An interview about mindfulness-based stress reduction

Transcript of Interview with Kimson Johnston, LMFT
Martin Carr, M.D.
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Hello everyone, it is January 26, 2018, and I am Martin Carr, a gastroenterologist in North Orange County, California. I work for the St. Jude Heritage Medical Group and I am with Kimson Johnston who is a Licensed Marriage and Family Therapist, and an experienced psychotherapist and wellness coach at what has been called the Synergy Medical Fitness Center now being called the St. Jude Wellness Center located here in Brea, California. I’m going to be interviewing Kimson about mindfulness based stress reduction or MBSR in general and specifically in regards to people who have irritable bowel syndrome or IBS. Thank you all for listening and I am going to now let Kimson do some talking and here is my intro for you, Kimson. You’ve been leading classes in mindfulness based stress reduction for a long time and I wanted to ask how you become interested in doing this, what is it exactly and what you like about it?
KJ: Thank you nice to be here today. First all I’ll address how I came upon mindfulness based stress reduction, then give a little bit of a definition of it and you why I find so fascinating about it.
So years ago I was pursuing my undergrad degree and I was running a small business and recently had been divorced. My children were quite young, I had a house-cleaning business and was going to school to finish my bachelor’s degree and I was doing a lot of cycling. I was pretty physically fit and had actually done a couple of triathlons. One day I had a very severe cycling accident. I woke up and I had been unconscious for close to 3 hours . They took me to the trauma center and when I came to, I had a Jane Doe wristband on, I was saying my friend’s phone number over and over, of where my children were. At that time in my life I had a lot going on. I had no health insurance and here I was in the hospital unable to go home right away. My life was pretty busy, I was going all the time, kids, school, work repeat.
A year or so later, I was at Cal State Fullerton, I began exhibiting all kinds of inflammation symptoms, lots of pain, I was really struggling with just walking being able to be mobile. By the time I graduated with my bachelor’s degree I was barely able to walk across campus. At that point I went to the ER and they diagnosed me with rheumatoid arthritis which is an autoimmune disease and I was put on some pretty powerful medications and I was not happy. It was a very aggressive course of this disease and early on I had some deformities that necessitated me getting some surgeries and because I had eaten, exercised and taken vitamins my whole life, I felt very betrayed by my body. I know this is not an unusual experience for folks who have chronic conditions. I lost confidence in being able to do what I once could. I knew that I was never going to be able to do triathlons anymore and I felt a sense of failure, worthlessness and it was really crushing. Of course this is not a person that I wanted my children to see but there is no way you can hide something like this. Even academically I was struggling to keep up and I did not want anyone to give me any special treatment but I really had to face this. So a few years later I was working as an admin assistant to the vice president of operations of a semiconductor company while pursuing my masters degree in clinical psychology. I can remember days when they needed me to bring lunch in and I did not want anyone to see me falter but I was really struggling. Then at one point they were scaling back on their business and so they said if anybody needed any surgeries that this would be a good time. I made this decision to go in for foot surgery which would have a pretty long healing process and during the time I was healing and at home I read Jon Kabat-Zinn’s book called Full Catastrophe Living. Jon Kabat-Zinn is actually the co-founder of the Center for Mindfulness at the University of Massachusetts and so I decided once I got well I was going to go and take one of these weeklong retreats. So I did, and there were about 150 other psychologists there. After we spent the morning just sitting meditating, following our breath, being present in the moment, I knew this was for me. I guess I would liken it to the same sense of wonder that I felt when I would go out hiking in the woods, or in the mountains, or even sitting by the ocean for a long period of time as I just felt that sense of calm and presence, and I think I had forgotten what that was like in my life. So the practices really began to change my life.
I was able to stop all the doing and just be. I began to see myself differently and have a glimpse of what it was like to feel whole again and not feel like I was broken because of this chronic illness. Yes, there was a tremendous amount of grief and loss involved, but every small act of stepping forward equated to long-term change. I can say that looking back–at the time, I do not think I saw those incremental, micro- movements as much, but in looking back I see that each step forward really became something big. I said to myself at that point, and this is a choice that I offer to people struggling with chronic illness and chronic pain, the choice was: you can be someone who is suffering and had chronic illness and pain and be stuck, or you can be a person who has chronic pain or chronic illness and has a life. That may sound harsh, but it really is something we have to reconcile ourselves to, and I think it was Mark Twain who said “I’ve been through a lot of terrible things in my life–some of them actually happened.” Because when we’re in that place we have all kinds of thoughts, worries, anxieties and our thoughts are not something that we have to believe. Thoughts are just thoughts. Sometimes a lot of our thoughts about things that we fear will happen, or we’re very anxious about happening, and so we become in mindfulness very aware of our thinking patterns and habits of our minds. To me this was very powerful, because my life was pretty much about doing, and there had been times when I had so much going on that just wanted to take my head off and set it aside, and not have to deal with the thoughts and anxieties.
