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Mindfulness Interventions in Physiotherapy

Mindfulness interventions are frequently used in health care to assist patients in managing pain, stress, and anxiety and in targeting additional health, wellness, and quality of life outcomes.

Mindfulness is a stress reducing strategy where an individual develops an awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally and accepting them as they are. This paradigm assumes that many people experience a high volume of future- or past-focused thoughts that produce anxiety. Hence, mindfulness is the practice of refocusing away from these distractions and toward lived experiences.

An individual attempts to control the focus and direction of their attention without rejecting or suppressing thoughts. The prevalence of mindfulness interventions in health care has grown substantially in recent decades, and several types of mindfulness interventions have emerged.

The first and most widely recognized mindfulness intervention is mindfulness-based stress reduction. Initially called the stress reduction and relaxation program, MBSR was developed more than 30 years ago for patients with chronic pain and involves guided sitting meditation, mindful movement, and education on the effect of stress and anxiety on health and wellness. The evidence supporting mindfulness interventions in health care has grown since the inception of MBSR, and modern mindfulness interventions are shown to be effective at reducing pain severity , reducing anxiety and enhancing well-being.

In a study with 34 participants (17 mindfulness practitioners and 17 control), testing for mindfulness that involves neural mechanisms to modulate pain to see if modulation through mindfulness will involve a decreased level of activity in cognitive modulatory regions (such as the PFC) and increased activation in regions involved in sensory processing of pain, such as posterior insult, somatosensory cortex and thalamus.

The result should that experienced mindfulness practitioners are able to substantially decrease experienced pain unpleasantness (22%) and anticipatory anxiety (29%) during a mindful state. it also suggests that pain and anxiety modulation through mindfulness involves a unique neural mechanism in the brain.

The 3 key elements for mindfulness are: 1. Observe (just notice) 2. Label (sounds, thoughts, emotions, pain) 3. Non judgment (acceptance We can have a Formal Practice of mindfulness (from 1 minute, to as long as multi-day retreats) with: Breath Awareness and Body-scan, mindful movements, visualization/imagery, Loving kindness, etc. And we can have an Informal Practice during everyday activities (i.e. washing dishes, walking, brushing teeth, eating, talking to someone) and Turning off autopilot mode - (Our mind is on autopilot 47% of the time) Practical Applications example of mindfulness session

1. Introduction: "Can we try something? - “Breath/Awareness Training" 2. Diaphragmatic breathing: 2 minutes as part of exercise program. 3. Additional Breathing techniques: 4-7-8 breathing, Box breathing (i.e. post exercise, or during manual therapy) 4. Encourage Mindful day to day activities (i.e. brushing, showering, walking) 5. Provide Handouts and Resources to patients 6. Guided Meditations/Apps: breath meditation, body scan, etc. 7. Find community mindfulness programs for patients (i.e., 6-14 week programs) 8. Encourage long-term practice (life-long student)

Let’s practice!

Apps that you can use: - Calm - Headspace - Insight Timer - Stop breathe and think

By Andrea Cutrupi

April 2023

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