This article left me feeling animated and inspired about the potential of mindfulness practices, and particularly interoception, to change our experience of and relationship to pain.
Interoception is the perception of sensations from inside the body. These may be physical sensations related to heartbeat, breathing, and hunger, as well as autonomic nervous system activity related to a sense of safety or fight, flight, or freeze. Interoception gives us clues about our basic response to whatever we may be experiencing. It is my experience, over the course of my mediation practice and in working with clients in noticing somatic experience, that developing interoception is central to self-understanding, acceptance, and eventually right action.
Which is why I was delighted to learn from Cayoun and colleagues that a brief self-implemented mindfulness-based interoceptive exposure task (MIET) led to immediate and lasting chronic pain reduction in long-term chronic pain patients.
Previous research has shown that the transition from acute to chronic pain is influenced by cognitive and affective factors and that fear avoidance to pain can result in increased distress and hypervigilance. This pattern sensitizes the brain to pain, increasing pain signals and decreasing the ability of the prefrontal regions of the brain (the parts of the brain responsible for executive functions) to inhibit pain from the top-down. This process results in the persistence of chronic pain even in the absence of its initial source. The chronification of pain is related to a decreased ability to process sensory information of pain—and a reliance on emotional processing instead. In this way chronic pain is generally learned. The good news is, that if chronic pain is learned, it can be unlearned.
MIET is used for regulating emotions in Mindfulness-Integrated Cognitive Therapy and integrates exposure to interoceptive experience, equanimity, and “egolessness” (i.e., not taking the pain personally). 15 participants were briefly coached in the 30-second MIET protocol. I’ve pasted the protocol here for those of you who are curious.
- Locate the part in the body in which the sensation is the most intense.
- Focus all your attention at the center of the most intense area
- Immediately, begin to perceive what the sensation is composed of, in terms of its four basic characteristics:
- Mass (Is it light, heavy, neutral?)
- Temperature (Is it cold, warm, hot, neutral?)
- Motion (Does it move? Slow or fast? Is it immobile?)
- Cohesiveness (Is it dense, solid, constricted? Or is it loose, fluid, diffused?)
- While you monitor these basic characteristics, do your best not to identify with the sensation and perceive it just as a physical event that is impermanent, knowing that sensations always change.
- As much as you can, allow and accept these four characteristics, instead of resenting and reacting to them emotionally. Prevent any judgement and emotional reaction while remaining aware of them. Instead, study what they are and how they change” (Cayoun et al., 2020, p. 116).
I found the results of this pilot study rather amazing. First, all participants adhered to the protocol. My sense is this alone is worthy of note. Furthermore, participants rated the MIET 9.38/10 for acceptability—that is they really liked the practice and found it helpful. Participants reported immediate and lasting relief after being taught the MIET for the first time. Participants’ pain and pain-related distress was also found to decrease after the two-week treatment period and at a two-month follow-up. Importantly, participants showed a reduction in pain anxiety after the two-week treatment and at the two-month follow-up. The more participants practiced the exercise, the greater the reduction in pain they experienced—this may be explained by both a decrease in pain severity and neuroplasticity (i.e. how their brains processed pain began to change).
This study teaches us about the potency and potential of mindful interoception to shift the experience of pain for chronic pain patients. For me, it also invites the possibilities of mindful interoception to shift other experiences of pain and suffering. Cayoun, B., Simmons, A., & Shires, A. (2020). Immediate and lasting chronic pain reduction following a brief self-implemented mindfulness-based interoceptive exposure task: A pilot study. Mindfulness, 11(1), 112–124. https://doi.org/10.1007/s12671-017-0823-x