TFME 2013 Organizational Professionalism Conference

1. Mindfulness in the Health
Care Workplace – Practical
Applications
Title slide - part 1
David Kearney, M.D.
Associate Professor of Medicine,
University of Washington
VA Puget Sound Health Care
System, Gastroenterology Section

2. “You ought not to attempt to cure the body
without the soul…For this is the greatest
error of our day in the treatment of the
human body, that physicians separate the
soul from the body.”
Plato

3. What is Mindfulness?

5. William James, Principles of Psychology (1890), on
the importance of attention in mental health:
“The faculty of voluntarily bringing back a
wandering attention, over and over again, is the
very root of judgment, character, and will. No one is
compos sui if he have it not. An education which
should improve this faculty would be the education
par excellence. But it is easier to define this ideal
than to give practical instruction for bringing it
about.”
compos sui: “master of one’s self”
Mindfulness Involves Attention

6. I. What is Mindfulness?
• Mindfulness is synonymous with
“awareness”
– “Paying attention, on purpose, in the
present moment, and without judgment”
(Kabat-Zinn)
• A quality of intention as well as
attention: flexibility of attention,
maintaining attention, noticing subtlety
• Non-judgment, patience, non-striving,
‘beginner’s mind’, or COAL: curiosity,
openness, acceptance, love (Siegel)

7. How Does Mindfulness Reduce Stress?
• Promotes ‘de-identification’ with ‘storyline’
– Taught to see ‘thoughts as thoughts’
– Theory: Mindfulness is of benefit across multiple
conditions due to the ‘universal human
vulnerability’ to language (Williams)
• Promotes self-compassion
• Grounds experience in the present moment
• Decreases rumination – a key factor in
relapse of depression
• Increases clarity of emotional states
(emotional intelligence)

8. How Does Mindfulness Reduce Stress?
• Promotes ‘de-identification’ with ‘storyline’
– Taught to see ‘thoughts as thoughts’
– Theory: Mindfulness is of benefit across multiple
conditions due to the ‘universal human
vulnerability’ to language (Williams)
• Promotes self-compassion
• Grounds experience in the present moment
• Decreases rumination – a key factor in
relapse of depression
• Increases clarity of emotional states
(emotional intelligence)

9. The Guest House
by Rumi
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’re 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.

10. Rate of Depressive Relapse for Treatment as Usual (TAU) and
Mindfulness-Based Cognitive Therapy (MBCT)
Teasdale et al, Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based
Cognitive Therapy, Jo Cons Clin Psych 68(4): 615-623, 2000.

11. Neural Correlates of Mindfulness During Affect Labeling
Creswell JD, Way BM, Eisenberger NI, Lieberman MD. Neural Correlates of Dispositional Mindfulness
During Affect Labeling. Psychosomatic Medicine 69:560-565 (2007)
Greater levels of trait mindfulness were significantly associated
with greater activity throughout the PFC during affect labeling
compared with gender labeling (neutral task).

12. Is Mindfulness a Panacea?
• In Greek mythology, Panacea (Greek
Πανάκεια, Panakeia) was the goddess
of cures. She was the daughter of
Asclepius, god of medicine, and the
granddaughter of Apollo, god of healing
(among other things).

13. Potential Limitations of Mindfulness Practice
• Practice tends to uncover personal issues by
holding a mirror to the mind
• Yet….uncovering these issues doesn’t
automatically bring insight in a psychodynamic
sense
• Classical meditation traditions actually
discourage working with “mental content”
– People may unconsciously use their practice to
avoid dealing with important issues….or students
may feel they are practicing incorrectly or not
wholeheartedly enough if issues arise
Engler J. Promises and Perils of the Spiritual Path. in Buddhism and psychotherapy across cultures:
essays on theories and practice, Mark Unno, Editor. Wisdom Publications 2006

14. Loving-Kindness
Meditation
Title slide - part 1
David Kearney, M.D.
Associate Professor of Medicine,
University of Washington
VA Puget Sound Health Care
System, Gastroenterology Section

