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WHOLE HEALTH:
Change the Conversation
Mindful Awareness &
The Power of the Mind
OCTOBER 2013
I never look at the masses as my
responsibility. I look at the
individual. I can only love one
person at a time. I can only feed one
person at a time. Just one, just one…
So you begin - I begin.
I picked up one person - maybe if I
didn’t pick up that one person, I
wouldn’t have picked up 42,000.
The whole work is only a drop in the
ocean. But if I didn’t put that drop
in, the ocean would be one drop less.
Same thing for you, same thing in
your family, same thing in the
community where you live. Just
begin… one, one, one.
-Mother Teresa
One by One…
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Objectives
• Define mindful awareness
• Explore why and how it matters
– Review some of the research
• Practical applications
• Resources for further learning
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Pause and Presence
Pause, Presence, Proceed
Pause
Be Present Proceed Towards Whole Health
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When are you most…
• Aware
• Present
• Centered
• Focused
• Calm
http://wallpapers916.blogspot.com
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Definitions of Mindful Awareness
• Way of being
• In the present moment
• On purpose
• Nonjudgmentally
Mindful awareness is an
opportunity to be in the
wholeness of life…
including suffering, joy, peace,
unrest, creativity, fullness,
emptiness – everything…
…Not merely a technique for
coping with a specific problem.
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Encompassed by many practices
• Yoga as preparation
• Meditation – Seated – Movement – Eating – Compassion
• Breathing
• Washing dishes, doing laundry
• Techniques found in most spiritual
traditions
• Goal is to bring it to moment-by moment awareness Dailyheal.com
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The Challengers – ‘TIES’
• Thoughts
• Images
• Emotions
• Sensations
Modernworld4.blogspot.com
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The nature of mindful awareness
Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.
-Victor Frankl, MD,PhD
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The Info-Medical Cycle
Information Perception
Emotion Somatic Change
Behavior
Memory Belief
Rakel D, Shapiro D. Textbook of Family Medicine, 6th Ed.
Perception
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How Many Fs?
FINISHED FILES ARE THE RESULT OF YEARS OF SCIENTIFIC STUDY
COMBINED WITH THE EXPERIENCE OF YEARS.
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Word Association with…
United States= #1 Answer = Guilt
France= #1 Answer = Celebration!
Rozin, et al. Health Psychology. 1996;15(6):438-47.
I am an old man and have known a
great many troubles, but most of
them never happened.
-Mark Twain-
Beauty Anger Hostility Self-Doubt Judgment
Awareness
Awakening
Awe
Authenticity
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Drop Beneath your mind’s thoughts and …..observe.
Thoughts Judgment
Emotions
Awareness
Guess what? When it comes right down to it, wherever you go, there you are…
Like it or not, this moment is all we really have to work with. Yet we all too easily conduct our lives as if forgetting momentarily that we are here, where we already are, and that we are in what we are already in.
In every moment, we find ourselves at the crossroad of here and now. But when the cloud of forgetfulness over where we are now sets in, in that very moment we get lost.
– Jon Kabat-Zinn,
Wherever You Go, There You Are
Mindful awareness is gently
bringing our attention back to the present moment,
with acceptance (and curiosity) of what is…
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Reversible cardiomyopathy with severe emotional stress
• 19 people with heart wall motion dysfunction after emotional stress
• Ejection Fraction = 20%
• Monocyte infiltration
• Moderate Troponin I
• catecholamines
• 95% had normal arteries
Wittstein, et al. NEJM 2005;352:539-548
A Wandering Mind Is
an Unhappy Mind Matthew A. Killingsworth*,
Daniel T. Gilbert
Science 12 November 2010:
Vol. 330 no. 6006 p. 932
2250 Adults in US.
Mean age = 34
Are you thinking about something other than what you’re currently doing?
What are you doing right now?
How are you feeling right now?
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J Am Coll Card: Vol 45(5);2005
Nationalgeographic.com
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Gamma wave synchronization
• Longtime practitioners show organized brain activation on scale never seen before
High-frequency gamma wave synchronization especially intense in the left prefrontal cortex
Gamma waves associated with attention and mood
Lutz et al. PNAS 2004;101(46):16369-73.
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Promega Study
Methods:
• 48 right handed subjects employees of Promega in Fitchburg, WI
• Subjects randomized into Meditation group (N=25, 19 females) and a wait-list control group (N=16, 10 females)
• Mean age 36 years
• Wait-list controls were provided 8-wk MBSR training program after completion of study
Richard J. Davidson, Ph.D., Jon Kabat-Zinn, Ph.D., et al. Alterations in brain and immune
function produced by mindfulness meditation. Psychosomatic Medicine. Aug/Sept. 2003
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Right vs Left Prefrontal Cortex
Negative ---- Positive
Balance predicts typical range of moods.
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Negative emotions: right prefrontal cortex
• Anger
• Fear
• Anxiety
• Depression
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Positive emotions: Left prefrontal cortex
• Enthusiasm
• Vigor
• Optimism
• Buoyancy
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Promega study
A short course of meditation practice increases left prefrontal cortex activity
• ↓ anxiety & negative affect
• ↑ positive affect
• ↑ immunity (antibody titer to flu vaccine)
Davidson et al. Psychosom Med 2003; 65(4):564-70.
fMRI
Brefczynski-Lewis, et al. 2007104(27):11483-8
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Genius means little more than the faculty
of perceiving in an un-habitual way.
-William James
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Mindfulness for Clinicians and Staff
Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study. Ann Fam Med. 11(5); 412-420. 2013
Arch Intern Med. Published online 08/20/12.
doi:10.1001/archinternmed.2012.3199.
Burnout by Specialty
(n = 7288)
0 10 20 30 40 50 60 70 Percent Reporting Burnout
Significant improvements with Maslach Burnout Inventory
Significant improvements with depression, anxiety and stress
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Mindful awareness in a nutshell
• Pause o Stop what you are doing; drop in
o Challenge is to make this a habit
• Presence o Observe it, acknowledge it
o Nonjudgmental. No striving – let it be
• Proceed o Return to your activity, anchored in present moment awareness (breath,
physical sensation, groundedness)
o Compassion, appreciation, positive intention
Adapted from: www.fammed.wisc.edu/mindfulness
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How can your meditation cushion become your clinical chair?
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Mindful Awareness and Medicine
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Healing Thresholds
47
What does this look like?
What does this look like?
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Suggestions for practice
• Listen with your whole body
• Deep breath before each patient
• Threshold exercise
• Stethoscope use as a reminder to be mindful
• Call room/office centering
– The moment you sit in your chair…
• Supportive group
• Daily practice
• Others?
http://www.virtualtoolbox.ca/
Tell me what you pay
attention to, and I will
tell you who you are.
Jose Ortega y Gasset
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Five Facet Mindfulness Questionnaire
• Feeling yourself walking
• Responding to emotions, not getting caught up in them
• Distractibility
• Noticing background sounds
• Feeling the water from the shower
• Noticing smells
• Putting experiences into words
• Self-judgment
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Appreciative Inquiry
Appreciative Inquiry is about the co-evolutionary search for the best in people, their organizations, and the relevant world around them. In its broadest focus, it involves systematic discovery of what gives “life” to a living system when it is most alive, most effective, and most constructively capable in economic, ecological, and human terms.
www.Appreciativeinquiry.case.edu
It is true that we are called to create a better
world. But we are first of all called to a more
immediate and exalted task: that of creating our
own lives. -Thomas Merton
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