00:00:04:15 - 00:00:29:16 Adam Hocking Welcome to The Rounds, a podcast of Marshfield Clinic Health System. I'm your host, Adam Hocking. The Rounds brings together medical experts to discuss fresh, fascinating and important topics from the world of health care. Meditation and mindfulness practices hold incredible potential for improving our daily lives, from lowering stress to increasing compassion and improving concentration. The mindfulness movement has much to offer in today's chaotic world. 00:00:30:03 - 00:00:56:04 Adam Hocking Joining us today to discuss incorporating mindfulness in our busy lives is Dr. Jennifer Michels. Dr. Jennifer Michels is a board certified clinical psychologist and has worked at Marshfield Clinic’s, Department of Psychiatry and Behavioral Health for 16 years. She received her master's degree and Ph.D. from Southern Illinois University and completed an internship and fellowship in psychiatry at the University of Wisconsin School of Medicine and Public Health. 00:01:00:20 - 00:01:03:04 Adam Hocking Dr. Michels, welcome to the rounds and thanks for joining us. 00:01:03:04 - 00:01:04:07 Dr. Jennifer Michels Thank you for having me. 00:01:04:12 - 00:01:25:20 Adam Hocking So we are going to talk about a topic today that I find really interesting and has been in vogue lately. If you read just about any media outlet, there's there's articles, there's meditation apps. I'm sure there's other podcasts about meditation and mindfulness. It seems like it's kind of everywhere right now. But I want to start by sort of defining terms. 00:01:26:16 - 00:01:31:12 Adam Hocking Can you talk to me about what it is to be mindful? What does mindfulness mean? 00:01:32:11 - 00:02:06:05 Dr. Jennifer Michels The definition that you most often see cited comes out from Jon KABAT-ZINN, and he's often cited as the father of mindfulness meditation based science in Western medicine. And this comes out of the University of Massachusetts, and he defined mindfulness as paying attention in a very specific way, in a particular way, purposefully in the present moment, and with a non-judgmental stance. 00:02:07:04 - 00:02:14:20 Dr. Jennifer Michels So again, I'll say it again is paying attention purposefully in a specific way to the present moment. 00:02:15:17 - 00:02:25:16 Adam Hocking And how do you differentiate that from that? Sounds like and I'm certainly no expert it sounds sort of like what meditation is or it sounds like a branch or maybe meditation is a branch of mindfulness. Is that right? 00:02:26:03 - 00:02:51:10 Dr. Jennifer Michels Yeah. I like to think about mindfulness as perhaps being a an umbrella term, kind of an overarching term that that can incorporate lots of different types of practices, meditation being one of them in meditation, often being identified as being someone a little bit more difficult to do than maybe other practices in mindfulness, particularly for beginners. 00:02:52:02 - 00:03:18:00 Adam Hocking And when you talk about meditation and mindfulness, there have been there's there's more and more research coming out about about the benefit. But we're seeing things like reductions in anxiety and depression levels, greater levels of self love, compassion, even higher levels of cognition and feeling better physically. I guess in your experience, are these things that you have witnessed and why do you think meditation and mindfulness are having this kind of effect? 00:03:18:02 - 00:03:42:13 Dr. Jennifer Michels Right. The research is really broad on the beneficial effects of mindfulness based practices and meditation based practice. So you're absolutely right in that regard. And we do see these these benefits. Now, I practice, of course, clinical psychology, and so I see the direct benefits that occur in the medical setting and with psychiatric populations or with populations that have various medical conditions. 00:03:43:00 - 00:04:20:04 Dr. Jennifer Michels And in in the setting that I'm in, we directly see benefits for anxiety reduction, depression reduction, and frankly, kind of globalized distress reduction, particularly with the suffering that can occur with a number of health conditions, whether it be chronic pain or cancer, other types of conditions like rheumatoid rheumatology conditions. And so what we see is patients being able to cope with the array of effects from those health conditions or to experience just a raw reduction of depression and anxiety from these types of practices. 00:04:21:10 - 00:04:46:08 Dr. Jennifer Michels And, you know, the research benefits, though, are far broader than that. You know, they're there. They've now documented evidence that patients, as they age, there's a natural atrophy in the brain. There's a reduction of gray matter. But for patients that are engaged in mindfulness based practices, there's a decrease in gray matter is is less than those that don't. 00:04:46:15 - 00:05:17:17 Dr. Jennifer Michels So it seems like there's some brain resilience that is occurring from the practice. With aging alone, we see boost to the immune system from mindfulness based practices. And that's an interesting area of research that they're looking at for all kinds of things, including cancer treatments. Just to understand can we better harness the immune system through various types of interventions to really get the best outcomes possible? 