15. Loving-Kindness Meditation (LKM)
• What is Loving-Kindness Meditation?
– Derived from the Buddhist tradition
• Originally taught as a response to fear
• A practice of cultivation of love
– Pali word metta: ‘unconditional friendliness’, ‘good
heartedness’, ‘agape’
– Not a sentimental love
– In LKM, there is no expectation that the practice will
necessarily benefit others

16. Loving-Kindness Meditation (LKM)
• LKM is both a concentration practice and an
awareness practice
• Concentration developed as a person places
attention on the LKM phrases
– A skillful means of entraining the mind, utilizing
phrases that have positive intention
– Often a more accessible means of becoming
collected/concentrated in the face of difficult
emotional states

17. Loving-Kindness Meditation (LKM)
• Classically practiced with 4 phrases that contain
positive intent
• Participants are asked to choose 4 phrases they
find meaningful. For example:
– May I be safe
– May I be happy
– May I be healthy
– May my life unfold with ease

18. • Classically, the phrases are repeated for the
following categories of beings:
• Benefactor
• Self
• Beloved Friend
• Neutral person
• Difficult person
• Dichotomous groups (e.g. all men / all women)
• All beings
Loving-Kindness Meditation (LKM)

19. Possible LKM Phrases
• May I be safe
• May I live in safety
• May I be free from
danger
• May I love and
accept myself just
as I am
• May I be free from
suffering and the
causes of suffering
• May I be happy
• May I be peaceful
• May I be joyful
• May I be
courageous and
joyful
• May I be open and
trust in this moment

20. Possible LKM Phrases
• May I be healthy
• May I be well
• May I be fully alive and
healthy
• May I be free from
distress and the causes
of distress
• May I be free from fear
• May I be free, and not
burdened by past
events nor by fears of
the future
• May I live with ease
• May my life unfold with
ease
• May I have ease of
well-being
• May I awaken to my
wholeness and be free
• May my actions be
skillful and kind
• May I be wise and
skillful

21. Loving-Kindness Meditation (LKM)
• Weekly 90 minute class x 12 weeks
– Creation of a manual for future classes
• 15 Veterans with PTSD
• Weeks 1 and 2: Mindfulness practice
• Weeks 3-12 progress through categories of beings in
order to cultivate loving-kindness
• Benefactor
• Self
• Beloved Friend
• Neutral person
• Difficult person
• Groups (e.g. men / women)
• All beings

22. Observations from Teaching LKM to Veterans with
PTSD
• Quotation from Class Session on Difficult Person:
– “I ran into an interesting division in my dealing with a difficult
person, I have no trouble wishing them safety and health but I don't
want their life to be filled with ease, some of the same thing with
myself, it’s like they are two different people- I can wish myself to
be healthy but hard to wish ease for myself”
– “I had a hard time doing the difficult person, yesterday I had a
revelation, maybe nobody has ever told them what they did was
wrong, maybe not my job to judge them but just wish love and
kindness, I can only change myself, why can’t people change, I had
to stop asking myself, it wasn't until the walk today- its not about
the other person it’s about you….the actions of the difficult person,
who is acting in ignorance? “

23. Observations from Teaching LKM to Veterans
with PTSD
• Quotation from Class Session on Difficult Person:
– “I moved someone from committed hate to committed love, a real
sense of gratitude, it washed through me when I was walking, my
sister - we are totally estranged, I couldn’t get over the commitment
to hate - but I got over that, a visceral feeling of relief, profound
relief.”
– “I realized that… its not that my anger was growing, it’s that I was
realizing how deep that anger was, curious about this, no sense of
judgment, I trust that those emotions I've held back with words to
not feel, to trust that those emotions are important, if I have hate
buried I need to feel it, I think it’s a choice you either act out or you
feel it.”

24. “I am larger and better than I
thought. I did not think I held so
much goodness.”
Walt Whitman

25. Thank you!