Rev. Mia Baumgartner MDiv, MNPL, BCC

UWMC Spiritual Care Manager

Rev. Michelle Todd MDiv, BCC

SCCA Spiritual Health Clinician

Resilience and Self Compassion

Self-Compassion &

Resilience

Joy Purpose

Self- Compassion

Grief

STS & Moral Distress

Care Plan

Compassion Satisfaction

& Social Cohesion

What brings you joy and meaning at work?

• Resiliency Practice: Reconnect with purpose, mission

Resilience

“the capacity to prepare for, recover from and adapt in the face of stress, challenge or adversity” -HeartMath Institute

“giving ourselves the same kindness and care we’d give to a good friend” –Kristin Neff

Self Compassion & Resilience • Sustains self-care practices • Soothes the inner critic/negative bias • Decrease burnout and exhaustion • Decrease anxiousness and depression • Increase expression of compassion to others • Increase in the ability to forgive •Mediates symptom severity of PTSD* *Hirakoa et al, Self-Compassion as a Prospective Predictor of PTSD Symptom Severity Among Trauma-Exposed U.S. Iraq and Afghanistan War Veterans, J Trauma Stress. 2015 April; 28(2): 127–133 All other references are from published articles of Kristin Neff, PhD, self-compassion.org

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Self Compassion Assessment take a look

Mindfulness Over-identification

Common Humanity Isolation

Self-Kindness Self Judgment

Kristin Neff, PhD, Self Compassion Scale www.self-compassion.org

Mindfulness

When something painful happens I try to take a balanced view of the situation. (3)

Over-identification When I’m feeling down I tend to obsess and fixate on everything that’s wrong.(9)

Common Humanity I try to see my failings as part of the human condition (5)

Isolation

When I fail at something that’s important to me, I tend to feel alone in my failure (8)

Self Kindness I try to be understanding and patient towards those aspects of my personality I don’t like. (2)

Self Judgment

I’m disapproving and judgmental about my own flaws and inadequacies. (11)

Influencing Our Inner Dialogue Exercise: Befriending our Self-Critical Talk

Befriending our Self-Critical Talk

• Recognize • Acknowledge • Investigate • Nourish yourself

• RAIN framework is from Tara Brach’s work. Speaking to one’s self-critical voice is from

Kristen Neff/Chris Germer. See more practices on her website www.self-compassion.org

• If I start to develop compassion for myself I will become dependent on it

• I will lose my self-criticism and my flaws will show • I will become someone I don’t want to be • I will become a weak person • Bad things will happen • My standards will drop if I become less self-critical. • If I start, I will feel overcome with loss/grief • When I try, I just feel kind of empty • I would not know where to begin. • Getting on in life is about being tough and not compassionate

• P. Gilbert, K. McEwan, M. Matos, A. Rivis. Psychology and Psychotherapy: Theory, Research and Practice (2011), 84, 239–255

Fear of self-compassion scale

“We burn out not because we don’t care

but because we don’t grieve.”

Rachel Naomi Remen, MD Kitchen Table Wisdom

Befriending our Grief • MORAL DISTRESS

Self Care

Diagnosis:

• Grief

• Secondary Traumatic Stress

• Empathic Fatigue

• Moral Distress

• Workplace Burnout

Symptoms: Practices:

• Grief

• Ongoing

• In the Moment

• Role Transition

Next Appt: (Ex: Check in monthly on the 30th?)

What are your Trauma/Grief Indicators?

Resiliency Skill: Awareness

Secondary Trauma Indicators • Feeling Helpless and Hopeless • A Sense that one Can Never Do Enough • Hypervigilance • Inability to Embrace Complexity •Minimizing • Chronic Exhaustion/Physical Ailments • Inability to Listen/Deliberate Avoidance

Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others, Laura van Dernoot Lipsky with Connie Burk, Chapter 4 (2009)

Secondary Trauma Indicators • Dissociative Moments • Sense of Persecution • Guilt • Fear • Anger and Cynicism • Inability to Empathize/Numbing • Addictions • Grandiosity : An Inflated Sense of

Importance Related to One’s Work

Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others, Laura van Dernoot Lipsky with Connie Burk, Chapter 4 (2009)

Self Care

Diagnosis:

• Grief

• Secondary Traumatic Stress

• Empathic Fatigue

• Moral Distress

• Workplace Burnout

Symptoms: Practices:

• Grief

• Ongoing

• In the Moment

• Role Transition

Next Appt: (Ex: Check in monthly on the 30th?)

Research Lack of Self Compassion (SC) • strongest personal resilience domain predictor of

burnout in Stanford Medicine Physicians. 2016 Physician Wellness Survey Final Report, Stanford Medicine, WellMD Center

Self Compassion Predicted Lower PTSD Severity • Self-Compassion as a Prospective Predictor of PTSD Symptom

Severity Among Trauma-Exposed U.S. Iraq and Afghanistan War Veterans Hirakoa et al, J Trauma Stress. 2015 April; 28(2): 127–133

SC 12 week course Decreased PTSD Symptoms in Vets: • Loving-Kindness Meditation for Posttraumatic Stress Disorder: A

Pilot Study, Kearney et al (2013), Journal of Traumatic Stress 26: 426-434. DOI:10.1002/jts.21832 (VA-Seattle)

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Helplessness and Self-Compassion “Why Are We Doing This?: Clinician Helplessness in the Face of Suffering,” Back et al, Journal of Palliative Medicine, Vol 18:1, 2015 • The feeling of helplessness reframed as an indicator of our internal

state and our connection to the patient.

