day 2 - 5 ffc spirit and pom 4-7-16projects.hsl.wisc.edu/service/sites/final/day 2 - 5 ffc... ·...
TRANSCRIPT
4/15/16
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WHOLE HEALTH:
Change the Conversa5on
CONNECTIONS: MIND-‐BODY, SOCIAL, AND SPIRITUAL
VETERANS HEALTH ADMINISTRATION
Around the Green Circle, Last three…
How are your connections… • …between your mind and
body? • …with others - your family,
friends, and coworkers • …with a higher power or
source of meaning?
VETERANS HEALTH ADMINISTRATION
Power of the Mind
VETERANS HEALTH ADMINISTRATION
Power of the Mind – Health for Life Video Office of Patient Centered Care & Cultural Transformation
VETERANS HEALTH ADMINISTRATION
Quick game: How many mind-body approaches can you name?
• Each table chooses a scribe • In 2 ½ minutes, brainstorm
a list of as many mind-‐body therapies as you can
• Different forms of meditaQon and psychotherapy are fair game
• We’ll see how many the larger group comes up with
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VETERANS HEALTH ADMINISTRATION
A Spectrum of Techniques
• Psychotherapies • Biofeedback • Progressive muscle relaxaQon • MeditaQon • Breathing exercises • CogniQve behavioral therapy • Eye movement desensiQzaQon
and reprocessing • TherapeuQc disclosure • Clinical Hypnosis
…and many others
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VETERANS HEALTH ADMINISTRATION
It all comes back to the Relaxation Response
• Coin termed by Herbert Benson, MD, a cardiologist
• The autonomic nervous system has 2 branches – SympatheQc (fight/flight) – ParasympatheQc (feed/breed)
Most mind-‐body exercises have the parasympathe5c ac5va5on and other physiological changes as a common endpoint • The key is, which approach will
best fit any given individual?
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Other Aspects of the Mind-Body Connection
• Placebo effect • Psychoneuroimmunology • EmoQons and Health • OpQmism and Health • HosQlity and Health
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VETERANS HEALTH ADMINISTRATION
Reversible cardiomyopathy with severe emotional stress (Takatsubo’s)
• 19 people with LV dysfuncQon post emoQonal stress
• Average ejecQon fracQon = 20%
• Prolonged Q-‐T • Û Monocyte infiltraQon • Û Troponin I (moderate) • Û Catecholamines • 95% had normal arteries
Wittstein, et al., NEJM 2005;352(6):539-48 VETERANS HEALTH ADMINISTRATION
J Am Coll Card: Vol 45(5);2005
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3"
Exercise(Mediates(the(Associa0on(Between(Posi0ve(Affect(and(58Year(Mortality(in(Pa0ents(With(Ischemic(Heart(Disease.(Hoogwegt,"M."et"al."Circula3on:"Cardiovascular"Quality"&"Outcomes."6(5):559C566,"September"2013."
Glass ½ Full
Glass ½ Empty
42% Lower Risk of Dying
Sur
viva
l
VETERANS HEALTH ADMINISTRATION
Laughter is Good for the Heart
• 150 people given humorous manuscripts.
• Those with heart disease were 45% less likely to laugh.
• Those who did laugh were less likely to have heart disease and had less hosQlity.
Clark, et al., Int J Cardiol 2001;80:87-‐8 Photo credit: symphony of love via Foter.com
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VETERANS HEALTH ADMINISTRATION
HOSTILITY
CARDIA study • 374 18-‐30 year-‐olds • HosQlity index at baseline • CT scans of caroQds in 10 years
later • Those with greater than the
median hosQlity score had twice the risk of coronary calcificaQons
• ….and had 9 Qmes the risk of those with below the mean hosQlity score.
