Transcript Slide 1

MINDFULNESS MEDITATION & NEUROSCIENCE
PROFESSOR EMERITUS
ROB MACFADDEN, UNIVERSITY
OF TORONTO
[email protected]
www.robertmacfadden.com
MORE ON NEUROSCIENCE
B41
Factor-Inwentash Faculty of Social Work
Continuing Education
Applied Mindfulness Meditation
University of Toronto
March 20-21, 2015
1
MINDFULNESS MEDITATION & NEUROSCIENCE
The brain is the most complex adaptive system known to science
We are built for survival of the species, not for happiness
Vigilance and fear are key to understanding our human condition
The brain is Teflon for positives and Velcro for negatives
Need for connection is as fundamental as fear for humans: We are completely
wired to connect
Many of the circuits for feeling physical pain are the same as those when we
experience feeling socially isolated
2
MINDFULNESS MEDITATION & NEUROSCIENCE
We are a species that requires the most home assembly: brain continues to
mature right into the twenties. It changes throughout all of our lifetimes
Emotion powers our lives. It is a background and foreground influence.
Understanding fear,safety and love is critical to understanding people and for
intervention.
3
MINDFULNESS MEDITATION & NEUROSCIENCE
The brain has developed over millennia and this history influences who we are
today. The brain is an archeological record. (Triune Brain by Paul MacLean)
In general terms, the brain can be seen in terms of three evolutionary
components:
The reptilian brain was the first core to develop and is basic life sustaining,
controlling key functions such as respiration, circulation, the endocrine system,
reproduction, arousal & homeostasis. Much is reflexive and drive based- fear,
rage, eating, and mating which still retains a degree of control over our actions.
(Brainstem)
4
MINDFULNESS MEDITATION & NEUROSCIENCE
The paleomammalian brain was added on and brought with it learning,
memory and emotion. (Limbic system)
The neomammalian brain was a third addition and brought enhanced
cognition, enhanced social connection and sense of self and selfawareness. Problem-solving was enhanced and an increased emphasis
on social connection enabled us to organize into larger communities, to
increasingly plan ahead and to learn more from experience. (Cortex)
5
MINDFULNESS MEDITATION & NEUROSCIENCE
Louis Cozolino describes psychotherapy in “It’s a Jungle in There”
(Psychotherapy Networker 2008 September/October) is like working with
an anachronistic menagerie- a human, a horse and a crocodile within the
same body.
Our skull shares its space with ancient brain equipment and our
functioning requires integrating and coordinating these highly specialized
and complex systems. These areas of our brain can vie for dominance
and experience conflict with each other without us being conscious of
this.
6
MINDFULNESS MEDITATION & NEUROSCIENCE
Velcro for Negatives: Tilted towards Anxiety and Fear
Evolution favours an anxious gene (Aaron Beck).
We can be anxious/fearful about anything (e.g., our furniture)
Human condition is tilted towards anxiety or fear
Different Neuroplastic Properties
Hippocampus
Etch a sketch-repeatedly
Influenced by experience
Constantly remodeled
Amygdala
Keeps a constant dendritic profile-memory
Generalizes to as many situations as possible
Can make us rigid
Therapists are amygdala whisperers: work to build
networks of new learnings in hippocampus & prefrontal
cortex
7
Empathy, warmth, positive regard creates the nourishing
MINDFULNESS MEDITATION & NEUROSCIENCE
During fear and stress, Broca’s area (speech) inhibited. Yet we
need to put feelings into words & narratives to support emotional
regulation.
Involves integration cognitions and emotions. Broca’s area also
involved in prediction & anticipation. Impacts good choices &
victimization and dissociation.
8
MINDFULNESS MEDITATION & NEUROSCIENCE
Most Important Discovery in Neuroscience?
Neuroplasticity and Neurogenesis
9
MINDFULNESS MEDITATION & NEUROSCIENCE
Neural Circuitry: We’re all electricians.
Circuits are being formed, weakened, strengthened, and purged. Experience
is like a scalpel. Much happening unconsciously and may be consciously
driven.
Meditation is an act of circuit building- if you have an awareness of this, then
it’s a conscious act of circuit building.The ability to control and to direct your
attention is essential to well-being. It is the core of emotional regulation.
Secret to deliberate circuit building: paying attention. Intentional attention.
The ability to connect with, attune to, and help build new neural connections at
the heart of psychotherapy. We are all gardeners, helping each other manage
and grow our gardens.
10
MINDFULNESS MEDITATION & NEUROSCIENCE
11
MINDFULNESS MEDITATION & NEUROSCIENCE
AUTOMATICITY
Automaticity drives our lives. We go through life much of the time without seeing
others, without tasting our food, without appreciating our loved ones, without being
mindful. Our brain thrives on automaticity. It is so much more efficient and we have
so little conscious processing power. When we learn something that we do often, it
becomes “second nature”- unconscious. Also when problems develop we may lose
sight of destructive patterns.
We are rarely focused on the present. We are frequently thinking of the past and
worrying about the future. It is estimated that our brain wanders 50% of the time.
That’s why mindfulness is so helpful. It focuses on the present through following
the breath. It enables us to reduce the prevalence of worry and anxiety through
consistently returning to the present moment. Being accepting of whatever is
experienced, not pushing it away but experiencing it with curiosity and acceptance
seems to reduce the occurrence of the worrying.
