Finding mindfulness through meditation. L. E. Carlson

Aswomen living with lymphedema we all know, it’s not always acute cancer treatments that are most difficult, but rather coping with the lingering symptoms and side effects of treatment including chronic or intermittent lymphedema. Lymphedema can be one of those long-term or late effects that emerge or worsen well after treatment completion, and may persist for years. The swelling, discomfort and pain that often accompany lymphedema can compromise quality of life, and the ability to complete dayto-day tasks. Sleeping may be difficult and as a result feelings of fatigue and lack of energy during the day can make getting things done a constant challenge.

Mindfulness for lymphedema

Treatments for lymphedema that can be helpful are compression bandages and lymphatic massage, but these treatments only go so far for helping with the psychological burden of having to live with this condition, perhaps indefinitely. One type of coping strategy that has proven helpful for people with cancer in general, and for treating symptoms including pain, fatigue and sleep problems, is training in mindfulness. Mindfulness is often defined as paying attention to the present moment with an attitude of acceptance and

Finding mindfulness through meditation

Coping with challenges of lymphedema using mindfulnessbased approaches

By Linda E. Carlson

nonjudgement. It is both a practice that you set aside time to do (mindfulness meditation) and also a way of being in the world (being mindful). The practice of mindfulness meditation trains you in how to think differently, which eventually translates into being more mindful in everyday life.

What is mindfulness?

There are three main components to mindfulness practice: Intention, Attention and Attitude. Your intention when you take up mindfulness practice can vary, but for most beginners the intention is just to learn to be present, rather than allowing the mind to dwell in regrets of the past or worries of the future.

Attention is the quality of awareness that you are honing through practice; this is the ability to keep your focus of awareness where you want it to be. Typically for beginners this focus is on the flow of your breath. Attitude is the way in which you pay attention; it needs to be kind, open, curious, accepting, nonstriving and nonjudgmental. A harsh or punishing attitude is unhelpful and in fact counterproductive in developing qualities of

Linda Carlson, PhD is a Registered Clinical Psychologist and Professor in Psychosocial Oncology at the University of Calgary Cumming School of Medicine. She has taught mindfulness courses at the Tom Baker Cancer Centre since 1998. She also conducts research on the program and has published over 130 scientific papers in the area of Psychosocial Oncology.

mindfulness. One of the best ways to learn how to be more mindful is through taking a training program. The most well known of these is called Mindfulness-Based Stress Reduction (MBSR). It was developed in the late 1970s by Jon Kabat-Zinn at the University of Massachusetts Medical Centre.

It incorporates stress reduction principles with daily training in mindfulness meditation and gentle yoga practices over the course of 8 weekly meetings. He’s written a wonderful book describing the program called Full Catastrophe Living 3 Over the years, it has become very popular and been tested in various groups of people suffering from pain, anxiety, depression and a very wide range of medical conditions.

Mindfulness-based cancer recovery

In Calgary in the late 1990s we developed an adaption of this program, which is called Mindfulness-Based Cancer Recovery (MBCR). We have tested MBCR in studies of people

with all types of cancers, and specifically in women with breast cancer, and shown benefits across symptoms of anxiety, stress, depression, anger, confusion, fatigue and sleep1. People in the group also report feeling more hopeful, having a greater sense of meaning and purpose in their lives and feeling more connected with others. We have also taken samples of saliva and blood and shown changes in immune function, inflammation and stress hormones, all in the direction of healthier

profiles. Women with slightly elevated blood pressure also showed significant reductions over the course of the MBCR program. While we have not directly measured lymphedema symptoms, people in these programs often report better pain control and an ability to be less bothered by symptoms.

So how can you get started?

There are many books on the topic of mindfulness, and we’ve written one specifically about our program, called Mindfulness-Based Cancer Recovery: A Step-by-Step MBSR Approach to Help You Cope with Treatment and Reclaim Your Life 2. It is available at most book stores and takes your through our in-person program week by week. Many cities and cancer centres across Canada also have local programs you can sign up for.

Meditation instructions

If you’d like to try the basics of mindfulness practice right now, simple instructions for sitting meditation are provided (see sidebar on page 8).

At the very least, learning to let go of thinking “what if” about the past, and having regrets or blaming yourself or others for the way things have turned out can be liberating. You can’t change the past so dwelling on it causes unnecessary suffering. Then many people worry about all the unknowns and uncertainty about the future. What if this or that happens? How will I cope? No one can predict the future. All you can do is live your life each moment with intention. The only time we have choice is in each individual moment—so practicing mindfulness gives you full access to your ability to make wise choices, learning from the past and not worrying about the future.

continued on page 8

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You can’t change the past so dwelling on it causes unnecessary suffering.

Sitting Meditation

Find a comfortable sitting position where the spine is upright, head gently balanced and shoulders drawn back and down. If seated in a chair, move for ward to the edge and place your feet flat on the floor. If seated on a cushion, make sure your hips are elevated so your legs are resting, or supported with cushions to avoid strain. Rest your hands on the knees or in your lap. Settle into a position in which you can remain comfortable and still.

Now allow focus to come to the in and out flow of breath. The mind relaxed, spacious; you don’t have to create anything. Simply feel the gentle rising of the belly, the abdomen, with each in breath, and the falling with each outbreath. Allow the breath to be natural, noting its in and out flow, not trying to force or control the breath in any way. Noting each in and out, each rising and falling, allowing a settling into the even rhythm of the breath. Allow your mind to rest in that place feeling the movement of the breath.

As you feel the breath, you can make a silent mental note to sharpen concentration: noting “in” as you feel the breath go in: “out” as you feel it leave. Very gently in your mind, just support the awareness of the actual sensations…just note in and out, rising and falling.

Your mind inevitably will wander from the breath. Noting this is a success. When you become aware of the wandering mind, very gently and kindly lead it back to the breath. You will have to do this time and again at first. Do so with kindness and compassion for yourself. After many weeks and months of practice your mind will become trained to wander less from the present moment.

Continue for just a short period at first, gradually extending up to 20 minutes each day.

Whether your challenges now are coping with lymphedema, other symptoms, worry about cancer recurrence or just trying to get through the day-to-day grind of family and work, cultivating a mindfulness practice can be a precious and long-lasting gift to yourself, one that everyone deserves and can cultivate. LP

References

1. Carlson, L.E. (2013). FEATURE: Mindfulnessbased cancer recovery, The development of an evidence-based psychosocial oncology intervention. Oncology Exchange, May 2013. 12(2): 21-25.

2. Carlson, L.E. & Speca, M. (2010) Mindfulness-based cancer recovery: A step-by-step MBSR approach to help you cope with treatment and reclaim your life. New Harbinger, Oakland, CA.

3. Kabat-Zinn, Jon (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York: Bantam Doubleday Dell Publishing Group, Inc.