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Iribarren, JAMA. 2000; 283:2546-2551 VETERANS HEALTH ADMINISTRATION
Emotions and Heart Rhythm
McCraty R. Bioelectromagnetic Interactions Within and Between People. HeartMath Research Center.
www.heartmath.com
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4-7-8 Breaths
IN for 4 seconds
OUT for 8 seconds
HOLD 7 seconds
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6 breaths per minute
4 seconds 6 seconds
VETERANS HEALTH ADMINISTRATION
Family, Friends, Coworkers No man is an island, entire of itself.
-John Donne
The ‘I’ in illness is isolation. The ‘W’ in wellness is ‘we.’
-Satchitinanda
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VETERANS HEALTH ADMINISTRATION
Family, Friends and Co-workers Video - Office of Patient Centered Care & Cultural Transformation
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Consider Your Relationships
Reflect for a moment: • Who are you closest to in your family? • Who are you closest to at work? • Who is your best friend? • Who is your favorite patient? • How do your relationships with the people you
care about influence your health? Take a few minutes to discuss this with a partner.
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VETERANS HEALTH ADMINISTRATION
Family, Friends, Coworkers: Connection = Life
• 2015 meta-‐analysis of 70 studies – Social isola5on led to a 29% higher likelihood of dying – Loneliness = 26% higher likelihood – Living alone = 32% – Results “…consistent across gender, length of follow-‐up, and world region…”
Holt-‐Lunstad, et al., Perspec@ves Psychol Sci, 10(2):227-‐37, 2015
• 2014 summary: Interviews with 23 Veterans who had alempted suicide. – Two things would have helped most:
• Social support • More compassion and empathy from care providers
Montross, et al. Crisis. 2014;35(3):161-‐167.
• Loneliness and poor social connecQon cause inflammaQon and chronic disease Fagundes CP, et al, Soc Personal Psychol Compass, 5(11):891-‐903, 2011
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High Social IntegraQon
Low Social IntegraQon
Tsai, A.C., et al., Social integra@on and suicide mortality among men: 24-‐year cohort study of US Health professionals. Ann Intern Med, 161(2):85-‐95, 2014.
2 x less Suicide! (and lower all-cause mortality)
34,901 Male Health Professionals Followed for 24 years
VETERANS HEALTH ADMINISTRATION
The importance of having a loving partner • 10,000 men with high heart disease risk:
– Saying , “yes, my wife shows me her love” was Qed to • 50% less angina • 50% fewer ulcers
Madalie, JH, American Journal of Medicine, 1976, 60(6): 910-‐21.
• 1400 men and women amer heart catheterization – If you were not happily married or didn’t have a confidante,
• Triple the 5 year mortality rate (50% died versus 15%) Williams, RB et al, JAMA 1992, 267(4):520-‐24.
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VETERANS HEALTH ADMINISTRATION
Entrainment of heart rhythms during sleep
23 McCraty, The Energetic Heart: Bioelectromagnetic Interactions Within and Between People, Heartmath
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VETERANS HEALTH ADMINISTRATION
Family, Friends, and Coworkers: Health Plan Options
• Explore social support (emoQonal, financial, mentorship, affirmaQon, informaQon) – There are a number of surveys they can complete
• Social workers – hlp://www.socialwork.va.gov/socialworkers.asp
• Support groups and peer-‐led groups – hlp://www.ptsd.va.gov/public/treatment/cope/peer_support_groups.asp
• Compassion meditaQon • Be strategic about their care team • Volunteering and other community acQviQes • Animal assisted therapy
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Photo: ableveterans.com
VETERANS HEALTH ADMINISTRATION
In addition to “What Really Matters?”
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VETERANS HEALTH ADMINISTRATION
Spirit and Soul
The human heart has a hidden want which science cannot supply.
