Combating stress and promoting wellness at UC's College of Law

From the Cincinnati Bar Association (CBA) Report

You have heard it before, but it deserves repeating: Lawyers are stressed out, and so are law students. For decades, we have been saying that law students arrive at law school with the same level of mental wellness as the general population, but by the time they graduate from law school, law students have surpassed the general population in depression, anxiety and stress. To counteract this trend at the University of Cincinnati (UC) College of Law, we offer an extra-curriculum mind-body class.

Luckily, Sian Cotton, PhD, director of the UC Center for Integrative Health and Wellness, had already developed a mind-body program to address the levels of stress heaped on to the typical medical student at UC, and she was willing to share. She adapted the program from a mind-body program created at the Georgetown University School of Medicine. Dr. Cotton brought it to the UC College of Medicine and then opened the program to other colleges at UC, including the College of Design, Architecture, Art, and Planning, the College-Conservatory of Music, and the College of Law. She trained faculty and staff at these and other colleges to be facilitators and then supported them with lesson plans and supplies as they offered the mind-body, non-credit class to students throughout the university. We have four professors at the College of Law trained as facilitators: A. Christopher Bryant, Sean Mangan, Nancy Oliver and me.

Tools to Manage Stress

In law school, heavy workload and academic demands in a competitive environment lead to stress. All that plus debt and financial constraints lead to chronic stress. Then, chronic stress impacts students in their academic and personal lives. In their academic life, chronic stress may cause students to commit errors. It may negatively affect their relationships at school and cause decreased empathy. It may cause students to engage in unprofessional behaviors. On the personal side, this chronic stress can lead to increased substance use, a reduced quality of life, emotional exhaustion, depersonalization, and a low sense of personal accomplishment.

Although chronic stress can cause problems, not all stress is bad. Stress creates an important physiological response in our bodies, which allows us to react to danger. Simply stated, acute stress triggers a cascade of hormones that produce effective physiological changes in our bodies. This is that “fight or flight” response - it enables us to react quickly to a threat, and that is a good thing.

The problem is when we are facing acute and prolonged stress (“chronic stress”) and we do not fully come back to baseline after each physiological response. Chronic stress can lead to headaches, insomnia, digestive issues, irritability, anxiety, depression and other problems. Law school can add stress on top of stress. Therefore, we need to help our students return to baseline.

What helps the body return to baseline are the tools that manage stress. Such tools include a healthy diet, exercise, positive relationships, adequate sleep and mind-body techniques. Mind-body techniques include meditation, biofeedback, yoga, tai chi, breathing techniques, imagery, autogenic training (self-hypnosis), exercise and group support.

Mind-body techniques use the natural connection between the mind and body to improve physical functioning, reduce stress, and promote health. Mind-body techniques focus on the interactions between the brain and the body. This is an ancient idea that the mind and body interact and influence one another. Moreover, modern medicine supports this idea. Considerable scientific evidence shows that mind-body therapies are beneficial for stress management and for alleviating many health problems including headaches, insomnia, anxiety/depressive symptoms and diseaserelated symptoms.4 Mind-body techniques have become extremely popular and are now are among the most widely used integrative medicine practices among adults in the United States.

The Mind-Body Skills Program

The nine-week mind-body course at UC teaches law students adaptive stress management skills using mind-body techniques to foster self-awareness and self-care. Each course can accommodate a maximum of 10 students and meets for two consecutive hours, once a week for nine weeks with two faculty members who facilitate the meetings.

During the first meeting, every participant, including the facilitators, agrees to keep confidential any information shared by the other participants. We do this to create a safe and supportive environment. We also promise mutual respect. Because we invite the students to share their thoughts and feelings within the group, we must ensure that the students feel comfortable. We ask the students to make every effort to attend each meeting. However, if someone is unable to attend a group meeting, that person must notify both co-facilitators and the other members of the group prior to missing a meeting.

Although some of the meetings may be emotional, we do not offer or substitute for psychotherapy or mental health treatment. At the first meeting, we remind the students that we intend these meetings to provide support in a nonjudgmental environment, but we do not provide therapy. Therefore, if the students feel they may need additional support, they can access the Counseling and Psychological Services, which are available for UC students, and we help them get in contact with those providers. However, we do bring tissues and chocolate to each meeting.

Meditation, Listening and More

Each meeting begins with the ringing of a bell and the lighting of a candle. These actions bring a sense of calm and help us separate our time together from the pressures of a typical law school day. Then, we do an opening meditation. The meditation is short (typically 6 to 10 minutes). We focus our attention on our breathing as a way to settle into the space and time that we share in the mind-body meeting. Also, this breathing meditation should counter any physiological reactions to stress we may be having at that time. By becoming mindful of our breathing, we can lower our stress.

Being mindful means that we focus our attention. We give full attention to our breathing. This is not easy to do. Everyone’s mind will wander, but by directing our attention back to our breathing, we are able to settle our minds and take the focus off our stressors for those few minutes. Mindfulness involves continually bringing the attention back to whatever is happening in the present moment. Mindfulness is noticing present events with openness and acceptance - without judging or trying to change them. When we are able to focus on just what is happening in the present moment, our minds can be less anxious and worried.

After the opening meditation, we check in. This is a chance for the students and facilitators to share with the group how they are feeling. We ask everyone to report how the previous week has been, how they are feeling, how the opening meditation was for them, or whether they have done any mind-body techniques. We go around the circle. Anyone who wishes to “pass” may. The group listens. We do not judge. We do not try to fix anyone or anything. We do not offer suggestions. We just listen.

Each week we learn about and practice a new technique. Because not everyone will like everything, the students get to try different techniques so that they can find something that works for them. That way, they can continue to care for themselves even after the nine-week class ends. We hope that they will continue to use some of the techniques throughout law school and throughout their careers, because the stress will continue, too.

Creating a Better Balance

The response from the students who have participated has been great. Most students report increased empathy and resilience. They note reduced stress and the ability to create balance in their lives. Many also comment that they have begun to better understand themselves.

We do not expect that the mind-body class will necessarily improve students’ grades. Instead, the expectation is that it will reduce the physiological and emotional impacts of prolonged stress caused by law school. We hope it leads to the proven benefits of mind-body techniques: reduced stress levels; decreased anxiety; decreased depression; improved confidence and concentration; and increased peace of mind, optimism, and self-worth.

If you would like to learn more about the mind-body program or how to support it, please contact me, rachel.smith@uc.edu, or Sian Cotton, sian.cotton@uc.edu.

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Smith is a Professor of Practice at the University of Cincinnati College of Law.

1. See Nat’l Task Force on Lawyer Well-Being, The Path to Lawyer Well-Being: Practical Recommendations for Positive Change (Aug. 14, 2017), http://lawyerwellbeing.net/.

2. Experience Change with UC Mind-Body Skills Program, University of Cincinnati Center for Integrative Health and Wellness, https://ucmindbody.wixsite.com/ucmindbody.

3. See Nat’l Center for Complementary & Integrative Health, Mind & Body Practices, NIH, https://nccih.nih.gov/health/mindbody.

4. See e.g. John A. Astin et al., Mind-Body Medicine: State of the Science, Implications for Practice, 16 J. Am. Bd. Fam. Pract. 131, 141 (2003).

5. Suzanne M. Bertisch et al., Alternative Mind-Body Therapies Used by Adults with Medical Conditions, 66 J. Psychosomatic Res. 511, 512 (2009),