Breathing Through a Fragile Moment

Dr. Greg Sazima (author of Practical Mindfulness) writes that meditation can help patients—and their caregivers—manage tough moments.

Pixabay, altered with Prisma


  • This difficult year has exposed all of us to the difficulty of holding powerful emotional states.
  • Mindful practices like meditation can help in both diagnostic and therapeutic ways.
  • Meditation can relieve stress in both patients and caregivers

With patients in my clinical practice but also among friends and professional colleagues, I’ve observed that many of us have been struggling to adapt to shifting inner states, driven by the uncertainties of this complex year in our shared history. Anxiety, grievance and despair rattle around the head and heart, competing for a fearsome primacy as “how this feels.”  Many times, I can only console, reinforcing that the ache felt is painful, but is actually a reasonable reaction to the current circumstances. 

It’s “ouch”… but not “crazy.”

I think there is a complicating, amplifying dilemma when the inner needle of coping tips ominously into the red.  I elaborate on this in more detail in Practical Mindfulness, but gist is that stressful events generate a reaction that resonates through all the aspects of our experience —physical, emotional, thought, and awareness.

The amplifier is in how we “hold” that experience and how we judge it, what I nickname “spin” with patients and in the book.  We can get upset, and then “spin” shame at feeling that upset.  We can get aggrieved at an opinion, and “spin” a kind of satisfaction at our righteous anger.

So, event… reaction… and spin.  But what if the spin is “This is threatening”?

Sometimes the intensity of a reaction can scare us, freak us out, drive a secondary spin of true dread.

This spin is present courtesy of our brain stems, of our evolutionary, primal threat neurology, what I call “OS 1.0” in the book.  When the reaction is overwhelming, it can generate a “collapse to 1.0,”  a fear that the state will never cease, that it’s too hard to hold, that it could literally kill. That’s a complex state—of suffering and also a “spin” of deep fear of that suffering.

One of the first patients I treated as a newbie shrink on an inpatient unit, way back in the late 80’s (I mean the 1980’s, for you snarky readers) used to parrot a line I grew slightly weary of:  “I have a fear of fear!”  But she actually had it right.

Mindfulness practices can’t prevent the suffering of daily bumps and bruises, let alone the deeper uncertainties we are all immersed in at this moment in history.  But I work with patients in benefiting from the use of meditation in two ways: as a “vitamin,” and as a “bandage.”  I’ll touch on that first, preventive/pre-emptive use in this blog and dig into a “first-aid” capability of a mindful practice in the next post.

(Nobody likes a blog the length of a novella. Not practical.)

As to that vitamin: A regular meditation practice, whether as uncomplicated as sitting with observation of our breathing or more complex sequences of witnessing various phenomena of our mindscapes, can’t help but cultivate adaptation.

  • Through observation, especially of the stuff that drives our attention south, we get to know those tough moments better.  We can become more familiar with them and how they operate, dance with each other. The novelty of the “spin” wears off—it’s “ouch”, but not so much a surprise.
  • Through repetition, even when the inner “phenomena” seem truly radioactive, we learn that these moments come and go, have a beginning and an end.  We’ve seen this flick before.

The standard meditation practice is a kind of laboratory of our experience, with optimal conditions set to examine how we operate. And it’s a training center for adaptation. As patients gain in both the understanding and the adaptation aspects, moments that generate that fearful, “collapse!” spin ease a bit, even in deep suffering, off the cushion.

Caregivers, it’s for us, too: our daily work lives often feature surprise, tough moments in compassionate attending to people in need, in suffering.  A regular meditation practice helps doctors, therapists, nurses, teachers, and other caring professionals in both those “learning” and “adapting” aspects. Whether or not we choose to directly teach some basic mindful tactics (psst…please do!), we’re always modeling healthy coping, or not so much, in every interaction.

That can seem like a burden; but it’s really an opportunity.

(Stay tuned for Part 2, on a “rescue” tactic for the toughest of moments. Cliffhanger!)


Sazima MD, G.(2021) Practical Mindfulness: A Physician’s No-Nonsense Guide to Meditation for Beginners. Miami, FL: Mango Publishing.

Practical Mindfulness

A Physician’s No-Nonsense Guide to Meditation for Beginners

Training exercises that work. Practical Mindfulness approaches mindfulness and meditation from a hands-on, how-to, irreverent perspective–appealing directly to smart readers curious about meditation. By applying Dr. Sazima’s training routines, learn to spend more time in real engagement with the world. Cultivate a deeper appreciation of experiences, from the everyday to the extraordinary, and live your life more fully, wisely, and joyfully.

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