Mindfulness and Chronic Pain – Vidyamala Burch

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It’s my honor and pleasure to, first of
all, meet Vidyamala, we only met yesterday and so today I have the pleasure to introduce
her to you. She has, obviously as you can see, she has had an accident where she
experienced a lot of pain and had then to deal with the incapacitation of,
changing life from one modality of operation to another, and so she’s spent a lot of time
of her adult life really researching, also, what does it mean to have pain and the
long-term effects of that and created a program called Breathworks and she has
been sort of working a lot on that, Breathworks and promoting it and it has been
adopted to many settings, different countries, and so thank you very much for
being here, and I’m looking forward to hearing you. Thank you, Vidyamala.>>Thank you. Thank you very much, Diego. [APPLAUSE] I’d also also like to thank Olah, who is a very good friend of mine, and Andush, for the vision behind this gathering… (it’s a bit tangled up here… don’t want to be garroted before my talk, that would be unfortunate). Yeah, it’s extraordinary isn’t it, that that these
two individuals can have this vision for how do we bring about a new society, a
better world, and we’re at the beginning of something, I feel very privileged and
honored to be here, at the first one and maybe in ten years when there’s thousands
of people here, people will say, “Were you at the first one?”, and we’ll say yes we were, so you know we really need visionaries in the world, and I feel very
touched by them… and thank you also for the other
speakers. It has been a really fascinating morning. So in my presentation, I’m going
to run through these topics, little bit of an introduction, the burden of chronic
conditions on society which is truly frightening, the power of self-management methods, such as Breathworks as a self-management method, what we teach, some applications, and where we going
next, or what are the doors that could open next. So little bit about Breathworks, so
Diego’s already said little bit, and I had… One spinal injury is unfortunate, and two
spinal injuries is careless, and I’ve had two, two different accidents, and it
was a long time ago, it was when I was a teenager. So all my adult life I’ve lived
with disability and pain, and for much of that time I haven’t managed at all well, but when I was in my mid-twenties I came across meditation, when I was in
hospital in Aukland, and realized that although my body was damaged in a way
that was not going to change, my mind was at least potentially healthy… yeah, it wasn’t
healthy at the time, but I felt, yes there was this tool, this extraordinary
tool, that I had which was my mind. So, I have devoted my, the rest of my life, to
investigating this tool that we all have called the mind, and when I say mind, I mean mind forward-stroke heart, so the whole mental- emotional dimension. So I often say that
Breathworks is an inside-out method. I haven’t come in as an academic or a
scientist with the hypothesis that I wanted to test out. I’ve come in as a human being with a problem. I’ve discovered something that works, ‘cuz it definitely
does and then I had to figure out how do you communicate that to other people in
a way that they gonna take it seriously, which of course means interacting with
the scientists. So it’s been very interesting moving from experience to
theory, rather than theory to experience, I mean, I know that’s kind of a false dichotomy, but that’s been the journey (still got problems with this noose). So here’s a few figures… 1.5 billion people worldwide suffer with
chronic pain. That’s generally defined as pain that you’ve had for at least three months, three months or more. That’s a lot of people, that’s a seventh of
the world’s population. A recent health of an England, 20 million
people in the UK live with chronic pain, 31 percent of men and 37 percent of
women, one in five people in Europe, so that’s probably the Swedish figure more
or less, suffer moderate to severe pain, a
very big survey done in 2006. In terms of Swedish costs, the cost of low back pain,
both the direct costs of health care, the indirect costs of lost productivity,
things like that, 20,000 euros per patient per year. It’s a
lot of money that’s been spent on lower back pain, and as we saw from Peter slide
that lower back pain is a very big, a very high incidence in some Western
countries. And in America, some 116 million people suffer with chronic pain at a
cost of something like 635 billion dollars a year. And of course the problem
worsens with age. In the UK, people who are over 75, 57% have pain daily and again as
we’ve heard, we have an aging population, people living to 100, for a lot of
these people, it’s not going to be a pleasant experience in their body. It’s going to be worn out
bodies with a lot of pain, and if we include all chronic health conditions,
really it’s quite epidemic, chronic pain, chronic health conditions, are becoming
one of the major problems for society. It’s taking up an increasing proportion of
health care costs. 10 years ago more money was spent on acute care, now a lot more money spent on chronic conditions, partly because the acute care is working, so people left fighting things like cancer and then they’re left with all the
long-term side-effects from the treatment. So this is where self-management can be very helpful. Self-management is what it says. It’s
