Just Breathe: Why breathing is so effective in reducing stress and how it can serve as a tool for influencing well-being

May 25, 2023

Information

YCSC Grand Rounds May 9, 2023

Priya Narayanan, MD, Instructor, SKY Healing Breaths Program

ID9959

To CiteDCA Citation Guide

00:00Wonderful. Well, good afternoon,
00:02everyone and welcome to Grand Rounds.
00:04And it seems somewhat unusual to
00:05be back in this virtual format,
00:07but we're very grateful to be joined today
00:10by a speaker joining us from the West
00:12Coast who will introduce in just a moment.
00:14So we're delighted to be sharing
00:16this virtual space together.
00:17And just a reminder about
00:19grand rounds next week,
00:20we'll have a very special Donald
00:22Donald Cohen lecture for this year.
00:25Amy Clinton will be joining us from Emory.
00:27So please do join us in person in
00:30the Cohen Auditorium next week.
00:33And now it is my great pleasure
00:35and to ask Amelia Krishnan to
00:37introduce our speaker for today.
00:40Amelia, over to you.
00:42Thank you, Karen.
00:43Thank you everyone for being here.
00:44I'm Amaya and have been connected
00:46to the Yale Child Study Center
00:49in a few different roles over
00:51the past almost nine years.
00:53First as a social work fellow,
00:55then clinician,
00:55currently as a trainee from the
00:57Yale School of Nursing and then
00:59joining the outpatient clinic
01:01as a nurse practitioner in July.
01:03And it is my great honor to get to
01:05introduce Doctor Priyanna Dyan,
01:07our speaker today.
01:09Doctor Nadayanan received her medical
01:11degree from McGill University in Montreal,
01:14completed her psychiatry residency
01:16at NYU Medical Center and fellowship
01:19in forensics psychiatry at
01:21Albert Einstein Medical Center.
01:23Dr.
01:24Nadayanan currently works in
01:26an ACT Assertive Community
01:27treatment program in Los Angeles,
01:29treating people with severe and
01:31chronic psychiatric illness,
01:32many of whom are experiencing
01:35homelessness and other structural
01:36and psychosocial stressors.
01:38Doctor Nadayanan is also a senior
01:40faculty member with the Sky Healing
01:43Breaths program and travels around
01:45the country to teach meditation and
01:47self development workshops to focus
01:50on addressing burnout and increasing
01:52resiliency among healthcare workers.
01:54She is a strong advocate for the role of
01:56integrative modalities in recovery and
01:58wellbeing and promotes the role of yoga,
02:01meditation,
02:01breath work,
02:02and a holistic perspective on
02:04healthy living as adjuncts to
02:06conventional psychiatric treatment.
02:08I would also like to note that
02:10she is an awardwinning documentary
02:11filmmaker and taught the first
02:14sky breathing workshop held in
02:16the Cohen Auditorium in 2015.
02:18I'm so glad that she could return to
02:20our community to share this knowledge
02:21and some of the practices with us today.
02:23So without further ado,
02:25over to you,
02:26Priya,
02:26thank you.
02:28Thank you, Amia.
02:30Amia snuck in some details that I
02:32had not submitted to her in the bio,
02:35which was very sweet of her to do.
02:38It's lovely to be back at Yale with all
02:41of you and also just the joy sometimes
02:44of not having to travel all the way
02:47and to be able to do this on Zoom.
02:49For those of us who don't travel so
02:51easily or feel exhausted from it,
02:54this is a real asset.
02:56And just I feel like the efficacy of doing
02:58this online also increases participation.
03:01So I'm very excited to
03:02be with all of you today
03:05this. 45 minutes to an hour that we
03:09have together may be a little different
03:12than your typical grand rounds because
03:14there's a significant portion of it that
03:16is dedicated to certain experiential
03:18processes of breath work and meditation.
03:21But I think that's going to be really fun.
03:24And when I look back to my residency
03:27and all those grand rounds that
03:28I was compelled to do,
03:29I think I would have loved to have something
03:32that was a little bit more practical.
03:34So we're going to have some real
03:36practical tools to have under
03:38our belt before we leave today,
03:40right? So
03:45our topic today involves breathing,
03:49which we're all doing all day long,
03:53and really delving a little deeper
03:56into why breathing or breath work
03:59is so effective in reducing stress.
04:01And how we can use it as a tool for
04:05influencing well-being overall.
04:08And that brings me to one of my
04:12favorite books. It's Robert Sapolsky's.
04:14It's inspired.
04:15This little slide is inspired by his book.
04:17He's the author of a book called
04:19Why Zebras Don't Get Ulcers.
04:21He's a stress researcher at Stanford.
04:24And I love the fact that this poor
04:27zebra stripes are unraveling.
04:29Which really.
04:30Obviously doesn't happen to this zebra,
04:33but arguably we are all the human
04:37species in a state of chronic stress.
04:42Stress is obviously integral to functioning,
04:46but we've reached a point and I think
04:50much more exacerbated by technological
04:53advances that we don't come back to baseline.
04:57So the notion of having stresses.
05:00Essential for life,
05:01but you're meant to have it like a zebra,
05:05just right before perhaps dying.
05:09Like there's a predator attacking the
05:11zebra and there's a high level of stress.
05:14The sympathetic nervous system
05:15is in full drive,
05:16and the zebra has to use that to escape.
