Bríd Shine CMS Bereavement & Mental Health Coombe Women & Infants University Hospital

1. The Institute Mindfulness-Based Approaches Mindfulness in Medicine Bríd Shine CMS Bereavement & Mental Health Coombe Women & Infants University Hospital

2. Outline of Presentation • Impact of Caring Profession • Stress & burnout • Mindfulness Revolution • What is mindfulness? • Scientific Evidence • Mindfulness in Workplace • Our need for Self Compassion • Experiential & Conclusion • Q & A’s ‘Mapping our Journey’

3. “The cost of caring” • While the capacity for compassion and empathy is at the core of our ability to care, • It is also at the core of our ability to be wounded by the work..

4. The Consequences.. ‘Those who work with the suffering, suffer themselves because of the work’ Psychosomatic illness Compassion fatigue Secondary Traumatisation Stress & Burnout

5. What is Burnout? • Burnout represents; an erosion in values, dignity, spirit and will- and erosion of the human soul. (Maslach 1998)

6. Burnout continued... • It occurs in a setting where job demands exceed the support & resources available for employees (Maslach 1998)

7. Symptoms of Burnout • Loss of concern for client • Apathy, irritation, negativity with clients / co-workers • Treating clients in mechanical/detached manner • Increasing pessimism, and fatalism about work • Rationalisation of failure, blaming the ‘system’ • Resistance to change, growing rigid and loss of creativity (Maslach1998)

8. The Journey back to wholeness When we do not care we lose our being, and care is the only way back to being (May 1969)

9. Mindful Revolution

10. Mindfulness in Medicine, Healthcare & Society

11. Definition of Mindfulness Mindfulness means; Paying attention in a particular way; • On Purpose • In the Present Moment • Non-Judgementally (Jon KabatZinn)

12. Mindfulness Meditation • Mindfulness is about stress reduction, NOT relaxation. • Think, “falling awake” as opposed to “falling asleep”.

13. Mindfulness Mindfulness is the practice of directing attention to what is happening, in the present moment. (ThichNhatHanh)

14. Mindfulness • Mindfulness is more recently being referred to as “Heart-fulness “

16. Mindfulness “ Mindfulness is not simply a technique. It is an act of love, our willingness to see clearly, to hold ourselves closely just as we are, it is a revealing and deeply healing expression of care – an embodiment of compassion. Compassion begins at home with ourselves; whether offering or seeking care, we are all wounded and we are all whole” (Saki F Santorelli)

17. Mindfulness – The Science Robust research suggests; regular practice of mindfulness helps both the body & mind to respond, rather than react to stress, allowing for improved health and wellbeing (Jon KabatZinn)

18. Scientific Evidence 1979- 1St Cohort; • Chronic pain, stress & debilitating medical conditions • Neuroplasticity • Immune Function • Attention Deficit • Mental Health Illness

19. Studies have proven that brain changes occur following training in MBSR • Mind has greater Resilience & Body’s immune function improves (McKay 2012- UMAAS)

20. Medical Conditions • Asthma(Madison, Druker, Olendzk, Read et al 2012) • Cancer (Carlson, Stephan, Faris, Drysdale & Spence 2013) • Chronic Pain (Reiner, Tibi & Lipsitz 2013) • Diabetes ( Hatmann, Kircher, Faude, Lang, Augustein et al 2012) • Heart Disease (Sullivan, wood, McGee, Johnson et al 2009) • HIV (Duncan, Neilads, Dilworth, Hecht & Johnson 2012) • GI disorders ( Zernicke, Campbell, Blustein, Bacon & Carlson 2013) • Hypertension (Hughes, VanDulman, Caltson & Josephson 2013)

21. Research on HCP’s Impact of MBSR training in Nurses & Physicians ; • Increased Empathy & Compassion • Positive impact on therapeutic relationship • Reduced risk of; 1. Stress & Burnout 2.Compassion Fatigue

22. Workplace Programme UMAAS • 32% decrease Medical Symptoms • 30% decrease Perceived Stress • 27% increase acting with self awareness • 26& increase in observational skills • 25% increase in non-reactivity • 22% increase in non-judgemental care Ongoing clinical trials on effectiveness of MBSR in Smoking cessation using RCT’s

