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How Mindfulness can help physicians to manage and reduce stress

 

“You catch your breath for two breaths, three breaths, and ask yourself ‘Which of my character strengths do I want to make sure I’m bringing forth?’”

-Dr Ryan Niemiec, Psy.D., Bestseller Author, Director, VIA Institute on Character

Today, psychologist Dr. Ryan Niemiec speaks again with Cohost and Lead Coach Jill Farmer about how physicians can practice mindfulness to better manage stress and increase well-being. “The Mindful Pause” is a short, one minute break in your day that can help you become present and awake in daily moments. Want to know where to start? Often, we as healthcare professionals may find ourselves overwhelmed with scheduling, productivity, time management, and other external factors. Dr. Ryan Niemiec shares how you can reclaim your mind, and how this helps to prevent burnout. Different from mediation, Dr. Niemiec ensures listeners that mindfulness is an easy and advantageous practice to add to your daily life. In addition to normalizing the practice of mindfulness, Dr. Niemiec discusses the intersection between character strengths and mindfulness and how their development can benefit you as a clinician.

DocWorking: The Whole Physician Podcast Episodes featuring Dr. Ryan Niemiec:

174: Keys to Flourishing for Physicians with Dr. Ryan Niemiec- https://docworking.com/2022/05/26/character-strengths-flourishing-for-physicians-healthcare-professionals-dr-ryan-niemiec/

Ryan M. Niemiec, Psy.D. is a leading international figure in character strengths that are found in all human beings. As an educator, scientist, and practitioner, Ryan is the education director of the renown VIA Institute on Character, a nonprofit organization in Cincinnati, Ohio, that leads the global advancement of the science of character strengths. Ryan is an award-winning psychologist, annual instructor at the University of Pennsylvania, and author of 11 books, over 100 academic papers, and several-hundred user-friendly articles. His books include the bestselling consumer book, The Power of Character Strengths, the popular stress workbook The Strengths-Based Workbook for Stress Relief, the 2020 workbook The Positivity Workbook for Teens, and Positive Psychology at the Movies. He’s also author of the two leading practitioner-focused books in positive psychology – Character Strengths Interventions and Mindfulness and Character Strengths. The latter book contains the evidenced-based program he founded, Mindfulness-Based Strengths Practice (MBSP), used by practitioners and researchers across the globe. He created VIA’s first character strengths certification program – MBSP Certification – in 2021.

His research areas include character strengths, MBSP, positive interventions, peace psychology, nature/environment connection, spirituality, life meaning, disability, and positive health.

Ryan has been interviewed by a number of luminaries including the legendary Larry King in 2020. He’s given over 1,000 presentations on positive psychology topics, including a character strengths world tour in 2009-2010, a TEDx talk in 2017, a speaking tour of Australia, a keynote at a Harvard conference, and invited keynotes and workshops at conferences across the globe. He is Fellow of the International Positive Psychology Association (IPPA) and serves on their Council of Advisors. He is co-founder and president of the Spirituality/Meaning Division of IPPA.

Ryan lives in Cincinnati with his wife and three young, zestful children. His highest strengths are hope, love, honesty, fairness, spirituality, curiosity, and appreciation of beauty. Ryan’s hobbies include playing tai chi, chess, basketball, and guitar; watching Michigan State athletics and The Walking Dead, and collecting vintage and rare Pez dispensers.

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Podcast produced by: Mara Heppard

 

Please enjoy the full transcript below

 

Ryan: You catch your breath for two breaths, three breaths, then you ask, “What are my character strengths, what do I want to make sure I’m bringing forth?”

[DocWorking theme]

Jen: Thank you for joining us here today on DocWorking: The Whole Physician Podcast. I want to take a moment and let you know that we’ve been working around the clock at DocWorking to bring you CME credit, so that now you can let your continuing education budget help you to prioritize your own wellness and get on the path to living your best life. Everything we do at DocWorking is specifically designed with you in mind. We hope you’ll head over to docworking.com today and take our two-minute quiz to find out where you are right now on the balance to burnout continuum. Take our burnout quiz and this simple step alone can put you in the right direction toward living your best life.

Jill: Hi everyone, and welcome to DocWorking: The Whole Physician Podcast. I’m Jill Farmer, a cohost of the podcast and lead coach at DocWorking. As always, this podcast is brought to you by DocWorking Thrive. Go to docworking.com to learn more today about how you can thrive at life and work. 

Today, we are joined by Ryan Niemiec, psychologist and international figure in character strengths that are found in all human beings. He’s is an educator, a scientist, a practitioner, and the education director for the renowned Via Institute on Character, which is based in Cincinnati, Ohio. He’s written 11 books, he’s an annual instructor at the University of Pennsylvania. 

