Chapters Transcript Video Mindfulness Practice in Medical Settings: Bringing Mindful Moments to Work Anna V. Agranovich, Ph.D., ABPP, presents at the Johns Hopkins Department of PM&R’s Grand Rounds on July 19, 2022. Good afternoon, everybody. Happy to be here. And as Doctor Freelander mentioned, the topic for today's grand round. Uh Grand rounds is to bring a bit more of wellness. And by that way, mindfulness into our daily practice at work could have benefits for your, for your personal life as well. So let's see if everything works. So I don't have much to disclose unfortunately. Um And there are some objectives that have been shared with you. So the purpose of uh this uh grand rounds is not so much research oriented, but to help us identify benefits of various practices of stress reduction and implement them in our daily life and maybe become more familiar with various resources that we have for that at Hopkins and outside of it maybe practice, not maybe but practice being present and mindful. So, uh I uh organized this grand round. This presentation is mostly experiential. We're going to practice a lot. But so that to help you uh understand that I didn't make it all up mindfulness has been a hot topic in literature for the past decade, was exponential growth of publications and various research studies devoted to benefits of mindfulness. In various settings. And the research I did just recently for mindfulness in medicine uh shows about 2000 publications in the past two decades. I didn't read them all, but I did read quite a few of them. So there is a lot of uh literature support and what we're gonna be doing today. Uh And with that, I'm gonna switch from academic presentation to mindfulness practice was your permission. So mindfulness uh has many things, but most of all and most important, it's a practice. This is something it's a meditation focused on being uh present in this moment. And so I would like us to start with a practice. So I invite you and I know many of us are, are using this time as a lunch break. So uh gonna be tea, but I invite you during the brief practices that we're gonna take maybe stop from eating and those of us who are driving, please don't follow my instructions too closely and don't close your eyes. And for the rest of us, I invite you to find a comfortable position, find the feet on the floor, allow your spine to be upright, just make any adjustment so that you could be comfortable for the next several moments. If you feel comfortable, allow your eyes to close or if not, then direct your gaze somewhere in front of you without looking at anything in particular and bring your attention to your breath, just notice your body breathing without any effort on your part, become aware of this inhale and that and this inhale. And I, no, it is in the quality of your breath and the depth perhaps become unaware of what it feels like to sense air at your nostrils or with your lips may be noticing that the temperature of the air that you inhale is slightly cooler than the temperature of the air that you exhale. Becoming aware of rising and falling off your belly as you breathe in and out, expanding your awareness to your whole body. Just noticing your body here and now in this moment, what it feels like to have your body being supported by the furniture and sensation of touch between your body and sitting surface or maybe your arms or your hands resting on your lap or any other surface. No, it doesn't send any and all sensations in your body. If there are any areas of your body that may ask for more than the love and care and attention, they maybe allow you a breast to travel to those areas and then let go of any no tension as you exhale and expanding your awareness to your sense of hearing, becoming aware of my voice, the silence between the words, any sounds in your immediate space, maybe even in your bodies sounds from outside, just noticing your body hearing and then the next exhale, gently blink your eyes open. If they were closed, inviting the sensation of scene to join your senses, just noticing the colors, objects, shapes, whatever your gaze rests upon and then blink your eyes one more time and bring your attention back to a virtual room and the computer's clean here and now present. That's what I always how that fits. So, mindfulness is defined all kinds of different ways. I once did a search and found 100 definitions and I'm not exaggerating but the most common one and operational definitions we're gonna use now is the one that John Cazin brought to the Western world by way of mindfulness based stress reduction, which is an evidence based program for stress and pain reduction. So mindfulness is paying attention in a particular way on purpose in the present moment and non judgment sort of like that doggy in the picture to whatever it is sounds pretty easy, right? I'm gonna take it apart a little bit and talk about why, why is that important? So paying attention uh our recent age has been referred to as a continuous partial attention. We are constantly bombarded by some kind of emails, phone messages, other technology under the pressure of uh work expectations, other expectations as the time that we have to enjoy. Uh the products of all our productivity continues to decrease. That's very difficult to be present in the moment because the the demands on time continue to increase. Uh mindfulness are thought as maybe a potential way to help cultivate our attention that by uh by its effect helps to prevent or maybe even treat various disorders, increase our ability to cope with pain and stress and um maybe reduce stress for ourselves and our patients. So some wise men said that our 10 could be in two different places. It's either in the world around us or