S3E2 – Mindfulness, with Dr Afrosa Ahmed

E: Hello, my name is Ellie.

 

W: And my name is Will.

 

E: You are listening to Lively Minds, the podcast about mental health challenges that go beyond the ebb and flow of the everyday.

 

W: The podcast that looks at how developing an understanding of our mental health challenges
influences how we address them.

 

E: In this episode, we will be talking with Dr Afroza Ahmed about mindfulness. We’ll be exploring what it is, what it tells us about the way we understand our mental health, and what prompted her to write a book all about it.

 

W: A practicing GP in the NHS for over 20 years, as well as a Harley Street-based mindfulness coach, Afroza launched life the coaching programme Mindful Doc in 2020, working alongside healthcare colleagues to incorporate medical history into bespoke wellbeing programmes for patients.

 

In her book Mindful Healing, Five Simple Steps to Transform Your Life, she shares her knowledge of how we can incorporate the ancient practice of mindfulness into our everyday lives, a practice now endorsed by the National Institute for Health and Care Excellence here in the UK and the NHS.

 

E: Dr Ahmed, welcome.

 

A: Thank you for having me on.

 

E: Thank you for coming, it’s really nice to speak to you.

 

I always find it funny if I’ve been reading someone’s book but not spoken to them yet, so it’s always like fun to meet.

 

So to start with, you’ve been a GP for many years, could you tell us a bit more about Mindful Doc and the work that you’re focused on at the moment?

 

A: Yeah, sure. So, Mindful Doc actually came around from my work as a general practitioner in the NHS, which is the UK-based healthcare system. And as I saw patients, I felt a little bit frustrated in not having been able to do a bit more for them. You know, as GPs, we kind of signpost our patients to other resources because we don’t have the time in general practice to deal with everything in 10 minutes. So I was very good at diagnosing patients with depression, anxiety, but after signposts them and then sometimes they would come back still not quite healed, not quite feeling that they found the answer. And I thought something’s lacking. Something where instead of working alongside each other, why don’t we have something that incorporates everything – medicine as well as mindfulness. And that’s really how Mindful Dot came about it’s a fusion of the ancient practices of mindfulness, but working with the natural body’s physiology and the mind. And that’s how mindful thought grew.

 

W: What is mindfulness?

 

A: Mindfulness is actually not very complicated. It’s very simple in that it’s the being present. But being present is something that we actually find very difficult to do. And it’s the practice of mindfulness that is a little bit more tricky, whereas the definition itself is actually rather simple.

 

W: Would it be fair to summarise then this idea of being present as about trying to not be distracted by worries, by things that are not existing in that moment and instead of focusing entirely on what is in that moment and what’s going on in terms of your body, or what’s going on in terms of your immediate environment?

 

Can you just a little bit more on what it actually means to be present?

 

A: Yeah, and I think that’s a bit of a myth that you can’t worry. That’s part of normal life. And a lot of what is mindful is accepting. So in that moment that let’s say we’re doing a mindful meditation, in that moment if worries happen, if worries come into your mind, accept them, your body wants you to notice them. But don’t ride on the train of being worried all the time. So don’t snowball into that thought, let it come and then watch it go away. So otherwise we get into a state where we’re constantly criticising ourselves, oh why am I worried about that? That’s silly. I’m not supposed to be doing that while I’m meditating. And that’s a very slippery slope that you go down. So we’re not saying it’s wrong not to worry. We just want you to notice it and deal with those worries in a healthier way.

 

W: I know that people talk about doing mindfulness as an exercise and also we hear people talk about doing things mindfully as well. Can you just talk a little bit about the difference between those things?

