nosm - may we please request that you sit beside and pair off … · 2019-03-19 · brief...
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May we please request that you sit beside and pair off with someone that you are less familiar with
Thank you!
Remaining Vital: Thriving in a challenging environmentTrevor Bon MD, FRCPC
Catharine Tombs, PT
Northern Constellations 2018
Disclosures
Trevor Bon:
I have no financial, academic or other competing interests
Catharine Tombs:
I have no financial, academic or other competing interests.
Safe Space Guidelines:
Exercises may be new and provoke some discomfort Beginner’s Mind- you’re not here to impress just be
you, allow yourself to explore Confidentiality Make “I” statements Inside voices out, outside voices in Respect differences If you can- turn off and put weapons of mass
distraction out of sight
Who is in room?
Physician’s ?Residents ?Health care
Practitioners?Others?
Exposure to mindfulness ?
Casual practitioners?
Dedicated practitioners?
Inspiration…
Participation in local Mindfulness-based Cognitive Therapy Program
Participation in Mindfulness-based Self-Compassion Workshop
Ongoing engagement with meditation and mindfulness practices
Participation in 2 day ‘Search Inside Yourself Leadership Institute’ Mindfulness-Based Emotional Intelligence for Leaders Training
We are not experts!
Outline:
Why Mindfulness in Medicine?
Literature on Mindfulness in Medicine
Neuroscience
Mindfulness Practices
Discussion & Reflection
Mindfulness Exercise:3 Minute Breathing SpacePURPOSE: Calms the mind and body when feeling ‘activated’ Allows focus on what’s most important now Settles the mind and ‘change gears’ or ‘clear the slate’ Regulates the nervous system- Neurological ‘reset’ Increases vagal tone
Micro practice: 3 Mindful Breaths Useful way to recognize transitions in the day
Mindfulness Exercise:3 Minute Breathing Space-Reflection
What effect did this have on you?
Do you use this practice now? When?
If not, how do you think this could be useful to you? When?
Embodied Mindfulness(Formal/Informal Practices)
Self-awarenessEmotional Intelligence
Focussed AttentionNervous System Regulation
Personal ResilienceCompassion
The Stressors: Busy, face-paced Attentional challenges ENVIRONMENT
Aging, medically-complex Emotional challengessuffering PATIENTS Compassion challenges
CULTURE of bravado and Emotional suppressionSelf-critical attitude
High-achieving, Self-Care & Self-Compassion perfectionistic challengesSelf-sacrificingMINDSET
Fear of showing weakness or Authenticity challengesvulnerability, denial of burnout Mental health challenges
Physician Burnout: “Erosion of the soul” Emotional exhaustion, depersonalization, and low sense of personal
accomplishment
29% of physicians, 38% residents
Depression (% screening positive): 33% physicians, 49% residents
Completed suicide rates are 1.4-2.3 X Canadian general population
300 doctors on disability out of 17 000 insured by OMA group disability, number one cause mental health
CMA , National Physician Health Survey, 2017, Simon C, McFadden, T
Maslach C, Jackson S, Leiter M: Maslach Burnout Inventory Manual, 3rd ed. Palo Alto, Calif, Consulting Psychologists Press, 1996
Maslach’s burnout scale: https://www.mindtools.com/pages/article/newTCS_08.htm
Ripple Effects of Burnout
SYSTEMIC IMPACT
Potential for increased medical errors
Impact on patient care
Patient satisfaction
Patient recovery times
Impact on health system
PERSONAL IMPACT
Relationship difficulties
Substance use
Suicidal ideation
Increase in divorce rates
Mental health disorders
Burned Out Resilient
1 2 3 4 5 6 7 8 9 10
Withdrawn Present
Defeated Bouncing back
Going through the motions Fully engaged
Rigid Bending, not breaking
Cynical, hopeless Capacity for positivity
Hypercritical A light touch
Feeling ineffective Becoming stronger
Treading water Moving forward
Fearing change Welcoming change
Source: Attending: Medicine, Mindfulness and Humanity
Ronald Epstein, M.D.
