Incorporating Mindfulness in Physical Therapy Practice

Help patients reap the physical, physiological, and cognitive benefits of mindfulness.

By Pauline Lucas, PT, DPT*

The concept of mindfulness originates in ancient Eastern philosophy and a secularized version became popularized in the West by pioneers like molecular biologist Jon Kabat-Zinn, PhD, founder of the popular Mindfulness Based Stress Reduction (MBSR) program.

MBSR is an eight-week program including weekly classes, meditation practices, and yoga, which Dr. Kabat-Zinn originally introduced at University of Massachusetts Medical School in the late 70s. Since that time, thousands of research studies on mindfulness have demonstrated benefits both in physical as well as psychosocial and cognitive domains accounting for the integration of mindfulness programs not only in health care institutions but in churches, schools, prisons, professional sports, and large businesses.

Especially over the past 10 years, mindfulness and meditation have gained popularity, evident by the explosion of mindfulness topics in scientific publications,¹ the vast amounts of books and magazines available on the topic, an ever-expanding variety of apps, and the rapidly growing number of mindfulness training programs.

Mindfulness Defined

Mindfulness has become a household word, typically used in the context of general paying attention, as in “be mindful of your step.” But the concept of mindfulness is actually a very complex one and refers to paying attention in a specific way: intentional, in the present moment, with kind and curious focus, and without judgment. Besides a technique or skill we can learn and practice, the term also refers to a state of mind, having an awareness of our own present moment experiences, and ultimately a way of living life. The Center for Greater Good Science Center at the University of California, Berkeley defines mindfulness as “maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment, through a gentle, nurturing lens.”²

An Experience of Mindfulness

Chances are, even if you have never consciously practiced, you have experienced a state of mindfulness — a time when all your attention was in the moment and nothing else seemed to matter. Recall walking in nature in breathtaking scenery, watching a beautiful sunset, being in the midst of a creative endeavor like making music or painting, falling in love, or witnessing the birth of a baby. The good news is that we can experience more moments of mindful presence without needing to create these types of perfect scenarios. With practice we can learn to be in this state and experience more fulfillment and pleasure in so-called “mundane situations.”

A brief experience will likely be useful in helping you understand how you can consciously practice mindfulness. I invite you to stop reading this article for a moment and simply observe your next three breaths. Feel the air as it enters your body ideally through the nose; notice the brief pause as the inbreath turns into an outbreath and then notice when the outbreath is complete and ready to turn into another inbreath. At the end of the three breaths notice how this practice made you feel. Were you able to maintain awareness of the breathing experience or did you notice your mind wandering? If so, were you able to bring the mind back to the practice without judging yourself? Did you find yourself analyzing your breathing pattern, or was it easy for you to simply experience the movement of the breath?

How to Practice Mindfulness

There are many ways to practice mindfulness. What we are really doing is training the mind to stay focused on the experience while we are engaged in certain activities. Author and meditation teacher Sarah McLean describes mindfulness practice as training of the ability to stay engaged with what you are doing while you are doing it.³ Common mindfulness practices include seated meditation, mindful walking, yoga, mindful eating, body scan practice, and breath awareness technique. As we develop our skills, we can bring an attitude of mindfulness to everything we do and eventually it becomes a way of living life.

Cultivating Mindfulness in Physical Therapy Practice

There are many great science-backed reasons to incorporate mindfulness in your practice, both for your personal and your team’s health and wellness, improved patient outcomes and treatment satisfaction, as well as for the benefit of the business.

Stress Reduction

Health care providers are under a significant amount of stress, and physical therapists are no exception. Not only are we caring for patients in various states of distress, we are also dealing with increasing workload, and ever-changing documentation, billing, and insurance demands. Managing the constant information overload through scientific journals, emails, social media, and trainings we participate in can cause us to feel like we are always catching up as to not get behind on the latest advances in our field. Add to this any personal stresses (e.g., student loans and other financial concerns, relationship issues, health concerns) and we are at increasing risk for stress-related illness and burnout. Although clinician burnout is a systemic problem requiring changes on many levels (including organizational), the cultivation of mindfulness has shown to decrease perceived stress level, lower burnout scores, increase self-compassion scores, and improve in the overall wellbeing of health care professionals and trainees.⁴

Improved Mood

A regular mindfulness practice either as stand-alone or as part of a more comprehensive treatment approach has been shown to reduce anxiety and depression. Additionally, people who regularly meditate tend to be happier. This not only benefits the meditator, but as moods are contagious, could positively affect the entire team, as well as the patients. One explanation for this benefit is that mindfulness trains us to become aware of our state of mind. When we notice our mind stuck in negative thinking about the past or future, we can choose to redirect our thoughts to the present moment or something more pleasant. This not only shifts our mood, but has the added physiological benefit of helping us to relax more. It is known that being stuck in thoughts of self-judgement, anger, and worry can actually activate the stress response with results like headaches, digestive distress, and sleep difficulties.

