1. Only that day dawns to which we are awake. HENRY DAVID THOREAU, Walden
What does this mean to you?
Only that day dawns to which we are awake.
HENRY DAVID THOREAU, Walden

2. Mindfulness: Live Life Awake Kay Theyerl, MD, FACP, MS, ABIHM
Today overview
Kay Theyerl, MD, FACP, MS, ABIHM
Medical Director, Lifestyle Medicine

3. Today Introduction to the concept of Mindfulness
Science of the Mind-Body connection
Practical examples
How we can shift our emotional response to be healthier and happier
Short experiential using Heartmath
TED talk - Gratitude
How an “Attitude of Gratitude” can change your day and your life
I would love to share with you how an attitude of gratitude can make all the difference in your day and your life!

4. Daily Life I am so busy doing that I feel I have lost a bit of myself
I have lost sight of my passion/spirit
I cannot turn my mind off
I do not take time for myself – I put everyone else first
I feel stressed much of the time
I worry about the future
I feel ___________ about the past
I feel I am on automatic pilot
I have a short fuse
I tend to react to people and situations
I am exhausted
Any of this resonate with anyone?
When we feel this way = how do we sleep? Eat? Exercise? Deal with coworkers? Spouse/Kids? Decision making? Thinking?memory? Are we in the mood for love?
Question is – are we really living or just going through the motions

5. What kinds of decisions are we making? How are our relationships?
How resilient are we?
How productive are we?
What kinds of decisions are we making?
How are our relationships?
Family
Friends
coworkers
How healthy are we?
Self care
How much are we enjoying life?
Begs the questions:

6. ME How are we recharging? Who feels guilty doing for yourself?
Flight attendant
Mother Theresa
Is there a pill to recharge the battery? NO

7. Mindfulness can change the pathways in the brain and recharge us
Just Be
“Doing” brain vs “Being” brain
Stress and exhaustion result from living in the “doing/thinking” brain
There is no pill or supplement
We must recharge by going to the “Being” brain
Mindfulness can change the pathways in the brain and recharge us
Primitive brain - -fight or flight - -release catecholamines - -great if we are avoiding danger – frazzled raw nerve - over time will wear us out and make us sick – weight/GI/BP
Control/orchestrate/taking care of the world/fixing everything
We must do and accomplish to prove our value
Sometimes DOING is an escape

8. Mindfulness
Means paying attention in a particular way: on purpose, in the present moment and nonjudgmentally. It is the art of conscious living – JON KABAT-ZINN This nurtures greater awareness, clarity, and acceptance of present-moment reality and helps us get back in touch with our own wisdom and vitality.
So what is t his mindfulness you speak of?
Wisdom and vitality – our humanness – our soul – follow our purpose

9. Mindfulness
Curious Bemusement
Al Bellg
examples

10. Mindfulness – Way of Being “Mindful Living”
Daily activities
Work
Eating
Interactions with others
Our own emotions
Do I need to go off to a retreat in the mountains
Incorporate into our lives

11. Don’t Just Do Something, Sit There!
We run around doing, fixing, orchestrating
We can learn to:
Shift into “being” mode
Become aware of breathing
Breathe and Let Be
Use something to which we have access
Our breath
Use something we have access to

12. Brain and Heart are wired together
The heart has its own complex nervous system - the “Heart Brain”
The heart sends far more information to the brain than the brain sends to the heart
The heart signals especially affect the brain centers involved in decision making, creativity, and emotional experience
The breath affects the heart

13. Resilience
Resilience: Ability to recover quickly from misfortune; able to return to original form after being bent, compressed, or stretched out of shape. A human ability to recover quickly from disruptive change, or misfortune without being overwhelmed or acting in dysfunctional or harmful ways.

