Mindfulness (Living Beyond Pain Podcast)

Mindfulness (Living Beyond Pain Podcast)


[Narrator] Stay tuned for [Army] Capt. Tracy Beegen,
of the “Living Beyond Pain” podcast, produced by the Defense Health Agency. [music] [Army Capt. Beegen] Welcome back to
the “Living Beyond Pain” podcast. Today, we’re going to be talking about mindfulness
and the impact that it really can have on chronic pain. We are fortunate to have [Navy] Cmdr. Bill MacNulty. [Navy Cmdr. MacNulty] Thank you, Captain. It’s a pleasure to be here. Thanks for having me. [Beegen] So mindfulness is a really hot topic
right now. There’s a lot of information out there about
mindfulness, about what it can do for your body and your mind. Can you help us make sense of all that information
and give us, first, just a definition? What is mindfulness? [MacNulty] Well, you’re right. It’s definitely very popular these days, but
it’s actually something that has been around, really, as long as human beings have been
around. It’s sort of a quality and a characteristic
that is natural to human beings. And the definition that I like for mindfulness
is one that was developed by a man named Dr. Jon Kabat-Zinn, who created mindfulness-based
stress reduction. And he says that mindfulness is the awareness
that results from paying attention to the present moment, on purpose, nonjudgmentally. That’s a pretty simple definition. But when you attempt to start doing that,
you quickly discover it’s quite difficult. [Beegen] I know for me, sometimes I just go
on autopilot on my way to and from work because I’m thinking about all the things I have to
do when I get to work. On the way home, I’m thinking about, “I need
to make dinner,” what activities the kids are doing. And so sometimes, I feel like it’s really
difficult to slow down and be in the present moment. [MacNulty] You’re absolutely right. That’s what makes it so difficult to do that
simple act of paying attention to the present moment, on purpose, nonjudgmentally. We hardly spend any time in the present moment. If you think about where our mind goes, it’s
very much like you describe. We are almost always traveling forward in
time to anticipate a problem that’s coming or how we’re going to take advantage of an
opportunity that might come along. Or we’re fantasizing about some time when
such and such difficulty is done and life is going to be so much better. And if we’re not doing that, then maybe we’re
traveling backwards in time, remembering this awkward conversation that just happened or
some terrible event that maybe happened five years ago. Or we’re fantasizing or rather, maybe, reminiscing
about some time before such and such bad thing happened and life was so much better. And then, the moments when we are present
when we see what’s really happening, it’s hardly ever without judgment. We are really quick to evaluate our experience
as something that we like and we want more of or something that we do not like and we
have to get rid of. And when we make those sorts of judgments
of our experience, even though we do it real kind of quickly and almost automatically without
thinking, it has a really profound effect on our experience of that moment. [MacNulty] It’s not as if I’m suggesting that
we just stop judging or making judgment calls and using our abilities of critical thinking,
for example. We have to do this in order to get by in the
world. When we talk about non-judging in the context
of mindfulness, it has to do with the quality of relationship that we adopt towards what
we’re noticing inside our own skin or the thoughts or feelings or physical sensations
that we’re experiencing, relating to them in a way that doesn’t automatically judge
them as bad or as good, but just rather observes them as experiences that are happening in
the present moment. So an example of that might be, if I’m driving
to work and I’m stuck in traffic and I have the thought, “Gosh, I might be late. I’m going to get in trouble.” And so now, suddenly my heart is racing and
I’ve got a sick feeling in my stomach. And this is not helping me get to my meeting
any faster, but it’s sort of a byproduct of my assessment of my situation as not good. [Beegen] So you talked about the paying attention
on purpose, just paying attention nonjudgmentally. And that sounds like a really difficult thing
to do. [MacNulty] Mindfulness is about awareness. At its root, I would argue mindfulness is
all about awareness. And oftentimes, when we are able to simply
be aware of our experience nonjudgmentally, then, oftentimes, relaxation will follow on
quite naturally without any effort from us. And so while there are ways that we can deliberately
seek to, and actually, be really quite effective at increasing relaxation in our body, mindfulness
invites us to change our relationship to our experience and just observe it differently
or, well, non-evaluatively. Getting curious about what’s happening without
trying to judge it as good or bad or without trying to make it any way other than it is. And interestingly, what we discover is that
when we do that, frequently, the pain will change and relaxation will quite effortlessly
follow. And even if it doesn’t, even if it doesn’t,
by just observing our experience nonjudgmentally, well, now we’re no longer kind of at war with
our self. We’re not at war with some aspect of our experience. We’re not fighting our pain. We’re living with it, carrying it with us
with more, you might say, patience and ease of mind. And with that, comes more room to maneuver,
to respond more creatively in terms of how we’re going to work with it and live with
it. [MacNulty] And so to go back to my example
of being stuck in traffic, I might distract myself or put on the radio or I might try
to convince myself of how unreasonable my thoughts are. Like, “No, nobody’s going to be that upset
with me because I was a few minutes late.” And those are all valid approaches, but a
mindfulness-based approach would invite me to do something somewhat different. And there’s a really useful acronym or a four-step
process called RAIN that I frequently invite people to practice at times like this. RAIN stands for– well, the first step is
recognize. You recognize that this is, in fact, happening. That I’ve had a thought, “I’m going to be
late,” and my body is having a response to that thought. And then, the next step, the A in RAIN, is
to allow it to happen, not try to suppress it, not try to distract myself from it. Just let it unfold as it will. Now, that’s a little harder to do, often,
than– just to say, “Okay, just allow it,” but with practice, we can get better at that. The next step, the I in RAIN, is investigate. So this is where we get curious about what
is actually happening in our body in this particular moment. Not only do we allow it to happen, but we
