Two holistic health practitioners at New York University Medical Center recently launched an innovative program to help staff and patients begin the practice of mindfulness. Mindfulness is the practice of moment-to-moment awareness. Mindfulness exercises can improve your attention span, mental clarity, memory, mood, and self-esteem. With regular practice, you can experience a reduction in anxiety, muscle tension, blood pressure, heart and respiratory rates.

Alex Tatarinov-Levin met recently with the founders of NYU's Mindfulness program,  Jackie Levin, RN, MS, and Tara Piergrossi, a Masters candidate in Public Health at Hunter College. Jackie and Tara talk about the concept of mindfulness and how to begin your own practice in this in-depth interview.

It’s All in Your Mind: an Introduction to Mindfulness

Alex Tatarinov-Levin: How did you get involved in the concept of mindfulness?

Jackie Levin: I have a master’s degree in holistic nursing, and as part of that I became interested in the practice of meditation. I studied mindfulness first with Jon Kabat-Zinn [Associated Professor of Medicine at the University of Massachusetts Medical School] and learned about his Mindfulness-Based Stress Reduction Program, and that became a foundation of my own personal strategy for becoming centered, focused and aware.

Alex: What kind of stress are you referring to?

Jackie: All types of stress are interconnected, so while we might see emotional stress manifested physically, for example, tense shoulders, aches, pains, and the beginnings of disease - we can also experience it emotionally through anxiety, lack of focus, forgetfulness, mood swings or spiritual distress, in which you don’t feel a connection to others or to a spiritual being.

Alex: Is mindfulness intended to relieve stress?

Jackie: No, but it can be a byproduct. Mindfulness is the moment-to-moment awareness of what is going on around you. It’s a practice of becoming more aware and awake. So many of us are spending most of our time distracted, consciously or unconsciously, thinking about memories of the past or worrying about the future, but the only moment that really exists is this one. The practice of mindfulness helps you become a better observer and non-judgmentally aware of what’s going on in your environment.

Alex: What’s the importance of non-judgment to mindfulness?

Tara Piergrossi: You’re not trying to change the moment, just to accept it without judging it, and without trying to hold on to it or labeling it as good or bad.

Jackie: Your judgment says,if I were to see a dog going down the street and as a child I was bit by a dog and maintained that fear my whole life, I would see that dog as threatening.So is that dog threatening? I don’t really know, but if I take a moment I can become a non-judgmental observer of the dog walking down the street, I can then better understand if that dog is a threat or not, and whether I should turn and run or whether I could actually stop and pet the dog.

Alex: What if I’m restless or have trouble clearing my mind for five minutes?

Tara: Then you’re probably normal.

Jackie: Yes, very normal. You’re not trying to clear the mind; you’re trying to wake up the mind. We think our minds are awake, but mostly they’re asleep to what’s going on.

Alex: So mindfulness helps you step back and assess each situation on its own merits?

Jackie: Yes, that’s it. Each moment is unique. It doesn’t mean you don’t have memories and it doesn’t mean you don’t utilize those memories to make current analyses but you’re not letting those past memories dictate your current experience.

Alex: Is there a relationship between mindfulness and meditation?

Jackie: Mindfulness is a type of meditation practice.

Tara: You can sit in meditation position and notice your thoughts. So thoughts come in, you notice them and just go back to your point of focus, whatever it is, and you do that as many times as you need to, without judgment.

Alex: So it’s intended to help you make sense of your thoughts?

Jackie: Most of the time, we’re not aware of what we’re thinking. Those thoughts are just having random effects on us. So if I stop and I just sit there, I see sometimes I have a repetitive thought. Which means I can begin to attend to it and say, oh, that’s a worry I didn’t realize I had, and what is it I’d like to do about that? Is it really as big a problem as I think it is? So you can begin to discharge some of the tension through natural stress reduction and observe it. And you develop a compassion for yourself—a softness. Saying, oh, I did something I wasn’t so happy about. Most of the time, we end up being hard on ourselves. In mindfulness you’d be able to say, well, ok, I can now see how I did that in a clearer way, and I have lots of options and choices now. I can go talk to that person, I can redo the situation, I can get more information.

Alex: What other benefits are there to mindfulness?

