The document discusses the importance of attention and mindfulness. It summarizes research showing that a wandering mind is associated with unhappiness, and that multitasking reduces cognitive performance. Mindfulness training is shown to improve focus, reduce stress and depression, and enhance performance. The document advocates for mindfulness to improve mental and physical health, and suggests it can help reduce medical errors by enhancing focus and attention.

1. Mindfulness: why
attention matters
Dr Craig Hassed
Senior Lecturer
Deputy Head of Department
Monash University
Department of General Practice

2. Mind wandering and happiness
 “In conclusion, a human mind is a wandering
mind, and a wandering mind is an unhappy
mind. The ability to think about what is not
happening is a cognitive achievement that
comes at an emotional cost.”
 Killingsworth MA, Gilbert DT. A Wandering Mind Is an Unhappy Mind.
Science 12 November 2010: Vol. 330. no. 6006, p. 932 DOI:
10.1126/science.1192439

3. Attention Deficit Trait
 Newly recognized neurological phenomenon:
attention deficit trait (ADT)
 Response to hyperkinetic environment
 Trying to deal with too much input, results in:
 Black-and-white thinking; perspective and shades of
grey disappear
 Difficulty staying organized, setting priorities, and
managing time
 Feel a constant low level of panic and guilt
 Hallowell EM. Overloaded circuits: why smart people
underperform. Harv Bus Rev. 2005 Jan;83(1):54-62, 116.

4. “The body is the shadow of the soul.”
Marsilio Ficino (1433-99)

5. Allostatic load
 Prolonged stress leads to wear-and-tear on
the body (allostatic load)
 Mediated through the Sympathetic Nervous System
 Allostatic load leads to:
 Impaired immunity, atherosclerosis, metabolic
syndrome, bone demineralization
 Atrophy of nerve cells in the brain
 Hippocampal formation: learning and memory
 Prefrontal cortex: working memory, executive function
 Growth of Amygdala mediates fear response
 Many of these processes are seen in
chronic depression and anxiety
 McEwen BS. Ann N Y Acad Sci. 2004;1032:1-7.

6. “Man is not disturbed by
events, but by the view
he takes of them.”
Epictetus

7. Current trends in happiness
 In developed
countries depression
is currently
overtaking heart
disease as the
leading burden of
disease

8. Mathers CD, Loncar D. Projections of global mortality and burden of disease
from 2002 to 2030. PLoS Med. 2006 Nov;3(11):e442.

9. Burnout and psychiatric morbidity in
new medical graduates
 8 months into internship: 75% interns
had burnout
 73% (of interns) met criteria for
psychiatric morbidity on at least one
occasion
 Willcock SM et al. Burnout and psychiatric
morbidity in new medical graduates. Med J
Aust. 2004;181(7):357-60.

10. Antidepressants and placebo
 Antidepressants no
different to placebo for
mild-moderate
depression, and a
relatively small difference
for patients with severe
depression
 Kirsch I et al. PLoS Medicine 2008
Feb;5(2):e45
doi:10.1371/journal.pmed.0050045
 Fournier JC, DeRubeis RJ, Hollon SD,
et al. Antidepressant drug effects and
depression severity: a patient-level
meta-analysis. JAMA. 2010 Jan
6;303(1):47-53.

11. Albert Einstein
 “Any man who can drive safely while
kissing a pretty girl is simply not
giving the kiss the attention it
deserves.”
11

12. Mobile phone use and motor vehicle
accidents
 Passenger carriage increased the likelihood of a
crash (odds ratio 1.6)
 Carrying two or more passengers twice as likely
to crash as unaccompanied drivers (OR 2.2)
 Driver's use of a mobile phone within 5 min
before a crash associated with fourfold
increased likelihood of crashing (OR 4.1)
 McEvoy SP, Stevenson MR, Woodward M.The contribution of passengers versus
mobile phone use to motor vehicle crashes resulting in hospital attendance by the
driver. Accid Anal Prev. 2007 Nov;39(6):1170-6. Epub 2007 Apr 9.

