Mindfulness and Pain and Illness

Living Mindfully With Chronic Pain and Illness
An interview with best-selling author Toni Bernhard

"One of the most useful applications of mindfulness is to help people accept and adapt to uncontrollable circumstances in their lives like chronic pain and illness. Toni Bernhard is an author who has used mindfulness-inspired practices to cope with a chronic illness that unexpectedly came into her life and forced her to give up a successful career as a law professor. Rather than succumbing to despair, Toni was able to use her buddhist and mindfulness knowledge and her own experiences with illness  to carve out a new career path as a best-selling author of three books. Toni's books offer a compassionate,  uplifting outlook and practical tools. I sat down with Toni to find out more about her latest book - How to Live Well with Chronic Pain and Illness. Below are my questions and her answers.

(1) What is new and different about your latest book, compared to your other books?
First, I want to make it clear that the words “chronic illness” include chronic pain. I’ve written three books. Two of them are about chronic illness: How to Be Sick and the new one, How to Live Well with Chronic Pain and Illness. The new book is broader in scope than How to Be Sick, and it’s organized differently. How to Be Sick is organized around mindfulness-inspired concepts and practices to help people learn to live with grace and purpose despite the limitations imposed by their health.

By contrast, the new book is organized around specific difficulties and challenges that people face, such as dealing with others who don’t (or refuse to) understand; making the best use of your short time with the doctor; facing isolation and loneliness; handling mood swings and painful emotions; and coping with your limitations during the holidays. The new book draws on the thousands of people who’ve written to me about their health struggles. This enabled me to cover topics about which I don’t have personal experience (for example, the special challenges facing young people who are chronically ill).

What the books have in common are dozens of suggestions and practices that are easy to implement, and my conversational style of writing. People tell me that when they read my books, they feel as if we’re sitting around a kitchen table, chatting over coffee or tea.

My third book, which was written in between the two on chronic illness, is called How to Wake Up. It’s being used as an introduction to Buddhism by many teachers. Because I write from personal experience, it has a lot in it about chronic pain and illness too.

(2) In the introduction, you say the path to peace begins with facing life’s stark realities. What do you mean by that?
By stark realities, I’m referring to the human condition. First, we’re in bodies and they get sick and injured and old. Living in denial about this keep us from making peace with the lives that we have. Second, life is uncertain and unpredictable. I often call these corollaries of the universal law of impermanence. Everything is in constant flux and we often have no control over what happens to us and in the world. Learning to calmly “ride the waves” of uncertainty instead of being tossed about by them brings with it equanimity—a balanced state of mind that can find a measure of peace in any circumstance.

(3) What does it mean to pay "compassionate attention” and how has that helped you cope with your illness?
In Buddhism, compassion is described as the quivering of the heart in the response to the recognition of suffering in ourselves or others. If we’re so self-absorbed that we’re not aware of what’s going on in and around us, we may not even realize that we ourselves are adding mental suffering to our lives.

For example, we may be unaware of the misery being caused by our inner critic—the voice inside that’s unrelenting in telling us that we’re not good enough or that we should have said this or should have done that. Many of us have been conditioned to be our own harshest critics; we bark orders at ourselves without realizing the suffering it’s causing us.

However, if we pay attention with compassion in our hearts, we can watch for the presence of the inner critic and take action to counter this negative voice. (In the book, I discuss several techniques for taming the inner critic.) Compassion is not a passive state. It requires that we take action to ease suffering in ourselves and others, rather than being the passive recipient of whatever happens to us in life.

(4) Why is mindfulness such an important tool when dealing with uncontrollable experiences, such as chronic illness?
I define mindfulness as paying caring attention to our present moment experience. Being mindful in this way can help ease both physical and mental suffering. In Chapter Ten, I write about how physical discomfort has three components: the unpleasant physical sensation itself; our emotional reaction to that sensation (anger, frustration); and the stressful thoughts we spin from that (“I’ll be in terrible pain the rest of my life”). This means that two of the three components of that comprise our experience of bodily discomfort are mental in origin!

With practice, mindfulness can help us catch stressful emotions when they first arise. This keeps them from ballooning into elaborate stress-filled stories that have no basis in fact but which we believe without question. For example, If your knee is hurting (like mine is right now), you can make things worse by reacting with anger and then compounding that anger with stories, such as “This pain will never go away.” As Buddhist teachers like to say: the suffering is in the stories.

