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Stories, tips, and articles about mindfulness, daily meditation, compassion, living well with illness and chronic pain, and more.
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The Problem of Burnout for Doctors

Breathworks New Statesman Parliament Roundtable discussion

The New Statesman held a roundtable discussion at the Houses of Parliament recently, in collaboration with the University of Buckingham, on the subject of how to make a profession in Healthcare more sustainable by altering the university experience for medical students. It was attended by NHS Directors, Professors, Politicians, and Charities, and Breathworks was delighted to be invited to attend; our Business and Research Manager Colin Duff (below) represented Breathworks in the discussion.

Breathworks New Statesman Parliament Roundtable discussion Breathworks Business and Research Manager Colin Duff

The issue of the work intensity for doctors in the UK is hard to overstate; only 1 in 10 Trainee GPs say that they want to work as a doctor full-time when they complete their training, citing, amongst other things, the intensity of the work. Given the eight years of gruelling work it takes to qualify as a GP, this is a shocking figure. In 2011, England lost 13% of its GPs and 22% of its Specialists to Australia, due to kinder working hours (and also probably the sun).

Self-maintenance and well-being strategies are not touched upon as part of a medical degree, despite having a huge influence on burnout rates and time lost to poor mental and physical health, job satisfaction, and basic quality of life for doctors. The medical school at the University of Buckingham has been an exception, emphasising mindfulness and well-being in the curriculum, thus far with excellent feedback from students and patients.

There is great potential for universities to incorporate a developing understanding of positive psychology into their degree programs. A recent paper1 from Sir Anthony Seldon and Dr. Alan Martin makes a number of excellent suggestions to this end, proposing that well-being strategies be taught to everybody before they are needed. They make the simile that waiting for an individual to develop mental health problems before helping them is like waiting for somebody to fall off a waterfall, and then trying to fix them, instead of employing prevention strategies which in the long-run would be more economical, effective, and encourage the flourishing of well-being for the whole student body.

A study2 published in February looked into the effectiveness of interventions for physicians to prevent burnout. It found that interventions targeted at individuals, many of which were mindfulness-based, were significantly effective in preventing burnout in physicians, but that those interventions which were directed at an organisational level were significantly more effective still. The study concluded that “burnout is a problem of the whole health care organization, rather than individuals”.

A letter sent to the committee from a retired GP echoed these findings strongly: Mindfulness and Compassion training would be very helpful as a part of a bigger package to improve resilience in young doctors, but if the package is used as a sticking plaster for a much deeper wound of a broken NHS, that is to say, if working conditions are not improved, the package will not be effective.” 

The former GP, Dr. Farhad Emad, was himself forced to retire from the profession early due to ill health resulting from chronic physical and mental burnout. He writes of himself and a colleague: Subsequently we both trained in Mindfulness practice with Breathworks organisation and managed to get ourselves out of our difficulties successfully, and in the process, we helped others including GP’s, by teaching Mindfulness. We are both of the strong opinion that earlier Mindfulness and Compassion training might have averted our premature retirement and that we would still be working as experienced GP’s.”

Breathworks runs introductory Mindfulness and Compassion courses for doctors and Healthcare professionals to help with these problems. Dr. Emad noted that  “Many junior doctors are taught empathy but know nothing about compassion and consequently struggle with empathic distress, which can lead to burnout.”

It seems essential that organisational changes take place and that aspects of this training become incorporated on an institutional level where they are sorely needed by trainee doctors at huge risk of severe physical and emotional burnout. In the meantime, we can hope that a knowledge of well-being training is spread organically through books, courses, and teachers.

You can find out more about Breathworks courses for Healthcare professionals and book a place here.

Ollie Bray

 

References

  1. Seldon, A., & Martin, A. The Positive and Mindful University. 2017
  2. Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., Chew-Graham, C., ... & Esmail, A. (2017). Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. Jama internal medicine, 177(2), 195-205.
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What Does a Ukulele Have to do with Mindfulness?

