Mindfulness Matters

Mindfulness Matters

Mindfulness for the Nursing Profession

posted by exquisitemind

“Today’s healthcare environment is turbulent, rapidly presenting nurses with stimuli, interruptions, and competing priorities. The stakes of success are extraordinarily high; nurses in all roles must cope successfully with numerous demands to make timely, accurate decisions affecting human lives.” (Pipe et al., 2009) 

Nursing professionals face enormous challenges. The work is difficult and demands full presence, energy, and commitment.  Stress is a pervasive fact of the profession, and it affects institutions and individuals, and even the caring relationship itself. 
Stress can impair the health care provider’s ability to observe, to listen, and to understand the patient. To practice safely, healthfully, and with compassion, nurses need to effectively manage stress. Taken to an extreme, when acute stress becomes chronic, impairments can be seen in immune system and cognitive functioning. One research group rang a note of caution that “unfortunately, breakdowns in attention raise the risk of serious consequences such as symptom recognition, medication errors, and patient safety issues” (Pipe et al. 2009). 
Mindfulness is a proven strategy that can help nurses to cope with the demands of their work and their lives (Baer 2003; Carmody et al., 2009; Grossman, 2004; Ludwig & Kabat-Zinn, 2008). Of the hundreds of clinical studies conducted on mindfulness-based interventions, 75% of them have been conducted in the past five years pointing to the mindfulness revolution sweeping health care. 
A wealth of different clinical interventions have been developed and researched that include mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), mindfulness-based relapse prevention (MBRP), and mindfulness-based eating awareness training (MB-EAT). 
 
Specific to nurses, Beddoe (2004) demonstrated that an 8-week mindfulness-based stress reduction intervention for nursing students significantly reduced anxiety. The students who practiced at home experienced additional benefits. These benefits spilled over into daily life and participants felt greater well-being and improved coping skills.  Mackenzie et al. (2006) studied a four-week mindfulness-based stress reduction intervention for nurses and nurse aides. The mindfulness intervention participants experienced significant improvements in burnout symptoms, relaxation, and life satisfaction. 
Pipe et al. (2009) studied nurse leaders with a 4-week mindfulness-based intervention (compared to a leadership intervention). The mindfulness group saw greater improvement in mood symptoms.
Neuroscience studies of meditation have demonstrated enduring and beneficial changes in both the function and structure of the brain that persist beyond the period of meditation (Davidson et al. 2003; Farb et al. 2007; Lazar et al. 2006; Luders et al. 2009; Lutz et al. 2008). 
Neuroscientist Daniel Siegel (2007) concludes that mindfulness produces a form of neural integration and coherence that leads to more adaptive functioning. The areas of the prefrontal cortex that show increases in grey matter are responsible for emotional regulation (including modulating fear) and an increased ability to be resilient in the face of stress. Other capacities affected include the regulation of body systems, attuning to others, responding flexibly, and exhibiting insight and empathy. 
For example, Lazar et al (2006) found that mindfulness meditation led to a thickening in areas of the prefrontal cortex linked to these functions, and that these changes were correlated with the length of time practicing. Lutz et al. (2008) conclude that:
Practitioners of mindfulness have recognized key benefits from cultivating attention in this way. 
By bringing ourselves into the present moment and away from future- and past-oriented narrative thinking (or critical commentary about the present moment) we shift our relationship to stress. We can think of the present moment as a vacuum chamber and that stress, anxiety, and depression-generating thoughts require an oxygen rich atmosphere to thrive. By being in the present moment we help ourselves as health care providers to moderate the challenges of stress, even having the opportunity to transform previously overwhelming situations into ones of challenge and mastery. 
This presence also helps us to be better clinicians. We are more present, more available, and better able to access empathy, compassion, and caring skills. The mindfulness teacher Sharon Salzburg noted, “the act of being completely present is truly an act of love.” Can we bring this love to our work? Mindful attention helps us to be wholehearted in our work and in full contact with both the joys and sorrows of patient care. When we are fully engaged we are devoting less internal resources to psychological and behavioral defenses and thus have more available for our patients. 
Cultivating the skills of mindfulness also gives us something to offer our patients. In any given moment we can encourage our patients to pay attention to their breathing, redirecting their attention away from painful narratives and into the present moment. The more we can embody mindful awareness the more we can give to our patients in this way.
In sum, mindfulness can help us to be the clinicians we aspire to be without paying the emotional cost of exhaustion and burnout. 
Whether nurses, physicians, or mental health providers we all endeavor to help our patients and we would like to provide this loving care in a way that does not damage our own health. We function within a highly stressful and often dysfunctional system of health care delivery. Mindfulness training can be a key component for coping with the demands of being a nurse today.
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Arnie Kozak, Ph.D. (http://exquisitemind.com) is a Licensed Psychologist and author of the recently published Wild Chickens and Petty Tyrants: 108 Metaphors for Mindfulness (Wisdom). 

