#42 Mindfulness - A Personal & Professional Project


July 11, 2018

Mindfulness is becoming increasingly integrated in mainstream society, but is this new wave of wisdom effective or just the latest trend? How does mindfulness impact our view of ourselves and our view of the world? In this episode, Marija and Grace sit down with Dr. Agnes Wong, a Professor of Ophthalmology and Vision Sciences at the University of Toronto, Ophthalmologist at the Hospital for Sick Children, and recent mindfulness advocate. They delve into the core foundation of mindfulness practice, and its potential for positive and lasting change. Grace then chats with Elli Weisbaum, a long-time mindfulness expert and instructor. Elli discusses the diversity of mindfulness techniques and shares a short practice that you can try yourself! On this special episode we are also running an exciting challenge called "5 for 5". Take 5 minutes of your day to do any form of mindfulness practice for 5 days in a row and share your experience with us on social media by tagging @rawtalkpodcast or using the hashtag #RawTalk5for5. In doing so, you'll be entered to win exciting prizes! Until next time, keep it raw!

Written by: Marija Zivcevska

Elli's Blog
Mindfulness Research Synposium

Marija Zivcevska [0:00] Hey everyone, this is Marija.

Grace Jacobs [0:01] And this is Grace.

Marija Zivcevska [0:02] And welcome to this episode of Raw Talk where scientists talk and we listen. On today's episode you'll hear from Dr. Agnes Wong, a professor of Ophthalmology and Vision Sciences at the University of Toronto, and an active researcher focused on understanding the neural mechanisms of different ocular abnormalities. Now, interestingly, Dr. Wong is also my master supervisor.

Grace Jacobs [0:25] In addition to her research, Dr. Wong is also an ophthalmologist at the Hospital for Sick Children, and served as the former Chief of Ophthalmology. On today's special episode, you'll learn a bit about Dr. Wong's research and their discovery of mindfulness and how it's impacted all aspects of her life.

Marija Zivcevska [0:40] Then we'll hear from Elli Weisbaum, a longtime mindfulness expert and instructor. Elli is currently pursuing a PhD supervised by Dr. Wong, focused on integrating mindfulness in the healthcare system.

Grace Jacobs [0:53] For this segment, Elli and I discussed the diversity of mindfulness techniques and the benefits of integrating a daily practice, particularly as a grad student. Stay tuned till the end of the episode for a short guided practice by Ellie that you can try.

Marija Zivcevska [1:05] Speaking with Dr. Wong, and Elli really inspired us to apply mindfulness to our own lives. So we've developed a challenge for ourselves, but we also want you to try it as well. We've called it the five for five.

Grace Jacobs [1:16] The goal is simple. Take five minutes of your day to do any form of mindfulness exercise for five days in a row. The main point is to try out different types of mindfulness practice to see what works best for you. Whether it be mindful eating, breathing, walking, or traditional setting practice. Once you've completed the challenge, tell us your experience at some point this summer before the end of August through Twitter, Instagram, or Facebook, tagging Raw Talk.

Marija Zivcevska [1:37] Oh, and did we mention that if you let us know you've completed the challenge, you'll be entered to win a number of prizes from coffee to gift cards. Stay tuned to learn more.

Dr. Agnes Wong [2:08] How I got involved in research in the first place. I think that actually started back in how far should I go back, perhaps maybe starting to undergraduate actually, because at that time, I was studying Boston University. And in order to graduate with the highest honor, they call it Summa Cum Laude, I have to do a thesis in my fourth year undergraduate. So at that time, I decided, I actually did not know what research is about, but I want to get higher score. So I signed up for this kind of thesis requirement. So at that time, I was actually working in the Massachusetts Mental Health Center, to look at diagnosis and to look at physical diseases in psychiatric population basically. So because I have a first taste of research and I found it, I like the troubleshooting aspect, because the supervisor can help you. But at the same time, you really need to kind of like roll up your sleeves and do the work. So I find that aspect to be quite interesting. Then again to medical school, and then research become very interesting for the summer as a summer job because, you know, I need to make some money for the summer. And at the same time that while I might as well you know, do something that will look good on my CV. You know, this is also practical perspective for all type A right? It's trying to get achievement. But because of that, I realized that I really like research. So that's I continue to research in medical school. And then finally, when I was in residency program, I took up the opportunity to use my last year of residency to do a PhD. So that saved me one year, my PhD. And at that time I worked with a world renowned neurologist, Dr. Jim Sharp, who is just a really wonderful supervisor, really got me interested in neuro-ophamological research. And that's why I decided to go to do a PhD with him. And that's how I started to carve my research career.

Marija Zivcevska [4:05] Wonderful.

Grace Jacobs [4:06] Where did you go to medical school?

Dr. Agnes Wong [4:07] I went to medical school at McGill University, and then I came to University of Toronto for ophthalmology residency, and then did my PhD with Dr. Sharp in neuroscience. And then I did my final training in pediatric ophthalmology clinical fellowship at Washington University in St. Louis. Yeah, so that's, I have been a professional student till I was like 35 years old.

Marija Zivcevska [4:36] So Dr. Wong, what made you choose an ophthalmology residency?

Dr. Agnes Wong [4:39] Very interesting. During medical school, you actually get exposed to many different disciplines through different rotations. And for some reason, I just get drawn into the eyeball because I have a simple mind and I thought, well, the eyeball is actually just the eyeball. There are only so many layers of the eyeball. I found it to be be easy to manage, but then it came full circle because when I decided to do neuro-ophthalmology, as you know, as a fellowship, as my PhD, as well as my career it's actually you have to go back to really understand other brains circuitries and neuroimaging all these things. So what I thought was simple, it turned out to be actually extremely complex. But that is actually kind of the kind of the magic or the fun of being in medical science is that as you explore different things as a while, there's more, there's more and more and more, you know the more you know, what you don't know, right? So is really fascinating in that respect.

Grace Jacobs [5:39] Wonderful.

Marija Zivcevska [5:39] You have a very rich and diverse traditional research background. So we just wanted to know a little bit about that, kind of what you're working on right now, what you've worked on in the past.

Dr. Agnes Wong [5:49] My clinical training is a neuro ophthalmology and in pediatric ophthalmology. So my research is primarily targeted at these areas. So the way I look at it is by virtue of being a clinician scientist, what is most amazing with this is with this kind of career opportunity, is that I'm able to bring a clinical question into the lab and answer the question with scientific evidence, right? So it's driven, it's always driven by clinical questions. So early in my career, my research focussed on eye movements, so different kinds of eye movements, and to understand the brain. Basically using a disease model, like a brain disease, studying the eye movements, the abnormal eye movements in order to infer the normal functions of the brain and the brain pathway. So that was an earlier kind of a research endeavor, especially when I was doing my PhD. So that was the main focus. And then as a graduate student, this is what you experienced as your science matures. As you finish your graduate studies. Then very slowly, slowly, you'll see different opportunities or different interests will start to attract you. And then you may start to shift gear a little bit, and many, many people, actually most mature scientists will have that shift in focus. So for me from eye movements, I shifted to amblyopia research. Amblyopia mean, lazy eye, lazy eyes, and lazy in turn means like decreased vision in one eye, which is kind of related, you know, because I'm fundamentally very interested in brain plasticity and neural mechanism of different diseases. So lazy eyes is actually a brain disease from misuse or disuse of the eye early in childhood. So this is kind of related to my clinical practice and my fundamental interest in brain plasticity. So we did a lot of work in amblyopia, looking at how in lazy eye doesn't only affect vision, but also affect other areas that you might not even imagine. So it affects vision, it affects eye movement, it affects eye hand coordination. Right? So we've shown that in people with amblyopia, their reaction, but not so much reaction time, their reaching movement, for example, is slower, deceleration is slower, because they have more uncertainty in the visual target. So they have to slow down and alter to reach the same accuracy. So we can infer from that from a real life perspective, many parents complain about the children being less coordinated than the other siblings, or they're not very good athlete, etc, that might actually be related to the poor vision that's affecting their, you know, the daily functions from a day-to-day point of view. And more interestingly, we also found that, believe it or not, lazy eye actually affect hearing. You actually hear less, you know, in terms of localizing where the sound comes from you actually is more inaccurate in doing that. And through that, you know, the practical implication will be 'Oh, wow, actually, there might be significance in the real world'. One example I like to use is cannot corroborate with if I'm a scientific, I don't know. But like, you know, remember, in dictation, we always asked, you know, children or students do when somebody dictates something, but also not only listening, but also look at the movement, right? Because it is combined both the sound and a sight together in order this is called multi sensory integration, having two sensory modalities increase accuracy of what you want to do, right. So you could imagine you have somebody who have poor vision, they're not able to use the modality also affect the development of the auditory ability to listen carefully because they're not in the sink anymore. Right? So the localization is also affected. So maybe that's why children have reading problem with amblyopia. That may be one explanation, right. So I just think, you know, I'm very fortunate in going into amblyopia research is really, really kind of fascinating to be able to discover that while actually, as an ophthalmologist, right is that 'Oh, actually treating amblyopia is actually beyond vision'. There's so many other real life implications. And that's something that is really interesting. And then at the same time after, so I'm still actively doing amblyopia research. And as a neuro ophthalmologist, another area that caught my attention more recently is how pupils responds to light. We call it pupil arbitrary or measurement of pupils, how the light, how the pupil responds to light, and using that pupil's response as a signature to tap into some brain mechanisms. For example, there is a newly discovered class of photoreceptors beyond rods and cones, and they are called intrinsic or IP rGc, or intrinsic photosensitive retinal ganglion cells, it's a newly discovered class of photoreceptors that we're only discovered, you know, about a decade ago. And we're able to kind of look into this class of cells and their relations with the pupillary response. So using this technique, we're actually looking, at the moment we're asking some really fundamental basic science questions. But the implication will be that we will be able to adopt this and Marija is doing this good work here. So adopt this technology, as well as a new cough psychophysical measure, to help in a clinical situation. A prime example that Maria is working on is people with migraine. Many people that have migraines have as a main symptom, as being photophobia, are sensitive to light. So by using this new technology, and this new kind of information about this special class of photoreceptors, we're able to explain this phenomenon of photophobia in migraine, as well as many, many other diseases like concussions and many eye diseases also have photophobia as a key symptom, and sign. So that's why it was fascinating. You know, every time you think about research is like there's no end in sight, because like every time you discover something, or you find something that you have to you know, and then you want to do something to pursue it just really, really so exciting about this. Very exciting.

