PROVIDENCE – A new book, The Mindful College Student, written by Eric Loucks, Ph..D., offers a self-help guide for college students on how to become engaged with the practice of mindfulness.

For Loucks, the book is an extension of his ongoing work at Brown University, which begun with his research into the relationship between mindfulness and cardiovascular health, working under a $4.7 million National Institutes for Health grant in 2015. [See link below to ConvergenceRI story, “The best way to improve heart health may be mindfulness.”]

This work led to the opening of The Mindfulness Center at the School of Public Health at Brown University in September of 2017, as well as the launch of a new pilot program, a mindfulness intervention for undergraduate students, called Mindfulness Based College, a randomized research trial, tracking certain kinds of health data. [See link below to ConvergenceRI story, “The Mindfulness Center opens at Brown.”]

In 2019, the work of The Mindfulness Center expanded to other schools in Rhode Island, with a focus on education and stress reduction, as governments and health insurers worldwide explored covering meaningful stress reduction. [See link to ConvergenceRI story, “Mindfulness moves into the health, education mainstream.”]

Now, with the publication of The Mindful College Student, the ongoing work by Loucks has moved to the next level, what Loucks described in a 2019 interview as “the desire for evidence-based mindfulness programs to be both high quality and scalable.”

Here is the ConvergenceRI interview with Eric Loucks, conducted by David Margolis, a research associate at the Center for Epidemiology and Environmental Health at the Brown University School of Public Health. Margolis has been a mindfulness and meditation teacher for the past 30 year, including meditation for anger management and stress reduction at the Moran Medium Security facility at Rhode Island’s ACI for 13 years.

MARGOLIS: Thank you for taking the time to meet with me for Convergence RI. I think what motivated this interview at this time is your recent publication, The Mindful College Student, which is a book form of a course you have been teaching at Brown University. What is your field of expertise? Did you come here with a plan to incorporate mindfulness as part of your research?
LOUCKS: My area of expertise was the intersection of social determinants of health and physiology. I investigated the impacts of social factors like educational attainment and early life adversity on cardiovascular disease, and the biological mechanisms, such as inflammatory markers, blood pressure, obesity, and epigenetics.

At that point, mindfulness was not part of my research, so I took a bit of a chance and put in a mindfulness questionnaire in a big birth cohort, a study of 400 participants that I had for a National Institutes for Health [NIH] grant. We ran those analyses and found that mindfulness levels were predicting smoking and physical activity and obesity. It looked like there was potential there.

At the same time, I had a strong personal mindfulness practice that I was doing outside of work. One of my main teachers, Joann Friday, was advising me to break down silos in my life. I had my family life, my athletic life, my spiritual life, and my work life. She said: “You have such strong walls between them all. Why? What would it be like to break down some of those?”

So, I started to break down the wall between my personal mindfulness practice and my work’s research focus. They talk about how it takes [something] like 10,000 hours of practice to produce mastery. And, I had about that in mindfulness. So, I was suddenly able to take all that mastery and bring it over to work, and it unleashed a lot of creativity and capacity.

I started to work with colleagues at Brown, like Willoughby [Britton], and Jared Lindahl and Harold Roth, and then with the broader community through the Mindfulness Research Collaborative, with colleagues up at Harvard and at Georgetown and Vanderbilt.

It’s just been a good fit for my personality. And, it’s a good fit for this moment in history.

There are a lot of things going on right now that promote stress and anxiety and distraction and depression and cardio-metabolic illness, [including] low physical activity, and high-processed foods in our diets, that mindfulness has capacity to help counterbalance. It’s been a good match between what Brown is good at, what I like to think about, and some of my skills – and also what’s needed at this moment in time.

ConvergenceRI: How did the course in Mindfulness-Based College evolve?
LOUCKS: It started when I taught a course for the School for Professional Studies one summer that was called “Meditation, Mindfulness, and Health.”

