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Physical Therapists’ Perceptions of Mindfulness for


Stress Reduction: An Exploratory Study
Annette M. Willgens, PT, EdD, MA, PCS, Shona Craig, PT, DPT, Monique DeLuca, PT, DPT,
Cali DeSanto, PT, DPT, Annmarie Forenza, PT, DPT, Tyler Kenton, PT, DPT, Elizabeth Previte, PT, DPT,
Courtney Woytovich, PT, DPT, ATC, and Gregory Yakimec, PT, DPT

agement using evidence-based strategies.6


Literature Review. The purpose of this influenced their professional lives, health
study was to explore how physical thera- habits, and ability to manage stress. After Based on eastern teachings, mindfulness
pists (PTs) conceptualize the theory and graduation, coauthors analyzed data with has become an evidence-based practice7,8
evidence-based practice of mindfulness as the principal investigator (AW) using the that cultivates the intrapersonal relationship
a means for stress reduction in a clinical constant comparative method. The pro- to foster emotional resilience,9 strengthen
setting. cess of learning about mindfulness is de- coping strategies,10 and decrease stress.7-10
picted in a series of pictures and is based Although general relaxation strategies ex-
Method. Using theoretical sampling and a
on themes from coded interview data. ist,11,12 mindfulness has been found to be a
grounded theory approach, 8 PT students
in their final clinical experience recruited reliable, transportable, and simple strategy
Results. Four themes emerged from the
8 PTs to participate in weekly mindfulness to manage stress in the health professions.
data. Theme 1 (I Need to Fix This) char-
activities. They interviewed participants It teaches one to “be with” difficult emotions
acterized a desire to manage stress with
in week 12. Interview questions explored such as anger, frustration, and sadness,13 and
a tangible strategy. Theme 2 (I Pause and
participant thoughts and feelings about that the mind can heal the body.13-15 This
I Notice but this is Hard) characterized
mindfulness, including how the activities concept is relatively new among PTs and may
awareness of difficult thoughts and emo-
be difficult for them to embrace.
Annette Willgens is director of Clinical Educa- tions. Theme 3 (Mindfulness Works)
tion and associate clinical professor at Drexel emerged as participants shared direct Epstein7 states that “mindfulness is inte-
University, Department of PTRS, 1601 Cherry benefits from practicing the tenants of gral to the professional competence of phy-
Street, Philadelphia, PA 19102 (annette@drexel.
mindfulness. Theme 4 (I Need Support) sicians” because it reduces psychological
edu). Please address all correspondence to An- distress and promotes emotion regulation
nette Willgens. characterized the desire to be led by an
expert, in an ongoing fashion, with the for clearer decision making and less medi-
Shona Craig is a physical therapist at Therapy cal error.7,14-17 To date, it is unclear how PTs
Solutions in Richland, WA. comfort of others to share the experience.
perceive mindful practice and why it is un-
Monique DeLuca is a physical therapist at Ar- Conclusion. Altogether, these data sug-
derutilized in this group of professionals. The
not Health in Elmira, NY, and a current physi- gest that PTs embraced this evidence-
purpose of this study is to explore how PTs
cal therapy orthopedic resident through Cayuga based strategy to practice self-care within
conceptualize the evidence-based practice of
Medical Center in Ithaca, NY. and outside of the clinic. Ideally, mindful-
mindfulness following a series of practical
Cali DeSanto is a physical therapist at Encore ness should be introduced early in the PT
applications.
Rehabilitation in Ocean Springs, MS. education program and practiced regular-
Annmarie Forenza is a physical therapist at Ex- ly to minimize student stress. It is recom-
cel Orthopedic Rehabilitation in Rutherford, NJ, LITERATURE REVIEW
mended that students, with instruction
and a home care physical therapist throughout from qualified teachers, lead efforts to in- Compassion, caring, and altruism are criti-
New Jersey.
troduce mindful practice to sites as part of cal for patient-centered care,18 but self-care is
Tyler Kenton is a sports physical therapist at their clinical training. equally valuable.19 No articles were found that
PHlex Health & Wellness Studio in New York, discussed the self-care of PTs. One article ex-
NY. Key Words: Physical therapy, Self-care,
plored the sources of stress on PTs’ emotional
Elizabeth Previte is a physical therapist at New Stress, Mindfulness.
well-being, citing role conflict, job ambigu-
York Presbyterian Weill Cornell Medical Center ity, emotional exhaustion, depersonalization,
in New York, NY. and somatic tension as concerns.20 In con-
INTRODUCTION AND PURPOSE
Courtney Woytovich is a physical therapist for trast, the healing benefits of mindfulness have
Genesis Rehab Services in Reading, PA, and is a Caring for patients and families with regular
been well-documented in physicians,7,10,13-17
certified athletic trainer. frequency bears an emotional cost.1,2 The in-
nurses,21 and occupational therapists.22 Ad-
Gregory Yakimec is a physical therapist at tent to help and offer compassionate care can ditionally, mindfulness benefits people with
Northern RI Physical Therapy in Greenville, RI. become clouded by workplace stress and per- depression,23,25 anxiety,24-26 chronic pain,27,28
The study received approval of the Ithaca College sonal tension. The connection between com- fibromyalgia,27 psoriasis,26,27 hypertension,26
Internal Review Board
passion fatigue and burnout among health obesity,26 cancer,26 arthritis,26,27 obsessive-
The authors report no conflicts of interest. care providers is increasingly clear.1,3-6 Less compulsivity,26 insomnia,26 human immu-
Received March 20, 2015, and accepted October understood is the physical therapist’s (PT) nodeficiency virus,29 Parkinson’s disease,30
2, 2015.
perceptions about self-care and stress man- multiple sclerosis,31 dementia,32 grey matter

