eMindful

By Deborah Kotz

Globe Staff January 31, 2011

Quick quiz. Which leaves you feeling more content?

A. Checking items off your mental to-do list.

The latest evidence suggests that the practice of paying attention leads to anatomical changes in the brain. Healthy volunteers given MRI scans both before and after they attended weekly mindfulness classes for eight weeks experienced a 1 to 3 percent increase in their brain’s gray matter in particular areas responsible for learning, memory, and emotional regulation, according to a Massachusetts General Hospital study published last week in the journal Psychiatry Research. Two years earlier, the same researchers found that mindfulness training led to a decrease in gray matter in the brain’s amygdala, the area of the brain that perceives stress.

“We don’t yet know what these brain changes mean,’’ points out study coauthor Sara Lazar, a neuroscientist at Massachusetts General Hospital, “but the part of the brain that grew a little involves perspective taking — seeing other people’s point of view and also the big picture.’’ That’s a central tenet in mindfulness: allowing yourself to be open to new experiences. “It’s all about adopting a receptive attitude: paying attention to how things are rather than how you want them to be,’’ says Ronald Siegel, an assistant clinical professor of psychology at Harvard Medical School and author of “The Mindfulness Solution.’’

After learning to practice mindfulness years ago, Siegel says he no longer walks without noticing the movement of his body. “Walk slowly and bring the full attention to the sensations of your feet lifting, moving forward, and stepping,’’ he says while inching forward on a brick sidewalk in Cambridge on a chilly January afternoon. “Of course, thoughts will enter your mind, but the idea is to step out of the thought stream and come to the actual sensations of life.’’

By THOM SHANKER and MATT RICHTEL
Published: January 16, 2011 New York Times

When military investigators looked into an attack by American helicopters last February that left 23 Afghan civilians dead, they found that the operator of a Predator drone had failed to pass along crucial information about the makeup of a gathering crowd of villagers.

But Air Force and Army officials now say there was also an underlying cause for that mistake: information overload.

At an Air Force base in Nevada, the drone operator and his team struggled to work out what was happening in the village, where a convoy was forming. They had to monitor the drone’s video feeds while participating in dozens of instant-message and radio exchanges with intelligence analysts and troops on the ground.

There were solid reports that the group included children, but the team did not adequately focus on them amid the swirl of data — much like a cubicle worker who loses track of an important e-mail under the mounting pile. The team was under intense pressure to protect American forces nearby, and in the end it determined, incorrectly, that the villagers’ convoy posed an imminent threat, resulting in one of the worst losses of civilian lives in the war in Afghanistan.

“Information overload — an accurate description,” said one senior military officer, who was briefed on the inquiry and spoke on the condition of anonymity because the case might yet result in a court martial. The deaths would have been prevented, he said, “if we had just slowed things down and thought deliberately.”

Data is among the most potent weapons of the 21st century. Unprecedented amounts of raw information help the military determine what targets to hit and what to avoid. And drone-based sensors have given rise to a new class of wired warriors who must filter the information sea. But sometimes they are drowning.

Research shows that the kind of intense multitasking required in such situations can make it hard to tell good information from bad. The military faces a balancing act: how to help soldiers exploit masses of data without succumbing to overload.

Across the military, the data flow has surged; since the attacks of 9/11, the amount of intelligence gathered by remotely piloted drones and other surveillance technologies has risen 1,600 percent. On the ground, troops increasingly use hand-held devices to communicate, get directions and set bombing coordinates. And the screens in jets can be so packed with data that some pilots call them “drool buckets” because, they say, they can get lost staring into them.

“There is information overload at every level of the military — from the general to the soldier on the ground,” said Art Kramer, a neuroscientist and director of the Beckman Institute, a research lab at the University of Illinois.

The military has engaged researchers like Mr. Kramer to help it understand the brain’s limits and potential. Just as the military has long pushed technology forward, it is now at the forefront in figuring out how humans can cope with technology without being overwhelmed by it.

At George Mason University in Virginia, researchers measure the brain waves of study subjects as they use a simulation of the work done at the Nevada Air Force base.

On a computer screen, the subjects see a video feed from one drone and the locations of others, along with instructions on where to direct them. The subjects wear a cap with electrodes attached, measuring brain waves. As the number of drones and the pace of instructions increases, the brain shows sharp spikes in a kind of electrical activity called theta — cause for concern among the researchers.

“It’s usually an index of extreme overload,” said Raja Parasuraman, a director of the university’s human factors and applied cognition program.

