Aegerter Resilience What's Buddhism Got To Do WIth It

Resilience: Whats Buddhism Got To Do With It?
Resilience: Whats Buddhism Got To Do With It? Julia J. Aegerter Upaya Zen Center
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TABLE OF CONTENTS
ABSTRACT INTRODUCTION LITERATURE REVIEW PSYCHOLOGICAL AND BIOLOGICAL FINDINGS 5 CULTURAL FACTORS NEUROSCIENCE FINDINGS ENHANCING RESILIENCE HOW FAITH IMPACTS RESILIENCE 19 APPLICATION RESILIENCE: A BRIEF SUMMARY OF THE RESEARCH 21 WHATS BUDDHISM GOT TO DO WITH IT 21 CONCLUSIONS REFERENCES APPENDIX A APPENDIX B BIBLIOGRAPHY
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Abstract
Hospital patients and people who experience trauma are often infantilized by their caregivers. And yet there is a growing body of evidence that the vast majority of human beings are resilient. This paper reviews the scientific research on resilience and the processes that enhance it. The Buddhist teachings and practices which chaplains might draw on to enhance resilience in themselves, their patients and clinical staff are explored.
Introduction In my work as a chaplain in long term acute care, and emergency rooms I have seen many degrees of suffering. I have often heard people state I know God wont give me more than I can bear and then their voice trails off. As a chaplain at a disaster site, I witnessed people coming through the rubble and shared stories of loss, and death. I witnessed the recovery of cherished pictures and childrens toys and the joy of finding something, when the expectation had been nothing. On bereavement calls, I have witnessed tears and laughter. As a minister I have observed that some people do bear all kinds of suffering and thrive, and others break. I have marveled at the resilience of human beings and I have asked why do some and not others thrive; and what can I do that will make a difference? This thesis arises from that quest to understand and to serve, and to pass on what I find to others who quest. It turns out that not only is the answer complicated but even the term resilience means different things to different people. Nobel prizewinner, Mario Capecchi(2007) had an early life of deprivation. By 4 years old his father abandoned his family, his mother was taken away by Nazis, and the family into whose care he was placed turned him out on the streets. Looking back on his life he remarks that he marvels at the resilience of a child. He has wondered if it was those early experiences that led to the success he achieved. He concludes: It is not clear whether those early childhood experiences contributed to whatever successes I have enjoyed or whether those achievements were attained in spite of those experiences. When dealing with human life, we cannot do the appropriate controls.... What I have learned from my own experiences is that the genetic and environmental factors that contribute to such talents as creativity are too complex for us to currently predict (p.7).
Review of Literature In materials science, resilience is understood to mean, the ability of a material to return to its original form after being bent, compressed or stretched (American Heritage Dictionary, 2009). In the world of humans and other animals, research focusing on psychological and physiological resilience, the term has had a variety of related definitions. Psychological and Biological Findings Early research on resilience focused on children, adolescents and families. Researchers sought to discover ways to help children who experienced adverse conditions develop psychosocially. It was assumed that resilient children, those who overcame adverse conditions and went on to thrive, were somehow special (Masten, 2001). Like Capecchi, one question researchers asked was could people be inoculated to stress. That is, could early doses of stress lead to future coping. Research done on adolescent monkeys demonstrated prefrontal ventro-medial cortex plasticity in response to stress inoculation. The authors (Katz et.al. 2009) suggest that this process might also occur spontaneously in humans. Lewitus & Schwartz (2009) suggested that immunological memory had a significant role in developing coping responses to stress. The stressful experience activates the hypothalamicpituitaryadrenal (HPA) axis, the sympathetic autonomous system, as well as other cognitive processes that orchestrate the immediate response to stress (fight or flight). The stress hormones induce the mobilization of immune cells to the central nervous system (CNS), where they are activated by local antigen presenting cells. In the CNS, the activated cells secrete and regulate neurotrophic factors that maintain homeostasis, while building the immunological repertoire(p. 534).
A review of literature on the role of the medial prefrontal cortex in coping undertaken by Maier & Watkins (2010) revealed that the subjects (rats) that had behavioral control which they defined as the ability to alter the onset, termination, duration, intensity or pattern of a stressor showed blunted responses, both behavioral and neuro-chemical to later stressors. This effect was a result of ventral medial frontal prefrontal cortical inhibitory control over brainstem and limbic structures. These findings support work done with human subjects, that posit a connection between resilience and perceived control and the studies which show that brain mechanism can regulate emotions. While chaplains are not likely to use stress inoculation as an intervention, this study is interesting in that it demonstrates a learning effect which may suggest that people can also adapt to stress through other modalities. Davidson et.al. (2003) found that meditation produced an increase in left side anterior activation of the brain, an area associated with increases in positive affect and decrease in anxiety and negative affect. They also found that immune function was enhanced. Bonanno (2004) noted that most of the psychological knowledge about how adults cope with loss and trauma was derived from people who experienced significant psychological problems or sought treatment which led to the belief that resilience was either pathological or rare. He states that the empirical evidence suggests that resilience to loss is not rare, but relatively common and is not a pathology nor does it lead to delayed grief reactions (p. 23). In 2001, Masten identified two approaches to the study of resilience. One was the variable focused approach in which researchers looked for linkages among various measures and the other, person focused which compared people to determine what differentiated the resilient
from others. Mancini & Bonanno (2006) suggested that resilience be defined as an outcome after a highly stressful event and then research factors that promote or detract from that outcome. Drawing on his own research, Bonanno (2004) identifies four patterns of human functioning following trauma of loss. The first, resilient individuals, may experience several weeks of disruption but generally exhibit a trajectory of healthy functioning over time and seem to have the capacity for positive emotions and generative experiences (p. 21). They represent about 50% of the population. Second, individuals who exhibit severe long term distress, represent 10% to 15% of the population and are described as being on the chronic trajectory. Third, those who exhibit initial distress which may last from two to 18 months but then recover on their own are said to be on the recovery trajectory. The fourth trajectory describes those who experience a delayed reaction which was not observed among individuals studied after loss. Bonanno (2004) reports that studies on individuals exposed to violent and life-threatening events report different symptoms but the same trajectories. He noted that Buckley, Blanchard & Hickling (1996) reported a rate of 5% to 10% of the population for delayed PTSD. Researchers have extended Bonnanos initial work by exploring resilience among people with various health issues. This is interesting because his earlier work focuses on an event, such as the death of a loved one, a natural disaster or a terrorist attack which was usually a single event. These studies were done retrospectively. Since health issues tend to be ongoing, one might wonder if the trajectories are the same. Hou et al. (2010) notes that cancer stressors are multiple and exist in both the past and future. They are also ambiguous since therapies can cause suffering and at the same time provide hope. They found that Chinese cancer patients showed the following trajectories: 65-67% resilient, 13-16% recovery, 10-13% delayed distress and 7-9% chronic distress.