It was a for-credit course. It taught the science of mindfulness – the methods, the research, the impacts of mindfulness on major health outcomes, like depression, anxiety, obesity, sleep or blood pressure.

But it also brought in evidence-based mindfulness training - personal training - through a boiled down curriculum for Mindfulness Based Stress Reduction [MBSR].

One of my grad students was really interested in this. She worked as a TA [teaching assistant] for the course, but she actually studied it for her thesis. She measured the students’ health baseline, and at the end of the course, she found that a number of health outcomes improved. The students [said they] really appreciated the course.

I started hearing more and more from Brown students who were interested in the science and practice of mindfulness. The course was so successful that I started offering it during the school year.

Then things started to evolve, when I tried to scale up the course, because I capped the course at 40 students, and it would fill up within 10 or 15 minutes. But that’s only 40 students being helped. [In response,], we started to develop a mindfulness-based college program that would be scalable, so you wouldn’t necessarily have to be taking a course at Brown to take it.

It’s an independent program. With support from the Provost’s office, we ran a randomized control trial on that program, [which was] published last year. [The study] showed significant improvements in overall well being in students. It also [found] significant improvements in [students’] sleep quality and depression symptoms.

The question about how to scale up the course came up. It was an in-person course, 2.5 hours for eight weeks, and people have to pay for it. Certain demographics can do that, pay for it and take that time, but there are others that can’t.

I was trying to find other ways to scale up [the teaching of] the concepts in the course. That is where the idea for the book came from – as a way to bring the concepts of the mindfulness-based college course, bringing in the science, but also putting it into a form that would be an effective self-help for young adults – and for people really of all ages, if they are interested in that. So that’s how the book happened.

ConvergenceRI: Obviously, there are more trainers than just you, so how does that part work?
LOUCKS: We have a training program for Mindfulness Based College trainers. It’s pretty bare bones at this point, but we are actually looking to be building it out. We require teachers to be level-one Mindfulness Based Stress Reduction [MBSR] instructors. They have to go through an evidence-based, mindfulness-based teacher training program, specifically MBSR, because Mindfulness Based College is grounded in MBSR.

And, from there, they need to have experience in working with young adults, because the course is designed for young adults. [Teachers] go through a training program where they learn all the adaptations of Mindfulness Based College.

Then they practice teaching it. We record all the videos, and then I observe the videos and give qualitative feedback. Once they [are able to] adhere to the curriculum by at least 90 percent, then they are considered certified Mindfulness Based College instructors.

An organization called the Mindfulness of Health Institute, MHI, has just launched in Providence. Its vision is to be in collaboration with Brown University but also to offer more community-based programs that the university isn’t set up to offer.

Mindfullness Based College teacher training is one of the programs that the MHI will be offering, along with straight up Mindfulness Based Stress Reduction and Mindfulness-Based Cognitive Therapy [MBCT]. It is a new organization that’s just launched in the last few months.

ConvergenceRI: With the purpose of spreading this [work] out into the community?
LOUCKS: Yes, it’s more community focused. Brown University is really good at research and education, particularly credentialed education for Brown students. We work with the School of Professional Studies to offer a certificate in Mindfulness Based Stress Reduction teacher training, so for that kind of credentialed certificate, it’s good.

The School of Professional Studies is also quite effective with working with businesses, but then for programs like Mindfulness Based Stress Reduction or Mindfulness-Based Cognitive Therapy, Brown isn’t really set up to offer those kinds of programs. It’s more of a medical kind of program, so we could link with the hospitals.

We’ve explored some of that; we’re still exploring that. The Mindfulness Health Institute is set up for offering programs like that for the community.

The vision is for the teacher-training program at the School for Professional Studies to partner with The Mindfulness Health Institute, so that the teachers and training are connected to the Mindfulness Based Stress Reduction classes.

ConvergenceRI: Can you talk some more about the book?
LOUCKS: The book is called The Mindful College Student. It is a self-help book that’s designed to foster young adults – and really people of any age – to be able to build the life of their dreams, and to foster happiness and health in an evidenced and informed way.

