Bryan Sexton, PhD • Live at the Summit

Bryan Sexton is the Chief Wellness Officer of Duke Health Integrated Practice and Director of the Duke Center for the Advancement of Well-being Science. After 30 years as a psychologist, psychometrician and investigator, he now works with leaders to assess and improve culture and work-force well-being. Bryan has conducted and published large studies and randomized controlled trials showing how to cause enduring improvements in the well-being of our workforce. He has authored over 100 peer reviewed publications, and his research instruments and well-being interventions have been translated and used in over 30countries.A perpetually recovering father of four, he enjoys running, using hand tools on wood, pickleball with friends, and hearing particularly good explanations of extremely complicated topics.

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Transcript

Narrator: 0:13

Welcome to another episode of the Wellbeing Connector Podcast, hosted by Roy Reid and sponsored by the Coalition for Physician and APP Well-being. This episode is one of a multi-part series recorded live at the 2025 Joy and Wholeness Summit. Thank you for listening.

Roy Reid, APR, CPRC, MCPC: 0:30

Welcome to a new edition of the Wellbeing Connector Podcast. We're coming to you live from the Joy and Wholeness Summit in Asheville, North Carolina. And I'm really pleased to be joined by Bryan Sexton with Duke. And Bryan, you just got off the stage. And so this is all going to be fresh from your presentation. Tell us a little bit about your journey into this whole work of wellness and wholeness. Sure.

Bryan Sexton, PhD: 0:58

Well, I so I just started a new role at Duke as a chief wellness officer, which is exciting, but it goes all the way back to my very first job out of training, which is at Johns Hopkins, where I got pretty severely burned out and was really curious about like the drivers and how to recover from that. And I started doing a lot of uh research in into it. And um at the time, my job at Hopkins was to study uh safety culture. Okay. And what are the things that that we do in the work settings that to kind of make uh clinical outcomes better for our patients, and uh operational outcomes are better for our patients and our in our workforce. And uh, once I started introducing well-being metrics into that culture assessment, it became richer, the opportunities for interventions were broader, the meaning that it had for healthcare workers was was was more potent. And um I left Hopkins to kind of rebuild myself at Duke with this knowledge about, oh, don't say yes to everything. And they say sometimes it's better to be from Hopkins than at Hopkins. That was certainly my experience, to be to be honest. Um uh and uh what has just happened since then has just been a snowball of um good methods, good metrics, uh the science is getting stronger. We've gone from observational studies to national studies to randomized controlled trials, where we now know here are things you can do to cause it to be better. Wow. And that's been really that's been exciting. So that's the it was my personal trajectory, which kind of dovetailed with my career trajectory.

Roy Reid, APR, CPRC, MCPC: 2:31

Absolutely. So let's unpack some of the programming uh that you just referenced and perhaps even uh into the topic that you talked about uh with the group here in Asheville.

Bryan Sexton, PhD: 2:43

So uh a lot of the time when it comes to well-being, uh there's a uh a sense that it's actually all about diet and exercise, or all about meditation, or all about, you know, you know, saying no, you know. And I think what what informed my journey of recovery from this uh uh just what was really severe uh burnout uh was you know, sometimes it's sleep and sometimes it's you know work-life balance factors, and sometimes it's um the way you connect with other people, and sometimes it's where you choose to go for vacation, like the Grand Canyon, versus, you know, uh uh three days at the beach kind of a thing. And um uh what what I was really driven to do was to help to build more of uh an arsenal of options. So it's not one thing that you do, you can match the right well-being intervention with the well-being needs of the individual. So giving people a sense of agency, that's been really exciting. So we've been we've been doing the the research and the studies to show these are the things that work, and we're now to answer your question, moving more in the direction of here are um the interventions that work more for these kinds of people versus those kinds of people.

Roy Reid, APR, CPRC, MCPC: 4:08

Talk about that a little bit. Yeah, yeah. Where where have you where what what program or offering might be a good illustration in within a certain population or group of people?

