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WHOLE HEALTH:

Change the Conversation

Mindful Awareness &

The Power of the Mind

OCTOBER 2013

I never look at the masses as my

responsibility. I look at the

individual. I can only love one

person at a time. I can only feed one

person at a time. Just one, just one…

So you begin - I begin.

I picked up one person - maybe if I

didn’t pick up that one person, I

wouldn’t have picked up 42,000.

The whole work is only a drop in the

ocean. But if I didn’t put that drop

in, the ocean would be one drop less.

Same thing for you, same thing in

your family, same thing in the

community where you live. Just

begin… one, one, one.

-Mother Teresa

One by One…

VETERANS HEALTH ADMINISTRATION

Objectives

• Define mindful awareness

• Explore why and how it matters

– Review some of the research

• Practical applications

• Resources for further learning


Pause and Presence

Pause, Presence, Proceed

Pause

Be Present Proceed Towards Whole Health


When are you most…

• Aware

• Present

• Centered

• Focused

• Calm

http://wallpapers916.blogspot.com


Definitions of Mindful Awareness

• Way of being

• In the present moment

• On purpose

• Nonjudgmentally

Mindful awareness is an

opportunity to be in the

wholeness of life…

including suffering, joy, peace,

unrest, creativity, fullness,

emptiness – everything…

…Not merely a technique for

coping with a specific problem.


Encompassed by many practices

• Yoga as preparation

• Meditation – Seated – Movement – Eating – Compassion

• Breathing

• Washing dishes, doing laundry

• Techniques found in most spiritual

traditions

• Goal is to bring it to moment-by moment awareness Dailyheal.com


The Challengers – ‘TIES’

• Thoughts

• Images

• Emotions

• Sensations

Modernworld4.blogspot.com


The nature of mindful awareness

Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.

-Victor Frankl, MD,PhD

10


The Info-Medical Cycle

Information Perception

Emotion Somatic Change

Behavior

Memory Belief

Rakel D, Shapiro D. Textbook of Family Medicine, 6th Ed.

Perception


How Many Fs?

FINISHED FILES ARE THE RESULT OF YEARS OF SCIENTIFIC STUDY

COMBINED WITH THE EXPERIENCE OF YEARS.


Word Association with…

United States= #1 Answer = Guilt

France= #1 Answer = Celebration!

Rozin, et al. Health Psychology. 1996;15(6):438-47.

I am an old man and have known a

great many troubles, but most of

them never happened.

-Mark Twain-

Beauty Anger Hostility Self-Doubt Judgment

Awareness

Awakening

Awe

Authenticity


Drop Beneath your mind’s thoughts and …..observe.

Thoughts Judgment

Emotions

Awareness

http://images.google.com/imgres?imgurl=www.geneseo.edu/~ror1/i/viscera/eye.gif&imgrefurl=http://www.geneseo.edu/~ror1/i/viscera/&h=151&w=200&sz=15&tbnid=5jHlmi-uvcgJ:&tbnh=74&tbnw=98&start=62&prev=/images?q=eye&start=60&hl=en&lr=&ie=UTF-8&sa=N&edition=us

Guess what? When it comes right down to it, wherever you go, there you are…

Like it or not, this moment is all we really have to work with. Yet we all too easily conduct our lives as if forgetting momentarily that we are here, where we already are, and that we are in what we are already in.

In every moment, we find ourselves at the crossroad of here and now. But when the cloud of forgetfulness over where we are now sets in, in that very moment we get lost.

– Jon Kabat-Zinn,

Wherever You Go, There You Are

Mindful awareness is gently

bringing our attention back to the present moment,

with acceptance (and curiosity) of what is…


Reversible cardiomyopathy with severe emotional stress

• 19 people with heart wall motion dysfunction after emotional stress

• Ejection Fraction = 20%

• Monocyte infiltration

• Moderate Troponin I

• catecholamines

• 95% had normal arteries

Wittstein, et al. NEJM 2005;352:539-548

A Wandering Mind Is

an Unhappy Mind Matthew A. Killingsworth*,

Daniel T. Gilbert

Science 12 November 2010:

Vol. 330 no. 6006 p. 932

2250 Adults in US.

Mean age = 34

Are you thinking about something other than what you’re currently doing?

What are you doing right now?