 

A: Yes, I think mindfulness we can categorise into informal mindfulness and formal mindfulness and I think that’s the most helpful way of dividing that. So formal mindfulness will be your kind of meditation mindfulness practice where you sit in a very quiet room away from distractions. You can either have it guided where you’re listening to a guide doing some mindfulness for you and that is done at a specific time at a specific location. The informal practice, so doing something mindfully that could be something that you’re doing in everyday life. So washing up the dishes, going on a walk, even sitting chatting to you, I could do that all mindfully and that’s really being present. So for example I’m sitting here, I’m being mindful of my posture, I’m being mindful of the way that my bones are in relation to the muscles, I’m being mindful of the way that my voice, my tongue and my mouth are articulating, or the way that my feet are present on the floor. So I can carry on with everyday life while being mindful and that’s the informal side of things. And I would say they’re like a jigsaw puzzle to each other, we can’t have one without the other. So the informal mindfulness and the formal mindfulness together, we need both bits, not just one without the other.

 

E: Yeah, it’s a really nice way of thinking about it as a jigsaw.

 

A: I think that’s a core fundamental principle of mindfulness, it’s this idea of balance. So we’re not just saying to be all the time, you need to be doing things, you know, that’s how life happens, we’re doing things, but we’re trying to balance it with being. We don’t want to have too much of either state.

 

E: You’ve recently written a book called Mindful Healing and I found it really interesting what you have said at the start about your reason for putting it together because it’s quite like practical and sort of pragmatic because you basically it seemed to be, obviously correct me if I’ve understood this wrong, but that you basically found that you were giving the same advice that was working to so many patients that it was like I should just put all this together. Is that right?

 

A: Almost. I found that a lot of symptoms, a lot of signs, a lot of problems that patients were coming in with were very similar. That definitely was the case and I think with Covid, with lockdown, mental health being on the rise, that was certainly true. Now, what isn’t so much true is what we can do to help our patients. So as a doctor, I found that my hands were quite tied because time was a big constraint. We have 10 minutes. So what we usually do is we signpost to another healthcare professional that could be like a counselor, a CBT type therapist, and so go and see them. But again, our system in the UK, the NHS, only allows for a certain number of sessions. Now, when I do a mindfulness practice, you know, we could be there for an hour for a session. At the moment that just isn’t set up on the NHS. There are places where you can go and get some free group mindfulness sessions, but again I think mindfulness should be tailored to the person. So almost like you’re seeing a doctor for your physical medical condition, we want you, it would be ideal in a way that you go and see a mindfulness medical practitioner and they tailor a mindfulness programme to you. And I think there are very few people who are doing that at the moment, combining medicine and mindfulness, which is why the book came together.And I thought, I’ve got so much to say through all this experience. I can’t possibly say that in a consultation. I need to write it all down. So that’s really how it all came about.

 

E: What is it about mindfulness that do you think that has made it so effective for so many of your patients?

 

A: I think it’s the simplicity of it that, you know, it’s not something that you need to buy in the sense that anyone can be mindful. You don’t need any props, you don’t need a mat, you don’t need a special music, you just need your body and your breath. It is remarkably simple to do. It takes time to get into the practice of kind of not having that monkey chatter around that comes with practice. But it works with the body’s natural physiology, we’re working with the breath, the out breath and the in breath. And that’s all there is to it. And I think that’s really what resonates. And from a medical point of view, I like to back it up with the fact that there is evidence behind it. You know, there’s a National Institute of Clinical Excellence, which a lot of doctors abide by, and they do promote mindfulness. So the two together, I think, is what really resonates with people.

 

W: So on this podcast, we do say that we’re more interested in a way in how we understand our mental health challenges in the first place rather than sort of how we fix them, as it were. And I’m kind of interested to know what your thoughts are on what you think mindfulness tells us about some of the sources of our mental health challenges.

 

A: A lot of the time we spend almost running away from ourselves because it’s uncomfortable. It’s uncomfortable to just be with ourselves. We’re full of distraction. We want to go to the cinema, I want to scroll our phones, I want to watch Netflix, but just to be with yourself is quite difficult. And when you’re with yourself and when you’re with your breath, it really forces you to look inside and to get to know yourself. So what we say is we use the breath as almost like a barometer. If your breath is very fast, you might be uncomfortable around certain situations or around certain people. And it’s knowing those feelings. So for example, there might be someone who triggers you, maybe at work or a family friend. And noticing those feelings every time you see that person really taking that time and thinking, oh, actually, yeah, my shoulders do hunch. I do get a bit of acid in my stomach. My jaw does clench. Actually, my breath is going a bit shallow and faster. And then before snowballing, when you recognize that stating yourself and think, okay, I know this is going to trigger me, this situation or this person, I need to come out of that and do some mindful breathing. very quick effective grounding or breathing techniques. Before you get into that, oh, here we go again, I’m going to have a confrontation with this person, because that’s what always happens. So knowing yourself, knowing your reaction to people in situations really helps people to gain control. And that’s not something that we have taught people in self care, is that you do have the power to take control of situations.

