Calmly facing the storm

2012-03-06 00:00

NO one knows better than Trish Bartley how hard it is to cope with a life-threatening disease. She’s faced cancer — twice.

In that 10-year journey this former development worker became exposed to a mental practice called mindfulness and found that it helped her cope with her first breast cancer, diagnosed in 1999 just after she returned from working in SA for 10 months.

The modern concept of mindfulness has its roots in Buddhism, but is not religious. It focuses on the practice of bringing the mind back to the current moment and has been used in medical contexts since the late seventies­ as a form of psychological therapy. Research suggests that it has benefits in the treatment of pain, stress, anxiety, depression, eating disorders and addiction, among others­.

Bartley describes mindfulness as being “fully present with your direct experience, whatever you are doing, thinking or feeling — here and now”. So rather than doing something on autopilot, you know that you are doing it, for example eating and being fully aware of the taste of each mouthful of food, or walking and feeling the ground under each foot.

“Anything can become a practice of being mindful. We just need to pause our busyness and come back to the experience we are having now — especially to the sensations in the body — and by using our senses deliberately,” says Bartley.

 

LEARNING ABOUTMINDFULNESS

 

Meditation had been a constant thread through most of her adult life before cancer and she had used it both in training processes in her work and helping her cope with her brother’s suicide. However, she didn’t immediately find it helpful in dealing with the disease, except when she was having chemotherapy. Events, however, led her to what has become her main occupation.

“My first treatment was given to me by the sister on the unit who was half-way through a mindfulness course at the university. It seemed an amazingly good omen. We practised together as the chemo dripped in. We often talked about the potential of mindfulness for cancer patients,” she writes in her recent book, Mindfulness-Based Cognitive Therapy for Cancer: Gently Turning Towards.

In August 1999, half-way through her treatment, she attended a mindfulness retreat with Mark Williams, John Teasdale and Zindel Segal who had just completed a study on Mindfulness Based Cognitive Therapy (MBCT), an intervention used to help people suffering from depression. They wanted to develop mindfulness teaching and Bartley found herself teaching the programme at the same oncology centre where she had received treatment.

When asked how learning to be more present in a painful situation can help, Bartley acknowledges that this is counterintuitive. “It is natural to try to avoid difficulty or pain. All creatures do it, even very simple organisms. We tend to tighten around pain, pull back from the unpleasant. But by doing that, we are just adding to our troubles.

“We have the original problem — say a cancer diagnosis and subsequent treatment — which is already tough to deal with. What we tend to do is add extra with thoughts that interpret things catastrophically and fuel emotions such as anxiety. This inevitably creates tension and tightness in the body, which, in turn, adds to stress.

“Vicious circles of anxious rumination can overwhelm us. This is the picture easily recognisable to many people with cancer. It is also in different forms recognisable to most of us — for example after a disagreement or facing a challenging upcoming event.”

But if the mind can create stress it can also create the opposite — balance and composure. In MBCT participants are shown how they can learn to relate differently to things they find difficult. This, she writes, is “not about getting distance from the experience … it is the opposite of turning away. A degree of courage, trust, confidence and even surrender is required. This allows a letting be, opening and softening to the pain of sickness and misery, that ultimately transforms our suffering”.

Compassion and connectedness are central in this process, and Bartley­ emphasises the role of the teacher. “Kindness became my hallmark of best medical care,” she writes about her cancer experience. She describes the difference a caring nurse made to her in a difficult moment — when she had the bandages removed after surgery — and writes about how the sense of connection “forged through a shared experience of suffering” is meaningful and comforting.

Bartley says that when she works with people with cancer there is an emphasis on the group process — “on how the learning is facilitated, not just what learning is there — and on the connection between teacher and participants. Compassion and kindness also feature strongly. People who are journeying with cancer have great need of both.”

Service and compassion have been important in Bartley’s career. After university she found herself in social services working with children, and then community development where she worked with people from an economically disadvantaged housing estate in Manchester.

 

SOUTH AFRICA

 

Before 1994 she had been a supporter of the anti-apartheid movement but had vowed not to visit the country until it was free. Then she found, after the elections, that with her children at university, she was free to go. She decided to come here “to research the ‘bones’ of development and see whether the [meditation] practice focus that I had developed in Manchester had anything to offer people living in much more disadvantaged circumstances”.

She arrived in SA in 1996 and spent 10 months working with the villagers of Mashabela in Limpopo. This resulted in a book, Holding Up The Sky, Love Power and Learning in the Development­ of a Community, published in 2004.

In 2000, she was introduced to Woza­ Moya, a community-based NGO working in the field of HIV/Aids in the Ufafa Valley near Ixopo. “Since then I’ve worked with Woza Moya every time I’ve come out, and will this year, too. My days with them are often the highlight of my trips.” She’ll be returning to work in Ufafa this month after running a mindfulness-based retreat at the Buddhist Retreat Centre­.

In moving from working with people suffering from cancer in a first- world environment to those working in the field of HIV here, Bartley had to make some changes to her training.

“People whom I teach in the hospital in Bangor [in North Wales, where she lives] make huge commitments to come on their eight-week course — two and a half hours a week — and up to one hour home practice every day.

“People whom I work with in the communities of KZN — usually community carers supporting people with HIV and Aids or members of community support groups — don’t have the time or opportunity to attend eight-week courses. Instead we focus on brief practices relevant to the lives they are leading. We always use threads (simple black cotton bracelets with a red bead tied onto them (wwwthoughtonathread.co. uk) to help them to remember to come back to the anchor of present moment — through the feet on the floor, or the breath breathing.”

Sue Heddon, director of Woza Moya, says Bartley’s work with their care workers has had a powerful impact. “We have our own support groups for care workers and we’ve drawn a lot on the mindfulness stress reduction techniques. We also teach the techniques in the community, and they are very useful.”

She says the techniques are very transferrable to a local rural environment as they are non-verbal and not culturally specific.

This intercontinental exchange has set up its own virtuous circle.

“The threads are now used in a variety­ of mindfulness-based contexts and make a deliberate link with others (such as people in KZN) also wearing the threads and doing simple practices to help them manage the considerable challenge of their lives. This enables some people to develop a sense of community, not just with other people with cancer in their group also practising mindfulness, but also with others with life-threatening disease living in other parts of the world. This is incredibly healing to people who feel isolated with their own experience of their illness.”

• IXOPO: Bartley will be running a five-day retreat called Gently Being With What’s Difficult at the Buddhist Retreat Centre, Ixopo, from March 16 to March 21.

It is especially relevant to those working in a stressful and challenging context, such as with people affected by HIV/Aids or a life-threatening illness. For more information, contact the BRC at 039 834 1863, 082 579 3037 or brcix opo@futurenet.co.za.

• PIETERMARITZBURG: She will also be running a one-day workshop titled Practically Mindful: Incorporating Mindfulness-based Practices Into Life and Therapy at Akeso Clinic in Scottsville on March 31, 8.30 am to 5 pm. Although aimed at therapists it is also open to anyone interested in learning more about mindfulness.

Contact John Soderlund at 033 342 7644 or at datepalm@newtherapist.com

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