A downward facing doc explains the brain wiring behind mindfulness

Do you ever just wish you could get someone who knows virtually everything that’s known about the brain and quiz them about mindfulness? Well, I do – a lot – and I just got my wish!

It is my pleasure to present this interview with John McBurney MD. A practicing physician with of over 35 years’ experience, he is board certified in Neurology, Clinical Neurophysiology and Sleep Medicine. He holds an Integrative Medicine Fellowship… The list of his professional accomplishments is obscenely impressive, so I will jump to the bit we all really want to know about: Dr. McBurney maintains a daily mindfulness meditation practice as well as home yoga practice, hence the downward facing bit. Needless to say, I was beyond curious to find out his understanding of how mindfulness affects the brain.

For those of us who are put off by the mystical connotations that surround mindfulness, could you take us back to a schematic, reflex-arc type view of the process and describe the neurological response to mindfulness practice?

I think that the issue of mindfulness intersect with the leading-edge of neuroscience. It is supported by extraordinarily robust data. This area of study has been termed contemplative neuroscience. The Mind and Life Institute which is an outgrowth of the dialogues between the neuroscience community and the Dalai Llama  is an important sponsor of research and education on contemplative neuroscience. It ultimately comes down to the concept of neuroplasticity.

Donald O. Hebb coined the doctrine: “neurons that fire together, wire together”. It was an extension of the work done by an American philosopher and psychologist William James in the early XX century. You can practice “bad” things or “good” things – and neuronal ensembles form accordingly. In mindfulness, we are essentially practicing good things.

There is a resting ensemble of neural networks called the default mode network that was discovered using fMRI studies where individuals were asked to lay in the scanner and think of nothing in particular. This kind of mindless mental activity is accompanied by a lot of  self-referential ruminative recursive thoughts that are subserved by brain regions that lie along the midline, especially the prominent in medial parietal lobe. Those types of internal mental states that are remarkably robust and persist under deep general anaesthesia and even in a coma and are probably the neural basis for the self.

The more outward facing parts of the brain – like the dorsolateral prefrontal cortex – are more responsible for an outward orientation to the world have top down executive influence on the activation of those networks.

In mindfulness, in cultivating awareness of the breath and voluntary moment by moment awareness of the brain, we are training the brain – just like when you are learning to play the violin or any other complex skill – we are training to break out of those self-referential ruminative recursive mental states and to achieve an orientation toward the outer world and in the present moment rather than anticipating the future or reliving the past.

contemplative neuroscience mechanisms behind mindfulness

There is evidence that mindfulness leads to weaker connections in default mode network. Could we be losing something by focusing more on the external realities rather than the self?

Not everyone has a well formed default mode network. People who have been subjected to severe developmental trauma, neglect and lack secure attachment do not have robust default mode networks. Mindfulness can lower defence mechanisms that are there with good reason. However, most people with a well formed default mode network and secure attachment. We are “taming an elephant”: there is very little chance that we will significantly weaken the elephant.

Occasionally, we do hear of adverse experiences arising from mindfulness. With any robust intervention there are always potential risks.

How long does it take for mindfulness to have a manifest effect?

The results can happen almost immediately, however, they are also cumulative. We are still figuring out what the minimum effective dose it. This reminds me of the discussion of the minimum effective dose of aspirin in stroke and heart attack prevention. When I was a resident, we were advising patients to take two 325 mg tablets twice a day. Over time this dropped to 81 mg of aspirin a day. There is speculation that the required dose may even be lower.

There is a study that defines a new marker. The original fMRI/EEG studies were done by Richard Davidson in Tibetan Buddhist meditators with over 10,000 hours of meditation. This number is somewhat arbitrary and refers to this idea that is the number of hours to become an expert at anything. However, the question arises: what is the relevance of the changes in functional connectivity in the brain in someone who has devoted such a monumental amount of time to meditation to the likes of you and me?

A very neat study was published by David Cresswell in Biological Psychiatry in 2016. They invited individuals with high level of stress, unemployed adults, to a weekend retreat experience. They were randomised to in 2 groups:

  • a 3 day mindfulness retreat (the treatment group) and
  • a 3 day relaxation retreat where they read stories, told jokes and had a good time (the control group).

The study was conducted in one centre over one weekend, so it is well controlled. Initially, both groups rated the interventions as being equally helpful to them, subjectively.

The researchers looked at the functional connectivity between the dorsolateral prefrontal cortex and the cingulate gyrus. They also looked at Interleukin-6, a known marker of inflammation, that has been previously shown to be elevated in stressed out unemployed people.