It’s built upon [what we have learned] through our clinical trial research, running mindfulness-based programs for young adults. It weaves in some of the science – it also weaves in a lot of stories of young adults that have gone through mindfulness training.

I interviewed more than two dozen young adults in the process, and I’ve had hundreds go through my programs. I’ve really tried to create a platform for young adults to teach each other. We’ve got a lot of stories from young adults about how it influenced their well being.

We also anchored it to the scaffolding of some of the Buddhist underpinnings of mindfulness training, particularly the “Discourse on the Full Awareness of Breathing.”

That one basically starts off with the understanding and caring for the body, and at this moment in history, when obesity rates are so high, and when sedentary activities are also so high, we’re at this time in history when food is really tasty and inexpensive, and a lot of our occupations and pastimes don’t require physical activity.

As a result, we are the most obese overweight society in recent times, possibly ever. And how can mindfulness help with that? The first chapter is on opening the body, or caring for the body.

Then the next chapter is focused on opening the heart and understanding our emotions. The entire human experience comes through our physical sensations and our emotions and thoughts, so if we can really understand our emotions and harness them and care for them, they can allow us to have much greater impact in our lives and also care for ourselves more, too.

The book continues through that, checking in with the body, then with the heart and emotions, then with the mind and thoughts, and then with the spirit – another way of saying that is the nature of reality.

The first four chapters are really based on the basic training of the body and the mind. And then it moves to very practical applications, whether it’s to our relationship with our career, or with our friendships, our relationship with the political environment, our relationship with the natural environment, and our relationship with social media.

It’s been designed to not just be some pie-in-the-sky training thing, but to really apply it to this moment in history and our lives as they manifest right now. That’s kind of the idea behind it.

ConvergenceRI: As I went through this book, I really appreciated all those connections. I think a lot of [meditation] teachers will teach the techniques but leave it up to the students to apply them to the world they are in, yet you’ve done both. Are there any further steps? You mentioned the Mindfulness Health Institute.
LOUCKS: Yes, there are some obvious next steps. If people want to take a self-paced online course, we’ve developed one with the Omega Institute in New York. There’s a course called “The Mindful College Student,” and it has 10 different modules that are self-paced. I show up live every so often as well, to provide feedback.

So that’s one place. If people want further training or a different kind of training, the Mindfulness Center at Brown has free programs just about every day on via Zoom that are taught by certified MBSR teachers.

ConvergenceRI: For the Brown community, or for anybody?
LOUCKS: For anybody around the world. We get about 400 people a week coming to these from all around the world. If people want to learn mindfulness from a teacher that’s skilled, just go to our website and look for the free programs. We have free daily sessions.

ConvergenceRI: How many students have gone through your training?
LOUCKS: For the Mindfulness Based College program, about 300. For the Meditation Mindfulness and Health Course [a Brown course], probably 200.

ConvergenceRI: You mentioned that your teaching assistant looked at the different metrics, in her research. Could you talk about some of those metrics?
LOUCKS: She looked at stress levels, and performance on measures such as the GRE, which is a standardized test for getting into graduate school.

And, she looked at some other health outcomes as well. The ones I’m remembering in particular are in stress levels. The stress levels were significantly improved, and there was some improvement on the test taking scores as well.

ConvergenceRI: You also did a study on blood pressure that showed, that after taking your course or your training, you got good results and those results were persistent for a year, whether people practiced at all again? How do you explain that?
LOUCKS: That was the Mindfulness Based Blood Pressure Reduction program that has some similarities to Mindfulness Based College, in that it’s grounded in Mindfulness Based Stress Reduction. It has a strong focus on health behaviors like diet and physical activity.

It’s even more specific to people with hypertension, so we are also looking at their medication adherence and weight loss.

We recently finished up a very large NIH funded randomized control trial on it, and we are actually just getting ready to submit those results, too, and they are quite promising.

