Kearney breakout 1

Mindfulness in the Health Care Workplace – Practical

Applications

Mindfulness in the Health Care Workplace – Practical

Applications

Title slide - part 1

David Kearney, M.D.

Associate Professor of Medicine, University of Washington

VA Puget Sound Health Care System, Gastroenterology Section

“You ought not to attempt to cure the body without the soul…For this is the greatest error of our day in the treatment of the human body, that physicians separate the soul from the body.”

Plato

What is Mindfulness?

William James, Principles of Psychology (1890), on the importance of attention in mental health:

“The faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of judgment, character, and will. No one is compos sui if he have it not. An education which should improve this faculty would be the education par excellence. But it is easier to define this ideal than to give practical instruction for bringing it about.”

compos sui: “master of one’s self”

Mindfulness Involves Attention

I. What is Mindfulness?• Mindfulness is synonymous with

“awareness”– “Paying attention, on purpose, in the present

moment, and without judgment” (Kabat-Zinn)• A quality of intention as well as attention:

flexibility of attention, maintaining attention, noticing subtlety

• Non-judgment, patience, non-striving, ‘beginner’s mind’, or COAL: curiosity, openness, acceptance, love (Siegel)

How Does Mindfulness Reduce Stress?• Promotes ‘de-identification’ with ‘storyline’

– Taught to see ‘thoughts as thoughts’– Theory: Mindfulness is of benefit across multiple conditions due

to the ‘universal human vulnerability’ to language (Williams)

• Promotes self-compassion• Grounds experience in the present moment• Decreases rumination – a key factor in relapse of

depression

• Increases clarity of emotional states (emotional intelligence)

How Does Mindfulness Reduce Stress?• Promotes ‘de-identification’ with ‘storyline’

– Taught to see ‘thoughts as thoughts’– Theory: Mindfulness is of benefit across multiple conditions due

to the ‘universal human vulnerability’ to language (Williams)

• Promotes self-compassion• Grounds experience in the present moment• Decreases rumination – a key factor in relapse of

depression

• Increases clarity of emotional states (emotional intelligence)

The Guest Houseby Rumi

This being human is a guest house.Every morning a new arrival.

A joy, a depression, a meanness,Some momentary awareness comesAs an unexpected visitor.

Welcome and entertain them all!Even if they’re a crowd of sorrows,Who violently sweep your houseEmpty of its furniture,Still, treat each guest honorably.He may be clearing you outFor some new delight.

The dark thought, the shame, the malice,Meet them at the door laughing, and invite them

in.

Be grateful for whoever comes,Because each has been sentAs a guide from beyond.

Rate of Depressive Relapse for Treatment as Usual (TAU) and Mindfulness-Based Cognitive Therapy (MBCT)

Teasdale et al, Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy, Jo Cons Clin Psych 68(4): 615-623, 2000.

Neural Correlates of Mindfulness During Affect Labeling

Creswell JD, Way BM, Eisenberger NI, Lieberman MD. Neural Correlates of Dispositional Mindfulness During Affect Labeling. Psychosomatic Medicine 69:560-565 (2007)

Greater levels of trait mindfulness were significantly associatedwith greater activity throughout the PFC during affect labeling compared with gender labeling (neutral task).

Is Mindfulness a Panacea?

• In Greek mythology, Panacea (Greek Πανάκεια, Panakeia) was the goddess of cures. She was the daughter of Asclepius, god of medicine, and the granddaughter of Apollo, god of healing (among other things).

Potential Limitations of Mindfulness Practice

• Practice tends to uncover personal issues by holding a mirror to the mind

• Yet….uncovering these issues doesn’t automatically bring insight in a psychodynamic sense

• Classical meditation traditions actually discourage working with “mental content”– People may unconsciously use their practice

to avoid dealing with important issues….or students may feel they are practicing incorrectly or not wholeheartedly enough if issues arise

Engler J. Promises and Perils of the Spiritual Path. in Buddhism and psychotherapy across cultures: essays on theories and practice, Mark Unno, Editor. Wisdom Publications 2006

Loving-Kindness Meditation

Loving-Kindness Meditation

Title slide - part 1

David Kearney, M.D.