Even with this brief weekend mindfulness intervention, the treatment group developed increased connectivity between the dorsolateral prefrontal cortex and the cyngulate gyrus. There was a neuroplastic response even after a 3 day mindfulness retreat. This was also associated with a decrease in the marker IL-6. Even after 4 months, IL-6 was decreased in the treatment group, but in the control group, IL-6 levels continued to rise, independent of whether they managed to get a job or not.

This is also relevant to doctors, who are at high risk for burnout. Because of their work commitments, the mindfulness retreat for doctors was condensed from the standard 8 week model developed by John Kabat-Zinn to a weekend intervention. The question was: does the weekend model work? The research at the University of Wisconsin where this was developed was reassuring: the residents are less stressed out, more effective and have a greater level of satisfaction.

We still don’t know the absolute minimum dose, but it seems that a weekend of mindfulness can be life-changing for the brain.

Another paper published in PLOS ONE from the Benson-Henry Institute for Mind Body Medicine in Harvard looked at the practices such as meditation, prayer, mindful yoga, Tai-Chi, Qi Gong, etc, i.e. ones that elicit a relaxation response (as opposed the stress response).

This study showed that in both novice and experienced practitioners of relaxation response modalities, there were changes in the epigenetic transcription of the genome. There was upregulation of pathways associated with mitochondrial integrity, downregulation of inflammatory pathways, improved insulin-related metabolism and improved nitric oxide signalling.

Long term potentiation, the standard mechanism for memory formation, strengthens existing neural connections. This happens immediately, as you read this. Over time, long term potentiation leads to formation of new connections,through synaptogenesis, dendritic arborisation and neurogenesis i.e. brain structure changes. In turn, this affects the most neuroplastic neurons located in the hippocampus.

mindfulness minimum effective dose response neurology

In reference to this fascinating recent study of the fight or flight response, it seems plausible that breathing regulates our stress levels much more than conscious thought. Could you explain the significance of this in terms of mindfulness?

The ancients believed that emotions reside in the body. This comes up a lot in serious yoga classes.

This highly innovative study shows that the control of the adrenal medulla – the main effector of the stress response – is not from the conscious ruminating thinking centres, but by the motor and sensory cortex.

This explains why breathing, as well as yoga and Tai-Chi, are an important part of meditative practice. In my experience, these kind of interventions do affect the stress response in a beneficial way.

Mindful exercise exists in many form. For example, weightlifters need to be very mindful to maintain perfect form. Cycling is another example: it is vital to concentrate on every pedal stroke and maintain an even cadence. Once you start to day dream, you notice straight away that your output is way worse. This overlaps with the concept of flow. It is about getting in the zone. There is a very inspiring TED talk by Judson Brewer MD, Ph.D. that explains the physiology behind flow and how it is augmented by mindfulness. Mindfulness is work, and it does require discipline. There is a paradox here of non-striving and non-doing while also being disciplined.

You are a sleep medicine expert. Could you comment on the relationship between mindfulness and sleep?

Insomnia is a complex problem with many causes. However, for most people with idiopathic insomnia, the cause it these self-referential recursive ruminations. They aren’t able to “turn their brain off”. Through mindfulness practice, they are generally able to tame the default mode network that’s responsible for ruminating and daydreaming. A simple strategy would be to lie in bed and concentrate on the breath. This would ease the transition between wakefulness and sleep.

mindfulness default mode network neurological basis for the self

Mindfulness is a mainstay treatment for many mental health disorders. What about use of mindfulness in the treatment for organic pathology of the brain usually treated by neurologists?

There is some preliminary data that mindfulness training has a beneficial effect of seizure frequency in patients with epilepsy. It is a medical condition associated with tremendous anxiety and stress, so mindfulness could have a significant benefit in more than one way. It may even have a benefit it terms of remembering to take medication on time, etc.

Some robust studies show that the frequency of relapse in multiple sclerosis decreases with mindfulness intervention. The effect from mindfulness is similar in magnitude to the effect from beta-interferon. There is also some research showing that the frequency of inflamed Gadolinuim-enhancing lesions decreases with mindfulness.

John Kabat-Zinn used to take the patients who suffered from chronic pain or had diseases for which we had no answer, and those patients got better. Even beyond neurology, there is some evidence that mindfulness can have benefits in psoriasis. We are probably only at the bottom of this mountain.

