Good evening, everyone, and welcome to the American Psychiatric Association's Looking Beyond Mental Health Equity webinar series. This series, and this particular webinar, is titled Meditation and Mindfulness, a Cultural Bridge to Mental Wellbeing. My name is Dr. Regina James, and I am one of the Deputy Medical Directors here at the APA, as well as the Chief for the Division of Diversity and Health Equity. So tonight, we have a very exciting webinar, and it will be moderated by Dr. Lisa Fortuna, and she will actually introduce the esteemed panelists. But before we get started with the panelist introduction, let me provide you with just a brief background about our moderator, Dr. Fortuna. And then after I introduce and provide you some background about her, we'll follow that up with a minute, minute and a half meditation exercise that will be led by one of the APA staff here, Ms. Fatima Reynolds. So Dr. Lisa Fortuna is a child and adolescent psychiatrist. She is professor and chair of the Department of Psychiatry and Neurosciences at the University of California, Riverside School of Medicine. She is a health services researcher with numerous awards and an extensive publication record. She was actually recently recognized by the APA as a mental health equity champion. Dr. Fortuna has also background in pastoral theology and brings to patient care the importance of spirituality and faith in overall wellbeing. And now I will ask my colleague, Ms. Fatima Reynolds, to please lead us in a minute mindfulness meditation exercise, and that will be followed by Dr. Fortuna. Thank you, Dr. James. Hello and welcome everyone to this moment. We're going to ground ourselves before we start the program. So feel free to close your eyes if you feel comfortable and take a comfortable position, but be sure to stay a little bit alert. Now I want you to become present in your body and fully aware of your physical self right now in this space, sitting in your room and hearing my voice. Allow your mind to feel loose and calm without chasing any thoughts and without adding any additional chatter. You're here now in this moment. So let's turn our attention to the breath, long and slow breaths, full and deep breaths. And as you breathe in, I am calm. And as you breathe out, relax your face. And as you breathe in, I am calm. And as you breathe out, relax your jaw and your neck. And as you breathe in, I am calm. And as you breathe out, relax your shoulders and your chest and your torso. And as you breathe in, I am calm. And as you breathe out, relax the rest of your body. Sweep the relaxation throughout your entire body with every exhale. And take a few moments to feel your breaths as they relax you and bring you to this present moment. Now bring your attention back to your body in the room that you're sitting in, back to my voice. Open your eyes, if you had closed them, and wiggle your fingers and your toes, roll your neck and your shoulders, bring a little blood back to your extremities. And continue with your calm breathing and do what you need to do throughout this webinar to stay calm and present and open. Thank you all for this moment. And now back to you, Dr. Fortuna. Thank you so much for that moment of mindfulness and centering us. It's perfect for this panel. And it is my pleasure now to introduce our panelists and do a little bit of introduction. We're going to have this be a very interactive, so I'm going to, you know, ask some questions and then we will definitely have your participation from the audience. So let me start introducing our panelists. So I'm Dr. Sastry is a board certified adult psychiatrist with 20 plus years of experience in multiple practice settings, public and private and academic hospitals, nonprofits and veteran affairs, and a completion of her fellowship in public psychiatry at Columbia University. Her professional focus has been on underserved and marginalized populations, where she specializes in treating severe and chronic mental illness and substance use disorders often co-occurring. And Dr. Sastry earned an MBA from the Ross School of Business at the University of Michigan. She had an adult general private practice for five years where she incorporated mindfulness techniques. For the past year, she has been employed as behavioral health medical director at Optum as part of the acute care utilization management team. Other professional interests include helping physicians struggle with burnout, and I think she'll talk a little bit about that today, as well as moral injury, and she's currently working on building a physician wellness coalition for local community with aspirations to make it a statewide support network, so very applicable. And outside of medicine, she's also certified in yoga and meditation as a meditation instructor as well, having completed 250 hours of training of mindfulness-based stress reduction. So again, very applicable for our conversation today. And Dr. Jeffrey Pollux is an assistant professor of psychiatry and human behavior at the Warren Albert Medical School at Brown University and serves as the associate director of diversity and inclusion at the Mindfulness Center at Brown. His work focuses on creating mindfulness programs for underserved communities, emphasizing how these practices can enhance resilience and health. And by integrating indigenous culture healing traditions with mainstream mindfulness approaches, he develops culturally responsive stress reduction interventions and draws from extensive experience collaborating with indigenous communities across North America. He founded the Indigenous Mindfulness Coalition, an initiative dedicated to training and increasing the number of indigenous mindfulness teachers, ensuring these practices remain rooted in the communities they serve. And his broader work includes designing mindfulness programs for Black communities, such as fostering connections between Black community members and police officers and supporting Black teens in high-risk neighborhoods through mindfulness practices. So a lot of expertise and context and importance for our conversation today in the panel. And I just want to start, you know, we know that meditation and mindfulness has been increasingly recognized as not only a sort of adjunctive practice or just focused on spirituality, but very much integrated within healthcare more and more, and especially behavioral health. And it also, you know, it really focuses on cultivating awareness, attention, not just relaxation, right, but can also assist with that as well, and can have some real benefits for diverse populations. So I just wanted to, you know, start us off with just some questions about, you know, just a little bit of introduction to your work, and why you think