Abstract
We all lead busy, frantic lives. We often get so caught up in our own thoughts that we don’t see what is happening around us. This tunnel vision is self-perpetuating, and we easily become disconnected from our surroundings and enter autopilot mode. This can be useful for getting things done efficiently. However, if your mind is constantly like a busy motorway that never slows down, the more likely you are to become exhausted, suffer the effects of stress and burn out. Mindfulness can be helpful for finding a place of calm among the chaos, especially in high-stress careers like medicine.
Definition
Mindfulness has been formally defined as ‘moment-by-moment awareness of one’s experience without judgement’. 1 It is a simple meditation technique that typically involves focusing on the breath for a short period of time. This focus allows us to be completely present in the moment and naturally develop a heightened awareness of the stream of thoughts in our mind. Once we become aware of our thoughts, it becomes easier to untangle ourselves from the unhelpful ones and avoid descent into negative cycles of thinking which contribute to anxiety, stress and low mood. It is not necessary to change our thoughts, just gently acknowledging them and realising that they are transient gives a profound sense of regaining control of our overactive minds.
Mindful moments can then be practised throughout the day and, through regular meditation, can eventually become a way of life. For example, imagine driving home from work after a stressful day. You might be ruminating about all the things that didn’t go so well at work and worrying about starting your new rotation tomorrow. You are completely distracted and lost in your own thoughts, which are descending into a negative spiral. However, you remember to be mindful and focus your attention on your surroundings. There’s a beautiful pink sky as the sun has just set. You can hear music from the car next to yours. You notice a tiny restaurant you’d never seen before. Not everything you notice around you will be pleasing but that’s ok too. With very little effort, this mindful moment has lifted you out of your thoughts and into the present.
Many people have preconceived ideas about meditation that may prevent them from being open to mindfulness. The roots of mindfulness lie in Buddhism; however, it is not a religious practice. 2 It can be adapted and personalised to suit everyone—some people to meditate cross-legged on the floor, others prefer to practise mindfulness on the train to work. There is no right or wrong; it’s simply about taking a few minutes every day to tune in to your own thoughts and feelings.
Benefits
Regular practice of mindfulness has been proven to reduce anxiety, stress and depression. 2 Mindfulness improves emotional regulation which enhances well-being and makes regular meditators less likely to suffer from psychological distress. 3 The development of deeper self-awareness strengthens the ability to override automatic learned responses to stressful stimuli. 4 Mental and physical resilience can also be improved by mindfulness. One randomised controlled trial examined the effect of mindfulness training on Marines preparing for deployment, compared to a control group who received standard training. The results showed that mindfulness training group had reduced recovery time for heart rate and respiratory rate following stress training and reduced stress biomarkers such as neuropeptide Y. MRI showed reduced activation of the insula and anterior cingulate cortex, which integrate feedback about the internal physiological state and the body’s response to stress. Together, these outcomes show that mindfulness allows the body to recognise, react to and recover from stressful stimuli more quickly. 5
Other applications of mindfulness
Mindfulness is being used to help patients with chronic pain, fibromyalgia and cancer, and there is evidence to suggest positive effects on both physical and psychological health. 6 Further studies are required to measure the long-term benefits in specific patient groups. NICE now recommends use of mindful-based cognitive therapies (MBCT) to prevent relapse in well patients with three or more episodes of depression. 7 Mindfulness is also being used outside the clinical setting to improve performance in elite athletes, in prison rehabilitation programs and schools. Many large companies provide mindfulness sessions for employees to promote well-being and reduce stress and sick leave.
Relevance for doctors
A routine day at work involves manic multitasking and working under constant pressure to provide good patient care. Our jobs can be emotionally and physically exhausting yet endlessly rewarding. The ability to anticipate, respond to and recover from recurrent stressors is essential for survival as a doctor. But do any of us prioritize our own well-being when we get home? Morale is extremely low among junior doctors. The future of our National Health Service is uncertain and many are considering emigrating. Postgraduate exams are expensive, time-consuming and stressful. Getting assessments signed off while doing shift-work and changing teams is a nightmare. Then there’s life outside work and trying to achieve some kind of work-life balance. Learning how to be mindful is a secret weapon to help get through the daily challenges of work and life without burning out.
Getting started
Make an effort to be more mindful on your journey to work. Look around and notice the sky, the sun, sounds and people. Be aware of your overall mood. Notice your thoughts but don’t try and change them. Focus all your awareness on being present in that very moment and stop thinking about all the things you need to do later. Practising mindfulness around the same time every day makes it easier to develop a routine. There are endless resources, including books and apps which guide you further into mindfulness. A good place to start is your hospital’s occupational health department. Most offer well-being sessions for staff, which include mindfulness, usually at lunch time and even after work. It’s hard to find time but start prioritising your own well-being so you can give your very best to your patients and colleagues.