Dr Kamila Hortynska Clinical Psychologist, CBT Therapist Mindfulness Teacher and Trainer

1. GP Burnout Special: How can we help ourselves and one another using mindfulness?A mini introduction Dr Kamila Hortynska Clinical Psychologist, CBT Therapist Mindfulness Teacher and Trainer 27th April 2017

2. Definition and context • The relevant findings and recommendations from of the evidence base review of MBIs commissioned by West CCG indicate that mindfulness can be a helpful strategy preventing burnout and building resilience in healthcare professionals. • Mindfulness is a form of attention and awareness training that helps people relate more effectively to their experiences. • Growing interest in mindfulness-based approaches and growing evidence base for their effectiveness in • physical health problems • mental health problems • work performance and employees stress reduction

3. What does it involve? Mindfulness involves paying attention to thoughts, feelings and body sensations in a way that increases awareness, acceptance and self-compassion in order to help manage difficult experiences, and create space to make wiser choices. It promotes self-regulation defined as individual’s capacity to effectively manage their thoughts, emotions, behaviours and to cope with adversity in their environment

4. What mindfulness is not: • Not a relaxation activity or just ‘sitting still’ • Not just focusing on breath as a distraction from anything else that is present • Not a trance experience or a manifestation of religious faith • Not about trying to be calm, relaxed, at peace, etc

5. Practice example 1 -Mindful Mintue

6. What benefits one can expect? • To take time out, and get relief, from preoccupations and worries • To tolerate difficult feelings, physical sensations or pain • To experience life more directly and step out of the relentless commentary of our thoughts • To feel more alive, engaged and happy • To feel less stuck and drained • To be more compassionate • To improve relationships with others

7. Key features of the training • Attention and concentration training - exercising our capacity for wide or narrow focus of attention • Developing skills in mind and body awareness – noticing and noticing that you are noticing • Working with direct experience in the present moment rather than thinking about the experience • Developing acceptance and openness to experiences • Letting go of the impulse to avoid, control or hold onto thoughts and feelings • Cultivating compassion and practicing a non-judgemental attitude especially suspending self criticism

8. Mindfulness and healthcare professionals The recent meta-analysis of the effectiveness of MBIs with healthy individualsfound that among all reviewed target populations, healthcare professionals benefited the most. (Kohury et al, 2013). Specific benefits reported for: general well-being, better self care, higher job satisfaction, lower experiences of burnout and reductions in perceived stress

9. Doctors’ psychological well-being Simone and Durand-Bush (2015) suggest that clinicians should consider developing self-regulation skills in order to maintain adequate level of health and well-being. They found that the more physicians effectively managed themselves and their environment the higher they scored on all well-being dimensions. The most recent systematic review of interventions to improve psychological well-being of GPs (Murray, Murray & Donnelly, 2016) found only 4 relevant studies (2 used CBT , 1 MBI and 1 simply fed-back GHQ scores and self-help info). The authors called for more high quality research and changing the focus from mental illness prevention to mental health promotion.

10. Mindfulness and GPs Two recent studies on GPs: • RCT of 42 Spanish physicians (Amutio et al, 2015) found significant improvements on levels of relaxation and other positive psychological states among those who completed an 8week mindfulness course with additional 10-month maintenance period. Change magnitudes significantly increased at 1 year follow up. • Controlled pre-post mixed method study of 43 Dutch GPs (Verweij et al, 2016) found that 8 week mindfulness course resulted in fewer burnout symptoms and increased work engagement and well-being. Qualitative data indicate that it also increased compassion towards self and others (including patients).

11. Local experiences • So far 2 courses have been offered • 28 GPs completed the training • No drop outs, and attendance was very high • The evaluation of the first course showed statistically significant improvements in 3 measures: • Perceived Stress Scale • Mindfulness Attention and Awareness Scale • Brief Resilience Scale • Feedback was super positive

12. Quotes from local GPs • It has helped me appreciate my life so much more. To be able to recognize stress and manage that stress is amazing. My mood has lifted. I feel kinder to myself and others. • This course has been life-changing. It has given me the tools and skills to be more self-aware, to manage my personal stress and anxiety and to understand myself better. • It has made me realize the very high stress levels I have been working at. Then it has provided me with the skills I need to manage this stress, live happier and enjoy each day. • The course has been very important to me as it has shown me another way of looking at my life and dealing with stresses and difficulties. It has given strategies which I can use and call upon in times of stress as well as making me appreciate the joys of life. • It has opened my mind to lots of choices and possibilities for the future. I am appreciating my family relationships and friends so much more and feel less irritated by things that are really not important.

