Living Well With MS While Managing Pain

Living Well With MS While Managing Pain

Episode 184 – Podcast Transcript

[(0:25)] Stephanie Buxhoeveden:  Welcome to the Can Do MS podcast. I’m your host, Stephanie Buxhoeveden. I live with MS. And I’m also a clinician and MS researcher. Today we’re joined by Mary Curran, who’s a clinical social worker, therapist and researcher at the University of Washington. She spent her career helping people living with chronic conditions like MS, manage their pain and depression, through practical, compassionate, and evidence-based strategies. Hi, Mary. Thanks so much for being with us today.

[(0:51)] Mary Curran: Oh, you’re welcome. I’m really happy to be here.

[(0:54)] Stephanie: We are gonna talk about a not-so-happy symptom of MS. Uh, and MS actually used to be considered a painless “disease”, which obviously is completely a myth.

[(1:05)] Mary: Yeah.

[(1:06)] Stephanie: It does cause pain. And it’s actually a pretty common symptom of MS. So can you talk to us about the different types of pain people with MS experience and how behavioral interventions can help regardless of what type it is?

[(1:18)] Mary: Yeah, yeah, so, so you’re right. Yeah. It wasn’t really recognized as a symptom of MS. Um, and so, but it’s really common and so typically folks may have musculoskeletal pain, there’s neuropathic pain, um, there might also be, you know, spas-, obviously spasticity or trigeminal neuralgia. I mean, there’s all different types. Um, and what’s… You know, with behavioral interventions often, you know, we’re really targeting kind of the meaning we make of the pain. And, and kind of what we do, you know. Um, and how we feel. So that’s where it can be really helpful this idea of basically turning the volume down on the pain we experience. And that doesn’t mean that folks don’t look for, you know, additional treatments and ways of managing pain. You know, we come at it from having a toolbox and, and we’re focusing very much on kind of our thoughts, emotions, interactions. Um, and how those can either sometimes amplify the pain or you know, the other side, turn it down.

[(2:28)] Stephanie: Yeah, absolutely. And this is a topic that’s, especially personal for me because pain is something I cope with every day and…

[(2:36)] Mary: Yeah

[(2:37)] Stephanie: …zero pain isn’t a realistic goal for me. Right? Um, and it’s all about living with it and having a high quality life despite it. So let’s talk about what we can do about it to help control that a little bit. Cognitive behavioral therapy, mindfulness, behavioral activation. These are all things that you’re an expert in. So can you tell us a little bit about hollow strategies work and why they help pain?

[(3:04)] Mary: Yeah, for sure. So oftentimes, you know, our thoughts have a big impact, the meaning we make of it. And so we might have a thought like, I can’t stand living with this pain. Which is a human response. But often it amplifies our frustration, um, and sadness. And maybe, you know, we’re, we’re doing things. So if you can target that and start to work with a thought like that, and maybe, you know, we might believe that that’s true and you start to pull it apart. And come up with another way of looking at it that’s less distressing. Um, so that’s what you’re doing in like with the cognitive piece of cognitive behavioral therapy. And then, you know, the behavioral part of it is like, oh, there may be some things I can, actions I can take, or skills, like we do a lot of what we call relaxation training. And sort of doing that as a way of turning the volume down on our pain experience by, you know, calming the body and not, not just physically, but also, you know, the emotions, um, and the thoughts that arise. Um, so by tuning into the breath is a really helpful tool. And then the emotions, you know, those… When those strong emotions arise, is there a way that I can better manage this or, you know, until we do a lot of stuff around stress management, because that contributes to, you know, you know, you think of MS as a chronic stressor and then pain is a chronic stressor. And then how do I… You know, when those strong emotions arise, what can I do to take care of myself?

[(4:39)] Stephanie: Yeah.

[(4:40)] Mary: Yeah. And I think you said, you know, sometimes it’s like, how do a lot of times things that bring us pleasure or that are meaningful drop away in the face of pain and managing this?

[(4:50)] Stephanie: Yeah.

[(4:51)] Mary: ‘Cause it’s, it’s challenging.

