Naomi Simon, MD, talks about her research into mindfulness-based stress reduction (MBSR) and yoga as treatments for anxiety disorders. Dr. Simon is a Professor in the Department of Psychiatry at the NYU Grossman School of Medicine, and Director of the Anxiety, Stress, and Prolonged Grief Program.
Topics:
Cited: Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders (Nov. 2022)
Visit our website for more insights on psychiatry.
Podcast producer: Jon Earle
Naomi Simon, MD, talks about her research into mindfulness-based stress reduction (MBSR) and yoga as treatments for anxiety disorders. Dr. Simon is a Professor in the Department of Psychiatry at the NYU Grossman School of Medicine, and Director of the Anxiety, Stress, and Prolonged Grief Program.
Topics:
Cited: Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders (Nov. 2022)
Visit our website for more insights on psychiatry.
Podcast producer: Jon Earle
NOTE: Transcripts of our episodes are made available as soon as possible. They are not fully edited for grammar or spelling.
[00:00:00] DR. THEA GALLAGHER: Welcome to NYU Langone Insights on Psychiatry, a clinician's guide to the latest psychiatric research. I'm Dr. Thea Gallagher. Each episode, I interview a leading psychiatric researcher about how their work translates into clinical practice. Today, I'm speaking with Dr. Naomi Simon. Dr. Simon is a professor in the Department of Psychiatry at the NYU Grossman School of Medicine and director of the Anxiety, Stress and Prolonged Grief Program. She recently caused a splash with a paper about using mindfulness-based stress reduction and yoga to treat anxiety disorders. In our conversation, we take a deep dive into that research and explore what it means for clinicians.Well, thank you so much for being with us today, Dr. Simon.
[00:00:39] DR. NAOMI SIMON: It's my pleasure. Thanks for having me.
[00:00:43] DR. THEA GALLAGHER: So, we're just gonna jump right in, and I'm super excited about, uh, this topic. But can you tell us a little bit about the overview of your work and current research focus connected to mindfulness-based stress reduction and yoga for anxiety disorders?
[00:00:56] DR. NAOMI SIMON: Yes. So my work has focused on a range of anxiety disorders. And maybe just to start, that anxiety disorders are very common in the population, and they tend to onset at young ages with, like, median of age 11. But they're often undetected and undiagnosed, so many patients do not necessarily receive care, and they often seek help in the community. And as I think you've probably become aware, mindfulness, meditation and yoga practices have become very popular as means of stress management and stress reduction. And it's really through this that, uh, my interest and through colleagues working in this area, came to focus on whether yoga and mindfulness-based stress reduction approaches might be effective if we test them formally, the way that we test other interventions in clinical trials as a treatment for patients who do have a full diagnosis of anxiety disorders.
Because, um, you know, as you know, we have some great first-line options. These include things like cognitive behavioral therapy and pharmacotherapy, medications such as the SSRI anti-depressant class of medications, but not all patients either can access them or may tolerate them, or even be willing to participate in them. So, you know, there's always a need for additional options. And in our work, we really want to build the evidence so that we can have evidence-based treatment practices. And this is how I became interested, through that and through some key colleagues who were doing work in the areas of yoga and mindfulness, to do this work.
[00:02:41] DR. THEA GALLAGHER: Yeah. And I think when you're talking about access to care and options and willingness, would you say that mindfulness-based resources and yoga are more accessible?
[00:02:53] DR. NAOMI SIMON: Well, they, there are definitely challenges to accessing mi- formal mindfulness-based stress reduction classes, so I can tell you about one of the studies that we did for this purpose was a study to really begin to build a formal evidence base that might allow MBSR, which is an eight-week formal class of, you know, two, two and a half hours, often with a retreat day. That does cost money and it's not covered by insurance. And our hope that was if we can build the evidence base, for example, compared to first-line treatment like an SSRI anti-depressant, in this case, Escitalopram in the study that we did, that insurers may be more willing to pay for that sort of treatment. I think yoga, because it's been in the community much longer in different forms, um, there are many forms of yoga that are accessible through different means, some of which are in person but, uh, even more so since the pandemic, um, accessible through apps or recordings or, um, over the internet. And that's starting to happen with MBSR as well. So, you know, I, I would say many people are accessing yoga who may not be going to see mental health practitioners.
