Magnetic Mindfulness: Managing Stress About the MRI

Source: GCS/Created with DALL-e/Open AI

We're in a wondrous era of medical technology. Robotic-aided surgeries can snip out problem gallbladders in mere minutes. Endoscopies can maneuver in the tightest of bodily spaces to beam back high-def images of polyps and ulcers and even fix them in the very same procedure. We now benefit from imaging information that used to require the equivalent of an easel and palette—or perhaps a deli slicer.

Yet we healthcare professionals, in thrall to the whiz-bang output, can under-appreciate the experience of the patient undergoing these tests and procedures. Physical placement in tender places, needle sticks, catheters, MRIs... all are necessary but provocative tools of modern medicine. The procedures themselves can be stressful in physical and especially in sensory terms. Of course, the tension inherent in medical uncertainty about the results and outcomes of the tests and procedures is already operating, another layer of stress.

It ain't easy being a patient. But we can help our patients by entraining some basic mindfulness tactics to manage and adapt to the momentary, unusual, and even weird stuff being done to (and for) them in the name of healing. This topic is a central one in Mindfulness in Medicine (Springer Nature, out 10/24), a book I've completed with my colleague Rajat Chand, M.D. Aimed at healthcare providers, it's a practical guide to all things mindfulness as they apply to healthcare practice for both our patients and ourselves as treaters.

Today, I'll engage with one common procedure that exemplifies the challenge and some helpful, mindful tactics: magnetic resonance imaging...the MRI. What a clever wonder—magnetically spinning the electrons of every bodily cell in one direction, then measuring how various tissues return to their prior state of spin to produce remarkable images. It also involves the strangeness of being hoovered into a high-tech, noisy sarcophagus and being asked to remain utterly still there. Sure.

I happen to have some deep "naturalistic" research experience here; as a survivor of a now-dormant hunk of chondrosarcoma in my neck (thanks to another modern wonder, stereotactic radiosurgery), I have had too many MRIs to count at this point. That's some serious road testing of mindfulness tactics, and some magnetic reviews of their utility.

In the book, we distill the most useful tactics to the "core four": breathing meditation, scanning practices, visualization or rehearsal, and gratitude or compassion work. Each of these has a role here, to be briefly reviewed with our patients before they get in the noisy tube.

First, let's briefly, sequentially review the "MRI experience" from a patient perspective:

• The sequence starts with pre-procedure jitters, some paperwork often reiterating information about the need for the imaging (and amping the anxiety).
• There's the gym locker area and a change into unfamiliar clothing—sometimes a patient gown or some "play doctor" scrubs—but all a bit alien.
• There's walking or being rolled through the sensory morass of a technical area with mission control monitors, bleeping instruments, and perhaps Sigourney Weaver in the back sipping stale coffee.
• Then, into the MRI room, onto the slightly firm (!) bed, wedged in, ear plugs inserted, some instructions given, and then into the techno-cannoli, ready or not.
• The experience inside is its own phantasm of sensory input: the tight space, the "ceiling" a few centimeters from the schnozz (at least my jumbo Slavic model), the awareness of not "failing the exam" by wiggling around or, God forbid, needing a scratch, and the sounds. Oh, the soundtrack: some sequence of starting jet engines, odd safecracking noises, the "gnomes with little hammers" percussive serenade, and my personal fave, the "coffee on the nuclear reactor console" alarm. This tense concerto sometimes comes with a brief intermission, where what is offered is not a glass of tepid chardonnay but a jab of dye in the arm. Quick, back to the show!

Obviously, almost everybody survives the performance without the need for sedation. But it can be immensely helpful to provide a little mindful prep for the uninitiated. Even the briskest of "high points" of that sequence reduces the novelty of it. But also consider these various uses of our "core four" tactics; members of this quartet have been covered in more detail in prior blogs.

• Breath meditation: the basic and best skill throughout the event. Encourage a little practice at home before (to reacquaint the patient with the calming self-care at hand), in waiting room prepping, and especially through the procedure; keeping a rhythm of in and out, in control of the breathing self as the not-self all around goes through the sequence.
• Scanning: especially in this unique situation of "body still, please," a basic body scan helps sustain calm by bringing gentle awareness and grounding to each part of the body. The tactics of "breathing into"—imaginally sending calm attention to a problem spot (for me, swallowing, as I know every inch of real estate there is being scanned)—is a riff off the basic scan. Especially as an anxious tone and some flooding of thoughts about the weirdness of the moment is common, a "self" scan—body, emotion, thought, whole being (and observing capacity)—brings in some careful identification of the whole experience.
• Visualization or rehearsal: while this requires a little pre-MRI prep, a brief walk-through of each phase as described above (maybe leave out the snark), and a moment of "visualize yourself in that part" (and even an imaginal "scan" thereof) can reduce the additional tension of novelty. Some adaptive and even exit strategies can be added. One important point: Include a scene of the completed, successful procedure, visualizing relief.
• Gratitude or compassion: this includes a few moments of self-compassion for the unwelcome but necessary event and hopeful gratitude in advance for its benefit in clarifying medical problems.

Mindfulness Essential Reads

Take Time for Your Heart to Meet Your Mind

What Kids and Pets Can Teach Us About Coping With Anxiety

Aside from softening the stress of an unusual, thoroughly modern human moment, every successful "rep" can be adapted to other ones we and our patients inevitably face in life. Mindfulness here is a tool for the moment and also that broader goal.