13. Multitasking or task-switching?
 Multitasking is an illusion (misnomer)
 Switching happens so fast that it appears we
are performing multiple tasks simultaneously
like the concurrent performance of several
jobs by a computer
 Reality is that we are switching back and
forth between tasks
 http://ucsdcfm.wordpress.com/2011/07/01/our-brains-
are-evolving-to-multitask-not-the-ill-usion-of-
multitasking/

14. Multi-tasking
 On the performance levels of extreme multi-
taskers: “These are kids who are doing 5, 6, or
more things at once all the time. ... It turns out
multi-taskers are terrible at every aspect of
multitasking! They get distracted constantly. Their
memory is very disorganized. Recent work we’ve
done suggests that they’re worse at analytic
reasoning. We worry that it may be we’re creating
people who may not be able to think well, and
clearly.”
 Dr. Clifford Nass on his studies at Stanford University from
Dretzin, Rachel. Rushkoff, Douglas. “digital_nation life on the
virtual frontier.” pbs.org Frontline. Feb. 2010. Web. 14 Apr. 2011.

15. Multitasking
 “In 2005, the BBC reported on a research
study, funded by Hewlett-Packard, and
conducted by the Institute of Psychiatry at the
University of London, that found, workers
distracted by e-mail and phone calls suffer a
fall in IQ more than twice that found in
marijuana smokers.”
 Christine Rosen, “The Myth of Multitasking.” The New
Atlantis thenewatlantis.com. Spring 2008. Web. 14 Apr.
2011.

16. Simple and Complex Multitasking
(Continuous Partial Attention)
 Simple multitasking: each task given the same priority
(e.g. stirring pasta while talking to spouse)
 Aim to be more productive
 Complex multitasking: two activities which demand
cognition (e.g. driving while speaking on phone)
 Aim not to miss anything by maintaining CPA
 Continuous overstimulation and lack of fullfilment
 “When we do this, we may have the feeling that our
brains process multiple activities in parallel. Researchers
say that while we can rapidly shift between activities, our
brains process serially.”
 Stone, Linda. “Beyond Simple Multi-Tasking: Continuous Partial
Attention.” Lindastone.net. Nov. 2009. Wen. 14 Apr. 2011.

17. Multitasking
 “Heavy media multitaskers performed worse
on a test of task-switching ability, likely due to
reduced ability to filter out interference from
the irrelevant task set.”
 Ophir, Eyal. Nass, Clifford. Wagner, Anthony D.
“Cognitive control in media multitaskers.” PNAS.org.
Proceedings of the National Academy of Sciences of the
United States of America, Jul. 2009. Web. 15 Apr. 2011.

18. Three regions of the brain
 Corresponding areas in the
brain
 Frontal lobes – reasoning and
emotional regulation
 Higher reasoning (buddhi)
 Emotional regulation
 Left (positive) vs. right
(negative)
 Appetite regulation
 Directs immune system
 Limbic system – emotion and
courage
 Mesolimbic reward system –
appetites

19. Stress
Performance
Inertia
Poor
performance /
burnout
Stress-performance curve
High performance

20. Doctor health and medical errors
 Study determined prevalence of depression
and burnout among residents medical staff in
3 US hospitals
 20% of residents met criteria for depression
 74% met the criteria for burnout
 Depressed residents made 6.2 times as many
medication errors as residents who were not
depressed
 Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of
medication errors among depressed and burnt out residents:
prospective cohort study. BMJ,
doi:10.1136/bmj.39469.763218.BE (published 7 February
2008)

21.  “The faculty of voluntarily
bringing back a wandering
attention over and over
again, is the very root of
judgment, character, and
will. No one is compos sui
if he have it not. An
education which should
improve this faculty would
be the education par
excellence.”
 William James, Principles of
Psychology, 1890
What is mindfulness?

22. Mindfulness
 Mindfulness is a mental discipline involving
training attention
 It is not a method of distracting ourselves or
tuning out, it is about tuning in – hence people
perform better when mindful (in the zone/flow)
 The anxious, stressed or depressed state of
mind is the distracted state
 Hence the negative impact upon performance

23. Applications of mindfulness
 Mental health
 E.g. depression relapse prevention, anxiety, panic disorder, stress,
emotional regulation, addiction, psychosis
 Neuroscience
 E.g. structural and functional changes in the brain, neurogenesis,
dementia prevention, amygdala, executive function, working memory
 Clinical
 E.g. pain management, symptom control, cancer, metabolic,
hormonal, genetic function and repair
 Performance
 E.g. sport, academic, leadership
 Spiritual
 E.g. deep peace, insight, oneness
23
Results suggest that MBSR
may help a broad range of
individuals to cope with their
clinical and non-clinical
problems. Grossman P. J
Psychosomatic Research.
2004;57(1):35-43.

