By Manuel Manotas, Psy.D.
Faculty and Staff Assistance Program
Imagine you are about to make an important case presentation to your medical team. All the Residents, Fellows, your Attending and other senior faculty members are present. The room is across the hall from a very noisy nursing station and the audio/visual systems are not working; you won’t be able to use your PowerPoint presentation and you will virtually have to yell to be heard in the back of the room. Suddenly, you feel your chest tighten, your palms begin to sweat, your heart is racing and your breath shallow. You begin thinking about how your colleagues will judge you during the conference. You feel light-headed and fear kicks in--you know you are not well enough prepared! This thought pumps up your worry and you remember an old idea that you are a bad presenter. You begin to recall how terribly you have presented in the past and in your mind, you screw up this presentation too. You will do a terrible job and end up humiliated and criticized by your supervisors and colleagues. You are now frozen in fear. In this mind/body state, it will be nearly impossible for you to deliver the presentation you have so well prepared. This is an example of how easily our mind and its future-tripping habits can control us in the present. Fortunately, we can learn to observe our thoughts and feelings in the present moment without getting caught up by them. This is called mindfulness.
In 1979, at the University of Massachusetts, Jon Kabat-Zinn Ph.D., began to teach mindfulness meditation to chronic pain patients who had exhausted all other medical and surgical alternatives. He brought this 2500-year-old practice into the medical setting without the religious component of its origins and developed a curriculum, Mindfulness Based Stress Reduction (MBSR), which is now taught and researched in over 400 universities and medical centers across the United States. Research studies have demonstrated MBSR training reduces symptoms of depression, anxiety, and perceived stress; it has been shown to help patients with GI distress, high blood pressure, cardio-vascular disease, sleep problems and chronic pain. Recent neuroimaging studies show gray matter increases in the areas of the brain associated with memory, empathy and emotional self-regulation following mindfulness training. In addition to the long term benefits of mindfulness training, there are immediate benefits including relaxation, reduced stress, and improved emotional regulation. At UCSF, the Osher Center for Integrative Medicine, teaches the full 8-week MBSR class and has an active research program investigating applications of MBSR to a wide variety of health conditions. Participating in an MBSR class can be a life changing experience. During Residency, however, it may be impossible to take a full class due to its significant time commitment (8-weekly 2-hour classes, 45-minutes of daily practice and a full day retreat). Fortunately, there are many ways you can begin to develop mindfulness. When the time is limited, short practices throughout the day have beneficial effects.
Kabat-Zinn defines mindfulness as a way of "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally." When truly in the immediate moment our perception is more accurate, and we respond simply and appropriately to the issue at hand by recognizing our feelings, thoughts or emotions and without identifying with them. This is very different from how we usually get caught up in our mental and emotional reactions, which are based on a story we tell ourselves based on past experience. With mindfulness training, we learn to recognize our stories and begin to free ourselves from their push and pull on our mind.
Re-imagine the presentation situation at the beginning of this article. This time, when you notice your body tightening and heart racing, you are able to acknowledge these feelings and the thought: "Here I go again – always screwing up presentations." Instead of believing this thought as true, you take a deep breath, feel your feet on the ground and notice how your body relaxes and your thoughts slow down. Simply observe the thoughts, sensations and feelings that arise without fighting them, acting them out, or even judging them. This frees you from old ideas and bodily tensions and allows your energy and attention to re-focus on your current presentation. The sooner you recognize old patterns and refocus, the easier it will be to disengage from unhelpful thoughts and reactions. When you are pressed for time, there are many simple practices that are helpful. Below are a few you might want to give a try.
- Stop what you are doing/thinking
- Close your eyes
- Feel your body sensations as they are (do not think about your body, but actually feel its sensations)
- Focus your attention on your breath, notice how it feels in your nostrils when the air flows across them—cool on the in-breath, warm on the out-breath.
- Choose an area of bodily sensation and focus your breath there. For example, you might focus your breath on the tension in your abdomen and notice how it expands and contracts with each inhalation/exhalation.
- Expect your mind to wander and get distracted. This is what minds do.
- Every time you notice your mind wandering, simply bring it back to your breath, without judgment.
- Letting go of judgment and self-criticism is an important part of this practice.
- Practice frequently, and extend your practice time (5-10 minutes) as your schedule permits.
Daily Mindful Activity
It can be very helpful to develop this habit. Choose an activity that you do on a daily basis (e.g., teeth brushing) that is simple and repetitive and does not require much thinking. Commit to bringing your full attention to this activity. For example, while brushing your teeth, feel how you hold the brush, how your hand moves, the sensation of the brush in your mouth, the flavor of the toothpaste, etc. Be prepared for your mind to wander and get distracted into thinking about something else (Did you order those patient labs?!). As soon as you notice that you have drifted, bring your attention back to the sensations of your body as you do your activity. Remember that the mind’s tendency is to drift and this will happen repeatedly--don’t use this as an excuse to beat yourself up. Beginning this practice can be very challenging and you may get lost in distraction the whole time. As you practice bringing your attention back again and again, your mind will begin to habituate to being in the present moment.
You don’t have to take a yoga class to get the benefits of mindful movement. Throughout the day, you can introduce very brief times (as little as 1-2 minutes) when you simply stretch while being aware of your body sensations. This simple exercise connects and grounds you. Our body is how we operate in the world, it is not separate from our mind and it is a powerful tool that is always available to bring our attention back to the present moment.
Mindful Deep Breathing
Deep, purposeful breaths have a very powerful calming effect. It is easy to undervalue the power of this simple practice. When tensions are high and anxiety rampant, we tend to take very shallow breaths or hold the breath. Counter this by taking a few deep, regular breaths to activate the parasympathetic nervous system and the relaxation response.
Although mindfulness and other coping mechanisms can be effective strategies in coping with everyday stress, at times work or personal problems can interfere with your functioning and you could benefit from some extra support. The Faculty and Staff Assistance Program (FSAP) can help you by providing you with counseling services as well as referrals for therapists in the community. FSAP services are free and confidential and available for both personal and work-related issues. Please contact us at 415-476-8279 or visit our Faculty and Staff Assistance Program Service page for more information.