29th March, 2022

What I Got So Wrong About Mindfulness and How it Might Transform Your Life

With Rachel Morris

Dr Rachel Morris

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On this episode

This week, Steve Pratt joins us to discover the benefits of mindfulness. We talk about how mindfulness is used to be able to live happier and less anxious. We also teach you how you can develop mindfulness practices and incorporate them into your life.

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Episode transcript

Dr Steve Pratt: Six weeks in, my brain just changed. I realised that I would have periods of feeling low for no obvious reason. It would often be my day off — but that went and hasn’t come back. I’d be moving between practice, going to run a course, and I’d worry about the third patient from the end in the last clinic, and whether I’ve messed that up. I’d wake up at three in the morning worrying about that — and that stopped.

It’s almost like a superpower — it just gives you a bit more time. My busy life, which I was enjoying, but I felt frazzled on the edges, suddenly became fine — every bit is fine. I’m passionate about evidence-based medicine. I think we should do things where we know they work and we have good evidence. Mindfulness has a secure evidence base on reducing stress and all.

Dr Rachel Morris: Are you sick of hearing about mindfulness? Does the answer to all of your questions about, ‘How can I feel calmer and reduce my stress?’ seem to come back as, ‘Do some mindfulness?’ And do you feel frustrated as it feels like there’s not enough time in the day to go to the loo — let alone spend 20 minutes on meditating? Are you a little cynical and unclear about why and how it will help in the first place?

In this episode, Dr Steve Pratt, GP, appraiser, and mentor, joins me to debunk some of the myths about mindfulness, and answer the question, ‘Is it really worth the time and effort? And will it help me?’ We talk about why so many of us have tried it and haven’t found it particularly life-changing, and how to actually make it work for you. Steve did a mindfulness-based stress reduction course a few years ago. And after six weeks, something changed. He felt so much better in every area of his life. Now, he’s becoming an accredited mindfulness trainer.

Let’s be honest, I really struggled with this episode, not because Steve isn’t a fantastic guest — he completely is, but I struggled with mindfulness. It’s one of those things I feel a bit guilty about if I’m honest. It’s a bit like flossing your teeth; you know you should do it, but somehow you can’t get into the habit. Even when I know I feel much better, even after just doing a five minute meditation app.

As Steve says, the evidence for its benefits in terms of beating stress and anxiety is so overwhelming that it’s mentioned in countless NICE guidelines. I’m also worried about putting off listeners who might not want to hit even more about mindfulness, probably for the same reasons as me. But as we discuss, life transformation is about more than quick fixes — it has to be.

Reflecting on this, I think the reason I feel so ambivalent about mindfulness is I know it will take some time investment and some effort to put aside the time to really develop this skill. And it is a skill. Just like any other, it takes practice. When we write off mindfulness after doing a couple of five-minute meditations, it’s a bit like spending just five minutes in a swimming pool and saying that we’ll never learn to swim and that it had no benefits at all.

Please listen to this episode with an open mind, and then seriously think about exploring some more of the resources we mentioned in the episode. I know I’m going to. At the end of the episode, Steve takes us through a three-minute breathing space meditation so you can try it yourself. Listen to this episode to learn why after six weeks, your brain will just change in very unexpected ways, how mindfulness can make you happier and less anxious, and what you need to do to get there.

Welcome to you are not a frog, podcasts for doctors and busy professionals in healthcare and other high-stress jobs if you want to beat burnout and work happier. I’m Dr Rachel Morris, a former GP, now working as a coach, speaker and specialist in resilience at work. Like frogs in a pan of slowly boiling water, many of us have found that exhaustion and stress are slowly becoming the norm. Because you are not a frog, you don’t have to choose between burning out or getting out. In this podcast. I’ll be talking to friends, colleagues and experts all who have an interesting take on this, and inviting you to make a deliberate choice about how you will live and work.

This is going to be the last episode before Easter, and I’m going to take a dose of my own medicine and have a complete break for a couple of weeks. I’m so grateful to all of you for listening, for recommending the podcast to your friends and colleagues, and for all your wonderful emails, comments, and feedback. Just a reminder that we do produce a workbook for each episode which you can use to reflect on what you’ve heard and submit it as evidence of CPD for your appraisal.

This episode really got me thinking about how we can help our community of listeners. If you’re interested in the You Are Not A Frog online mindfulness-based stress reduction course, then drop me a line. If there’s enough of you, we’ll make it happen. Those of you who are interested in a retreat, then watch this space. We’re trying to sort it out as we speak. Over the next few weeks, why don’t you catch up on some of our earlier episodes, and we’ll be back in two weeks time with some brand new episodes and content that will help you beat burnout and work happier.

