burn it

Up Next: Your Day in Review

There's nothing like formal seated meditation for training the mind in the art of equanimity, but seated meditation can often seem intimidating or time-consuming. I've recently been experimenting with a lightweight form of meditation that is not hard and won't take a single minute out of your day. It may even give you a few minutes back by helping you fall asleep more quickly. I call it the Day in Review, and here's how it works.

Unlike most meditation, you do this one by laying down in bed, with the lights out, at the end of the day. The technique is deceptively simple -- you simply visualize everything you did today, starting from the moment you woke up, right up to the moment you started to review your day, in as much detail as you can remember. Here are some guidelines to keep in mind:

Every detail matters. It's not enough to just think, "And then I brushed my teeth." Instead, try to visualize exactly where and how you were standing, what the toothpaste tasted like, what you were thinking about as you did it, where you were looking, what sounds you may have heard, etc. Bring in all five senses, and try to relive the experience. You might be amazed at what you end up remembering -- like the model and color of a car you were following, or the pattern on a colleague's shirt, or even the exact wording of an email you wrote.

You don't have to relive every second, but if something changed (e.g., you finished brushing and started spitting and rinsing), then you should review the new activity.

Don't worry about skipping something if you can't remember anything about it.

Most importantly, keep yourself on track. In other words, when your mind starts to wander off onto future events or things you did some other day, gently remind yourself that you can think about those things some other time, right now is your review time.

Also, don't cheat and jump ahead to the "juicy" or "important" events. The really juicy stuff is actually all of the other things you did. Try to remain a detached observer of your life, without looping back on the same "good" or "bad" experiences.

Try to keep it a little challenging. Some of us are much better than others at visualizing and remembering. If that's the case for you, just reach for the next level of detail, the one that makes it a little bit hard to recall.

There's one basic rule: You must review everything you did today, in the order you did it. It's okay to get sidetracked, and you'll probably want to replay some scenes, but you should always come back to your timeline review wherever you left off as soon as you realize that's happened.

By the way, I rarely make it much past my memories of this morning's breakfast before I fall asleep. And that's okay. In fact, it's a happy side effect!

You may be thinking, "That's not meditation! There's no paying attention to the breath, there's no sitting upright, there's no focus on the third eye or visualizing of lights or mantras!" Indeed, there aren't any of those things, except for the use of visualization. But the core activity of any meditative practice is control of your attention and maintaining your focus on something. That something doesn't have to be your breath -- it can be just about anything, and in this practice it's the story of your day and how you moved through the world in the last 16 or so hours. The practice of always returning to the true story of your day, as an external observer, will help you learn how to view your life with both detachment and acceptance. It may also motivate you to have more awareness during the course of the day, so that your nightly review can be that much more detailed.

I really like this practice for a number of reasons, and not just because it's easy and helps me fall asleep. First of all, it's different every time I do it, so there's no resistance on my part from being worried it may be boring. Second, like some other forms of meditation, it's the re-telling of a story, but this one doesn't involve any memorization and is super personal and relevant. Third, it's a nice way to put "bookends" on the day, closing today's chapter and letting you file away the good, the bad, and the ugly -- resetting your mind to start the next day anew.

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Healing by Degrees

I hate to sound jaded, but with age, most of us come to expect sadness, loss, and disappointment. From our newspapers to our Hollywood blockbusters, we are inundated with stories of pain and emotional scars, and if we're lucky, we will get to witness the sweet taste of retribution for all that hurt. There is definitely a societal price to be paid for our addiction to catastrophe -- and one that I believe vacillates between a callous disregard for suffering to a hyped-up endorphin-fueled rage.

Maybe that's why I'm always pleasantly surprised when I stumble upon love and forgiveness in the most unlikely of places. In my work as an advocate for survivors of child sexual abuse, I have the opportunity to share my experience and strength through various talks and panels. This past week, I participated on a panel with four other survivors of sexual violence, for a lecture series at York University. Before the first speaker got up, the anxiety in the room was palpable, as those in attendance expected to be decimated by stories of lost innocence and unimaginable transgressions. But with the telling of each survivor's story, a surprising theme began to take shape -- one of resiliency borne of forgiveness.

