Tag Archives: mindfulness

08Mar/14
Mindfulness for pain, health and performance

Want to feel happier, suffer less pain & anxiety, think more clearly?

Mindfulness for pain, health and performance

Mindfulness for pain, health and performance

Mindfulness programme

The brief practice of mindfulness for just 10 minutes each day has a positive affect upon physical and psychological health.

Mindful practice forms part of our treatment and proactive training programmes for chronic pain and health problems. However, learning the practice is beneficial for anyone who wishes to reduce feelings of tension, anxiety and stress; improve sleep, concentration and clarity of thought; and overall have a healthier and happier experience of life.

Mindfulness itself is very simple and practical. Much like we train our body in the gym to be fitter and stronger, mindfulness trains our ability to be aware of what is happening in the present moment, and without judgement.

How much time do you spend on autopilot? How much time do you spend noticing what is going on right now as opposed to dwelling on the past or constructing a future in your mind? Does the past or future make you feel bad or anxious? Do you relive scenarios that make you feel unhappy? The problem is that the brain does not distinguish between what is happening in reality and what is happening in our mind. The body still responds, often by protecting itself using different systems in the body such as the nervous system, the immune system and autonomic nervous system (‘fright or flight’). Gaining insight into the mechanisms and becoming skilled at being present not only creates time, but also disarms the effects of drifting into the past or the future.

Enhancing the potency of mindfulness

Alongside the practice of mindfulness, a simple exercise habit that includes strategies at work will create the conditions for the body systems to cultivate health. A rounded programme of physical and mental training that interlaces with normal living improves performance, sleep, clarity of thought, sense of self, social interactions and immune responses. These factors are related and positively affect each other once healthy habits are learned.

Call us now to book your first mindfulness session: 07932 689081

The Specialist Pain Physio Clinics in London – expert treatment and training to tackle the problem of chronic pain and injury.

15Feb/14
Brain~Body

Bear traps and how to avoid them

My old headmaster would warn us not to fall into bear traps. By this he meant pay attention to what you are doing so that you do not make a simple mistake. He would set a few bear traps and see if we were concentrating or if we were on autopilot. It was also a way to note tomfoolery.

As clinicians we can also fall into bear traps by not attending to or challenging our own thinking and beliefs. This is especially true with pain, where we can so easily rely on our own beliefs about pain and what we should do in response to pain. We know for example, that GPs can give advice about back pain according to what they would do if they suffered back pain — rest or remain active.

Cultivating awareness of our understanding, beliefs and noticing the messages that we give to patients is a simple habit. It takes practice but allows us to ensure that we are giving the best possible advice and information, perhaps in the form of a metaphor. This includes the mode of delivery: body language, tone of voice, timing of the message and the environment in which the message is given.

Here are a few simple tips:

1. Before each patient, gently notice your breathing — in, and sense the chest rise and expand; out, and feel the body tension ease. This helps to create an awareness of what is happening now, including preconceptions and thoughts that could flavour the coming session.

2. Listen deeply — by continuing to breath, remaining present and listening to every word and noticing the patient’s body language, we can learn all that we need to intervene in the right way. The most potent way for that moment.

3. Speak with compassion — our brains are wired to thrive on kindness. We can create an effective session by both listening and communicating in a mindful way without the clarity being lost by intrusive thoughts that obstruct effective messages being passed.

The Specialist Pain Physio Clinics in London provide treatment and training programmes for pain and dystonia based upon the latest neuroscience of pain, brain and mind. The approach is comprehensive, addressing the problems and influences in a compassionate and encompassing way. If you are suffering with chronic pain, call us now to book your first appointment: 07932 689081

30Jan/14
Mindfulness for pain, health and performance

5 reasons why mindfulness is part of our treatment programmes

1. Mindfulness reduces suffering: pain, anxiety, tension.

2. Mindfulness promotes clarity of thought.

3. Mindfulness develops a sense of calm.

4. Mindfulness creates an ability to focus ones attention where you want to, and not in response to the wandering mind.

5. Mindfulness changes physiology, triggering restorative processes: e.g./ healing, digestion, sleep, anti-inflammatory action.

