Practicing Stillness
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[00:00:00] Kara Wada, MD: Welcome back everyone, and welcome to our new listeners to the Becoming Immune Confident Podcast. Dr. Kara here, and I am so excited. I love welcoming colleagues and friends and guests onto the show, and this week we have Dr. Nissa Keyashian. She is a psychiatrist. She works in private practice in San Jose, California, but she's also the author of the book Practicing Stillness, which is a lovely introduction to meditation and yoga with psychotherapeutic principles weaved throughout the writing.
She's also a yoga and meditation teacher and a life coach, and I am so excited to get to talk and learn all about what you're doing this morning. So Dr. Nissa, how did you end up in doing the work that you're doing?
Introduction
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[00:00:56] Nissa Keyashian, MD: Yeah, so when I was in psychiatry residency, I had started meditating and doing yoga, and there was a psychologist at the VA that I was training at who was leading an MBSR group, a mindfulness-based stress reduction.
Yeah. Are you familiar with that?
[00:01:15] Kara Wada, MD: Yeah. But maybe we can talk about it more for those of our listeners who maybe aren't.
[00:01:21] Nissa Keyashian, MD: And so he was leading an MBSR group and I was so excited by that and I kept sending him all of these patients and he was like, "Oh, thank you so much, do you wanna come and join?"
And I was like, "Yes, I would love to".
And so I went and I did the group with him. And really just fell in love with incorporating mindfulness into my practice. And then I subsequently did a mindfulness clinical training program that he and this physician at Inside LA, which is a mindfulness center in Los Angeles.
They led this program together, and I did that program and I have been using mindfulness ever since.
Basics of Mindfulness and Meditation
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[00:02:10] Kara Wada, MD: So maybe we can start with some of the basics. I know for instance, I am always harping on my poor mom about, "Mom, you need to work on meditating, you need to work on mindfulness". And she will just tell me, "I can't".
So how would you talk to my mom or, a patient that says, "I've tried that. I can't do it"?
[00:02:31] Nissa Keyashian, MD: Yeah, so a lot of times people think that they're meditating wrong, and there's this saying that any meditation is a good meditation. So if you make it to your meditation chair or your cushion and you sit for two minutes, that is a success.
So a lot of people are like, "Oh , I'm bad at this. I can't clear my head. I have too many thoughts."
And that's great.
Our mind produces thoughts like our mouth produces saliva. It's not like you're doing anything wrong. Meditation isn't about not thinking at all. It's just about changing our relationship to our thoughts.
And so if you think the entire time that's okay with practice, you'll start to realize. And then when you realize that you've left your focus of meditation, whether that's your breath, or sounds or whatever focus you're using, you just gently and kindly come back to that focus. And that principle of beginning again is one of the most healing principles in meditation.
[00:03:42] Kara Wada, MD: So the take home message, you can't get it wrong, just like there's no dumb questions.
[00:03:49] Nissa Keyashian, MD: Exactly.
[00:03:51] Kara Wada, MD: Probably more true than that though.
So maybe we can talk a little bit about where mindfulness-based stress reduction kind of fits into this paradigm then.
[00:04:02] Nissa Keyashian, MD: Yeah, so MBSR was one of the first mindfulness clinical tools. It was developed by Jon Kabat-Zinn back in the seventies. And so a lot of the research data that we have hails from MBSR, and basically it's an introduction to mindfulness.
We go over a lot of like mindfulness of breath, mindfulness of walking. We also do body scans which have a lot of the data and people that have pain, but then also mental health and other medical issues. And there have been many other clinical mindfulness programs developed since then.
But that was like the original clinical mindfulness tool.
[00:04:49] Kara Wada, MD: And what sorts of like outcomes have they looked at? For the benefits for mindfulness and for MBSR in particular, maybe?
[00:05:00] Nissa Keyashian, MD: Yes. So they have looked at many different, you know, pain, asthma and then they've also looked a lot in education.
Like children's performance and then in mental health. Mindfulness Based Cognitive Behavioral Therapy. So MCBT has been found to be effective in depression. It also has evidence in anxiety as well. So they've looked, at a very broad range of different medical issues it sounds like too.
