Tilting Our Homeostatic Balance for COVID-19 Prevention (Part 2): Mind-Body Practices

By Luann Fortune, PhD & Shannon McLain Sims, PhD

 Mind-body medicine can help minimize risk to COVID-19 (see Tilting Our Homeostatic Balance for COVID-19 Prevention-Part 1). Mind-body therapies and practices encompass a full spectrum of activities that promote healing and well-being.  A diverse group of procedures or techniques can be administered or taught by qualified practitioners (NIH, 2018).  Many also can be applied as self-initiated practices, sometimes with foundational training, e.g. meditation and yoga.

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Prevention.  Evidence demonstrates multiple positive effects of mind-body practices that enhance wellness.  By mitigating the stress response, beneficial outcomes range from improved management of chronic conditions (Russo & Fortune, 2016) to healthier approaches to managing stress, pain, and mental states (McGrady & Moss, 2018).  As part of a COVID-19 prevention strategy, mind-body practices used daily can strengthen immune response to resist infection by controlling inflammatory response (Alschuler et al., 2020), like reducing levels of pro-inflammatory cytokines, and also improving health markers for existing chronic conditions that appear to worsen COVID-19 symptoms.

Recovery Support:  In addition to supporting COVID-19 resistance, mind-body practices can help those who get infected.  In a clinical study just released, the mind-body practice of progressive relaxation was found to reduce anxiety and improve sleep quality in COVID-19 patients, thus aiding their recovery. While further studies are needed, current evidence indicates that various mind-body practices could support COVID-19 patients even in active stages of infection.  Yet if introduced using sound clinical standards, some practices such as guided imagery could be introduced to patients in active stages of infection using passive means.

Mind-Body Practices

 A wide range of practices come under the mind-body umbrella. Some more widely used evidence-supported practices are chunked together.  Here is a summary of the main categories.

Evidence Based Mind-body Practices for Better Health

Self-Care Practice Percentage*
Yoga 92%
Hypnosis 91%
Biofeedback 90%
Meditation 86%
Qi Gong 86%
Tai Qi 83%
Relaxation Response Training 79%
Imagery 68%

 *Percent of patients benefiting from integrative health practices who would benefit from this particular intervention. Based on Russo & Fortune (2016)

Breathing. Controlled breathing is the primary and foundational mind-body practice.  Techniques can be learned to regulate breath flow and rate.  Breath practices are rooted in ancient traditions, such as prana yoga (Kupershmidt & Barnable, 2019), and foundational to contemporary mindfulness. Specific to COVID-19 prevention, experts recommend diaphragmatic breathing, deep and slow. Conversely, once infected with COVID-19, patients should adopt shallow breathing; this allows the lung tissue time to rebuild and heal (Peper & Harvey, 2020).  Those who contract the virus outdoors might end up with a milder case, but those they infect back in their close quartered homes seem to get worse cases (Peper &Harvey, 2020).  With this in mind, it may be helpful to keep fresh air circulating indoors.

Yoga. Multiple research results show that yoga improves fatigue, balance, mood and anxiety. It also slows the aging of the brain. While strenuous exercise is contraindicated for COVID-19 infection, gentle movement and postures of yoga can support immune functions for prevention and in later stages of infection recovery (Field, 2011).

Meditation and mindfulness. A vast body of research demonstrates positive outcomes with a range of mindfulness traditions and methods.  Meditation slows brain aging, reduces stress, anxiety and depression, improves mood and mental functions.  Specific to COVID-19, mindfulness meditation can have positive impact on inflammatory markers (Black & Slavich, 2016).

Tai Chi and Qi Gong.  Both practices involve postures and gentle movements that are accompanied by practiced breathing and mental focus, accomplished while moving or stationary. Research supports positive outcomes for musculoskeletal issues, pain management, and mental health (NCCIH, 2016).  Since these practices require sufficient strength and stamina for movement, these practices are more appropriate for prevention and later stages of recovery.

Relaxation response training: Autogenics and progressive muscle relaxation (PMR) are most researched practices with slight differences. Both can be guided practices that are adopted to individual use.  Autogenics directs awareness to explore different areas of the body, while PMR focuses on relaxing specific muscles in a progressive protocol.  In a recent study, PMR improved anxiety levels and sleep in COVID-19 patients (Liu et al., 2020).

Biofeedback. Biofeedback uses visual and auditory feedback to direct involuntary body functions including heart and pulse rate, blood pressure, and muscle tension.  It can involve sophisticated monitoring equipment, but the essential skills begin with channeling breath and somatic awareness.  Biofeedback has been linked to positive outcomes in a range of conditions including reduction of migraine symptoms, reduced hypertension, improved TMJ dysfunction, improving attention, and enhanced immune function (McGrady et al., 1992).  Specific to COVID-19, the foundational breath work in biofeedback could support respiration and pulmonary recovery.

Guided imagery. Various studies have shown it to mitigate symptoms of multiple conditions.  In a recent white paper, Mau (2020) introduces a guided imagery script specific to COVID-19 patients.  Because guided imagery is accessible and highly mobile, it offers possibilities for supplementary support while in confinement and otherwise non-ambulatory.

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Conclusion

COVID-19 poses a powerful threat.  Beyond damage from infection, the fear, anxiety, and daily living disruptions can result in multiple levels of dis-ease and distress.  The stress we feel, in both mind and body, can be harmful to the immune system, resulting in countless secondary infections and conditions.

Mind-body practices can improve immunity for better resistance and potentially support recovery.  For the COVID-19 patient, these can potentially provide comfort and support and at the least, do no harm.  For the many who are resisting infection, and particularly those on the front lines under unimaginable strain, mind-body practices can help with emotional regulation and mental balance.  Adopting mind-body practices during this crisis could lead to long-term adoption of practices that have been demonstrated to improve quality of life and overall health. These same practices can promote more mindful leadership at a time when it is most needed.

 

Luann Fortune, PhD, LMT is on faculty at Saybrook University in the Department of Mind-Body Medicine, where she also coordinates the specialization in Mindful Leadership in Healthcare. Her research focuses on integrative health and wellness.

 Shannon McLain Sims, PhD holds degrees Mind-Body Medicine from Saybrook University’s College of Integrative Medicine and Health Sciences where she currently serves as a post-doctoral fellow.

 

References

Alschuler, L., Weil, A., Horwitz, R., Stamets, P., Chiasson, A. M., Crocker, R., & Maizes, V. (2020). Integrative considerations during the COVID-19 pandemic. EXPLORE, 26. https://doi.org/10.1016/j.explore.2020.03.007

Black, D. S., & Slavich, G. M. (2016). Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Annals of the New York Academy of Sciences1373(1), 13.

Field, T. (2011). Yoga clinical research review. Complementary Therapies in Clinical Practice17(1), 1-8.

Kupershmidt, S., & Barnable, T. (2019). Definition of a yoga breathing (pranayama) protocol that improves lung function. Holistic Nursing Practice33(4), 197-203.

Kupershmidt, S., & Barnable, T. (2019). Definition of a Yoga Breathing (Pranayama) Protocol That Improves Lung Function. Holistic Nursing Practice33(4), 197-203.

