#114: Mindfulness, Medicine & the Biology of Stress - Dr. Craig Hassed

29:31Dr. Craig Hassed:Well, I think there's no one size fits all. mind you the traditions of meditation or contemplative practices that have been around for a long time they've probably been around for a long time because they've been pretty well thought out and applied and so that's always a very good reference um so you take something like mindfulness and um but there's an infinite number of ways you can apply mindfulness so for somebody who's got you know history of trauma and so on then maybe a different approach to somebody who's just got a high workload at work and you know so what's a person unable to do comfortable to do feels ready to do because it's not really helpful to go and push somebody where they're not ready to go you know so for somebody closing the eyes and all of a sudden just being much more aware of what's on your mind or what's just in the background of your mind can be a pretty confronting kind of thing.

30:36Dr. Craig Hassed:So there are lots of ways a person can learn to be mindful, which might emphasize certainly long practices of mindfulness meditation, but really emphasize ways of being mindful and present in your day-to-day life. Working at a pace that's comfortable for that person to work at, how long the practices might be. So, you know, dipping your toe into very brief practices could be a lot more achievable than trying to sit down and really push through a long practice, which can get pretty confronting. But there are lots of other ways too, you know, and just learning, you know, some breathing techniques.

31:23Dr. Craig Hassed:Yoga breathing techniques have been around for a long time in ways that can help to elicit a parasympathetic response with all of their sympathetic nervous system or stress system activation. So there are lots of ways, but a really important thing also is just being understanding what's going on in their own minds as well. So to notice how when we're not present, to actually realize how much of the time we're projecting into a future that hasn't even happened. And we've already lived a stressful situation a thousand times before it even got there. And it's like, I mean, I said right at the start that, you know, in my teenage years, I had a few moments of being present here and there.

32:06Dr. Craig Hassed:And I can remember when I was, I don't know, maybe 15 or 16, I used to do a lot of competitive swimming. And in the weeks leading up to big swimming meets, I get really nervous and I'm queasy in the stomach. Yeah. And I kind of realized, one day I realized, wait a sec, why am I feeling like this? Because I was sitting on a really comfortable chair in the lounge room at home. And I was like, all of a sudden I noticed that in my imagination there was an imaginary me on the starting blocks of the old Olympic pool in Melbourne waiting for the starters going to go. And all of a sudden I've been in a dream world.

32:48Dr. Craig Hassed:And I take it to be real. I wonder how much of the time I'm doing that. So as I came back to the present moment, it's like, it's a really comfortable place to be. And that stress response switch itself off. And I thought, that's interesting. And I wonder others are doing that same thing itself. So it's not just a breathing. It's not just a meditation practice, but it's really understanding what's driving the stress response on the level of the mind. So the whole cognitive aspect of it. and why being present is so important. You might have an exam to prepare for. Fair enough. Stay present. The exam's not going to happen for weeks or months or whatever it might be, but what's in front of you now is what you can control.

33:34Dr. Craig Hassed:So get your attention on what's in front of you, what's present, and meet the future when it comes. But these kinds of things help people to be productive but also to switch off that stress response when we don't need it. Do you think that helped your performance? Did you notice any change when you could observe that? Did you get less nervous and did it actually affect the outcome of the swims? It made it easier, you know, just to deal with the whole thing. I used to play quite a lot of basketball as well. And I can remember the same thing, particularly one time, the team we had lost to a few times throughout the season.

34:14Dr. Craig Hassed:We played them in the preliminary final. and for some reason we were on. We were coming back, we were coming back and there was about two seconds on the shot clock. I got fouled taking a shot. And so I had two free throws and it was like timeout and everybody ran me, oh, stay calm, Greg, stay calm. And everybody's so wrecked up and I just felt like this real sense of calm. It's just like, it's okay, it'll be what it'll be. I just felt really calm. But I tell you what, when I stepped up to that free throw line, and sunk those two free throws. I felt really calm, but that ring looked as, you know, very large hoop of it.

34:56Dr. Craig Hassed:And for me, that kind of sense of being present and dealing with emergency situations as a junior doctor, times when I was very present, I could process things. I could respond far, far better than if I was getting anxious about, how's this going to turn out? so for me I've found in terms of performance in lots of different ways being present, being on task being in the moment this sort of open attitude to letting things unfold moment by moment makes a massive difference It seems like you're describing in some ways what would be called flow are you aware are you aware of any evidence for meditation increasing flow in general Because I know, I think in Stephen Kotler's book, he talked about there being correlation between flow and happiness, overall happiness.

