does it really matter? hostility & cynicism

3. does it really matter?hostility & cynicism “A cynical and untrusting view of mankind, the frequent experience of negative emotions when dealing with others, and the frequent expression of overt anger and aggression when faced with frustration or problems.” Barefoot et al.: Hostility, CHD Incidence and total mortality A 25 year follow-up study of 255 physicians PsychsomMed 1983; 45:59-63.

4. mood and empathy resident physicians Anger and Hostility • prospective study of 61 categorical internal medicine residents during first post-grad year • self-reported mood and interpersonal reactivity measures • 2000-2001

5. okay, but how much does it matter? Pop Quiz: If you are stressed and lonely after a heart attack, your risk of dying is increased by: • 12% • 30% • 85% • 3 to 4 times

6. can somebody help me? social support and survival • Completely prospective • 2806 men and women; 197 had a heart attack • Simple measure of emotional support: • “Can you count on anyone to provide you with emotional support? • Graded 0, 1 or > 2

7. 60 50 40 mortality % 30 20 10 0 0 1 2 3 6 12 months after MI None One  Two number of sources of social support emotional support and mortality the EPESE cohort Controlling for clinical prognostic variables, patients who reported no emotional support reported had almost three times the risk of death (odds ratio 2.9; 95% CI, 1.2 – 6.9):

8. okay, but…is there a good animal model?Petting and atherosclerosis in rabbits Experimental social animals received “an early morning, half-hour visit during which each animal was handled, stroked, talked to, and played with; an hour-long feeding period during which the animal was also touched and talked to; and a number of 5-minute visits during the day.” NeremRM, Levesque MJ, Cornhill JF; Social Environment as a Factor in Diet-Induced Atherosclerosis; Science 1980; 208: 1475-1476.

9. but can the mind affect the body?

10. Psychological intervention in breast cancer 227 women with stage IIA-IIIB breast cancer Post-surgery awaiting adjuvant therapy Randomized and stratified No-intervention control (assessment only) Intervention: 90 minute group sessions, 1 year -stress management - problem solving - finding social support - coping - assertive communication - healthy lifestyle

11. Results Cox proportional hazards analysis: recurrence HR 0.55 (P = .034) cancer death HR 0.44 (P = 0.016) Psychologic intervention improves survival for breast cancer patients. Anderson BL, Yang H, Farrar WB, et. al. Cancer. 2008; 113:3450-3458.

12. stress:An Experience in Search of a Definition “Stress as a scientific concept suffers the misfortune of being too widely known and too poorly understood.”-Hans Selye, 1956. The Stress of Life “Stress is a creatively ambiguous word with little agreed-on scientific definition.” -Quick J, Quick J, Nelson I, Hurrell J, 1998 Preventative Stress Management in Organizations

13. Stress Enhances PerformanceBut only up to a point… Performance Demand The Yerkes-Dodson Curve (1908)

14. The Stress Reaction Thought Emotions Body

15. Emotions Sensations Thoughts Emotions Sensations Thoughts Emotions Thoughts Sensations Thoughts Thoughts Thoughts Emotions Thoughts Sensations Thoughts Thoughts Thoughts Thoughts Thoughts Thoughts Thoughts Thoughts Thoughts Thoughts Thoughts Thoughts Thoughts Emotions Emotions Thoughts Thoughts Emotions Thoughts Thoughts Emotions Thoughts Emotions Thoughts Emotions Emotions Emotions Thoughts Emotions Sensations Sensations Thoughts Emotions Sensations Emotions Sensations Emotions Emotions Sensations Sensations Sensations Emotions Thoughts Sensations Emotions Sensations Sensations Emotions Thoughts Sensations Emotions Thoughts Emotions Sensations Emotions Sensations Sensations Sensations Thoughts Emotions Sensations Sensations Emotions Emotions Emotions Sensations Emotions Emotions Thoughts Sensations Sensations Sensations Emotions Emotions Thoughts Sensations Emotions Emotions Thoughts Emotions Sensations Emotions Sensations Thoughts Sensations Sensations Sensations Emotions Sensations Sensations Sensations Sensations Sensations

16. tried-and-true stress relief • Exercise • Vacations • Music, Art • Family and Social Support • Sex • Prayer • Reading • Hot Tub (+/- Two Martinis) • Massage • TV, Movies • Alcohol and Drugs • Etc. what do all these remedies have in common???