Jackie: In the mental realm, it can increase focus, memory, clarity of thought. In the emotional realm, it can improve your mood. In the relationship realm, it can improve how you connect to others. In the physical realm, it may lower your blood pressure and regulate your heart rate and respiratory rate. Relaxation enhances your metabolism, so it can help your digestive processes because it’s actually activating the parasympathetic system.

Alex: What is the parasympathetic system?

Jackie: There are two systems: the stress response and the relaxation response. The stress response stimulates the sympathetic system that puts me in a fight or flight mode, and that raises the blood pressure and sends your blood out into the extremities so you can run or fight as you might need. It also narrows your focus, so you’re only able to focus on that stress. The relaxation response is the opposite and stimulates the parasympathetic system. It’s about the bodily processes that can go on when you’re not in a fight or flight situation. For example, you don’t need to digest food when you’re trying to fight or flee. The relaxation response reduces your blood pressure. Your heart rate is more regulated; your digestive system is working better and your body releases muscle tension. A lot of energy goes into stress-related anxiety. Stress requires a lot of energy in the body. Sort of like if you’re in a car and revving in the engine but not going anywhere, you’re wearing the engine down.

Take a Minute to be Mindful

Alex: What’s the best position for mindfulness practice and what can people do if they’re not comfortable with it?

Jackie: People should find a position in which they’re comfortable and not in pain, whether sitting or lying. If you’re sitting, your feet should be on the floor, your spine should be tall, but not rigid, and your neck should be long. You’re trying to give enough room for your ribs to breathe and take tension out of your spine. Arms are in your lap so there’s no tension in your shoulders. If you feel tension in your shoulders, put a pillow in your lap to reduce it. If your feet don’t reach the floor, put a pillow underneath them so that there’s no tension in your legs. You can also sit on the floor cross-legged, if that’s comfortable, with a little pillow under the buttocks so that your hips are higher than your knees.

Tara: Or lying down, but it’s sometimes hard not to fall asleep.

Jackie: If you’re lying down you may need a pillow under your knees. You can do it lying down, but the trick is not to fall asleep. Sleeping is not meditating. If you’re having difficulty sleeping, it’s sometimes helpful to meditate first. There’s also yoga meditation, anything that has a point of focus that captures your attention in which you practice not letting your mind wander off your point of focus. Walking can be a form of meditation, chanting is also a form of meditation.

Alex: What connection, if any, is there, between mindfulness and yoga? Between mindfulness and Buddhism or spirituality in general?

Jackie: Mindfulness meditation is a form of Buddhist meditation and many forms of eastern meditation practices. The Mindfulness-Based Stress Reduction program that Jon Kabat-Zinn and Saki Santorelli developed put the spiritual practice into a more secular format.

Alex: Is mindfulness similar to prayer?

Jackie: For me, mindfulness is related to contemplative prayer.

Alex: Is there any conflict between mindfulness and religion?

Jackie: No. people can practice their own forms of religion and spirituality and can also explore and practice meditation.

Tara: It can actually enhance religion.

Jackie: Other practices might call it prayer, concentration, contemplation. It’s a practice to give you insight into yourself. Jon Kabat-Zinn suggested in a program I took with him that we become our own scientist in our own laboratory, and just a keen observer of what goes on in that laboratory.

Alex: Do you have an example of an easy exercise that anyone can start out with?

Jackie: Start with a breath and smile. Put yourself in a comfortable position, with your feet on the ground and your neck and back long and feeling supported. Begin by bringing your awareness to your breath and letting your mind rest on your natural rhythm of breathing. Next, bring your attention to the full duration of your in-breath and the full duration of your out-breath. Wherever you notice your breath the most, at your nostrils or mouth as the air enters and leaves your body or during the rise and fall of your belly and chest.

Alex: Does that help you relax?

Jackie: It can help many people relax, but some people can become more agitated. Then you watch your agitation without judgment and observe it. We tend to run away from the difficult parts of our lives, so if agitation is a response you have to sitting quietly, just observe your experience with agitation, and then experience your mind frame. You might say, I want to get off this cushion as fast as I can, or, I just want to run away from the experience of agitation!

