Workplace Wellness: Cultivating Stress Resilience with Mindfulness Laura Smallwood, DVM DACVIM (SAIM) RYT-200

Context: Many individuals working in the veterinary profession face extreme stress on a daily basis. Stressors include long hours, lack of control over workload, pet owner grief and anger, adverse treatment outcomes, interpersonal conflicts, public shaming on the internet, and medical errors. Within the profession there is evidence of escalating risk for mental, physical, and emotional fatigue leading to high rates of substance abuse, depression, and suicide. Additionally, chronic stress is known to increase the risks of physical disease. Mindfulness training utilizes simple yet effective methods that reduce reactivity to stressful situations, thereby mitigating both the physical and emotional impact of stress. When incorporated as the cornerstone of a workplace wellness program, mindfulness training provides workers with a holistic and sustainable tool for building stress resilience and emotional intelligence. These personal skills, in turn, can positively benefit the entire working community by fostering a culture of compassion, collaboration, and creativity. In this workshop participants will learn the evidence for the health benefits of mindfulness training and explore introductory mindfulness practices that they can immediately begin to utilize. Goals for presentation: After participating in this session, participants will:

1. Understand how stress negatively impacts mental health, physical health, and the well-being of the workplace community.

2. Understand how mindfulness practices can be utilized to build resilience to stress in the workplace environment.

3. Have learned introductory mindfulness practices. 4. Have explored ways to bring mindfulness training and practices into veterinary workplace

environments.

Mindfulness Defined As defined by the founder of Mindfulness Based Stress Reduction (MBSR), the definition of mindfulness is “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” Let’s break that down. Paying attention: Scientists believe that the ability for humans to think and KNOW that they are thinking is an ability that separates humans from other species. The term for this is metacognition and metacognition is what allows us to recognize when we are lost in thought. The ability to be attentive is the foundational skill for awareness and focus and is what connects us to our present moment experience. On purpose: Mindfulness is an intentional practice. We have the capacity to choose to be fully present and attentive to the present moment. If we don’t make this choice, the brain will default to mind wandering.

In the present moment: The present moment is the only moment that matters. It is the only moment in which we can live our lives. It is the only moment in which we will find joy, connection, love, opportunity. Mindfulness expands our capacity to notice when the mind is wandering, to return our attention to the present moment, and to keep it there longer.

Without judgment: Mindfulness teaches us to be open to whatever experience the present moment brings. Rather than succumbing to the need to label everything as good/bad, pleasure/pain, we learn to just be with things as they are.

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Mindfulness IS a state of awareness that is cultivated through mindfulness practices such as meditation. Mindfulness is the ability to intentionally bring our awareness out of distraction and into our present moment experience, doing so without judgment of ourselves, others, or the circumstances of the situation. In cultivating this ability to be fully present, we gain greater awareness of when the mind is distracted and the ways in which distraction prevents clarity, connection, and compassion. Mindfulness is NOT: A religion A technique for stopping thoughts A technique for positive thinking A new age practice A relaxation technique Breath training A way to eliminate stress The United Kingdom Perspective on Mindfulness

According to the introduction of the United Kingdom Mental Health Foundation’s 2010 Mindfulness Report: “Mindfulness is a way of paying attention, in the present moment, to yourself, others and the world around you. Mindfulness boosts your attention and ability to concentrate and focus, raises your level of emotional intelligence, increases resilience to stress, and improves your relationships with others. Mindfulness is an integrative, mind-body based approach that helps people change the way they think and feel about their experiences, especially stressful experiences. It involves paying attention to our thoughts and feelings so we become more aware of them, less enmeshed in them, and better able to manage them. Based on a review of the literature, this report presents evidence that mindfulness confers significant benefits on health, well-being, and the quality of life in general”.

