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Pain Psychology Service

We know that living with pain doesn’t just affect you physically. Long-term pain also impacts on the way you feel, the thoughts you might have and your overall wellbeing. Our Pain Specialist Psychologists offer support and guidance to help you manage pain and the impact of pain on your mood and everyday life.

Seeing a clinical psychologist does not mean that we think your pain is ‘in your head’.

If you have been referred to the Pain Psychology Service for psychological support, you will be invited to attend a group-based information session to learn more about our service. This will be followed by an assessment appointment if you are interested in working with us.

Our support is usually provided through individual therapy or a group programme. We also provide support for individuals who would like to reduce their pain medicines, alongside our colleagues in pharmacy. 

We also offer psychological assessments as part of the neuromodulation pathway within the Leeds Pain Management Service. This is for people considering having implanted devices including spinal cord stimulators (SCS), posterior tibial nerve stimulators (PTNS, PNS), and occipital nerve stimulators (ONS).

The following psychologists provide input into the Pain Psychology Service:

  • Dr Vivienne Laidler, Principal Clinical Psychologist
  • Dr Andrea Brown, Senior Clinical Psychologist
  • Dr Maria Chu, Senior Clinical Psychologist
  • Dr Morgan Crummack, Clinical Psychologist
  • Dr Luke Todd, Counselling Psychologist

Appointments are available at St James’s Hospital (Fielding House) or via video consultation.

Understanding long-term pain

If you are reading this, then you probably have long-term pain, or are close to someone who does. Our aim is not to ‘educate you on your pain’, as you probably know pain better than most people. You know and feel it, you have the ‘lived experience’ of long-term pain. But what you might know less about is the ‘science behind pain’, the physiology of it.

As clinicians, working with people who live with long-term pain, it is our goal to share with you the most up-to-date scientific knowledge about pain. The consensus in modern science is that long-term pain is real. It is not ‘all in your head’. Moreover, long-term pain is as real as acute pain.

We believe that learning about the biology of pain can be extremely valuable, as it can give hope and direction on how to manage it. In this section you will find an explanation of long-term pain, and a list of carefully selected resources to help you learn more about the physiology of long-term pain.

Pain is a protective mechanism – it occurs when your body’s alarm system wishes to alert the brain to actual or potential tissue damage. This is extremely valuable to us as humans.

Some people cannot experience pain. One rare medical condition called Congenital Insensitivity to Pain with Anhidrosis, or CIPA, results in inability to experience pain. People diagnosed with CIPA often die in childhood, due to injuries or illnesses going unnoticed.

Pain is unpleasant and attention-grabbing by design. When it increases, we cannot think, feel or focus on anything else. However, the pain system sometimes acts oddly. The brain could decide that it is not in our best interest to feel pain, despite tissue damage – think of severely injured soldiers who do not report pain until they leave the battlefield, or surfers who cannot feel the pain of a shark bite, until they reached safety.  
Pain can also sometimes hang around for longer than is helpful, after the damage has healed. Think of phantom limb pain – pain in an area of the body that is no longer there (e.g. following amputation).

Events like this show us that the amount of pain experienced does not necessarily relate to the amount of tissue damage; this is particularly true in pain that persists over 6 months. Long-term (chronic) pain often does not indicate on-going damage, even though it feels like it. In fact, long-term pain is often associated with increased sensitivity of the nervous system. This results in an increased response to painful stimuli (hyperalgesia) and even normally non-painful stimuli becoming painful (allodynia) – both are common in people who experience long-term pain.

Information:

Understanding your pain is the first step to better managing it. It often takes time and effort, but it is possible! Please see the resources section of this website to find out more about mechanisms of pain.

Individual therapy

Individual therapy involves talking to a psychologist one-to-one. It’s sometimes called talking therapy. You’ll think together about the things that you are struggling with and the goals that you’d like to work towards.

During your initial appointment there will be time for you to talk to one of our psychologists to discuss your situation, and to agree what might help. It can feel a bit uncomfortable at first, but we will do our best to put you at ease. Just arrive for your appointment and we’ll take it from there. In the first appointment, we will tell you a bit more about how we work, we will ask you a few questions about how you manage your pain, and see if our service is right for you. It is normal to worry about your first appointment, but you will be surprised how quickly time flies in the initial session.

Important advice:

There are three types of talking therapies that we typically offer:

  • Cognitive Behavioural Therapy (CBT) 
  • Acceptance and Commitment Therapy (ACT)
  • Compassion Focused Therapy (CFT)

Cognitive Behavioural Therapy (CBT) is a very practical, hands-on, goal-oriented psychotherapy treatment that aims to help the person identify and change patterns of behaviour and thinking that can be unhelpful when living with long-term pain. CBT is a very popular approach, with a good evidence base supporting its use in managing long-term pain, as well as other problems such as depression, anxiety, and panic attacks. For more information about CBT you can visit Get Self Help.

The focus of Acceptance and Commitment Therapy (ACT) is creating a rich and meaningful life, while accepting the pain that comes with it. Instinctively, we as humans want to reduce the pain so it becomes a much smaller part of our lives. However, the reality is that this is not always possible. In these circumstances, ACT aims to help people add more to their life, make their life bigger, so the pain becomes more manageable. ACT can help to deal with long-term pain by developing mindfulness and acceptance-based techniques. For more information about ACT you can visit Get Self Help website.

