Cindee Quake-Rapp: Thank you for the nice introduction. I am very excited to be with you today to talk about an area that I find very fascinating and has emerged so much in the last couple of years.
I am hoping today to cover the above course objectives. One of the things that I find the most fascinating is the neural mechanisms that support mindfulness-based interventions for pain, stress relief and general well-being are the same neural mechanisms that house our feelings of pain, anxiety, stress. They are all interconnected. I just find that really fascinating that we might be able to influence how someone's feeling, their emotions regarding pain, their perception of pain, and that all of that well-being and stress could be influenced by mindfulness-based interventions. I would like to talk today about the psychosocial context that influences subjective experience of pain.
We place a psychological spin on pain. We interpret it in a totally emotional or psychological way, so we will be talking about that today, and things that we can do to help people that are experiencing pain. Mindfulness, and pain, and well-being is a complex interaction between sensory effective and cognitive factors. That is what allows us to perceive stress, pain, well-being, all our perceptions and how we feel are all interconnected in a very complex way.
Role of OT
There is not a lot of evidence that substantiates using mindfulness-based interventions for occupational therapy. What I am really excited about is a publication in 2016 AJOT (Hardison, M. E., & Roll, S. C. (2016). Mindfulness Interventions in Physical Rehabilitation: A Scoping Review. American Journal of Occupational Therapy, 70(3), 7003290030p1-7003290030p9). It was a systematic review on mindfulness-based interventions and physical rehabilitation. This is very exciting to me that there has been an occupational therapist looking at this in how it is being used in rehabilitation practice. It would be really great if we had a systematic review on how it is being used in behavioral health and occupational therapy as well, but this is a brand new publication and I thought that was pretty exciting that that just came out.
Just a few short years ago, mindfulness was considered kind of pseudoscience. There did not seem to be a lot of research that supported it, but that has really changed. There are many randomized controlled trials now. Again, the systematic review in AJOT is really good. Another great article was published in the Canadian Journal of Occupational Therapy (Reid, D. (2011). Mindfulness and flow in occupational engagement: Presence in doing. Canadian Journal of Occupational Therapy, 78(1), 50-56.). This looked at mindfulness and flow in occupational engagement. Even back in 2011, there was a publication about how using mindfulness in occupational therapy might help us get ourselves and our clients to engage. I thought that was a very interesting article as well. I hope you get a chance to check both of these out.
Definition of Mindfulness
What is mindfulness? It is based on Eastern tradition, goes back probably thousands of years. It is very much a cognitive or a thinking practice, but as we know, what we think influences how we feel. It can be a very powerful mechanism. The definition you hear in a lot of places and in the literature, it is a nonjudgmental awareness of sensory events. I will talk a little bit later about how mindfulness is a somatosensory event, which is so understood by OTs. We are talking about self-regulation and emotional well-being that we are dealing with with children and adults on a daily basis.
The neat thing that the research is suggesting is that it produces a sense of well-being across experimental and clinical populations (Zeiden, et al, 2015). One person I think is a lead researcher on this is Fadel Zeidan. If you look up his work he has produced a lot of really fascinating studies on how mindfulness affects neural mechanisms and provides some really great outcomes which we will talk about in just a minute.
Mindfulness
What does mindfulness mean? I wanted to go beyond yoga and meditation even though those are both very powerful interventions for mindfulness. Let's talk about what we deal with in practice, in society, and in our world (Figure 1).
Figure 1. Overview of mindfulness.
Mindful Eating
One area I would like to talk about is mindful eating. I live in Kentucky which has a large population of people who are obese and a large population who have diabetes. The two are very much related. As occupational therapists, what can we do to help people engage in mindful eating? People who are not using mindful eating are putting themselves at risk for a lot of food-related disorders, everything from obesity, bulimia, anorexia, diabetes, heart disease, and cancer. What do I mean by mindful eating? I mean paying attention to what we are putting into our bodies on a daily basis. Many of us do mindless eating. We eat for comfort. We often do not eat or drink fluids because we are hungry. We do it for comfort. There is an emotional override to eating. It gives people pleasure beyond sustenance. I think it is a very powerful thing that occupational therapists can look at when we are working with people who do not have the ability to really do mindful eating for their health.
Mindful Thinking
Another thing is mindful thinking. We, as occupational therapists, work with a lot of people who really have some negative cognitive processing. The way their brain thinks is in a very negative way that is not productive, and does not help them engage in daily occupations. Their brain is kind of stuck in this rumination or perseveration on negative thoughts. Those can be directly related to pain responses. If someone has chronic pain, it is really hard to not focus on that pain, which basically distracts you from engaging in meaningful occupation. This is a really powerful area to look at for health promotion and disease prevention.
Mindful Smelling
Another area I wanted to talk about is mindful smelling. It may seem bizarre but the saying, "Stop and smell the roses," is really powerful. Are we really doing that? Are we really using our olfactory senses in our environment to really take in and being mindful in the present moment about what is surrounding us? As you know, smell is a very important sensory system. I think a lot of times we basically ignore it unless it is so powerful that you cannot ignore it. Are we helping our clients thinking about stopping and smelling the roses?
