Mindfulness for Chronic Dizziness

Transcription

1 Mindfulness for Chronic Dizziness What is mindfulness? Mindfulness means deliberately attending to and becoming more aware of our experience: our thoughts, feelings and body sensations. This allows us to clearly perceive thoughts, physical sensations, emotions and events at the moment they occur without reacting in an automatic or habitual way. With mindfulness, experiences [such as dizziness] don t overwhelm us, and we become steady through life s ups and downs. ( Mindfulness is paying attention, in a particular way, in the present moment on purpose and non- judgementally (Kabbat-Zin) More simply, mindfulness can be thought of as choosing and learning to control our focus of attention (Vinjan) With mindfulness, even the most disturbing sensations [such as dizziness] feelings, thoughts, and experiences, can be viewed from a wider perspective as passing events in the mind, rather than as "us", or as being necessarily true. (Brantley) Mindfulness has been shown to help patients with chronic pain and other chronic health conditions, recurrent anxiety, stress and depression (Baer, 2003). It has also been shown to have positive changes in brain function and immune response in only 8 weeks (Davidson et al 2003). As balance problems can often be recurrent, and dizziness can become chronic, and lead to anxiety and depression, mindfulness can be a very useful technique for helping. This will often be combined with balance retraining exercises (vestibular rehabilitation) and some cognitive behavioural therapy (CBT) techniques. Early studies by Naber and colleagues (2011) have shown this to be the case, and the reference to this study is given at the end of this leaflet. What can happen when we get dizzy? It is normal for a first attack of dizziness to cause an emotional response of fear and anxiety. This is a helpful response, as your brain is alerted that something is wrong.

2 Your brain goes into stay safe mode until the dizziness passes, and a number of helpful behavioural responses may kick in: Initially you will sit or lie down/hold on for support until the dizziness passes The brain will look out more for the sensation of dizziness, and anything that could cause it (hyper vigilance) so that you can avoid it to keep safe The brain will also turn up its sensitivity to the sensation of dizziness, noticing it at a much lower level than it did before (hypersensitivity) Because the balance organs are not working well, the brain increases the sensitivity of the visual system (visual vertigo) in the hopes it can help feel more balanced. Your natural response will be to avoid anything that evokes the dizziness or situations in which you experienced the dizziness When you are acutely dizzy these strategies are sensible and help keep you safe. However when the acute dizziness resolves, the brain needs to get rid of these strategies for you to recover fully. Often this does not happen and depending on the cause of your dizziness one of the following can occur: The damage to your balance organ function on one or both sides persists. You may continue to actively avoid things that make you feel dizzy, and the brain does not compensate or adapt to the dizziness signals. If it does not compensate you will continue to experience movement evoked dizziness, and have problems with walking and in busy visual environments The cause of the dizziness resolves (e.g. your damaged balance organ function restores) but low level symptoms of dizziness become constant - this is called persistent postural perceptual dizziness (PPPD). Here, even though the cause of the dizziness has resolved, because the first episode was frightening, your brain decides to use unhelpful postural, behavioural and emotional strategies (high risk strategies). For example your brain continues to be hyper- vigilant for balance so you notice it more easily. You continue to avoid anything which increases dizziness. Any small amount of dizziness, even if it is normal, is interpreted as danger: anxiety can result. This in turn will cause more dizziness You continue to suffer from recurrent vertigo such as Menieres or migraine associated dizziness. Often every time you get episodes of dizziness, the emotional response gets stronger. A strong emotional response can enhance the dizziness, and a vicious cycle ensues. You may begin to restrict your activities just in case an attack comes on. Your recurrent balance problem may often become increasing debilitating, even though the frequency of attacks is no more than it was before. In all these situations, the dizziness can become in control of your life profoundly affecting your daily activities and mental state, in a vicious circle How can I apply my mindfulness skills to help my dizziness? Mindfulness can help you be more aware of any unhelpful thoughts, feelings and behaviours accompanying your dizziness which sometimes can be triggered without you being aware of them, and can often exacerbate the sensations of dizziness.

