Hello and welcome to another episode of incorporate mindfulness.
I'm your host Michelle I am an occupational therapist yoga instructor and mindfulness teacher I believe that together we can create positive change one mindful moment at a time So settle in for today's mindful moment.
Is it burnout or?
Compassion fatigue Finding the right mindfulness course for you with Donna Costa Have you ever had that person that when you met them they changed the trajectory of your life forever For me that person is Donna Costa Donna was one of my professors at the University of Utah when I was getting my master's degree in occupational therapy and She was the first person to introduce me to mindfulness and I was lucky enough to later Be asked to be her graduate research assistant Together we conducted a research study on the benefits of mindfulness based cognitive therapy on individuals with depression and comorbid substance abuse and we looked at if MBCT for short was able to help them return to meaningful activities and Our results found that in fact mindfulness did help these individuals return to the activities that were the most meaningful to them Unfortunately,
It was denied for publication due to a small sample size Lucky for you,
You can find plenty of articles that Donna Costa has published and she has also written and published three books as her graduate research assistant I also had the pleasure of being able to sit in on several of her mindfulness groups mindfulness based stress reduction,
Which is MBSR and mindfulness based cognitive therapy and MBCT for short and I joke that being her research assistant allowed me the opportunity to get free therapy But seriously this free therapy of being able to sit in on her mindfulness groups Really transformed my life.
I was a college student at the time and it totally transformed How I learned to manage my stress My relationships and one of the biggest things it taught me was being able to Respond to my thoughts and notice them instead of react which was really huge for me I am so excited for you to listen to this episode.
Donna has so much information to share with us She is currently the founding program director and associate professor at UNLV.
In this episode,
Donna is going to be talking about her history with mindfulness all the certifications that she's done So she goes really into depth about different mindfulness programs and certifications So if you're curious about which mindfulness program would be the best for you,
This is going to be an excellent episode If you're new to mindfulness,
This is also a great episode to learn More about the different styles of meditation and the different offerings that are out there We also go into a lot of depth on compassion fatigue and burnout What the signs and symptoms are of each how they impact our lives And some tools to help manage both compassion fatigue and job burnout.
I hope you enjoy this episode Thank you so much for listening Hi,
Donna.
Thank you so much for being here.
The way that I introduced you is that you are one of those people that have just changed the trajectory of my life and meeting you and you teaching me about mindfulness had such a big impact on my life and so I'm so excited to have the opportunity to interview you.
So thank you so much for being here And thank you for the invitation.
I I view things as opportunities.
So this is an opportunity Oh good.
Well,
I'm so happy and this is kind of fun for me to be in this interviewing you Instead of where you were my professor and um,
So it's really fun to be in a different seat for this interview So tell me a little bit about your background and how you got introduced into mindfulness So I am an occupational therapist currently a professor of occupational therapy At UNLV in Las Vegas,
Which is a big state university I've been there since I was a kid I was a student in the university of I've been there since 2016 Um starting a new occupational therapy program But i've been an OT actually 48 years.
So literally my whole life mostly working in mental health settings um but then moving more into management and administration And then after I went back to school for my doctorate started teaching so i've been teaching in Professional OT programs for about 20 years now New York,
Utah and now Las Vegas.
So my Experience with mindfulness,
You know,
I remember being in college and being very stressed and it was the end of the 60s So it was you know a horrific time um And I took a course remember that was when the Beatles were popular and They yeah,
And they got into tm transcendental meditation So I was like if it's good enough for the Beatles good enough for me So I signed up and took a course in transcendental meditation And I paid a lot of money.
Well,
I mean I was broke like most college students are so Um,
It seemed like a lot of money To learn this new method of managing my stress And I remember being told we're going to give you a mantra Secret mantra as part of this training nobody else has this mantra Which I believed right?
So,
Um,
I got trained and I started using it religiously And even you know after I got out of school and started practicing,
You know,
I would come home from work every day and meditate And then I met someone who also took the training and This person had the same mantra And I have to say it really bummed me out because I believed it was secret and you know just for you Right here.
Okay,
As they had said so um that actually was very disheartening to me and I wasn't much into the You know transcendental meditation was a little too eastern for me It was a little too Chanty,
You know if you will So I started learning about all sorts of other things and I think when you practice in mental health you are More swayed to try a lot of other things.
So I remember I learned auricular acupuncture I learned neuro-linguistic programming I took a certification in guided imagery just like whatever I found,
You know,
I took always expanding my skill set and it wasn't until 2001 that I Decided to take a course in mindfulness And it was in california,
Uh,
Watsonville And it was in california,
Uh,
Watsonville,
Uh,
Which is I think the avocado capital of the u.
S um But I had the great fortune,
Um to have as my teacher john tabitz in And sake santorelli and they ran the center for mindfulness at that time So remember john is the person who started mindfulness based stress reduction,
Right?
So The interesting thing about the training is that it was a week-long training where you were essentially in seclusion You weren't supposed to read you weren't supposed to even wear a watch You were to avoid eye contact with other people and you didn't talk to other people so it was very self-reflective Lots of meditation,
Of course we started at Either four or five a.
M.
In the morning and i'm godly hour And it was before coffee.
I do remember that Um,
But that's how the day started so it was really very rigorous it was meditation all day and then after dinner um John and sake would have a lecture essentially with us where we could ask questions about how to apply this to other people But it was you know,
Did you ever have those experiences in your life that really are transformative?
That really changed everything about you and and that was the case for me And I think partly because this was an immersive training You really?
Like that's all you did for a week So you learned it,
But you also learned to incorporate it into your life and to almost embody it So I came back hooked like okay,
That's it that's all i'm going to do for the rest of my life And I did start running mbsr groups right away But remember I worked in mental health And I had started a depression support group back in new york Which I ran every week for five years and there was no such thing before I started it So I was dealing with a lot of people with depression,
Of course and suicidal ideation and bipolar disorder And I read an article I read an article Within a year of taking that first training that was written by john teasdale,
Uh,
Zindel siegel uh Who else two other famous psychologists?
