11. HEALTHY CONNECTIONSprojects.hsl.wisc.edu/SERVICE/sites/final/2017/Day... · Whole Health in Your Practice - Healthy Connections . March 2017 . 14 . VETERANS HEALTH ADMINISTRATION

Whole Health in Your Practice - Healthy Connections

March 2017

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11. HEALTHY CONNECTIONS

Whole Health in Your Practice

VETERANS HEALTH ADMINISTRATION

Family, Friends, & Coworkers

No man is an island,

entire of itself.

-John Donne

The ‘I’ in illness is

isolation. The ‘W’ in

wellness is ‘we.’

-Satchitinanda


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Family, Friends and Co-workers Video - Office of Patient Centered Care & Cultural Transformation


Family, Friends, Coworkers: Connection = Life

• 2015 meta-analysis of 70 studies– Social isolation = 29% higher likelihood of dying

– Loneliness = 26% higher likelihood

– Living alone = 32%

– Results “…consistent across gender, length of follow-up, and world region…”

Holt-Lunstad, et al., Perspectives Psychol Sci, 10(2):227-37, 2015

• 2014 summary: Interviews with 23 Veterans who had attempted suicide.– Two things would have helped most:

• More compassion and empathy from care providers

• Social support

Montross, et al. Crisis. 2014;35(3):161-167.

• Loneliness and poor social connection cause inflammation and chronic diseaseFagundes CP, et al, Soc Personal Psychol Compass, 5(11):891-903, 2011

Photo credit: Caro's Lines via Foter.com

https://youtu.be/_CmqMRCezb0

https://www.flickr.com/photos/caroslines/5534432762/

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High Social Integration

Low Social Integration

Tsai, A.C., et al., Ann Intern Med, 161(2):85-95, 2014.

2 x less

Suicide! (and lower all-cause mortality)

34,901 Male Health Professionals

Followed for 24 years


The Importance of a Loving Partner

• 10,000 men with high heart disease risk:– Saying , “yes, my wife shows me her love” was tied to

• 50% less angina

• 50% fewer ulcers Madalie, JH, American Journal of Medicine, 1976, 60(6): 910-21.

• 1400 men and women after heart catheterization

– If you were not happily married or didn’t have a confidante,

• Triple the 5 year mortality rate (50% died versus 15%)Williams, RB et al, JAMA 1992, 267(4):520-24.

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http://www.flickr.com/photos/27506472@N04/

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Entrainment of Heart Rhythms in Sleep

McCraty, The Energetic Heart: Bioelectromagnetic

Interactions Within and Between People, Heartmath


In addition to “What Really Matters?”


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Family, Friends, and Coworkers: Health Plan Options

• Explore social support (emotional, financial, mentorship, affirmation,information)

– There are a number of surveys they can complete

• Social workers

– http://www.socialwork.va.gov/socialworkers.asp

• Support groups and peer-led groups

– http://www.ptsd.va.gov/public/treatment/cope/peer_support_groups.asp

• Compassion meditation

• Be strategic about their care team

• Volunteering and other community activities

• Animal assisted therapy

Photo: ableveterans.com


Spirit and Soul

The human heart has a

hidden want which

science cannot supply.

-William Osler

http://www.socialwork.va.gov/socialworkers.asp

http://www.socialwork.va.gov/socialworkers.asp

http://www.ptsd.va.gov/public/treatment/cope/peer_support_groups.asp




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Six Aspects of Spirituality

Religious

Humanistic

Nature

Experiential

Cosmos

Mystery


1. Religious

Closeness and connection to the sacred as described by a specific religion. Fosters a sense of closeness to a particular Higher Power

• 83% of US adults belong to areligious group

• 91% believe in God or auniversal spirit

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2. Humanistic Spirituality

Closeness and

connection to

humankind.

May involve feelings of

love, reflection,

service, and altruism.

Photos: Wikipedia.org


3. Nature Spirituality

Closeness and connection to nature or the environment, such as the wonder one feels when walking in the woods or watching a sunrise.

An important focus for many traditional healing approaches.

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4. Experiential spirituality

• Shaped by personal lifeevents

• Influenced by ourindividual stories

• Experience in warinfluences Veteransprofoundly

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Photo credit: Pierce Martin via Foter.com


5. Cosmos Spirituality

• Closeness and connection to thewhole of creation.

• It can arise when onecontemplates the magnificence ofcreation or the vastness of theuniverse – awe and wonder

• Such as when you look skywardon a starry night Photo credit: Sweetie187 via Foter.com


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http://foter.com/

https://www.flickr.com/photos/heraldpost/2472603469/

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https://www.flickr.com/photos/pierce-martin/8246427422/

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6. Mystery

• There is much that wesimply cannot know orunderstand

• Perhaps it is not possible tofully grasp or know, andpart of spirituality isallowing for theunknowable.

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A Summer’s Day, by Mary Oliver

…I don’t know exactly what a prayer is.

