Wellbeing For Real Life - Mindfulness

In this episode of the Wellbeing for Real Life podcast Dr Richard Pile and Dr Wendy Molefi talk about mindfulness:   what it is, the evidence for it being good for our wellbeing, and how to develop a mindfulness practice.  It includes a live session led by Wendy to demonstrate how you can do it in real life.  A video version of this episode  is available  on YouTube.

Richard is a GP specialising in Cardiology and Lifestyle Medicine, and author of "Fit For Purpose: your guide to health, wellbeing and living a meaningful life".  Wendy is a GP specialising in Mindfulness.   You can find out more about Richard here and Wendy here.

Fit For Purpose is available from Harper Inspire in paperback, e-book and audiobook format, with Richard reading the audio himself.  Find out more here.  This podcast has been produced the brilliant team at  Monkeynut Audiobooks. 

Transcript

Richard Pile  0:18  
Welcome to the wellbeing for real life podcast. Have you ever wanted to live life better, but found yourself baffled bewildered and bored by complicated, confusing and condescending advice. This podcast is the antidote. I'm Dr. Richard Pile, GP, lifestyle medicine specialist, and author of fit for purpose. Each episode, I'm joined by leading experts, as we explore different areas that affect our everyday lives. This is the wellbeing for real life podcast. Hello and welcome to wellbeing for real life. In this episode we're talking about mindfulness. I'm Dr Richard Pile GP with a special interest in cardiovascular medicine and lifestyle medicine, and author of fit for purpose.  My extra special guest is Dr. Wendy Molefi who is particularly qualified to help us with today's topic, Wendy, could you tell us a little bit about yourself?

Wendy Molefi  1:12  
Hi Richard. Thank you for having me once again. I'm a GP, I have a special interest in well being. So, I am a wellbeing coach, and I'm a mindfulness teacher as well. So very much appropriate

Richard Pile  1:25  
It's great to have you on the podcast, Wendy.  I wanted to start just by asking you a potentially slightly controversial question. Mindfulness has become a bit of a buzzword. We've heard a lot about it in the last year or two, particularly in the context of the pandemic and mental health. Is it a real thing, or is it potentially a bit of a fad?

Wendy Molefi  1:46  
That is a very fair question Richard, because it's certainly out there, isn't it? We have had a lot of our mindfulness:  Mindfulness this, mindfulness that so there's mindfulness everything, so it's understandable that perhaps there might be some sort of, I guess, question marks in terms of, yes. Is it a threat or is it just a tick box exercise for employers when they want to address the well being of their employees? But from my point of view and to be fair mindfulness has been out there for a long time for 1000s of years actually. Mindfulness has its roots in Buddhist tradition. It's actually called Sati, that's a Pali word and the literal translation for Sati is "remembering" and that means remembering to come back to this moment, because so often so often, more often than not, we are either living in the past, or living in the future. So mindfulness is really an invitation to cultivate our sense of awareness of this moment, this present moment of me talking to you right now, Richard instead of me planning what I'm going to do when I get home, remembering to do that. So it's really a cultivation of awareness of the moment awareness of our thoughts, our emotions, as well as what's happening in the body, and how that all relates to each other and links to each other. And in through doing that in becoming aware in that sort of way, we begin to notice the patterns of behaviour, some patterns that might not be so skillful in our lives that might not be so helpful, that we can, perhaps, learn to sort of step back and observe, and know that we have different choices instead of the usual reactive patterns that we tend to have. So that's what mindfulness simply means but it has been packaged into all sorts of various courses, and it's presented in various ways and forms. In fact, it was in the late 70s, that Jon Kabat Zinn secularised mindfulness by offering a course called Mindfulness Based Stress Reduction which is meant for people with chronic pain whom nobody else can help. So he packaged this programme, and is it has actually been shown to be quite successful, so much that there has been other courses that have burgeoned from this particular one. So, in as much as it might seem like it's a fad or it's some sort of corporate tick box, it has legs.  There is merit to behind it, it has meaning, and it has usefulness.

Richard Pile  4:49  
Thank you. So it sounds like not only is it not a fad, obviously a very leading question, it sounds like it also isn't necessarily something that requires you to embrace any particular philosophy or religious belief, it's got quite a long standing tradition in the Christian faith as well as I understand that, and others.