Mark williams was the third And it was about this thing called mindfulness based cognitive therapy And because I was working so much with depression as well as having you know,
My own personal history with depression What the findings really spoke to be volumes and the findings were that This new intervention cut The rate of depressive relapse by 50 That was the first thing that grabbed my attention The second thing was as they described in that initial randomized control trial how they did this they said they ran groups in both toronto and in oxford england And the groups were run by occupational therapists Well,
I didn't know that how cool yes,
Yes So clearly they knew what ot's were so I decide,
You know,
Go to the top right to john teasdale himself at oxford And this is why I love you And you go for it why don't you tell students,
You know,
Just write to people they will respond And I told you telling me that same And I told him you know who I was and that I was interested in mbct and if they ever did a training To please let me know.
Well,
He writes right back.
They just happen to be doing a training in toronto Um of clinicians from around the world and I was welcome to come as long as I knew something about cognitive behavioral therapy Well,
Duh,
Of course So I signed up I have to tell you this training in toronto is like a who's who cognitive behavioral therapists Really people who I read you know And not only were the three psychologists there who created mbct But also john kibitz was there and it was maybe 40 people,
Right?
So it was another week-long training very immersive very intense But there was more of a teaching component there so we actually would break into small groups and practice the various Meditations that we would be leading Again absolutely transformative Um,
I came back it was like that's it i've gotta find somewhere to run these groups and Started running them and I will tell you I had a few patients in my practice at the hospital Who were in and out of hospitals And so I convinced them to sign up for this group I don't know where I offered it.
I certainly didn't charge them for it It absolutely cut the cycle of their re-hospitalizations.
It was so dramatic Wow,
Um because what mbct?
What what mbct is supposed to do?
Is change the person's relationship to their thoughts?
And so if they are having a lot of depressive thoughts It really starts to turn that around because mbct is truly a blend of cognitive and cognitive Mbct is truly a blend of cognitive behavioral therapy and mindfulness seamlessly integrated So,
Um,
But you know as much as intense as a week-long training sounds I left there with more questions than I had answers.
So The following year I took the course again from zindel siegel And another well-known psychologist.
I think I went to texas that time another week long And then the following year they finally developed a teacher training And so that was really intense where you were trained and evaluated and then certified to lead mbct groups Um,
So that really got me started And I was running mbct groups,
You know initially in new york and then in utah when I moved to salt lake And I ran both mbsr groups as well as mbct groups kind of experimenting and they're they're really both very different I did have a research study going on when I was at the university of utah for women with urinary urge incontinence And we ran that study for over a year.
And what we found is that mindfulness was as good as medication And that did make it into two more.
Wow So there was continents.
Yes.
Wow And then I was also working with the mental health agency With individuals who had comorbid depression and substance abuse to see whether mbct helped with that And it helped but not as dramatic as just pure depression I shouldn't say pure depression but Depression alone is what i'm saying i'm glad that you brought up the and that's fascinating about like the urinary incontinence study that you did too because that's something I talk a lot about Is that the mind and the body aren't separate so a lot of these mindfulness techniques we find are also positively impacting the body And some of the original studies I think and correct me if i'm wrong.
I can't remember So mbsr you might have already said this stands for mindfulness based stress reduction and that's a mindfulness curriculum developed by john kabat-zinn and then mbct is mindfulness based cognitive therapy Which you're certified in both and many many more which we'll talk about but um I think the initial research wasn't it with like psoriasis and I think the initial research wasn't it with like psoriasis or something like that that they did an interesting study Well when john kabat-zinn started which was at the uMass medical center He actually this was 1979 And he actually went around to the physicians in the hospital and said Give me all your patients that you don't know what to do with Give me the most challenging patients and they can have any diagnosis whatever so yes,
They had psoriasis some of them But um also chronic pain depression and stress it was like anything And the curriculum evolved of course over time into what we now call mbsr But that was the beginning of it in 1979 Mbsr is now available in I don't know how many countries it's in many languages It's the most researched mindfulness intervention to date And you know,
I do lots of presentations on mindfulness So whenever I do it,
I always go into pubmed to see well how many more articles can be published and it's just this Exponential growth of research and it's almost always positive.
Okay So that's very good But there was another population that I had worked with Starting in new york and most of the people that came to my depression support group had chronic pain In fact in the community,
It was known as the pain support group That's not what I called it,
But that's what they called it because people with chronic pain often develop long-term depressive conditions absolutely and so I learned of a physician up in canada who had developed a mindfulness course based on my depression support group mindfulness course based on mbsr Which she called mbcpm or mindfulness based chronic pain management And this is a little longer.
It's a 12-week program And not only is it mindfulness but also mindful movement and guided imagery and art And different components like that But a lot of adaptations built into the program Because you know if somebody has a chronic pain condition Related to maybe low back pain.
They're not going to be able to sit still in a posture For 20 minutes.
That's that's not going to happen so you have to Be able to adapt it to different postures to people perhaps moving around to people doing alternate kinds of meditations And and dr.
Gardner nix who's the author of the curriculum Also changed some of the language she she felt that some of the language needed to be softer that people Didn't get so upset because their bodies are essentially broken and not working so well anymore So I trained with her in mbcpm and what's particularly fascinating about that is that in canada Well to begin with their health insurance pays for mindfulness unlike our country where it's not reimbursed But it was offered almost exclusively via telehealth and that was before covid right that was interesting And so her intervention was spreading like wildfire,
But again mostly through canada So when I was at the university of utah,
I actually started some groups and had a small research study going on mbcpm and what it did for people with chronic pain and we actually had a control group Of people that were just doing breathing exercises so There was a a control group that have had a more similar intervention to what we were doing in mbcpm I continued the mbcpm when I moved over to Nevada And got a grant to implement this at toro university,
Nevada But I had a very difficult time with recruitment of people with chronic pain Don't really they're not really interested in a 13 week 12 week intervention They want their pain to go away today Right,
Right.
