I teach mindfulness in a pain clinic in North East England as part of my role in the NHS. There is a long history of evidence that it can be helpful, dating back to the pioneering work of Jon Kabat-Zinn in the 1980's. At first though, it can seem counterintuitive. To many people in pain, mindfulness can seem like the exact opposite of what they want. Mindfulness asks us to turn towards our pain when we would rather turn away, to allow it when we would rather not experience it, to explore it when we would rather fight it.
So it's not surprising that I have often been asked how it can be helpful to bring mindfulness to pain. After all, many of the people who attend the courses have spent years trying to do exactly the opposite. The answer to the question lies in personal experience.
It seems logical to fight pain and other unwanted experiences such as difficult thoughts and emotions. It may fit with our view that we should not give in easily. We may have learned, over many years, that our culture expects us to keep on keeping on, to not give in without a fight and to pull our own weight. We may have observed people with long term pain and other physical symptoms being blamed for their difficulty in dealing with their symptoms, and labelled as lazy, unwilling to work, scroungers, burdens. The stakes are high. Nobody would want to be in this position so it might seem as if there is nothing else to do other than grit our teeth, put on a brave face and fight against how we feel. Not only is it the logical thing to do, our minds are set up so that we will automatically resist what we don't like, including pain.
We may fight against pain by trying to ignore it, pushing ourselves to keep going, taking more and more medication or telling ourselves that it's really not that bad. This tendency to fight is both an automatic reaction and also in line with what we believe we must do. Nearly everybody who suffers from pain has tried to fight against it. We need to reflect on our experience. What has been the impact of this fight? Has it helped? Most people find over time that a fight against pain is not a fight that can be won. While we may have some short-term success in doing what we want to do, in the long term fighting against pain usually makes it worse.
The mindful response of allowing our pain to be there is an alternative. We don't fight the pain because fighting would make it worse. Instead we simply tune in to how we feel. When we do, we can also tune in to what we need. We give ourselves the best chance possible of responding in a helpful way to our difficulties.
With mindfulness comes awareness. With awareness comes choice. We are no longer limited to our usual automatic or habitual reactions. We can consider what we really need and choose our response accordingly. Often this may involve making an effort to recognise that we are doing the best we can and letting go of the tendency to believe our self-critical or negative thoughts. It may involve recognising that we need to plan according to what we can do, not what we think we should be able to do. It will always involve starting from where we are in this moment.
Mindfulness is not just about paying attention to what is happening each moment. We are not just observing our experience. From this observation we are empowered to make wise decisions about what we need and how to respond. We are empowered to break some of the cycles that would otherwise increase our suffering. People who attend mindfulness courses for long term pain report a number of improvements, including improvements in their pain and in how they feel generally. As their ability improves to stay with their awareness even in difficult moments, so does their ability to choose a helpful response. These responses might include bringing kindness to times of difficulty. They may include choosing to focus on what feels important and not just on what needs doing. They will certainly include choosing what to do based on how thing really are. Mindfulness helps us to start from where we are rather than trying to start from where we would prefer to think that we are.
In this sense, mindfulness offers so much more than we might imagine at first. It is not a passive response. It is not allowing ourselves to give in. Rather it is a possibility of a renewed awareness of our feelings and needs in each moment which can open the door to the very choices and responses that we need. Choices and responses that will help us to break out of our automatic habits of resistance and self-criticism and direct us instead towards acceptance, change, growth and new possibilities.