Teaching Experiential Practices in Medicine

“Knowing” Through Direct Experience

What exactly is an “experiential” practice, and how is teaching such practices different from other forms of teaching in clinical medicine? A simple way to understand experiential practices is that they involve learning through direct experience, rather than by reading, listening or watching.  In other words, you cannot learn these practices by reading a book; you can only learn them by doing them. 

What “knowing” means is to have had direct experience of a state of body and mind, rather than holding a collection of facts.  Some examples of experiential practices include meditation, yoga, and breathing techniques. Some examples of non-experiential knowledge include the names and uses of medications, the pathophysiology of diseases, and the ability to accurately recognize and categorize different diagnoses.

To be effective for your goals, and the goals of your patients, it is essential to experience these practices with guidance from a teacher, who has also been a student.  That is, the teacher must have experienced these practices with guidance from their own teachers themselves.  As you can see, this is quite different from typical clinical teaching, which usually involves educating patients by sharing data, rather than guiding them through an experience. 

To Teach, you Must also Practice

I have been so pleased to see the progress the fields of psychiatry and psychology have made in recognizing the benefits of mindfulness-based practices in clinical work.  When I was a medical and graduate student (2003-2011), I did not hear the word “meditation” at all during my education.  Fast-forward to 2018, when I returned to clinical work after a hiatus, and there were dozens of psychiatry residencies proudly advertising mindfulness-based stress reduction (MBSR), and similar distillations of meditative practices, as a part of clinical training. 

However…what I found was that trainees were typically given written scripts, which they would read to their patients in order to teach them meditation.  Meditation was not necessarily experienced or practiced by the trainees, instead it was recited, similar to other types of medical education.  I wonder…did those patients benefit from the teaching, and did they continue to practice?  The teachers who have guided me in my own experiential practices have advised that if the teaching is mechanical, the practice is likely to become mechanical.  Although you may benefit from such a mechanical practice in the beginning, you will likely reach a barrier, and without guidance from someone with experience, you may not continue to progress.

A few studies have looked into the factors that influence whether or not people benefit from meditation, and if they continue to practice.  These studies have found that those who have had a retreat experience or have spoken with a meditation teacher are more likely to continue to practice, whereas those who had their first experience using a technology are less likely to continue to practice.  This does not mean that learning from apps or scripts is “bad”; they reduce barriers to entry, and get many people started with meditation who cannot access a teacher.  However, to move beyond the mechanics of experiential practices, and towards your goals, it is important to find a teacher, and importantly, find a teacher who also practices what they are teaching.

Why I Practice Integrative Psychiatry

My Parallel Education

Reason #1: I have more to offer my patients than just medications

Alongside my medical and scientific training, I completed what I like to call my parallel education in yoga therapy. This was a 3-year process that built on 10 years of experience as a yoga student, and was concurrent with my postdoctoral fellowship in neurobiology, while I was living in Switzerland.  What is most important is that this training, the time I spent as a student of yoga therapy practices, and my experience with teaching yoga and meditation to my colleagues, friends, and others, all occurred prior to my return to clinical work in psychiatry.  This allowed me to formulate a clinical approach to psychiatry that always included an integrative perspective on mental health treatment. It has also given me extra tools, beyond medications, that I can offer to my patients, as they chart their unique paths towards whole person well-being.

Things are Changing

Reason #2: The Evidence Base for Integrative Psychiatry is Growing

More and more evidence is accumulating demonstrating the efficacy of non-medication augmentation strategies for mental health.  What this means is that more researchers have become interested in studying the effects of combining nutritional and herbal supplements, life-style changes (such as diet, exercise, and other changes in habits), and mindfulness-based interventions with psychotropic medications for treatment of mental health diagnoses.  Since most academic clinicians, and any clinician keeping up with the evidence base, rely on researchers to conduct the studies that inform their treatment strategies, this is a really exciting time to be practicing integrative psychiatry, because we know more about which strategies are most likely to work.  There have also been innovations in the field of neuromodulation, which is just a fancy term for technology that involves activation (or inactivation) of regions of the brain that contribute to mental health symptoms.  These are newer and very effective non-medication treatments with an expanding number of applications across different age groups.  The evidence base for non-medication augmentation strategies continues to grow, making integrative medicine approaches more acceptable to the medical community, and more useful to patients.

Autonomy, Choice and Becoming Unnecessary

Reason #3: Integrative psychiatry relies on patient self-empowerment and autonomy

I don’t believe entering into a treatment relationship with a psychiatrist is meant to be a life-long commitment.  In fact, I believe our goal as physicians should be to become unnecessary. There is also something troubling to me about any treatment relationship that builds a feeling of dependency in a patient, rather than nurturing self-empowerment and autonomy. Integrative psychiatry places well-being in the hands of patients by offering medication augmentation strategies that are dependent on the patients daily choices, rather than relying on the psychiatrists prescribing privileges alone.  The role of the psychiatrist in integrative psychiatry is to provide knowledge, and to coach or guide, as it involves teaching, motivating, troubleshooting, and thoughtfully passing the responsibility for improvement from the psychiatrist to the patient, over time.