But what is this experience of agitation? You might feel your chest tightening or your heart racing, and observing these symptoms in your body will help you deal with them. What can often happen from there is that you can begin to relax. When we stop avoiding our problems and start gently, compassionately and non-judgmentally facing who we are in this moment, you’ll realize it’s just one moment. And this one might be different from the next. Mindfulness can lead to relaxation, but it’s different for everyone, there is no one way. It’s only you that you’re observing, in an intimate way, when you’re sitting in formal practice of meditation.

I want to connect this to making changes. The whole point of Healthy Monday is to develop a practice of reinventing yourself and changing once a week. If you’re not able to stop and reflect on what are the barriers to making change, or if you’re not able to observe yourself non-judgmentally and with compassion, when you realize you’re not making the choices that are good for you, you can just sit back and reflect on that and gain greater insight. And then perhaps you can make a more lasting committed change.

Formal vs. Informal Practice

Jackie: Formal practice is saying, I’m going to sit down for five to ten minutes a day and just sit with my breath and observe my thoughts and sensations that might be passing through my awareness in these ten minutes. If have the urge to get up or to avoid a thought, then that’s just my experience during this meditation. Informal practice is in our day-to-day life. Taking an everyday experience and being mindful throughout that activity. If I’m brushing my teeth and I let my mind wander to the 50 things I’m going to be doing the rest of the morning, I just stop and for two minutes just focus on the experience of brushing my teeth.

Tara: That’s a great way to utilize mindfulness. I was telling my students, pick one activity you do every day and just be mindful of it. Maybe washing your hair. Where are you going to go? Are you thinking about washing your hair? Probably not.

Jackie: Washing the dishes, making your bed, doing laundry. All those things in daily life are an opportunity to stop and just be present to this one moment. Let’s say you’re on this incredible beach and you’re watching the most amazing sunset. The first few moments you’re actually watching the sunset, but the rest of the time you’re thinking about how you’re going tell this friend of yours about it. In reality, you left the sunset and were actually in a conversation with your friend in your mind. You missed that beautiful sunset.

Tara: Another thing is when you’re on vacation, you’re thinking ahead to, oh, there’s only three days left, and you’re missing your whole vacation because you’re thinking about when you have to go back to work.

Jackie: Then as we go about our day, our formal and informal practices can be utilized spontaneously when moments of stress arise. For example, If I’m standing in a very long line at the supermarket and I’m running late, I may begin to experience a sense of agitation because I’m in a hurry. I just take a deep breath and observe my experience of standing in line, which then helps me realize it’s not that big a deal. I’ll be 5 minutes late, or I’ll put my groceries back and get them later, but I don’t have to let my blood pressure go up, I don’t have to let my agitation take over, I don’t have to stamp my foot and have all those experiences we have when you’re feeling stressed.

Tara: The benefit of using the breath-centered approach to mindfulness is that your breath is always with you; any time of day you can always focus on your breath.

Jackie: And your breath is always changing, so it’s dynamic, and that relates to life. If you’re able to connect to this ever-present dynamic aspect of yourself, you’ll be able to better manage the ever-present changing dynamics that go on in your external life as well. The thing that gets us most stressed and disrupted in our lives is that when we have an expectation of something happening and it doesn’t. Unrequited expectations cause stress. So the more you’re able to accept the moment for what it is, then there’s less chance of your being disappointed.

Alex: Is there a specific breathing method you recommend?

Jackie: In this form of mindfulness it’s just observing your breath. There are many powerful distinctive ways of breathing in meditation, but, mindfulness is just observing the breath, one breath at a time.

Jackie: So there are a hundred ways we can lose our balance - emotional balance, natural, psychological balance, physical balance – every moment. If you’re practicing mindfulness, you have a greater awareness of when you fall off balance, and you can then grab onto your practice of mindfulness to bring you back into balance. This way I don’t get so off-center.

Mindfulness Monday: Practice Living Each Moment

Alex: Let’s say I’m in an angry mood because I recently got laid off. What if meditating doesn’t make me feel any better?