meditation and mindfulness particularly is an effective tool in addressing mental health needs and challenges. And what have you learned in your work, and what do you think the research says? So maybe I'll start with Dr. Sastry. Hi, thank you so much, Dr. Fortuna. It's really nice to be here with all of you, and I'm excited to also hear other people's thoughts and questions. But to answer your question, you know, I think it's a personal journey, mindfulness, meditation, I think people come to it in different ways. I'll start by answering the second question, which is, why is it important, and why should we incorporate it? And the easiest response, the easiest answer I can give is that it's easily accessible. So specifically, I'm talking about an awareness practice or a breath-focused practice. You know, like I tell my students, your breath is a tool that you have with you at all times, anywhere you go. It's always readily available. And you know, it's up to you to decide whether to utilize it. So I think from the perspective of it's not a lot of bells and whistles when it comes to mindfulness. And that's, it's a blessing and a curse in a way, right? Because it's the easiest thing to access, but it can be the hardest to tap into. Research has shown over the years that a consistent mindfulness practice can lead to all sorts of health benefits from improved immune response to lowering rates of depression, anxiety. Specifically, the research has focused around MBSR. And I'm sure many of you here are familiar with that. That stands for mindfulness-based stress reduction. And it's a technique that was developed in the late 70s by John Kabat-Zinn in the University of Massachusetts setting. And the idea being, it's a very structured eight-week program, eight to 10 weeks, depending on the course, which really trains people on specific techniques to ease stress. And studies have shown that it has been found over eight weeks to reduce rates of depression and anxiety, even improve pain tolerance. So it can be used in the physical health setting as well. So the research is there. I think in psychiatry, it's not something that's always promoted. I personally don't recall in my training getting a lot of mindfulness experience. I kind of came to it on my own. You'd mentioned my interest in burnout and that my own personal struggles with moral injury and burnout in this profession is what led me to find this practice, actually at the height of COVID. That is when I realized I didn't have enough tools to cope. And I was experiencing a lot of anxiety and stress. And that's when I turned to these techniques as a way to center myself and ground myself. And I think I was so inspired and impressed by the power of what is seemingly a very simple practice that I decided to seek out more training and then ultimately to be able to teach it. But at the end of the day, I always say I'm forever a student. In this practice, there's no such thing as perfection. Even as progress, it's simply practice. And I think that's the beauty of it. Your ego is completely sublimated. And it's all about awareness and acceptance of the present moment as it exists now, rather than wishing for something to be different. Which is, you know, it's mind blowing in some ways, right? It's a complete antithesis of what we're taught. I mean, as physicians, you know, we're taught to heal suffering and heal pain. When you practice mindfulness, you're actually taught to sit with it, to sit with that suffering, to sit with some of this discomfort, to experience it fully. And I had never done that before. So from that vantage point, it really enables neuroplasticity, right? You're able to expand neural pathways and find other ways to see something that might be otherwise uncomfortable. And I think that's really, really powerful. Now, I really appreciate the breadth of that answer. You know, it could be so useful, right, in ongoing practice, right? For us as providers, as well as the people that we help to support as patients or otherwise. So I think, you know, it's excellent. Dr. Perlitz, do you want to sort of join in on your thoughts about this? Oh, yeah, absolutely. Thank you, Dr. Sastry. That was really great. And I'm at Brown, and we do, we generate MBSR teachers. So it's something, and I want to talk more about that, because the way I came, well, I came to mindfulness on my own, early on in life. And it was something that I particularly liked. But then as I got more into academia and into grad school, I started focusing on, I'm indigenous, as mentioned on Mohawk, and I'm very much interested in indigenous health. And so I started looking at a couple issues related to intergenerational trauma, but also in general, aging outcomes for older indigenous people. You've probably seen the rates on a lot of different things. But the way I looked at it is a lot of them are stress-related, right? And so if there's ways that we can, or at least exacerbated by stress. And so if there's diabetes, dementia, hypertension, a lot of these major ones that if we can come in, and just like the way Dr. Sastry mentioned that MBSR actually started with Jon Kabat-Zinn in the 70s at UMass, because he was at the pain clinic. And they were trying, they were having difficulty treating those patients. And Jon said, well, it's stress and pain are very much related. Can I try this thing? And they were like, sure, you know, this molecular biologist, whatever, you know, so he did it. And it was really, it worked, right? People were starting to report less pain, right? And so this is kind of how it all starts. And it's a lot of it's about where you place your attention and such. So I was thinking that these practices would be great for reducing stress and dealing with better health outcomes in my communities. But at the same time, I was also, and still am very much focused on centering tribal traditions at the core of treatment, right? In some way, being around how to do that. And so that's been my sort of my goal. And I'm a researcher. So I'm always an intervention developer. So I'm always thinking about how can we create these things that do represent these traditions in a way that that's the center for the medicine. The medicine comes from that, right? And well, mindfulness meditation didn't ever pop up. And like, I couldn't see that as being like traditional treatment, right? So we played around with it for a while. But what I started to notice that there were a lot of things in, I think, Dr. Shastri or Dr. Fortuna, I don't know if you mentioned, but there's a definition of mindfulness as being in the present moment on purpose without judgment, right? And so the sense of just being here, being present without letting anything sort of in your own mind interfere