How many times do you find yourself ruminating over the past? "If only I'd done… If wish I had said… I should have… etc." Or how much time do you spend worrying about the future - thinking about your to do list, mulling over what could be, what might happen, and what you may need to do or say? I could probably spend hours thinking about all the things on my to do list without doing any of them. I can spiral down when things go wrong, spending hours thinking about bad outcomes from a decision, outcomes that may not even come to fruition. So how to we stop living in the future and the past and instead focus on living in the present? How do we choose to be mindful instead of ruminating? What is mindfulness? Let’s delve in…
What is mindfulness?
Mindfulness is the
“basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us.” 1
Another definition according to Danny Penman, coauthor of Mindfulness: an Eight-Week Plan for Finding Peace in a Frantic World Mindfulness is a full awareness of precisely what is happening in the present.”2 A mindful mind requires us to have: focus, “the ability to concentrate on what you’re doing in that moment”, but also to have awareness, “the ability to recognize and release unnecessary distractions as they arise.”3
What are the benefits of mindfulness?
- Decrease the fight or flight response in your body
- Increase your relaxation response
- Decrease anxiety and depression
- Decrease blood pressure, heart rate, inflammation, chronic fatigue and pain
- Decrease stress
- Improve regulation of emotions
- Improve creativity
- “Mindfulness can change the structure of the brain increasing areas that affect learning, memory and emotion and decreasing the area that governs response to threat”4
- Mindful meditation leads to increases in gray matter in the anterior cingulate cortex and the hippocampus. The anterior cingulate cortex is “associated with self-regulation, meaning the ability to purposefully direct attention and behavior, suppress inappropriate knee-jerk responses and switch strategies flexibly… Meditators demonstrate superior performance on tests of self-regulation, resisting distractions and making correct answers more often than nonmeditators. They also showed more activity in the ACC than nonmeditators.”5 The second region, the hippocampus is part of the limbic system and associated with memory and emotion. “People with stress related disorders like depression and PTSD have a smaller hippocampus. People that underwent mindfulness training, however showed “increased amounts of gray matter in their brains.”5
Are mindfulness and meditation the same thing?
How does mindfulness differ from meditation?
What is Mindfulness-Based Stress Reduction?
- These are not easy questions. One definition I liked was this: mindfulness is the awareness of our outer life while meditation is the awareness of our inner life.6
- Mindfulness is that practice of us being aware of the present moment. It can be applied to ANY waking moment of our life. It requires us to be ACTIVELY aware of what we are doing WHILE doing it. So you can be engaging in activity! One example I liked is trying to be “mindful” during what you would normally consider a “mindless” task, such as washing dishes, folding laundry or driving. Focus on all of your senses. Engage them.
- Meditation on the other hand is the “formal practice of finding peace within”6. To find that peace, you need to decrease the mental chatter. There are many different types of meditation, including guided meditation, focused meditation (focusing on a mantra/sound, image, candle flame or type of breathing) and even mindful meditation, where your focus can be on mindfulness.
- Mindfulness Based Stress Reduction is typically a structured group program of 10-40 participants over a period of time (often 8 weeks) that learn to develop mindfulness in the form of meditation practice, mindful yoga and apply mindfulness to situations in everyday life.
Why should physicians care about mindfulness in their professional life?
- Several studies have shown that MBSR reduces stress and improves the wellness of medical providers.7-11
- Mindfulness probably helps us improve resilience. For physicians, this is a MUST!
- Krasner et al demonstrated that an educational program in mindfulness improved clinician well-being (burnout and mood) and increased a patient-centered approach to care. 12
- Beckman et al interviewed physicians that underwent mindfulness training and showed that mindfulness skills improved a clinicians’ ability to listen more attentively and respond more effectively to their patient. 13
- Fortney et al put participating physicians through an abbreviated mindfulness training course, adapted for primary care clinicians, and found the training was associated with reductions in indicators of job burnout, depression, anxiety, and stress.14
- Mindfulness among health care clinicians is associated with more patient-centered communication. 15
- Mindfulness may help us, as healthcare providers, to show more self-compassion, improve our own wellness and mental health, beat burnout, increase our job longevity AND improve our patient care. Mindfulness isn’t just for the executive suite, it is for the bedside too!
How do you practice mindfulness?