It’s fantastic to have with me today on the podcast, Dr Steve Pratt. Steve has been a GP for 35 years — both as a managing partner. Now, he’s working as a mentor for GPs on the fellowship scheme. You’ve also spent 25 years teaching evidence-based medicine to the VCS in Berkshire and the military, and Steve is very well-known throughout the country, I think, for being one of the Red Whale GP update presenters, which you did for several years — and you’ve only just stopped doing that.

I was leading my STRIVE course, and that’s where Steve and I met. I’m going to spring a question on you here because, obviously, this podcast is all about beating stress and burnout. But what was the most stressful thing that ever happened to you as a Red Whale presenter?

Steve: There’s actually quite a long list. I’m not going to miss being in a hall in Edinburgh — 350 people sat down, the murmurs still going on, and we’re still waiting for the cable to attach the audio so they can hear what I’m saying. 30 seconds to going live is the closest we’ve ever got. I’m not going to miss them.

Rachel: For 30 seconds. It’s so funny, isn’t it? Because when you’re presenting courses and stuff, you really worry about what you’re going to say, and what if you forget this award, what if you get it wrong — but that’s never what happens, is it? It’s always something like the tech, or there’s no coffee, or the projectors not working, or the trains are late, or something like that. It’s never the stuff that you worry about — it’s going to happen, happens. It’s always the stuff you haven’t thought of.

Steve: In fact, on one side, I developed my mindfulness practice. I would do the initial setup, you would hit the inevitable glitch, and I would disappear to the loose to do the three-part breathing space that we’re going to talk about as we go through this chat. Actually, eight or nine times out of ten just absenting yourself, reappearing, someone would have sorted it out. It didn’t just stop me from having to engage in the stress and anxiety. If I hadn’t been sorted, I was in a more resourced place to deal with it when I got that.

Rachel: I thought that’s a very good technique for dealing with children and teenagers actually — just leave the room for several minutes or several hours. By the time you get back there, they’re already sorting stuff out. Did your presenting colleagues say, ‘Oh, gosh! It’s a bad day, isn’t it? Because they spent three lots of three-minute mindfulness breathing spaces already today.’

We have got Steve onto the podcast to talk about mindfulness and I thought Steve would be a really fantastic person to talk about this. Steve, you just got so much experience across the board, you know exactly what it’s like to work in a really busy, busy environment with things coming at you. If I’m honest, I really like mindfulness, and I really wish I was better at it. In fact, one of my goals this year is to do some sort of mindfulness course, like mindfulness-based stress reduction, or something like that.

It can be a bit tricky, particularly working and doing the training that I do with people around resilience, productivity, and stuff. When you ask, ‘What must I do to be less stressed, to be less burnt out?’, the answer always seems to be, ‘mindfulness’, ‘mindfulness’, ‘mindfulness’. For people that aren’t used to doing mindfulness, or don’t know how to do it, or maybe have done it and tried it — and didn’t really get on with it or don’t quite know how to do it, that can get a bit irritating.

Now, I know that you come to it fairly late on in your career, and you said suddenly for you something clicked. Just tell me a little bit about how you got into it and what happened for you.

Steve: I agree with that needing that resilience. We would all agree — it’s not just putting a really hard tin hat on and just going into whatever you’re experiencing, and you’ve got this extra layer. Mindfulness is often part of resilience courses. I think some people link this, ‘You’re not changing anything in my environment, which is generating a lot of how I’m feeling. You just want me to feel better about the awfulness.’

Actually, I hope this conversation is going to antidote that because when you have a mindfulness practise, and you’ve moved to the deeper layers of what mindfulness offers, it actually allows you to access much more readily in the resourceful space. Particularly, when we’re under pressure, we will react, and we will tend to do what we’ve always done, and because we do that, we get what we can get.

If you can get into a more resourceful space, you can try things in a different way, have different conversations, plan things in a different way. I think mindfulness does open up a lot of possibilities; it’s not simply putting a thicker tin hat on. I knew very little about mindfulness, I must admit. We had a brilliant Associate Dean called Drew Chin in Hampshire, and she was putting on resilience courses. She invited a local mindfulness trainer to come and do a half-day session. Out of that, Drew funded classic eight-week MBSR, Mindfulness-Based Stress Reduction courses, for GPs.

I got an email, and I thought, ‘Yeah, I’ve got some CPD to do. That sounds interesting. I’ll sign up.’ I didn’t go by, ‘I’m in a terrible, terrible place, and I need a resource.’ I was okay. I was always balancing a portfolio. But I thought it was okay, I thought I was ticking the box. I went on the session — it’s two hours weekly for eight weeks. That’s the classic session. Of course, I went and invited many. You have a day of silent retreat — it’s part of that.

