Erik van den Brink MD psychiatrist & mindfulness trainer A PERSONAL REFLECTION ON THE ‘ CARE ’ IN HEALTHCARE

BURNOUT EMPATHY DECLINE

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 practice For patients and professionals Awake Body Open MindTender Heart Mindfulness training 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 patients Barbosa 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-CRITICISMSELF-KINDNESS SELF-ISOLATIONCOMMON HUMANITY OVER-IDENTIFICATIONMINDFULNESS SELF-SACRIFICE OVER-INVOLVEMENT COMPASSION TO SELF AND OTHERS FIGHT FLIGHT FREEZE TEND & BEFRIEND THREAT EXTERNAL INTERNAL Neff 2003 Germer 2009 Taylor 2006 ME YOU WE SOOTHING Gilbert 2009

Tend & befriend instinctual 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 focused safeness 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 STORIESSTORIES

Judging rank, comparing Achieving, rivalry Emotions Motivation Focus on reward Success and fame COMPETITIVE MIND Self enrichment, improving status Desire, envy BehaviourImagery AttentionReasoning Van den Brink & Koster, 2015 Adapted from Gilbert, 2010

COMPETITIVE MIND

Striving for self-esteem… … while we need self-compassion

Judging risk safe/unsafe Avoiding, resisting EmotionsMotivation Focus on danger Doom and gloom THREAT MIND Self protection Aversion, fear, anger BehaviourImagery AttentionReasoning Van den Brink & Koster, 2015 Adapted from Gilbert, 2010

THREAT MIND

Bullying ourselves… …while we need an inner helper

INTERVENTION ↔ DIAGNOSIS CURE IT and FIX IT Often 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, 2015 Adapted from Gilbert, 2010

COMPASSIONATE MIND

With gratitude for your attention and … compassion