A potential solution for stress, PTSD and chronic pain with Dr. Robyn Tiger. Learn about iRest meditation and somatic yoga in this episode.
“So when we can relieve the stress in our bodies, relieve the stress in our minds, we can feel better in our bodies and relieve that chronic tension.” -Robyn Tiger MD
In today’s episode, Dr. Jen Barna has an informative conversation with Dr. Robyn Tiger. Robyn Tiger, MD, is a physician & trauma-informed self-care coach. She founded StressFreeMD, a wellness practice that provides freedom through self-care education. In this conversation, Dr. Tiger shines a light on the importance of self care for the physician community and explains two of the types of therapies that she uses with her clients. The first is somatic yoga and the second is iRest meditation. Dr. Tiger has seen tremendous results in her work and if you have been suffering with pain or anxiety, we hope you’ll find inspiration and a potential solution in this episode.
You can find Dr. Tiger at www.stressfreemd.net and [email protected] or find her on LinkedIn at https://www.linkedin.com/in/robyntigermd/ on Facebook at https://www.facebook.com/robyntigermd and on Instagram at https://www.instagram.com/stressfreemd/ and check out her Podcast here https://www.podpage.com/the-stressfreemd-podcast/
Robyn Tiger, MD, is a physician & trauma-informed self-care coach. She founded StressFreeMD, a wellness practice that provides freedom through self-care education. Dr. Tiger utilizes her unique combination of trainings in medicine, yoga therapy, meditation and life coaching to educate others in stress management, burnout prevention and relief. Her teachings focus on complete physical, mental, and emotional well-being and resilience. Dr. Tiger’s innovative CME accredited program, Rx Inner Peace, was created at the request of several busy physicians seeking an accessible self-paced online self-care program. It contains the most effective evidence-based self-care methods compiled from several years of providing physician education. At the request of other healthcare professionals and the general public, she created the Self-Care Shop which houses six additional accredited self-care programs open to everyone.
Dr. Tiger is a Western Carolina Medical Society Healthy Healer Partner, Surge-On App Key Opinion Leader for Self-Care for Surgeons, faculty for Trauma Informed Yoga Therapy, Advisory Council member of Yoga Therapy Today & yogatherapy.health, and is an O2X Human Performance Specialist for first responders.
She received her BS degree in Natural Science and Psychology from Muhlenberg College. She earned her MD, completed an Internal Medicine internship and Diagnostic Radiology residency at the Medical College of Pennsylvania and also completed a fellowship in Body Imaging at Thomas Jefferson University Hospital.
Her deep passion to fully help her physician colleagues and patients grew out of her many years in medical practice experiencing and witnessing firsthand the need for self- care education. Dr. Tiger’s distinctive combination of qualifications makes her best suited to fill the gap in physician education and successfully guide individuals to become the best versions of themselves and live their most fulfilling lives!
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Podcast produced by: Amanda Taran
Please enjoy the full transcript below
Dr. Robyn: So when we can relieve the stress in our bodies, relieve the stress in our minds, we can feel better in our bodies and relieve that chronic tension.
[DocWorking theme]
Jen: Welcome to DocWorking: The Whole Physician Podcast. I’m Dr. Jen Barna and I’m so excited that you’re here with me today because I think you’re going to really enjoy our guest, Dr. Robyn Tiger. Dr. Tiger is a physician and trauma informed self-care coach, who founded StressFreeMD, a wellness practice that combines her unique combination of training in medicine, yoga therapy, meditation, and life coaching, to educate others in stress management, burnout prevention, and relief. Her teachings focus on complete physical, mental, and emotional wellbeing, and resilience. Dr. Tiger has an innovative CME accredited program, Rx Inner Peace. And I am excited to begin our conversation. Dr. Robyn Tiger, Welcome to DocWorking: The Whole Physician Podcast. So excited to have you here today.
Dr. Robyn: Thank you so much, Jen, for having me. I’m a really big fan of your podcast. So, this is really an honor. Thank you.
Jen: Thank you for being here. And I’m excited to talk with you about your podcast, StressFreeMD, and also about the work that you do as a physician, as a radiologist who has become a life coach. Can you tell me an overview about the kind of work that you’re doing and then I’d love to delve in with some questions about the specifics?
