How Mindfulness Can Help Relieve Stress

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How Mindfulness Can Help Relieve Stress

Wednesday, April 22, 2021

Presenter: Greg Flaxman LCSW, MPH

Presentation is 35 minutes with 20 minutes of Q & A.

Summary: The practice of mindfulness has proven benefits for transplant patients. It reduces stress and improves psychological health and well-being. This presentation describes several mindfulness practices and offers tips on how to integrate them into your daily life.

Highlights:

• Focusing on your breathing is a simple mindfulness technique that is always available and can have a calming effect on anxieties and fears.
• Another pathway to mindfulness is a heightened awareness of our senses, including our internal physical sensations and our thoughts, emotions, moods, and mental states.
• Mindfulness becomes more effective with practice over time. Just as we can improve our physical condition by regular exercise, we can improve our mental attitude with regular practice of meditation, yoga, body scans, and other mindfulness techniques.

Key Points:

(02:13) Mindfulness is a non-judgmental, intentional focus on the present moment. It promotes awareness and curiosity by paying attention to whatever is in our immediate environment.

(04:56) A meditation exercise: find a comfortable position, practice deep breathing, notice physical sensations, and continually attend to your breath.

(11:20) With some practice, mindfulness can be maintained throughout many activities and enrich our experience of those activities.

(13:16) Stressful events (like transplant) can lead to chronic stress with harmful consequences.

(15:42) The relaxation response can reduce this stress and restore psychological well-being.

(20:06) Studies show that for transplant recipients, mindfulness has many beneficial effects on fatigue, anxiety, depression, sleep, perception of pain, and fear of recurrence.

(23:13) Transplant recipients report the many benefits of mindfulness in a series of quotations from actual patients.

(25:55) Mindfulness also promotes self-compassion and emotional resilience in transplant survivors.

(27:50) Self-compassion exercises involve sending well-wishes to oneself. They can also be sent to those people in our lives that we care for deeply.

(33:59) In addition to formal classes, there are many mindfulness resources that people can access online and use themselves.

Transcript of Presentation:

(00:00) [Becky Dame]      Introduction. Yes. Hi, my name is Becky Dame. I'll be your moderator today. Welcome to this workshop, how mindfulness can help relieve stress. It is my pleasure to introduce to you, Mr. Greg Flaxman. Mr. Flaxman is a clinical oncology social worker with the Simms/Mann UCLA Center for Integrative Oncology. He has practiced with Simms/Mann Cancer Center since 2017, serving UCLA patients with cancer diagnoses and their families. Greg is passionate about sharing mindfulness meditation with others and has led mindfulness-based classes and groups since 2012. He received training in mindfulness-based stress reduction practices through Insight LA and he enjoys attending residential silent meditation retreats as a resource of renewal. Please join me in welcoming, Mr. Flaxman. Mr. Flaxman, over to you.

(01:06) [Greg Flaxman]     Overview of talk. All right. Thank you, Becky. And thank you, Victor. Well, it's my pleasure to be speaking to you all today, and so glad that you can join and participate in this workshop. It's an experiential seminar, so there will be an opportunity to practice mindfulness meditation, as well as information that I'll be presenting and a chance for you to ask questions at the end. So I look forward to those as well.

(01:38) Again, thank you Becky, for your introduction. I am Greg Flaxman, a clinical oncology social worker with the Simms/ Mann UCLA Center for Integrative Oncology. I work with patients with cancer diagnoses. Certainly, those who've been through stem cell transplant, stem cell transplant survivors. I'm passionate about mindfulness and meditation, and I'm here to present because I believe it can be a really helpful resource, a tool for you to use in your life as a survivor.

(02:13) Mindfulness is non-judgmental, intentional focus on the present moment. So I'll start out describing what is mindfulness. Perhaps, you've heard of it, are familiar with it or practice it yourself. Even so, it's helpful to have this opportunity for reflection on what is mindfulness and how can you use it in your life? The one working definition of mindfulness, it could be, that it's paying attention in the present moment with purpose or intention, curiosity, openness, and non-judgment. So, that means being aware of your present moment experience. You're paying attention. So you may be guiding your awareness in some way, doing so with a sense of curiosity and openness, non-judgment. Maybe approaching something as if it's totally new to you, even if you've experienced it a thousand times before. With this kind of an aliveness in the moment.

