Q&A with Dr. Greg Hammer, MD, author of GAIN without Pain: The Happiness Handbook for Health Care Professionals

1. What is GAIN without Pain: The Happiness Handbook for Health Care Professionals about and why did you write it?
I believe that the 4 pillars of our spiritual wellbeing are Gratitude, Acceptance, Intention, and Nonjudgment. The book discusses these elements in detail and then describes the simple GAIN meditation, which takes as little as 3 minutes. It is best practiced daily – who doesn’t have 3 minutes? People tend to remember mnemonics, and this one, like the practice itself, is simple.

The book was written to address the pandemic of burnout in medicine, which affects not only physicians but other health care professionals as well. Health care providers suffering from chronic stress-induced burnout make more medical errors, deliver a lower quality of care, and are at risk of depression and even suicide. We need to get the message of happiness out to all of them!

2. How can intentional living change our brain?

Jon Kabat-Zinn defined mindfulness as “paying attention to the present moment, on purpose, nonjudgmentally.” The “on purpose” is intention.
Our brains are wired in 2 ways that adversely affect all of us. We all have a negativity bias, meaning that we tend to remember the negative experiences in our lives and forget the positive ones. This leads to unhappiness. In addition, we are obsessed with the past and the future. Happiness dwells in the present moment, the only moment we ever truly experience. Yet we ruminate over the past, leading to shame, regret, and self-criticism. Similarly, we over-think the future, which brings fear and anxiety. We catastrophize – we imagine the worst possible outcome despite that it almost never materializes.

The good news is that our minds are malleable. We have the ability to change the way we think – this is called neuroplasticity. We simply have to set our minds to remember the good things we have, i.e. to be grateful. The practice of thinking of 3 good things that happened during the day each evening as we prepare for bed has been shown to help us sleep better and be happier. This is an example of intention bringing about a positive change in the way we think. I find this remarkable.

3. What is the difference between goals and intentions and why does that matter?

Living with purpose, on purpose, is a process of this moment. This process, intention, can be part of our daily lives almost continuously. Goals, on the other hand, are off in the future. It is OK to have goals, of course, but it is not beneficial to live our lives at arm’s length, always living for some future reality. For example, I take my bike out and ride up to the crest of the hills overlooking the Pacific Ocean. My intention is to smell the fresh air, experience the way the muscles in my legs feel, to appreciate each rotation of the pedals. When I reach the summit, the fog has rolled in and I cannot see more than 100 feet in front of me, not to mention the ocean. Have I failed? I did not reach my goal, after all. Of course I have not failed! I accomplished the outing with intention and thoroughly enjoyed it!

4. What advice would you have for people who set intentions but fail time and time again. What might be causing them to fail and how can they overcome that?

Again, it is all about the process, the journey. There is no actual destination. If they live with intention, e.g. that of experiencing the present moment with greater frequency, of being grateful, accepting, and nonjudgmental, they will have succeeded. Once people gradually realize this truth they will also realize that they have not failed.

5. How can we discover what we truly want, rather than what our ego wants or what society wants for us?

There is no true “ego” that is separate from ourself, so there is no ego to want anything. “Society” cannot want anything from us either. There is no being called “society.” All that we 7 billion people on the planet want is happiness. In reality, fortunately, happiness is our true nature and is always present. We simply need to learn how to sink into this awareness and we will be happier. Again, nobody is always happy – the art of life is to embrace our intention of being present more and more of the time by taking baby steps every day to re-wire our brains. We have the tools to do this!

6. Can you give an example of an intention you set that you failed at and one that you set that you achieved?  What were the differences?

I do not believe in failure. I believe that we are learning every day. As long as we are living with the purpose of being more present, we are winning. A benefit is that we will become kinder, more generous, and more open-hearted as we learn to be more present. These things come naturally. My true intention is always with me. Of course, some days are more blissful than others. Some days I am more distracted by the past and future than other days. Yet I do not consider this to represent failure.

7. Can you talk a little bit about the GAIN method 

The GAIN method is a way of living. This begins with as little as a 3-minute practice in the morning. After waking and doing our morning hygiene, we find a quiet, comfortable place to sit. We begin to focus on our breath as we allow our eyes to close. Slow, deep breaths to a count of 3 as we inspire through our nose, then a pause to the count of 3, and then we effortlessly let the breath go to a count of 4. There is no effort. Our heart rate and adrenaline levels begin to drift downward. We next begin to contemplate that for which we are grateful. We see our health, love for others and our work, the privilege to serve first and foremost. We allow the experience to wash over us.
As we again notice our breath, we transition our focus to the pain and suffering that are as inevitable in life as joy and happiness. We can all think of something – the suffering caused by the COVID pandemic; the intense agony people experience in Haiti, given the assassination of their president, earthquake, and hurricane; the horrors ongoing in Afghanistan; our own pain, too – physical ailments, loss of loved ones. We visualize the opening of our chest, our heart, to this pain. We bring it closer and closer until we merge with it until there is no separation. We notice that it is not so bad as we thought when we resisted or pushed away these thoughts. We go back to the breath and feel the pain begin to evaporate.
We transition to consideration of our intentions. We again become mindful of 3 good things that happened yesterday; we remind ourselves to bring our attention back to the present when we notice that we are fixating on the past or future. We remember to think of the wondrous elements in our lives when we begin to grasp the apparent negative ones. We even smile at our human-ness as we let go of any vibration of self-doubt or judgment.
This leads perfectly into our contemplation of nonjudgment. We realize how much energy we waste constantly comparing others to ourselves, rendering everything we encounter as either good or bad. We remember that we do not need to attach such adjectives to our experience. We may see in our mind’s eye the earth as seen from space – suspended there exactly as it is, neither good nor bad. As we become more adept at dropping judgments of the world and those living on it, we might even begin to turn toward ourselves and start to drop self-judgment. We are indeed our own harshest critic. We feel a weight lifting from our shoulders.
We go back to the slow, deep breath for a few cycles. We then slowly open our eyes to the world. We are ready to go out into the world with the fresh perspective of GAIN.
Importantly, we commit to focusing on one element of GAIN this day, e.g. nonjudgment. We vow to let go of any judgment of the driver that changes into our lane without using their turn signal as we drive to work. We begin to judge… then we become self-aware and let go of the judgment(s). It actually gives us a smile. A negative interaction becomes a positive one. There is a small hit of dopamine, a sense of satisfaction.
About Greg Hammer, MD: Greg Hammer, MD is a Professor at Stanford University School of Medicine, pediatric intensive care physician, pediatric anesthesiologist, mindfulness expert, and the author of GAIN without
Pain: The Happiness Handbook for Health Care Professionals _(May 15, 2020).