1. Everyday Mindfulness DPC Grand Rounds March 7, 2013
Dr Susan Abbey MD, FRCPC
Program Head, Medical and Surgical Psychiatry, TGH
Dr Monica Branigan MD, MHSc (Bioethics)
Professional Development Lead, Division of Palliative Care, U of T
Michele Chaban MSW, D Phil
Co-Director Inter-professional Applied Mindfulness Meditation Certificate, U of T

2. My intention
To create community around mindfulness in palliative care

3. Objectives
Discuss simple mindfulness interventions designed to benefit practitioners
Review interventions of benefit for people dealing with life threatening illness
Consider mindful questions to address pain and suffering

4. How can we cultivate mindfulness?
Paying attention we can bring awareness to
Mind
Heart
Body
Each center is associated with different ways of knowing, listening and speaking
Each functions from a different
place
Neocortex
Limbic system
Brainstem

5. The head center Our thinking center Knowing through rational thought
Listen to content: description,
explanation, story, beliefs,
assumptions
Speaking: “I think...”
Values: control
Pitfalls: critique, judgment,
“I already know”
Pamela Weiss
In a typical medical encounter, we lead with our head, our perceived expertise.

6. The heart center Our feeling center
Knowing through openness, attunement, acceptance
Listening to feelings, emotions, mood
Speaking: “I feel....”, “I am angry....”
Value: approval
Pitfalls: emotional
reactivity- entanglement
or distancing
Pamela Weiss
This center often scares us as we have been encultured to believe that to feel is unprofessional

7. The body center Our sensing center Knowing through intuition,
perception
Listen to energetic tone,
physical cues
Speaking: “I sense......”
Value: safety
Pitfalls: tension, agitation,
flight, fight or freeze
Pamela Weiss
We often ignore our body as something to be subjugated- over ride impulses to rest, to eat, even to breath deeply

8. Working with the three centers
Each center is valuable but limited
When working together, the centers together can express perception, compassion and confidence
Together they are more powerful and reliable
How do we invite the centres to work together?
Three part check in
This is counter cultural to value our wholeness. We have edited parts of your selves for so long in order to “fit in” that this may seem strange at first. The underlying truth is that everything serves:
our own fear serves as an antenna for our patients fear,
our humour can create other possibilities ,
our limitations can connect us to our patients,
our joy can sustain us and those around us

9. The three centers from our patient’s point of view
Mind: tell me what I can do to make the pain better and give me an explanation that makes sense to me
Heart: let me know that you accept my pain is real
Body: allow me to feel safe

10. The three centers from the provider point of view
Three part check in
Start with the body: big breath, relax shoulders down, expand back, sides, front
Bring awareness to your heart: feeling tone or mood
Notice your thoughts or general flavour: critical, curious….

11. Mindful approach to pain
Begin with a three part check for yourself so you can meet the patient as a whole person
Invite the patient to check in with their three centers
Notice the energy between you and the patient- are you connected?
YES: together you work with “the pain”
NO: the patient remains alone with “their pain”
When we CAN feel our connection to the patient, the pain becomes something bigger than only the patient’s experience. We create space around it and allow some curiousity about how to respond skilfully.
When we CANNOT connect to our patient, they are left with the burden alone. Resistance is likely and we may increase the second dart.

12. The Two Darts
"When an untaught worldling is touched by a painful (bodily) feeling, he worries and grieves, he laments, beats his breast, weeps and is distraught. He thus experiences two kinds of feelings, a bodily and a mental feeling. It is as if a man were pierced by a dart and, following the first piercing, he is hit by a second dart. So that person will experience feelings caused by two darts....
Sallatha Sutta
Over 2000 years ago the Buddha taught about pain

13. How do we usually approach pain?
The standard pain history
Major focus on the body- the first dart
Does not fully acknowledge the second dart
DISCONNECT: as HCPs we
often may come from our
head center and may ask
that our patients respond
from their body center
What is left out of this process is the heart- and the possibility of real compassion.
Often we put up our shield.

14. Questions for the mind What do you think about when you have pain?
Where does your mind go when you have pain?
Are there any thoughts that trigger your pain?
Are there any stories that come to you when you have the pain?
What is the meaning of your pain?

15. Questions for the heart
Tell me about the pain in your heart.
How does your heart feel the pain?
What in your life is causing pain in your heart?
What is your heart feeling?

16. Questions for the body Standard pain history
Where do you feel the pain?
What words describe it?
What makes it better?
Etc
How does the rest of you body feel?
Are there parts of your body that experience comfort?
Do you sense that your body is trying to tell you something?

17. Commitments
May I check in with myself in order to bring my wholeness to the patient that I may see them as whole and not broken
May I expand my awareness of pain beyond the first dart and allow the patient to explore body, mind and heart
May I see my own frustration and helplessness as something that connects me to the patient and not use it against myself

19. Resources- MBSR
The MBSR Clinic Location: Toronto General Hospital Time: Monday morning, Monday afternoon or Wednesday evening Instructors: Dr. Susan Abbey and Sarah Greenwood, RN, BScN Cost: $75.00 Call:

20. MBSR and Mindfulness
Centre for Mindfulness in Medicine, Health Care and Society
see for professional courses and teacher training and annual scientific conference

21. Communities of practice
Mindfulness Toronto
see for mindfulness courses, events, MBSR and sitting groups
See posted “Resources” on Community Space

22. Continuing professional development
Applied Mindfulness Meditation at the Factor Inwentash Faculty of Social work
ndfulnessmed.htm
Centre for Mindfulness Studies, Toronto
Insight Meditation Center- online
courses/

23. Continuing professional development
Being with Dying Program at Upaya
Metta End of Life Practitioner Program
Mindful Practice: Focus on Serious and Life-Limiting Illness, University of Rochester
serious-and-life-limiting-illness/event-summary- 9a33a7d3cfbe4e c6c7aa1964e.aspx

24. Online meditation podcasts
UCLA Mindful Awareness Research Center
Tara Brach, Buddhist meditation teacher
Insight Meditation Centre
Dan Siegel
brain-with-daniel-siegel-md-bsp-44.html

25. For patients
Mindfulness Based Cognitive Therapy (MBCT) for People with Cancer
Facilitators: Dr. Mary Elliott, MD, FRCPC
Dr. Evan Collins, MD, FRCPC
Dates: TBA
Location: Pencer Centre Group Room, 18th Floor, Princess Margaret Hospital
How to register: Physician referral required. Please complete the attached referral form and send to or fax to
Fees: Course covered by OHIP.

26. For patients
MBSR at Wellspring Programs/Mindfulness-Based-Stress-Reduction.aspx

27. Let’s talk…….