Mindfulness for Our Ver/go and Tinnitus Pa/ents. From “I can’t do this” to…. “I am prepared, and I can” Joanna Remenyi, Ves;bular Audiologist and Mindfulness Educator Seeking Balance Australia
Our workshop! • Let’s learn a liHle about mindfulness> demo • Let’s learn a liHle about ver;go> demo • Let’s look at how we can have a posi;ve impact on the pa;ents we see in clinic • Let’s prac;ce some mindfulness tools • Q & A
About Our Group: • Who currently prac;ces mindfulness daily? • Who is interested in mindfulness for themselves? • Who wants to help clients with difficult thoughts or feelings? • Describe what a TINNITUS client might “feel” or “think”… • Describe what a Ver;go client might “feel” or “think”…
What can I do when I am dizzy or ‘ringing’? • If there is no magic cure • I can’t predict the future • I might get it again on any day • I might not • How can I best prepare for it? • What skills do I need to feel confident in my body?
Our message to pa/ents: • There is something we can do • We can TEACH SKILLS to help support our immune system and the process of recovery (PNS) • We can feel be&er (and think clearer) • We CAN live a rich and meaningful life despite symptoms • “this ver*go has really taught me to slow down and think about what ma7ers in my life- I am grateful for that”
Mindfulness in a NUT shell. • From ancient tradi;ons of the east (4000 years ago) • Extensively researched by medical scien;sts, neuroscien;sts psychiatrists and psychologists • Umbrella term: CBT, ACT and other models of therapeu;c techniques • DEFINED: to observe on purpose; with openness to each present moment; and without judgment. • Touch, sound, thoughts, emo;ons, sights, ideas, breath…etc • Mindfulness is a way of life. It is a prac;ce, ongoing. It impacts our neural pathways.
Research… Jon Kabat-Zinn MBSR (mindfulness based stress reduc/on) Harvard University and MassacheseHs General Hospital (2010): fMRI showed thickening of regions in the brain associated with learning, memory, emo;onal regula;on, sense of self and perspec;ve taking. Overall result= stress reduc;on. -University of Wisconsin collabora;on (2013): Blister size reduc;on! Comparison of MBSR and control group to psychological stress ‘neurogenic inflamma<on ’… public speaking with an ar;ficially induced blister. (What wonderful volunteers.) -University of Wisconsin collabora;on (2003): Anxiety and frustra;on being handled beHer (showed change to electrical ac;vity in lek/right prefrontal cortex) and stronger an;body response in immune system following flu shot compare to controls. -UCLA & Carnegie Mellon University (2012): • Showed reduced loneliness (age 55-85) and reduced expression of genes related to inflamma;on in immune blood samples
Focus= body + mind ‘in sync’ • Willingness to feel • Openness to be where I am and how I am now. • Shiking aHen;on on purpose • Allowing discomforts rather than struggling • The rope exercise…
Psychoneuroimmunolgy or PNI • The immune system is known to be influenced by the brain and the nervous system (thoughts, beliefs, aptudes… fight/flight/freeze… rest/repair) • Can pa<ents who focus with purpose and willingness upon the healing process actually heal quicker? YES! • Study on UV light therapy for skin disease pa;ents (unknown cause and no known cure; known to fluctuate and is related to emo;onal stress). • Mindfulness par;cipants healed 4 <mes faster than controls. • Par;cipants listened to audio medita;ons whilst standing naked inside a UV cylindrical light box and visualizing that their condi;on was being reversed. Controls just stood there without medita;on audios.
