Mindfulness: What Is It, What Are the Benefits, Where to Begin

Transcript

Dr. Nathaniel Chin: Hello, Dementia Matters podcast listeners. Thank you for returning to the podcast during this COVID-19 pandemic. I know you have a lot on your mind and despite being at home, I know life is not easy. It's an understatement to say we are living in an extraordinary time. For whatever you want to call this ongoing experience, it is asking extraordinary things of us. Life doesn't just stop because of it, which is why this podcast continues. I want to pivot here on dementia matters and address important issues, affecting those with cognitive impairment and those without, during this COVID-19 coronavirus pandemic. I cannot cover all the issues, and frankly, shouldn't. I encourage you to go to trusted sources for specific information. Such as the U S centers for disease control and prevention, your state and local health department websites, and the Alzheimer's association. You can also find resources on our website at adrc.wisc.edu, and that of the Wisconsin Alzheimer's institute @waidotwisc.edu. For other interesting and important stories on the COVID-19 pandemic, I would recommend my colleague at UW-Health, Dr. Jonathan Kohler of the Surgery Sett podcast, who has a special series called The frontlines of COVID. We will include these links to all these resources in our show notes. For those of you affected by Alzheimer's disease or any cause of cognitive impairment, you know better than anyone, that it takes a community to care for those affected, and to work on the front lines of treatment, prevention, and cure. What we face with COVID-19 is no different. We all are needed in this fight. And I thank you for whatever it is that you're doing. Take care and be safe.

My guest today on Dementia Matters is Dr. Vincent Minichiello. Dr. Vincent is a board certified family physician and assistant professor within the University of Wisconsin-Madison Department of Family Medicine and Community Health. He completed both a family medicine residency and an academic integrative health fellowship in Madison, Wisconsin. He has completed training in medical acupuncture and mindfulness teacher training. Dr. Vincent's research has focused on developing, facilitating and evaluating mindfulness training programs for resident physicians. Welcome Dr. Vincent to Dementia Matters.

Dr. Vincent Minichiello: Thank you, Dr. Chin, It's a pleasure to be here with you.

Chin: We're doing a special series on Dementia Matters, that addresses issues being faced by our listeners during the COVID-19 pandemic. One of the topics discussed earlier is the anxiety and stress that comes with isolation and disruption of our daily routines. So on today's program, I want to focus on mindfulness and the benefits of mindfulness practice. We hear a lot of talk about mindfulness. So to begin, how do you describe mindfulness to someone?

Minichiello: I think one of the first things that I want to acknowledge even before starting the conversation, is just simply expressing some gratitude for all the teachers and mentors that I've worked with and trained with over the years that have really helped to inform, my own practice of mindfulness and my understanding of it as well. So when I talk about mindfulness with people, I think it's important to understand that there are many different ways to describe mindfulness. I think on reflecting on this question, what comes up for me is that it's a practice that involves choosing to bring awareness to the present moment with a quality of kindness in our attention. And so often this mindful attention might come in the form of a simple pause or a breath, or sometimes it can come in the form of an extended practice. So that can be done sitting or lying down, standing, walking, or through other forms of movement. One other piece that I think is really important to mention, is that out of this pause, whatever form that pause takes, we might begin to see in a different light, our relationship to ourselves and to those around us. And through recognizing or just simply being aware of this relationship, we then might choose to respond to ourselves or respond to others around us, in a way that is perhaps healthy, as well as compassionate.

Chin: That's a wonderful explanation, and thank you for sharing that and I do hope our listeners can rewind and go back over that because that is one of the most thoughtful and comprehensive ways of looking at it. I'm not even going to ask you my next question, frankly, because I think you did such a nice job. Mindfulness is not the same thing as meditation and breathing exercises. I mean, it's so much more than that. And that awareness that you speak of, I think is really important, especially during this time of the pandemic. I do wonder if you can share with us how mindfulness works, how does it affect our bodies?

