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The Art of Mindfulness: Cultivating Wellbeing
Lucia McBee, Laura Peters, Kimberly Coder
Leading Age Conference 2016 Indianapolis, IN
Session 145-C
Laura Peters, MA, PHR
Human Resources Development and Learning Manager,
Kendal at Ithaca, NY
Lucia McBee, LCSW, MPH, CYI
Author of Mindfulness-Based Elder Care, Consultant, New York City
Kimberly Coder, LSW
Social Services Director, Barclay Friends,
A Kendal Affiliate in West Chester, PA
The Art of Mindfulness: Cultivating Wellbeing
What is mindfulness? How does it work? What are the research outcomes? How can we bring it home? Practice Q & A
Agenda
60 Minutes
2015
Dr. Richie Davidson Center for Healthy Minds
U-WI Madison 2001
2014
Bill Moyers Healing and the Mind
1993
2012
2008
Dr. Jon Kabat-Zinn Mindfulness-Based
Stress Reduction 1979
Lucia McBee 2008
Paying attention on purpose
in the present moment
nonjudgmentally
--Dr. Jon Kabat-Zinn,
Founder of Mindfulness-Based Stress Reduction
What is Mindfulness?
Mindfulness Practice: 3 deep breaths
How mindfulness works:
Fight or Flight Sympathetic Nervous System
“Gas”
Rest and Digest Parasympathetic Nervous System
“Brake”
Physical:
Decrease chronic pain
Lower blood pressure
Improve sleep
Improve digestion
Strengthen resilience to stress
Boost immune system
What can mindfulness do?
Emotional:
Decrease anxiety, depression, ease grief
Strengthen impulse control:
anger management
weight loss, addictions
Enhance communication:
self-awareness, empathy, teamwork
What can mindfulness do?
Intellectual:
Improve cognitive function
Strengthen focus
Improve decision-making
What can mindfulness do?
MINDFULNESS: THE EVIDENCE
PERSONAL HISTORICAL EMPIRICAL
PERSONAL EVIDENCE: THE MIND BODY CONNECTION
THREE MINUTE BREATHING SPACE
1. Awareness: what is my experience right now?
2. Gathering: focus on the breath.
3. Expanding: including the entire body in awareness.
Segal, Williams, and Teasdale Mindfulness-Based Cognitive Therapy for Depression (2002)
MECHANISMS OF MINDFULNESS
Attention regulation
Sustaining attention, and returning
Body awareness
Physical sensations
Emotion regulation
Reappraisal (non-judging awareness)
Exposure, extinction, reconsolidation
Sense of self
Dis-identification with static sense of self
Compassion (Holzel et al. 2011)
HISTORICAL EVIDENCE
Based on Buddhist and yogic practices
Origins pre AD, approximately 2500 years
Continuously practiced and refined since origins
All major spiritual traditions include contemplative practice
MINDFULNESS: EMPIRICAL EVIDENCE
The growth in mindfulness research from1980–2015. Results from a search on the term "mindfulness" at the ISI Web of Science database.