Dr. Robyn: Yeah. So, thanks for watching my podcast. I started it at the beginning of August and I’ve had so much positive feedback so far. I love it. StressFreeMD Podcast is a podcast that was born because so many physicians and non-physicians said that everyone needs to know what you know. So, I started this podcast to just give little tiny, I like to call them stress free snacks. They’re in 15 minute-ish segments of things that you can do to relieve the stress in your life. That’s under the umbrella of StressFreeMD, which is a wonderful place that houses all of my coaching of my programs, my calls, my podcast, free videos, and lots of other good stuff.
Jen: Terrific. Yeah, it looks like your podcast really delves into very specific tidbits as you say to teach people about the work you do with meditation, and with yoga, and really to guide people on specific things that they can do right in that moment in that day. So, it’s very useful listening to it. I’m learning so much.
Dr. Robyn: Thank you. Glad you’re finding it helpful. Just kind of wrap up all the stuff that I’ve found helpful in my own transformation and in the things that I’ve been teaching others for about a decade now pulling all of those pearls out, and then making them into packages of little bit short contents that you can get just by driving in your car from one place to the next so that you can feel like you’ve learned something that you can implement into your life so that you can feel better all by yourself. Yeah.
Jen: Yeah. So, tell me a little bit about your journey. You were a practicing radiologist, and then what happened between when you were practicing and the transformation that you speak of?
Dr. Robyn: Yes. So, as a practicing diagnostic radiologist, fellowship trained in body imaging, and initially, I loved, loved, loved my job. I started back in the dinosaur age. When we had films, we had actual films that we were holding in our hands. I mean, we actually had to get there early to hang up all the films back in residency, it took hours, and even in practice, just holding those films and being in a reading room with lots of other radiologists. At one time, it was really this very wonderful, intellectually stimulating community where we’re all working together. When we’re in the hospital, different teams would come down. All the different areas, especially, that have rounds, they do radiology rounds, where they come down, and the surgeons, and the internists, and the ID, and the Peds, and the GYN, you can imagine every different team came down, and it was a really wonderful way to practice medicine. I felt that we were all on the same page, we really made great diagnosis because we all understood each other what was going on with our perspective fields.
Then at some point, actually, my fellowship, we were the beta site for the first PACS unit, which meant we were the very first site at Jefferson, where things went digital, where we had this amazing technology, where we could see images on a computer screen. That just went to everybody going digital over time into practice, and voice activated transcription. So, we no longer had assistants hanging our films or helping us to much of a degree. We no longer had transcriptionists, and we no longer had people around because every doctor could instantaneously wherever they were, see the cases you were reading, and get your report. So, it became a very gregarious, intellectually stimulating practice to a very isolating practice where I was talking into a Dictaphone about 9, 10 hours a day by myself most of the time, and it became very RVU generated. Relative value units for anyone listening who’s not a physician, where you were evaluated based on the amount that you were bringing in financially each day. If you took time to talk to a patient, or help a colleague, or take a phone call, you don’t get paid for any of those things and so what happened is everybody ended up being very isolated in their own space like doing their own thing, doing as much as they can in any given day, which was very different than the medicine I chose to begin to practice in. It became very stressful. I miss so much of what I went into medicine for and I also was a mom of two young kids, had a husband, a dog, a house, I was on every committee, I was on lots of boards, I said yes to everything, way too many yeses, and this just catapulted into me losing who I really was.
I didn’t remember who I was anymore, and I was just this robotic individual going through the motions, trying to talk myself out of bed every day, to go into work, or to do the things I was doing, and I became really sick. I started to develop all these illnesses. I became what we know as doctors as an interesting case, which we don’t ever want to be. We love working through them, but being an interesting case is not such a good thing and that’s what I became. Nobody could figure out what was a matter with me.
