S02E02 – Gregory Kelly- Physician Health & Wellbeing as a System Phenomenon Part 2

Physician Gregory Kelly explores the science behind flow state performance in part 2 of this two-part series.

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Transcript

Speaker 1:

Welcome to Heart-Based Medicine’s Heart of Healthcare podcast featuring Dr. Gregory Kelly and the naturopathic physician product formulator at Neurohacker Collective. Exploring the science behind flow state performance.

Jan Bonhoeffer:

I’m really grateful and pleased and honored that Dr. Greg Kelly is with us today. For those of you who haven’t seen the previous episode, he’s a naturopath and he’s the lead product formulator at the Neurohacker Collective. In the last episode, we explored your background and what got you into product design, and what got you into dedicating your life to facilitating and awakening process let me put it this way. Today we want to focus on flow state so we’ll build on our conversation last time and look at what is the science behind the flow state performance. What is the science behind flow state and that performance within that state? Welcome to this round and our conversation really looking forward to-

Dr. Gregory Kelly:

It’s great to be talking with you again. It’s always very enjoyable to meet heart to heart even if it’s over a great distance with you.

Jan Bonhoeffer:

Yeah. Yeah. So thanks. As a product formulator, as a product designer and formulator, you’re in this incredible situation of taking cutting edge science and see what can be actually learned from the cutting edge of science and how can we bring it to the ground so that we facilitate this flow state as far as we understand it today. I imagine this is a really fascinating role that you have there.

Dr. Gregory Kelly:

Yeah. Yeah. Well, for sure. I never feel bored. I always constantly challenged so which is good. Challenge would be almost a prerequisite for flow state if we’re not engaged in some kind of challenge it’s hard to get there. Maybe want to start off we’ll just give a little bit of background of what flow state means. I’m sure some of the audience would already know but just in case there’s some that don’t.

Dr. Gregory Kelly:

What you’ll usually see at least words that pop up that would represent being in a flow sense are things like effortlessness, hyper-focus. So really in the zone, locked in what you’re doing, timelessness. So that sense that the amount of time that’s passed by while you were engaged in this is a little bit disconnected from our normal clock time. Like you and I were talking about before we went live flow state is something when you’re in it it’s almost always apparent that you’re in it and when you dropped out of it you feel like, oh, I just lost that. But getting into it predictably that’s been a goal of performance optimization probably going back to Ayurveda, the Chinese mystics, Christian mystics. All kinds of the people that have what I think of as transcendental type of experiences to get into this state where our consciousness is performing at its optimal level as is our body, our physical capacities.

Dr. Gregory Kelly:

So to me, flow state is that. It’s like that state of both mind, body, and heart where we’re able to perform at our best in whatever that domain is that would be a challenge to have in that moment. So it’s super cool when we’re in it and I remember so we talked about my time in the Navy during the last episode I was on. I grew up like the big bowling balls with the holes for your fingers was not in the region of the US that I grew up in. That wasn’t a thing. We had these really tiny bowling balls called candlepins. So I had never had any experience with the big ball bowling other than I’d seen it on TV. So I remember going in the Navy to do this style of bowling and I was horrible at it because I had no skill.

Dr. Gregory Kelly:

There was one time I had started to meditate became much more aware of how important it was to breathe. So I figured well I’m going to be horrible at bowling this way anyways so I’m just going to focus on breathing nice and deeply in and out and let my body just take over and do whatever it can. Bowled, I think it was four strikes in a row and it was just like my brain blew me away. Somehow I toggled into this flow state that was way beyond my physical skill level at that point. As soon as my mind fixated on, wow, this is really… I’m really good at this. [inaudible 00:05:05] So I think we’ve all had spontaneous no maybe not all but certainly many people I know have had spontaneous instances like that where we’ve done something and dropped into a flow state and then our logical brain has kicked us out of it. If that makes sense.

Jan Bonhoeffer:

Yes, interesting. You’re describing a situation that others have heard the description of was stepping out of the way. Rather than doing something we’re tuned to in order to become better you need to practice the skill and do it more often and practice harder. Then there’s this moment where actually letting go of that practice and not practicing this any harder but to actually let then surrender yourself stepping out of the way rather than having to do something is going into let something be inside. So what is this moment? You described it for the bowling I guess you have experience-

Dr. Gregory Kelly:

Yeah. I’ve had the same thing so again I grew up playing hockey not that I was ever particularly good at hockey but that was my main sport. I was always really short so basketball wasn’t but in pick-up basketball had a few instances of again feeling like I just can’t miss. Like every shot I’m taking is going in. But I think if we’re not skilled in something it’s pretty rare to get into that flow state in it. I think when we have more skill in a domain it’s going to be a much higher percentage chance that we can get into flow in general but also intentionally. So I think many of us will have an experience of a flow state with something we’re not good at but we don’t have a recipe to get back there. But I think what you said is getting out of the way. I think that’s what happened that one instance where I just gave up the thinking about bowling, focused in on breathing, and got out of my body’s way. Then it was able to do a bit better job than if I was trying to run the show since I was a horrible bowler.

Jan Bonhoeffer:

So there you go. Here are examples of how to step into this zone. Into the zone as some would say or into this flow state. Then you’re popping out of this at some point. For example when a sense of self kicks in that then tries to claim that state or claim the results of the performance in that state and then it’s gone. Are you aware of those moments when you actually step in? Are you aware of that threshold point where it’s like okay, now I’m in flow state?