Quale & Schanke (2010) set out to explore resilience in the face of severe physical injury. The authors note that in Norwegian culture it is assumed that an individual who suffers a severe physical injury which includes a functional loss cannot return to a normal life. Individuals with disabilities often meet with prejudice and pity. In this study, resilience was defined as a pattern of adaptation and individuals were assigned to resilient, recovery or distressed trajectories based on their level of psychological distress and state of positive affect at admission and discharge. They found a resilience trajectory of 54%, a recovery trajectory of 25% and a distress trajectory of 21% and no delayed response trajectory. It was noted that those in the recovery trajectory seemed to have more stressors such as death of a family member or serious illness at admission, and/or relational and social problems at discharge than those in the resilience trajectory. These finding are consistent with Bonanno et. al. (2007) who found that people who experienced 9/11 and had no prior traumatic events and no recent life stressors were more likely to be resilient than those who had several recent life stressors. In addition to studying trajectories, numerous studies on resilience have been undertaken to look at what processes relate to resilience. Citing the work of other researchers, Bonanno (2004) identified four processes that appear to promote resilience: hardiness, self-enhancement, repressive coping and positive emotion and laughter. Bonanno (2008) labels two of these coping ugly. He reports that self-enhancement is ego-boosting; convincing yourself that you can handle whatever comes your way. Repressive coping is repressing negative thoughts and emotions. Coifman et. al. (2007) investigated repressive coping and resilience. They sought to extend previous research on a form of coping which had historically been identified as negative. They studied recently bereaved people who demonstrated heightened physiological responses to
stressful stimuli but did not report negative affect. In contrast to previous studies, no evidence linking repressive coping to negative health consequences was found in their investigation. Their findings support the theory that automatic emotion regulation (self-regulation that modulates emotional responding and yet is not effortful or activated by conscious intention) can be associated with adaptive rather than maladaptive outcomes (see Mauss, Evers, Wilhelm, & Gross, 2006) (p. 754). This finding is supported by evidence from neuro-imaging research (e.g., Tomarken & Davidson, 1994) which links repressive coping and left anterior resting brain activation (Coifman et.al 2007). Hardiness involves finding meaningful purpose in life, the belief that one can influence ones surroundings and outcome of events, and the belief that one can learn and grow from both positive and negative life experiences (see Kobasa, et.al, 1982). Lau and Van Nierkerk (2011) interviewed 6 burn victims from South Africa in a narrative study of resilience. The following excerpts of their stories reveal that hardiness was a strong factor in their resilience. They demonstrate learning and growing: Yes, well its just practicingdoing, doing things that no, nobody knows, but you only know inside of yourself. You just sit down and think, you think of what will happen, think of what happened and what changed it, and how you changed yourself and how you, have been able to, to, to defend yourself from other different diseases and other situations, where you dodge, where you like never will go through, but with family and friends, you made it, you made it through (p. 1173). Ive developed, strong full of knowledge, and I have learned a lot from this, this situation that Ive been through and now I know, how to like . . . cover it and like go
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through, through the disability that I have. And you . . . mustnt be scared, of anything (p. 1173). Give evidence of meaning making: I said to myself that maybe I am a new person. Ja, I was burned there and thenactually they didnt know that I will survive. I think I was, born again, ja, and now Im someone whos supposed to be here . . . to live again and to show people, whats exactly whwhwha you know. I dont know how I can explain this. I think thats the thing that keeps me going, cause of God, cause I think I wouldnt be here without him. He is the one who, whos inside me, who controls me (p. 1174). And seek to find purpose: One survivor expressed interest in becoming a lawyer to empower people about access to health care (e.g., They dont know law, because many of them, they dont have a lot of medication). Buhle positioned himself as one who would be a positive example to the young burn survivors (e.g., Maybe to go to hospital . . . show young kids who are burned, what other older kids who are older than them). Last, another perceived her role as one who would teach and guide others to pull through adverse challenges (Teach people . . . that you can live with something. You can live, whatever accident that you come across) (Lau and van Niekerk p. 1175). These survivors also spoke of the need for acceptance, and support from their friends and community. Buhle spoke of his need to be seen as a person amongst all people . . . [as] a human being(p. 1170). Park (2010) reported in a review of the literature on meaning making that there are many questions left to sort out, and that the many studies have varied in the questions asked, and how
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they went about it. The research seems to indicate -- it depends. In other words, we first need to better understand what meaning making is and then ask for whom, and under what circumstances, are particular types of meaning making and meaning made helpful and why? Park (2010) did note that it is clear that meaning making is reported by most people who face highly stressful situations. And further, that the evidence shows that blame and negative evaluations typically lead to poorer outcomes and those who engage in a nonjudgemental reflection tend to respond with better adjustment. Karoly & Ruehlman (2006) investigated resilience in people with chronic pain. They defined resilience as a response pattern consisting of high pain severity in the context of low interference and low emotional burden. Low and high resilient people were compared on a variety of factors. They found the following for resilient individuals: significantly higher control perceptions, significantly lower levels of disability belief, belief in a medical cure, and paininduced fear; significantly lower levels of catastrophizing, less likely to be receiving treatment, less prescription pain medication (though both groups used OTC pain medication). This study corroborates other studies in finding that resilience covaries with a sense of perceived control, self-confidence and positive attitudes and beliefs. Waugh et. al. (2008) examined fMRI studies of the insula, amygdala and orbitofrontal cortex when subjects were viewing innocuous events in the midst of a threat. This study adds neural data to confirm that high resilient and low resilient people differed on the flexible use of emotional resources. The two groups were both reactive to the possible threats. The difference was that the more resilient group returned to baseline more quickly. In her article on the broaden-and-build theory of positive emotions, Fredrickson (2004), reviews the history of research on positive emotions and summarizes current research findings.
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She distinguishes between positive emotions, pleasure and moods: pleasure is a response to fulfilling a bodily need; positive emotions are about a personally meaningful circumstance, typically short-lived and occupy the foreground of consciousness and moods tend to be freefloating and long lasting and occupy the background of consciousness (see Oatley & Jenkins 1996; and Rosenberg 1998). Fredricksons broaden-and-build theory (2004) asserts that positive emotions broaden peoples momentary thought-action repertoires and build their enduring personal resources. She reports that her studies (Fredrickson & Levenson 1998; and Fredrickson et.al. 2000) demonstrated that mild joy and contentment shared the ability to undo the lingering cardiovascular after-effects of negative emotions. In another study (Fredrickson et al. 2004), subjects that made a daily effort to find positive meaning in their day showed increases in resilience that were accounted for by the positive emotions garnered. According to Fredrickson (2004), research shows resilient people have been found to use a diverse set of coping strategies including humor, relaxation, and optimistic thinking. These strategies all have the ability to cultivate positive emotions. And resilient people not only cultivate positive emotions in themselves but are skilled at eliciting positive emotions in others (see Werner and Smith 1992; Wolin & Wolin 1993; Masten 1994; Murphy and Moriarity 1976; Anthony 1987; Demos 1989; Kumpfer 1999). Frederickson (2004) concludes that the Broaden and Build theory also carries an important prescriptive message. People should cultivate positive emotions in their own lives and in the lives of those around them, not just because doing so makes them feel better in the moment, but because doing so transforms people for the better and sets them on paths toward flourishing (p. 1375).
