Dr. Lauren Tober on Working with Mental Health as a Yoga Teacher

Dr. Lauren Tober  01:10

Thank you so much for having me here today, Rob.

Robert Maldonado  01:13

You’re a clinical psychologist, coach, yoga teacher, and author. You stay pretty busy these days.

Dr. Lauren Tober  01:24

I do. I try not to, but it is not easy.

Robert Maldonado  01:30

You have a new book coming out soon, Mental Health Aware Yoga: A Guide for Yoga Teachers. What a great book and a great title.

Dr. Lauren Tober  01:42

Thank you so much. I’m so excited about it.

Robert Maldonado  01:43

Tell us a little bit of why you saw the need for this book at this time.

Dr. Lauren Tober  01:51

A few years ago, I was teaching yoga classes for mental health, yoga for depression, and yoga for anxiety. I was enjoying teaching them, my students were telling me they’re getting a lot of benefit from them. But I started to think how is what I’m teaching any different from what would be taught in a well-rounded yoga class where a teacher understood mental health. It really got me thinking. Why does the clinical psychologist need to be teaching these yoga classes? Why can’t this be taught in a general yoga setting? Why aren’t all yoga classes supportive for people’s mental health? I went around and tried out different yoga classes just to get a feel of what was out there. I realized yoga teachers were doing some things that weren’t supportive of their students’ mental health. It makes sense because yoga teachers will start with a 200 hour yoga teacher training, then might go on to do another 300 hours, and very rarely is there any kind of mental health information shared in these yoga teacher training courses. When we look at the research, we can see that the majority of yoga students are actually practicing yoga for mental health reasons. There was a study done in Australia, a guy called Steven Penman did some research for his PhD. It was quite a while ago, nearly 20 years ago now. He found that nearly 80% of yoga students reported that one of the reasons they practice yoga was for the mental health benefits. It’s probably even more than that now. Yoga is more popular now, many people understand the psychological benefits of yoga. What became clear to me is that many yoga students are coming to yoga for the mental health benefits. But yoga teachers aren’t equipped to support their students experiencing mental health challenges. I wanted to change that and created a training called Mental Health Aware Yoga to teach yoga teachers how to support the students experiencing mental health challenges. Some of the yoga teachers that come and take the training are therapists as well as psychologists, doctors, coaches, counselors. They use this information to integrate it into their clinical or coaching work. Other people that take the training are yoga teachers without any other qualifications. They use this knowledge to support their students, often as an adjunct to other therapy, counseling, or whatever it is, to create these safe and nourishing and transformative spaces for their students.

Robert Maldonado  04:37

Yoga now has become a worldwide phenomenon, it’s everywhere we go. We do some traveling in our business, and everywhere we go, people are practicing yoga and interested in yoga. In the book, you start out the book in the introduction with your own personal journey into yoga and psychology. Can you share with our audience about your personal journey? We’re always interested in people’s personal experiences in these incredible fields.

