brain health and mindfulness october 2, 2015 tony seikel

Brain Health and Mindfulness

October 2, 2015Tony Seikel

Disclaimer

I have no relevant financial interests with respect to this subject.

Brain Health and MindfulnessToday:• What is this thing called

mindfulness?• What effect does

mindfulness have on the way we see the world?

• What are some physical and psychological benefits of mindfulness?

• What effect does mindfulness have on the brain?

• What effect does mindfulness have on the aging brain?

• How can I get some of that?!

My hope…

– Is that this presentation improves your life, and that of your patients and colleagues

– Mindfulness promotes caring, compassionate interaction with patients and colleagues, and my goal is to make the workplace (and the home place, for that matter) a mindful place

Mindfulness……• Mindfulness defined: (Kabat-Zinn, 1994, p. 4)“Paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.”

• A key component is “in the present moment”– Mindfulness allows self reflection– Self-reflection allows me to decide my reaction to circumstances, events, other

people– My reaction determines my level of psychological stress– Mindfulness allows me to make my own decisions about how I am going to respond,

what I am going to do– The only place decisions happen is in the present moment

• Mindfulness Meditation is a formal practice that allows me to pay attention, intentionally, non-judgmentally.

Research in Effects of Mindfulness has Grown Exponentially

Why Would I Want to Meditate?

Physical and Psychological benefits

Summary of Some Physical Benefits

• Reduced cardiac risk (anger, anxiety, emotional control• (Tacon et al., 2003)

• Reduced CVA risk: Hypertension, anxiety, anger• Campbell et al., 2012; Carlson et al., 2010; many, many more

• Improved immune function • (Jacobs et al., 2010; Cresswell eet al., 2009; Witek-Janusek et al., 2008;

Davidson et al., 2003; Carlson et al., 2003)

• Improved Severe Psoriasis treatment effects• (Kabat-Zinn, et al., 1998)

• Improved Diabetes control: Improved glycated hemoglobin through better self care

• (Gregg et al., 2007)

Summary of Psychological Benefits

Psychological benefits• Consistent decreases in

– Social anxiety and Perceived stress– Rumination , recurrence of depression (Sephton et al., 2007 Teasdale et al., 2000; Ma &

Teasdale, 2004)– Post-traumatic avoidance symptoms– Fatigue and depression

• Consistent increases in – Empathy & Mindfulness– Domain-specific sense of control (health, work, etc.)– Emotional regulation

• (Singh et al., 2003; Goldin & Gross, 2010; Farb et al., 2010; Brown & Ryan, 2003– Pain tolerance:

• (Pradhan et al., 2007; Zeidan et al. 2009; Morone et al., 2008; Grossman et al., 2007; Zeidan et al., 2011; Kingston et al., 2007)

– 3-month retention of gains• Chiesa & Serreti, 2009; Keng, Smoski & Robins, 2011; Bohlmeijer, et al., 2010; Hofmann, et al., 2010;

Miller, Fletcher, Kabat-Zinn, 1995

Let’s not forget Health of Insurance Companies! Orme-Johnson, 1987 in Dooley, 2009

Participants: Individuals practicing Transcendental Meditation (admittedly not Mindfulness Meditation) and controls (medical record searches)

Outcomes:

• Meditators use fewer health services • Reduced claims for

– Intestinal by 49% – Nose, Throat, Lung by 73% – Heart by 87.3% – Genital/Urinary by 37% – Injuries by 63.2 % – Tumors by 55.4% – Bone/Muscle complaints by 67.6%

– Ill-Defined conditions by 76%– Mental Disorders by 30.6% – Nervous System by 87.2% – Metabolism by 65.4% – Infectious Diseases by 30.4% – Services Covered by Medicare by 100% – Congenital Disorders by 50.6% – Blood by 32.8% – Other by 91.2% – Skin by > 60%.

