Please Pay attention now (it
could change your brain):
mechanisms of mindfulness.
Judson Brewer MD PhD
Director of Research
Center for Mindfulness
judson.brewer@umassmed.edu
“Money makes people funny”
-Scott Kriens
1440 Foundation
Disclosures
• There is no money in mindfulness training
• There is no money for research
– Write your congressperson!
– Formed goBlue labs (Claritas Mindsciences)
• Yale spin-off startup company
–Working with social entrepreneurs to
translate research into clinical practice
For our consideration
• Why Facebook (and love) is like
crack cocaine
• Why McDonald’s has served over
250 Billion
• How Lolo Jones could have won the
Olympic gold medal
• How we can become a Buddha in
nine minutes (and quit smoking too!)
Talking about ourselves is
rewarding!
Nucleus Accumbens
Tamir PNAS (2012)
Meshi Front Hum (2013)
Facebook Addiction Disorder
(FAD)
POSI = Preference for Online Social Interaction
Lee et al (2012)
Neural Correlates of Romantic Love
Bartels, Andreas; Zeki, Semir NeuroReport (2000).
Neural Correlates of Romantic Love
©2005 by American Physiological Society
Aron A et al. J Neurophysiol (2005)
“Love hurts, love scars, love wounds
And mars, any heart
Not tough or strong enough
To take a lot of pain, take a lot of pain
Love is like a cloud
Holds a lot of rain
Love hurts......ooh, ooh love hurts”
-Nazareth
“In their quest for happiness, people
mistake excitement of the mind for real
happiness.’”
-Ven. Sayadaw U. Pandita, In This Very Life
Sensory
Information
Changes
how we see
the world
Sensory
Information
Changes
how we see
the world
Sensory
Information
Cue/Trigger
(sight, smell, thought,
emotion, body sensation)
Pleasan
t
Unpleasant
CRAVING
Behavior
Birth (of self-identity)
Memory (“me”)
Brewer, Elwafi and Davis Psych of Addictive Behavior (2012)
Positive Cue
Neutral Cue
(have a good meal or
sex)
(get in your car)
Negative Cue
(get yelled at by your
boss)
AVOIDANCE
OF CUES
Negative Affect
(stressed out)
re
Positive Affect
(happy or relaxed)
CRAVING
in
Automated
SMOKE
SUBSTITUTE
BEHAVIORS
Maintain or Increase
Positive Affect/Decrease
Negative Affect
Reinforcement of
Associative Memory/Habit
(smoking makes you feel
better)
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
“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)
“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
Self-control: competing systems
• Affective (self-referential?)/hot processing
– involves 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 processing
– effortful, 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)
How to improve the balance
between cold and hot processing?
HOT
COLD
Why study mindfulness?
(a Darwinian perspective)
CBT
Psychoanalysis
Mindfulness
Ab
machine
Penicillin
t1/2=?
Overview of Mindfulness
Two 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
Sensory
Information
Mindfulness-based treatments
Effective 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)
The paradox of Mindfulness:
less is more
Pay attention, and everything else will
take care of itself (really).
Brewer Davis and Goldstein Mindfulness (2013)
Greater smoking abstinence with
MT vs. Freedom from Smoking
Point Prevalence Abstinence (%)
40
35
*
MT
FFS
**
30
25
20
15
10
*p = .063
**p = .012
5
0
End of Treatment
17 week follow-up
Brewer et al Drug and Alcohol Dependence (2011)
Working hypothesis
• Hypothesis: MT works by decoupling
craving and behavior (e.g. smoking)
• Prediction: should see dissociation
between craving and smoking
BEFORE they both subside
– i.e. should still have some craving,
but it is not coupled to smoking
Craving and cigarette use become
dissociated during treatment
Craving (QSU)
X
Cigarette Use
Baseline
(Week 0)
End of
Treatment
(Week 4)
6-Week
Follow-Up
3-Month
Follow-Up
4-Month
Follow-Up
r = 0.582
p < 0.001
N = 32
r = 0.126
p = 0.491
N=32
r = 0.474
p = 0.020
N = 25
r = 0.788
p < 0.00001
N=28
r = 0.768
p < 0.00001
N=29
p = .04
Mindfulness practice moderates dissociation
Predictor of Smoking
r
0.735
Overall Model
Baseline Craving
Baseline Cigarette Use
End of Treatment Craving
Informal practice (days/wk)
Craving*Informal (days/wk)
R2
β
p
Effect size
1.17
0.266
-0.053
0.208
-1.522
0.515
0.001
0.591
0.53
0.652
<0.0001
0.026
0.540
Elwafi et al Drug and Alcohol Dependence (2013)
Reduction of craving scores with MT
Craving Score (QSU)
4.5
Abstainers
4
3.5
Non-Abstainers
3
2.5
2
*
1.5
1
p = 0.03
0.5
0
Baseline
End of Trmt
6-Week f/u
3-Month f/u 4-Month f/u
Elwafi et al Drug and Alcohol Dependence (2013)
Positive Cue
(have a good meal or
sex)
Neutral Cue
(get in your car)
Negative Cue
(get yelled at by your
boss)
AVOIDANCE
OF CUES
Negative Affect
(stressed out)
re
Positive Affect
(happy or relaxed)
in
CRAVING
SMOKE
SUBSTITUTE
BEHAVIORS
Maintain or Increase
Positive Affect/Decrease
Negative Affect
Reinforcement of
Associative Memory/Habit
(smoking makes you feel
better)
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
“The destruction of craving conquers all
suffering.”