Dr. Gregory Kelly:

So when I’ve intentionally done it through breathing I’ll feel almost a calm centering through the breathing. So I think that would be what I’m aware of the output of the flow state. That I become aware of as I’m producing the output if that makes sense. So I would say in my normal job it would be writing something creative would be the most common experience of being in a flow state where that sense of effortlessness, the timelessness all those things kick in together and it almost always feels like the end product. Things will just fall into place and I’ll get a lot done in a relatively briefer period of time than what struggling would produce as an example. To me, some of that comes with expertise like I said breathing, anything personally where that helps me really hyper-focus. So becoming in the zone so to speak but something is much more likely to kick into an area I’m already skilled in to produce that flow state.

Jan Bonhoeffer:

Yeah. Nice.

Dr. Gregory Kelly:

For me that breathing but having some degree of having put the work in advance.

Jan Bonhoeffer:

Yeah. So when you’re working, when you’re developing products is this how you develop products? Is that what happens is that you go into this flow state and this is where you get the insights into what might be the right proportions of the ingredients and what might be the right mechanisms you want to feed?

Dr. Gregory Kelly:

Yeah. So what will happen when we develop products at Neurohacker Collective we start with doing just crazy amount of research but on pathways, mechanisms, but then individual ingredients it’s always our goal to find if there’s synergies in ingredients but that’s typically understudied. So ultimately you’re left trying to fill in the gaps and I think similar to what we just talked about as all of those things build the required expertise the skill and then often something will fall into place as we’re putting things together. So I’ve been working on a project on mood like we typically have a couple of different projects going on but this one’s been going on for well over a year in terms of the research trying out some initial recipes.

Dr. Gregory Kelly:

I think it’s somewhat through that trial and error so the last recipe we tried out we had 20 people I think we gave it to. It was close. There was the foundation seems there now it’s can we get that recipe to work even better to produce… What I would say is it produced a good result across the board but not quite enough excellent results in my mind in terms of what I would look for, for the feedback we get. So what then happens I have to step away for a little bit and let my brain sort all that out and then sometimes nature’s been really helpful for that. As I walk by the beach or out in a garden setting all of a sudden something will pop into my head like oh, that could be the thing to adjust here or the thing to drop out or add.

Jan Bonhoeffer:

Yeah. So one part let’s look at a product that is available. Let’s look at for example Qualia Mind. Okay, so here’s a product that is supposed to nurture and improve cognitive performance I feel like. Is that right? Is that-
Dr. Gregory Kelly:

Yeah. Yeah. I think that the core word probably is focus more so than anything else. Focus is a prerequisite to that flow state so a big part of the design of Qualia Mind was to get people more predictably in at least having the brain resources to get into and stay into that flow state. So focus would be a big part of the daily experience of it then longer-term memory, memory’s a much more long term game. Same with some other cognitive skills. So when Qualia Mind was designed I think focus, concentration, would have been the two key subjective experiences we wanted people to have the day they took it. Certainly, if not that day over the course of the first few days but then over time that’s when memory what we talked about last time social cognition, empathy and skills like that.

Jan Bonhoeffer:

So you used measures like evaluated, established methods of measuring cognitive performance. Yeah. I think you used the Cambridge Brain Score and then there’s obviously IQ testing. There’s a whole range of tests that can be used to measure cognitive performance and different domains in that cognitive performance.
Dr. Gregory Kelly:

Especially for things like there’s the apps you can get on your phone that would measure ability to essentially pay attention and then respond quickly to new stimuli. So there’s lots of things like that that we would normally or that we would use in the course of testing out different recipes for things.

Jan Bonhoeffer:

Mm-hmm (affirmative). Mm-hmm (affirmative). So those are established tools and measures if we’re talking about flow state how do you-

Dr. Gregory Kelly:

Then it’s more subjective so the only thing I’m aware of is I believe it’s called the flow state scale. You could put it in the show notes which I think it’s about 36 questions maybe that then has people rate these things we’ve talked about like effortlessness and timelessness and these essentially characteristics of being subjectively in that flow state.

Jan Bonhoeffer:

Mm-hmm (affirmative). So what is this flow state when you look at this scientifically? We have a subjective experience and I guess we will both argue that that’s part of science too although not every scientist would agree but let’s say that we want to have the subjective introspective scientific approach and we solicit this information by questionnaires for example. That’s one way. The others actually describe it or measure it from the outside so what we’re saying, we know that this is how we want to measure flow state. Is there a way? Is there any measurement? Is that your brain is in certain frequency or does it go into phase with some other frequency or what would be a way to describe it?

Dr. Gregory Kelly:

I’m going to I guess mention I’m not a neuroscientist but in general my understanding is when we talk about something like flow state we’re talking about very region-specific things going on in the brain. So in alpha brain waves would be characteristic but that wouldn’t be a full brain thing it would be in parts that that type of brain wave which is really that’s the relaxation response type of brainwaves and L-theanine which is a nootropic substance from green tea is one of the things that’s been studies and shown to induce alpha brain waves in some parts of the brain. So we know that typically is something that’s characteristic of being in the flow state. Dopamine which is our reward neurotransmitter that seems to play a very important role. I think going back to breathing, there’s a high wouldn’t be the correct word but there’s a satisfying experience of being in that really deep breathing calm state.

