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Mindfulness interventions teach and promote the use of psychological skills to improve quality of life among individuals with chronic conditions like rheumatic disease. These interventions largely act by reducing pain-related activation in the sensory cortex and increasing activity in the cingulate cortex, the area of the brain responsible for learning, memory, and processing bodily sensations, like pain.
Nearly half of the American population is living with at least 1 chronic condition, including arthritis and other inflammatory conditions, and are among the highest risk for poor psychosocial outcomes. Patients with rheumatic disease have a very high risk of developing depression. In 1 study,1 30% of patients developed depression within 5 years of their rheumatic disease diagnosis and in another,2 60% of patients complained of mood and cognitive impairment. The presence of pain, in particular, is a significant predictor of poor psychosocial outcomes, including depression and deficits in working memory, inhibition, planning, and decision-making.
One of the most powerful adjunctive interventions for these psychosocial complaints is a mindfulness routine which includes a suite of brief, self-directed exercises designed to reduce distress and pain. Mindfulness interventions teach and promote the use of psychological skills to improve quality of life among individuals with chronic conditions like rheumatic disease. The goal of mindfulness is to impart control of physical and mental experience to the patient. These interventions largely act by reducing pain-related activation in the sensory cortex and increasing activity in the cingulate cortex, the area of the brain responsible for learning, memory, and processing bodily sensations, like pain. Repeated activation causes a “decoupling”3 between brain circuits that interpret and analyze sensation. The overall aim of these interventions is to encourage patients to engage in active coping through awareness, acceptance, and acknowledgement of their thoughts, feelings, and sensations. The outcomes are nothing if not a little magical.
For newcomers to mindfulness, very brief exercises, such as guided meditation, can improve mood, processing speed, and working memory function. These interventions can also reduce the severity of pain, pain-related distress, and pain-related disruption to social function. One study4 of 28 rheumatoid arthritis (RA) patients found that mindfulness interventions improved illness perception and significantly reduced depression, stress, and anxiety ratings in actively symptomatic patients with RA. Another study5 of patients with chronic musculoskeletal pain found that exercises like breath awareness and body scan interventions, were related to improvements in mental health, engagement in pain self-management, and greater perceived control over pain. These interventions are also very well-tolerated, with 78% of participants finding mindfulness interventions moderately, very, or extremely useful.
One of the easiest mindfulness exercises to teach your patients is the Body Scan. In this exercise, your patients are asked to focus on sensations in different body parts and are “directed to focus attention on the present moment through observing the breath, and bodily sensations, while becoming aware of, and accepting without judgement, any thoughts and feelings which arise.”6
Body scans can be used anywhere, are free, require very little training, and yield nearly immediate benefit. In research7 settings, patients report reductions in pain after 10-minute body scans. Here is a set of directions, adapted from mindfulness-based stress-reduction expert, Dr. Jon Kabat-Zinn8, that you can share with your patients. You can encourage them to practice with you and on their own and then check back on their progress in future visits. You will likely be impressed with the results.
Maddy Pontius is a Master’s Student in Forensic Psychology at the University of Denver with interests in rehabilitation psychology, health psychology, and neuropsychology. She is hoping to work within the overlap of offender rehabilitation and healthcare in the future.