35:52And it seems as we kind of decondition these programs and these projections of the mind into the future or the past, that naturally more flow might kind of arise in life. Yeah.

36:07Dr. Craig Hassed:Is there any evidence of that? Yeah, there is. But it's a very hard thing to study. Yeah. because when you're trying to do a control trial, there's a whole bunch of things you can control, but you can't necessarily control. You know, people can practice getting better at being in flow. Yeah. Whether we actually practice getting into flow, whether we practice how not to be out of flow. Yeah, right. That's a good way to describe it. Because we often think our way out of it. I'm sort of, I've come to with this. We think and worry our way out of being in the flow, just being as present as we can and surrendering to the moment.

36:49Dr. Craig Hassed:So the zone flow, when you look at that, there are extremely mindful states. When an athlete describes being in the zone, it's incredibly mindful. And the paradox is there's such complete immersion in the moment with what the athlete's doing that there is no room for anxiety about the outcome. Because the outcome is always about the future. Even if that outcome is 20 seconds from now or half an hour from now, it's about the future. Whereas an athlete who's in the flow is just completely absorbed in the moment. And so that's one of the real paradoxes. No concern about the outcome. And yet because the attention is so fully engaged at the moment that the performance, you know, the peak performances are always flow or zine state.

37:45Dr. Craig Hassed:So there is some research, but a lot of it just depends on asking people, what's your state of mind? What's the state of attention when you're in that state? You know, so, and people will describe it and go like, well, yep, that's mindfulness like, you know, our excellence. Yes. Yeah, that's a good way to describe it. I think you do mindfulness courses and MOOCs. What are MOOCs? And can you tell us a little bit more about the implementation of mindfulness in the education system? Yeah. Well, Monash really got behind the mindfulness work that I was doing and a colleague as well. And we had a lot of support in the mindfulness area.

38:35Dr. Craig Hassed:So Monash dedicated funding just to do mindfulness, teaching around the university. And when some of the people who are with online learning were sort of heard about some of the work that we're doing, said, look, we'd love to develop these MOOCs with you. So we're going back to 2015 now and we developed these MOOCs on the FutureLearn platform. Monash doesn't have a relationship with FutureLearn. anymore. There'd been about half a million people who'd done those programs over the six years or so that we were running them there. But yeah, these massive online open courses, so Mindfulness, Wellbeing and Peak Performance, Maintaining a Mindful Life, and those courses we're now run through M3CS, so the Mono Centre for Consciousness and Content Studies.

39:32Dr. Craig Hassed:And so we We are in Melbourne, of course. And so they're very practical courses that sort of, well, you can get some of the theory, but the theory has got to be applied. If it was a course just, you know, like on hydration, we just give you the theory of hydration. Well, at the end of the course, you're thirstier than you were at the start. You know, so, okay, well, here's a bit of the theory of hydration, but here's the water. Drink it. Yeah. And how do you, you know, so in a way it's a very applied, practical, pragmatic course. Because for me, when I learned mindfulness, I wasn't learning it from somewhere else.

40:15Dr. Craig Hassed:I was kind of, in a sense, learning it intuitively. So when you're dealing with your first psych emergency as a junior doctor, it's like, where's your attention? And, you know, like when you're doing your first lumbar puncture, where's your attention when that needle's going in? So for me, I kind of taught myself that's a very pragmatic approach to it. And so these courses take a very pragmatic approach. How can you live it in your day-to-day life? Whatever your context, you know, doctor or not a doctor, these courses are really for anybody. so you don't have to be a doctor but it's a very practical approach so those courses were the highest ranked mindfulness courses globally MOOCs and since that time at N3CS we've had the opportunity to develop not just short courses but semester long units for undergraduates and postgraduates where they can take a deeper dive They can learn the practical side of it, but understand, go into it further, understand more connections, you know, so, and particularly how it relates to like one of our undergraduate units, true happiness.

41:36Dr. Craig Hassed:True happiness. That's beautiful. Yeah. I mean, happiness unit, but what's true happiness? It's kind of raised the question about, well, are there kinds of things we're chasing happiness that don't lead us to happiness? happiness so the science and practice of human flourishing so so how can you use these practices to help us to understand ourselves better be more resilient and we look at say in that unit again very practical implied but pressure points like stress yeah and conflict and sense of isolation we look at potential solutions like the cultivation of well contemplative practices compassion and connection.

42:18Dr. Craig Hassed:And then we look at big questions like, you know, what is meaning? You know, what is self? What isn't it? And what is happiness? So it's a kind of a deep dive. So it's great to be able to do that over a semester rather than just, you know, four or five or six weeks. So that's kind of the structure outlaid with science and then also practices as you move through. New tutorials. One of the things I think is just so important about these units is that when we get students in, you know, we've got 220 students doing that unit all semester. So, you know, there's a whole bunch of different tutorial groups, but you get the students into the tutorial room and you do the practices.

