Ep. 42 – Dr. Bal Pawa – Stress: Now Playing In A Person Near You
- ACE - Adverse Childhood Experience
- BMW - Breath, Mind and Word
- SODA - Stop, Observe, Detach, Affirm
In this episode, physician and author Dr. Bal Pawa is the author of the bestseller, The Mind-Body Cure – how we heal our pain, anxiety, and fatigue by controlling chronic stress.
Dr. Pawa describes that when we learn to name, tame and reframe the thoughts in our minds, we gain agency over much of our mental and physical health.
Dr. Bal PawaDr. Bal Pawa knows first hand why worry, fear, and negative thoughts lead to illness and why calming our mind is the single most effective practice we can pursue to restore balance to the body. At 32, a terrible accident altered her body, family and career. After seven years of chronic pain, anxiety and fatigue she went to Harvard Medical school and discovered answers for herself and for the thousands of patients she’s cared for since that time.
Dr. Pawa is the author of The Mind Body Cure; a comprehensive guide for understanding stress, wellness and healing. She’s now a physician with a focus on integrative medicine and cofounder of Westcoast Women’s Clinic in Vancouver British Columbia.
Transcript: Ep. 42 – Dr. Bal Pawa – Stress: Now Playing In A Person Near You
Rachel Cram – Well Bal, thank you so much for meeting today. I am so looking forward to this conversation.
Dr. Bal Pawa – Thanks for having me Rachel. Heard great things about your show.
Rachel Cram – Oh, thank you. Well, as I’ve been watching you over the last weeks in interviews and in your wonderful TED talk, and in reading your book, I have many questions and I know you have an abundance of responses and I think this is going to be a really informative interview.
Dr. Bal Pawa – Well, I hope so. I want your listeners to glean as much as they can out of this and I think you and I are going to discuss a lot of stuff today.
Rachel Cram – Some great stuff. That’s a good start. Well as I was preparing, I keep getting this visual of the lint drawer in my dryer, and RRSP contributions. There’s all these things that I didn’t know in life and then suddenly I discovered them and I thought, “Oh, my goodness, why didn’t I know this?”
Like, why did I not know that you had to empty the lint drawer after every load? Why did I not know that I was supposed to start making RRSP contributions way before I did? There’s so many things in life to know, and I feel like your book for Health, it’s this list of ‘these are the things that you must know to be able to survive and thrive in life.’ Yet we don’t.
Dr. Bal Pawa – You know, Rachel that filter in the dryer, I had no idea until I got married and it was full and I realized, “Oh, my God, we need to change this.”
But that’s a great analogy about the nervous system. It is so integral to our body and we all have one and we don’t have an instruction manual on the nervous system. So that’s what this book is about. To tell people, one, that they have a nervous system and two, how to use it to their benefit so it works for you, not against you.
Rachel Cram – Well, over this last year with the pandemic, obviously it’s ushered in whole new levels of stress. But even before the pandemic, we were at what many people were calling chronic levels of stress. And you even say, I’ve heard this in some of your talks, that “75 to 80 percent of the symptoms that come into a doctor’s office are related to stress.”
And I would say as an educator, the same is true in the classroom. I would say that probably 75 to 80 percent of the behavioral problems and the learning concerns that you see in a classroom are related to stress. And so this is such an important topic. But before we jump into that I like to start conversations on family360 with a question just to help listeners connect to you so we can connect before you direct.
Dr. Bal Pawa – Sure. That would be great.
Rachel Cram – OK, here’s the question. Aristotle stated, “Give me a child at seven and I will show you the adult.” And I’m wondering Bal, is there a story or experience from your childhood that has shaped the adult that you are today?
Dr. Bal Pawa – Well, you know, I immigrated here with my family to Newfoundland on the east coast of Canada back in 1967. And of course there were so many differences. But the one I remember the most, is sitting in a classroom, I was in grade two and there was a girl with very blond hair like yours sitting right in front of me, and I couldn’t speak a word of English, and her hair sort of fell on my desk. And first I just kind of gently touched it, but the curiosity was, “Is this real? I wonder if it’s attached to her head?”
And I gave it a big tug and she yelped and the teacher just looked at me and reprimanded me. But I just didn’t have the words to explain, I was just curious. I just want to know if it’s real. It was just like when you experience snow for the first time, that natural curiosity hasn’t left me. And I’m still curious to this day. And I think that’s what propels my passion and growth. I always ask questions and I want to know and I want to get to the literal root cause of the problem.
Rachel Cram – Where had you immigrated from?
Dr. Bal Pawa – From India. My father thought he was coming to the bright lights of Toronto and back then there’s no Internet. So he applied for the job and landed in this tundra and it was just middle of February and snow everywhere. It was quite a climate shock, a culture shock. But, it goes back to adaptability, resilience and the warmth that we received in the community and the way they embraced us. I think all those three components contributed to us making it a home here.
Rachel Cram – Well, I’ve never been to Newfoundland, but I want to go. It looks like a gorgeous province to explore.
