How Mindfulness Helps Providers and Patients
The additional pressure of COVID-19 has aggravated an already stressed healthcare system. Systemic changes must occur to better care for patients — and providers. But systemic change can be slow, even beyond a pandemic. Until then, what can you do? How can you take care of yourself so you can take care of others? The answer could be as simple as becoming more mindful.
Posted in Examiner Publication on Thursday, May 20, 2021
Mindfulness: More than a Buzzword?
The word “mindfulness” is getting a lot of attention, but it’s been part of the human experience since ancient times. In recent decades, mindfulness has morphed into stress reduction practices, such as the Mindfulness Based Stress Reduction (MBSR) program, popularized in the West in the 1970s by Jon Kabat-Zinn.
What is Mindfulness?
Simply put, mindfulness is the act of becoming aware of the present moment. Our minds often become stuck thinking about things that happened in the past or may happen in the future. Mindfulness is about being aware, moment by moment, of your thoughts, beliefs, emotions, physical sensations and environment.
Kabat-Zinn defines mindfulness as, “The awareness that arises when we non-judgmentally pay attention in the present moment. It cultivates access to core aspects of our own minds and bodies that our very sanity depends on.”
Practicing mindfulness is physically and psychologically beneficial and is associated with health, attitude and behavioral improvements. Mindfulness improves a practitioner’s well-being, thereby improving patient safety and reducing incidents of errors that lead to claims.
Is Mindfulness Feasible for Busy Professionals?
Kabat-Zinn’s eight-week MBSR program has been found to effectively improve resident practitioner personal and work-related well-being — a typically highly stressed and highly burdened group not unlike yourself.
In a small German study, nine resident practitioners assessed the feasibility of an eight-week mindfulness program. Researchers studied demand, acceptability, implementation, practicality, adaptation, integration and preliminary effectiveness domains.
Using a biomarker of stress, they examined participants’ hair cortisol level changes, as well as self-reported well-being increases. Given the resident’s lifestyle, researchers accounted for “the complex interplay of specific work stressors, personality traits and maladaptive attitudes that account for residents’ distress.” Citing perfectionism, workaholism and self-care neglect, researchers focused on improving well-being and attitude (i.e., not symptom relief or improved performance, due to fears that high-achieving residents would use mindfulness to optimize performance).
Medium-to-high improvements were observed in personal well-being, including the participants’ perceived stress and self-compassion. Small-to-medium improvements were observed with job strain, burnout and practitioner empathy. Additionally, medium reductions were noted in hair cortisol.
Mindfulness vs Meditation: What’s the Difference?
Mindfulness is the state of being. It means you’re focused on the present moment and are aware of your thoughts, beliefs, sensations, feelings and environment. Meditation is the practice of being mindful. It’s the thing you “do” to practice “being” in the moment. It typically refers to the formal practice of sitting and minding your breath or using mantras to guide your focus.
While meditation is a strong component of a mindfulness practice, there are other ways to practice mindfulness. This includes becoming aware of your breath, scanning your body to feel its sensations, and recognizing that thoughts do not define you. A mindfulness practice can be as simple as remembering to come back to your five senses throughout the day.
Three Benefits of Mindfulness
You’ve probably heard that being more mindful can help you reduce stress and anxiety. It’s something most of us need every day. Yet many people don’t realize how much deeper a mindfulness practice can take you to go beyond just “making it through” another day to reconnecting to what’s joyful and meaningful.
1) Improved Patient Outcomes
According to the Centers for Disease Control and Prevention, six in 10 Americans live with a chronic health condition. Could a mindfulness-based program help your patients cope?
In 14 studies of people with chronic disease, participating in an MBSR program was likely to “improve symptom management, overall quality of life and health outcomes in individuals with chronic disease.” All studies showed MBSR was associated with improvement, including significant anxiety and depression benefits. Four out of six relevant studies were associated with improved quality of life and well-being, with less pain experienced by four out of five patients.
Mindfulness is linked to reduced blood pressure, lessened migraines, and reduced PTSD and major depressive disorder relapse. Research indicates mindfulness supports better immune function. In a study titled, “Alterations in brain and immune function produced by mindfulness meditation,” researchers studied the effects on brain and immune function using the eight-week MBSR training program with healthy employees.
The program tested 25 people, measuring brain electrical activity before and immediately after the eight-week program and again four months later. A control group was also tested during the same timeframe. After the eight-week period, both groups received the influenza vaccine. “Significant increases in left-sided anterior activation, a pattern previously associated with positive affect,” in the individual meditators was found. They also found increased antibody titers to the vaccine in the meditation group versus the control group. And, the amount of the increase in left-sided activation predicted the increase of antibody titer, which led them to conclude that short-term mindfulness training can improve brain and immune function.
