J young plenary chronic stress
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2014 Physician Well Being Conference
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J young plenary chronic stress
- 1. Chronic Stress, Health Consequences and the Opportunity to Become More Resilient Jeff Young, MD Jeff Young, MD
- 2. Topics Resilience defined Brief overview: Acute and chronic stress; consequences The off switch, mind-body medicine strategies The Healthy Mind Platter Why Mindfulness? Mindfulness meditation versus mindful awareness Mindfulness exercises Resources for further exploration
- 3. Resilience “The ability to successfully adapt and function proficiently when faced with traumatic circumstances” “An organism with the ability to adapt to challenging environments will be able to minimize physiologic damage” “The ability to bounce back from adverse circumstances and go on” 3
- 4. Acute Stress Response: Effect on the Hypothalamic- Pituitary- Adrenal Axis “Fight-or- Flight” Response 6
- 5. Chronic Stress: Cause: Due to repeated severe stressors, OR related to daily life insecurities/fear, cognitive distortions, threats to ego, loss of sense of control, unpredictability Consequences: Brain remodeling (“plasticity”: more on next slide) HTN, CVD, Increased blood glucose Ulcers Anxiety, depression, burnout, exhaustion, “Stressed out”: insomnia, XS eating, smoking, drinking, social withdrawal, seeking of medication solutions Immune dysfunction Epigenetic changes Accelerated aging: decreased telomerase and telomere shortening, decreased anti-oxidant activity, increased oxidative stress1 10
- 6. Consequences of Chronic Stress: Brain plasticity, “neurons that fire together wire together, and survive together” (Dan Siegel) : Habits remodel the brain and strengthen proclivity for that habit Synaptic and dendritic remodeling demonstrated with PET and fMRI: Atrophy of hippocampus, PFC Hypertrophy of amygdala Result: diminished ability to cognitively process and respond to stressors over-active amygdala. 11
- 7. The Off Switch: The Relaxation Response Opposite physiology of acute stress response2 mediated by parasympathetic NS: Decreased metabolism, Oxygen consumption, carbon dioxide elimination, BP and respiratory rate, increased production of healthful nitric oxide3 Decreased heart rate and increased heart rate variability4 Decreased brain activity/increased alpha waves, state of “well being”, reduced psychological distress Increased brain activity (fMRI) in attention and decision making regions (pre-frontal cortex) of brain5 19
- 8. Mind-Body Medicine: Strategies for Wellness and Healthy Aging The “relaxation response”: Increased brain cortical thickness in prefrontal cortex and right anterior insula in those who intensively meditate. First evidence of experience-dependent cortical plasticity associated with meditation practice6 Is associated with changes in gene expression opposite of those associated with stress7 20
- 9. Strategies for wellness and resiliency Ancient and modern strategies for eliciting the relaxation response: Meditation Imagery Biofeedback Autogenic Training (self-hypnosis) Breathing Techniques Yoga, Tai Chi, Qi gong, Repetitive-prayer Relationships; helping others Healthy life-style and self care: sleep, nutrition, moderate exercise, avoid smoking, hobbies 21
- 10. Additional wellness strategies Development of self awareness and clarification of personal values/priorities8 Spirituality: developing this aspect of self Work attitudes and management: finding meaning, choosing to limit/manage aspects of work life Positivity: playfulness, gratitude, awe, love, interest, serenity, feeling connected to others Cognitive reframing Not relying solely on medications or procedures to correct health problems 22
- 11. The Healthy Mind Platter Sleep time, physical time, focus time, down time, play time, connecting time, TIME IN.9 11
- 12. Mindfulness and neural networks “Narrative”/”default” network: Medial PFC, hippocampus Where we keep our story, strategizing, planning, keeping track of self vs other, “Monkey mind”, dreaming, resting mind, autopilot mind Feels captivating: rehashing, rehearsing, ruminating Nothing wrong with it, just wouldn’t want to spend life here
- 13. Mindfulness and neural networks Direct experience network: Lateral PFC, right insula where we perceive sensations, anterior cingulate cortex which switches our attention You experience information coming to your senses in real time Activated with mindful attention Compare and contrast the two