Dr. Bal Pawa – It’s a beautiful geographical province. But you know what, the people are just so unconditionally loving and embracing and that’s still my home. It’s where my heart is and I’m still connected with all the people back there.
Rachel Cram – I love hearing that because, you know, there’s so many stories right now of where there is exclusion and us and them and people not having that kind of community. So we need to hear stories like that.
Dr. Bal Pawa – Yeah, it’s a wonderful story, and one of these days I’m going to write about it too. I have one more book in me.
Rachel Cram – You do. I know, and not just on Newfoundland, because you’re planning one more book about stress I believe, and I love the title, you’re talking, Mind Your Ovaries.
Dr. Bal Pawa – Yes. I talk to a lot of women, Rachel. So from ages 18, up to age 70, 75, and across the reproductive spectrum, we don’t realize how impactful stress hormones are to the ovarian tissue and the ovaries really react. So when we think about PMS, postpartum depression, PMDD, depression at menopause, our hormones are really powerful neuromodulators for women. So I think we need to have a conversation about that.
Rachel Cram – We do. And you and I need to have a conversation about that because that is exactly where my life is heading right now. I need to mind my ovaries. Perhaps that’s an overshare, but I am so looking forward to hearing other stories that you have to share as well. I know that you’ve had some very significant moments in your life that have absolutely shaped you, even in addition to those early memories. So I look forward to getting into that.
When I listen to you speak Bal, when I read your book. I feel like you are this wonderful mother wanting to scoop us all under your wings out of great, great care for humanity. It comes across with deep care connected to it. And I think that’s what makes it resonate.
Dr. Bal Pawa – You’re absolutely right. I am doing this as a passion project because I’m at the sunset of my career. I’ve been in practice for 30 years. My kids have left home. They’re independent. And I think the time was just right, not just for me personally, but I think people are ready to listen. They’re tired of just taking a pill for every ill. They’re tired of the list of drugs that they have to take and then deal with all the side effects. Right. I mean, antidepressants, sleeping pills, just the pandemic. Just look at the 40 to 50 percent rise in prescriptions for those drugs. Look at heartburn medication going through the sky.
People want a better, sustainable solution. And there’s no time like now to give them some tools to say, “OK, mental health is an issue and mental health becomes a physical problem. So what can you do? How can I empower you to do some self care?” So this is why it’s so important right now more than ever.
Rachel Cram – There’s a couple of reasons why I think your voice is particularly strong with this. One, because you are a medical doctor. Two, because you have experienced chronic stress in your own life, so you are speaking about this as someone who’s lived it and who has been changed as a result of these experiences.
I’m wondering, can you share a story that I know started when you were 32 years old and I know has changed your life?
Dr. Bal Pawa – You know there was a time that I felt very vulnerable to share my story because as a physician, you feel, “Wow, if she can’t heal herself, how is she going to heal others?”
And it happened at a time when I was at the pinnacle of my career. I was 32, had two kids, and I was pregnant with our third child. And as part of my general practice, I loved to deliver babies and I love bringing life into this world. And I had just finished doing a very difficult labor and I was looking forward to going home and seeing my own two children. I was driving home and I was literally hit by a truck and I was catapulted into traffic. And it was a horrific accident. And I was wheeled back to the same emergency I had just left an hour or two before that. And now I’m coming back, not as a physician, I’m coming back as a patient.
And that began a seven year journey. I lost my baby in the ordeal, I had PTSD from the accident because I kept reliving the accident over and over. I had multiple physical trauma, broken bones, a collapsed lung. And your body heals but in the seven years after multiple surgeries, many, many different medications, specialists galore, I couldn’t go back to doing deliveries. My shoulder was unstable. So I went to Harvard Medical School to learn how to do counseling on Mind/Body Medicine. And I met Dr. Herbert Benson, who’s a cardiologist. He was working on research for the nervous system; the way we function and how our body responds to the nervous system.
And it was just transformative, Rachel, because for me personally, I reclaimed my health and I was able to heal. He said, you cannot heal when you’re living in fight or flight. So my trauma, the emotional trauma, the physical pain, the chronic pain that I had was all keeping me stuck in fight or flight. And then he said, in order to heal, you have to live more in the parasympathetic system. That means put the brakes on. And he taught me how to put the brakes on.
So I had to really transform the way I was thinking, because your mindset becomes a victim mindset when you’re in chronic pain. And I had to do a lot of shifting myself to get back and reclaim who I was. And through that process, I was able to fully regain my health. I went off all the medication and then I co-founded a clinic that was integrative health, looking at hormone stress hormones, female hormones, and that was 20 years ago. And here I am. So I’ve helped to transform many other lives since then.
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Rachel Cram – Thank you for sharing that story Bal, I know it’s in the past, but I am sorry for your loss. At some time or another, we all encounter these moments in our lives, maybe not as dramatic as yours, but where everything shifts and life becomes complicated. And I think there is this tendency to fall into a victim mindset, as you said, an illness mindset instead of a health mindset?
Everybody has stress, how do we know that we’re dealing with the regular stresses of life or the more dire ones like you just described, how do we know if we’re dealing with it well?
