Mindfulness Skills for Self Reflection and Self Care Jennifer Egert, Ph.D. Montefiore Medical Center Department of Family and Social Medicine jenniferegert@gmail.com

Good morning

What is Mindfulness? Sati in Pali Connotes awareness, attention, & remembering Attitudinal Foundation Non-judgment Acceptance

Mindfulness Paying attention, on purpose, in the present moment, nonjudgmentally (Kabat-Zinn, 2003). 1. Awareness 2. Of present experience 3. With acceptance

Inviting a Beginner’s Mind

Practice

Discussion What was the experience like for you? How might this training impact: Self-Care Self-Reflection Our role as teachers

Insights from Mindfulness Practice The ever changing nature of life (therefore efforts to ‘hold onto’ or ‘push away’ causes suffering) Thoughts are not reality Difficulties are a normal part of life All we ever actually experience is the present moment Self-Compassion in the face of suffering

Mindful Self-Reflection Insights from Practice Non-verbal approach to self-awareness Presence Listening Less attachment to stream of emotions/reactions (resiliency) Compassion

R.A.I.N Tara Brach R = Recognize Pause and recognize that you are experiencing suffering A = Allow/Accept Allow the suffering to just be there, without pushing away, without judgment I = Investigate Explore what is going on? Is the situation itself causing your suffering or is there a larger source of? Again, to investigate without judgment, as if you were a sociologist of the experience. It is simply about what is. N = Non identification We see the experience not as “who we are,” or identity, but rather as an experience.

Mindful self-care for health care providers Following training in mindfulness (MBSR and modified MBSR training… Decreased emotional reactivity (Britton, W. B., Shahar, Szepsenwol, Jacobs, 2012). Reduced Burnout, Improved stress management, well being in psychotherapists (May & O’Donovan, 2007; Jain et al, 2007) Increased empathy and self-compassion in medical students (Shapiro et al 1998) Mindfulness as a Self-Reflective Practice (Epstein, 1999)

Mindfulness in Medical Education Resiliency for managing an increasingly complex, demanding medical system. Burn-out buffer. Improved Doctor-Patient Communication Skills to teach patients to manage stress, pain, affect regulation concerns and chronic illness demands.

STOP S = Stop What you are doing T = Take a breath O = Observe what is happening… around you… within you (Thoughts, Feelings, Body Sensations) P = Proceed with your day

Thank you May you be safe May you be healthy May you have peace May you go through life with ease and well-being. A Metta Meditation (Lovingkindness Meditation). See Sharon Salzberg’s book: “Lovingkindness: The Revolutionary Art of Happiness”

Resources Please see my website for mindfulness resources beyond that listed here: www.jenniferegert.com Books: Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness by Jon Kabat-Zinn A Mindfulness-Based Stress Reduction Workbook, By Bob Stahl and Elisha Goldstein Heal Thyself: Lessons on Mindfulness in Medicine By Saki Santorelli Coming to Our Senses: Healing Ourselves and the World Through Mindfulness, Jon Kabat Zinn Audio Tapes and Discs Guided Mindfulness Meditation (Disc of Guided Mindfulness exercises) by Jon Kabat-Zinn Mindfulness for Beginners (Audio Book mindfulness with exercises) by Jon Kabat-Zinn The Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts has many audio tapes for body scans, sitting meditation, yoga, etc. http://www.umassmed.edu/cfm/index.aspx Organizations, websites: Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School http://www.umassmed.edu/cfm/index.aspx MARC: Mindful Awareness Research Center at UCLA
free audio downloads: http://marc.ucla.edu/body.cfm?id=22 On the Healer’s Art: http://www.rachelremen.com/

Three Minute Breathing Space  AWARENESS Bring yourself into the present moment by deliberately adopting an erect and dignified posture. Feel your feet on the ground, bringing yourself into the room…feel your body in the chair. If possible, close your eyes. Then ask: “What is my experience right now…in thoughts…in feeling…and in bodily sensation?” Acknowledge and register your experience, even if it is unwanted.   GATHERING Then, gently redirect full attention to breathing, to each in breath and to each out breath as they follow, one after the other…Your breath can function as an anchor to bring you into the present and help you tune into a sense of awareness and stillness. EXPANDING Expand the field of your awareness around your breathing, so that it includes a sense of the body as a whole, your posture, and facial expression. What does it feel like to be in my own presence From: Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse, Zindel V. Segal, J. Mark G. Williams, John D. Teasdale, J. Mark G. Williams

Mountain Meditation Mountain Meditation Assume a relaxed yet straight posture Imagine a string attached to the spine pulling up towards the ceiling Imagine you are like a mountain. Arms like slope of mountain. Head is peak. Whole body is majestic and magnificent like a beautiful mountain Like the mountain, grounded, solid and still, rooted in the earth and beautiful just as you are whether seen by people and animals covered by snow in winter, green in spring, wrapped in clouds, shrouded in fog, dry or wet. As you sit majestic and dignified, the world continues to change, the sun comes up, reaches its zenith and sets in the evening. Clouds come and go in the sky, sometimes rain or snow on you, you get wet, eventually dry, Let all inner thoughts and feelings be like these inner weather events Sometimes animals come and take up residence on you, sometimes they leave Everything keeps changing, even you the mountain changes, but through these changes remain solid, rooted and dignified Let your breath be like the wind that blows across the mountain’s face, always changing. Allow yourself to sit as a mountain for 10 to 15 minutes. From Jon Kabat-Zinn’s: Full Catastrophe Living

Mindful, By Mary Oliver from the book, “Why I Wake Early” Mindful, Mary Oliver Every Day I see or I hear something that more or less kills me with delight, that leaves me like a needle in the haystack of light. It is what I was born for— to look to listen to lose myself inside this soft world— to instruct myself over and over in joy, and acclamation. nor am I talking about the exceptional, the fearful, the dreadful, the very extravagant-- but of the ordinary the common, the very drab, the daily presentations. Oh, good scholar, I say to myself, how can you help but grow wise with such teachings as these-- the untrimmable light of the world, the ocean's shine, the prayers that are made out of grass?

The Guest House, Rumi The Guest House This being human is a guest house Every morning a new arrival. A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor. Welcome and entertain them all! Even if they are a crowd of sorrows, who violently sweep your house empty of its furniture, still treat each guest honorably. He may be clearing you out for some new delight. The dark thought, the shame, the malice, meet them at the door laughing, and invite them in. Be grateful for whoever comes, because each has been sent as a guide from beyond.