Mindfulness and mental health

Sometimes life does not turn out as we expected. Coping with all the changes that accompany living with the effects of brain injury can be overwhelming. If you find yourself, or someone you love, dealing with depression or anxiety, you are not alone. Nearly half of all people with brain injuries experience depression and anxiety at some point in their recovery journey [1].

Studies have shown that mindfulness meditation can help decrease depression symptoms and improve anxiety among people with brain injuries [2, 3].

When we are in pain – whether it is physical or emotional – our instinct might be to avoid or deny it’s happening. This is often done out of fear.  “The root of all fear is the fear of our strong emotions,” says Kaira Jewel Lingo, a long-time student of Thich Nhat Hahn, the Buddhist monk who initially brought mindfulness to the West. “If we lose the fear of any emotion, then we lose the added layers of suffering. All emotions are workable.” [4]

One way of working with emotions is through mindfulness practices. Informal mindfulness involves paying attention to the activity you’re doing and engaging all your senses to fully observe your experience in each moment.
For example: slowly eating a meal, paying full attention to each bite. This includes looking, smelling, tasting, even hearing the crunch of food – with no distractions like television or a smartphone.

Often the experience is more enjoyable because you can really take in the small moments that are often missed. Another example is eating a meal without talking. With less stimuli and when your attention is not being divided, the experience is more restful.

How does mindfulness meditation work?

Mindfulness meditation is the practice of learning to sit with our experiences – including thoughts, emotions, and bodily sensations – to observe what we are feeling as it is happening. This is done with kindness, not through self-judgement or storytelling.

Although mindfulness meditation has its roots in Buddhism reaching back 2,500 years, Jon Kabat-Zinn, founder of the Mindfulness-Based Stress Reduction program [5] developed non-religious mindfulness meditation programs available in clinical settings to help patients.

Mindfulness practices can be particularly helpful after brain injury by learning to focus on the present moment by attending to one thing at a time. “For someone who has had a brain injury, it can come as a big relief to learn ways to cope with frustration, poor concentration, and memory issues. It is easier for the brain when we pay attention to one thing at a time to increase focus and concentration which is helpful for making and recalling memories,” says Melissa Felteau, who after struggling with her own brain injury recovery, adapted Mindfulness Based Cognitive Therapy for traumatic brain injury (MBCT-TBI) [6] and was a co-investigator on a number of research studies.

“Practicing mindfulness meditation can also help with improving low mood and feelings of anxiety, that can lead to mood swings and angry outbursts. All of us feel badly when our emotions get the better of us,” said Felteau. Learning how to sit with difficult emotions and diffuse the level of reactivity can go a long way in befriending the mind. “I am not talking about denying or covering up real issues or pretending everything is fine when it is not. Rather, it is about turning towards the experience and learning to build capacity to develop a different relationship with difficult emotions,” said Felteau. “Learning to extend kindness and compassion to oneself in the face of hardship can be a transformative game changer to improving overall quality of life.”

Benefits of mindfulness meditation

The benefits of mindfulness meditation include:

  • Slowing down to observe the moment and appreciate the feelings and sensations that are present
  • Allowing an openness to embrace what is here, building resiliency for difficult moments
  • Learning how to receive see your thoughts and self with kindness, compassion, and non-judgment
  • Helping to step away from repetitive negative thinking
  • Addressing apathy and helping to cope with feelings of loss of self and isolation
  • Recognizing warning signs of depression and actively taking steps to prevent decline [7].

The mind is always active – but you can still meditate

If you are thinking, “I can not meditate!  My mind is always active!”, you’re half right.  Minds are continually active: full of thoughts, feelings, observations, judgments, planning, daydreaming, analyzing, and a whole lot more. According to Felteau, “One myth worth busting is that learning to meditate will not “empty” the mind – you will still have a steady stream of thoughts, emotions, sensations – but you can learn how to have a different relationship to them to settle the mind, so it is not so anxious, sad, reactive, or all over the place.”

The practice of mindfulness meditation teaches us to sit with moment-to-moment awareness, returning from mind wandering time after time, while detaching from memories or worrying about the future.

It is easy to be hard on oneself when comparing to what was possible pre-injury. With mindfulness, you come back to just the moment. You let go of thoughts where comparisons are made. You try not to waste energy worrying about something in the future that may or may not happen. Instead, you try to develop the perspective that all thoughts and feelings are viewed as passing events in the mind [8].

Soon you will learn that all things – good, bad, or neutral – are flexible. Thoughts arise and pass away just like each breath. That’s why the first object of attention in meditation is the breath.  You will notice the same arising and passing away of emotions, sounds, and bodily sensations too.

Mindfulness meditation teaches that being with each moment is different, so you learn each moment brings another new experience, another fresh opportunity to begin anew.  “Practicing this form of acceptance and self-compassion invites us to soften our negative reactions and encourages tolerance for imperfection and failure much needed after a TBI,” [6].

The ‘Sitting Like a Mountain’ exercise
Practicing patience when thoughts come up, allowing them to pass like clouds moving across the sky, helps the mind to quiet naturally.

Using the image of sitting like a mountain is a classic meditation. Sitting solid, stable, and dignified as all forms of weather pass by including countless clouds, beating hot sun, rain showers, threatening thunderclouds, flashes of lightening, and snowstorms. These forms of weather all come and go but the mountain just sits, enduring it all – trusting in the knowledge that all weather phenomena arise and pass away. Just like life, all things come and go.

Two wings of a bird
Another traditional teaching sees mindfulness like two wings of a bird, with one wing being wisdom and the other wing being compassion. Without both wings, the bird cannot fly. The wisdom that comes with awareness of thought patterns is important to bring understanding, kindness, and compassion to the experience of meditation. Self-compassion is like the love and care one would extend to a small child but turning that nurturing on yourself. These moments of generosity and self-care are the heart and foundation of mindfulness.

Ways to practice

There are several ways to practice mindful meditation. The key is consistency in your practice, and not being afraid to change if something isn’t working for you.

Examples include:

  • Finding a compassionate teacher in person or online to help answer questions and guide you
  • Schedule a time every day, often at the same time so it becomes a habit to meditate
  • Start with 3 minutes of breath practices like the 4 by 6 breath or the 3-7-8 breath to settle the mind
  • When you can, do 3 minutes of mindfulness meditation without interruption. Next time try for 5 minutes. Then 10 minutes. Set a timer so your mind is not distracted by the clock. Work up to 20 minutes daily
  • If you’re having trouble sleeping, try doing a slow check-in with the different parts of your body while in bed to drift off to sleep
  • Use a free app like UCLA Mindful, or Healthy Minds Program from the University of Wisconsin Madison – both based on evidence-based research of MBSR/MBCT
  • Start small and begin again if you lose your daily momentum

Practicing mindfulness may help you to cope with the changes and challenges that brain injury brings. Learning mindfulness is like learning to use a new muscle. The more you “flex the muscle” the more you strengthen the neural connections in the brain.

Learning to intentionally view difficulties and discomfort as passing events in the mind [9] like weather passing a solid, stable, and dignified mountain can bring stability. Offering yourself openness, kindness, compassion, and acceptance in a way that befriends the mind and builds a sense of wholeness can be helpful and offer a sense of hope.

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