Mindfulness And Emotional Intelligence

Editor's Note: This text-based course is a transcript of the webinar, Mindfulness And Emotional Intelligence, presented by Ingrid Provident, EdD, OTR/L, FAOTA.

Learning Outcomes

• After this course, participants will be able to differentiate the basic principles of mindfulness and emotional intelligence.
• After this course, participants will be able to examine brief mindfulness practices and share personal reflections.
• After this course, participants will be able to examine how to utilize in times of stress and burnout.

Introduction

Thanks to all of you for being here today. Hopefully, you know something about this particular topic. Let's start with definitions.

Definitions

What is Mindfulness?

• Mindfulness is the self-regulation of attention with an attitude of awareness, curiosity, openness, and acceptance.
• Mindfulness is the idea of learning how to be fully present and engaged in the moment, aware of your thoughts and feelings without distraction or judgment.
• Strong Fit with OT Practice: Valuing the Mind-Body as a Whole Being.
• Mindfulness is both a meditative practice and a means to enhance the experience of occupations.

Mindfulness comes from a long tradition in the Buddhist tradition; however, mindfulness has become more secular and less religious. It is more of a practice, particularly in occupational therapy. Mindfulness is the self-regulation of having attention with an attitude of awareness, curiosity, openness, and acceptance. They say this is like having a childlike mind, where you come into situations with a degree of looking at it with some novelty.

Mindfulness is learning to be completely present and engaged in the moment. It is being aware of how our thoughts and feelings are causing our body to respond without judgment. It is not saying that fearful or angry feelings are necessarily bad. Feelings come and go. You need to help yourself first and then teach patients, children, or students how to utilize these mindfulness practices so they can be more aware of what their thoughts are and how their ideas may be directing their behavior. Mindfulness can help clients modify their behavior to promote positive outcomes.

There is a strong fit of mindfulness with occupational therapy practice. We, as OT practitioners, value the mind and body as a whole being. It is understanding how our thoughts guide our feelings.

It is also said that mindfulness is a meditative practice. It can be a therapeutic intervention in and of itself or a preparatory activity to help enhance our occupations. Throughout today's presentation, I will be talking about how mindfulness can be used to bolster your health and well-being. It can also be utilized by the persons you care for as an occupational therapist. I will be flipping back and forth between those two perspectives.

This topic is about both mindfulness and emotional intelligence, as these are linked.

Emotional Intelligence

• An individual's interpersonal and intrapersonal skills, such as communication skills, empathy, and professionalism. It encompasses a host of behavioral competencies that are independent of IQ and other knowledge-based technical skills.

Emotional intelligence is an individual's interpersonal and intrapersonal skills. It encompasses how someone communicates, how they demonstrate empathy or feel empathy, and how they act professionally. Emotional intelligence is how our emotions come across in our behaviors. It encompasses a whole host of behavioral competencies, and these things are independent of our intellectual quotient, our IQ, or our knowledge-based technical skills.

We may be good therapists and know how to deliver interventions using physical agent modalities or neuromuscular facilitation. However, if we do not do that in a way that demonstrates empathy or communicates in a way that the patients understand, our emotional intelligence may need some bolstering.

Mind Full or Mindful?

I love this graphic in Figure 1.

Figure 1. Mind full or mindful illustration.

The dog's mind bubble represents exactly what is in the environment in front of them, whereas in the person's mind bubble, you can see all these thoughts running through their head. Often, we have many distracting thoughts and are not mindful. We need to be more like the dog and put the distracting thoughts on a shelf, if you will.

Mindfulness is being present in the moment. The ideal would be what the dog sees; however, none of us are simple-minded. Do not equate simple-mindedness as being negative. It is just not having anything else that is distracting you so you can genuinely experience things encompassing your entire body and senses. Being mindful is our mind and body linked together. You are only present with what is happening at that particular moment.

How Do the Concepts Relate?

• Mindfulness Practice Can Improve Emotional Intelligence
• Stimulus  --------------Response
• Mindfulness with Emotional Intelligence is the integrated practice of being attentive to and aware of one's present circumstances and reactions to them. It is the ability to allow life experiences to come and go without holding on to, running away from, or trying to control them. It is the ability to notice both what is happening and our reaction to it while simultaneously considering the effect on others.

