Mindfulness, #120

[Unidentified voice]:

It's important to understand that mindfulness is, as much as anything, an experience. And it's, I think, the present moment that has the greatest potential to give us a sense of belonging and value within ourselves and in whatever work we're doing around in our life. Be aware of what you're doing right now.

[Unidentified voice]:

I think a lot of people can benefit from just learning the skills about how to sustain their attention in a different way and and how to be gentle with themselves when they've lost their focus and how to bring their focus back to whatever it is that they had been intending on resting their attention on.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and podcast show number 120, Mindfulness, airing for the first time on Sunday, December 29, 2013. Our guests today include Dr. Joe Dreher, Clinical Associate professor at Tufts School of Medicine affiliated with the Maine Medical center and Maine Health and Maureen Calnan, mental health clinical nurse with a specialty in mindfulness and memory issues. As we move into a new year, many of us are taking time to count our blessings and look forward to blessings ahead. We are best able to know the bounty of our lives when we are fully present, enjoying the moments as they come to us. Today we speak with experts in the field of mindfulness who are helping educate healthcare providers and patients about being more fully present. We hope that our conversations may give you an opportunity to count Your blessings from 2013 and consider the importance of mindfulness in the year ahead. Thank you for joining us. I've known Dr. Joe Dreher, George Dreher. I was a Clinical Associate professor with Tufts School of Medicine located here at Maine Medical center for many years. In fact, Dr. Dreher was one of my teachers and my advisor when I was a family medicine resident at the Maine Medical center, and I felt like I got to know him a little bit more when I spent time up at Mayo Hospital in Dover, Foxcroft. Even though he had already gone by that time and I was spending time as a resident, I sort of understood where he had been as he had processed through being a family doctor then, and then deciding to go back into medical education training and become a psychiatrist. So it's great fun for me to have Dr. Dreher across the microphone from me today to talk about a subject that I believe is pretty dear to his heart, and that is mindfulness. Thanks for coming in.

[Unidentified voice]:

My pleasure.

Dr. Lisa Belisle:

Dr. Drayer, you started your whole, I guess, adult career in the Navy as part of the submarine corps. I'm fascinated by this because I don't think I knew this about you, but you've kind of come a long way from submarine. And this is prior to medical school to now working with Tufts School of Medicine. Why did you become a submariner?

[Unidentified voice]:

I was greatly motivated by the draft. It was during Vietnam, and I actually got into the Navy one week before I was to be reporting for active duty in the Army. And my family had a background in the Navy, and I'd always been fascinated by submarines, so it was a natural choice.

Dr. Lisa Belisle:

So from being in the Navy and spending time in. Were you in Vietnam proper or were you just training and working stateside?

[Unidentified voice]:

I was in a submarine in the North Atlantic playing tag with the Russians and did that for three and a half years. And actually, while I was in the Navy, had the opportunity to spend time with some physicians and decided to change my career path from doing oceanography research at Scripps in Louisa, California, to going to.

Dr. Lisa Belisle:

Well, that was going to be my question, which is, how did being in the Navy and this sort of interesting turn of twist of fate called the draft, how did that kind of propel you into this career as a doctor?

[Unidentified voice]:

I enjoy working with people, and I enjoyed science a lot. And as I spent some time reflecting on all this in the Navy and visiting some of my previous college professors, I became aware that a life of working with people as a physician was probably going to be more satisfying to me than a life involving teaching and science, but a little more abstract in some ways. So I made the choice and headed for medical school.

Dr. Lisa Belisle:

You took a kind of a dramatic turn. You went first into family medicine, and then you decided that you wanted to go into psychiatry. That required going back to essentially going back to school, getting more training. Where did that come from

[Unidentified voice]:

in the middle of all that? I was also doing a lot of work in addictions. And I was aware in family practice and even more so in addictions, how Much psychiatry played a role in the well being of people. And it also gave me more of an opportunity to spend time with people, patients. And so I decided that would be the best way, the next logical step. It was a very difficult decision because I really enjoyed family practice and the work I was doing there, and also enjoyed addictions. But I could just feel that there was something more I wanted to learn, so I went back.

Dr. Lisa Belisle:

You've also done work with palliative care and end of life issues, so you're not really choosing the easy things.

[Unidentified voice]:

I think I'm probably a fringe physician. I always get involved with things that are not quite mainstream. I mean, family practice wasn't really mainstream, addictions wasn't mainstream, palliative care ethics. They're all things that I feel are very important parts of medicine and need to be paid more attention to. And it just drew me in. I find them very interesting areas and they all seem to have a lot to do with the suffering of people and trying to find ways to alleviate that, particularly the emotional suffering.

