Erik van den Brink MDpsychiatrist & mindfulness trainer

A PERSONAL REFLECTION ON THE ‘CARE’ IN HEALTHCARE

BURNOUTEMPATHYDECLINE

Implicit messages during my medical training

• Be a human doing; work hard at all times• Never say you’re too busy to see another patient• Never mention when your shift started• Go for cure at all costs• TLC* as a last resort (nurses only!) • Be smarter than your peers (but NOT your seniors!)• DON’T show your weaknesses• Be ‘still faced’ towards emotional pain, especially your own• If you can’t cope… try psychiatry

* Tender Loving Care

India

What if you can’t cure? CARE!

Yorkshire, UK: Resident in Psychiatry

• Symptom reduction and restraining• Often heavy medication in artificial environment• Forceful reduction of hospital beds• How to return hospitalized patients to an

unwelcoming society?• Striving for control of suffering rather than care• Still face towards deeper suffering

Psychotherapy

• Many models aimed at cure, but…• Basic is the patient-therapist relationship and

creating a caring environment• Holding emotional pain, the patient’s and your own• Melting the still face• Pitfall: dependency

Groningen, NL: day unit and home care instead of hospital admission

• Patients are experts of their own life• What’s right? rather than What’s wrong?• Involving network and resources already there• Care = learning to self-care and empowerment• Pitfall: neglecting emotional pain and return of the

still face

The silver lining of a dark cloud

Integrative psychiatry

• Integrating conventional and complementary approaches

• More room for self-healing capacity• Minimizing harmful side-effects and maximizing

positive side-effects• Life style: healthy eating, exercise,

communication, relaxation, meditation• Sustainable healthcare

Integrating a self-care practiceFor patients and professionals

Awake Body

Open Mind Tender Heart

Mindfulnesstraining

Compassion training

Self-compassion correlates with…• Psychological well-being and life fulfillment• Emotional intelligence and positive emotions• Healthier coping with adverse events • Healthier lifestyle • Social connectedness, empathy, altruism, forgiveness

Barnard & Curry 2011; Hofmann e.a. 2011; MacBeth & Gumley, 2012; Neff, 2012

Adding mindfulness-programs to education• Medical students: less anxiety & stress; more empathy & self-

compassion• Therapists in training became more effective: fewer

symptoms and more insight in their patientsBarbosa et al. 2013; Bond et al. 2013; Gordon 2014; Grepmair et al. 2007

Compassion is…

The capacity to be sensitive to the suffering of ourselves and others and…the willingness to relieve and prevent it.

(Gilbert, 2014)

•A natural human capacity inherent in all of us but often not very well developed. •The aim of compassion training is to develop and deepen it.

SELF-COMPASSION

SELF-CRITICISM • SELF-KINDNESS

SELF-ISOLATION • COMMON HUMANITY

OVER-IDENTIFICATION • MINDFULNESS

SELF-SACRIFICEOVER-INVOLVEMENT

COMPASSION TO SELF AND OTHERS

FIGHT

FLIGHT

FREEZE

TEND & BEFRIEND

THREATEXTERNAL INTERNAL

Neff 2003Germer 2009

Taylor 2006

ME

YOU

WE

SOOTHINGGilbert 2009

Tend & befriendinstinctual reaction in mammals to save the weak and vulnerable≠ compassion

SOOTHING SYSTEM content, safe, connected

DRIVE SYSTEM pleasure, excitement, vitality

THREAT SYSTEM anger, anxiety, disgust

Reward focused

Wanting, striving, achieving, consuming

Affiliative focusedsafeness seeking

Kind and caring

Threat focused,safety seeking

Fight, flight, freeze

R E

S T

S T

R E

S S

Van den Brink & Koster, 2012

adapted from Gilbert, 2009

How to keep the balance?

THREAT SYSTEM

I don’t like this

I don’t want this

I hate this

I can’t live with this

Avoiding what’s inevitable

DRIVE SYSTEM

I like this

I want this

I need this

I can’t live without this

Grasping what’s impermanent

S T O R I E S

Judging rank,comparing

Achieving, rivalry

EmotionsMotivation

Focus on reward

Success and fame

COMPETITIVEMIND

Self enrichment, improving status Desire, envy

BehaviourImagery

Attention Reasoning

Van den Brink & Koster, 2015Adapted from Gilbert, 2010

COMPETITIVEMIND

Striving for self-esteem…

… while we need self-compassion

Judging risksafe/unsafe

Avoiding, resisting

EmotionsMotivation

Focus on danger

Doom and gloom

THREATMIND

Self protection Aversion, fear, anger

BehaviourImagery

Attention Reasoning

Van den Brink & Koster, 2015Adapted from Gilbert, 2010

THREATMIND

Bullying ourselves…

…while we need an inner helper

INTERVENTION ↔ DIAGNOSIS

CURE IT and FIX ITOften motivated from threat (external control) or drive system (internal ambition)

? ?What about the care for the persons and their relationship.

Cure Care• Threat / Drive System• Change• Short term• Specific• Expertise of others• Sometimes feasible

• Soothing System• Acceptance• Longer term• Non-specific• Responsibility of self• Always supportive

Non-judging, allowing

Accepting, befriending

EmotionsMotivation

Needs of self and others

Peaceful connection and safeness

COMPASSIONATE MIND

Social bonding, well-being

Calm, content

BehaviourImagery

Attention Reasoning

Van den Brink & Koster, 2015Adapted from Gilbert, 2010

COMPASSIONATE MIND

With gratitude for your attention and … compassionwww.mbcl.orgwww.compassionateliving.info