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Tugade & Fredrickson (2007) reviewed the literature that explored the connection between health and positive emotions, and how positive emotions might be activated. Paying attention can aid in savoring an experience, relaxation therapy and guided meditation with thematic imagery might enable people to learn to savor. Smiling in the midst of sadness can speed cardiac recovery. Gratitude and sharing good news prolongs the positive experience. Research by Philippe (2009), suggests that resilient people are able to self-generate positive emotions by relying on positive affect laden memories. Tugade & Fredrickson (2004) investigated the undoing effect of positive emotions. Their results indicated that positive emotions were related to reduced cardiac reactivity following a stressful event. In a study of Aged Care Nurses working in a residential facility, Cameron & Brownie(2010) found that nurses reported that their resilience was enhanced by colleagues or mentors who provided physical or psychological support by offering the chance to self-reflect, debrief, or validate. Those who provided them relief through humor and camaraderie were also mentioned as resilience enhancing. Positive emotions have also been found to aid in cognitive reappraisal for patients with chronic pain. Pain catastrophizing is an important factor in pain severity, and emotional distress for people with chronic pain. Ong et.al. (2010) found that women were more likely than men to catastrophize pain and that elevations in positive emotions one day led to decreased catasthropizing the next. This was particularly true for women. The authors suggest that chronic pain suffers would benefit from enhanced attention to positive emotions and reframing. Harvey (2007) proposes an ecological understanding of resilience. She notes that community psychologists suggest (Riger, 2001, p.75) people are embedded in complex and dynamic social contexts which are themselves subject to change. As such, an individuals
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qualities are nurtured and shaped by any number of interactions. While the author is primarily interested in resilient communities, her understanding points to why personal relationships are important resources and stressors. Cultural Factors Tummala-Narra (2007) draws our attention to the way cultural factors might impact resilience. She notes that while the trajectories of resilience might remain consistent across cultural contexts, the way in which people mobilize their resources varies across cultures. She gives the following example: Juhi, a 23-year-old Indian American woman was sexually assaulted by a male acquaintance when she was 20 years old. Juhi sought psychotherapy after being encouraged by a friend to cope with her depression and traumatic memories. She was born in India, lived in England until age 10, and then moved to the U.S. with her family. Her parents worked in a small business and interacted primarily with other Indian immigrants both in England and the U.S. While growing up, she became a devout Hindu with the guidance of her parents, who visited the temple a couple of times a week.... Juhi explained that she felt strong and healthy in certain ways when she was with her family, and in other ways when she was with her college friends. She connected her ability to survive under difficult and changing circumstances with being an immigrant, an experience she shared only with her family and other Indians, and her ability to broaden aspects of her individuality, which included her sexuality and an understanding of trauma, refuel with her friendships outside of her family. She spoke in therapy of needing to herself by being in both worlds to cope with the rape and to feel resilience is expressed in her ability to participate in both cultural worlds,
grounded......Juhis
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her refusal to be defined by or isolated from either, and in her ability to draw upon critical resources in each. An important task of recovery involves the re-integration of cultural identity
through building awareness of how the traumatic experience challenges and/or reifies ones cultural identifications. This is a process that is an essential component of defining ones multicultural self (p44-45). Hou (2010) looked at how social support, relational quality, optimism, physical functioning and hope related to Bonnanos four trajectories of resilience. A possible cultural effect was noted in that social support was reported for the highly distressed and this was not a positive resource as it has been in studies of Caucasian and Hispanic women with cancer. The author notes that Chinese cancer patients worry more about distress and being a burden than recovery. In a collectivist culture, relational harmony is valued over seeking social support for coping with stress. This study corroborates Tummala-Narras contention (2007) that A particular trait or circumstance that is seen as promoting resilience in one cultural context may actually be seen as a liability in a different cultural context. For example, in cultures where individualism and individual accomplishment are highly valued, such as the United States and Western Europe, personal autonomy and achievement, selfexpression, and a strong sense of personal boundaries are upheld as ideal, particularly among the middle class.... In collectivist cultures, an individuals reliance on coping strategies that exclude family wishes and obligations as guides for coping with interpersonal violence, such as rape or domestic violence, can be experienced as isolating to the individual and stressful to both the individual and his/her communities of reference... Within more collectivist cultures, a sense of shared efficacy, or
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communal-mastery, may be more central to peoples resiliency in the face of stress and adversity (p 37-38). Neuroscience Findings What might we learn from Neuroscience about stress and resilience? The human animal has been programmed to scan for danger. And in response to real or perceived threat our bodies use the Hypothalamic Pituitary Adrenal (HPA) axis to respond by releasing cortisol. The sympathetic nervous system stimulates the adrenal medulla to release adrenaline and prime for a fight or flight response. The release of theses hormones causes our hearts to beat faster, our oxygen to circulate to the periphery of our body so we can move and to our brain to enable thought. When our nervous system detects safety, oxytocin is released in the body and stress responses from the HPA axis are suppressed. Thus we can say it modulates fear. Our natural body rhythms cause a fluctuation between sympathetic and parasympathetic responses. However, a high stress environment disrupts the bodies normal biorhythms, and can result in a state of chronic stress. High levels of cortisol in the blood stream are associated with lowered immunity and wound healing, higher blood pressure, impaired cognitive performance and a number of other health problems. (notes from TRM, Laurie Leitch Mar 2010 and PsychoNeuroImmunology by SusanBauer-Wu Aug 2010) Feder et.al. (2009) note that it is only in recent years that scientific and technological advances have made it possible to look at the biological processes associated with resilience. Many studies identify resilience with the ability to control increases in cortisol, providing a quicker return to baseline after a stressor. Neuropeptide Y (NPY) counteracts the effect of Corticotropin-releasing hormone (CRH) on Amygdala and Hippocampus, reducing anxiety. The
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author citing a study by Morgan (2000), gave the example of special forces soldiers who revealed higher levels of NPY. Sajdyk et.al. (2008) studied the effects of NPY in rats and found that NPY seems to work by increasing plasticity in the Central Nervous System (CNS). They did not observe any effect on the HPA axis. Brain imaging studies are allowing researchers to identify brain circuits that mediate mood and emotion. Endocrine and immune function studies also identify the biological reactions to stress. Much of the research on neural circuits and fear comes from animal research. The amygdala, ventromedial prefrontal cortex (vmPFC) and hippocampus make up the fear circuit. It appears that the acquisition of fear is centered in the amygdala and the extinction of fear involves the vmPFC as well as the amygdala. The hippocampus is involved in the strengthening and extinction of memory. It is believed that extinction of a memory is actually the creation of a new memory rather than the erasure of an old one (Feder et.al. 2009). Enhancing Resilience Cognitive reappraisal as a method of regulating emotions has been studied using fMRI. It appears that the PFC is used to regulate response. It is interesting to note that greater use of reappraisal in everyday life had been linked to greater PFC and lower amygdala activity in response to negative stimuli suggesting a way to promote successful coping (Feder et.al. 2009, p453-454). Buddhist teacher Thich Nhat Hanh notes that asking Is it so? can reduce a lot of suffering. Can people become more resilient? Recent studies suggest that people can be trained to modulate their own brain activity (Feder et. al., p. 455). Jackson et. al. (2007) reviewed literature on resilience in the interest of exploring resilience as a strategy of responding to workplace adversity. They concluded that nurses can develop and strengthen resilience by
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participating in mentoring programs, maintaining balance in their lives, and developing emotional insight (p. 7). In humans vmPFC is activated when people think about their own mental states and when thinking about those of other people (Feder 2009 p. 454). Oxytocin seems to enhance the reward value of social stimuli and reduce fear responses (p. 454). Humans value safe touch. Stewart & Yuen (2011) reviewed the literature on resilience in the physically Ill. They noted that health care professionals may help patients live and function better by helping them with coping, positive cognitive reappraisal, and an ability to handle uncertainty. Helping patients to recall other challenging situations that they have mastered, encouraging patients to take on their own self-care, and responsibility for pain management, and ask for information all promoted resilience.
