Presentation on theme: "Everyday Mindfulness DPC Grand Rounds March 7, 2013"— Presentation transcript:
1 Everyday Mindfulness DPC Grand Rounds March 7, 2013 Dr Susan Abbey MD, FRCPCProgram Head, Medical and Surgical Psychiatry, TGHDr Monica Branigan MD, MHSc (Bioethics)Professional Development Lead, Division of Palliative Care, U of TMichele Chaban MSW, D PhilCo-Director Inter-professional Applied Mindfulness Meditation Certificate, U of T
2 My intentionTo create community around mindfulness in palliative care
3 ObjectivesDiscuss simple mindfulness interventions designed to benefit practitionersReview interventions of benefit for people dealing with life threatening illnessConsider mindful questions to address pain and suffering
4 How can we cultivate mindfulness? Paying attention we can bring awareness toMindHeartBodyEach center is associated with different ways of knowing, listening and speakingEach functions from a differentplaceNeocortexLimbic systemBrainstem
5 The head center Our thinking center Knowing through rational thought Listen to content: description,explanation, story, beliefs,assumptionsSpeaking: “I think...”Values: controlPitfalls: critique, judgment,“I already know”Pamela WeissIn a typical medical encounter, we lead with our head, our perceived expertise.
6 The heart center Our feeling center Knowing through openness, attunement, acceptanceListening to feelings, emotions, moodSpeaking: “I feel....”, “I am angry....”Value: approvalPitfalls: emotionalreactivity- entanglementor distancingPamela WeissThis 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, perceptionListen to energetic tone,physical cuesSpeaking: “I sense......”Value: safetyPitfalls: tension, agitation,flight, fight or freezePamela WeissWe 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 limitedWhen working together, the centers together can express perception, compassion and confidenceTogether they are more powerful and reliableHow do we invite the centres to work together?Three part check inThis 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 meHeart: let me know that you accept my pain is realBody: allow me to feel safe
10 The three centers from the provider point of view Three part check inStart with the body: big breath, relax shoulders down, expand back, sides, frontBring awareness to your heart: feeling tone or moodNotice 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 personInvite the patient to check in with their three centersNotice 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 SuttaOver 2000 years ago the Buddha taught about pain
13 How do we usually approach pain? The standard pain historyMajor focus on the body- the first dartDoes not fully acknowledge the second dartDISCONNECT: as HCPs weoften may come from ourhead center and may askthat our patients respondfrom their body centerWhat 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?EtcHow 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 CommitmentsMay I check in with myself in order to bring my wholeness to the patient that I may see them as whole and not brokenMay I expand my awareness of pain beyond the first dart and allow the patient to explore body, mind and heartMay I see my own frustration and helplessness as something that connects me to the patient and not use it against myself
19 Resources- MBSRThe 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 MindfulnessCentre for Mindfulness in Medicine, Health Care and Societysee for professional courses and teacher training and annual scientific conference
21 Communities of practice Mindfulness Torontosee for mindfulness courses, events, MBSR and sitting groupsSee posted “Resources” on Community Space
22 Continuing professional development Applied Mindfulness Meditation at the Factor Inwentash Faculty of Social workndfulnessmed.htmCentre for Mindfulness Studies, TorontoInsight Meditation Center- onlinecourses/
23 Continuing professional development Being with Dying Program at UpayaMetta End of Life Practitioner ProgramMindful Practice: Focus on Serious and Life-Limiting Illness, University of Rochesterserious-and-life-limiting-illness/event-summary- 9a33a7d3cfbe4e c6c7aa1964e.aspx
24 Online meditation podcasts UCLA Mindful Awareness Research CenterTara Brach, Buddhist meditation teacherInsight Meditation CentreDan Siegelbrain-with-daniel-siegel-md-bsp-44.html
25 For patientsMindfulness Based Cognitive Therapy (MBCT) for People with CancerFacilitators: Dr. Mary Elliott, MD, FRCPCDr. Evan Collins, MD, FRCPCDates: TBALocation: Pencer Centre Group Room, 18th Floor, Princess Margaret HospitalHow to register: Physician referral required. Please complete the attached referral form and send to or fax toFees: Course covered by OHIP.
26 For patientsMBSR at Wellspring Programs/Mindfulness-Based-Stress-Reduction.aspx