Mindfulness Based Stress Reduction: Keeping the Brain in Shape

Mindfulness Based Stress Reduction at Work.

Mindfulness Based Stress Reduction at Work.

Mindfulness is one of those terms that seems self explanatory, but it really isn’t. We all have minds, so aren’t we all mindful?  Probably not.  The concept of mindfulness is just entering the portal of mainstream medicine. For many years, mindfulness meditation (also known as Mindfulness Based Stress Reduction, MBSR) was thought of as something akin to yoga, practiced mainly by “health nuts” who had the time to sit for hours in a trance, and mainly appealing to people who were interested in Eastern religions. It seemed “experience distant” to most people, meaning that it was interesting but not really relevant to their lives.

First of all, let’s define mindfulness. Jon Kabat-Zinn, who is credited with bringing mindfulness meditation into mainstream medicine, says that mindfulness is the awareness that arises through paying attention on purpose in the present moment nonjudgmentally.  Many people think that mindfulness meditation is about clearing the mind, having a blank mind. That is not the case.   Mindfulness Based Stress Reduction usually begins by sitting quietly and focusing on the breathing. As thoughts begin to intrude, and they will, they aren’t pushed away.  Attention is gently brought back to the present by focusing on breathing.  This back and forth between mind wandering and bringing back attention to the present occurs over and over again for most people, especially when beginning MBSR. The key is that thoughts and/or bodily sensations are not judged as good or bad; they are simply observed.  For example, while engaged in MBSR, you might experience some discomfort, maybe some back pain or a sensation of hunger. You experience that sensation, but you don’t try to resist it. You don’t try to judge it as good or bad. You might be curious about it. You simply experience it. You try to develop the ability to observe your sensations objectively. Most people focus on their breathing during the meditation, but some find it easier to listen to a sound in the back ground or some quiet music.  I will discuss more about the actual practice of mindfulness in the next blog.

What is the purpose of this exercise anyway?   There are actually two components to bodily sensations and emotions.  One component is the actual physical sensation or the emotion, while the other component is our judgment of it, how we perceive it. Do we perceive it as bad, good, pleasurable, noxious?  How we perceive it is really what determines how we respond.  Pain is deemed to be bad because we judge it to be. Kabat-Zinn would say that learning to stand back and observe emotions and sensations more objectively makes them more tolerable.  We have a tendency, understandably, to fight what we see as negative emotions. This simply activates the sympathetic nervous system which increases blood pressure, heart rate, tenses muscles, etc. That is our fight/flight response. But though adaptive in some situations, constantly being in fight/flight mode takes its toll on the body.

Kabat-Zinn and MBSR advocates are not suggesting that we need to learn to like pain or anxiety. But practicing MBSR can keep us from being so overwhelmed by intense sensations or emotions. It’s an acceptance of our present state without letting ourselves go down the slippery slope of negativisms such as “this will ruin my day,” or “I’ll never be free of this pain.”  We are so accustomed to thinking through our day as we drive to work and imagining worst case scenarios.  The concept of simply focusing attention on the present is rather foreign to most of us. How much of the present do we miss by constantly focusing on the past or future?

So far, recent articles have shown that mindfulness training can reduce stress during a period of high workload on military helicopters (Meland et. al. in the International Journal of Aviation Psychology, Oct. 2015), decrease fatigue, anxiety and mood symptoms in breast cancer survivors (Carlson et. al in Psychooncology, May 2016), and decrease pain intensity, pain catastrophizing, interference of pain in daily life and depression in cancer patients (Poulin et. al., Supportive Care of Cancer, May 2016).  There seems to be evidence that MBSR can help patients with addiction by modulating responses to environmental cues that instigate craving.  There is even evidence that MBSR can slow progression of Alzheimer’s Disease (Quintana-Hernandez et. al. Journal of Alzheimer’s Disease, 2015) and improve some problems with memory loss.  It seems to exercise the brain and keep it free of unnecessary debris.

In my next blog, I’ll explain more about the mechanics of Mindfulness Based Stress Reduction, including some tips on getting started.  I’ve included a YouTube video that explains more about mindfulness based stress reduction.    There are numerous YouTube videos on this topic including several by Jon Kabat-Zinn himself.





May is Mental Health Awareness Month.   I’ve written articles for this month before, usually with statistics about the frequency of mental illness, the stigma surrounding mental illness that prevents people from getting treatment, or perhaps about the difficulty that people with mental illness have getting access to good, affordable treatment.  All of those things are important, but they are just facts, opinions. They don’t put a face on the illness. What is it really like to live with severe depression or bipolar disorder. What is it like to live with a family member who is mentally ill?