-Dhammapada (354)
Craving to Quit
(iPhone App)
• 21 day training for
smoking cessation
• Daily modules
– animations
• In vivo exercises
• Experience Sampling
– Test efficacy
Applied mindfulness: RAIN
• RECOGNIZE
– “Oh that’s a craving”
• ACCEPT/ALLOW
– See if you are resisting the experience
• INVESTIGATE
– “what’s happening in my body right now?”
• NOTE
– Label or mentally note the body
sensations from moment to moment
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?
The Underperformance Continuum
DAYDREAMING STRESS
ADDICTION
Default Mode Network (DMN)
Andrews-Hanna Neuron (2010)
Overlap between DMN and
Self-referential processing
Whitfield-Gabrieli Neuroimage (2011)
Resting state anti-coupling
between monitoring (dACC) and
default mode network
self/conflic
t
monitoring
default mode
network
Castellanos et al Biological Psychiatry (2008)
Mindfulness meditation practices
Concentration
Lovingkindness
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
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!)
Experienced meditator study
(n=12)
Meditation hours
Mindfulness
Loving Kindness
Other
Total
7748.3+4250.5
1060.1+958.9
1756.8+2476.6
10565.2+5148.9
Trial Time Course
baseline
Instructions
2 min
30 sec
Choiceless
Loving
Concentration
Awareness
Kindness
Meditation
Meditation
4.5 min
2x Trial (randomized between conditions)
Decreased DMN activity during
meditation in experienced
meditators
(all meditations, Experienced > Novice)
x = -6
z = 21
Brewer et al PNAS (2011)
BOLD signal change (%)
x = -6
0.3
0.3
0.1
0.1
-0.1
-0.1
-0.3
-0.3
-0.5
Meditators
Controls
-0.5
z = 21
Meditators
Controls
Decreased DMN activity during meditation
as compared to both resting and active baselines
(n = 20 expert, 26 novice meditators)
Meditation > Resting Baseline (eyes open)
Meditation > Active Baseline (‘does the word describe you?’
‘is the word in upper
case?’)
Garrison et al (under review)
“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)
“Romantic love is one of the most addictive
substances on earth.”
-Helen Fisher
Neural substrate of loving kindness meditation
Reduced BOLD signal in meditators (n=20) v. novices (n=26)
Garrison et al (2014) Brain and Behavior
Hold the door
for someone
“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
Does practice make perfect?
• Relatively specific deactivation of DMN during
meditation
– Common to all 3 meditation types
– Reproducible
• 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)
Altered DMN connectivity in
experienced meditators
meditator > control
Connectivity z-score
2
1.5
1
0.5
0
-0.5
x=0
-1
Meditators
Controls
(PCC seed region)
Brewer et al PNAS (2011)
meditator > control
Baseline
(PCC seed region)
2
z = 15
z = 24
Meditation
meditator > control
Connectivity z-score
1.5
1
0.5
0
-0.5
-1
z = 15
z = 24
Meditators
Controls
Brewer et al PNAS (2011)
State to trait?
Meditators have a different
Default Mode!
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
“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
Real-time meditation feedback
baseline
1 min
“active”
“dummy”
meditate
feedback
feedback
3 min
Garrison et al NeuroImage (2013)
Real-time Neurofeeback
(PCC ROI, n = 22/group)
Novice
Expert
Run 1
Decreased
self-related
activation
Increased
self-related
activation
Run 4
Correspondence: 7.7 ± 0.29
7.4 ± 0.16
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…
Meditate by watching graph (graph of PCC, active feedback)
…and then I sort of immediately
settled in and I was really getting
into it…
Meditate by watching graph (graph of PCC, active feedback)
…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)
… 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)
…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)
…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.
