Mindfulness, mediation, and mental health: Integrating mindfulness and meditation into psychotherapy with Dr. Simon Goldberg Part 1

[Music] Broadcasting from the most beautiful city in the world, I'm your host, Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia. Welcome to season number two of psychotherapy and applied psychology, where we dive deep with the world's leading applied psychology researchers to uncover practical insights pull back the curtain and hopefully have some fun along the way, in an attempt to bring new ideas to helping professionals, those training to be helping professionals, and the applied psychology curious. I'd love to connect with you, send me a text or leave me a voice message, you can find links in the episode show notes, and if you're willing, I'd love to know your name and where you're from so I can give you a shout out on the show. Today I couldn't be more excited to welcome one of the world's foremost experts on meditation, mindfulness and psychotherapy. My guest is an associate professor in counseling psychology and core faculty member, the Center for Healthy Mines, at the University of Wisconsin-Madison. He conducts research on psychotherapy with a specific emphasis on the effects of and mechanisms underlying meditation and mindfulness-based interventions. He's currently completing a five year NIH-funded K-23 award focused on the delivery of meditation training through mobile health technology. He's also a fellow at the Mind and Life Institute and has won several prestigious awards, including early career awards from both the American Psychological Association and from the Society for Psychotherapy Research. This is part one of our conversation on meditation and mindfulness. In this conversation, we discuss the difference between meditation and mindfulness, if meditation's helpful, and how meditation's helpful, and the importance of quality mindfulness practice. The episode starts with my very successful guest responding to my question about times when he's questioned his ability to be successful. So without further ado, it is my pleasure to welcome Dr. Simon Goldberg. Have you heard of people who have made the CVs of rejections? CVs? Have you heard about this? We're instead of a CV of all the things you accomplished, it's the CV of all the things that you tried to accomplish, like all the grants you submitted that weren't funded, all the papers that were registered. Sure. So I feel like I've had some of those that have really felt daunting, like a paper that I worked super hard on, and I think especially earlier in my career, I think I took that stuff harder. It's still disappointing if you submit something that you really feel good about and it doesn't get accepted. I had a couple of those that were really painful, and another one early, I think this was in my second year or my third year of grad school. I'd been working with a group and spending a lot of time volunteering with them, and I had hoped to get a fellowship with them to a research assistantship rather with them, and it didn't end up working out that particular year. And I remember feeling super disappointed by that and really discouraged. So that was one, and that was early enough on, I don't know if it quite had me think,"You know, I'm never going to make it," but it felt like a setback and I took it very personally, and it was, yeah, it was hard. But then how about the inverse? Yeah. So there was one experience. This was a really cool kind of early, during grad school experience. We had, so one of my mentors in my advisor in grad school is a man by the name of Bill Hoyt, who is a methodology, is a methodology, primarily. And then another mentor is Bruce Wampold, who's done a lot of psychotherapy research, and I really benefited so much, kind of bringing their minds together to work on problems. And there was one particular week during a summer of graduate school when we had a woman from Norway visiting Helena and Eason Lee, who does a lot of work on therapist effects. And so she was in town. It was a really fun week and we had dinner and Bruce is an amazing cook, so he had us over to his house. And this week we spent the day kind of brainstorming. We'd spend the morning brainstorming together and then I'd spend the afternoon analyzing data, and then we'd come back, and then, you know, in the evening we'd get together whatever. And then we'd come back the next day and kind of look at it. It was this really such a rich kind of generative week working with those folks. And I just felt so lucky to be in the room with these great minds who'd been thinking about this stuff so deeply. And so that was just this really positive experience of being kind of in the company of scholars that I really respected and inspired by, you know, their ideas. And then having this chance to implement it so quickly was really a fun. Yeah, so that was an example, kind of early, positive example that really is kind of a touch point for me of how research can feel and collaboration can feel. Because for me that's been so much of what's been sustaining as the relationships and the kind of joyful, playful quality. That's where you put that reminds me of is I did an episode with Scott Miller. And so he was talking about when he was doing training and how much sort of the doing therapy and doing research on therapy was sort of part of his training and sort of sitting down with just lots of, you know, hey, let's