[00:04:10] DR. THEA GALLAGHER: And in your study specifically, um, you did focus on the formal MBSR. And can you just break that down again, what exactly that looks like, and then also, what the yoga piece looked like as well?
[00:04:22] DR. NAOMI SIMON: Yeah. And these are two different lines of work, so maybe we could start with the, um, MBSR, mind-body stress reduction one that you're talking about. And I had, uh, a wonderful psychiatrist who's working with me and did her career development award with me looking at mind-body stress reduction compared to a stress education class to see if mind-body stress reduction, if you really tightly control for a comparator group where there's time and attention matched, um, would be effective for patients who have generalized anxiety disorder. So that's the general worry-focused condition that tends to be, uh, early onset and, uh, usually fairly chronic. And she was able to show a significant effect compared to stress education of the mind-body stress reduction class.
So kind of building on that work, um, in my time here at NYU, we collaborated. Her name is Elizabeth Hoge. She is at Georgetown, uh, with her and another one of my collaborators, Eric Bui from Mass General, we did a three-site randomized, controlled trial, uh, funded by PCORI. And that study was designed as a clinical effectiveness study with the idea that we want it to be applicable to comparing what happens more closely in real-world settings, so we did not control for time.
What we did is we just compared it to the delivery of Escitalopram over eight weeks and the delivery of the class in groups of, uh, four to six people. And that's an eight-week class, so people come in and they have an instructor. They take a class for two two-and-a-half hour blocks with homework assigned to practice, so that has mindfulness and meditation exercises and really a lot of different options to learn some of these techniques. They may include body scan or other types of meditation that they can try, uh, and practice and a generally mindful awareness of their thoughts in a nonjudgmental way.
And, uh, we compared that to the delivery of Escitalopram at 10 to 20 milligrams in a kind of flexible titration. And the question in that study was set up very formally as what we call a non-inferiority design, so we were really asking the question, like, is MBSR class as good or non-inferior to a first-line evidence-based medication for anxiety disorders? And we allowed, uh, entry of patients with a range of core common anxiety disorders in that study, so generalized anxiety, panic disorder with or without agoraphobia, and social anxiety disorder. And those conditions tend often to occur comorbidly anyway. Um, but we had a broad entry criteria with the idea that this should be generalizable to people with different types of anxiety disorders. So that was the design of the study.
We didn't control. It's limited, you know, in, in the comparison in a different way. We didn't control for time and attention. It was less time for people who received the medication, but that is what happens in practice. So we're really having the aim of, of asking the question, like, you know, should this be considered similarly as a strong evidence-based intervention. And perhaps, to your, you know, answer your earlier question, increase access by, you know, making an established, evidence-based intervention at the level of a first-line medication and maybe insurers would consider it as an intervention in the future that they would cover.
[00:08:12] DR. THEA GALLAGHER: Yeah. And, um, and what were the results of the study?
[00:08:14] DR. NAOMI SIMON: So, remarkably, there was essentially almost no difference between the two treatments. So we did find, um, you set up ahead of time what, uh, in a non-inferiority design, you set up like, what's the allowable difference in the primary outcome measure that would still suggest they're about the same? And for us, we used, uh, CGIS, or Clinical Global Impression of Severity, anchored in anxiety symptoms. And we allowed just below about half a point to be still similar, and the difference was .07 between the groups. And actually, if you map, I can't show you on a podcast, but if you map the graph over time, because the primary outcome is at eight weeks, but then we had follow-up assessments as well at week 12 and 24. And if you map the graph, the lines are sitting exactly on top of each other across the response profile. So that was, uh, really remarkable how similar they were in response.