How do these two concepts relate? The ability to practice mindfully can improve emotional intelligence and promote emotional regulation. It often mitigates impulsivity by increasing the gap between the stimulus and response. Viktor Frankl wrote "Man's Search for Meaning" about surviving horrors in a Nazi death camp during World War II. He says between a stimulus and a response. There is always a space or a pause. This space or pause allows us to choose our response rather than having an immediate reaction. The space is what we want to utilize mindfully. When we marry mindfulness with emotional intelligence, we get an integrated practice of being attentive and aware of one's present moment and what our reactions to that moment are.

Mindfulness practice increases our internal operating system. Sometimes a spinning wheel appears when we click a computer button. We want a response that reflects what is necessary, not a long spinning wheel, but we also do not want to react in an emotional, quick way that we regret later. Knowing this is the first step, but we want to embody these concepts to respond to stimuli thoughtfully and professionally.

In essence, emotional intelligence is the ability to allow life experiences to come and go and not hold on to them or throw them back in somebody's face if they have offended you. It is also not escaping difficult situations or trying to control everything. It is the ability to notice what is happening and, more importantly, see our bodily response. We use emotional intelligence to do things that we feel proud of and that have a good effect on others.

Mindfulness and OT

• Used as or part of intervention for:
  • Musculoskeletal and Pain Disorders
  • Neurocognitive and Neuromotor Disorders
  • Urinary Incontinence
  • Vestibular Dysfunction
  • Depression and Anxiety
  • Cancer-related Fatigue
  • Social Emotional Learning
  • Focus and Attention
  • Self-regulation

Let's talk a little bit more about mindfulness in occupational therapy. When preparing for this lecture, I noticed many more applications of mindfulness. I have used mindfulness in my practice with students in a college setting to decrease anxiety. I have also used it with people who are going through a traumatic event, unable to experience pain in a particular manner, have avoiding behaviors, or have a lot of anxiety. Mindfulness has allowed these groups to be more skillful in responding to life events.

Within the literature, I think you will easily find how mindfulness is integrated into occupational therapy as an intervention or as a preparatory activity for persons with musculoskeletal and pain disorders. It can be used for persons who have neurocognitive or neuromotor disorders causing emotional regulation issues. We can use mindfulness as an intervention to help them understand the feelings they are having in their body and be able to create more purposeful responses.

I never thought of using mindfulness for urinary incontinence, but it makes sense when I think about it. It is using the knowledge of noticing the sensations in your body. Mindfulness has also been shown to positively affect persons with vestibular dysfunction. Again, this awareness of what is happening in the body at a particular time.

Probably the most documented application of mindfulness is with persons experiencing depression and anxiety. It can also help someone with fatigue and give them more energy to do the things they choose to do. Social-emotional learning in schools with children utilizes mindfulness ideas, particularly for those who do not know how their responses affect their relationships with others.

Finally, mindfulness can affect focus, attention, and self-regulation. 

Practice Settings

• Mindfulness programs are used in a myriad of healthcare / social contexts:
  • Schools
  • Workplaces
  • Clinics
  • Hospitals
  • Prisons
  • Corporate Offices
  • Military/Civil Services

Mindfulness has been shown in many different practice settings, including schools. It can be used with kids as young as elementary school. Mindful practices such as deep breathing and relaxation can decrease anxiety related to test-taking, for example. Mindfulness is used in workplaces and corporate offices like Google, Microsoft, and other high-stress workplaces where people have a lot of burnout.

Mindfulness has been used in clinics serving clients of lower socioeconomic status who may be waiting in lines for long periods and have increased anxiety related to medical procedures. Mindfulness has been integrated into hospitals through yoga and relaxation programs.

Another area is its application to those who are incarcerated. Occupational therapists in jails and prisons have used mindfulness to work on anger management or emotional regulation.

Other areas of mindfulness programming in the literature include the military and government services like the post office. It is becoming more mainstream.