05:20But we've all now incorporated this chronic
05:23level of stress into our physical body.
05:27And that has very detrimental effects
05:29to our physical and mental well-being.
05:34So. Burnout, I know this is the word
05:37burnout has been around for decades.
05:40Originally when the word was coined,
05:41it was specific to the healing
05:44professions folks that were involved
05:46in any kind of patient care.
05:48It's now used much more widely.
05:52The poignant thing to me about this is that.
05:56Each and everyone of you here or
05:58anyone in the health professionals
06:00was attractive that profession with
06:03a very Basic Instinct to make a
06:07difference to someone else's life.
06:09But how do you give of yourself
06:12fully when you are depleted?
06:16And to me almost this word burnout
06:19doesn't capture the essence of
06:20what I believe is going on and
06:23I would I like using the word.
06:25I I didn't coin the word.
06:26It's from actually a alumni who went to
06:29the same undergraduate college as me.
06:31Moral injury that in the
06:35healthcare professions were facing
06:39almost like a spiritual impact
06:43on our ability to provide care.
06:46Feeling a disconnect with what we
06:49want to do and being unable to do it.
06:53The impact of burnout.
06:56Is multidimensional.
06:57This is sort of common sense.
06:58It obviously impacts the
07:00healthcare provider,
07:01physicians, nurses,
07:03nurse practitioners, everybody
07:07on every level, anxiety, depression.
07:10It impacts patient care.
07:11There's robust data on how patient outcomes
07:15are compromised by high levels of burnout.
07:18It has an impact on institutions,
07:21the costs that institutions bear.
07:25If there are more medical errors,
07:26if there's increased patient dissatisfaction,
07:29that impacts the entire healthcare system.
07:34And I think it also impacts the community's
07:38trust of healthcare providers, right?
07:43I've heard patients say, you know,
07:44I went to see this doctor and he's just
07:46out there to make money or he's just out,
07:48he's too busy.
07:48I don't don't get to speak about the
07:50things that I want to speak about, so it.
07:52Trickles down all the way to a
07:55community level where there's a
07:57there starts to become a distrust
07:59with the health profession.
08:02So
08:05the impact is is multidimensional anxiety,
08:08depression, insomnia, fatigue.
08:10But it has an impact on
08:13other aspects of our life,
08:15our feeling of social connectedness
08:18impacting work, life balance.
08:20Every single aspect of our life is
08:23impacted when there's a higher burnout.
08:26So the question is,
08:29what is the best way to address this?
08:31What is the best way to recharge?
08:34What is the most effective,
08:36efficient way to reduce stress in our lives?
08:40And to get into this conversation,
08:44I'd like to talk about energy,
08:46so I'd love it if you could just
08:49unmute yourself and just share.
08:50What are the ways in which we get energy?
08:53Like this is just simple,
08:54like how do how does how do we gain energy?
08:58Oh, my slide tricked me.
09:01Food, right? Food is one of the
09:04basic ways in which we get energy.
09:07And when I use the word energy,
09:08I'll describe this in a
09:10little bit deeper way.
09:11What's another way in which
09:12we get energy besides food?
09:17Rest. Sleep. Sleep. Absolutely.
09:21What else can I exercise? I heard exercise.
09:31Connection with others.
09:33Connection with others, yes.
09:36What else? Anything else? I
09:38get Energy from nature.
09:41Nature. Like being outside in
09:44nature? Absolutely.
09:45So these are very thought out
09:48activities and they're unique
09:50probably to each of us that we
09:53engage in to very consciously bring
09:55ourselves into a calm state of mind.
09:58A walk in nature will do that,
10:00you know you walk,
10:01you're with with no other human being,
10:03just beautiful nature,
10:04beautiful sunset.
10:05You will notice that your energy
10:08levels or your overall sense of
10:11well-being is much higher after that.
10:13Or with your spending time
10:15with your loved ones listening
10:18to music that inspires you.
10:21But there's a source of energy
10:24that we're not tapping into.
10:28How about breathing? Yes, yes.
10:33It is literally the most impactful way in
10:37which we can impact energy in our system.
10:40And when I use the word energy,
10:42I'm going to now start talking about
10:44this in the context of where this
10:46body of breath work comes from.
10:48And it's an ancient science.
10:51And I use the word science very consciously,
10:55thousands of years old,
10:57mostly from the Far East,
11:00India and other parts of the world
11:02where there are books written on
11:05the value of breath in modulating
11:07the state of our mind and.
11:10On a very simplistic level,
11:13very, very simplistic level,
11:14but I think all of you would agree with this,
11:16is that it's not that easy to
11:21modulate the state of our mind
11:23by telling our mind to go there.
11:26So if I want to calm down,
11:29and I keep telling myself,
11:31calm down, calm down, calm down,
11:32calm down, does that work?
11:36No. Maybe does once in a while,
11:39but for the most part,
11:40especially when you need to calm down,
11:41you're not in a state where that your
11:43mind is going to listen to you anyway.
11:46Or even worse, you have a friend
11:48or a colleague or a sibling telling
11:50you just calm down and you're like,
11:53I'd love to calm down,
11:54but this is not the time to tell me that,
11:57so asking the mind to do
12:00something isn't very effective.
12:04Like at this moment,
12:05if I were to say to all of you,
12:06you know what,
12:07Think of anything in the world,
12:09anything at all,
12:10but don't think of a green apple.
