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Mindfulness-Based Pain Therapy (MBPT)

           

While it has been possible for decades to treat the physical aspects of chronic pain with the help of many highly efficient techniques, there has not been a useful psychotherapeutic treatment concept for the psychological components of this disorder with its intense suffering: Either undifferentiated relaxation techniques have been offered or a treatment according to the watering-can principle with a high percentage of “wastage” was recommended within the scope of a general, non-specific psychotherapy (frequently by therapists without adequate knowledge of pain therapy).

 

In his specialized practice for pain therapy, psychotherapy, and palliative medicine in Lüneburg/Germany, the pain therapist and psychotherapist Dr. Peter Tamme has treated chronic pain patients for more than 20 years. During this time, he saw the need to fill this gap in the psychological care of chronic pain patients and develop a practice-oriented, affordable technique that could also be used in practices without trained psychotherapists; above all, it should help patients be successful quickly.

 

This goal was achieved with the development of the mindfulness-based pain therapy (MBPT): Now a therapy concept is available that offers the complex concept of mindfulness in a way that can be put into action andis especially oriented toward the concerns of the patient with a pain disorder. It can be applied in both the individual and the group setting.

 

pillars

The Three Pillars of MBPT

 

The goal of mindfulness-based pain therapy (MBPT) is to learn how to differentiate between the natural suffering and self-made suffering, to let go of entanglement in the self-made suffering, and to find a balance between acceptance of natural suffering and the desire for change. Practicing what has been learned reinforces the mindfulness exercises (meditation).

The method is based on the following three pillars:

 

Psychoeducation  (communication of knowledge)

Skills (acquisitionof abilities)

Mindfulness (intervention method)

 

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Psychoeducation

Even though the first pillar of MBPT may sound like a set of instructions, this is not the case. Instead, the affected individual should be given important information about his or her disorder and made aware of the fact that:

 

  • Pain does not directly determine the extent of suffering.
  • Pain-associated suffering is dependent on negative states of mind.
  • Chronic pain is not comparable with acute pain.
  • Chronification leads to changes in the nervous system.
  • Chronification leads to psychological changes.
  • Treatment methods, goals, and the prognosis are different for pain chronification.
  • Chronification represents a bio-psycho-social phenomenon and the proportion of these three components is different for each patient.
  • Good therapeutic support allows patients to treat themselves to a large extent.

 

 

skills

Skills

The second pillar of MBPT defines the skills of patients in recognizing, evaluating, describing and finally overcoming their entanglement in negative states of mind with the help of therapeutically supported self-exploration. This requires much honesty toward oneself. Since the patients only engage in self-revelation instead of opening up to a stranger, the threshold is relatively low but still represents a factor that could limit success.

 

The negative states of mind are associated with various thematic areas:

 

Patterns of behavior: Pronounced non-verbal pain behavior (such as a facial expression or unnecessary walking aid), pronounced verbal pain behavior (rambling descriptions, unreasonably high indications of pain values), inappropriate staying power, not adhering to the recommended health behaviors (such as doing garden work despite back problems), pain as a means of regulating relationships, pain as a means of regulating social problems, flight into self-medication or changing the dosage of the medication, frequently switching therapists, and pronounced attention to the physical processes in one’s own body.

 

Attitudes: Rebelling against the diagnosis of “chronic pain”, stubborn attempts at wanting to solve an unsolvable problem, continuing search for causes, and basic pessimistic attitude.

 

Stress processing: Avoidance, resignation, illusion of control, anger-oriented stress processing, trivialization, catastrophizing, and excessive diversion.

 

Strains: Conflicts in the family or at work, threat of the existential basis, difficult conditions during upbringing with emotional deprivation, severe physical or psychological illness of a close relative, and threatened or actual loss of close relative or attachment figure.

 

Emotions: Irritated mood, sad/depressed mood, easily triggered inner excitability, exaggeratedly positive emotional expression, and hostility.

 

Belief systems and mindsets: Arbitrary conclusions, emotional argumentation, resignation, taking things personally, seeing things in terms of black-and-white, and blaming others.

 

It is obvious that this list could be expanded.

 

Why is it so difficult to discover these or other pain-intensifying factors within ourselves?

Most of us have a certain image of ourselves and tend to also just accept self-observations that correspond to this image. Perceiving negative states of mind within ourselves requires much openness, perhaps even courage. And in addition to this required ability to be introspective, another fact further complicates the intention of revealing these automated patterns of thinking, feeling, and behaving. This obviously only works when we are also truly conscious of our thoughts, actions, etc. But what happens when we are dealing with things that are preconscious or unconscious? We can access the preconscious mind in our brain’s alpha state, which corresponds with deep relaxation. This should not be a problem when we begin the mindfulness cascade with the attunement to calmness. But things are trickier when dealing with unconscious contents: They cannot be explored without psychotherapeutic (depth psychological) help.

But it is still possible to start with the mindfulness exercises and first deal with the conscious and preconscious contents. We certainly have plenty to do in this area.

 

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Mindfulness

The third pillar of MBPT is mindfulness, which represents the intervention method of MBPT. It has been divided into seven individual steps for didactic, therapeutic, and diagnostic purposes.

 

The automatisms – which control our everyday thinking, feeling, and actions – run without any effort on our part. Their original purpose is to serve as a relief for the nervous system and enable quicker reactions. So we cannot assume that automatisms are generally harmful. This must always be examined in each individual case. However, caution is always appropriate for automatisms on the emotional level. Since feelings generally operate on such a subliminal level and cannot be examined in the light of mindfulness, they seem to form “our nature”– which makes them an integral component of our “self.” We generally assume this without any further questioning. But if we also examine our feelings in the light of mindfulness, we discover that they – precisely like our body, our thoughts, and everything else that we may have considered to be integral components of our “self” – are transient and non-substantial. We feel completely different today than we may have felt yesterday or one year ago. This disidentification (step four of the mindfulness cascade) from our own feelings makes a new degree of freedom possible: Then we no longer automatically follow our feelings but consider whether we want to do so or not in each concrete situation.

 

Is There an "Action Moment" for MBPT?

 

Yes. Every emotionally oppressive situation triggers an alarm: The central and autonomic nervous systems become hyperirritable. This leads to the accessing of automated stored programs for a specific (inner) experience and a specific (outer) behavior. This overexcitation is the point of action for the mindfulness-controlled intervention of MBPT.

 

The intervention follows in the form of a cascade in seven subsequent steps: the mindfulness cascade (see next point).



Copyright Dr. Peter Tamme and Dr. Iris Tamme

Last update: September 15, 2012