Dr. Lisa Belisle:

What you're describing as, I guess, fringe medicine, it is really actually core to people and our humanity, and yet it does get kind of shunted off to the fringes because it's easier for us to say, okay, well, here's an ear infection, here's some amoxicillin rather than here's an ear infection, here's a parent who smokes, here's a parent who's unemployed, here's a grandmother who's depressed. It's easier to deal with that one thing rather than the whole. Was that one of the reasons why you decided to spend more time on the fringe because you wanted to look at this bigger picture?

[Unidentified voice]:

Well, the term fringe for me implies not anything good or bad, but rather that American medicine is understandably very good at technology and very good at finding treatment and cures for very serious diseases, which is an important thing to do. I'm concerned in the process, the doctor patient relationship has become lessened and that folks who are in primary care, family medicine, internal medicine, pediatrics, have not been well taken care of, compensated, listened to in the process of making decisions about what we need in healthcare in America. The medical systems around the world that are doing more for their patients overall health and spending a lot less money have a better primary care system where a primary care doctor really has time with patients and can really provide not only the, if you will, technological medical care they need, but also the personal care. Certainly it's very great to have all the technology available that we have here for the more complex illnesses, but without the foundation of primary care, it's somewhat the tail wagging the dog, in my opinion, about how healthcare probably would be best delivered. We're in a frantic race now to try and catch up and build enough primary care practices to allow the planned health care systems in this country to function in a more, not only economical, but I think actually productive way, particularly in preventing disease, which is one thing that family medicine I know does a really good job with. So I say fringe just because it's fallen out that way due to all kinds of forces that I'm sure I don't understand. And there's not all bad things by any means about the way it's fallen out, but a balance would be good.

Dr. Lisa Belisle:

You've seen a lot of changes between the time that you went into medicine and the time that, well, I guess in theory you've retired, unquote, which I think is not entirely true. You now you're no longer practicing clinical medicine as of this past summer, but you're still actively involved in the teaching program. What have you seen as far as physician attitudes, behaviors, well being? Because I know that a very important piece of this for you is physician and provider well being.

[Unidentified voice]:

You are correct that I've stopped doing official clinical medicine. And my focus now is trying to help the providers themselves, physicians, nurses, physician assistants, nurse practitioners, all of whom are under tremendous pressures and losing a lot of what gives them meaning in their work. And the more this occurs and the more burnout those folks are becoming, the more they're going to be leaving medicine sooner or the more prone they are to make mistakes or other things that we don't want to have happen. So the shift has just been for me, from, if you will, official patients to another whole group of people who are suffering just as patients do and trying to help them. The change has been for, I'm sure, many reasons that we can't get into here. Part of it is because medicine has become a business model, and that's partly because of the expense of it. And trying to provide care and not spend as much money without doing so by putting providers in a role where they don't have enough time to spend with each patient or really to attend to the details of the patient's needs is something that we're struggling with right now. I think we're going from a fee for service model where we get paid for everything we do, to hopefully something that's more holistic and is really looking at the whole patient's needs and the populations of patients, needs and preventing illness as much as we're treating it. And I think when we get there things will be much better. But this transition time is very tough on providers and the administrators who are trying to run the system as well. And I'm trying to do what I can to help modulate that a little bit.

Dr. Lisa Belisle:

I assume that that's part of the reason why mindfulness appeals to you.

[Unidentified voice]:

It's always appealed to me to try and help myself be more centered and clear when I'm working with patients, and I find it's one of the useful tools to help the providers I'm working with, and there are many others as well. Mindfulness is a powerful tool, but it also takes some time and effort to learn it and make it part of your life to a point where it becomes a constant background part of oneself and it can make a big difference. There are things one can do in little ways to be mindful to help you recenter during the day and reground yourself. And that's what I'm trying to work with folks on. But again, it's only one of the many tools we're trying to find to use to help providers be healthier.

Dr. Lisa Belisle:

Here on the Dr. Lisa Radio Hour and podcast, we've long recognized the link between health and wealth. Here to speak more on the topic is Tom Sheppard of Shepherd Financial. I'd like to take this opportunity to wish you and yours a holiday season filled with an abundance of love and gratitude. Be thankful for the things in your life that matter most and enjoy your

[Unidentified voice]:

time with family and friends

Dr. Lisa Belisle:

from all of us here at Shepherd Financial.

Dr. Lisa Belisle:

Well, let's take a step back and define what mindfulness is specifically or as specific as you would like to be. Because I think a lot of people believe that being mindful just means sort of paying attention, which it does in a sort of more simple way. But it means something more than that.

