managing personal and client stress through meditation

Managing Personal and Managing Personal and Client Stress Through Client Stress Through

MeditationMeditation

Managing Personal and Managing Personal and Client Stress Through Client Stress Through


I.I. Introduction to MeditationIntroduction to Meditation

II.II. ResearchResearch

III.III. Preparing to PracticePreparing to Practice

IV.IV. Breathing Techniques & Breathing Techniques & Progressive Muscle RelaxationProgressive Muscle Relaxation

V.V. Guided Imagery MeditationGuided Imagery Meditation


““Meditation is a mind-body process Meditation is a mind-body process that uses concentration or reflection that uses concentration or reflection to relax the body and calm the mind to relax the body and calm the mind in order to create a sense of well in order to create a sense of well being”being”

The American Cancer Society, 2002.The American Cancer Society, 2002.


““Meditation is any kind of deliberate Meditation is any kind of deliberate focus, usually on just one thing or a focus, usually on just one thing or a very narrow band of things. This clears very narrow band of things. This clears the mind, slows it down and calms and the mind, slows it down and calms and strengthens the meditator” strengthens the meditator” Naparstek, Naparstek, Belleruth 2000.Belleruth 2000.

www.healthjourneys.comwww.healthjourneys.com

Research:Research:

Meditative TechniquesMeditative Techniques

WorkWork

Common Problems Common Problems Experienced When We Don’t Experienced When We Don’t

Slow DownSlow Down PainPain InsomniaInsomnia DepressionDepression Mind Body AwarenessMind Body Awareness Sexual Dysfunction or DisinterestSexual Dysfunction or Disinterest Nausea Nausea AnxietyAnxiety FatigueFatigue Less clarity on clinical assessments and issuesLess clarity on clinical assessments and issues BurnoutBurnout

Burnout?Burnout?

Emotional exhaustionEmotional exhaustion– Fatigue, insomnia and depressionFatigue, insomnia and depression

Cynicism or depersonalizationCynicism or depersonalization– Decreased work effectiveness, performance, Decreased work effectiveness, performance,

longevity and creativitylongevity and creativity Perceived clinical inefficacyPerceived clinical inefficacy

– Feelings of despair & bitterness, inadequacy, Feelings of despair & bitterness, inadequacy, difficulty justifying work effort, and not looking difficulty justifying work effort, and not looking forward to going to work, along with feeling forward to going to work, along with feeling unappreciated and having little satisfactionunappreciated and having little satisfaction

Pellegrini, V. (2007). Physician Burnout: A Time for Healing. Pellegrini, V. (2007). Physician Burnout: A Time for Healing. Obstetrical & Obstetrical &

Gynecology, 62 Gynecology, 62 (5), 285-286(5), 285-286..

Benefits of Meditation Benefits of Meditation TechniquesTechniques

Reduces*Reduces*– AnxietyAnxiety– StressStress– Blood PressureBlood Pressure– Chronic PainChronic Pain– InsomniaInsomnia– Blood Cortisol Levels (brought on by stress)Blood Cortisol Levels (brought on by stress)

*NIH Consensus Development. Integration of behavioral and *NIH Consensus Development. Integration of behavioral and relaxation approaches into the treatment of chronic pain and relaxation approaches into the treatment of chronic pain and insomnia. Accessed Oct. 14, 2002.insomnia. Accessed Oct. 14, 2002.

*Spencer, JW, Jacobs JJ. Complementary/Alternative Medicine: An *Spencer, JW, Jacobs JJ. Complementary/Alternative Medicine: An Evidenced Based Approach. St. Louis, MO: Mosby Inc 1999Evidenced Based Approach. St. Louis, MO: Mosby Inc 1999

Increases*Increases*– Quality of lifeQuality of life– General healthGeneral health– ConcentrationConcentration

The Effectiveness of Meditation The Effectiveness of Meditation TechniquesTechniques