Grace Jacobs [12:17] You've integrated mindfulness into your clinical practice. How did that come about? And when did you really decide it was important enough to bring into your daily work?

Dr. Agnes Wong [12:24] Ah, about mindfulness. So there's a bit of a story also. And so about six years ago, I kept coincidentally, you know, discovered a book, which is called Mindfulness. And the title is called something I couldn't remember the title exactly, is something about frantic life, etc, I actually gave a copy to Marija. And it is a mindfulness-based cognitive therapy book. But it's a self guided eight weeks program modified from what we call the mbct is an eight week course to do on our own. And being a Type A being a very disciplined person, of course, I set my mind to do it, I follow the eight weeks program. And I found that even during that eight weeks without any really instructor, but constantly you read on your own, you follow the mp3, you know, in terms of a meditation, it actually started to change my life. And, and the very clever way, when they talk about the eighth week, you know, what is the program for the eighth week, the clever way that they say is the eighth week is actually for the rest of your life, you will continue of this, you know, practice. And on that day, I decided that, you know, I have made I have seen the changes in me. I said 'Okay, I will continue to do that, you know, hopefully for the rest of my life'. And then that's how I got introduced to mindfulness and then the over the last six years, so I just continued to do the practice, and realize that it continued to kind of open my mind, I think the main thing, if you ask me about mindfulness, of course, there's different definitions. But what for me, what is most important about mindfulness is really open my mind to different perspective, perspectives I've never think before or look at before. And also expose many of the unexamined assumptions, I call it my own unexamined assumptions of biases that I carry myself, without even knowing it, or around and in mindfulness, but being aware of your own thoughts, and your feelings, allow you to realize that 'Well, actually, there are many different ways to look at the same thing'. And that really, really opened up, you know, your curiosity and your mind, which in a way is very similar to the scientific paradigm, right? You have to kind of keep an open mind when you have findings that is contrary to your hypothesis. You need to kind of think about what this alternative, you know, explanation, you know, what else am I missing here? So from that point of view is actually I found it fascinating that we can combine an ancient wisdom tradition with our modern scientific paradigm. I found it really, really fascinating and it made changes in my life.

Marija Zivcevska [15:09] So speaking of broadening your perspective, how would you say this has changed your relationship with your patients and your colleagues?

Dr. Agnes Wong [15:19] I think, in a very subtle way, I think my colleagues and patients may not have noticed, or they might actually have noticed, because nobody tells me you know, what they think. But I think in a subtle way, or maybe not so subtle way, there are changes slowly, like, it's not like a sudden change, right? If you don't want things to be to like sudden because to sudden means you may be too excited, and then you will maybe become too one sided, right? So but I what I describe is the slow shifting of the perspective and slow shifting of your interactions, for example, with patients. I found that when I'm being mindful, when I'm really fully aware, and being present with the patient, I was able to establish a stronger relationship with them. I don't look at them as an eyeball and map this is like my specialty I look at usually in the past, perhaps, maybe I'll always have oversimplified maybe my colleague will not agree with it. But at least for me, I tend to look at the patient coming as an eyeball, what's wrong with your eyes, I would like to help your eyes. But now being more aware of that there's actually a whole person in front of me and especially in a pediatric settings is also the parents and the families in the same room with me, I'm much more aware of the presence and much more interested in understanding what they are going through from the eye problem and even beyond eye problem. And then we can work together. Well, sometimes you know, what, just by listening, even listening for 30 seconds, fully listening, the patients and the parents know, they can feel that you you understand them, you might even though you might not find a fix for them, they really appreciate it because 30 seconds or one minute of really attentive listening is something that they have not perhaps not experienced in many doctors office. So that's really kind of changed my interaction with patients that makes me even more more meaningful for me when I encounter a patient when I, when I interact with a patient is more meaningful for me as a physician, so I know that I'm taking care of the full person and I have more enthusiasm going to the clinic to see patients. And also, you know, if you talk about colleagues, I think that quality, again, just the act of listening, you might not be able to offer any solutions or fix any problems for them. But they really, really appreciate that kind of just that quality of fully attentive listening, so I cannot emphasize it more, because I found it just to be so satisfying for both me and for my colleagues and my patients.

Marija Zivcevska [17:55] It's amazing.

Grace Jacobs [17:56] How did you get interested specifically in pediatrics, and pediatric ophthalmology?

Dr. Agnes Wong [18:01] This actually is based on experience in the sense that when I was doing my regular ophtamology residency, we have to do basically a full year in pediatrics rotation. And I just found dealing with kids to be so much fun, you don't have to wear your white jacket number one, like as in other like as in the adult clinic, and you fool around with children, you can joke about things and you can ask about 'hey, how is your summer, you know, are you gonna do your summer camp', etc, you can really relate to them and have some fun, and parents appreciate you being having fun with them too, right? Whereas with adult sometimes, you know, they might not appreciate your humor, and you have to be more serious about things right. And I just really like, that aspect of the playfulness, you know, at work, you know, just incorporate some playfulness, not taking ourselves so seriously, you know, even though we're supposed to be an expert, but that doesn't mean that we cannot be playful and you know, come meeting the person where they are. This is the perfect example of meeting people where they are respecting and honoring their individual, right is like, oh, a child, you know, you meet them where they talk about things as interesting to them, rather than talking down on them, etc. So that's actually the biggest draw for me is I enjoyed the interaction. And then second major draw was there was a visiting professor who came to Toronto and he became my fellowship supervisor in St. Louis, where I did my fellowship training. He is a prime example of a clinician scientists who answers clinical questions. He looks at cross eyes in infancy. And he is one of the world's expert in this area using animal model. And when he came to give us a lecture when I was a resident, I was just completely drawn into his work, and that's why I said, oh, wow, actually, I'll be interested in working in this area. And that's how I chose to do pediatrics.

Grace Jacobs [20:01] So how is mindfulness currently integrated into the healthcare system and medical schools?

Dr. Agnes Wong [20:07] In the healthcare system, I think as part of kind of a wave of acceptance as my mindfulness becomes more like secularized and become more mainstream, I think it's part of that wave. I think healthcare is slowly kind of like accepting mindfulness as a way of being. You ask somebody, would you like to be more mindful? I think everybody was in 'Yeah, I would like to be more mindful'. Right? So think in that regard, there is more interest in mindfulness in the healthcare system. And then the I think the issues with healthcare is that because we usually work in a very high pressure situation, and because of that high pressure situation it's actually very difficult to be mindful. When your mind is full with all kinds of pressures, all kinds of things you have to deal with, it's actually really hard to pass without one second to be mindful. So I think, even though there is an interest, or there's increased interest in health care in incorporating mindfulness into healthcare delivery, but because of the nature of the high stress, high pressure situation, it is challenging to bring that into into the healthcare system,

Grace Jacobs [21:20] You always have to be reacting instead of practising to think before you react.

Dr. Agnes Wong [21:25] Exactly, exactly.

Grace Jacobs [21:28] Building on that, what do you think is required for a systemic change? And how receptive do you think health professionals are in terms of actually implementing a mindfulness program or a mindfulness practice?

Dr. Agnes Wong [21:40] We can talk for hours on this question. So how can we make the system change is the first question, right? You know, honestly, I actually do not know the answer. I think my journey so far, is really trying to search for the answer. And I don't think, you know, eventually, maybe there's actually no answer. I think to effect system change. One thing we need to remember actually, from even from system theory, point of view, which is also very aligned with the Asian wisdom tradition, is to remember that a system maker for many, many different parts, that can be a big part, smaller parts, and each parts plays a role. And they're all interdependent, they're all interconnected, right, in order to function as a whole. So my way of thinking right now is that although I might not be able to influence, you know, in the sense of like, I cannot, you know, make a culture change, or it will take a long, long, long time, or a lot of effort. But one thing we need to remember, and I think this is what I follow is that we, as an individual is a part of the system. And we can always start with ourself. Right, we might not be able to make changes and change other people's life, but by changing yourself first, in what you believe is the right thing to do, will have this intangible effect or ripple effect on others. And I truly, truly believe in that. Imagine, if everyone takes up that individual responsibility to make the change in the system, that the system will change, you know, in order to encourage myself I always go and say 'Agnes, you know, what, don't underestimate the ripple effect'. You know, you just don't know what one word you're after, or even one body, the gesture or one active listening, make an impact on one person, and this person, in turn will make an impact on many, many other people could be right. So this is something that, you know, when I have discouraged moments, then I will use that to remind myself that, hey, don't be discouraged, you know, because you never know what your impact could be.

