[00:00:00] Speaker A: Welcome to the Heart Rate Variability Podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness.
Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and Optimal HRV. Check us out at optimalhrv.com Please enjoy the show.
Welcome, friends, to the Heart Rate Variability Podcast. I'm so excited to welcome Dr.
Moss back to the program and Dr. McGrady to the program for the first time to talk about their new book, Pathways through long term health conditions, Lifestyle medicine to maximize your well being.
Not only was I thrilled, as somebody who's worked in public health and healthcare settings to to read this book, which as I told the authors and our guests today, that I highlighted a ton of stuff moving through here, I love how HRV is also integrated into this as well. So I am thrilled to have the authors of this book.
I hope that you will buy this book, if not during the podcast right afterwards because it was really, really well read and I'm excited to dive into it. So, Dr. McGrady, welcome to the podcast.
Let's just give, give our audience a quick introduction, a little bit about your background.
[00:01:38] Speaker B: Okay, so right now I am a clinical professor in the Department of Psychiatry at University of Toledo Medical Center. I've been here many years teaching in the School of Medicine, School of Nursing, Physician Assistant program as well.
And I also have a clinical, clinical practice in counseling and biofeedback.
But my earlier background is all in physiology and biology.
So when biofeedback started to increase in popularity and there were more availability of it then that was perfect for me because then I was able to connect my training in physiology to my training in counseling.
And so of course, most of the people that I work with are people who are suffering from various types of chronic illnesses, physical illnesses, and then with the, with the added burden of anxiety or depression or post traumatic stress disorder.
[00:02:51] Speaker A: Awesome. Awesome. Well, welcome to the show. It's so glad to have you.
Dr. Moss, you've been on the show. But, but for those that may not have listened, let's get a quick introduction of you. And somewhere along the line I know, how do you publish multiple books a year? So, so that is, that's the new question I have for you because I, I've got a little bit of a library going here, but the fact you published two great books this year is I, I praise you for that. My friend.
[00:03:26] Speaker C: Well, thank you, Matt. I, I will answer that first. And that is you get by with a little, a little help from your friends.
I've really enjoyed collaborating with people like Angelle McGrady and Patrick Steffen, producing some fascinating books Angela and I have written together, published. Whereas working with people like Patrick, he and I corel a bunch of gifted authors and then we heard them toward a finished book. But now let me introduce myself. I'm Don Moss.
I'm a professor at Sabrick University and dean of the College of Integrative Medicine and Health sciences.
I spent 40 years in clinical practice, much of that time working with people who were kind of caught between medicine and psychology.
They had physical symptoms, some of them directly, directly stress related, some of them very obscure, funk what we call functional disorders that medical testing doesn't show anything definitive. And yet the symptoms are very real and painful.
So I became interested in biofeedback already in the 80s, got into heart rate variability as soon as Dr. Paul Ehrer brought that modality from Russia to the U.S.
i've done other mind body practices, guided imagery, hypnosis, and of course over the years noticed that I could help people.
And then they would come back in my office six months or a year later because their symptoms were back. And we start looking at lifestyle and the conditions of their everyday life, which are undermining all these wonderful skills that mind body practices give them.
So somewhere around 2010, Angela and I began collaborating.
This project was her idea. She had the initial concept of looking at the pathways, including lifestyle and health risk behaviors that led to illness or that made illness more chronic, and then looking at corrective pathways that would guide people toward better health, supporting behaviors and lifestyle that was more supportive of well being.
We put together some technical books for clinicians and I will mention those because there may be, yeah, there may be some clinicians in the audience who want to go back and read all of the heavily referenced discussions of the available research supporting this approach.
But we wrote a book called Pathways to Illness, Pathways to Health, published by Springer in 2013.
The second one in that series came out in 2018, integrative pathways navigating Chronic Illness with a Mind, Body, Spirit Approach.
And there we'd already had a lot of feedback, people telling us, hey, look at the research.
Spirituality is so important. Spiritual practices, having a sense of purpose in life, existential and emotional factors. You better put more of that in here. And we did.
We also paid more attention to complementary and alternative practices, everything from acupuncture to Reiki and Adding lots of references, Starting with that 2018 book, to the use of complementary and alternative practices.
Since then we've published articles and journal articles and book chapters on the pathways, examples, narratives describing how particular people with a lot of different disorders have utilized pathways. But this year we brought out the new book and the new book is, as you mentioned, Pathways through long term conditions Lifestyle medicine to maximize your well Being. This one is written for the patient who wants to direct their own care, but it also serves as a wonderful guide for a counselor who wants to work with a patient interested in self directed corrective practices that will support their well being.
[00:07:32] Speaker A: Awesome.
So Dr. McGrady, I would love that.
