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MINDFULNESS PRACTICE & THE LAW

RICHARD E. BERGER, MD. MINDFULNESS PRACTICE & THE LAW. Criteria for Change. Perceived need Perception that work/change required will produce desired result Benefit Greater than Cost. Perceived Need?. Battle Stress / Efficiency and Exhaustion. Combat exhaustion. Soldier becomes.

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MINDFULNESS PRACTICE & THE LAW

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  1. RICHARD E. BERGER, MD MINDFULNESS PRACTICE & THE LAW

  2. Criteria for Change • Perceived need • Perception that work/change required will produce desired result • Benefit Greater than Cost

  3. Perceived Need?

  4. Battle Stress / Efficiency and Exhaustion Combat exhaustion Soldier becomes Hyper-reactive "battlewise" stage Period of Emotionalexhaustion maximumefficiency stage Period of overconfidence Degreeofcombat Vegetativephase 0 10 20 30 40 50 60 Days in combat (c) Lipsenthal 2011 Swank and Marchland 1946; redrawn from Mind-Body Medicine, Watkins 1997

  5. Predictors of Job Dissatisfaction in Lawyers ( approx. 25%) • Emotional Exhaustion and Burnout • Stress due to clients • Work load • Litigious > non-litigious • Female > Male Sharma et al 2010, Tsai et al 2009

  6. Law Practice & Secondary PTSD Levin et al. J NervMentDis 2011;199: 946Y955

  7. Surgical Error & Burnout Shanafelt et al Ann Surg 2010;251: 995

  8. In Medicine • Poor provider QOL proportional to burnout • Mistakes proportional to burnout • Patient dissatisfaction proportional to provider burnout • MBSR improves provider burnout and patient satisfaction and decreases medical mistakes.

  9. Will Mindfulness Practice Produce Results?

  10. Mental States

  11. Mindfulness: To see Clearly Intentionally paying attention in an open, accepting and discerning way

  12. Mindfulness • Paying attention in particular way • On purpose • In present moment • Openly and non-judgmentally • Alerting, re-orienting, executive control • Intention, motivation • Experiential approach • Acceptance, curiosity

  13. Mindfulness-Based Stress Reduction (MBSR) • Formal Mindfulness Practice • Breath focused • Body Scan • Attention Shifting • Compassion/Loving Kindness • Present moment awareness focus • Informal Mindfulness Practice • Pauses • Present moment shifts • Yoga

  14. Mechanisms of Mindfulness Training • Emotion Regulation • Attention Regulation • Self-Referential Processing • Self as Awareness Awareness

  15. Reperceiving • Rotation in consciousness from subject to object • Disidentify with the contents of consciousnes, thereby seeing freshly and clearly • Witness our storey rather than immersed in it

  16. Physiological consequences of stress driven by catecholamines and cortisol é heart rate é blood pressure é blood flow to muscles ê blood flow to skin é metabolic rate ê digestion é blood clotting and thickness é blood sugar é respiratory rate é fluid retention é alertness é breakdown of fats • triglycerides and LDL cholesterol (c) Lipsenthal 2011

  17. weight blood sugar bp Improved lipid profile cortisone inflammation Improved well-being, alertness pain with stress  brain size, grey matter  quality of life  concentration  learning  sleep quality  body awareness depression Changes DNA activation Burnout Effects Mindful Practices NIH conference 2009 Mind/Body Med.

  18. Emotional Response to Negative Self-Beliefs Golden et al, Emotion 2009

  19. Mindfulness Training and Memory Jha et al, Emotion 2010

  20. Pain Sensitivity in Meditators Grant et al. Emotion 2010

  21. Meditation “Bhavana” = Meaning Cultivation

  22. Brain Changes with Short Term Mindfulness Practice • Increased Prefrontal Cortex size • Increased white matter efficiency in Anterior Cingular Gyrus • Right becomes Left Amygdala predominance • Increased size insula • Increased hippocampus size and activity • Executive Function • Self-regulation • Positive emotional outlook • Perception, self-awareness, cognition • Memory Posner and Tang 2012

  23. Benefit Greater Than Cost?

  24. The Mindful Professional • Increased attention • Sustained attention and switching focus • Increases Empathy • Predictive of positive relationships and communication • Increased Self-Compassion • Compassion toward self improves compassion toward others • Increased Creativity and Problem Solving • Improved thinking in multiple perspectives and OOB • Improved Emotional Regulation • Emotions transitory and received without fear

  25. Mindfulness Practice • Results in 4-8 weeks • Practice 20-40 minutes daily • 12-24 hours of class (minimum amount unknown)

  26. END

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