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Dec 28, 2017 · Geniune Listening in Health and Mindfulness

In today’s fast paced world, communication is more important then ever, yet we seem to devote less and less time to really listening to one another.

Genuine listening has become a rare gift that builds relationships, solves problems, ensures understanding, resolves conflicts, and improves accuracy.

Listening also means fewer errors and less wasted time when doing tasks.

Listening builds friendships and careers, and saves money and marriages.

The Chinese character for listening (ting) is a composite calligraphy that eloquently express that listening is more than just attending to sounds, but involves many senses.

chinese1: Listen with your ears to what is being said (primordial).

2: Listen with our eyes (make eye contact).

In Western cultures, eye contact is considered a basic ingredient of effective communication. When we talk, we look each other in the eyes.

Put aside papers, books, the phone and other distractions. Look at people, even if they don’t look at you.

We exchange a great deal of information about each other without saying a word.

When face to face with a person, you can detect enthusiasm, boredom, or irritation very quickly from the expression around the eyes, the set of the mouth, the slope of the shoulders. These are clues you can’t ignore. When listening, remember that words convey only a fraction of the message.

3: Listen with your mind: Give undivided attention (do not be somewhere else).

Be mindful of distractions, like background activity and noise or most frequently your own thoughts, feelings, or biases. A common way of being away is judging the other person or mentally criticizing the things you are being told. As soon as you indulge in a judgmental path, you’ve compromised your effectiveness as a listener. Listen without jumping to conclusions.

4: Listen with your heart; try to feel what the speaker is feeling.

To experience empathy, you have to put yourself in the other person’s place and allow yourself to feel what it’s like to be her/him at that moment. This is not an easy thing to do. It takes energy and concentration. But it is a generous and helpful thing to do, and it facilitates communication like nothing else does.

Supporting Research

We previously have shown that health coaching among individuals with chronic lung disease discharged from the hospital, decreased readmissions and improved quality of life sustainably(1). We recently published a qualitative study investigating and trying to understand which part of health coaching was the most beneficial (2).

The results were striking and consistent. The most important factor in the health coaching was the kind and mindful communication between the patient and the coach. The listening skills of the health coach, a foundation of every health coaching training, really paid off.

In the context of apps and new technology, attentive and kind listening still seem to be a key ingredient for a care that heals.




  1. Benzo R, Vickers K, Novotny PJ, Tucker S, Hoult J, Neuenfeldt P, et al. Health Coaching and COPD Re-hospitalization: a Randomized Study. American journal of respiratory and critical care medicine. 2016;8:8.
  2. Benzo RP, Kirsch JL, Hathaway JC, McEvoy CE, Vickers KS. Health Coaching in Severe COPD After a Hospitalization: A Qualitative Analysis of a Large Randomized Study. Respir Care. 2017;62(11):1403-11. Epub 2017/10/25. doi: 10.4187/respcare.05574. PubMed PMID: 29061910.


Oct 5, 2017 · (10) Living With Cravings: How Mindfulness Can Help You Quit Smoking in Health and Mindfulness

Cigarette smoking is responsible for 1 out of every 5 deaths in the United States, making it the leading cause of preventable death and disease.1  Unfortunately, today’s smokers are more highly nicotine-dependent than ever, which makes quitting a constant uphill battle against intense and unrelenting urges to smoke, all the while enduring intense withdrawal symptoms.2 

Despite how difficult quitting smoking can be, nearly 7 out of every 10 smokers want to quit. While the task can seem daunting, it is possible – since 2002, former smokers outnumber current smokers.3 

Streets of Brazil

Photograph by Ivonne Begue de Benzo

So what makes a quit attempt successful? For smokers who go about it alone, without medication or the guidance of an established program, only 4% to 7% will be successful.4  For those who participate in a smoking cessation program, such as the American Lung Association’s Freedom from Smoking program or telephone-based programs known as Quit-lines, the success rate hovers around 13%.5 

But here is the shocking news – according to a systematic review released online this April, Mindfulness Training is nearly twice as effective as traditional smoking cessation programs, with 25% of participants remaining abstinent.

