Whole Health in Your Practice

Transcription

1 Whole Health in Your Practice 3. MINDFUL AWARENESS: PAYING ATTENTION TO WHAT REALLY MATTERS 1

2 A Core Concept Paying more attention to my body and mind helps me make better decisions in my self care Explore.va.gov 2

3 Definition of Mindful Awareness Way of being In the present moment On purpose Non-judgmentally 3

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 4

5 Mindful Awareness: What does the research tell us so far? 11 5

6 Mindful Awareness Changes Your Brain Nationalgeographic.com Promega Study Two groups Mean age 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):

7 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 7

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 16 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 hours of meditation Telomeres were longer in the meditation group Schutte & Malouff, Psychoneuroendorinol, 2014;42:

9 QUERI Evidence Map for Mindfulness 81 systematic reviews, up to Feb 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 VETERANS HEALTH ADMINISTRATION /cam_mindfulness-report.pdf 18 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: According to another study Enhances spirituality and values Increases empathy Fosters self-compassion Chiesa, J Altern Complement Med, 2009;15(5): Photo: Adam Rindfleisch, MD 19 9

10 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 20 Significant Improvements on Maslach Burnout Inventory Fortney, et al., Ann Fam Med, 2013;11(5):

11 Significant Improvements with Depression, Anxiety and Stress Fortney, et al., Ann Fam Med, 2013;11(5): Mindful Awareness: How do you cultivate it? 23 11

12 Mindful awareness is an opportunity to be in the wholeness of life Photo: Dave Rakel, MD including suffering, joy, peace, unrest, creativity, fullness, emptiness everything It is not merely a technique for coping with a specific problem. Discussion When are you most: Aware Present Centered Focused Calm 12

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 7 Attitudes of Mindful Awareness 1. Beginner s Mind 2. Non-judging 3. Patience 4. Non-striving 5. Acceptance 6. Letting go 7. Trust VETERANS HEALTH HEALTH ADMINISTRATION ADMINISTRATION 13

14 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 14

15 Mindful Awareness and Medicine 30 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

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? 16

17 Paying Attention: Tools and Resources Pages of your binder list mindful awareness audio and video resources, including a guided reflection around the Personal Health Inventory 34 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.»» 35 17