Archive for January, 2013

Preventing Burnout: An Interview with Dr. Mick Krasner

Thursday, January 31st, 2013

As someone in the helping profession, I can attest to the weight at times of care giving and without mindfulness or a space to process this, I would be a high candidate for burnout. This is what many people in our helping professions face today. That is why I am pleased to bring to you a dialogue Mick Krasner, MD, Associate Professor of Clinical Medicine at the University of Rochester School of Medicine and Dentistry and has been teaching mindfulness to over 1400 physicians over 12 years.  He was the project director of a study published in the Journal of the American Medical Association on the efficacy of “Mindful Communication” with physician burnout. He speaks nationally and internationally on this topic. You can find Dr. Krasner live on May 11th for a daylong of Mindfulness in Clinical Practice: Our Patients, Ourselves.

Today Dr. Mick Krasner talks to us about the state of affairs of physician burnout, how the approach of “Mindful Communication” is effective in healing, and thoughts he might lend to us some of our wounded healers.

Elisha: Can you share with us the current state of affairs with physicians in regards to burnout, emotional stability, and stress?

Mick: The current state of affairs regarding physician stress, burnout and emotional stability is not good.  A recent study reported in the Archives of Internal Medicine of over 7000 physicians report that nearly 1/2 had symptoms consistent with burnout.  Job stress leading to burnout may account for the excess suicide rate for physicians compared with the general population.  As disturbing as that is, burnout also seems to be associated with medical errors.  Burnout is not isolated to practicing physicians, but has been measured in trainees in residency and in medical students.  It is my opinion that burnout, in a lot of ways, is culturally determined- North American culture which places high value on achievement, material success, competition, and personal independence may be among the determining factors.  So, if we were to look at primary and secondary school children, and had instruments designed specifically for that population, I would predict that we would discover burnout, stress, and emotional instability there as well.

Elisha: What role do you see mindfulness playing in this and what is “Mindful Communication?”

Mick: Mindfulness in my opinion is a core competency for medical professionals, and in particular physicians.  The entire diagnostic process rests upon the ability to bring clear communication and observation skills into the patient encounter.  The potential for cognitive errors is larger when attention and awareness are smaller.  Not only is attention to detail important, but so is the larger picture.  My pathology professor in the first year of my medical education use to say “low powered microscope, high-powered brain.”

Recognizing the role that mindfulness plays as a core competency for medical professionals, and knowing that physicians are especially at risk for burnout, my colleagues and I developed a mindfulness-based intervention we call “Mindful Communication.”  In this approach, one could consider the container of the intervention or the field in which the intervention occurs as mindfulness, cultivated by training in mindfulness meditation.  Within this container, we focused on narratives from clinicians’ own practice experiences, centered on challenging themes such as conflict management, self-care, being with suffering, and meaning in medicine.  These narratives, reflected upon by individual practitioners, and held in awareness with the qualities of mindfulness, were then shared in dialogues with colleagues.  This sharing took on a particularly nuanced form, one that is influenced by Appreciative Inquiry, in which challenges, successes and capacities are focused on, even when considering difficult challenges.

The response to these appreciative dialogues, reflections on clinical experiences, and mindfulness training, has been remarkable, with improvements demonstrated in burnout, empathy, well-being measures, and patient centered qualities.  Not only that, practitioners have found the approach highlights the importance of a collegial community, of the contemplative reflections in medical practice, and of self-care as a way of building professional and personal resilience in combating burnout.

Elisha: What role does it play in the medical profession?

Mick: Mindful communication is just one of what I hope will be many options for practicing physicians to turn to for assistance in building adaptive reserve for the challenges placed now and in the future.

Elisha: If you were sitting across the table from of a physician on the brink of burnout, what approach would you take and what would be your parting words?

Mick: The first thing I would do would be to listen deeply to the concerns of this physician, and hear about the felt experience that he or she is currently struggling with.  I would then asked her or him to reflect for a moment on a challenging clinical experience that in some ways epitomizes their difficulty, and speak with me about what qualities they notice about themselves that have helped her or him to get as far through this challenge as they have.  At this point, I do not think I would have so-called parting words, but rather I would rely on my faith in their own potential for discovering themselves their own skill, their own genius, and there own capacity, already present, for meeting this and future challenges.  

