Mindfulness 101: The myths, the science, and the practical applications in stress and pain management

Shrey Vazir

Physiotherapist, Certified Mindfulness Teacher

Mindfulness meditation has recently skyrocketed in popularity and has become quite the buzzword. In fact, “Meditation”, “Relaxation” and “Breathing exercises” were one of the top searched keywords worldwide on Google as of May 2020.  So what is mindfulness, and is it different from meditation?  Is there science to support it? And if so, how can we practically apply it for our patients and for ourselves in stress and pain management?

Let’s start off with a question.  Is your mind full, or are you mindful?

The figure above summarizes the core themes of mindfulness meditation quite well: calmness, stillness, resilience and present-mode living - despite the hundreds of distractions fighting for our attention.   The truth is, our attention is limited, but the distractions in our modern-day life are limitless. 

Mindfulness meditation training essentially strengthens the “attention muscle” of your brain to make your mind calmer, fitter, kinder and more resilient. 

The Myths:

Now before we get further into what mindfulness is and what its benefits are, let’s first talk about what mindfulness is not; here are a few common myths about mindfulness: 

• It is a mystic practice only meant for monks and Zen masters.
• It is religious and/or hokey-pokey.
• It can be practiced only sitting down and with eyes-closed.
• It is relaxing/passive.
• You must have no thoughts while practicing mindfulness meditation. 

What is mindfulness?

With the myths out of the way, let’s discuss a commonly used definition of mindfulness:

“Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.”

- Dr. Jon Kabat-Zinn

(Founder of the Mindfulness-Based Stress Reduction Program - 1979).

If that definition was slightly confusing for you, here is mindfulness in other words:

Mindfulness is the ability to know what’s happening in your head at any given moment, without getting carried away by it.

So what is the difference between mindfulness and meditation?

Mindfulness is an ability (like strength, flexibly, agility), whereas meditation, is an activity that can be used to improve the ability (similar to running or going to the gym).  

While mindfulness can be practiced anytime and anywhere by being fully engaged in the present moment activity (i.e. driving, eating, washing dishes, talking etc.), meditation typically refers to an intentional and formal, seated practice.

Why practice mindfulness?

Here are some benefits of mindfulness that are backed by science:

1. Integrates emotions

2. Reduces symptoms of anxiety

3. Relieves chronic pain

4. Calms the body

5. Decreases stress

6. Improves sleep

In regards to pain management, the goal of mindfulness is not to eliminate the pain, rather it is to teach patients how to become more self-aware of their pain, and how to respond to it in a constructive and healthy way. Mindfulness also offers a way of managing and relieving stress, which if unchecked, can have detrimental effects in any chronic condition.

How do we practice Mindfulness?

In mindfulness practice (formal meditation or informal mindful living), there are three essential steps that we typically follow:

1. Observe: “Just notice” - open monitoring of any sensations, thoughts or emotions.
2. Label: Label (not in a negative way - not labelling good or bad, but just acknowledging what you are experiencing). This may include the following: sounds you hear, thoughts, emotions, any pain or discomfort, without placing any negative connotation on your observations.
3. Non-judgment:  the most critical step - teaches us not to react or judge whatever it is that we have observed and labelled in steps 1 and 2.  

Although these steps may sound simple, it can be quite difficult initially. You may notice that your mind will often wander (this is natural) and that you are no longer focused.  But as soon as you notice your mind has wandered, the goal is to gently return your attention to these three steps, or return to your breathing.

With enough repetition and practice (similar to when we are learning a new physical skill like learning an instrument or playing a sport), we can successfully rewire our brain to become non-reactive, calmer, fitter, kinder and more resilient.  

Is there science to support Mindfulness?