How Faith Impacts Resilience Peres et al. (2007) reviewed research on religiousness and resilience. One of the factors which has been investigated relative to resilience is religious/ spiritual. It has been seen to be helpful when it provides community, a cognitive framework that provides purpose and meaning, and a worldview that gives a positive meaning to suffering. Research on PTSD in veterans found a positive association between PTSD and a weakened religious faith, which was attributed to quilt they felt about things they had done in the war. Bartlett et. al. (2003) looked at spirituality, well-being and health of people with rheumatoid arthritis using the Aspires Scale developed by one of the authors. According to Piedmont, the developer of the scale (2004):
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Spiritual Transcendence (ST) represents the ability of an individual to stand outside of his/her immediate sense of time and place and to view life from a larger, more objective perspective. This transcendent perspective is one in which the person sees a fundamental unity underlying the diverse strivings of nature. People high on ST believe that there is a larger plan and meaning to life, something beyond our mortal existence. Despite all the ups and downs in life, there is something more permanent and constant that gives direction, meaning, and value to life. Those low on ST are more concerned with the material aspects of life and see no larger meaning to life other than what life offers in the here and now. There are three aspects to ST: Prayer Fulfillment, a feeling of joy and contentment that results from personal encounters with the god of one's understanding; Universality, a belief that all of life is intimately tied together; and Connectedness, a belief that one is part of a larger human reality that cuts across generations and groups. They found that spiritual transcendence was associated with happiness and joy as well as positive perceptions of health. Devson (2004) sums it up this way: Hope is important; learning how to ask for help; humour; viewing ourselves and others in terms of strengths not weaknesses; and having some kind of meaning in life which does not necessarily mean having a formal religion. Celebrated French writer, Colette, who was crippled by arthritis in old age found meaning in the beauty that she saw in the very room in which she was confined. For those whose spirits are darkened through trauma or illness, this isn't always easy. But I have seen it happen, through friendship, through helping people feel needed, through listening, through acceptance, and through
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finding those things that bring joy in life. Ultimately, a sense of connectedness lies at the heart of resilience (p. 3). Application Although each Chaplain has their own religious identity, their role in a hospital or disaster site is not to convert others to their beliefs but to assess what is needed in the way of spiritual support and to help people identify and draw on their own resources. In working with people, chaplains will encounter a variety of beliefs and serve people on the full gamut of resilient/ distressed trajectories. How then is the literature on resilience applicable to their work? And what does Buddhism have to offer?
Resilience: A Brief Summary of Research While some people may be inoculated by their genes and others by small stressors to which they have adapted, it seems that the majority of people that chaplains encounter will demonstrate some form of resilience. Those who exhibit PTSD or severe distress would most likely benefit from professional therapeutic intervention, which is beyond the scope of practice for a chaplain. The Neurobiological findings presented earlier offer a chaplain the knowledge that cognitive reappraisal can defeat fear, people can use their minds to modify their brain and older memories can be extinguished by creating new ones. And the assurance that neurobiological findings support the psychological findings. These findings are important in the age of evidence based practice. We can draw on the psychological research that has been done to develop practices which can be used to enhance resilience. The research suggests that positive emotions, and effort to find
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positive meaning can promote resilience. Smiling, sharing good news, recalling positive affect laden memories and gratitude and savoring can all contribute to positive emotions. In addition we can promote resilience by laughter, and helping the people we encounter: to discover how they might influence their outcomes and/or surroundings, to reflect non-judgmentally, find learning, and meaning in their experience. We can offer reframing to reduce catastrophizing. We can elicit positive memories and offer a listening ear as people seek to make sense of what has happened and re-story themselves. What does Buddhism have to offer? The core teachings of Buddhism offer each practitioner a path to resilience. The Four Noble Truths acknowledge the truth of suffering in every life, the recognition that the cessation of suffering can also occur, that there is a way to end suffering, and the eight-fold path for relieving suffering. The Buddhist chaplain can take refuge in the Dharma and see that the suffering they witness each day is part of the natural course of life. The suffering they experience when bearing witness can be transformed for they know that their presence with people in crisis can help them suffer less. As Thich Nhat Hanh (2007) writes: The meaning of the word Avoloketisevara is the one who looks deeply into the world and hears the cries of the world. This voice relieves our suffering and suppressed feelings, because it is the voice of someone who understands us deeply - our anguish, fear and despair. When we feel understood, we suffer much less (p 43). Impermanence helps us in many situations. We can know that we as well as the individuals we work with are capable of change. Anything can be withstood when we know that it will not last forever. We can learn not to attach to outcomes which Bernie Roshi Glassman
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says will help activists to be free of burnout (mentioned in his Aug. 2011 talk at Upaya). And isnt this resilience. Karma, the belief that every action has a reaction offers the recognition that we can change our situation by acting in a new way. When we help someone to look at their situation with new eyes, when they can learn: to reframe, to meditate, to laugh we are enfleshing our understanding of impermanence and Karma. The three tenets of a Zen Peace Maker are Not-Knowing, Bearing Witness, and Compassionate Action. Not-knowing is how we enter the situation. It is easy to listen to anothers interpretation of an event and get sucked into approaching a situation with a mind colored by what you have been told. The clinical staff often do this when they pass on information at shift change and the patient receives a label (e.g., drug-seeker, difficult family). Bearing witness is what follows not-knowing. We enter with soft eyes, and with receptive attention. Compassionate action arises in the moment when we are one with the situation. Buddhism offers the chaplain the model of Jizo for their work. This model differs from the oft cited Christian model of sacrifice. In the Jizo model the caregiver does not see their role as rescuer, rather they open their sleeves and the patient may choose to enter. This model sees people with their potential, rather than as broken. It enables us to see the resilience in people and to draw on what is known about resilience and help people to draw on their own resources and build new ones. In Oct. 2011, Martine Batchelor gave a talk on Creative Equanimity at the Upaya Zen Center. She said that Equanimity does not mean that nothing will disturb you but rather that you will learn to be with what occurs and what to do about it. Learning creative equanimity means we can flow, become more flexible.