- There are many variations of HOW to practice mindfulness. Some people will use 10 – 30 minutes of formal meditation time each day. For some of us, finding time to pee alone without children, pets, spouses, or cell phones interrupting is hard. Ten full uninterrupted minutes is unheard of. You WILL get a benefit out of a meditation or mindfulness practice WITHOUT dedicating thirty minutes of each day to it. Start small and grow!
- I like the idea of “Mindful Minutes” or micro-meditations. Take a minute or two out of your day to practice mindfulness. In the middle of any task, you can pause to squeeze in a mindfulness minute. When you’re at the stove waiting for water to boil, when you’re in line at the grocery store, when you’re at a redlight, or when you’re going for a walk.
- Set a reminder on your phone for your mindful minutes. Maybe 2-4 times per day. Maybe every hour.
- Try applying any of these techniques:
The STOP acronym :
Stop.
Take a few deep breaths.
Observe – how you feel? Your senses? Your emotions…
Proceed
Concentrate your attention on what is happening in the present minute. What do you see? What do you smell? What do you hear? Do you feel the steam from the pot on the stove? Do you hear birds chirping on your walk and feel the weight of your feet hitting the ground?
Try to focus on your breathing and the sensations involved with breathing. Count your breath on each exhale. When your thoughts come, and they will. Let them pass. If you get carried away with them, come back to focus on your breathing. Start over with breath 1 and see how far you get.
Try repeating a mantra over.
Try setting a timer.
Remember that you are TRAINING your mind. You can’t squat 300 lbs your first try… you work your way up. Think of your brain as a muscle and grow it like you would your quads and glutes. Don’t expect perfection. Pobody’s Nerfect!
Disclaimer:
I am not an expert. I have an MD after my name - in Emergency Medicine - not in psychiatry or psychology, not in mindfulness. I’ve reviewed the literature. I'm delving in to my own mindfulness, but I am NOT an expert. I am a human that is #workinonmywellness via mindfulness. Below I have included the videos and articles that helped me to start my practice. I started using guided mediation via the Headspace app and the Insight Timer, both of which are below.
Tips on starting a mindfulness practice:
https://www.mindful.org/meditation/mindfulness-getting-started/
https://hbr.org/2014/03/mindfulness-for-people-who-are-too-busy-to-meditate
https://hbr.org/2016/03/how-to-practice-mindfulness-throughout-your-work-day
https://www.headspace.com/headspace-meditation-app
https://insighttimer.com
References
1. Mindful Staff. (2014, Oct 8) “What is Mindfulness?” Retrieved from https://www.mindful.org/what-is-mindfulness/
2. Rodriguez, Tori and Nicola Nieburg. “Live Life In the Moment.” The Mindfulness Manual 2018. (10-13)
3. Hougaard, Rasmus and Jacqueline Carter. “How to Practice Mindfulness Throughout your Work Day” Mindfulness. Harvard Business Review Press. 2017 (37-45).
4. Marchant, Jo. “Discover the Benefits of Mindfulness” The Mindfulness Manual 2018. (16-17)
5. Congleton, Christina et al. “Mindfulness can Literally Change Your Brain” Mindfulness. Harvard Business Review Press. 2017 (27-35).
6. Remati, Kathryn. “Are Mindfulness and Meditation the Same? Retrieved from https://yogainternational.com/article/view/are-mindfulness-and-meditation-the-same
7. Beddoe AE, Murphy SO. Does mindfulness decrease stress and foster empathy among nursing students? J Nurs Educ. 2004;43(7): 305-312.
8. Hassed C, de Lisle S, Sullivan G, Pier C. Enhancing the health of medical students: outcomes of an integrated mindfulness and life- style program. Adv Health Sci Educ Theory Pract. 2009;14(3):387-398.
9. Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M. Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med. 2003;15(2):88-92.
10. Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998;21(6):581-599.
11. Ospina-Kammerer V, Figley CR. An evaluation of the Respiratory One Method (ROM) in reducing emotional exhaustion among fam- ily physician residents. Int J Emerg Ment Health. 2003;5(1):29-32.
12. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284-1293.
13. Beckman HB, Wendland M, Mooney C, et al. The impact of a program in mindful communication on primary care physicians. Acad Med. 2012;87(6):815-819.
14. Fortney L, Luchterhand C, Zakletskaia L, et al. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med. 2013;11(5):412-420.
15. Beach MC, Roter D, Korthuis PT et al. A multicenter study of physician mindfulness and health care quality. Ann Fam Med. 2013;11(5):421-428.