By Dr Amanpreet Kaur, Research Fellow, The George Institute for Global Health, India, @Amanpreet_CP
Awarded first prize in Original Paper presentation at 28th International Conference of Indian Association of Palliative Care (IAPCON) 2021
“It is difficult to accept death in this society because it is unfamiliar. In spite of the fact that it happens all the time, we never see it.” – Elisabeth Kubler-Ross
Death is a taboo word. It evokes difficult emotions within us. It challenges the living, because it is certain that we will all die, but time of death is uncertain. Anything uncertain creates fear, and fear of loss of oneself or one’s loved ones can trigger various emotional disorders. Recently, the pandemic has made us more than aware of our own mortality and death anxiety is not a new concept.
In my culture in India, anyone talking about his/her own death is told not to use that word or phrase, as if talking about death could actually cause someone’s death. Alas! We humans don’t have so much power!
Much before the pandemic had struck us, I had a personal life event in the year 2008, when I witnessed my maternal grandfather dying in front of me. It was sudden, difficult and took time to process. It gave a beautiful meaning to my life and it changed my outlook towards life at an early age. I always wondered how do professionals working in emergency settings, palliative care settings, and war-like settings cope with witnessing death and dying almost daily? Do they have enough coping skills to deal with it or do they learn that with experience? I wasn’t afraid to face difficult situations and probably that made me comfortable with death and dying. And it indeed is an integral part of our cycle, need to be talked about and accepted for planning end of life care.
As a trained and practising clinical psychologist, I got training in third generation cognitive behaviour therapies including ‘Mindfulness meditation’ under the supervision and guidance of Prof. Dr Mahendra P Sharma. Mindfulness is the English translation of a Pali word ‘Vipassana’ which means ‘to observe in a special way’. Mindfulness is about being ‘here and now’.In general, there has been growing interest in mindfulness to improve the overall well-being of health care professionals.[3,4] The origin of mindfulness and techniques in psychosocial care today hark back to ancient India and has roots in Buddhism. Meditation has been used as an adjunct to therapy and is perhaps the oldest of the relaxation techniques for stress. “Mindfulness is a kind of non-elaborative, non-judgmental, present-centered awareness in which each thought, feeling, or sensation that arises in the attentional field is acknowledged and accepted as it is”.
I worked in the area of palliative care as part of my Ph.D. in Clinical Psychology from NIMHANS, Bengaluru and specifically worked closely with professional care providers working at cancer palliative care centres (both hospice and hospitals). As part of my research, I explored the challenges and needs of the palliative care professionals, and evaluated the need-based Mindfulness Integrated intervention program developed for enhancing their psychological well-being.
It was a group intervention and involved doctors, nurses, nurse aids, counsellors and social workers working full-time at a hospice in Bengaluru. Mindfulness Integrated Cognitive Behavioural Intervention (MICBI) program was conducted for six sessions, held once a week and for a duration of 2-2½ hours. Each session comprised of a mix of formal practice of mindfulness meditation (Practice of Body scan, Sitting meditation) with other cognitive behavioural techniques (for more information read- paper hyperlink can be added once its published). Picture 1 (no personal identifiers and no faces can be seen) depicts how practice of body scan was carried out in smaller groups at the hospice.
At the end of the program and after three months of end of intervention, we observed gains and benefits in terms of better psychological well-being, improved mindfulness skills and reduced burnout and traumatic stress. Most importantly, the feedback given by the participants was really encouraging as the six-week intervention helped them in self-care, time management, perspective taking, compassion, empathy and using mindfulness as a daily self-care strategy. Mindfulness is not a technique, it’s a way of life.
To the best of our knowledge, this is the first study done in India to evaluate effects of mindfulness integrated cognitive behavioural interventions with cancer palliative care professionals. We believe findings of our work have significant implications on future palliative care research, development and implementation of mindfulness integrated interventions, and training for cancer palliative care professionals.
1 Burton A, Burgess C, Dean S, Koutsopoulou GZ, Hugh‐Jones S. How effective are mindfulness‐based interventions for reducing stress among healthcare professionals? A systematic review and meta‐analysis. Stress Health. 2017;33(1):3-13.
2 Lomas T, Medina JC, Ivtzan I, Rupprecht S, Eiroa-Orosa FJ. A systematic review and meta-analysis of the impact of mindfulness-based interventions on the well-being of healthcare professionals. Mindfulness. 2019;7:1193-216.
3 Sharma MP. Vipassna Meditation: The art and science of mindfulness. In J. P. Balodhi (ed.), Application of Oriental Philosophical Thoughts in Mental Health. National Institute of Mental Health and Neuro Sciences. 2002;69—74.
4 Kabat-Zinn J, Hanh TN. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delta. 2009
5 Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., … & Devins, G. (2004). Mindfulness: a proposed operational definition. Clinical psychology: Science and practice, 11(3), 230.