They want a quick fix Today,
Right,
Right.
They want a quick fix and there's something in las vegas called hangover heaven Uh,
Which is a mobile van that goes up and down the las vegas strip Uh-huh.
So if you're drunk or high you can go into the van They hook you up to ivs Electrolytes and then you can go back to drinking drugging or work whatever you need to do Oh my gosh,
This is what I call the ultimate in a quick fix.
Yeah,
Right and they have a fleet of vehicles It's like vegas.
Oh my gosh So we have a brilliant idea actually So even though I was offering this intervention for free,
You know,
Not charging people a cent.
It was really quite difficult Um to recruit people nonetheless the people who did come in And we found some interesting things like people were able to cut their opioid medication in half on their own not you know but You know,
I remember this one woman who was an elderly,
Um female and You know when she would wake up in the middle of the night with pain She would take half Her pain medication and then listen to the recording of the meditation and be able to get back to sleep.
She did that on her own Um to reduce her reliance someone else in the group completely got off medication wow,
So I now you know lecture extensively on pain management and always cover Mindfulness because it is an effective meditation It is a an effective alternative remedy,
But you know You can't take away people's medication and not give them anything in return yeah,
Um so and and Mindfulness is not something you learn quickly,
Right?
You have to kind of do it repeatedly Yeah um so I was teaching.
Um in toro at toro in nevada and found out about Yet another mindfulness training called the koru mindfulness approach which was specifically for college What number is this number five certification?
I should have been taking notes So what was interesting about it is This intervention was designed specifically with what they call the emerging adult So young adults from 19 to 29 Who have some very unique characteristics?
They don't really like new agey stuff They don't really they're really good at multitasking.
They don't have time To spend an hour a day on homework like mbsr requires they don't have time for eight weeks of classes They don't have the patience for two to two and a half hour classes like mbsr and mbctf And so the the authors of that which are two psychiatrists out of juke university Published a research study in 2013 a randomized control trial They enrolled hundreds of college students and found that this intervention increased sleep um decreased perceived stress increased mindfulness but also increased gratitude Because it it also builds in students Identifying at least two things a day.
They're grateful for when you do that on a regular basis.
It really increases positivity Absolutely,
So I thought this has pretty cool.
So I signed up for the very first training in koru Went down to duke university and got myself trained um And uh,
It was an excellent training.
I highly recommend it and they they now offer the training virtually which is nice Um,
It's a shorter training than the other shorter and cheaper than the other interventions But in order to get into it or to get certified You have to show that you have somewhere taken At least a three-day retreat style meditation course They want you to have that immersive experience and have some experience also with working with young adults with Running groups and with mindfulness,
Of course So I started running koru groups the minute I got back and we couldn't run that we were running them three and four times A week we just couldn't So what's different about koru is that instead of it being an eight-week class?
It's a four-week class eight class is only 75 minutes long And the students only have to do 10 minutes of homework a day So it's much easier.
It seems doable for a college student.
Yeah.
Yeah Um,
But we had the same outcomes that duke had in their first randomized controlled trial So we kept doing it and now that i'm at unlv What I decided to do is embed it in the mental health courses that I teach so You know in one of the mental health courses we're teaching students to run groups.
Well,
Okay,
It's just going to be a koru group,
But it's a group's a group And the other thing is students are given skills that they can use right away So even the first week they're given two meditations they can use right away There's an app which you can download to your phone for five dollars the website has a lot of the meditations But again,
They're all very short Okay Um,
I'd actually heard of that before and it yeah,
And I don't think I realized because I think i've actually Listened to some of their meditations.
I don't think I realized that was like a specific curriculum for college students Oh,
Perfect.
Okay,
Right,
But what we found is,
You know,
I I know at toro the faculty and staff were like well What are we chop liver?
Why can't you do koro for us?
We don't have time either for everything So it it actually became very popular and so It has spread and it's of course not limited to young adults.
That was just the Original population that it was tested on and for whom it was developed So now at unlv I run It's advertised throughout the university.
I run a weekly Drop-in mindfulness session for any faculty member throughout the whole university And I run it virtually at noon every what's today wednesday?
Yeah,
Every wednesday and I use most of the core of things because I only have 30 minutes and so I usually Teach two or three meditations in the 30 minutes I bet that's right now Yeah,
Yeah,
I mean People need it people are you know,
They're not going to be able to do it Yeah,
I mean it people need it people are you know having difficulty and look there are a lot of mind-body interventions out there and i'm not saying It is not one size fits all Um,
I think people take to different things Um,
Not everybody likes yoga.
Some people like tai chi better,
You know So I think you have to find what works for you But there's certainly been more research in mindfulness As an evidence-based intervention than anything else And if you look to the uk,
Which really has been kind of a leader Um,
And I will tell you mindfulness among ot's in the uk is huge rebecca crane is one of the leading Meditation teachers over in the uk and she is an occupational therapist also Um,
She's done a lot of research,
But they have developed competency documents for Um meditation teachers and you know,
They offer lots of training But uh,
The government actually published a report a couple of years ago of all the evidence of mindfulness and essentially what it said is this is from nice which is the national institute for clinical excellence,
So it's their Their evidence-based repository And what they said is that mindfulness really should be considered the first line intervention for stress-related illnesses Um that mbct in particular Should be the first line offering for people with depression Wow,
Say that one more time because I think that's such a huge statement nice recommends that Mbct mindfulness based cognitive therapy should be the first offering to people with depression based on the evidence Over prescriptions as a first trial.
Wow.
Yep Because quite honestly prescriptions take weeks to work assuming you get put on the right cocktail or right medication first But the the government goes a step further which is people don't have to pay for mbct all right,
And The government is actually training therapists in delivery of mbct Now you contrast that with the states That's in england,
Right?