14. Resilience Heart rate variability = coherence resilience
Tree that bends in the wind
Tennis player/skier
“Go with the Flow”
Resilience is the result of coherence which is driven by HR variability
Map out HR changes over time

15. Emotional coherence q
Coherence. In the groove /in the zone
We use the term physiological coherence in a broad context to describe a number of related physiological phenomena frequently associated with more ordered and harmonious interactions among the body’s systems.
Simply put, the definition of coherence can mean
Read slide.
You will learn now to order the pattern in one system, your ANS, which will allow all your systems to synchronize to that rhythm and bring about clear, focused thinking.
= more ordered and harmonious interactions among the body’s systems (synchronized)
Leading to clear, focused thinking
© 2007 HeartMath LLC

16. Coherence Quick Coherence®
feeling of ease and inner harmony - reflected in your heart rhythms.
The heart is a primary generator of rhythm in your body influencing brain processes that control your nervous system, cognitive function and emotion
More coherent heart rhythms facilitate brain function, allowing you more access to your higher intelligence to improve:
Focus
Creativity
Intuition
Higher-level decision-making
When you’re in heart-rhythm coherence, you perform at your best - You feel confident, positive, focused and calm, yet energized – keeps us resilient
In the groove/ your zone

17. Heartmath.org
You can use the Quick Coherence® Technique anytime, anywhere
Creates positive changes in your heart rhythms, sending powerful signals to the brain that can improve how you’re feeling
Use in the middle of a difficult conversation, when you feel overwhelmed or pressed for time, or anytime you simply want to practice increasing your coherence
Practice coherence – will become more resilient
Use mindfulness to shift our emotional response

18. LEVEL 1 COHERENCE Neutralize the stressful feelings.aa
We’ll spend the rest of the workshop learning and practicing your coherence skill set.
The first tool you’ll learn stops the negative impact stress has on your system. It’s called the Neutral tool.
Here’s how it works.
Neutralize the stressful feelings.
LEVEL 1 COHERENCE

19. Neutral Tool Shift your breathing to the area around your heartbb
Shift your breathing to the area around your heart
Breathing modulates the nervous system via the heart’s rhythms
Animated slide
When you’re stressed, you saw how ANS activity is chaotic-- each branch fighting each other. Breathing modulates the nervous system. With each inhalation, sympathetic activity increases. What does that do to heart rate? (increases it). With each exhalation, parasympathetic activity and the heart rate slows down. You can start to bring order to the ANS click with heart focus, heart breathing.
Focusing on the area around your heart and feeling your breath coming in around the area of the heart and back out through the heart is a deeper way of breathing that may feel awkward at first. But it interrupts the body's stress response and starts to bring more order or coherence to the heart's rhythm. Level one coherence.
Now let’s practice the two steps.
If you have trouble doing this, you may find placing your hand over your heart helpful. You may also find that closing your eyes will make it easier at first. With practice you will be able to do this with your eyes open so no one even knows you’re doing it.
Heart focus. Wait 5 seconds.
Heart breathing. Wait 5 seconds.
Take a deep breath and focus on the area around your heart. Now feel your breath coming in through the heart and out through the heart. Heart focus. Heart breathing. Wait 30 seconds.
What do you notice?
Solicit mental, emotional and physical observations. Refer to Grid: Write ‘Neutral’ on vertical axis. Ask for and answer questions RE the steps.
Have everyone practice again.
Focus on the area around your heart. Now feel your breath coming in through the heart and out through the heart. Heart focus. Heart breathing. Wait 30 seconds.
What are you thinking about as you do that? Mentally, you’re probably not really thinking about anything other than your breathing.