(03:17) Another way of looking at it, maybe this sustained awareness of the now, of right now, what's happening to you in this moment. For instance, listening to this talk right now, sitting in the room you're in or lying down, whatever position you're in. You can be simply aware and that is mindfulness. It includes awareness of your senses, the internal physical sensations you may be feeling, your thoughts, your emotions, moods, mental states. And particularly the awareness of the senses, a physical sensation can be a way of entering into a state of mindfulness, which I'll lead you in a meditation exercise in a moment, that will give you that experience.

(04:14) And this is a quote from Jon Kabat-Zinn, founder of mindfulness-based stress reduction, which is an evidence-based course in mindfulness. It's available throughout the country, across the world, actually. But here's a quote that I really like of his. "Mindfulness is a way of befriending ourselves and our experience." So it can be approaching your experience with kindness, friendliness, no matter what it is that you're facing.

(04:56) A meditation exercise: find a comfortable position. So now I'll ask you to find a comfortable position where you can actually sit for a few minutes. You can even lie down, engaging in this mindfulness meditation exercise. This will be a simple grounding, centering meditation. Something that should be about five to eight minutes, around then. Just a way for you to really arrive right here right now. I encourage you, if you are tuned in to this, to really set aside any distractions, perhaps turning off your phone. If you're in a room where there are other people talking, even if you can just let them know, "Hey, I'm going to be trying this out. Just want to have a few minutes where I can engage in this." If you do hear noises around you, so it's not impossible to practice this, you can even include that within a meditation, as well.

(05:58) Practice deep breathing. So allowing yourself to settle into whatever seated position you're in or lying down, if that's most comfortable for you, you can close your eyes or leave your eyes slightly open. Perhaps, starting by taking a few deep breaths, even place your hand on your belly. As you breathe in, noticing the belly expand and the chest rise. And release, breathe out through your mouth. At your own pace, taking a couple more deep breaths.

(06:59) Notice physical sensations. You can notice the sense of the weight of the body, as you're sitting or lying down. Entering where the feet are making contact with the floor. Feel the heels, or soles of the feet, toes. Simply noticing the sensation that you're feeling and even provide a mental note for that sensation. Is it tingling, warmth, fullness, numbness? You can also notice your hands wherever they may be resting. Any sensations; the palms of the hands, the fingers.

(08:22) And how does the body feel? Does the body feel tense, relaxed? Do you notice any tension you're holding that you can bring some ease to relax around the tension. Perhaps, the muscles of the face. You can soften eyes, cheeks, the jaw, neck and shoulders.

(09:15) Attend to your breath. Bringing your attention again to your breath. Perhaps, that's again, at the belly or perhaps noticing the air passing in and out through the nostrils. Whatever feels easiest for you to notice right now. It can help to label the in breath, ins, and noticing as you breathe in and out, as you breathe out. Not needing to force it in any way, simply noticing what it feels like. If you're having trouble noticing your breath, you can also just bring your attention back to your feet or your sense of sitting.

(10:27) Letting going now of this attention to the breath and the body, and simply noticing how you feel right now. How does it feel to settle into this moment right now? I'm going to ring a bell and I'd encourage you to listen the sound of the bell, until the very end of the sound of the bell.

(11:20) Maintaining mindfulness. Thank you to all of you for participating in that mindfulness meditation exercise. As we transition to a part of this presentation that'll involve providing more information, I'd encourage you to maintain this sense of mindfulness. It can be just simply noticing your posture or how you're sitting while you're listening to this, your checking in with your breath occasionally. So that's a way of maintaining this mindful listening and engaging with this presentation.

