picture a young internal medicine
resident sobbing in the back hallway of
the county hospital she had been paged
by the intensive care unit nurse about a
patient whose blood pressure had
plummeted after giving birth to her
first child her adrenaline was pumping
and her heart was racing the attending
physician had just screamed at her for
not having acted quickly enough and she
literally fell apart unable to think or
even breathe fortunately in that
situation the patient recovered quickly
the resident not so quickly that young
doctor in training of course was me I
have often looked back on that situation
and many others like it and wished that
I understood then what I know about
stress how it affects our minds and
bodies and how to counteract the effect
of stress on our minds and bodies we all
know what stress feels like our heart is
racing
we have rapid shallow breathing we have
a pit in our stomach we have that
dryness in the back of our throat our
palms are all sweaty I’m describing
myself right now but what we may not
know is that our blood pressure is
skyrocketing stress hormones are being
released in our entire body is
functioning differently we are in the
fight-or-flight response this is great
if you’re an antelope being chased by a
big cat for dinner but not so good if
you want to solve a complex problem or
perform on stage not only are our body’s
functioning differently our brains are
functioning differently to our amygdala
our emotions center is overwhelming our
prefrontal cortex the part of our brain
that allows us to be patient and
reason we have become reactive instead
of proactive our ability to
problem-solve is compromised as an
internal medicine physician I am a
witness daily to the toll that stress
takes on our bodies and minds especially
when that stress is chronic I see it
manifested as high blood pressure
diabetes and heart disease
I see chronic stress leading to
behaviors such as overeating and using
drugs and alcohol to excess which in
turn leads to obesity and addiction the
toll that chronic stress can take on our
mental health can be devastating
leading to crippling anxiety and
depression I know personally because I
have suffered from anxiety my entire
life
my anxiety interfered with my
relationships and interfered with my
ability to live to my potential
I learned through the years that
exercise and talking to friends helped
and as a doctor I knew which medications
to take and that therapy was beneficial
too but I had the sense that medications
and therapy were not the entire answer I
had the sense that something was missing
I need you to find out what that was
fortunately for me about 17 years ago my
husband brought me to my first yoga
class something between the sweat and
the mat hit me I was hooked I began to
practice more and more and little by
little a shift began I began to feel
better I became a yoga teacher because I
had the sense that I could do as much
healing on the mat as I could do in my
exam rooms maybe there was a way I could
combine what I was experiencing on the
mat with what I had learned in medical
school maybe there was a way
I could share this experience with my
patients so that they could benefit in
the way that I had but you know we
doctors were skeptics it’s not enough
just to feel it in our own bodies we
need to understand why and how things
work we need to see proof and we need
evidence in my quest to discover I went
to the mind-body medicine conference
sponsored by the Benson Henry mind-body
Institute at Harvard Medical School
bingo
it all made sense the conference
validated why and how practices like
yoga tai chi meditation mindfulness and
prayer work
I saw the scientific evidence and
research supporting what I was feeling
in my own body it was exhilarating and
what I found was this all of these
practices have something in common they
elicit what is called the relaxation
response the relaxation was response was
first described by dr. Herbert Benson in
a book that he published in the 1970s
dr. Herbert Benson is a cardiologist who
practices medicine still today and he
described the practice a bringing your
mind to a single point of focus such as
a breath a mantra or a prayer and when
your mind wanders you gently bring it
back and when your mind wanders you
gently bring it back and when you do
this over and over again a fundamental
physiologic occurs in your body your
blood pressure lowers your heart rate
decreases stress hormones are no longer
being released and you begin to
experience an internal state of peace
and calm so let’s give it a try I know
your mind is probably wandered too I
wonder what’s for lunch but let’s
I take this time to bring it back to the
mind so I invite you all to uncross your
legs let your feet rest lightly on the
ground and let your hands rest gently on
your lap blink your eyes closed bring
your awareness to the breath feeling the
air coming in through the nose and going
out through the nose feel the gentle
rise and fall of your chest if your mind
wanders bring it back if your mind
wanders bring it back inhale to the
count of one two three four exhale four
three two one inhale one two three four
exhale four three two one blink your
eyes open feel differently so this is
what you experience in the moment but
when you practice the relaxation
response on a long-term basis the
benefits are even more profound
functional MRI allows us to see
