Brain Health and Mindfulness
October 2, 2015
Tony Seikel
Disclaimer
I have no relevant financial interests with
respect to this subject.
Brain Health and Mindfulness
Today:
• 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_journa
l_individual.asp?blog_id=4793931
http://www.independent.co.uk/news/uk/crime/thieves-try-tosteal-sigmund-freuds-ashes-blame-it-on-their-mothers9061329.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.,
2007
Participants: 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
State Anxiety
Trait Anxiety
Participants: = 38
exp., 38 controls
Treatment: MBSR
Depression
Significant Pre-post
gains for MBSR
group:
-depression
-anxiety
-empathy
-spirituality
Spirituality
somatic
symptoms
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 of
mindfulness?
• 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)
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
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
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
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: 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.
From Seikel, Drumright & King (2015)
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
From Seikel, Drumright & King (2015)
Components of Mindfulness
Meditation
Mindfulness
meditation
• Attention control
• Emotion regulation
• Self Awareness
• Compassion (I
added this one)
compassion
From Tang, Holzel & Posner, 2015, Nature Reviews
Neuroscience
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
–
•
Increased density in right hippocampus,
right orbitofrontal cortex (Luders et al.,
2009)
–
–
•
From Vestergaard-Poulsen et al., 2009
Emotion regulation, attention
Experienced vs non-meditators
Increased density of right anterior insula
and dorsolateral prefrontal cortex (Lazar et
al., 2005):
–
–
•
(Vestergaard-Poulsen et al., 2009)
Awareness, conscious control of thinking process
experienced vs novices
From Lazar et al., 2005
After 8 weeks of MBSR, increased in gray
matter density in
–
left hippocampus, posterior CC, TPJ, cerebellum
•
(Holzel et al., 2011)
From Holzel et al., 2011
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)
Volume Increases, from
Literature
Activity Increases, from
Literature
Right
Left
Bilat.
Right
Left
Bilat.
Frontal
3
2
1
Frontal
3
4
1
Parietal
1
0
0
Parietal
2
2
1
Cingulate
2
0
1
Cingulate
1
1
1
Thalamus
1
0
0
Thalamus
0
0
0
Brainstem
0
0
2
Brainstem
0
0
0
Insula
2
0
0
Insula
1
0
0
Temporal
(excl.
hippo.)
1
3
1
Temporal
(excl.
hippo.)
1
0
1
Hippocampus
1
0
0
Hippocampus
1
0
1
Totals
11
5
5
Totals
9
7
5
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
The cerebral hemispheres
get thinner as we age…
…as does the
hippocampus
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.
…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!
Effect of Age on Hippocampal Neurons
Hippocampus is
critical for memory
70
60
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
Number of Neurons (millions)
Normal aging:
50
40
Millions of neurons
30
Linear (Millions of neurons)
20
10
0
16 17 20 25 28 33 47 52 71 75 76 77 78 78 80 80 88 99
Age (years)
From Data of Simic et al., 1997
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
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
Image from Luders, 2014
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 selfidentify, 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-tomoment 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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