Marija Zivcevska [23:49] I think as mindfulness is becoming more and more accepted, it's very clear that there is a huge potential for positive change. But how do we make that change sustainable over a long period of time? What would you say?

Dr. Agnes Wong [24:01] I don't think there is a concrete answer to that. What I'm concerned about and sometimes about the mindfulness, you know, you want to call it movement, as is exactly as you say, is that I'm worried that sometimes it become a fad. In a New York Times this maybe is Sunday, New York Times two weeks ago, there was a opinion piece by researcher in in a state saying that, well, you know, the mindfulness industry purported that it will increase productivity, but her research showed that it actually decreased people's in organizations cooperation. It decreased people's motivation, because mindfulness emphasizes acceptance and equanimity. And then when you're, when you're accepting an equanomist, then you don't have the drive to make changes and make progress, right. That's why there's always a risk of becoming a fad. When people just use it as a tool, right. As a tool to more relaxing or more happiness, when the way I look at it is, is really fully embodied as a way of life. Because if you really, really experience mindfulness in a deeper sense, it is not a chore to achieve some goals, it is just being, it is just being. So having that emphasis is very important. And that deep practice, this deep meditation practice on a daily basis, and I don't mean sitting on the cushion, I mean, just having the orientation of incorporating this practice into our daily life as a way of being, it would naturally bring the sustainability. But sometimes I wonder whether, you know, because in order to appeal to the largest possible number of people, sometimes this gets diluted, and then it becomes a fad. And then once it becomes a fad, and when a fad fades away, people will then classify mindfulness as one of these many, many other self help tools, right. And I, I really don't want to see this becoming categorized into something like that in the future. So that's why I think from a community point of view is very important to really rethink about what are we trying to do? Right, I get I don't have an answer. You know, and I'm actually quite new to this area, too. But I think there are some very deep questions that we need to think about, you know, as to why we have been doing this is is just a means to an end. Right. So.

Marija Zivcevska [26:34] So if we're talking about reservations that some people might have to mindfulness and especially professionals, as you mentioned, there could be negative effects that are associated with this practice. If it is treated like a tool, if it's treated like a transient way to solve a problem, rather than a general perspective and way of life, do you think that there should be some sort of incentive for professionals in order to try it out in the first place?

Dr. Agnes Wong [27:03] You know, if you ask specific about professionals, I think the way the mindfulness again, movement, I think is actually in a way is a very, very clever, because there has been like lots of like signs, right? They really combine a lot of sciences and having scientific evidence to show that, you know, mindfulness will bring you more stability, more, you know, better attention, etc. So I think, by using science, which is kind of something that is dominant in our culture, as a tool to prove that mindfulness is useful, I think, is a very ingenuine way of encouraging people to explore mindfulness. At the same time for professionals, because our society is so ingrained in the scientific principle is very appealing to the professionals, like if you talk to doctors or healthcare providers, or graduate students, or I don't mean to be, you know, exclusive other people. But in general, having this kind of very strong scientific background with scientific evidence, really sells mindfulness for them well.

Marija Zivcevska [28:05] And validates it.

Dr. Agnes Wong [28:06] And validates it very well, right. But at the same time, I think if you want to think about professionals, we also tend to have the paradigm of separating the body and mind and to find quick fix, right? You know, if a patient shows up to my clinic, my first inclination is, how can I fix this problem? Because we're so real, so oriented to fixing, then coming back to the same idea is then is very easy to fall through the trap of, again, using mindfulness as another technique, hey, I have something in my pocket now in addition to psychotherapy, or in addition to pills, and medicine, and surgery, etc, oh, I have one more, you know, pills for you called mindfulness, right? And that's when we need to be really, really careful about what do we actually want mindfulness to play in a society? Is this just a quick fix? Is it just another self help, you know, thing? Or is it again, a way of living. But to be able to embody mindfulness as a way of living, it requires time investment, it requires self awareness. It requires you to really look inside yourself and including the ugly side and the dark side and stuff. And it requires courage and being again, in a high pressure kind of a professionals situation, you might not have the time, right? Or you might have different demands on you. Or you may actually not have that self awareness, because of all our trainings is like you know, as a doctor, you know, we always even day one when you declare yourself as you want to be a doctor, you just follow all these steps, right? climb up the ladder, ladder, ladder. Many of us, I think, never developed that self awareness or that self introspection. To really look deep inside. So even if we willing to spend a time, or relieve, you know, the demands on you, but we might not have that skills, a self reflective skills and respective skills, or the courage to really look inside, to look at mindfulness and to look at once you see the essence of mindfulness, whether you want to embody it as a way of life, right? So is a very, very deep questions that, you know, I think about all the time, no answer. But it's not as simple as you think, right? It's not simple as you know, as simple as a fad. You know, just do it right, there is a really deeper and deeper, it really makes you examine, you're down to the core of who you are. And that makes it that's what actually that's where is fascinating about because really, really deep, deep, deep inside, right.

Grace Jacobs [30:50] So we're doing really interesting scientific studies to find like the benefits of mindfulness as a way to validate it, but also, in a way to kind of sell it. And so I think we've kind of figured out ways to sell it to kind of professionals who definitely need it. But we're not capturing the essence of it when we do sell it. And so building off of that, what would like where is mindfulness applicable? And also, what are the limitations? And do you think that we need to be careful about labeling it as a blanket solution?

Dr. Agnes Wong [31:20] That's a very loaded question. There's so many tentacles, I can't answer this question. In the one thing that I always found challenging in terms of using scientific evidence to support mindfulness is the idea of our quantitative signs kind of orientation, quantitative research, meaning that there's something that is measurable, right, you have this outcome measure, and you're tested against dependent independent variables, your outcome measures to actually measure it right. So the question will be, how do you measure compassion? How do you measure human flourishing? A lot? How can these things be measured? Right? But we all know what they are, when we talk about it, when we especially when we experience a moment of kindness. When we experience satisfaction, or fulfillment, we experience it. But how can you quantify it, something that cannot be measured doesn't mean that it doesn't exist. And that's why when Elli, my other PhD student approached me and do mindfulness research. And when she decided to change from a mixed method to a purely qualitative research design, it was kind of like an eye opener for me. Because number one, I was not a man don't even know what qualitative I still don't really know what qualitative research is. But my eyes were opened, because suddenly I realized, oh, there's actually another equally validated methodology out there that have used this kind of thinking and say 'How can we use our experience as a valid exposition of what we're trying to investigate?' Right? So I think this area, I'm still learning, I'm new. But actually, there's another beauty of working and again, accepting is actually I learned from my students I learned from Marija right, I learned so much from the graduate students, and my trainees, and you know, they learn something from me, it's a two way street. And that makes academic career to be so, so, so fulfilling, it's this wonderful is a really two way, you're always a student, right? So coming back to qualitative research, right? So the qualitative research, allows you to kind of capture this kind of experience, which is also grossly missing, grossly lacking in mindfulness research. So hopefully, by using a pure, a purely qualitative approach, will be able to expand mindfulness into not just quantifiable measures, like right now, the most common thing is just convert something into a scale, right? Like a scale of one to 10. How do how compassion do you think you are raised yourself? whatever number right, and it's so subjective. What does that number mean? Because a qualitative research will allow you to tell me, for example, describe a story when you experience kindness from someone, just write it for five minutes, write it down. And what you will tell us will resonate, that experience will resonate that language, use of language and thought resonate with another person so that the person actually feel what you're experiencing, rather than a number, which doesn't mean anything. So I think it's very important to combine both quantitative qualitative research into mindfulness research. And the last question you have about mindfulness is how do you make sure that what what is it again,

Grace Jacobs [34:52] Labeling it as a blanket blanket solution

Dr. Agnes Wong [34:55] This is a very important question because personally, I don't I think mindfulness is the answer . It's not. Obviously, if you have an open mind, then you just say, No there are actually so many other things that must be there to incorporate as a way of being. Mindfulness being just one of the doors that just like when you go to the gym, some people will gravitate to elliptical machines, some people gravitate towards weights, but they're equally good in terms of having a good workout, right? So whatever work works for you, you should go for that. So mindfulness is one of these things, I don't think that the whole world should be everybody will be chanting and meditating all, you know, is not that we would not be honoring our diversity, right? So what is that balance between honoring our diversity, and at the same time, allowing each of us to flourish in our own way. So I'm currently for example, exploring very many different kinds of approaches. One approach that I find it very fascinating recently is something called Narrative Medicine, which is basically very similar to quality, is one of a kind of qualitative research prose is through basically, the gist of it is a very, relatively new branch in medicine. It's about 20 years old that's why I only heard of it a few weeks ago, when I took a workshop on it. The idea is through storytelling and sharing in whatever literary form, it also requires a lot of awareness, a lot of being present. A lot of introspection, a lot of self reflection. It's not mindfulness. But it shares a lot of common, common ingredients as mindfulness. And for that it actually might be more appealing to some other some people that may be another door, right? So it's not a one size fits all thing I don't really think it should be. It shouldn't be one size fit all.

Grace Jacobs [36:53] Hi, Ellie, thank you so much for joining us. How did you first begin your mindfulness practice? And what was the journey that led you from practicing it personally to wanting to do a PhD focusing on it?