[00:05:38] Kara Wada, MD: As you talk about that. Going back to the logistics of how we're meditating, how we're bringing ourselves back to the beginning, restarting with gentleness and kindness. It sounds like there's elements of self-compassion that are woven in to these practices too.
[00:05:56] Nissa Keyashian, MD: Yeah, so in the mindfulness community, a lot of people say that if mindfulness is one wing of the bird, then compassion is the other wing and.
I'm not sure if you're familiar with loving kindness meditation.
[00:06:12] Kara Wada, MD: With Dr. Kristin Neff?
[00:06:14] Nissa Keyashian, MD: Yeah.
[00:06:15] Kara Wada, MD: Yeah. So really related things maybe.
[00:06:17] Nissa Keyashian, MD: Yeah. Sharon Salzberg is a mindfulness teacher, and she really brought a lot of loving kindness meditation to the west, in loving kindness meditation, we offer phrases of loving kindness to ourselves, a loved one, a neutral other, and a difficult other. And Kristin Neff, who developed a lot of like self-compassion meditations that are used in like research and clinical settings. She developed a lot of that from loving kindness meditation.
Self-compassion meditation is like practicing loving kindness for yourself.
[00:06:53] Kara Wada, MD: Neat. How like it's, as you get into this area, it's like peeling an onion. There are all these layers. And we've talked a little bit in different episodes and different points about the idea of sometimes you don't know what you don't know, you learn a little bit and you realize how much you don't know.
Then you finally learn what
you know,
And then you can easily the whole like becoming unconsciously confident when you can just do things and it's like a habit. But I feel like I continue to find myself in that, like I'm learning what I, all that I don't know within this area which is super exciting place to be and to try to stay into that like curiosity mode as opposed to "Ah, there's so much."
[00:07:46] Nissa Keyashian, MD: Yeah.
Yoga: Moving Meditation
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[00:07:47] Kara Wada, MD: How did you find how did yoga end up in your life?
[00:07:54] Nissa Keyashian, MD: So I started yoga back in college. I took this yoga class and I found that I kept going back to yoga at parts of my life and after my two sons were born in 2015 when I was trying to start exercising again after having babies, I decided to start going to yoga and I have been practicing on a very regular basis since 2015, and I have been on several yoga retreats and I completed yoga teacher training in 2020.
Right now I am doing some advanced certifications and breath work, and restorative yoga, and yoga alignment and all kinds of awesome yoga practices.
[00:08:46] Kara Wada, MD: How often do you find yoga incorporated in one way, shape, or form into your clinical practice?
[00:08:56] Nissa Keyashian, MD: So a lot of times when we use the word yoga, a lot of times we're referring to the physical practice of yoga. There's actually eight limbs of yoga, and the physical practice is just one of the limbs.
There's ethical precepts, there's meditation, breath work, and ultimately enlightenment in yoga. And so a lot of the meditation, that I speak about is part of yoga as well. And then also yoga is this very healing way that we come into our bodies. So a lot of my patients have anxiety, and a lot of times the anxiety is really made worse by really just like spending so much time in their heads.
And so there's this very healing aspect of yoga when we become fully embodied and we're not just all above our shoulders.
[00:09:51] Kara Wada, MD: Yes, very intimately familiar with the being too much in my head and anxiety. Yeah, I can see that. I have not been, I've dabbled in yoga from time to time and never fully committed to incorporating it on a regular basis, but I can see where that would absolutely be the case.
[00:10:17] Nissa Keyashian, MD: It's like a moving meditation. And it can be really helpful with balance and bone density and strengthening. And also obviously the flexibility piece too.
[00:10:33] Kara Wada, MD: Yeah. All important things, especially I think doing a little bit of reading for a patient of mine who was recently diagnosed with osteoporosis and thinking about the need for strength training as we get older, especially in women.
And if you are dealing with any sort of ongoing inflammatory condition, a lot of times some of the medications that you'll maybe need as part of your treatment or to get inflammation to control can increase the potential for having osteopenia or osteoporosis so weak bones, essentially. Yeah. You don't want any broken hips.
[00:11:15] Nissa Keyashian, MD: Yeah, a lot of yoga. The balancing pose, like when you're on one leg or the other for prolonged periods of time, that really helps build bone.