12
MINDFULNESS MEDITATION & NEUROSCIENCE
We all carry baggage. In psychotherapy we need to be centred and present
with the client to the greatest extent possible. Bringing in the baggage is like
having an elephant in the room. It impairs the therapist’s ability to be present,
to hear the client, to focus on the client and to resonate and attune. Clients
are engaged in an interactive processes with therapists. The can feel
whether you are feeling them. For a distracted therapist, the connection
could become problematic and the client might feel unconnected.
Daydreaming while the client is talking, answering the phone, checking your
watch are examples of common distractions.
13
MINDFULNESS MEDITATION & NEUROSCIENCE
Mindfulness helps with being centred and present. Recent research suggests
that doing mindfulness before conducting session for only 5 minutes can
improve aspects of the relationship with clients (Dunn, R. et al., 2013, Effects
of pre-session centering for therapists on session presence and
effectiveness. Psychotherapy Research, Vol. 23, No. 1, 78-85).
Therapists viewed themselves as being more present when they engaged in
pre-session mindfulness, while clients perceived therapists in both groups as
being highly present. Clients where therapists practiced brief mindfulness
rated the sessions as more effective.
14
MINDFULNESS MEDITATION & NEUROSCIENCE
Presence (from Geller & Greenberg, 2013 and Geller & Porges, in
preparation).
Being centered and mindful helps us with being:
Curious, open to experience, accepting and feeling love and kindness. This
improves the quality of the alliance and leads to feeling felt, the sweet spot
for clinical change.
Therapeutic presence involves therapists being fully in the moment along
several dimensions: physical, emotional, cognitive and relational
Therapists need to be first grounded, centered and steady as well as open
and receptive to the client’s whole experience. When present, therapists are
in direct contact with themselves, the client and the relationship
15
MINDFULNESS MEDITATION & NEUROSCIENCE
Presence (from Geller & Greenberg, 2013 and Geller & Porges, in
preparation).
A present centered therapist creates a feeling of safety in the client through a
warm facial expression and prosodic voice. This feeling of safety creates a
shift in body regulation which inhibits defenses and creates a response of
calmness, openness and trust.
Feeling engaged like this by a therapist who is present encourages clients to
feel open and present. This is a shared biobehavioural state that has healing
qualities and allows for deeper work.
In mammals there are two distinct vagal pathways. The vagus cranial nerve
exits the brainstem & provides bidirectional communication between the
brain and several visceral organs like the heart.
16
MINDFULNESS MEDITATION & NEUROSCIENCE
Presence (from Geller & Greenberg, 2013 and Geller & Porges, in
preparation).
The newer myelinated vagal nerve regulates the heart and lungs in particular
and helps to slow heart rate and calmness.
This newer circuit is linked to the cranial nerves that regulate the striated
muscles of the face and head which are primary to social engagement
behaviours. This is a face-heart connection the creates the “social
engagement system”. It involves facial expressions and voice prosody and
conveys the person’s physiological state to the other.
When working well, this newer vagal circuit inhibits sympathetic excitation
(flight or flight), promotes regulation of emotions, rich vocal prosody and
spontaneous social engagement behaviours.
17
MINDFULNESS MEDITATION & NEUROSCIENCE
18
MINDFULNESS MEDITATION & NEUROSCIENCE
http://www.youtube.com/watc
h?v=8tz146HQotY
19
MINDFULNESS MEDITATION & NEUROSCIENCE
Presence (from Geller & Greenberg, 2013 and Geller & Porges, in
preparation).
When the person feels safe, the bodily state is regulated through the new
vagal circuit which slows heart rate, inhibits fight/flight and dampens the HPA
(e.g., cortisol) and reduces inflammation by modulating immune reactions
(e.g., cytokines).
Evolutionarily, the nuclei that regulate the myelinated vagus (new) became
integrated with the nuclei that regulate the face and head. So this social
engagement system links the visceral systems (e.g., heart) with the musles
controlling gaze, facial expression, head gesture, listening and prosody
(Porges, 2001, 2007, 2009).
20
MINDFULNESS MEDITATION & NEUROSCIENCE
Presence (from Geller & Greenberg, 2013 and Geller & Porges, in
preparation).
Not only bidirectional communication between the brain and body but also
between nervous systems of others. Frequently outside consciousness, but
left with a “gut” feeling that alerts us to discomfort within a social interaction.
This automatic evaluation of risk is called neuroception.
Neuroception can either turn off defenses or prepare us for defensive
strategies. May bias our perceptions negatively during fight/flight or positively
during social engagement.
Being with someone who feels safe, positive social engagement behaviours
initiated, calmness increases and defenses are inhibited. Bias towards
positivity which can promote growth and change.
21
MINDFULNESS MEDITATION & NEUROSCIENCE
The face and voice are significant channels through which safety is
communicated to another. Face is the area particularly where presence is
communicated to the client (Geller and Greenberg). Faces are information
centres along with voice.
Over time, the therapist’s warm facial connection, receptive posture, open
heart and listening presence promotes safety and neural regulation of the
client’s physiology, strengthening emotional regulation.
Therapist’s preparation involves cultivating personal presence prior to
meeting. This is internal attunement which generates calm and safety within
the therapist. Therapeutic presence involves attuning to oneself and one’s
felt sense of the client. Feeling felt impacts the client’s physiology though
calming feelings of safety.