- 14. Why Mindfulness? Promotes self awareness, self-regulation, positive relationships between self and other, and increases pro-social characteristics…self transcendence. Improving one’s awareness of sensations/thoughts/feelings, and yet, reducing one’s reactivity to challenging situations and feelings even if unpleasant. Promotes action with awareness and attention. Enhances our openheartedness With practice: facilitation of more conscious choices, emotional regulation--equanimity, improved performance
- 15. Mindful awareness Not religious or esoteric, more about understanding ourselves, anybody can do it, with perseverance Everyday life awareness and presence Enhances ability to "place and hold attention"10, leave the commentary (“narrative”/default network) and return to the present (direct experience network), improve perception of your thoughts and feelings, make choices. Practices Picking a project, eg. Intending to watch for the expression of an issue in the course of the day Pausing Paying attention to the simple activities 15
- 16. Mindfulness meditation Intentional self-regulation of attention conducted without judgment and focused on observation of the present moment using a point of focus There is no single posture Still or moving Generally involves an object of focus Noticing when our mind has wandered and gentle coming back to the focus without judgment and beginning again, and again. This is the practice 23
- 17. Mindfulness practices Leaning forward with intention: COAL Reasonable expectations for mindfulness and meditation Meditation examples: Somatic centering/grounding Focused attention while still; the breath (with movement: walking meditation, yoga, Tai Chi) Loving kindness meditation Special place imagery 17
- 18. 39
- 19. Resources: Mindfulness meditation coaching: The Healthy Mind Platter: David Rock, Dan Siegel http://www.davidrock.net/files/02_The_Healthy_Mind_Platter_US.p df Mindfulness meditation: Mindfulness for Beginners, Kabat-Zinn (CD) Your Brain at Work, David Rock Walk Like a Buddha, Lodro Rinzler Healing the Healer, Saki Santorelli The Mindful Path to Self-compassion, Germer and Salzberg Loving Kindness Meditation, Sharon Salzberg Zen Living, Domyo Burk Physician wellness programs example: http://healthandwellness.vanderbilt.edu/work-life/faculty-physician-wellness/ 40
- 20. References: 1. Epel et al. PNAS USA 101:17312-5, 2004 2. Benson et al. The relaxation response. Psychiatry 37(1) 37-46, 1974. 3. Benson. Relaxation Revolution, 2010. 4. Thayer et al. A meta-analysis of heart rate variability and neuroimaging studies; implications for HRV as a marker of stress and health. Neurosci Behav Revs 36, 747-756, 2012 5. Lazar et al. Functional brain mapping of the RR and meditation. ANS, Vol 11, no7. 1581-1585. 2000 6. Lazar, et al. Meditation experience is associated with increased cortical thickness. NIH Neuroreport; 16(17): 1893- 1897. 2005
- 21. References: 7. Dusek et al. Genomic counter-stress changes induced by the relaxation response. PLoS ONE 3(7): e2576. doi:10.1371/jounrnal.pone.0002576. 2008. 8. Shanafelt, The well-being of physicians. A J of Med. 114:513- 19, 2003 9. Rock and Siegel, The Healthy Mind Platter 10. Burk, The Zen Guide for Living, 2014
Editor's Notes
- Brief version of intro: I’m going to discuss the many important health consequences of chronic stress and the resiliency strategies that are available to manage it. And, I’m going to invite you to consider these issues both from the point of view of the individual and as a member of a team or community. Perhaps you are a member of a clinical team that works together. Or maybe you are a member of a leadership team. In either case, there are choice opportunities available that can have a positive impact on your health and that of your team or community. This slide foreshadows several strategies that may be used to manage chronic stress; that of enjoying the outdoors, experiencing awe, joy, play. ------------------------------------- Training background: 90+ CME hours: mindfulness based psychotherapy CME x 2 x 25 hrs. International mind-body congress: 10 hrs. ISIS Baltimore training: 25. ISIS OHSU training: 4 hrs. TFME Oct 2012 physician wellness: 7 hrs, Promoting Organizational Professionalism: 6 hrs. Organizational