The medical profession is among the most mentally, physically, and emotionally stressful of vocations. With cases of depression and burnout on the rise among doctors, nurses, and medical students, a growing number of hospitals and medical schools across the United States are now moving training to equip their staff and students with the tools to combat these issues.
Emory University Hospital in Atlanta, Georgia, has offered courses in cognitively based compassion training (CBCT) since 2014, drawing on a secularized adaption of traditional mind training practiced in Vajrayana Buddhism. The course begins with meditative exercises that focus on compassion for the self, then progresses the compassionate awareness to encompass family members, friends, strangers, and finally difficult or negative people. The protocol has been adopted by a number of healthcare institutions across the US as evidence of its efficacy grows.
Geshe Lobsang Tenzin Negi, senior lecturer in Emory’s Department of Religion and a former Buddhist monk, developed CBCT specifically to address the high incidence of depression and anxiety among medical students. “Compassion is a skill that can be trained; you get better, like language,” he explained. “We all come with a predisposition for certain skills and abilities, but through the training we can get better.” (Peoria Public Radio)
Geshe Lobsang Tenzin Negi. From tibet.emory.eduTypical symptoms of burnout are depression, emotional exhaustion, a reduced sense of personal accomplishment, and feelings of cynicism toward one’s work. One aspect of burnout that can effect medical professionals in particular is known as “compassion fatigue,” which manifests in feelings of a loss of control over one’s life or career, emotional numbness, and reduced empathy for patients. A 2011 survey by the Mayo Clinic found that close to 50 per cent of medical practitioners in the US exhibited at least one symptom of burnout. Recorded rates of depression and suicide among physicians are also significantly higher than the general population.
Negative thought cycles, Prof. Negi observed, can eventually manifest as anxiety and depression and, if untreated, can lead to self-destructive behavior such as addiction or suicide. “CBCT draws from what is known as lojong in Indo-Tibetan Buddhism,” he said. “The strategy is to bring a shift of perspective through reflection about ourselves, our relationship to others as well as the events in our everyday lives and develop an understanding of our interconnection.” (PsychCentral)
“Lojong literally means mind training, which simply means training the mind to become altruistic. Among other things, one of the main focuses in lojong literature is to become more compassionate,” Prof. Negi explained. “The strategies involved in lojong literature are equanimity, impartiality—appealing to that basic fundamental aspiration that people (whether they are friends, strangers, or enemies) want to be happy and free from suffering.” (PsychCentral)
A study of second-year medical students at Emory found that those exposed to CBCT reported heightened levels of compassion and reduced feelings of loneliness. Students who joined the CBCT course while experiencing depression reported the most significant positive impact from CBCT, and were able to maintain their compassion practice beyond the training course and throughout the semester.
“Medical students are this really unique population that suffers from incredibly high rates of depression, suicidal ideation, and burnout,” said the study’s author Jennifer Mascaro, a biological anthropologist at Emory. “Not surprisingly, they also seem to suffer a decrease in empathy and compassion during training. It's hard to feel compassion when you're just trying to keep your head above water.” (The Washington Post)
