Managing Personal and Client Stress Through Meditation Sage Bolte, MSW, LCSW, OSW-C Oncology Counselor Life with Cancer ® INOVA Cancer Services Managing Personal and Client Stress Through Meditation Introduction to Meditation Research Preparing to Practice Breathing Techniques & Progressive Muscle Relaxation V. Guided Imagery Meditation I. II. III. IV. Meditation “Meditation is a mind-body process that uses concentration or reflection to relax the body and calm the mind in order to create a sense of well being” The American Cancer Society, 2002. Meditation “Meditation is any kind of deliberate focus, usually on just one thing or a very narrow band of things. This clears the mind, slows it down and calms and strengthens the meditator” Naparstek, Belleruth 2000. www.healthjourneys.com Research: Meditative Techniques Work Pain Insomnia Depression Mind Body Awareness Sexual Dysfunction or Disinterest Nausea Anxiety Fatigue Less clarity on clinical assessments and issues  Burnout          Common Problems Experienced When We Don’t Slow Down Burnout?  Emotional exhaustion  Cynicism or depersonalization  Perceived clinical inefficacy – Fatigue, insomnia and depression – Decreased work effectiveness, performance, longevity and creativity – Feelings of despair & bitterness, inadequacy, difficulty justifying work effort, and not looking forward to going to work, along with feeling unappreciated and having little satisfaction Pellegrini, V. (2007). Physician Burnout: A Time for Healing. Obstetrical & Gynecology, 62 (5), 285-286. Benefits of Meditation Techniques  Reduces* – – – – – – Anxiety Stress Blood Pressure Chronic Pain Insomnia Blood Cortisol Levels stress)  Increases* – Quality of life – General health – Concentration (brought on by *NIH Consensus Development. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. Accessed Oct. 14, 2002. *Spencer, JW, Jacobs JJ. Complementary/Alternative Medicine: An Evidenced Based Approach. St. Louis, MO: Mosby Inc 1999 The Effectiveness of Meditation Techniques  Holland J, Morrow G, Schmale A, et al: A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J Clin Oncol 9:1004-1011, 1991 Effectiveness of mindfulness  An exploratory mixed methods study of the acceptability and effectiveness of mindfulness -based cognitive therapy for patients with active depression and anxiety in primary care Statistically significant reductions in mean depression and anxiety scores were observed; – the mean pre-course depression score was 35.7 and post-course score was 17.8 (p = 0.001).    A similar reduction was noted for anxiety with a mean precourse anxiety score of 32.0 and mean post course score of 20.5 (p = 0.039). Overall 8/11 (72%) patients showed improvements in BDI and 7/11 (63%) patients showed improvements in BAI. In general the results of the qualitative analysis agreed well with the quantitative changes in depression and anxiety reported Finucane, A. & Mercer, S. (2006). An exploratory mixed methods study of the acceptability and effectiveness of mindfulness-based cognitive therapy for patients with active depression and anxiety in primary care. BMC Psychiatry. 6: 14 Alprazolam vs. PMR Sample:     3 centers over 10 days to test the efficacy of Randomized, non-blinded study of 147 patients (uncontrolled for site or disease stage) 70 assigned to drug 77 assigned to relaxation Alprazolam vs. PMR Instruments:  Four measures of anxiety and depression used: – – – – Covi Anxiety Scale Raskin Depression Scale Affects Balance Symptoms Checklist – 90 (SCL-90) Alprazolam vs. PMR Intervention: 1) A triazolobenzodiazepine: - Alprazolam, .5mg 3x/day 2) Behavioral Techniques: - Taught Progressive Muscle Relaxation (PMR) at session 1 with behavioral psychologist - Asked to listen to audio tape of PMR session 3x/day Alprazolam vs. PMR Results:  Both arms of study showed significant (P < .001) decrease in observer and patient-reported anxious and depressed mood symptoms  Drug arm showed more rapid decrease in anxiety and a slightly greater decrease in depression Alprazolam vs. PMR Application and Conclusion:  Findings confirm that both drug and PMR interventions are effective in significantly reducing distress  However, PMR is less invasive, can be more cost effective and teaches a skill to manage problems Why Don’t Social Workers Meditate?  