Linda Feature Image

I’m super excited today because we have Linda who is a world-leading expert at applying mindfulness to dealing with worries and uncertainty, both during cancer and beyond.  Here are some things that we cover today:

  • The truth about mindfulness
  • Untangling past, present and future
  • Two ways of coping with trauma
  • Putting mindfulness into practice
  • Step by step diaphragmatic breathing walk through
  • and much, much more!


About Dr Linda Carlson

Mindfulness-Based Cancer Recovery

Mindfulness Based Stressed Reduction

Mindfulness-Based Cancer Recovery Book

Am Mindfulness Mobile (Apple App store)

Am Mindfulness Mobile (Google Play)

Episode 029: What You Must Know About Clinical Trials Before Starting Treatment

Full Transcript

Joe:                 Tell me, what’s mindfulness and why is it important when you’re dealing with cancer?

Linda:              Okay, well, let’s start with the basic question, what is mindfulness anyway?  If you look at the simplest definition, mindfulness is just paying attention in the present moment with an open and accepting attitude.  It’s simple but it’s not easy because when you think of where your mind normally is, there’s research saying we have anywhere from 50,000 – 70,000 thoughts every day.  50,000 – 70,000 individual thoughts.  Yes, they’ve done research where they ping people with little beepers and they ask them, what are you think about and they ask their moods.  It turns out that, make a guess, how often do you think that our minds are not in the present moment?

Joe:                 Most of the time?

Linda:              We might think that, but in this study, they found that about half the time people’s thoughts weren’t on what they were doing.  In conjunction with that, they also found that people were happier when their attention and their thoughts were in the present moment.  If you ask yourself the question, why would that be?  Why is it that when my mind is wandering, I’m less happy?  Well, you can look to where the mind goes often.  If you look at our habitual ways of thinking, our minds might be in the past.

You might be reliving something and saying thing, or could have, should have, would have, or if only this, or if only that, things would be better.  Then you feel really down on yourself, you can have regrets.  You can get angry and resentful, right, when you’re thinking on the past, because you can’t change any of that.  You can get really wrapped up in blaming yourself for how things went.  Or, for a lot of people and a lot of people with cancer, their minds are zooming off to the future, they’re worrying about, what if this?  What if that?

I don’t know what’s going to happen.  What does my future hold for me, so then you get all stressed out and worried, right?  All that ruminating in the past makes you depressed, all that worrying about the future makes you anxious, so you miss the moments when you live your life, which is only in the present moment.  It turns out when we are able to keep our attention and our awareness in the present moment, we tend to be happier because we’re not so stuck with things we can’t change or things that may never happen.  That’s generally the idea of mindfulness, is learning to be awake and aware in the present moment.  There’s also lots of myths around, what is mindfulness, that it’s important to dispel.

One really common myth is that your mind just goes blank, right?  There are no thoughts and it’s all blissful and you’re floating like one of those yogis sitting in a lotus position.  That’s a common roadblock because people might try mindfulness practice and their mind doesn’t go blank and it isn’t calm and peaceful.  They think, “I don’t know how to do it or I’m doing it wrong, or I just don’t get it.  I can’t do it, it’s impossible.” Right?

Joe:                 Yes, I’ve been there, done that.

Linda:              It’s really important to understand that mindfulness or awareness in the present moment doesn’t always mean that it’s blissful because your present moment experience isn’t always blissful.  We can be aware and accepting of uncomfortable mental states, that’s still being mindful.  We often think of mindfulness as three main components called: IAA.  The first one is intention, so you make a purposeful intention that you’re going to try to be present in the moment.

The intention for doing that may be just because you want to be more available and awake and aware in your life, you want to be present, or maybe you actually want to hone this skill for a particular reason.  Like, you want to help cope with a difficult time or work with a symptom like pain or insomnia or something like that.  That’s your intention, which is your guiding light.  Then the second component – intention is like the why of the practice.  The second component is attention, attention training, that’s the core of the practice.  That’s the what, is attention.