[(4:53)] Stephanie: It’s absolutely challenging and…

[(4:55)] Mary: Yeah

[(4:56)] Stephanie: …isolating, right? ‘Cause…

[(4:57)] Mary: Yeah. ‘Cause it’s invisible.

[(4:58)] Stephanie: Yeah.

[(4:59)] Mary: Right.

[(4:60)] Stephanie: It’s a physical symptom. You don’t wanna do things to aggravate the pain and make it worse, but at some point, um, you’ve made this, this analogy before, respond to it rather than react to it.

[(5:09)] Mary: Right. So that’s where the pause comes in. And often the breath, we can use the breath for that, you know, distraction can be a really great skill, short-term of distracting with, you know, music or something that you enjoy, you know, getting outside, throwing the ball to the dog. You know, these different things to interrupt those thoughts that, um, can really pull us in that cycle where we start to have, you know, we do less, we feel worse, then we have another more unhelpful thought on top of it. Like, oh, I never get stuff done. I can’t accomplish what I wanna be doing in my life. You know, and then there’s those beliefs associated with that of what this means…

[(5:48)] Stephanie: Yeah.

[(5:49)] Mary: …about me as a person. So it kind of it’s this downward spiral. So by interrupting it, we’re trying to kind of reverse the spiral.

[(5:55)] Stephanie: Yeah, absolutely. And hang on to, to what you love and what you value.

[(6:01)] Mary: Yeah.

[(6:02)] Stephanie: And that’s sort of…

[(6:02)] Mary: Yeah.

[(6:03)] Stephanie: …where behavioral activation comes in, right?

[(6:06)] Mary: Yeah. Yeah. So we often use, you know, goal setting, small steps that help you move in that direction. But I’ll, you know, I’ll talk with people about, yeah, what, you know, what brings you pleasure, joy, meaning, and identifying some goals around that but… You know, and that doesn’t mean, you know, oftentimes people wanna do accomplishment goals, and that can help folks feel better. Um, and I also do encourage people to think about, okay, what do you enjoy? You know, what’s pleasurable? Um, because so much that, you know, that I try to help people maybe build in a little bit of replenishment.

[(6:44)] Stephanie: Mmh.

[(6:45)] Mary: Um, not only for the pain, but also because fatigue often goes hand in hand.

[(6:48)] Stephanie: Oh yeah.

[(6:50)] Mary: You know, so I think it’s funny how a lot of these skills and strategies, you know, benefit not just pain, but we talk about fatigue or depression and, you know, they’re all kind of, they all kind of walk together often, not always for everybody.

[(7:05)] Stephanie: Sure.

[(7:06)] Mary: So they can benefit multiple symptoMS that come up with living with MS.

[(7:10)] Stephanie: Oh yeah. Yeah. You definitely get stuck in that loop. Right.

[(7:13)] Mary: Yeah.

[(7:14)] Stephanie: And I’ve sort of run the whole gamut called the 50 shades of MS pain. Right? Like…

[(7:18)] Mary: Uh-huh.

[(7:19)] Stephanie: ..who knew you could be both numb and have sharp stabbing pain and you’re like…

[(7:24)] Mary: Right.

[(7:25)] Stephanie: …at the same time. It’s so fun.

[(7:26)] Mary: Yeah, yeah, yeah.

[(7:28)] Stephanie: But that, that I struggled with less because you can look at your leg, you can say there’s nothing stabbing me. You can sort of remove your thoughts and distance yourself and, and respond versus react. Um, but I will say spasticity, the MS hug and the spasticity in my legs.

[(7:47)] Mary: Yeah.

[(7:48)] Stephanie: That has been the real, like life changing pain.

[(7:53)] Mary: Mm-hmm.

