WHAT’S NEW IN MIND-BRAIN HEALTH:New Science of Healing and Resilience

R. Murali Krishna, MD, DLFAPAPresident & Chief Operating Officer

INTEGRIS Mental Health and INTEGRIS James L. Hall, Jr. Center for Mind, Body, and Spirit

Clinical Professor of PsychiatryUniversity of Oklahoma Health Sciences Center, Department of Psychiatry and Behavioral Sciences

Distinguished Life Fellow American Psychiatric Association

Confessions and Declarations

• I have no financial relationships or affiliations to disclose.

• I have no conflicts of interest related to material discussed in this presentation.

Noble Professions

• Most physicians and health professionals go into their profession to make a difference to others.

• They are incredibly smart, work hard, sacrifice immensely, have noble intentions and kind hearts.

• Society has traditionally respected physicians and health professionals and rewarded them with reverence and treated them as pillars of their communities.

Healers Burnout

• Physicians and health professionals today face monumental challenges unlike any in the entire history of modern medicine!

• Our sacred professions have not yet found a resilient way of responding to the challenge.

• We are paying a heavy price.

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• Less time with our customers Healer-Patient sacred relationship is weakened

• More demands to produce, to perform, to justify

• Loss of autonomy

• More non-essential, non-clinical work (paperwork, emails, reviews)

Challenges We Are Facing Today

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• Repetitive exposure to trauma, illness, suffering, inadequate options and death

• Sense of isolation and decrease in connectivity and collegiality

• Fear of malpractice suits

• Decline in life-work balance and quality of life

• Less time for self-care

• Loss of meaning and purpose

Challenges We Are Facing Today (cont’d)

• Almost half of U.S. health professionals report symptoms of burnout.

A state of physical, mental exhaustion combined with doubts about your value, competence and the value of your work.

1. Exhaustion Physical Emotional Spiritual – losing enthusiasm for work

Challenges We Are Facing Today (cont’d)

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2. Depersonalization Treating people as objects Having less empathy

3. Low sense of personal accomplishment, loss of meaning and purpose

4. Irritability, low tolerance for frustration, anger, impatience and cynicism

Challenges We Are Facing Today (cont’d)

Specialty Rates of Burnout

Preventive MedDermatology

Gen PediatricsPathology

Pediatric SubsIM Subspecialties

Gen SurgeryMean All Physicians

ORL, OB, Ortho, A, RadFamily Med

NeurologyGen Internal Med

Emergency Med

0 10 20 30 40 50 60 70 80

Could You Be Experiencing Burnout?

• Have you become cynical or critical at work?• Do you drag yourself to work and have trouble getting started once

you arrive?• Have you become irritable or impatient with co-workers or

patients?• Do you lack the energy to be consistently productive?• Do you lack satisfaction from your achievements?• Do you feel disillusioned about your job?• Are you using food, drugs or alcohol to feel better or to simply not

feel?• Have your sleep habits or appetite changed?• Are you troubled by unexplained headaches, backaches or other

physical complaints?

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• Quality of care goes down Low empathy, compassion Low professionalism, poor decisions Higher medical errors

• Quality of outcomes goes down Lower patient satisfaction and customer satisfaction of

care Decrease of trust and confidence Lower adherence to recommended treatment

Consequences of Stress and Burnout in the Healing Profession

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• Build more resilience

• More balance in work and life

• More connectivity

• Increased capacity to cope with change and to influence change

• Better self care

• Rediscover meaning and purpose

• Attitude of gratitude

RECLAIM YOUR JOY IN MEDICINE!

Desired Change For Physicians and Health Professionals

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The Key is Learning toContinuously Reinvent Yourself

It means learning to understand, cope,influence and adapt to change; stayingphysically, emotionally and spiritually

active; cultivating new strengths, skills andways to find joy, purpose and harmony; and

feeling connected with those you serve,loved ones and your community.

~ R. Murali Krishna, M.D.

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• Discover the Stress Neutralizing System

• Telomere length for health and longevity

• You may influence gene expression!

• Neuroplasticity: Improving brain connections for better health!