So why is Mindfulness Training effective?
In a Psychology Today article, leading researcher on mindfulness and smoking cessation Dr. Judson Brewer suggests that it is because standard treatments only focus on the surface level, whereas Mindfulness Training really gets to the root of the problem. 6

While traditional smoking cessation methods involve avoiding triggers or using substitutes, these actions only serve to avoid or dull the craving. However, this does not work in the long-term, because what we resist persists.

Mindfulness, on the other hand, is about paying a nonjudgmental attention to really examine the craving, to accept this moment as it is, and to be compassionate with yourself in all moments.

By teaching individuals to notice and pay attention to their emotional states and their cravings in this manner, they learn to ride them like a wave and let them pass. They learn to choose to be mindful of the moment, rather than instinctively and impulsively acting upon their cravings.


So how does mindfulness affect cigarette cravings? An article published in the Drug and Alcohol Dependence Journal found that after undergoing Mindfulness Training, participants no longer acted upon their cravings – despite experiencing them just as frequently as they did before the program.

Furthermore, the article found that mindfulness home practice significantly predicted reduced smoking behavior, even after controlling for initial craving and cigarette use. In fact, every day the participants meditated meant 1.2 fewer cigarettes, and every day they were mindful with their cravings and in everyday activities meant 1.52 fewer cigarettes.


So what aspect of mindfulness makes it so successful? The authors found that the nonjudging aspect of mindfulness uniquely predicted better odds of remaining abstinent up to 6.5 months post-quit, even after controlling for demographics and dependence.  Of those who were the most judgmental of their inner experience, at 3 weeks 23% remained abstinent and 6.5 months later only 4.5% were still abstinent from smoking. As for those who were the least judgmental of their inner experience, 54% remained abstinent from smoking at week 3 and 23% continued to remain abstinent 6.5 months later.

So what does all of this mean? Mindfulness Training for smoking cessation is nearly twice as successful as traditional programs. How is this? By teaching participants to be present with their suffering and cravings, they learn to ride them out instead of impulsively acting upon them. By teaching people not to judge their internal experience, they learn to accept their cravings and to stay present with them. Most importantly, they learn that it is so okay to suffer – that we do not always need to assuage our discomfort and cravings. They learn to simply be with this present experience, without labeling it as good or bad… but to just let it be the way it is.



Jul 1, 2017 · (9) Low Back Pain and the Practice of Mindfulness in Health and Mindfulness

Millions of Americans suffer from chronic back pain… and the numbers are only on the rise. Over a 14-year period, the percentage of Americans suffering from chronic, impairing low back pain rose from 3.9% in 1992 to 10.2% in 2006.   The Centers for Disease Control and Prevention (CDC) recently advised that those suffering from chronic pain should seek the use of therapies, such as exercise or cognitive-behavioral therapy, before resorting to the use of opioids.

orange sunset over the ocean

Photograph by Ivonne Begue de Benzo

One week after the CDC’s report, an article was published in The Journal of the American Medical Association (one of the most prestigious journals in the world) exploring mindfulness for treating individuals suffering from chronic low back pain. The study compared a mindfulness-based intervention with cognitive-behavioral therapy and usual medical care.

Cognitive-behavioral therapy (CBT), which has been demonstrated as an effective treatment for a wide variety of chronic pain conditions, focuses on training people to change the way they relate to pain. In CBT patients learn to challenge and reframe their negative pain-related thoughts. It encourages them to employ relaxation techniques, such as guided imagery, and emphasizes pain management skills – like planning activities that do not aggravate their pain.

Mindfulness-based interventions, on the other hand, focus on ways to be aware of and embrace “the now” in it’s entirety, including their pain. Mindfulness training encourages people to acknowledge their pain, their discomfort, and their emotional responses to their condition – and to embrace the experience of pain as it is. This is accomplished through the use of tools such as mindfulness meditation, yoga, as well as the continual cultivation of present-moment awareness.

So while cognitive-behavioral therapy focuses on change, mindfulness-based stress reduction focuses on awareness and acceptance.


What were the results?
At the end of the 8-week intervention period, both Mindfulness and CBT experienced clinically meaningful improvement in functional disability and pain at a rate that was much more significant than those who continued on with their usual care. Importantly, results were sustained for both treatments for an additional 4.5 months.