12:14That's the visual image.
12:16You can't control what the mind does.
12:19But if I were to tell you,
12:20take a long deep breath in,
12:23that is possible for you to do.
12:26So this ancient science that
12:29comes from the Far East.
12:31Established one thing which
12:34was very interesting is its
12:37connection with emotions, right.
12:39So there was a study done in
12:422002 looking at respiratory
12:44feedback in the generation of
12:46emotion and what it did is it,
12:48it brought a cohort of people and
12:51had them evoke one of four different
12:54emotions and they recorded what I think
12:57all of you would agree with is that.
13:00Different emotions have a different
13:02rhythm in the breath, right?
13:04So if I were to ask you,
13:08how is your breath when you're sad,
13:11is there a description
13:12you can give me for that?
13:13What's the what's the rhythm of
13:14your breath when you're sad?
13:29I could see it as being slower,
13:31yes? Absolutely.
13:32And Heather, I think you would
13:35say agree at least that even if
13:37it's hard to describe the rhythm,
13:39it's very different than when
13:41you're happy or excited.
13:42It's very different than when
13:45you're angry or anxious.
13:47So that was the first part of the study,
13:50which is there was a very
13:51distinct rhythm in the breath.
13:53The second part of the study was interesting.
13:55They brought in a new cohort and had them.
13:59Breathe in these rhythmic different rhythms,
14:02they were instructed and to breathe in
14:04those four different rhythmic patterns
14:06and in a self reported questionnaire,
14:09identify the emotion they experienced
14:13and with statistical significance.
14:16The participants were able to identify the
14:19emotions simply by breathing in that rhythm,
14:23which goes to show that the link between
14:27breath and emotions is bidirectional.
14:30So currently the way we function is an
14:33event happens and your body reacts and
14:35your heart rate is in a particular rhythm,
14:37your breath breath is in a
14:40particular rhythm and life goes on.
14:42But what if we could use the rhythms in
14:47the breath to modulate our state of mind,
14:50right so.
14:55Doctor Benson published
14:56this book back in the 70s.
14:59It's called Relaxation Revolution,
15:00where he was starting to look
15:02at the science and genetics of
15:04mind body healing and you know,
15:07spoke a lot about the relaxation
15:08response that comes from the breath.
15:10And more recently,
15:12I believe Breath was published in 2021.
15:15James Nastro,
15:15the New York Times writer,
15:17published this book called Breath,
15:19The New Science of a Lost Art.
15:22And I love that tagline because I do
15:25believe that modern medicine is only just
15:28catching up to this ancient science,
15:31which unfortunately didn't have
15:33enough double-blind control studies
15:36for it to become a commonplace
15:39tool that we all use in our lives.
15:43And there one article that completely
15:46speaks to this looked at it was a it's
15:49a a Medline database review that looked
15:52at you search parameters like reading
15:55techniques and psychophysiological outcomes.
15:57And they noticed that of course there's
16:00a connection between deep breathing and
16:02heart rate variability and respiration.
16:08So the the data on the the.
16:11Breath's ability to activate our
16:14parasympathetic nervous system,
16:16especially by deep breathing,
16:18is pretty evident.
16:19And the vagus nerve is interesting, right?
16:22So the vagus nerve puts us into
16:23a state of rest and relaxation,
16:25almost to the point where it's for
16:26those of us who've experienced it.
16:28You can faint from it, you know,
16:31you can have a syncopal episode.
16:33But that vagus nerve activation
16:36when done consciously?
16:39Switch us from that fight and flight
16:43to a rest and relaxation mode
16:45and you can do that simply from
16:48increasing the duration of your exhale
16:53and nothing. Just if your inhale is 2
16:56counts and your exhale is 4 counts,
16:58it will put you into a parasympathetic mode.
17:02But of course the science or the
17:03these techniques that are have
17:05been taught for thousands of years
17:06are much more elaborate than that.
17:08And So what I'd like to do is actually
17:11take a few moments if everybody's OK with
17:14this to do some breathing techniques.
17:16Does that sound like something that
17:18would be interesting and useful?
17:20And also one of those techniques I will.
17:23It's very simple,
17:24but it can be taught to your clients,
17:26your patients,
17:27anyone that you you would like to teach.
17:30But before we do that,
17:31is there anything anyone would
17:32like to ask me?
17:40No.
17:43OK, alright. So what we'll do is
17:46I'm going to give you a description
17:48of what we're going to do.
17:49The first breathing technique that I'm
17:51going to teach you is the simpler one,
17:55and it's called straw breath.
17:58And as the name implies,
18:03there's a little analogy to a straw and
18:05the way it would impact you is that.
18:07You breathe in through the nose.
18:08So you're breathing in through the nose,
18:11but you're breathing out as if you
18:13were breathing out through a straw.
18:16What that means, or what it
18:17looks like, is you breathe in
18:22and the out is
18:33so you can see.
18:34I extended that for quite a while.
18:36When we do it together,
18:38I'll gradually increase the count.
18:40If you feel like, Oh my God,
18:41it's very hard to catch up
18:42for the count that I'm doing,
18:44that's OK, Just relax.
18:45But as we do it, you'll notice that
18:47with each attempt at doing that,
18:49the exhale gets longer, right?
