Caution: Mindfulness Includes Pain, and Requires Readiness

In my previous post, Dr. Hopper explained "mindfulness" in detail. This practice of being completely in the moment is at the core of all spiritual teachings and is necessary for you to progress on your Path with Heart back to your True Nature. In these moments of "non-thought", some people may experience difficulty or discomfort if they access past negative emotions. This can be difficult and require emotion-regulation skills. In this second post, Dr. Hopper discusses this situation thoroughly and explains how you can be prepared in case this happens to you. I strongly recommend that you read this and learn these skills so you will be prepared for this unpleasant situation should it occur.

Unless you have overcome this material world, you have had and will continue to have bad experiences. The best thing to do is to deal with them as they happen with acceptance and love but few of us have mastered this very Zen state of Being. This means that we have repressed painful and unpleasant experiences and emotions hidden deep beneath our consciousness. As you meditate, you may encounter one of these repressed emotions so it is always good to be aware of this and prepared to deal with it. This is only natural and can be very therapeutic. You should never let this possibility interfere with your mindfulness practice and stop you from continuing on your Path with Heart. The wise person accepts the obstacles on their Path and deals with them even if he/she needs help in doing so. Whenever you need help, be sure to get it. Once you overcome this obstacle your life will be much better. You will also feel a stronger Love coming from our Source, your True Nature, because you are getting closer now that your Path is clear.

Namaste'

Caution: Mindfulness Includes Pain, and Requires Readiness

To better understand this section, a preliminary discussion of pain and suffering is necessary. Physical and emotional pain are inevitable parts of life. Our brains are designed to experience pain as a source of crucial information (e.g., this is harming me, I need to avoid doing that again, that part of my body needs care, etc.). While our brains are wired to avoid pain, the function of this avoidance is not to avoid pain itself, but rather to avoid causes of pain that are harmful to our well-being. And after harm has occurred, causes of pain are avoided because they can slow or prevent recovery from the harm that has already occurred.

A simple example of physical pain's function: When you cut your finger, the initial pain informs you of the harm, leads you to care for your finger, then to think about how this occurred so you can avoid it happening again. Later, after the initial first aid, pain lets you know that your finger is vulnerable, that it needs extra caution in how you move and use it, or ("ouch!") that you've just done something that may be slowing or preventing healing.

Emotional pain is different from physical pain. When someone is experiencing physical and emotional pain at the same time, different areas of the brain process the physical sensations of pain and the emotional pain, even though these may be subjectively experienced as inseparable.

Emotional pain is sometimes referred to as "emotional suffering," or just "suffering." Most of us have observed, to some extent in ourselves and others, that the experience of physical pain may or may not be associated with emotional suffering. And of course, emotional pain may arise on its own in the absence of physical pain. For example, experiences of sexual, physical or emotional abuse, and memories of abuse of various kinds, can be associated with extreme emotional pain.

Experiences of emotional and physical pain can be altered by the nature of our attention. We've all learned that ignoring (or attempting to ignore) pain can reduce our experience of it, and that focusing on experiences of pain can amplify them. An important difference between emotional and physical pain makes emotional pain more capable of being altered by attention: emotional pain usually involves an interweaving of feelings and thoughts. The thoughts can take many forms, but typically involve interpretation and judgment – about the emotional pain itself, about the events the pain is associated with, about oneself, or about others involved in the experience: "This is horrible!" "How could he have done that to me?" "I can't take this any more!" "I wish she would drop dead!" "There's no hope for me." In fact, such thoughts may even be the cause of emotional pain arising in the first place.

And like attention, thoughts can increase emotional pain. The greatest amplification of suffering comes from focusing one's attention on the pain while thinking thoughts that escalate the pain. Such thoughts can take many forms, including interpretations, judgments, and memories. Many of the thoughts that escalate pain and suffering are stories that we tell ourselves – about the past, the present, and the imagined future. The stories can be very involved and elaborate, and may revolve around themes of betrayal, rejection, failure, punishment or revenge that are guaranteed to generate more negative emotions and suffering.

We all know how such cycles of thinking, feeling, remembering, and imagining can spiral out of control, and sometimes lead to drastic attempts at escape (which can become causes of new physical and emotion pains).

As described above, mindfulness can help, by allowing you to catch these cycles of suffering early on, and to cut through the automatically unfolding chains of associated feeling, thinking, remembering, fantasizing and story-telling. The present-focused, non-judgmental attention of mindfulness allows one to directly observe the separateness of feelings and thoughts, to attend to feelings without running off into associated memories, stories, etc. The following techniques may help you to catch yourself in the midst of this and interupt the cycle of escalation by creating a moment of mindful reflection:

• Stop and ask yourself, quite directly, "Can I know, absolutely, that these thoughts are true?" If you can't answer "yes" with certainty, then it's probably a story you're telling yourself.
• When things aren't going well and you're in danger of escalating further, try asking yourself periodically, "Aside from the unwanted emotions I am experiencing, however unpleasant they are, am I otherwise OK right now?" This simple reality check can show that while you may not be feeling good, in that moment your mind is prolonging the suffering, or even creating additional misery.

