Scottish NHS Mindfulness Network

‘Simply put, mindfulness is moment-to-moment, non-judgmental awareness.  It is cultivated by purposefully paying attention to things we ordinarily never give a moment’s thought to.  It is a systematic approach to developing new kinds of agency, control, and wisdom in our lives, based on our inner capacity for paying attention, insight, and compassion that naturally arise from paying attention in specific ways.” (J. Kabat-Zinn, 2013)

There can be a number of misunderstandings of what mindfulness is and therefore what the mindfulness based interventions are which are offered within the NHS. These misunderstandings can be widespread within the media and popular culture and we may need to clarify and educate managers to address some of the myths which are around.

Mindfulness in this context is not:

• just a wellbeing strategy or lifestyle intervention which would be better placed in the third sector or community settings,
• just another relaxation, visualisation technique or tool for your toolbox,
• about creating positive mental states or “feeling good”,
• about “escaping” from the reality in which we find ourselves right now,
• a “quick fix”,
• for everyone or a panacea for all human difficulties.

Instead, mindfulness in this context is:

• a  process of training which enables us to be more present in our lives,
• creating a different relationship with our thoughts, emotions and physical sensations and changing our relationship towards what is difficult in our lives (be that stress,  depression, physical pain, etc.) instead of trying to “fix” or “cure” those problems,
• a turning towards whatever is happening (instead of pushing our experiences away) with acceptance, kindness and curiosity,
• noticing the difference between reactivity and responsiveness and more often being able to choose the most effective response (see example below),
• primarily experiential (based in direct experience rather than “techniques),
• empowering and potentially “life changing” in giving us more agency, control and insight in our lives,
• a high-intensity therapy for service users with major mental health problems, who are willing to explore a different approach to their difficulties (whilst care needs to be taken to assess that this is the right and timely therapeutic approach),
• a resilience building approach for dealing with stress which may be of benefit to health care staff.

If we were to describe what mindfulness means to us, we might use words such as “present moment awareness”, being fully awake to our lives, being more “embodied”, having the capacity to feel more gratitude, inner peace with a richer sense of connection with life, perhaps being more in charge of our “minds” and less lost in unhelpful thought patterns (such as depressive thinking or worry) or reactivity.  We may also relate to the development of mindfulness qualities, which strengthen over time (patience, curiosity, trust, non-judging, non-striving, acceptance, letting go), enriching our lives. Of course, the learning of mindfulness is essentially “experiential” and it is impossible to give out a full impression of its impact without directly experiencing it yourself. Perhaps our greatest tool in educating managers is our own embodiment of our practice and our encouragement for them to “try it out for themselves”.

The experiential aspect of mindfulness needs to be stressed and this is why we need to be fully embedded in our own mindfulness practice to teach it and why the group approach can be so helpful. We cannot experience something by reading about it, by hearing about it or making assumptions about it. For example, we cannot learn about the taste of a strawberry, how it feels in our fingers, how the fragrance, texture and taste meet our senses, without actually trying it (and being present whilst we do so).

The concept of “turning towards” our difficulties and accepting them of course may feel counterintuitive when our usual approach, and this can include the “medical model”, might be to push problems away, to fix them or to look for a cure or a solution.  The engagement with a mindful approach instead creates an openness that allows us to become responsive rather than reactive and to turn towards whatever is present in our lives in a more creative way. Reactivity is an automatic process, which will be triggered by our drive or fear systems (from our reptilian brain) whereas when we are responsive to something that has arisen in our lives it gives us choice in how we deal with it and that opens up more opportunity for wise choices which can lessen our suffering.  Here’s an example:

If you are struggling with back pain, do you find yourself tensing and bracing around it? Are you automatically adjusting your posture, clutching the areas of soreness, sighing, catching your breath? Are you having thoughts about how on earth  you are going to get through the day, cursing the pain for interfering with your life, wondering what you did to cause or deserve this? Reaching for pain killers? Just ignoring it? These are (understandable) reactions but we can see that not only are we dealing with back pain but we are adding a whole layer of suffering through our worry and efforts to “get rid of” the problem.  The mindfulness skills we have learned may help us instead to stay with the experience of the pain and notice what happens to it. Does it stay the same? Does it pulsate? Does it disappear?  What happens if you pause and offer yourself some kindness and check in what you need to do to “take care of” the experience of pain?  This may of course include taking pain killers, resting or taking time off our usual duties but by opening up mindful awareness you are able to be responsive rather than reactive and this may include the possibility of “being with” the pain in a different way.

Used as a high-intensity therapy Mindfulness can have a profound effect on service users with long-standing mental health difficulties. Their testimonials (maybe comments from evaluation questionnaires / follow up meetings) can speak volumes and may prove to be highly persuasive for service managers alongside some of the pertinent evidence base. Our own embodiment of the practice and enthusiasm is also not to be underestimated in terms of its persuasive value. Finally, getting managers to attend taster sessions or courses is invaluable in terms of enhancing their understanding and getting them “on side”. Just inviting them to experience “stopping”, putting aside their agendas for a few moments, to observe the breath and perhaps to recognise the restlessness of the mind, can speak volumes.  Maybe we can invite them to “taste a raisin” and experience how different and enriching this is from our habitual “automatic pilot”.