with that. So I started looking around, what are things that indigenous people do that gets them into that same state, right? Are there things, and I started noticing like tribal dance was, I could fit that in for walking meditation, right? Because of the way that they were doing some of that stuff. And there's a lot of ways we could start bringing in language. We can bring in actual tribal dances and teach them. We can bring in beating, which is an attentive focused exercise, right? That you have to focus your attention on something and do the practices that you would do with maybe a mindful breath, right? But instead, the attention would be on beats. And so we kept looking for different ways. And that's that, what are things that are already mindful? And we took that MBSR curriculum that was mentioned and I was able to kind of go through and say, okay, what could be switched out that is an indigenous practice that is already in the MBSR curriculum and switch those two things in there and see how that works. And so we've just spent years and years and years of kind of applying that focus of just trying it in the community, seeing what comes back, suggestions, taking that into account, doing it again, and to just keep doing it. While at the same time working to develop, and you were talking about plasticity, and it made me think about this work that we're doing with black teens in Hartford in the high crime area. And it's funny because I'm a gerontologist, so I've always been flummoxed by teens. But one of the things that I did, and young people in general, but one of the things I remember from child development, at least going back a few years, was like emotional regulation, emotional regulation. This is a big emotional regulation. But I saw it being treated as like eye color, right? So if you're a good emotional regulator at five, you're going to be that same way at 25, right? We're predicting whether people are going to go to college and stuff. But I was like, I think this is a lot more malleable because of plasticity than we think. And I'm thinking that this application of mindfulness in younger ages gives people that opportunity to do that restructuring by mindfulness practice. And like the work that we're doing with the teens in Hartford is we're involving them in the research. We've been doing it for five years now. And they're research partners and guiding where we're taking our interventions and such. And so on that level, it's empowering to the kids, right? There's a lot of research that shows that that type of interaction with stuff is like levels of self-efficacy and wellness and all these things just shoot up like way more than you would predict normally by being in that kind of activity. So this is the kind of work that we've done is how much can we bring the community in? So and I'm thinking that people here and one last thing I just want to point out because is that thinking when you think about mindfulness as a practice, there's a lot of different ways mindfulness can express itself, right? So there's the one minute meditation, but then there's the eight week mindfulness class, right? And then there's also day long, week long retreats. There's 10 day retreats. So I think one of the things is thinking about if you're interested in mindfulness to start thinking about what are the different ways that that's actually presented. And thank you for that. Now, I'm about to ask some follow up questions and I'm doing something I didn't think I was going to be able to do, but I saw an interesting question in the chat that kind of goes with what I want to ask next as well. So, you know, you've talked about working with mindfulness and integration with indigenous practices and culture, Native American culture and in black youth, working with black youth. And I similarly have integrated it in working with Latino immigrant populations, as well as immigrant Latino youth and other youth of color in looking at, you know, experiences of trauma and using mindfulness based approaches to help with that. And with substance use disorders. So I think there's a lot of questions out there about the applicability of mindfulness practice for diverse populations, especially minoritized populations. So I just wanted to see what, like maybe we can start with Dr. Sastry and then, you know, sort of go around about what are your thoughts about mindfulness for, you know, traditionally underserved populations for cultural, you know, cultural appropriateness for that? How can it be a resource for, you know, underserved populations? And what are some of the considerations we might have to think about in terms of applicability, culture, effectiveness in those populations? Yeah, thanks, Dr. Fortuna. Yeah, it's, it's, um, that's a good question. I, I can't speak to the research. I didn't see the question that was asked, which is excellent. Are there studies of MBSR in minority populations? I'm not able to speak to that. I don't know, Dr. Pru, I'm sure. But if you would like to, please, did you want to go ahead and... No, no, I got papers. That's a... Okay. But no, to answer the question about cultural appropriation and how do we bring it to underserved populations, I think something to keep in mind at the outset is whether or not these populations are willing to accept it. And I think we've got maybe some stigmas and hurdles to overcome. You know, when we were, we were speaking yesterday, you know, I heard you mention, I think it was you, Dr. Pru, that it's seen as a, as a quote unquote white practice, right? Or it's seen as something that is not for underserved or minority populations. You know, I, I had not really heard that before. So I've been kind of spending the past 24 hours kind of thinking about that. But I can, I think, speak from my own ethnic background, you know, as somebody of South Indian descent. It's very much a part of the culture, right? And this notion of Eastern ways of approaching suffering and pain, as opposed to Western, I kind of grew up with a mix of both. And that probably is, you know, in part what fueled my, my approach later in life to looking more into the Eastern side of things. I, I think that it's also important to remember what are some mainstream ways to, to incorporate some of this in, in the West. And I'm part of this. I took yoga here, right? I have not taken yoga in, in India. And the practice of yoga here is distinctly different, right? There is an appropriation element of it. And when I did my, my teacher training, that's when I learned about the roots of yoga 5,000 years ago in India, was all about mindfulness. I didn't know that it, the physical practice that's called asana based practice was actually meant to just calm the body down so that your mind would be