Utilizing Mindfulness to Cultivate Culturally- and Emotionally-Responsive Care.pptx

This presentation shows how mindfulness—focusing on the present moment without judgment—can help one communicate better, reduce errors from bias, and stay calm under pressure. By staying open-minded (“beginner’s mind”) and genuinely curious about each client's perspective, one can capture more accurate information, build stronger relationships, and prevent misunderstandings. Practical mindfulness techniques, such as focused breathing and active listening, also boost emotional resilience. Overall, these strategies help one deliver more efficient, culturally-aware, and empathetic outcomes.

1. Utilizing Mindfulness to Cultivate Culturally- and Emotionally-Responsive Care Abhi Dalal Research Associate, UC Riverside School of Medicine’s Center for Healthy Communities

2. Presentation Format Overview Mindfulness Concordant Care Compassion Dyadic Exercises

3. Overview

4. Anti-Racist Mindfulness The deaths of Breonna Taylor, George Floyd and more have brought attention to the deep racial inequities in our country. This society-wide discrimination and biases exist in us. But mindfulness lowers the threshold of consciousness to become aware of this cultural internalization and then not act on our implicit biases. Mindfulness illuminates our own internal reactions and biases and provides greater skillfulness to respond to our racial biases and others’. Mindfulness is a tool to cultivate an anti-racist way of being.

5. Mental Maps Unfortunately, the time-constrained, cognitively-challenging atmosphere of any healthcare setting limits our anti-racist way of being. In the intense healthcare environment, we all attempt to minimize spending cognitive energy by relying on our mental models of patients. We may end up treating a patient differently if they are female. Mindfulness enables us to provide the same level of care to all by consciously putting aside our mental models in order to connect best with whoever the patient may be.

6. What Exactly is Mindfulness? Mindfulness is training the mind to pay attention to what happens in the present moment in a non-judgmental way and with an attitude of friendliness instead of being constantly preoccupied with what happened in the past or what might happen in the future. Bringing our attention to our internal theater interrupts the habitual patterns of our emotions, sensations and thoughts and illuminates our racial biases. Through gaining impartiality when  cultivating mindfulness , we have an empowering vista to consider novel responses to our situations such as how to respond to our own racial conditioning or that of others. Ultimately, Buddhist psychology is a positive psychology that points us toward our own fundamental dignity and others’ and that trauma/grief are temporary visitors.

7. Beginner’s Mind Mindfulness involves a beginner’s mind . This is a conscious attempt to put aside our mental models to see the world with fresh eyes. Bedrock of Intentional Communication Beginner’s mind in clinical communication means stepping outside of our therapeutic lens of care and all collected assumptions about our patients to really hear the patient and be present. Creating this openness is a foundation to best take into account a patient’s lived experiences, social contexts, and diverse identities—the essence of cultural responsivity!

8. Presence Mindfulness deepens one’s attention and the presence that we bring into our human interactions, laying the foundation for compassionate care. In order to be most present with the patient and really hear and see clearly, we are aware of our own reactions and mental models so that we are not being guided by them and our perception is not being filtered by them. We are consciously seeing and hearing the patient as s/he is.

9. Respond The Self in Empathy Through the act of becoming in touch with our daily experience , we understand the relationship between ourselves and our circumstances, a level of interpersonal intelligence which helps us understand our patients better and respond skillfully in order to connect more deeply with them. Skillfulness By bringing attention to our internal theater and illuminating our conditioning, our impartiality through cultivating mindfulness is an empowering vista to consider novel responses. In action We put aside all our mental models to best take into account a patient’s lived experiences, social contexts and diverse identities, creating space for our patients to unburden themselves. We can better involve patients in their own care and work with them to address their traumas and spearhead their well-being. Respond

10. Our Direction Mindfulness is a self-regulation and cognitive management tool which promotes culturally-and emotionally-responsive care. In other words, mindfulness promotes patient-centered care to diverse patients as it strengthens our interpersonal intelligence , communication skills, and ability to continue finding vitality in patient care. Mindful physicians won the trust of patients and were more patient-centered. Beach MC, Roter D, Korthuis PT, Epstein RM, Sharp V, Ratanawongsa N, Cohn J, Eggly S, Sankar A, Moore RD, Saha S. A multicenter study of physician mindfulness and health care quality. Ann Fam Med . 2013 Sep-Oct;11(5):421-8.