where you learn to manage your own life. You could say, it’s life self-management, but in this context, it’s your own health, you learn how to take responsibility for your own
health, which sounds straightforward, but of course, many people, they don’t have
that concept, many of our, many of us have been taught, you go to a doctor, you go to someone in a white coat to fix you up. So the idea of taking responsibility
is is every shift, it’s a shift in one’s perception. It gives control back to the
individual which is very important and this is called having it an internal locus of
control, as opposed to an external locus of control, so you feel you can have some
control over your own well-being. And of course, if one is empowered you will then
seek external help appropriately. I’m not saying you don’t ever go to a doctor, but
you’d go to a doctor feeling that you are in the driving seat
of the dialogue, rather than the passive recipient of some external authority so
the method that we do at Breathworks is we’re teaching people to help themselves. So
we’re not helping them, we’re helping them learn how to help themselves. And I
think that proper self-management has probably got an enormous future in health care because it’s cheap. Obviously people are going to go to doctors a lot less if
they take responsibility for their own health. Certainly I go to, I hardly ever go to
doctors now, whereas I used to go to doctors a lot… and it’s
very accessible. It’s not high tech, strictly put them in a room and teach them some basic tools of self-awareness and diet and exercise and things like that and it can
be very very effective. And it can also overcome isolation. A lot of chronic
health conditions are very isolating. You’re stuck at home, you’re tired, can’t go out, you’ve lost your job, your friends don’t call around anymore. And if you teach things
like mindfulness in a in a group then it’s very, very very, helpful and we we
can also use virtual groups, which we’ll talk about later on, using the internet. So
how do we operate as a self-management method? Now there was a guy called Chris Brown who got one of these Varela awards that we’ve heard about from the Mind and Life Institute. That’s a very nice coincidence. He works at the human pain research group at the
University of Manchester Salford Royal Hospital. This was published in the
clinical Journal of Pain. This was working with 28 people with musculoskeletal
pain. These are some of the changes that we saw, so on the left hand slide you see
a big increase in self-management, so people were much more able to manage
their own pain after learning mindfulness, and we also teach compassion. Mindfulness increased their perceived control over pain, increased a lot, which is very
interesting and their sense of helplessness decreased a lot, and those
are the sort of changes we would hope to see. So, the quite sort of behavioral, psychological ways of relating to the difficult, we saw a lot of change. So what do we teach a Breathworks? It’s very simple. I think this is one of things that I’ve learned from my own experiences, is keep it simple. Mindfulness is not rocket science, you know, I think as Anita said, it’s simple to understand but hard to practice, that kind of idea, but we can wrap it up in all kinds of complexity but actually it’s very, very simple and the
basic problem that one has, when you’re living with a chronic health condition
is that you don’t like it. Really what your living with is “I don’t like this”,
and the way I don’t like this gets lived out in your life is very
distressing and very unpleasant. So how mindfulness can help is you’re
learning, or you’re teaching people, how to move away from this “I don’t like this” system of living to turning
towards it, which is very counterintuitive. It takes a lot of
courage to learn to turn towards the difficult. And then what you do is you investigate
what’s actually happening, not what you think is happening, or what you fear is
happening, or what happened yesterday, but what is actually happening right now, so
you look at it in quite a lot of detail. However, crucially, you do this with
tenderness, and care, and acceptance, and compassion. So it’s not a kind of, put
it under the microscope approach, but it’s embrace it the way you would hold a
child that was hurting. Its like, you know, “what’s wrong?”, why, you know, “how can I help you?” So you relate to your own difficulty with great tenderness. And, then crucially,
this is the kind of crucial theoretical part of our program. You can unpack that
experience into what we call primary and secondary suffering. so rather than it being just a great big blob
of “I don’t like this”, it becomes “I have some unpleasant sensations”, “I can accept those”, and then you realize how it’s the resistance to the unwanted that’s
causing most of your distress. Resistance, Primary Sensations + Resistance=Secondary Suffering. And thats all the mental emotional and
physical reactions, things like catastophizing thinking, depression, anxiety,
fear, and of course secondary physical tension. You’ve got pain, you tense against
it, and then you got more pain. So we use this exercise on our program, which is
fun, so that person on the, on your left, has got a blue cushion on her lap which represents
the unpleasant sensations in her back, say, for someone with back pain, let’s say for arguments sake, and then we get other people in the group to pile all these other cushions on, which are all the secondary reactions: I can’t go to work anymore, nobody likes me anymore, maybe I’m going
to end up in a wheelchair, I can’t walk the dog anymore, and you end up just
