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April/May 2014
Not everything that is faced can be changed, but nothing can be changed until it is faced.
James Baldwin
 

We need a picture here
Tulips ready to bloom at 200 Bloor St E in Toronto. Photo courtesy of ITRM Consulting 


Changes to the Newsletter


Putting together the newsletter is a challenge in both volunteer time and resources.  Our first step is to write and/or solicit articles, including from alumni. Once the articles have been researched and written they are sent to our editor who decides which ones will appear and edits content. Then, onto our copyeditor, who looks for spelling and grammatical errors.  Finally it comes to the publisher who figures out the layout and formats the newsletter.
 
It takes two or three hours laying out and formatting the newsletter; but due to the fulltime work commitments of the publisher, it may be the weekend before he can do the work. Same for the writers, editor and copyeditors: it can happen on nearly each step of the newsletter writing process.
 
NNC is getting increasingly busy with training new facilitators and referrals increasing for the courses.  Being Mindful of the stress generating a monthly newsletter creates, we will now start producing the newsletter on a bi-monthly basis.  We want to thank your understanding and continued readership.
 

Book Review: Mindfulness for Beginners 

Jon Kabat Zinn. Boulder, CO: Sounds True, Inc., 2012 .

Rather than a book review, this is a summary  of significant messages from this book done by one of our MBCPM facilitators.

 
Jon Kabat-Zinn, Ph.D., is the founding director of the world-renowned Stress Reduction Clinic at the University of Massachusetts Medical Center. He is the author of several books and is widely recognized for bringing mindfulness-based stress reduction (MBSR) into mainstream North American health care. “Mindfulness for Beginners” has been designed specifically to introduce beginners to the proven benefits of mindfulness practice, including: stress reduction, alleviation of depression, and chronic pain relief.
 
Mindfulness is awareness cultivated by paying attention purposefully in a sustained, particular, and nonjudgmental way, in the present moment. We will perhaps discover a deep intuition within ourselves that is genuinely trustworthy. Mindfulness can lead to a love affair—with life, with reality and imagination, with the beauty of our own being, with our heart, body and mind, and with the world. The very intention to practice mindfulness with consistency and gentleness, whether we feel like it or not on a given day, is a powerful and healing discipline. We are invited to enter and then explore, in our own way and at our own pace, the richness and depth of what is available to us.
 
Most of our lives are absorbed in doing, getting things done, going rapidly from one thing to the next, or multi-tasking. It is all too easy to become more of a human “doing” than a human “being,” and to forget about who is doing it and why. Mindfulness reminds us that it is possible to shift modes from “doing” to “being” through attention and awareness.
 
The cultivation of mindfulness may feel like the hardest work in the world. But the challenge for each of us is to find out who we truly are and to live our way into our own calling. We do this by paying close attention to all aspects of life as it unfolds in the present moment. Taking care of this moment can have a remarkable effect on the next.

Upcoming Sessions

Drop-In Mindfulness Maintenance
(14 consecutive weeks)
Thursdays April 24th to July 24th 
4:00-5:00pm
Aurora, Bracebridge, Brampton, Carleton Place Cobourg, Elliot Lake, Espanola, Haliburton, Iroquois Falls, Kingston, Lawrence West, Noelville, North Bay, Orangeville, Orillia, Oshawa, Picton, Sudbury, Timmins, Toronto (St. Michael's - only on specific dates).

MBCPM Level 1 Weekend Series
**Please note the revised dates**
Module 1:

Saturday June 28th, 9:30-4:30 pm
Sunday June 29th,  9:30-1:00pm
Module 2: 
Saturday July 12th, 9:30-4:30pm
Sunday July 13th, 9:30-1:00pm
Module 3: 
Saturday July 26th, 9:30-4:30pm  
Sunday July 27th, 9:30-1:00pm
Facilitators: 
Dr. Jackie Gardner-Nix and Dr. Paulette Licorish
Toronto, ON

August Practicum:  MBCPM Level 1
Monday August 11th to Friday August 15th
9:30-4:30pm
(includes 1 day free or for silent meditation)

Toronto, ON

MBCPM Facilitator Training
Monday August 18th to Thursday August 21st
9:30-4:30pm
Northumberland Heights
Cobourg, ON

All previous issues of our Newsletter are available at www.neuronovacentre.com/blog

Mindful Pain Solutions News is published by The NeuroNova Centre for Mindfulness-Based Chronic Pain Management
www.neuronovacentre.com
www.neuronovacentre.com