Language is power, and the language we use not only defines what we say but also who we are. You'll notice that I've chosen not to label myself as a "victim," but as a "survivor." What many may say is only a subtle shift in vocabulary is in fact predicated on a seismic shift in thinking, one to which I believe forgiveness is the key. Before I enter into a discussion on forgiveness, I'd like to state unequivocally that I am by no means a "saint" when it comes to the art of forgiveness -- there are many times I stubbornly choose to hang on to toxic, self-destructive resentments.

When I think about what lies at the heart of forgiveness, I'm reminded of a poem I studied in undergrad by the 18th century English writer Alexander Pope.

True Wit is Nature to advantage dress'd

What oft was thought, but ne'er so well express'd;

Something whose truth convinced at sight we find,

That gives us back the image of our mind.

There's nothing magical or ethereal about forgiveness. In fact, it's staring us directly in the face, yet so often we refuse to reach out and unveil its beauty. On those rare occasions when we do, we discover the truth of "what often was thought, but never so well expressed."

For me, truth lies in the faith of forgiveness, and when I surrender to this "faith of forgiveness," a newfound freedom enters my life. I don't believe that forgiveness is a one-time act, but rather an unfolding process. We often get hung up on the "other party" when it comes to forgiveness, as we struggle with whether or not this individual warrants our compassion. And it's at this point that I need to remind myself that forgiveness is not something I bestow on someone else -- it's a gift that is mine alone.

You may be asking yourself, "What does forgiveness look like?", and "Can we honestly expect anything from the person we forgive?" These are indeed valid questions, so I'd like to turn to Rabbi Jonathan Sacks who expressed this philosophy so beautifully. When asked how he copes with pain, anger, and grief in his life, he responded: "I say to the bad times, I will not let you go until you bless me." And this to me is why I see forgiveness as a lifelong process of connection. Like it or not, we are all connected, so it is impossible to live a life in silos, in which we let the good in and keep the bad out.

When it comes to forgiveness, we are well served to let go of our anger yet hold on to the lesson. By inviting this lesson into our lives every day, we maintain that connection with those we choose to no longer have contact with. There is a general misconception that "forgiveness" is somehow tied to "reconciliation," and it is within this misconception that we often deny ourselves the permission to forgive. Forgiveness is an inside job -- a coming to terms with our own anger and hate. When I forgive, I give myself the permission, and freedom, not to expect to rewrite my past. When I forgive, it does not mean I "condone" something that happened to me, and thus -- forgiveness -- a shift in my own thinking, does not entail an apology from someone else.

Author and ethicist Lewis B. Smedes describes the process in this way: "Forgiving does not erase the bitter past. A healed memory is not a deleted memory. Instead, forgiving what we cannot forget creates a new way to remember. We change the memory of our past into a hope for our future." If we are able to continue further down this path of forgiveness, one day we might reach a point of "reconciliation" -- seeking common ground and understanding to move forward with another.

In the end, the choice is ours whether or not we have faith in forgiveness. When I'm asked how I can possibly forgive the individuals who sexually abused me, I respond by saying, "How could I not?" Faced with the choice of indefinitely hanging on to the anger and fear nestled in self-pity and resentment, or the choice of releasing myself of those toxic feelings, I choose the path of freedom. Have I been released of all the hurt from my past? No, but I do have faith in the process. In the words of the immortal William Shakespeare: "How poor are they that have not patience! What wound did ever heal but by degrees?"

---

Need help? In the U.S., call 1-800-656-HOPE for the National Sexual Assault Hotline.

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Chronicles of Health Creation: Joint Commission Issues New Pain Standards in Response to Integrative Medicine Team

A Nov. 12, 2014 announcement from the principal accrediting agency for health care organizations could significantly impact access to integrative pain care throughout the United States.

The agency is the Joint Commission. The revised accreditation standard will apply to all the institutions under the agency's guidance and review: hospitals, ambulatory care facilities, home health and senior homes.

The focus of the change is great news for integrative health and medicine. The Joint Commission significantly elevated the potential value of "non-pharmacologic" approaches. Among those options directly called out are, in the terms used by the Joint Commission, acupuncture therapy, massage therapy, chiropractic therapy, osteopathic manipulative treatment, physical therapy, and relaxation therapy.

