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MINDFULNESS FOR EVERYONE

Last year I blogged about mindfulness and recommending this has become an integral part of our practice as we constantly see patients faced with the stress of modern living. For those that are not aware of mindfulness, which involves meditation, is defined as:-

 “the intentional, accepting and non-judgemental focus of one’s attention on the emotions, thoughts and sensations occurring in the present moment”.

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I was asked to proofread an  article written by Charlie Morgan, yogi and yoga teacher who promotes the slogan:-

                               ‘ Your health is your wealth, the rest is a bonus’

The article was to be published in the section on health and happiness on the blog of deliciouslyella the blogger, foodie, yogi, best-selling author, nut butter addict, Telegraph columnist, app creator & avocado enthusiast.

I was delighted to see it appear on her blog for many  people to view and subsequently read the positive comments.

Click on the link below to read the article:-

image                                     Mindfulness

Thank you Ella and Charlie for collaborating to promote mindfulness and help many people understand it’s value in today’s world.

http://www.charliemorganyoga.com

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Posted by on June 12, 2015 in Training and Advice

 

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IS LIFE FOR YOU LIKE GOING ON A BEAR HUNT?

Recently when I was choosing a book for my grandson I started to recall the many books I had read to my own children and then I stumbled on the book ‘We are going on a bear hunt’ by Helen Oxenbury’. I remember this story as one we used to tell each other around a camp fire when I was camping with the Girl Guides many years ago! We loved to build up that fear and scream out and then that that lovely feeling when all was well. Children love to feel fear when they know they are safe and can be reassured and know there will be a happy ending and I suppose that’s why so many popular children’s stories have an element of fear attached and why theme parks are so successful. It’s not just children as adults we sometimes get pleasure by experiencing a frightening experience as long as we are can somehow remain in or regain control.

Just to remind you of the emotions and feelings of fear take a look at this video of ‘We are going on a bear hunt’

How did that make you feel, how did you feel the characters feel? Did you see the fear on their faces, feel their heart thumping, their frozen fear, their legs and body shaking, breathing accelerate and become shallow and then witness their flight from the situation to find the safe haven of the bedclothes.

We have all been there whether it is before an examination, a job interview or an audition or going to experience something or someone unfamiliar. But sometimes there is feeling that flight is impossible and the safe haven does not exist.
This famous painting ‘The Scream by Edvard Munch’ (1893) portrays the sheer agony of his personal anxiety. He was taking a stroll along a path by the side of a beautiful fjord in Norway and instead of him finding it a pleasant, relaxing experience he became full of fear and indescribable anxiety.

The screamIn his diaries this is how he describes the event:-

“I was walking down the road with two friends when the sun set; suddenly, the sky turned as red as blood. I stopped and leaned against the fence, feeling unspeakably tired. Tongues of fire and blood stretched over the bluish black fjord. My friends went on walking, while I lagged behind, shivering with fear. Then I heard the enormous infinite scream of nature.”

I recall many patients who have attended surgery where fear has been so overwhelming that they feel frozen, unable to carry on, unable to face going to work or school even unable to get out of bed. One such patient came to me following a panic attack ( an extreme feeling of fear ) which occurred just before she about to sing a second Aria on Christmas Eve at the Chapel Royal. She had sung the first Aria beautifully then she became so overcome with anxiety she was unable to sing the second Aria.
She had graduated from Cambridge with a double First in Music and was about to launch on a career of being an Opera singer. She was devastated and felt her whole life had crumbled. Thankfully with treatment she overcame this anxiety and was a wonderful moment when I went to hear her sing in an Opera at St.Brides, Fleet Street. I think I was more anxious than she was! She then literally went off into the World to sing.
Other patients never make to the surgery but languish in there beds or at home too fearful to seek help.
These are the sort of patients that cannot wait in the waiting room and pace up and down the corridor or outside, desperate, on edge,trembling, asking for a glass of water or may simply walk out. Having talked to them I have shared their feelings, felt their anxiety and fears and now we try to arrange a time when they can come to be seen with a minimal waiting time, and we hopefully give them time to express how they feel because I know that if they are seen we can help treat this condition and they will ‘go off into the world and sing’
Ways we can signpost you to get help:-