(12:01) Mindfulness helps deal with stress. So that kind of exercise of mindfulness can be a way of dealing with stress. And at times when we're facing a source of stress that feels very acute and imminent to us, our bodies, our minds engage in a fight, flight or freeze response. And this is a normal natural response to perceiving, reading, a threat from our environment, which can be incredibly useful if you are in danger. If you're walking across the street and there's a car coming, it's great to get away from the car. Or if you sense something that is happening in your life, other sources of stress, such as whether it be something like financial stress that you need to act on. It really can activate your sympathetic nervous system and get you to a place of action, get you to a place of doing something about that stressor.

(13:16) Stressful events like transplant can lead to chronic stress with harmful consequences. And so that heightened stress response may lead to elevated cortisol adrenaline. So it has this real biological effect. And of course it can be triggered through experiences associated with a diagnosis of a serious disease. It can be associated with moments during your treatment, including transplant and survivorship. If you feel that a possible threat is involved with getting another scan or results, and you notice yourself feeling triggered by that into this fight, flight or freeze, that's something that's actually a really normal experience, as a survivor, to go through. And so, what's a good alternative to that reaction can be this use of mindfulness and meditation for finding these responses.

(14:28) One thing that can accumulate over time from a consistent, steady stream of these acute stressors causing these responses can be chronic stress. There are studies showing that there are wide ranging physical, psychological health effects due to this accumulated wear and tear on bodies and mind from chronic stress. And relaxation as a response, or the counter, to chronic stress, when it's under our control, when it's in our capabilities can be a wonderful tool to have at your disposal. That's really my purpose of bringing this here, is to present a possibility. A possible way of responding at times when you're not in immediate danger, you don't need any immediate call to action, but a time when you can introduce a relaxation response that'll help your body and mind to relax and create more space in making the kind of decisions that you want to make.

(15:42) The relaxation response reduces stress. This is a chart on stress response and relaxation response. So I mentioned a little bit about how our sympathetic nervous system activity increases when we're experiencing this acute stress. This really could be a habit of a way of responding to acute stress that may be engaging in more worry or anxious thinking. And then that feeding back into increasing some of these hormones related to stress. And that changes how the body functions in that moment. Again, on the other side of this chart is the relaxation response and how by introducing that relaxation response, we can introduce a balance to the system to bring it back to a more balanced state by decreasing sympathetic nervous system activity.

(16:40) So how do we go about building this relaxation response? How is that something that we can create and enhance in our lives, knowing that perhaps not all the time, we won't be able to access this response? There'll be many times when you'll move into this, responding to a stressor, or reacting in a way that feels habitual or feels instinctual and is really natural. And at the same time, mindfulness may allow for you to notice when that's happening and notice how is this serving me right now? Is there an alternative, is there a possibility for something else, some other way?

(17:30) How to create a relaxation response. So there's different ways of introducing a relaxation response. One can be associating cues with a moment of mindfulness. It can be washing your hands. So you can simply notice when you wash your hands, really attending to the sensations of your hand, the water and soap. It can be opening a door and noticing the feeling of the door knob on your hand, or listening to a sound such as a phone ringing, pausing after you hear the phone ring before you answer and pick up the call.

(18:05) Another acronym that's helpful is STOP. So this acronym stands for stop, take a breath, observe and proceed. So when you're feeling this acute stressor and you have this opportunity to respond in a way that is more out of a decision, a wise response, than maybe something that's very reactive, you can remember this acronym. Stop, take a breath, observe how you're feeling and observe the emotion that you're feeling, thoughts you're having, and then proceed from a place of mindfulness.

(18:49) Deep breathing can be done anytime. Also, deep breathing practices... So these are things that you can do throughout the day and it really builds up this habit, this kind of muscle of engaging in this relaxation response. So that it's not something you're only relying on in those times of need, but can really utilize because it's a habit that you've developed. It's something that you strengthened with practice over time.