Dr. Bal Pawa – That’s a great question and stress is pervasive and how we show up and manage stress is very individualized. I’ve had patients who’ve grown up on the streets, been knocked around. They’ve had so much stress but yet they’re very resilient. And then I’ve had other patients who went through a very pristine life without hardly ever a bump, and then they hit something and they fall apart. So where does resilience come from? And I think what we have to realize is that stress is either overt or covert. You can’t judge, you can’t look at somebody and say, “Oh, they’re stressed,” because overtly we know that divorce, we know that money matters, and health issues, and loss of a loved one, can all be stressful events. And we can all agree that that can be stressful. So that’s overt stress.
Rachel Cram – So overt means it’s clear
Dr. Bal Pawa – It’s clear to everybody else.
Rachel Cram – There’s tangibles in your life that are evidence of why you should feel stressed.
Dr. Bal Pawa – That’s correct. But the bigger issue is the colvert stress. So these are the sabertooth tigers that are in our head. We have to learn to tame those tigers. As human beings we embed a lot of trauma and suffering when we feel that we’re not safe or we’re not accepted. If we’re rejected, if we’re abandoned, if we’re lonely, if we feel jealousy, if we feel less than, if we’re not enough. All those fears, which are covert stressors, they travel on the same pathway as if your brain witnessed a saber tooth tiger. They still turn on your nervous system and you produce cortisol and adrenaline.
On the outside you might be this duck floating on a pond, very calm but underneath the feet are just going crazy. So a lot of people function like that. They look very calm on the outside but you want to know what’s going on covertly. And now we’re able to measure stress in different ways through functional MRIs. We can measure stressful thoughts. We can measure hormones of stress. We were not able to do that 30 years ago.
So now I can connect the science and the diagnostics with someone’s thought patterns and see that, wow, by thought alone, heart rate goes up, blood pressure goes up, they start to sweat, they go into a panic attack. By thought alone.
So this is what makes you realize that our thoughts are the language of the mind, but our feelings are the language of the body. And we’ve been focusing on feelings and trying to fix the feelings. We can’t fix how you feel until you heal what’s in the mind.
Rachel Cram – Where do those thought patterns originate?
Dr. Bal Pawa – Well, I think you have a background in early childhood education. And from zero to eight, we’re like a sponge. We’re taking in everything. The way your parents dealt with stress, how did they show up? What kind of home you were in. Did you have adverse childhood experiences? Were you abused sexually? Were you abused emotionally? Physically? Were you neglected? There are three kinds of aces, right? So you can have.
Rachel Cram – ACES, What do you mean by ACES?
Dr. Bal Pawa – Aces are adverse childhood experiences.
Rachel Cram – OK, and there’s three kinds of those. OK,
Dr. Bal Pawa – Yeah, there’s abuse, there’s neglect and then there’s household dysfunction. So abuse would be psychological or physical or sexual abuse. Neglect would be physical neglect, you’re not given proper food or clothing or shelter. And then there’s emotional neglect, you grew up in a very wealthy home, but the mother and the father are disconnected from you. As human beings were biologically hard wired to connect with other trusting adults and form stable relationships. So that’s a form of neglect.
Household dysfunction. You know, there’s divorce, there’s conflict, there’s violence. I have many patients who say, “Oh, my husband was abusive, but he never lifted a finger on the kids, he only beat me up.”
And I would say, “Well, the child witnessed that.” And so that’s a type of adverse childhood experience.
So when we have adverse childhood experiences, it actually causes changes in the child’s brain and they view the world as not a safe place, not a trusting place.
And so we know that ACE scores are associated with many diseases. Right. Autoimmune diseases, diabetes, long term chronic illnesses but it also is associated with mental health issues and repeating violence or substance abuse. So what can we do about it? This is the good news, is that neuroplasticity means that our brain is not concrete. It’s open to new neural circuits. But what we have to do is rise above all the conditioning and the trauma and reach a better place of consciousness.
So we have our conscious and a subconscious mind. Our belief systems and mindsets are formed by the subconscious but if you want to make some changes, you have to stay awake and say, am I just a product of my past? Am I a product of my conditioning? And you start catching yourself in your thought process and you’re able to create new neural circuits using some of the formulas that I’m going to teach you today.
Rachel Cram – Well, and with those formulas, especially for someone with a high ACE score, you can wonder, “Is this going to be too hard? Will I have the capacity to do this?”
And you say, “Simple, realistic changes to mindset and lifestyle can bring positive changes to your health right now.”
And I am just so excited for you to bring this forward because they are simple. They’re not necessarily easy, but they are simple.
Dr. Bal Pawa – They’re simple, but you have to be consistent and habituated to it. So maybe we should talk about the difference between the mind and the brain at this point.
Rachel Cram – Yes. Please do.
Dr. Bal Pawa – So think about the brain. We can take a CAT scan of your brain. And when I was doing anatomy as a medical student, we could dissect the brain. It weighs about three pounds. It feels like tofu. It’s a big glob of fat. But underneath all those layers there are millions and millions of neurons that wire together and form neural circuits, and these are our patterns of behavior that we’ve embedded.
