We are proud to celebrate our 10th anniversary of Teacher Training and welcome our 2015 cohort of mindfulness teachers who completed the M4 training requirements in the first full 3-day training retreat. Congratulations to all and we look forward to an on-going sharing in your insights and great work! Many thanks as well to our coach teachers, Brittany Glynn, Lakshmi Sundaram, Sheila Robertson, and Jessie Bossé.
Pain is unavoidable. We inhabit a system that is engineered to become wonky, cranky, and otherwise uncooperative over time. We know this conceptually but not when and how it matters. Why me? What now? tend to be our responses when the body fails us – as it inevitably does. In case you think this is only a problem for aging folk or those afflicted with strange hard-to-diagnose illnesses, it’s not. Athletes injure themselves. Random acts happen to young and old alike that leave them having to reshape not only their bodies but their mental attitudes towards their entire life.
Joy is unavoidable too. We have a resilient system that is subtly wired to sense into experiences that nourish and sustain us. We don’t know this in the definition of sensing joy; we hope and believe it will be true some day – if we’re really good, work hard, and check off all the boxes that we think entitle us to joy. And it’s not just aging folk who do that. In fact, the older you get the more you begin to see that it’s not the boxes you’ve checked off that brought you joy in any lasting way.
And then stuff happens. Like illness. Random events. Unplanned halts. Stuff. And in our frustration and anger we turn onto the machinery because we see our bodies as just that – the CanadArm of our mind. It is interesting to realize that until pain hits us, we don’t fully see how over-identified we are with what our body is. When we become unable to do the things we once took for granted, we lose our identity of being capable (because of the body), strong (because of the body), competent (because of the body) and so on. Pain of injury and illness is unavoidable. Suffering or stress arises when we feel we’ve lost our identity as someone capable, strong, and competent. However, pain is an important message from our body to pay attention; when we resist hearing it we get caught up in a deep suffering about who we are and all our fears about self, others, and the future.
There’s a mindfulness approach based in Buddhist psychology that teaches a dis-identification with these ideas of who we are (because of the body) or that we can only be who we were (with the body we had). This is not the same as dissociating from our body although under extreme stress and high levels of pain a dissociation can happen. “Dis-identification” is a process of seeing that our definition of who we are, if only based in external concepts is very, very limited.
“I am not my body” simply means there is so much more to me than just this physical container, biological process, and mental state. By extension “I am not my pain” means these sensations do not define who I am, they are not a mark of my character or potential.
This is important. We can sense the pain, discomfort, and even the frustration, sadness, and loss of our current situation; then we take the next step of turning towards it to see that these are sensations and not something that defines us. (This is also a powerful mindful approach to emotional pain.) And from that joy is accessible because it is also present as part of our experience.
I recently had the pleasure of attending a pain management training taught by Vidyamala Burch and Singhashri Gazmuri at the beautiful Garrison Institute. The program is called Breathworks (because breath works!) and, of all the training programs I’ve attended, it is the most clearly set out and well-paced teaching in pain management. As you might have read in other parts of this blog, I have been in partnership with fibromyalgia since 1998. I am grateful every day that I have been able to work (crazy hours – do as I teach, not as I embody), travel, practice my meditation at long retreats, and otherwise live a vibrant life. Breathworks offered me additional insight to this partnership I have with my bodymind.
- Pacing – set a timer to ring every 20 mins. Stand up, breathe, stretch for 3 mins. Repeat.
- Check into your body. What do you sense? Are there echoes of stress?
- Be kind.
- Be disciplined – not just with the pacing but also with discerning when to move into the pain sensations and when to step back.
- Experience leads us to the soft edges and hard edges. Can you tell the difference?
Burch and Gazmuri are wonderful teachers who fully embody they practice and their craft. If you need inspiration, read Burch’s story of her severe injuries and her journey to where she is now. There are also online courses and I highly recommend these two books: Living Well with Pain and Illness by Vidyamala Burch and Vidyamala Burch and Danny Penman’s excellent book You are not your pain: Using Mindfulness to Relieve Pain, Reduce Stress, and Restore Well-Being—An Eight-Week Program.
Pain management is actually a misnomer. What we are cultivating is expectation management.
And finally, let go of that belief in happy endings; there are only happy beginnings in each moment we stop resisting the reality of our pain.