A Few Studies On Benefits To Tease You

http://www.sparkpeople.com/mypage_public_journal_individual.asp?blog_id=4793931

http://www.independent.co.uk/news/uk/crime/thieves-try-to-steal-sigmund-freuds-ashes-blame-it-on-their-mothers-9061329.html

Increased Antibody Production Following Influenza Inoculation For MBSR Group: Davidson et al., 2003

Subjects: 41 adults

Intervention: • MBSR versus control• Inoculation with influenza

vaccine

Results• Significant change in

antibody development between 3 and 8 weeks post inoculation

• indicates stronger immune response in meditators

Stress Response in Cancer patients: Carlson et al.,

2007Participants: Breast and prostate cancer patients

Measures:• Cortisol levels, T-cell production, stress

symptoms• Pre, post, 6 month, 12 month

Results• Reduced symptoms of stress• Reduced cortisol levels• Reduced T-cell production:• “MBSR program participation was associated

with enhanced quality of life and decreased stress symptoms, altered cortisol and immune patterns consistent with less stress and mood disturbance, and decreased blood pressure..”

Medical Students in Training: Shapiro, Schwartz & Bonner, 1998

Participants: = 38 exp., 38 controls

Treatment: MBSR

Significant Pre-post gains for MBSR group:

-depression-anxiety-empathy-spirituality

State Anxiety Trait Anxiety

Depression somatic symptoms

Spirituality Empathy

Reduced Aggression and increased Self-Control in Mental Handicap: Singh

et al., 2003

• Participant: 27 year old with uncontrolled aggression and developmental disability

• Treatment: Trained in Walking meditation

• Results: Marked improvement in aggression and control

Physical aggression

Verbal aggression

Self control

Neurophysiology of Mindfulness

http://science.nationalgeographic.com/science/health-and-human-body/human-body/mind-brain/

What are the neural underpinnings ofmindfulness?

• The components of mindfulness include– Focused attention and non-judgmental observation– Non-judgmental observation of what arises during this focused attention– Insights that arise from that observation Increased awareness of the body

(body sense) and the individual’s environment and decreased dependence on judgment

• Predictions: Should see changes related to– Sustained attention – Cognitive processes– Emotional regulation– Body (Somatic) sense– Judgement

Basic neurophysiology

• Regions of control and processing work together to accomplish tasks– e.g. language areas work together to understand

(comprehension) and to express language (speech)

Most of our areas of interest are cerebral

• Cerebral cortex – responsible for virtually all voluntary

motor function and for all conscious activity

• Lobes of the brain:– Frontal lobe: cognition (memory,

attention, visual processes, language)– Parietal lobe: body sense and

integration of sensations with the sense of body

– Temporal lobe: auditory sense, language, memory, face recognition

– Occipital lobe: visual sense– Insula (not shown): sense of self

From Seikel, Drumright & King (2015)





attention, visual processes, language)– Parietal lobe: body sense and

integration of sensations with the sense of body

– Temporal lobe: auditory sense, language, memory, face recognition

– Occipital lobe: visual sense– Insula (not shown): sense of self





attention, visual processes, language)– Parietal lobe: body sense and integration

of sensations with the sense of body– Temporal lobe: auditory sense, language,

memory, face recognition– Occipital lobe: visual sense– Insula: sense of self, compassion,

interoception

Our culture is left-focused

• Will always show left hemisphere, not right

• We value analysis, attention to detail, planning, organizing stimuli

• We devalue anything that does not include organization, planning, and detail

• Hmmm. I wonder if that’s such a great idea?

(Ipse quod dixit: Latin for “What I said!”)

