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“A moment of self-compassion

can change your entire day.

A string of such moments can change the course of your life.”

—Chris Germer

Self Compassion: Resiliency 102

The Rev. Mia Baumgartner,

MDiv, MNPL, BCC

Chaplain

Seattle Cancer Care Alliance mbaumgar@seattlecca.org

206-606-8215

Opening exercise

May you be safe, peaceful, whole, live with ease Resiliency Practice: Engaging our Parasympathetic Nervous System

Resiliency

“the capacity to prepare for, recover from and adapt in the face of stress, challenge or adversity”

-HeartMath Institute

Autonomic nervous system

Sympathetic (SNS)

Parasympathetic (PNS)

Prepares the body for intense physical activity

Relaxes the body, inhibits or slows many high energy functions.

Stress, fight, flight or freeze response Rest and digest

Prepares the organism to act upon its environment

Prepares the organism to act upon itself

Speeds up the heartbeat, increases blood pressure, suppresses immune system

Slows down heartbeat, lowers blood pressure, activates immune system

Why am I here? Why do I do this work?

Take a minute to reflect with a partner

• Resiliency Practice: Reconnect with purpose, mission

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What meaningful benefits have I experienced through my work?

• Compassion Satisfaction

• Post-Traumatic Growth

• Vicarious Post-Traumatic Growth

• Self-Awareness

Workplace Challenges

Stress Burnout Compassion Fatigue

Compassion Fatigue • Secondary Traumatic Stress

• Vicarious Traumatization

• Grief (loss, change)

“We burn out not because we don’t care, but because we don’t grieve.”

Rachel Naomi Remen, MD

Kitchen Table Wisdom

Unrecognized Grief (disenfranchised, unsanctioned)

Social stigma • “This shouldn’t be affecting me. I’m strong. I’ve been

a nurse for X years.” • “If I show anyone I’m suffering they’ll think I can’t

handle the job.”

Absence of time for rituals • to acknowledge and express loss

Delayed or misplaced feelings of grief/loss • Stifling of emotions at present may lead to

exaggerated feelings of sadness later (commercials, movies)

What are your Stress/Grief Indicators?

Resiliency Skill: Awareness

On the job Grief Practices

• Light a virtual candle (Gratefulness.org)

• Create a journal/log (Hippa appropriate) to remember. Write 3 things you are grateful for knowing that patient

• Write a bereavement card.

• Debrief/Remember with another team member (Wake)

• Commit to attending one memorial service a year.

• Go to quiet place. Journal, sit, breathe, remember for 5 minutes

• Take a short walk. Get fresh air. Or walk to a place there is a view of nature and behold beauty, creation and give thanks for your life as you remember your patients life and qualities.

• Make an appointment with yourself to deal with it at a future time.

• Incorporate into your own tradition’s remembrance of the dead

• Create remembrance ritual: Rock in a bowl, Ribbons on a branch….

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16 Indicators of Trauma Response

Breathe.

Watch. Listen to your inner responses.

Notice what causes you to pause.

• Trauma Stewardship: An Everyday Guide to Caring for Self While Caring

for Others, Laura van Dernoot Lipsky with Connie Burk, Chapter 4 (2009) 14

Feeling Helpless and Hopeless

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A Sense That One Can Never Do Enough

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Hypervigilance

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Diminished Creativity

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Inability to Embrace Complexity

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Minimizing

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Chronic Exhaustion/ Physical Ailments

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Inability to Listen/ Deliberate Avoidance

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Dissociative Moments

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Sense of Persecution

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Guilt

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Fear

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Anger and Cynicism

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Inability to Empathize/ Numbing

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Addictions

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Grandiosity: An Inflated Sense of Importance Related to One’s Work

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What resonates with you?

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General self-assessment tips

• Assess yourself periodically

• Notice the response you’ve experienced. • Frequency, Intensity , What are your indicators of stress/grief?

• Inquire more deeply. What might be the source (fears, blocks, feelings, accumulated grief?)

• Assess current practices (grief, self-regulation, self-care)

• Going forward: What is your Resiliency Plan?

• Ongoing,

• In the Moment,

• Role-Shedding/Transition and Grief

Green Cross Self Care Inventory and Prevention Plan • Physical

• Psychological

• 4. Effective method of creative expression

• 5d. Cognitive Restructuring (Reframing)

• Social/Interpersonal

• Social Supports (5, at least 2 at work)

• Social Activism

• Professional

• Prevention Plan development

What can we do? Self Care, Resiliency, Trauma Stewardship

Engage Parasympathetic Nervous System (PNS)

Deep Breathing/Meditation/Practice Self-Compassion

Remember our Mission/Purpose

Increase self-awareness

Name stress/grief indicators

Assess level of compassion fatigue/STS monthly

Assess self–care habits

Self Compassion as a Resiliency Practice

Take a minute to look it over

Self Compassion Assessment

Over-Identification Mindfulness

Isolation Common Humanity

Self-Judgment Self-Kindness

Mindfulness

When something painful happens I try to take a balanced view of the situation. (3)

When something upsets me I try to keep my emotions in balance. (7)

Over-identification

When I fail at something important to me I become consumed by feelings of inadequacy (1)

When I’m feeling down I tend to obsess and fixate on everything that’s wrong.(9)

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Common Humanity I try to see my failings as part of the human condition (5)

When I feel inadequate in some way, I try to remind myself that feelings of inadequacy are shared by most people (10)

Isolation

When I’m feeling down, I tend to feel like most other people are probably happier than I am. (4)

When I fail at something that’s important to me, I tend to feel alone in my failure (8)

Self Kindness

I try to be understanding and patient towards those aspects of my personality I don’t like. (2)

When I’m going through a very hard time, I give myself the caring and tenderness I need. (6)

Self Judgment

I’m disapproving and judgmental about my own flaws and inadequacies. (11)

I’m intolerant and impatient towards those aspects of my personality I don’t like (12)

“We are always practicing something.” –Victoria Castle, Trance of Scarcity

What are you practicing?

Benefits of Self-Compassion

Increase in Self-Compassion has been linked to:

• Decrease in burnout and exhaustion

• Decrease in anxiousness and depression

• Increase in expression of compassion to others

• Increase in the ability to forgive

Kristin Neff, PhD.

25 question assessment, research and practices--online www.self-compassion.org

http://self-compassion.org/test-how-self-compassionate-you-are/#

Self Compassion Practices

Loving Kindness Meditation Invoke voice of a loved one as your voice (Jamal Rachman)

• Dear One, Nick name, • Oh… there you go, This is difficult

Compassionate Listening (Chris Germer, Kristen Neff)

• Inhale/Exhale: “One for me, One for you”

Quick Coherence (HeartMath heartmath.org) • Method to generate a positive, warm feeling /memory of calm, joy,

compassion, love to produce self-compassion.

Self Compassion Break (Chris Germer, Kristen Neff) • Mindfulness: “This is a moment of suffering” • Common Humanity: “Suffering is a part of life.” “I am not alone” • Self-Kindness: “May I be kind to myself” “May I give myself what I

need” “May I feel loved” Whatever you long to hear from others.

Self Compassion Exercise • Mindfulness: Awareness. Name the feelings

that arise. “This is a moment of suffering, fear, shame, frustration, anger….

• Common Humanity: Suffering is a part of life. Note the others that might be feeling this. “I am not alone, others also struggle in life”

• Self-Kindness: Be a friend to yourself. May I…. , May you… What would a friend say to you in this moment?

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Self-Compassion in Oncology

• Case Study and review of RENEW method

“Why Are We Doing This?: Clinician Helplessness in the Face of Suffering,” Back et al, Journal of Palliative Medicine, Vol 18:1, 2015

• Uses helplessness as a barometer for actions.

• Reflects on two common responses of hyper and hypo responses when feeling helpless with patients.

• Transforms classic grief steps into the RENEW acronym for a

method of recovery (self-care) and return to constructive compassionate patient engagement after identifying ones’ vulnerability and feelings of helplessness.

RENEW

•Recognize helplessness.

•Embrace your first reaction

•Nourish yourself

•Embody constructive engagement

•Weave a new response

How easily can you call upon our Parasympathetic Nervous System?

Sympathetic (SNS)

Parasympathetic (PNS)

Prepares the body for intense physical activity

Relaxes the body, inhibits or slows many high energy functions.

Stress, fight, flight or freeze response Rest and digest

Prepares the organism to act upon its environment

Prepares the organism to act upon itself

Speeds up the heartbeat, increases blood pressure, suppresses immune system

Slows down heartbeat, lowers blood pressure, activates immune system

Making a Plan What are we practicing?

Ongoing Practice All areas, What brings you joy/life/renewal? Exercise, Nutrition, Spirituality, Centering, Debrief/Remembrance, Exercise, Growth, Vacation schedule…Boundaries

In the Moment Practice Breathing/Grounding, how do you do a turnaround, reframe, practice self- awareness

Role-shedding and prep Practices Transitioning from work to home

Resiliency Tools –Summary Engage Parasympathetic Nervous System (PNS) Deep Breathing/Meditation/Grounding/Self-Compassion

Remember our Mission/Purpose

Increase Self-Awareness Name stress/grief indicators Assess yourself regularly (Secondary Trauma and Self Compassion) Debrief/Engage your community

Cultivate Self-Compassion

Develop Resiliency Practice Plan • In the moment • Ongoing • Role-shedding / Transition

PRACTICE APPS and RESOURCE list

Helpful Apps and Podcasts

Insight Timer: Meditation timer bell. Wide Variety of crowd sourced guided meditations. Android/iPhone and online access insighttimer.com/ Free

Lotus Bud Mindfulness Bell: Sends gentle bell reminders randomly throughout the day. Take the opportunity to breath, reset or activate any practice.

10% Happier-Meditation for Fidgety Skeptics (Podcast, App and website) Dan Harris and Joseph Goldstein 10percenthappier.com

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Research

THE CENTER FOR COMPASSION AND

ALTRUISM RESEARCH AND

EDUCATION (CCARE)

Books and related Websites

Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others Laura Van Dernoot Lipsky with Connie Burk (2009) www.traumastewardship.com

Self-Compassion: The Proven Power of Being Kind to Yourself Kristen Neff (2011) www.self-compassion.org

Book and Online Grief Ritual

Gratefulness.org/light a candle Create a mindful grief ritual right from your desk. Light a candle. Candle will burn down in 48 hours. Can be “shared” so others can visit it and share in the Vigil. www.gratefulness.org/light-a-candle/

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. Jon Kabat-Zinn, PhD. (1990, 2013) He Created

Mindfulness-Based Stress Reduction (MBSR) Trainings. 6-12 weeks.

“A moment of self-compassion

can change your entire day.

A string of such moments can change the course of your life.”

—Chris Germer

Articles of note

• “Self-care of Physicians Caring for patients at the End of Life: Being Connected… A Key to My Survival.” Kearney et al. JAMA, March 18, 2009—Vol 301, No. 11 Themes include: compassion fatigue, exquisite empathy, self care. Proves that Meditative Mindfulness (awareness) and Reflective Writing are two effective interventions for CF.

• “Why Are We Doing This?: Clinician Helplessness in the Face of Suffering,” Back et al, Journal of Palliative Medicine, Vol 18:1, 2015 Uses helplessness as a barometer for actions. Reflects on two common responses of hyper and hypo responses when feeling helpless with patients. Transforms classic grief steps into the RENEW acronym for a method of recovery (self-care) and return to constructive compassionate patient engagement after identifying ones’ vulnerability and feelings of helpless. Practical article for the whole team.

References

1. Self-Compassion assessment, research and interventions: See the work of Kristen Neff, PhD. Her book, website and research: Self-Compassion (2011) www.selfcompassion.org Neff, K. D. (2003). “Development and validation of a scale to measure self-compassion. Self and Identity,” 2, 223-250.

2. Secondary Traumatic Stress/Compassion Fatigue Trauma Stewardship by Laura van Dernoot Lipsky with Connie Burk (2009), www.traumastewardship.com

3. “Self-care of Physicians Caring for patients at the End of Life: Being Connected… A Key to My Survival.” Kearney et al. JAMA, March 18, 2009—Vol 301, No. 11 Themes include: compassion fatigue, exquisite empathy, self care

4. Parasympathetic Nervous System- HeartMath (www.heartmath.org) has evidenced based research, the tested QUICK COHEHERENCE practice and a biofeedback hardware and apps that measure Heart Rate Value (HRV) and train people to access their PNS.

5. Accelerated Recovery Program for Compassion Fatigue - Baranowsky, Gentry & Dunning

6. Mindfulness Based Stress Reduction (MBSR) John Kabat-Zinn, Full Catastrophe Living and many other volumes on mindfulness. Look for courses in your area.

7. “Why Are We Doing This?: Clinician Helplessness in the Face of Suffering,” Back et al, Journal of Palliative Medicine, Vol 18:1, 2015

8. Resiliency/Self Care Plan Outline: Green Cross Academy of Traumatology Self Care Guidelines/Inventory. http://compassionfatigue.dreamhosters.com/wp-content/uploads/2010/11/academy-ethical.pdf

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There is more to life than

merely increasing its

speed.

-M. Gandhi

Ongoing Practices

• Meditation/Breathing/Spiritual Practices

• Eating, Exercise, Sleep, Vacation habits

• Engaging Creativity

• Social Engagement: Community/Family/Friend

• Community Service/Social Activism

• What brings you joy and laughter?

• Personal growth and learning

• Consider all domains of life Emotional, Spiritual, Mental, Professional, Civic, Physical etc.

In the Moment Practices

• Grounding, Centering • Breathing

• Breathing + Emotional Shift/Recharge • Remember/Imagine Event of Love, Compassion, Inner-peace, Joy

• Self-compassion breathing, “One for me, One for you”

• Prayer, Recalling Mentors/Support

• Feeling feet on the ground, flicking fingers

• Preparatory – Set intention before seeing patient

• Symbolic fortitude (lab coat, necklace examples)

• HeartMath.org • Quick Coherence Technique

• Inner Balance Technique

• InnerEase (Biofeedback)

Role-Shedding/ Transitioning Practice

• Intentional Action : Change of coat, shoes, put away nametag and pager, Intentionally clean of desk and put in drawer. Write a list of things you will let go of until tomorrow. Light a candle (at home).

• Touch/Aural: Brush off the day, Loud music, Run/Walk/Bike home

• Visual: “Throw” in river, “Hang up in a tree to be gathered later.) Light a candle.

• Taste: Specific food or beverage

• Spiritual: Ritual of letting go, taking a pause, surrendering concerns of the day.

• Gratefulness practice: Writing down 3 things about today’s work that I’m grateful for.