Mindfulness for trainer's workshop

Mindfulness

1. What is mindfulness?

2. Benefits of mindfulness

3. Applications of mindfulness training

Does Mindfulness training for healthcare professionals improve outcomes for

themselves and their patients?

Dr Stephanie Jackson DipSIM

What is mindfulness?

Exercise

The term mindfulness refers to a quality of awareness that includes the ability to pay attention in a particular way: on purpose, in the present moment, and non-judgementally (Kabat-Zinn, 1994)

Mindfulness – a Buddhist teaching 7 fundamental attitudes:

• Non-judging• Beginner’s Mind• Non striving• Accepting• Patience • Trust• Letting go

Mindfulness training is . .

• An integrative mind-body based approach that helps people change the way they think and feel about their experiences, especially stressful experiences.

• It involves paying attention to our thoughts and feelings so we become more aware of them, less enmeshed in them, and better able to manage them.

• Mindfulness teaches us how to accept out thoughts without unhelpfully identifying with them.

• When people practice mindfulness, they are encouraged not to aim for a particular result but simply to “do it” and see what happens.

Mental Health Foundation. Mindfulness Report, 2010.

Background

• 1979 – Mindfulness Based Stress Reduction (MBSR)

• 2000 – Contemplative Neuroscience

• 2004 – Mindfulness Based Cognitive Therapy (MBCT)

• 2000 - 2011 exponential growth in published papers

Mindfulness-Based Stress Reduction (MBSR)

• 8 week group participation program• 2 hours teaching time per week• Home practice – 45 mins/ day for 6 days• Body awareness, yoga, walking and sitting

meditation• One day silent retreat

• Plus variations on this core structure . . .• Individual compliance with homework will vary.

Mindfulness-based Cognitive Therapy (MBCT)

• Developed by Segal, Williams and Teasdale, Oxford, 2004

• Same structure with cognitive therapy component

• Recommended by NICE for the prevention of depression for those with 2 + previous episodes.

What are the benefits of mindfulness training and how

does it work?

• Cognitive Neuroscience

• Psychology

• Physiology

Mechanisms of Mindfulness

• Attention

• Intention Control (emotional regulation)

• Attitude (a specific attitude marked by friendliness and acceptance)

Shapiro et al, 2006

Cognitive Neuroscience

•Long term meditators induce high amplitude gamma synchrony (associatedwith attention, conscious perception, learning and working memory)Lutz et al, 2004. Long term meditators self induce high amplitude gamma synchrony during mental practice. PNAS, 101(46), pp16369-16373

•Mindfulness is associated with enhanced prefrontal cortical regulationof affect through labelling of negative affective stimuli (emotional regulation)Creswell et al, 2007.. Psychosomatic Medicine, 69, pp.560-565

Increases in regional gray matter concentration in left hippocampus, posterior cingulate cortex, temporo-parietal junction and cerebellum compared to controls (learning, memory, emotional regulation and perspective taking)Holzel et al, 2011. Psychiatry Research: Neuroimaging, 191, pp.36-43

Significant increases in left-sided anterior activation (Left pre-frontal cortex) (previously associated with positive affect and approach orientated behaviour)Davidson et al, 2003. Psychosomatic Medicine, 65, pp.565-570

What does this mean?

• Meditation is associated with increased attention and affective processes

• Brain is flexible and can be trained and its function can alter over time.

Psychological outcomes

Why is Mindfulness helpful?

Mindfulness may aid well-being through a number of mechanisms:

• Greater insight• Improved problem-solving• Better attention• Less selfishness and neurosis• More acceptance• Greater enjoyment of life• Less “beating ourselves up”• Better mind-body integration

Mindfulness-based stress reduction for stress management in healthy people

• Design: Review & meta analysis – 10 low quality studies

• Results:• MBSR – non specific effect on reducing stress

and enhancing spiritual values

• Reduce ruminative thinking and trait anxiety

• MBSR increases empathy and self compassion

Chiesa & Serrett, 2009, Clinical Psychology Review,31, pp.449-464

Physiology outcomes

Short term meditation improves attention and self regulation

• Partipants: 80 Chinese undergraduates

• Randomly assigned – 5 days, 20 mins/day

• Outcomes• Lower salivary cortisol• Higher salivary IgA concentrations • In response to stress (mental arithmetic task)