Vol 30, No 2, 2016 Journal of Physical Therapy Education 45


disorders,32 white matter disorders,33 atten- lar practice of 5 minutes each day has been part of the research elective and because the
tion deficit disorder,34 diabetes,35 autism,36 shown to promote emotional awareness un- students chose the theoretical framework of
and posttraumatic stress disorder.37 der stress, increase resilience, improve deci- mindfulness, the principal investigator (PI)
sion making, and increase the accuracy of self (AW) led weekly mindfulness classes that in-
Mindfulness Theory assessment.14-17,26,40-47,49,50 cluded each of the items in the booklet. The
Mindfulness is a secular practice of medita- Typical stress reduction techniques, such PI is certified in mindfulness-based stress
tion and body awareness with origins from as relaxation training and exercise, offer reduction from the University of California,
Buddhism.14 Unlike transcendental medita- only a temporary feeling of contentment and San Diego School of Medicine.
tion, which teaches the use of mantras, im- calm.11,48,58 They do not decrease rumination, The intent of the Mindfulness Booklet was
agery, and chanting, mindfulness meditation which is a common by-product of worry.48 for students to share an evidence-based in-
teaches stillness with focus on one’s breath- Two specific activities have been shown to troduction to mindfulness with PTs at their
ing to gain insight into the contents of the provide tangible and easily accessible meth- clinical sites. This would serve as a means for
mind..14 Based on the medical model and the ods to practice mindfulness. The acronyms discussion, shared practice, and a resource
work of Kabat-Zinn,13,14 mindful practice is STOP (stop, take a breath, observe, proceed) manual for the site. It was decided that stu-
considered a way of being13 rather than a cog- and RAIN (recognize, accept, investigate, dents would do the activities (eg, seated
nitive ability,14 so it has application in both nonattach) help redirect the focus away from meditation) with the participant but that it
professional and personal venues. the stressful thought or event and return it to was up to the participant to practice outside
Mindfulness increases awareness of one’s the breath, which decreases the sympathetic of the weekly student-led session (eg, eat
thoughts and emotions, objectifying these nervous system response to threat.45 With lunch silently and mindfully each day). The
as simply “passing events.”19,26 Nonjudg- practice, threat perception decreases over student coauthors taught the participant PTs
ment and curiosity are important elements of time, as self-awareness becomes the default from the lower levels of Bloom’s taxonomy
mindfulness.13,14 Nonjudgment allows kind- activity and emotion regulation becomes (as compared to experienced mindfulness
ness toward oneself which fosters openness more automatic.40-43 Despite the positive re- teachers), which may have prevented the cli-
and curiosity for all experiences. Naming or search supporting mindfulness programs for nicians from translating the information into
describing emotions restores them to their stress reduction among health care profes- a meaningful practice.
proper function rather than allowing them sionals,15,16,19,22,24 research on physical ther- The PI emailed supervisors at each student
to dictate experience.14-16,19,38 Ultimately, re- apy clinicians is lacking. clinician’s site, inviting them to participate in
framing occurs as one’s perspective is shifted this exploratory study. Upon beginning their
to allow for a variety of viewpoints and choic- METHODS final 12-week clinical education experience,
es.13-16,24,26 student clinicians recruited PTs who were not
Mindful awareness has been shown to uti- Procedures and Role of Coauthors their own CIs and who had no prior knowl-
lize a distinct neural pathway.39,40 Functional In their final graduate year, 8 students, under edge of mindfulness practices to participate
MRI (fMRI) scans show that the default the guidance of the primary investigator (PI), in weekly information sessions (Table 1).
mode, or resting mode of the brain utilizes enrolled in a qualitative research elective in Theoretical sampling was used to inform the
midline connectivity, which is known for in- which they studied grounded theory.51 They theory of mindfulness in an unbiased and ex-
attentiveness to one’s thoughts. This allows practiced interviewing, coding, and thematic ploratory manner.51
for automaticity and emotional habits to in- development. Based on their interest in clini- Consent was secured and weekly meet-
fluence actions.39,40 In contrast, the salience cal instructor (CI) stress, they designed the ings between student and participant at each
mode,39,40 or mindful mode, requires at- study through the lens of mindfulness theory, site began. Using the Mindfulness Booklet,
tending to one’s body sensations. Functional creating a booklet of teachings and principles students introduced general concepts of
MRI scans of experienced meditators show to share with their clinical sites (Table 1). As mindfulness in sessions lasting from 10 to
lateralized brain structures that transmit
sensory data to the prefrontal cortex for pro- Table 1. Contents of Mindfulness Booklet
cessing.38-40 Recent studies suggest that the 2
modes are functionally connected, and with Lesson # Topic
meditation training, the mindful mode actu-
ally sends inhibitory influence on the default 1 Definition,7,10,13 STOP13,45 and RAIN13,45 Medical Benefits 19-26
mode, preventing reactivity from disrupting 2 Guided Meditation by Jon Kabat-Zinn13
moments of mindful attention.41 In brief,
habitual stress responses can only change if 3 The Four Foundations of Mindfulness13
thoughts and feelings are regularly brought
into awareness,7-9,13-17 thereby shifting the 4 The 5 Facets of Mindfulness13
neural network.39-41 5 Mindful Awareness13

