The Five-Step PAIN Process 

This process summarizes the “Five-Step Model of Mindfulness,” found in chapter 5 of Living Well With Pain & Illness by Vidyamala Burch. It is similar to the “STOP” One Minute Breathing Space, in that it begins with a pause to take stock of what’s happening (Step One) and ends with an opening to the outside world and new possibilities (Step Five), but this process is specifically for very difficult physical pain (or painful emotions).

Step One - The Starting Point: Awareness 

(Similar to “S” and “T” of STOP) Bring yourself into the present moment by bringing awareness to Thoughts (what are you saying to yourself), Feelings (enjoying, upset, excited, sad, mad, etc.) and Physical Sensations (tightness, holding, lightness). You might also notice where you are, what you are seeing and sensing of the outside world (sun on your face, what your hands are touching, other people,…) “Take a breath” is simply a cue to be aware of breath, not necessarily to change it.

Step Two - Move toward the Unpleasant

We normally react to pain in one of two ways: (1) to try to block or distract from the discomfort, or (2) get swallowed up in it, drowning in the discomfort and its associated fears (what if this continues, etc.). This step offers a third choice that may sound like option (2), but is actually quite different. Rather than drowning in it and the associated fears, you move your attention away from the story line and fearful interpretations, and instead, observe precisely the sensations corresponding to the discomfort. What precisely are the sensations (burning, cutting, tingling, aching, etc.)? Where are they precisely? What is the shape of the discomfort? Where are the boundaries? How thick, thin, deep or shallow is it?

Step Three - Seeking the Pleasant

At any moment, there are thousands of places we can put our attention, and pain is a siren call to pay attention to a particular set of inputs, whether physical sensation or our thoughts telling us how bad it feels. This step invites you to explore your inner and outer world, looking for something pleasant in your

 experience. As Vidyamala puts it in her book, “Seeking the pleasant is like being an explorer searching for hidden treasure. It might be as simple as noting the warmth of your hands or a pleasant feeling in the belly, or seeing a shaft of sunlight streaming through the window.”

Step Four - Broadening Awareness

Like the “O” of the STOP process, here you broaden your awareness so that it includes both the pleasant and unpleasant aspects of your experience, including your whole body, your surroundings, so that you are much bigger than an specific unpleasant or pleasant aspect of your experience. Joko Beck, in Everyday Zen refers to this as “becoming a bigger container.”

Step Five - Choice: Responding Rather than Reacting

Like the “P” of STOP, you let your attention now move into the world around you, letting yourself naturally respond rather than react habitually to the situation you are in, curious and open, with perhaps more possibility and choice than you might have had before this exploration. You may even be surprised by what happens next after creating this pause…