Wendy Molefi  5:08  
Yes, I mean, absolutely, there is no specific, I guess, having mentioned that it has Buddhist underpinnings, in itself, it's a word, no different to gravity, which means just noticing being aware of something in that little bit more of an intimate way so that you can see, if this is helpful or is it not helpful. So, through some of these courses, practising mindfulness I guess it'd be mentioned from a Christian point of view.  It's not just about that sense of awareness, it's imbued also with these other virtues or qualities like kindness and compassion and learning to accept yourself. And really that's what gives it its foundation, if you like.  That sort of that sense of awareness, which is imbued with kindness and compassion, of what is going on right now in my life, and instead of perhaps trying to push it away because what we tend to do when there is difficulty in our lives we want to either push it away, or suppress it in some sort of way, but the invitation through mindfulness practice is about sitting with it, sitting with the difficult, and actually seeing that it'll pass and also see a different perspective, that word perspective yet again that we've talked about, so it enables.

Richard Pile  6:39  
I was struck by your use of the word sitting with it. One of my observations is, and I've heard many other people say,  is that in our modern day society that there's relatively little tolerance for discomfort, for pain and there's almost the assumption, spoken or unspoken, that if you're in an unpleasant situation than what you deserve and what must happen is that, that must be removed as quickly as possible, because no one should have to experience it, but actually you're suggesting that there is a value in sitting with that, and learning from it I guess.

Wendy Molefi  7:13  
Absolutely, I mean, if there's a safety issues if there's pain, if you can move away from it yes do but more often than not, it's the kind of discomfort that we can't control we talked about that earlier as well, in that it's that challenge or the difficulty that you have no control over, instead of running away from it, which is habitual pattern, which doesn't bear anything in the end you don't learn anything by sitting with this. Whatever it is, because it's often a combination of thoughts that seem to be real, a whole turmoil of emotions that are also manifesting in the body. So it's just about really almost unpacking this inner unjudging way, just being with this kind of tingling or that tingling. If there's tightness, say that's tightness without creating a layer or story. On top of that, in doing that, but almost sort of dissipating, to some degree, that emotional charge that might come with any difficulty if you like. And let me be clear, it's not just about the difficulty. There's also joy in life, there's difficulty there's joy. So it's about also, being able to revel in moments of joy because sometimes we just have a moment and we are already thinking of something else.  It's about being able to be with the joyful moments and be with the difficult moments without unnecessarily judging and creating a whole load of narrative that compounds any kind of distress that might be there. I think in one of our podcasts. I talked about this Buddhist analogy about the second arrow, which essentially as I explained, the first arrow is deemed to be that pain from loss, from illness, from injury, from emotional distress that we cannot take away.  That's the first arrow and you can't change that. But what the human nature is to do is to then catastrophize, ruminate, or think what if this has happened and what if that had happened when it actually hasn't even happened. So in doing that you're shooting the second arrow.  You're compounding the distress, or the something that you needed to do, but you know we all learn it's about learning to notice that "Ah, there I am doing it" and pausing.

Richard Pile  9:46  
That's a really helpful description, I can actually identify with that in my own life as well. Although I'm not as expert on you as mindfulness, I did start to explore it, when our oldest, Luke, was it was at home, and life was quite stressful because of his seizures and he could have many seizures a night. Ambulances called out, hospital departments visited, and even on the nights when that didn't happen I would find myself lying on the on the floor in his bedroom, heart pounding, waiting for the next seizure, anticipating the next episode to arrive just like a person might feel a tingling in the chest and think it's gonna be a heart attack, and I found by developing mindfulness and I did it through the Headspace app, having read "Mindfulness, finding peace in a frantic world". I found that if nothing else, although I couldn't change those circumstances, when I found my thoughts beginning to spiral whether that was at work or at home, the discipline you learn, the mental discipline and the shift in mindset you get with the mindfulness, and I was able to kind of observe and acknowledge those thoughts for what they were without kind of being sucked down the rabbit hole and spiralling into despair and panic.

Wendy Molefi  10:54  
Absolutely and that's exactly what that practice encourages or teaches through perhaps starting as in a simple practice like focusing your attention on the breath. Essentially you're training your attention such that when it comes to thoughts, and you notice that you're on this train of thought that's spiralling somewhere else where you don't want to go, where you've been but somehow you're caught in the spiral, you're able to see, when you have that awareness, you're able to see "Ah, there I go".  Because the thoughts are just thoughts, they're just mental events, it's all happening in the mind, I know it's a bit annoying when somebody says that but it's all happening in the mind, they're not fact, so you're able to see that process and you're able to perhaps short circuit it, before it reaches a point of no return point whereby you're now a heap of stress on the floor.  Through various ways you can sort of learn to divert your attention to something else that will stop you going down that path.