Compassion Focused Therapy (CFT) encourages the person to respond to their pain using skills of compassion. It helps to deal with shame and self-criticism, which often accompany people living with long-term pain. CFT can help to deal with this by developing self-soothing, mindfulness and compassion-based techniques. CFT is a biopsychosocial approach developed to help people understand how their brains and bodies work, and recognise that by design we have “tricky brains”. For more information about CFT you can visit Get Self Help website. 

Often more than one type of therapy may be beneficial for a person, so do not worry about trying to pick the right one for you. We will discuss your options with you at your first appointment and suggest a treatment plan tailored to your needs.

Living with Pain Group

The Living with Pain group is based on a holistic model of pain. This means that we understand that your pain affects not just physical functioning, but also the things you do, your thoughts and feelings, and the people you are close to. The Living with Pain group aims to help you manage your symptoms better, so that these have less impact on your life. It aims to help you to engage in the things in life which are important to you.

The Living with Pain group is a group for people with long-term symptoms. There are up to around 12 people in the group. The group format means that you can gain ideas and support from other people who also live with long-term pain. The group is run by the multidisciplinary team from the Leeds Pain Management Service including psychology, physiotherapy, pharmacology, and pain consultants.

During the group sessions we will look at a range of physical, psychological and practical ideas for managing your symptoms and their impact on your life.  The sessions will involve teaching, discussion and practical tasks. These ideas will work best if you put them into practice in your daily life, so we will encourage you to work on these ideas between sessions.

For some people, the idea of being in a group can seem daunting. Please be assured that while we value participants’ feedback on the ideas we discuss in the group, no one would be put on the spot to speak. It is worth noting that most people have found the group to be a worthwhile and enriching experience despite initial hesitation. Here are what some previous participants have said about the group.

“Give it a chance – you are likely to learn something to help you move forward, towards a better quality of life”

“I liked that the group looks at your life in general rather than just focusing on the pain”

“Go for it. It’s fantastic. I thought I knew quite a bit about pain but it was only the tip of the iceberg.”

“I would highly recommend attending these sessions. The whole experience has made a difference to the way I now understand living with pain and the  tools i can use to help making living with pain easier.

“… be open to new experiences and emotions. You deserve to explore options available to you and you are definitely worth the time and effort these sessions might take”

To find out more about our Living with Pain Group please speak to a member of the Leeds Pain Service.

Three photos showing a mindfulness seminar, with clinicians presenting to patients who are sat taking notes.

Pain and medication

Medication can play a role in helping to live with long-term pain. But all medications have side effects, and side effects can become very difficult to live with over time, sometimes to the point where continuing to take the medication seems unhelpful. If this is the case, it might be worth considering reducing your pain medication. However, we know this is extremely challenging. Being afraid of what might happen if you reduce your medication is one of the biggest challenges. Many people fear that they may not be able to cope if the pain gets worse.

Unfortunately, when you first start reducing your medication, things could get worse before they get better, but the benefits can be worthwhile! After reducing medication, many people report feeling clear-headed and return to feeling more like their normal selves again. Other benefits might include improved attention, memory, and concentration, as well as reduced mood swings.

Your benefits might not become clear until after you start reducing your pain medication – you may find that it was actually making you feel worse rather than better, or that it is just as helpful at a lower dose and has fewer side effects.

Important advice:

Here are some ‘top tips’ from people who have reduced their pain medication:

  • Try and approach it with an open mind
  • Talk to people that are close to you about how you’re feeling
  • Remind yourself of how well you’ve done whenever you reach a goal
  • Take it slowly, reduce gradually
  • Remember there will be ups and downs when reducing your pain medication, but there were ups and downs when taking high doses too!
Learn more about pain and medication

Activity and Pacing

It is very common for people with long-term pain to do less over time. Following an injury, pain can be really useful in reminding us to slow down and avoid further damage as we heal. However, when pain persists even after the damage has healed, inactivity is no longer helpful and can even be detrimental to our wellbeing. Not doing enough can lead to muscle weakness, stiffness, and low mood, which in turn leads to more pain.

By gradually increasing your activity, you can reverse this negative cycle.

When you first increase your activity, it is likely you will still feel pain. That’s okay! Remember that pain does not equal damage. The important thing is to pace yourself.  This could mean doing less than your best on a good day, but could also mean pushing yourself on a bad day. You should aim to gradually increase your activity even if pain is present, but stop activity before the pain becomes unbearable.

You might find it useful to plan your activity. Adjust how you carry out your tasks so you can achieve them – this could involve adding in rest breaks, planning your journeys, and asking for help when it’s needed.

Mindfulness

Being mindful simply means paying attention, with flexibility, openness, and curiosity. This tells us that mindfulness involves being aware of your experience in the present moment, and being able to consciously direct your attention to different aspects of the experience (as opposed to being lost in your thoughts). Even if this experience is difficult, painful, or unpleasant, mindfulness can allow you to be open and curious about it instead of avoiding or fighting it.