18:52So simple instruction,
18:54breathing in through the nose,
18:56Breathing out through the mouth as if
18:58you were breathing out through a teeny,
18:59teeny, teeny straw, yeah.
19:02Any questions on that?
19:04Does that seem fairly straightforward?
19:07Okay.
19:07And what you'll do is before we begin,
19:10let's do a quick check in.
19:11So I want you to close
19:14your eyes for a moment
19:19and just notice the state
19:21of your mind at this moment.
19:30It's almost as if you're taking a
19:32snapshot of your mind at this moment.
19:41Are there a lot of thoughts,
19:44The thoughts rushing off to the future,
19:48the past, whatever It is,
19:49just observing the state of your
19:51mind simply so that it can allow you
19:54to compare this state with how you
19:56feel at the end of the straw breath.
20:00And if you wish, you can open
20:01the eyes to just watch me.
20:03But if not, we're going to go straight
20:05into a straw breath and a reminder
20:08you're breathing in through the nose.
20:10And exhaling through the mouth as if
20:13you're breathing out through a straw.
20:16And I'll be counting the exhale for you.
20:20So breathe in and exhale
20:31123456 Inhale
20:37Exhale 1.
20:47234-5678, breathe in.
20:54Exhale.
21:03123-4567 eight.
21:08Breathe in Exhale
21:231-234-567-8910 Breathe in
21:29Exhale
21:36123456.
21:4178910 And continue at your own pace,
21:47breathing in through the nostrils
21:50and exhaling as if through a straw,
21:55and extending that exhale as long as you can.
22:48And after this last exhale, you can
22:51relax the breath but keep the eyes closed
22:55and
23:02once again just observe the
23:04state of your mind at this moment
23:16and when you feel ready,
23:18you can open the eyes.
23:27Anyone want to share what that was
23:29like to do that? Have you noted?
23:30Did you notice a difference
23:42fall?
23:45It certainly is very relaxing
23:47and I would like to suggest we
23:49do it for every grand rounds.
23:53It's funny you said that.
23:54I was just thinking we really need
23:56to do this at the start
23:57of every class we teach.
24:00Just from the the chaos of the transition.
24:03It's like clearing out the the
24:05chaos from your your brain.
24:09Tina and Paul, you know this is it's to me.
24:12You know, when I I grew up in India.
24:14And believe me,
24:15the last thing as a child growing
24:17up in India was wanting to learn yoga.
24:19Like that was like what the old people did,
24:21and you didn't want to have
24:23anything whatsoever to do with it.
24:24And so my discovery of yoga and breathwork
24:29was my journey in the United States,
24:32you know, as a young resident is
24:34when I started delving into it,
24:36and I think the most.
24:38Interesting thing to me about
24:40breath work especially is that the
24:43effect is nearly instantaneous.
24:48It just slows your mind down.
24:50It's almost as if your mind
24:51and the breath are connected.
24:53And I also teach this because some of
24:56the breathing techniques we we teach,
24:59you know you don't don't.
25:00You couldn't teach it to folks
25:02that have very severe mental
25:03illness or a psychotic process
25:05that it could be too destabilizing.
25:08But straw breath is like
25:12an overarching favorite,
25:13and there's something about and in schools,
25:17they actually will do a fun thing
25:19where they'll give kids straws to
25:21to just have something tactile.
25:23But the process of exhaling through
25:26the mouth for that extended duration,
25:29and that's key.
25:30So when you teach it, the breath isn't.
25:38It's that wouldn't do it.
25:40It really is that straw
25:42description is very critical.
25:44So you're telling them breathe in
25:49as much as they can do it, you know?
25:51And as you noticed when I
25:53instructed you it was graded,
25:55I started at six and I built up to 8,
25:57then 10 and you can do that,
26:00but it's just an it's such a powerful
26:03tool but also one that I feel.
26:07With my patients,
26:08there's this feeling of self empowerment.
26:11So it's something they feel they're doing
26:14for themselves instead of everything.
26:16Feeling like someone is
26:18doing something for them.
26:19So it's a tool that anybody can use.
26:24So I, I and I agree, you know,
26:26few like 2 minutes of this before any
26:28grand rounds would be a great way
26:31to incorporate this into one's life.
26:33I also use straw breath.
26:36When I'm having a stressful conversation,
26:38and often stressful conversations are,
26:41I feel one way streets where I'm
26:43listening to someone who's stressed out.
26:45And if that's all they're doing,
26:47I will just be doing straw breath
26:50on the other end on the phone.
26:52Like, I just no one's going
26:56to know you're doing that,
26:57but you're experiencing the benefits
27:00of your parasympathetic nervous
27:03system being activated, Yeah.
27:05Great.
27:06Did anyone have any questions on using
27:10this as a tool to instruct your patients,
27:12clients or did that feel
27:14fairly straightforward?
27:17Paul, you're on mute.
27:21I had a quick question. Sometimes
27:23in either yoga or meditation,
27:26they teach a different kind of breathing.
27:29It's more like an ocean breath.
27:32At the back of your throat.
27:34What's the difference between the
27:37straw breath and that in terms of your
27:40feelings as an expert in this area?
27:44So Paul, absolutely. The ocean breath,
27:48also called victory breath and in a
27:50yoga class they'll call it Ujai breath,
27:53is on a very simple level.
27:56It's harder to teach,
27:58It's harder to instruct.
28:00Like, even if I would, I can.
28:02I'm happy to do that with
28:03all of you right now.