As the technology allows soldiers to pull in more information, it strains their brains. And military researchers say the stress of combat makes matters worse. Some research even suggests that younger people wind up having more trouble focusing because they have grown up constantly switching their attention.

For the soldier who has been using computers and phones all his life, “multitasking might actually have negative effects,” said Michael Barnes, research psychologist at the Army Research Lab at Aberdeen, Md., citing several university studies on the subject.

In tests at a base in Orlando, Mr. Barnes’s group has found that when soldiers operate a tank while monitoring remote video feeds, they often fail to see targets right around them.

Mr. Barnes said soldiers could be trained to use new technology, “but we’re not going to improve the neurological capability.”

On the other hand, he said, the military should not shy away from improving the flow of data in combat. “It would be like saying we shouldn’t have automobiles because we have 40,000 people die on the roads each year,” he said. “The pluses of technology are too great.”

The military is trying novel approaches to helping soldiers focus. At an Army base on Oahu, Hawaii, researchers are training soldiers’ brains with a program called “mindfulness-based mind fitness training.” It asks soldiers to concentrate on a part of their body, the feeling of a foot on the floor or of sitting on a chair, and then move to another focus, like listening to the hum of the air-conditioner or passing cars.

“The whole question we’re asking is whether we can rewire the functioning of the attention system through mindfulness,” said one of the researchers, Elizabeth A. Stanley, an assistant professor of security studies at Georgetown University. Recently she received financing to bring the training to a Marine base, and preliminary results from a related pilot study she did with Amishi Jha, a neuroscientist at the University of Miami, found that it helped Marines to focus.

Even as it worries about digital overload, the Army is acknowledging that technology may be the best way to teach this new generation of soldiers — in particular, a technology that is already in their pockets. In Army basic training, new recruits can get instruction from iPhone apps on subjects as varied as first aid and military values.

As part of the updated basic training regimen, recruits are actually forced into information overload — for example, testing first aid skills while running an obstacle course.

“It’s the way this generation learns,” said Lt. Gen. Mark P. Hertling, who oversees initial training for every soldier. “It’s a multitasking generation. So if they’re multitasking and combining things, that’s the way we should be training.”

The intensity of warfare in the computer age is on display at a secret intelligence and surveillance installation at Langley Air Force Base in Virginia, a massive, heavily air-conditioned warehouse where hundreds of TVs hang from black rafters. Every day across the Air Force’s $5 billion global surveillance network, cubicle warriors review 1,000 hours of video, 1,000 high-altitude spy photos and hundreds of hours of “signals intelligence” — usually cellphone calls.

At the Langley center, officially called Distributed Common Ground System-1, heavy multitasking is a daily routine for people like Josh, a 25-year-old first lieutenant (for security reasons, the Air Force would not release his full name). For 12 hours a day, he monitors an avalanche of images on 10 overhead television screens. They deliver what Josh and his colleagues have nicknamed “Death TV” — live video streams from drones above Afghanistan showing Taliban movements, suspected insurgent safehouses and American combat units headed into battle.

As he watches, Josh uses a classified instant-messaging system showing as many as 30 different chats with commanders at the front, troops in combat and headquarters at the rear. And he is hearing the voice of a pilot at the controls of a U-2 spy plane high in the stratosphere.

“I’ll have a phone in one ear, talking to a pilot on the headset in the other ear, typing in chat at the same time and watching screens,” Josh says. “It’s intense.”

The stress lingers when the shift is over. Josh works alongside Anthony, 23, an airman first class who says his brain hurts each night, the way feet ache after a long march.

“You have so much information coming in that when you go home — how do you take that away? Sometimes I work out,” Anthony said. “Actually, one of my things is just being able to enjoy a nice bowl of cereal with almond milk. I feel the tension is just gone and I can go back again.”

Video games don’t do the trick. “I need something real,” he said.

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Aetna, Duke Integrative Medicine, eMindful Inc. and American Viniyoga Institute Conduct Randomized Controlled Studies on Potential of Therapeutic Yoga and Meditation to Reduce Stress and Improve Health-­–Initial results prompt Aetna to expand pilot in 2011 -­

HARTFORD, Conn., January 13, 2011 – Aetna (NYSE: AET) today announced that early results from randomized controlled pilot studies of two stress-reduction programs showed significant reductions in stress as compared to the control group. Aetna’s review of medical claims’ data showed a positive correlation between costs and study participants’ stress levels, suggesting potential health care costs savings could be realized by reducing stress. Additionally, health improvements were suggested in the treatment groups over controls, leading to further studies.