The Science and Art of Thriving in Change,Finding Balance and Cultivating Joy

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M u ta tio n Research 730 (2 0 1 2 ) 8 5- 8 9

C o n ten ts l ists av a ilab le at SciVe rse S c ie nc eD ire c t

M u ta tio n R e se a rc h /F u n d am e n ta l and M o le cu la r M e ch an ism s of M u ta g e n e s is

jou rn a I h o m ep ag e : w w w .e lsev ie r .co m / I o c te /m o l m u t C o m m u n ity a d d re ss : w w w .e I s ev ie r .co m /lo c a te /m u tre s

R e v ie w

Telomeres and lifestyle factors: Roles in cellular a g in g jue L in a •* , Elissa Epelb, E liza be th B lack b u rn a

• U n iv e r s ity o f C a lifo rn ia . San F ra n c isc o , D e p a rtm en t of B io c h e m is tr y and B io p h y sic s ,S a n F ra n c is c o , C A 94158,USA b U n iv e r s i ty o f C a l ifo rn ia , San F ra n c isco ,C en ter for H e a lth and Community,3333 C a li fo rn ia S t.. S u i te 465,San F ra n c isc o . C A 94118,USA

A R T IC L E IN F O

A rtic le history: Received 3 May 2 0 1 1 Received in revised form 4 August 2 0 1 1 Accepted 16 August 2 0 1 1 Available online 22 August 2 0 1 1

Keywords: T e lo m e re Telomerase L ife s ty le A g in g S tre s s

A B S T R A C T Recent research has d e m o n s tr a te d that te lo m ere m a in ten a n ce might be a key in te g ra tin g point for th e cu m u la tiv e effects of genetic, en v iro n m en ta l and lifestyle factors on aging and ag in g-re la te d diseases. It is timely to 'take stock' of where this work has led the field. T h is. re v ie w su m m ar iz e s s tu d ie s that h av e ex am in ed asso c ia tio n s b e tw een lifestyle factors and te lo m e re length and te lo m eras e activity. In most o f the stud ies described in this ch a p te r , telomere length was measured in leu k o c y te s (L T L ) or pe rip h e ra l b lo od m o n o n u c lea r cells ( P B M C s ), taken from blood draws from the study s ub jec ts . M uch of this chap te r focuses on psychological s tress, a w id esp re a d factor often in tim a te ly tied in with lifestyle or b eh av io ra l factors that in turn are related to risks of clinical diseases. Together, these findings suggest that ce llu la r aging is linked to a range of in f lu e n ces , with an in d iv id u a l's life ev en ts and lifestyle p aram e te rs p lay in g significant roles. Lastly, we propose possible biochemical m ech an ism s that mediate these as so c ia tio n s and discuss fu tu re d ire c t io n s .

© 2011 Published by Elsevier B .V .

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Proceedings of the National Academy of SciencesArticle

A functional genomic perspective on human well-being 1. Barbara L. Fredricksona, 2. Karen M. Grewenb, 3. Kimberly A. Coffeya, 4. Sara B. Algoea, 5. Ann M. Firestinea, 6. Jesusa M. G. Arevaloc, 7. Jeffrey Mac, and 8. Steven W. Colec,d,1

Author Affiliations9. aDepartment of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599; 10. bDepartment of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27599; 11. cUniversity of California, Los Angeles, School of Medicine, Los Angeles, CA 90095; and 12. dJonsson Comprehensive Cancer Center, Norman Cousins Center for Psychoneuroimmunology, AIDS Institute, and

Molecular Biology Institute, University of California, Los Angeles, CA 90095

1 Edited* by Burton H. Singer, University of Florida, Gainesville, FL, and approved July 2, 2013 (received for review March 20, 2013)

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1. Learn to quiet the mind

2. Reignite your passion and purpose

3. Act with empowerment

4. Cultivate harmony

5. Rejuvenate and care for yourself

6. Nurture healthy connections

7. Savor altruism and spirituality

Dr. R. Murali Krishna’s Mindful Keys

• Inner peace and happiness• Emotional regulation• Creativity• Memory and Learning• Relationships• Resilience• Performance• Healing of mind and body

Positive Transformation

Learn to Quiet the Mind

Sevens Points of Self-Discovery:1. What motivated you to pursue this profession?

2. What specific memories of events, people and interactions stimulate your interest?

3. What gives you most joy, thrill and sense of accomplishment?

4. How do you see your purpose in life?

5. How do you want to be remembered by your loved ones, those you serve, and your community?

6. What keeps you going?

7. What simple message you give yourself symbolizes your determination to continue the journey and re-energize your passion?

