Another reason to be less demanding

“I weep because, each time he knelt beside my banks, I could see, in the depths of his eyes, my own beauty reflected.”

I came across the idea that our self-esteem is equal to our opinion of others.

Sounds esoteric, but I reflected on it and there may be something to it.

Assumption:

A mentally well person accepts that she is an ordinary human being and that most people who surround her are ordinary human beings.

Hence,

a) if she is highly critical of most ordinary human beings, on an average day she is critical of herself

b) if she is accepting of others’ faults,on an average day she accepts her own faults

Doesn’t this add up?

I sort of talked about this when I hypothesised that people criticise others for the things they hate about themselves. Reading over it, it seems naive and slightly needy, but I still think there was a grain of truth in it.

“Yet another reason to not be a demanding pig”, I gently remind myself.

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

Friday’s 5 cognitive curiosities journal club

Here are my top picks from the neuroscience-mindfulness spectrum for this week.

1. We judge our previous decisions based on new information

From The Journal of Neuroscience

Thinking about thinking (known as metacognition) is hugely important for adaptation, however, little is known about it. The results of this study demonstrate that the information used to make the initial decision differs from the information that is used in metacognitive judgments.

2. Obesity is linked to memory problems

From The Quarterly Journal of Experimental Psychology

Obesity could play a part in the development of neurodegenerative diseases such as Alzheimer’s Disease. It appears that the relationship is a two-way street: being overweight or obese impacts memory function, then the memories of eating experiences change and thus affect future eating behavioural patterns.

3. There is little or no diagnostic specificity in the fMRI results for mental illness

From Human Brain Mapping

It appears that individuals with mental illness – regardless of the diagnosis – have abnormalities in their limbic system responses to various tasks. The limbic system is associated with emotion.

Put simply, the fMRI of a depressed person isn’t different to the fMRI of a person with a (seemingly) completely different disorder schizophrenia.

This could be a reflection on insufficient sample sizes. It could also be a reflection on the worry of going into an MRI scanner. A number of studies emerged recently showing that we’re possibly misinterpreting the findings of fMRI.

neuroscience mindfulness latest news
From Addressing Reverse Inference in Psychiatric Neuroimaging: Meta-Analyses of Task Related Brain Activation in Common Mental Disorders

4. Fat shaming is associated with poor health outcomes

From Obesity

Individuals suffering from obesity who self-stigmatise may be at an increased cardiometabolic risk. Physiological and psychological mechanisms linking weight bias internalisation and metabolic syndrome warrant further research.

One of the researchers commented:

“There is a common misconception that stigma might help motivate individuals with obesity to lose weight and improve their health,” Pearl said. “We are finding it has quite the opposite effect.

When people feel shamed because of their weight, they are more likely to avoid exercise and consume more calories to cope with this stress.”

5. Thinking loops lead to emotional loops

From Tara Brach

Tara Brach humorously talks about the relationship between biases, emotion, beliefs and thinking. Emotions can subside in 90 seconds unless we generate cycles of thinking that re-trigger and reinforce them.

Have a great weekend everyone.

neuroscience mindfulness news

Best guided meditations for beginners

I don’t really use guided meditations anymore. They get  little “interrupty” after a while. I am at that point now that in any troubling situation, my mind goes straight to mindfulness. Tired? Mindfulness. Don’t know what to do next? Mindfulness. Want to check email for the 25th time today? Mindfulness. I don’t mean a full on session with all the (unnecessary) bells and whistles – I mean taking a few minutes to ground myself in the situation through conventional mindfulness techniques – breathing is a good one for me. I’m not giving up this habit any time soon.

best app for mindfulness review

Having said all this, I would consider guided meditations the best starting point to get into mindfulness. Most of these are free or have a free trial. Here are some recommendations:

1. Relaxing visualisation

This relaxing visualisation to bring stress levels down is narrated by a very talented practicing clinical psychologist from Trinity College Dublin Angie McLoughlin. It’s free and a good place to start. It get you to visualise a place you like. Angie speaks in a, I don’t know, Scottish or maybe Northern Irish accent? Showing my ignorance here. She trained in San Francisco, and so

I am primed to always think of the San Fran Pacific coast and sitting under a pine tree in Presidio when I listed to it.

This grounding exercise for anxiety is also narrated by Angie. More suitable for acute stress.

2. Headspace

Headspace: there’s a free trial that then leads into a subscription at about 70 euro per year. This app sends push notifications to practice for 10 minutes a day. It has some animations. The meditations are a little bit too preachy for my liking: it is almost like the narrator is trying to sell the concept. “You will feel the benefit of x, y, z…”

I found the animation about taming one’s mind like a horse by tying it to a stake using a long rope and shortening the rope every day disturbing.

I think their analogies are a little too crude, but to be fair they probably have been able to reach more people that way. It’s narrated by a man in a British accent.

3. Calm

Calm. Calm and Headspace are direct competitors. Calm is marginally cheaper. The difference is that Calm has no animations and is more psychology-driven. For example,

the narrator would deconstruct the beliefs that often underlie stress and anxiety – or goes through the cognitive processes behind judgement and self-esteem.

It’s more intelligent and less preachy than Headspace. It’s narrated by a woman in an American accent. The exact intonations are a little bit overemphatic at times – but that’s probably just an American thing. There are also a ton of “soothing ocean sound” type settings that can be nice on occasion as a kind of white noise that somehow automatically leads to more present moment awareness. I found it easier to stick with Calm than Headspace because it goes into the reasons behind feelings, allowing for relevant questions and insights.

