Archives for October 2020

New brain imaging study shows self-compassion training alters neural responses to chronic pain

A recently published study examined the effects of self-compassion training among people with chronic pain. The study found that self-compassion changes the way the brain processes pain and self-criticism, and suggests that self-compassion skills can improve patients’ mental and physical wellbeing.

Chris Germer, faculty at Harvard Medical School, along with Dr. Susan Pollak, designed and co-taught the intervention. Two articles were published on this research, which can be accessed here.

  • Berry, M. P., Lutz, J., Schuman-Olivier, Z., Germer, C., Pollak, S., Edwards, R. R., … & Napadow, V. (2020). Brief Self-Compassion Training Alters Neural Responses to Evoked Pain for Chronic Low Back Pain: A Pilot Study. Pain Medicine. [link to study]
  • Lutz, J., Berry, M. P., Napadow, V., Germer, C., Pollak, S., Gardiner, P., … & Schuman-Olivier, Z. (2020). Neural activations during self-related processing in patients with chronic pain and effects of a brief self-compassion training–A pilot study. Psychiatry Research: Neuroimaging304, 111155. [link to study]

As many as 1 in 5 adults currently suffer from chronic low back pain, making it one of the most debilitating health problems worldwide. Chronic pain not only interferes with daily activities, it can also affect patients’ mental wellbeing, for example by increasing self-criticism. Long-term opioid treatments for chronic pain are questionable, and there is growing interest in alternative, non-pharmacologic approaches, such as mindfulness. Mindfulness interventions often include teachings of self-compassion, the skill of being kind towards oneself during moments of pain. Self-compassion appears a valuable skill to cope with pain and increase wellbeing for patients with chronic pain, but current research is limited.

“From a theoretical and neurobiological perspective, self-compassion seemed very promising for patients with chronic pain, but there was barely any research on self-compassion trainings and related brain changes in patients with chronic pain,” says Jacqueline Lutz, PhD, former postdoctoral fellow at Cambridge Health Alliance (CHA), who spearheaded the innovative research study through a collaboration between research teams at the MGH Martinos Center for Biomedical Imaging and the Cambridge Health Alliance Center for Mindfulness and Compassion.

The researchers set out to explore the effects of a brief self-compassion training among twenty patients with chronic low back pain. 

“We were surprised to find that only two-weeks of self-compassion training reduced back pain and pain-related disability. Participants also reported more self-compassion and body awareness,” says Michael Berry, co-lead author, former research technician, and PhD student in Clinical Psychology.

Germer, also the co-founder of the Mindful Self-Compassion program, shares some real-life impact of the training:

“Self-compassion seemed to alleviate the stigma of chronic pain and many participants felt better about themselves even when their pain level didn’t change. Others reported that they experienced less pain and self-compassion allowed them to focus on other aspects of their lives.”

But how did self-compassion change brain activations during pain (which was induced using a pressure cuff around participant’s calf), and during self-criticism?

Using functional magnetic imaging (fMRI), the researchers found that when patients used their newly trained self-compassion skills, their brain reacted differently to pressure pain.

The right temporo-parietal junction (TPJ), which processes the salience of pain, was less active and this was associated with less clinical pain. Other brain areas, including the dorsolateral prefrontal cortex (dlPFC), showed increased activation after training, pointing to a specific neural signature of processing pain during self-compassion.

“If self-compassion training can beneficially change the way that pain is processed by the brain, it could significantly impact quality of life for chronic pain patients, who we know from prior brain imaging research have altered neural circuitry for integrating pain into conscious awareness.” says Vitaly Napadow, PhD, an international expert on the neuroscience of pain and the director of the Center for Integrative Pain Neuro Imaging at the MGH Martinos Center for Biomedical Imaging and an associate professor at Harvard Medical School.

Self-compassion training also changed the way participant’s brains processed self-critical situations in the brain scanner.

Areas involved in regulating emotions, including the dlPFC, which after 2 weeks of training, reacted more strongly during periods of self-criticism, suggesting that participants were better able deal with their self-criticism using self-compassion skills. 

Zev Schuman-Olivier, MD, an addiction psychiatrist at Harvard Medical School and director of CHA Center for Mindfulness and Compassion explains, “Self-criticism, stigma, and shame can impact our brain and body and accentuate chronic pain. This study helps us understand that even just two weeks of self-compassion training can impact the way we relate to ourselves and our brain data suggests that this healing process of becoming kinder to ourselves likely starts by activating regions involved in emotion regulation.”

The team warns that this study did not include a control group, and that longer self-compassion training might show even more impact. They hope the study shines a light on self-compassion as a remedy for patients with chronic pain and will spur further research into its potential. 

