cultivating reverence for living: mindfulness practices ...jack kornfield, a path with heart after...
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Cultivating Reverence for Living: Mindfulness Practices for Caregivers, Providers, and Patients
Bob Vahary, LCSW, OSW-C
“Sometimes the most important thing in a whole day is the rest we take between two deep breaths.”
Etty Hillesum
“Mindfulness is paying attention in a particular way:
on purpose, in the present moment, and non-
judgmentally”
Jon Kabat-Zinn
Paying attention in a particular way; Observer
Controlling attention not what we think
Present moment
Mental noting
Nonjudgmental and Accepting
Non-striving
It Is and Takes Practice;
Double duty:
Quality we all possess
Practices that enhance
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Better understand how Mindfulness can help with
compassion fatigue, errors, emotions, energy and promote
work life engagement.
Introduce mindful concepts and tools for patient care.
Increase clarity in our provision of care; what works?
Story of CRL In September of 2002 St Vincent launched a Mindfulness Based Stress Reduction
Program called "Cultivating Reverence for Living". It is a six-week program
where St Vincent staff and volunteers spend two hours per week learning spiritual,
physical and emotional practices. Initial research indicates its efficacy for reducing
stress; however its impact on the culture of cancer patient care is remarkable.
Innovation grant
Formative Spirituality Component, Formation field
Program for associates and volunteers
50 6 week classes from 2002 to present
13 years of data , SWB, State Trait Anxiety
State trait Anxiety Perceived Stress Scale
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Pre Test Post Test
State-Trait Anxiety Inventory
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Pre Test Post Test
Perceived Stress Scale
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“Cultivating Reverence for Living Program” offered to all
providers including leadership, physicians, hospice, pastoral care,
social work, nursing, pharmacy, information systems, housekeeping
and volunteers.
Integrative medicine team efforts: Hand Massage, aroma therapy.
Survivorship programs: Art, Yoga, Meditative practices.
“Calming the Mind, Calming the Body” CD available to all cancer patients; MP3 available on www.ourfightagainstcancer.com
Counseling involves mindful principals to help processing of emotions through self soothing practices, emotional regulation, present moment awareness, mental noting, non judgmental observation, and loving kindness practice.
Centering Meditative Practices
Relaxation menu on Skylight educational network include “Calming the Mind, Calming the Body” for inpatient and infusion.
“My first experience with mindfulness was attending the "Cultivating Reverence for Living: A
Stress Reduction Program". I was not sure what this was about and if this program was of any
value for our cancer patients or our care givers. Through the six week sessions we learned about
Mindful Living, Mental Noting, Emotions Regulation, Distress Tolerance, Interpersonal
Effectiveness Skills and Loving Kindness Meditation. Each session taught me how to intentionally
connect with my feelings and using relaxation, meditation and "being Present" how to reduce
stress and show calm and peace dealing with stressful situations. I started using some of the skills
we learned during our leadership team meetings and encouraged others to attend this program.
In addition to the emotional and physical stress our cancer care caregivers go through they are also
experiencing the immense changes in healthcare delivery with limited resources. Mindfulness has
been an amazing way for all of us to cope with all these challenges and keep our focus on caring
for our patients." Fuad Hammoudeh, FACHE, Executive Director, Cancer Care
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“The Cultivating Reverence for Living experience has
assisted me both personally and professionally. I have a
greater awareness of self through the meditative practice
which has translated into increased empathy,
compassion, and more mindful intentional counseling
when assisting cancer patients. This experience is both
rewarding and fulfilling as a therapist which leads to a
clearer and non-judgmental counseling sessions.” –
Jennifer M. Smith, MSW, LCSW, OSW-C, Patient
Navigator
1. Self soothe
2. Self define
3. Transform
Bell is sounding
Half smiling
Movement
Body scan
Centering meditation
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Observing
Acceptance
Mental Noting
Appreciation
Is it helping?
Clarity unties the knots, even those that become very tight
"Childlikeness has to be restored with long years
of training in the art of
self-forgetfulness.“
D. T. Suzuki
"My nature is subdued by what it works in, like
the dyers hand."
