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Spiritual Meditation and Health: Research published

At Saybrook University where I work and teach and research, in our Department of Mind-Body Medicine we are proud to contribute to evidence on the interconnectivity of mind-body and spirit for health and wellness.  Our latest research on meditation and health has just been published with @SpringerNature in Journal of Religion and Health (JORH).  “Spiritually focused meditation practices appear to increase the emotional, physical, and spiritual well-being of cancer survivors, which could translate into better physiological outcomes.”  Congratulations to new PhD Dr. Kanishtha Agarwal for taking the lead in this authorship and my colleagues Drs. Heintzman and Kelly for their contributions to this research and publication.  The entire peer-review article is available for all to ready via open-access. Read here: https://rdcu.be/b1KHF

Agarwal, K., Fortune, L., Heintzman, J., & Kelly, L. (2020). Spiritual experiences of long-term meditation practitioners diagnosed with breast cancer: An Interpretative Phenomenological Analysis pilot study. Journal of Religion and Health,(), 1-17. Advanced online publication. https://doi.org/10.1007/s10943-020-00995-9

 

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Unbound for Higher Ed Seekers

I am honored to be featured in hashtagSaybrooks blog hashtagUnbound article touting our mission and accomplishments. https://lnkd.in/e9KQaCW My work in hashtagintegrativehealth care hashtagmindbodymedicine and hashtagmindfulnessatwork in healthcare leadership inspires me each day. Thank you to my colleagues and students. To cite myself, at Saybrook hashtagCIMHS “.You might discover that, when you have finished your Saybrook work, the real work begins and in the process you have changed yourself.”

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Mindfulness for a VUCA Healthcare World

I am cautiously optimistic and also skeptical about the McMindfulness movement (Hyland, 2017; Purser & Loy, 2013).  Critics of proliferating mindfulness training in organizations point to challenges to the ethics (Wolverman, Schwartz, & Schoenberg, 2018) and over-capitalization of the movement (Hyland, 2017).  Plus, the tips provided by popular organizational gurus (e.g., Hougaard & Carter, 2018) sometimes strike me as simplistic, e.g. offer healthy food and drinks, control digital distractions, encourage boundary setting.  Perhaps each small change is meant to be a pebble in the pond towards shifting organizational culture.  Yet none of these tactics are novel, making me wonder why they have not worked up to this point to stem the volatile, uncertain, complex and ambiguous (VUCA) tide.

I teach a course in Reflective Leadership in Mindful Leadership in Healthcare at Saybrook University.  This course is experiential in that we are all doing the Mindful Leader app (Hougaard & Carter, 2018), practicing mindfulness meditation each day in addition to textbook readings and assessing original research.  As an educator and advocate of integrative healthcare, I am committed to integrative healthcare and envision myself as a “pebble in the pond”, creating large changes with small actions (Perlman, Horrigan, Goldblatt, Maizes, & Kligler, 2014). While our Mindful Leadership curriculum focuses on integrative healthcare and mind-body medicine, we have to do this in a VUCA world, where instability is the norm in fields and settings beyond healthcare.  Perlman et al.’s (2014) called for unique leadership to lead integrative healthcare systems, where mindfulness can serve as the connector between self-awareness, self-regulation, and the educated decision making needed to succeed.  They are not alone in suggesting that mindfulness is the answer, as evidenced by the volumes of readings, conferences, and apps readily available.

I admit to a slight mistrust of the panacea of mindful leadership tactics to reform VUCA environments. Turns out that my distrust is at least organic, a reflection of typical norms in the U.S.

Globalization of Trust

According to the Organisation for Economic Co-operation and Development (OECD, n.d.), the U.S. is lower than all but one of the European countries in the survey on trust and on a downward slide.  Generalized trust has declined steadily in the U.S. from 1972 to 2014.  More strikingly, trust in U.S government institutions declined from a rating near 80% trust in 1964 to <20% respondents expressing trust in 2015 (OECD, 2017). Based on this data, the U.S. is a global leader in the diminishment of trust in our institutions.

So, what is going on in the U.S.?  Deteriorating healthcare aside, was not the late 20th century a time of great solidarity, prosperity, and innovation lead by the U.S.?   I suspect a shadow side, the metaphor of the allegory of Plato’s Cave, and possible psychodynamics at play. “Human beings have a knack for getting trapped in webs of their own creation” (Morgan, 2006, p. 207).