43:09Dr. Craig Hassed:and it's very reflective. It's a lot of questions. So the tutor's not up the front saying, oh, this is what you need to know and this is how it is and this is what you need to think. It's like the tutor's there to facilitate. So what are you discovering? What are you noticing? Ah, your mind's more distractible than you actually realize. Isn't that interesting? What's the effect of that distractibility? Ah, you make errors. You don't listen to people. Oh, your mind wanders off into work. Ah, what's the effect of that? You know, so there's a lot of inquiry, a lot of questioning. So the students can make their own discoveries.

43:43Dr. Craig Hassed:But the thing is when the students are in the room, they're talking with each other, they're having one-on-one, coming back to the main group, small groups. This is a really rare thing for kids these days, you know. I'm saying kids, you know, adolescents, young adults. It's like life has lived so much on the screen, on the phone. And to actually have authentic and deep conversations with somebody is incredibly rare, but incredibly valued by the students. And that has a transformative effect in itself. We're losing that kind of ability to connect with each other in that sort of way. It is an absolute paradox that we, you know, through screens and technology, we're more connected than ever before.

44:32Dr. Craig Hassed:but all the research shows we're more isolated than ever before. The more we use this, the less we understand ourselves and the less we actually are able to manage our emotions and reactions and various things. It's like this is taking us away from ourselves, away from each other. It's like Harry Potter and the Dementors. The Dementors come in and suck for living daylights out. I reckon it's a smartphone. Yeah, it is. That's a good point. I was actually going to go there. You touched then on compassion, and I think the evidence from Richard Davidson is on loving kindness, which I think technically is somewhat similar anyway, but there's evidence that loving kindness reduces the default mode network quicker, he found quicker, at least in that study, than other types of meditation.

45:25is that um do you is that well established and how would you say there's like a 45 year old marketer like and they are looking at practicing some form of mindfulness like i'm still just wondering how they would decide on what what what to practice yeah well look if

45:47Dr. Craig Hassed:somebody came along and said, I've got real issues with, you know, anger and resentment and various things. Okay. You know, somebody might be ready and wanting to practice loving kindness or compassion practices right from the start, especially if they recognize, I really need to do something about this. For most people, if we stepped in first up with medical students and we started with that, It was like, whoa, this is too far, too far. So we're going there. So learning basic mindfulness techniques. And then later on in our course, we have a four-week compassion unit, which is core curriculum.

46:32Dr. Craig Hassed:It's not elective. So this is the other end of the curriculum when they'll be moving up into their clinical practice in the following year. So it's a compassion training module. So we have practices and ways of cultivating compassion. So it really depends on where a person is as to what kind of practice you'd start with. Because starting with a compassion or a loving kindness practice, especially to practice somebody or to try and bring that to somebody you've got a lot of resentment is very difficult. Yes. And a lot of people struggle with that and bring things up. So there's a kind of a certain amount of background, I think, which is really helpful in the more simpler practices.

47:21Dr. Craig Hassed:And that gives a person perhaps a little bit more wherewithal to work with things that may come up during perhaps a more challenging practice. It's easy to bring loving kindness to you. To you, you know, if you're in a good relationship with your partner, to your dog, to your, you know, that it's, it's harder to people you don't know so well or maybe will you work with or somebody you've really got some issues with so i think you kind of need to build up um to those sort of more challenging practices but i mean the research shows there's changes in the default mode network and so on as you've been sort of saying before but also that the stress circuitry and we're starting to completely rethink our understanding of compassion and empathy.

48:12Dr. Craig Hassed:So empathy was the kind of thing you've got to have empathy. And it's not that empathy is wrong, but for most of us, when we're with somebody who's distressed, we will experience empathy, but then we get distressed by their distress. And it's not just somebody at home or at work. you're watching the news and you're seeing stuff every day that you would rather really wasn't happening in the world and you experience empathy which is entirely natural but for most people the next step is into empathic distress and if there's a lot of that then pretty soon there's empathy fatigue and burnout and then avoidance and or anger and reactivity and so what we understand and Richie Davidson's really led the world with this, is that compassion's different.