Is that where they're doing that?
Yeah.
Yes So here you're going to have to find a therapist and you're going to pay them Several hundred dollars for an mbct course because you're not going to get your insurance company to pay for it It's really unfortunate Yeah,
I mean i've always been in a position With teaching that i've been able to run pro bono groups or right have it as part of a research study But that's not usual How do you recommend that people find an mbct practitioner?
Is there a database or do you have any recommendations?
I bet a lot of people are wondering so if you just google mindfulness based cognitive therapy There is a home a home page if you will And they do have a directory of practitioners who've been trained in mbct So you can look up your state It's just not enough to meet the demand Of people with depression say in this country.
Oh,
Yeah,
Absolutely that being said it also takes a certain amount of discipline michelle and You know Yes,
It works,
But you've got to put in Yes,
It works,
But you've got to put in the up to an hour a day of practice and You know when people are depressed It's hard for them to do that All right,
And then if they're suicidal or so originally Mbct was said to not be helpful for people with suicidal ideation that has since changed and they actually have uh a variant specifically for people with suicidal ideation um as well as you know mbct for children and There's actually mbct for people with cancer.
So there are different applications available now So,
You know in the minutes we've been here we've only talked about what four or five You know,
There are probably a hundred different mindfulness interventions You know for different populations for different problems Each with their own body of evidence most with their own specific curriculum But they're all based on you know,
The the father of it all if you will which really is mbsr They're really all variations on that Is there a population that you feel like mindfulness is not helpful with?
So you mentioned like suicidal ideation at at one point it wasn't recommended but Based on everything that you've been saying so far.
I mean we've talked about people with depression anxiety Um chronic pain there's also mindful eating practices as we both know uh,
So Is there a population that you feel like mindfulness is contra indicated or not recommended?
So what there's a population for whom you have to be cautious And that's anyone who has who has endured trauma Okay Now if you look at trauma here in the us The estimates are that and there is a study called the adverse childhood Experiences the aces by felitti,
Right?
Which says that if we look at just the us population more than 75 percent of us Had a childhood trauma before the age of 18 75 percent Yeah,
Right.
That's a lot so There is a book out that I highly recommend for anyone who practices mindfulness or teaches it and that's trauma sensitive mindfulness by david tree leaven David has uh his own website tsm trauma sensitive mindfulness He also has podcasts And webinars and training and all that other stuff okay,
Um and the other thing you can find is Um,
Oh,
I can't think of the name of the university on the east coast.
It's where brit britain willoughby is brown university They've developed what they call a safety toolbox So you can google that safety toolbox and what's in there is a variety of trauma assessments As well as information about how trauma imprints in the body and It reports there was a study that willoughby did a couple years ago,
Which started all this Which was as wonderful as mindfulness is Some people do have adverse experiences Some people do have psychotic episodes Yeah,
Some people do go into dissociation And if people Are kind of predisposed to that they're more likely to go into it in a longer meditation so just generally rule of thumb you don't want to Start out with really long meditations Nor do you you know,
A lot of people are fond of well i've got to dim the room For this mindfulness activity.
In fact,
You should not Yeah,
Okay because someone is more likely to dissociate or trigger a trauma experience and darkness You should keep the lights on and you as the teacher Need to be on the lookout for signs of dissociation signs of discomfort and be able to intervene Which may mean you stop the meditation And you engage the person in some grounding practices Yeah,
So now whenever I give mindfulness workshops,
I always you know end with Okay,
Here's some caveats for What you should keep in mind and and basically the rule of thumb is Anytime you're working with a group of people you need to assume that someone in that group will have experienced trauma And so you have to be cautious and careful with that I read oh,
Sorry,
Go ahead.
It's not that we say don't do it.
All right,
You have to be cautious Yeah um One study that came to mind and I should have I should have saved it and sent it to you It was a study that came to mind and I should have saved it and sent it to you.
It was kind of funny Well,
I actually don't know how evidence Uh based it was but it was actually it was talking about a population that may not benefit from mindfulness and they were talking about like,
Um Teleoperators or people who like if customer service Uh people so if somebody calls in and they're upset and you have a person yelling at you on the phone They did a study and it was that people who were in customer service that were dealing with upset people all the time some of them had positive effects from mindfulness and then others actually had more challenges because They were aware of their thoughts So as we know mindfulness helps us to be more aware of the thoughts that are coming up but so there they almost couldn't be um I don't know how to word it like not Not fake,
But you know how you're trying to like appease somebody and make them happy in customer service So you're supposed to be doing this but inside they're really feeling torn because they're like,
Wow,
This person is really frustrating me I'm,
Very aware of how i'm feeling and so it was like a conflicting response with how they had to show up for the person who was calling with how they were Feeling and I had never thought of that and uh,
It was just kind of an interesting study That they talked about um,
But something that I just read just recently because since I have I graduated Um from the occupational therapy program.
I became a yoga instructor as well and i've gone on to do some mindfulness certifications also in addition to some uh trauma sensitive yoga trainings and in one of my trauma sensitive yoga trainings they had This article that was from John Kabat-Zinn and it said something and I wish I had the quote in front of me But some basically along the lines of if you're working with somebody with trauma It's almost a disservice or I think he even worded it as like unethical to not incorporate some movement from the beginning and my assumption for that is that Just like you're saying sometimes for people if they have experienced trauma sitting in a long extended mindfulness or meditation session can be somewhat triggering but getting them to be able to move their body and maybe focus on different sensations And bring it back to the body Instead of just working on what's going on the head We really have to be aware of that too.
Have you heard that that same thing?
Okay.
Yeah A lot of the grounding techniques,
You know will be you know have people touch,
You know one finger at a time Have them put their hands together,
You know have them feel their feet,
You know,
Have them count,
You know The tiles on the ceiling or the floor Any of those will help bring somebody out of a dissociated state Yeah,
So let's let's talk about a population that I feel like Really right now we're seeing a lot.