[(7:54)] Stephanie: Um, and so as we’re talking about behavioral activation. Very specific breakthrough I had recently was, um, I was going on like three days of really bad spasticity in my torso. So bad that like my husband was having to help me get dressed. I was having trouble getting up and moving around. Like if I was repositioning, he’d have to haul me from the chair to the bed.
And, um, it was just, it was just miserable. Every little motion hurt. And he finally was the one who, who saw how frustrated and not, I won’t say depressed, but it was really discouraging. I had to cancel a work trip. So it interrupted my work life. Um, and he was the one that said, it doesn’t hurt to just try to do some yoga right now. And you’re already hurting, let’s just see if it helps. And cried the whole time. But it broke the spasm and it actually worked.

[(8:56)] Mary: Yeah. Yeah, yeah. And what you’re describing often comes up for people, right? Where we forget, you know, it, it kind of gets, it gets so overwhelming that we forget that there may be these other tools that actually do help us feel better. Um, you know, and I mean, obviously like the MS hug is so intense

[(9:16)] Stephanie: Mm-hmm.

[(9:17)] Mary: That it’s not, it’s understandable that it’s like, oh Lord, I don’t, there’s nothing I can do to…

[(9:23)] Stephanie: Right.

[(9:24)] Mary: …manage, nothing’s gonna help. This has been going on for days.

[(9:27)] Stephanie: And your brain is screaming at you.

[(9:29)] Mary: Yeah.

[(9:30)] Stephanie: Don’t do this. Don’t do this. It hurts. It hurts.

[(9:31)] Mary: Yeah.

[(9:32)] Stephanie: Yeah.

[(9:33)] Mary: Yeah. So, so that’s where having those, you know, like a tool, like whether it’s yoga remembering like, oh, actually yeah, doing some of those stretches helps. But that’s where the pause helps.

[(9:43)] Stephanie: Mm-hmm.

[(9:44)] Mary: If possible. As much as it’s possible to remind yourself. Oh, right. And so when we talk about behavioral activation, it’s like trying to act in line with your goal. We might say acting from the outside in as opposed to the inside out.

[(9:58)] Stephanie: Mm-hmm.

[(9:59)] Mary: As opposed to how we feel. Um, you know, and that doesn’t mean just push through the pain, you know, it’s honoring honoring that, but also that because we’re so habituated to it, that sometimes we ha-, we feel that sensation and, and we call it, you know, it’s kind of that fear avoidance thing where it’s like, oh…

[(10:18)] Stephanie: Yes.

[(10:19)] Mary: I’m gonna make it worse. If I move, I’m gonna make it worse.

[(10:21)] Stephanie: Yes.

[(10:22)] Mary: And so we stop doing some of the things that actually help us feel better. And sometimes the lack of movement in and of itself exacerbates our pain more.

[(10:31)] Stephanie: Yes. Exac-, that’s exactly, exactly it. And then once I had that breakthrough, which is, you know, uh, an example of what Cognitive behavioral therapy and mindfulness and and behavioral activation actually can impact somebody’s life, um, now I’m less afraid of the next attack. Right?

[(10:54)] Mary: Yes.

[(10:55)] Stephanie: And so you remove the fear and the anxiety since you have this toolkit, it’s…

[(10:59)] Mary: Right.

[(11:00)] Stephanie: …easier then to have the confidence to go back to the things you enjoy, so.

[(11:06)] Mary: Yeah, and I think when you said that, it’s like the thought would be like, yeah, I know this… Yeah. Here’s the pain again, and I know there’s some things I can do.

[(11:15)] Stephanie: Mm-hmm.

[(11:16)] Mary: To take care of myself. And that’s more of that helpful thought, you know. And that’s what you’ll be doing is you’ll be working to sort of shift that type of thinking,

[(11:25)] Stephanie: Mm-hmm.

[(11:26)] Mary: that, you know, we all have as humans and you know, but you’re working that, that’s why it’s kind of a skill like Oh, right.

[(11:32)] Stephanie: Yeah.

[(11:33)] Mary: That kind of reassuring thought. Um, that reminds you of it. Yeah. There are some things in my control that I can do. The pain is the pain, but I have a choice around what happens next and the extra layers that I might put on top of it that increase my suffering and generally amplify our pain experience. Does that makes sense?

[(11:54)] Stephanie: It does. It really does. Yeah. The, the, the volume knob makes less.

