CCB: Welcome to the ONEder Podcast. This is your host, CCB. And in today's conversation, Creating Healing and Thriving Environments, we'll explore the profound connection between our surroundings and our well-being.

To guide us in this discussion, we have the distinct honor of speaking with a true pioneer in this field, Dr. Esther Sternberg. Dr. Sternberg is an internationally recognized leader in stress and healing, a physician, and a scientist who has dedicated her career to understanding how our physical environments impact our health, emotions, and even our productivity.

She is the author of two groundbreaking books, "Healing Spaces, The Science of Place and Wellbeing"... And I'm going to tell you guys, you are going to want to get these books because they are so fascinating... and "Well at Work: Creating Well-Being in Any Workspace." Her work bridges the fascinating worlds of neuroscience Immunology and architecture offering us profound insights into how we can design spaces that truly nurture us She's also research director at the Andrew Weil Center for integrative medicine. So Dr. Sternberg bridges such a vast spectrum of areas that we are very interested in.

Dr. Sternberg, thank you so much for joining us today. We're eager to learn from your research and wisdom.

Esther Sternberg MD: Thank you so much for having me and thanks for that wonderful introduction.

CCB: My pleasure. It's so exciting when we have guests that really touch so much of what we are concerned about. So I want to say your work beautifully connects the scientific understanding of stress and healing with the design of our so physical spaces. Can you start by explaining to our listeners kind of the why? Why did you become involved in something this?

Esther Sternberg MD: It was a rather circuitous journey, but it really related to a single question that the then research director at the U. S. General Services Administration asked me when I was at and NIH at the National Institutes of Health. I spent 26 years at the National Institutes of Health as a senior scientist and section chief studying what became the science of the mind-body connection, the role of the brain's stress response in illness and and in health.

And knowing that that was my area of research, Kevin Kampschroer from the GSA asked me if I could help him measure the impact of the over 370 million square feet of office space that he oversaw for over 2 million federal workers and figure out how he could create spaces that made the workers healthy, happy, and productive.

That was back in 2000 when that concept was pretty new. And it actually, it wasn't new. There's always been health in the American Institute of Architects mission and design professionals. But at that time, and certainly around the downturn in 2008, 2009, health of people in the spaces was not a priority on the bottom line. That wasn't the priority. So we began back in 2000 using what were then available wearable health devices, measuring the stress response throughout the day in workers. And we started with a building that was being retrofitted and we measured the workers stress responses during and movement and and other aspects of of of health.

In the old space, which had high, six-foot high wall cubicles, was dark, no views to the outside, no circadian light, airflow was poor, it was musty, there was loud mechanical noise.

And we compared their stress responses when they moved into the new light and airy open office design, beautiful views, lots of circadian light, and low mechanical noise and excellent airflow. And we compared the people in the old space and the new space and much to my surprise, and and I don't know why I was surprised, but I was surprised that we could actually measure the stress response that was higher in the people in the old space compared to the new.

It carried through to when they went home at night and even while they were sleeping. There was a significantly greater stress response. We measured it both using what were then state-of-the-art wearable devices, very different from nowadays, for heart rate, heart rate variability. We also measured salivary cortisol, that stress hormone, throughout the day. And the amount of stress that they experienced in the older space was Of a medically relevant amount and that really piqued my interest and I went on to continue working after I left the and NIH 13 years ago and became research director at the Andrew Weil Center for Integrative Medicine.

I continued working with Kevin Kampschroer, who went on to become director of high-performance federal green buildings at the GSA, and chief White House Sustainability Officer. So he was then in a position to be able to implement our research findings. We use state-of-the-art wearable devices, small, quarter-size chest-worn heart rate variability devices for stress and relaxation response, for movement, posture, sleep quality, And we also asked people how they felt in various settings throughout the day. And we connected all of that health data using big data analytics to up to 11 different environmental attributes, light, sound, temperature, humidity, volatile organic compounds, and so on. And we came up with a prescription for a healthy well-being building.

CCB: Okay, I am just totally blown away when I think about the the, I'm gonna say the beginning, the the vast amount of research that you created at such an early time. And I will tell you that at One Workplace we, we give out what we call ONEder Grants to the design community. So every year we started them in 2019, we've given out about 25 ONEder grants. We're just in the seventh cycle right now, evaluating the proposals. The reason why I bring this up, I bring this up because across the previous six cycles, there have been people who were doing things that you did, 20 years ago, thinking about it now...

