Mindfulness and Living Well with a Long Term Condition · Mindfulness and Living Well with a Long Term Condition A Patient Workbook Developed by Clinical Health Psychology Services

Clinical Health Psychology Services

Mindfulness and Living Well with a Long Term Condition

A Patient Workbook

Developed by Clinical Health Psychology Services

Aintree University Hospital NHS Foundation Trust

Dr Mark Griffiths, November 2017

http://www.aintreehospitals.nhs.uk/


Contents

Section Page number

Introduction 1

Section one – An introduction to mindfulness 2

Mindfulness exercise 1- Mindful breathing 5-6

Mindfulness exercise 2- Mindful eating 7-8

Section two – Thoughts, feelings & behaviours 10

Mindfulness exercise 3- Body scan 15-17

Section three – Stress and difficult emotions 19

Mindfulness exercise 4- Three minute breathing space 24

Section four – Compassion and defusion 25

Mindfulness exercise 5- Visualisation (leaves on a stream) 28-29

Section five – Taking care of myself

30

Section Six – The impact of a long term condition 33 Section Seven –Barriers and Valued Action 41

Appendix: 46

Mindfulness pillars

Future goals (1)

Reference list


1

Introduction

This booklet has been designed to give you some information about mindfulness, and how you can adopt the principles and exercises of mindfulness to help you to cope with a long term condition or illness, such as the after effects of a stroke, diabetes, an amputation, renal difficulties, respiratory problems etc. Your clinician has recommended this booklet to help you live well, and cope as best you can, with your condition or physical health problem. This booklet is designed to encourage you to practice mindfulness skills and positive strategies for managing the emotional and psychological challenges of living with a long-term condition or illness.

The workbook is intended for you to work through at your own pace, with support from a friend or family member if needed. The aim is to identify current problem areas, as well as strategies to help you move forward in a positive and proactive way.


2

Section one: An Introduction to Mindfulness

Section one - Key points:

This workbook is designed to help you learn about and adopt mindfulness strategies in order to think differently and cope with your long term condition.

Mindfulness means paying attention in the present moment, without judgment. Often we go through life on ‘autopilot’, and are not always aware of the things that

we do or the effect our thoughts and emotions can have upon our behaviour and actions.

To do whilst reading this booklet It is important to attempt to practice mindfulness at least twice a day. You may find

it useful to use the daily practice worksheets in the appendix (page 44) to keep track of your mindful progress.


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Section one: An Introduction to Mindfulness

What is mindfulness?

Mindfulness means paying attention in the present moment, without judgment. Often we go through life on ‘autopilot’, and are not always aware of the things that

we do or the effect our thoughts and emotions can have upon our behaviour and actions.

We rarely think about the action we are taking and therefore aren’t always ‘living in the present moment’.

We can also find that our mind focuses on one specific area of our experience at any one time – good or bad; when there is much more that might be paid attention to at any given moment.

Mindfulness isn’t a relaxation technique as such; it is a way of seeking a heightened state of broader awareness of the present moment, by paying them attention in a purposeful and non-judgmental.

Using this strategy defends us against ‘runaway thinking’ that can unintentionally lead us to moments of distress or unhappiness.

However, although not the main intention, a common result in practising mindfulness is a feeling of relaxation or increased calmness of mind and body.

Maintaining this calmness increases our emotional resources and helps us to deal with the stresses of day to day life; then helping us to get on with our lives as we would like to.

Who uses it?

Mindfulness has proved helpful to lots of different people, but is especially helpful to those struggling with anxiety, depression, or stress, as well as people living with chronic health conditions.

Many schools and businesses use mindfulness as a way of helping employees become more mindful of themselves and others; helping reduce stress, improving levels of job satisfaction and improving work output.

When to use it

Mindfulness helps more, the more it is practiced. Most people find that if they give themselves space and time to practice once or twice a day over a number of weeks, it becomes easier to use the skills when they are feeling particularly stressed, worried, or low. Daily practice is key (both on good and bad days) to become familiar with the techniques that you can then apply and use to help yourself.


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The Seven Pillars of Mindfulness

Mindfulness is made up of seven pillars. At the back of this booklet each pillar is explored in turn.

Acceptance Accept yourself as you are (and remember that

this doesn't mean you can't change)

Letting go Recognise thoughts

as thoughts, and letting them pass

rather than holding onto them

Non-judging Trying not to judge ourselves or others

Non-striving Once we stop

demanding results from

ourselves, they become more

likely to happen

Mindfulness Patience Notice when you

are feeling impatient, not

letting this control us, and cultivating

patience in ourselves

Trust Respect your own experiences, no one can tell you

how you are feeling or how you should feel

Beginner's mind

Seeing things for the first time as if

revisit familiar places with an

open mind


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Mindfulness exercise 1: Mindful breathing

The point of this exercise: to be aware of something simple and every day, to pay attention in a new way, allowing thoughts and feelings to come and go without getting caught up in them.

Note: You may have access to audio scripts. If so please listen to the mindful breathing track

when practicing this exercise.

Sit comfortably, with your eyes closed and your spine reasonably straight.

Bring your attention to your breathing.

Imagine that you have a balloon in your tummy. Every time you breathe in, the balloon inflates. Each time you breathe out, the balloon deflates. Notice the sensations in your abdomen as the balloon inflates and deflates. Your abdomen rising with the in-breath, and falling with the out-breath.

Thoughts will come into your mind, and that’s okay, because that’s just what the human mind does. Simply notice those thoughts, then bring your attention back to your breathing.

Likewise, you can notice sounds, physical feelings, and emotions, and again, just bring your attention back to your breathing.

You don’t have to follow those thoughts or feelings, don’t judge yourself for having them, or analyse them in any way. It’s okay for the thoughts to be there. Just notice those thoughts, and let them drift on by, bringing your attention back to your breathing.

Whenever you notice that your attention has drifted off and is becoming caught up in thoughts or feelings, simply note that the attention has drifted, and then gently bring the attention back to your breathing.

It's okay and natural for thoughts to enter into your awareness, and for your attention to follow them. No matter how many times this happens, just keep bringing your attention back to your breathing.


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What is automatic pilot?

In a car we can sometimes drive for miles ‘on automatic pilot’. We get to where we needed to be without really being aware of what we are doing. In the same way, we may not be really present moment-by-moment, for much of our lives; we can often be ‘miles away’ without knowing it. This is our natural ‘default’ as human beings. For all of us.

This means that on ‘autopilot’, we can be influenced by our thoughts, feelings, and bodily sensations, without being fully aware of this, which can then trigger old habits of thinking which can be unhelpful, and contribute to feelings of worry, anxiety, low mood or anger. Self-critical thoughts are also very common when in ‘autopilot’ mode.

Becoming more aware of our thoughts, feelings and body sensations (in the moment) can help us to respond to situations with choice and increased awareness, rather than automatically; and reactively.

Thinking points: following mindful exercise 1 (mindful breathing)

1) Were you able to focus your attention on your breathing?