28:05The instructions on doing it
28:07can put people into their heads.
28:09The straw breath is much simpler because
28:13you're just breathing out through the mouth.
28:15So the ocean breath, victory breath.
28:18I can describe it the way you would
28:20when we teach it, is once again,
28:23you're breathing in through the nose,
28:26but your mouth is closed.
28:28You're breathing in and out
28:29through the nostrils.
28:30But your attention is in
28:32the back of your throat.
28:33So when you do that,
28:35if hopefully all my audio filters aren't on,
28:38you should be able to hear me.
28:39It sounds like this.
28:50So you're constricting the back of
28:51the throat. It is extremely powerful.
28:54It's it's just and it's also great sleep aid.
28:59So when when you're lying down and
29:01your mind is churning, there's so many
29:03things as you try to go to sleep,
29:05just doing like 8 to 10 victory
29:09breaths will put you right to sleep.
29:12So you know what?
29:13Since you brought brought it up, Paul,
29:14I think it's a good little reason
29:16to just learn the victory breath.
29:18So if everybody's OK with that,
29:19I'll teach the ocean breath to all
29:21of you and you'll do it together
29:23and maybe even have a the the
29:26ability to compare it with how.
29:28You felt at the end of Straw breath,
29:30although I will tell you that it
29:31starts to get accumulated right?
29:32So you're not comparing apples to apples.
29:35You've done straw breath and
29:37now you're doing victory breath,
29:38so might feel more powerful just
29:40by virtue of doing many long
29:42exhales by the time you get there.
29:45So victory breath is done, as I said,
29:49constricting the back of the throat.
29:51Now for those of you who don't
29:53know what that means.
29:55The analogy is if you had a mirror
29:58and you were trying to fog it,
30:00or a piece of glass and you
30:01were trying to fog it,
30:02you would go.
30:04And if you can all just do that.
30:06Like you're pretending to fog something,
30:15now do that with your mouth closed.
30:22You notice a little scratchiness at the
30:24back of your throat when you do that.
30:27Now you have to do that on the
30:30in and the out breath. So it's
30:50and a simple way to.
30:52To know that you're doing it right is.
30:53I'll have you do this now you can
30:56just cut your ears for a moment,
31:00and for the first few seconds,
31:03I just want you to breathe normally,
31:05like normal breath. As if nothing.
31:07No, no victory breath.
31:08Just normal breath.
31:12And
31:16now switch to victory breath.
31:25And you should start to notice
31:26that there's a difference.
31:28Do you notice that when
31:29you do the victory breath,
31:29you're hearing a sound,
31:31So you're doing it right?
31:33Sometimes we're not convinced we're
31:34doing something right when we are.
31:36So let's do a few rounds of victory breath.
31:39And what I'll do at the end of that,
31:41I'm just going to guide you
31:44through a brief meditation.
31:46And then we'll just look at some
31:48of the science pertaining to this
31:50particular practice that I teach.
31:51Yeah. So eyes closed.
31:54So really, for the next 6 minutes or so,
31:57your eyes are going to be closed throughout.
32:04Then just relax completely.
32:09There's nothing to do
32:14for the next few minutes, just
32:16following the instructions effortlessly.
32:25Let's begin with some big tree breaths,
32:30Ocean breaths, breathing in and
32:33out through the nose, gently
32:36constricting the back of the throat.
33:04Long, deep victory breaths,
33:07constricting the back of the throat and
33:10deepening the breath as you go along.
33:51And relax the breath. Allow the
33:55breath to come back to normal.
34:00We'll just meditate
34:02together for a few minutes.
34:04When you hear my instructions,
34:06just lightly and gently follow
34:08them without much effort.
34:15First, bring your attention to all
34:17the sounds in your environment,
34:22whatever they are.
34:29Just accept all the sounds and noises
34:31in your environment at this moment.
34:48Now become aware of your body.
34:53Your awareness is fully on your body
34:56and on the seat that you're sitting
34:58feeling the weight of your body
35:00on the seat that you're sitting.
35:12The body is a precious gift.
35:17Just becoming aware of
35:18your body at this moment.
35:22Now
35:35become aware of your thoughts.
35:44Your full attention and
35:45awareness is on your thoughts,
35:50good thoughts or bad thoughts
35:57Without judging, just become aware
35:59of your thoughts at this moment.
36:18Now bring your awareness to your feelings,
36:28pleasant or unpleasant,
36:32without any judgment.
36:33Just become aware of your
36:35feelings at this moment.
36:52You are peace.
36:57You are joy.
37:28Take a deep breath in and exhale.
37:38Breathe in again and as you exhale,
37:44become aware of your body and surroundings,
37:51and when you feel ready,
37:53you may open the eyes.
38:05How are you feeling? How is it?
38:06Is there a difference between
38:08your state of mind when you
38:10started this session and now?
38:15Yeah, fell asleep? Who, who?
38:18Who said that? Sorry, I missed.
38:21Wonderful. You felt like.
38:22And you know, it's interesting.
38:24That can be one of the first
38:26outcomes when you start to do
38:28breath work and meditation.
38:29There's so much fatigue.
38:31Restore in our body so that can
38:34manifest as feeling tired and sleepy.
38:36So anyone else,
38:38anything you wanted to share
38:43in more Peace
38:45of Mind in terms of daily
38:49tasks that I need to do?