You know, Dr. Moss kind of gave you a little bit of credit for being the spark of the idea where you, you gave us a lot about your background. But where, where do you go from like studying this, working in healthcare to saying there, there's a model here that the, the world needs. I, I'm always curious to talk to folks like yourself as we, we need a model about this. So I, I'm, I'm curious where, where that sort of starts spark came from.
[00:08:03] Speaker B: Well, I think the spark came from sitting in darkened rooms with patients, you know, trying to learn to relax. And I noticed that these patients that are referred here because we're tertiary medical center, they were already getting medication. They already had a psychiatrist, they already had a cardiologist, they already had GI documentary, they had all of these practitioners, but yet they were still, they were still suffering. Right. They had some very good, they had some very good health care. They had some very good health care, physical and emotional. And yet they're still sitting in my office telling me that, you know, they can't cope and telling me that they're suffering and they're still in pain.
And so I actually started thinking that we should really go down to the very basic, most practical level, which I think, by the way, biofeedback is really good at, and to really start at the beginning. And then I asked the question, well, what is the beginning?
What is the beginning? And so over time then Don and I talked about these various concepts and say, well, we should come up with a model where you're actually starting at the beginning.
[00:09:29] Speaker D: Yeah.
[00:09:30] Speaker B: You know, so even though, even though they're already getting, you know, what in the book we call level three interventions, which are the ones, which are the ones where they're seeking professional care.
So often the basics are ignored.
Yeah, the basics are ignored. And that's how the emphasis came around also to lifestyle, which The American College of lifestyle medicine, the ACLM, has grown over the past 10 years to this huge organization, you know, that focused on the pillars of lifestyle.
[00:10:10] Speaker D: Yeah.
[00:10:11] Speaker B: So the pillars of lifestyle fit very well with, you know, what we're doing as biofeedback practitioners, what we're doing as counselors, psychologists.
So that's how it came to pass. You know, just sitting in that room listening to people and thinking, well, you know, what are they doing here if they're already getting, you know, expert, expert medical and psychiatric care and say, well, it's because we've missed a bunch of steps.
[00:10:38] Speaker A: Yeah, yeah, absolutely. So. So, Don.
Dr. Moss, I'd love for you to maybe give us one of the things I found really powerful about the model is the simplicity of it.
That it was like, I've got other books I need to go read. I know, I know that from the past catalog, but I love that, at least this being my first Pathways book, that I felt like if I was in a position with dealing with a long term chronic illness, you gave me the tools that I needed to really set goals and work forward. So, Dr. Moss, why don't you give us an overview of what the pathway model is?
[00:11:22] Speaker C: Well, thank you.
First of all, Angelle was just emphasizing lifestyle. And the first thing we do is an assessment in which the patient rates themselves in 10 different areas.
What is their emotional well being? What is their cognitive well being? What's their physical activity level? What is their nutrition like? What is their substance abuse, their use of substances in destructive ways?
How is their sleep quality? What are their relationship supports? Since we know that being socially engaged is a strong support for good health, even for people with an illness, what is their spiritual base?
And that runs everything from a person who has no religious background, who is yearning for some kind of meditation or looking for a purpose for themselves, to people who have a more traditional religious background and who may be conflicted. They're ill and they wonder if they did something wrong. Did they? Were they unkind to their mother and are they being punished?
So we address those things and then self management of the illness.
How much have they taken over a responsibility to do things themselves that will moderate their symptoms? And what is their readiness for change?
James Prochaska really popularized that concept. And we find that if a person isn't ready for change, we can waste a lot of time talking about lifestyle goals and they won't happen.
Or if we can find one little pocket of the person's everyday life where they are ready for change, we'll start there yeah, so that's the first thing we do, this lifestyle oriented assessment and then we go into the pathway levels and Jill talked about the very basics and we start with level one, very basic things. What can the person themself do? Small self directed changes in their behavior, can they sleep? Can they get themselves better sleep hygiene so they can fall asleep at night and be more restored in the morning. Or as one of my patients was doing, she was running a cosmetics business off her computer in the bed at 11 to 2 in the morning and then wondering why she didn't sleep or living on Red Bull all day and then little hard to fall asleep in the evening. So that's level one, identifying a patient's goal, not my goal, but the patient's goal. And with this book, many of our, we hope many of our readers will set their own goals and get started on a Pathway Level 2.
We are interested in people learning some very specific skills like autogenic training, paced breathing, heart rate variability, using let's say an inner balance or some other self guided program, the optimal HRV program for heart rate variability, but acquiring specific skills using educational resources, using online resources, now that there's so many available, using classes in the community.
I teach mindful breathing often in my very first contact with a patient. And level one might include some simple paced breathing, but level two, the person saying, geez, you know, I felt more mindful when I did that paced breathing, what else can I do? Well, there's some audio downloads from John Cabot Zinn or in my community, some of the churches twice a year will have a mindfulness class and the person can go and use those community resources. That's level two.