An effective way to bring your attention out of your stories and into the present moment is to take three conscious in- and out-breaths while turning your attention to the present moment. As you do this, notice what’s available to your senses right now: a sight, a sound, the sensation of your clothes on your skin. Even if it’s not a particularly pleasant moment, at least you’re present for it instead of being lost in regrets about the past or worst-case-scenarios about a future you can’t predict. And, more often than not, being mindful of your present moment experience reveals that there’s something pleasant going on right around you that you just hadn’t noticed. This can be soothing and healing.

(5) If you have a chronically ill friend or relative, what are some helpful things you can do?
First, I’d say to simply be present for them. This means being a compassionate witness to their suffering. When I don’t know what to say to someone who’s chronically ill, I start with “I’m sorry” because I truly am sorry. I don’t expect people to say “the right” thing to me about my illness; I’m content if I can sense they accept me as I am and still treat me as a whole person.

If you want to help out in a more concrete way, ask them if you can do a specific task for them. They’ll appreciate it, I guarantee. When someone says to a chronically ill friend or relative, “Call me if you need anything” that call is unlikely to be made because the friend or relative won’t want to ask you to do something that may disrupt your day. But if, instead, you call them and say, “I’m going to the hardware store. Do you need anything?” they’ll know they’re not burdening you by asking you to get them light bulbs or other basic household stuff that they may desperately need.

(6)  What do you recommend doing when friends and relatives refuse to understand your illness and your limitations?

This is a such a major issue for the chronically ill that it almost always comes up no matter what the subject-matter of a chapter is. First, of course, try to educate them. The first chapter in the book has many suggestions for how to go about doing this.

Second, acknowledge with compassion for yourself how hard it can be to accept that some people in your life may never give you the support you need and want. This is both a compassion and an equanimity practice.

A mind that is equanimous stays balanced and peaceful in the face of life’s ups and downs. One of those “downs” is that some people don’t come through for us (this, of course, is true whether a person is chronically ill or not). To practice equanimity in the face of friends or relatives who don’t understand your illness and your limitations, it helps to recognize that there may be many reasons for their behavior.

They may be self-absorbed, trying to deal with their own problems. Or, illness may trigger their own fears about sickness or even mortality. Practicing equanimity also means recognizing that you can’t “fix” people to be the way you want them to be. The odds are high that they care about you and wish you well, even though they’re not lending support. In my experience, recognizing this so that you don’t take their behavior personally brings with it a tremendous sense of relief. It’s as if you’ve put down the burden of needing everyone to understand what life is like for you.

Toni Bernhard is the author of the award-winning  How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and their Caregivers, and How to Wake Up: A Buddhist-Inspired Guide to Navigating Joy and Sorrow. Her newest book is called How to Live Well with Chronic Pain and Illness: A Mindful Guide. Before becoming ill, she was a law professor at the University of California—Davis. Her blog, “Turning Straw Into Gold” is hosted by Psychology Today online. Visit her website at www.tonibernhard.com.

Melanie Greenberg, Ph.D., is a practicing psychologist in Mill Valley, California, and former Professor of Psychology at the California School of Professional Psychology. She is an expert on stress, the brain,and mindfulness. She provides workshops, speaking engagements, and psychotherapy for individuals and couples. She regularly appears on radio shows and as an expert in national media. She also does long-distance coaching via the internet. She is the author of The Stress-Proof Brain (New Harbinger, 2017)."
https://www.psychologytoday.com/us/blog/the-mindful-self-express/201610/living-mindfully-chronic-pain-and-illness

Using Mindfulness to Approach Chronic Pain
By Margarita Tartakovsky, M.S.

"Using Mindfulness to Approach Chronic Pain When we’re in pain, we want it to go away. Immediately. And that’s understandable. Chronic pain is frustrating and debilitating, said Elisha Goldstein, Ph.D, a clinical psychologist and Psych Central blogger. The last thing we want to do is pay more attention to our pain. But that’s the premise behind mindfulness, a highly effective practice for chronic pain (among other concerns).

Goldstein describes mindfulness as “paying attention to something on purpose and with fresh eyes.” This is why mindfulness is so helpful. Instead of focusing on how badly we want the pain to stop, we pay attention to our pain with 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 typically launch into a litany of judgments and negative thoughts. According to Goldstein, we start ruminating about how much we hate the pain and want to wish it away. “We judge the pain, and that only makes it worse.” In fact, our negative thoughts and judgments not only exacerbate the pain, they also fuel anxiety and depression, he said.