ready to meditate afterward. And for me, that was, that was really mind blowing because, you know, I always had thought yoga was exercise. It's, it's actually, it's not a workout. I call it a work in, right? So if you're doing it right, it's all about breath. It's all about focusing on this present moment. And like Dr. Proust said, being in this moment and observing this moment without judgment, without bias and learning to train the mind. So if anything, you know, people are, I think are scared of the word meditation. I, you know, I've certainly had friends tell me that, or they, you know, they say, oh, it's boring. There's no way I could do it. But I think we've got a lot to overcome in terms of stigma and fear. And I, you know, just share personally, I, I was afraid of meditation for a long, long time. I absolutely refused to do it. And it took me a long while to realize what I was afraid of was what I would see, what I would find if I sat still. And, you know, mind you, years of therapy and, and self-reflection, you know, has taught me that this constant state of doing and being, you know, held to standards of productivity and metrics, right, that require us to be busy all the time in a, in a way is a bit of a trauma response. We in, in Western society, broadly speaking, are afraid to be still because what might happen. And the first time I sat to meditate, I remember setting my timer. I lasted about a minute. That was it. That's all I could do. And it was a very gradual process. So I'm saying that in part because it, it is scary. It is scary because you're, you're searching and looking at your authentic self. And sometimes what you find is going to be uncomfortable, but that's part of the process. And it's very much like therapy and except you're, you're in stillness, right? It's recognizing the mind for what it is from a neuroscience perspective. That's called our thinking mind. It's called the default mode network, right? So when we practice these techniques, meditation, mindfulness, whatever you want to call it, we are slowly deactivating that network so that it silences the chatter and we can actually recognize who we really are, what our motivations are, what our goals are. What our desires are. And the longer you can sit, not a contest, but the longer you can sit, the stillness allows for clarity. And with greater awareness comes self-compassion. With greater awareness and observation comes peace. And I think John Kabat-Zinn discovered this years ago, and then people have been practicing some forms of mindfulness now for centuries, right? It is, it is to ultimately find that inner peace. So the spiritual elements are just as important, I think, as the psychiatric and the medical elements. Kind of convoluted answer, but I hope I kind of answered it somewhere in there. No, you definitely did. And you added more things for us to sort of, you know, dig deep into it because we're even getting questions about like, what is the mechanism by which that works? But Dr. Pearl, I want to see if you have some thoughts around, yeah, so for communities and populations and how this can work. Yeah, absolutely. Well, one thing that comes up, and I'll get to that in a second, is that one thing that you're getting to Dr. Sastry is the importance, I think, if anybody is considering this, the importance of developing your own mindfulness program first, right? And of going through some sort of training and of really incorporating it in your life as a daily practice, right? That's the first step because it's not something that, and then I think a lot of these questions that are being asked become a lot more, you know, it makes a lot more sense, like how you would apply it after going through it. So that's the first thing I would say is like, try not, don't, don't, and it's been done a lot of times that people take the manual, the recipe of a mindfulness practice, they try to apply it to some group of people and they say nothing worked, right? And it's because chances are, it wasn't applied correctly, right? And the people weren't doing it. So that would be my first thing is really consider, you know, developing your own practice, there's lots of ways to do that. But what we've done as far as, so that's my first step is developing that practice. The next step is to reaching out to people in those communities. So, and developing relationships with them. So like when I was, when I'm in Portland, Oregon, there's a particular pastor at a black church that I've made a relationship with, right? And I work with them and I develop a group of advisors. So I'm a lot privileged because I'm a researcher, right? So I have the time and sometimes years to like, let that all play out and cultivate these relationships. But once I cultivate these relationships with people, as I showed them what my product is going to be, I'm going to deliver this intervention. And here's how it's going to go. And I get their input on it, like how, what's the way that's going to make it the most appropriate for this particular group of people. And I have lunches with the community members. And so I try as much as I can to bring that community into the conversation. So that way they're contributing to it. And as I said, ultimately, for me, a lot of it's about the development. And this is a little bit outside of this conversation, but the development of other teachers to be from those communities. Because what I'm hoping is that they go through the program, they get the mindfulness training. When they go back, they'll know exactly what that neighborhood needs. Some of the things that we've come up with, like with the teens in Hartford, we could not really get them to settle down. I don't know if that was just teens or if it was trauma, if it was stress, whatever it was, we couldn't get them to sit. And I looked at the transcripts and there was a lot of like, oh, she's looking at me and things like that. We just couldn't get them to chill out. But one thing that did catch their attention was, and I took, because I couldn't figure out how can we get this mindfulness here, but they paid attention to the bell. Someone rang a bell and said, listen to the sound of the bell as it disappears into the room. And all of the transcripts after that were like the bell, the bell, the bell, the bell. It just really something about it just brought them right to where they needed to be. And they talked a lot about music. So what we developed, I was at an event in L.A. and I was treated to a sound bath. I don't know if anyone's ever taken these, but the sound healing. And there's all these different chimes and bells and things that go along with it. Swishing is really nice. But it made me think of the kids. I was like those kids and maybe we could