Level three, we keep going with all the self directed behaviors, the advanced skills they've learned, but we also began to help people find appropriate useful professional care, everything from acupuncture to medication. And there are, there are times when medication is the best intervention.
There are a lot of other times when some other form of treatment, physical therapy, biofeedback, heart rate variability, training by a professional.
That's level three.
[00:15:44] Speaker A: Great.
And so Dr. McGrady, I would love to as you developing this model, probably testing it out on the folks you were working with.
I mean one of the things that hit me is in typical western medicine, it's kind of been a theme of the podcast the last few episodes here is there's not been historically a lot of focus on things like lifestyle, healthy breathing, those sort of things that you bring in. So I'm curious as you have trained others and you have read books about this. Like, have. Has this changed how people approach their patients in providing care? And you can answer that from a systems level as well, because as you mentioned, it's not always just one person, but for a lot of people, it's maybe just one person that they're seeing.
[00:16:41] Speaker B: Well, one of the things that we've really focused on here in our department at the medical school is, of course, teaching medical students.
[00:16:51] Speaker A: Yes.
[00:16:52] Speaker B: And so we designed two colleagues that work very closely with me on these types of endeavors.
And one of the things I think answers your question is that we are teaching an elective in lifestyle medicine to the first and second year medical students.
And what's interesting about this elective is that the students set a goal for themselves and work through the goal with either myself for stress management or my colleague, Dr. Brennan for Nutrition, or my other colleague for physical activity.
And so they get to experience what it's like being a patient.
And the comments that we always get at the end of that elective is, oh, I think this is going to help me when I try to explain to a patient why their nutrition is so important.
All right, so that's a big part of what we're doing here to kind of spread the word to future providers.
All right. And. And we also have a board certification program here in lifestyle medicine for physicians and psychologists who are connected with the department of Family medicine. So again, that is training for the future and making a difference. Like you said, when these folks go out into practice, they will have this background. It'll be natural to them. They say, well, of course, somebody comes in, you know, with an anxiety disorder, of course I have to ask them about their nutrition.
[00:18:33] Speaker A: Right, right.
[00:18:35] Speaker B: So. And I think it's also made a difference in how I approach people and in the lectures, you know, that I've given at the institution. I'm sure Don has the same experience is that, you know, when we're providing lectures to the general public, than to change the way to change what they're going to ask for as well. Because there's two ends to this.
[00:19:00] Speaker A: Yeah.
[00:19:01] Speaker B: The provider has to be ready, and then the patient has to ask for something that may. They may have never asked for before.
[00:19:10] Speaker D: Exactly.
[00:19:11] Speaker A: Yeah, absolutely.
Dr. Moss, I'd love to just get your thoughts. And I'm always fascinated, as somebody who's studied human motivation, motivational interviewing, just sort of like the process that you have seen helping people work through these different levels of goals, because I love that strategy and how concrete it is of doing that. But, you know, there's all these different things and I would love to, like, what's it like to implement the level one, level two, level three, you know, kind of system with clients and patients.
[00:19:50] Speaker C: Well, I have to say that Angela and I are in some ways privileged because by the time patients are referred to us, they're often highly motivated to do something themselves because that's what they've been told we do, that's the kind of work we do. And they're frustrated because they've had 12 or 14 different medicines. Sometimes one of my patients had 28 medicines at the present, including overlapping medications that shouldn't have been given together. But they've had a variety of medical procedures, they've had a lot of medication and they're still suffering. So they're interested in what can, what else can they do. Now we still have to deal with the person who isn't fully sold that they have the power to help themselves.
Our colleague Dick Gewirtz has done a lot of lecturing on chronic back pain.
And he, he always emphasizes that the first step is actually to believe that I can do something and it will make a difference.
So the process you referred to motivational interviewing. And that's a tool that I learned a lot of what I do is, is health coaching.
I'm helping create a setting for the person to feel like they can set a goal, that I'm not going to set the goal and tell them what to do. They can set a goal. I might give them some ideas of options, but they're going to have to set that goal and then we're going to evaluate over the next month.
Is that goal working for them or is it the wrong goal for them? I've had a number of people who are overweight come in and right away they want to lose 40 pounds. And I always say that's one of the hardest goals. Let's, let's set that one on the side table and we'll come back to that one. I'd rather focus on things like what's your activity level, what kind of what, what's your nutrition like? Yeah, focus on some of those things that are the basic steps that are probably contributing to the other problem but are a lot easier to address.
So we really are looking at self directed activity. And the good thing starting simple is that it's not that difficult to practice breathing several times a week.
Every time I stop at a stoplight or stop sign that for that matter, I practice my paced breathing. Yeah, I, I get very mindful. I practice my Paced breathing and try to pay attention that when the light turns green, I'm still going to go.