Dr. Lauren Tober  05:19

My interest in yoga and psychology started at the same time. I was in my early 20s, doing my undergrad in psychology. I went on an exchange program from Australia, Canberra, to Vancouver at the University of British Columbia in Canada. I arrived in Vancouver from hot, sunny Australia, just a few days before Christmas, to cold, dark, snowing Vancouver where I didn’t know a single person. It was such a juxtaposition. I landed at a youth hostel. I met the guy who was running the youth hostel, he took me under his wing and took me to a yoga class in downtown Vancouver. I’d heard of yoga, but it wasn’t popular like it is now. I didn’t really know anything about it. I thought it was a little bit strange. But I went along, I was there to try new things. We went along to this class in downtown Vancouver in a community center, it turned out to be a kundalini yoga class. Everyone was dressed in white, they had white turbans, the room was dark, it was fairy lights everywhere. It was packed, this big space in the community center was packed full of all people coming to practice yoga. I think it was a free class they were offering or a by donation class. In that class, there was a part of me that was like “What have I got myself into? This is so strange.” I’ve never done anything like this before. It was actually quite difficult. If you’ve ever tried a kundalini yoga class, there’s quite dynamic breathing and chanting, and holding your arms up in the air for long stretches of time. It’s not a physically easy class to do. There was a part of me that was like “What have I got myself into? This is really hard. What am I doing here?” Another part of me that was really lit up was like “I don’t know what this is but I’ve got to keep doing this.” Over the years, I kept studying psychology and became a psychologist. I kept practicing yoga, and eventually went on and did my yoga teacher training course. For quite some time, they were quite separate. I was working as a psychologist over here and teaching yoga. But then over time, they’ve become more and more together. Yoga is the psychology. We do the physical practice of yoga, which is what we often think about with yoga, for psychological reasons, so we can cultivate a sense of calm, realize our true self, our true nature. I went to India and did my yoga teacher training. I spent nine months there, on and off one year. During that time, I went to India trying to decide if I actually wanted to be a psychologist. I completed my two-year internship in Australia but I wasn’t sure that I actually wanted to continue with the psychology. I went to London, then I went to India, I spent a year traveling and studying yoga. At the end of it, I was like “I actually do want to work as a psychologist, but I want to integrate yoga into it.” I decided to go back to Australia, back to the university, Australian National University. I was accepted into a doctoral program there. I wanted to research yoga and mental health, so I left India, I came back to Canberra. I don’t know if you’ve ever been to Canberra, but it’s like the exact opposite of India. It’s very organized, it’s very often quite conservative. I said to my professor who was supervising me I want to study yoga for my clinical psychology doctorate. He looked at me, he was interested, he hovered his fingers over the keyboard to look up their research database and said “How do you spell yoga?” He was willing to humor me but had no understanding of it himself. I consider myself a clinician more than a researcher, so I felt like I needed support to do the research at the time. I didn’t end up researching yoga and mental health but I did do my research on mindfulness-based cognitive therapy which integrates mindfulness meditation and CBT cognitive therapy for recurrent depression and anxiety. It’s a yoga practice as essence, they just don’t talk about it in that context and the research and the work. Slowly, I was able to bring those worlds together through my studies at university. Over the last however many years it’s been since I finished, I’ve been integrating more and more into my work. It makes so much sense to me that these worlds come together, yoga is a psychology.

Robert Maldonado  10:43

It’s such a deep psychology too. We teach Carl Jung’s work, he was very influenced by Eastern philosophy and yoga. How did you put these two worlds together? In yoga, the aim is enlightenment or Samadhi, this transcendental state of consciousness. In Western psychology, I was trained in clinical psychology as well, the focus is very much on diagnosis and treatment. How did you meld these two worlds together to make it cohesive so that you could apply it in a practical way?

Dr. Lauren Tober  11:42

There are so many different ways of doing this. The number one that I practice myself and recommend anyone else who’s interested in these worlds is to do the yoga practices yourself and find out about yoga philosophy yourself, because that makes you one, a better person, and two, a better therapist. You can hold everything that’s rising and falling in yourself, that’s rising and falling in the therapy or the coaching space. When you’ve done the work, when you’ve done the practices and understand the framework of yoga, then even if you’re not sharing it with your clients, there’s something powerful there. The first part of it is, do the practices yourself, have it as a resource for yourself so you show up in a different way in your work. In terms of the way you might bring yoga into your work, there’s so many different ways of doing this. One of the ways I find really helpful for clients and also a way that fits within the framework we have as psychologists, which is a little narrower in some ways than we might have in the coaching world, which is much more broad, is to look at yogic practices as a way to regulate the nervous system. We’re understanding more and more the effect trauma, stress, mental health have on our nervous system. Yoga has a huge plethora of practices that are so powerful to help us regulate the nervous system. Actually, yoga psychology and Western psychology overlap. In this way, in yoga, we talk about the gunas, for example. The gunas are three states that make up everything: tamas, rajas, and sattva. Is it okay if I dive into a bit of yoga psychology here? One of the big goals of yoga practices is to cultivate sattva. Sattva is a state of calm or equanimity. We can overlay it with one of the theories that comes out of the trauma research, which is the window of tolerance model. When we’re within our window of tolerance, there’s ups and downs in life, but we can do life, our emotions are regulated, nervous systems are regulated, we can tolerate life. This fits in with sattva, we’re feeling calm and equanimous. In the window of tolerance model, we also talk about a hyper arousal, this is when we become sympathetically dominant. We might feel anxious, agitated, angry, this regulated state. In yoga, we call this rajas. In the window of tolerance model, we also talk about hypo arousal, which is a down-regulated state when we’re feeling flat, exhausted, or lacking motivation, or depressed, or shutdown, or free state. In Western psychology, you might call this hypo-aroused or parasympatheticaly dominant. In yoga, we call this tamasic state. There’s these beautiful overlays of the language from Western psychology and yoga psychology that I think can be really helpful. Yoga practices, which are designed to help us to cultivate sattva or bring us back within our window of tolerance, to down-regulate when we’re feeling rajasic, or hyper-aroused, or to up-regulate when we’re feeling tamasic, or hypo-aroused.