[Unidentified voice]:

It does. And there's a lot of discussion about what this means. There's actually books written on just that. What's mindfulness about? To me, it's trying to be present in each moment as it occurs, without judgment and with as much awareness as you can bring to that moment. It's very natural. And our society reinforces a focus on worrying about the past or worrying about the future and ending up losing the moment we have right now. And when you're trying to accomplish something in this moment, such as working with a patient, it's good to be able to, as much as you can, put aside the past and future focus and bring more of yourself to what you're doing at the moment. Awareness or noticing is another way to consider the basics of it. And you take that awareness and noticing and then do some work in training yourself in it. One form of such training would be meditation. There are others. And then using that. Become aware of what your mind is doing as you go through your day and how much you may be adding unnecessary proliferation to what's being thought about and worried about and what's really true and what's really present before you, and using that presence. Then be more effective whenever you're trying to do and being less frenetic yourself. So there's a kind of a win win for both the person who's doing it and for whatever person or project they're working on. So that's a short outline of it. There's a lot more to it. Obviously.

Dr. Lisa Belisle:

One of the reasons that I know or became aware that you were working on mindfulness was that you and I had a conversation several years ago about how I had been incorporating mindfulness in my practice. I did. As you know, I did a mindfulness based stress reduction fellowship with Jon Kabat Zinn's program at the University of Massachusetts when I was a preventive medicine resident. And when I came back into medical practice, I spent a lot of time working with patients on their breathing. And that was sort of the basis of my sort of attempt to help them self heal. You've done a lot of work with medical students, residents and physicians on mindfulness, and it's looked slightly different because it's a different population. Tell me how you're incorporating mindfulness in the work that you're doing.

[Unidentified voice]:

Reflecting on a comment you just made about the breath that's frequently used as part of a mindfulness training, because you always have it with you and it reconnects you with your body. One thing that I believe we all can do, and particularly people in an intellectual profession will do, is become lost in our minds and lose track of the many other facets of who we are as a person of which being aware of one's body is a good anchor, if you will, to come back to, to pull you away from all the ups and downs and in and outs of the mind, which is always going. The anchor can be used, the breathing anchor can be used for meditation practice, but it can also be used in very brief ways. So if you're going from one task to another, just stopping for a moment, physically stopping, and let yourself catch up to where you are taking a breath or two and using the out breath as a relaxation process to bring you to this moment and just be there for just a second or two and collect yourself to then be ready to bring all of yourself into the next project. It's one example of ways to be mindful. The important thing about this is that it works much better if you do some training, if you will, to become present. So just telling somebody, well, stop, breathe, be and you'll be in better shape doesn't work. It's like giving somebody a pair of tennis shoes and say, okay, run a marathon. I mean, you got the shoes, but you need to practice and learn how to run in them and be with them. And when you do that and also get more in tune with your body and all the other aspects of yourself, then when you do the stop, breathe B, they all sort of roost for a second and really slow down the monkey mind that's always going and bring you to the present moment. With providers, there's a number of things we're underway with. We've been doing a course in mindful practice at Maine Medical center for providers, nurses, physicians, respiratory technologists, physical therapists for about three years now. And we have one going on right now and it's a 12 week course where people learn some mindfulness tools but then also look at how they have been dealing with the stressors in practice, such as how they deal with professionalism or the lack of it in other people, how they deal with suffering or death and dying and bringing all those things into a quieter place. Our class to look at them and how they cope with them and reminding them about how they cope with them. Well, many times, particularly if they let themselves just sit down and remember when they did these things. Well, cultivating that memory of skill renews many aspects of themselves besides just technology and just knowledge base. It really Renews the parts that allows them to be a healer. And that's what's really I think key for us not to lose as medicine forges its new role in our society and around the world is to remain healers and not just good technologists. So our work focused on that, our work in physician health and resilience is taking a bit of a different track. Still hoping to use mindfulness some, but really looking at what it is that gives professionals, in this case providers in medicine, a sense of autonomy, a sense of mastery and a sense of meaning or purpose in their work. And then how to promote those three things so that their work doesn't become empty and they don't become as burnout. There's been some very interesting research how rather minimal time spent with physicians, particularly in attending to the meaning in what we do, really renews them in a deep way and allows them to be much more satisfied in their daily work. Even though the stressors may be the same, it's how they bring themselves there and how they live within that stress that makes all the difference. And there's a lot of research going on around the country trying to find ways to do this that aren't too time consuming or too expensive. And it's interesting how some various minor things, such as more opportunities for peer to peer connection, can really make a big difference in folks daily work. So it's those kinds of things that we're trying to begin to find and find, find ways to incorporate in what we're doing in our practices and in the practices themselves, looking inward to see what they can do. We're having a conference on October 17, inviting several people from major practices around the Portland region to come together and start thinking about, well, what is it we might be able to do within our own practices, but also work with each other collaboratively to build up these resources that will save the people we're trying to have, be well enough to save others and heal them.