We are pleased to welcome Craig Mackie RSW to the Ottawa Mindfulness Clinic. Craig has a BA in developmental psychology, MA in philosophy and a Masters of Social Work. He has worked in therapeutic recreation, mental health, and social services for over 10 years. He is a certified Transformative Mindfulness practitioner, 16 Guidelines international facilitator trainer, and has taken multiple trainings in clinical and mindfulness modalities. Currently he teaches in the Applied Mindfulness Meditation program at the University of Toronto and is the Director of Essential Change.
At the clinic, Craig will be offering mindfulness programs for youth and adults.
Program and contact information on the adult and youth programs can be downloaded here:
Self-Compassion practices and programs are gaining momentum in psychological treatments and look like they might well become the next wave of transforming our painful feelings. Mindful Self-Compassion (1), developed by Drs. Christopher Germer and Kristen Neff, is an approach that can be both an adjunct to conventional therapies as well as a stand-alone treatment model. The interesting and very useful aspects of this approach are its applicability to our multilayered experiences of suffering. First, let’s look at what they define as Self-Compassion.
Neff (2) describes it as a three-fold system that are antidotes to the experiences that cause us suffering. (A sidebar note: Suffering is typically described as Pain multiplied by our Resistance to the reality of that pain (3)). Here’s a table that summarizes Neff’s definition of self-compassion.
How suffering happens
Self-Compassion practices that transform suffering
Dispersed, over-identified with our pain, autopilot
Isolated (shame, blame, anxiety)
|Self-blame, critical, negative self-appraisals||
When we become fused with our pain, see it as taking over the entire horizon, we suffer from that pain. It’s a layer that rolls out over the initial hurt: the anxiety about the pain, what it means, how we believe it now defines us. Feeling that way tends to lead to isolating ourselves from others; but that’s also isolating ourselves from help and support. Typically, we feel shame because we think we should have better control, be stronger, be better; this adds to the isolation. Of course, we’re also in a culture that values independent action, take-charge solutions, which is not always the best approach. Because we these limitations, we use the tools we have learned from childhood. Get over it! Suck it up! I shouldn’t feel this way! This self-critical mind is the Inner Critic. It’s a bit like a good friend who has your best interests at heart but is also really, REALLY unskillful in how to motivate you. It knows you more intimately than anyone in the world. It knows your good, even great qualities. And it unfortunately uses your achievements, those carrots, like a stick.
Many of the practices in Mindful Self-Compassion are intended to change how we respond to our pain and how to tone down that Inner Critic. Mindfulness de-fuses us from our painful experience. Seeing our Common Humanity, that we are not alone or unique in our suffering allows us to feel less shame and reach out. Self-Kindness teaches us that we are worthy of that help and support. Practices like loving-kindness, empathy-eliciting exercises, affectionate responses to our experiences engage us in a conversation with ourselves that – because it’s kind – we’re more likely to hear and feel encouraged to follow through. (Practice meditations are here.)
Self-Compassion doesn’t stop at being kind; that would end up being a bit self-involved. It goes deeper by connecting us with our physiological up-regulation that accompanies emotional distress. When we encounter difficult situations that are crises or even traumatic, our entire body becomes up-regulated, activated. In cases of trauma, we stay outside our Window of Tolerance (see graph below, 4) and that can lead to many kinds of painful reactions. Eventually, the body regulates itself but it can be a long, tough process.
There’s little research on the mechanisms by which self-compassion effects change. However, one study (5) showed that overall self-compassion scores are related to lowered avoidance of experiential distress. In other words, self-compassion is connected to a willingness to feel what we feel despite the discomfort in it. When we can do that, we’re less likely to feel the world is a scary, frightening place. So bringing ourselves back into that Window of Tolerance in a physical, emotional, and mental way is very important.
The practice of Soften-Soothe-Allow in the Self-Compassion can help to facilitate a down-regulation of internal distress. Softening our tension around the experience of distress (picture the effect of a warm compress on a sore muscle) meets our physical needs. Soothing (picture the effect of a back rub or hug) meets our emotional need. Allowing the experience just be what it is rather than what our fears tell us it will be (picture the effect of seeing the situation for what it is) meets our cognitive/mental needs. When we apply this to internal distress it looks like the picture below (6).
On the left side of the midline is a graphic of our system when it is hyper-aroused (or hypo-aroused) by stress, crises, trauma. When affected, we pop out of the zone of resilience and stay out there until we eventually reset. On the right side are two ways we can use the soften-soothe-allow practice to bring us back into the Window of Tolerance. It can be (and best as) a continuous practice. Stop signs, red lights, phone calls, and so on are opportunities to practice. When we really up-regulated, there’s already a body memory of that soften-soothe-allow process and it’s more likely to be helpful to reset.