Esther Sternberg MD: That's great. Wow.

CCB: ...Utilizing the wearables to determine, and this is going to bring me to a question, to determine what happens when people are working in multiple environments. So given the rise of the remote and the hybrid work models, how do the principles, that you're thinking about now, what do you think the impact is, on on the worker today?

Esther Sternberg MD: I mean, that's an excellent question. And that's that's not something we studied because we were focusing only on the work office environment that was controllable. And it's really hard doing research in many people in multiple environments. So that that's difficult to do. You need sophisticated mathematics to tease things apart. Now the wearable devices, I wear this this ring, they're much more easily adapted to that kind of varied environments.

But there's what we found is that personality matters. People who were more introverted preferred quieter, darker spaces, people who were more extroverted, preferred the open office setting with more noise going on and, more movement, more activity. But we also found that too much, will it's clear, everybody knows that too much noise is stressful. In fact, too much noise damages the ear. But we found surprisingly that when it's too quiet in an office space, the stress response is higher. And there's a sweet spot for the decibel level, which is about 45 decibels, which happens to be the same decibel level as birdsong. So there's this wellbeing response that is optimal when it's not too noisy and not too not too quiet.

So that can be applied to many different settings. I would say that it's the analysis, the data analytics for figuring out, combining many different settings, home, traveling, you have to take into account being in the car or, commuting, than an office space, which is more uniform, and also the different personalities of people. Iit's complex research, but I'm glad it's being done.

CCB: It certainly is. Yeah, there was another, there is another body of work that has been accelerating over the last couple of years, and that is the the impact of neurodiverse populations within the workplace.

Esther Sternberg MD: Yes. Yes.

CCB: And so we we also have supported and are very close with, and you probably know Kay Sargent from, yeah, who's done a lot of work and and has devoted probably six or seven years.

Esther Sternberg MD: Yes.

CCB: Thinking about that and and how does that layer on top of who the folks are?

Esther Sternberg MD: So, the paper we published, this is with was with Casey Lindbergh as a first author, on the personality types, the the the implication for office management and design of that is not that you should do personality studies on everybody who comes in and tell them where to work.

That is not a good idea. what really needs to be done is have many different workspaces to accommodate many different kinds of personalities, work styles. and, and also if you think about your own self throughout the day, there are times when you do want to be quiet heads down. There are times when you want to be interacting with colleagues. There are times when you may want to be sitting in a, in a coffee shop working, and and it also depends on how you feel. So when you're sick, you're less likely to want to have noise going on around or interacting with people. That's the the sickness response it’s called.

So, throughout the day, as you change the activities that you engage in, it's important to have many choices of places to sit, work, gather, small groups, large groups, with colleagues, and and that applies also to the neurodiverse. So so it's it's not a one size fits all. i think one of the problems with the the bad rap that open office design got is it simply a field of desks in an open office is not a good idea.

CCB: Hmmm.

Esther Sternberg MD: But it's more active office design, Robert Propst described it or developed it mid-century, where you have lots of different workstations, workplaces where you can go depending on your needs at that moment in time. And that applies to the neurodiverse. So it's really, it's important to have these choices so that individuals can choose where to work, when they want to work, and how they work.

CCB: Okay, I am going to interject here for all of our listeners. There is always a website page with each podcast and we will have links and to references that Dr. Sternberg is sharing with us, just in case you need to do more deep dive into any of this information.

Esther Sternberg MD: Actually, before you go on, yes. So I describe all of this in the book. And at the end of the the book, there's suggested readings for each chapter. And I also write a Psychology Today blog, and I go into more detail there too. But yes, thank you very much for providing that information.

CCB: Certainly. And thank you for all everything that you're sharing. I want to say that the reason that we met you, that would be the royal way, was because we're we're doing some work in senior living now and Colin Milner recommended that we speak with you. And I'd love for you to spend a little bit of time talking about that that more healing environment that's recognizably healing environments, if it's healthcare spaces or assisted living, senior living spaces.

So I'd love you to spend a little bit of time talking about your research around that. But also, i well I'm making a note to myself, the thing that you mentioned about sleep, i always think, i if I didn't get enough sleep, I'm going to be a crank in the office. I didn't think I was going to take the office home and have it disrupt my sleep.

