Day 2 - 5 FFC Spirit and POM 4-7-16projects.hsl.wisc.edu/SERVICE/sites/final/Day 2 - 5 FFC... ·...

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WHOLE HEALTH:

Change the Conversa5on

CONNECTIONS: MIND-‐BODY, SOCIAL, AND SPIRITUAL

VETERANS HEALTH ADMINISTRATION

Around the Green Circle, Last three…

How are your connections… •  …between your mind and

body? •  …with others - your family,

friends, and coworkers •  …with a higher power or

source of meaning?


Power of the Mind


Power of the Mind – Health for Life Video Office of Patient Centered Care & Cultural Transformation


Quick game: How many mind-body approaches can you name?

•  Each table chooses a scribe •  In 2 ½ minutes, brainstorm

a list of as many mind-‐body therapies as you can

•  Different forms of meditaQon and psychotherapy are fair game

•  We’ll see how many the larger group comes up with

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Photo credit: urbanworkbench


A Spectrum of Techniques

•  Psychotherapies •  Biofeedback •  Progressive muscle relaxaQon •  MeditaQon •  Breathing exercises •  CogniQve behavioral therapy •  Eye movement desensiQzaQon

and reprocessing •  TherapeuQc disclosure •  Clinical Hypnosis

…and many others

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It all comes back to the Relaxation Response

•  Coin termed by Herbert Benson, MD, a cardiologist

•  The autonomic nervous system has 2 branches –  SympatheQc (fight/flight) –  ParasympatheQc (feed/breed)

Most mind-‐body exercises have the parasympathe5c ac5va5on and other physiological changes as a common endpoint •  The key is, which approach will

best fit any given individual?

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Other Aspects of the Mind-Body Connection

•  Placebo effect •  Psychoneuroimmunology •  EmoQons and Health •  OpQmism and Health •  HosQlity and Health

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Photo credit: Wi2_Photography


Reversible cardiomyopathy with severe emotional stress (Takatsubo’s)

•  19 people with LV dysfuncQon post emoQonal stress

•  Average ejecQon fracQon = 20%

•  Prolonged Q-‐T •  Û Monocyte infiltraQon •  Û Troponin I (moderate) •  Û Catecholamines •  95% had normal arteries

Wittstein, et al., NEJM 2005;352(6):539-48 VETERANS HEALTH ADMINISTRATION

J Am Coll Card: Vol 45(5);2005

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3"

Exercise(Mediates(the(Associa0on(Between(Posi0ve(Affect(and(58Year(Mortality(in(Pa0ents(With(Ischemic(Heart(Disease.(Hoogwegt,"M."et"al."Circula3on:"Cardiovascular"Quality"&"Outcomes."6(5):559C566,"September"2013."

Glass ½ Full

Glass ½ Empty

42% Lower Risk of Dying

Sur

viva

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Laughter is Good for the Heart

•  150 people given humorous manuscripts.

•  Those with heart disease were 45% less likely to laugh.

•  Those who did laugh were less likely to have heart disease and had less hosQlity.

Clark, et al., Int J Cardiol 2001;80:87-‐8 Photo credit: symphony of love via Foter.com

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HOSTILITY

CARDIA study •  374 18-‐30 year-‐olds •  HosQlity index at baseline •  CT scans of caroQds in 10 years

later •  Those with greater than the

median hosQlity score had twice the risk of coronary calcificaQons

•  ….and had 9 Qmes the risk of those with below the mean hosQlity score.

Photo credit: Theophilos via Foter.com

Iribarren, JAMA. 2000; 283:2546-2551 VETERANS HEALTH ADMINISTRATION

Emotions and Heart Rhythm

McCraty R. Bioelectromagnetic Interactions Within and Between People. HeartMath Research Center.

www.heartmath.com

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4-7-8 Breaths

IN for 4 seconds

OUT for 8 seconds

HOLD 7 seconds

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6 breaths per minute

4 seconds 6 seconds


Family, Friends, Coworkers No man is an island, entire of itself.

-John Donne

The ‘I’ in illness is isolation. The ‘W’ in wellness is ‘we.’

-Satchitinanda

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Family, Friends and Co-workers Video - Office of Patient Centered Care & Cultural Transformation


Consider Your Relationships

Reflect for a moment: •  Who are you closest to in your family? •  Who are you closest to at work? •  Who is your best friend? •  Who is your favorite patient? •  How do your relationships with the people you

care about influence your health? Take a few minutes to discuss this with a partner.

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Family, Friends, Coworkers: Connection = Life

•  2015 meta-‐analysis of 70 studies –  Social isola5on led to a 29% higher likelihood of dying –  Loneliness = 26% higher likelihood –  Living alone = 32% –  Results “…consistent across gender, length of follow-‐up, and world region…”

Holt-‐Lunstad, et al., Perspec@ves Psychol Sci, 10(2):227-‐37, 2015

•  2014 summary: Interviews with 23 Veterans who had alempted suicide. –  Two things would have helped most:

•  Social support •  More compassion and empathy from care providers

Montross, et al. Crisis. 2014;35(3):161-‐167.

•  Loneliness and poor social connecQon cause inflammaQon and chronic disease Fagundes CP, et al, Soc Personal Psychol Compass, 5(11):891-‐903, 2011

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High Social IntegraQon

Low Social IntegraQon

Tsai, A.C., et al., Social integra@on and suicide mortality among men: 24-‐year cohort study of US Health professionals. Ann Intern Med, 161(2):85-‐95, 2014.