Elisha: Thank you so much Mick for your incredible work in this field that has ripple effects on us all.

As always, please share your thoughts, stories and questions below. Your interaction creates a living wisdom for us all to benefit from.

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com

Stress Less and Optimize Your Relationship with Technology

Tuesday, January 29th, 2013

One thing we’ve learned about the brain over the last 15 years is that it can form new neural connections throughout the lifespan. This is called neuroplasticity, you may have heard of it. Neuroplasticity occurs when we practice and repeat doing things and eventually it just become automatic, like a habit. We see this in walking, talking, learning new car routes, playing an instrument or even meditation. When it comes to the enormous repetition of a constant connection to our technology, you have to assume, or likely you’ve experienced that the brain is strengthening that habit often times with a stressful cost.

Technology is great, but we’re just infants with it and we have to begin evolving with a wiser relationship.

Not too long ago humans had many uninterrupted spaces in their lives. If you were sitting at lunch with a friend the focus was on the conversation and there weren’t many things that would intrude. Now the brain has rewired to constantly monitor beneath your awareness any incoming messages and if there is a sign of one, a knee-jerk reaction occurs to check it.

Sherry Turkle from MIT and author of Alone Together: Why We Expect More from Technology and Less from Each Other, has been studying this for decades. She talks about the need to create sacred spaces that are technology-free zones, especially at the dinner table. This reminds me of a past research study I did on cultivating sacred moments and how that was found to be directly correlated to stress reduction and happiness.

Where are your sacred spaces? Do you have any? When do you get a chance to disconnect and “be with” yourself or whoever is with you?

What would be different if you had more sacred space in your life? Would you have more time to attune and be intimate with yourself or with your friends, family or colleagues?

You might argue that you are connected to more people because of technology, but we have to look at the qualitative difference between connection and intimacy. We can all be incredibly connected, but sometimes shallow waters are noisy and lack depth. Intimacy on the other hand is deep and it’s important to continue intentionally bringing this into our lives.

Technology is wonderful, I’m a big advocate of it strengths. At the same time, we’re just in the courting stages with it, feeling it out and learning what the best way to relate to it is.

Let yourself experiment with having sacred spaces with yourself and in relationships.

See what you notice.

As always, please share your thoughts, stories and questions below. Your interaction creates a living wisdom for us all to benefit from.

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com

Practice Savoring

Friday, January 25th, 2013

Life goes by quickly and it’s only later that we look back with nostalgia. In The Now Effect I write about the ability to create “Present Nostalgia” as a means to savor the moment. This is the practice of imaging yourself in the future in a time when things have changed and looking back to see what is precious about this moment. Then, in the present moment you can savor what you’ve been missing. However, in his recent inauguration, President Obama also shows us how savoring is done.

Here’s the clip to watch: 

We often take things for granted in life because the brain is wired for routine.

The reality is, everything changes in life. This law of impermanence has yet to be proven wrong. The seasons come and go, children eventually get older, the happy and sad moments never stick around and even this blog post, someday will be gone.

What is happening in your life right now that is precious that is worth savoring?

Is it the next bite of food that you take, the smile of a child, a kiss or hug from a loved one or maybe even the final glimpse of a falling sunset.

What can you savor today?

What would the days, weeks and months ahead be like if there were more moments of savoring?

Let this answer be your source of motivation.

As always, please share your thoughts, stories and questions below. Your interactions provide a living wisdom for us all to benefit from.

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com

Relax, You’re Already Home

Tuesday, January 22nd, 2013

Our brains are amazing, so amazing that even with all the wonderful advances in technology, neuroscientists are only still scratching the surface as to the way they work. But this fabulous brain can work for us and it can work against us stressing us out, sleepwalking into addictive behaviors or just leaving us feeling far away from any semblance of balance. But the moment we realize we’re out of balance is a moment where we have touched a glimpse of balance.

