Nov 9, 2017

Interview Transcript

Dr. Jones: Uh oh, you're having a hot flash. That means you're not going to sleep tonight. Now you're getting sweaty. Now you have to go in the bathroom and wash your face and maybe change your shirt. You feel awful. This is Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah, and we're talking hot flashes on The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones, on The Scope.

Dr. Jones: We're not just talking about hot flashes today in The Scope. We're talking about the midlife transition with Dr. Lisa Taylor-Swanson, who is an Assistant Professor at the College of Nursing. And we're talking about what happens when you have a symptom, maybe it's a headache, maybe it's you're anxious, maybe you're not sleeping, maybe you're having a hot flash. Once you get ramped up and you're totally involved in that symptom, it makes you feel awful. And we know that for insomnia, cognitive behavioral medicine or mindfulness training definitely helps people get to sleep. But if you're in bed and you're saying, "I'm not sleeping. Oh my God, I'm not sleeping. Oh, I hate this, I'm not sleeping," then you are pretty sure not to fall asleep. So help us think a little bit about mindfulness training and how it might help in the menopausal transition.

Dr. Taylor-Swanson: Oh, I'm happy to do so. It's something I've thought a lot about because I think it's important to consider. When researchers were first investigating hot flashes, they looked only at hot flash severity and hot flash frequency. And over time, they started to ask about, "Huh, well, what about bothersomeness and interference?" And there's the question of, say, if I'm having a hot flash right now, I feel, "Oh, I'm getting warmer, I'm starting to sweat, this is a hot flash."

There's the question I have of, after you first perceive that, then there's the second piece of how you evaluate that. "Oh, no, now I'm in a meeting. I'm going to be all embarrassed. I'm going to sweat. I'm going to have to mop my brow. I can't think straight." So we can start to think about how we experience that symptom and then maybe catastrophize, "Oh, no, maybe these are more hot flashes than I should be having. Maybe something else is wrong with me." Or, "Oh, gosh, how is this going to be bothersome or interfering with my job?" Or what have you.

Dr. Jones: Right. So that word "catastrophizing" is such a great one. Because I think, as a woman, I catastrophize more than my husband. And I think my women friends catastrophize. Meaning, I have a joint ache, my joint aches, oh, it really hurts. That means tomorrow I'm not going to be able to work out, which means my back's going to hurt the following day, and I could have cancer in there, and then I won't be able to go play with my grandkids. And it's one thing after another, and then I really start to hurt.

But I think that there is, from the world of what we call mindfulness training or cognitive behavioral therapy, and you may call is something different, there's a way to just bring it all down, girl. Without alcohol.

Dr. Taylor-Swanson: Absolutely.

Dr. Jones: Just bring it down.

Dr. Taylor-Swanson: Yes.

Dr. Jones: So tell me about that.

Dr. Taylor-Swanson: Absolutely. So that bringing it down, so to speak, there's many roads to Rome. Definitely mindfulness-based stress reduction or MBSR, cognitive behavioral therapy. There's certain types of bodywork that have been developed where you see a massage therapist and they help you just to get out of your head really, to take some deep breaths, and be more in your body. There's some really beautiful research that's been done by Alan Fogel here at the University of Utah in psychology where he talks about cognitive self-awareness and embodied self-awareness.

So all of us do that, what you just described, Kirtly, of, "Oh, no, these symptoms," and, "What if I can't play with my grandkids?" To catch ourselves, that's the first thing. You have to catch yourself when you're doing that. And then to slowly try to take some deep breaths and come back to, "Oh, wait, that might not be it. I can be more embodied. I can just relax, feel my feet on the ground," and not spin in our heads.

Dr. Jones: Well, for many of my own symptoms and maybe for some of our listeners, I don't want to think about it. In fact if I have it, I want to ignore it. So I tend to, if I don't catastrophize, I'd say, "I'm ignoring this and I'm going on and doing my day." But this mindfulness process doesn't mean you ignore it either.

Dr. Taylor-Swanson: Absolutely.

Dr. Jones: So how does focusing on it make you not catastrophize? Wouldn't the best approach be, "I'm ignoring this. I am walking away and I'm starting to make cookies," or, "where did I put that bottle of wine?"

