#114: Mindfulness, Medicine & the Biology of Stress - Dr. Craig Hassed

Speaker A: If you look at telomeres, which are like a marker of our genetic aging, little caps on the end of our chromosomes that stop the DNA from unraveling with stress, they shorten and get whittled away fast. It's like a marker of our biological aging. We now know that meditation, it actually has an effect of switching on the repair enzymes, slowing down the rate of aging at the level of the DNA of the cells. How can you use these practices to help us to understand ourselves better? Uh, but I mean, the research shows changes in the default mode network and so on, but also the stress circuitry. And we're starting to completely rethink our understanding of compassion and empathy. And it's not that empathy's wrong, but for most people the next step is into empathic distress. Compassion's different. The stress circuits of the brain don't light up. Areas of the brain associated with positive emotions and affiliation do. It's quite neurologically it's a very different thing. As Einstein said, everything should be made as simple as possible, but no simpler.

Speaker B: Welcome back to the FitMind podcast. What if the secret to reversing cellular aging and beating professional burnout wasn't a new drug, but in a fundamental shift in how you relate to your mind? Today we're diving deep with an amazing in person interview with Professor Craig Hassett from the Monash center, uh, for consciousness and contemplative studies. Decades ago, Craig was a disillusioned 19 year old medical student. He sat down to quietly watch his mind with zero books, zero teachers and zero prior experience. And what happened in that single pivotal moment completely transformed his life and sparked an amazing career pioneering mindfulness in medical education. In this episode we trace Craig's story from a skeptical student to to a medical trailblazer. We break down the biology of stress. We explore allostatic load and look at the mind blowing epigenetics behind telomeres, showing how meditation can actually slow down aging at a DNA level. We also dive deep into why standard empathy tries professional burnout. And how true compassion rewires the brain's distress circuitry. And why we're potentially looking at consciousness through the completely wrong end of the telescope. And before we jump any further, I just want to let you know that our amazing founder, my friend Liam McClintock's book Fitmind has just released. I finally have a physical copy and I've been reading it here in Mexico while, ah, volunteering a school of fitmind's sponsoring and honestly I cannot recommend it enough. This is genuinely incredible. He somehow Woven his story, which is absolutely fascinating with both the contemplative science practice and the Western science. And it is just genuinely an incredibly unique book. You can order your copy right now@fitmind.org to support the mission and help elevate your mind. Thank you so much. And back to the episode. Craig Hassett, welcome to the podcast.

Speaker A: Good to be here.

Speaker B: I'd love to start in the not too distant past. I think you are a 19 year old disillusioned medical student in Melbourne.

Speaker A: We are on the distant past just

Speaker B: a couple of years ago and you had, I think, no teacher, uh, no meditation experience, no, no books. And yet you, you sat, you just decided one day to sit. So yeah, I'd love to go back to there and talk, uh, a little bit about what happened prior to that, leading to that and what happened during that sit that helped define your future.

Speaker A: Yeah, I think I'd had a few moments of being present, you know, in my teenage years and for some reason always had an interest in meditation and I was aware that the, you know, the mind and body were very much linked. So I, I was kind of in a sense already in that mind space. But in my second year of medicine, uh, I was just very disillusioned and very disconnected from the studies. And you kind of at that age feel like life's like a train that's running without a driver kind of thing. And realized I needed to sort of get clear about and what I need to do and just to manage the stress of falling behind and if I kept going that way, the potential failure. So for some reason I thought, look, meditation would be helpful and I hadn't read any books, I hadn't done any courses. I think about the only thing I can remember was in when I was uh, 12 and year seven, a teacher said, all right, everybody lie down, we're just going to practice a little bit of relaxation on the floor. I think that would be about the only taste I ever had of it. But I thought, well, okay, meditation, I don't know what it is really, so I'll just keep it as simple as I possibly can. I'm just going to sit here and I'm just going to watch and I don't know what to watch for, so I won't watch for anything in particular, but I'll just, just watch what happens in the body, the mind, and without any attitude to it. So I just sort of sat and just in a sense fell as still as I could just in that sort of quiet witnessing sort of attitude. Um, and as I sort of got quieter, um, there's sort of thoughts, feelings, you know, all these kind of things which can kind of really close in around you when you're very stressed and disillusioned. Kind of just got attenuated and thinner and less substantial.

Speaker B: Yeah. Wow.

Speaker A: And I kind of. That's interesting. All of a sudden. It wasn't just that I, uh, was a bit calmer or anything. It was just that recognition that these things come and go and they don't have anything particular to do with you. It wasn't like, oh, no, what's happening to me? Where am I? It was just like, what an incredible relief of burden that is. It was just like. So the curiosity just drew me more and more into that. So it was a very deep sense of stillness and peace that came with that. But from it, I came out of it with a deep sense that the worries and the anxieties and everything else that was kind of like underneath all that m. No matter what goes on, you're fine. And I don't mean Craig's fine. It was like Craig was kind of completely insubstantial. It was like your being, the core of your being is fine, and it's not affected by it. I was like, dude, that's infancy. And I didn't need a book to tell me that. Tell. It was just like, self evident. And I can remember years later when I got quite curious in different wisdom traditions and they kind of spoke of that sort of thing. I thought, I think I know what they're talking about. So that was a very formative experience for me. I was interested in the mind. That's why I got into medicine in the first place. And, uh. And so that just really deepened my interest in understanding the mind and our relationship to it and set me off on that path. Wow.

Speaker B: Yeah, that's an incredible. That's an incredible experience to happen, particularly so early on, and that's such a pivotal time in your life. Did that stay with you? Did you feel that you could easily kind of recall that that was.

