Improve Flow, Communication Skills, and Safety Attitudes of Surgeons with Mindfulness

Improve Flow, Communication Skills, and Safety Attitudes of Surgeons with Mindfulness

 

By John M. de Castro, Ph.D.

 

Once you can communicate with yourself, you’ll be able to communicate outwardly with more clarity. The way in is the way out.”― Thích Nhất Hạnh

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. Preventing burnout has to be a priority. Contemplative practices have been shown to reduce the psychological and physiological responses to stress and improve well-being. Indeed, mindfulness has been shown to be helpful in treating and preventing burnoutincreasing resilience, and improving sleep. Mindfulness has also been shown to improve flow, a state of mind that is characterized by a complete absorption with the task at hand, often resulting in enhanced skilled performance. Thus, there is a need to investigate how mindfulness effects doctors’ well-being, performance, and flow.

 

In today’s Research News article “Focused-Attention Meditation Improves Flow, Communication Skills, and Safety Attitudes of Surgeons.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9099589/ ) Chen and colleagues recruited surgeons and randomly assigned them to either a wait-list control condition or to receive 50 minutes of focused meditation practice 3 times per week for 8 weeks. They were measured before and after training for work-related flow, communications skills, safety attitudes, and clinical adverse events.

 

They found that in comparison to baseline and the wait-list control group the surgeons who received mindfulness training had significantly increased levels of work-related flow, communications skills, and safety attitudes. Eight weeks after the training the mindfulness trained surgeons had significantly lower levels of clinical adverse events.

 

Hence, mindfulness training significantly improved surgeons’ flow and medical performance. This further suggests that mindfulness training should be recommended for physicians.

 

physicians could use mindfulness as a stand-alone technique prior to engaging in bad news delivery to patients.” – AMRA

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Chen H, Liu C, Zhou F, Cao XY, Wu K, Chen YL, Liu CY, Huang DH, Chiou WK. Focused-Attention Meditation Improves Flow, Communication Skills, and Safety Attitudes of Surgeons. Int J Environ Res Public Health. 2022 Apr 27;19(9):5292. doi: 10.3390/ijerph19095292. PMID: 35564687; PMCID: PMC9099589.

 

Abstract

Objective: Patient safety is a worldwide problem and a focus of academic research. Human factors and ergonomics (HFE) is an approach to improving healthcare work systems and processes. From the perspective of the cognitive ergonomics of HFE, the aim of this study is to improve the flow level, communication skills, and safety attitudes of surgeons through focused-attention meditation (FAM) training, thus helping to reduce adverse clinical events. Methods: In total, 140 surgeons were recruited from three hospitals in China and randomly divided into two groups (FAM group and control group). The FAM group received 8 weeks of FAM training, while the control group was on the waiting list and did not receive any interventions. Three scales (WOLF, LCSAS, and SAQ-C) were used to measure the data of three variables (flow, communication skills, and safety attitude), respectively, at two times, before and after the intervention (pre-test and post-test). The incidence of adverse events during the intervention was also collected for both groups. Results: The ANOVA results showed that all three variables had a significant main effect of time and significant interactions between time and group. The independent-sample T-test results showed that the incidence of adverse events during the intervention was significantly lower in the FAM group than in the control group. Conclusions: The intervention of FAM could significantly improve surgeons’ flow levels, communication skills, and safety attitudes, potentially helping to reduce adverse clinical events.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9099589/

 

Distress Is Lower during a COVID-19 Pandemic Lockdown in Mindful People

Distress Is Lower during a COVID-19 Pandemic Lockdown in Mindful People

 

By John M. de Castro, Ph.D.

 

“During the current pandemic, there is so much uncertainty concerning the future, and many threats to our security (physical, social, emotional, and financial). It is totally natural and normal to feel anxious, fearful, and frustrated. . . Mindfulness can help us acknowledge this situation, without allowing us to be carried away with strong emotions; it can, in turn, help bring ourselves back to a centered calm. Only then can we see more clearly what it is we have control over and what it is that we do not.” – Michigan Medicine

 

Modern living is stressful under the best of conditions. But with the COVID-19 pandemic the levels of stress have been markedly increased. These conditions markedly increase anxiety. This is true for everyone but especially for healthcare workers and people caring for patients with COVID-19 and for people with pre-existing conditions that makes them particularly vulnerable. But it is also true for healthy individuals who worry about infection for themselves or loved ones.

 

The COVID-19 pandemic has also produced considerable economic stress, with loss of employment and steady income. For the poor this extends to high levels of food insecurity. This not only produces anxiety about the present but also for the future. It is important for people to engage in practices that can help them control their responses to the stress and their levels of anxiety. Mindfulness practices have been found routinely to reduce the psychological and physiological responses to stress, reduce anxiety levels, and improve mood.

