Dr. Daniel Knoepflmacher (Host): Welcome to On The Mind. The official podcast of the Weill Cornell Medicine Department of Psychiatry. I'm your host, Dr. Daniel Knoepflmacher. In each episode, I speak with experts in various aspects of psychiatry, psychotherapy, research, and other important topics on the mind. Our topic today is mindfulness, a state of consciousness marked by purposeful moment to moment awareness of one's mental and physical experiences. It’s characterized by a non-judgmental acceptance of the thoughts and feelings that emerge while meditating. The practice of mindfulness draws from over two and a half millennia of meditation that has been central in Buddhism and other religious traditions. Interest in meditation has grown along with the proliferation of technological distractions and stresses of modern life that fracture our attention.

According to data from a national health survey in 2022, about 18% of the American population practiced meditation, a percentage that has more than doubled in the 20 years since 2002. In 2023. The top two meditation apps had over 200 million downloads combined. Meanwhile, scientific studies of mindfulness have shown it to be effective at alleviating anxiety, reducing depression and pain, and contributing to a general improvement in quality of life.

With such solid evidence backing mindfulness based stress reduction and other similar approaches, one might wonder if we should be encouraging more people to improve their mental wellbeing through meditation?

Today, we'll take a deeper look into mindfulness, its history, its practice, the science supporting it and the ways it can be integrated into effective psychotherapeutic treatments. Our guest will also lead a brief guided meditation, which we invite you to practice along with the two of us. So, make sure you're seated in a comfortable place for listening and for practicing your own mindfulness.

Guiding us through all of this today is Dr. Susan Evans, a professor of Psychology and the Director of Education and Psychology here at Weill Cornell Medicine. Susan, I'm so happy to have you joining me today. Thank you for coming on the podcast.

Dr. Susan Evans: It's great to be here, Daniel. And thank you for inviting me.

Dr. Daniel Knoepflmacher: Well, it's exciting to be able to talk about this. And I'm going to begin by asking you about your story. Can you tell us about your path to becoming a psychologist and an expert in mindfulness-based stress reduction?

Dr. Susan Evans: Well, my story to psychology is a bit circuitous. I became interested in Psychology in college. But after graduating, I went to nursing school. I thought I would become a nurse anesthetist. And my first job was in the operating room, which turned out not to be a great fit for my personality and temperament. And I found I was having a better time outside the OR talking with patients before they came in for their surgeries than actually being in the OR. And I still remember there were some really meaningful, short conversations. And I eventually came to the conclusion this is not for me and decided to go into Psychiatric Nursing.

And I was very fortunate to meet Dr. Peter Stokes, who is the head of the Psychobiology Research Unit at Payne Whitney Clinic. And he, along with Dr. James Kocsis, who was the unit chief of the unit, invited me to lead a nursing team on the unit. So, over the next few years, I worked with a really fabulous group of nurses and staff and wonderful psychologists and psychiatrists. And we were doing really seminal research on depression and bipolar disorder as well as other psychiatric illnesses. And I loved it. I just loved the experience working with the patients, with my colleagues, but I really liked the research process. And I thought, "Well, I'd like to become my own investigator." And so, I decided the best route for that would be to go get a doctorate in Clinical Psychology. And so, I did. And after I finished internship, I ended up on a postdoc research fellowship, looking at the psychological effects in HIV. And that was a really nice combination of my background in Nursing and Medicine, along with Psychology.

So, I was very fortunate to get a grant. And so, over the next few years, I developed and tested out a very short succession cognitive behavioral therapy for HIV-related peripheral neuropathic pain. So, that was really how I got started. As I said, it's a kind of a circuitous path. And it was around that time as well that I attended a lecture by Jon Kabat-Zinn, this is in the late '90s, who had developed a program that you mentioned, mindfulness-based stress reduction. He developed that in the late '70s, early '80s. And he was giving a lecture. It was a small group of people, maybe about 70 of us. I actually attended one of his lectures just pre-COVID at Lincoln Center, and there were thousands of people.