MINDFULNESS: KEY STUDIES
Improvements in immune system and brain post MBSR group (Davidson et al, 2003)
Increase in brain’s “grey matter” (governs sensory perception such as seeing and hearing, memory, emotions,
speech, decision making, and self-control) following 8 week MBSR class (Holzel et al, 2011)
Decrease in cellular aging and disease protection: Increase in telomeres (Epel et al, 2009)
For all studies on mindfulness, visit: www.goamra.org
STOP
S- Stop what you are doing
T- Take a breath
O- Observe how you are feeling
P- Proceed with what you were doing
o Get off auto-pilot
o Bring attention to the present moment
o Build capacity to focus in an environment of information overload
o Accept ourselves and others with compassion
Mindfulness skills
1979
Jon Kabat-Zinn founds Stress Reduction Clinic
University of Massachusetts Medical Center
Mindfulness-Based Stress Reduction
1. Teaching from one’s own practice
2. Mindfulness practices:
sitting, body scan, yoga, walking
3. Education on research outcomes
4. Support Group
Mindfulness-Based Stress Reduction Class: 4 main components
Mindfulness-Based Stress Reduction
Kendal at Ithaca Mindfulness for Stress Reduction
8 weeks of 2.5 hour classes
6 weeks of 1 hour classes
45 minutes daily practice 10 minutes daily practice (gradually increasing)
Homework Handouts-voluntary
General population Tailored to older adults and their caregivers
Day-long retreat Weekly 30-minute drop-in sitting meditation
Customizing the Class
20% of community completed since 2012 (25 classes)
2/3 residents, 1/3 staff
Age range: 20s to 90s
4-12 people per class
Unassisted/cane/walker/wheelchair
Kendal at Ithaca class demographics
Gender
Men
Women
Kendal at Ithaca Stories
Mindfulness Practice: Yoga
MINDFULNESS BASED INTERVENTIONS FOR ELDERS AND CAREGIVERS: THE RESEARCH
NEED FOR NEW MODELS OF MEDICINE
Improvements in acute care decrease in death from acute illness = population living longer with 1+ chronic conditions
Treatment of chronic conditions is symptom management not cure
New models of care: palliative and CAM/integrative
PHYSICAL AND EMOTIONAL BENEFITS
Review of 15 peer-reviewed, quantitative studies support feasibility and acceptability of MBSR for older adults (Geiger et al, 2015)
Mindfulness interventions decrease:
Psychological distress (Young & Baime, 2010).
Sense of loneliness and pro-inflammatory gene expression in elders (Creswell, et al, 2012)
Lower back pain (Morone, Greco & Weiner, 2008)
Depression (Helmes & Ward, 2015)
Blood pressure (Palta et al, 2012)
COGNITIVE BENEFITS
Meta analysis of 7 studies suggest a positive effect of meditation techniques on cognitive functions in the context of aging and neurodegenerative diseases (Marciniak, et al. 2014)
Meta-analysis of 12 studies indicates meditation for older adults feasible and may prevent cognitive decline (Gard, Holzel & Lazar, 2014)
MBIs have been shown to increase telomere activity, and hold potential to thus impact cognitive decline (Sapozhnikov, 2015)
MBSR FOR ELDERS WITH MCI
MBSR and other Mindfulness Based interventions with modifications are teachable to elders with MCI (Mild Cognitive Impairment) and demonstrate:
Improved cognition, memory and wellbeing (Wells et al, 2013; Hyer, et al, 2013;
Sapozhnikov, 2015; Larouche, Hudon & Goulet, 2015)
MINDFULNESS BASED INTERVENTIONS for ELDERS WITH ALZHEIMER’S DISEASE
Large control group 2 year study compared cognitive stimulation, progressive relaxation and mindfulness interventions for elders with probable AD (Canary Islands)
Participants in groups with mindfulness remained stable in cognition, functionality and behavioral problems
Participants in 2 control groups declined in these areas (Hernández et al, 2014; Hernández & Barrachina, 2015).
MINDFULNESS GROUPS FOR
INSTITUTIONALIZED ELDERS
Elders who completed MBSR showed improvements in mood and health related quality of life (60% drop out, homework not feasible) (Ernst et al, 2008)
MBEC participants show improved quality of life and trends towards improved pain CDs and homework not feasible
Attendance irregular
Ongoing group more successful than time limited group (McBee et al, 2004)
QUOTES
“Makes me feel at peace with the world. It helps my whole body and spirit. I forgot all my troubles.”
“I’ve always liked this [group] since I started.. being quiet, relaxed.. a special feeling.”
“I feel more alive in spite of the pain”
“I feel uplifted. I realize we all have pain. We talk about how we are getting along. It is important to be with other people.”