We teach what we need to learn  What happens during stillness?  Resisting the thrill of distraction  Taking responsibility Why Haven’t I Managed My Stress?  “I don’t have the time”  “I think it is a waste of time”  “I don’t know how to begin”  “I don’t know where to begin” What If Social Workers Did Meditate?  Increased problem solving ability  Increased energy  Increased clarity regarding OUR options for change What If Social Workers Did Meditate?  We could teach from a place of experience  Negative reactivity would be quickly identified and managed  Complex experiences could be processed without harm to our minds/bodies and spirits Preparing to Practice Other Relaxation & Meditative Techniques Yoga Massage Therapy Spiritual Rituals Meditation Deep Breathing Exercise Body Work / Progressive Relaxation Journaling Social Activity Preparing to Practice  Setting Time  Body Positioning  Use of a Focal Point for Concentration – Breath, candle, mantra Exploring Your Style  Active – Yoga, Walking, Energy Release  Guided Passive – Imagery, visualization  Integrative – Moving into void Exploring Your Style  What rises to the surface when you become still?  Do you become aware of being “exhausted”?  What are the messages that your body conveys, (tension, pain, emptiness, gratitude)? Three Steps Into Meditation 1. Quieting our bodies 2. Quieting out minds 3. Opening our hearts Deep Breathing Technique 1. Breathe in slowly through your nose (count to five)  Imagine the air going into your stomach and feel it expand gently 2. Slowly exhale through your mouth (count to five)  Picture the air emptying out of your stomach Deep Breathing Technique  Repeat 10 times or until symptoms subside Note: If breath is difficult, focus on slowing your heart rate or using other relaxation techniques Steps to Self Directed Meditation  Step 1  Selecting a quiet place free from noise and distraction Steps to Meditation  Step 2  Sitting or resting quietly with eyes closed Steps to Meditation  Step 3  Focusing on slowing the breath by deep breaths in and out slowly (if breath is difficult focus on slowing your heart rate) Steps to Meditation  Step 4  Progressively relaxing all muscles in the body Steps to Meditation  Step 5  Paying attention to where tension still exists and repeat step 4 Steps to Meditation  Step 6  Repeating positive thoughts with every breath in and breathing out the tension (i.e. “I am breathing in strength and peace and breathing out the tension and stress”. Can also be a time of prayer, i.e. repeating your favorite verse or just spending quiet time with your spiritual connection) Progressive Relaxation  The muscle groups are tightened and relaxed one at a time in a specific order. (Breathing in tighten for 5-8 – feet – calves – thighs/hamstrings – buttocks – abdomen – chest/shoulders – forearms/hands – face seconds and then release breath and the tension) Progressive Relaxation  While releasing the tension, focus on the changes you feel when the muscle group is relaxed  Imagery may be helpful while you release tension (imagine stressful feelings releasing out of your body as you relax)  Repeat exercise in areas where tension still remains Meditation Setting the Stage for Your Practice  Set Realistic Goals: If you have never been one to be quiet or reflective, no more than 10 minutes per day of contemplation is realistic. Longer periods may lead to discouragement. Setting the Stage for Your Practice  Read Inspirational Material: Read whatever inspires you or whatever you think may inspire you. For some, this may be a religious book such as the Bible or the Upanishads. For others, it may be poetry or song. Inspiration is a unique individualized quality that only you can unlock for yourself. Setting the Stage for Your Practice  Surround Yourself with Things That Have Deeper Meaning: As with the inspirational material, use whatever provides or hints at a deeper meaning for you. It may be a photograph. It may be a bracelet, a ring, or a rosary. Whatever it is, it should help you get closer to your “center”. Setting The Stage for Your Practice  Be Open To Your Patient as a Spiritual Teacher. Everyday