Case Vignette
22
MINDFULNESS MEDITATION & NEUROSCIENCE
Automaticity or Predominance of Unconscious Processing
To survive we have kept many primitive responses and automatic
subcortical processes. It takes 500-600 milliseconds for our cerebral
cortex to process experience while the amygdala can react in less
than 100 milliseconds. Consciously by the time we have become
aware of an experience, it has been processed many times by more
primitive regions, activating memories and neural patterns from past
learning.
As Cozolino points out, so when we think about performing an action,
the choice has likely already been made unconsciously. Brain thinks
we are living in the present moment and acting of free will. The
conscious awareness is mostly a result of what’s already occurred in
our brains and over 90% of input to the cortex comes from internal
neural processing.
23
MINDFULNESS MEDITATION & NEUROSCIENCE
Paradox of therapy: increasing conscious awareness of our
unconscious, irrational impulses arising from older parts of the brain.
Our unconscious thoughts, emotions, perceptions are based largely on
reactions and emotions outside our awareness and not connected with
current realities.
Mindfulness interrupts automaticity. Slows us down, helps us to be
conscious and aware. We see things from a “beginner’s mind”.
24
MINDFULNESS MEDITATION & NEUROSCIENCE
Therapeutic Alliance
Decades of research into change in psychotherapy identifies the therapeutic
alliance as the main active ingredient, regardless of specific model. The alliance
is defined as having three components: the bond, the goals and the tasks.
The bond is the emotional relationship. It is characterized by positive regard,
empathy, resonance and attunement. The social brain and mirror neuron
system help to form the bond. Emotion charges the therapeutic alliance with
energy.
Much neuroscience has focused on the therapeutic relationship and building this
relationship. Allan Schore emphasizes the right brain to right brain connections 25
(therapist to client) as being essential to promote deep connection and change.
MINDFULNESS MEDITATION & NEUROSCIENCE
Much of this is also non-verbal. Therapy is not merely the talking cure, but
the communication cure.
The therapist’s whole being functions like a tuning fork, resonating,
attuning and feeling empathy. This is highly interactional between the
therapist and client. The therapist senses the client and is changed from
this feedback.
Emotions experienced by the client are being experienced by the therapist
and his/her feeling and body state changes. The client senses this
change and if there is attunement, the client “feels felt” which is the sweet
spot for change.
26
MINDFULNESS MEDITATION & NEUROSCIENCE
In mindfulness, Siegel believes the process of following your breath in
a certain way and with certain mental filters, leads to the meditator
developing a positive, supportive relationship with oneself.
This is similar to us being a secure parent to ourselves. We are
responsive, accessible and attuned to our behaviour, feelings and
perceptions.
Therapists talk about creating a supportive, holding environment with
clients. Mindfulness is a form of a supportive, holding relationship with
ourselves.
27
MINDFULNESS MEDITATION & NEUROSCIENCE
Goals are essential in change. Goals are navigational beacons that
are charged with emotions and values which are reflections of
emotion and goals. It is fundamentally essential that a therapist
builds a relationship based on an appreciation and commitment to
achieving client goals.
This is the fuel of momentum- identifying something (i.e., a goal) that
is essential for the client to achieve. The goal, anchored by
important emotions, becomes both a target and a fulcrum to foster
change.
28
MINDFULNESS MEDITATION & NEUROSCIENCE
Tasks similarly are infused with emotion/values. The accomplishment of a
task must be seen by the client to be connected directly to achieving the
goal. The task must make sense and it must generate considerable
commitment from the client.
So when you have a positive, supportive bond or relationship with the
client, this creates the environment for sharing feelings, identifying desired
goals which further infuses the process with emotional energy. Topped off
by tasks that anchor goal achievement and are emotionally connected, you
have the conditions for the therapeutic alliance to work- to promote change.
The Engine of Change (i.e., the therapeutic alliance) has its supportive
conditions, its direction and its fuel.
29
MINDFULNESS MEDITATION & NEUROSCIENCE
Understanding emotions is essential for a professional delivering psychotherapy.
It is important to acknowledge the complexity of emotions and that neuroscience
is providing many insights but that there is still much to discover.
Antonio Damasio makes a distinction between emotions and feelings. Emotions
are largely unconscious and occurs within the “theatre of the body”. Different
emotions have specific signatures and involvement of parts of the body. Anger, for
instance can be signaled by a raised voice, pounding heart, facial features that
look aggressive and flushing of the face. Emotions are largely unconscious and
difficult to conceal. Our development from infancy involves resonating and
attuning to others’ emotions so we become skilled in assessing the emotional
state of others.
30
MINDFULNESS MEDITATION & NEUROSCIENCE
Damasio describes feelings as occurring within the “theater of the mind” and are
conscious and the result of changes in the body that get transmitted through the
insula to the prefrontal cortex. These changes are sensed as a difference and as
a conscious feeling.
Emotion, also plays another fundamental role in our life and mental health. The
word, “e-motion” describes this motivating influence that emotion has on our
mental life. As Siegel points out (2012), emotion is more than the categorical
descriptions we think of such as anger, sadness, etc.. Emotion is also a type of
background activation state that underlies what we pay attention to, our feelings,
perceptions and actions.
Richie Davidson- Emotional Life of the Brain (43)
http://www.youtube.com/watch?v=GnwhoVR4fCw
31
MINDFULNESS MEDITATION & NEUROSCIENCE
Humans are built to be constantly vigilant, aware of stimuli from outside and from
within our body, for potential threats and opportunities. Emotion is a background
force that allows us to be alert and scanning for these stimuli. Through the
amygdala we appraise stimuli to determine if it is a threat. If it is, our sympathetic
nervous system is activated which prepares us to freeze, flee or fight.