Newsletter Staff
Dr. Jackie Gardner-Nix MB.BS., Ph.D., MRCP(UK), Editor-In-Chief
This Newsletter Edited by:  Camille Marajh 
ITRM Consulting Inc. Publisher

Submissions:

As always, we welcome your submissions! Please send any articles, book reviews, or contributions for the Newsletter to www.admin@neuronovacentre.com

Topics for Upcoming Issues

  • Book Review
  • The Female Brain
  • You Asked
  • Did You Know That
Deep listening is essential for mindfulness. Paying attention to the sensations of breathing and the body in the present moment serves as the first object of attention for beginning students. It is the ideal anchor for our wayward attention. It brings us back into the present moment because we are only breathing now, in this moment, as the last moment has already passed and the next has not yet arrived.
 
Paying attention to the breath or an object is not primarily about the breath or object itself. Objects of attention help us to focus with greater stability, and it is this stabilization of attention that helps us to become aware. This awareness is the primary intention of mindfulness meditation. If we are going to use our mind to observe and understand itself, we have to first learn how to stabilize it enough so that it can actually do the deep work of paying attention in a sustained and reliable way, and become fully aware of what is going on beneath the surface of our mind’s own activities.

One challenge of mindfulness is to be present for our experience as it is, rather than immediately jumping in to change it or try to force it to be different. What is most important is our awareness of our experience in a particular moment, whatever the quality of that experience. Could we make room for awareness of what is unfolding, whether we like what is happening or not, pleasant or unpleasant? This awareness is the essence of mindfulness practice no matter what we are experiencing.
 
To cultivate mindfulness, consistency of motivation and purpose is needed in the face of all the distractions in our day-to-day lives. This is the discipline—the willingness to bring spaciousness and clarity of awareness back, over and over again, to whatever is going on in our lives. Just taking this kind of stance towards our own experience, without trying to fix or change anything at all, is an act of generosity and kindness towards ourselves.
 
As soon as we take a seat or lie down to meditate, the first thing we notice is that the mind has a life of its own. It just goes on and on in a way we may not have even noticed until we stop for a few moments of non-doing, of just being present. It is important for beginners to understand right from the start that meditation is about befriending our thinking, about holding it gently in awareness, no matter what is on our mind in a given moment. It is not about shutting off or changing our thoughts. This is where true freedom can be found.

Our thoughts might tell us how boring meditation is, how silly we were for thinking that this non-doing approach might be valuable, or how uncomfortable and impatient we are. We may question the value of the meditation process, wonder how this can reduce our stress and anxiety, or think this is a waste of time. This is a sample of our thinking mind dominating our lives, coloring everything we think and do. There are several images that might be useful for working with this. For instance, we might liken our thoughts to soap bubbles, bubbles in a pot of boiling water, or as clouds moving across the sky. Alternately, we might imagine the energy of the thinking mind as the water of a flowing stream or great river. We can either be carried away by the water, or sit on the bank and watch the pattern coming and going.
 
The transience of thoughts, emotions and bodily sensations held in awareness in this way eventually lose their power to dominate and dictate our responses to life, no matter what their content and emotional charge. They then become workable rather than imprisoning. It is a big step towards reclaiming our lives when we recognize that no matter what the content of our thoughts—good, bad or ugly—they do not have to define who we are. We can recognize thoughts simply as thoughts: events that arise and pass away very rapidly sometimes. We tend to experience our feelings and our thoughts as facts, as reality, even when we might know somewhere deep within us that this is simply not the case. Mindfulness meditation is the ongoing practice of discovering our true selves in this very moment, just as we are, without judgment.
 

Parental Behaviour at Painful Events: Does it Affect Future Pain Behaviours and Perceptions in Children?

By Dr. S. Ansari
(For the full article, please contact sara@neuronovacentre.com)
Image Credit: iStock
            
One of the unique considerations in paediatric chronic pain management is the influence of children’s pain experiences with parental factors as a “two-way street”. Preliminary evidence indicates that child developmental processes are influenced by, and may also shape, a child’s pain experience. Parents’ emotions, behaviours, and health play a role in children’s pain experiences. For example, overly-protective parental behaviours (which increase distress in the child), and a history of chronic pain in parents are important influences on children.
 