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In speaking about the Buddhist understanding of impermanence, Batchelor (2011) reminded us that for those who are suffering, change is a gift. She applied this to her own life, she said, I wake up tired and old and aching and then something happens for example my IPAD comes back to life and then I see that I am having a much different emotional response. It reminded her that we are not solid, but made up of inner conditions that are constantly changing. Life can be interesting, she said. The idea that life is interesting is the result of her Buddhist understanding and a way that any of us, with practice, could use to reframe. Batchelor (2011) reminded us of our dependence, we survive through air we breathe, food we eat, water we drink, clothes we wear and all of these things come from outside us. We can look at this and feel our connection to all of life and all others in our situation, compassion may arise. It is a world view that we can draw on for ourselves and offer to others. One does not need to be Buddhist to see our dependence and thus connection to life. This may be helpful to those who feel lonely. Many people when aging or when suffering from a chronic disease or traumatic injury go through a time when they are at a loss, they dont know who they are and cannot do what they used to do. Often they are ashamed of being dependent on others. I have found that with Christians I can remind people that we have to take a turn letting others do for us so that they can have a chance to give rather than just receive. I believe that we need to honor their sense of loss, and I can see that it might also be helpful to have people think about all the ways everyone is dependent on someone or something so that they might be able to reframe their situation. Chaplains bear witness to incredible suffering and experience their own emotional distress, and we need to have a strong practice and emotional maturity to persevere. We need to
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be trustworthy and perceived as nonjudgmental and accessible if we want the staff to come to us. It is our transparency and the ability to be calm in the fire which will help them. In a book entitled How to be Sick Toni Bernhard (2010) describes how her long term Buddhist meditation practice and study has served to help her live her life after contracting a debilitating chronic illness. She has created her own practices based on core Buddhist teachings. The first noble truth supported her because it told her, it wasnt just her. She would remind herself: You know this is the way it is. You were born and so are subject to change, disease, and ultimately death. It happens differently for each person. This is one of the ways its happening to you (loc 454). Bernhard (2010) wrote, Buddha taught two things suffering and the end of suffering. By ending dukkha, Buddha was not referring to bodily pain, or other inescapable facts of human condition. He was talking about the suffering in the mind (loc 490). Relieving the suffering of the mind is the focus of her book. Bernhard (2010) reveals the many faces that suffering takes in the chronically ill: wanting a cure, envy of others and what they are able to do, delusion about why others are not doing what you want them to, the unpredictability and the self-judgement. Each chapter takes the reader through practices which can be used to reframe, make meaning, cultivate joy. Her practices can serve as resources and models for the Buddhist chaplain who is seeking to understand how to apply core Buddhist teachings when working in a multi-faith setting. The following examples demonstrate practices created from Buddhist concepts. These practices help her to exert control over the one thing she can control, her mind. She has used her beliefs to enhance her resilience through reframing, savoring, re-storying, reducing catastrophizing, building connections to others in her life and experiencing gratitude.
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The broken glass practice of Achan Chah helps her when she starts to think about all the things she had to give up. She reports (loc 599) that Achan Chah taught, we shouldnt worry about a glass breaking. He said, Can you prevent something that is breakable from breaking ....penetrating the truth of these things we see that the glass is already broken. She read this in a book of his teachings entitled Food for the Heart. The broken glass is a metaphor for the Buddhas teachings that every aspect of life is uncertain, unpredictable and in constant flux. In light of these teachings she looks to see what she can still do and cherishes those things. She also uses what she calls weather practice, its wind man, it blows all over the place. When something throws her for a loop she says, here it is again - the wind - moods blow in and out. We cant control it. Hold the painful ones lightly cause theyll blow through (loc 543). To help her let go of identifying with her illness she uses the practice sky-gazing. Lying in bed, her pupils rolling up, her identity as sick person goes away and what is left is pulsating matter, the mind a conduit of information flow. (loc 712) She also works with the four brama viharas. She notes that one of the poisons of chronic illness is envy and the cultivation of 1) mudita (sympathetic joy) is its antidote. When patients with mental suffering are stuck in a loop we say dont do it but how can they stop. She suggests a practice of cultivating joy by wishing the other well. For example when her family would be getting together but she couldnt she would repeat to herself: it is so nice they will be getting to .... She says this practice will eventually arise in you even if initially you have to do it through gritted teeth (loc 753). 2) Metta (loving-kindness). When practicing metta for herself the author became aware that when she said the end of suffering, she meant that her illness would go away and that this
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was out of her control and how much her suffering was from her mind. Her phrases then became focused with the addition of the phrase, in the mind. 3) Karuna (compassion). Applying compassion to ourselves is opening our heart. Toni notes that If we listen to our own-self-talk it is often full of recrimination and judgement. Reconditioning helps us to look at and name our suffering, bearing witness to ourselves. We say, Its so hard to want so badly not to be sick and our heart opens to our suffering (loc 875). 4) Upekkha (equanimity). As a person with chronic illness she is sometimes overwhelmed by her loss. She has been inspired by the story of a woman who lost her 14 yr. old son. When interviewed the woman speaking of her son said: this was a life that lasted 14 years loc 1234). Toni now works to reframe her own losses as things she had for a time, rather than as things she lost. Breathing, and the pause are a key focus in Buddhism. Matthieu Ricard (2011) noted the following in his blog: Meditation, or more accurately mind training, helps to cultivate the inner resources that give us confidence to deal with the ups and downs of life. These inner resources include inner freedom that makes us less vulnerable to ever-changing outer conditions. Here, inner freedom means being free from the influence of automatic mental processes that lead to animosity, obsession, envy, and other mental toxins that undermine our well being... These inner resources help build resilience. In her article on using a pause to improve ethical discernment, Rushton (2009) offers advice to clinical staff which applies equally well to chaplains. It is imperative that chaplains be able to take a step back from a situation of conflict as the breathe can provide a door into not-