Speaker A: It was possible recall, but not so easy to just click your fingers and go back there kind of thing? Um, in some ways, I don't know, sort of, um, beginner's luck or whatever it might be. But it, um, sowed a seed very deep. And when looking at a career, that's kind of where I wanted to head it. So to. And I started in my clinical practice when I graduated and started, um, teaching patients simple, uh, meditation techniques in the style of what is. Would be now called mindfulness. But I'm going back to the early 90s when mindfulness wasn't a word that was being widely used but um, called mindfulness and help them to be present and to uh, you know, not be so attached to the thoughts, a more accepting, open attitude, moment by moment to what's being experienced. So I started to do that in my clinical practice. But I thought look, these are the kinds of things and the mind, body, relationship, medical uh, students should know something about it so they can help their patients. And so I got involved in medical education, started teaching in 1989 and it kind of things grew from there.

Speaker B: Yeah, and I'd love to talk about that actually. I know that you implemented mindfulness as part of the curriculum at Monash University and then more recently compassion as part of the curriculum. How, how has that helped shape uh, or help the, the medical students?

Speaker A: It helps them to cope with their stress, it helps them to focus better on their work, it helps them to engage more with their studies and hopefully it helps them to be better doctors in the future to be more present with their patients, um, to pay better attention when they're doing procedures and not making errors. And so hopefully benefits them personally and professionally. So the aim is to benefit them and to enhance their resilience and well being. But to have something other than a script pad to help their patients who are dealing with stress and mild, moderate depression and um, anxiety and coping with chronic pain or chronic conditions. And so hopefully they've got something other than a script pad or scalpel to offer patients.

Speaker B: Right, yeah. Because that's quite an unusual. I've never been to a doctor that's prescribed me any form of meditation.

Speaker A: They clearly weren't a monoscription Right, right.

Speaker B: And is that, have you had response of how that's working out in the, in the wild? I guess.

Speaker A: Uh, we haven't got like surveys about graduates and compare them to. You'd have to have a big budget to do that.

Speaker B: Yes.

Speaker A: What we have done is when we've surveyed our students later in their curriculum, um, and their intentions when they go out to practice and their openness of mind. So there's a significant proportion of them when we compare to medical students from other universities, say they're aware of this area, uh, they're very open to it for use in different clinical scenarios and settings and um, uh, a significantly higher proportion say it's something they'll be recommending on a regular basis. Um, it'd be very interesting to know. Okay, so 10, 20 years down the track. Are they a different doctor to the um, students who never got this in their undergraduate training? We can't answer that question exactly.

Speaker B: Hopefully we can in the future. But I think yeah, the science out ah of that, outside of that is strong and it would be amazing if hopefully that could be funded on a wider scale.

Speaker A: Well, when we've researched our students we found by the end of their six week mindfulness program in first year, these are undergraduate medical students. So by the end of their program, 90% of them say I'm using mindfulness in my day to day life. Nice. Told me to study, to focus, to uh, cope with stress.

Speaker B: Yeah.

Speaker A: To be calmer and more present when I'm about to step into the exam room, et cetera. So, so, and that's a very high uptake because they're not self selected. They all get it.

Speaker B: Yeah.

Speaker A: Um, but uh, they use the elements of it that they find helpful. And this doesn't mean that 90% of them are sitting back and practicing 30 or 40 minutes of M meditation a day. That would be a pretty rare medical student. But we give them lots of short practices and lots of really pragmatic ways to be present, to be mindful without it necessarily end up being a 30 or 40 minute practice. It'd be great if they did, but if we ask them to do that, uh, I'm sure that whole bunch of them would march off somewhere and make complaints.

Speaker B: I think that leads us quite well into the effects on cells and genetics. There is this kind of old but sticky view that um, our genetics are fixed. And I think epigenetics has become um, much m more popularized now. Could you walk us through that, that kind of central claim and why you went after that, that kind of question?

Speaker A: I got interested in, in epigenetics just because it's fascinating and because as well it's very hard to explain mind body medicine without getting pretty granular about the biology, the physiology, the neurology and the genetics of it. So why for one person can they have a genetic disposition to anomalous and it plays out or plays out aggressively, uh, whereas another patient with the same genetic disposition doesn't play out at all. And we know there's a whole bunch of lifestyle factors that make a difference. So do you exercise, eat well, et cetera. So all of that, uh, lifestyle elements are important, but also the mind. And I'm um, fascinated about the mind and body relationship. And so a lot of the early research looked at how when we experience stress, particularly significant and chronic stress, uh, produces what's called allostatic load, like a physiological wear and tear on our system. What's allostatic? So allostatic load be like, um, as I said, a physiological wear and tear. But if, if you imagine getting your car and the way you drive your car is. Yeah. You're accelerating hard the whole time you're braking hard, you're taking corners fast, you're revving. Even when you're sitting at a red light, you're revving your engine like crazy. You know, somebody's going to come up and say, look, your parts are going to wear out.

Speaker B: Right.

Speaker A: Repair bills are going to go up, you're going to go through your fuel so much and um, faster. It's going to be inexpensive and, and look, your car's not going to last you very long. It's a little bit like that with our body. Yeah. You know, so even when we're sitting down at a red light, we're kind of. It's not just the. But we're sitting there.

Speaker B: Yeah.

