The Power of Mindfulness and Compassion

The Mindfulness Revolution

When it comes to healthcare and well-being, we like to know that what is being prescribed has been tested and that there is evidence that suggests effectiveness. In recent years, we have seen a steep rise in the research pointing to mindfulness and compassion as reliable ways for healthcare providers to improve their resilience, performance, relationships, and well-being. According to the American Mindfulness Research Association, the number of mindfulness studies published in journals rose from 10 in the year 2000 to nearly 700 in 2016. Our understanding is expanding rapidly, yet the field is still just emerging.

When people ask me what I do for a living and I say that I teach mindfulness, they usually respond with “I’d like to practice mindfulness but I’m so busy I can’t find the time.” Or “I tried meditating a few times but my mind would not stop racing.” Most people think mindfulness is something to add to an already full schedule, a special skill that only a few people can learn, or something that only works for people who have a baseline personality of being calm.

Instead, practicing mindfulness is about learning, bit by bit, how to train your attention to stay in the present instead of ruminating over the past or worrying about the future. The more you practice, the more mindful you become, and the more vividly you see the world as you tune into the moment at hand. In time, you cultivate a different way of being that is more focused, aware, and compassionate.

As you practice mindfulness, you’ll start to notice shifts: from being on autopilot, distracted, uneasy, and worried about the past or the future, to being alert, open, and tuned into the present; from being reactive in difficult moments to being able to take a breath and respond with equanimity and grace; from being lost in thought and judging how things and people should be to seeing things as they are with a clear, open friendliness. You put down your ruler of comparison or expectation and learn acceptance and skillful action.

Meditation or Mindfulness?

Meditation is to mindfulness as physical exercise is to fitness. Meditation is a body of mental training exercises—and there are many—that are designed to develop skills, strengthen your mind, and produce immediate states and long-term traits. A meditation session unfolds over a set time to produce an enhanced mental state. It starts with the intention of the meditator: I want to calm my mind and body; I want to open my heart toward this patient; I intend to empathize with my colleague and try and see his perspective. Over time, states become traits as the effects of neuroplasticity take shape. You hardwire your brain for well-being.

The Science of Mindfulness

In the book Altered Traits, Daniel Goleman and Richard Davidson share scientific confirmation that sustained practice can bring about enduring changes in brain function as well as observable transformation in behavior that stretches former ideas on human possibility.(1)

What You Practice Grows Stronger

We know that the brain is highly trainable. You can change your mental patterns through repeated practice of new mindsets and habits—a concept called neuroplasticity. Through the repetition of mental practices, such as mindful breathing meditation and compassion training, you can strengthen the areas of the brain associated with self-awareness, attentional control, emotional regulation, and compassion.

The science is compelling. A study from the University of California, Santa Barbara, showed that only eight minutes of mindfulness practice improved concentration and reduced mind-wandering.(2) Researchers found that mindfulness has a substantial effect on working memory, which helps us store and use data to make sound decisions in a timely manner, and students who participated in a two-week mindfulness program increased their scores on the Graduate Record Examinations (GRE) by 30%.(3,4) Other studies have found that meditators lose less gray matter over time compared with non-meditators, and that meditation may reduce the cognitive decline associated with aging.(5) Meditation has been shown to alter gene expression,(6) lower the body’s inflammatory response to disease and other stressors,(7) and lengthen telomeres, a marker for longevity of life.(8) Brewer and his team at the University of Massachusetts Medical School,(9) as well as research by Yu Tang,(10) suggest powerful findings regarding how mindfulness can undercut addiction. Solid results are emerging in the study of compassion, an area especially significant for countering the effects of empathic fatigue, stress, and burnout that are rampant in healthcare.(11)

Compassion as the Prescription

It might seem counterintuitive that compassion—attending to the suffering of another with the wish that the suffering be relieved—has measurable benefits for caregivers, not just for patients. Brain-imaging research by Singer at the Max Planck Institute suggests that compassion training increases your ability to be with other people’s suffering, helping you to help others without paying the cost yourself.(11) When you authentically connect with another person who is suffering, which takes courage and even vulnerability, you connect with the place in yourself that knows suffering. Your attention shifts away from yourself (I’m so stressed) toward focusing on others (What would best serve here?). This is highly correlated with well-being. According to Davidson, compassion training, such as loving-kindness meditation (discussed in a later section), can produce effects in as little as eight days to two weeks of practice. Brain scans after two weeks of training showed increased activity in circuits for attention, perspective taking, and positive feelings. Similar findings at Stanford University’s Center for Compassion and Altruistic Research and the Max Planck Institute show that compassion training yield a focus on others, perceived similarity, prosocial behavior, feelings of connection, closeness to strangers, and an increase in positive emotions.(12) Mindfulness is the first step in empathy and compassion—it all starts with being present to what is happening with openness instead of judgment.

Ironically, usually it is not being compassionate that creates burnout and fatigue for healthcare providers—it is the opposite. It is what gets in the way of being present and compassionate that leads to reduced well-being, burnout, and lower patient care.

So What Does Get in the Way of Being Present with Compassion?

Some suggest that a mindset gets instilled as early as medical school that providers need to keep an emotional distance from patients, creating a protective barrier against getting too close, or they will experience emotional contagion, the experience of getting caught up in the emotions of another. There is an assumption that hardening their hearts and keeping suffering at an arm’s length might provide a shield against the suffering of others, in turn reducing their own suffering. As Singer has pointed out, the opposite is closer to the truth.

When we are under pressure, we reduce our capacity to be skillful, wise, and caring.