Psychodynamics of Organizations and Mindfulness

We remember the Socratic teaching moment drawn in an ancient cave with three prisoners. They were shackled and tied so they could only see the outside world represented in shadows cast by firelight on a wall before them (Plato, VII, 514 a, 2 to 517 a, 7).  They never saw the world outside.  When one prisoner escaped and saw the other side of the cave wall, he was at first shocked but eventually realized that his former reality was false.  He returned to the cave and told his fellow prisoners.  But when he tried to set them free, they threatened to kill him.  Some philosophers argue this allegory shows the dangers of believing empirical evidence ensures knowledge, others claim it shows that people are afraid of higher truths, and others that we are psycho-dynamically predisposed to keeping ourselves trapped (Morgan, 2006).

Mindfulness consultants Hougaard and Carter (2018) admitted that organizational change is not easy and that influencing culture “goes deeper than articulating a set of values and posting them on the wall” (p. 163).  There are multiple practical and observable obstacles to implementing wide-spread change in any organization.  In addition, even in apparently well-functioning organizations, members experience normal psychological injuries, expected and normal hurts that people feel when collaborating with others to reach organizational goals in uncertain environments (Hirschhorn, 1999).

Hirschhorn is a global leader in training organizational consultants in psychodynamic structures (CFAR, n.d.).  I consulted Hirschhorn about his opinions on the current mindfulness movement and its potential to reach to the shadows of organizational prisons.  He positioned mindfulness as a useful tool, a “framework for knowing yourself and for being attuned to the tacit dimensions of organizational life around you.  A kind of tuning in to what is below the surface in yourself and in your setting” (L. Hirschhorn, personal communication, November 12, 2019).  Hirschhorn also pointed me to his blog site and a recent psychodynamic assessment of President Trump (Hirschhorn, 2019). In his post that examines psychological traits for larger organizational manifestations, one point involves the importance of considering how the role one occupies in an organization will describe potential contributions as well as the ability to successfully influence organizational change.  So, in affecting change, we need to remember our place.  In addition, Hirschhorn highlighted the importance of an effective leader marrying basic ideas to the entourage of organizational membership.  In a reframing of this consideration, I return to the challenge of shifting values and a recent personal experience (Donaldson-Feilder, Lewis, & Yarker, 2019).

Saga of an Orthopedic Surgeon: What Can and Cannot be Changed

I recently witnessed an illustration of the personal costs of unresponsive, unmindful leadership in a healthcare organization.  I share this story with the endorsement of the physician involved.  On Thanksgiving Day, I was visiting a hospitalized friend.  Overall, in her many weeks there, I observed the hospital operation was not entirely responsive, and I knew they had no competition in this community for the level of trauma care provided.  But I had several opportunities to observe the surgeon and his staff in this setting.  I was impressed by the level of patient-centered, compassionate care they provided my friend, and her level of trust in them.  On that morning, her surgeon visited her and delivered very unfortunate news.  This news was not about her condition, which improved steadily with his expert and abundant care. Rather, he came to tell her he had quit the hospital system, no longer able to work with inconsistent, unreliable, and inexpert support.

During the next minutes, he calmly explained to us the multiple issues with the organization, and the myriad issues tied to quality patient care that he repeatedly reported to administrators.  He explained he was hampered by so many incompetent systems and unresponsive management that he could not be the effective surgeon and healer he aspired to be.  He repeatedly said he was not burned out, at least not yet, but suffered on a moral level.  I suggested to him, “moral injury” and he concurred:  that was it.  Very soon, he would be returning to his place of residency, a nationally recognized leader in integrative healthcare, to pursue his surgery practice in a more compassionate, like-minded, supportive environment.  He hoped he could someday come back, when the climate of the organization had shifted to a more patient-centered and practitioner-supporting organization and system.

But he was not optimistic about changing the embedded mindset that was generating toxicity in this large, unmalleable organization.  This demonstrates the embeddedness of resistant thinking:  replacing a physician entails hundreds of thousands of dollars cost to an organization, plus loss of quality of care, safety, and patient satisfaction.  Yet this physician was aware of the larger risks of not leaving:  costs associated with burnout are escalating each day, physician suicide incidence is over three times the national average, and the associated costs are deep due to loss of skills, care quality, and sustainability (West, Dyrbye, & Shanafelt, 2018).

I propose that one possible strategy is decentralize, to diminish the size and power of the mega-organizations to smaller, collaborative entities.  Shifting the operations off the mothership onto smaller, innovative operations could be grounded in mindful-selfless-compassionate (MSC) principles, practices, and values.  By de-centralizing control, change makers can introduce the practices touted by Hougaard and Carter (2018) and cultivate MSC cultures.  Further, this could create a fertile ground for adopting integrative medicine models and components.

