by Laura Martin, LCSW, MBSR and Mindful Medicine teacher
I am proud to represent Mindful Medicine at the annual conference of the Center for Mindfulness at UMass Medical School! Though there is still a little snow on the ground here in Worcester, Massachusetts, inside it’s a warm and vibrant environment with many teachers, scientists, and mindfulness practitioners who have devoted much of their lives to this practice of mindfulness. So inspiring! This year, the conference’s theme will be on ethics.
Today, however, was a day of practice. A day-long retreat with Jon Kabat-Zinn, the originator of MBSR (Mindfulness-Based Stress Reduction), and Judson Brewer, MD, the resident researcher at the UMass Center for Mindfulness:
“This daylong retreat will be conducted using the laboratory of our own body-mind. Periods of guided practice that punctuate particular aspects of experience will be integrated with brief presentations and discussions of directly relevant research findings. In this way, our subjective, lived experience will be intimately linked to current scientific understandings of the underlying neurobiological processes.”
Between the two of them, they were able to put these centuries-old practices into context, creating a balanced and multi-dimensional view of some of the most recent brain science. One example: One of Dr Brewer’s projects has been getting experienced meditators and meditation novices into fMRI machines and measuring their Default Mode Network (DMN), which include the Posterior Cingulate Cortex (PCC) and the Medial Prefrontal Cortex (MPFC).
The Default Mode Network is activated by self-referential thoughts and activities: “What am I going to have for dinner? Why did she say that to me? What will they think of me?” These may be very familiar thoughts in our moments of disconnection and getting lost in thought or getting “caught up” in meditation! Jon referred to it as “The Story of Me.” We don’t need an fMRI to see that this is a habit that causes suffering: When we are insisting things be Our Way. When we are defending territory. When we are frightened about losing face or social status.
In studying these markers in the brain — the activity of the Default Mode Network — Dr Brewer was able to observe that in novices, these areas tend to be very active. Experienced meditators, however, were able to actually quiet these areas with meditation in real time, showing occasional spikes of DMN activity when the meditators were concerned how they were faring in the process of being tested.
DMN activity is characterized by a narrative process, and is relative to time — past and future. When the default mode network is less active, there is a more experiential process at work. Things just happening and in flow. This is one of the aspirations of MBSR: Non-striving. It’s paradoxical, but indeed, trying harder to achieve a certain state of mind leads us further away from what is actually happening in the moment.
Experienced meditators have learned to let go; not get so caught up in their conceptual self. Over time and with practice, this letting go, this effortlessness that can happen in meditation can also be applied to the activities of life. Mindfulness becomes a way of being.
And this is really what it’s all about. The science of meditation and mindfulness is not about trying to make pretty fMRI pictures, or “tune up” the insula, or try to get a thinner *amygdala. Trying to get somewhere else is not mindfulness. Science is a practice, and is never a finished story, just like we are. What we are really doing is being with things as they are, discovering who we really are; something much more vast than “The Story of Me”.
below- Judson Brewer, MD (left) and Jon Kabat-Zinn, PhD
By David Schroeder, M.D., cardiologist
Practicing the art of mindful medicine
Co-founded Mindful Medicine, a nonprofit to help providers lower their stress, overcome “compassion fatigue” and rediscover the joy of medicine
Medical degree, Rutgers Medical School; residency and cardiology fellowship, Oregon Health & Science University
When did you start practicing mindfulness?
In 2006 I was diagnosed with obstructive sleep apnea. At age 36, it was difficult to accept that I now had a chronic disease for which no amount of wishful thinking or healthy habits was going to fix. In addition, I was adapting to a relatively new role as father. As I struggled with these feelings of stress and changed identity, I found mindfulness.
What is it, exactly?
It’s the simple practice of maintaining moment-to-moment awareness of your breath, body sensations, thoughts and feelings. It’s surprisingly effective. Almost immediately I felt less stress, slept better and gained valuable perspective on my life. My sleep apnea is now treated – I no longer wake up to breathe – but I have continued a daily mindfulness practice. I’ve found that awareness of my breathing promotes waking up to the world around me.
Does this help you as a physician?
It’s been my experience – and this is supported by medical literature – that being truly present has enhanced my ability to understand my patients, and it has improved communication. Mindfulness skills do not add much time to a clinic visit and, in my opinion, they enhance the patient’s experience. I feel like I do a better job and have more fun doing it.
Is this why you helped create Mindful Medicine?
I and a group of like-minded physicians and mindfulness teachers thought other providers might benefit from these skills. Nearly half of all physicians in the United States have symptoms of burnout, which is associated with lower quality of life for the physician and worse outcomes for their patients. The opposite of burnout is engagement, which is something that mindfulness promotes. With Mindful Medicine, we hope to create a vehicle that supports mindfulness for the health care community.
