Becoming more mindful: Can you benefit?

1. Becoming more mindful: Can you benefit? Richard E. Berger, MD University of Washington

2. …receiving a cancer diagnosis is like a soldier being dropped into a jungle war zone without a map, compass or training. Michael Lerner-Commonweal Cancer Self Help Program

3. How do you make sound decisions and live fully, when you are up to your ass in alligators?

4. Mindfulness is a mental state, characterized by concentrated awareness of one's thoughts, feelings and actions. Paying attention, on purpose, in the present moment, non-judgmentally

5. Mindfulness promotes the replacement of reactivity withconsidered conscious decisions.Development generally requirespractice.

6. Benefits mindfulness • Live life more fully in present moment • Practice kindness toward yourself • Less suffering from pain • Appreciate what is right with you • Mobilize inner and outer resources • Take control of life and attention

7. Mindfulness Effects on Cancer Patients • Improved mood • Decreased stress • Decreased anxiety • Improved adjustment to diagnosis Metanalysis of 6 studies by Mitchim et al, ONCOLOGY NURSING FORUM - VOL 34, NO 5, 2007

8. 2 Mindfulness Effects on Cancer Patients • Improved quality of life • Improved feeling of control • Improved sleep • Less suffering from pain Metanalysis of 6 studies by Mitchim et al, ONCOLOGY NURSING FORUM - VOL 34, NO 5, 2007

9. weight blood sugar bp Improved lipid profile cortisone inflammation Improved well-being, alertness pain with stress  brain size, grey matter  quality of life  concentration  learning  sleep quality  body awareness depression Changes DNA activation Effects Mindful Practices NIH conference 2009 Mind/Body Med.

10. Mindfulness Increases Survival • Hypertension • Cardiac Disease • Cancer?? • Decrease PSA rise. J Urol. 2001 Dec;166(6):2202-7

11. "Moral excellence comes about as a result of habit. We become just by doing just acts, temperate by doing temperate acts, brave by doing brave acts." -Aristotle

12. What is cost of becoming more mindful? A. Nausea? B. Your hair falls out? C. 6 weeks painful recovery? D. 30-60 minutes/day of sitting quietly, alertly and non-doing?

13. PRACTICEPRACTICEPRACTICEBut the practice isthe goal!

14. Things for Pretty Sure • If you don’t practice something, you won’t get much better at it. • You are always practicing something. (Habits) • You can choose what youpractice.

15. A Native American elder once described his own inner struggles in this manner: “Inside of me there are two dogs. One of the dogs is mean and evil. The other dog is good. The mean dog fights the good dog all the time”. When asked which dog wins, he reflected… “The one I feed the most”. George Bernard Shaw

16. Start Easy Real life problems Mindfulness Practice

17. MEDITATION IS… • THE PUPOSEFUL PRACTICE OF MINDFULNESS • AWARENESSING • PRACTICING CALM ALERTNESS • PRACTICING EXPERIENCING “WHAT IS” • GETTING FAMILIAR WITH YOURSELF

18. What do you practice in mindfulness? • Quieting your mind • Recognizing discursive thoughts • Letting go of discursive thoughts • Recognizing urges

19. 2 What do you practice in mindfulness? • Letting go of urges • Recognizing emotions • Letting go of emotions • Creating space around mental events

20. RAIN • R-Recognize • A-Allow • I-Investigate • N-Not me or Let go or Let be

21. Mindfulness and View Sensory Perceptions , concepts Thoughts Thoughts, concepts Confusion Thoughts With Reality Mindful view of Thoughts, Emotions, Sensations Experience of World Experience of World

22. PINBALL WIZARD THINKING “That deaf, dumb, and blind boy, sure plays a mean pinball.” The Who

23. You Are Not Your Thoughts

24. Mindfulness Based Stress Reduction: MBSR • MEDITATION • BODY AWARENESS PRACTICE • YOGA • 8 weeks, 2-3 hours/week • Daily practice-45 min.