Breathworks Teacher Ben Hoff - Teaching with the Camden Society

You might imagine silence being the predominant feature of a mindfulness workshop. Wrong! Last week ­– teaching at the Camden Society where Breathworks is delivering a mini Mindfulness for Health intervention as part of a longer back-to-work course being run in conjunction with the DWP – we were treated to a ukulele rendition by participant Dan which touched us all. What does a ukulele have to do with mindfulness

We’re frequently sold an idea that happiness is something outside of ourselves – a far-away (and usually unreachable) tropical island or a winning lottery ticket the likelihood of winning is virtually zero. Here, as advertising exec Don Draper reminds us in the hit TV series Mad Men: ‘Happiness is the moment before you need more happiness’.  One important aspect of Breathworks courses is discovering pleasure in the small, everyday things things around us. In a sort of ‘show and tell’ we invite participants to bring in a small selection of personal objects which are pleasant to touch, smell, taste, feel or listen to. Whenever I do this exercise people are always amazed at the sense of wellbeing they derive from simply finding pleasure in the ‘everyday’  – the fragrance of essential oils, the sensual touch of a particular material, or in this case, the sound of a ukulele.  As Dan said afterwards: ‘When the world ends, and all the lights have gone out, I’ll still be able to play myself a tune on the ukulele’. 

-Ben Hoff

 

Ben Hoff will be teaching the Breathworks Mindfulness for Health Course in London this March. For more details about the course take a look at the Mindfulness for Health page, and find dates and times, and book your place here.

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The journey of a thousand miles starts with a single step

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In today’s column I want to write about how extraordinary change can come about through steadily taking small steps in the direction of healing. Never underestimate the power of seemingly ordinary acts.

I have lived with chronic pain for 40 years now, ever since my life as a sporty teenager was cut short with a spinal injury and two major operations. I have struggled with it, fought against it, hated it, almost been defeated by it. But, gradually, step by step, I have turned my life around and now, as a 57 year old, I have a better life than ever. Sure, I’m not particularly ‘able bodied’, but this doesn’t matter to me anymore as the quality of my life is better than ever.

How did this change come about? If I compare myself now to how I was 20 years ago, there has been a huge, almost unbelievable, change. And yet most of this change has come about very gradually, almost imperceptibly, through simply and steadily working away at developing new habits. Moment by moment, day by day, year by year.

I’d like to tell you about some of these new habits in the hope that you too can feel inspired to tread this journey of a thousand miles by valuing the steps along the way.

Become a routine lover – get your eating and sleeping in order

I try to go to bed, get up in the morning and eat my meals at regular times. This is a big change from the chaotic habits of earlier years. I’ve learned that the body loves routine and, far from being boring as I used to fear, it frees up time and energy for other things.

Regular exercise

I do my stretches every morning and I try to swim at least a couple of times a week. Again, I used to find these things boring and experience huge resistance. But I’ve got to the point now where I miss these simple activities if I miss them for a few days. I invariably feel better afterwards.

Seek help

I have had osteopathy for my back about once a month for the last 30 years. It has become a staple of my lifestyle and I know it has saved me from a lot of secondary degeneration. I know some of you won’t be able to afford it and I used to be on extremely low income when on benefits. But I always tried to scrape together the money for these treatments before other luxuries as I knew how much they helped me. Now I travel a lot teaching mindfulness and I make sure I have ‘an osteopath in every port!’. Likewise I try and have regular massage and for a time I had psychotherapy. I’ve learned there are people who can really help me and I’ve let go of pride in thinking I should be able to cope all on my own.

These are just a few tips on how to manage your pain as well as possible. I hope you’ve found them helpful. As I said at the start: never under-estimate the power of simple steps. If you keep taking them steadily, over time you can turn your life around. 

