Mark Neenan, M.Ed. on Mindfulness Based Stress Reduction & Back Pain

Mark Neenan, M.Ed. on Mindfulness Based Stress Reduction & Back Pain


SEAN MACKEY: By way
of introduction, Mark Neenan has a Master’s
in education and counseling and personal services from
the University of Missouri at Columbia. He’s a former World Health
Organization researcher and program coordinator for
UCSC’s Disability Resource Center, and has served as a
stress and pain management specialist for the Stanford
Department of Psychiatry, Kaiser’s Department
of Psychiatry in Redwood City at
El Camino Hospital, Stress Reduction Clinic
in Mountain View, and the Meridian Institute of
Traditional Chinese medicine in Monterey. He currently teaches
mindfulness-based stress reduction for the Palo
Alto Medical Foundation as part of the NIH
research group. For us, which I’m going
to get to momentarily, he’s a certified
instructor in MBSR, having interned at the
University of Massachusetts Medical Center,
where he completed his professional training
under the MBSR founder, Jon Kabat-Zinn. So as my son likes to
say, here’s the deal. We are studying
MBSR within Stanford as part of a very
large NIH grant. And we went out to all the
researchers who studied MBSR, and we said, we
want the best person who can lead this effort
across the whole Bay Area. And everybody said,
Mark Neenan’s your guy. They said, he’s the one
who’s done all this research. He teaches the instructors. He’s the one you want. He’s the one we
went out and got. And so we invite him
to come in and share some of his experiences
with you today. Please do give him
a very warm welcome. [APPLAUSE] MARK NEENAN: Thank you. You know, it’s towards the
end of the afternoon here, and I think it would be
good for you to go ahead, in any way that would be good
for you, to move a little bit. Just if it’s rocking forward or
back, or if you can, stand up. Go ahead and stand
up, and maybe twist. This is self-care. We’re taking care
of ourselves here. Maybe shrug the shoulders. And whether you’re
standing or sitting, I’d like you to take a moment to
be focusing in on your breath. And let’s go ahead,
take an in breath in. And on the out breath,
just imagining, as you’re breathing out, you
come to the end of your breath, you still have a
quarter capacity. Force the rest of the
breath out– ahh– all the way out. Now you can breathe
all the way in. Breathing out naturally,
and all the way out. Great. Please have a seat if
you’ve been standing. I want to acknowledge Dr.
Mackey and all our presenters earlier today. Thank them for the very
different and very effective treatments, the
reduction of pain. I also want to acknowledge
you, who have come here, and who are viewing this,
Stanford’s Back Pain Day. Because this means you’re
paying attention and responding to something that’s not really
working well in your body– your back pain. You’re taking some
sort of action to look at the different
treatment options. Many people don’t
get as far as you do. They try to ignore the pain. They just want to numb it. They’re like James
Joyce’s character in The Dubliner, Mr. Duffy,
who lived his entire life a short distance from his body. Now, others have
explained quite a bit about the complex interrelations
of pain, emotion, thoughts. I’m just going to reduce
this down to two slides, and reinforce what has
been said earlier today, and bring you more into
a visceral understanding of your experience
than just working so much with the thoughts
and cognitive pieces. It’s really
counterintuitive to look into our pain and our suffering. There seems to be
little advantage going into the discomfort, yet the
very resistance in doing so can turn the volume up
on the perception of pain and actually increase the
experience of suffering. Let’s look at this multiplying
effect of resistance to back pain, or for that
matter, any kind of pain. On the screen, you’ll see
the suffering equation. How pain is multiplied
by resistance to it, and that that equals the
suffering experience. The first column is
the level of pain. On a scale of 0 to 10, 5
represents moderate amount of pain. This isn’t the worst pain that
you can think of or experience. It’s more a level
that would interfere with your task of daily
living, or possibly your ability to concentrate. So it’s significant at a level. The middle column represents
the level of our resistance to these felt sensations
of physical pain– how much we fight it. It is also on a
scale of 0 to 10, starting out with a level
of 5, or a moderate amount. So in the first or top
of these three examples, the level of pain is moderates
all the same as you come down. However, the
resistance is changing. On the top situation,
the resistance level is a moderate 5, which would
be fighting with the pain, tightening up around it, pushing