References

Baer, R. (2003). Mindfulness Training as a Clinical Intervention: Conceptual and Empirical Review. Clinical Psychology: Science And Practice, 10(2), 125-143. 

Beddoe, A. E. & Murphy, S. O. (2004). Does mindfulness decrease stress and foster empathy among nursing students? Journal of Nursing Education, 43(7). 305-312. 

Carmody, J. et al. (2009). An Empirical Study of the Mechanisms of Mindfulness in a Mindfulness-Based Stress Reduction Program, Journal of Clinical Psychology, 65(6), 613-626. 

Davidson, R., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564-70. 

Day, P. O. & Horton-Deutsch, S. Using mindfulness-based therapeutic interventions in psychiatric nursing practice-part I: Description and empirical support for mindfulness-based interventions. Archives of Psychiatric Nursing, 18(5). 164-169. 

Day, P. O. & Horton-Deutsch, S. Using mindfulness-based therapeutic interventions in psychiatric nursing practice-part II: Mindfulness-based approaches for all phases of psychotherapy-clinical case study. Archives of Psychiatric Nursing, 18(5). 170-177.
Farb, N. et al. (2007). Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. SCAN. 


Grossman, P., et al. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research 57, 35-43. 


Kang, Y. S., Choi, S. Y., & Ryu, E. (2009). The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. Nurse Education Today, 29(5). 538-543 

Lazar, S. et al. (2006). Meditation experience is associated with increased cortical thickness. NeuroReport, 16. 1893-7. 

Luders, E. et al. (2009). The underlying anatomical correlates of long-term meditation: Larger hippocampal and frontal volumes of gray matter. NeuroImage, 45, 672-8. 

Ludwig, D. S. & Kabat-Zinn, J. (2008). Mindfulness in Medicine.  JAMA, 300(11), 1350-52. 

Lutz, A., et al. (2008). Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise. PloS ONE 3, e1897 

Mackenzie, C. S., Poulin, P. A., & Seidman-Carlson, R. (2006). A brief mindfulness-based stress reduction intervention for nurses and nurse aides. Applied Nursing Research, 19(2). 105-109. 

Pipe, T. B., Bortz, J. J., Dueck, A., et al. (2009).  Nurse Leader Mindfulness Meditation Program for Stress Management A Randomized Controlled Trial. Journal Of Nursing Administration, 39(3). 130-137. 

Shirey, M. R. (2007). An evidence-based solution for minimizing stress and anger in nursing students. Journal of Nursing Education, 46(12). 568-571.
Siegel, D. (2007). The Mindful Brain. New York: Norton.

“We are human beings who take form through an impetus to joy, interest, and concern”

