Mindfulness

1. Mindfulness From Neuroscience to Living Life Fully Maine Psychological Association Annual Meeting 2012 Anne Uecker PhD Edmund N Ervin Pediatric Center MaineGeneral Medical Center

2. Objectives • 1. Become familiar with the brain circuitry (neuroanatomy) underlying mindfulness and meditation. • 2. Identify potential neuroplastic and neuropsychological outcomes underlying mindfulness and meditation. • 3. Become familiar with personal, psychological and neuropsychological benefits of mindfulness for use at home and in your professional practice.

3. A Different Way of Saying … • Meditators are masters in introspection and awareness as well as in emotional control and self regulation. They are happy and accepting, of themselves and others, and experience a sense of peace. • Meditators regularly activate their insular and somatosensory cortices. By doing so, and over time, they strengthen connections in their anterior cingulate and ventromedial cortical areas. They achieve a left frontal lobe hemisphere advantage that assists in quelling stirrings that may arise from the amygdala with further benefits to the superior temporal cortex.

4. Mindfulness Vocabulary • Mindful intention • Resonate • Presence … in the moment • Receptive • Cultivate • Attunement • Reperceiving: a metamechanism that allows meditators to stand back and witness their own thoughts rather than being immersed in them.

5. Mindfulness Latent Variables A metaanalysis of numerous mindfulness questionnaires (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006) revealed five factors: • (1) nonreactivity to inner experience (e.g., perceiving feelings and emotions without having to react to them); • (2) observing/noticing/attending to sensations, perceptions, thoughts, feelings (e.g., remaining present with sensations and feelings even when they are unpleasant or painful); • (3) acting with awareness/(not on) automatic pilot, concentration/nondistraction (e.g., breaking or spilling things because of carelessness, not paying attention, or thinking of something else; • (4) describing/labeling with words (e.g., easily putting beliefs, opinions, and expectations into words); • (5) nonjudgmental of experience (e.g., criticizing oneself for having irrational or appropriate emotions).

6. Key aspects of Mindfulness • An increased ability to orient one’s attention to the present moment • Ability to recognize and accurately label emotions • A greater ability to control emotional reactions in the middle part of the brain by engaging the front part of the brain. • More refined self awareness

7. Goal: To attempt to SNAG you to consider to practice and promote mindfulness SNAG: A Daniel Siegel acronym for STIMULATE NEURONAL ACTIVATION AND GROWTH Mindfulness meditation carves new channels in the streambeds of the mind (Richardson and Begley, 2012).

8. Interface of Cognition, Emotions and the Brain Self Directed Neuroplasticity(Jeffrey Schwartz) Social Affective Neuroscience (Richard Davidson) Contemplative Neuroscience (Richard Davidson)

9. The Brain is Softwired!Recent Timeline for Evidence for Neuroplasticity in the Brainhttp://sites.lafayette.edu/neur401-sp10/what-is-neurogenesis/a-timeline-of-research-adult-mammalian-neurogenesis/

10. Neuroplasticity London Taxi Driver Exercise

11. Left versus Right Origins in EmotionsRough Beginnings • Guido Gainotti (from Davidson) • Pathological crying after damage to the left, and mostly front part, of the brain. Also, a lack of drive, an inability to set goals, and a lack of perseverance • Pathological laughter after right sided damage. • Lead Davidson to hypothesize that the left prefrontal region might be the seat of positive emotion • Eye direction during emotion • EEG • Commercials • First to demonstrate left versus right (positive versus negative emotion) changes • Positive emotion to Carol Burnett (clip) • Negative emotions mining accident • (incidental) • Prefrontal cortex important because of its role in cognition, “the seat of human reason.” This was a new discovery, and a homerun, for emotion. • (Also demonstrated this was present in 10 month olds with Jerome Kagan). Lead to the beginnings of affective neuroscience. (people laughing, people crying) • And then in newborns (with taste)

12. Depression and the Brain-Next stop- • Individuals with depression have less activity in their prefrontal cortex • Functional Implication • Left Prefrontal Cortex • Contributes to our emotional life • The ability to hold in mind a desired goal and form a plan of action to reach it. • Depression: Reduced Initiative and Little Drive to Accomplish Goals • (Davidson began to think about approach-avoidance) • Also, this eventually lead him to think about individual differences. Differences between individuals could be as great as 3000%. This lead him to develop his idea of emotional style.