What it looks like in clinic • Breath + movement (eg squapng + O2) • Pause and observe (without judgment) • Lik up trunk muscles (ac;vate propriocep;ve pathways) • No;ce thoughts (without judgment) • Visualise healing pathways • No;ce anxiety and give it space to calm down
Mr Tinnitus age 44 +ENT +psychiatrist +psychologist + audiologists + /me off work
Mr Tinnitus age 44 +ENT +psychiatrist +psychologist + audiologists + /me off work
Mr Tinnitus age 44 +ENT +psychiatrist +psychologist + audiologists + /me off work
Our pa/ents! Ver/go and Tinnitus • Mindfulness helps us to beHer relate to our symptoms • From: “I can’t live like this, I hate this, I need to be fixed now” • To: “It is no big deal, I can pause, take a breath. My body will fix this.
Case Study 1. With a happy ending. • Ves;bular migraine, Female, age 51- presented with 15-years of debilita;ng dizziness. Tried meds. Saw Mark Paine in 2000. Comprehensive inves;ga;ons performed and ves;bular rehab tried at the local public hospital. On disability pension. Also has CFS. • DHI was 82. Normal audio. Normal MRI. Had seen psychologist and also tried hypno-therapy. Referred for mindfulness from the GP. • Constant ver;go. +PANIC. + fear of ver;go. It was always on her mind. ALL THE TIME. It was there. And she focused on it.
The process of healing. • Tried very simple Ves;b rehab exercises but she rejected them in panic. • We moved to very basic mindfulness scans and self-awareness exercises. • Basic neuroplas;city educa;on: “I can change my brain pathways.” • Is now living without fear of dizziness and pauses with ‘no big deal’ when she no;ces it. NOW= DHI 26 … impact = 56% Huge improvement • Quote: “I talk to my dizziness and say .... ‘Ok there you my old friend ...come along for the ride I have a life to live ...wholeheartedly’
How did we get there?
Case study 2. Pain, migraine, dizzy for 30 years (age 54). Referred via GP for mind/body therapy • Had exhausted inves;ga;ons and tried medica;ons for years. • Painful migraine (intensity=8/10) for a dura;on of 3-days • Recurrence of every 10-days • 3 sessions with 1:1 (breath work, self-compassion, neuro-educa;on) • NOW: rarely uses drugs. Pain is now described as at 0/10 or “calm”.
13 months on, this pa/ent reflects • “The first point was really, really taking responsibility for my own pain & being completely minded that I could make changes to my chronic pain… • I came to realise that various drugs made it harder not easier , were obstruc*ve to me really dealing with pain- they generally distance yourself from geHng thru pain. I would say with help from people like you I recalibrated my brain aIer 30 years of living with pain! But I really had decided I wanted to change”
Easing the load of unnecessary stressors:
The pa/ent’s role is about learning. • Interac;ons between stress and ves;bular compensa;on (2012): Yougan Saman1*, D. E. Bamiou1,2, Michael Gleeson1 and Mayank B. Du=a3 • “Good stress” and “Bad stress” • Repeated exposure to stressful s;muli or chronic stress can lead to an inhibi<on of brain plas<city and las;ng detrimental changes in the hippocampus, amygdala, and prefrontal cortex
Mindfulness Tools • Mindfulness is not a tool to eliminate symptoms… • It is a resource to help us relax into our body and offer self-support • POCA: Pause, Observe, Choose, Act • NOTICING Breath, feelings, thoughts • PRACTSING Compassion • ACTING WITH Kindness • DAILY Gra;tude
Q&A • How will I know if a pa*ent is ready or suitable for this? • when the pa*ent is ready, this is quickly effec*ve • Ask them if they are willing and ready to try these new tools • CI Clients need visual tools… great idea. Write down your mindfulness exercises in simple sentences and guide client to read more about it. • Pema Chodron offers excellent wriHen resources.
Thank You! Come say hello! • Further 1:1 training available with CPD points- email me. • FREE Ver;go Recovery Starter Kit available online • www.seekingbalance.com.au • info@seekingbalance.com.au Skype therapy sessions available • Further reading: • Full Catastrophe living- Dr Jon Kabat-Zinn • Just One Thing- Dr Rick Hansen • The Happiness Trap- Dr Russ Harris
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