What also makes matters worse is that our minds start brainstorming ways to soothe the pain. Goldstein likens this to the Roomba, a robot vacuum. If you trap the Roomba, it just keeps bouncing off the edges. Our brains do the same with scouring for solutions. This “creates a lot of frustration, stress and feeling trapped.”

Mindfulness teaches people with chronic pain to be curious about the intensity of their pain, instead of letting their minds jump into thoughts like “This is awful,” said Goldstein, also author of The Now Effect: How This Moment Can Change The Rest of Your Life and co-author of A Mindfulness-Based Stress Reduction Workbook.

It also teaches individuals to let go of goals and expectations. When you expect something will ease your pain, and it doesn’t or not as much as you’d like, your mind goes into alarm- or solution-mode, he said. You start thinking thoughts like “nothing ever works.”

“What we want to do as best as we can is to engage with the pain just as it is.” It’s not about achieving a certain goal – like minimizing pain – but learning to relate to your pain differently, he said.

Goldstein called it a learning mindset, as opposed to an achievement-oriented 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?”

As Jon Kabat-Zinn, Ph.D, writes in the introduction of The Mindfulness Solution to Pain, “From the perspective of mindfulness, nothing needs fixing. Nothing needs to be forced to stop, or change, or go away.”

Kabat-Zinn actually founded an effective program called mindfulness-based stress reduction (MBSR) in 1979. While today it helps individuals with all sorts of concerns, such as stress, sleep problems, anxiety and high blood pressure, it was originally created to help chronic pain patients.

“In MBSR, we emphasize that awareness and thinking are very different capacities. Both, of course, are extremely potent and valuable, but from the perspective of mindfulness, it is awareness that is healing, rather than mere thinking…Also, it is only awareness itself that can balance out all of our various inflammations of thought and the emotional agitations and distortions that accompany the frequent storms that blow through the mind, especially in the face of a chronic pain condition,” Kabat-Zinn writes in the book.

Mindfulness provides a more accurate perception of pain, according to Goldstein. For instance, you might think that you’re in pain all day. But bringing awareness to your pain might reveal that it actually peaks, valleys and completely subsides. One of Goldstein’s clients believed that his pain was constant throughout the day. But when he examined his pain, he realized it hits him about six times a day. This helped to lift his frustration and anxiety.

If you’re struggling with chronic pain, Goldstein suggested these mindfulness-based strategies. He also stressed the importance of paying attention to what works for you and what doesn’t.

Body Scan
A body scan, which also is included in MBSR, involves bringing awareness to each body part. “You’re bringing attention to what the brain wants to move away from,” Goldstein said. However, instead of immediately reacting to your pain, the body scan teaches “your brain the experience that it can actually be with what’s there.”

You’ll find helpful videos with a three-, five- and 10-minute body scan on Goldstein’s website.

Breathing
When “pain arises, the brain reacts automatically,” with thoughts, such as “I hate this, what am I going to do?” Goldstein said. Though you can’t stop these first few negative thoughts, you can calm your mind and “ground your breath.”

Goldstein suggested simply breathing in slowly and saying to yourself “In,” and breathing out slowly and saying “Out.” Then you also might ask yourself, “What’s most important for me to pay attention to now?”

Distractions
A distraction can be a helpful tool when your pain is high (such as anything above an 8 on a 10-point scale), Goldstein said. The key is to pick a healthy distraction. For instance, it could be anything from playing a game on your iPad to focusing on a conversation with a friend to getting lost in a book, he said.

Mindfulness is an effective practice for approaching chronic pain. It teaches individuals to observe their pain, and be curious about it. And, while counterintuitive, it’s this very act of paying attention that can help your pain."
https://psychcentral.com/lib/using-mindfulness-to-approach-chronic-pain/

Mindfulness for Chronic Pain
Carolyn McManus, PT

"Chronic pain means you are likely to have more stress than people who don't have pain. You have probably noticed that when your pain is worse, you feel more stressed. It's true: pain is stressful! Also, having pain means you may be able to do less in your life and this can create stress. Stress is associated with tighter muscles, poorer sleep, anxiety, shallow breathing patterns, depressed mood — and all of these lead to worse pain! Without even knowing it, you may be medicating pain flares that are fueled by stress. Instead of focusing on medication, you can learn how to reduce the stress and will find you need less medication.

Mindfulness Stress Reduction

Why should I use the Mindfulness Technique?
How you choose to respond to the physical sensation of pain has a major impact on how your nervous system creates pain and on the quality of your life. Your automatic reactions to pain often amplify the pain generating activity of your nervous system and cause an increase in your pain and distress.

