Though mindfulness is increasingly discussed as a tonic against stress and burnout in healthcare settings, there still is some confusion about the nature of the practice and how to set up a program.
“We know that the population in general is reporting higher levels of anxiety and depression, and even more so in the healthcare environment,” says Teri Pipe, PhD, RN, chief well-being officer and founding director of the Center for Mindfulness, Compassion, and Resilience at Arizona State University in Phoenix. “The data from physicians, dentists, pharmacists, and nursing is becoming clearer about depression and suicide and, certainly, burnout.”
Mindfulness, which often is practiced in the context of meditation, is a focus on the present moment with nonjudgment and a sense of compassion.
“It is not just zoning out. It’s not just breathing, and it is not a religion,” Nika Gueci, BA, MA, EdD, executive director of ASU’s mindfulness center, said in a recent webinar. “It’s evidence-based, and there is a lot of research behind it.”
Mindfulness is a way to interrupt the stream of negative thoughts that typically dominate a person’s ongoing scan of their emotions.
“We are our own worst critics, so those negative thoughts are mostly directed at ourselves,” Gueci said. “Think about that on a cellular level — how do these negative thoughts impact day-to-day life? By focusing on the present moment, we free up that negative space in the brain that is spent worrying about the past or the future.”
People under stress are more likely to overreact to situations, an “amygdala hijack” in the brain that stirs inappropriate fight-or-flight responses over some work interaction or critical email. The idea of mindfulness is not to stuff these emotions, but to calmly observe that anger, anxiety, or sadness are passing through you but do not define you. In these moments, the mindful person can remind him- or herself that everything is in flux, and these negative emotions will change — much like moments of happiness.
“If we can become compassionate to ourselves and thereby more compassionate to others, we realize we are not our thoughts,” Gueci said. “We are not that negative space that we hold over ourselves.”
When practicing mindfulness and clearing the mind to the present, you can set an intention for future action. In such a moment, Gueci realized — when she just started her current job — that using her smartphone as an alarm clock was opening her day to stress.
“As soon as I woke up to hit the alarm I would check my work email,” she said. “This set me up to have a stressful day because before I even had a cup of coffee, I was checking my email and worrying about what was coming up. Just by waiting until I got to work to check my email, I set myself up for a much more peaceful morning and set [the tone] for the rest of the day.”
Mindfulness is a skill set that improves with practice, but anyone can access the present with this basic approach, Pipe says. Hospital Employee Health asked her to comment further on mindfulness in the following interview.
HEH: How can mindfulness help healthcare workers?
Pipe: Mindfulness has been shown in the scientific literature to decrease anxiety and depression. Anxiety is a focus on the future and the worry about things that may or may not happen. Depression is really looking back and maybe ruminating about things that you wish were different. Mindfulness brings us right into this moment.
The present is when we have the most decision [capability] about our situation and our behavior. The science is really showing a lot of promise in terms of anxiety and depression. In the healthcare arena, I think the need has never been greater, but I don’t want to overstate this. Mindfulness is not the only thing, but it is a pathway that people can look at in terms of reducing burnout and depression. Ultimately, suicide is a strong concern for us.
HEH: In mindfulness practice, what does it mean to be present without judgment?
Pipe: If I am dealing with anger or sadness, mindfulness teaches me that I need to experience these feelings in an appropriate way. These feelings aren’t bad, and they don’t define me. It doesn’t mean I will always be sad or angry or hurt. It’s like a weather pattern. My emotions come and go. So, mindfulness helps us see that in an appropriate time and place so that we are self-aware. We notice when we have those emotions. We don’t just numb them.
A lot of people overeat or overconsume substances, shopping — whatever it is. We actually sit with our emotions, and we notice that as we do, they pass. If we don’t, it sort of gets stuck and will come back even stronger than before. This is certainly a lifelong journey. Learning to sit with discomfort is not an easy thing.
Likewise, mindfulness helps us to be awake to things like joy, happiness, satisfaction, and contentment. We are not trying to hold onto anything. It teaches us that there is impermanence. Life is changing. It is more productive to go with the change rather than resist it.
HEH: There still seem to be misconceptions about mindfulness.
Pipe: A lot of people think mindfulness means to let go of goals or ambition — stop striving for anything. That’s not true. Mindfulness just helps you understand what is your personal goal and ambition a little more clearly. It doesn’t mean that you shouldn’t go after something, or that you shouldn’t strive for things you haven’t achieved yet. It just means that you give yourself a little bit more compassion about the journey. A lot of people think it is a stagnant state of being and that could not be further from the truth. It is about being alive.
To be the observer of your own emotions helps you see that the emotion does not define you. A lot of patients get identified with their pain and their diagnosis. Healthcare providers get identified with the pain they are carrying. This helps us understand that no, that is not the definition of you. You are you. The pain and the depression and the joy may be there today or tomorrow. You may have it your whole life, but it changes your relationship with that to be more compassionate with yourself as you go through it.
HEH: While mindfulness can be practiced formally at a time set aside only for that purpose, like practicing a sport, you note that it also can be brought to bear in everyday life and work.
Pipe: Certainly, sometimes mindfulness has a strong formal practice component, where you may spend time in solitude and quiet to build up your skills, just like an athlete would do in the gym or a musician would practice. Certainly, that is one way, but athletes practice for the game, and life is our game. In healthcare, it is actually saving lives and making life better for people. A lot of times the most meaningful way to begin is to have some small ways that people can take it into their real life. It is a skill set, so it does require practice.
There are different ways that I and others have used it in their lives and in the healthcare arena. One is to really focus, learning to pay deep attention to what you are doing or how you are interacting with a patient. Whether that is preparing a medication, preparing for a procedure, or having a deep conversation with a patient, it is the skill of being totally present in that situation, and that is not easy. In healthcare, there are so many interruptions and distractions. You are often thinking about the next patient, the patient you just came from, or the meeting that you are going into.
Patients notice. Patients can really tell if you are there with them or distracted and thinking about the next thing. They are much more likely to trust you and let you know what is really going on with them if they feel like you are very much with them. The opposite is there too. They may glaze over problems if they think that you are distracted.