Patient may be positioned supine, prone, side lying or sitting depending upon comfort levels
1. Establish therapeutic alliance / didactic introduction to meditation (1st session, 10 min)
Hello, _________. I’m ____________. I am a naturopathic physician who will be teaching you and guiding you in meditation. We’ll be spending about 45 minutes with each other about twice a week here in your room, if that’s OK with you.
Before we begin I wanted to first ask if you have any experience practicing relaxation and abdominal breathing. Have you ever practiced meditation?
The purpose of meditation is to both focus and relax the mind and the body. Meditation techniques have existed in all cultures of the world for thousands of years. In our modern world, meditation is practiced by patients at home and in hospitals to calm the mind and decrease pain. Many studies have shown that people feel calmer and less stressed when they practice meditation regularly. There are many types of meditation techniques. However, most techniques use the same principle: breathing deeply into your belly and watching your own breathing. The beginning student of meditation is instructed to simply watch the breath go in and out. We do this because the breath is the bridge between the mind and the body. Meditation is a tool every one of us can use to ease pain if we have pain, reduce fear if we are scared, and clear the mind if the mind is thinking non stop. By calming the mind, people who practice meditation find that it is easier to change the way they feel about things that can’t be changed. For example, people who meditate say they were able to find forgiveness when they were angry. When we meditate we are able to feel acceptance for situations that we fear and that we can’t change. Through meditation we can learn to let go of worries. We can feel more loving towards ourselves and those around us. Meditation is also a way to bring a sense of connectedness to our inner selves.
You and I will meet about two times a week. During each session we’ll do a series of things together. First, I will spend 5 minutes talking to you and seeing how you’re doing. I will answer any questions you may have since my last visit. Then in the next 15 minutes I will guide you through a relaxation exercise that will help you relax parts of your body that may feel tense. Then I will teach you what is called “abdominal breathing” (breathing deeply into your belly). After that, we will spend 10 minutes or so guiding you through what is called ‘mindfulness meditation.’ Mindfulness meditation is a technique for clearing, calming, and focusing the mind. During this part of the meditation we will just pay attention to breathing. You may experience sleepiness, or even fall asleep. It’s OK if you do. You may feel distracted or bored or restless. That’s normal, too. Don’t worry. You may feel sad. You may feel love. Simply notice what comes up for you as we proceed.
After practicing these techniques, we will spend 5 minutes in silent meditation. I will use this small chime to start and end this last part of our session together. At the end we’ll spend a few minutes talking about how the session went for you, any thoughts or comments you have, and how you’re feeling.
So before we begin I’d like to get a sense of how you’re doing today. How are you feeling physically and emotionally? LISTEN
2. Guided progressive relaxation (Modified from Kabat-Zinn) 15 minutes
During this process of guided relaxation it will be best if you close your eyes and try to stay awake. However, if you fall asleep, do not worry. Sometimes people fall asleep during the first sessions. It is important to remember not to try too hard to relax. This will just create tension. I will be telling you to focus your attention in one part of your body at a time. When you hear me naming a part of the body, simply become aware of that part of your body as I mention it.
While focusing on a part of your body, let’s say for example your legs, you may feel your legs are tense or in pain. You may want to make the tension or the pain disappear. When this happens, just become aware of the tension and “watch it” – as you would watch a movie. If you become upset, angry, bored, or feel any other disturbing thought or emotion, don’t try to change it. Just watch the emotion or the thought. Simply notice what you are feeling. If a critical thought appears, just notice the thought, observe it. Be aware of how you are feeling, aware of what’s happening right now. Remember there is no one right way to feel while doing this. The way you are feeling right now is the only “right way.”
Allow your eyes to close gently. Let your arms lie calmly at your sides, the palms open towards the ceiling if that feels comfortable for you, allowing your feet to fall away from each other. Slowly bring your attention to the fact that you are breathing. Simply experience the air moving in and out of your body. Now direct your attention to your belly. Feel the sensations in the belly as the breath comes into your body and the abdomen expands gently. Feel the breath moving out of the body and the belly deflating. Just follow the rhythmic movements of your belly with each breath. Imagine that you are watching yourself breathing in and out, your belly expanding when the air goes in, and deflating when the air goes out.
Now take a deep breath and as you let the air out, feel your body becoming heavy, sinking into the bed/chair. As you breathe in, your belly expands with the air. As you breathe out, your body becomes heavier and heavier, sinking deeper and deeper into the bed/chair.
Now we will start moving our attention through different parts of the body to help the body relax. We will go from the feet to the head. First let’s focus the attention on the feet. Take your mind away from your belly, and move your attention down to your legs. Become aware of whatever sensations may be coming from your feet. Perhaps your feet are tingling; perhaps you feel moisture, warmth. Whatever you feel, just become aware of that feeling. Nothing matters, except feeling your feet as they are. As you breathe in imagine that the air is moving right down through the lungs, down into your belly, down into your feet. As you breathe out imagine that the breath is moving back from your feet up through your body and out your nose. Imagine breathing into your toes, then breathing out from your toes.
