Gary attended a Seminar in Madison which provided a lot of gist for this discussion.
Below are Gary's actual notes provided to us to remind us of the great discussion.
Some Notes on the Mindfulness in Health Care Seminar (Notes written by Gary.)
Philip Chard was the 1st presenter. Some points of interest
that he raised involved a change in the medical model from one dominated by a
biological focus to one that includes a focus on spirituality. A mindful
physician would have a greater sense of purpose, presence and empathy.
Mindfulness includes the self-regulation of attention, conscious awareness of
one's thoughts, feelings and experiences as they unfold in the present and
curiosity, openness and acceptance of thoughts, feelings and experiences. The
result is a beginner's mind, meaning that experiences are new.
Things that get in the way of mindfulness include ADHD,
hurry sickness (this involves time being measured by the brain, it is a primary
cause of anger), emotional hijacking (the amygdala rules and the prefrontal
cortex is overloaded), burnout and the pursuit of “happiness,” as defined by
our culture with a focus on there and then.
Mindfulness melds the existential states of doing and being.
It allows us to do with an awareness of being fully aware. As you pay attention,
you notice what you're doing and have the power to change it. It allows you to
have a clearer sense of your life purpose by allowing the meaning you give to
life as opposed to the meaning of life. It also allows for forgiveness starting
with ourselves. It is about effort, not outcomes.
In practice, “The most precious gift we can offer others is
our presence.” You are in the present, aware of the now, resulting in
compassion, acceptance, and flow. You can be with the other person resulting in
an interpersonal dance. Rapport and empathy are created with presence and
pacing. Rapport is largely dependent on body language, less so on voice and
minimally on words.
Dr. Richard Davidson presented on the topic, “Change Your
Brain by Transforming Your Mind.” He started out with the concept that neuroplasticity
allows for the potential that well-being can be a skill. He noted that 5-10,000
brain cells are made each day. Stress impairs neurogenesis. The new concept of
epi-genetics means that genes can be turned on and off depending on our
interaction with the environment; therefore we can influence this turning on
and off. Essentially, we can change our gene expression and influence our neuroplasticity.
Meditation can lead to a change in gene expression within 8 hours. Studies have
been done regarding the inflammatory response that are consistent with this.
He went on to discuss studies regarding the voluntary
cultivation of compassion. He discussed his study of long-term meditators using
functional MRI. He found that long-term meditators had a more persistent
presentation of gamma oscillations (40 cps) on their EEG. This is associated
with focused intent. One of the circuits modulated by meditation is the
anterior insula, where a viscerotopic map is present, providing the brain and
mind with knowledge of the body. He would present sounds of human suffering to
the meditators while in the MRI and found that the insula would light up.
He thought it would be interesting to look at a group of
people trained in compassion meditation for 2 weeks and compare them to a group
trained in cognitive reappraisal for 2 weeks. The training involved
contemplation and visualization of suffering and relief of a loved one,
themselves, a stranger, a different person and all beings. The compassionate
contemplatives were trained in the phrase:
“May
you be free from suffering. May you experience joy and peace.”
The contemplatives were instructed to feel this phrase, not
merely repeat it cognitively. They were also instructed to notice their
visceral sensations, especially in the heart. Indeed, differences were found in
the MRIs of the contemplative group. There was lower activation of the
amygdala. There was increased connectivity between the prefrontal cortex and
the amygdala, the dorsolateral prefrontal cortex and the insula and the
dorsolateral prefrontal cortex and the nucleus accumbens. He felt this
connectivity predicted increased altruism. However, he thought this connectivity
might be lost unless you continue to practice meditation, i.e. use it or lose
it.
He went on to discuss the fact that meditation leads to an
increase in attention. He cited a quote by William James, “The faculty of
voluntarily bringing back a wandering attention over and over again is the very
root of judgment, character, and will. No one is the master of him or herself
if he have it not. An education which should improve this faculty would be the
education par evcellence.” His study utilized something called the attentional
blink test. This test takes advantage of the fact that we are more likely to
miss parts of a pattern the more immediately they follow similar parts of the
same pattern. Meditators have a much shorter attentional blink than
non-meditators. Thus, meditation may be associated with a dramatic change in
the capacity to pay attention. He did note that there was one study that
applied this to ADHD.
