Please Pay attention now (it could change your brain): mechanisms - PowerPoint Presentation

Slide1

Please Pay attention now (it could change your brain): mechanisms of mindfulness.

Judson Brewer MD PhDDirector of ResearchCenter for Mindfulnessjudson.brewer@umassmed.edu

Slide2

“Money makes people funny”-

Scott Kriens1440 Foundation

Slide3

DisclosuresThere is no money in mindfulness trainingThere is no money for researchWrite your congressperson!

Formed goBlue labs (Claritas Mindsciences)Yale spin-off startup companyWorking with social entrepreneurs to translate research into clinical practice

Slide4

Slide5

For our considerationWhy Facebook (and love) is like crack cocaineWhy McDonald’s has served over 250 BillionHow Lolo Jones could have won the Olympic gold medalHow we can become a Buddha in nine minutes (and quit smoking too!)

Slide6

Talking about ourselves is rewarding!

Tamir

PNAS

(2012)

Nucleus

Accumbens

Meshi

Front Hum

(2013)

Slide7

Facebook Addiction Disorder (FAD)

Lee et al (2012)POSI = Preference for Online Social Interaction

Slide8

Bartels, Andreas; Zeki, Semir

NeuroReport (2000).

Neural Correlates of Romantic Love

Slide9

Neural Correlates of Romantic Love

Aron

A et al. J

Neurophysiol

(2005)

©2005 by American Physiological Society

Slide10

“Love hurts, love scars, love woundsAnd mars, any heartNot tough or strong enoughTo take a lot of pain, take a lot of painLove is like a cloud

Holds a lot of rainLove hurts......ooh, ooh love hurts”-Nazareth

Slide11

“In their quest for happiness, people mistake excitement of the mind for real happiness.’”

-Ven. Sayadaw U. Pandita, In This Very Life

Slide12

Sensory Information

Wanting!

Pleasant

Behavior

Memory

Changes how we see the world

Slide13

Sensory Information

Wanting!

Unpleasant

Behavior

Memory

Changes how we see the world

Slide14

Sensory Information

Wanting!

Unpleasant

Pleasant

Behavior

Memory

Slide15

Cue/Trigger

Pleasant

Unpleasant

CRAVING

Behavior

Memory

(“me”)

MIND

(evaluation, interpretation)

(sight, smell, thought, emotion, body sensation)

Habit formation and reinforcement

Birth

(of self-identity)

Brewer,

Elwafi

and Davis

Psych of Addictive Behavior

(2012)

Slide16

Automated

Neutral Cue

(get in your car)

Negative Cue

(get yelled at by your boss)

Positive Cue

(have a good meal or sex)

Negative Affect

(stressed out)

Positive Affect

(happy or relaxed)

AVOIDANCE OF CUES

SUBSTITUTE BEHAVIORS

CRAVING

I

n

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R

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f

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r

c

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m

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N

e

a

i

g

Thorndike 1898, Skinner, 1938,

Zinser

1992,

Piasecki

1997, Carter 1999,

Lazev

1999, Cox 2001, Robinson 2003,

Bevins

2004, Baker 2004, Cook 2004,

Olausson

2004, Shiffman 2004, Carter 2008, Perkins 2010

SMOKE

Reinforcement of Associative Memory/Habit

(smoking makes you feel better)

Maintain or Increase Positive Affect/Decrease Negative Affect

t

Slide17

“Just as a tree, though cut down, can grow again and again if its roots are undamaged and strong, in the same way if the roots of craving are not wholly uprooted sorrows will come again and again.”

-Dhammapada (338)

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“I can't get no satisfaction I can't get no satisfaction 'Cause I try and I try and I try and I try I can't get no, I can't get no…”

-Mick Jaggar

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Self-control: competing systemsAffective (self-referential?)/hot processinginvolves self-referential valuation, is automatic and unplanned, and influences behavior through impulses

(Weber 2004, Kable 2007). fronto-striatal-limbic loop, including the orbitofrontal cortex, ventromedial prefrontal cortex (vmPFC), posterior cingulate cortex (PCC), and ventral striatum (McClure 2004; Hare 2009; Kober 2010) Deliberative/cold processingeffortful, influences behavior through rules of logic and involved in inhibitory control (Weber 2004; McClure 2004; Ochsner 2005,

Knoch 2007; Hare 2009) dorsolateral prefrontal cortex (dlPFC), and posterior parietal cortex etc (McClure 2004; Hare 2009; Kober 2010; Steinbeis

2012)

I

WANT

!

