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Mindfulness Research: Jeff Greeson
46 Plays6 months ago
Dr. Jeffrey Greeson is the director of the Mindfulness, Stress and Health Lab at Rowan University. Listen to Jeff discuss the health benefits of mindfulness, the challenges of measuring outcomes in mindfulness research and the distinctions between secular mindfulness and traditional Buddhist practice.
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Transcript
Introduction to The Wound Dresser Podcast
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare.
Dr. Greeson on Health Psychology & Mindfulness
00:00:14
Speaker
I'm your host, John Neery.
00:00:21
Speaker
Today my guest is Dr. Jeffrey Greeson. Dr. Greeson is an associate professor of psychology at Rowan University with affiliations at Cooper Medical School of Rowan University and Rowan Virtua School of Osteopathic Medicine. He has conducted research in the fields of health psychology, behavioral medicine, and integrative medicine since 1997.
00:00:42
Speaker
At Rowan, Dr. Greason directs the Mindfulness, Stress, and Health Lab, where his team researches the effects of stress on mental and physical health, as well as the potential health benefits of mindfulness meditation to reduce stress. Dr. Jeffrey Greason, welcome to the show. Thank you very much for having me.
Understanding Mindfulness
00:01:01
Speaker
So in the the field of mindfulness and integrative medicine, I think it's pretty and important important to define some terms. So ah in your own words, can you just define mindfulness for our listeners? so Sure, a good place to start. I think at its simplest, um mindfulness can be defined as non-judgmental awareness, or some people say compassionate awareness. I think that's really what it boils down to. um I've heard other people talk about it in terms of awareness, but also with acceptance, you know, being accepting of whatever it is we become aware of, which is not always easy, but that's sort of the principle. um But that's usually a good place to start.
Mindfulomics: Linking Mindfulness & Health
00:01:41
Speaker
And I know you've been um in your research, you've been also using a term, mindful omics. Could you kind of describe what that is and ah how it's effect, how it's relevant in your research?
00:01:52
Speaker
Yes. ah So all of these omics platforms have really um exploded you know onto the scene in the last 10, 20 years. ah With the human genome, there's genomics. And then with metabolism, there's metabolomics with different metabolites by the many thousands you know in cells and throughout the body. Then there's proteins and proteomics. There's the microbiome. There's the inflammasome. There's the nutrigenome of the omics induced by the foods yeah know that we eat.
00:02:21
Speaker
So I thought just like all of these other fields that are applying these omics technologies to study health, applying those same omics technologies to study the link between mindfulness and health, we could call it mindfulness. So that's been presented at a couple of conferences and it's a project that was supported by ah the Nova Institute for Health. I was a fellow with them, still am, um but that's sort of just a term that I came up with. I don't think it's anything that's been formally published or or anything like that.
Individual Responses to Mindfulness
00:02:51
Speaker
So with with the mindfulness and mindfulness in mind, ah what are what are some current projects that you're working on in your lab? The project that I was funded to do that I've presented at a couple of conferences and and we're still working through the data in terms of seeing what might be actually publishable in terms of a journal article for this. um But the three questions we had with this mindfulness project that I was funded to do was,
00:03:16
Speaker
because mindfulness, um not only is it non-judgmental awareness, but mindfulness, you can kind of think of it as three levels. Mindfulness is at once a state. We can be in a state where we're mindful of things around us and within us. Mindfulness is also a trait um like height or intelligence or whatever. We all have some degree of mindfulness just naturally They call it dispositional mindfulness, just our dispositional tendency to be mindful in everyday life, whether we've been trained in it or not. The third piece is kind of mindfulness. It's also a training. so We take these programs in mindfulness. Some people meditate on their own. Some do courses. Some use apps.
00:03:58
Speaker
some are part of a meditation community. But whatever the form is, the idea ah is that if we can spend time training ourselves to become more mindful, we're putting ourselves more in these mindful states and those be get more mindful traits so we can move the dial with respect to how mindful we naturally are.
00:04:15
Speaker
if we spend some time engaging in these mindfulness ah practices or communities.
Aspects of Mindfulness: States, Traits, Training
00:04:20
Speaker
So the Mindfulomics Project was to look at, from a genomic perspective or a gene expression perspective, there are certain genes that are tied to health through their relationship with inflammation and oxidative stress and antiviral properties and these sorts of things. And there are clusters of genes that do this. And so we looked at, on a questionnaire, people that said they were more mindful or less mindful on a on a survey questionnaire.