So, this is the late '90s. We were a small group. Jon is a scientist by background. And so, he had developed a protocol. MBSR is really like a protocol. It's an eight-session program with agenda for each week. And so, he had developed a protocol and he was studying it and he began to present some of the research that he was doing on it. And then, over the course of that lecture, we also did a brief five-minute sitting meditation. He's very charismatic and I was just taken by the whole experience. So, I started practicing on my own over the next year. And then, about a year later, I went up to the Center for Mindfulness that he started at UMass Medical School and participated in an internship program along with five psychiatrists. And that's how I got into mindfulness. I then brought the program back to New York Presbyterian and have been running this eight-week group for basically people in the community, as well as healthcare workers and other individuals. So, that's a little bit of my story.

Dr. Daniel Knoepflmacher: I knew that you had a background in Nursing, but the whole nurse anesthetist piece, I didn't know. And it's kind of interesting going from thinking about how to make people unconscious to make people get in touch with their consciousness. It's a real evolution there. Well, as we're talking about this, I realize that I want to try to clarify some of our terminology. I use the word mindfulness. I also use the word meditation. And you talked about mindfulness-based stress reduction or MBSR. Can you help us kind of clarify mindfulness versus meditation and how all of these things overlap but are distinct?

Dr. Susan Evans: Well, you did a great job in describing mindfulness in your introduction, Daniel. And I'll basically repeat what you said. Mindfulness can be defined as moment-to-moment non-judgmental awareness. So, it's really about paying attention on purpose in the present moment. And if you think of that definition, there are different components to it. So, there's the attention part, paying attention. There's intentionality to it, on purpose, in the present moment. And then, there's the non-judgment piece, which is really critical, as you know, and sometimes overlooked. And so, non-judgmental awareness, this is the practice you bring to mindfulness, and it's really a way of being, both in meditation and in life.

Non-judgmental awareness is being open to whatever is showing up in your consciousness. And that involves not evaluating it or judging it or bringing our own opinions or ideas or likes or dislikes to it. And I tell people who start the course, let go of the idea that something special is going to happen.

So, all of those are critical components of mindfulness. Now, we think of meditation as a way to practice mindfulness, and it is. And in mindfulness-based stress reduction, there are three, what we would call three formal meditation practices. One is a sitting meditation, where there's usually a focus on the breath. Another is the body scan meditation, where you're guided through your body, and you're focusing on different parts of your body. And then, gentle hatha yoga, where you're focusing on the pose and the breath. And those are the anchor points.

But if you think about the definition of mindfulness, really, you can practice mindfulness at any time during your everyday life. So for example, in the first class of MBSR, we do a mindful eating exercise. And I'll ask people, after doing this exercise, it's very interesting what people discover. It's called the raisin exercise, where people very mindfully eat one raisin. And it's fascinating to see the reactions that people have to that. But I'll ask people then to try and practice eating one meal mindfully each day. So, there's a lot of ways to incorporate mindfulness, well, definitely in meditation, but in your own life on a daily basis.

Dr. Daniel Knoepflmacher: I don't mean to be cheeky when I asked this question, but I've always wondered whether the term mindfulness is sort of helping us fall into a mind-body split, because in my experience of practicing mindfulness, I almost feel like that's the term bodyfulness would be as accurate. Because as you described, all three of those exercises that were part of MBSR are really involving a focus on the body in some way. And certainly, the mind is the instrument we're using for that. But I just was curious to hear your thoughts on that.

Dr. Susan Evans: Well, I know you practice mindfulness so you're aware that when you sit down that we do tune into our body and become aware of sensations and other experiences. But you'll also become aware of thoughts and emotions. And sometimes these can be very intense and strong. Sometimes they're positive, sometimes they're neutral, and sometimes they're difficult. And so, mindfulness is about being open to all that's in consciousness, not just bodily sensations, but thoughts, emotions, and other experiences.

Dr. Daniel Knoepflmacher: Thank you. That's really helpful. It's using the body as part of that and being aware of the body. But of course, in that is really an awareness of the mind. So, I want to talk a little bit, if possible, about some of the history of this. So, this came out of ancient religious traditions, the practice of meditation, certainly in the 20th century, and maybe even a little bit before this has been more integrated into Western culture and secular thinking, including, of course, within healthcare over the past few decades. And I think Jon Kabat-Zinn, who you mentioned, was a big figure in that. So, could you just tell elaborate a little bit more about that history, over at least the past few decades?

