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3 Coming Back to Yourself: The Efficacy of Compassion and Mindfulness

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预防慢性疼痛：人体系统方法

明尼苏达大学

4.7（119 个评分） | 11K 名学生已注册

Chronic pain is at epidemic levels and has become the highest-cost condition in health care. This course uses evidence-based science with creative and experiential learning to better understand chronic pain conditions and how they can be prevented through self-management in our cognitive, behavioral, physical, emotional, spiritual, social, and environmental realms. The goal of this course is to blend creative, experiential, and evidence-based teaching strategies to help participants understand chronic pain conditions and how a human systems approach can be applied to self-management strategies to reduce risk factors, enhance protective factors, and prevent chronic pain. There are four major objectives to the course; 1. Describe the prevalence, personal impact, and health care dilemma associated with chronic pain. 2. Recognize the clinical characteristics and underlying etiology of several common pain conditions and the peripheral, central, and genetic mechanisms of chronic pain 3. Based on the literature associated with risk and protective factors in the seven realms of our lives, learn specific strategies in each realm that can be employed daily to prevent chronic pain and enhance wellness. 4. Appreciate the value of a human systems approach to health care and how it can provide a basis for integrative, interdisciplinary, and individualized care to preventing pain and enhancing wellness. CONTINUING EDUCATION CREDIT Health Care Professionals Health care professionals who participate in this CE activity may submit this certificate statement of participation to their appropriate accrediting organizations or state boards for consideration of credit. The participant is responsible for determining whether this activity meets the requirements for acceptable continuing education. Email your Coursera certificate statement of completion to your appropriate organization.

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您将学习的技能

Chronic Pain Management, Plan, Pain Management, Opiod Addiction And Abuse Treatment

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4.7（119 个评分）

5 stars
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CH

Aug 02, 2019

An excellent continuing education course for those who are health professionals interested in chronic pain. In depth material providing good value.

CS

Oct 11, 2017

Very informative! Lots of food for thought as a patient....need to redo the lessons again to fully digest it all. Well worth your time!

从本节课中

Risk and Protective Factors in the Seven Realms (Week 9)

1 Restoring Wellbeing: The Roles of Hope and Purpose in Recovering from Chronic Pain 10:43

2 The Perils of Perception: The Effects of Stress on Mind, Body, and Emotions 11:49

3 Coming Back to Yourself: The Efficacy of Compassion and Mindfulness 15:24

4 Exercises: Breathing, Relaxation, and Mindfulness Meditation 20:34

Last Scroll: The Blessing of Love v2 Last4:06

教学方

Dr. James Fricton, DDS, MS
Professor and Pain Specialist

脚本

Welcome to part three in Coming Back to Yourself,

the efficacy of compassion and mindfulness in managing chronic pain.

Mindfulness and compassion are interrelated topics, as we will see.

Both are a part of a healthier way of relating to yourself, and

can be effective in managing stress, dealing

with negative emotions, and managing chronic pain.

This module has four objectives: to define mindfulness and compassion,

to discuss the research on mindfulness meditation, to talk about compassion

and how it is related to self-esteem, and to discuss the

role of compassion and mindfulness in the management of chronic pain.

The experience of chronic pain can leave people feeling

overwhelmed and tied in knots with stress and anxiety.

Perceptions of a future with an experience of chronic pain

can pave the way for feelings of hopelessness and despair.

We talked in part one about the importance of positive emotions for

restoring our health and well-being, how in the broaden and build theory

of positive emotions, we need to generate positive emotions to develop resources

for our own well-being and for our future, to lead to well-being.

So, how can we do that?

How can we encourage positive emotions, both in ourselves and in the

people that we treat for pain, and untie the knot of chronic stress?

There are two encouraging areas of study that

have sparked widespread interest in potentially offering a way.

Those are mindfulness and compassion.

Mindfulness and mindfulness meditation have been

studied extensively recently, and are the

conversation of a growing press interest and a growing area of research.

Mindfulness, simply put, is focusing ones attention in

the present moment, in a nonjudgemental and accepting way.

It is being fully present with wherever you are, and whatever

you are experiencing, both in your inner and your outer world.

The key components of mindfulness are being fully

present and nonjudgmental awareness of inner and outer experience.

The concept of mindfulness is often associated

with Eastern meditation traditions, but is extended

beyond a religious and spiritual context into

mental health, and certainly, into health care.

There are many forms of mindfulness meditation,

but I'm going to focus on one specific form

of mindfulness meditation, that of mindfulness-based stress reduction,

developed by Jon Kabat-Zinn in the late 1980s.

