The Buddhist roots to MBPM
Underlying all the different elements of the program are core Buddhist teachings. Two Pali Canon texts in particular stand out as being especially relevant to pain management, the Sallatha Sutta and Satipatthana Sutta, and we also draw on key compassion approaches. Language has been adapted to be suitable for a health care intervention but the underlying principles have been developed over the 2500-year history of Buddhist practice.
In this Sutta the Buddha is asked to describe the difference between the response of a wise person and that of an ordinary person to pain. He goes on to use an analogy for physical pain as like being pierced by an arrow. Any human being will experience this, at least from time to time, as unpleasant sensations come with the territory of being human. He goes on to say an “ordinary” (unwise) person reacts with resistance and resentment and this is akin to being pierced by a second arrow. So, they then have the pain of two arrows:
When an ordinary person experiences a painful bodily feeling they worry, agonise and feel distraught. Then they feel two types of pain, one physical and one mental. It’s as if this person was pierced by an arrow, and then immediately afterwards by a second arrow, and they experience the pain of two arrows . . .
Having been touched by that painful feeling, they resist and resent it. They harbour aversion to it, and this underlying tendency of resistance and resentment towards that painful feeling comes to obsess the mind . . .
Being overwhelmed and dominated by pain, the ordinary person is joined with suffering and stress (Burch 2008, pp. 41, 43).
According to the Buddha, there is an alternative response to painful bodily feelings, which is that of a wise person:
When a wise person experiences a painful bodily feeling, they don’t worry, agonise and feel distraught, and they feel physical pain but not mental pain. It’s as if this person was pierced by an arrow, but a second arrow didn’t follow this, so they only experience the pain of a single arrow . . .
The wise person is not joined with suffering and stress. This is the difference between the wise person and the ordinary person (Burch 2008, p. 47).
At Breathworks this Sutta forms the core theoretical basis for the program. We call the first arrow Primary Suffering and the second arrow(s) Secondary Suffering, and suggest that MBPM can help us accept the Primary Suffering and reduce or overcome Secondary Suffering.
As the Buddha says, Primary Suffering/first arrow is a “given” in the moment it is experienced and the mindful response is an attitude of kindly acceptance. Secondary Suffering comes from reacting to the Primary Suffering with resistance and aversion—all the ways we act out “I don’t want this to be happening” This Secondary Suffering causes the majority of distress, and usually manifests within two extremes of avoidance (blocking) and overwhelm (drowning). Blocking includes behaviors such as addictions, restlessness, an inability to stop, and “headiness.” Drowning includes behaviors such as depression, being overwhelmed and taking to bed, self-pity, and a tendency to catastrophize and lose perspective. People with chronic pain often cycle between these poles, running away from unpleasant experience until they become exhausted, and then falling into an overwhelming loss of perspective and low mood.
As the Buddha says in the Sallatha Sutta, we can move toward acceptance of Primary Suffering and avoid Secondary Suffering by being like the wise person who “discerns and understands” his or her feelings “as they are actually present.” In other words, pay attention to experience as it really is, without trying to block it out or feeling overwhelmed. By coming back to present moment body awareness, primary sensations can be accepted with an attitude of kindness and care, and Secondary Suffering can dissolve away. Central to this perception is also the direct seeing into the nature of pain—that it is a flow of changing sensations rather than an unchanging “enemy" This leads to the overall experience of suffering being lessened, often dramatically.