it away, not wanting it here. And this results in
a significant level of suffering, a level 25. Now the second layer is still
the same level of 5 in pain– it’s a moderate level. But now the resistance
has dropped to a level 2. And this would be maybe noticing
the pain, acknowledging it, but maybe intentionally
trying to loosen up a little bit around it. And you can see the
resulting in suffering– so there’s a significant drop,
less than half of what it was. Now, if we go down to
the bottom level of pain, again, it’s still
at a level of 5. But what would happen
if with the same level, our resistance somehow
could drop down to 0? Now, this would
mean a 0 resistance of merely observing it. Opening up to it with
some kind of curiosity– what’s really going on here? The physical pain and our
response to it, being curious. Because the sensations
are already here. That’s one reason
to look into them. Well, we know that
5 times 1 is 5, so that would still be
a level of suffering. Actually, in this
equation, if you can drop the 0 down
of resistance even to the same level of pain,
there would be 0 suffering. Now that we’ve seen the
effect of resistance, let’s look at two other
of the equation’s factors, pain and suffering,
and what more we can learn about
their interaction. Pain is the physical felt
sensations of the body. It could be a sharp,
shooting pain that’s related to nerve ending pain. Or it might be more the pain
of dull, aching muscle pain. Throbbing, soreness,
a prickly heat. Now, suffering has more
to do with our thoughts, and emotions, and reaction
to these sensations. So we have both the bad
news and the good news. The bad news is pain
is our birthright. It’s unavoidable at times. Whereas suffering
is more optional. It is the reaction
of our heart-mind to these uncomfortable
sensations. So if we look under pain in
this cycle that’s showing there, the physical sensations
of the body– let’s say, for example, I have
a back high shoulder pain, and I don’t like that sensation. We often just want to
kind of tighten up or hold this in a way that we aren’t
feeling it so strongly, trying to stop the muscle spasm. As we do that, though,
we’re cutting down the blood flow
and the other ways that the body and its
own natural relaxation could help heal the situation. So with that lowered
blood flow into the area and this tightening up– that might work for a while. But after a period of
time, the pain sensations would come back
into our awareness. And what would we do? Very often, just tighten
up a little bit more. And you can see how this
cycle goes around and round. Maybe it was from a long time
ago, maybe a car accident. But the stress is bringing it
back up into our experience. As we shift over to the
suffering side of the equation, again, many people earlier
brought to our attention that our thoughts and emotions
have a way of turning up the volume in the experience. We can get stuck in
this, this reactivity. This kind of being
on automatic pilot. All those concerns of
questions that could come up. Fear– is this
going to get worse? Is this permanent? Do I have to live
the rest of my life– is this really a
harbinger of something yet even more serious? And so it can go into anxiety. What’s next? From a specific
[INAUDIBLE], it could go into more free-floating
anxiety about other sensations or other concerns in our life. There could be some really
heartfelt anger about this. I’m too young for this. Medications should work. What is the therapy here? Darn this pain! Go into grief and loss. One loss is connected
to all losses. So in this, maybe I lose
a range of movement, and that connects me to
other grief and losses I’ve experienced in my life. There might be a sense of guilt,
that I’ve done something wrong. Or I should be able to do
these things for my family. So even with some intention to
not resist so much our pain, our minds can still stir
up a lot of suffering. So what are we to do when we
get stuck in these sensations? What I teach is
mindfulness-based stress reduction. This was designed by Jon
Kabat-Zinn, UMass Medical Center, but now it’s taught
all around the world. And Stanford has
mightily embraced this and has taught in a number
of different settings here within the campus. As research continues to go
on, it’s not research just whether mindfulness-based
stress reduction works or not. It’s looking at the
mechanisms of how it works and how it works
biologically in the brain. So what is mindfulness? Mindfulness has three
different characteristics. The first is, it’s
moment to moment. It’s in the current time. It’s a careful paying attention. And, in a certain attitudinal
way, of non-judgmentalness. So it’s moment by moment,
careful paying attention in a non-judgmental way. Now, this might
