When did you first become aware of mindfulness?
I first became aware of mindfulness about 8 years ago when, after a difficult time in my own life, I started to learn how to meditate. The technique, or practice, that I was first taught was called Shamata meditation or ‘calm abiding’ and it involved being ‘mindful’ of (or paying attention to) my breath. I found it really helpful – it enabled me see how busy my head was and how caught up I was getting in my thoughts. It allowed me to settle my mind down a bit and gain a more accurate perspective on my life. I then became interested in the potential benefits of meditation for health and started to research what evidence was available to support its use in helping manage both physical and psychological problems.
This was when I first came across the work of scientists such as Jon Kabat-Zinn. Originally a molecular biologist, he used his experience of Buddhist meditation practices to develop the first Mindfulness Based Stress Reduction (MBSR) programmes — bringing relief to many people with chronic medical conditions for whom conventional medicine had run out of options. His scientific training meant that he knew how important it was to study the effects of these interventions — particularly if they were to be accepted by a relatively sceptical medical establishment. It was only when I started looking at some of the research available that I really became aware of the potential for some of the meditation practices I had learned to be of benefit to my patients — in helping with both the physical and psychological difficulties they were experiencing.
Are more GPs recommending mindfulness to their patients? Why do you think that is?
To be honest, I really thought that I must be one of very few GPs who knew anything about mindfulness, hence the reason Ed and I decided to write the Mindful Manifesto, in part at least to try and raise awareness of it. However, soon after we started talking about the book Ed was asked to write a report for the Mental Health Foundation on Mindfulness. As part of Ed’s work for the report a survey of GPs was carried out that showed that an amazing 72% of them felt that mindfulness based treatments would be helpful for their patients with mental health problems and 69% said that training in mindfulness would be helpful for all of their patients!
As GPs we are more aware than most of the connection between the body and the mind. We regularly see patients with physical symptoms clearly due to a stressed out mind, and we know that psychological problems such as depression and anxiety are at least 30% more common in people with chronic medical conditions. We are also aware of how important someone’s state of mind can be in helping patients deal with and recover from illness.
The difficulty for most GPs has always been that there was no mental equivalent to taking regular exercise or eating healthily. That is perhaps why mindfulness makes such sense to GPs and patients alike. It helps manage stress, which has a direct impact on our physical health, but it also helps us pay more attention to how we treat our bodies, and gives us an opportunity to modify unhealthy behaviours, which can be so hard for us to change.
Can it help us as a pain management technique? What does the research suggest?
Chronic pain is incredibly common in general practice with some 20 per cent of adults suffering from it and, unfortunately, much of it remains ‘medically unexplained’. In other words it cannot be pinpointed to a known physical cause in the body. It is also something that conventional medicine is not very good at treating. Most people who came to Jon Kabat-Zinn’s clinic were reporting some kind of physical pain. Even though his mindfulness-based stress reduction course made no attempt to remove participants’ pain, by learning a different way of relating to it – experiencing it without judgment, without getting angry at it or trying to get rid of it — patients reported feeling less pain at the end of an MBSR course, as well as being less restricted by their pain.
In fact research at the stress reduction clinic found that 65% of patients who hadn't responded to standard medical treatments were less troubled by pain after learning mindfulness. So, when it comes to managing symptoms such as pain, mindfulness is not about looking for a ‘cure’ but much more about changing our relationship with our pain, accepting it, even paying attention to it.
Are there any specific medical conditions where mindfulness has been shown to be effective?
Primarily it enables us to regulate, consciously, the autonomic nervous system and reduce the damaging effects of stress. Stress triggers the sympathetic nervous system, releasing adrenaline and, amongst other things, increasing our pulse and blood pressure in preparation to fight or run away from a perceived threat. Mindfulness has the opposite effect, increasing activity in the parasympathetic nervous system. This relaxes blood vessels and decreases our heart rate – reducing our risk of developing high blood pressure and cardiovascular disease.
There is increasing evidence to suggest that the effects of mindfulness go far beyond simple relaxation, and research has shown significant benefits in managing a number of specific conditions. For example, psoriasis is a skin condition, often made worse by stress, which causes plaques of thickened red skin anywhere on the body. One study in the States found that in patients who practiced mindfulness while receiving ultraviolet light treatment to help clear the plaques, their psoriasis cleared up to four times more quickly than those who had the light treatment alone.
Mindfulness also helps to boost the immune system, the body’s natural mechanism for fighting off infection, by reducing the release of the stress hormone cortisol, which acts to dampen our natural defenses. One study to show this effect very clearly was carried out on office workers in Wisconsin. It found that a group who participated in an 8-week mindfulness course had a significantly greater antibody response after being given the flu jab than a group who had not received any mindfulness training. This has potentially very significant consequences, as it is our immune system that also helps us recover from other more serious illnesses.
Can we teach ourselves mindfulness, and how would you recommend we start?
In The Mindful Manifesto we have outlined a number of different mindfulness practices you can try. We have also created an audio guide to take you through these exercises. I would suggest you gain some personal experience by joining a mindfulness-based group taught by an experienced guide. There are many courses available across the UK – and you will find most of them listed on the Mental Health Foundation’s website.
The Mental Health Foundation are also developing an on-line course which you will be able to access through the same website. If you suffer with depression, anxiety or a number of other mental health conditions then increasingly mindfulness-based treatments may be available to you locally on the NHS via your GP. The other option is to look out for courses on meditation run by Buddhist centres if you have one near you.
Whatever option you should choose I would encourage you not to see it as any kind of ‘quick fix’. Be realistic in your expectations. If you had never even put on a pair of trainers you would not expect to be running a marathon in just a few weeks. The same is true of working with your mind. For most of us practicing mindfulness is a completely novel experience and it is not something that we should hope to master – just enjoy the journey!