24. Meditation and cognition
 Study on brief meditation training effects on cognition
and mood
 Four sessions of either meditation training
 Participants were assessed with measures of mood,
verbal fluency, visual coding, and working memory
 Mindfulness training improved mindfulness, mood, and
reduced fatigue, anxiety, and increased visuo-spatial
processing, working memory, and executive
functioning
 Zeidan F, Johnson SK, Diamond BJ, David Z, Goolkasian P. Mindfulness
meditation improves cognition: evidence of brief mental training. Conscious Cogn.
2010 Jun;19(2):597-605. Epub 2010 Apr 3.

25. Stress
Performance
Inertia
Poor
performance /
burnout
Stress-performance curve
Peak
performance
“The zone”
Restful
alertness

26. Mindfulness and mental health
 Meta-analysis on 39 studies totaling 1,140 participants receiving
mindfulness-based therapy for conditions, including cancer,
generalized anxiety disorder, depression, and other psychiatric or
medical conditions
 Effect size estimates show mindfulness-based therapy
moderately effective for improving anxiety (Hedges's g = 0.63)
and mood symptoms (Hedges's g = 0.59) in general population
 In patients with anxiety and mood disorders mindfulness
associated with effect sizes (Hedges's g) of 0.97 and 0.95
 Effect sizes were robust, unrelated to publication year or number of
treatment sessions, and maintained over follow-up.
 Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy
on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010
Apr;78(2):169-83.

27. Mindfulness and depression
 Patients with 3 or more previous episodes of
depression
 Mindfulness-Based Cognitive Therapy
reduced relapse from 78% (what you would
expect with usual treatment) to 36%
 Ma SH, Teasdale JD. J Consult Clin Psychol.
2004;72(1):31-40.

28. Mindfulness, depression and the
stress response
 Mindfulness negatively correlates with
depressive symptoms and reactivity of the
amygdala
 Way BM., Creswell JD., Eisenberger, NI., Lieberman MD.
Dispositional mindfulness and depressive
symptomatology: Correlations with limbic and self-
referential neural activity during rest. Emotion. Vol 10(1),
Feb 2010, 12-24.

29. Mindfulness and craving
 Study on the effectiveness of suppression vs.
mindfulness-based strategy for coping with cigarette
cravings
 Both groups reported significantly reduced amount
of smoking and increased self-efficacy in coping with
smoking urges
 Only participants in the mindfulness group
demonstrated reductions in negative affect (mood),
depressive symptoms, and marginal reductions in
their level of nicotine dependence
 Rogojanski J, Vettese LC, Antony MM. Coping with Cigarette Cravings: Comparison
of Suppression Versus Mindfulness-Based Strategies. Mindfulness 2011;2(1):14-26.
DOI: 10.1007/s12671-010-0038-x

30. The ESSENCE of health
 Education
 Stress management
 Spirituality
 Exercise
 Nutrition
 Connectedness
 Environment

31. HEP and student wellbeing
 Study of 2006 cohort of medical students found
that 90.5% of students personally applied
strategies
 Improved student wellbeing noted on all
measures of wellbeing even in the pre-exam
period
 Reduced depression, hostility and anxiety subscale
 Improved psychological and physical quality of life
 Hassed C, de Lisle S, Sullivan G, Pier C. Adv Health
Sci Educ Theory Pract. 2008 May 31. [Epub ahead
of print]

32. Mindfulness and doctor wellbeing
 An 8-week mindfulness program: improvements on all
measures of wellbeing including:
 Mindfulness
 Burnout (emotional exhaustion; depersonalization;
personal accomplishment)
 Empathy and responsiveness to psychosocial aspects
 Total mood disturbance
 Personality (conscientiousness; emotional stability)
 Improvements in mindfulness correlated with
improvements on other scales
 Krasner MS, Epstein RM, Beckman H, et al. JAMA. 2009;302(12):1338-40.

33. Mindfulness and the workplace
 8 week mindfulness program for ANU staff
 Key findings include:
 Increased self-rated performance (ECDP)
 Improved wellbeing (PANAS)
 Improved eudaimonic wellbeing (meaningfulness) (PWB)
 Increase in 2 subscales of work engagement (vigour and
dedication) (UWES)
 Increased authenticity (self-awareness, authentic
behaviour, open relationships) (AI3)
 Increased satisfaction with life (SWLS)
 Improvements sustained at 6 month f/up
 Atkins P, Hassed C. Unpublished data.