Reignite Your Passion and Purpose

Dealing With Difficult Emotions

ANGER

• A fire that may bring out the best in you or could destroy your peace and health

• A normal emotion

• Could become destructive if: Anger is frequent and intense Beyond your ability to control Disrupting relationships Occupying your conscious awareness persistently

• Assuming the worst of people most of the time

ANGER (cont’d)

• Being impatient and irritable

• Could contribute to: Decreased blood flow to heart Spasm of arteries Increased tendency to clotting Increased workload Increases inflammation Lowers immunity

Anger and Heart

• Risk of heart attack increases 2.3 times in the two hours following an episode of anger (AHA Journal Circulation )

• Men with highest levels of anger are 3 times more likely to develop heart disease than men with the lowest levels (Harvard Public Health Study)

Anger and Heart(cont’d)

• Loyola College of Maryland study with 41 patients who had angioplasty to unclog arteries: those with the highest hostility are 2.5 times more likely to need another angioplasty in one year

• Men with frequent outbursts of anger have twice the risk of stroke (JAMA)

• Anger worsens pain and inflammation of arthritis and other conditions

How To Deal WithAnger In A Healthy Way

• Recognize the early warning signs - e.g. resentment, frustration, impatience, etc.

• Determine what is causing you to feel powerless or a sense of injustice

• Pause• Identify and change the situation or modify mistaken

attitudes• Channel your anger constructively

- use anger to motivate you• Have balance in your life• Learn the art of forgiveness

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The most sacred part of our healing professions is caring for people in their

most vulnerable and fragile times.

Through our knowledge, wisdom and spirit we kindle their hope and healing.

No agency, entity or individual can take these reverential, fulfilling, and humble

healing moments away from us.

~ R. Murali Krishna, M.D.

Implications to Healthcare

Obesity Tobacco

Cardiovascular Disease

GI Disorders

Brain Disorders

Addictive Disorders

Mood Disorders

Anxiety Disorders

Metabolic Disorders

Skin Disorders

Allergy/Immunology

Healing & Recovery from Illness

Chronic Pain

Stress - Illness Connection

• Heart• GI System• Brain• Skin• Immune System• Hormones• Healing• Emotional Disorders

Men’s Mental Health

• Mental health and well-being is equally important to physical well-being– The two are linked

• many of the things that help our physical health also improve our mental health

• Science is telling us practicing mindfulness can improve your mind-brain health

• Mental health problems in men can often go undetected– Why?

• Lack of awareness there is a problem• Pressure due to associated stigmas• Reluctance to discuss depression symptoms• Resisting mental health treatment

• Mental illness can cause different symptoms in men than in women

Major Types of Mental Health Problems Affecting Men

• Depression– Signs and symptoms include

• Lack of interest in work hobbies and doing things you normally enjoy

• Low energy levels and lack of motivation• Trouble sleeping or sleeping too much• Lack of concentration• Increased anxiety• Anger or irritability

Major Types of Mental Health Problems Affecting Men

• Anxiety– Signs and symptoms

• Hot and cold flushes• Racing heart• Tightening f the chest• Snowballing worries• Obsessive thinking and compulsive behavior

– Post-traumatic stress disorder (PTSD) is a type of anxiety disorder caused by witnessing a violent or life-threatening event, such as war

• It is common in men, particularly those who have served in combat

Major Types of Mental Health Problems Affecting Men

• Bipolar disorder– Signs and symptoms

• Feeling high, over-excited and reckless or imagining you are more important or influential than they are in real life

• Feeling extremely low, feeling helpless and depressed, with difficulty making decisions or concentrating

• Behaving in an uncharacteristically irrational or risky manner

Major Types of Mental Health Problems Affecting Men

• Psychosis and Schizophrenia– Signs and symptoms

• Confused thinking – when acutely ill, experience disordered thinking. Everyday thoughts that let men live their daily lives become confused and disjointed

• Delusions• Hallucinations

Major Types of Mental Health Problems Affecting Men

• Eating Disorders - male eating disorders are on the rise with increasing rates of body dissatisfaction amongst men– Warning signs

• Preoccupation with body building, weight lifting or muscle toning

• Weight lifting when injured• Lowered testosterone• Anxiety/stress over missing workouts• Muscular weakness• Decreased interest in sex or fears around sex• Possible conflict over gender identity or sexual orientation• Using anabolic steroids

Mental Health Statistics: Men

• Men are more likely than women to have an alcohol or drug problem

• National Institute for Mental Health Disorders reports four times as many men than women commit suicide; however, women attempt suicide more often than men

• Why?– Use methods that are more likely to be lethal, such as guns– Act more quickly on suicidal thoughts– Show fewer warning signs, such as talking about suicide

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1. Learn to quiet the mind

2. Reignite your passion and purpose

3. Act with empowerment

4. Cultivate harmony

5. Rejuvenate and care for yourself

6. Nurture healthy connections

7. Savor altruism and spirituality

Dr. R. Murali Krishna’s Mindful Keys