Craig Hassed

Mindfulness as a concept and a process

Abstract The use of mindfulness meditation as a therapeutic intervention has been strongly promoted in the last few years. To date there has been limited opportunity for open discussion and sharing of knowledge in relation to theory, practice or outcomes. The purpose of this paper was to provide psychologists with an understanding of the theoretical underpinning and evidence base for incorporating mindfulness practice into their lives and work. Primarily, mindfulness is presented as a cognitive style that facilitates development of a heightened sense of awareness of thought processes and emotions, and utilisation of this awareness to cultivate the ability to engage actively in being rather than reacting or doing. Further, it is noted that the learning of mindfulness meditation is believed to empower the individual to find release from depressive rumination, anxiety and stress in their lives. Current limitations, potential implications and contraindications of utilising mindfulness meditative practice are ...

Bringing holism into mainstream biomedical education.

Introducing holism and complementary medicine into mainstream medical education provides many scientific, philosophical, and personal challenges. The growth of new knowledge always necessitates venturing into areas, which are, by definition, unknown, hence arise potential clashes of ideology, knowledge, evidence, interpretation, language, and personality. This paper outlines some of the experience and progress made at Monash University Victoria, Australia, in teaching this material in undergraduate medical education. The Monash medical course has always been known for its commitment to an integrated curriculum, a holistic perspective, and the personal development of its students. Some of the points of integration in the core curriculum already achieved include health enhancement and mindfulness-based stress management programs right from first year, lectures and forums on complementary medicine, integration of this material into weekly case-based teaching, and health promotion and mind-body medicine. For very interested students, electives provide an opportunity to explore subjects in more depth. Experience has taught us that it is as important to learn how to deliver the message as it is to refine its content. This presents challenges that are as much personal as they are intellectual. Areas of particular importance are the academic environment, language, diplomacy, style, relevance, and evidence. In this process, building relationships, collegiality, patience, objectivity, impartiality, and humor are helpful.

Chronic condition self-management support: proposed competencies for medical students

Objective: Governments and the medical profession are concerned that there continues to be less than optimal health outcomes despite escalating expenditure on health services from the effect of the ageing population with chronic illnesses. In this context, doctors will need to have knowledge and skills in effective chronic condition management (CCM) and chronic condition self-management (CCSM). Method: A national workshop of representatives of eight medical schools from the CCSM special interest group (SIG) of the Australian and New Zealand Association on Medical Education met in September 2004, to consider curriculum content in CCM and CCSM. Results: The workshop recommended that the Committee of Deans of Australian Medical Schools and the Commonwealth Department of Health and Ageing consider the identification and possible development of a specific curriculum for CCM and CCSM within the curricula of Australian Medical Schools. Discussion: Consideration needs to be given to the changing nature of medical practice and that as part of this; doctors of the future will need skills in team participation, continuity of care, self-management support and patient-centered collaborative care planning. Doctors will also need skills to assist patients to better adhere to medical management, lifestyle behaviour change and risk factor reduction, if optimal health outcomes are to be achieved and costs are to be contained.

The effects of a mindfulness-based lifestyle programme for adults with Parkinson's disease: protocol for a mixed methods, randomised two-group control study

Introduction Parkinsons disease (PD) is the second most common neurodegenerative disorder in developed countries. There is an increasing interest in the use of mindfulness-related interventions in the management of patients with a chronic disease. In addition, interventions that promote personal control, stress-management and other lifestyle factors, such as diet and exercise, assist in reducing disability and improving quality of life in people with chronic illnesses. There has been little research in this area for people with PD. Methods A prospective mixed-method randomised clinical trial involving community living adults with PD aged <76 years and with moderate disease severity (Hoehn and Yahr stage 2) PD. Participants will be randomised into the ESSENCE 6-week programme or a matched wait list control group. ESSENCE is a multifaceted, healthy lifestyle and mindfulness programme designed to improve quality of life. We aim to determine whether participation in a mindfulness and lifestyle programme could improve PD-related function and explore self-management related experiences and changing attitudes towards self-management. The outcome measures will include 5 self-administered questionnaires: PD function and well-being questionnaire (PDQ39), Health Behaviours, Mental health, Multidimensional locus of control, and Freiburg mindfulness inventory. An embedded qualitative protocol will include in-depth interviews with 12 participants before and after participation in the 6-week programme and a researcher will observe the programme and take notes. Analysis Repeated measures of Analysis of Variance (ANOVA) will examine the outcome measures for any significant effects from the group allocation, age, sex, adherence score and attendance. Qualitative data will be analysed thematically. We will outline the benefits of, and barriers to, the uptake of the intervention. Ethics This protocol has received ethics approval from the Monash University Human Research Ethics Committee project number CF11/2662–2011001553. Dissemination This is the first research of its kind in Australia involving a comprehensive, lifestyle-based programme for people with PD and has the potential to involve a broader range of providers than standard care. The findings will be disseminated through peer reviewed journals, primary care conferences in Australia as well as abroad and through the Parkinsons community. Registration details Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000440820.

The Health Enhancement Program at Monash University Medical School

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utmb.edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 500 to1,500 words. Please include any Web site or other resource that is relevant, as well as contact information.

Mindful learning: Why attention matters in education

Mindfulness is a generic skill with a wide range of applications relevant to education. These include fostering mental health; improving communication, empathy, and emotional development, improving physical health; and enhancing learning and performance. This article will give a brief overview of the science, practice, and philosophy of mindfulness, enlarge on the application of mindfulness meditation and related practices, and explore how these can be applied to the education, development, and well-being of children.

