November 2018 Mental Health, Well-Being, Coping
When Jon Kabat-Zinn was practicing mindful meditation in the 1970s, it was a hip way to strive for peace and self-awareness. But while on a meditation retreat, the young doctor had an idea: He would use mindfulness concepts to help people dealing with chronic illness manage their stress and anxiety.
In 1979, Kabat-Zinn opened what's now known as the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School in Shrewsbury, Massachusetts. The center attracted those eager to take his eight-week Mindfulness-Based Stress Reduction course, which teaches exercises such as meditation, gentle stretching, and deep breathing.
In the years since, hundreds of studies have proven what Kabat-Zinn seemed to know intuitively: Mindfulness-based stress-reduction exercises can help people with chronic illness cope with the mental health issues they may experience and improve their physical well-being and quality of life. Research suggests the practice has particular benefits for people with diabetes.
In a study published in the June issue of the Journal of Diabetes Research, adults with type 2 who did a mindfulness-based stress-reduction course improved their emotional well-being and suffered less depression and anxiety than those who did not do the program. There were benefits for diabetes management, too: Participants significantly reduced their fasting blood glucose and A1C levels, a sign of improved blood glucose management.
"Living with diabetes is a major life stressor, from the physical and psychological aspects of managing blood sugar and medications to the eating challenges," says Ivy Marcus, PhD, CDE, a psychologist and certified diabetes educator in New York City. "A great deal of what we go through in life is beyond our control. The diabetes is always going to be there, but until you connect with what you're feeling and experiencing, you're not going to be able to make conscious choices about living with its many challenges."
What Is Mindfulness?
We hear a lot about mindfulness. Health care providers often suggest we use it to help us make healthier choices. But what exactly does it mean to be mindful? Based on Kabat-Zinn's definition, mindfulness involves:
Paying attention. No matter what you're doing: enjoying a hobby or talking with your family, give it your undivided attention.
Living in the moment. Put aside past regrets (an opportunity you let slip) and future worries (a looming work project), and concentrate instead on what's happening right now.
Being nonjudgmental. Rather than deciding that someone's behavior, an experience you're having, or something you're observing is good or bad, right or wrong, desirable or not, simply notice it.
If you practice the above, you're being mindful. "Mindfulness can help people hit the pause button between thoughts and actions," says Aliza Phillips-Stoll, PhD, a psychologist who works at the Joslin Diabetes Center in Boston.
How Does Mindfulness Work?
Paying attention to what you're experiencing in the present moment gets easier with practice, which is where exercises such as mindfulness meditation come in. Unlike other forms of meditation, which can include intricate breathing techniques, chanting, or thinking kind thoughts, mindfulness meditation involves training your mind to pay attention to one thing, such as the rhythm of your breathing.
One basic mindfulness meditation exercise is called mindful breathing. It goes like this:
1. Find a quiet spot and sit in a comfortable position. Do a quick check of how your body feels from head to toe (mindfulness experts call this a "body scan"). Are any muscles tight? If so, try to relax them.
2. Move your attention to your breathing. Slowly count to four as you breathe in and again as you breathe out. Notice how your chest expands and contracts.
3. If other thoughts creep in as you're tracking your breath and it's likely they will, take note of them, but try not to react. Just direct your attention back to your breathing.
Though the process is simple, staying focused can be challenging, so don't feel discouraged if you get distracted. Learning to refocus is the point of the exercise. You can then use it to be mindful during other moments of the day when you're not meditating, including when you're managing your diabetes.
Manage Pain
We think of pain as being a physical feeling, but there's also a psychological component. If, for example, you have a burning sensation in your feet due to nerve damage (neuropathy), you may also feel despair, thinking, "This is never going to get better. How can I live a normal life?"
How you think about a physically painful experience can affect the way you experience it on an emotional level, says psychologist Paul Greene, PhD, director of the Manhattan Center for Cognitive Behavioral Therapy in New York City. Instead of dwelling on unsettling thoughts, try to calmly dismiss them and shift your attention to something less upsetting. A reliable go-to: your breathing.
In a study published in 2015 in the Journal of Neuroscience, people who practiced mindful breathing while exposed to intense heat had less activity in a part of the brain that processes the physical sensation of pain than those who didn't practice mindfulness.
Mindfulness also works by helping people feel that they have more control over their reaction to pain. A Canadian study published in 2017 found that people with nerve damage in their hands and feet had less severe pain, less depression, and a better quality of life after taking a mindfulness course. Effects lasted for up to 12 weeks.
"The next time you're experiencing discomfort, a headache or nerve or joint pain, for instance, try this: Calmly notice what it is you're feeling," suggests Judson Brewer, MD, PhD, director of research and innovation for the Mindfulness Center and associate professor in the Department of Behavioral and Social Sciences at Brown University School of Public Health in Providence, Rhode Island. "See if you might be resisting the pain and if you can, instead, be open to what it feels like. Note the different characteristics of your pain, such as heat or throbbing and how these might even subtly change over time," he says. "When we [embrace] our experiences instead of trying to make them go away, we can step out of our habit of reacting with fear." The result is a less traumatic experience overall.