Speaker A: We're worrying about the thousand things we've got to do before the end of the day. So we've got this kind of tension, um, this sort of low level activation of the fight or flight response running in the background the whole time. Because the fight or flight response is like getting your car and putting it into turbocharge. Fantastic. When you're eyeball to eyeball with a 4 meter shark like McFanning a few years ago, famous Australian surfer. For those of you who haven't heard of McFanning, M. Um, but uh, not um, so helpful, um, in other situations. And 99.9% of the time we switch on the fight or flight response. It's got nothing to do with, with what's happening in the present moment. There is no shark, there's no bear, there's no imminent threat. It's in here. So if we imagine a stress or oh, what could happen later on or uh, I've got a presentation to give. I got angry with somebody last week, last month, 20 years ago. So all of these things, we play these scenarios, little movies in our head and if we take them to be real, then the body. Okay, I'll translate that into the fight or flight response. Where's the shark? Where's the bear? We're activating it for no good reason. The chemicals are pumping around with nowhere to go and nothing useful to do. So this is the kind of wear and tear that accelerates aging, uh, physiological stress on the uh, cardiovascular system, immune dysregulation, which Means more inflammation and less defense against coughs, colds, infections, but also from a genetic level. So they, you know, why are the inflammation? Well, for example, when you look at the genes that regulate the immune system switch on inflammation, which is useful in certain situations of injury and various things. You know, you need that sort of inflammatory response. But when it's being switched on or weigh in excess M, that's um, terrible and can drive illnesses and it switches off our uh, defense against coughs, colds, infections. So that sort of two way lose lose situation is what's called immune dysregulation. And but it, it's actually being triggered right down on the level of the genes that regulate the immune system. So the genes are being upregulated, so whatever's coded into your DNA is still there. It's kind of, that's not going to change apart from a few mutations here and there. But all of these molecules are uh, going around the DNA, switching on this gene, switching off that one. So that's the epigenetic bit. The EPI is what's going on around the genetics.

Speaker B: Right.

Speaker A: So it's like you've got your computer in front of you, it's got thousands of things programmed into it, but you've only got a certain number of programs that are active. The other ones are sleeping and dawn.

Speaker B: Right.

Speaker A: And, and it's like these things that change the way our DNA expresses itself for better or for worse. And this is very adaptive in lots of ways because you need that. Um, but it can also be a powerful driver for illness. And so when looking at things like um, say meditation and it has an anti inflammatory effect, it helps to boost healthy resistance to disease, for example, it actually changes those genes, the expression of those genes. If you look at um, like telomeres, uh, which are like a marker of our genetic aging, little caps on the end of our chromosomes that stop the DNA from unraveling, um, with stress. They shorten and get whittled away fast. Genes mutate, unravel and so on. It's like a marker of our biological aging. We now know that meditation, sitting here looking like we're doing nothing, um, but in a very different kind of way to really doing nothing. It actually has an effect of switching on the repair enzymes and slowing down the rate of aging at the level of the DNA of the cells. So uh, I just find all that stuff mind blowing.

Speaker B: Yeah, it's, it, it really is mind blowing. And like anecdotally you feel it. But to get to uh, the like telomere Length is uh, I think for me that would have been a leap not too long ago. Um, so that's a really mind blowing finding.

Speaker A: Yeah. Well, one of the real leaders in that telomere research and an Australian scientist by the name of Elizabeth Blake Blackburn. And um, so she and her colleague discovered um, telomeres or why telomeres were important and their relationship with genetic aging that um, she's done collaboration with looking at the impact of meditation or Lassa Emerald in the States works with her. And um, so they've found that meditation slows down that telomere shortening which is a real anti aging medicine. She's done work with Dean Ornish to show that a mind body based, comprehensive, ah, healthy lifestyle program is actually associated with regrowth of telomeres. So it's like a reversal of the aging process. Has that been. I'm 166 and you should have seen me when I was 80. I was not traveling well. I got onto this stuff and it really turned a route for me.

Speaker B: Is there like a, a dose response curve for that? Like is it. Is. Do we know how much would be an effective dose for that? Kind of.

Speaker A: That's one of the um, uh, big questions.

Speaker B: Hey everyone. I just wanted to take a quick moment to share a message. Since you're listening to this podcast, you clearly care about optimizing the brain and understanding consciousness. And that's why you should absolutely check out this incredible book by our dear founder and friend, Liam McClintock. Liam really cuts through the fluff to deliver a science backed and beautifully written story and written roadmap that helps to reshape your brain and your mind. It's an incredible piece of work that will genuinely change your day to day life. You can order your copy right now@uh, fitmind.org to support the mission and help elevate your mind. Thank you so much. And back to the episode.

Speaker A: That's one of the, um, uh, big questions, um, that hasn't really been answered very well. Maybe there are different doses to do different things.

Speaker B: Yeah.

Speaker A: So now some of the people who kind of really look into this say, well, look around your 10 minutes of, you know, mindfulness meditation a day, you know, that that might be uh, enough to help you to deal with the stresses a bit better in day to day life and to be more present and focused on your work and whatever. But the studies that look at dealing with like major chronic illness, severe chronic pain, major recurrent depression and so on, they were using a dose of 30, maybe 40 minutes a day of the formal practice of meditation.

Speaker B: Yeah.