Practicing Stillness
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[00:11:25] Kara Wada, MD: That's really helpful to know because we don't have to be necessarily jumping around or lifting heavy weights. Can you talk to us a little bit about Practicing Stillness? Kind of what brought you to writing a book?
[00:11:41] Nissa Keyashian, MD: Yeah, so I just have found these practices to be so helpful for so many people, and I wanted to write about like the easiest way to get started because like we were talking about before, a lot of people feel like they're doing it wrong or they're bad at it.
Another challenge that people have is that they wanna start with 30 minutes if they have no practice. It's so important to set yourself up for success. So really just two, maybe five minutes, picking the same time of day is really ideal, just like starting any new habit. And a lot of people will practice this like first thing in the morning.
You can even set your alarm for just like five minutes earlier than you otherwise would, and then just, go to the bathroom, take whatever medicine you need, and then just go to your meditation area and just set a timer for two minutes.
And some people prefer to do it at lunch. You can incorporate mindfulness throughout your day. Like some people practice, like every time the phone rings before they pick it up, they'll concentrate on their breath for a couple of breaths. Or right when you get in the car, you can focus on your sense perceptions like feeling the chair underneath you, feeling the ground under your feet. So just like weaving it throughout your day.
[00:13:08] Kara Wada, MD: And it sounds like you are using this habit stacking of being able to tie things to activities that you're already doing every day without any kind of conscious input. You're just adding or tacking on a little bit extra, but it's not too onerous, but you're actually moving the dial.
[00:13:31] Nissa Keyashian, MD: In the book, there are 50 practices and many of the practices are things that we do every day, like cleaning or cooking or going through our email inbox, so you really can weave mindfulness into everything that you do, and it can be very helpful. All right.
Mindful Cleaning and Everyday Activities
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[00:13:51] Kara Wada, MD: Talk to me about the cleaning part.
My husband and I, he is the more tidy of the two of us. I just have never found cleaning to be particularly like joyful or there is a little bit of satisfaction in having a clean countertop, but yes. Yeah, I'm all ears.
[00:14:11] Nissa Keyashian, MD: So what I recommend is, when you start cleaning, set an intention to be very present with what you're doing and you might wanna start out with five minutes or 10 minutes or 15 minutes and to be very present with activity.
A lot of times when we're cleaning, our mind is like a million other places. And that's so much of our life.
[00:14:37] Kara Wada, MD: Disappointment. Gotta like, oh shoot, I gotta change the laundry over yes.
[00:14:43] Nissa Keyashian, MD: And there's this principle, there's seven principles of mindfulness, and one of the principles is beginner's mind, which is a Zen principle.
Are you familiar with it?
[00:14:53] Kara Wada, MD: Yeah, it's like you're doing it for the first time.
[00:14:56] Nissa Keyashian, MD: Exactly. And there's so many things as an adult that we just totally zone out on 'cause we're like, oh, I've done this a million times before. I don't need to be present for this. But then that becomes a habit of absence in our lives where we just like zone out when, and then we start to do it when we're interacting with other people, our family, our patients.
So just practicing being fully present with what you're doing. And I actually started to find a lot more joy in chores after doing some silent meditation retreats because during the silent meditation retreats, we had jobs like whether it was like cooking or cleaning, and we wove the mindfulness into our jobs and so it just, it's just another opportunity to practice showing up fully in this like kind and gentle way for all of life.
So it's just like another opportunity to practice mindfulness. So now, one of my favorite things is like opening a pomegranate because it can, it's so involved, yes. And I love pomegranates and my boys love pomegranates. And I think before I'd be like, "Oh my God, this takes so long and it's so messy."
And we have all these narratives that add so much like suffering to our lives that we don't even realize. Yes. And now I just see it as like a meditation, like an opportunity for me to practice weaving mindfulness, like throughout my day, not just like in the formal seated practice. But also the informal practice.
Self-Compassion in Emotional Activation
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[00:16:33] Kara Wada, MD: I could see that taking shape in our house with mangoes. My kids love mangoes and typically I reserve the cutting and peeling of them to my husband. Like for whatever reason that just has been delegated to his area. I don't like that. My hands always get all sticky. I could see where using the knife and being deliberate about how I peel it and cube it like that could be very much in the zone and in that zen space.