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Robert Maldonado  16:26

How did the ancients discover all these things? They obviously didn’t have the instruments we have, they didn’t run people through MRI machines or anything like that. All this was done through them sitting and meditating or philosophy. What was your sense when you were in India of how this knowledge came about and how it was transmitted?

Dr. Lauren Tober  16:57

I don’t really know because I wasn’t there, so I can’t give any definitive idea. But my understanding is that this knowledge was passed from teacher to student verbally over the years. It wasn’t written down, there wasn’t a book, like I’ve created. There was a guy called Geetanjali, who put together the Vedic knowledge at the time, in 296, sutras, short statements that communicate the essence of yoga. Then there’s so many books written about these very short 196 sutras. But in terms of how they got this knowledge initially, whether it came from God or whether it came from their own practice, I’m not sure. But we think about these days, we do research, we get lots of participants and try things out. Then we call it an evidence-based practice. We do some put it into SPSS and do some statistics around it, they publish it in a journal. This way of researching is only fairly recent, it’s only been going on in the last few decades. I can only feel that yogis were researchers, they tested this stuff out on themselves, on their students. This is a longitudinal study of thousands of years, not just a few years, like we often do a few hundred participants. I can only imagine thousands of participants over thousands of years that these concepts and ideas and practices were tried out.

Robert Maldonado  18:37

That’s a beautiful way of seeing it, it was thousands of years of experimentation and analysis, getting feedback from actual practitioners. I imagine they were refining these processes as they went along. As a clinical psychologist, how do you see yoga, let’s say if we were able to teach it in the hospitals, the clinics, the mental health clinics, take it to where it needs to be, how do you see it helping people with mental health problems?

Dr. Lauren Tober  19:28

I resisted this question for a while myself, because I was concerned about yoga being watered down, being brought into clinical settings and being stripped of its history and its depth, becoming “Here’s a breath practice for this.” I had some internal struggles with this idea for many years. I’ve come around to it more recently, because I think we enter into the world of yoga where we’re at. For some people, it’s when they’re first pregnant, they’ll go to a prenatal yoga class for support with the pregnancy for their baby. For other people, they want to get fit so they’ll go to yoga at a gym to get strong or to lose weight. For other people, it’ll be like a social thing they go to. And for other people it’ll be doing it as part of their therapy, as part of their clinical work they’re doing. I’ve come around to the idea of we all access these amazing practices in different ways. We’ll take what we need from them, depending on where we’re at at this moment. I think it’d be great to have these practices and this knowledge integrated into our medical system. I also think this can be a really wonderful, affordable way for people to access yoga, because yoga isn’t always cheap. It’s not affordable for everyone, especially if you’re working with someone who is very well-trained, their face can be quite expensive to access it. But also sometimes yoga teachers aren’t paid very well either, they’re expected to teach for free or to teach for very low rates and make it accessible for everybody. When yoga is offered in a setting like a hospital, or community health, or even in a workplace, or it’s funded by somebody else, it means the teachers get to be paid for their expertise and the students can access it either for free or at a really affordable rate. I think that bringing yoga into existing settings from a practical point of view is a wonderful idea.

Robert Maldonado  21:46

In the book, you mentioned some of the specific mental health issues you’ve actually worked with. Can you tell us a little bit about those?