Speaker A: And maybe to deal with, you know, the stuff that's more serious, maybe it needs longer practice. Um, so we don't, we don't really know. Um, and I just want to emphasize one point that the meditation side of things, we don't know 100%. Is it just the meditation, like just the sitting practice day to day. Yeah, that matters. Or is it how much does that help you to get out of the chair and be mindful and present in day to day life? Because what's the point in being mindful for five or 10 or 20 minutes sitting in a chair and then being unmindful for 23 hours and 55, 50 or 40 minutes in the rest of the day? So the aim is to live mindfully. So what's the relative contribution of the formal practice of mindfulness meditation compared to the informal practice of being mindful? Because one of the things we've found is students don't practice a lot of mindfulness meditation. They practice, 90% of them practice some um, each week. Um, but uh, the majority of them practice being more present and mindful in their day to day life. And we found for them at this kind of low dose, um, the informal practice seems to make a bigger difference to their stress than a really low dose of formal practice. M so we'll give you the answers to those questions.

Speaker B: Yeah, it must have been, I uh, mean it must have been amazing to see the explosion of this research. You would have, you would have been and I would say early like before probably there was, I don't know how many studies there would have been at the start of your interest or career in this compared to now.

Speaker A: Well in the mindfulness area, very few there had been. What's made it easier from 1990 were the first sort of um, optional workshops. Uh, our students, our ah, medical students could come to. Yeah what made it relatively easy to even introduce it then? Because evidence based, scientific. There was quite a lot of research had been done mostly on TM Huns and dental meditation and Herbert Benson's work on the relaxation response. So in the late 70s, um, early 80s. So there was, there are a few hundred studies on that mostly looking at isolated physiological effect, you know, blood pressure, cortisol, so on. Um, but there was enough there to give it a kind of some um, you know, reasonable scientific basis. Um, what really happened from a mindfulness perspective. John Kabatin had been doing his work from the early 70s as well into the 80s. But there was this sort of takeoff point of exponential Growth. And that was when John worked with Teasdale, uh, Williams and Siegel to develop what's called mindfulness based cognitive therapy. And so when they did their research on significantly reducing the relapse rates for current depression, that kind of started to. And that was around the year 2000 the first studies were coming out and that created a lot of interest. Depression's the pretty much the developed world's number one burden of disease. And prescribing more and more antidepressants weren't turning a Titanic. And um, so then it's not that people should never take antidepressants presence, but clearly we're not getting to the underlying causes. And so this work on M mbct ah created this sort of increasing interest. So if you look at MAP pubmedal, you know, a similar database, there's this sort of hardly any studies each year. I mean you get to about 2,000 and there's this. So these days there's about 4,000 studies a year. It's about 10 or 11 studies every day in peer reviewed time.

Speaker B: That's amazing.

Speaker A: Just the mindfulness, that's huge.

Speaker B: I didn't realize it was that many.

Speaker A: That's extremely high volume. Yeah, it's pretty hard to keep up with more.

Speaker B: I can imagine just to read a paper be taking quite a lot of time. So you have heard it? Well, you embed mindfulness into inside, uh, essence. Can you talk a little bit about what ESSENCE is?

Speaker A: Well, my experience of teaching in medical education for um, I'll be approaching 40 years soon. But um, I uh, can't teach a medical student anything unless it's based on an acronym. So ESSENCE is an acronym, stands for education. But not just education in the usual sense. We're talking about being educated about yourself, understanding yourself better. So um, education in a very broad sense, stress, um, management. So that's the mindfulness, mind, body, sort of side of things, spirituality, which kind of like where do you find meaning, purpose in your life and all the different ways of doing that? Um, exercise, nutrition, connectedness, that's your social support, your sense of community, relationships, an environment, um, and not just uh, like air quality and you know, so on that we normally think about. But what kind of environment do you create for yourself? Your social emotional environment. So do you get out into green spaces? So that's the essence of health.

Speaker B: Mhm.

Speaker A: So we teach the students how to apply these things in their own life and, and then we so say right, well in the prevention or management of chronic illness, what would be the recommendations? Um, you know, from the ESSENCE model. And so it can really be pretty much applied to any chronic illness alongside the best that modern medicine has to offer. It's not like, oh, do the lifestyle stuff or do medicine. It's like use the best of everything. But if you do that, you wind up with much, much better outcomes. So CS and small, uh, and for

Speaker B: somebody that is looking at getting into, or getting back into meditation, how would you, how would you prescribe? Or what would you prescribe? If would you prescribe? Say what someone is, is most interested in what they enjoy the most or is it dependent on maybe their, their current. Let's just assume this person is in um, nervous, uh, system dysregulation, they're quite stressed, um, maybe struggling a little bit with their relationships. Is there are different practices you would give for those people or is it just what they would do, what they would practice?

