Category Archives: Programs

Coming Home Research Project

I’m participating in an amazing experience with my close friend and colleague Steven Hickman Psy.D. Director of the UCSD Center for Mindfulness. We are co-teaching the first ever Mindfulness-Based Stress Reduction Program presented in the virtual world of Second Life for a research project called Coming Home.

Coming Home uses the power of online virtual worlds to create …a place of
camaraderie and healing for returning United States military veterans –
a virtual space that can help them deal with problems related to their
time of service and also assist in their reintegration into society.

Coming Home

The Coming Home research project for veterans includes an innovative 8-week MBSR program. This research project takes place in the virtual world Second Life. Through the use of avatars in Second Life veterans, who might not have access to an MBSR program, are able to experience the full range of its benefits.

Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians

PhysiciansMichael S. Krasner, MD; Ronald M. Epstein, MD; Howard Beckman, MD; Anthony L. Suchman, MD, MA; Benjamin Chapman, PhD; Christopher J. Mooney, MA; Timothy E. Quill, MD

JAMA. 2009;302(12):1284-1293.

Context Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce.

Objective To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians’ well-being, psychological distress, burnout, and capacity for relating to patients.

Design, Setting, and Participants Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo).

Main Outcome Measures Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months.

Results Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [{Delta}], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; {Delta} = –6.8; 95% CI, –4.8 to –8.8; depersonalization, 8.4 to 5.9; {Delta} = –2.5; 95% CI, –1.4 to –3.6; and personal accomplishment, 40.2 to 42.6; {Delta} = 2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; {Delta} = 4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; {Delta} = –4.1; 95% CI, –1.8 to –6.4); total mood disturbance (33.2 to 16.1; {Delta} = –17.1; 95% CI, –11 to –23.2), and personality (conscientiousness, 6.5 to 6.8; {Delta} = 0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; {Delta} = 0.5; 95% CI, 0.3 to 0.7). Improvements in mindfulness were correlated with improvements in total mood disturbance (r = –0.39, P < .001), perspective taking subscale of physician empathy (r = 0.31, P < .001), burnout (emotional exhaustion and personal accomplishment subscales, r = –0.32 and 0.33, respectively; P < .001), and personality factors (conscientiousness and emotional stability, r = 0.29 and 0.25, respectively; P < .001).

Conclusions Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians.

Author Affiliations: Departments of Internal Medicine (Drs Krasner, Beckman, Suchman, and Quill), Family Medicine (Drs Epstein and Beckman), Psychiatry (Drs Epstein, Chapman, and Quill), and Oncology (Drs Epstein and Quill); the Offices for Medical Education (Mr Mooney), Center to Improve Communication in Health Care and Center for Ethics, Humanities, and Palliative Care (Drs Epstein and Quill), University of Rochester Medical Center, Rochester, New York; Rochester Individual Practice Association, Rochester, New York (Dr Beckman); and Relationship Centered Health Care, Rochester, New York (Dr Suchman).

MBSR Program at Army Health Clinic

Health Care WorkersOur next formal 8-week Mindfulness-Based Stress Reduction Program will be held for health care practitioners. located at the Schofield Barracks Army Health Clinic, Honolulu, Hawaii.

Mental Stress Training Is Planned for U.S. Soldiers

New York Times
By BENEDICT CAREY
Published: August 17, 2009

PHILADELPHIA — The Army plans to require that all 1.1 million of its soldiers take intensive training in emotional resiliency, military officials say.

The training, the first of its kind in the military, is meant to improve performance in combat and head off the mental health problems, including depression, post-traumatic stress disorder and suicide, that plague about one-fifth of troops returning from Afghanistan and Iraq.

Active-duty soldiers, reservists and members of the National Guard will receive the training, which will also be available to their family members and to civilian employees.

The new program is to be introduced at two bases in October and phased in gradually throughout the service, starting in basic training. It is modeled on techniques that have been tested mainly in middle schools.

Usually taught in weekly 90-minute classes, the methods seek to defuse or expose common habits of thinking and flawed beliefs that can lead to anger and frustration — for example, the tendency to assume the worst. (“My wife didn’t answer the phone; she must be with someone else.”)

The Army wants to train 1,500 sergeants by next summer to teach the techniques.

In an interview, Gen. George W. Casey Jr., the Army’s chief of staff, said the $117 million program was an effort to transform a military culture that has generally considered talk of emotions to be so much hand-holding, a sign of weakness.

“I’m still not sure that our culture is ready to accept this,” General Casey said. “That’s what I worry about most.”

In an open exchange at an early training session here last week, General Casey asked a group of sergeants what they thought of the new training. Did it seem too touchy-feely?

“I believe so, sir,” said one, standing to address the general. He said a formal class would be a hard sell to a young private “who all he wants to do is hang out with his buddies and drink beer.”

But others disagreed, saying the program was desperately needed. And in the interview, General Casey said the mental effects of repeated deployments — rising suicide rates in the Army, mild traumatic brain injuries, post-traumatic stress — had convinced commanders “that we need a program that gives soldiers and their families better ways to cope.”

