In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing. Now, let's turn to examine several specific techniques to help cultivate mindfulness for practitioner and patient alike.
One effective method to cultivate mindfulness is to have a point of focus that is based within the physical body — whether it is the breath, the body as a whole, certain energetic centers (e.g. the lower dantian), or whatever area of the body has sensation (pain, constriction, numbness, etc) related to the trauma as it is triggered. It is through bringing the awareness into the body that the spirit can become more grounded in the body, and thus become more present to the moment-to-moment experiential reality. Becoming mindful through awareness of the body also has the ability to shift our nervous system response, to move us out of the sympathetic nervous system and into the parasympathetic — this will be explored in greater depth below.
Having a focal point that is based in the body allows the individual to concentrate awareness in such a way that the pain itself starts to shift and release — in other words, the individual can start to see the impermanence of the pain. In so doing, the individual often begins to see through the conditioned forms of pain and suffering, and finally sees where the pain is truly coming from, which is usually a deep rooted fear of not being ok, a fear that there is something fundamentally wrong with them.
The Pause Button
When it comes down to it, oftentimes we are recreating the same traumas over and over again, through the thoughts that occur and the reactions that come out of those thoughts. Coming from a conditioned place of fear, many people who have experienced trauma will tend to act out of reactionary fear and anger. Mindfulness starts to create space between the arising of the feeling and the immediate reaction; in this space is where one finds the choice to act differently. Mindfulness allows one to pause, to see the source from where our reactions arise. It is in this pause that we have the ability to choose something different, to choose love instead of fear, and to strengthen the neural pathways that take us in this direction.
Conditioned patterns of thought not only affect the mental state of the individual, they also affect the body through hormonal and biochemical regulations, in other words, if someone is always stuck in a state of fight-or-flight, their body's sympathetic nervous system is always on high alert and the associated hormones and neurotransmitters (such as adrenaline and cortisol) are more likely to be released and circulating through the body on a regular basis. The human mind is extremely powerful — so powerful that simply thinking about danger can cause our body to release these hormones. Such hormones have the ability to affect the body's ability to heal when an individual is regularly stuck in the sympathetic nervous system response, their body is not spending as much time or energy trying to heal as it is more occupied with the immediate perceived threats to survival. It is only when the individual is able to drop back into the parasympathetic nervous system that the body is able to again focus on healing.
However, the tendency for the individual to repeatedly trigger the trauma response is also the key to their healing, it is simply that whatever is strongly engrained and habitually re-played will create stronger neural pathways. This applies to fear, pain, and anger, yes, but it also applies to love, compassion, kindness, generosity, and gratitude. This is what it comes down to, the agency to choose our perspective, to choose love, awareness and truth over anger and delusion. This is not necessarily easy, but it is not impossible, either. This is an innate capacity of the human being, a capacity that can be trained through mindfulness practice and increasing one's ability to be present. Ultimately, this is a choice that we have, a choice to change our response to seemingly overwhelming circumstances, a choice to trust in ourselves, to trust in the flow of life. Through consistently choosing a different path, we create new pathways in the brain; over time, these will grow stronger and surpass the old imprinted pathways of trauma. And it is within the pause created by mindfulness that we enhance our opportunity of making this choice.
Besides mindfulness of the body, there are several other techniques that can help the individual in the process of grounding the spirit back in the body and breaking out of the sympathetic nervous system response, and through doing so lengthen the pause. One simple technique is to use abdominal breathing. In this exercise the individual places their hands on their abdomen (regardless of whether they are standing, sitting, or laying down), and as they breathe they allow only the abdomen to move in and out—the shoulders and chest should remain serenely still. While breathing with the abdomen, they can bring awareness into the shoulders if they are tense — relaxing the shoulders down and back helps to open the heart, and also helps the energy descend to the lower dantian. This exercise reverses the typical physical response to activation of the sympathetic nervous system. When the sympathetic nervous system is active, we start taking short, shallow breaths into the upper chest, raising the shoulders to breathe, which directs the energy up and out and keeps the individual ready for action. Abdominal breathing, on the other hand, engages the diaphragm, which then compresses the digestive organs and descends the energy downwards while bringing our awareness more to the interior.
Cultivating Presence as a Caregiver
Presence, mindfulness, and practices to ground the energy are not only important for the patient, this is also extraordinarily important for practitioners and caregivers. Presence is like a magnet, the more fully present the practitioner is, the more it draws the patient into greater presence. By extension, therefore, the greater degree of resilience of the practitioner, the more they can help patients to cultivate resilience.
When an individual is experiencing adversity, trauma, and spiritual loss, having a person that they can trust and turn to is of the utmost importance. Often in times of crisis, the individual may feel completely lost; building a trusting, dependable relationship with a caring other is often the first step to rebuilding trust in themselves, in other words, connecting with another allows them to reconnect within themselves. Thus the role of the caregiver is extraordinarily important, not only do they have the ability to offer practices and guidance to help the patient cultivate mindfulness and presence, but also (and perhaps more importantly) they are sometimes the first person that the patient may be able to trust. In this respect, it is of vital importance that the caregiver accept the patient completely as they are, without judgment, even while starting to offer a shift in perspective when the individual is ready for it. As trust builds, the caregiver can introduce more and more of the practices and suggestions listed above to help the individual become more mindful and present to themselves. This often happens slowly, over time, and depends on the rapport between practitioner and patient; therefore it is important for the practitioner to become skillful in knowing when the patient is ready to take the next step.
Times of adversity, trauma, and spiritual crisis can be overwhelming and can cause an individual to shut down, to disconnect from others as well as within oneself, and to shut down physically, emotionally, and spiritually. However, such times of difficulty and challenge are not inherently bad, they are simply part of the human experience. The more we are able to make space for these experiences, to be mindful of the sensations and thus to bring presence into them, the more they can teach us about how to heal and become whole. Being mindful, we create openings, and it is in the space of such openings that we can choose love over hate, compassion over anger, and wisdom over fear. As caregivers, we start by cultivating such mindfulness, presence, and compassion within ourselves; this then better enables us to guide others to do the same.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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