Now become aware of the lower legs, the front and the back of the legs. Become aware of any sensations in your lower legs. Try not to move them. How do the legs feel? Accept the feelings as you feel them. As you feel the air going in, expanding your belly, let that air run down into your lower legs. As you breathe out, imagine the air running up your legs, up through your upper body and out the nose. Feel your body becoming heavier, more relaxed with each breath, sinking deeper and deeper into the bed/chair.
Let the focus now move up to your knees. Feel your knees, the front, the sides and back of the knees. Breathe into your belly, in and out, deeply and slowly.
Let’s now move the attention into the thighs, all the way up to the groin. Feel your thighs, the back of your thighs sinking into the bed/chair. As you breathe in, feel the air expanding your belly and going down into your legs. Breathe into your thighs.
Become aware of your hips and your pelvis. Experience your pelvis, the entire area below your belly button. Breathe deeply into your pelvis and hips. Become aware of your hips in contact with the bed/chair. Feel the sensations of contact, or weight. As you breathe in, feel your hips sinking even deeper into the bed/chair, letting go of any tension as you sink even deeper and deeper. Totally present in each moment. Just being right here as you are right now.
Now let’s direct our attention to the lower back. Feel the sensations in your lower back. Let the breath move into every part of your lower back. When you breathe in, feel the belly expanding and the lower back sinking even deeper into the bed/chair. When you breathe out, feel the lower back relaxing, letting go of all tension.
Moving your attention now up into the upper back. Just feel the sensations in this part of the body. Breathing in you may feel your rib cage expanding in front and let go of any tension or discomfort in the upper back, just let it dissolve. Feel the belly expanding when breathing in. When breathing out, feel the lower back sinking even deeper into the bed/chair. Feeling very relaxed. Allowing your attention to shift to the belly again and to watch the rising and falling of your belly as you breathe. Just allowing the awareness to expand from the belly to the chest as well. Feeling the movements of your chest and ribs. Breathe into the center of your chest, into your heart. Breathe out tension.
Allow your attention to move now to your fingertips. Become aware of the sensations in the tips of your fingers and the thumbs in both hands. You may feel some pulsations. You may feel dampness. Just feel your fingers. Feel the front and the back of the fingers. Breathe into your fingertips and breathe out from your fingertips.
Allow your awareness to include the palms of your hands, the backs of your hands and your wrists. Perhaps you may feel the pulse of the blood moving to and from your hands. Become aware of the forearms and elbows as well. Become aware of any sensations, any discomfort, any tension.
Allow your awareness now to include your upper arms. Right up to the armpits and shoulders. The shoulders may feel tension or pain. Perhaps the neck feels tense. For a moment now just experience your shoulders and your neck just as they are. And feel the air going into your shoulders with the in breath and upper arms and out from your shoulder and upper arms during the out breath. Let that tension dissolve as you breathe out.
Now become aware of the face, the jaw and the chin. Just experiencing it as it is. Breathe into your face and out from your face. Let any tension in the face, jaw and chin dissolve.
Become aware of your lips and your mouth, your teeth, your gums, your tongue, the roof of your mouth. Notice your forehead, your scalp. Be aware of your eyes and the eyebrows and the space between the eyebrows and the entire region around your eyes. Become aware of your eyelids. Breathe into your eyes and out from your eyes. Allowing the sides of your head to relax as you experience the sensations on the side of your head. Breathe into your ears and breathing out from your ears and letting them relax as well. Breathing into your forehead and out from your forehead, letting it soften. Just being aware that you’re nourishing your face by breathing in, letting your forehead relax, letting tension and worries dissolve in relaxation and stillness.
Now become aware of the back of the head and the top of the head. Breathing in and breathing out from this part of the head. Imagine the air going in and out from the top of your head and right back down into it. Now you see yourself breathing into the top of the head and out from the top of your head. Just watching and allowing your breath to move in this way. Along the entire length of your body all of your muscles in a deep state of relaxation and your mind simply aware of this flow of the breath, experiencing your entire body breathing.
Feel your whole body breathing. Lying here in a state of stillness and deep relaxation. Sinking deeper and deeper into a state of well being as you come in touch with feeling complete, feeling whole, feeling at peace. Open to things just as they are in each moment. You are in a state of peace and healing, allowing the world to be as it is, beyond personal fears and concerns. Beyond the tendencies of the mind to want things a certain way. See yourself as complete right now, just as you are. Experience the fullness of the moment, experience the fullness of your ability to love and be whole – just are you are, right now.
Silence for 30 seconds.
3. Breathing meditation (based on Sharon Salzberg) 5 min
Now that the body and the mind are very relaxed, we will spend a few minutes just watching the breath. Bring a quality of relaxed, open, spacious awareness to feeling your breath. Take three deep, easy breaths and release them.
Allow the breath to become natural, so you’re not trying to force or control it in any way.
Notice the place where you feel the breath most clearly. It may be the in-and-out movement of the air at the nostrils. You may feel tingling or vibration, or changes in temperature. You may feel the breath most distinctly with the rising and falling of the chest or the abdomen: stretching … pressure … tension … release.