2) Did you notice any thoughts entering your mind?

3) How did you feel differently (before, during and after the exercise)?


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Mindfulness exercise 2: Mindful eating- a raisin

The point of this exercise: to be aware of something simple and every day, to pay attention in a new

way. Note: requires use of raisins; other types of foods can be substituted such as other fruit, popcorn, peanuts.

Please be mindful of allergies. Do not attempt if an allergy is known.

1.) Find a comfortable seated position.

2.) Pick up the raisin. Notice if you have an urge to pop it in your mouth right away.

3.) Start looking at it, feel it between your fingers, the feel of it touching your skin. Really give it close

attention.

4.) Exploring the folds, the texture, the shape, weight, colour. You may want to close your eyes while

doing this. Does it have a top, a bottom, front or back?

4.) Whatever is going on in your mind whilst you do this, you might be thinking “oh what the hell am I

doing, this is stupid”. Don’t worry, just notice what’s going on.

5.) And then, you might want to bring it up to your nose, experiencing the smell of the raisin, and as you

smell it, what does that evoke for you, what happens, does it bring back any memories or feelings?

8.) Does the raisin have a sound? If you crinkle it near your ear, do you hear anything?

9.) And then, if you’re happy to, placing it against your lips, without biting into it. Experiencing the raisin

against your lips, and then, if you’re ok with this, you don’t have to, placing it in your mouth.

10.) And starting to roll it around your mouth, without biting into it. Feeling the raisin against your

cheeks, tongue, against your teeth. Noticing what sort of tastes come, what happens in your mouth?

11.) And then if you’d like to, you can bite into it, and taking your time with that, perhaps noticing which

teeth get involved. And how that is, as you bite into it and the tastes get released.

12.) And then just pausing, and experiencing how it is, if you swallow it, following its journey down your

throat, into your body.

13.) And then just sitting with the experience of having eaten a raisin, and knowing that you are now

one raisin heavier.


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What was the purpose of that exercise?

Noting the contrast between mindful awareness and autopilot

How paying attention in detail can reveal things that we hadn’t noticed before

Noticing that our minds wander as normal

Daily practice of mindfulness skills

As we have demonstrated above, we can adopt a mindful approach to many simple tasks, such as breathing and eating and mindfulness can therefore be applied to everyday chores and experiences. It is important to attempt to practice mindfulness at least twice. Many people find it helpful to attempt a mindfulness exercise in the morning to start the day, and in the evening before bed, to end the day. However there are lots of everyday activities which can be completed mindfully.

An example, of completing a normal everyday activity mindfully, would be washing the dishes, or brushing your teeth (or similar). Something you currently do, each and every day, without thought (on autopilot).

Thinking points: following mindful exercise 2 (mindful eating)

1) How did it feel to be asked to pay attention to something in that way?

2) What did you notice about your thoughts and feelings towards the raisin?

3) Did paying attention in that way bring about any positive or negative memories?

4) What does paying attention like that say about how we pay attention to things day to day?


9

Washing the dishes on autopilot

Blitzing through the dishes, thinking about what I’m going to make for tea tomorrow, worrying about that appointment I have tomorrow, what will come of it, will I get there on time, and will it be bad news? Before I know it, the dishes are done, but I feel no more relaxed or accomplished than I did 10 minutes ago, before I started the dishes.

Mindfully washing the dishes

I notice the temperature of the water and how it feels on my skin, the texture of the bubbles on my skin; I can hear the bubbles as they softly pop. I listen to the sounds of the water as I take out and put dishes into the water. I am aware of the smoothness of the plates, and the texture of the sponge. I watch the bubbles move around the sink, the light catching them and changing their colour. I am noticing things that I might not normally notice.

A thought pops into my head, ‘what will come of that appointment tomorrow?’ Instead of turning to that thought and trying to answer an impossible questions (the appointment is in the future, I don’t know whether it will be good news or bad, and I can’t do anything about it now), I turn back to noticing the bubbles in the sink, the texture of the sponge, the sound of the water splashing against the sides…

It is normal for thoughts to intrude our mindful exercises. The aim of the mindful activity is continually bringing our attention and awareness back to the activity, the here and now, rather than paying those intrusive thoughts so much attention.

Other examples of everyday activities that could be completed mindfully:

Going for a walk (paying attention to how your body feels, looking up and down, side to side, instead of directly in front, noticing sights, sounds, smells, and sensations. What do your feet feel like as they touch the ground?)

Eating breakfast (noticing your experience of the food; taste, texture, temperature. Notice the movements your body makes as you eat)

A bus journey (noticing the sounds of the bus, the chatter of others, the changing sensations, smells, and sights, look out of the window more, what do you see?)

Putting the kids to bed (noticing the feel of the duvet as you tuck your child into bed, listening to the rustle of the covers, noticing the facial expressions of your child, the placement of their hair and hands as they settle into bed, the smoothness of the book you have picked to read them…)


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Section Two: Thoughts, Feelings, Behaviours

Section two - Key points:

Mindfulness encourages us to observe the thoughts we have, rather than react to them.

Often we can ‘run away’ with our thoughts, give them too much attention, and treat them as factual and accurate representations of both us and the world around us. Sometimes we do not stop to think about where those thoughts came from, or why we might be thinking that way (good or bad).

Being more aware can offer us the chance to take a more balanced view of our thoughts; not responding to our thoughts as ‘truths’ within any given moment; helping our emotional responses; and our emotional and behavioural management .

Thoughts are not facts. They are simply thoughts; not ‘truths’ about you or others or about life (the past, now or the future).

The more we can train ourselves to see thoughts as what they are; passing ideas, subjective and not necessarily factual or accurate, we can begin to prevent ourselves from ‘running away with our thoughts’.

The way we automatically think in any given situation, can at times make the situation far more difficult to cope with and live through.

By blocking and sinking, we are REACTING to our experiences; getting caught up in our immediate emotional responses to automatic thoughts. Instead, mindfulness teaches us to NOTICE & RESPOND to our experiences – allowing mental space for REFLECTIVE THOUGHT.


Thinking point:

Think of a time when your thoughts ran away with you, when you didn’t feel in control of

your thoughts or your behaviour.

Section two: Thoughts, feeling and behaviours

Runaway Thinking

To become more mindful we must train our awareness.

Being aware of the thoughts we have can help us to ‘pull back’ and reflect upon why we might be thinking this way, and whether this is a true reflection of our situation.

Helping us to not get caught up in the ‘thought train’ (i.e. runaway thinking).

Such a ‘reflective thinking’ approach can help us to establish a more ‘detached’ and ‘observing’ relationship to our thoughts; helping our ability to avoid our emotions getting carried away by our thoughts (which can otherwise sometimes take us to emotions, behaviours and outcomes that we wouldn’t choose or want).

Being more aware can offer us the chance to take a more balanced view of our thoughts; not responding to our thoughts as ‘truths’ within any given moment; helping our emotional responses; and our emotional and behavioural management

The more we can pull back and ‘observe’ our thoughts, the more accepting we can be of our experiences; and the less reactive we can learn to be in response of the variety of thoughts (good and bad) that can pop in our head, often randomly and without choice.