professionalism: the role of leadership: 3.5 rs. 40 hrs reading related literature and writing this power point ------------------------------------------ Why this topic, now: Personal experience with several year period of persistent stress: First patient suicide 1984, subsequent lawsuit Private practice partner murdered in his office and grieving process for my group and me. I ended up caring for many of his grieving patients. Malpractice lawsuit 1985. Anxiety, fear, worry. Plaintiff dropped case day before trial to begin. Attorney tells my attorney he and consultants tried to tell his client she didn’t have a case, she hoped we would settle. Sons born Oct 30, 1985 and April 23,1987 who were very active and slept little or erratically, sleep deprivation for Lauretta and I. Father died at age 59, Jan 3, 1988 Working every-other weekend in the hospital and on call frequently Grateful for support from wife, family and friends Interest in physicians, referrals from BME, medical staffs Interest in peer review providing compassionate, supportive and firm accountable support of patient-centered care, quality and safety Interest in new science on brain plasticity, and the opportunity to improve resilience to chronic stress, related training Involvement in the OHSU integrative self care initiative for students as volunteer instructor in wellness and resilience skills Vision for PHS: We offer same skill training for all PHS staff on volunteer basis We offer this training for docs who develop difficulties with stress or it’s harmful consequences We develop an organization that supports wellness, and high functioning teams
- Homeostasis: eg. Bodies temperature is controlled within a narrow range of only about 5-6 degrees. Sweating etc, to reduce temp and shivering to increase temp. Allostasis: Allo = variable, stasis = stand. Research model. Eg. Body can be challenged to deal with eating large amounts of food and body will adapt, carry extra fat stores, but over time, the adaptation may result in a cumulative load of strain, allostatic load which costs the mind-body and can result in wear and tear. “An example of successful allostasis in which wear and tear is minimized, and the brain retains considerable resilience in the face of stress”4 Fossion P et al. The relevance of the concept of resiliency in the field of psychiatry. Revue medicale de Bruxelles 28, 33-38. 2007 Carlson ED et al. Allostatic load and health disparities. Research in nursing and health. 28, 306-315. 2005 Dyer JG et al. Resilience: analysis of the concept. Arch of psych nursing. 10, 276-282. 1996
- Note the vague depiction of what the neural/hormonal connections are between the external “stress” and our midbrain. Will come back to this
- Repeating the adverse consequences, in summary, one more time. “stressed out” results commonly in sleep deprivation, which produces allostatic load. Sleep deprivation results in increased BP, decreases parasymp tone, increases evening cortisol and insulin levels, and promotes increased appetite, possibly through elevation of ghrelin, a pro-appetitive hormone, and decreased levels of leptin. Proinflamm cytokine levels are increased, increased BMI and obesity. Cognitive impairment. Epigenetics: the study of heritable changes in gene expression or cellular phenotype caused by mechanisms other than changes in the underlying DNA sequence, hence the name “epi” that is above, outer or over-genetics. It refers to functionally relevant modifications to the genome that do not involve change in the nucleotide sequence. See Dusek article, 2008, in slide on strategies for mind body medicine.
- Chronic stress: atrophy of neurons in the hipp, and PFC (memory, selective attention and executive function), hypertrophy of neurons in the amygdala (fear, anxiety and aggression). Consequently the ability to learn, remember and make decisions is compromised by chronic stress and may be accompanied by increased levels of anxiety and depression. (McEwen, 2006, p. 371) Positron Emission Tomography, and functional MRI show changes in activity and volume: decreased activity and volume of hipp and PFC and increased volume in amygdala and later atrophy. PTSD and borderline personality disorder, studies show atrophy of the hippocampus suggesting chronic imbalance in the activity of adaptive systems. Donald Hebb, 1949, Canadian neuropsychologist: Hebb’s axiom: “neurons that fire together wire together.” Repeated experiences become increasingly imbedded in the neural network. Dan Siegel: rephrases Hebb’s axiom: “neurons that firet together, survive together and wire together.” Reference for this slide: McEwen. Allostasis, allostatic load, and the aging nervous system: role of excitatory amino acids and excitotoxicity. Neurochem. Res. 25, 1219-1231. 2000