Dr. Susan Evans: Yeah. So, I'll bring in Jon Kabat-Zinn again. So, Jon was trained as a molecular biologist actually, and he was at the University of Massachusetts Medical School in the '70s. And at that time, he was working on the problem of pain. And he himself was doing meditation and yoga, and he began to think these practices could be really helpful for people with pain.

So, as I said, being a scientist, he ended up developing an eight-week protocol, which is mindfulness-based stress reduction. And it was originally for pain and stress. And being in a medical center, doctors and other healthcare professionals began to send their patients to Jon's groups. So over time, there were a whole array of people coming for a range of medical challenges.

And so then, over the course of time, people began to go for anxiety, depression. And then, people like me, who were interested, went up there, they had a teacher training program, and so began to participate in these programs. And so, over the course of time, in the '90s, I would say, in the early 2000s, and still now, they have a very robust teacher training program, that the program's been disseminated around the world. And actually, in terms of mindfulness, it's the most studied of all the mindfulness-based interventions. And in fact, it's been disseminated in hundreds of academic medical centers around the country like ours. So, that's a little bit of the story of Jon and where he went with this.

It was interesting, he was working with the problem of pain. And at the time, in the late 90s when I heard him, I was also working with the problem of pain, trying to help people with HIV peripheral neuropathic pain. I was using a cognitive behavioral therapy approach. And so, that really grabbed my attention, the idea of mindfulness. And of course, as you know, there's a lot of synergy between mindfulness and cognitive behavioral therapy in fact.

Dr. Daniel Knoepflmacher: Yeah. Well, knowing that you have a background in research too, I was wondering if you could give us some highlights of what the body of research has shown about the benefits of mindfulness. I know this has been applied to so many different both psychological and physical ailments. So, could you give us an overview of what the research has really shown?

Dr. Susan Evans: Yes. As you know, there's now a vast body of research in the area of mindfulness-based interventions, and really across different populations of people, older people, younger people, medical students, psychiatrists, healthcare professionals. And there are now thousands of studies for various medical conditions. So for example, heart disease, cancer, autoimmune disorders, skin disorders. Actually, Jon had been presenting some research he was doing on psoriasis when I heard him in the late '90s. And obviously with pain, headache, pain, migraine, pain, as well as an anxiety and depression and other emotional or psychiatric disorders, such as post-traumatic stress disorder, psychotic disorders, attention deficit disorder. And most of the studies are positive studies. In other words, they report findings that are positive and in various domains, including psychological functioning. And by that, I mean people experience decreased anxiety, decreased depression, decreased stress and, importantly, an improved quality of life. There's the experience of being able to enjoy life more and be really in the present moment.

And the other thing we see is that people, because In various conditions, medical and psychiatric or emotional conditions, there's a tendency to avoid. So, people are tending through the course to get more engaged in life and start improving their daily life, doing things that they weren't doing before.

So, those are some of the benefits that we see. And again, I do have to say that most of the research are reporting these positive effects, and you really don't see too much out there in terms of aversive reactions.

Dr. Daniel Knoepflmacher: Well, we could spend probably the entire time talking about all the different research findings, but I'm wondering if we focus on what's actually going on neurobiologically with mindfulness. What is happening in our brains and in our bodies as we meditate that is creating these positive effects in these studies.

Dr. Susan Evans: We clearly see the benefits of mindfulness. And over the last 20 years or so, scientists are trying to understand what are the mediating effects of these improvements in mindfulness. And so, in terms of the brain, one of the first people to look at this is Richard Davidson at the University of Wisconsin. And so, in the early 2000s, he conducted a study of meditators and non-meditators using EEG readings. And he did this in collaboration with Kabat-Zinn, in fact, and found that there was increased interior activation in the brain related to positive emotional states. So, that was published in Psychosomatic Medicine in 2003. And since then, there's really been a burgeoning of research in the area of neuroscience and looking at the correlates in the brain.

