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Mindfulness in Psychotherapy: Managing Pain


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Title: Mindfulness in Psychotherapy: Managing Pain

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Mindfulness in Psychotherapy Managing Pain
  • with
  • Steve Shealy, PhD

What is Mindfulness?
Mindfulness isintentionally directing ones
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
  • ones 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

Mindfulness in Psychotherapy Pain
  • Clear Focus of Mind Often Occurs
  • In a Very Relaxed State
  • OR in a Very Dangerous or Threatening Situation

Mindfulness in Psychotherapy Pain
  • We balance this
  • Increased Awareness
  • Equanimity

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

Mindfulness in Psychotherapy Pain
  • Equanimity is remaining relaxed and open to the
    experiences passing through our
  • awareness with an attitude of lovingkindness

Chronic Pain Patients
  • Four-year Follow-up of a Meditation-Based Program
    for the Self-Regulation of Chronic PainTreatment
    Outcomes and Compliance. Kabat-Zinn, et al
    Clinical Journal of Pain (1987)

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

  • 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

Chronic Pain Patients 4 Yr FU
  • Comments
  • ?impressive maintenance of
  • gains
  • ?high compliance
  • self-controlled

  • How does Mindfulness work for pain
  • reduces suffering (reduces resistance)
  • works as a deep cleansing of emotional
  • decreases anger, fear, sorrow and guilt
  • develops a sense of connectedness with all
  • 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

Mindfulness in Psychotherapy Pain
  • The silver lining regarding having a pain
  • 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.

Mindfulness in Psychotherapy Pain
  • Three aspects of this method
  • observe precisely
  • have equanimity
  • be sensitive to how things change

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

Mindfully Working with Pain
  • Divide and Conquer Method
  • Emotions Ideas in the Mind and Sensations in the
  • Mind Mental Images and Internal Conversations
  • Sensations Flavors and Locations

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

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

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 O2 Entering the Body

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)

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

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

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)

Mindfulness in Psychotherapy Pain
  • A conceptual reframing of pain
  • into a Spiritual Path
  • Pain X Acceptance Spiritual Purification

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.

Mindfulness Based Stress Reduction
  • Steve Shealy, PhD
  • www.BeMindful.org
  • 813-980-2700
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