17. all conventional stress reduction approaches have two things in common: they remove you from the stressful event but your stress returns as soon as you do

18. rest in awareness • The part of you that “knows” and “feels”. • It is there right in the middle of chaos and reactivity. • It is quiet, balanced, relaxed, and still. • It is easy to overlook. • Mindfulness is training in cultivating and sustaining this balance. It is always available.

19. try it for yourself take a three minute mindfulness break • notice what is happening with you…your body, your emotions, and your thoughts; what distracts you or takes you away • gather the attention around the breath, and then focus in more closely. Make sure that all of your attention engages with the breath • expand the attention to the rest of the body, notice how it feels now. Open the eyes and rest for a moment with your environment.

20. What is this awareness? It is the part of you that senses the world and that feels your heart It is the part of you that ismost alive

21. meditation and awareness Meditation or “mindfulness” is a structured mental process that steadies and deepens awareness by bringing it to rest on a stable focus Mind — or awareness — becomes more stable as awareness learns to rest Relaxation (that is, relief from stress) and this stability of awareness come together It takes practice to learn, but once learned, it is simple and instantaneous

22. resting in the present moment Recognizing, then putting aside,distractions by learning to bring awareness into the present moment In the present moment there is: -absence of inner reactivity and conflict -relaxation and rest in the body -andwe return fully to the task at hand -with enhanced sensitivity to others In the present moment we find… ourselves!

23. The Only Totally Essential Piece of Equipment for Your Joband Your Familyand Your Life You and Your Presence

24. it doesn’t matter how good we are if we’re not paying attention

25. mindfulness training and attention ----- Control & Retreat MBSR Attention Network Test: orienting Jha, Krompinger, & Baime

26. improved working memory Low demand High demand Low demand High demand Baseline After intervention n = 33 professional and graduate students P<.05, corrected

27. resistance to distraction undistracted distracted undistracted distracted after intervention baseline

28. what do Buddhists and Christians have in common? before meditation (baseline) frontal lobes superior parietal lobes during meditation

30. mindfulness in practice this “present moment” attention is exactly what you need in your work AND family life. its absence leads to • loss of depth and meaning in encounters • sense of alienation and disconnectedness • fatigue, burnout and irritation • loss of empathy and compassion

32. Changes in Profile of Mood StatesHealth Care Providers 2002 cohort n = 47 HHM POMS Scores - Before & After 25.0 20.0 15.0 Average Score 10.0 5.0 37% 52% 32% 64% 45% 29% 0.0 Vigor After Anger After Anxiety After Vigor Before Fatigue After Anger Before Anxiety Before Fatigue Before Confusion After Depression After Confusion Before Depression Before Subscale

33. Scheie Eye Hospital program • 74 (of 92 eligible) full-time employees • 52 (70%) completed the eight week, 16 hour program and the final assessment • Employees covered one another to attend • Workload was not decreased and no additional manpower was available. • Program completed in June, 2003 • Data collection completed October, 2003

34. Healing the Heart and Mind:SEI Profile of Mood States Results

35. Maslach Burnout InventoryEmotional Exhaustion

36. Scheie patient satisfaction:nurses

37. Scheie patient satisfaction: physicians

38. Penn Stress Management Program • Eight weeks, 27 class hours • More than 6,000 participants since 1992Extraordinary participant satisfaction • 99.3 % would send friends and relatives! • 98 % found the tools “very” or “extremely” effective • 82% are practicing meditation 6 months later • Documented results • Customized programs for specific needs

39. University of Pennsylvania classes • School of Medicine and Nursing • Mind-Body Medicine and Mindfulness Meditation: Theory and Practice • Spirituality and Medicine • Healing the Heart and Mind (CME) • Department of Psychology • Psych 249: “The Cognitive Neuroscience of Meditation” • Graduate School of Education: • PLN 11 “Enhancing Our Learning Communities” • Wharton

40. Research Programs • Obesity • Funded by the NIH/NCCAM • Multicenter 4 years • Mindfulness and Caregiving • University of Washington, Group Health, Seattle • NIH intramural, Suburban Hospital, Bethesda • Multiple Sclerosis • ADHD • Cognitive Neuroscience of Meditation • Three NIH Grants • Spirituality and Meditation