Dr. Lisa Belisle:

How are the providers responding to this idea of mindfulness? It's been, I know having worked in this field for many years, it can be a challenge to do all the things that we're supposed to do and then also simultaneously take a moment to sit down and breathe. Because there's always this feeling of being rushed. It's always this feeling of having to multitask to almost an extreme degree. What do people say when you say, okay, now we're going to learn about mindfulness and this is important and we're going to fit this into your curriculum somehow?

[Unidentified voice]:

It's interesting that when I have conversations with physicians and talk about what's causing their burnout and their dissatisfaction, they all are enthusiastically agreeing with it and they would all like to find some ways to change that. And many of them are open to ideas to try out of which mindfulness is one, and many just can't click with that idea and want to try other things, and that's fine too. What I've learned is that just working with the physicians alone is not likely to make an adequate change so that they can back away from the edge of burnout. So that's why I'm trying to work with physicians and the administrative systems to find ways they can work together on this program, because the administrative systems are also aware that when physicians are burnt out and tired, they make more mistakes. Patient satisfaction drops, prescription practices are not as good. There's all kinds of clinical things that have been shown to be less well done by a burnout provider, even if the patient doesn't know they're burnout. So the systems also want to correct this. Not to mention that it's just the right thing to do to try and help their employees if you will be in better health. The difficulty with suggesting mindfulness as a treatment for this is, first of all, not every is into mindfulness won't click for them, and that's fine. Second of all, when I say mindfulness, everybody thinks they go off somewhere and meditate for six weeks on the top of an isolated mountain in a cave. Which is not what I'm thinking at all. It's learning how to do it a little bit every day in your life. So another example, we teach a course to medical students called the Healer's Art, put together by Rachel Naomi Raymond. And one of the really neat exercises there is the three question journal, where at the end of the day you literally think about your day going backwards from where you are now backwards into the day and think about what inspired you in that day and just write it down. And then start again from where you are going backwards in the day and find what intrigued you. And write that down. And then again starting from where you are in the evening, usually going backwards in the day and find what surprised you. Just doing that and writing those three things down will help people be aware of the many fascinating things that happen during the day, inspiring things that are lost in the rush. And if you do that on a routine basis in the evening, after a while you'll start to notice it as it occurs in the day. And so you'll have these little Pockets of feelings of renewal and a sense of meaning of what you're doing. And it'll help you through the day. I'm not pretending that all these things are going to make everybody's life happy and wonderful. There's going to be a lot of stress still. But I think of it as a tachometer where there's on a car, there's a red line and you get above a certain RPM and that's where the engine starts to fall apart. I'm just trying to help people move back from the red line a little ways and keep them practicing in a way that they're happy, their patients are happy, and they'll stay in practice longer. We need as many docs as we can get right now, and anything to help the doctors do better, feel better in a small way, I think will help all of the system be better as well. So mindfulness is a nice tool, but it comes in many different forms. You can be mindful of what you're eating instead of talking during a meal or reading a newspaper or reading the back of a cereal box. Sit there and really just taste the food and chew it a few times and look at the food before you eat it and just appreciate it. And I think appreciating the moments you have during the day, if you're caught in a traffic jam, okay, appreciate the tail lights flashing on and off in front of you. Finding something that just settle you down and not get all revved up when you can't do anything about it or enjoying the things you do. Have time with the people you care about, some time outdoors. There's these little pockets we can all find in our day to be a little more aware of the day and of our lives and sort of slow down for a few minutes and that can be helpful. So mindfulness comes in many different shapes and forms and there's any activity I can think of that you couldn't use a little mindfulness for and just be aware of what you're doing right now.

Dr. Lisa Belisle:

Dr. Dreher, how can we find out more about the work that's being done in mindfulness and medicine? Through Tufts School of Medicine and the Maine Medical center here in Portland.

[Unidentified voice]:

We're just beginning locally and there's many things we like to do and are trying to mindfully choose amongst them with our limited resources. I would suggest if people want to learn more about this, that what you discuss, the mindfulness based stress reduction would be a great place to start. The Maine Medical Center Learning Resource center provides what they call MBSR course a couple times a year. There are great practitioners in the community who do this, a number of them. Nancy Hathaway is one I know who does this kind of work, has an office down on India Street, I believe. You can probably go to the website for the Mindful Space Stress Reduction Program at the University of Massachusetts and they'll have a list of people who've been certified by them to teach. So that would be a convenient way, I think, to start. And that is very palatable to most people because it's really based on the physiology and the science of awareness and not requiring one to take a transcendent or spiritual approach to it, although that may arise from it. So that's where I would start MBSR.