(19:14) So there's deep breathing, belly breathing. Similar to in the exercise of putting a hand on your belly and really noticing the belly expand as you breathe in and contract as you breathe out. There's four, seven, eight breathing. So counting your breath and having a little bit longer exhale than inhale. And formal mindfulness practices you can use at times too, such as mindfulness meditation, or movement practices. Some people, when their bodies are ready for it and allow for it, really enjoy engaging in movement practices such as yoga, Qi Gong or Tai-Chi. And that can really strengthen your ability to notice how your body is and to incorporate mindfulness with the movement of your body.

(20:06) Studies show mindfulness has many beneficial effects for transplant survivors. There are various benefits of mindfulness-based interventions. Different studies have revealed these benefits, some being beneficial effects on fatigue, anxiety, depression, sleep, perception of pain, fear of recurrence, which is one attribute that I know can be very helpful as a survivor. Anxiety related to MRI or CT scans, family caregiver stress. So these are all researched benefits that have been shown through different studies as something where mindfulness has been particularly helpful in this, as a way of seeing some really powerful effects in your daily life. Especially, as someone who's experienced a serious illness or disease and gone through significant treatment in the form of a transplant.

(21:22) One study that is maybe particularly relevant for you all engaging in this seminar today was one done at the University of Wisconsin in 2019, that looked at mindfulness meditation in 111 hematopoietic stem cell transplant survivors and showed some really wonderful association between mindfulness and less depression and anxiety in coping with survivorship.

(21:56) In these cases for these participants, they found that mindfulness, the trait of mindfulness, was associated with psychological wellbeing. Specifically in these domains of being able to attend to the present moment, that stay with the present moment experience, having a nonjudgmental attitude towards your current experience. So being able to observe it, be aware of it without applying extra judgment of, "This is terrible, or this is great." Maybe sensing some of that judgment, but also being open to whatever is happening in the moment. And allowing thoughts and sensations to come and go without reacting to them. So these are different correlates with psychological wellbeing they found in this study in 2019, specifically for transplant survivors. Those different correlates, those traits, are things that can really be developed and cultivated and grown through mindfulness practice when it's done on a regular basis.

(23:13) Transplant recipients report mindfulness benefits. I'd like to share with you some quotes from transplant survivors on what mindfulness meditation has meant for them in terms of their experience as survivors. How it's helped them, been beneficial.

(23:30) "Mindfulness meditation has changed my thinking. When I go for a walk, I see things I never saw before. I'm open to possibilities and take my time savoring what I'm doing instead of rushing through from one task to start another. Mindfulness meditation has helped me to live my life in gratitude every moment of every day. Together, my practice and gratitude have enhanced my recovery and health in general."

(23:57) And here's a quote from another survivor. So this next one is a two part quote. "This July will be my ninth year of rebirth after my ASCT, and successful treatment, following a diagnosis of Multiple Myeloma. Although I'm eternally grateful for the scientific advances that have kept my disease in remission, the medical treatments have only been a part of my recovery and sustainability. I, for one, have benefited tremendously from a wholesome strategy of diet, exercise, support groups, and education, Qi Gong, acupuncture, and especially Mindful Meditation; on my own, listening to seminars, but specifically a weekly group practice."

(24:48) "Even if none of the elements I've mentioned can be clinically proven to be effective in altering the course of an illness, I believe meditation gives me a sense of empowerment to counteract the victimization and powerlessness inherent in my illness. I've found, not only during the meditation itself, but carried on throughout the day, an ability to be more conscious, aware, present and alive, with myself and in relating to others. And thus, I'm more calm and appreciative, compassionate, relaxed, and well, healthier. The same way that someone goes to a gym to improve their physical condition, I believe having meditation practice alters our mental attitude and approach, not only to our cancer, but to life and relationships overall. Life isn't about to how to survive the storm but how to dance in the rain."

(25:41) So thank you to those transplant survivors out there who may be listening to you who provided those quotes to share with everybody participating today. I really appreciate it.

