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Everyday Mindfulness DPC Grand Rounds March 7, 2013

Everyday Mindfulness DPC Grand Rounds March 7, 2013. Dr Susan Abbey MD, FRCPC Program Head, Medical and Surgical Psychiatry, TGH Dr Monica Branigan MD, MHSc (Bioethics) Professional Development Lead, Division of Palliative Care, U of T Michele Chaban MSW, D Phil

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Everyday Mindfulness DPC Grand Rounds March 7, 2013

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  1. Everyday MindfulnessDPC Grand Rounds March 7, 2013 Dr Susan Abbey MD, FRCPC Program Head, Medical and Surgical Psychiatry, TGH Dr Monica Branigan MD, MHSc (Bioethics) Professional Development Lead, Division of Palliative Care, U of T Michele Chaban MSW, D Phil Co-Director Inter-professional Applied Mindfulness Meditation Certificate, U of T

  2. My intention • To create community around mindfulness in palliative care

  3. Objectives • Discuss simple mindfulness interventions designed to benefit practitioners • Review interventions of benefit for people dealing with life threatening illness • Consider mindful questions to address pain and suffering

  4. How can we cultivate mindfulness? • Paying attention we can bring awareness to • Mind • Heart • Body • Each center is associated with different ways of knowing, listening and speaking • Each functions from a different place • Neocortex • Limbic system • Brainstem

  5. The head center • Our thinking center • Knowing through rational thought • Listen to content: description, explanation, story, beliefs, assumptions • Speaking: “I think...” • Values: control • Pitfalls: critique, judgment, “I already know” • Pamela Weiss

  6. The heart center • Our feeling center • Knowing through openness, attunement, acceptance • Listening to feelings, emotions, mood • Speaking: “I feel....”, “I am angry....” • Value: approval • Pitfalls: emotional reactivity- entanglement or distancing Pamela Weiss

  7. The body center • Our sensing center • Knowing through intuition, perception • Listen to energetic tone, physical cues • Speaking: “I sense......” • Value: safety • Pitfalls: tension, agitation, flight, fight or freeze • Pamela Weiss

  8. The three centers from our patient’s point of view • Mind: tell me what I can do to make the pain better and give me an explanation that makes sense to me • Heart: let me know that you accept my pain is real • Body: allow me to feel safe

  9. The three centers from the provider point of view • Three part check in • Start with the body: big breath, relax shoulders down, expand back, sides, front • Bring awareness to your heart: feeling tone or mood • Notice your thoughts or general flavour: critical, curious….

  10. Mindful approach to pain • Begin with a three part check for yourself so you can meet the patient as a whole person • Invite the patient to check in with their three centers • Notice the energy between you and the patient- are you connected? • YES: together you work with “the pain” • NO: the patient remains alone with “their pain”

  11. The Two Darts "When an untaught worldling is touched by a painful (bodily) feeling, he worries and grieves, he laments, beats his breast, weeps and is distraught. He thus experiences two kinds of feelings, a bodily and a mental feeling. It is as if a man were pierced by a dart and, following the first piercing, he is hit by a second dart. So that person will experience feelings caused by two darts.... • Sallatha Sutta

  12. How do we usually approach pain? • The standard pain history • Major focus on the body- the first dart • Does not fully acknowledge the second dart • DISCONNECT: as HCPs we often may come from our head center and may ask that our patients respond from their body center

  13. Questions for the mind • What do you think about when you have pain? • Where does your mind go when you have pain? • Are there any thoughts that trigger your pain? • Are there any stories that come to you when you have the pain? • What is the meaning of your pain?

  14. Questions for the heart • Tell me about the pain in your heart. • How does your heart feel the pain? • What in your life is causing pain in your heart? • What is your heart feeling?

  15. Questions for the body • Standard pain history • Where do you feel the pain? • What words describe it? • What makes it better? • Etc • How does the rest of you body feel? • Are there parts of your body that experience comfort? • Do you sense that your body is trying to tell you something?

  16. Commitments • May I check in with myself in order to bring my wholeness to the patient that I may see them as whole and not broken • May I expand my awareness of pain beyond the first dart and allow the patient to explore body, mind and heart • May I see my own frustration and helplessness as something that connects me to the patient and not use it against myself

  17. Resources- MBSR The MBSR Clinic Location: Toronto General HospitalTime: Monday morning, Monday afternoon or Wednesday eveningInstructors: Dr. Susan Abbey and Sarah Greenwood, RN, BScNCost: $75.00 Call: 416- 340-4452

  18. MBSR and Mindfulness • Centre for Mindfulness in Medicine, Health Care and Society http://www.umassmed.edu/cfm/index.aspx see for professional courses and teacher training and annual scientific conference

  19. Communities of practice • Mindfulness Toronto http://mindfulnesstoronto.ning.com/ see for mindfulness courses, events, MBSR and sitting groups • See posted “Resources” on Community Space

  20. Continuing professional development • Applied Mindfulness Meditation at the Factor Inwentash Faculty of Social work http://www.socialwork.utoronto.ca/conted/certificate/mindfulnessmed.htm • Centre for Mindfulness Studies, Toronto http://www.mindfulnessstudies.com/ • Insight Meditation Center- online http://www.insightmeditationcenter.org/programs/online-courses/

  21. Continuing professional development • Being with Dying Program at Upaya http://www.upaya.org/bwd/ • Metta End of Life Practitioner Program http://mettainstitute.org/EOLoverview.html • Mindful Practice: Focus on Serious and Life-Limiting Illness, University of Rochester http://www.cvent.com/events/mindful-practice-focus-on-serious-and-life-limiting-illness/event-summary-9a33a7d3cfbe4e4993128c6c7aa1964e.aspx

  22. Online meditation podcasts • UCLA Mindful Awareness Research Center http://marc.ucla.edu/body.cfm?id=22 • Tara Brach, Buddhist meditation teacher http://www.tarabrach.com/audiodharma.html • Insight Meditation Centre http://www.audiodharma.org/series/1/talk/1762/ • Dan Siegel http://brainsciencepodcast.com/bsp/meditation-and-the-brain-with-daniel-siegel-md-bsp-44.html

  23. For patients Mindfulness Based Cognitive Therapy (MBCT) for People with Cancer Facilitators:Dr. Mary Elliott, MD, FRCPC Dr. Evan Collins, MD, FRCPC Dates: TBA Location: Pencer Centre Group Room, 18th Floor, Princess Margaret Hospital How to register: Physician referral required. Please complete the attached referral form and send to sherene.tay@uhn.ca or fax to 416-946-2047. Fees: Course covered by OHIP.

  24. For patients MBSR at Wellspring http://www.wellspring.ca/Odette/Programs/Full-List-of-Programs/Mindfulness-Based-Stress-Reduction.aspx

  25. Let’s talk……. monica.branigan@utoronto.ca

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