20. Neutral is the ready position for flexibilitycc
Neutral disengages you from any negative, non productive emotion or feeling you may be experiencing (stress) which will allow for more objectivity, prevent you from jumping to conclusions or making assumptions that can derail a meeting. E.g. saying something stupid! Does anyone have an example when remaining neutral or objective worked? How about when the lack of being neutral compromised an interaction with a customer or co worker? Meeting? Etc.
Neutral puts you in the ready position for flexibility. Just as a car goes into neutral before it goes into drive or reverse, you’re ready to go where you need to in any situation. Neutral is not only an attitude, it’s something you do to change your physiology.
This simple act of focusing on the heart combined with a deeper level of breathing draws energy away from the distressed thoughts and feelings, and stops any damaging effects they have on your system. Focus on the area around your heart. Now feel your breath coming in through the heart and out through the heart. Wait 20 seconds.
Focus on the area around your heart. Now feel your breath coming in through the heart and out through the heart. Wait 10 seconds.
Now in your guidebook, list specific situations to use level one coherence—the Neutral tool--and the benefits you hope to gain. When most are done, ask for examples.
Let’s practice it again: Heart focus. Heart breathing.
Activity
The trick is to learn how to do this with your eyes open, any time any place. Invite everyone to stand up and start to walk, in a line, around the perimeter of the room while practicing the steps.
After about one minute, ask them to return to their chairs. Was getting neutral easy? Any challenges? Discuss.
Some might have thought, ‘this is silly!’ Where do you that comment or attitude puts you on the Emotional Landscape? You can see how quickly we can get right back into the stress zone.
Neutral is not just an attitude – it is a way to change our physiology!

21. Where would being neutral help you?
This simple act of focusing on the heart combined with a deeper level of breathing draws energy away from the distressed thoughts and feelings, and stops any damaging effects they have on your system.

22. Your Emotional Landscape
High Arousal
High Energy
Adrenaline p
We live in all four quadrants every day and they make up our emotional landscape. What are some examples of high energy negative emotions? Low energy, negative? High energy and positive? Low energy, negative? Important: always start with high energy negative emotions and move counter clockwise, ending with high energy positive emotions.
Instruct each person to map out his/her own Emotional Landscape in the guidebook with emotions they typically experience throughout a day. As everyone creates their own landscapes, prepare a f/c version of this slide to post and refer to throughout the workshop.
Allow 5 minutes and then ask everyone to turn to a partner and discuss their Grid for another 5 minutes. Ask for examples of emotions for each quadrant and fill in the f/c version to use throughout the rest of the workshop.
It’s fairly obvious that we all want to spend more time on the right side of the grid which reflects the physiology of peak moments and optimal health. It’s the stress free zone. When you look at the qualities of peak moments we listed earlier, you’ll see a lot of the same emotions.
What makes the HeartMath System different from most other approaches to stress reduction, is that rather than relying on the relaxation response, which keeps you here click, these techniques work by moving you here. click.
When you consider how much time you spend on the left side, it’s important to know how to literally flip the switch and get back over to the stress free zone.
To do this, we need to use a whole systems approach to stress reduction. You’ll learn how to move click to the stress free zone, on demand, by creating, in your body, a state called coherence
Stress Zone
Negative Emotion
Positive Emotion
Stress Free Zone
Low Arousal
Low Energy
Relaxation

23. Level 2 Coherence Add the power of positive emotions
Stopping the negative impact stress has on your system with Neutral is important, but now let’s gain the benefits that an emotional shift can bring-- level 2 coherence.
How do positive emotions impact physiology? Refer to the grid.

24. Heart Feelings Think of 2 people you really love:
Think of two things that you love to do:
Think of two places that give you a sense of peace:
Where do you feel it?