13. Resilience • Bold 9 year old children (those who had less behavioral inhibition, in the terminology of the experiment) had greater left than right activity in their prefrontal cortex, whereas the shy (more behaviorally inhibited) children had greater right than left activity. This was the first time the asymmetry was linked to anything that was not clearly an emotion: This time, left-right asymmetry was seen in conjunction with being bold or shy. • Bold children recover quickly from setbacks and are able to get on with what they were doing without getting derailed by them.

14. Mindfulness lead to a shift to the left • Subjective feelings substantiated by physical findings • Richard Davidson’s finding, that there was a left anterior shift in function during emotion-provoking stimuli tests, reveals that mindfulness practice enables individuals to regulate their emotions in a more positive manner with approach rather than withdrawal (Davidson, 2004). Also correlates with several health functions such as immune function. • This left shift is thought to reflect a shift toward the approach state of the left hemisphere—in contrast to the tendency of right frontal activation to be associated with withdrawal from novelty or challenge. For this reason alone, formal mindfulness training is thought to promote resilience, the ability to approach rather than withdraw from difficult issues.

15. Relevance for Health • As reported in Davidson and Begley’s recent book, (NK, Natural Killer) cells, a type of white blood cell that is a major component of our immune system, serving to us from tumors, viruses and other germs, have a higher activity level in individuals with a left frontal asymmetry pattern that is associated with more positive emotional style. NK cell activity could be up to 50 percent higher activity than in individuals with high right frontal activation. Similar results have been observed in mice. The study with people has been replicated: greater left frontal activity brings greater NK cell activity.

16. Who Better to Study? For spiritual expansion and perusal: http://www.matthieuricard.org/en/index.php/index/

17. For you and me? • Research has found that Tibetan monks with greater than 10, 000 + hours of meditation experience have greater activation of brain regions associated with empathy toward other individuals. • Gamma Up to and greater than 52,000 hours

18. Some of Richard Davidson’s early studies • G. E. Schwartz, R. J. Davidson, and F. Maer, “Right Hemisphere Lateralization for Emotion in the Human Brain: Interactions with Cognition,” Science 190 (1975): 286–88. • P. Ekman, R. J. Davidson, and W. V. Friesen, “The Duchenne Smile: Emotional Expression and Brain Physiology II,” Journal of Personality and Social Psychology 58 (1990): 342–53. • R. J. Davidson and N. A. Fox, “Asymmetrical Brain Activity Discriminates Between Positive Versus Negative Affective Stimuli in Human Infants,” Science 218 (1982): 1235–37. • N. A. Fox and R. J. Davidson, “Taste-Elicited Changes in Facial Signs of Emotion and the Asymmetry of Brain Electrical Activity in Human Newborns,” Neuropsychologia 24 (1986): 417–22. • R. J. Davidson and N. A. Fox, “Frontal Brain Asymmetry Predicts Infants’ Response to Maternal Separation,” Journal of Abnormal Psychology 98 (1989): 127–31. • C. E. Schaffer, R. J. Davidson, and C. Saron, “Frontal and Parietal Electroencephalogram Asymmetry in Depressed and Nondepressed Subjects,” Biological Psychiatry 18 (1983): 753–62. • R. J. Davidson and A. J. Tomarken, “Laterality and Emotion: An Electrophysiological Approach,” in Handbook of Neuropsychology, F. Boller and J. Grafman, eds. (Amsterdam, Netherlands: Elsevier, 1989), 419–41.

19. My Expertise Chart(to qualify my experience with regard to the present topic)

20. Brain Scan Techniques • EEG • 1995 MRI The Method of Choice • PET • fMRI • Diffusion Tensor Imaging

21. A view of the human brain PREMOTOR SPACE MOTOR SOMESTHESIA “EXECUTIVE” LANGUAGE VISION AUDITION SOCIAL SCHEMATIC VIEW!

