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Whole Health in Your Practice - Mindful

Awareness: Paying Attention to What

Really Matters

March 2017

1

3. MINDFUL AWARENESS:

PAYING ATTENTION TO WHAT REALLY MATTERS

Whole Health in Your Practice



Really Matters

March 2017

2

VETERANS HEALTH ADMINISTRATION

A Core Concept

Explore.va.gov

Paying more attention to my

body and mind helps me

make better decisions in my

self care



Really Matters

March 2017

3


Definition of Mindful Awareness

• Way of being

• In the present

moment

• On purpose

• Non-judgmentally



Really Matters

March 2017

4


Mindful Awareness

We all have it...

the natural capacity to pay

attention with curiosity and

openness.


Mindful Awareness

We also have the capacity for

mindlessness, inattention, or going on

autopilot.

Foter.co

m



Really Matters

March 2017

5

11

Mindful Awareness:

What does the research tell us so far?



Really Matters

March 2017

6


Mindful Awareness Changes Your Brain

Nationalgeographic.com

13 VETERANS HEALTH ADMINISTRATION

Promega Study

• Two groups – Mean age 36

– 25 in meditation group (took 8 weeks MBSR course)

– 16 in wait-list control group took course later

• Groups’ brain electrical activity was different – Meditators had more activity of the left prefrontal cortex

– Less activity of the right prefrontal cortex

Davidson, et al. Psychosom Med. 2003;65(4):564-70.



Really Matters

March 2017

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LEFT prefrontal cortex activated means

People have MORE

• Vigor

• Optimism

• Enthusiasm

• Buoyancy

• Meditators also have a better

response (antibody titer) to the flu

vaccine


RIGHT prefrontal cortex less active

People have LESS

•Anger

•Fear

•Anxiety

•Depression



Really Matters

March 2017

8


Mindful Awareness: Physiologic Effects

• Increases gamma wave oscillations

on EEG

• Lengthens time in a relaxed state

• Activates brain attention center

• Lowers chronic inflammation

• Lowers stress hormones

• Stabilizes CD4+ counts in HIV

• Enhances natural killer cell function

• Alters interleukin levels

Foter.co

m


Mindful Awareness Lengthens Telomeres

• Longer telomeres = longer life and less chronic illness

• 2014 review of 4 studies

– 190 people

– Different approaches to mindfulness meditation (MM)

• MM and Qigong

• MM and mindful eating

• MM and loving-kindness

• Yogic meditation

– Ranged from 11-560 hours of meditation

• Telomeres were longer in the meditation group

Schutte & Malouff, Psychoneuroendorinol, 2014;42:45-8.



Really Matters

March 2017

9


QUERI Evidence Map for Mindfulness

http://www.hsrd.research.va.gov/publications/esp

/cam_mindfulness-REPORT.pdf

• 81 systematic reviews, up to Feb.

2014

• Y axis = size of the literature

• X axis = efficacy

• Size of circle = number of reviews

• Color represents the type of

mindfulness studied:

– Green a mix

– Pink is Mindfulness Based Stress

Reduction (MBSR)

– Purple is Mindfulness Based Cognitive

Therapy (MBCT)

– Blue is a combo of MBSR and MBCT

is for “unique interventions”


Research Highlights: Healthy Individuals • Reduces

Stress and anxiety

Depression

Rumination

Anger

Distress

• Improves Quality of life

Emotional intelligence, creativity

Concentration Khoury, J Psychosom Res 2015;78:519–528.

• According to another study Enhances spirituality and values

Increases empathy

Fosters self-compassion Chiesa, J Altern Complement Med, 2009;15(5):593-600.

Photo: Adam Rindfleisch, MD



Really Matters

March 2017

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Research Highlights: Specific Health Issues

• Remember, mindfulness is not

merely a ‘therapy’ but it does

help some conditions

• Especially responsive: – Chronic stress

– Depression

– Somatization

– Various types of pain

– Anxiety disorder

– Psychosis

– Substance use

– Binge eating

– Insomnia

Significant Improvements on Maslach Burnout Inventory

Fortney, et al., Ann Fam Med, 2013;11(5):412-20.



Really Matters

March 2017

11

Significant Improvements with Depression, Anxiety and Stress

Fortney, et al., Ann Fam Med, 2013;11(5):412-20.

23

Mindful Awareness:

How do you cultivate it?



Really Matters

March 2017

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Mindful awareness is an opportunity to be

in the wholeness of life…

including suffering, joy, peace, unrest, creativity,

fullness, emptiness – everything…

It is not merely a technique for coping with a specific problem.

Photo: Dave Rakel, MD


Discussion

• When are you

most:

• Aware

• Present

• Centered

• Focused

• Calm



Really Matters

March 2017

13


Mindful Awareness and Meditation: Formal and Informal Practices

• Breath Awareness

• Seated Meditation

• Moving and Walking Meditation

• Mindful Eating

• Compassion Practice

• Contemplative Prayer

• Mantram Repetition

• Body Scans Dailyheal.com

VETERANS HEALTH ADMINISTRATION VETERANS HEALTH ADMINISTRATION

7 Attitudes of Mindful Awareness

1. Beginner’s Mind

2. Non-judging

3. Patience

4. Non-striving

5. Acceptance

6. Letting go

7. Trust



Really Matters

March 2017

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Drop beneath and ... Observe

Thoughts Judgment

Emotions

Awareness


Breath Awareness Practice

1. Find a comfortable position

2. Allow eyes to close if you like

3. Remember the attitudes

4. Let go of busy-ness or life concerns

5. Pay attention to your breath

6. When attention wanders to thought, sensation, emotion

etc. simply notice

7. Gently return focus to your breath

8. Practice as long as you wish

http://images.google.com/imgres?imgurl=www.geneseo.edu/~ror1/i/viscera/eye.gif&imgrefurl=http://www.geneseo.edu/~ror1/i/viscera/&h=151&w=200&sz=15&tbnid=5jHlmi-uvcgJ:&tbnh=74&tbnw=98&start=62&prev=/images?q=eye&start=60&hl=en&lr=&ie=UTF-8&sa=N&edition=us



Really Matters

March 2017

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30

Mindful Awareness and Medicine


Meditation: How much at a time, and is it safe?

–Safety

–Very safe, and…

–…If risk of psychosis

or flashbacks, should be

guided by a trained

professional

28



Really Matters

March 2017

16


How can your clinical stool or chair become your meditation cushion?

How might you integrate mindful

awareness in your daily life?


How might you integrate mindful awareness into your clinical practice? In your daily life?

• Pause for a moment before every interaction

o Threshold exercise

o A few deep breaths

• Stethoscope or other object as a reminder

o Sitting in a chair or shaking hands can also remind you

• Join a group to practice

o Some PACTs do mindfulness before they start the day

• Other daily practices

o You will experience several during this course

• Other ideas?

http://www.virtualtoolbox.ca/



Really Matters

March 2017

17


Paying Attention: Tools and Resources

Pages 21-22 of your

binder list mindful

awareness audio and

video resources, including

a guided reflection around

the Personal Health

Inventory

35

Between stimulus and response, there is a space.

In that space is our power to choose our

response.

In our response lies our growth and our freedom.

»

»

-Victor Frankl, MD

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