Elli Weisbaum [37:03] Really interesting question. You know, I meet a lot of people who have come to mindfulness maybe because it was recommended to them by a clinician or they read a random book. I have a very different way that I got here, which is my parents, my dad's a physician, and my mom is a theatre director. And when I was 10 years old, they decided that we would go to a Family Retreat being led by someone named Thích Nhất Hạnh, who's a Zen Buddhist monk from Vietnam, who was nominated for a Nobel Peace Prize by Martin Luther King, and has done a lot of work translating mindfulness practices, into kind of everyday secular spaces. So there I was, 10 years old, we got in a car, we went to our first retreat. And it was actually a funny story, how we got there, I had like a really important sleepover with friends, that was happening on the second last day of the retreat. So actually, as a family, we had a whole like, discussion about what to do. And we agreed that we would go, but my dad would bring me home early for the sleepover. So it was a whole, a whole other story. But that was my first time actually practicing mindfulness and meditation. After that, you know, as a young child, you know, it's a lot of fun. It's kind of more like a retreat kind of feels like camp, because you're there. And people are practicing mindfulness, and you're doing some mindfulness. But you're also like running around playing games with other kids. But I think it was when I was in my teens that I came back from a retreat. And I was talking with some of my girlfriends, and at the time, the girls were being so nice to each other, we were doing a lot of like talking behind each other's backs and gossiping, and things like that. And I remember listening to one of my friends, and I could hear that she was really suffering, she was sharing about a difficulty she was having with another teenage girl. And in that moment, I remembered what I had been trained in at the mindfulness retreats, which was how to speak and listen with compassion. And it kind of hit me in this moment, as a 15 year old, I didn't have to tell her, like, let's practice mindfulness, I could just apply this skill that I had been taught of compassion to the situation. And it really changed how I interacted with her, how much of her like suffering and the whole situation I took on. And I started to see that this kind of mindful communication was having a really great impact on myself with my friends and on my relationship to my parents. And so, on a personal note, it really clicked for me, like, wow, this is a skill set that's really valuable. I didn't start really sharing it out loud, or doing anything like that. It was just kind of using it in my own way with my parents, and then with my friends. But then as my life continued, I went on and actually worked in the film industry for a little while, I have an undergraduate in arts. And again, I was in these spaces where people were really stressed and having these terrible times. And they thought, you know, I missed the skill set this thing that I think is really important for life to be happy. And so I went back and did a master's and I did research around the application of mindfulness and healthcare. And I started thinking like, how do we actually translate this, how do we make this something that has fidelity and feasibility in a way that can be applied, you know, beyond just my personal circumstances. And so bringing it in as a researcher, specifically in education at that time started to make the shift in terms of how I related to it, not just personally, but professionally. And so I guess that's kind of how the trajectory has got me to here.

Grace Jacobs [40:21] How much time was there between your masters and beginning your PhD?

Elli Weisbaum [40:25] Yeah, so I completed my master's and actually took two years off. In that time I worked for, during my master's I studied bringing mindfulness into educational settings, looking at the impact it had on learning on communication. And I did that work with Thích Nhất Hạnh's community. So I actually went into schools in Bhutan and in India, and then the UK, applying mindfulness within school settings, with a bunch of monastics from Plum Village, which is Thích Nhất Hạnh's community, and then with some also researchers, and after that they hired me. So I worked for a year as the international program coordinator for their schools program, and started going into universities, elementary schools, working with teachers, parents, and different stakeholders to bring mindfulness into education. In that time, I was in Toronto more while I was also working for them internationally. And when I was here, I got hired as an instructor for the Continuing Education faculty at the University of Toronto, to teach in their mindfulness certificate program. So I spent some time really working on the translation, kind of diving into the practical side of delivering mindfulness, organizing retreats, facilitating retreats for young adults. And then in that time, decided that I wanted to come back and continue the research.

Grace Jacobs [41:35] And as you've become kind of more of a teacher and an advocate of mindfulness, how has your personal practice changed? And have you felt kind of pressure from kind of building a lot of a lot of your life at this point around it?

Elli Weisbaum [41:48] Yeah, no, it's really interesting. When you see kind of different components of your life coming together. Personally, I've really enjoyed it. But I think there's always this question that comes up, like how do we separate our personal and professional life maybe to be productive, or to feel like we're being the professional we're supposed to be? I think something that's interesting, when you practice mindful awareness is you kind of come to the understanding that you are yourself wherever you go. So well, you want to kind of hold up the professional norms, you're not going to like walk into a certain space and share all about what you did on the weekend necessarily. But I also think that who you are as a human being, you know, your skill sets, your ethics, your values really impacts you everywhere. And so for me, mindfulness is kind of this great thing that underpins my whole life, in terms of who I want to be how I approach situations, take that Hạnh's brand of mindfulness, as we call it engaged mindfulness. So it's more than just sitting on a cushion with your eyes closed, which empirically has been shown to have amazing impacts on the structure and function of your brain. Um, but to allow it mindfulness to kind of permeate into how you speak and listen. And it's really like a lens to see the world through. So I guess, for me so far, the journey of bringing it into my kind of what I call, practice, work and play across my life has been really fulfilling.

Grace Jacobs [43:05] Before we go any further, perhaps we could talk about the variety of types of mindfulness and types of practices. Maybe you talk a bit about how mindfulness is defined.

Elli Weisbaum [43:14] So how mindfulness is defined is a great question. And the field is really emerging and growing at this time, in terms of the translation of mindfulness practice into Western spaces, clinical spaces. And you know, there's a tricky thing with that, which is there isn't necessarily one agreed upon definition of mindfulness. So when you're submitting a research proposal, for an RAB at a hospital, for example, it would be really handy to have one single definition. There's a few that are quite popular out there. So there's, you know, a precedent to be set from research that's been done specifically Jon Kabat-Zinn's work with Mindfulness Based Stress Reduction (MBSR), there's some nice definitions in there. But the kind of knowledge translation of these traditional practices into secular clinical spaces is very much alive and happening. So when we talk about definitions, or when we talk about types of mindfulness, there's a lot of different answers that could be given. And I think as a researcher, it's actually really interesting moment because I have a chance to add to the kind of theoretical and methodological significance of the field by really looking at what precedents have been set, and how are we going to define things moving forward.

Grace Jacobs [44:24] In terms specifically of types of practices and kind of misconceptions about mindfulness or when people hear the word mindfulness?.What are the most common misconceptions you kind of hear, and also, a little bit about, there's so many different ways to practice mindfulness, walking, eating, and just kind of being able to integrate that into a lot of your life. Whereas I feel like often people think of just sitting down trying to think of nothing, which is not necessarily how mindfulness can be defined.

Elli Weisbaum [44:53] Yeah, and I think you just touched on it right there. One of the big misconceptions is that mindfulness means clearing your mind of all thoughts. Which from like a scientific perspective is like, I don't think it's possible. And so then you're really setting yourself up maybe for some disappointment and failure. If mindfulness means total emptiness. What I would say is, again, we often also think that mindfulness means sitting on a cushion, or in a chair with our eyes closed. And that, as I said, is a really great thing to do, having some sort of what we would call maybe a formal or dedicated practice where you're spending 20 minutes a day, maybe in an awareness practice, which would be paying attention to your in and out breath, you know, noticing thoughts as they arise, and then putting them down, or what we might say, noticing distractions as they arise and then returning to the breath is a very kind of practical, almost, we would call it like going to the gym for your mind, like you're strengthening your ability to focus your attention. And so that kind of a dedicated practice is often what people imagine when they think of mindfulness. And it certainly is a great component, as I said, great empirical studies around the direct impact of that on the function and structure of your brain. But also, we don't want to limit the practice of mindfulness or even the practice of meditation to this one thing. And so the kind of tradition that I come from, my training background in engaged mindfulness is all about, where does it play out in your life? How does mindfulness meet you where you are? So you know, you mentioned walking meditation, we could take the same principles of an awareness practice, bringing our mind back to a sensation of the breath, as a say, an anchor, allowing our mind to focus on the present moment. So really training our attention or our ability to attend to the present, which is basically not having our mind wander to the future or the past. We sometimes say the default mode network is like really useful in some situations, but also is there to help us mind wander. And so mindfulness can also be seen as attention training. And what we're doing is training our attention to be in the present moment. And that kind of attention training can happen while you're on a walk. It can happen while you're, you know, dancing. So there's all different places that you could kind of do this mind training that isn't necessarily sitting alone on a cushion.

Grace Jacobs [47:07] With yoga, too?

Elli Weisbaum [47:09] Yeah, and there's also components in yoga, sometimes I say to people, you know, there's a lot of things we do that are already looking very similar to a mindfulness practice, if we do a sport, something that pulls in our full attention. But I like to sometimes say like, level it up to a mindfulness practice by adding intentionality. So just because I'm focused on the present moment, doesn't necessarily mean that I'm doing a mindfulness practice, it does probably mean that I'm training awareness in a specific way by attending to something very specifically. But maybe to make it a mindfulness practice, I can do that by being aware of my awareness. Not only am I attending to the here, and now by being focused on my dancing or my hockey playing, but I've intentionally decided to do that. And I'm aware that I'm doing it. And that awareness of the awareness is kind of where we see a lot of the long term benefits for what we would call like an expert or a long term meditator.

Grace Jacobs [48:00] So you've kind of started to touch on this as well. But could you talk a bit about the research that's out there in terms of the neuroscience and neural circuitry involved in the effects seen from or related to mindfulness?

