of casting and winding in, casting and winding in, while all the time the water is flowing past. Beautiful.

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