The Joint Commission did not act in a vacuum. The action was prompted by an April 2013 request for review of the pain management standard by a team led by acupuncturis Arya Nielsen, Ph.D., Ac from the Department of Integrative Medicine at Mount Sinai Beth Israel. The team subsequently provided consultation and support for the Joint Commission's investigation.

The full story of the collaboration speaks to the power of two impassioned individuals backed by their health care organization plus the well-utilized muscle of the growing Consortium of Academic Health Centers for Integrative Medicine.

The effort began with a recollection of Nielsen. She recalled reading nearly 15 years earlier in the Integrator for the Business of Alternative Medicine that the Joint Commission had vaguely referenced non-pharmacological approaches in a 2000 pain standard. The intervening period had been robust for acupuncture research. Wasn't it time, Nielsen reasoned, for taking another look?

Nielsen is director of the Acupuncture Fellowship for Inpatient Care at Mount Sinai Beth Israel Hospital. She took a comprehensive literature review she'd presented at a hospital grand rounds to Ben Kilgler, M.D., MPH, vice chair of the hospital's Department of Integrative Medicine. Kligler happened also at that time to be the chair of the above-mentioned Consortium.

Two excellent suggestions emerged. First, why not open the query to the Joint Commission to a range of non-pharmacologic approaches rather than just acupuncture? The interval since the 2000 standard almost precisely coincided with the era of research funding by the NIH National Center for Complementary and Alternative Medicine following its creation in 1998. Studies funded by this agency alone vastly expanded the science on multiple non-drug approaches.

Nielsen and Marsha J. Handel, MLS, the department's informatics lead, submitted a literature review of acupuncture therapy for pain. A subsequent review was submitted for massage therapy with assistance of researcher-massage therapist Janet Kahn, Ph.D., LMT from the University of Vermont College of Medicine. The Nielsen-Handel team also submitted a review of studies of relaxation therapy.

Second, why not ask those members of the consortium of medical schools with integrative programs who wished to do so to co-sign a request that the Joint Commission revise the standard. This could add a measure of gravitas. Twenty chose to do so. They spoke to the significant opioid abuse problem in the United States and the typical lack of treatment options given patients despite the mounting research supporting integrative therapies and practitioners in pain treatment.

The door opened at the Joint Commission. Nielsen subsequently served on a January 2014 stakeholder panel of pain medicine specialists throughout the US that was tasked to help the Joint Commission revise the standard.

The beauty in the language of the revised standard is the side-by-side placement of "non-pharmacologic" and "pharmacologic" approaches. In fact, the non-pharma options are listed first. While this order was likely for alphabetical reasons, it follows a proper therapeutic order in which less-invasive approaches are considered first.

Accreditation insiders will note that the revised pain standard does not have the full police force the Joint Commission can put behind an action. Hospitals and clinics will not be "scored" on their compliance. Thus the move is seen more as a carrot that empowers integrative interests rather than a stick to force integrative pain treatment among the reluctant.

Notably however, in their statement on the revision, the Joint Commission specifically asked that "when considering the use of medications to treat pain, organizations should consider both the benefits to the patient, as well as the risks of dependency, addiction, and abuse of opioids." The admonition helps tee up exploration of other options.

Gratitude in this time of giving thanks. Credit the Joint Commission for its responsiveness. Credit Nielsen for seeing the opportunity and doing the major work, with Handel, to create the case as the core Mount Sinai Beth Israel team. Credit Kilgler and the Consortium of Academic Health Centers for speaking up for the need for change.

The new standards will bring patient care a step closer to a "Never Only Opioids" era, blogged about here on HuffPost, that can help us undo the present harm to human beings, families and communities from unnecessary use, and overuse, of prescription pain-killers.

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Creating Is a Drug

Creating, producing, making, enhancing, growing. All of these things provide pure, exuberant joy in my soul. I am completely happy when I'm using my creativity, and I am blessed and grateful to say that I'm able to do this through writing and doing hair. Utilizing my creativity has become an incredibly healthy and much-needed outlet that alleviates my anxiety and brings me peace, calm, and happiness.

