Interview with Dr. Jeff Brantley

Dr. Jeff BrantleyJeffrey Brantley, MD, is one of the founding faculty members of Duke Integrative Medicine, where he started the Mindfulness-Based Stress Reduction program in 1998.  He served as a member of The Community of Scholars of the Center for Spirituality, Theology, and Health at Duke University for academic years 2009 and 2010. Dr. Brantley is the author of Calming Your Anxious Mind:  How Mindfulness and Compassion can free you from Anxiety, Fear, and Panic and is the co-author with Wendy Millstine of the Five Good Minutes series, Daily Meditations for Calming Your Anxious Mind;  and True Belonging:  Mindful Practices to Help you Overcome Loneliness, Connect with others & Cultivate Happiness.

How did you develop an interest in mindfulness?

I had a lot of good fortune when I think about that. I was a psychiatry resident at Irvine in 1979 and one of our faculty there, Roger Walsh, M.D., Ph.D., was offering a course in transpersonal psychology. He was my first mindfulness teacher; he held seminars on mindfulness and taught us some basic meditation techniques. It hit home right away to stop, notice, and be present. Back then, I didn’t really have the language to know exactly what was going on but I knew that it was a really good thing. I valued growth and self-awareness because of my training in psychotherapy and my own participation as a patient in a psychotherapy group. I came to appreciate the value of the inner life. To have an actual contemplative practice that illuminated that was very helpful.

Could you tell us briefly what MBSR is? 

MBSR is shorthand for Mindfulness-Based Stress Reduction, which is an educational training that helps people bring mindfulness forward in their life in service of their health and well-being. It was the first mindfulness-based health intervention developed in the Western world by Jon Kabat-Zinn at UMass Medical Center. Jon Kabat-Zinn was a student of Zen and he began to observe the great amount of suffering and pain in both the patients and the staff while he was working at the hospital.  He found a way to approach that suffering from the framework of stress in Western medicine. His insights led to a creation of a model that teaches people mindfulness; mindfulness of breath, body, emotions and their contexts. The model trains people in several techniques of mindfulness over an 8- week period in order to help people understand how much each of us contribute to the alarm and stress that we experience in so many situations.

What types of populations enroll in MBSR?

It’s an educational model so it’s open to anyone who wants to manage their own stress and well-being. In my experience, participants are as young at eighteen and there is no upper limit, as long as the person is physically and mentally capable enough to participate. I’ve had people in their nineties take the class, although the typical range include people in their 20’s-60’s. Although there are many mindfulness-based therapies that are derived from the MBSR model, MBSR itself is an educational experience. People come for all kinds of reasons. Some participants are healthy and some have terminal illnesses, but most are somewhere in between.

What are the benefits that MBSR participants report?

In the early days of MBSR, people would self-report more peacefulness, better sleep, less pain interruption in their life, and improvements in relationships. In recent years, the research has detailed more of the benefits of the practice. Currently, researchers find subjective reports of improvements in a variety of stress-related factors like anxiety, depression, anger, distress, and stress as well as objective physiological changes in people who practice. For instance, research now studies the how certain brain waves change as a result of practice and how those changes reflect states of their subjective experience. Also, new research demonstrates changes in gene-expression in meditators, notably in telomeres and telomerase, and the degradation of the chromosomes; there might be positive impact in meditation in the enzyme that reduces the degradation. Other exciting research examines the positive impact of gene-expression on inflammation, the improvements in cortisol response to stress, and other biological stress markers. There are biological changes now linked with subjective reports of well-being.

Currently, researchers find subjective reports of improvements in a variety of stress-related factors like anxiety, depression, anger, distress, and stress as well as objective physiological changes in people who practice.

Are the benefits uniform for everybody, or do some people derive more benefits than others? If so, what accounts for that?

That’s the million dollar question! According to what I can tell from the meta-analysis and the conversations with professional researchers, there is data that suggest that mindfulness practices offer a host of benefits. That doesn’t mean that everyone who practices experience the same degree of improvement. Some people don’t participant as thoroughly- people have to do the meditation. Like exercise, those who don’t practice as much won’t have the same degree of benefit.

It’s not as simple as that though, there’s an interesting dimension being studied, referred to as trait mindfulness- how much natural awareness people have. According to psychologists, the amount of trait mindfulness varies with people. Some people are more awake, alert, and present than others are. So if someone like that participates in the MBSR class, they already score so high on the mindfulness trait scales that it doesn’t look like they gain much mindfulness from the course. However, they might gain an understanding in terms of being able to manage their stress better and give language to the experience. The measures might not show a significant shift.  It wouldn’t be because they didn’t practice, but because they already started with a high degree of trait mindfulness. It’s a complex question.

Are there any participants that find MBSR too difficult to complete? What are some of the challenges that they face?

Again, it’s complicated. Some people aren’t ready for the personal commitment. We ask them to meditate up to an hour a day and many people are just so busy that they can’t find the time. But if people find even half an hour to practice informally, they can benefit. One of the red flags that we screen for in our program is substance abuse; if someone is managing their pain with drugs, and they might be high some of the time, they need to get sober before they can be fully engage with the course. The question becomes whether people aren’t finding time to practice because they are too busy, or if they really are practicing but their consciousness is impaired. In other instances, if people have poorly managed mental illness, such as mania, they may not be able to manage the type of discipline. They would have to get that under control first in order to have optimal success in the class.

As a teacher of MBSR, would you ever advise a struggling participant to drop out or would you encourage them to continue?