What we normally think of as an emotion such as fear, anger, joy, surprise and
sadness can be viewed as a special type of discrete or categorical emotion that
are characterized by specific and common body and mind changes. Sadness,
for instance, can be signaled by a droopy face, low energy, quiet voice and lower
levels of activity.
32
MINDFULNESS MEDITATION & NEUROSCIENCE
Viewing emotion in this variegated and complex way allows us to
understand its fundamental nature. It powers so much of our lives and it is
fundament to integration. Indeed Siegel views emotion as being shifts in
integration.
Integration is a process that involves the activation of individual components
as well as the linking or collaboration of these components with each other.
When we are experiencing integration, there is a FACES flow to the system
which reflects: flexibility, attunement, coherence, being energized and
stable. Emotion, as integration, creates a flow to the system that avoids the
dual dangers of rigidity and chaos. Siegel notes that all DSM diagnoses
reflect essentially a disruption of this flow through excessive rigidity, chaos,
or a combination of both.
33
MINDFULNESS MEDITATION & NEUROSCIENCE
Emotions, Emotional Regulation (Taken from Emotional
Regulation in Psychotherapy by Robert Leahy, Dennis Tirch, and
Lisa Napolitano. NY: Guilford Press, 2011) and other sources
So integration is mental health and emotion is fundamental to this.
Mental illness can be viewed as a form of disintegration. Neuroscience
has underscored the importance of emotional regulation to mental and
physical health and social functioning.
When we are infants, we lack emotional regulation capabilities and
basically react directly to stimuli. A crucial part of a parent’s role is
helping the infant to learn how to emotionally regulate.
34
MINDFULNESS MEDITATION & NEUROSCIENCE
We do this through the process of emotional resonance, attunement and
empathy. The parent manages the infant’s emotions through this process
and the infant develops self-soothing skills.
Gradually as the child is able to self-soothe more and develops the neural
ability to regulate his or her emotions. The child and young adult also
learns how to co-regulate emotions of others and contribute to the
regulation and integration of important others in his/her life.
Thus emotion helps to regulate mental activity and is also regulated itself.
35
MINDFULNESS MEDITATION & NEUROSCIENCE
Why is emotional regulation so important? The inability to emotionally regulate
can cause problems in a wide range of areas. It can create aggression, lead to
personal and social problems. It can fuel depression and lead to withdrawal. It
can lead to overstimulation and/or under stimulation. It can hamper the
development of relationships, reduce motivation and activity.
The flow of energy and emotion can be blocked and lead to disintegration. For
instance, there can be problems between left brain and right brain integration.
Recall that the left brain is the centre for language and logic and is digital in the
sense of right or wrong, fostering order and patterning. The right hemisphere is
especially important for processing emotion. It views things more holistically and
contains attachment schemas, autobiographical memory and how to
understand body language, including faces and social communication.
36
MINDFULNESS MEDITATION & NEUROSCIENCE
If these two hemispheres are not functioning well both independently and
collaboratively, the integration may be impeded. An example would be an
individual who has learned to suppress emotion and to stay logical and rational
in life. The richness of the right hemisphere would not be available to this person
and he or she would likely have problems in establishing and maintaining close
relationships. This would be an example of a problem with horizontal or bi-lateral
integration.
Similarly, an individual may have a problem with the up and down flow from the
body to the brain and vice-versa. An example would be a person who has
experience a trauma to the body (e.g., rape) and has managed, over time, to
ignore or block sensations from the neck down. Not being able to be aware of
these sensations from the body can impair vertical integration. The individual is
not able to use these feeling to help understand what’s happening to his or her
body.
37
MINDFULNESS MEDITATION & NEUROSCIENCE
Many of the problems that the client brings into social workers are
related to problems with emotional regulation. Couples may be arguing
constantly and experience deterioration in their relationship. An
individual may be depressed and unable to be motivated enough to
attend school. Parents may be at the end of their rope in dealing with an
adolescent who has violent outbursts at school and in the home.
There are many ways for social workers to foster emotional regulation.
The development of a positive therapeutic alliance that promotes safety
and security can enable a client to express and manage feelings that
have become dysregulated.
38
MINDFULNESS MEDITATION & NEUROSCIENCE
In trauma, for example, the client may be troubled by images and emotions that
recur and victimize the client continually. These images and emotions may not be
remembered from past events so they appear mysterious, frightening and
disorienting.
Within a safe therapeutic environment, when these emotions and images are
shared, they begin to be associated with more calmness and safety (right brain).
Discussing these experiences and fitting tem into a life narrative (left brain) helps
the client to make some sense of the experience which enhances coping. These
new feelings and associations about the experience are recorded into memory
and they progressively lose some of their frightening nature. The more times
these are discussed within the safe therapeutic relationship, the less frightening
they become.
39
MINDFULNESS MEDITATION & NEUROSCIENCE
This is another example of how therapy can foster integration. Instead of being
blocked, these implicit memories are shared and the feelings moderated within
a secure environment. Siegel says, “If you can name it you can tame it”.
Focusing on the emotions stored in the right brain, and using the left brain to
identify it and name it enhances integration, coping and well-being.
Much of this emotional regulation involves right brain to right brain (therapist to
client). Schore describes psychotherapy as essentially right brain to right brain
where the therapist resonates and attunes to the client. This leads to a
“holding” environment where the therapeutic bond is established and fosters
change in the client.
