Actress Goldie Hawn stood in the playroom of the UCSF Benioff Children’s Hospital San Francisco, surrounded by children and their parents. She addressed her audience by asking each person, “What are you grateful for?”
“My cat,” a little girl said, grinning up at Hawn.
“The nurses taking care of my kid,” a father said, gripping his son’s hand.
“Hope,” a young boy said quietly.
Hawn led the gratitude circle before speaking about the cognitive and health benefits of gratitude and mindfulness, principles that underlie MindUp, her foundation’s curriculum that teaches children to regulate their emotions and concentration by practicing mindful awareness, like deep breathing.
“When we feel grateful, the heart opens up and we can help each other,” she told the group. “If you’re nervous, scared or sad, just breathe. Every inhale energizes the body and every exhale relaxes the body.”
Hawn’s strategies for improving wellbeing complements the work of specialists at the hospital who use similar techniques to help patients manage pain and stress, said Michael Towne, manager of UCSF Benioff Children’s Hospital’s Child Life Services.
“A life-threatening diagnosis takes an enormous psychological toll on the kids and their families,” he continued. “Mindfulness gives the kids some control over their fear and pain, a powerful tool when they have no control over their illness.”
On each floor, whimsically painted gratitude trees line the hallways. Patients write what they’re grateful for and stick them to the branches. The trees are hugely popular because it allows for a small moment to focus on something positive, Towne said.
Along with stress and pain management, mindfulness has been gaining traction as an effective tool for treating depression, said UCSF psychiatrist Stuart Eisendrath, MD, who studies how mindfulness-based cognitive therapy (MBCT) affects the patients with depression for whom medication has failed. His research has shown that the mindfulness practice shifts brain functions toward a healthier mindset.
“People with depression ruminate on negative thoughts about something that happened in the past,” said Eisendrath. “MBCT trains patients to selectively focus their attention on the here and now. “
Depressed people have brain abnormalities that prevent the logical, problem-solving regions of the brain from functioning properly. Instead, they have an overactive amygdala, a region of the brain that processes emotion.
“The amygdala clouds the thought process with emotion. It prevents the logic region of the brain from keeping negativity in perspective.” Eisendrath said.
During an eight-week course, patients learn to focus on their breath and let go of negative thoughts as they pop up. Eisendrath took a functional magnetic resonance imaging (fMRI) of each participant’s brain before and after the course, and followed up clinically one year after the treatment.
“We saw pretty dramatic results after just eight weeks. The mindfulness training increased activation in the brain region responsible for emotion regulation and decreased the amygdala, the alarm bell,” Eisendrath said.
Focusing on Non-Judgmental Thoughts
The UCSF Osher Center for Integrated Medicine applied this technique to help homeless youth. They partnered with the Larkin Street Youth Services, the largest service organization in the city for homeless youth.
“These teens are runaways. You can only imagine how troubling their experiences have been,” said Kevin Barrow, MD, the Osher Center’s director of mindfulness programs and co-director of the Mindfulness for Urban Youth project. “If you’re constantly pushing the painful memories away, you’re never going to sleep well; you’re going to keep yourself busy because you don’t want those memories to come up.”
The Lisa and John Pritzker Family Fund funded the program to make a series of mindfulness workshops available to kids at the Larkin Street Youth Services center. The curriculum director and lead instructor, Forest Fein, MA, teaches participants how to focus on the breath and to be completely non-judgmental about anything that comes to the surface.
“Someone might say, ‘I feel terrible about myself because my parents threw me out,’ and we would ask them, ‘How does that feel in your mind? Study it,’” Barrows said.
“Mindfulness trains you to control the kind of attention you bring to these traumatizing memories. It’s open, it’s accepting. It gives you a container to hold these things,” he continued. “They learn to be unafraid of confronting their past.”
Barrows thinks the growing popularity of mindfulness is due to the chaotic nature of modern day life. “It’s the perfect medicine for our times. There’s so much going on – screens, obligations, distractions – and breathing and practicing mindfulness taps into a deep human desire for peace. “
Mindfulness Practice for Caregivers
Along with children and families, caregivers can be susceptible to emotional distress from caring for very sick children.
Growing awareness of widespread compassion fatigue and burnout in nurses and physicians has led to a movement to support the mental health of hospital staff. Eight years ago, Helge Osterhold, PhD, started the UCSF Benioff Children’s Hospital Staff Support Program. One way the program aims to promote care team well being is to build mindfulness into caregiving to help staff relax and recharge throughout their shift.
“Mindfulness is a key skill to being present with the patients,” said Osterhold. “If you’re fatigued and tired, you’re only half present to what the patient is telling you, and you’re more likely to make mistakes.
Besides offering a variety of caregiver retreats and classes, Osterhold spearheaded ‘mid-day mindfulness’ a daily guided meditation that is offered with Spiritual Care Services Monday through Friday at noon. Everyone meets in a peaceful meditation room on the first floor of the hospital to recharge, reflect and refocus. The program also trained more than 40 nurses to lead simple yoga classes at the nurse’s stations. The 5- to 10-minute yoga class promotes mindful breathing, coordinated with some movement, said Osterhold. They call it ‘You Time.’
Additionally, during the nurses huddle – when nurses finishing a shift hand over the duties and debrief about the patients for that day – some units begin by saying three good things that happened during the shift. Beginning on a positive note helps the new nurses avoid feeling like they’ve walked into an overwhelming environment and aids the leaving shift with a sense of accomplishment.
“The hope is it will always help the patient,” Osterhold said. We’re not doing it for indulgence – we’re recognizing how hard these caregivers are working to care for these patients and families.”