- Key points: “Mind-body practices that elicit the RR have been used worldwide for millennia to prevent and treat disease.” Dusek, 2008. Stress can manifest in system-wide changes in cellular functioning, accelerated aging, increased vulnerability to disease states Despite observations about the effects of RR on physiology etc, the mechanisms underlying RR have not been identified. RR RESULTS IN: Nitric oxide: depth of the RR is associated with increased NO. NO mediates diverse physiologic processes including CV, immune and nervous system functions including decreased HPA axis activation. NO may serve as a biological mechanism underlying the RR. VITAL SIGNS: Decreased BP, RR, HR HEART RATE VARIABILITY: Respiratory sinus arrhythmia (RSA) is observed. This is a naturally occurring variation in heart rate that occurs with the breathing cycle. RSA is a measure of parasymp. Nervous system activity, which denotes” rest and digest” behavior. More HR variability means better “vagal tone”. See notes for slide 55 on M-B medicine and strategies for wellness and healthy aging, under cultivating interpersonal connection and Fredrickson. THE DESIRABILITY OF FINIDNG BIOLOGICAL MARKERS THAT COULD HELP ASSESS THE STRESS SYSTEM: From Heart Math: heart rate variability increases with meditation. Also referred to as dynamic variability in HR. HRV is felt to perhaps represent a kind of “window” into the balance of the autonomic nervous system, ANS. HRV a marker of health and fitness: Ability of the body to react to stress and environmental demands Marker of biologic aging. Less HRV with aging Lower HRV associated with illnesses, and all cause-mortality HRV increases with sleep and decreases with sleep restriction HRV can occur in an “incoherent” or jagged and irregular pattern. This is associated with: Stress, anger, frustration, anxiety HRV can occur in a “coherent” rhythm. This is associated with: Uplifting emotions, love, care, appreciation, joy Over-all shift toward parasymp activity More synchrony between heart and brain With practice one can increase HRV Thayer et al, A meta-analysis of heart rate variability and neuroimaging studies; implications for HRV as a marker of stress and health. 2012: Heart is under tonic inhibitory control from the PS ANS, which favors energy conservation Symp ANS has relatively slow response on heart too slow( SECONDS) to influence beat to beat HR which is influenced by PS ANS and Vagus nerve (MILLISECONDS) . HRV may provide an index of the degree to which the brain’s integrative system for adaptive regulation provides flexible control over the periphery. HRV may serve as an easily measured output of this neural network that may provide valuable information about the capacity of the organism to effectively function in a complex environment. Vagal connection between heart and brain allows two way communication. The heart and brain represent a system. BRAIN ACTIVITY RESEARCH: Lazar, et al. Functional brain mapping of the RR and meditation. Autonomic nervous system. Vol 11, no. 7, 1581-1585. May 2000: Used fMRI to identify and characterize the brain regions that are active during a simple form of meditation. Meditation involved observing the breath while ignoring every-day thoughts. Kundalini meditation: passively observed breathing ans silent phrase “sat nam” during inhalations and “”wahe guru” during exhalations. Control state: silently generated a list of animals while not observing breathing. Participants were Kundalini meditation daily practitioners x 4 + years. Significant signal increases were observed in the attention areas: DL prefrontal and parietal cortex and the arousal/autonomic areas: temporal lobe, pregenual anterior cingulate cortex. In addition, activation of the, hippocampus, parahippocampus, striatum and pre and post central gyri during meditation. Changes in CV function were not responsible for fMRI signal increases measured here. Conclusion: the practice of meditation activates neural structures involved in attention and control of the ANS.