Jackie: Mindfulness is not necessarily about changing an angry person into a non-angry person, it’s about you becoming aware of your anger and how you experience it. So imagine you’re feeling anger, and you send all this rage externally. Unless you’re being violent to someone physically, most of the violence is done to ourselves. Only we’re not aware of it because we’re so focused on our emotional hurt. The goal is not to take away the anger, the goal is for you to become awake to the feeling that you’re angry and that you might have all these varieties of thought and physical and emotional experiences while being angry. When you allow yourself to be aware of your experience, the experience shifts. Say you got laid off and you’re angry. A lot of us would be resentful and angry towards the person who laid us off and we’d blame them for our problems, instead I could become more specific about the concerns of being laid off like, I’ve been laid off, I don’t know if I’m going get another job. I’m scared about not paying the mortgage. What am I going to tell my family? If you can get down to that beginning level of awareness, you can begin to sort through and go on. Just breathe for the next few moments and don’t try to change anything at all. Then see where your thoughts can lead you. Oh, I didn’t like this job anyway, or, maybe I can tell the bank I was laid off, and they’ll give me a month without penalty of paying my mortgage.

Tara: Mindfulness helps you not to cling to that past experience. If you’re in the present, you know, that happened, I’m here now, not looking forward, not looking ahead, just being here for a moment.

Alex: How can mindfulness help you stay away from extreme behavior while encouraging acceptance of it?

Jackie: The beauty of mindfulness, like life, is that it is full of paradoxes. On the one hand, mindfulness helps you not get so angry, but then you say but mindfulness is not asking you not to be so angry, so both are true. It’s a paradox. Human beings want things defined, without confusion. But what mindfulness teaches is that if we’re being present fully in the moment, we become aware of the multidimensionality of our existence. So there is no absolute. So when I practice mindfulness long enough, I become more aware of what takes me, personally, out of balance, so that I am much more sensitive and alert to those situations - and when they start to happen, I go into my practice which is to be present to my own responses. However, if I’m observing my anger, I’m not necessarily acting my anger out. So you could say something to me that makes me angrier than I’ve ever been, and you might never know.

Tips for Starting Your Own Practice

Alex: Who are your Monday Mindfulness Memos intended for?
Jackie: This is on the NYU Medical Center intranet, available for any employee of the NYU Medical Center right now.
Tara: But eventually we’d like to house them on our website, which is being created. We already have one for our preparatory surgery program, but we’re creating one for the Mind Body Patient Care program, and we’ll put these on there - so they’ll be available to anyone. We want to do one memo a month and then supplement that memo with weekly Monday tips on how to use mindfulness and apply it to your daily life. So every Monday you start fresh – you use mindfulness and incorporate it into your life.

Alex: Are the tips cumulative? Or can anyone start fresh?

Jackie: Anyone can start fresh. We’re going to have links and an archive for monthly memos so people can click on that and then utilize those tips.

Tara: The first one is basically, what is mindfulness? and that will always be on the intranet in case you come into this later and you don’t already know what mindfulness is. Later on we are going to write memos on mindful communication, mindful eating… all sorts of ways to use mindfulness in your everyday life.

Alex: What are you trying to communicate with these memos and tips?

Jackie: Basically it’s utilizing the principles of compassion and non-judgmentalness when we listen and speak with each other. The more skillful we are at listening deeply to what another is trying to communicate to us, the more we are able to understand the intent of the speaker.

Tara: It’s an ideal way of communicating. Also, when you’re talking to someone, instead of thinking of what you’re going to say next –you’re actually listening, mindfully listening, and then responding.

Alex: Sounds brilliant - and common sense.

Jackie: The practice of meditation is essentially common sense. But in order to implement it on a regular basis you have to practice. It’s difficult to always remember to be mindful when somebody says something that I want to react to. It also helps me remember that the other person has a frame of reference too, and I want to understand it. That’s where the compassion comes in and the non-judgmental attitude. If you say something to me, I first try to understand your motivation, your reason for saying that, then I can honestly assess what kind of response I should give.

Alex: How does Monday fit in?

Jackie: I think the Monday idea is great. Change doesn’t happen overnight, and it takes practice and commitment. Using Monday helps you realize, without judgment, that changes will eventually occur if you stick with it. And on the days that you don’t, you’re not harsh on yourself. Be kind to yourself. If it’s Thursday, you can decide to meditate or skip meat or whatever else you’re trying to do on that day, but you also know that every Monday is another day when you can begin seeing yourself fresh and anew. In mindfulness, every moment gives you that opportunity – but I think it’s very clever to connect it to a day of the week. The whole point of Healthy Monday is to develop a practice of reinventing yourself and working on changing once a week. If you’re not able to stop and reflect on what are the barriers to making change, or if you’re not able to observe yourself non-judgmentally and with compassion, when you realize you’re not making the choices that are good for you, you can just sit back and reflect on that and gain greater insight. And then perhaps you can make a more lasting committed change.