    • We have an in-house counsellor Tony who sees patient on a relatively quiet time in the surgery and a chance to give space to talk.
    • a referral or self referral to IAPT
      IAPT
      You can phone or email as below
      Telephone 020 3313 5660
      Email. wellbeing.selfreferral@nhs.net
    • we recommend self help books such as:-
      Mindfulness
      A sequel to Danny Penman’s other book ‘ Finding peace in a Frantic World’
      These can be obtained from Amazon as a book or downloaded onto a kindle

Peace
‘Want a happier, more content life? I highly recommend the down-to-earth methods you’ll find in Mindfulness. Professor Mark Williams and Dr. Danny Penman have teamed up to give us scientifically grounded techniques we can apply in the midst of our everyday challenges and catastrophes,’ Daniel Goleman, author of Emotional Intelligence
Many patients have been grateful to having this book recommended to them.

http://www.moodjuice.scot.nhs.uk/anxiety.asp – this can be easily printed

http://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/#.U4G8JX-9KK0. This has a useful podcast from someone suffering anxiety and how it was overcome and a booklet with information and ways to help anxiety

  • join a Yoga class or follow a class on YouTube or try the following 10 poses
    which I have re blogged to follow this blog.
  • finally if you are feeling too desperate to leave your home, phone a friend or seek help outside there will always be anytime day or night a sympathetic listening ear at the end of the phone from the Samaritans. Hence, everyone reading this I suggest that as Dr Livingston and myself have done make sure the number is on your mobile or near your phone as none of us know when we may need to phone that number.
    Samaritans
 
 

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Pain is inevitable suffering is optional

Pain is inevitable

Pain can be defined as a highly unpleasant physical sensation caused by illness or injury but can also be defined as mental suffering or distress.

Pain accounts for a substantial number of reasons for patient consulting with a doctor We know that 27% of patients attend with a musculoskeletal problem most of whom will describe an element of pain. There are also those who will complain of pain associated with their chest, abdomen or head of another part of the body. It can be localised or more generalised and can be referred from a site where the cause of pain originates. It is estimated that > 10 million people have persistent pain.

The following video attempts to give an understanding of pain

I have always been interested and puzzled about the concept and the complexities of persistent or chronic pain and how it manifests itself in people of all ages. It is one of the reasons why I took up acupuncture and studied Traditional Chinese Medicine(TCM) in an attempt to treat pain with something other than tablets, capsules or applications as well as develop a deeper understanding of pain and how it can be treated.

Pain words

Pain can be described using many adjectives such as shooting, burning, stinging, stabbing, throbbing and pricking but these all not only describe the unpleasant sensation but have association with a frightening experience. Hence, with pain there is usually a feeling of fear or emotion of some kind. I attended two lectures a few years ago; one was from an eminent American psychiatrist talking about the neurophysiology of depression and how depression could present with pain such as back pain, chronic abdominal pain or headaches and how these pains could be treated with antidepressants medication. The second lecture was from a Swedish neurophysiologist who impressed us by drawing intricate nerve pathways to demonstrate how acupuncture worked bug also by treating pain this could treat depression.

Many years ago it seemed appropriate that when I carried out intricate procedures on very premature babies that because I assumed that it must be painful, it was remarked by nursing staff that when I made the effort to talk reassuringly and stroke them the procedure went more smoothly but analgesia was never routinely given.

Premature baby
It was not until 2010 that research showed that premature babies do perceive pain and are now given analgesia routinely when procedures are performed. Infact premature babies are sensitised to pain by intensive care treatments they receive after birth, a study in 2010 suggested. Tests showed that pre-term infants that have spent at least 40 days in hospital feel pain more acutely than healthy newborns. From this study it was suggested that better pain relief should be given to premature babies under intensive care to prevent them becoming pain-sensitive. Brain activity comparing full-term babies and premature babies was seen when both sets of babies were gently touched on the heel and showed no difference, suggesting that the sensitisation of pre-term babies is specific to pain. This is important, since the sense of touch is triggered by being held or cuddled. It implies that premature babies can benefit from a mother’s touch as much as normal infants.

I remember a child coming to surgery with his mother in floods of tears and when I asked ‘What’s the matter?” He said” A lion bit my ear!” Clearly he felt the sensation of pain but expressed a terrifying fear of how it had occurred. Pain from an acute ear infection is probably for many children their first experience of severe pain and not only do they need pain relief but they need comfort and reassurance.

