Mindfulness-based pain management

Last updated

Mindfulness-based pain management (MBPM) is a mindfulness-based intervention (MBI) providing specific applications for people living with chronic pain and illness. [1] [2] Adapting the core concepts and practices of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), MBPM includes a distinctive emphasis on the practice of 'loving-kindness', and has been seen as sensitive to concerns about removing mindfulness teaching from its original ethical framework. [1] [3] It was developed by Vidyamala Burch and is delivered through the programs of Breathworks. [1] [2] It has been subject to a range of clinical studies demonstrating its effectiveness. [4] [5] [6] [7] [8] [9] [1]

Contents

Origins

MBPM was developed by Vidyamala Burch, growing out of her experience of chronic pain, her practice of Buddhist meditation, and her work with medical experts in pain management. Having suffered several accidents in her early life which, alongside a congenital spine condition, left her with severe long-term pain and partial paraplegia, Burch turned to meditation initially as a way to escape her bodily experience, after having been introduced to visualization practice during a long hospital stay in her mid-20s. [10] : 172  [11] Eventually, after encountering the Triratna Buddhist Community, she became a practicing Buddhist, and moved from New Zealand to the UK to live full-time in a residential Buddhist community. [10] : 173  In the late-1990s she suffered a further collapse in her health, confining her to home for long periods and requiring her to start using a wheelchair, which led her to re-evaluate her meditation practice. [10] : 173  Burch realized that "my approach was out of balance: Too much striving and not enough acceptance." [10] : 173  She read widely about pain management and the emerging secular mindfulness movement, and eventually began teaching a course in meditation for people with chronic pain and illness in Manchester. [12] In 2004, she co-founded the organization Breathworks, which delivers MBPM programs. [13]

Philosophically, the origins of MBPM lie in the Buddha's teachings about suffering, mindfulness, and loving-kindness. The "core theoretical basis" of MBPM is the distinction between "primary" and "secondary" suffering, as explicated in the Buddha's parable of the two arrows in the Sallatha Sutta. [10] : 166  [14] According to this parable, while primary suffering or the unpleasant physical sensations that "come with being human" are inevitable, secondary suffering, which arises from mental "resistance and aversion", is not. [10] : 166  MBPM programs train participants in kindly present-moment acceptance of primary suffering, leading to the diminishment or disappearance of secondary suffering. [10] : 165–7  Initially, training focuses on the cultivation of focused attention and mindfulness of the present moment, and its transient character, through meditation, as taught in the Satipatthana Sutta. [10] : 167–9  The training develops towards and is framed by an emphasis on the cultivation of loving-kindness, as outlined in the Brahma Viharas. This takes place both through explicit loving-kindness practices utilizing the imagination, and through bringing an attitude of kindliness and compassion to meditation practice and daily life as a whole. [10] : 169–70  Although the underlying principles of MBPM are drawn from Buddhism, it is presented in secular language accessible to all and suitable for a modern healthcare intervention. [10] : 165 

The scientific origins of MBPM lie in academic literature on pain and the medical benefits of mindfulness-based interventions (MBIs). In particular, MBPM grows out of new scientific understandings of pain that developed in the second half of the 20th century, which showed the complexity of the experience of pain and "the extent to which it involves the whole person—the mind as well as the body". [10] : 154  The well-established "gate control theory", for instance, suggests that the experience of pain is connected with the operation of neural "gateways" that are affected by "emotional states, mental activity, and where attention is focused". [10] : 156  These become persistently opened in people with chronic pain, even where underlying tissue damage has healed or is absent. Modern pain management draws on these understandings in the biopsychosocial model of pain, which holds that pain is best managed through a multifaceted approach addressing the biological, psychological, and social aspects of a patient's life. [10] : 154  MBPM is intended to form one part of a multifaceted pain management program, based on the understanding that mindfulness and meditation may reduce the experience of pain through calming the "mental, physical, emotional, and nervous systems, allowing them to return to a state of balance." [10] : 154  This is based on extensive research indicating that mindfulness-based interventions (MBIs) including mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) can result in clinically significant reductions in pain, in addition to other health benefits. [15] [16] [17] [18]