(25:55) Mindfulness promotes self-compassion and emotional resilience in transplant survivors. I'll move in towards the end of this presentation, focusing on self-compassion. Here's a quote from Rick Hanson, a psychologist who studies mindfulness meditation. "You can have compassion for yourself, which is not self-pity. You're simply recognizing that this is tough, this hurts. Bringing the same warm-hearted wish for suffering to lessen or end that you would bring to any dear friend grappling with the same pain, upset, or challenges as you."

(26:40) So I'm aware, from my work in this area, how challenging of a time this can be going through transplant, recovery from a transplant and how challenging it can be for you and your family. There are at times many things that can come up along the way, whether it feels like bumps in the road in your recovery, scans, results. I'm familiar with this and I work with many who've been in your shoes, and I truly believe that self-compassion can be a wonderful resource to have at your use at times that you're going through great difficulty. Self-compassion is another area that has been studied, shown that it's associated with emotional resilience and really a key piece of what makes mindfulness based practices work.

(27:50) Self-compassion exercises. There are different self-compassion exercises you can use, finding one that works for you. There are even courses called mindful self-compassion, if this is something you really want to dedicate time to. But you can write a letter to your current self from your future self. So finding that voice, the wise voice, inside of you, the one who's speaking to you from the future. You can practice mindfulness meditation exercises, such as the compassionate body scan, and you can really practice in caring for yourself as you care for others. So if you're a caregiver, you're one who really puts others first, it's an opportunity to include yourself in that circle of care.

(28:34) Send well-wishes to someone you care for. I'll go ahead and lead a brief self-compassion practice before we end this presentation today. So again, just finding yourself in a comfortable seat, taking a couple of deep breaths. Again, reconnecting with your breath. You can close your eyes for this if it's helpful for you. Notice yourself sitting if you're sitting or lying down if you're lying down. Bring in to mind someone who you care for deeply. It can be a dear friend, a child you care for, a beloved pet. Someone who brings about an easy, sensible feeling of warm for you.

(29:40) In this moment you'll send out some well-wishes to them. You can do so with phrases, you can even place a hand on your heart. Simply noticing a sense of warmth emotionally for this person, your loved one. May you be safe. May you be happy. May you be healthy. May you live with ease and wellbeing. You can silently send them these well wishes. You can bring a warm smile to your face, to your heart when you send these wishes. May you be safe. May you be happy. May you be healthy, live with ease.

(31:23) Sending well-wishes to self and others. Now, including yourself. So if this person's here with you, putting yourself in this space, right in the room with you, even if they're not. May I be safe. May I be happy. May I be healthy. May I live with ease and a sense of wellbeing. You can keep your hand over your chest, over your heart, if that feels natural for you. Sensing the warmth coming from this loved one, your dear one, you wish yourself well. May I be safe. May I be healthy, live with ease and a sense of wellbeing.

(32:41) Perhaps now, in imagining all the others listening to this presentation right now, all the others been through transplant, who know it's like to have been through what you've been through, sharing in this common humanity, wish everyone here joined together today. May we all be safe. May we all be happy, healthy, live with ease and a sense of wellbeing.

(33:44) We'll conclude this mindfulness meditation of compassion presentation today. It's been wonderful to be with you all.

(33:59) Some mindfulness resources. Here are a few resources, I know that this is saved and will be available for you to review afterwards. A few resources of very many that are out there. I encourage you, if you found this interesting, if you want to continue to pursue it on your own, then look for a local organization where you live on mindfulness meditation. Otherwise, there's national organizations. I know through UCLA, we have the Mindful Awareness Research Center and marc.UCLA.edu that offers six week courses in mindfulness that you can engage in from anywhere. They're online. There's also some great smartphone apps out there and guided meditations you can find on YouTube or elsewhere online. And many, many books to recommend, as well, on this topic.

Question and Answer Session

(35:05) [Becky Dame]     Q & A. Thank you. Sorry to cut you off there. Thank you for this excellent presentation. We are now going to be taking questions. A reminder, if you have a question, please type it in the chat box on the lower left-hand corner of your screen. We have had questions come in.