So, what we find generally, one, is that there are structural changes that occur in the brain and also changes in brain circuitry. So in terms of the structural changes, the studies show that we see increased gray matter density in parts of the brain, including in the hippocampus, which is as you know, part of the limbic system and involved in emotion and memory. There's also, not surprisingly, increased activation in areas of the brain related to attention, right? That makes sense because that's what we're doing. And there's a part of that called the anterior cingulate cortex that is involved. It has a number of functions, but one is self-regulation, being purposely directing one's thoughts and behaviors. So, we see increased activity in these parts of the brain. What's become interesting too is this looking at connectivity between brain circuits in the brain.

So, one is particularly interesting because there are two circuits that typically oppose each other. So, one is the default mode network, which operates when we're mind wandering, which is a lot of the time, maybe half the time, and the executive attention network, so when we're really paying attention, that is turned on and the default mode network gets turned off. And what we're finding with meditation, that there's seems to be increased functional activity between these two brain circuits. And so, there's a lot of interest in brain circuitry and what's happening, but very exciting to be looking at actually what's happening in the brain. And there are also psychological factors that people are interested in what are some of the psychological effects that may mediate improvement from programs like MBSR. And I can talk about those now or later.

Dr. Daniel Knoepflmacher: Let's go there. Go ahead.

Dr. Susan Evans: Okay. So, we talked about mindfulness and I mentioned that the nonjudgment part of the process is kind of a way of being and practicing because we basically come into things with judging our experience, ourselves, and others. And so, a couple of the factors that we cultivate in mindfulness is acceptance, which means not just lying down and throwing your hands up. It's a very active process where you're being with whatever is coming up. And as I mentioned, sometimes that can be really difficult.. But people, when they're stick with it, people realize that they can really tolerate very strong emotions and sensations, very difficult ones. And so, that can be really transformative.

The other practice we cultivate is an attitude of patience and kindness towards oneself and the practice. And so, I've been interested in both acceptance and self-compassion and how these two factors may mediate the positive effects of MBSR. And so, my colleagues and I have done a couple of studies. And in fact, one showing that mindfulness training leads to increased mindfulness, which is not surprising, which then affects increased acceptance, which then has a direct effect on improved well-being. And this same pathway occurs with self-compassion. So, MBSR leading to more mindfulness, leading to more self-compassion, having the effect on improved well-being. So, these are some of the psychological factors that we're looking at.

Dr. Daniel Knoepflmacher: That's really helpful. And I can relate to what you're saying based on my own experience of something that I really got into doing daily, starting with the pandemic and how it's impacted my life. But frankly, also as a psychiatrist and a psychotherapist, I've seen direct benefit for several of my patients who've adopted regular mindfulness exercises into their daily life. And I don't actually use guided meditations in my sessions with patients. I instead recommend it, provide education about it and resources, for they can find means to practice. But I'll say anecdotally that I've seen such clear benefit, first, you know, in overall well-being, but understandably, in the psychotherapy. And I'm not practicing CBT, but more, supportive or exploratory, like psychodynamic psychotherapy with my patients. And just to see which makes sense based on what you were saying with the neurobiology in terms of attention, acceptance, non-judgment, that there's these positive differences in psychological mindedness and some kind of openness to insight that I can tell the improvement that has occurred with the adoption of mindfulness practice.

So having said all of that, you are somebody who has much more experience with this than I do and are directly using it in your psychotherapy practice. Can you describe because I know you teach MBSR, but also how you integrate it into your work with your patients?

Dr. Susan Evans: Yeah. So, it was soon after that I attended the internship at the Center for Mindfulness, and I was working as a study therapist at the time, a CBT study therapist on a study for chronic depression. And so, again, this is late '90s, and one of the people I was working with had a significant improvement in their mood from cognitive behavioral therapy on this trial. And then, I started seeing them after they finished the trial. But what I was noticing, there were still residual symptoms of depression, a lot characterized by this very self-critical stance and voice that was running in his head. And I thought, "Okay, well, this could be a process that we could target with mindfulness." And so, I introduced the idea to him and also said, "This is not just something you do a couple of times. This is a commitment in terms of practicing daily." And he was open to it. And so, I introduced him. I guided him in meditations in the office and sitting meditation, body scan, we actually did some yoga.

