What Else Do I Do Besides Work?

The other day one of the medical students asked me what I do when I’m not on duty. Believe it or not, I can’t remember ever getting a question like that from a medical student. My first answer was that I don’t have a lot of time for much else but work. That’s not a very encouraging remark for trainees to hear as they embark on a career in medicine.

And then I remembered my mindfulness meditation practice and I told him about that. I’ve been making time for mindfulness practice since I first took the Mindfulness Based Stress Reduction (MBSR) class last June. That seemed to get his attention.

It also got my attention. I remember hearing our MBSR teacher telling us how common it is to hear students tell her there doesn’t seem to be any time for meditation. She said something like, “You don’t have time…so you’ll have to make time.”

Somehow I make time for mindfulness. If I can make time for that, what stops me from making time for other things in my life which point away from my work?

There is so much being written in the popular and scientific literature about mindfulness nowadays that it boggles the mind (no pun intended). Mindfulness may enable me to sustain an exercise routine. Hey, just because I take the stairs in our 8 floor hospital every day doesn’t necessarily mean I couldn’t do something else for my physical health [1].

And just because I’ve been getting up at 4:00 a.m. for years doesn’t mean that eventually my mindfulness practice won’t eventually result in getting more sleep. I’ve seen other benefits over the last  8 months [2]. They’re subtle, but they keep me exploring.

There’s a lot of high level research happening using neurimaging to work out the underlying theoretical framework and neurobiological model for mindfulness.

Don’t feel bad–I haven’t read it all either. Mindfulness may help me make more time for other healthy activities, something other than work. One idea I picked up from mindfulness is that acceptance of myself and the world means much more than sitting still and letting the world as it is simply be.

I don’t sit still for what I believe is unfair and unjust. Mindfulness doesn’t stop me from constructive activism and finding effective responses to what I might see as problems. In fact, it may help me withstand the strain that can sometimes arise from it. My mindfulness teacher recently signed my petition calling for a more constructive solution to our state’s dwindling access to inpatient mental health care than simply closing Mental Health Institutes. And the President and CEO of the American Board of Psychiatry and Neurology (ABPN) recently replied to my open letter about what I see as the problems inherent in Maintenance of Certification (MOC) by opening a constructive dialogue about whether or not the UIHC psychiatry consultation services Clinical Problems in Consultation Psychiatry (CPCP) case conference might be developed into a learning activity which could actually be relevant to many ABPN psychiatry diplomates’ practices.

Maybe the medical student’s question about what I could do besides work could propel me to use mindfulness to explore and broaden my world. It’s amazing what you can learn from a medical student.

References:

1. Tsafou, K.-E., et al. (2015). “Mindfulness and satisfaction in physical activity: A cross-sectional study in the Dutch population.” Journal of Health Psychology.
Both satisfaction and mindfulness relate to sustained physical activity. This study explored their relationship. We conducted a cross-sectional study with 398 Dutch participants who completed measures on trait mindfulness, mindfulness and satisfaction with physical activity, physical activity habits, and physical activity. We performed mediation and moderated mediation. Satisfaction mediated the effect of mindfulness on physical activity. Mindfulness was related to physical activity only when one’s habit was weak. The relation of mindfulness with satisfaction was stronger for weak compared to strong habit. Understanding the relationship between mindfulness and satisfaction can contribute to the development of interventions to sustain physical activity.

2. Black, D. S., et al. (2015). “Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: A randomized clinical trial.” JAMA Internal Medicine.
Importance  Sleep disturbances are most prevalent among older adults and often go untreated. Treatment options for sleep disturbances remain limited, and there is a need for community-accessible programs that can improve sleep.Objective  To determine the efficacy of a mind-body medicine intervention, called mindfulness meditation, to promote sleep quality in older adults with moderate sleep disturbances.Design, Setting, and Participants  Randomized clinical trial with 2 parallel groups conducted from January 1 to December 31, 2012, at a medical research center among an older adult sample (mean [SD] age, 66.3 [7.4] years) with moderate sleep disturbances (Pittsburgh Sleep Quality Index [PSQI] >5).Interventions  A standardized mindful awareness practices (MAPs) intervention (n = 24) or a sleep hygiene education (SHE) intervention (n = 25) was randomized to participants, who received a 6-week intervention (2 hours per week) with assigned homework.Main Outcomes and Measures  The study was powered to detect between-group differences in moderate sleep disturbance measured via the PSQI at postintervention. Secondary outcomes pertained to sleep-related daytime impairment and included validated measures of insomnia symptoms, depression, anxiety, stress, and fatigue, as well as inflammatory signaling via nuclear factor (NF)–κB.Results  Using an intent-to-treat analysis, participants in the MAPs group showed significant improvement relative to those in the SHE group on the PSQI. With the MAPs intervention, the mean (SD) PSQIs were 10.2 (1.7) at baseline and 7.4 (1.9) at postintervention. With the SHE intervention, the mean (SD) PSQIs were 10.2 (1.8) at baseline and 9.1 (2.0) at postintervention. The between-group mean difference was 1.8 (95% CI, 0.6-2.9), with an effect size of 0.89. The MAPs group showed significant improvement relative to the SHE group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity (P < .05 for all). Between-group differences were not observed for anxiety, stress, or NF-κB, although NF-κB concentrations significantly declined over time in both groups (P < .05).Conclusions and Relevance  The use of a community-accessible MAPs intervention resulted in improvements in sleep quality at immediate postintervention, which was superior to a highly structured SHE intervention. Formalized mindfulness-based interventions have clinical importance by possibly serving to remediate sleep problems among older adults in the short term, and this effect appears to carry over into reducing sleep-related daytime impairment that has implications for quality of life.Trial Registration  clinicaltrials.gov Identifier: NCT01534338

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