burdened by all these cushions, all the secondary suffering. It’s a very good exercise, you
can steal if you want, very, very useful, because it’s very felt. That person
there, she’s burdened, isn’t she? She can’t see out anymore and she’s weighed down
by all this secondary suffering. And she can let of all the red cushions. They’re
all optional. The blue question isn’t optional. So mindfulness helps us accept the blue cushion, the primary suffering, to soften or dissolve
resistance that’s very, that’s kind of crucial training, and then to reduce or even
overcome the secondary suffering, so one can have pain and have an excellent
quality of life. That’s the thing that we’re showing people. Very quickly the
methods: We take three different formal
meditation practices, a body scan, mindfulness of breathing, and kindly awareness,
which is based on a Buddhist practice called the development of
loving-kindness. So that gets an equal weight with mindfulness, but with research, I’m not quite sure how we’d work out which one was effective, but it seems to work, so
that’s the main thing. We teach mindfulness in daily life in a very systematic and
detailed way, because that’s very, very important for people who are living with chronic health conditions. Meditating on today is helpful, but then
you’ve got another 23 hours to go crazy in, so we really unpack it in a very
specific way. For example, I use a timer when I’m working, and after 20 minutes I
stand up, and that’s changed my life more than meditating, because that’s really changed my
behavior. So one of their phrases that we use is, take a break before you need it. That’s the take-home little phrase you can have: Take a break before you need it. I think
intuitively as human beings we push the envelope, and we keep going until we’re
desperate, and then we crash and we have this kind of pushing and crashing cycle, so
take a break before you need it. We teach mindful movement. I’m going to teach
a little one in a moment, and everything that we do is based around
the breath and learning to rest into gravity. Gravity’s remarkable, it’s here
all the time, and very often we’re kind of pulling away from gravity, which creates
a lot of secondary tension. So we’re just going to do a little experiential thing now, even though I’m told I’ve only got 5 minutes left, just to show how simple this is, so if you just sit comfortably, and I would like you to make a fist with one hand… What’s happened to
your breath?… Anyone breathing? Yeah?, yeah, did people find their breath stopped when they made the fist? Yeah. So that’s that’s what happens
when you have pain or the unwanted in your body. It’s like you got a fist in your
body, and not only have you got the tension, but you’ve got this inhibited
breathing around the body So now, I’d like you to drop into gravity, really
sort of rest down onto the chair, just imagine that you’re allowing your body
to be held by gravity and you got your fist, and imagine breathing into the
fist. And what does the fist want to do?.. …does it want to soften?… Yeah, so that’s one of the main trainings. So it’s learning how to drop into the body, drop into gravity,
identify these kind of areas of holding in the body, and then learn how to take
the breath into those, and to soften, and dissolve, and that’s a very, very good way
of releasing this impulse to secondary suffering. So just a couple of drawings
about the kind of theory, again, of the way we work. So, the unaware human being tends to live, strung out, we don’t like the unpleasant, we’re pushing away the unpleasant and we’re pulling the pleasant towards us, so the
pain is the unpleasant, don’t like that, ohh, want more of that, and does that look comfortable?!?
Interestingly is the crucifix as well, which I find quite interesting. So you’re sort of crucified on your impulses of trying to avoid the pain and to prolong
pleasure. So what we’re doing is we’re learning and teaching people to turn
towards the pain with tenderness, and the dotted lines mean you’re seeing into the fluid nature of experience. This is very very important, ‘coz people think of pain has
being solid, the enemy, a thing… Actually it’s just a flow of sensations that are
ever changing. And we don’t leave people there. We do not leave, we don’t leave people to
turn towards the pain, and seeing into its nature. That would be not a very pleasant
way of living. So then we get people to hold that, but then to also pay attention
to what’s pleasant. And we’ve not yet found anyone on a program who couldn’t
find something pleasant, which I think is very, very interesting, because people can
think oh, there’s nothing pleasant, my life is awful, but it might be, you’ve got a
soft, a softness, in your face, your hands are warm, your tummy’s soft, you’re not hungry, that might be pleasant. In hospital, it might be that the sheets on the bed
clean. That can be extraordinarily pleasant when you’re in a lot of
suffering. And then you hold both, and you see into their fluid and changing nature, so
you’re no longer strung out, but you’re just resting back, and it’s a very broad, open awareness, and you’re just allowing everything to rise and fall and rise and fall, moment by moment and that’s a much more restful whole, healthy way of living. And
we don’t end with self. This is also very, very important. It’s not just a self-awareness training, but you then expand your awareness to include awareness of
others, and the world around you. And you realize how we’re also very, very alike.