It’s not about me

Slide21

HOT

COLD

How to improve the balance between cold and hot processing?

Slide22

Slide23

Why study mindfulness?(a Darwinian perspective)t1/2=?

Ab machine

CBT

Penicillin

Psychoanalysis

Mindfulness

Slide24

Overview of MindfulnessTwo Component Definition:

1) Self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment. 2) Adopting a particular orientation toward one’s experiences in the present moment, characterized by curiosity, openness, and acceptance.

Bishop 2004

Slide25

Sensory Information

Wanting!

Unpleasant

Pleasant

Behavior

Memory

Mindfulness

Slide26

Mindfulness-based treatmentsEffective for: Anxiety (Kabat-Zinn

et al 1992, Goldin 2009, others)Depression (Teasedale et al 2000; Ma et al 2004, Eisendrath 2008, Segal 2010, others)Pain (e.g. Kabat-Zinn et al 1985, Kingston et al 2007, others)Addiction (e.g. Brewer 2009, Bowen 2009, Brewer 2011,

Carim-Todd 2013)Boost immune system function (e.g. Davidson 2003, Pace 2009, others

)

Boost GRE scores!

(

Mrazek

2013)

Slide27

The paradox of Mindfulness: less is morePay attention, and everything else will take care of itself (really).

Brewer Davis and Goldstein Mindfulness

(2013)

Slide28

Greater s

moking abstinence with MT vs. Freedom from Smoking

*

p

= .

063

**

p

= .

012

*

**

Brewer et

al

Drug and Alcohol Dependence

(2011)

Slide29

Working hypothesisHypothesis: MT works by decoupling craving and behavior (e.g. smoking)Prediction: should see dissociation between craving and smoking BEFORE they both subsidei.e. should still have some craving, but it is not coupled to smoking

Slide30

Craving and cigarette use become dissociated during treatment

Baseline(Week 0)End of Treatment(Week 4)

6-WeekFollow-Up3-Month Follow-Up

4-Month

Follow-Up

Craving (QSU)

X

Cigarette

Use

r = 0.582

p < 0.001

N = 32

r = 0.126

p = 0.491

N=32

r = 0.474

p = 0.020N = 25

r = 0.788p < 0.00001N=28 r = 0.768p < 0.00001N=29 p = .04

Predictor

of Smoking

r

R

2

β

p

Effect

size

Overall Model

Baseline Craving

Baseline Cigarette Use

End of Treatment Craving

Informal practice (days/

wk

)

Craving*Informal (days/

wk

)

0.735

0.540

0.266

-0.053

0.208

-1.522

0.515

0.001

0.591

0.53

0.652

<0.0001

0.026

1.17

Mindfulness practice moderates dissociation

Elwafi et al

Drug and Alcohol Dependence

(2013)

Slide31

Reduction of craving scores with MT

*p = 0.03

Elwafi et al Drug and Alcohol Dependence (2013)

Slide32

Neutral Cue

(get in your car)

Negative Cue

(get yelled at by your boss)

Positive Cue

(have a good meal or sex)

Negative Affect

(stressed out)

Positive Affect

(happy or relaxed)

AVOIDANCE OF CUES

SUBSTITUTE BEHAVIORS

CRAVING

I

n

c

r

e

a

s

e

d

a

l

i

e

n

c

e

S

P

o

s

i

t

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v

e

R

e

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n

f

o

r

c

e

m

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t

I

n

c

r

e

a

s

e

d

a

l

i

e

n

c

e

S

t

v

e

R

e

i

n

f

o

r

c

e

m

e

n

N

e

a

i

g

Zinser

1992,

Piasecki

1997, Carter 1999,

Lazev

1999, Cox 2001, Robinson 2003,

Bevins

2004, Baker 2004, Cook 2004,

Olausson

2004, Shiffman 2004, Carter 2008, Perkins 2010

Reinforcement of Associative Memory/Habit

(smoking makes you feel better)

SMOKE

Maintain or Increase Positive Affect/Decrease Negative Affect

t

Mindfulness

Slide33

“The destruction of craving conquers all suffering.”