From the top down, I had migraine headaches with intractable vomiting, I had bleeding gums, tinnitus and vertigo, I had really bad gastroesophageal reflux, no food that I ate could be digested, I had all this abdominal pain, my body hurt everywhere, couldn’t sleep, couldn’t focus, no concentration. I was a real fun person to be around, I could tell you that. I’m joking here, but it was actually very serious. I had this paresthesias where I would lose sensation in my palms and bottoms of my feet, and they would happen at some very inopportune moments such as, when I was doing a breast biopsy and might be right there at the lesion, the gun was right where it’s supposed to be, and my tech was like, “Hey, Dr. Tiger, you’re right there,” cueing me on. I’m just standing there like, “Mm, yeah, I know. If I could just feel my hands, I could actually get this thing over with.” So, I just would have to wait until that paresthesia passed, and then I could do the biopsy and move on.. So, while these things are happening physically and then mentally, ah, so many other things were happening. Lots of negative thought loops turned into suicidal thoughts. “I don’t really want to be here, I don’t want to live like this anymore,” and I just spiraled down to bottom. Really, what we know now is a burned-out physician. So, nobody talked about this stuff 15 years ago, 12 years ago, and I thought I was just by myself.
It just kind of happened over time. It’s like not I woke up one day with all these things. It was hard to figure out. But every doc I went to, gave me pills. “Take this, take this, take this pill.” I had imaging, I’m a radiologist, so popped in the magnet as you can imagine, everything was normal, mental health care professionals on board, nobody could really help. So, that’s where I was. I had also lost three physician colleagues to suicide. So, one day, I just had this aha moment where I said, “You’re heading down that path like your friends, so you got to do something. Because no one can help you. You’ve gone to all the specialists, you’re seeking mental healthcare, you’re doing all the things, everything we learned in medical school, but something is missing. You haven’t figured it out yet, but you’ve got to figure it out because it’s going to be up to you to save your own life. Otherwise, you’re going to end up like the rest of them.”
So, that’s when I started thinking, like, “Okay, what else is out there? What else haven’t I done? What else can I do?” At the time, there was talk more and more in the news, in the media, and everything I was reading, it was on television about things like meditation, things like yoga, and I thought that they were like for those people way over there [giggles], totally not me because I was a gym rat and I still am. I didn’t understand what those people were doing. Twisting their bodies up, and turning them upside down, and creating shapes that as a radiologist I didn’t think they should be doing or even could be doing. We have all these preconceived notions, weird music, weird language, weird clothes, and all those weird people over there.
To answer your question that was then, and then the transition began, when I said, I have nothing to lose and everything to gain. So, I grabbed my next-door neighbor who was a nurse one day and I said, “Hey, there’s this yoga one-on-one class down the street, why don’t we go? It’ll get us out of the house. She said, “I don’t know about this. I said, “Come on, if it’s terrible, I’ll take you to dinner.” So, we did and that was the beginning of the journey.
I went with my tail between my legs down to this studio and I took this really wonderful class, which was very informal, it wasn’t anything that I thought it was going to be. At the end of it, I just felt calm, and I felt grounded, and I’ve had focus and clarity, and that was the beginning of my doctor left brain saying, “I need to understand more about this stuff.” That was the beginning of that next chapter of my life.
Jen: So interesting that you tell the story because we do have so many shortcomings in our medical system. I think a lot of people listening are going to relate to your story in some way. Certainly, I expect all of us have experienced the loss of a colleague due to suicide. So, we can relate either personally or due to the loss. So, I also think that it’s really interesting to hear your story from the perspective of realizing that you had no choice, but to figure it out for yourself. And thankfully, for us, you have figured out a lot, and what you’re doing is using some very specific techniques. So, I’m curious if you can tell us about iRest, specifically, how you discovered that and why you find that to be the best form of meditation as a whole, and then I’d also like to hear about somatic yoga and what that is? So, why don’t we start with iRest? Can you tell me a little bit about that?
Dr. Robyn: Yes, absolutely. So, my journey began as I mentioned taking that very first class and we’re doctors that were hungry for knowledge. So, I went to teacher training just to learn, never to think I was going to teach anybody anything. I learned there was this whole other field called yoga therapy, which yoga teachers are 200-hour base level of education and yoga therapy is at least a thousand hours over three years. That is where you learn how to specifically use tools from yoga discipline, meditation to implement to help people with all types of symptoms, and illnesses, and diseases. In my yoga therapy training, was where I first became aware of iRest. The meditation component of my training included every day after lunch, we were guided in this meditation. When I first looked at the schedule, I was like, “Okay, this is ridiculous. Why would I lie down and listen to something after lunch every day?” Because like, I still have my skeptical doctor brain on even though I was in this training.
