How to be a little bit less, just a little bit less, worried or stressed? Try the physiologic sigh. In Part 1 of my conversation with Brian Ferguson, we cover Brian's take on interoception, deliberate practice, and the growth mindset. Interoception is the bedrock of elite performance, according to Brian and his team at Arena Strive/Arena Labs. Interoception helps you become intentional with your attention, and deliberate practice (see episode 7) and having a growth mindset (see episodes 25 and 26) helps cultivate interoception (see episode 15). Brian Ferguson has built his career in high-performance organizations, including the military. He has continuously learned from leaders and decision-makers in US national security and technology, founding Arena Labs, a company pioneering healthcare’s first “Performance as a Solution” platform. Arena Labs brings the tools, training and technology of the world’s top performers into frontline surgical teams, ICUs and trauma environments. Brian served in the military as a Navy SEAL Officer where he deployed to Afghanistan and various parts of the Middle East. He received an MSc from The London School of Economics.
How to be a little bit less, just a little bit less, worried or stressed? Try the physiologic sigh. In Part 1 of my conversation with Brian Ferguson, we cover Brian's take on interoception, deliberate practice, and the growth mindset. Interoception is the bedrock of elite performance, according to Brian and his team at Arena Strive/Arena Labs. Interoception helps you become intentional with your attention, and deliberate practice (see episode 7) and having a growth mindset (see episodes 25 and 26) helps cultivate interoception (see episode 15). Brian Ferguson has built his career in high-performance organizations, including the military. He has continuously learned from leaders and decision-makers in US national security and technology, founding Arena Labs, a company pioneering healthcare’s first “Performance as a Solution” platform. Arena Labs brings the tools, training and technology of the world’s top performers into frontline surgical teams, ICUs and trauma environments. Brian served in the military as a Navy SEAL Officer where he deployed to Afghanistan and various parts of the Middle East. He received an MSc from The London School of Economics.
[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I have the great pleasure and honor of speaking with Brian Ferguson. Brian Ferguson has built his career in high performance organizations including the military. He has continuously learned from leaders and decision makers in US National Security and Technology, founding Arena Labs, a company pioneering healthcare's first "Performance as a Solution" platform. Arena Labs brings the tools, training, and technology of the world's top performers into frontline surgical teams, ICUs and trauma environments.
[00:00:33] I discovered your work, Arena Labs and Arena Strive through a podcast. I heard about Dr. Huberman and the physiologic sigh, and then I think next [Mm-hmm.] I listened to you on a podcast. I was drawn to your work and Arena Strive. When I was reading about it online, on your website, it was like, Oh, short, simple. This kind of thing can really change your life. Could you talk a little bit about your vision for Arena Strive?
[00:00:56] Brian Ferguson: Where we start in Arena Strive is around this idea of self-awareness. Can you be self-aware? Because the first step of accessing the healthiest version of human flourishing, however you define that, as high performance, being the best version of ourselves, not just for our teammates and our patients, but in our home life. The first step of that is being self-aware. And the term that we talk about in our platform is interoception, which is, Am I aware of my inner landscape? Emotionally, How do I feel? It's the reason we have a daily check-in and ask you, How are you feeling? Are you stressed? Are you focused? Because to be very clear, it doesn't mean that people have to walk around and have overly emotional conversations. But if you look at the highest performers in the world and people who are flourishing, they have a very sophisticated understanding of their emotional landscape, and they know how to move in and out of that landscape in the context of their work. And again, it doesn't mean that in the middle of a trauma someone is emotional, screaming or crying. Any of those things are a disservice. But after an intense experience, how do I process, move through that, and rest and regenerate so that I'm not holding onto that experience the next day or the next day.
[00:02:06] Christine Ko: Yes. I love that. I appreciate that you mentioned interoception because I had spoken to Antoine Bechara who's worked with the Damasios on the gut feeling and that kind of interoception.
[00:02:19] Brian Ferguson: Interoception, the first time I heard that term was from Dr. Karen Kelly, who's a physiologist and runs the war fighter performance initiatives in the Naval Health Research Center. She's an extraordinary scientist. She talks about interoception as being the bedrock of elite performance for war fighters. I think some people can frame interoception maybe as an overly either touchy feely or emotional concept, when in reality it's the bedrock of human flourishing and performance.
[00:02:44] Christine Ko: Yes, absolutely. I think Arena Strive is built also on the concept of deliberate practice. Is that true?
[00:02:53] Brian Ferguson: It is.
[00:02:54] Christine Ko: Can you talk about that?
