Dan Keller 0:08
Welcome to this episode of Substantial Matters: Life and Science of Parkinson's. I'm your host, Dan Keller. At the Parkinson's Foundation, we want all people with Parkinson's and their families to get the care and support they need. Better care starts with better research and leads to better lives. In this podcast series, we highlight the fruits of that research—the treatments and techniques that can help you live a better life now, as well as research that can bring a better tomorrow.
While medication is a mainstay of treatment for Parkinson's disease, many other interventions and techniques can also be helpful, such as exercise, dance, and music therapy. Another avenue is mindfulness, in which a person becomes consciously aware of something, whether external or within their own body. This mental state of awareness focuses on what is happening and perceived in the present moment. Calmly acknowledging and accepting these feelings, thoughts, emotions, and bodily sensations is at the heart of this therapeutic technique. Research has shown benefits on stress, pain, anxiety, and even immune response.
Occupational therapist Dr. Jordan Staenberg works with people with Parkinson's and says she has seen profound results using yoga and mindfulness for self-regulation of nervous system function. When I spoke with her, she said Dr. Jon Kabat-Zinn, the person who is credited with applying mindfulness within a scientific framework, gave one of the best definitions,
Dr. Jordan Staenberg 1:56
which is the awareness that emerges when we pay attention on purpose, in a particular way, non-judgmentally, from moment to moment, as the moments unfold in front of us.
Dan Keller 2:13
What are some of the components of mindfulness?
Dr. Jordan Staenberg 2:16
The components boil down to that paying attention, and then you really want to do that intentionally, so really being open and curious. I like to take an experimental approach, so that we're really open and curious about the body, noticing what's happening at any given moment, and then maybe performing some sort of action and seeing what the results are within the body.
Dan Keller 2:48
This sounds like sort of an if-then scenario. If I do this, then that might happen. Can this work positively and/or negatively?
Dr. Jordan Staenberg 2:56
Yes, so we can use that kind of if-then phenomena as we learn about our own bodies and notice if I do something that creates a positive effect, then I want to remember the things I did that led up to that point, so that I can repeat it again in the future if needed. For example, I like to teach my clients about the breath and the breath's interaction with the nervous system, and the breath is deeply tied to the nervous system. And I draw it out for all my clients using the three diaphragms model that's illustrated by Dr. Matthew J. Taylor, and you can find this model on YouTube, if you just pull up YouTube and search for "three diaphragms model."
What this model tells us is that the diaphragm and the pelvic floor work in a rhythm, and this rhythm alerts the parasympathetic nervous system or provides parasympathetic optimization, and what that means is that brings the body into a more calm and relaxed state. So, parasympathetic is sometimes referred to as the "rest and digest" state of the nervous system, where everything's kind of calm and relaxed, and you can move forward with clarity in the world.
And then there's another breathing pattern that comes in times when we need extra breath, and that comes from the thoracic outlet and can be seen as the muscles of the chest and the neck tightening and lifting the rib cage in order to get that extra breath needed. And so when the body is in this mode of breathing, then we are in the sympathetic or "fight or flight" pattern of the nervous system, and what that means is that the body is activated in a stressful way.
And so, for example, a patient might have increased tremor during that time of sympathetic activation, so we can then teach our clients and our patients, "If I notice I'm having a lot of tremor, I can feel what my breath is in my body and notice which state of the nervous system I'm in." So the mindfulness component comes in with the developing of this internal awareness, knowing what the sensations are of the body, and being able to recognize patterns of the body that match different patterns of the nervous system, or even different outputs like tremor or increased respiratory rate or shuffling of gait, things like that, freezing of gait.
And then we can teach control of the nervous system or self-regulation of the nervous system by teaching techniques that change the breath pattern, for example, like expanding the lower belly breath, and maybe even doing some exercises or stretches to stretch the muscles of the thoracic area of the rib cage, the intercostal muscles. And so then we can get a deeper, more full breath that links up with that parasympathetic rest and relax component of the nervous system. And then the client can do that breathing technique, and then again we come back to that if-then paradigm: so if I'm tremoring excessively, then I implement this low belly breathing pattern, the result is decreased tremor, or I'm more calm sitting with my friends, or I'm able to perform a buttoning task, or use my toothbrush, or handle a utensil better. So we bring all of those skills then back into their daily life.
Dan Keller 7:03
It sounds like you sort of divide the body into components—there's breath, there's muscle relaxation. Am I on the right track there?
Dr. Jordan Staenberg 7:11
I really like to view the body as a whole dynamic system, so there's different ways that you can approach the system to create change. It's a dynamic system, and each aspect of the system—the mind, the body, the breath—they all influence each other. And so it's more that we want to choose for each individual client which is going to have the greatest impact if I address the breath, if I address the body, or if I address the mind. How can I influence the dynamics of the system?
