The global intensifying effect of mindfulness research has resulted in a filtration of the practice in the UK healthcare sector. Whether it is in the NHS (mindfulness-based cognitive therapy) or the voluntary sector, it is now common to hear about the ways in which we can practise mindfulness.
I often hear of people attending a weekend workshop to become a facilitator or going on a ‘retreat’ aimed at destressing, or combating compassion fatigue. It is fair to say we now find ourselves among the jungle of modern-day adaptations. Whether we have the results of the latest randomised control trial in our back pocket, or neuroscientific brain images etched in our memories, there is now a consensus among healthcare professionals of how mindfulness can benefit them or at least their patients. Indeed, this is confirmed by NICE guidelines advocating it as preferential treatment for depression.1
However, more must be done to realistically map out the potential pitfalls and challenges that a healthcare professional may experience and what may lead them to revert to burnout or apathy. In an industry so often fuelled by targets, bed blocking and call cramming, the budding mindful hopeful faces enormous challenge, due to the stresses and volitions subsumed in their daily activities.
I have been fortuitous enough to facilitate mindfulness with trainee nursing associates, assistant practitioners, allied health professionals, health visitors, district nurses and the wider care team. I have also trained consultants, managers and doctors. In my limited experience, there are several barriers to practice that I often come across. I hope this short commentary dispels any myths and assists health practitioners in overcoming these hurdles.
Barriers to practice
‘I work 40-hour weeks with few breaks and have an incredibly busy caseload – how am I supposed to be mindful?’
This is the ‘no time’ myth. Mindfulness requires no extra time and, in many ways, frees time up, once things have been prioritised and accomplished effectively. The misconception comes from the idea that mindfulness is meditation only. However, putting it into practice is not just about requiring a quiet place to sit and monitor your breath. Indeed, making mindfulness all about the meditation is counterintuitive. Yes, meditation is extremely helpful in building the strength of your practice; however, you only ever require conscious awareness to practise mindfulness, regardless of context. And the good news with that is… you are alive, so you can practise! Throughout your day, irrespective of duties or client demands, you can consciously bring attention back to the breath, back to the sensation in your body, back to your mood, or emotion – every single second is mindfulness practice. Thus, time is certainly not a barrier to practice.
‘I need to be able to multitask –my work environment is so busy, it’s impossible to practise’
Yes, this is a tricky battle to navigate. However, what mindfulness requests is gently observing who you are in the moment, which requires a subtlety of being that enables you to respond with care, rather than react from autopilot or emotion. Our reaction to the ‘busyness’ is dependent on how we relate to our mind in any given moment. We can either be swept away with the busyness, and add to the anxiety, or simply observe our mind naturally being drawn into anxiousness. If we remain calm in the face of a stressful situation, by observing our mind and not fuelling the fire with thoughts or labels, our ability to remain a pillar in the wind increases. This, then, has the added benefit of affecting our colleagues and clients in similar ways. As we repeat this process on a regular basis, we may find this becomes easier and easier.
Nobody is saying that mindfulness requires you to stop multitasking; just stop thinking of the different tasks at the same time, which ends up in giving half your attention to each one. Attend to your duties in your own capacity, one at a time, without allowing thoughts of other tasks to infiltrate your current activity. Mindfulness is, therefore, the most appropriate thing for someone who needs to multitask.
‘It feels a bit selfish – always bringing it back to my breathing, my body. My work is about others’
Responding with compassion is one of the ‘6 Cs’ in nursing, midwifery and care staff2 and the most fundamental way of transmitting care to an individual. Mindfulness requires you to investigate your own momentary experience, not so that you become fine and the people around you suffer, but rather to then be able to respond with compassion. Perhaps there should be a 7th C – calm. Only by being calm via mindfulness are you able to give your fullest effort.
‘Mindfulness can have negative effects and is not for everyone’
There is some research to show how it might not be for everyone.3,4 However, let us go back to the basics – mindfulness is awareness of the moment, just how it is. Now, if we are not used to awareness in its purest form, without being lost in myriad thoughts, then after practising mindfulness, we can suddenly become aware of aches and pains in the body, or perhaps nagging thoughts that will not go away. Mindfulness is, at best, a form of very mild self-therapy, but it does not mean you should not seek help from a professional if there is a key issue going on for you. Indeed, in times of extreme emotional distress, it might be best to avoid mindfulness meditation. However, it may be useful to monitor your own mental and bodily reactions in order to help navigate through difficult trauma.
‘It’s hard to want to help people who are rude’
By monitoring your own bodily and emotional internal reaction, noticing, observing and resting with this uncomforting moment, you are then in the best place possible to extend the parameters of your compassion. This brings us on to the practice of equanimity, which seems to be two pronged. Firstly, it is aimed at cultivating an inner equanimity, and secondly it is also geared towards others. Inner equanimity can be defined as open acceptance of non-reactivity towards your discrimination faculties (pleasure, displeasure, neutrality), so that you can respond with compassion for self and others. External equanimity can be defined as accepting an individual’s discrimination faculties (pleasure, displeasure, neutrality) with patience, so as to respond with compassion for self and others.