Group interventions to promote mental health in health professional education: a systematic review and meta-analysis of randomised controlled trials

Effects of interventions for improving mental health of health professional students has not been established. This review analysed interventions to support mental health of health professional students and their effects. The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC and EMBASE were searched until 15th April 2016. Inclusion criteria were randomised controlled trials of undergraduate and post graduate health professional students, group interventions to support mental health compared to alternative education, usual curriculum or no intervention; and post-intervention measurements for intervention and control participants of mindfulness, anxiety, depression, stress/distress or burnout. Studies were limited to English and short term effects. Studies were appraised using the PEDro scale. Data were synthesised using meta-analysis. Four comparisons were identified: psychoeducation or cognitive-behavioural interventions compared to alternative education, and mindfulness or relaxation compared to control conditions. Cognitive-behavioural interventions reduced anxiety (−0.26; −0.5 to −0.02), depression (−0.29; −0.52 to −0.05) and stress (0.37; −0.61 to −0.13). Mindfulness strategies reduced stress (−0.60; −0.97 to −0.22) but not anxiety (95% CI −0.21 to 0.18), depression (95% CI −0.36 to 0.03) or burnout (95% CI −0.36 to 0.10). Relaxation strategies reduced anxiety (SMD −0.80; 95% CI −1.03 to −0.58), depression (−0.49; −0.88 to −0.11) and stress (−0.34; −0.67 to −0.01). Method quality was generally poor. Evidence suggests that cognitive-behavioural, relaxation and mindfulness interventions may support health professional student mental health. Further high quality research is warranted.

A Peer-Support and Mindfulness Program to Improve the Mental Health of Medical Students

ABSTRACT Problem: There is evidence that peer-support programs can improve mental health indices and help-seeking behavior among students in some secondary school and university settings and that mindfulness can improve mental health in medical students. Peer-led programs have not been formally assessed in a medical student population, where psychological issues exist and where it has been shown that students approach peers for help in preference to staff members or professional services. Intervention: Medical students elected peer leaders who underwent training and then provided the intervention. The peer leaders provided support to students in the intervention group, as well as offering teaching in mindfulness meditation. Context: An exploratory study was conducted with 2nd- and 3rd-year medical students at 1 medical school in New Zealand randomized into 2 groups. In addition to existing mental health resources, intervention participants received a program including peer support and peer-taught mindfulness practice. Study participants not offered the intervention participants could use existing mental health resources. Primary measures included depression (PHQ-9) and anxiety (GAD-7) scores. Secondary measures were quality of life, resilience (15-item resilience scale), academic self-concept, and motivation to learn, assessed at baseline and 6 months. Outcome: Of the 402 students eligible, 275 (68%) participated and 232 (58%) completed the study. At baseline, 53% were female and mean age was 21 years (SD = 3)—PHQ-9 score (M = 5.2, SD = 3.7) and GAD-7 score (M = 4.5, SD = 3.4). Twelve peer leaders were elected. There was good participation in the intervention. One fourth of intervention students used the face-to-face peer support and more than 50% attended a peer social event and/or participated in the mindfulness program. Although improvements in mental health were seen in the intervention group, the difference between the intervention and nonintervention groups did not reach statistical significance. Lessons Learned: Although evidence exists for effectiveness of peer support and mindfulness in other contexts, this exploratory study was not able to show a statistically significant effect. Future studies could consider using a longer training period for the peer leaders, as well as targeting the study population to those most likely to benefit such as those with poorer mental health, or using a more intensive intervention or larger sample size. A cluster randomized study design would also reduce the risk of contamination.

Mindfulness-based stress release program for university employees a pilot, waitlist-controlled trial and implementation replication

Objective: The aim of this study was to evaluate the effectiveness of a 6-week mindfulness-based stress release program (SRP) on stress and work engagement in fulltime university employees. Methods: Perceived stress, workplace wellbeing, and engagement were measured at baseline and within 1 week of the SRP completion, and contemporaneously 6 weeks apart for a waitlist control group. A second program was implemented to examine reproducibility of results. Results: Fifty participants undertook the SRPs, and 29 participants were waitlisted. A significant improvement in distress, workplace wellbeing, and vigor was observed within the first SRP group, when compared with the control group. The improvement in distress and wellbeing was reproduced in the second SRP group. Conclusions: This study adds to the growing body of research that mindfulness may be an effective method for reducing workplace stress, improving employee wellbeing, and enhancing work engagement.

Mindfulness: why attention matters

The importance of training attention is not a new idea and it may be the single most important life-skill we ever develop. Attention training is an important aspect of what is called mindfulness which is a form of meditation, a way of living, and a foundation for new approaches to psychotherapy such as mindfulness-based cognitive therapy (MBCT). Mindfulness-based approaches are receiving considerable interest from a number of disciplines on the back of an emerging evidence base. Particular areas of interest in the basic sciences include studies on neuroplasticity, genetics, and immunity. But it is the applications which are of particular importance in areas such as enhanced mental health, improved executive functioning, greater mental flexibility and memory, and improved physical health. In the medical setting it is also attracting interest because of its capacity to enhance clinical performance and reduce burnout. This interactive and experiential masterclass will explore the science, philosophy and practice of mindfulness including its importance for enhancing wellbeing and performance. Discussion will also focus on how it can be applied in personal and professional life.