Can Mindfulness Meditation Deliver Us From Burnout?

http://blogs.aafp.org/cfr/leadervoices/entry/can_mindfulness_meditation_deliver_us

What do you do for fun? This is an important question I have started to ask patients so I can get to know them better and assess whether they find joy in their lives. I appreciate that the absence of joy can be a significant contributor to absence of personal health and sense of wellness.

I often wonder if we should be asking our physician colleagues the same question. A recent survey of nearly 36,000 physicians found that 63 percent of family physicians suffer from at least one symptom of burnout, an increase of 12 percent in just three years.

Not surprisingly, the same survey, which was published in December in Mayo Clinic Proceedings, found that physician satisfaction with work-life balance was falling nearly as fast as burnout was rising. The percentage of family physicians who were satisfied with their work-life balance in this survey was roughly 35 percent, which was down from 50 percent in the previous study done three years earlier.

Although the AAFP, its constituent chapters and other physician organizations are working hard to address the many drivers of burnout that exist in our external environment -- including electronic health records, reimbursement and administrative burden -- it also is important that we, as physicians, ask ourselves what else we can do to survive and thrive amidst the current chaos.

A growing body of evidence points to mindfulness meditation and practicing the principles of mindfulness-based stress reduction as a key answer to this important question.

Back in 2013, there already was ample evidence that mindfulness meditation could help people reduce stress when researchers at Carnegie Mellon University used MRI scans to show that the process, after just eight weeks, appeared to shrink the amygdala and thicken the prefrontal cortex. In other words, participants' connection to their fight-or-flight response got weaker as their attention and concentration improved. Researchers reported that the scale of these changes correlated with the amount of time spent on meditation.

Earlier this year, a research team that included the authors of that 2013 study found that mindfulness meditation stimulated areas of the brain that may help control emotional reaction and attention and decreased blood levels of interleukin-6, which is associated with inflammatory disease risk, meaning the process may protect participants' from emotional distress and decrease inflammation.

Yet another study published last fall in the Journal of Continuing Education in the Health Professions found that participants' heart rate, blood pressure and Maslach Burnout Inventory scores improved after eight weeks of mindfulness meditation, and results continued during a 10-month followup period with low attrition and high compliance rates.

Not surprisingly, I'm hearing more and more about mindfulness wherever I go. Daniel Friedland, M.D. recently gave a presentation on how mindfulness can play a role in leadership during the AAFP's Annual Leadership Conference. And Renee Crichlow, M.D., an assistant professor in the department of family medicine and community health at the University of Minnesota in Minneapolis, recently presented the evidence for using mindfulness meditation to prevent burnout at the Minnesota AFP's annual meeting. 

Skeptics might be reluctant to invest time on something they aren't sure about, and maybe you aren't comfortable with the idea of sitting in the lotus position and getting in touch with yourself. The good news is there are plenty of free resources to help you get started and you can practice mindfulness meditation in whatever position is comfortable for you in just few minutes a day.

As this short video on the basics of meditation from Happifyhealth.com says, meditation is simple, secular, scientifically validated exercise for your brain. Another short YouTube video from Happify explains whymindfulness is a powerful tool for your well-being.

If meditation isn't for you, there are other options to reduce stress and build resiliency. A Minnesota community that lost two physicians in a short time period -- including one to suicide -- started a Bounce Back campaign that aims to improve physician and public health by making the community a happier place. The initiative encourages people of all ages to perform random acts of kindness.

Family Practice Management recently published a three-part series by family physician and burnout expert Dike Drummond, M.D., that covers recognizing symptoms and causes of stressreducing stress and work-life balance. All three articles are eligible for AAFP Prescribed CME credit for one year from the date of publication.

I appreciate that none of these tools is going to improve reimbursement, make payers more reasonable about prior authorizations or improve the interoperability of our electronic health records systems. However, these tools can help us be the best we can be in our "inner space" while we struggle to eliminate the challenges and burdens that occupy the "outer space" of our practice of medicine. After all, if we can't take care of ourselves, we won't have anything left to care for others.

Lynne Lillie, M.D., is a member of the AAFP Board of Directors.

