Mindfully Building Resilience Among Interdisciplinary Primary Care Teams Dana Dharmakaya Colgan, MS, MA, CYI-500 Eli Dapolonia, MA Michael Christopher, PHD Pacific University, Hillsboro, Oregon Eric Oslund, MS Virginia Garcia Memorial Health Center, Hillsboro, Oregon

BURNOUT Percentage of Primary Care Physicians endorsing clinical elevated symptoms of burnout Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D.,... & Oreskovich, M. R. (2012). Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of internal medicine, 172(18),

RESILIENCE Dynamic process of positive adaptation within the context of significant adversity

FOSTERING WELLNESS & RESILIENCE RESILIENCE MINDFULNESS DEVELOPS 1.Self-Awareness 2.Skillful Self-Regulation 3.A positive relationship between self and others & prosocial behavior (Vago, 2012) 1.Self-Awareness 2.Skillful Emotional Regulation 3.Communities of Care (Krasner, Epstein et al., 2009)

MINDFULNESS TO PROMOTE WELLNESS

ABSENT IN THE LITERATURE Cultural Considerations & Adaptations for IPCTs Address the unique ethos of intact interdisciplinary primary care teams Enhance feasibility for onsite delivery

MINDFULNESS- BASED WELLNESS & RESILIENCE TRAINING Designed to Increase resilience & reduce burnout among members of intact primary care teams Informed by Resilience Theory Science of Mindfulness and Compassion Psychophysiology functioning of Stress Based On MBSR & Mindful Practice curricula Delivered in eight-60 minute weekly sessions Emphasizes Experiential practice Integration of informal practices into work environment

MINDFULNESS- BASED WELLNESS & RESILIENCE TRAINING Designed to Increase resilience & reduce burnout among members of intact primary care teams Informed by Resilience theory Science of mindfulness and compassion Psychophysiology functioning of stress Based On MBSR & Mindful Practice curricula Delivered in eight-60 minute weekly sessions Emphasizes Experiential practice Integration of informal practices into work environment

MINDFULNESS- BASED WELLNESS & RESILIENCE TRAINING Designed to Increase resilience & reduce burnout among members of intact primary care teams Informed by Resilience Theory Science of Mindfulness and Compassion Psychophysiology functioning of Stress Based On MBSR & Mindful Practice curricula Delivered in eight-60 minute weekly sessions Emphasizes Experiential practice Integration of informal practices into work environment

MINDFULNESS- BASED WELLNESS & RESILIENCE TRAINING Designed to Increase resilience & reduce burnout among members of intact primary care teams Informed by Resilience Theory Science of Mindfulness and Compassion Psychophysiology functioning of Stress Based On MBSR & Mindful Practice curricula Delivered in eight-60 minute weekly sessions Emphasizes Experiential practice Integration of informal practices into work environment

MINDFULNESS- BASED WELLNESS & RESILIENCE TRAINING Designed to Increase resilience & reduce burnout among members of intact primary care teams Informed by Resilience Theory Science of Mindfulness and Compassion Psychophysiology functioning of Stress Based On MBSR & Mindful Practice curricula Delivered in eight-60 minute weekly sessions Emphasizes Experiential practice Integration of informal practices into work environment

Mindfulness MBWR Self Compassion Interoceptive Awareness Resilience Burnout

UNIQUE FEATURES MBWR Provided to intact multidisciplinary primary care teams Experiential & informal exercises have been modified Pranayama practices are taught to regulate the ANS Teams develop personalized strategies to cultivate resilience as a team integration into daily work environment

UNIQUE FEATURES MBWR Provided to intact multidisciplinary primary care teams Experiential & informal exercises have been modified Pranayama practices are taught to regulate the ANS Teams develop personalized strategies to cultivate resilience as a team integration into daily work environment

UNIQUE FEATURES MBWR Provided to intact multidisciplinary primary care teams Experiential & informal exercises have been modified Pranayama practices are taught to regulate the ANS Teams develop personalized strategies to cultivate resilience as a team integration into daily work environment

UNIQUE FEATURES MBWR Provided to intact multidisciplinary primary care teams Experiential & informal exercises have been modified Pranayama practices are taught to regulate the ANS Teams develop personalized strategies to cultivate resilience as a team integration into daily work environment

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Orientation to Mindfulness

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Awareness & Attentional Allocation Kindness, Curiosity, & Non-reactivity

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Body Scan

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Stop Breath Body Be

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Mindful Breathing Extended Exhalations Diaphragm Breathing Alternative Nostril Breathing

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Just This Breath

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Defusion

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Being with Suffering Compassion for Self & Others

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Body Scan With a Willingness Practice

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Responding vs Reacting

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act May we be safe May we be peaceful May we be healthy May we be at ease

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Mindful Walking Exploring with 5 Senses

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Mindful Listening with patients & colleagues

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Resilience & the Myth of Balance

Session One Automatic Pilot and Mindfulness Session Two Mindfulness Begins in the Body Learning to Notice Session Three Anchoring into the Breath Session Four The Observing Mind Session Five Being with Suffering: Ours & Others Session Six Compassion for Self & Others Session Seven Beginner’s Mind & Authentic Presence Session Eight Resilience: It’s a balancing act Mindful Breathing Prior to Team Meetings Mindful Scrubbing Visual Reminders Verbal Supports

PRELIMINARY FINDINGS Feasible & Acceptable 100% retention 88% attendance Focus Groups & Surveys revealed Enhanced team cohesion Increased adaptive coping Increased quality of care Increased quality of life and work life balance

Co-variates = expectation effects & baseline scores Wait-list Control Pilot Trial Meaningful Change

FUTURE DIRECTIONS Analysis 3-month follow up data Including dose effects Larger RCT Investigate the effects on Pt – Provider Communication Pt perceived trust Biomarkers of stress

PROMOTING MINDFULNESS & RESILIENCE

MANY THANKS Virginia Garcia Memorial Health Center Gill Munuz Tanya Kapka, MD and Geoffrey Cardon, MD Eric Olsund Michael Christopher, PHD Resilience & Mindfulness Lab at Pacific University Eli Dappolonia, MA