Dr. Lauren Tober  22:06

In the book, we speak mainly about depression, anxiety, stress, and trauma. These are diagnoses that many people are getting, it’s a common experience, whether it’s a clinical diagnosis of depression, anxiety, or trauma, or subclinical levels where we’re feeling down or feeling worried or anxious. Whether you’re diagnosed in this or it’s something you’re struggling with, it might not necessarily meet diagnostic criteria, yoga can be really powerful and helpful in that process in many ways. One of the ways we talk about in the book that links into what we were talking about before, is regulating the nervous system. When we’re feeling anxious, or when we’re feeling the residual effects of trauma, we might feel hyper aroused, in yoga psychology, we might call this rajasic, or in new psychology, sympathetically dominant or hyper aroused. We can do practices to down-regulate, to help us cultivate more sattva, to help us to calm. When we’re feeling depressed, or shut down, or flat, we might be feeling more tamasic in yoga language, or hypo-aroused in psychology. We might do practices to up-regulate, to bring us back within our window of tolerance, or cultivate sattva. There’s a whole heap of practices yoga shares with us to do that. But what we need to do even before we engage in any kind of practices and in itself is infinitely powerful, is to notice your internal state. Where am I? These are different maps. The window of tolerance is a map to understand our internal experience. The gunas is another map. Looking at the autonomic nervous system is another overlapping map. We have these maps from different traditions that help us understand our internal experience. It sounds simple when I say it, but it’s often something that’s missed. Where am I now? What’s going on for me now? It means taking that moment to really sit with myself, to be present with what’s unfolding in my experience, and to notice that without judgment or without expectation, that in itself is often a big shift. Often is all that we need to do. Once we have some insight about where we are, about how we’re traveling, then we can make an informed decision about what’s next. Do I want to do or practice to regulate? Do I need to sit with this a little bit more? Sometimes I need to distract myself because it’s all getting too much and I just need to go and do a few cartwheels or watch some Netflix or put my feet on the sand outside. But this first point of tuning in and noticing is powerful. This is one of the gifts yoga and many other wisdom traditions shared with us.

Robert Maldonado  25:09

I can see how valuable this information would be to yoga teachers to have a sense of “What am I looking for? What am I seeing in my students? What do I do when these circumstances arise in my yoga class?” In the book, you talk specifically about what we should do when these types of situations come up, when somebody cries, for example, in a yoga class. Can you take us through some of those approaches that you talk about?

Dr. Lauren Tober  25:59

Crying in a yoga class is surprisingly common. I’ve cried in a yoga class. It’s for a couple of reasons. One, I think yoga teachers are often great in holding a safe space, so students can come and things will well up. In practice, often we do shivasana, which is lying down at the end of a yoga class. It can be a time of stillness, we can be with ourselves. Often, we’re so busy in our day, we’re running around, doing all the things. We come, we lie and be still. The stuff we were pushing down bubbles up to the surface. Sometimes we’re been holding some traumas in our body, holding a yoga posture for a time can bring that up. I remember myself. I’m going to share one of my own traumatic experiences here, so if anyone doesn’t feel comfortable with that, maybe tune out. Quite a few years ago, I was in Melbourne, which is a big city in Australia, in the south, in a mall with my two young kids. Somebody drove their car down Bourke Street in the mall and killed lots of people. He was using drugs, it turns out at the time. I wasn’t there, I arrived just after it happened. But there were helicopters going over, there was police sirens, everyone was frozen, there was people lying on the footpath. Nobody knew what was going on, it was very scary. I’d also been to London a few years previously, when the bombs would go off. My mind went to “This is a terrorist attack.” There was that retraumatization of what had happened. I had my two young kids, running, calling my brother to come and pick me up, I don’t know what’s happened. It was very scary, not knowing what was going on. A couple of years later, I was in a yoga class, and the yoga teacher had us hold this pose called katasana. You’re bending your knees and holding your arms up in the air. He had us holding arms up in the air for a very long time. This sensation of me holding my young children very tightly, running and holding them very close to my body felt very similar to me the way that we were holding our arms in this yoga pose. It all came back to me in this class, it had nothing to do, it was a different city, it had nothing to do with what was going on. It was a year or so later, I wasn’t feeling traumatized by it anymore, I’d processed what we’d been through, but it was still stored in my body. Holding this position, feeling not pain, but the intense sensation in my arms brought it all back. The yoga teacher didn’t do anything wrong, it’s not that you shouldn’t hold your arms up in the air if you don’t want to, just in case somebody has had an experience similar to mine, but as yoga teachers, we have to understand that this stuff can come up in our yoga classes, even if we teach a really mental health aware or trauma sensitive yoga class. It’s important that we understand how to support our students through that. I hope it was okay to share that experience with your listeners.