23. The Hub

24. Brodmann Areas Lateral Surface Medial Surface

25. Frontal Lobe Brodmann Areas • (10/9/8/32/24) • 8: Frontal eye fields • 9: Dorsolateral Prefrontal Cortex • 10: Anterior Prefrontal Cortex (most rostral part of the superior frontal gyrus) • 11, 12: Orbitofrontal area • 24: Ventral anterior cingulate cortex • 25: Subgenual cortex (part of ventromedial prefrontal cortex) • 32: dorsal anterior cingulate cortex • 44: pars opercularis, part of Broca’s area • 45: pars triangularis, Broca’s area • 46: dorsolateral prefrontal cortex • 47: inferior prefrontal gyrus

26. General Organizing Principlein Self Development Structures Dorsal Versus Ventral • Dorsal: Cognitive Aspects • Ventral: Affective and Motivational Aspects • Dorsal frontal: regulation, motor planning, organization, and regulation, working memory • Ventral Frontal: social functions, emotion regulation • Dorsal ACC: cognitive control; detecting and evaluating conflict • Ventral ACC: conflict resolution in emotional and unemotional circumstances

27. The Frontal Lobe (Prefrontal Cortex) in Self Regulation and Decision Making • The Chocolate Cake Experiment • To make their decision, people will make their choice on the basis of their highest value. • To override the impulsive chocolate –loving system in the brain (the ventromedial cortex), one must have the ability to activate the dorsolateral prefrontal cortex, the part of our brain involved in executive function decision making. • The dlPFC – sits behind the temples • The vmPFC – behind our forehead. • Cognitive Regulation during decision making shifts behavioral control between ventomedial and dorsolateral prefrontal value systems. The Journal of Neuroscience September 2012.

28. Mindfulnessas an Attention Intervention • How we focus attention helps directly shape the mind. Over 100 years ago, the father of modern psychology, William James (1890/1981), said that such a practice of returning a wandering attention back to its target again and again would be the “education par excellence.”

29. Cultivation of Attention Concentration Mindfulness Staying present in the moment Maintaining an alert, aware state Factor Analysis: Observing (internal and external stimuli) Describing (mentally labeling) Acting with Awareness Nonjudging of inner experience Nonreactivity to inner experience One’s Own Breath Mantra Physical Experience ________ These are the object of attention

30. The Art …. • Bringing the mind back • Nonjudgmental labeling of the current thought experience (stress, anger, itching…) • Guided Meditation • Loving Kindness • Metta • Self-Compassion • Compassion • Deeper Awareness

31. … and the science … • Able to focus attention for a longer period of time • Less susceptible to distractions • Improved Body Awareness • Better Top-Down Control • Bottom-Up control (awareness of actual sensation)

32. Attention and Executive Functions • Attention • Selective Attention: conscious decision to selectively focus on certain features of the environment and ignore others • Attention Filtering • Dorsal Attention: orienting • Ventral Attention: alerting • Working Memory • Self Regulation • Impulse Control • Self Monitoring

33. Attentional Blink • Limitations of processing two stimuli presented in close temporal succession. • Attention resources preferentially allocated to first target. • Only fleeting attention resources directed to the second target. • Open Monitoring (Vipassana) meditation • 17 participants beginning and end of a 3 month retreat • Novice meditators in a 1 hr/wk meditation class, with homework to meditate 20 minutes each week. • Primary result: Purely mental training can reduce the propensity to “get stuck” on a target, and assist with allowing the system to be more open to process information in the moment. • 33% reduction in attentional blink (Cognitive resources more evenly distributed) • Less elaborate stimulus processing • More efficient engage and disengage

34. Insight Meditation Society---Barre, MA

35. Prefrontal functions • These functions include regulation of body systems, balancing emotions, attuning to others, modulating fear, responding flexibly, and exhibiting insight and empathy. Two other functions of this prefrontal region is being in touch with intuition and morality (Siegel, 2007). Meditation is not Relaxation

36. Studies: Mindfulness vs Relaxation(Does mindfulness complement multitasking)Neuropsychology Paradigm: Levy, Wobbrock, Kaszniak, and Ostergren, 2012) • Reality: fragmentation due to efficiency demands, stress, effort and increased interruption due to technology • Focused Attention: strengthens the ability to stay focused and ignore distracting information • 8 week program: Cohen , Darlene (2004). The one who is not busy: Connecting with Work in a Deeply Satisfying Way. • Open Monitoring: strengthens the ability to attend to a succession of stimuli without being drawn in by any one of them. • Relaxation: progressive tensing and relaxing, aided by relaxation imagery