00:05:19:02 - 00:06:05:16 Dr. Jennifer Michels You know, outside of your health benefits, you also just see impacts to relationship functioning and in general, individual functioning organizations that have instituted mindfulness based practices in their companies are seeing improve employee relations, better regulated employees, employees with lower rates of distress and psychiatric conditions, improved team based interactions. So it seems to be one of those things that has really broad application to not only our health, our or our physical health, but also our psychological and relational well-being. 00:06:06:16 - 00:06:21:00 Adam Hocking And, you know, I mean, the research is everywhere that this works, that that the benefits that you're talking about are real. But I wonder, you know, the skeptic in me says, how, you know, I mean, just paying attention to the moment. How is this do we know the mechanism? 00:06:21:16 - 00:06:51:22 Dr. Jennifer Michels Well, there's been there's been a lot of research on this. Much of it's coming out of the University of Wisconsin. And one of the things that they have found about the effects of mindfulness is that it seems to reduce activity in what is called the limbic or the the limbic center of the brain in the core structure that much of the research focuses on is on the amygdala, which is sort of right in the core of the brain in the limbic region. 00:06:52:02 - 00:07:26:14 Dr. Jennifer Michels And this is sort of our stress and worry center. And so this idea, honing our attention to the present moment, to the breath or to a visual stimuli like the flicker of a of a candle or to the sounds in the environment, honing our attention seems to quiet that place in the brain. And what we see at the same time is an increase in activity in the cortical loop, and that's largely associated with the frontal, the prefrontal cortex, the frontal lobe of our brain. 00:07:26:14 - 00:07:52:18 Dr. Jennifer Michels And the area that they predominately study there is the left prefrontal cortex. And as people quiet their brain in this way and focus their attention, and the moment, as opposed to being sort of up in their heads, thinking and multitasking, there's greater left prefrontal cortex activity, and that is associated with positive emotions, positive affect, people reporting improved mood, reduced anxiety as well. 00:07:53:03 - 00:08:02:02 Dr. Jennifer Michels And so so those are the brain regions that seem to be most affected by this process of honing attention. Hmm. 00:08:02:10 - 00:08:06:00 Adam Hocking So can actually change your brain in a way exact. 00:08:06:05 - 00:08:29:13 Dr. Jennifer Michels You know, we used to think about neuroplasticity as, you know, this term that's been around as we talk about development in young children and really the explosion of neuroplasticity happens between that 0 to 5 age range. And that's always been the core area of study work. Children's brains are just changing at an enormous rate and neural connections are being formed. 00:08:30:00 - 00:08:58:19 Dr. Jennifer Michels But there's been a great deal of neuroscience research in the last ten or 15 years that suggests that neuroplasticity persists through over the lifespan, not at the rate that it does in younger children, but that we can really impact our our brain health through various types of cognitive practices and that we can impact how our brains tend to focus themselves through these types of activities. 00:08:58:19 - 00:09:06:04 Dr. Jennifer Michels And hence neuroplasticity is is something that we can capitalize on at other phases of life. 00:09:06:22 - 00:09:40:05 Adam Hocking I find it interesting that, you know, meditation as a practice has been around for thousands of years. In my limited knowledge, I would think it originated at sort of an Eastern philosophy and now it is sort of migrated as a Western practical application. Do you think that it has become so in vogue in the West? Maybe because of the time we find ourselves in with all the distractions that we have cell phones glued to our hands, all the information that we're inundated with does it almost underscore the importance of this practice or make it more important now than, let's say, 30, 40 years ago? 00:09:40:17 - 00:10:04:01 Dr. Jennifer Michels Right. You know, this really was introduced in the seventies, in Western in the western in western medicine. And I think the things that have led it to really take off is that patients who in medicine, it was introduced in patients who are suffering and really struggling with various types of conditions found benefit. And from there it has grown. 