Dr Susan Abbey MD, FRCPC
Program Head, Medical and Surgical Psychiatry, TGH
Dr Monica Branigan MD, MHSc (Bioethics)
Professional Development Lead, Division of Palliative Care, U of T
Michele Chaban MSW, D Phil
Co-Director Inter-professional Applied Mindfulness Meditation Certificate, U of T

 To create community around mindfulness in palliative care

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Discuss simple mindfulness interventions designed to benefit practitioners
Review interventions of benefit for people dealing with life threatening illness
Consider mindful questions to address pain and suffering

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Paying attention we can bring awareness to
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Mind
Heart
Body
Each center is associated with different ways of knowing, listening and speaking
Each functions from a different place
 Neocortex
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Limbic system
Brainstem

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Our thinking center
Knowing through rational thought
Listen to content: description, explanation, story, beliefs, assumptions
Speaking: “I think...”
Values: control
Pitfalls: critique, judgment,
“I already know”
 Pamela Weiss

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Our feeling center
Knowing through openness, attunement, acceptance
Listening to feelings, emotions, mood
Speaking: “I feel....”, “I am angry....”
Value: approval
Pitfalls: emotional reactivity- entanglement or distancing
Pamela Weiss

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Our sensing center
Knowing through intuition, perception
Listen to energetic tone, physical cues
Speaking: “I sense......”
Value: safety
Pitfalls: tension, agitation, flight, fight or freeze
 Pamela Weiss

 Mind: tell me what I can do to make the pain better and give me an explanation that makes sense to me
 Heart: let me know that you accept my pain is real
 Body: allow me to feel safe

 Three part check in
 Start with the body: big breath, relax shoulders down, expand back, sides, front
 Bring awareness to your heart: feeling tone or mood
 Notice your thoughts or general flavour: critical, curious….

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Begin with a three part check for yourself so you can meet the patient as a whole person
Invite the patient to check in with their three centers
Notice the energy between you and the patient- are you connected?
 YES: together you work with “the pain”
 NO: the patient remains alone with “their pain”

"When an untaught worldling is touched by a painful (bodily) feeling, he worries and grieves, he laments, beats his breast, weeps and is distraught. He thus experiences two kinds of feelings, a bodily and a mental feeling. It is as if a man were pierced by a dart and, following the first piercing, he is hit by a second dart. So that person will experience feelings caused by two darts....
 Sallatha Sutta

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The standard pain history
Major focus on the body- the first dart
Does not fully acknowledge the second dart
DISCONNECT: as HCPs we often may come from our head center and may ask that our patients respond from their body center

 What do you think about when you have pain?
 Where does your mind go when you have pain?
 Are there any thoughts that trigger your pain?
 Are there any stories that come to you when you have the pain?
 What is the meaning of your pain?

 Tell me about the pain in your heart.
 How does your heart feel the pain?
 What in your life is causing pain in your heart?
 What is your heart feeling ?

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Standard pain history
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Where do you feel the pain?
What words describe it?
What makes it better?
Etc
How does the rest of you body feel?
Are there parts of your body that experience comfort?
Do you sense that your body is trying to tell you something?

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May I check in with myself in order to bring my wholeness to the patient that I may see them as whole and not broken
May I expand my awareness of pain beyond the first dart and allow the patient to explore body, mind and heart
May I see my own frustration and helplessness as something that connects me to the patient and not use it against myself

The MBSR Clinic
Location: Toronto General Hospital
Time: Monday morning, Monday afternoon or
Wednesday evening
Instructors: Dr. Susan Abbey and
Sarah Greenwood, RN, BScN
Cost: $75.00
Call: 416- 340-4452

 Centre for Mindfulness in Medicine, Health Care and Society http://www.umassmed.edu/cfm/index.aspx
see for professional courses and teacher training and annual scientific conference

 Mindfulness Toronto http://mindfulnesstoronto.ning.com/ see for mindfulness courses, events, MBSR and sitting groups
 See posted “Resources” on Community Space

 Applied Mindfulness Meditation at the Factor Inwentash
Faculty of Social work http://www.socialwork.utoronto.ca/conted/certificate/mi ndfulnessmed.htm
 Centre for Mindfulness Studies, Toronto http://www.mindfulnessstudies.com/
 Insight Meditation Center- online http://www.insightmeditationcenter.org/programs/onlinecourses/

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Being with Dying Program at Upaya http://www.upaya.org/bwd/
Metta End of Life Practitioner Program http://mettainstitute.org/EOLoverview.html
Mindful Practice: Focus on Serious and Life-Limiting Illness,
University of Rochester http://www.cvent.com/events/mindful-practice-focus-onserious-and-life-limiting-illness/event-summary-
9a33a7d3cfbe4e4993128c6c7aa1964e.aspx

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UCLA Mindful Awareness Research Center http://marc.ucla.edu/body.cfm?id=22
Tara Brach, Buddhist meditation teacher http://www.tarabrach.com/audiodharma.html
Insight Meditation Centre http://www.audiodharma.org/series/1/talk/1762/
Dan Siegel http://brainsciencepodcast.com/bsp/meditation-and-thebrain-with-daniel-siegel-md-bsp-44.html

Mindfulness Based Cognitive Therapy (MBCT) for People with
Cancer
Facilitators: Dr. Mary Elliott, MD, FRCPC
Dr. Evan Collins, MD, FRCPC
Dates: TBA
Location: Pencer Centre Group Room, 18 th Floor, Princess Margaret
Hospital
How to register: Physician referral required. Please complete the attached referral form and send to sherene.tay@uhn.ca
or fax to
416-946-2047.
Fees: Course covered by OHIP.

MBSR at Wellspring http://www.wellspring.ca/Odette/Programs/Full-List-of-
Programs/Mindfulness-Based-Stress-Reduction.aspx

monica.branigan@utoronto.ca