00:04:44
Speaker
We looked at people before and after they did this eight-week mindfulness course, so that was the training. And then for a a state of mindfulness, before and after they did a 15-minute mindful breathing meditation, looking at these patterns of gene expression as a virtuous state, mindfulness, trait, mindfulness, and mindfulness training. And basically, the main take-home message we we found from it was,
00:05:07
Speaker
Although those clusters of genes tied to inflammation, oxidative stress, and antiviral activity didn't change on average during the course of the eight-week course, and they really didn't differ as a function of people's scores on a questionnaire, what we did find is that the less stressed people and the less anxious they reported becoming after the eight-week course, the greater reduction in inflammation and oxidative stress-related genes and a greater increase in antiviral gene activity they had after the program. so Some individuals, depending on how they respond to mindfulness training, might show these gene expression changes, whereas the overall group as a whole may not. So this idea of individual differences and how we respond to mindfulness training might be tied to some of these omics biomarkers.
Effectiveness of Mindfulness Training
00:05:53
Speaker
So to go back to for a first second, to that you said state, ah trait and training are kind of like the three buckets or or like kind of categories you think of in terms of mindfulness. Does generally like a person who is high in one is is high in the other two or do they kind of like how do you ah kind of correlate those three things?
00:06:10
Speaker
Well, good question. So they can be related, but also not necessarily. So for example, one of the questions in the research field is um not only is mindfulness training effective, whether it's for for mental health or quality of life or stress-related physical symptoms or certain medical conditions or employees or what have you. um So there's is mindfulness training effective? Those are talking about averages, the averages response to a ah program, for example. But then there's individual differences in how people respond to the training.
00:06:40
Speaker
That's where how mindful we are coming into a program or not might matter, our our baseline level of of mindfulness, if you will. And there are all sorts of questionnaires that sort of get at that. There's big problems with the questionnaires. there's There's reporting biases and what questions are on them and and what qualities of mindfulness those questionnaires get at.
00:06:58
Speaker
um There is no perfect questionnaire. But the question in terms of the research field right now is not only is mindfulness effective, but for whom is it most effective and kind of under what conditions. So how mindful we are or not, relatively speaking, coming into a program can be one of those factors. so Simon Goldberg at University of Madison, Wisconsin, and others have found that when you do these meta-analyses looking at a study of other studies, there isn't a whole lot of evidence that whether you're less mindful or more mindful coming into ah a mindfulness program that it really meant.
00:07:28
Speaker
that doesn't really matter. You tend to get the same outcome, at least in terms of mental health and quality of life outcomes. Other people have argued mindfulness works better for people that are already more mindful when they come in. Other people make the argument that it's really the people that are lower on mindfulness coming and they might benefit more from the program. Either of those, you can make an argument for it. The statisticians argue it's all regression to the mean that if you start off really low, you're likely to go up. If you start off really high, you're likely to come down. So we don't really know in terms of which of those perspectives.
Mental Health Benefits of Mindfulness
00:08:01
Speaker
They could all be right. It might depend on the conditions, the population, the type of training, and and so forth. But we think the three are related, but they may not necessarily always be.
00:08:12
Speaker
And so I know you've been doing ah this research for a really long time. um And it it seems like just looking over like all the publications you've done and whatnot, ah the the scope of the research in terms of like different parts of the body, whether it be mental health or blood pressure, or um it kind of varies across the whole body, like the benefits of mindfulness. So in your um and your your many years of research, what are the main benefits that you've seen ah you know definitely proven by research?
00:08:42
Speaker
the The main slam dunk benefit we've seen, not only in the studies I've been involved with over the almost 30 years I've been doing this, I got involved in this in 1997, so as of 2027, that'll be 30 years. so um But in our own research from Jefferson, to Duke, to Penn, to Rowan, and other collaborators I've worked with elsewhere. um The mental health benefits of mindfulness are pretty well documented. A lot of that comes from the self-report questionnaire studies where from the patient's perspective, how they feel if we're a doctor, a psychologist, or a
00:09:16
Speaker
friend or a family member How the person says says they feel, that's kind of the number one criterion, especially when it comes to mental health. We just ask people about these symptoms and whether they're experiencing them and how severe they are. Those types of questionnaires and scales that measure psychological or psychiatric symptoms or mental health symptoms, those and all the meta-analyses have really been found to be the most responsive to mindfulness training, whether that's in students, college students, medical students, healthcare care students, law students, ah healthcare employees, including physicians and other healthcare providers.
