Category Archives: Caregiving

Mindfulness Shines A Light on Anger

by Margaret Cullen and Gonzalo Brito Pons

margaretMargaret Cullen and Gonzalo Brito retrato-gonzalo-argentinaPons, co-authored “The Mindfulness-Based Emotional Balance Workbook. Join them for the Mindfulness-Based Emotional Balance (MBEB) Teacher Training Intensive, April 9-15, 2017 at EarthRise Retreat Center, Petaluma, CA. Mindfulness-Based Emotional Balance is an empirically-supported 9-week psycho-educational group intervention that teaches mindfulness meditation and emotion training.

It’s such a shame to think of how often we deride ourselves, and each other, for being “emotional.” It’s like jumping on someone for breathing. Emotion is a process that is a vital part of being alive. As the pioneering psychologist of emotions Paul Ekman has said, emotion is a kind of rapid, automatic appraisal of what’s going on. It’s influenced by our evolutionary past as well as our personal past, such that when “we sense that something important to our welfare is occurring…a set of physiological changes and emotional behaviors begins to deal with the situation.”

You’ve been endowed with a nervous system that has evolved over thousands of generations in a way that you didn’t choose. By the time you actually realize that you have a mind and a brain, the basic rules of how they work are already in place. The events that trigger our emotional responses are sometimes universal and sometimes personal. Almost anyone would feel fear at the sight of an oncoming car, but only some of us are afraid of hiking down steep trails while others happily scramble down them like a mountain goat. The triggers that each of us carries with us often come from early childhood and can continue quite unconsciously into adulthood.

And opportunities for emotion abound. Remembering, talking about, or imagining a past emotional scene or thinking of future scenarios can trigger emotions. Observing another person’s emotions (even on a TV screen) can elicit an emotional response. Role playing or theater can elicit emotion; and so can seeing an event that offends our sensibilities, like someone talking on a cell phone at the symphony or throwing trash into the street.

One of our most potent emotions—whose inward and outward effects can have disastrous consequences—is anger. In evolutionary terms, its main adaptive function is to remove obstacles that thwart us. When we feel anger, it’s because the primitive brain is trying to tell us something needs to change. We share this emotion with other mammals and even with reptiles. Baby humans come already well equipped with the capacity to get angry. If you hold a baby by her arms from behind, preventing her from grabbing a toy, she will get pretty angry, furrowing her brow, tightening her muscles, trying to move forcefully to get the toy, and perhaps shouting with a squeaky voice. When the baby grows up, she can have an analogous reaction when someone cuts her off on the road, especially if she’s already late for an important meeting! Anger also shows up when you—or others you feel connected to—are treated unjustly, or when someone or something prevents you from meeting your goals and needs.

Regardless of what triggers them, emotional responses can be either functional or dysfunctional. If we automatically swerve from an oncoming car, the fear response is extremely functional. If we’re afraid to leave the house for fear something terrible will happen, we are now in a disorder that is on the very dysfunctional side of fear, a disorder that no doubt is being triggered by an imported script from past trauma.

Until around the 1970s, it was commonly believed that the nervous system was essentially fixed throughout adulthood; that brain functions remained constant and that it was impossible for new neurons to develop after birth. If you were born with a “glass half-empty” attitude, it would be a life-sentence of unhappiness. Neuroscience has changed all that with the concept of neuroplasticity, which suggests that, in reality, human brains are flexible and change through experience. Although there are some fixed rules about what minds and brains can do, it’s also true that there is a space of freedom to respond rather than react that can be cultivated through mindful observation and practice. And in that space, we have an opportunity to work creatively with the dysfunctional aspects and enhance the more functional aspects of our emotional life.

Consciously or not, we’re constantly training our minds and brains to respond to circumstances. By virtue of repetition, our reactions crystallize into emotional patterns and neural pathways, which, in turn, influence the way we perceive reality. This is particularly true when we’re in the grips of a strong emotion, which is sometimes called the refractory period, a period of time when we’re only able to take in information and evoke memories that confirm, maintain, or justify the emotion we are feeling. This same mechanism that guides and focuses our attention can also distort our ability to deal with both new information and knowledge already stored that does not match the current emotion. We can all think of countless examples when we have missed obvious cues or forgotten historical data when we were “blinded” by a strong emotion. It’s not called “blind rage” for nothing.

Blind and Blaming

MindfulnessBasedEmoBalanceWB-CF.inddAlthough it’s quite possible to get mad at ourselves, the energy of anger is generally directed outward and it’s often linked with blame. This tendency to blame, strike out, punish, and retaliate makes anger especially challenging to sit with, and a big source of interpersonal suffering. When we feel anger toward someone, our sense of “self” and “other” gets very solid. In this state, we exaggerate all the negative qualities of the other person and become blind to positive attributes, which in turn feeds the aversion. The complexity and nuance of the other is reduced to a monolithic negative cartoon called “the enemy.”

We often wonder why we’re angriest at those we’re closest to. For one thing, people who know us intimately also know what can hurt us the most. Someone said, “Your family knows how to push your buttons because they actually installed them.” But a less glib reason is that it tends to be safer to show anger to an intimate than to a stranger. You can express aggression to your partner when you’re actually mad at your boss, probably because it’s less likely your partner will fire you. We can be frustrated about ourselves but direct our anger outside. It’s uncanny that we can even get quite angry at inanimate objects—a door, a table, a wall, or a shoe.