And so we know that the brain is in the head but where’s the mind? The mind lives everywhere. It’s your consciousness. And your mind is like the programmer, it sets the program and then your brain plays the program and your body is like a display monitor.
And as physicians, we just look at the display monitor. “Oh, Mrs. Smith, how are you feeling today?”
“I’m tired. I have insomnia, my legs hurt.”
She’s telling me how she’s feeling. But if I want her to change how she’s feeling, I’ve got to go back, put in a new program in the brain and who puts in the new program? The mind. The mind is your consciousness.
So if we can learn how to tap into our consciousness, the ability to think about what you’re thinking. Well, that’s metacognition. The ability to think about what you’re thinking. So if you can tap into that through some techniques I’m going to show you, that’s when you can rewrite a new program and embed that program and do it over and over until you form new neural networks that change your habits, your behavior, the choices and the decisions and ultimately your feelings, the way you feel.
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Rachel Cram – You have a title in your book. You say, “How to short circuit stress hormones and create a healthy brain.” And that’s what you’re describing there.
Dr. Bal Pawa – That’s what I’m describing. Yeah. Our brain is electrical. It’s chemical, it’s biochemical. It’s biological. There are so many aspects. And we can actually measure brain waves with the EEGs, we can measure neurotransmitters, we can measure how neurons fire now with functional MRI. We can see where blood flows with people who meditate. We can see blood flow going to separate areas.
People who are stressed, chronically abused, we can see that certain areas in their brain grow bigger than other areas. So, so much new data and new diagnostic technologies are emerging that we can now measure what we could never measure before. We always knew stress could cause disease, but now we see stress is made in the brain through the nervous system and it actually affects the very organ that originated the stress.
Rachel Cram – Humm, this is so fascinating. Bal, I wonder if now is a good time to move into your BMW? I liked how you started your Ted talk offering everyone a BMW. I wonder if that’s a good direction to head now, into your BMW mindful practice, how we prevent our mind from driving our brain around the bend. And I think realizing we have control over our thoughts and our minds.
Dr. Bal Pawa – Yeah, so Rachel, I think the thing that people need to know is we can name it, tame it and reframe it. And let me take you through that.
Rachel Cram – And what are we naming?
Dr. Bal Pawa – We’re going to name the thoughts. We’re going to be the metacognition expert and say, “OK, there I go. I observe it and I name it. That’s a fear thought. That’s a negative thought.”
So you name it and then you tame it. You tame it by using the BMW meditation. So meditation is the thoughtful act of creating order and when you look at our mind, it’s constantly going, there’s so many thoughts, but mediation is going to allow you to create that order. And what you want to do is engage three things. BMW. Breath, mind and word.
Rachel Cram – Ok, so breath, mind, word. I’ll be like your point monitor for the listeners. So ‘breath.’ How is breath important?
Dr. Bal Pawa – Breath is very important because it’s going to turn on your rest and repair. You inhale through your nose, you hold for five seconds and exhale through your mouth. When you do that slowly and deeply for about five minutes, your heart rate will go down, blood pressure goes down. The blood flow to your gut is better. The oxygen flow is better. So we know you’re in rest and repair. That’s the breath.
The M is the mind. We’ve got to get your mind to be calm and just focus on the breath. Don’t think about anything else, be in the present moment and just focus on the breath.
The W is a word. It really helps if you pick a word. It could be amen, or om, whatever resonates with you. And you say the word when you exhale. So you’re breathing in, holding for five seconds and exhaling through your mouth. And when you exhale, just say the word amen or om, whatever works.
Those three things together get you into the nervous system. That’s where you tame it. You’re now controlling your nervous system. Your nervous system is not controlling you. That’s the difference.
Rachel Cram – Ok, so just to clarify, you can let me know if I’m off track here. When a stressful thought is in our mind we name it; identify the thought. We tame it; use BMW, breath, mind and word to control the thought. So we named the thought, tamed the thought, and then how do we reframe the thought?
Dr. Bal Pawa – OK, so name it, tame it and reframe it, now you move to the next section.
Rachel Cram – If I can continue on as your point monitor Bal, you have another acronym for reframing our thoughts. SODA. S O D A. What’s the SODA technique?
Dr. Bal Pawa – Yeah. SODA’s wonderful. You can now lay down new neural circuits. You want new thoughts, new patterns, new decisions and choices. So you stop, you observe, you ‘D’ for detach from the fear based thought that you identified and ‘A’ is for affirming a trust based thought.
So it might be that, you know, you have a fear of walking into a room with strangers and you say, “Oh, they’re not going to like me.”
So you’ve got this, this fear. So a better thought that would serve. You say, “I am safe, I’m whole, I’m complete. I don’t need anyone’s approval.” Right.
So you use a different affirmation and you show up in the same situation but now your mind has shifted. You’re not in a fearful state, you’re in a trust state.
So that’s called the SODA technique. And you can use that for almost any situation because any situation is individually perceived and it’s not the actual reality, it’s just how you’re reacting to it. Right.