Mindfulness is a skill that you have to learn through practice, just like you would learn to play tennis or play the piano.  You’re not a piano virtuoso overnight, and you’re not a tennis star by watching people play tennis or reading about it.

Joe:                 Although, that would be nice.

Linda:              Yes.  People love to read books about mindfulness but if you don’t actually do the practice, you’ll never get any better at it.  Just wanting to be mindful doesn’t make you mindful.  I would love to speak 12 languages, but I don’t because I haven’t practiced doing that, right?  The core of the mindfulness practice is attention training.  That’s when we purposefully turn our awareness towards what we’re paying attention to, and when our minds wander, like it inevitably will, you gently lead it back, over and over again.  Our awareness often is on something mundane in the present moment, like your breath rising and falling, or a sensation in your body, if you’re doing a body scan.  It can be any element of present moment experience.

You can focus on sounds in your environment.  You can focus on sensation in your body or thoughts that are passing.  You have to have that vigilance to notice when your attention wanders and bring it back.  That bringing back, each time you do that, it’s training your mind to walk a different path, it’s actually strengthening neural connections in your brain that support the ability to be in the present moment.  The strong neural pathways we have now take us to the past and the future and analysing and judging.

We have to retrain the brain to beat new paths.  We do that through repetition and attention training.  That’s the second component, the a is attention.  The third component is how we do it.  That’s the a of attitude.  It’s really easy and you’ve probably had this experience, to be very harsh and judgmental when you try to do mindfulness practice, like, “I suck at this, I can’t do it.  I give up.”

Joe:                 Absolutely.

Linda:              That’s obviously not helpful.  We want to apply attitudes of kindness and non-judgment, openness and curiosity, as well as self-compassion.  Thinking, wow, this is really tough.  This isn’t an easy thing I’m doing.  I’m just going to have to accept that it’s going to take time.  Another attitude is patience.  Another one is acceptance.  When we sit and pay attention to our experience, often, it’s not pleasant and it’s not what we would optimally like it to be.  Your mind is crazy and worrying and driving you up the wall, but can we accept that’s where we’re at, we’re having difficult emotions.  Can we be kind about that?  The attitudinal component helps soften the discoveries through the attention all towards the intention of being more present and awake and aware.  That’s mindfulness in a nutshell, I guess.

Joe:                 Yes, fantastic.  I really love how you say that you have to have an internal reason of why you’re doing it, right?

Linda:              Yes.

Joe:                 Sorry?

Linda:              Yes, I was just going to say, your intention may change, or it will evolve over time.  For some people, they may have really grand intentions just to become more self-aware and personal growth and ultimately, to be liberated from suffering and reach enlightenment, these types of objectives.  It also may be very mundane, I want to cope with day-to-day stressors in my life.

Joe:                 Yes, absolutely.  I know how you mentioned that you focus on where you are on and you don’t allow yourself to wander off, to think about other things.  When you do, you have to be kind to yourself and let it go.  How do you actually focus on bringing yourself back to that moment?  Bringing yourself back to the space where you are now?

Linda:              There’s this meta awareness, we call, right?  There’s a larger awareness that sees what we’re doing.  We’re trying to channel or develop the skill of this meta awareness.  Say, for example, we’re doing awareness to breath meditation.  You’re using mental noting to help you.  You’re noting to yourself in, every time you breathe in, you might be feeling the rising of your belly.  You might be breathing in and thinking in, rising, out, falling.  In, rising, out, falling.  Then you think, “I forgot to return that phone.”

Then you might think, “I have to do it now or maybe I could do it later.” Then that meta awareness says, you’re off the breath, you’re off the breath.  It might take a while or maybe it chimes in right away and you go, I’m off the breath.  Then you say, let it go, I’m going to let the phone call go and then you’re going to come back.  In, rising, out, falling.  That’s the training.  That’s it.  Right there.  The noticing and the coming back.  Diverging from your focus isn’t a failure.  That’s how you get better, right?  That’s how you learn the skill, if you work constantly on your breath all the time in the beginning, then you’re already doing it, right?