In addition to mindsets and assumptions, when we are under pressure, we reduce our capacity to be skillful, wise, and caring. When we get activated by difficult situations or people, we trigger the physical and emotional aspects of the stress response—our system floods with cortisol and adrenaline, we contract our bodies, withdraw from others, disconnect, and ruminate on our favorite subject: ourselves. We say things we regret, avoid decisions, seek approval, push too hard, or surrender our power. We are much less able to be present and compassionate.

Practices to Strengthen Mindfulness and Compassion

Here’s the bottom line—and the opportunity. You can learn to radically shift how you relate to your daily experiences and to other people, and cultivate the capacity to be more mindful and compassionate. It just takes intention, commitment and practice, like most things.(13)

Mindful Breathing

Mindful breathing trains the ability to focus attention while also calming the mind and body:

1. Use the breath as an anchor. Feel the sensations of breathing: air coming in at the nose, the chest or abdomen rising and falling. Wherever you can most easily discern the breath can be your anchor of attention.

2. Recognize and return. When your mind wanders, as it will naturally do, simply notice it and gently return your attention to the breath.

3. Follow a full cycle of breathing: the inhale, the exhale, and the space in between the breaths. Allow your mind to rest on the breath.

4. Use helpful phrases, such as In, Out, or Here, Calm, or counting breaths to hold your attention as you inhale and exhale.

Loving-Kindness Meditation

Loving-kindness meditation strengthens caring and compassion for yourself and other people, and promotes emotional balance:

1. Begin with mindful breathing to calm the mind and body. You can do this in just three breaths, or take a few minutes, depending on your day.

2. Now bring to mind a loved one that you love easily and unconditionally. Fully see them in your mind’s eye, smiling at you, sending you loving wishes. Sense the positive emotions that might arise in you.

3. Offer kind wishes to your loved one. Silently repeat phrases such as May you be happy; May you be healthy; May you be peaceful; May you know that you are loved.

4. Next bring to mind coworkers, patients, and colleagues, and send them kind wishes, repeating the same set of phrases.

5. Extend further, to the entire practice, or hospital, or industry. You can widen the circle to all living beings as you strengthen your practice. And don’t forget yourself. End with sending kind wishes to yourself, and notice the effect in your own mind and body.

Sustainable, Portable, Adaptable Tools for Well-Being

Try integrating mindful breathing or loving-kindness mediation into your everyday routine. Commit to 10 minutes a day for a month, in the morning, on a short break, or between patients. And don’t take it from me or the research—be your own scientist. Tune in to what you observe: a change in your emotional state; a decrease in self-focus with a shift to being oriented to others; or perhaps the associated positive feelings of well-being. Where do you feel this in your body? This shift powers an increase in empathy and compassion, which can benefit you and everyone in your practice, and in your life.

References

1. Goleman D, Davidson RJ. Altered Traits: Science Reveals How Meditation Changes Your Mind, Brain, and Body. New York: Avery; 2017.

2. Tang YY, Lu Q, Geng X, et al. Short-term meditation induces white matter changes in the anterior cingulate. Proc Natl Acad Sci U S A. 2010;107(35):15649-15652.

3. Mrazek MD, Franklin MS, Phillips DT, Baird B, Schooler JW. Mindfulness training improves working memory capacity and GRE performance while reducing mind wandering. Psychol Sci. 2013;24:776-781.

4. Pagnoni G, Cekic M. Age effects on gray matter volume and attentional performance in Zen meditation. Neurobiol Aging. 2007;28:1623-1627.

5. Luders E, Cherbuin N, Gaser C. Estimating brain age using high-resolution pattern recognition: younger brains in long-term meditation practitioners. Neuroimage. 2016;134:508-513.

6. Buric I, Farias M, Jong J, Mee C, Brazil IA. What is the molecular signature of mind–body interventions? A systematic review of gene expression changes induced by meditation and related practices. Front Immunol. 2017;8:670.

7. Rosenkranz MA, Davidson RJ, Maccoon DG, Sheridan JF, Kalin NH, Lutz A. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain Behav Immun. 2013;27:174-184.

8. Blackburn E, Epel E. The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer. London: Orion Spring; 2017.

9. Brewer J. The Craving Mind: From Cigarettes to Smartphones to Love – Why We Get Hooked and How We Can Break Bad Habits. New York: Yale University Press; 2017.

10. Tang YY, Tang R, Posner MI. Brief meditation training induces smoking reduction. Proc Natl Acad Sci U S A. 2013;110:13971-13975.

11. Singer T. The neuroscience of compassion. Presentation at the World Economic Forum. Video, 20:00. Mar 9, 2015, youtube.com/watch?v=n-hKS4rucTY .

12. Singer T, Klimecki O. Empathy and compassion. Curr Biol. 2014;24(18):R875-R878. doi: 10.1016/j.cub.2014.06.054.

13. Cameron L. The Mindful Day: Practical Ways to Find Focus, Calm and Joy from Morning to Evening. Washington, DC: National Geographic; 2018.

What Is Mindfulness?

Mindfulness is the awareness that arises when we deliberately direct our attention toward our inner experience, toward others, and toward the environment around us. But more than just focusing your mind, it’s about your mindset—the attitude or filter through which you view the world. Mindfulness reinforces a mindset of being open, receptive, accepting, and compassionate. And that starts with noticing your natural tendency to judge, assume you already know something, or resist what life brings or what is out of your control.

Practice Tip

If you notice distractions, thoughts, or emotions coming up during meditation, simply say silently or quietly to yourself, This is here, or It is what it is, and return your attention to your object of focus, whether it is your breath or the loving-kindness phrases.