Patricia L. Dobkin, PhD* King’s College London’s School of Medicine
September 17, 2014
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*With Nicolò Francesco Bernardi, PhD, statistical analyses
The awareness that emerges
from paying attention,
on purpose and non-judgmentally,
to what is occurring
as it unfolds from moment to moment.
pause…
breathe…
notice…
3
Mindfulness of the body ◦ breath, movements
◦ sensations as a cue to the mind-body state
Mindfulness of feelings and emotions ◦ unpleasant, pleasant and neutral
Mindfulness of thoughts, attitudes, beliefs ◦ state of alertness/attentiveness/distractedness
◦ cognitive processes (decision-making, reflection)
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What is Mindfulness Meditation?
MM is a refined, systematic attention-based practice that develops:
– stability of mind and body
– insight into mental and physical conditions that inhibit the capacity to respond effectively to life events.
Formal practice and informal practice
Living Fully with Chronic Illness
UMass Medical Center (1979- present)
8 week structured program teaches- ◦ Principles of mindfulness ◦ How to apply these principles to deal more
effectively with illness and stress Mindfulness practices include: ◦ Body awareness (body sensations) ◦ Meditation (breath) ◦ Yoga (body in movement) ◦ Cognitive awareness (mind)
N= 126
Mean age = 53
86% women from 2006-2012
47% with breast cancer
43% other chronic diseases
Attendance= 92.7%
0
5
10
15
20
25
CES-D*
(0.74)
PSS*
(0.83)
MAAS*
(0.71)
MSCL*
(0.63)
Pre-MBSR
Post-MBSR
* p<.0001
0
5
10
15
20
25
30
35
chip dc*
(0.34)
chip pc*
(0.1)
chip ic*
(0.22)
chip ec*
(0.68)
Pre-MBSR
Post-MBSR
* p<.0001
0
20
40
60
80
100
120
140
160
Compreh Manage Meaning TOTAL SOC
Pre-MBSR
post-MBSR
p <.0001
10 MBSR Components: 3 Factors
Factor 1 Group Interaction
reduction in symptoms
Factor 2 Moment-to-moment Awareness
reductions in symptoms
increases in mindfulness
Factor 3 Body Awareness
reductions in symptoms and stress
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With: Julie Irving, PhD and Dr. Tom Hutchinson, Director of McGill Programs in Whole Person Care &
Palliative Care physician
Garneau, K., Hutchinson, T., Zhao, Q., Dobkin, P. Cultivating person-centered medicine in future physicians. European Journal for Person Centered Healthcare 2013;1(2):468-477.
Enhancing intra-personal and inter-personal self-awareness can improve well-being and effectiveness in clinical practice
More attentive to the presence of stress
More able to attenuate stress reactivity
RESULTS: Increased mindfulness; Decreased burnout; Increased empathy; Increased conscientiousness; Increased emotional stability; Mindfulness was correlated with these outcomes.
43 in the program
25 in the control group
Those in the program improved on: ◦ Reduced mood disturbance
◦ Increased mindfulness
◦ Reduced burnout
◦ Increased empathy
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Cross-sectional study in 7 sites 47 clinicians (mostly MDs) with 417 HIV+ patients
Encounters were audiotaped - coded using the RIAS
More mindful clinicians:
1. More patient-centered communication
2. More positive emotional tone with patients
3. Patients reported better communication
4. Patients were more satisfied
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One day workshops for MDs & Clinicians
8 week courses for MDs & Clinicians (20 CME credits)
4 week elective for 4th year medical students
One day workshops for 2nd year medical students
8 week course for family medicine Residents
Weekend workshop-retreat for MDs & Clinicians
2015: All medical students prior to clerkship
MBSR format
Role plays, and other exercises focus on interpersonal mindfulness
Emphasis on communication
Self-care highlighted
Bilingual
Mindfulness-Based Medical Practice
Practice medicine with competence, compassion, and integrity
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Effectively work with
other health
professionals to
prevent, negotiate, and
resolve inter-professional conflict
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Develop rapport, trust and ethical therapeutic relationships with patients and families;
Accurately convey relevant
information and explanations to patients and families, colleagues and other professionals
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Quality of caring (empathy - detachment)
Physician well-being
(resilience – burnout)
Quality of care (safety – errors)
Mindful practice
S: Slow down/Stop
T: Take a breath
O: Observe
P: Proceed
N = 126
Mean age = 47
79 % women from 2008-2012
54 % MDs
46 % other (PhDs, nurses, etc.)
10 % screened as depressed before MBMP
90 % attendance
37
* p<.001
** p<.002
*** p<.006
****p<.005
1. Reduction in professional isolation
2. Mindfulness skills improved physicians’ ability to be attentive and listen deeply to patients more effectively
3. Developing greater self-awareness was positive and transformative; yet, physicians struggled to give themselves permission to attend to their own personal growth
1. Formal meditation practice led to informal applications of mindfulness in clinical settings
2. Group support lessened feelings of isolation
3. Awareness of breath led to emotional regulation
4. Attitudes towards self-care improved
* p<.026
** p<.003
*** p<.0001
Dobkin, P.L., Hutchinson, T.A. Teaching mindfulness in medical school: Where are we now and where are we going? Medical Education 2013:47:768–779.
Dobkin, P., Balass, S. Multiple influences contribute to medical students' well-being and identity formation. Medical Education, 2014;48:340–342.
Medical System
Social System
A
B
Health Care
Professional
Patient/Person
Disease
C D
A: Where healing may occur B: Where curing may occur
C: HCP ‘s “Tool box”
D: Patient’s illness experiences; hopes, fears, behaviours
Please turn to the person next to you and relate an experience when you were mindful in a clinical encounter.
What was occurring in you, in the other, and what was the context?
Sabbatical Leave in Paris
Corinne Bagnis, MD PhD
Hôpital Pitié-Salpêtrière
Université Pierre et Marie Curie
Enhancing the Therapeutic Alliance and Well-Being of Clinicians and Their Patients Through MBSR
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Patricia Lynn Dobkin (Ed.)
2015 Springer Press
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47
Thank you for your invitation!
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