Dr. Gregory Kelly:

So I would typically say dopamine’s playing somewhat of a role in that. There’s a compound our brain makes and it turns it over really, really fast called anandamide. It would be an endocannabinoid so what happened when with marijuana there’s compounds in that essentially trigger receptors in our brain so the assumption was there must be something we produce internally that is designed to stimulate those receptors. So that’s the endocannabinoid system these cannabinoid-like signaling molecules that our brain makes and the anandamide is one of the core ones and ananda is from the Sanskrit term for bliss. So that would be our innate bliss chemical so that one from what I read that would be expected to go up we’re in this flow state.

Dr. Gregory Kelly:

If it’s a flow state with other people I think oxytocin starts to really rev up which is our tendon define chemical. So I think depending on the circumstances and maybe what we’re doing the exact recipe of these compounds will change but we need to be able to make those and to use those well to really get that sense of a flow state.

Jan Bonhoeffer:

Which way around does it work? Is it that I am in a state of focus and being in this state of focus leads to the release of these substances, being in a flow state that is what triggers the release of the substances and then I have subjectively the feeling of wow, this is kind of cool or at the end, I get the feeling whoops that show’s over? Or is it the other way around? Then we’re releasing these substances as a result of releasing these substances is we’re in flow state.

Dr. Gregory Kelly:

So my bias would be it could go both directions. But what calmly we have but take something that would get us more the fight or flight response so a really high dose of caffeine. If we do that we’ll create a physiological stew of a response because of that degree. You’ll have a classically nature pass what are called caffeinism irritability, some anxiousness, things like that. So if we produce that physiological state someone will find things in the environment that their brain will blame that state on. Where the state actually proceeds the things going on outside. So that definitely happens physiologically. A lot of what we are experiencing externally is because of this physiological state that our brain and body has created in that moment. So our interpretation I guess of the external is colored by that.

Dr. Gregory Kelly:

But I’m also definitely aware of things where you change the external so a walk in nature or something much more calming than that cues up different recipe of molecules of emotion inside as well. So I think it’s one of those chicken and eggs like you can get there in either direction.

Jan Bonhoeffer:

What do you think that let’s say providing the brain with substances as a means to an end is this helpful when I’m in a state of substance deficiency so you know if I’m short of dopamine then if I’m adding dopamine then I’m getting to my basically baseline or is it so that if my buckets are all full then actually there’s still a possibility to go higher? Is there a ceiling effect? Is there sort of a saturation effect?

Dr. Gregory Kelly:

So I think I tend to use the term resources. I think to be able to perform at our best the resource tanks need to be filled across the board. There’s a deficiency or inadequacy somewhere it’s going to be challenging to get them to stay there. In one of the studies that I personally found super cool was one on L-Tyrosine and military people that were going through an interrogation drill. So L-Tyrosine would be a molecule that we use to eventually build dopamine. It goes through a couple steps to get there but that’s its pathway. Now it can also be used to make epinephrine and norepinephrine because it’s all the same basically building block. So that amino acid tends to be in pretty good supply in the diet. It’s not one 100 milligrams is going to make much of a difference.

Dr. Gregory Kelly:

So in the study, I want to say they gave 20 grams which that’s a pretty big dose and usually during these interrogation training and I think it was for pilots is my recollection but don’t quote me on that but these are long grueling things where they’re treating like you as if you’re encaptured or prisoner trying to get information from you. What eventually typically happens is these soldiers wear down. They become essentially learn helplessness during that couple hour time period. What the L-Tyrosine did it allowed them to stay angry at the interrogator through the entire thing. It essentially prevented that wearing down mentally and I think because it created now a big surplus of things to continue to make and I think it would have been more epinephrine and norepinephrine. They keep that anger and intensity up to counter this mentally wearing thing that you were being put through.

Dr. Gregory Kelly:

So in that context, a bigger dose was needed to maintain that. In daily life, we probably wouldn’t need that much. Now what I’ve also seen is I’ve seen some viral hackers mistake and say oh, be careful of taking a lot of L-Tyrosine it will make you angry. That’s not what it showed it was actually adaptive to have that resource in higher supplies in that context. If we were in a different context to L-Tyrosine on its own wouldn’t have produced anger per se.

Jan Bonhoeffer:

Yeah. Which would follow the general rule that the body rarely overregulates it regulates into normality or into optimal state and rarely overregulates into the other extreme unless it’s a toxic substance. So I see. Basically when we are supplying even though we might be our nutrition is really great and we’re taking care of ourselves and we’re sleeping well and we’re managing physical health and we’re managing emotional balance. When we are in a good state of health we might benefit from a nootropic. When in view of or when we’re facing a more stressful period or a more challenging period we could almost create a bit of a reserve for the hard times ahead of us.