Now you have an opportunity to find out.  Mental Health America has set up an area for people living with mental illness to post their experiences. Feel free to post your own experience. Go to www.mentalhealthamerica.net/feelslike.

Sometimes we forget that an adult’s mental illness can affect children as well. For example, children growing up with depressed parents have a significantly  increased chance of developing depression themselves. This is due to both biological and environmental influences. Parents who are depressed usually have a hard time really being emotionally present.   Children, as we all know, tend to feel that whatever happens is their fault.  They have fewer positive interactions with parents which can lead to a more negative view of the world. Their self esteem may be lower, and they may not develop the same resilience in the face of adversity that other children have.

I’ve worked with several patients who had parents who were severely mentally ill. Some had parents who were psychotic (probably schizophrenic), severely bipolar, or so depressed that they required institutionalization.  You would think that growing up with mental illness would lead them to seek out mental health treatment, but I don’t find that to be true. Sometimes they have negative perceptions, accurate or not, of mental health treatment based on what they’ve seen with their parent.  I find that they question their own “normality.” They continuously wonder if they are “OK” or if they might really be ill like their parent.

If you are living with mental illness or know someone who is, be aware of the effects on other family members. Your treatment benefits them in the long run. Even if they don’t need treatment themselves, they need a lot of support.   They need contact with other families, they need positive experiences outside the family, at school or in extracurricular activities.   We may not be able to control our genetic makeup, but we can influence the environment that our children experience, and that improves the environment that their children experience. It definitely has a long-term pay off.

Don’t forget to check out www.mentalhealthamerica.net/feelslike.

Love and Addiction

The short answer is – the same way you love everyone else. Love is not always a two-way street.  Have you ever loved someone who desperately needed your love but seemed to reject it? People with addiction are not easy to love because they do unlovable things.    Most of us have struggled with this in one way or another. It’s almost impossible to go through life without experiencing the effects of someone’s addiction.  There are non-substance addictions such as internet, gambling, shopping, even perhaps cell phone.  Some of these addictions may seem more innocuous, less disruptive than, say, heroin addiction. But they are still addictions.

Though I do believe that there is a strong biological component to addiction,  and it resembles other medical illnesses in many ways,  people with addictive disorders have problematic behaviors that affect other people. They steal, they lie, they end up in jail sometimes, they get sick, they become homeless, they need money, they lose jobs. Families and friends have to deal with that. Diabetics may not follow their diet or they may play passive-aggressive games with their medication, but they usually don’t steal money or end up homeless.

I find that people with addiction who grew up in a household surrounded by addiction have a double whammy. They have the genetic predisposition, but they also missed the benefit of good role-modelling.  Good parenting (though no parents are ever perfect) is essential for the development of things like empathy, ability to delay gratification, frustration tolerance, etc.  So when these people stop using drugs, they still don’t function that well because they missed some important developmental tasks.  They need a lot of therapy and support to maintain sobriety.

So what are friends and family to do when they have a child, spouse, friend who is actively using and seems to be skyrocketing downward?  The pat answer has always been “don’t enable them.” But what does that really mean? Assuming that you’ve tried to get them in treatment and they’ve refused, what next?

Refusing to enable someone has usually meant letting them hit rock bottom. It means never giving them money, which they will surely use for drugs rather than food, never allowing them to stay with you as long as they are using, perhaps completely stopping communication with them.  The theory is that this may push them to get treatment. Sometimes it does, sometimes it doesn’t. Sometimes they die.

I wonder how I would handle it if my child suffered from a drug addiction.  Could I really cut them off totally? I’m not sure that I could.   You can always hope that your loved one finally agrees to treatment, but I’m not convinced that totally cutting them off is any guarantee.  However, I realize that sometimes families may need to do this to maintain their own sanity.

How can you provide some basic support for the addicted person, yet not enable their drug addiction? I don’t have easy answers to that.  I have worked with some families who provide food (not money for food) and a place to live – that’s it. No money and no transportation except to doctor’s appointments.   Sometimes they’ve come to that compromise after trying harsher approaches such as kicking the person out.  However, if the addicted person is violent or negatively affecting other people in the family, particularly younger children, then they really can’t be in the home.

Al-Anon is a good resource for families of people with addiction.  It is helpful to talk with other families who are going through the same thing.   Families dealing with addiction often tend to isolate. Don’t do it. It isn’t helpful in the long run.

People with addiction are masters at making their families and friends feel guilty for not helping them – in the way they want help.  Sometimes you have to love someone from afar.  You remind them that you believe that a better life is possible, that you are willing to help them, that you love them. You offer what you think they need, not what they think they need. If they don’t accept it, that is their choice.  It may be a choice fueled by their addiction, but in our society today it is still their choice.