11. Keep it Simple Our practice starts with contemplative exercises. Mindfulness is returning to a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and/or surrounding environment Just do it . You may fall asleep or lose your concentration or keep thinking about other things. Mindfulness is nonjudgmental, but our programming to seek pleasure and avoid pain shows up in our practice. Our barometer is often defined by the level of pleasure in our practice. We think a practice was good if we feel good and bad if bad. All of this is your experience in the present moment. And we are not changing our present experience but becoming aware of it. Everything will change again and again. Keep it Simple

12. Breathing Exercise

13. Mindful Living Stepping out of habitual thinking. Responding with “clarity, compassion, sincerity, and wisdom” to help the world. Realizing your own experience to find your direction. Don’t worry too much about all these teachings but “use the practice to discover your own experience and use that experience to attain your true” way and help the world. Each one of us has different conditionings and circumstances.

14. Mindfulness

15. Mindfulness In-Depth There is substantial evidence for the positive benefits of mindfulness such as addressing chronic pain, depression, and even promoting healthier body weight “ Mindfulness is returning to a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and/or surrounding environment” Paying attention to things as they are VS Ruminative thinking that strengthens low moods.

16. Health Research Moves Emotional Setpoint to a Happier Place Patients who learned mindfulness decreased their pre-hypertension and more so than those that learned progressive muscle relaxation. A mindfulness training group of Alzheimer’s patients improved much more significantly on cognitive scores than those engaged in cognitive stimulation therapy, relaxation training, or no treatment. Mindfulness increases immune system activity positively in HIV and breast cancer patients.

17. Triangle of Awareness Our experience is comprised of closely interrelated phenomena that are not exactly the same.

18. Body Sensations Exercise: Turn Your Attention Toward An Ache “Not monolithic but is part of a transient stream of mutually-reinforcing emotions, sensations and thoughts.” Triangle of Awareness 1 Not allowing our inner horse to drive our car.

19. Straightjacket of Unconsciousness This is a phrase that Dr. Jon Kabat-Zinn popularized to describe the experience of not being aware of the labels that we hold. As the triangle of awareness points out, our conceptualizations are often no more than an empty construct of our mind, limiting us unnecessarily. Traumatized patients may view the world as a danger which is certainly accurate. But it is also safe. Through cultivating mindfulness, you begin to appreciate the evanescence of both constructs so you can move confidently.

20. Breathing Exercise

21. How to Practice Mindfulness is returning to a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and/or surrounding environment Keep it Simple. There are additional vehicles than a breath-based practice, the most traditional and standardized method. When sitting, you can notice the ebb-and-flow of sounds, as well as the silence in-between sounds. Pick any sensory experience to be your anchor. Or allow yourself to observe the entirety of your experience without changing it. Just do it . You are simply aware of and not manipulating your changing experience. Persistence! Find a place, a time, and make space everyday—even 10 minutes. This will benefit your patients.

22. Mindful Living Stepping out of habitual thinking. Responding with “clarity, compassion, sincerity, and wisdom” to help the world. Realizing your own experience to find your direction. Don’t worry too much about all these teachings but “use the practice to discover your own experience and use that experience to attain your true” way and help the world. Each one of us has different conditionings and circumstances.

23. Appreciative Listening Listening is not passive. Bring your whole being for the speaker. This generosity is furthered by mindfulness, a non-judgmental, steadfast presence to overcome distractions and to be attentive to the speaker. Consider Simply allowing yourself to listen intently and trust that this is the only time to focus on me with everything else at some later time. Enjoy this presentation! Silence is reflection. Listen openly. Attentive body language through soft eye contact, leaning forward slightly, and a relaxed body stance. Non-verbal encouragers such as head nods and responsive facial expressions.

24. Concordant Care

25. Implicit Bias When one acts in a manner that demonstrates bias without one’s conscious knowledge Our decision-making is driven by unconscious heuristics, biases, and stereotypes. Decisions that are framed as a loss are different than when framed as a gain. We have a finite working memory so our brain makes “choices” when processing information.

