How mindfulness can help reclaim the body when living with pain and illness (part I)
There is a growing body of research showing that mindfulness based interventions can have a positive impact on the experience of pain and pain-related comorbidities such as depression, anxiety and distress (Zeidan, et al., 2010, Cayoun, Simmons, Shires., 2017, Wong et al., 2011, Bawa et al., 2015, la Cour and Petersen, 2015, Reiner et al., 2013, Ussher et al., 2014, Gard et al., 2012). The following summary provides proposed mechanisms of action, based on experiential evidence from practitioners over the centuries.
One rational for these effects lies in training attention. The ability to intentionally redirect attention away from dominating unpleasant thoughts, emotions or sensations is one example. Changing the content of what the mind is processing may increase a sense of agency and self-efficacy over one’s health condition (Teasdale and Chaskalson, 2011b). Additionally, learning how to widen awareness offers a more complete picture of our present experience. Inviting the awareness of pleasant or neutral sensations in the body along-side the more dominating unpleasant sensations offers perspective on perceived dis-ease. I liken this to shining a torch light onto a dark scary corner of a room, versus switching the light on at the wall and thus illuminating the whole room and all of its attributes. This approach, when done with mindfulness rather than habitual patterns of distraction, opens possibilities for gratitude and other pleasant relational qualities to an often vilified ‘failing’ body.
Perhaps a more significant way however, in which attention can be used for pain and illness, lies in training the mind to do something quite unfamiliar –to come towards the discomfort and reclaim the body. This has been shown to shift brain activity away from patterns characteristic of fear and avoidance (Davidson et al., 2003) and cultivates improved interoception which enhances our ability to see things as they really are (Craig, 2003, Craig, 2015, Craig, 2002).
For example, when we are aversive towards pain, (try to ignore it, push it aside, distract from it with business or thoughts) we are seeking to escape ownership, causing us to feel beside oneself with pain. Although distraction techniques may work in the short-term, they have been shown to have no long-term benefit. When we attend, as through mindfulness training, we come into ownership by coming to one’s senses. This ‘control’ factor, plays a large role in building resilience for managing chronic conditions.
In persistent pain states specifically, our attention becomes hypervigilant (very good) at processing actual or potential threat. So much so, that as demonstrated through the neuromatrix and somatic marker theories (Melzack, 2001, Dunn et al., 2006), we cease to listen anew to messages arising from the body, instead unconsciously assuming their meaning based on sophisticated processing of past experience, expectations, fear etc. This automatic mechanism (the dark side of neural plasticity) becomes increasingly problematic as by reinforcing habitual ways of thinking about the pain, feeling, behaving and relating to the pain, it fuels pain itself. In sum, the effect of relating to unpleasant emotions or sensations in the body through our perception of them, rather than the direct experience of them, is one of further disconnect from the body, distress, escalation of pain and feelings of hopelessness and helplessness.
Another way of saying it, is that attending to body sensations (as unpleasant as they may be) offers practitioners a direct experience of sensations as they are, not as the brain has remembered them or fears they may be.
Brave work, indeed! Yet why not? After all, it is already here!
Receiving and coming towards perceived threatening body sensations allows for a once monolithic, overwhelming sensation to be broken down and understood for its smaller parts (pulsing, tingling, warmth). A meditator may begin to notice the individual qualities of the bodily sensation such as its mass, temperature, movement, or cohesion and sit with this experience equanimously, meaning, without the habitual emotional reaction. In this way, the practice offers the opportunity to experience the effects that thoughts and emotions contribute to the unwanted body sensations. This is of particular transformative value.
Mindfulness enables a mode of mind where we can break our habits of interpreting danger and re-conceptualise painful sensations or emotions as less threatening. Neuroanatomically, this occurs through strengthening the pre-frontal cortex (responsible for reasoning, impulse control, planning, organising attention etc) in order to inhibit (quieten) our loud and gregarious amygdala and anterior cingulate cortex (areas of the brain responsible for running our unconscious patterns of predictive modelling and threat detecting) (see blog on stress). We are now able to observe these functional (connections between brain areas) and anatomical (structural) changes in meditators through modern imaging techniques (Fox et al., 2014, Lazar et al., 2000, Chiesa and Serretti, 2010).
As we begin to pay attention to our inner world, insights in how we sustain our own suffering (Buddhism’s Second Noble Truth samudaya) through clinging towards, or aversion against, particular experience may arise. In fact, the very act of attending to our inner world means that there is something other than the body-mind which is doing the attending. This attending brings one into contact with an aspect of Self which lies beyond the body-mind, creating the opportunity for practitioners to gain perspective on our often all-encompassing, inbuilt sense of me and mine. Instead it opens up a new paradigm in which to view unpleasant phenomena (body sensations/feelings/thoughts) that arise within our internal landscape. Namely, viewing them as phenomena that arise, stay for some time and ultimately pass away again, instead of being inherent parts of who we are. This offers those living with pain a tremendous ability to reduce suffering through non-identification with pain, illness and negative thoughts and emotions (Teasdale and Chaskalson, 2011b).
Summary -mindfulness...
1. Trains our attention, so that it's not continuously hijacked by dominating unpleasant sensations
2. Leads our attention towards the sensations (rather than avoiding them), in order to
a) reclaim the body and
b) reconceptualise painful sensations as less threatening
3. Helps us to gain insights into how emotions and thoughts perpetuate suffering
It is important to highlight that mindfulness meditation requires the practitioner to refrain from engaging in learned safety behaviours such as avoidance when encountering unpleasant phenomena. In such, this maximises exposure to these phenomena. While this process of exposure has been positively described to lead to extinction of the fear response of which it is coupled with (Öst, 1989), it must be highlighted that (particularly initially) being with pain can make it appear more intense, as we are accustom to distracting ourselves away from the direct felt experience. From this, provocation of reactivity towards the pain, and subsequent distress may ensue as we embrace this new way of coming towards the difficult (Carmody and Baer, 2008).
In this way, mindfulness training is not intended for ‘relaxation’ (albeit this may be a bi-product of the practice), as the process can be challenging. The importance of fostering a kindliness towards ourselves and our experience as we meditate is therefore paramount to a mindfulness practice, as is the understanding that it is through an ongoing commitment to practice that the fruits present themselves.
To end I would like to acknowledge that in this brave work of bridging the relationship with ourselves, our bodies and our minds, we also lay a path to connect with others. Social connectivity can be understood as an important coping mechanism for pain and illness. Emerging evidence suggests that the painful feelings arising from social isolation rely on many of the neural correlates that underlie physical pain (Riva et al., 2011, Eisenberger, 2010, Eisenberger, 2012). Fascinating!
And so, I will leave you with this curious comment to investigate for yourselves…
There is no experience that is not improved by directly experiencing it (through direct felt sensations, not through analysis or thought) -we can never improve an experience in the long-term by trying to avoid it (by thinking/analysis about it, or through distraction)
Stay tuned for part II of this blog which explores the practicalities of how to practice mindfulness when resting with an unpleasant experience.
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