Interviews

Robert Cowan, MD Neurology Professor How do you think being mindful has changed you as a physician and as a person? Probably a better question to ask my wife and patients. The shortest answer is that I am a happier guy, spend much less time pissed off or frustrated, and am better able to deal with the unexpected, unresolvable, and unfortunate. What attracted you to mindfulness? I may  not be the best person to talk about mindfulness in any structured way. While I have read extensively on it, I am not a "practitioner" in any sense in that I do not meditate or participate in any of the martial arts or anything like that. I am not a very mystical guy. What attracts me to mindfulness is that it unshackles you from past behaviors and fears of the future and frees you to be here now, as Alan Watts used to say. This is particularly important for people who experience episodic, chronic pain. Why do you think more and more physicians are looking into this topic for themselves and their patients? Medicines are good, but you don't have to do what we do for very long to realize medicine alone does not heal. Mindfulness, as well as biofeedback, counseling, arts like Tai Chi and Yoga, are essential to move from the sick state to health. Physicians have a long tradition in every culture of cleaving to what works. Sometimes, we even figure out why it works, but that is another story. How long have you been interested in the subject of mindfulness? To be honest, I didn't know I was interested in mindfulness until my nurse practitioner, a practicing Buddhist, told me that much of what I was counseling my patients to do was to practice mindfulness.  As you know, there are many paths, and mine is typically circuitous and meandering. I seem to have come to mindfulness through my own struggles in dealing with pain and the vicissitudes of life. The more time you spend in the present, the better off you are. I think the subject of mindfulness is the subject of living in the moment and I have been interested in that for a long time. How do you incorporate mindfulness into your daily life? My approach is a mish-mosh of things that work for me. I like technology. I have an alert on my computer that goes off every hour. It reminds me to stop what I am doing, assess my body posture, breathing, thought processes, etc. I find ritual very helpful, so I try to maintain certain patterns in my daily activities, including exploring new things. Over the years I have gotten pretty good at self-monitoring my reactive self and letting the  negative stuff go. Not always, but usually.

Alec Palmerton Medical Student What do you feel are the benefits to you from learning mindfulness? It's difficult for medical students to justify spending time on "wellness" when there are so many demands for our time.  What I have come to see more, however, is that the more you are able to incorporate the principles of mindfulness into your routine, the better student you will become.  Case-in-point - while studying for/taking Boards, instead of getting worried and letting my thoughts run away with me, I was able to focus and remain much more calm and present.  We spend so much time in lecture, reading, studying, etc. that a small increase in efficiency through mindfulness, if compounded over many hours, can increase our productivity while simultaneously helping us to relieve stress, improve sleep, and reap the myriad other benefits that have been associated with regular mindfulness practice. You have spent a lot of time and effort getting mindfulness classes set up for med students. How worthwhile has this seemed to you? Very much so.  Our main goal with setting up mindfulness classes was to expose students to the subject and to get the ball rolling.  We wanted to create an organization that could grow to match the needs of busy medical students.  We already have 60% more students registered for the class this year than last year at the same period, and we hope to continue to reach more and more students. How do you find the time to incorporate mindfulness practice into your busy schedule? It is difficult.  For the class, we receive several CDs that walk us through various mindfulness techniques.  Because of the variability of my schedule during the day, I decided to listen to one of the CDs every night when I go to bed.  It ensures that I practice mindfulness every single day.  Plus, I have never had more restful sleep. How will this help you as a physician? I hope to apply mindfulness to every aspect of my future practice, but the aspect I am most keen on is in listening.  It is always a challenge to be fully present and actually listen to everything the patient is saying, and not allow my mind run away and prevent me from forming a connection.  The practice of mindfulness helps us both to recognize when this is occurring, and to return to the present more easily.

Resources

Classes

Psych 233
Mindfullness: An Awareness-Based Stress Reduction Program in Medicine
Contact mindfulness instructor Mark Abramson (650-498-5566) to form additional classess for healthcare practitioners

Athletic 18
Strengthening the Heart through Compassion

Campus Mindfulness - HIP
Mindfulness Class - class code msm-01
Mindfulness at Work Class - class code msmw-01

Community Mindfulness-Based Stress Reduction Classes
Stanford Center for Integrative Medicine
Palo Alto Medical Foundation
El Camino Hospital
O'Connor Hospital
In addition, there are periodic classes in Mindful Yoga, Mindful Qi Gong, and Mindful Parenting - contact mindfulness instructor Bob Stahl

