Mindfulness & General Practice
‘Just when I seemed to be walled up in a
life sentence of chronic pain, someone proposed a bizarre way out: sit still,
they said, and breathe.’
Tim Parks, Teach us to Sit Still
Five years ago, mindfulness started to appear in the UK literature with respect to relapse prevention in depression. Prior to that, it had been pioneered by Jon Kabat-Zinn in Boston, with his Mindfulness Based Stress Reduction Programme (MBSR) at Massachusetts General. But it all seemed, to many doctors at least, slightly ‘kooky’ generating images of kaftans, beards and incense. Now mindfulness seems to be the therapy ‘du jour’, and the new psycho-panacea as its evidence base grows not just for depression and anxiety but also for coping with chronic pain and disease.
As GPs we see so much chronic pain, disease, unexplainable distressing symptoms and unhappiness. Most of the time, of course, people cannot be cured and our raison d’etre is to ease the burden. For patients, the bitter paradox is that the natural human desire to be cured of something from which we can’t (and indeed the cultural expectation to ‘fight it’), only increases our suffering and makes it worse. As we know better than anyone, when patients are understood, cared for and supported into a ‘coping rather than curing’ mind-set, things improve. CBT awareness and mindfulness are the two core, evidence-based skills we can give to patients to help them learn to cope better with the ‘full catastrophe’ of living.
In 2010 the Mental Health Foundation commissioned a report which examined the evidence for the effectiveness of mindfulness based therapies, as well as laying the groundwork for greater access to them throughout the NHS as an evidence-based intervention. You can read it here:
For patients, and for us, it has never been easier to
access mindfulness groups. We can do this through IAPT programmes, through MIND or
private groups (which are often relatively low-cost). Many areas of the country
are now providing MBSR and MBCT on the NHS, for example:
http://www.exeter.ac.uk/media/universityofexeter/schoolofpsychology/mooddisordercentre/Mindfulness_GP_QA_web_version_indd.pdf
The evidence of efficacy of mindfulness results from
group based interventions, however groups are not for everyone. Anecdotally, I
have never been one for groups and I’ve never done a mindfulness course. Ironically,
I have a bit of a hang-up about speaking in public…But, reading and learning
more about mindfulness using the resources below has helped me enormously to
deal with my low moods, migraines and the stress of 2 jobs, 3 children and a ludicrous
mortgage! These are useful resources to tap into:
An excellent resource of courses and on-line materials from the Mental Health Foundation. Includes a ‘surgery toolkit’ to promote mindfulness in your patient population. Great idea for practice development.
·
Mindfulness: a practical guide to finding
peace in a frantic world by Mark Williams and Danny Penman. Very
readable, practical yet erudite, and with a CD of guided meditations. Highly
recommended to all GPs and most of our patients! I think the best mindfulness self-help
book for most patients.
·
Quiet the Mind by Matthew Johnstone.
Matthew is the author of the quite brilliant picture book about depression, I Had a Black Dog. This is a similar
book that teaches us, and patients, that learning to relax takes some work! Excellent
for all, but particularly for those not into reading books….He deserves every
medal going.
·
Mindfulness
for Beginners, by Jon Kabat Zinn. What is says on the tin. Has an e-book
version on i-books with integrated
guided meditations which is excellent on the i-pad.
·
Full
catastrophe living, by Jon Kabat Zinn. This book was based on JKZ’s work on
the MBSR programme. It was first given to me by a patient 10 years ago. She
said it changed her life; I was sceptical. It is a good read but I think it is
too long to be useful as a self-help book for most people. It is worth reading
though if only for the opening chapter which describes the patients in your
waiting room perfectly!
·
Teach us
to Sit Still, Tim Parks. Not a book on mindfulness as such, but a superb
account of living with chronic pelvic pain syndrome, the failure of a medical
profession driven by interventions and drugs to help and eventual resolution
through meditation. It makes us realise how much ‘unexplained’ chronic pain is
tied up with stress and muscle tension. It is also a very funny and erudite
read, and full of great quotes such as: ‘Every
illness is a narrative. What matters is the version you tell yourself.’
Learning more about mindfulness, and practising it, over
the next year would be an incredibly worthwhile thing to have on your PDP and
use of your CPD time and ‘learning credits’. But, much more importantly, it will
also help you to help your patients and to look after yourself. Remember the in-flight
advice: first put the oxygen mask on yourself
before you place it on those you are caring for.