And that very fact reveals something that illuminates what’s really happening: although it feels as if the source of anger is out there, the anger comes from within. Other people are just pretending to be the real enemies. In fact, it’s possible to see them as our “patience coaches,” offering us opportunities to explore and tame the anger habit. If everyone was nice and considerate, how could we train in patience, how could we learn to tame our anger?

There’s an old story about a man who was sailing his boat on clear and sunny day, when a dense fog rolled in. Just as he had decided to return to shore, he noticed the profile of another boat coming in his direction. “Keep your distance!” the boatman shouted, concerned about a possible collision. But the other boat just kept approaching. The boatman used all his skills to swiftly shift direction, so there was more room for the other boat. He got really upset when he saw that the other boat changed its own course, now coming directly to him. “Stay out of my way!” he shouted again, but the other boat just kept coming closer, until it finally crashed into his boat.

The man was enraged: “You idiot! What the hell are you doing?!” He got totally worked up and continued his rampage until the fog lifted enough so that he was able to see that the other boat was empty—it was just an old abandoned boat floating downstream. Now he was perplexed and frustrated: To whom could he express his anger? Could he project his anger onto an empty boat? Without a person to blame, it was impossible to keep the story of anger going.

Ask yourself: Do I ever get mad at “empty boats”? If so, where does this anger come from? Where does it go?

Becoming aware of the inner terrain of anger can be helpful in catching it sooner and sparing ourselves and others the hurt and regret that often ensue from acting out anger. To work with anger, we need to see the space between trigger and reaction in order to mindfully look within.

Door Number Four

Anger is tricky because there’s a cost both to showing anger and to suppressing it. Suppressing doesn’t actually solve anything. It only postpones having to deal with anger while it keeps quietly simmering under the surface, wreaking havoc with our bodies. But if we show it, almost invariably we either hurt others or provoke retaliation. Another common habit is unconsciously “feeding” the mind states of anger with our stories of blame and victimization, thereby reinforcing the anger habit.

It’s rare that therapists nowadays advise their clients to act out their anger with real or symbolic others (punching pillows, shouting loudly in an empty room, and so on), partially because brain science has demonstrated that each time anger is expressed it gets rehearsed and strengthened. The idea that if you let your anger out you will reach peace and calm is simply not true—the satisfaction of the discharge will invariably be transient relief. And the anger will be saying, “I’ll be back.”

Most of us know we can get a certain satisfaction or relief when we express aggression. There can be a seductive quality to the anger, and an adrenaline rush, and that’s why it can become a habit, even an addiction. Anger is like a fuel. When we get angry we can feel energized, stronger, bigger—picture an angry cat with a curved spine and raised hair, pretending to be bigger than it is to scare away what it’s actually scared of. However, anger isn’t a very efficient fuel, because it burns hot and costly. It can be quite polluting on the inside and outside, and it’s heavy and corrosive in the system.

Fortunately, there are other options besides the “three doors” of suppression, expression, and unconscious fueling. When insults or obstacles are perceived, it’s normal for an anger response to arise. It’s just our nature and evolutionary history at work. Though we may succeed in becoming angry less often, it will always be a part of our emotional lives and it is therefore critical to learn how to relate skillfully with this challenging energy. As soon as you remember that you’re not just a victim of your anger, that you can actually use it as a path of self-discovery, you can practice being present with the feeling of anger, connecting with it, and allowing its energy to arise and pass away without acting on it or suppressing it.

This is “door number four.”

Don’t underestimate the power of this simple method. As with mindfulness generally, it’s simple, but it’s not easy.

The capacity to work with anger mindfully is not a binary, either-you-have-it-or-you-don’t proposition. It’s a practice that builds gradually, strengthening the muscle of mindfulness in the face of pleasant and unpleasant experiences. Instead of identifying with, rejecting, or being unaware of anger, we can learn to approach it with openness and curiosity, trusting that anger has something to teach us, and that this can be a very productive part of practice.

Anger is not a special problem getting in the way of mindfulness practice. It actually provides you with an exceptional opportunity to practice mindfulness, to open up when habit tells you to shut down, to connect with experience when habit makes you disconnect, and to question if the image you’ve constructed of yourself and others is as solid as it appears.

There’s a Cherokee story that captures the nature of anger beautifully. A boy tells his grandfather about his anger at a friend who had done him an injustice. His grandfather replies: “Let me tell you a story. I too, at times, have felt great hate for those who have taken so much, with no sorrow for what they do. But hate wears you down, and does not hurt your enemy. It’s like taking poison and wishing your enemy would die. I have struggled with these feelings many times. My son, the battle is between two wolves inside us all. One wolf brings happiness. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith. But the other wolf…ah! The littlest thing will send him into a fit of temper. He fights everyone, all of the time, for no reason. He cannot think because his anger and hate are so great. Sometimes it is hard to live with these two wolves inside me, for both of them try to dominate my spirit.”

The boy looked intently into his grandfather’s eyes and asked, “Which one wins, Grandfather?”

The grandfather smiled and quietly said, “The one I feed.”

Training in mindfulness is remembering that every moment is an opportunity to practice peace, no matter the circumstances. Our thoughts, words, and actions are food for the wolves we all have inside. There’s no need for guilt when you notice you’re feeding the angry wolf (we all do this, and guilt won’t help). Instead, know that you have the freedom to learn from your experience and keep practicing with patience. Trust that it’s the small—often invisible—steps that take you forward.

