Becoming more mindful: Can you benefit? Richard E. Berger, MD University of Washington
Dec 30, 2015
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
2
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, [email protected]
• Carol McManus, PT, MS, MA, http://www.carolynmcmanus.com/pages/workshops.html