My personal experience of severe pain was when I was admitted with renal colic as a medical student and realising it was ‘for real’ not one of those pains that all medical students have as they study every speciality. I remember being petrified wondering, imagining what it was and although it was thoughtful to put me in a sideward I felt abandoned and desperate wondering if anyone realised how much pain I was suffering. I was given intramuscular pain relief, which gave me florid hallucinations of Monty Python feet descending on me and those around me changing in form in seconds. I was violently vomiting and terrified and this lasted several days. Then a very gentle doctor sat by my bed explained exactly what was happening and how the stone was working its way out of my system and if not it would be removed surgically next morning. He also listened to the effects I described( this drug has subsequently been taken out of use) changed the medication and then said in a gentle kind manner that if I felt distressed he was prepared to come and see me anytime. The pain instantly became more tolerable and I was able to cope much better feeling less fearful and knew it was happening. Much to the consultants chagrin, as he had come especially early to perform the surgery, about 10 minute before surgery I passed the stone! I never saw the kind doctor again but he taught me what was meant by bedside manner and what being a doctor was really all about – having the knowledge but combined with the gift of being able to allay fear by giving the time when it is needed.

Several cases of severe pain puzzled me for years and interestingly all were in severely mentally ill patients.
The first case was a gentleman who walked into A&E looking pale, cold and clammy holding his fist against his chest but not complaining of any pain despite being asked several times. A routine ECG was performed, at that time performed on all patients >50 yrs and this showed a massive hear attack across the anterior part of his heart.

The second case was of a gentleman again walking into A&E vomiting copious amounts of brown fluid clutching his distended, rigid abdomen but showing no history of pain and on palpating his abdomen no complaints of pain but X-ray corfirmed an obstruction with perforation and emergency surgery revealed widespread peritonitis.

The third case was that of a gentleman who had had a severe mental breakdown whilst working in the City as an analyst and had been treated for skin cancer and was attending a follow up appointment and it was found that he had spinal bone metastases. The day prior to being seen he had walked 7 miles on a country ramble, sadly a week later of widespread metastatic cancer.

The final case I would like to mention was that of a lady who I had been seeing in surgery regularly and knew she had a diagnosis of severe dissociative disorder,which had been the result of years of abuse in her childhood and early teens. Dissociative disorder is a condition whereby your sense of reality and who you are, which depends on your feelings, thoughts, sensations, perceptions and memories becomes ‘disconnected’ from each other, and doesn’t register in your conscious mind. Your sense of identity, your memories, and the way you see yourself and the world around you will change. This is what happens when you dissociate. It’s as if your mind is not in your body; as if you are looking at yourself from a distance; like looking at a stranger. She had been developing swelling of her joints which looked as if they should be painful but she denied severe pain and the distribution of the joint problem was typical of rheumatoid arthritis. I performed the relevant blood tests which came back extremely high supportive of the diagnosis of rheumatoid arthritis . After consultation with the rheumatologist she was seen and given high doses of intramuscular steroids. She then had to have surgery to her cervical spine as she was at serious risk of becoming paralysed from the neck down due to extensive disease in this area. She has been on many powerful drugs for rheumatoid arthritis but is now taking regular injections of an immunosuppressant treatment called adalimumab (Humira) which is a Tumour necrosis factor-alpha inhibitors (TNF-alpha inhibitors) – the human body produces tumor necrosis factor-alpha (TNF-alpha). TNF-alpha is an inflammatory substance. TNF-alpha inhibitors are used for the reduction of pain, morning stiffness and swollen or tender joints. These drugs are only used in exceptional cases of Rheumatoid Arthritis.

Pain can be helpful in diagnosing a problem. Without pain, you might seriously harm yourself without knowing it, or you might not realize you have a medical problem that needs treatment as in the case of those mentally ill patients. I realise many people are brought up not to make a fuss about pain but it is important that the symptoms of pain are shared with your doctor and necessary investigations are done, as treating an underlying cause can often cure the pain. However, sometimes pain goes on for weeks, months or even years. This is called chronic pain and it has been found that a pain cycle evolves as shown below:-

Pain cycle

Sometimes chronic pain is due to an ongoing cause but sometimes the cause is unknown and usually there is a psychological element to a greater or lesser extent. The pain may occur because the brain can’t make enough endorphins. These are chemicals that shut down pain signals. Or, pain signals continue after an injury has healed. In some cases, increased pain sensitivity makes even minor injuries very painful.

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The British Pain Society is the largest multidisciplinary professional organisation in the field of pain within the UK.

