By Ronald D. Siegel,Pys.D., Harvard University
Our bodies often suffer aches and pains for physical reasons. However, symptoms like anxiety-induced stomachaches and erectile dysfunction also run rampant in society. How can we overcome them without heading to the pharmacy first?
How can we use the placebos with practices of mindfulness to treat common disorders?
Mindfulness for Pain
Let’s look at muscle tension disorders—headaches, temporomandibular joint disorder, neck, knee, foot, wrist, and shoulder pain. We don’t have quite the data we have about these disorders that we have with chronic back pain. With chronic back pain, we know that the correlation between what’s found in the imaging of the spine and what people experience in terms of subjective distress is very, very low.
The condition of the spine only rarely influences whether or not people will be in pain. It’s not never—there are people for whom it s the spine that’s causing the problem and repair of the spine is what’s called for—but in the vast majority of cases, this isn’t the case. With the case of neck, knee, wrist, shoulder pain, we don’t quite have the data. Largely because large-scale studies haven’t been done in which we take people without knee pain, shoulder pain, or wrist pain, and take a look at what the body parts look like for them.
This is a transcript from the video series The Science of Mindfulness: A Research-Based Path to Well-Being. Watch it now, on Wondrium.
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Mindfulness for Sexual Dysfunction
Mindfulness can be used for other kinds of wellness issues, like sexual dysfunctions. It’s essentially the fear of the dysfunction that brings on the dysfunction. Looking at erectile dysfunction as an example, before the invention of Viagra and Cialis, there was the work of Masters and Johnson—they were kind of the original sex therapists.
They developed some very effective non-pharmacological treatments that targeted awareness of present experience with acceptance. They taught what they called “sensei focus.” Here’s what the instructions were like: They would send a couple home and they would instruct the couple to touch one another sensually and sexually. But there were rules to this activity: they were not allowed to pet to orgasm nor have intercourse. Instead, Masters and Johnson instructed them to bring their attention to the sensations of touching their partner (if they were the one doing the touching) or being touched by their partner (if they were the one being touched).
Every time your mind wanders and goes off to other things, just gently bring your attention back to the sensations of touching or being touched and let go of any goal orientation and simply accept whatever happens.
They were teaching mindfulness practice where the focus was sensual touch. They found, for example, with erectile dysfunction, that about 75 percent of the time, just training couples to do this resolved the disorder.
They also addressed other issues, such as people’s attitudes toward sexuality, and the dynamics of the couple’s relationship—whether people felt close or not. These days, these kinds of interventions are a little bit academic. Viagra and Cialis are used in the replacement of successful communication, where people who don’t like each other and struggle to communicate can successfully have intercourse regularly.
Learn more about how mindfulness can positively affect our relationships
Mindfulness for Insomnia
Insomnia sufferers can also benefit from a little mindfulness training. The conventional treatment for insomnia is stimulus control, sleep hygiene, and relaxation. Stimulus control means teaching people to associate the bed with sleep. The standard instruction is to reserve the bed for sleep and sex.
If we’re being firm and logical about this to genuinely develop a paired association between the bed and sleep, we should reserve it for just sleep—not reading, watching TV, or having sex. We should be recommending people have sex in another room, but only sleep in the bed. Unfortunately, researchers have been a bit too prudish to say, “Have sex in the living room, sleep in the bed,” so both are included.
The second thing we ask for is sleep hygiene. That means get up the same time each day, even if you haven’t had a full night’s sleep, and try to go to bed the same time each day, even if you’re not tired. Thirdly, do relaxation training.
An alternative is to do mindfulness treatment. The way mindfulness treatment works is to simply use the time in bed as an opportunity to be aware of present experience with acceptance. This is what I do every night when I go to sleep. I lie down, close my eyes, and I begin following my breath as is taught in breath awareness training. If the mind wanders to other things, I gently bring the attention back to the breath.
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It turns out that mindfulness practice reduces our need for sleep. People who go on meditation retreats who are doing mindfulness practice all day long find that they need a lot less sleep. There’re two theories to this. One is that what’s happening is that some of the processing of what happens, the restorative functions of sleep, is happening in mindfulness therapy or mindfulness practice.
What’s happening in sleep is many kinds of unintegrated material is being re-integrated. We’re reconnecting with thoughts, feelings, and memories that might have been difficult to be with prior. If some of that’s happening while we’re doing the mindfulness practice, we don’t need as many hours of sleep to do it. The other hypothesis is that because we work through these things, we tend to sleep more deeply during the hours that we are sleeping, so that it’s more efficient. Either way, what happens is, if we trust that mindfulness practice will help to be restorative for us, then we can give up the goal orientation.