How are you feeling right now?

http://www.sciencemag.org.ezproxy.library.wisc.edu/search?author1=Matthew+A.+Killingsworth&sortspec=date&submit=Submit

http://www.sciencemag.org.ezproxy.library.wisc.edu/search?author1=Matthew+A.+Killingsworth&sortspec=date&submit=Submit

http://www.sciencemag.org.ezproxy.library.wisc.edu/content/330/6006/932.full

http://www.sciencemag.org.ezproxy.library.wisc.edu/search?author1=Daniel+T.+Gilbert&sortspec=date&submit=Submit


J Am Coll Card: Vol 45(5);2005

Nationalgeographic.com


Gamma wave synchronization

• Longtime practitioners show organized brain activation on scale never seen before

High-frequency gamma wave synchronization especially intense in the left prefrontal cortex

Gamma waves associated with attention and mood

Lutz et al. PNAS 2004;101(46):16369-73.


Promega Study

Methods:

• 48 right handed subjects employees of Promega in Fitchburg, WI

• Subjects randomized into Meditation group (N=25, 19 females) and a wait-list control group (N=16, 10 females)

• Mean age 36 years

• Wait-list controls were provided 8-wk MBSR training program after completion of study

Richard J. Davidson, Ph.D., Jon Kabat-Zinn, Ph.D., et al. Alterations in brain and immune

function produced by mindfulness meditation. Psychosomatic Medicine. Aug/Sept. 2003


Right vs Left Prefrontal Cortex

Negative ---- Positive

Balance predicts typical range of moods.


Negative emotions: right prefrontal cortex

• Anger

• Fear

• Anxiety

• Depression


Positive emotions: Left prefrontal cortex

• Enthusiasm

• Vigor

• Optimism

• Buoyancy


Promega study

A short course of meditation practice increases left prefrontal cortex activity

• ↓ anxiety & negative affect

• ↑ positive affect

• ↑ immunity (antibody titer to flu vaccine)

Davidson et al. Psychosom Med 2003; 65(4):564-70.

fMRI

Brefczynski-Lewis, et al. 2007104(27):11483-8


Genius means little more than the faculty

of perceiving in an un-habitual way.

-William James


Mindfulness for Clinicians and Staff

Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study. Ann Fam Med. 11(5); 412-420. 2013

Arch Intern Med. Published online 08/20/12.

doi:10.1001/archinternmed.2012.3199.

Burnout by Specialty

(n = 7288)

0 10 20 30 40 50 60 70 Percent Reporting Burnout

Significant improvements with Maslach Burnout Inventory

Significant improvements with depression, anxiety and stress


Mindful awareness in a nutshell

• Pause o Stop what you are doing; drop in

o Challenge is to make this a habit

• Presence o Observe it, acknowledge it

o Nonjudgmental. No striving – let it be

• Proceed o Return to your activity, anchored in present moment awareness (breath,

physical sensation, groundedness)

o Compassion, appreciation, positive intention

Adapted from: www.fammed.wisc.edu/mindfulness

http://www.fammed.wisc.edu/mindfulness


How can your meditation cushion become your clinical chair?


Mindful Awareness and Medicine


Healing Thresholds

47

What does this look like?

What does this look like?


Suggestions for practice

• Listen with your whole body

• Deep breath before each patient

• Threshold exercise

• Stethoscope use as a reminder to be mindful

• Call room/office centering

– The moment you sit in your chair…

• Supportive group

• Daily practice

• Others?

http://www.virtualtoolbox.ca/

Tell me what you pay

attention to, and I will

tell you who you are.

Jose Ortega y Gasset


Five Facet Mindfulness Questionnaire

• Feeling yourself walking

• Responding to emotions, not getting caught up in them

• Distractibility

• Noticing background sounds

• Feeling the water from the shower

• Noticing smells

• Putting experiences into words

• Self-judgment

53


Appreciative Inquiry

Appreciative Inquiry is about the co-evolutionary search for the best in people, their organizations, and the relevant world around them. In its broadest focus, it involves systematic discovery of what gives “life” to a living system when it is most alive, most effective, and most constructively capable in economic, ecological, and human terms.

www.Appreciativeinquiry.case.edu

http://www.Appreciativeinquiry.case.edu

It is true that we are called to create a better

world. But we are first of all called to a more

immediate and exalted task: that of creating our

own lives. -Thomas Merton

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