Just like my yoga experience, after the very first-guided meditation, I was blown away about how I felt, and I needed to learn more about that. It was called iRest, little i, big R, because the i which is you, gets to rest. It was initially created for Walter Reed Army Hospital several decades ago to help our military relieve suffering from posttraumatic stress disorder, posttraumatic stress growth as we tend to call it now and when Dr. Miller who created iRest, who is a yoga scholar and a psychologist was asked to come into Walter Reed to help with relief of the suffering, he took the traditional yoga nidra, which is a meditation that’s like thousands and thousands of years old. He removed things that were potentially triggering. So, lots of meditations are imposing imagery, imposing thoughts, imposing things where you say, “Think about this, imagine that.”
What they found was, that was triggering for a lot of people. For example, someone in the military who was forced to jump out of a plane and land in the water or have their plane crash into water, well, if you were to say, “Oh, imagine you’re floating down the water in an ocean or a river, that could really, really trigger someone.” So, Dr. Miller had the wherewithal to remove a lot of the potentially triggering things, and then he wove in what he found helpful in psychotherapy and created this 10-step meditation, which he called iRest. Because if he said meditation or anything that sounded like that, nobody at Walter Reed was going to do it. He had to create something that sounded like who doesn’t want to rest, right? So, that’s where this was born, and it was found to be so incredibly beneficial for relieving suffering from PTSD. But so much more beneficial as well as in relieving chronic pain.
That’s because so much of the pain we feel in our body is related to the tense muscles that are caused by the chronic stress response, what starts with our thoughts up here. So, when we can relieve the stress in our bodies, relieve the stress in our minds, we can feel better in our bodies and relieve that chronic tension. This type of meditation in 2010, a tier-1 treatment for chronic pain, which means that it’s equivalent to taking pain pills and opioids. So, the reason why I choose this as my go to is because it personally was so helpful to me. It’s circular, it’s evidence based, and it’s culturally sensitive to whoever you’re sharing it with, and that’s what I share with my clients, my groups, my private sessions, and my program.
Jen: First of all, what is somatic yoga and how does that tie into iRest or how does it complement compliment iRest?
Dr. Robyn: Yes, it definitely does. So, I went through all the training of traditional yoga as we may know it and people think of certain positions and certain things. In being on the faculty of trauma informed yoga therapy, I dove more into trauma and more into stress wanting to help individuals. In that way, I was introduced to a specific type of movement called somatic yoga and it understands the principles that when we stretch a muscle, which feels really, really good, we love stretching our muscles. I love stretching one, it feels good. But physiologically, what we know from what we learn in medicine and the way muscles work is that when you stretch a muscle, it’s like a rubber band. When you release it, it re-contracts and that’s because muscle stretching is a spinal cord reflex.
So, a muscle stretch is, it sends a signal to our spinal cord or spinal cord says, “Okay, muscle, you stretched,” sends a signal back to the muscle and says, recontract and it does that all day long. If I were to say to you, “Jen, bend over and touch your toes, you’ll feel your hamstring muscles stretch, and then when you stand up, it re-contracts.” And you know that because if I told you to bend over and touch your toes again, you would feel it stretch again. So, it doesn’t stay long. It’s like a rubber band. So, how do we release chronically tense muscles? Because we know that stretching doesn’t work. It works through the principles of somatics, created by Thomas Hanna and Eleanor Criswell back many, many decades ago.
What we understand is that when we move in a very opposite way contract to chronically tense muscles and then slowly release them, which is known as pandiculation or eccentric contraction, we can lengthen those muscles and that’s in combination with interoception. Interoception being that first-person experience of what something feels like in your body. So, we have extra reception which is, what’s outside of us, and then we have proprioception which is knowing where our bodies are in space.
Interoception is what does that feel like on the inside, what’s happening on the inside, bringing your awareness to that sensation? Most of the time we’re working out, we’re doing three sets of 15 bicep curls, we’re making our grocery list. We’re not paying attention to what I think feels like. So, the combination in somatics is to contract into a chronically tight muscle and slowly release it, and to focus on the sensation of those movements as you come in and out the contraction, the decontraction. Those two principles make somatic movements very different than anything else that we do and that allows your brain to recognize what’s going on in your body and increase the resting length of those chronically tense muscles.