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knowing. A chaplain skilled in pausing can change the field of the room into which he/she enters. The individual who brings the pause, models awareness to those who are present and creates a space for the people involved to also step back, check assumptions, gain a deeper understanding of each other and perhaps create new possibilities. As Kabat-Zinn (2003) notes, there is nothing particularly Buddhist about breathing, awareness, or attention. The contribution of Buddhism is that it has offered simple and effective ways to cultivate these capacities and bring them into all aspects of life. Mindfulness Based Stress Reduction (MBSR) was meant to serve as a way to help people assume some responsibility for their well-being, and improve health by refining their own innate capacities. MBSR is probably the most widely known application of Buddhist practice to the nonBuddhist world. Its efficacy in reducing stress, improving memory and its contribution to the well-being of those suffering from mental and physical illnesses has been widely studied. Krasner et.al.(2009) investigated the efficacy of a program in mindfulness, communication and self-awareness on the well-being of primary care physicians. Short-term improvements in compassion and empathy did not last. Over the long term (3mos. after study) a reduction in burnout, decrease in depression and fatigue and improved emotional stability emerged. Jha et. al.(2010) asked could MBSR programs provide psychological prophylaxis. They created a Mindfulness Based Fitness Training program (MT) and tested it with Marines who were undergoing a pre-deployment training period. They were specifically studying working memory capacity which has been shown to degrade with pre-deployment stress. The sample size was limited and study design did not allow for strong causal inferences (p. 61)
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however, the results did suggest that MT exercises may protect against Working Memory Capacity degradation and reduce negative affect. Bauer-Wu, et.al. (2008) conducted a pilot study of the use of Mindfulness Meditation with patients undergoing autologous stem cell transplant and found that patients were able to perform these practices even when highly stressed. The patients had one on one sessions with a mindfulness meditation instructor and also listened to an audio CD. The CD contained a 17 minute guided meditation that led patients through an awareness of breath, sound, physical sensations, thoughts and feelings (p.63). These skills were taught to the patients by their instructors and in addition they were taught to integrate mindfulness into their everyday activities for example eating ice chips (this was to help them integrate these experiences into their hospital stays when they would feel less well). The intervention was well received by patients and had a high completion rate. The study suggested short and long term benefits to symptoms. MBSR programs are usually 8 weeks in length. Participants are trained in breathing and walking meditation, body scans and yoga; learning to bring mindfulness to all facets of life. These programs were created by Dr. Jon Kabat-Zinn. His book, Full Catastrophe Living; Using the W isdom of Y our Body and Mind to Face Stress, Pain and Illness (1990) is a useful resource on the foundation of this practice as well as a how to guide. In the hospital setting, using MBSR with patients can be challenging. Often patients are not free to leave their rooms or participate in group programs due to infection control, many cannot eat, and often they cannot concentrate for extended periods of time. Bauer-Wu (2011), offers many insights into how to adapt MBSR to work with patients in a hospital setting in her book, Leaves Falling Gently. In a chapter on Mindfulness, she offers mindful personal care, mindful range of motion exercises and mindful ice chips. She points out
5/31/12 11:46 AM Comment [1]: juliaaegerter Dec 31, '11, 11:25 AM
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that being mindful can help the patient notice what they are still capable of doing. She encourages patients to notice satisfaction that they obtain during the day. All of these activities can enhance resilience through reframing, and teaching nonjudgmental reflection. In the second section Bauer-Wu (2011) addresses Loving-Kindness. She offers practices to cultivate forgiveness as well as goodwill toward the self and others. These practices can induce positive emotion and enhance a sense of connection. She then focuses on engendering gratitude through appreciating others love and care, taking stock of simple pleasures and life review. Savoring, gratitude and recalling positive memories are all important ways of inducing positive emotions. Chaplains will find that practices based in Buddhism can also benefit the staff that they work with. Staff will have a variety of beliefs and their own suffering. They too have moral distress by seeing those who choose paths they would not follow, by having to treat patients they perceive as dying with more tests and the belief they are causing suffering to these patients. Sometimes the distress is over discontinuing care when they yet believe there is hope for a cure. In addition they are often people who are very giving and I have observed many are in intimate relationships with people who take advantage of them. In the hospital setting in which I worked, the staff noticed and commented on my calmness. They count on the fact that if things are crazy and I go into the room, things get better. Because they commented on my calmness, I talked with them about my meditation practice and offered the staff a lunch and learn which I marketed as Got Stress. The script for this program can be found in Appendix A. It is based on various teachings I have received at Upaya: a brief explanation on the resilient zone using the teaching of Laurie Leach, Sky gazing based in James Austins Zen brain lecture (2010), and meditative practices
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based on Dan Siegels (2010) Hub practice. I introduced this as a sampling and offered to provide in depth practice for anyone who wanted it. They found the hour to be so relaxing that they went back to their floors and talked about it. I began to get referrals. This led to a 3 day a week drop-in time of 15 minutes at the start of their lunch hour and a request that I offer the program for the night staff, which I did. I led people in a guided meditation which was based on a body scan practice from Fleet Maul (see Appendix B). As time went on, I increased the silence. I also added some comments on resilience and introduced new staff to this body scan practice each month when they had their staff orientation. I referred to it as giving yourself a mental massage. I taught one patient this practice, after she asked if I was the chaplain the nurses had been talking about in the hall. I also offered it to family members who were stressed. In time I began to get referrals from case managers and respiratory therapists who experienced my work and had patients who were very anxious when they tried to get them off the ventilator. Again, I adapted this practice. Drawing on my knowledge from TRM, I used the guided meditation to help move them from a focus on lungs and breathe to another part of body. Sometimes we were successful and sometimes not. It was especially rewarding when patients would tell me they didnt need me to guide them and explain something they had now created for themselves. According to Salzburg (1995) the Buddha taught his disciples metta meditation to help them overcome fear. She states that the power of metta comes from its ability to teach us to sustain a loving heart toward ourselves and others, and to perceive the unity of all. The practice consists of creating four phrases that are meaningful to us and repeating them over and over.