Aetna collaborated with eMindful Inc.’s research team headed by Ruth Q. Wolever, PhD, Director of Research at Duke Integrative Medicine, and Gary Kraftsow, MA, E-RYT 500 of the American Viniyoga Institute, to test whether mind-body approaches, such as mindfulness meditation and therapeutic yoga, can reduce stress and improve overall health. The success of both programs offers evidence that certain mind-body approaches can be an effective complement to conventional medicine, a field broadly known as Integrative Medicine.

“Helping people take control of their health is a critical step in achieving better health and reducing the cost of health care,” said Aetna President and CEO Mark Bertolini. “Stress takes a significant toll on physical and mental health. We want to understand, and also demonstrate, whether integrative medicine can offer our members options that both better suit their lifestyles and can be proven to improve their health. We will continue to build an evidence base for the mind-body approach to health.”

The American Psychological Association estimates that 43 percent of U.S. adults suffer adverse health effects from stress including reduced immunity to illness, increased risk of diabetes and weight gain. Among the Aetna study volunteers, those reporting the highest level of stress had higher medical costs, nearly $2,000 more annually, than those reporting the lowest level of stress.

“Prior evidence for effectiveness of stress-reduction programs has typically been linked to higher program doses – requiring more class time and intensity,” said Dr. Ruth Wolever, director of research at Duke Integrative Medicine and Principal Investigator on the study. “We found these new mind-body programs to produce results in about half the time of other commonly used mind-body interventions. We are highly encouraged by the effectiveness observed in these studies.” “The positive results seen in these studies offer evidence that mind-body approaches to health improvement are an effective and targeted solution for employers who want to lower the costs associated with stress and help their employees achieve better overall health,” said Kyra Bobinet, MD, MPH, medical director of Health and Wellness Innovation at Aetna, and clinical director of the study. “Furthermore, the studies showed that online classes and in-person delivery showed equivalent results, and both had high engagement rates among participants. This finding is particularly important as it will enable the program to be offered to customers with employees in multiple locations and among different organizational levels.”

Research study

In 2010, 239 Aetna employees who volunteered to participate in a mind-body stress reduction program had access to a pilot that offered complementary therapies focused on mindfulness meditation and yoga. As part of the studies, 96 employees were assigned to mindfulness-based classes, 90 were assigned to therapeutic yoga classes and 53 were assigned as the control group.

The 12-week mindfulness meditation-based online program was developed and offered by eMindful. Participants interacted using video, audio and instant messaging chat or in-person instruction. Expert instructors from eMindful helped participants learn self-care, with the objective of improving overall health and energy levels. Participants also learned stress reduction techniques, more effective management of work load and better ways to prioritize tasks to increase efficiency and effectiveness.

The second group of Aetna employees participated in a 12-week therapeutic yoga-based program developed by American Viniyoga Institute founder Gary Kraftsow. Participants received instruction for managing stress including physical yoga postures, breathing techniques, guided relaxation and mental skills. The yoga classes helped relieve muscle tension in the back, neck and shoulders, improve sleep and increase feelings of well­being. The classes also provided coping strategies for dealing with stressful events and promoted use of home and office strategies for reducing stress through yoga. The program offered weekly in-person classes, home practice handouts and yoga break handouts for home and office use.

“According to the National Institutes of Health, 40 percent of Americans use alternative health therapies and, among these, mind-body techniques have shown the greatest increase in adoption over the past few years,” said Elease Wright, head of Human Resources at Aetna. “We are seeing the benefits first-hand here at Aetna. We offer programs and services that balance the focus between the physical aspects of health, as well as the mind and emotions.” Aetna will expand the research studies to more Aetna employees, and pilot the mind-body programs with select employers this year. Full results from the pilot program will be available later this year.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 35.4 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com. To learn more about Aetna’s innovative online tools, visit www.aetnatools.com.

About eMindful

eMindful, Inc. (www.eMindful.com) is the nation’s leading evidence-based provider of live, online mind-body wellness programs. Its courses are lead by highly credentialed instructors who deliver engaging curriculums in a virtual classroom to participants around the world. With the ability of participants and instructors to interact with each other in a real-time format the resultant experience produces an effective and efficient means of learning. eMindful, Inc. is based in Vero Beach, FL and has support facilities throughout the United States.

