Becoming more mindful: Can you benefit?

Becoming more mindful: Can you benefit?

Richard E. Berger, MD

University of Washington

…receiving a cancer diagnosis is like a soldier

being dropped into a jungle war zone without a map,

compass or training.

Michael Lerner-Commonweal Cancer Self Help Program

How do you make sound decisions and live fully, when you are up to

your ass in alligators?

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Mindfulness is a mental state, characterized by concentrated awareness of one's thoughts,

feelings and actions.

Paying attention, on purpose, in the present moment, non-judgmentally

Mindfulness promotes the replacement of reactivity with

considered conscious decisions.

Development generally requirespractice.

Benefits mindfulness

• Live life more fully in present moment

• Practice kindness toward yourself

• Less suffering from pain

• Appreciate what is right with you

• Mobilize inner and outer resources

• Take control of life and attention

Mindfulness Effects on Cancer Patients

• Improved mood

• Decreased stress

• Decreased anxiety

• Improved adjustment to diagnosis

Metanalysis of 6 studies by Mitchim et al, ONCOLOGY NURSING FORUM - VOL 34, NO 5, 2007

Mindfulness Effects on Cancer Patients

• Improved quality of life

• Improved feeling of control

• Improved sleep

• Less suffering from pain

Metanalysis of 6 studies by Mitchim et al, ONCOLOGY NURSING FORUM - VOL 34, NO 5, 2007

2

Effects Mindful Practices

weight blood sugar bp• Improved lipid profile cortisone inflammation• Improved well-being,

alertness pain with stress

brain size, grey matter quality of life concentration learning sleep quality body awareness depression

• Changes DNA activation

NIH conference 2009 Mind/Body Med.

Mindfulness Increases Survival

• Hypertension

• Cardiac Disease

• Cancer??– Decrease PSA rise. J Urol. 2001 Dec;166(6):2202-7

"Moral excellence comes about as a result of habit. We become just by doing just acts, temperate by doing temperate acts, brave by doing brave acts."

-Aristotle

What is cost of becoming more mindful?

A. Nausea?

B. Your hair falls out?

C. 6 weeks painful recovery?

D. 30-60 minutes/day of sitting quietly, alertly and non-doing?

PRACTICEPRACTICEPRACTICE

But the practice isthe goal!

Things for Pretty Sure

• If you don’t practice something, you won’t get much better at it.

• You are always practicing something. (Habits)

• You can choose what you practice.

A Native American elder once described his own inner struggles in this manner: “Inside of me there are two dogs. One of the dogs is mean and evil. The other dog is good. The mean dog fights the good dog all the time”. When asked which dog wins, he reflected…

George Bernard Shaw

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“The one I feed the most”.

Start Easy

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Mindfulness Practice Real life problems

MEDITATION IS…

• THE PUPOSEFUL PRACTICE OF MINDFULNESS• AWARENESSING• PRACTICING CALM ALERTNESS• PRACTICING EXPERIENCING “WHAT IS”• GETTING FAMILIAR WITH YOURSELF

What do you practice in mindfulness?

• Quieting your mind

• Recognizing discursive thoughts

• Letting go of discursive thoughts

• Recognizing urges

What do you practice in mindfulness?

• Letting go of urges

• Recognizing emotions

• Letting go of emotions

• Creating space around mental events

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RAIN

• R-Recognize

• A-Allow

• I-Investigate

• N-Not me or Let go or Let be

Mindfulness and View

Sensory Perceptions

Thoughts

Mindful view of Thoughts,Emotions, Sensations

Confusion ThoughtsWith Reality

Experience of WorldExperience of World

, conceptsThoughts, concepts

PINBALL WIZARD THINKING

“That deaf, dumb, and blind boy, sure plays a mean pinball.”

The Who

You Are Not Your Thoughts

Mindfulness Based Stress Reduction: MBSR

• MEDITATION

• BODY AWARENESS PRACTICE

• YOGA

• 8 weeks, 2-3 hours/week

• Daily practice-45 min.

