Breath Works Research Presentation 2009
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Breathworks Research
breathworks-mindfulness.co.uk
Overview of Presentation Qualitative - Part of a PhD by Natasha Doran
Quantitative - questionnaires pre and post Our own questionnaire – trying to measure the inner process
1
Qualitative Study
Exploring Self Management Approaches to Living With Back Pain La Danaide Auguste Rodin 1889
Natasha Doran University of Manchester E-Mail: [email protected]
2
Full title of study • ‘Journeys through healthcare: A qualitative study exploring perceptions and experiences of health-seeking for chronic back pain in the north-west of England’. • PhD funded by the MRC at School of Primary Care, Manchester, UK
Study Aim • To look at the processes of adjustment to living with long-term pain and explore how exposure to mindfulness-based techniques relates to participants perceptions and management of their pain
3
Methods: Semi-structured interviews Biographical time line Participant Observation Informal Group Discussions
Fieldwork Settings: • Manchester Breathworks Self Management in Pain Group programmes.
• Liverpool Whiston hospital Spinal unit.
Breathworks sample ● 25 volunteer participants in total ● 16 volunteers through Breathworks - 11 Female - 5 Male ● Age 33 – 66 Years ● Back pain diagnoses ( prolapsed disc, arthritis, spondylitis) ● Duration of symptoms 4 – 28 years ● 9 on incapacity benefit
4
“I found if you give pain space it's a lot better, rather than trying to get rid of it, cos then you build emotions up and things tense and this brings more pain on.”
“I’ve learnt that much of my tension is unconscious…it’s been an unconscious response to my pain.”
“I looked at things in a very absolute way, so my pain was solid… my pain was everlasting... with the perception that I got through the course, I see that everything is always changing and that includes my pain. That helps me… It gives me a life that’s liveable.”
“Before I went to the [pain management] course, I was just fighting it, fighting the condition in my back all along the line.”
“It’s only now that I’m actually learning to breathe into the pain rather than tighten around it… living with pain means learning this difference.”
“[Now] I try not to get too hooked on the diagnosis; I just think, well, “What is my experience in this moment?” I don’t think, “What’s it called? What’s the label?”… I think there comes a point where it can be very liberating, to get away from the labels.”
5
Breathworks Self-Management in Pain Group Programme • Self-management techniques: • Key tools: Meditation & Body Scan, Relaxation, Mindful Movement, Diary keeping, Pacing, Working with Thoughts & Emotions. • Key concepts: ‘Moment by Moment Awareness’, Breathing into the pain, Learning to ‘Respond’ rather than ‘React’ to pain. • Awareness of pain/tension distinction Awareness of pain/suffering distinction
Results ● All reported far more acceptance of pain – rather than fearing/blocking pain, looking at ways to ‘move through it’ and ‘live with it’ ● Participants reported a shift in their self perception away from over identification with their illness identity. ● Despite some reported increase in pain over time, all reported increased quality of life.
6
Concluding Remarks • This qualitative study shows the benefits of using mindfulness-based approaches for managing persistent pain. • Initial interviews were conducted 4 years before end of study – showing that benefits have been sustained over time (including managing flare ups).
