Our bodies often suffer aches and pains for physical reasons. However, symptoms like anxiety-induced stomachaches and erectile dysfunction also run rampant in society. How can we overcome them without heading to the pharmacy first?
How can we use the principle of placebos through mindfulness to treat common disorders?
Mindfulness for pain
Let’s look at muscle tension disorders—and here I’m talking about headaches, temporomandibular joint disorder, a lot of neck, knee, foot, wrist, and shoulder pain. Now, we don’t have quite the data we have about these disorders that we have with chronic back pain. With chronic back pain, we know that the correlation between what’s found in the imaging of the spine and what people experience in terms of subjective distress is very, very low.
The condition of the spine only rarely actually influences whether or not people will be in pain. It’s not never—there are people for whom, yes, it’s the spine that’s causing the problem and yes, repair of the spine is what’s called for—but in the vast majority of cases, this isn’t the case.
With the case of neck, knee, wrist, shoulder pain, we don’t quite have the data. Largely because we haven’t done large-scale studies in which we take people without knee pain, without shoulder pain, without wrist pain, and take a look at what the body parts look like for them. The preliminary data is interesting.
For example, there’s a study of knee pain that showed that a torn meniscus is very common in men over the age of 55. The majority of pain-free men have a torn meniscus.
Learn more: Placebos, Illness, and the Power of Belief
Mindfulness for Sexual Dysfunction
Let’s move on to some other areas. Let’s move on, for example, to sexual dysfunctions. It’s basically fear of the dysfunction that brings on the dysfunction. Let’s take erectile dysfunction as an example. Before we had Viagra and Cialis, we had the inventions of Masters and Johnson—they were kind of the original sex therapists.
They had some pretty effective non-pharmacological treatments and they all targeted awareness of present experience with acceptance. They taught what they called “sensei focus.” And here’s what the instructions were like. They would send a couple home and they would say, here’s the deal. I want you to touch one another in a sensual and sexual way, only there are rules to this: You’re not allowed to pet to orgasm, and you’re not allowed to have intercourse. What you need to do instead is to simply bring your attention to the sensations of touching your partner (if you’re the one doing the touching) or being touched by your partner (if you’re the one being touched).
Every time your mind wanders and goes off to other things, just gently bring your attention back to the sensations of touching or being touched and let go of any goal orientation and simply accept whatever happens.
They were teaching mindfulness practice where the focus was sensual touch. And they found, for example, with erectile dysfunction, that about 75 percent of the time, just training couples to do this would resolve the disorder.
They also addressed other issues, such as people’s attitudes toward sexuality, and the dynamics of the couple’s relationship, whether people felt close or not. Nowadays, I’m sorry to say, these kinds of interventions are a little bit academic. We have Viagra and Cialis where people who don’t really like each other and can’t communicate can successfully have intercourse on a regular basis.
Mindfulness for Insomnia
Let’s look at insomnia. The conventional treatment for insomnia is stimulus control, sleep hygiene, and relaxation. And stimulus control means, we want to teach people to associate the bed with sleep. And the standard instruction is, I want you to reserve the bed for sleep and sex.
Now, if we’re really being logical about this, and we want to develop a paired association between the bed and sleep, we should really reserve it for just sleep—not just not reading and not watching TV, but not having sex either. We should be saying, you should have sex in another room, but sleep in the bed. I’m afraid that researchers have been a little bit too prudish to say, “Have sex in the living room, sleep in the bed,” so we include both.
The second thing we ask for is sleep hygiene. That means get up the same time each day, even if you haven’t had a full night’s sleep, and try to go to bed the same time each day, even if you’re not tired. And thirdly, they do relaxation training.
Learn more: When You Cannot Sleep—Insomnia
An alternative is to do mindfulness treatment. And the way mindfulness treatment works is to simply use the time in bed as an opportunity to be aware of present experience with acceptance. This is, frankly, what I do every night when I go to sleep. I lie down, I close my eyes, and I begin following the breath as we’ve done in the breath awareness training. If the mind wanders to other things, I gently bring the attention back to the breath.