Bryan Sexton, PhD: 4:21

So there's always going to be things like um coaching and interventions, but uh in our uh which are great, and the science behind that's great, it's growing all the time, and people are getting better at it, and and there's definitely demand and a need for it. It's getting cheaper and easier to do, which is really exciting. That's always the the the onward march of science to making it more accessible, more affordable. Um what uh I like about uh the bite-sized offerings that we put out there are little things you can do to uh cultivate gratitude, to cultivate uh a sense of peace, uh, to cultivate uh awe and wonder, like scenes from nature, spending time kind of like uh um uh uh a big variable that we look at is called emotional recovery. So, how how readily do you bounce back after an upheaval? And one of the really fascinating things is if you spend time in nature, and it doesn't have to be at the Grand Canyon, it could be like you're taking a walk outside and you're just noticing the sunlight dappling through the leaves and splashing onto the ground in front of you. If you if you uh spend time noticing nature, it's remarkably good for your ability to bounce back after emotional upheavals. So uh connecting people with the intervention that's gonna be most meaningful and accessible to them in that moment is has been something that's been really, really important. So things like uh uh processing grief, um, cultivating joy, cultivating humor, cultivating on wonder, um, uh interventions like three good things is a really popular one where every day before you head into the pillow, you just pause and you reflect back on three things that didn't suck that day. Good thing number one, good thing two, good thing number three. And you actually rewire your brain to notice good things as you go through your day. Once you've been doing that for about three or four days. Uh and if you do it for a week, the benefits last for six months. But if you do it for uh 15 days, it's for every night for 15 days, you just pause and say, what are some things that went well today? Uh the benefits last about 14 to 18 months, which is pretty cool. And then like just to do this brief thing that has this long-standing benefit of rewiring the way your brain processes information. So um the randomized control trials and that stuff are really impressive. And that's where we're trying to uh um make those kinds of bite-sized interventions accessible so that people don't think that well-being is all about yoga. It yoga is a part of it. Yeah. But but there are other things that are simpler that might actually get more people, that might actually get more people interested in well-being because they don't have to enroll in a yoga class or a mindfulness retreat just to do something for well-being.

Roy Reid, APR, CPRC, MCPC: 6:59

Two questions, and you can take them however you feel it's easier to answer. What has been the biggest hurdle um in getting to the place where you're really engaging in all of this real excellent research? And what biggest surprise that you've discovered? The hurdle and the surprise. Yeah.

Bryan Sexton, PhD: 7:18

Oh man, the hurdle is just that um as you know, a lot of people enroll in gym memberships and then never step foot in the gym. So one of the biggest is we we we recruit like crazy for these studies, but uh, half of the people that we recruit never take the next step and do anything. They don't click a link that we send them, they don't show up to do that. So half. So we literally have to recruit 5,000 people to get 2,500 to participate in a study. Wow. Um, uh, and then from that, we have what we call the initiate the initiators of the 2,500 people, and then we about uh 77% of them actually finish it. So that's been the biggest hurdle is to get people to initiate. Um and we've done some things to that that uh to to to uh uh incentivize it a little bit more. We've made it as bite-sized and as minimal uh of a burden on a ri on a participant as possible. So can you give us 60 to 90 seconds every day for four days? And then like boom, we'll do it. We'll do a work like balance intervention, but you can do that for us. Um the other thing that we do is continue education credits, so CME and CU credits as a draw, and we give it to you at the end of the study so it gets people to kind of get to the end before they say I've got other things to do. So that's been a big hurdle. Um, the biggest surprise, um, you know, I think I think I've been surprised by the the kinds of things that end up being potent and the kinds of things that end up not being potent. Wow. Um so uh uh I'm a big fan of uh mindfulness-based meditation or meta meditation, kindness medication meditation. They the the data behind them is is just kind of it's not controversial, it's really good data, but it's also really hard to do to dedicate yourself to 45 to 60 minutes a day of doing this stuff. Um so uh I'm not surprised that meditation works. I am surprised that you can get similar results by spending a minute to a minute and a minute and a half every day for 15 days, um, just pausing on what are three things that didn't suck today? Right. And that the results are so similar. Wow. So that's so so the efficacy of some of the bias-sized strategies relative to the not bias-sized stuff, that's been surprising to me. That's why I've focused 20 years of my research on curating more of those uh interventions.

Roy Reid, APR, CPRC, MCPC: 9:47

That's awesome. Where do you hope this research is taking your team, but maybe at an even more macro level? Where is it going to take health care and this work that happens in the coalition throughout the country?

Bryan Sexton, PhD: 10:02

Yeah, uh well, I'll speak first for for Duke and then for everyone else. We we we are actively now um recruiting and training uh well-being fellows so that we can build a well-being infrastructure to do this work because it's it's one thing to have like a goal, uh, it's another thing to have like the right metrics and the right methods to meet the goal. But if you don't have the people that continue to show up to do the work, or if the turnover is so high that the one person you trained is gone three months later, you have to have a robust infrastructure of people that connect with this concept and keep showing up. And so supporting them in this work is is is priority number one. Building that that workforce and and making sure that they have the uh the resource, they become the infrastructure, the engine for the interventions, the engine for the research that is forthcoming uh to kind of further support what's the right thing to do and the wrong thing to do in a situation like this. Um and so inside Duke and outside Duke, uh, those are kind of our our goals. We have to put the right interventions in the hands of the right people to do the right thing.

Roy Reid, APR, CPRC, MCPC: 11:15

Is are you recruiting fellows within Duke to be the champions for it, or is this a program you're offering to people outside of Duke?

Bryan Sexton, PhD: 11:23

So we've trained 17,000 people outside of Duke and over 800 people inside of Duke. But until now, it's always been, oh, I want to look at that, I want to try that. And so right now it's always been a uh, you know, uh if you're interested, you can enroll. Here's the QR code. What's different now is we're going to academic chairs and saying, we need you to nominate um a number of people from this academic department that can be the nodes of change for well-being going forward. And we don't want one, we want multiple. We want to have a lot of redundancy uh in this effect. And so that's that's a it's uh a push versus a pull.