So name it, tame it and reframe it is something you can use in any situation. And it’s a skill that a lot of parents want to teach their kids when they’re young because stress is not going away. Stress is pervasive and what if we could teach our kids to do relaxation techniques when they’re very young? That would be a life skill that they could use and implement for the rest of their lives. Because stress is not going to leave them.
Rachel Cram – Yeah. You know what’s really interesting in schools right now, there are lots of changes that are happening to try and alleviate stress for kids. We’ve taken away grades. We’ve really changed how testing happens. We’ve changed how sports happens. There’s been elimination of a lot of competitions. And while part of that’s healthy and probably important, I do think what you’re just describing is that we need to know how to deal with the stress. Trying to take it away isn’t really the answer.
Dr. Bal Pawa – It’s not going to work.
Rachel Cram – So if I can just make sure that I’ve got this clear. So you’re saying when we feel stress, what we need to do is try and name it, name one of those thoughts, and there might be a lot of them I’m thinking in my mind when I’m stressed. And how specific do we need to get?
Dr. Bal Pawa – Just say that’s anger. That’s resentment. That’s guilt. That’s fear. That’s uncertainty. You know, that’s what you identified. Mostly it’s fear based.
Rachel Cram – OK, because often in my brain, there’s a lot of different emotions that are going on there. So we’re just trying to get one of them at a time?
Dr. Bal Pawa – Yeah, basically you’re recognizing most of them are fear or negative based. So you just say, “Ah, I see you. You’re a fear based thought. That’s anger. You’re angry because it didn’t go your way. So you recognize the emotion, you name it, and then you work on taming it.
Rachel Cram – Which is the BMW. Love that. I’ve always wanted a BMW.
Dr. Bal Pawa – That’s right, you get your body into rest and repair. Ok.
Rachel Cram – OK. And then you’re reframing it with “SODA,” S O D A.
Dr. Bal Pawa – So when you use the soda technique, now you’re not just going to be calm, you’re actually going to be different the next time you show up, because that’s what lays down the framework, is SODA technique helps you to put in new pathways. You’re creating a new program. Remember, the mind is the programmer and your brain is going to play a different program, a program of trust, not fear. So this is what we’re aiming for, is when we create resilient minds, we want our mind to create a program of trust, of safety, of feeling whole and complete.
And as I was saying, teachers and parents, you know, the newer way to impart some of these techniques to children is first working on yourself, doing the work so that when you show up as a parent or a teacher, you’re consciously role modeling. You’re showing up, you hear them and feel them and not just react to what they’re saying.
Rachel Cram – So how would that look different to less conscious parenting? Parenting without access to this knowledge?
Dr. Bal Pawa – Ok, let me talk on that a little more. So you as a teacher or parent will actually walk into a room, see a kid who’s taken a pair of scissors and cut his hair off. And immediately you might react and say, “Oh, my God, what did you do? You could have cut your ear off.”
Or the conscious parent might take a deep breath in, not worry about what other people are going to think or what might have happened and respond, not react and say, “Oh, this is really interesting. I’m curious, what were you trying to do here? What did you think was going to happen with those scissors?”
So you’re more inquisitive. So then that allows a child to say, “OK, I made the mistake.”
It’s not the parent pointing out the mistake. The child then realizes, “Oh, scissors have a consequence. The scissors cut off hair and this could last a long time, this mistake.” So they realized it on their own. So the consciousness that comes into parenting and teaching has to begin with the individual doing their own work when you show up.
Musical Interlude #3
Thanks for listening to family360 and our conversation with physician and author, Dr. Bal Pawa.
Our next release is the first of a 4 episode highlights series, starting with The Road To Resilience, our conversation with parenting specialist, author and Australia’s Queen of Common Sense, Maggie Dent. Join us!
And now back to our conversation with Dr. Bal Pawa who is about to describe how we begin to move out of anxiety and into calm by altering the depth of our breath.
Rachel Cram – So it comes down to how we breathe our way through the day and through the stress.
Dr. Bal Pawa – That’s right. You know, everybody thinks, OK, you’re born, you take your first breath and it’s automatic. And then when you die, you take your last breath and every breath in between, we call it life. And we breathe twenty three thousand breaths a day, but we don’t have to consciously think about breathing. If you tried to stop breathing, you can’t. Your autonomic nervous system kicks in. However, you can control how you breathe. And I had to relearn breathing. When I went to Harvard to do the training I had to learn it, that I was holding my diaphragm way up high because I was in chronic pain. I had a lot of pain from my neck and shoulder. I had the whole PTSD from the accident. And that makes you very, very hyper vigilant, alert. So your diaphragm is constantly living up high in your chest. Well, that sends a message to your brain saying, “Oh, we’re going to be attacked by a saber tooth tiger any second, be on alert.”
So I had to learn to lower my diaphragm, learn to take deep breaths and be very mindful when I was breathing. Breathing, which is so integral to life, that is what life is, when we have no breath, we have no life. Breathing is so important and if we can become more mindful of our breathing at every moment, we’re sending a signal to your nervous system saying, “We’re calm, we’re safe, we’re OK.”