Now it turns out that mindfulness practice actually reduces our need for sleep. People who go on meditation retreats who are doing mindfulness practice all day long find that they need a lot less sleep. And there’re two theories to this. One is that what’s happening is that some of the processing of what happens, the restorative functions of sleep, is happening in mindfulness therapy, or in mindfulness practice.Well, you could think of this as what’s happening in sleep is all sorts of unintegrated material is being re-integrated. We’re reconnecting with thoughts and feelings and memories that might have been difficult to be with. So if some of that’s happening while we’re doing the mindfulness practice, we don’t need as many hours of sleep to do it. The other hypothesis is that because we work through these things, we tend to sleep more deeply during the hours that we are sleeping, so that it’s more efficient. Either way, what happens is if we trust that mindfulness practice will help to be restorative for us, then we can give up the goal orientation.
And we all know that it is much easier, typically, to fall asleep on a Friday night if you don’t work over the weekend, then it is on a Sunday night if you work during the week. Because on Sunday night, you’re thinking, gosh, I got to get to bed so I’ll be well rested, otherwise tomorrow’s going to be a disaster at work, whereas on Friday night, it doesn’t really matter.
So when we remove the goal orientation, that helps a great deal. So the way I think of it is one of two things is going to happen: I’m either going to have the opportunity for eight uninterrupted hours of mindfulness practice—pretty good in a busy life, you don’t get that opportunity that often—or I’m going to fail and I’m going to fall asleep. And that would be fine as well.
Mindfulness for Gastrointestinal Distress
Let’s look at gastrointestinal distress. Now, this system is remarkably sensitive to our emotional lives. What the stress physiologists tell us is, there’s no need to digest your own lunch when you’re about to become somebody else’s lunch. So our GI system will often shut down when we’re under stress, or it will suddenly become overactive—kind of dump its load, if you will, so we can run away.
And people experience all manner of gastrointestinal distress. They experience upper GI symptoms, in which the stomach is producing too much stomach acid, and churning too much. And they experience lower GI symptoms very often that have to do with having alternating diarrhea and constipation, as we see in irritable bowel syndrome, or other kinds of disruptions.
Now ulcers were once thought to be caused by stress, and then we discovered the role of H. pylori. It turns out that you could treat an ulcer by giving an antibiotic that kills H. pylori bacteria, and often it would heal. But then we discovered that H. pylori infections are actually endemic to large percentages of the population.
In fact, there are some countries, I know Columbia was one of them, in which the majority of people have H. pylori infections. So, then that brings up the question, what’s determining whether somebody with H. pylori infection gets an ulcer or not? Well we’re back to the stress hypothesis. It turns out that stress is a critical factor in whether the stomach lining becomes broken down in a way that makes it vulnerable to the infection.
I mentioned irritable bowel syndrome. This is very, very common as a disorder. This is where you have this often alternating constipation and diarrhea. And here, the distress about the symptom is often the stressor that keeps it going, not unlike what we saw in chronic back pain.The distress about the symptom is often the stressor that keeps it going. Click To Tweet
So, a person’s afraid that they’re going to be caught off-guard and suddenly need the bathroom and they won’t be in a place where it’s convenient. Or they’re afraid that they’re going to get backed up, and they’re going to feel terrible cramping and things, and that’s going to get in the way of participating in life. It’s only when people can relax about IBS, and actually use mindfulness practices to simply ride the waves of different sensations. Like OK, this is what needing to go feels like. OK, this is what being stopped up feels like. Then they do considerably better.
This is true for the upper GI symptoms as well. Very often, people start to micromanage their diets. They start to try to figure out which foods are making me feel better or worse, and then eliminating foods from their diet.
Now of course, there are genuine food allergies, and these need to be treated medically. However, for a lot of people, what happens is as they’re trying to figure this out, as they’re becoming a junior scientist, we can’t differentiate from eating a tomato being problematic because the tomato is interacting with our stomach in a bad way, or whether the thought of eating a tomato is causing us anxiety and that anxiety is upsetting our stomach. Because as soon as we have the experience of a tomato making our stomach worse, we’re locked in a pattern where all future tomatoes will make our stomach worse through the anxiety mechanism.
Learn more: The Power of Placebos