00:09:49
Speaker
um different types of patients with stress-related medical conditions, diabetes, hypertension, chronic pain, and so forth, cancer. The mental health benefits for for stress, anxiety, depression, sleep disturbance, those types of self-reported stress-related symptoms really changed consistently as the equality of life measures well
Challenges in Measuring Mindfulness
00:10:09
Speaker
-being.
00:10:09
Speaker
daily functioning. Those are well documented. um What's far less documented and less reliable that is more suggestive based on the principle that um if we perceive some stress, we feel like it's difficult to cope, that perception of stress in the brain, the brain innervates all the other organs of the body.
00:10:29
Speaker
uh, muscles, the heart, the gut, uh, et cetera, et cetera, and even the immune system. So if stress is affecting the brain and the brain's innervating the rest of the body, those symptoms of stress can get translated into physical stress related symptoms. So therefore something like mindfulness that can help lower stress should help ah alleviate some of those stress related symptoms.
00:10:48
Speaker
When you get to the more objective measures of those types of symptoms, the biomarkers, the disease related progression, um blood pressure, cetera et cetera, those types of studies that are on objective biomarkers of disease are a lot.
00:11:02
Speaker
um less demonstrated, less replicated, and and less reliable than the self-report kind of survey studies are. So that's in broad brushstrokes kind of where we are. As a field with some of the main findings in mindfulness research, there's also been all of this neuroscience of mindfulness,
00:11:20
Speaker
There are all sorts of areas of the brain from sensation, ah attention, perception, ah emotion regulation, emotional reactivity, the default mode network. All of these things are tied to cognitive and emotional functioning, personality, risk for depression, trauma, and addiction. Lots of these areas of the brain are neuroplastic. They're changeable through experience, including with mindfulness meditation experience. So there are a lot of investigators looking into the brain and now the omics kind of level of this as well.
00:11:51
Speaker
So you mentioned the objective um physical biomarkers like that that you're looking at with mindfulness. feel like they're Is there now like ah ah more of an emphasis to do studies like that? Or because there's the the results aren't as fruitful? Are people kind of like shying away from doing that research?
00:12:07
Speaker
I think it's a mixture. um it It seems like people aren't shying away. There's been more of an approach to do those types of studies. Because of sort of the the principles and the philosophy and the and the theories, it makes sense that if those things are biological markers of stress and mindfulness can help with stress, according to all these other studies, it should play out in those markers.
00:12:29
Speaker
Looking at those types of genetic and brain imaging markers and things like that, though, are much more expensive because the ability to affect those markers is probably smaller. The smaller the effect of an intervention is, the far greater number of people you need to detect such effects. So the scope starts to expand. The staff needs to expand. Running these assays, it's very costly. um So there's there's a greater push to study those types of things. But the team you need to bring together, the amount of Resources through grants and other institutional funding and levels of expertise and recruiting for clinical trials. It becomes very complex, um but more people are doing it not really shying away um as the results tend to come in and quite a few things there. There are some that are significant and promising.
00:13:16
Speaker
quite a few are also null. That can't be demotivating, but we kind of say with respect to evidence-based practice or evidence-based medicine, null
Adverse Effects of Mindfulness
00:13:24
Speaker
evidence is still evidence. Evidence isn't always just positive. In fact, there can be a file drawer problem where the null studies end up in our file drawer and never get published. If it was done rigorously and it was well planned,
00:13:35
Speaker
transparent, it had adequate power, and it just was null. It should still be published as part of the evidence-based, you know, for a field, medicine or psychology or mindfulness. um But there are funding pressures and other things that sometimes that prevent that, or those findings can seem not as exciting.
00:13:52
Speaker
But I don't think people are shying away. I think there's interest and um a push to study those and sort of as those results keep coming in, we'll see what the balance is between really vigorously pursuing those types of cutting edge technologies and biomarkers.
00:14:08
Speaker
Versus, and it's not an either or, you can also do questionnaires or qualitative, I saw you were interested in the qualitative approaches too, of just asking patients what they feel about this. What was their experience like? What did they like? What didn't they like? What did they understand? What was unfamiliar? To compliment all biomarkers all the time. So some of it's cost, some of it's expertise, some of it's what's patient centered or not, and some of it's what is responsive to these interventions or not. And all of that is still happening.