MindfulnessBasedEmoBalanceWB-CF.inddMargaret Cullen and Gonzalo Brito Pons, co-authored “The Mindfulness-Based Emotional Balance Workbook. Join them for the Mindfulness-Based Emotional Balance (MBEB) Teacher Training Intensive, April 9-15, 2017 at EarthRise Retreat Center, Petaluma, CA. Mindfulness-Based Emotional Balance is an empirically-supported 9-week psycho-educational group intervention that teaches mindfulness meditation and emotion training.

 

 

What Time is It? Inspiring a shift from tic-toc to lub-dub.

by Royan Kamyar

royanRoyan Kamyar, M.D., MBA is Founder and CEO of Owaves, a lifestyle medicine technology company based in Encinitas, CA producing software tools for wearable devices that inspire and motivate the next generation to engage in healthy lifestyle activities.  Royan has presented at TEDxUCSD and been quoted by Forbes, Reuters, FOX News, Xconomy, U-T San Diego and the San Diego Business Journal.  Royan earned his M.D. at Baylor College of Medicine, MBA at the Rady School of Management, UC San Diego, and BA and BS in Biochemistry and Business Administration at UC Berkeley and the Haas School of Business.  He serves on the Formative Board of Directors for UC San Diego Center for MindfulnessMindfulness-Based Professional Training Institute and is an active member of the American College of Lifestyle Medicine.

Image Credit: Dadara

[Image Credit: Dadara]

Imagine a flowering plant. A baking cake. A rising stock price. A healing wound. Time passing can be a beautiful thing.

Why then does the cartoon above resonate so deeply with us? Is it our fear of mortality? Our never-ending list of to-do’s and things left undone that haunt us moment-to-moment? Are we as a culture, as a species, doomed to brood on the past, fear the future, and run away from the present?

The Centers for Disease Control and Prevention (CDC) identifies our sense of “time scarcity” as a leading source of stress in the United States — a primary cause of heart disease, our number one killer. Meanwhile, growing positive psychology research demonstrates the healing power of “being in the present.”

What if our relationship with time shifted? What if we began to view time as a source of inspiration instead of dread? What if each glance at the watch put us more “in the moment,” made us feel more focused, centered and alive? Few realize that our modern timekeeping system is fundamentally arbitrary. Hours, minutes and seconds have no home in cosmology, but rather the digits of our hands…

Technology is evolving as we speak to put smartphones on our wrists. The era of smartwatches with heart rate sensors and real-time monitoring systems is dawning upon us. With processing powers greater than the earliest mainframes and NASA spaceships embedded into our timepieces, we are no longer compelled to settle for a construct of time rooted in hand gestures, ropes and rocks. What if we, as a community of innovators and healers, took the first step in evolving our modern-day answer to the age-old question, “What time is it?”

Mindfulness & Innovations in Timekeeping

The mindfulness community actually has a long and storied track record of innovation in timekeeping, centered around spiritual observations, holidays, rites, rituals, meditation and prayer:

32,000 BCE – Cave art found in France and Germany depicts lunar and seasonal cycles of the “heavens”, representing the first known calendaring system. Its creators are believed to be astronomer-priests of the late Upper Paleolithic Cultures.

4,200 BCE — Ancient Egyptians calculate 365 days between alignments of the sun and Sopdet, goddess of Sirius the Dog Star, marking the Nile’s concurrent flooding and enrichment of the soil.

3,000 BCE — Stonehenge in modern-day England demarcates the annual winter and summer solstices, serving as burial grounds and a venue of ancestor worship and rituals.

2,400 BCE – The first known clocks are the shadow clocks or “obelisks” of ancient Egypt, erected by clerics in pairs at temple entrances for ritual observances.

2,100 BCE — Assyrians, Sumerians and Babylonians of the Middle East establish twelve phases of the moon, or “moonths”, per lunar calendar year. Holy days are declared on the first, seventh and fifteenth of each month.

1,000 BCE – Egyptian clerics develop water clocks or “clepsydras” to continue tracking proper timing of rituals throughout the night, i.e. in the absence of sun and shadows.

100 BCE – Chinese, Korean and Japanese Buddhist monks advance incense timers to replace the more flammable and inaccurate candle clocks of the day. Utilizing various scents, one smells the time change.

1200-1300 AD — Benedictine Monks of Western Europe become the first clockmakers of the region and create the mechanical clock. Adding weights and escapements to water clocks automates ringing of the communal prayer bell.

1582 AD — To more accurately celebrate Easter in its relation to the March equinox, Pope Gregory XIII spearheads the Gregorian Calendar widely used today. The Gregorian Calendar arrives closer to the tropical or “solar” year than the preceding Julian Calendar.

The Origins of Tic-Toc

The divisions of years, months and days are rooted in cosmological events and account for consistent measurements across disconnected cultures. Subdivisions of weeks, hours, minutes and seconds, however, are largely arbitrary and varied more greatly throughout history.

Weeks, for example have seen lengths of 3 to 13 days depending on prevailing leadership. Decisions usually hinged on what was deemed a reasonable workweek as per autocrat or religious text, i.e. “… on the seventh day he rested.” Papal States used six hour days as recently as the 1800’s with 6 o’clock pointing fixedly to sunset, and the Japanese had a twelve hour system with intervals that varied in length according to the season. Decimal time was used by China throughout most of its history dating back to 1000 BCE, was espoused by the French Revolutionary thinkers of the late 1700’s and resurfaced in 1998 when the Switzerland-based Swatch company proposed “Internet Time” of 1000 beats per day.