Liu, K., Chen, Y., Wu, D., Lin, R., Wang, Z., & Pan, L. (2020). Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complementary Therapies in Clinical Practice, 39, 101132.https://doi.org/10.1016/j.ctcp.2020.101132

Mau, F. (2020). No need for a hammer A guided imagery process for patients suffering from COVID-19. Retrieved from http://0102.nccdn.net/1_5/000/000/05f/b06/Mau-2020-No-Need-for-a-Hammer-revised-4-2-20.pdf

McGrady, A., Conran, P., Dickey, D., Garman, D., Farris, E., & Schumann-Brzezinski, C. (1992). The effects of biofeedback-assisted relaxation on cell-mediated immunity, cortisol, and white blood cell count in healthy adult subjects. Journal of Behavioral Medicine15(4), 343-354.

McGrady, A., & Moss, D. (2018). Integrative pathways: Navigating chronic illness with a mind-body-spirit approach. Springer.

National Center for Complementary and Integrative Health (NCCIH). (2016, October).  Tai chi and qi gong: In depth.Retrieved from https://www.nccih.nih.gov/health/tai-chi-and-qi-gong-in-depth

Peper, E. & Harvey, R. (2020, April 4). Reduce initial dose of the virus and optimize your immune system. Retrieved from  https://peperperspective.com/2020/04/04/can-you-reduce-the-risk-of-coronavirus-exposure-and-optimize-your-immune-system/

Russo, R., & Fortune, L. D. (2016). Six evidence-based integrative health practices to manage eight common chronic conditions and promote self-care: A review with findings inspired by a workplace wellness case study. SM Journal Community Medicine, 2(2), 1018.

 

 

 

 

 

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Tilting Our Homeostatic Balance for COVID-19 Prevention (Part 1): Mechanisms from Mind-Body Medicine

By Luann Fortune, PhD & Shannon McLain Sims, PhD, MS

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Not a person on the planet has been untouched by the COVID-19 pandemic.  In these articles (Parts 1 & 2), we explain evidence for using mind-body practices to help minimize risk to COVID-19. We also offer an extensive collection of resources in the references list.  For the discerning and inquiry reader, we provide a platform for an interdisciplinary, integrative strategy to fight COVID-19 and also come out stronger on the other side.

As of April 26, authorities had reported 2,962,915 cases globally of COVID-19 infections, with 961,969 cases confirmed in the U.S. (Johns Hopkins, 2020).  While the numbers sadly change each day, Johns Hopkins reported a total of 205,936 deaths globally, with 53,755 of those in the U.S. alone.  With limited testing, experts assume there are far greater numbers of persons infected than reported (Fitzpatrick et al., 2020).  Also, early evidence indicates many people are asymptomatic or contract sufficiently mild cases so that they do not even seek medical help.  It is still unclear whether those who have recovered from the virus develop immunity.  Scientists project that a vaccine is at least a year away (Ercolano, 2020).  With the duration and long-term impact of this outbreak so unpredictable, this situation demonstrates more than ever that our world is VUCA: volatile, uncertain, complex, and ambiguous.

While scientists and public health officials race for a cure and vaccine, it is clear that every person needs to adopt a strategy of prevention and to optimize their ability to recover.  To boost immunity and mitigate the ever-present inherent stress, myriad self-care practices can be customized and adopted to suit each individual (Fortune, 2019).  Amongst the self-care repertoire lie a spectrum of mind-body practices that are evidence based (Fortune, 2019).

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Mind-body medicine (MBM) is based on an inherent connection between mind-body-spirit, and includes practices such as mindfulness, biofeedback, and imagery. When faced with the seemingly gargantuan challenges of negotiating a COVID-19 VUCA environment, deep breathing, mediation, or yoga might seem insignificant responses.  Yet the benefits associated with mind-body practices could be exactly what we need to tilt our homeostatic balance to fortify resistance to infection and, if needed, more readily cope with an infection.  There is some growing indication that mind-body practices can support recovery in those already infected with the virus (Liu et al., 2020).  The key mechanisms appear to relate to reducing systematic inflammation and managing the stress response.

Research on Stress & Immunity

 The word stress often carries a negative connotation, but the experience of stress is a familiar and unavoidable feature of life.  Stress is a constellation of events, including a stressor (i.e., stimulus) and our perception of that stressor (i.e., the reaction on our brain), that activates the body’s natural biological reaction: the fight-or-flight response.  While short-term stress (i.e., lasting minutes or hours) is helpful, motivating, and protective, long-term stress (i.e., lasting several hours per day, week, or months) throws the body out of balance and causes unwanted inflammation, which is damaging to both the mind and body (Dhabhar, 2014; Straub & Cutolo, 2018).  As it turns out, a prolonged episode of stress will disrupt a wide variety of immune functions (Sapolsky, 2004).

But the good news is that we can reverse, or even prevent, the damage caused by chronic stress by engaging in mind-body practices.  Researchers now think they have identified the mechanisms that allow such practices to minimize the harmful effects of stress. The stress response also increases harmful pro-inflammatory cytokines.  In re-orienting our stress response, we can enhance our immune system (Dhabhar, 2014), balance our body’s production of cytokines, and be better equipped to resist COVID-19.

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Mechanisms to Fight COVID19 Using Mind-body Channels

As research continues to emerge, we are beginning to see the health effects this novel virus.  Data suggests that the major way in which the Corona Virus kills is by triggering a cytokine storm (Chen, Zhang, Ju, & He, 2020), a form of systemic inflammation that is triggered in the immune system.  In the case of COVID-19, this inflammatory response can attack the lungs and respiratory system leading to further, potentially lethal, complications (Prompetchara et al, 2020).  In most cases, this cytokine call to action is a healthy immune response, but a cytokine storm is a damaging overreaction by the immune system (Mau, 2020).

Given what we know about stress’ ability to increase harmful cytokines, one response to COVID-19 might be to use mind-body practices to help support the immune system.  Research suggests that mind-body therapies and practices can lower markers of inflammation and cytokine expression (Bower & Irwin, 2015; Creswell et al., 2016; McLain, 2019).  It is important to emphasize that such practices cannot replace conventional medical treatment.  Still, mind-body practices can prompt the body to respond in a more appropriate, balanced way.

Mind-Body Medicine for COVID-19

MBM focuses on the interactions between the mind and the body and the powerful ways in which you can participate in your own health and healing (NCCIH, 2018).  This occurs through the complex psycho-neuro-immunological system (PNI) where mind and body physiology mutually influence the whole (Litrell, 2008; Yan, 2016).  MBM remedies share a common function: they initiate a change in one realm to affect a positive change in equilibrium of the whole.  That is to say, thoughts, feelings, beliefs, and attitudes can affect and shape every aspect of our psychological and physiological functioning, and in turn, how we care for our bodies can affect how we think, feel and what we believe.  This means that we have many opportunities and can do many things to care for ourselves.

In Part 2 of “Tilting our Homeostatic Balance” we suggest specific mind-body practices to help manage the challenges of the COVID-19 pandemic.

 

Luann Fortune, PhD, LMT is on faculty at Saybrook University in the Department of Mind-Body Medicine, where she also coordinates the specialization in Mindful Leadership in Healthcare. Her research focuses on integrative health and wellness.

Shannon McLain Sims, PhD, MS holds degrees Mind-Body Medicine from Saybrook University’s College of Integrative Medicine and Health Sciences where she currently serves as a post-doctoral fellow.

 

References

Bower, J. E., & Irwin, M. R. (2016). Mind–body therapies and control of inflammatory biology: A descriptive review. Brain, Behavior, and Immunity, 51, 1-11. doi: 10.1016/j.bbi.2015.06.012

Chen, C., Zhang, X. R., Ju, Z. Y., & He, W. F. (2020). Advances in the research of cytokine storm mechanism induced by Corona Virus Disease 2019 and the corresponding immunotherapies. Zhonghua shao shang za zhi= Zhonghua shaoshang zazhi= Chinese journal of burns, 36, E005-E005.