But if a person practices their breathing, let's say four times a week, I'd like every day, but four times a week and they actually start to feel calmer within and they start to notice things that are impacting them more than they have in the past.
Suddenly you have that feeling of what we call self efficacy.
I'm doing something and it's making a difference and I can feel the difference. So we start with very basic things.
Activity is an area for a lot of level one goals. But at, at level one we're not talking I'm going to run 10 miles. We're talking somebody who's been in a chair watching television all day because it hurts to move has makes the commitment. I'm going to walk to the rural mailbox out at the street every day or I'm going to walk with my daughter to a park which is three blocks away or in. One woman I worked with, she moved to music. She turned some nice melodic music on and she just moved. That was more movement than she'd had in a long time.
So we start with very basic things. And when they feel good, when there's something positive they experience, there's more motivation for moving on to that next level. Level two, where they might learn progressive muscle relaxation, mindfulness skills, guided imagery, things like that.
[00:23:50] Speaker A: Yeah, very cool. Dr. McGrady, I'd love there, there seems to be this movement now which, which I obviously been in the heart rate variability arena. I'm very fascinated with, about really understanding what a dysregulated nervous system does to our overall health. So, so I would love, you know, it's kind of maybe a little bit out of left field question, but with your expertise, I think you probably got a good answer for me.
You seem to be in some of the strategies that Dr. Moss has mentioned as well, doing things to help regulate a dysregulated nervous system if that accompanies or maybe underlying the chronic condition. And I would love for, since I got an expert on here, how do you think about helping to regulate dysregulated nervous systems as part of managing or even curing long term illness?
[00:24:49] Speaker B: Well, so yes, that is something that I deal with every single day.
Often patients will come in and they will be just focused on what's wrong with them.
Okay. And they have no really understanding of the broader concept of what dysregulation means. And that dysregulation, if you have a gi Issue, then dysregulation is. Is not only in your stomach, all right? It's everywhere. It's everywhere else.
[00:25:25] Speaker D: Yeah.
[00:25:26] Speaker B: Right. And I think the perfect example of that is actually the anxiety disorders, which just by definition, to meet criteria, you have to have some physiological dysregulation to meet criteria for an anxiety disorder. So that plays into panic disorder, generalized anxiety disorder, and phobia somewhat as well.
And so the approach, then, is to educate first to explain to them what the connection is between their multiple symptoms, if they have multiple symptoms, or the connection between the thing that they're totally focused on, which is, as one of our chapters, is actually the anxiety disorder chapter. The woman has very intense GI symptoms, and that was her focus, you know, since childhood. My stomach hurts. My stomach hurts. My stomach hurts. And so, you know, dealing with a patient like that in practice would be, okay, let's. Let's get her out of her stomach and try to get her into her head. You know, sometimes we have to do the reverse. They're too much in their head, and they're not in their body. You know, they've cut it off from the neck down.
Right. Okay. So we just had to do this assessment like Don was describing, and then see where they're at on these various modalities. And then I get a sense, you know, what do you want to accomplish?
And then you start, you know, making suggestions on what they could possibly accomplish.
And then sometimes, you know, sometimes they say, I can't do that. That never bothers me, because that relates to the fact that they feel helpless.
And a lot of times they've been trained to be helpless, because that's what our medical system does really well, all right, is take this medicine, take this dose. Don't take any more than this.
Don't take any less than this. Go for this kind of pt, don't go for that kind of pt, and so on and so forth.
Now, when they say, I won't do this, then that's a different story.
All right, That's a different story. But so many of them say, I can't do that. I can't do that. I can't do that. That never bothers me. We just kind of roll with it.
[00:27:54] Speaker A: Yeah, exactly. Exactly.
[00:27:56] Speaker B: But I think education is the key, because that's part of how they become empowered is to understand what's really going on.
[00:28:06] Speaker D: Yeah.
[00:28:07] Speaker A: And I found there's such a. Like you, there's so much power in understanding, you know, how many people have ever thought about their autonomic nervous system. I Mean, I think about mine every day, but that I'm an outlier. Probably all three of us think way more about autonomic nervous systems than the average person, who may not know there's even a parasympathetic and a sympathetic part of that or even heard the word autonomic nervous system. But, yeah, that. That. That is such a. Then why. I love the assessment pieces. You're getting to the lifestyle things as well. There may be trauma behind the ptsd, but as I've learned, if I'm not talking about healthy breathing, nutrition, movement, and sleep, the nervous systems that I'm trying to regulate is also. Or help them regulate is going to be continuously dysreg.
[00:28:59] Speaker B: I think that often. Often to the.
The actual major.
The actual major symptom is not even accessible to the person's conscious mind at that point. So the chapter that we wrote actually on ptsd, the person.