About Duke Integrative Medicine

Duke Integrative Medicine is a gateway to patients’ optimal health and healing, a portal to the vast spectrum of scientific advances at Duke Medicine, and an open door to the innate healing power held within each person. The focus of care is on individual patients and how cutting-edge medical research and the powerful impact of their knowledge, choices and spirit can transform their health and healing. Duke Integrative Medicine guides patients through the complexity of modern medicine to unleash their individual power for optimal health. Experts partner with patients –providing treatments, resources, time and support –so they can address and plan for all their health needs and goals

About American Viniyoga Institute

American Viniyoga Institute (AVI) is an organization of yoga practitioners and professionals sharing core values, guided by the teachings of Viniyoga, and dedicated to offering quality experiential educational and professional training opportunities in the fields of health and fitness, therapy and self-care and personal transformation. AVI (www.viniyoga.com) is a leader in the United States in training advanced-level Viniyoga teachers and yoga therapists.

There is solid evidence that mindfulness therapy, which combines elements of Buddhism and yoga, can relieve anxiety and improve mood.

January 08, 2011|By Chris Woolston, Special to the Los Angeles Times

“Mindfulness has become a buzzword, especially with younger therapists,” said Stefan Hofmann, a professor of psychology at Boston University’s Center for Anxiety and Related Disorders.

Mindfulness therapy encourages patients to focus on their breathing and their body, to notice but not judge their thoughts and to generally live in the moment. It may sound a bit squishy and New Agey to some, but Hofmann and other experts say mindfulness has something that discredited theories of the past never had: solid evidence that it can help.

“I was skeptical at first.” Hofmann said. “I wondered, ‘Why on Earth should this work?’ But it seems to work quite well.”

Hofmann and colleagues burnished the scientific credentials of mindfulness therapy with a review article in the April issue of the Journal of Consulting and Clinical Psychology. After combining results of 39 previous studies involving 1,140 patients, the researchers concluded that mindfulness therapy was effective for relieving anxiety and improving mood.

The treatment seemed to help ease the mental stress of people recovering from cancer and other serious illnesses, but it had the strongest benefits for people diagnosed with mood disorders, including generalized anxiety disorder and recurring depression.

Jordan Elliott, a 26-year-old marketer for a New York publishing company, said mindfulness training had helped pushed his once-disabling anxiety — about work, the weather, the meaning of life — into the background. “The anxiety is still there, but it’s not as bad as it was,” he said.

Elliott started getting one-on-one therapy four years ago at the American Institute for Cognitive Therapy in New York. It was hard at first, partly because he was skeptical of the technique and partly because he didn’t feel particularly mindful. “I was such a nervous wreck I could hardly sit still for three minutes,” he said.

Now he starts every day with a 10-minute meditation. He sits cross-legged in his apartment, TV and music off, and thinks about his breathing.

“When a negative thought pops off in my head, I say to myself, ‘There’s a thought. And feelings aren’t facts.’ ”

Elliott said he was taking Prozac before he started mindfulness therapy, but he no longer needed medication to keep his anxiety under control.

“It’s pretty clear that people can improve their health if they can encourage this practice in their lives,” said David Fresco, an associate professor of psychology at Kent State University in Ohio. “But we have to be careful not to move beyond the data too quickly.”

Fresco warns that mindfulness treatment is unlikely to help someone suffering from severe and ongoing depression. Those patients, he said, need a more active approach to recovery, perhaps including antidepressants and cognitive behavioral therapy, a type of counseling that encourages patients to question the validity of their negative thoughts.

Once recovery from depression begins, however, mindfulness therapy could provide a valuable defense against future episodes, said Zindel Segal, a professor of psychiatry at the University of Toronto who was one of the pioneers behind mindfulness-based cognitive therapy, or MBCT, a treatment that combines mindfulness with cognitive behavioral therapy.

In December, Segal and colleagues published a study in the Archives of General Psychiatry suggesting that the treatment was as effective as antidepressants for preventing relapses of depression.

The study involved 84 patients who had recovered from at least two bouts of major depression. The patients were broken up into three groups: One had eight weekly group sessions of the therapy, one took an antidepressant and one took a placebo. Over 18 months, about 70% of patients taking a placebo suffered at least one more episode of depression. By comparison, only about 30% of patients receiving therapy or taking an antidepressant had a setback.

Segal said mindfulness therapy could help patients avoid rumination, the process of endlessly chewing on incidents from the past. Rumination is a driving force behind depression, he said, and it just doesn’t mesh with mindful thinking. He also believes that by encouraging patients to focus on their current thoughts, mindfulness can discourage anxiety and worry — up to a point.