[00:17:02] Nissa Keyashian, MD: Yeah. Yeah. And it's a way to slow down and show up fully present for our children, and it's fruit, healthy food.
[00:17:12] Kara Wada, MD: I would love to hear, are there other ways that you see meditation and coaching principals, mindfulness principals coming into your parenting with your kiddos? 'cause they must be seven or eight, I'm guessing. 'cause I have a baby that was born in 15 too.
[00:17:31] Nissa Keyashian, MD: So much. So mindfulness really helps us in conjunction with self-compassion. Notice, like when we're getting activated, and then practice being kind to ourselves, like a lot of us have this habit of like when we're dealing with these big emotions to be hard on ourselves or judge ourselves. Like, "why am I like this? What's wrong with me?" And then that resistance or judgment actually just further perpetuates our activation, and then sometimes we show up with that energy with our children. And so if you instead, like you start,
"Oh, like I'm tensing my muscles, like my mind is going quicker, I'm stressed".
Instead, maybe you practice the self-compassion break, and I'm not sure if you're familiar with that practice, but it's one of my favorites and one of the pieces of it is the soothing touch piece, which actually really soothes our nervous system.
So like placing a hand on your heart or giving your hands a squeeze or giving yourself a hug. And if you're with other people, you can just squeeze your hands in your lap and nobody needs to know that you're doing it. And then to say something kind to yourself, and my favorite phrase is, "I'm here for you".
Because a lot of times when we're dealing with big emotions, we abandon ourselves.
[00:19:00] Kara Wada, MD: Yeah. That tendency to lean back instead of what we really need is to lean in.
[00:19:06] Nissa Keyashian, MD: Yeah. Yeah. And then once we're calm, then show up for our children because when we are activated and then our children, they're really not going to hear us.
[00:19:19] Kara Wada, MD: We talked just recently on an episode that will actually come out tomorrow but was recorded a week or so ago, but about we've been having like lots of struggles of her food in particular with my five-year-old and her asserting her independence and she has particular flavors and things that she likes, of course.
And the one day, like I was really activated, triggered whatever word you wanna use and part of it we were feeding off of one another, those emotions and we just, we laughed. We went into a different room, we sat down and we did like some belly breaths and she was able to stop crying and it was one of those moments that I need to just continue to remind myself of, " Okay, I am able to do this in a different way. This is a win". And to realize that is a tool in the toolbox that we can come back to and really like... where I'm going with it is that like a lot of these different mindfulness, meditation, yoga related practices are all just other tools to have in our toolbox to help us through life's shenanigans.
[00:20:31] Nissa Keyashian, MD: Yeah, absolutely. Yeah. And I think we can bring these principles to so many different relationships. Like with partners, when we get activated.
How can we show up for ourselves and be kind and loving, and then get to a more grounded place and choose a wiser response.
[00:20:50] Kara Wada, MD: I go back to one of Brené Brown's questions that I remember her mentioning. I think she had said has kept her married, "What is the story I'm telling myself about the situation versus like the actual situation?" And that's something that comes up in coaching too and what are the stories our brains telling us about a situation versus the actual facts?
And that has that has helped me considerably. My dear husband is like doing something or another that I like for the life of me, can't like figure out. And the reality is typically his intentions are like always for the best of the family and very, he's a great human, but at the same rate, we're all human and yeah, human brains decide to do human brain things.
[00:21:37] Nissa Keyashian, MD: Absolutely. The stories that had so much suffering to our lives.
Integrating Coaching with Psychiatry
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[00:21:43] Kara Wada, MD: Yes. I'm curious with your background in psychiatry how did you find coaching and how do those two kind of work together?
[00:21:54] Nissa Keyashian, MD: Yeah, as part of my book, I came out with it last year. I had some marketing requirements with the publisher and I was trying to convince them to not have those marketing requirements because I found it so difficult to promote myself.
And they were like, "No, we need somebody that is going to do this". And I'm like, "Oh my God". And so it got time to that, those marketing requirements. And the first time I was discussing my book in like a professional setting, I was meeting with other therapists that work in my suite and I just realized that I was so struggling to promote myself.