do this. And we partnered up with the community group Compass in Hartford. They loved the idea. And we picked up $20,000 from a group and they gave us enough money that we're going to bring the sound healing to these groups. So I think a lot of it is just about trying to just like anything else, doing, getting that practice under your belt, but then listening to the communities about things that could be mindful, right? That doesn't have to be yoga or it doesn't have to be looking at your breath, but what could be the thing that brings a person to this moment without judgment, you know, and for them, it was the sound of a bell and I'm hoping that it would be further something else. Then what we're going to do, and I'll finish after this, but I'm going to trick them. A colleague of mine, Tremaine Gaither, is a big, really handsome black man and big, nice voice from the South, son of a preacher. He likes to bring that out. So I'm bringing Tremaine, we're going to do the sound healing first and then see, have Tremaine lead them through the meditation practice to see if the sound healing doesn't bring down all of that temperature and then they can listen, you know, and be able to just get into it. So these are the kinds of things that we just sort of play around the edges and think about, you know, what would really be the best for that community if you got the time to figure all that out. Yeah. I mean, I appreciate all your responses because it really sort of speaks to, I mean, I just want to sort of highlight a few things you said. We need to cultivate a practice ourselves, right, because it's not really something that you just do from a manual without having a practice, right? So it's really important to have that training, to have that practice that's ongoing. And then really sort of looking at what are some of the adaptations and ways that we can, you know, apply it to specific cultural contexts. I think you're mentioning developmental, you know, developmentally appropriate, right, as well as contextually appropriate and working, right, with individuals and communities in that sort of adaptation, that sort of integration. And so if I'm, if I'm, so it's from a clinician sitting somewhere and I'm building up, you know, my own practice of or doing the practice, right, of mindfulness and meditation, and I want to integrate this into mental health practice or clinical practice, what are some of the ways that clinicians can do that? What should they be thinking about in doing something like that? Yeah, that is the million dollar question, right, Dr. Fortuna? So with my patients, I would ask them to choose a daily activity, didn't matter what it was, pick an activity that you would do mindlessly, right, eating, running an errand, walking, driving, right? And I think the easiest way to open the door to mindfulness is to incorporate it into something that we do anyway, but to really pay attention. And I find or I have found that, you know, my patients would find that less intimidating than saying, you know, I don't, you know, they'd say I don't have time to sit for five minutes or 10 minutes separately and meditate. So why not incorporate it into your day to day routine, and it might be, you know, walking up and down the stairs, you know, eating your breakfast in the morning, like I said, anything can be done mindfully. You know, last night, I had my weekly meditation group, and we did a hugging meditation. I, you know, that was actually new to me, but the idea that you could mindfully hug someone and make it a meaningful connection, rather than a perfunctory thing you do when you meet someone, right? So anything, it just goes to show, you know, it's a fun example, but there's, you can literally meditate in any way. And I think that takes the stigma out of it. I talked about that earlier and makes it more accessible. So that's one technique. Yeah, and I found that to be, so a lot of the people that, the community members that I tend to partner with, they, so I've worked in communities all over North America, usually indigenous communities is what I'm thinking of now. And those partners that I tend to pick up a lot of times are in behavioral health, right? And so they're thinking, same thing, like, what's beyond this eight week class that we're developing this big, huge flagship program? What can that do for people in clinic kind of thing? And so I think a lot of folks that I work with tend to be in groups and they found it really comfortable introducing a five minute meditation to start the group, right? So, and that seems like, it doesn't seem like it's that big a deal, but they were not doing that before. Most of the time, this is all just, I don't have data to back it up, just what people are telling me, but they said that, you know, everyone said it's made the group much better. So it could be as simple as that, you know, but those are mostly in groups, you know? So, but I think a lot of that comes to, goes back to your own personal practice thing that, you know, there's a lot of answers that we may already know, or a lot of things become more intuitive when doing these practices. And one thing that I've, for whatever reason, except for bankers, I'm able to convince that it's really impossible to like, really hold a lot of thoughts in your head at the same time. You're really just switching around, right? But, and so what the thing is, we convince ourselves that we can. So what I've noticed when I do mindfulness practice, I make less mistakes in my day, right? And so I don't have to go back and do things. I don't have to forget things, or I'm not forgetting things. I'm just present with what I'm doing. So I have an extra two hours each day because of the things that I don't make mistakes on. And mindfulness gives me that, you know, so the 10 minute, two hour trade-off, a lot of it's hard to explain, you know, like it's a little bit non-intuitive. It's still 10 minutes, you know, I don't want to do it, but it makes a big difference, you know? Well, another, I really liked that, you know, Dr. Puru. But something else, you know, that I want to add to this is it can be as simple as pausing. So one of my favorite quotes is by Dr. Victor Frankl. I think most of you guys know he's the famous psychiatrist, Holocaust survivor. And the quote is, between stimulus and response, there is a pause. In that pause is the ability to make a choice. And because of the choice, we are able to grow. So the application of that, the functional application of that is pause between tasks, any time throughout your day, when you are making a transition, pause, take a breath. This is something that is really simple, but very profound. Because when you pause, you're able to think a little bit more clearly and