“If you’re having panic attacks in the mall, mindfulness therapy on its own isn’t going to be enough,” he said.

Segal adds that mindfulness treatment changes the relationship people have with their emotions, so much so that shifts in brain activity even show up in magnetic resonance imaging tests.

“When your mind has a thought, such as, ‘My colleague just insulted me at the office,’ you can explore the consequences of that thought,” he said. “Thoughts have a less intense grip because you are an observer.”

Hofmann said most patients could pick up mindfulness fairly easily, but it’s not for everyone.

“It takes quite a bit of intelligence,” he said. “It’s good for people who like intellectual stimulation.”

In addition, children, older people (who tend to be more set in their ways) and rigid thinkers may have trouble understanding or embracing the treatment, he said.

Hofmann hopes that the ongoing flood of mindfulness studies will help clarify the benefits and limitations of the approach and ultimately shape the way that the therapy is offered in the real world.

“Some therapists embrace these new and sexy treatments without a lot of critical thinking because they sound cool,” he said.

health@latimes.com

By LINDSEY TANNER,  AP Medical Writer – Mon Apr 26, 6:26 PM PDT

Four common bad habits combined — smoking, drinking too much, inactivity and poor diet — can age you by 12 years, sobering new research suggests. The findings are from a study that tracked nearly 5,000 British adults for 20 years, and they highlight yet another reason to adopt a healthier lifestyle.

Overall, 314 people studied had all four unhealthy behaviors. Among them, 91 died during the study, or 29 percent. Among the 387 healthiest people with none of the four habits, only 32 died, or about 8 percent.

The risky behaviors were: smoking tobacco; downing more than three alcoholic drinks per day for men and more than two daily for women; getting less than two hours of physical activity per week; and eating fruits and vegetables fewer than three times daily.

These habits combined substantially increased the risk of death and made people who engaged in them seem 12 years older than people in the healthiest group, said lead researcher Elisabeth Kvaavik of the University of Oslo.

The study appears in Archives of Internal Medicine.

The healthiest group included never-smokers and those who had quit; teetotalers, women who had fewer than two drinks daily and men who had fewer than three; those who got at least two hours of physical activity weekly; and those who ate fruits and vegetables at least three times daily.

“You don’t need to be extreme” to be in the healthy category, Kvaavik said. “These behaviors add up, so together it’s quite good. It should be possible for most people to manage to do it.”

For example, one carrot, one apple and a glass of orange juice would suffice for the fruit and vegetable cutoffs in the study, Kvaavik said, noting that the amounts are pretty modest and less strict than many guidelines.

Study participants were 4,886 British adults aged 18 and older, or 44 years old on average. They were randomly selected from participants in a separate nationwide British health survey. Study subjects were asked about various lifestyle habits only once, a potential limitation, but Kvaavik said those habits tend to be fairly stable in adulthood.

Death certificates were checked for the next 20 years. The most common causes of death included heart disease and cancer, both related to unhealthy lifestyles.

Kvaavik said her results are applicable to other westernized nations. June Stevens, a University of North Carolina public health researcher, said the results are in line with previous studies that examined the combined effects of health-related habits on longevity. The findings don’t mean that everyone who maintains a healthy lifestyle will live longer than those who don’t, but it will increase the odds, Stevens said.

Too much body fat linked to wide range of the disease, researchers say

One night during my training, long after all the other doctors had fled the hospital, I found a senior surgeon still on the wards working on a patient note. He was a surgeon with extraordinary skill, a doctor of few words whose folksy quips had become the stuff of department legend. “I’m sorry you’re still stuck here,” I said, walking up to him.

He looked up from the chart. “I’m not working tomorrow, so I’m just fine.”

I had just reviewed the next day’s operating room schedule and knew he had a full day of cases. I began to contradict him, but he held his hand up to stop me.

“Time in the O.R.,” he said with a broad grin, “is not work; it’s play.”

For several years my peers and I relished anecdotes like this one because we believed we knew exactly what our mentor had meant. All of us had had the experience of “disappearing” into the meditative world of a procedure and re-emerging not exhausted, but refreshed. The ritual ablutions by the scrub sink washed away the bacteria clinging to our skin and the endless paperwork threatening to choke our enthusiasm. A single rhythmic cardiac monitor replaced the relentless calls of our beepers; and nothing would matter during the long operations except the patient under our knife.