Roy Reid, APR, CPRC, MCPC: 12:04

Yeah. What are the skills or the the content of the fellows program that people go through to be qualified?

Bryan Sexton, PhD: 12:13

So we have um uh a five-hour um uh training that we give people that is completely free and it's available to anybody who wants to do it. And you can find that uh on the internet at B I Toller, it's bit like B I T.ly forward slash well be do W-E-L-L-B-D-U-K-E. It's all over case. That is free to anybody who wants to do it. That's the first. And if you like that and you want to do the other 12 hours, the full training is 17 hours. Okay. So the the first five hours is where we like, hey, if this is your jam, yeah, come check out these other 12 hours. And the types of things that we do is we give people uh interventions and insights about where to start. If there's a severe level of burnout, start with these kind of low-hanging fruit. Okay. Build some trust and some capacity and get some wins before you go a new turn to some of the more complicated interventions. We have interventions for for uh uh cultivating hope, uh, which is really powerful, but you don't want to start with that. Right. Uh we have uh uh I'll give you an example of cultivating gratitude is really easy to do if you're severely depressed or highly anxious. You can be in a really bad way and you can still feel grateful. Yeah, so we can turn on that positive emotion and make that intervention work. Um, but if you're severely depressed, telling you, asking you to tell us what you're looking forward to is the wrong thing to do. So we we have to sequence in certain things that this group is ready for and then build up you know readiness for the other things like building hope is very potent, but you don't start there if people need training wheels.

Roy Reid, APR, CPRC, MCPC: 13:46

You mentioned that you're utilizing your chairs to nominate people for the for the um fellows within the organization. Uh can people from the outside apply and just go through the program? Absolutely. It's the same program. Okay. Yeah, we have a 10,000 line. But it's but it's so it's open.

Bryan Sexton, PhD: 14:03

Yes. So we have a 10,000-line Zoom that we use at Duke to train the people internally to do, and we keep it open for people who want to register and do that uh from the outside. Is there a cost? There is a cost. Um uh for anybody who has a Duke ID, it costs nothing, obviously. For people from outside of Duke, there's uh we have like 20-line packages, 50 line, 100-line, 500 line packages. Health systems will do this, state hospital associations will do this. Well, they'll purchase like 500 lines and then give them out to people. But uh they just basically uh purchase access to um uh log in and get the monthly uh session. And if they can't make it live, it's recorded and sent to you the same day. Nice, and you can get continuing education credit from the recording for up to a year afterwards. So it's not meant to be like if you're not there on it's the third Thursday of every month at June Eastern time, but if you're not there at that time, we'll make sure you still have access to it and you can do it that way. It's it's meant to be not be stressful. It's meant to be like this resource is here if you need it. The other thing that's really cool about this format is that um one ambassador can take that recording and they can take five minutes of it that they thought was particularly meaningful or potent, and they can play it at their staff meeting. Or they can play the whole thing at the staff meeting and give everyone at the staff meeting CME or CEU credit for listening to it. So it puts in the hand of the of that like well-being champion the ability to spread those resources to others.

Roy Reid, APR, CPRC, MCPC: 15:32

And is that just if can they find it on the the Duke website?

Bryan Sexton, PhD: 15:36

Yes, just generally uh I'm sorry, www.caws.dukehealth.org. CAWS stands for the Center for the Advancement of Wellbeing Science.

Roy Reid, APR, CPRC, MCPC: 15:47

Very cool.

Bryan Sexton, PhD: 15:48

That's our our center. And and we're yeah, we're we're excited to kind of continue to build on it. It's been it's been it's been a journey.

Roy Reid, APR, CPRC, MCPC: 15:56

You have a ton going on between the research, the the programming, um, and and it and it's exciting to to see the research side in particular because this this space can often be difficult to give tangibility to. Right. And what that and what that looks like.

Bryan Sexton, PhD: 16:17

Yeah, I I think that um my my mentor pounded into my skull in my training that um uh data is your best Kevlar. Uh so you're gonna get lots of arrows. You better have you better bring the receipts, man. You better bring the data. And so we we try to have good methods and metrics behind everything that we do. And that's that's meant a lot.

Roy Reid, APR, CPRC, MCPC: 16:35

That's great. That's great. Well, listen, I want to thank you for your time today. Uh, I appreciate you being a champion and being here at the summit. I know that your talk uh will inspire people just based on what we talked about today. And I look forward to following up with you at some point.

Bryan Sexton, PhD: 16:50

It's a pleasure to be here. Thank you for having me.

Roy Reid, APR, CPRC, MCPC: 16:51

You bet. Take care.

Narrator: 16:55

Thank you for tuning in to the Wellbeing Connector Podcast, brought to you by the Coalition for Physician and APP Wellbeing. The Wellbeing Connector offers insightful conversations with healthcare professionals devoted to fostering wholeness within their organizations. Each episode delves deep into the holistic approach to well being, underscoring the importance of physical, mental, social, and spiritual health. For more episodes, visit our website at www.bethejoy.org/podcast.