Dan Keller 7:50
I know it must vary from person to person, but how long does it take to learn these techniques for them to become effective for someone?
Dr. Jordan Staenberg 7:59
So that's a really good question, and it does—it varies from person to person. In my experience, the earlier you begin to develop this skilled awareness—being open and curious and non-judgmental about the body—then the more skilled you will become at implementing the tools in your daily life.
So one factor is home practice. Clients come to see me, and I might spend one to two hours a week with them in order to facilitate these skills. However, if they go and do their home practice, or exercises I give them to do at home, or experimental techniques to do when they're out with their friends—just paying attention, different ways to pay attention—if they practice those, then they have more rapid results. If you don't practice regularly, it becomes more difficult to implement in social situations, for example. So there's a difference between regimented practice, like an exercise, and then practice in the real world, and both are very important.
The other factor in the effectiveness of the mindfulness techniques is really, in my experience, based on how much anxiety the person has. If they are already very anxious and have a very busy mind—even if they don't feel that their mind is negative with thoughts, but if the mind is just busy and has difficulty quieting—there's techniques that we can use before we get to this mindfulness aspect that will help them to harness their attention in a better way.
Dan Keller 9:47
Once someone is adept at this, and they're in a situation, how long does it take them to sort of put it into motion and relieve or alleviate what would otherwise be a problem?
Dr. Jordan Staenberg 10:00
Well, I've had clients really be able to implement it within one or two sessions. If you can really be aware and open and curious, then you can see the change. So we use a technique of baseline action and reflection, and I ask all my clients to examine their own body, their thoughts, feelings, sensations, emotions, breath before we take any action, and then maybe complete an action step, and then reflect: "How do I feel now? What has changed?" And nothing is revealed except in contrast. So, if clients are able to see contrast, then they can pick up very quickly on what they want to achieve.
Dan Keller 10:54
Is there a take-home message for someone about learning these techniques and what it can do for them?
Dr. Jordan Staenberg 11:02
Yes, I would say that learning mindfulness techniques can help improve your awareness and really empower you to feel in control of the symptoms that so often feel out of control. So, I would recommend even just looking up some meditations or mindfulness techniques on the internet. There's a lot of great apps for your phone; Insight Timer is one of my favorites, where you can listen to a mindfulness meditation or a guided meditation to take you through a scan of the body, so that you can begin to become more skilled in it. It also could be helpful to find a mindfulness or yoga teacher in your area and work with someone one on one.
Dan Keller 11:54
Great, thank you. Bye. In these trying times of social isolation, everyone could use some stress reduction. So, the Parkinson's Foundation invites you to Mindfulness Mondays, where every Monday we have expert speakers giving tips on staying mindful and giving you a chance to interact with other people with Parkinson's as part of our PD Health @ Home virtual educational and wellness programs. These events can help you kick off your week with calmness as you take part in guided relaxation techniques.
You can register for upcoming Mindfulness Mondays at parkinson.org/pdhealth, and you can find archived versions of past Mindfulness Mondays on our website as well. You can also check out our podcast episode 78, "Benefits of Self-Awareness with PD," for more on the benefits of cultivating self-awareness and how it relates to health confidence. And as part of Mindfulness Month, next week's episode will continue on this theme, expanding on the benefits of mindfulness techniques.
Also in the virtual realm, in May, are our signature spring walks, Moving Day, a Walk for Parkinson's. Even though we won't be able to move together in person, we can still unite in the fight against Parkinson's from the comfort of our homes. Join us online Saturday, May 9, for a virtual walk to celebrate the power of exercise by moving and fundraising to beat Parkinson's together. For more information and to register, go to movingdaywalk.org.
As always, our PD Information Specialists can answer questions and provide information in English or Spanish about today's topics or anything else having to do with Parkinson's. You can reach them at 1-800-4PD-INFO. To receive news and updates about future events and resources, you can opt into our email list at the bottom of our website's homepage. If you have questions or want to leave feedback on this podcast or any other subject, you can do it at parkinson.org/feedback, or if you prefer, email us at podcast@parkinson.org.
If you enjoyed this podcast, be sure to subscribe and rate and review the series on Apple Podcasts, or wherever you get your podcasts. At the Parkinson's Foundation, our mission is to help every person diagnosed with Parkinson's live the best possible life today. To that end, we'll be bringing you a new episode in this podcast series every other week. Until then, for more information and resources, visit parkinson.org or call our toll-free helpline at 1-800-4PD-INFO, that's 1-800-473-4636. This episode is supported by a grant from Genentech, a member of the Roche Group. Thank you for listening.