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)
What about me and the PCC?
Andrews-Hanna et al (2014) Ann NYAS
Can we take a deeper dive
into the PCC?
• Active during a number of cognitive states
– Activation seen across multiple
populations
• Deactivated during mindful states
• What exactly does PCC activity correlate
with?
Neurophenomenology
(Lutz and Thompson 2003)
• Use first-person self-report to better
understand cognitive processes related to
third-person physiological (e.g., brain
imaging) data
• Grounded Theory Method (GTM)
– Qualitative analysis of self-report data
– Derive theory from empirical data
Open Code
Open awareness
Not “efforting”
Central Code
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
Not “efforting”
Pleasure
Theoretical Code
Equanimity
Focus
Not “efforting”
Clarity
Contentment
Physical sensations
Concentration
Mental objects
Observing sensory experience
Auditory objects
Engaging with …
Visual objects
Interpreting
Deliberating
Discontentment
Remembering
“Efforting”
Self-related thinking
Distraction
Displeasure
“Efforting”
Muddled
Discomfort
Emotion
Surprise
Restlessness
Confusion
Searching
Garrison et al (2013) Frontiers in Hum Neuroscience
Activation
Distracted
Awareness
Controlling
Distraction
Interpreting
“Efforting”
Discontentment
n = 64
n = 56
n = 19
n = 14
Muddled
Self-related
thinking
Deliberating
Memories
Physical
sensations
Visual
objects
Auditory
objects
Mental
objects
Displeasure
Garrison et al (2013) Frontiers in Hum Neuroscience
PCC Activation
“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”
Deactivation
Undistracted
Awareness
Concentration
n = 99
Focus
Focus on
breath
Effortless
Doing
Observing Sensory
Experience
n = 76
Clarity
Physical
sensations
Visual
objects
Not “efforting”
Contentment
n = 48
n = 28
Auditory
objects
Mental
objects
Equanimity
Pleasure
Garrison et al (2013) Frontiers in Hum Neuroscience
PCC Deactivation
“Toward the middle I had some
thoughts which I don’t see on the
graph maybe because I let them
kind of flow by”
“I noticed …that the more I
relaxed and stopped trying to
do anything, the bluer it went”
How do studies of the PCC
converge?
• What about the self is processed in
the PCC? (Brewer, Garrison and WhitfieldGabrieli, 2013)
– “getting caught up” in experience?
– Mental contraction?
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
Flow
a mental state when a
person is fully immersed
in the present in a
feeling of energized
focus.
“
“
There was a sense of flow, being with the
breath…flow deepened in the middle.
-Experienced Meditator
Are you kidding?
I have to practice 10,000 hours
to change my default mode?
"Practice does not make perfect.
Only perfect practice makes
perfect.”
-Vince Lombardi
What ingredients are needed
for mindfulness practice?
Pay attention
NOVICE MEDITATOR
“felt a lot more
relaxed, like it
was less of a
struggle to
prevent my mind
from wandering”
RUN 1
RUN 2
RUN 3
RUN 4
What ingredients are needed
for mindfulness practice?
Pay attention
Relax
EXPERIENCED MEDITATOR
“focus on the breath and in particular the feeling of
interest, wonder, and joy that arises in conjunction with
subtle, mindful breathing”
What ingredients are needed
for mindfulness practice?
Pay attention
Relax
Be interested
NOVICE MEDITATOR
Thinking
about the
breath
RUN 1
RUN 2
RUN 3
”focused more on
the physical
sensation instead
of thinking in and
out”
RUN 4
What ingredients are needed
for mindfulness practice?
Pay attention
Relax
Be interested
Drop the
self
EXPERIENCED MEDITATOR
Repeating name
Exploring image
Future thinking
On task
Run 1
Run 6
Next steps to move into
clinical utility:
EEG source-estimated
neurofeedback from the
PCC
Mindfulness may increase cold
while decreasing hot processing
ACC
PCC
dlPFC
HOT
COLD
“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
Thanks!
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)
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
BOLD signal change (%)
x = -6
0.3
0.3
0.1
0.1
-0.1
-0.1
-0.3
-0.3
-0.5
Meditators
Controls
-0.5
z = 21
Meditators
Controls