Subsequent to the Mental Health Foundation’s report, a Mindfulness All Parliamentary Group was set up to explore the potential of mindfulness in shaping public policy cross health, education, the workplace and criminal justice. An interim report in Jan 2015 concluded “We find mindfulness is a transformative process, leading to a deeper understanding of how to respond to situations wisely. “ The final report stated: “We have been impressed by the quality and range of evidence for the benefits of mindfulness and believe it has the potential to help many people to better health and flourishing. On a number of issues ranging from improving mental health and boosting productivity and creativity in the economy to helping people with long-term conditions such as diabetes and obesity, mindfulness appears to have an impact. This is a reason for government to take notice and we urge serious consideration of our report.” Mindfulness Meditation Mindfulness meditation is a methodology for developing the mind’s innate capabilities of attention and focus. Mindfulness meditation is the practice of intentionally redirecting the focus of our attention over and over and over. We don’t stop the mind from thinking but, rather, learn to how notice when we are distracted by our thoughts and to quickly bring the mind back to our chosen point of focus in the present moment. Each time we bring our minds back to the present moment, we create new neural networks that are connected with sustained attention. In so doing we take advantage of neuroplasticity which is the reorganization of neuronal networks and the alteration of neuronal function over time.

The good news is that we all have the capacity to be mindful. The bad news is that it takes practice. You can become more mindful through informal practices like taking mindful walks and

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mindful eating, but you cannot cultivate the ability to be mindful under stressful or challenging situations (the times when we need mindfulness the most) without learning to meditate and committing to a daily meditation practice. The Power of the Present Moment

The brain is hard-wired to think and, left to its own devices, the prefrontal cortex will automatically begin to drift away from the experience of the present moment and into thought. As a result, we spend much or our lives in a state of distraction—thinking about the past or the future—only to miss out on the present moment, the ONLY moment we have to live and the only moment we can affect. Mindfulness allows us to recognize when we are lost in thought (that recognition being a capacity referred to as metacognition) and intentionally bring our attention back to the present moment.

In 2010 researchers at Harvard University published a study that examined mind wandering. Their data showed that test subjects were not paying attention to what they were doing 46.9% of the time. Researchers also found a correlation between mind wandering and feelings of unhappiness, regardless of what activity the test subjects were engaged in. In other words, even when doing something that would be pleasurable, thinking about something else caused test subjects to experience feelings of unhappiness. This research suggests that for almost half of our waking hours, we are not fully present for what is happening in our lives. Imagine how many opportunities for joy, connection, and creativity we can miss in that amount of time! And not only that, these researchers concluded that “a wandering mind is an unhappy mind”. Workplace Benefits of Mindfulness The personal benefits of mindfulness training for individuals has been well-documented in thousands of studies conducted since the introduction of Mindfulness Based Stress Reduction as a clinical intervention over 37 years ago. Reported psychological, social and physical benefits include:

Decreased propensity to experience psychological distress, including depression and anxiety Improved awareness, understanding and acceptance of emotions, able to recover from bad

moods more quickly Decreased frequency of negative thoughts and improved ability to let negative thoughts go

when they do arise More likely to enjoy satisfying relationships; better at communicating; less troubled by

relationship conflict; and less likely to think negatively of their partners as a result of conflict Improved emotional intelligence, which is associated with good social skills, ability to cooperate,

and ability to see another person’s perspective Less likely to react defensively or aggressively when threatened More likely to succeed in reaching academic and personal goals Improved job performance, productivity and satisfaction; and better relationships with

colleagues, resulting in reduction of work related stress Improved awareness of thoughts and feelings resulting in decreased likelihood of acting on

impulse Reduced risk of hypertension; reduced risk of developing and dying of cardiovascular disease Decreased risk of hospital admission for heart disease, cancer, or infectious disease Reduction in risk for addictive behavior

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The impact of mindfulness taught in the context of the workplace has been less studied, in part due to mindfulness-based workplace programs being a more recent intervention compared to MBSR and similar personal interventions. Reported business-related benefits include:

Lower levels of stress and illness-related absenteeism Improved employee engagement Improved productivity Decreased workplace conflict Higher levels of job satisfaction Lower levels of employee turnover Higher levels of creativity and innovation

How does Mindfulness work?