see more clearly what it is that you might have done otherwise. And what it is that you really ought to do, if you're especially if you're in the middle of making a decision, or simply you're pausing to allow your brain to breathe, you know, it's kind of how I think about it. It breaks up this cycle of really, you know, the sympathetic nervous system being activated constantly. You know, as a physician dealing with burnout, I found that it was just not sustainable. We are not programmed to constantly be going, right? But the system, the way it's designed is 15 minute appointments, 30 minute appointments, you just have to keep going, you don't take a break. So incorporating those pauses deliberately, mindfully, is one technique that I found useful. I'm not saying it's the solution, but it is a solution, a technique to be able to literally breathe as you go throughout your day. So I hope that's applicable and useful. Oh, and I just wanted to add, that's that whole thing of reacting versus responding, right? You know, and then just this whole sense of, you know, are you are you jumping at impulse? And because, you know, this particular part of your brain is, and it's all innervated into your hormones, and you're like going, you know, or are you taking that moment to allow, and I, you know, you can just map that out in the brain, like what, which part of your brain are you actually using to make these decisions. And you know, that if we're going with the first impulse, so there's a lot of that. And I think that there's, so we haven't mentioned NBCT in this at all. And I think that it's, so mindfulness-based cognitive therapy is, is, was developed out of MBSR. So, but it takes that simple function of being able to say, okay, well, if you can be able to, instead of, you know, responding versus reacting, then the whole process will probably work out a little bit better. And I think that's something that people will be able to see thoughts as they arise, right, and do something with them rather than not. So there is, that is something that people can, as far as a straight up clinical tool, MBCT is something that's taught, and you can be, you can take just like MBSR training, you know, be trained in that too. I think what you're saying is, is so important. And it goes to some other questions I had around, you know, how to introduce this idea to patients, right? Because, I mean, and we're thinking about cross-culturally and, and contextually, and, you know, I know for some populations, you know, some immigrant populations, you know, some of the first questions I got was like, is this to make my mind blank? Like, I can't do that, you know? And the young people too, like, I don't do that breathing thing, you know? But when I contextualize it in this very way that you're speaking about in terms of, it gives you this pause and that pause is an opportunity to sort of have awareness and to see what you might, how you might respond, right? Without sort of first judging or reacting. And I was able to sell it to some young people as a tool so that they could actually manage very stressful situations. I was working with young people who were in very stressful situations chronically and they didn't want to tune out, right? And they had to react appropriately at certain times, but I sort of spun it in terms of responding. Like, how can we sort of, you know, soup up your ability to respond to things in the way that you need to, to know when you have to do something for your safety and when is it something that's distracting you from what really, you know? And so putting it that way, they accept it as like, oh, this is a tool that can actually help me manage this world that I'm in, right? It's not just some like wild thing that this lady's saying. So I don't know if either one of you have, you know, any kind of sort of reflections on that of sort of selling it to patients, right? Making it applicable and something that they can see as a positive thing they can use. I like your example. Again, I think it comes down to ease and accessibility and simplicity. So yeah, the power of the pause is one easy way to kind of incorporate it. But I also want to make something clear. It's so much easier to talk about this than to do it. Yes. And something I readily share with, you know, my friends, patients is this is a practice. Like I said earlier, I am by no means an expert. Every day, you know, there are moments when I thought, oh, I shouldn't have reacted, right? So it just goes to show that it takes a lot of cognitive awareness. And I think ultimately that's what it boils down to is just that if you're able to be aware enough to recognize, oh, I'm about to react, I should pause. That's a big step right there. Just the recognition of it has to start there. But in terms of ways to sell it. So I want to actually, the answer I'm going to give is also going to address the question that was asked about mechanism of action a little bit. Yeah, ultimately, you know, from a neuroscience standpoint, it's about stimulating the parasympathetic nervous system. Again, you know, we live in a world that between the constant distraction, social media, instant gratification, the sympathetic nervous system is firing all day long. So how do we reverse that? So, you know, you want to be able to target the vagus nerve, right? So you can get to the parasympathetic nervous system. And the easiest way that at least I've found to do it and how I teach is through breath control. In the yogic tradition, it's called pranayama. Prana in Sanskrit means breath, but more broadly, it means life force. So in India, prana is thought to be, the breath is basically in control of the entire body, your entire energy systems, right? So to be able to be aware, to take a breath in, I do what I call like the 3-3-3 system or the 5-5-5 where it's count to three breathing in, count to three breathing out and do that three times. And you can take any permutation and manifestation of that, but to really target the parasympathetic nervous system, you want to prolong the exhalation. So breathing in for three, breathing out for five. That is really, really what tells the body and the mind, relax, calm down, it will be okay. So it's a self-soothing technique that, I mean, you can use it pretty much anywhere. It literally takes seconds to do. So that's, I think, a tried and true technique and the science does back that up. There's so many different types of breathing techniques, but to be able to practice the lengthening of the exhalation can lead to a lot of reduction in stress and anxiety as you go throughout just day-to-day activity. That's great. And I know we wanted to leave some time for some questions and we've kind of been answering some of the questions