October 26, 2018 at 11:01 am #10546Patricia BurkeKeymaster
Mindfulness in Behavioral Health
Responses to Lesson 2 Homework
Patricia A. Burke, MSW
As I read through your responses to the homework exercises I became aware of feeling a sense of deep regard for your commitment to practice. We cannot bring our full and mindful presence into the clinical work unless we engage in a regular practice of mindfulness. Experiencing these exercises also gives us knowledge we can bring directly to our clients about the potential benefits and challenges of mindfulness practices. It also enhances our ability to teach the practice to our clients. So, I appreciate your efforts to experience mindfulness through engaging in the homework exercises.
Question 1: Lying Down/Body Scan Meditation
What did you notice about your physical experience during the Lying Down/Body Scan Meditation? What was it like to make contact with the different areas of your body? What was it like to make note of your sensate experience, accept it, then move on without trying to change or fix that experience? How would you evaluate the effectiveness of this meditation to help you make contact with your sensate experience in the present moment? How would you evaluate the effectiveness of this meditation to help you develop both concentration and flexibility of attention simultaneously?
One of the potential healing effects of mindfulness practice is that it can help us become more present to our moment-to-moment experience as it unfolds, instead of letting the mind take us to the past or the future.
Being present in the moment helps us come into a different relationship to our pain and discomfort. In AA we talk about One Day at a Time as a kind of mindfulness bell to stay in the moment. Mindfulness practices are another path to present moment awareness that can be applied to recovery. If we are paying attention to our experience as it arises in the moment, we are not caught up in the pain of the past or anxious about what might happen in the future.
People often notice that during the Lying Down/Body Scan Meditation what arises when they notice a place of tension or discomfort in a particular area of the body is an impulse to change or “fix” the discomfort. This impulse to “fix” is normal and part of our habitual response to pain. This meditation can short circuit that habitual response.
When we experience pain we want to stop hurting. The paradox of the human experience, however, is that the more we try and “fix” what we think is “bad” or “wrong” the more we suffer. The point of meditation is not to get rid of pain, but to change our relationship to pain so that it no long takes over. By bringing mindful, non-judgmental attention to an area of discomfort in the body, we enhance our awareness of the impulse to “fix” and begin to realize that we can simply notice that impulse and the thoughts of distress associated with that impulse and refrain from acting on the impulse. As a result, our relationship to the “fixing” impulse changes and a “letting go” can happen.
Some folks may notice a bit of anxiety and the urge to move quickly through the process. However, if you stick with the process it can be illuminating. As Jennifer noted, “Making contact with the different areas of my body was challenging and anxiety provoking to varying degrees. I appreciated the guided mediation because I would have been tempted to move on quickly from the areas that had sensations that I perceived as anxiety. I was able to get a half-step of distance as an observer with these body parts. I also did notice that some body parts felt better (that is, less perceived anxiety) and I moved on from them as well and resisted the urge to stay there. Afterward I felt more connected to my body than I had all day.”
Enhancing our ability to notice discomfort in a non-judgmental way has tremendous potential for non-chemical pain management. For example Elaine wrote: “Since I had a bit of a headache while doing this exercise and this was done after work, I felt that my head was making a strong connection to the earth, and overall I felt heavy and able to sink into the floor to relax. With the guidance, it was helpful to have the “reminder” to focus on different areas of the body and divert my attention from my headache, which in my opinion makes this technique very effective in terms on concentration.”
By bringing mindful attention to sensations in different areas of the body and refraining from “fixing” them, people often simply began to feel lighter and more relaxed. The effort shifts from trying to change our experience to practicing noticing our experience without judgment and refraining from changing it. The result is a lessening of the anxiety and stress associated with trying to “fix” our pain, our discomfort, ourselves, our lives.
The body scan can also bring us to more of a place of acceptance of whatever we are experiencing in the moment and bring attention to physical experiences that we often disregard.
Some people find the meditation to be unpleasant or uncomfortable at certain points. Discomfort during this mindfulness practice is a common experience and it is important to let clients know that this might occur. It is a normal response to paying attention in a way that we are not used to doing.
Clients often ask the question: Why should I do this exercise if it just brings attention to my pain? I think the answer is because it has the potential of alleviating the suffering associated with pain. Accepting the pain without avoiding, ignoring, or holding onto it is a concept that our minds cannot easily understand. That’s why it is so important to practice so we can experience the potential healing for ourselves– same for our clients. We are all in the same boat. However, it is also okay to give people permission, before starting any mindfulness exercise, to stop the exercise at any point if it becomes so uncomfortable that it is not helpful.