We have had a chance, Ryan, to talk to you in the past a little bit about character strengths and how putting our character strengths in actions can help us thrive and flourish in life. And today, I want to talk about something else that I know is near and dear to your heart that I think, we don’t put enough emphasis on it in conversations in the healthcare community, and that is the idea of mindfulness and mindfulness helping us particularly with that activated stress response in the pressurizing situations and the amount of stress that healthcare professionals have been under, always, but particularly in the last two years, even more. So, thanks for joining us for this conversation.

Ryan: Yeah, thanks for inviting me back, Jill. It’s great and I am so grateful again to the service that you provide to so many physicians and medical people, it’s so important.

Jill: Let’s talk a little bit about mindfulness. I know for some really busy physicians or people, self-described physician clients that I’ve worked with as type A, anytime I say anything about meditation or mindfulness are like, “Yeah, yeah, yeah, that doesn’t work for me.” [laughs] I’ve got so much going on in my head. So, let’s just talk with foundationally why as a psychologist and as a professional you like this topic and why you think it’s important for people to understand it better.

Ryan: Sure. The way that I think about mindfulness in the way that the research really speaks to it is that this is something for everybody, because in a word it’s about being more awake in life, it’s about being more present in life. It can have to do with meditation, and doing a meditation practice, and managing your wandering mind. It can have something to do with meditation and building up a practice of meditation, but that’s not the biggest picture. That actually helps us to become more mindful, but that’s not the main point. The main point is to be more present and awake in our daily life. 

Researchers have defined mindfulness. Researchers gathered in the early 2000s to come up with an operational definition of, what is this thing called mindfulness? There’s all this talk about it, and all these different prolific people, where the Dalai Lama, Thich Nhat Hanh, or Jon Kabat-Zinn, or Jack Kornfield, or Tara Brach, everybody has their own definition. What is it? Because everyone changes it a little bit. These researchers scoured the literature and they came up with a two-part definition for what mindfulness really is and I think this is really helpful for us. They said that “Mindfulness is the self-regulation of our attention.” And then second, “Having an attitude of curiosity, openness, and acceptance.” That’s very different than us saying that we have to sit down and meditate for 45 minutes, or we have to get certain syllables from a guru in a different country, or we have to take total control of our mind. Instead, it’s something that’s–again, it’s for everybody. 

To self-regulate our attention, what does that mean that first part of the definition? It means to take a little bit more control of what you’re focusing on. I might bring my attention to your face, Jill. I might bring my attention to our interview and hopefully, I am. A person might bring their attention to the water they’re drinking, bring their attention to their body as they walk. That’s mindfulness. Feeling the pacing of your body, each step touching the ground, that’s taking some control, self-regulation of your attention. Or, of course, you can bring your attention to your inbreath, into your outbreath. You can bring it to a candle flame, you can bring it to the smile on your child’s face. 

Then what do we do with that attention? Once we bring it to that stimulus, we have this attitude of curiosity, openness, and acceptance, which is the researchers’ words, not mine. Curiosity, meaning, to be interested in that thing that you’re focused on. Interested in that smile, to express a sense of exploration and curiosity with the tree that you’re looking at and a sense of openness. We don’t know always what’s going to happen in our unfolding moment to moment experience. It’s about having an openness to it. There might be some stress and difficult pieces going on in our life. How do we be open to that experience and to learning from that? 

Then acceptance, acceptance does not mean that we want the experience to be there or that we approve of it. It’s that we can accept it as it is in this particular moment, because we know that things are always slightly changing over and over again. Sometimes slightly, sometimes pretty big. If we use that definition, that can help us to, in a way, normalize what mindfulness really is and then therefore, use it to our advantage, because it’s a skill, it’s a trait, it’s a state. Some people have the trait of mindfulness stronger than others. It doesn’t matter, if you do or you don’t. Either way, you can build your own mindful attention better. And it’s a state, because we’re mindful for a few seconds. Phenomenological research shows that we’re only mindful on average for about five to seven seconds. 

Even these great guru meditators, they might be mindful for longer than seven seconds, but it’s not they’re mindful their whole life. Nobody on the planet is fully, perfectly mindful. We’re always dipping in and out, fading out, and unaware, and lost in our thinking, and distracting us, and then we come back. That can be really important for us to remember that there’s no perfect mindfulness.

Jill: What would you say are the benefits, particularly for somebody who is often under pressure, is having a stress response as a healthcare professional, often in situations describes themselves as under a lot of stress or stressed out is what I hear a lot from my physician clients? What does learning how to integrate mindfulness in the self-regulation of your attention and what does that do for somebody that makes it worthwhile cultivating those strengths and practicing more mindfulness?

Ryan: Yeah. I think of a physician that I was working with not too long ago, that began some mindfulness training with me. She was feeling some of the things that you were talking about. Feeling a little bit more depressed, feeling a lot of burnout, she’s been at the same hospital location for quite some time, and was just going through the motions of life, just going through the motions in her relationships and at work. She’s still doing a good job and getting that– basically, just functioning. Just existing and making the bottom line, but not really pushing forward beyond that, not really thriving. 