Very simply Mindfulness trains the mind to focus and refocus over and over again, freeing us from the random thinking patterns of our busy minds. Each time we bring the mind back to the present moment, we create new neural networks that are connected with sustained attention. This reorganization of neuronal networks and alteration of neuronal function within our nervous system over time is referred to as neuroplasticity. Like building muscle at the gym--when we use our minds in a particular way we physically change and rewire the brain over time. Each time the mind wanders and we bring it back to the present moment, we build the neural networks of attention and focus.

Through mindfulness practice we learn about where the mind wants to go and we can learn the pattern of our preoccupations. Every time we notice that we’re thinking we have a moment of metacognitive awareness. Specifically, mindfulness as an expression of metacognition is:

The skill of seeing that the mind is not where you want it to be The skill of detaching the mind from where you don’t want it to be. The skill of placing the mind where you want it to be. The skill of keeping the mind where you want it to be. How do we know Mindfulness works?

Since 1979 when Jon Kabat-Zinn recruited patients suffering from chronic pain to participate in the first 8 week stress reduction course that served as the prototype for what we now call Mindfulness Based Stress Reduction (MBSR), thousands of behavioral, medical, and neuroscientific studies have examined the effects of meditation on the brain. Demonstrated behavioral benefits include reduced psychological stress, increased empathy, and improved working memory capacity and attention. Studies have demonstrated that meditation can decrease negative emotions; shift brain activity into the left prefrontal cortex—an area of the brain associated with happiness and optimism; and improve physical health. The introduction of the functional MRI (fMRI) in 1990 has allowed neuroscience research to study the effects of meditation on the brain. fMRI studies have demonstrated that the activity and the size of the amygdala (the primitive part of the brain associated with fight or fight response) is decreased in meditators compared to non-meditators. A 2003 workplace study demonstrated increased activity in the left prefrontal cortex and the experience of feeling more energized, alert and joyful in workers who practiced meditation. There was also an improved response to flu vaccination in this group compared to non-meditators. Additional studies examining the impact of meditation on the immune system have demonstrated reduced cortisol levels, less decline in CD4+ T cells in HIV+ patients; and faster resolution of lesions is patients suffering from psoriasis.

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A 2009 study published in the Journal of the American Medical Association demonstrated that training in mindfulness meditation reduced psychological distress and burnout in physicians and improved their well-being while also expanding their capacity to relate to patients which, in turn, resulted in enhanced care. Stress in the Workplace

According to the American Psychological Association, 69 percent of employees report that work is a significant source of stress, and 41 percent of people say they typically feel tense or stressed out during the workday. Over the past 30 years stress levels have increased 18 percent for women and 25 percent for men according to Carnegie Mellon research. Our tendency is to blame stress on our circumstances. It is important to recognize that stress is a neuro-physiologic reaction in the body to an external trigger. This reaction occurs first in the primitive part of our brain known as the amygdala, and then is mediated via the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. This neuro-physiologic reaction exists to protect us from imminent life-threatening danger—situations where there simply isn’t time to engage the higher levels of our cognitive brains. One of the benefits of living in a modern industrialized nation is that imminent life-threatening danger is an extremely rare. However, our perception of external threat has widened to include a myriad things that don’t threaten our actual survival. We can feel threatened by the behavior of a coworker, by something our spouse says, by a contentious email, by something we see on social media, by an impending deadline, by heavy traffic when we are late to an important meeting. The list is endless. But here is the thing. When we perceive something as a threat, the neuro-physiologic reaction that occurs is the same as if we were being threatened by something that could actually kill us. The amygdala is activated, the sympathetic nervous system is activated and the hypothalamic pituitary axis is activated. The result is a toxic cocktail of neurotransmitters and hormones that has a systemic impact that is literally killing us. Therein lies the irony. The very system that was meant to protect us from life threatening danger is killing us… Our bodies are built to withstand this level of stress as a rare occurrence but, because we have expanded our perception of what is threatening us, we spend a significant amount of our waking hours under the influence of our amygdala and sympathetic nervous system. In fact, triggers for intermediate levels of stress (traffic, noise, technology) are omnipresent in modern life. The impact of this on our bodies and minds can only be described as catastrophic. Studies have shown that chronic stress elevates bad cholesterol, diminishes good cholesterol, elevates resting cortisol, impairs immunity and increases the risk for hypertension, cancer and diabetes. Symptoms associated with chronic stress include heart palpitations, dizziness, insomnia, weight gain, irritability, fatigue and muscle pain. Chronic stress is also associated with an increased risk for depression, anxiety and substance abuse.