4. Tara Brach

Tara Brach is a bit of a meditation-guru. She brings the whole Buddhist vibe in – if you’re into that. I once heard her story – it is very interesting. A few dodgy things happened to her at the hands of yogis, but she didn’t run away.  For me, Buddhism is endlessly interesting but not something I want to commit to. If you are different, Tara will be great for you.

She has a very gentle manner and doesn’t take herself very seriously, which is so endearing.

I’ve never met her, but I imagine that if I did, it would completely change how I felt for the day. She kind of radiates this feminine loving-kindness-acceptance vibe. She speaks in a very non-grating American accent.

5. UCLA

UCLA Mindful Awareness Research Center meditations are free and complete.

UCLA probably cover the lion’s share of what Calm and Headspace cover – but they are less personable.

They are more clinical, kind of like the safety instruction on a plane. They are narrated by a woman in an American accent. They are also available in Spanish.

There a lot of meditations on YouTube. I’ve bumped into a few too many dodgy ones, so I would recommend sticking with the tried and tested above.

6. Simple Habit

Simple Habit is much like Calm. However, it is 5 minutes every time. There are a variety of speakers and styles, so it’s a great starting point.

For the sake of balance, I include this FT article that reflects the limitations of mindfulness apps. Apps and internet resources are a great starting point. However, really, it’s not just a ritual. It’s about being in the moment in our daily lives.

You may also like:

Beginner mistakes in mindfulness and how to avoid them

Mindfulness changes brain structure

Mindfulness colouring sheets

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Exercise and thinking

I recently chanced upon a study showing that aerobic exercise can be beneficial in mild cognitive impairment. It literally increases the size of the brain. The fact that we can now image brains in a way that detects this is exciting. Nobody is really quite sure what it means, but the fact that it is so tangible and obvious is really gratifying – and hard to argue with. Interestingly, mindfulness also changes brain structure on imaging.

There have been plenty of studies of this sort – including on healthy people. They show that exercise benefits one’s mood and working memory, enhanced cognitive strategies, hippocampal neuroplasticity – in short, exercise helps your brain do its thing. I wish this message was easier to spread. Exercise for a functional brain.

In my own subjective n=1 experience, exercise makes a huge difference to how I feel emotionally. It’s like a shield that keeps irrelevant noise out – and it was quite hard to believe how well it works until I tried it. At this point, I’ve been non-stop at it for over 3 years. My main motivator to stay going with exercise is how it makes me feel. Not immediately, not right after a gym session, but on average. Having said that, isn’t our motivation nearly always how it makes us feel? How I got into it was the classic monkey-see-monkey-do dynamic. Some like to call it having a role model. During my masters, I was surrounded by a bunch of health-freaks: they were all from continental Europe, wore fancy running shoes, drank a lot of coffee and read the Economist. The enthusiasm with which they discussed running routes for their new city, whether or not a Fitbit is worth the investment – and so on, rubbed off on me. I had to try this, ze fitness. I never stopped.

exercise benefits depression

I’ve experimented with running, spinning, HIIT, swimming, weights – pretty much anything that is solitary and non-competitive is good. During a particularly busy stint at the hospital, I injured a joint – meaning I couldn’t properly weight bear. I could barely get around the seemingly endless corridors of a large Dublin hospital with nobody to cover for me on call. Exercise was not on the menu. About a week into this state of affairs, I noticed that I was starting to get sad for no reason at all. It took some introspection to figure out that it was likely down to the fact that I wasn’t exercising. The biochemistry shifted, the chemicals released during exercise wore off – and now I was feeling down. I took corrective action: so I cannot weight bear. Time for abs of steel! As if. In any case, the change in my mood from a week of significantly diminished physical activity was stark.

This experience is echoed in the story of a patient I once saw in a psychiatric hospital. He was a young guy who exercised a lot: 20 miles on a bike every day, marathons, the works. For about a year and a half he attended a cardiologist about a chest pain. He had virtually every conceivable test done – none of these tests detected any abnormalities. By the time he saw me, he had had a few attacks of this chest pain in the space of a few days – and a very low mood. The week before two things happened: he twisted his ankle and his girlfriend had just broken up with him. Long story short, the man’s chest pain was psychosomatic. He had a perfectly healthy heart. The stress of his girlfriend breaking up with him, superimposed on not being able to exercise due to a twisted ankle, led to the mood collapse as well as the chest pains.

Clearly, exercise is addictive. This is part of the reason why people keep exercising despite pain. Before I discovered the absolute must that is a foam-roller, I caused a repetitive strain injury in my calf from running too much. I couldn’t really stop: I was so into it, I just gobbled down two Nurofen and off I went. If, six months previously, someone told me that I would be like this, I would never have believed them. My buzz was all about cuddling up with a book and drinking hot chocolate – not hopping around with a painful calf in the permeating Dublin rain.

Once a psychiatry professor came to talk to us during lunch. His opening question was: “What is the single most effective intervention for both physical and mental health?” Some annoying know-it-all raised their hand and said: “Exercise.” (Okay, okay, it was me). I would still say it though.

I think it is the perfect example of the 80/20 rule, or even a 99/1 version of it. Exercise takes up very little time – if you’re clever about it – and delivers unbelievable results. In short, exercise is definitely on the to-do list of anyone who is interested in having a clear head. It’s surprisingly easy to get carried away into fitness-junkie territory, however, it is definitely worth the risk. In any confusing situation, it’s mindfulness and exercise.

exercise for healthy brain and good mood