It took me a really long time to realize that I'm a creative person. I grew up thinking I was merely an academic and not talented elsewhere. I believed my brother had all the talent in the family -- the kid is an amazing drummer and an uber awesome artist. I got the good grades, so I thought that was it for me. However, I had always loved doing hair and practiced on friends since middle school. I simply explored the way the hair moved and reacted to my touch; I developed a relationship with it, allowing it to tell me which direction it wanted to go. It was my art. Despite this intense love for my art and the great pleasure and relaxation it gave me, I was too scared to attend beauty school. I falsely believed it wasn't a feasible, practical option for me. I never thought it was a possibility, so I attended college aimlessly and drifted for years afterwards.

Eventually, my love for beauty took over, and I couldn't ignore my curiosity and passion any longer. They compelled me to enrolled in cosmetology school in 2006. I've been doing hair and makeup since but merely as a side job, not able to invest my time fully into it because of working full-time elsewhere for health insurance. This year, I decided to devote my time to the loves of my life intead of working a "have-to" job. Now that I have the time, I am able to do hair more, and I am obsessed with it. It doesn't feel like work. I get to transform the women I work on and create art using their beauty. The science behind color, the math behind cutting, and the art behind styling join to make the best combination to satisfy all areas of my brain and my heart. It gives me such a deep sense of elation, an inner glow that emanates from the inside out. That glow is building and manifesting into more opportunities to get my hands in more hair. The more I use my creativity, the more it grows, along with my confidence. I. LOVE. IT.

This somewhat recently discovered creativity of mine lends itself to my writing as well. I love getting my words on paper (or a computer screen). I so enjoy the craft of weaving my thoughts into articulate sentences and creating pictures with my words. Again, there's that word: creating. I am happiest when I create. It's me, my own, my rules, my time, my soul. It's pure freedom, and I've become addicted to it like a drug.

The natural high that ensues after I've written a new post or have finished a client's 'do is nearly indescribable. It is intoxicatingly joyful. I did that. I made that. I followed my own rules. I am in control of my life. I am doing what I love. I've found my heart's desires, and there's no ignoring them; they're pretty much yelling at me at this point making it impossible to turn away. Turning away would be the dumbest, worst thing I could do anyway. My path has opened up for me, and I'm going to follow it.

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Could Mindfulness Be The Fountain Of Youth?

Arc of Progress Fighting Heart Disease Evident in This Family

Bernie Dennis Sr. always wanted a grandson. While he dearly loved his three granddaughters, there was just something about the idea of a little boy sharing his passion for tinkering around -- fixing everything and anything that broke, building models and tossing a ball around in the back yard.

His one and only grandson finally arrived in June 1977. He was named Patrick, Bernie Sr.'s middle name.

Bernie, however, never met him. A heart attack had taken the patriarch's life that February; he was only 62.

Fast forward to April 1995. Patrick is weeks from graduating high school, so he and his mom go off to visit a college. His dad, Bernie Dennis Jr., didn't join them because he wasn't feeling well. As it turned out, he was having a heart attack.

Bernie Jr. wound up in the same emergency room of the same hospital that treated his dad. Horror-stricken by the memory of his father's final days, he'd soon learn what a difference 18 years had made in the fight against heart disease.

Bernie Jr. received great emergency care in the Coronary Intensive Care Unit during his month in the hospital where his life was saved as a result of several innovations supported by the American Heart Association.

Jr. received tPA, a clot-busting medicine that became standard about a decade after Sr. died.

Eventually, Jr. was administered an angioplasty, a procedure that was new and considered highly risky in Sr.'s day.

Despite those treatments, trouble persisted, so Jr. underwent a quadruple bypass, a procedure that also had become far more common and reliable. This did the trick, giving Jr. the second chance at life his father never got.

Bernie saw Patrick graduate high school, then college. He was there for his son's wedding to Victoria. Around Christmas in 2007, Anya arrived, making Patrick a father and turning Bernie into "Poppy." Another granddaughter, Elyse, arrived in 2010. Bernie and his wife, Joyce, meanwhile, are steaming toward their 43rd wedding anniversary in April.

Four-generation stories like this show the arc of progress in the fight against heart disease. In only a few years, the impossible has become routine. This is further illustrated by the following graphic, which shows the rate of deaths from heart disease plummeting from the 1970s to 2012, the most recent year for which statistics are available.