Um of just this particular Experience that we're having and that is burnout.
I think with everything happening in in the world over this last year Stress burnout as we know anxiety depression all those things are happening Burnout as we know anxiety depression all those numbers are going up significantly And so I want to talk a little bit specifically about burnout and I know the population that you're working a lot with is students so And that can certainly be Affecting them.
We know it is affecting them But whether you have a job or you've lost a job or you're a caregiver or you've been a parent that's been At home suddenly now a full-time teacher to your child.
I think that all of us have probably experienced some level of burnout So how do you define burnout?
So burnout is a state of tension And a preoccupation with that tension.
So it's very hard to like snap snap out of it,
Right?
But it's caused by organizational stress it's caused by factors within the workplace And essentially it can be a mismatch between the person and their job functions But more often than not it's that the demand exceeds the capability So there's too much work and not enough resources You know people can do it for a little bit of time but not for an extended period of time But not for an extended period of time um The and and burnout develops over time it's not sudden So it can develop over years and the trajectory is different for different people The thing that we have to differentiate burnout from is compassion fatigue.
Yeah and compassion fatigue develops much quicker than burnout But it has some of the same symptoms.
So when you compare the two A lot of times people aren't really sure and I know when I run workshops Because after 9-11 I actually became a certified compassion fatigue specialist And so i've been running compassion fatigue workshops since then and I always have people take a test which I would encourage your listeners to do And i'll tell you how to access it and what this test does is show you Your levels of compassion fatigue burnout and compassion satisfaction So compassion fatigue is also a state of stress But it's generally happening more because of emotional involvement like you're too involved or You're you're getting you know,
We're really good if you're a good therapist.
You're really good at putting yourself in your patient's shoes But then it's kind of rubbing off on you and you're feeling their pain and suddenly their pain is your pain So because compassion fatigue develops quicker it's also easier to address And literally sometimes all the person needs is a day off You know,
They haven't taken a day off in a while.
They haven't gone out to lunch.
They haven't Self-care is something that is missing from most of our professional training programs.
We don't teach students to do that And practitioners If they were taught don't have the time for it.
So they just you know abandon those practices And yet it really is essential.
We all need To be practicing self-care and it's not selfish Right Now there are many factors contributing to compassion fatigue But the other thing I mentioned was compassion satisfaction So when you get a lot of rewards out of your work,
Even though it's very demanding It takes away some of those negative effects that you're feeling because of the workload issues And that's so that's what's called compassion satisfaction And so when we do workshops,
We actually give a lot of ideas for things you can do to increase your Compassion satisfaction so that If you can ameliorate some of the burnout and compassion fatigue levels So the assessment I referred to is called the professional quality of life scale It is available in the public domain.
It's available in over 20 different languages And It it's something that I encourage you to do Periodically,
You know Every couple of months quite honestly,
It's a way of kind of taking your emotional temperature if you will There's actually an app What is this app called I think it's the provider professional the professional quality of life scale That's not necessarily just specific to compassion fatigue or burnout.
It's more just looking at The quality of life your stressors if i'm correct,
Or maybe i'm thinking of a different assessment that i've taken What kind of questions are on this particular assessment?
It's statements,
I find my work challenging My work makes me happy it's statements about Work life your so this is more work.
Okay.
Okay That being said there's been a lot of studies that show that compassion fatigue affects parents Morg attendance clergy Yeah,
You know anyone who's working with people caregivers that are caring for say aging parents or okay Or a child if you had a child with a disability or ill child,
Okay So I think that's a really good example of how you can identify yourself So,
Um,
There are a couple of apps the provider resilience app is one That actually embeds the professional quality of life scale into it And then there's a new one the well-being index Which has a different quality of life scale But the point is these scales are designed to remind you that you need to do this periodically Okay,
And once you identify so,
You know when I do a workshop it's usually about three hours You know,
I tell people about the differences between compassion fatigue and burnout Then we take the assessment and then we spend time talking about how do you avoid it?
Right Um,
And there's there's a book.
I know I keep mentioning resources,
But a book I The resilient practitioner it is just a wonderful book I think it should be required reading for anyone in the human service field For teachers and therapists and again anyone working with people,
But we have to have strategies for self-care We absolutely must do that What are some so let's talk about compassion fatigue First,
Um,
Because I think uh,
Just like you're mentioning I kind of sometimes blend them together But let's make sure we separate them so that people can understand so with the compassion fatigue What are some of the first signs that you might notice that you are experiencing compassion fatigue?
And at what point do you recommend?
Getting help Well,
It can be something as minor as you've lost your sense of humor Usually it's things like you You start withdrawing from other people You start not answering the phone when people call you You might get more cynical You might be experiencing Some of the same symptoms that occur in ptsd so sleep disturbances or a pronounced startle reflex or a cynicism Being sharp with other people in your interactions where you're normally more patient So it's a departure from your usual Manners if you will Sometimes people in the workplace there's more calling in sick Because they just can't do it.
They can't drag themselves to work another day but again,
There's a chart that I show and actually the symptoms of compassion fatigue and burnout Many of them are the same Okay um So then you have to look at some of the other factors and also then how long you've had it And you know what's going on?
And that helps you that and an assessment helps you determine is it more compassion fatigue or is it more burnout?
You know if you're somebody that Goes home every night and you're thinking about your patience you wake up in the middle of the night.
You're thinking about your patience That's more compassion fatigue Uh when you have this I don't care anymore attitude because nothing that I do makes any difference.
That's burnout Okay,
So there's more of an extreme with burnout You don't care Where compassion fatigue it's more like you care too much Yeah Would you say that compassion fatigue numbers are probably on the rise with everything that we're experiencing?
Right now with covid 19 and stuff like that.