Our membership comprises doctors, nurses, physiotherapists, scientists, psychologists, occupational therapists and other healthcare professionals actively engaged in the diagnosis and treatment of pain and in pain research for the benefit of patients.
It has published several publications which can be easily downloaded
http://www.britishpainsociety.org/patient_publications.htm

  • Managing pain effectively using ‘Over the Counter’ (OTC) Medicines (2010)
  • Understanding and Managing Pain (2010)
  • Help the Aged – Pain in Older People: Reflections and Experiences from an older person’s persepctive (2008)
  • Opioids for persistent pain: information for patients (2010)
  • Managing Cancer Pain – information for patients (2010)

It is very important to communicate how your pain effects you describing it carefully , what you do to ease it and what makes it worse and how intense it is using a scale as below:-

Pain scale

It is useful to keep a diary either using a calendar or using an App
This helps to communicate progress that is being made and how it is affecting daily life.

Pain can be classified into several categories:-

Nociceptive Pain:

Nociceptive pain is believed to be caused by the ongoing activation of pain receptors in either the surface or deep tissues of the body. There are two types: “somatic” pain and ” visceral” pain.
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“Somatic” pain is caused by injury to skin, muscles, bone, joint, and connective tissues. Deep somatic pain is usually described as dull or aching, and localized in one area. Somatic pain from injury to the skin or the tissues just below it often is sharper and may have a burning or pricking quality.

Somatic pain often involves inflammation of injured tissue. Although inflammation is a normal response of the body to injury, and is essential for healing, inflammation that does not disappear with time can result in a chronically painful disease. The joint pain caused by rheumatoid arthritis may be considered an example of this type of somatic nociceptive pain.

“Visceral” pain refers to pain that originates from ongoing injury to the internal organs or the tissues that support them. When the injured tissue is a hollow structure, like the intestine or the gall bladder, the pain often is poorly localized and cramping. When the injured structure is not a hollow organ, the pain may be pressure-like, deep, and stabbing.

Neuropathic Pain:

Neuropathic pain is believed to be caused by changes in the nervous system that sustain pain even after an injury heals. In most cases, the injury that starts the pain involves the peripheral nerves or the central nervous system itself. It can be associated with trauma or with many different types of diseases, such as diabetes. There are many neuropathic pain syndromes, such as diabetic neuropathy, trigeminal neuralgia, postherpetic neuralgia (“shingles”), post-stroke pain, and complex regional pain syndromes (also called reflex sympathetic dystrophy or “RSD” and causalgia). Some patients who get neuropathic pain describe it as bizarre, unfamiliar pain, which may be burning or like electricity. The pain may be associated with sensitivity of the skin.

An interesting account of the mystery of chronic neuropathic pain

click on link below:-

Mystery of chronic pain

Psychogenic Pain:
Most patients with chronic pain have some degree of psychological disturbance. Patients may be anxious or depressed, or have trouble coping. Psychological distress may not only be a consequence of the pain, but may also contribute to the pain itself. “Psychogenic” pain is a simple label for all kinds of pain that can be best explained by psychological problems.

This close relationship between pain and psychological distress means that all patients with chronic pain should have an assessment of these psychological factors, and psychological treatments should be considered an important aspect of pain therapy. In some cases, psychological problems appear to be a main cause of the pain. This does not mean that the person is not actually experiencing the pain. Rather, the patient is truly suffering but the main cause somehow relates to the emotions, or to learning, or to some other psychological process. Although doctors sometimes encounter patients who pretend to be in pain (some can be called malingerers), this appears to be a rare occurrence. Most patients with pain that appears to be determined primarily by psychological processes are hurting just like those who have pain associated with a clear injury to the body.

Sometimes, psychogenic pain occurs in the absence of any identifiable disease in the body. More often, there is a physical problem but the psychological cause for the pain is believed to be the major cause for the pain.

Another website which gives interesting insights into pain is:-
http://painconcern.org.uk
It also has a series of podcasts which talk about various aspects of pain the edition talks about exploring the possibility of controlling pain through techniques that focus on the brain and the mind using mindfulness a topic I wrote about in a previous blog.

Pain

Pain

http://audioboo.fm/boos/1709910-airing-pain-programme-47-the-power-of-the-mind-05-11-13

Because chronic pain is so complex, there are often multiple treatment goals. These goals may include more comfort (being “pain-free” is often not possible when pain has become chronic), better physical functioning, improved coping and less distress, getting back to work, helping the family cope, and other positive outcomes. To accomplish these goals, chronic pain often is best managed using what is called a “multimodality” approach.