Mindfulness Exercise:Self-Care ‘Check-In’
PURPOSE:
Barometer of how you are doing
Way to develop self-awareness through tuning in to the body
Develops sense of impermanence of thoughts/emotions
Awareness of what your mind is practising
Micro practice: Head-Body-Heart Check in
1st breath HEAD- What are my thoughts?
2nd breath BODY- What emotions & intuitions are present?
3rd breath HEART- What are my values & intentions?
Mindfulness Exercise:Self-Care ‘Check-In’- Reflection
What did you discover? Any surprises?
Do you think this could be useful to you? When?
Know thyself
“Your beliefs become your thoughtsYour thoughts become your wordsYour words become your actionsYour actions become your habitsYour habits become your characterYour character becomes your destiny”
Mahatma Gandhi
WELLNESS STRATEGIES:
STRESS RESILIENCE
Resilience Factors
Realistic Optimism
Facing fear
Moral compass
Religion & spirituality
Social Support
Role Models
Physical fitness
Brain Fitness
Cognitive & emotional flexibility
Sense of meaning & purpose
S.M. Southwick and D.S. Charney, Resilience: The Science of Mastering Life’s Greatest Challenges (Cambridge: Cambridge University Press, 2012
Mindfulness Moment-by-moment awareness of sensations, perceptions,
emotions and thoughts
Paying attention with curiosity and without judgement
Helps us relate to ourselves and others with compassion
Allows individuals to choose what they’ll strengthen and bring into action and what they’ll let go of
Greater sense of agency and control
Discernment of self vs. other’s emotions
Video: Mindfulness is a super power
https://www.youtube.com/watch?v=w6T02g5hnT4
Embodied Mindfulness(Formal/Informal Practices)
Self-awarenessEmotional Intelligence
Focussed AttentionNervous System Regulation
Personal ResilienceCompassion
The graph above represents the number of peer-reviewed publications as referenced by PubMed (through 2014). PubMed is a division of the US National Library of Medicine and the National Institute of Health. contemplativemind.wordpress.com
The graph above represents the number of grants awarded by the NIH through 2014 based on the RePORTER database. RePORTER indexes data and analyses of NIH research activities. contemplativemind.wordpress.com
Mindfulness Exercise:Mindful listening: Dyad Practice
Exercise Guidelines:Split into pairs
Sit across from one another facing each other with nothing between you
A talks, B listens without interrupting
Switch roles
Exercise Questions:1. What do you love about your work?
2. What challenges are you facing in your work?
Mindfulness Exercise:Dyad Practice
Debrief Questions:
1. How did you feel in each role?
2. Which role was more comfortable for you? Why?
3. What would it be like not to go into your ‘knee jerk’ reactions in dialogues?
4. How might your reflections on this exercise serve you in your work?
Embodied Mindfulness(Formal/Informal Practices)
Self-awarenessEmotional Intelligence
Focussed AttentionNervous System Regulation
Personal ResilienceCompassion
Developing ResilienceSelf-Compassion Practice
Bring to mind a recent difficult experience you encountered or a failure you experienced.
What happened? Who was involved?
How did you feel? How did you treat yourself?
Developing ResilienceSelf-Compassion Practice- Reflection
Discuss with a partner
How does the idea of self-compassion feel to you cognitively How did the practice feel in your body?
Is self-compassion something that is challenging for you? Why?
How can you be a better friend or ally to yourself in times of challenge?
Self-Compassion
Instead of mercilessly judging and criticizing
yourself for various inadequacies or shortcomings,
self-compassion means you are kind and understanding
when confronted with personal failings –
after all, who ever said you were supposed
to be perfect?
