Breathworks Research

breathworks-mindfulness.co.uk

Overview of Presentation
 Qualitative - Part of a PhD by Natasha
Doran
 Quantitative - questionnaires pre and post
 Our own questionnaire – trying to
measure the inner process

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 Qualitative Study

Exploring Self Management Approaches to

Living With Back Pain
La Danaide Auguste Rodin 1889

Natasha Doran
University of Manchester
E-Mail: natasha.doran@alumni.manchester.ac.uk

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 Full title of study
•  ‘Journeys through healthcare: A qualitative
study exploring perceptions and experiences
of health-seeking for chronic back pain in the
north-west of England’.

•  PhD funded by the MRC at School of Primary Care, Manchester, UK

Study Aim
•  To look at the processes of adjustment to
living with long-term pain and explore how
exposure to mindfulness-based techniques
relates to participants perceptions and
management of their pain

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 Methods:
Semi-structured interviews
Biographical time line
Participant Observation
Informal Group Discussions

Fieldwork Settings:
•  Manchester - •  Liverpool -

Breathworks Self Whiston hospital -

Management in Pain Group Spinal unit.
programmes.

Breathworks sample
●
25 volunteer participants in total

●
16
volunteers
through
Breathworks

-

11
Female

-



5
Male

●
Age
33
–
66
Years

●
Back
pain
diagnoses
(
prolapsed
disc,

arthritis,
spondylitis)


●
Duration
of
symptoms
4
–
28
years

●
9
on
incapacity
benefit



4
 “I found if you give pain space
it's a lot better, rather than
trying to get rid of it,
cos then you build emotions up
and things tense
and this brings more pain on.”
“I’ve learnt that much
of my tension
is unconscious…it’s been
an unconscious response to my pain.”
“I looked at things in a very
absolute way, so my pain was solid…
my pain was everlasting...
with the perception that I got
through the course, I see that
everything is always changing
and that includes my pain.
That helps me… It gives me
a life that’s liveable.”
“Before I went to the
[pain management] course,
I was just fighting it,
fighting the condition in my back
all along the line.”
“It’s only now that I’m actually
learning to breathe into the pain
rather than tighten around it…
living with pain means
learning this difference.”
“[Now] I try not to get too hooked
on the diagnosis; I just think, well,
“What is my experience
in this moment?”
I don’t think, “What’s it called?
What’s the label?”…
I think there comes a point
where it can be very liberating,
to get away from the labels.”
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Breathworks Self-Management in Pain
Group Programme
•  Self-management techniques:
•  Key tools: Meditation & Body Scan, Relaxation,
Mindful Movement, Diary keeping, Pacing,
Working with Thoughts & Emotions.
•  Key concepts: ‘Moment by Moment Awareness’,
Breathing into the pain, Learning to ‘Respond’
rather than ‘React’ to pain.
•  Awareness of pain/tension distinction Awareness
of pain/suffering distinction

Results
●
All reported far more acceptance of pain –
rather than fearing/blocking pain, looking at
ways to ‘move through it’ and ‘live with it’
●
Participants
reported
a
shift
in their self
perception away from over identification with
their illness identity.

●
Despite some reported increase in pain over
time, all reported increased quality of life.

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 Concluding Remarks
•  This qualitative study shows the benefits of
using mindfulness-based approaches for
managing persistent pain.
•  Initial interviews were conducted 4 years
before end of study – showing that benefits
have been sustained over time (including
managing flare ups).

Acknowledgements:

natasha.doran@alumni.manchester.ac.uk

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Quantitative Study

Questionnaires pre and post

  13 – 97 cases
  Pain experience – Pain Scale
  Depression, anxiety & positive outlook - DAPOS
  Confidence in activity despite pain – PSEQ
  Mindfulness – Freiburg Mindfulness Questionnaire
  Rumination, magnification & helplessness - PCS
  Activity engagement & pain willingness - CPAQ
  Quality of life - SF-36
  Self-compassion questionnaire

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 Pain Questionnaire
Pre‐programme mean 
Post‐programme mean 
100 

90 

80 
p≈0.002 
70  N= 45 
p≈0.003 
60  p≈0.000  N=45  p≈0.001 
p≈0.024 
N= 45  N=46  N=46 
50 

40 

30 

20 

10 

0 

Intensity  Distress  Interference  Days (Good)  Days (Bad) 

Depression, Anxiety and Positive

Outlook
14 

p≈0.000 
12  p=0.021 
N= 47 
N=47 

10 
p≈0.000 
8  N= 47 
Mean 

Pre‐programme mean 
6  Post‐programme mean 

4 

2 

0 
DAPOS: Depression   DAPOS: Anxiety   DAPOS: PosiLve Outlook  

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 Pain Self Efficacy Questionnaire
60 