How can we practise compassion without awareness of self in that moment? How can we communicate compassionately to the client who has just offended us, the manager who has just placed extra demands upon us, or the person who just refuses to engage?
Working with things that are stressful for us, that give rise to discomfort, physical fatigue or anxiety, means we are working with the very things that turn us toward our discomfort and pain, and potentially restrict us from providing quality care. Therefore, with mindfulness, we are able to emotionally regulate by practising equanimity. This involves monitoring how we feel about the situation, yet obtaining that inner wisdom that, regardless of how we have internally labelled the experience (positive, negative or neutral), it is the labelling itself that begins to knock us off balance.5 The sensation, label and thinking can trampoline us into a physiological and emotional reaction. Our pulses may rise, as cortisol and adrenaline begin to ravage our bodies. Thus, we are no longer able to provide the best care in the moment.6
This does not mean that we become robotic towards experience and negate how we feel about something. We do not become ‘doormats’ to others but, rather, wiser, non-judgmental practitioners, guided by an overarching sense of compassion. The therapeutic benefit of mindfulness depends on the quality of mindfulness that an individual deploys. Simple breath awareness gives rise to an increased focus, attention and sense of peace, but equanimity really enables us to emotionally regulate and then fuel our mindfulness practice toward the benefit of others. No matter what occurs to us in the day, we are propelled by self-care and compassion as our encompassing guide.
Equanimity: a new hallmark of professionalism
To be equally present along the spectrum of feeling requires only awareness of sensation as a practice. Whether an experience is pleasurable, unpleasant or neutral, the practitioner is able to step outside of their instantaneous reaction and just work with whatever presents itself until it is done. This is evident in research by Greenberg, Reiner and Meiran,7 who show how mindfulness practice reduces cognitive rigidity. The freedom of cognitive rigidity – or equanimity – is perhaps a missing hallmark of quality healthcare professionalism.
Extending the boundaries of our compassion
Without mindfulness and equanimity, we run the risk of restricting compassion to those people we like, those clients with whom we have rapport, or those things that give us satisfaction. What happens to the people who we neither like nor dislike? Potentially our compassion dwindles. And what of those we dislike? Almost certainly it dissipates and, at worst, breeds gossip and malpractice. The direct antidote to the restrictive sphere of our compassionate boundaries is practising mindfulness and equanimity. That way, we may not like the person, but we are still being compassionate; we may be indifferent towards them, but our work is at its fullest.
It is easy to practise mindfulness for a few moments, then tick it off in your mind as something you have done, or as something you have embedded within your daily life. However, it is not as easy to remain mindful in times of stress, or when the demands feel too much. Let’s not make mindfulness into a quick solution for the masses. It takes time, energy, and commitment to continually engage and, therefore, requires a disciplined approach. However, if you wish to become a better version of yourself, to learn from old habits and to cultivate compassion and other good qualities, it may be the simplest and most profound place to start.
Joey Weber is a lecturer in health and social care at the University of Bolton. He is a trained mindfulness consultant and has a specialist interest in equanimity. His PhD is on the role of equanimity in cultivating positive mental states. Access his previous work.
1 National Health Service. Overview: clinical depression. [Online.] NHS; 2016. https://www.nhs.uk/conditions/clinical-depression/ (accessed 21 February 2019).
2 National Health Service. The 6 Cs. [Online.] NHS; 2016. https://www. england.nhs.uk/leadingchange/about/the-6cs/ (accessed 21 February 2016).
3 Foster D. Is mindfulness making us ill? [Online.] The Guardian; 2016. https://www.theguardian.com/lifeandstyle/2016/jan/23/is-mindfulness-making-us-ill (accessed 25 February 2019).
4 Finucane A, Mercer SW. An exploratory mixed methods study of the acceptability and effectiveness of mindfulness-based cognitive therapy for patients with active depression and anxiety in primary care. BMC Psychiatry 2006; 6: 14.
5 Weber J, Lowe M. Development and validation of the Equanimity Barriers Scale [EBS]. Current Psychology 2018; 1–15. DOI: 10.1007/s12144-018-9969-5.
6 National Health Choices. Stress. [Online.] Nursing Times 2009. https:// www.nursingtimes.net/stress/1995960.fullarticle (accessed 21 February 2019).
7 Greenberg J, Reiner K, Meiran N. ‘Mind the trap’: mindfulness practice reduces cognitive rigidity. PloS one 2012; 7(5): e36206 (accessed 21 February 2019).