Mindfulness for Stress Reduction

• Stress can be caused by many competing demands:
  • Work responsibilities
  • Family responsibilities
  • Internal desires
  • External Forces

As I said, mindfulness was introduced as a stress reducer in the literature. This is not a presentation on stress, but we will talk about stress before we start our first mindfulness practice. Stress can be caused by many things. I do not think it is news to any of you how stress is related to work responsibilities, particularly those of us who worked through COVID. There was a lot of stress related to things out of our control. Now that we are in a more post-COVID world, people still have increasing work responsibilities. I continually hear that most are being asked to do more with fewer resources. 

Mindfulness allows us to put a boundary around things or disassociate with some of the crazy-making in our brain regarding work and family responsibilities. We may have to care for younger children, older adults, a spouse, or yourself. There can be many responsibilities to keep your personal life working. These things may be behind the scenes, but they can add stress.

I never considered this a stress-producing entity, but sometimes our goals and aspirations can cause stress. Our goals may be too lofty. We may have plans about how much money we want to save or places we want to go. These things can add up and cause us stress.

External forces, like the weather or our daily commute, are out of our control. All of these things can cause stress in our lives.

Where Do We Experience Stress?

• Physical
  • Headaches
  • Muscle Tension
  • Chest Pain
  • Fatigue
  • Upset Stomach
  • Sleep Issues
• Mental
  • Anxiety
  • Restlessness
  • Lack Of Motivation
  • Lack of Focus
  • Anger
  • Depression
• Behavior
  • Tobacco /Drug Use
  • Over-eating
  • Social Withdraw
  • Physical Outbursts
  • Less Exercise

Stress can manifest physically, such as headaches and muscle tension. There has been documentation of chest pain coming from anxiety or stress. Stress can leave us tired and not feeling like we have the energy to do the things we want. It can cause an upset stomach or an inability to quiet our minds for proper sleep.

We can feel anxious or restless. Stress can reduce our motivation to do things we have to do or want to do. We can be unfocused, angry, disassociated, apathetic, or depressed.

Our behaviors can either cause stress or come from wanting to reduce stress. We may use tobacco or drugs to reduce stress or help us to sleep. We might try to squelch some of the stress by overeating or eating things that are not good for us. We may socially withdraw from people that we enjoy or have outbursts. We may feel that we do not have time and therefore exercise less. This all leads to a downward spiral.

Stress is not necessarily a bad thing. Sometimes people work well under stress. I have taught in university settings for 20-plus years, and many students say this.

Stress Reactivity

• Stress – nonspecific bodily response to any pressure or demand, internal or external. How we react to stress is important to our health and well-being!
• Wandering mind leads to decreased perception and creative responding: how we see things (or don't see them)
• It is not the stressors that affect us but how we handle them (or deny, avoid, magnify, or otherwise ineffectively cope with them).

Stress is this nonspecific bodily response to any particular pressure or demand. Those demands, as we talked about, could be internal or external. How we react to stress is key to how our health or well-being is promoted. We may have a wandering mind when stressed, like the thought bubble we saw earlier. We can have decreased perception or creative responses with a wandering or busy mind. Or we may think there is more to do than there is.

We need to separate those things that are desires from necessary things. Think about Maslow's hierarchy. We need to do things at the bottom of the pyramid to ensure we are meeting our physiological needs to complete higher levels like self-esteem or those we aspire to do. Mindfulness can be seen as the base where we are taking care of ourselves or teaching people to take care of themselves. Remember, it is not the stressors that are the problem, but it is how we handle those stressors. What do we do? Do we deny them, avoid them, magnify them, make them seem more significant than they are, or ineffectively cope with them? Mindfulness and emotional regulation are the ways we can cope with these.

Building Our Mindfulness & Emotional Intelligence Muscles

• Just like lifting for strength training, start with smaller weights- shorter time frames
• Incrementally add time and weight
• Practice builds the habit
• Start in calm situations (lighter weights)
• Focus your mind to pay attention to your thoughts
• Let go of judgments
• Goal to habitually respond skillfully in stressful situations

How do we build mindfulness and emotional intelligence into our habits? It is like strength training and building muscles. We start with lifting smaller weights. If you want to become more mindful, I suggest taking five minutes instead of sitting for 60 minutes and meditating. You can then incrementally add time and weight. What I mean by weight is doing meditation when you are more stressed and have more on your mind. It is good to start mindfulness when you are not stressed so you can build that habit. Starting in calm situations is like using lighter weights, focusing your mind on paying attention, and letting go of judgments and thoughts. The goal is to notice how your body feels in particular situations and then skillfully respond to stressful situations when they arise.