 

In today’s Research News article “Mindfulness, Age and Gender as Protective Factors Against Psychological Distress During COVID-19 Pandemic.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2020.01900/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1437459_69_Psycho_20200922_arts_A ) Conversano and colleagues solicited adult participants online during a government ordered lockdown and had them complete measures of COVID-19 experiences, mindfulness, psychological distress, and mental illness symptoms.

 

They found strong negative relationships between mindfulness and psychological distress. They found that the higher the levels of mindfulness the lower the levels of psychological distress including somatic symptoms, symptoms of obsessive-compulsive disorder, internalizing symptoms, depression, anxiety, hostility, phobia, paranoia, psychoticism, and sleep disturbance. They also found weak relationships with age and gender such that younger and female participants tended to have higher psychological distress.

 

It needs to be kept in mind that these results are correlational and as such causation cannot be determined. Mindfulness may produce reduced distress or conversely distress may produce reduced mindfulness or some third factor may produce both. Nevertheless, the results show that during a pandemic lockdown that the people who have high levels of mindfulness also have low levels of psychological distress.

 

So, distress is lower during a COVID-19 pandemic lockdown in mindful people.

 

In many ways, COVID-19 has shown us just how connected and how much the same we really are. All of us—and some of us more than others—are vulnerable to getting sick and none of us wants to become ill. Viewed through the lens of interconnectedness, practicing mindfulness as the coronavirus spreads is not only a way to care for ourselves but a way to care for everyone around us.” – Kelly Baron

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Conversano C, Di Giuseppe M, Miccoli M, Ciacchini R, Gemignani A and Orrù G (2020) Mindfulness, Age and Gender as Protective Factors Against Psychological Distress During COVID-19 Pandemic. Front. Psychol. 11:1900. doi: 10.3389/fpsyg.2020.01900

 

Objective: Mindfulness disposition is associated with various psychological factors and prevents emotional distress in chronic diseases. In the present study, we analyzed the key role of mindfulness dispositions in protecting the individual against psychological distress consequent to COVID-19 social distancing and quarantining.

Methods: An online survey was launched on March 13, 2020, with 6,412 responses by April 6, 2020. Socio-demographic information, exposure to the pandemic, and quarantining were assessed together with psychological distress and mindfulness disposition. Multivariate linear regression analysis was performed to study the influence of predictive factors on psychological distress and quality of life in Italian responders during the early days of lockdown. Pearson correlations were calculated to study the relationship between mindfulness and psychiatric symptoms.

Results: Multivariate linear regression run on socio-demographics, COVID-19-related variables, and mindfulness disposition as moderators of overall psychological distress showed that mindfulness was the best predictor of psychological distress (β = −0.504; p < 0.0001). High negative correlations were found between mindfulness disposition and the overall Global Severity Index (r = −0.637; p < 0.0001), while moderate to high associations were found between mindfulness and all SCL-90 sub-scales.

Discussion: Findings showed that high dispositional mindfulness enhances well-being and helps in dealing with stressful situations such as the COVID-19 pandemic. Mindfulness-based mental training could represent an effective intervention to stem post-traumatic psychopathological beginnings and prevent the onset of chronic mental disorders.

https://www.frontiersin.org/articles/10.3389/fpsyg.2020.01900/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1437459_69_Psycho_20200922_arts_A

 

Improve Anxiety Disorders with Mindfulness

Improve Anxiety Disorders with Mindfulness

By John M. de Castro, Ph.D.

 

“it’s clear that mindfulness allows us to interrupt automatic, reflexive fight, flight, or freeze reactions—reactions that can lead to anxiety, fear, foreboding, and worry.” – Bob Stahl

 

Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. A characterizing feature of anxiety disorders is that the suffer overly identifies with and personalizes their thoughts. The sufferer has recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. This may indicate that treating the cognitive processes that underlie the anxiety may be an effective treatment. Indeed, Mindfulness practices have been shown to be quite effective in relieving anxiety.

 

Anxiety disorders have generally been treated with drugs. But, there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disordersMindfulness-Based Cognitive Therapy (MBCT) was developed to treat depression but has been found to also be effective for other mood disorders. MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate mood disorders. MBCT has been found to help relieve anxiety.