just watch these videos and see what we're doing well or not doing well. Let's sort of, you know, this. And I mean, you're describing something different, but just sort of thinking about how those, you know, almost this being like a peer with these people that are your mentors and just being a part of the process with them and, you know, and that sort of social, legal and that playful part of it too really stands out. Totally. Yeah, yeah, kind of gathering around it. I'm sure that Scott brings that to the fit training and the stuff that they're doing that kind of we're all in this together. Yeah, really fun way to learn. Do you feel like that's something that you've been able to facilitate in your faculty role? I hope so. You should ask my students how they feel. But I, you know, one way, I guess a concrete example of a way that we've been doing that we had trouble getting people to come back to meetings after COVID. We did okay when it was fully zoomed, but then we had these hybrid meetings and they were really, it was really challenging. I know hybrid is always challenging, but I would get so frustrated because I would always have to show up and then if only two of, say, six or eight students would show up, I would feel frustrated with them. So I can plate it up to my wife about this that she said, Simon, you need to have them over for dinner and you need to make it mandatory. So that's what we did. That's what we did last year and it was so much more fun. So I would, I provide food. They have to come and then they're each schedule kind of 20 minutes to talk about whatever they want. However they want to use the time, whatever would best serve them. So that's been a fun, we try to create some of that vibe in the group meetings that way. So it's sort of like a lab meeting but at your house. Yeah. I'm with food. Yeah. Scheduling during the day. I'm curious how you do it in your group because it's been a total nightmare in a schedule during the day. Oh, I can, yeah, I completely agree. And that with particularly post COVID, but then, you know, particularly in our field, we have students who there have clinical placements all over the place. Yeah. And all these topics. Yeah, exactly. You know, where I did my postdoc, one of the things that they did, it was something like Tuesdays from noon to three, I'm making that up. Nobody's allowed to schedule anything. This is when all lab meetings happen and all whatever happens. Yeah, and I always thought that that was. It was really useful, just really useful. Yeah. To have that sort of reserve. I've heard of departments doing that like four o'clock, four to five, even just an hour of the week that people are expected to be available. That could go a long way. Yeah, absolutely. It could go a long way. Yeah. And then also, you know, then the students, when they're talking with their sites, they can blame us. You know, right? Exactly. Yeah. No, exactly. Yeah. Totally. Yeah. So we're going to jump into one of your main research areas, which is mindfulness and meditation. You know, before we get into it, could you help us for the sake of this conversation differentiate the two? Yeah, I love that question. So another mentor of mine is Richie Davidson, who's done, done doing research on meditation for a long time. But one of the things that he likes to say is that the word meditation is like the word sports where there's, you know, all of these different varieties. And we have one word for it, but it really is designed to capture the wide range of what he and others have described as kind of mental training paradigms that are designed to, you know, cultivate emotion regulation and attention regulation capacities to put it in sort of dry clinical terms, or I guess, sort of neuroscience terms. In mindfulness is one of those sports, right? And it's a really important sport. It's a really in Buddhism, in particular, it's this really kind of foundational quality and has a really central place in Buddhism, but is only one of many different forms of meditation. And I think that's one of the things that as a field, we've kind of confused where the word mindfulness is conflated with the word meditation and that relationship between them isn't always so clear. And that's not to mention the fact that mindfulness has also become this kind of psychological trait variable, which can be distinct from mindfulness practice, which are designed to cultivate the trait of mindfulness. So it can get a little bit muddled, but that's how I would differentiate at least mindfulness and meditation if that makes sense. So mindfulness being a subset of the broader meditation category. Okay. So what would you say when we're having this conversation, are we usually going to be talking about mindfulness or meditation? I like to talk about meditation, because there's a wide variety of practices that are out there, and I think it's worth kind of being a little more precise about how we're thinking about these things. And for example, this meditation app that we've been studying, the Healthy Minds program, has mindfulness in it, but it has other stuff in it too. And I think it's worth kind of highlighting some of those other pieces that said a lot of the research that's been done has been done on mindfulness-based interventions. So when we, at least the meta-analyses that we've done and some of the trials that we've done have been with mindfulness-based interventions. So there's, you know, I