40
MINDFULNESS MEDITATION & NEUROSCIENCE
There are many more ways to assist with emotional regulation. A client
assessment can be used to identify the ways that are more individualized for
each client. For clients who are more cognitively oriented, focusing on
negative self-talk and cognitive errors that trigger negative emotions can be
helpful. A client who refuses to go outside because of bacteria and disease
can be challenged cognitively by pointing out discrepancies I logic and
including scientific and medical findings on risk.
For clients who value behavior change, using this same example, clients can
experience exposure therapy where in a graduated way, the client is exposed
to increasing levels of going outside balanced with returning to a safe haven
when anxiety intervenes. Gradually the anxiety and fear is reduced and the
beliefs change to support the safety of leaving the home.
41
MINDFULNESS MEDITATION & NEUROSCIENCE
For clients who are more emotionally oriented, an approach to help clients
regulate emotions is through emotionally focused therapy (EFT). This
involves working with the couple and having each member share deep
primary feelings which are witnessed by the other partner.
Gradually the partners come to realize the anxious and fearful emotions
being experience by the other and they start listening and connecting with
each other. This new bonding experience leads to beginning trust and
safety and changes other thoughts and behavior. The partners begin to
see the other as caring and are more interested in spending time with
each other.
42
MINDFULNESS MEDITATION & NEUROSCIENCE
So within a safe, therapeutic environment with a positive therapeutic alliance, the
couple are encouraged to explore their relationship and bond with each other.
The therapist continues to encourage each person to share deep and frequently
painful feelings with each other in the presence of the other. The partner listens
and then shares his or her emotions to the partner.
Gradually understanding and empathy for each other arises and the relationship
bond is strengthened. Each partner develops skills and the ability to understand
the emotion of the other and builds trust and safety. The secure relationship with
the therapist is replaced by the secure relationship with the partner. Emotional
co-regulation is enhanced and positive emotions generated.
43
MINDFULNESS MEDITATION & NEUROSCIENCE
Emotional regulation is not only important for clients but it is also essential for
therapists. Therapy can be a difficult process characterized at times with negative
emotion and sometimes hostility.
Based on our previous discussion of how sensitive humans are to the emotions of
others, therapists who are involved in environments characterized by intense and
frequently negative emotions can find themselves resonating and attuning to these
emotions. Like tuning forks, therapists can be impacted by these negative emotions.
Back to back sessions involving difficult situations can be an emotional roller coaster
for therapists. Therapists need to be able to emotional regulate themselves and
become centered for the next client. If they carry excessive negative emotions into
the next session, it may impact their ability to be with the client and to attune to their
feelings. Clients can sense when a therapist is distracted and this can lead to
44
ruptures in the alliance.
MINDFULNESS MEDITATION & NEUROSCIENCE
Therapists need to be sensitive to how their minds and bodies are experiencing
these emotions and familiar with ways to manage them. Mindfulness meditation,
as one example, helps therapists to become aware of and to be able to control
their reactions. Taking a 5 to 10 minute break between sessions to meditate or
relax can help therapists to regulate their emotions and be “present” with their
next client.
45
MINDFULNESS MEDITATION & NEUROSCIENCE
Prior to explicit memory development which begins at 2 or 3 years of age, the child
develops knowledge based on experiences that saved in implicit memory. This type
of memory is used unconsciously and helps to direct decision-making. This
knowledge may be expressed as a preference towards or against something.
Implicit knowledge helps us to make decisions quickly and automatically.
Unfortunately some of this knowledge is faulty and problematic. See the discussion
on the unconscious and conscious mental system elsewhere in this book.
Another way that emotion is relevant to therapists is that emotion drives learning
and therapeutic change. All therapeutic change involves changes in the brain. New
synapses formed or older ones reinforced. All learning involves neural change.
46
MINDFULNESS MEDITATION & NEUROSCIENCE
Regulation. As infants, we move from an automatic, inflexible, nonconscious level to
a purposeful, flexible conscious system of self-regulation. We begin to incorporate
rudimentary self-regulatory functions at around 10-12 months of age, when our OFC
(orbitofrontal cortex) comes online (Schore, 1994).
Impulse control and frustration tolerance are orbitofrontal, self-regulatory functions
that are not fully completed until the frontal lobe matures in early adulthood. We learn
to self-regulate with the help of our first external regulators, our primary caregivers.
Our young self-regulatory system is a duplicate of theirs.
Besides some constitutional and genetic factors, we are only as good at arousal
regulation as our external regulators. If our primary caregiver was an effective
modulator of his/her own feelings of anxiety, fear, anger and excitement, we tend to
be effective in turn. 100
47
MINDFULNESS MEDITATION & NEUROSCIENCE
Parents may avoid or actively dismiss, discourage or devalue certain bodily
states so children must avoid or regulate these states on their own. This can
lead to poorly managed internal experience which can produce later
negative social consequences.
In couples, one person may avoid high states and approach low states and
the other may be the reverse. Together they form a biphasic couple.
Therapy can help each partner to regulate or tolerate higher states and
lower states. 101
48
MINDFULNESS MEDITATION & NEUROSCIENCE
Autoregulation is the earliest and simplest level of arousal regulation.
It is insular and automatic. Gaze aversion in an infant is an example,
preventing over stimulation. Helps to calm down. Looking at eyes very
stimulating, baby may need to calm down. If parent persists, may
dissociate. Blankie and sucking thumb are further examples.