Eat Healthier
Studies show that mindful eating can help change behaviors that lead to obesity. It includes exercises such as learning to savor food and understanding how to recognize when you're really hungry or when you've had enough.
"Many of us are not eating out of hunger; we're eating because it's lunchtime or there's food around or we're bored," says Carla Miller, PhD, a professor of human nutrition at The Ohio State University, who has conducted research on mindfulness and eating habits. "Mindfulness can help you pause before you start eating to check your level of hunger and prevent overeating." Start with a body scan: Is your stomach growling? Does it feel empty? Do you feel listless or slightly headachy? These are physical signals that you need to eat.
It can also help you examine conflicting feelings around food. "A lot of people I work with aren't enjoying food," says Jean Kristeller, PhD, a psychology professor at Indiana State University in Terre Haute, Indiana, and cofounder of The Center for Mindful Eating. "If it's something they've labeled as bad, as soon as they put it in their mouth all they're experiencing is guilt."
Practicing mindfulness can help you move past guilt. Start by connecting with the feeling of guilt, Marcus says. If you binged on rich foods while on vacation, for instance, think about why you made those choices and how they might contradict your values, such as trying to be healthier. What might you do differently next time to be more in line with your goals? "Mindfulness is useful with helping people make more values-based [choices], rather than pleasure-in-the-moment choices," she says.
Paying closer attention to what you're doing and feeling can also help you avoid overeating. Kristeller counsels her patients to savor the experience of eating. Next time you eat, do so slowly, using all of your senses to experience color, smell, taste, and texture. Not only will you enjoy the food more, but the slower pace will help you eat less. "Our taste buds actually get satisfied and tired quickly, in just a few bites, but you have to learn to bring mindfulness to the experience," Kristeller says.
Reduce Stress
Mindfulness is a particular balm for the stress of dealing with diabetes. Focusing on an unwelcome blood glucose reading can lead to anger and panicky thoughts about potential complications down the road. You may even avoid blood glucose checks to escape such unpleasant emotions. Getting into the habit of spotting these worst-case-scenario thoughts can help you realize that results from a single reading aren't going to ruin your future; in fact, they can help you better plan your care. If you still feel upset, take a few moments to calm down with a mindful breathing break.
Your diabetes care may benefit, as well. In a study of 86 overweight or obese women published in the journal Obesity, researchers found that stress levels dropped significantly among those who took a mindfulness-based stress-reduction course. Fasting blood glucose levels dropped, too. "People who have chronic stress may be making higher amounts of cortisol and adrenaline," says Nazia Raja-Khan, MD, associate professor of diabetes, endocrinology, and metabolism at Penn State University College of Medicine in Hershey, Pennsylvania. "Mindfulness might reduce some of these stress hormones and so reduce fasting glucose."
Let Go of Self-Judgment
Cutting yourself some slack, another facet of mindfulness, can help with diabetes-related guilt. Maybe you blame yourself for that high blood glucose reading or for the low you had this afternoon. Or maybe you feel others are blaming you for developing diabetes in the first place. "There can be stigma," says Robin Whitebird, PhD, an associate professor in the School of Social Work at the University of St. Thomas in St. Paul, Minnesota, who researches mindfulness for diabetes care. "People sometimes make judgments about how you got diabetes, especially if you have other issues like being overweight."
Mindfulness can help you avoid self-blame while focusing on how to help yourself in this very moment, Whitebird says. Mindful breathing exercises can train you to stop your mind from wandering to thoughts that may be hurtful or not grounded in reality, such as your diagnosis being your fault. It can also help you look at your thoughts without judging them so you can focus on living in the present.
"The reality is that these are just thoughts passing through us," says Whitebird. "Mindfulness means accepting your feelings [about the past], then releasing and letting them go. Mindfulness teaches us to be gentler with ourselves."
Seize the Moment
The best way to maintain mindfulness habits is to practice regularly. There are smartphone apps that can help, especially for guided meditation. Here are a few to try.
Headspace
Get guided mindfulness meditations along with how-to articles and videos
headspace.com, free for a basic version; $7.99 per month for full features
Insight Timer
Get more than 11,000 timed meditations from a number of experts
insighttimer.com, free
Unwinding Anxiety
Get mindfulness exercises to ease panic attacks, live Q&A sessions with experts, and group support sessions
unwindinganxiety.com, $29.99 per month
Becoming Mindful
Interested in learning the basics of mindfulness? There are a number of ways to take the eight-week Mindfulness-Based Stress Reduction (MBSR) course.
It is available at many health centers and community centers around the country and may be reimbursable. The Center for Mindfulness has a list of qualified instructors and courses. In-person training includes group discussions about how to achieve greater awareness in everyday life.
The Center also offers its flagship MBSR course online. Tuition starts at $545. Find out more. You can also learn the elements of the program in the book Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness (Bantam, $22) by John Kabat-Zinn.
