1. Breathing, Muscle Relaxation & Mindfulness
Strategies for difficult thoughts, feelings and physical sensations

2. Introduction Neil Micklewood Consultant Clinical Psychologist
Tel:
Introduction
Neil Micklewood
Consultant Clinical Psychologist
Clinical Advisor for ACC and private practice
Areas of interest:
Promoting integrated wellness and wellbeing.
Biopsychosocial models of physical injury, pain, TBI

3. What is Mindfulness? We are all naturally mindful at times.
Crossing the street, listening to our favourite piece of music
Mindfulness- being fully alive, fully open to life as a whole
“Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgementally. It’s about knowing what is on your mind.” Jon Kabat-Zinn

4. Two Parts to Mindfulness
Awareness:
Directing our attention to what is happening in the present moment, both within us (our thoughts, feelings and physical sensations in our bodies), and the world around us.
Acceptance:
Taking a curious, open, accepting approach to the experiences one becomes aware of through awareness.
Serenity prayer captures mindfulness well:
“Grant me the serenity to accept the things I cannot change, The courage to change the things I can, And wisdom to know the difference.”

5. Mindfulness: formal or informal
Formal – meditation.
Informal – doing the dishes, attending a meeting.
Don’t expect to be a Zen master from the word go.
Start by noticing when:
You are on autopilot (mindlessness)
You are not allowing yourself to fully experience things (avoiding, struggling)
You are engaged in judgement (instead of acceptance).

6. Mindfulness versus Mindlessness

7. Benefits of Mindfulness
Immune boosting – reduces the risk of stress related illness.
Pain management.
Improved brain functioning.
Promote greater wellbeing/reduces stress.
Greater productivity.
Improve relationships.
Fights obesity.

8. How it works
Pain, mental distress, physical and neurocognitive injury activate very similar fight/flight systems in the brain .
A distressing thought is processed and responded to in a very similar way to a physical injury.
“Cueing” the body into activating the rest/relax parasympathetic nervous system via sensory input.
Use neurological, cognitive emotional and physiological mirroring of the “rest and relax” state.
This produces a short term “rest and relax” state, which with repeated practice, reprogrammes the brain’s baseline levels of arousal & activation pathways.

9. ….How it works
It becomes easier to activate a state of rest and relax, and to maintain this state.
This decreases inflammatory and immune responses, physiological arousal, anxiety and improves mood, cognition and blood sugar regulation.

10. Mindfulness and the brain

11. Things to keep in mind when choosing a mindfulness exercise
Client familiarity with techniques (work with the familiar)
Injuries and coping mechanisms for this (try to avoid head-on challenges)
Poorly managed central sensitisation issues (e.g. CRPS)
Past history – mental health concerns or traumatic experiences (know the pitfalls and triggers)
YOUR CLIENT’S PERSONALITY  (funny hand movements and blokey farmers don’t mix well)

12. Types of exercises Diaphragmatic breathing
Progressive Muscle Relaxation
Visualisation
Mindfulness of Emotions
Mindfulness of Pain
And many, many more 

13. Diaphragmatic breathing
Physiological mirroring of parasympathetic NS activation
Non threatening exercise which people may at least be partially familiar with.
Tends to be beneficial to most people
However, some clients with anxiety & trauma with panic symptoms might find this triggering. An alternative would be a passive mindfulness of the breath exercise.
See word doc

14. Progressive Muscle Relaxation
Physiological mirroring of parasympathetic NS activation.
Involves the physical tensing and relaxation of different muscle groups to promote neurocognitive and physiological calming.
Good for clients who dislike mindfulness or have strong bodily awareness.
Needs to be modified to physical injury and pain sites (do not use on a CRPS site).
See word document.

15. Visualisation exercise
Activates cognitive, neurological and physiological relaxation pathways through the use of thoughts and emotions.
Great beginner exercise.
Good for clients whose injuries limit them engaging in physical relaxation strategies.
Check that the imagery you are using is not associated with an adverse experience for the client (e.g. using beach imagery with a client who had a drowning experience at the beach.)
See word doc

16. Mindfulness of Emotions Exercise
Activates cognitive, neurological and physiological relaxation pathways through attentional shifting.
Great beginner exercise for mindfulness.
Good for clients who struggle with emotional distress or physical pain.
A small number of distress intolerant clients may experience either no changes in SUDS ratings or an increase (that okay -sometimes practice is required to see the benefit in the technique.)
See word doc and tolerating distress

17. Mindfulness of Pain exercise
Supporting mindful flexibility around pain (attentional shifting)
Passive activity so safe with clients with physical injuries
Should be used with caution in clients with unstable pain presentations with a central desensitisation component (i.e. CRPS).
The practitioner needs to know what the client’s cognitive, emotional and somatic triggers are and how to manage these to avoid/manage pain flares.
See attached docs

18. Which exercise would you like us to work through?
Diaphragmatic breathing
Progressive Muscle Relaxation
Visualisation
Mindfulness of Emotions
Mindfulness of Pain

19. Key things to remember with mindfulness exercises for clients
Get guidance/supervision on how to use them with clients if you are new to using them or unsure. (I am happy to help )
Practice them on yourself – you will then know the benefits and pitfalls and can help clients with this.
Use mindfulness exercises that fit with a client’s personality – don’t force them to do activities they don’t like – it defeats the purpose.
Be creative – come up with different informal and formal ways of doing mindfulness which the client enjoys.
Apps: MindBell, My Calm Beat, Satify Mindulness, Headspace
Web resources: