FAQs - Frequently Asked Questions           



Why should I go through the considerable effort of learning mindfulness?


Mindfulness can have a deeply transformational effect. It can enable us to enjoy the simple things and endure much hardship. It makes it possible for us to live independent of automated patterns of thoughts and actions in a self-determined manner. This is like switching from a doing to a being mode and abandoning mental activities such as daydreaming, fantasies, thoughts about the future, and pondering.



Why not simply use MBSR (mindfulness-based stress reduction according to Kabat-Zinn) instead of MBPT?


MBSR was one of the first mindfulness-based therapy methods. The credit belongs to Kabat-Zinn for having successfully integrated mindfulness into medicine and psychotherapy. His method has been applied to various disorders. Good results have also been achieved for chronic pain patients.


The MBSR program lasts 8 weeks with weekly sessions of 2.5 hours, a concluding full-day of mindfulness training, and a follow-up session after 6 months. The course participants must agree to meditate formally every day for 45 minutes with the CDs. In addition, informal exercises are assigned as homework: mindful washing, eating, drinking, etc. The mindfulness includes physical exercises (yoga), the body scan (a meditative body journey), and sitting meditation. MBSR silently assumes that our negative states of mind are accessible to the consciousness. But this is not true. A (very large) portion functions on the preconscious or unconscious level. It is important to do justice to this fact.


When applied in pain practices, Kabat-Zinn‘s yoga sessions quickly prove not to be viable for pain patients. The evaluation sheets reveal that the body scans are seen as too boring, the mindfulness days are frequently skipped, and sitting meditations are difficult to perform according to Kabat-Zinn’s approach. The practice times are rated as unnecessarily long. Skills are not taught at all, and the meditations do not use the thoughts of pain as an object. But, above all: The educational section does not convey any knowledge about chronic pain. A technique that is tailored to pain patients absolutely must contain a psychoeducation section in which current scientific findings from pain research can be communicated. This could not even apply to MBSR since the most valuable findings of pain therapy were discovered long after the introduction of MBSR.

In summary: MBSR is the classic method and an excellent option for people who are stressed. Although changes occur when it is applied to pain patients, the effects are not substantial enough when considering it from the perspective of cost and time required.


In contrast, MBPT is a psychotherapeutic technique that is specially oriented toward pain patients and has been tested with them. It is not very time-intensive, yet it is affordable and can be quickly put into action under consideration of the essential points mentioned above for pain patients (preconsciousness of  most of the negative states of mind, decoupling of meditations and specific body postures and exercises, imparting of skills, pain-related meditations, and a psychoeducation section on the disorder).



What sense does it make to take a scientific approach to the topic of mindfulness? Isn’t it enough that mindfulness practices have stood the test of time over thousands of years?


The goal of the mindfulness tradition that has been historically passed down to us extends beyond what clinical psychological attempts to achieve (such as insight into the true nature of our existence versus insight into the pain-intensifying thought and behavior automatisms). In order to achieve recognition as a therapeutic technique, the rules for the scientific proof of effectiveness must be followed. This means that the medical-therapeutic mindfulness concept must be cleansed of cultural-religious elements and the concept of mindfulness – which was originally very complex and rather vague – must be put into practice so that it becomes possible to train in its individual steps in a verifiable way.


With a touch of exaggeration, we could say that the thought system of the historic mindfulness concepts come from Buddhist psychology.  The psychotherapeutic mindfulness concept is a subset of it that has eliminated the cultural-religious elements so that it can be used deliberately for the treatment of specific disorders.



Are there patients who you would not accept into your MBPT course? What are the options for these people?


Yes. For example, people with psychoses, impulse disorders, or severe personality disorders could feel that they are threateningly close to the unconscious contents in the trance sequences of the therapy when calmness is induced. This could lead to overstimulation, which would also be contagious to other participants. This is why we then prefer to recommend individual settings.

Problems on the level of language communication ability, as immigrants may have, can also have a restrictive effect. Then the therapist must consider whether the patient could adequately benefit from it. It is helpful to consider that MBPT is not a “pure” technique but also borrows from other forms of psychotherapy: psychoeducation, hypnotherapy, Gestalt therapy, the humanistic technique, and cognitive-behavioral therapy. Our patients may not always benefit equally from all of these approaches, but definitely from some of them. This must be discussed in the preparatory conversation. If the patient still wants to be accepted into the course after receiving this information, nothing else stands in the way.


There are also other, so-called low-threshold psychotherapeutic offers at our practice. We decide if they should be used on a case-by-case basis. They include fairytale therapy, psycho-functional ergotherapy, intuitive painting, and relaxation courses.



Must a therapist who would like to offer MBPT have long years of meditation and mindfulness experience?

No. Therapists who decide to do this must have numerous qualifications: In addition to many years of experience as a therapist, they must have sound psychotherapeutic and medical skills and knowledge. This is the most important premise. They must understand the concept of MBPT and be able to represent it to themselves and others. Furthermore, it would be an exaggeration to demand that therapists have long years of mindfulness and meditation experience – especially if required to somehow provide evidence of this. The authenticity of well-trained therapists and the serious approach to the topic is absolutely necessary. This should include their own experiences with the seven individual steps of the mindfulness cascade.


Apart from the therapists, there are also MBPT-trainer who do not have a therapeutic qualification. In general, they will come to teach MBPT because of their own meditation and mindfulness experience. This means that it is not irrelevant whether there is own meditation experience.



Am I bound to a religion or philosophy through meditation?


No. It is not necessary to belong to a specific religion or be a spiritual person in order to benefit from meditation. You must have the ability to approach a new experience with openness, always be willing to start over again, tune out thoughts of achievement, and practice with discipline on a regular basis. If you feel that you belong to a specific religious orientation, which one you have chosen does not play a role here. The practice of meditationcan be integrated into every religion and world view.



Is it necessary to assume the classic seated meditation pose in order to meditate?


You do not need to assume a meditation pose. Do not let yourself be pushed into any kind of attitude on either the psychological or the physical level. Asians also frequently sit on hard surfaces in a position similar to that of meditation. This is different for Westerners, and staying in the classic seated meditation pose can be painful and dangerous for them. In addition, the meditation is intended to help you achieve greater self-determination. So do not adopt anything without reflection and examination. The classic seated meditation pose has two advantages (for those who have practiced it):


1. It counteracts sleepiness. Too much comfort, such as in a half-supine or supine position, promotes sleepiness and uses energy to maintain concentration that would be put to better use for your meditation.


2. It makes it possible for you to sit in a completely balanced way. This position can be orthopedically sustained and requires just a minimum of strength for the battle with gravity.


So try to find a comfortable position in which you are "resting perfectly within yourself" and can stay for a while without needing to change your posture. Experienced meditation teachers often use this phrase: "Assume a posture that is as dignified as possible, in which you can calmly stay with ease for a long time and without moving. On the outside and the inside, stay completely... still."


However, meditation is not really dependent on a motionless posture. The only important things are the objectives that you should achieve in this manner: calmness and concentration on the object of the meditation. How you put this into practice can be left totally to your imagination. For example, if your pain should prevent you from assuming a motionless posture, you can also try something like walking slowly. Or you can combine your meditations with an everyday activity that you personally connect with calmness and the possibility of concentrating such as spending time in the restroom, brushing your teeth, or whatever else may occur to you in this regard.



brushing teeth



Meditation requires time. There is no “space” in my everyday schedule that would allow me to allocate this additional time.


Who has spare time today? But one result of meditation is that you will have the feeling of time “slowing down” – so you will even gain more time through meditating. This cannot be grasped intellectually. Only personal experience can convince you of it. Unambiguous reports on experiences by sensible people can encourage your motivation to start.


But how much time is actually required in concrete terms? We assume that five to ten minutes every day are already enough to gain some positive experience. At some point, you will have the strength for this “investment”: Try practicing for ten minutes each day for a two-week period. Then you will see whether the decision to meditate on a regular basis from now on will be made in favor of meditation when comparing the effort and the benefit. In the course of time, you will frequently meditate informally anyway as you turn your experiences of the moment into meditation objects under everyday conditions. This can even be done while riding the subway to work, etc.



Can spirituality influence my pain?


Not directly. However, spirituality can make you more sensitive to strategies that have the effect of reducing your suffering. But this requires translating spiritual considerations to a context of pain. For example: If you generally apply point one of Buddha’s Eight Point Program (right or realistic view), this is suitable for improving the quality of your life. However, this will only help you in relation to pain if you perceive what realities you are dealing with in your disorder (such as that a deterioration of the spinal column cannot be changed). Not realizing this fact will intensify your pain. Something similar also applies to meditation: It does not relieve pain in general, and; stubborn clinging to spiritual conventions (lotus position) can even have a pain-trigger, pain-maintaining, or pain-intensifying effect. These measures are only suitable for relieving pain when a pain-related insight meditation is performed.



When acute pain is inadequately treated, does it inevitably become chronified?


No. Longer pain exposition and inadequate treatment are promoting factors. However, there is also a natural protection against chronification, such as the individual skills that are conveyed within the scope of MBPT and arealready present within some people in various degrees.



Acute pain can become chronic. Is the reverse also possible?


This is improbable, but cannot be completely ruled out. As stated in the chapter on “Chronic Pain,” neuroplastic changes in the central nervous system and negative states of mind (both as a result of learning processes) are responsible for the chronification. Decades usually pass until the time when relearning once again occurs.


Chronic pain is not curable, but it usually responds well to treatment – so well that the result can be a life that is almost unimpaired by it. But – and this cannot be emphasized often enough – this depends on your own efforts and not, as is often assumed, on the nature of the medical treatment or the therapist. Improvement is mainly a matter that occurs from within you and cannot be mediated externally. Therapists can only provide support and show you the path, but you must take it on your own.


Is there any other non-pharmacolocical kind of therapy that you can recommend for the treatment of chronic pain?


Yes, just look up the following linkk, describing methods of neuromodulation: http://www.wege-aus-der-depression.de/index.php/neuromodulation


Copyright Dr. Peter Tamme and Dr. Iris Tamme

Last update: September 22, 2012