Elli Weisbaum [48:11] Yeah, so it's really interesting, we've seen a kind of exponential growth in peer reviewed journal articles. If you do a search of PubMed, you'll just see this kind of clear indication that there's a lot more research coming out in this field. And when we look at what is being researched some of the main areas that people have kind of dived into things like looking around neuroplasticity, so trying to understand the kind of changes and functional and structure of our brains that are impacted by attention based practices, we're seeing a lot of research come out around the default mode network. So specifically, you know what some people will call your mind wandering network. So how does mindfulness impact our ability to have more control over that network. We're also seeing greater connectivity between expert meditators and parts of the brain that monitor and modify. So in terms of our executive function, how is that impacted on a structural and functional level by people who experience meditation. We're also seeing some interesting research around empathy and compassion, looking at what networks in our brain light up, when we actually experience another human beings distress, versus when we are having a compassionate response, maybe an observer, an observational response that allows us to be more engaged and have more pro social behaviors. So we're seeing a lot of research kind of across all these different levels. Also some interesting research around pain networks, and looking at what lights up in our brain in relation to other people. And then in terms of in groups and out groups, if we're looking at how do we kind of create more pro social behavior, we see that people who have maybe a lower set of empathy for another group if they feel like they're an out group can actually through meditative practices like a loving kindness practice, a just like me practice where you're working on understanding that people are the same as you through meditation can actually increase your pro social behavior in terms of your in group out group responses. So there's a lot of different things. One other study that I really like that was done was looking at anticipatory stress, and how long term and expert meditators; if they have, say, a shock, painful shocks going on over every, like 15 minutes, we'll have lower level of anticipatory stress, knowing that another shock is coming, versus a non-meditator continues to have their salience network very activated in between and this has some really practical potential applications, because all of us have stressors coming up. We have an exam, we have a big proposal. And if we don't know how to monitor and regulate ourselves, really self management, then we may have our salience network activated, you know, two weeks out three weeks out, like how much anticipatory stress do you have to have when you have to go through the difficulty anyway. And so around exams around job interviews, there's a lot of potential applications kind of coming from the research.

Grace Jacobs [50:58] For people who are interested in finding out more about kind of the science behind mindfulness and what we do know about it, do you recommend a review or place to find that information?

Elli Weisbaum [51:08] Yeah, there's some great books out there, when that came out recently in 2017, is called altered traits. It's by Richard Davidson and Dan Goleman, two of the leading researchers in this field, it's a really easy kind of fun read. But they give an amazing overview of basically all the research that's come out. And also really explicitly share where the problems are within mindfulness research, you know, you have an emerging field, people want to say that it's all good. And so there's a really nice review of what's come out that is really empirically viable, and also some critiques around where as a field, we need to be careful for the claims that we're making, so that we can kind of keep up our sustainability and rigor.

Grace Jacobs [51:47] Coming back a bit to your research, would you mind giving a quick overview of your project.

Elli Weisbaum [51:52] So I'm currently in my second year at IMS, and I've just finished my qualifying exam. So doing a kind of halfway defense

Grace Jacobs [51:59] Congratulations!

Elli Weisbaum [52:00] Yay, um, it was actually really fun to get a whole bunch of people in a room and like, share what I've been thinking about and typing about in the library and actually get feedback on the spot. So it was a great experience. So we're going to be conducting a five week mindfulness training program that's specifically tailored for physicians, and based on the teachings of engaged mindfulness by Thích Nhất Hạnh. And we're going to be doing a qualitative study, using semi structured interviews to really dive into what the lived experience of participants are. And our kind of aims and intentions behind this are really to look at physician wellbeing in burnout, which in recent years, there's been a ton of publications coming out around this crisis that physicians are facing. Some numbers coming out from the Mayo Clinic in terms of levels of depression, suicide and difficulties being faced specifically by fully licensed physicians. And so we're going to be focusing on them as our population and really asking this question 'What impact does mindfulness have on their lives?'

Grace Jacobs [52:57] So what are some challenges that you face so far, both expected and unexpected? Are you finding that there's resistance to your project? And what exactly are people's reservations and how are you trying to overcome them?

Elli Weisbaum [53:09] So one thing that I've been hearing ever since I had the idea for this study is that you're going to have trouble getting physicians to commit their time to something like this. There are a busy population. And so that's been the kind of major challenge that I've been told I would have. So in order to address this question of feasibility, I started in the last year doing some preliminary outreach to kind of get an idea of like 'will people actually commit to this, is there interest?'

Grace Jacobs [53:36] What, what is the time commitment, say per week?

Elli Weisbaum [53:38] So we're going to be running a five week program, and each week, participants will be asked to attend a two hour mindfulness training session. And what we're going to be doing to kind of address the busy schedules of our population is at the time of recruitment, people will have the choice to either enroll in an afternoon session or an evening session. So at the very least based on their work schedules, we'll be able to accommodate slightly. What's been interesting in our outreach. So I've been doing presentations on well being in mindfulness through the Medical Staff Association at SickKids. And I've also been doing and been invited to do division rounds. So I have presented for the Neuroscience Division, the Ophthalmology division, and I just recently got invited to present for the SickKids Center for Brain and Mental Health, which brings together a whole bunch of divisions. At each one I just closed that I was doing this research study that it was coming up, we were going to be moving through RAB, but I was just interested in knowing who might be interested in the study. So we had a sign up sheet by the door, you know, no pressure, just part of the presentation. And we've already gotten over 40 people's emails saying they're interested in hearing when we open recruitment. So, you know, we still don't know how big a challenge it will be. But I think so far the interest is there. I've had people pulling me aside after the presentations, heads of departments saying, you know, I see clearly that there is an issue of burnout of stress. I see clearly that I need skill sets and tools to better take care of myself and communicate with my patients. So the interest seems to be out there. And now it's just a question of actually getting the recruitment done.

Grace Jacobs [55:09] That's very cool. In terms of other challenges you face. So that seems like that was potentially a challenge, but ended up being, hopefully, we'll see. It's still too early to tell, but looks good. In terms of other challenges, though, perhaps, as kinda we've touched on it can be so subjective. And so trying to make that objective in a way that you can quantitatively assess.

Elli Weisbaum [55:30] yeah, so there's, you know, really interesting question, which is when you get into any kind of intervention that has to do with, like, human experience and behavior, how do you actually research that? How do you know what happened? For us part of the answer is having a major qualitative focus. We know that, you know, physicians as a population, and I've experienced this also with educators really value the experience of other physicians. And so to do these kind of semi structured interviews, as our main measurement of the study, I think, is really important, because we're really focused on the actual lived experience of participants. We're also going to be doing participant observation, so treating each of the sessions a bit like a focus group to see what actually happens when people experience this. And then we're going to be including two research scales within the study as well. So one has been a validated scale since 1981, and specifically a burnout scale that's been adapted for medical personnel, which is the mass loss burnout survey, which is NBI. And then we're going to be using the five facets of mindfulness questionnaire. And this is a survey that looks at trait mindfulness and whether trait mindfulness shifts. So it's going to be interesting to kind of put the two things together, and really go in with a qualitative framework of not having a priori assumptions, trying not to kind of put ourselves on to the subjects, but to really hear what do they actually experience. And part of the rigor around that is bringing in this idea of triangulation, where when we analyze the interview data, we bring in different perspectives, to codependently read it, code it and then come back together to discuss our findings. And a big part of this that's kind of interesting, being a qualitative researcher, is really that we don't have this idea of removing researcher bias, because we accept that when you're dealing with human subjects as another human being, you can't not be a human being. There's a famous kind of qualitative quote 'the researcher is not separate from the research', which might sound a little bit controversial. But really, you know, even someone who's studying a new drug is probably studying it, because like, they might care about the population and hope it works. It's like that element is there. But from a qualitative perspective, our real rigorous question is, how do you position yourself by explicitly discussing who you are as a researcher? And then in terms of reflexivity, how do you then mitigate that factor in terms of where you place yourself for data analysis. So for me, I have this long background with mindfulness. This give me some benefits, because I'm able to really understand the teachings, their potential applications, and listen for that when I code. But that also could be considered something that could stand in my way, I might see something that isn't there. And so that's where triangulation comes in. We're bringing in Dr. Nicholas Chadi, who's a pediatrician, who has a background in mindfulness based cognitive therapy, but also as a physician and a researcher from a quantitative perspective. And so when he reads the data and codes it, when we bring our two codings together and discuss them, we're able to kind of come to a place where it feels like we'll be able to have some really rigorous analysis. So it's definitely a whole process. But something that I think is really valuable in terms of actually understanding what human beings are experiencing and how this impacts their behavior.

Grace Jacobs [58:40] So right now, you're kind of recruiting people, they're volunteering. Do you think in an ideal world one day say you find really great results, This is really great for physicians, do you think there'll be a difference between people who willingly join the program and say, if there was like a rollout of the program to everyone had to participate?

Elli Weisbaum [58:57] Yeah, it's a great question. I mean, what data are we going to be able to collect if the population is kind of self identifying? So something that I think is really great about doing these presentations at division rounds, where you have a whole bunch of people present who maybe wouldn't sign up for a mindfulness thing is I have had people come up to me afterwards and say, I would never do mindfulness usually but that was quite interesting about the research. So I'm going to put my name down to hear about your study. So my hope is that we can have a more purposive sampling. So we will actually through recruitment be asking people about their level of expertise with mindfulness. And if we can purposely sample people into more homogenous groups where we actually choose people who have less experience, that would be ideal. So when you talk about who is our ideal population, it's physicians who are fully licensed, who have none or very little experience with mindfulness. That would be my ideal group. We'll have to see a little bit through recruitment who we get. But I think that overall, having knowledge translation and transferability to other spaces is really important. So hopefully part of what we'll be able to get at is, you know, for people who did attend, what were your potential barriers? What do you think barriers of your colleagues will be? So through our exit interviews to really find out. If this feels like it's beneficial to address physician well being how do we make it possible? And I think that's one of our main research questions.