Variability in Mindfulness Experiences
00:14:38
Speaker
quickly you know in the field right now. Yeah, related to what you were saying about the like the negative and no findings. um I feel like in not among like the research community, but I feel like in the media, mindfulness can often be painted as sort of like a panacea, like ah like a cure all that it helps with so many things. um But I imagine, you know, with with with all the research that's going on that that isn't the case. Have you ever has there been anything pieced out where it's like mindfulness is either not helpful in this situation or can even be harmful in a situation?
00:15:10
Speaker
Yeah. Well, a couple of things. I think in 2018, Nicholas Van Dam and colleagues published a highly cited paper called Mind the Hype. I forget what the subtitle was, but Mind the Hype was the idea, the overhyped nature of the empirical basis of mindfulness and mindfulness-based interventions. It gets over-hyped by the media. It gets over-hyped by some of the investigators. It gets over-hyped by people that have a conflict of interest that are profiting off of books, trainings, retreat centers, other types of products tied to their particular
00:15:46
Speaker
branded intervention um and things like that. so So there's all those types of biases. there There's the positive a kind of positive finding bias. If we get grants, we're supposed to publish everything. But in science, a lot of times, there's a positivity bias toward publishing findings that are positive. So there can be an inclination to look for that sort of thing. In terms of ah possible harms,
00:16:11
Speaker
Will it be Britain? Simon Goldberg, others have started to look at this um under-appreciated, under-investigated role of possible harms or contraindications for mindfulness meditation training. One thing multiple researchers have found is that Having childhood trauma can be a risk factor for having an increased likelihood of of experiencing sort of adverse effects with with mindfulness training. Some of the like the three most adverse effects that I saw in the literature found in one of these reviews was
00:16:49
Speaker
higher levels of anxiety, not lower, can happen. um Kind of re-experiencing past traumas can get reactivated when you're sort of sitting and in quiet stillness with your thoughts and observing the breath in the body and kind of watching things come and go. Well, some of the things that come and go might be previous traumatic experiences and that's where the teacher credentials and the safety of the space and the qualifications and your own preparation kind of all play into that.
00:17:15
Speaker
but anxiety, re-experiencing traumatic experiences, and just kind of a heightened level of emotional sensitivity. Those are three things that can happen with mindfulness meditation practice, um and those are particularly sensitive for people with a history of Child you know trauma, there's different forms of it from sexual abuse to exposure to violence to you know other things. um And so from a practical standpoint, um if you are a therapist, a physician, a retreat center, a mindfulness group leader, having sort of a
00:17:51
Speaker
transparent, ah ethical, responsible intake process, and not just check boxes, but whatever people check off talking to them about it to sort of make sure it's a match between their past experience, their preparation, your experience as an instructor, the sort of safety and ground rules of the environment, a clinic, a retreat center, whatever ah are you as an individual therapist, that those things are all in alignment to give people the past the greatest likelihood of benefiting from this instead of having adverse experiences happen. We alluded to some of the the challenges of of like mindfulness research before, but I kind of want to just pick your brain a little bit more about that. i think ah First off, when you think about like what can be measured and what can't be measured, do you run into just challenges of how um like what can be measured in your mindfulness research?
00:18:45
Speaker
Absolutely. This was something that ties back to the definition of what mindfulness even is in the first place, because depending on what mindfulness is or isn't, that then dictates what the measures are or aren't. So for example, some people mindfulness really centers on attention.
00:19:02
Speaker
That's really what it all comes down to, the ability to pay attention in the present moment on purpose, et cetera. Well, there are computer tasks like in neuropsychological testing, the continuous performance tasks, the CPT, press the spacebar for every letter except X, you know? So for 15 minutes, I'm watching the letters pop up on this A, could it be, hit it C? It's not in order. X, I hit, oh, shoot, I shouldn't have hit that. I was supposed to not do that.