that we have there. So I'd invite people, if they have any questions, please put them in the chat or a question area. But I want to make sure that we have a little bit of opportunity to delve in a little bit more on this idea of helping physician or provider burnout, right? Because even as we're talking about how some of these practices can be integrated, very helpful for communities, if we're doing that work too, right? Working in busy practice, the way things are, right, in practice these days, and as well as working with communities that might have a lot of challenges, we have to take care of ourselves as well. So, you know, what's the opportunity for preventing burnout or moral injury, right? When you're working in very challenging situations. We're all going to get rich if we answer this one. Well, I've seen, you know, cause I work, I'm on like health committees and such, you know, for faculty and staff. And so these are always questions and we always try to come up with these grand ideas. And so, but oftentimes for me, it's, you know, get into the eight week class that's offered by the university, or if there's some system, or get into the class somehow, you know, start taking mindfulness. But there's a lot of things that I, a lot of people are like, I don't got time for that. So we'll work with some physicians about being able to go, if you're in clinic, you know, and you're going from patient to patient, you know, what are you doing in that time, you know, between going through doors? Is there a moment that you could actually just center for those 10 seconds and be able to let go of one patient to the next? I mean, simple little moments like that, because one of the things you got to think about, and you can test this for yourself, but, you know, drive down the road for five miles and see how many cars you remember, or what houses were there, or what, we just do a lot of stuff on autopilot, right? And we just let our minds, we can continue to keep driving, but not remember anything that's around us, which is crazy at 60 miles an hour like that. And that gives you a sense of just constant, how much our brains are just constantly going. Maybe it's important, maybe not, but the main thing is once in a while to be able to just stop that circling, and even just, and if it's a little tiny bits, there's ways to do it. I want to, I guess, preface my response by making sure I acknowledge the fact that burnout and moral injury are systemic problems. I have worked in settings where the solution has been touted as do yoga during lunch, or, you know, there's a mindfulness or relaxation class after work. I mean, I'm a yoga teacher. That's not the answer. That's not the answer to burnout or moral injury. It's much more deep-rooted. And so I don't want to trivialize the enormity of that issue. But what I do, what I will say is that, you know, during the height of my burnout, personally, being able to learn how to meditate, and I am choosing my words carefully because it was a combination of things, but being able to really tap into what gave my life purpose and value, being able to see more clearly was ultimately the benefits of mindfulness, being able to slow down enough to recognize what I was willing to tolerate and what I wasn't. And up until then, I had never paused. So I think, for me, the power of the practice is giving yourself the space and the compassion to simply be as opposed to do. And when you can do that, I think things start to make more sense. You start to prioritize what really matters. And then you see solutions a little bit more clearly. So I hope that kind of answers that question. And I'm happy to speak to people privately about my own journey. And, you know, it's ongoing. It hasn't ended. So it's a complicated issue. Yeah, I mean, I think this whole discussion, right, just scratches the surface, right, of really what mindfulness is, what meditation is, the applications in all kinds of areas. And we're just scratching the surface. And it's clear in the question that is in the chat. And by the way, we also have provided some resources and links for the audience to be able to do some more reading and delve into this a little bit more. But one of the comments or questions in the chat was, you know, I have a few more practical and ethical questions about implementing MBSR with low income and minoritized populations. Could I possibly speak with the panelists, you know, outside of this meeting? And let us know if people can reach out to you. But any sort of like, you know, words around, this is a big thing, right? There's a lot of, you know, how do I apply this? What are the practical ways of doing it? Ethical questions, you know, what are your sort of thoughts on any of that that could be, you know, future conversation? I would say doing the right thing is reach out to people who've been doing it, right? There is a pretty good knowledge now and out in the world about, you know, what people have done in different communities, the ethical considerations that they've come up with. And that's great to bring that up, you know, I mean, it's more than just, it's real, you know, when you're working with these communities. But I think ultimately it's, maybe it's just reaching out and you're welcome to reach out to me. I think my email should be available. So I'm happy to take that conversation further, but I think most of it is about making those connections to community members, starting with your own practice, first of all, but then making those connections with community members and exploring those issues with them, right? Because they'll tell you the history of what happened in the community. They'll tell you what's going on with the kids or the older adults or whatever it might be, you know, because they know they're in there all the time. Yeah, I would agree, you know, communities will tell you what they're willing to tolerate and what they're not, or what they think is quote unquote fake or not. So again, to be authentic in your approach and also be aware of what the cultural factors are that might prohibit them from embracing, you know, any sort of mindfulness practice and tailoring it to that community. But yeah, I think reaching out to people who have practiced it, the body of works out there, the research is out there. I think also making sure people know that there's many different ways to practice mindfulness. There's no one set path. You know, there's no wrong way to do it. I think that's the beauty of it too. So to find what works for you. And I hope the resources that we provide give a variety of options. So I hope that helps. And I mentioned Tremaine, so that's my, you said, how do you sell this to communities? I just bring Tremaine with me, but Tremaine was doing