Pain Management

There is an abundance of studies measuring the effects of mindfulness-based interventions (MBI) on people suffering with chronic pain. The results are encouraging, and although many report a decrease in pain intensity, the most significant findings include better coping and improved quality of life. Although MBI should not be seen as a substitute for treatments like physical therapy, they complement each other perfectly. The final recommendation in an article on the topic published in the Journal of the American Medical Association was that the health care provider should be prepared to educate patients on the potential benefits of practicing mindfulness.⁵

Better Patient Care

In his book Full Catastrophe Living, Dr. Kabat-Zinn writes: ”Physical therapists often undertake to teach people healing things for their bodies while neglecting two of the most powerful allies people have for healing; the breath and the mind.”⁶ He makes the case that, when patients have better body awareness and learn how to use their breath correctly, they show better outcomes with physical therapy treatment. The therapist may choose to teach mindfulness skills to the patient and integrate them in their treatment plan, but if that’s not part of their expertise, the therapist may encourage their patient to use one of the widely available mindfulness apps. If the therapist has a regular mindfulness practice, there will be benefits for the patients as well, the result of increased provider compassion and improved quality of the therapeutic relationship.

Good for Business

In recent years mindfulness research has expanded to include the effects on various aspects of the workplace. Large companies like Aetna, Google, General Mills, Apple, Nike, and Intel have implemented mindfulness programs for their employees. The benefits cited in research on these workplace mindfulness programs include improved productivity, reduced stress level, greater job satisfaction, increased happiness, mental clarity, and enhanced creativity. A recent article in Forbes describes the importance of mindfulness programs in fast-paced businesses, not only to increase employee well-being, but also to improve company savings as result of a drop in medical claims.⁷

Getting Started

Although there is no substitution for in-depth mindfulness training with an experienced teacher, with the availability of many resources, it is easy to acquire basic knowledge needed to start a personal mindfulness practice. The following are five practical techniques you can implement today.

1. Upon awakening, take one minute to notice the state of your body, state of your mind, and pace of your breath.
2. Choose a recurrent activity in your day like hand washing and commit to practicing it each time with full attention.
3. When sitting down for a meal, take a moment to contemplate what it took for the food to end up on your plate, from the seed planted in the soil to the vegetable prepared on your plate. Then take your first bite with full awareness of the taste, texture, and your experience of eating.
4. Take a long slow breath before you answer the phone, a text, or email.
5. When meeting a new person, practice being fully present as they introduce themselves. Perhaps notice the color of their eyes.

Although the concept of mindfulness is rather complicated, the practice is actually quite straight forward. I encourage you to choose one of the activities listed here and mindfully practice it for a week, simply noticing the effect it has on you. The following weeks expand this by gradually adding additional practice activities, until pretty soon you sprinkle many moments of mindfulness through your day. For additional benefit, consider doing it together with a friend or colleague or consider a “mindfulness challenge” with your entire work team. Science is unequivocal: taking a bit of time to include mindfulness in your day will benefit your well-being, the health of your practice, and your patients’ satisfaction with their care. 

References:

¹The American Mindfulness Research Association. About AMRA. https://goamra.org/about/. Accessed June 5, 2020.

²What is Mindfulness? Greater Good Magazine website. https://greatergood.berkeley.edu/topic/mindfulness/definition. Accessed June 5, 2020.

³McLean S. The Power of Attention: Awaken to Love and Its Unlimited Potential with Meditation. Carlsbad, CA: Hay House Inc.; 2017.

⁴Shapiro SL, Carlson LE. The Art and Science of Mindfulness: Integrating Mindfulness Into Psychology and the Helping Professions. Washington, DC: American Psychological Association; 2009.

⁵Goyal M, Singh S, Sibinga EM, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA. 2014;174(3):357-368.

⁶Kabat-Zinn J, Hanh TN. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. London, UK: Bantam; 2009.

⁷Schenck J. Mindfulness Programs Are The Next Big Thing In Business Leadership. Forbes. https://www.forbes.com/sites/forbesfinancecouncil/2019/07/02/mindfulness-programs-are-the-next-big-thing-in-businessleadership/#62bac53e49c9. Published July 2, 2019. Accessed June 5, 2020.

Pauline Lucas, PT, DPT, is an integrative physical therapist at Mayo Clinic in Arizona. She provides mindfulness and resilience training to health care providers and health and wellness coaching to individuals and groups through her business, Phoenix Yoga and Meditation, LLC. She can be reached at pauline@drpaulinelucas.com.

*The author has a professional affiliation with this subject.