For several decades, mindfulness-based therapeutic approaches have been used by psychologists and other healthcare professionals that work with patients experiencing long-term pain. There is evidence to show that mindfulness can be useful to individuals with all kinds of concerns, including long-term pain, but also stress, sleep problems, anxiety, and high blood pressure.

Whilst mindfulness practice is not designed to alleviate pain, it can help reduce distress. It does so by helping you to connect with the ‘here and now’, to notice what is happening, and thereby giving you an opportunity to take positive action and move towards what is important to you.

Mindfulness Practice Audio Tracks

Below are some guided mindfulness exercises that may be used during your pain psychology sessions.

Warnings

Do not listen to any of these audio tracks while driving or while doing any activities that require concentration.

Notice 5 things

This is a simple exercise to centre yourself, and connect with your environment. Practise it throughout the day, especially any time you find yourself getting caught up in your thoughts and feelings.

1. Pause for a moment

2. Look around, and notice five things you can see.

3. Listen carefully, and notice five things you can hear.

4. Notice five things you can feel in contact with your body. (E.g. your watch against your wrist, your trousers against your legs, the air upon your face, your feet upon the floor, your back against the chair etc)

5. Finally, notice what you can see, hear and feel all at the same time.

Mindfulness of the breath exercise

Mindful Breathing

(Unless stated otherwise, the word “pause” indicates a pause of around 5-10 seconds. A row of dots “…” indicates a pause of about 2-3 seconds)

I invite you to sit with your feet flat on the floor and your back straight, and either fix on a spot or close your eyes. And bring your attention to your breathing and observe it as if you’re a curious child who has never encountered breathing before. (pause)

Notice the air as it comes in through your nostrils … and goes down to the bottom of your lungs

(pause)

And notice it as it flows back out again

(pause )

Notice the air moving in and out of your nostrils … how it’s slightly warmer as it comes out … and slightly cooler as it goes in .

(pause)

Notice the subtle rise and fall of your shoulders (pause)

And the gentle rise and fall of your rib cage (pause)

And the rise & fall of your abdomen (pause)

Fix your attention on one of these areas, whichever you prefer: on the breath moving in and out of the nostrils, on the rising & falling of the ribcage, or the shoulders or the abdomen

(pause)

Keep your attention on this spot, noticing the movement – in and out – as the breath comes and goes

(pause 10-20 seconds)

Whatever feelings, urges or sensations arise, whether pleasant or unpleasant, gently

acknowledge them – as if nodding your head at people passing by you on the street. (pause)

Gently acknowledge their presence, and let them come and stay and go in their own good time.

(pause)

And keep your attention on the breath, observing it with curiosity.

(pause 10-20 seconds)

Whatever thoughts, images, or memories arise, whether comfortable or uncomfortable, simply acknowledge them and allow them to be…

Let them come & go as they please, and keep your attention on the breath.

(pause 10-20 seconds)

From time to time, your attention will wander, as you get caught up in your thoughts. This is normal. Each time this happens, notice what distracted you, then bring your attention back to the breath.

(pause 10-20 seconds)

No matter how often you drift off – whether a hundred times, or a thousand – your aim is simply to note what distracted you, and refocus on your breath.

(pause)

Again and again and again, you will drift off into your thoughts. This is normal and natural and happens to everyone. Our minds naturally distract us from what we are doing. So each time you realise your attention has wandered, gently acknowledge it, notice what distracted you, and return your attention to the breath.

(pause 10- 20 seconds)

If frustration, boredom, anxiety, impatience or other feelings arise, simply acknowledge them, and maintain your focus on the breath.

(pause 10-20 seconds)

No matter how often your attention wanders, gently acknowledge it, note what distracted you, and then refocus on your breath.

(pause)

And when you are ready, bring yourself back to the room and open your eyes

Mindfulness of the hand


In the following transcript, the ellipses indicate pauses of about three seconds.

I invite you to get into a comfortable position. And just turn one of your hands palm upward, and hold it a comfortable distance from your face. For the next few minutes, I’d like you to observe your hand as if you’re a curious scientist who has never seen a hand before. And from that perspective, first notice the outline. Mentally trace the outline of your hand, starting at the base of the thumb, and tracing around all the fingers… and notice the shapes of the spaces in between the fingers… and notice where your hand tapers in at the wrist. And now, notice the color of your skin…. notice it’s not just one color… there are different tones and shades, and dappled areas … and ever so slowly, stretch your fingers out, and push them as far back as they will go, and notice how the color changes in your skin… and then slowly release the tension, and notice how the color returns… and do that once more, ever so slowly, noticing the color disappear… and then return … and now notice the large lines on your palm… notice the shapes they make where they come together or diverge or intersect… and zoom in one of those lines and notice how there are many, smaller lines feeding into it and branching out of it… and now shift your attention to one of your fingertips… and notice the spiral pattern there… the pattern that you always see on fingerprints… and notice how the pattern doesn’t stop in your finger tip… it carries on down your finger… and trace it right on down and notice how it continues into your palm… and now ever so slowly, bring your little finger toward your thumb … and notice the flesh in your palm scrunches up…and now slowly release…. and notice the flesh resume its normal contours…and now turn your hand to the karate- chop position… and notice the difference between the skin on the palm and the skin. on the back… and look at your index finger, and notice there’s a sort of dividing line, where those two types of skin meet each other… and ever so slowly turn your hand over… and notice the skin on the back… and notice any criticisms or judgments your mind makes… notice any scars, sunspots, blemishes.. and notice the different colors in the skin… where it passes over a vein… or over your knuckles… and ever so slowly, curly your hand into a gentle fist … and notice how the texture of your skin changes… and notice any comments your mind makes about that… and focus in on your knuckles…and gently rotate your fist, and notice the contours and valleys of your knuckles… and now tighten your fist, and notice what happens to the knuckles ….. to their color and their prominence … and then ever so slowly open your hand up, straighten your fingers, and notice how your knuckles just disappear… and now bring your attention to one of your fingernails… and notice the texture of the nail… and the different shades of color … and notice where it disappears under the skin… and the cuticle that seals it in there… and now ever so slowly, ever so gently, wiggle your fingers up and down … and notice the tendons moving under the skin…. pumping up and down like pistons and rods… and that brings us to just over five minutes.