She under, underwent some of the work that I do connecting mindfulness and character strengths together. She began to build in the sense of what we call like a freshness or beginner’s mind. Seeing things as if we’ve not seen them before, being in, slowing her stuff down, getting more of a sense of what’s going on in her mind. We all have some sense of what’s going on in our mind, but when we’re mindful, we’re even more attentive to what’s going on with our thoughts, and the patterns, and things that might cycle us into a worry spin, or into a helplessness, or a guilt spin, or whatever it might be. For her, she was always lost in planning mode. “Okay, what’s the next thing? I saw this patient, I’m going to get these next three patients, and I got to think about this, and I got to make this phone call, and blablabla” — you can see how fast I’m talking just to represent what was going on in her mind. 

Being more mindful, again, it’s not like this perfect monk that’s just being present as much as possible. Instead, she’s she was just more aware of what was going on in her mind, able to catch going into planning mode, come back to the present moment, back to her breath. It made a big difference with her burnout. She’s continuing to still to this day, still working at the hospital, and reports feeling a lot happier, improved the relationship with her significant other and with her children. That reflects the research as well, that mindfulness is associated with better stress management, better wellbeing. When we talked in the Character Strengths Podcast, there’s this wellbeing benefit to character strengths and there’s this adversity benefit. Mindfulness is the same in that sense. Mindfulness is similar to character strengths in that it’s universal. Just like character strengths, we can turn to mindfulness at any point when we need to. All you have to do is pause, come back to your breath. 

I think of myself and going through as all of us here did, the COVID pandemic that I mean, it’s still raging in some areas, but being at home, and life being in disarray, and my kids were here, and I’m trying to work, and lots more stress, me turning to my breathing. Just finding moments, finding the moments is all it is, sometimes. It’s like in between emails, or right before a meeting, and just pausing and doing what I call the mindful pause, which is two steps, which is to pause, lot of times, I would close my eyes but not always. Step one, take three breaths. We can even do that now. We’re short circuiting our autopilot, busy body, mind wandering mind. Just feeling this inhale and feeling this exhale. 

Then step two is to ask ourselves in this little bit more clear space, “Which of my character strengths might I use right now?” It’s you asking you and then whatever strength comes up, you might use that in your thinking, in your words, in your actions. It might be kindness, it might be bravery, it might be perseverance. That practice called, the mindful pause, which can be 10 seconds long, 30 seconds long, you can make it how you like with those two steps. I would use that just simply going to the restroom. Going to the restroom and that takes me away from the busyness of everybody, doing a mindful pause before I leave the restroom and then going out. 

A lot of times when I do talk with physicians, I’ll encourage them like, “Right before you turn the doorknob of the exam room you’re about to go into, you’re about to turn the doorknob and just do a mindful pause for 5 seconds, 10 seconds, where you breathe, you catch your breath for two breaths, three breaths, then you ask, “Which of my character strengths, what do I want to make sure I’m bringing forth or what’s going to come up in me?” When I ask that question, which of my strengths might I use right now, maybe it’s just a little bit more kindness, maybe it’s a little bit of zest, and I’m not feeling too energetic, so, maybe I’m going to uplift my energy just a little bit, maybe it’s forgiveness, because I know this patient, I know they’re going to be very difficult, so, I’m going to have forgiveness right at the top my head to try to let that go. Each situation can be different. But to do that right before you turn that doorknob or something like that could be really helpful. 

Jill: Yeah, it’s really, it’s wildly helpful. In another way, I think of it and you can tell me where I’m wrong or how you’d look at it, either the same or differently is, mindfulness practice has helped me be so much less reactive and more responsive and I see that a lot with my clients as well. We have these maladaptive coping mechanisms, which is the default mode we might go into when we’re under pressure or we’re in an activated stress response. And so, to be able to do exactly what you said, change the channel, really, from that rumination place, that spinning place into a place where you’re more likely to be able to access your best self. I’m not talking about best self like A+ best or perfectionism best, but where you are at your best when your character strengths, when your values get to be taking more of a front seat.

Ryan: Well, I couldn’t agree more with the non reactive element. The main measure of mindfulness used in scientific studies, well over hundred studies, is called the Five Facet Mindfulness Questionnaire, 39 questions. It measures five facets of mindfulness from the mindfulness literature. Gathering basically, I think was four or five mindfulness tests that were out there, pulling them all together and taking the very best items of all of those already validated mindfulness tests to get an even better test. That’s what the Five Facet Mindfulness Questionnaire is. And the five facets are observing, describing, acting with awareness, non judging, and non reactive.