Resea
rch has found that parents of children with chronic pain, particularly mothers, had high levels of stress and anxiety, and symptoms of depression. As well, the care required for their children could cause a significant social, emotional, and financial impact on the family, and put stress on parental relationships. In the research that has been done so far, there have been signs that a mother's stress level could directly affect a child's pain level. For example, one study examined children with juvenile arthritis and found that children with arthritis reported more pain if their mother had more difficulty coping emotionally than children of mothers who were in less psychological distress [1].
 
Data suggests parents' anxiety before a distressing medical procedure is related to children's anxiety and pain during the procedure. Analyses show that children's procedural anxiety mediates the relation between parents' anticipatory anxiety and children's procedural pain. So, targeting parents' pre-procedural anxiety might be beneficial to the parents as well as the children undergoing a distressing medical procedure [2].

Observational research by Dunford and colleagues (2013), which involved watching video recordings of parental behaviour at exercise sessions during an adolescent pain management program, provides descriptive data of parental behaviour in a clinical environment. This research identifies categories of parental behaviour that were derived directly from observation. Careful description of parental behaviours highlighted potential drawbacks of apparently “too positive” parental actions [3].  Research also indicates that maternal distress and childhood chronic pain is likely a “two-way street.” For example, it was found that maternal depression was a direct predictor of depression in children with chronic pain, while maternal use of active coping strategies was related to lower levels of depression in children with chronic pain [4].
 
Parents’ behavioural functioning in reaction to children’s pain has also been shown to play an important role [5]. Parental pain catastrophizing behaviour is a particularly important process (involving rumination, magnification, and helplessness about the child’s pain) that has been studied. For example, research has demonstrated that maternal but not paternal catastrophizing is significantly related to the child’s pain intensity, whereas neither mothers’ nor fathers’ catastrophizing was significantly related to the child’s disability [6]. 
 
Moreover, parents who reported a high level of catastrophic thinking experienced more distress and wanted to stop their child’s pain-inducing activities more than did parents with lower pain catastrophizing [7]. However, research that looked at the influence of parents’ presence in the dental procedure room on their child’s behaviour during a dental treatment found no significant differences in the child’s perception of the treatment in relation to parental presence or absence [8]. In paediatric chronic pain studies, social reinforcement refers to those parental behaviours, such as attention to children’s pain complaints, that may serve to inadvertently reinforce poor child pain and coping behaviours (e.g., activity restriction and catastrophizing) [9]. Other parental approaches, too, found poorer child pain-coping outcomes. For example, parents who allowed their children to get out of more everyday activities due to pain symptoms could actually make their children complain more often about pain [10].
 
Studies show that the child’s perception of and response to pain, and their development of coping strategies through life, are both influenced by: parental characteristics, such as parental emotional functioning, behaviours, and medical history (e.g., parental chronic pain) via parent-child interactions; and, by family factors, such as family functioning, environment, and life cycle stage [11]. In addition, parental and family factors are themselves influenced by the child’s perception of and response to pain and the child’s developmental stage. For example, a parent or family may function differently in the context of caring for an infant experiencing chronic pain vs. an adolescent. Also, parental characteristics and family factors interact with one another to indirectly influence the child’s pain experience and development [12].
 
A study by Axelin showed that in a stressful and painful Neonatal Intensive Care Unit (NICU) environment, parents are willing and capable of alleviating pain in preterm infants using a taught response to the child, called Facilitated Tucking by Parents (FTP). The type of parental involvement in pain management is dependent on the mother and her experiences before and during NICU admission. Nurses need to consider maternal factors when involving mothers in the pain care of preterm infants. This study concluded that FTP was a safe and effective pain management method that could be recommended for use in the pain care of preterm infants in clinical practice [13].
 
Interesting research was reported by Jacobsen et al. (1990), who studied: (a) the impact of demographic, medical, and psychological factors on overall child distress during an invasive medical procedure required for paediatric cancer treatment, and: (b) the relationship of individual parental behaviours to child distress across phases of the procedure. Their work showed that overall distress was greater in younger children who had fewer previous blood work procedures and poorer veins for procedures, and whose parents rated them prior to the procedure as less likely to be cooperative. Providing explanations regarding the procedure was the parental behaviour most clearly associated with child distress. The impact of parent explanation depended on when the explanation was given, and on the child's level of distress at the time [14].
 
