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 requires practice.

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 2 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

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?

PRACTICE PRACTICE PRACTICE But the practice is the 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… “

The one I feed the most

”.

George Bernard Shaw QuickTime™ and a decompressor are needed to see this picture.

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Start Easy 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 , concepts Thoughts, concepts Mindful view of Thoughts, Emotions, Sensations Confusion Thoughts With Reality Experience of World Experience of World

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 RAIN RAIN RAIN RAIN Response Event Emotion Pre-response Thoughts Past associations

Neuron Qui ckTime™ and a decompressor are needed to see thi s pi cture.

Neuroplasticity QuickTime™ and a decompressor are needed to see this picture.

Meditation Brain Studies QuickTime™ and a decompressor are needed to see this picture.

Mindful Meditation Orientation/Association Area of Parietal Lobe Attention/Association Area of Frontal Lobe amygdala/hyppocampu s emotional significance and LT memory A H Th mb Activation sympathetic/ Parasympathetic n.s.

Increased activity Decreased activity CVS, Immune effects

Right v Left Brain

Labeling

Analytic thought Logic Language Conceptual thought Discursive thought

Experiencing

Holistic thought Creativity Art/Music Intuition

Increasing Awareness Gradual acceptance of holistic, non reductionist experience Holistic experience of analysis, conceptual thought and discursive thought =awareness

We are Human Beings Analyzing & Ruminating About Past The Present Fantasizing, Ruminating, Planning About Future What lies behind us and what lies before us are tiny matters compared to what lies within us.

Oliver Wendell Holmes

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 Narrative I’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_resourc es.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