But if we don’t breathe mindfully, the poor nervous system thinks you’re on alert. So a busy mom running around, you know, she got to go pick up the kids, get the groceries, pick up dry cleaning, pick up the dog. Well, that busy to-do list, our primitive little brain where stress is processed, cannot tell the difference between a busy to-do list and a saber tooth tiger chasing her. So it’s going to still produce cortisol and adrenaline and make her very edgy. Well, what does that do to the mom when the kid she picks up from school gets in the car and the mom is on edge and hyper vigilant and the kid says something, she reacts, not responds. She reacts right away. She’s already jumped the conclusion and figured out what she’s supposed to say or, she might have gone to the worst case scenario, catastrophizing. So this is why it’s really important as parents that we show up very consciously and say, “How am I showing up? Do I respond or do I react? Is my nervous system just automatically going into stress?” Because stress is automatic, but relaxation is not. It’s conscious. It’s something that you have to bring on voluntarily by using your conscious mind.
Rachel Cram – You talked about breathing in your diaphragm. Am I understanding you correctly to say that when you’re breathing in your diaphragm, that is when you’re living in anxiety, is that right?
Dr. Bal Pawa -Well, if you’re on edge, it was designed that when you were running from a tiger, your diaphragm would be riding up high. And if you’re shallow breathing, you’re only using the top part of your lungs. That’s what you do when you’re in fight or flight. You shallow breath.
Rachel Cram – So, how do you know if you’re breathing like that? How do you know if you’re shallow breathing and maintaining that kind of constant vigilance for tigers? Is that something we can feel with our hands on our chests?
Dr. Bal Pawa – Yes, you can. You can actually locate your diaphragm. When you take a deep breath in your belly, you should fill up with air. When you take a deep breath in, you should be belly breathing.
Rachel Cram – So when you take a deep breath in, your stomach should be going out.
Dr. Bal Pawa – Going out, yeah. So that’s one way.
Rachel Cram – And if your stomach is going in, when you breathe in, if your stomach is coming in, does that mean that you are breathing in your diaphragm where you don’t want to be breathing? Is that correct?
Dr. Bal Pawa – Where you don’t want to be breathing. Yeah, that’s more shallow breathing. So deep breathing would be belly breaths where your belly pops out. And also where are your shoulders? If your shoulders are riding high and you’re carrying a lot of stress, all these muscles around our chest, called intercostal muscles, they become very tight when you’re habituated to being in stress all the time.
So I’ll see patients and I’ll say “Take a deep breath,” and I really have to force them to open up their lungs. But if I just watch them, they’re using just the top part of their lungs and they’re very stressed and their muscles are tight. I can feel their trapezius and their intercostal muscles are very tight.
So we’ve become habituated. If you’re in chronic pain or chronic anxiety, you just learn to live like that. But we’re not living with true breathing. And oxygen is the drug of choice. That’s what we want for all our cells.
Rachel Cram – Yeah, yeah. This is so excellent Bal. “Oxegen is the drug of choice.” That’s a great line. Now, I know there is so much more you have to say on this and so people probably need to pick up your book but is there more you want to say right now on Name it, Tame it, Reframe it, or do you want to move on? Is there anything else you want to say?
Dr. Bal Pawa – I think it’s important for people to know that our brain will naturally default to what’s missing and the negative. We have a negative bias because that’s how we learn to survive as humans is always to look for what’s missing. So we have to consciously, you know, savor the good, take in the good, relish the good moments and celebrate the good moments, because that actually helps our neural circuits to become more resilient.
So if we’re trying to create resilient minds, which is the opposite of stress minds, then taking in the good is very important.
Rachel Cram – That sounds fabulous. I’d love to explore that with you. Now, you’ve got some techniques. I don’t know if that’s the right word. Some practices that people could consider in addition to BMW and SODA to help override that negative bias. Would you want to share what some of those are?
Dr. Bal Pawa – Yes, we’ll share a couple of them. As I say, our brain was designed to just live in the negative and always be hyper vigilant and default to stress because that’s how we survived as a species. So some people have cultivated gratitude, for example, or they’ve learned optimism. So optimism can be learned. So taking in the good is very important. If we want to create resilient minds, we have to teach people how to cultivate the good stuff. We gloss over the good stuff and we focus on what’s missing. We say, “Oh, you know, how was your day today?”
“Oh, you know what? The teacher yelled at me and then this kid knocked me over in the playground.” And the kid starts to realize that if he complains and brings home negative things, then the mother picks up on that.
Rachel Cram – Well, that’s true. Because how often when your kids get into the car and you say, “How was your day?” How often do they go, “It was glorious.”
Dr. Bal Pawa – Exactly. But if they’re modelled that at home, and if we as parents say, “Let’s sit and savor. You know what? We just had a really great dinner. Let’s just savor the moment.”