And the other thing that was remarkable about it is that the dropout rate was lower due to adverse effects for the MBSR group, and in general, there were just fewer, um, you know, difficulties tolerating the MBSR class compared to the Escitalopram. Really, the one thing maybe, um, you know, if people are having their patients go to MBSR to be aware is that for some people when they initially start to meditate and be internal with their thoughts, they may initially have some increased anxiety. So we had about 10% of the population that did report that at least transiently, but it's something that you work with directly in, in MBSR and learn different methods over time.
So in the end, the MBSR wa- was, uh, shown to be, as hypothesized, non-inferior in terms of efficacy and effects for, um, anxiety symptoms themselves over time in this population with a range of different anxiety disorders, but actually better tolerated and significantly lower dropout. Um, so 8% dropped out from the Escitalopram group and none from the MBSR group. And even more striking, fully 78.6% reported some side effects, at least one kind, with the medication, and only 15% with MBSR. And as I mentioned, the majority of that was a transient increase in anxiety as they were first getting comfortable with learning how to meditate and finding a practice.
One of the nice things about MBSR is it's quite flexible by design and nonjudgmental in approach. So it works, uh, with anyone doing the course to find what works for them and how to kind of notice what's going on with them. So you know, uh, if you first begin to attend to your internal thoughts and sensations, at first, you might have some increased anxiety in some settings. So that's really only 11% of people who had any of that. But what it, what happens over time is that people who participate in, in that kind of approach and practice over time find what works best for them, and they learn to be aware of their thoughts and feelings and not judge them and not, you know, get as caught up in them so that they can kind of reappraise what's happening with them. And it helps with emotion regulation, uh, and the management of anxiety and stress over time. So, uh, i- it's really a well-tolerated approach if you're able to access it, as we were talking about.
[00:11:56] DR. THEA GALLAGHER: Yeah. And you said it's a course, an eight-week course, and then you kind of utilize... D- did people need to, like, utilize it on their own for maintenance of gains, do you expect?
[00:12:06] DR. NAOMI SIMON: Well, um, the, this is a course, it was developed by Jon Kabat-Zinn. Uh, and there is now beginning to be more experience with delivery online. It was an in-person course. I don't think there's too much data on those growing efforts to try and look at it through apps and things like that. But we actually have some data we haven't fully analyzed or put out there yet that just happened to occur during COVID because we turned the class into an online class, the whole study, actually, during a period of time just as a pilot. So we're going to go and now look at how that was.
It's not a perfect randomized, you know, comparison, but we will be looking at that to see how the delivery through the internet, um, because, you know, certainly there's some things you lose when you have a group of people on Zoom and they're not in person and interacting with each other. And you know, we have different types of, um, primary anxiety disorders present. So people who have social anxiety and they have to come to a class, there may be other aspects that are helpful in, uh, making a community with the people in the class. And uh, it's a question, is it as effective over Zoom in a group or in person, and for whom is it more effective? So we're going to be looking at that in more detail as a pilot study going forward.
[00:13:28] DR. THEA GALLAGHER: Yeah. And it sounds like if it can, you know, if it can be accessed on the internet, that would really allow for greater access to care. And it, and it's, it's not clinician administered, correct? So, you know, it, especially if there, if there is a component where it's in a group format or an internet format, that would really create greater opportunities for access to the, to the program, right?
[00:13:50] DR. NAOMI SIMON: Well, yeah. To, to be clear, currently, you know, we used all fully certified and trained MBSR instructors. So they have to go through a full certification process. Um, but, you know, whe- whether you have to be a clinician, I don't think that is required as long as you can learn and go through all of the training and certification. We wanted to make sure that we had high fidelity, uh, that we were testing as designed the, the full course. And there are many places, um, you know, around the country where, where that is delivered. I don't think it's been tested as a course without an instructor to my knowledge, not a full course. Because there are kind of interactive aspects that occur in discussion, so uh, I think people are working on this, and certainly there are many apps out there that haven't necessarily been tested, uh, in randomized, controlled trials. Um, although there's some evidence for effects of some apps with mindfulness approach, it's not exactly the same as the class.
