SURGEON GENERAL’S RX FOR STRESS IN AMERICA

The National Institutes of Health (NIH) has put itself firmly on record as being deeply concerned about our national epidemic of stress at the individual, organizational and societal levels. NIH’s National Center for Complementary and Integrative Health (NCCIH) broadcast on September 7th its annual Stephen E. Straus Distinguished Lecture in the Science of Complementary Therapies. The lecture was titled A Nation Under Pressure: The Public Health Consequences of Stress in America.

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PROMOTING RESILIENCE WITH OPTIMISM AND MINDFULNESS

The American Psychological Association (APA) recently documented a worrisome increase in stress in the U.S. population (Stress in America https://www.apa.org/news/press/releases/stress). Uncontrolled stress can cause or worsen anxiety, depression, PTSD and a wide range of clinical conditions affecting every organ system. Medical students, residents and practicing physicians experience higher levels of stress than their age-matched counterparts at all levels of medical training....

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ALLOWING AWE IN MEDICINE

Of all the sciences, medicine uniquely combines all domains of the human condition-biological, cognitive, emotional, environmental, interpersonal and transpersonal. The more we learn about the benefits of the interpersonal and transpersonal dimensions of health, disease and medical practice, the more we seek to populate medical schools with well-rounded students and humanize medical training and the healthcare workplace.

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trouble with this interoceptive perception. Interoception is important for recognizing changing physiologic cues such as hunger, satiety, hypoglycemia, migraine or epileptic aura, fever, bowel and bladder fullness, heartbeat and the full range of emotions.


Interoception is essential to emotional intelligence. Interoceptive training can help those who are unable to distinguish tension from relaxation, safety from fear, pleasant from unpleasant, comfort from pain, anxiety from peacefulness, sadness from happiness, anger from empathy and other emotional states as they come and go. Links between emotions and physical sensations in the body can help identify emotions and anchor emotional intelligence in the body.


How to do the body scan meditation?

This practice can be done very quickly or very slowly. I have provided 5 minute and 40-minute recorded versions on my website (4). Lying down or reclining are ideal positions. Taking three deep breaths, bring full attention to your breathing. Feel relaxation spreading throughout the entire body as each deep breath ends with a long slow outbreath that dissolves into stillness.


Beginning with the feet and sequentially progressing throughout the entire body, one focuses on the felt sense in each body part while non-judgmentally accepting all experience (pleasant, unpleasant and neutral). It is important to let go of any expectations, the need to change or fix anything and the temptation to become fixated on a particular sensation. Letting go of thinking and conceptualizing, one just notices thoughts arising and gently escorts the attention back to the body. As you place your awareness on a body part, tune into what you feel there- comfort, discomfort, pain, itching, numbness, tingling, lightness, heaviness, warmth, coolness, etc. Recognizing any emotions that arise can refine one’s interoceptive sensitivity, affective recognition and emotional intelligence. Allowing emotions to be just as they are during body scan can lead to acceptance of emotions in daily life.


Try using the body scan to help you calm the racing mind and fall asleep at night. Try it in the morning, paying close attention to your body as you wake up, beginning your day with the intention of alertness, awareness, presence and paying close attention to your family, patients, staff and colleagues. Tune in to your body throughout the day, noticing how it feels interoceptively to be hungry or thirsty, rushed or relaxed. Notice how you communicate with your tone of voice, facial expression, body posture, silence- while interacting with those who test your patience and those that touch your heart.


Resources


  1. NIH Resources for Mind Body Domain https://nccih.nih.gov/health/mindbody
  2. Shapiro, S. L., & Carlson, L. E. (2017). The art and science of mindfulness: Integrating mindfulness into psychology and the helping professions (2nd ed.). Washington, DC, US: American Psychological Association
  3. Body scan meditation https://palousemindfulness.com/docs/ bodyscan.pdf
  4. Body scan audio recordings, a 5 minute and 40 minute version, I created for patients and students http://www.mindbodystudio.org

Behavioral medicine research confirms the value of mind-body approaches for both physician self care and patient care. Physician adoption of such lifestyle approaches is a key ingredient in our professional well-being, helping us promote resilience, manage stress, prevent burnout and cultivate compassion. Stepping off the daily treadmill of hurry and worry is a critical component of our personal strategy to live an ethical, effective and compassionate life in medicine. It also gives us the authenticity with which to counsel or refer patients for such training as a means of staying well or intervening in chronic disease. The National Center for Complementary and Integrative Health at NIH has extensive resources for consumers and health professionals, emphasizing research and evidence-based recommendations.(1)


Mindfulness-based stress reduction (MBSR) is among the leading mind body approaches world-wide and has demonstrated efficacy in many chronic physical and emotional conditions, especially anxiety, depression and chronic pain. MBSR includes several distinct and interrelated practices, including the foundational practice of body scan meditation.


What is mindfulness?

Researchers who study mindfulness emphasize the following components-  having the conscious intention to direct attention to immediate experience in the present moment with the attitudes of openness, curiosity, acceptance, non-judging, patience, non-striving and self- kindness. (2)

BY JOHN A. PATTERSON MD, MSPH, FAAFP

What is the body scan meditation?

The mind is often in the past or the future. This can be useful but it can also be a real obstacle to effectiveness and contentment in our personal and professional lives. The mind can also be in some other place besides where the body actually is. For these reasons, mindfulness of the body is considered the first foundation of mindfulness practice. The body is always dependably in the present moment and in this place. The body is always here and now. We train the mind to ‘be here now’ by paying attention to the body. (3)


The under-appreciated sense of interoception

The body scan meditation emphasizes interoception, shifting from cognition to somatic perception of the gross and subtle “sensing” or “feeling” of the interior of the body-musculoskeletal, visceral, cardiovascular, neural and energetic. This is very different from thinking about the body or imagining the body. It is also different from exteroception (perception of external stimuli in contact with the body) and proprioception (perception of the body’s position, movement, equilibrium and balance).


We know from clinical practice and from our own experience, that some people can “feel” their heart beating fast/slow or regular/irregular- while others have

JOHN A. PATTERSON MD, MSPH, FAAFP

Dr Patterson chairs the Lexington Medical

Senator Alvarado earned his bachelor's degree in biology from Loma Linda University (California) in 1990, and then went on to receive his Doctorate in Medicine in 1994. He completed his medical residency in Internal Medicine and Pediatrics at the University of Kentucky in 1998. Society's Physician Wellness Commission and is certified in Physician Coaching. He is on the family practice faculty UK College of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org