38:52I was in rush to call patients
38:54family clinician, so I was like,
38:57I'm gonna do that slowly, slower. Yeah.
39:01It's slowing it, literally.
39:03It slows you down.
39:04And the thing about slowing down
39:06isn't in that negative way, you know?
39:09So much of our energy is wasted
39:11in mindless chatter in the mind,
39:15like it's not getting you anywhere.
39:17You're just like, you know,
39:19it's bombardment of thoughts.
39:23But the clarity thoughts get.
39:26Thoughts are thoughts are part of us.
39:29Your thoughts are critical to our existence.
39:31But it's the overwhelming nature
39:35of our thought patterns that causes
39:37stress to our nervous system,
39:38and that's where the breath comes
39:41in and allows us to really slow the
39:45pace of that mind modulation so
39:48that we're really living life from
39:50a place of being more centered.
39:54Charlene, thank you.
39:55It's so soothing to do breath work.
39:57I feel nourished,
39:58and my breath actually sounds like
39:59the ocean when I constrict my throat.
40:01Absolutely. And that's the analogy.
40:04It's ocean breath, like Paul mentioned.
40:07Because you sound like an ocean.
40:08You know, like or like as kids,
40:10you'd put a seashell on your ears
40:11and hear the sound of the ocean.
40:13It's very similar.
40:15So what I'd like to do is just
40:17take a few minutes to share some
40:18of the science on this particular
40:21breath work meditation technique.
40:23That I teach,
40:25it's actually taught over multiple
40:28consecutive sessions because it's much
40:30more intensive than what we learned today.
40:34And so let me just make sure
40:35that I have this and this.
40:37To me,
40:37the first of that slides really is very
40:40important to share with all of you
40:42because it was done at Children's National.
40:45Hold on for a second,
40:46I have a text message here that is.
40:50In my way.
40:51I don't know how to hold.
40:52Sorry.
40:53I'm just gonna take a moment to close
40:55that chat so I can see my screen
40:59and we don't see it. Priya.
41:00Yeah, I'm gonna put it back on, Karen.
41:06There we go.
41:10Is that visible? Perfect.
41:12OK, so it was this guy workshop that was
41:16done at Children's National Hospital.
41:17Sample size of 27 healthcare professionals.
41:20And this group was actually instructed to
41:23practice the the they did the workshop,
41:25but they also practiced the sky technique,
41:27which takes about 20 minutes for 40 days.
41:30And we noticed pretty significant declines
41:34in anxiety and depression scores,
41:36but also burnout, a very significant
41:40decline in emotional and deep
41:43personalization and emotional exhaustion.
41:45And to us that is, you know, really again.
41:48Speaking to this idea of how can
41:50we be the best that we want to be,
41:53how can we function,
41:55especially when we provide care to
41:57patients at our optimal capacity.
41:59So this was very nice to see that the
42:01the study actually showed the impact
42:03because we had anecdotally heard that,
42:05heard a lot of testimonials from workshops,
42:08but that was quite nice to see the effect
42:11on burnout directly and then the study
42:14was done during the pandemic as well.
42:16This study had a sample size of 92 people.
42:18It's not 100,
42:20that's an error.
42:21And the parameters we looked at
42:22is self report of stress,
42:24anxiety and depression and also self report
42:30of sleep resilience and life satisfaction.
42:32And I think to me the most interesting
42:35thing is that sleep and resilience
42:37and life satisfaction scores were
42:40sustained and increased by day 40.
42:43So there was a cumulative effect over time.
42:46Which was also my personal,
42:47you know, my if I was the case study.
42:51I remember when I did this practice that
42:53I noticed that my sleep had improved.
42:55The quality of my sleep improved
42:57to the point where I felt like I
42:59needed less than 8 hours,
43:00which previous to this was
43:02like 8 hours or death.
43:04I started to feel like I was more
43:06restful with 7 hours of sleep because
43:09the quality of my sleep had improved.
43:12And this study I think is really
43:14wonderful to share with you because
43:16it was done at the Child Study Center
43:19and the in collaboration with the Yale
43:21Center for Emotional Intelligence.
43:23And it was an 8 week randomized control
43:26study with 131 participants who were
43:29assigned to a mindfulness based program,
43:32emotional intelligence,
43:33the sky and control.
43:35And there was an equal dosage of
43:37meditation that was done which was
43:39a total of 30 hours over 8 weeks.
43:42And what we noticed is that Sky and
43:45this also because it's a younger age group.
43:48Part of the reason for doing the study
43:51was really to address this crisis of
43:54mental health issues in our youth,
43:56our college students, graduates,
43:59undergraduates,
44:00and Sky showed the greatest impact
44:03in six different parameters.
44:05Emotional intelligence actually showed
44:07a pretty high score with mindfulness.
44:09And but not the others.
44:12So it it is, you know,
44:14that I think the the the researchers
44:16themselves were kind of kind of
44:19befuddled by why the the sort of
44:21robust response which of course
44:23incorporates to some extent the
44:24degree to
44:25which breath can play a role in
44:27much more of an immediate impact.
44:29You know some of you who are
44:32seasoned mindfulness practitioners,
44:33it's it's a practice and it you the
44:36benefits are sustained by daily
44:38practice over an extended period.
44:40But breathwork seems to give
44:43a more instantaneous effect,
44:45and that perhaps contributes to sustaining
44:48the practice and noticing the benefits.