Of course, these aren't just numbers. Each digit represents a person -- family and friends, neighbors and colleagues, grandparents and grandchildren.

Bernie Dennis Jr. was so awed by the quantum leap in care from his father's heart attack to his own that he became an active volunteer for the American Heart Association, the nation's oldest and largest voluntary organization devoted to fighting cardiovascular diseases and stroke. He is now in the second year of a two-year term as national board chairman, and it's my pleasure to turn this space over to him to continue this conversation.

---

I'm a collector. Everywhere I go, I collect stories of heart disease survival.

AHA volunteers love sharing their personal stories with me, and I love hearing them. I now say that the story of the American Heart Association is the story of many stories. No one story is better than another, all are delivered with passion and each embraces our mission.

This brings me back to that graphic.

The death rate dropping means that survival is up -- way up. Let's crunch those numbers in another way:

Death rate from heart disease in 1970: 1 in 200

Death rate from heart disease in 2012: 1 in 500

When you factor in a huge spike in our population over those years -- from 203.4 million in 1970 to 312.8 million in 2012 -- the number of survivors becomes even more staggering. I'm constantly in awe of how fortunate I am to be among them.

I can't help but wonder whether the tools that saved my life might have saved my father's. I try not to linger on that, though, instead focusing on how much better the odds are for my son and my granddaughters. That's comforting.

(A quick aside: I work closely aside the president of the American Heart Association, Dr. Elliott Antman, and I've learned that he was among the researchers who helped discovered the benefits of tPA in heart care. The same drug that helped me survive while in the hospital, Wow.)

There's no telling what the future holds, but I know it's exciting stuff. That downward trend for the death rate will continue as we refine and discover new ways to not only treat heart disease, but also to prevent it.

As my offspring age, I hope the care for them and their generation is less invasive. I hope medicines can be administered long before problems manifest. Because we know that so many causes of heart disease are preventable, I dream of a day where the only risk factor is family history. Wouldn't that be wonderful?

I'd like to close with one last story that underscores why beating heart disease is so personal to me.

When my granddaughter Anya was about 4, her imagination overwhelmed reality. She loved coming over to our house and play-acting different characters. For about six months, she was always Tinker Bell, my wife was Peter Pan Mimi and I was Captain Hook Poppy.

Last year, I heard that Cathy Rigby was coming to Boston to do a final show of Peter Pan, and I got orchestra seats so Anya, Joyce and I could be right up close. We happened to arrive at the last possible moment, then were ushered right up to the stage; we felt like royalty being escorted to the front.

Just as we sat down, the show began. Cathy Rigby immediately comes flying by, dropping pixie dust on us.

Anya stood in her chair, grabbed me by the neck and said, "You're the best Poppy ever!"

I'll never forget that moment.

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How Experts Practice Better Than the Rest

My dad and I were standing in the front yard. Maybe that's why I remember it. We typically practiced baseball in the backyard, but for some reason we were out front that day. I was around 9 years old and learning how to pitch. My dad was walking me through the basic mechanics.

On this particular day, we were working on the backswing of my arm. The ball came out of the pocket of my glove, my elbow went up, and my arm began to swing back behind me in preparation to throw.

"Elbow up." That was the cue. "Elbow up. Elbow up. Elbow up."

We spent that whole session focused on one little movement of 12 inches or so when my hands parted and the backswing started. We probably repeated it hundreds of times that day. Sometimes with full throws, but mostly with drills and little practice patterns.

"Elbow up."

We kept working on this for a few days and then, at some point, we stopped talking about getting my elbow up and moved on to the next phase of the pitching motion. It wasn't until weeks later, when I realized we hadn't said "elbow up" in awhile, that I noticed that I was getting into the right position automatically.

I didn't know it at the time, but this was one of my first exposures to the concept of deliberate practice.

What Do Experts Do for 10,000 Hours?

Malcolm Gladwell published his blockbuster book, Outliers , in 2008 and the most talked about idea from the text was the 10,000 Hour Rule. Gladwell, citing research by K. Anders Ericsson, explained that the key to becoming world class in any field was to practice a specific task for at least 10,000 hours.