Some people find the body scan challenging. It is important to give ourselves and our clients permission to learn from each practice and use that information and insight to either modify the practice or find a different practice to start with that is not as challenging.
I gleaned from reading your responses that the Lying Down/Body Scan Meditation is effective in a number of ways including feeling less distracted, connecting with the present moment, feeling more connected to the body, enhancing awareness of body sensations, enhancing relaxation, a sense of calm and control, decreased thought drifting.
Bravo to you all for your deep awareness and willingness to experience this mindfulness meditation for yourselves.
Question 2: Focusing on a Single Object
What was it like to focus fully and completely on the object first visually and then through your sense of touch during the Focusing on a Single Object exercise? What did you notice about the experience of sustaining your focus of attention on an object in the present moment? What was it like to notice your mind wander, then gently bring your attention back to the present moment? How would you evaluate the effectiveness of this mindfulness exercise to enhance your ability to focus your attention, maintain your focus for longer periods of time, and concentrate fully on the present moment?
We can bring mindful attention to even the most stimulating experiences of everyday life and learn to slow down. It is one thing to sit in meditation at home and practice mindful awareness, but another thing entirely to practice mindfulness at work. For example, when we have ten people demanding something from us at once, or the noise of the conversations in the hall intrude on our private space, or the telephone rings off the hook. We can practice mindful awareness in the midst of this kind of stimulation and it still can have the effect of helping us slow down and be present. Focusing on a single object can help focus the mind in the midst of other stimuli. Elaine commented on how helpful it is to begin her day at work with this mindfulness practice: “I chose an artificial succulent plant in my office and enjoyed being able to concentrate on the varying green colors of the plant itself and the ceramic container. Choosing to do this meditation first thing in the morning, before any of my co-workers arrived at work was helpful too, as my mind wasn’t wandering too much due to the lack of other sounds or distractions outside my office door. Being able to focus on one item that I generally overlook was a nice shift in perspective and helped me to ease into my workday with a general calm feeling honestly.”
One of the things that can happen when we begin to focus our attention in a mindful, curious, non-judgmental way on an object of attention is that we begin to notice things that we had never noticed before. This kind of attention can lead to expanded awareness of the present moment and a deep sense of calm and even an absence of mind chatter.
In my experience, mindfulness is a wonderful practice because it is about cultivating an open, non-judgmental awareness within which thoughts come and go. If we practice enough, mindfulness is a doorway into moments of “no thought.” Focusing on a single object of like the breath, a sensation, counting numbers, or an external object are practices that build our capacity to enter more deeply into the mindful, open attention. However, the point of mindfulness meditation is not to achieve an experience of “no thought;” the point is to expand awareness in a non-judgmental way, so that as thoughts arise they are simply noticed as thoughts that come and go within the context of awareness itself.
In this particular exercise, the addition of touch can be an effective way to ground one’s attention on the point of focus. As Jennifer mentioned, “I loved exploring it visually and then through touch. I focused fully on the spoon, especially the way the light in the room reflected on it. The touch sensation that most stuck with me was temperature: the spoon was much colder than my hands and the air. I felt fully wrapped up in the exercise.” Cherie noted, “I chose a smooth stone. I enjoyed exploring it visually and by touch. I was able to focused fully on the object. . . I did not find my mind wandering during this time as it felt like a treat to only focus on one thing during that time, and to stay fully focused on the present moment. I would evaluate the exercise as effectiveness as it did enhance my ability to focus my attention and maintain my focus.”
Using visual cues and touch to heighten concentration can be important elements of mindfulness practice for people who are more externally oriented or folks who have a history of trauma and dissociation. Keeping your eyes open helps some folks stay more grounded in the moment. Adding touch also increases the focus on the external and can make concentrating on an object of attention easier and less emotionally evocative than focusing on an internal sensation, feeling or thought.
When our attention is engaged in this way, an interesting thing often happens. Everything seems to slow down. We may even begin to lose track of time. For example, Jennifer commented: “I used the guided meditation and was surprised how short the five minutes felt.” This is the experience of the timeless moment. This is the experience of being fully in the moment. When we are fully engaged in the moment, the past and the future have less impact on our state of mind, emotions, and physical experience. We become less attached to our thoughts and more open and accepting. A side effect of being present in the moment is a sense of peace. This practice can also help us become more aware of all of our senses and how our senses interact with the world and enhance our experience in the moment.