Grace Jacobs [1:00:15] As a beginner or someone earlier, in the stage of developing your practice, what would you recommend as a place to start?

Elli Weisbaum [1:00:22] Yeah, so I think starting a mindfulness practice is an awesome thing to do, obviously, I enjoy it. But I think one of the biggest barriers can be kind of setting up bigger expectations than what is actually possible for you. So I always encourage people, you know, sometimes I meet someone, they're like, I'm gonna start meditating every day. And like, it's kind of I think you should think about it. Like if you were starting to go to the gym again, if you were like, I'm going to go to the gym every day this week, would you actually do it? And like, how discouraging would it be if you didn't? And so I like to think of mindfulness practice a lot like mental fitness, which is, you know, pick the activity that's right for you. I love dancing. So when I want to get in shape, I find dance classes. You know, you might be someone who likes to play hockey or soccer or do weightlifting. So take a look at the mindfulness practices. Is sitting practice, right for you? Walking? Do you want to try a body scan? Like, which one feels like the thing you would do if you went to the gym that would make you go and so start there. And then from that, how many times do you want to try and do it? What's like really realistic, and maybe set the bar a little low, so you can accomplish it at first, and then gently increase your mental activities or your mental fitness. So I think, for me thinking about it, like the gym, what really motivates me, and what makes me happy when I'm doing it is a great way to start a practice. And also remember, the kind of novel thing about mindfulness is it's not just about paying attention. But almost all the definitions, even though as we discussed, there isn't one agreed upon, have something like with non-judgment or kindness or curiosity. So mindfulness is not only about like doing a new task, but it's about doing a task with kindness towards yourself, which is kind of interesting. And so I think, keeping that in mind when you first start a practice and not thinking, Oh, I'm doing it wrong, or like I'm a failure, but that like part of a mindfulness practice actually means being okay with what is. And so if you include that in your mental fitness, then I think you'll be off to a good start.

Grace Jacobs [1:02:16] That makes a lot of sense. There's also some apps out there. I don't know if you have any favorites, I use Daily Habit. And I noticed you were one of the instructors on Daily Habit. I was like 'Oh, hi, Ellie'.

Elli Weisbaum [1:02:28] Yeah, you know, I think there's a bunch of great apps out there and a lot like I was saying, like pick the like mental fitness that's right for you, I would say check the different ones out. Because maybe there's like a voice of someone you really like maybe there's like a pacing of someone that you really like, but definitely like Headspace, Simple Habit. There's a whole bunch that are really get out there. And I would say just check them out. See what kind of resonates for you. Also, I often get asked, you know, people say like, Oh, it's good for like younger people. So if you're working with other populations, I did an intervention at SickKids for adolescents with chronic illness. And there's something called the MindfulTeen.com, and they have a whole bunch of great mindfulness recordings on there. And I often find that things that are good for adolescents are good for the rest of us. So that's another place that you can check out.

Grace Jacobs [1:03:13] Maybe also, if you can talk a bit about like Stop, I know is kind of something simple that people can try out and get them kind of thinking about this idea that they can really have a mindfulness practice and a lot of ways in their life.

Elli Weisbaum [1:03:26] So Stop is a great practice to kind of have in your back pocket. And I have adapted and borrowed it from the MARS-A program, which is the intervention for adolescence that I was part of written by Dzung X. Vo, who is an amazing pediatrician from Vancouver, BC. And he's written the book 'The Mindful Teen'. So it kind of outlines a bunch of really simple practices that you can keep with you and use throughout the day. And he'll refer to it as like an informal practice where you don't necessarily have to like sit in a room on your own, spend 20 minutes, but it's something that you can do, like lock yourself in the restroom at work and just like do this practice for a minute and then have a kind of easier, maybe more stable day. Something that you can do on the bus. So that kind of thing. So in the Stop practice, we basically use the word Stop as an acronym to remember four steps that we can do anytime to stop and take care of ourselves. So the S in stop simply stands for stopping. It's a reminder to put down the thoughts or the narratives that may be running through your head that day. We have a tendency to keep replaying difficult conversations we had or continuously planned for the next thing we have coming up. So the S is the reminder to just physically and mentally take a moment to stop. The T stands for take three breaths. So once we've set this intention to stop, we use the breath as a kind of anchor to slow us down to reconnect to our bodies. And so taking three breaths simply involves following the full sensation of breathing in and breathing out three times. And after that we move to O. And O stands for observe. And the O is an invitation. Now that we've kind of practiced this intentional stopping, to really observe what's going on in our mind. What thoughts are present, what feelings and sensations are present in our body? Sometimes you observe, like, there's a tightness, I didn't realize I was holding my shoulders up this whole day. And just to really observe, again, with kindness and curiosity, what's going on in our mind and bodies to get some data on ourselves. And then the final step is the P. So P stands for proceed. So before we open our eyes, or continue with our day, now that we've done, the stopping the breathing and the observing, you set an intention for how you want to proceed, perhaps you want to go a little more slowly, maybe you want to just be a little kinder to yourself for the rest of the day, maybe you have an intention to not check your email for the next hour, because you've just been on it all day. Whatever it is, you just set an intention for proceeding and then you either open your eyes or just continue on with the day. So it's this little nice four step practice, you can take more time with it, you can take less time with it. But I find it's this great reminder in your day that you can just keep in your back pocket.

Grace Jacobs [1:06:11] And so talking a bit about kind of Canada, how prevalent do you think, I don't know if you have statistics on this? But how prevalent is mindfulness practice in Canada? And how do you feel like the perception of it has evolved in Canada or in North America since you began?

Elli Weisbaum [1:06:28] Great question. Yeah, I don't have any specific statistics. One thing that's interesting to note is the majority, if not all, major hospitals in downtown Toronto, do offer some sort of mindfulness based intervention. The two kind of biggest ones right now are Mindfulness Based Stress Reduction (MBSR) and mindfulness based cognitive therapy (MBCT). So there's a lot of clinical use of those two interventions. There was also a report done by the government in the UK called the all parliamentary mindfulness report, representatives from every single party in the government got together and did an inquiry into the applicability of mindfulness within public sectors. And they officially recommended that mindfulness be brought into healthcare, education, the criminal justice system and the workplace. And they've actually started operationalizing this so...

Grace Jacobs [1:07:19] What year was that?

Elli Weisbaum [1:07:20] This was in 2015. And so MBCT is actually officially supported through their public health program, as a intervention for people who have experienced relapse and depression. So there's some really interesting applications going on in terms of acceptance, I think in terms of public perception, and also within the sectors of healthcare and education. It really is reminiscent or mirrors what we're seeing in terms of peer reviewed journal articles, there's just an exponential growth, to the point that it's a very exciting time to be a researcher. And also, there's really, some need to be careful in terms of what we're saying it can do, because people come and they're like, right, if I do mindfulness, it will fix everything right away. And so as a researcher, and someone that really does want to see it taken into policy, it's really important for me to see rigorous and clear research and communication and knowledge translation being done.

Grace Jacobs [1:08:12] So kind of building on the increasing popularity in Western cultures, how does modern practice in Western cultures differ from kind of the origins of mindfulness?

Elli Weisbaum [1:08:23] So this question around, you know, what are we translating, where does it come from, how does it meet us in the spaces that we're in is a great question. And I will say actually, that, you know, mindfulness as it's being translated, maybe into more secular spaces or just into modern spaces, I don't know the exact wording, it's something that I'm working on, is really something that's happening globally. I just finished training with Search Inside Yourself, which is program based in mindfulness that was developed at Google headquarters. And in that training, this teacher training, there was 100 of us from around the world. And so I really think it's a global interest in terms of well being, in terms of taking care of human beings, what that means. So but this global kind of modern interest in these skill sets, and what does that look like is a huge question in the field right now. There's huge debates around, you know, who owns it, who can teach it? What does it look like? And there's a lot of different answers to that. One thing that I'll say is if we look at the kind of historical lineage that we're taking a lot of these practices from, which comes from kind of Buddhist philosophy. Everywhere that that philosophy has moved in the world historically, it has adapted and changed to the culture that it met, because it is really a philosophy. It's a way of thinking about your mind of activating mental fitness. And so when I work with more traditional communities, such as you know, Thích Nhất Hạnh, I have people who are advising on this program who are monastics they have shaved heads, they're in robes, they practice mindfulness 24 hours a day. They're a great group to get information from and they'll laugh and sometimes say like, we meet researchers in this field who are way more Buddhist than us and they think they say that because at the core have kind of Buddhist philosophy is this idea of non attachment to form and thoughts that it's really about understanding who we are and being open to change. So there's this kind of interesting answer to your question, which is, mindfulness looks very different wherever it's practised, because inherently, it meets that culture where it is. And so when we look at this modern translation, for me, mindfulness is meeting us where we are, which is in a cultural space of scientific inquiry. And so that's kind of the adaptation that we're seeing right now. And I think it's exciting. And I also think it's important to pause and say, like, are we losing something in this translation? You know, some critiques are that if we isolate mindfulness to being a tool that decreases anxiety, then we lose some things like interconnection, and the understanding that community is really important. And so there's no one answer yet. But I think it's a really important part of the research that's happening right now.

