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Generations 2013

Sabine Weil CMCHJohn Barbuto MD

USING THE MIND TO HEAL THE

BRAIN

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Objectives• Working definition of the mind• Working definition of mindfulness• Explore a neurological and evolutionary approach to

mindfulness• Empirically supported benefits of mindfulness• Evidence-based practices and practice-based evidence

for treatments incorporating mindfulness• Practicing mindfulness

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Defining the Mind

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Defining the MindWebster’s Dictionary:

• a : the element or complex of elements in an individual that feels, perceives, thinks, wills, and especially reasons

• b : the conscious mental events and capabilities in an organism

• c : the organized conscious and unconscious adaptive mental activity of an organism

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The Mind Defined by Others

• “The mind is involved in helping you constructively focus your attention” –Jeffrey Schwartz MD and Rebecca Gladding, MD from You Are Not Your Brain (2012)• “Mind is a regulatory process that can be monitored, measured, observed and modified” –Daniel Siegel MD• “The mind is the neural subsystems involved in integrating mental constructs”—John Barbuto MD• “The mind is a collection of subjective experience generated by, for and of the brain” Sabine Weil

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What does the mind do? Ben and Jerry’s

Häagen Dazs

Ben and Jerry’s

Häagen Dazs

I can’t decide

(grumble, grumble)

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How can the mind heal the brain?• Suffering is a subjective experience•We know that experience changes the brain• How can we use the mind to create experiences that change the brain in a way that will diminish our suffering?

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Meditation PracticeIn Buddhist thought, a purpose of meditation practice is to help the practitioner cultivate a certain state of mind with an emphasis on equanimity.

There are many different types of meditation practice including:• Breath and body sensation• Visualization• Sound (Mantra)• Open field awareness• Analystic-linguistic-reasoning meditation• Precious human birth• Death meditation• Generating Loving Kindness

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Mind and Life InstituteConversations with the Dalai Lama, Buddhists monks and Western scientists including Daniel Goleman, Richard Davidson, and Paul Ekman among others. Matthieu Ricard “happiest man alive” has spent much more time meditating than the requisite 10,000 hours to become an expert at something.

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Matthieu Ricard

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Effects of Meditation•Meditating on love and compassion leads to a sharp increase in brain gamma-waves of left middle frontal gyrus which is a locus of positive emotions•Meditation leads to a thickening of the cortex• Increases ability to detect emotions of others.

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Mindfulness

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Defining Mindfulness

“Paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (Kabat-Zinn)

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The Brain and Mindfulness

•What’s happening in our heads when we practice mindfulness?

•What follows is an evolutionary approach to understanding.

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Evolution of the Mind: In a few minutes.•Steps to the development of the mind from the time of single cell organisms.• Step 1: Creatures learned to act

Move Move Move

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Evolution of the Mind•Step 2: Then to react

Stimulus Response

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Evolution of the Mind•Step 3: Then to remember in rudimentary form (past actions and effects)

Stimulus Response

Stimulus Response

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Evolution of the Mind•Step 4: Then to produce action based on past actions

Stimulus Response

Response

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Evolution of the Mind•Step 5: Then to abstract actions and their effects into overviews.

St imu lus Response

Stimulus Response

Stimulus Response

Stimulus RESPONSE

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Evolution of the Mind•Step 6: Then to predict effects

Stimulus

St imu lus

Response

Response

Match

Mismatch

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Evolution of the Mind•Step 7: Then – the pivotal event – we learned to process “what if”, extrapolations based on memory not current sensations - thus the foundation of imagination.

STIMULUS?

THEN

31 2 RESPONSE

!

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Evolution of the Mind•Step 8: Then the “what ifs”, and other personal

extrapolations, not based on actual experience, became segregated but interconnected as the foundations of “self”

NOTEXPERIENCED

EXPERIENCEDEXPERIENCED

Foundation of “self”

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Evolution of the Mind•Step 9: Then the web of reflections of self on memory, abstractions, and imaginations summarized as “consciousness”.

