The Mind-Body Team: Mindfulness in College Health

American College Health Association

June 2, 2010Robin Boudette, Ph.D.Shefalika Gandhi, LCSWDeanna Nobleza, MDVictoria Rosenfeld, RD, CSSDLaura Rubinstein, Health Educator

Today’s Objectives

Introduction to mindfulnessOverview of mindfulness based

interventionsMindfulness in college health, why?Evolution the Mind-Body Team at PrincetonCase StudyApplications for college counseling centersBest practices in bringing mindfulness to

college health settings

Definitions

Introduction to mindfulnessOverview of mindfulness based

interventionsMindfulness in college health, why?Evolution the Mind-Body Team at PrincetonCase StudyApplications for college counseling centersBest practices in bringing mindfulness to

college health settings

Mindfulness Based InterventionsDialectical Behavior TherapyAcceptance and Commitment TherapyIntegrating mindfulness in individual

therapyMindfulness-Based Stress Reduction

▫MBCT▫MBRP▫MB-EAT▫MBRE▫MBAT

MBSR: John Kabat-Zinn

Developed in 1979 at U MassMost researched mindfulness interventionInvolves 8 week psycho-education programParticipants learn and practice mindfulness

meditation and mindfulness in a variety of activities

Suggested practice: meditation 40 minutes 6 times per week

Program appropriate for all stress-related conditions

Positive Clinical Outcomes with MBSR

Chronic Pain: Kabat-Zinn, 1985 Anxiety: Kabat-Zinn, 1992Fibromyalgia: Goldenberg, 1994 Psoriasis: Kabat-Zinn, 1998Binge Eating: Kristeller, 1999Depression: Teasdale, 2000Cancer: Speca, 2002Immune Function: Davidson, 2003

Studies Funded by National Institutes of Health

Does Mindfulness Change the Brain:Findings in Neuroscience

The Impact of Mindfulness: Domains of Possibility

PhysicalCognitivePsychologicalBehavioralSocialSpiritual

Mindfulness in College Health: Why?

Chronic stress in college students is implicated in:▫Physical Illness: sleep disturbance, colds,

headaches▫Psychological disorders: anxiety and

depression▫Unhealthy behaviors: substance use, suicidal

ideation▫Declining academic performance

National College Health Association Survey: Students reported the following factors affected their academic performance

National results

Princeton results2006N=543

2008N=752

2009N=641

Stress 29.3% 31.1% 29.5%

Sleep 21.6% 22% 20%

Cold & Flu 26% 31.1% 16.7%

2006N=94,806

2008N=80,121

2009N=87,105

Stress 32.0% 33.9% 27.8%

Sleep 23.9% 25.6% 20.o%

Cold & Flu 26.0% 28.8% 19.0%

Mindfulness in College Health: Research

Shapiro, et al. (1998) RWLC Medical students reported decreased levels of stress and depression with reductions maintained during exams; findings replicated with WL group.

Rosenzweig et al. (2003) Medical students reported significant reduction in negative mood and increased ability to cope with stress.

Jain et al. (2007) RWLC Pre-med undergrads students reported significant reduction in psychological distress and increased empathy.

Integrated Approach at UHS

Comprehensive Health Service▫Medical Services▫Counseling and Psychological Services▫Employee Health Services▫Health Promotion and Wellness Services▫Inpatient Service

Multidisciplinary Team Approach▫Eating Disorders Team▫Alcohol and Other Drugs Team▫Mind/Body Health Team▫Integrative Case Conference

Evolution of the Mind Body Team

UHS Mind Body Team: Mission

Create a culture that supports use of mind/body interventions in the treatment of stress related problems.

Give treatment providers the education, skills and materials to inform students about the effectiveness of mind/body interventions and resources available on campus.

Develop a multidisciplinary team within UHS that specializes in behavioral medicine and provides medical, psychological and nutritional services to students with stress-related problems.

Liaison with campus groups that provide mind/body services to create a network of resources for students beyond UHS.

Mind Body Interventions

Psycho-education on mind body connectionRelaxation ResponseMindfulnessAttuned EatingHealthy ExerciseMental ImageryCognitive Behavioral Therapy

Mind Body Team: Clinical

Take a holistic approach to treating physical illness and psychological disorders.

Educate staff and students about the mind/body connection and the effectiveness of mind/body interventions in healing physical and psychological concerns.

Use mind/body interventions such as meditation and relaxation to address psychological and physical concerns.

Refer staff and students to campus activities for mind/body health.

Provide prevention services for staff and students.

Support the Peer Health Educators.

Mind Body Services Flyer

Team Members

CounselingMedicalPsychiatryNutritionHealth EducationAthletic Trainer

Team Members: Counseling

Mindfulness-Based Therapy o Acceptanceo Patience and Compassiono Mindfulness Meditation

Practice

Applicationso Stress, Management o Depression and anxietyo Interpersonal issueso Medical issues

Psycho-education/ Interpretationo Triangle of Awareness o Reacting vs. Responding to

Stress o Mind’s Conditioningo Holding on vs. Letting go

Therapeutic Effectso Present Moment

Awarenesso Tolerance of Rumination/

Worryo Ability to Disengage o Shift Perspectiveo Cultivate Positive Emotions

Mindfulness Trainingo Mindfulness and

Psychotherapy conferenceso MBSRo MBCTo MB EATo MBRP

Mindfulness Groups

Clinical▫ Mindfulness Skills Training for Graduate Students▫ Mindfulness for Undergraduates ▫ Mindfulness for Health and Healing▫ Mindfulness-Based Performance Enhancement for