think good reason to talk about mindfulness as well as a specific subcategory. So can you give us an example of mindfulness meditation and another type of meditation for the listener? Totally. Yeah, yeah, yeah. Yeah, I love that. So the kind of classic first mindfulness-based, secularized mindfulness-based intervention is mindfulness-based stress reduction. It's an eight-week program. And it has all of these different techniques that are designed to cultivate what John Cavitzin has described as a way of paying attention that's in the present moment with non-judgmental awareness. How does he say it exactly? The awareness that arises from paying attention in the present moment without judgment, something like that. And so that could be, you know, the first practice is this body scan where you're moving the attention through the body and noticing all the physical sensations without judgment in the present moment. And then it moves on to mindfulness of breathing or mindfulness of thought or these other kind of mindfulness is this capacity to be with experience and it can be turned towards anything that's happening. So that's the, in the Healthy Minds program app that we've been studying, we think of that as this awareness quality, this ability to be aware of what's happening and kind of regulate attention in this non-reactive way. And then another widely studied family of practices are the kind of loving kindness and compassion practices that are designed to cultivate our capacity to experience states of kindness and connection and appreciation and compassion towards ourselves, towards other people, towards all beings traditionally. And those actually, you get little taste of that in programs like mindfulness-based stress reduction, but those are whole kind of lineages in some ways or those are whole kind of practice paths in a way that have a lot of depth and richness to them. And those are really just starting to get studied seriously in the last, I don't know, 10 or so years. Okay, so as we're having this conversation, then feel free, like I'm going to ask you questions, but feel free to edit my question to be consistent with what would make me a sense in terms of mindfulness or meditation. Okay. So how did you get into studying meditation? Yeah. So I got interested in college. I was a jazz trumpet player once upon a time and I was doing this dual degree program at a music school and a university and I sort of suddenly fell out of love with playing the trumpet. And this was really unmooring for me because it had been such a huge part of my identity. And so my world was turned upside down. I was having trouble sleeping, actually, was the thing that really got me interested in meditation because this was the first time I had no trouble sleeping in all of a sudden I have this major disruption in my life and I'm super grown off by it. And I ended up getting, I ended up enrolling in a yoga class that had some other Eastern practice, had some Chigong practices in it and then kind of through that got introduced to meditation. And from the very first exposure to it, actually, I felt like it was something I wanted to understand better and to really explore deeply. It's one of the only things in my life where the very first time I connected with it, felt good for lack of a better way to say it. And I felt like there was this kind of edge taken off that was really refreshing. And so I even, it's been one of the things, I mean, that was 25, 22 years ago now. So it's been something I try to do every day. I've managed to do most days since then. And I think because of that, the sense that it's helpful, it's kind of been, not something I have to necessarily convince myself to do, it's sort of this negative reinforcement. It feels good or it doesn't feel bad when I do this thing. So it's really been motivating and yeah, really grateful for it. So pretty literally, what was that experience like then? What was the practice then and then what is your practice now? Yeah. I mean, I think then, you know, I didn't, like most of us, I didn't really have training for working with my mind. I'd never been to therapy at that point. And I had a lot of big feelings and scary thoughts and a confusing sense of identity. And the practice gave me a way to be with my mind. And then actually studying Buddhism gave me a way to kind of think about the world and think about the mind. And actually really got very interested in Buddhism. I ended up doing a Buddhist studies program in India for my last semester and kind of went down this Buddhist rabbit hole and then lived at a Zen Center, Wind Tours Zen Center in North Carolina for a couple of years before grad school. And I got really interested in the practices, but also some of the kind of theory and psychology behind the practices too. So now when you do your daily practice, what does that look like? Yeah, yeah, sorry, I missed that part of the answer. I mean, I think now, you know, for whatever reason, it's a lot easier to be with my mind now than when I was 20, hopefully for most of us, there's some kind of evening out that happened as we get older. You know, we have a one-year-old at home. So some, depending if I don't sit in the morning, it can be super sleepy. So I, you know, I am not getting as much sleep as I should be. So sometimes it's just very sleepy and boggy. But sometimes, and if I have a good night's sleep, it can often be this way. You can just have this