Mindfulness: How can it help my

patients? How can it help me?

Dr Katie Amiel

What is mindfulness?

• Paying attention

• On purpose

• In the present moment

• With qualities such as compassion,

curiosity and acceptance.

Making a shift

• Living in the past/ future living in the

present

• Moving from autopilot and habitual thought

patterns awareness

• Creating a space around our experience

so we can respond rather than just react

on autopilot.

Sati

– Awareness

– Attention

– Remembering

Coming back to your senses

Cultivating mindfulness

• Formal • meditation (sitting, walking, in movement)

• Informal • Remembering to back to present moment

whenever we notice we have drifted onto automatic pilot, into past or future.

• Bringing mindfulness to everyday activities

• Using natural pauses/ opportunities to bring attention to breath eg traffic lights, computer, phone, queues.

From Monastery to Mainstream

Mindfulness Based Stress

Reduction (MBSR)

Mindfulness Based Stress

Reduction (MBSR)• Jon Kabat-Zinn

• University of Massachusetts Medical Centre

• secular programme run in the hospital

• 30 patients

• participants learnt the practice of mindfulness meditation

through a course of classes held weekly for an 8-week

period

• included daily mindfulness practice supported by tapes

of guided meditations

Evidence for MBSR

Significant positive effect sizes

• chronic pain,

• fibromyalgia,

• multiple sclerosis,

• generalised anxiety disorder and panic,

• psoriasis,

• cancer

• health care provider self care.

Baer et al 2003; Kramer et al 2012, Shapiro et al.

Neuroplasticity

• London taxi drivers- larger hippocampus –associated with spatial processing and memory and this is more noticeable the longer they have been doing the job.

• String musicians have differences in brain in areas relating to fine motor movement.

• Juggling study - significant increases in grey matter in areas important for detecting visual motion.

Meditation and the Brain

Meditation and the Brain

• Hippocampus – learning, memory and emotion regulation.

• Tempo-parietal junction - perspective taking, empathy and compassion.

• Amygdala: decrease in grey matter –correlated closely with the measured and self-reported level of stress reduction.

• Shift in activity from right prefrontal cortex to left.

Developing MBCT for

Depression

Mindfulness Based Cognitive

Therapy (MBCT)

• Very similar to 8 week MBSR

• also includes

– basic education about depression

– number of exercises derived from cognitive

therapy that demonstrate the links between

thinking and feeling

– how participants can care for themselves,

especially when they notice a downturn in

their mood.

Research

• NICE guideline depression - recommends MBCT for people who are currently well but have experienced three or more episodes.

• 44% reduction in depressive relapse risk compared with usual care

• in head-to-head comparisons with antidepressants, MBCT at least as effective as staying on a maintenance dose of anti-depressants in terms of relapse prevention.

(Williams et al 2000 & 2004; Piet et al 2009- meta-analysis; Geschwind et al 2012 Br J Psychiatry; Kuyken et al 2008; Kenny et al 2007)

MBCT – other applications

Theory development and treatment research

has extended to:

Suicidality

health anxiety

chronic fatigue,

current depression

bipolar disorder,

Childbirth and parenting

Addiction- MBRP

MB-EAT - binge eating disorder

Finding Peace in a Frantic

World

Burnout

• BMJ 2012

• 564 GPs

– 46% - emotional

exhaustion

– 42% - negative and cynical

attitudes towards their

patients

– 34% - reduced sense of

personal accomplishment

in their work with patients.

• “Whatever the reasons, a

significant group of

doctors is in trouble.”

Mindfulness and health

professionals

• Decreased burnout and emotional

exhaustion

• Decrease in rumination, anxiety and

negative affect

• Decrease in perceived stress and anxiety

• Positive changes in mood, life satisfaction,

self-compassion and empathy

• Increase in patient centred behaviours(Krasner et al 2009 JAMA, Irving et al 2009, Shapiro et al 2005, Goodman et al 2012 Int J Psychiatry,

Fortney et al 2013 Ann Fam Med)

MBCT

• does not try to change the content of negative thinking (unlike CT).

• change relationship to thoughts, feelings and body sensations discover that these are fleeting events in the mind and the body that they can choose to engage with – or not.

• participants to realise that their thoughts, emotions and sensations are just thoughts, emotions and sensations, rather than ‘truth’ or ‘me’.

• break the old associations between negative mood, thinking, behaviour and bodily sensations.

Thoughts are not facts!

