1. Powell, Suzanne K. RN, MBA, CCM, CPHQ


Case managers and their patients/clients may benefit from the practice of mindfulness-based stress reduction. Recently, using MRI technology, science has found that the gray matters in specific areas of the brain increased from premindfulness training to postmindfulness training. The area affected improves regions involved with learning and memory processes, modulation of emotional control, and the process of awareness. This can be another tool in the case management toolbox.


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If you are depressed, you are living in the past.


If you are anxious, you are living in the future.


If you are at peace, you are living in the present. - -Lao Tzu


Did you ever get the feeling that life was trying to tell you something? It started out simply as two PCM Journal article submissions that contained "mindfulness" as a method to increase resiliency and decrease stress. Sounding promising, I decided to learn more about it when a multiple-CD university lecture class was offered in my mailbox-and a class at work appeared in my work e-mail. I accepted both offers.


In this issue's article, "Reducing Moral Distress in Case Managers," the author discusses the multiple compelling and competing ethical priorities that case managers face today. Living in today's case management world and connected to the "front lines," I cannot honestly tell anyone that life in case management will get easier. All we can do is mitigate the stress and dilemmas using evidence-based tools (or even tools without evidence base, but ones that work for you).


One evidence-based tool that is promising is called "mindfulness-based stress reduction" (MBSR). Cited in the above article, and also in this issue's article on, "Trauma-Informed Care: A Paradigm Shift Needed for Services With Homeless Veterans," it warrants a more in-depth look.


MBSR was first developed in the Stress Reduction Clinic at the University of Massachusetts Medical Center in 1979 by Dr. Jon Kabat-Zinn. The National Institutes of Health's National Center for Complementary and Alternative Medicine provided several grants to study the outcomes of MBSR. It is now offered in over 200 medical centers, hospitals, and clinics around the world. My experience with MBSR was an invitation to a class at Mayo Clinic Hospital-Arizona. This class has been offered only to patients, families, and caregivers of transplants, but had a few openings that were offered to staff.


Since the early years, mindfulness has been associated with yoga and produced results in reduction of chronic pain. Later, mindfulness-based cognitive therapy (MBCT), a form of MBSR that includes work with depression and cognitive therapy exercises, was developed; this form links thinking with feeling.


Recently, the research has gotten more academic. In a longitudinal study (Holzel et al., 2011), pre-post changes in the brain gray matter were studied via MRIs before and after an 8-week MBSR program. Here is what was found: whole brain analyses identified increases in gray matter concentration in the posterior cingulate cortex, the temporoparietal junction, and the cerebellum in the BMSR group compared with the control group. In layman's terms, this improves regions involved with learning and memory processes, modulation of emotional control, and the process of awareness-or, you may have read about "neuroplasticity," which has replaced the formerly-held position that the brain is a physiologically static organ; scientists now realize that the adult nervous system has the capacity for plasticity and changes in response to training.


Training takes us back to mindfulness. The training teaches you, for example, to stay with your breathing, or other tasks in your life (mindful driving comes to mind: "How did I get here? I don't remember the last three miles."). It is quite amazing for me to realize how short my attention-span is! Practice makes perfect (or at least improvement). One of the first things I noticed is that, during conversations with others, my mind was not going in one-hundred different directions: that I was calmly listening to what was being said, in "real time" and with interest ... and being present in the "present." This is nothing new. Lao Tzu, who was a peer of Confucius (about 500 B.C.E.), knew this (see beginning quote).


The two full-length articles in this issue have suggested that mindfulness training can assist as another useful tool in the case managers' toolbox. I, for one, plan to continue this for a while and see where it takes me. We (case managers) certainly need all the tools we can garner for resilience in our fast-changing health care world.




Holzel B. K., Carmody J., Vangel M., Congleton C., Yerramsetti S. M., Lazar S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 191(1), 36-43. [Context Link]


mindfulness-based stress reduction (MBSR); mindfulness-based cognitive therapy (MBCT); neuroplasticity