We all sat around — 12 GPs, eight women and four men, and Ali said, ‘Why are you here?’ We literally said, ‘Well, it was a possibility. I wanted to do some CPD. I want to help my patients. I need to understand this new technique.’ Four or five weeks in when we got to know each other well, we all shared — we struggled in a large number of areas. Some people were just barely clinging on. I went through the programme, and each individual session was interesting. You have the support of your colleagues, but I wasn’t noticing anything huge.

But then at week six, and this is a lot of research in any psychological technique and habit-breaking techniques, CBT — any of these things that are designed to help your brain rewire. If it works for you, it usually works about 40 days in, six weeks in. My brain just changed. I realised that I would have periods of feeling low for no obvious reason. It would often be my day off — the one day I was looking forward to do the things I would just feel inexplicably low. That vanished — that went and hasn’t come back.

I’d be moving between practice, going to run a course or going to meet a colleague in an appraisal — and I’d worry about the third patient from the end in the last clinic, and whether I’ve messed that up. I’d wake up at three in the morning worrying about that. I would think about the appraisal when I was preparing the teaching — and that stopped. I just was able to be, ‘You’re in the room full of patients’, ‘I’m doing the best for you.’ We finished the conversation — cheerio. That’s gone.

I’ve done what I can, and I sometimes used to be a duty doctor — would finish the day, jump in a car, drive a couple of hours into a District General Hospital to work with specialists, trainees in general practice. I could love being with those 40 odd people in Milton Keynes, get back in the car, forget what had been quite a good day, not worry about the tricky question I maybe stumbled over, and then think about the appraisal I had before.

I saw it had immense practical value for me. I listened to your last podcast with Graham, and he teaches mindfulness. He said, ‘A lot of people don’t develop a mindfulness practice’, and that’s probably true in my group. But if you can develop from mindfulness practice, one of the things to do there is to fit it into things that you’re doing anyway. So I do a mindful movement every time I exercise. You can find ways of including a mindful practice in your life. I do that because I got these big benefits and I didn’t want to lose them.

Now, there are certain skills that you acquire as you deepen your mindfulness that give you practise, that do specific things. If you are struggling with relationships, if you’re struggling with pain, if you’re struggling in other areas, you can use these techniques. You can’t use them unless you’ve developed the skill of attention. A lot of people feel that — because that’s often what they’ve been exposed to is a taste of it.

Mindfulness is a process where you notice something — you’re calm into your breath, notice a flower. If you do more of that, you’ve got mindfulness. Actually, that’s just the warmup. The muscle of attention — we go to the gym to get fit for our bodies, and we build up the muscles. Mindfulness is building up the muscle of attention because we’re going to the gym for our mind because we want our mind to be strong.

Once you can direct your mind, once you realise that your mind is full of chatter — and when you focus on something, that chatter is very loud. But once you can recognise that chatter is there and bring your focus of attention — once you have that skill, you can use that in a quite sophisticated and very helpful way. That’s where the resourcefulness comes, that’s where the dealing with difficult conversations and relationships comes as you deepen it by going through the full course.

Rachel: There’s so much in that I want to ask you about. Can I just ask you, firstly, about this attention because I think there is a bit of probably a misconception from what you’ve said that ‘mindfulness is about completely emptying your mind and not having the thoughts’ because you pin them to a cloud, and send them off on a car — or whatever you do with the thoughts and you just sit there with a completely empty mind. But that’s not true.

Steve: No. That’s almost mindfulness 101 first session. But when it’s the sky, and thoughts, and feelings, and emotion of a client, and actually, when you choose to focus your attention, whether it be on your body, your breath, sound — later on, as you get more skilled on a thought, our minds just constantly chatter. But a lot of people are just not aware of that.

What you do is you become aware of the chatter, ‘Oh, I’ve got that tricky meeting tomorrow’, ‘Oh, I am supposed to be doing the breathing practise’, ‘We’re focusing the breath’, ‘I’ve got that tricky meet’. What you can do is just go, ‘That’s a tricky meet. I am going to a cloud that you pushed to the side, and you come back.’ But you may go back to it. That’s, as we say on the training, that’s not a mistake — not done anything wrong.

In fact, it’s the noticing that’s the work. All you have to do is bring your attention back. Nothing bad has happened — you haven’t done anything wrong. I’ve had people who’ve gone away on retreats to try and meditate, and the scrambled brain and all the worries and concerns just go away as they get quiet — and that’s the muscle. It’s noticing that this is happening but choosing to remain direct, and that’s what changes the shape of the brain or an MRI.

That’s what changes the way your brain works on a functional MRI. We have great neuroscience to back up what we’re doing. So yes — it is not learning the skill of clearing your mind, it is choosing to focus your attention. When your mind is distracted from that, log it — and that’s the scale in your practice, roughly for the first half of the MBSR.

