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Erik van den Brink MDpsychiatrist & mindfulness trainer
A PERSONAL REFLECTION ON THE ‘CARE’ IN HEALTHCARE
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BURNOUTEMPATHYDECLINE
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Implicit messages during my medical training
• Be a human doing; work hard at all times• Never say you’re too busy to see another patient• Never mention when your shift started• Go for cure at all costs• TLC* as a last resort (nurses only!) • Be smarter than your peers (but NOT your seniors!)• DON’T show your weaknesses• Be ‘still faced’ towards emotional pain, especially your own• If you can’t cope… try psychiatry
* Tender Loving Care
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India
What if you can’t cure? CARE!
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Yorkshire, UK: Resident in Psychiatry
• Symptom reduction and restraining• Often heavy medication in artificial environment• Forceful reduction of hospital beds• How to return hospitalized patients to an
unwelcoming society?• Striving for control of suffering rather than care• Still face towards deeper suffering
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Psychotherapy
• Many models aimed at cure, but…• Basic is the patient-therapist relationship and
creating a caring environment• Holding emotional pain, the patient’s and your own• Melting the still face• Pitfall: dependency
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Groningen, NL: day unit and home care instead of hospital admission
• Patients are experts of their own life• What’s right? rather than What’s wrong?• Involving network and resources already there• Care = learning to self-care and empowerment• Pitfall: neglecting emotional pain and return of the
still face
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The silver lining of a dark cloud
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Integrative psychiatry
• Integrating conventional and complementary approaches
• More room for self-healing capacity• Minimizing harmful side-effects and maximizing
positive side-effects• Life style: healthy eating, exercise,
communication, relaxation, meditation• Sustainable healthcare
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Integrating a self-care practiceFor patients and professionals
Awake Body
Open Mind Tender Heart
Mindfulnesstraining
Compassion training
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Self-compassion correlates with…• Psychological well-being and life fulfillment• Emotional intelligence and positive emotions• Healthier coping with adverse events • Healthier lifestyle • Social connectedness, empathy, altruism, forgiveness
Barnard & Curry 2011; Hofmann e.a. 2011; MacBeth & Gumley, 2012; Neff, 2012
Adding mindfulness-programs to education• Medical students: less anxiety & stress; more empathy & self-
compassion• Therapists in training became more effective: fewer
symptoms and more insight in their patientsBarbosa et al. 2013; Bond et al. 2013; Gordon 2014; Grepmair et al. 2007
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Compassion is…
The capacity to be sensitive to the suffering of ourselves and others and…the willingness to relieve and prevent it.
(Gilbert, 2014)
•A natural human capacity inherent in all of us but often not very well developed. •The aim of compassion training is to develop and deepen it.
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SELF-COMPASSION
SELF-CRITICISM • SELF-KINDNESS
SELF-ISOLATION • COMMON HUMANITY
OVER-IDENTIFICATION • MINDFULNESS
SELF-SACRIFICEOVER-INVOLVEMENT
COMPASSION TO SELF AND OTHERS
FIGHT
FLIGHT
FREEZE
TEND & BEFRIEND
THREATEXTERNAL INTERNAL
Neff 2003Germer 2009
Taylor 2006
ME
YOU
WE
SOOTHINGGilbert 2009
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Tend & befriendinstinctual reaction in mammals to save the weak and vulnerable≠ compassion
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SOOTHING SYSTEM content, safe, connected
DRIVE SYSTEM pleasure, excitement, vitality
THREAT SYSTEM anger, anxiety, disgust
Reward focused
Wanting, striving, achieving, consuming
Affiliative focusedsafeness seeking
Kind and caring
Threat focused,safety seeking
Fight, flight, freeze
R E
S T
S T
R E
S S
Van den Brink & Koster, 2012
adapted from Gilbert, 2009
How to keep the balance?
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THREAT SYSTEM
I don’t like this
I don’t want this
I hate this
I can’t live with this
Avoiding what’s inevitable
DRIVE SYSTEM
I like this
I want this
I need this
I can’t live without this
Grasping what’s impermanent
S T O R I E S
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Judging rank,comparing
Achieving, rivalry
EmotionsMotivation
Focus on reward
Success and fame
COMPETITIVEMIND
Self enrichment, improving status Desire, envy
BehaviourImagery
Attention Reasoning
Van den Brink & Koster, 2015Adapted from Gilbert, 2010
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COMPETITIVEMIND
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Striving for self-esteem…
… while we need self-compassion
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Judging risksafe/unsafe
Avoiding, resisting
EmotionsMotivation
Focus on danger
Doom and gloom
THREATMIND
Self protection Aversion, fear, anger
BehaviourImagery
Attention Reasoning
Van den Brink & Koster, 2015Adapted from Gilbert, 2010
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THREATMIND
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Bullying ourselves…
…while we need an inner helper
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INTERVENTION ↔ DIAGNOSIS
CURE IT and FIX ITOften motivated from threat (external control) or drive system (internal ambition)
? ?What about the care for the persons and their relationship.
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Cure Care• Threat / Drive System• Change• Short term• Specific• Expertise of others• Sometimes feasible
• Soothing System• Acceptance• Longer term• Non-specific• Responsibility of self• Always supportive
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Non-judging, allowing
Accepting, befriending
EmotionsMotivation
Needs of self and others
Peaceful connection and safeness
COMPASSIONATE MIND
Social bonding, well-being
Calm, content
BehaviourImagery
Attention Reasoning
Van den Brink & Koster, 2015Adapted from Gilbert, 2010
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COMPASSIONATE MIND
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With gratitude for your attention and … compassionwww.mbcl.orgwww.compassionateliving.info