-Dhammapada (354)

Slide34

Craving to Quit(iPhone App)21 day training for smoking cessationDaily modulesanimations

In vivo exercisesExperience SamplingTest efficacy

Slide35

Applied mindfulness: RAINRECOGNIZE“Oh that’s a craving”A

CCEPT/ALLOWSee if you are resisting the experienceINVESTIGATE“what’s happening in my body right now?”NOTELabel or mentally note the body sensations from moment to moment

Slide36

Mechanisms of Mindfulness?Improved attentional focus (Jha

2007; Lutz 2009)Improved cognitive flexibility (Moore 2009) Reduced affective reactivity (Frewen 2008; Farb 2010; Goldin 2010)Modification or shifts away from distorted or exaggerated self-view (Teasdale 2002; Ramel 2004;

Farb 2007; Goldin 2009) What’s going on in the brain?

Slide37

Slide38

Slide39

DAYDREAMING

STRESS

ADDICTION

50

%

The Underperformance

Continuum

Slide40

Default Mode Network (DMN)

Andrews-Hanna Neuron (2010)

Slide41

Overlap between DMN and Self-referential processingWhitfield-

Gabrieli Neuroimage (2011)

Slide42

Resting state anti-coupling between monitoring (dACC) and default mode networkCastellanos et al

Biological Psychiatry (2008)

d

efault mode network

s

elf/conflict monitoring

Slide43

Mindfulness meditation practices

Concentration

Loving-kindness

Choiceless Awareness

In the next period, please pay attention to the physical sensation of the breath wherever you feel it most strongly in the body. Follow the natural and spontaneous movement of the breath, not trying to change it in any way. Just pay attention to it. If you find that your attention has wandered to something else, gently but firmly bring it back to the physical sensation of the breath.

Please think of a time when you genuinely wished someone well (pause). Using this feeling as a focus, silently wish all beings well, by repeating a few short phrases of your choosing over and over (for example: May all beings be happy, may all beings be healthy, may all beings be safe from harm.)

In the next period please pay attention to whatever comes into your awareness, whether it is a thought, emotion, or body sensation. Just follow it until something else comes into your awareness, not trying to hold onto it or change it in any way. When something else comes into your awareness, just pay attention to it until the next thing comes along.

Attention directed at single (physical) object

Attention directed at physical and mental objects

Attention focused, but not directed to specific object

Slide44

Task of MT?The “task” common to all of these meditation techniques is the training of attention away from self-reference and mind-wandering and toward one’s immediate experience. (Don’t feed the self!)

Slide45

Experienced meditator study (n=12)Meditation hours

 Mindfulness

7748.3+4250.5

Loving Kindness

1060.1+958.9

Other

1756.8+2476.6

Total

10565.2+5148.9

Slide46

2 min

baseline

Trial Time Course

30 sec

Instructions

4.5 min

Choiceless

Awareness

Meditation

Concentration

Meditation

Loving

Kindness

Meditation

2x Trial (randomized between conditions)

Slide47

Decreased DMN activity during meditation in experienced meditators

z = 21(all meditations, Experienced > Novice)

x = -6

Brewer et al

PNAS

(2011)

Slide48

z = 21

x = -6

Meditators Controls

Meditators Controls

Slide49

Garrison et

al

(

under review

)

Meditation > Resting Baseline (eyes open)

Meditation > Active Baseline (‘does the word describe you?’

‘is the word in upper case?’)