Mindfulness Practice 6 Mindfulness versus Mindlessness13


A core activity in mindfulness is seated
7 Doing Mode versus Being Mode13
meditation, while using one’s breathing as an
“anchor” to practice present moment aware- 8 Neuroscience of Mindfulness39-43
ness.13-16 Mindfulness is the exact moment
in time when one notices that the attention 9 Mindful Eating13,35
is no longer on the breath, and focus is gently
10 Summary/Overview
and deliberately returned to it.22,26,40 A regu-

46 Journal of Physical Therapy Education Vol 30, No 2, 2016


Table 2. Interview Guide The PI served as the methods expert and
“devil’s advocate.”55 Within-case analysis as
Anonymous identifier: well as across-case analysis51 continued for
I am interested in hearing about your thoughts and feelings regarding mindfulness. 8 weeks until completion. Investigator trian-
gulation ensured trustworthiness, as each co-
Know that these responses have no bearing on my feelings. There will be no judgment author maintained memos to bracket biases,
placed on your responses and your interview data will be kept confidential. You will review transcriptions prior to meetings, and
be assigned a number and your interview recording will be deleted after transcription. provide input throughout the analysis pro-
cess. At each phase of the analysis process,
Based on the weekly activities from the Mindfulness Booklet,
consensus of all group members was critical
Q1. Please describe/share your initial thoughts and feelings about the theory and before moving on to the next code.
practice of mindfulness? What thoughts/feelings arose for you? Thematic development required an addi-
tional 4 weekly WebEx meetings. To ensure
Q2. How did the activities influence your professional practice? What thoughts/ congruence and clarity of the constructs ex-
feelings arose for you? pressed by the transcripts, codes were cat-
egorized by subject and by research question
Q3. How did the activities influence your health habits or stress management? What
thoughts/feelings arose for you?
to ensure that themes generated were repre-
sentative of the data collected.51 Code words
Q4. Which of the mindfulness activities was most helpful to you? How did it help you? and phrases that reflected related categories
became preliminary themes, and with con-
Q5. How would this type of information best be shared with other physical therapists? sensus, final themes for the resultant theo-
retical model.51 Themes were traced back to
participant transcripts at regular intervals
15 minutes weekly, for 10 weeks. In week 12 responses, and as a whole, met the criteria for and quotes were selected to support themes.51
of the clinical experience, each student com- saturation.59 Reflexivity was given regular discussion and
pleted 1 audio-recorded interview based on was documented to provide an audit trail at
the interview guide (Table 2). Data Analysis each phase of the data collection and analysis
The research team, led by the PI, employed process.52 Member-checking was completed
Participants the constant comparative data analysis meth- by the PI for credibility and transparency.52
In all, 16 clinicians volunteered. Eight volun- od.51 The group met for 2 hours each week Each participant confirmed that the themes
teers were excluded for the following reasons: via a WebEx60 platform so that individual generated matched their intended responses.
1 was a physical therapist assistant (PTA), verbatim transcripts from each interview
5 were students’ CIs, 1 had a language bar- could be viewed on a shared screen by all. Results
rier, and 1 had extensive prior knowledge Each coauthor had completed 1 transcript, so Four main themes emerged from the data.
of mindfulness through yoga practice. Table each took a turn as lead for the coding ses- Theme 1 (I Need to Fix This) characterized
3 includes the participants’ practice settings sion. Open codes (discrete textual units that early openness to learning and wanting to
(ie, inpatient, outpatient, private, all practice represent the meaning of the text verbatim) have a tool to “address” and “fix” the stress,
patterns), years of experience (2–37 years), were discussed until consensus was reached which was conceptualized as “inevitable”
locations (PA, NY, NJ, FL, CA), ages (26–60), and documented on a template.51 Next, axial and “heavy.” Participants were unaware that
and sex (2 male, 6 female).59,60 This sample codes (groupings of open codes that form cat- a practice in mindfulness existed and com-
was similar in size to other qualitative studies egories) were assigned using the same process mented on the qualitative nature of the study,
in physical therapy research.58 Investigators with group consensus.51 This process was re- sharing a preference to know, have facts, and
agreed that all 8 participants shared truthful peated until all transcripts were coded. be told what to do, rather than turn inwards

Table 3. Participant Demographics

Identifier 1 2 3 4 5 6 7 8

Age 26 37 27 29 60 43 51 28

Gender M F F F F F M F

Years as a PT 2 13 3 7 37 23 30 4

Credential PT, DPT PT PT, CST, MS PT, DPT PT PT PT PT, DPT

Subacute
Manual Manual
Outpatient Subacute Subacute rehab/
Expertise/ therapy Inpatient therapy Inpatient
orthopedic/ rehab/ rehab/ neuro,
Setting outpatient acute care outpatient neuro
sports geriatrics amputee traumatic
orthopedic orthopedic
brain injury

