Well-being

“Physician, Heal Thyself” with Mindfulness

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“As physicians we owe our patients two things– only two things– our time and our skill. We do not owe our patients our lives. To excessively devote our lives to the practice of medicine while we neglect other aspects of living may be tantamount to never having lived at all.” – Joseph D. Wassersug, M.D.

 

Primary healthcare provides are a critical component of any healthcare system. Yet there is a shortage of primary care providers. It is estimated that there is a shortage in the U.S. of over 9,000 physicians. The shortages are not just due to training insufficient numbers of healthcare provides but also due to high turnover rates. In part because of the shortage and high patient loads, primary healthcare providers experience high stress and burnout. They experience a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.

 

In a recent survey 46% of all physicians responded that they had burnout. Currently, over a third of healthcare workers report that they are looking for a new job. Nearly half plan to look for a new job over the next two years and 80% expressed interest in a new position if they came across the right opportunity. Since there is such a great need to retain primary healthcare providers, it is imperative that strategies be identified to decrease stress and burnout.

 

Mindfulness is a possible help in reducing perceived stress and burnout. Indeed, high mindfulness has been shown to be associated with less stress and burnout in emergency medicine personnel (see http://contemplative-studies.org/wp/index.php/2015/08/10/burnout-burnout-with-mindfulness/). This is promising and suggests theat there is a need for continued research into the relationship of mindfulness and stress in primary healthcare providers.

In today’s Research News article “Mindfulness, perceived stress, and subjective well-being: a correlational study in primary care health professionals”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1106301519393773/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557919/

Atanes and colleagues performed a survey of 450 primary healthcare provider in Brazil, including family physicians, registered nurses, nursing assistants, and community health workers. They measured mindfulness, perceived stress and subjective well-being and found that these groups reported high levels of perceived stress. Importantly, they found that high levels of mindfulness were associated with low levels of perceived stress and high levels of subjective well-being.

 

These results suggest that mindfulness is to some extent and antidote to high stress and burnout in primary healthcare providers. There are a number of benefits to mindfulness that could be responsible for the reduced perceived stress and increased well-being. In particular mindfulness has been shown to reduce both physiological and psychological responses to stress (see http://contemplative-studies.org/wp/index.php/2015/07/17/destress-with-mindfulness/). Mindfulness has also been shown to increase emotion regulation which prepares the individual to experience and respond to emotional situations appropriately and thereby reduces stress (see http://contemplative-studies.org/wp/index.php/2015/07/17/be-smart-about-emotions/). Finally, mindfulness is associated with higher levels of focus on the present moment. This tends to reduce catastrophizing, worry, and anxiety (see http://contemplative-studies.org/wp/index.php/2015/07/17/stop-worrying/) and thereby can reduce psychological stress in primary healthcare providers.

 

These results are potentially important and strongly suggest that the employment of mindfulness training might help primary healthcare providers deal with the stresses of their work environments. This need to be studied with controlled trials. Additionally, the results may have more far reaching applicability than just to the healthcare field. Mindfulness may help with all kinds of stresses in all kinds of situations. Obviously more research is needed in this promising area.

 

So, practice mindfulness and heal thyself from stress and burnout.

 

“Stress, burnout and strain on the human heart are all increasingly taking their toll for millions of hardworking people. However, even someone who is working in a job that simply ‘pays the bills’ can turn mundane and stressful tasks into pleasant activities with a slight adjustment in attitude and by adopting a daily mindful practice.” ― Christopher Dines
CMCS – Center for Mindfulness and Contemplative Studies

 

Yoga and Meditation Improves Well-Being in Prisoners

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“We consistently teach a practice to provide prisoners with a skill to become more sensitive to how they feel in their bodies. When you develop a close relationship with your own sensitivity, you are less apt to violate another. This is empathy. And empathy, when encouraged, leads to compassion. Gradually, the cycle of violence is interrupted.”  ~ James Fox

 

Prison is a very stressful and difficult environment for most prisoners. This is compounded by the fact that most do not have well developed coping skills. In addition, many have suffered from trauma, often experienced early in life such as abandonment, hunger, homelessness, domestic violence, sexual abuse, bullying, discrimination, drug and alcohol abuse, and witnessing crime – including murder. In addition, prisoners frequently suffer from attention deficit disorder. So, prisoners are often ill equipped to engage positively in society either inside or outside of prison.