Holland J, Morrow G, Schmale A, et al: Holland J, Morrow G, Schmale A, et al: A randomized clinical trial of A randomized clinical trial of alprazolam versus progressive muscle alprazolam versus progressive muscle relaxation in cancer patients with relaxation in cancer patients with anxiety and depressive symptoms. J anxiety and depressive symptoms. J Clin Oncol 9:1004-1011, 1991Clin Oncol 9:1004-1011, 1991

Effectiveness of mindfulnessEffectiveness of mindfulness

An exploratory mixed methods study of the acceptability and effectiveness An exploratory mixed methods study of the acceptability and effectiveness of mindfulness -based cognitive therapy for patients with active depression of mindfulness -based cognitive therapy for patients with active depression and anxiety in primary careand anxiety in primary care

Statistically significant reductions in mean depression and anxiety scores Statistically significant reductions in mean depression and anxiety scores were observed; were observed; – the mean pre-course depression score was 35.7 and post-course score was 17.8 the mean pre-course depression score was 35.7 and post-course score was 17.8

(p = 0.001). (p = 0.001). A similar reduction was noted for anxiety with a mean pre-course anxiety A similar reduction was noted for anxiety with a mean pre-course anxiety

score of 32.0 and mean post course score of 20.5 (p = 0.039). score of 32.0 and mean post course score of 20.5 (p = 0.039). Overall 8/11 (72%) patients showed improvements in BDI and 7/11 (63%) Overall 8/11 (72%) patients showed improvements in BDI and 7/11 (63%)

patients showed improvements in BAI. In general the results of the patients showed improvements in BAI. In general the results of the qualitative analysis agreed well with the quantitative changes in qualitative analysis agreed well with the quantitative changes in depression and anxiety reported depression and anxiety reported

Finucane, A. & Mercer, S. (2006). An exploratory mixed methods study of the Finucane, A. & Mercer, S. (2006). An exploratory mixed methods study of the acceptability and effectiveness of mindfulness-based cognitive therapy for patients acceptability and effectiveness of mindfulness-based cognitive therapy for patients with active depression and anxiety in primary care. with active depression and anxiety in primary care. BMC Psychiatry. 6BMC Psychiatry. 6: 14 : 14

Alprazolam vs. PMRAlprazolam vs. PMR

Sample:Sample:

3 centers over 3 centers over 10 days10 days to test the to test the efficacy of efficacy of

Randomized, non-blinded study of Randomized, non-blinded study of 147147 patients (uncontrolled for site or patients (uncontrolled for site or disease stage)disease stage)

7070 assigned to drug assigned to drug 7777 assigned to relaxation assigned to relaxation


Instruments:Instruments:

Four measuresFour measures of anxiety and of anxiety and depression used: depression used: – Covi Anxiety ScaleCovi Anxiety Scale– Raskin Depression ScaleRaskin Depression Scale– Affects Balance Affects Balance – Symptoms Checklist – 90 (SCL-90)Symptoms Checklist – 90 (SCL-90)


Intervention:Intervention:

1)1) A triazolobenzodiazepine:A triazolobenzodiazepine:- Alprazolam, .5mg 3x/dayAlprazolam, .5mg 3x/day

2)2) Behavioral Techniques:Behavioral Techniques:- Taught Progressive Muscle Relaxation Taught Progressive Muscle Relaxation

(PMR) at session 1 with behavioral (PMR) at session 1 with behavioral psychologistpsychologist

- Asked to listen to audio tape of PMR Asked to listen to audio tape of PMR session 3x/daysession 3x/day


Results:Results:

Both arms of study showed significant Both arms of study showed significant (P < .001)(P < .001) decrease in observer and patient- decrease in observer and patient-reported anxious and depressed mood reported anxious and depressed mood symptoms symptoms

Drug arm showed more rapid decrease in Drug arm showed more rapid decrease in anxiety and a slightly greater decrease in anxiety and a slightly greater decrease in depressiondepression


Application and Conclusion:Application and Conclusion:

Findings confirm that both drug and Findings confirm that both drug and PMR interventions are effective in PMR interventions are effective in significantly reducing distresssignificantly reducing distress

However, However, PMRPMR is is less invasiveless invasive, can be , can be more more cost effectivecost effective and teaches a and teaches a skillskill to manage problemsto manage problems

Why Don’t Social Workers Why Don’t Social Workers Meditate?Meditate?