Dr. Lisa Belisle:

Dr. Durayer, thank you for coming in today and speaking with me. And thank you for also being my teacher, my mentor, my advisor when I was a family medicine resident back in the day. We've been speaking with Dr. Joe Drayer, clinical Associate professor with the Tufts School of Medicine and affiliated with the Maine Medical center right here in Portland.

[Unidentified voice]:

Thank you.

Dr. Lisa Belisle:

As a physician and small business owner, I rely on Marcy Booth from Booth Main to help me with my own business and to help me live my own life fully. Here are a few thoughts from Marcie on this, the Last episode of 2013 I wish you all a happy, healthy and above all prosperous New Year. As you enter into 2014, take a moment each day to give thanks and appreciate the joy that is all around you. Happy New Year.

[Unidentified voice]:

I'm Marcie Booth.

Dr. Lisa Belisle:

Let's talk about the changes you need. Boothmaine.com

Dr. Lisa Belisle:

During the holiday season. One of the things that we like to think about is how we can make it through and enjoy ourselves and enjoy our families and be looking forward to the new Year in a way that really generates well being. This individual who's sitting across the microphone from me today is well versed in the area of well being and mindfulness. This is Maureen Calnan, who is a mental health clinical nurse and specialist in mindfulness and memory issues. Thank you for coming in and talking to us today.

[Unidentified voice]:

Thanks for having me.

Dr. Lisa Belisle:

Maureen, you are a board certified psychotherapist and a psychiatric nurse practitioner. You work in private practice and at the Maine Medical center. You've earned an undergraduate degree in psychology, a master's degree in nursing, and you've done postgraduate work in psychotherapy at Boston College. You likely could have chosen any way of looking at this. And yet something about mindfulness called to you. What is it about mindfulness that you found so intriguing?

[Unidentified voice]:

Well, I think kind of the road that I took in getting to this particular specialty or therapeutic modality is that I had been working in cognitive behavioral therapy for quite some time and wanted to expand that work. And at about the same time, which was about 10 years ago, there were some researchers who were looking to develop what's called a maintenance therapy for people who are struggling with chronic depression. We had good therapies to help people out of acute episodes, but what they were really looking for is how could we prevent relapse situations from happening? About the same time, a researcher in Canada and a couple in England had hooked up with Jon Kabat Zinn's program, Mindfulness Based Stress Reduction. They were intrigued. They thought, well, what would happen if we put together together the mindfulness approach with cognitive behavioral therapy and then they moved into what's called mindfulness based cognitive therapy. And it appealed to me both professionally and personally. And I think it really enhanced cognitive behavioral therapy and made it more useful for different stages of illness with depression. And, and I think it just brought just wellness skills to individuals that were struggling with mental illnesses and also people that were not necessarily struggling with mental illness, but just experiencing emotions that were difficult to get through.

Dr. Lisa Belisle:

We've discussed cognitive behavioral therapy before. I believe it was on a show related to anxiety. For people who aren't as familiar with cognitive behavioral therapy or mindfulness work. Can you describe what those two are and the similarities and differences?

[Unidentified voice]:

Cognitive behavioral work is about developing the skills to really take a look at your thinking. We all have an inner dialogue that's kind of chatting away all day long throughout the day and, and some of the things that we tell ourselves are very accurate and factual and some of the things that we tell ourselves are completely non accurate and not factual. And what happens when we go through depression or if we're struggling with anxiety, our distortions in how we see ourselves in the world around us will become more magnified. And so cognitive behavioral therapy is really to address that very predictable thought process change. And so you help a person learn how to challenge and become more flexible with their thinking and also to change their behaviors, sometimes just to add more fun or enjoyable activities into their daily schedule or weekly schedule in contrast, but also very complementary. What mindfulness brings is that it really brought more attention to, well, how do you check in with yourself throughout the day and really monitor that inner dialogue because it's so familiar to us. A lot of times we kind of have this chatting going on in our head that we're just barely aware of. And so the mindfulness skills, which is really about just being paying attention in a particular way, really helps bring attention to that. And also there's kind of a softness or a kindness that goes with it, checking in with gentle curiosity. And sometimes that works very well with kind of the harshness that can go with anxiety or depression, where sometimes we can be very hard on ourselves for hardly any reason at all.

Dr. Lisa Belisle:

Can you give me an example of some of the things that we tell ourselves that could be possibly harmful?

[Unidentified voice]:

Well, a lot of times they can be things about kind of who we are in general, in which we'll doubt our worth. Well, you know, if I'm not exceeding in this part of my life, then I'm worthless. Or if I'm not loved by this person, then that might mean that I'm not lovable at all. So really kind of extremes in terms of one part of our experience may really magnify to have a lot of meaning in terms of who we are

Dr. Lisa Belisle:

in that moment and in that situation. How would you work with cognitive behavioral therapy and mindfulness to help people to pay attention more and to rethink things?