Another effect of mindfulness practice is that we begin to become aware of how much we don’t notice. This is a kind of meta awareness. It is like noticing that I judge how many judgments I have in my mind. This meta awareness can help us step away even further away in our witnessing position to gain even a bigger perspective on our experiences as they unfold in each moment. A good way to get a visual of this meta awareness is to go to Google Earth or Yahoo Maps on the web. Find a location on the earth and zoom in. This is a metaphor for the focus on a particular sensation, thought, feeling, image etc. as it enters into awareness. Now zoom out. As the map puts that particular location into a larger spacial context we can use this metaphor to begin to notice that any particular thought, feeling, sensation, image etc. is a tiny speck in the spaciousness of our lived experience.
Some folks notice that it is harder to keep their eyes open and focus visually on an external object of attention and while it was easier when they touch the object.
These are important awarenesses and reactions you can explore with clients. Is your client more internally or externally focused? Is your client someone who takes in things visually or more through physical touch or both equally? These reactions might give you some ideas about which mindfulness practices to work with first and/or how to adjust the exercise to work more effectively with your particular client at that particular time in their recovery.
Although sometimes challenging this exercise is a useful practice for many to help build a facility for concentrating for longer periods of time, bringing the mind back from wandering, and focusing on the present moment. As Catherine commented, “When I practiced this exercise, it was nice to focus on something that was outside of my mind and body and had nothing to do with work or other life stressors. I focused on my Little Mermaid water cup in my office. It was easy to focus on this object without too much mind wondering.”
Folks who find this exercise more challenging initially, are often able to benefit from their insights about those challenges. Even when an experience is challenging and uncomfortable, if we bring mindful attention to that experience, we can still derive useful insights from that experience. This is an important awareness and one that I think is useful to communicate to clients.
Integration Into Clinical Practice
How would you envision adapting and integrating the Lying Down Meditation and/or the Focusing on a Single Object into your clinical work with people who suffer from addictions?
Below is a sampling of some of the ways you might integrate the Lying Down/Body Scan Meditation and/or the Focusing on a Single Object exercise into your clinical practice:
* I would use this exercise with people over the phone, and I would take the role of the person guiding the meditation (after discussing the basics with the client, including that either perceived positive or perceived negative sensations are just to be observed, and neither will last forever).
* I feel like this exercise may be difficult to convince my patient to try, as teens may find it a bit silly. It may be useful to verbally guide them through the experience rather than have them do it themselves the first few times.
Focusing on an Object
* I have client’s open stop mid-session (when indicated) and just pick up one of the fidget tools, or therapeutic tools for a thought stopping moment. I find this type of exercise most beneficial with my clients with a diagnosis or components of ADHD.
* I do this exercise often with my clients, especially when they are experiencing anxiety or a lack of control.
* I’ve used a similar single object exercise with my college students previously, so it was nice to revisit this technique with more objects at my disposal in my office than a classroom
Both Mindfulness Practices
* For my clients with either straight MH or co-occurring utilizing these techniques is more about distress tolerance and learning the new skills and then taking them back to their own community for continued use.
* I felt I could use both exercises in my practice, and I felt I could use this exercise with patients in person or via telehealth sessions as I could guide the experience.
* Working with patients with SUD and teaching these skills will be very beneficial to them, as they can take the skills and apply to so many situations that come up between therapy groups and sessions.
Terrific ideas and insights about how you might apply these specific mindfulness tools to your clinical work.
I want to encourage you to be creative and feel free to adapt them to your particular context. For example, if you don’t have a place for clients to lie down or don’t feel comfortable with doing that in a session. That’s okay. You can do a variation of the body scan while people are seated in chairs. It may be a bit more challenging for people to let their bodies fully relax in a chair, but if you offer them some initial instructions to relax their bodies as best they can in the chair and let the chair support them, you can then begin to guide them through the body awareness exercise. The contact with the chair simply becomes part of the experience of sensations arising in awareness. So don’t be afraid to experiment with the meditations in order to adapt them to your particular situation. Bring your non-judgmental curiosity to bear as you engage your creativity as you integrate mindfulness into your work.
Melissa noted, “Given I have some medical issues laying flat is a challenge, but I was able to easily modify the body scan experience. I actually did both directions (toes to head, then head to toe) at two different times. I found it much more effective to go from head to toes as I could “relax” the brain and had and settle into the moment. And Cherie wrote: “I found it more useful to go from head to toe be toe to head as it seemed as soon as my brain and head were in a more aware state, I as able to focus more fully on the other areas of the body.”
Once again, thank you all for your willingness to engage in the exercises and your thoughtful comments. Your participation enriches the experience for us all. In our next lesson we will be focusing on specific ways that mindfulness can be integrated into addiction counseling, the importance of clinician mindfulness, strategies for designing and teaching mindfulness practices to clients, and the concept and practice of radical acceptance.
Be well. Be in peace.
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