34. Mindful practice
 Mindfulness is essential underpinning for
self-monitoring
 “Mindful practice is conscious and intentional
attentiveness to the present situation – the
raw sensations, thoughts, and emotions as
well as the interpretations, judgments and
heuristics that one applies to a particular
situation.”
 Avoids automatic pilot
 Epstein R, Siegel D, Silberman J. Self-monitoring in clinical
practice: a challenge for medical educators. J Cont Educ Health
Prof 2008;28(1):5-13.
 Epstein RM. Mindful practice in action (II): Cultivating habits of
mind. Fam Syst Health . 2003;21: 11-17.

35. Roots of Diagnostic Errors
 “Cognitive dispositions to respond that influence
the diagnostic process are characterized by a
lack of awareness and responsiveness by the
individual to his or her own cognitive and
affective processes.”
 Confirmation bias: the pursuit of data that support
a diagnosis over data that refute it
 Anchoring bias: a resistance to adapting
appropriately to subsequent data that suggest
alternative diagnoses
 Sibinga EM, Wu AW. Clinical Mindfulness and Patient Safety.
JAMA 2010;304(22):2532-3.

36. Self-monitoring leads to;
1. Early recognition of cognitive biases
2. Avoidance of technical errors
3. Awareness of emotional reactions
4. Facilitation of self-correction
5. Development of therapeutic relationships
 Epstein R et al, 2008

37. Mindfulness and the brain
 Brain scans on long-term
meditators
 Regions associated with attention,
self-awareness and sensory
processing thicker in meditators
(E.g. prefrontal cortex)
 Offset age-related cortical thinning:
“evidence for … cortical plasticity”
 Lazar SW, Kerr CE, Wasserman RH, et
al. Neuroreport. 2005;16(17):1893-1897.
 “The regular practice of meditation
may have neuroprotective effects
and reduce the cognitive decline
associated with normal aging.”
 Pagnoni G. Cekic M. Neurobiology of
Aging. 2007;28(10):1623-7.

38. Meditation and compassion
 Limbic brain regions implicated in empathic
response to another's pain
 Meditators have more active empathic response
 Activation in insula greater in expert than novices
 Empathy w/o stress reduces carer fatigue
 Lutz A, Brefczynski-Lewis J, Johnstone T, Davidson RJ.
PLoS ONE. 2008 Mar 26;3(3):e1897.

39. Emotional Intelligence & mindfulness
 Mindfulness related to
aspects of personality
and mental health
 Lower neuroticism,
psychological symptoms,
experiential avoidance,
dissociation
 Higher emotional
intelligence and
absorption
 Baer RA, et al.
Assessment.
2004;11(3):191-206.
EI Definition
Self-
awareness
Ability to recognise and
understand emotions,
drives and effects
Self-
regulation
Can control or redirect
disruptive impulses, can
think before acting
Motivation Passion for work that goes
beyond money or status,
energy and persistence
Empathy Ability to understand
emotions of others, skill in
interacting with others
Social skill Can manage relationships
and build networks, can
find common ground,
rapport

40. Genetic ageing and pessimism
 The combination of lower optimism and higher
pessimism increases risk for disease and early
mortality
 Sample of healthy post-menopausal women
 Pessimism is independently associated with
over10 years accelerated ageing
 Shorter Telomere length and higher Interleukin-6
concentrations
 Lin J,Dhabhar FS, Wolkowitz O, Tillie JM, Blackburn E, Epel
E.Pessimism correlates with leukocyte telomere shortness and
elevated interleukin-6 in post-menopausal women. Brain Behav
Immun. 2009 May;23(4):446-9.

41. Mindfulness and cellular ageing
 Meditation may slow genetic
ageing and enhance genetic
repair
 “...we propose that some forms
of meditation may have
salutary effects on telomere
length by reducing cognitive
stress and stress arousal and
increasing positive states of
mind and hormonal factors that
may promote telomere
maintenance.”
 Epel E, Daubenmier J, Moskowitz JT, Folkman
S, Blackburn E. Can meditation slow rate of
cellular aging? Cognitive stress, mindfulness,
and telomeres. Ann N Y Acad Sci. 2009
Aug;1172:34-53.