Sunday, 11 August 2013

Things I learnt in clinic: Mindfulness

One of the first things that we did at clinic was learn about mindfulness. It is a technique that can be used by anyone regardless of the state of their health and is a way of focusing the mind and taking time out to refresh and relax. Similar to meditation. In fact in draws upon many meditative qualities. Lately it has been hailed as a great technique for mental health improvement especially with conditions such as depression and anxiety as it can help calm the mind. In fact it was a featured technique on that programme on BBC 3  Failed by the NHS. In fact they are trying to get mindfulness courses free for those that would benefit the most.

So what exactly is mindfulness? According to www.bemindfulonline.co.uk it is ' a mind-body approach to life that helps people relate differently to experiences. It involves paying attention to thoughts, feelings and body sensations in a way that increases our ability to manage difficult experiences and make wise choices.' It can be a combination of two different types Mindful Based Stress Reduction and Mindul Based Cognitive Behavioural Therapy. The first MBSR, relates to reducing stress in ones life and therefore being able to think more clearly, which can be useful for conditions such as anxiety. And the latter, MBCBT is a technique that involves changing the way you think about certain situations, to be more in the moment rather than having your thoughts race. They also say that mindfulness 'enables us to be aware of our thoughts and emotions so we can make wise choices and respond better to different situations.' And in turn make us more aware of our bodies, which can 'even help people cope with chronic pain.'

Well that last quote sounds really good. But what mindfulness does is allow you to relax and slow down. To have some time just for you. So as I said my first experience with mindfulness was on my first group visit to the ME clinic. I had heard of CBT before with having councelling but never really put it actively into practise. Or so I thought until I have done some research into mindfulness and noticed how perhaps I had been using it but had never associated it with relaxation.

So how was it introduced? We were all asked to sit comfortabley but with our feet firmly on the ground. Then to close our eyes and to do some deep breathing. Breathing in for a count of 7 and breathing out for a count of 11. By breathing out for longer it helps the body to relax faster. Then after we had taken a few breaths we were asked to just zone in and concentrate on our breathing. Noticing the minutae of the process. The sound as we inhaled the air through our noses, whether we moved certain parts of our bodies as we inhaled and what the movement was. The sensation of our diaphrams expanding as the air filled our lungs and as it then detracts as we breathe out. As the excerise went on we were told to notice whether our concentration was lapsing at all, as in away from focusing on our breath and if it was to notice what it was our attention had been drawn by. Then to try and take our attention back to our breathing each time our attention wandered off.

In total we did this for 5 minutes on that first session and built on it in the following sessions. After the excercise we were asked about how we found it and whether we did find our focus wandering away from our breathing. Personally I found it difficult to begin with. As did many of the others. I found it difficult to relax as it was an alien concept back then and I also felt quite self-conscious with doing it in a group (somehow you feel like you are the only one and everyone else is watching or have left the room.) These were the main things that took my focus away from my breathing but when I did get into the mindfulness I did feel very relaxed in fact I was trying not to fall asleep. Oops!

But falling asleep is in contradiction with the aims of mindfulness. But at first it happens to many people, especially if you are not used to relaxing. It is a natural reaction to your body and mind calming down and if you are not used to it then it can make you feel sleepy. Because what mindfulness is supposed to do is to ger you more in tune with your body and mind. To understand more about your thought processes or how we use our bodies. For example focusing on what our bodies do when we are breathing. Therefore rather than using it to aid sleep it is more of a relaxation tool that also helps us become more aware. As I said to give us 5 minutes or more to ourselves. To help us think more clearly and focus on the next task that we undertake and forget about what we had been doing. Or even worries about past or future problems and anxieties. To just be in the moment. We were told that using this technique between tasks/activities that it would help us to be more present and in turn use less 'effort' (see post 'things I learnt at clinic: diaries) or spoons.

Building on from this you can start off in the same vain, focusing on your breathing, and then start assessing each part of the body. Focusing on only that body part. Noticing whether there is any pain or tension there? And if there was to keep with that thought, focusing on the pain and noticing how the more focus is placed on it the more intense it became. But the aim is to keep focusing as much as possible on it until we noticed our attention drifting, as it is want to do, and with this how the pain generally plateaud and faded.