The patient’s response to therapies may be influenced by age, gender, race or ethnicity, cultural beliefs, or any of a variety of physical, emotional, social, family, occupational, and spiritual circumstances. Treatments for pain must be tailored to the individual, based on each person’s unique condition.

A multimodality approach to chronic pain includes a combination of therapies selected from eight broad categories:

  • drug therapies
  • psychological therapies
  • rehabilitative therapies
  • anesthesiological therapies
  • neurostimulatory therapies
  • surgical therapies
  • lifestyle changes
  • complementary and alternative medicine therapies

In many cases, a multimodality strategy requires the involvement of several types of health care professionals -the interdisciplinary team.

Effective pain management is therefore collaborative in nature, involving good communication among the patient, family, and the practitioners involved in the care. A sense of partnership in trying to find the best therapeutic approach promotes the most creative, and ultimately the most effective, approaches. Patient-practitioner partnership can maximize the patient’s involvement and sense of control in the healing process. Patients must feel empowered to seek the best care and to act in a way that uses their own resources in the service of health. If an interdisciplinary team of practitioners is involved in developing a multimodality approach, the members must communicate freely to ensure the appropriate targeting of therapy. Family communication helps promote positive patterns within the family and may reduce the stress caused by prolonged pain and impaired function.

Integrative pain managementFrom this perspective, Integrative Pain Therapy is a natural extension of state-of-the-art conventional pain management.

Integrative Pain Therapy

The term, “integrative pain therapy,” can be used to describe a broad therapeutic approach to the management of chronic pain, which attempts to combine the best of traditional treatments for pain and disability with the best of the therapies widely considered complementary or alternative. It is part of a larger effort to develop an “integrative medicine approach” to many clinical problems.

This integrative medicine approach links traditional, so-called allopathic, medical treatments with varied complementary and alternative treatments. It is a comprehensive system of medicine, which emphasizes wellness and the healing of the whole person (physical, psychological, social, and spiritual), above and beyond the treatment of any specific symptom or disease (Bell, 2002). It involves the use of all safe and effective therapeutic approaches that can potentially facilitate healing, while empowering the patient to participate in the process of healing. Integrative medicine acknowledges the complexity of health and illness by identifying multiple causes of disease and multiple interventions based on the physical, biochemical, psychological, social and spiritual aspects of health and disease. It recognizes that multiple outcomes may be positive for the individual, and that these outcomes may vary from one person to the next (Rosomoff, 1999).

The goals of an integrative pain therapy approach may include:

  • reducing or eliminating pain
  • using medicines that are appropriate, provide sustained benefits, have tolerable side effects, and support the functional goals of the patient
  • reducing distress and enhancing comfort, peace of mind and quality of life
  • improving the understanding of the role of emotions, behavior and attitudes in pain
  • improving the ability to function physically and perform activities of daily living
  • improving the ability to function in social and family roles
  • supporting the patient’s ability to return to work and function on the job
  • educating patients in ways to maintain rehabilitation gains and avoid re-injury
  • empowering patients to actively participate in pain control strategies
  • promoting awareness and understanding of the factors that contribute to physical and emotional distress related to pain
  • developing the skills and knowledge needed to increase the patient’s sense of control over pain

Integrative pain therapy draws from a broad spectrum of therapeutic approaches. It recognizes the value of multiple approaches to pain management (a multimodality approach) and acknowledges the individualized nature of good medical care. The goal is to employ the safest and most effective therapies to provide maximum benefit.

Foundations of Health

In developing an integrative approach to pain therapy, the starting point is a broad view of health and well being. The foundations of health include at least four elements:

    • stress management
    • proper diet and nutrition</li
    • regular exercise
    • psychosocial support

There are literally thousands of studies confirming the importance of each of these foundations. Careful attention to each can have profound effects on health and illness. The work of Dean Ornish (Ornish, 1999), for example, demonstrated that interventions targeted to these areas can not only halt, but actually reverse, coronary artery disease.
Stress Management.
All people experience stress and some degree of stress may be needed to generate excitement, engage fully in tasks, and perform well. However, too much stress, or poor coping with stress, can undermine health and well being.There are many tools available to help reduce the debilitating effects of acute and chronic stress. The most important approach is to recognize triggers and behavior patterns, and to utilize emotional and spiritual approaches to reverse stress’s negative effects. These approaches can be learned in a variety of ways, such as psychotherapy, education, and training in mind-body techniques. Sometimes, herbal, nutritional or pharmacologic therapies are needed to assist in coping with persistent stress.