Not just calming down, but also the other way- being stimulated: tv,
drugs, fantasy, reading. We regulate our up and down (I’m bored…).
102 These are individual, personal.
49
MINDFULNESS MEDITATION & NEUROSCIENCE
For avoidant persons (attachment style), reliance creates a 1 person
psychological system of non-mutuality. It confers a pleasantly dissociative
state. For angry-resistant style, extended periods of noninteraction with primary
figures leads to intensely dysregulated states. For them, autoregulation
demands high energy expenditure. 101
Interactive regulation is the process where two individuals co-manage and
dynamically balance ANS (autonomic nervous system) arousal in real time. If
not available (e.g., neglect), turn to self-regulation which is lonely.
50
MINDFULNESS MEDITATION & NEUROSCIENCE
Autoregulation is self-absorbed, internally focused, pro-self, and
interactive regulation is interpersonal, externally focused, and prorelational.
Attunement is being on the same page, in alignment, in synchrony.
Produces a sense of safety, security, attraction and is sustained by a
couple’s capacity to remain predictable and friendly on a micromoment
basis. 103
Misattunement is unpleasant. Negative reactions need to be repaired.
Skillful couples will repair without much awareness of what they have
done. Discomfort arises if the couple takes longer than usual to repair. Too
much time without repair breeds insecurity and threat. Time is of the
essence. 104
51
MINDFULNESS MEDITATION & NEUROSCIENCE
SOME IDEAS ABOUT EMOTION & REGULATION &
PRACTICE
Understand importance of emotion and now it works
Offer psychoeducation for clients re: emotions and the brain and mental health
Focus on emotional regulation, identification and naming, horizontal and vertical
integration
Become mindful of emotions and able to quickly attune, resonate and be
empathic
Continue to check on emotional bond with clients using Session Rating Scale
and others
Uses emotion to enhance motivation and as a target for some clients
Keep yourself emotionally balanced regulated and integrated
Practice attunement and resonance
Allow time between sessions to regulate and de-stress
Understand importance of mental health, integration and positive emotions
52
MINDFULNESS MEDITATION & NEUROSCIENCE
SOME IDEAS ABOUT EMOTION & REGULATION &
PRACTICE
Become a specialist in positive emotions, what they are, how they work and
explaining to clients
After honoring the problem, move to positive emotions: caring days;
reminiscence; mindfulness; strengths-based
Your therapy context needs to foster learning: work with goals that are highly
relevant; tasks that make sense; building positive relationship with bond and
security
Evaluate process and outcome
Practice changes with clients- use homework for stronger circuits
Used varied sources: tools, scales, tapes, video, role playing
Goals are navigational beacons reflecting valued and emotionally positive
things.
53
MINDFULNESS MEDITATION & NEUROSCIENCE
SOME IDEAS ABOUT EMOTION & REGULATION &
PRACTICE
Watch the client continuously for emotional experiences, ask
questions, evaluate. Pay attention to non-verbals and your own
resonance
Have routines or approaches ready to help clients identify feelings,
name them experience them, share them with others
Use things that help manage emotions such as structure, rules,
positive feedback and review of progress
54
MINDFULNESS MEDITATION & NEUROSCIENCE
SOME IDEAS ABOUT EMOTION & REGULATION &
PRACTICE
Become an expert in fostering emotional regulation both self and coregulation
Self-regulation: anticipate of negatives, planned avoidance, prevention; selfhypnosis; meditation-self-attunement, interpersonal attunement; supportive
relationships; psychoeducation; time-outs, identifying patterns
Mutual regulation: psychoeducation, active listening of emotions; eft,
bonding; friendship-oriented relations, knowing triggers, knowing supports
Mindfulness & Emotional Regulation (from the workbook, Emotional
Regulation in Psychotherapy)
55
MINDFULNESS MEDITATION & NEUROSCIENCE
MINDFULNESS
Mindfulness fosters an adaptive, flexible orientation to emotional
experiences
Building acceptance of emotions
Openness to experience of emotions- don’t have to be surpressed
Non-judgmental, reduces guilt, shame
Experience emotion in the moment without intense behavioural reactivity
Decentered nature: thoughts are thoughts, feelings are feelings, emotions
are emotions, physical sensations are sensations THEY ARE NOT YOU
56
MINDFULNESS MEDITATION & NEUROSCIENCE
MINDFULNESS
Doing mode is resistant, active, problem-solving, pushing away:
negative feelings/cravings. Can lead to dissatisfaction, self-criticism,
futility
When we suppress feelings, thoughts events, they can come back
more intensely and frequently
57
MINDFULNESS MEDITATION & NEUROSCIENCE
MINDFULNESS
Being mode not goal-oriented, observational, deep contact with the
present
Sleepwalking through life. We enter reality with expectations that
distort what we are experiencing in the moment. Early memories, for
instance, colour the way we see things and people. It sets up a
distorted lens which uses expectations to contort present realities.
Mindfulness fosters an intentional awareness that creates a
paradoxical disidentification from the contents of one’s own
conscious mind while gently allowing a non-judgmental, full
experience of the present moment.
Mindfulness may enhance the functioning of emotional processing by
encouraging the direct translation of bodily sensations into emotion.
58
MINDFULNESS MEDITATION & NEUROSCIENCE
Somatic Psychotherapy (Pat Ogden)
How the body holds PTSD and attachment issues and how we can
work through the body to help those issues heal.
