Back when I was about to have my first baby, the hospital educator taught us about two philosophies of natural childbirth.  In the Lamaze method, the mother-to-be focuses her attention on specific breathing patterns, along with pleasant memories or her ideal relaxing environment – basically, putting your mind elsewhere so you don’t notice the pain.  In the Bradley method, by contrast, she “tunes in” to her body, calmly noticing the way each contraction builds and then diminishes, so that (at least in the early stage of labor) you get to feel completely normal again for a few minutes, each time, and the pain of labor becomes less daunting and more tolerable.

I’m wondering to what extent the two approaches to discomfort that people use to get through labor pains might be more generally useful. Childbirth is inevitable, once you get sufficiently far along in pregnancy, but discomfort is relevant to our lives much more broadly because it can affect our decision-making.  Feeling uncomfortable – or expecting to feel uncomfortable – is one of the biggest barriers to doing what we want to do.  Whether it’s exercising regularly, changing careers or going back to school, modifying our relationships, or quitting an addiction, many people often find it easier just to avoid making the change.  Depression, anxiety, and other mental health problems are often only problems because they lead us to misinterpret the world around us and encourage us to stay within our comfort zones.  My professional expertise is in tobacco cessation, and we know that many people find it hard to quit and stay quit simply because quitting can be so uncomfortable.

I don’t know if these two approaches to coping with discomfort have ever been compared – and as far as the “put your mind elsewhere” method goes, I don’t even know the degree to which it’s been developed and tested yet.  For that matter, maybe some hybrid method could let people learn to use them both in some particularly effective combination.  It’s worth thinking about, though, so, here we go!

The “mindfulness” method is already being tested in numerous mental health care fields, so I’ll talk about it first.

ACT: Acceptance and Commitment Therapy

The founders of ACT believe that ingrained habits of interpreting discomfort in problematic ways can be overcome by attending to two main issues: commitment and acceptance.  Commitment refers to identifying your values and goals, and determining the degree to which you’re willing to put up with uncomfortable sensations in order to act consistently with those values.  Acceptance means accepting that those uncomfortable sensations can’t be prevented and cultivating willingness to act anyway.  Once you accept that those sensations might happen, you stop fighting them or trying to avoid them – and, paradoxically, because you’re not getting caught up in them, they generally become much weaker.  Borrowing from Buddhist meditation practices, the ACT model encourages people to practice just observing those unpleasant sensations, not identifying with them.  Watch them appear, see just what they’re like (as if you’re observing from outside), and watch them go away again.  They do go away!

This practice has several benefits.  It teaches you that your feelings of discomfort are not as overpowering as they may seem to be – they are finite.  They neither take over your entire mind nor last forever.  You learn not to interpret the sensations as having a deeper, possibly alarming meaning, and you learn that they aren’t shameful or strange.  With practice, you also get to strengthen your identification with the observing part of your mind rather than the transient thoughts and feelings that come and go, which lets you make more informed and less reactive choices.

ACT has now been used successfully in numerous contexts, especially for anxiety, but also for depression, weight management and eating disorders, chronic pain, and even schizophrenia.  Recently, researchers have begun using ACT with people trying to quit tobacco.  The two biggest hurdles in tobacco cessation are withdrawal symptoms and cravings.  If someone’s been smoking for years, they have a lot of experience with knowing that going without a cigarette can be very uncomfortable.  They learn to interpret withdrawal as something quite daunting, best addressed by resuming their intake of nicotine.  With ACT, they can learn not to be overwhelmed by those symptoms and even to reinterpret them as signals that their bodies are getting healthier and their brains are learning how to live without tobacco.  Likewise, cravings can creep up months and even years after quitting, but if the former smoker learns to watch the craving from outside and not take it seriously, they become manageable, especially as they actually turn out to be relatively brief (a few seconds or minutes).

But mindfulness can be hard, especially if you’re in so much pain, or so busy, tired, or stressed, that you don’t have the mental resources for this kind of caring self-attention.  That’s where the other approach might come in handy.

Distracting Immersion

In the movie French Kiss, the Meg Ryan character is terrified of flying, especially the airplane ascent, but she is determined to get to France.  The Kevin Kline character sits down next to her on the plane, sees how petrified she is, and proceeds to act so boorishly (probably on purpose) that she ends up chewing him out for so long that she doesn’t notice the plane taking off.  Eventually he points out that they’re in flight, and she relaxes again.  Phobia gone.

In this case, the Meg Ryan character was so involved in the argument that she lost track of her surroundings, in very much the same way that people can stop noticing the world around them when they’re really involved in reading a book, watching a movie, or playing a video game.  This is called “narrative transportation” (because you’re “transported”), absorption, or immersion.  When you’re doing something like this, you can ignore both your body and what’s going on around you, and the usual parade of thoughts in your mind is relatively quiet.

