Mindfulness as a form of self-Care in End-of-Life Care
Dr. Amanpreet Kaur, Ph.D., M.Phil. in Clinical Psychology*
End of Life care is challenging to all persons. This is especially so for professionals and personally working in palliative care settings.
I worked in the area of cancer palliative care as part of my Ph.D. in Clinical Psychology from NIMHANS, Bangalore. I specifically worked closely with professional care providers working at cancer palliative care centres (both hospice and hospitals) in Bangalore. As part of my work, I explored the challenges and needs of the cancer palliative professional and developed Mindfulness Integrated intervention program.
Being a palliative care professional is both challenging and rewarding. Since the young professionals working in cancer palliative care are quite ill-equipped to handle their own grief because they do not have the facility/time/orientation to take care of their own mental health. In addition, senior professionals distance themselves from such difficult emotions more often or psychological hardening takes place in them. Poor self care, poor awareness, running on automatic, with given work related hazards could make these professionals really vulnerable for various psychological disorders and poor overall well-being.
Meditation has been used as an adjunct to therapy and perhaps the oldest of the relaxation techniques for stress management.
It is being increasingly used as part of the approach in the field of mental health care (Bishop, 2002). Mindfulness is the English translation of Pali word ‘Vipassana’ which means ‘to observe in a special way’ (Sharma, 2002). Mindfulness is about being ‘here and now’ (Kabat-Zinn, 1990). “Mindfulness is a kind of non-elaborative, non-judgmental, present-centered awareness in which each thought, feeling, or sensation that arises in the attentional field is acknowledged and accepted as it is” (Bishop et al., 2004).
Mindfulness is cultivated by assuming the stance of an impartial witness to our own experience. Mindfulness Meditation has been used in variant forms as different mindfulness-based/ integrated interventions, though the underlying mechanisms and principles remain same. Mindfulness practice is essentially experiential which involves both formal and informal meditation practices (Hick, 2010).
Formal practices can be done at varying periods of time on a regular basis (for example, sitting meditation, body scan etc.). Informal practices are aimed at developing a continuity of awareness in all activities of daily living (for example, mindful walking, mindful eating etc.) (Kabat-Zinn, 2003). One has to set up time and space for the formal practices while informal practices are carried out as a way of life. To go to a gym one needs equipment, clothing, membership etc. but to practice mindfulness one doesn’t need much except for their openness, awareness and acceptance which further leads to cognitive change.
Letting go and impermanence principles can be made a part of one’s life and behavioural patterns will automatically change. One needs to be aware about one’s physical and mental health.
To take care of one’s mental health, social support, self-care and behavioural changes are enough.
Social support would involve healthy interactions with family or relatives or friends or colleagues where one can share their thoughts and emotions without fearing about the judgement. Having said that, one needs to build an environment where we could act like a lifeguard for others in help.
Self-care not only involves taking care of one’s medical, sleep and food regime, exercising regularly rather regulating one’s emotions, managing one’s time well, involved in pleasurable constructive activities and engaging in gratitude, kindness and compassion. Mindfulness is one form of self-care, which is just a breath away, and to be in present moment one needs to be mindful and grateful. For the beginners it would be better to attend some courses or sessions run by professionals or experienced meditation teachers and later they can follow on their own.
Once one learns to be mindful of the present moment without judging one’s own emotions or others around and do not have the need to react to each and every situation, that in itself builds a certain level of satisfaction and peace. This is an effortless effort which has nothing to do with any certain position or regulation of breath, rather one way of self-management which results in a different perspective towards life. When one starts living adaptively and mindfully, one would be able to embrace the suffering and not be fixated at losing something.
The intervention I had developed and designed under supervision of Dr. Mahendra P. Sharma (Professor of Clinical Psychology at NIMHANS) and Dr. S. K. Chaturvedi (Senior Professor of Psychiatry at NIMHANS) included Mindfulness meditation practice in each session and homework assignments included the same. In the earlier forms of therapy, it was seen that challenging the thoughts (especially about death and grief) or emotions doesn’t really help in all settings and all the time. There comes, third generation cognitive behavioural therapies with concepts of acceptance, introceptive exposure and psychological flexibility using mindfulness.
All these terms are not taught rather individuals experience the changes in how they deal with their thoughts or emotions over a period of time with practice.
There were professionals who couldn’t practice after going back home or the work pressure was too much. However, study showed that they were able to maintain positive changes in their psychological states even after three months from intervention sessions. Most importantly, the feedback given by the participants was really encouraging as the six week intervention helped them in self-care, time management, perspective taking, compassion, empathy and using mindfulness as self-care strategy.
I wish for more and more people to start becoming aware for their psychological health and start practicing mindfulness meditation.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., … & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical psychology: Science and practice, 11(3), 230-241.
Bishop, S.R. (2002). What do we really know about Mindfulness based stress reduction? Psychosomatic Medicine, 62, 71-84
Hick, Steven F. (2010), Cultivating Therapeutic Relationships: The Role of Mindfulness. In: Steven F. Hick, Thomas Bien (eds.), Mindfulness and the Therapeutic Relationship, Guilford Press.
Kabat‐Zinn, J. (2003). Mindfulness‐based interventions in context: past, present, and future. Clinical psychology: Science and practice, 10(2), 144-156.
Sharma, M. P. (2002). Vipassna Meditation: The Art and Science of mindfulness. In: JP Balodhi (Eds). Application of Oriental Philosophical Thoughts in Mental health, (pp. 67-73). Bangalore, NIMHANS
*Dr. Amanpreet Kaur, Ph.D., M.Phil. in Clinical Psychology
Clinical Psychologist and working as Research Fellow (mental health) at George Institute for Global Health, India