Dr. Taylor-Swanson: Absolutely. I think you raise a great point, and it's something I've wondered about as well. And what both the literature show and just my own experience working with these tools is that it's a different type of awareness. So, instead of that spinning and worrying and anxious and usually not breathing deeply, breathing from higher in the lungs and whatnot, from that type of appraisal you could say, to a type where you can relax yourself, calm yourself, and often just be more self-aware literally of, "Oh, actually, that pain I'm feeling, it's not so bad. I can breathe through this or I can do a stretch and help myself feel better."

And so it's like flipping a switch so to speak, from that, "Ner, ner, ner," worry, worry, worry, anxious, anxious to, "Oh, I can just be with sensation." Here it is, not judge it. That's actually, I think, the key, is to be aware and to not judge it, not to put that spin on it. Just, "Oh, here's that pain again or here's that hot flash again. But it's okay, I can just be with this and I can still go play on the floor with my grandkids," or something.

Dr. Jones: We actually have a program in the Department of OB-GYN using this very technique for people who have urge incontinence. So it turns out that urge incontinence is a common problem for midlife women. You got to go and you got to go now, and maybe you even leak a little. And, "Uh oh, I'm going to leak a little." Or, "Uh oh, I've got that urge." And it turns out that the medicines that you might take for this that we might prescribe are awful, because they cause dry mouth and dry eyes and people hate them. And they actually worked on mindfulness training or just mindfulness. Not really about urge, but just mindfulness training at large.

Dr. Taylor-Swanson: Wow.

Dr. Jones: And they found it worked as well and for longer than the medications we gave the people that hate it. So urge incontinence is something that happens at midlife, and so are headaches, and so are anxiety and sleeplessness. And so if many of these things might be amenable to mindfulness therapy or mind body . . . it's had a bunch of different names. Where do people kind of get this kind of training? And can you do it just once or do you have to practice it every day?

Dr. Taylor-Swanson: Right. Well, there's a lot of different options. One is to pick up a book or there's often like a six or eight-week duration workshop on mindfulness-based stress reduction and BSR. That's been highly researched out of the Church of Harvard as we talk about on your other shows.

Dr. Jones: Yes, we have. Right.

Dr. Taylor-Swanson: And really is safe, easy to use. And once you've had a little bit of information about it, there's YouTube videos, you name it, it's something you can practice in any moment.

I used to teach a class that was very well-received at the University of Washington for undergrads, and it was basically how to be less stressed out for the stressed out students. And I had guest lecturers come and talk about nutrition. I talked about acupressure, since I'm an acupuncturist. I had someone come and teach some mindfulness, yoga therapy, etc. And the best tool I learned all quarter along with my students was from a counselor. And he basically said to people, "Okay, if you're finding you're feeling stressed out, or anxious, or catastrophizing," all these things we've been talking about, "just notice it." And you can actually try this. Your listeners can try this at home right now. You can be in a meeting with other people. No one will know what you're doing, and there's three things to do.

One is to look very attentively at five different things, so notice the color, the texture, etc. And the second thing is to listen. Listen to five different things. So you might hear your own breathing, the person that you're listening to in a meeting. You might hear someone walking down the hall or shut a door, or if the window's open, you might hear cars driving by. But just to take your attention and slowly go from sound to sound to sound. And then the third thing to do is to touch, so you can scratch your head, you can rub your wrist. You can just put your hand on the table and feel, "Oh, this table's kind of cool compared to my wrist, and my hair feels a little dry," or whatever you feel. And what that does is it takes you down a notch, like we were talking about earlier. It immediately brings you back into your body, because you're looking, you're listening, and you're feeling, and you're not in your head, spinning. It's amazing.

Dr. Jones: Oh, those are very good suggestions. We've talked before on The Scope about taking a deep breath and how that's a phrase that's important in our everyday life. Our mothers told us to calm down and take a deep breath. But actually, taking a deep breath slows your brain waves down and it can be very helpful. So I think there are many places now where mindfulness training, you can do it online. There are groups within yoga centers that do this. Maybe, Lisa, you'll be starting when you get your practice going.

Dr. Taylor-Swanson: Absolutely.

Dr. Jones: You'll help us. I think the School of Nursing should have its very own for the stressed out faculty here at the School of Medicine and Health Sciences. So everybody who's listening, just take a deep breath, feel your seat in the chair, feel your feet on the floor, listen to my voice, and thanks for joining us on The Scope.

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