Creswell, J. D., Taren, A. A., Lindsay, E. K., Greco, C. M., Gianaros, P. J., Fairgrieve, A., … &Ferris, J. L. (2016). Alterations in resting-state functional connectivity link mindfulness meditation with reduced interleukin-6: A randomized controlled trial. Biological Psychiatry, 80(1), 53-61. doi: 10.1016/j.biopsych.2016.01.008

Dhabhar, F. S. (2014). Effects of stress on immune function: The good, the bad, and the beautiful. Immunologic Research, 58(2-3), 193-210.

Ercolano, J. (2020, April 16).  A coronavirus vaccine is in the works – but it will not emerge overnight.  Johns Hopkins Coronavirus Resource Center.  Retrieved from https://hub.jhu.edu/2020/04/16/coronavirus-vaccine-timeline/L

Fitzpatrick, S., Przybyla, H., De Luce, D., Strickler, L., & Kaplan, A, . (2020, April 17). Coronavirus testing must double or triple before U.S. can safely reopen, experts say. NBC News. Retrieved from https://www.nbcnews.com/news/us-news/coronavirus-testing-must-double-or-triple-u-s-can-safely-n1185881

Fortune, L. (2019, September 13).  Self-care: Pursuing the ultimate path to optimal wellbeing.  UnBound. Retrieved from https://www.saybrook.edu/unbound/self-care-optimal-well-being/

Johns Hopkins University. (2020).COVID19 dashboard. Retrieved April 25, 2020, from https://coronavirus.jhu.edu/map.html

Littrell, J. (2008). The mind-body connection: not just a theory anymore. Social Work in Health Care, 46(4), 17-37.

Liu, K., Chen, Y., Wu, D., Lin, R., Wang, Z., & Pan, L. (2020). Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complementary Therapies in Clinical Practice, 39, 101132.https://doi.org/10.1016/j.ctcp.2020.101132

Mau, F. (2020). No need for a hammer A guided imagery process for patients suffering from COVID-19. Retrieved from http://0102.nccdn.net/1_5/000/000/05f/b06/Mau-2020-No-Need-for-a-Hammer-revised-4-2-20.pdf

McLain, S. (2019). The impact of mind-body skills training on medical students: A mixed-methods research study (Doctoral dissertation). Available from ProQuest Dissertations & Theses Global database. (Accession Order No. 27738770).

National Center for Complementary and Integrative Health (NCCIH). (2018, July).  Complementary, alternative, or integrative health: What’s in a name? Retrieved from https://nccih.nih.gov/health/integrative-health

Prompetchara, E., Ketloy, C., & Palaga, T. (2020). Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic. Asian Pacific Journal Allergy Immunology, 38(1), 1-9.

Sapolsky, R. M. (2004). Why zebras don’t get ulcers: The acclaimed guide to stress, stress-related diseases, and coping-now revised and updated. Holt paperbacks.

Straub, R. H., & Cutolo, M. (2018). Psychoneuroimmunology—developments in stress research. Wiener Medizinische Wochenschrift, 168(3-4), 76-84.

Yan, Q. (2016). The translation of psychoneuroimmunology into mind–body medicine. In Psychoneuroimmunology: Systems biology approaches to mind-body medicine (pp. 121-129). Cham, SZ: Springer.

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COVID-19 Self Care Coping Strategies

By Luann Fortune, PhD & Shannon McLain Sims, PhD

Self-care is vital for wellness and quality of life in normal times and has special meaning in the context of the COVID-19 pandemic. While science races to find a cure, a vaccine, and better testing, self-care has never been so important.  First and foremost, we all need to take care and precautions to minimize infection.  The Center for Disease Control provides regularly updated guidelines on reducing risk.  In addition, self-care routines can help manage the increased burden of emotional trauma and avoid burnout, especially for front line workers.  In addition to adequate sleep, a balanced diet, and various supplements and vitamins, mind-body practices to mitigate stress can be beneficial (Alschuler et al., 2020).

COVID19 self care figure

What about the role of the mind in protecting the body? Healthcare workers and the many who provide us essential services in these challenging times suffer the added burden of perpetual fight-or-flight response.  Those on the front lines need to adopt vigilance, but also stay calm. The ever-present threat of infection results in increased anxiety.  Stress and anxiety not only affect the quality of daily life, but can impact immune response and result in weariness, and eventually, burnout.  Burnout, emotional exhaustion, and empathy depletion are all related.

Previous research indicates that integrative practices can support prevention and healing.  Early research specific to COVID-19 found that mind-body practices that promote stronger immunity can reduce infection risk and promote recovery in those who become infected (Liu et al., 2020). Many mind-body practices that have already been demonstrated to support wellness can be used to manage stress and calm body-mind-spirit.

With many being forced to self-isolate, either away from family or within their own homes, options are appearing to help support a calm and relaxed state through online offerings.  Mind-body techniques and practices offer a rich tool box of in-the-moment remedies for emergency relief.  Many online resources are available to help mitigate the strain of isolation.  Even a few minutes a day spent to reverse hyper-stress can have long term effects.  Some of these are also offered live, providing the added benefit of connection and community to help deal with the disruption in social support.

One such example is a daily program provided by Saybrook University as a free public service.  The faculty of the Department of Mind-Body Medicine offer live mindfulness meditation sessions each weekday at 12:15pm ET/9:15am PT. The audio podcasts are also available at https://saybrookinsights.buzzsprout.com/  The 15 minute guided interludes are open to anyone globally and can be joined live at http://ow.ly/zfcg50yVuAt.

Hopefully, the COVID-19 pandemic crisis will soon be a chapter in our personal and collective histories. Refining our self-care practices and strategies will remain important to our continued health and well-being.  Building a bigger ensemble of mind-body practices can become one reward we carry forward.

 

References

Alschuler, L., Weil, A., Horwitz, R., Stamets, P., Chiasson, A. M., Crocker, R., & Maizes, V. (2020). Integrative considerations during the COVID-19 pandemic. EXPLORE, 26. https://doi.org/10.1016/j.explore.2020.03.007

Liu, K., Chen, Y., Wu, D., Lin, R., Wang, Z., & Pan, L. (2020). Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complementary Therapies in Clinical Practice, 39, 101132. https://doi.org/10.1016/j.ctcp.2020.101132

 

Luann Fortune, PhD, LMT is on faculty at Saybrook University in the Department of Mind-Body Medicine, where she also coordinates the specialization in Mindful Leadership in Healthcare. Her research focuses on integrative health and wellness.

Shannon McLain Sims, PhD holds degrees Mind-Body Medicine from Saybrook University’s College of Integrative Medicine and Health Sciences where she currently serves as a post-doctoral fellow.