To answer your question about how is it like iRest, where’s the compliment? They are both very, very somatic-based practices. Because iRest involves focusing on different parts of your body, for example, focusing on the sensations in your body whether it’s physical, whether it’s an emotion, a thought, a feeling, you’re bringing yourself back into your body. It’s very embodying because we live most of the time from here up, right, our thinking mind. We’re barely in our body. Somatics is the same thing. So, they’re both very, very mindful, very interoceptive practices, and they go very well together hand in hand.
Jen: That’s a wonderful explanation and it sounds like from talking with you, you’ve seen incredible results with people that you’ve worked with. Can you tell me some stories of people that you’ve worked with and what they’ve been able to overcome?
Dr. Robyn: Yeah. Oh, how much time do we have?
[laughter]
Dr. Robyn: I love nothing more than to hear the success stories of the clients that I work with. I work with several different populations, the physicians this past year have been doing amazing. So, I have one physician client who was a competitive gymnast as a child, and had an injury, and she has a pars defect at the lumbosacral level, and she also had an injury to her shoulder. She also has a scoliosis, so injury to her back, injury to her shoulder, and scoliosis as a child. Now, she’s several decades older, in her 40s, and she came to my program because she wanted to learn to relieve her stress. She didn’t even say anything about these injuries, or her curvature of her spine, or anything.
The interesting thing is she spent many, many decades of her life going to chiropractors, physical therapists, occupational therapists, massage therapists, you name it. She’s tried it to relieve the pain in her body that was caused by her scoliosis and her traumas and palliatively, yeah. She feels better after she goes through treatments, but there’s like all that in between time, she doesn’t feel good. She has since relieved all of her pain, every single ounce of it by learning somatic yoga, by learning how to move her body in certain ways to relieve the tension that was caused by injuries from when she was a kid. She’s made it a very dedicated practice every day. It doesn’t take long. You do a 10-minute daily sequence, you can feel amazing, but she relieved her symptoms all by herself. So, she even got to the point where she was going to her chiropractor and he said, “Hey, what you have been doing? Things are really looking different here.” Being able to be empowered to relieve your own discomfort is amazing. So, somatics for her was pretty incredible.
With iRest, I had another client who, she herself had lost a spouse to suicide. She herself is a cancer survivor thriver as I like to call it and while she was working with me, she also had a mother who had a stroke, and then her mother passed away. She was then diagnosed after having an injury and having traumatic fractures to her pelvis with yet another cancer. To taking all of this in, she could do very small movements. While she was recuperating, she couldn’t do very much. But something that really, really helped her was iRest. Being able to process all of her feelings, all of her emotions, all of her thoughts, not just recognize them, which a lot of other meditations do, be aware of your feelings, notice your thoughts, notice your emotions, notice the sensations, and actually process them, recognize them, and process them, which makes iRest very different, and help to relieve what’s going on in her body, any tension she was feeling, she gives iRest credit for being able to navigate everything that she experienced and continues to experience in a very calm, very grounded way with everything that she’s going through.
Just knowing that all she has to do is put her headphones on and listen to recordings that I’ve made so that she can do that. She had a lot going on, she still does is amazing. My military clients and first responders, many of them who are military have had tremendous results. That my 75-year-old military veteran, Vietnam vet hadn’t slept in decades. He said, because of iRest, he is now sleeping for the first time since he was 20 years old and the same gentleman was only able to garden for 45 minutes, his back pain was terrible. He now gardens for five hours at a time because of somatics. So, here are three different examples of different clients using these principles to really, really make their lives more fulfilling and to navigate what is coming their way.
Jen: Thank you for those examples. How do you see this type of therapy relating to physicians, residents, and medical students in particular, and how can it be useful?
Dr. Robyn: It’s a really great question and what’s really, really disturbing is that the medical literature shows that chronic stress, and all this burnout, and all this depression, and suicidal thoughts actually begin very, very early. So, in 2016, JAMA, the Journal of the American Medical Association put out a research paper that documented medical student statistics with respect to these topics. What they found was that, one in four medical students are depressed or have depressive symptoms, and that 11% have suicidal thoughts, and only 15% of medical students affected sought out help, which means that 85% of medical students who are suffering have not sought out help.
