Patricia L. Dobkin, PhD* King’s College London’s School of Medicine

September 17, 2014

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*With Nicolò Francesco Bernardi, PhD, statistical analyses

The awareness that emerges

from paying attention,

on purpose and non-judgmentally,

to what is occurring

as it unfolds from moment to moment.

pause…

breathe…

notice…

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Mindfulness of the body ◦ breath, movements

◦ sensations as a cue to the mind-body state

Mindfulness of feelings and emotions ◦ unpleasant, pleasant and neutral

Mindfulness of thoughts, attitudes, beliefs ◦ state of alertness/attentiveness/distractedness

◦ cognitive processes (decision-making, reflection)

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What is Mindfulness Meditation?

MM is a refined, systematic attention-based practice that develops:

– stability of mind and body

– insight into mental and physical conditions that inhibit the capacity to respond effectively to life events.

Formal practice and informal practice

Living Fully with Chronic Illness

UMass Medical Center (1979- present)

8 week structured program teaches- ◦ Principles of mindfulness ◦ How to apply these principles to deal more

effectively with illness and stress Mindfulness practices include: ◦ Body awareness (body sensations) ◦ Meditation (breath) ◦ Yoga (body in movement) ◦ Cognitive awareness (mind)

N= 126

Mean age = 53

86% women from 2006-2012

47% with breast cancer

43% other chronic diseases

Attendance= 92.7%

0

5

10

15

20

25

CES-D*

(0.74)

PSS*

(0.83)

MAAS*

(0.71)

MSCL*

(0.63)

Pre-MBSR

Post-MBSR

* p<.0001

0

5

10

15

20

25

30

35

chip dc*

(0.34)

chip pc*

(0.1)

chip ic*

(0.22)

chip ec*

(0.68)

Pre-MBSR

Post-MBSR

* p<.0001

0

20

40

60

80

100

120

140

160

Compreh Manage Meaning TOTAL SOC

Pre-MBSR

post-MBSR

p <.0001

10 MBSR Components: 3 Factors

Factor 1 Group Interaction

reduction in symptoms

Factor 2 Moment-to-moment Awareness

reductions in symptoms

increases in mindfulness

Factor 3 Body Awareness

reductions in symptoms and stress

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With: Julie Irving, PhD and Dr. Tom Hutchinson, Director of McGill Programs in Whole Person Care &

Palliative Care physician

Garneau, K., Hutchinson, T., Zhao, Q., Dobkin, P. Cultivating person-centered medicine in future physicians. European Journal for Person Centered Healthcare 2013;1(2):468-477.

Enhancing intra-personal and inter-personal self-awareness can improve well-being and effectiveness in clinical practice

More attentive to the presence of stress

More able to attenuate stress reactivity

RESULTS: Increased mindfulness; Decreased burnout; Increased empathy; Increased conscientiousness; Increased emotional stability; Mindfulness was correlated with these outcomes.

43 in the program

25 in the control group

Those in the program improved on: ◦ Reduced mood disturbance

◦ Increased mindfulness

◦ Reduced burnout

◦ Increased empathy

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Cross-sectional study in 7 sites 47 clinicians (mostly MDs) with 417 HIV+ patients

Encounters were audiotaped - coded using the RIAS

More mindful clinicians:

1. More patient-centered communication

2. More positive emotional tone with patients

3. Patients reported better communication

4. Patients were more satisfied

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One day workshops for MDs & Clinicians

8 week courses for MDs & Clinicians (20 CME credits)

4 week elective for 4th year medical students

One day workshops for 2nd year medical students

8 week course for family medicine Residents

Weekend workshop-retreat for MDs & Clinicians

2015: All medical students prior to clerkship

MBSR format

Role plays, and other exercises focus on interpersonal mindfulness

Emphasis on communication

Self-care highlighted

Bilingual

Mindfulness-Based Medical Practice

Practice medicine with competence, compassion, and integrity

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Effectively work with

other health

professionals to

prevent, negotiate, and

resolve inter-professional conflict

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Develop rapport, trust and ethical therapeutic relationships with patients and families;

Accurately convey relevant

information and explanations to patients and families, colleagues and other professionals

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Quality of caring (empathy - detachment)

Physician well-being

(resilience – burnout)

Quality of care (safety – errors)

Mindful practice

S: Slow down/Stop

T: Take a breath

O: Observe

P: Proceed

N = 126

Mean age = 47

79 % women from 2008-2012

54 % MDs

46 % other (PhDs, nurses, etc.)

10 % screened as depressed before MBMP

90 % attendance

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* p<.001

** p<.002

*** p<.006

****p<.005

1. Reduction in professional isolation

2. Mindfulness skills improved physicians’ ability to be attentive and listen deeply to patients more effectively

3. Developing greater self-awareness was positive and transformative; yet, physicians struggled to give themselves permission to attend to their own personal growth

1. Formal meditation practice led to informal applications of mindfulness in clinical settings

2. Group support lessened feelings of isolation

3. Awareness of breath led to emotional regulation

4. Attitudes towards self-care improved

* p<.026

** p<.003

*** p<.0001

Dobkin, P.L., Hutchinson, T.A. Teaching mindfulness in medical school: Where are we now and where are we going? Medical Education 2013:47:768–779.

Dobkin, P., Balass, S. Multiple influences contribute to medical students' well-being and identity formation. Medical Education, 2014;48:340–342.

Medical System

Social System

A

B

Health Care

Professional

Patient/Person

Disease

C D

A: Where healing may occur B: Where curing may occur

C: HCP ‘s “Tool box”

D: Patient’s illness experiences; hopes, fears, behaviours

Please turn to the person next to you and relate an experience when you were mindful in a clinical encounter.

What was occurring in you, in the other, and what was the context?

Sabbatical Leave in Paris

Corinne Bagnis, MD PhD

Hôpital Pitié-Salpêtrière

Université Pierre et Marie Curie

Enhancing the Therapeutic Alliance and Well-Being of Clinicians and Their Patients Through MBSR

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Patricia Lynn Dobkin (Ed.)

2015 Springer Press

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Thank you for your invitation!