These are trying times for everyone.
Patients, already feeling stressed and vulnerable because of an injury or illness, can experience these feelings amplified because of the fear and uncertainty surrounding the coronavirus pandemic and imposed social restrictions. In many cases, a patient’s stress reaction amplifies symptoms and fuels a vicious cycle of stress: Symptoms worsen, driving more stress, which then in turn further escalates symptoms.
One therapeutic strategy we can offer patients to help them self-regulate their reaction to stress is mindfulness training. Mindfulness is much more than a stress-management technique; however, principles of mindfulness can be adapted for this purpose.
Because your ability to effectively explain mindfulness to a patient depends on your own experience of the practice, you should practice these exercises yourself before giving them to a patient.
When introducing mindfulness to patients, it is helpful to remind people that life is a constantly changing experience of pleasant, unpleasant, and neutral experiences. This is true for every human being and makes our lives, at times, very challenging and difficult.
We can do our best to create agreeable circumstances, but no matter how hard we try, we still inevitably face unpleasant and unwanted experiences, such as the one we are now in. When we face a situation that we cannot change or control, then our power resides in observing and taking control of our response to the situation. This is where mindfulness training can come in handyl.
Stress = Situation + Our Reaction
I like to introduce patients to the equation Stress = Situation + Our Reaction. Our reaction is made up of our physical, cognitive, and emotional reactions:
- Our physical reaction includes things like our breathing pattern, muscle tension, and posture.
- Our cognitive reaction includes how we talk to ourselves, the stories we create about our circumstances, and our beliefs.
- Our emotional reaction includes the full range of human emotions from joy to sorrow, peace to agitation, and courage to fear.
The first step to taking control of our reaction to a stressful circumstance is to observe what is happening. We cannot take control of what we are not aware of. Developing a calm mind to skillfully observe what is happening and support wise choices to reduce stress is something that we can accomplish through mindfulness training.
Mindfulness training provides us with a skillful way to pay attention. In school, we are taught to think logically and problem solve, but we are not often taught how to pay attention. Mindful awareness is present moment awareness. We observe sensory experiences, thoughts, and emotions happening here and now. In addition to attention to the present moment, mindful awareness has qualities of acceptance, kindness, and curiosity.
Calming Your Mind
All sensory experiences, thoughts, and emotions are pleasant, unpleasant or neutral. When mindful, rather than struggling with this fact of life, you train to accept and open up to the whole of life, even when what you experience is unpleasant, such as pain or anxiety. You meet yourself and your experience with friendliness and curiosity and avoid self-judgment and criticism.
You are not a physical sensation or an emotion. You are a whole human being, and sensory experiences, thoughts, and emotions arise and pass like a river through a riverbed. When we let go of the struggle with our experience, we often can experience greater ease.
One metaphor for this is the surface of a pond. When the surface is agitated, it distorts the surrounding terrain. However, when the surface of the pond is calm and still, it is like a mirror, clearly reflecting surrounding trees, rocks, mountains, and sky.
The mind is similar. When we are all worked up, we can distort our perception of things, exaggerating some aspects of our experience and minimizing others. We can make a difficult situation even worse by escalating distorted thinking and amplifying unpleasant emotions and body tension. We can obscure our natural wisdom and capacity for understanding, insight, and skillful action.
As you train to calm your mind, quite naturally, the body begins to calm as well. This doesn’t occur by forcing your body to relax or having the goal to relax; it occurs by accepting your body just as it is in the present moment. If you feel tense, you accept those areas that are tense and trust the process.
A mind that is calm, open, friendly, and curious doesn’t come naturally to us. It takes training. Simple mindfulness exercises help people improve their ability to regulate their attention so they are not as easily caught in distorted thinking. They enable people to better regulate their emotions so they don’t spin out of control. They improve people’s body awareness and ability to reduce their stress reaction. In addition, when people do get stressed, they are able to return to being calm more quickly. They enable people to savor the good and better navigate life’s challenges.
It is key to remind patients when they practice mindfulness exercises that when the mind wanders, it is not a problem. This is totally normal! It is not cause for self-criticism and it doesn’t mean they cannot meditate or are doing something wrong. Just like it takes time to train a muscle to strengthen, it takes time to train the mind to rest in the here and now.
With daily practice, they—and you!—can do it!
For a thorough introduction to mindfulness and its application to patient care, Full Catastrophe Living by Jon Kabat Zinn is an excellent resource.