As challenging as it may be for some people suffering from chronic pain, the skill of “being kind to oneself,” could really be a simple but much needed addition to current chronic pain management.

This study was funded by grants from the Osher Center for Integrative Medicine, Harvard Mind-Brain Interfaculty Initiative the Mind and Life Institute, and the neuroimaging tasks were developed with funding from NCCIH and the NIH Common Fund through the Science of Behavior Change Initiative.

MSC and Being with Ageing Parents

Compassion is relational. And perhaps the most complicated of these relations at times are within our family.

Families are the very foundation of this human experience, and so many threads of the tapestry of our life may well be family relations. Bearing the complexity of this in mind, I humbly offer my story of the caring relation-shipping that I had with the four elders in my life: my parents and my husband’s parents.

I share these with the understanding that they are simply my stories — I wish for you to hold them in the understanding and compassion that your stories may relate and they may not.

I have lived long enough to care for both my parents and my husband’s parents as they aged and as they died. There seems to be a lot written about how MSC can help with parenting, but what about the other end — the caring of our parents?

I am no expert in the area of aged care or palliative care, but I have a few stories to share regarding the role MSC and the lack of it played during these times.

—✧—

All four of our parents died with complications from chronic lung disease. I trust that everyone reading this has had a moment of struggling to get a breath for whatever reason. Any form of breathing struggle activates acute fear; chronic breathing issues can awaken old fears and angers and really bring them to the fore. I witnessed that it can also bring rapid movements towards grace and surrender.

We saw all of this unfold with our parents. Sadly my dad, Jack, died still as angry and scared as a breathless person could be. I did not have my MSC practice then. What I had was a lot of resistance, an inability to truly be with and hear his struggle. What I have learned with MSC is the freedom of forgiveness and the blessing of trusting my love to be able to restore its true connection with my dad even though he died 22 years ago. I speak with and hold him in love as often as I can.

MSC has helped to transform the pain of guilt through forgiveness into a deeper loving connection with my dad.

My father-in-law, Jimmy, seemed easier to care for, as unlike my own dad he did not push any old familiar buttons in me. This was before MSC, but even still, I learned a great deal about the grace of patience. There was so much waiting. I would get embarrassed over so many of his downright rude comments to nursing staff and then humbled by their incredible capacity for loving acceptance of him. There were so many appointments and phone calls in the middle of the night. I learned the hard way that offering more than I could realistically do led to resentment and a lack of true caring. Sometimes I think we find the balance of our own needs and limits via these periods of being out of balance. It all gave me wonderful fertile grounds for MSC to flourish.

My mother-in-law, Laurel, bless her, was a soul sister to James Baraz’s mother, (if you have seen the video ‘My Son Ruined My Life’). She went totally blind, and she struggled with her breathing. Losing her sight opened her to meet me with a little more curiosity. I had so many judgements about her habits of worry and prejudices. Prior to MSC I would get fused in a sense of feeling so right about her behaviour being so wrong. MSC brought such insight into her simply doing the best she could and like the rest of us messy humans, a product of a lot of habits and conditions. Common humanity and a good sense of humour were the MSC medicine that helped me learn to love her more unconditionally. More than ever before my ability to find balance in my caring was called for with Laurel, as so much else in my life was in upheaval during her last year of life.

My mum, Alice, was living with me when I truly awakened to MSC (neck down). We learned together, and she taught me so much. She had dementia on top of her chronic lung disease. She had such grace and so, so much forgiveness as I stumbled with truly learning how to simply be with her.

I say ‘simply’, but truly to let go enough to be with an ageing person is profound and one I continually stumbled with.

The most precious thing was she had humour. Her loving humour effortlessly acted to drop all my resistance, allowing me to meet her in her new and continually changing world. The impact MSC had on the way I was able to communicate with my siblings — from a place of peace and non-violence — truly helped to navigate such a painful time for all of us.

Within these last two relationships, MSC allowed me to truly know what was important, to own my capacity and limits, and to honour them.

As a daughter, guilt became a constant companion, I often had to speak to it and understand that it may never leave, but I could deepen my understanding of the reason for it. I loved these four people so deeply, and guilt always wanted to remind me of it.

So rather than guilt seen as an enemy, I allowed it to be the voice I spoke to, saying ‘I care deeply and have cared deeply; I am doing my best, and my parents understand this. They wish me to be there but they also wish me to be well. Thank you for checking in, guilt’.

The last chapter of my mum’s life was in a nursing home. There was not a day where I did not get in my car with guilt sitting next to me. As I mentioned I used the opportunity to check in and confirm my love. Sometimes it didn’t work, so I would call my husband or sister, they would lovingly speak to that part of me that felt guilt.