Search for Classes
Find a program nationally or internationally

Groups

Listserve
Sign up at stanfordmindfulness@yahoogroups.com

Weekly mindful practice group
Tuesdays 6-6:45pm LKSC 130

Information

Self Assessment
Mindfulness Quiz - Greater Good Science Center, UCB

Videos
What is mindfulness? 2:21min Jon Kabat-Zinn
Mindfulness - Life is Right Now 7:14min Jon Kabat-Zinn
Cognitive Neuroscience of Mindfulness Meditation 48:54 min Dr. Philipe Golden, Stanford
The Science of Self-Compassion 1:02 hrs Kristin Neff, PhD
Conversations on Compassion with Dr. James Doty and Jon Kabat-Zinn 1:03 hrs (Stanford Center for Compassion and Altruism Research and Education)

Books
Kabat-Zinn, Jon, Wherever You Go There You Are, 2005, ISBN:1401307787

Tips
Mindful Eating
Nine Tips for Mindfulness from UCLA Semel Institute for Neuroscience
Ten Simple Ways to Practice Mindfulness each Day - MBMI
The Health Benefits of Compassion from BeWell

Tools:
Set computer bell to signal taking a brief break
Mindful meditation apps, online free mp3 files, and commercial CDs are available

 

Research

General

Mindfulness in medicine.  Ludwig DS, Kabat-Zinn J. JAMA. 2008 300(11):1350-2. PMID: 18799450.

Clinician mindfulness and patient safety. Sibinga EM, Wu AW. JAMA. 2010 304(22):2532-2533. PMID: 21139116.

Demystifying mindfulness. Lawson K. Minn Med. 2011 94(1):37-9. PMID: 21366106.

Medical Trainees

A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Warnecke E, Quinn S, Ogden K, Towle N, Nelson MR. Med Educ. 2011 45(4):381-8. PMID: 21401686.

Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program. Hassed C, de Lisle S, Sullivan G, Pier C. Adv Health Sci Educ Theory Pract. 2009 14(3):387-98. PMID: 18516694.

Mindfulness-based stress reduction lowers psychological distress in medical students. Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M. Teach Learn Med. 200315(2):88-92. PMID: 12708065.

Effects of mindfulness-based stress reduction on medical and premedical students. Shapiro SL, Schwartz GE, Bonner G. J Behav Med. 1998 21(6):581-99. PMID: 9891256.

Component processes of executive function-mindfulness, self-control, and working memory-and their relationships with mental and behavioral health. Black DS, Semple RJ, Pokhrel P, Grenard JL. Mindfulness (N Y). 2011 2(3):179-185. PMID: 22013495.

Mindfulness and health behaviors: is paying attention good for you? Roberts KC, Danoff-Burg S. J Am Coll Health. 2010 59(3):165-73. PMID: 21186446.

Teaching self-care to caregivers: effects of mindfulness-based stress reduction on the mental health of therapists in training. Shapiro SL, Brown KW, Beigel GM. Training and Education in Professional Psychology.  2007 1(2):105-115. Link

Viewpoint: reflections on a well-traveled path: self-awareness, mindful practice, and relationship-centered care as foundations for medical education. Dobie S. Acad Med. 2007 82(4):422-7. PMID: 17414201.

Curiosity and medical education. Dyche L, Epstein RM. Med Educ. 2011 45(7):663-8. PMID: 21649698.

Faculty

Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, Quill TE. JAMA. 2009 23;302(12):1284-93. PMID: 19773563.

Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care. Shanafelt TD. JAMA 2009. 302(12):1338-1340.  PMID: 19773573.

Cultivating mindfulness in health care professionals: a review of empirical studies of mindfulness-based stress reduction (MBSR). Irving JA, Dobkin PL, Park J.  Complement Ther Clin Pract. 2009 15(2):61-6. PMID: 19341981.

Stress management and balance for the orthopaedic surgeon: mindfulness.  Esch JC. Instr Course Lect. 2011;60:627-31. PMID: 21553805.

The Claude Organ Memorial Lecture: the practice of surgery: surgery as practice.  Brandt ML.
Am J Surg. 2009 198(6):742-7. PMID: 19969123.

Trauma

Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Thompson RW, Arnkoff DB, Glass CR. Trauma Violence Abuse. 2011 12(4):220-35. PMID: 21908440.

Impact of mindfulness on the neural responses to emotional pictures in experienced and beginner meditators. Taylor VA, Grant J, Daneault V, Scavone G, Breton E, Roffe-Vidal S, Courtemanche J, Lavarenne AS, Beauregard M. Neuroimage. 2011 57(4):1524-33. PMID: 21679770.

Mindfulness is associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems in urban firefighters. Smith BW, Ortiz JA, Steffen LE, Tooley EM, Wiggins KT, Yeater EA, Montoya JD, Bernard ML. J Consult Clin Psychol. 2011 79(5):613-7. PMID: 21875175.

Mood

Effects of mindfulness on psychological health: a review of empirical studies.  Keng SL, Smoski MJ, Robins CJ. Clin Psychol Rev. 2011 31(6):1041-56. PMID: 21802619.