And, and to your question, participants were asked to do 40 minutes of homework a night. Most people can't do every day 40 minutes of a meditation practice of one kind or another, but they did, um, you know, participate in some of the homework and learn how to be able to do it. The idea is to be able to learn skills and then to find what works for you and try and integrate it into your life going forward. We didn't require that people continued after the eight weeks, and we don't have really good data to say exactly how much people were practicing. We just didn't, um, collect that in that level of detail, like, how many minutes did they practice after they finished the primary end of the study itself. But we do know that they were continuing to do well out to, you know, the 24-week follow-up.
[00:15:42] DR. THEA GALLAGHER: And what advice would you give or what do you think that clinicians, psychiatrists, therapists can do with this data? Like, should they encourage their patients with anxiety to enroll in a course, um, as an adjunctive maybe to medication or the therapy that they're doing? Uh, what's, like, the takeaway for, for practitioners?
[00:16:04] DR. NAOMI SIMON: Well, actually, the, the suggestion here is that it can be first-line intervention. So you know, perhaps, for, if you're a psychotherapist, you're already doing a therapy, you might have a different perspective. Um, you know, and there is, uh, other data looking at CBT as a comparison that, um, suggests that, uh, it may not be quite as potent as CBT, although that's just, you know, different studies come up with different designs and, and findings. But our data suggests that it, uh, it's comparable to a first-line intervention. So if that's available and what the patient is interested in, and this is, you know, also important for primary care doctors who often can't get their patients into therapy or evidence-based practice or get an appointment with a psychiatrist for six months. And so if you're waiting, it's also a good thing that one could try and see if it's effective, because we know it's well tolerated and, uh, there are probably many other health benefits that one gets from integrating this.
And it's really a lifestyle practice change comparable to, um, other work that's going on looking at exercise, for example, which may also have effects for anxiety disorders. And Kristin Szuhany in our department is actually studying that right now, trying to understand, for example, like, do you need to have high-intensity exercise, or is low-intensity exercise sufficient to get, gain benefits if you have an anxiety disorder? So I think all of these types of approaches, and we can talk about in a few minutes, um, the yoga studies, but all of them are really trying to take, um, these integrative health approaches and understand how well can they really address, uh, core anxiety disorder symptoms and improve outcomes, with the idea that you would probably need to integrate that on some level into your lifestyle over, over time.
I, I do want to just mention that we have another exciting area of research going on in follow up to this work right now. Uh, I have grant with Dr. Mohammed Milad, who I understand has done a podcast with this, um, series already and perhaps mentioned us, but it's a follow-on study really trying to understand, how does MBSR work in the brain to improve anxiety disorders and anxiety symptoms? And uh, you know, it's, again, to be considered at the same level, it's helpful to understand mechanism. We understand a lot of psychological mechanisms, but there is preliminary data suggesting that you do get functional changes in the brain with fMRI, but it had been studied with MBSR in a healthy control population in an initial smaller study. And uh, we are doing this really in follow up to that work and in follow up to our clinical work right now.
So we're doing a comparable design, as I mentioned, as the first study with comparing classes of mind-body stress reduction, in this case, for patients with generalized anxiety disorder. And we're comparing that to the stress education class, and we're using a paradigm to understand how kind of fear learning in the brain is managed functionally and the changes that occur in the brain over time. So we're assessing fMRI, uh, with a paradigm that looks at this question, like, how do you make connections of fear learning and then how do you extinguish those? And how do those changes affect brain changes that may be present in a different way after you've had the class compared to before the class?
So we'll be able to look at questions like, are those changes different for people who are in the mind-body stress reduction compared to the control condition? In this case, we did the time and attention control, so we can control for that when we're looking at mechanism and not have a medication in the mix. And then questions like, if you do get brain changes, like functional MRI changes when you do a, a behavioral paradigm, is that associated with your symptom change both initially and then over time, because we'll have the symptom follow-up. Like, can that predict who's gonna continue to do well if they get... is that, you know, helpful or necessary?