This space of awareness is a “choice point” to understand this nugget of wisdom and practice:

“When we are able to settle into truly being present to ourselves, we begin to get the sense that home lies within us. There’s nothing to get, we already have it, it’s all right here. The Vietnamese Buddhist monk Thich Nhat Hanh has a wonderful phrase that helps us realize this:

‘Breathing in, I have arrived. Breathing out, I am home.’

You can shorten it to ‘arrived’ on the in-breath and ‘home’ on the out-breath.

Take a minute to practice this and notice what arises.”

~ Mindfulness Meditations for the Anxious Traveler

Saying these phrases along with the breath is grounding. Focusing on the breath brings awareness to the body which has been shown to be inversely correlated with our mental ruminations about the future and the past. At the same time you’re reminding yourself of this ancient wisdom that you have already arrived to the only point there is to arrive to, “here.” In this place called “here” you are home, have everything you need and it’s going to be okay.

Practice this for yourself a few times throughout the day and definitely when you’re traveling. Allow your experience to be your teacher.

As always, please share your thoughts, stories and questions below. Your interaction creates a living wisdom for us all to benefit from.

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com

3 Ways for Adults and Teens to Use Mindfulness in the Tech Age

Thursday, January 17th, 2013

Rainn Wilson is the goofy guy that you may or may not know in the hit series The Office. In a recent interview with him he said something enlightening, “We’re so focused on the externals, looking outwards all the time and this is the trap of technology.” This is without a doubt true and for our developing kids and teens there is less and less time spent in self-reflection. We’re still infants in this technology age and if we’re aware enough, we can learn how to have the best relationship with it. One article recently came out with some suggestions and here are a few more key ones. 

Here are a 3 mindful ways for Adults and Teens to get started.

  1. With so much stimuli demanding our attention, formal Apple and Microsoft Executive Linda Stone calls “continuous partial attention” the main state of our brains nowadays. That’s why the first thing we want to do is cultivate ways for “continuous anchoring attention” to bring us back to the present moment, to this life. This is important for adults and teens. This is one of the reasons Stefanie Goldstein, PhD and I created Mindfulness for Teens – CALM (Connecting Adolescents to Learning Mindfulness) that is starting in LA on Thursday, November 24th from 4-5:30pm.One way of doing that is just taking some time during the day to take a few deep breaths. You can even breathe counting up to 10 and back down to 1.

    You might even consider just using this 3-minute guided video from The Now Effect to train this grounded attention.

  2. Experiment with Your Phone – Another very interesting and worthwhile experiment is to get curious about your relationship to your phone. What’s it like to leave it at times? What happens in your body when a message comes in? What’s it like to set a 10 second rule before you check a message when it comes in just to be aware of the potential pull that’s been developed and break your enslavement? I like the rule that when you’re with a group of friends at lunch everyone stacks their phone on each other and the first one to grab their phone pays for the bill :) .
  3. Experiment with “No Texting” While Driving (at all) – Can you make a no texting or checking your phone while driving rule for a day and see what happens? Can you do it? If not, is it worth seeing why that’s outside of your control? Does your mind come up with reasons not to do that? “I can manage it; I only check it at lights.” This may be true, but is also often a slippery slope as it gets pulled out as you’re slowing down, or there’s last minute checking as after the light turns green. This is a particularly important experiment when teens are just learning to drive. 

These are all experiments that you can engage with an eye of curiosity and learning. You don’t have to commit for long periods to any of them (although the driving one is a good one to commit to for everyone’s sake). Do it more just to see what you notice, to be aware what it’s like to be human in this technology age.

Share these ideas with your friends and colleagues, do them together and check-in with what you noticed.

As always, please share your thoughts, stories and questions below. Your interaction creates a living wisdom for us all to benefit from.

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com

Bringing Mindfulness to Children and Schools: An Interview with Holistic Life Foundation

Tuesday, January 15th, 2013

mindful schoolsOur kids are our future and nowadays we are seeing them in them higher states of anxiety, impulsivity and other behavioral problems. In recent years mindfulness has been shown as an effective approach for children in lower stress and anxiety and even increasing states of feeling well. Susan Kaiser Greenland wrote The Mindful Child, I did an interview with Meg Cowan on her work with Mindful Schools, and Goldie Hawn has successfully started and organization called Mind Up. There is another very special organization started by two brothers Ali and Atman Smith and their friend Andres Gonzalez called Holistic Life Foundation. The three men made a choice to move back to their hometown and make a difference helping the kids transform their lives.