Traditional Chinese Medicinal use of Mindfulness Therapy

The origins to mindfulness conception and creation can be traced back thousands of years to traditional approaches from East Asian functional medicine, philosophy and spirituality, birthed from the basic underlying tenets from classical Taoist, Chinese Buddhist and Traditional Chinese medical texts, doctrine and teachings. [19]

Mindfulness is considered the branch of its root practice meditation and is used extensively in Wuxing heqidao,Taiqi, Qigong, Neigong and by Chinese medicinal physicians as part of an integrative mind/body therapy for the prevention and treatment of injury, pain, disease and suffering. [20] [21] [22]

Content and delivery

MBPM is delivered primarily through the Breathworks Mindfulness for Health course, which is structured according to a "six stage process" corresponding with practices taught at different stages of the course. [23] [3] [24] The process is as follows:

The Breathworks Six Stage Process
StageThemeMeditations/Practices8 Week Course
1Awareness: establishing basic awarenessBody scan

Breathing anchor

Mindful movement

Weeks 1–3
2Acceptance: turning towards the unpleasantCompassionate acceptanceWeek 4
3Wonder: seeking out the pleasantTreasure of pleasureWeek 5
4Equanimity: gaining broader perspectiveOpen heartWeek 6
5Connection: connecting with othersConnectionWeek 7
6Choice: responding not reactingMindfulness in daily lifeThroughout the course

The course begins by establishing basic meditation skills — in particular the ability to apply focused awareness ( Samatha ) to physical, mental, and emotional experience — then goes on to train participants in the cultivation of a broader, non-reactive awareness ( Vipassanā ), and the bringing an attitude of compassion and kindliness ( Metta ) to oneself and others. [10] : 164  In addition to learning various forms of meditation — which constitute the core of the course — participants engage in mindful movement, diary-based activity management, three-minute "breathing spaces", and habit-releasing practices. [9] [10] : 164  The course takes place over eight weeks, with weekly classes lasting 2.5 or 3 hours, and participants required to practice 20 minutes of meditation per day at home, as well as other short practices. [9] [25] In addition to the Breathworks Mindfulness for Health course, the MBPM approach has been adapted for those suffering primarily from stress in the Breathworks Mindfulness for Stress course. [2] [3]

MBPM courses draw many practices and concepts from mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), but provide specific applications for those living with chronic pain, illness, or other forms of suffering. [4] [1] [2] The three core practices of MBSR – the body scan, breath awareness meditation, and yoga – are all utilized in MBPM, but MBPM meditations are shorter and MBPM movement practice involves cultivating body awareness during simple, non-challenging movements. [4] [2] Like MBCT, MBPM places emphasis on working with difficult thoughts and emotions and on mindfulness in daily life, but MBPM incorporates a pacing program drawn from pain management practice, and involves a distinctive emphasis on the concepts of primary and secondary suffering. [4] [10]

According to many observers, the most notable distinction between MBPM and other mindfulness-based interventions (MBIs) is its emphasis on loving-kindness, which is manifested in its stress on bringing kindliness and compassion to all forms of meditative awareness, in its teaching of loving-kindness practices utilizing the imagination, and in its six-stage process progressing from the individual to the interpersonal and collective aspects of human experience. [4] [1] [3] This emphasis has been connected by some observers with a sensitivity to concerns about removing mindfulness teaching from its original ethical framework within Buddhism, while at the same time providing a secular evidence-based approach appropriate for people of all faiths, and none. [1] [3] [10] : 165 