The sexagesimal system which lies at the heart of our modern-day “tic-toc” was similarly devised for convenience, not derived from scientific fact or basic principles. The ancient Sumerians and Babylonians used sixty as a mathematical base due to its ease of counting with two hands. Each finger segment on one hand represented a number one through twelve demarcated by the thumb, and each digit of the other hand represented a multiplier. Multiplying twelve finger segments by five digits provided a max count of sixty. The number sixty is also considered a “superior highly composite number” in mathematics, meaning it is easily divisible and lends itself well to fractions.

hands

[Image Credit: Ministry of Education, Brazil]

The Problems with Tic-Toc

Dr. Jon Kabat-Zinn presents a valuable anecdote from the Mindfulness-Based Stress Reduction (MBSR) program he developed at the University of Massachusetts Medical Center, in his manuscript Full Catastrophe Living:

Linda described feeling as if a large truck were always right on her heels, driving just faster than she can walk. It was an image people could relate to; the vividness of it sent a wave of acknowledging nods and smiles through the room…

Her mind was the truck. It was always right behind her, pushing her, driving her, allowing her no rest, no peace.

In the modern age, feeling overwhelmed and out-of-sync is an increasingly common experience. Heart disease is real, heart attacks are real, and the CDC sobers us with the knowledge that this “time scarcity” mentality is a chronic stressor.

Perhaps it is not surprising then that one of the central tenets of mindfulness-based stress reduction is to encourage patients to adopt the present moment. As Dr. Kabat-Zinn explains:

Mindfulness is paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment.

The ancient Greeks embraced two definitions of time to help carry this distinction. “Chronos” was used to discuss chronological or sequential concepts of time, with which we are most familiar and tic-toc describes quite well. “Kairos”, on the other hand, translates to the “eternal moment” in which everything actually happens. This latter concept is missing from our current communication of time and resonates with Dr. Kabat-Zinn’s teaching.

Among pools of evidence collecting around the importance of present moment awareness, Science published a Harvard study in 2010 demonstrating a link between “mind-wandering” and mental health. Over 250,000 data points from 2,250 subjects between the ages of 18 and 88 shows our minds are focused on the past or future 46.9% of the day, leading directly to poor mood. As summarized by study co-author psychologist Matthew A. Killingsworth:

Mind-wandering is an excellent predictor of people’s happiness. In fact, how often our minds leave the present and where they tend to go is a better predictor of our happiness than the activities in which we are engaged.

The tic-toc almost by definition puts us in a sequential frame of mind rather than in the moment. This shift first took hold in the Western world during the Middle Ages with the spread of the mechanical clock. Benedictine Monks lived ascetic lives centered on punctual communal prayer six to seven times per day. Bells (Celtic = clocca or “clock”) were rung manually to inform the community of established timetables. By adding weights and escapements to water clocks, a bell could be rung automatically without requiring a brother present, and more dependably as well.

As the National Watch and Clock Collectors Association notes:

Time no longer flowed like water through a clepsydra — it ticked. It was no longer a seamless continuum, but a succession of short periods.

The streaming of water, passing of a shadow or burning of a flame became replaced by the now familiar “tic-toc”. With the dawning of the Industrial Revolution and mass scaling of clock and watch production, “dollar watches” put everyone in a mechanical state-of-mind and helped synchronize the workforce. Time became money as factories calculated hours worked as key labor costs and employees as wages. As per American historian Lewis Mumford, “… the archetypal model for the industrial era was the clock.”

The tic-toc represented a major departure from cosmological cues for the average person organizing her or his day, as the sundial became officially obsolete in the 1800’s. Perhaps the greatest divorce came more recently with the International Committee for Weights and Measures decision to re-define the second in 1967. A “second” no longer represents an arbitrary fraction of Earth’s rotation around the Sun, but rather:

9,192,631,770 periods of the radiation corresponding to the transition between the two hyperfine levels of the ground state of the caesium 133-atom.

While this advances our computer networking capabilities and satellite communications, the tightening of our “tic-toc” does not necessarily serve to heal our emotional relationship with time. In fact, the focus by such governing bodies on the physics and engineering components of time misses the human implications that actually define it.

Within some of our lifetimes, Albert Einstein brought forward the general theory of relativity, which proved without a doubt that a second for you is not the same as a second for me:

Put your hand on a hot stove for a minute, and it seems like an hour. Sit with a pretty girl for an hour, and it seems like a minute. That’s relativity.

Our speed, our culture, our circumstances, our environment, our climate, our neighbor, our mindspace all dramatically impact our individual perceptions of time. Further, Einstein’s contributions to quantum mechanics helped show the existence of time actually depends on our perceptions of it. No consciousness, no time. So these changes in perception that we feel and experience on a regular basis are not simply novelties or asides in the calculations of time, but real occurrences that get neglected in our current approach.

In the 1950’s, University of Minnesota biologist Franz Halberg coined the term “circadian” (Latin = around a day). Known as the “godfather of chronobiology,” he helped establish a fundamental, evolutionary relationship between our biology and time. We now know that every cell in our body, down to the DNA level, has some “awareness” of (or dependency on) the time of day. This is true for virtually every known organism, even those that are single-celled.

The implications of these “circadian rhythms”, or physiological patterns dictated by the rise and fall of the sun, are both broad and deep. Recent research encouraged the World Health Organization to label night-shift work as a “probable carcinogen”, in the same class as UV radiation, due to its devastating impact on circadian rhythms. Poor circadian rhythms are also linked to heart disease, obesity, diabetes, metabolic syndrome and mental health disorders. Our 24/7, hyper-connected, always-on smartphone culture makes the bulk of us “social-shift workers,” exposed to blue light late into the night… and shifting our hormones into dangerous patterns.

circadian

Why then has nothing changed? Does our new subjective, dynamic definition of time, no longer static and mechanical, not change the underlying formula? Does the realization that our biology has a fundamental, natural and overarching relationship with time not beg us to re-evaluate why this is not factored into the perennial question, “What time is it?”