Today Ali, Atman and Andres talk to us about how mindfulness is helpful for behavioral problems, some key practices they have found to make a difference, why it’s important to help kids lead, and some advice for parents and teachers. Ali, Atman and Andres will be speaking at the Bridging the Hearts and Minds of Youth Conference in San Diego, Ca Feb 1-3, 2013.

Elisha: How is mindfulness helpful with kids who are impulsive, prone to behavioral problems and anger issues?

Ali, Atman and Andres: The first thing that mindfulness gives these kids is awareness. Most of the kids we work with who act impulsively, have behavior issues, and anger issues aren’t even aware of what’s going on, they are just instantly reacting to the things that go on around them and inside of them. Mindfulness helps them get in touch with their thoughts, emotions, and energy. Once the kids are aware of these things then they can learn to deal with impulsivity, behavior issues, and anger issues. One of the greatest things that mindfulness gives them is the ability to have that split second of reflection before they act.

Elisha: What are some key practices that are helpful to kids, what differences are you seeing?

Ali, Atman and Andres: Meditation and breathing are two of the practices that have the greatest impact on the kids. The breath work gives them a base and a center that they can always go back to. It helps regulate their thoughts, emotions, and behavior. It also gives them a tool they can use in any situation and in any environment. The meditation gives the kids a sense of inner peace. Many of them live in environments where finding peace outside of them (in their homes and communities) may not be possible, so having a place inside of them that they now they can always go to for peace and serenity is very liberating and empowering. Meditation and breathing are two invaluable tools to be able to give kids so that they have the ability to be present.

Elisha: I hear you actually get kids to eventually lead these practices themselves. What effect does this have for them?

Ali, Atman and Andres: The kids take more ownership of the practices and are a lot more engaged. They know they have to be able to demonstrate, teach, and explain the benefits of whatever it is they are interested in teaching to their peers before they are allowed to. They pay closer attention to what is being said when we are teaching them and soak up everything. With this knowledge the kids are more likely to take these practices home with them, incorporate them into their lives, and teach people in their families, because they have a thorough understanding of the practices we are showing them. This helps to manage behavior as well, because kids know that if they do not model good behavior they will not get a chance to lead the practices. It also builds self-esteem, confidence, and leadership in the kids. The other thing it really helps develop in the students is compassion. Some kids when teaching, may yell at one of their peers for not doing something correctly their first time teaching, but we always ask them is that how we talk to them when teaching and is that what a good teacher does. We remind them that a good teacher is nurturing and supportive, and builds up their students. They begin to understand and practice compassion with their peers when teaching and it spills over into all of their interactions with others.

Elisha: If you were sitting across the table from a parent or teacher right now, what advice would you give them for working with kids?

Ali, Atman and Andres: Have your own practice and meet the kids where they are. You have to have your own mindfulness practice to teach mindfulness to kids. Kids are very honest and observant if you are trying to teach them things that you are not modeling in your own life, they will pick up on it and you will definitely get called on it. So take the time to develop your won mindfulness practice it will not only help you model it for the kids, but will also make you more compassionate and effective when teaching them. Always meet your students where they are and listen to them. You may have a great idea for what they need and how to teach it to them, but that might not be where they are at that time. Have the flexibility to throw things out the window at the drop of a dime and work from where your students are.

Elisha: Thank you Ali, Atman and Andres for your incredible work and inspiration. You’re making the future a brighter place.

As always, please share your thoughts, stories and questions below. Your interaction creates a living wisdom for us all to benefit from.