Athletes▫ Mindfulness- Based Graduate Women’s Therapy group

Outreach▫ Lunch Time Stress Management▫ Mindful Food Group▫ Meditation for Staff▫ Monthly Series at the Graduate School

Mindful Time Management Mindful Interpersonal Skills Mindfulness Skills for Job Search Mindfulness and Happiness

Groups Flyer

Mindfulness Skills Training for Graduate Students: Outcomes42 participants over 6 semestersFormal mindfulness practice

▫71% of students found it “very helpful”▫64% would continue to practice

Mindful activities▫57% of students found it “very helpful”▫62% would continue to practice

Weekly group▫86% of students found it “very helpful”▫75% of students expressed an interest in

participating in another group in the future

Mindfulness Skills Training Group: Student Feedback“My stress level went down. My awareness of my

moods went up. I learned to be more accepting of myself.”

“I feel happier somehow. I use the methods to ground myself when I run away from problems.”

“Thoughts are not facts”“I’m more attentive to thoughts, feelings, at least

some of the time. I meditate more regularly.”“Group participants made me realize that I am not

alone with feeling anxieties about graduate school, my work, etc.”

“Helped me very much with dealing with my depression.”

Team Members: Psychiatry

Evaluations with an ear to…o Medical comorbiditieso Somatic symptomatologyo Openness (or not) to

psychotropic medications o Self care

Psychoeducationo Exerciseo Mind/Body Interventionso Sleep Hygieneo Light therapyo Herbals/Supplements

Referralso Individualo Groupso Nutritiono Massage Therapyo Medicalo Herbalist/CAM specialist

Mindfulness Trainingo Nutritional and

Complementary Approaches to Mental Health Disorders

o Herbal Medications in Psychiatry

o Orthomolecular Psychiatry

Team Members: Medicine

Evaluations with an ear to… Illnesses that have a

Med/Psych and/or Stress Componento Chronic paino IBSo Headacheso Insomnia

Role of stress and lack of self-care on presenting problem(s)

Psychoeducationo Studentso Medical Staff

Referralso Mind/Body Interventionso Mind/Body Teamo Nutritiono Counseling

Mindfulness Trainingo UHS Wide trainingo Mindfulness Based Stress

Reduction for HealthCare Providers

Team Members: Nutrition

Nutrition assessment including:o Spiritual practiceo Current or past use of mind

body modalities- meditation, guided imagery, yogao Stress o Sleepo Coping skills

Presenting problemso BEDo IBSo Ulcerative Colitiso Weight worriedo HTN

Approach:o Integrate M/B practices into

treatment plano Mindful eating/Intuitive eatingo Mindful awarenesso Correct sleep and stress

management early in processo Refer to other team members,

groups, written and online resources

Mindfulness Trainingo UHS Wide trainingo Mindfulness Based Stress

Reduction for HealthCare Providers

Future directions:o Additional trainingo Intuitive eating groupso Integration of structured

HAES/Intuitive eating process

Team Members: Health Promotion and Wellness

Outreacho Team Marketingo Mindfulness Workshopso Eating Mindfully at the holidayso Graduate Mindfulness Series

Peer Advisor Trainingo Healthy Mindso Eating Concerns Advisorso Student Athlete Wellness

Leaders

Infusing into “Traditional” Contento Smoking Cessationo “Healthy Eating”o Eating Disorderso Depressiono Stresso Order in’s

Educational Resources:o Online informationo Audio Downloadso Books and DVDs at the

UHS lending library

Case Study

EG

Mindfulness Initiatives in University Settings Mindfulness Centers:

▫Teach mindfulness through programs, courses, workshops

▫Engage in research that furthers the understanding of mindfulness and its benefits

▫Serve campus community through special events, publications, and other activities

Groups and online resources:▫Mindfulness Programs for students, staff and

faculty▫For credit MBSR classes▫Extensive educational materials, audio

downloads

Mindfulness At Other UniversitiesTraining in mindfulness for post-doctoral

cliniciansCampus-wide initiatives:

▫Centers, departments and groups partner to support and offer education and training in mindfulness

Mind-Body Lab:▫Self-paced environment designed to help students

explore various resources for improving their emotional and physical health

▫Features self-directed audio and video instructions on mind-body practices, biofeedback equipment and other interactive tools

Integrated health services- Medical and counseling within one service department

Mindfulness in College Health

Benefits ChallengesHolistic approach to

healthcareEvidenced-based, short-term

clinical interventionsEffectively and efficiently

offered in large group settingsAttracts diverse student

groups to servicesAppropriate for prevention

and treatmentEncourages participants to

take and active role in healthcare

Fosters health of campus community

Competing clinical demands within health services

Barriers to engaging students in stress management

Motivating students for groups and home practices

Competing interests for students’ time

Future Directions

What ideas or experience do you have in bringing mindfulness into college health?

What are some “best practices” in bringing mindfulness into college health?

Best Practices for Mindfulness in College HealthProfessional training for designated staff

members in the Health Services DepartmentAn integrative, multi-disciplinary team

approachIn-service trainings across disciplinesDiversity of services for students

Clinical interventionsOutreach activities

Monitor outcomesPartner with student groups Partner with other student life departmentsOpportunities for staff and faculty to learn

and practice