Mindfulness techniques are evidence-based practices (research has been done and published in the medical literature) that help change the nervous system back towards a normal non-pain state.

Through the Mindfulness Technique:
You can learn skillful responses to pain that reduce pain and distress.
You can identify and choose skillful responses to more effectively manage pain.
Consider the following equation. Do you relate to it?

Pain = unpleasant physical sensation + your physical, cognitive (thinking, understanding) and emotional reactions to the sensation
Mindfulness means present-moment awareness and offers you a constructive, practical and effective way to observe your physical, cognitive and emotional reactions and make skillful choices that can decrease your pain and distress.
Remember you may not have control over the sensation of pain, but you do have control over your reactions to the sensation of pain. Your choices directly impact your nervous system activity.

Steps to Get There

Formal Mindful Awareness Exercise

1. Pause now and direct your awareness to your body and breathing. Listen to your present-moment experience with a stable, steady mind. Some sensations may be pleasant; others, such as pain, may be unpleasant; and still others neutral.
2. Imagine your mind is like the sky, and the pain is like a cloud in the sky.
3. Listen with compassion. Be kind to yourself. Listen with the same friendliness you would offer a loved one if he or she were in your situation.
4. Avoid any tendency to judge or criticize yourself. Pay attention to your body as if you were doing so for the first time. Accept your experience just as it is without needing to change or improve anything.
5. Deliberately scan your body. Observe your feet, legs, torso, hands, arms, shoulders, neck, face and head.
6. When you have completed scanning your body, let your attention rest with the rhythm of your breath. Breathe deeply.
7. Observe your abdomen and rib cage move with your in breath and out breath, here and now. Breathe into your waistband.
8. Count each exhalation. On the first out breath, say to yourself "one," on the second out breath, say to yourself "two," and so on up to the tenth exhalation. When you reach the tenth out breath, return to "one" and begin again. When your mind wanders, label it "thinking" and return your attention to your breath and the counting practice. Begin again with "one." Continue for 5 minutes.

A wandering mind is the most common concern people have when beginning to meditate.
This is normal and not a sign that you are doing something wrong. When you become distracted from the present moment, notice that your mind has wandered like a cloud drifting by in the sky. Avoid judging your experience as right or wrong. Note "thinking" and return your attention to the present moment and your breathing.

Although these instructions may sound simple, the mind quickly wanders off and becomes lost in thought. Pain is also distracting. Just as the body can be trained to perform with greater strength and endurance through regular exercise, the mind can be trained to function with greater stability and clarity through this mindfulness practice. Begin practicing this formal mindfulness exercise for 5 to 10 minutes each day.

Informal Mindful Awareness Exercise
An informal practice involves bringing present-moment awareness into daily activities. For example, when walking, notice your present-moment experience. Notice your breath, the sensations of your feet when they touch the ground and the feeling of your legs moving through space. Or, when you wash your hands, again, notice your breath, the warm water on your fingers and palms, and the sensations in your shoulders. Any daily activity can become an informal meditation practice.

Mindfulness and Pain Management

• You are not your pain.
• Pain is a physical sensation, not your identity.
• You are a whole human being who is dealing with a medical condition.
• By learning to be mindful, you can observe pain with a stable, compassionate and curious mind. You can identify pain sensations and your physical, mental and emotional reactions to pain sensations. This alone is helpful.
• You can experiment with new responses that reduce your distress and often decrease your pain intensity.
• By training your mind to be in the present moment, you also worry less about the future and put your energy into skillful choices and living well today.

Resources
The Mindfulness Solution to Pain: Step-by-Step Techniques for Chronic Pain Management by Jackie Gardner-Nix
Full-Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness by Jon Kabat-Zinn
What Meditation Really Is with Jon Kabat-Zinn, http://goo.gl/dXjpK
Guided Mindfulness practices with Jon Kabat-Zinn, http://goo.gl/6aQPV
Cognitive Neuroscience of Mindfulness Meditation with Philippe Goldin, Ph.D., http://goo.gl/Idnw
Guided Mindfulness Meditation Body Scan, http://goo.gl/rpk9R
University of Wisconsin, Department of Family Medicine: Guided Meditation Instruction by multiple teachers,
Mindfulness meditation CDs can be found at www.carolynmcmanus.com

Body Mind Spirit Success
How to be successful in a body, using energy psychology.
Find this blog at: https://bodymindspiritsuccess.blogspot.com/
Also visit: http://hypnosisrecordings.blogspot.com/
Jane Leu Rekas, LCSW