Esther Sternberg MD: Yeah, nor did we. We were quite surprised, but you do take your office home at night. Speaking to the first question, the I'm glad you brought that up because as I was talking about office space design for neurodiversity, really that's that concept, universal design, started in the senior living domain.

CCB: Hmmm.

Esther Sternberg MD: You want to be able to have beautiful, pleasant, home- atmosphere, and yet you want the railings on the wall and, to give you to steady yourself if you have trouble walking and patterns on the floor that don't look you're going to fall off a cliff, accommodate people whose memory may be beginning to fail and provide landmarks so that they can navigate and find their way to their room or their home. so But that applies to universal design. It used to be that hospitals had these ugly railings, and and people people who had difficulty were sort of segregated from the rest.

And so now the concept of universal design, so the railings look nice wainscotes, pictures or landmarks in one senior living, a residential community. They have lamppost, a big clock, sort of landmarks that. So it's important to have features that help help guide peoples people who have some degree of memory loss.

CCB: Arguably, as you've just referenced, there are some elements of design that should be omnipresent, that some considerations should certainly be in all built environments.

Esther Sternberg MD: Yes.

CCB: So I'm wondering, and you referenced this earlier when you were talking about biophilia and the the views to nature, and there're there's a whole other set of, and we compartmentalize things, sadly on occasion, but designing for the senses. So how do we, what are your thoughts on, how do we manage that effectively? And what's the value?

Esther Sternberg MD: Well It's interesting because in in Healing Spaces, in my previous book, I talk about the first the first five chapters are really the five senses, what you see and hear and smell and touch and do in a space. And then the rest is how do you apply this to healing environments hospitals? How do you apply it to at the city scale, the urban design scale? And then the well at work, creating wellbeing in any workspace takes those concepts and applies it to the to the work environment. And the thing that the Well at Work does that goes beyond the senses but includes the senses is i use a framework of integrative health. So the Andrew Weil Center for Integrative Medicine has defined the seven domains of integrative health as, and this is what is integrative health? It's how do you stay healthy and thrive and prevent disease?

So it's sleep, really important. Resilience, which is the balance of your stress and relaxation response and how quickly you bounce back from any stressor, whether it's physical or emotional. Movement, relationships, spirituality, nutrition, and importantly, the environment. And the environment includes not only the green environment and biophilia and access to nature and being in nature, but clean air.

It's really important to to have minimal volatile organic compounds and off gassing and frequent fresh air turnover with lots of filtration and ventilation. And that became very obvious during COVID. And you remember all of the animations on the internet showing people getting sick by sitting underneath event event and virus spewing out so what happened during covet is the focus became to create a healthy space you fix the ventilation and that is absolutely essential but the point that i make in well at work is that's not good enough you have to start with excellent clean air but you need to create spaces that enhance emotional well-being as well as physical health

Yes, you want to get rid of allergens and toxins and bacteria and mold and and and viruses and so on. But if you don't create a work environment or a healing environment that includes enhancing what you see and hear and smell and touch and do in a space, enhancing the the emotional side, then Number one, in terms of workspaces, people aren't going to want to go back to work in a crowded six foot high wall cubicle farm with terrific ventilation.

You want to be in a space that is welcoming, that is beautiful. And the same goes for health care environments, whether it's for senior living or whether it's hospitals. In order to stay healthy and and get and and get healthy if you're sick, you need an environment, that environment that supports both physical and emotional well-being, both physical health and emotional well-being. So in terms of the senses, it's what you see, beautiful views, lots of light, circadian light, lots of early morning sunlight is important for healthy sleep.

Sleep is essential. If you're not sleeping well, you're gonna wake up the next morning crabby, as you said, and and fatigued and and not productive. There are some studies that show that sleep, people who have difficulty sleeping for whatever reason, can cost an organization about $3,500 per worker per year. Now that may not sound a whole lot, but it is an awful lot. And if all you need to do is fix the sleep by having people be exposed to sunlight early in the day, moving more, we also found that people who moved more during the day had less stress when they went home at night, and that's stress measured by wearable devices. And the people who were less stressed slept better and woke up the next day less fatigued and in a better mood. So it all kind of connects together.

CCB: It certainly does. I mean, you're just thinking about an organic, and the organic nature of the human being in all of these environments, which should be considering that entire organic nature. So yeah it's it it's almost common sense, only we don't do that all the time.