Acceptance of feelings

Acceptance of Feelings

I invite you to sit upright in your chair with your back straight and your feet flat on the floor.  And either close your eyes or fix them on a spot, whichever you prefer.  And take a few slow, deep breaths, and really notice the breath flowing in and out of your lungs. 

(Pause 10 seconds.) 

Now quickly scan your body from head to toe, starting at your scalp and moving downward.  And notice the sensations you can feel in your head … throat …neck … shoulders … chest … abdomen … arms … hands … legs … and feet.  Now zoom in on the part of your body where you’re feeling this feeling most intensely. And observe the feeling closely, as if you’re a curious scientist who has never encountered anything like this before. 

(Pause 5 seconds.) 

Observe the sensation carefully … Let you thoughts come and go like passing cars, and keep your attention on the feeling.  Notice where it starts and where it stops … Learn as much about it as you can … If you drew an outline around it, what shape would it have?  … Is it on the surface of the body or inside you, or both? … How far inside you does it go? … Where is it most intense? … Where is it weakest?

(Pause 5 seconds.) 

If you drift off into your thoughts, as soon as you realise it, come back and focus on the sensation. …Observe it with curiosity … How is it different in the centre than around the edges?  Is there any pulsation or vibration within it?  Is it light or heavy?  Moving or still?  What is its temperature?  Are there hot spots or cold spots?  Notice the different elements within it… Notice that it’s not just one sensation – there are sensations within sensations… Notice the different layers.

(Pause 5 seconds.)

As you’re observing this feeling, breathe into it … Imagine your breath flowing into and around this feeling … Breathing into and around it …

And as you’re breathing into it, it’s as if, in some magical way, all this space opens up inside you … You open up around this feeling … Make space for it … Expand around it … However you make sense of that … Breathing into it and opening up around it…

And see if you can just allow this feeling to be there.  You don’t have to like it or want it … Just allow it … Just let it be … Observe it, breathe into it, open up around it, and allow it to be as it is. 

(Pause 10 seconds.) 

You may feel a strong urge to fight with it or push it away.  If so, just acknowledge the urge is there without acting on it.  And continue observing the sensation.  (Pause 5 seconds.) 

Don’t try to get rid of it or alter it.  If it changes by itself, that’s okay.  If it doesn’t change, that’s okay too.  Changing or getting rid of it is not the goal.  Your aim is simply to allow it … to let it to be. 

(Pause 5 seconds.)

Imagine this feeling is an object … as an object, what shape does it have? … Is it liquid, solid or a gas? … Is it moving or still?  … What colour is it? … Transparent or opaque? … If you could touch the surface, what would it feel like? … Wet or dry? … Rough or smooth? … Hot or cold? … Soft or hard?  

(Pause 10 seconds)

Observe this object curiously, breathe into it, and open up around it …  You don’t have to like it or want it.  Just allow it … and notice that you are bigger than this object … no matter how big it gets, it can never get bigger than you

(Pause 10 seconds).

This feeling tells you some valuable information … It tells you that you’re a normal human being with a heart  … It tells you that you care … that there are things in life that matter to you … And this is what humans feel when there’s a gap between what we want and what we’ve got … The bigger the gap, the bigger the feeling. (Pause 5 seconds.)

Take one of your hands and place it on this part of your body … imagine that this is a healing hand … the hand of a loving friend or parent or nurse … and feel the warmth flowing from your hand into your body … not to get rid of the feeling but to make room for it … to soften up and loosen up around it. 

(Pause 10 seconds.) 

Hold it gently, as if it’s a crying baby or a frightened puppy.  (Pause 10 seconds.)  And letting your hand fall, once again breathe into the feeling and expand around it.

(Pause 10 seconds.)

Life is like a stage show … and on that stage are all your thoughts, and all your feelings, and everything that you can see, hear, touch, taste, and smell … and for the last few minutes, we dimmed the lights on the stage, and we shined a spotlight on this feeling … and now it’s time to bring up the rest of the lights… So bring up the lights on your body … notice your arms and legs and head and neck … and notice that you’re in control of your arms and legs, regardless of what you’re feeling … Just move them around a little to check that out for yourself … and now take a stretch, and notice yourself stretching … and bring up the lights on the room around you… Open your eyes, look around, and notice what you can see … and notice what you can hear … and notice that there’s not just a feeling here … there’s a feeling inside a body, inside a room, inside a world.

