Abstract
Alejandro Chaoul, PhD, is the founder and Huffington Foundation Endowed Director of The Jung Center's Mind Body Spirit Institute and an adjunct professor and former director of education at MD Anderson Cancer Center's Integrative Medicine Program, in Houston, Texas, where he teaches Tibetan meditation to cancer patients, their families, and caregivers, and researches the effects of Tibetan mind–body practices with cancer patients. He is also an adjunct professor at the McGovern Medical School at the University of Texas Health Science Center in Houston. Dr. Chaoul has studied in the Tibetan tradition since 1989, and for almost 30 years with Yongdzin Tenzin Namdak and Tenzin Wangyal Rinpoche, completing the 7-year training at Ligmincha Institute in 2000. Since 1995, he has been teaching meditation classes and Tibetan yoga workshops nationally and internationally under the auspices of Ligmincha International and is the research director for Ligmincha International. Here, Dr. Chaoul discusses his insights on the role of meditation in addressing burnout.
This is where meditation can be a great tool. Over 40 years of research shows that there are ways to counteract chronic stress. In 1975, Dr. Herbert Benson from Harvard University published a book based on his research on meditation and stress and coined the phrase “relaxation response.” 1 This response explains the mechanism that counteracts the fight or flight response, empowering the individual's parasympathetic system to resume a sense of normalcy.
As we understand more about the effects of chronic stress—shown to have deleterious effects on almost all the biological systems in our bodies and our brain—there are more research studies on mind–body practices to mitigate stress. Unmanaged chronic stress can also speed the aging process through shortening of our telomeres (which protect the integrity of our chromosomes) and can increase the risk for heart disease, difficulties with sleeping, digestive problems, and even depression. 2
During my 20 years at the MD Anderson Cancer Center as a provider and researcher, we found that mind–body practices such as meditation, Indian and Tibetan yoga, and t'ai chi do not necessarily cure cancer, but they significantly improve the quality of life of patients and their caregivers as an adjunctive therapy. What was also clear is that one's stressors, regardless of the why or what, can also lead us to forego healthy habits (including eating, exercise, and mind–body practices). This is one of the many reasons we must remember to train in focusing, and thus calm our minds—disengaging from the stressor and reconnecting to ourselves. To help with this, we can use the breath, for example, with a meditation tool such as the STOP formula:
Stop
Take a deep breath
Observe how you are feeling (as you keep breathing)
Proceed (when you are ready to do so more calmly and focused)
This can take 45 seconds to a couple of minutes, and it can become a great tool to recalibrate during a busy day.
And as I mentioned earlier, it is characterized by a sense of energy depletion or feeling exhausted physically, emotionally, and mentally. In addition, the Maslach Burnout Inventory™ for health care providers includes scales of depersonalization and personal accomplishment. In other words, burnout can manifest as impersonal responses to patients and a lack of professional achievement.
At MD Anderson, I started teaching meditation classes for patients and caregivers. As we started researching the benefits and publishing them, our colleagues asked, “what about us?” So, I started offering classes for faculty and staff. At the same time, teaching at UT Medical School in Houston, students from the integrative medicine class asked me whether I would offer meditation sessions for them. These expanded over the years to include staff and faculty and now, during COVID-19 times, we continue the meditations through online platforms. The feedback has been increasingly positive over the decade of running these meditations to health care providers and students of health care professions—medicine, nursing, dentistry, and public health.
A number of research studies show that meditation, mindfulness, yoga, and other mind–body practices can help health care professionals with stress and burnout. This is exemplified in Leonard Calabrese's article “Why Mindfulness/Meditation is a ‘No-Brainer’ for Health-Care Professionals.” 3
In my experience with health care professionals, they want to learn: Simple practices that they can include as part of their lifestyle. Mostly focusing on breath, simple visualizations, and sometimes adding a simple movement or sound. Tips to be able to STOP, as I mentioned before, like washing one's hands more mindfully as they go from one patient to another or one meeting to the next (now even more useful during COVID-19), taking a moment to breath between one Zoom or Webex, and taking a moment to stop and breathe in a red light, instead of grabbing the phone and sending a message. Trainings, including some of the mind–body research, and how they can create their own toolbox of mind–body practices to deal with stress and burnout. I call it CPR, which in this case stands for compassionate professional/personal renewal.
The CPR programs can be tailored to the organization, hospital, medical school, etc. We see what the needs are and create a program accordingly. This could be a combination of weekly meditations, workshops, as well as handouts and recordings that they can use as resources. Now, for example, for UT Health I do 15-minute meditations twice a week, to help support giving them a break of the day, and include some weekly topics, such as “Paying Attention to our Fatigue and Exhaustion with Compassion,” and record some meditation videos on helping with anxiety, stress, and sleep disturbances.
We have also realized that these programs may be needed beyond health care, and so we extended these programs to what we call four areas of impact: health care, education, corporate, and community. Since COVID-19 restrictions applied, we started weekly free meditations, some of 15 minutes, some 30 minutes, and some 1 hour, under the title of the Power of Community to support all people who need them. Meditation and mind–body practices can help one cope, feel a little better, and reconnect to a sense of normalcy. Particularly done in a group, even online, there is a sense of support in the community.
The continued use of these practices can help us move from CPR to flourish. In some traditions, they use the lotus flower as a symbol of restoration and renewal. It is a plant that grows its roots in the mud, and yet flourishes beautifully as it blooms above. Some say, “no mud, no lotus,” and the same stress and burnout can be the mud that can be the ground for us to use these practices, first as CPR and as continued, to flourish.
For me it is important that we think of stressful situations, such as COVID-19, and the lessons learnt, as a community. It is not just about one of us learning from these experiences, but each of us, so that we can have a whole community of flourishing individuals—a flourishing community. I picture it as a pond full of lotuses.
We are now at a point in our culture where meditation is no longer weird or esoteric. Science, medicine, and the humanities have created a large compendium of knowledge, proving the benefits of mind–body practices, including meditation. Thus, it has become an opportunity for these programs to reach a wider audience. At the same time, it does not mean that they are a panacea. It is important to know why we would like to practice meditation or implement a meditation program. And that is part of what is discussed in a tailored program. It is a question that must be answered on both an organizational and individual level.
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E-mail: achaoul@junghouston.org
For organizations wishing to address stress and burnout, you know that these tools can help your providers, which are undoubtedly the most valuable asset to any health system. And so, the question to reflect on is, are you providing these opportunities for yourself and others in your workplace? Are you creating space during the day for meditation or other tools for self-care? What is the duration and frequency of these opportunities? Are the leaders practicing too, or at least involved in the program? These are all very important questions, which are both challenges and opportunities. They will undoubtedly impact the individuals' process, the relationship with self-care, and the well-being of your organization, and your community.▪