our immediate environment, whatever that we see, whatever that we sense here or it's in our mind. And by proportion, it actually tends to be a whole lot more in our mind that in the world around us, uh and our thoughts and various uh experiences that we continue to relieve or anticipate. Uh for that matter. Nowadays, our, I think our attention is divided between the world and mind and the phone uh that also takes uh away from mindful presence. So the for the purpose of this presentation, I invite you unless you're using your phone to connect uh to maybe put it aside for a moment and see if that can bring some benefits. And if you are on your phone for the grand rounds, then maybe silence, it don't put it on, do not disturb. So paying attention on purpose, uh think about attention being like a radio station, we could switch back and forth, right? And we could tune to a particular station on purpose and choose to stay there for a while or we choose to switch channels on purpose. So uh for the duration of this uh our time together, I'd like to offer a little mindfulness exercise here. See how well we are paying attention on purpose. So every time you see this guy, the radio thing, I'd like you to put your feet on the floor if you can and just notice what it feels like to have your field being connected to the ground and take it in breath and exhale and imagine that your feet are connecting, not just to the floor or your shoes or whatever they're resting on. But that connection goes deeper through the floor, through whatever the floor is beneath you, connecting you to the earth. Just feeling connected to that very moment I am taking and the person paying attention on purpose in the present moment. Oh One wise man said that there's only two places where we could be at any given moment. It's either present or not. Unfortunately, a lot of time is spent not being present. And even though time machine has not been invented, we tend to travel in our own self invent a time machine to the past and try to change the future and analyze and grieve and or try to predict the future, which we also can't and which creates a whole lot of unease and anxiety and tension and spent maybe 95 of our time, as they say, you know, above our, above our neck, traveling in our mind back and forth in time. So bringing our attention to the present moment here and now, and that one brings peace and without judgment, paying attention on purpose in the present moment and without judgment, probably the most difficult part, we tend to judge all experiences that we have. It's good or bad or useful or not, or pleasant or unpleasant or hot or cold. They still not part of it is probably evolutionary useful and part of it is not so oftentimes in mindfulness practice with cupboards in another's book, uh is about creating an observer's mind. So instead of identifying with our thoughts or emotions or our sensations, our judgments, we observe them come and go. As we would observe, the clouds appear and move a around around on a clear blue ski and then dissolve and change shapes, etcetera. There is no need to become any of those clouds or jump on them and travel with them on most in instances, we can just watch them come and go. So sounds sounds easier, right? Star says mindfulness practice is simple but not easy, simple but not easy. There is a, a poem that I like to share with you uh that often used in all the mindfulness training about. What, what is that being at peace? Poem named Peace by Dorothy Hunt. Do you think peace requires the end of war or tigers eating on the vegetables? Does peace require an absence from your boss or your spouse or yourself? Do you think peace will come some other time than now, some other place than here. Some other hard than yours. Peace is this moment without judgment. That's it. This moment in a hard space where everything that is is welcome is is this moment without thinking that it should be some other way that you should feel some other thing that your life should unfold according to your plans. Peace is this moment without judgment by everything that is is welcome. So, mindfulness is about being aware of everything that's going on with us, our body here and now and being ok with that simple but not easy. So, mindfulness is a practice and of course, the more we practice, the better we become of it. So there's two types of practice, there's formal practice and there's informal practice and formal practice. So we did a little bit of that in the beginning, the breathing space. Uh and that could be very brief, all, all very alone focusing on your breath and just staying connected because our breath happened to be always here and now always an anchor to the present moment. There's a famous body scan practice that uh helps us to connect with where our body is and how it's doing in the present moment attending to different parts of body uh in order, uh which has a lot of um benefits for treating chronic pain. And you know, stress reduction in general, we're not gonna do it now, but I have plenty of recordings to share. There's various guided meditations uh as well as for various forms of mindful movement. So think about yoga that are all mindfulness practices being present with your body and your breath and your movement, Emma in the real time. And then there's all kinds of informal practices. So taking a walk, right, we could talk on the phone while we walk or we could just notice somebody moving, you know, from heel to toe and all the smells and sounds and uh sights that surround us as we walk. It could be even mindful driving for that matter, mindful eating as you're enjoying your lunch, paying attention to what it tastes like and what the texture of the food and how your body responds