“Hey, how nice was that wonderful picnic in the park? Let’s think about that.” And on a multi sensorial level, use all your senses to take in the good. It’s called taking in the good. And when we do more, TIG, taking in the good helps to create a resilient brain. And then you get habituated to always savoring the good moments rather than amplifying the bad stuff.
So if you look at certain households, they amplify the bad stuff, right? “Oh, this happened to Johnny.” And the parents get caught up in it and it becomes a big drama. And what if they acknowledge something bad, of course, we don’t gloss over it, but we also equalize it by amplifying the good stuff? “Well what good happened today?”
So I got into practice with my children when they were young. I said, “Tell me five good things before you go to bed. What happened? What are the five things you’re grateful for? Or five good things that happened today?”
Rachel Cram – I’ve done this with my kids too. Sometimes they’re like, “Ah, Mom,” but I think I have done it without the full understanding of how that does habituate gratitude as you explain in the book, and how we can habituate optimism and gratitude in place of anxiety and worry. So, so important to know these things!
Now Bal, I know there is so much you can talk about and I’m whipping through my notes in front of me right now, knowing that we’re about to run out of time. Can we spend a little more time on our propensity toward a negative bias versus taking in the good? You have some very simple but intriguing practices for this and I know our listeners will really appreciate concrete examples.
Dr. Bal Pawa – That there are some things that they can do?
Rachel Cram – Yeah. I’m thinking of three in particular that really caught my attention. I have them highlighted here. They start on page 56 in your book. The first is Story, Savor, Smile. The second is Train Your Brain and the third is Neurobic Exercises, which I found quite fascinating.
Dr. Bal Pawa – OK, so those are great reframing techniques, as I mentioned earlier, we have a negative bias and we don’t spend enough time taking in the good way. So a way to take in the good is to amplify the story, to savor it and to smile. And what that means is, relive a good experience by using all your senses to remember it.
The sun was shining on my face. How did that feel? The grass was soft on my feet. There was a fragrance of lilacs close by. So all the sights and sounds of the story are embedded into your brain on a multi sensorial level. And just by thought alone, you can create a good feeling. Just by thought alone we can create stress and bad scenarios, by thought alone, we can create good scenarios by amplifying them.
The reason that we remember bad stories, things that happened in the past, is because our brain honed in on it. And when you’re reframing a story, it’s really important to amplify the good things and then taking the time to savor it. Savor it means, relive it over and over.
And smiling. Our muscles embed memory also. They did a study on depressed patients and just getting them to laugh at humor, showing them a funny movie and reminding them about laughter. Once they started, the facial muscles sent messages back up to the brain and reactivated good memories again about laughter and joy.
So it’s not just a mind body connection, but also a body mind connection. There’s a bidirectional flow between the body and the mind that our muscles also carry memory and they can help us to relive good things by using smiling as an example of a muscle memory.
Musical Interlude #4
Rachel Cram – I see a real importance in the way that we ask each other questions. We ask people questions that lead into the difficulties in their life, into the traumas in their life, because that’s kind of what’s interesting. That’s kind of how media works, isn’t it? They play the horrific because that’s what grabs people’s attention. And I think even just as parents or as friends or partners, remembering to ask about those beautiful experiences, because it is so important.
I think of when after a woman is given birth, it is a traumatic experience but you tend to need to tell that story again and again with all the senses. You just want to keep reliving it.
Dr. Bal Pawa – Yes, but the women interestingly enough, I used to do a lot of obstetrics and deliveries. So what’s interesting is they forget the horrendous pain. They forget all the trauma associated. Most women just remember holding that baby. And that’s why it’s beautiful. They go on to have another baby because imagine if they just remembered the pain and the difficulty. So it’s really important to say, OK, what was the good thing that came out of this? And that’s why I’ve reframed the accident as well. If I used to think about the accident, the loss and the pain, I could go into a bad place. But I now look at it and I’ve reframed it and I say, “I became a better parent. I became a better human being. And I definitely became a more comprehensive physician because I started to look at patients through a different lens.”
So I think something really good happened from something bad. And that’s an example of reframing and learning to savor the story. And you put it into a context that works for you rather than against you.
Rachel Cram – Well you know when you have those group discussions where people are sitting around and doing those get to know you questions, there’s a common question, “Tell about an experience in your life that really shaped who you are today.”
Very frequently people share something that was difficult at the time.
Dr. Bal Pawa – It’s actually really interesting you bring that up, because I was just recently speaking with another researcher talking about PTSD. And so they took assault victims and they said if an assault happened and that person was nurtured afterwards, if that victim was taken and given a lot of love and support and care, their brain did not remember the trauma as negatively as another person who got assaulted, but then weren’t listened to or they weren’t addressed. The trauma actually was deeper and had more stress producing hormones in those patients.
So parents and teachers who are around kids who just had a traumatic event in the playground, what they do with that event to frame it and put it into context is very important. If they provide the support, the safety, the security and say, look, you’re going to be OK, we got this, and we’re going to get you through it. That really helps to create resilience in the brain. So this is the new trauma informed therapy that they’re doing for bullying, for example, in schools.
