Introduction to Mindfulness for SW Peninsula GP Trainers workshop

1. Mindfulness
1. What is mindfulness?
2. Benefits of mindfulness
3. Applications of mindfulness
training

2. Does Mindfulness training for healthcare
professionals improve outcomes for
themselves and their patients?
Dr Stephanie Jackson DipSIM

3. What is mindfulness?

4. Exercise

5. The term mindfulness refers to a quality of
awareness that includes the ability to pay
attention in a particular way: on purpose,
in the present moment, and non-
judgementally (Kabat-Zinn, 1994)

6. Mindfulness – a Buddhist teaching
7 fundamental attitudes:
• Non-judging
• Beginner’s Mind
• Non striving
• Accepting
• Patience
• Trust
• Letting go

7. Mindfulness training is . .
• An integrative mind-body based approach that helps people change
the way they think and feel about their experiences, especially
stressful experiences.
• It involves paying attention to our thoughts and feelings so we
become more aware of them, less enmeshed in them, and better
able to manage them.
• Mindfulness teaches us how to accept out thoughts without
unhelpfully identifying with them.
• When people practice mindfulness, they are encouraged not to aim
for a particular result but simply to “do it” and see what happens.
Mental Health Foundation. Mindfulness Report, 2010.

8. Background
• 1979 – Mindfulness Based Stress Reduction
(MBSR)
• 2000 – Contemplative Neuroscience
• 2004 – Mindfulness Based Cognitive Therapy
(MBCT)
• 2000 - 2011 exponential growth in published
papers

9. Mindfulness-Based Stress Reduction
(MBSR)
• 8 week group participation program
• 2 hours teaching time per week
• Home practice – 45 mins/ day for 6 days
• Body awareness, yoga, walking and sitting
meditation
• One day silent retreat
• Plus variations on this core structure . . .
• Individual compliance with homework will vary.

10. Mindfulness-based Cognitive Therapy
(MBCT)
• Developed by Segal, Williams and
Teasdale, Oxford, 2004
• Same structure with cognitive therapy
component
• Recommended by NICE for the prevention
of depression for those with 2 + previous
episodes.

11. What are the benefits of
mindfulness training and how
does it work?
• Cognitive Neuroscience
• Psychology
• Physiology

13. Mechanisms of Mindfulness
• Attention
• Intention Control (emotional regulation)
• Attitude (a specific attitude marked by
friendliness and acceptance)
Shapiro et al, 2006

14. Cognitive Neuroscience

15. •Long term meditators induce high amplitude gamma synchrony (associated
with attention, conscious perception, learning and working memory)
Lutz et al, 2004. Long term meditators self induce high amplitude gamma synchrony
during mental practice. PNAS, 101(46), pp16369-16373
•Mindfulness is associated with enhanced prefrontal cortical regulation
of affect through labelling of negative affective stimuli (emotional regulation)
Creswell et al, 2007.. Psychosomatic Medicine, 69, pp.560-565
Increases in regional gray matter concentration in left hippocampus,
posterior cingulate cortex, temporo-parietal junction and
cerebellum compared to controls
(learning, memory, emotional regulation and perspective taking)
Holzel et al, 2011. Psychiatry Research: Neuroimaging, 191, pp.36-43
Significant increases in left-sided anterior activation (Left pre-frontal cortex)
(previously associated with positive affect and approach orientated behaviour)
Davidson et al, 2003. Psychosomatic Medicine, 65, pp.565-570

16. What does this mean?
• Meditation is associated with increased attention
and affective processes
• Brain is flexible and can be trained and its
function can alter over time.

17. Psychological outcomes

18. Why is Mindfulness helpful?
Mindfulness may aid well-being through a number
of mechanisms:
• Greater insight
• Improved problem-solving
• Better attention
• Less selfishness and neurosis
• More acceptance
• Greater enjoyment of life
• Less “beating ourselves up”
• Better mind-body integration

19. Mindfulness-based stress reduction for
stress management in healthy people
• Design: Review & meta analysis – 10 low
quality studies
• Results:
• MBSR – non specific effect on reducing stress
and enhancing spiritual values
• Reduce ruminative thinking and trait anxiety
• MBSR increases empathy and self compassion
Chiesa & Serrett, 2009, Clinical Psychology Review,31, pp.449-464

20. Physiology outcomes

21. Short term meditation improves attention
and self regulation
• Partipants: 80 Chinese undergraduates
• Randomly assigned – 5 days, 20 mins/day
• Outcomes
• Lower salivary cortisol
• Higher salivary IgA concentrations
• In response to stress (mental arithmetic task)
Tang et al, 2007. PNAS, 104(43), pp. 17152-17156