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Fredrickson, et.al. (2008) researched the use of Loving Kindness Meditation (LKM) which is also called metta, to induce positive emotions and build personal resources for resilience. The results confirmed that LKM increased the participants positive emotions and resulted in a cumulative increase over time. A direct effect of time spent meditating and change in life satisfaction was observed. The results suggest that,people judge their lives to be more satisfying and fulfilling, not because they feel more positive emotions per se, but because their greater positive emotions help them build resources for living successfully (p. 1057). Metta practice can be very useful for a chaplain. I used it myself as a way to prepare before working with patients that were difficult for me. On occasion I offered a Metta meditation when asked to provide a prayer before a meeting. I also introduced it to patients who had something they were struggling with. On one occasion I worked with a mother dying of AIDS, who was not very verbal and was adverse to the Christian faith of her childhood. When I learned that she worried about her children, I gave her a homework assignment of thinking of a couple of things she wished for each of her children. During the next visit I created Metta phrases from her wishes and we said them together, I suggested she might say these phrases when she thought of them. On another occasion I had a cancer patient who told me a story about her children. Several months earlier she had been admitted to hospice and her children went into her home and divided up her belongings. To her surprise and theirs, she did not die and went home. But they did not return her things. This time she was not informing her children she was in the hospital. She told me she was depressed and said, I do not want to die bitter. She agreed that she would welcome my help with this. I visited her regularly and we would pray the Our Father at her request. During one visit I told her I had a little something I liked to do when I was angry at
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someone and wondered if she would like to hear about it. I explained Metta practice to her and we chose 4 phrases to say together focused on her. She seemed to like it so the next time I visited I brought her a laminated copy of the four phrases. The following visit she showed me that she had had the nurse hang them on her wall and she said she repeated them all the time and she was going to take them home with her. We never got to praying for her children but her disposition had changed by the time she left the hospital. I think she left the depression behind. Conclusions A Buddhist hospital chaplain stands in two worlds. In one we value presence and the emergence of what will be, and in the other we find a system which values evidence based practice, measurable goals and documentation of accomplishments. It is comforting that psychological and neurobiological research provide the evidence basis for a Buddhist chaplain. This thesis started with the questions, Why are some people more resilient than others? and What can I do that will make a difference? Bonnano (2004) notes that research suggests that human resilience is common and delayed reactions seem limited to those exposed to life threatening and violent events. Whether we look at individuals exposed to death or loss (Bonnano, 2004), or people with ongoing health issues such as cancer (Hou, 2010), or severe physical injury (Quale & Schanke, 2010) upwards of 80% of the people studied demonstrated resilience. Those who were low in resilience evidenced prior mental illness, prior traumatic events and or a number of recent life stressors (Bonanno, 2007; Quale & Schanke, 2010). We can also draw on the literature to ascertain what contributes to resilience. Studies of resilient individuals suggest that positive emotions (Bonnano, 2004; Fredrickson, 2004; Phillippe, 2009; Tugade & Fredrickson, 2007; Cameron & Brownie, 2010) contribute to resilience. Waugh et.al. (2008) demonstrated that highly resilient people also demonstrate
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emotional flexibility. The ability to find meaning and purpose in life (Bonnano, 2004; Kobasa et. al., 2008; Park, 2010; Lau &Van Nierkerk, 2011), as well as the belief one can learn and grow from positive and negative life experiences (Kobasa et. al., 2008; Lau &Van Nierkerk, 2011) are all processes that relate to resilience. And while we might assume that relationships would be important to resilience, they can be either sources of resilience or the further cause of stress (Harvey, 2007; Tummala-Narra, 2007; Hou, 2010). Neuroscience reveals that humans are programmed for danger and that our brains also exhibit pr, thus we can adapt. Our brain circuits can mediate emotion and mood (Feder et. al., 2009). Given that it is possible to enhance resilience, how can we help? The teachings of our tradition on suffering, and the cessation of suffering provide a foundation that can support us and provide us with a framework and tools to offer to patients who want to use them. Like Avoloketisevara, we look deeply and bear witness to suffering. Our listening can help those who are suffering to feel heard and to suffer less. The teachings on impermanence can be transmitted to others by having them look and notice the changes all around, internal and external. This can help people to reframe and reduce catastrophizing. Mindfulness training can be used to help people see what they can still do and to find meaning in each day. Metta practice can enable people to see a connection to something larger than themselves and to nurture gratitude. Savoring, gratitude and recalling positive memories are all important ways of inducing and strengthening positive emotions. The practices of Not-knowing and Bearing Witness by a Buddhist Chaplain will hopefully, give rise to Compassionate Action, enabling us to see what is needed, what is skillful and when is the right time. These are the tools of the art of Chaplaincy. Like Jizo, we bear witness to the suffering of others and offer our sleeves.
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MY TITLE
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Appendix A Taking Time Out
1. Sky Gazing 3 deep breaths and let yourself arrive now look out the windows eyes above horizon, observe, open and receptive [pause] Today we are going to sample a few things that can help with stress. The first one you just did uses a different part of the brain than you use all day for critical thinking and so can be restful. You might consider going outside during a break or just staring out a window to rest your mind each day. 2. Intro to Neurobiology and Trauma & the Resilient Zone (based on TRM) As you know the body is organized for survival and danger oriented. Our brain is constantly scanning the world to assess the danger. And so our bodies are constantly being cycled by our sympathetic and parasympathetic nervous systems. This is our normal. But when we experience constant stress, our bodies move out of balance and may get stuck either on high alert where our breathing is up, heart rate up, blood pressure up and we might be anxious, angry and ready to fight; or we might completely shut down with exhaustion, become numb, disconnect, sink into depression. You may have experienced this yourself and we see this all the time in patients families who are so worn out from the long stays and uncertainty. 3. Another thing we might try to heal and restore ourselves is movement. So please stand up - get some space between you and the next person and lets shake. Shake your arms---- shake your legs --- twist your body and then dance and shake it out. 4. Next we are going to try to focus on our breath. I invite you to sit up - feet flat on floor, feel the back of you legs on the chair, imagine a string lifting up the crown of you head. Like those skeletons we have all studied, head up, chin down, arms and legs hanging from a spine that is straight. You can close your eyes, if that is comfortable or gaze down a little in front of you but not trying to focus in. And now, please direct your attention to your breath. See where you feel it. Is it at your nostrils, maybe in your throat, or is it easiest to feel your chest go up and down or your abdomen go in and out?
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Put your mind where you most notice your breath and let your awareness ride on the waves of your breath. As you follow your breath, Im going to tell you an ancient story. The mind is like the ocean and deep in the ocean it is tranquil and serene. From the depth of the ocean you can look toward the surface and see the activity there, it might be choppy or smooth but deep in the ocean it is tranquil and serene. From the depth of your mind you can also notice all the activity of the mind, the thoughts, feelings, sensations. From this deep place it is possible to become aware of the activities of your mind, but not to be swept away by them. Your thoughts and your feelings are your minds experience, they are not you. See them come and go; let them float away as you sit peacefully in the depth of your mind. Just a body breathing. (Pause) (Siegel, 2010, pp. 90-91.) This is the basic practice of following your breath. When you are distracted, lovingly and kindly, notice it and return your attention to the breath again and again. It is a practice of many religious traditions and if we were doing only breath practice, this is all we would do. You might want to try spending a little time, say 15 minutes doing this each day. 5. Now we are going to turn our attention to something called wheel of awareness practice (Siegel, 2010). Ill explain it and walk you through. Picture a wheel, the hub is an inner place of tranquility and the rim is anything that you can be come aware of. And we are going to spend a little time attending to the things on the rim. First we are going to focus on the outside world. As you sit breathing - notice if you hear any sounds, [pause] next what is it that your eyes detect, [pause] are there any odors that you can sense, [pause] are you aware of any tastes, [pause] let yourself notice any sensation of touch where your skin and clothing touch, skin on skin, a breeze on your skin. Now take a breath and let this go and lets focus on the inner sensations of the body. Focus on the face - do you feel muscles or bones? If you smile does the sensation change? Then move to your neck, then to the muscles and bones of shoulders, then down arms to fingers - open your fingers. Now focus on you torso, chest, upper and lower back, legs and feet. Then pelvic region - abdomen, genitals, hips - your intestines, gut, and maybe the breath moving in and out, your heart. And now with another deep breathe, let this go and let your focus be your mental life. Invite any activity in and pay attention - see what comes - is it hopes, dreams, thoughts, feelings? Then watch how they come, are they fast or slow, what flows what, do they stay present, fall away. How does it leave, and what is the next activity. Do they overlap? And another deep breath and let your attention come out of your body to the room. Fortunately our body has the ability to heal and restore itself. Some of the key practicel findings of neuroscience ate that we can direct our attention and sape our brains by the firing patterns we use. We can use our mind to change our brains. And our focused attention can improve cardiac function and our immune system.