Dr McBurney is a board member of Mindful Medicine. It is a non-profit organisation that focuses on teaching mindfulness to health professionals using retreats. He is founder of McBurney Integrative Neurology and is a clinical assistant professor at the University of New Mexico School of Medicine. Dr. McBurney is a native of Alabama and a graduate of Auburn University and the Emory University School of Medicine. He completed his neurology residency and EEG/Epilepsy fellowship at Walter Reed Army Medical Center.  In 2014 he completed the Integrative Medicine Fellowship at the University of Arizona Center for Integrative Medicine.

Dr McBurney has given me so much to think about. I will follow up with part 2 of our discussion that focuses more on the philosophical and life experience aspects of mindfulness once I wrap my head around it.

neurological path mindfulness default mode network adrenal medulla

12 tips for thinking more clearly and making better decisions

This is one of those articles that I wrote for myself: for those mornings when the only things you want to do are browse Facebook and watch BBC1, or at least you think you do. Then you remember that you’ve about 20 problems to solve that day and get that feeling in your stomach like both your adrenal glands just emptied their contents into your bloodstream.

1. Enter into deep work mode

Wall off some distraction free time. The phone goes on airplane mode. Close all the tabs you don’t need.

Let’s be honest, if you are reading this, you are probably dealing with quite challenging and cognitively demanding.

These things require extreme levels of focus and uninterrupted immersion for an effective resolution.

As such, the goal is to enter into a state of flow. It is a paradoxical mix of mindfulness and being very goal-directed at the same time. Flow, also known as the zone, is the mental state of operation in which a person performing an activity is fully immersed in a feeling of energised focus, full involvement, and enjoyment in the process of the activity.

how to think more clearly deep work

2. Do a brain dump

If you are at a loss, the thoughts are messy and you don’t know where to start, an unstructured flow of consciousness style “brain dump” is required. It straightens out circular ruminations and allows the writer to identify what is really wrong. There is something liberating about getting things down on paper. You can always throw it out. Nobody has to see it. It is only for you to see.

In the best possible way, it lowers expectations and gives you the licence to be really honest.

I am putting my money where my mouth is with this tip: a lot of this blog is really me writing for me. I often reread what I have written because it answers questions that bother me (and catch a few typos on the way!) It turns out that the same questions bother a lot of people, hence our little community.

3. Draw a spider diagram

Difficulties in solving problems often arise from the fact that problems are interdependent, they are not isolated. Drawing a spider diagram (a mind map) is a very good way to figure out what’s going on.

how to think clearly

As a one-time medical student in the rather fundamentalist anatomy department, I had to learn everything about the brachial plexus (pictured above).  The structure was just the starting point of what I needed to know. The the origins at the spine and the muscle activation were at least as complex on top of that. I drew a spider diagram.

When my father was splitting from his second wife and I arrived home to find my stuff packed away in boxes by the latter, well, I also drew a spider diagram. Because I needed to understand what’s going, what everyone is thinking and where to move (not just literally) from there.

This approach to thinking is resonant with the structure of our brain with its nodes and links.

4. Make a to-solve list (not a to do list) and tell a story

Lists are great, says the ENTP. Even checklists. They really are great because they give us a sense of control. I have studied motivation in great detail as I deal with students doing their final school exams to get into college. They keep asking me about motivation. These 17 year olds have the most fine-tuned BS filter on the planet, so I really need to try hard. I finally found a solution for them, which is: a sense of control.

Feeling in control is the key to being motivated.

There is a mountain of evidence about this. However, a small study done on nursing home residents really illustrates it best. Some people who go into nursing homes don’t do well and fade away in less than 6 months. Others seem more alive than any of us. What’s the difference? Well, as one of the lively 85 year olds explained: “I trade my chocolate desert for a piece of fruit from one of the other guys at every dinner”. Why? Doesn’t he like chocolate? The answer lies in the fact that now he has control: in an environment where you are told when to sleep, where to sit and when to take your tablets, it is crucial to eke out a sense of control by being in charge of something small like that.

How do you structure a list? There are two great ways:

  • list of problems to solve
  • a chronological story-plan

A plain to-do list just makes you feel like you are doing chores. A list of problems to solve automatically gives both purpose and perspective.