As you might expect, people quickly latched onto the number 10,000 and forgot the details of the argument.

Obviously, there is no magic in the 10,000th hour, but it is true that you need to put in a lot of work to become world class in any task. However, the important question is this, "What should that work look like? If you want to become great at your craft, what exactly should you do with your 10,000 hours?"

You can't simply put in your time and log 10,000 hours. You have to practice deliberately on a specific skill.

But what does that mean? What, exactly, does deliberate practice look like?

What is Deliberate Practice?

During a 2012 talk, programmer and author Kathy Sierra explained deliberate practice with a very simple and elegant answer. [1]

Deliberate practice is when you work on a skill that requires one to three practice sessions to master. If it takes longer than that, then you are working on something that is too complex.

Once you master this tiny behavior, you can move on to practicing the next small task that will take one to three sessions to master. Repeat this process for 10,000 hours. That is deliberate practice.

This is the first practical definition of deliberate practice that I have come across. It's the first time I have seen the 10,000 Hour Rule broken down into something tangible that you can use at your next practice session or the next time you show up to work. And it also ties in quite nicely with the idea of getting 1 percent better each day. Each practice session should be focused on mastering a tiny skill that makes you slightly better at your craft.

The Idea in Practice

This basic method of deliberate practice applies to nearly any behavior, but let's use weightlifting as an example.

This is what deliberate practice might look like if you are trying to learn the clean and jerk...

During the first session, you learn how to grip the bar properly and the fundamentals of the hook grip. There might be an additional session where you learn how to properly apply chalk to your hands before a lift.

Once you learn how to grip the bar, the next session is focused on teaching you the basic movement with a broom stick in your hand. At this point, you are simply learning the primary phases of the lift.

After a few sessions with the broom, you learn how to set the starting position of your feet. You experiment with different variations and get feedback over and over again on your foot position.

Next, you learn how to get into the set position to begin the lift. Perhaps you spend a few sessions focusing on different aspects of this set position. For example, you might spend one day working on keeping your shoulders back and your scapula down as you prepare to lift off the floor. Or, you could spend another session learning how to take the slack out of the bar before beginning the lift.

After that, you move on to actually lifting the bar off the floor (known as the "first pull").

And so on...

Notice that during each practice session focused on one individual skill. Your energy and effort were directed toward something small enough that you could master it (or at least master the basics of it) within one to three sessions.

Also notice, however, that each skill built upon the one before it. The knowledge that you built in early sessions, like learning how to grip the bar or how to set your feet properly, was required for succeeding in later sessions as well. (This is why good teachers make such a big deal about the fundamentals. Get them right and they help you every time you go to work. Get them wrong and every task suffers because of it.)

This is what deliberate practice looks like. I like the 10,000 Hour Rule because it is a reminder that you have to put in your reps. But it's not as simple as working for a long time. It has to be vigilant work. And in many ways, you have to be continually obsessed with building upon your current skill set in small ways.

3 Questions for More Deliberate Practice

From what I can tell, the experts who embrace the idea of deliberate practice continually ask themselves three questions...

1. Do I understand the fundamentals? No matter how advanced they become, experts never lose sight of the fundamentals. In many ways, they are advanced for that very reason: They understand the fundamentals better than anyone else.

2. Am I working on the next step? There are a lot of smart people who know what the next step is, but never do it. Similarly, there are many people who take action, but waste time working on skills that don't build upon each other. Experts build knowledge and skills that are cumulative.

3. What am I missing? One of the greatest pitfalls of the 10,000 Hour Rule is that it makes expertise seems like a finish line that can be crossed. It can't. Expertise is not a race that can be won. It is simply a process that can be embraced. Experts are constantly asking themselves, "What am I missing? What new information is out there? What can I learn? How can I grow?"

Expertise is a process, not an outcome. "Elbow up."

James Clear writes at JamesClear.com, where he shares science-based ideas for living a better life and building habits that stick. To get strategies for boosting your mental and physical performance by 10x, join his free newsletter.

This article was originally published on JamesClear.com.

References:

"Building the Minimum Badass User" by Kathy Sierra. 2012.

Let it be known that Charlie Hoehn, a true American hero, is an expert at expertise. This article does not apply to him.

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