Transcript Everyday Mindfulness - Department of Family and Community

Everyday Mindfulness
DPC Grand Rounds March 7, 2013
Dr Susan Abbey MD, FRCPC
Program Head, Medical and Surgical Psychiatry, TGH
Dr Monica Branigan MD, MHSc (Bioethics)
Professional Development Lead, Division of Palliative Care, U of T
Michele Chaban MSW, D Phil
Co-Director Inter-professional Applied Mindfulness Meditation Certificate, U of T
My intention
 To create community around mindfulness in palliative care
Objectives
 Discuss simple mindfulness interventions designed to benefit
practitioners
 Review interventions of benefit for people dealing with life
threatening illness
 Consider mindful questions to address pain and suffering
How can we cultivate mindfulness?
 Paying attention we can bring awareness to
 Mind
 Heart
 Body
 Each center is associated with different ways of knowing,
listening and speaking
 Each functions from a different
place
 Neocortex
 Limbic system
 Brainstem
The head center
 Our thinking center
 Knowing through rational thought
 Listen to content: description,
explanation, story, beliefs,
assumptions
 Speaking: “I think...”
 Values: control
 Pitfalls: critique, judgment,
“I already know”
 Pamela Weiss
The heart center
 Our feeling center
 Knowing through openness, attunement, acceptance
 Listening to feelings, emotions, mood
 Speaking: “I feel....”, “I am angry....”
 Value: approval
 Pitfalls: emotional
reactivity- entanglement
or distancing
Pamela Weiss
The body center
 Our sensing center
 Knowing through intuition,
perception
 Listen to energetic tone,
physical cues
 Speaking: “I sense......”
 Value: safety
 Pitfalls: tension, agitation,
flight, fight or freeze
 Pamela Weiss
The three centers from our patient’s
point of view
 Mind: tell me what I can do to make the pain better and give
me an explanation that makes sense to me
 Heart: let me know that you accept my pain is real
 Body: allow me to feel safe
The three centers from the provider
point of view
 Three part check in
 Start with the body: big breath, relax shoulders down, expand
back, sides, front
 Bring awareness to your heart: feeling tone or mood
 Notice your thoughts or general flavour: critical, curious….
Mindful approach to pain
Begin with a three part check for yourself so you can meet
the patient as a whole person
2. Invite the patient to check in with their three centers
3. Notice the energy between you and the patient- are you
connected?
1.

YES: together you work with “the pain”

NO: the patient remains alone with “their pain”
The Two Darts
"When an untaught worldling is touched by a painful (bodily) feeling, he
worries and grieves, he laments, beats his breast, weeps and is distraught. He
thus experiences two kinds of feelings, a bodily and a mental feeling. It is as if
a man were pierced by a dart and, following the first piercing, he is hit by a
second dart. So that person will experience feelings caused by two darts....
 Sallatha Sutta
How do we usually approach pain?
 The standard pain history
 Major focus on the body- the first dart
 Does not fully acknowledge the second dart
 DISCONNECT: as HCPs we
often may come from our
head center and may ask
that our patients respond
from their body center
Questions for the mind
 What do you think about when you have pain?
 Where does your mind go when you have pain?
 Are there any thoughts that trigger your pain?
 Are there any stories that come to you when you have
the pain?
 What is the meaning of your pain?
Questions for the heart
 Tell me about the pain in your heart.
 How does your heart feel the pain?
 What in your life is causing pain in your heart?
 What is your heart feeling?
Questions for the body
 Standard pain history
 Where do you feel the pain?
 What words describe it?
 What makes it better?
 Etc
 How does the rest of you body feel?
 Are there parts of your body that experience comfort?
 Do you sense that your body is trying to tell you
something?
Commitments
 May I check in with myself in order to bring my wholeness to
the patient that I may see them as whole and not broken
 May I expand my awareness of pain beyond the first dart and
allow the patient to explore body, mind and heart
 May I see my own frustration and helplessness as something
that connects me to the patient and not use it against myself
Resources- MBSR
The MBSR Clinic
Location: Toronto General Hospital
Time: Monday morning, Monday afternoon or
Wednesday evening
Instructors: Dr. Susan Abbey and
Sarah Greenwood, RN, BScN
Cost: $75.00
Call: 416- 340-4452
MBSR and Mindfulness
 Centre for Mindfulness in Medicine, Health Care and Society
http://www.umassmed.edu/cfm/index.aspx
see for professional courses and teacher training and annual scientific
conference
Communities of practice
 Mindfulness Toronto
http://mindfulnesstoronto.ning.com/
see for mindfulness courses, events, MBSR and sitting groups
 See posted “Resources” on Community Space
Continuing professional development
 Applied Mindfulness Meditation at the Factor Inwentash
Faculty of Social work
http://www.socialwork.utoronto.ca/conted/certificate/mi
ndfulnessmed.htm
 Centre for Mindfulness Studies, Toronto
http://www.mindfulnessstudies.com/
 Insight Meditation Center- online
http://www.insightmeditationcenter.org/programs/onlinecourses/
Continuing professional development
 Being with Dying Program at Upaya
http://www.upaya.org/bwd/
 Metta End of Life Practitioner Program
http://mettainstitute.org/EOLoverview.html
 Mindful Practice: Focus on Serious and Life-Limiting Illness,
University of Rochester
http://www.cvent.com/events/mindful-practice-focus-onserious-and-life-limiting-illness/event-summary9a33a7d3cfbe4e4993128c6c7aa1964e.aspx
Online meditation podcasts
 UCLA Mindful Awareness Research Center
http://marc.ucla.edu/body.cfm?id=22
 Tara Brach, Buddhist meditation teacher
http://www.tarabrach.com/audiodharma.html
 Insight Meditation Centre
http://www.audiodharma.org/series/1/talk/1762/
 Dan Siegel
http://brainsciencepodcast.com/bsp/meditation-and-thebrain-with-daniel-siegel-md-bsp-44.html
For patients
Mindfulness Based Cognitive Therapy (MBCT) for People with
Cancer
Facilitators: Dr. Mary Elliott, MD, FRCPC
Dr. Evan Collins, MD, FRCPC
Dates: TBA
Location: Pencer Centre Group Room, 18th Floor, Princess Margaret
Hospital
How to register: Physician referral required. Please complete the
attached referral form and send to [email protected] or fax to
416-946-2047.
Fees: Course covered by OHIP.
For patients
MBSR at Wellspring
http://www.wellspring.ca/Odette/Programs/Full-List-ofPrograms/Mindfulness-Based-Stress-Reduction.aspx
Let’s talk…….
[email protected]