Decreased DMN activity during meditation

as compared to both resting and active baselines

(n = 20 expert, 26 novice meditators

)

Slide50

Slide51

Slide52

“For people who Have agitated thoughts And intense passion, And who are focused on what’s pleasant,

Craving grows more and more. Indeed, they strengthen their bonds”-Dhammapada (349)

Slide53

“Romantic love is one of the most addictive substances on earth.”

-Helen Fisher

Slide54

Neural substrate of loving kindness meditation

Reduced BOLD signal in meditators (n=20) v. novices

(n

=26)

Garrison et

al

(2014)

Brain and Behavior

Slide55

Hold the door for someone

Wanting!

Pleasant

Behavior

Memory

Slide56

“Whatever joy there is in this world All comes from desiring others to be happy, And whatever suffering there is in this world All comes from desiring myself to be happy

.” -Shantideva

Slide57

Does practice make perfect?Relatively specific deactivation of DMN during meditationCommon to all 3 meditation typesReproducible

Do state changes during meditation correlate with changes in default brain activation patterns after (a lot of) practice?Functional connectivity Seed-based using DMN (Andrews-Hanna 2010)Helps to control for control state (i.e. what if experienced meditators are meditating during baseline)

Slide58

meditator > control

x = 0

Connectivity z

-score

Meditators

Controls

Altered DMN connectivity in experienced

m

editators

(PCC seed region)

Brewer et al

PNAS

(2011)

Seed region

Slide59

Connectivity

z-scoreMeditators

ControlsBrewer et al

PNAS

(2011)

z = 24

z = 15

meditator > control

Baseline

z = 24

meditator > control

z = 15

Meditation

(PCC seed region)

Slide60

State to trait?Meditators have a different Default Mode!

Slide61

Relation between Granger causal influences and

behavioral

performance

during visual spatial attention task

.

Wen X et al.

J.

Neurosci

.

2013

©2013 by Society for Neuroscience

Slide62

“Science is a way of trying not to fool yourself. The first principle is that you must not fool yourself, and you are the easiest person to fool.”

-Richard Feynman

Slide63

1 min

baseline

Real-time meditation feedback

3 min

meditate

“active”

feedback

“dummy”

feedback

Garrison et

al

NeuroImage

(2013)

Slide64

Real-time Neurofeeback (PCC ROI, n = 22/group)

Run 1Run 4

Expert

Novice

Decreased self-related activation

Increased self-related activation

Correspondence

:

7.4 ± 0.16

7.7 ± 0.29

Slide65

Meditate by watching graph (graph of PCC, active

feedback)

So at the beginning, I caught myself, that I was sort of trying to guess when the words were going to end and when the meditation was going to begin. So I was kind of trying to be like “okay ready, set, go!” and then there was an additional word that popped up and I was like “oh shit” and so that’s the red spike you see there…

Slide66

…and then I sort of immediately settled in and I was really getting into it…

Meditate by watching graph (graph of PCC,

active

feedback

)

Slide67

…and then I thought “oh my gosh this is amazing it’s describing exactly what I am saying” and then you see that red spike...

Meditate by watching graph (graph of PCC,

active

feedback

)

Slide68

… and I was like “okay, wait don’t get distracted” and then I got back into it and then it got blue again…

Meditate by watching graph (graph of PCC,

active

feedback

)

Slide69

…and I was like “oh my gosh this is unbelievable, it’s doing exactly what my mind is doing” and so [chuckles] then it got red again…

Meditate by watching graph (graph of PCC,

active

feedback

)

Slide70

…So I just find it really funny because it’s…that’s…to the next question, that’s a perfect map of what my mind was going through.

Meditate by watching graph (graph of PCC,

active feedback

)

Slide71

The curious case of the PCC“Resting state” (Raichle 2001)

Mind-wandering/Disruption of attention (Greicius 2003, Weissman 2006, Mason 2007, Li 2007, Eichele 2008, Wen 2013)Autobiographical memory, Past and future “self” (Schacter 2007, Andrews-Hanna 2010, others)Judgment about trait adjectives (Kelley 2002, Whitfield-Gabrieli

2011, others)Self-attribution in social situations (Cabanis 2013)Liking a choice you made (Jarcho

2011,

Kitayama

2012)

Prevention goals

(

Strauman

2013)

Induced immoral behavior

(van

Veen

2009)

Care and justice issues

(Caceda 2011)Guilt (Morey 2012)Emotional processing (Peyron 2000, Maddock 2002, Zhao 2007, Gentili 2009, Bluhm 2012)Craving (Garavan 2007, Brody 2002 & 2007, Jarraya 2010)

Slide72

What about me and the PCC?

