Body and mind always interact

It is unhelpful to think of body and mind as separate entities, they always work together, and both are responsive to our lifestyle and daily habits such as regular exercise, good nutrition, and adequate sleep. Most people readily accept that physical health can have an impact on mental states, but the reverse is also true - mental health problems are a major contributor to a wide range of chronic physical conditions. Our mental states can impact our physical health, and this is recognised in the WHO statement, "there is no health without mental health''.⁹ This section focuses on the management of stress and pain as good examples of the interaction between body and mind, and describes how both mental and physical states can be improved through mindfulness practice.

Managing stress and pain

Mild or moderate stress is part of normal life and can be good for our physical and mental performance. Only when stress is intense or prolonged does it cause problems. Intense stress triggers a cascade of physiological responses in hormones, immune function and the central nervous system which can lead to numerous physical and mental health conditions, including chronic fatigue, metabolic disorders (e.g. diabetes, obesity), depression, and immune disorders.

Research shows that the amount of harm stress causes is influenced not only by the severity of stress but by our attitude towards it.¹⁰ If our heart is pounding from anxiety, we can think of this as a danger signal or we can reframe the experience as our body giving us the energy we need to rise to a challenge, and perhaps learn from it. Viewing stress as a helpful part of life, rather than as harmful, is associated with emotional wellbeing, increased productivity at work, better health and improved physiological responses to stress - even during periods of high stress. Of course, wherever possible, we have to ensure that high levels of stress do not result from unreasonable demands imposed by the systems with which we interact.

How stressful is a maths test?

Prior to undertaking a maths exam, students were randomly assigned to a stress reappraisal intervention or a control group. The intervention group was taught about the adaptive benefits of stress arousal whereas controls were instructed to ignore the stress. Stress reappraisal resulted in less test anxiety and improved test performance. Other studies have shown that the benefits of instilling a 'stress-is-enhancing' mindset may persist for weeks or years.¹¹

Like stress, pain is part of normal life, and our attitude towards it can have a profound effect on the experience. When we feel pain, we tend to tense and brace, or tell ourselves stories about how the pain will never go away and our lives will be ruined - which only makes the pain worse. Mindfulness training is one way of changing our attitude to pain by approaching it with interest and curiosity, observing how it ebbs and flows, opening and softening into it, and not over-identifying with it. This in turn reduces the experience of pain and explains why mindfulness training has been adopted in many pain clinics.

Reflections:

Have you noticed times when your physical health impacts your mental functioning or emotional health - either in a positive or negative way?

Have you noticed times when your mental functioning or emotional health impacts your physical health - either in a positive or negative way?

Mindfulness and compassion as foundations of physical and mental health

Mindful awareness is both a characteristic of some people and a skill that can be learned - described in more detail in the Introduction. Mindfulness training programs have been shown to produce widespread benefits across many outcomes in clinical and general population samples. In patients with mental health problems substantial benefits have been shown in depression, anxiety and substance abuse. A study of patients with a history of recurrent depression by Willem Kuyken and colleagues showed that over a 60-week period patients who had received mindfulness training were one third as likely to have a relapse compared to those receiving usual treatment, and one fifth as likely compared to those receiving active treatment (anti-depressant medication or psycho-education).¹² Mindfulness training can rewire the brain by strengthening neural pathways that are conducive to healthy behaviour, whereas medication can only facilitate changes in neural firing. Physiological benefits of mindfulness training include reduced systolic blood pressure, better regulation of the parasympathetic nervous system which has a calming effect, improvements in immune function, and telomerase activity which is a marker of healthy biological aging. The self-compassion that is integral to mindfulness training has been shown to mediate some of the health benefits.

Mindfulness training not only reduces symptoms of mental and physical health problems, but also enhances wellbeing through developing skills and processes that enable us to function at our best, physically, mentally and socially. These include the basic skills of awareness, attention, emotion-regulation, self-compassion, and self-acceptance that enable us to feel more in control of our lives, more able to appreciate positive experiences and manage difficult ones. Mindfulness also enhances interpersonal relationships and prosocial behaviour that play a major role in personal wellbeing, while at the same time contributing to the wellbeing of the wider community.¹³

Mindfulness and compassion in healthcare staff play an important role in effective patient communication, and safe and compassionate care. More mindful clinicians listen more deeply and are rated more highly by patients on communication and their overall experience.¹⁴ A large study found that teams of nurses who had higher levels of mindfulness were less likely than other teams to make patient medication errors.¹⁵ Because mindfulness training has a positive impact on clinicians' wellbeing and treatment outcomes, it is increasingly being offered in healthcare settings, and since 2002 has been part of the core curriculum for medical students at Monash University in Australia.