We all know that it is much easier, typically, to fall asleep on a Friday night if you don’t work over the weekend, then it is on a Sunday night if you work during the week. On Sunday night, you mentally prime yourself by thinking about how you have to get to bed so you’ll be well-rested, otherwise, Monday is going to be a disaster at work. Friday night matters less because you’re not focused on it the same way.
When we remove the goal orientation, that helps us a great deal. The way I think of it is one of two things is going to happen: I’m either going to have the opportunity for eight uninterrupted hours of mindfulness practice—pretty good in a busy life—or I’m going to fail and I’m going to fall asleep, and that would be fine as well.
Mindfulness for Gastrointestinal Distress
The gastrointestinal system is remarkably sensitive to our emotional lives. What the stress physiologists tell us is, there’s no need to digest your own lunch when you’re about to become somebody else’s lunch. Our GI system will often shut down when we’re under stress, or it will suddenly become overactive—kind of dump its load, if you will, so we can run away.
People experience all manner of gastrointestinal distress. They experience upper GI symptoms, in which the stomach is producing too much stomach acid, and churning too much. They also experience lower GI symptoms very often that has to do with having alternating diarrhea and constipation, as we see in irritable bowel syndrome or other kinds of disruptions.
Interestingly, ulcers were once thought to be caused by stress before scientists discovered the role of H. pylori. It turns out that you could treat an ulcer by giving an antibiotic that kills H. pylori bacteria and often it would heal. But then it was discovered that H. pylori infections are endemic to large percentages of the population.
Conversely, there are some countries in which the majority of people have H. pylori infections. This then brings up the question: what’s determining whether somebody with H. pylori infection gets an ulcer or not? This takes us back to the stress hypothesis. It turns out that stress is a critical factor in whether the stomach lining becomes broken down in a way that makes it vulnerable to the infection.
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Go back to the condition of irritable bowel syndrome, a very common disorder. Sufferers often have alternating constipation and diarrhea. Here, the distress about the symptom is often the stressor that keeps it going, not unlike what happens in chronic back pain.
The distress about the symptom is often the stressor that keeps it going. Click To TweetA person’s afraid that they’re going to be caught off-guard, suddenly need the bathroom, and they won’t be in a place where it’s convenient. Or, they’re afraid that they’re going to get backed up, they’re going to feel terrible cramping and things, and that’s going to get in the way of participating in life. It’s only when people can relax about IBS, and use mindfulness practices to simply ride the waves of different sensations. They learn to recognize the signals from their body of this is what needing to go feels like, or the sensation of constipation feels like. Then they do considerably better.
This is true for the upper GI symptoms as well. Often, people start to micromanage their diets. They start to try to figure out which foods are making me feel better or worse and then eliminating foods from their diet.
Of course, there are genuine food allergies, and these need to be treated medically. However, for a lot of people, what happens is as they’re trying to figure this out, as they’re becoming a junior scientist, they can’t differentiate eating a tomato as problematic because the tomato interacts with our stomach in a bad way, or whether it is the thought of eating a tomato that causes anxiety and that anxiety upsets our stomach. As soon as we have the experience of a tomato making our stomach worse, we become locked in a pattern where all future tomatoes will make our stomach worse through the anxiety mechanism.
Listening to our body’s signals regarding stress, discomfort, or unease, while practicing mindfulness techniques, are steps on the path to better managing our mental and physical health daily.
Learn more about when to do practices that cultivate a sense of safety
Common Questions About Mindfulness and Placebos
Mindfulness is the conscious act of focusing on non-judgmental awareness and attention to whatever experience is taking place around or in contact with one’s body. The goal is to attain self-control in regulating any response to stimuli.
There is much evidence to corroborate mindfulness practices. Studies have produced data evidence of neuroplastic changes that demonstrate control over brain activity, depression, mental health disorders, pain, and sleep disorders.
By being in the present, we can reduce past and future concerns such as dwelling in the past or worrying about the future. This can reduce or eliminate anxiety as we process concerns with clear thinking minus the judgment.
Mindfulness is practiced in essentially one way over various behaviors: to be consciously aware of what, how, and why one is behaving. Mindfulness involves focusing on the breath, observation of senses, noticing what limbs and organs one is using, pausing to consider actions, and listening with intent. Meditation is also one of the essential means to mindful awareness.