Harvard Business Review Mindfulness Can Literally Change Your Brain

by Christina Congleton, Britta K. Hölzel, and Sara W. Lazar

https://hbr.org/2015/01/mindfulness-can-literally-change-your-brain

The business world is abuzz with mindfulness. But perhaps you haven’t heard that the hype is backed by hard science. Recent research provides strong evidence that practicing nonjudgmental, present-moment awareness (a.k.a. mindfulness) changes the brain, and it does so in ways that anyone working in today’s complex business environment, and certainly every leader, should know about.

We contributed to this research in 2011 with a study on participants who completed an eight week mindfulness program. We observed significant increases in the density of their gray matter. In the years since, other neuroscience laboratories from around the world have also investigated ways in which meditation, one key way to practice mindfulness, changes the brain. This year, a team of scientists from the University of British Columbia and the Chemnitz University of Technology were able to pool data from more than 20 studies to determine which areas of the brain are consistently affected. They identified at least eight different regions. Here we will focus on two that we believe to be of particular interest to business professionals.

The first is the anterior cingulate cortex (ACC), a structure located deep inside the forehead, behind the brain’s frontal lobe. The ACC is associated with self-regulation, meaning the ability to purposefully direct attention and behavior, suppress inappropriate knee-jerk responses, and switch strategies flexibly. People with damage to the ACC show impulsivity and unchecked aggression, and those with impaired connections between this and other brain regions perform poorly on tests of mental flexibility: they hold onto ineffective problem solving strategies rather than adapting their behavior. Meditators, on the other hand, demonstrate superior performance on tests of self-regulation, resisting distractions and making correct answers more often than non-meditators. They also show more activity in the ACC than non-meditators. In addition to self-regulation, the ACC is associated with learning from past experience to support optimal decision-making. Scientists point out that the ACC may be particularly important in the face of uncertain and fast-changing conditions.

The second brain region we want to highlight is the hippocampus, a region that showed increased amounts of gray matter in the brains of our 2011 mindfulness program participants. This seahorse-shaped area is buried inside the temple on each side of the brain and is part of the limbic system, a set of inner structures associated with emotion and memory. It is covered in receptors for the stress hormone cortisol, and studies have shown that it can be damaged by chronic stress, contributing to a harmful spiral in the body. Indeed, people with stress related disorders like depression and PTSD tend to have a smaller hippocampus. All of this points to the importance of this brain area in resilience—another key skill in the current high demand business world.

These findings are just the beginning of the story. Neuroscientists have also shown that practicing mindfulness affects brain areas related to perception, body awareness, pain tolerance, emotion regulation, introspection, complex thinking, and sense of self. While more research is needed to document these changes over time and to understand underlying mechanisms, the converging evidence is compelling.

Mindfulness should no longer be considered a “nice-to-have” for executives. It’s a “must have”: a way to keep our brains healthy, to support self-regulation and effective decision making capabilities, and to protect ourselves from toxic stress. It can be integrated into one’s religious or spiritual life, or practiced as a form of secular mental training. When we take a seat, take a breath, and commit to being mindful, particularly when we gather with others who are doing the same, we have the potential to be changed.

Ohio State Study: ICU Nurses Benefit From Workplace Intervention To Reduce Stress

ICU Nurses in Ohio taking steps towards decreasing burnout in highly stressful workplaces. 

COLUMBUS, Ohio – A study by researchers at The Ohio State University Wexner Medical Center found that a workplace mindfulness-based intervention reduced stress levels of employees exposed to a highly stressful occupational environment.

Members of a surgical intensive care unit at the large academic medical center were randomized to a stress-reduction intervention or a control group. The 8-week group mindfulness-based intervention included mindfulness, gentle stretching, yoga, meditation and music conducted in the workplace. Psychological and biological markers of stress were measured one week before and one week after the intervention to see if these coping strategies would help reduce stress and burnout among participants.

Results of this study, published in the Journal of Occupational and Environmental Medicine, showed that levels of salivary [alpha]-amylase, an index of sympathetic activation of the nervous system – also known as the fight or flight response – were significantly decreased from the first to second assessments in the intervention group. The control group showed no changes. Psychological components of stress and burnout were measured using well-established self-report questionnaires.

“Our study shows that this type of mindfulness-based intervention in the workplace could decrease stress levels and the risk of burnout,” said one of the authors, Maryanna Klatt, associate clinical professor in the department of Family Medicine at Ohio State’s Wexner Medical Center. Chronic stress and stress reactivity have been found associated with increased levels of salivary [alpha]-amylase.