Joe:                 Yes, absolutely.  Tell me, Linda, is mindfulness and meditation, are they different?

Linda:              Well, mindfulness is a form of meditation.  Mindfulness is also something a little bit broader because you can think of mindfulness in two ways.  Mindfulness is a way of being in the world.  You can be more or less mindful at any given time.  It doesn’t take extra time to be more mindful as you go throughout your day.  It’s just a way of being.  It’s almost like a trait.  Mindfulness is also a practice, mindfulness meditation.  That practice of sitting down and paying attention on purpose and training our attentional capacity.  That’s the meditation of it.  It’s a form of meditation practice.  There are many other forms of meditation practices, as well, that are practiced around the world.  Mindfulness is more like a sub-type of meditation practice.

Joe:                 Cool.  How did you discover that mindfulness is something that really helps people during cancer?

Linda:              Well, I had already been practicing mediation and yoga for about ten years when I started working with cancer patients.  I had some colleagues that also practiced yoga and meditation.  We all got together and said, this could really be helpful for the people we work with.  There are a number of features or elements of the cancer experience that made us think that.  I don’t know if you have a personal experience, but what’s it like to be diagnosed with cancer, do you think?

Joe:                 Yes, I do have a personal experience.  It’s an incredible shock to the system.  I think you described it so eloquently when you said that you spent a lot of time, on the one hand, ruminating on the past.  You’re thinking, what could I have done differently?  Could I have picked up the cancer earlier?  What have I done in my life?  Then, again, like you said, you also spend some time living in the future because you spent time thinking, well, what’s going to happen, is this treatment going to work?  Is this cancer going to come back?  It’s incredibly difficult to stay and be in the moment, with the life that you already have.

Linda:              Yes, exactly, so you’ve encapsulated the main challenges, that are uncertainty about the future, loss of control, right, because we often feel like we control the path of our lives.  We’re going to work for X number of years, maybe have a family, then we’re going to retire and live well into our 80s or 90s.  We feel like that’s something we have some control over, but then cancer steps in and that’s all turned upside down.  People often question, what is my life going to look like?  I don’t really have as much say as I thought I did.

Then there’s this unpredictability about your treatments and you have to take time off work.  There’s loss of control, there’s this uncertainty about the future.  As you said, too, there can be, for many people, blame and guilt and shame about even being diagnosed with cancer in the first place.  Then there’s all the stuff you have to cope with because of the cancer and the treatments.  There’s insomnia that’s a very common symptom, fatigue from the treatment, super common.

There can be cognitive problems that are a consequence of the treatment and the anxiety.  There can be symptoms like pain and then there’s usually anxiety and depression and decreased quality of life.  There’s a whole host of different things that a person’s having to deal with, right from day one, going forwards.

Joe:                 Exactly.  That’s exactly right.  This feeling of not knowing what the hell is going on and trying to navigate your normal life, because that also doesn’t stop because you still have to do the things you always do, whether that’s work or family or friends.  Then you have to figure out this whole system and an entire new language around treatment.  Yes, it’s incredibly difficult not to be anxious and not to have your mind jump all over the place, right?

Linda:              Yes.  We’re really good in western societies of one type of coping, which is called problem-focused coping.  This is writing the to-do list.  I need to schedule an appointment for this, I need to buy certain supplies, I need to book time off work and get someone to take the kids to school.  We can write all these lists and solve problems quite well, but there’s this whole other realm of coping called emotion-focused coping that we’re not very good at, often.  All of this emotional stuff that’s out of our control, the fear and uncertainty, and all of these difficult emotions that are swirling around, well, what do we do with those?  That’s where the mindfulness practice is so very helpful.

There are so many features of it that really the people that I’ve worked with find very helpful in dealing with that loss of control and loss of certainty.  With the mindfulness practice, we talk about just accepting things as they are and really trying to do the best we can in the moment and letting go of outcome.  We also talk about these attitudes of non-attachment, which is this idea of letting go.  Of really making a distinction of things that we have control over and things we don’t, focusing on the things we can do.