[Unidentified voice]:

Well, one of the things that I think is particularly helpful with the mindfulness combined with the CBT is that part of my work in the groups that I've done, we invite people to have what's called a formal practice where they may be sitting down and doing a mindfulness meditation for 5 minutes, 45 minutes, you know, they choose the length of time. But then to try to really stick with that. And what that does, it's a formal practice of really tuning into what happens with the mind when you try to sit down and focus on one thing. And what most people discover is that the mind then wants to go all over the place with a busy mind, and that's okay. It's really about just paying attention and noticing. And then there's also informal practices of, you know, perhaps you're going to try to brush your teeth and keep your mind on brushing your teeth while you're brushing your teeth. And often what people notice is that in the matter of two minutes, you know, they may have thought about 12 different things other than brushing their teeth during that exercise. So how that then translates into helping therapeutically is that the more vulnerable a person is to depression, and often that vulnerability is about the number of depressive episodes that they've been through, the more easily it is for a sad mood, even a twinge of a sad mood, to kind of hijack a person's attention and. And get them onto one of these thought patterns that really aren't accurate and in the long scheme of things, aren't really doing them any favors. So it helps with the attention of noticing, oh, I've left this conversation, and I'm now in my head thinking about something completely different in which the theme of it is, I'm not doing so great or I'm not such a great person. So. So the first part is the awareness, and the second part, which is more the CBT is then being able to challenge the thought process. And maybe you'd say to yourself, again in your head, hey, is that really accurate? Is that really true? And sometimes we'll say, oh, yeah, it's really true. And then another step would be, well, what evidence do you have to support that? What evidence do you have to support that? Because I don't have a date tonight. I'm going to be alone for the rest of my life. So, you know, kind of phrases that are intended to help interrupt some of that automatic thought process.

Dr. Lisa Belisle:

Most of us have people in our lives and have experienced this ourselves, but really have people in our lives that have this sort of mantra that they come to their life with, you know, I'm too fat, I'm not good enough, nobody loves me. And it can be really hard as. I mean, it's hard enough for us as individuals to deal with our own stuff. It can be really hard to deal with somebody who has this mantra that we want to help, we feel compassion towards, but nothing we say ever seems to help change their mind. How do you work with that?

[Unidentified voice]:

Well, and that's also an area in which the two modalities differentiate. With cbt, I think sometimes that sounds a lot like how we talk with a friend who's being very harsh on themselves in which we might try to talk them out of coming to the conclusions that they're coming to. So really kind of challenge their thinking, see if they can kind of broaden that. With the mindfulness approach, it's really not about kind of getting in there and wrestling with the thought, but rather it's about changing the relationship with the thought that they have. So with this approach, it's less of a fix it kind of approach and more of a just notice it. So with that, if I'm sitting across from someone and they start to talk about their weight and how they feel about that in terms of their worth, I might just say, okay, so just notice the judging. And in that moment, I don't want them to get caught up in the content of their appearance or how smart they are. I just want them to notice that they've now moved into judging. And what happens once people have really spent some time with this work? They'll just, you know, they'll just kind of smile and say, oh, yeah, how did I get there? And then they'll go right back to where they were before that thought kind of hijacked them out of the present moment.

Dr. Lisa Belisle:

And there's also some noticing of ourselves and how when somebody else sitting in front of us says something about themselves as bad says, you know, I don't like my weight or nobody loves me, we also can notice how it makes us feel as individuals, and that can go a long way toward not trying to fix it and not feeling frustrated because we really often can't.

[Unidentified voice]:

Yeah, absolutely. Yeah.

Dr. Lisa Belisle:

The goal of the Dr. Lisa Radio Hour is to help make connections between the health of the individual and the health of the community. The goal of Ted Carter Inspired Landscapes is to deepen our appreciation for the natural world. Here to speak with us today is Ted Carter.

[Unidentified voice]:

A world lives within you.

[Unidentified voice]:

of this inner world. That's something by John o' Donohue and

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the other day when I was reading this book.

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about what can be in my life,

[Unidentified voice]:

I try to honor the spirit of

[Unidentified voice]:

human being that inhabits that land and

[Unidentified voice]:

They're quite different, and it's part of the human journey. And I think that the land and

[Unidentified voice]:

too can have a landscape that really

[Unidentified voice]:

what you really want in this world.

Dr. Lisa Belisle:

the Doctor the ELISA Radio Hour and Podcast understands the importance of the health of the body, mind and spirit. Here to talk about the health of the body is Travis Boyer of Premier Sports, a division of Black Bear Medical.