(McBee, 2008)
STOP
S- Stop what you are doing
T- Take a breath
O- Observe how you are feeling
P- Proceed with what you were doing
Mindfulness Based Elder Care: OVERVIEW
Connect- with each person, regardless of disability or impairment
Communicate- create novel, non verbal ways of communication
Care for the caregivers- bringing stress reduction skills to all persons engaged with elders
MBEC APPLICATIONS FOR ELDERS
• Groups for nursing home residents with physical and cognitive disabilities
• Groups for elders with moderate-severe dementia and behavioral problems
• 1:1 with isolated elders • MBEC by telephone
TEACHING ADAPTATIONS
Shorter groups
Simplified language
Increased repetition
Imagery simplified with use of key words
Stretches, meditations and other exercises modified for elders
Verbal, visual and physical cuing
ENVIRONMENTAL ADAPTATIONS
Creating a calming milieu
Aromatherapy
Music
The most important factor is the teacher
A calm demeanor
Flexibility
Acceptance
TEACHING MEDITATION TO FRAIL ELDERS
Shorter practice time
More directive, less quiet time
Repetition
Concrete language
Consider tone of voice
Use visual cues
YOGA
Meditation in movement
Learning to listen to our body
Breathwork is also yoga
Working with abilities not disabilities
Exploring our limits (edges)
Becoming stronger, more flexible and more balanced
ADAPTING YOGA FOR
FRAIL ELDERS
Postures can be adapted for wheel chair or bedbound Demonstrate visually Give hands on guidance Remind elders to breath Focus on what elders can do!
ADAPTING YOGA
For caregivers Postures can be integrated into daily life Standing and seated mountain pose Diaphragmatic breathing
For both elders and caregivers Teach a reconnection with the body Be positive and have fun
DIAPRAGMATIC BREATHING
STOP
S- Stop what you are doing
T- Take a breath
O- Observe how you are feeling
P- Proceed with what you were doing
CARING FOR THE CAREGIVERS
• Emphasize importance of stress reduction
• For physical and mental health
• For communications with care receiver
• Consider short meditations and those that can be integrated into a busy life
• Integrate meditation that can be used while caregiving
MBEC FOR CAREGIVERS
Staff stress reduction offerings One, one hour in-service for entire staff Seven session class for interdisciplinary
staff on two units Wellness coordinator offering stress reduction
Family and friend caregivers
Nursing home residents and caregivers together
QUOTES FROM STAFF
“The deep breathing was so soul searching and relaxing. It makes me more aware of myself.”
“I appreciate taking the time during the day when it’s stressful, to learn ways to come back to a state of equilibrium.”
“I know how to control myself when I feel nervous and angry.”
“I am pretty flexible for my age. I like myself.”
TREVISO (Italy) ELDER CARE MODEL (ISRAA) AN INTEGRATIVE APPROACH TO ELDER CARE
850 residents, 4 facilities, 27 care units, 2 day care centers, 1 Specialized Dementia Centre, 32 independent living flats 690 staff, Budget 30 million € MODELED ON: Person Centered Care (Kitwood)
Alzheimer Cafè (B. Miesen)
Ambiguous Loss (P. Boss)
Mindfulness-based elder care (McBee)
Mindful Ageing, Family Systemic Model, Age friendly community (World Health Organization)
The most important intervention we can bring to our elders is our selves-
who we are in each moment. - McBee
How to Bring Mindfulness to Your Communities:
A Beginner’s Perspective
The Start of Mindfulness at Barclay Friends, Kendal Affiliate
• Wellness Committee for Staff - Weight Loss Group and Guided imagery - Roving Meditation In-services
(5-10 minutes) • Compassion Fatigue and Self-
Care In-Services - Education: Symptoms and
Prevention - Self-reflection of current and
desired lifestyles - Mindfulness Practices
Modified Mindfulness Practices and Tools for Direct Care Staff
5-10 minute guided meditation
Deep breathing exercises
Mindful eating exercises
Use of reflection to set intentions
Creating a Maintenance Self-Care Plan: Assessing mind, body, emotions, and spirit
Informal visualization of “happy place” for stressful times
From Informal Practice to Formal Mindfulness Meditation Groups
• Support from your Executive Director and Wellness Program
• Determine who will facilitate the groups
• Facilitator training and daily practice
• Determine who will be included: staff, residents, and/or family members
Qualifications and Training
Mindfulness-Based Stress Reduction (MBSR): 8 Week courses which were originated by Jon Kabat-Zinn at the University of Massachusetts
Certification Programs: Durations vary although many are one year training programs
MBSR and certification programs are typically offered at universities and hospital systems
Local meditation and yoga centers
Barriers and Feedback
“Too much noise:” Choose your setting wisely.