Dr. Gregory Kelly:

Both that and in the midst of it. That’s why most people with Qualia Mind we would recommend five days on two days off. So we’re very big believers in cycling essentially it tends to create a more sustained positive response over durations of time but personally if I was going to go to a trade show and be exhibiting at a booth with lots of background noise and people demanding my attention for long hours of the day. I’ll do a bit bigger dose of Mind because I know my brain is now going to compared to my normal comfy life that I have my environment dialed in. I don’t have the noise assaults, the people clamoring for my attention. My brain needs more resources for that. I know when I’ve done that I experientially feel like I’m an upgraded version of myself across that more demanding time period. With that cycling, even a more modest dose of Mind during a normal workday or workweek can be advantageous because our brain is constantly being given surprises at work. Social surprises but I know in the medical profession as choreographed as a doctor can make their day there’s… I don’t recall when I was in practice rarely had everything go according to plan.

Jan Bonhoeffer:

Yeah. Sure. It’s a constant adaptation, right? That is why you have to be really aware and you have to be really alert and you have to be present. If you’re roboting through the day or you’re overtired you’re making more mistakes to actually it becomes dangerous is a question of patient safety at some point. Obviously when we look at those colleagues that are really frustrated and disillusioned and may be depressed and questioning their profession and the wonderful profession that they have. So when it goes as far as that then clearly we have been out of balance before that so I guess everybody working in healthcare knows about that being really present for possibly a number of patients during the day. Then that requires a lot of energy. So one of the key drivers of this I feel like performance is available energy. We can do a lot of sleep. So what is the signs behind the nootropics adding on top of just sleep well and you’re going to be fit?

Dr. Gregory Kelly:

Yeah. So when I think of… Nootropics to me is a category of things that we just talked about L-Tyrosine that does a really relatively specific suite of outcomes because it’s a building block for a certain pathway. L-tryptophan is a nootropic but I think it’s much more of a weakened pathogen. Something that is more because it can go two pathways. Serotonin eventually melatonin or kynurenine which is another pathway and lots of metabolized but one is NAD so like a building block for cellular energy. But what I’ve seen in research of L-tryptophan given just on its own you see a lot more of altruistic behaviors than studied with L-tryptophan. Obviously, mood is a big thing that’s been studied a lot with it. It’s also been looked at for behavior but again what seems like L-tryptophan.

Dr. Gregory Kelly:

When we talked about L-Tyrosine in that military study anger doesn’t seem like a particularly great emotion but in that context it was adaptive. So L-tryptophan it’s the same. It tends to make us more homeostatic socially. So if someone’s being trampled it will allow them often to stick up a bit better for themselves. But for other people, it would bring out the altruistic behavior. Unlike Tyrosine where we get a lot in our diet tryptophan on average, I think we might have mentioned this last time we only get six to 800 milligrams on average. So it doesn’t take much of a dose of L-tryptophan to change our state sometimes.

Jan Bonhoeffer:

That’s interesting. So it almost seems the way you’re describing this it almost seems like when you have a beautiful radio channel and you have some good tunes coming through on this radio channel. If you have a radio receiver that doesn’t really work really well. That’s kind of broken and that doesn’t really have all the parts that it needs to pick up the vibes and it only picks up three-quarters of it. The experience is not going to be quite the same. So if I were a state if we go let’s say into state-changing practices and yet our instrument if you like that we’re playing on isn’t able to really resonate with that frequency that is being established or that we’re trying to allow to come through. We talked about stepping out of the way. It sounds like that nootropic would have it’s almost like tuning an instrument or kind of an instrument builder.

Jan Bonhoeffer:

When you have the string instrument and it doesn’t have a clean sound and if we just shape it a little bit and bring it into a better shape then actually aha. If you then strike it actually then there’s resonance. Is that how we could see a nootropic in it’s optimizing or central neural system to the degree that if we’re changing state then I feel like the body of resonance is prepared to actually go with that flow rather than being in the way and not really being able to go in phase with the state change.

Dr. Gregory Kelly:

Yeah, I think even some of these that we talked about they’re changing subtly our state. So like L-theanine typically is experienced as somewhat of an anti-stress response. Like a relaxation response. It’s often with green tea which does have some caffeine not as high concentration as coffee but enough but the reason we experience drinking green tea differently than a cup of coffee is often attributed to that L-theanine because it’s creating that counterbalance. I think resources would be my baseline thing. Do we have enough resources to make what we need given context that might be more strenuous than sitting at home with loved ones? So we want to make sure yes, do we have those?

Dr. Gregory Kelly:

We can get a lot of those from our diet but depending on a diet… So I’ve seen a couple interesting studies on vegetarianism and creatine. So creatine for 25 years that’s been used for sports performance and great compound. I’ve seen really a burgeoning amount of research on supplementing creatine for both memory, memory with aging but also mood. Part of the reason is we talked or we touched briefly on it this idea of making energy. These things when our brain is challenged with more things even staying in a flow state it’s using a lot more energy. So yesterday I was talking with someone about chess and they mentioned that they’d seen I don’t know if it was in a documentary I’d have to look this up to verify it. But that a grandmaster will burn 600 calories during a chess game because of all the mental energy that they’re putting into that.

Dr. Gregory Kelly:

Now when I play chess I’m sure I’m not burning that much but that gives a sense of that would be a lot of exercise to burn that amount of energy. Part of the reason is that our brain burns about 20% of the energy that our body uses in a day. That’s pretty wild when you think it’s about 3% of our mass. So it’s just a very active tissue. So where creatine fits in, creatine’s the buffering system to make ATP cellular energy. It’s something that we can make a certain amount of in our liver and tissues but we need to get the rest from the diet and if we’re not eating meat it’s hard to make up that gap.