I think the rise of mindfulness and the interest in

mindfulness can be traced along with the growth of MBSR.

MBSR, as it is offered, is an eight week manualized

or set program that teaches mindfulness meditation and gentle yoga.

Kabat-Zinn developed this program at the University of

Massachusetts Medical Center to help people who were

experience significant pain and symptoms from chronic disease

that could no longer be helped by Western medicine.

These were patients doctors had tried everything with,

and didn't know what else to do, so they

referred them to Kabat-Zinn's growing program, that he

developed and that program became the focus of another

program by Bill Moyers called Healing and the Mind, in the early 90s, and it was at

that point that significant interest in MBR really

began to generate, and the role, the rise of

mindfulness and mindfulness research also began.

So what is mindfulness research?

We're studying the role of mindfulness and health and well-being in a

pursuit, in particular related to chronic disease, pain relief, and other symptoms.

So mindfulness has been studied for a

very wide variety of conditions, for chronic pain,

in the treatment of cancer with Linda

Carlson and her work, and other chronic conditions.

Phototherapy for psoriasis, anxiety disorders and depression.

There is a new rise of, a

new mindfulness technique combined with cognitive behavioral

therapy called mindfulness-based cognitive therapy, which has

been shown to be significantly helpful with depression.

It's also been used in stress reduction and

enhancing immune response for family caregivers of people

with dementia, which we'll talk about, and more

recently looking at it improving with diabetes management.

So what does MBSR research show?

The research has been impressive.

It has shown significant decreases in pain and the number

of medical symptoms that people experience and are reported by patients.

They're shown large and significant reductions

in mood disturbances and psychiatric symptomology.

Mindfulness has also been combined with

cognitive behavioral therapy into a mindfulness-based

cognitive therapy, that has shown significant

reductions for depression, especially recurrent depression.

In psoriasis sufferers, a skin disease for which

people undergo ultraviolet treatments, research has shown that those

who are practicing MBSR healed at approximately four times

the rate as those who are not practicing MBSR.

Richard Davidson and his colleagues who have studied MBSR and

mindfulness looked at the effects of MBSR in corporate settings.

They found that electrical currents in certain areas

of the brain associated with emotion shifted to indicate

that they were handling emotions, such as anxiety

and frustration, better in people who were practicing MBSR.

In that same population, they gave them flu

shots and found that they mounted a significantly

stronger antibody response in the immune system than

controls did who had not been practicing MBSR.

There are many personal and profession benefits in bringing mindfulness to work.

Overall, we've seen decreases in physiological responses, changes in brain

function, improved mood and wellness, and marked improvement in overall well-being.

I'd like to give you a concrete example of a study that my colleagues

and I have done on mindfulness-based stress

reduction for family caregivers of patients with dementia.

This was a randomized control study, looking at people practicing

MBSR in comparison to a caregiver community education and support group.

We focused and invited people to participate, had 78 people participating

in an age range from mid-40s up to the early 80s.

We looked at outcomes for stress,

depression, mental health, anxiety, self compassion

and mindfulness, caregiver burden and social

support, and physiological and biomarkers for stress.

We actually had them draw blood, and we looked at their cortisol and

we looked at telomere length, other types of markers for stress and inflammation.

This was one of the most interesting studies that I've done.

I've never experienced a study where I had people calling

to participate, not in the intervention, but in the control group.

Caregiver resources are very much dwindling within

our country, and so when people found that

there was a caregiver group for education support

being offered, they were very interested in that.

As we age, we often become less interested in types of

integrative therapies, and this certainly was the case for this study.

People were very interested in participating in

the control group, but not the intervention

group, which is why when it did work, we know that it significantly worked.

There was little self-selection this, so we often had to

talk people into or encourage them to be a part

of the study, but they had to be willing to

be randomized to either MBSR or to the control group.

So what did we find?

We found significant changes in outcomes in particular for distress and depression.

People practicing, caregivers practicing MBSR had significant

and sustained reductions in depression, and in stress,

at two months and at six months from the time that they started their MBSR course.

In comparison to those who were in the education and support group,

who had some change over time going down in depression and stress.

We also found out that they improved their

mental health significantly, rapidly from baseline to two

months, and sustained those improvements with some slight

improvement from that, at six months as well.

In comparison to those who had the

education support group, where there was little

change between the beginning of the group, in two months, and six months out.

We also found out that research showed significantly,

significant benefits at two and six months, for MBSR

on, on self-compassion, something we're going to talk about here

shortly, and with a trend towards improvement in mindfulness.