And stress is contagious. This is one of the reasons that stress is such a big deal in the workplace. Stress is contagious because emotions are contagious. Humans are hardwired for empathy. We have neurons in our brain referred to as “mirror neurons”. These neurons are what allow us to have a felt sense of what another person is experiencing. Unfortunately, our tendency is to internalize the emotions of others, often acting out on them. In this way, negative emotions can spread throughout a workplace and even outside of the workplace as workers go home to their families and non-work communities.

Our greatest weapon against stress is the ability to choose one thought over another and to create the space to choose how we respond to each situation. By learning to attend to what is actually happening in the present moment, rather than defaulting into habituated reactivity, we can begin to free ourselves from stress.

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Distraction Due to Technology “Our inventions are wont to be pretty toys, which distract our attention from serious things. They are but improved means to an unimproved end.” This was Henry David Thoreau’s take on the invention of the telegraph…

Research abounds on the perilous impact of technology in society. Our attention spans are getting shorter, our long-term memory is degraded, and as a result, we are feeling less connected to one another. Emails, texts, social media--how often do these things divert our attention from attending to what really matters in the present moment. We now live in a state of what neuroscientists describe as “continual partial attention”—a state where we are only slightly aware of what is happening around us and very much lost in thought. It has become increasingly difficult for us to maintain sustained attention.

As a culture, we embrace the idea of multi-tasking as effective work strategy despite the fact that research has shown that multi-tasking actually reduces efficiency in the workplace. We also multi-task outside of the workplace and that is proving deadly. According to the National Highway Traffic Safety Association (NHTSA), 80% of accidents and 16% of highway deaths are the result of distracted drivers. The National Safety Council (NSC) estimates that 1.6 million (25%) of crashes annually are due to cell phone use, and another 1 million (18%) traffic accidents are due to text messaging while driving. NHTSA found that fatalities from “distraction-affected” crashes increased 8.8% for that period with 3477 people dying at the hands of a distracted driver.

Thoughts and Emotions We live in a society that values intellect over all else. Around the age of two, we begin to disconnect from the body as a source of wisdom as our parents and teachers begin to fixate on the development of our prefrontal cortex. We are taught to give our thoughts tremendous weight and eventually learn to take each thought as truth. Over time our thoughts begin to define how we see ourselves and the world.

In reality, thoughts are simply random ideas that may or may not be true. Jon Kabat-Zinn describes thoughts as “secretions of the mind”. If we begin to think of thoughts this way, we begin to see that our thoughts may or may not be aligned with our values, may or may not be accurately judging a person or situation, and certainly do not define who we are. The awareness that thoughts are actually quite random frees us from the need to constantly engage with them. This, in turn, frees us from the need to constantly judge ourselves, others and situations, and begins to allow us to access the inner wisdom of our intuition. This awareness allows us the time and space to intentionally choose how we respond to a situation rather reacting habitually. Just as we can learn to work with our thoughts in a way that frees us from spiraling into more thoughts or assigning our thoughts more importance than is due, we can work with our emotions in a similar way. Emotions arising in response to people and situations are a trigger for reactivity. Mediated by the limbic system, emotions can easily induce a fight/flight/freeze response that is totally inappropriate to the situation at hand. Because we experience emotions in the body, our dependence on intellect has cut us off from being able to reliably even know that we are experience certain emotions. In addition to teaching us to be more aware of our thoughts, mindfulness practice teaches us how to be more aware of our emotions. When we develop deep sense of awareness of our emotions, we are able to respond intentionally and skillfully to situations rather than being mindlessly triggered into reactivity.