In an argument I never expected to make, for-profit healthcare does have advantages:  it could benefit from innovation if it leads to improved outcomes.  This approach should ultimately make for more satisfied customers, measurable outcomes, and provide competitive edge.  As I have seen in my association with IM4US (n.d.), we can also include the under-served.

According to Hirschhorn, there will always be psychodynamics to overcome:  These can be better overcome with awareness.  There will also be nay-sayers who prefer Plato’s Cave: leaving them behind requires decisive and hard actions.  At the heart of my proposed evacuate-and-rebuilt strategy are MSC-oriented leaders able to garner support and willing to take risks.  Even my sense of mistrust is optimistic.

Perlman et al. (2014) concluded in their argument for mindful, integrative leadership that each leader and each member should do what they can in the present moment and wait until the foundational support is stronger to do more.  In the meantime, we build up each other, which we can do with MSC practices. Donaldson-Feilder, Lewis, and Yarker (2019) found that mindfulness practices enhanced the leader’s well-being, resilience, leadership capabilities, and possibly their innovation.  The analysis failed to identify which type of mindfulness practice was most effective.  Also, the researchers found little evidence of benefits to the leaders’ direct reports.  Hence, the evidence indicates the leaders should first attend to self, in whatever mode best builds individual self-efficacy.  If we are each attending to self, we need to be less worried about bringing along the other:  they will bring along themselves and also become empowered in the process.

In conclusion, I argue for continuing our individual practices and sharing with members of our organizations and communities and the people we serve.  By cultivating our awareness and also our fortitude, we are preparing for the opportunity of each moment, as it unfolds.  MSC practices are endeavors that remind us we are solitary and concurrently interconnected.  We simultaneously operate at the systems level, joined by our underlying intention to transform healthcare based on shared values.  By taking an MSC approach, we have added tools to achieve sustainable transformation, and in the process, transform ourselves.

I welcome your comments here as we all continue with this important work.

References

CFAR. (n.d.). Dynamics of Consulting.  Retrieved from https://www.dynamicsofconsulting.net

Donaldson-Feilder, E., Lewis, R., & Yarker, J. (2019). What outcomes have mindfulness and meditation interventions for managers and leaders achieved? A systematic review. European Journal of Work and Organizational Psychology28(1), 11-29.

IM4US. (n.d.).  Mission and philosophy.  Retrieved from https://im4us.org/about/mission-philosophy/

Hirschhorn, L. (1999). The workplace within: Psychodynamics of organizational life (Vol. 8). Cambridge, MA: MIT Press.

Hirschhorn, L. (2019, July 22).  Trump’s style of executive functioning. Learning from experience: Larry Hirschhorn.  Retrieved from http://learningfromexperiencelarryhirschhorn.blogspot.com

Hougaard, R., & Carter, J. (2018). The mind of the leader: How to lead yourself, your people, and your organization for extraordinary results. Boston, MA: Harvard Business Review Press.

Hyland, T. (2017). McDonaldizing spirituality: Mindfulness, education, and consumerism. Journal of Transformative Education15(4), 334-356.

Morgan, G. (2006). Exploring Plato’s Cave: Organizations as psychic prisons. In Images of organzations (pp. 207-240). Thousand Oaks, CA:  Sage.

OECD. (2019) About. Retrieved from https://www.oecd.org/about/

OECD. (2017).  Guidelines on measuring trust. Paris: OECD Publishing. http://dx.doi.org/10.1787/9789264278219-en

Perlman, A., Horrigan, B., Goldblatt, E., Maizes, V., & Kligler, B. (2014). The pebble in the pond: How integrative leadership can bring about transformation. EXPLORE: The Journal of Science and Healing10(5), S1-S14.

Plato. Allegory of the cave.  Republic, VII, 514 a, 2 to 517 a, 7. (T. Sheehan, Trans.).  Retrieved from https://web.stanford.edu/class/ihum40/cave.pdf

Purser, R., & Loy, D. (2013). Beyond mcmindfulness. Huffington post1(7), 13.

West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: contributors, consequences and solutions. Journal of internal medicine, 283(6), 516-529.

Wolever, R. Q., Schwartz, E. R., & Schoenberg, P. L. (2018). Mindfulness in corporate America: Is the Trojan Horse ethical?  The Journal of Alternative and Complementary Medicine,  24(5), 403-406.

 

 

 

 

 

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Self-Care: Pursuing the Ultimate Path to Optimal Well-Being

September 8, 2019

The past months I have been engaged in a lot of conversations about self-care.  I sense a self-care zeitgeist arising in communities and healthcare settings.  A spirit is gaining momentum to educate and empower individuals, strengthen communities, and also stem the tide of escalating healthcare costs.  More so, from the humanistic perspective, self-care offers each individual a path to improve their life-quality and become the best they can be.