 

Although the ability of Mindfulness-Based Cognitive Therapy (MBCT) to relieve anxiety is well established in western populations, there is less research employing oriental populations. In today’s Research News article “Feasibility study of mindfulness-based cognitive therapy for anxiety disorders in a Japanese setting.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127937/ ), Sado and colleagues recruited Japanese participants who were diagnosed with either panic disorder, social anxiety disorder, obsessive compulsive disorder, or generalized anxiety disorder. They were provided with an 8-week program of MBCT. The participants met in groups for 2 hours, once a week, and were asked to practice at home. They were measured before, during, and after training and 4 and 8 weeks later for mindfulness, anxiety, depression, psychological distress, health status, quality of life, agoraphobia, and social anxiety disorder.

 

They found that after treatment there were significant increases in mindfulness and decreases in anxiety and agoraphobia that were maintained 8 weeks after the end of treatment. There was also a significant improvement in psychological distress after treatment, but this was not maintained at follow-up. These results are similar to those observed in western populations. So, it appears that MBCT is similarly effective in eastern (Japanese) anxiety disorder sufferers. This suggests that MBCT is a safe and effective treatment for anxiety disorders in a wide range of patients, races, and cultures.

 

So, improve anxiety disorders with mindfulness.

 

“A review of 47 studies showed a 5 percent to 10 percent reduction in anxiety symptoms and a 10 percent to 20 percent improvement in depression in individuals who meditated.” – Nicole Ostrow

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Sado, M., Park, S., Ninomiya, A., Sato, Y., Fujisawa, D., Shirahase, J., & Mimura, M. (2018). Feasibility study of mindfulness-based cognitive therapy for anxiety disorders in a Japanese setting. BMC Research Notes, 11, 653. http://doi.org/10.1186/s13104-018-3744-4

 

Abstract

Objective

Mindfulness-based cognitive therapy (MBCT) could be a treatment option for anxiety disorders. Although its effectiveness under conditions of low pharmacotherapy rates has been demonstrated, its effectiveness under condition of high pharmacotherapy rate is still unknown. The aim of the study was to evaluate effectiveness of MBCT under the context of high pharmacotherapy rates.

Results

A single arm with pre-post comparison design was adopted. Those who had any diagnosis of anxiety disorders, between the ages of 20 and 74, were included. Participants attended 8 weekly 2-hour-long sessions followed by 2 monthly boosters. Evaluation was conducted at baseline, in the middle, at end of the intervention, and at follow-up. The State-Trait Anxiety Inventory (STAI)-state was set as the primary outcome. Pre-post analyses with mixed-effect models repeated measures were conducted. Fourteen patients were involved. The mean age was 45.0, and 71.4% were female. The mean change in the STAI-state at every point showed statistically significant improvement. The STAI-trait also showed improvement at a high significance level from the very early stages. The participants showed significant improvement at least one point in some other secondary outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127937/

 

Improve Neuroticism with Mindfulness

Mindfulness Neuroticism2 Armstrong

By John M. de Castro, Ph.D.

 

“Self-deprecating comedians and complainers wear their neuroticism as a badge of honor. In truth, the negatively biased are more prone to depression, anxiety, self-consciousness and hypochondria, to name just a few behavioral tripwires. Neuroticism is no fun for anyone.” – Psychology Today

 

We often speak of people being neurotic. But, do we really know what we’re talking about? Do we really know what it is? Neurosis is actually an outdated diagnosis that is no longer used medically. The disorders that were once classified as a neurosis are now more accurately categorized as post-traumatic stress disorder, somatization disorders, anxiety disorder, panic disorder, phobias, dissociation disorder, obsessive compulsive disorder and adjustment disorder.

 

Neuroticism, however, is considered a personality trait that is a lasting characteristic of the individual. It is characterized by negative feelings, repetitive thinking about the past (rumination), and worry about the future, moodiness and loneliness. It appears to be linked to vulnerability to stress. People who have this characteristic are not happy with life and have a low subjective sense of well-being and recognize that this state is unacceptable. There is some hope for people with high neuroticism as this relatively stable characteristic appears to be lessened by mindfulness training. This is potentially important and deserves further investigation.

 

In today’s Research News article “Mindfulness-Based Cognitive Therapy for Neuroticism (Stress Vulnerability): A Pilot Randomized Study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1245647922125798/?type=3&theater

or below

Armstrong and Rimes examined the ability of Mindfulness Based Cognitive Therapy (MBCT) to treat individuals high in neuroticism. They randomly assigned participants with high neuroticism to either an 8-week, once a week for 2-hours, MBCT treatment group or and on-line self-help treatment control group. Measures were taken before and 4-weeks after treatment of mindfulness, neuroticism, impairment in everyday functioning, anxiety, depressive symptoms, self-compassion, beliefs about emotions, rumination, and decentering.