However, this is where the caution comes in: Only a solid foundation of self-regulation skills, and disciplined practice, will enable one to attend to emotional pain with a sustained mindfulness that does not bring escalation – as opposed to having one's attention grabbed, dragged, and swept away in escalating cycles of suffering.

That is, for someone who (a) lacks skills for tolerating and regulating the intensity of painful feelings, and (b) typically copes by escaping or acting impulsively, practicing mindfulness can bring a flood of intolerable painful feelings into awareness. For some, it will be necessary to learn mindfulness practices in the context of a therapy relationship.

Important: If you have any of the following problems at times, then practicing mindfulness before you are ready will tend to make them worse or create new problems:

• Tendencies to become overwhelmed and "flooded" by painful feelings and memories, due to underdeveloped self-regulation and coping skills. For people with histories of traumatic child abuse, this is common and normal during the "first stage" of recovery, when learning such skills and establishing safety and stability in one's life are the main tasks. (To learn more about the "stages of recovery" from child abuse, see the About Therapy and Recovery section of my Child Abuse page and Judith Herman's book, Trauma and Recovery – links open as new pages.)
• Tendencies to "dissociate" – that is, blank out, space out, leave one's body, etc. – in stressful or upsetting situations. These are not uncommon experiences among those with histories of severe child abuse, and can become automatic and habitual. Originally self-protective in otherwise inescapable situations, dissociation can later cause many problems. For beginning meditators with abuse histories, dissociative states are sometimes confused with mindfulness. Learning "grounding techniques" and other emotion-regulation skills will probably be necessary first steps toward cultivating mindfulness.
• Tendencies to get "lost in your own world" and withdraw from relating to others, or to not even bother trying to connect with others. In this case, mindfulness practices could possibly be "co-opted" by strong habits of self-absorption and disconnection from others.
• Tendencies to hear voices in one's head that sound like those of real other people, or to become convinced of ideas that are extremely unlikely or clearly untrue to other people. (As this can be a delicate topic for people with such experiences, and difficult to address in writing rather than thoughtful and respectful conversation, I will not write anything more.)

Even if you have one or more of the tendencies or problems above, it is possible to practice mindfulness. But to be ready, you will need a foundation of self-regulation skills.

Good therapists can help you improve your self-regulation skills. For people with histories of child abuse (an area of expertise for me), excellent self-help resources are available too. I highly recommend those below, and the first one is particularly helpful if you struggle with dissociation.

• Growing Beyond Survival: A Self-Help Toolkit for Managing Traumatic Stress, by Elizabeth Vermilyea
• The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms, by Mary Beth Williams and Soili Poijula
• Post-Traumatic Stress Disorder Sourcebook, by Glenn Schiraldi
• Peter Levine's book Waking the Tiger and Healing Trauma audio tapes have some great exercises, including how to "pendulate" or move back and forth between experiences of pain or fear and safety.

How does a mindfulness meditator learn to feel strong emotions and bodily sensations without getting overwhelmed or dissociating?

• First, choose an object of attention that can provide a "base" and "safe place" to come back to when experiences threaten to become overwhelming. People often choose their hands, feet, or the center of their belly as a comfortable or neutral place. For others the breath will work, or a comforting phrase, or an image or memory of a safe place or person. Practice gently bringing your attention back to this base whenever it becomes distracted or pulled along by something else.
• In all meditation traditions, cultivation of focused attention precedes cultivation of the open attention associated with mindfulness. For people who can become overwhelmed by "opening" to whatever arises in their experience, including painful feelings and memories, it is even more important to practice focusing one's attention on one object and repeatedly bringing attention back to it. The idea is not that you will never get distracted (only very advanced meditators achieve this), but that you will usually be able to bring your attention back soon after it has wandered (i.e., within 10-20 seconds), and sooner when it wanders into emotionally painful territory (i.e., 1-5 seconds).
• Once you have achieved some skill at concentration, when a difficult emotion, sensation or memory arises during meditation, you can choose to "touch up against it" in small increments. Briefly touch the pain with your attention, and then back off and return to your safe object of attention until you feel the strength and presence to touch the difficult experience again.
• Other ways to back off include opening your eyes and focusing on something you can see, or switching to a lovingkindness or compassion practice. *
• Such gradual, tolerable and deliberate re-experiencing of painful feelings and memories can modulate their intensity and foster increasing confidence and mastery. It really is possible to relate to painful experiences and memories without trying to escape or becoming overwhelmed.

For many people, it is necessary to work with a therapist and/or meditation teacher who is experienced at helping people deal with the four problems listed above. One therapy that can be extremely beneficial is Dialectical Behavior Therapy (DBT). This treatment approach incorporates mindfulness into a comprehensive individual and group program designed to cultivate skills of emotion tolerance, emotion regulation and interpersonal effectiveness. (For more information on DBT, see the section, "Resources for Learning to Be More Mindful")

Finally, some people need to take medication for severe depression, anxiety, posttraumatic or other symptoms. A group of long-term meditators who are also physicians – Roger Walsh, Robin Bitner, Bruce Victor and Lorena Hillman – have written a very thoughtful article on this issue, Medicate or Meditate? They discuss preliminary research findings on potential benefits of anti-depressants for meditators who suffer from major depression.

* I will post the section about this practice next time.

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