Evaluation of effectiveness

In addition to extensive evidence indicating the effectiveness of mindfulness-based interventions (MBIs) in general for pain management, [15] [16] [17] [18] and further evidence indicating the effectiveness of compassion-based practices for pain, [26] [27] [28] [29] [30] a range of studies have specifically supported the effectiveness of Breathworks Mindfulness for Health MBPM programs for the management of chronic pain and other long-term conditions. A 2010 study found that chronic pain patients participating in a Breathworks MBPM program reported significantly higher levels of wellbeing than those in the control group, with significant positive changes in catastrophizing, depression, outlook, pain self-efficacy, and mindful attention, along with particularly large improvements in pain acceptance. [1] (Catastrophizing has been found to be a particularly important predictor of quality of life in those with chronic pain. [31] ) A randomized controlled trial in 2013 found that chronic pain patients participating in an MBPM program experienced improvements in their mental health and perceived control of pain symptoms, as well as exhibiting physical changes in brain regions associated with cognitive control and emotional regulation. [9] Long-term qualitative studies with MBPM course participants suffering from chronic pain and other long-term conditions found significant sustained improvements in quality of life, pain acceptance, and self-directed self management, with one study finding benefits sustained up to nine years after course completion. [8] [7] 2018 studies conducted in Brazil and Spain found significant lasting improvements in pain and quality of life among musculoskeletal pain and cancer patients. [5] [6] A 2018 literature review found that research on Breathworks MBPM courses has shown them "to be very helpful for people with severe chronic pain and illness", while also noting that further randomized controlled trials were needed. [4] In addition to research indicating the effectiveness of MBPM as delivered through the Breathworks Mindfulness for Health course, the effectiveness of MBPM as delivered through the Breathworks Mindfulness for Stress course and online Breathworks courses has also been supported by a number of studies. [3] [32] [33]

See also

Related Research Articles

<span class="mw-page-title-main">Meditation</span> Practice of mindfulness

Meditation is a practice in which an individual uses a technique – such as mindfulness, or focusing the mind on a particular object, thought, or activity – to train attention and awareness, and achieve a mentally clear and emotionally calm and stable state.

<span class="mw-page-title-main">Pain management</span> Interdisciplinary approach for easing pain

Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.

Mind–body interventions (MBI) or mind-body training (MBT) are health and fitness interventions that are intended to work on a physical and mental level such as yoga, tai chi, and Pilates.

Mindfulness is the cognitive skill, usually developed through meditation, of sustaining meta-attention of the contents of one's own mind in the present moment. Mindfulness derives from sati, a significant element of Hindu and Buddhist traditions, and is based on Zen, Vipassanā, and Tibetan meditation techniques. Though definitions and techniques of mindfulness are wide-ranging, Buddhist traditions describe what constitutes mindfulness such as how past, present and future moments arise and cease as momentary sense impressions and mental phenomena. Individuals who have contributed to the popularity of mindfulness in the modern Western context include Thích Nhất Hạnh, Joseph Goldstein, Herbert Benson, Jon Kabat-Zinn, and Richard J. Davidson.

<span class="mw-page-title-main">Jon Kabat-Zinn</span> American professor emeritus of medicine

Jon Kabat-Zinn is an American professor emeritus of medicine and the creator of the 'Stress Reduction Clinic' and the 'Center for Mindfulness in Medicine, Health Care, and Society' at the University of Massachusetts Medical School. Kabat-Zinn was a student of Zen Buddhist teachers such as Philip Kapleau, Thich Nhat Hanh, and Seung Sahn, and a founding member of Cambridge Zen Center. His practice of hatha yoga, Vipassanā and appreciation of the teachings of Soto Zen and Advaita Vedanta led him to integrate their teachings with scientific findings. He teaches mindfulness, which he says can help people cope with stress, anxiety, pain, and illness. The stress reduction program created by Kabat-Zinn, mindfulness-based stress reduction (MBSR), is offered by medical centers, hospitals, and health maintenance organizations, and is described in his book Full Catastrophe Living.

A relaxation technique is any method, process, procedure, or activity that helps a person to relax; attain a state of increased calmness; or otherwise reduce levels of pain, anxiety, stress or anger. Relaxation techniques are often employed as one element of a wider stress management program and can decrease muscle tension, lower blood pressure, and slow heart and breath rates, among other health benefits.

