Mindfulness and Health - What is Mindfulness

Mindfulness is the practice that cultivates paying attention on purpose, in the present moment, nonjudgmentally to our experience.^{[1, 2]} It is not a belief or philosophy, but an awareness of the nature of the mind and our emotions.^{[1, 3]} Mindfulness is often confused with meditation, and while the practices are interconnected, they have different origins. Meditation, a practice involving awareness of our breath, stems from Buddhism. It is one of the many tools used to cultivate awareness of the self and nonjudgment towards the self and others. Along with other mindful practices like mindful eating, walking, and acting, meditation is a tool thought to assist people to journey towards enlightenment.^[4]

Mindfulness associated with health and healing in Western philosophy was developed by Jon Kabat-Zinn in studying meditation with the Buddhist monk Thich Nhat Hanh. Motivated to help others to reduce stress and pain in medicine, Jon Kabat-Zinn developed a program called Mindfulness-Based Stress Reduction (MBSR), which has shown to be a valuable approach for a multitude of health concerns, including but not limited to chronic pain, PTSD, addiction, fatigue, anxiety, depression, weight loss, and cardiovascular incidents.^{[1, 5, 6, 7]}

MBSR involves both alone and in-group experiences to change negative consequences of patterned, habitual conditioning, to become self-regulating in distress, to cope more effectively with stress, challenge, and change, and to become self-reliant on learning, growing, healing and thriving.^[1] Students are taught formal mindfulness practices, including body-scan meditations, sitting meditations, hatha yoga, and walking meditations. Other mindfulness practices include nonjudgmental awareness of pleasant, routine events, and unpleasant events, which may include interactions between people, repetitive thoughts and emotions, body sensations, habits, or everyday behaviours.^{[7, 8]} After 8–10 weeks of exploration, the significance of mindfulness for health has been proven time and time again.^{[7, 9]}

Mindfulness is thought to explore the relationship in humans between pleasure and pain. Being taught to notice triggers (stress or pain), become mindful or interested/fascinated with what is causing the stress, rather than reacting to the stress and/or pain, and then rewarding ourselves (noticing peace, equanimity) in the moment may be setting up habits of self-reliance and control over our circumstances, regardless of what they are.^[10] Greater positivity can arise out of this investigation, which — if repeated over time — become kindness to ourselves and others in distress.^[9]

Mindfulness for Chronic Pain

Chronic pain costs health-care billions of dollars yearly; time away from employment, an inability to take care of loved ones or one’s self, and possible dependency on pharmaceutical drugs to relieve pain. Pain is a complex experience that has psychological and physical components, and they are often additive; the longer the experience of pain, the more apt one is to experience psychological or psychiatric conditions such as anxiety, depression, or posttraumatic stress disorders. In addition, pain affects basic physical activities such as sleep, energy, appetite, and so in turn, people become more depressed or anxious because they are not meeting basic requirements for good health.^[11]

Mindfulness has been explored for chronic pain since its inception in Western medicine by Jon Kabat-Zinn in 1976. As part of a stress-reduction program that is now called Mindfulness-Based Stress Reduction (MBSR), patients with chronic pain over 10 weeks were exposed to meditation practice and encouraged to use mindfulness meditation daily.^[12] The great significance of this practice is that during the study and following the study, participants after 15 months and in subsequent studies, years, had decreased need for the original dosages of their pain medications, decreased avoidance of activities in daily life due to their pain, and decreased anxiety and depression.^{[11, 12]} A multitude of studies have been performed since this original study, with a multitude of health conditions; chronic pain has seen significant improvements with MBSR techniques, most notably with respect to osteoarthritis, fibromyalgia, and chronic neck and back pain.^{[13, 14]}

Mindfulness practices can be used despite dependency on medication, especially opioids such as morphine, oxycodone, or codeine, and mindfulness has been used more recently in a program called Mindfulness-Oriented Recovery Enhancement (MORE).^{[15, 16]} Designed to improve the quality of life in those with chronic pain, randomized controlled trials including the MORE approach are demonstrating that those participating have a decreased dependency on opioid medications, as well as increased resiliency in stress and the ability to manage pain.^{[15, 16]}

How exactly then is mindfulness reducing chronic pain? Pain perception is where mindfulness appears to have its strengths, in that individuals who are more accepting of their pain and less reactive to its presence, or those who can essentially breathe with their pain through meditation see pain reduction.^{[16, 17, 18]} Mindful awareness of pain basically exposes a person in chronic pain to different body-awareness activities such as eating, walking, sitting, or through meditation. While the pain itself may not dissipate, the emotional experience of the pain is shown to change and lessen.^{[12, 17, 19]} Just as one would notice how the grass feels under the feet in a walking awareness, pain perception becomes almost a curiosity, and then can be accepted more easily, and with less distress. In fact, pain acceptance through mindfulness decreases worrying thoughts about the pain so significantly it may explain why long-term benefits of MBSR training for chronic pain are seen even with very little time spent with mindfulness activities.^{[11, 12, 14]} Hence, being aware of what is happening is the most important part of mindfulness and pain, without judgment.

