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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
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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]
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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
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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●16volunteersthroughBreathworks-11Female-5Male●Age33–66Years●Backpaindiagnoses(prolapseddisc,arthritis,spondylitis)●Durationofsymptoms4–28years●9onincapacitybenefit
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“Before I went to the [pain management] course,
I was just fighting it, fighting the condition in my back
all along the line.”
“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.”
“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.”
“I’ve learnt that much of my tension
is unconscious…it’s been an unconscious response to my pain.”
“[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.”
“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.”
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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’ ●Participantsreportedashiftin 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.
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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:
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Quantitative Study
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
Questionnaires pre and post
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Pain Questionnaire
0
10
20
30
40
50
60
70
80
90
100
Intensity Distress Interference Days (Good) Days (Bad)
Pre‐programme mean
Post‐programme mean
p≈0.002 N= 45
p≈0.003 N=45 p≈0.001
N=46 p≈0.000 N= 45
p≈0.024 N=46
Depression, Anxiety and Positive Outlook
0
2
4
6
8
10
12
14
DAPOS: Depression DAPOS: Anxiety DAPOS: PosiLve Outlook
Mean
Pre‐programme mean
Post‐programme mean
p≈0.000 N= 47
p≈0.000 N= 47
p=0.021 N=47
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Pain Self Efficacy Questionnaire
0
10
20
30
40
50
60
Pain SelfEfficacy QuesLonnaire (PSEQ)
Pre‐programme mean
Post‐programme mean
p≈0.000 N=48
Freiburg Mindfulness Scale
0
5
10
15
20
25
30
35
40
Pre‐programme mean
Post‐programme mean
p≈0.000 N=50
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PCS: Rumination, Magnification and Helplessness
0
6
12
18
24
PCS:RuminaLon Pre PCS:MagnificaLon Pre PCS:Helplessness Pre
Pre‐programme mean
Post‐programme mean
p≈0.000 N= 48
p≈0.000 N= 48
p≈0.000 N=48
CPAQ
0
6
12
18
24
30
36
42
48
54
60
66
CPAQ: AcLviLes Engagement CPAQ: Pain Willingness
Pre‐programme mean Post‐programme mean p≈0.000
N= 47
p≈0.000 N= 47
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Quality of Life: SF-36 scales
0
10
20
30
40
50
60
70
80
90
100
SF‐36 PH
YSICAL
FUNCT
IONING
SF‐36 SO
CIAL
FUNCT
IONING
SF‐36 RO
LE‐PHYSICAL
SF‐36 RO
LE‐EMOTIONAL
SF‐36 MEN
TAL HEA
LTH
INDEX
SF‐36 EN
ERGY/VITALITY
SF‐36 PA
IN IN
DEX
SF‐36 GEN
ERAL HEA
LTH
PERC
EPTIONS
Pre‐programme mean
Post‐programme mean
p=0.362 N=25
p=0.008 N=26
p=0.002 N=26
p=0.017 N=24
p=0.034 N=26
p=0.017 N=26
p=0.001 N=25
p=0.011 N=26
Self Compassion Questionnaire
0
2
4
6
8
10
12
14
16
18
20
self kindness
self judgement
common humanity
isolaLon Mindfulness over idenLfied
Pre‐programme mean
Post‐programme mean
p≈0.000 N= 32
p≈0.000 N= 33 p≈0.000
N=35 p≈0.009 N=33
p≈0.003 N=33 p≈0.000
N=31
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Breathworks questionnaire
We have also been developing our own questions looking at areas most sensitive to process and change
Breathworks questionnaire
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Living with a Painful Body
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1
2
3
4
5
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A B C
Pre‐programme mean Post‐programme mean
N= 50 p≈0.000
N=49 p≈0.000
N=50 p≈0.000
A. How accepting do you feel you are of it?
B. Can you live in harmony with it?
C. Are you able to maintain perspective when in pain?
Kindness to self and others 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)
0
1
2
3
4
5
6
A B C D E F
Pre‐programme mean
Post‐programme mean
N=50
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Awareness of self How aware are you of
A. Bodily sensations? (p=0.004)
B. Feelings and emotions? (p=0.017)
C. Thoughts? (p=0.001)
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1
2
3
4
5
6
A B C
Pre‐programme mean Post‐programme mean
N=50
Awareness of the World
How aware are you of the world around you?
A. The unpleasant things B. The beautiful things
p=0.952 N=50
p=0.063 N=50
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Choice
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1
2
3
4
5
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A B C D E F G
N=50 p≈0.000
N=50 p≈0.000 N=48
p≈0.000
N=50 p≈0.000
N=50 p=0.001
N=48 p=0.002 N=47
p=0.115
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?
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
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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