Maitrī means benevolence, loving-kindness, friendliness, amity, good will, and active interest in others. It is the first of the four sublime states and one of the ten pāramīs of the Theravāda school of Buddhism.

Mindfulness-based cognitive therapy (MBCT) is an approach to psychotherapy that uses cognitive behavioral therapy (CBT) methods in conjunction with mindfulness meditative practices and similar psychological strategies. The origins to its conception and creation can be traced back to the traditional approaches from East Asian formative and functional medicine, philosophy and spirituality, birthed from the basic underlying tenets from classical Taoist, Buddhist and Traditional Chinese medical texts, doctrine and teachings.

Conscious breathing encompasses techniques directing awareness toward the breathing process, serving purposes from improving respiration to building mindfulness. In martial arts like tai chi and qigong, breathing exercises are said to strengthen diaphragm muscles and protect organs, with reverse breathing being a common method. Meditation traditions, including yoga and Buddhist meditation, emphasize breath control. Yoga's pranayama is believed by practitioners to elevate life energies, while Buddhist vipassanā uses anapanasati for mindfulness of breathing.

<span class="mw-page-title-main">Effects of meditation</span> Surveys & evaluates various meditative practices & evidence of neurophysiological benefits

The psychological and physiological effects of meditation have been studied. In recent years, studies of meditation have increasingly involved the use of modern instruments, such as fMRI and EEG, which are able to observe brain physiology and neural activity in living subjects, either during the act of meditation itself or before and after meditation. Correlations can thus be established between meditative practices and brain structure or function.

<span class="mw-page-title-main">Buddhism and psychology</span> Buddhism, Mindfulness and Psychology

Buddhism includes an analysis of human psychology, emotion, cognition, behavior and motivation along with therapeutic practices. Buddhist psychology is embedded within the greater Buddhist ethical and philosophical system, and its psychological terminology is colored by ethical overtones. Buddhist psychology has two therapeutic goals: the healthy and virtuous life of a householder and the ultimate goal of nirvana, the total cessation of dissatisfaction and suffering (dukkha).

In psychology, self-compassion is extending compassion to one's self in instances of perceived inadequacy, failure, or general suffering. American psychologist Kristin Neff has defined self-compassion as being composed of three main elements – self-kindness, common humanity, and mindfulness.

Chronic care management encompasses the oversight and education activities conducted by health care professionals to help patients with chronic diseases and health conditions such as diabetes, high blood pressure, systemic lupus erythematosus, multiple sclerosis, and sleep apnea learn to understand their condition and live successfully with it. This term is equivalent to disease management for chronic conditions. The work involves motivating patients to persist in necessary therapies and interventions and helping them to achieve an ongoing, reasonable quality of life.

Mindfulness-based stress reduction (MBSR) is an eight-week evidence-based program that offers secular, intensive mindfulness training to assist people with stress, anxiety, depression and pain. Developed at the University of Massachusetts Medical Center in the 1970s by Professor Jon Kabat-Zinn, MBSR uses a combination of mindfulness meditation, body awareness, yoga and exploration of patterns of behavior, thinking, feeling and action. Mindfulness can be understood as the non-judgmental acceptance and investigation of present experience, including body sensations, internal mental states, thoughts, emotions, impulses and memories, in order to reduce suffering or distress and to increase well-being. Mindfulness meditation is a method by which attention skills are cultivated, emotional regulation is developed, and rumination and worry are significantly reduced. During the past decades, mindfulness meditation has been the subject of more controlled clinical research, which suggests its potential beneficial effects for mental health, athletic performance, as well as physical health. While MBSR has its roots in wisdom teachings of Zen Buddhism, Hatha Yoga, Vipassana and Advaita Vedanta, the program itself is secular. The MBSR program is described in detail in Kabat-Zinn's 1990 book Full Catastrophe Living.

