Resilient Living. Amit Sood, MD Professor of Medicine Mayo Clinic

Transcription

1 Resilient Living Amit Sood, MD Professor of Medicine Mayo Clinic

2 Speed of Change Time

3 2016 MFMER

4 BRAIN QUIZ Our brain struggles with F F F

5 BRAIN QUIZ Our brain struggles with FOCUS FATIGUE FEAR

6 WORK HEALTH CHILDREN PARTNER HOME FINANCES PARENTS ECONOMY

7 PARENTS FINANCES HOME WORK PARTNER HEALTH CHILDREN ECONOMY

8 Courtesy - David T. Jones, M.D. Courtesy of David T. Jones, M.D., Mayo Clinic

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10 Attention Capacity Used Learning to Drive Driving as an Adult

11 Attention Capacity Used Learnin g to Drive Driving as an Adult Eating Brushin g Teeth Talking to Significant Other

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13 Fatigue 7.3 Reaction times 1.7 Accuracy Time in minutes Time in minutes Adapted from Faber LG, et al. Mental fatigue affects visual selective attention. PLOS ONE. 2012;7.

14 Fatigue Engagement Time on task Performance Time on task Adapted from Hopstaken JF, et al. The window of my eyes: Task disengagement and mental fatigue covary with pupil dynamics. Biological Psychology. 2015;110:100.

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18 WORLD PAST PRESENT FUTURE Hurts and regrets MIND Concerns and fears

19 ATTENTION BLACK HOLES Avoidant response Ruminatio n Imagination (Catastrophizing) Kernel of negative memory or fear

20 WORLD PAST PRESENT FUTURE Hurts and regrets MIND Concerns and fears

21 PRACTICE INSIGHT

22 GRATITUDE PRESENCE KINDNESS MINDSET MORNING GRATITUDE

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25 GRATITUDE PRESENCE KINDNESS MINDSET PART 2: MINDFUL PRESENCE

26 World Mind Smartphone

27 GRATITUDE PRESENCE KINDNESS MINDSET CURIOUS MOMENTS

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29 Attention Interpretation

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31 GRATITUDE PRESENCE KINDNESS MINDSET TWO-MINUTE RULE

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33 VIEW AS NOVEL DO NOT TRY TO IMPROVE

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35 MAYO CLINIC PHYSICIANS SoodA, et al. JGIM 2011

36 MAYO CLINIC PHYSICIANS SoodA, et al. JGIM 2011

37 MAYO CLINIC PHYSICIANS SoodA, et al. JGIM 2011

38 MAYO CLINIC PHYSICIANS SoodA, et al. JGIM 2011

39 MAYO CLINIC PHYSICIANS Active (n = 20) Control (n =12) Treatment Effect Baseline Week 8 Baseline Week 8 Estimate (95% Cl) Cohen s d p Connor Davis Resiliency Scale 69.6± ± ± ± (+3.8, +17.4) Perceived Stress Scale 28.5± ± ± ± (-13.1, -2.0) Smith Anxiety Scale 55.2± ± ± ± (-23.1, -6.4) Overall Quality of Life 7.6± ± ± ± (+0.1, +2.0) Fatigue 4.5± ± ± ± (-2.6, +1.2) Sood A, et al. JGIM. 2011

40 MAYO CLINIC RADIOLOGISTS SMART (n = 13) Control (n = 13) Treatment Effect Baseline Week 12 Baseline Week 12 Estimate (95% Cl) Cohen s d p Connor Davis Resiliency Scale 70.0± ± ± ± (-2.9, +7.2) Perceived Stress Scale 25.0± ± ± ± (-8.3, -0.8) Smith Anxiety Scale 57.2± ± ± ± (-18.4, -0.6) Overall Quality of Life 6.9± ± ± ± (+0.0, +2.4) Mindful Attention Awareness Scale 3.6± ± ± ± (+0.0, +2.4) Sood A, et al. Explore.2014