[(11:58)] Mary: Yeah.

[(11:59)] Stephanie: Up and down. Yeah.

[(12:01)] Mary: Yeah. Because it gets at the role of the brain in praying… In pain processing.

[(12:06)] Stephanie: Yes, absolutely. And I love that you said, being able to face these symptoms and control them as a skill. ‘Cause it absolutely is.

[(12:15)] Mary: Yeah, yeah, yeah. Well it’s ’cause it feels like pain is just happening to you.

[(12:22)] Stephanie: Mm-hmm.

[(12:23)] Stephanie: You know, and there’s some truth. I mean, pain, you know, pain is real, it’s happening. But what happens next is often up to us, you know, and how… And that’s where, you know, cognitive behavioral therapy or mindfulness or movement, you know, all of these pieces can be so helpful. And, and it’s something like, oh, I actually have some agency here.

[(12:45)] Stephanie: Mm-hmm.

[(12:46)] Mary: And some control. Um, and so it’s… I think it can be really empowering.

[(12:52)] Stephanie: Yeah. And a lot of people, myself included, you know, a month ago thought I’ve tried everything right. And

[(13:00)] Mary: Ah, right.

[(13:01)] Stephanie: What do, what do you say to, to the skeptics?

[(13:04)] Mary: Ah, yeah. I validate that, you know, like, yeah, a lot of people have, and people have been living with MS for years. And because pain is so invisible and sometimes gets minimized, it can feel pretty hopeless. Um, and so what I often say is, well, let’s just do an experiment. Let’s just, you know, kind of have an open curious mind and let’s just try this out. So… And, and see, see what you notice over. You know, oftentimes I’ll meet with people weekly and just see what you notice. So I’ll have them do some kind actual experiments. Like if you did a breathing practice and maybe you’re just tracking it over the week and what you notice in terMS of how you feel, you know, physically, emotionally and also just normalizing that some of these, some of these tools take some time.

[(13:51)] Stephanie: Mm-hmm.

[(13:52)] Mary: You may not notice something in the first week. Um, and they’re not like a pill where sometimes people might get a quick relief, potentially, not always, especially with chronic pain, but, so to let them know that, yeah, this may take some time. Um, but to just see, see what you discover. I try to just be like that.

[(14:11)] Stephanie: Give it a try. Give it a try.

[(14:13)] Mary: Yeah.

[(14:14)] Stephanie: It might surprise you. I was surprised,

[(14:15)] Mary: Yes

[(14:16)] Stephanie: for sure. Yeah. Now, unfortunately, not everyone has ready access to cognitive behavioral therapy or a therapist. So what are some options for people who want to try, um, but don’t live near a specialist?

[(14:32)] Mary: Yeah. Yeah. Great. Great question. Um, well there’s… Um, one is of course, Can Do MS has lots, lots of resources as does the National MS Society. Um, and our group along with the, um, university of Michigan, uh, put together a, it’s called my MS Toolkit and it has a lot of… The types of strategies I’m talking about it’s a web-based, um, version of it. And you can just access it on your own. It’s self-paced where you can learn some of these skills. Um, so I think there’s a lot of different ways and, you know, that people can go about it.

[(15:12)] Stephanie: Yeah. That’s great. And we’ll link to that toolkit.

[(15:15)] Mary: Oh, good.

[(15:16)] Stephanie: And the description of the body.

[(15:17)] Mary: Yeah.

[(15:19)] Stephanie: People can work and go through it.

[(15:20)] Mary: Yeah, absolutely. You know, and, and I think, you know, I know on Can Do MS, I mean they just have a lot of like the physical movement stuff whether it’s chair yoga or stretching or these other pieces that can actually be really helpful in pain management.

[(15:35)] Stephanie: And what about if someone is saying to their care team, to their healthcare provider that they have pain, but they’re not feeling like they’re being heard. What can people do? To advocate for themselves and their needs?