For pain, stress, anxiety, performance, concentration, call us to make an appointment: 07932 689081

14Jan/14
Turned on?

Are you turned on?

Turned on?

Turned on?

At the risk of sounding ambiguous, many people are turned on. In particular, city dwellers and workers who are being hit with innumerable stimuli, bombarding the senses, triggering on-going responses by the brain, the mind and the body. Whether it be the noise of the traffic, the lights at night, the phantom vibrations of the phone, pollution or close-quarter travel on the train, outputs are being generated by the nervous system, the immune system and the endocrine system that are experienced as thoughts, feelings and physical sensations, some being pleasant, others not so.

Once a chronic state of arousal has been reached, the on-going energy demands can eventually result in burn-out or a gradual state of declining physical and mental health — the two being inextricably linked.

How does this manifest?

The all-too common conditions that we see include general body-wide muscular aches and pains, headaches and migraines, irritable bowel syndrome (IBS), anxiety, indigestion, pelvic pain, fertility issues. The thread that ties these seemingly unrelated problems is stress. Stress however, is a physiological response to a situation that is perceived to be threatening. Two people can give entirely different meanings to a particular scenario, thereby having diverse experiences — it is all about an individual’s perception. Our perception is based upon beliefs about the world, sculpted over the years by exposure and influences.

stress-2The biological response to threat involves the autonomic nervous system and the motor system at least, preparing to either flee from the danger or confront the situation. An incredible set of responses, they evolved from the need to deal with wild animals. Fortunately this does not happen too often these days, but there are plenty of potential threats including the thoughts that pass through our mind. The brain does not differentiate between a thought and actually being present. The response is similar and usually thinking about something unpleasant that may happen will lead to feelings of anxiety — tingling in the tummy, tension, increased pain.

If these systems are persistently triggered by stress, there is less opportunity for smooth digestion, conception, healing and clarity. Being chronically turned on hence results in digestive issues, sensitivity of the bowel (bloating, pain etc), difficulty conceiving (thoughts of sex and conceiving are not going to be high on the brain’s agenda if there is a constant perception of danger) and pain that results from gradual changes in the tissues. In fact, every body system is impacted upon by the chemicals released during an on-going stress response. And not in a good way. Performance is affected, mood varies, sleep is disrupted, concentration is poor, catastrophising becomes rife and negative thinking about life predominates.

How do we turn off?

Specialist Pain Physio Clinics in London for pain, complex pain and injuryRelaxation or having the ability to switch off is often a skill that requires learning and practice. Going to the gym, having a cigarette or a coffee is not turning off. These are all stimulating a system that is already fraught. It is the calming, restorative, digestive and healing mechanisms that need to be fortified.

Promoting calm in a habitual way across the day is a potent way of re-programming the right responses for the right scenarios. Checking in on the body and thought processes, attending to the present moment rather than automatically drifting into the past or future, avoiding stimulation (e.g./ electronic screens, coffee, cigarettes, sugary foods and drink, certain reading material), mindful practice, breathing techniques and cultivating focused attention are all ways in which we can build our positive bank account in terms of energy and feeling good. Creating good habits. Exercise although stimulating, and certainly in a gym with bright lights and loud music, should form part of a routine for the overall healthy benefits. It is the best wonder drug that we know of and it is free.

Changing behaviours is difficult but it is achievable with the right programme that addresses both body and mind. Cultivating a routine around sleep, movement, diet, exercise, mindfulness, work and family will groove a healthy, resilient, positive and happy path forward. Turn off.