It's assumed. It's assumed that the trauma is one thing.
In that case, it was military service, and it turns out that's not the trauma at all. The trauma was not even accessible until years later, and then it was triggered by a specific situation. So that person was experiencing physical symptoms, and you kind of have to take them through the pathways. You're waiting for it to emerge. You can't force it.
[00:29:47] Speaker A: Right.
[00:29:48] Speaker B: And then once it emerges, then that's a crisis point.
[00:29:51] Speaker D: Yeah.
[00:29:52] Speaker B: And then you. You need professional intervention at that point to get them through the price. But the basic.
The basic levels one and levels two already in place.
[00:30:03] Speaker D: Yeah.
[00:30:04] Speaker B: So the person is able to deal with the crisis better than they would if they didn't have all this other training and intervention ahead of time.
[00:30:13] Speaker A: I love that. Dr. Moss, you got anything to add to that? Because I know.
[00:30:17] Speaker C: Yep, I will add something because the.
[00:30:19] Speaker A: Autonomic nervous system nerd category with all of us is. Well, well.
[00:30:24] Speaker C: And that's the other book I brought out last fall with Patrick Steffen, Integrating Psychotherapy and Psychophysiology.
Both Angelle and I bring a background in psychophysiology to this pathways model.
And angel gave you the obvious example of anxiety disorders where there's autonomic dysregulation.
But in fact, most illnesses, if a person is living with illness over time, in most cases, there's dysregulation.
And we see that as we look at the medical literature on heart rate variability.
Heart rate variability tends to be very low in people with most chronic conditions, whether it's diabetes, heart disease, chronic pain, or the psychiatric disorders.
Heart rate variability is low. Parasympathetic activation is low.
And when we are able to actually enhance that parasympathetic activation by up training heart rate variability, we get improvements in symptoms that we didn't even know were related to this.
You've also had Ina Kazan on your, on your podcast.
Yes.
Well, and Ina has emphasized the physiology of breathing.
[00:31:45] Speaker A: Yeah.
[00:31:46] Speaker C: And I've seen with some of my chronic pain patients, when I did an evaluation, I began to include a capometer every time because the majority of my chronic pain patients were hypocapnic. They were deficient in carbon dioxide.
[00:32:02] Speaker D: Yeah.
[00:32:03] Speaker C: So we train adaptive, healthy breathing and their pain symptoms are moderated. Doesn't necessarily cure them of whatever is originally triggered the pain, but the pain is moderated because they now have adequate carbon dioxide in their body.
[00:32:21] Speaker D: Yeah.
[00:32:21] Speaker C: So these very basic changes that we make at level one and level two often have really strong corrective physiological effects.
[00:32:32] Speaker A: I love that. So I've got a couple questions that I want to ask you both about this. Dr. McGrady, I'll start with you. So this is book number three.
You teach this as well.
How has your under. How has Pathways evolved for you over a decade plus now? And probably you could probably go back another decade as you were thinking about this and had had these pieces floating out there before they were a coherent model.
How has this evolved in your mind?
It's one thing to create a model, it's another thing to teach others to implement your model. So I'm just curious, how's Pathways evolved for you over these years?
[00:33:17] Speaker B: Well, my background was mostly science based and then with the clinical degree as well. So the first two books that we worked on together were really very heavily research based books. So those were totally for the professional audience.
And so it evolved from book one and then as Don described, and the second book, Integrative Pathways, added in a number of other modalities that we thought were important, but they also contained cases from our practices.
So there was always a focus on, well, what does the patient experience? And even in the strictly science chapters in the books, there's, there's examples in there of people. And by the way, we should state some at some point that the cases that are in these books are composites. So they are not a single individual.
It's all brought in from our practice, you know, different pieces of various patients that we've treated.
[00:34:29] Speaker A: But you, but as a reader, you did a great job as they, they, they. I feel like I have a relationship with the person that is the composite. So I just want to give you that feedback, even though it is. It doesn't feel like that.
[00:34:44] Speaker B: Well, thank you. Yeah, I appreciate that. Because we worked very hard about at that. We loved writing the cases, and we actually had considered, you know, in the old days, they used to be case books.
[00:34:57] Speaker D: Yeah.
[00:34:57] Speaker B: That were published. Well, probably that those aren't published anymore. But we actually considered that at some time just developing a case book.
So then, you know, book three, we finished the first two books for professionals, and then we thought, well, you know, we're living this every day with real live people.
[00:35:18] Speaker D: Yeah.
[00:35:19] Speaker B: So it would be.
It would be good to put a book together for people out there that were serving, essentially.
And then it's also useful for practitioners, because I think people reading the book will connect with the various characters.
Right. Even if they don't have that disorder. And that's a question that we're often asked. And maybe you're getting to that. It's like, why should people read the chapter on diabetes when they don't have diabetes?