37. Studies: Mindfulness vs Relaxation(Does mindfulness complement multitasking) • Multitask –Meditation –Multitask • Multitask—Relaxation—Multitask • Multitask—Nothing—Multitask—Meditation—Multitask • RESULTS___________________________________________ • Overall Time improved, but no effect of group • Number of activities engaged in decreased in meditation group as compared to control and relaxation • Meditation reduced task switching • Increased time per activity in meditation groups, whereas C and R groups decreased their time per activity. • Expectation of benefit was greater in the relaxation group • Task Memory improved in both the relaxation and meditation group • Less negative affect in M group as compared to R group (Positive and Negative Affect Scale) • Greater Mindfulness as assessed with the Mindful Awareness Attention Scale (see end slide)

38. White Matter Neuroplastcity • Anterior cingulate cortex • Diffusion Tensor Imaging • Fractional anisotropy: index for measuring white matter integrity. Higher FA value related to improved performance. • Axial Diffusivity: associated with axon morphological changes • Radial Diffusivity: implicates the character of the myelin.

39. Studies: Mindfulness vs Relaxation(Diffusion Tensor; Tang et al 2012) • 4 wks Integrative Body-Mind Training • 11 hours total • Enhanced FA in several brain areas communicating with the anterior cingulate • Corpus callosum and anterior and superior corona radiata • Increased numbers of brain fibers or axonal caliber • Increased myelinization • Improved regulation may be mediated by improved communication efficiency between ACC and other areas.

40. 10,000 + hoursContinuum of TimeA few minutes • Tang et al (series of studies 2010-2012) showed 4 wks of integrative body-mind training (11 total hours) enhanced FA in several brain areas involved in communication to and from the anterior cingulate, including the corpus callosum and superior corona radiata. • Also a two week, 5 hour group. • Also, a one week. • This series of studies has shown short term meditation to increase the ability to resolve conflict in a cognitive task, altered neural activity in the ACC, and improved connectivity of the ACC to other brain regions. A synapse can be formed in the matter of minutes. It is dynamic and has a relatively short life span

41. Interactions Between Brain Areas(Brain regions do not act in isolation. Path analysis diagram with functional interactions) • Left Prefrontal to Amygdala • Calming effect; shortening the period of amygdala activation • When the amygdala is quiet, the left frontal cortex is able to do its job

44. Open Monitoring • The quality of open, nonjudgmental awareness implies a balance, so you do not get stuck on an engaging stimulus but are, instead, open to all stimuli.

45. Brain activation during compassion meditation: a case study. • OBJECTIVES: • B.L. is a Tibetan Buddhist with many years of compassion meditation practice. During meditation B.L. uses a technique to generate a feeling of love and compassion while reciting a mantra. The aim of the present study was to investigate the neural correlates of compassion meditation in 1 experienced meditator. • METHODS: • B.L. was examined by functional magnetic resonance imaging during compassion meditation, applying a paradigm with meditation and word repetition blocks. • RESULTS: • The most significant finding was the activation in the left medial prefrontal cortex extending to the anterior cingulategyrus. Other significant loci of activation were observed in the right caudate body extending to the right insula and in the left midbrain close to the hypothalamus. • CONCLUSIONS: • The results in this study are in concordance with the hypothesis that compassion meditation is accompanied by activation in brain areas involved with empathy as well as with happy and pleasant feelings (i.e., the left medial prefrontal cortex and the anterior cingulategyrus). • J Altern Complement Med. 2010 May;16(5):597-9. Engström M, Söderfeldt B

46. Compassion feels good. The Caudate Nucleus, Dopamine, and reward. Brian Knutson, Stanford

47. Caudate Nucleus--and more rewards-- • Brian Knutson, a neuroeconomist and an expert in the involvement of the pleasure center of the brain in motivating financial decisions, is now studying if similar brain areas are activated for altruistic reasons. Can extending compassion to another person look the same in the brain as anticipating something good for oneself? And who better to test than Tibetan monks, who have spent their lives pursuing a state of selfless nonattachment? • Meditation science • The “monk study” at Stanford is part of an emerging field of meditation science that has taken off in the last decade with advancements in brain image technology, and popular interest.

48. Social Neuroscience • Body Awareness • Intrapersonal Acceptance • Empathy and Compassion toward others • Attention • Impulse Control Neurally Inspired Interventions

49. Cortical Midline Structures--Self Development-- • Medial prefrontal cortex • Which includes the anterior cingulategyrus and medial aspects of superior and middle frontal gyri (extending over multiple Brodman areas (10/9/8/32/24) • Medial posterior parietal cortex • Which includes the precuneus, posterior cingulate, and retrosplenial cortex • These are also regions involved in autobiographical memory tasks

50. Social Neuroscience • Social circuitry