Tell us about your group’s research on mindfulness
Several recent non-controlled pilot studies have shown improvement in physician well-being following mindfulness training. We’re planning a small, randomized-controlled trial that will extend these findings to include patient outcomes as well. Providence has generously supported us with a research grant to investigate this in primary care physicians. Stay tuned!
Do you offer courses for patients?
Not yet. Our teachers currently offer mindfulness and compassion training for the general public. In the future we would like to expand so that all health care staff can participate. Eventually courses specifically for patients might even be available.
Mindful Medicine is holding a physicians retreat Oct. 17-19 in Portland. Space is limited, click here to register
Your roots are with Providence?
The physician co-founders of Mindful Medicine work at Providence Portland Medical Center, and are inspired by the Mission that explicitly celebrates compassionate service. We are grateful to the support from, among others, Jennifer Zelensky, Dr. Craig Wright, Dr. Ben LeBlanc, Providence Portland Medical Foundation and the Providence Clinical Transformation Council. That said, our goal is to reach interested physicians in the entire region, no matter their affiliation.
Besides mindfulness, how do you live a healthy life?
I am pretty committed to good diet, exercise, sleep and appropriate relaxation. I love running to work when my schedule permits, and being active outdoors with my family. Most nights I practice yoga in my daughter’s bedroom as she is falling asleep. I try to eat a whole food diet, largely plant-based, and am encouraged by Dr. Miles Hassell’s book, “Good Food, Great Medicine.” I make sure to leave room for warm chocolate chip cookies and ice cream!
Bedside manner. What an understated term for a doctor’s ability to relate with another human being. While looking around online to research what differentiates “good” beside manner from “bad,” I came across this gem written in 1892.
“The true basis of the good bedside manner is a large heart. Some expansiveness of the intellect is undoubtedly an advantage but a humane and sympathizing nature outweighs all other qualities.” (JAMA Vol. XVIII No. 7, Feb 13, 1892)
How do we cultivate having a “large heart?” It does not seem to result from having a large head. Ego and preoccupation with self-interest often interferes with our ability to be humane. Fortunately, the metaphorical heart is a muscle that can be developed and strengthened through the right kind of exercise.You know what’s coming next…
Contemplative skills such as mindfulness and compassion have been growing and strengthening hearts for thousands of years. We now know more than ever about how the “heart” is literally in the brain. Mindfulness and compassion training has been demonstrated to change the structure of the brain in areas related to empathy, sustaining positive emotions, attentional regulation, and emotional regulation. These are key bedside manner skills and can be developed into enduring traits. The metaphorical heart is literally in your head, and it is biologically who you are. Your bedside manner is more than something you do, a way to simply be better at your job. It is an expression of your brain, your wellness, your character, of you as a human being. So bring your full humanity and large heart to what you do. Because when you do, that is who you are.
Let’s help the people who help people. This simple inspiration to help is at the heart of Mindful Medicine. We are a group of mindfulness teachers and physicians dedicated to physician wellness and resiliency. Our doctors are suffering, and they need help.
According to a study published in JAMA in 2012 nearly half of all physicians surveyed had symptoms of burnout.
“Burnout can have serious personal repercussions for physicians, including problematic alcohol use, broken relationships, and suicidal ideation. When considered with the mounting evidence that physician burnout adversely affects quality of care, these findings suggest a highly prevalent and systemic problem threatening the foundation of the US medical care system. The fact that almost 1 in 2 US physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals. Policy makers and health care organizations must address the problem of physician burnout for the sake of physicians and their patients.”
Our doctors are burning out at alarming rates, and the impact of burnout on their capacity to care for themselves and their patients is a problem that affects us all. Mindful Medicine is dedicated to being part of the solution. We believe that physicians and the health care systems in which they work need to address the causes of burnout, how to prevent or reduce it, and most importantly, how to create a healthcare culture that actively fosters wellness and resiliency in its providers as well as consumers, a system of healthcare truly characterized by health and care. Our doctors deserve better care. The systems they work in deserve better health. We think we can help.
We are dedicated to teaching physicians evidence-based, secular mindfulness skills to improve self-care as well as patient care, including skills to reduce stress, increase compassion for self and others, and improve cooperative problem solving with patients and coworkers. We want to help doctors rediscover the joys of practicing medicine and create a positive community of doctors based on peer support, mutual respect, and wellbeing. Our goal is mindful doctors participating in and being supported by mindful community. We hope this will help the people who help people. Stay tuned!