And we'll also be looking at gender differences in outcome and response as well because there is some preliminary data that we have that women respond more strongly to mind-body stress reduction than men. And we also have many more women come into our studies, so we had about three-quarters present for this study compared to one-quarter men.
[00:20:56] DR. THEA GALLAGHER: Amazing. And my final question about this is you were talking about that you're going to look at kind of the mechanism of action in the brain and try to understand more. Is there anything that we already know, because you said some psychological mechanisms? Like, what do we know about the mechanism of action here?
[00:21:12] DR. NAOMI SIMON: I mean, I think we could say that, um, you know, definitely we're still learning about this, but we do know that, uh, there are changes in, uh, acceptance and tolerability of distress … uh, and different changes in self-judgment that occur, uh, so some of the kind of acceptance-based mechanisms. We think that there are changes that occur as well in terms of emotion regulation. So instead of, um, taking a thought and needing to focus on it and accept it as a real thing, so like, if you're having a negative self-thought, for example, or you're worrying about something that's going to happen, that you are able to step up a level from it and be able to not judge yourself and be able to consider that it, it may not be a reflection of reality. So it's kind of a reappraisal mechanism that helps for emotion regulation. There's some, uh, you know, data that suggests this may be the case.
[00:22:19] DR. THEA GALLAGHER: It's really great, too, that finding that there are all of these options that more research is coming out about. There are more things that people can do on their own or, you know, with minimal time commitment, uh, from an instructor. That things that people can utilize for the rest of their life, skills, tools, habits, um, that are seemingly to be, finding, you're finding that it's just as effective as medication. And that's really so powerful and so important in our field. And, and I kinda want to talk about, get into the, um, the studies you've done and the research you've done with yoga because again, yoga is wildly accessible. Um, so what have you found with yoga and anxiety disorders?
[00:23:01] DR. NAOMI SIMON: So, we actually did the studies with yoga before we did the mind-body stress reduction, but I think there's probably some overlaps in terms of the mindfulness aspects. And MBSR has a small amount of yoga within it, and I would say yoga has a smaller amount of mindfulness within it. And both of them work, I think, to improve what we've talked about, sort of self-efficacy, tolerance, distress tolerance, and emotion regulation are the hypotheses. But this, the work that I did with, um, yoga, uh, was really inspired by two collaborators, so Sat Bir Khalsa, who is an expert in yoga and yoga research. A lot of his work's also in sleep. He's at the Brigham in Boston. And my collaborator Stefan Hofmann, who's at, uh, BU. Uh, during the study, we collaborated, and they had done, uh, pilot data. So similar idea of kind of building on some initial data just looking at kundalini yoga, it's a specific form of yoga, um, compared to treatment as usual in patients who had generalized anxiety and did find effects across anxiety measures.
Kundalini yoga, uh, is one type. As you know, there are many different types of yoga. That one was selected in part because it, it is a multi-component popular style, and it includes many of the different elements that are part of yoga. So there's the kind of theory philosophy part, the physical postures and exercises part, and th- a little bit of the kind of meditation, deep relaxation practice component. And then I think a part that's perhaps a little bit more than in some, say, yoga classes you might take for exercise where they're focused on very much the exercise component of yoga, uh, there's a lot of breath practice integrated into that. So we, uh, thought that would be a good one, um, particularly to address generalized anxiety disorder.
So in follow up to that pilot, we designed a three-armed study, uh, that was done at two different centers. And we compared yoga to cognitive behavioral therapy, again, to that stress education control condition. So we, same concept, we could take a well-established first-line treatment for an anxiety disorder, here, generalized anxiety, because uh, similar to the other studies, we thought that's the first one to go for because it's a common one. We already know that patients with generalized anxiety disorder have problems with muscle tension, difficulty relaxing. It's targeting a lot of core symptoms that are present within GAD.