Location FL NY NY NJ PA PA PA CA

Vol 30, No 2, 2016 Journal of Physical Therapy Education 47


and become curious about the contents of it’s not actually the person or a situa- Participants practiced nonreacting, pres-
their mind. For example, 3 participants made tion, it’s actually your values – the way ence, pausing, or “stepping back.” They no-
the following statements: you were brought up – or the way you ticed that the contents of the mind could
think things should be. So you’re actu- create negative responses to workplace man-
We’re in a very high-stress, demanding ally feeling frustrated because you’re agement and barriers to patient care. They
job, and working with people can be dif- taking things too personally. So say ‘OK discovered that accurate self-awareness was
ficult…any technique that could help well this is going on, but truthfully that powerful in itself because it yields unbiased
work better with patients, work better doesn’t define who I am’…because that’s and truthful information. Several participants
with students, and just reduce stress. (1) what makes you feel worse. (2) shared the desire to reconnect with their pa-
I find the practice to be very, very dif- tients, see their patients as individuals, and to
ficult…things get in your way. Espe- I haven’t ever meditated and I rarely ever “bring the practice home.” Three participants
cially as a woman, we tend to multitask just stop…it was good to actually have a began to understand that the perception of
so much that…you’re trying to do one moment to realize that you can do that the stressful event could be reframed to see
thing, but you’re thinking about some- and not let your mind wander. (6) “what is actually happening.”
thing else…I do have trouble sleeping…
just because I have a constantly running I go home and I’m tired…I grab some- I think mindfulness helps to remind
mind. I will get up in the middle of the thing and make it as quick as possible… people that it’s your perception of what’s
night and jot down um, the grocery list I put the TV on, eat while I’m checking going on that makes something stressful
that just popped into my head…it’s al- voicemail…If you asked ‘what did you or not stressful…if you try to keep that
ways running in the background. (3) have to eat last night?’ I would have to in mind that most of the stress is self-
stop and think. There’s nothing memora- inflicted, then that can help cut down on
I could focus on myself and my body… ble because I wasn’t in the moment. (8) the stress…so I can think more logically
It was a release of…stress and energy. So versus just emotional reaction. (8)
Participants shared that they rarely pause
this was a way not to focus on the things
to notice the contents of their minds and Theme 3 (Mindfulness Works) emerged as
I had to do at work or reports I had or
that it was difficult to maintain a “nondoing” participants shared direct benefits from paus-
who I had to call, I could focus on myself
mode. ing to notice their thoughts. Benefits includ-
and my body. (5)
Theme 2 (I Pause and I Notice, but this is ed improved overall attitude, awareness that
Each participant cited the presence of Hard) characterized awareness of thoughts emotions are transient events, feelings are
stress to varying degrees and shared that and emotions. This was the moment when “real but not always true,” reactions are dif-
they benefitted from pausing to notice their participants realized the work related to ferent than responses, noticing food intake,
regular stress-related habits. Some of these mindfulness is not easy because the mind relational awareness, emotional balance, self-
included multitasking, seeing patients as wants to run, wander, and be busy. Partici- acceptance, positive self-talk, improved sleep,
frustrating, seeing students as a chore, poor pants began to practice the tools offered to slowing down to reduce errors, and aware-
sleep, and having a constantly running mind. them and noticed mind wandering, negative ness that “I’m still a good therapist, even if….”
Each participant described their favorite thought processes, past-oriented thoughts,
tool to help them decrease mind wandering and future-oriented worry. They shared feel- We’re getting a lot of pressure to get
and gain awareness of their body and mind. ings of anger, self-doubt, defensiveness, and things done…but a lot of it I think is just
Responses included breath-awareness, mind- irritation. taking a look at why are we so angry?
ful eating, seated or walking meditation, and It’s because we’re professionals. Every co-
using the STOP and RAIN methods to notice The main thing is the stress of multitask-
worker here has high ethics and expects
thoughts. ing and pressure of trying to get things
to give a lot to their patients. So because
done. But after some of the exercises and
of the emphasis on documentation be-
I like the grape eating one because I’m discussing what mindfulness entails. It’s
ing a reflection on your care…[the new
more of a ‘do-er’. If I am given something just stopping to realize what is actually
documentation system] fuels that anger
to do…it doesn’t give my mind so much happening. (7)
and frustration. So, just stepping back
room to wander… to question or to judge
or to do what it wants. It really gives me I struggle with self-confidence problems and saying “listen, I’m still a good thera-
a point to focus….I stopped dwelling on and work stress…because I always feel pist, the system is not working with how
my negative emotions. (4) like I’m not doing as good a job as maybe I want to document. (2)
I can with my patients…mindfulness at
The concept that your emotions and feel- work, as well as at home, [can help me] It was one of the first teachings—iden-
ings are not the same. That really made be a little more fair to myself and be a tifying your emotion and don’t judge it
a lot of sense. We tend to react to a situ- little less judgmental towards myself, but then learning later on how are you
ation without really giving focus on why and have a little less stress, then my pro- going to deal with it or change it in a
you are reacting that way. When things fessionalism and my work effectiveness way that is constructive. (5)
are going well, then it’s positive feedback can only improve. (1)
and everything is nice. But when you I tend to carry work stuff home and just
react to anger or frustration it becomes I tend to…take things more personally… word vomit all over my boyfriend – and
negative feedback…I really liked RAIN. when I am questioned or sometimes I’m I would carry a lot more emotion with
Just stop ‘Ok, how am I feeling? What’s defensive or angry…[but] I’m recogniz- it…I think I’ve been better at separating
the emotion that’s driving it? It’s OK. I ing that I’m angry…or feeling defensive that emotion and saying to myself: this is
can be angry.’ But then identifying what and…take a step back, and not have it what happened…but it’s my reaction to it
is making you angry because sometimes eat at me so much. (2) that’s making me angry or frustrated. (7)