And the body scan really resonated with him and he started doing that every day. And after about three weeks, I really started to notice a shift. In this view of himself, and he himself was hearing this very negative voice and recognizing how powerful and what a negative effect he was having on his life, and then started to be able to talk back to this critical voice and saying, " I wouldn't treat my worst enemy this way." So, that was really the start. And then, over the years, I have recognized that mindfulness could be very helpful for other people engaging in the kind of transdiagnostic processes that we see. So for example, in depression, rumination and anxiety, worry. And so I began to integrate it with people who were interested, again, uh, person has to be really on board and be willing to commit. And so, I see a lot of people with generalized anxiety disorder. And CBT is really effective, but there's also a fair percentage of people who either don't remit or experience some partial remission from CBT. So, integrating mindfulness, I think, has really helped a number of people who engage in rumination and worry.

Dr. Daniel Knoepflmacher: Can you speak to the different modalities? Because I think of DBT where mindfulness is a pillar of DBT, so how it's been integrated into different psychotherapy modalities.

Dr. Susan Evans: So, DBT is probably the one that people think about most in terms of integrating mindfulness and that form of therapy introduces mindfulness right off the bat in the first module of treatment. And so, what it involves is teaching people to be able to step back. So, that's a big part of mindfulness, is stepping back and observing in sort of a detached observational way. And so, people learn to pay attention to what they're experiencing. Anxiety, sadness, but observe it and say, "Oh, I'm having this experience. What's going on?" And so, they both observe and describe the experience, which gives them bit of a distance from their emotions and sensations.

There's a psychotherapy called ACT, Acceptance and Commitment Therapy that was developed by Stephen Hayes. The goal of this therapy is to increase psychological flexibility, and it incorporates Exploring the person's values and getting them to take committed action towards their values. But it also uses mindfulness and acceptance. And so, in the therapy, people learn to develop some distance or detachment from their emotions and their thoughts. So, there are various exercises we use in ACT. So for example, one typical one is you're sitting or standing by a stream, and there are leaves on the stream and you're just watching these leaves float by. And then, what you do is place your thoughts on the leaves, and then just watch these thoughts float by. It's what we call diffusion. It's a way of creating distance between our thoughts. And it's kind of the experience of thoughts are just thoughts. They're not necessarily reality. So, those are some of the ways that sacred therapies employ mindfulness.

Dr. Daniel Knoepflmacher: We've talked about how effective this is in transdiagnostically. I mean, you're talking about attention. That's going to be helpful for ADHD. As we talked about with DBT, which is meant for borderline personality disorders. When you think about, you know, emotion regulation and distress tolerance that these kind of acceptance skills and self-awareness are going to be really important as part of that.

All of that said, you alluded to you really need buy in, right? You can't just prescribe this to everybody. I'm just wondering I guess two things. One is when has it been difficult to convince people to try to adopt this? And then, are there times where maybe you don't recommend it, that it's not the right time for that person or it's not the right exercise for that person?

Dr. Susan Evans: I'm glad you brought this up. You're absolutely right. It really requires buy in because we're talking about a big commitment. The practice is really a daily practice and carving out perhaps 20-30 minutes a day. With people who are interested, I actually start with shorter meditations and build up, and that's how I started as well. But the person has to be-- as I mentioned, that patient I was telling you about, they have to be on board. So, I don't try and convince people to take this on. I talk to them about it, present why I think this could be a good approach. And I also discuss that it is a time commitment, and that they should think about it. And so, that's really critical. The other thing is this is not a criticism, but it is kind of thrown around a lot. So, just practice some mindfulness.

So when I teach the interns and the other psychologists in our department, I stress that it's really important that you have your own mindfulness practice before you start prescribing it to your patients. If you don't, you won't have any idea what your patient is experiencing. So, it can be part of manuals and just do, you mentioned apps. Forget how many thousands of downloads. But if you look at the literature, there's thousands of downloads, but people often don't actually open it or listen to it. And they have the idea, "Okay, this is great." Or they may listen to one or two of the guided meditations. So, the follow through is pretty weak, in fact. And it speaks to the fact that this is a commitment of time.

