Managing Personal and Client Stress Through Meditation

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Managing Personal and Client Stress Through
Meditation

• Sage Bolte, MSW, LCSW, OSW-C
• Oncology Counselor
• Life with Cancer
• INOVA Cancer Services

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Managing Personal and Client Stress Through
Meditation

• Introduction to Meditation
• Research
• Preparing to Practice
• Breathing Techniques Progressive Muscle
  Relaxation
• Guided Imagery Meditation

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Meditation

• Meditation is a mind-body process that uses
  concentration or reflection to relax the body and
  calm the mind in order to create a sense of well
  being
• The American Cancer Society, 2002.

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Meditation

• Meditation is any kind of deliberate focus,
  usually on just one thing or a very narrow band
  of things. This clears the mind, slows it down
  and calms and strengthens the meditator
  Naparstek, Belleruth 2000.
• www.healthjourneys.com

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• Research
• Meditative Techniques
• Work

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Common Problems Experienced When We Dont Slow
Down

• Pain
• Insomnia
• Depression
• Mind Body Awareness
• Sexual Dysfunction or Disinterest
• Nausea
• Anxiety
• Fatigue
• Less clarity on clinical assessments and issues
• Burnout

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Burnout?

• Emotional exhaustion
• Fatigue, insomnia and depression
• Cynicism or depersonalization
• Decreased work effectiveness, performance,
  longevity and creativity
• Perceived clinical inefficacy
• Feelings of despair bitterness, inadequacy,
  difficulty justifying work effort, and not
  looking forward to going to work, along with
  feeling unappreciated and having little
  satisfaction
• Pellegrini, V. (2007). Physician Burnout A Time
  for Healing. Obstetrical Gynecology, 62 (5),
  285-286.

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Benefits of Meditation Techniques

• Reduces
• Anxiety
• Stress
• Blood Pressure
• Chronic Pain
• Insomnia
• Blood Cortisol Levels (brought on by stress)
• NIH Consensus Development. Integration of
  behavioral and relaxation approaches into the
  treatment of chronic pain and insomnia. Accessed
  Oct. 14, 2002.
• Spencer, JW, Jacobs JJ. Complementary/Alternative
  Medicine An Evidenced Based Approach. St.
  Louis, MO Mosby Inc 1999

• Increases
• Quality of life
• General health
• Concentration

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The Effectiveness of Meditation Techniques

• Holland J, Morrow G, Schmale A, et al A
  randomized clinical trial of alprazolam versus
  progressive muscle relaxation in cancer patients
  with anxiety and depressive symptoms. J Clin
  Oncol 91004-1011, 1991

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Effectiveness of mindfulness

• An exploratory mixed methods study of the
  acceptability and effectiveness of mindfulness
  -based cognitive therapy for patients with active
  depression and anxiety in primary care
• Statistically significant reductions in mean
  depression and anxiety scores were observed
• the mean pre-course depression score was 35.7 and
  post-course score was 17.8 (p 0.001).
• A similar reduction was noted for anxiety with a
  mean pre-course anxiety score of 32.0 and mean
  post course score of 20.5 (p 0.039).
• Overall 8/11 (72) patients showed improvements
  in BDI and 7/11 (63) patients showed
  improvements in BAI. In general the results of
  the qualitative analysis agreed well with the
  quantitative changes in depression and anxiety
  reported
• Finucane, A. Mercer, S. (2006). An exploratory
  mixed methods study of the acceptability and
  effectiveness of mindfulness-based cognitive
  therapy for patients with active depression and
  anxiety in primary care. BMC Psychiatry. 6 14

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Alprazolam vs. PMR

• Sample
• 3 centers over 10 days to test the efficacy of
• Randomized, non-blinded study of 147 patients
  (uncontrolled for site or disease stage)
• 70 assigned to drug
• 77 assigned to relaxation

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Alprazolam vs. PMR

• Instruments
• Four measures of anxiety and depression used
• Covi Anxiety Scale
• Raskin Depression Scale
• Affects Balance
• Symptoms Checklist 90 (SCL-90)

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Alprazolam vs. PMR

• Intervention
• A triazolobenzodiazepine
• Alprazolam, .5mg 3x/day
• Behavioral Techniques
• Taught Progressive Muscle Relaxation (PMR) at
  session 1 with behavioral psychologist
• Asked to listen to audio tape of PMR session
  3x/day

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Alprazolam vs. PMR

• Results
• Both arms of study showed significant (P .001) decrease in observer and patient-reported
  anxious and depressed mood symptoms
• Drug arm showed more rapid decrease in anxiety
  and a slightly greater decrease in depression

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Alprazolam vs. PMR

• Application and Conclusion
• Findings confirm that both drug and PMR
  interventions are effective in significantly
  reducing distress
• However, PMR is less invasive, can be more cost
  effective and teaches a skill to manage problems

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Why Dont Social Workers Meditate?