We can learn a mindfulness practice, we can learn how to respond to things in our environment in a more thoughtful way.  We can look at how we perceive events in our environment and do we blow things out of proportion, do we jump to conclusions?  Do we have these cognitive habits that are unhelpful?  Taking control of those sorts of things where you do have choice and you do have option and you can learn these skills and techniques.

There’s so much really you can’t control, so not focusing on that stuff and instead, focusing on all the things you can do in the moment, in the day, that’s going to set you up for better days in the future.

Joe:                 Absolutely.  I love how you break it down into this problem-solving way of coping and emotion-based way of coping.  Tell me, with mindfulness, does that mean that when you’re more mindfulness of being in the moment, when you’re more present in your own reality, that some of the negative thoughts, do they go away somewhere?

Linda:              Yes, well, you’ll still have the negative thoughts, but you’re not feeding them, you’re not latching onto them and ruminating about them.  Another thing you learn when you practice mindfulness is impermanence.  We have this slogan: The only certainty in life is change.  Everything is coming and going all the time and it’s our need to make it a certain way and grasping on to wanting things to be one certain way and pushing away other experiences we don’t like, that’s what causes suffering.

It’s not the experiences themselves because they just come and go.  If you are having a bad day, it’s comforting to say, well, this is going to pass, this will pass.  It’s another common saying.  This idea of just the recognition of impermanence allows us to accept difficult emotions, watch them, understand them, spend some time with them, then let them come and go at their own pace.

Joe:                 Linda, that’s such a great way of looking at things.  I’m always the type of person who sees something negative and I jump on it.  You know, I think a lot of us do that.

Linda:              It’s counterproductive because it’s only natural to have all sorts of emotions coming and going, especially with such a challenging life experience.  When we don’t allow the ones we consider undesirable or negative, we supress them or say, “No, I have to be positive, I have to put on a happy face.” Well, they’re just going to keep popping up.  I don’t know if you have the game whack-a-mole in Australia.  You don’t?

Maybe it’s a Canadian thing.  It’s an arcade game where there are these little creatures, moles they pop up and you hit them with a stick and it goes down and the next one pops up and you hit it.  Anyway, the whole point is that you try to squish it down here, but it’s going to pop up over there when you don’t want it to.  If you just let it do what it’s going to do, it will run its course.  It’s when we try to supress emotions that they’re actually more harmful to us.

Joe:                 That’s fantastic.  It’s all about not supressing them, but just observing them.  Like you said, it’s going to pass.

Linda:              Yes, and observing them with this meta awareness I talked about.  You can be really anxious and feel it in your body and have an awareness of that anxiety that’s not anxious at all, if that makes any sense to you?

Joe:                 Yes, I think it does because I guess you’re not – I’m thinking of, for example, insomnia is something that if you wake up and you want to go back to sleep, but you can’t go back to sleep because you’re thinking that you can’t sleep and you’re focused on it and it makes you… you’re running in a loop.

Linda:              Yes, it’s like, I’m not sleeping, I’m only going to get four hours of sleep and I’m going to be wrecked tomorrow.  I really have to sleep.

Joe:                 Yes, exactly.

Linda:              You’ll never sleep then, right?

Joe:                 Like you said, maybe just quite all right then, thinking that it will go away.   It will be what it will be.  What if I don’t get my perfect sleep or whatever, right?

Linda:              Yes.  We actually teach people specific breathing techniques that help to calm your nervous system and bring on the relaxation response and also, occupy your mind, so it actually helps you sleep better.  That’s part of some of the teaching we do to patients in our programs.

Joe:                 That’s fantastic.  Can you share some of those techniques right now, in terms of breathing?

Linda:              Sure.  Well, really, the simplest thing to do to calm yourself down is just to switch over to a slower, deeper type of breath.  We might call it diaphragmatic breathing or belly breathing or slow breathing.  If you sit in a way that you can breathe, because often we’re slumped over and there’s not much room for movement, but if you sit upright and don’t even try to change your breath, but just maybe close your eyes if you’re comfortable, but just pay attention to how you’re breathing.  One thing you could do is put a hand on your lower belly and a hand on your chest, just to feel it better if you want.