25. MEDITATION IS NOT… • SPACING OUT • ANALYZING • TRYING NOT TO THINK • THINKING HAPPY THOUGHTS • VISUALIZATION • DISTRACTION • AVOIDANCE • POSITIVE THINKING • PRAYER?

26. Need faith to start Need 6-8 weeks to see results Hardest in the beginning Gets more enjoyable with time Takes 2 weeks to establish habit Lifelong benefits Mindfulness v Phys. Exercise

27. Application Mindfulness RAIN RAIN RAIN RAIN Event Emotion Pre-response Response Thoughts Past associations

28. Neuron

29. Neuroplasticity

30. Meditation Brain Studies

31. Mindful Meditation Orientation/Association Area of Parietal Lobe Attention/Association Area of Frontal Lobe Th amygdala/hyppocampus- emotional significance and LT memory A mb H Increased activity H H Decreased activity Activation sympathetic/ Parasympathetic n.s. CVS, Immune effects

32. Right v Left Brain Labeling Analytic thought Logic Language Conceptual thought Discursive thought Experiencing Holistic thought Creativity Art/Music Intuition

33. Increasing Awareness Gradual acceptance of holistic, non-reductionist experience Holistic experience of analysis, conceptual thought and discursive thought =awareness

34. We are Human Beings Analyzing & Ruminating About Past Fantasizing, Ruminating, Planning About Future The Present What lies behind us and what lies before us are tiny matters compared to what lies within us. Oliver Wendell Holmes

35. GOALS • Better decision making • Increased quality of life • Increased enjoyment of life as it is • Being present

36. How do you know that you are doing it right? If you try, you are doing it right! Do only as much as maintains your enthusiasm! .

37. What is Measures of Success? • KINDNESS to yourself & others • Less reactive decisions

38. Cancer and Mindfulness As long as you are breathing, there is a lot more right with you than is wrong with you. Practice Being Aware of What is Right With you!

39. Laboratory Your Mind and Life Practice Living Every Moment

40. We All Have an Illness Story Be mindful of your story

41. Views of Illness • Restorative • Chaos • Quest

42. Restorative Narrative • I’ll be healthy again • Our institutionalized narrative • For every suffering there is an outside remedy given by some authority • Isolating, authority gives patients story • Evades question of mortality and medical failure • No personal story to fall back on Arthur Frank

43. Chaos Narrative • Life never gets better, no sequence of causality • Vulnerability, futility and impotence. • There is no plot to story, no voice, no one is in control • Isolating and no motivation • Too easy to dx depression Arthur Frank

44. Quest (Mindful) Narrative • Accept illness and attempt to use it • Awareness of illness and life in the present • Illness as personal but shared journey • Teller tells own story • Personal perseverance and purpose. • Relationship to others- Empathetic Arthur Frank

45. Resources • Selected Readings on Mindfulness • 8 Minute Meditation: Quiet Your Mind. Change Your Life. by Victor N. Davich • Turning the Mind Into an Ally by Sakyong Mipham and Pema Chodron • Silence: How to Find Inner Peace in a Busy World by Christina Feldman • Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness by Jon Kabat-Zinn • Wherever You Go, There You Are by Jon Kabat-Zinn • Coming to Our Senses: Healing Ourselves and the World Through Mindfulness by Jon Kabat-Zinn • The Miracle of Mindfulness by Thich Nhat Hahn

46. Web Resources • www.mindandlife.org • http://www.dharma.org/ims/ss_meditation_resources.html • http://www.umassmed.edu/cfm/home/index.aspx • http://amberstar.libsyn.com/index.php?post_category=Introduction%20to%20Meditation

47. Resources Mindfulness Based Stress Reduction courses. • John Wendt MD and Sherry Williams http://paccentermind.org • Carol Jakus, MA, MSW, LICSW-Seattle Washington, cjakus@mindfullivingnw.com • Carol McManus, PT, MS, MA, http://www.carolynmcmanus.com/pages/workshops.html