Dr. Daniel Knoepflmacher: So, this commitment, there might be people who are not ready to make that commitment. Are there specific times when you wouldn't even recommend it for somebody where it's, I wouldn't say contraindicated, but might not be the right choice?

Dr. Susan Evans: As you have heard and I have heard over the years, people will say you can't do mindfulness with people with psychotic disorders or post-traumatic stress disorder because, for example, they'll start dissociating and really have a bad experience. What we know now, because there's very strong literature of randomized clinical trials, is that mindfulness can be very helpful for people with schizophrenia, people with ADHD, people with PTSD.

In my own experience of seeing hundreds of people go through the Mindfulness-Based Stress Reduction program, there are only a couple of times. where it was just not a good idea. And in both cases, the person was experiencing very intense emotional instability and was having difficulty tolerating the meditation process.

So, I spoke to these individuals and suggested that this may not be the right time. And in fact, one of those people came back a couple of years later and took the course. So in my own experience, I really haven't found a lot of problems or issues that people bring that this would be contraindicated for.

Dr. Daniel Knoepflmacher: Yeah. No, that makes sense. I mean, I guess someone's acutely manic. There are other things that we're going to be focused on than mindfulness at that moment. But short of those kinds of acute or intense situations where it would be so difficult, as you pointed out, it has this transdiagnostic benefit.

Well, really one of the most exciting, for me, benefits of having you as a guest today, and this is the first time we'll have ever done this on the podcast, is that given that you're experienced in teaching and guiding people in meditations, this gives us the opportunity to offer a brief guided mindfulness exercise for our audience. So, can you tell us what you'll be doing today for our listeners.

Dr. Susan Evans: I thought we could do a brief sitting meditation. And for any of the listeners out there, if you haven't done this before, let me just explain the process. So, we'll sit quietly. And what I'll be asking you to do is bring your awareness and focus to your breath, perhaps the sensations of breath, the nostrils.

What's going to happen is our minds will go off the breath sooner or later. And the idea is simply notice when it's gone off. And then, letting go of any judgment, criticism, to gently bring your attention back to the breath with patience. So if your mind keeps going off, which it will, you simply notice and bring it back. And that is really what we're going to be doing.

Dr. Daniel Knoepflmacher: Wonderful. So, this will be a three-minute exercise.

Dr. Susan Evans: This will be a three-minute exercise.

Dr. Daniel Knoepflmacher: Terrific. I'm excited. I'm going along with you.

Dr. Susan Evans: Okay, good. I could use it myself right now. So, let's get started. So, we'll be doing a brief sitting meditation. Feel free to be seated in your chair or if you prefer on a cushion or on a mat on the floor. And what we want to be doing is taking a moment to find your seat. So by that, I mean tuning into your posture and really taking on a posture that's dignified with your back being straight and erect, but not stiff. And if you're aware of any tension in your shoulders, just releasing that. And if you're comfortable with this, just closing your eyes or dropping your chin and gaze to the floor.

Now, we're going to let go of the day's activities, what we've been talking about. And what will happen next. And just begin to tune into your internal awareness. Becoming aware of your body sitting here in this posture. And now, perhaps bringing your awareness to your breath, to the sensations of the breath at the nostrils. Perhaps you're aware of the cool air as you breathe in, the warming as you exhale, or whatever it is you're noticing here. All your attention on the breath. Keep in mind that you're not forcing the breath or manipulating it or changing it in any way. You're just having your attention here. And when your mind wanders off the breath, as it inevitably will do, that's the nature of our minds. You're simply noticing, and letting go of any judgment, gently return your awareness to the breath. So if your mind goes off a thousand times, you bring it back a thousand times. You may become distracted by thoughts or sounds, either inside or outside sensations. Simply noticing these and returning your awareness to your breath.