Mindful Occupation

• Occupational Presence- "Fully here"
• Occupational Awareness- "Non-reactive observer"
• Occupational Engagement- "Joyful participation"
• Occupational Well-being- "Emotional Balance"
• Occupational Fulfillment- "Feeling Blissful"

Goodman, V., Wardrope, B., Myers, S., Cohen, S., McCorquodale, L., and Kinsella, E.A (2019). Mindfulness and human occupation: A scoping review. Scandinavian Journal of Occupational Therapy, 26(3), 157-170, DOI: 10.1080/11038128.1483422

This is one of the most impactful articles that I read. It is a scoping review published in 2019. The researchers looked at over 900 articles related to mindfulness and its applicability to occupational therapy. They found five particular themes in the literature. The first is occupational presence. How fully are we present when we are engaged in a specific activity? Occupational presence is this notion of being in the place where the action is happening. It is being fully present where you are and what you are doing. One example of not being present is when we drive home and do not even remember doing it. It is paying less attention to automatic things. To be fully present, you pay attention to everything that is happening with all of your senses.

The next theme was occupational awareness. This is when you are a non-reactive observer. When something stressful is happening, rather than reacting, you sit and notice how your body feels and are aware of what is going on. We will do a very brief exercise in a moment that talks about non-reactive responses and taking away judgment.

Occupational engagement is when we are joyfully choosing to participate in particular things. It might be taking a walk without answering texts. If we pick an activity that we enjoy, we should experience all of the things related to that. 

The fourth theme is occupational well-being. One of the foundational elements of occupational therapy is to achieve this balance. This is the balance of what you are spending your time doing. As occupational therapists, we do occupational profiles with clients to assess this area. We ask patients what they do and how they engage in their time. The theme of occupational well-being goes a step deeper and looks at emotional balance. How many activities do you engage in during the day that bring you joy and happiness? And how can you monitor that so that you are making good life choices to support your wellness and that you emotionally enjoy?

Occupational fulfillment reflects those things we choose and love to do. I love to spend time creating things. I am not a very good painter, but I enjoy painting pictures. I also enjoy quilting. I enjoy doing those things. Sometimes I feel like I do not have a lot of time to do it, but the weeks that I do carve out time to pick occupations that I enjoy are when I feel the best. Regardless of what the outcome is, I enjoy the process. 

Breathing/Body Scan

• Let's Practice
  • Scale of 1 to 10:
  • 1 being tense 
  • 10 the most relaxed
  • Rate where you are now as far as relaxation

I want to begin with one of the three simple meditations that might benefit you. You start by giving yourself a rating, one being the tensest and ten being the most relaxed. Think of that number. You can ask your patients this before and after a body scan. They are similar to a pain profile and can be found on Google.

Mindfulness has a lot of anchors, and one of the anchors can simply be noticing your breath. Let's try it.

Sit in a comfortable position and breathe in a relaxed fashion. Let your feet rest on the floor. Let your hands rest in your lap. Keep your spine tall. And begin to bring your awareness to your breath. The feeling of breathing in and out of your body. Next, focus your attention on the bottom of your feet. And notice the feeling of your feet on the floor. Perhaps you'll notice how the socks feel on your feet. Or if you're wearing shoes, be curious about the sensations in your feet. Notice if there is any tension that you're holding in your feet.

Concentrate as if you are breathing the air that you are breathing in through the bottom of your feet. And then, as you exhale through the bottom of your feet and become more aware of your breath, see if you can imagine with each in-breath, allowing the attention or awareness to sharpen, and notice what's happening in your feet. And with the next out-breath, allow any tension or tightness to be released from your feet. So when you breathe in, focus your attention, and when you breathe out, release any tension that you're feeling there. Now I want you to move your awareness up to your lower legs and allow your attention to settle there for a moment.