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6. And now I would like you to try one last activity. I am going to ask you to hug yourself and repeat after me - May I be happy, May I be safe, May I be calm and peaceful, May I be filled with lovingkindness. I thank you for your attention today. If you would like to learn more about any of these practices. I would be glad to teach you more. Note: reactions to this program were very positive and I was asked to repeat it and a meditation group began. A number of people sought me out at later times to tell me how they were using the practice. One woman reported that she was afraid of flying on airplanes. When she had to she would use the sky-gazing practice which helped her to relax on the plane. Another person found the body movement to be helpful and something she could squeeze into her morning routine.
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Appendix B Fried Egg meditation How we sit is important and so I am going to ask you to sit in your chair with your feet flat on the floor. Next I would like you to sit up, with a straight back - not rigid but think of a string attached to the crown of your head and lifting you up and let the rest of your body hang (with clinical staff I refer to those skeletons used to study bones). Let your shoulders be loose and your hands can rest on your thighs or you can place your hands like this (demonstrate a mudra). You can close your eyes if that is comfortable or let your eyes look down a few feet in front of you and think about letting them be soft. Great. Just settle into your chair and feel the floor support your feet and the chair seat supporting the back of your legs. Dont worry about you breathing - just let is be however it is. And dont worry that you cant meditate because I m going to give your mind something to do. Now, Id like you to focus your mind on the crown of your head. See if you can feel anything maybe it tingles, maybe you dont feel anything, that is okay too (at this point I may, with permission, put a hand or a warm washcloth on the patients head). Now Id like you to think about that warmth spreading out on top of your head. Warmth, and comfort, massaging your head. Now Id like you to think of something soothing, like water, or oil or butter and let that warm relaxing energy now flow down from your head along the side of your face - relaxing it as it goes. If you like you can just try a little smile to help you relax and loosen up your face - can you feel that change. You can use a little smile any time you want to relax. Now let your eyes relax, just rest them. And now we are going to let that relaxing energy move down to your shoulders and warming and relaxing them. Let the feeling of warmth flow down your arms and into your hands - trying wiggling your fingers and then let them fall back to rest. And now the energy flows down from your shoulder into your trunk, relax your ribs and let it flow down into your belly. Let your belly be loose - let it hang. Maybe you feel it fill up when you breathe in and contract when you breathe out. Now let the ease flow down through you thighs, loosening your muscles of the upper leg and then continuing to flow and loosening you calves and flowing down to your feet. You can wiggle your toes, and smile to them.
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Now feel the ease in your body. And now go back through your body, on your own. Back to your head and let the ease flow down smile as you go. ---And now please cross your arms across your chest and hug. And and repeat after me: may i be safe, may I be happy, may i be free from suffering, may I be filled with loving kindness. -If I am working with one person I will usually observe them while they do this and help them loosen whatever appears tight by talking them through. When I do this with group I usually go through this myself and move at a comfortable pace. I observe them to see how it is going (if they are asleep) and early on may lead them through the second time - for people who come regularly - I might let them do it a second time by themselves and/or do a meditation centered on following the breath.
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Bibliography Anthony, E. J. 1987 Risk, vulnerability, and resilience: an overview. In The invulnerable child (ed. E. J. Anthony & B. J.Cohler), pp. 348. New York: Guilford. Boden, J. M., & Baumeister, R. F. (1997). Repressive coping: Distraction using pleasant thoughts and memories. Journal of Personality and Social Psychology , 73, 4562.
Buckley,T.C., Blanchard, E.B., & Hickling, E.J. (1996). A prospective examination of delayed onset PTSD secondary to motor vehicle accidents. Journal of A bnormal Psychology , 103, 617-625. Demos, E. V. (1989). Resiliency in infancy. In The child of our times: studies in the development of resiliency (ed. T. F. Dugan & R. Cole), pp. 322. Philadelphia, PA: Brunner/Mazel. Kobasa, S.C., Maddi, S.R. & Kahn, S. (1982). Hardiness and health: A prospective study. Journal of Personality and Social Psychology , 42, 168-177. Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the W isdom of Y our Body and Mind to Face Stress, Pain, and Illness. NY, NY: Bantam Dell. Kumpfer, K. L. (1999). Factors and processes contributing to resilience: the resilience framework. In Resilience and development: Positive life adaptations (ed. M. D. Glantz & J. L. Johnson), pp. 179224. New York: Kluwer/Plenum. Fredrickson, B. L. (2000). Cultivating positive emotions to optimize health and well-being. Prevention and Treatment 3. http://journals.apa.org/prevention/volume3/ pre0030001a.html. Accessed 17 September 2003. Fredrickson, B. L. & Levenson, R. W. (1998). Positive emotions speed recovery from the cardiovascular sequelae of negative emotions. Cogn Emotion, 12, 191220.
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Masten, A. S. (1994). Resilience in individual development: Successful adaptation despite risk and adversity. In Educational resilience in inner-city A merica: challenges and prospects (ed. M. C. Wang & E.W. Gordon), pp. 325. Hillsdale, NJ: Erlbaum. Mauss, I. B., Evers, C., Wilhelm, F. H., & Gross, J. J. (2006). How to bite your tongue without blowing your top: Implicit evaluation of emotion regulation predicts affective responding to anger provocation. Personality and Social Psychology Bulletin, 32, 589602. Morgan, C. A. et al. (2000) Plasma neuropeptide-Y concentrations in humans exposed to military survival training. Biol. Psychiatry, 47, 902909.
Murphy, L. B. & Moriarty, A. (1976). V ulnerability, coping and growth: from infancy to adolescence. New Haven, CT: Yale University Press. Oatley, K. & Jenkins, J. M. (1996). Understanding Emotions. Cambridge, MA: Blackwell. Riger, S. (2001). Transforming community psychology. A merican Journal of Community Psychology , 29(1), 69-81. Rosenberg, E. L. (1998). Levels of analysis and the organization of affect. Rev. Gen. Psychol. 2, 247270. Tomarken, A. J., & Davidson, R. J. (1994). Frontal brain activation in repressors and nonrepressors, Journal of A bnormal Psychology , 103, 339349. Werner, E. & Smith, R. S. (1992). Overcoming the odds: High risk children from birth to adulthood. Ithaca, NY: Cornell. Wolin, S. J. & Wolin, S. (1993). Bound and determined: Growing up resilient in a troubled family . New York: Villard.

Aegerter Resilience What's Buddhism Got To Do WIth It

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Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Appendix A Taking Time Out

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

Resilience: Whats Buddhism Got To Do With It?

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