2. Mindfulness in Psychotherapy: Managing Pain with Steve Shealy, PhD

3. What is Mindfulness?

4. Mindfulness is: intentionally directing one ’ s 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 one’s 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 Pain:Treatment 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 O 2 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