Footstep 9

Relaxation and mindfulness

There is plenty of evidence showing that relaxation and mindfulness can help people with difficult health problems such as persistent pain. For example, we know it can lessen pain levels, reduce stress and improve concentration.

So let's look at how you can make a positive difference to your life and your pain by learning how to unwind your body and your mind ...

What is relaxation?

Relaxation happens when you or someone else guides your mind to unwind the tension and tightness within your body.

Relaxation often involves using breathing skills and focusing the mind on relaxing images, colours or experiences.

Gentle tightening or stretching and relaxing movements with focus on the breath can also help to lessen the tension within the muscles and body.

Most people who have struggled with pain say that it is so important to learn relaxation. It helps to do it with support and keep doing it on good and bad days.

Learning relaxation can be easier than you expect and many people say they can feel positive results very quickly.

Some different types of relaxation to explore

Breathing and muscle relaxations

  • Belly breathing (also called diaphragmatic breathing)
  • Progressive muscle relaxation
  • On the spot reduction anxiety or anger reduction (OTSAR)

Distracting the mind’s attention

Imagining a pleasurable activity like a walk in the countryside or along a beach can help shift your focus away from pain and other unpleasant feelings.

Doing activities that help you unwind

Here are some suggestions:

  • Gentle exercise programmes like Yoga, Tai Chi or Pilates
  • Sitting in a beautiful garden and smelling the flowers
  • Listening to a relaxation CD or app
  • Listening to a favourite piece of music
  • Taking a photograph of a beautiful scene
  • Attending a local relaxation group, gym or self help group
  • Listening to recorded nature sounds
  • Knitting or crocheting
  • A warm bath and using scented oils

Experiment and build your own relaxation programme. Choose to do one or even two things that are helpful each day.

A discovery of relaxation: Jacky and Dave’s story

Jacky was in a mega struggle with stress, bill payment problems and the worst of pain flare ups. Her friend Dave had pain too and had done a self management course for pain where he found out about relaxation. He lent Jacky a CD with some relaxation tracks, saying “Give it a go. It really helps; don’t do all the tracks at once. Choose one track and explore it.” That night, to help her sleep, she followed the relaxed muscle breathing track from the CD. She was drifting off when her mobile phone rang. It was her son saying he’d be late home.

Jacky felt irritated as she was feeling quite soothed and comfortable. She listened again to the same track and she slept through her son’s arrival home at 1am.

She had a sense she was more rested in the morning.

Dave rang that day to find out how she had gone on. He was glad to hear that Jacky had a better night. He suggested that she explore more of the CD and use the guide to relaxation skills sheet: “Find your two or three best tracks and work with them for a few weeks. I use the breathing one at work. No one notices and it is gets me through the busy times on the job.”

Practising relaxation – how to develop your relaxation skills

Here are two useful approaches that people with pain find helpful:

1. Time-out relaxation

Making time to practise and focus on relaxing will help you learn how to relax fully and deeply. For a ‘time-out’ relaxation session, set aside about twenty to thirty minutes.

When you first learn a relaxation technique, being in a quiet, comfortable place can help. Lie down on a bed or mat, or sit in your most comfortable chair. Try to find a time when you are unlikely to be disturbed.

If you wish, a partner or friend could do the relaxation session with you. Or you may prefer to do it alone.

Listening to a recording or going to a class can be called ‘time-out’ relaxation. There are lots of relaxation apps or online recordings available to buy.

Try and look at your relaxation sessions as part of your self care skills, viewing it in the same way as a daily activity programme.

NOTE: If you plan to use a relaxation recording, don’t use it while driving or operating machinery!

2. Quick relaxation

As well as using a ‘time-out’ technique, you can start to use relaxation in everyday situations. As soon as you notice any tension or hardness build in your muscles, practise ‘letting go’ of the tension, ‘breathe it gently away’ and relax. When you have had a bit more practice, you can use relaxation and breathing in more stressful situations – for instance, when you feel yourself getting angry or frustrated.

You can also practise ‘scanning’. This means checking your body for tension by noticing your feet, your legs, your knees, your hips, your abdomen, your chest, your shoul- ders, your neck, your head, your face and your jaw. As you notice any tension let it go, release it from you. As a tip, start from toes and work upwards, ‘letting go’ of your tension on the out-breath.

You can also observe your breathing, and remember to breathe calmly and comfortably. As you breathe in, your tummy should rise a little; then rest back as you breathe out. Don’t force things, as this may make you feel a little ‘light-headed’.

TIP: Use ‘reminders’ – for example, put a sticker on the fridge or on your mirror, and check for tension each time you see the sticker.

What is mindfulness?

Mindfulness is being aware of your body and mind in the “now”. It is about noticing what you think, feel or want at this moment without being critical or judging yourself.

Mindfulness is about exploring with all your senses: taste, touch, sound, sight and smell.

It guides you to see your thoughts as events in the mind rather than facts or truths.

It allows you to choose how to respond to your thoughts rather than react to them.

It helps you make kinder choices on how to manage your pain, your situation or your thoughts.

We now know from research that mindfulness helps us to live better with difficult health problems like pain, tiredness and so on. It also helps the brain to work better in many different ways, like improving memory or helping with attention so you focus and concentrate better. It is good for learning problem solving and being creative, so helps self management. Mindfulness practice helps to reduce stress hormones and so lessen moods like anxiety, depression and anger and our thoughts getting tied in with them.