Self-care topics beckon researchers to reframe medical science and healthcare studies. I am inspired by excellent work done by my students and colleagues along with a wider proliferation of wellness scholarship.  Translating evidence to practice demands inter-professional collaboration and interdisciplinary worldviews, appropriate to an increasing number of scholar-practitioners.  My own self-care workshops and presentations have received enthusiastic responses from healthcare professionals as well as people simply wanting more from everyday living. I see this as a further shift, moving healthcare consciousness from providing cures to promoting optimal well-being.

There is no shortage of information.  One can hardly log onto the internet without encountering news and products to improve wellness.  Myriad educational and commercial offerings flooding inboxes can lead to information overload.  Now is a good time to reflect on how the self-care movement is authentic and meaningful both personally and professionally.

Why Self-Care

Self-care is the collection of actions and attitudes intentionally taken to promote and maintain health, prevent disease, and cope with illness and disability when it occurs.  It functions at several levels: for each individual, as family, and within community.   Self-care practices can be undertaking with or without the support of a healthcare professional.  As well, I see opportunities for healthcare settings to engage in quality education.

To borrow from the World Health Organization (2019), “Just as high quality healthcare is important, high quality self-care is too.”  Quality self-care is particularly important when healthcare access is limited and, in some cases, not available.  Self-care can also be a preferred option in some situations, allowing autonomy and agency, particularly for vulnerable populations.  Self-care is equally important for healthcare providers who are experiencing burnout and lack of well-being at unprecedented rates (Kuhn & Flanagan, 2017).

Key ingredient:  An Appropriate Framework

As a practical matter, adopting a self-care model or framework is key (WHO, 2019).  Plentiful sources are ripe with self-help ideas, possibilities, and solutions, from community programs to self-help articles, from workplace wellness to wellness tourism.  The self-care explorer can easily become inundated by the latest research or practice recommendations.  From a cognitive as well as an idiosyncratic level, it makes sense to first adopt a framework that considers readiness to change, provides integration of various practices, and is rewarding (Prochaska, Redding, & Evers, 2015).  A framework that matches with individual beliefs, preferences, and understanding provides a skeletal structure to support exploring, adopting, and developing practices.

A model is a framework, based on theories and principles, that provides structure.  It allows sense-making, in terms of which practices to adopt and when.  There are various scholarly-based, thoughtful models available.  The best self-care models reach beyond monitoring exercise frequency and whole food eating. Individualization can allow for flexibility according to each individual’s biochemistry, life-style, and preferences.

Here are two models that I find helpful for practice translation as well as suggesting avenues for further research.

The 7 Sources of Health (7SOH)(SoHL7x. com) is an original framework to teach and develop self-care skills and support community health systems.  Drawing from seven sources (Life Purpose, Body, Mind, Emotions, Creativity, Community, and Environment), the model’s education component offers evidence-based practices that individuals can adopt based on their needs and preferences (Russo, & Fortune, 2016).

The Pathwaysmodel is a behavioral medicine approach that directs individuals to improve self-care through three levels of engagement: self-care and skills acquisition, use of community resources, and with professionally administered treatments.  This model is particularly compatible with complementary-integrative practices and mind-body skills, such as mindfulness, guided imagery, self-hypnosis, and biofeedback (e.g., heart rate variability training) (McGrady & Moss, 2018).

Call for Action

In addition to supporting individual self-actualization, quality self-care is a sustainability issue.  Self-care is a need for those who live in communities, who fuel organizations and businesses, and also for the professionals who address healthcare needs.  While the path to better well-being is individual, there is a broader opportunity for collaboration.  Consider becoming a self-care advocate:  because self-care adopted on a community systems level has implications for shifting the future of healthcare.

References

Kuhn, C. M., & Flanagan, E. M. (2017). Self-care as a professional imperative: physician burnout, depression, and suicide. Canadian Journal of Anesthesia/Journal canadien d’anesthésie64(2), 158-168.

McGrady, A., & Moss, D. (2018). Integrative pathways: Navigating chronic illness with a mind-body-spirit approach. Cham, SZ: Springer.

