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Mindfulness practices have been shown to result in multiple benefits, including stress reduction and increased wellbeing. Welcome to UAB Medcast. I'm Melanie Cole, and today we’re discussing promoting wellbeing by practicing mindfulness in everyday life. Joining me is Dr. Michael Wiederman. He’s the director of leadership and professional development in family and community medicine at UAB Medicine. Dr. Wiederman, it’s a pleasure to have you join us again today. We’re all feeling a lot of stress right now, and many of us feel it from time to time. How do we know if the stress that we are feeling is taking a toll on our psychological or our physiological self?

Michael Wiederman, PhD (Guest):   Yeah. Well, I think the sort of obvious signs are feeling fatigued and getting to the end of the day and feeling spent in the negative way. I meant sometimes we’re feeling spent in a positive way that we really were invested and had a great day. If we feel like we’re chronically fatigued and rundown and distracted and we get to the end of the day and it feels like it’s been a whirlwind and we can't really remember much other than the fact that it was not a good day then to me that’s a sign that something needs to change.

Host:   What a great point. So then let’s talk about the concept of mindfulness. For other providers right now, this is an extreme unprecedented time of stress, Dr. Wiederman. What role does mindfulness play? What questions can we ask ourselves? How aware are we of our own behavior and what drives them?

Dr. Wiederman:   Yeah. I think what we sometimes forget is that the stress technically isn’t being caused by what's happening outside of us. It’s caused by what we’re thinking and how we’re perceiving what's happening outside of us. So when I'm feeling overwhelmed, it’s technically because how I'm interpreting and trying to deal with the things that are happening. So I think why mindfulness really work or helps reduce stress is that it keeps us focused on one thing at a time rather than our mind sort of swirling and thinking about all of the things that we need to be doing or the things that could go wrong. So by sort of having more of a laser focus, we can actually do what we need to do and not get caught up in the swirl that creates anxiety and stress.

Host:   So that is great to say and maybe not as easy to do. So before you give us some tips on how to do that, what’s the difference between mindfulness and meditation which we’ve heard about for oh so many years.

Dr. Wiederman:   I think about mindfulness as the end result of the product of meditation. So if you think about meditation—To me it means setting aside some time to sort of focus on one thing and sort of clear my mind. So typically people focus on their breathing because it gives them something very concrete. So therefore I'm, in a sense, practicing mindfulness. So to me it’s like going to the gym and saying I'm working those muscles because they're going to be useful to me outside of the gym. So for me meditation is sort of setting aside that time. That part of sort of doing it has never really appealed to me. So I've tried to develop practicing mindfulness in everyday life as opposed to setting aside specific times per se.

Host:  That’s definitely so interesting. So then Dr. Wiederman, you’ve probably heard misconceptions and myths when people hear that term mindfulness. For providers that are listening now that maybe want to practice this, they want to be able to sort things out so they can get on with their jobs and do really what they need to do right now, what are some of the myths that might be going through their minds?

Dr. Wiederman:   There's the myth that we as humans are able to effectively multitask. By multitask if we mean simultaneously think about different things at the same time, that has been shown to not be possible. What we typically do when we think we’re multitasking is switch our attention or our focus, thoughts, very quickly between things. That not only is very stressful and exhausting, but has been shown to be less effective because, again, you're sort of being distracted or dropping the ball. When you're looking over here, the ball’s dropping over there. So that idea that somehow being efficient means trying to multitask or juggle a million things, that’s certainly one big misconception I think.  

Host:   So then can we learn to pay attention in different healthier ways? Can we learn to focus? Can mindfulness help us to not be distracted and multitask?

Dr. Wiederman:   The metaphor that I find so useful is to think about our attention as a spotlight and whatever I'm focusing my spotlight on is where my attention is. Of course, I can make it a little bit broader or definitely more narrow, but I only have one spotlight. So that’s why it’s impossible to technically multitask because if my spotlight is focused to the left then obviously to the right I'm not focused. So we switch our spotlight back and forth very quickly, and sometimes we need to. I think we probably—at least I’ll speak for myself—have a flabby muscle when it comes to what is controlling that spotlight. So I think mindfulness practice for me is anything that increases the strength of that muscle so that when I do want to focus just naturally, it’s going to come easier because that muscle has been strengthened. I don’t want to think about it anymore. So that’s why I think the analogy of meditation practice being like going to gym is so apt because, again, it’s just setting aside time to be very conscious of practicing and building that muscle so that when I do need to focus on my activities it’s easier because that muscle is stronger.

Host:   So then tell us how to do that. How can we practice mindfulness? When we wake up in the morning, starting from the morning until we go to bed at night what are some things that we can do that can help us to stop, take a breath, look around, focus on what we’re doing. Tell us how to do it.