 

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Spiritual Meditation and Health: Research published

At Saybrook University where I work and teach and research, in our Department of Mind-Body Medicine we are proud to contribute to evidence on the interconnectivity of mind-body and spirit for health and wellness.  Our latest research on meditation and health has just been published with @SpringerNature in Journal of Religion and Health (JORH).  “Spiritually focused meditation practices appear to increase the emotional, physical, and spiritual well-being of cancer survivors, which could translate into better physiological outcomes.”  Congratulations to new PhD Dr. Kanishtha Agarwal for taking the lead in this authorship and my colleagues Drs. Heintzman and Kelly for their contributions to this research and publication.  The entire peer-review article is available for all to ready via open-access. Read here: https://rdcu.be/b1KHF

Agarwal, K., Fortune, L., Heintzman, J., & Kelly, L. (2020). Spiritual experiences of long-term meditation practitioners diagnosed with breast cancer: An Interpretative Phenomenological Analysis pilot study. Journal of Religion and Health,(), 1-17. Advanced online publication. https://doi.org/10.1007/s10943-020-00995-9

 

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Mindfulness for a VUCA Healthcare World

I am cautiously optimistic and also skeptical about the McMindfulness movement (Hyland, 2017; Purser & Loy, 2013).  Critics of proliferating mindfulness training in organizations point to challenges to the ethics (Wolverman, Schwartz, & Schoenberg, 2018) and over-capitalization of the movement (Hyland, 2017).  Plus, the tips provided by popular organizational gurus (e.g., Hougaard & Carter, 2018) sometimes strike me as simplistic, e.g. offer healthy food and drinks, control digital distractions, encourage boundary setting.  Perhaps each small change is meant to be a pebble in the pond towards shifting organizational culture.  Yet none of these tactics are novel, making me wonder why they have not worked up to this point to stem the volatile, uncertain, complex and ambiguous (VUCA) tide.

I teach a course in Reflective Leadership in Mindful Leadership in Healthcare at Saybrook University.  This course is experiential in that we are all doing the Mindful Leader app (Hougaard & Carter, 2018), practicing mindfulness meditation each day in addition to textbook readings and assessing original research.  As an educator and advocate of integrative healthcare, I am committed to integrative healthcare and envision myself as a “pebble in the pond”, creating large changes with small actions (Perlman, Horrigan, Goldblatt, Maizes, & Kligler, 2014). While our Mindful Leadership curriculum focuses on integrative healthcare and mind-body medicine, we have to do this in a VUCA world, where instability is the norm in fields and settings beyond healthcare.  Perlman et al.’s (2014) called for unique leadership to lead integrative healthcare systems, where mindfulness can serve as the connector between self-awareness, self-regulation, and the educated decision making needed to succeed.  They are not alone in suggesting that mindfulness is the answer, as evidenced by the volumes of readings, conferences, and apps readily available.

I admit to a slight mistrust of the panacea of mindful leadership tactics to reform VUCA environments. Turns out that my distrust is at least organic, a reflection of typical norms in the U.S.

Globalization of Trust

According to the Organisation for Economic Co-operation and Development (OECD, n.d.), the U.S. is lower than all but one of the European countries in the survey on trust and on a downward slide.  Generalized trust has declined steadily in the U.S. from 1972 to 2014.  More strikingly, trust in U.S government institutions declined from a rating near 80% trust in 1964 to <20% respondents expressing trust in 2015 (OECD, 2017). Based on this data, the U.S. is a global leader in the diminishment of trust in our institutions.

So, what is going on in the U.S.?  Deteriorating healthcare aside, was not the late 20th century a time of great solidarity, prosperity, and innovation lead by the U.S.?   I suspect a shadow side, the metaphor of the allegory of Plato’s Cave, and possible psychodynamics at play. “Human beings have a knack for getting trapped in webs of their own creation” (Morgan, 2006, p. 207).

Psychodynamics of Organizations and Mindfulness

We remember the Socratic teaching moment drawn in an ancient cave with three prisoners. They were shackled and tied so they could only see the outside world represented in shadows cast by firelight on a wall before them (Plato, VII, 514 a, 2 to 517 a, 7).  They never saw the world outside.  When one prisoner escaped and saw the other side of the cave wall, he was at first shocked but eventually realized that his former reality was false.  He returned to the cave and told his fellow prisoners.  But when he tried to set them free, they threatened to kill him.  Some philosophers argue this allegory shows the dangers of believing empirical evidence ensures knowledge, others claim it shows that people are afraid of higher truths, and others that we are psycho-dynamically predisposed to keeping ourselves trapped (Morgan, 2006).

Mindfulness consultants Hougaard and Carter (2018) admitted that organizational change is not easy and that influencing culture “goes deeper than articulating a set of values and posting them on the wall” (p. 163).  There are multiple practical and observable obstacles to implementing wide-spread change in any organization.  In addition, even in apparently well-functioning organizations, members experience normal psychological injuries, expected and normal hurts that people feel when collaborating with others to reach organizational goals in uncertain environments (Hirschhorn, 1999).

Hirschhorn is a global leader in training organizational consultants in psychodynamic structures (CFAR, n.d.).  I consulted Hirschhorn about his opinions on the current mindfulness movement and its potential to reach to the shadows of organizational prisons.  He positioned mindfulness as a useful tool, a “framework for knowing yourself and for being attuned to the tacit dimensions of organizational life around you.  A kind of tuning in to what is below the surface in yourself and in your setting” (L. Hirschhorn, personal communication, November 12, 2019).  Hirschhorn also pointed me to his blog site and a recent psychodynamic assessment of President Trump (Hirschhorn, 2019). In his post that examines psychological traits for larger organizational manifestations, one point involves the importance of considering how the role one occupies in an organization will describe potential contributions as well as the ability to successfully influence organizational change.  So, in affecting change, we need to remember our place.  In addition, Hirschhorn highlighted the importance of an effective leader marrying basic ideas to the entourage of organizational membership.  In a reframing of this consideration, I return to the challenge of shifting values and a recent personal experience (Donaldson-Feilder, Lewis, & Yarker, 2019).

Saga of an Orthopedic Surgeon: What Can and Cannot be Changed

I recently witnessed an illustration of the personal costs of unresponsive, unmindful leadership in a healthcare organization.  I share this story with the endorsement of the physician involved.  On Thanksgiving Day, I was visiting a hospitalized friend.  Overall, in her many weeks there, I observed the hospital operation was not entirely responsive, and I knew they had no competition in this community for the level of trauma care provided.  But I had several opportunities to observe the surgeon and his staff in this setting.  I was impressed by the level of patient-centered, compassionate care they provided my friend, and her level of trust in them.  On that morning, her surgeon visited her and delivered very unfortunate news.  This news was not about her condition, which improved steadily with his expert and abundant care. Rather, he came to tell her he had quit the hospital system, no longer able to work with inconsistent, unreliable, and inexpert support.

During the next minutes, he calmly explained to us the multiple issues with the organization, and the myriad issues tied to quality patient care that he repeatedly reported to administrators.  He explained he was hampered by so many incompetent systems and unresponsive management that he could not be the effective surgeon and healer he aspired to be.  He repeatedly said he was not burned out, at least not yet, but suffered on a moral level.  I suggested to him, “moral injury” and he concurred:  that was it.  Very soon, he would be returning to his place of residency, a nationally recognized leader in integrative healthcare, to pursue his surgery practice in a more compassionate, like-minded, supportive environment.  He hoped he could someday come back, when the climate of the organization had shifted to a more patient-centered and practitioner-supporting organization and system.

But he was not optimistic about changing the embedded mindset that was generating toxicity in this large, unmalleable organization.  This demonstrates the embeddedness of resistant thinking:  replacing a physician entails hundreds of thousands of dollars cost to an organization, plus loss of quality of care, safety, and patient satisfaction.  Yet this physician was aware of the larger risks of not leaving:  costs associated with burnout are escalating each day, physician suicide incidence is over three times the national average, and the associated costs are deep due to loss of skills, care quality, and sustainability (West, Dyrbye, & Shanafelt, 2018).