- Dusek et al. 2008: Hypothesis: We hypothesize that RR elicitation is associated with systemic gene expression changes in molecular and biochemical pathways involved in cellular metabolism, oxidative phosphorylation/ generation of reactive oxygen species and response to oxidative stress and that these changes to some degree serve to ameliorate the negative impact of stress. Gene expression changes can be used to measure physiological responses elicited by the RR in an unbiased fashion. Method: Assessed whole blood transcriptional profiles in 19 healthy, long-term practitioners of daily RR practice (M group), 19 health controls and 20 people who completed 8 wks of RR training (N group); short term practitioners. Short term practitioners trained in RR: “N”/novice subjects: received 8 weeks of RR training. Information, 20 min elicitation of RR. Diaphragmatic breathing, body-scan, mantra and mindfulness meditation while passively ignoring intrusive thoughts. At home, listened to CD guiding meditation 20 min a day. Long term practitioners: “M” group, average years of practice: 9.4 years, range 4-20. Their practice was: several types of meditation, Yoga, repetitive prayer. Results: Significant differences in expressed genes comparing practitioners vs controls and short-term practitioners vs controls. Significant differences in cellular metabolism, oxidative phosphorylation, generation of reactive oxygen species and response to oxidative stress in practitioners, trainees. Differences may counteract cellular damage related to chronic psychological stress. Conclusions: First compelling evidence that RR elicits specific gene expression changes in short and long-term practitioners. Gene ontology expression categories: long-term practitioners compared to controls was greater compared to short-term practitioners in every category except one. Li et al. 2005. Referred to in above Dusek article. Qigong practitioners have different gene expression compared to controls. Cortical plasticity:
- Key Points: The opportunity here is for individuals of all types including all citizens of the community, health care professionals, health care systems on behalf of caregivers, and also health systems on behalf of communities to make systematic changes that improve the life of many people. At the system or community level this means education, incentives, services and support to promote development of healthy lifestyle practices. Prevention of disease promotes full enjoyment of life, optimal productivity and helps prevent later diseases, reduces financial burdens. Each of these strategies has scientific evidence that it results in changes in markers of AL. EXAMPLES: REPETITIVE PRAYER: repeating a word, sound, phrase, prayer or focus on breathing with disregard of intrusive every-day thoughts POSITIVITY: 1. Positive outlook on life and good self-esteem: lower cortisol production and higher heart rate variability (showing higher parasympathetic activity) as well as lower fibrinogen response to stress test. Pressman SD, Cohen S. Does positive affect influence health? Psychol Bull. 2005;131:925-971 2. Steptoe A, Wardle J, Marmot M. Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes. Proc Natl Acad Sci U S A. 2005;102:6508-6512 Poor self esteem causes recurrent increases in cortisol levels. Poor S-E and low internal locus of control correlated with 12% lower volume of hippocampus and higher cortisol levels: Pruessner JC, Baldwin MW, Dedovic K, et al. Self-esteem, locus of control, hippocampal volume, and cortisol regulation in young and old adult- hood. Neuroimage. 2005;28:815-826. Pruessner JC, Hellhammer DH, Kirschbaum C. Low self-esteem, induced failure and the adrenocortical stress response. Pers Individ Diff. 1999;27:477- 489 INTERPERSONAL CONNECTION: Good social support has positive influences on AL. Seeman TE, Singer BH, Ryff CD, Dienberg G, Levy-Storms L. Social relationships, gender, and allostatic load across two age cohorts. Psychosom Med. 2002;64:395-406. Loneliness, often found in people with low S-E, associated with larger cortisol responses to waking in the am, and higher fibrinogen and natural killer cell responses to stress tests and sleep problems. Steptoe A, Owen N, Kunz-Ebrecht SR, Brydon L. Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle- aged men and women. Psychoneuroendocrinology. 2004;29:593-611 Having three or more regular social contacts, as opposed to zero to two is associated with lower AL scores. Seeman et al, 2002, above. Fredrickson: study participants ( to be published 2013) who practiced metta/loving kindness meditation in a 6 wk workshop, “felt” more “upbeat and socially connected” but also “altered their vagal tone.” Vagal tone is plastic too and is altered by social habits. The more vagal tone the better. It is related to ability to facial expression and ability to tune into the frequency of the human voice. By improving vagal tone we can increase the capacity for connection, friendship and empathy. More vagal tone means your body is able to do a better job of regulating your internal systems that relate to your health such as cardiovascular, hormonal (glucose ) and immune systems. Like our muscles, if we don’t use it we lose it; this capacity for connection. Our social connection histories (or loneliness history) alter how our genes are expressed that influence our immune system MEDICATIONS: can be useful for example to help with insomnia or depression, but the systems of allostasis are non-linear and the effect on one may have a deleterious impact on another. So best to not rely on meds.