During my master’s program I became a biofeedback clinician at St. Jude Medical Center, and had the honor and privilege of working with so many patients who also had intense pain. I began to integrate and interweave some of these practices of mindfulness into my sessions of biofeedback and I really began to see that people began to learn to quiet their pain, they didn’t feel that they just had to sit at home and that this was their destiny in life to forever be in chronic pain, that they could actually have a better quality of life, have greater control over what they were experiencing, and that they could begin to titrate down off some of these medications. So that was so wonderful for me to be a part of, and I am so deeply grateful to have been part of their journey to have a greater quality of life.
What I want to do is define mindfulness for you now, because I think there’s a lot of “What’s mindfulness, what does that really mean?” So I’ll give you the real definition: ‘Paying attention, on purpose, in the present moment, with non-judgmental awareness.’ Or ….we could say ‘Paying attention to present moment experience with open curiosity and a willingness to be with what is.’ So let’s take that first piece—paying attention on purpose, in the present moment.
Why is that important? We have this tentative relationship with the present moment and oftentimes we are in the present, the future and the past simultaneously. Who has not been in their car when they have missed their off ramp and suddenly realized, “Well, I am not sleeping at the wheel but I have just kind of drifted off in thought.” Our attention gets hijacked and especially these days were are on the web or doing your email and suddenly we are in a million different other websites. We realize that it is very hard to sustain present moment awareness. This is a big piece of mindfulness—how do we come back to the present moment. The second piece of that is nonjudgmental awareness– present moment with nonjudgmental awareness. That sounds kind of weird but think about this. “Nonjudgmental”–we have so many opinions about so many things. “The freeway, the traffic, oh, I do not want to drive on this—the weather–it is too hot or too cold–the food—it’s too much or not enough.” I call this is the yum-yuck ratio or yum-yuck factor. We all want more yumminess in life and when yummy and wonderful things are happening, we want more of it. When the yucky or not so wonderful things like pain or illness are happening we want distance from it, we do not want any part of it.
The next part is –willingness to be with what is. There is this quality of attention, affection and compassion that we bring to being in the moment, nonjudgmentally with what is. It is also having a sense of curiosity, because what happens? We as adults know lots of things and are not curious anymore, we do not have this wonder about standing at the ocean and seeing it sparkle. We kind of know it and have this glibness that comes with that. So what do I enjoy most about mindfulness– now that I have given you this definition? Because it really may not give you a sense of what it is like to sit in a room and practice present moment awareness with just breathing. But what I love about it is its’ simplicity. Not that it is easy, because it is not easy, but it is simple. As we begin to guide people towards cultivating a sense of well-being, and how that comes as we are sitting and staying, say with just this breath, then we began to notice our mind drifts off. Where did my mind go? When we notice that our mind has drifted off, we bring it back, right in the present moment with the next breath. So this noticing is what is that present moment awareness, and then that is like a single rep at the gym. We’re getting this strengthening of focus and attention and present moment awareness. As people practice this they notice that they have a greater confidence. They begin to notice small things in their lives. It may be just the simple sense of sipping their coffee in the morning, and they also learn to care for themselves better as they begin to know about this interplay of mind and body. Life is really the true meditation, and how we approach how things are happening. I think with people that are dealing with chronic conditions it’s, “My life is always going to be like this–how is it ever going to be any different?” But we are all looking so far forward that we think this is the only way that it can be. As we begin to learn that we can take one moment at a time, and we can engage with every day experiences, they begin to develop this confidence. We are reducing the effects that stress has on the body but really what we are really reducing is the way that people get lost in their suffering and their pain. They forget that they have this inherent capacity to be whole. We are easing their suffering as they are on this journey of discovery. I think that this is essentially called mindfulness based suffering reduction, because as folks develop their inner resources for coping and growing and healing, they are developing their own relationship with themselves, and discovering more about who they are, and beginning to honor that in a very real sense of how that will show up for them in their relationships and work and in their everyday lives.
MC: That is very beautiful and understandable, and thank you. Where can people look to find mindfulness based stress reduction classes near where they live? How can they look that?