Cerebral Hemispheres: Specialization of function

• Left hemisphere: “Just the facts, ma’am”– Grammar and details of

language– Detail oriented, generally– Planning– Organization– Rapid response– Analysis– Left fusiform gyrus

• parts of the face: eyes, nose, mouth

– Significant pathology: Aphasia (acquired language deficit)

• Right hemisphere: “Whole from the Parts”– Context of language– Placing detail in context (Larger

picture)– Not planning!– Not organizing detail, but rather

seeing the larger view of how details fit together

– Synthesis– Slower response– Right fusiform gyrus

• the face in its totality; facial recognition

– Significant Pathology: Hemispatial neglect syndromes

Specific areas to watch in Mindfulness and cognition

1. Dorsolateral cortex (DL or DLPFC) (BA 9, 46) • This area is responsible for the

highest cognitive function • It controls the controller• It is the seat of self-reflection• It controls our cognitive process• It mediates cognition and

metacognitive function • Right DL is part of the attention

network of the brain

Areas Of Interest Relative To Mindfulness And Emotion Regulation

2. Ventromedial cortex (VM) including orbitofrontal region and anterior cingulate gyrus• BA 10, 11, 47, 24• Decision-making and emotion• Social and moral judgment• Social inhibition: ability to not say

something• Abstract thought processes• Reward, empathy, emotional regulation• Note the sad story of Phineas Gage

Damasio, H., Grabowski, T., Frank, R., Galaburda, A. M., & Damasio, A. R. (1994). The return of Phineas Gage: clues about the brain from the skull of a famous patient. Science, 264(5162), 1102-1105.


Areas Of Interest Relative To Mindfulness And Self-perception, Compassion, And Insight Into The Way Things Are

3. Insular cortex (IC) • Sense of taste (Gustation)• Motor planning for speech• Self awareness and awareness of change• Empathy & compassion• Craving and suspension of craving• anterior insula (AIC) involved with emotional

awareness of cognitive functions• Awareness of stimulus presence (e.g., from

background of noise)• Intuition: “Immediate effortless awareness” rather

than “deliberation” (Allman et al., 2005)• “aha” moments: activation in conjunction with

anterior cingulate cortex• Generally, perception, awareness and cognition• Craig, 2009: “abstract representation of oneself…

one’s sense of self.”

4. Cuneate gyrus and precuneus• Awareness of self as agent (precuneus) and self in

space (cuneate gyrus


Components of Mindfulness Meditation

From Tang, Holzel & Posner, 2015, Nature Reviews Neuroscience

Mindfulness meditation• Attention control• Emotion regulation• Self Awareness• Compassion (I

added this one)

compassion

So what happened when you meditate? Active areas during mindful meditation are

related to attention…• Attentional areas are activated

– Right dorsolateral prefrontal cortex (Lazar et al., 2000)• Executive Function

– Right insula in novices; left insula in experts • (Farb et al, 2007; Lutz et al., 2008;

2009)• Empathy, self-awareness

– Hippocampus (Lazar et al., 2000)• Memory, attention

– Right Inferior frontal gyrus and TPJ (attentional) (Pagnoni, 2012)• Attention (note hemispatial neglect)

Temporoparietal junction (TPJ)

The Cycle of Meditation• Ability to focus is limited and

transient– Vigilance function

• Attention goes through 4 identified cycles– Focus:

• Right dorsolateral prefrontal cortex

– Mind-wandering: • R & L Posterior frontal and

ventromedial posterior cingulate

– Awareness of wandering: • R & L Insula, dorsal anterior

cingulate gyrus

– Shift back to focus: • Right dorsolateral

prefrontal cortex & R posterior parietal

• From Hasenkamp et al., (2012)

What happens over time through meditation?• Increased gray matter density in lower

brainstem : Experienced vs novices; attention– (Vestergaard-Poulsen et al., 2009)

• Increased density in right hippocampus, right orbitofrontal cortex (Luders et al., 2009)– Emotion regulation, attention– Experienced vs non-meditators

• Increased density of right anterior insula and dorsolateral prefrontal cortex (Lazar et al., 2005): – Awareness, conscious control of thinking process– experienced vs novices

• After 8 weeks of MBSR, increased in gray matter density in – left hippocampus, posterior CC, TPJ, cerebellum