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Emotional Intelligence Mindfulness is a highly effective methodology for the cultivation of emotional intelligence and

emotional intelligence is a highly desirable attribute for workers in any workplace. Emotional intelligence is defined as the capacity to be aware of, control, and express one’s emotions and to handle interpersonal relationships judiciously and empathetically. The capacities necessary to emotional intelligence include self-awareness, self-management (self-regulation), social awareness (awareness of others), and relationship management (impact awareness).

The evolutionary processes that shaped our neurobiological mechanisms gave rise to neural networks that allow us to empathize with others. As mentioned in the section on stress, we have the capacity to sense and to simulate within our own experience other people’s actions, emotions and thoughts. The networks in the brain that light up when you perform an action also light up when you see someone else perform that same action. This gives you a felt sense of what others are experiencing in their bodies. The affective emotion-related circuits that are active when you experience strong emotions such as fear and anger also are activated when you see others experiencing the same. For this reason, the more aware you are of your own feelings and body sensations, the better you will be at reading others. Training in mindfulness teaches us self-awareness of thoughts, feelings and emotions. As we become better able to sense our own thoughts, feelings and emotions we become better able to perceive the thoughts, feelings and body sensations of another. Mindfulness also gives us the skill to manage our emotional response to situations (emotional self-regulation) and to skillfully choose responses that are most likely to result in a best outcome (relationship management).

Mindful Practices

There are two ways to practice mindfulness, both of which are necessary. The first is formal practice. Formal practices commonly taught in the context of mindfulness include seated guided meditation, seated silent meditation, body scan which may be practiced lying down, and walking meditation. These practices serve to cultivate awareness of the body and breath, awareness of thinking and thoughts, awareness of the emotions and feeling tone, and an increased capacity to sustain focus and attention. Informal practices include incorporating mindful awareness into daily activities (i.e. brushing the teeth, preparing food, driving), mindful eating, mindful walks, and mindful pauses. Informal practices allow us to practice mindfulness “on the go”. Meditation Tips --Consistency is important. A daily practice of ten to fifteen minutes is much better than meditating once weekly for an hour. Likewise, if you commit to practicing at the same time and place each day, you are more likely to stick with it. --If you miss a day or a few days, don’t give up. Simply begin again. --Don’t set expectations for what you will experience during meditation. Depending on the state of your nervous system on any given day, your experience during meditation will vary and this is NORMAL. There is no such thing as a good meditation or a bad meditation. In fact, we don’t even meditate for the experience of meditation. It is the impact that a regular meditation practice has on the mind outside of your meditation practice that matters. Implementing Mindfulness in the Veterinary Workplace There is currently no gold standard for implementing mindfulness in the workplace. Unlike MBSR and other prescriptive programs which follow a very specific format, the structure and content of workplace programs varies widely. Evidence thus far suggests that the most successful workplace

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programs are those which have been collaboratively developed by someone with the competency and experience to teach mindfulness (including a longstanding meditation practice) working with someone who has a deep understanding of the day to day challenges of the workplace. Teaching mindfulness in the context of the day to day challenges of a workplace likely makes the training more effective because workers can immediately begin to apply what they learn. There is no standard for the number of trainings that should be included in a workplace program or the number of hours. Programs that are structured with weekly training sessions over a period of 4 – 8 weeks may be more effective because that structure allows time for practice between sessions and, subsequently, the opportunity for participants to have their questions answered as they develop their practice. An inherent difference between MBSR and workplace programs is that MBSR participants are motivated to sign up because they are seeking intervention for serious conditions like chronic pain or severe stress while participants must be recruited for workplace programs. For this reason, it can be extremely helpful to introduce workplace mindfulness training with what is called a “taster” session. This is a session where prospective participants can learn about the science behind mindfulness, the benefits of mindfulness, and be introduced to the methodology. It also an opportunity for prospective participants to meet their course instructor.