And as you practice, also be aware of cultivating an attitude of acceptance, whatever it is that you may be sitting with today. Maybe a sense of calm or anxiety, boredom, fatigue, whatever it is, just allowing it to be. Letting go of the wish, or desire, or need for things to be different than they are. When you're ready, opening your eyes and bringing your attention back to wherever you are.

Dr. Daniel Knoepflmacher: Thank you, Susan. I had to wish that it went on longer, but we only have so much time. I want to reflect as I hope others who are listening to this and just engage in that exercise with us on something that I think I struggle with when it comes to mindfulness, meditations. And as I'm discussing it with other people, perhaps to people I'm recommending it to who may be engaging in mindfulness practice, there's an inherent thing, whether it's cultural, personal, of trying to think about improvement and getting better.

And you talk about acceptance. And obviously, you want to accept the state you're in and the thoughts coming. And I think some people think, "Oh, my mind should be totally clear," yet there's a point that you're doing daily practice and the reason you're doing daily practice is because there's benefit from it and I imagine that practice evolves. So, how do you kind of talk to people about where they're going without trying to put this in this achievement-oriented, self-judgment-laden tendency that is so prevalent? I was just wondering if you could explain that to me.

Dr. Susan Evans: Yeah. So, inherent in the process of mindfulness is fact that we're always judging. There's the natural tendency to judge the experience. And often times, it's not in a good way. And because of the fact that when people start this, naturally they have expectations and goals. And so, I hear from people in the class all the time, this frustration that, one, they're failing at it, that they're bad at it. And a big one is I can't empty my mind. And so, we spend a lot of time talking about this. And I encourage people I understand you have goals and expectations, but if you could suspend those for now. My goal for you over the course of the eight weeks is simply to start a practice, to carve out time to be with yourself and by yourself every day. And then, whatever happens, happens. Now, you're going to judge things along the way, but the idea is to notice that and then let go. So, until you do it, it's a hard thing to grasp because of the fact that we are so goal-oriented.

Dr. Daniel Knoepflmacher: Yeah, I think it's almost nonlinear. You do it, and then you notice the effects, but it's not like you take a pill and you feel better. Yeah, wow. Susan, this is probably the calmest I've felt at the end of podcast recording that I've done. So, I'm just so grateful that I was able to have you on today and to talk about mindfulness and to actually benefit from your expertise directly. So, thank you so much for sharing your extensive experience and knowledge about this topic. It's so great to have you on.

Dr. Susan Evans: Well, it was great being with you, Daniel, and with all the listeners out there.

Dr. Daniel Knoepflmacher: Thank you. And thank you to all who listened to this episode of On The Mind. This is the official podcast of the Weill Cornell Medicine Department of Psychiatry. Our podcast is available on many major audio streaming platforms that includes Spotify, Apple Podcasts, YouTube, and iHeartRadio. If you like what you heard today, please give us a rating and subscribe. That way, you can stay up to date with all of our latest episodes, and please tell your friends. We'll be back again next month with another episode. So until then, wishing you good health in body and mind.

Promo: Back to Health is your source for the latest in health, wellness, and medical care for the whole family. Our team of world-renowned physicians at Weill Cornell Medicine are having in-depth conversations covering trending health topics, wellness tips, and medical breakthroughs. With the spotlight on our collaborative approach to patient care, the series will present cutting edge treatments, innovative therapies, as well as real life stories that will answer common questions for both patients and their caregivers. Subscribe wherever you listen to podcasts. Also, don't forget to rate us five stars.

disclaimer: All information contained in this podcast is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. We urge you to always seek the advice of your physician or medical professional with respect to your medical condition or questions. Weill Cornell Medicine makes no warranty, guarantee or representation as to the accuracy or sufficiency of the information featured in this podcast and any reliance on such information is done at your own risk.

Participants may have consulting, equity, board membership or other relationships with pharmaceutical, biotech or device companies unrelated to their role in this podcast. No payments have been made by any company to endorse any treatments, devices or procedures. And Weill Cornell Medicine does not endorse, approve or recommend any product, service or entity mentioned in this podcast.

Opinions expressed in this podcast are those of the speaker and do not represent the perspectives of Weill Cornell Medicine as an institution.