• Reflects on two common responses when clinicians are faced with helplessness: hyper (over-identifying) and hypo (detaching) engagement.

• RENEW Model: Prompts self-nurture and return to constructive patient engagement after becoming aware of how we embody helplessness in ourselves.

From Empathic Distress to Compassion Satisfaction

Kelly McGonigal, CCARE, Cultivation Compassion Training-CCT

1.) Awareness of suffering

2.) Feeling of concern for the one who is suffering

3.) Desire to relieve that suffering

4.) Belief that you can make a difference

5.) Willingness to respond or take action

6.) Sense of satisfaction warm glow

Empathic Distress

(pain response)

Compassion Satisfaction (reward/caregiver response)

PROTECTIVE FACTOR FOR : Secondary Traumatic Stress Burnout Compassion Fatigue POSITIVE PREDICTOR of Compassion Satisfaction Journal of Professional Nursing Jan-Feb;30(1):89-99. doi: 10.1016/j.profnurs.2013.04.004

Social Cohesion

Self-Compassion Resilience

Joy Purpose

Self- Compassion

Grief

STS Moral Distress

Care Plan

Compassion Satisfaction

Social Cohesion

J.Bryan Sexton, PhD - Duke University

Take aways….

“A moment of self-compassion

can change your entire day.

A string

of such moments can change the course

of your life.”

Chris Germer

Helpful Apps & Gadgets

Insight Timer: Meditation timer bell. Wide Variety of crowd sourced guided meditations. Android/iPhone and online access insighttimer.com/ Free

Lotus Bud Mindfulness Bell: Sends gentle bell reminders randomly throughout the day. Take the opportunity to breath, reset or activate any practice.

10% Happier-Meditation for Fidgety Skeptics (Podcast, App and website) Dan Harris and Joseph Goldstein 10percenthappier.com

Books and related Websites Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others Laura Van Dernoot Lipsky with Connie Burk (2009) www.traumastewardship.com

Self-Compassion: The Proven Power of Being Kind to Yourself Kristen Neff (2011) www.self-compassion.org

Book and Online Grief Ritual

Gratefulness.org/light a candle Create a mindful grief ritual right from your desk. Light a candle. Candle will burn down in 48 hours. Can be “shared” so others can visit it and share in the Vigil. www.gratefulness.org/light-a-candle/

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. Jon Kabat-Zinn, PhD. (1990, 2013) He Created Mindfulness-Based Stress Reduction (MBSR) Trainings. 6-12 weeks.

Research Loving-kindness Meditation (LKM) • Reduced the severity of PTSD symptoms

• Loving-Kindness Meditation for Posttraumatic Stress Disorder: A Pilot Study, Kearney et al (2013), Journal of Traumatic Stress 26: 426-434. DOI:10.1002/jts.21832

• Improved well-being, sense of connection to others, self and other-focused affect • Loving-kindness meditation: a tool to improve healthcare provider compassion,

resilience and patient care, Seppala et al. (2014) Journal of Compassionate Health Care 1:5 DOI:10.1186/s40639-014-0005-9

Social Cohesion • Protective factor for STS, Burnout, Compassion

Fatigue, Compassion Satisfaction • Group Cohesion and Organizational Commitment: Protective Factors for Nurse

Residents' Job Satisfaction, Compassion Fatigue, Compassion Satisfaction, and Burnout, Li et al (2014), Journal of Professional Nursing Jan-Feb;30(1):89-99. doi: 10.1016/j.profnurs.2013.04.004

References 1. Self-Compassion assessment, research and interventions: See the work of Kristen

Neff, PhD. Her book, website and research: Self-Compassion (2011) www.selfcompassion.org Neff, K. D. (2003). “Development and validation of a scale to measure self-compassion. Self and Identity,” 2, 223-250.

2. Secondary Traumatic Stress/Compassion Fatigue Trauma Stewardship by Laura van Dernoot Lipsky with Connie Burk (2009), www.traumastewardship.com

3. “Self-care of Physicians Caring for patients at the End of Life: Being Connected… A Key to My Survival.” Kearney et al. JAMA, March 18, 2009—Vol 301, No. 11 Themes include: compassion fatigue, exquisite empathy, self care

4. Parasympathetic Nervous System- HeartMath (www.heartmath.org) has evidenced based research, the tested QUICK COHEHERENCE practice and a biofeedback hardware and apps that measure Heart Rate Value (HRV) and train people to access their PNS.

5. Accelerated Recovery Program for Compassion Fatigue - Baranowsky, Gentry & Dunning

6. Mindfulness Based Stress Reduction (MBSR) John Kabat-Zinn, Full Catastrophe Living and many other volumes on mindfulness. Look for courses in your area.

7. “Why Are We Doing This?: Clinician Helplessness in the Face of Suffering,” Back et al, Journal of Palliative Medicine, Vol 18:1, 2015

8. Resiliency/Self Care Plan Outline: Green Cross Academy of Traumatology Self Care Guidelines/Inventory. http://compassionfatigue.dreamhosters.com/wp-content/uploads/2010/11/academy-ethical.pdf

Self Compassion • Sustains self-care practices • Soothes the inner critic/negative bias • Decrease burnout and exhaustion • Decrease anxiousness and depression • Increase expression of compassion to others • Increase in the ability to forgive • Mediates symptom severity of PTSD* All other references are from published articles of Kristin Neff, PhD, self-compassion.org