Body intimately tied to emotion, hormones,
Harvard research, Dr. Amy Cuddy, has done studies that show the if
people take a two minute power pose (like Wonder Womanconfident and upright- that cortisol lowers and testosterone rises.
Movement and posture can impact hormone levels, mood, stress
and anxiety.
If we take PTSD and explore how it lives in each person’s body,
then we can start working directly with the body to help resolve
some of those symptoms (Ogden).
59
MINDFULNESS MEDITATION & NEUROSCIENCE
Body is a constant influence. If we tighten our bodies, lift our shoulders,
widen our eyes- the position of fear- we start feeling afraid.
Some clients have a chronic posture- constant vigilance, fear.
Constant stress changes our bodies. Constantly holding ourselves in
vigilance impacts our immune system and adrenals.
Flight, fight or feigned death. These symptoms can show up in PTSD as
feelings of immobility, not enough energy to get through the day, losing
interest in life.
Important to work with posture with PTSD.
60
MINDFULNESS MEDITATION & NEUROSCIENCE
Secure attachment gives us a better immunity to trauma and to PTSD. Strong
attachment to parents builds resilience. Comforting and soothing the child
starts to develop the child’s own ability to regulate those lower-brain structures
(Ogden).
Mindfulness quiets our automatic responses so we can become aware of
them.
Pierre Janet said that “…trauma is a failure of integrative capacity”. With
normal experience, we absorb it. With trauma we fail to process it fully and
often elements become dissociated. Feelings are so overwhelming, we push
them away. Our bodies have such strong responses that we might try to
supresss them or disconnect from our bodies
When trauma is integrated, the trauma looks like it is in the past. When not
integrated people feel trauma is happening now.
61
MINDFULNESS MEDITATION & NEUROSCIENCE
Positive Emotions: Hanson and Happiness.
Inner strengths include character virtues such as generosity, modesty,
patience, and also secure attachment, executive self-regulation, distress
tolerance, resilience, plus mindfulness, compassion and loving-kindness
and positive emotions. These are related to happiness.
Have to activate inner states first, then install them. Fostering states until
they become traits is the secret.
Negative states can quickly become negative neural traits.
Most positive states are wasted because they are too short-term. Need
to transfer short term states from short-term memory buffers to long term
storage or no lasting value.
62
MINDFULNESS MEDITATION & NEUROSCIENCE
H-E-A-L PROCESS
Have- you have the positive experience – notice one or create one
Enrich. Increase duration, intensity, multimodality (bring into body,
sit up proudly), Novelty heightens learning and increase personal
relevance.
Absorb. Visualize it sinking in, sense it, build it.
Link. (optional). Hold positive feelings or thoughts or memories in
awareness and introduce some painful thoughts, feelings, etc. (natural
antidote).
63
MINDFULNESS MEDITATION & NEUROSCIENCE
The positive material will gradually associate with the negative
material, soothing, easing and eventually replacing it.
Have more episodes over the day, even 30 seconds at a time, half
dozen times a day. Dozen or so seconds each time. Will turn
activated states into traits eventually.
It is startling to realize how unwilling the mind is to give the gift to
oneself of a positive experience (Hanson).
http://www.youtube.com/watch?v=jpuDyGgIeh0
64
MINDFULNESS MEDITATION & NEUROSCIENCE
Let us be grateful to people who make us
happy. They are the charming gardeners
who make our souls blossom.
Marcel Proust
65
MINDFULNESS MEDITATION & NEUROSCIENCE
Memory Reconsolidation
Excerpts taken directly from Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the
emotional brain. NY: Routledge and from “Is Memory Reconsolidation the Key to
Transformation? In Psychotherapy Networker at
http://www.psychotherapynetworker.org/magazine/currentissue/item/2156unlocking-the-emotional-brain written by Bruce Ecker, Robin Ticic and L. Hulley.
http://www.youtube.com/watch?v=raPLE_XjDDQ
Bruce Ecker Unlocking the Emotional Brain
Most currently thinking about working through past based issues is that therapists
can help clients develop new emotional and behaviours that work around but don’t
change deep emotional programming. These circuits were thought to be
ultradurable and immutable.
66
MINDFULNESS MEDITATION & NEUROSCIENCE
New neuroscience knowledge suggests that under certain conditions therapists
can help to unlock neural pathways and actually erase them & add new learning.
New therapies called “deep change” approaches all share an experiential
component. Examples include EMDR, EFCT, Coherence Therapy & NLP.
The brain is built to identify threats and keep the memory circuits active that
involve these threats. The staying power of these learnings have survival value &
do not reflect pathology.
Memories of events and the learnings from these events are different and are
stored in separate memory networks. You may not remember a negative event but
you remember the emotional learnings or implicit memories from this event (e.g., I
have to be loved by everyone). So emotional learnings are the target of the
erasure, not the memory of events.
67
MINDFULNESS MEDITATION & NEUROSCIENCE
The implicit memory can become triggered by different circumstances and
along with it comes an emotional state with no awareness of why this is
occurring.
Neuroscientists discovered the memory reconsolidation process that
turns off a learned emotional response at its roots, not by suppressing it
but by unlocking the neural connections sustaining it and then erasing it
completely.
Whether it is with crabs, chicks, mice or humans, there is a three step
process to unlock and erase: reactivate the emotional response; unlock the
synapses maintaining it and create new learning that rewrites the unlocked
target learning.
68
MINDFULNESS MEDITATION & NEUROSCIENCE
Reactivating an emotional memory and at the same time
experiencing contradictions (a prediction error or vivid new
experience that contradicts the emotional memory) unlocks the
synapses.