• It is remarkable how liberating it feels to be able to see that your thoughts are just thoughts and that they are not ‘you’ or ‘reality’

• The simple act of recognising your thoughts as thoughts can free you from the distorted reality they often create and allow for more clear-sightedness and a greater sense of manageability in your life

Jon Kabat-Zinn

Changing Relationship to

Thoughts

• Being able to achieve space between me and my thoughts, put

things in perspective, and reflect on my thoughts, emotions and

responses to situations.

• A new ability to ‘see’ my thoughts rather than being immersed in

them, and respond to them in a more constructive way.

• Living less in my negative thoughts and being able to recognise that

these thoughts are not reality and do not define me. I can now

choose not to get sucked into them.

Standing behind the waterfall

• see more clearly the patterns of the mind without adding to the problems by falling into analysis and rumination

• develop the capacity to allow distressing emotions, thoughts and sensations to come and go, without feeling that they have to suppress them, run away from them or fight them.

Turning towards difficulty

• ‘Too often, driven largely by time, training

and uncertainty, health professionals lose

sight of or turn away from the deeper issue

of engaging in the intimacy of suffering –

our own, and that of those who seek our

care’

Saki Santorelli ‘Heal Thyself’

Turning towards difficulty

• I learnt there are ways to live with difficult sensations and emotions

in myself that involve exploring and staying with difficulties rather

than avoiding them.

• Before I would have reacted by trying to escape/ run away in some

way but now I am starting to face things more and respond more

wisely.

• I learnt new approaches to difficult, complex and demanding

situations that avoid them being additionally stressful.

• It has transformed my relationship with my chronic pain.

Turning towards Difficulty

• I learnt ways of relating differently to patients in distress.

• I realised the value of mindfully listening, noticing and

witnessing suffering, rather than my automatic reaction

to jump in and try and ‘fix’ it.

• In coming closer to and getting to grips with difficult

emotions, I am less inclined to flee from difficult

emotional patient encounters and am better able to

engage with the patient.

Patient-Centred Care &

Compassion • The ability to increasingly focus on the patient in front of me and their

concerns rather than worrying about the patients I’ve just seen, or thinking

there are 10 more patients still to see!

• I am more able to be present in the consultation and really engage with

patients rather than be constantly anxious about what tasks I need to

complete.

• I am more compassionate to both myself and my patients.

• The course made me realise I was in a position to lead on compassion and

mindfulness in my [hospital] department and that this was achievable.

Resilience at Work

• The distinction between doing vs being has helped me to feel less stressed

and overwhelmed by work. Sunday nights are now much more pleasant!

• I was becoming very stressed and angry at work. A colleague remarked she

had noticed how much less angry I get! I feel calmer, more compassionate

and that hopefully means I’m a better doctor.

• Significantly increased my ability to manage stressful situations, recognise

my reactions and choose to respond differently.

• Increased ability to recognise my body’s signs of increased stress levels.

• My enjoyment of work has increased.

Marie Asberg – Exhaustion

Funnel

Mindfulness and Self-Care

• Thinking about what nourishes me and how I had

dropped these – I’m now making an effort to build these

back into my life and take better care of myself.

• I am much better at maintaining life balance by keeping

up the nourishing aspects of life when work particularly is

depleting me.

• I’m actively increasing the nourishing times in my work

day eg having lunch with colleagues.

Mindfulness and Appreciation

Mindfulness and Appreciation

• Noticing an improved awareness and sense of gratitude in the simple

pleasures in life eg cycling to work, has really changed my perspective on

life.

• I’m more able to appreciate each moment rather than dwelling on the past/

fearing the future.

• Much more aware of enjoying and appreciating time with the important

people in my life and truly ‘being’ with them. This has really strengthened

my relationships.

• I am living in the present and enjoying and appreciating it more.

Peer Support

Peer Support

It was great to have the opportunity to do this course with other doctors, taught by a

doctor and in a medical context.

it was so helpful to talk openly with other doctors from different specialities and at

different levels in their career in a safe and kind environment…I’ve never been able to

do that before!

Realising I’m not alone with these problems and that other doctors suffer too! I learnt

that the problems I’ve faced at work are universal and that they are not

insurmountable.

Learning from others’ experiences – work related or personal was extremely helpful

Being able to tell colleagues about my illness and overcoming the stigma in my own

mind.

• I found the shared experiences, the meditations and the group

support extremely beneficial to my day to day functioning and to my

mental health. The course has changed my life.

• A huge and lasting impact on my personal and professional life.

• It feels like this should be built into our training and our careers.

• Lots more doctors should do this, to benefit not just themselves but

their patients.

• This is so needed in the NHS at the moment!

‘I increasingly feel I am living

rather than just exisiting.’