Proper Diet and Nutrition

Although science has a great deal more to learn about the role of nutrition in health and disease, it is certain that poor nutrition can contribute to a range of problems. Poor nutrition is common in many developing countries, and there is clear evidence that people living in developed countries, such as the United States, may not obtain enough of the essential nutrients needed for maintaining health (Fairfield & Fletcher, 2002). Because the diet may not be a complete source of all the nutrients needed for optimum health, the use of supplements may be necessary, either to help prevent disease or to aid in treatment.

Exercise

Proper exercise maintains fitness and is very helpful in reducing stress. Intense aerobic exercise is not necessary to achieve these benefits. Brisk walking may be sufficient for many people. Modest, regular exercise, particularly when combined with stretching and relaxation, or approaches such as yoga and tai chi, provides another essential element for optimum health.

Psychosocial Support

There is a huge body of research that demonstrates the importance of psychological and social factors in health and disease. Emotions, thoughts, connections to others, the response of others to our behaviors-all these factors contribute. Dealing with these types of issues and problems is an essential part of pain management.
Although integrative pain therapy as an approach to the management of chronic pain is in its infancy, several recommendations are possible.

Based on current research the integration of psychological approaches (such as behavioral and relaxation therapies) with conventional medical treatment is strongly recommended for the successful treatment of chronic pain conditions. Some mind/body strategies, like biofeedback, hypnosis, and imagery, are already considered to be mainstream treatments by pain specialists. Others, such as meditation, Qigong, and yoga have extensive historical use and need more study to determine their exact role in an integrative program. The potential benefit of all these approaches is the ability to learn to regulate anxiety, improve coping, and possibly reduce pain.

Research also supports physical activity and exercise as a part of most treatment programs for chronic pain. For example, active back exercises can be effective in reducing pain intensity, pain frequency and disability, as well as in helping to prevent recurrences of back pain. Activity can be supported by conventional physical therapy and exercise approaches, or by a wide range of movement therapies.

There is strong support for a treatment strategy that combines therapies that address the physical, psychological and social aspects of chronic pain. Based on a slowly growing experience, the integration of complementary/alternative approaches with standard treatments may offer the best chance of addressing these broad concerns. All patients should be educated about the range of options and the goals of treatment.

The interdisciplinary approach to chronic pain may involve not only traditional health care providers, including physicians, nurses, psychologists, and physical therapists, but integrative providers comfortable with the widest array of healing modalities, whether conventional or complementary, as well as specialists in specific complementary approaches.

In Ealing we are fortunate that we have an excellent Community Musculoskeletal service which offers standard treatments alongside Complementary therapy.
Shortly,The Ealing improving access to psychological therapies (IAPT) service offers support for common mental health problems such as depression, anxiety and panic for people living in Ealing.
It can provide self-help treatments, cognitive behaviour therapy (CBT), counselling and sign-posting to other servces. For more information view http://www.mhws.org.uk.
It will be offering Mindfulness therapy with a special reference to Chronic Pain in the New Year.
Referral information
Ask your GP for more information, or call 020 3313 5660 or email wellbeing.selfreferral@nhs.net.

 
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Posted by on December 20, 2013 in Training and Advice

 

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MIND FULL OR MINDFULNESS

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Have you ever felt that your mind is over full, cluttered with so many thoughts and worries that you almost feel your head is about to explode?

Moreover,have you developed techniques to deal with this?

This need has been recognised since the beginning of time and I feel as soon as we become aware of the world outside ourselves as a child we instinctively know how to do this. Unfortunately, children are not encouraged or nurtured to preserve this skill and many modern toys are brightly coloured and noisy and the opportunity to just ‘be’ and enjoy stillness and silence and the simple life around them is missed.

One of the best pieces of advice I was given when I had my first child was ‘if the baby cries remember she may just want to be put down’ and it often worked.

Several years ago I talked to a group of 5-6 year olds about being quiet and still and I was surprised when most of them revealed how this was something in their own way they found a way of practising. They then proceeded to tell me how they found space to do this. “I always go under my sisters bed,” said one child. “I go in the garden behind the shed” said another.” I sit under the stairs” said another.