 

Yet prison provides a great deal of time for reflection and self-exploration. This is an opportunity for growth and development. So, contemplative practices are well suited to this environment.

Yoga and meditation teach skills that may be very important for prisoners. In particular, they put the practitioner in touch with their own bodies and feelings. They improve present moment awareness and help to overcome rumination about the past and negative thinking about the future. They’ve been shown to be useful in the treatment of the effects of trauma and attention deficit disorder. They also relieve stress and improve overall health and well-being. Finally, these practices have been shown to be useful in treating depression, anxiety, and anger.

 

So, yoga and meditation would appear to be ideally suited to addressing the issues of prisoners. Over the last several years there have been a number of yoga and meditation programs implemented in prisons. In today’s Research News article “A Systematic Review and Meta-Analysis of Yoga and Mindfulness Meditation in Prison: Effects on Psychological Well-Being and Behavioural Functioning”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1100073980016527/?type=3&theater

Auty and colleagues summarize the research literature that has studied the effectiveness of these programs. They found that the research suggested that these programs are effective in a wide range of locations, from the UK and US to India and Taiwan, with a wide variety of ethnicities and ages, and with both males and females.

 

They found that the yoga and/or meditation programs almost universally produced improvements in psychological well-being in the prisoners. The magnitudes of the effects were significant and moderate, suggesting that these practices produce meaningful psychological changes. They also found that the longer term programs produced greater change than the shorter, more intense programs.

 

In addition to the psychological effects the yoga and/or meditation programs the research reports significant improvements in behavioral functioning. Overall, the magnitudes of the effects were significant and smaller than those found for psychological well-being. But, nevertheless the results suggest that these practices produce meaningful behavioral changes. These effects were particularly large for prisoners who had substance abuse problems.

 

This literature summary suggests that yoga and meditation programs are quite effective in prisons, improving the psychological health and well-being of the prisoners and improving their behavior while in prison. There are some suggestions in the literature that these programs decrease recidivism. It is to the benefit of society to assist the prisoners while incarcerated to improve their skills for dealing with themselves and others, as this would make them easier to deal with in prison and make it more likely that they would successfully transition back into society upon release.

 

So, yoga and meditation programs should be employed broadly in prisons for the benefit both of the prisoners and of society.

 

“With the barrage of negativity in prisons, they are unyielding breeding grounds for intense suffering, chaos, noise, overcrowding, violence, ineffective medical care and poor food. But occasionally, every so often, friendship, kindness, compassion and programs of meaningful substance come along. The Yoga program is a life-sustaining and meaningful one that I nurture and value because it is not only positive, it supports my growth and success as a young man. Yoga helps me navigate my life as a good and successful person. This practice is life-changing and will continue to enhance my life.” K.L.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Mindfully Improve Psychological Wellbeing

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Meditation, focusing, and CBT all have been shown to be effective treatments for a number of psychological problems. In previous research Sugiura and colleagues identified five factors in common to meditation, focusing, and Cognitive Behavioral Therapy (CBT), refraining from catastrophic thinking, self-observation, logical objectivity, detached coping, and acceptance. This raises the questions as to whether these common factors may be responsible for the common clinical outcomes, and which of these common factors is most important for each of a variety of disorders.

In today’s Research News article “Common Factors of Meditation, Focusing, and Cognitive Behavioral Therapy: Longitudinal Relation of Self-Report Measures to Worry, Depressive, and Obsessive-Compulsive Symptoms Among Nonclinical Students.”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1052052538152005/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432024/

Sugiura and colleagues pursue these questions with a sample of undergraduate students.