Vidyamala Burch - Breathworks Founder and author of Mindfulness for Health

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How Mindfulness Practice Has Changed My Life – My Personal Story

How Mindfulness Practice Has Changed My Life - Karen Liebenguth

I have dreadful memories from when I was 4 or 5 and onwards of feeling terribly frightened and anxious about anything and everything. Going to sleep was the worst. Ideally I would have liked to stay at my mother’s side day and night. I didn’t want to go to school because I was feeling scared of being in a big group of children I didn’t know, I didn’t want to be in a car with more than three people in it because I was feeling terribly anxious about the car breaking, I did not want to be on a boat for fear it would sink, I didn’t want to be at home with a child minder because I was worried that my mother was not coming back.

Many things terrified me. I constantly believed that something bad was going to happen to me, that I would get lost, that I had to go to hospital, that I was going to be separated from my mother and sister, that I was going to be in a lot of pain, that I was going to die…

Those were some of my catastrophic thoughts that kept me in a constant state of high alert and worry. Life felt very scary to me.

Anxiety – worrying about what has not happened yet - has inhibited me from fully living.

Of course I had therapy when I was a child; also later when I was a student and as young adult. It reduced the level of anxiety I was suffering from considerably.

Still, anxiety had been a constant unpleasant companion in my life for almost four decades until I was introduced to the practice of mindfulness in 2008 – when I was forty.

Thanks to mindfulness practice I understand myself better and the cause for my anxiety. That in itself is not a remedy but it helped me bring understanding and compassion to myself and that has helped me to come into a different, more supportive relationship with myself.

My parents divorced when I and my sister where two and three years old. My mother never remarried and brought us up a s single mum needing to work full-time. It meant that we had to grow up quickly, to get on with our life, and that felt deeply scary and unsafe. Don’t get me wrong, my mother was certainly not a bad mother – this is not about blaming my parents – it was just that she wasn’t around enough to reassure me that I was okay.

Mindfulness has helped me become more and more aware of my stress pattern.

When I feel anxious and then stressed I have a narrative in my head that goes like this: It’s too much, I have too much work to do, I can’t cope, I won’t be able to do it. These thoughts trigger my mind’s alarm system which in turn triggers more tension in my body and makes my breath shallow and inhibited which in turn impacts on the choices I make; what I say to my colleagues, friends, partner, family etc and how I say it, aka knee-jerk reactions.

Then, to top it all off, I beat myself up for being so stressed, inefficient, grumpy or moody, which adds another layer of anxiety and stress. And this is the crucial bit that was a complete eye-opener for me that mindfulness has taught me: harsh self-criticism or self-judgement is the very thing that puts most pressure on me, on us, that creates most stress, anxiety and can lead to depression. Mindfulness practice has helped me to see things more for what they are. Yes, I have work to do, and deadlines that perhaps are unpleasant but they are just deadlines and work is just work and giving a talk is just giving a talk – no more no less. It’s called primary experience. What we do with it, i.e. how we interpret what happens to us is called secondary experience and that’s what can cause us a lot of pain depending on how we interpret, judge, analyse life’s events.

Mindfulness has helped me become more and more aware of my stress and anxiety pattern. So when I feel stressed or anxious, I now notice my breath getting shallow, I recognise the thoughts racing through my head, and the feelings in my body (eg tightness, racing heart, anxiety, sweating, panic, overwhelm, too muchness) and take some deeper breaths and let my breath find its natural rhythm again which allows my mind and body to calm down and relax.

Mindfulness has transformed how I experience myself, has helped me see and understand my helpful and unhelpful habitual ways of thinking and behaving which in turn has helped me respond differently, more kindly and compassionately to myself, others and life’s challenges.

Today, I still suffer from anxiety occasionally, particularly in the early hours of the morning when I wake up sweaty and with a beating heart. The difference is, today I know what I need to do. I expand my in-breath and slow down my out-breath. I feel my body on the mattress, my feet, legs, bum, back, back of my head. I become aware of whatever catastrophic thought is going through my head, I ask myself: Is this true? 99% of the time the answer is ‘No’. I’m back in the here and now and continue to sleep.