Richard Pile  12:03  
I think that leads us nicely understood why the practical side of things, you know, we've had a really good conversation about, about the theory, we've talked about it in detail. Let's take it back to a consultation where you or I or anyone listen to this podcast is sitting in front of say a patient for example if they're a doctor and the patient says "Well, thank you for describing mindfulness.  That seems very complicated. I'm glad that you're good at it.  It sounds like it would take a long time to develop".  How would you solve that conversation practically in a 10 minute consultation? Doyou talk about the theory? Do you ever take them through any exercises? How do you approach it?

Wendy Molefi  12:38  
Yes, it depends whether the consultation lends itself to that conversation in the first place. It may come when somebody is describing to you the mental health related problem. And firstly, I would invite, I guess I would have this conversation about mindfulness as an option and might explain all the ins, the ins and outs, as we've already discussed. And I would just invite the patient, you know, to have that sort of open mind to have that sense of curiosity about what it could be in fact, to be honest, mindfulness, we can talk about it, intellectualise it. The thing is, it needs to be experienced. It's an experiential practice, searching, I was wondering, we could, we could do a short practice or not. I mean, this doesn't have to take long, so we could do a short practice and I could just demonstrate to you what I might do within the limitations of the 10 minute consultation, but it's a useful mindfulness practice.  Are you game?

Richard Pile  13:40  
I am absolutely up for it. Yes.

Wendy Molefi  13:42  
Excellent. I don't have my bells but we'll imagine that I have my bells, which I will cling, and then just sort of invite you to make that intentional change in your posture, perhaps just sitting for the little bit so that your back is self supporting.  Just ensure that your legs are resting on a leg rest, your hands resting on your lap. Just embodying the sense of dignity being alert, being awake. If you're comfortable with it, you can even close your eyes, but if not you can just simply drop your gaze onto the ground in front of you. Relaxing your shoulders. Softening the muscles on your face and jaw, because that's where we tend to hold our stresses and our tension.  Just arriving in this moment, giving yourself permission to arrive in this moment.  Then just becoming aware of what's happening in the body and mind right now

What thoughts are here? What emotions are here? What sensations can you feel in the body right now?

Not changing anything, just letting it being here with.  Rolling out the welcome mat and allowing it to be there because it's here.

Whatever is here, feeling it. When you're ready, just narrowing your focus of attention and bringing it to your breath, becoming aware that you're breathing. And then just following the in-breath for its full duration and the out-breath for its full duration.  Just following the breath. Sooner or later you'll notice that your mind wanders off elsewhere. That's normal. That's what minds do. Just simply noticing where the mind has gone and just kindly and gently bring it back to the breath, to that point in the body where you feel the breath most vividly.  Just following the in-breath. And the out-breath

This breath. Then this.

When you're ready on the next moment, just expanding your awareness around the breath to include the whole body sitting here. Becoming aware that you are here in this room. Sensing sensations with you sitting on the chair, sounds in the room. Perhaps the presence of others in the room, just taking the sense of awareness, a sense of openness to the next moments of your day. If your eyes were closed just opening them and just coming back into the room as it were. Taking a breath, little stretch if you need to. So Richard, that was a short mindfulness practice.I don't know how long that took. But that's something sometimes I do when I notice that it is needed, and it can be so powerful in just grounding someone into the present moment. I don't know what you notice?  Have you noticed anything? I forgot to ask.  Did you notice anything from that short practice? What was your experience?

Richard Pile  18:18  
First of all, thank you very much for that. And even though I have practised by myself in the past regularly, having someone else take me through it in a slightly different way from the way that I've done it is really interesting. I feel physically I feel like I'm very relaxed and kind of feeling like I'm sort of all together in just in one place, not, not distracted not thinking about other things. I can feel the physical tension that's gone out of my shoulders and was very nice.

Wendy Molefi  18:50  
It's interesting, and actually that's not even the intention.  That's a by-product of actually focusing on this moment: you notice that any physical sensations that might have been lurking about out of tension, out of stress, somehow they dissipate.  Any emotional charge somehow dies down through just that sense of awareness focus, not  judging, allowing things to be feels heard.  The body feels heard in a sense sometimes I say. And what's interesting from my point of view as a clinician because we get interested in these things is that there's plenty of evidence to support that mindfulness based approaches, actually are beneficial. There's NBCT a course that I teach, it has been shown in numerous studies that it's very effective in reducing rates of relapse of depression in people who have a recurring depression, and there's plenty of evidence as well in terms of anxiety and reducing pain and patients with cancer, just improving their sense of well being. I know there are other programmes to do with relapse-prevention in addictions. And also, there are studies that have looked at functional MRI is looking at the brain. Actually they can show that there are changes in the brain called in neuroplastic changes. Pathways that are related to the sense of the areas that are to do with this sense of training our attention. So, you know, there is evidence that over the last 30 years there's certainly been an exponential growth also research supporting the efficacy of mindfulness, programmes. So much that actually, NICE, which regulates what treatments are offered in the NHS, actually recommends mindfulness based cognitive therapy as a treatment for curing depression. So for me, that's quite reassuring.