[(15:51)] Mary: Mm-hmm. Mm-hmm. Um, well, I would encourage them, you know, you do have to self-advocate and, you know, and talking, you know, circling back, um, sometimes it can be helpful if you do have a care partner of having someone else there to support you. But I think, you know, a lot of… I’ve worked with so many people where, you know, it hasn’t been acknowledged or they’re not being offered, say some of these types of treatments. So, you know, I think getting a broken record oftentimes people also, you know, find, find other avenues if you’re, you know, it’s… You can clearly, you know, not always so easy in some places whether you can switch providers, but that’s, that is an option if, if available. Um, I guess I would say, you know, I know a lot of people have really shared, you know, that often it’s reaching out to the MS community and other people…

[(16:47)] Stephanie: Mm-hmm.

[(16:48)] Mary: …with like experience and, and they’ve had to do a lot of it on their own…

[(16:53)] Stephanie: Yeah.

[(16:54)] Mary: …to be honest.

[(16:55)] Stephanie: Yeah.

[(16:56)] Mary: Finding out what’s worked for other people on forums through the MS Society. Um, you know, and I do think there is more awareness now that pain is real and that some of these types of treatments can be beneficial. It’s just at times hard to access, I would say.

[(17:12)] Stephanie: Yeah, it is. It is. And I think if, uh, you know, if your healthcare provider isn’t referring you to somebody with mental health experience who could walk you through these things, you can also look at your insurance website and see who’s covered and who’s in network and, and… Yeah, I think the the MS community is a rich resource of, you know, have you ever worked with somebody who had experience with…

[(17:36)] Mary: Yeah.

[(17:37)] Stephanie: …MS patients or not? ‘Cause that makes a big difference.

[(17:39)] Mary: Absolutely.

[(17:41)] Stephanie: Yeah. And then once you have this toolkit, you’ll know what to ask for.

[(17:45)] Mary: Yeah. Yeah. And I think that is. It’s a bi-directional relationship. I think, you know, you go into an appointment and you think, well, they’re the expert and they may be an expert, you know, obviously in, in their field but not necessarily. And some of these other pieces that help with pain management, um, or may not have had, you know, training in that. Uh, so…

[(18:07)] Stephanie: And there are many medications, right? That you can use to help control pain, right?

[(18:12)] Mary: Absolutely, absolutely.

[(18:13)] Stephanie: So sometimes the, the clinicians get a little focused on the pills and and adjusting doses and adjusting regimens, and I’ve certainly…

[(18:23)] Mary: Yeah.

[(18:24)] Stephanie: …been there, yeah, and I’m on treatment every day, but still have some residual pain. And that’s where the behavioral activation really in combination with what, you know, we’ve worked out with my healthcare team has really helps that volume go down.

[(18:41)] Mary: Yeah, and I think you bring up such a good point, which is that oftentimes it… You know, to really be able to treat pain you’re looking at multiple ways of…

[(18:49)] Stephanie: Mm-hmm.

[(18:50)] Mary: …managing it and it shifts over time.

[(18:52)] Stephanie: Mm-hmm.

[(18:53)] Mary: Too for folks with, and yeah, they may have a medication that’s helping with spasticity, um, you know, and they may be doing some PT, and then it’s like, okay, you know. And they’re still paying, you know, and I’m… So, where… What happens next? How do I work with this? And so I think you said, you know, it’s not… We’re not trying to, you know… It’s not realistic to be like, oh, I can just be completely pain free.

[(19:18)] Stephanie: Right.

[(19:19)] Mary: So, so sometimes I’m working with folks on adjusting expectations, but still looking at like, oh, and there’s some things you can do.

[(19:27)] Stephanie: Mm-hmm.

[(19:29)] Mary: Um, and so that can be helpful because I think some people go in thinking like, I just want it to go away which…

[(19:36)] Stephanie: Of course

[(19:37)] Mary: …makes sense, like…

[(19:38)] Stephanie: Yeah.

[(19:39)] Mary: …you know.

[(19:40)] Stephanie: Of course. But that’s not reality for…

[(19:42)] Mary: Yeah.

[(19:43)] Stephanie: …for many of us. Right.