But for the paper that you’ve read, that’s a one-year follow up, our first study on it. It was exciting to see the reductions in the blood pressure and how long they lasted. And then in terms of explaining the practice effects – there’s two ways I think about the impact of mindfulness practice and training on health outcomes.

One is kind of like riding a bike. Once we learn the mindfulness practices, they are always there for us. Kind of like once we learn how to ride a bike, we always know how to ride a bike.

What we found in that study is the people that practiced the most during the course itself had improved blood pressure a year later, compared to people who didn’t practice as much while they were taking the course.

And so, there might have been some crystallized learning there while they were in a supportive environment that allowed them to not only have short-term impacts, but to stand the test of time.

But then, the other piece around mindfulness practice training is kind of like, “use it or lose it.” If we are learning how to play piano, and we practice piano over the years, chances are we are going to get a lot better at piano than if we just took lessons for eight weeks and then didn’t play again.

That is certainly my personal experience with mindfulness training. If I don’t meditate for a day I’m OK, two days not bad, three days and I start to deregulate.

We also measured the amount that people practiced mindfulness when they came in for their six-month assessment and their one-year follow up.

The amount that they practiced at the six-month follow up and the one-year follow up did not predict the blood pressure. And that was a surprise to us.

ConvergenceRI: I have a question about the mechanism for reducing the blood pressure. I’m assuming that using the mindfulness allows you to be more mindful of the activities that will reduce blood pressure, rather than the meditation itself [directly] bringing the blood pressure down, but I might be wrong, so I wanted to clarify that.
LOUCKS: The mechanisms that we hypothesize, one is the self-awareness – the awareness of the body. And it’s something that a lot of participants reported on. We have a paper on that as well, reporting on the qualitative interviews that we did with participants, asking them how they thought the program influenced their cardiovascular health, and the self-awareness was one.

So, they became more aware of their stress, but they also became more aware like, of how food influenced their mental well being.

ConvergenceRI: But, you can be aware of that stuff without doing anything about it. So, just the awareness itself is not enough to bring down your blood pressure. You are aware that you need to do something, and because you’re aware you are more likely to do it, and then your blood pressure is affected.
LOUCKS: Yes, but I think that one of the other mechanisms that we are training was called attention control, so meditation trains us to place our mind where we choose to place it.

And the idea is the self-awareness might come first, like “I’m really stressed right now,” or “Wow, I’m emotionally eating this thing to deal with some kind of stressor that’s happened in my life.”

And then, the self-awareness of like, “Oh, and I ate that sugary thing or drank that caffeinated beverage or yelled at my loved one.”

It’s one thing to notice it, but then, with the attention control, we can say, well, I’m aware of it, some insights have arisen in terms of its impact on myself and others, and now what?

If our attention control gets better, then we can say, a skillful next response is this – and if we are training ourselves to be able to place our mind where we choose to, we may be more likely to actually take that step rather than just dwell in self-flagellation. Why are we doing what we do? Which is most of us, including myself.

ConvergenceRI: How many years have you been teaching these mindfulness classes?
LOUCKS: It will have been eight now.

ConvergenceRI: Do you conduct follow-ups with them to see if they are continuing to practice? Or, if they have gone on to further practice paths in their life?
LOUCKS: Not formally. Informally I’m connected to some people who have gone through the program, just socially and as a mentor.

With the blood pressure study we did actually follow people two years out, and haven’t published those data yet, but the blood pressure findings did hold two years out.

ConvergenceRI: Are you planning on doing any formal research on other things you’ve mentioned, like mindfulness-based obesity work, or addiction, or attention deficit disorder? Are those or anything similar on your radar?
LOUCKS: I think in my capacity as director of the Mindfulness Center, I try to foster conditions for this kind of work to happen, because I only have so much bandwidth personally to do it.

For example, a donor recently gave us $100K that we’re using for pilot funding so we can allow investigators to propose pilot research to help them get those early findings that can lead to an NIH grant. So, part of what I do is to foster that kind of research.