• We teach what we need to learn
• What happens during stillness?
• Resisting the thrill of distraction
• Taking responsibility

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Why Havent I Managed My Stress?

• I dont have the time
• I think it is a waste of time
• I dont know how to begin
• I dont know where to begin

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What If Social Workers Did Meditate?

• Increased problem solving ability
• Increased energy
• Increased clarity regarding OUR options for change

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What If Social Workers Did Meditate?

• We could teach from a place of experience
• Negative reactivity would be quickly identified
  and managed
• Complex experiences could be processed without
  harm to our minds/bodies and spirits

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• Preparing to Practice

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Other Relaxation Meditative Techniques

• Yoga
• Massage Therapy
• Spiritual Rituals
• Meditation
• Deep Breathing
• Exercise
• Body Work / Progressive Relaxation
• Journaling
• Social Activity

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Preparing to Practice

• Setting Time
• Body Positioning
• Use of a Focal Point for Concentration
• Breath, candle, mantra

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Exploring Your Style

• Active
• Yoga, Walking, Energy Release
• Guided Passive
• Imagery, visualization
• Integrative
• Moving into void

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Exploring Your Style

• What rises to the surface when you become still?
• Do you become aware of being exhausted?
• What are the messages that your body conveys,
  (tension, pain, emptiness, gratitude)?

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Three Steps Into Meditation

• Quieting our bodies 
• Quieting out minds  
• Opening our hearts

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Deep Breathing Technique

• Breathe in slowly through your nose (count to
  five)
• Imagine the air going into your stomach and feel
  it expand gently
• Slowly exhale through your mouth (count to five)
• Picture the air emptying out of your stomach

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Deep Breathing Technique

• Repeat 10 times or until symptoms subside
• Note
• If breath is difficult, focus on slowing your
  heart rate or using other relaxation techniques

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Steps to Self Directed Meditation

• Step 1
• Selecting a quiet place free from noise and
  distraction

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Steps to Meditation

• Step 2
• Sitting or resting quietly with eyes closed

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Steps to Meditation

• Step 3
• Focusing on slowing the breath by deep breaths in
  and out slowly (if breath is difficult focus on
  slowing your heart rate)

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Steps to Meditation

• Step 4
• Progressively relaxing all muscles in the body

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Steps to Meditation

• Step 5
• Paying attention to where tension still exists
  and repeat step 4

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Steps to Meditation

• Step 6
• Repeating positive thoughts with every breath in
  and breathing out the tension
• (i.e. I am breathing in strength and
  peace and breathing out the tension and stress.
  Can also be a time of prayer, i.e. repeating your
  favorite verse or just spending quiet time with
  your spiritual connection)

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Progressive Relaxation

• The muscle groups are tightened and relaxed one
  at a time in a specific order. (Breathing in
  tighten for 5-8 seconds and then release breath
  and the tension)
• feet
• calves
• thighs/hamstrings
• buttocks
• abdomen
• chest/shoulders
• forearms/hands
• face

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Progressive Relaxation

• While releasing the tension, focus on the changes
  you feel when the muscle group is relaxed
• Imagery may be helpful while you release tension
  (imagine stressful feelings releasing out of your
  body as you relax)
• Repeat exercise in areas where tension still
  remains

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Meditation
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Setting the Stage for Your Practice

• Set Realistic Goals If you have never been one
  to be quiet or reflective, no more than 10
  minutes per day of contemplation is realistic.
  Longer periods may lead to discouragement.

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Setting the Stage for Your Practice

• Read Inspirational Material Read whatever
  inspires you or whatever you think may inspire
  you. For some, this may be a religious book such
  as the Bible or the Upanishads. For others, it
  may be poetry or song. Inspiration is a unique
  individualized quality that only you can unlock
  for yourself.

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Setting the Stage for Your Practice

• Surround Yourself with Things That Have Deeper
  Meaning As with the inspirational material, use
  whatever provides or hints at a deeper meaning
  for you. It may be a photograph. It may be a
  bracelet, a ring, or a rosary. Whatever it is, it
  should help you get closer to your center.

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Setting The Stage for Your Practice

• Be Open To Your Patient as a Spiritual Teacher.
  Everyday we are exposed to people who are in
  crisis. Frequently, the same people expose us to
  grace and peace in the midst of chaos. Being open
  to them as spiritual teachers permits us to learn
  from their experiences.

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Setting The Stage for Your Practice

• Plan for conversations with friends or colleagues
  that address deeper meaning, not just issues
  around work, so you have someone to talk to.