For more on our healthy programme and treatment for painful conditions, stress and anxiety, call us now on 07932 689081

03Jan/14
The fulcrum point

Changing pain and suffering in 3 steps

The fulcrum pointLogically, anecdotally and empirically, understanding one’s pain is a foundation from where action can be taken to initiate change. Conversely, lacking insight into the cause of pain and being unaware of the contributing factors creates anxiety that forms its own cycle of problems. This is certainly true when pain persists with no obvious structural or pathological reason — a common scenario.

The initial feeling of pain could be termed the primary sensation. The location, quality and intensity are noted, motivating responses: have a look, move, perhaps touch and seek advice. From the primary feeling comes an automatic thought that is deeply grounded in a belief system about pain, injury, life, health and the landscape of our world. This automatic thought triggers a range of emotional and physical responses that are experienced as secondary effects. The secondary effects of limitation, suffering, further pain and sensitisation — an often downward spiral accompanied by despair,  a perceived loss of control — accounting for much of the impact upon quality of life.

There is a fulcrum point between the primary and the secondary that is so potent; a fulcrum point being the place where leverage can be applied to affect a process. In physical therapy — for this is my background — this could be the careful and reasoned application of a hands-on technique to effect change in the way the brain processes sensory information from the body; the basis for relief as the brain alters it’s outputs and hence the sense of physical self. Similarly, to intervene at the point of feeling pain so as to minimise or even prevent the secondary effects that are driven by the automatic thought is a practice that can be cultivated.

  • Pain -> thought — meaning? -> increase in pain, tension, suffering
  • Pain -> thought — mindfulness -> reduced pain, tension, suffering

3 steps to easing pain & suffering 

There are several steps to developing the practice. Firstly, understanding your own pain is vital. What are the biological mechanisms and sources? And what can influence this biology? The latter includes stress, fatigue, movement, thinking, beliefs and the environment. A further point to consider is always that of perception. We all have our own unique perception that is created by our mind~brain, again based on our view of ourselves and the world, moulded by years of experience that blends with our genetics. No matter what the situation, our own reality is the one we respond to, and in the case of pain and sensitivity, the responses can increasingly be triggered by non-threatening situations and environments that are perceived now to be threatening.

The second step is to develop awareness of one’s own thinking and perception at the point that pain is noted. It is by becoming aware that we can then make the necessary change and apply leverage. To be aware means that you must be present as opposed to the autopilot mode where the mind drifts into the past, replaying tapes of previous events — that can equally trigger emotional and physical responses — ruminating on what has been, or fantasising or constructing a future. Neither fundamentally exist, yet we respond and behave as if this is the case; it is our reality for that moment. In doing so, the present moment is missed and we follow the mind and it’s wanderings. All minds do this, this is normal, but if the wanderings create suffering, angst and discomfort, it does not bode well for a happy existence.

The third step is to practice. Being aware is being mindful; the way in which pain and suffering can be eased. Creating a habit of regular practice is certainly achievable with a little motivation, guidance and support. Within a few weeks, people often report a significant difference in how they feel in terms of pain but also in their ability to deal with pain, their resilience. Mindfulness practice changes how the body physically feels and there is a fortified sense of facing life. The release of tension, the removal of the sandbags from the shoulders is welcome in all cases.

Specialist Pain Physio Clinics in London for chronic pain and injury — mindfulness is part of a comprehensive treatment and training programme to reduce pain and suffering, and guide individuals back to a fulfilling life — call us on 07932 689081

01Jan/14
Specialist Pain Physio Clinics in London for pain, complex pain and injury

Mindfulness programme

The light out of the darkMindfulness commonly forms part of a comprehensive treatment and training programme for pain, anxiety and stress. The origins of the practice stem from many years ago but in a modern sense, mindfulness is mind training that is akin to physical training used to improve fitness. A great deal of time is dedicated to physical activity for health, less so on the mental side, however the two are inextricably entwined. For one you simply need the other, and to combine the training is the most potent way of cultivating the conditions for healthy living or recovery from pain and injury.