Observing is to be able to come back to your senses. It’s very, very easy to think of mindfulness that way as well. I hope everyone thinks about it from that two-part definition I shared. But in a practical way, it’s just, “Come back, what do you smell right now?” Feel the touch. “I’m mindful of my hands and my skin right now.” “What are the colors that I’m seeing right now and the dimensions of things?”, and “These trees are further back” So, just coming back to the senses. That’s the observing part of mindfulness. 

Then there’s the describing and we can, of course, get a little intellectual on this element of mindfulness, but it is essentially describing in details what’s going on and especially, the way this test measures that about our feelings. To describe, “What are the details of that sadness, or that joy, or that fear that you’re feeling?” So, that’s an element of mindfulness. 

Acting with awareness means that any action that you’re taking, you can bring some mindful attention to it, that self-regulation element to it. If you’re walking, walk and be present to the walking, to be present to the food you’re eating, the water that you’re sipping, the doorknob that you’re turning. 

The fourth non-judging, just as it sounds, to catch the inner self-criticism. This is more about intrapersonal than interpersonal, at least the way this test measures it. Your own inner judgment, which every one of us has a judge in ourselves, and inner critic, and we need to watch, “Does your inner critic go too far, being mean to yourself essentially, being too negative?” We want an inner critic for sure, but do you go too far with it? The non-judging element is to have a balance with that.

Then non-reactivity is to be able to catch oneself from being particularly emotional, particularly angry, frustrated, and so on to be able to handle stress with some calmness and equanimity, not that you’re not feeling rapid heart rate, but you can be present in it as a non-reactivity rather than just flying off the handle upset. I wanted to point all that out as a lead in to say that I at one point, interviewed, a few years ago, Ruth Baer. She’s the creator of that Five Facet Mindfulness Questionnaire and one of the leading mindfulness researchers on the planet. I asked her about those five facets and I can’t remember, I might have asked her what does she think is most important? She said, without a doubt, “It’s the non reactivity” out of those five. They’re all important, they all matter, they’re all part of mindfulness. It’s like, “What’s the most important character strength?” Well, they’re all important. But she said, “If you have that non reactivity element down, then the rest will probably follow with that.

Jill: Let’s talk a little bit, we talked to you in the past about character strengths and putting those in action, what a positive influence that can have on people’s lives. Let’s talk about the connection of character strengths and mindfulness, if you would.

Ryan: Hmm. Sure. it’s a, yeah, really rich and robust topic. One way to answer it is to share that there’s this program called MBSP, which stands for Mindfulness-Based Strengths Practice, which is the integration of mindfulness, the best science and practice of mindfulness, with the best science and practice of character strengths. Integrated in an eight-week manualized program. This is an evidence-based program that’s been compared head-to-head with the most popular mindfulness program, mindfulness-based stress reduction, and three published studies, and was found to be superior in all three of those studies. 

MBSP, Mindfulness-Based Strengths Practice, was superior in terms of raised wellbeing variables, workplace performance, even boosting up certain strengths, and so on. This is an example of a way to do training with mindfulness and with character strengths together. We talked about how anybody could just start to become a little bit more present, a little bit more self-regulated in any moment. I hope everybody now, wherever they are on their mindfulness journey and their character journey, they’ll up it another tick mark. But if you want to maybe make an even bigger jump or just have a deeper training for the mind and for character strengths, then you might consider taking the program, Mindfulness-Based Strengths Practice. The Via Institute offers it two times a year, lead live by me by Zoom. We have a half-day retreat, that’s part of the eight weeks and it’s taken by people across the globe. A lot of those people then go on to want to lead MBSP with their populations, but the program is about just building it in within yourself, building your own mindfulness-based strengths practice, and then if you decide to lead it, there’s lots of pathways for that, too.

Jill: Fantastic resource. Thank you. It’s been so helpful, I think, not only to understand why mindfulness matters, but some of the ways that you reminded us that it’s simpler a lot of times than we make it be and it isn’t about needing to go take a course on it or study intensely with lots of books, it’s starting today, counting your breaths for five seconds. For years, I’ve had physician clients to just work up to setting a timer for one minute and counting their breaths in the morning and just using that practice of bringing themselves back, taking one wrist and holding the other just to bring themselves back to the present moment. 

And years later, I’ll hear an email from somebody saying, “You know, that still really helps me. That simple way of just feeling air on my skin, so, I’m using my senses to come back to the present moment.” You’ve given us some really good fresh ways to think about this again and I really appreciate this conversation. 

Ryan: Absolutely. Yeah, very cool, Jill. 

Jill: Ryan Niemiec, psychologist, if you want to get more information on the work that he is so involved in at the Via Institute for Character Strengths, go to viacharacter.org. Make sure you share this conversation with colleagues, friends, anyone else you know that could benefit from more mindfulness in their life. Until next time, I’m Jill Farmer.

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