[00:02:55] Brian Ferguson: One of the things that we've really put time into is understanding the tension between teaching and doing. And if you only have five minutes a day, the people on our platform are all brilliant, and they're practitioners in a way that they don't have a lot of time. And so on one hand they need to understand, as you just mentioned, sleep. So understanding circadian cycles is really important because it helps to then start to understand human hormone production and when rest is optimal, if you can't get optimal rest. So all that stuff, on one hand, if it's not framed, it can feel like I'm just telling you to do something. Make your room cold, dark, and quiet. And it sounds silly, but if we actually understand the science behind why it needs to be dark, why it needs to be roughly 67 degrees Fahrenheit, and why it needs to be quiet, most science minded clinicians go, Okay, that makes sense now what do I do?
[00:03:49] And so then it becomes, we need to build a practice. Now there is a massive amount of literature these days on what does it take to build a habit. Our current endeavor at Arena Strive is to say, we want to take someone who is eager to have one or two tools that when implemented can allow them to be a better version of themselves. And that, again, as I said earlier, that can mean a lot of different things, and it is intentionally individual. I say this respectfully, because our belief is that the reason most hospital employee assistance programs fall short is a resource that's built for everyone serves no one, especially when we're talking about the realities of human emotion and stress and being under slept and having personal lives outside of the hospital. So we believe that technology, scalable technology like Arena Strive addresses both. It provides a scalable, democratized solution that can be hyper individualized. And so when you come through our platform in those six weeks, we are deliberately exposing you to quite a bit. It can feel almost overwhelming, but if you're doing it five minutes a day, it's digestible. And then what we're asking is each week to pick a practice that feels like it works best for you.
[00:05:00] Christine Ko: Yes, I have been using that physiologic sigh since I learned about it, I guess probably a year and a half. That physiologic sigh has helped me so much. And who knew? I didn't know about it. I've been telling patients about it. I've been telling some colleagues, trainees, students around me about it. I think it's very useful. I love efficiency. I love things that don't take time. And it's been very helpful. Even just if I'm standing at a microscope or especially with masks on, it works well because people can't tell that I'm doing it.
[00:05:33] Brian Ferguson: There's nothing that fires me up more, for two reasons. One, a lot of times these tools don't need to be dramatic. You can do it while you're looking through a microscope in the middle of the day. But secondly, the thing that I've been humbled by, Christine, is that a lot of these things are so basic. They're so basic, and I think that's one of the reasons Dr. Huberman has seen so much success in his own platform in the last two years as a scientist who's really trying to make science free and available. He puts out such simple tools that are anchored in things that are not sophisticated technologically. Two inhales through the nose and an exhale through the mouth, it takes about three seconds.
[00:06:09] Christine Ko: Yeah.
[00:06:09] Brian Ferguson: But if you do that periodically throughout the day, it's getting back to you're doing that because you're self-aware to say, Hey, my breath is a little bit short in my chest and I'm anxious. And so you're feeling a sense of agency. Most people in medicine feel overwhelmed like they're a cog in a system. If you can feel a little sense of agency, it starts to allow a return to that emotional landscape that's fulfilling in one's profession.
[00:06:30] And it could be the physiological sigh, which is just two inhales through the nose and an exhale through the mouth. Dr. Andrew Huberman, who's a neuroscientist at Stanford, talks about how his laboratory has researched it as a mechanism to de-stress, why it's useful. We say, Look, just try this several times throughout the day. And building those practices is about ritual and habit, but it's also about making the connection between the performance science behind human performance; one or two tools that when applied regularly leads to just a different feeling, or maybe being more mentally clear and making better decisions.
[00:07:07] All of it is scientifically grounded, and we believe that because people in medicine are kinesthetic creatures, it's got to be skewed more towards doing than just the science. And that's something, again, we learned very humbly and many iterations of our platform.
[00:07:22] The more present we can be in the thing we're doing, the better the outcome for everyone.
[00:07:26] Christine Ko: Yeah. I have one friend who he always seems to be very present. And I don't think I fully really understood what it was about him that I appreciated from the beginning, but like he never has his cell phone out, for example.
[00:07:43] Brian Ferguson: Before we recorded, we were talking about Simon Sinek. He's got an amazing piece where he talks about the subtle social signal of having a phone on the table. As soon as you set that phone on the table in a conversation, it suggests that there might be something more important. And it erodes the inherent connection that's required to have a deep, bidirectional conversation with someone, which is fascinating.
[00:08:04] When you're around someone who almost is surprisingly present, when you deconstruct why that is? I would say 95% of the time they have figured out how to be intentional with their attention, and they have a means of controlling their physiology.