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Evolution of the Mind•Step 10: Then there were two systems:•One for action based on sensation•One for action based on “thought” (the “what if’s” based on imagination, extrapolation, etc)

“A distributed network, of distributed networks” (www.unc.edu)

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Evolution of the Mind• The second “distributed network” became known as “mind” because it was personal and only known to the individual.•The “mind” evaluates according to summaries from the unconscious and also evaluations from the conscious.• It stores information as discrete “conclusions” and also motivations including goals, values, expectations, and beliefs.

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Where is “the mind” located?• Consciousness (as we think of it) is located in the cerebral hemispheres (based on neurological case studies).

• The mind is an abstraction of certain process types. Though not equivalent to consciousness it is, however, predominantly located also in the hemispheres, distributed.

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The path to “mindfulness”• Evolution thus created systems for response to stimuli and also for response to stimulus-independent thought.• The “sub-conscious” is primarily designed for orchestrating automatic responses to stimuli AND for setting body states for anticipated stimuli. (Largely, emotions are its language.) • Consciousness has resulted in abilities to shut off automatic responses• Mindfulness involves using consciousness to reduce or shut off automatic responses.

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Using Mindfulness• It is the conscious disconnection of sensation from automatic response, which – when done fully - frees sensation from automatic judgment.• This opens the path to re-evaluation, and to new valuations.• This reduces or shuts down unhelpful emotions based on old valuations. This is how you “free your mind”.

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Mindfulness and Research

• In 2008, the “NIH financed more than 50 studies testing mindfulness techniques, up from 3 in 2000, to help relieve stress, soothe addictive cravings, improve attention, lift despair and reduce hot flashes”. Benedict Carey The New York Times, May 27, 2008, “Lotus Therapy”.

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Empirically Supported Benefits of Mindfulness

• Reduced rumination• Stress reduction• Boosts to working memory• Focus• Less emotional reactivity• More cognitive flexibility• Increased relationship satisfaction• Other benefits such as enhanced self-insight, intuition, fear

modulation and improved immune function

(“What are the benefits of mindfulness” by Daphne M. Davis, Ph.D and Jeffrey A Hayes Ph.D. in the American Psychological Association Monitor July 2012 Vol 43, No 7 ) http://www.apa.org/monitor/2012/07-08/ce-corner.aspx

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Evidence-Based Mindfulness Treatments(NREPP –SAMHSA’s National Registry of Evidence-Based Programs

and Practices)

•Mindfulness-Based Stress Reduction (MBSR)

•Dialectical Behavioral Therapy (DBT)

•Acceptance and Commitment Therapy (ACT)

•Mindfulness-Based Cognitive Therapy (MBCT)

]

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Mindfulness-Based Stress Reduction• Developed by Dr. Jon Kabat-Zinn in the 1979 at the University of Massachusetts Medical Center to treat patients with chronic diseases and chronic pain. • The NREPP describes it as a structured “10-session, manual-driven program and includes 31 hours of instruction by professionally trained teachers, who deliver the sessions in a group setting over 8 weeks”This practice incorporates:1) Mindfulness meditation, 2) Body scan and 3) Gentle hatha yoga

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Dialectical Behavioral Therapy• In the 1990s, Marsha Linehan took notice of Kabat-Zinn’s work and incorporated “radical acceptance” into her work with suicidal and borderline patients. She developed DBT as an evidenced-based model for treating borderline personality disorder.