As for the story plan, there is something about our brains that makes us dead set of prioritising stories over any other kind of information. It is therefore important to tap into that. A fair portion of NLP is snake oil, but their emphasis on story-telling is right on. Things seem far less daunting if you write them down on a piece of paper as bite-sized steps. For example, recently, I have been moving between countries. It’s an overwhelming amount of paper work, a complex process with many catch-22’s to machete through like you need a lease to set up utility bills, and a utility bill to set up a bank account and a bank account to set up a lease. By writing it down, it is easier to see solutions and the impossible soon becomes possible. There are 2 reasons for this:

  • we find it difficult to store long sequences in our heads, so a written down prop is key (this is mentioned a lot in Thinking Fast and Slow and GTD)
  • by going through the steps required to build out the story, we think of the entire contexts – the things we would have otherwise forgotten about

think more clearly write things down

5. Snap out of being on rails by getting perspective

It’s precisely when we are “on rails”, when we have some kind of contagious emotion unfolding in us, when we want to “just get this done”, that we need to pause and switch to something else. Ideally, we would go straight to taking 10 minutes to be mindful, but for most of us mortals that just seems impossible. Instead, it is a good idea to think of something completely different.

Let’s say there is an enraging email that you can’t wait to respond to so as to make it go away. Mindfulness? Now? No!…

To ease yourself out of the hijacked state, think of something completely different, preferably something even more challenging, that makes the original issue seem like nonsense.

Recently, I was dealing with an unruly real estate agent who just wouldn’t listen and kept sending me emails with unreasonable demands. I thought to myself: there are lots of people who don’t have this problem – because they simply cannot afford to live on their own. It’s not even that it made me feel grateful and empowered, that’s not the point, but it gave me perspective and an ability to deal with the tyrant in a way that accomplished my aims rather than just telling them “for the n-time, will you…”

6. Take 10 minutes to meditate

It is when we are busiest that we need to take the time to be mindful.

I recall Ray Dalio talking about it. Yes, the guy is filthy rich, but I can just imagine him losing a billion bucks (it happens in that business) and going into his office to do his TM routine. What else would he do? Shout at the researchers for not seeing into the future? The traders for not getting out of the trade earlier? There is no point. It is much better to get centred again and then do what is actually going to help the situation.

7. Have a cup of matcha, or any good green tea

I’ve always loved green tea. However, after my trip to Japan, it became clear to me that there is something quite magical about certain varieties of green tea. I am a big fan of Ippodo and specifically Ummon-no-mukashi.

Like salbutamol opens the bronchioles, this stuff clears the head.

For those who aren’t keen on concentrated green goo, a cup of Hosen Sencha will do wonders too. The way the Japanese drink tea is more or less an exercise in mindfulness, so I would make use of that aspect too. It is part of my morning routine. It is especially something that people who can’t drink coffee should consider. Unlike coffee, matcha doesn’t give you a jolt of energy and then a come down, but a steady state of clarity.

thinking more clearly mindfulness meditation

8. Listen to some upbeat classical music you’re not very familiar with

Listening to something you know well calls in all kinds of associations and other hardcoded Pavlovian nonsense we don’t always need.

Thankfully, there is so much classical music out there, we’re unlikely to ever be stuck. Some may prefer house music. Sometimes house music has lyrics or distracting sexy sounds. My personal recommendation would be listening to Béla Bartók or anything played by Lang Lang, a virtuoso pianist. You may also like some great apps for mindful focus.

9. Jump in for a very short burst of exercise

Even two minutes of HIIT or a quick few sets of sun salutations are likely to be quite refreshing. In an upcoming post, a neurologist will explain that

our adrenal medulla – the seat of the flight-or-fight response, the ultimate thinking and creativity saboteur, is controlled more by the motor cortex than it is by the conscious decision making centres.

10. Don’t even attempt it if you are tired

Sleep is massively undervalued in today’s society. Sleep deprivation has incredibly significant effects. Not that much sleep deprivation at all will give you the insulin resistance of a type 2 diabetic.

All the most intelligent people I know sleep at least 8 hours a night and don’t even attempt anything cognitively taxing unless they are refreshed.

This is obviously challenging for people with young children, for example, but if you can work to put yourself in a situation where you can be refreshed, it will really pay off.

11. Have a shower

Special troops are told to prioritise staying clean even in extreme circumstances. It raises morale. There is something life-affirming about water and cleanliness. The chemical changes, such as an oxytocin increase, is likely to have a positive effect on one’s emotional state.

12. Talk to a human being

We are social animals: that is just how we’ve evolved. Not all problems need to be attacked by the entire tribe, but calling in help is required sometimes because other will help us navigate through our weaknesses, see new perspective and just feel like a human being again.

think clearer mindfulness meditation deep work