Introducing Lub-Dub

The arbitrariness of our current timekeeping method, combined with the facts that it is out-of-date and fosters a stressful mindset, presents us with a wide-open opportunity to improve. Coupling our evolved understanding of time with modern needs and the latest technologies, perhaps we can imagine a way to re-define the concept so that it better serves our bodies, hearts and minds.

Consider your daily routine. It might look a lot like this: wake up, meditate, eat breakfast, drive to work, work, eat lunch, go for a walk, work some more, drive home, cook dinner, spend time with family, relax and read a book, go to sleep. What is the optimal way to get you from one “daily milestone” to the next? When you realize the bulk of these milestones don’t generally change from one 24-hour block to the next, you begin to sense there might be a better way to organize and track your day.

Peter Galison, physics professor, historian and philosopher at Harvard University defines clocks accordingly:

We’re always looking for things that repeat, over and over again… and that repetition, that cycle of things, forms a clock. That’s all time becomes, is some repetitive process.

So since my daily activity patterns generally repeat from one day to the next, what if they became my “tic” and my “toc”? So my cadence became linked to “breakfast time” and “exercise time” rather than some mechanical, arbitrary construct that lies beneath it? In essence, I become my clock. Lub-dub.

What we can imagine is a shift from a quantitative, mathematical and mechanical view of time towards a more heartful, experiential and soulful view of time — one that makes sense on an emotional and psychological level.

Amazingly, this approach has a biological basis as well. In his study of circadian rhythms, Dr. Aschoff also coined the term “zeitgeber”, German for “time giver” or “synchronizer. ” The zeitgeber is any external or environmental cue that “entrains” or synchronizes an organism’s biological rhythms to Earth’s 24 hour light/dark cycle and twelve month orbit.

Decades of chronobiology research tells us that these same types of intuitive markers for progression of the day, or daily milestones outlined above, are in fact biological zeitgebers. Meals, exercise, and socializing each play a role in establishing our cyclical physiological relationship with the solar environment. This has implications for: our sleep/wake cycle, body temperature, patterns of hormone secretion, blood pressure, digestive secretions, levels of alertness, mood and reaction times just to name a few.

brain

[Image Credit: Nature Reviews Neurology]

Timothy Monk, Professor of Psychiatry at the University of Pittsburgh Sleep Medicine Institute summarizes the value of this framework well:

Circadian rhythms are driven by endogenous processes, are self-sustaining, and rely upon circadian time cues (zeitgebers) to remain appropriately oriented to the individual’s environment and desired routine. The gold-standard measures of human circadian rhythms have been core body temperature and salivary or plasma melatonin levels. However, one can also make the case that the behavioral circadian rhythms related to the timing of sleep, meals, work and social interactions are just as valid circadian rhythms as the physiological ones. Moreover, these are the rhythms most salient to the individual himself or herself.

An additional “bonus” of shifting to this type of intuitive, biologically-based system is that these same behaviors — nutrition, sleep, exercise and socializing — are deemed by the American College of Lifestyle Medicine to be the fundamental building blocks of a long, healthy life. Also called “lifestyle vital signs,” measuring and monitoring these parameters might be more meaningful in predicting long-term morbidity and mortality than the traditional set of vital signs for current and future generations (due to an overall shift from acute to chronic and preventable disease). Following the age-old adage that you cannot manage what you do not measure, taking these health fundamentals into account would help prevent and treat diabetes, obesity, heart disease, high blood pressure, depression, anxiety and more.

For example, we know that heart attacks are most likely to occur shortly after dawn due to concurrent rises in blood pressure and cortisol levels. We also know they are more likely to occur at the beginning of the workweek, when stress from anticipating future events reaches its peak. What if your timekeeping tools took this knowledge into account, and helped you time activities accordingly? Perhaps optimizing algorithms to discourage Monday AM work meetings when possible? Or suggesting stress-reducing sounds or images during these times? Something as simple as a picture of a loved one, left in ambient view on your wristwatch at the right time, might go a long way in dipping your odds for a cardiac event.

CFM OWAVES

[Image Credit: Owaves]

Now time becomes something we can control, name, juggle, design, manipulate and relate to according to our personal biology, desires and needs. Granted, a universal timekeeping system would always need to lie at its base. Meeting times must be coordinated and train crashes prevented. And yet, analogous to “personalized medicine”, we can evolve or grow from this generalized base to create a truly individualized and relevant concept of time that inspires and heals rather than stresses and reduces.

Commonly in mindfulness courses today, we are taught that certain external stressors cannot be changed, and are best addressed by mobilizing our internal resources to better respond and adapt to our environment. Yet our maligned relationship with time seems to be universal and we know now, increasingly, that our historical perspective of time is incomplete, arbitrary and malleable. Perhaps we should learn from the mindfulness leaders of millennia ago, and play an active, creative role with regard to understanding, communicating and measuring time.

As we speak, physicists and engineers continue to develop incredible methods for fine-tuning existing calculations of timekeeping tools to better run the machines of the world. I propose it is our duty, as a community of healers and innovators, to ensure that human health and well-being is plugged more squarely into the equation.

