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