We had entered “the zone.” We were focused on nothing else but our patients and that moment.

But my more recent conversations with surgical colleagues and physicians from other specialties have had a distinctly different timbre. While we continue to deal with many of the same pressures that my mentor dealt with — decreasing autonomy, increasing administrative requirements, less control over our practice environment — the demands on our attention have gone, well, viral.

Extreme multitasking has invaded the patient-doctor relationship.

Now, along with the piles of forms to fill and blinking lights of phone calls on hold, are threads of text messages, columns of e-mails and lists of electronic medical record alerts to attend to. In this ever-widening sea of distractions, all that once gave meaning to our work and allowed us to enter the zone — the operations, the diagnostic saves, the lifetime relationships — have turned quaintly insufficient.

As one surgical colleague confided, “I still like operating, but it’s not enough. There are so many hassles it’s hardly worth practicing.”

Or as another doctor said to me recently while simultaneously typing an electronic medical record note, checking e-mail and holding a phone to his ear, “It used to never bother me to put in extra time at work. But I cannot do that anymore.”

The time pressures and demands that drive this endless multitasking and loss of focus on patients have contributed to high rates of burnout among physicians. Depending on the study, anywhere from one out of every three to more than half of all doctors is suffering from burnout, with potentially devastating clinical implications. Doctors who are burned out are more likely to depersonalize their patients and treat them as objects rather than as individuals suffering from disease. They are less professional, exhibit less empathy and are more prone to making errors. And these physicians are also more likely to become depressed, commit suicide and leave a profession that is already facing severe shortages in specialties like primary care.

As with most other occupations and aspects of our lives, it is probably impossible to hold back the rising tide of demands on our attention. But within the clinics, the wards and the operating rooms, is there a way for physicians to do all their work and maintain their focus on the patient in front of them, without accelerating the rate of burnout?

It turns out that working and living in the zone, not just getting into it on occasion, may be one solution.

Last month, The Journal of the American Medical Association published the results of a study examining the effects of a year-long course for primary care physicians on mindfulness, that ability to be in the zone and present in the moment purposefully and without judgment. Seventy physicians enrolled and participated in the four components of the course — mindfulness meditation; writing sessions; discussions; and lectures on topics like managing conflict, setting boundaries and self-care.

The effects of the sessions were dramatic. The participating doctors became more mindful, less burned out and less emotionally exhausted. But two additional findings surprised the investigators. Several of the improvements persisted even after the yearlong course ended. And, those changes correlated with a significant increase in attributes that contribute to patient-centered care, such as empathy and valuing the psychosocial factors that might affect a patient’s illness experience.

I asked Dr. Michael S. Krasner, lead author of the study and an associate professor of clinical medicine at the University of Rochester, about mindfulness and its effects on physician burnout and the patient-doctor relationship.

“We all use mindfulness at some point,” Dr. Krasner said. “It’s not something that you go out and get, but it’s something you can cultivate.” Some examples of mindfulness in everyday life include nursing a baby, attending to a young child in distress or, for surgeons, being engrossed in an operation. “Mindfulness allows us to be in a whole host of situations with a sense of equanimity. We don’t get sucked into how charged an experience is but are simply having that experience.”

While many physicians try to be present for their patients, “there are so many other distractions and traps that pull us away,” Dr. Krasner observed. Those distractions can make practicing mindfulness particularly difficult. “It’s one thing to sit and be comfortable with oneself. But trying to be mindful in a busy clinical practice can be really challenging.”

Over time, the persistent distractions of such a practice can lead to burnout. For many of the study participants, “they barely recognized certain experiences as either powerful or challenging before they moved to the next experience,” Dr. Krasner noted. The word “silo” came up again and again during the course, and the physicians recounted how they “kept their nose to the grindstone” and rarely reflected on their work. “It becomes easy to look at our patients as objects,” Dr. Krasner said, “rather than appreciating the meaning and joy of an experience, even if that experience is difficult. But lack of meaning goes hand in hand with ineffectiveness and a lack of well-being as a physician.”

Acquiring the ability to be mindful in the most challenging circumstances can do more than improve a physician’s well-being; it can also sharpen clinical skills. “If something goes wrong and you fail to notice,” said Dr. Krasner, “you end up going down one path in your care. But if you fully accept these challenges — not resign yourself to them but fully accept them — you can see more clearly and proceed down a path where you have a better chance of success.”