00:19:30
Speaker
That's a test of attention that's on neuropsychological testing and neuropsych exams, um but when they've looked at sort of dispositional mindfulness or mindfulness training, there really, as I understand it, has not been much of an effect, if any, of mindfulness on those types of neuropsych tests. Again, in theory, you would think if we're more mindful, we're better able to kind of pay attention and sustain attention and not be reactive to things where not supposed to react to, but when you do objective tests like that, those haven't borne out you know the hypotheses as much. So that's with attention, for example. um Another one could be, well, mindfulness, for one of the qualiti core qualities of mindfulness is non-reactivity. We're supposed to experience stress and you can kind of feel it, but not feed it, not overreact.
00:20:18
Speaker
we can get hooked up with sensors to our brain or our, you know, heart EKG or have a blood pressure cuff on or be taking hormones like epinephrine or cortisol samples. And there have been quite a few studies that have found that people that are naturally more mindful, that trait mindfulness or that do mindfulness training, they're actually more biologically reactive to a stressor in the lab instead of less.
00:20:41
Speaker
And so that doesn't make a lot of sense of being more mindful. We're supposed to be less reactive to stress and not more. But there are these kind of stress testing paradigms in the lab that that have been done to test the non-reactivity or stress-reactivity piece of stress. Other ones um that I know, a University of Wisconsin-Madison, Dr. Richie Davidson's lab and and his colleagues, pro-social behavior.
00:21:05
Speaker
um I know that as I think you've looked into yourself, one of the critiques of kind of the modernization of mindfulness is mindfulness can kind of be all about me, me, me, me, you know my stress levels and my anxiety and my mental health and and my ah physical health and so on versus mindfulness being more about we in the world and life and ah is much bigger than just me and and my problems. So pro-social behavior and orientation toward others and helping others and being of service and part of a community instead of so self-focused. And that can be have implications for children and learning and growth and development or
00:21:45
Speaker
other-centeredness versus self-centeredness, which there's mental health implications to that, possibly even physical health implications to that, um ah societal judgment you know implications of that. So there's different ways to measure all those things. Some of that can be done on the computer or sort of vignettes where what would people do under certain conditions, whether they've had mindfulness training or not, or their score higher on mindfulness or not, same thing with these compassion measures. So there's all different ways to measure different core qualities of mindfulness, be it attention, emotions, stress reactivity, prosocial behavior, and et cetera, areas of the brain. um But the field is looking at all of those, but it's hard to distill the findings down into sort of central takeaways. Some things it's shown to be significant. A lot of the times it's not. um And it's hard to reconcile that with a theory and philosophy versus the empirical results. But part of it is because what is mindfulness and how do you measure whatever it is?
00:22:45
Speaker
And then who's defining mindfulness? Who's teaching the mindfulness? Who's taking the mindfulness teaching? Where is mindfulness being offered or not? um Is it being adapted and is it culturally sensitive and accessible or not? Who's paying for it? Is it covered by insurance? So on and so forth. So there's a lot of issues revol revolved around ah measurement of mindfulness. How is it measured? What are the outcomes and who does it represent when when those findings come out?
00:23:15
Speaker
Yeah, along those lines ah in terms of, you know, i guess I guess the intervention you're using ultimately is like some form of mindfulness training for a lot of your subjects. And do you run into kind of issues where it's like, okay, we're giving everybody the same mindfulness you know training, but then it's like, we don't know kind of what experience they're having from that that will eventually downstream affect all their biomarkers. Like I think maybe if it's like a pill,
00:23:41
Speaker
you're more likely to think that at least like the experience of doing something is similar among your subjects, but for the the mindfulness training, the experience could be just so just so distinct for everybody. absolutely hit the nail on the head with that one. um So yes, there's tremendous heterogeneity variability with how people respond to a a mindfulness training program for for multiple reasons. um Somebody explained this to me once, and I've shared this with other students I have, is we used to think and in terms of ah so comparing you know meditation with medication.
00:24:18
Speaker
Say you have a bottle of aspirin, 100 milligrams, whatever, all the pills are the same, it's it's regulated. We have a class of 50 people, we all take an aspirin. Does that same 100 milligrams of aspirin affect someone the same? Yeah, Dr. Greason, it's 100 milligrams, it's from the same bottle, it's USP, it's regulated.
00:24:38
Speaker
nope The field of pharmacogenomics based on differences in liver enzymes and how we metabolize these medications and substances which differ from individual to individual, the same 100 milligrams does not affect everybody the same way. This works for me. The same pill doesn't work for me, doc. It must. It's 100 milligrams. Pharmacogenomics, no, it doesn't. That's just for a standardized pill. Now you're in a class, a meditation class with 50 people.