Mindfulness is not an idea, it’s a practice. It requires daily commitment, faith and stamina. The pay-off is huge and can be life-changing. It certainly has given me back my life.

Engaging in an 8-week mindfulness for stress course can help you tap into your inner resources, can help you become more aware and awake in order to make more creative, wiser choices about how to respond to what’s happening in life.

Karen will be leading the upcoming 8-Week Mindfulness for Stress Course in London, Starting 17 Jan 2018; 7-9.30pm at The West London Buddhist centre. For more information and to book take a look at the London Mindfulness for Stress Course Page.

Image of Karen Liebenguth - Breathworks Accredited Teacher

 

Karen Liebenguth is an accredited and associate mindfulness teacher with Breathworks UK. She teaches 8-week Breathworks courses for stress and pain management and offers 1:1 mindfulness training and tailored mindfulness programs for the workplace. Karen is also a qualified life coach and MBTI facilitator. She specialises in 1:1 coaching while walking outdoors in green space where she believes insight, change and creativity can happen most naturally. For more information on Karen’s work visit her website: http://www.greenspacecoaching.com

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How (and Why) to Enjoy Your Meditation Practice

How and why

During meditation practice, it is inevitable to have periods of feeling impatient, restless, and distracted. Usually our response to this is to try to knuckle down and use willpower to fix attention on the meditation object, or decide that we’re not in the right place and not to meditate today. Neither of these, as it happens, will help us very much.

The problem is that our unconscious mind is always working away to seek pleasurable experiences and avoid unpleasant ones (e.g. by fantasising and worrying). When it comes up with a better idea about how to find enjoyment or avoid displeasure than what you are currently doing, it will fire some distracting thoughts (like about those blueberry muffins you just bought) into consciousness. When we are concentrated on an activity which is engaging and enjoyable, however, all of our mind is unified in engaging with the current task. This happens when the mind is already satisfied and experiencing ongoing reward.

If our response to distraction is to tighten attention onto the breath, like we’re tightening our grip on something which might get away from us, we are exercising a misunderstanding of how attention works. Clasp your fist as tight as you can, and hold it; what effect does this have on the rest of your body, on your breathing, on your mind? When we attempt to use power of will to force attention on the object in this way, we are moving further away from a relaxed and happy engagement. Parts of our brain will go into overdrive reminding us of all the other things we could be doing, and even more distractions will sneak up.

This creates a feedback loop where distractions lead to a forcing of willpower, which leads to tightening and vexation, and this leads to more distractions. It’s like trying to pull a seat belt too fast; if you didn’t know how seatbelts worked, your natural reaction may be to get frustrated and try to pull harder and harder. This is why it is so important to understand the mechanics of your own attention.

So, then, if you shouldn’t be responding to distractions by trying to force your attention, how should you deal with them? The simple answer is to enjoy your practice. This isn’t always easy, but it is so important to focus on any and all positive aspects to your meditation. Is your mind calm today? Is your mind worried and distracted, but you’ve kept your resolve and you’re sitting anyway? Congratulate yourself. Do you feel comfortable, or in a little less in pain than earlier? Are your feet warm? Appreciate these simple treasures.

See if you can enjoy the subtle sensations of the meditation object; see if you can imagine the breathing as a kind of internal massage. Savour the sense of accomplishment of following a whole breath from start to finish without getting distracted. And when you get distracted again, as every meditator will, focus on the only moment that matters; the moment when you realised your mind was wandering, and returned to the wholeness of the present moment.

Enjoy and reinforce any fleeting pleasure or enjoyment of any aspect of the meditation like you were savouring your favourite food. When the mind is happy and in a relaxed engagement with the task it is doing, distractions naturally become quiet, and we don’t need to waste any energy in trying to quiet them.

If you try to meditate by rowing with as much force as you can muster, you will end up quickly exhausted, uncomfortable, and dispirited. Meditate by stringing up a sail to catch the pleasure and enjoyment of sitting, as wide and as wonderful as you can. Then relax, and enjoy the ride.

Ollie Bray

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