different parts of the brain lighting up
with different activities we can see the
amygdala our emotions Center activated
when we’re under stress we can observe
the prefrontal cortex the part of our
brain that allows us to have selective
attention integrate our memory and have
moral decision-making light up in
meditating monks we can measure the size
of the hippocampus the hippocampus is
our memory storage center and it
actually increases in size with
long-term meditation we can look at
structures such as the insula and see
that it thickens with long-term practice
the relaxation response and the insula
is what allows us
to understand the relationship between
our feelings and our thoughts and it
also helps us be aware of bodily
processes such as hunger and scientists
have observed that people who suffer
from schizophrenia and bipolar illness
have a thinner insula so on a macro
level our brain function and structure
changes but on a microscopic level cell
your function and protein synthesis
changes to with long-term practice of
the relaxation response for a
microbiology nerd like me this is
mind-blowing
mind-body practices can alter the way
key genes are turned on and off in our
white blood cells an integral component
of our immune system mind-body practices
can turn on genes coding for proteins
associated with energy metabolism and
lengthen telomeres telomeres being the
caps on the ends of our DNA that allow
for cellular longevity mind-body
practices can also turn off genes coding
for proteins that cause and ignite the
inflammatory response such as NF kappa-b
an NF kappa-b appears to be a master
switch for inflammation the implications
for our health and wellness are profound
currently the smart program which stands
for stress management and resilience
training is being used to combat burnout
in physicians at Harvard it has been
used with the World Trade Center
responders in the New York Police
Department to help them with her PTSD I
am thrilled to have just received a
grant to be able to give the smart
program to my physician colleagues at
Park Nicollet and Health Partners and
study the effect on burnout and
resilience why invest money in this kind
of Train
because the economics make sense a
research study done with a selected
group of patients trained in the smart
program has shown that they decrease
their healthcare costs by 40% how do
they do that by decreasing the number of
times they come to the emergency room
for the visits by decreasing the number
of unnecessary lab tests and x-rays
ordered by anxious physicians demanded
by their patients and by decreasing the
number of office visits in general think
about that at a time when healthcare
costs are escalating we have a low-cost
high-yield tool I am lucky enough to
have gone through the smart program as a
participant and together with my yoga
practice I finally feel a measure of
freedom from my own anxiety I would not
be standing on this stage today had I
not so let’s imagine a new model for
medicine imagine a patient comes in for
treatment of their high blood pressure
the doctor gives them the best possible
medication and great advice about
exercise losing weight and a low salt
diet but is also able to talk to the
patient about the value of practicing
the relaxation response and do that in a
way that makes sense to them in terms of
their culture and lifestyle so for some
that’s prayer for others it’s an act of
yoga practice for others still it’s
meditation six months later the patient
returns she’s exercising
she’s sleeping better maybe she’s lost a
little weight and lo and behold
her blood pressure is lower she’s able
to get off her blood pressure lowering
medication she’s saving herself money
because she no longer has to buy her
blood pressure lowering medication she
doesn’t have to come in for lab tests to
monitor the use of her blood pressure
medication and she doesn’t have to come
in as for frequent office visits most
importantly she feels empowered to take
charge of her own health and
while being but she’s not only saving
money for herself she is saving the
healthcare system money because she has
significantly lowered her risk for
having a stroke heart attack and kidney
failure so what are the next steps first
and foremost we need to educate our
doctors and the value of training and
stress management and resilience we need
to learn these practices ourselves so
that we can model this behavior for our
families and recommend it authentically
to our patient we need to add training
and stress management and resilience to
our medical schools and residency
curricula not just for the trainees but
ultimately also for their patients so
stress is part of all of our lives
and stress in and of itself is not a bad
thing in fact we have learned on the
stage today that overcoming stress and
stressful situations can build
resilience but often we don’t have those
tools learning the skills of stress
management through the relaxation
response has the power to change the
paradigm of medicine it has the power to
combine the best of Western medicine
with giving our patients tools and
skills to lead happier and healthier
lives it also has the power to heal us
as physicians to bring us back to why we
went into the medicine in the first
place to
– he’ll give me a dose and your hair
again this is what gives me hope for the
[Music]
[Applause] [Music]