Kristin Neff
Self-compassion.org
Compassion
From the Latin word compati meaning to ‘suffer with’
Components:
1. Cognitive = “I understand you” RELATE
2. Affective = “I feel with you” RESONATE
3. Motivational = “I want to help you” ACT
Compassion is a trainable skill
Hippocratic Oath
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
Principles of beneficence and non-maleficence not only in the care of patients, but also for ourselves
“If your compassion does not include yourself, it is incomplete.”
—Jack Kornfield
Why is compassion important?
Improves health and well-being in relationships Increases resilience in the face of suffering Helps prevent empathy (compassion) fatigue and vicarious
trauma Protective against loneliness and stress Reinforces motivation and values behind desire to become
a healer Improves patient outcomes
“Compassion is the heart of healthcare” - Pope Francis
Just Like Me
Human beings are ‘tribal’
Identification with people we see as ‘self’
Separation from those we see as ‘other’
Inability to see self in other = disconnection
Degrading of compassion
Developing ResilienceCompassion for others practice: Just Like Me
Bring to mind a recent interaction you had with someone difficult
What was the situation? Who was involved? How did you feel?
What did you assume in this situation about this person that was perhaps not true?
Developing ResilienceCompassion for others practice: Reflection
Talk with a partner
Was there a shift in your feeling toward this person during this exercise?
What changed? Was there any shift in the felt sense in your body while
doing this exercise?
How might you use this practice?
Brief Mindfulness Practices in Healthcare workers
Studies looking at effect of brief mindfulness interventions on provider well-being and behaviour
Studies found positive effect on levels of stress, anxiety, mindfulness, resiliency, and burnout symptoms
No studies reported differences in provider behaviour
Interventions: sitting meditation, breathing exercises, guided imagery, relaxation methods, yoga, or desensitization-relaxation in person or through virtual modalities
Brief Mindfulness Practices for Healthcare Providers – A Systematic Literature Review, The American Journal of Medicine, (2017) 130, 1219.e1-1219.e17
Mindfulness as measured by Electroencephalogram
Does mindfulness meditation work 56 studies (out of 284), 1715 subjects, looking for commonality on EEGs during
meditation
Study types: mindfulness compared to resting state and effects of mindfulness practice on EEG over time
Main finding: increased in alpha wave synchronization with mindfulness relative to a resting state and increased theta power during meditation compared to a resting state
Results were variable across studies
Alpha waves synchronization associated with greater ‘inner directed’ attention
Inner directed attention associated with better memory, imagination, improvement in attention networks in terms of focused-attention aspects and awareness in terms of its open-monitoring aspects
Variables – control vs experimental condition, participants (novice vs expert), clinical vs non-clinical, outcomes by bandwidth (alpha, beta, theta, delta and gamma), hemispheric asymmetry and event-related potential outcomes
A systematic review of the neurophysiology of mindfulness on EEG oscillations, Neuroscience and Biobehvioral Reviews 57 (2015) 401-410
fMRI Evidence for Mindfulness
Review of MRI studies involving mindfulness that enhance understanding of the neural processes associated with mindfulness meditation
Great variability in methods and populations studied do not allow for firm conclusions
Convincing evidence that mindfulness is associated with brain activation and/or connectivity of a number of regions:
Frontal cortex: lateral FC, Ventrolateral FC, Dorsolateral FC, Medial FC, Medial FC, Orbitofrontal cortex, Posterior medial cortex, Insula, Temporal Cortex, Temporoparietal junction, Sensorimotor cortex, Inferior parietal lobule, Parahippocampal gyrus. Amygdala, Basal Ganglia, Thalamus
Automatic thoughts associated with depression and anxiety and associated with the DMN, objective awareness of automatic thoughts (mindfulness) is a primary mechanism by which mindfulness decreases symptoms of depression, anxiety and stress
Neural mechanisms of mindfulness and meditation: Evidence from neuroimaging studies, World Journal of Radiology, 2014 July 28; 6(7): 471-479
Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia, J Neurosci., November 18, 2015 – 35(46)
Thank you for your mindful
attention!
Resources: Apple’s favourite app of 2017
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