Observing our thoughts

Mindfulness encourages us to observe the thoughts we have, rather than react to them. We do not need to judge ourselves for having these thoughts, but instead, simply seek to observe the thoughts we notice. Learn to notice and observe whatever thoughts pop into mind, (whether, negative / critical/ worrisome or more positive) and remind yourself that thoughts of all kinds will be present and pass through our minds at all times. This is a usual and normal part of human experience.

Thoughts are thoughts not facts. They are simply thoughts; not ‘truths’ about you or others or about life (the past, now or the future).

As we train ourselves to see thoughts as what they are; passing ideas, subjective and not necessarily factual or accurate, we can begin to prevent ourselves from ‘running away with our thoughts’. In this way we protect ourselves from the negative emotional states that ‘runaway’ thoughts can trigger.

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12

What happens when we react to our thoughts?

The more attention we give our thoughts, the more we become ‘fused’ with them. This means that our thoughts can drive our feelings and our actions, with little space to stop to consider what is happening to us (back in autopilot). Mindfulness can help correct this imbalance.

We know that life is filled with stress, and events and situations which challenge us and make us feel bad. A long term condition such as diabetes, the after effects of a stroke, renal problems, chronic pain etc, can often be stressful (worrying, aggravating etc) and hard to manage.

As we have discussed above, we tend to go through our lives on ‘autopilot’, subconsciously using our thoughts (and the judgements we then make in relation to these), to direct our ‘un-checked’ or ‘mindless’ behaviours. Our behaviours are often led by worry or fear; sometimes by the rules we impose on ourselves without realising (e.g. “I have to”; “I should…” etc.). Our runaway thoughts thereby make our decisions about things and inform our actions. This way of being leads to frequent patterns of ‘negatively-led’ behaviour. This is not always helpful, and can mean that we struggle to find peace by failing to live ‘in the moment’. We are therefore unable to enjoy the moment, due to being cognitively and emotionally entangled, in actions from the recent past or the impending future. Such patterns fuel anxious and agitated living rather than self-acceptance, contentment and happiness.

What this means, is that we allow our automatic thoughts to determine and lead how we feel and then act, this can at times make the situation far more difficult to cope with and live through. An example of this is as follows:

Building blocks metaphor

Chronic

Pain

“I can’t do what I want

because of the pain”

“This pain is ruining my life, it’s

not fair”

“I hate my pain, I just want it to go away,

no one understands or wants to help”

“I can’t cope with my pain, I feel depressed and anxious

about what will happen in the future, it is overwhelming”

Your own

thoughts

The

problem

itself


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The

problem

itself

Think of the example as a series of building blocks; each heavier than the last. The chronic pain is the original building block, and can be difficult enough to cope with and adjust to on its own. The thoughts that naturally come to mind when we are in pain make it even harder to cope with. The thoughts above demonstrate the idea of ‘piling on negativity’. It is normal to have negative thoughts, however the more they pile up and the more attention we give them, the more difficult it is to cope with the first building block; the pain itself.

If we took those other building blocks away, you would still have the pain, but would it feel any less daunting or more manageable?

Your own

thoughts

Thinking point:

Can you think of your own building blocks example?


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How can we help with the building blocks?

Going through life on ‘autopilot’, means that our runaway thinking can draw us into unhelpful patterns, of distress. In contrast being more aware of our thoughts (such as those in the example above) can help to defend against such patterns of unhappiness.

The principles of Acceptance and Commitment Therapy (ACT) helps demonstrate how this can be achieved.

We need to move away:

Fusion with our thoughts

Evaluation of experience

Avoidance of our experience

Reason giving for our behaviour

We can achieve this by:

Accepting our reactions and be

present

Choosing a valued direction

Taking action

The principles of ACT

Accept our reactions and be present:

Trying to rid ourselves of pain and distress is a natural impulse, but often ends up increasing our pain and distress. The alternative is to accept each experience, as it is happens, even those that painful or distressing. This doesn't mean giving up or being defeated by your pain or distress. Acceptance is an acknowledgement of, and a willingness to allow these experiences.

Choose a valued direction

What do you value in your life, what is most important to you in your life? Where do you want to be in life; how do you want others to see you and know you? Consider the bigger picture, what are your ultimate goals? How can you build positives and enjoyment back into your life?

Take action

Be proactive. Identify your runaway thoughts and begin practicing ways to change your relationship with them.

These principles can be achieved through mindfulness. Becoming aware, being in the moment, and taking a non-judgemental but inquisitive stance towards your thoughts, can help you to accept your experience and to not become ‘fused’ with your thoughts. Once we can observe our thought processes more clearly, we can begin to take action and consider our values, which will in turn lead to desirable outcomes.


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Mindfulness exercise 3: The body scan

Please use the audio for this exercise if you have one.

The purpose of this exercise: to be aware of the different physical sensations in your body, to use

your body as an anchor in order to be present and aware of your experiences.

1. Make yourself comfortable, lying on your back or sitting on a supportive chair, in a place where you will be

warm and undisturbed. Let your eyes close gently.

2. Take a few moments to get in touch with the movement of your breath. … Now bring awareness to the

physical sensations in your body, especially the sensations of touch or pressure where your body contacts the

mat, bed or chair. On each out-breath, let go, allow yourself to sink deeper into the mat, bed or chair.

3. Remind yourself of the intention of this practice. Its aim is not to feel any different, relaxed, or calm; this may

happen or it may not. Instead, the intention of the practice is, as best you can, to bring awareness to any

sensations you detect, as you focus your attention on each part of the body in turn.

4. Now bring your awareness to the physical sensations in the lower abdomen, becoming aware of the changing

patterns of sensation in the abdominal wall as you breathe. Take a few minutes to feel the sensations as you

breathe in and as you breathe out.

5. Having connected with the sensations in the abdomen, bring the focus or “spotlight” of your awareness down

the left leg, into the left foot, then to the toes of the left foot. Focus on each toe of the left foot in turn, bringing

a gentle curiosity to investigate the quality of the sensations you find, perhaps noticing the sense of contact

between the toes, a sense of tingling, warmth, or no particular sensation.

6. Next, on an in-breath, imagine the breath filling the lungs, then passing down into the abdomen, into the left

leg, the left foot, and out to the left toes. Then, on the out-breath, imagine the breath coming all the way back

up out of the foot, into the leg, up through the abdomen, chest, and out through the nose. Continue this for a

few breaths, breathing down into the toes, and back out from the toes. It may be hard to get the hang of – just

practice this “breathing into” as best you can, approaching it playfully.

7. Now, when you are ready, on an out-breath, let go of awareness of the toes, and bring your awareness to the

sensations on the bottom of your left foot – bringing a gentle, investigative awareness to the sole of the foot, the

instep, the heel (noticing, for example, the sensations where the heel makes contact with the mat, bed or floor).