00:25:05
Speaker
The instructor's the same, the classroom's the same, but you got 50 different people, 50 different motivations, 50 different personalities, 50 different ways you're relating with the instructor and each other, and your ability to learn and absorb things and apply it and practice outside of class, and so on and so forth.
00:25:22
Speaker
you can just feel the variability and the heterogeneity expanding under those types of circumstances.
Comparing Secular and Buddhist Mindfulness
00:25:28
Speaker
So the meta-analyses not only in the research estimate kind of ah the main effect, but there's also there these bars that are kind of the confidence interval. And often in these reviews and meta-analyses, the bars are pretty wide.
00:25:42
Speaker
for those reasons. So there's kind of how confident and are we that a given person is going to fall within that 95% confidence interval. Tighter is better because it's much more predictable for a patient going into a given intervention, medication, meditation, whatever. The the wider the confidence interval, we go into it with a lot more uncertainty. We don't know. Are we going to get a great effect, a very modest effect, and no effect at all?
00:26:04
Speaker
We don't really know because the confidence intervals are are so wide with a lot of these behavioral intervention studies, be it psychotherapy, mindfulness exercise, and so forth, and also with medication. But because those are standardized, it's narrower, but not the same.
00:26:19
Speaker
you You mentioned before, um kind of like one of the critiques of ah you know mindfulness is whether like how how much the pro-social behavior comes out. Does it become all about me or is it about sort of we developing a community? And I sent along and an article to you earlier.
00:26:35
Speaker
that was in in Time magazine where they basically um were talking, the title was, you know, how we ruin mindfulness and it was, it quoted a, ah you know, individual, I think his name's Dr. Matthew Ricard, who's who's a well-known, you know, Buddhist scholar, Buddhist mon mindfulness expert.
00:26:53
Speaker
um And his kind of his kind of thing was that we we don't have like an ethical framework. We don't have morals and values attached in a lot of secular modern day mindfulness. um do you think First off, do you do you think that you know mindfulness like in like deployed by itself without kind of like ethics and morals and and those sorts of things is is like is it is a good thing for our society communities?
00:27:23
Speaker
Yeah, I read the story and I've met Mathieu Ricard a couple of times at these mindfulness conferences over the years so that he often attends. And it does seem like there are there are a couple of of paths to to learn mindfulness and meditation. There's more than a couple, but if we had to kind of simplify it, there's sort of the spiritual or the religious path, in this case Buddhism, the Noble Eightfold Path, you know, and all that stuff, the Four Noble Truths. I'm not Buddhist, I'm not a Buddhist scholar, I've read some of that, and being around these conferences, I'm a little bit familiar, but I'm um'm not a practicing Buddhist or anything. But if people want to pursue that path, there are Shambhala Centers, there's other retreat centers that are steeped in Buddhist tradition, and it offers that way, if people would would like to learn that.
00:28:14
Speaker
um So those are here with teachers with the established you know strong lineage. What has exploded a lot more in terms of the commercialization and the corporatization or the MIK mindfulness is it's really not based in that.
00:28:30
Speaker
Take ten deep breaths, do some mindful breathing, you'll relax. Take a few deep breaths, even one mindful you know breath might be enough. Now all of a sudden we we've gone from a spiritual path with a sort of formulation and steps in the history and lineage. So sort of taking that completely out of context and just simplifying it to a couple of practices and almost minimizing it to the point where is it even mindfulness anymore or not? Again, given that mindfulness is so many things and Buddhism is about way more that mindfulness is one of the core tenets, but it's way more than that, including the moral and ethical compass and ways of right mindfulness, right like livelihood, and all those things.
00:29:12
Speaker
um So where i'm where I stand on this right now is it sort of depends what what people want, what they're drawn to, and if they're drawn to Buddhism and wanting to sort of learn that path and it's really a spiritual practice, those opportunities and centers are available.