• (Holzel et al., 2011)

From Vestergaard-Poulsen et al., 2009

From Holzel et al., 2011

From Lazar et al., 2005

Effects Of 40 Minutes Of Meditation Per Day

• 9 year veterans of meditation, 36 Year Olds

• Right hemisphere changes in 20 meditators, compared with controls:– Insula volume increased

(indicated by 1)– Orbitofrontal cortex volume

increased (BA 9,10: indicated by 2)

– Somatosensory cortex volume increased (BA 1,2,3: indicated by 3)

– Auditory cortex volume increased (BA 41: indicated by 4)

From Lazar et al., 2005

Changes in cortical gyrification through meditation: Luders et al., 2012

Greater depth and curvature of cortical gyri is indicative of “species intelligence:” it is related to processing function and capacity (greater surface area)

50 Meditators, 20 yrs. Practicing vs age-matched:• Right anterior insula• Left inferior temporal gyrus• Left central sulcus• Right parietal operculum

(SII)• Right fusiform gyrus• Right cuneus• Longer experience increases

right insula, right TPJ, right DLPFC,

• The more you meditate the greater the contrast

Summary of Changes from 17 articles(number of articles showing change, by location)

Right Left Bilat.

Frontal 3 2 1

Parietal 1 0 0

Cingulate 2 0 1

Thalamus 1 0 0

Brainstem 0 0 2

Insula 2 0 0

Temporal (excl. hippo.)

1 3 1

Hippo-campus

1 0 0

Totals 11 5 5

Right Left Bilat.

Frontal 3 4 1

Parietal 2 2 1

Cingulate 1 1 1

Thalamus 0 0 0

Brainstem 0 0 0

Insula 1 0 0

Temporal (excl. hippo.)

1 0 1

Hippo-campus

1 0 1

Totals 9 7 5

Volume Increases, from Literature

Activity Increases, from Literature

But What About Aging And Mindfulness: Does Mindfulness Affect The Aging Brain? • So what happens when we age? • At our peak we have incredibly robust

brains– adult cerebral cortex contains between 20 and

25 billion neurons– Contains about 18 trillion astrocytes, critically

important for long-term memory– volume of around 400 cubic centimeters – one cubic centimeter (1cm x 1 cm x 1cm)

contains 40,000 neurons (Pakkenberg & Gunderson, 2011).

As we age, things change: Cognition

• Cognition– Cognitive processes

• Memory• Attention• Visuospatial processes• Linguistic processes• perception

– As we age, we decline in memory and executive function

– We decline in memory and attention abilities

Committee on the public health dimensions of cognitive aging. (2015). National Academies Press (prepublication)

Brain volume changes as we age: The cortex gets thinner

From Raz, N., Gunning-Dixon, F., Head, D., Rodrigue, K. M., Williamson, A., & Acker, J. D. (2004). Aging, sexual dimorphism, and hemispheric asymmetry of the cerebral cortex: replicability of regional differences in volume. Neurobiology of aging, 25(3), 377-396.

The cerebral hemispheres get thinner as we age…

…as does the hippocampus

…and this change is seen throughout all of the cerebral cortex!

From Raz, N., Gunning-Dixon, F., Head, D., Rodrigue, K. M., Williamson, A., & Acker, J. D. (2004). Aging, sexual dimorphism, and hemispheric asymmetry of the cerebral cortex: replicability of regional differences in volume. Neurobiology of aging, 25(3), 377-396.

The biggest changes in the brain during aging:

“Of the brain regions affected by ageing, the hippocampus and the PFC [prefrontal cortex] seem to be particularly vulnerable, but even within and between these regions the impact of ageing on neuronal function can differ…”

– Burke, S. N., & Barnes, C. A. (2006). Neural plasticity in the ageing brain. Nature Reviews Neuroscience, 7(1), 30-40.

Neuron loss in hippocampus: Why memory fades!