Dr. Gregory Kelly:

So what I’ve seen in one study was with women that when they went to become vegetarian they started to slowly build a hole. They couldn’t make enough creatine essentially meet their daily demands and it only took 1000 milligrams so a gram which is way less than bodybuilders or strength athletes would use to more than make up that deficit and keep them filled over time. So with something like creatine that’s what I look at is all right, we know this is super important for essentially making that buffering system for ATP. We know for strength athletics obviously, that’s why it plays in for sprinting and powerlifting and things like that. But for lots of the things our brain does especially for mood and strenuous mental activity creatine also plays a prominent role because our brain’s even more active than our tissues are when we’re exercising. My bias is we don’t need crazy high amounts of it to get a nootropic effect. Our diet, our lifestyle, the context of how we’re living our life all those things play into whether we would need some to experience our best performance.

Jan Bonhoeffer:

Yeah. Okay. So there is a minimal viable I feel like a concentration of a profile of different substances that we would ideally have in order to facilitate flow state.

Dr. Gregory Kelly:

Yes.

Jan Bonhoeffer:

So is there a way can we turn this around and actually measure? So if you’re taking a blood sample could you say by analyzing this profile of substances in the central compartment in blood would you be able to say this guy’s in flow state or not?

Dr. Gregory Kelly:

Not to my knowledge. I mean maybe there is a way to do that but I’m not aware of it and the other thing with… So this will be my belief about things in the blood is that what’s in the blood isn’t always predictive of what’s going to be in tissues. And even in something like the brain so we know that the brain uses a lot of glucose is it’s preferred fuel but what will happen if we’re engaged in say a specific type of energy-draining task what will happen it will create local depletions of glucose in that part of the brain. There may be plenty of glucose in our blood. There may actually be more than enough in other parts of our brain we’ve just created an allocation problem.

Dr. Gregory Kelly:

What we have there’s not enough of it in the region that’s using it most aggressively. So blood would never show that. The other thing and we talked about this a little bit I think off the camera in one of our talks is the idea of signal to noise ratio. So my belief about most things are receptor-mediated. Something has to get that substance from the blood into the cells into tissues and often that’s some type of receptor. Receptors function on change just like vision and hearing too they don’t function on quantity. So my analogy always one that makes sense to me is if this was an incredibly dark room right now and you lit one candle we would both notice a big difference. But in this bright room lighting, one candle’s not going to really… We wouldn’t even be able to tell.

Dr. Gregory Kelly:

So the one candle on its own was irrelevant. It was the change from the background noise level. So things in the blood like I remember getting frustrated at naturopathic conferences 20 years ago because they would mention oh, well, in this study folic acid was high in the blood, and yet heart disease was higher that doesn’t make any sense. It’s like well, it would make complete sense if the folic acid can’t get into the tissues. So a study I remember seeing again 20 something years ago so my details might fuzzy but the gist of it was I had this really good friend. He’s one of the only true short sleepers that I’ve ever encountered. So he thrives on about five hours sleep which is definitely not enough for me. But at the time he was only allowing about four.

Dr. Gregory Kelly:

His conversation in the late 90s was sleep’s a weakness like less is better and so going along with this not getting quite enough sleep he very active guy. Ran. He was not someone that could just sit still. He’d like to move. He said, oh, I get leg cramps all the time but as long as I take high amounts of magnesium, some potassium I’m all cool. At the time what I used to convince him that he might benefit from a little bit more sleep was a study that found that when you were sleep derived cells became magnesium resistant. So because of that, he needed a much larger dose of magnesium to overcome that resistance that the lack of sleep was causing.

Dr. Gregory Kelly:

So if we had measured his blood at the time magnesium would have probably looked high because he was getting a lot in the supplements he was taking. It just couldn’t get into the tissues to play its role. So he was then experiencing cramps. My biased is in general that expects when we’re not performing at our best there’s one or more molecules that there’s going to be resistance problems too. So those will show up sometimes higher but it’s not like insulin resistance. Insulin will be higher but it’s not doing its job. So I’m really cautious about over-interpreting things in the blood.

Jan Bonhoeffer:

Excellent so makes a lot of sense. What would you say for healthcare professionals? What is in the way? What are the typical features in healthcare professionals that are blocking flow state and what will be necessary for those in healthcare profession to really show up at their best if you like?

Dr. Gregory Kelly:

I think there’s many paths that we can take to get there but I know personally for me what I remember going back to my Navy time period I had all these different things competing for my limited brain bandwidth. So what should I do with my car when I go out to sea for the next six months? Should I sell it? Should I find a place to park it for six months? I can remember even something that seems slow like that it’s not like I needed the money or my life was going to be significantly changed one way or another no matter what I did with this car. But until I made a decision about that it would consume a lot of the bandwidth and then stack that with 50 other things all competing for what I think of as a finite capacity our mental bandwidth. So what I learned really that stuck with me over the decade since then is if I feel there is rumination about something.