kind of like sweetness, like how amazing it is to be a human being and have a mind that can hear the birds and feel the body and, I mean, still having plenty of thoughts and emotional experiences that come and go. But I think there's a much deeper sense of connection to myself in a way or the universe or however you want to talk about it and an openness to being with changing experience, that things are going to keep changing and there's some sense of stability and trust in a way that I can be with those experiences. Yeah. And then the other side of it, I just want to flag, especially if we're going to end up talking more about kind of secular or even the app-based interventions. Because this whole other side of doing retreat practice, which I felt lucky to be able to do some of that over the years. And that's been really truly fascinating to see how the mind can operate differently, even say after three days of doing a practice intensively, the mind is different. It experiences the world different and I'm sure that there's neurological things that are happening where it actually is physiologically working in a different way. But that's been really fascinating to me. I really haven't started doing research on it. There are folks who have studied that. It's hard to study. But that piece that kind of potential of the mind to experience really profound states of peace and well-being that aren't contingent on external circumstances, that's really inspiring to me and fascinating to me. And something that I feel like we've only really started to scratch the surface of scientifically. Now, when you're saying retreat, is that like a silent retreat? Yeah, for example. Yeah. And then where you're for several days basically working to kind of almost constantly be in a more mindful state. That's the intention, you know, that you're... So we were talking about mindfulness. If it was a mindfulness retreat and like we were talking about, there might be other practices that one's focusing on during that time. But that you're really trying to carry that throughout your daily activities. And we might, you know, I have that aspiration to do that every day. But that's, you know, most of our minds don't have that capacity to really kind of keep that moment of in-keep that intention going. And the retreat setting really makes it, you know, is sort of like training wheels in a way to build those skills. So when in your day to day, like today or yesterday, you know, when you've been doing your mindfulness practice or your, I'm sorry, your meditation practice and you sit down, are you mostly using a mindfulness type of, you know, what instructions are you telling yourself? I'm sure this is varied over the years, over time, but, you know, generally. Yeah, it has. And actually, so I started in most of my early practice was in the Zen tradition, which has certain instructions and a certain kind of spirit to it and all the lineages have their own flavor. And it has more of like a questioning, like trying to get really curious about what reality is and what the self is and what the mind is. And there's sort of different techniques that they'll use to cultivate that. Maybe more of the sort of devotional energy, almost like a prayerful quality in a way. And then more, which can happen in lots of different traditions, but more recently, I've been doing more of a pasta and a style practice, which has more of this kind of inquiry trying to see what the mind's doing and a practice that I've gotten really interested in the last few years is a noting practice where you actually use words in the mind to label experience. And the classic introductory technique is just labeling the rising and falling of the breath. So staying with the breath, but with this gentle label of rising and falling. And then it can be labeling other objects, hearing sensations, other sensations that are happening in the body, thinking. And then even as the attention gets more refined, you know, different thought patterns planning, worrying, remembering, or different kind of layers of emotional experience. So that's a practice in the last few years that I've been really interested in. So to the extent that I'm able to stay with, you know, moment to moment experience in the mornings, for example, when I would do some practice, it might be kind of labeling that rising and falling and staying with that to the extent that I'm able to. And that's been a really interesting practice as, you know, as a psychologist, just as a way of seeing what's happening in the mind. And it feels in a way like this concentrated CBT in a way or it can have that quality to it where you're seeing these different patterns that the mind is engaging in and just noticing that. And maybe there's some kind of unseeing through in a way like you might in the context of CBT seeing like a cognitive distortion, but just having that experience of what, and that's talking about thinking, but you can, you can witness all of these different processes happening interactions between the mind and the body, for example, while you're sitting there, while you're sitting there meditating. And I just think, I just think it's also fascinating. And honestly, I feel so grateful that we live in a time where we have access to this stuff and people have spent, you know, thousands of years kind of refining this and keeping it alive is, yeah, super inspiring to me. So I want to get in a minute, I want to get