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Final Thought

• As social workers, we have a responsibility to
  our patients to stay true to ourselves and allow
  the time to struggle with hard questions, to
  rejuvenate, to find joy, and to come to peace
  with life struggles.

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Research Resources

• Resources
• American Cancer Society www.cancer.org
• CancerGuide by Steve Dunn http//www.cancerguide.
  org
• National Cancer Institute www.cancernet.nci.nih.g
  ov
• National Center for CAM http//nccam.nih.gov/
• University of Texas Center for Alternative
  Medicine Research in Cancer
• http//www.mdanderson.org/departments/cimer/
• Health Journeys
• http//www.healthjourneys.com
• Alternative/Unproved Methods Information
• National Council Against Health Fraud
  http//www.ncahf.org
• Quackwatch http//www.quackwatch.com

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Articles Showing Positive Effects of Meditation

• Baider L, Uziely B, Kaplan De-Nour A Progressive
  muscle relaxation and guided imagery in cancer
  patients. Gen Hosp Psychiatry 16340-347, 1994
• Kabat-Zinn J, Massion AO, Kristeller J, et al.
  Effectiveness of a meditation-based stress
  reduction program in the treatment of anxiety
  disorders. Am J Psychiatry 1992149936-43

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Articles Showing Positive Effects of Meditation

• National Institute of Health Integration of
  Behavioral and Relaxation Approaches into the
  Treatment of Chronic Pain and Insomnia
  http//consensus.nih.gov/ta/017/017ta_statement.pd
  f
• Holland J, Morrow G, Schmale A, et al A
  randomized clinical trial of alprazolam versus
  progressive muscle relaxation in cancer patients
  with anxiety and depressive symptoms. J Clin
  Oncol 91004-1011, 1991

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Recommended Resources

• Belleruth Naparstek, tapes on
  www.healthjourneys.com
• Full Catastrophe Livingby Jon Kabat-Zinn. A
  Practical guide to mindfulness meditation and
  healing, using the wisdom of your body and mind
  to face pain, stress and illness based on his
  work at the Stress and Pain Clinic at the U. of
  Massachusetts Medical Center.
• Wherever You Go, There You Areby Joh Kabat-Zinn.
  The practice of mindfulness mediation in everyday
  life. Stories, anecdotes, poems.
• The Miracle of Mindfulnessby Thich Nhat Hanh.
  Basic book on mindfulness meditation.
• Peace is Every Stepby Thich Nhat Hanh.
  Mindfulness in everyday life.  A wonderful
  collection of personal anecdotes, stories, and
  experiences from his own life that show the
  reader how to attain awareness and peace.

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Recommended Resources

• The Four Agreementsby Miguel Don Ruiz.
  Techniques to live a peaceful life.
• Instant Calmby Paul Wilson. A complete
  collection of calming techniques that are easy to
  use.
• Emotional Intelligenceby Daniel Goleman. The
  author argues that our emotions play a much
  greater role in thought, decision making and
  individual success than is commonly acknowledged.
• Way of the Peaceful Warriorby Dan Millman. A
  story of a world champion athlete who is guided
  by a powerful old man who teaches Millman what it
  means to live like a peaceful warrior.

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Bibliography

• Astin J Stress reduction through mindfulness
  meditation. PsychotherPsychosom 6697106, 1997
• Austin JA. Stress reduction through mindfulness
  meditation effects on psychological
  symptomatology, sense of control, and spiritual
  experience. Psychother Psychosom 19976697-106.
• Baider L, Uziely B, Kaplan De-Nour A Progressive
  muscle relaxation and guided imagery in cancer
  patients. Gen Hosp Psychiatry 16340347,1994
• Holland J, Morrow G, Schmale A, et al A
  randomized clinical trial of alprazolam versus
  progressive muscle relaxation in cancer patients
  with anxiety and depressive symptoms. J Clin
  Oncol 910041011, 1991

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Bibliography

• Kabat-Zinn J, Massion AO, Kristeller J, et al.
  Effectiveness of a meditation-based stress
  reduction program in the treatment of anxiety
  disorders. Am J Psychiatry 1992149936-43.
• Loscalzo M. Psychological Approaches in the
  Management of Pain in Patients with Advanced
  Cancer. Hematology/Oncology Clinics of North
  America (Pain
• and Palliative Care), Vol. 10, No. 1, 1996
• National Institute of Health
• http//home.mdconsult.com/das/journal/view/269406
  98/N/12074347?sourceMI
• Spiritual role in healing. An alternative way of
  thinking.
• Boudreaux ED - Prim Care - 01-Jun-2002 29(2)
  439-54, viii From NIH/NLM MEDLINE