Esther Sternberg MD: Well, it is common sense, but when Kevin Kampschroer first came to me at and NIH back 25 years ago, he needed the data to convince the powers that be that it was worth to spend the money to create these healing well-being spaces.

CCB: Yeah.

Esther Sternberg MD: And again, that's what we came up against over and over again before the downturn, before COVID. where we'd talk to organizations and CEOs, chief medical officers, and they'd say, yes, yes, we want healthy people. What can you do for $5,000? Well, you can't do anything. If the priority is mainly squeezing as many people into a space as possible, you're not going to be creating well-being environments for for workers, which will ultimately cost the organization far less in the long run, because the greatest expenditure for organizations is are the people in them.

And so it's really important to create these environments that support physical health and emotional well-being.

CCB: Okay, a little bit of a change of topic, but not. Looking forward, what emerging trends or technologies in design or in health science do you believe hold the most promise for creating even more effective healing or well spaces in the future?

Esther Sternberg MD: There's no question that the the most important thing that I see coming down the road is individualized spaces. And that and that speaks to what you mentioned before about neurodiversity, but also different people's work styles and what they need at different times during the day. Mid-century office buildings were created one size fits all, but one size fits nobody. So the easiest thing think about is temperature. think about ther thermostat wars. Everybody has a different set point for for thermal comfort. There's also, we found in terms of that, that when it's too dry, the stress response is higher. When it's too wet, it's higher. So when it's less than 30% relative humidity humidity and greater than 60%, so outside the ASHRAE standards, the stress response was 25% higher.

If you're in an and an environment every single day with 25% more stress load on your body, that is a cumulative amount of stress that's medically relevant. So how do you fix that? It costs a lot of money to dehumidify in a humid environment. It costs a lot of money to humidify in a dry environment. And you also have the risks of Legionnaire's disease and so on. So the solution is individualized humidifiers, dehumidifiers.

There are chairs now, office chairs that have seat heating and also cooling. So, then you don't have to spend so much to change the whole building. And people are happier because they can set their own their own local environment. The same applies for sound, noise. People who may have some difficulty hearing may find It annoys the environment more more stressful.

If you think about going into a museum where you have cones of sound as you're standing in front of a painting and it tells you something about it, but the person next to you doesn't hear it, there is technology now that can do that. You remember the movie Get Smart? I think that dates us, but with the but the cone of silence that comes down around them, and they can't get out of this bubble.

CCB: Yeah.

Esther Sternberg MD: But, that's the kind of thing that acoustical engineers can design sound that is directed into into a space. To a yeah of course, you can wear headphones and listen to music, listen to nature sounds and so on. But there are many ways that are being developed to create individualized local environments that optimize your own sense of well-being.

CCB: That is just so darn fascinating. I think about precision medicine, it's just making, and leaps and bounds and moving forward because we can understand the individual nature of the the human structure, if you will.

Esther Sternberg MD: Right

CCB: So, and I also am thinking about project that we just did with UCSF Benioff Children's and it's a rehabilitation floor, and they have all the sensory rooms, which are just spectacular.

Esther Sternberg MD: Yes. Yes. Well, we also have in in our office space, we Mirelle Phillips, who is CEO of Studio Elsewhere, donated a recharge room.

CCB: Hmm.

Esther Sternberg MD: I tell the story in the book. This is an immersive virtual nature space. So the story is that Mirelle Phillips was in the video game industry and she was in a serious accident and had neurotrauma, was in and out of hospital, was desperate to be in nature and couldn't be in nature. And read my previous book, Healing Spaces, The Science of Place and Well-Being, and shared with me that she had an aha moment, that she decided to quit the video game industry and create a studio, studio elsewhere in New York City, to create these immersive nature environment rooms. And that was in 2019. Then 2020 happened. And she found herself in the middle of ground zero for COVID health care, worker, burnout, suicidality, depression, anxiety.

And she quickly ramped up first with Mount Sinai Hospital in New York and now has over 70 of these recharge rooms in hospitals around the country. and is finding with research, and we're working with her as well, that there's a dose effect of being in such a nature environment where you sit and you call out Studio Elsewhere, take me to quiet mountain lake. And all of a sudden the whole wall lights up and there's a quiet mountain lake and you feel you're there. And you need to be in it for about 15 minutes. And after 15 minutes, your stress response reduces, your anxiety reduces, you sleep better at night, and we're measuring that cortisol also goes down, salivary sweat cortisol also goes down. So, these kinds of technologies are now coming online to provide places of respite for people, whether it's in hospitals, in senior living communities, and certainly in in office spaces as well.