MEDITATION IS NOT…

• SPACING OUT• ANALYZING• TRYING NOT TO THINK• THINKING HAPPY THOUGHTS• VISUALIZATION• DISTRACTION• AVOIDANCE• POSITIVE THINKING• PRAYER?

Mindfulness v Phys. Exercise

• Need faith to start

• Need 6-8 weeks to see results

• Hardest in the beginning

• Gets more enjoyable with time

• Takes 2 weeks to establish habit

• Lifelong benefits

Application Mindfulness

Event Emotion

ThoughtsPast associations

Pre-response Response

RAIN RAIN RAIN RAIN

Neuron

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Neuroplasticity

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Meditation Brain Studies

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Mindful Meditation

Attention/Association Areaof Frontal Lobe

Orientation/Association Area of Parietal Lobe

amygdala/hyppocampus-

emotional significance and LT

memoryActivation sympathetic/

Parasympathetic n.s.

AH

Th

mbIncreased activity HH

Decreased activity

CVS, Immune effects

Right v Left BrainLabeling

Analytic thoughtLogic

LanguageConceptual thoughtDiscursive thought

ExperiencingHolistic thought

CreativityArt/MusicIntuition

Increasing AwarenessGradual

acceptanceof holistic,

non-reductionistexperience

Holistic experience of analysis,

conceptual thoughtand

discursive thought

=awareness

Analyzing &Ruminating About Past

Fantasizing, Ruminating, PlanningAbout Future

We are Human Beings

What lies behind us and what lies before us are tiny matters compared to what lies within us.

Oliver Wendell Holmes

The Present

GOALS

• Better decision making

• Increased quality of life

• Increased enjoyment of life as it is

• Being present

How do you know that you are doing it right?

If you try, you are doing it right!

Do only as much as maintains your enthusiasm!

.

What is Measures of Success?

• KINDNESS to yourself & others

• Less reactive decisions

Cancer and Mindfulness

As long as you are breathing, there is a lot more right with you

than is wrong with you.

Practice Being Aware of What is Right With you!

Laboratory

Your Mind and Life

Practice Living Every Moment

We All Have an Illness Story

Be mindful of your story

Views of Illness

Restorative

Chaos

Quest

Restorative NarrativeI’ll be healthy again

Our institutionalized narrative

For every suffering there is an outside remedy given by some authority

Isolating, authority gives patients story

Evades question of mortality and medical failure

No personal story to fall back on

Arthur Frank

Chaos Narrative

Life never gets better, no sequence of causality

Vulnerability, futility and impotence.

There is no plot to story, no voice, no one is in control

Isolating and no motivation

Too easy to dx depression

Arthur Frank

Quest (Mindful) Narrative

Accept illness and attempt to use it

Awareness of illness and life in the present

Illness as personal but shared journey

Teller tells own story

Personal perseverance and purpose.

Relationship to others- Empathetic

Arthur Frank

Resources• Selected Readings on Mindfulness• 8 Minute Meditation: Quiet Your Mind. Change Your Life. by Victor

N. Davich• Turning the Mind Into an Ally by Sakyong Mipham and Pema

Chodron• Silence: How to Find Inner Peace in a Busy World by Christina

Feldman• Full Catastrophe Living: Using the Wisdom of Your Body and Mind

to Face Stress, Pain, and Illness by Jon Kabat-Zinn• Wherever You Go, There You Are by Jon Kabat-Zinn• Coming to Our Senses: Healing Ourselves and the World Through

Mindfulness by Jon Kabat-Zinn• The Miracle of Mindfulness by Thich Nhat Hahn

Web Resources

• www.mindandlife.org• http://www.dharma.

org/ims/ss_meditation_resources.html• http://www.umassmed.edu/cfm/home/index.aspx• http://amberstar.libsyn.com/index.php?post_categ

ory=Introduction%20to%20Meditation

Resources

Mindfulness Based Stress Reduction courses.

• John Wendt MD and Sherry Williams http://paccentermind.org

• Carol Jakus, MA, MSW, LICSW-Seattle Washington, cjakus@mindfullivingnw.com

• Carol McManus, PT, MS, MA, http://www.carolynmcmanus.com/pages/workshops.html