Dr. Gregory Kelly:

If something I become aware of it keeps resurfacing what should I do about this just do something is for me. So in that situation, it was really almost the synchronicity this person I randomly met that was also in the Navy had a side business selling used cars and wanted a car just like mine to give to his daughter. I’m like literally dude you can have the car for a dollar. I just want to free up my bandwidth. I think that to me is the core thing. So I love Jamie Wheal’s wake up, grow up, show up analogy for performance optimization and flow state and what can often inhibit that wake up that prerequisite stage is our bandwidth is being consumed with all these low-level things. Then sometimes really big things like relationship issues or ongoing conversations we have with something at work or in other areas of our life.

Dr. Gregory Kelly:

So I think a prerequisite to be able to more predictably get to flow state is to become aware of these things that are eating up or consuming lots of our bandwidth and take steps to remedy as many of those as possible. What I experience personally and have definitely seen with other people I’ve worked with is when more bandwidth becomes available then all kinds of good things happen but our ability to perform in areas that require being in that flow state are much more likely now to occur.

Jan Bonhoeffer:

Yeah. Wow, and that is something that is very key to healthcare professionals often being burdened with a lot of simultaneous tasks or really intercepting tasks that are very complex building or managing 20 patients in the ward and a lot of them are in critical conditions. They’re all needing very rapid decision making you need to find a way to stack it all up so it looks a little bit like well, that’s exactly the kind of task set so that’s the kind of mental environment you don’t want to be in to be at full performance. Is to have all these many decisions that you need to make is that right?

Dr. Gregory Kelly:

Well, I think if that’s the only thing that’s consuming your bandwidth I think you’d be able to do it. So challenge is also a prerequisite so we don’t want to bored like challenging the brain but we want to have enough bandwidth available to then allocate to that challenge. So what I’ve seen is low-level things that keep popping in. As an example and this would have been super small but when I used to actually have hair before shaving my head there was a little bit of mental energy every day that went into does my hair look okay? Not a lot but it was one of the big things I became aware of when I started shaving my head is that that small amount of mental energy that went into being concerned about what my hair looked was completely shut down. It became irrelevant.

Dr. Gregory Kelly:

So what I’m talking about is more of these low-level things that are just consuming small amounts of our bandwidth but when added together they’re really squeezing that. So it then allows less to do what you just described which would be a challenging job under the best of circumstances but one that those professionals they’ve trained for that. They’ve got the skill. They’ve got all of the things to be able to do that and get into flow at least this is my story if we could free up more bandwidth for them to use during their day.

Jan Bonhoeffer:

That is really interesting so this is something that I noted during high-performance sport. So in martial arts, there was a practice that we were given and when I went into sailing there was another practice that I learned some kind of sports psychology training, and the practice that I thought a really nice description of this practice was they call it the black box exercise. So you basically when you’re in for a competition and you really want to have absolutely, full clear attention on just that and nothing else what you’re going to do if you just had some private life stuff that is really lagging? What do you do when there’s some… Yeah, whatever. Whatever is coming out of left field from a competition point of view where you want to be one-pointed focused. What do you do with that?

Jan Bonhoeffer:

There was this practice where you basically acknowledge that that is there, recognizing you can’t push it away. You can’t say no. No doesn’t work. It will knock on your door constantly and disturb the process so can we say yes to that? Actually, acknowledge it and say okay, you’re here. I see that you will get attention that is fine now we’re actually going to medical self-diagnosis kind of process. I’m now going to put you into that black box. You will be revisited we’re now closing that lid and you’re going to sit here until I’m back from the competition. It’s amazing what that actually does. So that’s bringing attention to what you’re just saying. This could be a lot of little small things.

Dr. Gregory Kelly:

It was one of my personal experiences that not all small but that it’s a combination so sometimes all we can really deal with in the moment might be the small. But if we take care of even a few small things that’s going to free up some bandwidth and all of sudden with the freed-up bandwidth the bigger thing might now be more manageable or something that we could take an action on that before we had removed these little things we just couldn’t even foresee how we would get there. So I’m a big believer in don’t let what you can’t do prevent you from doing what you can. Let’s find the small things that we can do now that will free up some bandwidth and we’ll worry about the bigger ones once we get more resources in the system and have shut down some of these lower-level concerns. It’s always great when you can address a big one that’s a bigger catalyst for change in my experience and it’s not always possible.

Jan Bonhoeffer:

Yeah. So there’s one where we talked about is one option in how we can show up in the best version of ourselves as healthcare professionals is to optimize headspace. So that is our ability to focus, our ability to declutter, our ability to select of all the possible things that can be thought that we’re actually focusing what is and then really stay with that. I guess that’s what most healthcare professionals know from stressful situations where you’re just drawn into this and if you’re not breaking down under the stress you’re actually excelling and that would create this constant emergency type situation that healthcare professionals seem to live in.

Jan Bonhoeffer:

So it tends to be a sympathetic overdrive type situation where we’re just going from emergency to emergency because that is where we last had that flow state experience. It almost creates an addiction to something that you’re describing actually not very conducive to flow state because now we’re in sympathetic overdrive and not in parasympathetic [inaudible 00:48:37].

Dr. Gregory Kelly:

Yeah. This would be my story about what is happening based on how you’re describing that would be high stress has a temporary ability to move everything else off the table so to speak. But it hasn’t gone away. As soon as that stress now it becomes less necessary to deal with. All these low-level things will start to creep back in on the edges. So they’re still there they still weren’t resolved. Two words I’m a huge believer in are resolving the resolvable and then congruence. Finding areas of incongruence and closing the gaps. In general, if we do those two things our ability to perform mentally typically rises quite up.

