Mindfulness for Medics Amanda Mc Gough Nurse Consultant

Mindfulness for Medics Amanda Mc. Gough Nurse Consultant and Mindfulness Teacher

Welcome • NHS Mindfulness and Wellbeing Service • The Garth Surgery, Guisborough • Mindfulness Teacher • Tees, Esk and Wear Valleys NHS Mental Health Trust • Seven Wellbeing Centre, Butterwick Hospice • Mindfulness and Wellbeing training • Schools & Colleges • NHS & Local Authorities • Local businesses

Outline • What is Mindfulness? • History and development • Evidence and emerging research • Mindfulness for staff

What are your thoughts? • Your personal • • Awareness Knowledge Understanding Experience of Mindfulness?

Take a breath…

Definition of Mindfulness • Mindfulness is bringing awareness to the present moment “Paying attention in a particular way: on purpose, in the present moment and nonjudgmentally” Jon Kabat Zinn • Key principles • • • Bringing awareness to the present moment Developing the ‘attention’ muscle Recognising thoughts, emotions and body sensations Self compassion and kindness Non judgemental

Where did Mindfulness come from? • Evolved from Buddhist tradition of meditation • Jon Kabat Zinn and the development of MBSR • Mindfulness Based Stress Reduction • Breathworks • Oxford University developed MBCT • Mindfulness Based Cognitive Therapy • For people suffering chronic depression and anxiety • The Mindful Nation (2015)

Jon Kabat Zinn’s research • 8 week Mindfulness Based Stress Reduction course • People scored themselves higher on resilient traits üHappier üMore energised üLess stressed üFelt their lives were more meaningful üMore control over their lives üMore likely to see challenges as opportunities rather than as threats • Encourages ‘approach’ mode rather than ‘avoidance’

Mindfulness benefits • Cognitive • Psychological Attention span Depression and anxiety Clarity of thought Emotional reactivity Creativity Behavioural regulation Decision making Compassion and altruistic behaviour

Mindfulness is big business • Many companies now offer Mindfulness courses for staff wellbeing • MBSR – Mindfulness Based Stress Reduction • 8 week programme • Research* shows programmes can improve • Psychological health • Reduction in stress reactivity Fjorback 2011, Grossman 2094 & Bohlmeijer 2010 • Improvements in productivity and individual performance • Reduction in sickness absence, turnover and errors

Staff Health and Wellbeing • Transport for London Reduction in days off sick due to stress, anxiety and depression • Introduced MBSR for staff • Benefits • Reduced sickness absence • Improvements in: Decision making Strategic thinking Ability to focus Enhanced creativity 90% 80% 70% Percent • • 100% 60% 50% 40% 30% 20% 10% 0% 71

Institute of Mindful Leadership Survey of organisational leaders 100 90 80 Percent 70 60 50 40 [VALUE]% 30 20 10 0 More innovative Ability to listen to self and others Strategic thinking

Mindfulness in the NHS

Mindfulness Based Cognitive Therapy • Do. H asked Oxford University to develop a maintenance programme, (non drug-based) • For people suffering recurrent depression and anxiety • Developed from JKZ’s MBSR 8 week programme • MBCT 8 week programme • • • Weekly sessions 2¼ hours Small group (8 -12 people) Taught curriculum Weekly home practice Meditations plus CBT teaching & exercises

‘Thinking’ • When ‘thinking’ goes wrong • Aversion and reactivity • Stress & habitual coping strategies

When ‘thinking’ goes wrong • Unhelpful thinking patterns • Rumination • Over analyse • Catastrophic thinking • Negative bias • Discrepancy processing

Reactivity Ø Thoughts Ø Feelings Ø Sensations Ø Behaviour ØAvoidance ØAversion

Making stress worse. . Substances Blame others Worry Blame yourself STRESS Bury head in the sand Keep busy Fight it Sharing it around

Teasdale, J. D. , Segal, Z. V. , Williams, J. M. G, et al (2000). Reducing risk of recurrence of major depression using Mindfulness-Based Cognitive Therapy. Journal of Consulting & Clinical Psychology, 68, 615 -23. • 60 wk relapse rate (pts with 3 or more episodes): • MBCT - 37% • Treatment as Usual - 66%

Clinical groups • • Recurrent depression Anxiety Health anxiety Other long term conditions • Chronic Fatigue Syndrome/ME

‘Other’ benefits of mindfulness • • • Living with chronic pain Reduces stress Psychological wellbeing Emotional intelligence Resilience

Onset of mental health problems 75% of adult mental disorder has its onset before 24 years Data from Kessler et al. (2005)

Mindfulness in Schools Project • . b for Secondary Schools • 9 lessons in the curriculum • 11 -18 years • Paws b for Primary Schools • 6 themes in the curriculum • 7 – 11 years • Train to teach with Mi. SP • Personal practice and completion of 8 week Mindfulness course

© Mindfulness in Schools Project

• . b is the UK’s leading mindfulness curriculum for 11 -18 year olds in schools • . b stands for ‘stop and be’, a simple practice at the heart of this course • Each. b lesson (between 40 minutes and 1 hour) is expertly crafted for use in the classroom to teach a distinct mindfulness skill • National research trial (MYRIAD) • Investigating how schools prepare young people to improve resilience and manage their emotional health www. mindfulnessinschools. org