Teacher and student photo available from Shutterstock

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com

Where is the Happiest Kingdom on Earth? An Interview with Lisa Napoli

Wednesday, January 9th, 2013

There’s no getting around it, life is finite. Some people realize that earlier on and for others it doesn’t come until later. But for Lisa Napoli, author of Radio Shangri-La, that day came at the age of 43 when her mid-life crisis hit and she was confronted to come to terms with who she was. By chance she was invited to the landlocked state in Southeast Asia, Bhutan and what she found there are some nuggets of wisdom that can help the rest of us through our own moments of crisis and even be a path to happiness.

Today, I’m happy to bring Lisa to you answering what she learned about happiness, how it changed her life and some advice about how to deal with the inevitable challenges of suffering. If you’re lucky enough to be in the area, this weekend Lisa will be speaking on her transformational journey through Bhutan at InsightLA in Santa Monica, Ca on January 12th from 7-9pm.

Elisha: What does Bhutan have to teach us about how to be happy?

Lisa: I think changing your location always changes your perspective on where you live, who you are, how you conduct your daily life.  For me, because Bhutan was so vastly different than Los Angeles or New York, the two places I’ve lived over the last 20 years; it reframed how I looked at the busyness of my surroundings.  Life was slower paced, people walked more, they dropped in on one another unannounced (and lived more communally in the first place) and were unafraid to express their spirituality.  On my first stint in Bhutan, it was almost unheard of to eat out at a restaurant—there just weren’t many.  So cooking and eating together was a big part of the day.

I loved the casual spirit of the day to day life there.  It’s what I’ve always aimed to mirror in my life here, although circumstances conspire to make that a challenge, especially in LA.

And yet: Bhutan is changing, fast, as modernization creeps in.  I have mostly spent time with people in their twenties, since I went to volunteer at a radio station (with no small amount of guilt for being ‘part of the problem.”  Since media are changing how Bhutanese perceive themselves, giving them a window to consumerism and desire that they didn’t have before…)

In the end, people are people and want the same things, and that message was important for me to learn.  We are all struggling with the same issues; it’s the particulars that change.

So it wasn’t as much Bhutan that taught me to be happy—as it was my openness to rethinking how I was living my life.  I could bring some of the slower pace of a less developed and deeply religious country into my more modern world—by giving up habits and work that was not making me happy.

That said, the natural beauty in Bhutan is extraordinary.  And so is the culture.  And both those of things greatly enrich our lives, my life.

Elisha: How has Bhutan changed you as a person?

Lisa: I wrote an entire book about that!  It’s hard to distill.  But basically, for me, going to Bhutan to volunteer unlocked a deeply hidden spirituality that I now feel comfortable exploring and expressing.  It also showed me I could not go back to the old way of living (for me that meant leaving the daily news business.)  It made me understand certain deeply personal life choices I’ve made.  It made me come home and commit to volunteering here, immersing myself in my community more than I had allowed myself before.  (Work was always an excuse, but dialing down the work made it possible.)

And it made me less afraid to proclaim that my priorities were people, time, silence, worship, healthy food and living.  Those were my priorities—not wedging those things around an insane work schedule and making tons of money.  (Not that I ever made tons of money.)   Of course this meant dissonance with some people in my life, because not everyone understands.  But it also meant welcoming in new people with similar values.

Elisha: If you were sitting across the table from someone experiencing the inevitable sufferings that life sends our way, what can you share about what you learned that may be helpful?

Lisa: Take a deep breath.  Slow down.  Listen.  Walk.  Change your scenery.  Be in nature.  Turn off your cell phone, instead of clutching and being afraid that you are going to ‘miss’ something.  Be kind to yourself.

After a personal loss 13 years ago, I found myself being drawn to swimming.  At age 37, I did not know how to swim, but I learned.  I immersed myself in the experience, and swimming became an integral part of my life.  Breathing, I realized, is the essential ingredient—I learned to meditate in the water!

I also love the Three Good Things exercise.  It’s simplistic to some, but it works.  You make a list of the three things that happened that day that were the best.  They are usually small things, like something you ate.  My swim and the view out my window are routinely on my list.  But doing this makes you focus on the small beautiful things that make up a life—rather than focusing on what you perceive as missing.  (i.e. relationship, house, baby, lucrative job, fame.)

Elisha: Thank you so much Lisa!