The meditation is here. Make it your practice for week or a month and see how it helps!
2. Neff, K. (2003). Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self and Identity, 2: 85–101.
3. Shinzen Young
4. Ogden, P., Minton, K., and Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: Norton
5. Thompson, B.L. and Waltz, J. (2008). Self-Compassion and PTSD Symptom Severity. Journal of Traumatic Stress, Vol. 21, No. 6, December 2008, pp. 556–558.
6. Adapted from Monteiro, L. and Musten R.F. (2013). Mindfulness Starts Here: an eight-week guide to skillful living. Victoria BC: Friesen Press.
A well-thought through article on informed consent and the impact of mindfulness meditation in clinical settings.
Originally posted on Aloha Dharma:
“Jill” is 32 and works as a lawyer in the southwest. She wrote to me explaining that during her meditation she sometimes feels a panic attack coming on and has disturbing mental images. She cannot control it and does not know what she is doing wrong. When we talk for the first time I ask her when it began. “It started a few months after my therapist taught me mindfulness…”
Third wave Cognitive-Behavioral Therapy (CBT) is the marriage of modern psychology and ancient buddhist meditation. It has grown rapidly in the past decade, and many psychologists and meditation teachers are enthusiastic about the development, seeing it as a blend of the very best of eastern wisdom with western psychological science. Third wave CBT goes under a variety of names such as Mindfulness-Based CBT (MBCBT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Stress Reduction (MBSR). There are…
View original 1,978 more words
Today, February 6, 2015, the Supreme Court of Canada allowed the appeal against the “blanket prohibition on assisted suicide.” An earlier appeal by Sue Rodriguez (Rodriguez v. British Columbia) in 1993 to have the Criminal Code ruling against assisted suicide declared unconstitutional was denied. The upholding of the current appeal (Carter v. Canada) is destined to be controversial for many reason, not the least of which is the ethical weight it will place on health care practitioners. The ruling is clear that while the Criminal Code is still valid for assisted suicide, it is over-reaching in its application in regards to persons who suffer from intractable medical conditions that compromise their ability to live well. It states that the Criminal Code infringes on the individual’s “right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.
“…and are of no force or effect to the extent that they prohibit physician‑assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”
There will be many issues to clarify as this ruling enters the health care system. Parliament could enact a legislation should it “choose to do so” though whether it will be in favour is in some contention given the current government’s opposition to assisted suicide. Not only are there definitional issues, there will also be issues of a chain of decision-makers who can effectively guide and support individuals who wish to avail themselves of this right. Ultimately, one would hope this does not become a decision that is relegated to the hands of a few but one that will be made in community with compassionate support and wisdom of our past experiences. In order to meet these demands, we will be called upon to examine our own values and conscience with regard to a primary precept we hold, especially as mindfulness practitioners: What are the nuances of the ethic of respecting life in this context?
Can Mindfulness Practices Have an Ethical Role in Physician-Assisted End-of-Life Care? The complex issues facing us will be challenging. More and more in the writings on mindfulness, an important point is being made that the practice of mindfulness must contain an ethical core. That means not doing harm, avoiding acts that encourage or precipitate harm, and respecting life in all its intricacies. Will we therefore wonder, as mindfulness teachers, if supporting requests for mindfulness training in cases of assisted suicide is ethically within our scope of practice? There are no easy answers however, as with all koans it invites us to examine how these questions play out in our life.
A common question asked of secular mindfulness teachers is – given the purported absence of ethics in a mindfulness program – whether one can therefore rob a bank mindfully or shoot and kill someone mindfully. This argument maintains that what we learn in a mindfulness program is how to pay attention to what is unfolding in the moment and letting it be. Thus, we can bring our attention to the gun, the bank, the person we are about to kill and let that be without engaging in any critical thinking that may have us wonder if this is the right thing to do. Similar arguments may end up being levelled against an involvement of mindfulness teachers in end-of-life care that involves assisted suicide. (I should note that end-of-life work by many conscientious and compassionate colleagues is a powerful part of health care.)