41 NEW NURSES Chesak C, et al. J of Alt and Compl. Med. 2014

42 NEW NURSES Chesak C, et al. J of Alt and Compl. Med. 2014

43 MAYO CLINIC NEW NURSES SMART (n = 27) Comparison (n = 39) Baseline Week 12 Week 52 Baseline Week 12 Week 52 p Connor Davidson Resiliency Scale 26.5± ± ± ± ± ±6.4 < Perceived Stress Scale 23.5± ± ± ± ± ±6.4 < Chesak C, et al. Manuscript in Preparation 2017

44 TRANSPLANT NURSES Design Outcomes Baseline Week 8 P Value Week 24 P Value Subjective Happiness 4.86 (0.91) 5.06 (0.79) (0.78) <0.001 Anxiety 8.32 (4.95) 5.60 (4.39) < (3.00) <0.001 Single arm (N=50) Stress (6.92) (6.60) (6.43) <0.001 Burnout (19.87) (19.80) < (19.12) <0.001 Burnout(W) (19.44) (18.40) < (20.03) <0.001 Burnout (C) (18.99) 29 (18.39) (19.14) <0.001 Mindfulness 2.66 (0.78) 2.94 (0.68) (0.59) <0.001 Magtiby D, et al. J. Nurse Admin 2017

45 MEDICAL STUDENTS Steinkraus, et al. AAMC 2015

46 MEDICAL STUDENTS Steinkraus, et al. AAMC 2015

47 MEDICAL STUDENTS Steinkraus, et al. AAMC 2015

48 PATIENTS WITH BREAST CANCER SMART (n = 12) Control (n = 8) Baseline Week 12 Baseline Week 12 p Resiliency(CDRS) 73.6± ± ± ± Stress (PSS) 22.1± ± ± ± Anxiety (SAS) 49.4± ± ± ± Overall Quality of Life 38.4± ± ± ± Loprinzi C, et al. Clin. Breast Cancer 2011

49 PATIENTS WITH TRANSPLANT Baseline Week 6 Month 3 Change rate per 6 weeks (95% Cl) P value Perceived stress scale; n, mean (SD) 31, 17.3 (8.0) 22, 11.6 (5.4) 15, 11.6 (7.1) -3.2 (-5.1 to -1.4).001 PHQ-9 (depression) total; n, mean (DS) 31, 8.1 (5.3) 26, 4.3 (3.5) 16, 4.4 (5.1) -2.0 (-3.3 to -0.8).003 Connor-Davidson Resilience Scale; n, mean (SD) 31, 75.0 (14.3) 25, 80.5 (13.3) 15, 80.5 (18.4) 3.0 (-0.4 to 6.4).085 GAD-7 (anxiety); n, mean (SD) 31, 6.5 (5.1) 26, 3.3 (2.4) 16, 2.7 (2.5) -2.1 (-3.1 to -1.0).0002 Sleep quality; n, mean (SD) 31, 2.9 (1.1) 26, 3.7 (0.7) 16, 3.1 (1.2) 0.2 (-0.1 to 0.5).17 PANAS positive; n, mean (SD) 31, 33.3 (7.8) 26, 37.9 (5.3) 16, 37.9 (8.0) 2.6 (0.8 to 4.5).006 PANAS negative; n, mean (SD) 31, 22.0 (7.5) 26, 15.7 (5.0) 16, 17.8 (6.6) -3.0 (-4.9 to -1.1).003 MAAS; n, mean (SD) 31, 4.3 (0.9) 26, 4.5 (0.9) 13, 4.7 (0.9) 0.2 (-0.0 to 0.4).059 SF-36 PCS; n, mean (SD) 30, 34.8 (9.3) 22, 36.6 (10.0) 16, 40.2 (10.2) 1.8 (-0.6 to 4.1).13 SF-36 MCS; n, mean (SD) 30, 43.9 (11.0) 22, 52.8 (7.9) 16, 49.1 (11.7) 3.4 (0.5 to 6.4).023 Stonnington C, et al. Clin. Transplant 2016