When you breathe in and breathe out, imagine that it's going in and out through your calf muscles. Notice if you have any tightness or tingling in this area of your body. Notice the air on your skin or the clothes against your lower legs. And see if you can be aware, with the in-breath of any sensation in your lower legs and with the out-breath, releasing any tightness. If your mind is wandering, notice that. And with an attitude of kindness, bring your mind back to doing this body scan. And we'll continue up to our thighs, so as you bring in the next breath of air, notice any sensation in your thighs. And with the out-breath, release any tension you might be holding in this area of your body.

As we continue the body scan, bring your in-breath to your belly and to your back. Notice any tightness or tingling that you're feeling there. And with the out-breath, let any tension go. Take a moment now to bring your awareness to your shoulders and your arms, and with your in-breath, notice any sensation that you're feeling here. Notice the clothing on your skin. Notice any tightness you might be holding in your shoulders. And with the out-breath, let that go. Finally, let's bring our awareness to our necks and to our heads. Do you notice any tightness in your jaw or in your forehead?

If so, breathe in and out through this particular area of your body. And with the out-breath, let that go. I'll give you a moment to breathe in and out. Notice any sensations that are in your body. If you can release any tension, just let that go.

As we finish this body scan, I ask you to rate if you are feeling any change in the amount of tenseness that you are feeling or if you feel improvement in relaxation. I did that body scan in a relatively quick manner. You can do it quickly or spend a bit more time teaching patients to do this. This is an effective practice if you are a person who has difficulty falling asleep.

It is moving your busy mind down into your body and noticing the things happening in your body. If your mind wanders or you get off track, bring yourself back. That is the practice. That is what I mean by starting with "lighter weights" and working up to more extended periods. You can do this when you are feeling particularly tense. It is an effective strategy.

This next slide is about our thinking mind. Our thoughts and emotions are very closely linked to our experience of pain. Pain is a primitive signal in our body designed to alert us to something wrong or stressful. We all have experienced pain, but we must realize that sometimes we ruminate on pain and suffering. We can be our worst enemy. I challenge you to think about if your thoughts are drowning you.

Your Thoughts May Be Drowning You

Are your thoughts drowning you and blocking joy, or do you have persistent negative thoughts? Can you move some of your thoughts down into your body? The goal is to separate yourself from your thoughts, not to stop thinking. We can think about our thoughts as drowning in water or safely being in a kayak or onshore noticing our thoughts. This is separating from our thoughts or simplifying them. Thoughts can also feel like waterfalls. They can be beautiful, but you do not want to be stuck underneath them. You are soaked, cannot move, and are paralyzed. Your thoughts should serve you, not the other way around.

A few practical things to build into mindfulness is to think about how you use time. As occupational therapists, we are skilled in this. We help people figure out to utilize energy conservation, work simplification, and time management techniques to increase a person's energy.

Use Time Wisely to Allow Space to Decompress

I also wonder to what degree we think about these concepts for ourselves. Spending five minutes in silence once a day can make a huge difference in increasing your awareness. I challenge you to try it by setting a timer and noticing your thoughts in a tranquil environment. Even out in nature, you can notice the beauty of the sounds around you.

When I give this presentation in large venues of corporate people, I often talk about avoiding being over-scheduled. One of the things I read in the literature that I think is brilliant is scheduling 50-minute meetings instead of 60 minutes. You can generally get something done in 50 minutes to allow you the extra 10 minutes to decompress, take notes, and spend five minutes reflecting before rushing to the next thing. Even if you have patients scheduled, think about a 55-minute hour so you have a short break before the next client. This is particularly helpful for younger children as they learn to transition from one activity to another. It is difficult for their nervous systems to shuffle them from one activity to another without time for decompression.

Focus on the Present: "Occupational Presence"

Another thing to help you focus on the present is to take an inventory to see if your mind is preoccupied with past or future things.

Figure 2.

A good reminder is to check and see if your mind is where your feet are. When you constantly ruminate about the past, you cannot do anything about it. The past is over, and there is not much you can do except learn from it. Do not repeat anything that is within your control not to repeat. And worrying about the future seldom is helpful.