Leaves on a Stream

Exercise

(1) Sit in a comfortable position and either close your eyes or rest them gently on a fixed spot in the room.

(2) Visualize yourself sitting beside a gently flowing stream with leaves floating along the surface of the water. Pause 10 seconds.

(3) For the next few minutes, take each thought that enters your mind and place it on a leaf… let it float by. Do this with each thought – pleasurable, painful, or neutral. Even if you have joyous or enthusiastic thoughts, place them on a leaf and let them float by.

(4) If your thoughts momentarily stop, continue to watch the stream. Sooner or later, your thoughts will start up again. Pause 20 seconds.

(5) Allow the stream to flow at its own pace. Don’t try to speed it up and rush your thoughts along. You’re not trying to rush the leaves along or “get rid” of your thoughts. You are allowing them to come and go at their own pace.

(6) If your mind says “This is dumb,” “I’m bored,” or “I’m not doing this right” place those thoughts on leaves, too, and let them pass. Pause 20 seconds.

(7) If a leaf gets stuck, allow it to hang around until it’s ready to float by. If the thought comes up again, watch it float by another time. Pause 20 seconds.

(8) If a difficult or painful feeling arises, simply acknowledge it. Say to yourself, “I notice myself having a feeling of boredom/impatience/frustration.” Place those thoughts on leaves and allow them float along.

(9) From time to time, your thoughts may hook you and distract you from being fully present in this exercise. This is normal. As soon as you realize that you have become sidetracked, gently bring your attention back to the visualization exercise

Hexaflexercise – The Observing Self

I invite you to sit up straight, let your shoulders drop, and gently push your feet into the floor and get a sense of the ground beneath you.

You can either fix your eyes on a spot, or close them, whichever you prefer.

Now just take a moment to notice how you’re sitting. Notice how you are breathing. Notice what you can see, and notice what you can hear.

Notice what you can feel against your skin. Notice what you can taste and feel in your mouth. Notice what you can smell or feel in your nostrils.

Notice what you’re feeling in this moment.

Notice what you’re thinking.

Notice what you are doing.

So there’s a part of you in there that can notice everything that you see, hear, touch, taste, smell, think and feel. We don’t have a good word for this part of you in everyday language. I’m going to call it the Observer Self, but you don’t have to call it that. You can call it whatever you like.

Life is like a stage show, and on that stage are all your thoughts, and all your feelings, and everything that you can see, hear, touch, taste and smell. The Observing Self is that part of you that can step back and watch the stage show, focusing on any part of it or step back and take it all in at once.

Now taking a moment to reflect on why you’re doing this exercise today. There is something that matters to you, something that is important deep in your heart that motivated you to do this. Is it about improving your life, personal growth, learning new skills, building better relationships. Is it about improving things at work or with your family or your friends. Or perhaps it’s about your health, nurturing your body or enhancing your well-being. Just do a search deep inside your heart to clarify what values led you here today.

Now take a moment to reflect on how you got here today. You didn’t get here by magic. You’re only here because of committed action. You had to organise yourself, you had to reschedule things, you had to set aside time, and all these take effort and energy. The chances are that doing this exercise today may bring up some uncomfortable thoughts and feelings for you, and yet here you are. Recognise that right now in this moment you are taking action. You’re sitting here doing an exercise that probably seems a bit odd or unusual. You probably have all sorts of thoughts whizzing through your head, and all sorts of feelings passing through your body. And there are all sorts of things you could be doing right now that may be more fun than this and yet here you are taking action to improve and enrich your life.

Now for the next few breaths, I would invite you to focus on emptying out your lungs. Push all the air out of your lung until there’s no more left, and then allow the air to gently fill your lung all by itself. . Really notice the breath. Notice it flowing in and out. Observe it as if you are a curious scientist who has never encountered breathing before. Notice how when the lung is empty, it will just refill itself with air all by itself. You can take a deep breath in if you want to, but there is no real need, as your breathing just happens naturally by itself.

I now invite you to undertake a challenge for the next couple of minutes. See if you can keep your attention on your breath going in and out. Just observe the breathing as it is. You’ll find it’s hard because your mind is a master storyteller, it would tell you all sorts of interesting stories to grab your attention, to hook you away from what you’re doing. See if you can let the thoughts come and go, as if they’re merely passing cars, driving past outside your house. And keep your attention on the breath.

Notice your breath flowing in and out. Notice your abdomen rising and falling. Notice the rise and fall of your chest.  Let your mind chatter away as if it’s a radio playing in the background. Don’t try to turn the radio off. It’s impossible, not even Zen masters can do that. Just let it play in the background, and keep your attention on the breath.

From time to time, your mind will succeed in distracting you. It will hook you in with a good story, and you’ll lose track of your breathing. This is normal and natural, and it will happen repeatedly. When you notice this happening, just take a moment to notice what hooked you, and then gently refocus on your breathing.

