12/24/2013
Cultivating Mindfulness,
Self-Compassion and
Attunement in
Our Work With Youth
Steven D. Hickman, Psy.D.
Associate Clinical Professor
UC San Diego Departments of Psychiatry and Family & Preventive Medicine
Director, UCSD Center for Mindfulness
Awareness of the Breath
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Learning Objectives
At the conclusion of the lecture, attendees will be able to:
• Define and describe mindfulness, and identify some key
mindfulness-based interventions
• Define and describe self-compassion and differentiate it from selfesteem
• Engage in the practice of some core mindfulness and selfcompassion practices and exercises drawn from the literature
• Articulate how mindfulness might support healthy function,
balance and quality of life in the educator, administrator or coach
who works with youth
• Identify some key ways in which a mindful approach might
support and facilitate the professional work of those in
attendance
What is Compassion?
"Deep awareness
of the suffering of oneself
and other living beings,
coupled with the wish
and effort to alleviate it.”
--Paul Gilbert
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What is Compassion Fatigue?
Compassion Satisfaction
• The pleasure you derive from
working with others—
colleagues, patients.
• It’s feeling like you’re making
a contribution to people and to
society.
• A related term is vicarious
post-traumatic growth
(Calhoun, 1999)—the sense of
deepening and being enriched
by seeing how others grow and
respond to trauma.
Compassion Fatigue
•
•
•
Progressive lessening of the ability to
feel and express compassion
Like PTSD, although it is the result of
experiencing vicarious or secondary
trauma:
Hyperarousal – disturbed sleep,
irritability
Avoidance – avoiding thought and
feelings associated with a situation
Re-experiencing – distress, intrusive
thoughts or dreams
AKA: “vicarious traumatization” or
“secondary traumatization.”
(Drawn from the work of Charles Figley)
Symptoms of Compassion Fatigue
(Cunningham, 2003; Pearlman & Saakvitne, 1995).
•
•
•
Disruptions in beliefs about oneself
and others
Disruptions in sense of safety, trust,
power, esteem, intimacy,
interdependence, and control
Anxiety, disconnection, avoidance of
social contact, becoming judgmental,
somatization
John Pfifferling (1990) lists the following warning signs: • Abusing drugs, alcohol or food
• Anger
• Blaming
• Chronic lateness
• Depression
• Diminished sense of personal accomplishment
• Exhaustion (physical or emotional)
• Frequent headaches
• Gastrointestinal complaints
• High self‐expectations
• Hopelessness
• Hypertension
• Inability to maintain balance of empathy and objectivity
• Increased irritability
• Less ability to feel joy
• Low self‐esteem
• Sleep disturbances
• Workaholism
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What is Burnout?
A related term that refers more to the work environment—frustration,
powerlessness, and inability to achieve work goals.
Burnout is a syndrome of:
• 1.
emotional exhaustion,
• 2.
depersonalization, and
• 3.
reduced personal accomplishment
Characterized by
• 1.
cynicism,
• 2.
psychological distress,
• 3.
feelings of dissatisfaction,
• 4.
impaired interpersonal functioning,
• 5.
emotional numbing, and
• 6.
physiological problems (Fothergill, Edwards, & Burnard, 2004).
Fits Under The Umbrella of Compassion Fatigue
Mirror Neurons
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Compassion Fatigue vs. Empathy Fatigue
• Empathy: Carl Rogers: “An accurate understanding of the
[another’s] world as seen from the inside.” Feeling With.
• Compassion is…empathy with emotional pain…. with the
wish to alleviate it. Feeling For.
• Compassion gets it’s strength from GOOD WILL, whereas
just empathically connecting with the pain of others can
be depleting.
• Empathic Concern vs. Empathic Distress (Singer et al)
Exquisite Empathy
Harrison and Westwood recently published an article on “exquisite
empathy”, defined as:
– highly present,
– sensitively attuned,
– well-boundaried,
– heartfelt empathic engagement
These people were “invigorated rather than depleted by their intimate
professional connections with traumatized clients” and were protected
against compassion fatigue and burnout.
The key factor that has been identified in those with exquisite
empathy is INDIVIDUAL SELF-AWARENESS.
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“So How Do We
Cultivate
Exquisite Empathy
in Our Work?”
The Limitations of our Perceptions
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What is Mindfulness?
Moment-to-moment...
... non-judgmental...
... awareness.
“…paying attention in a particular way:
on purpose, in the present moment,
and non-judgmentally.”
—Jon Kabat-Zinn
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The “Landscape” of Anxiety
The Field of
Awareness
How can I
stop this
anxiety?
I have to
stop this anxiety
before I can
live.
