1. Looking After Yourself, Looking After Others
Jo Soldan Doc.Clin.Psy Clinical Psychologist in Critical Care & Ko Awatea Counties Manukau DHB.
Sue Dykes MSc Dip Clin Psych Clinical Psychologist in Private Practice Mindfulness Auckland
Date:
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2. Coming onto room practice
Acknowledge all things of the morning, getting here, seeing people or not, head buzzing, maybe even next session!
Deliberately letting them go – nothing need to do in next 75 mins than be here – check in with self – not to change it but to just be aware – how am I feeling right now?
Body emotion mind
Gather Awareness to breath in out flow – not control
Expand to body - scan through body
Notice feet on floor, contact, posture
Silence 1 min? every time mind wanders bring it back – not judging – just noticing
Back to room
Turn to neighbour – say what you noticed – doing that (busy mind, slow down etc)

3. Illustration from ‘Quiet the Mind’ – Matthew Johnstone
You know about mindfulness – best way often t introduce is the opposite e- people recognise that - mindlessness
Illustration from ‘Quiet the Mind’ – Matthew Johnstone

4. Illustration from ‘Quiet the Mind’ – Matthew Johnstone

5. What is Mindfulness? Jon Kabat Zinn: Paying attention ‘on purpose’
Rooted in the present moment
Non judgmental
Story of John moving form eastern traditions ot medicine
Not – clearing your mind
Mindlessness – drive to work – not aware how you got there – frazzled – hard to focus
Automatic pilot
Preoccupied with past or future
Average time we conc in work before interruption – 3 mins

6. Mindfulness Based Stress Reduction
Jon Kabat-Zinn and Saki Santorelli
University of Massachusetts
8 week group programme, with one day silent retreat
Various mindfulness practices
Strong research base
Modified programmes used in many areas
Started in 1979
Working with peoplewith serious healht issues
Mindfulness is not relaxation – achieveing out of body experience
Working with patitns with pain not going away – enabling them to sit with different relationship with the pain etc
Sit with unpleasant

7. Efficacy of Mindfulness Based Stress Reduction
Depression
Anxiety
Psoriasis
Chronic Pain
Cancer
Mindful Eating.
Evaluated on various patient groups
Indeed starting to be added to Nice guidelines

8. A Beginners Mind Raisin exercise Focus Clarity Calm Openness
Equanimity

9. Following the breath

10. Why the breath? Accessible Regular Away from thinking
Only ever in the present moment
At the intersection of body and mind
Innate capacities for calming

11. Mindfulness restores the balance
Too much sympathetic nervous system (fight or flight) leads to problems remembering, fatigue, lack of energy and frequent illness.
Parasympathetic system (rest and digest) counteracts this
Huge amount of neuro research at the moment – v exciting
When frazzled thought control shifts from the prefrontal area to the more primitive emotional circuitry of the mid brain/limbic system.
This gives priority to speed and knee-jerk reactions over thoughtfulness and creativity.
Left activated by meditiationWandering mind
Fragmented attention
Clinging/Ruminating
Avoidance

12. The nature of the mind Wandering attention “monkey mind”
Fragmented attention, leads to mistakes
Clinging/chasing after/ruminating
Experiential avoidance – what we resist persists

13. Illustration from ‘Quiet the Mind’ – Matthew Johnstone

14. Facing the unpleasant
When we bring full awareness....to the whole of our experience....our relationship to the difficult emotions can shift dramatically
Williams et al. In The Mindful Way Through Depression( 2007)

15. Illustration from ‘Quiet the Mind’ – Matthew Johnstone
Not fighting with mind to insist on calm – but understanding the mind
Illustration from ‘Quiet the Mind’ – Matthew Johnstone

16. Outcomes of Mindfulness Practice
Focus, clarity and wisdom
Interruption of autopilot (ruminating,etc)
Metacognitive awareness
Approaching rather than avoiding
Responding rather then reacting
Compassion

17. Matthieu Ricard

18. Effects of meditation on the brain (Lazar, 2013)
Increased gray matter in long-term meditators, and after 8 weeks of MBSR, in regions involved in:
Learning and memory
Emotion regulation
Empathy
Self-referential processing
Decreased gray matter density in Amygdala, correlated with perceived decreases in stress levels
“meditation may result in enduring, beneficial changes in brain function,”Frontiers in Human Neurosciences, November 2012
1)Insula (anterior)- interoception, self-awareness ,empathy for emotions (Holzel et al. 2008, Lazar et al. 2005)
2) Hippocampus – visual-spatial memory, establishing context, emotion regulation, inhibiting amygdala and cortisol (Holzel et al. 2008, Luders et al.2009)
3)Prefrontal cortex -executive functions,(cognitive processing) attention control , decision-making, And sensory cortex....observing internal and external physical sensations(Lazar et al. 2005, Luders et al. 2009)
Reduced cortical thinning with aging in 1) and 3),(Lazar et al. 2005)
Also, studies showing changes after only 8 weeks of MBSR training, ie in novices....(in 4 regions, hippocampus, posterior cingulate cortex (contect and self-reference), temporal-parietal junction (empathy and compassion, and monitoring of internal bodily states...ie embodiment)and part of the cerebellum, NB Insula changes were not stat. Signif after 8 weeks))

