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Mindfulness practice is increasingly utilized across a multitude of settings and with various populations, including graduate students and healthcare trainees of various disciplines. Recent changes in healthcare call for the use of interprofessional teams to provide patient-centered care, which requires practitioners to be attentive and practice adaptive emotional regulation skills (Shaller, 2007). Students, historically having limited access to other professionals during training, must now anticipate working with patients and each other. This document explores how mindfulness/acceptance-based approaches may be valuable to healthcare professionals’ training for intrapersonal, interpersonal, and interprofessional, gains, and proposes one such protocol.
Mindfulness-based interventions have gained popularity with students and trainees of various professions. Mindfulness has been defined as paying attention on purpose, in the present moment, and non-judgmentally (Kabat-Zinn, 1994), cultivated by practicing self-regulation of attention. Mindfulness training has several benefits consistent with patient-centered care. Mindfulness practice aids social work, counseling and occupational therapy graduate students in managing stress and anxiety, promoting attention to patients, and increasing self-awareness, empathy, and self-compassion (Felton, Coates, & Christopher, 2013; Gockel, Cain, Malove, & James, 2013; Reid, 2013). Moreover, mindfulness practice has been utilized to prevent burnout (Felton et al., 2013). Thus, it appears that mindfulness and related training may be applied across disciplines with intrapersonal and interpersonal benefits.
With changes in American healthcare, interprofessional practice has become a salient issue. Interprofessional teams are expected to evaluate patients and collaborate on treatment planning. Patient-focused care, thus, demands that teams practice together efficiently and effectively, a goal not always easily achieved. To date, interprofessional practice has been primarily addressed through education provided by individual training programs, with lack of consistency in how such education is provided, and limited data regarding outcomes (Olson & Bialocerkowski, 2014). As healthcare reform continues to transform how treatment is delivered, it is essential that health professional trainees are exposed to a comprehensive method of interprofessional training.
Since mindfulness training has been associated with improved communication, awareness of others, and empathy, it is possible that conducting mindfulness training sessions with healthcare professional trainees from different disciplines would foster interprofessional socialization. Provision of mindfulness training may offer them skills with which to cope with the stresses of being a student as well as of their chosen occupation. In addition to these intrapersonal benefits, gathering students together may promote empathy, compassion, and awareness of other professionals. Further, mindfulness practice and acceptance-based interventions such as acceptance and commitment therapy/training (ACT; Hayes, Strosahl, & Wilson, 2012) foster psychological flexibility, or the capacity to contact the present moment fully and persisting in or changing behavior in the service of what matters most. Psychological flexibility promotes perspective-taking and values-driven behavior (Hayes et al., 2012) both of which may improve interprofessional effectiveness.
While mindfulness and related practices are likely to aid interprofessional familiarization, it is important to acknowledge that interprofessionalism may enhance mindfulness practice as well. Practitioners from different disciplines gathering together for a shared purpose with common values may promote communication and a strong sense of common humanity. Mindfulness practice, thus, may be an appropriate way to introduce students to other professions while providing a rewarding training opportunity.
Interprofessional mindfulness/acceptance-based workshop
The proposed workshop protocol contains several mindfulness exercises as well as those more specific to ACT in the service of increasing students’ psychological flexibility. What follows is a description of elements of this interprofessional workshop protocol from the perspective of workshop leaders, faculty and doctoral students in a professional psychology program.
The workshop begins with an introduction in which leaders introduce themselves, invite students to be open to whatever arises for them, and indicate that they may always sit quietly or step out of the room if there is an exercise they do not want to participate in. Workshop leaders then formally begin by asking participants what they currently feel stressed about (i.e., “What is on your plates?”) and list responses on the board. Leaders might then motion toward the board and ask, “As you see and hear all of these things, what thoughts, sensations, and emotions show up for you?” and list responses on another section of the board. Finally, leaders ask participants what they typically do when these experiences (e.g., thoughts, sensations) arise. The concept of “effectiveness” of these potential coping strategies is then explored, in terms of shorter-term relief and longer-term effectiveness (i.e., behaviors in the service of values). The rest of the workshop is then framed as an opportunity to get a taste of practices centered on this second definition of effectiveness.