Associate Professor of Medicine, University of Washington

VA Puget Sound Health Care System, Gastroenterology Section

Loving-Kindness Meditation (LKM)

• What is Loving-Kindness Meditation?– Derived from the Buddhist tradition

• Originally taught as a response to fear• A practice of cultivation of love

– Pali word metta: ‘unconditional friendliness’, ‘good heartedness’, ‘agape’

– Not a sentimental love– In LKM, there is no expectation that the practice will

necessarily benefit others

Loving-Kindness Meditation (LKM)

• LKM is both a concentration practice and an awareness practice

• Concentration developed as a person places attention on the LKM phrases– A skillful means of entraining the mind, utilizing

phrases that have positive intention– Often a more accessible means of becoming

collected/concentrated in the face of difficult emotional states

Loving-Kindness Meditation (LKM)

• Classically practiced with 4 phrases that contain positive intent

• Participants are asked to choose 4 phrases they find meaningful. For example:– May I be safe– May I be happy– May I be healthy– May my life unfold with ease

• Classically, the phrases are repeated for the following categories of beings:

• Benefactor• Self• Beloved Friend• Neutral person• Difficult person• Dichotomous groups (e.g. all men / all women)• All beings

Loving-Kindness Meditation (LKM)

Possible LKM Phrases

• May I be safe• May I live in safety• May I be free from

danger• May I love and accept

myself just as I am• May I be free from

suffering and the causes of suffering

• May I be happy• May I be peaceful• May I be joyful• May I be

courageous and joyful

• May I be open and trust in this moment

Possible LKM Phrases

• May I be healthy• May I be well• May I be fully alive and

healthy• May I be free from

distress and the causes of distress

• May I be free from fear• May I be free, and not

burdened by past events nor by fears of the future

• May I live with ease• May my life unfold with

ease• May I have ease of

well-being• May I awaken to my

wholeness and be free• May my actions be

skillful and kind• May I be wise and

skillful

Loving-Kindness Meditation (LKM)

• Weekly 90 minute class x 12 weeks– Creation of a manual for future classes

• 15 Veterans with PTSD• Weeks 1 and 2: Mindfulness practice• Weeks 3-12 progress through categories of beings in

order to cultivate loving-kindness• Benefactor• Self• Beloved Friend• Neutral person• Difficult person• Groups (e.g. men / women)• All beings

Observations from Teaching LKM to Veterans with PTSD

• Quotation from Class Session on Difficult Person:– “I ran into an interesting division in my dealing with a difficult

person, I have no trouble wishing them safety and health but I don't want their life to be filled with ease, some of the same thing with myself, it’s like they are two different people- I can wish myself to be healthy but hard to wish ease for myself”

– “I had a hard time doing the difficult person, yesterday I had a revelation, maybe nobody has ever told them what they did was wrong, maybe not my job to judge them but just wish love and kindness, I can only change myself, why can’t people change, I had to stop asking myself, it wasn't until the walk today- its not about the other person it’s about you….the actions of the difficult person, who is acting in ignorance? “

Observations from Teaching LKM to Veterans with PTSD

• Quotation from Class Session on Difficult Person:– “I moved someone from committed hate to committed love, a real

sense of gratitude, it washed through me when I was walking, my sister - we are totally estranged, I couldn’t get over the commitment to hate - but I got over that, a visceral feeling of relief, profound relief.”

– “I realized that… its not that my anger was growing, it’s that I was realizing how deep that anger was, curious about this, no sense of judgment, I trust that those emotions I've held back with words to not feel, to trust that those emotions are important, if I have hate buried I need to feel it, I think it’s a choice you either act out or you feel it.”

“I am larger and better than I thought. I did not think I held so much goodness.”

Walt Whitman

Thank you!