Dr. Krasner acknowledges that courses like his may not be helpful for every doctor. “There are people who aren’t going to be interested because it may seem different, even a little frightening, to get together with colleagues and be silent for a while, then talk about these things with one another.” Instead, he proposes offering physicians in the future a “menu of options” to choose from to help prevent burnout. “But I think mindfulness should be among the menu of educational interventions that are evidence-based.”

“Patients know when their doctors are or are not present,” Dr. Krasner said. “As a practitioner, I know when I’m really there for my patients and when other things are pulling me away and I’m not.” It seems fitting then that physicians, who are constantly asking their patients to be mindful — asking them to talk about how they feel — should also be able to do so themselves.

“One of the most wonderful things about practicing medicine,” Dr. Krasner said, “is that you have the opportunity to be in the middle of challenging events. Reflecting on those events while also holding them in your thoughts has to do with not only physician well-being but also patient healing.”

“If we can be mindful in the midst of those challenging circumstances,” Dr. Krasner reflected, “we can derive a greater sense of meaning from even the most demanding situations.”

Jacksonville Business Journal
by Kimberly Morrison

Ken Jacobs wasn’t looking for a ticket to nirvana when he embarked on a journey into the ancient spiritual tradition of yoga.

As a partner at Gray Robinson PA, long hours and high stress had begun to take a toll on his body. He took to running for relief from tension in his neck, shoulders and back, but instead ended up with knee pain and shin splints.

Like a good attorney, he switched strategies and headed for a yoga class at his gym. Three years later, he and a dozen other attorneys at his firm were practicing yoga together on a hotel lawn to get focused before an intense year-end law firm meeting.

Among the 16 million Americans practicing yoga, they represent a new class of yogis. They are neither the obnoxious yoga yuppie breed sporting $98 Lululemon yogawear, nor the incense-burning, Maharishi-loving hippie in search of enlightenment. These overworked corporate types are finding a practical application for yoga in their work life: balance.

Stress at Work and at Home Takes a Toll on Your Physical Health

Every year, millions of workers suffer disabling injuries and thousands lose their lives to work-related stress.

In the movie “Network,” a stressed out news anchor loses it on live television, “I’m as mad as hell, and I’m not going to take this anymore,” he screams as he storms off set.

Other movies feature employees crashing computers and bashing fax machines.

But are these examples of art imitating life?

Three-quarters of Americans in a new study say they experience nerve-racking moments at work — though few people are aware that those hostile job conditions can be deadly.

“Repeated exposure to workplace stress can definitely increase the risk of a heart attack, death or stroke,” said Dr. Pk Shah, director of cardiology at the Cedar Sinai Medical Center.

The Journal of American Medical Association study, whose results were published on Oct. 10, found people who return to a stressful job after recovering from a heart attack are twice as likely than those without stress to experience another one.

“This should be a wake up call not only for patients,” Shah said, “but also for employers, because employers should recognize that chronic exposure can have a very adverse effect on their employees’ health.”

Inner city high school teachers, police officers, miners and air traffic controllers are among those with the most stressful jobs in America, according to Health magazine.

“Four controllers that I have known over the years I’ve have been at O’Hare have died of a heart attack,” former air traffic controller Bob Richards said. “And you say, ‘Well, people die; that happens. Let me give you the ages — 29, 30, 38, 39. Now if that’s normal, then I must be missing something.”

And if someone thinks they can escape the stresses of work by going home, they should think again. A second study of 4,000 men and women published in the journal Psychosomatic Medicine said how someone argues with a spouse could also affect their heart.

Women who don’t speak their minds are four times more likely to die than those who do.

“One of the biggest coping mechanisms is not keeping your feelings bottled up,” ABC News workplace contributor Tory Johnson said. “By not venting by not making their feelings known whether it’s at home or work they are at greater risk for stress and all kinds of physical and mental illness.

ABC’s Andrea Canning contributed to this report.

COLUMBUS, Ohio – A new study here shows that even slight stress and anxiety can substantially worsen a person’s allergic reaction to some routine allergens.

Moreover, the added impact of stress and anxiety seem to linger, causing the second day of a stressed person’s allergy attack to be much worse.

Janice Kiecolt-Glaser

Ronald Glaser

The finding, the latest in more than three decades of study on stress and immunity, is important since allergic reactions are the fifth-most-common chronic disease in America, and medical costs to treat them can reach $3.4 billion each year.

In a report presented today (8/14) at the annual meeting of the American Psychological Association in Boston, Ohio State University researchers described recent experiments meant to gauge how psychological stress might affect allergy sufferers.

