Many studies have consistently shown that doctors experience tremendous amount of stress. Doctors generally have better physical health compared to the general population – but not for mental health. This article will introduce to you simple and practical mindfulness-based exercises for stress reduction.

What is mindfulness? It is a popular self-help concept that springs from ancient contemplative traditions, in particular Buddhism. However, it was introduced in a secular way by Dr. Jon Kabat-Zinn as Mindfulness-based Stress Reduction (MBSR) programme in the University of Massachusetts Medical Centre in 1970s for coping with chronic pain.

Recent meta-analyses indicate that mindfulness-based interventions are effective for reducing stress, anxiety, and depression among healthy and clinical population. It has also specifically proven to benefit primary care physicians in reducing burnout; improving mood, empathy, job satisfaction, well-being, and quality of life.

Mindfulness involves training the mind to pay wise attention to the present moment with attitude of kindness and beginner’s mind. The opposite of it is mindless preoccupation with worries about the future and regrets over the past. Below are four mindfulness-based exercises that you could apply easily in busy clinic or hospital settings.

Mindful-S.T.O.P

This is an exercise for taking short breaks throughout the day and ‘seasoning’ it with positive energy of mindfulness. Taking regular mindful breaks (e.g. 3 times per day) recharges ourselves and enables us to cope more effectively with challenges. Remember Kit Kat chocolate slogan? It is “Have a break, have a Kit Kat.” Similarly, “Have a break, take a Mindful-S.T.O.P.”

Mindful Breathing

This involves paying attention to breathing for calming the mind and developing positive mental attitude. As breathing is accessible to us at all times, it is a wonderful natural resource for cultivating mindfulness.

Gently invite our attention to rest on the breathing: movement of tummy, chest, shoulder; tiny air sensations around the nostrils or throat, sound of breathing, etc. It is not necessary to change the breathing – just observe with curiosity and kindness.

Notice how the experience changes during in-breath and out-breath. See if we could follow the whole cycle of breath, observing any changes moment-to-moment. You may gently place your hand on your tummy (which moves with breathing) to help you focus.

If the attention drifts away, it is OK. Gently bring it back to the breathing. At times, labelling the breathing, “breathing IN, I know I’m breathing in; breathing OUT, I know I’m breathing out” could be helpful in anchoring attention.

Anchoring the breath with positive attitude could also be helpful, “Breathing IN, I see myself as a flower (imagine), breathing out, I’m fresh and energized,” “Breathing IN, I see myself as a tree (imagine), breathing OUT, I’m strong and stable.”

Radiating ‘Loving-Kindness.’

This involves cultivating kindness and related feelings (e.g. friendliness, gentleness, compassion) towards ourselves and others. As kindness is a positive feeling, it buffers stress, promotes well-being, and improves interpersonal relationships. This practice has been shown in studies to reduce burnout and empathy fatigue.

Recall to mind all the people whom you have met throughout the day, e.g. patients, family members, nurses, other doctors, birds tweeting outside the clinic.

Mentally send positive wishes to them, “Pinky (patient), I wish you a speedy recovery,” “Pinky, may your family be free from worries,” “Liza (nurse), I hope you could have a good rest over the weekend.”

Do not forget to send good wishes to yourself, “I wish myself well, healthy, and happy. Well done for trying your best to help all your patients.” Savour the kind, friendly, gentle and loving feelings – it is therapeutic.

‘Google-WWW-Yahoo.’

This involves training the mind to pay attention to the positive aspects of life (e.g. strength, blessings, good deeds, accomplishments) – the opposite of finding faults. Instead of allowing our mind to generate thoughts randomly, we could purposefully cultivate positive thoughts. Research in positive psychology has shown that this helps in rewiring the neurons in the brain to stay positive, healthy and happy.

After a busy day of clinical work, try to ‘Google’ (mentally search or recall) all the good things that have happened throughout the day (e.g. good health, able to help many patients, having helpful nurse, written an article for sharing, read a journal paper, had lunch with a friend) – the WWW’s (What Went Well). Then, rejoice or celebrate (‘Yahoo’) on the blessings. Happiness is found ‘here-and-now’ whenever we pay mindful attention to the wonderful moments of life.

To be mindful is easy; remembering to do it is difficult. For improving compliance in mindfulness training, we may install a phone apps (i.e. ‘Mindfulness Bell’) that could be programmed to chime periodically (e.g. 3 times per day) to remind us on mindfulness practice. As a start, I recommend the following daily ‘mindful vitamins’ prescriptions:

1. Mindful Breathing – OM (5 minutes)
2. Mindful-S.T.O.P. – TDS (1-2 minutes each time)
3. Radiating Loving-Kindness – OD (while driving back home from clinic/hospital)
4. Google-WWW-Yahoo – ON (before sleep)

Four Mindful Exercises For Reducing Stress In Doctors
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