and whether you're full or not and whether you like it or not. And uh and this has also a lot of implications for improvement in health behaviors. There's mindful communication that hopefully will get to practice a little bit and there, you know, mindful living, implementing all kinds of mindful moments during our day, work day and personal space and personal life and work life. So why would we do that? Right? Why would we do that? Why would we stop and smell the roses because it's good for us, right? There has been, as I said, the publications to show the benefits of mindfulness in various settings. And if we organize them in terms of clusters of helpfulness, there are several. So one of them is practice of mindfulness. Uh remember paying attention on purpose uh that helps to increase focus and concentration. So I do that a lot with my n health patients, as well as my colleagues do to help with attention retraining after various types of brain injury. But also for all of us, uh it's a good thing to practice paying attention uh and not divide it all the time. It helps to improve resilience because being present helps to reduce our stress by deactivating our Amygdala Olympic uh system and bringing frontal lobes online. And uh by being able to deal with stress better, we improve our resiliency. People who practice mindfulness also get stressed and don't get their own right, but we hopefully get over that stress a little faster and return to meaningful life. Um There's implications for improved some of the sensory awareness and reduce pain suffering by practicing attention to your body, uh enhance self awareness by be becoming aware of our triggers and avoiding or de identifying from unhelpful behaviors and choosing behaviors and responses that are more helpful. And the cousin of uh mindfulness called loving kindness that I also hope we're gonna practice today. Uh has a lot of benefits that studies show to help people connect with each other to improve intergroup relationship, qualities of leadership, uh family relationships, et cetera. There have been a lot of studies about mindfulness at work and I invite you to pay attention and maybe take a breath and find your feet. Uh that showed that various program programs implemented in uh various work settings. So when people even used uh an app to meditate 10 to 20 minutes once a day that, that showed uh after several weeks, a significant improvement in reduction of stress and work improvement, work satisfaction and decrease in blood pressure and those effects uh remained a few months out. Uh practice mindfulness increases self compassion, that also brings more happiness and work satisfaction and health care providers. There was a study that showed that work based mindfulness programs uh improve uh well being and again, job satisfaction. But also uh important thing that we could only do that uh when uh work environment is supportive, right? That it's seen as something that you do that helps you and helps your patient care and helps uh improve uh quality of life for you and others rather than a waste of time. So I think our education committee and Doctor Freelander and our administration that we, that we have the opportunity to practice them at Grand. So why does it work? Right. So I'm a neuropsychologist. I'll talk a little bit about what, what happens in the brain and then we get to practice some more. So we stress engages our sympathetic neuros systems, right? And oftentimes puts us on the sympathetic overdrive, there's always something going on with on constantly on high alert. There's a lot of stressors bombarded from the news from daily life from everywhere. So, so one of my mindful is called the hijack, uh introducing mindful presence awareness of this moment, brings our part sympathetic nervous system online and sort of creates a balance in our nervous system. So she calls it a person, sympathetic nervous system is attend and befriend the system. So think about even brief mindfulness practice as that break, that breaks the stress response, the continuous stress response and allows us to stop and just be and uh decrease activation of our limbic system and increase our frontal lobe engagement. Which studies showed that even after eight weeks of uh that standardized mindfulness practice or mindfulness based stress reduction, the size of amygdala and activation of amygdala decreases. And with that, the connections between uh amygdala and frontal lobes become weaker. Whereas connections of frontal lobes with other systems in the brain strengthen and front prefrontal cortex seem to thicken. Uh So there's another, you know, useful picture of one of the studies where they connected people to F MRI scans. And as they meditate, that shows that uh in this particular study, uh several meditators were instructed to pay attention to the breath and they clicked the button every time their attention wandered or when they redirected attention to the brain. And what they noticed that as we pay attention continuously and sustain attention, uh there's a lateral prefrontal cortex. So the part of the brain that supports attention and executive function stays online whereas activation and various other parts decreases. And so there's a lot of implication of being present and, you know, using our brain at the, at the best capacity. So let's let's maybe take mindful break and something that you could do um any time in your daily life, just take a few seconds to a few minutes. Let me stop. Right. Uh Where else means stop, stop what you're doing right now. Don't stop listening to me. But if you were doing anything else, then just stop that and allow yourself to be in a comfortable position, sit it or wherever you are and just notice your body, your feet