25. Quick Coherence® Techniqueff
Animated slide
First you get Neutral. click with heart focus and heart breathing. Everyone practice that again now. Wait 20 seconds. Now you activate a heart feeling click to impact the longer lasting hormonal shifts that come from positive emotions. Refer to the horizontal axis on the Grid.
We call these heart feelings for two reasons. 1. People typically associate these kinds of emotions with the heart and 2. they impact your heart’s rhythms which you can observe in real time as HRV. One of the easiest ways to do this step is to remember a special place, the appreciation, care or love you feel for a close friend or family member or click anything that feels good to you. It could be something funny; it can even be a dish of your favorite ice cream. It can be a genuine feeling of any of the emotions on this side of the right side of the Grid. Ask for more examples. In your guidebook, jot down a few examples you can use for this step.
The important thing is to feel these emotions; not just think about them or visualize them. You want to re-experience the moment. It's the sincere feeling that comes from the experience that counts and anchors HRV coherence. Aren’t these peak moments?
Now let’s practice these steps to Quick Coherence. Closing your eyes will help you practice this step until it becomes more natural. Remember: Don't just think positive. Feel positive. And sustain that positive feeling for about 20 seconds.
Okay, now first get Neutral.
Focus on the area around your heart. Feel your breath coming in through your heart and out through your heart.
Wait 10 seconds. Now, make a sincere effort to activate a positive feeling. Wait 30 seconds.
What did you notice? Mentally, emotionally, physically? Relate responses to physiological shifts on the Grid.
Where did this experience put you on the Grid? How can this help you throughout the day?
Let’s do it again.
Heart focus. Heart breathing. Heart feeling. Wait 30 seconds.
Let’s see what this can do to your hormonal balance.
NOTE: Some may find it easier to focus first on the positive feeling rather than on the breathing. A sincere feeling of appreciation, care, etc. will bring more order to the ANS and make heart breathing easier or in some cases, not necessary. Keep in mind that the goal of level 2 coherence is to shift the emotion. And in highly charged situations it is often easier to disengage from the negative emotion first with the Neutral tool. Some may not be able to shift the emotion but will be able, at the very least, disengage from the negative feeling and achieve level 1 coherence with the Neutral tool.
Shift your breathing
Activate a positive emotion – FEEL IT

26. Sustain Coherence Heart Lock-in techniqueqq
It increases your ability to sustain coherence. To achieve level 4 coherence we use the Heart Lock-in (HLI) technique. The goal is to sustain a positive emotion and “lock-in” to how that feels, until it becomes more familiar—the new standing wave or baseline for your ANS.
Once you access your coherent state it will tend to sustain itself until you do something to upset that rhythm.
By generating positive energy with emotions such as appreciation, compassion, care and love and sending that energy to yourself and others—you can impact both your internal and external environment.
Over time, you increase the ratio of time you are able to sustain coherence.
The Heart Lock-in® Technique is different than relaxation. Something very different happens in the nervous system.
Who remembers where relaxation is on the grid? By definition, relaxation is a parasympathetic response, which is in the bottom half of the grid (refer to the grid).
But simply being in the lower half, says nothing about your emotional state.
Let’s look at relaxation and a positive emotional state a different way.
Heart Lock-in technique
Sustain a positive emotion and “lock in” how that feels
Becomes new baseline
By generating positive energy with emotions such as appreciation, compassion, care, and love and sending that energy to yourself and others—you can impact both your internal and external environment
Coherence vs Relaxation
Sustain Coherence

27. The Power of Coherence Anger Relaxation Appreciation Seconds 60 12060
120
180
240
300 50 70 90
110
130
150
100
600
700
0.05
0.15
0.25
0.35
0.45
Frequency (Hz)
Anger
Relaxation
Appreciation rr rr
The traces on the left are HRV data taken over 6 minutes during 3 different states or moods: Anger, Relaxation and Appreciation.
While we expect the average heart rate to be slower during relaxation and the heart rhythm to be more coherent during appreciation there’s another way to see how different these 3 states truly are. What’s interesting is how different relaxation is from appreciation when you look at the graphs on the right side.
The right side of the slide shows what’s happening to the two branches of ANS.
Scientists know that the left end of the x axis represents sympathetic activity while the right end represents parasympathetic. During anger there is increased activity in the sympathetic range; in the parasympathetic range during relaxation. Neither is surprising when you look where each state lands on the Grid. But Appreciation shows a peak in the middle of the axis which denotes synchronization between the two systems.
And a higher more powerful peak (y axis is 700!). This shows us that when the two branches are working together, like everyone in a tug of war pulling on the rope in unison, it’s more efficient and powerful.
Fade to black.
No worries if you don’t understand all this. The take home message is: Relaxation is a very different physiological state than the one created by sincerely feeling a positive emotion. Let’s learn how to make this coherent state the standing wave for your nervous system.
© 2007 HeartMath LLC