Rachel: What are you choosing to focus your attention on if you’re being distracted? Being distracted from what?

Steve: What you choose to focus your attention on is up to you, as my wife, Jeanette, and I have taught for my mindfulness courses for MBSR courses in a sort of faith-based context. If early on, you’ll do a mindfulness practice called a ‘body scan’, you often do that lying down and do it in other positions. Often, people are so exhausted and busy at work — they go to sleep when they’re trying to probably scan. But you are focusing on sensations that are arising from your body.

What you’re practising there is noticing what’s going on for you physically. There’s this really interesting set of work that in the West, our minds and bodies have become dissociated. It’s not only in our Greek logical heritage about what we value, but our heads are kind of physically separate. As many as 80% of folk in the West cannot access what’s going on in their bodies. Whereas in the east, there’s much more connection between brain and body.

One of the skills you practise later on is to think about or get into mildly difficult situations, and then become aware of what’s going on in your body. Because our minds are so dissociated with so much in our head, you’ve got to train yourself to recognise what’s going on in your body. Then, instead of waiting until your shoulders are up around your ears, you’ve got a pain over your left scapular, you feel gastritis, and you just feel lousy. There was a sensation about two hours ago that would have told you that this is not good. and then you can go, ‘Okay, what do I need to do?’

Take a breath, think about things that I might change, as opposed to just going on. The point, in terms of the whole course, is to give you the skill of being able to monitor what’s been going on in your body, giving you an early warning when you’re using this in day-to-day life. But it’s also practising the skill of attention. There are several things that struck me after I finished my training, personally and professionally. Perhaps I’ll give you an example of both that.

I’m a keen walker. When I was in the Welsh mountains with my daughter, we were doing a long day 20 miles plus a day with a group — so it’s early in the year, a stand of silver birches. I just always feel compelled to talk to people. I would have gone over naturally either to check — my daughter, Laura, was okay, or someone I’ve been speaking to on the walk.

I felt really comfortable, just detaching myself from the group and I looked at the stand of silver birches — I can see the map, and I just focus all of my attention on early spring and the birch trees blowing around in the wind. I just felt incredibly graceful, incredibly pleasant, incredibly grateful for the time that we had just had. I knew my default in that situation was to be social, ignore the trees, and then I’d make a klutzy conversation with someone and slightly regret it. That was me, and I was able to go, ‘I don’t need to do that.’

Then, I was doing a locum for a friend. I’ve changed the practice — I was working as a salaried GP, and I worked there for six weeks and they’re lovely people, but the pressure is like everybody else. The practice manager came up to me early afternoon said, ‘The locum, who’s doing duty this afternoon, can’t be here. You’re going to be the only doctor, is that okay?’ I know what the previous me would have done — my gut would have clenched up, my heart would have pounded out, I’ll be gone sweating, I’d have been in a definite red mode in Graham’s way.

I’d have probably said ‘yes’, and I’d have hated all afternoon. What I did was, I said, ‘Okay, thank you for coming along and having that conversation — I realised that’s difficult for everybody. Can I just take a beat?’ She said, ‘Yeah, that’s fine.’ I said, ‘I’ll come and find you.’ I went into the loo, and I did a three-part breathing space we’ll come to, and I came out and I thought, ‘Okay, yeah! We can do this. We might need to change one or two things, but I think we can do.’

I went down to her office, and actually, she came out of the office and met me halfway down the corridor. She said, ‘That was a crummy thing to ask, and I’ve actually just got on the phone to someone we use, and they can come a bit later on this afternoon. If you don’t mind doing the duty bit, they’ll do the routine bit.’ I went, ‘If she hadn’t come, I’d have tried to help — but I’d have had one or two suggestions. But that really works for me.’

I just thought, ‘Who’s the person who’s just done that?’ That’s not how I behave, but that was literally about a couple of months the course. What I love about it is it’s almost like a superpower; it just gives you a bit more time. My busy life, which I was enjoying, but I felt frazzled on the edges — suddenly became fine every bit is fine. Now, I became energised by a bit. Whereas perhaps without mindfulness — I’ve got more involved with Red Whale — it would have been less fine because I’d have felt cold, and I was able to compartmentalise in a way I couldn’t before.

Rachel: It’s so amazing how much difference that’s made to your life. I guess what I’ve never thought of it before is that muscle analogy. That’s — you go to the gym to build muscle so you can lift that, or you can be fit, or whatever. The brain is — it’s like a muscle, you have to train certain bits, and it’s about actually really training, developing that muscle so that you can actually behave differently.

It’s not about just feeling calmer — although that is a good piece of it, but actually, that mindfulness muscle that you train, that attention muscle meant that you could actually change your behaviour in the moment to respond differently. It’s not just about — the idea of mindfulness, I will feel better, although you probably will. But actually, my behaviour will then change as a result of this, which means I will feel better as well.