And in this study, uh, we compared the similar kind of idea of small classes of yoga compared to cognitive behavioral therapy compared to that stress education class, so we could see, you know, if you have a control condition, do both yoga and CBT beat the control condition as an active intervention? And then how do they compare to each other? So that was the design of that primary study that we did, and the study was in this case 12 weeks, uh, to allow for the full course of CBT of 12 weeks using a standardized protocol that had been used many times, um, led by Stefan Hofmann, um, kind of overseeing that part. And then the kundalini yoga whi- which as I mentioned, is, um, with our colleague, uh, from the Brigham.
And in this study we also, interestingly, attracted a lot of women, so it was about two-thirds women to men in the study. But what we found is that in the study at the short-term primary outcome, both yoga and CBT were better than the stress education class. So this one of the, one of the first studies to really show that yoga could be an evidence-based practice to, again, have patients participate in if they have generalized anxiety disorder maybe as a first step. Could be an augmentation, but we didn't really address that question. That wasn't the design of this study. The design was to compare it to a first-line treatment of CBT, but again, as you say, like, if you can't access CBT in the community, then you know, there's evidence that yoga may be effective.
I would say the one, um, kind of hesitation about being as strong is we were not able to show that it was non-inferior. So unlike the MBSR, Escitalopram study, uh, we did not meet our kind of a priori non-inferiority margin. Uh, and actually, if you look at the graph, which again, I can't show you, yoga, it falls somewhat between the control condition and cognitive behavioral therapy. So it's still significantly better than the control stress education class, but not quite as strong as CBT, even though we weren't, we didn't have enough, um, difference to have a significant difference. It wasn't significantly poorer.
The other thing is that in the longitudinal follow-up, so following patients again to see, you know, after they finished the class, three months later, how are they doing? The findings with cognitive behavioral therapy were more robust, so it continued to be more effective than the control condition, whereas yoga did not quite meet that, even though we still had, uh, a greater reduction numerically at the six-month follow-up. So at the six-month follow-up, just to be more specific, with the CBT response rate was 77% compared to 48% in the stress education class. And the yoga was in between that, so 63%. So we still had almost, you know, almost two-thirds of people achieving response with the yoga intervention.
So again, I think following on your question, what do clinicians do with this, I think it's really helpful to know that this can be helpful for some patients and may be another option, especially to overcome barriers to care. Um, you know, also, some patients are not willing to take a medication or not able to get into a CBT ever even, o- or for a long time. So, you know, more research hopefully is going to, to, you know, study if it matters which type of yoga it, it is and what form of delivery is needed. Does it have to be in person in a class? Can you do it through an app? Or, there's so many ways that you can access yoga now in different forms. Like, how much do you need to do? These are really open questions that we don't fully, uh, have the answer.
[00:29:42] DR. THEA GALLAGHER: Yeah. An- and it sounds like the research kind of looking at it as maybe an adjunctive to CBT or like, you know, for wait list, you said if people are trying to, you know, get in with a provider, we know that that can be a big barrier right now with just wait lists being what they are. And you know, in this current mental health crisis, um, having other resources that are more easily accessible, it sounds like yoga is a great intervention. But kind of, how do you guide your patient into what kind of yoga? Um, it sounds like from your research, you would say a safe bet would be kundalini style yoga?
[00:30:18] DR. NAOMI SIMON: Yeah. I mean that, at least there's good data with that, but I do think that any... um, and I, and I know Dr. Khalsa would say, any multi-component yoga that's going to hit on each of those core aspects is... you know, there's good data for at least, uh, anxiety and stress symptom reduction, even if it's not in the specific full anxiety disorder population for all of those multi-component ones. I think another important aspect that a psychologist in our group, Dr. Kristin Szuhany, studied as a secondary analysis is patient preference, and I think we sometimes underrate that. Like, what does the patient prefer to do? And we, we did ask this question.
Clearly, people came in knowing they'd be randomized, but you know, it was pretty equal split as to who wanted CBT and who wanted yoga. But interestingly, more the women preferred yoga over CBT, so, you know, it may be that different types of patients, uh, uh, may prefer different types of treatments. And I think, as we know, your likelihood to engage and really, um, you know, put in the effort and time for what you have to do, practice, you have to go to class or do the classes, it may in part be driven by if you think it's a good thing to do for yourself and how that works for not just your outcome. There are other factors that are involved in that as well. So I think considering patient preference is another important component.