I can’t
take this
anxiety!
What did I
do to cause
these feelings?
What if…?
What if the
anxious thoughts
never leave?
Thoughts Turn to Feelings
(Thoughts Treated Like Facts)
How can I
stop
this
HELPLESS
anxiety?
Will this anxiety
affect my
HOPELESS
marriage?
What did I
doGUILT
to cause
this pain?
What
if…?
DREAD
I can’t
take
this
SAD
pain!
What if the pain
FEARFUL
never
leaves?
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The Thoughts are Still There!
How can I
stop
this
HELPLESS
anxiety?
What did I
doGUILT
to cause
this pain?
I have to
stop this anxiety
HOPELESS
before I can
live
I can’t
take
this
SAD
anxiety!
What
if…?
DREAD
What if the
anxious
thoughts
FEARFUL
never leave?
Coping Using Distraction
(Guided Imagery)
GUILT
“Picture yourself
on a beach
somewhere. Imagine
the sound of the
waves and the image
of your anxious thoughts
floating away
on a cloud.”
HELPLESS
I have to
stop this anxiety
before I can
live.
DREAD
SAD
How can I
What if…?
HOPELESS
stop this
FEARFUL
anxiety?
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What Happens When You Stop
Guided Imagery?
HELPLESS
GUILT
“Picture yourself
on a beach
somewhere. Imagine
the sound of the
waves and the image
of your anxious thoughts
floating away
on a cloud.”
What if the
anxious thoughts
never leave?
I have to
What did I
stop this anxiety do to cause
before I can these feelings?
live.
FEAR
GRIEF
How can I
What if…?
ANXIETY
stop this
DEPRESSED
anxiety?
Holding Anxiety in Awareness
Mindfulness
How can I
stop this
HELPLESS
anxiety?
I have to
stop this anxiety
beforeHOPELESS
I can
live.
What did I
do to cause
GUILT
these feelings?
What if…?
DREAD
I can’t
take thisSAD
What if the
anxiety!
anxious thoughts
FEARFUL
never leave?
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Holding Anxiety in Awareness
Mindfulness
How can I
HELPLESS
stop this
anxiety?
What did I
GUILT
do to cause
this anxiety?
I have to
stop this anxiety
HOPELESS
before I can
live.
DREAD
What if…?
I can’t
take thisSAD
What if the anxiety
anxiety!
FEARFUL
never leaves?
Coping
With
Stressors
Onset or
Exacerbation of Pain
Internal
Stress Events
Fight or Flight
Alarm Reactivity
Stress
Reaction
Responding
vs.
Reacting
Mindfulness
Stress
Response
Internalization
Maladaptive
Coping
Breakdown
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The Prototypical Mindfulness-Based Intervention:
Mindfulness-Based
Stress Reduction (MBSR)
• Developed and implemented at the University of
Massachusetts Medical Center over the past
30 years by Dr. Jon Kabat-Zinn
• Rooted in 2000-year-old Eastern traditions
• Outlined in Full Catastrophe Living
by Jon Kabat-Zinn, Ph.D.
The Practice of MBSR
• An Eight-Week Program of . . .
– Meditation
– Guided Relaxation
– Gentle Yoga/Stretching
– Group support/discussion
– Weekly classes for 2.5 hours
– Daily practice of 45-60 minutes
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The Evidence for Mindfulness
The Simplest Mindfulness Exercise
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“Mindfulness Sounds Good:
But What Do I Do
When I Am Mindful of Difficulty
and Suffering
That I Can’t Change?”
The first step to the knowledge of the wonder and mystery of life is the recognition of the monstrous nature of the earthly human realm as well as its glory, the realization that this is just how it is and that it cannot and will not be changed. . . .
. . . So if you really want to help this world, what you will have to teach is how to live in it. And that no one can do who has not themselves learned how to live in the joyful sorrow and the sorrowful joy of the knowledge of life as it is.
‐‐ Joseph Campbell
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12/24/2013
“You can search the whole universe and not find a single being more worthy of love than yourself.”
‐‐ Buddha
Self-Compassion
Self-compassion is compassion turned inward toward our own suffering
Involves three components:
Self-Kindness vs. Self-Judgment
Treating self with care and understanding rather than harsh judgment
Actively soothing and comforting oneself
Common humanity vs. Isolation
Seeing own experience as part of larger human experience rather than
isolating or abnormal
Recognizing that imperfection part of being human
Mindfulness vs. Overidentification
Avoiding extremes of suppressing or running away with painful feelings
Allows us to turn toward suffering and “be” with it as it is in the present
moment
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12/24/2013
What Counts as Suffering?