We look different, but we’re all very, very similar. And this overcomes this
preoccupation with self, and one’s own problems, and you shift from a perception
of isolation, you know, I’m the only one in pain, and you’re all healthy, which is
often the perception that one has when you’ve got a health condition, you look out to the world and you think they’ve got perfect lives, and my life is terrible. But you realize
it’s not like that. Every single one of you, I know, have some kind of
difficulty in your lives, just like me, and we also have this explicit cultivation
of compassion… So, things we’re doing now… I wrote this book in 2008 that’s now out in 12 languages. The title in Swedish different, but the
English title is very important, actually, which is: Living Well WITH Pain and
Illness, so it’s not overcoming pain and illness,
but learning to live well with the human condition, that includes pain and illness.
We’ve got two 8 week programs that are developed in many countries, mindfulness for health and mindfulness of stress. We’re working on online courses with Olah from the mindfulness center here in Sweden, very, very exciting, involves two ten-minute practices a day,
so we’re trying to make it achievable for people, and in fact, we probably getting
reports back from people that two ten minute practices a day, one in the
morning, one in the evening, is more effective than one 20 minute practice a day, because you’re breaking up all hours that you’re not meditating, yeah, so
you’re coming back to center twice a day rather than just once a day. And you can do that on your own, using the online platform, but we’re also
experimenting with using other forums where you can bring people together for
a web-based group and I think with voice thread, which is brilliant. So we’ve had
people from many many different countries all reporting back how they
getting on with their practice, and again, some people say it’s more effective than a
weekly face-to-face class because they’re talking to people every day. Now, of course, you could do a weekly face-to-face class and voice
thread which would be really brilliant, but you know, embrace the technology
that’s out there, it’s very exciting. That’s what the platform looks like. Doing couple of projects with the Department of Health in the UK. This
one’s very, very exciting, working with people recovering from
addictions, alcohol and drugs. Carers and asylum seekers and people
have been incarcerated for a long time, or many times, and we just did an eight
week course with them. It was so life-changing that then the Department
got us more funding to train them up, to become mindfulness champions, and then
they’re gonna go into their communities and deliver the program. And they’ll be
able to go into prisons much more effectively than, say, me, because they can
speak to their own population, their own community. They’re really remarkable people… …horrific stories. And we involvement at the moment in a workplace trial, Department of Health, trying an online course, face-to-face course, and then mixed, the online course plus some input from the trainer. Obviously
online course is very attractive because it’s cheap, but it does seem that people
benefit from some additional input and sort of teaching about what they’re
doing on the online course. And they’re hoping to roll it out nationwide. So our vision for where do we go next… Well,one of the things which I personally am very, very passionate
about, is how do we get mindfulness to the hard-to-reach populations, yeah, like in the north of England, the average reading age is 12. These people aren’t going to read on mindfulness, they’re not going to read literate, educated books on mindfulness. So I’ve just written a book with this journalist, Danny Penman who’s a journalist for one of the tabloid newspapers in the UK, so he really knows how to write for your
average reader and he’s done a book, a sister volume that he published a couple
years ago, with Mark Williams, called Mindfulness, that’s been a real bestseller,
so I’m hoping that working with Danny, he knows how to write about this stuff in a
way that people can access, otherwise it just stays a kind of academic interest, and
and I don’t want to just be for the middle classes, the educated middle
classes. There’s all kinds of evidence that poor health is much worse in lower
socio-economic groups, and we’re not reaching those people at the moment. So this is one
of my huge passions. So, I’m wondering about computer games, I’ve got a friend
who’s a GP, and says when you go into the homes, home visits into people
from these from really deprived populations, there’s no books in the
house, but there are great big plasma TVs and computer games, so I’m just curious… I don’t know anything about computer games, but I’m very excited about how do we
engage with these people, ‘coz they need mindfulness and they would really benefit
from mindfulness. And I’m very excited to be alive at this
time, where we’re we’re living through a revolution, you know, the last decade has been a digital revolution, it’s a bit like the industrial revolution in 10 years, and we’re alive now,
there’s all this the stuff happening, and how can we really embrace technology, to roll this stuff out. I suspect, you know, reading books about 8 week courses probably isn’t a thing of the
future, but I’m not quite sure what the thing of the future is yet. So, really, anything to bring ease about, and reduce the suffering in society. That’s the passion, to just it get out there. Okay, thank you [APPLAUSE].


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