on the floor and teas will take a breath. So let's take a few slow the breath perhaps inhaling through your nose, initial and exhaling through your mouth by pushing the air out through your lips like until there's nothing there and then repeat it a few more times. Just noticing your breath, the flow of the air as you inhale and exhale. Maybe not the brass just noticing how each brass is slightly different from the previous one. Oh For observe, observe your body breathing, noticing if there's any tension in your body and it's so and as you exhale, maybe let go of the tension, allow your shoulders to drop down and back. You notice any tightness anywhere. See if you can relax into that, perhaps noticing your thoughts or emotions or anything like that, that's present here. And now just observe him without judgment, noticing your body noticing where your mind is going. No making the choice if any of those thoughts or emotions should be carried on to the next moment I drop here. Maybe not in your mind. Wondering grounding it one more time with your breath. Just noticing your body breathing, inhaling and exhaling and then proceeding, peace will proceed to whatever is important right now. Hopefully, the turn round presentation, but maybe something else. What does that they need right now and bringing the attention back to our virtual room, feeling more mindful and present. So the reason we are doing this is because it's important to take care of ourselves before we take care of others. And we're all very good at taking care of others and not always so good at taking care of maybe just me, but I have a feeling that others as well, right? Can't help anybody when you're dead, can't help anybody when you're burned out and exhausted. And there is a lot of burnout, right? There's uh was uh even before the pandemic, there have been quite a few studies on the clinicians burnout and various causes for that. And since the pandemic even more so, uh and as you, as you exploring all the reasons why you may feel burn out, but hopefully not yet because in July, we're not, right. Uh I invite you to also find their feet on the floor. They can, I, I just noticed that. So what do we do to prevent that burn out burnout or deal with it when it already settles one of those things that we have already done, right? So, noticing the emotions just being present with what you feel, right? Because we, we react, we, we make mistakes, we do all kinds of things we're not proud of when we're overwhelmed and tired and not present. And our mind is 10 steps ahead or somewhere and fast. So when we're noticing those kind of sensations will be here and ourselves, so it's a good time to stop and practice what we just need. We just find a minute to take a few slow deep breaths. We'll have a minute here and there and guess what? 10 slow deep breaths like, oh, that's still one. They call one minute, let's say 50 slow deep breaths, take five and we usually can five, I can find 1 to 5 minutes in our busy day to just stop and take a few slow deep breaths. And when we do that, that brings on that parasympathetic nervous system and balance to our brain and decrease our activation and brings out frontal lobes back line which allow us to make better judgment, engage in better behaviors. There's another brief practice. We can just do it now. Three breath. All right. So we're gonna take three breaths on the first breath just inhale and exhale slowly. Just notice your body breathing was an next inhale, feel your belly was there. And then as you exhale, allow your body to relax, just notice any tension and let go was a just ask yourself, what am I doing right now? What's important? Where am I going with that and then proceed. Another thing we could do throughout the day is take brief breaks uh between patients, right? Uh Some of us are still virtual. Some of us are see people in person. And when we do that, we do need to wash our hands in between patients, right and sing happy birthday twice as we do that. But besides swing in a happy birthday twice, it's a good idea to just pay attention to that simple act of hand washing. Even if you are not between patients all wash hands, right? So choosing that a particular as a particular activity, you might want to pay attention and just notice the temperature of the water and the sensation of touch and any smells and anything 30 seconds or whatever brains are balance to the nervous system. They can walk from one patient's room to another, from one task to another between tasks and between patients or between research appointments or what have you and while doing that, not processing what just happened or what will happen in the uh behind the next door, but actually paying attention to the movement your feet rotating from a heel to toe, oh what you see around yourself and the sounds that you hear and the smells of the air and the temperature spending time in nature when we can um difficult to do during work. But maybe before or after it has a powerful healing power and also paying attention to that if we happen to be among trees or flowers, grasses to what they smell and look like and any other attributes that you notice, because every time we come to our senses, every time we pay attention to what we see and hear and touch and smell, we bring our attention to the present moment right here right now. And then, and that helps to bring the stress level down. And as I mentioned before, trying to take breaks from electronics also tends to be therapeutic. There's another uh useful practice we can implement during work day and otherwise, uh cousin of mindfulness is practice of gratitude and compassion starting with ourselves and then others and perhaps would take maybe five minutes or so to practice. Now, if