48 Journal of Physical Therapy Education Vol 30, No 2, 2016


It made me more aware if I was binge revealed by comments such as having a “con- time, with awareness of one’s body sensations
eating which I do when I get stressed. (2) stantly running mind” and “feeling pressure to remain present focused, rather than past or
to get things done.” Participants in this early future-focused.13,14
It helped me sleep. I could tune into my stage demonstrated awareness that stress was Participants’ thoughts and feelings led to
body and slow my mind down. (6) very real but felt helpless to manage it because frequent epiphanies that began with “I no-
“there is no time.” ticed” and served to dampen the habitual
Things that would bother me didn’t as With the use of mindfulness tools and ac- stress response, especially as they learned that
much. (7) tivities, the second picture illustrates stones they could regulate their emotions by labeling
Theme 4 (I Need Support) represented placed along a continuum, with spaces be- them (eg, “here is anger,” “mind wandering,”
participants’ responses noting that skilled tween each to symbolize purposeful pauses “self-doubt”).8,53 Nonjudgmental awareness
mindfulness teachers should lead clinicians and focus on breathing. Participants shared offered participants a renewed feeling of con-
for consistency and accountability. The state- mindfulness benefits such as noticing their trol over random life stressors for improved
ment below, “we all need this practice,” was thoughts, words, and actions, sleeping better, equanimity and feelings of hope.53 The sec-
made by all participants in response to ques- awareness of tasting food, and responding ond picture of stones represents a never-
tion 1, but was followed with, “but there is rather than reacting to negativity. This fol- ending journey and an ongoing practice, as
no time.” This theme illustrated participant lows the theory of mindfulness which em- stress does not stop, but one’s relationship
desire to be supported by a formal practice phasizes addressing stress one moment at a with stress can change dramatically.53,54 This
among colleagues.

Probably together is better because in-


Figure 1. Process of Physical Therapists Exploring Mindfulness for Stress
dividually I think people would be like
Reduction
“oh yeah, I did it” but I don’t think they
would really get it. We all need this prac-
tice. (2)
Stressful Thoughts and Feelings
I think other therapists may think it’s I’m too busy
another kind of like silly, psychothera-
I’m a do-er
py thing…it would have to come from
someone who’s practiced mindfulness I’m not good enough
and can share [their experiences]. (4) I can’t stop my constantly-running mind
All 8 participants shared a desire to con- I don’t taste my food
tinue a mindfulness practice led by an experi- I word vomit
enced individual. It was equally important for I have trouble sleeping
participants to feel supported in their ongo-
ing practice, be reminded of the value of the I can’t calm myself
practice, and practice alongside colleagues
who shared their struggles.
As participants learned about mindful- Tangible Tools for Self-Awareness
ness, each gained awareness by noticing their
STOP
thoughts and feelings throughout the day.
They responded openly to the unfamiliar top- RAIN
ics, finding the practice challenging but re- Meditation
warding. They noticed changes at work and at Mindful Eating
home, and shared some of the activities with
5 Facets of Mindfulness
family members. All participants preferred
tangible tools to practice the activities, such Doing versus Being Mode
as focusing on the breath as “anchor.”13-16 Neuroscience of Mindfulness
They all suggested ongoing small group work Medical Benefits
led by a mindfulness expert.

Discussion
To illustrate the process of PTs exploring Increasing Awareness With Practice
mindfulness in their own lives, Figure 1 rep- I notice how I think
resents a sequential progression grounded in
I can respond rather than react
the theory of mindfulness and represented by
each theme. The sequence of pictures depicts I can pause and notice
participants’ initial thoughts and reactions I judge myself
of learning about mindfulness as illustrated I am not my emotions
by varying configurations of stones. In the
I can label my feelings
first picture, the stones are in disarray, repre-
senting the disordered, distressed, and self- I can stop and breathe
critical thinking expressed by participants,