The modern day use of mindfulness is to create health, foster clarity of thought, increase awareness of thoughts and actions for self-improvement and to reduce stress, anxiety and pain that occurs as a consequence of simple practices. Mindfulness is not steeped in religion, but is a philosophical framework to attain a more fulfilling existence.

See Vietnemese Buddhist monk Thich Nhat Hanh speaking here 

Thich Nhat HanhA programme of mindfulness activities, followed week by week over a period of 8-10 weeks is an excellent way to groove the habit. It is a learning process that increasingly develops awareness in order to make the necessary changes to promote health. Many activities and thought processes are automatic or habitual, but do not point us towards a positive, fulfilling existence. To change this situation requires practice, in essence to re-wire the way we are working via the characteristic neuroplasticity, a feature of the nervous system that underpins learning and adaptation.

Over the 8-10 weeks the practice of a variety of mindfulness activities creates a healthy habit. Several daily sessions of 12-20 minutes focused training is the goal. In addition, forming a routine of performing tasks in a mindful way is a powerful way of regularly enrich awareness; this is simply by paying attention to a normal activity such as cleaning, making a drink or walking. Attend to the sounds, the feel, the aroma and physical sensations thereby standing in the present moment rather than drifting automatically into the past or building a future.

Typically over the period of training, the practice of mindful breathing to cultivate awareness of the effects of thoughts upon the body and vice versa, the body scan to regain a sense of the physical body and how it constantly changes and responds, mindful movements that combines awareness with comfortable motions that nourish the body tissues, working with the pain and suffering and developing compassion towards oneself and others.

For further information or to book, please call us: 07932 689081

31Dec/13
Matthieu Ricard

The habits of happiness | Matthieu Ricard speaks

Matthieu RicardPreviously a scientist, Buddhist monk Matthieu Ricard, talks about happiness and the ability to train the mind to cultivate well-being, serenity and fulfilment.

How can we nurture happiness?

Ricard describes how we can do this in order to lead happier and fulfilling lives, blending the fundamentals of mind training with science.

Many people who are starting the journey towards changing their pain, begin from a start-point of unhappiness. Beginning the treatment and training programme by creating a positive mindset builds a strong foundation from where one can move forward, by both understanding pain and cultivating the practice of specific mind training techniques.

23Dec/13
lion

Thoughts can be threatening

lionA threat can arise in many forms. Years ago, it would have been a wild animal that posed a potential danger, responded to with a fight or by running away — flight. Nowadays we don’t often face the physical threat of an animal attack, more likely it being the menace of street crime or the risk of an injury whilst undertaking activity. The context of each of these scenarios is very different with distinct and personal meanings that result in varying responses.

The key point about a threat is that is must be interpreted as being dangerous in order to arouse activity in the autonomic nervous system. This system is the link between what we think, the meaning we ascribe to a circumstance and how the body responds. With connections that reach far into the body systems, in particular the cardiovascular system and the gut, the autonomic system is a major player in creating awareness that something is potentially unsafe and hence drives behaviours to approach or avoid.

Most of the time we do not face a physical threat. However, familiar feelings in the body signify anxiety most likely on a daily basis: tension, butterflies in the stomach (actually changing blood flow that triggers neural activity), increased heart and breathing rates and perhaps a sense of panic. Why? Because of our thoughts.

Thoughts can be threatening. A thought that is lived, given significance, engaged with or is considered to be self-defining, will evoke emotional and physical responses. If the thought is one that plays a tape of an unpleasant past experience, fashions an image or a story that is troubling or builds a future of uncertainty, the autonomic system will be aroused. This happening over and over ensures that the system becomes more easily switched on and vigilant to a range of cues, even normal situations that can become threatening in some cases.

Feeling anxious is normal. It warns us that we need to place our attention upon the trigger and take the necessary action. Once this has been done, there is no need to continue to feel anxious, but often the association continues. Automatically there is a response to a thought, or waves of thoughts, and without control over this, the spiral continues. How can we gain control?