The MYRIAD collaboration

Mindfulness in Schools https: //mindfulnessinschools. org

Meditation

Neuroscience and Mindfulness

Neuroplasticity • The brain has an amazing ability to rewire itself • This is called neuroplasticity • We are able to change our • Habits • Behaviours • Automatic reactions • A daily Mindfulness practice can help to achieve this

Mathieu Ricard • Mathieu is a Buddhist monk • He works with neuroscientists • to research the impact of Mindfulness on the brain • Mindfulness increases • Attention span • Concentration • Focus • Watch Change your mind, change your brain (1 hr)

Neuroscience research • Anti-anxiety effect of mindfulness meditation is visible on MRI brain scan • Individuals with no past experience in meditation • Who participated in 4 x 20 -mins daily training sessions • Technique: • Focus on breathing • Conscious acknowledging of distracting thoughts and feelings • Simultaneously, a decision not to react to them • Fadel Z et al (2013) Neural correlates of mindfulness meditation-related anxiety relief. Social Cognitive and Affective Neuroscience journal

Mindfulness for staff

Stress & the NHS staff have higher rates of sickness absence than those in other public sectors. Almost 40% of NHS staff absences in England were attributed to stress, depression and anxiety. NHS Workforce Health and Wellbeing Review: staff perception research. RAND Europe and Aston Business school. 2009

Organisations that prioritised staff health and wellbeing performed better, with improved satisfaction, stronger quality scores, better outcomes, higher levels of staff retention and lower rates of sickness absence. Health and wellbeing of NHS staff should be a central consideration and acknowledged at all levels of NHS operation The Boorman review of NHS Health and Wellbeing. DOH 2009

Tees, Esk and Wear Valleys NHS Trust • Trust Mindfulness team • Delivers MBCT courses for • • Service users Carers Parents of children in CAMHS Staff • Trust-wide courses and Days of Mindfulness • MBCT Teacher training

Primary Care • NHS Mindfulness and Wellbeing Service at The Garth Surgery • GPs refer patients • Depression and anxiety • Fatigue • Long term conditions (including pain management) • Wellbeing assessment • 8 week Mindfulness programme • Wellbeing review

Depressive symptoms (PHQ 9) Pre and post MBCT Depression scores (PHQ 9) 25 20 15 Change in score 10 5 PHQ 9 pre 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 -5 -10 -15 -20 -25 PHQ 9 post Change

Anxiety and worry (GAD 7) Pre and post MBCT Anxiety scores (GAD 7) 25 20 15 Change in score 10 Pre GAD 7 5 Post GAD 7 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 -5 -10 -15 -20 Change

Patient Wellbeing (EQ-5 D) Pre and post MBCT Wellbeing scores (EQ-5 D) 12 10 Change in score 8 6 Pre Post 4 Change 2 0 1 -2 -4 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Lifestyle and behaviour change • Patients often volunteered other changes • • Increasing their activity levels Improved sleep and energy levels A reduction in fatigue Healthier eating Improved hydration and reducing caffeine A reduction in alcoholic drinking Improved wellbeing at work

GP feedback • Patients seeing GP less often • Improvements in • • Pain management Sleep Fatigue Activity • Verbal feedback from patients is positive

A word from the wise… Still doing a 20 minute meditation session each morning, currently using the Headspace app. I know I still have a lot to learn but have felt much more myself over the last 6 months. The mindfulness reminds me to slow down and to remain present. If I'm busy at work I often return to the breath and consciously slow myself down which at the same time clears my mind and helps me to work more constructively. Of all the techniques we learnt on the course I have found "noting" to be the most useful. To be aware of thoughts but not to get caught up in them and then to refocus either on the breath or whatever I'm doing at the time. I share this technique regularly with my patients as well. If you want to share this with the GP Registrars then do. It sounds almost too simple and yet, as you know, can be really transforming. GP, South Tees CCG

Case studies • Teacher • I have enjoyed all the different styles of meditations we have done. The classes have definitely made me ‘slower’ in a good way. I am also finding it easier to be more detached in situations that would normally ‘stress’ me but in reality, ones where I have no control. Thank you for this! It sounds small but isn’t for me! I am also getting better at tuning into my thoughts and body. • Health professional • Since beginning the course, I have recognised how my responses to situations affect my mental and physical health. I have recognised that tension in my body has reduced, stress headaches have reduced and sleep has improved since beginning practice. I feel equipped to deal with daily situations in a calmer manner, with a positive effect on home and professional life.

Mindfulness at work • Easy to build simple practices into daily routine • 3 minute breathing space • Create a quiet area for staff • Allow protected time for • Attention and focus • Strategic thinking • Creativity • Mindfulness at home • Regular daily practice • Commitment to daily meditation • Try it for 4 weeks…. and see what happens….

Pebble meditation…

Sources of support • Professional body and employer • Mindfulness courses and classes • Seven Wellbeing Centre, Stockton • Tees Esk & Wear Valleys NHS Trust www. tewv. nhs. uk • The Garth Surgery, Guisborough www. thegarthsurgery. nhs. uk • Online support • Oxford Mindfulness Centre www. oxfordmindfulness. org • Be Mindful http: //bemindful. co. uk/ • Your local library • Mindfulness and Wellbeing reading • (Free) apps • Calm and Headspace

Thank you for listening • And paying attention….