we are exposed to people who are in crisis. Frequently, the same people expose us to grace and peace in the midst of chaos. Being open to them as spiritual teachers permits us to learn from their experiences. Setting The Stage for Your Practice  Plan for conversations with friends or colleagues that address deeper meaning, not just issues around work, so you have someone to talk to. Final Thought As social workers, we have a responsibility to our patients to stay true to ourselves and allow the time to struggle with hard questions, to rejuvenate, to find joy, and to come to peace with life struggles. Research Resources Resources:  American Cancer Society: www.cancer.org  CancerGuide by Steve Dunn: http://www.cancerguide.org  National Cancer Institute: www.cancernet.nci.nih.gov  National Center for CAM: http://nccam.nih.gov/  University of Texas Center for Alternative Medicine Research in Cancer:  http://www.mdanderson.org/departments/cimer/  Health Journeys:  http://www.healthjourneys.com Alternative/Unproved Methods Information:  National Council Against Health Fraud: http://www.ncahf.org  Quackwatch: http://www.quackwatch.com Articles Showing Positive Effects of Meditation  Baider L, Uziely B, Kaplan De-Nour A: Progressive muscle relaxation and guided imagery in cancer patients. Gen Hosp Psychiatry 16:340-347, 1994  Kabat-Zinn J, Massion AO, Kristeller J, et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry 1992;149:936-43 Articles Showing Positive Effects of Meditation  National Institute of Health: Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia http://consensus.nih.gov/ta/017/017ta_statement.pdf  Holland J, Morrow G, Schmale A, et al: A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J Clin Oncol 9:1004-1011, 1991 Recommended Resources  Belleruth Naparstek, : tapes on www.healthjourneys.com  Full Catastrophe Living by Jon Kabat-Zinn. A Practical guide to mindfulness meditation and healing, using the wisdom of your body and mind to face pain, stress and illness; based on his work at the Stress and Pain Clinic at the U. of Massachusetts Medical Center. by Joh Kabat-Zinn. The practice of mindfulness mediation in everyday life. Stories, anecdotes, poems.  Wherever You Go, There You Are  The Miracle of Mindfulness by Thich Nhat Hanh. Basic book on mindfulness meditation.  Peace is Every Step by Thich Nhat Hanh. Mindfulness in everyday life. A wonderful collection of personal anecdotes, stories, and experiences from his own life that show the reader how to attain awareness and peace. Recommended Resources  The Four Agreements  Instant Calm by Miguel Don Ruiz. Techniques to live a peaceful life. by Paul Wilson. A complete collection of calming techniques that are easy to use. by Daniel Goleman. The author argues that our emotions play a much greater role in thought, decision making and individual success than is commonly acknowledged. by Dan Millman. A story of a world champion athlete who is guided by a powerful old man who teaches Millman what it means to live like a peaceful warrior.  Emotional Intelligence  Way of the Peaceful Warrior Bibliography  Astin J: Stress reduction through mindfulness meditation. PsychotherPsychosom 66:97–106, 1997  Austin JA. Stress reduction through mindfulness meditation: effects on psychological symptomatology, sense of control, and spiritual experience. Psychother Psychosom 1997;66:97-106.  Baider L, Uziely B, Kaplan De-Nour A: Progressive muscle relaxation and guided imagery in cancer patients. Gen Hosp Psychiatry 16:340–347,1994  Holland J, Morrow G, Schmale A, et al: A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J Clin Oncol 9:1004–1011, 1991 Bibliography  Kabat-Zinn J, Massion AO, Kristeller J, et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry 1992;149:936-43.  Loscalzo M. Psychological Approaches in the Management of Pain in Patients with Advanced Cancer. Hematology/Oncology Clinics of North America (Pain and Palliative Care), Vol. 10, No. 1, 1996  National Institute of Health: http://home.mdconsult.com/das/journal/view/26940698/ N/12074347?source=MI  Spiritual role in healing. An alternative way of thinking. Boudreaux ED - Prim Care - 01-Jun-2002; 29(2): 439-54, viii From NIH/NLM MEDLINE