Self-Care

Learning Objectives:

• Identify and develop practices to build resilience

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• Try some brief practices that can be used to recover from

set-backs and build resilience.

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Deep gratitude for my patients and their loved ones who have inspired me with their resilience and their courage.

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Respect for my alphabet soup of colleagues in the Movement Disorder Clinic and the Memory Care Program at the U of Roch.

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Profound respect for my friend, Dr. Michelle Burack, for her resilient pursuit of better models of care for folks with PD.

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A deep bow to Drs. Ron Epstein and Mick Krasner, who taught me Mindful Practice so that I could teach it with them.

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Acknowledgement that I have been lucky (so far).

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Introductions and Invitations

• Lesson 1: Defining Resilience
• Lesson 2: Settling the Mind
• Lesson 3: Intention Setting
• Lesson 4: Emotional Balance
• Lesson 5: Self-Compassion
• Lesson 6: Gratitude
• Lesson 7: Developing a Regular Practice

Lesson 1: � �Defining Resilience

Burnout

• Emotional and physical exhaustion

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• Depersonalization (cynicism)

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• Sense of ineffectiveness

What we can do humanely

• Value care and support one another.
• Foster everyone’s sense of autonomy and control
• Connect people rather than isolate them
• Cultivate deep and appreciative listening
• Appreciate what’s working, rather than always focusing on what’s not
• Articulate an intention to flourish and keep to it

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Where are you in this moment?

Burnout Resilient

Resiliency

• The capacity to recover from setbacks
• Elements of Resiliency:
• Purpose beyond self / pro-social intention (vs meaninglessness)
• Authentic connection (vs. isolation)
• Choice / self-efficacy / sense of agency (vs. helplessness)

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“Everything can be taken from a man but one thing: the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.

Victor Frankl (1905-1997)

Lesson 2:��Settling the Mind

• Breath with Grounding

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• Counted Breath

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• Heart Breath

Breath with Grounding

• Breathe in: Gather your attention
• Notice the sensation of the air entering your nostrils on the in-breath

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• Breathe out: Drop into your body
• Notice the physical sensation of the support of the chair beneath your sit bones or of the floor beneath the soles of your feet

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Counted Breath

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• Breathe in for 4 counts

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• Breath out for 8 counts

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• Repeat for a full 60 seconds

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Heart Breath (biofeedback technique)

• Direct your attention to your heart area
• Notice your chest expand on the inhale, contract on the exhale
• Imagine that you are breathing directly into and out from your heart

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• Increases heartrate variability
• Engages the parasympathetic nervous system

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• Breathe at your own natural rate and rhythm.
• When your mind wanders, gently bring it back to your heart and continue.

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Lesson 3:�� Intention Setting

Choose a value you would like to bring into your life a little more consciously (e.g., kindness, patience, gratitude, humor, etc.)…

Bring to mind a recent time when you experienced a stressful interaction

Silently recall your word.

Notice how recalling your word impacts you now.

Daily Intention Setting Practice

• Each morning, select one of your values.
• During your day, notice any feelings of stress that may arise.
• Silently recall your word.
• At the end of your day, consider if you had a chance to recall your intention. If so, how did it feel? If not, might you try it tomorrow?

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• Consider that when something shifts for you, the other person sees a different version of you and may in turn respond differently.
• Whether or not the other person responds differently, know that you’re living in accord with your values

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Lesson 4:�� Emotional Balance

Emotional Balance

A few facts about emotions:

• Emotions have a shelf-life
• Emotions come in waves
• We can notice an emotion even while it’s happening
• When emotions are at their strongest they are said to be refractory (that is, we perceive only that which is congruent with the emotion)

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• Bring to mind a recent time when you experienced a difficult emotion…

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• Silently name the emotion in a curious, interested voice, such as “Oh, this is frustration.”

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• Notice how silently naming offers us cognitive perspective – so we can choose a skillful response

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• When we notice, we can choose; otherwise we’re down the rabbit hole…

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Emotional balance practice

• Notice when you begin to experience a difficult emotion…
• Silently name the emotion in a curious interested voice (e.g., “Oh, this is frustration.”)
• Choose to do what will really serve for the good of everyone including yourself

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Lesson 6:�� Gratitude

• Consider your day today.
• Bring to mind a time when you experienced gratitude (it can be something big or small).
• Take a minute or so now to silently savor this memory.

Gratitude practice

At the end of the day, think back on your day and find three things that you’re grateful for:

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• They can big or small
• They must be specific
• Write them down

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• Try this nightly for two full weeks.
• Notice whether you’re beginning to become more aware of positive things during the day.