I had done a similar excercise at university, using some of Stanislavski's methodology on acting to become aware of the body and how we use it and also to fully relax it before transforming into a different character. A character that would use their body in a totally different way. One difference though was that as we focused on each body part we would also need to tense it and then let it go to relax the muscles more.

Another mindfulness technique is that of 'active mindfulness', which draws upon some of the CBT techniques. As you might have guessed this is a more 'active' exercise but no it does not require a gym membership. It simply means using some of the techniques in your everyday life. One that comes to mind from when I was learning about CBT is to not just have a shower but to 'feel' the shower. Oh dear how pretencious did that sound? Notice the minutae of what it is you're doing. Notice what the water feels like. The smell of your shampoo and shower gel. How it feels on your hair and skin. Be 'present'.

How often have you had a shower and been thinking of other things? Being late for work, your outfit for the day? So many things that you probably don't heed much attention to showering. Unless it suddenly goes boiling hot or freezing cold. This is because it is so much a part of our routine that it is locked in our muscle memory. Meaning we can do certain things without really giving them much thought. The same could be said for driving, especially on a trip that you do often, your daily commute for example. It is only when you go somewhere new or have a passenger in the car when you are not used to it that you really pay attention to what you do when you drive, otherwise our minds are usually elsewhere or singing along to our favourite driving tunes.

So what can be done is just being more present in different situations and activities. For example if you are out for a walk or a wheel on a nice day, notice the sun on your skin, where do you feel it the most? Notice the sounds of the birds, the things and people that you pass. If you are walking, how are you walking? Does your heel or the ball of your foot hit the floor first? Am I sounding hippyish yet? As I said it's just thinking about the minutae that we do without really 'thinking' about it. Or it could be said that it is stopping and appreciating the world around us.

I can see how this would be a great technique for those with anxiety related disorders as it would help to focus the mind and try to calm any worries or fears that are provoking the anxiety. Not letting it all build up into mega panic attack levels. Obviously this all depends on the level of exposure, someone with severe social anxiety may take a while to practise the technique and for them to use it successfully in a social situation. I remember when I used to go out when I suffered from anxiety and by trying to slow down and focus more on what was going on around me or on my breathing did help. In that programme 'Failed by the NHS' some of the patients with anxiey and OCD found mindfulness helpful as it gave them a break from dwelling on their anxieties or thinking about ritualizing.

As for those of us with ME then I think the relaxation is very useful. It's also a good thing to do between tasks, depending on what the tasks are. If you are in bed and going from surfing the internet to reading then not so much. However if you have done something like organizing your wardrobe and then want to do something quieter like watching tv then it's worth a try. You will be better equipt to focus on the tv programme without your mind wandering off too much and you using up more spoons or effort as your mind is on other things as well.  We were asked to at least implement it once a day, more if possible, depending on the activities we were doing. Say for example if you were working then it would be good to try during your break. As for active mindfulness I think it can be helpful. We already need to break things into smaller chunks as it is to think about our stamina levels. But by thinking more deeply about experiencing them it can save some brain focus too. Plus by focusing more on doing something it can help with the brain fog as you are more likely to remember doing something. I should try this more with taking my tablets. I write it all down but as taking them has become second nature I can never remember actually taking them.

I have to say that it is useful in this vain and can actually be more refreshing than a short nap. Make sure that you have somewhere quiet to practise and if you don't live alone maybe tell othets that you don't want to be disturbed for 10 mintues. It can be hard to get into at first, especially with no one guiding you through it but once you get the hang of it you can use it anytime, anywhere you like. Try not to force your thoughts though or get annoyed if you do find your mind getting sidetracked during the excercise because that only winds you up, defeating the purpose of it. Our minds wandering is perfectly natural, especially if we are drawn by sounds or smells as that again is our fight or flight instinct kicking in.There is an online course available at the be mindful website (see link above) and also courses that you can attend. As well as books or audio sources available.

I don't practise it as much at the moment but that's because life is at a much slower pace but if I'm feeling stressed out then I will use it. Hopefully when I'm out of this flare and slightly more active again I'll be able to use it some more, when I remember that is! I think it's a useful technique for anyone. It is good to have 5 or more minutes just to reset and relax. Maybe try it after getting home from work, to set a clear distinction between work and home. Leave work thoughts at work as much as possible. Especially if you are on the go a lot and feel like your feet don't touch the ground. I wish I'd have known about it back when the only down time I had was sleeping. So give it a go and see what you think.

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