Mindfulness: tools for transitions

Mindfulness and the Emergency Healthcare Professional

Chapter 6: the right tools for the job

Defining the terms

So last time we ended up talking about the main difficulty in all of this mindfulness meditation caper as being the first stages of transitioning away from the frenetic day-to-day thinking, into the quieter, spacious thinking of mindfulness or meditation.

But we need some definitions, because using these two terms mindfulness and meditation together is confusing.  For me, too.

Mindfulness 

Mindfulness has many definitions. The term mindfulness describes the conscious development of self-awareness and observation of one’s surroundings, in the present moment. There are many techniques

Dr Jon Kabat-Zinn, PhD is an American professor emeritus who developed Mindfulness-based stress reduction (MBSR) and founded the UMass Medical School Center for Mindfulness. He has been instrumental in launching mindfulness in the West. Kabat-Zinn correctly realised that making these techniques approachable in a modern setting required an apparent separation of the study and techniques of mindfulness from their historical background; in this case, from the Buddhist traditions of meditation that are over two thousand years old. 

Meditation

Meditation is more a descriptor of the process and methods by which we can enter different levels of consciousness – apart from waking and sleep.  There are many techniques and ‘languages’ here also.

Meditation as an idea is less approachable perhaps for our busy minds, whereas mindfulness may be a more accepted term in the Western world

But does it really matter?

I respectfully suggest that it really doesn’t matter which term we choose.  The overlaps are so great, and the techniques are so similar.

We need to keep all of this terminology as simple and credible as possible. 

So, what’s this transition stuff he is talking about?

As a launching idea, the people who developed the techniques of mindfulness and meditation really knew what they were doing; they understood how hard it is for our minds to get though the early stages of learning this.  Perhaps like training a race horse, or a puppy, or an intern in the ED.

We are so used to noise and interruptions and distractibility, and of course all of the emotional reactivity that goes along with having a partly trained mind.  We think of ourselves as being disciplined in some ways, but in terms of the mind itself our thinking is kind of all over the place for huge parts of our days

Sitting down for the first few times and trying to relax or meditate usually fails spectacularly.  Some lucky individuals immediately have profound experiences when they learn to meditate, but for most of us, it requires regular practice with plateaus and some accelerated periods of growth.

To help us pull back on track, as we sit and meditate, there are tricks, and by understanding  a few of these at a cognitive level we can use several, if our mind is wandering.  Everybody gets distracted in meditation.  I will put some diagrams into subsequent articles to explain that this does not matter.

I remember The Beatles, don’t you?

One example is mantra meditation which is used in Transcendental Meditation ™, made popular by the Beatles as they too explored new horizons in their early adulthood. And, perhaps, some pharmacology sessions of a rather different nature to the usual ED Registrar tutorials.

A mantra is a word, or a series of words, that the meditator repeats.  When distracting thoughts come, as of course they will, the person tries to remember to re-start the rhythmic repeating of the mantra, perhaps linking the mantra to an in-breath, or to the out-breath.  Mantras in TM™ are old Indian or Sanskrit words, but any word works.  It could be shoelace or defib repeated quietly, and the effect would still occur.  Others use words with an emotional resonance, such as love, or stillness.  I find it powerful to quietly repeat something like thankyou, which brings in one of the values of mindfulness, which is gratitude.  But more on that in a later article.

Mantra meditation is certainly successful as a technique of transitioning.  This success is not because of the word or words chosen, but because of the repetitive nature of repeating the inner word sequence.  Our mind becomes slowly but steadily prised off its rock, despite its determination to hold on. People use rosary beads, or tap on a table with a small glass at a certain speed, to effect the transition.  Repeated lines of prayer have the same meditative effect, and these have been used for aeons in religious meditation and prayer practice.

So, try using mantras. Make up your own. Finding a word that is sacred to you really helps with the whole mindfulness and meditation journey; a dedication to yourself is an essential element.  You will likely ‘chop and change’ a lot as you explore what works and what does not, and that is all very healthy.

Next, we have some of the mindfulness body scan  techniques, where you sit with eyes closed – or open, it does not matter – and sequentially start somewhere in your body and just observe physical sensations such as weight, muscle tension, temperature, air movement through the respiratory tract etc. 

This is similar to the many breathing techniques, where we focus on the sensation of air passing in and out of our nostrils, or throat, or the expansion of the abdominal and chest area with respiration.

These have developed as transition techniques because we simply have to breathe, so the stimulus is there to pull our mind away from “busy thoughts” to something calmer.  And likewise there is nothing particularly special about the body scan mindfulness techniques, other than the awareness being easily available from the physical sensory inputs we receive as we sit down in a chair.

They are just techniques of distraction, to help us transition.  Practising all of these a few times enables us to use any or all of these, while we ‘wrestle the tiger of distractibility’ in the early stages of learning how to meditate.

It all sounds pretty hard

But it is just repetition.  Calm non-judgmental repetition.  And we don’t listen to negative self-thoughts, such as “I can’t do this”.  Just repetition.

Depending on how “wired” we are, the initial practise sessions may be as brief as a few minutes.  With time, sessions of 5 or 10 minutes may not be intimidating. 

And as the Oracle in the Matrix films almost said, what really ‘fries our noodle’ with meditation is that the mind gets used to the amazing feeling from mindfulness sessions, and about the same time each day and often in between times, our mind urges us to meditate.  If you can escape from your day for even a few minutes to respond to these inner signals, and sit quietly and mindfully, you should do so.

So what’s coming next?

Next time, we will look at other techniques of transition, including the use of music, metronomes, guided meditations, flashing light devices and visualisation.  It all sounds a bit complicated, but the good news is that once we master transition to meditative states, it does get easier.  The focus on the transition zone is really important.

Take care of yourself and thanks for reading this.



Further reading

Waiver: These articles represent my own views and approach to mindfulness, and do not purport to be the official view of ACEM.  They are not intended to replace appropriate medical or mental health care, provided by professionals in these domains

Cite this article as: Andrew Dean, "Mindfulness: tools for transitions," In: LITFL - Life in the FastLane, Accessed on December 1, 2021, https://litfl.com/mindfulness-tools-for-transitions/.
A/Prof Andrew Dean, MBBS FACEM Grad Cert Clinical Simulation. Emergency Physician and DEMT at St John of God Hospital, Ballarat, Victoria, Australia. Head of Ballarat Rural Clinical School, School of Medicine Sydney, University of Notre Dame Australia.
Still searching for new and innovative teaching methods for emergency medicine education.  Also a committed advocate for mindfulness meditation, and the nurturing of emotionally intelligent clinical teams in health care.

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