Reminders for OTs

• Stay fully present
• Use all your senses while engaged in the task
• Listen to others
• Scan your body for responses to the situation
• Pause before responding
• Avoid quick reactions
• Engage the Observing Mind

As a reminder, occupational therapists need to stay fully present with our clients. Our patients or clients recognize if we are busy thinking about something else. We must be engaged and actively listening to other people. These are good reminders for your clients and students as well. You can do a quick body scan to see what is happening in particular situations and then give yourself a pause before making a response. Persons who are exceptional at mindfulness frequently avoid speedy reactions. They take in what's happening and make the best decision with the information that they have at present. These are good reminders for you as practitioners and for your patients who may be struggling with anxiety, depression, pain, and all of these same kinds of things.

Eat Slowly and Savor the Flavor

• Consider the source of the food
• Don't rush- Eat Slowly
• Love what you Eat
• Sit at a table without other distractions
• Enjoy the Experience

Occupational therapists often work with clients on feeding. One example of being fully present is slowing down when we eat to savor the food, the flavors, and the food source. We do this daily, so why not do it mindfully by eating slowly and ensuring healthy choices? We also should eat in an environment without distractions, like sitting at a table. You do not attend to your food if watching tv, on the computer, or rushing. Eating should be an enjoyable experience. ]Now, if eating is not your favorite activity during the day, think about an activity you like and do it well. For example, you can be mindful when making the bed by noticing the sheets' texture and the bedspread's colorfulness. You can be mindful while washing the dishes, feeling the sensation of the bubbles on your hand. You can be mindful in any occupation.

Fable of Farmer and Horse: Occupational Awareness

• Mindful Exercise
  • Labeling Thoughts
  • Practice of Non-Judgment

Another mindful experience is how we label our thoughts and practice nonjudgmentally. I will read you a brief fable of a farmer and a horse to illustrate occupational awareness. 

"There once was a farmer who had a very beloved horse, and one day that horse ran away. The farmer's friends and neighbors offered many condolences. 'Oh, you poor man, you have lost your beloved horse. This is a terrible tragedy.' To which the farmer responded, 'Good, bad, who knows?' Several days later, his horse returned to the farm, bringing with it six wild horses, and the farmer's friends and neighbors came to the farmer and praised his good fortune. 'What great luck you now have. Now you have seven horses instead of one. You have more horses to do the work. Your labor should be reduced.' To which the farmer said, 'Good, bad, who knows?" Now attempting to tame one of these wild horses, the farmer's son rode out on the horse's back and fell, breaking his leg. The farmer's friends and neighbors came around, as they often did, and said to the farmer, 'What, terrible luck. You poor man. You have horses, but your son can no longer help you on the farm doing the work, and perhaps his leg will never heal.' To which the farmer said, 'Good, bad, who knows?' Shortly thereafter, a military unit came through the town enlisting all the young able-bodied men to fight in the war. The farmer's son was unable to go because of his wounded leg. And the friends and the neighbors came around and said, 'You lucky man. What great fortune. You are so incredibly lucky to be spared losing your son to the military.' To which the farmer said, 'Good, bad, who knows?'" 

This fable reminds us of some things that happen in our lives to which we add labels. We tend to judge our life experiences as good or bad based on whether our life fortunes offer us what we want or what we do not want, but life rarely matches our expectations or plans. While this story illustrates that we cannot see the big picture of each circumstance, we can always predict our response to that situation. As the farmer did in every perceived misfortune, he did not judge it good or bad because there might be a gift that we could not see yet. And in each perceived success, there may be a hidden cost. I hope this fable allows you to develop a story you are willing to share, even if it is within yourself. It teaches us to step back, zoom out, and remain calm and steady as we ride the waves of life.

There will be many disappointments and celebrations, but if we tightly hold onto our dreams and plans, we frequently find this rocking of emotion. Whereas, if we hold them more lightly, we can be aware of the gifts that come in the things for which we do not plan. Remember, mindfulness is about noticing how we label things. The more nonjudgmental we can become, the less anxiety or emotional pain we may feel.

Occupational Awareness

• Mindfulness non-reactivity
• Metacognition
• Recalibrate the alerting feature of our brain
• Recognize and lessen the consequences of challenging situations in work

Regarding occupational awareness, mindfulness is about not being reactive and using a calculated response, considering both the good and the bad. It is like metacognition in the occupational literature. Metacognition is thinking about how we are thinking. Mindfulness allows us to recalibrate the alerting feature of our brain. If we constantly have these knee-jerk reactions, mindfulness can give us space to lessen the consequences of challenging situations. As clinicians, we can also help those we see as overresponsive or overreactive to develop a pause for a better response.

