Mindfulness for Chronic Pain and Illness
What Is Mindfulness?
You may be asking yourself, “What in the world is mindfulness?” “How is this going to help me with my pain or illness?” Put simply, mindfulness is paying attention on purpose (this is the definition most frequently used by Jon Kabat-Zinn, who is considered the father of Western/modern mindfulness). What that really means is taking the time to stop and just notice what is going on in your thoughts and in your body. All too often we get caught up in the hustle of everyday life; mindfulness allows us to take a break from all of the daily hassles and stressors that may actually cause your more tension and pain.
Isn’t mindfulness just the newest fad?
NO. In fact it’s the opposite.
Did you know that the mainstream practice of mindfulness in the USA started as part of a program to help individuals with chronic pain? It’s true, it didn’t start with yoga, or psychotherapists, or meditation apps. Mindfulness as we know it was started by biologist, Jon Kabat-Zinn at a multidisciplinary pain clinic at the University of Massachusetts in the 1970’s. Since then, hundreds of people have been through that program and other programs like it. Many of these people have had great improvements in not just the amount of pain they experience but in HOW the pain impacts the rest of their life; this is supported by dozens of empirical studies (Hilton et al, 2017; Song et al, 2014). Additionally, mindfulness started to be effectively incorporated into helping people with all sorts of medical conditions including cardiovascular disease (Scott-Sheldon et al, 2020), multiple sclerosis (Carletto et al, 2020), and cancer (Zhang et al, 2015) to manage the impact of their health condition on their mental health.
How do I practice mindfulness?
There are many different ways to practice mindfulness. We say “practice” mindfulness, because no one ever really masters it, it’s something that is always changing with each new moment and each new experience.
Practicing mindfulness can look different for each person. There are both informal and formal ways of being mindful. For example, you could practice being mindful (i.e. just paying attention on purpose) by taking extra care to notice the way that water and soap feel when you are washing your hands. There are also more formal exercises that ask you to notice sensations as you eat, as you sit, as you walk, etc.
What is the difference between mindfulness and relaxation exercises?
This is a very common question, especially for people who have tried relaxation exercises for their chronic pain or cardiovascular disease.
Most (but not all) formal mindfulness exercises ask you to focus on your breathing and have an awareness of your breath and how it feels in your body. Because of this, many people think mindfulness is the same as relaxation exercises. In some ways, mindfulness and relaxation are very similar. They both may ask you to pay close attention to your breathing and other sensations in your body, but they are not really the same.
When you are engaging in a relaxation exercise, you are likely focusing on slowing down and controlling your breathing, or you may be actively focusing on your muscles and trying to release tension. In a mindfulness exercise, you may still be paying attention to the same areas (i.e. your breath, regions of your body) but you are not trying to change anything. You are just noticing what is going on in that part of your body. This noticing paves the way for learning how to just notice your thoughts, without judging them as good or bad, or allowing them to lead you to unhelpful emotions and actions.
Is mindfulness meditation?
Not really.
I frequently hear that people are concerned about starting to practice mindfulness because they think it is associated with Buddhism or another religion. For some people, engaging in an exercise that they believe to part of another religion, may go against their own religious beliefs. However, mindfulness isn’t about religion or transcendence. While mindfulness does share some commonalities with certain forms of traditional meditation (some of which are tied to Eastern religions and philosophies), mindfulness is not a religious practice. Mindfulness is simply about paying attention to what is happening in our minds and bodies, on purpose. Anyone can practice mindfulness, no matter their religious or spiritual background.
How will practicing mindfulness may help me manage my pain/illness?