Grace Jacobs [1:10:57] Well, thank you so much for joining us, Ellie. I really appreciate it. And that was a great conversation.

Elli Weisbaum [1:11:02] Yeah. And it's been fun. You know, it's always great to get out of the library and pure questions and explore the research outside of like, working on my own in front of my computer. So it's a good time.

Marija Zivcevska [1:11:14] Do you think that mindfulness should be integrated within the medical curriculum early on, so that future doctors are equipped with these skills, so that it's no longer just a tool, but it's, again, a way of life?

Dr. Agnes Wong [1:11:29] I think that the medical curriculum, but you know, I graduated many years ago, of course, when I was in medical school, we were never exposed to mindfulness, or even the word compassion has never even received once in the entire medical school. In fact, we were, you know, through the, I call it a medical socialization process. You know, even if you have some idealistic idea of going to medicine, you know, want to help people around the service. As soon as the talking about these your colleagues, your you know, your your peers, or your faculty will kind of start to look at GSA. Well, we don't talk about these things. We talk about what are the symptoms, what is science, what is differential diagnosis, right? So it's not encouraged. And that flicker of flame get kind of extinguished, that's all call it right, at least that that was my experience when I went through medical school. So fast forward to current situation, again, I don't claim to really know about the medical curriculum right now. But from what I understand, some medical school are incorporating some mindfulness training classes, University of Ottawa have something like

Marija Zivcevska [1:12:36] Western too.

Dr. Agnes Wong [1:12:37] Western too, and I think UofT has a year elective offer for medical students, I think it's a very good start. Because I think, especially medical students, and as they become residents and fellows, the highest stress is even higher, like it will be only escalated. Right? And in fact, I will say residency is the worst time in your entire medical career. Once you become licensed, and your practice on your own either in committee or an academic setting, at least you have more control of your time, you're a little bit more autonomous. But in residency, you know, some people not me describe it as kind of a slavery is you really do not have time to do anything on your own. And you're really tied to the schedule, right. So to be able to have some exposure in mindfulness training, in medical school, while you're still relatively in a protected environment, I think it will fortify them to go into the real world of real medicine when you're in residency and fellowship. But then again, with the ultimate understanding that it is, again, not just a skills, what technique to make you, you know, to make you above resilient, of course, you know, this will be one of the goals, but that's not the primary goal, it will be a secondary goal, or maybe a collateral benefits, right. But I think the goal of you know, maybe there's no goal is just again, if you look at it, you frame it as if your orientation is a way of being is not about a goal of being that way is about the way of being right. To be mindful, to be present, and to be non judgmental, to be open to all kinds of experiences. Right. But it contradicts the medical paradigm very much so. So to kind of sum up, you know, your question is, I think it is very encouraging to see that the medical school is more open now to incorporate this training into medical curriculum. And I personally would like to see that, you know, you're becoming more uniform rather than just elective as well as also for residents.

Marija Zivcevska [1:14:54] So just to double up on that, Elli mentioned that you lead resident study groups, could you tell us a little bit about that.

Dr. Agnes Wong [1:15:00] The idea of this study group is actually I call it a book chapter club. So the idea is that, because everybody's like time is, you know, is precious and everybody's busy. So to expect a resident to finish a whole book a month is impossible, right? So instead, I can change a tweak a little bit, I call it a monthly book, Chapter club. So it's one chapter at a time, right? So it's manageable it's just one chapter, take your, like, 15 minutes the night before, you know the beating to discuss about the book. And the book I chose, which actually inspired me with this idea is called attending written by family doctor, the name of the author is Ron, Dr. Ron Epstein, who was actually in Toronto here just about two weeks ago to give grand rounds, basically emphasize the quality of our mindfulness of being aware, as a doctor, and with many scientific backup, etc, is a very well written book. So I decided I was so inspired that decided to do the book chapter club, for residents and fellows will be once a month. The idea is also to take them out of the hospital. So we actually rented a room in a hotel and provide them with some food, because food is always a big draw to busy residents. But for me is more like honoring the humanity, right to really treat them as a human being, despite, you know, the kind of situation they're in and just to honor them with some good food and outside in a more non-medical setting, so that they will be more conducive to discuss the different chapters in the book. So the first one went very well. I was just genuinely surprised that that many residents and fellows will be very open and sharing their some of the actual very traumatic experience of, you know, maybe unprofessional behaviors of other people unethical. And residents were, you know, and fellows, were able to express some of these stories. The format is that each person if they want to share, they have a full five minutes without interruption, and it's very healing. Because how often in the medical world, do you have five minutes of everybody will not say a word, and just really listen to what you have to say what they'll questions without, you know, prompting questions, or, further clarifying questions or etc, right. And I think that is already kind of like the beginning of healing. And of course, at the same time, another kind of hidden kind of agenda, no hidden training, in this format, is actually to train our doctors to be good listener. Right? How many, how often do we jump in ask questions like even like, not even doctors in our, in a regular relationship with our spouses or significant others how often within the first 30 seconds of somebody said something you got, you know, either cut the person or ask question, etc, right?

Grace Jacobs [1:18:08] Or even when somebody is talking to you, you can't help but think of what you're going to say in response. Instead of just listening, you're always with a good question asked with, especially in the professional world, you're always under pressure to respond in a, I guess, an intellectual way.

Dr. Agnes Wong [1:18:22] Exactly. You're already rehearsing work on an essay, right? So I think that's a very important skill to develop. And that's why I try to incorporate that training. Even though I never tell people this is the goal, one of the goals of the training, but just to slowly incorporate that kind of skills into the physicians kind of like their repertoire of how do they interact with patients as well as in the daily life. The disappointing part comes now the disappointing part was after two book chapters club, the attendance fell precipitously. Now, I don't know why. I just still don't know why. But I think it's a reflection of the medical culture. This kind of thing is not as important as medical knowledge, right? For medical knowledge kind of teaching, everybody will show up and they will apologize sorry, Doctor Wong, you know, I have this that and I cannot come, with this one nobody even bother to explain right. But, again, it's just a reflection of how the medical system encourages hardcore knowledge, hardcore skills over the soft stuff. And one could argue that these soft style is kind of grossly underestimated in our curriculum, but they are actually equally important for somebody to be a humane Doctor who is really, who cares about the patient. These are the soft stuff I hate to use the word soft up is because it is soft, but it doesn't mean that it's not important, but these soft serves are the key ingredients for a meaningful fulfilling doctor patient relationship. But we don't emphasize that and the trainees, they pick up on the cues, there's something called a hidden curriculum in the medical school and the hidden curriculum is what is not said, right. So, by role modeling, if your faculty staff keeps telling you this soft stuff is not important or they maybe not verbal, they say it, but they give you the message that you know, nonverbally, it's not important, this is not something that my staff really approves or this is not something that will affect my grades, then, of course, they will quickly you know, pick up on this hidden teachings right and behave the way they behave. And this related to a very important point here, which also related a better medical education is the importance of role modeling for faculty. Because if you have like a whole school of faculties, who is trained from like one of those who are trained before mindfulness, right, or before even anything, like more integrative approach to medicine, the trainees will use them as role model. So you can have the perfect medical curriculum introduced mindfulness etc. They can be trained in a very protected environment, this is what you need to do and you use mindfulness etc. But as soon you're thrown into the real world, and you have this real people out there who are kind of nonverbally expecting to perform a certain way, perhaps not in a very mindful way, everything that you'll learn will be thrown down the drain, because why residency is a survival mode, you just do whatever you need to survive. And how can you expect somebody in survival mode to be mindful? This kind of is not possible. Your basic needs are not even met, how can you expect somebody to be self reflective, when your basic needs aren't met. I think is wonderful, it's a great start to introduce mindfulness and medical curriculum, but without a simultaneous education of the people already in the system, then this will be just like a flicker of flame, it will just get wiped out as soon as it come into the real world of medicine. So I think what I would advocate, it is a two pronged approach. One is at the Medical School residency fellowship level to introduce this, but the same time from a faculty development point of view. The faculty also needs to be trained to do in this kind of way of being. And then that's how you can really affect change in the system. Until our existing people existing doctors working the system also change. Then there is a gap here, there's a gap here. So that's why the prognosis is guarded. I'm noot optimistic, but I'm not pessimistic, either. because things change have to start somewhere. But it is not as simple as we think sometimes, right?

Grace Jacobs [1:22:58] How has your mindfulness practice or your journey with mindfulness affected your research and kind of how you approach research?