Acknowledgements:
[email protected]
7
Quantitative Study
Questionnaires pre and post 13 – 97 cases Pain experience – Pain Scale Depression, anxiety & positive outlook - DAPOS Confidence in activity despite pain – PSEQ Mindfulness – Freiburg Mindfulness Questionnaire Rumination, magnification & helplessness - PCS Activity engagement & pain willingness - CPAQ Quality of life - SF-36 Self-compassion questionnaire
8
Pain Questionnaire Pre‐programme mean Post‐programme mean 100 90 80
p≈0.002 N= 45
70
p≈0.000 N= 45
60 50
p≈0.003 N=45
p≈0.001
N=46
p≈0.024 N=46
40 30 20 10 0
Intensity
Distress
Interference Days (Good)
Days (Bad)
Depression, Anxiety and Positive Outlook 14 12
p≈0.000 N= 47
p=0.021 N=47
Mean
10 p≈0.000 N= 47
8
Pre‐programme mean 6
Post‐programme mean
4 2 0 DAPOS: Depression
DAPOS: Anxiety
DAPOS: PosiLve Outlook
9
Pain Self Efficacy Questionnaire 60 50 p≈0.000 N=48
40 30
Pre‐programme mean Post‐programme mean
20 10 0 Pain SelfEfficacy QuesLonnaire (PSEQ)
Freiburg Mindfulness Scale 40 35 30 25 20
p≈0.000 N=50
Pre‐programme mean Post‐programme mean
15 10 5 0
10
PCS: Rumination, Magnification and Helplessness
24
Pre‐programme mean
18
Post‐programme mean p≈0.000 N=48
12
p≈0.000 N= 48 p≈0.000 N= 48
6
0 PCS:RuminaLon Pre
PCS:MagnificaLon Pre
PCS:Helplessness Pre
CPAQ
66 60 54 48
p≈0.000 N= 47
42
Pre‐programme mean Post‐programme mean
p≈0.000 N= 47
36 30 24 18 12 6 0 CPAQ: AcLviLes Engagement
CPAQ: Pain Willingness
11
Quality of Life: SF-36 scales 100 90 80 70
p=0.362 N=25
p=0.017 N=26 p=0.034 N=26
p=0.002 N=26 p=0.001 N=25
60 50
p=0.017 N=24
p=0.011 N=26
p=0.008 N=26
40 30
Pre‐programme mean
20
Post‐programme mean
SF‐36 GENERAL HEALTH PERCEPTIONS
SF‐36 PAIN INDEX
SF‐36 ENERGY/VITALITY
SF‐36 MENTAL HEALTH INDEX
SF‐36 ROLE‐EMOTIONAL
SF‐36 ROLE‐PHYSICAL
SF‐36 SOCIAL FUNCTIONING
0
SF‐36 PHYSICAL FUNCTIONING
10
Self Compassion Questionnaire 20 18 16
p≈0.000 N= 32
p≈0.000 N= 33
p≈0.000 N=35
14
p≈0.009 N=33
p≈0.003 N=33
p≈0.000 N=31
12 10
Pre‐programme mean
8
Post‐programme mean
6 4 2 0 self self common kindness judgement humanity
isolaLon Mindfulness
over idenLfied
12
Breathworks questionnaire We have also been developing our own questions looking at areas most sensitive to process and change
Breathworks questionnaire
13
Living with a Painful Body 6
Pre‐programme mean
5
N= 50 p≈0.000
4
N=49 p≈0.000
Post‐programme mean
N=50 p≈0.000 A. How accepting do you feel you are of it?
3
B. Can you live in harmony with it? C. Are you able to maintain perspective when in pain?
2 1 0 A
B
C
Kindness to self and others
6
Pre‐programme mean
5
A. Kindness to self (p≈0.000) B. Kindness to others (p=0.244) C. Open to others (p=0.127) D. Communication (p ≈0.219) E. Honesty about needs (p ≈0.000) F. Open to others’ needs (p=0.153)
Post‐programme mean 4
3
2 N=50 1
0 A
B
C
D
E
F
14
Awareness of self
6
Pre‐programme mean Post‐programme mean
5
How aware are you of A. Bodily sensations? (p=0.004)
4
B. Feelings and emotions? (p=0.017)
3
C. Thoughts? (p=0.001) N=50
2 1 0 A
B
C
Awareness of the World
p=0.952 N=50
How aware are you of the world around you? p=0.063 N=50
A. The unpleasant things B. The beautiful things
15
Choice
6
5
4
3
2
N=48 p=0.002
N=50 p=0.001
N=50 p≈0.000
N=50 p≈0.000
N=50 p≈0.000
N=47 p=0.115
N=48 p≈0.000
1
How much choice do you feel you have in how you respond to: a,c,e: pleasant bodily sensations/feelings/ thoughts? b,d,f: unpleasant bodily sensations/feelings/ thoughts? g: unpleasant external events outside your control?