Finally, mindfulness training in the workplace has greater traction when championed by those in leadership positions throughout the organization. Providing leadership with the information they need to understand the science behind mindfulness, the methodology, and expected benefits in advance of offering taster sessions to workers can be of benefit.

The Ripple Effect of Mindfulness in the Workplace

Rich Fernandez, the CEO of Search Inside Yourself Learning Institute, a mindfulness training program developed at Google, stated in his address at the 2017 Mindful Leadership Summit that “We meditate for world peace.” While this seems like a lofty goal, mindfulness can have an impact that ripples through businesses, organizations, governments, communities, and eventually the world. What would our world look like if kindness and compassion became common practices within organizations? What would our world look like if we could all learn to listen mindfully and had the freedom to speak truthfully and the discipline to do no harm with the words we speak. What would our word look like if we could be fully present for others and for our own lives more than 53% of our waking hours?

We are all stewards of our workplaces. Regardless of our professional roles, we all have responsibility for fostering healthy, emotionally intelligent, resilient workplaces. We also are responsible for identifying and changing the unhealthy traditions that have become the norm in the veterinary profession—long shifts, no breaks, unreasonable on-call hours, chaotic noisy work environments, and toxic work cultures to name a few. Too often we work with needless sustained urgency. Too often we go through the day mindlessly engaging in habitual behaviors that harm us and the people we work with. Mindfulness in the workplace offers an alternative and the opportunity to created healthy joyful workplaces where employees can flourish. The late Michael Stone, psychotherapist and Buddhist monk wrote: “All actions have an effect, so pay attention to the kind of effect you want to have in the world”. We can take that one step further by acknowledging that each action has an effect, which has another effect, and another, and another ad infinitum. In this way, we all have opportunities to make a positive difference in this world.

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References David Gelles, Mindful Work: How Meditation is Changing Business from the Inside Out, 2015 Margaret Chapman-Clark, ed. Mindfulness in the Workplace: An evidence-based approach to improving wellbeing and maximizing performance, 2016 Michael Chaskalson, The Mindful Workplace: Developing Resilient Individuals and Resonant Organizations, 2011 Martin Boroson, One Moment Meditation: Stillness for People on the Go, 2009 Janice Maturano, Finding the Space to Lead: A Practical Guide to Mindful Leadership , 2014 Additional Resources Laura van Der Noot Lipsky, Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others, 2009 Jon Kabat-Zinn, Full Catastrophe Living, 2013

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GVMA 2018 Fall Convention Topic: Workplace Wellness: Compassion Fatigue Presenter: Laura Smallwood, DVM DACVIM (SAIM), RYT-200 Format: 3 hour workshop Context: Compassion is defined as a response to the suffering of others that leads to the desire to help. The first written use of the term “compassion fatigue” was in reference to public lack of patience with immigration issues in the early 1980’s. In 1992 the term appeared in a nursing journal to describe the impact of emergency room work on nurses and thereafter began to be used routinely to name what the mental health sciences defines as secondary traumatic stress disorder. Unfortunately, the term “compassion fatigue” distracts us from the thing that actually puts us at risk--which is not the practice of compassion, but our emotional response to witnessing the pain and suffering of others. With escalating rates of depression, anxiety, addiction, and suicide being blamed on this phenomenon, there is a need for the veterinary profession to consider a holistic approach to secondary traumatic stress that integrates the practice of true compassion for others and one’s self, mindfulness as a strategy for trauma resilience, and the connection of community.

Goal for presentation: After participating in this session, participants will:

1. Understand that the term “compassion fatigue” refers to individual response to trauma exposure.

2. Understand how cumulative stress can negatively impact trauma exposure response. 3. Have learned how mindfulness practices can be utilized to build resilience to cumulative stress

and trauma exposure. 4. Have learned introductory meditation and mindfulness practices to cultivate resilience to stress

and secondary trauma. 5. Have explored possibilities for transformation of our veterinary work culture to support wellness

at the organizational level.

Schedule: 12:50—2:30 Workplace Wellness: Compassion Fatigue 3:30- 4:20 Workplace Wellness: Compassion Fatigue (continued)

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