All right. Because each chapter has a healing theme, what we call the healing theme, which is applicable to most other clinical conditions. Most other chronic conditions.
[00:36:07] Speaker D: Yes.
[00:36:07] Speaker B: All right. So the diabetes chapter, for example. Yes. It's about a patient with diabetes, but it really is also about how this person tries to make changes and the resistance that she meets because of the culture in which she is. Which she is living.
[00:36:25] Speaker A: Yeah.
[00:36:26] Speaker B: And the culture of the family.
[00:36:27] Speaker D: Yeah.
[00:36:28] Speaker B: So that can apply to a lot of other things.
[00:36:29] Speaker A: Absolutely. I think that was my favorite case, even though they were all good. I think that was because I've been so many times.
Yeah. The culture, stigma, all kinds of stuff that we may not. If you're not in health care, you might not think of driving health outcomes, but. Wow. Do they. And I thought you did a brilliant job of exemplifying that. That. That one.
[00:36:56] Speaker B: Well, in the one chapter that Don wrote on irritable bowel, they say, well, I don't hear irritable bowel. Why should I read that chapter? But it's really about embarrassment.
[00:37:07] Speaker D: Yeah.
[00:37:08] Speaker B: And embarrassment of having a condition.
And, you know, he could say some more about that. But, you know, the embarrassment leads to avoidance, leads to social isolation, which, you know, is one of the pillars of lifestyle medicine.
[00:37:22] Speaker A: I love that. I love that. Don, what about you? I'd love to know how is your journey with pathways as it's evolved. I just love to hear your experience now getting. Having published the third book.
[00:37:36] Speaker C: Well, I appreciate angel bringing up the. These healing themes, and that's something we also Covered in this third book and not in the previous books. You know, human beings are not machines.
When we get sick, it's not just an objective set of symptoms. We feel, we, we hurt, we're afraid, we're discouraged, we lose hope.
And these emotional experiences are incredibly important for the possibility of recovery.
[00:38:08] Speaker D: Yeah.
[00:38:08] Speaker C: Because if I. If I remain so discouraged, believing that there's nothing, there's no hope. I've already seen nine doctors and none of them helped me.
Then I began to feel the doctors don't care. They would have helped me.
And now they're sending me to a shrink, somebody who, they think that this is imaginary.
They're not going to help me. There's nothing I can do. They want me to make changes, but it's not going to make a difference. We have to address that.
[00:38:38] Speaker D: Yeah.
[00:38:38] Speaker C: And we address it in the pathways model. We address it, as I said earlier, in very small ways initially.
Is there something you can do that will make a difference?
Something we didn't really strongly emphasize in any of the books is the immersion in nature. But some of that came out in one of the case narratives, this time in the third book. And this is important to me. I live in nature.
My house is on a sand dune in a pine forest across the street from Lake Michigan.
[00:39:10] Speaker A: That's awesome.
[00:39:11] Speaker C: And I've lived in this town now. I moved here from Pittsburgh where I did my internship at the University of Pittsburgh.
And I got here and took a job in community mental health. And one of the things that shocked me, I was meeting with people who were chronically depressed.
And I would say, well, do you ever walk the beach? Well, I haven't been to the beach.
You mean you haven't been to the beach lately? Well, no, I've never been to the beach.
[00:39:39] Speaker B: Yeah.
[00:39:40] Speaker C: Living in one of the most beautiful places in the world. I mean, we have greenways along the river, we have boardwalks along the harbor. We have beaches where you can walk for miles. And they've never been there. And I came to discover over time I can remember I hired someone and his family came along for. To wait for him while he worked. And I said, geez, take the kids across the street. The park is beautiful.
They sat in the car, the kids and the wife sat in the car and looked at their screens, their tablets.
And yet they were across from one of the most beautiful places in the world.
And that impacts. That impacts our well being. It impacts our soul.
[00:40:30] Speaker D: Yeah.
[00:40:31] Speaker C: So that's what those are the kinds of initial steps we have to make love that.
[00:40:36] Speaker D: Yeah.
[00:40:37] Speaker A: I love it. And just appreciating too the, you know, I mean if you live three blocks from a beautiful beach, that's one thing. But you know, being in Colorado and again I'm up here at 10,000ft enjoying the mountains and the 70 degree weather, you know, how many of the youth I worked with in their families had never been to the mountains, you know, even though, I mean in Denver you see them, you know, west is mountains. Like that's, you just become oriented to those and yet, you know, and some of that was the ability to get up there. But you know, then, then taking the youth to the mountains for the first time, it was a special experience because they'd never seen anything like it. Like it, it was just even like close up was spectacular. So I, I love that. I always like to say, hey, if you have a city park nearby, don't underestimate. I actually think there's something about walking out of an urban area into a park that is a special type of nature. Like even though you may still hear traffic, you just escape one world into another world, which you know, may be more powerful than Don, you and I being lucky enough to live in beauty and then go walking in beauty, still good for us. But that never underestimate the power of a city park as well.