0 A
B
C
D
E
F
G
Summary of Breathworks questionnaire Greater acceptance of pain, and ability to maintain perspective Increased sense of kindness to self and others Increased awareness of the beautiful Greater sense of choice in response to unpleasant physical sensations, feelings and thoughts
16
Thank you to everyone who has helped us with our research Elaine Weatherley-Jones, PhD Alice Plummer, PhD Ian Wray, PhD Amanda C de C Williams, PhD Natasha Doran, PhD Caro Edwards Glenn Miller Hayley Morris Maggie Muir and Annie Bracken
Breathworks Research
breathworks-mindfulness.co.uk
17
breathworks-mindfulness.co.uk
Overview of Presentation Qualitative - Part of a PhD by Natasha Doran
Quantitative - questionnaires pre and post Our own questionnaire – trying to measure the inner process
1
Qualitative Study
Exploring Self Management Approaches to Living With Back Pain La Danaide Auguste Rodin 1889
Natasha Doran University of Manchester E-Mail: [email protected]
2
Full title of study • ‘Journeys through healthcare: A qualitative study exploring perceptions and experiences of health-seeking for chronic back pain in the north-west of England’. • PhD funded by the MRC at School of Primary Care, Manchester, UK
Study Aim • To look at the processes of adjustment to living with long-term pain and explore how exposure to mindfulness-based techniques relates to participants perceptions and management of their pain
3
Methods: Semi-structured interviews Biographical time line Participant Observation Informal Group Discussions
Fieldwork Settings: • Manchester Breathworks Self Management in Pain Group programmes.
• Liverpool Whiston hospital Spinal unit.
Breathworks sample ● 25 volunteer participants in total ● 16 volunteers through Breathworks - 11 Female - 5 Male ● Age 33 – 66 Years ● Back pain diagnoses ( prolapsed disc, arthritis, spondylitis) ● Duration of symptoms 4 – 28 years ● 9 on incapacity benefit
4
“I found if you give pain space it's a lot better, rather than trying to get rid of it, cos then you build emotions up and things tense and this brings more pain on.”
“I’ve learnt that much of my tension is unconscious…it’s been an unconscious response to my pain.”
“I looked at things in a very absolute way, so my pain was solid… my pain was everlasting... with the perception that I got through the course, I see that everything is always changing and that includes my pain. That helps me… It gives me a life that’s liveable.”
“Before I went to the [pain management] course, I was just fighting it, fighting the condition in my back all along the line.”
“It’s only now that I’m actually learning to breathe into the pain rather than tighten around it… living with pain means learning this difference.”
“[Now] I try not to get too hooked on the diagnosis; I just think, well, “What is my experience in this moment?” I don’t think, “What’s it called? What’s the label?”… I think there comes a point where it can be very liberating, to get away from the labels.”
5
Breathworks Self-Management in Pain Group Programme • Self-management techniques: • Key tools: Meditation & Body Scan, Relaxation, Mindful Movement, Diary keeping, Pacing, Working with Thoughts & Emotions. • Key concepts: ‘Moment by Moment Awareness’, Breathing into the pain, Learning to ‘Respond’ rather than ‘React’ to pain. • Awareness of pain/tension distinction Awareness of pain/suffering distinction
Results ● All reported far more acceptance of pain – rather than fearing/blocking pain, looking at ways to ‘move through it’ and ‘live with it’ ● Participants reported a shift in their self perception away from over identification with their illness identity. ● Despite some reported increase in pain over time, all reported increased quality of life.
6
Concluding Remarks • This qualitative study shows the benefits of using mindfulness-based approaches for managing persistent pain. • Initial interviews were conducted 4 years before end of study – showing that benefits have been sustained over time (including managing flare ups).