Speaker A: Well, I think there's no one size, it fits all. Or mind you, the traditions of meditation or contemplative practices that have been around for a long time have probably been around for a long time because they've been pretty well thought out and applied. And so that's always a very good reference. Um, so you take something like mindfulness, um, but there's an infinite number of ways you can apply mindfulness. So for somebody who's got, you know, history of trauma and so on, then maybe a different approach to somebody who's just got a high workload at work. And so what's a person able to do, comfortable to do, feels ready to do because it's not really helpful to go and push somebody where they're not ready to go, you know. So for somebody, closing the eyes and all of a sudden just being much more aware of what's on your mind or what's just in the background of your mind can be a pretty confronting kind of thing. So there are lots of ways a person can learn to be mindful, um, which might de, emphasize certainly long practices of mindfulness meditation, but really emphasize ways of being mindful and present in your day to day life, um, working at a pace that's comfortable for that person to work at, um, how long the practices might be. So you know, dipping your toe into very brief practices could be a lot more achievable than trying to sit down and really push through a long practice, which can get pretty confronting. Um, but there are lots of other ways too. You know, and just learning, you know, some breathing techniques, yoga, uh, breathing techniques have been around for a long time in ways that help to elicit A parasympathetic response with all of the sympathetic nervous system or stress system activation. Um, so there are lots of ways. But really important thing also is just being understanding what's going on in our own minds as well. So to notice how when we're not present, to actually realize how much of the time we're projecting into a future that hasn't even happened. We've already lived a stressful situation a thousand times before it even gotten there. And it's like, I mean, uh, I said right at the start that, you know, in my teenage years, I had a few moments of being present here and there. And I can remember when I was, I don't know, maybe 15 or 16, I used to do a lot of competitive swimming. And in the weeks leading up to big swimming meets, I'd get really nervous and queasy in the stomach. And, um, I kind of realized one day I realized, wait a sec. Why am I feeling like this? Because I was sitting on a really comfortable chair in the lounge room at home, and I was like. All of a sudden I noticed that in my imagination there was an imaginary me on the starting blocks at the old Olympic pool in Melbourne, waiting for the m. You know, um, starters gun to go. And all of a sudden I'm getting in the dream world, and I take it to be real. I wonder how much of the time I'm doing that. So as I came back to the present moment, it's like, this is a really comfortable place to be. That stress response switched itself off. And I thought, that's interesting. And no wonder others are doing that same thing itself. So it's not just a, uh, breathing, it's not just a meditation practice, but it's really understanding what's driving the stress response on the level of the mind. So the whole cognitive aspect of it and why being present is so important. You might have an exam to prepare for. Um, fair enough. Stay present. The exam is not going to happen for weeks or months or whatever it might be. But what's in front of you now is what you can control. So get your attention on what's in front of you, what's present, and meet the future when it comes. Um, but these m kinds of things help people to be productive, but also to switch off that stress response when we don't need it.

Speaker B: M. Do you think that helped your performance? Did you notice any change when you could observe that? Did you get less nervous and did it actually affect the outcome of the swims?

Speaker A: Uh, it made it easier, you know, just to Deal with the whole thing. Yeah, I used to play quite a lot of basketball as well. And I can remember, uh, the same thing. Particularly one time. The team we had lost to a few times throughout the season, we played them in the preliminary final. And, um, for some reason we were on. We were coming back. We were coming back. And there was about two seconds on the shot clock. I got fouled taking a shot. And so I had two free, um, free throws. It was like time out. And everybody ran me. Oh, stay calm, Greg. Stay calm. And everybody's so wrecked up. And I just felt like this real sense of cut. It was just like, it's okay. It'll be what it'll be. I just felt really calm. But I tell you what, when I stepped up to that free throw line and sunk those two free throws, I felt really calm. But that. That ring looked as, you know, very large hoop if it. And for me, that kind of sense of being present and dealing with emergency situations. As a junior doctor, times when I was very present, I could process things. I could respond far, far better than if I was getting anxious about how's this going to turn out. So for me, I've found in terms of performance in lots of different ways. Being present, being on task, being in the moment, in this sort of open attitude to letting things unfold moment by moment makes, um, a massive difference.

Speaker B: It seems like you're describing in some ways what would be called flow. Like, are you aware. Are you aware of any evidence for meditation, increasing flow in general? Because I know. I think in Steven Kotler's book he talked about there being correlation between flow and happiness, overall happiness. And it seems as we kind of decondition these. These programs, um, these projections of the mind into the future or the past that naturally more flow might. Might kind of arise in life. M. Yeah. Is there ever any evidence of that?

Speaker A: Yeah, there is, but it's a. It's a very hard thing to study.

Speaker B: Yeah.

Speaker A: Because when you're trying to do a control trial, there's a whole bunch of things you can control, but you can't necessarily control. M. People can practice getting better at being in flow.

Speaker B: Yeah.

Speaker A: Whether we actually practice getting into flow, whether we practice how, um, not to be out of flow.

Speaker B: Yeah. Right. That's a good way to describe.

Speaker A: Because we often think our way out of that kind of where I'm. And sort of, uh. I've come to. With this. We think and worry our way out of being and flow. Rather than just being as present as can and, uh, surrendering to the moment. So the zone flow, when you look at that they're extremely mindful states. When an athlete describes being in the zone, it's incredibly um, mindful. And the paradox is that there's, there's such complete immersion in the moment with what the athlete's doing that there is no room for anxiety about the outcome. Because the outcome's always about the future. Even if that outcome is 20 seconds from now or half an hour from now, it's about the future. Whereas an athlete who's in the flow is just completely absorbed in the moment. And um, so that's one of the real paradoxes. No concern about the outcome. And yet because the attention's so fully engaged in the moment that the performance, peak performances are always flow or zone state. So there is some research, but a lot of it just depends on asking people what's your state of mind? What's the state of attention when you're in that state? And people will describe it. And ah, I like. Well, yep, that's mindfulness. Like you know, um. Power, Excellence.

Speaker B: Yes. Yeah, that's a, that's a, that's a good way to describe it. I think you do ah, mindfulness courses And I think MOOCs. What, what are MOOCs? And you tell us a little bit more about the implementation of um. Yeah, mindfulness in the education system.