Mindfulness is a very potent way of tackling stress. The bodily feelings of stress are triggered by our perception of a situation being negative, risky, dangerous and somehow threatening to our beliefs about ourselves and our world. At the point where a thought or a situation prompts an automatic thought that is negative, these emerging from our belief system that has been evolving from a very young age, this propels us into greater suffering, pain, and sensitivity with increasing impact. Mindfulness practice refines the awareness of this process, maintaining a presence that prevents the dwelling upon the past or a leap into the future. Neither of these actually exist as they are constructs of our mind. The problem is the brain’s response to past or future thinking is very similar to actually being there — a lack of discrimination means that the same autonomic actions are triggered.

In the short-term, the autonomic responses are adaptive and useful. If they persist, the chemicals released over and over become problematic as certain systems are shut down due to the perception of danger. For example, the gut and reproductive system are not needed when we are escaping the clutches of a wild animal. But, similarly, chronic stress from an on-going negative assessment of a situation, thinking, will have the same effect. This is often a feature of infertility when the reproductive system is being impacted upon time and again.

The biological reality then, is that no matter what the situation, it is the individual interpretation that is key in determining what happens next. In developing mindfulness practice and emotional intelligence at the fulcrum point that is the automatic thought popping into consciousness, suffering, pain and on-going stress responses can be subdued and dissolved as presence and awareness rules over.

For further details about our treatment and training programmes for persisting pain and stress, call now 07932 689081

26Nov/13
Thich Nhat Hanh

Buddhist monk Thich Nhat Hanh talks to Oprah Winfrey

Thich Nhat HanhThich Nhat Hanh, a Vietnamese Buddhist monk who has written and spoken about compassion and mindfulness for many years, talks to Oprah Winfrey. There is a great deal that we can learn from him, in particular the potency of breathing and awareness of the breath that anchors us to the present moment, the only ‘real’ time that exists.

Mindfulness is being practiced increasingly as people realise that the simple techniques benefit their health, performance and sense of self. We have been incorporating mindfulness into our treatment and training programmes for persisting pain for a number of years to tackle anxiety, stress and the experience of pain itself.

29May/13

Prepare the brain and immune system for surgery

We know that catastrophising about pain can shape the way in which the immune system responds to nociception – see the article

Fig.1 Catastrophising & Immune Responses – Full article here

in Figure 1. Catastrophising refers to the interpretation of pain as signalling something damaging and dangerous and is often preceded by hypervigilance to body sensations. This maintains a negative focus upon the body and alongside a belief that pain is a sign of damage, this can drive behaviours that affect the recovery from an injury or surgery. Pre-existing beliefs that develop from prior experience, knowledge and from what one has been told will combine to create that individual’s ‘truth’ or landscape. The problem is that it may simply be untrue. 

What can we do to optimise outcomes?

Identifying hypervigilance and catastrophising pre-operatively allows for interventions to tackle these issues. Understanding pain, the operation, knowing what will happen afterwards in terms of pain control and the post-operative plan for mobilisation can all help. In addition, prehabilitation is often used to develop fitness and function so that the recovery and rehabilitation process are more rapid and successful.

Beyond these more common strategies there are techniques that can tackle the stress and anxiety that naturally develops. Controlling these normal responses to both the thought of, and the actual operation, will create a more positive mindset for recovery and potentially hasten the process along – recall that what we think about has a physiological consequence, i.e. thinking about surgery evokes anxiety that is noted as the churning tummy (actually a change in blood flow) and tension. Priming the nervous and immune systems in a positive way is a way of preparing for the operation and optimising the outcomes.

How can we do this?

The techniques that we use include pain education alongside good explanations from the surgeon and anaesthetist, motor imagery, mental imagery, visualisation, mindfulness, breathing techniques and other bi-directional strategies (using the body and recognising how thinking affects the body as mentioned above).