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I then sat with them and focused on a candle, which I allowed one of them to carry to the table. The child who was the noisiest and most active carried it with great care and placed it on the table. I spoke with these children on several occasions and on each occasion a child carried the candle a short distance to the table and we all sat in silence. Week by week the length of time they remained silent and still grew until they were able to sit quietly for up to 5 minutes. Following this they came out of the silence quieter and played together in a much calmer, friendlier manner.

Similarly, talking to children in a a quiet monotone causes absolute relaxation and puts them in a state of selfhypnosis. This technique I have used on many occasions to administer injections and take blood from children. On one occasion when I was a junior paediatrician and a child was admitted with an asthma attack. The nursing staff were lining up to hold him down to put up a intravenous infusion. The child was distressed and frightened. I asked the staff to leave the room and quietly spoke to him with full eye contact and gradually the child quiet ended and he cooperated fully to allow me to put up the infusion much to the surprise of the nursing staff.
On another occasion more recently I was working as a locum in a practise and a mother came to the surgery with 3yr old active twins. She was distraught as her husband had terminal cancer and she had no-one to look after the children and wanted to talk about her own problems. When I looked at the computer notes there were four entries from previous doctors recording that they were unable to have the consultation with the mother and she should return on her own. I started to talk to the twins and then gently massaged the centre of their scalp (a calming acupuncture point) and both children stood still for long enough for the mother to pour out her concerns. The children were then led calmly away by their much calmer mother.

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As an adult to achieve this level of relaxation we need to focus on a sound, a picture or simply your own breath sounds and may need help from another person.
Using techniques like this, meditation, breathing and yoga can help us pay attention to the present moment. It helps us become more aware of our thoughts and feelings so that instead of being overwhelmed by them, we’re better able to manage them.
This awareness of the present moment or Mindfulness as a psychological concept is based on the concept of mindfulness in Buddhist meditation. It has been popularised in the West by Jon Kabat-Zinn. Despite its roots in Buddhism, mindfulness is often taught independently of religion.
Mindfulness teaches individuals to be present in the moment rather than being distracted about the past or projectingd into the future. It doesn’t stop you feeling emotions per se, but it does allow you to deal with them more dispassionately.

Practising mindfulness can give people more insight into their emotions, boost their attention and concentration and improve relationships. It’s proven to help with stress, anxiety, depression and addictive behaviours, and can even have a positive effect on physical problems like hypertension, heart disease and chronic pain.

Mindfulness practice, is increasingly being employed in psychology to alleviate a variety of mental and physical conditions.

I think that mindfulness is something many of us have done – have you ever sat looking out to sea and found yourself listening to the rhythmic sound of waves or watching the trees/ grass swaying in a breeze or listening to your favourite music and suddenly realised that time has passed and for a short time you were only aware of that present moment and following this you feel more at ease. Have you swum lengths in a swimming pool with gentle rhythmic arm and leg movements and your mind taking up by feeling of movement in the water and finished the swim feeling that problems have seemed less or gone. Jogging at a gentle rhythmic pace around the park in a similar vein can give the same effect. This is not overexerting the body but calming the mind in a similar way to yoga. However, the benefit is only appreciated by being aware of the present moment and your thoughts and emotions at the time.
This can be a start to achieving full awareness or mindfulness by zoning in on the feeling of relieving the mind of excessive, overwhelming clutter so that eventually you can reach mindfulness with perfect stillness of body and mind.

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Although the practise of meditation is in no way a religion it may be it is part of your religious practise and you need to be aware of how it can be helpful physically and mentally; you may want to call it prayerfulness.

I have been surprised as to how many people from all walks of life benefit from regular meditation although it is now it can be referred to as mindfulness.

Mindfulness. If you’re not yet au fait with the concept, it might be a good idea to familiarise yourself with it now, because you’ll be hearing a lot about it in 2013; from business leaders, academics, politicians and educationalists they are all making it part of their lives.

It is also being introduced into some schools as part of the curriculum.
I read an account of a school that played music and instructed the schoolchildren that when played they were to stay still and think about themselves. After a while the head teacher only had to start the music and the whole school became quiet.
Mindfulness is being increasingly recognised as an incredibly effective way to cope with stress and also recognised by NICE and the NHS as the most effective way to prevent relapse into depression and anxiety states. It has been found to help with pain management and weight loss.