Minichiello: Yeah. It's fascinating, fascinating research. And this is research that's been going on for decades now. And what I'll share is just really, really tip of the iceberg since the effects of mindfulness really are quite systemic. A few of the things kind of specifically that the research has pointed to in different areas, one: altering brain activity.  People have shown that through functional MRIs, the prefrontal cortex actually gets activated more. Specifically, one of the areas that has been shown to be activated more, is the left anterior cerebral cortex and other areas of the brain that are linked to a positive mood. There's also an increase of activation in the brain's attention centers through mindfulness practice. And what's fascinating about this too, is that a lot of these studies show that, while some of the research has been done in sort of the “Olympians” of meditators: Tibetan monks that Richie Davidson at the UW-Center for Healthy Minds has worked with. That population has shown benefit. And even people that have practiced for just short periods of time. I think one study looked at even just a couple months, showed that there are brain changes that are showing up as a result of practice. In addition, to bring changes, we actually see a lot of changes in different biomarkers, so different signals of inflammation or stress in our body. So noting that through mindfulness practice, there are changes in cortisol levels, C reactive protein, TNF-alpha. These are different factors that can be related to markers of stress. In addition, we see through mindfulness practice that there can be changes to blood pressure, to heart rate. There can be changes to how the body's immune system functions. There are some influences specifically on the T lymphocyte counts, in people that have HIV and cancer. One other study though this year too, which is fascinating is that there have actually been changes in the lengths of the Telomeres. So this is part of the chromosome, so we're talking in our genome and our DNA. This telomere is associated with a person's risk of chronic illness and mortality. And there's actually some research that has shown that compassionate meditations have actually increased the length of telomeres. This is something that meditation practice can have an effect on as well.

Chin: So it seems very, diverse and profound as far as the impact of mindfulness on the body. I know that when I'm practicing mindfulness afterwards, I feel less tense. And I feel like my muscles are more relaxed. I mean, is that a common response?

Minichiello: Yeah. And so, yeah, that's funny. This is an interesting thing. So part of the work that I do too, is through the VA hospital system nationally. We share some of the work, some of the research around mindfulness to different clinicians throughout the VA hospital system. And one of the, one of the things that we talk about when we present on mindfulness is kind of, what mindfulness is and what mindfulness is not. And this is a perfect example of your question, Dr. Chin is you know, mindfulness in and of itself isn't explicitly a practice with the intention of relaxing us, right? However, often whether it's intended or unintended consequences of it is that we do experience a sense of relaxation in our bodies. So, so yes, absolutely. To answer your question, that is, that will be something that will show up for a lot of people. I think especially initially as you enter into a mindfulness training and practice,

Chin: Well, knowing that mindfulness really affects our body in so many different ways, you know, what conditions or medical problems do you recommend mindfulness, as a treatment option?

Minichiello: So one thing that I just want to share briefly, a little interlude that I think can be helpful to share, is recognizing the terminology that we're using, mindfulness as a practice and then a mindfulness based interventions, which is something that's kind of researched and studied in sort of mindfulness training, that's packaged in a certain way to be delivered  in a research study. So just keeping that in mind, you know, a lot of the research that's been done on mindfulness based interventions, has focused primarily largely on some of the work that came out of the University of Massachusetts back in the late seventies through a program that was developed by Jon Kabat-Zinn called Mindfulness Based Stress Reduction. And so this is one, sort of, way in which mindfulness teaching or mindfulness training is sort of delivered, I guess you could say, in a research setting. And so, if you look over the research since the late seventies through now, many, many different areas in which sort of our Western biomedical research has looked at mindfulness based interventions in specific conditions, for specific diagnoses, a few of the ones that have very strong evidence would be things like irritable bowel syndrome, a lot of good research on chronic pain. A lot of good research on depression and anxiety. Some research shows that biomarkers for diabetes can actually change as well. People with high blood pressure, people who smoke and are interested in quitting smoking. And so, these are a lot of the areas that have been researched that are sort of disease states that mindfulness has been shown to have some benefit with. I, you know, I think it's also relevant to mention too, that part of what makes mindfulness practice unique, is that it doesn't need to be disease focused. It can actually be health focused. And from some of the teachers that I've worked with, really the underlying philosophy or the underlying principle of mindfulness practice is that we, as human beings, are already complete. So most people would say we're already whole, right? And so mindfulness as a practice helps to sort of reveal that more easily to us, because there can sometimes sort of be a veil over that philosophy or over that understanding that we are already complete, as we move through our lives. And so I think it's important to mention too, there are many reasons that mindfulness can be really helpful for, to maintain health, right? So helping people through pregnancy, there's a mindfulness based childbirth and parenting course that is very supportive for women that are going through pregnancy and afterwards, just as an example. 