Dr. Wiederman:   Yeah. So when I stumbled into this probably 15 years ago, I had read a little activity where it said just start with brushing your teeth because it’s something we do twice a day, only lasts for a few minutes, and will be a thing that reminds you to practice mindfulness. I remember thinking okay. Well, I'm just going to pay attention to what I'm doing. I'm not going to have any thoughts about what I'm doing. I'm not going to make any judgements. I'm just going to pay attention. So I put the toothpaste on the toothbrush and low and behold in one or two seconds I'm having a thought. Like okay when I get to work I need to—It’s like nope. Stop. Let that go. Come back to just paying attention to what I'm doing. Then it lasts about two seconds before I think well this is stupid. Well that’s a though, right, and that’s a judgement. So I found is like wow so shocking to me that I couldn’t even go a couple of seconds of just paying attention to what I'm doing without having some intruding thought or extraneous thought. So every time I would bring my attention back to simply say let it go, focus on just paying attention to what I'm doing then that is like doing a repetition of a bicep curl or a leg press. We’re building that muscle. So over time you're just simply getting better and better at bringing that spotlight back to what you want to focus it on. Then you start to notice that that period between distractions, if you will, or thoughts or judgements starts to be extended. So now it’s easier for me after 15 years to sort of pay attention to what I'm doing because, again, I've just been practicing building that muscle.

Host:   That’s so interesting, Dr. Wiederman. Usually we wait to feel better before we do things. When we’re not feeling great or we’re not being able to pay attention, well you kind of say oh well when I'm feeling better I’ll do this. What can motivate us to do it right now? Can the relationship between what we’re feeling, our behaviors, can they go back and forth? How can we put them into the center and say, “Okay, this is what I need to take charge of right now because this is what I'm involved in.”

Dr. Wiederman:   Yeah. I think you hit it right on the head that if we can remind ourselves—especially when we’re feeling that anxiety or stress or that physiological response that is the fight or flight response—that if we can say wait a minute. I'm focused on this patient right now or I'm focused on this task at work right now and thinking about these other things isn’t helping because I can't get to those other things yet. If anything, it’s just distracting me from the present and it’s making me anxious. So that was the motivation for me to say when I'm finding myself feeling that way, that’s the time to really practice just focusing on what's going on. Now, sometimes I would find that I might think I need to remember x, y, and z because if don’t… So then I would write that down on a little slip of paper and keep that off to the side or keep it in my pocket. I would remind myself that’s not going to go anywhere. I don’t need to think about it right now. I can't get to it anyway. So, for me, that’s sort of the anchor to bring it back is when I'm feeling stressed then it’s probably because I'm trying to swirl many different things in my head at once. That’s, again, not helpful, and also not productive.

Host:   Well, it’s definitely not. If we practice mindfulness, can changing the way that we think translate into an improvement in our behavior, in our feelings, even in our physical self? Can this help us to really change the way that we respond to stress on a daily basis?

Dr. Wiederman:   Absolutely. So there's lots of good research, particularly around meditation because that is something that people can sort of document that you practiced if we randomly assign you to a meditation group. Again, I think just practicing in daily life. So practicing mindfulness in whatever form that we do that has been shown in research to relate to improved concentration in memory, which makes good sense because we’re focusing our spotlight on something intentional. So we’re going to be more likely to remember it and concentrate on the moment. Also related to decreased stress response. I think for the reasons we’ve been alluding to that if I'm focused on what's going on right now then I'm not whipping myself into an anxious or stressful frenzy by thinking about these other things or worrying about these other things. Then I was shocked when I delved into literature to learn that practicing mindful is also related to improved interpersonal relationships. Then the more I thought about that, I guess it makes sense because that means, I think, we’re more present with the people that we interact with. How can that not improve relationships to be less distracted and more in the moment.

Host:   That makes perfect sense. Can you recommend any good mindfulness apps?

Dr. Wiederman:   Most of the mindfulness apps actually guide you through guided meditation. So in that sense it gives you something to focus on. So I was saying earlier that if you don’t have something, somebody guiding you, then you would just sit, and you would maybe focus on your breathing or you would focus on whatever. So there are lots of good free ones out there. I like Insight Timer as one, but there's Calm and of course Headspace has a free version as well as a premium version. All of those offer guided meditations. What I like is that sometimes you can pick one that’s—Let’s just say I have two minutes. So you pick a two minute one or three minute, they can be very brief. So anything that brings our attention to the moment and gives us a chance to practice a few of those reps.

Host:   It is absolutely great advice and imperative at this time for other healthcare workers. Dr. Wiederman, wrap it up for us. By using mindfulness to help us with all of the stress of today’s living, what would you like other providers to know about utilizing what we’ve discussed here today to help in their own practice, to help in their own lives whether it’s personal or professional, and how it can help us to be the best person we can, do the best job, and also be present and really mindful.

Dr. Wiederman:   Yeah. I would say a couple of things. One is to realize that the research shows it doesn’t take much practice to start seeing benefits. So regardless of what skepticism you might have or say I don’t have a lot of time to try something and just to see for yourself the benefits, even in the moment but certainly spillover benefits afterwards. To remember that it doesn’t—Just like getting a little bit of physical exercise. Some is better than none. So setting aside time. Saying when I'm walking between buildings, I'm going to practice my mindfulness or when I'm brushing my teeth. Just set aside those little times to begin with. Or when I'm talking to my spouse or my kids or whatever. Just create a few different if then or when this happens I'm going to practice mindfulness as a starting spot. Realize that any skill, especially building a muscle, practice makes it easier. So it’s most difficult at the beginning, so start small, and then recognize that you will start to see the benefits but also it will get easier with practice.

Host:   Well it absolutely does. Thank you so much Dr. Wiederman for joining us today. A community physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. That concludes this episode of UAB Medcast. To refer your patients or for more information on resources available at UAB Medicine, please visit our website at uabmedicine.org/physician. Please also remember to subscribe, rate, and review this podcast and all the other UAB Medicine podcasts. I'm Melanie Cole.