How to Remain Human and Not become a Robot (Mindfulness, Compassion and Medicine) Dave Richardson, MD Peace and Love

How to Remain Human and Not become a Robot (Mindfulness, Compassion and Medicine) Dave Richardson, MD Peace and Love

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Objective: Breathe Underwater Physicians who use self-care without self-awareness feel as though they are drowning and barely able to come up for air, whereas self-care with selfawareness is like learning to breathe underwater Kearney: JAMA 2009; 301(11): 1155-64

Pain Experience Fear Anger Emotions Non-Acceptance Wanting something different Beliefs Judgments Meaning Past experiences Congitive Fusion Taking things personally Mental Process

Pain Mental Process Suffering

Pain Experience Fear Anger Emotions Acceptance Awareness Objectivity Non-Judgmental Perspective taking Open/Willingness Flexibility Compassion Mental Process

Serenity Equinimity Mental Process Pain

You know it s a hot topic when...

Origins of Mindfulness Eastern Contemplative roots Secular forms of mindfulness brought to western society more recently (1960 s) Perhaps the most popular new intervention technique of the past decade New York Times

What is Mindfulness? Moment-to-moment...... non-judgmental...... awareness. paying attention in a particular way: on purpose, in the present moment, and non-judgmentally. -- Jon Kabat-Zinn

Mindfulness includes the following features: Clear Non-conceptual, nondiscriminatory Flexible Empirical Oriented to the present moment Stability Curiosity Intention

Attention Not Auto-pilot Mindfulness Not Sniper or Surgeon Attitude Non-judgemental, Non-striving, Letting go Patience, Beginners Mind, Acceptance, Trust Intension: Why are you practicing? Self-regulation, self-exploration, selfcompassion Outcomes associated with intentions

Mindfulness in Medicine Exercise in Mindfulness

Mindfulness Reduces distress and increases well-being Cancer Heart disease OAB, Irritable Bowel Syndrome Anxiety, Depression Chronic fatigue syndrome Physicians and medical students Healthy adults

Resiliency and Mindfulness Self-Care Sleep, diet, relationships, excercise Self-Awareness Being in tuned with your emotions and stress Moment to moment, without judgment Mindful Awareness Deep awareness, experiencing life as it arises and passes Positive, negative and neutral in an open and receptive way Increase resiliency = More positive outlook

Do you WANT to SUFFER? Getting out of your head Dangerous place It s not about you!! Getting into your body You are not your thoughts Cognitive fusion Living in the present Finding Serenity Finding Equanimity Finding Acceptance

Kindness Antidote to Suffering Compassion Not judgment Common Humanity Not Isolation Awareness Not Over-Identification I am the mistake! Shame

Why Mindful Self- Compassion? No Value! Foo-Foo! Psycho Mumbo-jumbo! Even though: Decrease stress, anger, depression, anxiety, shame Decreases medical errors Among caregivers, it is associated with less burnout and secondary traumatic stress Linked to happiness, life satisfaction, and optimism

Antidote to Shame Self-Compassion Not a form of Self-Pity Not a sign of weakness Not selfish Not self-indulgent Ice cream vs a hug/kiss Not making excuses Will not undermine motivation

Model Teaching Compassion G.R.A.C.E. Joan Halifax

Experiential Avoidance

Model Teaching Compassion G.R.A.C.E. Joan Halifax

GATHER Accepting who I am without judgment Strengths Think IT -- Write IT Declare IT Strength Finders Demons and Prejudices Rumi Guest House 23 rd Psalm Bruises your life experiences Who am I? Letting go of beliefs

Ground Letting Go Past and Future Bring yourself out of mindlessness Sitting/Standing/Walking Skipping, Dancing, Hopping, Backwards STOP Breathing Dragon Breaths Twenty Breaths 3 minutes Breathing

Ground in the Strength of Your Own Voice I m not afraid To open my bleeding heart I m not afraid to cry To taste those tears I m not afraid to feel my pain To touch my sorrow, grief, shame, my deepest wounds I m not afraid to fly!

Recall Intentions Motives Reasons you chose: To be in your chosen profession To be a Caregiver To have a significant Relationship To be a Mother or Father What do you really want out of life?

Attune to Self Noting feelings (What? and How?) Fear, anger, boredom, repulsion Caring, compassion, empathy, contentment Seeing stories as the emerge Not getting lost in the why Letting go of the stories Don t reify thoughts, emotions, stories They aren t real Get out of your head and into your body! Noting actions Assessment/Evaluation Understanding motives, needs, values

Attune to Self Note judgments of others Good, bad, indifferent Note your judgments of your actions This creates feeling Note how you judge your feelings Remember: Should-ing is like Sh*tting Try not to practice: Experiential Avoidance

Attune to Self Be the Observer I am not my right big toe!! How (in your body) are you feeling? If I can feel it, I can heal it! What am I feeling? If I can name it, I can tame it! What is it that I need?

CONSIDER Not about FIXING HEALING is about bringing wisdom to your empathy before action Identify the NEEDS (not the WANTS) Recognize appropriate boundaries Not FIGHTING or STRIVING Being with what IS!

Engaging: Self-Compassion Show Up Ground and Recall your intention Turn Toward Take a Seat Connecting Offer Time and Space Slow down Meet with Breathing Opening all your senses Letting go of thoughts

Soothing Touch Hand on Heart Hand on cheek Gently stroking your arms Giving yourself a gentle hug Hand on your stomach Hand on stomach and heart Neff/Germer

Self-Compassion Break This hurts I m not alone. I m only human. May I give myself the compassion that I need Monday in the Operating Room

Engage Choosing Not to Suffer Embrace Complexity and Change Embrace Your Emotions Embrace Your Strengths, Prejudices, Demons, Fears, Beliefs Observer Not the Judge Focus on What Needs to be Done in the Moment I Lived... I did it all!

Engage Choosing Not to Suffer Authentic self and voice HOW: Honest Open Willing Let go of fear Let go of expectations Sometimes we can only just breath We can t fix, but can still heal There is something that is always free

Mindfulness Compassion Being in Touch Paying attention In the present On purpose Non-judgmental Paying attention to the present moment with intention while letting go of judgment as if your life depends on it Jon Kabat-Zinn: Where ever you go, there you are (2005)