Continue to explore the Mindfulness courses presented at the UC San Diego Center for Mindfulness. Registration is open for our local 8-Week Mindfulness programs along with our Mindfulness-Based Professional Training Programs that are held in various locations in North America.

 

THANKFUL: Appreciating Beautiful Gifts from Children and Youth

By LeesaMaree Bleicher

LiseeMaree-Bleicher-300x168-2Visit LeesaMaree Bleicher, along with M. Mick Gardener, at the 2015 Bridging the Hearts & Minds of Youth Conference in their 90-minute breakout session called enlighten: a Trauma Informed Mindfulness Based Therapeutic approach combining Restorative Justice as an answer to youth involved in the criminal justice system. Promoting the concept of: Survivor Empowerment not Victimization of Recovery not Incarceration.

LiseeMaree BleicherAlbert Schweitzer said, “At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.”

Nowhere is this spark as bright than in the heart of a youth. Nowhere does there lay a stronger elixir to waken your purpose than in the sparkling enthusiasm of a child’s spirit. And nowhere is there a grander purpose than the need to ease the suffering of a child.

The beautiful thing about helping children is that buried beneath the armor and attitude is this snow-white innocence, this flawless foundation, this feral potential still connected to God, or source, or that which is greater than us individually. This goodness remains steadfast despite the harm adults have done.

Our mission is to guide them back to this place of bliss, if only momentarily. In the shift to recovery, not treatment, we have come to understand “recovery” as recovering that which was lost from us: innocence, joy, light, that feral potential. Discovering the road back to that place of purity and reclaiming our power is the key to freedom from suffering.

Our mission, should we choose to realize it, is to be the guides whose purpose is to steer youth back to reclaim their potential. We do this each time we teach that even in the unbearable moments in life and in the dark of a night of unimaginable pain, there shines a dim but powerful light that will one day illuminate the darkness. And within this light, there shines their power and their way out of suffering.

Ideally we strive to plant the seeds of patience, tolerance and acceptance in our youth.

We affirm: “Life is not fair 8359890249_ed085986b0_b-360x200-1and no you did nothing wrong. No it is not your fault. No you do not deserve what happened to you. No one can make it better, but one day if you just hang on — have faith — one day, I promise you will be OK. One day you will emerge from this stronger and more powerful than you can ever imagine.”

When the testimony of sharing lived experience trumps our cool “professional boundaries,” we make a true and lasting difference. Speaking from the heart and sharing our human experience plants seeds of hope, inspiration, and resilience in youth. Nowhere can we feel the way of freedom from suffering than knowing someone who has walked down a similar path of torment, come out standing steady despite someone else’s best effort to make them fall, and still has enough fierce courage left to tell their story.

Speaking candidly, most youth who like myself come to be in jail, in foster care, or other programs do so by force of their external circumstances. Many come from fragmented, broken homes where they witness and endure unspeakable acts of cruelty from the adults who should be protecting them. Rarely do youth land in these places by their own choice.

Emotional, physical, spiritual, and sexual abuse manifest in the blueprint of our souls and spirits. Such abuse might express itself as a 4th grader bullying his classmate, a youth stealing, a youth who yells obscenities at authority figures, who refuses to eat, who is promiscuous, who skips school, who takes drugs, who cuts their flesh in an effort to feel or not feel pain. It’s the days of silence before an attempted (or successful) suicide where we often mistake the symptom for the cause and fail in our attempts to “treat” them. It’s that approach which undermines the very core of their suffering. And it’s where we as adults fail them yet again.

It was in the vacant blue eyes of an 8-year-old boy named Travis who came to live in my home when I first realized how futile, how misguided, and how inhumane this system to care for children was. It is still raw, and I am not sure yet if I can fully capture how profoundly my time with him altered my heart. This experience both expanded my heart beyond what I thought was possible and then reduced it to nothing when he was gone.

One day while we were together, Travis “disconnected.” Fell silent, withdrawn. And I asked him, “What are thinking about? What makes you so sad? You can tell me anything, and I will believe you. And there’s nothing you tell me I won’t think is important.” After awhile, he came to me and said, “I’m sorry. I don’t know why sometimes I can be happy, and all of the sudden I feel sad. It comes out of nowhere.” I looked at him, cupped his tiny perfect chin in my hand, peered into his blue eyes and wrapped my arms around him. I hugged him tightly and said “I know. And it’s OK. I feel like that sometimes too. And you know what? One day you won’t feel like that all the time. One day you’ll take that sadness and turn it into happy.”

All he was unable to say was conveyed in the way he hugged me back. And in that precious moment when he mumbled “Thank you.” I thought my heart would break.

There was nothing I learned from a text book, nothing from evidence-based practice, and nothing in the foster parent orientation that prepared me for that moment. I reacted from my heart.

My only desire was to ease his suffering and instill within him the tiniest notion that no matter what he felt, it was OK and that it was only temporary.

The reality is that when we come into a child’s life to aid them, they are held in a punitive, restrictive, inflexible system. We don’t always look past that to what brought them into that system to begin with. If we increased our awareness, we would see that few children are delinquent, homeless, end up in jail, or in foster care by their own volition. They come to these places battered, bruised, and sad, having been victimized by adults.

In the months that passed with Travis, after my heart ran ahead of any reason, I watched a sad little boy turn into a bright, happy, fun-loving child who didn’t need medication or to be bounced around from foster home to foster home. What he needed was to be loved.