Meditation and pain is the study of the physiological mechanisms underlying meditation—specifically its neural components—that implicate it in the reduction of pain perception.

Trauma-sensitive yoga is yoga as exercise, adapted from 2002 onwards for work with individuals affected by psychological trauma. Its goal is to help trauma survivors to develop a greater sense of mind-body connection, to ease their physiological experiences of trauma, to gain a greater sense of ownership over their bodies, and to augment their overall well-being. However, a 2019 systematic review found that the studies to date were not sufficiently robustly designed to provide strong evidence of yoga's effectiveness as a therapy; it called for further research.

<span class="mw-page-title-main">Breathworks</span> British mindfulness organization

BreathworksCIC is an international mindfulness organization founded in the United Kingdom, which offers mindfulness-based approaches to living well with pain, stress, and illness. It is known particularly for developing the approach of mindfulness-based pain management (MBPM), which shares many elements with mindfulness-based stress reduction (MBSR) but is adapted specifically for those living with chronic pain and illness, and incorporates a distinctive emphasis on the practice of 'loving-kindness'. Breathworks is a registered Community Interest Company (CIC) in the United Kingdom, and has nearly 500 accredited teachers working in 35 countries.

<span class="mw-page-title-main">Vidyamala Burch</span> Mindfulness teacher

Prudence Margaret Burch, known professionally as Vidyamala Burch, is a mindfulness teacher, writer, and co-founder of Breathworks, an international mindfulness organization known particularly for developing mindfulness-based pain management (MBPM). The British Pain Society has recognized her "outstanding contribution to the alleviation of pain", and in 2019, 2020, 2021 and 2022 she was named on the Shaw Trust Power 100 list of the most influential disabled people in the UK. Burch's book Mindfulness for Health won the British Medical Association's 2014 Medical Books Award in the Popular Medicine category.

The Breathworks Foundation is a registered charity in the United Kingdom that aims to broaden access to mindfulness and compassion training. It provides bursaries enabling people in financial hardship to access the programs of Breathworks CIC, develops partnerships with charities and community groups to expand the delivery of mindfulness training, and initiates research projects investigating the efficacy of Breathworks programs. It was founded by Vidyamala Burch and is advised by a group of academic experts.

<i>Full Catastrophe Living</i> 1990 book by Jon Kabat-Zinn

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness is a book by Jon Kabat-Zinn, first published in 1990, revised in 2013, which describes the mindfulness-based stress reduction (MBSR) program developed at the University of Massachusetts Medical Center's Stress Reduction Clinic. In addition to describing the content and background of MBSR, Kabat-Zinn describes scientific research showing the medical benefits of mindfulness-based interventions (MBIs), and lays out an approach to mind-body medicine emphasizing the depth of the interconnections between physical and mental health. The book has been called "one of the great classics of mind/body medicine", and has been seen as a landmark in the development of the secular mindfulness movement in the United States and internationally.

