Benefits of Stress Reduction

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• Speaker: Andrea Lee, BSN, RN

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The information and services provided by Fight Colorectal

Cancer are for general informational purposes only. The

information and services are not intended to be substitutes

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Speaker:

Andrea Lee, BSN, RN currently works in Dallas, Texas, as the

Oncology Program Manager at Methodist Dallas Medical

Center where her work focuses on improving the utilization of

Shared Decision Making in oncology by reducing barriers, like

stress, to improve patient-provider communication, learning

and memory.

She is a champion for the integration of traditional cancer care

with mindfulness-based stress reduction techniques to improve

patient experience and treatment outcomes. She continues her

work with FightCRC, because she believes in the work they do

to lobby for system improvements, educate patients with

accessible educational resources, and provide a community of

support for those facing the fear-inducing diagnosis of

colorectal cancer.

The Benefits of Being Present

Role of Mindfulness in Managing Cancer-Related Stress

Andrea Lee, BSN, RN andrealee2@mhd.com

Objectives

• Recognize the impact of stress on physical and psychological health and wellbeing

• Demonstrate how self-compassion can reduce suffering

• Identify how stress and mindfulness impact brain function

• Integrate real-time stress-reduction techniques

The Journey by Mary Oliver

One day you finally knew what you had to do, and beganthough the voices around you kept shouting their bad advice

though the whole house began to tremble and you felt the old tug at your ankles. “Mend my life!” each voice cried.

But you didn’t stop. You knew what you had to do

though the wind pried with its still fingers at the very foundations though their melancholy was terrible.

It was already late enough, and a wild night,

and the road full of fallen branches and stones. But little by little,

as you left their voice behind,the stars began to burn though the sheets of clouds,

and there was a new voice which you slowly recognized as your own, that kept you company as you strode deeper and deeper into the world,

determined to do the only thing you could dodetermined to save the only life that you could save.

Introduction

Oncology Nurse Navigator:• Sits at center of healthcare team

and walks patient through system• Patient advocate• Physician liaison• Develops unique perspective of

healthcare system• Sees how all elements of system

work together• Understands gaps in care• Serves as a patient advocate

ensuring members of multidisciplinary team collaborate on patient care

Introduction

Oncology Program Manager at Methodist Dallas Medical Center:

– Working to improve the system for patients and physicians

– Promote Shared Decision Making

– Facilitate multidisciplinary approach to cancer care

– Integrate mindfulness into fabric of traditional cancer care

Locus of Control

Cancer-Related Post Traumatic Stress

• Cancer-related post-traumatic stress (PTS) – like post-traumatic stress disorder (PTSD) but

not as severe

• Can occur anytime during or after treatment

• Range of reactions:– Repeated frightening thoughts

– Being distracted or overexcited

– Trouble sleeping

– Feeling detached from oneself or reality

Stress and Oncology

Reactive anxiety &

depression

22%

Major depression

4%

Organic mental

disorders

3%

Personality disorders

2%

Anxiety disorders

1%

Distressed

32%

Patients coping

adequately

36%

Post-Traumatic Growth

PTGI Domains Sample Question

Appreciation of life I changed my priorities about what is important in life

Relating to others I have a greater sense of closeness with others

New possibilities in life I am able to do better things with my life

Personal strength I know better that I can handle difficulties

Spiritual change I have a better understanding of spiritual matters

• Linked to resiliency

• A positive change experienced as result of the struggle with a major life or traumatic event.

• Positive change that occurs after encountering life challenge.

• PTG tends to occur in 5 general areas

• Research suggests link between mindfulness and PTG

Exercise

An effective way to anchor in the present moment, in body sensation, especially when you’re upset and can’t calm yourself down.

• Awareness of sensation

• Diaphragmatic breathing

• Labeling thoughts

Stress and Telomeres

• Telomeres protect our DNA from degradation

• Studies have linked stress to shorter telomeres

• Associated with aging and disease

• Telomerase: protective enzyme

• Mindfulness is proven to increase serum telomerase, having a protective effect on our telomeres and DNA

Thinking/Feeling Feedback Loop

Information Processing

Hand Model of the Brain

Default Mode Network

• Mind wandering• Rumination• Confusion• Distorted thinking• Inappropriate negative rxn• Only see what confirms

belief (confirmation bias)• Ignore what disconfirms

belief • Believe worst possible

thing most likely to happen(negativity bias)

Awareness of Mental Activity

*The act of observing your mental activity causes it to change.

• Thinking fast and slow• Emotionally charged

memory is stickier• Memory is stored as

generalizations• Memories co-activate• Have to interrupt the

pattern, but first have to become aware of it

Pre-frontal Cortex

Breaking out of a Thinking/Feeling Loop

• Breathe into the feeling

• Label thought or emotion

• Become aware of mental activity

• Practice self-compassion

• Reframe/Reorient

• Choose Differently

Mindfulness Research

What is Mindfulness?

• Jon Kabat-Zinn Father of mindfulness

– Intentionally drawing your attention to the present moment experience with an attitude of kindness and non-judgment –JKZ

• Ellen Langer Mother of mindfulness

– A flexible state of mind in which we are actively engaged in the present moment and noticing new things –Ellen Langer

Mindlessness VS Mindfulness

Mindless Mindful

An inactive state of mind characterized by reliance on past experience and rely on rules or routines to govern behavior

Mindfulness is the very simple process of actively noticing new things in the present moment

Most of our suffering, psychological and physical, is the direct or indirect effect of mindlessness

It’s engaging and enlivening

The lights are on but no ones home The end game of meditation is to produce post-meditative mindfulness

Problem is you’re not there to know you’re not there

Mitigate reactivity of stress response with mindfulness practice as a means of seeing more clearly, understanding situations fully and acting wisely.

Mindfulness ResearchMindfulness and Colorectal Cancer

• Cancer Survivor Mindfulness Influences Health Characteristics of Primary Support Person

• Mindfulness Practice Reduces Cortisol Blunting During Chemotherapy in CRC patients

• Mindfulness and Disgust in Colorectal Cancer Scenarios: Non-judging and Non-reacting Components Predict Avoidance

Attitudes of Mindfulness

• Beginners mind • Non-judgment• Acceptance • Non-striving • Letting go/Letting

be• Gratitude• Generosity• Patience • Trust

Suffering = Pain x Resistance

Role of Resistance

• The Fly

The One You Feed

“A fight is going on inside me,” an old Cherokee man said to the his grandson.

“It is a terrible fight and it is between two wolves. One is evil—he is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority and ego.” He continued, “the other is good—he is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith. The same fight is going on inside you—and inside every other person too.”

The grandson asked his grandfather “which wolf will win?”

The old Cherokee simply replied, “The one you feed.”

Mindful Self Compassion

• How we are oriented to our experience • Internal narrator dictating the story of our lives• Can be self-critical or self-compassionate • Our attention can have a critical quality, or it can be compassionate• Attention training without an attitude of self-compassion can result in a

practice that is condemning or judgmental of inner experience• Self- kindness vs. self-judgment

– Treating self with care and understanding rather than harsh judgment– Actively soothing and comforting oneself

• Common humanity vs. isolation– Seeing own experience as part of larger human experience not isolating or abnormal – Recognizing that life is imperfect (expecting perfection is irrational)

• Mindfulness vs over-identification– Allows us to “be” with painful feelings as they are– Avoids extremes of suppressing or running away from painful feelings

Mindful Self-Compassion

When you notice that you’re feeling stress or emotional discomfort, see if you can find the discomfort in your body. Where do you feel it the most?

Now, say to yourself, slowly:

1) this is a moment of suffering• That’s mindfulness. Can also say: this hurts or this is stressful

2) suffering is a part of life • That’s common humanity. Can also say: I am not alone. Others are just like me.

This is how it feels when a person struggles in this way.

Now, put your hands over your heart, or wherever it feels soothing, feel the warmth and gentle touch of your hands. Say to yourself:

3) May I be kind to myself, or May I give myself what I need.

See if you can find words for what you need in times like this.

May I accept myself as I am. May I forgive myself. May I be patient.

Allow by Danna Faulds

There is no controlling life. Try corralling a lightning bolt.

Containing a tornado. Damn a stream and it will create a new channel. Resist, and the tide will sweep you off your feet. Allow, and grace will carry you to higher ground.

The only safety lies in letting it all in –the wile and the weak; fear, fantasies, failures and successes.

When loss rips off the doors of the heart, or sadness veils your vision with despair,

practice becomes simply bearing the truth. In the choice to let go of your known way of being,

the whole world is revealed to your new eyes.

References

• Shennan, C., Payne, S., Fenlon, D., (2010).What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psycho-Oncology DOI: 10.1002/pon.1819

• Bartley, T., (in press), Mindfulness-Based Cognitive Therapy for Cancer: Gently Turning Towards. Oxford: Wiley Blackwell

• Hanley, A., Peterson, G., Canto, A., (2014) The relationship between mindfulness and posttraumatic growth with respect to contemplative practice engagement.

• Speca, M., Carlson, L.E., Goodey, E., & Angen, M., (2000) A randomised, wait-list controlled clinical trial: The effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosomatic Medicine, 62, 613-622.

• Black, Peng, Sleight, 2017. Mindfulness Practice Reduces Cortisol Blunting During Chemotherapy: A Randomized Controlled Study of Colorectal Cancer Patients

• Cancer Survivor Mindfulness Influences Health Characteristics of Primary Support Person: http://mindful.usc.edu/author/admin/

Resources• Greater Good Science Center:

https://greatergood.berkeley.edu/• Self-Compassion: http://self-

compassion.org/category/exercises/• UCLA Mindful Awareness Research Center

(MARC): http://marc.ucla.edu/mindful-meditations

• https://www.mindful.org/• Self Compassion Test:

https://centerformsc.org/learn-msc/take-the-self-compassion-test/

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