13. Quotes from local GPs 2 • It has made me more aware of my own feelings/thoughts. Allowed me to acknowledge my thoughts and also taught me not all my thoughts are real. Allowed me to deal with my recurring thoughts and acknowledge they are there and it’s OK. • Coming back to mindfulness has taught me new things that I didn’t know – thoughts are not facts. This has helped with my mood better than Sertraline ever has and has given me a sense of self-determination and self-healing; it’s my choice. • I have realized that I am not alone in my anxieties re work and life. I have gained practical experience of mindfulness. • A new way of life – slowing down, enjoying life in all aspects, recognizing stress early on and taking positive steps to manage this. • I learnt that it is not a given that unpleasant feelings and physical symptoms are there. I learnt to work with them and breathe into painful feelings and miraculously they became less noticeable.

14. Quotes from local GPs 3 • I learned how to be more accepting of my own feelings and of the inevitable ups and downs of life. I also clearly learned the necessity of ‘weaving the parachute before jumping out of the plane’. • I thought I was the only one and this has made it difficult to talk about it or access help for the fear of stigma or GMC referral. Also that my own reactions etc. have the greatest impact on my mood and well-being. • I am able to live better with uncertainty and have learned to relax, be there to myself and confront difficult feelings which in turn have made them less difficult. • I’ve learned so much about how to look after myself in a positive way. I will promote this course to all my friends and colleagues. • Could not have predicted impact of using breathing and physical techniques to increase awareness of self and the fact that I can use such techniques to help how I feel. • I feel I am making better decisions as I am not stressed when seeing patients.

15. Quotes from local GPs 4 • This course has really helped me both professionally and personally. It has allowed me to accept certain things about myself and my life and helped me find joy in the little things again • I have gained so much from this course. I’ve learnt how to be kind to myself and recognize early on when I need to look after myself. I learnt how recurring thoughts of self-doubt and criticism had impacted my confidence levels and now I can recognize these as thoughts not facts and that is so freeing. • Now I feel more able to cope with everyday stresses through self-care, responding not reacting, remembering to breathe and being more aware of small positive moments in life. • It has helped me to manage stress, make conscious choices and stop trying to do everything myself. • My family says I’m calmer, that I seem happier. • I appreciate my family more and focus on happy/nourishing things for the whole family.

16. Quotes from local GPs 5 • Meditation practices give a calming effect on body/mind. It partially reduced stress in home/work life. • It has allowed me to recognize all the ‘nourishing’ things/actions that I’m already doing. I feel a lot calmer and more relaxed. I recognize thoughts as just that. • It has changed the way I relate to my thoughts. I am no longer consumed with worrying thoughts. • It has allowed me to understand how good my life is and how the bad parts are something to allow and not avoid, as is in my learned behaviour. • I feel calmer, less stressed. • Very quick and easy techniques to help with worry, upset and stress. • Feel so much calmer, more relaxed. Feel more positive things are happening to me. • Calmer in the face of stressful patients/days and also less worry about the future.

17. Practice example 2 -Mindfulness of Breath & Body

18. Books to get you started • Mindfulness: A Practical guide to finding peace in frantic world. Williams & Penman • Wherever you go there you are: Mindfulness meditation in everyday life. Jon Kabat-Zinn • Mindfulness for Dummies Shamash Alidina • Stop Physician Burnout: What to Do When Working Harder Isn't Working Dike Drummond • Hardwiring Happiness or Buddha’s Brain. Rick Hanson

19. Useful websites and apps • The Mental Health Foundation’s website has information about the clinical application of mindfulness. It also provides links to mindfulness courses for common mental health difficulties around the country as well as teachers profiles www.bemindful.co.uk • General information on mindfulness, along with information on the neuroscience of mediation practicewww.mindfulnet.org • Free mindfulness resources, guided mediations and downloads www.freemindfulness.org • Headspace, Insight Timer or visit www.mindful.org/free-mindfulness-apps-worthy-of-your-attention

20. Thank you Questions? Comments? Reflections? kamilahort@hotmail.com www.leedscbt.co.uk