Again and again and again you will drift off into your thoughts. This is normal and natural. It happens to everyone. As soon as you realise it, gently acknowledge it and refocus on your breath

As this exercise continues, your feelings and sensations in your body may change. There may be pleasant feelings showing up, such as relaxation, calm, peacefulness. There may be unpleasant ones such as boredom, frustration, anxiety, or pain. See if you can allow these feelings to be exactly as they are in this moment. Don’t try to control your feelings and sensations. Just let them be as they are, regardless of whether they’re pleasant or unpleasant. Try to keep your attention on your breathing.

Again and again, you will drift off into your thoughts. As soon as you realise it, gently acknowledge it, and refocus on your breath.

This is not a relaxation exercise. you’re not trying to relax. The aim is to let your feelings be as they are, to feel whatever you feel without a struggle. So if you’re noticing a difficult feeling, then quietly say to yourself, here is a feeling of frustration, or here is a feeling of anxiety, or here is a feeling of boredom. If you notice a thought, then quietly say to yourself. Here’s a thought. Acknowledge your feelings and your thoughts, and keep your attention on the breath.

Life is like a stage show. On that stage are all your thoughts, and all your feelings, and everything else that you can see, hear, touch, taste and smell. In this exercise, you dimed the lights on the stage, you focused a spotlight on your breathing, and now it’s time to bring up the rest of the lights. This breathing is happening inside the body, so now bring up the lights on your body, sit up in the chair, and notice your arms and legs, head, neck, chest and abdomen. And your body is inside a room, so now bring up the lights in the room around you. Look around and notice what you can see, hear, and smell, and taste, and touch.

Notice what you’re feeling.

Notice what you’re thinking.

So there’s a part of you that notices everything – what you can see, hear, touch, taste, smell, think, feel, or do in any moment. And that’s your Observer Self.

And that brings the exercise to an end.

Mountain Meditation

Allowing your eyes to close gently as you bring your attention to the flow of your breathing. Feeling each inbreath and each outbreath. Just observing your breathing without trying to change it or regulate it in any way, allowing the body to be still and sitting with a sense of dignity, a sense of resolve, a sense of being complete, whole, in this very moment, with your posture reflecting this sense of wholeness…
And as you sit here, picturing in your mind’s eye, as best you can, the most beautiful mountain you know or have seen, or can imagine, just holding the image and feeling of this mountain in your mind’s eye, letting it gradually come into greater focus…
Observing its overall shape, lofty peak high in the sky, the large base rooted in the rock of the earth’s crust, it’s steep or gently sloping sides…
Noticing how massive it is, how solid, how unmoving, how beautiful, both from afar and up close…
Perhaps your mountain has snow at the top and trees on the lower slopes. Perhaps it has one prominent peak, perhaps a series of peaks, or a high plateau…..
Observing it, noting its qualities and when you feel ready to, seeing if you can bring the mountain into your own body so that your body sitting here and the mountain in your mind’s eye become one so that as you sit here, you share in the massiveness and the stillness and majesty of the mountain, you become the mountain
Rooted in the sitting posture, your head becomes the lofty peak, supported by the rest of the body and affording a panoramic vista. Your shoulders and arms the sides of the mountain. Your buttocks and legs the solid base, rooted to your cushion or your chair, experiencing in your body a sense of uplift from deep within your pelvis and spine.
With each breath, as you continue sitting, becoming a little more a breathing mountain, unwavering in your stillness, completely what you are, beyond words and thought, a centered, unmoving, rooted presence…
As you sit here, becoming aware of the fact that as the sun travels across the sky, the light and shadows and colors are changing virtually moment by moment in the mountain’s granite stillness.
Night follows day and day follows night. The canopy of stars, the moon, then the sun. Through it all, the mountain just sits, experiencing change in each moment, constantly changing, yet always just being itself. It remains still as the seasons flow into one another and as the weather changes moment by moment and day by day, calmness abiding all change…
In summer, there is no snow on the mountain except perhaps for the very peaks or in crags shielded from direct sunlight.
In the fall, the mountain may wear a coat of brilliant fire colors.
In winter, a blanket of snow and ice.

In any season, it may find itself at times enshrouded in clouds or fog or pelted by freezing rain. People may come to see the mountain and comment on how beautiful it is or how it’s not a good day to see the mountain, that it’s too cloudy or rainy or foggy or dark.
None of this matters to the mountain, which remains at all times its essential self. Clouds may come and clouds may go, tourists may like it or not. The mountain’s magnificence and beauty are not changed one bit by whether people see it or not, seen or unseen, in sun or clouds, broiling or frigid, day or night.
It just sits, being itself.
At times visited by violent storms, buffeted by snow and rain and winds of unspeakable magnitude.
Through it all, the mountain sits.
Spring comes, the birds sing in the trees once again. Leaves return, flowers boom in the high meadows and on the slopes. Streams overflow with the waters of melting snow. Through it all, the mountain continues to sit, unmoved by the weather, what happens on the surface, by the world of appearances…
In the same way, as we sit in meditation, we can learn to experience the mountain, we can embody the same unwavering stillness and rootedness in the face of everything that changes in our own lives, over seconds, over hours, over years.
In our lives and in our meditation practice, we experience constantly the changing nature of mind and body and of the outer world, we have our own periods of light and darkness, our moments of color and our moments of drabness.
Certainly, we experience storms of varying intensity and violence in the outer world and in our own minds and bodies, buffeted by high winds, by cold and rain, we endure periods of darkness and pain, as well as the moments of joy and uplift, even our appearance changes constantly, experiencing a weather of it’s own…
By becoming the mountain in our meditation practice, we can link up with its strength and stability and adopt them for our own. We can use its energies to support our energy to encounter each moment with mindfulness and equanimity and clarity.
It may help us to see that our thoughts and feelings, our preoccupations, our emotional storms and cries, even the things that happen to us are very much like the weather on the mountain, we tend to take it all personally, but its strongest characteristic is impersonal.
The weather of our own lives is not be ignored or denied, it is to be encountered, honored, felt, known for what it is, and held in awareness… And in holding it in this way, we come to know a deeper silence and stillness and wisdom.
Mountains have this to teach us and much more if we can come to listen…
So if you find you resonate in some way with the strength and stability of the mountain in the sitting, it may be helpful to use it from time to time in your meditation practice, to remind you of what it means to sit mindfully with resolve and wakefulness, in true stillness…
So, in the time that remains, continuing to sustain the mountain meditation on your own, in silence, moment by moment, until you hear the sound of the bells…