00:29:28
Speaker
I feel like many more people sort of in the healthcare care settings, in hospitals, in schools, and that's a whole other controversy, at least in public schools, in the police force, and law firms, and so on, and and universities. um It's really distilled down into kind of mindful breathing, the body scan, some basic yoga, some mindful eating and and things like that and trying to pick a couple of things during the day that you'd like to deliberately be mindful of and seeing if that helps largely for stress related stress reduction reasons. But even that motive to
00:30:08
Speaker
lower our symptoms of stress, be they mental health symptoms, physical expressions of muscle tightness, you know, I'm breathing too fast, I can't fall asleep, those types of stress or anxiety things that if we're doing it kind of for those health-related purposes, now all of a sudden the mindfulness is to lower stress or become healthier versus what about not being attached to any so certain outcome and we're just learning and practicing mindfulness for its own sake without having to be attached to be less stressed or get that anxiety down or lower that blood pressure, make my pain go away after we do this body scan. And if it's not, mindfulness doesn't work because you hear a lot of that. So a lot of this comes back to expectations and motivations, which really I was talking about the assessment if we're a clinic or an individual or a physician or a psychologist, and we want to offer this to people. Number one, we should have done it ourselves for quite a while before we start teaching anything to anyone else, but also understanding expectations, motivations, willingness,
00:31:06
Speaker
Possibility because all that ties into outcome and if in education and health care and things like that we're interested in outcomes. Versus a path where we just do things without being attached there there is no outcome to gain we're just doing this as part of our life as part of our growth and we don't know.
00:31:23
Speaker
where it's going to go or we don't know what's going to happen. In education and healthcare care and things like that, people often do it to achieve an education or health-related outcome. And ironically, the more strongly attached people are to gaining those outcomes, the greater a hindrance it can be to getting there in the first place.
00:31:41
Speaker
You know, so I think Mathieu Ricard and others that have devoted their whole life to this, they're really sensitized to those kind of perceptions and expectations. And if you're gonna offer people another path, a more simplified kind of denatured path, and our country with these types of options and these types of settings, it is, you know, controversial as to how effective or ineffective or moral or immoral, you know, those those opportunities might be.
Cultural Adaptation of Mindfulness Programs
00:32:09
Speaker
So is it possible to study that like more spiritual path mindfulness that you were talking about or because it's like unattached from outcome? It's basically like not really set up to be studied in a scientific through a scientific lens.
00:32:25
Speaker
Well, yeah, so so um if we introduce, I guess, the the goal of studying you know outcomes of um Buddhist religion or Buddhist practice or you know learning,
00:32:42
Speaker
Buddhism, and we're trying to study that. So say, for example, Richie Davidson collaborated with His Holiness the Dalai Lama and and the monks, and they tried to sort of utilize modern neuroscience with EEG and and m MRI and fMRI and all these types of things to look at levels of brain activity and the Buddhist monks that have been doing it their entire lifetime from childhood up into adulthood, older adulthood.
00:33:07
Speaker
And one of the earliest findings from sort of I think in the early 90s or something was they were seeing gamma amplitudes on on EEG g that they they thought to the machine was broken. you know They had never seen a human being you know with amplitudes that high at that wavelength. But the monks had been meditating with compassion, loving kindness, and all that sort of thing their whole life. So they're probably able to achieve neural states and states of consciousness that an ordinary person who hasn't devoted their whole life to it can't attain, but it's humanly possible you know if you've had a ah life like that. um So trying to study kind of religious practices or commitments like that versus sort of these eight-week mindfulness programs like mindfulness-based stress reduction that was developed in the 70s and now it's disseminated all over the place,
00:34:00
Speaker
They don't even really mention Buddhism or spirituality in the class at all, you know as I understand. So it's just basic practices. The goal is not to become Buddhist or really to learn about the deep origins of all this unless people want to do it on their own. but in the classroom and kind of part of class discussion. That's really only marginally, if at all, part of the conversation. And those are the interventions, the MBIs, the mindfulness-based interventions that are really deployed on schools, hospitals, and healthcare care settings and things like that for mental or physical health purposes, largely or academic performance in contrast to a religion or a life path or a spiritual path.
00:34:38
Speaker
So sometimes you can apply some of the same scientific methodology and the group at Wisconsin has has done some of that, but it's somewhat uncommon.
00:34:50
Speaker
Yeah, building off that, um you know you work closely with the the Cooper University healthcare system that's that's in Camden. Do you think like you know mindfulness and integrative medicine in general is um is it would be an effective tool for underserved communities like Camden? I guess on one side you have, oh, a lot of these things can be low cost, maybe maybe not if you're going for an expensive training class, but in general,
00:35:16
Speaker
you know there There is a ah certain DIY you know prospect to it. um Or is it something that you know maybe these sorts of things aren't a good foot for the community? How do you kind of view ah you know met whether mindfulness and and integrative medicine would be good for underserved communities like Camden?
