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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feelings, or sensations you are experiencing. Simply allow your experience, whether you like it or dislike it, remaining open to being present with “what is.” Allowing increases your capacity for “letting things be” and develops the positive personality trait of equanimity.


I: Investigate inner experience with kindness

Investigation means being truly curious, paying close attention and asking yourself, “What is happening inside me?” Experiment and engage in an active inquiry into your experience. Ask yourself questions like: “What most wants attention? How am I experiencing this in my body, my mind, my emotions? What am I believing? What does this feeling want from me?”         


Really roll out the welcome mat to all your experience with curiosity, openness and acceptance. Brach reminds us to “Investigate with kindness. Without this heart energy, investigation cannot penetrate; there is not enough safety and openness for real contact.”


N: Natural Awareness  (or Non-identification)

The first three steps of RAIN require your active intention on focused attention. In contrast, the N of RAIN expresses the result of these first 3 steps: an experiential, non-verbal realization of your natural awareness. There’s no action required. All of our physical, mental and emotional experiences have arisen within our natural, pure, open awareness. Now we allow awareness itself to arise spontaneously. Importantly, we no longer ego-identify with our experience. We simply rest in natural awareness.         


You can use the R.A.I.N. written document(4) and audio recording(5) below as guides for your own practice or as resources for your staff and your patients. Curing our national epidemic of stress can begin with skillfully managing our own.


Resources


  1. A nation under pressure- The public health consequences of stress in America September 7, 2017 NIH webinar with Vivek Murthy, MD
  2. Goyal M, Singh S, Sibinga EMS, et al. Meditation Programs for Psychological Stress and Well-being A Systematic Review and Meta-analysis. JAMA Intern Med. 2014;174(3):357–368. doi:10.1001/jamainternmed.2013.13018
  3. Tara Brach, PhD, psychologist, founder of Washington Mindfulness Community
  4. R.A.I.N. handout pdf
  5. R.A.I.N. practice audio recording (11 minutes)

Former Surgeon General Vivek Murthy MD has sounded the alarm regarding our country’s epidemic of stress.(1)  He calls for a serious national effort to mitigate the corrosive effect of chronic stress on every organ system. He calls for a nationwide campaign to spread a preventive, behavioral lifestyle prescription of healthy eating, physical activity and genuine social support (other than social media). Based on solid peer-reviewed evidence, he also recommends meditation as a health promoter and stress buster. As Surgeon General, he offered meditation training to his entire staff. They often meditated together at work.


Mindfulness is the leading meditation and awareness practice worldwide, with broad applications across the lifespan and across cultures in health, medicine, education, business, law and criminal justice. A 2014 meta-analysis in JAMA(2) concluded that anxiety, depression and chronic pain can often be improved by the addition of mindfulness-based stress reduction (MBSR) to a patient’s treatment plan.         


The R.A.I.N. practice is one of many useful tools taught in MBSR. It was developed by psychologist and mindfulness teacher Tara Brach(3) and serves several useful mindfulness goals. It reminds us to direct our attention to the present moment- to what is actually happening here and now- rather than spending so much time replaying the past and anticipating the future. It reminds us to fully experience life as it is right now- both the pleasant and the unpleasant- the comfortable and

BY JOHN A. PATTERSON MD, MSPH, FAAFP

the uncomfortable. It can be a portable tool of self-care and help silence the inner critic of self-sabotage. We can learn to transform self-criticism, self-neglect and self-judgment into self-kindness, self-friendliness and self-compassion


Practicing R.A.I.N.

Begin by pausing anytime you remember to do so. The frequency of remembering increases the more often you do the practice, especially if you keep a personal practice journal each day or practice with a dedicated group. This journaling helps you hold yourself accountable to your goal of mindful self-care.


R: Recognize what is happening

Anywhere, anytime, simply ask yourself: “What is my immediate experience? What is happening inside me right now?” Turn your attention inward with genuine, natural curiosity, letting go of assumptions, automatic responses and preconceived ideas. Listen with kindness to your body, heart, thoughts, emotions, feelings, or sensations just as they are- right here- right now.


A: Allow life to be just as it is

Allowing means “letting be” and “being with” whatever thoughts, emotions,

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