The general agreed to the interview after The New York Times learned of the program from Dr. Martin E. P. Seligman, chairman of the University of Pennsylvania Positive Psychology Center, who has been consulting with the Pentagon.

In recent studies, psychologists at Penn and elsewhere have found that the techniques can reduce mental distress in some children and teenagers. But outside experts cautioned that the Army program was more an experiment than a proven solution.

“It’s important to be clear that there’s no evidence that any program makes soldiers more resilient,” said George A. Bonanno, a psychologist at Columbia University. But he and others said the program could settle one of the most important questions in psychology: whether mental toughness can be taught in the classroom.

“These are skills that apply broadly, they’re things people use throughout life, and what we’ve done is adapt them for soldiers,” said Karen Reivich, a psychologist at Penn, who is helping the Army carry out the program.

At the training session, given at a hotel near the university, 48 sergeants in full fatigues and boots sat at desks, took notes, play-acted, and wisecracked as psychologists taught them about mental fitness. In one role-playing exercise, Sgt. First Class James Cole of Fort Riley, Kan., and a classmate acted out Sergeant Cole’s thinking in response to an order late in the day to have his exhausted men do one last difficult assignment.

“Why is he tasking us again for this job?” the classmate asked. “It’s not fair.”

“Well, maybe,” Sergeant Cole responded. “Or maybe he’s hitting us because he knows we’re more reliable.”

In another session, Dr. Reivich asked the sergeants to think of situations when such internal debates were useful.

One, a veteran of several deployments to Iraq, said he was out at dinner the night before when a customer at a nearby table said he and his friends were being obnoxious.

“At one time maybe I would have thrown the guy out the window and gone for the jugular,” the sergeant said. But guided by the new techniques, he fought the temptation and decided to buy the man a beer instead. “The guy came over and apologized,” he said.

The training is based in part on the ideas of Dr. Aaron Beck and the late Albert Ellis, who found that mentally disputing unexamined thoughts and assumptions often defuses them. It also draws on recent research suggesting that people can manage stress by thinking in terms of their psychological strengths.

“Psychology has given us this whole language of pathology, so that a soldier in tears after seeing someone killed thinks, ‘Something’s wrong with me; I have post-traumatic stress,’ ” or P.T.S.D., Dr. Seligman said. “The idea here is to give people a new vocabulary, to speak in terms of resilience. Most people who experience trauma don’t end up with P.T.S.D.; many experience post-traumatic growth.”

Many of the sergeants were at first leery of the techniques. “But I think maybe it becomes like muscle memory — with practice you start to use them automatically,” said Sgt. First Class Darlene Sanders of Fort Jackson, S.C.

To track the effects of the program, the Army will require troops at all levels, from new recruits to officers, to regularly fill out a 170-item questionnaire to evaluate their mental health, along with the strength of their social support, among other things.

The program is not intended to diagnose mental health problems. The results will be kept private, General Casey said.

The Army will track average scores in units to see whether the training has any impact on mental symptoms and performance, said Gen. Rhonda Cornum, the director of Comprehensive Soldier Fitness, who is overseeing the carrying out of the new resilience program. General Cornum said that the Army had contracted with researchers at the University of Michigan to determine whether the training was working, and added that corrections could be made along the way “if the program is not having the intended effect.”

This being the Army, the sergeants at the training session last week had questions about logistics. How would teachers be evaluated? How and when would Reserve and Guard units get the training?

Perhaps the biggest question — can an organization that has long suppressed talk of emotions now open up? — is unlikely to have an answer until next year at the earliest. But the Army’s leaders are determined to ask.

“For years, the military has been saying, ‘Oh, my God, a suicide, what do we do now?’ ” said Col. Darryl Williams, the program’s deputy director. “It was reactive. It’s time to change that.”

Mindfulness Meditation Helps Relieve Fibromyalgia

Zen StoneA study published in Psychotherapy and Psychosomatics, 2007 in which a group of fibromyalgia sufferers were given an 8-week training in mindfulness meditation and then studied to see how their pain, anxiety, depression, coping, and other general measures of Quality of Life compared with those of patients who did not receive the training.

The patients who received the mindfulness intervention were found to have significantly better scores across the board compared with the control group. Even more impressive – in a follow up evaluation 3 years later, the comparative improvement was still present. It appears that even a short exposure to meditative techniques can have long term impact on clinical measures of pain and Quality of Life.

The health benefits of meditation are becoming clearly established as continued scientific research is conducted.

New MBSR – Rheumatoid Arthritis Study

Woman Meditating on BeachIn a new study, rheumatoid arthritis patients reported less psychological distress after practicing meditation for six months, compared with RA patients who didn’t get meditation training during that time.
Meditation didn’t cure RA or erase the joint disease’s physical symptoms, but it appeared to help the patients deal with those symptoms, according to the researchers, who studied 63 adults with RA.
The patients were randomly split into two groups. One group took an eight-week class in mindfulness-based stress reduction (MBSR) and members were asked to practice meditation at home for 45 minutes per day, six days a week. The other group of RA patients in the study was listed for a free MBSR training program held after the study concluded.
After two months, the groups reported similar reductions in psychological distress. But at the end of the six-month study, those benefits continued only for patients in the meditation group, who cut their psychological distress 35%.