We teach what we need to learnWe teach what we need to learn

What happens during stillness?What happens during stillness?

Resisting the thrill of distractionResisting the thrill of distraction

Taking responsibilityTaking responsibility

Why Haven’t I Managed My Why Haven’t I Managed My Stress?Stress?

““I don’t have the time”I don’t have the time”

““I think it is a waste of time”I think it is a waste of time”

““I don’t know how to begin”I don’t know how to begin”

““I don’t know where to begin”I don’t know where to begin”

What If Social Workers Did What If Social Workers Did Meditate?Meditate?

Increased problem solving abilityIncreased problem solving ability

Increased energyIncreased energy

Increased clarity regarding OUR Increased clarity regarding OUR options for changeoptions for change

What If Social Workers Did What If Social Workers Did Meditate?Meditate?

We could teach from a place of We could teach from a place of experienceexperience

Negative reactivity would be quickly Negative reactivity would be quickly identified and managedidentified and managed

Complex experiences could be Complex experiences could be processed without harm to our processed without harm to our minds/bodies and spirits minds/bodies and spirits

Preparing to PracticePreparing to Practice

Other Relaxation & Other Relaxation & Meditative TechniquesMeditative Techniques

YogaYogaMassage TherapyMassage TherapySpiritual RitualsSpiritual Rituals

MeditationMeditationDeep BreathingDeep Breathing

ExerciseExerciseBody Work / Progressive RelaxationBody Work / Progressive Relaxation

JournalingJournalingSocial ActivitySocial Activity

Preparing to PracticePreparing to Practice

Setting TimeSetting Time

Body PositioningBody Positioning

Use of a Focal Point for ConcentrationUse of a Focal Point for Concentration– Breath, candle, mantraBreath, candle, mantra

Exploring Your StyleExploring Your Style

ActiveActive– Yoga, Walking, Energy ReleaseYoga, Walking, Energy Release

Guided PassiveGuided Passive– Imagery, visualizationImagery, visualization

IntegrativeIntegrative– Moving into voidMoving into void

Exploring Your StyleExploring Your Style

What rises to the surface when you What rises to the surface when you become still?become still?

Do you become aware of being Do you become aware of being “exhausted”?“exhausted”?

What are the messages that your What are the messages that your body conveys, (tension, pain, body conveys, (tension, pain, emptiness, gratitude)?emptiness, gratitude)?

Three Steps Into MeditationThree Steps Into Meditation

1.1. Quieting our bodies Quieting our bodies

2.2. Quieting out minds Quieting out minds

3.3. Opening our heartsOpening our hearts

Deep Breathing TechniqueDeep Breathing Technique

1.1. Breathe in slowly through your nose Breathe in slowly through your nose (count to five)(count to five)

Imagine the air going into your Imagine the air going into your stomach and feel it expand gentlystomach and feel it expand gently

2.2. Slowly exhale through your mouth Slowly exhale through your mouth (count to five)(count to five)

Picture the air emptying out of your Picture the air emptying out of your stomachstomach

Deep Breathing TechniqueDeep Breathing Technique

Repeat 10 times or until symptoms Repeat 10 times or until symptoms subsidesubside

Note:Note:If breath is difficult, focus on slowing If breath is difficult, focus on slowing your heart rate or using other your heart rate or using other relaxation techniquesrelaxation techniques

Steps to Self Directed Steps to Self Directed MeditationMeditation

Step 1Step 1

Selecting a quiet place free Selecting a quiet place free from noise and distractionfrom noise and distraction

Steps to MeditationSteps to Meditation

Step 2Step 2

Sitting or resting quietly with Sitting or resting quietly with eyes closedeyes closed