 

E: That’s really interesting and I was thinking, what you were saying before about mindfulness and doing things mindfully being like jigsaw pieces. There’s obviously so many different types of therapy, talking therapy, that people will be prescribed or recommended or to go through but mindfulness can be an accompanying jigsaw piece with other forms of help people get. It’s almost like putting some of it into practice.

 

A: There’s lots of other therapies out there and I’m not saying that CBT is not as great as mindfulness. What we’re saying is that this comes down to the way you practice medicine. Patients have choice. Go for one that suits you. For me, that’s the one I advocate because from a medical background I think there’s a lot of evidence behind it and I see the results and for me personally it’s worked really great. It’s like a patient comes in with blood pressure. We start with one tablet. It might not suit everyone. They might need to add something else. And that still doesn’t work. We might need to take one away and try something else to get the blood pressure under control. And I think this is very much like it. What I’m saying is that I think mindfulness is great. I think there’s a lot of evidence out there, but you might want to try it in a conjunction with something else. That’s okay. Try things that work for you.
E: Yeah, actually, I have a personal experience of that that I’d completely forgotten about
until you were just saying that then. I’ve been in and out of therapy for ages and lots of the things that I have learned, the really good bits are mindfulness techniques. So when I was looking through your book, there’s lots of stuff that I recognise as something I now do without thinking as just part of coping. And there’s still some new ones in there. So I was like, Oh, that’s interesting. But I remember when I, a friend and I were both referred to like a mindfulness group when we first moved to Manchester, both have chronic health conditions so I’ve got lots of chronic pain and fibromyalgia and things like that. And I remember leaving the mindfulness session because they made us do a body scan where you’re kind of are paying attention to every single part of your body and I was quite reluctant to do it because I need to be distracting myself from my nerve endings, not indulging in them. And I did the whole scanning thing and honestly I almost passed out it was such a bizarre experience because it’s like focusing on this pain made it so much worse and yeah and so I remember and then I was like I don’t really want to do mindfulness that was really awful but actually I’ve ended up using so many different aspects of it like the other bits of it, physical grounding like feet and hands on the floor that are really helpful

 

yeah but yeah it’s just kind of yeah like some bits might not work for everyone.

 

A: Yeah and sometimes it’s a matter of timing.

 

Some people are ready for body scan, some people are not and we shy away from it and I think we have to approach this in a very kind, a very gentle way and say well how about we try two minutes today, six minutes tomorrow, ten minutes later on. It’s a very bespoke way of dealing with mindfulness and the practice and this is why I’m not so much of a fan as a group session because you’re probably in a group when you did that.

 

E: Yeah.

 

A: Yeah. And when we can do a one-to-one, we really can tailor it. We have so much flexibility. We can go according to your time and we can graduate things. So sometimes, again, group doesn’t work for everyone. And the natural tendency of people is like, “Oh, well, that didn’t work for me.”

 

E: Yeah. Whereas if I do it now, I don’t have the same experience at all.

 

A: Exactly. Exactly. And that’s a very common thing, you know, and our of mind tends to think, “Well, that wasn’t for me, it didn’t work. Well actually that’s not really true.

 

E: Yeah actually I was possibly just in too much pain that day to be able to get something out of, you know, it was just not the right time.

 

A: Yeah exactly and I think this is where medicine and mindfulness come together.

 

So if you had a medical mindfulness practitioner, well let’s have a discussion about your pain
control.

 

E: Yeah.