It’s a case by case issue. I would advise against continuing if the participant was too sick. I had a client who was hospitalized and wasn’t feeling well when he returned. He missed a few sessions and we encouraged him to get well and come back when he was physically able. So medical, psychological, and also family issues might interfere with a participant’s full engagement with the class.  If these issues disrupt their personal exploration and practice, we would recommend that they resolve that before returning to us.

In recent years there has been more scientific evidence in support for the health benefits of mindfulness-based interventions.  How can we increase knowledge of these mindfulness-based interventions among more traditional medical providers?

That’s another million dollar question! The history of the science of mindfulness, as I see it, hasn’t been centralized on a certain population in a certain context. It’s not like the focus on cancer where the problem is substantially funded. Within medical specialties and groups, their own leaderships and associations have the responsibilities to keep up with trends. There is more coverage now- trainings, conferences, journals- it might be a slow process, but now there’s more penetration now than ever. For example, one of my medical school classmates has been a practicing physician for 40 years but was generally unaware of mindfulness. He heard things about mindfulness but it was never clear. More evidence-based research will be needed to demonstrate its application to more clinical populations and in more contexts.

Can you give me any example of a research study that is making mindfulness more accessible to medical populations?

I’ve been involved with an interesting study at Duke University in which family medicine providers are testing a model called ‘Shared Medical Appointments’, where patients with the same basic diagnosis  are treated together in a group. You combine the time allocated to each single patient for a more comprehensive session with all patients together at the same time. The advantage of that is that providers don’t repeat the same information each time and also they can deliver the pertinent information in the first half of the session. With the rest of the time, they can devote more attention other questions the patients might have.

This study is an R34 grant to study a mindfulness-based training in a ‘Shared Medical Appointment’ model for obese Type 2 diabetic patients. This is a great example of creative solutions on the clinical side. They have pilot data that shows that the patients and the doctors were receptive to the format; everyone felt they had plenty of time with their doctors, they could talk and communicate better, and they were able to learn techniques in stress reduction. There were very positive outcome in the pilot data.

What has been the most rewarding part of being a teacher of mindfulness over the years?

Similar to what drew me into medicine in the first place, I think the most rewarding part is trying to have some sort of impact on helping people reduce their suffering and become healthier and happier. I try to encourage people to practice mindfulness and support them to work with what’s happening. What I find most rewarding is just to see how people change when they let mindfulness into their lives, the beautiful stories. Some of it is what they were hoping for- maybe their blood pressure goes down, maybe they sleep better- but so much of the beauty of it are things they never even imagined; maybe they communicate better with their children, or perhaps they discover something about being alive that they haven’t really expected because they haven’t been paying close attention, like the beauty of their garden. It’s that sense of wonder, ease, and joy that turn on in people- that’s one of the sweetest pieces of it!

Similar to what drew me into medicine in the first place, I think the most rewarding part is trying to have some sort of impact on helping people reduce their suffering and become healthier and happier.

What does the future hold for the science? What more is there to learn?

There is a lot to be learned about gene-expression and how the mind body interfaces at that level, as well as brain function. We know the brain shifts its pattern activity and even its morphology, depending on how we use our brain. So we also know that contemplative practices, like mindfulness meditation, can direct the brain to function in certain patterns and activity. There’s a lot to learn about the patterns of connectivity and also understanding the translation of the objectives measures of brain function into subjective experience. I think from a scientific and neuropsychological view, those are exciting prospects.

We now have a firm understanding of the mind without the technical blueprint of brain function. And that understanding of course is the teachings of the Buddha, the Buddhadharma, the Four Noble Truths, the Satipatthana Sutta, and the foundations of mindfulness. If you look at those things closely, there’s a great deal of explanation about things like feeling, thinking, and sense of self. But where Western science is excelling is studying the actual functional activity of the mind and the body and how that translates into the moment-by-moment subjective experience of life.

Any advice to aspiring scientists or new practitioners getting into mindfulness?

The advice is the same I heard years ago: deepen your own personal practice the best you can, including retreats and personal practice. Let that guide you.

Mindfulness is not really about ideas; it’s about observed, direct experience. The ideas and thoughts that we have about those direct experiences, and how the world understands that, follow from our own direct observations. So personal practice!

Mindfulness is not really about ideas; it’s about observed, direct experience. The ideas and thoughts that we have about those direct experiences, and how the world understands that, follow from our own direct observations.

Is there anything else that I haven’t asked you related to work or in general that you would like to share?

I always try to point to the heartful quality related to the mindfulness work. In other words, people know mindfulness is non-judging, present-moment awareness, which in English can sound pretty cold. For those of us who teach mindfulness, the experience that most of us point to is the heartful quality. The warm-hearted acceptance, the willingness to receive and allow the experience and to welcome whatever experience arises. In fact, in some Asian cultures, when talking about the mind, they point to what we would call the heart. There’s a wholesome quality, a dimension to this noticing that is not really about ideas and in the physical head; it’s about a willingness to embrace and include experience without judgment. That really is a heart-based attitude.

daily-meditations-for-calming-your-anxious-mindYou can read find more of Dr. Jeffrey Brantely’s teaching in his latest book.

Trying to control your anxious thoughts can backfire, making them more prevalent, not less. The best way to calm these common feelings is by attuning yourself to your thoughts in a nonjudgmental, attentive manner, acknowledging your anxieties but choosing to act rather than react.

From the author of Calming Your Anxious Mind comes Daily Mediations for Calming Your Anxious Mind, a collection of more than sixty-four daily mindfulness-based meditations to help you engage with the present moment, manage stress and anxiety, and rediscover the joy in living. Each meditation contains an easy-to-learn visualization exercise, affirmation, or activity, with meditations grouped into four sections: relaxing and feeling safe, embracing joys and fears, befriending your anxious mind and body, and connecting to the web of life.

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