• Any experience in which we experience
emotional pain
• Includes self-criticism, feelings of
unworthiness, annoyance, frustration,
stress, sadness, and “unjustified”
negative reactions
Research on Self-Compassion
•
•
•
Greater self-compassion is linked to less anxiety and depression (see Neff, 2009 for a
review). Of course, a key feature of self-compassion is the lack of self-criticism, and
self-criticism is known to be an important predictor of anxiety and depression
(Blatt, 1995).
SC is related to wisdom, emotional intelligence, less rumination and thought
suppression, emotional resilience, clarity about feelings, ability to repair negative
emotional states, feelings of social connectedness and life satisfaction, autonomy,
competence, less perfectionism, intrinsic motivation to learn and grow, less
motivation to enhance self-image.
Interpersonally, self-compassionate people were described by their partners as more
emotionally connected, less controlling or aggressive. Self-compassionate people
feel greater relationship satisfaction and attachment security, they feel more
authentic, more likely to compromise in conflict situations.
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What Self-Compassion Is Not
•
•
•
•
•
•
Not Sugarcoating - we’re opening to pain more fully, not bypassing it.
Not Complacent - it’s a force of will--good will. It takes COURAGE!
Not Pity Party - we’re disentangling from pain by entering into it, but we’re
not wallowing in it.
Not Exhausting - we’re struggling less, not more. A patient of mine said,
“This is easy, since it’s not about fighting!” We also stop being a fugitive from
our moment-to-moment experience. No fight, no flight.
Not Selfish - it’s the first step toward compassion for others. Dalai Lama said:
For someone to develop genuine compassion towards others, first he or she must
have a basis upon which to cultivate compassion, and that basis is the ability to
connect to one’s own feelings and to care for one’s own welfare... Caring for others
requires caring for oneself.
Not Unnatural: self-compassion (the wish to be free from suffering) is
completely natural, even as it feels awkward at first. We are all born with the
wish to be happy and free from suffering.
Self-Compassion Break
Bring a problem to mind that you are going through right now. Make it a
moderately difficult problem, not a big problem.
Speak kindly to yourself:
“This is a moment of suffering” (mindfulness)
“Suffering in a part of life” (common humanity)
Now put your hand on your heart, feel the warmth, pressure, and say to
yourself…….
“May I be kind to myself” (self-kindness)
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Alternate Phrases
For the third phrase, use whatever words speak to your particular
situation, such as:
•
•
•
•
•
•
•
•
•
•
•
•
May I accept myself as I am
May I, just for now, love myself just as I am.
May I give myself the compassion I need
May I forgive myself
May I be free from fear
May I be free from shame
May I be safe
May I safely endure this pain
May I find peace in my heart
May I be strong
May I protect myself
May I learn to live with ease and well-being
Giving and Receiving Compassion
and Equanimity
Please bring to mind someone who needs you,
but caring for them is starting to exhaust or
frustrate you. For this introductory exercise,
please choose someone who is not your child.
See the person clearly in your mind and feel the
struggle in your own body.
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Compassion Fatigue Phrases
• Everyone is on his or her own life journey.
• I am not the cause of this person’s suffering,
nor is it entirely within my power to make it go
away no matter how much I wish I could.
• Although this moment is difficult to bear, it
remains a privilege to help.
Kindness by Naomi Shihab Nye
Before you know what kindness really is
you must lose things,
feel the future dissolve in a moment
like salt in a weakened broth.
What you held in your hand,
what you counted and carefully saved,
all this must go so you know
how desolate the landscape can be
between the regions of kindness.
How you ride and ride
thinking the bus will never stop,
the passengers eating maize and chicken
will stare out the window forever.
Before you learn the tender gravity of kindness,
you must travel where the Indian in a white poncho
lies dead by the side of the road.
You must see how this could be you,
how he too was someone
who journeyed through the night with plans
and the simple breath that kept him alive.
Before you know kindness as the deepest thing
inside,
you must know sorrow as the other deepest
thing.
You must wake up with sorrow.
You must speak to it till your voice
catches the thread of all sorrows
and you see the size of the cloth.
Then it is only kindness that makes sense
anymore,
only kindness that ties your shoes
and sends you out into the day to mail letters
and purchase bread,
only kindness that raises its head
from the crowd of the world to say
it is I you have been looking for,
and then goes with you every where
like a shadow or a friend.
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For More Information . . .
Steven D. Hickman, Psy.D.
UCSD Center for Mindfulness
5060 Shoreham Place, Suite 200
San Diego, CA 92122-0980
(858) 334-4633
[email protected]
http://mindfulness.ucsd.edu
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