I propose that one possible strategy is decentralize, to diminish the size and power of the mega-organizations to smaller, collaborative entities.  Shifting the operations off the mothership onto smaller, innovative operations could be grounded in mindful-selfless-compassionate (MSC) principles, practices, and values.  By de-centralizing control, change makers can introduce the practices touted by Hougaard and Carter (2018) and cultivate MSC cultures.  Further, this could create a fertile ground for adopting integrative medicine models and components.

In an argument I never expected to make, for-profit healthcare does have advantages:  it could benefit from innovation if it leads to improved outcomes.  This approach should ultimately make for more satisfied customers, measurable outcomes, and provide competitive edge.  As I have seen in my association with IM4US (n.d.), we can also include the under-served.

According to Hirschhorn, there will always be psychodynamics to overcome:  These can be better overcome with awareness.  There will also be nay-sayers who prefer Plato’s Cave: leaving them behind requires decisive and hard actions.  At the heart of my proposed evacuate-and-rebuilt strategy are MSC-oriented leaders able to garner support and willing to take risks.  Even my sense of mistrust is optimistic.

Perlman et al. (2014) concluded in their argument for mindful, integrative leadership that each leader and each member should do what they can in the present moment and wait until the foundational support is stronger to do more.  In the meantime, we build up each other, which we can do with MSC practices. Donaldson-Feilder, Lewis, and Yarker (2019) found that mindfulness practices enhanced the leader’s well-being, resilience, leadership capabilities, and possibly their innovation.  The analysis failed to identify which type of mindfulness practice was most effective.  Also, the researchers found little evidence of benefits to the leaders’ direct reports.  Hence, the evidence indicates the leaders should first attend to self, in whatever mode best builds individual self-efficacy.  If we are each attending to self, we need to be less worried about bringing along the other:  they will bring along themselves and also become empowered in the process.

In conclusion, I argue for continuing our individual practices and sharing with members of our organizations and communities and the people we serve.  By cultivating our awareness and also our fortitude, we are preparing for the opportunity of each moment, as it unfolds.  MSC practices are endeavors that remind us we are solitary and concurrently interconnected.  We simultaneously operate at the systems level, joined by our underlying intention to transform healthcare based on shared values.  By taking an MSC approach, we have added tools to achieve sustainable transformation, and in the process, transform ourselves.

I welcome your comments here as we all continue with this important work.

References

CFAR. (n.d.). Dynamics of Consulting.  Retrieved from https://www.dynamicsofconsulting.net

Donaldson-Feilder, E., Lewis, R., & Yarker, J. (2019). What outcomes have mindfulness and meditation interventions for managers and leaders achieved? A systematic review. European Journal of Work and Organizational Psychology28(1), 11-29.

IM4US. (n.d.).  Mission and philosophy.  Retrieved from https://im4us.org/about/mission-philosophy/

Hirschhorn, L. (1999). The workplace within: Psychodynamics of organizational life (Vol. 8). Cambridge, MA: MIT Press.

Hirschhorn, L. (2019, July 22).  Trump’s style of executive functioning. Learning from experience: Larry Hirschhorn.  Retrieved from http://learningfromexperiencelarryhirschhorn.blogspot.com

Hougaard, R., & Carter, J. (2018). The mind of the leader: How to lead yourself, your people, and your organization for extraordinary results. Boston, MA: Harvard Business Review Press.

Hyland, T. (2017). McDonaldizing spirituality: Mindfulness, education, and consumerism. Journal of Transformative Education15(4), 334-356.

Morgan, G. (2006). Exploring Plato’s Cave: Organizations as psychic prisons. In Images of organzations (pp. 207-240). Thousand Oaks, CA:  Sage.

OECD. (2019) About. Retrieved from https://www.oecd.org/about/

OECD. (2017).  Guidelines on measuring trust. Paris: OECD Publishing. http://dx.doi.org/10.1787/9789264278219-en

Perlman, A., Horrigan, B., Goldblatt, E., Maizes, V., & Kligler, B. (2014). The pebble in the pond: How integrative leadership can bring about transformation. EXPLORE: The Journal of Science and Healing10(5), S1-S14.

Plato. Allegory of the cave.  Republic, VII, 514 a, 2 to 517 a, 7. (T. Sheehan, Trans.).  Retrieved from https://web.stanford.edu/class/ihum40/cave.pdf

Purser, R., & Loy, D. (2013). Beyond mcmindfulness. Huffington post1(7), 13.

West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: contributors, consequences and solutions. Journal of internal medicine, 283(6), 516-529.

Wolever, R. Q., Schwartz, E. R., & Schoenberg, P. L. (2018). Mindfulness in corporate America: Is the Trojan Horse ethical?  The Journal of Alternative and Complementary Medicine,  24(5), 403-406.

 

 

 

 

 

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Self-Care & Mind-Body Medicine: Structure, Function, and a Thoughts of a Tattoo

Tattoo Self-care conversations are expanding as we seek strategies for advancing better wellness and transforming healthcare.  We live in increasingly challenging, divisive times and healthcare costs continue to escalate.  Drawing nurturing attention inward helps us connect daily with our humanity and corporeal presence.  It seems like almost anything can qualify as self-care.  My practice experience has taught me that each individual must find their own path to well-being.  My advocacy work has exposed me to the music of collective steps that can remodel entire systems.  Self-care energy could be animating a rhythm of hope for a better way of being human on this planet.

In theory, integrative medicine loves self-care.  This multi-disciplinary genre of healing has earned a place in our lives as well as at the Academy.  At my day job at Saybrook University, I get to teach and research a growing collection of practices that inspire and enhance self-care, from guided imagery to mindfulness.  Various techniques and therapies, captured under the umbrella of complementary and integrative healthcare, including mind-body medicine, are increasingly supported by evidence and availability.

Ever ready to share the good news of integrative medicine and self-care, I recently gave a TV interview where I was asked to summarize my views in 5 minutes or less.  Much to my surprise, I found myself stuck on the simple question, “what exactly is mind-body medicine?”.  Even though I teach and champion this subject every day, I failed to deliver a cogent message.  In order to enlighten and advocate, I needed to first define: What exactly is mind-body medicine?  (And what does a tattoo have to do with it?)

Structure

Faced with higher costs and reduced satisfaction, patients increasingly seek solutions through what was initially termed alternative medicine (Moss, 2003).  In 2015, NIH revised the lexicon and complementary-alternative medicine (CAM) became complementary and integrative health reflecting its improved acceptance into conventional healthcare systems (NCCIH, 2018).  Beginning in the 1990s and continuing to today, surveys reported use of complementary therapies and practices in majority of populations and in increasing numbers (Eisenberg et al., 1993; Eisenberg et al., 2016).  One assortment of complementary practices is labeled mind-body medicine.

Reflecting a sort of medical science colonialism, mind-body medicine is defined by its position in the prevailing healthcare delivery system, situated offsides in the realm of complementary therapies and practices.  According to NIH, mind-body interventions remain “a large and diverse group of procedures or techniques” that are administered or taught by qualified practitioners (NIH, 2018).  By logical extension, the individual can then continue to practice what they learn independently, thus perpetuating prevalence (McGrady & Moss, 2018).  But the debate over what constitutes a mind-body therapy and where it sits in healthcare’s hierarchy remains under-developed.