Then notice where there is movement.  You may feel some rising and falling in the chest or some in the belly, or maybe more in one area or the other.  Then notice also the length of the in and out breath, then the mind is probably wandering, so just notice that and bring it back to your breath.  Then slowly you can drop your hands if you want, but slowly just allowing that breath to become a bit deeper, so that you feel more movement in your belly and you’d be breathing in for a count of four, if that’s comfortable.

Then breathing out the same, so maybe counting down.  For example, you’re breathing in, one, two, three, four.  Then out, four, three, two, one.  Then I like to add in a little visual image of a wave, as you breathe in, it goes up.  One, two, three, four.  Then as you breathe out, it goes down, four, three, two, one.   Trying to find a count that’s comfortable and release tension through the chest and the belly, then just following that wave of the breath.

As you exhale, there’s a bit of a release of tension with your shoulders moving away from your ears.  Relaxing the muscle through the belly and the buttocks and the legs.  You can open your eyes from that, but how did that feel?

Joe:                 That was great, Linda.  Yes, it was really great.  It really started with the breath, but it made my whole body feel more relaxed.

Linda:              Yes, so if you pay attention to muscle tension in your body that you’ll notice, it’s always there but often we’re not aware of it.  As you exhale, that stimulates your relaxation response.  That’s a good time to let go of a lot of that tension you don’t need.  What that type of even breathing will do is bring you to balance between your sympathetic nervous system, which is your fight or flight reaction, you know, which revs up your body and increases your heart rate and your blood pressure.  The parasympathetic response, which is the relaxation, which tones down all of that.  Just a really simple even deep breathing will balance out those arms of sides of your nervous system.

Joe:                 That’s fantastic.  Is that in some way related to something like chi-gong or even tai-chi in some way?

Linda:              Yes, we’re actually doing a study now comparing mindfulness meditation to tai-chi chi-gong program.  Yes, those are forms of what they might call moving meditation.  Chi-gong especially uses a lot of control of the breath and different ways of breathing and moving to bring about balance to the nervous system in a state of relaxation and calm, as well.

Joe:                 Yes.  I think it’s so incredibly useful during cancer because it’s such a stressful time.  People say, well, just take it easy and relax.  How are you actually supposed to do that, right?

Linda:              Yes, there are lots of different things.  We call them mind-body therapy.  There are lots of mind-body therapies that have shown to be beneficial, just relaxation exercises.  Things like using imagery, self-hypnosis, or seeing a therapist for hypnosis.  Meditation.  Yoga, as well, has a lot of research, tai-chi, chi-gong.  All of these types of therapies are ways to relax physiologically through the nervous system.  Also, strategies you can learn for personal empowerment and taking some control over how you feel in the moment.

Joe:                 Yes, exactly.  Linda, there are lots of negative emotions that come up during cancer.  You start to worry, of course, you know, like a pain or an ache may trigger worries.  You go down this rabbit hole of worries and negative thoughts that really affect you.  You really want to get these out of the way and break the loop.  What advice do you have on that front?

Linda:              Fear of cancer recurrence is so common, even for people who have a really good prognosis.  Almost everybody talks about that.  You get an ache in your armpit and maybe that’s where it started if it was a lymphoma or something, right?  Then you start to think, it’s coming back.  Then you get all worked up and your body gets tense.  That tensions and the increased arousal in the heartrate makes the symptoms worse.  You think, it really is, now it’s spread.  I can feel it in all these different parts of my body.  Then you think, what if it’s coming back?  Is it going to be worse this time?  Within a few minutes, you’re digging your grave, right?  Yes, it’s very common.  The mindfulness practice helps you notice that right at the beginning.