It has been discussed in Parliament as a therapy in relation to both unemployment and depression. But it isn’t about zoning out. If anything, it’s about zooming in; paying attention to the present and decluttering the brain to make room for creativity – and in business that means boosting the bottom line.

To that end, mindfulness training has been embraced by organisations as diverse as Google, Transport for London, PricewaterhouseCoopers and the Home Office, by way of an antidote to the relentless pressure and information overload common in many workplaces.

HOW CAN YOU MAKE A START IN THE PRACTISE OF MINDFULNESS

1) Make it a formal practice. You will only get to the next level in meditation by setting aside specific time (preferably two times a day) to be still. At first it maybe for only 3-4 minutes.

2) Start with the breath. Breathing deep slows the heart rate, relaxes the muscles, focuses the mind and is an ideal way to begin practice.

3) Stretch first. Stretching loosens the muscles and tendons allowing you to sit (or lie) more comfortably. Additionally, stretching starts the process of “going inward” and brings added attention to the body.

4) Meditate with Purpose. Beginners must understand that meditation is an ACTIVE process. The art of focusing your attention to a single point is hard work, and you have to be purposefully engaged!

5) Notice frustration creep up on you. This is very common for beginners as we think “hey, what am I doing here” or “why can’t I just quiet my mind already”. When this happens, really focus in on your breath and let the frustrated feelings go.

6) Experiment. Although many of us think of effective meditation as a Yogi sitting cross-legged beneath a Bonzi tree, beginners should be more experimental and try different types of meditation. Try sitting, lying, eyes open, eyes closed, etc.

7) Feel your body parts. A great practice for beginning meditators is to take notice of the body when a meditative state starts to take hold. Once the mind quiets, put all your attention to the feet and then slowly move your way up the body (include your internal organs). This is very healthy and an indicator that you are on the right path.

8) Pick a specific room in your home to meditate. Make sure it is not the same room where you do work, exercise, or sleep. I may help to use a candle and gentle music or sounds to help you o feel relaxed.

9) Read a book (or two) on meditation. Preferably an instructional guide AND one that describes the benefits of deep meditative states. This will get you motivated. John Kabat-Zinn’s Wherever You Go, There You terrific very  good for beginners.

10) Commit for the long haul. Meditation is a life-long practice, and you will benefit most by NOT examining the results of your daily practice. Just do the best you can every day, and then let it go!

11) Listen to instructional tapes and CDs.

12) Generate moments of awareness during the day. Finding your breath and “being present” while not in formal practice is a wonderful way to evolve your meditation habits.

13) Make sure you will not be disturbed. One of the biggest mistakes beginners make is not insuring peaceful practice conditions. If you have it in the back of your mind that the phone might ring, your children might wake, or an alarm is about to go off then you will not be able to attain a state of deep relaxation.

14) Notice small adjustments. For beginning meditators, the slightest physical movements can transform a meditative practice from one of frustration to one of renewal. These adjustments may be barely noticeable to an observer, but they can mean everything for your practice.

15) Use a candle. Meditating with eyes closed can be challenging for a beginner. Lighting a candle and using it as your point of focus allows you to strengthen your attention with a visual cue. This can be very powerful.

16) Do NOT Stress. This may be the most important tip for beginners, and the hardest to implement. No matter what happens during your meditation practice, do not stress about it. This includes being nervous before meditating and angry afterwards. Meditation is what it is, and just do the best you can at the time.

17) Do it together. Meditating with a partner or loved one can have many wonderful benefits, and can improve your practice. However, it is necessary to make sure that you set agreed-upon ground rules before you begin!

18) Meditate early in the morning. Without a doubt, early morning is an ideal time to practice: it is quieter, your mind is not filled with the usual clutter, and there is less chance you will be disturbed. Make it a habit to get up half an hour earlier to meditate.

19) Be Grateful at the end. Once your mediation is finished spend 2-3 minutes feeling appreciative of the opportunity to practice and your mind’s ability to focus.

20) Notice when your interest in meditation begins to wane. Meditation is hard work, and you will inevitably come to a point where it seemingly does not fit into the picture anymore. THIS is when you need your practice the most and I recommend you go back to the book(s) or the CD’s you listened to and become re-invigorated with the practice. Chances are that losing the ability to focus on meditation is parallel with your inability to focus in other areas of your life!

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Posted by on September 28, 2013 in Training and Advice

 

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