Researchers in Seattle have been studying whether this type of distracting immersion in an alternate “world” can have therapeutic effects.  The pain suffered by burn victims is said to be excruciating, especially when their bandages are changed.  These scientists have been experimenting with having young burn patients explore an ice-themed virtual reality world during their bandage changes, and this technique seems to be effective in lowering the amount of pain the children experience.  The power of suggestion for the very cold environment is considered to be a key element in this effect, but the imaginative act of putting their minds into a different world is probably also important.  For a brief time, their identity is not fused so tightly to their bodies – the pain is there, but it’s more in the background and less urgent.

This approach probably has a place in dealing with discomfort more generally.  During exercise, for example, many people like to watch videos, listen to music, or even read, as it helps you pass the time much more nicely than just focusing on your body’s growing fatigue.  Back to my tobacco example, some people schedule their quitting (and withdrawal) for a time that they’re working so hard that they can’t pay attention to their bodies.  People can also deal with cravings by putting their focus into a different mental “world” than the one where they’re focused on tobacco, with a walk around the block or through the woods, a relaxing back rub from a romantic partner, or even just getting up to brush their teeth.  Distracting immersion seems especially suitable for big, one-time stressful things, or when you don’t have the personal resources to focus mindfully – you’re too busy or tired or freaked out to stop and pay watchful attention to your experiences.  (Regular distraction itself isn’t enough, for why shouldn’t the mind’s attention bounce right back to whatever’s stressful?  It would need to be engaged and interested elsewhere for the effect to be reliable.)

The Need for Meaning

The two approaches interact very differently with the natural human drive to find meaning in experiences.  Even the most difficult situations can be endured if there’s a point, and meaningful suffering is far less distressing than suffering that is random and senseless.  Much of the unhappiness associated with anxiety and depression can be thought of in terms of the need for meaning:  People have an experience that has some negative aspects, and then they interpret the negativity to have deeper significance.  For example, depression is often accompanied by overgeneralizing thoughts – if we have a negative interaction with someone, we can leap to the conclusion that we’re bad or unworthy, whereas it may easily be that the other person is having a bad day.

ACT has the more proactive approach to meaning.  The values and goals to which one is committed provide a focus, such that when one experiences unpleasant sensations, it becomes more possible to keep one’s attention on the meaning of one’s intended actions, and less attention is available for any mental efforts to ascribe potentially disruptive meanings to the sensations (like “I’m bad” or “I can’t do this”).

Immersion sidesteps the meaning issue by declaring that the most relevant meaning is, temporarily, to be found in whatever other world one is immersed in, such as the goals and values of the point-of-view character if we’re reading a book, watching a movie, or playing a game.  Our attention is so caught up in the other world (or, like in the case of the French Kiss example, in some other context like an argument or an idea) that the actual sensations we’re experiencing can receive much less notice from us and should in theory have less of an impact on our memories and our identity.

When it’s the case of helping children avoid the pain from a serious burn, this makes a lot of sense – we don’t need to have children find meaning in pain; they shouldn’t have to.  Or if we just need to get through some really daunting thing once and know we’ll never have to face it again, putting your mind elsewhere can be the easiest way to get through it.

Some times, however, it may be more worthwhile to cope with recurring problems by learning new things.  For example, the French Kiss method of resolving phobias doesn’t normally quite work. Maybe if the Meg Ryan character took lots of plane trips and distracted herself each time, this could function like a form of desensitization training, but it seems more likely that both some reflection about what happened and some expectations of lingering stress would be an important part of integrating this one experience into her life.  For example, creating a new meaning for future anxiety about plane travel (it’s just something her body habitually does but it’s brief and then she gets to be somewhere else she wants to be, for example) would be better than interpreting it as meaning that plane travel is actually very dangerous and she ought to avoid it.

Research questions!

Researchers are already studying the mindfulness approach, with ACT, but I think the distracting immersion approach might also be worth developing.  In general, I’m wondering – while distracting immersion in a book (or an argument) may be a useful trick to get through something stressful, could it also be a skill that one can learn to use thereafter?  And when and how might it complement the valuable experience of finding that you really can get through the discomfort if you’re fully aware of it as it happens?

(While writing this, I didn’t notice how hungry I was getting, but now that I’m no longer “immersed”… where’s my dinner?)

Also – neither approach seems practical when you’re in the middle of something that also needs attention, like driving, having a conversation, or getting ready to perform.  If your “something that also needs attention” is itself immersive, then, great, but what if it’s the thing that’s got you stressed?  Mindfulness may not work either, if you’re too busy doing that stressful thing to be able to pay careful attention to your thoughts and feelings.  What would work best in this circumstance?

Anyway, these are ideas in progress.  Discussion is welcome!