- There are two “ways” of relating to the self and world, two association networks for interacting with the world: 1. Narrative network, Farb et al, 2007/ default network: Brain regions involved: mPFC, hippocampus Involved with strategizing, planning, goal setting Resting state of brain function when no task to perform Circuitry of network links various parts of the brain together Involves self reflection, continual surveying of environment, seeking sources of social support and connection, trying to understand what is going on with self and others. (Siegel) Creation of an ever-changing narrative of our socially interdependent self. Siegel Holds the narrative when thinking about self and other The network involved in Monkey mind: planning, dreaming, ruminating about past and future. Rehashing and rehearsing. Nothing wrong with this network, but you wouldn’t want to spend your whole life in this mode Direct experience network: Insula which relates to perceiving body sensations Anterior cingulate cortex which is involved in switching attention You experience information coming into your senses real time
- Functional MRI imaging demonstrates that when subjects switch from one form of mental activity to the other, the specific parts of the brain referred to become more active. Lazar: Years of meditation experience and respiration rate were correllated with cortical thickness in two regions, the infer occipitotemporal visual cortex and right anterior insula. Correlation not causation. Right hemisphere is essential for maintaining attention. Age and cortex thinning: the rate of thinning is variable across the cortex. Thinning is most pronounced in the frontal lobe. Versus not much thinning in parietal, temporal and occipital lobes. Such age related thinning may account for why the largest differences in meditators vs controls was in the occipitotemporal lobes. Brodmann area 9/10 was similar in thickness in 40-50 yr olds as with 20-30 yr olds. Suggests regular meditation may slow the thinning of this specific locus.
- Sharon Saltzberg, discussing her book Real Happiness: Real Happiness is feeling connected, able to hold both pain and celebration, able to actually appreciate real joy (we often are into control, doing or are embarrassed about enjoying ourselves) Sharon on Mindfulness and it’s benefits: Balance of mind Tranquility Sense of wholeness Face our fears and challenge our habits of self-judgment. May protect against aging and improves capacity for learning new things Mindfulness practice: Can be formal and with one’s special time, space and equipment. But it also can be done even in midst of a stressful event like a work meeting. You can engage in mindful activity eg. Wishing everyone to be well. Common experience with mindfulness practice she hears about, “I couldn’t keep my thoughts from coming, from feeling sleepy or restless” It’s not about making your mind blank its about forming a different relationship with your experience Concentration by choosing an object and gathering attention to that object. When see your mind has wandered off, gently bring attention back to a sound, a mantra a prayer, a sensation or for example the sensation of the breath. The breath is “portable” and fundamentally human not attached to any religion. Mindfulness is a quality of awareness or attention, which is our perception of awareness without judgment. It is openness. We practice letting go of the wandering mind and gently begin again. Starting over and over is the path. We can use the body as a point of focus and anchoring, tuning into sensations, a way then of tuning into the emotional world. General benefits of mindfulness meditation: Lowering one’s reactivity to challenging situations, ability to observe bodily sensations, thoughts, feelings even if unpleasant. Acting with awareness and attention. Grossman, P, et al. MBSR and health benefits a meta-analysis, 2004: Construct of mindful awareness originated in earliest Buddhist documents but “is neither religious or esoteric”. Esoteric = likely to be understood by only a few individuals with specialized training. Religious: part of a relig prac or belief system. Mindfulness is non-deliberative, it is a form of naturalistic observation where objects of observation are the perceptible mental phenomena that arise normally during waking consciousness. Mindfulness is dispassionate, non-evaluative, and sustained moment to moment awareness of percep mental states and processes. Includes continuous, immed awareness of sensations, perceptions, affective states, thoughts, imagery. Underlying this concept and approach: 1.Humans are ordinarily largely unaware of their moment to moment experience and often operate in auto-pilot mode We are capable of developing the ability to sustain attention to mental content Devel of this ability is gradual, progressive and req regular practice Moment to moment awareness will provide a richer and more vital sense of life as awareness replaces unconscious reactiveness Such persistent, nonevaluative observation of mental content will gradually give rise to greater veridicality of perceptions (reality based) Because more accurate percep of one’s own mental responses to ext and int stimuli is achieved, additional information is gathered that will enhance effective action in the world, and lead to a greater sense of control Fortney, L, Abbreviated mindfulness intervention for job satisfaction…….2013.: “mindfulness is a form of mental training that enables one to attend to aspects of experience in a non-judgmental, nonreactive way, which in turn helps cultivate clear thinking, equanimity, compassion and open-heartedness. The goal is to maintain open awareness in one’s experience in a way that generates a greater sense of emotional balance and well-being. Through mindfulness practice, unhelpful habitual thoughts and behaviors can be recognized, allowing for new and creative ways of responding.” Gil Fronsdale, practice notes: Don’t try to do too much When you notice your mind has wandered off and you are involved in thinking. See if you can notice how thinking diminishing your engagement with yourself and the world. When you wander off or when you come back to the breath, what shifts or changes for you? Maybe coming back to your breath is uncomfortable? With practice you will make wise choices
- Example: walking on the beach lost in thought about a conflicted relationship versus directly experiencing sensations in the moment Farb, 2007, measured mindfulness using the MAAS Mindfulness promotes self awareness, self-regulation, positive relationships between self and other, and increases pro-social characteristics…self transcendence.