Steve: It gives you skills, both for in the moment because you get better and quicker information from your body that gets you thinking makes you aware. The trick is to become aware because then you can get into a resourceful space. I’ve worked with mentees, and who’ve needed both as a tool or resource.

It’s interesting — I’m thinking of one particular individual who had the classic exposure to a taster, and actually found mindfulness quite useful and would use it as a kind of relaxation at the end of a busy day but didn’t realise that with a bit of a deeper practice, they would have a skill that they could use in the moment, and they were struggling with a particular issue.

Then, we said on the training, ‘Mindfulness is like having a parachute when you jump out of a plane. Actually, if you’ve stitched your parachute together before you jump out, it’s a lot less stressful than trying to do that on the way down.’ And I think a lot of people try and stitch their parachute on the way down, ‘Here’s my tool’, ‘What’s my tool?’, ‘Let’s use my tools’, as opposed to, ‘I have a skill. I have a really well-prepared parachute.’

‘I’m out of the plane that someone pushed me out. I’m just deploying my parachute landing skill.’ There’s a meditation within mindfulness called ‘the dealing with difficulty’ meditation. When you practice it on the course, you do it with a cue and the signal — something not too demanding. Just a sidebar, the number of people who — the most stressful thing they could come up with that they were happy to deal with on the course was queuing in a supermarket.

Rachel: Why is that the most stressful thing you’ve come up with today? If you’re a GP, that would be great. I long for the days when I just had to deal with queues at the supermarket.

Steve: In terms of the practice, you can take a more difficult thing when you feel an okay place — go into a deep meditation, become aware of what your body’s doing in response. Almost, as you take the thoughts, look at the situation, become aware of what’s going on in your body. It allows you sometimes to see that in a very, very different way. You understand which bits of it are most difficult for you, and it can be a very helpful way to deal with things.

I go through moments where I need to do a meditation. I feel I’m slipping away from my body, I know I need to do a body scan. If I feel there’s a relationship that I struggle with, I do a kindness meditation. Kindness meditation is when you wish health, safety, and ease of being to yourself, someone you love, someone you don’t really know — the person who serves you a coffee in the local coffee shop, and someone you find really difficult.

Actually, the next time you meet that person who you find really difficult, it changes things dramatically. This happened this weekend — we went to see the movies. It’s only the second or third time we’ve been since that’s possible. Sitting next to three teenage boys — my wife was the other side of me — 12 to 13, on their phones, eating crunchy snacks. Just about tolerable for halfway through the film, I turned around and did the dad thing and said, ‘Keep it down, lads.’

I actually just spent a couple of minutes wishing them health, happiness, and ease of being, and I completely lost my agitation with them. I even said, ‘Cheerio!’, when we left the cinema at the end because I wasn’t going to get them to leave or shut up, but it made it easier to do. I, sometimes, almost run to the space where I meditate. I need to do the kindness meditation as I kind of need within me to get into that space.

Rachel: This is really, really helpful, Steve. It’s about absolutely being aware of what’s going on in your body so you can detect stuff as it’s happening or before it happens. If you’ve practised the mindfulness stuff, you’ve sown your parachute together already before stuff happens. Can I ask you a ‘so-what’ question? My courses always get people to write a ‘so-what’ and a ‘yes-but’ post-it so they can come at me with challenges.

I think some people might be thinking, ‘Yeah, that’s all very well, Steve.’ But when you were doing that locum, the practice manager said, ‘You’re on call’, and you recognised your shoulders gone up, and you went, and you took a minute — that’s great. You gave yourself some time. Then, you came back to — and luckily she sorted the situation, that’s actually great.

What if you go off, you do your meditation, and you’re feeling a bit better, but the situation is still flipping awful — and you’re still going to do that dreadful thing. How does it, then, help you then?

Steve: Perhaps I’ll give you another example. This is relatively recent — we’ve been moving dictation systems in practice. There were some glitches with the old one before we finally shut it down, and got the new one. There was a kind of — our dictations lost or not. I came into the practice early, and I was met with a suggestion that maybe up to 20 or 30 patients had been chewed up by the system. I had a busy day, and I don’t normally get concerned about patients, but I had a particularly difficult conversation off the bat.

There’s some relational stuff going on in practice, and I was caught in a corridor about that. I was going, ‘Got this tricky person, and I’ve got to be in the right place to meet them, and I’m having this conversation with you, and I want to be supportive. But actually, the last thing I need to do is be with you because I possibly have to do 20 or 30 dictations, and seven or eight of those need to be done by lunchtime because they’re all urgent.’