I do know how to pay attention, how to fall down

into the grass, how to kneel down in the grass,

how to be idle and blessed, how to stroll through the

fields, which is what I have been doing all day.

Tell me, what else should I have done?

Doesn’t everything die at last, and too soon?

Tell me, what is it you plan to do

with your one wild and precious life?


http://foter.com/


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Partner Exercise Take a Moment to Consider…

• Consider the six differentaspects of spirituality (andothers you may think of)

1)Religious

2)Humanistic

3)Nature

4)Experiential

5)Cosmos

6)Mystery

• Which ones resonatewith you the most, andwhy?

• How might your viewsinfluence how you takecare of patients?


Religious Communities and Health

• ….if the the community if functional

• 19x lower risk of death from all causes if you attendweekly services versus none (over 8 years)– And 7.5 years longer life expectancy

– Especially for women

• Predicts social connections and better mental health

• Tied to healthier lipid and stress hormone levels

Mallin R, Prim Care Clin Office Pract 2008; 35:857-66.


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Religious Gatherings and Relative Benefit

• 2000 meta-analysis found 22% lower mortality if youattend a religious gathering at least once weekly

• Criticized for not showing a “clinically significantchange”

• But, the benefit is equivalent to:

– Using statins for primary prevention

– Exercise-based rehabilitation after an MI

– The opposite of how much harm heavy drinking causes

McCullough ME et al. Health Psychol, 19(3):211-222, 2000.


More Spirituality Equates to

• Lower systolic and diastolic blood pressures

• Greater compliance with medications

• Exercising more

• Eating healthier

• Being able to quit smoking more readily

Mueller, PS et al, Mayo Clinic Proc.2001;76:1225-35.


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Spirit and Soul: Health Plan Options

• Explore their beliefs with them

– How can you respect and support what they believe?

– And how can you respect and support what you believe?

– Consider religious communities and/or spiritualpractices

• Chaplains

– http://www.patientcare.va.gov/chaplain/

• Spiritual anchors

• Help them work with forgiveness

Photo: atlanta.va.gov


Power of the Mind

http://www.patientcare.va.gov/chaplain/

http://www.patientcare.va.gov/chaplain/


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A Spectrum of Techniques

• Psychotherapies

• Biofeedback

• Progressive muscle relaxation

• Meditation

• Breathing exercises

• Cognitive behavioral therapy

• Eye movement desensitizationand reprocessing

• Therapeutic disclosure

• Clinical Hypnosis

…and many othersPhoto credit: grimeshome via Foter.com


Relaxation Response: A Common Denominator

• Coin termed by Herbert Benson,MD, a cardiologist

• The autonomic nervous systemhas 2 branches

– Sympathetic (fight/flight)

– Parasympathetic (feed/breed)

*Most mind-body exercises havethe parasympathetic activation and other physiological changes as a common endpoint

• The key is, which approach willbest fit any given individual?

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Laughter is Good for the Heart

• 150 people givenhumorous manuscripts.

• Those with heart diseasewere 45% less likely tolaugh.

• Those who did laugh wereless likely to have heartdisease and had lesshostility.

Clark, et al., Int J Cardiol 2001;80:87-8

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Hostility

CARDIA study

• 374 18-30 year-olds

• Hostility index at baseline

• CT scans of carotids in 10 yearslater

• Those with greater than themedian hostility score had twicethe risk of coronary calcifications

• ….and had 9 times the risk ofthose with below the meanhostility score.

Photo credit: Theophilos via Foter.com

Iribarren, JAMA. 2000; 283:2546-2551.

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https://www.flickr.com/photos/theo_reth/15993544987/

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Emotions and Heart Rhythm

McCraty R. Bioelectromagnetic Interactions Within and Between People. HeartMath Research Center.

www.heartmath.com


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Your Turn: Teaching a

Mind-Body Skill

1:2 ratio breath

6 breaths per minute

3-4

counts

6-8

counts


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Another option: 4-7-8

breath

3 breaths per minute

IN for

4 counts

OUT for

8 counts

HOLD

7 counts


Practice Teaching Your Partner

• Introduce a breathing exercise

• 4-7-8 breath

• 1:2 ratio breath

• Centering Breath with hand on heart/belly

• Model it for them

• Get centered and grounded

• Guide them through it

• Ask for feedback from your partner

• Switch


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Partner Exercise: Relationships, Spirit and Soul, Power of the Mind

Take a few minutes

to ask your partner

about these areas.

See some sample

questions on pages

37-8.


Arthur’s Amazing Transformation

https://www.youtube.com/watch?v=qX9FSZJu448

Documents

11. HEALTHY CONNECTIONSprojects.hsl.wisc.edu/SERVICE/sites/final/2017/Day... · Whole Health in Your Practice - Healthy Connections . March 2017 . 14 . VETERANS HEALTH ADMINISTRATION