[00:42:00] Speaker C: Well, at Saybrook University, I'm the dean of the College of Integrative Medicine and Health Sciences and we really challenge our graduate students. Sometimes they challenge us.
I've had nutrition students who say this integrative nutrition is way too important. It can't only be for the wealthy. Well, how are we going to make it available?
Yeah, to the underserved, the people in an urban environment where there's not even a supermarket nearby, where food comes from a convenience store at a gas station.
As you're mentioning urban green green areas.
La. I, I teach in Pasadena, I'm out in la. Griffith park is one of the most beautiful natural settings I've seen. Yeah, but how are we going to get people from a low income urban neighborhood to experience that park?
Yeah, the cities are doing a better and better job of preserving green areas and we have to find ways.
Immersion in nature shouldn't only be for the affluent who go to some spa in Colorado.
[00:43:06] Speaker A: Absolutely.
[00:43:07] Speaker C: It should be for everyone.
[00:43:09] Speaker D: Yeah.
[00:43:10] Speaker B: Some of these modalities that we're talking about, like enjoying nature, you know, and, and using that as a recommendation for a patient, it's connected to re regulation of the autonomic nervous system. Because there actually is some literature that supports that that Viewing nature will calm down the nervous system. And then the experience of awe, a u dub a w e will actually stop the stress response. So they've actually measured that. So when you have an opportunity, you're out in nature, you can't force awe, but awe may come around.
[00:43:51] Speaker D: Yeah.
[00:43:52] Speaker B: And then that will actually stop the. Stop the stress response.
[00:43:57] Speaker A: Regulate as a new student to pathways. That's where, where I believe with the. The level one goals, you can really bring up things that may not. I mean, I would imagine you two have been bringing this stuff up pro for, for your career.
But, but I think the typical, you know, physician assistant or nurse practitioner physician or even like a social worker who's. This person's not housed. So everything's got to be about getting this person housed, which should be a lot of the work. But, you know, understanding level one goals, because some of those might include safety, but some of those may be like, like I love just moving back and forth that that melodic movement is the next might be walking down to that rural mailbox eventually. And that's what, that's what I love about the model. It's, you know, kind of. I'm a big harm reduction person and I think sometimes we jump to too big of goals that seem unattainable to folks and this, this allows those little successes to build towards greater health goals as well.
[00:45:07] Speaker B: You know, and understanding, understanding the bodily rhythms is also really important. And that connects after level one or level two to the heart rate variability is the rhythms. You know, when they see the rhythm on the screen that makes. That makes a big difference. But they have to be prepared for that.
[00:45:31] Speaker A: Right.
[00:45:31] Speaker B: Because I never start with that. I have to start with giving them some sense of control like slowing down, slowing down your breath or being in the moment.
[00:45:43] Speaker D: Yeah.
[00:45:44] Speaker B: Because so often they say, well, yes, that was. I had a nice time over the weekend, but it went by too fast. They said, well, where was your head while your body was having a nice time?
And oftentimes their head was already on Monday morning going back to work.
[00:46:02] Speaker A: Yep, exactly.
[00:46:03] Speaker B: I think the principle of mindfulness that Don mentioned that again, that goes through all the levels.
[00:46:12] Speaker D: Yeah.
[00:46:12] Speaker B: But stopping time, I have found that that makes a huge difference for myself as well. I love that, you know, let's just stop. Let's just stop time.
[00:46:22] Speaker D: Yeah.
[00:46:23] Speaker B: And be in the. Be in this moment without letting yourself be distracted.
[00:46:28] Speaker A: I love that this has been. And I just got to say too, one of the things that I really have been obsessed about ever since finishing the book last week is I really think the assessment is such a beautifully done. I just wanted to give you that feedback of, you know, I think about the different professionals that I work with in different ways and I just think that along with the different level and goal setting is just a really beautifully integrated model that you've created here and very accessible I would say as well. So congratulations.
I think I know you've done a great service for us all with your work that you've done.
[00:47:17] Speaker C: So thank you. Matt. I wanted to make a comment on something that Angelle introduced a little bit ago.
She said that the person might think I'm only going to read the chapter on arthritis because I have arthritis. I don't have any of these other disorders. But every one of these case narratives includes some kind of self care practice, some kind of advanced skill that the person uses.
And most of these self care practices and skills are valuable across the spectrum. No matter what you're suffering with, even if you're, you're healthy, but you're suffering just life stress or work stress or relationship tension, these self care practices are still valuable. And we also include worksheets in the book for identifying emotional, un. Healing, healing problems. Emotional problems and then the healing themes, the healing pathways to, to address them.
