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5/7/2015 1 Cultivating Reverence for Living: Mindfulness Practices for Caregivers, Providers, and Patients Bob Vahary, LCSW, OSW-C “Sometimes the most important thing in a whole day is the rest we take between two deep breaths.” Etty Hillesum “Mindfulness is paying attention in a particular way: on purpose, in the present moment, and non- judgmentally” Jon Kabat-Zinn Paying attention in a particular way; Observer Controlling attention not what we think Present moment Mental noting Nonjudgmental and Accepting Non-striving It Is and Takes Practice; Double duty: Quality we all possess Practices that enhance

Cultivating reverence for living: Mindfulness practices ...Jack Kornfield, A Path with Heart After the Ecstasy, the Laundry Keating, Thomas Open Mind, Open Heart Smith, Jean, ed.,

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Page 1: Cultivating reverence for living: Mindfulness practices ...Jack Kornfield, A Path with Heart After the Ecstasy, the Laundry Keating, Thomas Open Mind, Open Heart Smith, Jean, ed.,

5/7/2015

1

Cultivating Reverence for Living: Mindfulness Practices for Caregivers, Providers, and Patients

Bob Vahary, LCSW, OSW-C

“Sometimes the most important thing in a whole day is the rest we take between two deep breaths.”

Etty Hillesum

“Mindfulness is paying attention in a particular way:

on purpose, in the present moment, and non-

judgmentally”

Jon Kabat-Zinn

Paying attention in a particular way; Observer

Controlling attention not what we think

Present moment

Mental noting

Nonjudgmental and Accepting

Non-striving

It Is and Takes Practice;

Double duty:

Quality we all possess

Practices that enhance

Page 2: Cultivating reverence for living: Mindfulness practices ...Jack Kornfield, A Path with Heart After the Ecstasy, the Laundry Keating, Thomas Open Mind, Open Heart Smith, Jean, ed.,

5/7/2015

2

Better understand how Mindfulness can help with

compassion fatigue, errors, emotions, energy and promote

work life engagement.

Introduce mindful concepts and tools for patient care.

Increase clarity in our provision of care; what works?

Story of CRL In September of 2002 St Vincent launched a Mindfulness Based Stress Reduction

Program called "Cultivating Reverence for Living". It is a six-week program

where St Vincent staff and volunteers spend two hours per week learning spiritual,

physical and emotional practices. Initial research indicates its efficacy for reducing

stress; however its impact on the culture of cancer patient care is remarkable.

Innovation grant

Formative Spirituality Component, Formation field

Program for associates and volunteers

50 6 week classes from 2002 to present

13 years of data , SWB, State Trait Anxiety

State trait Anxiety Perceived Stress Scale

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10

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50

60

70

80

90

100

Sco

re

Pre Test Post Test

State-Trait Anxiety Inventory

0

5

10

15

20

25

Sco

re

Pre Test Post Test

Perceived Stress Scale

Page 3: Cultivating reverence for living: Mindfulness practices ...Jack Kornfield, A Path with Heart After the Ecstasy, the Laundry Keating, Thomas Open Mind, Open Heart Smith, Jean, ed.,

5/7/2015

3

“Cultivating Reverence for Living Program” offered to all

providers including leadership, physicians, hospice, pastoral care,

social work, nursing, pharmacy, information systems, housekeeping

and volunteers.

Integrative medicine team efforts: Hand Massage, aroma therapy.

Survivorship programs: Art, Yoga, Meditative practices.

“Calming the Mind, Calming the Body” CD available to all cancer patients; MP3 available on www.ourfightagainstcancer.com

Counseling involves mindful principals to help processing of emotions through self soothing practices, emotional regulation, present moment awareness, mental noting, non judgmental observation, and loving kindness practice.

Centering Meditative Practices

Relaxation menu on Skylight educational network include “Calming the Mind, Calming the Body” for inpatient and infusion.

“My first experience with mindfulness was attending the "Cultivating Reverence for Living: A

Stress Reduction Program". I was not sure what this was about and if this program was of any

value for our cancer patients or our care givers. Through the six week sessions we learned about

Mindful Living, Mental Noting, Emotions Regulation, Distress Tolerance, Interpersonal

Effectiveness Skills and Loving Kindness Meditation. Each session taught me how to intentionally

connect with my feelings and using relaxation, meditation and "being Present" how to reduce

stress and show calm and peace dealing with stressful situations. I started using some of the skills

we learned during our leadership team meetings and encouraged others to attend this program.

In addition to the emotional and physical stress our cancer care caregivers go through they are also

experiencing the immense changes in healthcare delivery with limited resources. Mindfulness has

been an amazing way for all of us to cope with all these challenges and keep our focus on caring

for our patients." Fuad Hammoudeh, FACHE, Executive Director, Cancer Care

Page 4: Cultivating reverence for living: Mindfulness practices ...Jack Kornfield, A Path with Heart After the Ecstasy, the Laundry Keating, Thomas Open Mind, Open Heart Smith, Jean, ed.,

5/7/2015

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“The Cultivating Reverence for Living experience has

assisted me both personally and professionally. I have a

greater awareness of self through the meditative practice

which has translated into increased empathy,

compassion, and more mindful intentional counseling

when assisting cancer patients. This experience is both

rewarding and fulfilling as a therapist which leads to a

clearer and non-judgmental counseling sessions.” –

Jennifer M. Smith, MSW, LCSW, OSW-C, Patient

Navigator

1. Self soothe

2. Self define

3. Transform

Bell is sounding

Half smiling

Movement

Body scan

Centering meditation

Page 5: Cultivating reverence for living: Mindfulness practices ...Jack Kornfield, A Path with Heart After the Ecstasy, the Laundry Keating, Thomas Open Mind, Open Heart Smith, Jean, ed.,

5/7/2015

5

Observing

Acceptance

Mental Noting

Appreciation

Is it helping?