To further explore values, leaders conduct an experiential exercise dubbed “The Retirement Party.” This is a variant of an ACT exercise entitled, “80th birthday party” (Harris, 2007). Participants are provided with instructions to help ground them in the present moment (e.g., connecting with current bodily sensations and sounds in the room) and then encouraged to imagine a celebration of their retirement from their respective field of study, and to imagine what they most want colleagues, family and friends to say about their work and how they practiced. Participants are then encouraged to attend to their unfolding sensory experiences again in transitioning back to the experience of being in a classroom with peers. They are asked to write down any salient observations from this practice, related to what they noticed during the exercise or what they are experiencing in the moment.
Discussion of this practice explicitly connects it with “values” and leads to a more general discussion of this term. Participants are encouraged to explore how they want to be and what matters to them in professional roles, acknowledging that this involves considering themselves as “whole people.” Several literary references and quotes then shared highlight the essence of living in accordance with values, including the vulnerability that comes from working and living deeply.
Leaders then move into how such vulnerability and related thoughts and feelings might be “held,” by engaging in a practice that involves thinking of an issue or situation with which one is currently struggling.1 While keeping this issue in mind, participants are asked to engage in various gestures or postures that reflect different levels of openness and kindness (i.e., fists clenched tightly, palms open, arms out to the side, and both hands placed over one’s heart). This exercise encourages participants to notice thoughts and feelings, and to relate to them differently, aiming to foster openness to one’s thoughts, bodily sensations, and other aspects of emotion, seeing them as thoughts, bodily sensations, and such, rather than just seeing through their content. In debriefing this practice, leaders make sure to indicate that there is no “right” or “wrong” way to hold experiences and that life often involves a back-and-forth between these stances. Related, moving from one posture to another does not “make the problem go away,” but practitioners may notice that by moving from tightly clenched fists to the other positions, energy that goes into the clenching may be freed up for other activities that are values-consistent.
The interprofessional module uses a patient vignette, through which participants are asked to share their perspective and clinical approach to the particular case, exploring applicable skills and knowledge. A similar exercise has been used in interprofessional education (Olson & Bialocerkowski, 2014). It is hoped that these interactions will lead to a sense of shared values emerging. Workshop leaders encourage participants to speak to the common values that may guide professional work from various disciplines (e.g., alleviating suffering and fostering vitality). Lastly, a discussion about the potential intrapersonal, interpersonal and interprofessional benefits of mindfulness and associated practices follows, and participants are provided with information about additional resources should they want to learn more.
Due to healthcare reform, healthcare professionals are expected to work together more closely, to balance multiple roles, and to remain present in session with patients. As such, professionals in training would likely benefit from interprofessional education beyond the traditional classroom (completely separate from trainees in other programs). Mindfulness- and acceptance-based workshops may bridge the gap between schools of professions, providing interprofessional training while also offering intrapersonal and interpersonal benefits to those involved. By sharing one protocol, we hope others will investigate it as well as their own approaches that might serve similar functions.
Agnes Lenda1*, Jennifer Block-Lerner1, Donald R. Marks1, Ashlyne Mullen1, Claire Mulry2
- Department of Advanced Studies in Psychology, Kean University, USA
- Department of Occupational Therapy, Kean University, USA
- This practice was introduced to us by Dennis Tirch, Ph.D., who indicated that a modified version was shared with him by Christopher Germer, Ph.D.
Felton, T. M., Coates, L., & Christopher, J. C. (2013). Impact of mindfulness training on counseling students’ perceptions of stress. Mindfulness. doi: 10.1007/s12671-013-0240-8
Gockel, A., Cain, T., Malove, S., & James, S. (2013). Mindfulness as clinical training: Student perspectives on the utility of mindfulness training in fostering clinical intervention skills. Journal of Religion & Spirituality in Social Work: Social Thought, 32(1), 36-59.
Harris, R. (2009). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. New Harbinger Publications.
Hayes, S.C, Strosahl, K.D., & Wilson, K.G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd edition). New York, NY: The Guilford Press.
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.
Olson, R., & Bialocerkowski, A. (2014). Interprofessional education in allied health: A systematic review. Medical Education, 48(3), 236-246. doi:10.1111/medu.12290
Reid, D. T. (2013). Teaching mindfulness to occupational therapy students: Pilot evaluation of an online curriculum. Canadian Journal of Occupational Therapy, 80(1), 42-48. doi: 10.1177/0008417413475598
Shaller, D. (2007). Patient-centered care: what does it take? Commonwealth Fund. Retrieved from: http://www.commonwealthfund.org/usr_doc/Shaller_patient-centeredcarewhatdoesittake_1067.pdf?section=4039