 

They found that after treatment in comparisons to the control group the MBCT group had significantly lower neuroticism scores, and rumination, and a trend toward lower functional impairment due to stress. In addition, the MBCT group had significantly higher self-compassion and decentering and trends toward lessened unhelpful beliefs and emotions and higher mindfulness. Surprisingly, since MBCT was developed specifically to treat depression, there were no significant differences in anxiety or depression.

 

These results are interesting and potentially important. This, however, was a pilot study that had relatively small group sizes (17). The fact that significant differences were detected nonetheless indicates that the effects were fairly strong. The results clearly indicate that a larger randomized controlled trial is called for.

 

Mindfulness may affect neuroticism in a number of ways. By focusing the individual on the present moment, mindfulness should lessen the neuroticism characteristics of rumination about the past and worry about the future. Mindfulness is also known to reduce the psychological and physiological responses to stress and stress is known to contribute to neuroticism. Finally, mindfulness has been shown to produce heightened emotion regulation. So, the mindful individual feels and appreciates their emotions but responds appropriately and adaptively. This should lessen the moodiness, negative feelings, and loneliness characteristic of neuroticism. So, it is not surprising the mindfulness based treatments would be effective in lowering neuroticism. This is a hopeful development, as people high in neuroticism are very unhappy people. Mindfulness may provide some relief and help them toward a happier life.

 

So, improve neuroticism with mindfulness.

 

“Being in the moment with those thoughts and recognizing them for what they are has really helped me to kind of shove them aside, or to kind of diffuse them,” she says. “I think it’s really helped me become a more aware person of what other people might be feeling.” – JoSelle Vanderhooft

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available  on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Armstrong L, Rimes KA. Mindfulness-Based Cognitive Therapy for Neuroticism (Stress Vulnerability): A Pilot Randomized Study. Behav Ther. 2016 May;47(3):287-98. doi: 10.1016/j.beth.2015.12.005. Epub 2016 Jan 5. PMID: 27157024. doi:10.1016/j.beth.2015.12.005

 

Highlights

  • A new MBCT intervention for neuroticism versus online general self-help is examined
  • Compared with self-help, MBCT results in significantly lower levels of neuroticism
  • Rumination and self-compassion improved more in the MBCT group than the control group
  • MBCT is an acceptable and feasible intervention for neuroticism
  • Neuroticism may be amenable to change through psychological intervention

Abstract

Objective: Neuroticism, a characteristic associated with increased stress vulnerability and the tendency to experience distress, is strongly linked to risk of different forms of psychopathology. However, there are few evidence-based interventions to target neuroticism. This pilot study investigated the efficacy and acceptability of mindfulness-based cognitive therapy (MBCT) compared with an online self-help intervention for individuals with high levels of neuroticism. The MBCT was modified to address psychological processes that are characteristic of neuroticism. Method: Participants with high levels of neuroticism were randomized to MBCT (n = 17) or an online self-help intervention (n = 17). Self-report questionnaires were administered preintervention and again at 4 weeks postintervention. Results: Intention-to-treat analyses found that MBCT participants had significantly lower levels of neuroticism postintervention than the control group. Compared with the control group, the MBCT group also experienced significant reductions in rumination and increases in self-compassion and decentering, of which the latter two were correlated with reductions in neuroticism within the MBCT group. Low drop-out rates, high levels of adherence to home practice, and positive feedback from MBCT participants provide indications that this intervention may be an acceptable form of treatment for individuals who are vulnerable to becoming easily stressed. Conclusions: MBCT specifically modified to target neuroticism-related processes is a promising intervention for reducing neuroticism. Results support evidence suggesting neuroticism is malleable and amenable to psychological intervention. MBCT for neuroticism warrants further investigation in a larger study.

 

Promote Physical and Mental Well-Being with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Tai Chi exercise had positive effects on the self-assessed physical and mental health of college students. Scores on the mental health dimension appeared to be particularly sensitive to change. Colleges/universities might consider offering Tai Chi as a component of their ongoing physical activity programs available to students.” – Y. T. Wang

 

Many people have fond memories of their college years. It is likely, however, that they forgot about the stress and angst of those years. The truth is that college is generally very stressful for most students, from the uncertainty of freshman year, to the social stresses of emerging adulthood, to the anxiety of launching into a career after senior year. Evidence for the difficulties of these years can be found in college counseling centers which are swamped with troubled students. In fact, it’s been estimated that half of all college students report significant levels of anxiety and depression.

 

Being able to perform at an optimum level is important in college. It would be very helpful if a

safe and effective way could be found to reduce stress, depression and anxiety in college students. Mindfulness training has been shown to reduce anxiety, stress, and depression . So, mindfulness training would appear to be well suited to deal with the problems of college students. The ancient eastern practice of mindful movement Tai Chi has been shown to reduce stress, depression, and anxiety. Hence, it would make sense to investigate whether Tai Chi practice might be effective for improving college student angst.

