Mindfulness in Psychotherapy: Managing Pain

1
(No Transcript)
2
Mindfulness in Psychotherapy Managing Pain

• with
• Steve Shealy, PhD

3
What is Mindfulness?
4
Mindfulness isintentionally directing ones
attention to their present experience without

• judgment
• internal dialogue/self-talk
• emotional reactivity/acting in
• physical reaction/acting out
• attempting to avoid the experience

5
Definitions of Mindfulness

• As Mindfulness relates to psychotherapy,
  it may be best defined as
• awareness of
• ones present experience
• with acceptance.

6
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

7
Mindfulness in Psychotherapy Pain

• Clear Focus of Mind Often Occurs
• In a Very Relaxed State
• OR in a Very Dangerous or Threatening Situation

8
Mindfulness in Psychotherapy Pain

• We balance this
• Increased Awareness
  with
• Equanimity

9
Mindfulness in Psychotherapy Pain

• Equanimity Maintaining a Balanced Mind
• Between
• Suppression stuffing the experience down
• Identification fixating and holding onto the
  experience, not allowing it to pass through

10
Mindfulness in Psychotherapy Pain

• Equanimity is remaining relaxed and open to the
  experiences passing through our
• awareness with an attitude of lovingkindness

11
Chronic Pain Patients

• Four-year Follow-up of a Meditation-Based Program
  for the Self-Regulation of Chronic PainTreatment
  Outcomes and Compliance. Kabat-Zinn, et al
  Clinical Journal of Pain (1987)

12
Chronic Pain Patients 4 Yr FU

• decreased pain (PRI)
• 30-55 great improvement
• 40 moderate improvement
• 25 no change
• 5 worse
• decreased negative body image (BPPA)
• ?decreased medical complaints (MSCL)
• ?decreased psych symptoms (GSI)
• ?gains maintained (except PRI) x 4yrs

13

• overall improvement (3.8-4.0)
• maintained at 4yrs
• ?anything of lasting value or
• importance? 86 yes
• 67 reported 8-10/10 importance
• Compliance
• 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

14
Chronic Pain Patients 4 Yr FU

• Comments
• ?impressive maintenance of
• gains
• ?high compliance
• self-controlled

15

• 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

16

• 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

17
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.

18
Mindfulness in Psychotherapy Pain

• Three aspects of this method
• observe precisely
• have equanimity
• be sensitive to how things change

19
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

20
Mindfully Working with Pain

• Divide and Conquer Method
• Emotions Ideas in the Mind and Sensations in the
  Body
• Mind Mental Images and Internal Conversations
• Sensations Flavors and Locations

21
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

22
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

23
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

24
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)

25
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.

26
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

27
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)

28
Mindfulness in Psychotherapy Pain

• A conceptual reframing of pain
• into a Spiritual Path
• Pain X Acceptance Spiritual Purification

29
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.

30
Mindfulness Based Stress Reduction
Psychotherapy

• Steve Shealy, PhD
• www.BeMindful.org
• 813-980-2700