They found that the greater the detached coping the lower the levels of obsessive-compulsive (OCD) symptoms. Detached coping emphasizes detachment and distancing from external conditions. This is exactly what mindfulness training is supposed to do, to allow us to see things objectively as they are. This suggests that mindfulness training is effective against obsessive-compulsive symptoms through its development of the skill of detached coping. Similarly, it was found that the greater the detached coping the lower the levels of depressive symptoms. This suggests that mindfulness training is effective against depression by allowing the individual to look at their situation more objectively, with detachment, and as a result not respond to it as something to feel bad about.

Worrying is also effectively reduced by mindfulness. The mechanism appears to be more complicated than that for OCD or depressive symptoms. It was found that the greater the level of refraining from catastrophic thinking the lower the levels of worrying, while the greater the level of self-observation the stronger the levels of worrying. Refraining from catastrophic thinking reflects the skills necessary to detach from and to suspend negative thinking, which frequently involves a fear of a future negative outcome, a worry. Mindfulness, by focusing on the present rather than the future interferes with worrying about the future and thus can be an effective antidote to worry.

Finally, Self-observation constitutes engagement in self-focus with curiosity and openness. Surprisingly it was associated with increased worrying. It appears that self-observation activates negatives beliefs about worrying. This suggests that it produces a worrying about worrying that increases worry.

So, it appears that the factors in common to meditation, focusing, and CBT of refraining from catastrophic thinking, self-observation, and detached coping are also associated with the symptoms common to psychological problems. But, that different factors are involved with different issues. This suggests that the three treatments may be effective by invoking common intermediaries for various disorders.

So, practice mindfulness and improve your psychological wellbeing.

CMCS

Spirituality Improves End of Life

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Death in inevitable, but that does not mean that it has to be awful. We don’t know how or when we will die, but we will die. It could be sudden or gradual or prolonged. We don’t know which it will be. But, regardless, how we approach it makes a huge difference.

Suzuki Roshi at the end of his life was in excruciating pain from cancer yet he told everyone around him “Don’t worry, It’s just Buddha suffering”. He passed with a smile on his face. Augustus Montague Toplady, the preacher author of the hymn “Rock of Ages” dying from tuberculosis said “”Oh, what delights! Who can fathom the joy of the third heaven? The sky is clear, there is no cloud; come Lord Jesus, come quickly!” These stories exemplify how our religiousness and spirituality can influence the quality of our passing.

In today’s Research News article “Religion, Senescence, and Mental Health: The End of Life Is Not the End of Hope”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1051111154912810/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357420/

Van Ness & Larson showed that individuals with high levels of religiousness/spirituality had significantly higher levels of well-being and were less likely to be depressed or suicidal at the end of life.

Americans 65+ portray themselves as more religious than do their younger counterparts. Hence it would appear that people understand that religiousness/spirituality can help in confronting end of life. But, how exactly does religiousness/spirituality help when dealing with eminent death?

Religiousness/spirituality can function by providing hope that helps the individual overcome increasing disease, disability, and emotional difficulties. Indeed, it has been shown that people high in religiousness/spirituality are significantly lower in hopelessness. This hope may take the form of belief in a life after death, reincarnation, or rebirth. Such a hope may be interpretable as a symbol of personal integrity that survives the indignities of illness, disability, and dissolution. This can be a great comfort to the dying person improving well-being and decreasing depression.

Religiousness/spirituality in older individuals is associated with a higher sense of well-being. This in turn can help the individual cope with the afflictions and challenges they face as death approaches. It can also help to bring families and communities to the dying process. It is often these connections that are the most important to the dying.

When approaching death, religiousness/spirituality can provide the structure to grapple with the basic questions of existence. Without it the person may experience spiritual distress. “When our bodies are under assault from disease or illness and our minds are reeling from the threat of disability or death, our spirit is there to hold it all together.” (Rev. Dr. Walter J. Smith).

So, practice religiousness/spirituality to be better prepared for death.

CMCS