Mindfulness for Anxiety and Depression

Mindfulness and its ability to strongly change the trajectory of the lives with mental health disorders is one of the main reasons this way of life has become such a strong practice in the Western world, both informally and in medicine. Mindfulness is, in a sense, a version of mental training, rather than a relaxation technique.^[9] Mindfulness is essentially the ability to stay attentive to what is happening in the present moment, and watch like an observer what is happening, rather than get caught up in strong emotions or be influenced by external circumstances. This “emotional observation” is what allows mindfulness to be an amazing tool to help with depression and anxiety.^[20]

So how is it that practicing mindfulness reduces the intensity of the experience of anxiety and/or depression? There are several theories, but it appears that we develop better coping mechanisms in a more mindful, gentle attitude towards ourselves.^[9] There is also some evidence to suggest that those with mental health struggles have less of an ability to regulate their intense emotions than those without.^{[10, 20]} When negative feelings arise, there can be negative thoughts associated with the self, which can be very distressing, and lead to loops of negativity.^[9] Paying attention to these “loops” or ruminations is what mindfulness provides; objectivity to thoughts, behaviours, and feelings that may not be in our best interest and seeing that they are in fact negative and maladaptive to us. With less attention to these negative loops, or stories, a more positive view on life can be attained.^[21–23]

Fear or anxiety are complex combinations of signals between a few areas in the brain. The amygdala is one such area in which fear learning occurs, and when stress hormones are high, connections that are associated with fear are enhanced.^{[14, 24]} Mindfulness activities such as mindfulness-based stress reduction (MBSR) programs are demonstrating structural changes in the amygdala in addition to reduced experience of anxiety by a mere 8–10 weeks, in which participants are taught seated and walking meditations, hatha yoga, mindful awareness, journaling, and emotional attention.^{[5, 20, 25, 26]} The same changes in the brain have also shown to be true in those suffering with depression. The brain neurotransmitter norepinephrine, when at lower levels than normal in a location in the brain called the locus coeruleus, is implicated in depressive feelings. Recent studies have explored imaging of the locus coeruleus after mindfulness practices, and it was found that the locus coeruleus was more active.^[27] It suggests that as a result of these practices, more activity and blood flow would also increase the activity and presence of norepinephrine, and in doing so, may reduce the symptoms of depression and anxiety or the feelings of anxiety and depression related to those imbalances.^[27-29] The beauty of mindfulness practices is that not only are we seeing changes in those afflicted with anxiety and depression, but also in all individuals (or mentally healthy individuals).^{[30, 31]} Therefore, all people practicing mindfulness have an increased ability to resist the effects of stress, but also to prevent episodes of anxiety and depression!

Conclusion

Compassion is a huge part of our ability to connect and care about ourselves and other human beings. Mindfulness is the practice of curiosity, openness, and attention to the current moment without changing the nature of it.^{[32, 33]} With respect to many health conditions, including those who support those whom are ill in a care-giving role, mindfulness and self-compassion used together are demonstrating tremendous capacity for deep and powerful healing.

The word “compassion” is defined as being with (“com”) another’s suffering (“passion”).^[34] This does not mean that we must take on all of the suffering of others, but that we witness or acknowledge pain of ourselves or another.^[34] Witnessing our pain or another’s pain can, however, be deeply distressing. Not being able to fix or change a feeling or sensation in the body can create a great deal of anxiety, anger, or anxiety.^[35] Integrating the concept of mindfulness to a loving understanding (compassionate) of pain or distress can change these distressing emotions into loving attention rather than indifference. As in the words of Dr. Kristin Neff, a leader on self-compassion work for health and healing, “mindfulness is necessary to insure that compassion doesn’t become a slick new form of resistance (‘I’ll be kind to myself to make the pain go away’), while compassion provides the emotional safety needed to fully feel and open to one’s pain.”^[36–39]

How exactly then are self-compassionate and kinder activities with mindfulness known to influence health and healing? Self-compassionate thoughts (sending love to one’s self, being kind to imperfections) has been shown to decrease cortisol, the stress hormone, when used as part of meditation.^[38] It is also known to activate oxytocin, also known as the “love” hormone, that allows us to have connections to others.^[34] When oxytocin is active, it is associated with the calmer, healing aspect of the nervous system or the parasympathic nervous system.^[38]

Interestingly, mindfulness with self-compassion is also able to shift old thought patterns or behaviours that are not useful to us, without causing harm.^{[38, 40]} In self-injurious disorders such as cutting, sitting with painful thoughts and emotions (or being mindful of their presence) is a huge step in stopping harming activities, rather than acting them out out of habit or reactivity.^{[41, 42]} Mindfulness with self-compassion involves noticing the self-harming thoughts (“I want to cut’) with the feelings invoking depression or anxiety (“I’m not good enough, I hate myself, I’m very sad that I can’t stop”), which in turn can be triggers of continued self-harm.^{[39, 41, 42]} These observations with kindness (compassion) are what allow people to see what they experience in their mental world and their emotional world as ever-changing and transient. The sense of self becomes less entrained with thoughts and emotions and more curious, but with a loving eye.

Hence, enhancing the skill of mindfulness or noticing ourselves and our environment, without judgment, and using the tools described in the previous three sections on mindfulness, can be solidified and acted upon with kindness to facilitate true healing. That we are not alone in our struggles as imperfect humans, trying our best, is what makes mindful activities truly revolutionary in life, for all ages and walks of life.