“Allergies are not minor problems,” explained Jan Kiecolt-Glaser, a professor of psychology and psychiatry at Ohio State.  “A huge number of people suffer from allergies and, while hay fever, for example, is generally not life-threatening, allergy sufferers often also have asthma which can be deadly.”

Some data suggest that 38 percent of the people who suffer from allergic rhinitis also have asthma, and that 78 percent of asthma sufferers have allergic rhinitis.

Kiecolt-Glaser and Ronald Glaser, professor of molecular virology, immunology and medical genetics at Ohio State, recruited 28 men and women.  All of the volunteers had a history of hay fever and seasonal allergies.

The volunteers spent two half-days in a research unit at the Ohio State University Medical Center.  Each time, they were given the standard skin prick test several times to determine their reactions to various allergens, and blood, saliva and serum samples were taken before, after and at several times during the research project.

All of the participants were given a battery of psychological questionnaires to determine their levels of stress, anxiety, self-confidence and feelings of control over situations.

On the day that individuals were assigned to the low-stress control condition, they were given the skin prick test and then asked to read from a magazine.  Then they were asked to tape themselves reading the same material aloud.

During the day that people were assigned to the experimental condition, however, they had a much tougher time.

“We used a ‘speech stressor test’ used in a lot of psychology research,” Kiecolt-Glaser said.

“Basically the participants each appeared before a panel of several ‘evaluators’ who supposedly were behavioral experts.  Participants had to give a 10-minute speech, which was videotaped, and then are asked a series of math questions they had to solve without paper or pen.”

Afterwards, they had to watch their videotaped performance.

“The whole exercise is a nice stress experiment in the laboratory,” she said.

The researchers measured the raised “wheals” that formed on the arms of the participants before and after they were stressed, as well as the next day.

“The wheals on a person who was moderately anxious because of the experiment were 75 percent larger after the experiment, compared to that same person’s response on the day when they were not stressed,” Kiecolt-Glaser said, signifying a stronger reaction.

“But people who were highly anxious had wheals that were twice as big after they were stressed compared to their response when they were not stressed.  Moreover, these same people were four times more likely to have a stronger reaction to the skin test one day later after the stress,” she said.

This next-day change – labeled a “late-phase reaction” – is important because it signals an ongoing and strengthening response to the allergens, and even suggests that sufferers may react strongly to other stimuli that previously hadn’t caused them to develop an allergic reaction.

Gailen Marshall, a co-investigator on the project and professor of medicine and pediatrics at the University of Mississippi, said that late phase, or delayed, reactions are typically unresponsive to the most common forms of allergy treatment, such as antihistimines.

“Late phase reactions also occur in allergic asthma and can, in the proper settings, be potentially life-threatening.

“The results of this study should alert practitioners and patients alike to the adverse effects of stress on allergic reactions in the nose, chest, skin and other organs that may seemingly resolve within a few minutes to hours after starting, but may reappear the nest day when least expected,” he said.

Partner Ronald Glaser, director of the University’s Institute for Behavioral Medicine Research, said that they stimulated cells taken from study participants and then measured the levels of cytokines like interleukin-6 (IL-6) that the cells produced.

Lymphocytes taken from participants during the study showed increased levels of cytokines like IL-6.  High levels of IL-6 are part of the allergic response to an allergen, Glaser said.  The researchers also measured levels of stress hormones called catecholamines and they were elevated as well.

He suggests that the raised levels of these compounds are to blame for the residual effects seen in the late-phase reaction.

“What’s interesting about this is that it shows that being stressed can cause a person’s allergies to worsen the next day,” she explained.

“This is clinically important for patients since most of what we do to treat allergies is to take antihistimines to control the symptoms – runny nose, watery, itchy eyes, and congestion.

“Antihistimines don’t deal with those symptoms on the next day.
People may be setting themselves up to have more persistent problems by being stressed and anxious when allergy attacks begin,” Kiecolt-Glaser said.

The researchers estimate that Americans pay $2.3 billion for allergy medications each year and $1.1 billion for doctor visits to treat allergy attacks.  Those amounts don’t include approximately 3.5 million workdays lost as well.

Working along with Kiecolt-Glaser, Glaser and Marshall on the project were William Malarkey, professor of internal medicine; Stanley Lemeshow, professor and dean of public health; Kathi Heffner from Ohio University; Kyle Porter, Cathie Atkinson and Byron Laskowski, all from Ohio State.

The research was supported in part by the National Institutes of Health.