Breathe: A Call to Mindfulness

By Sheldon Herring, Ph.D., Clinical Director, Roger C. Peace Brain Injury and Young Stroke Program, Founder of the Brain Injury Leadership Academy

“Between stimulus and response there is a space, in that space is our power to choose our response, in our response lies our growth and freedom” – Quoted by Viktor Frankl, Psychiatrist and Holocaust Survivor

As professionals in the field of neuro rehab we have many different stimuli requiring our response: A patient presenting with complex cognitive and neurobehavioral changes, insurance demanding yet one more treatment plan to justify what you feel is owed and clearly needed, a coworker asking of your time as mentor or coverage in the context of your own full clinical load.

Sometimes it feels we have very little time or mental space to formulate a meaningful response to these challenges as they arise; we find ourselves responding on autopilot, from a non-mindful space. We find that the space between our particular stimulus and our response becomes compressed and the automatic responses are frequently a reflection of “autonomic” processing: fear, anger, or sadness. Like many of our patients, much of the time we are not aware of where these responses are coming from.

Over time, these responses develop into habits that may not serve us well and result in not only decreased clinical efficiency and team citizenship, but increased stressors that impact our adjustment, our job satisfaction, and even our health. Throughout the field of medicine this impact of stress on professionals is gradually being recognized and addressed.

Just like in our clinical work, the first step toward growth is becoming aware of our response to stress and consciously stepping into the space between stimulus and response, a core skill of mindfulness practices. When “mindfulness” and mindfulness practices are mentioned, one frequently thinks of extended meditation and related activities such as yoga. But Jon Kabot-Zinn notes that at its core mindfulness “is the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experiences moment by moment.” The first step can be as simple as a single breath and asking yourself “Where am I right now?”

Am I still in yesterday’s treatment session where the patient and I disagreed?

Am I already in tomorrow’s staff meeting where I will have to present?

Or can I stop and with a deep breath allow myself to be present to the moment before me?

Our growth as specialized clinicians and educators requires dedicated time to learn and grow those clinical and evidence-based skills. So does our growth in awareness of how we are showing up. Mindfulness is a skill that can be developed with conscious awareness and commitment over time.

Consider taking a breath and:

• Pausing for a moment with your patient at the beginning of each session to get centered
• Allowing for silence in a staff meeting as the team processes challenging news
• Recognizing that a response may be coming from a place of fear or anger, and being willing to acknowledge that without judgment of yourself or others

The inclusion of mindfulness practices throughout your day will not only decrease felt stress but will allow you to bring your clinical skills to bear in increasingly challenging world of rehab and help you stay connected to what called you into the field in the first place.

To further support your and your team’s practices of mindfulness, a list of additional brief practices and tools can be found here.