Function

Even in the imprecise language defining complementary therapies and practices, mind-body medicine definitions are vague.  Mind-body services and procedures are described by what they are not:  they are not typically found in primary care physicians’ medicine bag.  Researchers and clinicians, striving for a standard taxonomy, lumped together as mind-body a wide variety of interventions not otherwise connected in foundational tenets or practice conventions.  Initially, these included psychotherapy, hypnosis, biofeedback, dance and movement therapies, massage and body work, mediation and prayer, biofield therapies, and homeopathic remedies (Lake, 2003; NIH, 2018).  It seems like almost anything could qualify as mind-body medicine.

Gradually, some of these became elevated to sub-disciplines, such as psychotherapy, now a mostly reimbursable mental health treatment.  This raises the issue of legitimacy through economic valuation or demonstrated return-on-investment.  I will save this consideration for another discussion.

Mind-body medicine remedies share a common function: they initiate a change in one realm to affect a positive change in equilibrium of the whole.  Thus, our mental states can affect our physiology and susceptibility to illness.  Mind-body therapies and practices encompass a full spectrum of activities and all promote healing and well-being through the mechanisms of the psycho-neuro-immunological system (PNI) (Litrell, 2008).  Initially understood as how the mind influenced biological functions, the PNI is now seen as a complex, bi-directional system where mind and body physiology mutually influence the whole (Yan, 2016).

Changes attributed to mind-body interactions can be viewed from every crevice of physiology, behavior, and attitude.  Research now well establishes that environmentally-based perceptions are linked to illness as well as well-being.  For instance, stress impacts quality of life and is also a primary factor in cardiac conditions, the foremost global disease (Kivimäki & Steptoe, 2018).  Further, bodily generated effects influence the mind, e.g. research on the gut-brain axis links digestive microbes to mental states such as depression (Rieder, Wisniewski, Alderman, & Campbell, 2017).  Evidence abounds demonstrating positive effects of mind-body approaches (Russo & Fortune, 2016), including mitigation of pain and addiction (Hart, 2016).

Yet aside from how mind-body interventions function in healing, and plentiful examples supported by evidence, we lack a concise definition of what exactly is mind-body medicine.

Thoughts on a Tattoo

I asked a colleague who practices as a primary care physician how he defines mind-body medicine.  He referenced the PNI interactions and provided some anecdotes on related illness triggers he has witnessed.  Pressed to define mind-body medicine based on mutual interconnectivity of states and systems, we agreed that mind-body practices can refer to just about anything that one undertakes on behalf of improving their well-being.  For instance, I suggested that reading a good novel could trigger a positive PNI reaction.  He agreed and shared his own unexpected story.

By accident, he discovered that receiving a tattoo initiated for him a state of deep relaxation, with a subsequent ripple effect of improved well-being.  Recent studies have linked the practice of tattooing with non-suicidal self-injury (NSSI) behavior (Solís-Bravo et al., 2019).   Findings indicate that NSSI activities relieve tension and induce positive feelings. He was aware of research linking tattoo-ing with risk of self-injury and assured me that he did not present with such indications.  However, he was equally certain that the process of receiving a tattoo induced a deeply healing state on a physical and possibly a spiritual level:  Tattoo Medicine.

Theoretically, the experience of tattoo medicine could be a mind-body intervention.  In the anecdote provided, it sits in the structure of non-conventional approaches.  Functionally, it appears to have invoked the relaxation response and triggered PNI reactions.  In addition, the exact symbol used in the tattoo could have influenced the experience if it conveyed emotional or spiritual meaning.  Clearly, more research is indicated about the prevalence of this phenomenon and its place in the collection of mind-body medicine practices.

Implications

 When considering the possibility that tattoo practice is a mind-body intervention, perhaps defining mind-body medicine is ultimately all about intentions.  Alternatively, the mismatched components and practices now termed “mind-body” might simply be in a taxonomy holding-space, awaiting more informed and sophisticated knowledge systems to define, examine, and apply more precise terms.  If practices as apparently unconnected as tattoos and meditation can be grouped together for the greater good, what indeed is in a name.  Certainly, healthcare and well-being can use an incentive to empower uncommitted individuals to step into their own self-care path.

Based on popularity and the potential to infuse self-care with creative options, the practice and research of mind-body medicine is timely.  Proponents need to be articulate and clear about applications and relevance, even if that includes acknowledging that the definitions are still under construction.  Under any name, better tools for health and wellness are needed now.

So, scholars and practitioners can roll up our sleeves and get to work on this.  In the meantime, consider a recent statement from the World Health Organization calling for quality self-care: adopting evidence-based practices that the individual undertakes with or without the support of a healthcare professional.  Consider also how NIH recently defined mind-body medicine as large collection of procedures and techniques that are administered or taught by qualified practitioners to affect healing (NIH, 2018).   Self-care and mind-body medicine seem like a perfect match, even minus the tattoo.

References

Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F. E., Calkins, D. R., & Delbanco, T. L. (1993). Unconventional medicine in the United States: Prevalence, costs, and patterns of use. New England Journal of Medicine328(4), 246-252.

Eisenberg, D. M., Kaptchuk, T., Post, D. E., Hrbek, A. L., O’Connor, B. B., Osypiuk, K., … & Levy, D. B. (2016). Establishing an integrative medicine program within an academic health center: Essential considerations. Academic Medicine: Journal of the Association of American Medical Colleges91(9), 1223-1230.

Hart, J. (2016). Chronic pain, addiction and complementary therapies. Alternative and Complementary Therapies, 22(3), 117-119. https://doi.org/10.1089/act.2016.29058.jha

Kivimäki, M., & Steptoe, A. (2018). Effects of stress on the development and progression of cardiovascular disease. Nature Reviews Cardiology15(4), 215.

Littrell, J. (2008). The mind-body connection: not just a theory anymore. Social Work in Health Care46(4), 17-37.

Lake, J. (2003). Complementary, alternative, and integrative medicine. In D. Moss, A. McGrady, T. Davies, & I. Wickramasekera (Eds.), Handbook of mind-body medicine for primary care, (pp. 57-68). Thousand Oaks, CA: Sage.

McGrady, A., & Moss, D. (2018). Integrative pathways: Navigating chronic illness with a mind-body-spirit approach. Cham, SZ: Springer.

Moss, D. (2003).  Mind-body medicine, evidence-based medicine, clinical psychophysiology, and integrative medicine.  In D. Moss, A. McGrady, T. Davies, & I. Wickramasekera (Eds.), Handbook of mind-body medicine for primary care, (pp. 3-18). Thousand Oaks, CA: Sage.

National Center for Complementary and Integrative Health (NCCIH). (2018, July).  Complementary, alternative, or integrative health: What’s in a name? Retrieved from https://nccih.nih.gov/health/integrative-health

Rieder, R., Wisniewski, P. J., Alderman, B. L., & Campbell, S. C. (2017). Microbes and mental health: a review. Brain, behavior, and immunity66, 9-17.

Russo, R., & Fortune, L. D. (2016). Six evidence-based integrative health practices to manage eight common chronic conditions and promote self-care: A review with findings inspired by a workplace wellness case study. SM J Community Med2(2), 1018.

Solís-Bravo, M. A., Flores-Rodríguez, Y., Tapia-Guillen, L. G., Gatica-Hernández, A., Guzmán-Reséndiz, M., Salinas-Torres, L. A., … & Albores-Gallo, L. (2019). Are tattoos an indicator of severity of non-suicidal self-injury behavior in adolescents?. Psychiatry investigation16(7), 504.

