MINDFULNESS PRACTICE & THE LAW
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Transcript of MINDFULNESS PRACTICE & THE LAW
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MINDFULNESS PRACTICE & THE LAW
RICHARD E. BERGER, MD
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Criteria for Change
• Perceived need• Perception that work/change required will
produce desired result• Benefit Greater than Cost
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PERCEIVED NEED?
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(c) Lipsenthal 2011 Swank and Marchland 1946; redrawn from Mind-Body Medicine, Watkins 1997
0 10 20 30 40 50 60
Degr
ee o
f com
bat
Days in combat
Soldier becomes"battlewise"
Period ofmaximum efficiency
Combat exhaustion
Hyper-reactivestage
Emotional exhaustionstage
Period ofoverconfidence
Vegetative phase
Battle Stress / Efficiency and Exhaustion
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Predictors of Job Dissatisfaction in Lawyers ( approx. 25%)
• Emotional Exhaustion and Burnout• Stress due to clients• Work load• Litigious > non-litigious• Female > Male
Sharma et al 2010, Tsai et al 2009
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Law Practice & Secondary PTSDCriteria Attorneys (n=238) Support Staff (n=109)
PTSD 11% 1%
Depression 39.5% 19.3%
Functional Impair. 74.8% 27.5%
Burnout 37.4% 8.3%
Secondary TS 34% 10.1%
Pleasure from Doing Good Work
19.3% 27.5%
Levin et al. J Nerv Ment Dis 2011;199: 946Y955
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Surgical Error & Burnout
Shanafelt et al Ann Surg 2010;251: 995
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In Medicine
• Poor provider QOL proportional to burnout• Mistakes proportional to burnout• Patient dissatisfaction proportional to provider
burnout• MBSR improves provider burnout and patient
satisfaction and decreases medical mistakes.
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Will Mindfulness Practice Produce Results?
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Mental States
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Mindfulness: To see Clearly
Intentionally paying attention in an open, accepting and discerning way
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Mindfulness
• Paying attention in particular way
• On purpose • In present moment• Openly and non-
judgmentally
• Alerting, re-orienting, executive control
• Intention, motivation• Experiential approach• Acceptance, curiosity
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Mindfulness-Based Stress Reduction (MBSR)
• Formal Mindfulness Practice– Breath focused– Body Scan– Attention Shifting– Compassion/Loving Kindness– Present moment awareness focus
• Informal Mindfulness Practice– Pauses– Present moment shifts
• Yoga
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Mechanisms of Mindfulness Training
• Emotion Regulation• Attention Regulation• Self-Referential
Processing• Self as Awareness
Awareness
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Reperceiving
• Rotation in consciousness from subject to object
• Disidentify with the contents of consciousnes, thereby seeing freshly and clearly
• Witness our storey rather than immersed in it
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Physiological consequences of stress driven by catecholamines and cortisol
é heart rateé blood pressureé blood flow to musclesê blood flow to skin é metabolic rateê digestioné blood clotting and thickness
é blood sugaré respiratory rateé fluid retentioné alertnessé breakdown of fatstriglycerides and LDL
cholesterol
(c) Lipsenthal 2011
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Effects Mindful Practices• weight• blood sugar• bp• Improved lipid profile• cortisone• inflammation• Improved well-being, alertness• pain with stress
• brain size, grey matter• quality of life• concentration• learning• sleep quality• body awareness• depression • Changes DNA activation• Burnout
NIH conference 2009 Mind/Body Med.
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Emotional Response to Negative Self-Beliefs
Golden et al, Emotion 2009
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Mindfulness Training and Memory
Jha et al, Emotion 2010
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Pain Sensitivity in Meditators
Grant et al. Emotion 2010
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Meditation
“Bhavana” = Meaning Cultivation
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Brain Changes with Short Term Mindfulness Practice
• Increased Prefrontal Cortex size
• Increased white matter efficiency in Anterior Cingular Gyrus
• Right becomes Left Amygdala predominance
• Increased size insula• Increased hippocampus
size and activity
• Executive Function• Self-regulation• Positive emotional outlook
• Perception, self-awareness, cognition
• Memory
Posner and Tang 2012
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Benefit Greater Than Cost?
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The Mindful Professional
• Increased attention– Sustained attention and switching focus
• Increases Empathy– Predictive of positive relationships and communication
• Increased Self-Compassion– Compassion toward self improves compassion toward others
• Increased Creativity and Problem Solving– Improved thinking in multiple perspectives and OOB
• Improved Emotional Regulation– Emotions transitory and received without fear
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Mindfulness Practice
• Results in 4-8 weeks• Practice 20-40 minutes daily• 12-24 hours of class (minimum amount
unknown)
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