Rachel Cram – Thank you for sharing that. I’m loving this. Again, so much more I could ask, but we’ll keep moving through these 3 reframing techniques. So with turning a negative bias into a positive perspective, you’ve just talked about ‘Story Saver, Smile.’ Then you talk about ‘Train Your Brain’ and you say, “At least ten times each day I try to become aware of my automatic pathways and consciously change my vocabulary if it’s negative.”
I found this very interesting.
Dr. Bal Pawa – So awareness is the agent of change Rachel. When we become aware of our inner dialog, we actually can go to high places. And I think for me, after the accident, the dialog was, this is hopeless. I’m never going to get better. I’m never going to be a doctor again. And I started to get into that negative bias mentality and they became habituation. Emotions became behavior patterns and that became my personal reality. What is personality? Personality is your personal reality.
And what woke me up from my personal reality was my daughter at the age of six, she was two when I had the accident, at the age of six she brought home this Mother’s Day booklet. And she said, “This is my mommy. She always has pain. This is me bringing an ice pack to my mommy.”
And I was devastated Rachel. I thought, “Oh, my goodness, my daughter’s going to remember this debilitated woman. That’s not who I am. And this is what she’s going to remember me as.”
And this is what propelled me to change my inner dialog. And I said, “I’ve got to be aware of what I’m thinking because this is what she’s seeing.”
So the awareness piece is very important. Be aware of what you think. And when you change your mindset, you change your health.
Rachel Cram – I love the detail you’re going into with us because I think it just shows how accessible this is. So I was going to do a quick recap. So you’ve talked about Story Savour Smile. You’ve talked about Training Your Brain, then you wrote about Neurobic Exercises. I found this one so interesting. Can you share the example about brushing your teeth?
Dr. Bal Pawa – Oh, I was talking about how our brain gets conditioned. You get up, you do the same thing every day. The brain, it’s an organ of efficiency, so you don’t even have to think about it. You just do it. But to shake it up a little bit and shake up your neurons, I say, “Look, just stand on one leg and brush your teeth with the other hand.”
Well, now the brain says, “Oh, what just happened here?”
So the neural receptors in your leg muscles sent a message up to the brain, “Oh oh, we have a new program. We’re taking a new route today.”
So the brain then has to think harder and create new neural pathways to embed that. So that’s why it’s good to change things up and not do the same thing every day. So neurobic exercises mean, ‘Challenge your brain, learn a new language, talk to different people, have different conversations, eat different foods, try stimulating different senses, your creativity or physically challenge yourself.’
So challenging your brain through diverse experiences helps your neural circuits to stay new and in growth mode. Otherwise they just become what we call patterns of recognition and that’s it. They’re the same old pathways. You do the same old things. You think the same thoughts and you get the same results.
So it keeps your brain very plastic when you introduce new experiences, new senses and new ideas. I like people who say, “I changed my mind,” because when you change your mind, that means you’re open and curious.
But when people say “No, this is the way it is,” they have a very fixed mindset, they don’t have a growth mindset. So a fixed mindset is the opposite of a growth mindset. Health mindsets are open and curious. They’re constantly adding new information and adapting to new experiences.
Rachel Cram – Bal, we’re going to need to wrap up this interview, because you need to go out with your husband for an anniversary lunch, I think, and we need to keep this in a time frame for the episode. So maybe I can just end with this as a last question. Knowing that around 75 to 80 percent of the symptoms that come into a doctor’s office are related to stress, when we have a symptom and we’re feeling like we need some medical help, where do we start? How can we be mindful as we step into that?
Dr. Bal Pawa – I think the most important thing is being aware, what’s your symptom trying to tell you. So is the symptom connected to a psychosocial event? Do you notice that you use your asthma inhalers more when there’s an exam or you have a deadline for work? So you start connecting your symptoms to your psychosocial environment, connecting the dots, and then you can see if you manifest stress in muscle tension or high blood pressure or gut issues. So making the connections is very important.
Number two is recognizing that you have an autonomic nervous system. It’s a very powerful apparatus with hormones and nerves.
And number three is that you have control to some degree over that nervous system. And when you can learn to regulate your emotions, you can learn to regulate your nervous system and thereby regulate some of your symptoms that you’re experiencing.
The father of medicine, Hippocrates, said “The most powerful forces of healing in nature are within us.” You have the best doctor inside of you. You have the best pharmacy inside of you. And once you learn to master your mind and then regulate your nervous system, then you can master your health as well.
And if we can teach that skill to your children at a very young age, that’s going to be the best gift you give them, that keeps on giving.
Rachel Cram – Bal, thank you so much for this conversation today. We have only started to scratch the surface of your book. In this conversation you’ve focused on Mind your Breath, but you cover so much more than breath. You write about Mind your Gut, your Heart, your Sleep. So I highly recommend listeners pick up their own copy of your book, The Mind Body Cure. This has been a really fascinating conversation.
Roy Salmond – Thank you.
Dr. Bal Pawa – And thank you to you both for having me on here. I really enjoyed it. Great questions.
Have a great rest of your day.
All right. And that’s a wrap.