• DBT incorporates 1) Mindfulness, 2) Distress tolerance, 3) Emotional Regulation and 4) Interpersonal Effectiveness

• (See www.DBTselfhelp.com )

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Acceptance and Commitment TherapyDeveloped by Steven Hayes, Kelly Wilson and Kirk Strosahl in the mid 1980’s. It has the following core processes:

• creative helplessness (the futility of current efforts to feel better)• cognitive diffusion (our thoughts are just thoughts, not what we interpret them to be)• acceptance (allow experience to be what it is while effectively engaged)• self as context (identify with the observer of thoughts) • valuing (rededicate one’s life to what gives life meaning)

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Mindfulness-Based Cognitive Therapy• Described as an integration of MBSR and CBT for depression• A manual-driven program that is delivered by trained instructors through • 1) an initial one-to-one session, • 2) Eight 2-hour core sessions delivered weekly in a group format with 9-15 patients who are either in full (no antidepressant medication) or partial remission (with antidepressant medication) from symptoms of depression and • 3) up to four 2-hour follow-up reinforcement sessions in a group format 4-12 months after the core sessions

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Mindfulness and Addiction•What does the research tell us? •Mindfulness-Based Relapse Prevention• “Urge surfing” – observing urges as they appear, accepting them nonjudgmentally and ‘riding the waves’ without giving in to the urges

• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2818765/• www.ptsd.va.gov/professional/pages/mindful-PTSD.asp/ • Breslin, F. C., Zack, M., & McMain, S. (2002). An information-processing analysis of mindfulness: Implications for relapse prevention in the treatment of substance abuse. Clinical Psychology: Science and Practice, 9(3), 275-299.

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Mindfulness and Obsessive-Compulsive Disorder• The Four Steps • 1) Relabel• 2) Reframe• 3) Refocus• 4) Revalue

(Jeffry Schwartz and Rebecca Gladding, 2011 “You are not your Brain”, Penguin Group NY:NY)

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Mindfulness for Treatment of Trauma

• Has yet to be examined empirically but is currently being studied by the Veteran’s Administration

• As an adjunct therapy, may decrease experiential avoidance, reduce arousal and foster emotional regulation• www.ptsd.va.gov/public/pages/mindful-ptsd.asp/

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Benefits to therapists who practice mindfulness meditation

• Empathy• Compassion• Counseling skills• Decreased stress and anxiety• Better quality of life• Increased patience• Increased gratitude• Increased body awareness

(“What are the benefits of mindfulness” by Daphne M. Davis, Ph.D and Jeffrey A Hayes Ph.D. in the American Psychological Association Monitor July 2012 Vol 43, No 7 ) http://www.apa.org/monitor/2012/07-08/ce-corner.aspx

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Who Benefits from Mindfulness Therapy

• Little evidence yet to show which patients are most likely to benefit

• “Patient preference and enthusiasm are a good guide” July 11, 2012 Dr. William Marchand of the George E. Wahlen Veterans Affairs Medical Center and the University of Utah (ScienceDaily.com)

• No evidence to show increased benefit to clients whose therapists meditate

(“What are the benefits of mindfulness” by Daphne M. Davis, Ph.D and Jeffrey A Hayes Ph.D. in the American Psychological Association Monitor July 2012 Vol 43, No 7 ) http://www.apa.org/monitor/2012/07-08/ce-corner.aspx

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Practicing Mindfulness

•Meditation •Mindfulness Without Meditation• Breath work• Focusing on the senses• Yoga• Tai Chi• Qui Gong• Etc.

• http://www.mindfulness.org.au/index.html

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Practicing Mindfulness in Salt Lake City• Red Butte Garden Mindfulness Based Stress Reduction Feb 4-March 25, 2013 9 sessions Sold Out!!

• Intermountain Healthcare Website

• Numerous Sites, Teachers and Resources

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Incorporating Mindfulness into Psychotherapy

• Focusing sensation• Teaching breathing• Connecting to the “observer”• Present moment reminder• Noticing what is happening in the body• Refuting judgment• Encouraging acceptance of what is• Encouraging being instead of doing• Noticing instead of thinking

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Updated Slide set•For the updated version of this presentation and references see: LimbicZen.wordpress.com•See “Individual Change and Adaptation” section•Will be available tomorrow.

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Thank You!