Astonishingly, those who participated in mindfulness-based stress reduction continued to reduce their functional disability and pain bothersomeness as time went on.

At the end of the mindfulness-based intervention, 47.4% experienced a clinically significant reduction in functional disability. Four and a half months later, that number jumped up to 60.5%. At 11-months post-intervention, that number reached 68.6%. The same pattern occurred with the participants’ self-rating of their pain bothersomeness – continual improvement as time progressed.

For those who participated in cognitive-behavioral therapy, while significant improvement occurred over the 4.5 months after therapy ended, the benefit plateaued at the 11-month follow-up.

On the contrary, the mindfulness-based intervention that was tested provided long-term pain relief, remaining significantly more effective than usual care 11-months post-intervention.

This important study put Mindfulness Training in the frontline as an effective treatment option for individuals with chronic low back pain, which affect the lives of many people worldwide.

Jun 1, 2017 · (8) Chronic Pain: How Can Mindfulness Meditation Help? in Health and Mindfulness

Chronic pain is a prevalent disease, affecting 1 in 10 U.S. adults, according a 2012 national survey . Commonly these patients are prescribed opioids to dull the physical experience of their pain. This has led to an opioid epidemic – in 2012 alone there were enough opioid prescriptions written for every adult in the U.S. to have a bottle of pills!

To address this issue, the Centers for Disease Control and Prevention (CDC) recently advised that those suffering from chronic pain seek the use of alternative therapies before resorting to opioid use.


Photograph by Ivonne Begue de Benzo

Pain is a complex and multifaceted experience that goes beyond just the sensory experience of pain. Many factors affect the experience of pain, such as one’s emotional state or the way that one thinks.  This subjective nature of the pain experience means that there is a multitude of ways to reduce one’s pain experience apart from popping pills.

Mindfulness meditation can alter the subjective experience of pain. Although Buddhist monks have been claiming this for thousands of years, research has only begun to verify this within the last 30 years or so. Just this past summer a comprehensive review was published detailing just exactly how mindfulness meditation diminishes pain, specifically by looking at the mechanisms within the brain.

What it boils down to is this: our experience of pain is dependent upon our appraisal and interpretation of the sensory experience of pain, as well as the meaning which we assign to it. Although we cannot alter the physical sensation of pain, we do have control over how we experience that pain.

This is exactly what researchers found when examining the brains of long-term meditators. In response to a painful stimulus, the areas of the brain associated with processing sensory information (such as a hot probe) were highly active, while the areas associated with pain appraisal (the areas that would assign meaning to the pain) showed decreased activation – even in a non-meditative state. (1 , 2)

The beneficial effect of mindfulness meditation on the pain experience is not just reserved for monks with decades of experience, or even for those wealthy enough to participate in a two-month long course… it is open and available to all who have the willingness to sit, breathe, and just be.

In fact, in 2011 the authors of the aforementioned review found  that the experience of pain is diminished after only four 20-minute mindfulness meditation training sessions – that’s only 80 minutes!

Mindfulness meditation teaches us to feel and experience what is – but also to refrain from explaining and contextualizing that experience. Instead of comparing our current pain to past experiences and assigning it meaning, we simply say, “I am experiencing pain.” By refraining from contextualizing the pain, we effectively decrease our experience of the pain.

For those of you who experience chronic pain, please understand: this does not mean that you should go throw all of your pain pills away to sit down and focus on your breath. But it does mean that there are practices available – such as mindfulness meditation – that can complement your current treatment and help you cope with that pain more effectively.

Click here to begin your journey.


May 1, 2017 · The Mindful Athlete: beyond training the muscles and technique in Health and Mindfulness

While it is a given that muscle training and technique are crucial to peak performance, recently more and more attention has been given to the impact mindfulness has on performance. The connection between the essence of mindfulness, the experience of flow, and peak performance lies in maintaining a nonjudgmental present-moment awareness.


Critical ingredients to mindfulness in performance are willingness, resilience, emotional buoyancy, the cultivation of present-moment awareness, and action (do something about it!). I do not claim that these are the only ingredients; however, they are some that I have found useful. Let’s discuss them a bit.