“Too busy:” Consider the duration of your group.
“You’re going there?” Expect some judgment from others.
Let’s Pause for a short
guided meditation
1) Notice the sensation of breath
2) When your mind wanders, bring your attention back to your breath
Resident-Centered Groups: Structure and Plan
Consider varying degrees of cognitive ability
Consider location of group(s) offered and accessibility for your residents
Will you offer different
groups for different levels of care or offer inclusive groups?
Resident Groups at Barclay Friends
Monthly groups are offered in both our skilled nursing and personal care communities
Residents from either community may decide to attend both groups
Group times/locations are announced on both recreation calendars
Guided Imagery with Sensory Components
Benefits to Residents
Fosters a sense of community and belonging
Cultivates a feeling of security and safety
Greater acceptance of aging
Stress management Pain management Connection to higher
power and spirituality Reminiscing and
reflection
Put on your own oxygen mask first!
While stress is contagious, a relaxed attitude is also
contagious.
You can be a powerful source of change just by
taking steps to reduce your stress!
Lucia McBee, Consultant, Author of Mindfulness-Based Elder Care
[email protected] Laura Peters, Human Resources Development and Learning Manager, Kendal at Ithaca [email protected] 607.266.5360 Kimberly Coder, Social Services Director, Barclay Friends, A Kendal Affiliate [email protected] 610.918.3437
Contact information
Appendix
Improve assessment skills Reduce errors when administering complex procedures Improve listening skills Enhance communication through higher level of empathy,
self-awareness, and non-reactivity Increase resilience to stress Source: American Nurse Today, Sept. 2015 https://americannursetoday.com/mindful-nurse/
Benefits for Nursing Staff
13,000 employees (25%) 2011 to date completed free meditation/yoga classes at Aetna
Stress level: 28% reduction
Sleep quality and pain: 20% improvement
Reduced rates of heart rate variability and cortisol (markers of stress) validated self-reports
Efficiency gain: 62 min./week
$3,000/employee/year
2012: health care costs dropped 7% (11:1 ROI)
Aetna Mindfulness Class Outcomes
Mark McLellan, Director of the Robert J. Margolis Center for Health Policy and Margolis Professor of Business, Medicine and Health Policy Duke University 2015 Leading Age Conference Presentation Health care financial reform to “align payments with value at the person level” Innovation toward “personalized, prevention-oriented” care
Health care funding implications
Steve Jobs Bill Ford Google “Search Inside Yourself,” Leadership Institute (SILYI) General Mills Institute for Mindful Leadership: Janice Marturano clients include Centers for Disease Control, Mayo Clinic BlackRock Financial Services Aetna
U.S. Marines “M-Fit” (Mindfulness-Based Mind Fitness Training) U.S. Olympic Rowing Team, Seattle Seahawks, Boston Celtics UCSF Law students-Prof. Rhonda Magee
Meditators
When you’re mindful, you’re aware of your presence and the ways you impact other people….And that prevents you from slipping into a life that pulls you away from your values. Bill George, Harvard Business School professor