I just I think I think a lot about Yeah,
Our our members in the hospital and our first line staff and stuff like that I think we'll see reports of that but they haven't come out yet Yeah,
But I remember You know reading stories like five years after 9 11 where there were stories of you know reports of How did social workers and psychologists and other healthcare workers cope with what happened after 9 11?
Um,
Um,
And you know,
The article said,
You know people poked with it with increased substance use I mean We we all have coping mechanisms.
Some of them are good coping mechanisms.
Some of them are negative right and of course be a combination So we've got to make sure we have some healthy coping mechanisms as well as the not so healthy So once you so maybe you have identified some of these signs that you're experiencing compassion fatigue,
I also really would recommend the professional quality of life scale.
I've taken that one and another one which you'll have to remind me of It's it's the one like your stressor scale I feel like you always had a student Perceived a stress scale and that's also a very fascinating one And it looks at different events that are happening in your life and it rates how stressed you are Do you think is that a also maybe a helpful one for somebody experiencing compassion fatigue or burnout to?
That's just going to tell you how stressed you are Yeah It's not it.
It isn't targeting the areas that bring on compassion fatigue and burnout.
So it's a different kind of scale Okay May make you feel more stressed when you see how high Usually again the majority of people that come to my workshops come in thinking i'm burnt out And they leave saying I thought it was burned out.
I actually found out it was compassion fatigue But I also have a lot of compassion satisfaction now the people who don't bother coming to workshops,
Right?
They're usually burnt out because they don't care right or they are so suffering from compassion fatigue and they have very little hope for the future and that's unfortunate so I will say that The national academy of medicine,
Which is a large healthcare organization They are recently Within the last two years really getting on this bad bandwagon and they've created a microsite within the national academy of medicine called the Clinician well-being Collaborative I think it's called And they have all sorts of resources on clinician well-being because they're saying that the healthcare system has largely paid attention to things like reimbursement and patient care and patient satisfaction That what we have called up till now the triple care the triple aim of health care And that it really should be called the quadruple aim of health care And that needs to include clinician well-being And so they have all sorts of initiatives They have a section with poetry and artwork They have a traveling art show that healthcare organizations can bring in Articles research,
You know apps for phones.
I mean just a lot of resources What's that called again the clinician well-being initiative?
Is that what it's called?
Yes collaborative Yeah,
Collaborative.
Okay,
And then there's um two physicians in new york Epstein and krasner Which have developed it started out as a mindfulness course for physicians Called mindful communication.
It's essentially a variation on mbsr,
But it is open to any healthcare professional I took it a couple years ago.
So it's called mindful practice And Um,
And it's a shorter course.
It's a two to three day course,
But it really allows you to get in touch with What what's getting in the way of you feeling good about your career And and for many physicians and other healthcare professionals It's the quantity of patients.
They have to see it's having a caseload of a thousand patients that You know is just overwhelming Absolutely.
So that's another great resource for people.
Um,
And epstein has a A real landmark paper that he wrote in 1999 called mindful practice Which I recommend to All students all healthcare practitioners.
It's just very well written You know and it it talks about that mindfulness is not this thing that we wait till we get home and Everything's done for the day and now we engage in mindfulness We create opportunities within our day to be mindful So before we go in to see a patient We we kind of clear the deck of everything that's swimming in our head So that when we go in to see our patient You know,
It's kind of a sacred space And that you've gotten rid of everything.
So it's just you and that patient.
That's all that exists in that space um and When we do that kind of thing what what their research has shown patient care goes up patient satisfaction goes up Because they're getting our undivided attention As opposed to you know,
We're still thinking about the last patient or writing our note as we walk into the next patient's room And we don't give them our full attention.
We're preoccupied Um that causes our patients to be dissatisfied but also us to be dissatisfied with our work Yeah,
And that is something that it takes practice because I think everyone that goes into these fields You know,
Especially whether you're a practitioner a therapist whatever it is it's usually because you really genuinely care about people and you want to help and you want to serve and So it is hard when you start feeling like that this work is consuming you and you you I think for some people start to question.
Is this the right career for them or being excited if a patient cancels or you know all those things when really what you care about most is your patient But you're so overwhelmed by the day to day and the demands And I think even in our busy world,
Sometimes it takes practice just to be present to like pause before you go into the room and reset and remind yourself What is my intention for?
This experience with this person and wanting to be present because we are so busy and and so preoccupied that Something as simple as that.
I will say even for myself takes practice like reminding myself Okay,
Pause let go of everything that was happening before and show up and show up present for this person And it takes practice just like you were saying.
Yes But if you have an established mindfulness practice Then before you go into that patient's room,
You might only need a couple of breaths To center yourself to clear the deck so to speak um,
And then you come out and We should reflect on what happened right good bad or indifferent Um,
You know not just rush right into the next Patient there needs to be a little transition and we may need to take a break during the day.
I can't tell you How many practitioners I speak to you?
And when I suggest that we have a A mindful lunch people like I don't remember the last time I went to lunches You know,
I I have lunch at my desk while i'm writing notes Right,
Yeah,
So all the things we tell our patients to do we need to hear our own advice and listen to that What are some other ways that we can improve our compassion satisfaction there may be some things that we can't change about like the structure or say the number of patients or We can't change that our family member has an illness and that they Need help What are some of the things that you've found have been successful?
Well,
One thing is we ask people to make a list of what nourishes you and what depletes you right and Sometimes we have a tendency to kind of be mean to ourselves and to You know,
We're already exhausted and yet we take on additional things that deplete us instead of Doing something that will fill up our reserves I also have people get in touch with why did you go into this line of work in the beginning?
And I have people construct what's called a professional timeline.
So when did you decide to be whatever a physician and a mom?
And You know,
What were your values at the time?
What did you stand for?
And what's happened along the way?
All right,
So awards you've gotten thank yous.