Dr. Gregory Kelly:

So resolving the low-level thing. I have these clothes should I lose weight and fit into them or give them to Goodwill or whatever like name the thing. But if you continually over time go back to what should I do with those clothes my baseline recommendation would be I don’t really care. Do whatever action you need so that you don’t continue thinking of them and usually that action is getting rid of it. That’s the simplest stuff. Then congruence I love an old Denzel Washington movie called Courage Under Fire. Meg Ryan was in it. I think a younger Matt Damon. I’m drawing a blank on a few of the other actors maybe Mark Wahlberg but basically, the setting was he was a tank commander. It was a late 90s movie so it was probably set the first Gulf War time period and as the commander, during friendly fire, his friend’s tank got blown up.

Dr. Gregory Kelly:

The army said well, we can’t talk about friendly fire so you can’t tell anyone what happened. So there’s a gap between what he knows happened and what he’s allowed to share with the world around him that happens. He starts to struggle with alcoholism and since he’s now underperforming as an officer they say okay, well, we’re going to just have you go investigate this case. It’s a slam dunk. We’re going to give this deceased woman, Meg Ryan’s character a medal for heroism. He actually does a better job than they expected and starts to find irregularities in the story. I don’t want to spoil the movie in case people do want to watch it but what you find is all the characters have some gap between what they’re saying happened and what actually did happen.

Dr. Gregory Kelly:

So that’s when I say congruence it’s that gap. It could be a gap between what we know happened and what we’re saying happened. Between our intentions and our actions. Anything, where there’s a gap if we can close then again my experience is that I think this might go back to bandwidth is bandwidth just really opens up. I don’t think our heart likes incongruence and the bigger the incongruence I think the more it weighs on us. When it weighs on us everything is squeezed.

Jan Bonhoeffer:

I’m glad you bring that up because that is… We talked about headspace performance kind of cognitive performance and then I guess part of flow state is a congruence I guess you would call it or synchronization or a being an in phase. There’s different terms for this between heart and play. So that’s not just our emotions in terms of what we’re feeling but the heart has a receptor with feeling things at least with most cultures allocate to the heart area, the heart or chest area. We’re saying that we’re kind of feeling something in a situation that doesn’t seem to be the result of our five senses but there’s a different kind of sensorium available as well. Hmm, this doesn’t kind of feel right, or hmm it’s kind of fishy here. There are other receptors and will you feel that part of flow state is coherence between brain and heart as well? Is that part of the flow state?

Dr. Gregory Kelly:

I do. I think that’s part of the reason that the right style of breathing is often one of the more predictable ways to get into that flow state because breathing tends to synchronize a lot of… My simple story is I think of my Greg like my internal physiology has the equivalent of being in this big opera hall. Something like breathing if I was to breathe say like breathe in for five seconds out for five seconds so six breaths in a minute. That tends to be a really harmonizing cycle but what happens in something like a concert hall if a C note was on a high-frequency instrument struck everything that’s a lower frequency C will start to resonate a little bit. So what tends to happen if we’re breathing is any slower frequencies will now be dragged into phase.

Dr. Gregory Kelly:

So to me breathing is a core thing to get into flow state and once we’re in flow state some of these things we talked about like our making decisions become easier. I’m a huge fan of what I call paced breathing that five seconds in five seconds out but pretending that I’m breathing through this area. So my focus isn’t just on breathing it’s imagining somehow that I’m almost breathing into my heart if that makes sense. So I don’t focus on diaphragm or anything like that. It’s I’m literally imagining that the breathing’s coming in and out through here. When I focus on that it tends to very much and really quickly center me. Now I know there’s lots of other techniques but that’s just one that I’ve personally worked with and helped other people with. For something like the HeartMath the heart rate variability biofeedback, you can visibly see the change as soon as you drop into that pace of breathing.

Jan Bonhoeffer:

Yeah. It’s very old medicine going back to [inaudible 00:55:11] breathing is a very ancient Buddhist culture that have and just observed this by being very scientific and actually looking kind of meticulously looking this subjective experience without having all their technological options that we have these days. But that with refining our sensorium we could actually feel that so part of then moving into flow state and out of flow state. One is to have the prerequisites and to have the nutritional basis, to have the sleep basis to tune into practices that are helping to discipline the mind. So to select out of the wealth of potential thoughts to really focus on that realm of thoughts that is now required. So those are different kind of behavioral things and possibly substances, nutritions, and sleep.

Jan Bonhoeffer:

Is there a way that we can… How do I put that question? Is there a way that we can become more aware of whether we are in flow state or not? So that sensorium that you were just describing. That is not our five senses. Can we become aware of huh, I’m not in flow state and what is required now in order to move back to flow state? Is there an internal skill set that can be developed here?

Dr. Gregory Kelly:

My belief would be yes, obviously I think the more we invest in techniques like medication or things that would be… So think of martial arts. We’ve done Tai chi for a while where we put the work in to now once we started we’re going to tend to move and do it more focused state so you’ll go and any almost moving meditation practice seems over time if we’ve invested in it it will kick us into that. But the other thing like I’m a big fan of Daniel Kahneman’s work thinking fast and slow and his two characters system one and system two. I was listening to this neuroscientist on it’s actually called We Study Billionaires. It’s an investing podcast but the episode I was listening to when I was driving yesterday was this neuroscientist John Gald. During the midst of this he’s like this has happened to me a whole bunch of times I get in the shower and then realize hey, did I wash my hair?