Experiment with “breathing with” the sensations – being aware of the breath in the background, as, in the

foreground, you explore the sensations of the lower foot.

8. Now allow the awareness to expand into the rest of the foot – to the ankle, the top of the foot, and right into

the bones and joints. Then, taking a slightly deeper breath, directing it down into the whole of the left foot, and,

as the breath lets go on the out-breath, let go of the left foot completely, allowing the focus of awareness to

move into the lower left leg – the calf, shin, knee in turn.


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Mindfulness exercise 3: The body scan continued…

9. Continue to bring awareness, and a gentle curiosity, to the physical sensations in each part of the rest of the

body in turn – to the upper left leg, across the pelvis, down the right thigh, right knee, right lower leg, right ankle,

right foot, the right toes, back up again, to the right foot, right leg, up to the pelvic area, back, abdomen, chest,

then through to your fingers, hands, arms, shoulders, neck, head and face. In each area, as best you can, bring the

same detailed level of awareness and gentle curiosity to what you can feel in your body. As you leave each major

area, “breathe in” to it on the in-breath, and let go of that region on the out-breath.

10. When you become aware of tension, or of other intense sensations in a part of the body, you can “breathe in”

to them – using the in-breath to gently bring awareness right into the sensations, and, as best you can, have a

sense of their letting go, or releasing, on the out-breath.

11. The mind will wander away from the breath and the body from time to time. That is entirely normal. It is what

minds do. When you notice it, gently acknowledge it, noticing where the mind has gone off to, and then gently

return your attention to the part of the body you intended to focus on.

12. After you have “scanned” the whole body this way, spend a few minutes feeling the body as a whole, and the

breath flowing freely in and out of the body.

13. If you keep falling asleep, open your eyes, or sit up rather than lie down.

Tips for the body scan

Regardless of what happens, 'just try it'. It doesn’t matter if you fall asleep, lose concentration, keep thinking of

other things, keep noticing the wrong part of the body etc. These are your experiences in this moment. See if it is

possible to be aware of them all, just as they are.

If your mind is wandering a lot, simply note the thoughts (as passing events) and then bring the mind gently back

to the body scan.

Let go of ideas of "success", "failure", "doing it really well", or "trying to purify the body". This is not a competition.

It is not a skill for which you need to strive. The only discipline involved is regular and frequent practice. Just do it

with an attitude of openness and curiosity, then allow the rest to take care of itself.

Let go of any expectations about what the Body Scan will do for you: Imagine it as a seed you have planted. The

more you poke around and interfere, the less it will be able to develop. So, with the Body Scan, just give it the

right conditions - peace and quiet, regular and frequent practice. That is all. The more you try to influence what it

will do for you, the less it will do.

Try approaching your experience in each moment, with the attitude: "OK, that's just the way things are right now".

If you try to fight off unpleasant thoughts, feelings, or body sensations, the upsetting feelings will only distract you

from doing anything else. Be aware, be non-striving, be in the moment, accept things as they are.

Adapted from Mindfulness-based Cognitive Therapy for Depression (2013).


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Note: Allowing your body to be as it is, is sometimes a difficult and uncomfortable thing for people to do, especially if they have physical long term conditions i.e. being asked to pay attention to your arm, when your arm has become weak and numb due to a stroke. Being asked to pay attention to your thigh, when your thigh regularly feels painful due to diabetic nephropathy. This is an important skill within mindfulness, as it teaches us to let an experience be, instead of fighting against it or pushing it away. Like we said before, the less we fight and avoid, the more likely we are to cope with the experience we are having.

How we cope with challenge: blocking and sinking

When people are struggling with pain or distress, it tends to be because they are REACTING to things rather than RESPONDING to things. We tend to find that those having difficulty coping with long term conditions or challenging life events, other challenges in life cope in either one of two ways:

Blocking

It is common to resist and avoid something that is causing us upset or pain. For example after having a stroke it would be common for a person to avoid thinking about the changes to their body after the stroke such as muscle weakness, in the hope that it will ‘get better eventually’. By avoiding the problem (or thoughts and emotions about it) we never truly acknowledge it, and therefore cannot move forward in life (for example, through rehabilitation and adaptation).

In addition, people may find themselves using strategies such as alcohol, drugs, cigarettes, shopping or eating to temporarily blocks out bad thoughts or feelings. This can soon become an unhelpful means of avoiding the problem, which brings about its own, further problems.

Thinking point:

1) How did it feel to be asked to connect with and be aware of the physical sensations in your body?

2) The body scan can help us to focus and sustain attention, why do you think this ability is helpful and important?


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Sinking

In contrast to blocking, sinking describes the tendency to obsess about the thing that is causing pain or upset. For example trying to meticulously plan our meals, routine or life around our condition, dwelling upon how we might cope with it in the future, and how we are coping with it currently.

We might also find ourselves feeling generally ‘overwhelmed’ by our condition; feeling as if this is the only thing in our experience nothing else.

By blocking and sinking, we are REACTING to our experiences; getting caught up in our immediate emotional responses to automatic and instinctive thoughts and letting them dictate how we are and what we feel.

Instead, mindfulness teaches us to NOTICE & RESPOND to our experiences – allowing mental space for REFLECTIVE THOUGHT and constructive observation.

Not judging the thoughts, or yourself; but simply having a space to mentally consider: ‘are these thoughts helping me now?’; ‘what will be helpful for me to do now?’ This observing approach towards our thoughts therefore leads to:

Awareness of our thoughts

Awareness of our feelings

Awareness of our body, muscle tension and breathing

Awareness of the full content of our experiences

Awareness of what might be the most helpful cause of action; being able to live in and through the rather than be ‘pulled in’ by your immediate runaway thoughts and feelings, that would otherwise lead to a less helpful experience.


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Section Three: Stress and Difficult Emotions

Section three - Key points:

Mindfulness can be used to help with feelings of stress.

Stress is a normal part of life, and an automatic response in our body. We cannot stop challenging life events and stress from happening- but we can

change how we respond to the stressors, and thoughts and feelings they provoke.

We can respond differently, by responding mindfully. Following logical thoughts (automatic pilot thoughts) is not always helpful. The more

CONSIDERED and CALM we can be, when presented with a problem, the better we may cope with the problem.

The less we fight and avoid, the more likely we are to cope with the experience we are having.


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Section three: Stress and difficult emotions

This section is going to look at stress and the impact of this upon our thoughts, feelings, and behaviour, in more detail. We will also look at how practicing mindfulness can affect our body as well as our minds.

Stress A very common human experience is the idea of feeling stressed. Stress is a normal emotional and physiological response to events that make us feel threatened, unwell or upset. When we feel threatened (physically or emotionally) our body’s defense mechanism kicks into high gear in a rapid and automatic process known as ‘fight or flight’ or the ‘stress response’.

Our body cannot distinguish between physical, cognitive or emotional threats. This means that when we are stressed about a mounting bill, an argument with a loved one, our health or an upcoming operation, our body responds in the same way as if we were facing a physical threat. Therefore we need to recognize this response and respond differently.