44:53So this was really wonderful to see.
44:56And a similar study was done at the
44:59University of Arizona looking at sky breath
45:02in comparison to a cognitive workshop,
45:05and again the improvement was significant.
45:08In sky birth meditation as compared
45:11to the cognitive retraining program
45:13and this study on PTSD was done at
45:16the University of Wisconsin, right?
45:18I think 2014 right after somewhere
45:21around with returning vets
45:23from Iraq and Afghanistan.
45:25And the interesting thing about
45:27this study is the PTSD scores were
45:29decreased at the end of the workshop.
45:31Which for vets has done
45:33smaller breaks over 6 days.
45:35So generally the workshop is over three days,
45:38but this was done slightly modified.
45:41But to me, the most interesting aspect
45:43of the study is that this cohort was
45:47instructed to not practice every day.
45:49So they were, you know,
45:50the day there's a daily practice
45:52that's part of the program.
45:53Just to avoid variability,
45:55they were instructed to not practice
45:57and a year later there were still.
46:00There was still a reduction in scores,
46:02obviously not as dramatic as
46:03right at the end of the workshop,
46:05but the benefits were sustained
46:07over the long term,
46:09which we're still trying to figure
46:12out how to explore that further.
46:15And last but not the least,
46:17a randomized clinical noninferiority trial
46:20of this breath based meditation comparing
46:23it to cognitive processing therapy and.
46:26The this paper reports that which is
46:28obviously you know the non infrared
46:30trial is a preferred design when there's
46:32an established efficacious treatment,
46:34that there was a significant
46:37improvement with sky meditation.
46:39So this is just a little overview
46:43of the sky meditation technique
46:46and the way it's taught is it's
46:48three live online sessions,
46:50usually with two instructors.
46:53And you you learn the sky technique.
46:55There's also some cognitive reframing
46:57tools that are integrated into the
46:59workshop and there are some reflective
47:01group activities that are done online.
47:03So you know,
47:04over the pandemic has really made
47:06us all zoom experts to some extent.
47:09And in the beginning even I was like oh,
47:11there's no way like how can
47:12you do this online,
47:14but it's incredible how many things
47:17can be achieved as impactfully with.
47:20Our ability to to sort of
47:22navigate these online platforms,
47:24yeah,
47:24So I will stop for questions,
47:26but I want to make sure I share
47:28this last slide is that there is a
47:31workshop that we've organized at Yale.
47:33It's weekdays, Tuesday,
47:34Wednesdays and Thursdays on June 13th,
47:3714th and 15th.
47:38And it's a 2 1/2 hour workshop each day.
47:42And just to remind you,
47:44it is 3 consecutive sessions.
47:46So it's not one of three, it's all three.
47:49Because that's how much time it
47:51takes to learn the technique and
47:53incorporate it into a daily practice.
47:55But with that,
47:56I'd like to let me make sure I have.
47:58Yeah, we have it's, we have about 10 minutes.
48:02If there are any questions,
48:03anything anyone wants to share,
48:05I'm happy to take them.
48:06Now
48:08would
48:16you be willing to put the link to that
48:18workshop maybe in the chat or someplace that.
48:22Yeah, in the chat.
48:23Amir, do you have it handy?
48:27Um, yes, it's. I'll grab it and I'll
48:29put it in the chat. OK And if I have
48:31it as well, I just wondered if
48:33you had it. Thank you very much.
48:38Yeah. Thank you so much for that.
48:39I think that was the most relaxing
48:42grand rounds I've ever experienced,
48:45but also incredibly informative.
48:46And thank you for buttressing
48:48it with the science.
48:50At the end of the presentation you
48:52mentioned about daily practice.
48:53I'm just wondering about what,
48:55what length or what what would
48:57you recommend in terms of the
48:58time spent in daily practice.
49:01So Karen, you know,
49:02I'll answer that in two ways.
49:03One is that say you you don't have
49:05the time for the Sky workshop,
49:07just want to incorporate breath
49:09work into your day-to-day life and
49:11you already have an established
49:12meditation practice or you use an app.
49:14For many of you that might
49:16be true I would say.
49:185 minutes of breath work before your
49:22regular practice will deepen the
49:24effect of your meditation practice.
49:27So as a common sense,
49:28practice straw breath or victory
49:33breath if you enjoyed that.
49:35There's also another breathing technique
49:37called alternate nostril breathing.
49:39We didn't have time to do that,
49:40but you can actually find that online.
49:43You go on to YouTube,
49:44you'll see it's a.
49:45Technique that involves using
49:46the thumb to block the nostrils
49:48and you're breathing in through
49:50one and out through the other
49:52and then back in through the same
49:53one that you exhaled out of.
49:55Very straightforward.
49:56It sounds complicated,
49:57but very straightforward if you find that.
50:01So either of those or in combination,
50:035 minutes of breath work before any
50:06meditation practice you have if you
50:09don't have a meditation practice.
50:12My recommendation would be just
50:1410 minutes of breath work a day.
50:17You could even do like you know
50:20you're getting ready for lunch.
50:22Like instead of maybe you break
50:24for lunch for like 30 minutes,
50:265 to 10 minutes before you have lunch.
50:28Now that's critical though all
50:31these practices are best done
50:34on a relatively empty stomach.
50:37The reason for it is.