(35:22) Our first question, Greg, came in right after we did the first exercise. So it's in relation to the exercise. And the question is, could it be better, for some, to find a way to distract your mind from the body sensations through guided imagery work, as well? They noticed pain during the exercise.

(35:47) [Greg Flaxman]     Yes. Thank you so much for bringing that to my attention, asking that question. I would say it depends on the level of pain. So if you're experiencing some very severe pain, if it's at like a pain level of eight, nine or 10, then maybe it's not a great moment to sit and engage in one of these practices. Perhaps, like you mentioned, something like a guided imagery, you might find more helpful.

(36:19) Other times I would encourage you, if it's a little bit more manageable where you can, at least briefly, attend to notice what the pain feels like. You can notice it, is this pain, the sensation of tightness, tension? Bring, like I mentioned at the beginning, some of those attitudes of mindfulness, of curiosity and openness and see does the pain stay the same or change? Mindfulness-based stress reduction, the evidence-based class I mentioned, was developed for people who are experiencing chronic pain. So there's good evidence of mindfulness actually being something that's helpful in coping with pain. But that's, again, when it's at a manageable level and not necessarily severe. It's not meant to be something where you're having to grit your teeth through. But I would encourage you to try to bring some gentle attention and awareness to pain that feels manageable and include it in your mindfulness practice.

(37:28) [Becky Dame]     Thank you so much. Another question is how can the person avoid falling asleep during a meditation? Did you try to stay awake?

(37:39) [Greg Flaxman]     Yeah, that's another great question. So a lot of people use meditation at the end of the day, at night even, because it may help with sleep. Personally, I enjoy doing it every night because it helps me get ready for sleep. And when you're practicing in mindfulness meditation, however, it's good to stay alert and aware. So this is a practice of one of alertness and awareness and relaxation. So you can actually open your eyes a little bit if you're getting sleepy. You can wiggle your toes and fingers. It's okay to open your eyes and notice what's around you. I like to look at it as we're practicing something that we can bring in our daily life and it doesn't have to feel like this space that has to be so separate necessarily. We live with our eyes open a lot of the time. So you can open your eyes a little bit and see what that's like and continuing to practice. I think that's great.

(38:46) [Becky Dame]     Thank you so much. Similar to... More questions on this. I had trouble getting things out of my mind when I try to relax and meditate. Any suggestions?

(39:00) [Greg Flaxman]     Yeah. Well, tell me about it. I know the feeling very much. Yeah, that is something. There are times, I think, when it may naturally feel like if this isn't a practice you do often, it may feel a lot easier for the mind to settle down. One thing that can be helpful if you notice that your mind feels very restless, a lot of thoughts coming up and really you feel like they're pulling you away from what you're trying to focus on, is perhaps counting the breath. So you can note your breath. One on the in breath, two on the out-breath, all the way to 10. Start again at one, if you notice that you went off before you got to 10, you can just start over. And that may have a settling effect on your mind, it gives you this extra anchor for your attention. So that's one thing that you can try out and see how it works for you.

(40:03) [Becky Dame]     Okay. Thank you so much. Now this is a question that's a little more physical oriented. This patient notes, if they are more prone to bone fractures, is it safe to do Tai Chi or yoga? Excuse me.

(40:26) [Greg Flaxman]     Yeah. Unfortunately, I'm not the right person to answer that question. Hopefully, if you have a physician who you're working with on this concern, they can advise you better on it. So, I'm sorry. I don't think I really have the appropriate knowledge to give a good answer.

(40:53) [Becky Dame]      Yes. They should probably reach back out to their health care provider for that, for more details there.

(41:01) So here's a wonderful question, Greg. What tools are available to help reduce or eliminate my stress when passing through glass doors on my doctor's office?