3 Once more aware of these you then have the choice of how to respond to such emotions and behaviours. Over time you can learn how not to get caught up in such negative thoughts and let them pass by. You can also learn to choose to gently change unhelpful behaviours such as avoiding going out (for fear of a dizzy attack). Although mindfulness won t directly stop your symptoms, it may help you begin to lead a life where your dizziness is no longer in control over you. In turn you may be able to lead a life that is meaningful and worthwhile to you, even if your dizziness continues. Mindfulness will sometimes need to be combined with other techniques such as cognitive behavioural therapy (CBT) (to help any anxiety, depression, and avoidance), and vestibular rehabilitation exercises (to promote recalibration/compensation from static balance organ difference). Where recalibration/compensation needs to occur: mindfulness can help us be more aware of understandable yet unhelpful emotional responses (such as anxiety) which may arise when dizziness is evoked upon doing balance exercises. Once aware of this, we have the choice of whether to get caught up in these responses (which may well exacerbate the dizziness and cause us to stop doing the exercises) or to be able to let them go. By learning to let these unhelpful emotional responses go, this will in turn allow us to better physically perform the balance exercises required to compensate/habituate from the dizziness. (Compensation can be impeded by anxiety or depression) Where acute attacks of dizziness continue: due to recurrent dysfunction of the balance system, such as in Meniere s or migraine associated dizziness, we may not be able to stop them. However we can chose not to get caught up in negative emotional response to the dizziness (which will often increase the severity of attacks). As well as learning to respond differently to our dizziness, another component of mindfulness is focussing on the breath. If vertigo attacks become too severe this can also serve to help minimize the severity of attacks, serving both to ensure that you are breathing well and also to refocus your mind away from the attack onto the breath For persistent postural perceptual dizziness, where the initial cause of the dizziness has resolved we can again be more aware of any unhelpful emotional or behavioural responses. These may be causing our symptoms to continue or even increase. Once we are more aware, we again have the choice of how to respond. This may include allowing ourselves to help our bodies desensitize to the visual and motion-induced dizziness (by exercises), to choose whether to get caught up in the unhelpful emotional responses or to let them go. Mindfulness is sometimes preceded by CBT techniques which your clinician will teach you What is it about dizziness that is so distressing? Psychologists who work with pain talk about primary and secondary suffering. This theory can also be applied to dizziness (from Burch and Penman) The dizziness you experience can be considered to be a combination of primary + secondary dizziness/suffering.

4 Primary dizziness/suffering Basic unpleasant symptoms from vestibular disorder including rotatory vertigo, dizziness, light headedness, nausea and vomiting Resistance and emotional response to symptoms Secondary suffering- minds reaction to primary dizziness Thoughts, feelings and emotions and memories associated with the dizziness e.g. anxiety, stress, anger, worry depression, hopelessness, fatigue and exhaustion This is (in part) the result of the body s resistance to dizziness Resistance causes worsening of symptoms What you resist, persists Mindfulness teaches: Greater awareness of negative thought processes and unhelpful behaviours Once aware you have the choice of how you react (or don t react) to the symptoms Non reactance- surfing the wave of the symptoms rather than swimming against the tide Reduction of resistance to primary symptoms, Acceptance of symptoms- with goals of continuing with a full and active life even if dizziness persists Fostering of kindness to yourself (and others) which is key to help you be able to accept your dizziness (or other primary suffering) Mindfulness in chronic dizziness. Adapted for dizziness with permission from How does mindfulness help the dizziness? Whilst we may not be able to take away the primary dizziness (for example if you have Menieres ) at this particular point in time, you can learn to help control the secondary dizziness, which in turn may help lessen the severity of the primary dizziness. In their Mindfulness for Health book, Burch and Penman write: If you resist the messages (both dizziness and emotional reaction to them) that your mind and body are sending you, those messages will keep on being dispatched (and felt) until your accept them. If you mindfully accept (or feel) these message, they will have done their job and will tend to melt away. Mindfulness meditation creates as sense of safety, of space, in which you can begin to tentatively being to exposure the raw sensations (of pain), and as such it is the vehicle through which you can begin to accept these messages One of the goals of mindfulness is to learn to observe your dizziness, whatever the cause, with calm detachment, and open awareness. It teaches you to be curious about the dizziness, rather than react to it negatively which will only serve to