Speaker A: Them. Yeah. Well Monash really got behind the mindfulness work that I was doing and a colleague as well. Um, and we had a lot of support um, in the mindfulness area. So Monash dedicated funding just to do mindfulness teaching around the university. And when some of the people who um, with uh, online learning were sort of heard about some of the work that we're doing, um, said look, we'd love to develop these MOOCs with you. So we're going back to 2015 now and we developed um, uh, these MOOCs on the FutureLearn platform. Monash doesn't have the relationship with FutureLearn anymore. There've been about half a million people who've done those programs over the six, uh, years or so that we were running them there. But um, uh, yeah, these massive online open courses. So mindfulness, well being and peak performance, um, maintaining a mindful life. And those courses were now run through M3Cs, so the Monash center for Consciousness and Contemporary Studies. And so we are in Melbourne of course. Um, and uh, so they're very practical courses that sort of. Well you can get some of the theory, but the theory's gotta be applied if, if it Was a course just um, you know like on hydration. We just give you the theory of hydration. Yeah, well at the end of the course you're thirstier than you were at the start and I say okay, well here's the bit of the theory of hydration, but here's the water, drink it.

Speaker B: Yeah.

Speaker A: And how do you so you know a way it's a very applied, practical, pragmatic course because for me when I learned mindfulness, I wasn't learning it from somewhere else. I was kind of in a sense learning it intuitively. M so when you're dealing with your first psych emergency as a junior doctor, it's like where's your attention then? You know, like when you were doing your first lumbar puncture, where's your attention when that needles going in. So for me I kind of taught myself that's a very pragmatic approach to it. And so these courses take a very pragmatic approach. How can you live it in your day to day life, whatever your context, you know, doctor or not a doctor. These courses are really for anybody. Um, so you don't have to be a doctor, but it's a very practical approach. So those courses were the highest ranked mindfulness courses globally among MOOCs. And then um, uh, and since that time at M3Cs we've had uh, the opportunity to develop not just short courses but semester long units for undergraduates and postgraduates where they can take a deeper dive. They can learn the practical side of it but understand, go into it further, understand more connections, you know. So um, in particularly how it relates to like one of our undergraduate units, true happiness.

Speaker B: So true happiness, that is beautiful.

Speaker A: Yeah, um, I mean happiness unit. But what's true happiness? Which kind of raised the question about um, well are there kinds of things we're chasing happiness that don't lead us to happiness. So the science and practice of human flourishing. So, so how can you use these practices to help us to understand ourselves better, be more resilient? And we look at say in that unit again very practical and apply but pressure points like stress and conflict and sense of isolation. We look at potential solutions like the cultivation of well, contemplative practices, compassion, uh, and connection. And then we look at big questions like you know, what is meaning? Um you know, what is self, what isn't it? And uh, what is happiness?

Speaker B: So it's awesome.

Speaker A: Yeah, so it's a kind of a deep dive. So it's great to be able to do that over a semester. Um, rather than just you know, four or five or six weeks.

Speaker B: So that's kind of the structure outlaid with, uh, science and then also practices

Speaker A: as you move through. Yeah, new tutorials. One of the things I think is just so important about these units is that when we get the students in, you know, we've got 220 students doing that unit a semester. So, you know, there's a whole bunch of different tutorial groups, but you get the students into the tutorial room and you do the practices and it's very reflective. It's a lot of questions. So the not up the front saying, oh, this is what you need to know and this is how it is and this is what you need to think. It's like the tudor's there to facilitate. So what are you discovering? What are you noticing? Ah, your mind's more distractible than you actually realized. Isn't that interesting? What's the effect of that distractibility? Oh, you make errors, you don't listen to people. Oh, your mind wanders off into work. Ah, uh, what's the effect of that? You know, so there's a lot of inquiry, a lot of questioning, so the students can make their own discoveries. But the thing is, when the students are in the room, they're talking with each other, they're having one on one coming back to the main group, small groups. This is a really rare thing for kids these days. I'm saying kids, adolescents, young adults. It's like life has lived so much on the screen, on the phone. And to actually have us authentic and deep conversations with somebody is incredibly rare, but incredibly valued by the students. And that has a transformative effect in itself. Um, we're losing that kind of, uh, ability to connect with each other in that sort of way. It is an absolute paradox that through screens and technology we're more connected than ever before. But all the research shows we're more isolated than ever before. The more we use this, the less we understand ourselves, the less we actually were able to manage our emotions and reactions and various things. It's like this is taking us away from ourselves, away from each other. It's like Harry Potter and the Dementors. You know, the dementors come, uh, suck the living daylights out of someone, I reckon. It's a smartphone.

Speaker B: Yes, it is. Yeah, that's a good, that's a good point. I was actually going to go there like you touched then on, um, compassion. And I think the evidence from Richard Davidson is on loving kindness, which I think technically is somewhat similar anyway, but there's evidence that loving kindness reduces the uh, default mode network quicker, he found quicker at least in that study than other types of meditation. Is that, um, do you, is that well established? And how would you say there's like a 40, ah, five year old marketer like, and they are looking at practicing some form of mindfulness, like uh, I'm still just wondering how they would decide on what, what, what to practice.

Speaker A: Yeah, well look, if somebody came along and said I've got real issues with, you know, anger and resentment and various things, okay, um, you know, somebody might be ready and wanting to practice loving kindness or compassion practices right from the start, especially if they recognize I really need to do something about this. For most people, if we stepped in first up with medical students and we started the bits out, or it was like, whoa, this is too far too fast or where are we going there? So learning basic mindfulness techniques. And then later on in our, our course we have a four week um, compassion unit which is core curriculum. It's not elective. So this is the other end of the curriculum when they'll be moving out into their clinical practice, um, in the following year. So it's a compassion training module. So we have practices and ways of cultivating compassion. So it really depends on where a person is as to what kind of practice you'd start with. Because starting with uh, a compassion or a loving kindness practice, especially to practice somebody or to try and bring that to somebody, you've got a lot of resentment is very difficult and a lot of people struggle with that. It'll bring things up. So there's a kind of a certain amount of background I think which is really helpful in the more simpler practices. And that gives a person perhaps a little bit more wherewithal to work with things that may come up during a, uh, perhaps a more challenging practice. It's easy to bring loving kindness to you, to, if you're on a good relationship with your partner, to dog to your, you know that it's, it's harder