 

A: Right? Whereas a mindfulness practitioner on its own cannot do that. Were as I could say, oh right I could see you on this tablet, let’s up that a little bit and how about we try the body scan later. Yeah. And very few people in the world who are doing that at the moment.

 

E: Which seems bonkers that no one’s doing it because as you talk about it makes so much sense.

 

A: Yeah, exactly.

 

And I’m almost really sad that I have to practice it privately.

 

E: Yeah.

 

A: And I haven’t found anywhere I can practice it in a normal government NHS kind of clinic. Because the two go together so well, medicine and mindfulness, it’s been around for ages and, you know, like a jigsaw, my knowledge of that.

 

E: Yeah.

 

W: So I’m really interested that you say that you’re not a massive fan of the group-based mindfulness because that seems to be the standard go-to, doesn’t it, through the NHS. Certainly, my experience has been when referred to mindfulness has always been a group basis rather than an individual basis. And you can understand completely why that would be. Of course, it’s obviously much more cost-effective or one could say, you know, more affordable to go down that route from the NHS’s point of view. But then that, of course, limits the level of bespoke-ness that you can apply to that process. I guess there could be some advantages to group-based work in that everyone’s doing it together so you’re kind of vibing off each other a little bit but I can totally see also why not being able to apply a bespoke approach to that mindfulness exercise means that there could be some things that people are being asked to do which are inappropriate or troubling or stuff that people can’t do at that moment in time.

 

A: Yeah and I think there’s two ways to look at this. Look something is better than nothing right? A little bit of mindfulness exposure is better than no mindfulness exposure but let’s say you’ve got a room full of patients together and I said to them right all the people who have headaches come into this room let me try and treat you all together. You would say that was crazy. Right? I can’t see why that same principle would work.

 

Yes for some people group works very well, I’m not discounting that but it’s certainly not for everyone and we need to give options to to have both.

 

E: So you’ve seen lots of positive results from a lot of your patients in terms of the way that you work and how it’s helped them and I just wondered is that for patients who have presented with quite similar mental health challenges or areas of difficulty or is there a big kind of variety in like the presenting difficulties that these patients have had?

 

A: Yeah I think it’s very much similar. Unfortunately because it’s a paid service where are you going to go into reach a certain demographic? We’ve already have a niche area of who I’m working with. So it’s not representative of the whole population who needs help. But those who do come, it’s the usual kind of anxiety, high pressure jobs, some depression. So those are the usual kind of presentation of the kind of cases that I see. And if they need some more input, again, because I’ve come from a medical background, I could say, well, actually, I think you need a psychiatric review. Why don’t we go and get some more help on this way?

 

E: Yeah.

 

A: So just coming back to that medical link, it really does make a lot more sense. So if I see a patient, I know, right, okay, you’ve got depression, you’ve got these medications, I know exactly what that means.

 

E: Yeah.

 

A: Whereas a normal mindfulness practitioner without that medical background might not be able to help them in that way.

 

W: In the email that we received about this interview, there was a reference to meditation apps not being useful that we need to put on our phones. Can you speak to that for a bit?

 

A: Mindfulness is like a subject in itself. So for example, if we’ve got geography, history, philosophy, I think mindfulness is on its own entity like that, in the sense that you need to do the theory first and then we can do the practical. So by doing the actual jumping straight to the practical and you haven’t understood what this all means, if you haven’t studied what the physiological response of your body is to mindfulness, what’s happening with that dampening down of the stress response, the lowering of the blood pressure on the heart rate, why do we use the breath? What areas of my life needs evaluating that’s causing me so much stress? If you don’t put in the work, you’re not going to get the results. Similarly, if a patient comes to me back to my blood pressure analogy and they just want to bubble it, but yet we don’t identify the
the areas of stress that’s going on in their lives, or their diet, their lifestyle, their fitness, that’s all part and parcel of that problem. So when you do an app, it’s just like a very short term fix. And I think society and probably people now, they want something quick.

 

E: Yeah.