- Can reduce CRH release by focusing attention and thereby decrease anx and flight or fight / acute stress response. General benefits of mindfulness meditation: Lowering one’s reactivity to challenging situations, ability to observe bodily sensations, thoughts, feelings even if unpleasant. Acting with awareness and attention. Grossman, P, et al. MBSR and health benefits a meta-analysis, 2004: Construct of mindful awareness originated in earliest Buddhist documents but “is neither religious or esoteric”. Esoteric = likely to be understood by only a few individuals with specialized training. Religious: part of a relig prac or belief system. Mindfulness is non-deliberative, it is a form of naturalistic observation where objects of observation are the perceptible mental phenomena that arise normally during waking consciousness. Mindfulness is dispassionate, non-evaluative, and sustained moment to moment awareness of percep mental states and processes. Incl continuous, immed awareness of sensations, perceptions, affective states, thoughts, imagery. Underlying this concept and approach: 1.Humans are ordinarily largely unaware of their moment to moment experience and often operate in auto-pilot mode We are capable of developing the ability to sustain attention to mental content Devel of this ability is gradual, progressive and req regular practice Moment to moment awareness will provide a richer and more vital sense of life as awareness replaces unconscious reactiveness Such persistent, nonevaluative observation of mental content will gradually give rise to greater veridicality of perceptions (reality based) Because more accurate percep of one’s own mental responses to ext and int stimuli is achieved, additional information is gathered that will enhance effective action in the world, and lead to a greater sense of control Fortney, L, Abbreviated mindfulness intervention for job satisfaction…….2013.: “mindfulness is a form of mental training that enables one to attend to aspects of experience in a non-judgmental, nonreactive way, which in turn helps cultivate clear thinking, equanimity, compassion and open-heartedness. The goal is to maintain open awareness in one’s experience in a way that generates a greater sense of emotional balance and well-being. Through mindfulness practice, unhelpful habitual thoughts and behaviors can be recognized, allowing for new and creative ways of responding.” Gil Fronsdale, practice notes: Don’t try to do too much When you notice your mind has wandered off and you are involved in thinking. See if you can notice how thinking diminishing your engagement with yourself and the world. When you wander off or when you come back to the breath, what shifts or changes for you? Maybe coming back to your breath is uncomfortable? With practice you will make wise choices
- Intention: C: curiosity. Which brings a positive, hopeful, energy to practice O: Openness: Which includes an element of courage and trust that what may be revealed will be true and useful. Faith in a higher power? A: Acceptance: Willingness to be influenced by the universe L: Love or compassion towards oneself as you go about the journey of life Reasonable expectations: Caution regarding any plan to be fixed or cured of some problem. Rather, willingness to focus on the practice. In time, the problem will pass when it is time. The practice is not about clearing the mind or having an empty mind, that is not the goal, the goal is noticing that our mind has wandered and then gently and without judgment, bringing our attention back to the object of focus, or the mindful moment. In mindfulness practice, the idea is to notice, spend a few moments enjoying the focused attention to right now, expect that to pass as you move on with your day. Notice the themes of your thoughts. Relationships? Work? Performance? Sex? Money? Worries? Past/future? Rehashing/rehearsing? Getting? Practice will bring, heightened self awareness, noticing one’s experience early and as a result, shorter periods of automatic\\/mindless behavior. With awareness comes an opportunity to make better choices. Equanimity.