There is a window of a few hours and then the synapses
automatically relock keeping the original learning. Experiential
methods in therapy can erase and transform the neural networks.
69
MINDFULNESS MEDITATION & NEUROSCIENCE
Table 2.3 Comparison of the therapeutic effects of therapeutic reconsolidation process and emotional regulation (p. 33)
70
MINDFULNESS MEDITATION & NEUROSCIENCE
Table 3.1 Steps of clinical process for using new learning to nullify or update an existing
emotional learning (p. 41).
Therapeutic Reconsolidation
Coherence Therapy
71
MINDFULNESS MEDITATION & NEUROSCIENCE
Case Example:
A 37 year old single woman Charlotte who wanted therapy to end her painful
daily obsessing about her former lover “Nina” persisting even after two years.
She described her connection as “primal”.
Finding Coherence
Primal suggested an implicit emotional schema driving her obsession
consisted of an attachment pattern in which she relied on a deeply merged
sense of connection for security. “If I let this end, I lose me”.
To integrate this recognition, wrote on a card “An important part of me wants to
be you and doesn’t want to give that up” and read daily.
Mismatch Detection
Over the week Charlotte came to feel that “no boundaries equals death. That’s
not right”.
72
MINDFULNESS MEDITATION & NEUROSCIENCE
Case Example:
This contradiction became emotionally real which is essential. So contradiction
revealed: I’m much better off by merging and I’m much, much worse off by
merging.
Contradiction explored deeply and emotionally. Several explorations and
repetitions of the juxtaposition statement. One part feels…. The other part
feels this merging is a kind of living death…
How could I have possibly thought to leave myself out like that?
Taken from Unlocking the Emotional Brain, written by Bruce Ecker, Robin
Ticic, & Laurel Hulley.
73
MINDFULNESS MEDITATION & NEUROSCIENCE
Related Videos
http://www.youtube.com/watch?v=5TeWvf-nfpA
Richie Davidson, Jon Kabat-Zinn & Neuroscientist
1:14 hours
74
MINDFULNESS MEDITATION & NEUROSCIENCE
FORMER REFERENCE MATERIALS
75
MINDFULNESS MEDITATION & NEUROSCIENCE
From Hanson, R. (2009). Buddha’s
Brain.
76
MINDFULNESS MEDITATION & NEUROSCIENCE
Anatomy of a
neuron and a
synapse from
“Brain Facts” of
the Society for
Neuroscience,
http://www.brainfa
cts.org/AboutNeuroscience/Brai
n-Facts-book
77
MINDFULNESS MEDITATION & NEUROSCIENCE
http://www.youtube.com/watch?v=DDlfP1FBFk
“FLIPPING YOUR LID”
Dan Siegel’s Brain Hand Puppet from Siegel & Hartzell (2003),
Parenting from the inside out. P.173
78
MINDFULNESS MEDITATION & NEUROSCIENCE
From Hanson, R. (2009). Buddha’s Brain.
79
MINDFULNESS MEDITATION & NEUROSCIENCE
Mindfulness Research
See Mindfulness Research Handout
80
MINDFULNESS MEDITATION & NEUROSCIENCE
•
•
•
•
•
Physical Impact of Meditation
Enhances immune system
Reduces stress-related cortisol
Increases activation of left frontal regions
which lifts mood
Thickens & strengthens frontal cingulate
cortex & insula
Enhances attention, empathy &
compassion (Hanson, 2009)
http://www.youtube.com/watch?v=m8rRzTtP7Tc
Neuroscientist, Dr. Sara Lazar
81
MINDFULNESS MEDITATION & NEUROSCIENCE
Mindful Brain by Daniel Siegel
(2007) mindful awareness helps to:
Developing
Regulate emotion & combat emotional dysfunction
Improve thinking
Reduce mindsets
Reduce stress
Enhance immune system and physical well-being
Improves the ability to perceive others’ emotions
Improves ability to sense world of others
Promotes capacity for intimate relationships, increased resilience & well
being.
82
MINDFULNESS MEDITATION & NEUROSCIENCE
Outcome Rating Scale (ORS)
Name ________________________Age (Yrs):____ Sex: M / F
Session # ____ Date: ________________________
Self_______ Other_______
Who is filling out this form? Please check one:
If other, what is your relationship to this person? ____________________________
Looking back over the last week, including today, help us understand how you have been
feeling by rating how well you have been doing in the following areas of your life, where
marks to the left represent low levels and marks to the right indicate high levels. If you are
filling out this form for another person, please fill out according to how you think he or she
is doing.
ATTENTION CLINICIAN: TO INSURE SCORING ACCURACY PRINT OUT THE
MEASURE TO INSURE THE ITEM LINES ARE 10 CM IN LENGTH. ALTER THE FORM
UNTIL THE LINES PRINT THE CORRECT LENGTH. THEN ERASE THIS MESSAGE.
Individually
(Personal well-being)
I----------------------------------------------------------------------I
Interpersonally
(Family, close relationships)
I----------------------------------------------------------------------I
Socially
(Work, school, friendships)
I----------------------------------------------------------------------I
Overall
(General sense of well-being)
I----------------------------------------------------------------------I
Institute for the Study of Therapeutic Change
_______________________________________
www.talkingcure.com
© 2000, Scott D. Miller and Barry L. Duncan
83
MINDFULNESS MEDITATION & NEUROSCIENCE
84