49:06Dr. Craig Hassed:You sort of start with empathy, but instead of stepping into empathic distress, when you step into compassion, the stress circuits of the brain don't light up. Eras of the brain associated with positive emotions and affiliation do. It's quite neurologically, it's a very different thing. and um uh and it's not as there is really uh the people are really know this feel better so that compassion fatigue is a misnomer there's no such thing as compassion fatigue people do not get fatigued by compassion um they get fatigued by empathic distress and um one of the interesting things that happens from an intentional point of view and where mindfulness kind of overlaps a lot is that with empathic distress, the attention goes off the person who's experiencing the distress and turns to ourselves and like, oh no, I'm feeling like this.

50:02Dr. Craig Hassed:I don't want to feel like this. I'm quick, how to make it go away. And whereas with compassion, the attention stays fully that the person is experiencing distress, that there's a complete openness to be ready to help if there's something there. With empathic distress, It's quick, I need to fix you so I can feel okay again. And that doesn't always lead to the best kind of helping, but the, the attentional side from self-focus as opposed to the focus on the so-called other. That's, that's interesting. I hadn't heard, um, I hadn't heard a scientist put it that way before that's exactly the way I would anecdotally experience it, that empathy is very tiring.

50:54And if, say, I'm with a person that sometimes I might find the situation somewhat tiring, and if I do remember to be compassionate, and it is a practice, then the situation is usually quite energizing and has the opposite effect, I think. and the reason I was asking about it is just anecdotally we did I've been doing uh just like a zen anapanasati like breath meditation retreats with high doses it was like I don't know just a normal like 10 hours a day or something and then we did we did a a retreat with Alan Mollis a compassion for a measurable a measurables retreat and that was going through a compassion loving kindness empathetic joy and equanimity but there was only 24 20 minute meditations in that retreat but before i'd read richard davidson's book i've noticed a bigger shift off that in terms of how my kind of the only way i can describe it subjectively is it's like everything was softened like these kind of i just remember being in traffic in things that would would be quite frustrating before.

52:08And it just wasn't triggering me in the same way, or any way, actually. But now with what you've said, I had had high doses of mindfulness prior to that. So maybe I was somewhat ready to have that part of the training, I guess.

52:27Dr. Craig Hassed:Yeah. Well, I think that capacity to not step into empathic distress. So when you're practicing mindfulness, and when we kind of, you know, you're sitting there and you've got frustrations or anger or, you know, mind wanders off, you know, we often get irritable, you know, we get reactive to what we're experiencing, but we're just a human being having human dynamics. Right. So when we kind of soften our reactivity to that, get less judgmental and, you know, reactive about it. Yeah. In a sense, we're learning to cultivate a kind of a gentleness or a kind of a self-compassion. Although people argue, you know, is there any such thing as self-compassion?

53:09Dr. Craig Hassed:It's just compassion. But you cultivate a kind of compassion in the presence of things that experience you don't necessarily want to. But when we do that day by day and then something happens in our day-to-day life, reactions happen. It's easier to notice it than just to soften the attitude to it, to get less caught up in it, to notice it. and to have the attention stay with the person rather than, oh, no. Right. This shouldn't be happening. Quick, make it go away. And when we get reactive to it and aversive to it, then we actually escalate the very thing we're trying to get rid of. I've noticed that for myself.

53:51Dr. Craig Hassed:Like as a medical student about when I was 19, getting into the anatomy dissection room was not my favorite thing. and bits of body. And I kind of thought, in a couple of weeks, that's going to be, you're going to need to step in there. So a couple of weeks prior to that happening, I kind of thought, I'm going to stand at the end of a very long corridor where the doorway to the anatomy lab is, and I'm just going to stand here and just feel repulsed. But I'm just going to stand here and just feel comfortable with feeling uncomfortable. I'm just going to let those feelings kind of be there. And so I did that for five or 10 minutes.

54:35Dr. Craig Hassed:And then the next day I went further down the corridor and I'm just going to let those feelings be there and just not trying to do anything about them, but just learn to observe them with kind of less sense of being caught up in them. And then the next day, until, you know, the second week, I just stepped in there and just helped those feelings. So by the time that section started a couple of weeks later, it wasn't an issue. Wow. And I kind of, again, I mean, sort of like intuitively it made sense to me that, you know, I guess when I taught myself mindfulness, they were the kind of, I don't know, I thought of them as experiments.

55:10Dr. Craig Hassed:I'll do an experiment and see what happens. But I think that when we practice mindfulness meditation and we're learning to bring that attitude to the things we find uncomfortable, it then makes it easier for us to bring that to the discomfort that others are feeling. And being comfortable with others' discomfort doesn't mean not caring. It just means able to be at peace with the situation as it is, and yet a readiness to respond, a readiness, a very natural readiness to help if help is possible. Yeah, exactly. I think it increases our ability to help because we're not caught up in the stickiness of the situation or assumptions.