Speaker B: to people you don't know so well

Speaker A: or people you work with or somebody you've really got some issues with. So I think you kind of need to build up um, to those sort of more challenging practices. But I mean the research shows there's changes in the default M mode network and so on, as you're sort of saying before, but also the stress circuitry and we're starting to completely rethink our understanding of compassion and empathy. So empathy was kind of thing. You've got to have empathy and it's not that empathy is wrong, but for most of us, when we're with somebody who's distressed, we will experience empathy. But then we get distressed by their distress. And it's not just somebody at home or at work. You're watching the news and you're seeing stuff every day that you would rather really wasn't happening in the world. And you experience empathy, which is entirely natural. But for most people the next step is into empathic distress. And if there's a lot of that, then pretty soon there's empathy fatigue and burnout and then avoidance and, or anger and reactivity. And so what we understand, and Richie Davidson's really led the world with this, is that compassion's different. Um, you sort of start with empathy, but instead of stepping into empathic distress, when you step into compassion, um, the stress circuits of the brain don't line up. Um, areas of the brain associated with positive emotions and affiliation do. That's quite neurologically, it's a very different thing. And um, uh, Um, the people are really know this feel better. So that compassion fatigue is a misnomer. There's no such thing as compassion fatigue. People do not get fatigued by compassion. Um, they get fatigued by empathic distress. And um, one of the interesting things that happens from an intentional point of view and where mindfulness kind of overlaps a lot is that um, with empathic distress the attention goes off the person who's experiencing the distress and turns to ourselves and like oh no, I'm feeling like this, I don't want to feel like this. Quick how to make it go away. And um, whereas with compassion the attention stays fully that the person is experiencing distress, there's a complete openness to be ready to help if there's something there. With empathic um, distress it's quick, I need to fix you so I can feel okay again. And that doesn't always lead to the best kind of helping, but the attentional side from a self focus as opposed to a focus on the so called other.

Speaker B: That's interesting. I hadn't heard, um, I hadn't heard like a scientist put it that way before. That's exactly the way I would anecdotally experience it. That empathy is, is very tiring. And if, if say I'm with a person that sometimes might uh, I might find the situation somewhat tiring. And if I do remember to, to be compassionate and it is a practice, then then the, the situation is usually quite energizing and it has the opposite effect I think. And the reason I was asking about it is just anecdotally we did. I've been doing uh, just like a Zen anapanasati, like breath meditation retreats with high doses. It was like, I know just a normal amount, like 10 hours a day or something. And then we did, we did um, a retreat with Alan Wallace, a Compassion, a Forum Immeasurable Immeasurables retreat. And that was going through compassion, loving kindness, empathetic joy and equanimity. But there was only 2420 minute meditations in that retreat. But before I'd read Richard Davidson's book, I've noticed a bigger shift off that in terms of how my kind of. The only way I can describe it subjectively is it's like everything was softened like these kind of. I just remember being in traffic in things that would. Would be quite frustrating before and it just wasn't triggering me in the same way or. Anyway, actually. Um, but now that you now with what you've said, I had had high doses of mindfulness prior to that, so maybe I was somewhat ready to, to have that. That part of the training, I guess.

Speaker A: Yeah, well, I think that capacity to not step into empathic distress. So when you're practicing mindfulness and then we kind of, you know, you're sitting there and you got frustrations or anger or you know, mind wanders off. You know, we often get irritable. You know, we get reactive to what we're experiencing. But we're just a human being having human minds. Right. So when we kind of soften our reactivity to that, get less judgmental and you know, reactive about it. Yeah. In a sense we're learning to cultivate a kind of a gentleness or a kind of a self compassion. Although people argue, you know, is there any such thing as self compassion? It's just compassion. But you cultivate a kind of compassion in the presence of things that experience. You don't necessarily want to, but m. When we do that day by day and then something happens in our day to day life reactions happen, it's easier to notice it and just to soften the attitude to it, uh, to get less caught up in it, to notice it and to have the attention stay with the person rather than oh no, uh, this shouldn't be happening. Quick, make it go away. And when we get reactive to it and aversive to us, then we actually escalate the very thing we're trying to get rid of. I've noticed that for myself, um, like as a medical student about when I was 19, getting into the anatomy dissection room was not my favorite thing. You know, bits of body. And I was like. And I kind of thought m. In a couple of weeks, I mean that's going to be um, you know, you're going to need to step in there. And so a couple of weeks prior to that happening, I kind of thought I'm going to stand at the end of a very long corridor where the doorway to the anatomy labyrinth. And I'm just going to stand here and just feel repulsed. Just really. But I'm just going to stand here and just feel comfortable with feeling uncomfortable. I'm just going to let those feelings kind of be there. And um, so I did that for five or 10 minutes and then the next day I went further down the corridor and I'm just going to let those feelings be there and just not trying to do anything about them but just learn to observe them with kind of less sense of being caught up in them. And uh, then the next, until you know, the second week, I just stepped in there and just helped those feelings. So by the time dissection started a couple of weeks later, it wasn't an issue. Wow. And I kind of again, I mean sort of like intuitively it made sense to me that, you know, I guess when I say I taught myself mindfulness over the kind of, I don't know, I thought of them as experiments. I'll do an experiment and see what happens. And um. But I think that when we practice mindfulness meditation and we're learning to bring that attitude to the things we find uncomfortable, it then makes it easier for us to bring that to the discomfort that others are feeling. And being comfortable with others discomfort doesn't mean not caring. It just means able to be at peace with the situation as it is. And yet our readiness to respond, a readiness, a very natural, uh, readiness to, to help its help as possible.