As always, please share your thoughts, stories and questions below. Your interaction creates a living wisdom for us all to benefit from.

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com

3 Steps to Making Intentions Stick in the New Year

Tuesday, January 8th, 2013

It’s been a week out since The New Year has set upon us. Whether you’re a resolution person or not, odds are there are some thoughts that you have about what you’d like to see unfold over this next year. In The Now Effect I call this “Paying Attention to Your Intention” and one of the best ways to do that is to intentionally carve some time out of your busy life and take a mindful look at how you’d like to be in this next year. Taking a retreat is a great way to create the space to do this. You can do a mini-retreat of blocking out an hour or more or go to an organized retreat for deeper connection.  This weekend, I’ll be at Kripalu in the Berkshires this weekend teaching The Now Effect Retreat to get the year started right. I’d love to see you there.

Whether your intentions for the year have to do with work, parenting, stress, relationships, procrastination, compassion or any other areas of your life, setting goals is an integral piece to making change. But often times when we do this we are rigid, it has to be a certain way or else we haven’t achieved success. But this rigidity only backfires on us.

The thought arises, “I’ve failed once again,” arises, leading to a sense of sluggishness and the next thought, “What’s the point?”

There’s another way.

There three mindful steps we can take for make our intentions come alive in this New Year:

  1. Expect to stray – This is just a fact of life that sometimes we refuse to own up to. We’ll almost always wander with the goals we make. Maybe we commit to exercise and then we get sick or we set a path for meditation and our minds get caught up in daily busy-ness while days go by without practice. One scenario or another of your behavior wandering is going to happen, so now step #2.
  2. Don’t Judge – Your behavior wandering is not a good or bad thing, it’s just the natural course of someone trying to make a change. Simply notice that you’ve wandered and where you wandered to so you can burn it into your memory and notice it sooner the next time. If judgments do arise, “I can never do this or what was I thinking,” simply note them just like you noted your wandering behavior and move to step #3.
  3. Refocus – Gently bring yourself back to the plan you had created or see if it needs revisions.

It’s important to keep an open heart toward yourself as you practice; it’s not going to be perfect, so the question is can we accept the reality of our imperfections? If you’re perfect, you’re not human; unless we reframe it by saying we’re perfect with our imperfections.

There’s no need to wish you good luck, because making change is not about luck, it’s about having a good strategy of being kind and compassionate with yourself as you continue to wander off and gently guide yourself back to the object of focus.

So I’ll wish you a good heart during this year! Hope to see you at Kripalu this weekend, if not, stay connected here.

As always, please share your thoughts, stories and questions below. Your interaction creates a living wisdom for us all to benefit from.

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com

Know That You Matter and Imagine the Ripple Effects

Friday, January 4th, 2013

Is it possible that everything you do matters? A  number of years ago social scientists Nicholas Christakis, M.D., Ph.D., and James Fowler, Ph.D., conducted a study that found obesity is contagious by up to three degrees of separation. Then later found that loneliness is also contagious by three degrees of separation and it matters if you have people in your life who feel happy. In 1951 David Bohm wrote a book with a theory that if you split an atomic particle into two sub-units and sent them to opposite ends of the universe, if you gave one a spin, the other would spin too. Neuroscience shows us that how we pay attention and what we pay attention to effects neural growth in our brains. What would be different if we understood that our actions matter?

Here’s a picture that says it well:

 

Life is a paradox. On the one hand we are these infinitely small beings walking around on this tiny spinning rock in a vast universe that spreads out farther than our brains can even imagine. On the other hand, we are all connected in a way where are very actions create reactions that affect other people and the way life unfolds in the following moments.

Consider for a moment that you actually matter. If that is true and you had the power to influence this world, what might you be doing differently on a daily basis? If you spin one particle at one end of the universe and it spins another, imagine the ripple effects of your meaningful actions.

How can you make that happen?

As always, please share your thoughts, stories and questions below. Your interaction creates a living wisdom for us all to benefit from.

Source: The Now Effect: How a Mindful Moment Can Change the Rest of Your Life

Reposted from Elisha Goldstein’s Mindfulness Blog on Psychcentral.com