KJ: I use Google a lot, and I would say if you go into any of the search engines, Internet Explorer, Google, and just type in either MBSR or mindfulness based stress reduction classes, my guess is because the computer knows where you are at, it will give you a classes exist locally. There are very many online classes that are available, but I would say for this kind of a class, I think is always better to do it in person if you can, just because you get so much more from other people’s experiences too. When you are online you can miss out on that human connection part, and I think that human connection piece is also part of our healing, coming together with other people who share similar kinds of struggles.
MC: How long do your classes run that that you are in charge of, and what is different about your mindfulness based stress reduction classes compared to visiting a psychologist, and also is there anything different about helping IBS patients using MBSR?
KJ: Our class is very closely aligned with the flagship program out of UMass. The program is 8 weeks long, 2-1/4 hours a week and then we also have a day of mindfulness between weeks 5 and 6 which is about 6 hours long. We maintain fidelity to the program that is based out at UMass, which is the program on which the evidence-based research is conducted. I know there is so much of mindfulness out there, so the reason I say that is there are a lot of diluted versions. It’s not that smaller, lesser programs don’t offer something, but I think it’s important to really have a commitment to the work, and I really think you can get what you need out of something that is a little bit longer, because it is not a quick fix. This is something that takes time. We don’t want to feel like, “ I’m going to go to a mindfulness class for a week and suddenly my pain’s going to go away.” Probably not going to happen. The research is very strong for mindfulness’s positive impact especially in the areas of mental health, including stress reduction, emotion and attention regulation, reducing rumination and for also reducing mild to moderate depression and anxiety, and preventing depressive relapse. When suffering causes someone to have a fixed and negative view of themselves, or their circumstances, mindfulness is very helpful in giving them access to a different perspective and to be open to other possibilities, and to enhance their resilience and their capacity to tolerate emotional distress. But it is important to note that mindfulness is not a silver bullet, it is not a panacea. We have to be discerning about what it’s good for or at least not harmful for, and where we need to be cautious. Is mindfulness better than medication or psychotherapy? No, probably not, but if you are someone who does not believe in taking medication, and you are uncomfortable with talk therapy, and you do not want to see an individual therapist, this is a modality that people tend to like. It’s appealing, it’s accessible, and if you are motivated to use it, it may work better for you.
When you come to class you are also connecting with others who shares similar challenges. This connection, I think, is very powerful. Barbara Fredrickson wrote a book Love 2.0 and she talks a lot about even just the perception of feeling isolated is more powerful even than the actual being isolated. I think connecting with other people is hugely healing, and many people have written about this. While it’s important to reach vulnerable populations, and especially those with chronic conditions, if someone is too ill or too depressed or too dysregulated or they have unprocessed trauma, or they may be actively psychotic, and don’t have any support in their life, my recommendation is that probably this is not a good time for them to take the program, and that they need to receive some other form of treatment first. This is a program that actually works very well collaboratively with psychotherapy, so oftentimes seeing a psychologist they will recommend that you can take this class alongside it. That’s never a bad idea. As far as there being anything different about helping folks with IBS, I would say that each and every person comes to us very uniquely different and we begin wherever they are in life. How each person responds to life events and what their habits and patterns are are all part of their journey of discovery. We know that folks with IBS often have a lot of heightened anxiety around food, digestion and a lot of pain and discomfort once they’ve eaten and so often times living their lives hinging on knowing where one restroom is or another is a huge piece of what creates this anxiety as well as takes up a lot of energy for them.
From my observation, I really want to emphasize the importance of a dietary consult with a dietitian specializing in IBS because I think this makes a huge difference. It is very key to beginning to initiate that healthy gut function and so I think that his step one. Coming to our program is step two. As with any other chronic conditions, there is often a lot of self-judgment, perfectionism, and this can at times show up as being kind of rigid in the way that we approach life. In one of the classes that we had here, what I noticed was that folks tend to plow through their pain, and even when they are feeling pain, they do not listen to that physical sensation of pain. They continue to do things, kind of this boom or bust cycle, and when that happens we know that we have to set limitations and say, “Can I be able to stop midway through a task give myself some relaxation, take some time to do my breathing?” I find that this is oftentimes helpful but oftentimes not something that comes to mind right away when we have this habit of plowing through. We also know that many people come from a background of abuse, and this can create a lot of fear, a lot of physical tension and anxiety and oftentimes create a pattern of avoidance or isolation. How folks have learned to keep safe within themselves–this is all part of it. This can take time, a lot of compassion and tenderness is very key when it comes to this. I believe mindfulness helps us to uncouple our sensations of pain from our thoughts about it, because oftentimes we think, “I am never going to get better, I’ll never be able to have a normal life and leave home.” We can learn to free ourselves from those thoughts and we realize that they are just thoughts. The class and practices offer people a glimpse of this wholeness and allows them to begin to experience more of these moments in their lives.