Andrews-Hanna et al (2014) Ann NYAS

Slide73

Can we take a deeper dive into the PCC?Active during a number of cognitive statesActivation seen across multiple populations

Deactivated during mindful statesWhat exactly does PCC activity correlate with?

Slide74

Use first-person self-report to better understand cognitive processes related to third-person physiological (e.g., brain imaging) dataGrounded Theory Method (GTM)Qualitative analysis of self-report dataDerive theory from empirical data

Neurophenomenology(Lutz and Thompson 2003)

Slide75

Not “efforting”

ContentmentOpen awareness

Not “efforting”

Acceptance

Calm

Tranquility

Relaxation

Focus on the body

Focus on the nostrils

Focus on the graph

Focus on sensations

Focus on visual input

Thinking about work

Remembering

Thinking about a place

Thinking about an object

Interpreting the task

Interpreting the graph

Interpreting experience

Discomfort

Emotion

Surprise

Restlessness

Confusion

Searching

Not “efforting”

Pleasure

Equanimity

Focus

Clarity

Physical sensations

Mental objects

Auditory objects

Visual objects

Deliberating

Remembering

Self-related thinking

Displeasure

“Efforting”

Muddled

Observing sensory experience

Concentration

Engaging with …

Discontentment

“Efforting”

Distraction

Interpreting

Open Code

Central Code

Theoretical Code

Garrison et

al

(

2013) Frontiers in Hum Neuroscience

Slide76

D

istracted

Awareness

Controlling

Distraction

n = 64

Interpreting

n = 56

“Efforting”

n = 19

Discontentment

n = 14

Muddled

Deliberating

Memories

Self-related

thinking

A

ctivation

Auditory

objects

Physical

sensations

Visual

objects

Mental

objects

Displeasure

Garrison et

al

(

2013) Frontiers in Hum Neuroscience

Slide77

“I worried that I wasn’t using the graph as an object of meditation, so I tried, like, to look at it harder or somehow pay attention more to it”

PCC

A

ctivation

Slide78

Undistracted

Awareness

Effortless

Doing

Concentration

n = 99

Observing Sensory Experience

n = 76

Not “efforting”

n = 48

Contentment

n =

2

8

Focus

Clarity

Physical

sensations

Focus on

breath

Deactivation

Mental

objects

Visual

objects

Auditory

objects

Equanimity

Pleasure

Garrison et al (

2013) Frontiers in Hum Neuroscience

Slide79

“I noticed …that the more I relaxed and stopped trying to do anything, the bluer it went”

“Toward the middle I had some thoughts which I don

’

t see on the graph maybe because I let them kind of flow by”

PCC Deactivation

Slide80

How do studies of the PCC converge?What about the self is processed in the PCC? (Brewer, Garrison and Whitfield-Gabrieli, 2013)“getting caught up” in experience?

Mental contraction?

Slide81

Life is an art, and like perfect art it should be self forgetting; there ought not to be any trace of effort or painful feeling…As soon as there are signs of elaboration, a man is doomed, he is no more a free being.

—Suzuki, 1964

Slide82

Flow

a mental state when a person is fully immersed

in the present in a feeling of energized focus.

Slide83

There was a sense of flow,

being with the breath…flow deepened in the middle.

“

“

-Experienced Meditator

Slide84

Are you kidding? I have to practice 10,000 hours to change my default mode?

Slide85

"Practice does not make perfect. Only perfect practice makes perfect.”

-Vince Lombardi

Slide86

What ingredients are needed for mindfulness practice?