00:10:04:01 - 00:10:31:05 Dr. Jennifer Michels And there's been, you know, sort of this development over the last 30, 40 years in the area of medicine and science and I think in some regards that pathway has legitimized it a bit more than what you might see if it had come through a different kind of pathway into sort of western, western world. You're absolutely right that this is an ancient practice and people have found benefit in this forever. 00:10:31:13 - 00:11:00:04 Dr. Jennifer Michels But it really is something that I think has drawn more attention because people are looking for relief valves from this constant barrage of of information that's thrown at them all the time. We're certainly in a stage where there is sort of a hyper information sort of chamber that everybody is stuck in. Often due to our own behaviors, frankly, you know, with cell phone access and and whatnot. 00:11:00:04 - 00:11:28:15 Dr. Jennifer Michels And also culturally, there has been for many years a push that to be successful and to really be functioning well means that you're an excellent multitasker. And I think that what we're now seeing are the consequences of those types of pushes in our society and that people, frankly, are burned out and they're tired. You know, businesses are seeing this. 00:11:28:15 - 00:11:56:08 Dr. Jennifer Michels Certainly health care is seeing this among physicians and their staff providers across multiple types of industries. We've had to pay attention to the fact that we're sort of suffering workers are suffering, and people out there aren't doing well because of this push for more and more and more and more and more productivity and functioning in our brains. And, you know, now the research suggests that we're really not as good when we're multitasking. 00:11:56:08 - 00:12:21:03 Dr. Jennifer Michels We're better when we can hold attention and one thing or one thing at a time. And so I think it's it's kind of generated a a need a place for some other practices to help people get back to a way of honing their attention, more specifically in moving out of this multitasking arena. 00:12:21:04 - 00:12:41:09 Adam Hocking Mm hmm. There is a study that came out of Yale, I believe, and it was it was talking about how mindfulness and meditation kind of helped to slow down what they called our monkey brain. Right. That's the, you know, self-obsessed sort of when your mind is wandering thoughts that may creep into, you know, why did I say this or why did I do that? 00:12:41:09 - 00:12:59:13 Adam Hocking Or, you know, these real self obsessive and kind of not very productive thoughts. I guess I'm curious, in your opinion, why does our brain tend to cling to sort of sponge up the negative when we have this, you know, alternative and mindfulness of meditation? Why is the default of our brain to go into that monkey mode? 00:12:59:19 - 00:13:33:22 Dr. Jennifer Michels The cognitive scientists would say that, you know, that's been a survival mechanism for us over the course of time and that sort of hyper vigilance right to our environment, paying attention to all the stimuli around us has been adaptive for survival. The problem now is that it it it doesn't really fit anymore, that our temptation doesn't really fit to what the demands are that are, you know, that we're confronted with as as human beings at this point in the essentially overstimulation that occurs. 00:13:34:04 - 00:13:56:21 Dr. Jennifer Michels But the brain naturally is drawn to looking at unique novel experiences. It's drawn to that as a as a survival mechanism. So we're going to see the thing that sticks out or the dramatic thing that grabs our attention or the loud noise that happens over here. Our brains are going to be drawn to that versus a quieting kind of effect. 00:13:56:21 - 00:14:21:01 Dr. Jennifer Michels That's just, you know, I think what is what has facilitated maintenance of the species over the course of time. So it actually takes sort of a manual override to scale that back to to to deliberately move out of that that practice. I don't think it's all that much different than physically what we see for people with the inertia that can kind of happen with the body. 00:14:21:11 - 00:14:43:09 Dr. Jennifer Michels You know, if you talk with many people, they, you know, they feel a pull that it's, you know, often easier to sit or to stay idle or whatnot. And and it takes sort of a manual override of activity of forcing regular exercise to kind of keep that body in motion. We tend to degrade to certain, you know, status as certain status quo. 00:14:44:09 - 00:15:05:22 Dr. Jennifer Michels We see that with food choices, too, Right. Were drawn to certain things that are high fat or high, you know, and that takes this sort of deliberate activity to move away from those natural inclinations. So I don't think the mind is really any different than that way. Ways were drawn, hyper vigilance, you know, in that regard. 00:15:06:17 - 00:15:30:21 Adam Hocking And you had mentioned earlier that that some companies are starting to put in into play mindfulness meditation practices. I just read an article on LinkedIn that talked about Google and General Mills and Intel and Aetna and even Goldman Sachs, which I found kind of surprising, implementing meditation and or mindfulness practices. And they're noticing, as you said, increased productivity, lower stress, better teamwork. 