23. Coombe Project -MBSR • Staff Training & Education • One day ProgrammesCME • Introduction in Clinical Setting • Perinatal mental health • 8 wk MBSR

25. Feedback from Training Programmes; One Day Programme • ‘A good kick start to self awareness and tools for dealing with stress’ • ‘Recommend to co-workers to attend future programme’ • ‘As well as mindfulness the day is very beneficial to staff relations’ • ‘Being much more aware of the importance of minding ourselves’ 8 Week Programme • ‘Like someone gifted me my life back’ • ‘I cannot believe I have been journeying through life with the blinkers on..for so long!’ • ‘How the discipline became a gift to my inner life’ • ‘The course end makes me feel sad but I am “aware” and able to hold that sadness’

26. Mindfulness Based Stress reduction • Scientifically based 8 week educational programme teaches people how to take better care of themselves to live healthier, more adaptive lives. • People have to be very motivated –And they usually are!!

27. Overview of 8 week MBSR; Huge Commitment..!! • 2.5 Hrs once weekly, daily practice, weekly exercises • Full day silent practice • Formal Practices • Informal Practices • Stress Theory • Dealing with Difficult emotions • Integrating MBSR daily life

28. Mindfulness & Stress It is not the potential stressor itself but how you perceive it, and then how you handle it that will determine whether it leads to stress or not.

29. Dealing with Difficult Emotions • Taking a step back, recognising what is present • Turning towards & Befriending difficult emotions

30. Mindfulness & Compassion What is Compassion..? “Concern for the alleviation of suffering of sentient beings” (Kristin Neff 2011) 3 Components; Mindfulness Kindness Common Humanity www.self-compassion.org/

31. Importance of Self Compassion • Fosters connectedness • Helps us to relate to ourselves & our lives with an open Mind & Heart • Transforms suffering • Activates the mammalian care-giving system (Paul Gilbert 2013) “A baby is born with a need to be loved, and never outgrows it..” (Frank A Clarke)

32. Summary Slide • Impact of working in caring profession • Consequences of self care neglect • Practice of Mindfulness & Self Compassion

33. Sharing a Mindful Moment Experiential..

34. The Journey (by Mary Oliver) One day you finally knew what you had to do and began, though the voices around you kept shouting their bad advice – though the whole house began to tremble and you felt the old tug at your ankles, “Mend my life” each voice cried, But you didn’t stop .You knew what you had to do, though the wind pried with its stiff fingers at the very foundations-though their melancholy was terrible. It was already late enough, and a wild night, and the road full of fallen branches and stones. But little by little as you left their voices behind, the stars began to burn through the sheets of clouds, and there was a new voice which you slowly recognised as your own, that kept you company as you strode deeper and deeper into the world determined to do the only thing you could do – determined to save the only life you can save – Your Own..

35. Conclusion

36. Recommended Reading List • Kabat-Zinn, J. (2005) Coming To Our Senses Healing Ourselves and the World Through Mindfulness. London • Santorelli, S. (1999) Heal Thy Self; Lessons on Mindfulness in Medicine. New York: Bell Tower • Nhat Hanh, T. (1987) The Miracle of Mindfulness. NY

37. Further Recommended reading Skovolt, T,M. (2001) The Resilient Practitioner. USA, Allyn and Bacon Zinn-Kabat, J. (2001) Full Catastrophy Living;how to cope with stress, pain and illness using mindfulness meditation. New York: Piatkus Books. Maslach, C. (1982) Burnout: the cost of caring. Englewood Cliffs NJ: Prentice-Hall Figley, C (2001) Treating Compassion Fatigue. New York, Brunner-Routledge

38. Online Resources. • www.cfm.ie • www.mindfulness.ie • www.sanctuary.ie • www.kalyanacentre.com • www.oscailt.iew • www.mindfulnessireland.org • www.umassmed.edu/cfm • www.bangor.ac.uk/mindfulness • www.tarabrach.com