References

  1. 1 2 3 4 5 6 7 8 Cusens B, Duggan GB, Thorne K, Burch V (2010). "Evaluation of the breathworks mindfulness-based pain management programme: effects on well-being and multiple measures of mindfulness". Clinical Psychology & Psychotherapy. 17 (1): 63–78. doi:10.1002/cpp.653. PMID   19911432.
  2. 1 2 3 4 5 "What is Mindfulness based Pain Management (MBPM)?". Breathworks CIC. 22 January 2019. Retrieved 2020-05-22.
  3. 1 2 3 4 5 6 Pizutti LT, Carissimi A, Valdivia LJ, Ilgenfritz CA, Freitas JJ, Sopezki D, et al. (June 2019). "Evaluation of Breathworks' Mindfulness for Stress 8-week course: Effects on depressive symptoms, psychiatric symptoms, affects, self-compassion, and mindfulness facets in Brazilian health professionals". Journal of Clinical Psychology. 75 (6): 970–984. doi:10.1002/jclp.22749. PMID   30689206. S2CID   59306658.
  4. 1 2 3 4 5 6 Mehan S, Morris J (2018). "A literature review of Breathworks and mindfulness intervention". British Journal of Healthcare Management. 24 (5): 235–241. doi:10.12968/bjhc.2018.24.5.235.
  5. 1 2 Lopes SA, Vannucchi BP, Demarzo M, Cunha ÂG, Nunes MD (February 2019). "Effectiveness of a Mindfulness-Based Intervention in the Management of Musculoskeletal Pain in Nursing Workers". Pain Management Nursing. 20 (1): 32–38. doi:10.1016/j.pmn.2018.02.065. PMID   29779791. S2CID   29170927.
  6. 1 2 Alonso Llácer L, Ramos-Campos M (2018). "Mindfulness y Cáncer: Aplicación del programa MBPM de Respira Vida Breatworks en pacientes oncol´ógicos". Revista de Investigación y Educación en Ciencias de la Salud (in Spanish). 3 (2): 33–45. doi: 10.37536/RIECS.2018.3.2.101 . hdl: 10017/35501 .
  7. 1 2 Long J, Briggs M, Long A, Astin F (October 2016). "Starting where I am: a grounded theory exploration of mindfulness as a facilitator of transition in living with a long-term condition" (PDF). Journal of Advanced Nursing. 72 (10): 2445–56. doi:10.1111/jan.12998. PMID   27174075. S2CID   4917280.
  8. 1 2 Doran NJ (June 2014). "Experiencing Wellness Within Illness: Exploring a Mindfulness-Based Approach to Chronic Back Pain". Qualitative Health Research. 24 (6): 749–760. doi:10.1177/1049732314529662. PMID   24728110. S2CID   45682942.
  9. 1 2 3 4 Brown CA, Jones AK (March 2013). "Psychobiological correlates of improved mental health in patients with musculoskeletal pain after a mindfulness-based pain management program". The Clinical Journal of Pain. 29 (3): 233–44. doi:10.1097/AJP.0b013e31824c5d9f. PMID   22874090. S2CID   33688569.
  10. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Burch V (2016). "Meditation and the management of pain". The Psychology of Meditation. Oxford University Press. pp. 153–176. doi:10.1093/med:psych/9780199688906.003.0007. ISBN   978-0-19-968890-6.
  11. ↑ "Interview With Vidyamala Burch". www.everyday-mindfulness.org. Retrieved 2020-05-29.
  12. ↑ Vajragupta (2010). The Triratna Story. Windhorse Publications. p. 65. ISBN   978-1-909314-28-3.
  13. ↑ Burch V (2010). Living Well with Pain and Illness: The Mindful Way to Free Yourself from Suffering. Sounds True. pp. xxx. ISBN   978-1-60407-637-0.
  14. ↑ "SN 36:6 Sallattha Sutta | The Arrow". www.dhammatalks.org. Retrieved 2020-05-29.
  15. 1 2 Goyal M, Singh S, Sibinga EM, Gould NF, Rowland-Seymour A, Sharma R, et al. (March 2014). "Meditation programs for psychological stress and well-being: a systematic review and meta-analysis". JAMA Internal Medicine. 174 (3): 357–68. doi:10.1001/jamainternmed.2013.13018. PMC   4142584 . PMID   24395196.
  16. 1 2 Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, et al. (April 2017). "Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis". Annals of Behavioral Medicine. 51 (2): 199–213. doi:10.1007/s12160-016-9844-2. PMC   5368208 . PMID   27658913.
