Mindful-Based Stress Reduction
(MBSR) for Wellness
It goes without saying that reflecting on past experience can arouse emotional memories. But if a past experience was difficult or challenging in some way, just thinking about it can cause the brain to respond automatically with the same feelings of anxiety and physical health symptoms (Kabat-Zinn, 1990; Oyan, 2003). However, being present and aware can lessen arousal so that feeling and being nervous have less power. As the next case study shows, turning inward through mindfulness and expressing through art enabled this client to detach from emotional refuse and begin to visualize his health and well-being.
Luke
Luke, a 26-year-old man, was referred by his GP for generalized anxiety (GAD) and irritable bowel syndrome (IBS). He had previously attended therapy employing desensitization methods, which he found ineffective, and he hoped art therapy might help.
Luke had been experiencing severe stomach cramps for the past year or so that prevented him from engaging in social activities and often resulted in a day or two off work each week. He explained that the IBS symptoms were immobilizing and associated with stress, but they were reduced or ameliorated once the stress triggers were removed (i.e., anticipating an exam brings them on, after the exam, they dissipate). Cognizant of both his emotional triggers and capacity for recovery (though conditional), Luke felt as though he were on a roller coaster between the inner tensions of worry and the outer demands of needing to perform where he functioned through his “drive and willpower.”
Following a guided meditation, Luke’s first image was of a cross within a circle, which he said represented the difficulty he experienced in saying “no” to people. Aware of his acquiescent nature, Luke didn’t want to let anyone down. However, he found himself giving too much and, despite understanding the need to be more assertive, he struggled with this. Both metaphorically and literally, he took to the image again, transforming it this time into “how he would like things to be.” Reflecting on the revisions, Luke reasoned that he had choices, that he “no longer had a cross to bear…it’s now a butterfly…more freeing from this perspective. It was unintentional, but seemed to be what worked…freedom.”
In the next session, Luke’s image characterized the inner divisions he felt between the debilitating effects of IBS symptoms and his need to function. Connecting with the felt sense of his condition, Luke explained that the IBS symptoms “start with tightness … heartburn and my stomach locks and the feeling is tight and burning. Once stress is over the symptoms are removed with it.” But then he explained how he managed to function through his “willfulness and drive.” Luke drew an ocean scene where he used color resourcefully to delineate between sensory feelings. He explained that
the worst feeling is red [anxiety and tension]…the tight, tense spasms of the stomach…I imagined washing it away. Blue water was stronger going back out to sea…gentler [lighter blue] coming in. Toward the end I saw yellow…a shifting…like in hypnosis…like…[representing] freedom from resistance, when the mind won’t let go.
As the sessions progressed, Luke began to cultivate a daily meditation practice at home as well as in therapy. Throughout this time he used art to symbolically express and chart his progress. Stress was debilitating and the IBS symptoms continued to immobilize him, keeping him from work and taking part in the sport activities that he enjoyed (particularly competition tennis with friends on the weekend). However, over the next few weeks, Luke’s symptoms slowly began to improve. He was also becoming more mindful of how “worry” robbed him of his vitality and capacity to engage with others.
Figure 14.1 Feeling trapped/cage (see color plate)
The cage with an open door represented feelings of being trapped in a job he didn’t like, but also didn’t know how to leave at the time. Luke said it’s “of a prison cage with black bars…but the door is open now because there is a choice [of another job].” He feared risking the repercussions of giving notice to a difficult boss, as well as beginning a new job that represented uncertainty. As Luke explained, “the prison is extended to life in general…in terms of everything. It would be better if…I don’t take the opportunity for change…then I would know everything…like what to do…where to be…and I would know what to expect.” The fear of giving notice was also compounded by the fear of “burning his bridges” and the uncertainty should the new job not work out. Nonetheless, Luke inherently knew that the shift from one job to the other was the right move. He was just uncomfortable with change.
In a spontaneous image, an absence of cages represented the idea that Luke had again had a shift in his thinking. In this image, elements of nature and color combined to give rise to green grass (relaxing) and yellow sunshine (hope) amidst blue (ocean waves). These Luke said were to “restore vitality, heal immunity, and gain freedom from stress.” To Luke, this represented the possibility of a brighter future if he could learn to take control of his anxiety. He was attempting to do this through breath and positive intentions.