CCB: Oh, my gosh. So your work brings together the diverse fields, which I think is fascinating because the nature of how collaboration is is usually a better result in in whatever the the goal is. So if you've got medicine and neuroscience and architecture and urban planning, kind of what advice do you give professionals in these fields when it comes to working with other disciplines.

Esther Sternberg MD: That's a great question. I've i've done interdisciinplinary interdisciplinary work my my whole career. I started out trained as a rheumatologist and arthritis doc. And because of a single patient, which is, I won't go into this now, I was convinced that the brain and the immune system talked to each other at a time when the scientists and physicians didn't believe that there was such a thing as the mind-body connection. They thought it was pretty flaky and out there. And that was... Back in 1989, I discovered in rats that the brain's stress response is important in susceptibility to inflammatory diseases arthritis.

And doing that, I mean, In retrospect, that was much less interdisciplinary than what I do now, but it required bringing neuroscientists and immunologists together and endocrinologists. And what I learned from that experience of decades, and by the way, i do have a my first book was all about that, the balance within the science connecting health and emotions. And it asked, where did we in Western medicine go wrong, where we forgot about these connections? and answers it through the through the language of science. But the in order to work with another discipline, you need to become an informed consumer of the other person's fields.

It doesn't mean that, I have a joint appointment in the College of Architecture, Planning and Landscape Architecture, but I tell people, don't ask me to design a building or build it, it will fall down. I do not know... I am not an architect, but I have, by working with these with architects, building experts for over 20 years, become an informed consumer of their disciplines. And likewise, they have become informed consumers of mine. I work with engineers. It's really important in what we do to work with engineers, bioengineers, mechanical engineers, and Big data analytics, that's essential in this. You can't connect all these very complex types of data, granularity of data, different times streams of data without the expertise of a data analytics a person who knows how to do that.

So it doesn't mean that I have to stop being a doctor and stop doing what I'm doing and go back and get a PhD in engineering. but we work together to understand what are the constraints of each field.

I may say, oh I wanna have build a castle in the sky. And the engineer will say, yeah, that's great. We can build a castle, but it has to be on the ground. So, we learn from each other and through iterative process, that was what was so rewarding. And I actually do talk about this in in Well at Work. The first part of Well at Work is how I came together with these researchers of other fields and how we We put our knowledge together. And when my editor first read that section of the of the book, she said, oh, I love it. It's you're describing the Marvel universe because each of the each of the researchers, each of the building experts were our characters who came together to create a new universe.

CCB: I am telling you, Dr. Sternberg, we could listen to you for hours and hours. And sadly, we're at the end of our of our time here on the ONEder Podcast. But I'd love for you to share with us one key message or something that you hope listeners take away about the power of our physical surroundings.

Esther Sternberg MD: Well, I think the the key the key message is, I actually wrote an piece about this. I live in Tucson about 10 or 20 minutes from five world-class spas, and nobody is mandating people to go to those spas. People are going to those spas because they are designed and operated to make people feel well. physically and emotionally in them. And there's no reason why you can't apply that principle to workspaces, to healing spaces, whether it's senior living or hospitals or outpatient clinics, to create environments that make people feel good and and actually then help them heal.

People who go to hospital, you're anxious, you're sick. You don't need to be in in in a maze where you can't find anything, where you where it's smelly, it's dark. Fortunately, hospitals are now way better than they were back when I was coming up through the ranks. But all spaces should be designed to support both physical and emotional health, and do it through the five senses and through integrative health. And in the book, in in Well at Work, I describe how you can embed each of those seven domains of integrative health into work environments, but it applies also to learning environments. You mentioned that at the beginning. It applies to your home environment. I talk about in the book, think about your own home office. How can you embed the seven domains of integrative health into your work environment, wherever you work.

CCB: Fantastic, Dr. Sternberg, we are enormously grateful for your time here on the w ONEder Podcast. I'm gonna remind everybody that the ONEder Podcast is available on all streaming services. We'll be sending this conversation out to the universe so that people can hear and I'm gonna say thrive from the wisdom that you've shared. Thank you very much, Dr. Sternberg.

Esther Sternberg MD: Well, thank you so much for having me. It's been a pleasure.