A nonprofit psychology group has launched the Caring for Our Caregivers initiative, distributing computer tablets with meditation and wellness exercises to help healthcare workers during the COVID-19 pandemic, according to Saloumeh Bozorgzadeh, PsyD, president of the Sufi Psychology Association, in Davis, CA.

The pandemic has exacerbated the longstanding issues of staff burnout in healthcare, adding elements of fear that may lead to post-traumatic stress disorder (PTSD), she says.

“Unlike burnout, which is this extreme mental and emotional exhaustion — on top of that you have this fear of not only your life, but your family can be affected by this if you pass something on to them,” she says. “There is this profound fear. You don’t really know what you’re dealing with because COVID seems to manifest differently.”

The prime mission of taking care of the patient can be threatened by this “incredibly strong” uncertainty, she adds. “You are in there as an expert who is supposed to fix people and know what to do. It is really frightening to think what these incredibly selfless people have had to go through.”

Driven by donations and volunteers, Caring for Our Caregivers has distributed 491 tablets and 16,300 headsets to 151 hospitals to in the United States and globally. The tablets include Sufi meditation exercises and mental health apps that can be accessed when healthcare workers take a break. The headsets are disposable and the tablets can be wiped down between users.

Q&A

Hospital Employee Health asked Bozorgzadeh to comment further on the program in the following interview, which has been edited for length and clarity.

HEH: Can you talk a little more how the tablets are used?

Bozorgzadeh: This actually originated with the Sufi Psychology Association [SPA], a nonprofit organization that provides a lot of wellness for hospitals. We look at burnout and present workshops, meditation classes, and such. When COVID happened, we were already focused on burnout, and we knew the [coronavirus] had to be addressed right away. We have found from presenting wellness workshops at hospitals that one of the challenges is getting everybody together for a class. People have different schedules, they have patients that need them, so getting everyone together is challenging.

We tried to remove any barriers that will get in the way of these exercises. We didn’t want to have wi-fi on these tablets or anyone logging in. They consist of visualization, deep breathing exercises, and meditative movements. We have six well-researched stress relief techniques such as guided imagery. There are about 12 videos on the tablets and range in time from about five minutes to 30 minutes.

HEH: Where are these tablets typically placed?

Bozorgzadeh: We catered to each hospital because the cultures are different. Some have wellness rooms, some have a chapel or a break room. We see what they have and we donate accordingly. Typically, it is a wellness room and we put in three tablets with a hundred disposable headsets. Three people can use them, put back the tablets, and throw away the headphones. Some of the bigger hospitals might have more. One hospital created 11 nooks.

HEH: Can you comment on the efficacy of this type of meditation?

Bozorgzadeh: This form of meditation has been researched.1-3 Previously, I was teaching it at a hospital in Chicago with cancer patients and the staff. It has been researched at Kaiser Permanente in California with heart patients. It’s been taught as a course for years at the University of California, Berkeley. There was research done on the students there. It was really interesting because it showed that even though those students had higher stress levels than the average college population, their stress kept going down as they were practicing — even when they hit midterms and finals. It has been researched showing its effects on stress.

It has also been shown to increase positive emotions. Interestingly enough, it also increases people’s daily spiritual experience on a scale that we use. What is fascinating about that is it didn’t necessarily depend on someone’s religious experience. Even people who identified as agnostic and atheist scored higher on that [spiritual] scale as well. Typically, in Western medicine, we focus on the biopsychosocial model of human beings. We think we are being holistic [saying], “psychology, biologically, socially they are healthy — great.” But I thought this was interesting — someone experiencing spirituality even if they don’t identify as having any kind of religious or spiritual practice.

HEH: Can you tell us a little more about your experience with this program in medical settings?

Bozorgzadeh: I was doing a resident wellness [program] at a hospital, presenting lectures on burnout and holding meditation classes to decrease stress for both oncology patients and staff at the hospital. We just finished [a program] at San Quentin (CA) State Prison Medical Center. They have a huge COVID issue right now. Our thoughts were of the healthcare workers and how stressed they must be. We created wellness rooms for the healthcare staff and put the tablets in there. In addition to that, we are creating an online wellness program to supplement what they already have in place. People need to be able to access these things on their own.