Vol 30, No 2, 2016 Journal of Physical Therapy Education 49


journey is rarely linear, as depicted by the information about whether or not partici- References
winding placement of the stones in the pic- pants continued to practice the activities or 1. Z eidner M, Hadar D, Matthews G, Roberts
ture. This follows the theory of mindfulness, continued to seek out mindfulness resources. RD. Personal factors related to compassion
which states that regular, daily practice is re- fatigue in health professionals. Anxiety Stress
quired.13,14 Seated meditation, walking medi- Recommendations Coping. 2013;26(6):595–609.
tation, eating meditation, and other forms of Stress among physical therapy practitioners is 2. van Schie CH. Neuropathy: mobility and qual-
formally tuning in to the body assist the indi- ity of life. Diabetes Metab Res Rev. 2008;24
inevitable given the landscape of health care
vidual later, as they manage daily, recurring Suppl 1:S45–S51.
in the United States. Mindfulness is an eas-
stressors with more awareness.13,14,53-58 3. Stubbs B, Schofield P, Patchay S. Mobility
ily accessible, transportable practice that has
limitations and fall-related factors contribute
The third picture in Figure 1 illustrated a solid evidence base,7-10,15-17,19,23-47 but it has to the reduced health-related quality of life
participants’ ability to clearly express and not yet reached recognition and acceptance in older adults with chronic musculoskeletal
confirm the benefits of the practice in their among PTs. A recent randomized controlled pain. Pain Pract. 2016;16(1):80–89.
own lives. In this picture, the stones are ar- trial of 42 physicians who completed an 4. Gallagher R. Compassion fatigue. Can Fam
ranged on top of one another in an erect 8-week (1 hour per week) mindfulness-based Physician. 2013;59(3):265–268.
fashion, depicting emerging personal em- stress reduction program showed signifi- 5. Sanchez-Reilly S, Morrison LJ, Carey E, et
powerment for participants in this sample. cant improvements in heart rate, measures al. Caring for oneself to care for others: phy-
The insightful statement “…it’s your percep- of peace/ease, energy, optimism, happiness, sicians and their self-care. J Support Oncol.
tion of what’s going on that causes stress…” and accepting difficult emotions.58 After 1 2013;11(2):75–81.
illustrates the ability to influence stress by year of a maintenance program, effect size 6. Campo MA, Weiser S, Koenig KL. Job strain in
regulating the influx of emotions that habitu- significantly increased in magnitude. This physical therapists. Phys Ther. 2009;89(9):946–
956.
ally accompany it.13,14,40,43,53-58 This follows demonstrates ongoing evidence for a lasting,
7. Epstein RM, Siegel DJ, Silberman J. Self-
the theory of mindfulness, which states that it efficient, cost-effective stress reduction pro-
monitoring in clinical practice: a challenge for
is not the stress itself that is harmful, it is one’s gram that requires little time and effort.58
medical educators. J Contin Educ Health Prof.
negative perceptions of stress that causes Ideally, mindful practice should be intro- 2008;28(1):5–13.
harm for the body and mind.13,26,53 duced to PT students before they enter the 8. Baer RA. Self-focused attention and mecha-
workforce. Students can elect to further ex- nisms of change in mindfulness-based treat-
Limitations plore mindfulness by providing in-services to ment. Cogn Behav Ther. 2009;38 Suppl 1:15–20.
This study controlled for the influence of their clinical sites on mindfulness for chronic 9. Haase L, Thom NJ, Shukla A, et al. Mindful-
the CI-student relationship. However, par- pain, workplace stress, and athletic perfor- ness-based training attenuates insula response
ticipants may have offered positive inter- mance. Alternately, creative methods, such as to an aversive interoceptive challenge. Soc
view responses in an effort to be helpful to utilizing teaching assistants (TAs) from other Cogn Affect Neurosci. 2016;11(1):182–190.
the student clinician. This was addressed by campus-wide disciplines (eg, psychology, 10. Grossman P, Niemann L, Schmidt S, Walach
social work), can introduce students to the H. Mindfulness-based stress reduction and
member checking59 and through voluntary
health benefits. A meta-analysis. J Psychosom
participation. Researchers regret not asking tenants of mindfulness, just as TAs are used
Res. 2004;57(1):35–43.
participants more directly about the influ- in physical therapy courses like anatomy and
11. Park ER, Traeger L, Vranceanu AM, et al. The
ence on their personal lives, although this orthopedics. development of a patient-centered program
may have prevented authentic responses due For practicing clinicians, site directors and based on the relaxation response: the Relax-
to the sensitivity of such a question. Ques- supervisors can approach local profession- ation Response Resiliency Program (3RP).
tions about direct patient care and productiv- als to more formally support mindfulness- Psychosomatics. 2013;54(2):165–174.
ity would have added valuable information based stress reduction initiatives. Employers 12. Lemaire JB, Wallace JE, Lewin AM, de Grood
for employers. who foster such initiatives, such as the Mayo J, Schaefer JP. The effect of a biofeedback-based
Furthermore, the brief, informal mind- Clinic, can only benefit from clinicians who stress management tool on physician stress: a
are productive, patient-centered, safe, and randomized controlled clinical trial. Open
fulness activities (Table 1) were inconsistent
Med. 2011;5(4):e154–e163.
with formal mindfulness practices with a who manage stress effectively.17 Likewise,
13. Kabat-Zinn J. Full Catastrophe Living: Using
skilled teacher. Had the student coauthors department administrators are in a position
the Wisdom of Your Body and Mind to Face
been formally trained, they may have had an to include mindfulness materials in orienta- Stress, Pain, and Illness. New York, NY: Ran-
even greater influence on their participants tion documents, open weekly meetings with dom House; 2013.
because they could have offered more breadth mindful practices, and provide space to al- 14. Smith SA. Mindfulness based stress reduction:
and depth to the teachings. Likewise, the par- low PTs to commit to decreasing stress in an intervention to enhance the effectiveness of
ticipant clinicians may have been biased to- the workplace. Finally, the American Physi- nurses’ coping with work-related stress. Int J
ward positivity with mindfulness since they cal Therapy Association (APTA) can lead Nurs Knowl. 2014;25(2):119–130.
actively sought out participation and “want- efforts to offer continuing education courses 15. Shapiro SL, Astin JA, Bishop SR, Cordova M.
ed” to reduce stress using these methods. and share resources for evidence-based stress Mindfulness-based stress reduction for health
reduction. Future research should focus on care professionals: results from a randomized
Given the exploratory nature of this study,
the impact of mindfulness on compassion trial. Int J Stress Manag. 2005;12(2):164–176.
investigators were curious how mindfulness
fatigue, burnout, workplace productivity, pa- 16. Krasner MS, Epstein RM, Beckman H, et al.
would be perceived by PTs. Of interest, recent
tient care outcomes, and patient satisfaction. Association of an educational program in
evidence shows that short, informal practices mindful communication with burnout, empa-
within the scope of daily life have direct ben- thy, and attitudes among primary care physi-
efits (sustained after 12 months) on positive Acknowledgement cians. JAMA. 2009;302(12):1284–1293.
affect, wellbeing, job satisfaction, quality of Thank you to the physical therapists who 17. Sibinga EM, Wu AW. Clinician mindfulness
life, and compassion.54 In this study, a follow- shared their experiences with us. and patient safety. JAMA. 2010;304(22):2532–
up (1–3 months) would have added valuable 2533.