 

A: But you have to put in the work. And I say this to everyone in the very beginning, my first you need at least eight sessions to embed the theory. We’ve got a hell of a lot of undoing to do, right? You’ve been thinking a certain way for many, many years. That is not going to suddenly undo just by listening to some apps. So we have to really put in expectations in at the beginning, you have to put in some work, know the theory, embed those concepts, and then
we would start doing the meditative work. An app is a very dilute form of what mindfulness is.

 

E: That makes a lot of sense.

 

A: And unfortunately, there’s no quick fix. And we’re always looking for a quick fix. But there isn’t one. And we’re talking about changing your whole life, your whole way of thinking.

 

E: Yeah, humans are far too complex and dynamic to ever be able to have a quick fix for something, I think.

 

A: Yeah, exactly.

 

So that’s why I think apps have a place probably towards the end when someone’s quite experienced. Then I would say that’s where the app would come into it.

 

E: And would that app potentially be helpful there more in terms of it being almost like a prompter.

 

A: Yeah.

 

E: Yeah, so it’s like a tool.

 

A: Exactly, exactly.

 

But, and you know, our mindfulness is very evidence-based. So we look at the evidence. We know that when they got the results, when John Kabat-zinn, he’s a founder of the modern mindfulness practice, did his eight-week sessions. And that’s what we need to do. We need to replicate the program that had the most evidence. Let’s replicate how they did it back then that got the results.

 

W: It feels to me as though because this kind of much more bespoke approach to mindfulness is something which you do for your private practice, it feels like the book is an attempt to spread the word about this to that broader audience in terms of people being able to be given the tools to be able to approach mindfulness in a way that works.

 

A: I think that’s a nail on the head really is that I’m trying to get the word out to the masses, something that’s quite affordable I hope and has got as much information as I can so it’s kind of really appealing to as many people as possible through the book.

 

E: That’s great and do you have any advice to people as to if they buy the book how to use it, how to work with it?

 

A: Forget about timings and deadlines. Okay? So don’t feel like I want to get this done I want to change my life in a week, get rid of that pressure of putting on yourself. If you’re the kind of person that’s just managing to read a little bit each day that’s so much better than trying to finish the whole book in a couple of days. Consistency is the key and I do say that in the book a lot. Please do a little bit each day. And the other mistake that people make is they get into a mindfulness practice and everything’s going great and then they stop it because everything’s going great. Well, that means it’s working. Don’t give up. Don’t stop. It’s something for life. So my advice is to really set aside a time each day where you know you’re not going to be disturbed, really get the book, try and do the exercises. One day here and there you’re not going to be able to do it. That’s fine. Don’t beat yourself up about it. But the majority of the time, set aside some time, do the exercises in the book. At the end of each chapter, there’s some advice that I give you to try and do.

 

E: Yeah.

 

A: And then it’s really like a guide. Sometimes there are points in life you’re going to have to come back to it.

 

E: Yeah.

 

A: And review it and revisit it. So don’t lose track of it. That would be my biggest advice for the how to use a book.

 

E: Thank you so much. I feel really inspired to put some time in my calendar every day to make sure that I can properly integrate some of the practices.

 

A: Yeah and I think that idea of time is probably the biggest excuse that we have, isn’t it? I don’t have time to do this. This is your life.

 

E: Yeah.

 

A: Right?

 

This is your future. If you can’t have time for this then what else is there? So it’s just a matter of rearranging time. You can definitely find the time and believe in that you’re important that you’re worth investing in.

 

E: Thank you so much.

 

So Mindful Healing: Five Simple Steps to Transform Your Life is published by Michael O’Mara Books and is available from the usual bookstores and online.

 

W: Thank you so much to Dr Afroza Ahmed for joining us today. Thank you so much for listening and please do tune in again in a month’s time for another episode of Lively Minds The Mental Health Podcast.

 

E: Please note that this show does not constitute medical advice and is not a replacement for seeking professional help. You can find signposting to support on our website anyamedia.net/LivelyMinds. Make sure that you keep up to date with our shows by subscribing
wherever you get your podcasts, and follow us on social media @LivlyMinesPod.

 

E: Take care and bye for now.

 

W: Bye bye.

 

Thank you.

 

Thank you, and thank you, again, for the great work that you’ve done for us.