How we cope with stress Our usual attempts at coping with stress can involve attempting to either block out the stressful situation or feelings, or attempt to control and solve the feelings (which usually ends up with us feeling overwhelmed).

Instead of trying to come up with more ways to struggle against the stresses and strains of living with a long-term condition or illness, one of the aims of adopting mindfulness in everyday life, is to help you move away from this struggle altogether.

Our body’s stress response

When we perceive something to be a threat, our nervous system responds by releasing a

flood of stress hormones (including adrenaline and cortisol). These rouse the body for

emergency action.

Our heart begins to beat faster, breathing becomes shallow, blood pressure rises, and

our muscles tense.


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The quick sand metaphor

Our experience with our thoughts, and with negative experiences such as stress, is quite similar to being trapped in quick sand. When we are caught in quick sand, our initial instinct is fight as hard as we can to get out.

What we know about quicksand is, the more we fight and move, the more trapped we become. The more trapped we become, the harder we struggle. Even though it makes sense to us to fight against it, our way of trying to solve the situation can actually trap us more.

The most effective method in saving yourself from quicksand is to attempt to stop moving, and slowly lay backwards, so that the back of our head begins to touch the quick sand. This stops us from sinking and enables us to ‘float’ instead. This goes against all our instincts, but it’s exactly what we need to do.

The same can sometimes be said for negative thoughts; fighting against the thoughts we have is a natural, logical (and instinctive) response (just as our reaction to quick sand), however, that does not mean that it is helpful to respond in this way, and can sometimes make the situation worse.


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Responding to stress and difficult emotions We cannot stop challenging life events from happening- but we can change how we respond to stressors – through planning and preparation. This is where learning mindfulness skills is beneficial.

Instead of attempting to fight against stress and challenging thoughts / situations through ‘blocking and sinking’, mindfulness helps to cultivate the following, alternative way of coping:

RECOGNISE & RESPOND TO OUR EXPERIENCE, MOMENT BY MOMENT

RESPONDING to our experiences leads to:

Increased awareness of our thoughts

Increased awareness of our feelings

Increased awareness of our body, muscle tension and breathing

Increased awareness of the full content of our experiences

Adopting a mindful approach means taking a non- judging stance towards ourselves and our thoughts. It means not getting too tangled up with worrying thoughts, which are a normal part of human experience. This can be achieved by introducing the STOP mantra into everyday life:

Stop

Take a breath

Observe

Proceed (differently)


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Stop – bring yourself into the present moment by asking- “what is my experience right

now?”

Thoughts… (What are you saying to yourself, are you being rational, negative, positive etc)

Feelings… (Upset, sad, mad, angry, numb etc)

Sensations… (Physical sensations, tightness, lightness, tenseness etc)

Acknowledge your experience, even if it is unconformable

Take a breath – direct your awareness towards your breathing. Your breath is an anchor to

the present moment.

Direct your attention to your breathing, to each in-breath and outbreath, one after another. Count to ten in your head whilst you are doing this. Your breath helps you to anchor yourself to the present and stay in tune with your awareness.

Observe - expand your awareness outwards

Expand the field of your awareness outwards away from your breath, so that it includes a sense of the body as a whole, your posture, facial expression, and then further out to what is happening around you; sights, smells, sounds etc.

Proceed differently – continuing without expectation

Let your attention move with the world around you, instead of it being solely in your head. Sense how things are right now, in the present. Be open, curious, to new possibilities and experiences.


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Mindfulness exercise 4: Three minute breathing space

Please use the audio when completing this exercise.

1) Become aware of your experience - your thoughts and feelings in the here and now

- Noting what thoughts, feelings, and body sensations are present for you right now

-

2) Gather your attention towards a single object - the breath

3) Expand your awareness to include a sense of your body as a whole, and the next

moments of the day

The three minute breathing space- to use when unpleasant thoughts and feelings arise

4) Become aware of your experience - your thoughts and feelings in the here and now

- Noting what thoughts, feelings, and body sensations are present for you right now

- DESCRIBE, ACKNOWLEDGE AND IDENTIFY the experience.

For example “I am having a self-critical thought right now”

5) Gather your attention towards a single object- the breath

6) Expand your awareness to include a sense of your body as a whole, and the next

moments of the day

Thinking point:

1) How was it, trying to observe the unpleasant sensations or thoughts, rather than react to them?

2) How do you think your posture and facial expression was during that exercise?


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Section Four: Compassion and Defusion

Section four - Key points:

Adopting a different stance towards ourselves.

Being more in the present means that we can see our own thoughts for what they really are; thoughts (not truths).

Thoughts are not facts (they are based upon our automatic judgments and beliefs).

We are often ‘fused with our thoughts’. Training ourselves, through mindfulness and other techniques, to take a step back from thoughts can help us to move forward in a more positive or proactive way.

There are numerous ‘defusion’ techniques, not all of which are listed here, but most work under the premise of identifying thoughts as thoughts.


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Session four- Compassion and Defusion

Self-compassion and self-kindness

Throughout this booklet we have discussed how mindfulness can help us cope with life’s challenges, through adopting a different stance towards our own thoughts, feelings, and current situations. Adopting a different stance towards ourselves.

Being more in the present means that we can see our own thoughts for what they really are; thoughts (not truths).

Thoughts are not facts (they are based upon our automatic judgements and beliefs).

Mindfulness teaches us to watch our thoughts pass by us with a gentle interest and curiosity.

Adopting this different way of being with and understanding our thoughts, brings the opportunity to be more compassionate and kinder towards ourselves.

The more understanding we are, the calmer and more at peace we can often feel.

Cognitive defusion

At times of upset and distress, we are often ‘fused with our thoughts’. This happens when we are running on autopilot, treating thoughts as facts, and not fully aware of the effects of this upon our behaviour, feelings and emotions.

When we are stuck to our thoughts, it is almost as though we cannot separate ourselves from them. We are often so stuck that we cannot create any distance between our self and our thoughts.

Cognitive fusion means that our experience is completely dominated by our thoughts.

“It’s just a

thought!”


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Defusion involves learning to step back and detach you from these thoughts. By consciously choosing to disentangle yourself from your internal dialogue, you are practicing mindfulness. Mindfully observing the internal processes that you have, noticing them, but not passing judgment upon them, letting them pass.

The following are a list of defusion techniques:

1) Using the STOP mantra (Section 3) is one method for defusing thoughts.

Other defusion techniques include:

2) Label your thoughts more specifically. E.g. is my thought a prediction, an insult, an evaluation, a memory, an unhelpful thinking habit such as mindreading, am I assuming I know what someone else is thinking?

3) Practice and use mindfulness daily, so that you are more aware of when you are in your own head as opposed to being in the present moment.

4) Use visualisation techniques to separate and observe your thoughts.

5) Mental appreciation- thank your mind for that passing comment. “Thank you for telling me that”.