William Shakespeare
Reduces vulnerability to emotions
Balance between expression and suppression
Breathe with worry, anger etc..
Practice mindfulness “Watch your temper”
Knowing, not showing anger
What do you have power over?
Not jumping over but engaging experience
Mindfulness: What and How skills
Distress tolerance Half smiling Awareness Exercises Radical acceptance
Emotional regulation Working with fear and anger
Interpersonal Effectiveness Effective anger communication
Dialectal Behavior Therapy ; Marsha Linehan
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Centering Meditation
Prayer
Body Scan
Yoga
Tai Chi
Qi Gong
Breathing Practices
Eating
Driving
Mindfulness
Half Smiling Practice
Exercise
They are good at getting our attention
They have thoughts and emotions attached
Some things can become habits like worry and anger
Put energy where there is power
House guest, be friendly but don’t let it have the run of the house.
More right with us than wrong
Be friendly to them
Creating space
Smile at your habit energy
Emotions are like weather
“Anger arises, naturally , to signal disturbing situations that might require action. But actions
initiated in anger perpetuate suffering”
Thich Nhat Hahn
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Directing Awarness
Contrasting awareness
Meditation
attention
intention Meditation has two essential forms:
“familiarizing” or analytical
“settling” or focused
Calm Alertness
Word or Phrase
Gaze
Sound
Mindful words or phrases
Centering prayer
Practice 1st thing in the morning, doing routine tasks or when thinking of something (or someone) that distresses you
"Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy." Thich Nhat Hahn
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Breathing in, I know I’m breathing in; breathing out, I know I am breathing out
Breathing in, I calm my body; breathing out, I smile
Breathing in, my breath goes deep; breathing out, my breath goes slow.
Breathing in, I dwell in the present moment; breathing out, I know it is a wonderful moment.
From The Blooming of a Lotus by Thich Nhat Hanh
CBT, counseling
Resistance
Pain management
Emotions
Helps with Symptom management
Helps mediate perceptions taste, dyspnea
Meaning and purpose
Stress reduction
Tool for healthy lifestyle choices
Tool for habit change
Helps clarify and support healthy relationships
Teaches appreciation for life
Problem Solving Tool
Empowering Device
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Reducing compassion fatigue, (beginners mind)
Work life engagement
Evidenced based practice
“Mindful practitioners attend in a nonjudgmental way to their own physical and mental processes during ordinary and everyday tasks. This critical self reflection enables physicians to listen attentively to patients, make evidence based decisions, clarify their values so they can act with compassion, technical competence, presence and insight” JAMA
Carlson, L. and Garland, S. 2005. Impact of mindfulness-based stress reduction on sleep, mood, stress and fatigue symptoms in cancer outpatients. International Journal of Behavioral Medicine, 12: 278–285. 11.
Carlson, L., Speca, M., Patel, K. and Goodey, E. 2003. Mindfulness based stress reduction in relation to quality of life, mood symptoms of stress and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine, 65: 571–581.
Epstein, R., 1999. Mindful Practice. JAMA,282:833-839.
Kabat-Zinn, J. 1990. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness, New York, NY: Dell.
http://www.fammed.wisc.edu/mindfulness http://www.urmc.rochester.edu/family-medicine/mindful-practice.aspxredir=www.mindfulpractice.urmc.eduhttp://www.mskcc.org/cancer-care/survivorship/videos-survivors
Austin, Miriam, Yoga for Wimps. (see also: www.yogaforwimps.com)
Boorstein Ven. Henepola Gunartana, Mindfulness In Plain English
Hanh, Thich Nhat The Miracle of Mindfulness
Peace is Every Step
Living Buddha, Living Christ
Touching Peace
Jon Kabat-Zinn, Full Catastrophe Living
Wherever You Go, There You Are
Jack Kornfield, A Path with Heart
After the Ecstasy, the Laundry
Keating, Thomas Open Mind, Open Heart
Smith, Jean, ed., Breath Sweeps Mind: A First Guide to Meditation Practice
Strand, Clark, The Wooden Bowl
Tolle, Eckhart, The Power of Now