He discussed briefly the role of meditation on peripheral
biology. Meditation-based stress reduction (MBSR) is found to lead to enhanced
immune response. Meditators developed higher titers to a flu vaccine than did
non-meditators. Thus a change in the brain correlated to a change in the body.
Meditators heal more quickly.
He briefly discussed the future of some of these findings.
His hope is that these kinds of practices will be increasingly pursued. We
might develop a science of virtuous qualities. We would incorporate the mind
back in to medicine and take more responsibility for our health.
From an education standpoint he noted that the children have
an even greater capacity for neuroplasticity. He discussed the implications for
puberty occurring at a younger age, while the prefrontal cortex continues to
develop until the age of 20 or so. This leaves adolescents increasingly
vulnerable, as hormones flourish while brain is not done developing. His sense
is that meditation could be a very helpful bridge to this increasing
discrepancy.
The advantages of meditation in social emotional learning
were cited. There have been 207 studies of social emotional learning. There
were increases in positive attitudes, decreases in bullying, decreases in
emotional distress, and improvement in tests and grades. They have developed a
preschool children program in Madison and have begun taking it into the Madison
schools. They have an 8 week program that they are working on. Very hopeful.
On Saturday morning, we spent much of the time listening to
David Rakel M.D. He has put together a book on integrative medicine and written
several papers. He spent time talking about the mindful encounter in medicine.
It allows us to pause and be self-aware. It allows us to have a presence and be
more authentic, using our child's eye. It impacts our perception, allowing for
meeting and mystery. Much of our life is habitual, and mindfulness helps
address this. The key part of mindfulness again is the concept of forgiveness.
He cited a quote that, “Forgiveness is giving up hope of a better past.” And
again, this is because we are in the present.
He cited a little bit of research about neural protein Y
(NPY). They're looking at increases in the production of this protein in
relation to the stress response. It leads to craving of carbohydrates to give
us energy and causes an increase in weight. He noted that the number 1 emotion
associated with heart disease is hostility.
We live life as we are, not as life is. Mindfulness allows
us to live life as it is and start to see the mystery and awe of life and the
people that we see. It allows us to carve out time to see people as they are.
Subsequently he cited 4 ingredients of a healing in counter
that include an emotionally charged relationship with a helping person, a
healing setting, an explanation, ritual, procedure, or plan that allows for
belief in action.
He went on to discuss the power of touch. He noted that, as
a doctor, who you are trumps the power of a pill. An enhanced visit with the
doctor includes a positive prognosis, empathy, empowerment, connection and
education. If a patient perceives empathy, studies have shown an improved
immune response. They have found an increase in interleukin 8 leading to
increases in neutrophils. He cited a study that revealed that empathy is the
best treatment for the common cold.
He cited a study comparing the use of the medical system in
3 groups: one group that regularly followed a moderate exercise routine over 8
weeks, another group that was trained in MBSR for 8 weeks and a control group.
Interestingly the exercise group showed the greatest reduction in cold symptoms
but had more M.D. visits and used more medication. The mindfulness group also
had a reduction in cold symptoms but fewer M.D. visits and medication use. The
mindfulness group utilized the medical system about half as much as the
exercise group, while the control group utilized the medical model 4 times as
much as the mindfulness group.
Unfortunately, studies also revealed that medical school
leads to a decrease in empathy. He showed a graph of changes in empathy during
medical school, noting that women come in to medical school with greater
empathy than men, but leave medical school with the same empathy that men had
when they entered medical school. (Of course, men really decrease in empathy
during medical school as well.) He went on to comment that the best way to
change a woman into a man is to send them to medical school.
He closed the morning talking about guided imagery and how
it may be used in things like enuresis (locked gate, how do you open it), and
the fear of the dark (a protector). The session closed with some guided
imagery.
All in all, this was a wonderful seminar.
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