Acknowledgements:
[email protected]
7
Quantitative Study
Questionnaires pre and post 13 – 97 cases Pain experience – Pain Scale Depression, anxiety & positive outlook - DAPOS Confidence in activity despite pain – PSEQ Mindfulness – Freiburg Mindfulness Questionnaire Rumination, magnification & helplessness - PCS Activity engagement & pain willingness - CPAQ Quality of life - SF-36 Self-compassion questionnaire
8
Pain Questionnaire Pre‐programme mean Post‐programme mean 100 90 80
p≈0.002 N= 45
70
p≈0.000 N= 45
60 50
p≈0.003 N=45
p≈0.001
N=46
p≈0.024 N=46
40 30 20 10 0
Intensity
Distress
Interference Days (Good)
Days (Bad)
Depression, Anxiety and Positive Outlook 14 12
p≈0.000 N= 47
p=0.021 N=47
Mean
10 p≈0.000 N= 47
8
Pre‐programme mean 6
Post‐programme mean
4 2 0 DAPOS: Depression
DAPOS: Anxiety
DAPOS: PosiLve Outlook
9
Pain Self Efficacy Questionnaire 60 50 p≈0.000 N=48
40 30
Pre‐programme mean Post‐programme mean
20 10 0 Pain SelfEfficacy QuesLonnaire (PSEQ)
Freiburg Mindfulness Scale 40 35 30 25 20
p≈0.000 N=50
Pre‐programme mean Post‐programme mean
15 10 5 0
10
PCS: Rumination, Magnification and Helplessness
24
Pre‐programme mean
18
Post‐programme mean p≈0.000 N=48
12
p≈0.000 N= 48 p≈0.000 N= 48
6
0 PCS:RuminaLon Pre
PCS:MagnificaLon Pre
PCS:Helplessness Pre
CPAQ
66 60 54 48
p≈0.000 N= 47
42
Pre‐programme mean Post‐programme mean
p≈0.000 N= 47
36 30 24 18 12 6 0 CPAQ: AcLviLes Engagement
CPAQ: Pain Willingness
11
Quality of Life: SF-36 scales 100 90 80 70
p=0.362 N=25
p=0.017 N=26 p=0.034 N=26
p=0.002 N=26 p=0.001 N=25
60 50
p=0.017 N=24
p=0.011 N=26
p=0.008 N=26
40 30
Pre‐programme mean
20
Post‐programme mean
SF‐36 GENERAL HEALTH PERCEPTIONS
SF‐36 PAIN INDEX
SF‐36 ENERGY/VITALITY
SF‐36 MENTAL HEALTH INDEX
SF‐36 ROLE‐EMOTIONAL
SF‐36 ROLE‐PHYSICAL
SF‐36 SOCIAL FUNCTIONING
0
SF‐36 PHYSICAL FUNCTIONING
10
Self Compassion Questionnaire 20 18 16
p≈0.000 N= 32
p≈0.000 N= 33
p≈0.000 N=35
14
p≈0.009 N=33
p≈0.003 N=33
p≈0.000 N=31
12 10
Pre‐programme mean
8
Post‐programme mean
6 4 2 0 self self common kindness judgement humanity
isolaLon Mindfulness
over idenLfied
12
Breathworks questionnaire We have also been developing our own questions looking at areas most sensitive to process and change
Breathworks questionnaire
13
Living with a Painful Body 6
Pre‐programme mean
5
N= 50 p≈0.000
4
N=49 p≈0.000
Post‐programme mean
N=50 p≈0.000 A. How accepting do you feel you are of it?
3
B. Can you live in harmony with it? C. Are you able to maintain perspective when in pain?
2 1 0 A
B
C
Kindness to self and others
6
Pre‐programme mean
5
A. Kindness to self (p≈0.000) B. Kindness to others (p=0.244) C. Open to others (p=0.127) D. Communication (p ≈0.219) E. Honesty about needs (p ≈0.000) F. Open to others’ needs (p=0.153)
Post‐programme mean 4
3
2 N=50 1
0 A
B
C
D
E
F
14
Awareness of self
6
Pre‐programme mean Post‐programme mean
5
How aware are you of A. Bodily sensations? (p=0.004)
4
B. Feelings and emotions? (p=0.017)
3
C. Thoughts? (p=0.001) N=50
2 1 0 A
B
C
Awareness of the World
p=0.952 N=50
How aware are you of the world around you? p=0.063 N=50
A. The unpleasant things B. The beautiful things
15
Choice
6
5
4
3
2
N=48 p=0.002
N=50 p=0.001
N=50 p≈0.000
N=50 p≈0.000
N=50 p≈0.000
N=47 p=0.115
N=48 p≈0.000
1
How much choice do you feel you have in how you respond to: a,c,e: pleasant bodily sensations/feelings/ thoughts? b,d,f: unpleasant bodily sensations/feelings/ thoughts? g: unpleasant external events outside your control?
0 A
B
C
D
E
F
G
Summary of Breathworks questionnaire Greater acceptance of pain, and ability to maintain perspective Increased sense of kindness to self and others Increased awareness of the beautiful Greater sense of choice in response to unpleasant physical sensations, feelings and thoughts
16
Thank you to everyone who has helped us with our research Elaine Weatherley-Jones, PhD Alice Plummer, PhD Ian Wray, PhD Amanda C de C Williams, PhD Natasha Doran, PhD Caro Edwards Glenn Miller Hayley Morris Maggie Muir and Annie Bracken
Breathworks Research
breathworks-mindfulness.co.uk
17
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