So these things are valuable regardless of what you're dealing with.
Also want to emphasize the appendices to the book.
There's one appendix on self care skills with some handouts. Then we have an appendix which has online resources, websites.
I've done a lot of YouTubes that are free. They're available through my, my YouTube channel, Sabrook University Self Care Channel.
And those things are referenced in the book so that people can get a 15 minute exercise with meditation, a mantra meditation or a 15 minute progressive muscle relaxation or 15 minute breathing, guided breathing.
So there's a lot of resources today that are available and I, I love it when, when I talk to someone and they're seeking care, but they're already doing something like that for themselves.
[00:49:14] Speaker A: Absolutely. Absolutely. Dr. McGrady, I, I will kind of lead us out with this question. This has been a fabulous interview. So you've written three books, I, I think and correct me if I'm wrong. And Dr. Moss can jump in here too. If you're an individual managing a chronic health issue.
The new books, the book for you, I think I could say that and probably be correct. If I'm not, you can correct me. But what, what if I'm a mental health therapist or a medical provider? Where would you encourage me and in my pathways through Pathways.
Where would you. Where would you encourage me to start?
[00:49:56] Speaker B: So, as a practitioner, you mean? As a practitioner. Okay. Well, I think it's. I think it's very useful for.
For practitioners because as soon as they pick up one of the chapters and start reading the story, they're gonna say, oh, yeah, I've seen this woman, you know. Yeah, I've seen this guy. So I think that hopefully will help them be actually more efficient.
[00:50:24] Speaker A: Okay.
[00:50:24] Speaker B: Because sometimes, you know, sometimes we waste a whole lot of time delving into stuff with a patient. And then I think, well, you know, where did. How far did we get?
[00:50:35] Speaker D: Yeah.
[00:50:36] Speaker B: Instead of say, okay, well, where are they at?
Always start where the patient is. And I think we make that point. We make that point in the book. So I think that would be useful for practitioners.
And, you know, really, physicians in this day and age have a. Have a really tough life, you know.
[00:50:57] Speaker A: Yeah.
[00:50:57] Speaker B: I mean, you've got 8 minutes, 10 minutes, 12 minutes to assess somebody, come up with. Come up with some plan.
And I think reading the book and reading the cases will hopefully help them to, say, wealth, you know, I need to bring in a behavioral specialist into my practice.
[00:51:21] Speaker A: Yes.
[00:51:22] Speaker B: That is going to save me so much time.
So much time.
The structure of practices needs to change.
[00:51:32] Speaker D: Yeah.
[00:51:33] Speaker B: All right. And actually, our family medicine practice here at the university has changed, and they're still overwhelmed with patients, but at least they have a system there where they can follow a patient. Now, let's say the physician has the training in stress management.
[00:51:52] Speaker D: Yeah.
[00:51:53] Speaker B: All right, so that's fine. They can begin the process, but then you need to get feedback from that patient. How are you going to get it, and how fast do you need to get it? Fast.
[00:52:08] Speaker A: Yeah, absolutely.
[00:52:10] Speaker B: You got to have them checking in in two weeks. They can't come back to you in two weeks.
[00:52:14] Speaker A: Right, right.
[00:52:16] Speaker D: Thank you.
[00:52:16] Speaker B: So you need to recommend these resources, and then you need to have a system where they call in or they send data to the portal, and then the physician can review it and write back.
[00:52:30] Speaker A: Yep, absolutely.
[00:52:32] Speaker C: And there are more. Yeah, there are more and more programs like that in medical settings. My.
A family member was dealing with cancer and was assigned right away to a nurse navigator. And the nurse navigator hadn't, at that point, hadn't heard of the Pathways model, but was basically doing a Pathways job, putting people in touch with a variety of resources that would be helpful to them, as well as, you know, audio downloads, educational CDs on imagery for reducing nausea after chemotherapy, things like that.
Health coaches work in a lot of settings. There are a lot of nurse coaches, people who are trained both as nurses and in health coaching.
And the pathways model is a useful tool for them to work with patients. And I would recommend the new book, Pathways Through Long Term Health Conditions. I also would recommend the Integrated Pathways book.
You may want it. You may need to persuade some of the referring parties that this is scientific.
[00:53:34] Speaker A: Yeah.
[00:53:35] Speaker C: And the Integrative Pathways book includes more of that science. There's some of it in the new book, but it's all there in the Integrative Pathways book.
[00:53:45] Speaker A: Well, that gives us a good direction in my next read. So, Dr. Moss, Dr. McGrady, thank you so much for joining us. And thank you for our listeners for joining us as well. As always, we'll put links to the books and other resources about our great guests
[email protected] and as always, I will see you next week.