into like how mindfulness works and sort of quality of mindfulness practice and this sort of thing. But before I do, I feel like we should just spend 30 to 90 seconds on is meditation, is mindfulness helpful? Like what does the data say? What does it help for? What does it help for? What does it not help for? I think we should just sort of spend a minute or two on that. I love that. Yeah, so this is where I think the mindfulness literature is the most mature and the most robust because there have been the most trials on mindfulness programs like mindfulness space stress reduction. There's a really beautiful literature on mindfulness space cognitive therapy. Is this kind of merging of MBSR and cognitive therapy and then some programs like mindfulness oriented recovery enhancement for addiction and these other addiction and pain. So there's a really nice, really an amazing literature. And from my perspective, and we've done some of the meta-analyses in this area and also we've done some reviews of meta-analyses in this area, I think there's a few things that we can conclude. One is that mindfulness practice fairly reliably reduces common mental health symptoms, things like depression, anxiety, and stress. And the data is, you know, I think quite good for that. And in particular, when you compare mindfulness-based interventions to other evidence-based treatments, they tend to perform almost indistinguishably. So they're really performing on par whether that's comparing with CBT or comparing with antidepressants, for example. So there's a really kind of strong evidence-based there. You know, there are some exceptions. For example, CBT per anxiety seems like it may be more helpful in some ways than mindfulness in some of the trials, although in the meta-analysis that we did that difference wasn't statistically significant. So I would feel confident kind of recommending mindfulness training for those symptoms. And then beyond that, I think it gets a little bit less clear. There's pretty good data on benefits for chronic pain is another area. There's some evidence for substance use, although that the findings are a little more mixed in that area. Some evidence for sleep, although CBT for insomnia seems to do the best. And there's maybe more evidence for that. You know, there are literatures on ADHD and suicide and some of these other disorders too that I think are a little bit less mature. And it's not as clear how strong the evidence is there. And then the evidence for kids actually is a little bit more mixed also. So there was a really amazing trial that was done in the UK recently with, I think it was 8,000 kids and they randomly assigned them to a mindfulness training or their kind of school curriculum as usual type of control group. And they actually found there was no evidence for benefits actually from the mindfulness training and potentially some evidence that it had eye atrogenic effects, very small magnitude eye atrogenic effects. So the effects on youth I think are less robust. And we've seen that in some of the reviews of meta-analyses that the effect sizes do tend to be smaller and maybe more prominent in clinical youth samples rather than the general youth population. So are you saying that, so you were saying there were different effects for kids with, I forget the language you just used, sort of like normal. These kind of universal implementations were they, so that was the study in the UK. They gave it to all the students regardless of the students' diagnoses or symptoms or anything like that. And it doesn't seem that that kind of implementation is very effective. That it's more helpful for the kids who are struggling. To the extent that there's an effect there, it seems like it may be more helpful for the kids who are struggling when they run those trials. But it's just been interesting to see that that trial has been a big blow in a way to the mindfulness for kids literature. And there are other layers to it. And there's been a lot of discussion in the meditation research community about issues with that, the design or the intervention or did the kids, was it an intervention that they liked? And there's been a lot of kind of discussion of issues there. But my guess is that the effects tend to be a little bit smaller if they're there for the younger populations. And Jevney thought says to why that might be? I mean, I think some of it for kids of a certain age, depending on how it's framed, it can feel kind of like a punishment. You're told to go and be mindful. You're forced to do it. I think it's a really hard thing to force people to meditate. And I think, depending on who you have delivering it, it could kind of easily elicit, I think, some reactivity. And I don't work with kids. I don't have an adolescent at home. So this is sort of speculation. But I think those kinds of implementation factors, whether the students were asked to meditate at home or not, which I think in this particular study that wasn't part of the design they were doing it in school. And those sorts of things could make a big difference, I think. Yeah, totally. Yeah, I mean, because it's sitting there and being quiet is kind of like, could feel like being in time out. And even-- Exactly. There must be something developmental. I mean, just the sort of this meta idea of, you know, attending to your thoughts, being aware of your thoughts, but not being in your thoughts or being aware of your breath. You