Prior to these techniques we will have listened to your story, spoken to you about your operation, the build-up, how long you have had pain, learned about your current health and previous experiences you may have had in healthcare. From there we can design a programme for you addressing factors that may affect recovery such as catastrophising about pain, fear of movement, stress and anxiety.

For further information or to book a session please contact us on 07932 689081 

Here are two papers that looked at this issue:

Guided imagery to improve functional outcomes post-anterior cruciate ligament repair: randomized-controlled pilot trial

R. Maddison et al (2012) 

Imagery can improve functional outcomes post-anterior cruciate ligament repair (ACLR). Research is needed to investigate potential mechanisms for this effect. The aim of this study was to (a) evaluate the effectiveness of an imagery intervention to improve functional outcomes post-ACLR, and (b) explore potential mechanisms. A randomized-controlled pilot trial was conducted. Participants were randomized to guided imagery and standard rehabilitation or standard rehabilitation alone (control). The primary outcome was knee strength 6-month post-operatively. Secondary outcomes were knee laxity at 6-months, and change in psychological (self-efficacy) and neurohormonal (adrenaline, noradrenaline, dopamine) variables. Participants (n=21; 62% male) were 34.86 (SD 8.84) years. Following the intervention, no statistical differences between groups for knee strength extension at 180°/s (t=−0.43, P=0.67), or at 60°/s (t=−0.72, P=0.48) were found. A statistically significant effect was found for knee laxity, F=4.67, P<0.05, mean difference of −3.02 (95% CI −4.44 to −1.60), favoring the intervention. No differences were found for self-efficacy; however, an overall effect was found for noradrenaline, F(1, 19) 19.65, P<0.001, η2=0.52, and dopamine, F(1, 19) 6.23, P=0.02, η2=0.29, favoring the intervention. This imagery intervention improved knee laxity and healing-related neurobiological factors.

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Brain Behav Immun. 2012 Feb;26(2):212-7. doi: 10.1016/j.bbi.2011.06.014. Epub 2011 Jun 28.

A brief relaxation intervention reduces stress and improves surgical wound healing response: a randomised trial. 

Broadbent E, Kahokehr A, Booth RJ, Thomas J, Windsor JA, Buchanan CM, Wheeler BR, Sammour T, Hill AG.

Source

Department of Psychological Medicine, The University of Auckland, New Zealand. [email protected]

Abstract

Psychological stress has been shown to impair wound healing, but experimental research in surgical patients is lacking. This study investigated whether a brief psychological intervention could reduce stress and improve wound healing in surgical patients. This randomised controlled trial was conducted at a surgical centre. Inclusion criteria were English-speaking patients over 18 years booked to undergo elective laparoscopic cholecystectomy; exclusion criteria were cancellation of surgery, medical complications, and refusal of consent. Seventy five patients were randomised and 15 patients were excluded; 60 patients completed the study (15 male, 45 female). Participants were randomised to receive standard care or standard care plus a 45-min psychological intervention that included relaxation and guided imagery with take-home relaxation CDs for listening to for 3 days before and 7 days after surgery. In both groups ePTFE tubes were inserted during surgery and removed at 7 days after surgery and analysed for hydroxyproline as a measure of collagen deposition and wound healing. Change in perceived stress from before surgery to 7-day follow-up was assessed using questionnaires. Intervention group patients showed a reduction in perceived stress compared with the control group, controlling for age. Patients in the intervention group had higher hydroxyproline deposition in the wound than did control group patients (difference in means 0.35, 95% CI 0.66-0.03; t(43)=2.23, p=0.03). Changes in perceived stress were not associated with hydroxyproline deposition. A brief relaxation intervention prior to surgery can reduce stress and improve the wound healing response in surgical patients. The intervention may have particular clinical application for those at risk of poor healing following surgery.