[Unidentified voice]:

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Dr. Lisa Belisle:

Using the breath is an important part of sort of recentering. This is something that is used in most major spiritual practices, but it's something that's really very easy to do. Do you work with this in your population of clients?

[Unidentified voice]:

Absolutely. And one of the things that I say to folks is that the breath is always with us. So it's not like we have to worry about whether or not we have a particular tool in our briefcase or our pocket. We always have the breath. I think sometimes folks can be rather skeptical because of the simplicity of just pausing and dropping into our breath. And so I just invite that, say, okay, you don't have to be completely on board with this. That's okay. But what I do invite people to do is just try it. Utilize the breath to help you to pause. Utilize the breath to help you to cope when you're going through a stressful moment and then just see what happens. So, so basically I invite them to not necessarily trust me or what's been written about for hundreds, thousands of years, but rather to just trust their own experience. And a lot of times, either in that session or they'll come back and say that there's really something to this.

Dr. Lisa Belisle:

There is a practice involved with this. It's not something that magically transforms itself overnight.

[Unidentified voice]:

Yeah, absolutely. Yeah, yeah, yeah. I was talking with a person this morning, and I said, you know, it's not like it's a magic pill. You can't just hope that by wanting to be better or wanting to be more comfortable that you will be. There's a lot of effort that goes into this work. And, you know, the efforting can be very different in terms of, you know, what's going on at that moment, in terms of what's needed.

Dr. Lisa Belisle:

The end of a year during which we're celebrating holidays, but we're also looking into the new year, and we're thinking about. We're thinking about our family dynamics. You know, say you're celebrating Hanukkah with your aunt who you've never gotten along with, or you're celebrating Christmas with your father, and you feel like he judges you. That can be particularly challenging, as can starting a new year thinking, I need to change myself. I need to do this differently. I need you to do that differently. How do you work with clients who come in and talk to you about the stressors of all of that? Are there specific things that you suggest to people?

[Unidentified voice]:

Well, I think in terms of the Christmas, Hanukkah holidays, I think one of the things that gets in the way is, again, is how much we are in our head around those holidays. So kind of thinking about the way that they should be with a future orientation of, okay, this is how my culture says that they're supposed to be. Beautiful, amazing food, fun times with families. So we put a lot of expectation on how an experience is supposed to be, as opposed to just allowing the holiday to unfold in whatever way it's going to unfold and just trying to enjoy the pleasant moments or also be able to trust that we can get through the unpleasant moments. So just being able to feel the twinge of rejection that might happen if there's a critical statement, but just to know that, okay, that's one part of this whole experience. And I can feel that I can pause and allow that, investigate it if I need to, and then move on. So that's kind of the. Kind of the forward or future part that can get in the way. I think also there are a lot of individuals in which they are looking backward and they're thinking about the holidays that they've been through, either as children or adults, that weren't great holidays. And so there's kind of that regret that's coming up around that. So, again, the skills are very Similar in terms of noticing that you're in your head, noticing that you're remembering an event or your recall of that event, as opposed to truly being present for this holiday and just being open to whatever it is that's going to happen. So kind of letting go of striving and just the attitudes of allowing and letting be. I talk about those a lot in December. And then I think in terms of the pressure that we can put on ourselves in terms of goals for the New Year, I think a lot of the time that can really create opportunities for our inner critic to just have a heyday. And, you know, what I invite people to do is, you know, absolutely. To put together the goals, but also to do that in a soft way, in that, you know, maybe some of these goals you're going to find yourself moving towards, maybe some you won't, but then also to balance that with values and to really think about what's valuable in your life in terms of how you spend your time, the people that you choose to be with, and kind of the characteristics of yourself that you want to develop. And so with that, it's not so much a goal of, oh, I'm going to exercise five days a week in 2014, but it's really about thinking about the core characteristics of who you are and developing some kind of practice for being able to check in periodically and just asking yourself, am I living or did I live this day in a way that was consistent to my values and trying to have a balance between the two. The inner critic has a more difficult time when we're moving or trying to live in a way that's consistent with our values than it does when we are kind of putting together goals or kind of traditional New Year resolutions.

Dr. Lisa Belisle:

These can also be important things to remember. Again, as we're talking to other people in our lives. If we focus more on the fact that all we really have any ability to change is the way that we perceive things, the way that we feel things. If we're constantly frustrated by the people in our lives and the way that they are doing things, then that really doesn't get us anywhere. If we focus in on our own values and our own lives and how we want to live, then we will end up feeling better about things and possibly impacting some sort of change.