(41:21) [Greg Flaxman]     I think maybe that acronym that I mentioned, that STOP might be something. And these are all things worth trying and experimenting with. It doesn't mean you'll feel an immediate result from it. It may be the second, third time, fourth time you try it you notice that it's helping. But that stop of taking a pause. You can pause before you enter in through those doors, taking a few breaths, observing how you're feeling, noticing if you're feeling anxious. What does that feel like in your body? We often say butterflies. It gets butterflies, but what does that really feel like for you in that moment? Noticing it and proceeding. So I would encourage trying that one out, in that situation.

(42:16) [Becky Dame]     I know I have another question on how often do you need to practice mindfulness for it to work?

(42:29) [Greg Flaxman]     Well, I know there are studies out there that are trying to look at more dose effects. So seeing how frequent the impact is. I'm pretty sure most of them have shown that the frequency matters. I really do encourage some kind of daily practice, because you'll be able to, I think, see the benefits from that, most regularly, and start to develop it as a habit. Similarly to how you may brush your teeth every day, it's the way of bringing a sort of mental hygiene to your daily life. And also, I recommend classes, taking a six week class, eight week class. Something that can really be the booster to getting started if this is new for you.

(43:23) [Becky Dame]     Very good. Another patient is asking, sometimes they have difficulty staying focused when they are doing yoga meditation in class. How can they control their focus? They also suffer from Tinnitus.

(43:44) [Greg Flaxman]     Yeah. That does sound difficult. Yeah. I think it's normal to lose focus and mindfulness is often a practice of coming back once you noticed that you've lost focus. That in itself can be this powerful moment of mindfulness. I have to say, I'm not an expert in practicing Tinnitus. I do know that, generally, with mindfulness meditation, we're trying to open to the experience as we're having it. Not necessarily as how we would want it to be or how maybe we desire it to be. So if you're noticing that sensation Tinnitus, what does it feel like simply to notice it, observe it, be with it? It may feel unpleasant and that's okay if you notice that sensation of it being unpleasant. But this is one reason why I think it's also really helpful to have supports out there for you for this kind of practice. And one of the survivor quotes, they mentioned being part of a weekly group being helpful because it does help with some of the challenges that can come when you do wish to engage to mindfulness practice.

(45:14) [Becky Dame]     Another question we have here is what are your thoughts on mindful based cognitive therapy?

(45:25) [Greg Flaxman]     Yeah. Well, I think it really can be a wonderful thing to use if you wish to find a therapist who has this approach. I think incorporating some of the practices ,similar to what I led you in today, and also using techniques from cognitive behavioral therapy and it's something that has some good research evidence. So I definitely would encourage it if this is what feels right for you and feels like it's going to be the right thing for you right now. I'm all for it.

(46:10) [Becky Dame]     Thank you. I believe this question is probably coming from a health care provider, but they're asking how do you get patients to participate or buy into mindfulness type practices?

(46:35) [Greg Flaxman]     Yeah. I think it's important to really sometimes sense where people are at and sometimes finding out, folks that I work with, what do they like to engage in already? What is it that may bring about these natural moments of mindfulness? If there's something, a hobby or passion, and kind of encourage noticing there... If there's a hobby or passion, can they notice what it's like? How that makes them feel when they're engaging it, what is there attention like? They can even write in a journal or write down afterwards about that experience.

(47:22) And then from there, perhaps expanding to some areas that are much more simple, like breathing or washing the dishes. Like I mentioned, things that may feel a little bit more mundane, but bringing some of the same kind of highlights of what makes something feel very special to something that may seem a lot more mundane. I know a lot of people love drinking their cup of coffee in the morning, and it may be even just encouraging them to really savor that cup of coffee and put aside the distractions and really pause and taste it. And that can be a good entry point into mindfulness for a lot of people.

(48:05) [Becky Dame]     Thank you, Greg. I believe this next question, probably a lot of patients have. How do I let go of heavy thoughts like disease reoccurrence?

(48:24) [Greg Flaxman]     Yeah, I wish there was an easy answer to this question. I definitely think practices like this in mindfulness help. I think if you're experiencing those thoughts on a frequent basis and they're causing distress for you, I think counseling can be a wonderful resource. It's something that I offer, the center I work for, we offer, and can really be so helpful. Whether it is like the question earlier about mindfulness based cognitive therapy or other counseling that's available for you, I think having that individual personalized attention and care can make a huge difference.