I just went into — it’s perfectly possible to go, ‘Oh, I don’t want to do that right now.’ So be rude to the person I’m talking to who needs me and to go and shout to them separately — all things I might have done. I just invested in the conversation — we completed, I went to the loo, did a three-part breathing space, came out, came up with a plan that probably our League Secretary would just review a number of the notes to see whether — the most important ones to see how many of those might be missing. I asked her to do that project, and then I went into my room, I gave myself five minutes of breathing practice.

Before I turned, a tricky patient comes in. Like these things, it was actually a blast and really easy. And the rest of the day flowed, I just was in a really positive state. We’d lost two or three, but not 30 patients. What it does is it’s that turning what can be — you start dismissing people, shouting at people going into consultations. You can slow yourself down — it’s almost like this magic trick as a matrix thing where you just have more time.

That’s not finding a trick and leaving yourself in acceptable difficulty. You can have the best colleague, the best practice in the world, and you’ll have really tricky days because we get sick, sad, and in pain. People walk through our doors and get enough of those in a row — it feels hugely challenging. This is about how to deal with that in the most expert way that you can. So you’re the best bit of you from most of the time.

I get bad days — I still get days when I’m just keeping people alive that I’m prescribing at a great rate to shut things down so I can move on to the next important thing. But I get more days when I go, ‘You know what? I’m choosing to spend 20 minutes here. I’m going to do some motivational interviewing, and I’m going to see if we can crack this because I feel resourced to do that and I feel I want to give that a go.’ That’s what it gives me. That’s why I’m passionate about it.

Rachel: That makes a lot of sense. Obviously, mindfulness does not change your situation. But what it does is it slows you down gets you out of your stress zone gets you into that more resourceful state. And I’ve been quoting this equation quite a lot recently that stress equals resources minus demands. So if you feel we’ve got this much resources, but this much demands then you’re going to be really, really stressed. But actually, if you’re then more resourceful than the demands, even though they might be the same, suddenly you don’t feel so much. Does that make sense?

Steve: And I certainly do not claim to be an expert on this. I’m doing a lot more reading at the moment, because I’m in the middle of a qualification. So I’m going back to the basic science. But yeah, I have taught evidence based medicine consistently since 1993 when I finished my master’s in public health, I’m passionate about evidence based medicine; I think we should do things where we know they work and we have good evidence, we should, we should do those things.

Mindfulness has a secure evidence base on reducing stress, end of. If you’re stressed, you do a mindfulness course, it won’t make it worse, it’s very unlikely to be neutral. And when we work with our patients, it’s in NICE guidelines, the pages for recurrent depression, it’s as good as drugs. There’s very few conditions where it doesn’t help. The evidence base is stronger in some areas. So we know from MRI studies, you go through an eight week MBSR course, your amygdala and hippocampus change shape. When you do a functional MRI, the bits of your brain that are resourceful, and calm, and generating new ideas will light up the way they didn’t before.

So it’s not woowoo or, you know, this is basically Buddhism canned for a Western audience. There’s a lot to learn from Buddhism. But that’s not what it is. It is a carefully worked out psychological technique to give people the benefits that they need. If you ever get time, Jon Kabat Zinn really developed the MBSR course or mindfulness as we know it in the West. He was a physician in Massachusetts, in the 1970s. And he recognised like, nearly every GP on the planet recognises a lot of people you can’t pigeonhole. And there were lots of people with pain or symptoms from their guts. The gastroenterologist had checked everything and everything was fine. And the chest doctor had said this chest pain just doesn’t seem to have a physical cause. And he developed MBSR. He set it up as a PBS documentary made back in the 1970s of Jon Kabat Zinn’s first course.

If you’re interested in human beings who are in pain and struggling and how you might help, that is a wonderful power. Just Jon Kabat Zinn working with a group of people who come to realise they can handle their pain in a completely different way. It’s just a lovely piece of television art. But that’s why it was developed; that’s its core. Jon Kabat Zinn had a real deep understanding of Buddhist dharma. As I’ve just been explaining, with the evidence, there is strong, secure modern neuroscience evidence that backs up the formulation that we now have. In people who are struggling with depression, you could choose to do a mindfulness based CBT course. And I suppose that’s almost part two for me that, here it is beneficial for me. I keep it up. I attach practices to things I do in my everyday life. When I’m driving, when I’m cleaning my teeth, when I’m exercising, I feel this need to things. I had that practice.

In setting up for this podcast, I was talking about an early attendee on one of our courses who came with a congenital problem that left them with muscle imbalance and chronic pain. They’ve been well looked at, the team for pain service, usual pain service thing: lots of drugs and injections, but stuck with a pain level of 8 out of 10. After Barkos developed their personal practice followed them up a couple of months later: pain 3 out of 10. So if you look after someone who’s in pain, and it’s a question of ‘Do I up the neuroleptic, or are they just codeine-seeking?’ All those quite tricky and demanding conversations. Here’s a technique that did all of that. And we’ve got a strong evidence base for this. We teach this on Red Whale courses, mindfulness, and chronic. But see it happened to someone that you know, and you see them change — just so brilliant.