00:15:31:06 - 00:15:41:15 Adam Hocking I guess how do we make the case I mean, that data is pretty compelling, but how do we make the case to more employers, businesses and people in general that this is something that can help? 00:15:43:01 - 00:16:05:11 Dr. Jennifer Michels Right. Well, I think, you know, the most powerful thing is the are the people who are the companies that are willing to take chances this way and experiment with it. And it's the raw data that comes out of that. You know, that becomes the most convincing argument. You know, it's these progressive companies that are willing to experiment that can then say these are the effects that we see. 00:16:06:10 - 00:16:25:06 Dr. Jennifer Michels I think the other thing that comes from grassroots efforts, frankly, you know, within the organization and right here at Marshfield Clinic, we've actually seen some unique initiatives that have that have played out that were in that way in certain areas of the organization where they've been groups of people that have come together and have started mindfulness based practices. 00:16:25:12 - 00:17:06:17 Dr. Jennifer Michels I don't know that those have a lot of publicity yet, But, you know, I think that that core level of employees saying this is what we need, you know, to have additional wellness in our workplace, you know, is the other is the other venue for that. Ultimately, these are business decisions. Right. And I think as businesses recognize that they have happier employees, that they have less attrition of employees out of their organization, which is costly, that their employees are functioning better, that their utilization of a health insurance for various conditions is reduced. 00:17:06:23 - 00:17:14:20 Dr. Jennifer Michels Those become the most compelling arguments to say this is part of a wellness program for for our organization that's important to us. 00:17:15:08 - 00:17:28:12 Adam Hocking So if someone's sitting here listening and saying, This all sounds great, but how do I how do I do it? How do I start to incorporate mindfulness meditation into my daily life? What is your advice for someone that wants to get started? 00:17:29:05 - 00:17:59:04 Dr. Jennifer Michels You know, I think the easiest way to do this is more through the mindfulness pathway. From my observations in maybe one of the most simple things to do is to simply try to take a few minutes to just be present in what you're doing in your actual environment. So a couple of easy ways to do this might be if you're washing dishes tonight, Steve, you could just pay attention to washing dishes. 00:17:59:12 - 00:18:22:12 Dr. Jennifer Michels And how warm does the water feel? Is there a sense of the dish soap that you can get a hint of from the distance that you're at from the water? What's the slick of the soap off the plate or the pan that your that your washing? Do you have a window that you're looking out and is there anything that you see, you know, out that window that captures your attention? 00:18:22:20 - 00:18:45:08 Dr. Jennifer Michels But it's that idea of what I almost call shifting tracks in the brain and coming out of the thinking brain where your brain is analyzing, running details and thinking to trying to hone your focus on what's right in front of your face. Another place that's a classic way to do this is in the shower in the morning and have mindful showering. 00:18:45:18 - 00:19:18:13 Dr. Jennifer Michels You know, could you notice the water off the shoulders? How warm is the water, the slick of the soap, you know, the smell of the shampoo? Is there a feeling of just having a nice warm shower in the morning that you can sense through your system? That would be another, you know, another pathway to do this, even through a relationship area, can sometimes be easy as well, particularly people who have may have children in their lives or, you know, a loved one that they're particularly enjoy time with is very nice with younger children. 00:19:19:10 - 00:19:45:01 Dr. Jennifer Michels And just the idea of sitting down with them and just playing in and trying to really hone your attention on what are they doing, how are their hands moving, how do they laugh, What toy are they drawn to? How do they like to sort of interface with you and come in and just noticing the nuances of what's right in front of your face, sitting out in a back patio or a deck and just trying to pay attention to the sounds of nature. 00:19:45:01 - 00:20:09:08 Dr. Jennifer Michels Do you hear birds around? Are there any other rustling of the leaves, you know, that are that you can hear around you? Is there a traffic sound of a road that's in the in the distance? Just that ability to bring the attention into the present moment is often one of the easiest ways to start. Probably the most classic thing that people do is their attention to their breath. 