 

In today’s Research News article “A systematic review of the health benefits of Tai Chi for students in higher education”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1180406471983277/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733099/

Webster and colleagues review the published literature on the effectiveness of Tai Chi practice in improving college student physical and psychological states. They found that that the preponderance of evidence in the literature reported that Tai Chi practice significantly improved muscular flexibility. But the most interesting effects were in the psychological domain with Tai Chi practice significantly reducing depression, anxiety, symptoms of compulsion, somatization symptoms, hostility, and symptoms of phobia, and improved interpersonal sensitivity.

 

Hence, the published scientific literature suggests that Tai Chi practice can be of significant benefit for college students, improving them physically and improving their psychological well-being. Tai Chi practice is a gentle mindful movement practice. It is safe, having few if any adverse consequences, and effective with college students. This suggests that the engagement in Tai Chi practice should be encouraged in college promoting the physical and mental well-being of the students.

.

 

“Of all the exercises, I should say that T’ai Chi is the best. It can ward off disease, banish worry and tension, bring improved physical health and prolong life. It is a good hobby for your whole life, the older you are, the better. It is suitable for everyone – the weak, the sick, the aged, children, the disabled and blind. It is also an economical exercise. As long as one has three square feet of space, one can take a trip to paradise and stay there to enjoy life for thirty minutes without spending a single cent.” ~T.T. Liang

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Buffer Yourself from Neuroticism with Mindfulness

We have long observed that every neurosis has the result, and therefore probably the purpose, of forcing the patient out of real life, of alienating him from actuality.Sigmund Freud

 

We often speak of people being neurotic. But, do we really know what we’re talking about? Do we really know what it is? Neurosis is actually an outdated diagnosis that is no longer used medically. The disorders that were once classified as a neurosis are now more accurately categorized as post-traumatic stress disorder, somatization disorders, anxiety disorder, panic disorder, phobias, dissociation disorder, obsessive compulsive disorder and adjustment disorder.

 

But, neuroticism is considered a personality trait that is a lasting characteristic of individuals. It is characterized by negative feelings, repetitive thinking about the past (rumination), and worry about the future, moodiness and loneliness. People who have this characteristic are not happy with life and have a low subjective sense of well-being and recognize that this state is unacceptable.

 

This relatively stable characteristic appears to be lessened by mindfulness training. Mindfulness training also has been found to improve individuals’ subjective well-being. So, it makes sense to think that mindfulness may be involved in the link between neuroticism and low subjective well-being. This possible link is explored in today’s Research News article “Curb your neuroticism – Mindfulness mediates the link between neuroticism and subjective well-being”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1094124517278140/?type=3&theater

Wenzel and colleagues studied individuals high in neuroticism and found that they tended to have negative mood and low vitality and general interest in life; that is low subjective well-being.

 

Wenzel and colleagues then added mindfulness to the prediction and found that mindfulness in part mediated the relationship between neuroticism and low subjective well-being especially in individuals who had high levels of neuroticism. It thus appears that neuroticism lowers mindfulness which in turn results in negative mood and low vitality and general interest in life. This suggests that being mindful may in part protect an individual from the effects of neuroticism on their well-being.

 

There are a number of potential explanations for these effects of mindfulness. Neuroticism is characterized by rumination and worry, which are thought processes centered on the past and future. Mindfulness, on the other hand, is an ability to focus on the present moment. Hence, mindfulness could be seen as an antidote to the past and future orientation in neuroticism.

 

Neuroticism is also characterized by moodiness and loneliness. Mindfulness has been shown to improve emotion regulation; the ability to feel and recognize an emotional state but be able to understand it and respond to it appropriately (see http://contemplative-studies.org/wp/index.php/2015/08/20/regulate-emotions-with-mindfulness/ and http://contemplative-studies.org/wp/index.php/2015/07/17/control-emotions-the-right-way-with-mindfulness/). So mindfulness would also appear to be an antidote for the moodiness involved in neuroticism. Indeed, it has been shown that mindfulness can reduce feelings of anger and depression and improve self-control among people with high neuroticism.

 

So, buffer yourself from neuroticism with mindfulness.

 

Mindfulness has helped me succeed in almost every dimension of my life. By stopping regularly to look inward and become aware of my mental state, I stay connected to the source of my actions and thoughts and can guide them with considerably more intention.” – Dustin Moskovitz

 

CMCS – Center for Mindfulness and Contemplative Studies