Several sessions later, Luke produced a trio of images that seemed to move beyond critical thinking and penetrate deeper levels of consciousness. In all three, kinesthetic lines visually and conceptually expressed his deeper concerns across a trajectory of feelings that were embodied within a tight knot in his gut. These symptoms represented an impenetrable state of fear shielded by perfectionism that guarded his self-worth. The first was a sketch of a man with a large parcel on his back, much like a heavy knapsack that seemed to be weighing him down. This image represented a general sense of Luke “feeling like there is something on my back.”
In the second image, Luke produced a single word written in the middle of the page, which was underlined: “dread.” Luke began by explaining the sensory quality of it, before moving on to the visual image that articulated it. Luke said:
It’s like there is a mental block and I can’t think properly…then I get an upset stomach and generalized anxiety where my heart speeds up, and I have a slight tremor in my hands…and then I feel a headache coming on.
Then he explained the dread of going to work, being at work, and the need for perfectionism. As we explored this theme further, Luke explained a long history of perfectionism, and that he had experienced IBS symptoms since his final university exams. Although this was already a few years ago, and that Luke was currently working in a supportive environment with opportunities to specialize and achieve in his field, he remained anxious and unsure whenever he thought about his work.
This single word “dread” was accompanied by another image shaped squarely and filled with scribbles that seemed to represent a jumble of wire. A cross (also scribbled) diagonally wended its way beneath and atop the shape. Luke described this image in relation to his recent bout of flu representing “the black hole…and feeling sick this past week; it was all encompassing…everything a void.” We stayed with this image, further exploring the history and trajectory of dread across the next session. Subsequently, Luke shaded green over two-thirds of the image to illustrate that there were times when he felt relaxed, for example while at home or walking the dog near the river. The green highlighting nature represented the nearby parks which he frequented and where he found solace. A prominent red dot in the center of the image referred to Luke’s “worries about the future; his capacity to perform well at work, and to survive general health.”
Figure 14.2 Dread (see color plate)
Occupational stress is commonplace these days. Notwithstanding the possibility of a toxic working environment, debilitating work stress, if left unchecked can contribute to more enduring forms of anxiety. Although Luke left a “toxic” workplace a few weeks after our first session, he remained traumatized for several months afterwards. During the transition to his new job, he felt emotionally stuck and found it difficult to trust that things would be better, even though he liked the work, and his new boss seemed welcoming and supportive. Furthermore, Luke was still in contact with his former co-workers, and although he didn’t feel responsible for their welfare, he felt somewhat guilty when they filled his ear with their ongoing complaints and disgruntlement with the old workplace.
As Luke began to connect with the emotional and physical sense of “feeling stuck,” the therapeutic process enabled him to entertain the idea of emotional freedom and physical relief. Consistent with the idea that change and healing from trauma require a person to deal with “body sensations, emotions and the totality of experience” (Levine, 2010), Luke used the breath to calm himself, guided meditation to explore felt emotions and body sensations, and the creative power of the art to bring out both problems and possibilities for change. The silent power of the art brought additional therapeutic gains in helping Luke to move beyond ordinary reasoning to felt awareness of his IBS symptoms. The butterfly, in response to his notion of having a cross to bear, seemed to conjure up hope of freedom and transformation.
The imaginal shift from feeling trapped in a prison cage to a calming scene of nature shows the beginnings of psychological flexibility and a desire for freedom. This took place when Luke began to reappraise worry (shifting from what if…) to an open attitude (so what if…) that he paired with a calming breath. Nonetheless, it took several weeks before he could trust that the new work environment would remain positive “beyond the honeymoon period.” In Luke’s mind, he was still working to release “three years of learned behavior and maladaptive coping,” which he found difficult to let go of.
However, Luke’s image of dread seemed to mark a turning point for him, owing to insights about his deeper lack of self-worth. Beyond conceptual reasoning where he feared his work might not be good enough, Luke learned to sense the mounting tension of IBS symptoms, which he could at least partially manage with breath and intention. Reducing symptoms was one of his goals for therapy. Gradually requiring less medication, Luke found that daily practice of meditation was helping to prevent and relieve his symptoms. Added to this, we began working on his emotional compass to guide self-acceptance where Luke gradually acknowledged that he was learning to “become his own best friend.”