Step 3Step 3

Focusing on slowing the Focusing on slowing the breath by deep breaths in and breath by deep breaths in and out slowly (if breath is difficult out slowly (if breath is difficult focus on slowing your heart focus on slowing your heart rate)rate)


Step 4Step 4

Progressively relaxing all Progressively relaxing all muscles in the bodymuscles in the body


Step 5Step 5

Paying attention to where Paying attention to where tension still exists and repeat tension still exists and repeat step 4step 4

Steps to MeditationSteps to Meditation Step 6Step 6

Repeating positive thoughts with Repeating positive thoughts with every breath in and breathing out every breath in and breathing out the tensionthe tension

((i.e. “I am breathing in strength and i.e. “I am breathing in strength and peace and breathing out the tension and peace and breathing out the tension and stress”. Can also be a time of prayer, i.e. stress”. Can also be a time of prayer, i.e. repeating your favorite verse or just repeating your favorite verse or just spending quiet time with your spiritual spending quiet time with your spiritual connection)connection)

Progressive RelaxationProgressive Relaxation The muscle groups are tightened and The muscle groups are tightened and

relaxed one at a time in a specific order.relaxed one at a time in a specific order. (Breathing in tighten for 5-8 seconds and (Breathing in tighten for 5-8 seconds and then release breath and the tension)then release breath and the tension)– feetfeet– calvescalves– thighs/hamstringsthighs/hamstrings– buttocksbuttocks– abdomenabdomen– chest/shoulderschest/shoulders– forearms/handsforearms/hands– faceface

Progressive RelaxationProgressive Relaxation

While releasing the tension, focus on the While releasing the tension, focus on the changes you feel when the muscle group changes you feel when the muscle group is relaxedis relaxed

Imagery may be helpful while you release Imagery may be helpful while you release tension (imagine stressful feelings tension (imagine stressful feelings releasing out of your body as you relax) releasing out of your body as you relax)

Repeat exercise in areas where tension Repeat exercise in areas where tension still remainsstill remains

Setting the Stage for Your Setting the Stage for Your PracticePractice

Set Realistic GoalsSet Realistic Goals:: If you have never If you have never been one to be quiet or reflective, no been one to be quiet or reflective, no more than 10 minutes per day of more than 10 minutes per day of contemplation is realistic. Longer contemplation is realistic. Longer periods may lead to discouragement. periods may lead to discouragement.


Read Inspirational MaterialRead Inspirational Material: Read : Read whatever inspires you or whatever you whatever inspires you or whatever you think may inspire you. For some, this think may inspire you. For some, this may be a religious book such as the may be a religious book such as the Bible or the Upanishads. For others, it Bible or the Upanishads. For others, it may be poetry or song. Inspiration is a may be poetry or song. Inspiration is a unique individualized quality that only unique individualized quality that only you can unlock for yourself.you can unlock for yourself.


Surround Yourself with Things That Surround Yourself with Things That Have Deeper MeaningHave Deeper Meaning: As with the : As with the inspirational material, use whatever inspirational material, use whatever provides or hints at a deeper meaning provides or hints at a deeper meaning for you. It may be a photograph. It for you. It may be a photograph. It may be a bracelet, a ring, or a rosary. may be a bracelet, a ring, or a rosary. Whatever it is, it should help you get Whatever it is, it should help you get closer to your “center”.closer to your “center”.

Setting The Stage for Your Setting The Stage for Your PracticePractice

Be Open To Your Patient as a Spiritual Be Open To Your Patient as a Spiritual TeacherTeacher. Everyday we are exposed to . Everyday we are exposed to people who are in crisis. Frequently, people who are in crisis. Frequently, the same people expose us to grace the same people expose us to grace and peace in the midst of chaos. Being and peace in the midst of chaos. Being open to them as spiritual teachers open to them as spiritual teachers permits us to learn from their permits us to learn from their experiences.experiences.

Setting The Stage for Your Setting The Stage for Your PracticePractice

Plan for conversationsPlan for conversations with friends with friends or or colleagues that address deeper colleagues that address deeper meaning, not just issues around work, meaning, not just issues around work, so you have someone to talk to.so you have someone to talk to.