World Health Organization (WHO) (2019, April 2).  Self-care can be an effective part of national health systems. Retrieved from https://www.who.int/reproductivehealth/self-care-national-health-systems/en/

Yan, Q. (2016). The translation of psychoneuroimmunology into mind–body medicine. In Psychoneuroimmunology:  Systems biology approaches to mind-body medicine (pp. 121-129). Cham, SZ: Springer.

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Self-Care: Pursuing the Ultimate Path to Optimal Well-Being

September 8, 2019

The past months I have been engaged in a lot of conversations about self-care.  I sense a self-care zeitgeist arising in communities and healthcare settings.  A spirit is gaining momentum to educate and empower individuals, strengthen communities, and also stem the tide of escalating healthcare costs.  More so, from the humanistic perspective, self-care offers each individual a path to improve their life-quality and become the best they can be.

Self-care topics beckon researchers to reframe medical science and healthcare studies. I am inspired by excellent work done by my students and colleagues along with a wider proliferation of wellness scholarship.  Translating evidence to practice demands inter-professional collaboration and interdisciplinary worldviews, appropriate to an increasing number of scholar-practitioners.  My own self-care workshops and presentations have received enthusiastic responses from healthcare professionals as well as people simply wanting more from everyday living. I see this as a further shift, moving healthcare consciousness from providing cures to promoting optimal well-being.

There is no shortage of information.  One can hardly log onto the internet without encountering news and products to improve wellness.  Myriad educational and commercial offerings flooding inboxes can lead to information overload.  Now is a good time to reflect on how the self-care movement is authentic and meaningful both personally and professionally.

Why Self-Care

Self-care is the collection of actions and attitudes intentionally taken to promote and maintain health, prevent disease, and cope with illness and disability when it occurs.  It functions at several levels: for each individual, as family, and within community.   Self-care practices can be undertaking with or without the support of a healthcare professional.  As well, I see opportunities for healthcare settings to engage in quality education.

To borrow from the World Health Organization (2019), “Just as high quality healthcare is important, high quality self-care is too.”  Quality self-care is particularly important when healthcare access is limited and, in some cases, not available.  Self-care can also be a preferred option in some situations, allowing autonomy and agency, particularly for vulnerable populations.  Self-care is equally important for healthcare providers who are experiencing burnout and lack of well-being at unprecedented rates (Kuhn & Flanagan, 2017).

Key ingredient:  An Appropriate Framework

As a practical matter, adopting a self-care model or framework is key (WHO, 2019).  Plentiful sources are ripe with self-help ideas, possibilities, and solutions, from community programs to self-help articles, from workplace wellness to wellness tourism.  The self-care explorer can easily become inundated by the latest research or practice recommendations.  From a cognitive as well as an idiosyncratic level, it makes sense to first adopt a framework that considers readiness to change, provides integration of various practices, and is rewarding (Prochaska, Redding, & Evers, 2015).  A framework that matches with individual beliefs, preferences, and understanding provides a skeletal structure to support exploring, adopting, and developing practices.

A model is a framework, based on theories and principles, that provides structure.  It allows sense-making, in terms of which practices to adopt and when.  There are various scholarly-based, thoughtful models available.  The best self-care models reach beyond monitoring exercise frequency and whole food eating. Individualization can allow for flexibility according to each individual’s biochemistry, life-style, and preferences.

Here are two models that I find helpful for practice translation as well as suggesting avenues for further research.

The 7 Sources of Health (7SOH)(SoHL7x. com) is an original framework to teach and develop self-care skills and support community health systems.  Drawing from seven sources (Life Purpose, Body, Mind, Emotions, Creativity, Community, and Environment), the model’s education component offers evidence-based practices that individuals can adopt based on their needs and preferences (Russo, & Fortune, 2016).

The Pathwaysmodel is a behavioral medicine approach that directs individuals to improve self-care through three levels of engagement: self-care and skills acquisition, use of community resources, and with professionally administered treatments.  This model is particularly compatible with complementary-integrative practices and mind-body skills, such as mindfulness, guided imagery, self-hypnosis, and biofeedback (e.g., heart rate variability training) (McGrady & Moss, 2018).

Call for Action

In addition to supporting individual self-actualization, quality self-care is a sustainability issue.  Self-care is a need for those who live in communities, who fuel organizations and businesses, and also for the professionals who address healthcare needs.  While the path to better well-being is individual, there is a broader opportunity for collaboration.  Consider becoming a self-care advocate:  because self-care adopted on a community systems level has implications for shifting the future of healthcare.

References

Kuhn, C. M., & Flanagan, E. M. (2017). Self-care as a professional imperative: physician burnout, depression, and suicide. Canadian Journal of Anesthesia/Journal canadien d’anesthésie64(2), 158-168.

McGrady, A., & Moss, D. (2018). Integrative pathways: Navigating chronic illness with a mind-body-spirit approach. Cham, SZ: Springer.

Moss, D. (2019, August 30). Self care in palliative care — Pathways model.  Retrieved from https://www.youtube.com/watch?v=MrYpTUk61_A&list=PLUakTEuPjbFDg-IbovVkI_dRwSCFCSZ3s&index=13&t=0s

Prochaska, J. O., Redding, C. A., & Evers, K. E. (2015). The transtheoretical model and stages of change. Health Behavior: Theory, Research, and Practice, 125-148. Retrieved from https://www.researchgate.net/profile/Daniel_Montano2/publication/233894824_Theory_of_reasoned_action_theory_of_planned_behavior_and_the_integrated_behavior_model/links/0a85e53b67d742bc29000000.pdf#page=135

Russo, R., & Fortune, L. D. (2016). Six evidence-based integrative health practices to manage eight common chronic conditions and promote self-care: A review with findings inspired by a workplace wellness case study. SM J Community Med2(2), 1018.

World Health Organization (WHO) (2019, April 2). Self-care can be an effective part of national health systems.  Retrieved from https://www.who.int/reproductivehealth/self-care-national-health-systems/en/

 

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Five Dissertation Tips from Game of Thrones

I am a latecomer to explore elements of popular culture.  So not surprisingly, I took on viewing the Game of Thrones in its entirety only a few weeks ago, weeks after the final episode aired.  The national conversations had mostly died off when I called up Season 1 and started at the beginning.  Initially enticed by the filming and acting, I also could converse with many who openly shared with me the plot twists and even the surprise endings far in advance.  No matter I knew the endings:  I was hooked on the quality of the productions and soon made my way through all 73 hours of fantasy, relationships, power brokering, military engagements, and heart break.

I know from social media that I was not alone in falling down this tunnel after the proverbial train had left the station.  Why so many others binged along with me is another developmental question.  In the end, I was not compelled to find deeper meanings in the plot line finishes, even where I was disappointed.  But I was haunted by naming meanings to the Game of Thrones storytelling experience and process.  Like any other carpenter who sees the need for a hammer and nail in every situation, I found lessons for my academic work in the unfolding and ending of Game of Thrones. Hence, I see lessons for my dissertation students as they forage toward their final chapter and the blessed typing of the word REFERENCES.