26. In Healthcare In the time-constrained, cognitively-challenging and emotionally-intense climate of any healthcare setting, we all attempt to minimize spending cognitive energy by relying on mental shortcuts like biases and stereotypes. Burgess DJ. Are providers more likely to contribute to healthcare disparities under high levels of cognitive load? How features of the healthcare setting may lead to biases in medical decision making. Med Decis Making . 2010 Mar-Apr;30(2):246-57.  Allen TJ, Sherman JW, Conrey FR, Stroessner SJ. Stereotype Strength and Attentional Bias: Preference for Confirming versus Disconfirming Information Depends on Processing Capacity. J Exp Soc Psychol . 2009 Sep 1;45(5):1081-1087.  We may unconsciously invalidate the emotional pain of male clients, for example. Despite the same disease characteristics, physicians provide less optimal cancer treatment to Blacks than Whites.

27. Mindful Intervention There are a few studies that demonstrate the promise of mindfulness to reduce implicit bias. Y. Kang, J. Gruber, and J. R. Gray, “Mindfulness and De-automatization,” Emotion Review 5(2) (2013): 192–201. A. Lueke and B. Gibson, “Mindfulness Meditation Reduces Implicit Age and Race Bias: The Role of Reduced Automaticity of Responding,” Social Psychology and Personality Science (2014): 1–8. A. C. Hafenbrack , Z. Kinias , and S. G. Barsade , “Debiasing the Mind through Meditation Mindfulness and the Sunk-Cost Bias,” Psychological Science 25(2) (2014): 369–76.

28. De-Biasing Mindfulness illuminates our mental processes that are normally below the level of consciousness. This allows us to understand our implicit biases. The clinical decision-making scientist Croskerry advocates practicing metacognition to better consider information available but also how we filter this information, processes that are normally unconscious. This is an act of mindfulness, regulating one’s own “mindware,” to have the mental stability and clarity for effective actions in the healthcare setting.

29. Beginner’s Mind In the intense healthcare environment, we all attempt to minimize spending cognitive energy by relying on our mental shortcuts. Mindfulness involves a beginner’s mind . This is a conscious attempt to identify our mental models which may or may not match our territory and then to put them aside accordingly. Beginner’s mind in clinical communication means stepping outside of our therapeutic lens of care and all collected assumptions about our patients to really hear the patient and be present. Creating this openness is a foundation to best take into account a patient’s inner needs.

30. Presence Mindfulness deepens one’s attention and the presence that we bring into our human interactions, laying the foundation for compassionate care. In order to be most present with the patient and really hear and see clearly, we are aware of our own reactions and mental models so that we are not being guided by them and our perception is not being filtered by them. We are consciously seeing and hearing the patient as s/he is.

31. The Flipside Beginner’s mind involves putting aside our mental models. Curiosity is a deep interest in our situation. Beginner’s Mind and Curiosity are two sides of the same coin to furthering presence, creating an openness to best take into account a patient’s lived experiences, social contexts, diverse identities, and preferences—concordant care.

32. Driver of Concordant Care When we involve patients in their own care and work with them to navigate their lived experiences, social contexts, diverse identities and preferences—concordant care—we are sharing a task, an act which cutting-edge neuroscience demonstrates through hyper-scanning coordinates the brain activity for the two “individuals”. These individuals also experience more social connection. Presence matters! Presence not only foregrounds the act of delivering concordant care but is also an outcome.

33. Presence Revisited Presence is a function of mindfulness and I argue that mindfulness in our patient interactions is culturally- and emotionally-responsive care. We are more skillful with patients’ inner needs and preferences, lived experiences, diverse identities and social contexts. Presence can be described as a state or quality of bringing oneself fully into the engagement, creating an affect that is attentive and reassuring.

34. Mindfulness-in-Action The latest developments in philosophy and the sciences are revealing how our minds are not completely distinct. Hence, a firm understanding about myself feeds an understanding of the other. My own experience has been that through the act of becoming in touch with our daily experience , we understand the relationship between ourselves and our circumstances, a level of interpersonal intelligence which helps us understand our patients better and respond skillfully in order to connect more deeply with them. “In Chapter 33 of the  Tao te Ching  Lao Tzu taught: ‘Knowing others is intelligence; knowing yourself is true wisdom.’”

35. Ripples of Inner Stability Mindfulness deepens one’s presence that is brought into one’s human interactions. We have to be really clear and present, one-on-one. Our ability to be present rests with our ability to self-regulate emotionally, as our patient could die before our next patient needs to be seen or a patient can confide in us their traumas that are personally triggering before starting over with the next patient.