Tang et al, 2007. PNAS, 104(43), pp. 17152-17156

How it works

• Develops awareness

• Reduces anxiety and stress in present moment

• Prevents rumination

• Promotes healthy coping strategies

Healthcare professionals

• Evidence for:• Decreasing stress, negative effect, rumination, both state

and trait anxiety

• Increasing positive effect, self compassion, and QOL

• Clinical skills: increasing empathy and improving care-giver patient relationship

Exercise

Applications of Mindfulness Training

Transport for London workers

• Mindfulness based programme led to major changes in health related absenteeism

• Days taken off due to stress, depression and anxiety fell by over 70% in following 3 years

• Absences for all health conditions were halved

Of those who took course:

• 80% said their relationships had improved

• 79% said they were more able to relax

• 53% said they were happier in their jobs

Mental Health Foundation (2010) Mindfulness Report, London.Executive summary available from:http://www.bemindful.co.uk/media/downloads/Executive%20summary.pdf

Healthcare professionals work in stressful environments, with long hours, heavy caseloads and limited control over their working conditions. Added to this are frequent restructuring of organisations and changing guidelines about practice. Burnout is common, as are associated physical health problems (Irving et al, 2009).

Doctors

• Reduction in psychological stress

• Improves quality of life

• Improvement in performance

• Reduced physician burnout

(Shapiro et al., Int J of Stress Manag, 2005; 12: 164-176)(Hassed et al., Adv Health Sci Educ, 2009; 14: 387-398)

MBSR for Healthcare professionals: results from a randomised trial

• Intervention: 8 week MBSR course - physicians,

psychologists, nurses, social workers, physiotherapists

• Results: Effective for reducing stress and increasing QOL and self compassion in healthcare professionals

• Other possible outcomes: enhancement of working relationships / patient care

Shapiro et al, 2005. International Journal of Stress Management, 12(2), pp. 164-176

Mindfulness andResilienceDr Duncan Shrewsbury,Dr Rebecca Viney, Dr Paquita de Zuluetta

Resilience

• Positive Psychology

• “falling over 5 times, getting up 6”

• • Bending without breaking

• • Bouncing back

• • Self righting

• • Learning and growth

Patients

• Mindfulness has been used for patients suffering with:

• Low mood or Depression• Anxiety and panic• Stress• Conditions such as chronic fatigue, chronic pain,

fibromyalgia, high blood pressure, psoriasis, sleep disorder and headaches

Mindfulness helps with the art of Medicine

• Medicine has traditionally been described as a healing profession. Healing can be defined as being cured when possible, reducing suffering when cure is not possible, and finding meaning beyond the illness experience (Scott et al, 2008).

NICE guidelines for healing

• Mindful practice supports healing relationships, and as a link between relationship centred care and evidenced based medicine, mindfulness should be considered a characteristic of good clinical practice (Epstein, 1999).

Physician competencies that facilitate healing relationships

• Self confidence• Emotional self management• Mindfulness• Knowledge

• Self acceptance, emotional regulation and mindfulness all outcomes of mindfulness training

Scott et al, 2008. Annals of Family Medicine, 6(4), pp.315-322

Promoting mindfulness in psychotherapists in training influences the treatment results of their

patients

• Design: a randomized double-blind, controlled study

• 124 psychiatric inpatients treated by 18 interns – treated for 9 weeks

• Intervention: Zen meditation

Grepmair et al, 2007. Psychotherapy and Psychosomatics, 76(6), pp.332-338

Results: Patients whose therapists had received mindfulness training:

• Rated their therapists higher on their therapeutic relationship, problem solving skills and ability to communicate clearly

• These patients did significantly better in terms of symptom severity including: somatisation, insecurity on social contact, obsessiveness, anxiety, anger/hostility, phobic anxiety, paranoid thinking and psychotism

Grepmair et al, 2007. Psychotherapy and Psychosomatics, 76(6), pp.332-338

Bringing mindful practice into GP Training

• Three mindful breaths waiting for chose and book to load / computer to load…

• Breathing with patient when listening to their chest…

• Mindful moment – walking through door to collect the next patient.

If you would like to learn some more…

• www.mindfulnesscornwall.co.uk

www.bemindful.co.uk

• • MINDFULNESS IS A MIND-BODY

APPROACH TO WELL-BEING THAT CAN HELP YOU CHANGE THE WAY YOU THINK ABOUT EXPERIENCES AND REDUCE STRESS AND ANXIETY.

• THE MENTAL HEALTH FOUNDATION WANTS TO MAKE MINDFULNESS AVAILABLE TO EVERYONE.

Thank you!