Maybe you've gotten from patients or families Degrees you've earned Jobs that you've gotten that have been particularly meaningful And there may be some bad stuff that's happened along the way but it's not going to be all bad,
Right?
But you bring this timeline and and then you know The right-hand side is where you are today and two or three of us are going to be in the same place And then the right-hand side is where you are today.
And who are you today?
And what do you stand for?
And just that you know a lot of times and then I have people share that with each other and People get very animated because it's like oh,
I haven't thought about this stuff.
They get very excited at talking about The why I chose to do what I do So anything you can do to get yourself in touch with that is great.
Yeah,
I having worked in a hospital for many many years I can relate to everything that you're saying and I Saw a lot of my co-workers going through the same thing and it's hard.
It's devastating to just to see The change of what the person goes through from when they get start and they're so ambitious and excited and then Just that drain and overwhelm that can really happen And it's hard because just like you were saying usually it's because you care too much You care so much,
But I think that that's why mindfulness has been so helpful for me is One helps me be intentional.
So it helps me come back to like what is my why?
Why am I doing this?
Why did I become an OT?
Why?
How do I want to show up in different areas of my life?
But also it helps me That reset button that like pause button and I can reset just like you said the more that I practice The quicker I am at resetting and getting back into the present moment And so I think that those are huge skills and I also wholeheartedly believe that we need to Start teaching this more and offering it especially in our medical settings for our providers And I will not be surprised if we see The compassion fatigue numbers going up just after everything that we've dealt with in the last year Let's talk a little bit about burnout.
Um,
There's just one other exercise I have people do and it's worth Saying it's called the joys of work exercise And you pair people up and you know when you get together with your co-workers It's usually a complain fest.
I'm being polite.
I'm not saying what I usually say this right?
But that's when I'd have to mark it explicit if you said that So you actually talk about a time you experience joy at work,
You know a breakthrough with a patient You know,
Somebody gave you a compliment Your boss gave you an evaluation You laughed at work because something was truly funny,
You know,
And again people get so animated and engaged because they're talking about what brings their life meaning And getting in touch with them All right,
As opposed to you know,
I hate my job and here are all the reasons why right,
You know Here are all the reasons why right,
You know Then why are you doing it,
You know?
But sometimes it's easier to complain than it is to think about.
Well,
What are the joys of work?
Right.
Well and our brains are wired that way.
That's a whole nother conversation,
Right?
But our brains are really drawn to the negative and so it's like You could have the best things going on and then suddenly you get with a friend You're like,
Oh,
You know,
You have all these negative things that you want to share and our jobs are the same way often Sadly,
It just helped with how our brains work.
It's like that's the thing you will remember from your day when you go home to tell somebody about it often.
It's the thing that didn't go well And a lot of that as we know is survival.
It's our brain is trying to figure out.
Okay What do we do different next time or how do we fix this problem?
So we really do have to pay attention to the positives so and I've been to I know that in a lot of my Places of employment we've started meetings with like positive things and people always roll their eyes at the beginning They're like,
Oh great another positive moment But it is like it's a snowball effect the more that other people share About what is exciting them and this really cool story that happened with their patient Then other people really get excited and it totally shifts the energy in the room So I love that the choice of work exercise So what do you do you recommend they do something different than compared to compassion fatigue?
What are some things that they should the next kind of steps?
It's kind of hard because By the time they get to burn out.
Um There's little that can be done in the way of intervention And so oftentimes it does mean okay What else could you do with your life because this really it gets too bad.
Yeah Um,
It's almost unredeemable But again,
I don't encounter that many people they think they're burnt out,
But they find out it's actually something else The people that are burnt out don't come to the workshops.
They're not curious.
They're they don't care right um,
And I think we've all worked with people who are burnt out and and they're they can be very toxic in the workplace because They're very negative to deal with Um,
But they they oftentimes do need to think about something else now They won't necessarily do that.
I mean there are we do then maybe before so When we get to the point that we're burnt out where we're completely shut down.
We Like cannot do this one more day.
Maybe that person needs like a total shift in their life.
What do we do?
Um before we get to that point so it really is that's why these self-assessments i've mentioned are so important because We want to monitor where we're at in the continuum before it gets to that,
You know breakdown point before There's nothing I can do that's going to make this any better And you know the work that's been done on burnout by maslatch and others shows that there's a continuum of burnout There's actually a list of symptoms so if you can Address it earlier on there are things you can do.
It's just once you get to that burnout state you don't care And you're not going to care enough to put in the effort to make a change Where do you recommend?
What is like a bite-sized place to start with mindfulness?
Because we've also talked we've talked a ton about the research and I think people are probably especially if they were listening to this podcast They're sold on the idea of mindfulness or maybe they're interested But haven't taken that next step Where do you where do you recommend that people start or some tools to make it a little bit more manageable?
I really recommend that people take a course and I say that because Almost everybody Can benefit from some guidance.
It's one thing to say well mindfulness is great.
So i'm going to start doing it on my own i'm going to teach myself And okay,
That's your intent for the first day,
But it usually falls off pretty quickly Where if you sign up for an eight-week course or a week-long course,
Whatever it is You're going to get You're going to get more of a dosage effect.
It's you know,
And it's going to have a more lasting impact um We do have the advantage now with more things being online that you don't have to travel somewhere necessarily to take a mindfulness course So that actually is very helpful,
I mean there are books you can Read about mindfulness some of which have instruction in them but also you You have to be very disciplined to teach this to yourself so I would really recommend that people explore resources and You know try to find a mindfulness group class of course that they can take.
I want to ask you a question because I think about I think often Back to when I first learned about mindfulness and as i've shared with our listeners it was through you And I think back to I think MBSR was I attended both your MBSR and MBCT groups I joke that um My capstone project or not capstone I guess for me it was my thesis project I got free therapy Because I in order to research MBCT I had to first sit down on groups and experience it and learn it and then being your research assistant I also got to sit in and on MBSR and so So life-changing for so many reasons But I think back to like what was the one moment where I was like oh my gosh this like totally changed me And I want to share mine,
But or maybe i'll share mine in first But I want you to be thinking because I know it's years ago It might even have been in your transcendental meditation Which by the way i'm also curious what the mantra was Maybe you'll tell that to us.