19. Why - Mindfulness at Work?
Association with Emotional Intelligence
More engaged in work, energised and less anxious. Reduced Cortisol, increase immunological response to flu jab (Davidson et al 2004)
70% reduction in sick leave
American Army safeguards against distraction and emotional reactivity (reduced Depression and PTSD, clearer thinking in stressful situations)
"It's like doing push ups for the brain."
Emotional Intelligence(85% of the difference between good and average senior lead
Davidson rct in lab workers
Outcomes demonstrate Mind body interaction
Transport worker s- 70% reduction in sick leave for anx and depression – cited in mental health foundation mindfulness report 2010

20. Mindfulness at work – moved fr0m patient groups into resilience and workplace
Not surprisingly corporates there first
Average conc is 3 mins before ibterrupted at work
Mindful e mailing etc
Write ..breathe
Read form others perspective

21. Why Relevant in Health Care
Burn Out and Depression are known to be high in staff.
Increase Resilience to Nature of our Work.
Mirroring Neurons - A way of balancing brain activity.
Clearer Thinking – Patient Safety.
Self Compassion
PAFCC
Average time we concentrate for in work before interruption – 3 mins
Burn out/peak performance works for a sprint, but does not provide the resilience needed for a marathon
Mirroring – we either learn to block it out – or deal with this brain activity – need to over develop our parasympathetic system (balance sympathetic/parasympathetic)
Clearer thinking – decreased amygdala activity - Meditation training has been shown to affect emotional processing in the brain outside of the meditative state
Study group (MBSR _ showed decreased activity in the right amygdala in response to emotional images
Overall these results are consistent with the overarching hypothesis that meditation may result in enduring, beneficial changes in brain function, especially in the area of emotional processing
Research at Mass General Hospital reported in Frontiers in Human Neurosciences November 2012
Self compassion - (recent paper of self esteem/self compassion following critical incidents)
PAFCC stidies reporting staff feel better able to be present with patient/family sand listen to them

22. Efficacy of Mindfulness Training in Health Care
Reductions in stress, depression, anxiety, burn out.
(Krasner et al (2009) Shapiro et al 2005,Corey et al 2006,Britt et al 2009 )
Increased Empathy (Krasner 2009, Shapiro et al 2009)
Staff report increased ability to listen and be patient-centered
(Krasner 2009)
(Krasner et al (2009) - Drs, Shapiro 2005 study of HCP ,Corey et al 2006 –nurses,
Britt et al stress in nurse leaders )groups studied - Nurses, doctors, mixed groups and nursing leaders
Empathy – demo’d to drop off as students meet patients!
Britt et al 2009 – 4 week Mindfulness course – reduced self reported measures of stress journal of nursing administration
Shapiro int jnl stress management vol 12 no 2– 8 week mbsr reduced stress, increase self compassion and qoL (8/18 dropped out of intervention)
Corey et al 2006 applied nursing research Waiting list control – sig improvements in burn out, relaxation and life satisfaction.
Coehn Katz et al -(12/14 nurses completed the prog)nurses sig reduction in burn out over waiting list controls – 8 week mbsr

23. Not Just Self Care - Compassion
Nurses told to focus on compassionate care
Three-year strategy unveiled to tackle 'crisis in standards of care' amid concerns over treatment in NHS hospitals and care homes
Trainee nurses should be selected on compassion
to avoid repeat of Mid-Staffs scandal:
As can see form these headlines - Concern in current health care system about how we maintain compassion in health care staff
How do we put the compassion back into healthcare?: Full round table discussion
In the wake of the Francis report, the BMJ gathered experts to discuss compassion in the health service.

24. With help of learning and development – Carole Stiles our course organiser..,.,.

25. Mindfulness at Work in Counties Manukau
Abbreviated Courses 4 x 2 hours
Intensive – 8 hour day followed by follow up at 4 weeks
Lunchtime sits
Integrated into work day
Tell oyu a bit about the course – doing with Dianne May form Mindfulness Auckland
Groups are Educational and Experiential – Practice is key
Exercises such as raisin, mindful communnication
Formal Practice – Body Scan, Sitting Medication, Walking Meditation, Mountain meditation.
Short Practices – Three minute breathing Space, STOP whilst washing your hands, Mindful movement -Cued by everyday events.
Raisin Exercise, Pleasant and Unpleasant Events, Mindful communication - listening and e mails.
Attitudes of Mindfulness, Stress and Mindfulness, Accepting and Allowing, Thoughts, Stress Reactivity.

