4 Small but Mighty Mindfulness Tactics

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I've been absent from this page for a couple of months, digging into a new book project (Mindfulness in Medicine, to be published by Springer later this year) as a follow-up to Practical Mindfulness. In this brief interlude, artificial intelligence has swiftly bullied us toward an uncertain future or a grand new age, depending on what you read.

But for today, I'll stick to my mindful noggin and hot-dog fingers to preview some ideas germinating out of the new project. It's a "policy" book on how we can apply mindfulness concepts and tactics, in ways large and small, in every crack and crevice of the health care system, from the basic office visit to procedures and surgery, from individual interactions to system-wide strategies. And, as I belabor incessantly on this page, they are for use by both our patients and ourselves as health professionals—for better health care as well as our own improved coping with a wonderful but stressful, burnout-laden profession.

One tension point in understanding the use of meditative tactics in mainstream medical work is an old topic of debate within the "mindfulness industry": whether only longer-form meditation sessions, lasting 20 to 30 minutes or more, are truly of some or any benefit, versus the briefer yet more flexible benefit of short meditative exercises and routines, especially in particular settings and situations.

My own conclusion is "Lāmō jīvita bhinnatā."* Having trained in the "more is more" orthodoxy of longer-form vipassana training, with daily longer sittings and multi-day retreats for deeper dives into the prospect of experience of non-duality (or, mostly unearthing deeper conditioning), I have a deep respect for that path. Yet as a shrink, I recognize that many of the folks I work with want or need a simpler and more practical way of developing and utilizing the capacity of mindfulness.

Like, now.

My own experience in field-testing "what's enough to help?" tactics leads me to recognize that the effectiveness of mindfulness practice is not solely dependent on session duration. Shorter meditation sessions, as brief as a few minutes, can still offer valuable benefits such as stress reduction, increased present-moment awareness, and improved focus.

For individuals with busy schedules or limited time availability, shorter sessions can be more practical and realistic to incorporate into our daily routines—yet still beneficial. Some of us may find it challenging to sit and sustain focus for extended periods, which is a recipe for frustration and a quick exit from practice. I think the key lies in collaborating with our patients (and contemplating for ourselves) what kind of consistent practice works for our unique circumstances and preferences.

That "it's all good" consensus in mind, for the new book I've been culling the "lit-trit-shuh"** for evidence-based, short-form mindfulness training tactics, looking for a consensus handful of uniformly helpful ones—the "core four," I'm nicknaming them. I'll give a brief review of them here, and dive into each in subsequent posts.

1. Mindful Breathing. The core technique of mindful breathing—observing the sensation of breathing to build facility in observation while limiting additional judgment or added thought, especially in the inevitable losing and regaining of that action—is the firstest and arguably the best among the four care tactics. As both an entry path to mindfulness more broadly and as a routinely therapeutic response in terms of adoption to acute, momentary stress, basic breath meditation is an essential tactic, one that other momentary mindful practices can be built upon.

2. Scanning. This tactic builds on the basic targeting of the breath as a particular sensation and location to involve shifting our observation sequentially from one target of personal experience to another. Building familiarity with flexibly directing our awareness reinforces it as a capacity of mind that can operate like a camera, focusing and directing attention on individual phenomena of our current experience, like the breath, heartbeat, or back pain, and out to the "landscape" of the physical, emotional, and thought phenomena of the moment, in part or whole.

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Body scan meditation simply involves moving the target of one's mindful awareness, up or down the physical self from the experience of one's breath to, say, feet, then legs, then waist and upward, or scalp and downward, covering the full body of somatic experience. This brief tactic is particularly applicable in medical practice, around identifying and adapting to pain and other discomforts.

A slightly broader variation on the body scan, which could be called a "self" scan, involves sequential targets of awareness beyond physical phenomena to a full attending to body, emotions, and thoughts and then a full opening to self-in-the-moment. Whether of the physical "territory" or of a fuller survey of all inner experience, the scanning practice is valuable in acute suffering and in grounding individuals in better momentary self-awareness and sense of control.

3. Visualization. This is an imaginal tactic that can also be paired with mindful breathing. It is used regularly in working with phobias; for example, using imagination to mentally rehearse and gradually desensitize to the feared situation, such as driving over a bridge, prior to and preparing for subsequent, direct exposure to the event.

Visualization techniques can include creating a detailed mental picture of an anticipated event, incorporating remembered or anticipated sights, sounds, and physical sensations, and proceeding through the event in imagination. "Imaginal Rehearsal Therapy" (IRT) is another term of art for this practice, which has also shown benefit in veterans populations to address flashbacks and night terrors associated with PTSD. It can operate beneficially as a basic "run-through" of an event.

In addition, the visualization/imaginal "script" can also include creating and mentally rehearsing successful or preferred outcomes. This practice helps create a positive mindset, enhancing self-belief and reducing anticipatory stress. Individuals can mentally prepare for potential scenarios, enabling them to respond calmly and effectively during the actual visit. This technique helps reduce surprises, build confidence, and enhance our communication with our patients.

4. Gratitude/Compassion Meditation. The inclusion of brief meditations on opening to the aspirational states of gratitude and compassion can also be valuable in medical settings. These practices focus less on a momentary awareness of one's state and instead work to generate and/or access one's positive, aspirational feelings, to the extent they can be accessed in the midst of discomfort.

Gratitude meditation involves focusing on feelings of appreciation and acknowledging the positive aspects of one's healthcare experience, including the opportunity to receive medical care, the knowledge and expertise of healthcare professionals, and the support of loved ones. shifting the mindset from anxiety and worry to a more positive outlook. Compassion meditation, on the other hand, cultivates empathy towards oneself, fellow patients, health care providers, and staff, while acknowledging one's own fears and anxieties.

The favored direction is to "open to" images or feelings of compassion and gratitude, and then observe the effect in heart and mind—rather than a forced sense of "play-acting" at a state of mind. When accessible, these meditations can foster a sense of resilience, optimism, and collaborative trust in the healthcare process.

These four practices are compact but nevertheless potent, especially in medical settings. There are roles for them in the sequence of basic office visits, and in a variety of other medical moments—blood draws, enduring an MRI or colonoscopy, or managing a frightening trip to an ER. Brief can be good.

* "Vive la difference" in Nepali.

** "Online research" in Grandiose Academese.

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