And then I saw an advertisement for EWP, Sonny Smith's group and I, something in my heart was like, "Okay, this is what you need". And it helped me so much with that, and I've become so much more confident in marketing and promoting myself. And it was funny because when I started doing it, I was like, "But I'm not gonna become a life coach.
Why would I become a life coach? I'm a psychiatrist". And sure enough, I became a life coach. I loved the idea of being able, so there's so many parallels between therapy and coaching. And I liked the idea of being able to step out of the medical model and not need to be like diagnosing or prescribing and really just like focusing on the coaching piece.
[00:23:20] Kara Wada, MD: Yeah. Yeah. It's funny that parallel so much. I did EWP fall of 2021. I was pregnant with Oliver, my third little dude. And I knew from my other two pregnancies and maternity leaves that like I had this tendency to struggle with anxiety, depression, after, postpartum depre I never necessarily conceptualized it or medicalized it until like after the fact.
And I wanted to explore that and I found those tools so helpful just in being able to reframe. And so I spent my maternity leave doing coach certification. It wasn't the things that sometimes we do as doctor moms, but it was a nice, it was nice to have some adult interaction.
It was like weekly zooms where he could join and it was like, no big deal. 'cause he was, this like little newborn that was just eating, sleeping and pooping all the time. And it is interesting 'cause although we're both certified, certification, like really is this nebulous thing. But a lot of the tools are based in similar concepts that are used in CBT and other kind of modalities.
[00:24:38] Nissa Keyashian, MD: And you went through the life coach school. Yeah, so actually too, like I, when I first had exposure to the model in EWP, I was like, oh, this is just a lot of CBT and then when I started listening to Brooke Castillo's podcast, I actually realized that she drew a lot from some of my favorite spiritual teachers, like Byron Katie and Eckhart Tolle. And so there is the CBT part of it, but then also there's like a very spiritual part of it as well.
[00:25:08] Kara Wada, MD: And there are, I believe, several hundred of us now in the like physician coach space kind of forging our own path and this like hybrid mode and I find it interesting too because around the same time I found EWP I was doing lifestyle medicine like program, and they talked so much about coaching in like a health coaching paradigm, like within that training.
And so not only, do these similar principles help in regards to how, how we think about things how we approach the world, but also have some of those like practical aspects too of like behavior change and like moving the dial in our physical health as well.
And I don't know, it all goes back to I say this probably at least twice a day to my patients. Like one of the biggest disservices I think modern medicine did was separate the head from the body 'cause they're all one human
[00:26:12] Nissa Keyashian, MD: Exactly.
[00:26:13] Kara Wada, MD: But and to think that it would be separate is silly, but.
That's how I learned about it in these separate paradigms too. And then had to reincorporate it in the everyday, in the office and outside the office.
Where to get Practicing Stillness and connect with Dr. Nissa
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[00:26:26] Kara Wada, MD: So I would love, like where could people pick up Practicing Stillness? How can they connect with you if they're in, if they wanted to see you as a patient where are the best ways to find you?
[00:26:39] Nissa Keyashian, MD: So Practicing Stillness is on Amazon, so you can get it on Amazon. I know it's in some stores, but I think probably Amazon would be the best place to find it.
And my website is amindfulmd.com and I have a coaching website, coaching.amindfulmd and I'm on Facebook and instagram.
[00:27:05] Kara Wada, MD: Awesome. We'll make sure to link to all those, including a link for the book as well in the show notes and I am really excited to pick it up to read to recenter. I had been doing really well going into and even after we got home from vacation, and then I don't know what exactly happened, my morning meditation routine kind of fell off the way. So we gotta just re recalibrate? Yep. Yeah. Yep.
Yeah.
[00:27:39] Nissa Keyashian, MD: Just begin again.
[00:27:40] Kara Wada, MD: Begin again. I think that is a great way to end in saying that. We will just continue to begin again. Thank you so much.
[00:27:50] Nissa Keyashian, MD: Thank you.
[00:27:51] Kara Wada, MD: This was lovely and I can't wait till we connect again.
[00:27:55] Nissa Keyashian, MD: Yay. Thank you so much.
[00:27:58] Kara Wada, MD: Take care.
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