Many people have asked me “how is paying attention to my pain going to help me manage it better?”. And if you’ve been reading my other posts, you might even be thinking “I thought paying attention to the pain was supposed to make it worse!”. These are valid questions, but here is how it may help:
For many people, when they start noticing pain or tension in their body, their minds automatically jump into all kinds of judgments about what they are feeling. They might think something such as “Oh no, my back is starting to act up again, this is going to be a horrible day again”. Usually when people have thoughts like this, it does make the pain worse. The pain ends up increasing because they get upset or frustrated over their concern about the rest of the day being ruined and painful. It is important to remember that it doesn’t matter if the thoughts and feelings are valid or justified (which they often are), the problem is that they are not helpful because the cause a domino-effect of problems for the person. What happens then is that the body responds to this frustration by creating muscle tension and releasing chemicals that amplify pain. So, the day ends up being as horrible as they were anticipating, or maybe even worse.
The same thing can happen with other symptoms, not just pain. For example, If someone is worrying about how their cardiovascular disease may impact their future, they may start to experience anxiety symptoms such as increased heartbeat, quickening of breath, and general unease (all of which are not only uncomfortable but also feel much like cardiovascular symptoms).
Mindfulness may help a person to simply notice that pain is present but be able to have the pain without judging it. That person may say to themselves “I’m noticing that having some pain in my back right now” and that’s it! Without the judgment of the pain, they get less worked-up and they can get on with whatever they were doing. The same applies to thoughts, feelings, and other physical experiences.
Getting Started
Now that I’ve answered some of the most common questions about mindfulness for people with medical conditions, you might be eager to start trying. The good news is that you can start right away, on your own. All you have to do is pick something to pay attention to (it could be your breath, the sounds you hear in your home, or the way the first sip of coffee tastes in the morning). It can be anything, you just have to commit to placing all of your awareness on whatever you choose and to just notice what you experience, no judgements.
It is important to note that mindfulness is something that you have to keep practicing, and for most people setting aside a small amount of time everyday helps them to feel more comfortable and committed to the practice. It is not uncommon for your brain to get distracted during an exercise, as long as you notice that you’ve been distracted and bring your attention back to your designated target, you are on the right track. You just have to keep practicing. Give yourself grace, some days will be easier than other days, and that’s ok.
Sometimes it can be helpful to use a guide for your practice. I am not officially endorsing any specific apps or programs in this post, but there are many available on the internet (some for free).
Additionally, in my clinical experience, I have found that people normally find it easiest to start mindfulness with a guide or therapist and then graduate to more independent or self-directed practice.
Happy noticing…
Additional Resources
YouTube Video: Dr. Jon Kabat-Zinn talks about Mindfulness for Chronic Pain
https://www.youtube.com/watch?v=KqS9qHEWnaA
YouTube Video: Dr. Fadel Zeidan TEDtalk about Mindfulness for Chronic Pain
https://www.youtube.com/watch?v=OLQJJDrbj6Q
Body Scan for Chronic Pain Instructions: https://www.health.harvard.edu/pain/body-scan-for-pain
References
Carletto, S., Cavalera, C., Sadowski, I., Rovaris, M., Borghi, M., Khoury, B., ... & Pagnini, F. (2020). Mindfulness-based interventions for the improvement of well-being in people with multiple sclerosis: a systematic review and meta-analysis. Psychosomatic Medicine, 82(6), 600-613.
Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., ... & Maglione, M. A. (2017). Mindfulness meditation for chronic pain: systematic review and meta-analysis. Annals of Behavioral Medicine, 51(2), 199-213.
Scott-Sheldon, L. A., Gathright, E. C., Donahue, M. L., Balletto, B., Feulner, M. M., DeCosta, J., ... & Salmoirago-Blotcher, E. (2020). Mindfulness-based interventions for adults with cardiovascular disease: a systematic review and meta-analysis. Annals of Behavioral Medicine, 54(1), 67-73.
Song, Y., Lu, H., Chen, H., Geng, G., & Wang, J. (2014). Mindfulness intervention in the management of chronic pain and psychological comorbidity: A meta-analysis. International Journal of Nursing Sciences, 1(2), 215-223.
Zhang, M. F., Wen, Y. S., Liu, W. Y., Peng, L. F., Wu, X. D., & Liu, Q. W. (2015). Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: a meta-analysis. Medicine, 94(45).