you indulge me, so if you're eating, perhaps I'll take a slight break from that and allow yourself to find a comfortable position where you could be still for a few months, take your breath. If you feel comfortable, allow your eyes to close, if not just direct a ge somewhere in front of you without looking at anything, know it is your body breathing. Now, it is what it feels like to be supported by the furniture. I can see your feet on the floor. Notice what it feels like to have your eyes being uh covered by your eyelids, any and all sensations and then bring to your mind something, someone you're grateful for today, maybe a brief moment, something that broke you joy, maybe just your body breathing and functioning without assistance. Maybe something happened that you're grateful for. Just allow that experience to settling, perhaps allowing a smile to come to your face by bringing the corners of your lips up and see how that changes the sensations and experience. Expanding. That smile to your heart's face, feeling your body is smiling. Wow. And that feeling of gratitude to stay with you for a moment, noticing how your body reacts autism, anything that comes up, any sensory experiences and emotions around your eyes and that smile in your heart space and we'll take that practice a little further. It's called that practice of joy. So I want you to think about three people you love. Just think about three people you really care about. Bring to your mind's eye, the first person and imagine seeing them at their happiest notice. Notice how your body and soul reacting that smile on your face and then your heart face, allow yourself a moment there and think about another person you love dearly and see if you can imagine yourself looking into their eyes. Just noticing the shapes and color of their eyes and their eyes smiling and again, experiencing what it feels like in your body and emotions and bring it in your mind. Another person you care about and think about the first time you met them and that smile on your face and then your heart space and any other emotions or sensations that come up, just noticing what's there here and there as you bring those experiences of gratitude and love into your mind and to your heart space. Now bringing the attention back to your breathing here. And now just noticing your body breathing, taking a deep breath, exhaling and then another deep breathing and then allowing your eyes to blink open, hopefully keeping that smile on your face and in your heart as the benefit of this practice, I cannot see anybody but I very much hope a smile is present. There's another technique I learned somewhere that I'm happy to share with you. It's called a slide show, patient success story. So we tend to oftentimes fixate on, you know, any particular particular patient interaction that didn't go well or you know, something didn't happen or any complaint or uh anything, right? But yet, uh all of us are in this healing profession for, for the reason that we probably wanna help people, right? So in order to help us to reverse this negative bias, you know, they say our mind is like well to anything negative and like to anything positive, right. Anything that everybody, anybody told us something wrong or, you know, we didn't have a good day that sticks, you know, something went well. And so the flight to office and doesn't stick. So in order for it to stick, sometimes it's a good idea to have that record in your mind. Or maybe even in paper or maybe you wanna create your own power point of uh patient success stories. So think about all those grateful patients, think about all those interactions you had here and there where, where you felt that what you did was of a lot of benefit to somebody's well being somebody's life, somebody's health, right? And having a good memory, a slideshow of those experience is also a good thing to bring our mind uh into a more balanced state to counteract effect of burnout and stress and practice and practice and practice. Another important cousin of mindfulness is a practice of loving kindness. That's my favorite one. So love and kindness is a poly word meta and that's a very short word that translates into a very long word because there's no better way to translate it. So, and the love and kindness stands for this uh wishing well to yourself and others sending the positive wishes into the world directed to particular people or groups of people ourselves. And um there's been quite a few studies uh looking at the effect of uh regular practice of uh and kindness and uh what people report is that they feel that they become more open to the needs of others, more connected with others, more likely to help uh loving kindness, practice of love and kindness, facilitate connections within groups and improves leadership uh quality. And also their studies to show that groups that practice, that tend to uh report greater job satisfaction. So with all that being said, I think it would be important for us to take a few moments to practice it too. And uh I warned you and there's a lot of practice on this. So I invite you to, we're gonna do a brief practice but uh find some position in which you can be still for, for a moment. Oh, more like five minutes, maybe seven minutes. Make any adjustments that you need to make, find your feet on the floor, connect it to the ground, find your breath, just this brass, your body breathing here and now find that smile and that it was on the face not that long time ago, bringing the corners of your lips up and noticing what it does allowing your eyes to close. If you feel comfortable again, look at the screen, look somewhere if you're not closing your eyes and then I invite you to bring into your mind's eye. Somebody