In 2016, researchers conducted a comprehensive review of randomized controlled trials to examine how mindfulness meditation affects the immune system. They concluded that mindfulness meditation is “associated with reductions in pro-inflammatory processes, increases in cell-mediated defense parameters, and increases in enzyme activity that guards against cell aging.”
2) Reduced Clinical Error
Diagnostic errors are among the highest professional liability claims. While much emphasis is placed on systemic problems, individual cognitive bias also plays a role. The Agency for Healthcare Research and Quality (AHRQ) identifies the following cognitive biases associated with diagnostic error.
Availability heuristic: The mental shortcuts we take that relies on what immediately comes to mind when presented with patient data
Anchoring heuristic: Relying on the first piece of information received
Framing effects: Biased decision making based on collateral information, such as a patient’s known drug use
Blind obedience: Overreliance on a false positive/negative test
How can a mindfulness practice help? Mindfulness practices have been shown to increase a person’s ability to see the context surrounding another person’s decisions or actions. An example is making a quick judgment about a noncompliant patient. You may assume the patient missed the appointment due to apathy, when in reality he or she lacked reliable transportation.
A study compared the responses of three groups: one group was given a mindful eating task, the next group was given a task that required attention to detail, and the last group was given nothing to serve as control. Afterward, all participants read an essay and asked to gauge how strongly they believed the writer was pro- or anti-nuclear power (understanding the writer was assigned the article and had not chosen a position). The mindfulness group was less willing to assume the writer’s position, suggesting they were less biased.
3) Reconnection with Purpose
In a survey of 9,000 health care professionals, 67.5 percent of respondents said they chose their careers for the personal fulfillment of helping others. But the long-term stress in health care led many to experience cynicism and lack of empathy toward patients, along with emotional exhaustion that made it difficult to connect.
Research suggests that mindfulness boosts your compassion for others and for yourself. One study found compelling evidence of mindfulness’s interpersonal benefits. In 2013, Paul Condon, Gaëlle Desbordes, Willa B. Miller and David DeSteno published, “Meditation Increases Compassionate Responses to Suffering,” which examined how people would react to a person in pain. Their theory was that participants who completed a brief meditation course would act to relieve the other’s suffering more often than those who hadn’t completed the course. As predicted, those who meditated did act to relieve pain with more frequency, increasing the odds of acting by more than five times.
Be Kinder to Yourself
Being able to treat yourself as you would a good friend can be hard to cultivate, especially for high-achieving individuals. But it’s not impossible. Dr. Kristin Neff, an expert in mindful self-compassion, breaks down the components of self-compassion into three parts:
“Self-kindness vs self-judgment. Self-compassion entails being warm and understanding toward ourselves when we suffer, fail, or feel inadequate, rather than ignoring our pain or flagellating ourselves with self-criticism. Self-compassionate people recognize that being imperfect, failing, and experiencing life difficulties is inevitable, so they tend to be gentle with themselves when confronted with painful experiences rather than getting angry when life falls short of set ideals. People cannot always be or get exactly what they want. When this reality is denied or fought against suffering increases in the form of stress, frustration and self-criticism. When this reality is accepted with sympathy and kindness, greater emotional equanimity is experienced.
“Common humanity vs isolation. Frustration at not having things exactly as we want is often accompanied by an irrational but pervasive sense of isolation – as if ‘I’ were the only person suffering or making mistakes. All humans suffer, however. The very definition of being ‘human’ means that one is mortal, vulnerable and imperfect. Therefore, self-compassion involves recognizing that suffering and personal inadequacy is part of the shared human experience – something that we all go through rather than being something that happens to ‘me’ alone.
“Mindfulness vs over identification. Self-compassion also requires taking a balanced approach to our negative emotions so that feelings are neither suppressed nor exaggerated. This equilibrated stance stems from the process of relating personal experiences to those of others who are also suffering, thus putting our own situation into a larger perspective. It also stems from the willingness to observe our negative thoughts and emotions with openness and clarity, so that they are held in mindful awareness. Mindfulness is a nonjudgmental, receptive mind state in which one observes thoughts and feelings as they are, without trying to suppress or deny them. We cannot ignore our pain and feel compassion for it at the same time. At the same time, mindfulness requires that we not be ‘over-identified’ with thoughts and feelings, so that we are caught up and swept away by negative reactivity.”
During the difficult times, providers and patients alike need to take more control of their own health and wellbeing. Mindfulness practices have been proven to reduce stress, anxiety, and depression while increasing focus, compassion, and meaning. It’s not a quick fix, but in combination with other therapies and techniques, incorporating mindfulness practices may be a great way to combat the significant stressors faced by the modern practitioner.