Since the 1970s, research conducted on mindfulness meditation has exploded. In 2019 alone, there were close to 2400 journal articles published on PubMed that studied mindfulness.  Many of these studies have shown direct effects of mindfulness on our physiology and our psychology.  Emerging studies in the field of neuroscience and mindfulness have shown us that an 8 week program of Mindfulness can physically alter the structure of our brain.  More specifically, mindfulness has been shown to increase the neural connections in the pre-frontal cortex¹ (the area responsible for ration and logic) and also decrease activation of the amygdala² (the region of our brain that deals with fear and stress).  Another study has shown mindfulness can increase the regional brain gray matter density in the hippocampus³ (area responsible for emotional regulation).   Furthermore, many studies have shown that mindfulness leads to improvements in pain, depressive symptoms and quality of life.^4-6

Practical applications of mindfulness for our patients:

Considering the benefits and the how-to of mindfulness, how can we apply it for our patients? From breathing exercises, to visualization techniques, to guided meditations, there are many ways of integrating mindfulness into a patient’s treatment plan and clinical care. Ultimately, this will depend on the practitioner’s training, skill level and also comfort. The goal of each technique (i.e. meditation) is typically to target one or more of the key benefits of mindfulness meditation as noted earlier (i.e. managing difficult emotions, reducing symptoms of anxiety, calming the body, reducing chronic pain, improving sleep, and/or decreasing stress). 

How does mindfulness help the healthcare practitioner?

“You cannot pour from an empty cup”. 

As healthcare professionals, and essential “helpers”, we often stretch our personal resources thin when we are faced with high-paced work environments, time pressures, long hours and contexts which require large amounts of empathy and emotional intensity. There is no doubt that the role of a healthcare practitioner is challenging and stressful. 

This is where a practical and effective self-care tool like mindfulness meditation can come handy.
 

Studies investigating the effects of Mindfulness-Based Stress Reduction programs on employees’ mental health have found that such programs can be effective at reducing stress, reducing levels of emotional exhaustion, reducing depression and anxiety, while also improving sleep and relaxation for workers.⁷ Other studies investigating mindfulness have also shown improvements in resilience⁸ (the ability to bounce back from an adversity or failure), and self-compassion⁹ (being warm & kind to oneself when encountering pain and personal shortcomings, rather than judging/criticizing oneself).  

Conclusions:

In summary, Mindfulness meditation is a vital tool that can benefit both healthcare practitioners and patients. It is supported by a rapidly growing body of scientific research. Through formal meditation practices and informal mindful living, there are several benefits of regular mindfulness practice including: reduction in stress, reduction in anxiety/depressive symptoms and reduction in pain. Mindfulness practice can also be an effective self-care tool for healthcare practitioners looking to manage their stress levels and to prevent burnout.

In essence, mindfulness promotes calmness and resilience in the face of adversity and hardship. Now let’s finish off this blog with a fantastic quote by Dr. Jon Kabat-Zinn:

About the Blog Writer: 

Shrey Vazir MSc (PT), Applied MBCPM

Shrey is a Registered Physiotherapist and a Certified Mindfulness Meditation Facilitator specializing in chronic pain and stress. Having gone through a personal journey with persistent pain, Shrey has embraced mindfulness into his daily practice – both personally and clinically. With his advanced training in the Mindfulness-Based Chronic Pain Management (MBCPM™) program, he has integrated the principles of mindfulness meditation to teach patients and coworkers on how they can better cope with chronic stress, pain, and burnout. Shrey has also been a guest presenter at the University of Toronto and is deeply involved in their Physical Therapy Department’s pain curriculum. As a passionate clinician who is well-versed with pain neuroscience and evidence-based rehabilitation practice, Shrey’s mission is to inspire current and future rehabilitation professionals to incorporate mind-body approaches in their own practice.

References

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3. Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011, January 30). Mindfulness practice leads to increases in regional brain gray matter density. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004979/

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7. Janssen M, Heerkens Y, Kuijer W, van der Heijden B, Engels J. Effects of Mindfulness-Based Stress Reduction on employees' mental health: A systematic review. PLoS One. 2018;13(1):e0191332. Published 2018 Jan 24. doi:10.1371/journal.pone.0191332

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