Now, there was nothing I could have offered Travis that ever could have replaced what his parents failed to give him. My love was a Band-Aid to soothe him until he could grow enough to care for himself. But far more miraculous than anything that I gave him was what he gave to me.

One of my tendencies was to over-explain myself; to offer excuses and/or apologies for nearly everything to everyone. One day, I was going on and on to a friend about why I didn’t do something when from the top of the stairs I heard this little voice say, “LeesaMaree, stop that. You don’t have to explain yourself. It’s OK whatever you do.” I froze at his wisdom and the fact that he cared to try to ease my suffering. Wow.

Then, I came to deeply understand the bigger context of this whole boundary thing. And I came to know that anytime we seek to engage in the helping of another being, it is not so simply a gift we give. It is not one sided.

The moment we think this, we have already failed. We as the perceived “givers” are really part of a mutually beneficial healing exchange connected to a greater energy. Once we come to understand and seek to increase our sensitivity and re-establish the heart in recovery and treatment, once we incorporate living testimony in our practice, only then will we make a true and lasting impact.

This time of year we celebrate thanks for Bridging Badgemany blessings. But as a “profession,” we overlook the rich and beautiful gifts that the children we encounter give us: the opportunity to care, to express our warmest compassion, and to ease suffering. All these things alter us. They allow us to ascend toward the deeper meaning of our shared human experience. The next time a child or a parent or someone else says thank you for the work you do, with humility and honor defer him or her and say, “No, thank you.”

Thankful

(a poem inspired the youth who have walked into my life and left imprints upon my heart)

The leaves fall…fluttering to the ground…landing like a thrush
Awaiting winter’s rush from summer’s dream
I remember summer… bright green and sparkling
and I remember you…your hand extended towards mine…offering me your heart
Giving me that moment…your time…yourself
You said, “Come this way. Here, let me show you… See the sun how it shines?”
Your smile confused the sun and stole starlight’s sparkle
“Listen. You can hear the grass tell its secrets …follow the burrowing bunny, he knows the way…see the Stellar Jay…as he chats up dawn…urging the flowers to wake up…he knows what I am talking about. His blue wings touch heaven”
I ran away from you…but never far… You were everywhere…in everyone
You tied me with a fragile cord of compassion…bound me to the fertile ground…tied me to heaven…left seeds in my hand
You allowed me to fall but not be crushed
Like the leaves, I too have been pink, russet, pumpkin and golden
It was the seeds you left… clutched tight in my hand
One day I remembered…it all came back in one fell whoosh
You cared …You took the time…You forgave me
You gave me another chance and a million more
You listened to me…You reignited the spark
Oh I am so thankful for You
Oh those seeds you left… I planted them under the moonlight…and when they blossomed…I crushed them and stuffed them in my heart
I knew what to do ’cause you said “the best way to show someone how much you appreciate them is to pass on what they gave to you.”
So…I watered the seeds with tears…transformed my fears…infused them with love
Oh I didn’t have it for myself…that care and concern
But I do for them…the ones that come behind me
So I scattered the seeds in the wind of each encounter
Oh, and I did exactly as you taught me …I gave my heart generously and… I fertilized the seeds with glitter…so that those who come behind me will sparkle brighter…than I ever did

Mindful Matters: Nourishing Our Wellbeing in Clinical Practice

by Chris Gauthier

There are lots of people, many of them healthcare professionals, who are serving this world by caring for others. Something within some of them is so completely synchronous with the desire to heal others that there is nothing in this life they would rather do. The fact that there are people so committed to helping others become whole is awe-inspiring. However, too many times the basic premise of healing is forgotten: we must heal ourselves if we have intentions of healing others, so we can better serve all.

stethoscopeWith the world of medicine constantly changing, areas of improvement in patient care are abound while its practitioners continue to meekly manage mindful self-care rather haphazardly. In America, this recent structural revolution in the medical industry, regardless of personal opinions and politics on the subject, is significant. The demand for physicians, psychologists, and other medical practitioners is exponentially growing. Medical professionals that do well in their care – because let’s face it, we have or know someone who has had a needlessly negative experience seeking quality care, can be likened to an oasis in this increasingly desert-esque landscape. How do we as practitioners, continue to offer the top care that we do, while combating increasing instances of burn-out, fatigue, and a general lack luster experience where on occasion we may dip our toes into the depths of existential darkness? With greater work loads and less time that we do not have, it is imperative for us to find ways to care for ourselves. These sharp changes in the field require equally acute transformations of focus.

There is another movement germinating in this field z krasner9258-1within the western context that proffers a way for us to take care of ourselves so that we can do what we love: take care of others. This movement is towards mindfulness. Mindfulness in clinical practice is essential to thriving long-term in the duty of serving our patients to the best of our abilities. Mick Krasner, MD FACP practices primary care internal medicine in Rochester NY and teaches that the University of Rochester School of Medicine and Dentistry. Going strong after 12 years of integrating Mindfulness-Based Stress Reduction into the lives of his patients, medical students and various health professionals, Mick might be on to something. A plethora of research on this topic shows an improvement in quality of care of patients, and an increase in well being for the health professionals who practice it. An example of one of the aspects whereby we can incorporate mindfulness is within the context of communication education with our colleagues.