6) Label your thoughts as thoughts. “I am having the thought that…”

Stop

Take

Observe

a breath

Proceed (differently)


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Mindfulness exercise 5: Leaves on a stream (visualisation)

Please use the audio CD when completing this exercise.

Find a comfortable seating position and close your eyes. Focus your attention on your breathing – breathing in, and then breathing out. Be aware of your breathing and of the feeling of calmness and relaxation you can feel begin to wash over you, as you breathe in ….and out, in…..and out. Find a breathing rhythm that feels comfortable to you.

Imagine there is a balloon in your stomach, with the balloon inflating as you breathe in…..and deflating as you breathe out……..the balloon getting larger as you breathe in…….and smaller as you breathe out.

You’ll notice thoughts pop into your mind as you breathe – just be aware of them, notice them but don’t pay them too much attention. Be aware of them, and bring your mind back to your breathing, and the feeling of increasing calmness on each out breath.

Notice sounds around you that you would not normally be aware of – both inside and outside of the room. Just be aware of these – don’t pay any one thing too much thought. Notice….. and then continue to bring your attention back to your breathing.

Notice different feelings in different areas of your body……..some parts may feel warmer or colder than others; some muscles may feel tighter and some looser than others; some areas of your body may feel more comfortable than others. Just be aware of these differences that you can notice… ..and then bring your attention back to your breathing.

Now imagine you are sat at the side of a stream, which is calmly flowing down a hill, on a warm sunny day. There is a tree next to the stream and its leaves are falling, one by one, into the stream, as the wind gently blows. Picture this in your mind. Take each thought that pops in your mind and place each one on one of the leaves, drifting down the stream. Watch each thought drift away, gently, as the stream runs gently down the hill. For every thought that pops in your mind, place it on a new leaf and watch it drift down the stream…calmly and gently.

Bring your attention back to your breath, feeling calmer with every out breath.

When you are ready, bring your attention back to the room and open your eyes

Mindfulness Script (M, Griffiths, 1/ 2014)


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Thinking points:

1) What was it like being asked to visualise something, as opposed to being asked to just paying attention to different aspects of experience?

2) Did you struggle to visualise the river? Did you feel able to put your thoughts onto the leaves

and let them float by, as opposed to holding them, reacting to them, judging them?

3) How does this tie in with the idea of cognitive defusion?


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Section Five: Using mindfulness to continue to take care of your self

Section five – key points

The more we practice mindfulness, the more helpful it can be in coping with challenging life events.

The point of mindfulness isn’t to try and avoid challenges in life or to avoid the thoughts that we have. Instead it is about changing our relationship with our thoughts, and how we react to them.


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Section Five: Using mindfulness to continue to take care of your self

Mindfulness helps more, the more it is practiced. The more that the seven pillars of mindfulness are incorporated into everyday life, the greater the potential benefit to your wellbeing. Daily practice, both formal and informal is key to becoming familiar with the techniques.

Acceptance Accept yourself as you are (and remember that

this doesn't mean you can't change)

Letting go Recognise thoughts

as thoughts, and letting them pass

rather than holding onto them

Non-judging Trying not to judge ourselves or others

Non-striving Once we stop

demanding results from

ourselves, they become more

likely to happen

Mindfulness Patience Notice when you

are feeling impatient, not

letting this control us, and cultivating

patience in ourselves

Trust Respect your own experiences, no one can tell you

how you are feeling or how you should feel

Beginner's mind

Seeing things for the first time as if

revisit familiar places with an

open mind


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How else can we apply the principles of mindfulness? By doing things that make us happy; things that offer us a sense of fulfillment

By doing something which gives us a sense of achievement

By doing things that are personally meaningful or valuable.

By doing something which provides calm enjoyment for example, bird watching, Pilates, Tai Chi, painting, jigsaws, gaining enjoyment from simply ‘being’ with family etc.

Take pleasure from moments in life that may be unexpectedly enjoyable or which we may seek to engineer.

For your final exercise…

Write a letter to yourself, about your goals, aspirations, feelings and behaviour, in order to reflect upon this after some time. This is a powerful exercise to consider how you might put these mindfulness skills into practice over the next 6-12 months.

What to include in the letter: A.

Who are you today?

What makes you happy?

What gives you a sense of purpose?

What are your goals?

What makes you hurt?

What are some of the things you are struggling with?

What makes you sad? What are the wonderful and happy things in your life? - Family, friends, hobbies, pets, nature,

surrounding etc.

B. Then include the following answers to these questions in your letter:

6-12 months from now who will you be?

What will be your goals?

What will you have accomplished?

What makes you happy? What are the things you used to feel stressed about, but don’t any longer?

Then reflect on this letter to yourself and focus your thinking on 3 things:

1. How are you going to get to your ‘future self’ (as described in part B)? 2. What are the ‘small steps’ you need to take to get there? 3. What might mindfulness offer you in reaching this destination?


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Section Six: Using mindfulness to live well with your long term condition


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In the earlier sections we have looked into our thoughts in detail; how to notice our thoughts and

the impact they can have on how we feel and act. The aim of becoming more aware of our thoughts

is not to try to change or stop them, but to take a step back from them and create the opportunity

to react differently; not being automatically drawn into responding in the same old way. So often

these automatic responses (which may once have been a useful strategy) bring about unintended,

negative consequences in the long-term. For example, getting stuck in a struggle with our thoughts,

trying to control them, through avoidance usually ends up getting in the way, narrowing and

limiting our positive experiences and opportunities in life.

Acceptance

Rather than getting tangled up in this struggle, consider the idea of acceptance of our thoughts and

feelings about our long-term condition, illness or situation. Remember that acceptance is not

“throwing in the towel” but learning to live well alongside your condition, without trying to struggle

against it, which we know results in greater problems in the long term.

Learning to live well with a long-term condition or illness can be extremely difficult and challenging.

People often feel they are expected to merely “get on with it”, or “accept it.”

When it comes to dealing with illness or a long-term condition, acceptance is a positive way of

addressing an unchangeable situation. It is not the same as defeat, helplessness, quitting, or

resigning to a life of unhappiness, struggle, or misery.

Acceptance can be defined as, “the mental attitude that something is believable and true.”

Accepting that you have a long-term condition is different than giving up all hope.

Acceptance means taking action in a valued direction despite experiencing the difficult and

challenging aspects of your condition.


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Values

If we know that struggling (sinking or blocking) against our difficult thoughts and feelings doesn’t

work (and even makes things worse) then acceptance is a means of freeing yourself from this

struggle to focus on other, more valued aspects of life.

Perhaps you have found that your plans, goals, hopes and ambitions have been blocked by your

long-term condition or illness. It is common to feel unsure about your values; what you want your

life to stand for. So often we use our physical health to measure success with life (i.e., is my long-

term condition solved or cured and removed from my life?) but if our condition cannot be cured or

reversed, how long might you wait around to get rid of your health problems before moving on

with life?

Values are your desires for how you want to behave as a human being. Values are not about what

you want to get or achieve; they are about how you want to behave or act on an on-going basis.

