When a Professional Gets Burnt Out: Rediscovering What We Preach Part 1

Over the years, there have been numerous articles about professionals and burn out.  The general public is becoming aware of burn out.  And the one modality that can help both groups deal with stress is mindfulness-based stress reduction or MBSR.

Dr. Jon Kabat-Zinn first created MBSR in 1979 at the University of Massachusetts Medical Center. The National Institutes of Health's National Center for Complementary and Alternative Medicine has provided a number of grants to research the efficacy of the MBSR program in promoting healing. Completed studies have found that pain-related drug utilization was decreased, and activity levels and feelings of self-esteem increased, for a majority of participants.

For a history of the Center for Mindfulness at UMASS, click here

http://www.umassmed.edu/cfm/about/index.aspx

Studies of health care providers who use MBSR suggest that there is a decreased perception of stress and greater self-compassion. Job burnout and psychological stress were also decreased.

So just what is MBSR and how does it work?

MBSR is a behavioral program that uses the psychological concept of mindfulness to help with coping skills, reduce pain and increase mental focus.  Juliet Adams, founder of mindfulnet.org explains mindfulness through the ABC’s of Mindfulness:

A. is for awareness.  Becoming more aware of what you are thinking and doing – what’s going on in your mind and body.

B. is for “just being” with your experience.  Avoiding the tendency to respond on auto-pilot and feed problems by creating your own story.

And

C. is for seeing things and responding more wisely.  By creating a gap between the experience and our reaction, we can make wiser choices.

MBSR includes developing a sense of peace, heightened awareness,  and tranquility through regular meditation and relaxation.  MBSR helps to cope emotionally and physically with everyday stress, challenges and demands.  It is bringing awareness to the present moment – while trying to not allow your mind to wander onto other topics past or future.  In his Center, Kabat-Zinn has seen over 18,000 individuals who have reported a decrease in physical symptoms of stress, increased ability to relax, reduction in pain levels, greater energy and enthusiasm for life, and improved self-esteem.

Part of MBSR involves breathing - not unlike Lamaze!  Watch Dr. Kabat-Zin here: 

References and resources:

Davis, D.M. and Hayes, J.A. (2012)  What are the benefits of Mindfulness.  American Psychological Association. Vol 45, No 7.

Fjorback, L.O. (2012) Mindfulness and bodily distress.  Danish Medical Journal.

Goodman, J.H. et al. (2014) CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Archives of Womens Mental Health.

Mindfulnet.org

Shapiro, S. et al. (2005) Mindfulness-based Stress Reduction for Health Care Professionals: Results from a Randomized Trial.  International Journal of Stress Management Vol. 12, No 2. 164-176.

Fundamentals of Relaxation Part 5 - Breathing

In spite of the new technology associated with labor and birth, women are still fearful.  Fear may come from hearing stories, reading articles, or simply by not knowing the full truth about the events of the birthing process.  An important aspect of relaxation for fear is breathing.

Any source that addresses fear, stress or anxiety will also address breathing.  Breathing is an effective and easy way to reduce stress and fear by decreasing the body’s reaction to the stress.  Slow, rhythmic breathing has been shown to lower blood pressure, reduce heart rate, and reduce the secretion of stress hormones such as cortisol. Relaxed breathing also balances O₂ and CO₂ levels and decrease muscle tension.

Behaviors for coping with severe fear of childbirth or SFOC were related to six domains of childbirth education relaxation: concentration or focusing, support from family or doula, breathing, relaxation and perception of control.  Since breathing helps to maintain focus and relaxation and hence perception of control, breathing seems to be a foundational skill to learn.

For decades, Lamaze has taught patterned breathing to offset the intensity of the contractions. Since Lamaze has become as synonymous to breathing as Kleenex is to tissues, many expectant parents come to childbirth class, regardless of the method, to learning breathing.  While Lamaze still offers instruction on breathing, it is not so much how one breathes as that one does breathing effectively.

In a 2011 article in the Journal of Perinatal Education, author Judith Lothian gives these guidelines for using breathing in labor:

• Breathing is easily subject to conscious control. Therefore, controlled breathing is easy to learn.
• Slow, deep breathing is particularly effective. The “right” way to breathe is whatever feels right. There are no rules related to how many breaths per minute, whether to breathe through the mouth or nose, or whether to make sounds. The key here is that the breathing is conscious, not automatic.
• As labor contractions get stronger and the work of labor gets harder, speeding up the breathing and making it shallower is sometimes, but not always, more effective.
• Focusing on something, either with eyes closed \or open, can help maintain the rhythm of the breathing.
• Using conscious breathing in everyday life, either to relieve stress or to increase body awareness and mindfulness, is excellent practice for labor. It is an excellent life skill.
• Conscious breathing works best in combination with many other comfort strategies. In Lamaze classes, women no longer spend large amounts of time practicing breathing. Women move, change position, slow dance, sway on birth balls, learn massage, and identify the countless other ways they normally relax and find comfort. Each of these comfort strategies can be used in combination with breathing.
• In restrictive environments, breathing may be one of very few comfort strategies available for women in labor. It is one coping strategy that cannot be taken away.

References:

Lothian, J. (2011) Lamaze Breathing: What Every Pregnant Woman Needs to Know.  Journal of Perinatal Education.  20(2), 118-120.

Salomonsson, B.  (2013). Self-efficacy in pregnant women with severe fear of childbirth.  Journal of Obstetrics, Gynecologic and Neonatal Nursing. 42(2): 191-202.

Turankar, A. et al (2013) Effects of slow breathing exercise on cardiovascular functions, pulmonary functions and galvanic skin resistance in healthy human volunteers – a pilot study.  The Indian Journal of Medical Research.  May 137(5): 916-21. 

Taking A Look At Mindfulness Guided Imagery as an Add-on to Relaxation

Research shows that relaxation during labor and birth allows for a dramatic reduction in the stress reaction.  When subjected to stress (of any kind) or fear, be it real or anticipated, body changes take place that trigger a defense mechanism and institutes the fight or flight mechanism.  The fight or flight mechanism is started by the autonomic (or involuntary) nervous system and includes body changes such as an increase in respirations and mild/moderate rapid heart rate.  With this stress response, females have a strong tendency to take flight or flee.  Obviously this is not practical during labor/birth.

Most of us teach about the Fear-Tension-Pain Cycle as first described by Dr. Grantly Dick-Read in the late 1950s.  Fear (due to lack of education and practical knowledge), leads to tension in the body – tension in the muscles of the body uses oxygen that would have normally been made available to the fetus and the uterus.  This, in turn, decreases the efficiency of the uterine contractions and thus slows or in some cases, stops the labor process.  Tense striated muscles contribute to an increased in lactic acid build up that impinges on pain receptors, magnifies pain perception and increases fatigue. Fatigue decreases the pain threshold, further increasing pain perception and reduces the laboring mother’s ability to conserve energy for the expulsive efforts needed during the second stage of labor.

Conscious relaxation and practicing coping techniques may be some of the first items removed from childbirth education curricula when timing in the class becomes an issue.  However, initiating a relaxation response to contractions or pain stimuli can decrease metabolism, slow down the heart rate, calm breathing, reduce blood pressure and relax muscles – all of which has a positive effect on the baby, mother and labor.   Click here to read entire article