[Unidentified voice]:

Absolutely, yeah. And sometimes when I'm working with a person who's really struggling with the way someone else is living their life, I just ask them a question, in whose business are you in? And sometimes it can be pretty tempting to try to work on someone else's self improvement plan or how they could be a better person. And it really protects us from doing our own work. Sometimes just change. Gentle reminders of where's your attention? What do you focus on? Are you trying to manage something that's beyond your control and then kind of bringing it back to self? And what is it that I can do in this moment? Or is it really about not doing anything at all? Maybe it's about just kind of being with the feelings that are coming up as I react to someone else's behaviors or life choices.

Dr. Lisa Belisle:

The holidays are particularly good for getting us all distracted. And it seems like distraction can be on one hand a very good thing, on another hand, kind of debilitating. So how do you deal with distraction when it comes to this time of year? Or how do you deal with people who are chronically distracted, People who might have some adhd people might have some issues with not being able to be fully present long term?

[Unidentified voice]:

Well, I think in particular with adhd, one of the things that I'm really concerned about is how the person perceives themselves, because I think a lot of times this is a childhood illness. So they have a lot of practice of really being harsh with themselves, related to their difficulty with attention and that they take it very personally and develop or have the vulnerability to develop beliefs about themselves that aren't true. So I think a lot of the work is really about helping that person come to a place where they can accept who they are, difficulties and strengths as well, and then trust that they can dabble in this work as well. So with the mindfulness approach, when the developers for this particular therapeutic were starting, they didn't want to use the word meditation, so they were trying to skirt around that and they were calling it attention control. And so they were trying to teach people attention control rather than meditation. And then finally they got to the point where they just let that go. But whether it's a person just who's not necessarily struggling in significant ways with their attention, or someone who is with adhd, I think a lot of people can benefit from just learning the skills about how to sustain their attention in a different way and how to be gentle with themselves when they've lost their focus and how to bring their focus back to whatever it is that they had been intending on resting their attention on.

Dr. Lisa Belisle:

And this can be useful also during busy times of the year where just being able to sort of acknowledge that things are a little busier than usual, that we might get a little distracted. But it's okay, we don't need to judge ourselves. We can sort of pull ourselves back to a place of centeredness.

[Unidentified voice]:

Right, Right. Absolutely. And I think in addition to that, in terms of the distraction, one of the things that happens is that the more distracted we are, the more vulnerable we are for these negative tapes to come in and take hold. And so if we kind of go into the holidays knowing that that's a vulnerability and at the end of a stressful weekend, we're feeling a little crazed just in terms of, oh, I can't juggle all this. I can't. How can I start Monday with the weekend that I just have? I don't feel rested or restored. But then if just part of our awareness says, oh, yeah, and that can be part of the holidays. Yeah, doesn't mean that I'm losing it or anything else. It's just part of when there's a lot that's happening and we're more likely to be distracted. We're also more likely to. To kind of get caught up in these negative thought loops.

Dr. Lisa Belisle:

Maureen, you have a private practice right here in Portland.

[Unidentified voice]:

I do.

Dr. Lisa Belisle:

How can people find out more about your private practice or the work that you're doing locally?

[Unidentified voice]:

They can find me via Psychology Today. And I also have a website which is just MaureenCalnan.com and I'm in the. If anyone still uses the telephone book, I'm in the Yellow Pages.

Dr. Lisa Belisle:

Well, I know there are people who are out there using the telephone book, so that is very helpful. And for those of you who might be interested in calling, Maureen, her last name is spelled C A L L N A N. We've been speaking with Maureen Calnan, who is a mental health clinical nurse and specialist in mindfulness and memory issues. This is certainly an important topic for us all, and I'm very pleased that you're offering this type of work to the people in our community.

[Unidentified voice]:

Yes. And thank you so much for the opportunity. It's really meaningful work and it's great to have the opportunity to have a few moments to talk about it.

Dr. Lisa Belisle:

You have been listening to the Dr. Lisa Radio Hour and podcast show number 120 Mindfulness. Our guests have included Dr. Jo Dreher and Maureen Calnan. For more information on our guests and extended interviews, visit drlisabelisle.com the Dr. Lisa Radio Hour and Podcast is downloadable for free on itunes. For a preview of each week's show, sign up for our e. Newsletter and like our Dr. Lisa Facebook page, follow me on Twitter and Pinterest and read my take on health and well being on the Bountiful Blog. We'd love to hear from you. So please let us know what you think of the Dr. Lisa Radio Hour. We welcome your suggestions for future shows. Also let our sponsors know that you have heard about them here. We are privileged that they enable us to bring the Dr. Lisa Radio Hour

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to you each week.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle. I hope that you have enjoyed our mindfulness show. Thank you for allowing me to be a part of your day. May you have a bountiful Life and Happy 2014.