Willingness and Commitment The recognition of reality – of what really is – requires attention. Research has shown again and again that attention is critical for well-being and balance. We often make goals that are entirely unrealistic; goals that are based on our poor appreciation of what is. Commitment to reality, and to what you really want (not your coach, not your environment), is the critical first step to realizing peak performance and experiencing flow.

Foster Resilience There is much to learn from people who push limits, challenge conventional wisdom, and can excel in moments that are packed with intensity. One of the characteristics that many of them have developed is the skill of resiliency – being able to adapt and adjust to challenging circumstances. Going through some heavy stuff is catalytic in this process of becoming flexible. Being able to respond after a loss, and to cultivate a positive mindset in the face of adversity, fosters resiliency 1, 2.

Research has suggested factors that promote resilience include: a challenging situation, a sense of meaning (what is really important to you – what gives you the energy to keep going), cultivating a positive mindset despite adversity, and maintaining a sense of being aware of your own reactions 3. Importantly, cultivating resiliency is not merely reserved for the world’s best performers; it is for garden-variety people like you and me.

Emotional Buoyancy It is important to cultivate awareness in the moments when you are dwelling on thoughts, particularly when it is disappointments or stuff from the past (even during the competition!). Athletes (and average people) lose energy when they get into that vortex. Rather than getting caught up in judging yourself or in finding solutions to those mental events (your thoughts), admit that the churning of your mind is happening and try to go back to something simple, like the awareness of your body moving or the sensation of your breath. The latter is NOT easy and requires work (read below about a few tips to cultivate awareness). However difficult it may be, it is crucial to your well-being that you find a more productive focus and take a different action.

A critical tip for your emotional buoyancy: We cannot control the outcomes, so “when the lights are on” concentrate on the process (biking, running, playing tennis) and not on results.

Cultivate a Present-Moment Awareness Present moment awareness is realizing your focus or lack of focus. I compete in triathlons, and I found for myself that after I finished my swim and did not like my time, then many times I got on the bike and dwelled on the swim. I lost focus and took myself away from a good performance on the bike. Present-moment awareness (and acceptance) is seeing the negative thinking. Acknowledging the dwelling on the past performance and going back to pedaling is mindfulness in action.

Athletes need to cultivate present moment awareness. I am using the word cultivate on purpose: plant the seed for your self-awareness practice, patiently water that seed every single day, and observe the process as it unfolds.  This process never ends (sorry).  Meditation to me is a great tool for that cultivation. But hey, do not simply trust me on this… just do it and see what happens. Results can be unpredictable (remember we cannot control the outcomes, just the process), but that unknown is the nature of the practice.

Train yourself to be in the difficult moments. Find for yourself the right effort; find what you need to embrace a difficult state of mind. Again, this is tough. If anybody tells you that it is easy or that they have a recipe for an easy fix, be very careful – I personally do not believe there is any easy way to do this.

Take Meaningful Action The power of present moment awareness is to realize what is happening, and to be able to act on these observations. This could mean reminding yourself to breathe in a particular way or it could mean choosing a specific action to focus on, such as good mechanics on the bike.

Tips for the Cultivation of Mindfulness for Peak Performance (and for life) Have a strong commitment to the sport, to the truth, and to seeing reality as it really is. This is critical to setting goals and evaluating the progress. Take responsibility to figure out the reality in front of you now (as Phil Jackson may say).

Engage yourself in a regular meditation practice. This is the greatest “equalizer,” as we all have the ability to meditate and the capacity to see reality as it is. This is a foundational and necessary practice in my view.

Push yourself a bit to sit in meditation regularly (I said a bit). Seeing what is in the present moment will light a candle that was never thought possible and create a new condition, a new standard for you. Meditation is a physical practice that you do sitting on a cushion and having a balance of your erect (but not stiff) upper torso. It is like a balanced yoga pose that you maintain for a long time (20 minutes).

