2. Utilizing Mindfulness Training to Reduce Stress and Improve Well-being in CF Staff Elizabeth Hente, MPH Cincinnati Children’s Hospital Cincinnati, OH

3. Disclosure
Elizabeth Hente, MPH There are no relationships to disclose related to this presentation.

4. Why focus on stress management?
Wellness, Education, and Learning Laboratory (CF WELL)
Focus areas include:
Project Areas: exercise, nutrition, school success, sleep, and stress management
Emphasis on wellness from the time of diagnosis
We must practice what we preach!

5. Why focus on staff stress management?
On a scale from 1-10, how stressful is your job?
Range = 3-9, Mean = 6.55
Why is it stressful?
40%
Competing demands/lack of time
30%
Stress is relative/comes and goes
10%
Good self-regulation, Chronic care population, Pressure to perform

6. How does stress impact us?
Depression, emotional exhaustion, and anxiety
Psychosocial isolation
Decreased job satisfaction
Reduced self-esteem
Disrupted personal relationships
Loneliness
Poor attention and concentration
Weakened decision-making skills
Reduced ability to establish effective relationships with patients
Shapiro, S., Brown, K., & Biegel, G. (2007). Teaching Self-Care to Caregivers: Effects of Mindfulness-Based Stress Reduction on the Mental Health of Therapists in Training, Training and Education in Professional Psychology, 1(2),

7. Mindfulness
Mindfulness is “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to things as they are.”
(Williams, Teasdale, Segal, and Kabat-Zinn, 2007)

8. Mindfulness-Based Cognitive Therapy (MBCT)
Pioneered by Segal, Teasdale, & Williams
Based on components of Jon Kabat-Zinn’s mindfulness-based stress reduction
Originally adapted to prevent relapse of depression
Incorporates elements of cognitive behavioral therapy (CBT)
Recognizing cognitive distortions
Relapse prevention plan
Relating to others in different ways, changing behaviors

9. Overview of Staff Training
MCBT expert and trainer, Dr. Richard Sears
Six 1-hour sessions held at Cincinnati Children’s Hospital during work hours (9a-5p)
Homework, skill-building completed between sessions
Sessions video recorded, available online
All CF health professionals invited - adult and pediatric, multi-disciplinary team

10. Practical Application
3 minute breathing exercise, body scan
Acknowledgement of automatic thoughts
Mindful walking, eating
Identification of positive/negative experiences + observation of our reactions to experiences
Acceptance of current state, stepping into the difficult situations
Audio link for 3 minute breathing exercise:

14. Nurturing or Depleting?
What does a typical day look like for you?
Take 5 minutes to write down your daily activities from the moment you wake up until you go to bed at night
Review each item and label them:
Nurturing: is this task/event building into you and your energy level?
Depleting: is this task/event reducing your energy and/or mood?
Look at your list as a whole:
What is your ratio of Nurturing to Depleting?
Are there opportunities to add more Nurturing tasks?
Are there Depleting tasks you can reduce or remove entirely?
How can you balance this ratio when you know you’ll have a draining day?

15. Feasibility and Acceptability of Training
15-28 people attended each session, average=19
On average, how often did you practice skills between sessions?
On a 1-10 scale, how important has this program been for you?
0 times
1-2 times
3-4 times
5-7 times
8+ times
17%
39%
11% 1 2 3 4 5 6 7 8 9 10
18% 0% 6%
35%
12%

16. Effectiveness of Training
Assessment
p value
Empathy
<0.0005
Perspective Taking
0.02
Resiliency
Perceived Stress
0.00
Negative Affect
0.04
Positive Affect
0.64
Anxiety
Depression
0.06
Fatigue
0.25
Sleep Disturbance
0.86
Depersonalization
0.01
Emotional Exhaustion
0.46
Differences in pre-post surveys (n=24):

17. How has this program impacted your professional career?
“I am able to keep my mind more focused as it wanders.”
“I feel I am more able to handle stress, am more thoughtful about how I cope or experience my emotions, and am better at putting work activities in perspective.”
“I have started to go into patient encounters with a different frame of mind and have been more able to consider other people’s responses to things and perspectives before reacting. Still work to do!”
“Better sleep. Less reactive.”
“Stepping back and looking at experience that is clouded by context.”

18. Lessons Learned
Anticipate challenges before starting training (scheduling poll, videotape for future viewing)
Better engagement of staff between sessions
Find a trainer with practical application
These are not useful skills for everyone…and that’s okay!
Emphasize these skills as standard practice

19. Next Steps Monthly booster sessions – reinforce skills, self-care
More intensive training for small group of staff
Plans to offer skill building to patients and families

20. Thank you! Research Team:
Thomas Boat, MD – Pulmonary Medicine, Cincinnati Children’s Hospital
Sian Cotton, PhD – Center for Integrative Health and Wellness, University of Cincinnati
Harini Pallerla, MS – Senior Research Assistant, University of Cincinnati
Richard Sears, PhD – Center for Integrative Health and Wellness, University of Cincinnati
Christopher Siracusa, MD – Pulmonary Medicine, Cincinnati Children’s Hospital
Resources available on Dr. Richard Sears’ website: