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Description : Check out this medical presentation on Neurology, which is titled "Manage your Mind", to know how to manage mind wth wellness and mindfulness strategies.

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Published on : Aug 23, 2021 | Views : 2064 | Downloads : 0

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Slide 1-

Looking after Yourself Manage your Mind Strategies for Wellness & Mindfulness AFRM Annual Trainee Meeting, 5 & 6 March, 2016 Dr Barbara Hannon
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Personal Perspective & Myths The system/ work environment will should provide protection Coping skills/strategies for each of us are the same Putting my head down and working harder will get me through difficult times Once I am through the examinations everything will be easier so I will pick up strategies as I need them Now is the time I should be taking it easy Mindfulness/Relaxation therapies are soft options
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Stress Performance Inertia Poor performance / burnout Stress-performance curve High performance
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Stress Performance Inertia Poor performance / burnout Stress-performance curve High performance Peak performance “The zone” Mindfulness
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Mindfulness Strategies From today take what resonates with you……. Following up strategies such as mindfulness or other forms of healthy life balancing activities does require commitment of time and energy i.e. regular practice on an ongoing basis Not always the easy option in the short term however potentially significant benefits long term
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Physiological Changes in the “Stress & Relaxation Responses” Stress response Relaxation Response Heart rate Blood Pressure Respiratory Rate Muscle Tension Sweating Mental Arousal Adrenalin/ cortisol Flow
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Adaptive responses vs harmful responses Fight or Flight Response? Freeze Response?
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Or……. Tend & Befriend, also known as Calm & Connect. Mediated by oxytocin Turns down stress response & modulates activity in the amygdala
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Physiology of the Relaxation Response is mediated through the Parasympathetic Nervous System Immediate benefits of Relaxation: reduces heart rate and thereby the work of the heart reduces blood pressure slows the rate of breathing, which reduces the need for oxygen decreases muscle tension change in blood flow distribution from skeletal to GIT Longer Term benefits in a range of chronic diseases
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Healthy lifestyle and WC (NK-cell) activity Behaviour Exercise Managing stress Enough sleep Balanced meals Not smoking Eating breakfast Not overworking Avoiding alcohol Advantage in NK activity 47% 45 44 37 27 21 17 0 Kusaka Y. et al. Preventive Medicine 1992;21:602-15.
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Early Research in Stress and Immunity Study participants had their levels of stress measured after they were inoculated with 5 different cold viruses The likelihood of getting a cold was directly proportional to level of stress which the host was experiencing not just at the time of exposure but over the preceding six months Cohen S. et al. N Eng J Med 1991;325:606-612.
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Research in Stress and Immunity If one contracts a viral illness, like influenza, then higher stress levels are associated with more severe symptoms Volunteers inoculated with measured dose of influenza A High stress levels associated with more severe flu (higher symptom scores, more mucous, higher interleukin-6) Cohen S et al. Psychosomatic Medicine. 1999;61(2):175-80.
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Research in Stress and Immunity Profound immune suppression of medical students over the exam period Lowered WC (Natural Killer cell) activity 90% reduction in gamma interferon Students often succumb to illness during or just after exams Those who practiced relaxation or kept journals for important events had significantly better immunity & fewer infections in the exam period IgA levels reduced by stressful life-events such as exam pressure, social isolation, grief, anxiety, and anxiety about control Kiecolt-Glaser J et al. J Cons Clin Psych 1992;60:569-75. Kiecolt-Glaser J et al. Annual Rev Psych 1991;11:169-80.
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PNI –psychoneuroimmunology Psychological stress and social factors can: Lower immune markers (WCC, Ig) Increase susceptibility to infections Increase severity and progression of infections Increase relapse of chronic and latent infections Increase activity of inflammatory illnesses Increase activity of autoimmune conditions Poor response to immunization Effect the activity of allergic conditions Impair immune response to cancer Metabolic syndrome- impaired bone mineralisation
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Allostatic load and the brain Prolonged stress leads to wear-and-tear on the body (allostatic load) is mediated through the Sympathetic Nervous System Longer term Physiological Changes Atrophy of nerve cells in the brain Hippocampal formation: learning and memory Prefrontal cortex: working memory, executive function Plus growth of Amygdala is mediated by fear response McEwen BS. Ann N Y Acad Sci. 2004;1032:1-7.
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Mindfulness and the brain MRI assessed cortical thickness in 20 long-term mindfulness meditators Brain regions associated with attention, concentration and sensory processing thicker in meditators than matched controls Lazar SW, Kerr CE, Wasserman RH, et al. Neuroreport. 2005;16(17):1893-1897. * Recent robust studies on long term mediators show increased activity in the prefrontal cortex
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Stress and telomere shortening Study on healthy premenopausal women: psychological stress associated with: higher oxidative stress lower telomerase activity (telomerase repairs DNA telomeres) leading to shorter telomere length Women with highest levels of perceived stress c/w low stress women have shorter telomeres Average equivalent at least one decade of additional ageing Epel ES et al. Proc Natl Acad Sci U S A. 2004;101(49):17312-5.
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Mindfulness and telomerase Study of mothers caring for children with disabilities – intervention “meditation may slow genetic ageing and enhance genetic repair…. ….by reducing cognitive stress and stress arousal and increasing positive states of mind and hormonal factors, that may promote telomere maintenance” Epel E, Daubenmier J, Moskowitz JT, Folkman S, Blackburn E. Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres. Ann N Y Acad Sci. 2009 Aug;1172:34-53.
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Mind wandering and ageing The greater the level of mind wandering, the greater the level of telomere shortening (a marker of biological age) Epel ES, Puterman E, Lin J, Blackburn E, et al. Wandering Minds and Aging Cells. Clinical Psychological Science 2012, in press
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Mental Practice and stroke RCT Mental practice (MP) of a motor skill activates the same musculature and neural pathways as physical practice of the same skill Subjects receiving MP showed: statistically and clinically significant reductions in impairment significant increases in daily arm function new ability to perform important activities of daily living Page SJ, Levine P, Leonard A. Mental practice in chronic stroke: results of a randomized, placebo-controlled trial. Stroke. 2007 Apr;38(4):1293-7. Epub 2007 Mar 1.
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Burnout and psychiatric morbidity in new medical graduates 8 months into internship: 75% interns had burnout 73% (of interns) met criteria for psychiatric morbidity on at least one occasion Willcock SM et al. Burnout and psychiatric morbidity in new medical graduates. Med J Aust. 2004;181(7):357-60
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Doctor health and medical errors Study determined prevalence of depression and burnout among residents medical staff in 3 US hospitals 20% of residents met criteria for depression 74% met the criteria for burnout Depressed residents made 6.2 times as many medication errors as residents who were not depressed Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ, doi:10.1136/bmj.39469.763218.BE (published 7 February 2008)
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Signs of Burnout Would you recognise these signs of burnout in yourself or a colleague? 1. Emotional exhaustion 2. Cynicism 3. Perceived clinical ineffectiveness 4. Sense of depersonalisation in relationships with co-workers, patients or both If it was you consider how your health might be affected.
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Mindfulness in medical education “At Harvard, a group of faculty members and students are developing workshops for first and second year students to teach “mindfulness” and self-renewal skills, based on the ESSENCE program developed by Dr Craig Hassed, Monash University Administrators at Duke, discouraged by a low turnout for mental health education programs, have decided to present a wellness program focused on enhancing performance. Rosenthal JM, Okie S. White coat, mood indigo--depression in medical school. New England Journal of Medicine 2005;353;11:1085-8.
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ESSENCE Model E Education S Stress management S Spirituality E Exercise N Nutrition C Connectedness E Environment The Essence of Health: The seven pillars of wellbeing Craig Hassed Random House 2008 Craig Hassed Essenc:e the seven Pillars of Wellbeing
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What are some of the daily stresses in Rehab Medicine? Challenging personalities- pts/ families Unwell patients –clinical decisions/ goals Clear communication with staff- across a spectrum of nursing and >= 4 therapists Communication & documentation- face to face, written, electronic not to mention devices....... Iphone, Ipad,sms email ……. …………..multiple usernames & passwords!
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Multi tasking & procrastination – “wired for distraction” Physiologically there is a small release of dopamine from reward centre every time the brain switches to something novel so not paying attention can become “hard wired” Studies on all ages do not show improved efficiency or that the brain copes well with multiple distractions Multitasking is actually switching attention back & forth from different tasks so is actually “task switching”
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Applications of Mindfulness The ability to engage and remain focused on the current task & to keep returning to it The ability to move on to the next task with confidence and without the constant pull of thoughts in default mode
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In other words Hebbe’s hypothesis Neurones that fire together…… ………..Wire together –old patterns or new Science of neuroplasticity What you feed the mind strengthens the neural circuits associated with those patterns
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Steps in Mindfulness Formal Practices attention training/meditation Informal Practices - being mindful whilst engaged in activities Craig Hassed & Richard Chambers Mindfulness for Wellbeing & Performance - online course 2016 Monash University
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Steps in Mindfulness 4 Main Cognitive Practices 1)Perception or awareness 2)Letting Go - non attachment 3)Acceptance 4)Presence of Mind Craig Hassed & Richard Chambers Mindfulness for WellbeingPerformance - online course 2016 Monash University
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1. Perception- Observing Thought
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Your thoughts create your experience of reality Tendency to focus on a positive thought or emotion versus the tendency to repeatedly focus or ruminate on negative thoughts (whether these be in the past or the future) Leads to activation of the relevant physiological response in the body Physiologically the brain & body cannot distinguish between what is real from what is imagined or not real.
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Default Modes of Thinking Rumination-dwelling on the past, worrying about the future Procrastination Daydreaming Catastrophising Diagnostic errors can occur through non objectivity eg Confirmation or Anchoring bias
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What is your “AUTOPILOT” or default response under stress, fatigue or exams?
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Consider Examination Stress 1) What is my own pattern of self talk/default mode of thinking like? 2) What is my relationship to that self talk? 3) Am I self sabotaging?
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2. Letting GO- Non attachment
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3. Acceptance Includes learning to notice and tolerate uncomfortable thoughts and feelings which can be physical or mental Improving tolerance & softening of attitude to it can prevent escalation Transience or non permanence of thoughts and feelings Acceptance may allow them to subside &/or redirect Craig Hassed & Richard Chambers Mindfulness for WellbeingPerformance - online course 2016 Monsh University
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4. Presence of Mind Paying attention to the present moment The ability to sustain the focus of concentration The ability to return to the focus of concentration Absorption in the present moment Craig Hassed & Richard Chambers Mindfulness for WellbeingPerformance - online course 2016 Monsh University
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Practical exercise
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Types of Meditation Practices 1. Mindfulness - focus of the mind based on breath, body scan, awareness of external surroundings, then awareness internally -process of bringing awareness back to the focus again & again - analogy of contracting a muscle repeatedly 2. Visualization - may be a preferred option for some 3. Movement based awareness with mindfulness eg Tai chi, Yoga 4. Mantra based
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Mindfulness strategies for health What stimulates your ‘relaxation response’?.. music, getting outdoors in nature etc Punctuate your day- concept of traffic control for the mind Develop an ability to recognize on your own individual limits & triggers which “push your buttons” Be Kind to yourself
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Plus general strategies for health Exercise Nutrition- moderation and healthy choices (obviously) AND watch what you go to for ‘comfort” Massage & other forms of “bodywork” Humour Take regular “breaks” which may need to be a bit longer as you get older Plan for medium and long hobbies with other interests eg existing or new?....
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Recommendations & Resources Craig Hassed & Richard Chambers Mindfulness for Wellbeing & Performance Monash University - online course 2016 https://www.futurelearn.com/courses/mindfulness-wellbeing-performance SBS on demand until March 14 2016 Michael Mosely : Don’t worry, be Happy https://www.theconnection.tv -The Connection DVD www.goAMRA.org Mindfulness Research monthly How Doctors Think. Jerome Groopman Scribe publications 2007 Appendix :RACP – Summary Health of Doctors Position Statement May 2013
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RACP -Health of Doctors Position Statement May 2013 Doctors, like anyone else, need to look after their own health. As an important component of maintaining their own health, doctors should have their own general practitioner and undertake regular health checks. While doctors as a group enjoy comparatively good physical health, certain characteristics of the medical profession predispose doctors to specific health risks. Historically, the medical professional culture has encouraged doctors to sacrifice their own health through accepted practices such as working long hours and taking work home. Increasingly efforts are being made to address counterproductive workplace behaviours, and workplace bullying is no longer tolerated. RACP Health of Drs Posotion Statement
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• When health concerns arise for doctors, they may be reluctant to seek appropriate medical care. Doctors may feel uncomfortable assuming the role of patient, and may opt instead to treat themselves or seek informal care from a colleague. • Regulatory frameworks are an important consideration, as mandatory reporting of impaired doctors can act as a deterrent to seeking help. • Doctors are encouraged to seek independent medical consultations, and there is growing recognition that a particular skill set can be taught to help doctors treat other doctors more effectively. RACP Health of Drs Posotion Statement 53
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• Doctors’ health advisory and referral services are important avenues by which doctors can seek help, and these operate in all jurisdictions of Australia and New Zealand. We welcome the action that regulatory, accreditation and indemnity bodies are taking to support doctors’ health. • Medical colleges have an important role as they engage with doctors in the course of their training and continuing professional development. The RACP has a number of initiatives underway and in development to support Fellows and trainees with health concerns. • Occupational and environmental medicine physicians and rehabilitation physicians have a key role to play in supporting impaired doctors to realise the health benefits of work. RACP Health of Drs position statement 54