Engage in a regular yoga or QiGong practice, especially balance poses. Just as in muscular training, push yourself far enough to grow but not so far as to injure yourself. With your meditation practice, challenge your boundaries and push past your edge, but do not go so far as to strain so much that you risk your well-being.  Practice finding your balance within as you flow from one pose to the next, always drawing upon this place of stillness to help keep you balanced and grounded.

Take time to just relax. Relaxation is actually just letting whatever happens in the moment to just be.

Investigate your values: know them very, very well and align your behavior with them more clearly. This is very, very tough, but it will make you a more rounded athlete (and human being).

Ask yourself frequently: What is it like to be you? You are an athlete and a person. What do I really need to be the athlete I want to be? What do I really need to be the person I want to be? What is the training I need to get there?

As coach Pete Carrol says in his book ‘Win Forever’: have a clear philosophy and be a great listener, particularly of yourself.

The obstacle is the path. When you make mistakes, take ownership of the mistake. Instead of belittling yourself, take a quick moment to get perspective: about the big picture of your life, or the even bigger picture of how this moment in time is so small in relationship to the totality of all moments (tough…). Make the conscious effort, as much as you can, to hold yourself kindly through the uncomfortable times as if you were coaching your closest loved one.

Trust yourself (your inner coach). The most important coach is within you. You can train yourself more often than any other person in your external world ever could. That training, that self-coaching, happens through silence (during meditation). Investing in the awareness of your inner dialog can be a life-altering effort. Once we become aware of that inner coach, we can let go of the conversations that shred us to the core. Over time, just like you would trust a coach who has your best interest at heart, you’ll be able to trust your inner coach (you). This is an experience that can be transformative, and can accelerate performance (both on and off the field) at a rapid pace.

Give yourself permission to trust you and your condition at the moment (do not berate yourself mentally, it just doesn’t work). If you are constantly judging yourself, it is difficult to be in touch with your true self. Stop, meditate frequently, and you will find the needed balance and know what to do. Note I did not say create your balance, but rather you will find your balance because it is already within you.

You may never be what you think is 100% or perfect, but you are what you are in the moment, and that is true perfection. Anxiety and fear are not a problem unless you make them as such by ignoring your feelings and letting them build up inside of you. Anxiety and fear cease being a problem when you label it, and say that it is okay to feel those things. Do not identify with fear, but rather allow yourself to simply feel what you are feeling without judgement.

There is no such a thing as the big game or the big anything. We just have this moment.

These are just ideas from my own practice and training, research, and particularly from paying attention and listening to some special people like Jon Kabat-Zinn, Michael Gervais, and George Mumford .

Remember there is no recipe, as the recipe becomes a limitation. We do not need to “sell” or intellectualize the practice of mindfulness: we just need to do it.



  1. Luthar SS, Sawyer JA, Brown PJ. Conceptual issues in studies of resilience: past, present, and future research. Ann. N. Y. Acad. Sci. 2006;1094:105-115.
  2. Davidson RJ. Affective style, psychopathology, and resilience: brain mechanisms and plasticity. Am. Psychol. 2000;55:1196-1214.
  3. Frankl V. [Happiness and the meaning of life]. Krankenpfl. J. 1994;32:427-428.

Apr 1, 2017 · Mindfulness of Emotions Helps Coping with Chronic Conditions in Health and Mindfulness

Improving quality of life is one of the most important goals in health care, particularly in the treatment of chronic conditions. Emotions can play a critical role in the quality of life of individuals with chronic conditions. For example in individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD), one of the most prevalent chronic conditions in the planet, more than one third experience negative emotions, such as anxiety, fear of breathlessness, and depressive symptoms – all of which are associated with poor outcomes, like hospitalizations. 

looking down the steps on the wall of china

Photograph by Ivonne Begue de Benzo


EMOTIONAL INTELLIGENCE & COPD We recently looked to a large group of COPD patients to study the relationship between emotional intelligence, quality of life, and how the patients deal with their chronic illness and its physical, social, and psychological consequences – also known as self-management abilities. 

Our hypothesis was that emotional intelligence, or the ability to understand and regulate emotions, may serve as a buffer against negative emotions and alter illness perception. In other words, “the ability to reduce the impact of emotions may have the potential to influence what it means to live with a chronic disease.”