How to learn mindfulness

There are lots of ways to learn. It just depends on how you learn best. You could:

  • Get support from a friend or help from a mindfulness trainer.
  • Access an internet course, read a guide book or work with a CD course.
  • Join a local relaxation class or mindfulness meditation course and practice at home.
  • There are also mindfulness movement courses that link breathing and movement together and are very helpful for stiff and tight muscles and bodies.

At the end of this footstep there are ideas and resources that you can explore. Give them a try and if you are struggling then find some professional help.

You could get support from a pain specialist physiotherapist, a talking therapist or a mindfulness teacher who can guide your relaxation and mindfulness skills.

Jan’s moments of mindfulness

“It was a wet, cold day and I wasn’t keen to do my regular walk. I’d had a bad night with back pain and a busy morning. But I knew from experience that if I missed my walk and stayed sitting or lying down my pain would be worse.

Somehow I found the energy to put on my waterproof gear and stepped out into the stormy day.

Soon I was splashing through puddles and being whirled along by the wind. I started to take a real interest in everything around me. I noticed the catkins dancing and pussy willows softly gleaming in the rain. My path led across a field where gulls and crows were feeding. They let out great squawks of annoyance at being disturbed as they took to the air. The gulls whirled round in the wind before settling down again. The crows tried to fly in a straight line to a tall tree, the wind forcing them into zigzag patterns against the sky. I love to watch birds so I waited as they settled down on the field to feed again. Time stood still.

Then I noticed I had been standing for too long so headed for home. As I went indoors I noticed my pain was less and I felt boosted and re-energised.

I suddenly realised – this must be what people mean by mindfulness!”

Mindfulness exercises

Here are some exercises that you can do to experiment with mindfulness:

1. A mindful breathing exercise

  • Give yourself a few minutes to sit quietly.
  • Notice your breathing.
  • Pay attention to your breath going in and coming out.
  • Try to let your attention focus on the bottom of your in-breath.
  • Actively ‘let go’ as you breathe out.
  • When you notice that your thoughts have wandered, always bring your attention back to your breathing.
  • Spend a few minutes bringing your attention back to the centre in this way. This can lead to a state of feeling calm and secure.

2. A mindful observation exercise

  • Be aware of your hand on a cool surface (e.g. a table or a glass of cold water). Be aware of your hand on a warm surface (e.g. your other hand).
  • Pay attention to, and try to sense, your stomach and your shoulders.
  • Stroke just above your upper lip. Stop stroking.
  • Notice how long it takes before you cannot sense your upper lip any longer.
  • ‘Watch’ the first two thoughts that come into your mind – just notice them.
  • Imagine that your mind is a conveyor belt and that thoughts and feelings are coming down the belt. Put each thought or feeling in a box near the belt.
  • Count the thoughts or feelings as you have them.
  • If you find yourself becoming distracted, observe that too. Observe yourself, as you notice that you are being distracted.

Note: It is usual to have to start and re-start several times when you practise ‘stepping back’ and observing in this way.

3. A ‘describing’, ‘non-judgemental’ exercise

  • Practise labelling thoughts in groups, such as ‘thoughts about others’ or ‘thoughts about myself’.
  • Use the ‘conveyor belt’ exercise described above. As the thoughts and feelings come down the conveyor belt, imagine sorting them into boxes, e.g. one box for thoughts, one box for sensations in your body, one for urges to do something, etc.

Resources for you to use

Breathworks

Breathworks helps people living with pain, illness and stress to re-claim their lives, through mindfulness and compassion training including courses, products and teacher training, Their website is full of useful links and resources.

Oxford Mindfulness Centre

The Oxford Mindfulness Centre's mission is to reduce suffering, promote resilience and realise human potential across the lifespan through mindfulness. THeir website includes useful case studies, links and resources.

Self compassion

Having compassion for others means offering understanding when they fail or make mistakes, rather than judging them harshly. Self-compassion involves acting the same way towards yourself when you are having a difficult time. Instead of just ignoring your pain, you stop to tell yourself “this is really difficult right now, how can I comfort and care for myself in this moment?” You can learn more about self compassion and how to practice it here:

Living with Chronic Pain

Living with Chronic Pain is a non-profit audio CD by clinical psychologist Neil Berry, for people with persistent pain. You can buy the CD, download it or listen to it – free – on his website.

Books

Living Well with Pain and Illness: The Mindful Way to Free Yourself from Suffering

by Vidyamala Burch, Piatkus Books 2008

(also available as an audiobook, with downloadable meditations)

Mindfulness for Health: A practical guide to relieving pain, reducing stress and restoring wellbeing

by Vidyamala Burch and Dr Danny Penman, Piatkus Books 2013

(available in both print and audiobook formats)

The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness

by Mark Williams, John Teasdale, Zindel Segal and Jon Kabat-Zinn, Guilford Publications

Relaxation and mindfulness: key ideas

  • Mindfulness and relaxation can lessen pain levels, reduce stress and improve concentration
  • Learning relaxation skills can be easier than you expect
  • Mindfulness helps in many ways, such as improving memory or attention so you can focus and concentrate better