50 

40  p≈0.000 
N=48 

30  Pre‐programme mean 
Post‐programme mean 
20 

10 

0 
Pain SelfEfficacy QuesLonnaire (PSEQ) 

Freiburg Mindfulness Scale

40 

35 

30 

25  p≈0.000 
N=50 
Pre‐programme mean 
20 
Post‐programme mean 
15 

10 

5 

0 

10
 PCS: Rumination, Magnification and
24  Helplessness

Pre‐programme mean 
18 
Post‐programme mean 

p≈0.000 
N=48 
12 
p≈0.000 
N= 48 

p≈0.000 
6  N= 48 

0 
PCS:RuminaLon Pre  PCS:MagnificaLon Pre  PCS:Helplessness Pre 

66 
CPAQ
60 
Pre‐programme mean 
54 
p≈0.000  Post‐programme mean 
48  N= 47 
42 
p≈0.000 
36  N= 47 
30 
24 
18 
12 
6 
0 
CPAQ: AcLviLes Engagement  CPAQ: Pain Willingness  

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 Quality of Life: SF-36 scales
100 
90 
p=0.017 
80  N=26 
p=0.002 
p=0.362  N=26 
p=0.034 
70  N=25 
N=26  p=0.017  p=0.011 
p=0.001  N=24  N=26 
60  N=25 

50  p=0.008 
N=26 
40 
30  Pre‐programme mean 

20  Post‐programme mean 

10 
0 
FUNCTIONING 

SF‐36 ROLE‐PHYSICAL 

SF‐36 ROLE‐EMOTIONAL 

SF‐36 MENTAL HEALTH 

SF‐36 ENERGY/VITALITY 

SF‐36 GENERAL HEALTH 
SF‐36 PHYSICAL 

SF‐36 PAIN INDEX 
FUNCTIONING 

SF‐36 SOCIAL 

PERCEPTIONS 
INDEX 

Self Compassion Questionnaire

20 
p≈0.000  p≈0.000 
18 
N= 32  N= 33  p≈0.000  p≈0.003 
16  N=35  N=33 
p≈0.009  p≈0.000 
14  N=33  N=31 

12 

10 
Pre‐programme mean 
8  Post‐programme mean 
6 

4 

2 

0 
self  self  common  isolaLon  Mindfulness  over 
kindness  judgement  humanity  idenLfied 

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 Breathworks questionnaire

We have also been developing our own

questions looking at areas most sensitive
to process and change

Breathworks questionnaire

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 Living with a Painful Body
6  Pre‐programme mean  Post‐programme mean 

5  N= 50  N=49  N=50 

p≈0.000  p≈0.000  p≈0.000 
4 
A.  How accepting do you feel you are
of it?
3  B.  Can you live in harmony with it?
C.  Are you able to maintain perspective
2  when in pain?

1 

0 
A  B  C 

6 
Kindness to self and others
Pre‐programme mean 
A.  Kindness to self
5 
(p≈0.000)
Post‐programme mean 
B.  Kindness to others
4  (p=0.244)
C. Open to others (p=0.127)
D. Communication (p
3 
≈0.219)
E.  Honesty about needs
2  (p ≈0.000)
F.  Open to others’ needs -
N=50 (p=0.153)
1 

0 
A  B  C  D  E  F 

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6 
Awareness of self
Pre‐programme mean  How aware are you of
5  Post‐programme mean 
A.  Bodily sensations? (p=0.004)

4  B.  Feelings and emotions?

(p=0.017)

3  C. Thoughts? (p=0.001)

2  N=50 

1 

0 
A  B  C 

Awareness of the World

How aware are you

of the world around
p=0.952  you?
N=50 
p=0.063  A.  The unpleasant things
N=50  B.  The beautiful things

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6 
Choice
5 
How much choice do you
feel you have in how
4  you respond to:
a,c,e: pleasant bodily
3  N=50 N=48 sensations/feelings/
N=50 N=47
p≈0.000
p=0.001 p=0.002
p=0.115
thoughts?
b,d,f: unpleasant bodily
2  N=50 N=50 sensations/feelings/
p≈0.000 p≈0.000 N=48
p≈0.000 thoughts?
g: unpleasant external
1  events outside your
control?
0 
A  B  C  D  E  F  G 

Summary of Breathworks
questionnaire

 Greater acceptance of pain, and ability to

maintain perspective
 Increased sense of kindness to self and others
 Increased awareness of the beautiful
 Greater sense of choice in response to
unpleasant physical sensations, feelings and
thoughts

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Thank you to everyone who has
helped us with our research

Elaine Weatherley-Jones, PhD

Alice Plummer, PhD
Ian Wray, PhD
Amanda C de C Williams, PhD
Natasha Doran, PhD
Caro Edwards
Glenn Miller
Hayley Morris
Maggie Muir and Annie Bracken

Breathworks Research

breathworks-mindfulness.co.uk

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