We assessed emotional intelligence by asking participants to identify their way of dealing with emotions with a well-establish scientific questionnaire that inquired about their ability to express emotions when they  want to or how often they pause and think about feelings.

We confirmed our hypothesis and found that higher levels of emotional intelligence independently corresponded with increased quality of life and with increased self-management abilities, regardless of age or disease severity. Additionally, higher emotional intelligence was linked with lower odds of visiting the Emergency Department. This finding provides an opportunity to lower health care utilization, and in turn lower health care costs.


WHY DOES THIS MATTER? Given that emotional intelligence is a highly trainable skill that can be learned at any age, it may represent a unique opportunity to complement existing treatment plans with the specific intention of improving the quality of life of people suffering from chronic conditions. We fully recognize that being more emotionally intelligent is meaningless unless tangible, real-life experiences are improved.


HOW CAN YOU BOOST YOUR EMOTIONAL INTELLIGENCE? Mindfulness training is the foundation of emotional intelligence programs currently found in the corporate world. One way to practice mindfulness is through mindfulness meditation , which was found by a recent study to be associated with significantly higher scores on measures of emotional intelligence.


In essence, emotional intelligence, which can be learned at any time in life, may be a “smart” tool to help individuals live better with a chronic condition and can be a novel tool to be incorporated into current treatment programs for chronic conditions.


We wish you well.



1 Abascal-Bolado, B., Novotny, P. J., Sloan, J. A., Karpman, C., Dulohery, M. M., & Benzo, R. P. (2015). Forecasting COPD hospitalization in the clinic: optimizing the chronic respiratory questionnaire. International Journal of Chronic Obstructive Pulmonary Disease, 10, 2295–2301.

2 Roberto P. Benzo, Janae L. Kirsch, Megan M. Dulohery, and Beatriz Abascal-Bolado “Emotional Intelligence: A Novel Outcome Associated with Wellbeing and Self-Management in Chronic Obstructive Pulmonary Disease”, Annals of the American Thoracic Society, Vol. 13, No. 1(2016), pp. 10-16.


[PMA1]Link to post #2, 15 tips on meditation

Mar 1, 2017 · About a Mindful Provider in Health and Mindfulness

As a provider I have come to realize that the challenges and difficulties we face when dealing with the health care system are a given. It is only through profound listening and observation that we can recognize the moment for action, the opportunity for growth, the path that will allow us to transform the problem into a purpose…only then can we find our way to creative innovation. It is through the power of willingness that we can literally create new possibilities.

Stopping, looking deeply, and focusing intently on the task at hand make us more attentive, more effective, and more complete doctors. It is only when we are attentive, engaged, and actively listening that true healing can occur.

bridge in nature

Photograph by Ivonne Begue de Benzo


I refer to my encounters with my patients as interdependence, as I also benefit from our interactions. This interdependence is characterized by awareness of suffering, by the courage to face challenges, and by altruism that borders on pathological optimism.

When I talk to health care providers I try to always emphasize that a collective shift in health care begins with us, with our personal shifts. We must first be the prototype before we can see widespread change. By embodying mindfulness and presence in our daily work we create the inner conditions to see more clearly the changes that are needed, and become the ultimate laboratory for testing these changes in the field. These changes can be as simple as actively listening and observing more. Changes so easy that anybody can understand them when we translate them into systemic innovation.

Mindfulness is the awareness that arises from paying a particular attention to the present moment, not judging (not ‘liking’ or ‘disliking’). Mindfulness is more than just paying attention to the present moment; it means befriending those dark moments that are a given in our personal lives, in our relationships, and in dealing with institutions. Mindfulness entails the realization that befriending those dark moments is okay, especially when they are our own. The latter is the true essence of compassion.

The health care system can be simplified to the patient and the doctor encounter: that is where we must start. We must remind ourselves that the effect of any intervention depends first upon the inner state of the one intervening. This means that working on ourselves must come first. If we cannot embody the principles of mindfulness and presence, how can we expect others or the larger system to?