00:20:09:17 - 00:20:43:16 Dr. Jennifer Michels So they may just do a sitting mindfulness activity or sitting sitting meditation where they try to pull off two, 3 minutes, 5 minutes, you know, where they sit and just pay attention to the sensation of the breath coming in and out of the lungs. And sometimes that can be enhanced by thinking about breathing into the mouth or breathing in through the nose and out through the mouth to kind of hone concentration a little better on and a kind of a structure for that activity. 00:20:45:02 - 00:21:02:09 Dr. Jennifer Michels Some people will add counting to it, and as they breathe in, it will be a count of one. And as they breathe out, they'll say in their head, not out loud, too. And as they breathe in, it would be three. And as they breathe out, it would be for up to like a count of ten or so. And then they may start again at one. 00:21:02:16 - 00:21:38:03 Dr. Jennifer Michels The trick with all of these things, that becomes the risk factor, I guess, for people getting frustrated and giving up is that people have an expectation that if they can't hold their focus, bear that they failed at the task when really the core of the activity is that exact process of having your focus slip away and building the muscle of having to bring the focus back to whatever you were on over and over again. 00:21:38:10 - 00:22:10:14 Dr. Jennifer Michels That is the core of this. But people often mistake it and feel that if that's happening to them that they have they're failing at the task or it just isn't working, or is it useful? It's that bringing yourself back over and over again when your attention slips away. And it absolutely will. That is the muscle building activity and the thing that does improve with with practice that that people get better at holding their attention for longer periods of time. 00:22:11:07 - 00:22:32:04 Dr. Jennifer Michels When I fall off of a meditation practice, which happens often in my life and I come back to a mindfulness practice, you know, I find myself maybe being able to hold it my focal point, if that's the breath or if that's just nature sounds or whatnot. Sometimes for 5 to 10 seconds before my head is darting off to some other arena. 00:22:32:04 - 00:23:11:13 Dr. Jennifer Michels Oh, I should get more tomorrow, you know, because I think we're almost out or that there's a lot of laundry or I need to call that person or whatever it is, you know, of a thousand things that could go through one's mind. So that idea of losing the focus very, very quickly is a universal phenomenon. It's the idea of being used that drain in the mind and to bring the mind back to the breath or to the focal point, say, nope, that's come back in a gentle way, inviting it back and trying to start again and and as Dan Harris, who is a ABC News correspondent and has written a number of books on this, 00:23:11:13 - 00:23:37:12 Dr. Jennifer Michels you know would say it's that a process of starting over again starting over, starting over. That is the muscle building. If you thought of this in a physical metaphor, you know, if you were thinking about running a longer race and you hadn't run in a long time and you took off running, and if you couldn't run the full ten miles the first time, you wouldn't necessarily just say, Well, I've failed. 00:23:37:12 - 00:23:57:17 Dr. Jennifer Michels Clearly I can't do it. You know, there's nothing that works about this and I'm done. You would more so recognize. Well, no, I got to kind of build up my longer opacity in my physical capacity to be able to get a quarter mile or get a half mile and then go longer and longer. Right. If you're lifting weights and you have a goal of strengthening your muscles, you don't necessarily see it as failure. 00:23:57:20 - 00:24:22:10 Dr. Jennifer Michels When your muscle gets fatigued at the, you know, 10th rep that you're doing right of the of the bicep curl or whatnot, you would see that as no, the muscle is fatigued and it's breaking down. And that is actually the process of building the muscle. Right. It's breaking it down and that it's coming back to it over and over again and having that muscle build and continuing to work through it. 00:24:22:17 - 00:24:42:10 Dr. Jennifer Michels That gets you to your goal. Same thing with mindfulness practice. It's the process of falling off focus and bringing it back. That is the core skill to learn and and that will improve with fewer and fewer times of falling off of the focal point as you progress. 00:24:42:22 - 00:24:59:13 Adam Hocking I'm glad you said that because I've experimented with meditation and meditation apps and whenever I'm doing it, I'm sitting there thinking, Am I doing it right? Am I supposed to be doing this? I got distracted. Is that wrong? So it's really about building that muscle up rather than being perfect right away. 00:24:59:14 - 00:25:29:11 Dr. Jennifer Michels Exactly. Exactly. You know, in some people, you know, in addition to just trying to be present with what you're doing in this in this moment, some people will find that apps where there's a guide provide or a certain line of music or there's maybe counting going on. There's a variety of apps for smartphones and iPads and whatnot that people can turn to to engage this activity maybe from an easier starting point. 