Chin: So then knowing that, with that answer, where do you see mindfulness practice fitting into healthcare in general, but then also during this COVID-19 pandemic?

Minichiello: I think as a family doctor, what I've noticed the benefit of mindfulness really is, is supporting me, my own health, my own understanding of my wellbeing, my own relationship with myself. And it's helped me to start to bridge the gap in my clinical care by really meeting people where they're at when they, when I talk to people in a clinical context. And so I think that that serves a really important role in that way. There's a lot of research now looking at mindfulness in the healthcare setting. That mindfulness based interventions can support medical students, resident physicians, attending physicians, and healthcare professionals of all types, to decrease experience of burnout, perceived stress, depression, and anxiety. To help support healthcare professionals in the work that they do. I think what's fascinating too, is as you talk about this in the context of healthcare professionals - and this is really the research that I've been doing - is really being intentional about making sure mindfulness is not a band aid approach. Often we talk about burnout and people are like, “Oh, let's just throw some mindfulness at it and that'll make it go away and get better.” So it's recognizing that mindfulness is, and sort of this personal resilience, is one component of a much larger picture of a particular healthcare professional's overall sense of professional fulfillment and wellbeing. Making sure we keep that in the context as well.

Chin: Going back into the COVID-19 pandemic, are you able to practice mindfulness with others remotely? Or how are you finding mindfulness being useful during the pandemic?

Minichiello: You know, you look at the spectrum here of how mindfulness can have an impact potentially. And this is a spectrum really. We talked earlier about the effects of mindfulness practice on the immune system health and upregulating our immune system. And so really on a physiologic level, there is definitely benefit as we're talking about strengthening our immune systems as we are in a place where that can be challenged very easily with COVID-19. On a more human being level, there are lots of ways to practice meditation and a lot of different resources that are offering opportunities for people to practice meditation, even in the midst of COVID-19. I know the UW-Health Mindfulness Program will be rolling out courses that are offered online remotely through video conferencing. There are drop-in sessions, also the UW-Health mindfulness program has been offering remotely as well through video conferencing. So there are a lot of different ways to access this that don't necessarily at this time need to be done in person.

Chin: And thank goodness for that. It's nice to know that such a useful practice can be done using the current technology that we have, even in the midst of stay at home orders and directives from our government. You know, for our audience members with cognitive impairment, be that mild cognitive impairment or dementia, do you see mindfulness as a useful practice for someone's thinking or their memory or mood?

Minichiello: Definitely. And there's a lot of research that is coming out that is supporting this. I'm going to share a few specifics. There has been some research showing that mindfulness practice has a positive effect on attention, cognitive functioning, psychological well being, and in reducing systemic inflammation, all of which can have a direct impact on people that are experiencing cognitive impairment, mild cognitive impairment or dementia. In addition, there's been some research in this area around the benefit that mindfulness has to support people in perspective taking, mental flexibility and is sort of reducing the negative impact of stressful events on people. And it's this sort of ability to reappraise or ability to have perspective on these unpleasant events that has actually been shown to increase prefrontal brain activity, which has a direct impact on people with cognitive impairment or dementia. It can be very supportive. The final piece I wanted to share about this is there is a significant amount of research showing that mindfulness practice can be really helpful for the caregivers of people with dementia as well. Helps with decreasing experience of depression, mitigating that experience of sometimes feeling burdened in caring for family members or loved ones with dementia.

Chin: Now what's your recommendation for someone wanting to start a mindfulness practice and where does one begin?