For providers it is imperative to consider this alternative paradigm: the power of caring is more powerful than intellectual knowledge. In order to care more, we must first listen, listen again, and listen some more. We must make our patients experts in their disease, thereby empowering them. We must learn to put ourselves in their shoes and see from their perspective. In essence, we must begin practicing participatory medicine: a process by which the doctor and the patient craft the healing process together.

I believe with my heart that these practices have the capacity to close the gap between the people we are now and our highest selves. I believe that this will transform us into better providers, and that this will translate into better interpersonal relations and better institutions. I believe that these changes will give us freedom and lightness of being.

I once heard of an exercise that asks us to imagine ourselves on our deathbed, on our last day of life, in our final moments. What would we say to ourselves right now? I, personally, would tell myself that living with intensity – as if each day were my last – will produce profound transformation.

So I ask you: stop and look deeply inside yourself. Be ready for your free-fall into this journey called ‘mindfulness.’ Although the journey of mindfulness is one in which we are offered no securities, it is the one journey we may take in which we can be truly free.

Feb 1, 2017 · The Power of Listening: Mindful Communication in Healthcare in Health and Mindfulness

Often when we speak, we assume that the other person is intently listening to what we are saying. Unfortunately, this is not always the case. Without truly listening, proper communication cannot take place. This breakdown in communication is particularly devastating within the context of medical care, when a person’s health and well-being depends on the quality of communication.

tree branches over peaceful lake

Photograph by Ivonne Begue de Benzo

Research has found that, on average, physicians interrupt patients after 23 seconds. This shows a lack of listening – a necessary skill for a correct diagnosis and treatment, which rely heavily on the information provided by the patient.

A recent review on patient-provider communication, validated across multiple studies, showed that as trainees progress through programs they experience a decline in empathy and communication. The review also demonstrated a link between poor communication and malpractice claims.


Finding ways to communicate that make a difference.
We recently demonstrated in a large research study funded by the National Institutes of Health that high quality communication can not only improve well-being, but can also decrease hospitalizations in patients with the very prevalent chronic condition of COPD or smoking-related lung disease.1

The study recruited more than 200 individuals hospitalized with COPD. After hospital discharge the patients were allocated to one of two treatments: usual care or usual care plus weekly personal follow-up of a health coach trained in a particular way of mindful communication called Motivational Interviewing.

The study results showed that the health coaching and motivational interviewing decreased hospitalization and improved well-being.


So what lessons can we take away from these findings?
(1) The need to promote mindful communication – a critical and perhaps underrated aspect of care that we firmly believe is at the heart of practicing the art of medicine.2
(2) The need to emphasize aspects like compassion (a true will to decrease suffering in the patient), empathy (an active effort to understand the other’s internal perspective and to see the world through their eyes), autonomy for self-care (honoring and respecting each person’s autonomy – their irrevocable right and capacity of self-direction) and the role of the health coach to facilitate activation of the person’s own motivation and resources for change.3


So how can we encourage providers to practice an active and compassionate listening to their patients? Encourage providers to listen compassionately to themselves: silence and meditation  may work for that purpose. Cultivating the habit to listen to oneself may translate into better listening to others, such as patients.

Another way, is through the practice of mindfulness.


In a study published in the Journal of the American Medical Association, Michael Krasner and his colleagues studied the effects of an educational program in mindful communication on primary care physicians.  The year-long course was divided into two phases: an 8-week intensive phrase and a 10-month maintenance phase.

The study found that participants became increasingly more mindful from baseline to the conclusion of the study, and that these effects were maintained at 3-months post intervention. Following the same pattern, the physicians also demonstrated a significant increase in empathy, specifically in perspective taking and standing in the patient’s shoes.


What it breaks down to is this: the price to pay for the breakdown in patient-provider communication is very high and the consequences can be significant. Learning to listen mindfully may be the way to a potential solution.



  1. Benzo R, Vickers K, Novotny PJ, et al. Health Coaching and COPD Re-hospitalization: a Randomized Study. American journal of respiratory and critical care medicine. Mar 8 2016.
  2. Benzo RP. Mindfulness and motivational interviewing: two candidate methods for promoting self-management. Chronic respiratory disease. Aug 2013;10(3):175-182.
  3. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol. Sep 2009;64(6):527-537.