50:39This is where the mind body complex
50:42becomes so fascinating is that
50:43when the body is in digest mode,
50:46it's not going to go into a meditative mode.
50:49It just is going to do one or the other.
50:51So and you'll know you can try it.
50:53You know you do the breath work
50:54on a full stomach and you do it
50:56on an empty stomach,
50:57you'll instantly know the difference.
50:59So if you have 10 minutes that
51:02you can do this before a meal or
51:04a window where you're just like
51:06happen to have a free window.
51:08I would say that would be very useful.
51:11With the sky practice, that's a much more.
51:15It's multiple reading techniques
51:17that are like stepwise put together
51:19in a very particular format.
51:21That practice takes about 20 to 25 minutes.
51:25And it's not just a breath work.
51:27I call it breath based meditation
51:29because at the end of the breath work
51:33you're effortlessly going into a state of.
51:36Whatever you want to call it.
51:36Transcendence, quiet, calm,
51:39you know, so the breath.
51:43And to me that, you know, when I was,
51:45I knew meditation was good for me.
51:46Like that was.
51:47And I really wanted to meditate,
51:49but I just couldn't.
51:51I would sit to meditate and I would
51:54feel like I just spent, you know,
51:5730 minutes running errands in my head.
51:59I might as well run those errands.
52:01Like, why am I wasting my time?
52:04Observing all the errands I have to run.
52:07So that's when I learned this technique.
52:12And for someone like me,
52:14you know, my mind is on OverDrive.
52:16I have so many different responsibilities.
52:19The ability of the breath to
52:22settle my mind was so impactful,
52:24like it just felt like I just
52:25had to follow instructions,
52:26like give me instructions 1234.
52:29And so it worked really well
52:31for me and interestingly.
52:33We feel in in sort of the questionnaires
52:35we did when we did the study with deaths.
52:38They shared that that the the
52:41instruction aspect of it instead of
52:43just sitting there and being aware
52:45of the body and breath which for
52:48some people that provokes anxiety,
52:51you know that the ability to do
52:55something structured in a step
52:57by step fashion which then gives
52:59you the the equivalent outcome.
53:01Can be very beneficial to certain people.
53:05Brilliant.
53:05Thank you. Are there questions?
53:13Oh, you're welcome.
53:14Kathy and I hope to see some
53:16of you on that workshop.
53:17It would be really fun to do
53:19this together and just, you know,
53:22go through like a more intensive process.
53:25This was just like, I would say this
53:28was just a little like a little taste.
53:31Of the power of the breath.
53:34But the the Sky Workshop is a deep dive
53:36and I should remind all I forgot the mayor,
53:39the the Sky Workshop.
53:41You get CME credits, CME credits,
53:43CNE credits and there's C credits,
53:46but I'm not sure for which categories.
53:48So Amir,
53:49I can send that information out to you.
53:50So it's a 7 1/2 hour workshop and you
53:54would get CME/CN E credits for it, Yeah.
53:58Wonderful not to monopolize the Q&amp;A,
54:01but I did. You was very interested
54:03when you mentioned about teaching
54:05straw breath to school children.
54:07And I was just wondering, you know,
54:09what's the age range that you've
54:10tried to implement these breathing
54:13techniques and how low can you go?
54:17You know, Karen,
54:17I I don't teach the children,
54:19so I'm not certified to teach.
54:21It's not I'm not a certified sky
54:23instructor for that for the kids program.
54:24Amir, can you comment on that?
54:26Like what's the age group that we
54:27teach the Yes for Schools program?
54:30Yes, I believe it's 7.
54:32Like, they're kind of grouped by age.
54:35So it's like 7 to 12.
54:37And then there's a,
54:38like a teenagers course.
54:40We do have a course for really little
54:42guys that's called Angels course.
54:44They don't really do intensive breathing,
54:46but they do a lot of like moving
54:48around and kind of sweet like grounding
54:50stuff that's that's developmentally
54:52appropriate for toddlers and
54:54preschoolers and kindergarteners.
54:55But yeah, seven,
54:56starting at about 7 years old,
54:57we can teach a modified version of the Creat,
55:01the Sky breath meditation.
55:04And then also these techniques
55:05that we some of the simpler
55:07techniques that we did today.
55:20Any other final questions for Yeah,
55:25just a quick question,
55:26is this guy program, is it open to others,
55:30it's open to everyone or just yell?
55:33Great question. So this particular
55:35one will be open to others.
55:38We've just felt like you know if you had a
55:40family member you wanted to have joined,
55:41but I don't know,
55:43you know Amir is going to look into
55:45sponsorship from Yale and answered,
55:48I don't know that piece.
55:49I would say the best,
55:50your best bet would be to
55:52connect with Amir and we'll
55:54address everything one-on-one.
55:55But the idea was to keep it open.
55:57So more than that,
55:58if you know you expect more in
56:00the in the in the vein that if
56:01you had a family member or a
56:03friend you wanted to invite that
56:05they should be able to join
56:08May any concluding remarks?
56:13No. Thank you so much Priya.
56:15It was truly a pleasure to have you
56:17with us and I do hope that many of
56:20you can join us for the workshop.
56:22Or just reach out if you have
56:24questions or would like to
56:26connect about this in other ways.
56:28But thank you all again and and big
56:30thank you to Priya for doing this.
56:34Have a wonderful day. Bye, bye. Thank
56:37you so much.