this work with people. I was saying the black community members and police in Flint, and they had developed this. We just put a paper, we just got a paper accepted on this project. They started humming, right? What they wanted to do is explore African roots of spirituality. And so they did a lot of like exploring spirituality, which tends to come up a lot in black communities, scripture and connections to compassion. And so there's a lot of that. And so they were doing that and they ended up starting humming. And so that became their practice was this humming practice that they would start doing. And so that just grew organically from there, and I think that's the one thing about these practices. What I have found is once people get in it, we have a whole MBSR teacher training program now that's just for people who serve underserved populations. Right, so now you've got this, all the people who are going through those cohorts are from a very diverse groups of background. And the conversations that have been generating in those spaces has just been extraordinary. So this is also possibly a place where people can find an opportunity to not just work on our own self calmness, but also as a mediator for social change and of structural change, and how can mindfulness be an avenue for that? And these conversations are what's arising in these, out of these mindfulness practices and it's just been great. Yeah, I would add to that and kind of piggyback off of it that there's a real collective power in this practice. So I'm gonna put a plugin for if you have not done mindfulness or meditation in a group setting, give it a try. And especially if you're hesitant to do it individually for whatever reason, you know, there's plenty of online groups. The MBSR training that I did was online and I was a bit skeptical. I was like, I don't know if I'm gonna get much out of this, but wow, it was really amazing. Online too, there is still palpable energy there and almost like a collective power. The dopamine question, I saw that and I was curious about that. I haven't seen any studies about dopamine, but you know, I think there is a part of the brain, the pleasure pathway that is triggered when you get into deep, deep states of meditation, kind of described as that Nirvana or bliss like state. So I would imagine that that does play a role. Well, I've been doing a lot of work with people with Parkinson's in this. So my fingers are crossed, there's a big dopamine. Yeah, sort of effect. And I like the comment too, that we have a comment from Carissa Cavan. You know, I facilitate community workshops to address climate injustice impacts in very underserved areas of Puerto Rico that always include a mindfulness exercise. And most people are really open to it, but we also address mental decolonization and incorporate ancestral cultural practices. The feedback has been very positive. And I think it speaks to, you know, sort of really listening and being with the community, right, which I think mindfulness helps a little bit of sort of how can we be in a process with others, right? And really thinking about contextualizing that in a really respectful way. So thank you for that comment. I'm interested in Puerto Rico and mindfulness, if anyone. Yeah, yeah, I go to Puerto Rico. I'm from Puerto Rico, so I'm definitely- Oh, really? I would love to be at UPR, but my Spanish is- Yeah, well, you just have to immerse. Yeah, I will. And then someone said, thank you for this important session, which addresses one of the pillars of lifestyle medicine stress management. Some systems alternate slow breathing with fast breathing. Can you comment on that physiology? I don't know if that's a little bit, I know we only have like a couple of minutes, but I don't know if Dr. Sands or Dr. Perl. Yeah, there's a whole, the relaxation principle. What was his name over at Harvard, Matt? There's a whole nice, there's a lot of literature on that, but look at the, that goes directly into the physiology of all that, and vagus nerve, and I'm trying to think of his name. It'll come to me, hopefully before this is over. Yeah. No, thanks Dr. Viswanathan, nice to see you here too. And Carissa, by the way, she's a friend. She's our president of APA. Yes, yes. I will speak to this, wearing my hat as a yoga teacher. For me, the fast breathing exercises, or that Ujjayi breathing, or the lion's breath, builds energy and heat. So I tend to reserve that for an active practice. The slower breathing techniques are much more beneficial. Box breathing, as an example, varying the duration of your exhales and inhalations, for example, as I mentioned, that's much more amenable for stress reduction and reducing rates of anxiety and even depression. Great. Well, yeah, I just want to comment. Thank you, Dr. and Mr. President, for that question and comment. So we have two minutes left, I believe. Any takeaways, last takeaways that you want to offer or shout out for resources that would help people to continue on this path of learning? I think, you know, we've covered the main things of, you know, if this is a path you want to go, really develop and cultivate that sort of practice for yourself and make connections with the communities. A lot of this stuff, I mean, with the community part, for people who are already interested, this should be pretty easy, you know, of just reaching out and knocking on doors and finding out what people are gonna really respond to. Mine will be more towards individual practice. Don't be afraid, number one. And number two, the best way to learn about meditation is to do it. We can talk about it all day long, but my teacher said from day one to me, just do it. And you gotta start somewhere. And even if that's 30 seconds to start, that's fine. So honor yourself where you're at. Excellent. Well, thank you so much. And I know that there's still a lot of interest in the chat. I know that we have some residents and, yeah, and, you know, one from Charlotte that says, I've learned quite a bit from this conversation. I'll be reaching out to incorporate some of these practices at my hospital. Herb Benson is the one you were taking. Yes, thank you, Benson. About the relaxation response research. Benson, Herb Benson. Yes, Herb Benson. And then lots of thank yous. And really, thank you for the great topic and the conversation. So thank you everyone for being here. Again, lots more that we could talk about on this topic. You know, reach out for those resources and further learning. And thank you for your interest in this topic this evening. Thank you.

Meditation

Mindfulness

Mental Wellbeing

Cultural Bridge

Underserved Communities

Culturally Responsive

Indigenous Traditions

Physician Burnout

Healthcare Providers

Community Engagement