Observer Exercise

We are going to do an exercise now that is a way to begin to try to experience that place where you are not your programming.  There is no way anyone can fail at this exercise: we’re just going to be looking at whatever you are feeling or thinking, so whatever comes up is just right.  Close your eyes, get settled into your chair, and follow my voice.  If you find yourself wandering, just gently come back to the sound of my voice.  For a moment now, turn your attention to yourself in this room. Picture this room. Picture yourself in the room exactly where you are. Now begin to go inside your skin and get in touch with your body.  Notice how you are sitting in the chair. See if you can notice exactly the shape that is made by the parts of your skin that touch the chair. Notice any bodily sensations that are there.  As you see each one, just sort of acknowledge that feeling and allow your consciousness to move on. Now notice the emotions you are having, and if you have any, just acknowledge them. Now get in touch with your thoughts and just quietly watch them for a few moments. Now I want you to notice that as you noticed each one of these things, a part of you noticed them.  You noticed those sensations … those emotions … those thoughts. And that part of you we will call the “observer you.” There is a person in there, behind those eyes, who is aware of what I am saying right now. And it is the same person you’ve been your whole life.  In some deep sense, this is observer you is the “you” that you call you.

I want you to remember something that happened last summer. When you have an image in mind, just look around in this image. Remember all the things that were happening then. Remember the sights … the sounds … your feelings … and as you do that, see whether you can notice that you were there then, noticing what you were noticing.  See whether you can catch the person behind your eyes who saw, and heard, and felt. You were there then and you are here now. I’m not asking you to believe this. I am not making a logic point. I am just asking you to note the experience of being aware, and check and see whether, in some deep sense, the you that is here now, was there then. The person noticing what you were noticing is here now and was there then.  See whether you can notice the essential continuity – in some deep sense, at the level of experience, not belief, you have been you your whole life.

I want you to remember something that happened when you were a teenager. When you have an image in mind, just look around in this image. Remember all the things that were happening then. Remember the sights … the sounds … your feelings … take your time. And when you are clear about what was there, see whether you can, just for a second, catch that there was a person behind your eyes then, who saw, and heard, and felt all of this.  You were there then too, and see whether it isn’t true – as an experienced fact, not a belief – that there is an essential continuity between the person noticing what you are noticing now, and the person who was noticing what you noticed as a teenager in that specific situation. You have been you your whole life.

Finally, remember something that happened when you were a fairly young child, say around 6 or 7. When you have an image in mind, just look around again, in the image. See what was happening. See the sights … hear the sounds … feel your feelings … and then catch the fact that you were there, seeing, hearing, and feeling. Notice that you were there behind your eyes. You were there then, and you are here now. Check and see whether, in some deep sense, the you that is here now was there then. The person noticing what you were noticing is here now and was there then.

You have been you your whole life. Everywhere you’ve been, you’ve been there noticing. This is what I mean by the “observer you.” And from that perspective or point of view, I want to look at some areas of living.  Let’s start with your body. Notice how your body is constantly changing. Sometimes it is sick, and sometimes it is well. It may be rested or tired. It may be strong or weak. You were once a tiny baby, but your body grew. You may have even had parts of your body removed, as in an operation. Your cells have died, and not all the cells in your body now were there when you were a teenager, or even last summer. Your bodily sensations come and go. Even as you are listening to this, they have changed. So if all this is changing and yet the you that you call you has been there your whole life, that must mean that although you have a body, as a matter of experience and not of belief, you do not experience yourself to be just your body. So just notice your body now for a few moments, and as you do this, every so often notice that you are the one noticing.

Now let’s go to another area: your roles. Notice how many roles you have or have had. Sometimes you are in the role of a mother or father … or a friend … or a daughter or son … sometimes you are the worker … other times you are a leader … or a follower. In a world of form you are in some role all the time. If you were to try not to, then you would be playing the role of not playing a role. Even now part of you is playing a role … the listener role. Yet all the while, notice that you are also present. The part of you you call you is watching and is noticing what you are noticing. And in some deep sense, that you does not change.  So, if your roles are constantly changing, and yet the you you call you has been there your whole life, it must mean that although you have roles, you do not experience yourself to be your roles. Do not believe this. This is not a matter of belief. Just look and notice the distinction between what you are looking at and the you who is looking.