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18. A
 merican Physical Therapy Association. Pro- 32. L
 arouche E, Hudon C, Goulet S. Potential 46. C arlson E. Overcoming the barriers to self-
fessionalism in Physical Therapy: Core Values. benefits of mindfulness-based interventions knowledge: mindfulness as a path to seeing
http://www.apta.org/uploadedFiles/APTAorg/ in mild cognitive impairment and Alzheimer’s yourself as you really are. Perspect Psychol Sci.
About_Us/Policies/Judicial_Legal/Profession- disease: an interdisciplinary perspective. Behav 2013;8:173–186.
alismCoreValues.pdf. Updated July 27, 2012. Brain Res. 2015;276:199–212. 47. Dunning D, Heath C, Suls JM. Flawed self-
Accessed December 8, 2014. 33. T
 ang YY, Lu Q, Fan M, Yang Y, Posner MI. assessment: implications for health, education,
19. I rving JA, Dobkin PL, Park J. Cultivating Mechanisms of white matter changes induced and the workplace. Psychol Sci Public Interest.
mindfulness in health care professionals: a re- by meditation. Proc Natl Acad Sci U S A. 2004;5:69–106.
view of empirical studies of mindfulness-based 2012;109(26):10570–10574. 48. Jain S, Shapiro SL, Swanick S, et al. A random-
stress reduction (MBSR). Complement Ther 34. S malley SL, Loo SK, Hale TS, et al. Mindful- ized controlled trial of mindfulness meditation
Clin Pract. 2009;15(2):61–66. ness and attention deficit hyperactivity disor- versus relaxation training: effects on distress,
der. J Clin Psychol. 2009;65(10):1087–1098. positive states of mind, rumination, and dis-
20. D
 eckard GJ, Present RM. Impact of role stress
traction. Ann Behav Med. 2007;33(1):11–21.
on physical therapists’ emotional and physical 35. M
 iller CK, Kristeller JL, Headings A, Nagaraja
well-being. Phys Ther. 1989;69(9):713–718. H, Miser WF. Comparative effectiveness of a 49. Santarnecchi E, et al. Interactions between
mindful eating intervention to a diabetes self- neuroanatomical and psychological changes
21. G
 authier T, Meyer RM, Grefe DG, Gold JI. An after mindfulness based training. PLOS One.
management intervention among adults with
on-the-job mindfulness-based intervention 2014:9(10):1–9.
type 2 diabetes: a pilot study. J Acad Nutr Diet.
for pediatric ICU nurses: a pilot. J Pediatr Nurs.
2012;112(11):1835–1842. 50. Marchand WR. Neural mechanisms of
2015;30(2):402–409.
mindfulness and meditation: evidence
36. d
 e Bruin EI, Blom R, Smit FM, van Steensel
22. R
 eid DT. Teaching mindfulness to occupa- from neuroimaging studies. World J Radiol.
FJ, Bögels SM. MYmind: mindfulness training
tional therapist students: pilot evaluation 2014;6(7):471–479.
for youngsters with autism spectrum disorders
of an online curriculum. Can J Occup Ther. 51. Strauss A, Corbin J. Basics of Qualitative Re-
and their parents. Autism. 2015;19(8):906–914.
2013;80(1):42–48. search. Techniques and Procedures for De-
37. B
 ergen-Cico D, Possemato K, Pigeon W. Re-
23. F
 rewen PA, Evans E, Maraj N, Dozois DJ, veloping Grounded Theory. London, United
ductions in cortisol associated with primary
Partridge K. Letting go: mindfulness and Kingdom: Sage Publications; 1998.
care brief mindfulness program for veterans
negative automatic thinking. Cogn Ther Res. 52. Creswell JW. Research Design: Qualitative,
with PTSD. Med Care. 2014;52(Suppl 5):S25–
2007;32:758–774. Quantitative, and Mixed Methods Approaches.
S31.
3rd ed. Thousand Oaks, CA: Sage Publications;
24. M
 orone NE, Lynch CP, Losasso III VJ, Liebe K, 38. C
 offey KA, Hartman M. Mechanisms of action 2009.
Greco CM. Mindfulness to reduce psychoso- in the inverse relationship between mindful-
cial stress. Mindfulness (N Y). 2012;3(1):22–29. 53. Jazaieri H, McGonigal K, Thupten J, Doty JR,
ness and psychological distress. J Altern Com- Gross JJ, Goldin PR. A randomized controlled
25. M
 asuda A, Tully EC. The role of mindfulness plement Med. 2008;13(2):79–91. trial of compassion cultivation training: effects
and psychological flexibility in somatization, 39. F
 arb NA, Segal ZV, Mayberg H, et al. Attend- on mindfulness, affect, and emotion regula-
depression, anxiety, and general psychologi- ing to the present: mindfulness meditation tion. Motiv Emot. 2014;38(1):23–35.