Minichiello: Excellent question. Bringing my clinical experience forward, I like to meet people where they're at. So if somebody is coming to me and saying, “Hey, I've heard about this mindfulness thing, I'm really interested in learning more about it. I want to practice more. I have this time, this period in my life where I can actually dedicate some energy towards this. Where would you recommend I start?” At that point, if that's where a person is at, then I would say start with the UW-Health Mindfulness Program. It's extremely well-developed with a 26 year history plus, at this point in time. And there are many different avenues to tap into it from the UW-Health mindfulness program. There are some entry-level foundational courses that we have, which are the MBSR course, as well as a mindful awareness practice course, which is a six week course that sets the stage for a long term mindfulness practice. And there are a multitude of different other courses that are offered through the mindfulness program to really, again, meet people where they're at. So I had mentioned before the mindfulness based childbirth and parenting course. There's a mindfulness course for people of color. A mindfulness course in Spanish. A talking about mindfulness in motion course. Mindful photography, mindfulness in aging, mindfulness for smokers, mindfulness for eating awareness as well. And again, I have much gratitude for all of the teachers in this program for the development of programs for youth as well. My first program for families with young children for middle schoolers and for teens as well, that’s a really great resource if people are local in Madison.

Chin: And of course some of those programs I'm sure are available in other places in the country and the world. Mindfulness based stress reduction is a well known program that I know other institutions have. I wonder what you would say to this, because a lot of people ask me about online programs or phone apps or other other opportunities that they can do from home. How do you feel about those?

Minichiello: Yeah, I think they can be really helpful. I think they'd be very supportive for people. And again, it's another way to sort of explore, investigate, discover mindfulness practice in a way that fits with where you're at right now in your life. For some people that I see in the clinic, you know, they're like, “Hey, I'm interested in mindfulness. I'm interested in an app in particular.” And so if there are apps that people are interested in, I'll often share some ones that I think are well done. Those would be, Headspace, CALM, Buddhify is another good one. Another one that comes out of the VA hospital system, which is free to use, is called Mindfulness Coach. Also very well done app. So that's something that people can sort of tap into from home. I think there are a lot of really wonderfully written books as well. If people are interested, a starter book for some people that I will mention is Jon Kabat-Zinn, his book, Wherever You Go, There You Are. That can be an introduction for some people. And again that's just barely scratching the surface. There are so many well-written books that meet people where they're at and where they’d like to begin with their understanding and practice of mindfulness.

Chin: And we will have some of those resources and links in our note section on podcasts. So for those listening, if they go to our website, we'll be able to share those. But, you know, as we talk about mindfulness as a practice and as a component of what is needed for overall wellbeing, I would like to end by asking what you specifically are doing to stay healthy and maintain wellbeing during the COVID-19 pandemic?

Minichiello: Thanks Dr. Chin, this has been a time that I've really recommended a global pause and as much as things have been busy clinically, I've been tuning in to listen to what does this mean? What does this sort of global pause mean to me? And have taken time to exercise every morning with my wife. We either go for a run or we go for a bike ride in the morning. I make sure that I'm getting to sleep at a reasonable time. Usually it's pretty late for me, but I've been aiming towards 10 and 10:30, which is good for me. Eating well, cooking as much as I can, and doing my best in that way. And practicing meditation. For me, what's shown up recently is different types of compassion meditations that have been supportive for me and my own experience of the anxiety and the fear and the stress that have been present recently. And as a way for me to sort of attend to that feeling or that experience in our community as well.

Chin: Well, with that, thank you so much for being on the podcast and being able to share all of this information with our listeners during this very scary time, but something that we are going to get through. Thank you, Dr. Vincent for being on Dementia Matters.

Minichiello: Thank you, Dr. Chin.

Outro: Please subscribe to Dementia Matters on Apple Podcasts, Spotify, Podbean, or wherever you get your podcasts. And rate us on your favorite podcast app -- it helps other people find our show and lets us know how we're doing. Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health and the Geriatric Research Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers. This episode of Dementia Matters was produced by Bonnie Nuttkinson and edited by Bashir Aden. Our musical jingle is "Organisms" by Chad Crouch. To learn more about the Wisconsin Alzheimer's Disease Research Center and Dementia Matters, check out our website at adrc.wisc.edu. You can also follow us on Twitter or Facebook. If you have any questions or comments, email us at dementiamatters@medicine.wisc.edu. Thanks for listening.