Robert Maldonado  29:21

We live in such a stressful world that we all have similar experiences where we feel intense stress. Our mind body is recording all these experiences, especially the difficult, challenging ones. It keeps track of all these things. Its purpose is to protect us, to give us a reference point to watch out for these things and be ready for them. When we don’t process, they might come up in unexpected situations like a yoga class. What’s a proper response for the teacher who’s running the session or the class and needs or should respond? What is the proper protocol or approach to these kinds of situations?

Dr. Lauren Tober  30:43

It’s going to depend on the situation in front of you. There is no cookie-cutter way of doing this. But there is some really important considerations. The first one is to not see it as a catastrophe. In the training we talk about, in the chapter in the book called Mental Health Crisis, it can feel like a crisis. But as the yoga teacher, your job is not to see it as a catastrophe. That’s actually a very normal, helpful, functional response to the situation. If we, as yoga teachers, start to get very anxious or very concerned or freak out about it, the student is going to take that on as well. We need to cultivate our own cyclic state, our own calm in the midst of this, and to be able to hold that space very matter of factly and compassionately for the student. Having done our own work, being able to regulate our own emotions and stay calm in the face of that is one of the most beneficial things we can do for our students and really anybody in our lives. But in this context, we’re talking about yoga students. The other thing that’s really important is that people in the helping professions, whether it’s yoga teachers, psychologists, coaches, or any kind of teachers want to do is to try and make it better, try to fix it, try to take away this person’s pain. We can’t do that, it’s usually not helpful to try to do that. Trust that people can regulate themselves, trust that people can do what they need to do to be okay. Occasionally, there will be something that we do need to do to step in, but we need to watch this rescuer mode that we go into. Keeping calm ourself, watching out for that rescuing mode, simply being a compassionate presence, being present with somebody. You don’t need to go into hugging somebody or saying “There, there, it’s okay, it’s all gonna be okay” to try to diminish or shut down their experience, even if it’s coming from a really loving place. But to be present with that person, you get to judge what they need. Do they want to be just left alone? Because oftentimes, if emotion’s coming out, we do just want to be left alone, we want our teacher to give us a look to say “I’m here, if you need me” kind of look, or actually going and saying those words, letting people know just with that look, with a few simple words that it’s perfectly okay to be having the experience they’re having. You do what you need to do. Other times, they’ll be in need. If someone’s very in distress, they might need you to come up and sit with them, perhaps do some grounding practices. One really simple way to support someone to ground is simply to ask them “Can you name five things in the room?” Go through the senses. “What can you see? What can you hear? What can you smell? What can you taste? What can you feel?” It can be a powerful way to help somebody to ground when they’re feeling really disregulated to bring them back into the moment. But oftentimes, it’s your compassionate, non-judgmental presence. Often, that’s all that’s needed. 

Robert Maldonado  34:13

I love it. In the book, you talk about the specific ways of approaching these kinds of situations, not only crying but a panic attack or a real crisis point in the student’s life that’s going on. You instruct people and especially yoga teachers on what to do in these particular situations. In general, what’s your sense of, I don’t know if there’s a typical yoga teacher, but, let’s say, somebody that gets trained as a yoga teacher out there or online, do they get any instructions regarding mental health issues?

Dr. Lauren Tober  35:16

I know I didn’t when I did my teacher training, it wasn’t part of my training. I did most of my training in India and lots of different trainings in Australia and the UK as well. It definitely wasn’t a part of my training. I’m seeing now more and more that some yoga teacher trainings will do an hour workshop on trauma sensitive yoga, for example. That’s a really good start but it’s definitely not enough. Most people get their knowledge about mental health from their own research rather than it being part of a yoga teacher training course. I want to change that. I can feel that things are changing in the world generally. In the yoga world now there’s more understanding of the benefits of yoga for mental health and how important it is that yoga teachers understand mental health. I feel the tides are turning, it’s changing. I’m excited to be a part of that. We also run a training called Mental Health Aware Yoga for yoga teachers, both online and in person for people who have already taken their yoga teacher training, so you need to be a yoga teacher to come and do this training. We spend 60 hours or six months learning about mental health for yoga teachers. A yoga teacher training course, the first training many people take is a 200-hour course. This is a vast body of knowledge that takes a whole lifetime to learn, you can’t fit everything into a two-week intensive. It’s impossible. There’s a lot of criticism around these 200-hour yoga teacher training courses. But the way I see it is it’s a starting point, you have to start somewhere and the way our society is functioning at the moment, we do things in institutionalized ways, with certificates and registration bodies, this is the system we’re living and working in at the moment. This is the first step. We might take a 200-hour yoga training course, it’s never going to cover everything you need to know, it’s the first step. If you find a reputable teacher who really resonates with it, it can be a really great first step, but it’s just a first step. There’s a lifetime of practicing and reflecting ahead of you.