-William Osler
VETERANS HEALTH ADMINISTRATION
Spirit & Soul – Health for Life Video Office of Patient Centered Care & Cultural Transformation
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VETERANS HEALTH ADMINISTRATION
Six Aspects of Spirituality
² Religious ² HumanisQc
² Nature ² ExperienQal ² Cosmos
² Mystery
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1. Religious
Closeness and connecQon to the sacred as described by a specific religion. Fosters a sense of closeness to a parQcular Higher Power
• 83% of US adults belong to a religious group
• 91% believe in God or a universal spirit
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VETERANS HEALTH ADMINISTRATION
2. Humanistic spirituality
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Closeness and connection to humankind. May involve feelings of love, reflection, service, and altruism.
Photos: Wikipedia.org
VETERANS HEALTH ADMINISTRATION
3. Nature spirituality
Closeness and connecQon to nature or the environment, such as the wonder one feels when walking in the woods or watching a sunrise. An important focus for many tradiQonal healing approaches.
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VETERANS HEALTH ADMINISTRATION
4. Experiential spirituality
• Shaped by personal life events
• Influenced by our individual stories
• Experience in war influences Veterans profoundly
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VETERANS HEALTH ADMINISTRATION
5. Cosmos spirituality
• Closeness and connecQon to the whole of creaQon.
• It can arise when one contemplates the magnificence of creaQon or the vastness of the universe – awe and wonder
• Such as when you look skyward on a starry night
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VETERANS HEALTH ADMINISTRATION
6. Mystery
• There is much that we simply cannot know or understand
• Perhaps it is not possible to fully grasp or know, and part of spirituality is allowing for the unknowable.
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VETERANS HEALTH ADMINISTRATION
Take a Moment to Consider…
• Consider the six different aspects of spirituality (and others you may think of)
1) Religious 2) HumanisQc 3) Nature 4) ExperienQal 5) Cosmos 6) Mystery
• Which ones resonate with you the most, and why?
• How might your views influence how you take care of pa@ents?
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VETERANS HEALTH ADMINISTRATION
Being part of a healthy religious community can promote health • ….if the the community if funcQonal
• 19x lower risk of death from all causes if you alend weekly services versus none (over 8 years) – And 7.5 years longer life expectancy – Especially for women
• Predicts social connecQons and beler mental health
• Tied to healthier lipid and stress hormone levels
Mallin R, Prim Care Clin Office Pract 2008; 35:857-‐66
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Attending religious gatherings and relative benefit
• 2000 meta-‐analysis found 22% lower mortality if you alend a religious gathering at least once weekly
• CriQcized for not showing a “clinically significant change”
• But, the benefit is equivalent to: – Using sta5ns for primary prevenQon – Exercise-‐based rehabilita5on aKer an MI – The opposite of how much harm heavy drinking causes
McCullough ME et al. Health Psychol, 19(3):211-‐222, 2000
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VETERANS HEALTH ADMINISTRATION
Attending religious gatherings and relative benefit
• A 2001 study found the risk improvement was beler than – Air bags – Taking angiotensin receptor blockers for chronic heart failure
– Screening for colorectal cancer using fecal occult blood tes5ng
– Prescribing sta5n therapy for people without heart disease
– Out-‐of-‐hospital defibrilla5on. Lucche\ G et al., Explore, 7(4):234-‐238, 2001
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More spirituality equates to
• Lower systolic and diastolic blood pressures
• Greater compliance with medicaQons
• Exercising more
• EaQng healthier
• Being able to quit smoking more readily
Mueller, PS et al, Mayo Clinic Proc.2001;76:1225-‐35.
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A summary of all the spirituality and religiosity research up through 2010 Koenig HG, Adv Mind Body Med, 29(3):19-26, 2015
VETERANS HEALTH ADMINISTRATION
Spirit and Soul: Health Plan Options
• Explore their beliefs with them – How can you respect and support what they believe? – And how can you respect and support what you believe? – Consider religious communiQes and/or spiritual pracQces
• Chaplains – hlp://www.paQentcare.va.gov/chaplain/
• Spiritual anchors • Help them work with forgiveness
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Spirituality is a brave search for the truth about existence, fearlessly peering into the mysterious nature of life.
-Elizabeth Lesser
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