mindfulness in psychotherapy: managing pain with steve shealy, phd

Mindfulness in Psychotherapy: Managing Pain

with

Steve Shealy, PhD

What is Mindfulness?

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

Definitions of Mindfulness:

As Mindfulness relates to psychotherapy, it may be best defined as

awareness of

one’s present

experience

with

acceptance.

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


Clear Focus of Mind Often Occurs: In a Very Relaxed State

OR in a Very Dangerous or Threatening Situation


We balance this

Increased

Awareness

with

Equanimity


Equanimity: Maintaining a Balanced MindBetween:

Suppression: stuffing the experience down

Identification: fixating and holding onto the experience, not allowing it to pass through


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

Chronic Pain PatientsFour-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)

n=225 t= pre-/post-, 4 yr. follow-up

chronic pain patients (min pain = 6 mos., mean pain = 8.1 yrs.)

Chronic Pain Patients: 4 Yr FU

decreased pain (PRI)30-55% great improvement40% moderate improvement25% no change5% worse decreased negative body image (BPPA)decreased medical complaints (MSCL)decreased psych symptoms (GSI)gains maintained (except PRI) x 4yrs

overall improvement (3.8-4.0) maintained at 4yrs

“anything of lasting value or importance?” 86% yes 67% reported 8-10/10 importanceCompliance:

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%

Chronic Pain Patients: 4 Yr FU

Commentsimpressive maintenance of

gainshigh compliance self-controlled

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

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


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.


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


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

Mindfully Working with PainDivide and Conquer Method

Emotions: Ideas in the Mind and Sensations in the Body

Mind: Mental Images and Internal Conversations

Sensations: Flavors and Locations


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

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


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


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)


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.


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


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)


A conceptual reframing of pain into a Spiritual Path

Pain X Acceptance = Spiritual Purification


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.

Mindfulness Based Stress Reduction

& Psychotherapy

Steve Shealy, PhDwww.BeMindful.org

813-980-2700

mindfulness in psychotherapy: managing pain with steve shealy, phd

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