Final ThoughtFinal Thought

As social workers, we have a As social workers, we have a responsibility to our patients to stay responsibility to our patients to stay true to ourselves and allow the time to true to ourselves and allow the time to struggle with hard questions, to struggle with hard questions, to rejuvenate, to find joy, and to come to rejuvenate, to find joy, and to come to peace with life struggles. peace with life struggles.

Research ResourcesResearch ResourcesResources: American Cancer Society: www.cancer.org CancerGuide by Steve Dunn:

http://www.cancerguide.org National Cancer Institute: www.cancernet.nci.nih.gov National Center for CAM: http://nccam.nih.gov/ University of Texas Center for Alternative Medicine

Research in Cancer: http://www.mdanderson.org/departments/cimer/ Health Journeys: http://www.healthjourneys.com

Alternative/Unproved Methods Information: National Council Against Health Fraud: http://www.ncahf

.org Quackwatch: http://www.quackwatch.com

http://www.cancer.org/

http://www.cancerguide.org/

http://nccam.nih.gov/

http://www.mdanderson.org/departments/cimer/

http://www.healthjourneys.com/

http://www.ncahf.org/



http://www.quackwatch.com/

Articles Showing Positive Articles Showing Positive Effects of MeditationEffects of Meditation

Baider L, Uziely B, Kaplan De-Nour A: Progressive Baider L, Uziely B, Kaplan De-Nour A: Progressive muscle relaxation and guided imagery in cancer muscle relaxation and guided imagery in cancer patients. Gen Hosp Psychiatry 16:340-347, 1994 patients. Gen Hosp Psychiatry 16:340-347, 1994

Kabat-Zinn J, Massion AO, Kristeller J, et al. Kabat-Zinn J, Massion AO, Kristeller J, et al. Effectiveness of a meditation-based stress Effectiveness of a meditation-based stress reduction program in the treatment of anxiety reduction program in the treatment of anxiety disorders. Am J Psychiatry 1992;149:936-43disorders. Am J Psychiatry 1992;149:936-43

Articles Showing Positive Articles Showing Positive Effects of MeditationEffects of Meditation

National Institute of Health: Integration of National Institute of Health: Integration of Behavioral and Relaxation Approaches into the Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia Treatment of Chronic Pain and Insomnia http://consensus.nih.gov/ta/017/017ta_statement.pdf

Holland J, Morrow G, Schmale A, et al: A Holland J, Morrow G, Schmale A, et al: A randomized clinical trial of alprazolam versus randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J Clin with anxiety and depressive symptoms. J Clin Oncol 9:1004-1011, 1991Oncol 9:1004-1011, 1991

http://consensus.nih.gov/ta/017/017ta_statement.pdf

Recommended ResourcesRecommended Resources Belleruth Naparstek, : tapes on www.healthjourneys.comBelleruth Naparstek, : tapes on www.healthjourneys.com

Full Catastrophe LivingFull Catastrophe Livingby Jon Kabat-Zinn. A Practical guide to mindfulness meditation and by Jon Kabat-Zinn. A Practical guide to mindfulness meditation and healing, using the wisdom of your body and mind to face pain, stress healing, using the wisdom of your body and mind to face pain, stress and illness; based on his work at the Stress and Pain Clinic at the U. and illness; based on his work at the Stress and Pain Clinic at the U. of Massachusetts Medical Center.of Massachusetts Medical Center.

Wherever You Go, There You AreWherever You Go, There You Areby Joh Kabat-Zinn. The practice of mindfulness mediation in everyday by Joh Kabat-Zinn. The practice of mindfulness mediation in everyday life. Stories, anecdotes, poems.life. Stories, anecdotes, poems.

The Miracle of MindfulnesThe Miracle of Mindfulnesssby Thich Nhat Hanh. Basic book on mindfulness meditation.by Thich Nhat Hanh. Basic book on mindfulness meditation.