16 17 20 25 28 33 47 52 71 75 76 77 78 78 80 80 88 990

10

20

30

40

50

60

70

Effect of Age on Hippocampal Neurons

Millions of neuronsLinear (Millions of neurons)

Age (years)

Num

ber o

f Neu

rons

(mill

ions

)

From Data of Simic et al., 1997

Hippocampus is critical for memory

Normal aging:

Between 16 and 90 years:

• 311,000 neurons lost per year

• About 6,000 neurons lost per week from the hippocampus after 16 years of age

Meditators Have Greatly Reduced Volume Loss In The Hippocampus

• Luders et al., 2009– Meditators had larger hippocampal volumes than non-meditators

• 22 meditators, 30-71 years old• Significantly greater hippocampal volume in meditators

• Holzel et al., 2008– 20 meditators, 34.1 years old– Significantly greater hippocampal volume in meditators

• Pickut et al., 2013– Increased hippocampus volume in Parkinson’s patients who meditate

compared with treatment-as-usual

• Holzel et al., 2011– 8 week MBSR course– Increased volume in hippocampus

“Meditation may slow, stall, or even reverse age-related brain degeneration.“

-Luders, 2014

Image from Luders, 2014

Lazar et al., 2005 • 40-50 year old meditators’ brains

were the same thickness as 20-30 year olds

• Right Frontal lobe: Executive function (BA 9,10), emotion regulation

Pagnoni and Cekic, 2007• Zen meditators• Putamen volume remains

essentially as meditator ages• putamen involved in

attention• Reaction time remains essentially

the same in meditators Putamen volume (figure from Pagnoni, 2007)

Sustained attention task: reaction time and accuracy

Meditation and degenerative disease: Parkinson’s Disease:

• Patients with Parkinson’s disease compared with treatment as usual

• Significant improvement in volume of right and left hippocampus with meditation

• Significant amygdala increase with meditation

From Pickut et al., 2013

What the meditator gains from all this…

• Is the ability to shift from self- or other-judgment • Is the ability to hold perception of self as a whole,

and as related to other things and people• Is the ability to control your own mental processes: – when you want to be detail focused, you can choose– When you want to suspend judgment, you can choose– When you feel yourself getting distraught, angry, upset,

you can choose• …and, of course, an improved and younger brain!

Right insular cortex seizures: patient quotes from Picard, 2013

• “…during my seizures, all of these boundaries would suddenly be erased. Although all my judgments of shape, size, color, texture, and so on would remain totally unchanged, the evaluation of my environment would undergo a sudden transformation. Everything would be joined together into one whole, as if every single thing in my surroundings were deliberately placed by an artist with the goal of composing a photograph. ”

• “One often has (what is sometimes called) an “aha!” moment when we can suddenly explain several puzzling facts simultaneously with the same answer. The sense that I had when I was experiencing some of these seizures was not unlike a continuous series of profound “aha!” moments. Although nothing around me seemed to have changed in any concrete way, every observation of my surrounding environment seemed to “make sense” in this way. ”

Summary• Long term meditation alters activation of prefrontal cortex related to attention and

self-awareness– Increased right dorsal prefrontal cortex: attention– Increased right insula in novices; left insula in experts: perception of self-identify, empathy,

awareness– Increased activation of right Temporoparietal junction (TPJ): attention, particularly to body– Increased activation of hippocampus (attention and memory)

• Meditation alters volume of brain– Increased brainstem, L hippocampus, TPJ, CC, Rt. VM in experts– Increased hippocampus, CC, TPJ in brief training

• “Following an intensive 8 week course in mindfulness meditation, during which individuals learn to develop the capacity to monitor moment-to-moment experience, Experiential focus [condition] resulted in a pronounced shift away from midline cortices towards a right lateralized network comprised of the ventral and dorsolateral PFC, as well as right insula, SII and inferior parietal lobule.” Farb et al., 2007,pg. 319.

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brain health and mindfulness october 2, 2015 tony seikel

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