(49:15) [Becky Dame]    Thank you. Another question that we have is, is the benefit of doing mindfulness on your own the same as going to do Tai Chi or yoga?

(49:34) [Greg Flaxman]     Yeah, I don't know. I don't know. My sense is that there are probably studies out there, but it might be like comparing apples and oranges. That there may be something that is similar benefit there that can be found, but I'm not really sure particularly what that is. But that's a good question. I've worked with folks who I think really prefer the movement based practices like yoga or Tai Chi and I think if you find that's the thing that you enjoy and love then I think that's wonderful and great to stick with. And you can still try out meditation occasionally if it's something that you want to increase in your life, as well.

(50:26) [Becky Dame]      And now, Greg, we have some questions based on, does mindfulness help with any physical ailments that a patient may be experiencing?

(50:44) [Greg Flaxman]     Yeah. I think this goes back to my answer to the question about pain and what I highlighted in that slide about the benefits of mindfulness, sometimes in terms of how to deal with pain, coping with pain. So, that would be a sense of it being helpful in terms of dealing with the pain. Sometimes mindfulness, it can help you notice when you're thinking about the pain or worried about the pain, but maybe you're not actually experiencing it. Similarly with other physical elements, maybe you're thinking about it or worried about it, but not actually in this very moment right here, right now, experiencing an effect from it, experiencing this physical effect. So that's certainly in no way to minimize how these physical ailments really have a psychological impact, but rather a way that mindfulness can help to, hopefully, really reduce some of that psychological effect that disease or pain can have.

(52:00) [Becky Dame]     Okay. Thank you. I have a question. I am a caregiver and practice mindfulness, but unfortunately my partner/survivor does not, and they are stressed. What is a good way to encourage them to practice mindfulness?

(52:24) [Greg Flaxman]     Yeah. There are different ways. I think it's become more available and accessible. If you have Netflix, I actually saw the other day on Netflix that they have... It's by Headspace. They have a new special out there. I think a six part series. And I think they're coming out with another one. It's really beautifully animated, wonderful to see and watch. That's something that feels like it's making mindfulness more accessible for people who have a bit of an obstacle. If you like to watch TV together, maybe that's something that you can watch and can try out to encourage. At the same time, I think the more that you practice it for yourself and work on it for yourself, it may help in the long-term, in terms of perhaps they'll notice. "Hey, they seem they're really benefiting from this. Maybe that's something I want to try too." So although with our partners, it can be really hard to convince them of something that we know is maybe helpful. They may want to do it eventually just by seeing how much it helps you.

(53:46) [Becky Dame]     Now, we are just about out of time. So I'm going to give one last question. Greg, are there any resources that are especially good for children for this area?

(54:11) [Greg Flaxman]     Yeah, they are out there. I know that it's worthwhile looking on even Amazon or other booksellers for different books. I work with only adults, so I'm not really an expert on resources that are available for children. But it is something that I've noticed that's really increased in time. So that's something, I think, if you do a quick Google search on, I'm pretty sure you'll find some good things out there, some books that you can find recommended for kids.

(54:49) I know some activities can be even really simple that you can do deal with a child like shaking a snow globe and having them just sort of observe the snow globe. It's an example of kind of the mind when it's unsettled after you shake it and then when it's still, an example of what the mind is like when it's still. Some other exercises with children, maybe just that belly breathing. Very simple, noticing the belly rise and fall. Some very simple exercises, but I think there are some good resources out there. If you go ahead and search for them, I don't think it'll be too hard to find.

(55:29) [Becky Dame]    Closing. Well, thank you so much. On behalf of the BMT InfoNet and our partners, thank you, Greg, for your helpful remarks today and thank you to the audience for your excellent questions. That will conclude our session.

(55:45) [Greg Flaxman]      Thank you so much, everybody. It's been my pleasure to be here with you today. Take care.