MINDFULNESSUSING THE MIND TO CHANGE THE MIND

Dr. Eng-Kong Tan MBBS, MPM, FRANZCPkeynote address to 17th Annual Hunter Mental Health ConferenceAt Noah’s on the Beach, Newcastle, NSWFri 13th May 2011

MINDFULNESS

In Daily Life as a practice as an attitude as a mental set as a mode of

being

In Therapeutic Setting as a technique as a presence as a therapy as coaching

The Eight Fold Path

Right speech Right action Ethics Right livelihood Right effort Meditation as a Right mindfulness Mental

Development Right concentration Right view Wisdom Right thought

4 FOUNDATIONS of MINDFULNESS

1. Contemplation of the Body 2. Contemplation of Feelings

AWARENESS3. Contemplation of Mind States4. Contemplation of Teachings

INTERACTIONS

(Dharma)

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Using the Mind to Change the Mind

As the brain changes, the mind changes. As the mind changes, the brain changes. - neurons that fire together, wire together - neural pruning and epigenesis

We can use our mind to change our brain to change our mind for the better: self-directed neuroplasticity.

The practice of MINDFULNESS and MEDITATIONS

are self – therapies.

WHAT IS THERAPEUTIC MINDFULNESS?

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Definition:the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgementally to the unfolding of

experiencemoment by moment

-Jon Kabat-Zinn

PSYCHOTHERAPY REBUILDING the BRAIN

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Safe & Empathic Relationshipemotional/neurobiological contextconducive to neural reorganisation

Positive and attuned relationshipbiochemical changes neural

plasticity and

learning (Schore 1994)

NEUROSCIENCE of MEDITATIVE PSYCHOTHERAPY-1-

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During Intense Emotions

Amygdala overactiveTraumatic Memories Hippocampus

underfunctions Cortex shuts down

NEUROSCIENCE of MEDITATIVE PSYCHOTHERAPY

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Calmness Slowing Down neural nets activated

heightens imagery

Mindfulness on body neuropeptides useful

information digested

Focused attention UC is accessed CONSCIOUS

implicit memory explicit memory

Sense Immediacy memory trace re-coded

vulnerable in hippocampus

NEUROSCIENCE of MEDITATIVE PSYCHOTHERAPY

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L Brain R Brain

make up causal explanations emotional & sensory data

needs time to be connected together

(understanding and insight)

facilitated by Empathic Attunement

(emotional resonance)

mediates a new context and meaning

via frontal lobes and hippocampus

(recovery/healing)

MINDFULNESS-BASED THERAPIES

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M-B Stress Reduction (Jon Kabat-Zinn et al) M-B Cognitive Therapy (Teasdale, et al) Dialectical Behaviour Therapy (Marsha

Linehan) Acceptance & Commitment Therapy

(Stephen Hayes) Hakomi Therapy (Ron Kurtz) Morita Therapy (Morita) Core Process Psychotherapy (Maura Sills) Meditative Psychotherapy (Eng-Kong Tan)

WORK STRESS in NURSES

Intensive support in the face of pt’s suffering

Insufficient power & control Dealing daily with pain, loss and

trauma Changing work environment

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SYMPTOMS & SIGNS of Burnout and Compassion Fatigue

Boundaries Blurred – between work & private life

Feeling Unsafe – hyper vigilance, hypochondrias

Overcritical – of self & others Pessimistic – cynical, hopelessness Alienation – withdrawing, isolating Powerlessness – anxious, loss of control Meaninglessness – indecisiveness,

depression

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BUILDING RESILIENCEBUDDHIST TEACHINGS & PRACTICES

MINDFULNESS Training – improved concentration managing counter transference BRAHMA VIHARAS – Cultivation of: loving-kindness true compassion altruistic joy equanimity

The Buddha on Lovingkindness

Wishing: In gladness and in safety, may all beings be at ease.

Omitting none, whether they are weak or strong, the great or the mighty, medium, short, or small, the seen and the unseen, those living near and far away, those born and to-be-born: May all beings be at ease.

Let none through anger or ill-will wish harm upon another. Even as a mother protects with her life her child, her only child, so with a boundless heart should one cherish all living beings; radiating kindness over the entire world: spreading upwards to the skies, and downwards to the depths, outwards and unbounded, freed from hatred and ill-will.

One should sustain this recollection.

This is said to be the sublime abiding.

MBSR for Nurses by Dr Cohen-Katz et al, Santa Clara University at Lehigh Valley Hospital, California - 2005

8 wks MBSR, 25 nurses, 46 yrs, 21 yrs in Healthcare

RESULTS:Caring for Everyone SELF-CAREPositive changes in RelationshipsMore fully present with OthersLess reactive, defensiveResolving old wounds and issues

NURSE LEADER Mindfulness Meditation Programme by Dr Pipe et al, at Mayo Clinic Arizona, Phoenix

33 High Function Nurse Leaders randomly assigned to Mindfulness Meditation Course (MMC) or Leadership Course

MMC – 4 weeks, 2+1 hr/week, at workplace and at low cost

NURSE LEADER Mindfulness Meditation Programme (cont’d)

RESULTS:SCL – 90 R : significantly more improvement

in 10 out of 14 measures Depression, Anxiety Positive Symptom Total Caring Efficacy Scale

CONCLUSION: Mindfulness is a way of caring and nurturing self so that LEADERSHIP can be more effective