22. How it works
• Develops awareness
• Reduces anxiety and stress in present
moment
• Prevents rumination
• Promotes healthy coping strategies

23. Healthcare professionals
• Evidence for:
• Decreasing stress, negative effect, rumination, both state
and trait anxiety
• Increasing positive effect, self compassion, and QOL
• Clinical skills: increasing empathy and improving care-
giver patient relationship

24. Exercise

25. Applications of Mindfulness Training

26. Transport for London workers
• Mindfulness based programme led to major
changes in health related absenteeism
• Days taken off due to stress, depression and
anxiety fell by over 70% in following 3 years
• Absences for all health conditions were halved

27. Of those who took course:
• 80% said their relationships had improved
• 79% said they were more able to relax
• 53% said they were happier in their jobs
Mental Health Foundation (2010) Mindfulness Report, London.
Executive summary available from:
http://www.bemindful.co.uk/media/downloads/Executive%20summary.pdf

28. Healthcare professionals work in stressful
environments, with long hours, heavy caseloads
and limited control over their working conditions.
Added to this are frequent restructuring of
organisations and changing guidelines about
practice. Burnout is common, as are associated
physical health problems (Irving et al, 2009).

29. Doctors
• Reduction in psychological stress
• Improves quality of life
• Improvement in performance
• Reduced physician burnout
(Shapiro et al., Int J of Stress Manag, 2005; 12: 164-176)
(Hassed et al., Adv Health Sci Educ, 2009; 14: 387-398)

30. MBSR for Healthcare professionals: results
from a randomised trial
• Intervention: 8 week MBSR course - physicians,
psychologists, nurses, social workers, physiotherapists
• Results: Effective for reducing stress and increasing
QOL and self compassion in healthcare professionals
• Other possible outcomes: enhancement of
working relationships / patient care
Shapiro et al, 2005. International Journal of Stress Management, 12(2), pp. 164-176

31. Mindfulness and
Resilience
Dr Duncan Shrewsbury,
Dr Rebecca Viney, Dr Paquita de Zuluetta

32. Resilience
• Positive Psychology
• “falling over 5 times, getting up 6”
• • Bending without breaking
• • Bouncing back
• • Self righting
• • Learning and growth

33. Patients
• Mindfulness has been used for patients suffering
with:
• Low mood or Depression
• Anxiety and panic
• Stress
• Conditions such as chronic fatigue, chronic pain,
fibromyalgia, high blood pressure, psoriasis,
sleep disorder and headaches

34. Mindfulness helps with the art of Medicine

35. • Medicine has traditionally been described as a
healing profession. Healing can be defined as
being cured when possible, reducing suffering
when cure is not possible, and finding meaning
beyond the illness experience (Scott et al, 2008).

36. NICE guidelines for healing

37. • Mindful practice supports healing relationships,
and as a link between relationship centred care
and evidenced based medicine, mindfulness
should be considered a characteristic of good
clinical practice (Epstein, 1999).

38. Physician competencies that facilitate
healing relationships
• Self confidence
• Emotional self management
• Mindfulness
• Knowledge
• Self acceptance, emotional regulation and
mindfulness all outcomes of mindfulness training
Scott et al, 2008. Annals of Family Medicine, 6(4), pp.315-322

39. Promoting mindfulness in psychotherapists in
training influences the treatment results of their
patients
• Design: a randomized double-blind, controlled study
• 124 psychiatric inpatients treated by 18 interns – treated
for 9 weeks
• Intervention: Zen meditation
Grepmair et al, 2007. Psychotherapy and Psychosomatics, 76(6), pp.332-338

40. Results: Patients whose therapists had received
mindfulness training:
• Rated their therapists higher on their therapeutic
relationship, problem solving skills and ability to
communicate clearly
• These patients did significantly better in terms of
symptom severity including: somatisation, insecurity on
social contact, obsessiveness, anxiety, anger/hostility,
phobic anxiety, paranoid thinking and psychotism
Grepmair et al, 2007. Psychotherapy and Psychosomatics, 76(6), pp.332-338

41. Bringing mindful practice into GP Training
• Three mindful breaths waiting for chose and
book to load / computer to load…
• Breathing with patient when listening to their
chest…
• Mindful moment – walking through door to
collect the next patient.

42. If you would like to learn some more…
• www.mindfulnesscornwall.co.uk

43. www.bemindful.co.uk
•
• MINDFULNESS IS A MIND-BODY
APPROACH TO WELL-BEING THAT
CAN HELP YOU CHANGE THE WAY
YOU THINK ABOUT EXPERIENCES
AND REDUCE STRESS AND ANXIETY.
• THE MENTAL HEALTH FOUNDATION
WANTS TO MAKE MINDFULNESS
AVAILABLE TO EVERYONE.

44. Thank you!