[(19:44)] Mary: It… [crosstalk] Yeah.

[(19:45)] Stephanie: For many people with MS, we do have symptoms daily.

[(19:48)] Mary: Yeah.

[(19:49)] Stephanie: And we have to live fully [crosstalk] despite them.

[(19:51)] Mary: Yeah. Yeah.

[(19:52)] Stephanie: And so I love this resource and toolkit and, and all of these options you’ve gone through.

[(19:58)] Mary: Yeah. Yeah. I thought maybe, you know, we could do a little breathing practice.

[(20:04)] Stephanie: Wow.

[(20:05)] Mary: Um, or some type. So I… You know, we do a lot of training and basically relaxation training and in mindfulness. But sort of a short breathing practice. Um, ’cause I’ve had a lot of people say, well, yeah, I mean, it’s something I can just do, especially with practice on the go,

[(20:19)] Stephanie: Mm-hmm.

[(20:20)] Mary: in these moments. And, and it also allows for that pause where.

[(20:23)] Stephanie: Mmh.

[(20:25)] Mary: Or sometimes I can tune in and respond rather than react. Um, and for some people it’s like, it doesn’t also require me to access technology.

[(20:34)] Stephanie: Yeah.

[(20:35)] Mary: You know, I just ’cause… Yeah. Yeah.

[(20:38)] Stephanie: …you can do it in the line at the grocery store. Right?

[(20:41)] Mary: Exactly.

[(20:42)] Stephanie: Yeah.

[(20:43)] Mary: Um, yeah, so, and have you done like relaxation practice and things?

[(20:47)] Stephanie: I have, yeah.

[(20:48)] Mary: Mm-hmm

[(20:49)] Stephanie: So I, I, I’ve used apps and, and metaphors to help through some of the, some of the worst moments and they do work, so I would love to do a relaxation exercise together.

[(21:01)] Mary: Yeah, so this is just a, it’s just a really short, short, uh, breathing practice. The diaphragm active breathing or belly breathing, where you’re just really activating the diaphragm so that you can breathe deeper, you know, and so we’re starting low and moving up. Um, so just sit, you know, comfortably with your feet on the floor, and your hands can be on your lap or the chair, whatever’s most comfortable. Um, and just suggest as you need. Um, and if it’s comfortable to you, you can close your eyes. Um, and so just, just keeping your mouth closed, you’re just gonna inhale and exhale through your nose three times. And now just place one hand on your abdomen and the other on your chest and just take a normal breath in and notice which hand moves the most. And most people find that the hand on their chest moves more, you know, which just indicates you’re, you know, breathing more in a shallow manner, which is often what happens. So now we’re just gonna try to take a breath from our abdomen.

It might feel as though you’re pushing your abdomen out, and that’s how it should feel. And now just close your eyes and take a breath in through your nose feeling the hand on the abdomen rise as you inhale. And then breathe out either through your nose or mouth, just slowly noticing the hand on your abdomen fall as you exhale. And it may be helpful to slow your exhale down a little more and just continue to breathe like this for a few moments in through the nose and out through the nose or mouth, in through your nose and out through the nose or mouth. And just noticing the hand on your abdomen rise and fall with each breath. You may notice that the hand on your chest moves as well, and that’s okay. Just continue to focus on breathing with your abdomen, taking full, deep, satisfying breaths. Noticing an increase feeling of relaxation and calm spreading over your body as you continue to breathe. And if at at any time you start to feel lightheaded, don’t be alarmed. This often happens as people shift their breathing from shallow to deep. And if you do feel lightheaded, just go back to your regular breathing style until the symptoms go away. And most people find that these symptoms disappear as they continue to practice and their body adjusts to deep breathing. And now just take a few more slow, deep breaths. Just in through the nose and out through the mouth or nose. And then as you’re ready, just coming back to the room and the space you’re in and just slowly allowing your eyes to open, giving yourself a moment to adjust your surroundings. Yeah. So, yeah, what’d you notice?

[(24:48)] Stephanie: At first I noticed I really needed that today.

[(24:52)] Mary: Yeah. Yeah.

