Brief Compassion Training for Physician Well-Being Robert Horowitz, MD1, Mickey Trockel, MD2, Tia Rich, PhD3, Sue Kim, MD2, Sandra J Winter, PhD, MHA1, Marcia Stefanick, PhD1

1Stanford Prevention Research Center, Stanford University School of Medicine, 2Psychiatry and Behavior Sciences, Stanford University School of Medicine, 3Health Improvement Program, Stanford University School of Medicine

Abstract

Goals/Objectives

Methods Findings/Results

Conclusions

•  Burnout is widespread among physicians and appears to be increasing in recent years.

•  While contemplative practices, such as mindfulness meditation, are beneficial, available programs are inaccessible or unattractive to many physicians because of the lengthy time, travel, and formal meditation practices involved.

•  Compassion training holds promise for improving physician well-being by reducing empathic burnout and increasing self-compassion.

•  We developed a program for physician well-being centered on:

-  compassion training, emphasizing self-compassion, and

-  convenience for physicians.

•  To maximize convenience, short training sessions were conducted with physician practice groups in their current clinical work settings, teaching brief compassion exercises (< 3 minutes long) that could be readily performed during the day.

•  The purpose of this pilot study was:

-  to test the feasibility of the program

-  to determine if measures of compassion and confidence in performing the skills taught during training improved over the course of the program.

•  To recognize that empathy may be associated with burnout and that compassion training may reduce empathic distress.

•  To recognize that self-compassion training has been shown to improve life satisfaction and decrease anxiety, depression, and stress.

•  To be able to describe key components of a successful brief compassion training program for physician well-being, including obstacles to implementation.

•  A brief compassion training program for physicians, emphasizing convenience for providers and self-compassion skills, was feasible and effective in engaging physician participation.

•  Significant improvements were observed in measures of self-compassion and self-efficacy for skills taught in the program.

•  Self-compassion is an attractive orientation and a trainable skill that holds promise as a tool to promote physician resilience and well-being.

Participants: Physicians (n = 26, 81% women) were enrolled as pre-existing groups from 5 primary care clinics in Santa Clara County, CA.

Program:

•  A 45-minute orientation was followed by 8 weekly 30-minute sessions.

•  Weekly sessions taught 6 compassion skills. Each skill was presented as a 7-10 minute guided exercise and then repeated as a condensed 3-minute exercise to reduce the time needed to access the target effects.

•  Exercises were distilled into “Compassion Cards” designed as visual triggers. Online recordings of the sessions were also available.

•  2 sessions were devoted to feedback from participants as research partners to suggest modifications and improvements to the program.

Data Collection and Analysis:

•  Participants completed pre- and post-training surveys of empathy, compassion, and self-compassion based on items from validated instruments, and of self-efficacy regarding skills targeted by the program. All items used 5-point Likert scales (1=Strongly disagree, 5=Strongly agree).

•  Differences between pre- and post-training surveys were analyzed using the Wilcoxon Signed Rank Test.

Compassion Cards

Takeabreath

SettlingDown•  Senseintoyourbody.•  Focusyourattentiononyour

breathing.•  Whenyoubecomeawarethatyour

mindhaswandered,gentlybringyourattentionbacktoyourbreathing.

Copyright©2016TheBoardofTrusteesoftheLelandStanfordJuniorUniversity.AllRightsReserved.

•  23 of 26 physicians completed the program and post-training survey. •  Overall attendance was 75% (in-person or by phone). •  Statistically significant increases were observed in median differences

(MD) before and after training for: -  Self-compassion (self-kindness) (MD = 1, p = 0.002) -  Self-efficacy for mindful breathing (MD = 1, p = 0.005); recognizing

common humanity (MD= 1, p = 0.008); and evoking self-compassion (MD = 1, p = 0.002).

•  Participants liked the convenience and brevity of the training, and particularly valued self-compassion as a way to improve their well-being.

•  Obstacles encountered included: -  Challenges in matching the program schedule to clinic meeting times. -  Interruptions related to issues and demands from the clinic. -  Limited time for review and discussion within training sessions.

•  Study limitations included: small sample size; single trainer; variations in the delivery schedule; modifications to the program during the study.

1.Se&lingDown2.RecognizingCompassion*3.BasicCompassion

5.Self-Compassion*4.DiscussionSession

6.SharedHumanity7.Giving&ReceivingCompassion*8.DiscussionandWrapUp

0.OrientaOon

TrainingSequence

*AdaptedwithpermissionfromMindfulSelf-CompassionbyK.NeffandC.Germer

Q&Afrompriorweek(5-10min)

LongerpracOce(7-10min)

BriefpracOce(3min)

Q&Aforexercise(5-10min)

SessionTimeline(30mintotal)

IntroducOontotheme(5min)

Funding: Initial support for building the Wellness Living Laboratory was provided by an unrestricted gift from Amway to Stanford University for the Nutrilite Health Institute Wellness Fund. Special thanks to Stanford General Medical Disciplines.

Participant Feedback •  “It was amazing and there were things that I will remember and always

affect my viewpoint of myself and my practice.”

•  “So helpful at work and life outside of work to pause, understand it is OK to have self-compassion, and that I am not alone.”

•  “The program is unique in providing short effective tools to make clinic flow more smoothly.”

In the Clinic

Empathy and Compassion Measures: Pre- and Post-Training

0%0%

I notice when people are upset

Post

Pre

0%0%

100%100%

0%0%

I get a strong urge to help someone who is upset

Post

Pre

100%96%

0%4%

0%9%

I imagine myself in my patient’s shoes when I’m providing care

Post

Pre

100%78%

0%13%

15%61%

I’m kind to myself when I’m experiencing suffering

Post

Pre

70%17%

15%22%

5%30%

I see the difficulties as part of life that everyone goes through

Post

Pre

70%52%

25%17%

(-) I do not feel empathy for people who cause their own serious illness

90%83%

Post

Pre

0%13%

10%4%

10%18%

(-) I’m disapproving and judgmental about my own flaws and inadequacies

30%14%

Post

Pre

60%68%

35%27%

35%27%

Post

Pre

30%45%

100500 50100Percentage

1.Strongly Disagree 2.Somewhat Disagree Disagree

3.Neutral 4.Somewhat Agree Disagree

5.Strongly Agree Response:

(-) My inadequacies make me feel cut off from the rest of the world

Wilcoxon Signed Rank Test p

p = 1.00

p = 0.02

p = 0.15

p = 0.002

p = 0.08

0 = 0.07

p = 0.20

p = 0.51

Self-Efficacy for Skills Taught in the Program: Pre- and Post-Training

5%27%

I feel confident that I can use my breathing to direct my attention

Post

Pre

80%45%

10%18%

I feel confident that I can think about a compassionate individual to feel more kindness

Post

Pre

85%55%

0%14%

I feel confident that I can generate feelings of kindness in difficult situations

Post

Pre

85%77%

0%14%

I feel confident that when I am struggling, I can recognize that everyone struggles

Post

Pre

85%50%

15%36%

5%41%

I feel confident that when I am struggling, I can direct compassion to myself

Post

Pre

85%32%

10%27%

5%27%

I feel confident that in difficult interactions, I can remember that no one wants to feel distressed

0%9%

Post

Pre

95%64%

10050050100Percentage

1.Strongly Disagree 2.Somewhat Disagree Disagree

3.Neutral 4.Somewhat Agree Disagree

5.Strongly Agree Response:

Wilcoxon Signed Rank Test p

p = 0.005

p = 0.14

p = 0.82

p = 0.008

p = 0.002

p = 0.11

15%27%

5%27%

15%9%

Wilcoxon Signed Rank Test p