Remember the Why?

• Why did you choose this work?
• What do you enjoy most about your work?
• Why is it meaningful to you?
• When have you taken some action during your work day to reduce stress, enhance your effectiveness, or improve your sense of well-being? 

If you are feeling any degree of stress at work or burnout, I often tell people to reflect on the why. Why did you choose the particular work that you are doing? It would help if you focused on what you enjoy about your work. Perhaps you have a significant degree of flexibility, which makes some unsavory things palatable. What meaningful activities do you perform at work? You can also give yourself time within your workday to reduce stress and to think about the positives. You can do a body scan or notice judgment.

Occupational Engagement

• Mindfulness combined with movement or meaningful activities has been shown to decrease anxiety.
• Yoga
• Engaged sensory-based ADLs

Occupational engagement is when we combine mindfulness with things that we enjoy and have movement. People who are not comfortable sitting and thinking find that being engaged in mindfulness during an activity adds this element of awareness. Yoga and sensory-based ADLs can do this. As I described, washing dishes, making a bed, brushing your teeth, and eating can be mindful.

Examine Beliefs about Self-Care Mindfulness- Occupational Wellbeing

• Caregivers may believe self-care is selfish
• Small self-care gestures can make a difference
• Practice self-compassion
• Commit to good nutrition, sleep & exercise

I think sometimes we neglect our self-care, which relates to our occupational well-being. As occupational therapists or caregivers, we may feel that taking time for ourselves is selfish. There are so many people we need to help. In my experience, small self-care gestures make me a stronger practitioner and enable me to help people suffering. So, practicing self-compassion is not a selfish act. It adds to your toolbox and increases strength and energy to help others. Occupational well-being is committing to good nutrition, sleep, exercise, and making time for important things.

Create Community-Occupational Fulfillment

• Connect with like-minded individuals
• Help colleagues
• Normalize stress
• Build Mindfulness into the workday

You can create a community, pay attention to the people you are spending time with, and connect with like-minded individuals. You can also help your colleagues feel supported and contribute to a good work environment. And it also normalizes stress when we talk about particular events that may be very stressful. We can build mindfulness into the workday by role-modeling and encouraging our colleagues to do that and building it into our repertoire of interventions.

Environmental Modifications

• Create a comfortable, relaxing environment in a designated place in the work or home
• Staff members can assist in selecting components of work environment.

Any good occupational therapist knows that the person is intricately linked with the environment. We can create a comfortable, relaxing space, either at work or home, and staff members together to do this. It can be like a sensory corner, where a person can go when feeling overwhelmed. It could be a space in your clinic with some element of beauty where people can practice mindfulness.

Mindfulness Is...

• Attention – learning to bring our awareness to our body, our mood, our mind
• Attitude – with openness, non-judging, noncritical, curiosity, patience, and tolerance
• Intention – in the present moment on purpose as a witness to what we are experiencing inside and out
• By changing the way we see ourselves in relation to stress, we change our experience by choosing different responses.

Mindfulness is learning to bring awareness to our body, understanding our mood, paying attention to our mind, and doing it openly and nonjudgmentally. We are not being critical of ourselves or others and doing things with this element of curiosity, patience, and tolerance.

Mindfulness requires that we do this intentionally in the present moment, on purpose. We are witnesses to what is happening, both inside of us and outside of us. By changing how we see ourselves in response to stress or anxiety, we can change the experience by choosing a different response.

Emotional Intelligence Is...

• Emotion – ability to identify one's own emotions
• Awareness – consciously aware of emotions as they happen
• Regulation – regulate emotions and improve awareness of their effects on one's behavior
• EI skills include the ability to accurately sense and empathize with the emotions of other people and use the awareness of emotions to negotiate interactions.