It’s important to ask these questions. It’s also important to use the right understanding of what mindfulness practice actually is. If paying attention is the sole characteristic of a “mindfulness” practice, then the practice is missing a crucial component. Attention by itself generates raw and unusable data. Heat, cold, tingling, blue, red, grey, snow, sun and so on are data points but have no intrinsic ability to change our life path. Remembering consequences of past experiences and recalling our intention for paying attention makes the data meaningful. Mindfulness practice is the opportunity to cultivate wisdom from information to which previously we were reactive but which we now can hold with equanimity to facilitate a better choice. So, there is no mindfulness involved in knowing one is in that bank with a gun pointed at the clients and employees. Mindfulness is in remembering that this action is about to bring harm and recalling a core value.
How might this play out in the potential future of end-of-life and assisted suicide? We have to ask which carries the greater potential to harm: teaching someone to “live well” with a grievous, intractable, unendurable illness or teaching them how to be truly mindful by opening to all the consequences of their wish to be free of pain and suffering. I believe, in this context, the former risks reducing our work to trite phrases like “be grateful for the life you have,” “be in the moment,” or any of the aphorisms we find in mindfulness memes these days. The later however may allow for a clarity of mind in our clients and therefore a range of decisions they can make in conjunction with family, faith communities, physicians, psychologists and all other health care support available to them.
We are entering interesting times.
Edited at 16:43 for typing errors & paragraph spacing.
As we enter the New Year, let’s make 2015 a year of exploring the many gifts from skilled researchers and clinicians which can support our resolution to live better. The participants of the Mindfulness-Based Symptom Management, Burnout Resilience and Pain Management programs at the Ottawa Mindfulness Clinic have one wish in common: a desire to find a way to live their lives differently. In fact, this wish is not only that of the participants but also of everyone who works at the OMC. We share together the realization that despite our best intentions, we falter in caring for ourselves and others in a way that is kind, nourishing and supportive. We have strong values and tend to be committed to making ethically informed choices and yet we find ourselves wondering where all the wisdom went as we choose against those exact purposes.
If you’ve taken a mindfulness course, good start! You know over eight classes there can be shifts in your thoughts, actions and speech. You also know it’s not a quick fix and that the Ninth Class is the toughest! So to help with the rest of your practice life, here’s a collection of books that we recommend to support, boost and sustain your practice!
Mindfulness Starts Here: An eight-week guide to skillful living by Lynette Monteiro & Frank Musten. Now you didn’t think I would miss a chance to prop up our own book? If you’ve taken the 8-week program at the OMC, this is a great way to extend your practice. It also helps to come to the monthly Alumni groups! Nuff said. Let’s get on to the books you really need to get for yourself!
Leaves Falling Gently: Living fully with serious life-limiting illness through mindfulness, compassion & connectedness by Susan Bauer-Wu. This is likely my all-time favourite. Bauer-Wu is an expert in the field of pain, oncology and mindfulness. The book is infused with compassion and an open-hearted approach to the vagaries of chronic pain. The exercises are easy and helpful, realistic and encouraging. The sections on the impact of chronic illness on memory, attention, emotions, etc. is invaluable. This book also is unstinting in its honesty about life-threatening illness and offers opportunities to change our rigid stance to the reality of living and dying.
The Practicing Happiness Workbook by Ruth Baer. This is a terrific book that brings together Dr. Baer’s skills as a clinician, methodical approach as a researcher and clear understanding as a mindfulness practitioner. I loved the set-up of the workbook because it … well, it works. Start with a nice pithy overview and then jump in at your own pace. The second section explores four very important traps that can derail our practice: rumination, avoidance, emotion-driven behaviours and self-criticism. The section following on mindfulness skills is clearly written and I truly appreciate the inclusion of values and goals. The chapters are punctuated with stories about people with whom we can identify and the worksheets are very user-friendly. It makes me happy just to read it!
Hardwiring Happiness: The new brain science of contentment, calm, and confidence by Rick Hanson. Neuropsychologist Rick Hanson is well-known for his ability to pull together neuroscience and psychological mind states in a way that is immanently understandable by most of us non-neuroscientists. There are so many catch phrases used in the mindfulness circles that originate with his teachings and in his books! Velcro for bad/Teflon for good, HEAL yourself, metaphors for resilience and vulnerability, the list is endless. What is important though is his ability to explain why we act the way do and how this is hard-wired. The section “Paper Tiger Paranoia” is my favourite and has helped me out of many a flight reaction! Mostly, in this book, we get to practice the ways in which to make changes to those survival instincts and hard-wire responses to experiences that sustain and help us. If you find this book helpful (or if you’re curious), also try his new program called Foundations of Well-Being which is a year-long on-line program and worth taking.
Living Well with Pain & Illness: The mindful way to free yourself from suffering by Vidyamala Burch. This book is written by and is based on the Breathworks program developed by someone who truly understands the challenge of physical pain. Vidyamala Burch’s history is unlike anyone I’ve read about and her strength is apparent throughout the book. Chapter 2 explains what is pain and is one of the clearest and most useful descriptions available. The use of research-based information is well-placed and does not overwhelm the information in each chapter. I totally fell in love with the third chapter. It’s my favourite allegory of how we create our suffering out of pain. And Burch patiently tells the story in gentle sequences making it come alive. The exercises and case stories are accessible and very user-friendly. I prefer the book to the e-book simply because the text set up is more compelling.
Empathy: Why it matters and how to get it by Roman Krznaric. This is an important book to keep the practice of mindfulness from becoming a self-centered practice. While we start our practice because we suffer the effects of personal difficulties, it is important to see that we are created, and can be undone, in a social context of family, community and global events. Mindfulness brings our awareness to our suffering and we practice so that we don’t repeat the same cycles of interactions with ourselves and others. However the deeper intention of mindfulness is to create a compassionate world and that change can’t happen without seeing that others too want to be free of the same suffering we endure. Empathy is the capacity to walk in their shoes, to make choices that are informed by understanding that what others need is not what we think they need. The exercises and examples in the book are wonderful and challenge us to find a different way to know the world. Grow your connection with those you love and beyond!
Mindful Compassion by Paul Gilbert & Choden. Paul Gilbert is well-known and respected for his work on compassion and cultivating the compassionate mind. In this book, he teams with Choden, a Buddhist monk who helped develop the graduate program in mindfulness and compassion at Aberdeen University. I particularly like the way they organize the book so that the arising of compassion is a natural outcome of how we organize the world as we know it. Gilbert’s perspective of compassion as a social mentality which helps us negotiate through relationships and interactions is an important understanding. In other words, being compassionate is far from being soft and squidgy or a door mat. The exercises are nicely explained and inviting. The definitions of compassion clear up misconceptions. The development of a compassionate self (Chapter 10) is probably the most important part of the book. However, it rests on all that precedes it; I especially liked that the exercises in this chapter are also empathy cultivating ones. An important addition to your mindfulness practice!
The Mindful Way Workbook: An 8-week program to free yourself from depression and emotional distress by John Teasdale, Mark Williams & Zindel Segal. This book is a user-format version of the previously published A Mindful Way through Depression. The first section lays out the foundations and the next section takes us through the eight weeks. I liked how the issue of traps and obstacles is re-framed as “another way of knowing” which opens up the thought patterns and is subtly a practice in cognitive flexibility. It is focused on addressing depression through mindfulness however, the various exercises also might be useful for anxiety and general stress. I had trouble with the layout of the book (too many boxes for a book that wants us to get out of our mental boxes) and the excessive number of balloon quotes are distracting (not cool for a mindfulness book). I have used it as a guidebook with individual patients and found it organizes the sessions well. Be patient when you use this but do try it!
The Mindful Path to Self-Compassion: Freeing yourself from destructive thoughts and emotions by Christopher Germer AND Self-Compassion: The proven power of being kind to yourself by Kristin Neff. These two books come as a perfectly balanced pair. Germer approaches self-compassion with a clinical understanding of the emotional impact of our often harsh inner critic. Neff comes from the perspective of a research-based understanding of what self-compassion means and how it works. With both the experiential practice and the knowledge base to ground it, I find the practice of self-compassion inviting and easy to integrate into my life. As both Neff and Germer remind us in their workshops: don’t chose a practice that sets off an argument in your mind about it. Folded into both books is also the much-needed practice of forgiving ourselves for not being that superhuman being we think we need to be.
The Mindful Way to Study: Dancing with your books by Jake Gibbs & Roddy Gibbs. For all you students out there and those of us who are perennial students, this is a terrific guide to setting down and getting the work done. And more. I like the way this book addresses the various obstacles we encounter (traps) by setting the perspective of “gumption”. Just do what needs to be done! Well, it’s not that easy and Gibbs & Gibbs walk us through a number of gumption traps. The first one was ego (but I figure I already know how that works so I skipped it… no, not really). Check out the section on procrastination though; it’s not just about boredom or priorities! Gibbs & Gibbs’ focus on Right Effort (the last section) is helpful and has a nice balance of meditative practice with insight to our actions.