Mindfulness in Chronic Pain and Trauma: Interview with Beatriz Rodríguez Vega

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Beatriz Rodríguez Vega, MD, works as a psychiatrist at the University Hospital La Paz in Madrid where is Section Head of the Liaison Unit and Psychotherapy and associate professor at the School of Medicine of the Autonomous University of Madrid.Since 1997 she directed with Alberto Fernández Liria the Master of Psychotherapy, University of Alcala de Henares. She has written books in the field of psychotherapy as Narrative Therapy and Mindfulness for Depression (DDB, 2013) Interview Skills for psychotherapists (DDB, 2003) and The Practice of Psychotherapy (DDB, 2002). She currently runs courses and seminars on psychotherapy and mindfulness to different places in Spain and Latin America.

Expert in the treatment of pain, develops her work in areas such as cancer, chronic pain, trauma, etc. The University Hospital work has brought experience in the clinical setting, as researcher and teacher. By sharing with us your knowledge, it allows us to enrich widely. She teaches courses on psychotherapy and coordinates from a therapeutic perspective construction of narratives and since 2000, has introduced the practice of Mindfulness in various treatments.

AMyS.- Since when has incorporated into their clinical practice Mindfulness, how was your approach to this perspective, as has been its development?

B.R.- Can not say specific years, since I had entered the practice of meditation and personal practice, but not in therapy.In therapy it was perhaps the approach to patients who were in a position of great linguistic restriction, people with serious illnesses, with much pain, trauma situations where it was not easy to have a more explicit narrative to work; then work with the body and somatic awareness became a necessity. So my first approach in the sense of a therapeutic tool was with hypnosis and practice, perhaps psychodrama body techniques. Then in the 90s, they began Mindfulness currents acquire more force and in 2000 was the emergence of Mindfulness publications. Then it began to converge in my practice it was a personal practice with a professional and maybe it was at the beginning of 2000 when I began to introduce the practice of Mindfulness with patients.

AMyS.- You have visited the Stress Reduction Clinic Medical Center of the University of Massachusetts, where Dr. Jon Kabat-Zinn developed the program to reduce stress, MBSR What has been your experience and what has provided the meeting with this program and the team that performed?

B.R. Hence what I brought was a working method, a systematic, an approach to make groups of patients with more training idea of therapy. I learned new things about techniques already used and I met many great therapists, of which it is always possible to learn. What I think is very important in this center it is that it has been chiefly responsible for introducing Mindfulness techniques in academic and medical means.Now there are more than 300 or 400 Hospitals in the US and Europe are using this method. Kabat-Zinn had – I think- the pioneering value to introduce it and also provided an empirical basis. The merit is to have introduced in the scientific community as a strategy for health development, not only in the treatment of diseases.I learned many things, and I curdle others already had. I went with a therapeutic level of maturity and clinical experience that helped me to delve into things that had gone to start my professional career, he had used otherwise.

AMyS.-What is the degree of integration of Mindfulness in the practice of public health in Spain?

B.R.- In Spain, it is still beginning, is very recent introduction.We at the Hospital de la Paz we are applying, both in the training of therapists as with patients, and both individual and group therapy. We have groups of chronic pain, eating disorders, diabetes …. also is the heart of Valencia, with Vicente Simon and Maria Teresa Miró, also in Barcelona ….But what it is inside hospitals, public health, as far as I know, is beginning, there are only personal initiatives. But my feeling is that in 5 years we will see many initiatives flourish.

AMyS.- When he talks about the application of Mindfulness to pain, it refers to all types of pain, both physical and emotional, chronic or occasional?What reduction targets, disappearance, or better pain management is proposed?

B.R. – Indeed, speaking of pain am referring to all kinds of pain suffered by a person.Regarding the objectives, Mindfulness is said that expectations are future disappointments and sometimes very tight objectives prevent us meet other aspects, things jumping us the way and we do not see if we have an open awareness of what goes emerging. We started with the idea of reducing emotional distress. Pain more resistance equals suffering. In general, patients with chronic pain living with much struggle, with much emotional suffering for the pain itself. In chronic pain, we can do things to reduce or alleviate it, we can work a lot with the resistance of that pain to promote acceptance. It is something that when I start working with patients their sounds weird, think “how can I accept this, “but it’s true, acceptance is the little brother of the change, only if something is accepted it is when you can start trying to change .So avoid that struggle, promote acceptance, understanding and compassion for oneself -I think- are first baseman to work with chronic pain and trauma.

AMyS.-I said before about the importance of the psychotherapist-patient relationship and the need to enter this dialogue with the patient, in this dialogue with their pain..Could you talk about it?

B.R. -‘Sometimes the difficulty is to impose what we think is good for the other, the different experience of that other person.I think people the need to find where they are and that effort and our responsibility as therapists is to go looking to try to carry out a preferred way for him or her and not us, where the suffering is less I presented. In this way the therapist acts as a facilitator, regulator. Some authors speak of the therapist is a psychobiological regulator, including the idea of mind and body. Helps regulate other not only with your words but with your attitudes, with the signs that make him with creating a climate of trust, empathy, not critical, because one of the problems as we mentioned earlier, both in trauma as chronic pain, that internal dialogue is the patient himself, that non-acceptance of self-loathing. And through the relationship mirror the therapist conveys to the patient, “You are a valuable person and worth to be careful, you’re taken care of ..” for perhaps some positive elements are integrated and starts a different dialogue, acceptance and compassion.

AMyS.-What significance attaches the therapists to their own experience of Mindfulness prior to applying it to patients?

B.R. – That’s essential. One thing has to go with the other. A teacher said: who can not teach a path that one is not willing to go. I think to teach the way you have to cross it previously. And you can not teach you Mindfulness without being a practicing Mindfulness. And this is necessary at all, not only in Mindfulness. What you are commenting on a patient, argue, work.. you need to have it built inside. There is no place for therapeutic imposture, you can not train something you’re not working.

AMyS. – And finally, how is viewed, from their point of view, the clinical application of Mindfulness among patients, students and other doctors?

B.R.- I think there is much more acceptance than we think.Sometimes it is the fear of psychologists, psychiatrists, to approach other professional groups with some techniques that challenge the traditional discourse. It is much more our fear rejection. I think we have to learn to substantiate it, and you have to speak their language. In neurobiology there are a lot of research that supports us in that direction, so that it is more accepted by his speech, but that is a more cognitive level. If we talk about patients, the patient is much more willing to work this way than we are therapists, I think they are very willing to meet someone to guide them in this way because there is a kind of wisdom this is necessary, we have lost that connection with ourselves and we have to go to the reunion with her.

AMyS.-. We are very grateful for your time, for your answers and for sharing with us your experience.Thank you very much.

By: Vicenta Orriach