Keep in mind there are no such things as ‘right values’ or ‘wrong values’; only those which are

meaningful to you. Values are about how you want to behave towards your friends, your family,

yourself, your environment, your work, etc. Values are not the same as goals. Goals can be

achieved or ‘crossed off’, whereas values are on-going. For example, if you want to be a loving,

caring partner, that is a value: it involves on-going action. In contrast, if you want to get married,

that’s a goal - it can be ‘crossed off’ or achieved. If you want a better job, that’s a goal. Once you’ve

got it - goal achieved. But if you want to fully apply yourself at work, contribute your best, and

engage fully in what you’re doing, that’s a value: it involves on-going action.

Thinking about what is truly important to you in life may help you to highlight goals that will give

your life most meaning and consider what you might do right now to meet these values.

Thinking point:

What do YOU want your life to be about?


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.

Thinking points:

1) Deep down inside, what is important to you?

2) What do you want your life to stand for?

3) What sort of qualities do you want as a person?

4) How do you want to be in your relationships with others?


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For each of these domains write a quick summary of your values, for example “to live a healthy life and take care of my body” (physical wellbeing), or “to be a good friend to people who need me, and to enjoy my time with the people I love” (friendships). Rate each domain for how important it is to you from 0-10 (0=not important)


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Thinking points: Take an honest assessment of how closely you have been living your life according to these values.

1) Have you been engaged in activities that are consistent with your stated values?

2) Are you doing things that are important priorities for you? If so, how are you able to

do this? If not, what is getting in the way for you to accomplish things that are

important?

Once you have completed this worksheet, please consider the following:

Let’s take this opportunity to consider which of the values you identified are most important to

you. Becoming aware of your own values and the life direction to work towards will highlight goals

that will give your life more meaning.


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Section six - Key points:

When we move away from the struggle with our thoughts, feelings, situation or physical

health condition, we create the opportunity to try responding differently.

Considering our personal values helps to identify targets for valued action, that is, actions

you can take, right now, to give life more meaning.

Accepting our physical health problem or situation means taking such action despite

experiencing the difficult and challenging aspects of your condition.

Acceptance is a positive way of addressing an unchangeable situation.

Acceptance is not the same as defeat, helplessness, quitting, or resigning to a life of

unhappiness, struggle, or misery.

To do before moving onto the next section

Complete all thinking points in this section

Complete the values worksheet before moving onto the next section


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Section Seven: Overcoming

barriers to valued action

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Section seven: Taking a wider view

Key points from the booklet so far:

Living with a long-term physical health problem can make life more challenging (physically,

practically and emotionally).

These emotional challenges often end up causing more difficulties than coping with the

condition / health problem on its own.

Although we cannot “get rid of” our long-term health problem, we can learn to notice our

thoughts, feelings and behaviours about our conditions and choose to respond differently.

Remember – trying to block out or avoid these difficulties only make them stronger in the

long-term.

Instead – let go of the struggle; rather than focusing on your difficulties and thinking of

nothing else, take a step back from what is going on and create the opportunity to react

differently.

Accepting your health problems in this positive way, means taking action in a valued

direction despite experiencing the difficult and challenging aspects of your condition.

Acceptance is not the same as resigning to a life of unhappiness.

In section six we asked you to think about your values in life and to consider:

What do YOU want your life to be about?

Values vs. Goals

Sometimes values and goals can be confused. The key difference between values and goals is that

values can never be reached, whereas goals can. Values and goals are, however, almost always

closely tied to one another.

Thinking point:

What values did you identify as being most important to you?


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Barriers to valued action

All values, and their related goals, are going to have barriers that interfere with your ability to

pursue them. Some of these barriers are external to you, and some of them may be internal, in the

form of fears and worries, perhaps. Additionally, there may be no way to get rid of a few barriers –

pain for instance. So, it may be useful to think what is to be done in those cases.

Common barriers that can interfere with valued action are negative thoughts. How often does your

mind point out your strengths and achievements? Conversely, how often does it criticise your

efforts or imply that you’re a failure?

Common fears that get in the way

Fear of failing

Fear of harm if undertaking an activity

Fear of pain if undertaking an activity

Fear of disappointing or burdening others

Fear of not being good enough

We have already noticed how easily our mind tends to focus on the negative and we know that we

cannot force our minds to think (or not think) a certain way.

So, what are our options for moving forward despite the negative commentary our mind might

make along the way?

Thinking point:

What fears might be getting in the way of your valued actions?


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Remaining entangled with and pushed around by our thoughts?

How much has worrying about your condition or health problem helped you to live the life you

want to? Could your thoughts and actions about your condition be holding you back from the things

in life that are really important to you?

Taking a wider view

If you’re willing to try something different, consider taking a quizzical view of your mind – that is,

try to notice what it is doing without reacting.

When facing difficult or stressful situations, it's all too easy to be drawn, automatically, back into

the struggle with your thoughts. We do this without thinking, because our body and mind have

become so used to reacting this way; we can do it on autopilot.

As we have discussed, however, most often that automatic reaction is not the best or most helpful

one, and can sometimes make the situation, or us, feel worse.

Instead, try to pull back from the situation.

Take a wider view; compose yourself.

Remember:

Thoughts are not facts.

They don’t have to be engaged with. You can have a thought without buying it.

Engaging with negative or worrying thoughts only makes them stronger.

Stop Take a breath Observe Proceed (differently)


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The “BUTS”

“BUTS” are another barrier that often prevents us from acting in line with our values.

Because a long-term condition cannot be “cured” or “reversed,” we may become stuck on trying to

“get better” before focusing on other aspects of life or before other aspects of life can be enjoyed.

It can feel too difficult to move on with life while also experiencing health problems at the same

time. In this way, it can become easy to stay focused on what is difficult about your condition. This

can lead to thoughts such as, “this is too hard, I can’t do it”, or “it’s too painful,” as well as the

“buts”…

‘BUTS’ are a common aspect of our thinking that suggest a conflict between what we want to

achieve and what we are able to achieve.

‘I’d like to do that BUT I’m busy with hospital appointments (so I CAN’T)’

‘I’d like to go out BUT something bad might happen (so I CAN’T)’

“I want to do……..BUT I CAN’T because of my pain’

‘BUT leads to ‘CAN’T’ and prevents a desired action or goal. It keeps you safe, but not happy! When

you notice thinking ‘BUT’ try replacing it with ‘AND’ and then consider what options this frees up;

how does this feels different?

‘AND’ acknowledges that we can think one thing, and do another. It also indicates that we can try

something, even when it’s a struggle or challenge.

Thinking points:

What fears might be getting in the way of your valued actions?

1) When are you most likely to use BUT or CAN’T?

2) What would be different if you replaced it with AND?


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Appendix


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The 7 Pillars of Mindfulness

1) Patience

Cultivating patience towards our self (our own mind and bodies) is an important skill to develop through mindfulness.

Practice being patience with yourself. Why rush through some moments in order to get to the ‘better ones’? Each moment is your life.