5 increase the sensation. You will learn to surf the wave of the dizziness rather than swim against the tide. This in turn this may help reduce your secondary dizziness/suffering. Image courtesy of Michelle Morgan Art Instead of actively avoiding the dizziness, though distraction, mindfulness invites the dizziness in, and the brain learns not to respond to it. As much mindfulness consists of observing the breath, it can help us normalize our breathing if this is disordered, again decreasing symptoms. Finally, with breath as the anchor, if our symptoms get too distressing, we can always go back to the breath, and use this as a focus, again diminishing symptoms. From Secondary anxiety and depression and mindfulness If anxiety or depression is present, mindfulness can again be useful. Often we run on autopilot and are not aware of these feelings until they spiral out of control. As mindfulness helps you be aware, in the present moment, of your thoughts and feelings, it can help you detect negative thoughts and feelings at a much earlier stage. Once again, you can learn to observe these rather than get caught up in them by worrying and analysing which will in turn exacerbate them. You can also begin to

6 start techniques to help prevent them spiralling out of control. You may be given additional techniques such as those given during cognitive behavioural therapy to help at these points. Image courtesy of Doug Neill on the Wellness and Psychology Blog Kindness to yourself.. and others Mindful self-compassion is another important component of the course. Mindful self-compassion means holding difficult emotions fear, anger, sadness, shame and self-doubt (or our physical dizziness or other suffering) and ourselves, in loving awareness, leading to greater ease and well-being in our daily lives. (Germer) A theme of fostering kindness or compassion to yourself runs through the course. Although people often find this difficult, it becomes easier to accept and hold your dizziness or other suffering if you are able to do this. Image from Breathworks Finally There is no magic pill for recurrent or chronic dizziness, but in many cases the symptoms can be lessened considerably, or be made more manageable with resultant less negative impact on your life. Mindfulness is not a skill that comes overnight, but with persistence you should be able to begin to live a life that is meaningful to you, even if in the context of continuing dizziness.

7 Ok, I m sold. What do I do next? Complete an 8 week course in mindfulness to give you basic mindfulness skills. Depending on what method of learning you prefer recommendations are: Courses: look online for a course near you. These are often face to face 8 week courses with homework. Search for breathworks or mindfulness courses. It is best to search for one which is tailored to people with chronic illness. Books: Paper or audio version: Suggestions: o Mindfulness for Health: A practical guide to relieving pain, reducing stress and restoring wellbeing (Burch and Penman). Online: o Mindfulness for health course Periodic online courses with fixed start dates in a worldwide web based group with chances for interaction with teacher and other participants Not quite sure? There are lots of mindfulness resources available (books, articles, videos etc). Here are a few of the Breathworks ones: Read: The mindful way to wellbeing- a good introductory article Jan-2010.pdf (a good basic article) Look at the Breathworks website: Try Breathworks online taster mindfulness course which will tell you about the potential benefits of mindfulness What the course involves: Week by week the course will teach a number of techniques including the body scan, breath meditations, mindful movement and the importance of being in being mode rather than the doing mode. You are then encouraged to learn how not to judge or ignore your thoughts, feelings or bodily sensations, but rather to turn towards them, and to see them as events, allowing them to pass through your mind as clouds do in the sky. The course will also teach you compassionate acceptance of your difficulties, how to seek out pleasant experiences and enjoy them, and how to be more compassionate towards yourself and others. Your mindfulness skills should help you view your dizziness differently, giving you the choice of how you react to it and in turn help you feel more in control. Although not a primary goal, it may lessen your dizziness, and should also lessen the likelihood of secondary anxiety and depression, or help relive those if you already have them. Remember the primary goal of mindfulness is not to alleviate your dizziness, but rather to live a life according to your values, a life that is meaningful to you, where you are in control of your dizziness, not it in control of you.

8 References Baer RA (2003). Mindfulness training as a clinical intervention. A conceptual and empirical review. Clinical psychology: Science and Practice 10(2): Davidson RJ, Kabat-Zin J et al (2003). Alterations in brain and immune function produced by mindfulness mediation. Psychosomatic Medicine 65, Naber CM, Water-Schmeder O, Bohrer PS, Matonak K, Bernstein AL, Merchant MA Interdisciplinary treatment for vestibular dysfunction: the effectiveness of mindfulness, cognitive-behavioural techniques, and vestibular rehabilitation. Otolaryngol Head Neck Surg. 145(1):117-24