[00:08:23] Someone who is controlled by the external world and exogenous factors has a frenetic sense of not being in control, which physiologically translates to higher heart rate, less attention, harder time focusing typically poorer sleep. When you're around somebody who has figured out how to be intentional with their time. They feel not only present in the sense of they're focused, but they feel present physiologically. They're calm, they're relaxed, they speak with a cadence that's intentional. And that to me is always the pursuit. Most people who are pursuing hard things for the world are not able to be monks. So the reality is there's a tension for all of us, myself included. But I do think this is a lot of the work we pursue in medicine. Whether someone is brand new at a nursing school or a 20 year, veteran attending, how do we think about tools that allow someone to feel more in command of their attention in order to physiologically feel and be more present and healthy?
[00:09:22] Christine Ko: Another cognitive psychology concept that has been really helpful to me is the growth mindset. To me, Arena Strive is built on the growth mindset. Can you speak to that?
[00:09:31] Brian Ferguson: Carol Dweck's concept of the growth mindset, which says just to revisit that, there's a fixed mindset where I believe I have been endowed with a fixed set of traits, generally, in terms of intelligence, in my ability to learn. There's a fixed set, and at some point I hit the boundaries, a finite pool of understanding, learning, and intellectual capacity. On the other side, she talks about a growth mindset, which is to say, through the process of learning and failing and reflecting, and the hunger to constantly want to grow, that mindset allows me to have a seemingly ever expansive set of intellectual capacity to learn and grow. Her book, The Growth Mindset, I believe it's called, is phenomenal. If I can switch to a growth mindset, I can understand what's limiting me. What we believe and hope Arena Strive does is give that individual clinician a point of access into having a sense of agency, which our hope is that after six or 12 weeks on the platform, it moves into this growth mindset. And the growth mindset is around self-actualization, human flourishing, and performance.
[00:10:35] This is not about being technically better as a nurse or physician. This is about understanding the link between the profession one has chosen and home life, personal life, and that those two things are bidirectional. And so these tools help someone understand how to flourish more. And if we can get you intrigued, just like you described to the physiological side, our belief is that starts to open up a different way, of whether that's growth mindset or not. It's moving beyond the fixed sense of not having any sense of agency in this large bureaucracy that's focused on efficiencies and economics and not on me. Yeah.
[00:11:12] Christine Ko: My last specific question would be, what do you wish you had known earlier?
[00:11:15] Brian Ferguson: That's a deep one. Ultimately life is about doing the work. Be self aware. It's the work in terms of excavating one's own identity, Who do we want to be in the world? Ultimately the work and the context of how that changes. This is the irony of that kind of a question, which is if I'd known it earlier, I probably wouldn't have been on the learning journey I needed to be on. But, my younger life, I was really blessed and fortunate and, like any of us I've had hurdles, and grief, and loss. With that, the challenge is often how we look at the evolution of our identity and who we want to be in the world based on how we're changing in the world around us. Some people find that in their faith, but whether that's in a faith tradition or individually through a different set of tools and introspection, it comes down to learning to listen to the heart. One of the first books that I read before I joined the military was called The Alchemist by Paulo Coehlo. The entire sort of premise of that book is learning to listen to the heart. And I do think the wisdom of our own hearts is powerful. If you're like me, I spend a lot of time in my head. And that journey from the head to the heart is a long one, and it's about doing the work. And if you do the work and the work is all the tools we're talking about to understanding our own physiology, to understanding who we are. It's a full spectrum. And that's why for me, this concept of human flourishing, human performance, it's not at all about the physical or winning a gold medal. It's about how do we become the best version of ourselves, which I think is one of the most extraordinary narratives of human existence, human potential. I think I falsely probably assumed in previous seasons of life that I had figured it out or reached the destination when in reality I was probably just starting.
[00:13:07] Christine Ko: It's true. Life is a process. I don't think I really regret anything actively right now, but what I would want to go back and redo if I could, was to just have a little bit less, just a little bit less, worry and stress as I went through.
[00:13:22] Brian Ferguson: Yeah.
[00:13:22] Christine Ko: Which I think is what Arena Strive is all about that even just the physiologic sigh that would've reduced my worry and stress in the moment.
[00:13:31] Brian Ferguson: Yeah. It's well said. Very well said.
[00:13:33] Christine Ko: I'm going to end here because there's more that Brian and I go into, and I want to be able to have listeners hear a little bit more in-depth about the concept of Arena Strive. So tune in for a continued conversation with Brian Ferguson.