know, I think that my kids, I feel like they're, you know, who are eight and ten. Like, they're, you know, maybe the ten year old, but there's like borderline with like, could they even get the concept in order to do it? Or are they just going to sit there and more likely ruminate the whole time, you know, and just like, because just that idea of being able to separate it. Yeah, that makes a lot of sense. Yeah, that's-- yeah, it does sort of seem like developmentally. There would be a place where perhaps, you know, where would make more sense to do these types of interventions. And I guess also, as you were talking, I was thinking like, well, I guess you can't really do like a play version of mindfulness. But then I was like, well, you know, there's like the, like, you know, the, the raisin, you know, that sort of experiential activity that people do all the time, which is really great, I think, you know, where you sort of put a raisin in your mouth. How does it feel? Or you know, you sort of look at it. All that sort of stuff. So I guess there are more perhaps child-friendly versions of mindfulness that one could attempt. Yeah. And we've actually-- we've done some-- where in other groups have done some work studying those kinds of implementations. So we did a study with preschoolers when I was in grad school. And one of the things that they would use during the meditation were these things called belly buddies, which were basically like rocks. They were rocks that they would put on their bellies, they would lay on their backs and put those on their bellies, and they would use the rock as a way of kind of having a physical sensation to pay attention to. And it was a way of just like you're saying, kind of a cuter like child-friendly version. And then they had this little jar that had glitter in it in this sort of glycerine solution. So the glitter would kind of float down slowly. And they would shake it. And it was a mine jar. And you would shake up the glitter and then watch it settle as a sort of metaphor for how the mine can settle when you slow down and just pay attention. So they have these really sweet kind of ways that I think sweet ways to give an experience of some of those practices, just like you're saying. Yeah. Yeah, yeah, yeah. So you've sort of flirted with it. What, based on the data, how do we understand how meditation or mindfulness, how it actually works, what the active ingredients are? So I would be curious to hear your answer to what the active ingredients of psychotherapy in general, and even a specific psychotherapy is. I don't know if I'm allowed to ask questions first. I'm happy to give you my answer. Sure. I mean, so one of the things that relates to this is sort of, you know, from the act framework they talk a lot about how the way that this works is by sort of creating a distance, right? That sort of diffusion from your, and that's one of the things that I think about with mindfulness is just having that being diffused from your thoughts, your feelings, and being able to watch them and see them and realize they're not me. Yep. And so that's one of my understandings of how mindfulness is generally presented as working or one of the ways in which it works. But I don't know, you know, from a researcher who actually, you know, who does a lot of research on this, is that backed up? I think that is the best answer that's out there. That said, my sense, and based on things that I've read from people like Tim Kipers, who have been studying this stuff a lot longer than I have, is that we don't really, we're not really collecting the kind of data and running the kinds of studies that we'd need to run to really be able to know definitively whether a certain aspect is a mechanism or not. And, you know, there are dismantling designs. There are some ways that we can look at these things scientifically, but our methods are relatively crude in terms of isolating. This is definitely the specific mechanism of X treatment. And we're sure it's not this other mechanism that we could have measured that's probably correlated with this mechanism at .6 or something. And I think, so I think we have a lot of that, but I think the strongest evidence that I've seen from, you know, meta-analyses of tests of mediation, which is, of course, one of the ways that we look at mechanism does support just like you're saying changes in this reactivity and in particular, the repetitive negative thinking, our tendency to kind of get stuck in these repetitive negative thinking loops. So it seems that mindfulness training can reduce that tendency, you know, presumably through giving us some of that distance from our thoughts. I don't know how specific that is to mindfulness. My guess is that CBT and a lot of other psychotherapies do that in a way, whether or not they're doing it as explicitly as you might get in mindfulness or CBT for that matter. And so those repetitive negative thoughts, would you, is that rumination or is that something different? Yeah, yeah, rumination. Yeah. Rumination, worry, that sort of stuff. Yeah. Are there any other, like, potential, like, candidates that you see as potential other ways that this might be working? I mean, people, so the folks, some of the meta-analyses that have looked at this, they'll look at something like mindfulness. I mean, mindfulness itself, and there's actually a non-reactivity in one of the most widely used measures the five-passive mindfulness