Pay attention

Slide87

Run 1

Run 2

Run 3

Run 4

“felt a lot more relaxed, like it was less of a struggle to prevent my mind from wandering”

Novice Meditator

Slide88

Pay attention

R

elax

What ingredients are needed for mindfulness practice?

Slide89

Experienced Meditator

“focus on the breath and

in particular the feeling of interest, wonder, and joy

that arises in conjunction with subtle, mindful breathing”

Slide90

Pay attention

Relax

What ingredients are needed for mindfulness practice?

Be interested

Slide91

Novice Meditator

Run 1

Run 2

Run 3

Run 4

Thinking about the breath

”focused more on the physical sensation instead of thinking in and out”

Slide92

Pay attention

Relax

What ingredients are needed for mindfulness practice?

Be interested

Drop the

self

Slide93

Run 1

Run 6On run 6, I had a familiar memory image appear, one of a pond, willow tree and fields of my parents farm. I noticed the strong red deflection in response to this, although I don't appear in the image. I went back to the image to see if there was a sense of watcher-subject and noticed that image has a sense of being seen through a child's eyes. The somewhat desolate feeling landscape corresponds to that child's subjectivity. So there is a subject there, even though I never noticed it before, the scanner feedback made me look for it. If you look at run 6 you can see me exploring the image in a long run of red in the middle. Then I remembered I wasn't doing the task so I let it go for a while. Then I started

imaginging

myself in the future, telling Jud about what I had discovered about

childhoold

memories, which you can see clearly in the second run of red at the end of run 6.

Repeating name

Exploring image

Future thinking

On task

Experienced Meditator

Slide94

Next steps to move into clinical utility:EEG source-estimated neurofeedback from the PCC

Slide95

HOT

COLD

Mindfulness may increase cold while decreasing hot processing

ACC

dlPFC

PCC

Slide96

“To study Buddhism is to study the self. To study the self is to forget the self. To

forget the self is to be enlightened by all things. To be enlightened by all things is to be free from attachment to the body and mind of one's self and of others.”—Dogen

Slide97

Thanks!

www.umassmed.edu/cfm

FUNDING

: NCCAM (R01 AT007922-

01), NIDA

(R03 DA029163-01A1, K12 DA00167, P50 DA09241), Mind and Life Institute (Varela award), Yale Center for Clinical Investigation (UL1 RR024139),Yale Stress Center (UL1 DE019586-02), VAMC MIRECC

Subjects

Keri

Bergquist

(Yale)

Sarah Bowen (UW)

Willoughby Britton (Brown)

Kathy Carroll (Yale

)

Neha

Chawla (UW)

Todd Constable (Yale)Michael Crowley (Yale)Jake Davis (CUNY)Gaëlle Desbordes (MGH)Cameron Deleone (Yale

)

Susan

Druker

Hani

Elwafi

Kathleen Garrison

Jeremy

Gray (Yale

)

Sean (

Dae

)

Houlihan

Catherine Kerr (Brown)

Hedy

Kober

(Yale

)

Cheryl

Lacadie

(Yale

)

Sarah

Mallik

G. Alan Marlatt (UW

)

Linda

Mayes (Yale

)

Candace Minnix-

Cotton

Stephanie Noble

Alex

Ossadtchi

(SSI)

Prasanta

Pal

Xenios

Papademetris

(Yale

)

Lori

Pbert

Mark Pflieger (SSI)

Marc Potenza (Yale

)

Maolin

Qiu

(Yale

)

Rahil

Rojiani

Bruce

Rounsaville

(Yale

)

Juan

Santoyo

(Brown)

Cliff

Saron

(UC Davis)

Dustin

Scheinost

(Yale

)

Rajita

Sinha

(Yale

)

Yi-Yuan Tang

(Texas Tech)

Evan Thompson (Toronto)

Tommy

Thornhill

Nicholas Van Dam

(NYU)

Katie

Witkiewitz

(UNM)

Jochen

Weber (Columbia

)

Sue Whitfield-

Gabrieli

(MIT)

Patrick

Worhunsky

(Yale

)

Slide98

Slide99

z = 21

x = -6

Meditators Controls

Meditators Controls