Richard Pile  21:01  
Absolutey.  I was struck by your comments about the functional MRI scanning. I'm aware of that evidence too and it just strikes me as, as amazing that you don't just demonstrate an improved score, but actually you can see how people's anatomy has changed and the bits of their brain that have slightly enlarged or shrunk, as a result of mindfulness practice, which I think is hopefully something that would persuade people of its value.  If they're arguing about the more subjective side of things, that's pretty solid evidence isn't it really?

Wendy Molefi  21:32  
Yeah, absolutely.

Richard Pile  21:34  
We started off talking about the concepts of mindfulness,.  We've talked about how you do it, and you give us a lovely example, including what a GP might even do it in a consultation or any sort of other health practitioner. What would be your tips your takeaways from today in terms of just just to start people off in the right direction,. You might still be feeling potentially a little bit daunted at the whole prospect. 

Wendy Molefi  21:57  
Certainly I think it's coming from that point of view of being curious and being open minded to just see, explore it.  You've tried different things so this is worth exploring. Coming with thatk that openness of mind certainly allows, I guess, for more exploration for more discovery. In terms of simple things, I sometimes recommend to my patients is that, like say when you get up in the morning, instead of bounding out of bed, just spend a few moments just focusing your attention on the breath taking a few breaths. Following the breath, it might be that you focus on sensations of the breath in their tummy area and just follow a few breaths before you get up and get on with your day. In addition, you could sometimes recommend doing one activity in the day mindfully. And by that, I've just mean being present in that activity that you're going to do. If you're going to drink a cup of tea: just having the whole sensory experience as you lift the capsule to put it on there, noticing what your hand is doing, the forming and feeling the temperature and just really being present with the activity.  Even emptying the bins or washing the dishes you can be mindful and be present with any activity that you choose. And what's interesting is, as you're doing that, naturally, because we do the mind slides off to other things to memories daydreams or whatever, it's about noticing where the mind has gone.  That is part of the practice. Your task in that is just to notice "Oh, there I go again come back".  Remember what we said about "sati" meaning, remembering.  Just bring back the mind again to this.  Some of the studies have shown that it's actually healing. It improves our sense of happiness, this ability to manage our tension, it actually helps regulate emotions as well. There's certainly a lot of apps out there that people can just explore and you mentioned Headspace - that's one good one. There's another one called Calm, and then there's one that I use a lot more often called Insight Timer. So it's just a question of yet again, inviting that curiosity and trying it out, and just see if it works for you or not and just giving it a chance. And of course that books you mentioned: "Finding peace in a frantic world" by Mark Williams and Danny Penman.  That's a really good book and in that actually, they have a CD with practices and courses.  There are courses out there that people can explore to go on to be guided structurally in that sort of way.

Richard Pile  24:50  
That's very helpful Wendy, thank you.  You are of course showing your age by referring to having a CD in the back of the book because most people nowadays would take that out of the book and go "now what do I do with this?

Wendy Molefi  24:59  
You had to point that out Richard, didn't you?

Richard Pile  25:03  
I loved your illustration of emptying the bin. I have practised mindfulness whilst eating whilst walking, whilst running (limited success) whilst driving...but whilst emptying the bins? I'm going to put that on my list. That's not my favourite job and if I'm honest, I do it slightly resentfully at the moment!

Wendy Molefi  25:21  
Put it on the list and give it a go and let me know what happens!

Richard Pile  25:26  
Wendy it's been a great, great conversation with you today. Thank you for sharing your considerable expertise. I hope that our readers have found it even more helpful than I have.  It's been a pleasure to talk to you.  Thank you very much for your time.

Wendy Molefi  25:38  
Thank you for having me. It's been an absolute pleasure.

Richard Pile  25:41  
You've been listening to wellbeing for real life with me, Dr Richard Pile. If you've enjoyed this episode, please give it a nice review and tell other people about it. If you'd like to learn more, my book fit for purpose is out now, published by Harper Inspire and available in paperback ebook and audiobook. You can also follow me on Twitter, YouTube, and my website WellbeingForReal.life. This podcast was recorded at MonkeyNut audio books. Until next time, take care of yourself.