you love dearly, somebody you really care about. Maybe a family member, a dear friend, a beloved pet, somebody. It's really easy to send those wishes to and then repeat after me in your mind's voice, sending those wishes to this individual you care for deeply. May you be filled with loving kindness? May you be happy? May you be healthy? May you be free from inner or out of harm? May your leaf was eased noticing how your body responds? Anything that arises as you send those wishes to your loved one? And then we're gonna expand that circle and I want you to think about another person in your life. Maybe somebody you feel neutral about calling a neighbor oh, more distant uh acquaintance. See if you can bring that person to your mind's eye. And then it after me in your mind's word voice, sending those wishes to, to this person. May you be filled with love and kind? May you be happy? May you be healthy? May you be free from inner or outer harm? May you live with ease? And again, noticing what arises if it was easy or not anything soft? And maybe you care about the person a little more and now I'm gonna challenge you to bring into your mind. I a person. Maybe you don't care very much about maybe somebody you had a recent argument with or disagreement or don't bring any global dark forces into your minds eye. But maybe you know somebody you really don't care about very much and then repeat that to me in your mind's voice, sending those wishes to one person that maybe you had a conflict with us. May you be filled with love and kindness? May you be happy? May you be healthy? May you be free from inner or, or to harm? May you be safe? Was eased noticing again what arises how you buy the response? Any emotions if that was, you know, if you need to practice it a few more times, I invite you to expand his wishes to the whole group, the Department of Physical Medicine Rehabilitation, to the whole Hopkins community, to uh all the people, you know, to all the creatures on earth as far as you wanna go and repeat enough to me, your mind's voice. May we all they field with love and kindness? My old creatures be happy. May all creatures be healthy? May we all be safe from inner and outer harm? Maybe we'll leave at peace. May there be peace? No, it's again, how are you by the response and the sensations of the rise and the emotions of the rise? Just not me, any responses from all your systems and then gently bringing the attention back to your body. Noticing what it feels like to have your body being supported by the furniture. Any sensation of touch between your body and the furniture and the sensation of your skin being touched by your clothing and open part of your body open to the air. Now, it isn't what it feels like to have your eyes. Being covered by your eyelids as you're breathing in and out, listening to my voice, expanding your awareness to the sensation of hearing any sounds in your immediate environment and in your body, taking another deep breath and gently blinking your eyes open and bringing your attention, the things that you can see that was another out breath back to a virtual rule here. And now maybe we all do. Well, I will be healthy. Thank you. Now, all this mode, I'm gonna talk a little bit for the remaining time about what, what is that we are doing here at the Department of Physical Medicine and Rehabilitation to bring a little bit more mindfulness to work setting besides this round. So um uh we lucky to get the small grant sponsored by office of uh Well being for implementation of mindfulness in various work meetings. So uh most of you probably have seen the emails and some of you have participated or will participate in the training. So there are five uh trainings. One already happened for to go where I share various mindfulness practices to uh representatives and leaders of different service groups within our department was an idea that we're going to start. Each meeting was just brief, mindful moment. Uh We have been doing that at the division of rehab, psychology and neuropsychology for the past almost four years. And I think people have liked it and there there has been benefit especially through pandemic to help us deal with our stress, but also to connect with each other and send love and kindness. Uh So a set of various practices uh that we could implement during the beginning of the meeting, during the meeting at the end of the meeting, but at least start in the meeting with a brief mindful moment where we will connect was here and now and the stress and then proceed. Uh If there are any more, any, any other people who would like to take part in it, uh just send me an email and I add it to the group or create another one. There's another useful thing that we could do at work is to increase mindful communication, right? Uh that tends to decrease conflict and improve understanding and collaboration and lead to um better outcomes. So there's three types of communication that generally exist, right? Adversarial, when we argue and uh logistical, we meet somewhere at two o'clock and then affiliative when we actually listen to each other, right? And mindfulness practice takes uh helps to bring that um sort of uh um level of communication back uh closer to, to the one that helps us connect. So, uh for example, taking one to uh minutes in the beginning of any meeting or before every meeting to practice that love and kindness. So by sending wishes of love and kindness to somebody you're gonna meet with or to the group you're gonna meet with, whether with the group or even before that by yourself, before you, while you're waiting for your, I don't know in your review. Um And that helps to uh to, to improve the outcomes of those meetings. People say research says, so making