Dr. Agnes Wong [1:23:06] It's a huge impact. Actually, this is very relevant in how I should frame it is that mindfulness has changed my way of being to the point that I'm actually shifting my research focus. So I've decided not to do so much lat base cut basic science research, and was shifting to more experience based research if you will, like for example, supervising Elli on mindfulness in physician wellbeing, right, so that will be a prime example. And also shifting my life. You know, I have turned part time myself in as a clinical career clinician, a scientist for 16 years now. I was turned part time decided to pursue other things. So my life has changed. But what I want to say is this is mindfulness creates that opening in the mind, that free you up from, from some preconceived notion of who you are, and have that courage to really follow your heart. So for example, shedding the idea or the title of being clinician scientist, has been a huge challenge for me. Huge, because that's my entire identity in my career so far. But at one point in time, you just have to be true to yourself is if what you are doing now no longer interests you as much as when you first started, you will say that mindfulness has, positively, surprisingly, amazingly unhinged a world of possibilities for me that is so refreshing and energizing. Be courageous and follow where your heart wants to go. And have fun. Just to give people a little bit of context, what do you mean by you following your hearts. And, you know, the shift is basically I was the chief of my department for several years. And then I've a major illness about two, three years ago. And that really makes me think about what is my priority in my life. And, and because I've also been practicing mindfulness for several years, that made me realize that you know, what, I really need to re-examine my values and my goals, and you know, what I, what do I really want in my life and be and be honest to myself, because of that, and really seeing that, I really feel that my colleagues are suffering, you know, from loss of stress, burn out the unrelenting demand, whether it is from clinical work, or even research work. We all are under all kinds of stress that many times is actually self imposed, because we have internalized what the society want, you know, we want to held up that image or the expectations of our society, our culture, our parents, or whatever expect of us. And in the process, we become miserable or burnt out or giving ourselves so much stress, if you really think about is actually not necessary, you have a choice, right? So because I believe that we have a choice, I actually make a very unconventional decision of stepping down as a chief before my term is up. As a Type A ultra achiever all my life that never quit on anything ever in my life that was a big shock to the system. Right? You can imagine that your colleagues or all the society will say, oh, you're a quitter. Oh, you're no good. Oh, you know, or what would be your reputation from now on? Right. So that was the first shift, first major shift in my in my career is to decide to step down as the chief, even though it is a very, very strange thing to do in our world. And then comes next is turning part time. So turning part time to the point of just only working one and a half day a week in the hospital. This is again, a very major challenge to my system. But again, it's about being honest to myself as to what I want to do next in my life. I don't want to frame myself just because I'm a doctor because I'm a scientist. And for me, there's so many things to explore. So many things I want to d. I'm becoming interested in end of life care, palliative care, becoming interested in physician well being. That's why the mindfulness, if you incorporate as a way of being it really fundamentally change how you see the world, how you interact with the world, and fundamentally change and ask who you are. Who are you? What is your purpose in life? What is the meaning of life? These are so important questions is beyond about just you know, is not beyond, is beyond a fad is about a way of being.

Grace Jacobs [1:28:05] Thank you so much for sharing.

Dr. Agnes Wong [1:28:06] Thank you.

Marija Zivcevska [1:28:09] So as we mentioned, Grace, and I began the five for five challenge to start to incorporate mindfulness more regularly into our lives. Now on my end, I'm pretty familiar and open to mindfulness in general, but don't have a standard daily practice. I'm currently writing my thesis. So it's a really stressful time for me. And I thought that this was the perfect opportunity to try to get on this mindfulness train.

Grace Jacobs [1:28:31] I'm also pretty familiar with different mindfulness practices. And I've been trying different practices kind of on and off for the last couple of years. As a grad student, when I'm particularly stressed, it often affects my sleep, which kind of only decreases my productivity and ends up just adding to my stress and kind of like an ongoing cycle. So I found in the past that really practicing before bed for even five minutes, even a couple of minutes really drastically improves my sleep, and lets me calm down. I really want to take advantage of this challenge to try different types, and almost be mindful of my mindfulness practice to keep track of the ones that are the most effective for me.

Marija Zivcevska [1:29:04] So for me, I try doing mindfulness at different times of the day, I try doing it before bedtime, first thing in the morning, during the middle of the game, as well as during my commute. I found that different approaches actually worked better on different days depending on my schedule, but in general, I found that my morning commute was the best time for me because no matter what I was doing, I was stuck in that subway, whereas during different parts of my day, I could always find something else that seemed more important, or more pressing to occupy my time. Overall, I would say that I felt more relaxed and more ready to tackle my day. Most times when I'm commuting, I'm constantly running lists in my head of what I have to get done for that day, both for school and for extracurriculars. So having that moment to focus on my attention and on my breath really calmed me down. I actually found that the subway was too loud sometimes to listen to a guided meditation practice. So I really liked using the breathe for a minute function on my Apple Watch, just repeated five times in a row. I also tried mindfulness walking, which was really great, just to kind of get out of my head and focus on my surroundings. Usually, I'm pretty oblivious to what's around me so having that time to just kind of stop and smell the roses was really great.

Grace Jacobs [1:30:23] I also tried different times of the day, although I found kind of practicing in the morning was a bit stressful, because I felt like it was just, I was delaying the onset of my day, and I wasn't really able to focus. But I really like coming home after working in the lab and practicing. It really kind of changed my evenings and made my evenings a little more relaxed. And there's not the same time crunch as the morning. I also practice on my commute, although I bike to and from the lab, and I found that was really kind of beneficial and a great way to start the day. For my practice at home, I found a really comfy cushion for the sitting practice, which I found really improved the quality and also wheirdly got me excited to practice, having a specific place or something associated with it kind of helps create that pattern or routine a little bit better. I tend to use the guided meditation app 'Simple Habit'. So they have different types of meditation for different lengths. The one I focused on was actually improving focus, which I found was really applicable to my daily life. Often when I took the time to practice, I didn't even realize how tense my body was. And taking that time to just let myself relax really stayed with me after the practice. It definitely also makes me focus on my priorities. And what I really need to get done that day, instead of just being kind of overwhelmed by all the the endless to do lists.

Marija Zivcevska [1:31:33] So now that you've heard a little bit about our experience with the challenge, please tell us yours and share it on our social media.

Grace Jacobs [1:31:40] Now we have a short practice led by Ellie to get you started, I hope you enjoy and stick with it for five days and find what works for you.

Elli Weisbaum [1:31:48] So welcome to our five minute guided meditation. I want to invite you before we start to just take a moment to find a comfortable position. So whatever that means for you right now, just something where you feel both stable and at ease, maybe there's something in your hand that you want to put down, you can take a minute to wiggle around, wherever you're sitting, just check that your legs, your bottom, your hands, your shoulders, your head are in a position that feels comfortable. And if you're ready, you can close your eyes. The great thing about closing your eyes is it removes a little bit of stimulus. So it will make focusing a little easier. But if that's not comfortable, you could also pick a specific point to focus on in front of you. And for this practice, today, we're going to try what we call a keyword guided meditation. So that means that I'm going to give you some guidance and some keywords to focus on and then also let you have some moments where you're just self directing your own practice. And the practice that we're going to share today comes from the tradition of engaged mindfulness, which is from my original teacher who I met when I was 10 years old, Thích Nhất Hạnh. And one final invitation before we start is just to really notice your mind. We tend to judge ourselves a lot whether we're getting it right or wrong. So I just want to note that we all have a dmn we're all prone to mind wandering. So perhaps before we begin, you can set an intention to be kind to yourself when your mind wanders, but also to set an intention that whenever you notice it wandering, the real skill building comes from noticing the distraction and then reorienting your attention to the guidance. So don't worry if you get distracted, but do feel very accomplished if you are managed to notice a distraction and come back to the guidance. Alright, so here we go.

Gong [1:33:40] Sounds.

Elli Weisbaum [1:33:40] Let's begin by becoming fully aware of the sensation of breathing in and the sensation of breathing out. As you breathe in, you can focus on the key word in as you breathe out. Focus on the key word out. In. Out. Breathing in, become aware if your breath is becoming deeper, not fixing or forcing it to change. Just offering it your full awareness. Breathing out. Become aware if your breath is becoming slower. Breathing in, you can focus on the word deep. Breathing out, you can focus on the word slow. Deep. Slow. Breathing in, become aware if your mind is becoming calmer. Wait, I'm gonna redo that because he was making some noise. Here we go again. Breathing in, invite your mind to become aware of the calm of the space. Breathing out, invite your entire body to feel at ease. Breathing in, you can focus on the word calm. Breathing out, you can focus on the word ease. Calm. Ease. Breathing in, invite your mind and body to fully arrive in the present moment, smiling to any thoughts or distractions that may be pulling you away. Breathing out, notice the qualities that make this a wonderful moment, a moment where you have nowhere to go, and nothing to do. Breathing in present moment, breathing out wonderful moment. Present Moment. Wonderful moment. Now you can take a moment to open your eyes and intentionally come back to the space you're in. And I want to invite you just to take a moment to collect some data on yourself. You might have really enjoyed that you might have felt totally uncomfortable, your mind might erase the whole time. All of that is fine. That's the kind of curiosity and openness that's the stance we want to have for mindfulness. The real question is just what are we now aware of? Is there something that we really need to take care of that kept pulling us away. And as a long term practitioner, I sometimes have days where I can just do a whole practice and feel very at ease. And then I know wow, life is okay. And it's slow enough that I can focus and sometimes I cannot sit still for a moment. And that just lets me know that there's maybe something to take care of. So mindfulness is a great way to collect data on yourself. And also if you do it a bit ahead of time before going to bed, it can be a great way to shut things down before you need to go to sleep. So thank you for trying that mindfulness experiment with me.

Eryn Tong [1:39:25] Raw Talk podcast is a student presentation of the Institute of Medical Science at the University of Toronto. The opinions expressed on the show are not necessarily those of the IMS, the Faculty of Medicine or the University. To learn more about the show, visit our website at RawTalkPodcast.com and stay up to date by following us on Twitter, Instagram and Facebook at Raw Talk Podcast. Support the show by using the affiliate link on our site when you shop on Amazon. Also, don't forget to subscribe on iTunes, Google Play and Stitcher and rate us five stars. Until next time, keep it raw.