28. Heart Lock-in® Steps Shift Activate Sustain
Animated slide switches from full to quick steps.
Generally speaking the goal of the Heart Lock-in technique is to sustain coherence. It builds on the Quick Coherence tool. Practice helps your system become more familiar with coherence. Not only can it rejuvenate your nervous system, it enables you to get coherent more easily when you need it.
For the most powerful impact HLI should be done minutes every day, or at least 3-5 times at week.
Read slide:
Step 1. Shift your attention to the area of your heart and breathe slowly and deeply.
Step 2. Activate and sustain a genuine feeling of appreciation or care for someone or something in your life.
Step 3. Send these feelings of care toward yourself and others.
When you catch your mind wandering, gently focus your breathing back through the heart and reconnect with feelings of care or appreciation.
After you’re finished sincerely sustain your feelings of care and appreciation as long as you can. This will act as a cushion against recurring stress or anxiety.
Ask for and answer questions.
All you have to remember is, click Focus. Where? Appreciate. How? Sustain. What?
Some find that music designed to facilitate your focus and a positive emotional state during the HLI helps practice the steps. We all know that music affects us in a variety of ways. Certain musical phrases have a specific effect regardless of race or culture. HeartMath research supports this specific music’s effectiveness in promoting coherence. People just felt better when they listened to it and didn't know why. However, the point of the Lock-in is not to focus on or listen to the music but to use it as background. Ask for and answer questions about the steps.
Play track 1 or 2 while people practice the steps. Do not talk while the music plays. When the music stops, ask: What do you notice mentally, physically and emotionally? List on flip chart. What you’ve defined is coherence and how it manifests in your system. Do any of these relate to anything else we talked about today? Was this a peak moment?
How many of you felt energized? How many relaxed? That’s why this technique has benefits when done first thing in the morning and the last thing at night. It’s all about balance. And sometimes balance means speed up while other times it means slow down.
Let’s review what we’ve learned today.
Shift your attention to the area of your heart and breathe slowly and deeply.
Activate and sustain a genuine feeling of appreciation or care for someone or something in your life.
Send these feelings of care toward yourself and others.
Shift
Activate
Sustain
© 2007 HeartMath LLC

29. Josh and Mabel
© 2004 Institute of HeartMath

30. Josh enters room and loves Mabel
A Boy and His Dog
(Heart Rhythms)
Mabel
(The Dog)
Heart Rate (BPM)
Josh and Mabel in separate rooms
Josh enters room and loves Mabel
Josh leaves room Mabel wants him to stay
Josh
(The Boy)
Heart Rate (BPM)
Time (minutes)

31. Rescuing Hug
This is a picture from an article called “The Rescuing Hug.” The article details the first week of life of a set of twins. Apparently, they were in separate incubators and one was not expected to live. A hospital nurse fought against the hospital rules and placed the babies together in one incubator. When they were placed together, the healthier of the two threw an arm over her sister in an endearing embrace. The smaller baby’s heart rate stabilized and her temperature rose to normal.

36. STOP S – Stop T – Take a breath O – Observe P -- Proceed

37. TED Talk
schwartzberg nature beauty gratitude.html

38. May today there be peace within you
May today there be peace within you. May you trust that you are exactly where you are meant to be. May you not forget the infinite possibilities that are born of faith in yourself and others. May you use the gifts that you have received, and pass on the love that has been given to you. May you be content with yourself just the way you are. Let this knowledge settle in and allow your Soul the freedom to sing, dance, praise and love. It is there for each and every one of us.
Shared by Mimi Guarneri, MD
Interventional Cardiologist
May today there be peace within you. May you trust that you are exactly where you are meant to be. May you not forget the infinite possibilities that are born of faith in yourself and others. May you use the gifts that you have received, and pass on the love that has been given to you. May you be content with yourself just the way you are. Let this knowledge settle in and allow your Soul the freedom to sing, dance, praise and love. It is there for each and every one of us.

39. Questions

40. Credits Jon Kabat-Zinn, PhD – U Mass Peg McEwen, APNP – TCBH
Lee Lipsenthal, MD
Al Bellg, PhD