Speaker B: Mhm. Yeah, exactly. I think it increases our ability to help because we're not caught up in the stickiness of, of the situation or assumptions. Yeah. And so as we, I think this is the last big big question. But you, you've had 37 years at Monash and um, I think you've been involved with 120 papers. But what's the big question left on the mind or my body connection for you? Is there anything left?

Speaker A: Well, um, M3Cs, there's the word consciousness in there. For me the big question is um, understanding consciousness. So when we, if we can understand it because there's this sort of, I don't know, debate, uh, the material Science perspective is. Yes, you got material matter, you know, it's physical matter. And then it becomes complex. And um, eventually you got a brain and thinking gets more complex and eventually you got sentience and something self conscious. But from that view it starts with physical matter. Yes. And that's the underlying reality of the universe is the physical matter. When you look at not just the world's great wisdom traditions, but also great physicists of last century and they said no, um, actually I think the wisdom traditions had it right.

Speaker B: Right.

Speaker A: Consciousness is primary. M and then things that manifest on other levels. You know, the physical world is not as substantial as we think it is. It's actually, there's nothing really there. It's just that impressions, you know, sort of, it's all happening in the mind and in a kind of a way the consciousness, primary mind, physical matter. Um, so the big question, like can we answer that? Can we just get that sorted? Because there's a lot of implications that flow from that. Yeah. So yeah, if M3Cs can resolve that question, uh, over the next few years, I'll be very happy with that. It'll be on my come back.

Speaker B: Yeah.

Speaker A: Because I mean the physical matter thing first. And to explain consciousness as a product of physical matter, that's the hard problem of consciousness. Yeah. Nobody's got a clue how it happens. And um, uh, and you know, I kind of think, well, if we're looking at the universe through a telescope, um, well, maybe m. We've been looking through the wrong end of the telescope. We need to look at it from the other perspective and maybe, ah, ah, the universe opens up a bit. So, so that's a big question. That's a great question.

Speaker B: Uh, just to push you a little bit somewhere you might not want to go. But if you were to take like a Bayesian probabilities approach, what would you put probabilistically that that might be true, that consciousness might be primary and you don't have to answer that. And also, is there any, is there

Speaker A: any

Speaker B: like test that you know of that could start to answer that? Because I'm also extremely interested in that question and I think it's becoming much more popularized now, at least in my peripheral.

Speaker A: It is.

Speaker B: Uh, and a lot of people were probably quite dogmatic about the materialist approach, seemed to have swung the other way in the past probably couple of years. But I wonder if it is primary. Is there a, is there a. Is there some sort of experiment you could create to look in that direction?

Speaker A: Probably, uh, not if the wisdom traditions are right. I Think it's immeasurable, formless, because that's what science tries to measure. There's gotta be something measurable. Etc. Probably not from that perspective. I think the answer to the question comes in very deep meditation when it kind of becomes self evident. When I was 19, I got out of the chair with that sense.

Speaker B: Yeah, yeah, right.

Speaker A: Uh, that was a kind of like, interesting. And. And for me that's the only thing that really answers the question.

Speaker B: M. Yeah.

Speaker A: Once it's answered like that, you don't need any more debate about it.

Speaker B: Right. Yeah, exactly. And uh, that's probably with the emergence and popularity of psychedelics, I think that might be what's potentially causing at least part of. And meditation, of course, like primary. But I think both aspects of that. There's a really amazing channel that I follow called Essentia foundation. And they started off mostly, um, interviewing quantum physicists and through contemplating quantum physicist physics. A lot of these quantum physicists arrived at that view M Just because they couldn't see how even mathematics. I think it was Frederico Fagin, he said that he felt it was impossible. He had an experience actually. But where he saw that it was

Speaker A: impossible for

Speaker B: matter to create consciousness and then within that mathematics to arrive.

Speaker A: Yeah.

Speaker B: Um, and that it had to be consciousness being primary.

Speaker A: Yeah. As Einstein said, everything should be made as simple as possible, but no simpler for me to quote Winnie the Pooh bear a very little brain. I try to keep things simple if I can so I can understand that.

Speaker B: Didn't know the Winnie the pre. The quote. That's amazing. I have to add that to the repertoire. So the final thing is just a really, really quick. I'll just do a couple of quick fire questions. A book that changed your life. Uh, Plato, Symposium and one word for what mindfulness is. And a practice every day for at least a year

Speaker A: for somebody else to

Speaker B: practice or yourself, I think yourself

Speaker A: practice. Um, meditation half an hour, twice a day, every day. One final one.

Speaker B: A teacher whose voice you still hear.

Speaker A: Socrates. Great.

Speaker B: Thank you so much. We really appreciate it. Really great work. And uh. Yeah, I hope you can answer that question and keep going. We really appreciate it. Thanks Greg.

Speaker A: Thank you very much. Hidden pleasure.

Speaker B: Josh, thank you so much for listening to the episode. If you enjoyed it, please, if you could give us a like a subscribe and hit the notification bell that would really help us out or just share this episode with a friend. Share the course with a friend. Anything would go such a long way. Thank you so much and I hope to see you soon.

Speaker A: Sam.