Oh Oh,
Oh,
Okay.
Oh,
So yeah Give it to everybody Everybody uses that okay Okay,
I thought it was going to be something okay Well rats,
Um,
But I want you to think back to when you very first took a mindfulness class or Yeah,
Let's say a mindfulness class that aha moment where something was like,
Oh my gosh,
This is this is it that kind of hooked you so i'll let you think about it for a second because i'm sure you've had so many experiences with mindfulness over the years,
But um,
One of the Pivotal moments for me was um and correct me if it could be mbsr or mbct because again I did both but You read the story of like the person walking down the street And they waved to you or you wave to them and they keep walking And that's it.
That's literally the story And then you have people open their eyes and then they can like discuss what?
Happened And I remember very clearly in my mind like my version of the story like what had happened And then every person's going around the story and i'm like,
Oh my gosh,
Like some people thought Oh,
They didn't see me or somebody felt embarrassed like oh I waved and the person didn't see me and um Then there was me over here who was like,
Oh that person's upset with me or you know,
And I had a whole story in regards to that simple Um story that you mentioned and I had made up this whole thing in my head And that was the first aha moment where I was like,
Oh my gosh Like our thoughts are not facts and you would always say that too thoughts are not facts and it sounds so simple um,
But That was the first time that I really started to Evaluate like what are some of my thoughts that i'm having and not all of them are true or real or that I have to believe And then of course you can start seeing how those thoughts can seep into you know Um,
If you're a student having all these thoughts about i'm not going to be good enough or i'm going to fail and How do you hold on to those thoughts?
And so just that realization of I don't have to attach to my thoughts for me.
It was life-changing And to this day I have to tell myself if i'm starting to get overwhelmed with something i'll tell myself Thoughts are not facts.
And so anyway,
I tell that story all the time and It was a profound moment for me But what can you think back to?
A mindfulness moment for you This is going to sound silly,
But I remember going on that first retreat and it was in silence and I think we actually wore signs on us that said silence.
So nobody talked There was oatmeal for breakfast I eat oatmeal all the time that oatmeal tasted the most amazing oatmeal that i'd ever had in my life And and it that was just such a powerful realization Of being in the moment not shoveling it down while i'm reading the paper or checking emails on my phone,
Right?
Yeah,
I'm just savoring the moment You know we we were eating outside Eating the oatmeal um eating the oatmeal probably put nuts and sugar who I don't even know what I put in it it was just blissful You know And and that's the thing that's you know,
I usually when i'm teaching mindfulness.
I will teach a couple of short meditations first the raisin Mindful walking we'll try some breathing One of those is likely to end up in an aha moment for something.
Oh now I get what mindfulness is You know I didn't have any thoughts while I was eating that raisin Yes,
That's it.
That's what mindfulness is because usually our minds are so busy Right,
Right And we can't will it away.
We have to truly experience it So yeah I just did my I did a five-day vipassana silent retreat cautious almost two years ago now and Life-changing I feel like for me also I I also remember the meals which yeah is so funny I remember everything that I ate and just really experiencing it and loving it And being so present there was actually a really cool experience as you said in a vipassana silent Retreat which this is a specific style not all I should clarify that not all mindfulness or meditation Retreats are going to be silent.
So when you sign up for a vipassana,
You know,
You're going to be silent the whole time but as I said,
I'm a yoga instructor now as well and there are moments where Like the the leaders or teachers of the group will speak and so we were having they were having a talk and a discussion And they said something like we aren't going to be doing yoga today we're going to be doing it tomorrow and One of the people you could respond to the teacher just during this time and she was like,
Oh like my my back is so sore From sitting she's like I really was looking forward to it and they were like,
Well if you would like to you can gather as a group if you'd like to do yoga and If if there's any yoga instructors and I felt this feeling like oh great.
I'm a yoga instructor.
How am I going to teach yoga silently?
And so I raised my hand and we locked eyes we couldn't speak to each other so and they all nodded So I just had people all over the room nodding at me that they wanted to to join me and so somehow we communicated like Where we were going to meet and so we met in this area and I set up my yoga mat and then they were all there and It was one of the most beautiful moments where we we just understood that we were all there and they followed me through the practice and had to do little things like tapping the ground so they'd know when we'd move out of a position because they couldn't always see me where they were but like The presence and just beauty of like sitting together and honoring one another It was just a really really sweet special moment that I'll remember forever.
It really brings you back to just this present simplicity And joy of life and just being able to just be there and just be there and just be there and just be there and just be there and it's just this joy of life that is here all the time.
We're just so busy that we miss it.
Thank you so much for for chatting with me.
This has been such a meaningful conversation to me as I said Mindfulness has really changed my life.
I feel like it came into my life as such a pivotal time of being a student and feeling a lot of those things that we have been talking about feeling stressed and overwhelmed and probably not quite burnout but It really it helped me in so many ways and so I'm so grateful that I met you and you are just a wealth of knowledge.
I feel like I should have also said when I was listing your bio before this interview I should have listed that you are one of the people that I think you know something about everything and every book and every author and you have this like fascinating detailed memory for research and I just I love picking your brain about topics like this.
So thank you so much for talking with me.
Please stay in touch and if any questions come up with your listeners please send them my way.
And she means it too.
When people email her she responds and just like you said you always encourage us like if you read a book and you're interested in that topic email the author and yep so that's what she's offering too.
So if you have any questions please feel free to reach out to her and she's at UNLV.
They're starting their new occupational therapy program so if you're an OT or interested in becoming an OT I highly recommend her program.
Thank you.
Have a good evening everybody.
Bye now.