Howard B. Beckman et. al. published a fascinating study exploring mindfulness-based interventions with practitioners, finding that these kinds of mindful communications skills when learned and practiced, promote a sense of community and an increase in time devoted to personal growth. In the paper, “The Impact of a Program in Mindful Communication on Primary Care Physicians,” they conduct in-depth interviews with physicians who had completed a specific 52-hour mindful communication course, which had known effects of reducing distress and burnout as well as increasing empathetic capacities. Generally there were three main themes that surfaced through the randomized qualitative data: 1) sharing personally the experiences from medical practice with other colleagues in the class setting reduced professional isolation, 2) increased skill sets to listen attentively to patients, 3) developing a greater sense of self-awareness is a positive experience. It is clear here as is true in other studies, that learning how to engage in mindfulness practice (and practicing!) does tremendous good for the individual and by proxy, for the community as a whole.

This education in mindfulness has ineffable multi-facetted value, but we already don’t have enough time as it is! So what do we do? Well, one way is by looking for those CE’s that will offer us this kind of education that will teach us to nourish ourselves so we can continue to do the important work that we do. Being aware of the consequences, good and bad, of our decisions we make for ourselves and about ourselves is one of the pillars of this mindfulness journey to creating the life we want to live. We can seek out continuing education courses that we have to do anyway, that will also aid us in this journey towards taking care of ourselves therefore enabling us to sustainably care for others.

We are delighted Dr. Krasner is coming to San Diego on May 11, 2013 to present a daylong workshop on mindful practice entitled “Mindfulness in Clinical Practice: Our Patients, Ourselves.” This event will include an hour-long presentation on the Neuroscience of Mindfulness by Tom Chippendale, MD, Director of Neuroscience at Scripps Health and longtime MBSR teacher. The day-long training has been approved by the AMA PRA for Category 1 Credit.

Work Cited:

Beckman, Howard B., MD, Melissa Wendland, Christopher Mooney, MA, Michael S. Krasner, MD, Timothy E. Quill, MD, Anthony L. Suchman, and Ronald M. Epstein, MD. “The Impact of a Program in Mindful Communication on Primary Care Physicians.” Academic Medicine 87.6 (2012): 1-5. Print.

Krasner, M. S., R. M. Epstein, H. Beckman, A. L. Suchman, B. Chapman, C. J. Mooney, and T. E. Quill. “Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians.” JAMA: The Journal of the American Medical Association 302.12 (2009): 1284-293. Print.

About the Author:

Chris Gauthier is an alumnus of the University of California, San Diego with a degree in Cognitive Science and a focus in Neuroscience. He has many passions, most revolving around skills of wholeness, health, and self-discovery. Chris is affiliated with the UCSD Center for Mindfulness. He also travels and presents a variety of topics in a workshop style, mostly to college-level minds. Mr. Chris Gauthier can be reached at: chris.a.gauthier@gmail.com.

Pioneering Mindfulness-Based Dementia Care Program Launched at UC San Francisco

Marguerite Manteau-Rao is a mindfulness colleague and friend, editor of the Mind Deep blog, psychotherapist and now a pioneer in bringing much-needed mindfulness training to people caring for those with dementia. 

By Marguerite Manteau-Rao

‘Mindfulness’ and ‘dementia’, two words to do with mind:
mindfulness
dementia, from Latin word demens, which means ‘without mind 

Mindfulness and dementia are not just connected in words. Mindfulness also happens to be a key element of successful dementia care, working on two fronts: 1) to reduce caregiver’s stress, 2) to help the caregiver be present for the person in their care. Facts gathered by the Alzheimer’s Association show the extraordinary stress suffered by most family caregivers:

• 61 percent of dementia caregivers suffer from high emotional stress.
• 33 percent report symptoms of depression.
• 43 percent experience high physical stress.
• 75 percent are concerned about maintaining their health.
• Dementia caregivers are more likely to have adverse physiological changes such as high levels of stress hormones, reduced immune function, increased hypertension, coronary heart disease.
• In the last year of their loved one’s life, 59 percent feel they are on duty 24 hours a day.

This goes on for an average of 4 to 8 years post-diagnosis. It is no wonder 72 percent of caregivers express relief after their loved ones die. For professional caregivers and health care providers, the stress is also intense and can lead to burnout.

Until recently, most mindfulness-based approach to dementia care referred to Mindfulness-Based Stress Reduction for dementia caregivers. Having observed numerous times the unique challenges as well as mindfulness practice opportunities in dementia care, I realized the need for a mindfulness-based program specially tailored to dementia caregiving. Hence began the Presence Care Project, a non-profit initiative aimed at promoting a new form of dementia care training. In the Presence Care approach,  mindfulness, informed by experiential understanding of the person with dementia, becomes the foundation upon which a caregiver can rest, moment-to-moment, day after day, during the long journey of dementia. UCSF OSHER Center for Integrative Medicine has now taken on this new approach and recently launched its new Mindfulness-Based Dementia Care (MBDC) program.

MBDC builds upon the now very well proven model of Mindfulness-Based Stress Reduction (MBSR),  and combines solo mindfulness practices, interactive mindful care practices, lectures, and group sharing. Throughout, aspects of mindfulness practice and dementia care are interwoven. The emphasis is on practice during and between classes. The end goal is for participants to experience a radical shift in attitude from mostly doing and reacting, to being skillfully present for themselves and the person in their care. MBDC is appropriate for the whole range of persons involved in dementia care: family and friend caregivers, professional caregivers, elder care professionals, nurses, doctors, and other health care providers.

MBDC rests on this central premise: mindfulness, that which helps dementia caregivers reduce their stress, is also what can help them provide the best care for the person with dementia.

The first series of 8-week classes has started and is taught by Marguerite and Dr. Kevin Barrows, physician and director of mindfulness programs at the Osher Center.