  17. 1 2 Khoo EL, Small R, Cheng W, Hatchard T, Glynn B, Rice DB, et al. (February 2019). "Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: A systematic review and network meta-analysis". Evidence-Based Mental Health. 22 (1): 26–35. doi: 10.1136/ebmental-2018-300062 . PMC   10270397 . PMID   30705039.
  18. 1 2 Zeidan F, Martucci KT, Kraft RA, Gordon NS, McHaffie JG, Coghill RC (April 2011). "Brain mechanisms supporting the modulation of pain by mindfulness meditation". The Journal of Neuroscience. 31 (14): 5540–8. doi:10.1523/JNEUROSCI.5791-10.2011. PMC   3090218 . PMID   21471390.
  19. ↑ "Huang di nei jing su wen". Library of Congress, Washington, D.C. 20540 USA. Retrieved 2023-09-27.
  20. ↑ Segal, PhD Zindel (2015). Mindfulness-Based Cognitive Therapy for Depression (Second Edition) (in Chinese) (Second ed.). Xin Ling Gong Fang.
  21. ↑ Liu, Tianjun (2016-12-21). The Key to the Qigong Meditation State: Rujing and Still Qigong. Singing Dragon. ISBN   978-0-85701-177-0.
  22. ↑ Johnson, Jerry Alan (2002). Chinese Medical Qigong Therapy: Differential diagnosis, clinical foundations, treatment principles, and clinical protocols. International Institute of Medical Qigong. ISBN   978-1-885246-30-1.
  23. ↑ Guzmari S (2018). "Change the Focus". Community Practitioner. 91: 48–9.
  24. ↑ "The Breathworks approach to mindfulness and compassion". Breathworks CIC. Retrieved 2020-05-31.
  25. ↑ "Mindfulness for Health course". Breathworks CIC. 28 January 2019. Retrieved 2020-05-31.
  26. ↑ Carson JW, Keefe FJ, Lynch TR, Carson KM, Goli V, Fras AM, Thorp SR (September 2005). "Loving-kindness meditation for chronic low back pain: results from a pilot trial". Journal of Holistic Nursing. 23 (3): 287–304. doi:10.1177/0898010105277651. PMID   16049118. S2CID   22556878.
  27. ↑ Pace TW, Negi LT, Adame DD, Cole SP, Sivilli TI, Brown TD, et al. (January 2009). "Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress". Psychoneuroendocrinology. 34 (1): 87–98. doi:10.1016/j.psyneuen.2008.08.011. PMC   2695992 . PMID   18835662.
  28. ↑ Costa J, Pinto-Gouveia J (2011). "Acceptance of pain, self-compassion and psychopathology: using the chronic pain acceptance questionnaire to identify patients' subgroups". Clinical Psychology & Psychotherapy. 18 (4): 292–302. doi:10.1002/cpp.718. PMID   20806418.
  29. ↑ Halifax J (January 2011). "The precious necessity of compassion". Journal of Pain and Symptom Management. 41 (1): 146–53. doi: 10.1016/j.jpainsymman.2010.08.010 . PMID   21123027.
  30. ↑ Wren AA, Somers TJ, Wright MA, Goetz MC, Leary MR, Fras AM, et al. (April 2012). "Self-compassion in patients with persistent musculoskeletal pain: relationship of self-compassion to adjustment to persistent pain". Journal of Pain and Symptom Management. 43 (4): 759–70. doi: 10.1016/j.jpainsymman.2011.04.014 . PMID   22071165.
  31. ↑ Lamé IE, Peters ML, Vlaeyen JW, Kleef M, Patijn J (February 2005). "Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity" (PDF). European Journal of Pain. 9 (1): 15–24. doi:10.1016/j.ejpain.2004.02.006. PMID   15629870. S2CID   11766769.
  32. ↑ Hearn JH, Finlay KA (August 2018). "Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial". Spinal Cord. 56 (8): 750–761. doi: 10.1038/s41393-018-0090-2 . PMID   29581519.
  33. ↑ Henriksson J, Wasara E, Rönnlund M (December 2016). "Effects of Eight-Week-Web-Based Mindfulness Training on Pain Intensity, Pain Acceptance, and Life Satisfaction in Individuals With Chronic Pain". Psychological Reports. 119 (3): 586–607. doi:10.1177/0033294116675086. PMID   27780873. S2CID   4935877.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.