For example, Judson Brewer at Brown developed the Eat Right Now program that’s an app that’s delivered, that’s designed specifically for healthy eating. I’m really excited about his work in that area.

[Loucks is also working with Jeff Proulx, a Native American faculty member at Brown, who has been working with Native American communities to "indigenize" Mindfulness Based Stress Reduction in support of diabetes management. Loucks and Proulx have received a grant to work with the Mohegan tribe in Connecticut to co-create a mindfulness program for blood prssure control.]

For me personally, it’s like a lot of researchers do one or two studies on a new intervention and then move on to other stuff, and that usually results in the interventions not really going anywhere in terms of public impact.

So I am trying to go deep on the Mindfulness-Based College and the Mindfulness-Based Blood Pressure Reduction programs, to be able to move them towards really seeing if they impact people from lots of different racial-ethnic backgrounds, and lots of different socio-economic backgrounds and geographical locations, and to shift it towards health care coverage if the evidence supports it. So I’m going pretty deep on those two.

We just got a big NIH grant for Mindfulness Based Stress Reduction. That program got developed over 40 years ago, and it’s still not really covered by health insurance yet. Why is that? If it was covered by health insurance, it could bring the cost down and allow people from lower socio-economic backgrounds and rural backgrounds and people with various racial-ethnic backgrounds to be able to access it.

And so why isn’t it covered by health insurance? And, from a policy maker perspective or a health insurer perspective or a clinician’s perspective, what do they need to know in order to health insurance coverage, for Mindfulness Based Stress Reduction to get its own billing code?

That’s what this grant is doing. It’s interviewing stakeholders who are policy makers, health insurers, clinicians, and patients – to really understand what they need to know in order to make a decision on health insurance reimbursement for Mindfulness Based Stress Reduction.

[We hope to] get them the answers in part by doing the biggest systematic review and meta-analysis in the history of Mindfulness Based Stress Reduction. So that’s the focus of a five-year, $3 million, NIH grant that we were just awarded [in April].

ConvergenceRI: Is there any plan to scale up the Mindfulness Based College program at other universities and colleges?
LOUCKS: I had a meeting last week with a professor at a military college in Virginia who is training military engineers. They have a for-credit class that’s focused on resilience skills and stress.

She read this book and took the self-paced online course through Omega, and felt like it was a really good fit for them. So she is taking these materials and putting it into a program that’s going to meet the needs of military personnel that are also engineering students.

Part of what I’m trying to support is scaling it, but scaling it in a way that meets of the different organizations. That’s important. I know from my own work that it’s easy for someone or entity that comes up with a great solution for a particular problem, thinking that we could just move this implementation somewhere else to address the same problem and it will work there, too.

But, it is also dependent on the people involved and the environment, that no two places are the same and the solutions need to be individually tailored.

I gave a talk a few weeks ago at the MIT Sloan School of Management. They have a club there on mindfulness and leadership. The way that mindfulness is coming into Sloan is through leadership development, and how mindfulness can really help with the self-knowledge of what our natural skills are as leaders.

There are many different ways to be a leader. And, if we look at the top leaders in the world, they certainly share some qualities, but there’s a lot that they don’t share, too.

What makes them unique gives them a particular leadership style, and so mindfulness can help with the self-awareness of what our style and our skills are, along with helping with the attention control to focus on the top priorities.

At Yale University, at the medical school there, they have a mindfulness of medicine club. One of the Brown Contemplative Studies graduates got into Yale medical school; she took a couple of my courses and invited me to give a talk to the medical students a few weeks ago.

And so the way that it’s coming into Yale medical school is, one, through understanding the science and the impacts on health so that we can be getting into the medical school curriculum. But then the other one is around resilience.

[Becoming a doctor], it’s a very high-demand, high-stress occupation and being a medical student, it’s tough. Mindfulness training can be a good fit for help their resilience and their self-care, as they are going through medical school.