Claar and research team (2008) designed a study that examined the impact of parental responses (including protectiveness, minimization of pain, and encouraging and monitoring responses) on children’s functional disability and pain and suffering symptoms. Previous studies examining the impact of parental responses on children’s pain focused mainly on protective or solicitous responses. Claar’s study showed that for children with higher levels of emotional distress, maladaptive parental responses to pain (e.g., criticism, discounting of pain, increased attention to pain, and granting of special privileges) were associated with increased disability and physical symptoms. Results of this study demonstrated the important ways in which parents can influence how their children cope with and manage chronic pain. Children whose parents are overly protective or critical of their pain may experience more impairment or physical symptoms, particularly those children who are already at risk for difficulties due to higher levels of emotional distress [15].
              
Research on childhood chronic pain that pays greater attention to developmental processes may lead to innovations in how to help children deal with pain, which may affect their adult pain coping strategies. Applying family therapy approaches to childhood chronic pain may help clinicians in the treatment of children/adolescents of particular ages with chronic pain. It is very important that future research focuses on how to help parents manage their reactions, as their behaviour does have a direct impact on their children's' chronic pain perception.
 

Sources:

  1. Palermo, TM, Eccleston C. “Parents of children and adolescents with chronic pain.” Pain. 2009; 146(1-2): 15–7.
  2. Bearden DJ, Feinstein A, Cohen LL.  “The influence of parent preprocedural anxiety on child procedural pain: mediation by child procedural anxiety.” J Pediatr Psychol. 2012; 37(6): 680–6.
  3. Dunford E, Thompson M, Gauntlett-Gilbert J. “Parental behaviour in paediatric chronic pain: A qualitative observational study.” Clin Child Psychol Psychiatry. 2013 Jun 27 [Epub ahead of print].
  4. Williamson GM, Walters AS, Shaffer DR. “Caregiver models of self and others, coping, and depression: Predictors of depression in children with chronic pain.” Health Psychol. 2002; 21(4): 405–10.
  5. Rhee, H. “Physical symptoms in children and adolescents.” Annual Revf Nurs Res. 2003; 21: 95–121.
  6. Hechler T, Vervoort T, Hamann M, Tietze AL, Vocks S, Goubert L, Hermann C, Wager J, Blankenburg M, Schroeder S. Zernikow B.  “Parental catastrophizing about their child’s chronic pain: Are mothers and fathers different?” Eur J Pain. 2011; 15(5): 515.
  7. Caes L, Vervoort T, Eccleston C, Vandenhende M, Goubert L. “Parental catastrophizing about child’s pain and its relationship with activity restriction: The mediating role of parental distress.” Pain. 2011; 152(1): 212–22.
  8. Cox IC, Krikken JB, Veerkamp JS. “Influence of parental presence on the child’s perception of, and behaviour, during dental treatment.” Eur Arch Paediatr Dent. 2011; 12(4): 200–4.
  9. Fordyce WE, Fowler RS Jr, Lehmann JF, Delateur BJ, Sand PL, Trieschmann RB. “Operant conditioning in the treatment of chronic pain.” Arch Phys Med Rehabil. 1973; 54(9): 339–408.
  10. Palermo TM, Eccleston C. “Parents of children and adolescents with chronic pain.” Pain. 2009; 146(1-2): 15–7.
  11. Walker LS, Baber KF, Garber J, Smith CA. “A typology of pain coping strategies in pediatric patients with chronic abdominal pain.” Pain. 2008; 137(2): 266–75.
  12. Palermo TM, Chambers CT. “Parent and family factors in pediatric chronic pain and disability: an integrative approach.” Pain. 2005; 119(1-3): 1–4.
  13. Axelin A. “Parents as pain killers in the pain management of preterm infants.” Department of Nursing Science, Faculty of Medicine, University of Turku, Finland. 2010.
  14. Jacobsen PB, Manne SL, Gorfinkle K, Schorr O, Rapkin B, Redd WH. “Analysis of child and parent behaviour during painful medical procedures.” Health Psychol. 1990; 9(5): 559–76.
  15. Claar RL, Simons LE, Logan DE. “Parental response to children’s pain: The moderating impact of children’s emotional distress on symptoms and disability.” Pain. 2008; 138(1): 172–9.
 
 
Rosedale Valley looking west from the Sherbourne Street bridge
Photo courtesy of ITRM Consulting


You asked: Now the Level 3 MBCPM Emotional Skills course is running in Ontario, what is the definition of Emotional Skills?

Answer:
“Abilities such as being able to motivate oneself and persist in the face of frustrations; to control impulse and delay gratification; to regulate one’s moods and keep distress from swamping the ability to think; to empathize and to hope” [1].
 