As you feel the breath, say to yourself “in” as you feel the breath going in; “out” as you feel the breath leave your body. Very gently, very quietly in your mind, become aware of the actual sensations … just note “in” and “out”…“rising” and “falling.” 10 sec
You don’t need to make the breath special. It doesn’t have to be deep or long or different from however it is and however it changes. It’s happening anyway, so simply be aware of it … one breath at a time. 10 sec
You may find your attention wandering. You may realize that you’ve been lost in thought, planning, remembering, whatever. Perhaps it’s been quite some time since you last felt the breath consciously. It doesn’t matter. You don’t have to judge or analyze how you got there. Don’t worry. See if you can gently let go of whatever the distraction has been and simply begin again. Gently let go, and return the attention to the actual feeling of the breath.
This act of beginning again is the essential art of meditation practice … over and over and over, we begin again. You may find your attention wandering again and again. It doesn’t matter. The mind has been trained to be distracted. In a very patient manner, just let go … reconnect … come back to the feeling of the breath in this very moment … the natural, normal breath. 15 sec
Simply feel your breath ....
If you find your attention has wandered, that’s fine. See if you can practice being patient, being gentle, and beginning again. You may discover that there’s a pause or a gap between the in breath and the out breath, or between the out breath and the next in breath. If you find such a pause, you can allow the attention to settle there, in the space between breaths. Simply feel your body lying/sitting here. Then allow the next breath to come naturally.
Notice the difference between feeling the breath and observing the breath from some distance. You’re not struggling to see the breath or visualize it, but simply feeling it. Feel the tingling or the heat or the coolness at the nostrils … or the stretching, the pressure, the movement in the chest or abdomen.
There’s nothing you need to do about it. You don’t need to change it; you don’t need to force it or perfect it. Focus your mind on each breath. We’re simply here. This is our life, right in this moment, this one breath. Many, many distractions will arise. A torrent of thoughts and plans and images and aches and pains – it doesn’t matter. Just watch your breath.
If you’ve lost touch with an awareness of the breath … just recognize it and simply come back to the breath. If you start to feel sleepy, just notice it and return your mind to the breath. Take a few deep breaths consciously … and then again, allow the breath to become natural. If you have to begin again and again and again in the course of one sitting, that’s the practice. That’s what meditation is. 10 sec
Focus your attention on the breath that’s appearing right now. See if you can sustain attention through the course of one entire breath. 10 sec
4. Counting breaths meditation (Based on Marsha Linehan’s Walking like Buffalo) 10 min
For the last part of today’s session I want to teach you another simple method of meditation that involves counting your breaths. Counting your breaths is another method of mindfulness meditation.
Place your hands on your chest or your belly. Notice the air coming in filling up your lungs; just notice whatever happens – without expectation. First we will learn to focus the mind. The way to practice focusing the mind is to practice an activity. The activity we will practice is counting the breath. Let me go over the instructions first before we try this method together.
You will count your in breath and count your out breath. One in, two out, three in, four out, and so on. When you get to 10 you start over. If you find that you’ve gotten lost on the way, simply start over. Sometimes people don’t stop at 10 and keep going and then notice that they’ve counted beyond 10. If you notice that, simply return to one – just start over. Focus on the breath in and the breath out. Count one, two, three, four.
When you are counting “one” try to count as if every part of your body is saying “one” – your mind and your body – your whole self is saying one and nothing else. When you say two – everything about you is saying two and nothing else – as if your whole body and mind is saying two. Your whole self is saying two – and nothing else. Every time a thought comes through, try to notice it, and gently return your mind to counting. Gently always returning the mind to counting your breaths. If an urge to move comes in just notice it. Just keep counting. If an itch or urge to blow your nose – just notice it. See what happens if you don’t follow your impulse to move. Notice the natural movements of the body as you breathe. If it is a strain not to move, then move mindfully. Then bring your attention back to counting your breaths – in and out.
You may want to move because you have a pain in your hips or back – just notice it. Sometimes the body will move when tension is released. That’s OK. You may notice you’re in an uncomfortable position – just notice it. Just observe your impulses. Just notice. Simply count your breaths. One in, two out, three in … until you reach 10 and start again.
I’ll start our counting meditation with a sound of the chime. When the time is over, you will hear the chime again. Between the chimes we will practice counting breaths silently. It won’t be too long and it won’t be too short.
Silent counting meditation for 5 minutes. Start by ringing chime softly. End with a soft ringing of the chime.
When you’re ready, wiggle your fingers and your toes. When you’re ready, gently open your eyes and come back to the room and to me. When you’re ready, I’d like you to tell me your experiences during our meditation session today.
After each session, ask the patient how s/he is feeling, if s/he has questions or comments s/he would like to share with you. Also, ask for feedback about what worked and did not work, what the patient was able or not able to follow, and what s/he was comfortable with. Use this feedback to tailor subsequent sessions to meet the patient’s needs. Modifications are allowed as long as they are consistent with the techniques used in the protocol: for example, if the guided relaxation is not appropriate for a patient, increase the time used for silent meditation or other portions of the protocol.
When patient has finished reporting to you, end the session by saying; “See you on _______ at ______. Good bye. Be well.”