cal distress in a nonclinical college sample.
reveals distinct neural modes of self-reference. 54. Fortney L, Luchterhand C, Zakletskai L, Zgier-
J Evid Based Complementary Altern Med.
Soc Cogn Affect Neurosci. 2007;2(4):313–322. ska A, Rakel D. Abbreviated mindfulness in-
2012;17(1):66–71.
tervention for job satisfaction, quality of life,
40. L
 utz A, Brefczynski-Lewis J, Johnstone T,
26. H
 olzel BK, Lazar SW, Gard T, Schuman-Oliv- and compassion in primary care clinicians: a
Davidson RJ. Regulation of the neural cir-
ier Z, Vago DR, Ottu. How does mindfulness pilot study. Ann Fam Med. 2013;11(5):412–
cuitry of emotion by compassion meditation:
meditation work? Proposing mechanisms of 420.
effects of meditative expertise. PLoS One.
action from a conceptual and neural perspec- 55. Geschwind N, Peeters F, Drukker M, van Os
2008;3(3):e1897.
tive. Perspect Psychol Sci. 2011;6(6):537–539. J, Wichers M. Mindfulness training increases
41. M
 razek MD, Mooneyham BW, Schooler JW.
27. Z
 eidan F, Grant JA, Brown CA, McHaffie JG, momentary positive emotions and reward ex-
Insights from quiet minds: the converging
Coghill RC. Mindfulness meditation-related perience in adults vulnerable to depression:
fields of mindfulness and mind-wandering.
pain relief: evidence for unique brain mecha- a randomized controlled trial. J Consult Clin
In: Schmidt S, Walach H, eds. Meditation-
nisms in the regulation of pain. Neurosci Lett. Psychol. 2011;79(5):618–628.
Neuroscientific Approaches and Philosophical
2012;520(2):165–173. 56. Desbordes G, Negi LT, Pace TW, Wallace BA,
Implications, Studies in Neuroscience, Con-
Raison CL, Schwartz EL. Effects of mindful-
28. G
 arland EL, Howard MO. Mindfulness-orient- sciousness and Spirituality. Volume 2. Cham,
attention and compassion meditation training
ed recovery enhancement reduces pain-atten- Switzerland: Springer International Publishing
on amygdala response to emotional stimuli in
tional bias in chronic pain patients. Psychother AG; 2014:227–241.
Psychosom. 2013;82(5):311–318. an ordinary, non-meditative state. Front Hum
42. V
 ago DR. Mapping modalities of self-aware-
Neurosci. 2012;6:292.
29. C
 reswell JD, Myers HF, Cole SW, Irwin MR. ness in mindfulness practice: a potential
57. Papes EK, Barsalou LW, Custers R. Mindful at-
Mindfulness meditation training effects on mechanism for clarifying habits of mind. Ann
tention prevents mindless impulses. Soc Psych
CD4+ T lymphocytes in HIV-1 infected adults: N Y Acad Sci. 2014;1307:28–42.
Pers Sci. 2012;3(3):291–299.
a small randomized controlled trial. Brain Be- 43. G
 oldin PR, Gross JJ. Effects of mindfulness- 58. Amutio A, Martinez-Taboada C, Hermosilla
hav Immun. 2009;23(2):184–188. based stress reduction (MBSR) on emotion D, Delgado LC. Enhancing relaxation states
30. P
 ickut BA, Van Hecke W, Kerckhofs E, et al. regulation in social anxiety disorder. Emotion. and positive emotions in physicians through
Mindfulness based intervention in Parkinson’s 2010;10(1):83–91. a mindfulness training program: a one-year
disease leads to structural brain changes on 44. B
 rown KW, Ryan RM, Creswell JD. Mindful- study. Psychol Health Med. 2014;8:1–12.
MRI: a randomized controlled longitudinal tri- ness: theoretical foundations and evidence for 59. Harper M, Cole P. Member checking: can ben-
al. Clin Neurol Neurosurg. 2013;115(12):2419– its salutary effects. Psychol Inq. 2007;18(4):211– efits be gained similar to group therapy? Quali-
2425. 237. tative Report. 2012;17(2):510–517.
31. S impson R, Booth J, Lawrence M, Byrne S, 45. S iegel DJ. Mindfulness training and neural 60. Cisco WebEx. Site administration user guide.
Mair F, Mercer S. Mindfulness based interven- integration: differentiation of distinct streams https://support.webex.com/meetings/mp85/
tions in multiple sclerosis: a systematic review. of awareness and the cultivation of well-being. common/en_US/siteadmin/pdf/wx_sitead-
BMC Neurol. 2014;17;14:15. Soc Cogn Affect Neurosci. 2007;2(4):259–263. min_ug.pdf. Accessed August 17, 2015.

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