“What’s stressful about the work environment is never going to change. But what we were interested in changing was the nursing personnel’s reaction to those stresses. We measured salivary alpha amylase, which is a biomarker of the sympathetic nervous system activation, and that was reduced by 40 percent in the intervention group.”

Klatt, who is a trained mindfulness and certified yoga instructor, developed and led the mindfulness-based intervention for 32 participants in the workplace setting. At baseline, participants scored the level of stress of their work at 7.15 on a scale of 1 to 10, with 10 being the most stressful. The levels of work stress did not change between the first and second set of assessments, but their reaction to the work stress did change. 

When stress is part of the work environment, it is often difficult to control and can negatively affect employees’ health and ability to function, said lead author Dr. Anne-Marie Duchemin, research scientist and Associate Professor Adjunct in the department of Psychiatry and Behavioral Health at Ohio State’s Wexner Medical Center. 

“People who are subjected to chronic stress often will exhibit symptoms of irritability, nervousness, feeling overwhelmed; have difficulty concentrating or remembering; or having changes in appetite, sleep, heart rate and blood pressure,” Duchemin said. Although work-related stress often cannot be eliminated, effective coping strategies may help decrease its harmful effects. The changes in the levels of salivary alpha-amylase suggest that the reactivity to stress was decreased after the eight-week group intervention.”

This study was funded in part by the OSU Harding Behavioral Health Stress, Trauma and Resilience (STAR) Program, part ofOhio State’s Neurological Institute. The STAR program serves as a resource for psychological trauma education and training. STAR supports innovative, interdisciplinary research focused on the causes, biological and behavioral markers, prevention and treatment approaches related to psychological trauma. 

Other Ohio State researchers involved in this study are Beth Steinberg, Donald R. Marks and Kristin Vanover.

Xpedition Health Presents at the Experience Innovation Network CXO Roundtable

On November 4, 2015 Robert Eric Dinenberg, MD, MPH, President and Chief Medical Officer, Xpedition Health presented results of a Xpedition Health Mindful Lifestyle Program at the Experience Innovation Network CXO Roundtable.  

Vocera’s Experience Innovation Network works in partnership with Stanford Clinical Excellence Research Center to foster adoption of solutions that revolutionize healthcare experience and outcomes.  Leaders of over 40 healthcare organizations met at the November CXO Roundtable to accelerate the discovery and adoption of innovations that meet the Quadruple Aim of improving population health, elevating patient-centered care, and reducing costs while restoring joy to the practice of medicine.

Dr. Dinenberg presented results of a Xpedition Health Mindful Lifestyle Program that was delivered to healthcare providers.  This innovative program delivered a mindfulness course to clinicians via an in-person 8-hour retreat followed by a 6-week remote follow-up program that clinicians accessed by mobile phone.  Clinicians completing before and after surveys demonstrated significant improvements in mindfulness, burnout, and satisfaction with medicine.

These results demonstrate how an innovative program can begin to heal healthcare.  Clinicians who are more mindful, who enjoy more satisfaction with medicine, and who suffer from less burnout are more likely to deliver high quality patient-centered care. 

While addressing provider burnout through mobile phone accessible curriculum can transform healthcare by helping clinicians, mobile phone accessible lifestyle change programming can also be delivered directly to patients.  Xpedition Health is a virtual/remote provider of the Centers for Disease Control and Prevention (CDC)’s National Diabetes Prevention Program- delivering the evidence-based curriculum and mindfulness training directly to the mobile phones of patients with prediabetes.  

Patients and healthcare providers who do not have to look further than their own mobile phones to access evidence-based healthy lifestyle change programming are more likely to engage in healthy habits. The days of waiting for healthcare providers to suffer from so much burnout that they begin treating patients like objects may be as limited as the days of waiting (hoping) for patients to come to clinic so we can help them with healthy lifestyle change.  

Now that Xpedition Health’s evidence-based healthy lifestyle change programming is accessible by mobile phone, both patients and providers can get started from wherever they are.  In this light, in our mobile phone in hand society, we see that the Quadruple Aim of improving population health, elevating patient-centered care, and reducing costs while restoring joy to the practice of medicine is literally within our grasp.