Then we fast forward to today. So, Medscape’s 2021 physician suicide and burnout report showed us that what was half of all physicians being burned out pre-pandemic now turned into two thirds, and that 89% of physicians are somewhere on the depression scale. 89%, only 11% are not somewhere on the depression scale. And that less than a third of physicians are caring for themselves on a regular basis. The suicide is expected to rise during the pandemic and even worse so following the pandemic, which was already twice the national average. So, I believe that the self-care education really needs to begin the first day of medical school, when those students are in their orientation, when they’re looking around, when imposter syndrome is starting, that is when they need to start to learn how to take care of themselves to prevent going down this path of depression, and burnout, and anxiety, and ultimately, unfortunately, suicide.
Jen: Absolutely, I agree. The alarm bells are sounding and as a community we need to listen and take action. And I agree in terms of the outreach that we’re doing to create DocWorking Thrive as well, which is, as you know, as part of the community, it is a community built of physicians in addition to offering coaching, and of all different stages of training, and also access to resources like you coming in and talking within the private Facebook group. I look forward to having you there as a Facebook live guest, so that we can delve in further to some of these details. And I am thrilled to partner with you and collaborate with you to help in bringing this mission to our fellow physicians and executives within the medical system, within the healthcare system to help try to reach physicians, provide self-care options, and make our work sustainable.
Dr. Robyn: It’d be my honor to work with you in any capacity to make all that happen.
Jen: Thank you so much. If someone’s listening and they’re interested in learning about iRest, learning about you, and how they can reach you, first of all, the process for achieving these kinds of results, what is the process from the beginning, is it typically a certain amount of time, where they are learning these techniques? Can you walk me through a little bit about how your process works and then I absolutely want to know how people can reach you?
Dr. Robyn: Yeah. So, it usually starts with, I have a free 30-minute stress relief strategy call. So, usually we get on a call because I need to recognize what the client really is looking for, how can I be of service to you, what do you need? Lots of times, it’s a combination of things. And it may also be some life coaching. You know, working with their thoughts. So, I like to first understand, how can I best serve you on that call, and then, we can go from there. So, whether it’s going into one of my programs, I have seven now, CME accredited programs, the larger one is Rx Inner Peace, and that is both online learning as well as live group and private coaching. Or, if it’s one of the smaller programs where I focus on a specific topic like meditation, or somatics, or sleep, or breathing, sometimes, it’s a combination. It might be live coaching, where we work with thoughts, and then, there are videos involved where you learn specific topic or sometimes it’s only the programs themselves. It really depends on what that individual wants, how best they learn, and how they need me to serve them.
Jen: Fantastic. Thank you for telling me about this. I think there are going to be a lot of people who are very interested in reaching out to you and learning more. How can people reach you?
Dr. Robyn: They can find me best through my website at stressfreemd.net. There’s the link for the free 30-minute call, there’s a link to my podcast you can listen to that. There are three free self-care videos on the website. You can learn a release for neck and shoulders, breathing tool, and you can sample an iRest meditation. Then all of my programs are there as well. If you want to find me on social media, you can find me on Instagram @stressfreemd, you can find me on LinkedIn at Robyn Tiger MD, Facebook at StressFreeMD or at Robyn Tiger MD. And I’m happy to support to answer any questions that you may have.
Jen: Robyn Tiger, MD of StressFreeMD, thank you for joining us on DocWorking: The Whole Physician Podcast.
Dr. Robyn: It’s an honor to be here. Thank you, Jen.
[DocWorking theme]
Jill: Life as a physician can be packed with pressure. Let’s face it, it’s stressful. And everyone says, you should manage your stress. But how do you do that? Everyone needs to be less stressed, but it can be a mystery how to get there. The good news is, there are proven ideas and techniques that you can put into action today that can lower your stress. You just need the right coach to help you put those tactical-practical tools into action. You need an experienced coach who’s worked with physicians and helped countless doctors put these ideas into play in their daily life to see big results.
Amanda: I’m Amanda Taran, producer of DocWorking: The Whole Physician Podcast. Thank you for being here. Please check us out at docworking.com and please don’t forget to like and subscribe. Thank you for listening.