Dr. Gregory Kelly:

He’s essentially gone on autopilot. So even something like that is now he’s not even sure if he did. I think that’s what we run into is that the system wants us to have two character from automate. The idea is that we have system one character that is very much instinctual and autopilot and is not inclined to put in a lot of work and to focus. Then we have system two that’s going to do that much more cognitively demanding things but only has enough energy. We only have enough energy for that one to show up selectively. So I think what can happen is that many of us don’t have enough mental energy for system two character to show up much of the day. So unfortunately a lot of the day is on autopilot when that’s the case we’re unaware like in this case how was joking about he said, did I even wash my hair?

Dr. Gregory Kelly:

But imagine all the things we’re unaware did we do or not do because in a sense we didn’t have enough mental energy to be tracking how we showed up and what we did. So I think one of the best gifts we can give each other is to have people close to us that can give us feedback. I’m a huge believer like the idea of feedback is the breakfast of champion. So I remember I lived in New Haven at one point when I was teaching naturopathic students and a girlfriend I had at the time out of the blue one day she’s like, what’s up with this word literally? I’m like, oh, well, what do you mean? She goes, well, you literally say literally a lot. I’m like, I do? So I was completely unaware it was this black box for me.

Dr. Gregory Kelly:

What I noticed as soon as she pointed that out I became more aware and she was right. I was saying literally a lot. So as I became aware I was able now to consciously filter that out but what ended up happening a few months went by and I can’t remember what the other word is. She’s like, it seems like this word replaced literally. [crosstalk 01:00:10] attention too and she was right. Another one had crept in. So I think if we really want to optimize in any area having someone or some group that can give us feedback is going to be one of the more predictable ways. Now we can do some with technology that’s the HeartMath the whole idea of their heart rate variability. Really it’s a biofeedback device.

Dr. Gregory Kelly:

So I guess my base case would be especially areas that are blind spots where I’m likely to improve those without having some form of feedback because if we could have we would have. Usually, to me, I’m almost going to assume the feedback loop is broken and so we need to build that feedback loop first. So resource is super important through products like Qualia Mind fit in, practices that we talked about, using meditation, breathing, sitting meditation, sleep. All the things that build our reserves and are building to focus but then that last piece is super important and that’s having people that will give us feedback and again my base cases and this is just personally. I know how important feedback is I still don’t love getting it.

Dr. Gregory Kelly:

So realizing none of us like to necessarily get feedback. It feels hard, it feels critical, judgemental and that’s fine. But if we have that reaction don’t penalize the person giving the feedback let them know. It might be an hour, a day later that you really value that feedback. Then like I said feedback tends to once we have that loop closed is when good things can now start to happen because it becomes almost like a virtuous circle.

Jan Bonhoeffer:

Beautiful. If in addition to the prerequisites to supplements to sleep to behavior to practices to focus. If in addition to that we could actually promote team behavior in healthcare so in those teams that actually work together where it’s part of being a professional to actually help others recognize when they’re not present. When they’re in some sort of default system mode and they’re actually not fully aware and they’re not really available for the moment. They’re just roboting preprogrammed behavior rather than actually being available and possibly doing something quite unexpected. That I guess would be threatening to a lot of the hospitals if you have employees that are not predictable because they’re in presence. That are following the protocol but they might actually do things that are not quite protocol.

Jan Bonhoeffer:

I guess that’s not maybe what every HR department wants to see but at least we could help by staying presence and maybe what the CEO of the hospital would like to see is that we’re having less patient safety issues. We’re actually safer and people are actually happier and there’s less depression, less suicide going on in the health profession.

Dr. Gregory Kelly:

Yeah. I think both pilots in hospitals have done that where they’ve created simple checklists and other things that act almost like a degree of feedback. It’s not feedback for a person but it’s feedback because you’re going through the sequential step to make sure that system one doesn’t essentially zone out. Something that was important. Yeah. I’m a big believer in… Again so my base case would be taking the system one, system two-character analogy and assuming… So what I’ll often hear is this idea that the brain’s really lazy and given a choice like it’s system one if it thinks it can handle it it’s going to take that job over and system two’s not even going to get engaged. I think some of that has to do with not enough brain energy but some of that there’s a truism there. That we’re going to be on autopilot some of the time no matter how great we are at meditating or our job. So things that we can build in to make sure that even when we’re in system one we’re not going to have washed our hair and forget about it are important.

Jan Bonhoeffer:

Great. Thank you. Thank you, Gregory Kelly. Thanks a lot for a lot of insights, reporting from a very fascinating field of product development, and your own experience. With a lot of I feel very useful pointers for healthcare professionals in how we can support each other and take responsibility each and every one of us to actually show up as the best version that we can.

Dr. Gregory Kelly:

Absolutely. Well, thanks again for having me on your show it’s been wonderful talking with you again.

Jan Bonhoeffer:

Thank you. All the best. Take care.

Speaker 1:

This has been a Heart Based Medicine production thanks for listening.