resident sobbing in the back hallway of
the county hospital she had been paged
by the intensive care unit nurse about a
patient whose blood pressure had
plummeted after giving birth to her
first child her adrenaline was pumping
and her heart was racing the attending
physician had just screamed at her for
not having acted quickly enough and she
literally fell apart unable to think or
even breathe fortunately in that
situation the patient recovered quickly
the resident not so quickly that young
doctor in training of course was me I
have often looked back on that situation
and many others like it and wished that
I understood then what I know about
stress how it affects our minds and
bodies and how to counteract the effect
of stress on our minds and bodies we all
know what stress feels like our heart is
racing
we have rapid shallow breathing we have
a pit in our stomach we have that
dryness in the back of our throat our
palms are all sweaty I’m describing
myself right now but what we may not
know is that our blood pressure is
skyrocketing stress hormones are being
released in our entire body is
functioning differently we are in the
fight-or-flight response this is great
if you’re an antelope being chased by a
big cat for dinner but not so good if
you want to solve a complex problem or
perform on stage not only are our body’s
functioning differently our brains are
functioning differently to our amygdala
our emotions center is overwhelming our
prefrontal cortex the part of our brain
that allows us to be patient and
reason we have become reactive instead
of proactive our ability to
problem-solve is compromised as an
internal medicine physician I am a
witness daily to the toll that stress
takes on our bodies and minds especially
when that stress is chronic I see it
manifested as high blood pressure
diabetes and heart disease
I see chronic stress leading to
behaviors such as overeating and using
drugs and alcohol to excess which in
turn leads to obesity and addiction the
toll that chronic stress can take on our
mental health can be devastating
leading to crippling anxiety and
depression I know personally because I
have suffered from anxiety my entire
life
my anxiety interfered with my
relationships and interfered with my
ability to live to my potential
I learned through the years that
exercise and talking to friends helped
and as a doctor I knew which medications
to take and that therapy was beneficial
too but I had the sense that medications
and therapy were not the entire answer I
had the sense that something was missing
I need you to find out what that was
fortunately for me about 17 years ago my
husband brought me to my first yoga
class something between the sweat and
the mat hit me I was hooked I began to
practice more and more and little by
little a shift began I began to feel
better I became a yoga teacher because I
had the sense that I could do as much
healing on the mat as I could do in my
exam rooms maybe there was a way I could
combine what I was experiencing on the
mat with what I had learned in medical
school maybe there was a way
I could share this experience with my
patients so that they could benefit in
the way that I had but you know we
doctors were skeptics it’s not enough
just to feel it in our own bodies we
need to understand why and how things
work we need to see proof and we need
evidence in my quest to discover I went
to the mind-body medicine conference
sponsored by the Benson Henry mind-body
Institute at Harvard Medical School
bingo
it all made sense the conference
validated why and how practices like
yoga tai chi meditation mindfulness and
prayer work
I saw the scientific evidence and
research supporting what I was feeling
in my own body it was exhilarating and
what I found was this all of these
practices have something in common they
elicit what is called the relaxation
response the relaxation was response was
first described by dr. Herbert Benson in
a book that he published in the 1970s
dr. Herbert Benson is a cardiologist who
practices medicine still today and he
described the practice a bringing your
mind to a single point of focus such as
a breath a mantra or a prayer and when
your mind wanders you gently bring it
back and when your mind wanders you
gently bring it back and when you do
this over and over again a fundamental
physiologic occurs in your body your
blood pressure lowers your heart rate
decreases stress hormones are no longer
being released and you begin to
experience an internal state of peace
and calm so let’s give it a try I know
your mind is probably wandered too I
wonder what’s for lunch but let’s
I take this time to bring it back to the
mind so I invite you all to uncross your
legs let your feet rest lightly on the
ground and let your hands rest gently on
your lap blink your eyes closed bring
your awareness to the breath feeling the
air coming in through the nose and going
out through the nose feel the gentle
rise and fall of your chest if your mind
wanders bring it back if your mind
wanders bring it back inhale to the
count of one two three four exhale four
three two one inhale one two three four
exhale four three two one blink your
eyes open feel differently so this is
what you experience in the moment but
when you practice the relaxation
response on a long-term basis the
benefits are even more profound
functional MRI allows us to see
different parts of the brain lighting up