26. Mindful Minute Short in work practices eg
As when came in – sot comfortable if comfortable clos eyes
Become aware of breath – not control it – focus on physical sensations of breathing – count them – 1 min
Now you know how to readily take 1 min breathing space
Can do anywhere any time – groups choose a cue – computer loading, phone ringing, climbing stairs ec

27. S stop what you’re doing T take a breath O observe your environment (int and ext) P proceed
Another great one in clinical area
STOP whilst WASHING HANDS

28. Mindful communication – participants get excited – what would it be like if in work we really listened to one another

29. Mindfulness Based Resilience in the Workplace at Counties.
Quantitative outcomes
p value
paired sample test
Brief Resilience Scale
Maslach Burn Out Inventory :
Emotional Exhaustion
Depersonalisation
Perceived Stress Score
MBI D and PI and PSS t test others signed rank test
Personal Accomplishment
Irene Zeng
Research Office Ko Awatea

30. Mindfulness Based Resilience in the Workplace CMDHB/Ko Awatea
Has the course impacted on you professionally?
100%
Have you noticed any positive change in your reactivity at work?
95%
Have you noticed and positive change in your ability to handle stressful situations
97%
Would you recommend the course to colleagues?
100% 

31. Mindfulness Based Resilience in the Workplace CMDHB/Ko Awatea
“I believe the course is a real gift from the organisation in terms of the cost and time commitment. However I do think this is more than outweighed by the positive benefits that follow that can be taken into the participants personal and professional life”
“it has huge benefits for reducing stress levels and produce a more positive attitude which is noticed by others”

32. Mindfulness Based Resilience in the Workplace CMDHB/Ko Awatea
Changes noticed in themselves “more able to focus on the moment – I can do the work faster” “Singing again” “able to handle things differently, confident, better at making decisions, cope with stress better” “I am much more relaxed and alert in dealing with stressful issues and concerns and people”
Remember their jobs havent changed – they are being more present – their capacity to sit with it - different attitude to it

33. Mindfulness Based Resilience in the Workplace CMDHB/Ko Awatea
Many reported colleagues noting changes in them over the 4 weeks:
“Not taking negative feedback so personally”
“Seems calmer” “More even tempered”
“Not getting overwhelmed by stressful situations”
“Much more present and confident”
“Less anxious and more positive about things”
“My manager attended the course last year and speaks very highly of it. There is also a noticeable change in his demeanour and stress response. I would like to see if I can obtain the same benefits from the programme”
Next quote speaks directly to the patient safety potentials - doctor talking about impact of doing short workplace pratcises

34. Mindfulness Based Resilience in the Workplace CMDHB/Ko Awatea
“I have noticed that I am as present with the last patient on my list as the first
If I tell you this was an Anaesthetist even more powerful
This quote supports my vision – bear with me…..

35. Not just Self Care – Patient Safety
Mid Staffordshire NHS Trust 'should be dissolved'
Another pressing issue in health care is patient safety and compassionate care
mid staffs
Recent report about this by Don Berwock Obama IHI

36. ‘A promise to learn - a commitment to act’
“Leaders and managers should actively support staff by
excellent human resource practices, promoting staff health
and well-being” (Berwick Report 2013).
Amongst other things they call for attention to staff well being
Sets staff well being as central to achieving safety

37. Escape Fire – Don Berwick
There are a number of things we need to do in health care
“The first is the toughest: we need to face reality. This is very very hard….Our challenge is to have the courage to name clearly and boldly the problems…we must find ways to do this without either marginalizing the truth teller or demoralizing the good people working in these bad systems”
Quote form Dons early work on patient safety and health care system
Mindfulness – sitting with unpleasant, non judging, acceptance etc……..
RCA……

38. Mindfulness in Healthcare
Staff Resilience – reducing Burn out, Depression, Anxiety.
Increasing Joy at Work
Supporting Compassion, Patient Centered Care
Patient Safety – being present
– ability to sit with difficulty
Summary of potential benefits- some proven now others need more research
Continue to measure
Find ways of tapping into any change in patient safety – compassion etc
Find ways tp evaluate and research impact on patient safety

39. Resources
‘The Mindful Workplace: Developing Resilient Individuals and Resonant Organizations with MBSR’ Michael Chaskalson
‘Search Inside Yourself: The Unexpected Path to Achieving Success, Happiness (and World Peace)’ Chade-Meng Tan
CALM.ac.nz
- 5 ways to well being - take notice
- online courses
(Paul Gilbert)
(Krisitin Neff)
Best resource - having a go! / developing a practice …….