‘Just when I seemed to be walled up in a life sentence of chronic pain, someone proposed a bizarre way out: sit still, they said, and breathe.’ Tim Parks, Teach us to Sit Still
Is mindfulness the new CBT?
Ten to fifteen years ago CBT evolved from being a form of psychotherapy little known in mainstream medicine to panacea for all chronic ills. Panacea, of course, was the goddess of universal remedy and, interestingly, was a sister of Hygieia the goddess of cleanliness and sanitation. They knew how to run a health service up on Mount Olympus.
Five years ago, mindfulness started to appear in the UK literature with respect to relapse prevention in depression. Prior to that, it had been pioneered by Jon Kabat-Zinn in Boston, with his Mindfulness Based Stress Reduction Programme (MBSR). Now mindfulness seems to be the therapy ‘du jour’, as its evidence base grows not just for depression and anxiety but also for coping with chronic pain and disease.
This is perhaps not surprising. CBT and mindfulness are complimentary ‘life-skills’, fused together as mindfulness based cognitive therapy (MBCT), from which we can all benefit. We all have repetitive patterns of dysfunctional thinking and behaviours which can trap us; learning to recognise and challenge them through CBT can be revelatory and helpful. Likewise, with mindfulness. Our minds are perpetually buzzing with random thoughts; they blind us to the joy of the present, and trigger emotional reactions which make us feel ill. Learning to empty the mind, to meditate and to recognise our random passing thoughts and moods as just ‘clouds that skim across the sky’, and without reacting to them emotionally, is a life skill which will simply make you feel better. It is not our thoughts that make us feel ill or hurt us, but our emotional reaction to them.
As GPs we see so much chronic pain, disease, unexplainable distressing symptoms and unhappiness. Some of the time, people cannot be cured and our raison d’etre is to ease the burden. For patients, the bitter paradox is that the natural desire to be cured of something from which we can’t - and indeed the cultural expectation to ‘fight it’- only increases our suffering and makes it worse. When people are understood, cared for and supported into a ‘coping’ mind-set, things improve. CBT awareness and mindfulness are the two core, evidence-based skills we can give to patients to help them learn to cope better with the ‘full catastrophe’ of living.
What is the evidence that mindfulness-based therapies are effective?
In 2010 the Mental Health Foundation commissioned a report which examined the evidence for the effectiveness of mindfulness based therapies, as well as laying the groundwork for greater access to them throughout the NHS as an evidence-based intervention. You can read it here: http://www.livingmindfully.co.uk/downloads/Mindfulness_Report.pdf
MBCT has the strongest evidence to support it for mental health problems (recommended by NICE for relapse-prevention in depression since 2009) and MBSR for chronic pain and distress associated with chronic disease. MBSR has been shown to help patients cope with their problems http://www.ncbi.nlm.nih.gov/pubmed/15256293 As we discussed on our recent Hot Topics course, for chronic pain Acceptance and Commitment Therapy, which incorporates elements of mindfulness, is actually more effective than CBT (http://www.painjournalonline.com/article/S0304-3959(11)00339-3/abstract).
How do I find out more?
Web-sites http://www.bemindful.co.uk/ An excellent resource of courses and on-line materials from the Mental Health Foundation.
Mindfulness: a practical guide to finding peace in a frantic world by Mark Williams and Danny Penman. Very readable, practical yet erudite, and with a CD of guided meditations. Highly recommended to all GPs and most of our patients! I think the best mindfulness self-help book for most people
Quiet the Mind by Matthew Johnstone.
Matthew is the author of the quite brilliant picture book about depression, I Had a Black Dog. This is a similar book that teaches us that learning to relax takes some work! Excellent for all, but particularly for those not into reading books.
Mindfulness for Beginners, by Jon Kabat Zinn.
What is says on the tin. Has an e-book version on i-books with integrated guided meditations which is excellent on the i-pad.
Teach us to Sit Still, Tim Parks.
Not a book on mindfulness as such, but a superb account of living with chronic pelvic pain syndrome, the failure of the medical profession driven by interventions and drugs to help, and eventual resolution through meditation. It makes us realise how much ‘unexplained’ chronic pain is tied up with stress and muscle tension. It is also a very funny read, and full of great quotes such as: ‘Every illness is a narrative. What matters is the version you tell yourself.’
Adapted by Dr Newman from a blog post written by GP and writer Dr Simon Curtis.