[(24:54)] Stephanie: Um, and I… You know, even having done it before, I’m always blown away by how easy it is, how you can do it anywhere. It’s accessible. I wiggled around, it doesn’t have to be perfect to work. Right? My feet don’t touch…

[(25:08)] Mary: Oh.

[(25:09)] Stephanie: …the ground ’cause I’m short. My…[laughter] I was a little fidgety.

[(25:14)] Mary: Yeah.

[(25:15)] Stephanie: But it still worked, right?

[(25:16)] Mary: Yeah.

[(25:17)] Stephanie: Perfection is not necessary.

[(25:18)] Mary: Yeah. And sometimes, I mean, you know, in the moment, like that was probably two minutes, three minutes. I don’t know exactly, but you know, sometimes when people will be like, yeah, I noticed… Yeah, I feel more a little calmer in the moment and maybe… You know, then they’ll be like, but uh, yeah, kind of it comes back, you know. But sometimes I’m just like, uh, it’s giving you, you know, these moments of relief, a little bit of relief.

[(25:42)] Stephanie: Because how many moments in a day do we actually get that.

[(25:46)] Mary: Yeah, and so you’re trying to, with relaxation training, cultivate that relaxation response so that throughout the day, so maybe you’re just at a level that’s slightly calmer, which often lowers the volume on our pain.

[(25:58)] Stephanie: Yeah, I love that.

[(26:00)] Mary: So it doesn’t magically make it go away always.

[(26:04)] Stephanie: But it definitely does lower the volume. And now we have it perfectly captured. Here on this episode so people can bookmark it and, and return to the practice until you feel like…

[(26:14)] Mary: Yeah.

[(26:15)] Stephanie: …you really have it down.

[(26:16)] Mary: Yeah. And I… yeah, and I encourage people to make it their own.
So there may be things that don’t quite fit for you, but you’re just really tuning into your breath and your direct experience.

[(26:27)] Stephanie: Yeah. Such a relief for your brain to only think about one thing, right?

[(26:32)] Mary: Yes. Yeah. And what would it be like for you? Just to give yourself that moment.

[(26:36)] Stephanie: Yeah.

[(26:37)] Mary: Right? To take care of yourself. You know, not multitask, not do all these other things. Yeah.

[(26:44)] Stephanie: Yeah.

[(26:45)] Mary: So it’s a nice, it’s a nice gateway, you know.

[(26:47)] Stephanie: A gateway to mindfulness. I like that.

[(26:50)] Mary: Yeah. Well, and mindfulness, you know, and mindfulness. I know we didn’t talk as much about it, but you know, it’s more about that letting things just flow through.

[(26:58)] Stephanie: Mm-hmm.

[(26:59)] Mary: So not actually expecting any specific experience. ‘Cause sometimes you may not feel relaxed when you’re mindful, but you may notice other things. But can I just notice a thought or emotion and just let it roll by like a cloud in the sky without attaching any sort of judgment to it.

[(27:16)] Stephanie: Yeah.

[(27:17)] Mary: And just be with what is.

[(27:19)] Stephanie: Yeah.

[(27:20)] Mary: Um, so letting go of the struggle essentially. So that’s… With those practices that’s more of what we would be doing.

[(27:27)] Stephanie: That’s great. I look forward to diving into your toolkit. I am excited to share it with our community. And just wanna thank you for being here.

[(27:36)] Mary: Oh, you’re so welcome.

[(27:37)] Stephanie: I wish everybody had a Mary. But we’re very happy we could share with our listeners a little bit of your knowledge. So thank you so much.

[(27:45)] Mary: Oh, you’re so welcome, and I appreciate you guys asking me. This was lovely. So thank you.

[(27:52)] Stephanie: Thank you. Thank you for listening to this episode of the Can Do MS Podcast. If you liked this episode, please leave us a rating and review on Apple Podcasts or Spotify. We really appreciate your feedback. We’d also like to thank all of our generous sponsors for their support of this episode of the Can Do MS podcast. Until next time, be well and have a great day.
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