Thanks to MSC, I know the voice of guilt to simply be a reminder that I am showing up and that yes, I do love. Guilt as that voice reminding me of how precious connection is.

Thanks for reading, and if you are in the time of your life where you are caring for an elderly parent/s, my wish for you is to include yourself in your caring. An integral part of MSC is forgiveness, and being human means we have needs and limits, that we are all doing our best despite all our broken bits. Know that the caring goes on long after they die and that loving relation-shipping is eternal. I have found so much solace and healing in this.

Building Inner Strength for Hard Times: Self-Compassion for Young Adults

It’s never been easy being a young adult. And let’s face it, in today’s coronavirus crazy-making world, the normal challenges are magnified. Besides the usual struggle of trying to figure out a career path or vocation, manage intimate relationships and maybe attempt to be financially independent for the first time ever, everything is a thousand times harder. Jobs are limited – or in some fields, non-existent, which means that maybe you have to move back home. With your parents. Which can be really stressful when you’re used to being independent, going about your business, making your own rules, deciding when and what you’ll eat, how late you’ll stay out, and basically living your own life. 

Take Marta, for example. Marta was training to be a pastry chef for upscale restaurants and fancy hotels. She had been studying and apprenticing for three years, and was about to finish and launch her career, and then … enter Covid-19. Swanky eateries were shut down overnight, and there were no jobs to be found. Restaurants were merely trying to pay bills and maintain staff until they could re-open. Marta had to move back home and although she knew it wasn’t her fault that she couldn’t get a job, she still felt like a failure.

Like Marta, maybe you feel like everything’s been taken away from you – opportunities that just a short time ago were lying there seemingly awaiting you to graduate college — are now are simply gone. Maybe you’re angry and feel that all this is terribly unfair. You’ve worked so hard, and now it’s supposed to be your chance to start your own life. Maybe you’re anxious – worried about what’s going to happen, wondering when you’ll be able to be out in the world, hanging out with friends, going to concerts, having the time of your life … in other words, doing the things that young adults are supposed to do. Maybe what you’re feeling is deep sadness – for those who are suffering and dying of Covid-19, for the healthcare folks who are working around the clock to take care of those who are suffering, while putting themselves at risk. Or perhaps you’re feeling distressing emotions about so many other things – the environment, the economy, politics – it all feels so overwhelming.

What do you do with these strong emotions? How do you deal with the anxiety and the frustration? The feeling of incredible unfairness? 

One way through this suffering is called self-compassion. In other words, you can begin by being kind and understanding to yourself. Maybe you say something to yourself like “This situation just sucks. No wonder I’m so anxious. Anyone would be anxious in a situation like this!” And then maybe you offer yourself some tenderness, some kindness. You say something to yourself like “I know how hard this is for you. I’m so sorry. It won’t last forever.” And along with that, maybe you cross your arms and give yourself a hug – just like the hug you might give a friend who was having a hard time.

In our Embracing Your Life course for young adults, we introduce ways in which you can meet your emotional challenges – your anger, sadness, anxiety – so that these emotions don’t overwhelm you and take over your life. We give you tools – guided meditations, interactive exercises — that will help you be stronger and more resilient during these challenging times. So that rather than drowning in a sea of despair, you’re bobbing at the surface, and maybe, eventually, even riding the crest of a wave or two.

 

What is Embracing Your Life?

Embracing Your Life contains material from both Mindful Self-Compassion and Making Friends with Yourself, both of which are evidence -based programs that have been linked to less anxiety, stress and depression. New exercises specific to this age group are also included. Embracing Your Life meets weekly for six weeks, for approximately 1.5 hours per session and is taught live by a certified Mindful Self-Compassion or certified Making Friends with Yourself teacher.

Like MSC and MFY, Embracing Your Life provides young adults with the opportunity to explore how they typically respond when difficulties arise in our lives and to learn tools for becoming a warm and supportive friend to themselves. Although Embracing Your Life offers conceptual learning, it is designed to be more experiential than theoretical.

In other words, Embracing Your Life is nothing like taking a college course, per se. It’s not a strain on your brain. In fact, after the class is over each week, you will likely feel more rested and more at ease. It is more of an experience, involving guided meditations and discussion about what the experience of the guided meditation was like.

Embracing Your Life is therapeutic, but it’s not therapy. We don’t talk about deep emotional issues you might have and we don’t try to analyze why you might feel the way you do. It’s about building resilience skills so that you can meet emotional challenges when they arise, as they do in life.

This is what you get if you take Embracing Your Life:

–> Live sessions once weekly

–> Optional small group meetings between classes

–> Email contact with the teacher (online one-to-one chats if necessary)

–> Opportunity to participate in a research study

–> Audio recordings of meditations