55:57Yeah. And so as we, this is the last big, big question, but you've had 37 years at Monash and I think you've been involved with 120 papers, but what's the big question left on the mind or my body connection for you? Is there anything left?

56:19Dr. Craig Hassed:Well, in 3CS, there's a word consciousness in there. For me, the big question is understanding consciousness. So when we, if we can understand it, because there's this sort of, I don't know, debate, the material science perspective is you've got material matter, physical matter, and then it becomes complex and eventually you've got a brain. and thinking and it gets more complex and eventually you've got sentience and something self-conscious. But from that view, it starts with physical matter. Yes. And that's the underlying reality of the universe is the physical matter. When you look at not just the world's great wisdom traditions but also great physicists of the last century and they said, no, actually, I think the wisdom traditions had it right.

57:20Dr. Craig Hassed:Right. Consciousness is primary and then things that manifest on other levels. The physical world is not as substantial as we think it is. It's actually, it's nothing really there. It's just that impressions, it's all happening in the mind. In a kind of a way, the consciousness, primary, mind, physical matter. So the big question, can we answer that? Can we just get that sorted because there's a lot of implications that flow from that yeah so yeah if m3cs can can resolve that question uh over the next few years i'll be very happy with that well i think it'll be on i'll come back yeah because i mean that they're trying to the physical matter thing first and to explain consciousness as a as a product of physical matter that's the hard problem of consciousness that's a very hard problem yeah nobody's got a clue how it happens And, you know, I kind of think, well, if we're looking at the universe through a telescope, well, maybe we've been looking through the wrong end of the telescope.

58:28Dr. Craig Hassed:Right. We need to look at it from the other perspective and maybe our universe opens up a bit. So that's a big question. That's a great question. Just to push you a little bit somewhere you might not want to go, but if you were to take like a Bayesian probabilities approach, what would you put probabilistically that that might be true, that consciousness might be primary and you don't have to answer that? And also, is there any, is there any like test that you know of that could start to answer that? Because I'm also extremely interested in that question and I think it's becoming much more popularized now, at least in my peripheral it is.

59:13And a lot of people that were probably quite dogmatic about the materials approach seemed to have swung the other way in the past probably couple of years. Um, but I wonder if it is primary, is there a, is there a, is there some sort of experiment you could create to look in that direction?

59:33Dr. Craig Hassed:Uh, probably not if the wisdom traditions are right. I mean, it's an immeasurable formulas. because that's what science tries to measure. There's got to be something measurable, et cetera. Probably not from that perspective. I think the answer to the question comes in very deep meditation when it kind of becomes self-evident. When I was 19, I got out of the chair with that sense. Yeah, right. That was a kind of like interesting, and for me, that's the only thing that really answers the question. And once it's answered like that, you don't need any more debate about it. Right. Yeah, exactly. And that's probably with the emergence and popularity of psychedelics.

1:00:18I think that might be what's potentially causing at least part of, and meditation, of course, like primary. But I think both aspects of that. There's a really amazing channel that I follow called Essentia Foundation. And they started off mostly interviewing quantum physicists. and through contemplating quantum physics a lot of these quantum physicists arrived at that view just because they couldn't see how even mathematics i think it was frederico fagin who said that he felt it was impossible he had an experience actually but where he saw that it was impossible for um matter to create consciousness and then within that mathematics to arrive and that it had to be consciousness being primary.

1:01:10Dr. Craig Hassed:As Einstein said, everything should be made as simple as possible. Perhaps. But no simpler. For me, to quote Winnie the Pooh, a bear of very little brain, I try to keep things simple if I can so I can interpret it. Didn't know the Winnie the Pooh quote, that's amazing. I'll have to add that to the repertoire. are so the final thing is just a really really quick i'll just do a couple of quick fire questions a book that changed your life

1:01:42plato symposium and one word for what mindfulness is thing and a practice every day for at least a year

1:01:54Dr. Craig Hassed:for somebody else to practice or yourself i think yourself practice meditation half an hour, twice a day, every day. One final one. A teacher whose voice you still hear? Socrates. Great. Thank you so much. We really appreciate it. Really great work. And yeah, I hope you can answer that question and keep going. We really appreciate it. Thanks, Craig. Thank you very much. It's been a pleasure, Josh. thank you so much for listening to the episode if you enjoyed it please if you could give us a like a subscribe and hit the notification bell that would really help us out or just share this episode with a friend share the course with a friend anything would go such a long way thank you so much and i hope to see you soon

1:02:56you