One thing I have found is that residents are required to attend the weekly meetings and workshops. The general staff are not. They have such widely varied schedules. We basically created an online platform with five- to 10-minute wellness videos from professionals from all over. These include how to manage anxiety, how to communicate better, and being more assertive and less aggressive. These are some of the workshops we have on these platforms for the staff whenever they have a moment. We are hoping that as people get more comfortable with the concept of meditation, we can ideally stream live sessions. Then, when things get better, perhaps go in person and do sessions.

HEH: What are some of the tenets of Sufi meditation?

Bozorgzadeh: Sufism is a spiritual practice and it’s typically known as a mysticism of Islam. The goal of Sufism is that it is an individual journey for each person to know themselves. The way that is related to psychology is that when the SPA was formed, all of these practicing professionals saw that these teachings actually apply very well to the medical field. In psychology, a lot of what we feel — the anxiety and depression — stems from a lack of trust and knowledge of yourself. The more you have these experiential moments where you are tapping into the strength within, the more confident and powerful you feel, you can deal with life’s ups and down much easier because you have something stable.

HEH: What are you seeing in healthcare workers dealing with COVID-19?

Bozorgzadeh: I have [counseling] clients who are nurses and physicians. One of my nurses was talking about going into a room and being given an N95 mask. She was already kind of nervous and said “Is this enough? They say that’s all we have — it’s enough.” Then, a physician walks in in full [PPE] garb and she is feeling that she [does not have enough protection]. She worries about going home — [thinking] “Did I get it, too?” There is the whole thing about having to clean everything, undress before you go into the house, [worried] about infecting her family. She even suffers when she comes home, saying, “Please turn down the lights. I don’t need any more stimulation.”

It has heightened or sped up the whole burnout process. Typically, burnout happens slowly. You don’t realize you are experiencing it — you are just kind of a little bit more irritable or annoyed with people. It kind of drags on before you actually burn out and you’re showing a lot of symptoms. With COVID, you are going through it quickly, and because you are in crisis mode, your adrenaline is pumping. It’s fight or flight. Everyone is just pushing through. When things quiet down, they recognize that there is something wrong with them.

HEH: How does meditation address these issues?

Bozorgzadeh: The research has shown it decreases your cortisol levels. It stimulates your autonomic nervous system because of the deep breathing techniques. It tells your body to relax. One of the more impressive things about meditation is that we are not really trained to navigate our brains. We know how our muscles work and how to strengthen them, but we don’t really talk about our brains in this culture. A lot of us have wandering minds, going all over the place thinking about different things. It is hard to focus and concentrate. This is one of the things meditation does. You actually learn to direct your mind, quiet it down, focus it, which can be incredibly helpful if you are stressed and pulled in 20 different directions. If you’re at home and relaxing, you can focus on just that and everything else can be put to the side. With burnout, what happens is that our mind is really adding a lot to the energy dispensed because we are thinking about different things. When you have anxiety, it is almost like a spiral you go down. It slows down that process and the feeling of your mind just racing. You can take control a little bit better. It also helps with reactivity because you are now becoming aware of thoughts and how they are affecting you. It builds a little bit of a gap between a stimulus and your reaction. You are not as reactive.

REFERENCES

  1. Bahadorani, N. Abstract: Effect of Tamarkoz, a Sufi meditation, decreases perceived stress and increases positive emotions in university students. American Public Health Association 2019 Annual Meeting and Expo. Nov. 2-Nov. 6, 2019, Philadelphia.
  2. Crumpler, C. Tamarkoz (Sufi meditation) for heart patients: A pilot study. Sufi Psychology Journal: Science of the Soul 2005;7:9-10.
  3. Crumpler C. Sufi practices, emotional state, and DNA repair: Implications for breast cancer. Sufi Psychology Journal: Science of the Soul 2002;4:25-37.