This means letting things unfold in their own time and being open to experiences, knowing that things will emerge in their own time.

For example- sometimes, in work, getting something done as quickly as possible doesn’t always lead to the best outcome. When we rush, we make mistakes, and the quality of the work or experience may be dampened.

Like we noticed during our raisin exercise, we find our mind wandering, in these instances, patience is particularly important as we can say to ourselves “it is normal that my mind is wandering.”

2) A Beginner’s Mind

Adopting a beginners mind helps to broaden your awareness of the present moment.

Often we let our thinking and our beliefs about what we ‘know’ stop us from seeing things as they really are.

Instead try being open to seeing everything ‘for the first time’, as if with a fresh pair of eyes.

This approach opens up new possibilities and changes to ways of thinking, looking at life or coping, that could enhance wellbeing.

Thinking point: when practicing mindfulness at home, notice your mind

wandering, and instead of telling yourself off, or giving up, see this as an

experience, and carry on i.e. “It is normal that my mind is wandering, it’s part of

life, I won’t rush myself, and I’ll keep going.”

Thinking point: during the week, try and see familiar things with a fresh pair of

eyes. For example, a loved one, when you look at the sky, when you look at your

pet dog etc.


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3) Non-Judging

The more you notice your thoughts, the more you may recognise your minds natural tendency to evaluate everything. These automatic judgements can obscure experience of the present moment. Therefore mindfulness teaches us to:

Take the stance of an impartial witness to your own experience. A bit like ‘beginner’s mind’- we are looking at things with a fresh pair of eyes, but not necessarily attempting to judge or label things.

Notice the stream of judgements and snap decisions that we make on autopilot mode (good / bad / neutral). Being ‘non-judging’ isn’t about stopping these streams of thought (they are a normal part of our lives and experiences), however by noticing the stream of thought we can be more aware of the way our mind works, without trying to stop it.

Our habit of categorising and judging ourselves, others, and our experiences means that we get caught up in the things we like and the things we dislike, being unable to find peace with ourselves.

4) Acceptance

Acceptance means seeing things as they actually are in the present. If you have a headache right now, accept that you have a headache. Don’t dwell on thoughts that will come to mind such as ‘I can’t cope with this’.

We have to accept ourselves as we are before we can really change.

Acceptance is not passive. It does not mean that you have to like everything about your life at present, and abandon your values and ideals. It does not mean that you have to give up your desire to change or improve your quality of life. Accepting you have a headache doesn’t mean you can’t take a painkiller.

Acceptance is a willingness to see things as they are. This is usually a natural progression, from denial / anger / feeling overwhelmed, to processing the events and situations and coming to terms with what is happening in the present moment.

Thinking point: when practicing a mindfulness exercise at home, such as mindful

breathing, you may find your mind saying things like “this is stupid”, “this isn’t

working”. These are judgements. When they come up in your mind, it is important to

recognise them as judgements, remind yourself that the practice is about being an

‘impartial witness’, your job is therefore to watch the judgements, but not act upon

them in any way.

Thinking point: when practicing a mindfulness exercise at home, remember to

‘accept’ each moment as it comes. Try not to impose any ideas about how you

should be feeling or thinking, onto the experience; accept it as being as things are

in the here and now.


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5) Letting go

A key component of mindfulness is letting things be as they are, just watching things pass by instead of reacting to them

Cultivating the idea of letting go, rather than holding on, is fundamental to the practice of mindfulness. When we begin to pay more attention to our inner thoughts and feelings, we discover that there are some thoughts / feelings / situations that the mind does not want to let go of. When these are pleasant, the mind tries to prolong the thoughts or feelings, stretch them out and revisit them over and over again. Similarly there are thoughts / feelings / situations that the mind tries to push away. Usually because they are unpleasant, painful or frightening.

Mindfulness teaches us to intentionally put aside the tendency to elevate some experiences and reject others. Instead, we just let our experience be what it is and practice observing it from moment to moment.

An example of letting go would be every night when we go to bed. If we can’t let go, we cannot sleep. When people begin to notice times when they cannot shut down and go to sleep, this is usually a sign of elevated stress. We find it hard to let go of the thoughts and feelings we have because our involvement in them is just too powerful.

6) Trust

A mindful approach encourages us to:

Develop a basic trust in yourself and your feelings This means trusting your own authority and intuition (even when you make some

mistakes along the way)

Take responsibility for yourself and your own wellbeing

Be your own person and learn more about what it means to be yourself

Thinking point: Sometimes we may find things (events, feelings, thoughts)

particularly difficult to let go of, because of the strong hold they have upon our

minds. In these instances, during mindfulness practice at home, direct your

attention towards the ‘holding on to’ feeling. How does it feel to hold on so to these

thoughts? Being willing to explore and look at the way we hold onto things shows us

a lot about the opposite experience of this. In mindfulness, it is not about ‘being

successful’ in letting go, but about being willing to look at our minds in more detail.


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7) Non-Striving

In your mindful practice:

Pay attention to how you are right now, just observing, not trying to change it. Sometimes, the best way to achieve our goals is to stop striving for them. This

doesn’t mean give up; it means focus on seeing and accepting things as they are, moment to moment. Once this has been achieved people find that they begin to move towards their goals naturally.

Thinking point: when practicing at home, listen to your own intuition. For example, if

your mind and body are telling you to do something differently from how you have

been taught, that’s fine. As long as you are following the seven steps of mindfulness

you should be free to develop your own mindful practice and model.

Thinking point: when practicing at home, notice if you are telling yourself things like “I

am going to get relaxed”, “I am going to become a better person”, “I am going to cope

better”. When you do this, you are introducing an idea into your mind of where you

should be and where you are striving for, which can make you feel as though at the

current moment you are “not okay.” In these instances, bring you attention back to

observing and paying attention to what is happening, rather than trying to change it.

Exercise: Future goals

Set yourself individual goals for mindfulness practice in the future using the table below.

Map out your future mindful routine (structured) and think of situations where it may be useful to adopt a mindful approach (unstructured).

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Mindful activity:

Mindful exercise


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Context (What was the situation?) Thoughts (What was running

through your mind?)

Actions (What did you do as a result?)

Emotions (What was your mood or feelings about it?)

Physical Sensations (How did your body feel? Tense? Heart racing?)

Think about a recent, specific time when you felt upset, stressed, annoyed etc. Fill in the above boxes to describe what was going on to cause it, the thoughts going through your mind at the time, how you were feeling in mood and any changes in your body.

Reference list


If you would like to read more about mindfulness please look at:

Websites:

http://bemindful.co.uk/

https://www.headspace.com/

Books:

Quiet the Mind: an illustrated guide on how to meditate. By Matthey Johnstone

The Happiness Trap. By Russ Harris

Mindfulness for Dummies. By Shamash Alidina

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http://bemindful.co.uk/

https://www.headspace.com/

Documents

Mindfulness and Living Well with a Long Term Condition · Mindfulness and Living Well with a Long Term Condition A Patient Workbook Developed by Clinical Health Psychology Services