Let's look at emotional intelligence. Emotional intelligence is the ability to identify one's emotions. Mindfulness is identifying our thoughts, while emotional intelligence is recognizing the emotions in our bodies and being consciously aware of how our emotions may trigger reactions to things that may not be serving us. The goal is to regulate our emotions and improve our awareness of how our emotions affect our experiences of tension and stress and how it affects other people. Emotional intelligence skills include the ability to accurately sense and empathize with our emotions and the emotions of other people. We use this awareness of our emotions to negotiate interactions so that people leave feeling respected and heard.

Emotionally Intelligent Healthcare Professionals

• Notice employee dissatisfaction
• Notice Patient / Family Fear
• Recognize that dissatisfaction or fear conveys information about a problem
• Manage emotions in such a way that they provide informative feedback when generating and developing ideas

Emotionally intelligent healthcare professionals notice when other people are dissatisfied. Rather than running away, they talk about it. There is an openness in having uncomfortable conversations. Emotionally intelligent professionals may notice when a patient or a family is fearful or does not understand the instructions we are giving them. Emotional intelligence is stopping and allowing people to talk about what they are scared of or what information they do not understand. We want them to discuss things freely. An example may be that they give us feedback about our interventions. Maybe it is not working for them, and with the discussion, you can generate and develop better treatment interventions.

Loving Kindness

The final thing we will do is a meditation called loving kindness that does not have to be spoken aloud. I read somewhere that people who practice loving kindness sometimes do this in their minds when they notice somebody having a difficult time. They send out these feelings of kindness towards that person. I am going to read you a very simple script of what loving kindness is. Loving kindness can be directed toward yourself, a person you love, a person you are neutral about, or a stranger having a difficult time. Loving kindness can even be sent out to people with whom you hold grudges or have angry feelings.

In essence, loving kindness is saying four things. "May I be happy, may I be healthy, may I be peaceful, and may I be safe." When you direct this to another person, you can say, "May you be happy, may you be healthy, may you be peaceful, may you be safe. Imagine hearing that as a patient who is feeling unheard.

Summary

Thank you for your kind attention throughout this hour. Hopefully, some pearl of wisdom in here allows you to be more mindful or perhaps more emotionally intelligent to help another person.

Questions and Answers

How do you suggest broaching the subject of mindfulness with children in an acute behavioral health setting and meeting them where they are developmentally to increase coping skills?

This is a fascinating and astute question. I use motivational interviewing and ask, "How much do you want to get better at this?" or "Do you want to do this differently?" I have mindfulness exercises that I use as well.

Where did you do your mindfulness training?

The mindfulness training that I went through is called Koru. It is mindfulness, particularly for young adults. I did this as I noticed that more and more students were anxious. So I built mindfulness training into the occupational therapy curriculum so students could feel less anxious and have tools in their toolbox to use in fieldwork and practice settings.

This would be perfect in group treatment with clients who are depressed and have anxiety.

Absolutely. I suggest introducing these in short snippets. You can do body scans or label thoughts, do the fable, and have people talk about things that went well or not so well.

How do you suggest making a goal for this in the acute care setting?

The goal would be to have them do tangible things like ADLs in a way that increases sensory awareness. 

References

Azulay, J., & Mott, T. (2016). Using mindfulness attention meditation (MAO) with a mixed brain injury population to enhance awareness and improve emotional regulation. J Psychol Clin Psychiatry, 6(5): 00372. DOI: 10.15406/jpcpy.2016.06.00372 

Benzo, R. Kirsch, J. & Nelson, C. (2017) Compassion, mindfulness, and the happiness of healthcare workers. EXPLORE, 13(3) 201-206.

Chiesa, A., & Serretti, A. (2009) Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. Journal of Alternative and Complementary Medicine, 15(5) 593-600.

Goodman, V., Wardrope, B., Myers, S., Cohen, S., McCorquodale, L., and Kinsella,  E.A (2019). Mindfulness and human occupation: A scoping review, Scandinavian Journal of Occupational Therapy, 26(3), 157-170, DOI: 10.1080/11038128.1483422 

Hardison, M. & Roll, S.C. ( 2016)  Mindfulness interventions in physical rehabilitation: A scoping review. American Journal of Occupational Therapy, 70(3), 1- 9.

Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The Effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: A systematic review. Mindfulness, 12(1), 1–28. https://doi.org/10.1007/s12671-020-01500-9