00:35:34
Speaker
I think that the first thing I think of when it comes to that is um is learning from all this experience that even if we have you know a nice theory, a nice philosophy, or what we think of as a nice intervention and even if there's some evidence for it, there's a lot of biases and assumptions there, especially when we're trying to take it to a new place with a new population, with a new community, with different sets of values, a different culture than we have or we've been around before. That's an enormous leap.
00:36:03
Speaker
So I think where people are going now, and I've even heard of, I'm i'm on these um grant review panels for the National Institutes of Health quite commonly, and I've seen a lot of um expectation that when people apply for a grant now, including ah a mindfulness intervention grant, that they build in a mixed methods design where it's got to have a sort of patient-centered community, informant community involvement in this to not just roll out you know eight-week mindfulness-based stress reduction to population X, Y, or Z.
00:36:37
Speaker
Do they find that acceptable? Do they find that feasible? Do they understand the terminology around it? Does this make sense to them or not? How would they explain it? Can they suggest who would teach it you know or not? Do they identify with it or not? So I think it it really has to um kind of evolve into there. I think the funding ah sponsors understand that and and that's where the funding is going toward now to make sure we don't just roll out intervention studies and study advocacy and we wonder why a lot of them are null. Well, it could be because these interventions that coming from the ivory tower we thought were pretty solid when you deliver them to more diverse groups, they're not that interested. Maybe they don't care, don't understand, don't
Integrating Mental Health with Healthcare
00:37:19
Speaker
comply, don't really resonate with the teacher, who who knows what. But I think kind of making these things more culturally sensitive, more adapted, more informed and involved by the people that are ultimately possibly going to have access to it upfront instead of post-hoc afterwards makes a lot of sense and that's starting to happen more often now, thankfully.
00:37:42
Speaker
So yeah, I want to finish up by doing a lightning round. This is a series of fast-paced questions that tell us more about you. So what is ah your go-to mindfulness activity? Mindful leading. Mindful leading. Mindful leading, yes. Who is your favorite mindfulness teacher? I would say Dr. Jeff Brantley at Duke University. Retired now, but he's my ah most important and favorite mindfulness instructor.
00:38:12
Speaker
What's your pet peeve? Oh, biggest pet peeve, um, would be, uh, and this ties into this topic is people that sort of, um, uh, come across as, uh, knowing more than, than they do their, um,
00:38:36
Speaker
Making things seem like more than they're not and I have that reaction at conferences not only to mindfulness Things but it it does apply to mindfulness as we've talked about this last half hour or so, but I guess kind of Misrepresentation, you know whether that's of data of a person of experience that that is a pet peeve of mine What's your early morning beverage? coffee ah What's your late-night snack?
00:39:03
Speaker
Late night snack, unfortunately, which ties to my favorite mindfulness practice of mindful eating, it's usually chips you know at night, which I'm trying to cut that out, but it is a source of enjoyment and those damn dopamine receptors you know light up every time, so it's it's a very hard habit it to break. But I will say at other times, you know celery or carrots, even without dressing, those are good too, and it's just got to be a matter of changing habits. So maybe we can still have the habit, but but substitute something a little bit healthier that can be just as enjoyable if we have it mindfully. And lastly, what's one change you'd like to see in healthcare? care
00:39:41
Speaker
A change in healthcare I'd like to see is um If the evidence supports it, ah more of a focus on behavior and and sort of mental health is an equal priority to pharmaceutical interventions and procedural things. Those things are very helpful and important. It would just be nice if we can do more before things get to the stage of needing to use that.
Conclusion & Farewell
00:40:12
Speaker
um And so I do think, this is a psychologist of me speaking, but
00:40:15
Speaker
mental health, psychology, psychology is the study of human behavior. Our behavior often ties to a lot of the health conditions we end up getting that eventually need medications and procedures to kind of correct those things. But if we could use all of those earlier on, particularly if there is data to support it, I think that would be very helpful and to kind of help bring psychology and medicine together instead of as separate. Dr. Jeffrey Greeson, thanks so much for joining the show. Enjoyed it. Thank you for having me.
00:40:53
Speaker
Thanks for listening to The Wound Dresser. Until next time, I'm your host John Neery. Be well.