2 x less Suicide! (and lower all-cause mortality)

34,901 Male Health Professionals Followed for 24 years


The importance of having a loving partner •  10,000 men with high heart disease risk:

–  Saying , “yes, my wife shows me her love” was Qed to •  50% less angina •  50% fewer ulcers

Madalie, JH, American Journal of Medicine, 1976, 60(6): 910-‐21.

•  1400 men and women amer heart catheterization –  If you were not happily married or didn’t have a confidante,

•  Triple the 5 year mortality rate (50% died versus 15%) Williams, RB et al, JAMA 1992, 267(4):520-‐24.

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Entrainment of heart rhythms during sleep

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Family, Friends, and Coworkers: Health Plan Options

•  Explore social support (emoQonal, financial, mentorship, affirmaQon, informaQon) –  There are a number of surveys they can complete

•  Social workers –  hlp://www.socialwork.va.gov/socialworkers.asp

•  Support groups and peer-‐led groups –  hlp://www.ptsd.va.gov/public/treatment/cope/peer_support_groups.asp

•  Compassion meditaQon •  Be strategic about their care team •  Volunteering and other community acQviQes •  Animal assisted therapy

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Photo: ableveterans.com


In addition to “What Really Matters?”

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Spirit and Soul

The human heart has a hidden want which science cannot supply.

-William Osler


Spirit & Soul – Health for Life Video Office of Patient Centered Care & Cultural Transformation

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Six Aspects of Spirituality

² Religious ² HumanisQc

² Nature ² ExperienQal ² Cosmos

² Mystery


1. Religious

Closeness and connecQon to the sacred as described by a specific religion. Fosters a sense of closeness to a parQcular Higher Power

•  83% of US adults belong to a religious group

•  91% believe in God or a universal spirit

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2. Humanistic spirituality

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Closeness and connection to humankind. May involve feelings of love, reflection, service, and altruism.

Photos: Wikipedia.org


3. Nature spirituality

Closeness and connecQon to nature or the environment, such as the wonder one feels when walking in the woods or watching a sunrise. An important focus for many tradiQonal healing approaches.

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4. Experiential spirituality

•  Shaped by personal life events

•  Influenced by our individual stories

•  Experience in war influences Veterans profoundly

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Photo credit: Pierce Martin via Foter.com


5. Cosmos spirituality

•  Closeness and connecQon to the whole of creaQon.

•  It can arise when one contemplates the magnificence of creaQon or the vastness of the universe – awe and wonder

•  Such as when you look skyward on a starry night

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6. Mystery

•  There is much that we simply cannot know or understand

•  Perhaps it is not possible to fully grasp or know, and part of spirituality is allowing for the unknowable.

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Take a Moment to Consider…

•  Consider the six different aspects of spirituality (and others you may think of)

1) Religious 2) HumanisQc 3) Nature 4) ExperienQal 5) Cosmos 6) Mystery

•  Which ones resonate with you the most, and why?

•  How might your views influence how you take care of pa@ents?

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Being part of a healthy religious community can promote health •  ….if the the community if funcQonal

•  19x lower risk of death from all causes if you alend weekly services versus none (over 8 years) –  And 7.5 years longer life expectancy –  Especially for women

•  Predicts social connecQons and beler mental health

•  Tied to healthier lipid and stress hormone levels

Mallin R, Prim Care Clin Office Pract 2008; 35:857-‐66


Attending religious gatherings and relative benefit

•  2000 meta-‐analysis found 22% lower mortality if you alend a religious gathering at least once weekly

•  CriQcized for not showing a “clinically significant change”

•  But, the benefit is equivalent to: –  Using sta5ns for primary prevenQon –  Exercise-‐based rehabilita5on aKer an MI –  The opposite of how much harm heavy drinking causes

McCullough ME et al. Health Psychol, 19(3):211-‐222, 2000

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Attending religious gatherings and relative benefit

•  A 2001 study found the risk improvement was beler than –  Air bags –  Taking angiotensin receptor blockers for chronic heart failure

–  Screening for colorectal cancer using fecal occult blood tes5ng

–  Prescribing sta5n therapy for people without heart disease

–  Out-‐of-‐hospital defibrilla5on. Lucche\ G et al., Explore, 7(4):234-‐238, 2001


More spirituality equates to

•  Lower systolic and diastolic blood pressures

•  Greater compliance with medicaQons

•  Exercising more

•  EaQng healthier

•  Being able to quit smoking more readily

Mueller, PS et al, Mayo Clinic Proc.2001;76:1225-‐35.

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A summary of all the spirituality and religiosity research up through 2010 Koenig HG, Adv Mind Body Med, 29(3):19-26, 2015


Spirit and Soul: Health Plan Options

•  Explore their beliefs with them –  How can you respect and support what they believe? –  And how can you respect and support what you believe? –  Consider religious communiQes and/or spiritual pracQces

•  Chaplains –  hlp://www.paQentcare.va.gov/chaplain/

•  Spiritual anchors •  Help them work with forgiveness

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Photo: atlanta.va.gov

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Spirituality is a brave search for the truth about existence, fearlessly peering into the mysterious nature of life.

-Elizabeth Lesser

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Day 2 - 5 FFC Spirit and POM 4-7-16projects.hsl.wisc.edu/SERVICE/sites/final/Day 2 - 5 FFC... ·...

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