Ah-ha, I’ve got an ache or a pain and I’m starting to go down that rabbit hole, like you said.  You can stop it right there, you can say, no, I’m not going to go there.  The rule of thumb we usually tell our patients is, wait a week, okay, just notice it, use your relaxation practices, use your mindfulness to not get worked up.  If it’s still there in a week, then go see your doctor, make an appointment.  Usually, these things are so transient, that they come and go.  The thing that makes them worse is our worrying about them and us having all of that muscle tension and stress around the area.  It does make the symptoms worse.

Then, of course, you think, yes, it’s coming back.  Then you’re running to the doctor’s office all the time, getting tests you don’t need.  Use the mindfulness practice, go to the yoga class.  Just noticing that you’re doing it is really the most important step.  It’s being like, this is a red flag, this is happening.  I know what this is, I know what I can do, I’ll keep an eye on it and I won’t ignore these things if they persist, but I’m not going to jump on every one of them, right?

Joe:                 Yes.  Yes, absolutely.  Another thing that I stumbled upon, Linda, is after going through cancer and getting a good result, you start to really look at life in a really good way.  I’ve spoken to lots of people who went through this experience, as well.  You start to look at some things in a much more different, in a much more positive way.  You realise that things have changed, things will probably never be the same, but at the same thing, you’re not so much focused on things that are not really important, and you really start to put your energy and your time into things that you care about and into people that you care about, as well.  Finding something positive in your life after cancer, or despite cancer, what’s your perspective on that?

Linda:              Yes, Joe, you’ve hit the nail on the head there.  In academic circles, we call this benefit finding or post-traumatic growth.  This idea, yes, people study this, we’ve looked at it with our people, as well, it’s this idea that a traumatic experience, something like cancer or other traumas, as well, can trigger people to take a broader look at their life and what does bring them meaning and purpose in life and where is the value.  If my life is foreshortened, because every person who hears that diagnosis, “You have cancer”, thinks, “I could die prematurely and is this what I wanted my life to be about?” You revaluate where you thought you were going and what’s really truly important.  If your time is limited, and all of our time is limited, you just realise it more concretely with the cancer diagnosis.  Is this how I want to live my life?

We look at things like this, benefit finding, or post-traumatic growth, and also that concept of spirituality, which is finding a connection with something larger than yourself.  It might be a connection with other people, with community, with some kind of a higher power, with the universe.  Feeling a sense of interconnectedness, as well as this sense of meaning and purpose in life and, yes, revaluating the way you live your life day-to-day and we’ve done many interviews with people who go through the mindfulness program who talk about how that practice has facilitated their pathway through this personal growth.

Joe:                 Yes, fantastic.  Linda, if someone wanted to find out how to get immersed in mindfulness, what are the resources that you can recommend?

Linda:              Well, there’s lots of stuff online in terms of mindfulness training programs.  Well, specifically for cancer, I would say start with our book.  There’s the mindfulness-based cancer recovery book that Michael Speca and I wrote.  It really takes you week-by-week through the program.  It’s got scripts for guided meditations.  We’ve also actually just… I’m not sure if it’s released to the public yet, but we made an app out of that program.  It’s an app called: Am Mindfulness.

Just A-M Mindfulness.  There’s a cancer journey within that that actually has teachings from me and Michael that we do in our class.  That one is specifically for cancer survivors and patients.  There are many, many others.  There’s Calm and Headspace and so lots of app-based things.  We also made an adaptation of the in-person program to a web-based real-time video conferencing program through a company called: Be Mindful.

They’re in the States, but they do these video conferencing mindfulness-based cancer recovery sessions on a regular basis, so anyone can sign up for any mindfulness-based cancer recovery program.  Then there’s the generic mindfulness-based stress reduction that ours is based on.  There are people trained to provide those programs all over the world.  Starting with an NBSR program is a great way for anyone to start.  Then maybe going to more of the more cancer-specific resources after that.

Joe:                 Yes, fantastic.  Thank you so much, Linda, that was fantastic advice.

Linda:              Well, I hope it’s helpful.

Joe:                 Absolutely.  Thanks so much for your time, I feel like it’s been fantastic.  Love it.  Love what you do.

Linda:              I enjoyed it, too.