My Five Dissertation Tips from Game of Thrones

  1.  Avoid rush and compress at the end. If you think you can finish the last chapter off in a weekend, remember how it felt to have 10 episodes cramped into seven in the stage that was supposed to explain and make meaning of it all.  When writing and delivering your Discussion Chapter, there is no substitute for space, time, and well chosen words.
  2.  Remember your context. Do not ignore important information and questions you raised in your introductory chapters (chapters 1 and 2). Like abandoning the direwolves or the people of Meereen without explanation, it is very unsatisfying.  Likewise, you cannot discount or kill off a point or perspective you brought into the story earlier only to have it show up and save the day in the end.  It is like the Dothraki storming Kings Landing after they were all killed off earlier at Winterfell.
  3.  Hold sight of your question. You started this enormous quest with a question and a purpose. If you argue deeply for some idea and create many platitudes to elevate it, you should not kill it off without fighting just as hard to reframe it or clearly showing you had no alternative. It sinks your credibility even if you allow the fallen hypothesis to be flown off in the talons of a dragon.
  4.  Select your final comrades strategically. Choose carefully from the experts and theories that have come before as you assemble who will support you at the end. These stars should be your best and brightest, not simply the ones who had not been killed off or broken contract.  They will determine whether you even get a chance at a sequel.
  5.  No proselytizing.Above all, do not justify your ending by emotional pandering in the final statements.  You must find a better conclusion than that it was all about storytelling for the sake of the stories.

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Self-Massage: Guided Instructions for Body & Mind

Here are the instructions to follow along for the May 2 workshop on self-massage.  Consider printing it out for future reference.

The recording of this offering is now available by clicking here.

Massage Series

Neck , Shoulders, Back                                                           

  • Stretch & Shrug: Gently nod head back and forth, up and down, side to side, letting chin drop to chest and then to neutral; shrug shoulders to ears and roll shoulders.
  • Neck cradle: Place flat of hands on either side of neck, placing fingertip at base of skull.
  • Occiput circles: Find the ridge at the base of your skull (occiput). Using fingertips, press fingertips into the ridge, make circles, work outward toward the ears.
  • Stroke neck sides: Using flat of hands, stroke down sides of neck to shoulders.
  • Knead shoulders: Place hands on shoulders (same side); using fingers and palms, squeeze and knead outwards to shoulder joint. One side at a time, place hand across onto opposite shoulder, kneading across, reaching fingertips to top of scapula.
  • Glide: Place flat of hands on same side of torso and stroke down to waist. Reach down and around lower back and use fingertips to make circles along back of pelvis.
  • Hug: Bring hands and arms across front of chest and give yourself a hug.
  • Self-massage tool: Lie supine and position tennis balls tool on either side of spine at neck. Gradually roll your body over the tennis balls, working the pressure points down along either side of the spine to reach the lower back. Pause over tender spots and allow your body to release into the tennis balls.  When done, roll to one side to release tennis balls and, when ready, use your hands to slowly push up to sitting.

T-Ball tool

Hands

  • Hold: Add a few drops of oil to hands and rub together, then hold one hand with the working hand. Take a moment to notice temperature, texture, weight.
  • Spread: With pad of thumb pressing into palm and fingertips around the top of the hand, spread open the hand.
  • Finger twirls: Using thumb and forefingers, gently massage each finger from base to tip.
  • Glide fingertips between hand bones (metacarpals) on top of hand, from knuckles to wrist.
  • Palm spread: Interlace fingers of both hands and stretch outward. Relax stretch, and keeping fingers interlaced, reach working thumb into palm, making circles. Release interlock, use fingers to support top of hand, and continue pressing thumbs into palm and base of thumb pad.
  • Knead wrist area with fingers and thumbs.
  • Glide up forearm to elbow, gently circle inside and outside of elbow, and continue gliding up upper arm to shoulder.
  • Stroke underarms (armpits).
  • Brush lightly down the arm with fingertips over the forearm and off ends of fingers.

Pause, breathe, and notice how the massaged hand feels.

Repeat series on the other hand.

When done, allow both hands to rest, take a few deep breaths.

 

Foot Self Massage                                                                            

  • Position your foot in your lap or in front of you; hold with both hands.
  • Place a small amount of oil on your hands.
  • Slide, with one hand on top and the other on the bottom of foot.
  • Spread, with thumbs side-by-side into sole and fingers wrapped around top.
  • Toe twists: using thumb and forefingers, gently pull and twist from base to tip. Weave fingers between toes.
  • Thumb press into entire sole of foot, working to cover the entire surface from base of the toes to the heel.
  • Ankle circles: Using fingertips and thumbs, circle around the bones. Then hold the foot with one hand and rotate the foot around the ankle.
  • Wringing: Wrap the foot with both hands and rotate back and forth around foot.
  • Tapping: Using fingertips, tap the entire bottom of foot and then lightly brush surface.

Reflexology points can be affected. See one foot reflexology chart at https://anhs-school.com/foot-reflexology.html

Pause, breathe, and notice how the massaged foot feels.

Repeat series on the other foot.

When done, find a comfortable position, take a few deep breaths.

 

Integration: Abhyanga

  • Rub hands together and, one a time, use flat of hands and fingertips to brush down each arm.
  • Brush with fingertips down chest and torso. Tap fingertips on sternum (breastbone).
  • Flat hand brush down thighs and lower legs, front and back as you can reach.
  • Scalp massage with fingertips.
  • Rub hands together, place hands over eyes, allowing your head to gently rest on your palms.

Breathe.  Return your head to neutral, remove your hand, and take another dee

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Self-Massage:  Guided Instruction for Body & Mind- Free workshop

The recording of this offering is now available by clicking here.

 A Free 1 hr Online Workshop

Saturday, May 2 at 9:15am PT/12:15pm ET to 10:15am PT/1:15pm ET

In these challenging times, while all strive to stay well and sane, we are inevitably missing a vital source of health:  touch and massage.  This free online workshop guides participants through applying techniques on themselves or another.  The workshop leaders will lead you through massaging three areas:  Hands, feet, and shoulder/back.  This workshop is set up for full participation; no prior experience with massage is needed.  It is not necessary for attendees to share their own cameras.

Location: Via Go To Meeting ~  https://www.gotomeet.me/LuannFortune/mindfulness-meditation-moments   

Questions? Contact Luann Fortune and lfortune@saybrook.edu

* Come prepared with clean hands and by wearing comfortable clothes; have massage oil or cream on hand (you can use what you have in your kitchen); and for an optional technique, bring two tennis balls and a sock.

** Please mute your line when entering the online meeting space.  

*** We will be recording this session. By joining the session, you acknowledge you understand that the session will be recorded. 

Workshop Leaders

Luann Fortune, LMT, NCBTMB, MA, PhD is faculty at Saybrook University’s College of Integrative Medicine and Health Sciences where she teaches Mind-Body Medicine.  She has been practicing and teaching massage for almost 30 years.

Jenny DeDecker, LMT, NCBTMB, MS is a doctoral student at Saybrook University’s College of Integrative Medicine and Health Sciences.  Jenny owns and runs Full Moon Rising in Norway, MI where she practices massage and teaches yoga and meditation.

 

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Unbound for Higher Ed Seekers

I am honored to be featured in hashtagSaybrooks blog hashtagUnbound article touting our mission and accomplishments. https://lnkd.in/e9KQaCW My work in hashtagintegrativehealth care hashtagmindbodymedicine and hashtagmindfulnessatwork in healthcare leadership inspires me each day. Thank you to my colleagues and students. To cite myself, at Saybrook hashtagCIMHS “.You might discover that, when you have finished your Saybrook work, the real work begins and in the process you have changed yourself.”

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