MC: I assume that participants in MBSR classes and training who continue to practice what they learn will do the best in the long-term. What advice do you have for IBS patients or any patients who have been through mindfulness based stress reduction training or have been through multiple visits to a psychologist to address their anxiety issues, and then have lost their habit of practicing what they learned. What is your advice for them?
KJ: When we go to a therapist, we have a very definite reason to be there. When we feel that life is going well, we feel there is no need to be there. But sometimes things can shift in our lives, our health changes, we go through losing people in our lives. The same is true with mindfulness, that while we teach the skills and we begin to feel better, and our pain is reduced, our anxiety dissipates a bit, but if we do not maintain the practice, and we do not keep the skill– we do know that there are significant changes in the brain that occur too when we practice mindfulness meditation. So the advice is that we always want to come back to it, and coming back to the practice is definitely helpful. This is a practice that we hope people will be engaged with over a lifetime. We know that our brain is shaped by these practices in building the mental muscle and this has real-life implications. We are creating new neural pathways. As with a psychologist, things change so it is okay to go back and check in and have another visit and gain insight into where we are at in our lives. It’s the same with mindfulness. I have taken the same class over 5 times, and it was a different experience each and every time. It’s nice to have it available to do that with.
MC: What role does yoga therapy have for in particular IBS patients who are also trying to learn MBSR?
KJ: Yoga therapy and mindfulness is not like your standard kind of yoga, which may be very rigorous and there is a lot of push and putting our bodies into these contorted positions. There is a lot of focus on body awareness and we oftentimes are so much in our heads. Yoga is in itself it’s own meditation. It is this way of your working with the mind and body together. As we tune into the body and begin to slow down, we notice that we have different sensations in the body. We begin to pay attention in a very different way. The practice really encourages this inner work of meditation quite a bit, and it takes it far beyond the physical benefits that come naturally with stretching and strengthening. There are particular postures especially in yoga therapy that are very soothing to the gut and offer aid to the whole digestive process. We begin with this awareness in the body that because of this ability that we have to constantly be in our heads and feeling anxious or feeling our pain. These moving practices are very helpful for awakening us up in our lives much the same way that mindfulness meditation is about waking up. These patterns of our minds and how emotion shows up comes even into the yoga practice. Sometimes these are the most tender moments in our classes, when people really discover this for the first time and they begin to share that and how beneficial it is to them to be doing a moving meditation.
MC: What advice, Kimson, do you have for primary care physicians or GI doctors regarding recommending mindfulness based stress reduction for their IBS patients?
KJ: I think that it’s one of those therapies that is not harmful, I would say it’s a very conservative treatment. It’s holistic and it really can offer people a greater quality of life and really help them to take a closer look at the many components of it. To gain a sensitivity and increase the quality of their life, I think that that is huge. They may even want to come take the course themselves so they can see how it is to benefit by the same things that other people are learning, because oftentimes physicians are stressed out too.
MC: That’s for sure, and I will be sure to recommend to all my colleagues that they listen to this interview. I think they will get really good insight for themselves as well as for family members and their patients. How about for our listeners? Do you have any final advice you would like to share with our listeners today?
KJ: Just that I am always happy to answer any questions, and if I do not have the answer I can point you somewhere else, and to come and see us. We are here over in Brea. Give the class to try or give me a shout out—to at least have the opportunity to give this a chance and see how your life might be better impacted by taking a class like this. You can reach me at 714-578-8724 at Synergy–new name is now called the St. Jude Wellness Center. Thank you for listening.
MC: Very good, thank you very much, Kimson, for that wonderful interview. Those of you who are listening who are IBS patients and who live near us in the North Orange County, California, area near Fullerton and Brea, you could reach Susan Watkins who is the manager of the Center for Health Promotions where our dietitians are based. Their phone number is 714-618-9500, and their location is a few miles west of the St. Jude Center for Rehab and Wellness where the St. Jude Wellness Center is located. They are at 955 W. Imperial Highway in Brea. Thanks again to all of you for listening and good luck in 2018.