posted by exquisitemind

A recent New York Times Blog by Judith Warner describes the author’s journey into mindfulness (http://warner.blogs.nytimes.com/2009/03/05/the-worst-buddhist-in-the-world/). The initial reaction of her husband was “I never thought that you, of all people, would get into that New Age stuff,”  That’s funny, Pema Chodron, whose work she is reading seems decidedly old age — 2500 years to be exact. The author describes the disorienting and perhaps even alienating effect when people around suddenly become less reactive — a consequence of embracing mindfulness practice. She notes this in one of her friends and sees it in herself interacting with an old friend. She cautions that mindfulness can be an extreme form of solipsism. I agree and I disagree. Americans often misappropriate mindfulness practice into something that becomes self-absorbed, but this is not inherent to the practice or the wisdom tradition from which it is derived. Mindfulness made significant mention in a special health issue of U.S. News and World Report. The work of Jon Kabat-Zinn and the Center for Mindfulness were featured, as well as the brain research of Richard Davidson in Madison. The cover image of the article shows a blissed out corporate woman sitting with her hands in mudra (ancient yoga-like postures for the hands). This is a stereotyped image of mindfulness and meditation in general. It suggests tranquility, transcendence, bliss, other-worldliness. And as with all stereotypes, the image is misleading and inaccurate. Transcendent piety is a caricature of mindfulness, cobbled from Buddhist images and through the marketing of meditation. We must be careful that such non-reactivity is authentic and not just our ego’s way of taking control of the situation. If we identify with the role of mindfulness we are missing the point. I tell my students that they will be more themselves rather then less if they travel this path. Transcendental piety could be evidence of what Chogyam Trunpga called spiritual materialism.
Judith Warner continues, “People who are embarked on this particular “journey of self-exploration,” tend to want to talk, or write, about it. A lot. But what they don’t realize — because they’re so in the moment, caught in the wonder and fascination and totality of their self-experience — is that their stories are like dream sequences in movies, or college students’ journal entries, or the excited accounts your children bring you of absolutely hilarious moments in cartoons — you really do have to be the one who’s been there to tolerate it.” I certainly have read such tracts, and have written my book Wild Chickens and Petty Tyrants: 108 Metaphors for Mindfulness (http://108metaphors.com) as a reaction against this style. I’m not sure Warner has gotten beyond the cultural role of mindfulness. Mindfulness is rather ordinary. At its simplest, it represents a process of getting to know ourselves, becoming intimate with our experience, as the teacher Larry Rosenberg points out. It is not about getting beyond ourselves; it is, rather, being ourselves more completely. I discuss this issue in one of the chapters in Wild Chickens when I quote Thoreau, “Beware of all enterprises that require new clothes, and not rather a new wearer of clothes.”  Mindfulness is a matter-of-fact orientation to experience that is native and accessible to all. What people often talk and write about and sometimes act out is that caricature of mindfulness. And if this is ego-laden then it isn’t authentic mindfulness.
Warner, I think, misses the point when she say, “For the truth is, however admirable mindfulness may be, however much peace, grounding, stability and self-acceptance it can bring, as an experience to be shared, it’s stultifyingly boring.” I don’t get this. If mindfulness leads us to equanimity (e.g., peace, grounding, stability, self-acceptance) it can’t be boring. Equanimity is a translation of the Pali uppheka that can also be rendered as interest. We become keenly interested in what happens, even when that happening is quotidian. Mindfulness is a pervasive and permanent cure for boredom because this moment is always interesting no matter what is happening.
Warner cautions, “I’ve also come to wonder if something desirably human is being lost in all this new and improved selfhood. That is to say: an edge. That little bit of raggedness that for some of us is really the heart of what makes us human.” Would that mindfulness practice could smooth all these edges. The limerence of practice may suppress these edges but doesn’t remove them. Ram Dass lamented that after many decades of practice he still had the same neuroses. We don’t lose our edges, we just learn to manage them better — in ways that are less self-destructive and less harmful to others. “We are human beings who take form though an impetus to  joy, interest, and concern.” This is what I tell my students when they fear losing themselves and becoming mindful zombies — falling into the same misconception as Warner. When we move on the path of mindfulness we learn to strip away the conditionings that make us reactive and habitual. In the space created, we can then move towards experience based on joy, interest, and concern for other living beings and the environment in which we live. We can become unencumbered in this way, and what would be wrong with that?

It’s a new day

posted by exquisitemind

It’s hard not to get caught up in the enthusiasm of the inauguration. People are excited and who can blame us? Obama is an orator who inspires us with invitations to the best parts of ourselves. People were queued up outside of Nectar’s (the famed Phish bar) for an inauguration party and the desire to see Obama’s inauguration speech. Millions gathered to be part of history. Obama’s speech was a call to action: ”Starting today, we must pick ourselves up, dust ourselves off, and begin again the work of remaking America.” This invitation sounds like an invitation to mindfulness. One of the metaphors in Wild Chickens and Petty Tyrants: 108 Metaphors for Mindfulness talks about falling down. If we can embrace a child-like enthusiasm, as if we were learning to walk, this getting up off the ground can be done in a matter-of-fact, if not a joyful way. We don’t spend our mental energy bemoaning the fact that we have fallen, we don’t berate ourselves for being clumsy. We act in the moment. We move confidently into the future when our attention is trained on this present. Obama concludes with the invitation: ”With hope and virtue, let us brave once more the icy currents, and endure what storms may come.” He invites us to embrace adversity with equanimity, and once again the challenge is to be in the present moment. If the current is icy, we will be cold; if a storm hits we will get wet. To be effective we can’t shy away from these ever-present realities, nor can we complain about them. Instead we engage the present with mindfulness. The metaphors in Wild Chickens provides the tools to make this happen. The book and the wisdom tradition it represents teaches the skills to keep our attention in the present, to scale back our complaining about a difficult present moment or shying away from it. They allow us to move effectively into the present to act, and to do so in ways that don’t cause further harm. We are challenged to move from the excitement of this historical day to embrace our new President’s call to action.

Wild Chickens in Uncertain Times

posted by exquisitemind
The current economic challenges we confront may qualify as wild chickens or evenpetty tyrants (petty tyrants can range from simply annoying to distraction to holding the power of life and death). The financial crisis reveals the impermanent matrix that underlies the workings of the world. Key people and institutions have shown us the dangers of ignorance, greed, and delusion. They attributed a solidity and value to things that were neither. The house of cards now reveals itself. We are confronted with a painful reality. The concept of “wealth” spills through our fingers like water. We are unable to grasp it; we cannot hold on to it. This has always been the case, we are now acutely aware of it. These challenging remind of us of the need to proceed through days with as much mindfulness as we can muster. If we can know in our bones that change is the order of the day we may be able to ride these waves of tumult with more equanimity.
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