Peace is Every StepPeace is Every Stepby Thich Nhat Hanh. Mindfulness in everyday life. A wonderful by Thich Nhat Hanh. Mindfulness in everyday life. A wonderful collection of personal anecdotes, stories, and experiences from his collection of personal anecdotes, stories, and experiences from his own life that show the reader how to attain awareness and peace.own life that show the reader how to attain awareness and peace.

Recommended ResourcesRecommended Resources The Four AgreementsThe Four Agreements

by Miguel Don Ruiz. Techniques to live a peaceful life.by Miguel Don Ruiz. Techniques to live a peaceful life.

Instant CalmInstant Calmby Paul Wilson. A complete collection of calming techniques that are by Paul Wilson. A complete collection of calming techniques that are easy to use.easy to use.

Emotional IntelligenceEmotional Intelligenceby Daniel Goleman. The author argues that our emotions play a by Daniel Goleman. The author argues that our emotions play a much greater role in thought, decision making and individual success much greater role in thought, decision making and individual success than is commonly acknowledged.than is commonly acknowledged.

Way of the Peaceful WarriorWay of the Peaceful Warriorby Dan Millman. A story of a world champion athlete who is guided by Dan Millman. A story of a world champion athlete who is guided by a powerful old man who teaches Millman what it means to live like by a powerful old man who teaches Millman what it means to live like a peaceful warrior.a peaceful warrior.

BibliographyBibliography

Astin J: Stress reduction through mindfulness meditation. Astin J: Stress reduction through mindfulness meditation. PsychotherPsychosom 66:97–106, 1997PsychotherPsychosom 66:97–106, 1997

Austin JA. Stress reduction through mindfulness meditation: Austin JA. Stress reduction through mindfulness meditation: effects on psychological symptomatology, sense of control, effects on psychological symptomatology, sense of control, and spiritual experience. Psychother Psychosom and spiritual experience. Psychother Psychosom 1997;66:97-106.1997;66:97-106.

Baider L, Uziely B, Kaplan De-Nour A: Progressive muscle Baider L, Uziely B, Kaplan De-Nour A: Progressive muscle relaxation and guided imagery in cancer patients. Gen Hosp relaxation and guided imagery in cancer patients. Gen Hosp Psychiatry 16:340–347,1994Psychiatry 16:340–347,1994

Holland J, Morrow G, Schmale A, et al: A randomized Holland J, Morrow G, Schmale A, et al: A randomized clinical trial of alprazolam versus progressive muscle clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive relaxation in cancer patients with anxiety and depressive symptoms. J Clin Oncol 9:1004–1011, 1991symptoms. J Clin Oncol 9:1004–1011, 1991

BibliographyBibliography

Kabat-Zinn J, Massion AO, Kristeller J, et al. Effectiveness of Kabat-Zinn J, Massion AO, Kristeller J, et al. Effectiveness of a meditation-based stress reduction program in the a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry treatment of anxiety disorders. Am J Psychiatry 1992;149:936-43. 1992;149:936-43.

Loscalzo M. Psychological Approaches in the Management Loscalzo M. Psychological Approaches in the Management of Pain in Patients with Advanced Cancer. of Pain in Patients with Advanced Cancer. Hematology/Oncology Clinics of North America (PainHematology/Oncology Clinics of North America (Pain

and Palliative Care), Vol. 10, No. 1, 1996and Palliative Care), Vol. 10, No. 1, 1996

National Institute of Health:National Institute of Health:http://home.mdconsult.com/das/journal/view/26940698/N/http://home.mdconsult.com/das/journal/view/26940698/N/12074347?source=MI12074347?source=MI

Spiritual role in healing. An alternative way of thinking. Spiritual role in healing. An alternative way of thinking. Boudreaux ED - Prim Care - 01-Jun-2002; 29(2): 439-54, viii Boudreaux ED - Prim Care - 01-Jun-2002; 29(2): 439-54, viii From NIH/NLM MEDLINEFrom NIH/NLM MEDLINE

managing personal and client stress through meditation

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mean depression

mean precourse anxiety

anxiety scores

cancer patients

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