sure that before we get into problem solving mode, we tend to, we connect first and that helps the problem solve better, making sure that we actually listen right being mindful of present as other people are talking as opposed to preparing our own response while people are, can we in their point? Uh So here, mindfulness has a whole lot of implications for improving our communication and outcome of those. So that's a lot that's going on. There's a lot of resources available for that uh for deepening and our practice, right? So remember in the beginning, I said that mindfulness is many things, but most important, it's a practice. You, the more you practice being present, the more benefit it has, the more your frontal lobes uh cooperate, the less your limbic system gets in the way uh not that limbic system is wrong, but sometimes it does get annoying. So at Hopkins, right? So as you, most of, you know, we have free access to Com app which is number one ranked uh mindfulness uh application that has all kinds of various brief and longer and different types of mindfulness practices. So if you don't have it yet, I encourage you to download, I, I'm not being paid by. And that matter, I don't even use it. But many of my patients, colleagues and friends uh say that it's very helpful. Uh Apparently there's space somewhere at Hopkins called Carry the capsule and we could go in a few minutes and just be quiet and listen to the music or just breathe and meditate. Uh There is a mindfulness um office of mindfulness uh that Nether good of Department of Psychiatry represents and she runs um M BS R courses for faculty uh as well as groups of patients. And there are other related resources there. Uh If we expand it from Hopkins. So there is a local community that now of course is all online, but maybe with some in person interaction as well. It's called Inside Meditation Community of Washington that's led by Tara. And there are many, many, many different types of mindfulness based resources there on website and various classes that people can drop uh to and then a longer and more elaborate types of practices and retreats and groups. And M BS A of course, is mindfulness based stress reduction uh through them as well. I mean, not through them, but Tara Brack and Jack Corn will probably the, you know, the living in one of the, you know, some of the most famous mindfulness teachers do this course. Uh 40 40 day course for mindfulness at work, which is a 15 minute a day type of medi meditation. And you can just do it during lunch. And the outcomes are also quite uh supportive of uh better quality of life and enjoyment of work. And there's all kinds of online resources. I just put a few links here of, you know, sites that I've used online. But there are zillion, if you Google mindfulness, you can find all kinds of things. And I don't think any of them are harmful, some of them more helpful than others, but uh lots, lots of different uh brief and longer practices that you could listen to and uh do during, during the day. Uh There's a lot of apps and this is probably not all. Uh so this top 20 maybe a few years outdated. I don't know, it's top 20 now, but there's some that are free that, you know, evidence based and agrees to relax just maybe taking a few slow deep breath here and there. And I already mention come as uh sponsored by Hopkins. But the other ones are also helpful, headspace and inside timer and others that um have a lot of whereas mindfulness practice for, for all all pace, right? So, and I wanna close by this quote uh by Victor Frankl, uh who wrote the Man in Search of Meaning uh after his Auschwitz experience, that mindfulness is what helps us. So, in difference between responding versus reacting, right? But in stimulus and response, there is a space and in the space is our power to choose from our response and in our response wise, our growth and our freedom and that being present, active presence in the moment. Is that what makes it possible, commons questions? Thank you. Um Just one quick question for you, Anna, you mentioned the mindfulness training um that you've done a few already and that there are a few more. Is there room for additional people to participate? And if so can you share with us when and what dates this will be? Yes, there's definitely room for additional people to participate. So I initially scheduled five, we, we had one and four more scheduled. One is tomorrow and 11 week, different days of the week, I can send those uh dates again through email to the department or, or you, if anybody is interested, just email me and you know, I'll add you to a group that might work or if there are more participants that uh are interested, then we, I can create another group. So we have one on the 20th 26th, August 1st and August 4th right now. Fantastic. Thank you so much. Thank you. And this was great. And you have a lot of comments there and I think that you gave us several tips to how to go ahead and practice on our own in our own terms and time. So this is great. Were you able to participate? I didn't see anybody that I usually I do any kind of training of the sort and it's interactive. Um But everybody was hiding. So hopefully you were able to take a moment, just be present and don't think. And now everybody can happily return to their thinking mode. Good things that you do. Thank you. Thank you again, everyone have a wonderful day. Thank you. Thank you. Created by Related Presenters Anna Agranovich, PhD Assistant Professor of Physical Medicine and Rehabilitation Anna V. Agranovich, Ph.D., ABPP, is a rehabilitation neuropsychologist at the Johns Hopkins outpatient brain injury rehabilitation program. View full profile
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