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

Transcript

• 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&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.