questionnaire. There's a non-reactivity facet of that. So people will have measures of mindfulness that there's non-reactivity, non-judgment, acting with awareness, observing, and describing is the fifth one. I believe in ability to put words to one's experienced thoughts and feelings. So they'll look at that. I mean, there's a literature on reappraisal, that that's something that happens for people. There's also a literature on changes in the self-construal or one's self-sense of self. Other people that focused on self-compassion as another kind of important mechanism. But my read is that the mechanism literature is just really messy, and you have people that kind of have their pet mechanism that they'll study, and they'll find evidence for it by running these mediation models. And we've done some of that in our own work, and quite frankly, we can find evidence for lots of different mediators. And it's really hard to isolate, you know, to say that it's definitely X psychological characteristic. And like we were saying before, they tend to be pretty highly correlated, too, because we're often talking about self-reporting. So you've done some work. Oh, good. So I was just going to raise, this isn't my area so much, but there are people that look at biological measures and different behavioral measures. And there is some evidence for changes in inflammation as a candidate kind of biological mechanism by which meditation training may produce benefits. You know, a lot of those studies aren't particularly large, and so it's a little challenging to draw firm conclusions. But there is a literature suggesting that there are reductions in inflammation. You know, to the extent that we would think of that as a biological mechanism that might lead to psychological benefits, people might set it up otherwise, where it's the psychological mechanism that leads to biological benefits if you kind of just reverse the paths. But that's another one to put it out there. And then of course, there's all of the neurological kind of brain function and structure changes potentially. So Kate, can you sort of help me understand the inflammation thing? Because I've heard people talk about this and I say, I don't really get it. So yeah, could you sort of connect those dots for me? Yeah, so I'm a little bit speaking out on a limb here. We're collecting actually some biological measures and some of our work and have done that in the past, but it's always been in collaboration with people who study this stuff more than I do. But there's different inflammatory markers like interleukin 6 and 8, for example, or a C-reactive protein that are these indicators of inflammation that you can get from a dried blood spot, for example, or a venous blood sample. And that would be something that could potentially be changed through meditation practice, that there's a change actually in stress physiology, presumably, that impacts inflammation. And we know that inflammation is implicated in things like depression and there is clearly a link between the psychology, so to speak, and biology. And inflammation is just one of those systems that we can measure. It has lots of health and chronic health correlates to it. And so that's one of the places that we can look relatively easy and easily in the body to get a sense of things that might be happening psychologically. So to push you on something that you're not an expert in, which is totally unfair of me. So like inflammation of what? Yeah, so my understanding is that it's systemic inflammation. So it's these circulating inflammatory markers that would reflect sort of a more global inflammation that's happening. There are, you know, when we collect these kinds of measures, we ask people whether they've recently been sick. And I think there are various illnesses that can kick up an inflammatory response. I don't know if cuts or things like that kick up inflammatory responses that would be detectable in venous blood, for example. But I guess it's kind of what you're getting at. It's probably a somewhat crude sort of marker, but also is related to, it's a pretty amazing list. And again, I don't, not an expert, but things like obesity, things like asthma, there's all of these physical diseases and it's related to stress and depression and, you know, heart health. And it's really, it's something that seems to be really important for well-being and flourishing. And I think where it gets complicated is there can be so much individual variation in that. So it's in a way kind of a noisy measure to see how the body is doing, but there's some signal there. It does tell us something about what's happening physiologically for someone. So you've done some work on mindfulness practice quality. Yes. So, can you help us understand what is quality or high quality mindfulness practice versus low quality? Yeah, this is a great question. And I don't have to tie this back to biology, right? I can just answer the question about. I promise. You're good. Okay, okay. I'm going to reverse it. You're going to quickly lose me too. I already lost myself. But this was, yeah, this is some work that AC Del Rey, who was a mentor and friend during Gretzbo, he's graduated. That's a wrap on part one of my conversation with Dr. Simon Goldberg. Please be sure to check out part two, which drops next week. And please reach out by sending a text or leaving a voice message using the links in the show notes. Until next time.[Music][Music]