Clarity unties the knots, even those that become very tight

"Childlikeness has to be restored with long years

of training in the art of

self-forgetfulness.“

D. T. Suzuki

"My nature is subdued by what it works in, like

the dyers hand."

William Shakespeare

Reduces vulnerability to emotions

Balance between expression and suppression

Breathe with worry, anger etc..

Practice mindfulness “Watch your temper”

Knowing, not showing anger

What do you have power over?

Not jumping over but engaging experience

Mindfulness: What and How skills

Distress tolerance Half smiling Awareness Exercises Radical acceptance

Emotional regulation Working with fear and anger

Interpersonal Effectiveness Effective anger communication

Dialectal Behavior Therapy ; Marsha Linehan

Page 6: Cultivating reverence for living: Mindfulness practices ...Jack Kornfield, A Path with Heart After the Ecstasy, the Laundry Keating, Thomas Open Mind, Open Heart Smith, Jean, ed.,

5/7/2015

6

Centering Meditation

Prayer

Body Scan

Yoga

Tai Chi

Qi Gong

Breathing Practices

Eating

Driving

Mindfulness

Half Smiling Practice

Exercise

They are good at getting our attention

They have thoughts and emotions attached

Some things can become habits like worry and anger

Put energy where there is power

House guest, be friendly but don’t let it have the run of the house.

More right with us than wrong

Be friendly to them

Creating space

Smile at your habit energy

Emotions are like weather

“Anger arises, naturally , to signal disturbing situations that might require action. But actions

initiated in anger perpetuate suffering”

Thich Nhat Hahn

Page 7: Cultivating reverence for living: Mindfulness practices ...Jack Kornfield, A Path with Heart After the Ecstasy, the Laundry Keating, Thomas Open Mind, Open Heart Smith, Jean, ed.,

5/7/2015

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Directing Awarness

Contrasting awareness

Meditation

attention

intention Meditation has two essential forms:

“familiarizing” or analytical

“settling” or focused

Calm Alertness

Word or Phrase

Gaze

Sound

Mindful words or phrases

Centering prayer

Practice 1st thing in the morning, doing routine tasks or when thinking of something (or someone) that distresses you

"Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy." Thich Nhat Hahn

Page 8: Cultivating reverence for living: Mindfulness practices ...Jack Kornfield, A Path with Heart After the Ecstasy, the Laundry Keating, Thomas Open Mind, Open Heart Smith, Jean, ed.,

5/7/2015

8

Breathing in, I know I’m breathing in; breathing out, I know I am breathing out

Breathing in, I calm my body; breathing out, I smile

Breathing in, my breath goes deep; breathing out, my breath goes slow.

Breathing in, I dwell in the present moment; breathing out, I know it is a wonderful moment.

From The Blooming of a Lotus by Thich Nhat Hanh

CBT, counseling

Resistance

Pain management

Emotions

Helps with Symptom management

Helps mediate perceptions taste, dyspnea

Meaning and purpose

Stress reduction

Tool for healthy lifestyle choices

Tool for habit change

Helps clarify and support healthy relationships

Teaches appreciation for life

Problem Solving Tool

Empowering Device

Page 9: Cultivating reverence for living: Mindfulness practices ...Jack Kornfield, A Path with Heart After the Ecstasy, the Laundry Keating, Thomas Open Mind, Open Heart Smith, Jean, ed.,

5/7/2015

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Reducing compassion fatigue, (beginners mind)

Work life engagement

Evidenced based practice

“Mindful practitioners attend in a nonjudgmental way to their own physical and mental processes during ordinary and everyday tasks. This critical self reflection enables physicians to listen attentively to patients, make evidence based decisions, clarify their values so they can act with compassion, technical competence, presence and insight” JAMA

Carlson, L. and Garland, S. 2005. Impact of mindfulness-based stress reduction on sleep, mood, stress and fatigue symptoms in cancer outpatients. International Journal of Behavioral Medicine, 12: 278–285. 11.

Carlson, L., Speca, M., Patel, K. and Goodey, E. 2003. Mindfulness based stress reduction in relation to quality of life, mood symptoms of stress and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine, 65: 571–581.

Epstein, R., 1999. Mindful Practice. JAMA,282:833-839.

Kabat-Zinn, J. 1990. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness, New York, NY: Dell.

http://www.fammed.wisc.edu/mindfulness http://www.urmc.rochester.edu/family-medicine/mindful-practice.aspxredir=www.mindfulpractice.urmc.eduhttp://www.mskcc.org/cancer-care/survivorship/videos-survivors

Austin, Miriam, Yoga for Wimps. (see also: www.yogaforwimps.com)

Boorstein Ven. Henepola Gunartana, Mindfulness In Plain English

Hanh, Thich Nhat The Miracle of Mindfulness

Peace is Every Step

Living Buddha, Living Christ

Touching Peace

Jon Kabat-Zinn, Full Catastrophe Living

Wherever You Go, There You Are

Jack Kornfield, A Path with Heart

After the Ecstasy, the Laundry

Keating, Thomas Open Mind, Open Heart

Smith, Jean, ed., Breath Sweeps Mind: A First Guide to Meditation Practice

Strand, Clark, The Wooden Bowl

Tolle, Eckhart, The Power of Now