[00:31:52] DR. THEA GALLAGHER: And like you said, one that, um, I think has been underutilized. And a big theme from this podcast that's coming out is this personalized medicine approach and figuring out what is best for each individual at different stages, um, and it, you know, what, what might be the best approach for them at this time. And you're saying even maybe for some, you know, more women, they find that it's more, you know, that that's their preference, but finding things that will work for people. And if you have motivation and buy-in to do it, that's also going to help the treatment process in the long run. So I think there's a lot of key takeaways for, um, psychiatrists and clinicians from your work that they can use today and they can suggest today, which is great.
[00:32:34] DR. NAOMI SIMON: Yeah. And I would say we've been talking about our work specifically looking at anxiety outcomes, but we don't want to ignore the fact that there is also a lot of research looking on health outcomes. So you know, with all of these types of approaches, like meditation, yoga, exercise, you can have other health benefits, like cardiovascular health, for example. So those are additional benefits and motivators for people to, you know, participate. And uh, really the challenges are, um, you kind of hinted at it, so you know, if somebody does a class and it's a short-term thing, are they going to continue that? Just like the challenge that we have with exercise, which is engagement over time, when, you know, your motivation may be high initially for a variety of reason, but how do you continue to integrate these practices over time? And how much do you need to for the anxiety benefit? We do know for some of those other benefits, you need to continue those practices over time.
[00:33:35] DR. THEA GALLAGHER: Yeah. And I think it's looking less at people, um, kind of just this symptom and this symptom and fix this thing. It's kind of looking at, again, the whole person, the mind-body, um, interaction and connection. And hopefully, there'll be a variety of, you know, skills and tools and ways to interact with habits in our life that will also help the, the greater whole. And it does seem a bit more, um, holistic for the person.
[00:34:02] DR. NAOMI SIMON: Exactly. And certainly, I know I hesitated on your answer about like, should it be adjunct, just because we were talking about what our studies and, you know, the formal studies for disorders is showing, but there really isn't any harm. So if you're taking a, a medication and you have a patient who's interested in doing an MBSR class or, uh, yoga, integrating that or exercise in their life, there's so many positive reasons to support that, um, you know, in, as even a way to engage in their life in a different way, uh, that there-
[00:34:38] DR. THEA GALLAGHER: Yeah and minimal side effects, which is great.
[00:34:39] DR. NAOMI SIMON: Exactly. As long as they, you know, don't have risk factors for exercise. If you're gonna be doing exercise, you do want to make sure they're able physically not to have that as a contraindication, but beyond that, yes.
[00:34:53] DR. THEA GALLAGHER: Yeah. The cool thing with yoga, too, just there's a lot of, uh, adaptations, you know, with chair yoga and a lot of things that can meet also people at, you know, various levels of mobility, which is also another kind of, when we're speaking of access, um, a lot of options. And it seems like it's a greater approach to meet the needs of so many people, not just, um, you know, specific groups. So, thank you so much for, uh, being with us today. This was a great conversation, and I think, um, one where people can, can use the research that you've done today. And that's so exciting 'cause we, you know, we're trying to minimize that lag between research and practice. So, uh, thank you for all the work you're doing, and we'll be looking forward to seeing maybe some of the functional mechanism work, um, in the future.
[00:35:38] DR. NAOMI SIMON: Absolutely. It's been a pleasure. Thank you.
[00:35:42] DR. THEA GALLAGHER: Thanks so much again for that conversation, Dr. Simon. If you enjoyed this episode, be sure to rate and subscribe to NYU Langone Insights on Psychiatry on your podcast app. On the next episode, I'll be speaking with Dr. Michael Bubu about his research on the link between sleep and neurodegenerative diseases. For the Department of Psychiatry at NYU Langone, I'm Dr. Thea Gallagher. See you next time.