“Being able, for example, to rein in emotional impulse; to read another’s innermost feelings; to handle relationships smoothly – as Aristotle put it, the rare skill ‘to be angry with the right person, to the right degree, at the right time, for the right purpose, and in the right way’” [2].
 
“Holding the emotions from causing rapid action that we might regret, and yet still tolerating feeling the emotions” [3]. 
 
Sources:
1.  Goleman, Daniel. Emotional Intelligence. USA: Bantam Books, 1995; p.34.
2.  Goleman, Daniel. Emotional Intelligence. USA: Bantam Books, 1995; p.xxiii.
3.  Dr. Jackie Gardner-Nix, Class One of Emotional Skills, Spring Cycle 2014.
 
 

Future MBCPM Courses: Different Strokes for Different Folks.

Please see the sidebar of this Newsletter to know which MBCPM courses are currently ready for enrollment, and keep an eye on our website for the sites ready to enroll participants for courses in the Fall 2014. There will also be one level 2 course offered in the Fall via telemedicine.
 
We are trying different formats for offering our Level 1 MBCPM courses in Ontario: 1/week for 13 weeks in Toronto and via telemedicine to other communities; in Toronto: alternate weekends (Saturday 9.30 am to 4.30 pm and Sunday: 9.30 am to 1 pm) for 3 weekends from the end of June to the end of July 2014; and a 4 day course, 9.30 am to 4.30 pm during the week of August 11th to 15th 2014.
 
MBCPM facilitator training also takes on different formats: either a 2 weekend training in Winter, Spring or Fall in Toronto (the second weekend may be done through Skype under certain conditions); or a Summer 4 day training, which follows the 4 day MBCPM level 1 course in August, allowing those from out of province or country to audit a patient course.  
 

 Did You Know That?

Our Level 4 Mindfulness-Based Chronic Pain Management (MBCPM): Lumina Spark course will be offered again, in a weekend format, on October 4 and 5, 2014. This course is for alumni of course Levels 1 to 3. It will be held at Northumberland Heights Retreat Centre near Cobourg, Ontario for a maximum of 30 participants. Classes will run on Saturday from 9:00am–4:30pm, and on Sunday from 9:30am–1:00pm. An expert on Lumina Spark, psychologist Dr. Peter Smyth, will co-facilitate this course with Dr. Gardner-Nix. (Dr. Smyth’s biography is available on our website.)  Gardner-Nix trained in this Level 4 course in 2011, and has since offered three such courses to 50 alumni. Pilot research showed that it did reduce pain. Course materials and instruction cost $500 plus HST, in addition to the cost of accommodation, which is detailed on our website.
 
Here are some comments about Level 4 MBCPM: Lumina Spark from a 2013 alumnus:
 
“Upon first hearing of Lumina Spark, past corporate trainings such as Myers-Briggs or other Personality-Type/Psychometrics training sessions one may have attended in the past came to mind. What follows is my attempt at a comparison.
 
Many of these courses are geared toward one’s ‘working style’ or ‘at-work persona’ and, I found, offer little insight into one’s critical family and social styles. Having worked most of my career in a corporate world, I found these corporate offerings useful. They helped by giving folks a common terminology, insights for bringing out their best, and how to truly benefit from the diverse styles and backgrounds within the team.
 
Stepping into Lumina Spark, I was expecting another similar product. What I found most beneficial was the very detailed profiling of the various ‘personas’ or ‘modes’ we operate within during our daily lives, away from work as well: how we operate at work vs. how we act with family or friends vs. how we truly feel inside about how we are perceived. Lumina Spark helped me to profile at least three of my personas and understand previously unrecognized differences between them, and at times, internal conflicts between them.
 
So as much as Lumina Spark could be applied to a work or corporate setting, to me it seems to be somewhat unique by providing methods to resolve internal conflicts between our various personas, putting one’s mind at ease. Interpersonal relationships are usually a significant stressor on our lives and this tool does seem to help with this a great deal. Having identified a direct link between pain and stress, Dr. Jackie takes it one step further by leveraging her years of experience and customizing the course to the everyday needs of those of us experiencing chronic pain. The results are surprisingly effective.”


As always, we welcome your submissions! Please send any articles, book reviews, or contributions for the Newsletter to: www.admin@neuronovacentre.com



 
Copyright © 2014 NeuroNova Centre for Mindful Solutions Inc., All rights reserved.