Now let’s go to another area: emotions. Notice how your emotions are constantly changing. Sometimes you feel love and sometimes hatred, sometimes calm and sometimes tense, joyful – sorrowful, happy – sad. Even now you may be experiencing emotions – interest, boredom, relaxation. Think of things you have liked and don’t like any longer; of fears that you once had that are now resolved. The only thing you can count on with emotions is that they will change. Although a wave of emotions comes, it will pass in time. Yet while these emotions come and go, notice that in some deep sense, that “you” does not change. It must be that although you have emotions, you do not experience yourself to be just your emotions. Allow yourself to realise this as an experienced event, not as a belief. In some very important and deep way you experience yourself as a constant. You are you through it all. So just notice your emotions for a moment and as you do, notice also that you are noticing them.

Now let’s turn to the most difficult area. Your own thoughts. Thoughts are difficult because they tend to hook us and pull us out of our role as observer. If that happens, just come back to the sound of my voice. Notice how your thoughts are constantly changing. Over your life you have gained new ideas and new knowledge. Sometimes you think about things one way and sometimes another.  Sometimes your thoughts may make little sense. Sometimes they seemingly come up out of nowhere. They are constantly changing. Look at your thoughts even just today, and notice how many different thoughts you have had. And yet in some deep way the you that knows what you think is not changing. So that must mean that although you have thoughts, you do not experience yourself to be just your thoughts. Do not believe this. Just notice it. And notice, even as you realize this, that your stream of thoughts will continue. And you may get caught up in them. And yet, in the instant that you realise that, you also realise that a part of you is standing back, watching it all. So now watch your thoughts for a few moments – and as you do, notice also that you are noticing them.

So, as a matter of experience and not of belief, you are not just your body … your roles … your emotions … your thoughts. These things are the content of your life, whereas you are the arena … the context … the space in which they unfold. As you see that, notice that the things you’ve been struggling with and trying to change are not you anyway. No matter how this war goes, you will be there unchanged. See whether you can take advantage of this connection to let go just a little bit, secure in the knowledge that you have been you through it all and that you need not have such as investment in all this psychological content as a measure of your life. Just notice the experiences that show up, and as you do, notice that you are still here, being aware of what you are noticing. Now again picture yourself in this room. And now picture the room. Picture all the things that you know are in the room. And when you are ready to come back into the room, open your eyes.

Goal setting

SMART-ER Goals

Goal setting is an essential part of life. We all need goals to help guide our lives towards what is important to us. However, we are often discouraged, or even scared, about setting goals. This tends to be caused by our human tendency to set unspecified, unrealistic, and not well thought-through goals. Another common mistake is setting ‘other people’s goals’, doing what other people tell us to do. Most of us will also be scared of failure, preferring not to set any goals in order to avoid disappointment. Long-term pain makes it extremely difficult to set goals and to find motivation. More than anything you will need a good strategy in setting your goals. One strategy that we find particularly useful is the SMART model.

SMART is an acronym that can be applied to the goals we set for ourselves in order to make them easier to tackle. It specifies that our goals should be:

  • Specific (What exactly would this look like? What do I need to start?)
  • Measurable (How much? How many? How will I know when it is accomplished?)
  • Achievable (How realistic is it? Is this the right time?)
  • Relevant (Is this really important for me?)
  • Time-bound (When? What can I do today?)

More recently the SMART model had an upgrade to include two more important aspects of goal setting. The new and improved SMART-ER model takes goal setting two steps further. It encourages us to always Evaluate the goals we set, and to Reward our efforts. An example how this model can be used is presented below.

Jane, who lives with long-term pain due to a failed back surgery and arthritis, has found it very difficult to find time and motivation to do her hobbies. She wanted to ‘be creative’, and to feel like she ‘achieved something’ in her day. Initially Jane did not know how that would look like. She said that in the past she really enjoyed drawing and painting.

There were many obstacles for Jane to set a right goal. She was scared that she will set her hopes high, spend a lot of money on art supplies, and end up not doing anything, and feeling worse in herself. She was also worried about being able to hold the pencil or brush for a prolonged period of time. She said that sometimes she has a hand tremor, which can make it difficult to hold a pen, and was worried that her drawings will be ‘ugly’.

In the end Jane’s SMARTER plan looked like this:

  • Specific: I want to start drawing again
  • Measurable: I would like to draw something everyday, a small sketch maybe
  • Achievable: I could start with simple pencil drawings, I found some video tutorials online, this will make it easier to start
  • Relevant: Drawing makes me feel like I have done something useful, and I am being creative. I always enjoyed arts and crafts, specifically drawing and painting.
  • Time-bound: I will start small, 15 minutes a day, from tomorrow
  • Evaluate: After the first two weeks I noticed that on some days I don’t have the time to draw, so a more achievable goal is to do it 3 to 4 times a week. I also notice that having my pad and pencils next to the sofa reminds me to draw, so I always leave it there.
  • Reward: I noticed that it gives me great pleasure to show my drawings to my family. After the first week I also got myself a bigger notepad so that it is more comfortable for me to draw.

If you would like to learn more about setting goals you can go to our resources section

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