Treating chronic worry: Psychological and physiological effects of a training programme based on mindfulness.  Delgado LC, Guerra P, Perakakis P, Vera MN, Reyes del Paso G, Vila J. Behav Res Ther. 2010 48(9):873-82. PMID: 20541180.

Minding one's emotions: mindfulness training alters the neural expression of sadness.  Farb NA, Anderson AK, Mayberg H, Bean J, McKeon D, Segal ZV. Emotion. 2010 10(1):25-33. PMID: 20141299.

Effects of mindfulness on meta-awareness and specificity of describing prodromal symptoms in suicidal depression. Hargus E, Crane C, Barnhofer T, Williams JM. Emotion. 2010 10(1):34-42. PMID: 20141300.

The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Piet J, Hougaard E.
Clin Psychol Rev. 2011 31(6):1032-40. PMID: 21802618.

Substance Use Disorders

Mindfulness impairments in individuals seeking treatment for substance use disorders.  Dakwar E, Mariani JP, Levin FR. Am J Drug Alcohol Abuse. 2011 37(3):165-9. PMID: 21410417.

Mindfulness-based treatments for co-occurring depression and substance use disorders: what can we learn from the brain? Brewer JA, Bowen S, Smith JT, Marlatt GA, Potenza MN. Addiction. 2010 105(10):1698-706. PMID: 20331548.

Brain Effects

Mindfulness meditation improves cognition: evidence of brief mental training. Zeidan F, Johnson SK, Diamond BJ, David Z, Goolkasian P. Conscious Cogn. 2010 19(2):597-605. PMID: 20363650.

Manipulating attention via mindfulness induction improves P300-based brain-computer interface performance. Lakey CE, Berry DR, Sellers EW. J Neural Eng. 2011 8(2):025019. PMID: 21436516.

Mindfulness practice leads to increases in regional brain gray matter density.  Hölzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, Lazar SW.  Psychiatry Res. 2011 191(1):36-43. PMID: 21071182.

Impact of Mindfulness-Based Stress Reduction training on intrinsic brain connectivity.  Kilpatrick LA, Suyenobu BY, Smith SR, et al. Neuroimage. 2011 56(1):290-8. PMID: 21334442.

Effects of mindfulness meditation training on anticipatory alpha modulation in primary somatosensory cortex. Kerr CE, Jones SR, Wan Q, et al. Brain Res Bull. 2011 85(3-4):96-103. PMID: 21501665.

Other Physiologic Effects

Brain mechanisms supporting the modulation of pain by mindfulness meditation. Zeidan F, Martucci KT, Kraft RA, Gordon NS, McHaffie JG, Coghill RC. J Neurosci. 2011 31(14):5540-8. PMID: 21471390.

Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres. Epel E, Daubenmier J, Moskowitz JT, Folkman S, Blackburn E. Ann N Y Acad Sci. 2009 1172:34-53. PMID: 19735238.

Mindfulness intervention for stress eating to reduce cortisol and abdominal fat among overweight and obese women: an exploratory randomized controlled study.  Daubenmier J, Kristeller J, Hecht FM, Maninger N, Kuwata M, Jhaveri K, Lustig RH, Kemeny M, Karan L, Epel E. J Obes. 2011;2011:651936. PMID: 21977314.

Genomic counter-stress changes induced by the relaxation response.  Dusek JA, Otu HH, Wohlhueter AL, Bhasin M, Zerbini LF, Joseph MG, Benson H, Libermann TA.  PLoS One. 2008 3(7):e2576. PMID: 18596974.

Enhanced psychosocial well-being following participation in a mindfulness-based stress reduction program is associated with increased natural killer cell activity.  Fang CY, Reibel DK, Longacre ML, Rosenzweig S, Campbell DE, Douglas SD. J Altern Complement Med. 2010 16(5):531-8. PMID: 20455784.

Effects of brief and sham mindfulness meditation on mood and cardiovascular variables. Zeidan F, Johnson SK, Gordon NS, Goolkasian P.  J Altern Complement Med. 2010 16(8):867-73. PMID: 20666590.

QOL/Relationships

Measurement of quality of life and participant experience with the mindfulness-based stress reduction program.  Flugel Colle KF, Vincent A, Cha SS, Loehrer LL, Bauer BA, Wahner-Roedler DL. Complement Ther Clin Pract. 2010 16(1):36-40. PMID: 20129408.

The role of mindfulness in romantic relationship satisfaction and responses to relationship
stress.  Barnes S, Brown KW, Krusemark E, Campbell WK, Rogge RD. J Marital Fam Ther. 2007 33(4):482-500. PMID: 17935531.

Mindfulness-based childbirth and parenting education: promoting family mindfulness during the perinatal period.  Duncan LG, Bardacke N.  J Child Fam Stud. 2010 19(2):190-202. PMID: 20339571.