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Where we direct our attention becomes the inclination of our minds.

Lesson 5:�� Self-Compassion

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• Bring to mind a time when you felt disappointment or failure in your own life.
• What kinds of things do you typically say to yourself at such times?

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• Now bring to mind a time when a good friend told you about a disappointment or failure in his or her life.

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• What sorts of comforting words do you often say to such friend?

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Consider

• Is there a difference between your typical words for another and your typical words for yourself?

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Toward Self-Compassion—

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• Noticing when something is difficult
• Understanding that we’re not alone; everyone has moments of difficulty
• Bringing a kind, self-mentoring voice to yourself

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Self compassion practice

During the coming week:

• Notice when something is hard and silently acknowledge that this is hard.
• Remind yourself that everyone has difficult moments.
• Give yourself a kind, self-mentoring message, like you would to a good friend.

Be your own best friend!

Lesson 7:�� Developing a Regular Practice

Practice, Practice, Practice �(What works for me? One thing, many times.)

• Settling the mind
• Breath with grounding
• Counted breath
• Heart breath

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• Intentions for the greater good
• Daily intention setting

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• Emotional balance
• Naming emotions and choosing

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• Self-compassion
• Self-compassion break

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• Gratitude practice
• Three nightly gratitudes

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References and Resources (1)

• Busis NA, Shanafelt TD, Keran CM, et al. Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology. 2017 Feb 21;88(8):797-808.
• Cacioppo JT, Patrick W. Loneliness: Human nature and the need for social connection. WW Norton & Company; 2008 Aug 17.
• Cullen M, Pons GB. The mindfulness-based emotional balance workbook: An eight-week program for improved emotion regulation and resilience. New Harbinger Publications; 2015 Sep 1.
• Damon W, Malin H. The Development of Purpose. The Oxford Handbook of Moral Development: An Interdisciplinary Perspective. 2020 Jan 24:110.
• Emmons RA, Shelton CM. Gratitude and the science of positive psychology. Handbook of positive psychology. 2002;18:459-71.

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• Emmons R. The little book of gratitude. Octopus Books; 2016 Jul 14.
• Epstein RM. Attending: Medicine, Mindfulness, and Humanity. Scribner; 2017
• Epstein RM, Krasner MS. Physician Resilience: What it Means, Why it Matters, and How to Promote It. Acad Med. 2013;88:301-303
• Frankl VE. Man’s search for meaning. Simon and Schuster; 1985.
• Germer CK, Neff KD. Self‐compassion in clinical practice. Journal of clinical psychology. 2013 Aug;69(8):856-67.
• Halifax J. A heuristic model of enactive compassion. Current Opinion in Supportive and Palliative Care. 2012 Jun 1;6(2):228-35.
• Halifax J. Standing at the edge: Finding freedom where fear and courage meet. Flatiron Books; 2018

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References and Resources (2)

• Jinpa T. A fearless heart: How the courage to be compassionate can transform our lives. Avery; 2016 Apr 12. (See pp 73-78)
• Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attidues among primary care physicians. JAMA 2009;302:1284-1293
• Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Pscyhol. 2001;52:397-422
• Neff K, Germer C. The Mindful Self-Compassion Workbook: A Proven Way to Accept Yourself, Build Inner Strength, and Thrive. Guilford Publications; 2018 Aug 15
• Porges, SW. The pocket guide to the polyvagal theory: The transformative power of feeling safe. WW Norton & Co; 2017
• West CP, Dyrbye Len, Ervwin PJ Shanafelt TD. Interventions to prevent and reduce physician burnout: systematic review and meta analysis. Lancet, 2016; 388:2272-2281

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References and Resources (3)

• Center for Mindful Self-Compassion https://centerformsc.org/
• Greater Good Science Center, UCBerkeley, Gratitude in Health Care https://ggsc.berkeley.edu/images/uploads/Gratitude_as_Medicine_Survival_Kit.pdf
• UCLA Health, Mindful Awareness Research Center https://www.uclahealth.org/marc/
• UCSD Center for Mindfulness – Mindfulness and Compassion Practice -https://medschool.ucsd.edu/som/fmph/research/mindfulness/Pages/default.aspx
• University of Rochester Medical Center, Mindful Practice Programs -- https://www.urmc.rochester.edu/family-medicine/mindful-practice.aspx
• Upaya Institute, G.R.A.C.E. Training: Cultivating Compassion-Based Interactions https://www.upaya.org/social-action/grace/

References and Resources (4)

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THANK YOU