50 EMPLOYEE POPULATION Baseline Post program 3-Month follow-up Mean (SD) Mean (SD) Effect size Mean (SD) Effect size Connor-Davidson Resilience Scale 65.9 (11.1) 77.0 (11.1) (10.8) 1.24 Perceived Stress Scale (7.2) 17.5 (6.9) (6.8) 1.22 Generalized Anxiety Disorder 7-Item 6.8 (4.6) 3.4 (3.5) (3.7) 0.70 LASA Overall QOL 7.1 (1.4) 8.3 (1.1) (1.0) 0.79 Mental (intellectual) well-being 6.9 (1.4) 8.1 (1.2) (1.1) 0.84 Physical well-being 6.7 (1.6) 7.4 (1.5) (1.5) 0.51 Emotional well-being 6.2 (1.7) 7.7 (1.4) (1.4) 0.82 Social activity 6.2 (2.1) 7.7 (1.7) (1.8) 0.67 Spiritual well-being 6.8 (1.7) 7.9 (1.4) (1.6) 0.65 FACIT-Sp 12 Overall 30.6 (7.8) 38.2 (7.2) (7.5) 0.93 Peace 8.6 (3.1) 11.7 (2.9) (3.0) 0.88 Meaning 12.0 (2.9) 14.0 (2.3) (2.5) 0.58 Faith 10.1 (4.1) 12.3 (3.5) (3.7) 0.71 Health Behaviors 72.1 (12.9) 82.0 (11.9) (14.0) 0.65 Mindful Attention Awareness Scale 3.5 (0.8) 4.2 (0.7) (0.7) 1.06 WernebergB., et al. In Press 2017

51 EMPLOYEE POPULATION Program Completers (N=98) Study Completers (N=85) T0 T3 T0 T3 T6 Mean (SD) Mean (SD) Effect size Mean (SD) Mean (SD) Effect size Mean (SD) Effect size Mindfulness (MAAS) 3.4 (0.8) 4.1 (0.8) (0.8) 4.2 (0.8) (0.8) 1.04 FACIT-Sp 12 Overall 28.7 (8.6) 35.8 (8.7) (8.2) 36.8 (8.2) (7.9) 1.02 Meaning 11.9 (3.1) 13.7 (2.9) (3.0) 13.9 (2.5) (2.4) 0.65 Happiness 4.5 (1.3) 5.2 (1.3) (1.2) 5.4 (1.2) (1.0) 0.84 Gratitude 35.2 (6.2) 38.5 (5.0) (5.6) 38.6 (5.1) (3.8) Effect size calculated as the difference in absolute value from baseline divided by the standard deviation of the paired differences. P-values for comparison to baseline among post-program completers were all <.001, P-values for comparison to baseline among study completers were all <.001. Berkland B., et al. In Press 2017

52 BIBLIOTHERAPY Baseline Week 12 (n = 33) P Connor Davis Resiliency Scale 73.4± ±13.8 <.001 Perceived Stress Scale 25.7± ±7.3 <.001 Smith Anxiety Scale 55.5± ±14.9 <.001 Overall Quality of Life 7.0± ± Mindful Attention Awareness Scale 3.7± ±0.9 <.001 a Scores at baseline and week 12 are summarized using mean ±SD. Changes from baseline to week 12 were assessed using the paired t-test. Sharma V, et al. Explore.2014

53 HAVE THE SKILLS YOU LEARNED POSITIVELY IMPACTED HOW YOU INTERACT WITH THE STUDENTS? 77% A lot or Very much so Somewhat Little None at all Chesak S., et al. Manuscript in Review 2017

54 Additional Positive Studies Mixed Results Ongoing Studies SMART for IVF (Khan Z, et al) Pulmonary Critical Care Fellows (KashaniK, et al) Effect on Brain Networks (Jones DT, et al) Train the trainer course outcomes data (Fuehrer D, et al) Irritable Bowel Syndrome (Sharma V, et al) Anesthesia Staff (Gnagey A, et al) Public School Teachers (Sood A, et al) Medical Students (Dyrbye, L et al) Women s Heart Clinic (Bhagra A, et al) Welltok Employees Armstrong, J et al Sex SMART (Faubion S, et al) Latham and Watkins Sood, A et al Patients with Melanoma (Kalaaji, A et al) Employee Population Berkland, B et al

55 Core Practices Week 1 Morning Gratitude Week 2 Two Minute Rule Week 3 Kind Attention Week 4 Resilient Mindset Meditation

56 resilience.mayoclinic.org