with different activities we can see the
amygdala our emotions Center activated
when we’re under stress we can observe
the prefrontal cortex the part of our
brain that allows us to have selective
attention integrate our memory and have
moral decision-making light up in
meditating monks we can measure the size
of the hippocampus the hippocampus is
our memory storage center and it
actually increases in size with
long-term meditation we can look at
structures such as the insula and see
that it thickens with long-term practice
the relaxation response and the insula
is what allows us
to understand the relationship between
our feelings and our thoughts and it
also helps us be aware of bodily
processes such as hunger and scientists
have observed that people who suffer
from schizophrenia and bipolar illness
have a thinner insula so on a macro
level our brain function and structure
changes but on a microscopic level cell
your function and protein synthesis
changes to with long-term practice of
the relaxation response for a
microbiology nerd like me this is
mind-blowing
mind-body practices can alter the way
key genes are turned on and off in our
white blood cells an integral component
of our immune system mind-body practices
can turn on genes coding for proteins
associated with energy metabolism and
lengthen telomeres telomeres being the
caps on the ends of our DNA that allow
for cellular longevity mind-body
practices can also turn off genes coding
for proteins that cause and ignite the
inflammatory response such as NF kappa-b
an NF kappa-b appears to be a master
switch for inflammation the implications
for our health and wellness are profound
currently the smart program which stands
for stress management and resilience
training is being used to combat burnout
in physicians at Harvard it has been
used with the World Trade Center
responders in the New York Police
Department to help them with her PTSD I
am thrilled to have just received a
grant to be able to give the smart
program to my physician colleagues at
Park Nicollet and Health Partners and
study the effect on burnout and
resilience why invest money in this kind
of Train
because the economics make sense a
research study done with a selected
group of patients trained in the smart
program has shown that they decrease
their healthcare costs by 40% how do
they do that by decreasing the number of
times they come to the emergency room
for the visits by decreasing the number
of unnecessary lab tests and x-rays
ordered by anxious physicians demanded
by their patients and by decreasing the
number of office visits in general think
about that at a time when healthcare
costs are escalating we have a low-cost
high-yield tool I am lucky enough to
have gone through the smart program as a
participant and together with my yoga
practice I finally feel a measure of
freedom from my own anxiety I would not
be standing on this stage today had I
not so let’s imagine a new model for
medicine imagine a patient comes in for
treatment of their high blood pressure
the doctor gives them the best possible
medication and great advice about
exercise losing weight and a low salt
diet but is also able to talk to the
patient about the value of practicing
the relaxation response and do that in a
way that makes sense to them in terms of
their culture and lifestyle so for some
that’s prayer for others it’s an act of
yoga practice for others still it’s
meditation six months later the patient
returns she’s exercising
she’s sleeping better maybe she’s lost a
little weight and lo and behold
her blood pressure is lower she’s able
to get off her blood pressure lowering
medication she’s saving herself money
because she no longer has to buy her
blood pressure lowering medication she
doesn’t have to come in for lab tests to
monitor the use of her blood pressure
medication and she doesn’t have to come
in as for frequent office visits most
importantly she feels empowered to take
charge of her own health and
while being but she’s not only saving
money for herself she is saving the
healthcare system money because she has
significantly lowered her risk for
having a stroke heart attack and kidney
failure so what are the next steps first
and foremost we need to educate our
doctors and the value of training and
stress management and resilience we need
to learn these practices ourselves so
that we can model this behavior for our
families and recommend it authentically
to our patient we need to add training
and stress management and resilience to
our medical schools and residency
curricula not just for the trainees but
ultimately also for their patients so
stress is part of all of our lives
and stress in and of itself is not a bad
thing in fact we have learned on the
stage today that overcoming stress and
stressful situations can build
resilience but often we don’t have those
tools learning the skills of stress
management through the relaxation
response has the power to change the
paradigm of medicine it has the power to
combine the best of Western medicine
with giving our patients tools and
skills to lead happier and healthier
lives it also has the power to heal us
as physicians to bring us back to why we
went into the medicine in the first
place to
– he’ll give me a dose and your hair
again this is what gives me hope for the
[Music]
[Applause] [Music]
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