00:25:29:16 - 00:25:54:18 Dr. Jennifer Michels One of the things that I've sometimes encouraged people to do is just walking out of their work setting at the end of the day and, you know, as they maybe leave the exit door and they've got a bit of a walk to their car. Using that as an opportunity to hone attention and just notice, you know, is it how dark is it out or how light is it if it's, you know, lighter as opposed to the depths of the winter, you know, what's the cloud pattern? 00:25:54:18 - 00:26:18:12 Dr. Jennifer Michels Is there a bit of a wind? How warm does the temperature feel? How much activity is going on around me as other people are exiting for their workday? And just that ability to sort of transition into being in the moment as opposed to often being up in their head and still carrying through with the jet trail of work Related thoughts is a natural break point and can have a relaxing effect. 00:26:18:18 - 00:26:54:06 Dr. Jennifer Michels There's something about that act of church shifting tracks in the brain out of this kind of thinking, brain analytical brain to observing, noticing of being aware and focused on one thing in the moment that tends to have that stress relieving effect. So there are just a variety of ways to do this, that whether it's the breath or whether it's paying attention as you're walking from one place to another or the shower example that I gave that are entry points into trying to hone attention in this way. 00:26:54:15 - 00:27:17:03 Adam Hocking So we talk about meditation and mindfulness, and it has all these wonderful applications for pretty much anyone. We all think we all have stress. We all probably could use these these tools. I guess I'm just curious, in your practice, is there any condition, depression, anxiety, whatever that meditation and mindfulness are most helpful with or you see the best results? 00:27:17:06 - 00:27:17:14 Adam Hocking Well. 00:27:18:12 - 00:27:48:03 Dr. Jennifer Michels I think the the the area that it's most useful for is for anxiety based conditions, although we see lots of benefit for depression as well. There's some research that's come out in the last 5 to 10 years looking at people with recurrent episodes of depression and that mindfulness based stress reduction interventions were very helpful in getting patients back into a state of remission above and beyond treatment as usual. 00:27:48:03 - 00:28:15:16 Dr. Jennifer Michels So again, there's broad applications, but particularly for anxiety. That is the key place because our brains are particularly active with anxiety and jumping around into different arenas with a variety of anxiety disorders, we see a strong rumination effect where people are really stewing or they're they're caught in worry, they're caught in in in sort of an obsessiveness about various stressors of their lives. 00:28:16:01 - 00:28:46:16 Dr. Jennifer Michels And this is one of those essentially cognitive practices that can be a significant relief valve to stepping away from that arena of the mind, just being caught in its own loop of rumination. So, you know, in my practice in clinical psych as well as as well as health psychology with cancer patients, you can imagine in in cancer that there's significant distress, particularly early on with a diagnosis. 00:28:46:16 - 00:29:20:01 Dr. Jennifer Michels And the brain just wants to run into all types of territories that are scary to think about as someone is facing uncertainty with the condition and waiting for a treatment plan to be constructed by their medical team. These are key times where mindfulness based practices are something that we help patients with and help a skill set that will help them grow so that they can have some way of trying to get out of that other zone and come into another place in their mind for little moments of reprieve, little moments of break. 00:29:20:01 - 00:29:40:17 Dr. Jennifer Michels And it's not something that, you know, you do this and then you're you're protected endlessly from rumination. It's something that you have to do routinely because the rumination, you know, that stewing is going to keep trying to bombard your brain. But it is one pathway that has really had substantial benefit for providing relief for patients. 00:29:41:10 - 00:29:47:08 Adam Hocking I feel more relaxed already. Dr. Jennifer Michels, thank you so much for joining us today on the rounds. We really appreciate your time. 00:29:47:09 - 00:29:50:02 Dr. Jennifer Michels Thanks for having me. 00:29:56:00 - 00:30:21:03 Adam Hocking The round is produced by Ryan Maderic and supported by the Marketing and Communications Department of Marshfield Clinic Health System. You can subscribe to the rounds and download episodes via iTunes or by visiting shine365.marshfieldclinic.org. I'm Adam Hocking and I hope you'll join us next time on The Rounds.