Tara: I think it really supports being compassionate to yourself. I know in my life, if I don’t go to the gym, I’ll be like forget it. But with Monday, you have a weekly opportunity to start over. It helps you not get discouraged with quitting or having a setback.

Jackie: Mindfulness has really helped with my greater sense of patience. When we’re taking on a big change, like quitting smoking – which is huge – you commit to Monday, you commit to being mindful of every time you have an urge to smoke, and you accept that urge, but in this moment, I can resist that urge because next moment that urge might go away. I know that if I can wait 30 seconds, that urge will be gone. That urge may come back later in the day, and then you sit with it. You can quit cold turkey, but it doesn’t mean you won’t have other desires for cigarettes.

Tara: When you have the urge to smoke, you supplement it for something else, unless you really feel the reason why you’re smoking.

Tara: You don’t practice mindfulness to make yourself a better person or to relax or make changes in yourself, but to help you tune in to what’s going on. All those things could happen as a result, but it is really easy to think I need to practice mindfulness to be better, to do more.

Alex: How has mindfulness changed your lives or perspectives?

Tara: Well I found mindfulness through yoga, and from the process of yoga I started teaching it. I just started doing yoga and it really changed my perspective on my life, and I didn’t know why. I wanted to figure out why and then help teach that to other people. I spent so much of my younger years looking forward, thinking I’ll be happy when I’m in college or I’ll be happy when I’m doing this. You can keep saying you’ll be happy when you get somewhere else, but this is your life right now. So that really helped me to live now and be happy.

Tara: My brother is a mindfulness meditation instructor. He did a workshop with people, and he had a little cup with sunflower seeds. We were sitting and observing our thoughts, and every time you had a thought, you’re supposed to drop a sunflower into the cup. So you could hear when everyone else had a thought, and it was like a rainstorm, and it was just a wonderful to hear everybody’s thoughts. You’re always giving off thoughts, and there’s nothing wrong with having them, just remember to come back.

Jackie: Mindfulness has helped me take things less seriously, be more playful. I can deal with things that are serious and hard, but also have an accompanying lightness to that experience. The people that I know who practice mindfulness on a regular basis smile a lot more, laugh a lot more, enjoy life a lot more.

Tara: Since you’re observing your thoughts, and if you notice your thoughts, it’s like, oh, that’s interesting. Where did that come from? It’s much more playful.

Alex: How’s this for a headline? Mindfulness: live for the moment.

Jackie: It’s more, be present in each moment, really.

Jackie: The more mindful I am the more precise I am. Not in an exhausting way; but, because I’m trying to actually capture everything as it is. I’ve become less satisfied with a lazy approach to understanding what others are trying to say or do. It’s a very precise practice.

Tara: We’re also much more curious about ourselves, and the world around us.

On Mindful Eating

Alex: Can you tell our readers a little bit about mindful eating?

Tara: If you’re mindful of your body, you will be swallowing and chewing when you need to, and you will stop way before you have gorged yourself. To be full, sometimes we throw food in our mouths, but you’ll enjoy and taste the food more if you practice mindful eating. You can extend it to the mindfulness of purchasing and preparing the food, and it will also connect you to the food though awareness of who grew the food, who harvested it, packaged and delivered it, if we’re not in a rural community and growing it ourselves.

Alex: Why is it important to have a connection with our food?

Jackie: I think it’s important to have a connection with everything that’s around us, and that I think good food is important, and the more we’re aware of how our food came to us, the more likely we are to make healthier choices.

Tara: If you’re mindful that you’re hungry, you’ll eat when you’re hungry, and you might make better choices if you’re mindful of your body’s hunger. So if right now I’m hungry, I know that I would probably go eat that whole counter, but if I’m aware of that it will help restrict me.

Jackie: When you connect to where your food is grown and the environment it’s grown in, we have a global awareness, and global awareness will help eventually bring peace.

Tara: It shows that we’re all connected—

Jackie: —and we should appreciate the people who grow our food.

Jackie Levin, RN, MS, and Tara Piergrossi, a Masters candidate in Public Health at Hunter College, are the founders of the NYU Mindfulness program.