The reason that it's important with caregivers and self-compassion,

is often they are so focused on the person

they're caring for, that they do it at the

expense of their own health, and their own well-being.

So their self-compassion is very low as they're

focused solely on the person that they're caring for.

We also show that in both groups where they had significant improvements in

anxiety, perceived burden, and social support, and

significantly improved social support in both groups.

What we heard from the care givers who

participated in MBSR, when we talked with them

after about their experience, was that they were

less judgmental about the person they were caring for.

They were more able to be with them in the time they had.

This is a significant issue for caregivers who are often faced with

significant stress, depression and burden, in caring for someone with dementia who

often may not know whats going on, may have real challenging behaviors

to manage, and that be, can become very challenging for the caregiver.

So in this particular intervention, MBSR

worked significantly and it worked very well.

Compassion is a feeling of empathy.

It's an emotion that is evoked in response to the

suffering of others, and should not be mistaken for pity.

In the English noun, compassion means to suffer together.

Compassion is considered a great virtue in many philosophies

and in most religion, is among the greatest virtues.

Compassion is a part of the love and care and

concern that you have for yourself, as well as others.

Doctor Kristen Neff is a researcher at the University of Texas, Austin.

She studies the relationship between self-compassion and self-esteem.

Self-esteem refers to our sense of self-worth, our

perceived value, and how much we like ourselves.

She notes that society's relentless drive for success, for being

special and above average, is really at odds with our reality,

and it creates a culture that's focused on self-criticism, and

driven by success, really at the expense of our own well-being.

She sees compassion as a more effective path to happiness

and wholeness and wellness, than an obsessive focus on self-esteem.

Self-esteem can rise and fall depending on our activities and our environment.

Self-compassion is not based on self-evaluations, as is self-esteem.

It is based on a nonjudgmental acceptance of ourself, and this

is where it is very similar to our concepts of mindfulness.

Is based in a nonjudgmental acceptance of our

experience, ourselves and the people in our world.

Self-compassion is associated with greater emotional resilience, fewer negative

emotions, and found to lead to wellness and wholeness.

In managing chronic pain, feelings of compassion for those we

serve, and helping them bring and develop compassion for their own

suffering, can help tone down some of the more negative

emotions that people experience, and that are associated with chronic pain.

We're not very good at being self-compassionate,

and sometimes when we're dealing with patients who

are challenging and difficult, it's hard for

us to be compassionate to others as well.

Feelings, and acts of compassion however, have been found to stimulate areas of the

brain that regulate homeostasis, such as the insular cortex, and the hypothalamus.

Compassion is a healing and accepting emotion, when directed inwardly

at the self, and a social emotion when directed at others.

As medical providers, it helps

us establish connections and relationships which

are based and needed for building trust and a healing therapeutic relationship.

Compassion is one of the most important attributes, I think, of medical providers.

Think about how you would like to be

treated by your doctor, your nurse, your therapist.

The duty to do no harm and to deliver proper care are all based in compassion.

Self-compassion is an important key to sustaining us as

providers and not burning out, and compassion for our

patients is an important part of building trust in

a therapeutic relationship to help manage and heal chronic pain.

So what do we take away from this section?

First, when we talk about mindfulness and we talk about compassion, and we

talk about stress, encouraging a focus on the present moment can be helpful.

Nonjudgmental awareness of current experience is really the key.

It's not just about being present where you are, it's also

about nonjudgmental awareness of both your inner world and your outer world.

That includes all the thoughts and emotions

that are going through, and our own self-criticisms.

Focusing on compassion rather than self-esteem can be a stronger

basis for building stronger emotional repertoire and healing in ourselves.

Demonstrating compassion for patients is a very

important part of the therapeutic relationship, and demonstrating

compassion for yourself is a necessary and important

part of your own healing and your well-being.

Adding moments of mindfulness through the day can

help in reducing stress and managing those challenging times.

An example of a mindfulness moment might be on entering a room, where you put your

hand on the door knob and pause for

a moment, just grounding yourself where you are.

Preparing to meet the patient where they are,

rather than rushing into the room and starting immediately.

Acknowledging yourself, acknowledging the present moment,

and grounding yourself where you are.

Trying an MBSR course or other type of mindfulness practice can be helpful

for you, and if your patients are

under significant stress, recommending one for them.

There are many different mindfulness courses within the

community, that people have found helpful, significantly helpful.

So again I want to encourage you to think about

both compassion, and mindfulness, in your management of chronic pain.

Thank you.

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