Moss, D. (2019, August 30). Self care in palliative care — Pathways model.  Retrieved from https://www.youtube.com/watch?v=MrYpTUk61_A&list=PLUakTEuPjbFDg-IbovVkI_dRwSCFCSZ3s&index=13&t=0s

Prochaska, J. O., Redding, C. A., & Evers, K. E. (2015). The transtheoretical model and stages of change. Health Behavior: Theory, Research, and Practice, 125-148. Retrieved from https://www.researchgate.net/profile/Daniel_Montano2/publication/233894824_Theory_of_reasoned_action_theory_of_planned_behavior_and_the_integrated_behavior_model/links/0a85e53b67d742bc29000000.pdf#page=135

Russo, R., & Fortune, L. D. (2016). Six evidence-based integrative health practices to manage eight common chronic conditions and promote self-care: A review with findings inspired by a workplace wellness case study. SM J Community Med2(2), 1018.

World Health Organization (WHO) (2019, April 2). Self-care can be an effective part of national health systems.  Retrieved from https://www.who.int/reproductivehealth/self-care-national-health-systems/en/

 

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Five Dissertation Tips from Game of Thrones

I am a latecomer to explore elements of popular culture.  So not surprisingly, I took on viewing the Game of Thrones in its entirety only a few weeks ago, weeks after the final episode aired.  The national conversations had mostly died off when I called up Season 1 and started at the beginning.  Initially enticed by the filming and acting, I also could converse with many who openly shared with me the plot twists and even the surprise endings far in advance.  No matter I knew the endings:  I was hooked on the quality of the productions and soon made my way through all 73 hours of fantasy, relationships, power brokering, military engagements, and heart break.

I know from social media that I was not alone in falling down this tunnel after the proverbial train had left the station.  Why so many others binged along with me is another developmental question.  In the end, I was not compelled to find deeper meanings in the plot line finishes, even where I was disappointed.  But I was haunted by naming meanings to the Game of Thrones storytelling experience and process.  Like any other carpenter who sees the need for a hammer and nail in every situation, I found lessons for my academic work in the unfolding and ending of Game of Thrones. Hence, I see lessons for my dissertation students as they forage toward their final chapter and the blessed typing of the word REFERENCES.

My Five Dissertation Tips from Game of Thrones

  1.  Avoid rush and compress at the end. If you think you can finish the last chapter off in a weekend, remember how it felt to have 10 episodes cramped into seven in the stage that was supposed to explain and make meaning of it all.  When writing and delivering your Discussion Chapter, there is no substitute for space, time, and well chosen words.
  2.  Remember your context. Do not ignore important information and questions you raised in your introductory chapters (chapters 1 and 2). Like abandoning the direwolves or the people of Meereen without explanation, it is very unsatisfying.  Likewise, you cannot discount or kill off a point or perspective you brought into the story earlier only to have it show up and save the day in the end.  It is like the Dothraki storming Kings Landing after they were all killed off earlier at Winterfell.
  3.  Hold sight of your question. You started this enormous quest with a question and a purpose. If you argue deeply for some idea and create many platitudes to elevate it, you should not kill it off without fighting just as hard to reframe it or clearly showing you had no alternative. It sinks your credibility even if you allow the fallen hypothesis to be flown off in the talons of a dragon.
  4.  Select your final comrades strategically. Choose carefully from the experts and theories that have come before as you assemble who will support you at the end. These stars should be your best and brightest, not simply the ones who had not been killed off or broken contract.  They will determine whether you even get a chance at a sequel.
  5.  No proselytizing.Above all, do not justify your ending by emotional pandering in the final statements.  You must find a better conclusion than that it was all about storytelling for the sake of the stories.

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Dr. Luann Fortune will be co-presenting with Dr. Ruthann Russo, at the upcoming IM4US annual conference on August 22 at University of Santa Clara, CA (https://im4us.org/conferences/2019-conference/).  Their half-day workshop titled, Self-Care for Sustainability andAdvocacywill present the original evidence-based 7 Sources of Health Model, specifically for application to healthcare practitioners and underserved populations.  Drs. Fortune and Russo are frequent co-facilitators and collaborators on this subject which is based on Dr. Russo’s dissertation research.

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March 10, 2019 Topic: Care of Self:  A Practical Model for Health and Spiritual Wellness

Speaker:  Luann Fortune, PhD
We have all heard that our bodies are our “temples”, but our busy lives and many responsibilities can seem to get in the way of taking care of ourselves first.  But beyond pursuing the joys of better personal quality of life, self-care can honor our community and also our beliefs.  Each of us has an innate capacity for wellness and there are many possible paths for improving our mind-body-spirit experience.  At this forum, Dr. Luann Fortune will introduce the Seven Sources of Health, an original, integrative model for improving individual self-care practices and outcomes.  Dr. Fortune will explain simple techniques for self-awareness and improved health based on the science of behavioral and mind-body medicine.  In addition to offering a practical approach based on recent research, she will connect self-care to spirituality and sound Christian practice.

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