36. Ripples to Inner Stability Curiosity/beginner’s mind is challenging in the psychologically-demanding healthcare setting as we are eager to seek certainty . But curiosity illuminates how certainty is evolving, never complete nor permanent. We need the stabilizing effects of a mindfulness practice to effectively utilize curiosity in the clinical setting, a deep interest in the patient and his care which I argue is substantial to emotional- and cultural-responsivity. Resonating with another’s distress is difficult and mindfulness helps this goal through its self-regulation benefits. Moreover, mindfulness involves a kind, nurturing lens or in other words, compassion to face life’s difficulties and make a difference.

37. Compassion

38. Positive Psychology The esteemed mindfulness teacher Jack Kornfield recounts “the story of one of the first international Buddhist teacher meetings with the Dalai Lama. The Western teachers brought up the enormous problem of unworthiness and self-criticism, shame and self-hatred, and how frequently they arose in Western students’ practice. The Dalai Lama was shocked. He could not quite comprehend the word self-hatred. It took the Dalai Lama 10 minutes of conferring with his translator even to understand it. ‘But that’s a mistake,’ he said. ‘Every being is precious!’” “ We are not limited by our circumstances or history. The primary aim of Buddhist psychology is to help us see the inner beauty and goodness of ourselves and others. Nelson Mandela put it this way: ‘It never hurts to think too highly of a person; often they become ennobled and act better because of it.’”

39. Compassion Research Cognitive research shows that compassion activates the brain’s “reward”, empathy, and self-regulation circuits. We can be there for patients in challenging circumstances with greater ease and find great meaning, in other words. Without compassion, we would experience negative affects like exhaustion and overload from continuing to empathize with many negative situations of our patients. Burnout is a growing concern among healthcare providers.

40. Inner Seeds From first-hand experience, I know how easy it is to construct a bat with your practice. The best advice I have continued to receive from my teachers is to adopt the attitude as of a grandmother in my mindfulness practice. Can you take a few moments to call into mind that special person who really appreciated you and illuminated your goodness? Can you think about that person and their love for a few moments? Imagine how happy they would be to know their effect on you. Hold this reassurance and do good things.

41. Kindness Business consultant and zen practitioner Marc Lesser wrote a book Know Yourself, Forget Yourself . This paradox helps us to develop confidence by deep listening to ourselves and others and also recognizing the evanescence of our constructs to continue moving forward.

42. Mindful Living Stepping out of habitual thinking. Responding with “clarity, compassion, sincerity, and wisdom” to help the world. Realizing your own experience to find your direction. Don’t worry too much about all these teachings but “use the practice to discover your own experience and use that experience to attain your true” way and help the world. Each one of us has different conditionings and circumstances. Experiment to realize your way and trust it.

43. “Even though no human being is perfect, we always have the chance to bring what’s unique about us to life in a redeeming way.” --Fred Rogers

44. Dyadic Exercises

45. Reactive Listening The 21 st century is an age of ineffective communication, rampant across society: in our families, in politics, between races, and between nations. We need transform these social habits especially in our relationships with patients. Poor listeners interrupt as they jump to conclusions about your speech or they are not interested. Good listeners provide an open-minded attention—presence—to fully process your words and provides space to speak honestly.

46. Deep Listening “ Deep Listening involves listening, from a deep, receptive, and caring place in oneself, to deeper and often subtler levels of meaning and intention in the other person.” You seek not only the surface meaning of words but also “ where the speaker is ‘coming from’”. “ Trust … does not imply agreement, but the trust that whatever others say, regardless of how well or poorly it is said, comes from something true in their experience.”

47. Let’s Try It. Let’s split off into groups of two. Brainstorm a story about a powerful moment of growth for yourself. Try deep listening. Be really present. If you find yourself getting lost, ground yourself and assume a dignified bodily position that will support your presence.

48. Appreciative Inquiry Definition . “Discovering, studying, valuing, and honoring the best in others.” Element of Mindfulness Always build on strengths. Think about time that you overcame adversity.

49. Possible Questions What strengths or talents did you bring to the situation? What was challenging for you in this situation and did it change how you see yourself? Who helped you in this situation and how did it make you feel? What did you learn about yourself? What did you learn about others? What did you learn in this situation and how can you apply it in your daily work?

50. Contact Abhi Dalal [email protected] [email protected] Delighted to share wellness and mindful healthcare practices!