I had this in this particular patient about a year ago struggling on a number of levels, overweight, which was going to impact another health problem that needed addressing very little exercise, very anxious, been anxious since they were in their early 20s. Now mid 30s and lived with chronic pain, had fibromyalgia was on tricyclics and neuroleptics. Really in not a great place and needed to get this medical problem sorted out. And we talked about a different approach to diet, and how exercise may benefit weight loss. But about halfway through the year, I introduced this individual to the Netflix series. So Andy Puddicombe, who put the Headspace app together, 19 year old lad got got a bit sad at university, thought I can’t hack this, went off to Tibet to be a Buddhist monk. Not the common path when you hit back road at 19. Came back set up Headspace, find him on YouTube, his inspiration. But he’s worked with Netflix, put together effectively a classic MBSR course, eight programmes, about 20 minutes each. And towards the end of each programme is a meditation.

And I’ve just seen this individual, they’ve lost weight. And not only have they lost weight, they’ve lost three stone. They do open water swimming, they have no pain. They are on no amitryptyline, no neuroleptics, no pain. They lived daily with anxiety since the 20s. And they said, ‘You know, I haven’t had an anxious thought for last month. Why didn’t people tell me about this when I was in my 20s? How I’ve been allowed to live for 15 years of my adult life without people telling me?’

Obviously that person was open. I have the ability to do that motivational piece. But the resource is a mindfulness resource. And there it is, it’s relatively easy to get hold of. And it’s helped that change, we can all recognise that patient probably. And the outcomes for a lot of them are nowhere close to what they have been able to achieve. And mindfulness is a component of what that person is using. So I think, you know, the other reason is I use it, and encourage people to pursue it. And it works. Making people better is a nice bit.

Rachel: And I love the fact that you’ve taught evidence based medicine for 25 years, and you’re saying it works, we need to use this. And we’re almost out of time, Steve, we do need to finish up. In a second, I’m going to ask for your three top tips. I do want to just get really practical with this, because one of the reasons people don’t manage to do it is just because of the time it takes.

Now I know that for any skill, because I’m learning ice skating at the moment, I need to practise. And if I go from one week, my half an hour lesson to the next week and a half an hour lesson and I’m not practised in between, then I still can’t go backwards on one foot in a circle very well. Right. So I know you got to practise. But we all think, Okay, we’ll do mindfulness, I’ll do my five minute app, or whatever — will that cut it? Or do you really need to put in more time and effort into it?

Steve: I went to a conference on mindfulness, and someone put it beautifully. It’s about prescription and dose. So what are you doing? And how often are you doing it? So what we know is if you’re talking about stress, you go through a classic MBSR. That’s two hours, once a week for eight weeks, plus or minus. And you can practise six days out of seven, roughly 20 minutes, maybe a bit. Mark Williams’ Meditations on Finding Peace in a Frantic World are quite short: 10 or 12 minutes. If you can do that, at the end of that period of time, we have evidence that it’s for the benefit. And if you get those benefits, then you’re going to be hooked. And then the only other bit is where do you hook those things into your life.

Every morning I do it brushing my teeth. I become aware of coldness of the water and the taste. I do it for 10 minutes on my drive to work. I turn the radio off. I’m aware of the seat, noise of the tires moving over ground. I look at the trees, I think colours, the different times and the different colours. I do that and I don’t think about Mrs. Megan who I’m seeing third, which is what I used to do. I would drive thinking about Mrs. Megan and I would ruminate. But if Mrs. Megan comes in, I’m seeing you third, bye-bye, back to the road noise. I do it when I exercise.

I do it because I know I have a need. So if I’ve got 20 minutes, I won’t flick through Twitter. I’ll go 20 minutes not on Twitter for this bit of my life. And 20 minutes of a kindness meditation because I’ve got a tricky chat with someone tomorrow. I just want to think good things for them. I want them to be happier. I want them to be safe, I want them to be at ease. When I have that chat, I know it’s going to get there.

Rachel: Those are absolutely fantastic tips for actually how to get that into your life, although it does strike me that that rabbit eats into your podcast listening time.

Steve: I do that on the drive to the gym and back. And that’s when I do my podcast or when I’m ironing a shirt.

Rachel: Heard it here first. Okay, that’s so, so helpful. I love that thing about dose and response, yes, you can do it a little bit. And that will benefit you. But actually, if you want a really good benefit, and let’s face it, we all have 20 minutes a day, even though we say we don’t. We make time for what is important to us. And if it’s 20 minutes, doing a meditation rather than scrolling through social media, then I think I’m up for that. So I’d like some three tips in a minute. But you’ve mentioned a few resources, which I think would be useful.