Robert Maldonado  38:06

You can always go deeper into this beautiful philosophy. I love that the West can contribute through research and clinical practice, inform this ancient wisdom, improve it, make it more adaptable to today’s world.

Dr. Lauren Tober  38:32

When you said improve it, I’m thinking, does that improve it? I think what it does is it makes it relevant to our lives now, because the core issues we’re grappling with are probably the same as they were potentially thousands of years ago, but the way we’re experiencing life is different. I think Western psychology and the scientific method can definitely help make it relevant to our contemporary lives. My understanding of yoga, and I don’t want to speak definitively about anything to do with yoga, I feel the more that I learn, the more a baby I am in this world, so I don’t really speak definitively about anything. But it feels to me that yoga is an evolving, growing practice. It has been evolving over thousands of years and it continues to evolve. The way we’re evolving now for many people is through the scientific method, the research and psychological part of it. From that point of view, we continue to evolve this very living practice. It’s not a static, “this is how it is and it’s never going to change” practice.

Robert Maldonado  39:52

Some of the more advanced teachings out there get into meditation and deeper states of consciousness. Are there particular issues that you’ve learned in adapting your psychology to those deeper practices like meditation?

Dr. Lauren Tober  40:17

In terms of teaching meditation to somebody who might be going through mental health challenges at the time, you need to be really careful. Some people take to meditation, it’s such a bomb, it’s such a help. We look at some programs like mindfulness-based cognitive therapy, which is what I did my doctoral research on and mindfulness-based stress reduction, these clinical type meditation practices where they have people meditating for 20-40 minute settings. For some people, these long guided meditation practices are incredibly helpful when they’re going through challenging times. But for other people to sit still when you’re feeling anxious or depressed is really difficult and can actually make it worse. If you’re have a lot of negative thoughts, you’re ruminating, and someone asks you to sit still, especially if you’re doing it with a teacher who doesn’t understand the implications of that, you can ruminate and spiral even further, or you can feel really anxious or triggered. It can be very unhelpful for for some people and extremely helpful for others. Coming back to this, when I teach, one of the things I say the most when people ask questions in the trainings is “It depends.” Really, it does, it depends on the individual and the capacity and the skill and the experience of the teacher as well. For the most part, I find that keeping meditations very short and very engaged is important. It might be even that a one or a two-minute meditation, or a five-minute meditation is all that is tolerated, it can be amazing in itself. Also keeping it engaged. It might mean an active meditation, like a movie yoga practice, or a walking meditation, or it might mean a guided practice, like a yoga nidra practice, or maybe a visualization, something where somebody’s talking to you the whole way through rather than a simple instruction to focus on your breath and then you’re left with your breath and your ruminative thoughts for the next half an hour. Often, short practices and practices that are active, whether it’s physically active or cognitively active, are really helpful. You said to me before we started recording, Rob, that you interviewed Ann Swanson, so I’ll give a little shout out to her and her book I coincidentally had sitting here because I interviewed her on my podcast the other day. Her book is Meditation for the Real World. She has a bunch of practices in there that are really about short meditation practices we can do in all different settings, whether it’s in nature, or at home, or at work, or in the car, bringing meditation into our life in short doses. Those kinds of meditations she talks about in her book can be really helpful.

Robert Maldonado  43:15

She’s an incredible author as well. Dr. Lauren Tober, the book is Mental Health Aware Yoga: A Guide for Yoga Teachers. Highly recommended not only for yoga teachers, psychologist and coaches interested in yoga and teaching yoga. Great book, great work. Please come back when you have a chance and talk to us again, we need to go deeper into these topics, get the word out that we need to understand a lot more about psychology and yoga and the interface between these two traditions so that we can share with the world that needs these practices so badly. Keep up the good work. Thank you so much for being on the show and sharing your wisdom with us.

OUTRO  44:18

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