sound like a cliche. What does that really mean? Well, why don’t we
just put it to the test with a little bit
of mindful focusing? So what I’d like you to do
now is in whatever position you’re in, go ahead and let
your eyes come to a soft focus and then close all
together, so that we can better
focus our attention to the sensation of breath– breath in the body. Maybe breathing out,
and all the way out. And breathing in,
just naturally. Now notice as you’re breathing
in that the air in the room is maybe cooler and drier
than as you breathe out. And when you breathe out,
that it’s more like the breath is body itself,
warmer and more moist. And just try that
for a few times. Just notice how
you’re breathing in. The air is like
the room itself– cooler, drier. And as you breathe out,
it’s more like the body. It’s warm and moist. That we could notice
where we perceive the breath most strongly. It could be about the
nostrils, or the nose. See if you can feel the tip
of your nose with the breath, or the area just
above the upper lip as the breath enters the body. Perhaps you can follow
one of the breaths down into the area of the chest
and feel the gentle expansion of the chest, including
from the back of the spine around the sides of
the ribcage, as well as the front of the chest,
expanding slightly, contracting slightly. It’s even possible to
feel the breath deep down in the region of the belly
and the abdominal wall. Perhaps even placing a hand down
here in the area of the belly, and just kind of feel the
gentle rising or expansion with the in breath. The falling away
with the out breath, so that your mind’s
attention is right down here, feeling the belly
with the breath. And now we’re going to bring
our attention back to the room by gently refocusing
and opening your eyes. If you want to stretch
or reposition yourself. Take a nice breath in. So much of what
you’ve heard today is about self-care,
self-management. Knowing something
about yourself to be able to share that with your
healthcare professionals. Checking in with yourself to
see, what is this experience? And this is one of the methods
to turn the volume down on pain– by looking into it. Being with the experience
and not resisting it so much. Looking into our emotional
reactivity to it. So this is a part
of what you would learn in a mindfulness-based
stress reduction course. There would be body scans. The tapes for 30 to 45
minutes would be just having you visit the
sensations of different areas of your body. There would be a
sitting meditation which you could do lying
down, or with cushions, or whatever that support you,
and have you really check in with the breath,
check in with sounds. Check in with your
thoughts, and emotions, and begin to use
the mind as a tool to see, where can you go from
reactivity into some kind of automatic pilot? To some kind of response
that’s appropriate? And in this way
over time, we can learn to be less judgmental. So the typical class– they’re eight weeks long. They meet for two, two and
a half hours once a week. In the class, there is a
form of mindfulness practice. It could be the body
scan, as I was mentioning, or sitting meditation. But it would also
bring in some movement. Very, very gentle yoga, both
simply standing or lying down. And people would just
participate to the degree that they can. It’s all very adaptive. Everyone taking
care of themselves. I also bring in some
reference to Chinese medicine, some qigong or tai chi. It’s not uncommon to be taught
in this mindfulness-based stress reduction class. We look at stressful
communications. We look at stressful eating. We look at stress itself,
and what are the elements, and how can we break it down,
knowing what is actually going on viscerally in our body. There are so many
places on campus within the medical
center and elsewhere where mindfulness
is being taught, and also in the community. I teach at three different
sites of the Palo Alto Medical Foundation. But whatever region you
are, if you’re watching this on television, you could Google
“mindfulness-based stress reduction” and the name of
the region where you live, and find the closest hospital. There’s over 1,000 hospitals
in the United States and many more all over the
world teaching this. Again, the research is
in that it is effective. The research that’s
being done now is looking at why it’s
effective, how it’s effective, what is actually
changing in the brain? The neuroplasticity that
was brought earlier today in terms of how we
respond to the sensations that we are picking up. So with that, again, I
appreciate your being here. And I want to
acknowledge you again for looking at the
options that you have and blending maybe
some of these together to make them more potent. So thank you. [APPLAUSE]

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