That book Finding Peace in a Frantic World by Mark Williams is fantastic. And you can get his meditations I think for free on Audible. There’s a CD that comes with the book. There’s the Netflix documentary. And the Headspace. And Netflix’s that documentary with Jon Kabat Zinn as well. Would you recommend any particular MBSR courses? How would somebody find one of those courses?

Steve: I mean, if you literally put MBSR and your county, things will start coming up. I was often asked that when we were on the road with Red Whale and got some amazing responses. I was in Northridge, and in the new medical school there is giving medical students an opportunity to train in mindfulness. So there may be something within your trust and maybe something within your patch, something within your deanery — I’d look at all of those to be a teacher. I’m going through that formal accreditation process; you need a properly trained and supervised and ongoing simply didn’t type teacher.

Rachel: Great. Thank you Steve. So what would your three top tips be just to finish this off?

Steve: If something I’ve said about what the benefits of this are strikes you as ‘I’d like that’. But I would strongly encourage you not to just simply try an hour or something like that. To do a formal MBSR course, that’s what’s got the evidence. And it has to be the right time, obviously. But I would strongly encourage you to do that. I think even if you don’t develop a formal practice, I would explore skills like the 3-part breathing space that we might have a little go at in a minute. Because even without the depth of the practice, that is a way of just giving you a chance to get into a more resourceful state. And so I offer that as something that anyone can use, you know, I looked on my phone, and it’s there on YouTube; Mark Williams, he’s got a beautiful voice. And I think, you know, even if it’s not something that you feel you need, you’re in quite a good place, this doesn’t seem to be something that you need, then the resources, we’ve started talking about, the patients — it’s flipping yourself to kind of ‘What resource with this person actually be able to practically access use and get a benefit from?’ and the Netflix programme is has really made a difference to a lot of my patients. So if you’re not aware of that, give that a go. It’ll make a big difference.

Rachel: That’s great. Thank you. So Steve’s really kindly offered to take us through the three part breathing space that takes three minutes or less. But Steve, before we do that, and we’ll finish up with that. If people wanted to get hold of you, where should where should they bit, presumably they can get you on Twitter.

Steve: I’m on Twitter, we can put the link to that in the show notes.

Rachel: So before we get to the breathing space, thank you so much. That has been absolutely fascinating. I think I’m definitely going to be on an MBSR course and maybe we can test your answer, run one for us, Steve. How would that be?

Steve: I teach it in a faith based context, which I’m accredited to do but I’m going through the accreditation process with Bangor University to get that formal accreditation and that allows you to be much more flexible with the way you use it.

Rachel: Marvellous. We’d love to get you back on the podcast again some time to share your wisdom with us again. So thank you so much for being with us.

Steve: It’s my pleasure.

Rachel: For those of you that want to carry on, Steve’s going to lead us on a three part breathing space, which I’m going to do now so I’m gonna mute myself and just listen to you, Steve.

Steve: Those we come to this practice. We can do it sitting or standing or in any position you feel comfortable in. Just take a moment to ground yourself. Just become aware of whatever’s supporting you. If you’re standing, it’s the ground coming up to meet your feet; of the pressure on the balls and the heel of the foot. If you’re sitting in the chair you’re sitting on. Maybe the back of the chair you’re sitting in. Now let’s become aware of the weather system for us now. Our thoughts, our feelings, our emotions, maybe physical sensation. Just noticing, it’s tempting sometimes, a distraction may come for us, a thought about something we have done or should do. Just notice that.

Then come back. You can think of it like an hourglass and we’re at the top of the hourglass and we’re just aware of all that’s going on. Now I want you to focus your attention on that pinch point,

the hourglass. Focus on your breathing. Just follow a few breaths all the way in and all the way out. Noticing your coolness in the back of your throat, your tummy rising and falling.

Just follow the movement of the breath. Breathing all the way in and all the way out. Finally, you’re ready. The bottom of the hourglass expands again. Just become aware of what you’re sitting on, the room you’re in, what building the back room is in. Where you are. Sounds around you. When you’re ready, you can open your eyes. And perhaps we can commit to be more mindful in the moments as they come. Just deal with things as they are in this moment. There you go.

Rachel: Thanks for listening. Don’t forget, we provide a self coaching CPD workbook for every episode. You can sign up for it via the link in the show notes. And if this episode was helpful, then please share it with a friend. Get in touch with any comments or suggestions at hello@youarenotafrog.com. I love to hear from you. And finally, if you’re enjoying the podcast, please rate it and leave a review wherever you’re listening. It really helps. Bye for now.