kind of turn our attention to it and we really notice, “Okay, so where do I feel this frustration
or this agitation? Is it in my chest? Oh, I noticed tightness in my jaw. My face is flushed. My respiration, my breathing is shallow and
rapid.” Not trying to change anything, just observing
it with as much depth and precision as possible. And then the last step, N, I’ve already spoken
to, but it’s note. We note what we find there and just label
it. We can just say, “Oh, tension, heat, urgency,
an impulse to act,” with whatever words we can think of. And honestly, if we can’t even think of the
word to describe what it is we’re noticing, that’s fine too. Just the simple act of noticing like, “Gosh,
I don’t know how to describe this, but I see it.” All of this functions to put a little distance
and perspective between us and what we are experiencing. We give making it a little easier for us to
give it room just to be there. [Beegen] And I really think that can be the
challenge for us. [MacNulty] Yeah. And sometimes, as you point out, when sensations
are really quite intense, practicing RAIN can be pretty challenging. The question that one might ask oneself in
the investigation stage to help get that shift of mind towards curiosity, we can ask our
self questions like, “What is the shape of this sensation? If I could touch it or hold it, would it be
heavy? Would it be light? Would it be rough or smooth?” You can ask yourself, “Is it hot? Is it cold? What’s its color? Is it one color? Is it many? Does it pulsate or is it static?” And just get as curious and try to develop
as rich and full a sense of this experience as possible. The one other thing, though, I’d like to add
about that, in working with sensations of real intensity. It’s an idea that we take from the medical
world. And it’s a concept called titration. And by titration, we mean you get to dial
it up or dial it back, little by little. And so in this case, if a sensation is really
intense, then, perhaps, you could practice RAIN with it just for a second or two, maybe
one breath. And then you back off and you send your attention
somewhere else to another part of the body that’s not feeling pain, for example. And then, when you’re ready, you come back
to it and maybe you linger a little while longer. And the point is that you get to decide how
close you get, how long you stay there. And as you do that, then, well, you come to
discover, “Hey, we have a little more control and agency in this process and how we relate
to our experience of pain than we might otherwise assume.” [Beegen] With the different hats we wear and
the different roles we have in our life, taking away that judgment, whether it’s a parent
who is feeling guilty because they can’t engage with their child at the playground or playing
soccer with their child or if it’s a soldier or a veteran who used to be very physically
active and now, there’s some limitations because of how their chronic pain is impacting them. Something I’ve found with the patients I’ve
worked with, with chronic pain, is when they start to incorporate some of these strategies
and really developing a practice of mindfulness, they start to become more aware of when they
do have their good days when they’re not having flare-ups, that they’re enjoying interactions
with people. They’re able to engage in enjoyable activities
and they’re more aware of that. And that’s taking up more space than the pain
that’s been dominating their awareness. [MacNulty] Well, I think, just to begin, I
want to agree with you and reiterate that this is an ability that we all possess, like
the ability to speak a language or to play an instrument, but we cannot simply just pick
up a guitar, for example, and start doing it. It requires practice for us to refine our
abilities. And this is no different. And so to answer your other question, how
do we go about developing those abilities? The first step is, I would say, dedicating
a regular amount of time every day, maybe 10 or 15 minutes, to practicing mindfulness,
practicing paying attention to the present moment, on purpose, nonjudgmentally. And fortunately, there are many, many tools
and resources that can help us with this. There are several app-based platforms. Mindfulness Coach is one. And I think there’s the Military Meditation
Coach podcast. Those are both free. And there are also several commercially available
mindfulness apps, as well. [Beegen] So that just reminds me of, for our
military folks and our veterans that have ever had to do a PT test in the military,
and you see those guys out there that two weeks before the PT test they’re trying to
get in shape for the PT test. And it’s typically not very effective for
most folks. So what you’re telling us is that mindfulness
is really a practice that needs to be developed and practiced consistently. Is that accurate? [MacNulty] Yeah I completely agree. If you think about mindfulness training like
physical training, you don’t have to join a gym and spend a whole lot of money in order
to exercise. You can actually exercise your body by going
for a run or even for a walk. And so you don’t have to go to a Zen monastery
or go on a retreat in order to begin to practice mindfulness and have a really robust mindfulness
practice. If we can be aware of it and we can become
aware of it on purpose, whatever that is can be the grounds for a really, vibrant mindfulness
practice. [Beegen] Well, Cmdr. MacNulty, I really appreciate you taking the
time to share with our listeners about some practical strategies that they can use in
developing their own mindfulness practice. [MacNulty] Thank you very much for the opportunity
to talk with you about this and all the best to you, Captain Beegen and to your listeners. [Beegen] So again, we just want to remind
our listeners, developing a mindfulness practice is just like physical exercise. You’re going to get the most out of it by
developing a consistent routine and you’re going to see the long term results by being
consistent and keep going at it. But again, it doesn’t have to dominate your
life. You don’t have to become a Zen master. You can just develop that practice daily and
just see what happens. And exploring the present moment with that
curiosity in mind and trying to do it nonjudgmentally. Please download those apps and get started. And we’d love to hear what your experience
has been in the comments section below. And please join us next time as we continue
our “Living Beyond Pain” series to give our listeners tools to help decrease their
intensity, frequency, and duration of their pain flare-ups so that they can live beyond
their pain. “The Living Beyond Pain” podcast is produced
by the Defense Health Agency. Until next time, be well. [music]

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